Maryn McKenna

Journalist and Author

The Risks You Don't Think of: A Plea to Pack a 'Go Bag'

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Photo: OnlyAnEgg, CC/Flickr

What if you had 15 minutes’ notice to leave your home, and you didn’t know when you’d be coming back — or what shape your home would be when you did?

Could you find your key documents, medications, ID, devices, cables? Sturdy shoes, suitable clothing, stuff to comfort your kids and control your pets? Mementos, valuables, things you couldn’t live without? While trying to stay calm, keep your family calm, and figure out what’s going on?

I ponder this, sometimes, as an academic exercise: when I’m watching horrific tornado footage, or wondering how far inland a tropical storm is going to come. I’ve lived on a hurricane coast (Texas) and in a tornado alley (Minnesota), and I thought regularly about preparedness while I lived there. But now I live mostly in Atlanta, and sometimes in inland Maine, and my rare thoughts about preparedness extend mostly to keeping documents in a fireproof safe and making sure the flashlights scattered around the house have good batteries.

Last night I learned how shortsighted that was. TL;DR: All’s well, my house didn’t burn down, and I got a useful reminder about how you can be taken by surprise.

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The Cool Factor (With Feathers): New York Chefs React To Pastured Poultry

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Photo: OZinOH/Flickr

If you’ve been around here a while, you might remember a couple of posts about the pastured-poultry movement. Pastured poultry is new old-style: beyond cage-free, beyond free-range, it puts chickens out on grass for most of their lives, producing a bird that lives longer, looks healthier, and tastes distinctly different from standard supermarket chicken. (“They have huge, old-fashioned taste,” Shaun Doty, a chef who has been working with them, told me last year. “They cook differently, and they eat differently.”

Pastured poultry represents a radically different way of raising chicken than the standard large-intensive model: no antibiotic use, no crammed chicken houses, no genetic-monoculture birds with their inevitable physical vulnerabilities. So far, it’s a niche in the market: The number of producers is small, the birds are more expensive — and even though the chickens taste like what our grandparents would have eaten, most of us have never known chicken tasted like that, so they can be a challenge to sell. The first problem, though, is raising awareness that the alternative exists at all.

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The "Road Not (Yet) Taken" On H7N9 Flu — And How Far We've Gotten

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Last week’s New England Journal of Medicine included a thoughtful meditation on the possibility that the new bird flu out of China, H7N9, could become a globe-spanning pandemic — and on how much knowledge is needed before we’ll be able to predict whether it will or not. The authors, all from the US National Institutes of Health, know a fair amount about pandemics: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Dr. David Morens, Fauci’s senior advisor and a medical historian; and Dr. Jeffery Taubenberger, a physician and microbiologist who brought back to the world the viral cause of the worst pandemic: the influenza of 1918, which killed 100 million people.

In various combinations over the past 10 or so years, the three have written a number of papers looking back at the record fro 1918, interrogating its impact, and particularly examining the causes of its extraordinary death toll. So they are probably the perfect authors to write about gaps in knowledge about H7N9.

But aside from its useful examination of the virology, what struck me as most interesting about their paper is how soon it is to be able to write something like this. After all, H7N9 only emerged to public knowledge in late February, and so far has caused 132 cases and 37 deaths, all in eastern China. That these authors could write this paper now is yet another marker, I think, of how different this outbreak is from SARS 10 years ago, as well as how rapidly international public health science can move, if everyone cooperates.

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Summer Is Lyme Disease Season. The Price of the Drug to Treat It Just Exploded

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If you’ve been reading for a while, you might remember some posts about nationwide shortages of drugs. The Food and Drug Administration was concerned, and so were very senior physicians working in infectious disease, cancer, everyday emergency medicine and even veterinary care.

The crisis faded from view, as they do. So it wasn’t much noticed that back in March, the American Academy of Pediatrics warned of an FDA alert over an apparent shortage of doxycycline, an old and inexpensive drug that is used mostly for uncomplicated infections such as sexually transmitted diseases and acne. It is also used, though, as the first treatment for a new case of Lyme disease — and that, more than anything, has sparked alarm.
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How Do You Know Which Chicken to Buy? This Kickstarter Might Help.

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There’s a project I’ve been watching on Kickstarter and I’m a little surprised it hasn’t gotten more traction, so I thought I’d call it out. TL;DR: You know those wallet cards and apps that help you make good choices about buying seafood: what’s endangered, what’s overfished, what’s responsible to eat? This effort, BuyingPoultry.com, hopes to do the same for chicken — but it’s only halfway to its goal.

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To Prevent MRSA In Hospitals, Don't Prevent Only MRSA

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Practically since the multi-drug resistant bacterium MRSA became a public health issue in the 1960s, health care has been arguing over how best to prevent its spread — particularly in hospitals, where the bug first became a problem and where the most vulnerable patients are concentrated. The camps break down, more or less, into procedures which look for MRSA specifically, and procedures which reduce the risk of spreading any pathogen in the hospital environment. The MRSA-specific strategies, popular in Europe and in some health-care systems in the US, involve checking patients to see who is carrying the bacterium, and then taking extra care with those who are positive, usually by isolating them within the hospital and making sure health care workers wear protective gear when they encounter them. The more general ones involve mandating actions, usually but not always things  that health care workers do — such as washing their hands more regularly and bathing patients with disinfectant — which will reduce the risk of not only MRSA transmission but of any other pathogen as well.

The back and forth between these views has been intense and prolonged; most of the infectious-disease meetings I’ve attended over the past 6 years have staged some sort of debate between representatives of the two sides. In the United States, the “active detection and isolation” strategy (often just called “search and destroy”) has been ascendant; among other things, it has been written into law in at least nine states, and adopted by the VA healthcare system. It has been demonstrated to work (though that demonstration was later challenged), but it is costly in staff time and also in equipment, since detection is usually done by molecular methods; and isolation has been shown to be rough on patients as well.

In the latest round — though given the contentiousness of this debate, probably not the last — a strong study just published in the New England Journal of Medicine, describing a careful trial of both systems, establishes that the non-specific strategy works better to reduce not just MRSA, but hospital-associated infections of all kinds.

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World Health Organization Annual Meeting: New Flu, Coronavirus Urgent Priorities

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In Geneva today, the World Health Assembly — that is, the annual meeting of the 194 governments whose collective commitment support the World Health Organization — opened as traditional, with a speech by the WHO’s director-general, Dr. Margaret Chan. It is a very interesting time, not just for the WHA to be meeting, but for Dr. Chan to be addressing them. That’s because, 10 years ago when SARS exploded into the world from China, she was the director of health for Hong Kong, the city that was hit first and hardest. Ten years later, with H7N9 flu emerging from China, and a viral relative of SARS — the novel coronavirus now being dubbed MERS — bubbling in the Middle East, the questions and lessons of SARS are bizarrely resonant. That has been true for the past several weeks, but is even more so today, with one more case of MERS announced, in one more country: Tunisia, this time.

Here are the opening paragraphs from Chan’s speech (full text online here). To me it’s quite interesting how much she praises China for its transparency in dealing with H7N9 flu — while not extending the same praise to the Kingdom of Saudi Arabia, where MERS is concentrated. In fact, she doesn’t even mention Saudi Arabia by name; whether that is meant to give offense, or to avoid it, other public-health tea-leaf readers can say better than me. Though her closing comment — “the current situation demands collaboration and cooperation from the entire world” — sounds pretty pointed to me.

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Fecal Transplants: The FDA Steps In

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Hi constant readers: I am traveling again, and while I’m in a far time zone, news has broken that you might be interested in. So while I don’t have a full understanding myself yet of what’s going on, I’m going to throw up what I’ve got, because I know how many people are interested in this.

Briefly: The US Food and Drug Administration has decided to bring the semi-outlawed — but very safe and very effective — procedure called “fecal transplant” under its auspices, ruling that to perform it, physicians must have applied for an “investigational new drug application,” or IND. This requires a lot of advance paperwork, 30 days of consideration, and does not return not a guaranteed yes. For the transplants, which have been performed informally but carefully by a growing number of physicians as a treatment (and often cure) for devastating C. difficile infection, it may improve safety, but it can’t help but impose obstacles and delay. (My past posts on fecal transplants here and here.)

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More On The New Coronavirus: Cases in France, The WHO In Saudi Arabia

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My last two posts looked at the problems that might be caused by hospital spread of the new coronavirus, based on what happened during the early days of SARS 10 years ago. Hospital spread of this new virus is a real concern; it was first identified, retrospectively, in an outbreak in a hospital in Jordan a year ago, and international concern really picked up after the acknowledgement of a current outbreak in the Al-Ahsa region of Saudi Arabia. Now it appears there is a third instance of hospital spread, in France. Several days ago the French Ministry of Health announced a single case, a Frenchman who had traveled to Dubai and may have been infected there. This morning, there is news of a second case, a person who shared a hospital room with the first patient. Here’s the announcement from the French Ministry and one from the World Health Organization. (And if you read French, I talk to the French newspaper Le Figaro about it here.) Simultaneously, the WHO has announced that two more patients have been recognized in that Saudi hospital cluster. That makes 15 patients (three of whom died) in that cluster, and 34 patients (18 deaths) worldwide.

There’s additional news today as well, which is both heartening and a little concerning too.

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How The New Coronavirus Might Be Like SARS: Hospital Spread (Part 2)

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The most recent official update on the novel coronavirus raises the possibility that most of the recent cluster — 13 cases out of 30 — may be due to the novel disease spreading within one hospital. (Yesterday there were reports of the spread having to do with dialysis. I’m skeptical of that.) Infectious disease experts find the idea of hospital spread very worrisome, because when the related disease SARS arose 10 years ago, hospitals unknowingly caused its first rapid spread. International health authorities are taking this threat seriously: On Monday, the World Health Organization published a multi-page infection-prevention guide for any hospitals that might take in victims.

When SARS broke out of southern China in early 2003, I was in the midst of a year-long project shadowing members of the disease-detective corps of the Centers for Disease Control and Prevention, known as the Epidemic Intelligence Service. Some of the most explosive SARS outbreaks they were sent to investigate were in hospitals, and front-line health care workers were some of the earliest victims.

This is the second of two excerpts from a book I wrote in 2004 about the EIS, Beating Back the Devil, describing what the early days of SARS were like. In the previous one, a hospital swamped by SARS locks its doors, with its sick staff inside. In this one, a doctor who worked in that hospital — and alerted the world to the threat — loses his life to the disease.

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