Deadly Outbreak Of Black Death Which Has Killed 165 In Madagascar May MUTATE And Become UNTREATABLE; Infectious Disease Experts Believe If The Disease Reaches Europe Or The U.S.  We Can Likely Contain It — But, Sooner Or Later………..

Deadly Outbreak Of Black Death Which Has Killed 165 In Madagascar May MUTATE And Become UNTREATABLE; Infectious Disease Experts Believe If The Disease Reaches Europe Or The U.S.  We Can Likely Contain It — But, Sooner Or Later………..
     Are we on the verge of the next global pandemic?  Stephen Matthews and Chris Pleasance posted articles on the November 13 and 12, 2017 editions (respectively) of the DailyMailOnline, warning about “a strain of pneumonic plague which has already killed more than 165 people in Madagascar;” and infected at least 2,034.  Infectious disease physicians are concerned that the disease could mutate and become untreatable — and spread to the U.S. and Europe via plane travel as Ebola did in 2014, with ten African nations already put on alert for signs of infection.”  
     Physicians and scientists warn that the disease is at a “crisis point;” and perhaps a tipping point — towards either significant escalation, or hopefully, burning itself out.
    Professor Paul Hunter, an infectious disease specialist at the University of East Anglia, told the Daily Star:  “If it reaches the U.K., Europe, or the United States — it would be similar to the Ebola outbreak,” in 2014.  Professor Hunter told the publication that “it would be easy to contain the disease it in its present form;” but. he expressed concerns it could evolve into something far more dangerous.  We would have a few isolated cases but, it shouldn’t spread [in Europe, U.K., & U.S.] like it has in Madagascar.”
     “As with any disease, it’s a real worry that it mutates and becomes untreatable,” he added.
     “In total,” Mr. Matthews wrote that at least “2,034 people have been infected; and, 165 others have died as a result of the disease in Madagascar, during what officials describe as  the worst such outbreak in the country in at least 50 years.  The majority of those cases have been pneumonic plague, a more-deadly form of the bubonic plague, which devastated Europe’s population in the 1300s.  Two thirds of the cases have been caused by the airborne pneumonic plague, which can be spread through coughing, sneezing, or spitting, and can kill within 24 hours,” of initial infection.  Symptoms include severe fever, headaches, and coughing, with patients coughing up blood; and, it can be fatal within 72 hours of infection — though it can also be cured  with a course of antibiotics if administered quickly,” or within the first hours of initial infection, he added.
     Local officials told the Daily Mail that “health checkpoints are in place across the country, with passengers traveling on buses and taxis needing to pass a [health] check with a thermometer.  Banks and schools have similar checks [protocols] in place; and, the trade of infrared thermometers has soared with prices 100,000 to 200,000 ariary (27-60 Euros, $31-$69),” Mr. Pleasance wrote.  Meanwhile, “schools and universities have been closed; and, a ban is in place with respect to public gatherings.”
     “The current outbreak is considered unusual — as it has affected urban areas — [thus] increasing the risk of transmission,” according to the World Health Organization (WHO).  The WHO has delivered 1.2M doses of antibiotics to fight the disease, while the Red Cross has been training hundreds of volunteers on the island to publicize preventive measures,” Mr. Pleasance wrote.  And, Mr. Matthews adds that the World Bank “has released an extra $5.8M,” to help Madagascar financially cope with the mounting crisis.
     “Plague season hits Madagascar each year,” Mr. Matthews wrote; and, “experts warn there is still six months to run [go] — despite already seeing triple the amount of cases,” that would normally be expected thus far, this year.  He adds that “health officials are unsure of how the outbreak began; but, local media reporting suggests that “forest fires have driven rats into the communities.  The first recorded death this year from the disease was recorded “on August 28, when a passenger died in a public taxi, en route to a town on the east coast,” of Madagascar.  “Two others, who came into contact with the passenger, also died,” from the disease, Mr. Matthews wrote.
      There are conflicting reports about whether or not the outbreak is peaking; or not; and, even if the infection rate is slowing down, scientists and infectious disease specialists are warning that we’re early in the game; and, a second-wave of the disease could still be coming.
The Next Pandemic: How Plagues Really Work; The Next Pandemic Will Not Come From The Jungle; But, From The Disease Factories Of Hospitals, Refugee Camps, And Cities
     Who knows how this current outbreak is going to turn out.  And, it is comforting to hear that this form of the plague is ‘easily’ contained/controlled with antibiotics.  But, those in the know — all say we are long overdue for a large-scale, deadly pandemic here on planet Earth — either from nature, or genetically altered in a makeshift laboratory.  And, this fear is rational, Wendy Orent wrote on the website, Aeon, August 14, 2014.  “The fear seems confirmed by historical memory: after all,” she wrote, “Plagues have killed a lot of people, and deadly diseases litter history like black confetti. The Antonine Plague, attributed to smallpox or measles in the year 165CE, killed the Roman Emperor Marcus Aurelius and millions of his subjects. The Justinian Plague, caused by the deadly bacterial pathogen, Yersinia pestis, spread from North Africa, across the Mediterranean Sea, to Constantinople, and other cities along the Mediterranean. By 1542, infected rats and fleas had carried the infection as far north as Rennes in France; and, into the heart of Germany. Millions died.
     “Then, there was the Black Death of 1348-1350, also caused by Yersina pestis, but this time…spread by human fleas — from human lung, to human lung, through the air. The plague spread along The Silk Road, to what is now Afghanistan, India, Persia, Constantinople, and thence across the Mediterranean to Italy and the rest of Europe, killing millions worldwide,” with some estimating 100 million people worldwide, died from the disease.. Of all the past pandemics,” Ms. Orent wrote “the 1918 Influenza (also known as the Spanish Flu), is now considered the uber-threat, the rod by which all other pandemics are measured. It killed 40M people around the globe,” she writes.
     “One mysterious, ancient outbreak, the Great Plague of Athens, shows how deadly epidemics unroll in time,” Ms Orent suggests. “The [Athens] Plague, — said to have been caused by typhus, measles, small pox, or Ebola, depending on whom you ask — exploded in Athens in the summer of 430 BCE, during the early days of the Peloponnesian War, an [epic] 27 year struggle between Athens and Sparta over hegemony in the Hellenic world. Pericles, the de facto leader of Athens — who pushed for war, developed a defensive strategy that proved fatal, to him; and, as many as a third of Athenian citizens. He insisted on bringing all citizens — people who lived in towns and the rural areas outside the city — into Athens, leaving the rest of the city-state to be ravaged by the invading Spartans. The Athenian Long Walls ran down to the separate ports of Piraeus and Phaleron, each of which lay about four miles from the city of Athens proper. Thus, sealed off, fronting only on the sea, Athenians could shelter safely Pericles argued, until the Peloponnesian War.”
     “The normal population of the [ancient] city [Athens] was around 150,000. Scholars estimate that 200,000 – 250,000 farmers and townsmen; and, their families, came streaming in, bringing everything they could carry with them — down to the woodwork of their farmhouse walls. But, Pericles made no provision for the newcomers, who were used to their country manors, their quiet towns, their open fields,” Ms. Orent elegantly writes. A few had homes, or relatives within the walls. But, most had no where to go, and huddled in stifling huts, or tents flung up in the narrow spaces between the walls. The crowded encampments were ripe for a virulent infection,” she writes.
     “Physicians and attendants died quickly, and the only people who could care for the sick, were survivors immune to further infection.”
     “The infection came from the sea,” Ms. Orent notes, “the portal that Pericles had left open to feed the Athenian people and bring in enough money to keep the war effort alive. The Athenian historian Thucydides tells us that the disease originated in Ethiopia, traveled northward into Egypt, and Libya, moved across the Mediterranean to the island of Lemnos, and on to Athens. ‘There was no record of the disease being so virulent anywhere else, or causing so many deaths as it did in Athens,’ wrote Thucydides; and, we have no reason to doubt him. This is a critical bit of information,” Ms. Orent contends. “It tells us,” she argues, “that The Great Plague evolved: it became much more lethal in the great refuge camp of wartime that Athens had become. Thucydides continued: “People in perfect health, suddenly began to have burning feelings in the head; their eyes became red and inflamed; inside their mouths, there was bleeding from the throat and tongue, and the breath became unnatural and unpleasant. The next symptoms were sneezing and hoarseness of voice, and before long, the pain settled on the chest and was accompanied by coughing. Next, the stomach was affected, with stomach-aches; and, with vomiting of every kind of bile that has been given a name by the medical profession, and this being accompanied by great pain and difficulty. In most cases, there were attacks of ineffectual retching, producing violent spasms; this sometimes ended with this stage of the disease, but sometimes continued long afterwards.”
     “Thucydides goes on to describe rashes, delirium, mental confusion and, among the survivors, blackened, dead tissue on the extremities and sometimes blindness. This was a highly transmissible, virulent, systemic disease. Physicians and attendants died quickly, and the only people who could care for the sick — were survivors immune to further infection.”
     Ms. Orent concludes that “the Athenian plague shows how a disease of mild to moderate virulence can heat up in what we can only call a ‘disease factory’ — a place where the sick are trapped together with well, causing infection to spread with wildfire. If the Athenian infection was typhus, the most likely culprit,” Ms. Orent argues, “it would normally be spread by the human body louse and its infected feces. There must have been body lice among the Athenian squatters.” she observes. Usually, just scratching lice bites, thus digging louse feces inadvertently into the skin, causes transmission. But, in crowded conditions, transmission of typhus can be more direct. For instance,” she notes, “in the Serbian prison camps of World War I, where typhus was rampant, transmission through the air – possibly caused by aerosolized louse feces — was known to occur. The right conditions, in other words, can cause the short-term evolution of a louse-borne disease into something explosive.”
     “As Ewald has shown,” she writes, “a similar evolutionary process gave rise to the 1918 flu, propelled by the trench-warfare system of the Western Front. In the Spring of 1918, a first wave of mild flu broke out in the U.S.; and, spread across the country to the troop ships loading for Europe. From those ships, the infection spread into the trenches, where it swiftly heated up to deadly virulence in the disease factory conditions of the Front: the trenches, the trains, the trucks moving the wounded and the sick together, where virus from the people immobilized by illness was able, over and over, to infect the well. The whole system was a giant viral delivery service. The disease left the Western Front by several ports and exploded across the planet, killing about 2.5 percent of those it infected — and, it infected hundreds of millions.”
     “This predatory influenza was not caused by some random combination of bird flu genes, as the new plague paranoia predicts. Both the Athenian plague and the 1918 flu evolved in predictable Darwinian fashion,” Ms. Orent writes. “Germs that ravage the body more swiftly, and effectively, will out-compete milder strains. If those lethal strains have repeated access to fresh hosts, the brakes on virulence are off, and deadly disease evolves and spreads.”
     “Looking at epidemics, and pandemics through this evolutionary lens makes it clear that the most important condition necessary for the evolution of virulent, transmissible disease is the existence of a disease factory. Without social conditions that allow the evolution of virulent, transmissible disease, deadly outbreaks are unlikely to emerge,” Ms. Orent says.
     “Deadliness itself, isn’t all that uncommon: SARS, or severe acute respiratory syndrome, which terrorized China in 2002 and 2003, killed ten percent of its victims; Ebola kills 60-90 percent; untreated rabies kills close to 100 percent, as does pneumonic plague, caused by Yersinia pestis, the bacterial agent of The Black Death, the worst pandemic in human history. But, to be both deadly, and efficiently transmissible — requires exacting circumstances,” Ms. Orent observes. Even the Black Death — though to originally have come from Central Asian marmots — must have evolved in a chain of human-to-human transmission, to become as lethally effective as it was.”
     “Fighting existing pathogens is more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”
     “So, what is wrong with listening to the drumbeat, to the endless calls to protect ourselves against the coming plague — against Ebola from Africa to bird flu from Asia? Is it possible that a huge pandemic could erupt from some as-yet unknown pathogen? Is apocalypse lurking out there, among rats, or monkeys, or bats or flying squirrels, or birds? The Black Death shows that you can never say never: there might be an animal pathogen out there that, under the right circumstances, can evolve and maintain both virulence and transmissibility among humans as well as animals.”
     “The Central African Monkey Pox virus (so-called because it was first identified in macaques in 1958) has dangerous attributes: like smallpox virus it is often deadly, and it’s also a ‘sit-and-wait pathogen,’ in Ewald’s terms — highly durable in the outside environment. Yet the evolution of monkey-pox into a human disease such as smallpox seems, at this point, unlikely: some strains of monkey-pox have transmitted from person-to-person for several iterations, but, the chains of transmission have easily been broken; and, the evolutionary processed stops in its tracks,” Ms. Orent wrote.
     “Instead, people continue to die of human-adapted disease,” Ms. Orent adds. “Malaria kills more than one million children annually. Tuberculosis, in its ugliest, drug-resistant forms, is well-entrenched worldwide. Polio, despite our noblest efforts, continues to cripple and kill children. Fighting existing pathogens seems more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”
     Ms. Orent ends on this note. “If The Great Plagues Of Athens tells us anything,” she notes, “it is to avoid social conditions that allow pathogens to evolve to great virulence and transmissibility. Preventing disease factories — trench-like warfare conditions, crowded hospitals, enormous refugee camps — is our best protection. While alarmists among us wait for the plague to pounce out of the jungle, it is far more likely to come from inside us, our disease factories, and our social world.”
The Next Pandemic Could Be Downloaded From The Internet
     The other problem we have now, is that the next pandemic doesn’t have to come from the jungle, or the urban ghettos of today.  Now, a competent high school biology major, with access to the Internet, can genetically alter a bacteria or virus into something that could kill hundreds of millions in a fairly short period of time. Eric Nller had a pretty frightening article on the November 22, 2016 edition of, “warning that new gene-editing technology (readily available on the Internet), could be turned into a biological weapon — by transforming a common virus into an unstoppable, drug-resistant killer,” and thus, unleash a global pandemic.
     Mr. Nller wrote that “gene-editing technologies such as CRISPR/Cas-9, act like a very accurate set [pair] of scissors, that snip bits of genetic material; and, reshuffle the gene so that it can produce a new protein.  The promise of CRISPR is to one day be able to eliminate the malfunctioning genes that cause inherited diseases and conditions, such as Huntington’s, Down’s Syndrome, or Parkinson’s for example.”  But of course, the darker angels of our nature likely have something more sinister in mind.
     “While interest in CRISPR/Cas-9 has exploded since its discovery in 2012,” Mr. Nller wrote, “the president’s science advisers also looked at possible risks of a terror group, or rouge state using CRISPR/Cas-9 as a weapon.  “In that scenario, a scientist working for this group could take a normal virus, or other infectious agent, edit some genes, and turn it into a killer disease for which we have no vaccine, or other treatments.”
     “One of the most powerful things about CRISPR/Cas-9 — is how easy it is to use,” Mr. Nller wrote.  “Ellen Jorgensen, teaches a CRISPR class for beginning biology students at GENSPACE, a community biology lab in Brooklyn, New York.  She gets young scientists and medical students, as well as amateur DIY biologists.  Part of the curriculum is talking to students about the ethical issues behind a powerful new tool.”
     “There are plenty of black hat scenarios with CRISPR, from potential eco-terrorism, to inserting it into a virus,” Professor Jorgensen said.  “The devil is always in the delivery.  CRISPR is no different.  It has to penetrate the cell, and get inside.  It’s always the hardest part of any gene delivery system.”  
     Professor Jorgensen said “many people can use CRISPR; but, any potential misuse would require some tinkering. {Thank goodness for small favors; but, those hurdles are likely to have a lower bar as big data mining and artificial intelligence matures].  To work as a weapon, any new, engineered infectious agents would have to get past the human immune system, which tends to adapt to new organisms over time, as well as find a way to infect other people.”
The Next Pandemic — When, Not If
     We all hope of course that the pneumonic plague outbreak in Madagascar has peaked.  But, sooner or later……..Author, explorer, David Quammen, had a May 9, 2013 Op-Ed in the New York Times, “The Next Pandemic:  Not If, But When,” which I highly recommend.  Mr. Quammen wrote, “TERRIBLE new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention.”  Madagascar for example?  
     He concluded, We can’t detach ourselves from emerging pathogens either by distance or lack of interest. The planet is too small. We’re like the light heavyweight boxer Billy Conn, stepping into the ring with Joe Louis in 1946: we can run, but we can’t hide.”  And now, we have the threat from the Internet/Worldwide Web as well.  RCP,

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