Maryn McKenna

Journalist and Author

Ebola Could Cause Thousands More Deaths — By Ushering In Measles

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Women gather in the Guinean village of Meliandou, believed to be Ebola's ground zero.

Women gather in the Guinean village of Meliandou, believed to be Ebola’s ground zero. Jerome Delay/AP

Awareness of Ebola is picking up again in the United States: An American volunteer who was working in Sierra Leone has contracted Ebola and been medevac’d to the National Institutes of Health Clinical Center for Ebola treatment, and 10 more volunteers have been brought back to NIH, Omaha and Atlanta, to be examined at three of the four institutions in the US that have safe units to house them.

It’s a reminder that Ebola still persists in West Africa: In the last period the World Health Organization reported on (the 7 days ending March 8), there were 116 new cases. One bit of good news: None of them were in Liberia, for the second week in a row. But Guinea and Sierra Leone, where this volunteer was infected, continue to struggle.

And in a research paper published as that volunteer was being flown back, there’s a reminder that the Ebola outbreak is creating layers of health risks for those countries. In Science , researchers from NIH and four universities warn that Ebola’s interruption of other health services, such as childhood immunizations, threatens to create secondary epidemics of preventable diseases that would dwarf Ebola’s impact. In particular, they warn that there could be 100,000 additional measles cases, and up to 16,000 additional deaths, if health services are not restored.

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Still Fighting Ebola: A View from Liberia's Front Line

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Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia.

Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia. Jerome Delay/AP

We’ve pretty much signed off on Ebola in the United States — last week, President Obama withdrew the US troops sent to fight the disease — but in Africa, the news on the epidemic has seemed pretty good. The overall number of known cases stands at 22,894, with 9,177 deaths, far below the dire predictions made last fall that the epidemic could sicken millions.

Progress at beating the disease is stalling, though. According to the World Health Organization, the number of new cases has gone back up for two weeks in a row. Sierra Leone, now the outbreak’s epicenter, still has what the WHO calls “widespread transmission,” and on Saturday its government quarantined part of the capital. Guinea has had a spike in cases, and in several areas, mobs have attacked clinics.

The news is best from Liberia, where there were just three new cases last week compared to 65 in Guinea and 76 in Sierra Leone. Liberia was hard-hit, with 8,881 confirmed cases and 3,826 deaths — 300 cases per week at some points. But it also seems to have done the most to curb the disease’s spread: Today, schools that had been closed since last fall are supposed to open again.

Last week, though, I had the opportunity to speak to a front-line Ebola fighter in Liberia, and what he told me underlined how precarious that country’s progress is.

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A New Polio Case in Pakistan and an Unsolved Epidemic

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A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi on January 20, 2015.

A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi on January 20, 2015. Rizwan Tabassum/AFP/Getty Images

Time to check in on another globe-spanning epidemic. While we were all watching Ebola, polio continues—and as long as it does, it holds the possibility of surging back over the rest of the world.

A quick refresher: Polio has been the target of a very expensive and aggressive multi-national eradication campaign since 1988. By last summer, polio was endemic—that is, transmission from one person to another has never been interrupted—in Afghanistan, Pakistan and Nigeria. Very high rates of vaccination have kept the paralyzing disease from leaking over those countries’ borders to most of the rest of the world—but every once in a while, something slips through, or a country runs out of money and lets its vaccination campaigns lapse.

As a result, last year, there was still polio in seven other countries — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria—and the World Health Organization declared an international emergency.

So, updates: Despite its ongoing civil strife, Syria has not had a polio case in a year. There has been no detection of polio virus in sewage in Israel or the West Bank or Gaza since March. It has been almost 6 months since the last polio case in Nigeria—extremely good news because that country has periodically re-infected other areas of Africa.

But: Pakistan remains a problem.

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Ebola Here and There: Knowing When It Is And Isn't Over

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It may have skipped your notice, but the United States is now Ebola-free. Dr. Craig Spencer was released from treatment in New York City Tuesday; that day also marked the end of the watch period for Kaci Hickox, the nurse force-quarantined in New Jersey and then allowed to go home to a remote town on the Maine border. The two nurses who treated deceased patient Thomas Duncan, Amber Vinson and Nina Pham, were both released from treatment two weeks ago. The health care workers who were sickened in Africa and came home for treatment have all gone home.

There are some things to note in these events. The first is that the Ebolanoia over the possibility of the disease spreading in the United States  is now clearly shown to have been an over-reaction. No one got sick because Spencer went around New York City in the days before he developed symptoms. No one got sick, either, from contact with Kaci Hickox — and, an important point, she never developed symptoms herself. Her quarantine was self-evidently unnecessary. The only people to have contracted Ebola in the United States are the two nurses who were in close face-to-face contact with Duncan when he was floridly ill, and while the hospital that treated him, and the Centers for Disease Control and Prevention, were working out the best protective protocols.

So we really could calm down now. (Have you noticed how the chatter has died down? Especially since the election?) But we also shouldn’t forget that Ebola continues in West Africa, and could return to the US at any time.

Here’s an example of the continuing challenges: the West African country of Mali.

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Found: Forgotten Vials of Smallpox

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Variola, CDC

Variola, CDC

Headline-making news today from the Centers for Disease Control and Prevention: Workers clearing out an old storage room on the Bethesda, Md. campus of the National Institutes of Health have found a forgotten box of vials that contain smallpox.

Yes, smallpox. The “most terrible of all the ministers of death,” as Thomas Babington Macaulay called it in his 1848 History of England — a disease that was the world’s most dreadful killer, until it was declared eradicated in 1980. A disease caused by a virus that now is supposed to reside in only two highly secure laboratories on the planet, in Russia, and at the CDC.

Smallpox is the only human disease ever successfully eradicated — pursued to elimination by a relentless dragnet that closed nooses of vaccination around every identified case. After the last natural infection, in Somalia in 1977, the World Health Organization launched a second dragnet, scouring lab freezers and storage rooms for any remaining samples of the virus, and consolidating them in Siberia and Atlanta.

Somehow, these six tubes of freeze-dried virus evaded the search. They were found in the storage room of a lab that now belongs to the Food and Drug Administration but was ceded to that agency by NIH in 1972. They may date back to the 1950s.

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A World Cup Visitor: Polio from Africa in Brazil

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Eutroph-outflow

Gerick Bergsma via Eutrophication & Hypoxia / Flickr

Unnerving news from Brazil, now hosting travelers from all over the world because of the World Cup: The virus that causes polio has been found in sewage in one of the cities where matches are being played.

The World Health Organization, which announced the finding on Monday, says the virus was discovered last week in a sample collected in March at Viracopos International Airport in Campinas, which is about 60 miles outside Sao Paulo, and is where many of the World Cup teams have been landing. The agency said no cases of polio have been identified and there is no evidence the disease has been transmitted.

Genetic sequencing of the virus—the WHO didn’t say, but probably done by the Centers for Disease Control and Prevention in Atlanta—revealed that it was closely related to a poliovirus that recently caused a case of the disease in Equatorial Guinea in West Africa. Humans are polio’s only host; so that probably means the virus was carried into Brazil by a traveler, likely someone who never knew he was harboring it.

Brazil, like most of the rest of the world, continues to vaccinate against polio, even though there have been no cases of polio in Brazil since 1989, and the Americas were declared polio-free in 1991. The high vaccination rate — 95 percent of children nationwide, and higher than that in Sao Paulo State — kept the  virus from spreading.

Still: not good.

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World Health Organization Drafting Global Plan on Drug Resistance. Is That Enough?

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NathanReading-staph

Image: Nathan Reading (CC), Flickr

The annual World Health Assembly — the meeting of representatives of the 194 countries that belong to the World Health Organization — ended Saturday. Each year, the Assembly defines policy and sets out goals for the coming 12 months in a series of voted-on resolutions. This year it zeroed in on antibiotic resistance, upping the ante on the WHO’s previous efforts to fight the emergence of resistance globally. The biggest initiative: A global action plan that the agency expects to have drafted by next January, in order to have it approved by all the levels of the organization so that it can be voted on next May.
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Polio Declared An International Health Emergency

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Prefvotuporanga (CC), Flickr

Image: André Luiz D. Takahashi (CC), Flickr

In a move that is simultaneously discouraging, urgent and deeply unusual, the World Health Organization has declared that the resurgence of polio is a “public health emergency of international concern.” It’s an extraordinary statement, coming less than four months after India — once considered a place where polio might never be vanquished — was declared polio-free after three years without a new case.

That achievement left only Afghanistan, Nigeria and Pakistan as countries where the chain of polio transmission had never been broken. But as the virus persists in those countries, it is also moving out across their borders. Seven other nations that previously had beaten polio — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria — have now been reinfected, and the virus is spreading in communities there.

If the continued existence of polio is news to you, you’re not alone. It’s a largely forgotten disease in the industrialized West; the last United States case occurred in 1979. The WHO, the Centers for Disease Control and Prevention, the fraternal organization Rotary International and a raft of partners have been pressing an international and very expensive eradication campaign since 1988. Every time the world has gotten close, though, polio has flared up again. The WHO once thought it would be able to declare the disease eradicated in 2000; then it set 2005 as a target; then 2008; 2012; 2015; and now, a hoped-for 2018. (Here’s my archive of posts.)

But the past couple of months have thrown even that into doubt. The trigger for the WHO’s action was the discovery that there have been 74 cases of polio so far this year. That seems like a low number, but there were only 417 in all of 2013. And, crucially, winter is considered polio’s “low season” — so for polio to be spreading now rings an alarm bell for the warmer, wetter months when it usually spreads faster and further.

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World Health Organization: Antibiotic Resistance Grave Global Problem

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NathanReading-staph

Image: Nathan Reading (CC), Flickr

The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.

The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “It’s clear that rates are very high of resistance among bacteria causing many of the most common serious infections – the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”

But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.

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H7N9 Flu, Year Two: What Is Going On?

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Live-poultry market, Shandong, China, 2009. Jonas_in-China (CC), Flickr

Live-poultry market, Shandong, China, 2009. Jonas_in-China, Flickr

Cast your mind back to about this time a year ago. A novel strain of flu, influenza A (H7N9), had emerged in China, in the provinces around Shanghai. International health authorities were deeply concerned, because any new strain of flu bears careful watching — and also because, on the 10th anniversary of the SARS epidemic, no one knew how candid China would be about its cases.

By the time peak season for flu ended in China, there had been 132 cases and 37 deaths from that newest flu strain. But, confounding expectations, the Chinese government was notably open about the new disease’s occurrence, and scientists worldwide were able to ramp up to study it. Still, no one could say whether that flu would be the one to make the always-feared leap to a pandemic strain that might sweep the globe. As with other, earlier, worrisome strains of flu, science could only wait and see whether it might return.

And now it has.
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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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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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How The New Coronavirus Might Be Like SARS: Hospital Spread

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The most recent update on the novel coronavirus that has been spreading in the Mideast since last summer adds three more cases to the outbreak, and raises the possibility that most of the recent cluster — 13 cases out of 30 — may be due to the infection spreading within one hospital. Infectious disease experts find that worrisome, because when the related disease SARS arose 10 years ago, hospitals unknowingly amplified 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 outbreaks they were sent to investigate were in hospitals, and front-line health care workers were some of the earliest victims.

I thought it would be worth remembering what the early days  of SARS were like, while we wait to see what this new virus does next. So over the next few days, I’m going to run a couple of excerpts from a book I wrote in 2004 about the EIS, Beating Back the Devil. In this one, a hospital swamped by SARS locks its doors, with its sick personnel inside. In the second excerpt, a doctor who worked in that hospital — and alerted the world to the threat — loses his life to the disease.

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Transparency Unlocked: More New Saudi Coronavirus Cases Reported Quickly

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In my last post 36 hours ago, I raised questions about Saudi Arabia’s apparent delay in reporting new cases of the novel coronavirus that has been causing low-level unease since last summer. (For the full history of that, check these posts.) So it’s only fair to say that, within 24 hours, the Saudi government behaved very differently with a new report.

The bad news is, the new report is about yet more cases of the novel virus. But the good news is, the report of the new cases was quickly shared internationally, by the government’s Deputy Minister for Public Health, via the international disease-alert mailing news ProMED.

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New Diseases and National Transparency: Who Is Measuring Up?

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I’m still catching up on all the news that happened during the weeks I was away, and I had a food-policy post just about set to go today. And then this happened.

I opened my morning mail to find a note from a private list I subscribe to, published by a company that monitors hazards for businesses with expatriate employees. The note flagged new news from Saudi Arabia:

Saudi Arabia: Seven more case of novel coronavirus reported
Seven people in Al-Ahsa governate in the Eastern province have been confirmed infected with the novel coronavirus. Five have died and the other two are critically ill in intensive care. It is unclear whether there are any links between these cases or whether they are “sporadic” infections. Overall the risk to travellers remains low.

This was odd. You’ll remember the new coronavirus, distantly related to SARS, which surfaced last year in a slow and not well-disclosed manner (for the back story, see these posts from last September, October, November and December). Since the initial reveal last year, there has been very little information released about the virus and whatever illness it might be causing. The World Health Organization has been monitoring the gradual accumulation of cases, but there has been almost nothing published since last fall. In fact, though teams from Columbia University and the Centers for Disease Control and Prevention have been to the Kingdom of Saudi Arabia to help investigate the new illness, neither entity has published anything since those trips were made. And at the point at which I opened my inbox this morning, the WHO’s last update on the new virus had been published on March 26.*

Meanwhile, of course, the infectious disease world has been riveted by the rapid emergence in China of a different virus, the new avian flu H7N9, and many questions have been aimed at whether the Chinese government, which attempted to conceal the emergence of SARS 10 years ago, has learned the lesson of transparency. (I talked about that history, and how the world found out about SARS, in this segment from On the Media a few weeks ago.)

Almost since H7N9 emerged in March, though, the WHO and other bodies have been averring that China is actually doing a good job this time around. And with this overnight news from Saudi, it seems that the questions about disease-outbreak transparency may have been directed at the wrong country.

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Almost-Untreatable Gonorrhea: Proof That It's Here

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If you’ve been following this blog for a while, you might have noticed a thread on health authorities’ growing concern over gonorrhea not responding to the drugs used against it. (And if you didn’t notice you can find those posts here.) A paper published Wednesday evening shows that worry has not been misplaced.

The concern is this: Treatment of STDs in infected people, and programs that aim to keep STDs from spreading from those people to others, rely on drugs that are inexpensive to buy, simple to administer, and work after a single dose and clinic visit. Since the late 1990s, there have been only two drugs that fulfill those criteria: an oral drug called cefixime and an injectable called ceftriaxone (both belonging to the same broader drug family called third-generation cephalosporins). Since the early 2000s, there have simultaneously been signs that resistance to cefixime has been spreading from the Pacific Rim — Japan and Hawaii — to North America, Europe and the rest of the world.

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Polio Eradication: The Bad News Continues

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When last we left the long asymptote of polio eradication, nine health workers in Pakistan who had been administering polio vaccine had been murdered, presumably by the Taliban or its sympathizers, because polio eradication has been cast by them as a plot against Islam in the wake of a CIA operation which used vaccinations as an attempt to get close to Osama bin Laden.

(If this story is new to you: Yes, really. For background, start with this post, and then read this, this, and this.)

So it’s discouraging to say that, in the past few weeks, the news hasn’t gotten any better — though some additional voices have joined the debate in an attempt to stress to the world how important this moment is.

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An Old Disease Returns: Dengue Is in Florida and May Be Heading North

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This month, Slate has been running an intermittent series on pandemics under the guidance of new science editor Laura Helmuth. The latest entry in the series is one that I wrote (my first time writing for Slate, which is exciting). It’s about the under-appreciated threat to the United States of a disease that we barely think about: the mosquito-borne illness called dengue, formerly known as “breakbone fever.”

Dengue was once endemic in the United States. When I started researching it for this piece, I discovered a whole series of historical outbreaks I knew nothing about: Charleston, SC, 1828; Savannah, Ga., 1850; Austin, 1885; Galveston, 1897; most of Louisiana, 1922; Miami, 1934. Dengue was not eliminated here until the government undertook mass mosquito-eradication programs in the 1940s, because mosquito-borne illnesses were making so many military members so sick that the toll was hampering the war effort. (Public-health history buffs: Those were the campaigns that gave rise to the CDC, which grew out of a government agency called the Office of Malaria Control in War Areas.)

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Taliban Murders Six Immunizers in Wake of CIA Polio Ruse

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(This post has been updated. Read to the end.)

There is news today, confirmed by several media outlets and also by the World Health Organization and UNICEF, that six people working as polio vaccinators were murdered in three separate coordinated attacks in Pakistan. While no one has yet claimed responsibility, it is widely assumed that the attackers have ties to the Taliban, which has opposed the polio-vaccination campaign as a Western plot and accused vaccinators of working as spies for the CIA.

This is grievous and appalling. Infuriatingly, it was also predictable. Constant readers will remember that, back in 2011, the CIA did use a vaccination campaign as a ruse to attempt to to find Osama bin Laden. The unsuccessful attempt was denounced all over the world for putting the polio campaign at risk, and news sources within Pakistan quickly began reporting that vaccinators were feeling threatened. Adding to the sense of threat, a Taliban commander blocked the campaign in one province last June, a United Nations doctor and his driver were fired on in July, and a vaccinator was executed in October by a man who roared up on a motorbike and dashed away.

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