THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, April 9, 1995 TAG: 9504070650
SECTION: COMMENTARY PAGE: J1 EDITION: FINAL
LENGTH: Long : 151 lines
They've been the subject of the best-selling book ``The Hot Zone'' and ``Outbreak,'' a new movie starring Dustin Hoffman.
They're what the Centers for Disease Control and Prevention calls ``emerging infections'' - new viruses and bacteria, or bacteria resistant to penicillin and other drugs that traditionally defeated them, or the reappearance of infectious illnesses, like tuberculosis, that Americans thought were long gone.
If you need proof of the problem, says Dr. David Satcher, CDC's director, look at AIDS - a deadly illness with no vaccine and no cure.
``The threat is real, and nobody knows how far the threat will go,'' Satcher said, who spoke by phone with medical reporter Marie Joyce. ``You don't even know what the next infection's going to be. It may even be one like in the movie `Outbreak.' All you have to do is get something like AIDS that passes through the air instead of through the blood, so people can get it from each other through coughing.''
Below are excerpts from their conversation.
Q. An AIDS-type disease spread through the air? How likely is that scenario?
A. I don't know. I don't think any of us know. We haven't seen anything like that - that was an exaggeration. The concern is that we have in place the public health infrastructure, so that when it does happen we can detect it very early and contain it; we can prevent an epidemic.
And that's just not at the federal level, that's at the state and local level. And international.
Q. International?
A. We need to have in place a global surveillance system, so that when there is a new drug-resistant organism or a resurgence we detect it at the earliest possible time and contain it in a small area.
Q. So sometimes human actions can make the problems worse?
A. If you were to ask me what are the major factors that fuel emerging infections, I would list, No. 1, human demographics and behavior. The way people live. The crowdedness of day care, the crowdedness of prisons, homeless shelters, the way people behave sexually.
Two, I would talk about changes in technology. Let's just take an example: One hamburger patty may have contributions from over a hundred cows. The likelihood of an infection being spread is much greater.
Also changes in land use, in the environment.
Q. How do changes in land use affect the spread of disease?
A. Well, one of the theories about AIDS and other new viruses is that we messed with the rain forest. By going in there and cutting down trees and destroying the rain forest, that gave rise to some of these viruses that were contained.
Q. How?
A. I'm not sure anybody fully understands. Organisms may be contained, whether it's in the rain forest or in the ground. Then you get an earthquake, or something that really disturbs the environment, you get a spread of those organisms.
Q. So this disturbance sort of releases them from their natural habitat?
A. Exactly. So anything that changes the environment or the use of land can add to emerging infections.
Q. You mentioned living conditions. We hear about, for instance, an outbreak of cholera in the Rwandan refugee camps in Zaire. What about the places in the United States where people live in crowded, poor living conditions? Are these breeding grounds for new infections?
A. Well, sure. Look what happened in New York City with tuberculosis. Why was New York City the place that had the overwhelming numbers of people with tuberculosis? It related to homelessness, to shelters; it related to crowded prisons, day-care centers.
Q. What can the CDC do about that?
A. Well, first we've got to educate people and the government, about why everybody is at risk when we allow people to live that way . . . It is in our selfish interest. Public health is a global issue, because what happens in Zaire, what happens in India, affects us almost directly, not indirectly anymore.
Q. So money spent to improve health conditions in other countries is money spent to improve our own health?
A. I can give you a very specific example: polio. The last case of polio in this country was in 1979. The last case of polio in the Western Hemisphere was in 1991. Yet, CDC is involved in a major effort to eradicate polio in Southeast Asia and in sub-Saharan Africa. Why? One - it's humanitarian. We care about people. But also it's very selfish. If we could eradicate polio in the world, as we think we can do around the year 2000, it will save this country as much as $230 million a year, because then we don't have to immunize against polio, just as we don't have to immunize against smallpox now.
Q. There's been talk of cutting off health benefits to illegal immigrants living in the United States. Would something like that have a negative impact on the health of U.S. citizens?
A. I thought it was not wise because in doing that, we actually put at risk other people in our society. If people are in our country, it's in our best interest to treat them for diseases.
Q. How did the misuse of antibiotics over the past decades contribute to the development of drug-resistant bacteria?
A. That's one of the major factors. Physicians often misuse them. Patients demand antibiotics. They want penicillin for a cold, when penicillin does nothing for the common cold. But they like the doctors who will give them a shot when they have a cold. They'll go find another one if one won't do it.
Q. How do you deal with that?
A. We educate.
Q. Do you really think that will change behavior? Won't people still say: ``I don't care what the public health problems are - I'm sick. I'll feel safer if I have penicillin''?
A. I think there are many people who, if they understand penicillin doesn't do anything for common colds, won't want it. People believe that it helps. The problem is convincing them that it doesn't.
We try to get physicians and hospitals to use antibiotics appropriately. It's very easy to overuse antibiotics in hospitals. They use them to clean things.
Q. What about the antibiotic that is often mentioned as one that still can handle these infections, vancomycin?
A. It's one of the last drugs we have that most organisms are sensitive to. The question is: How long is that going to be true?
Q. How long do you think?
A. If we can get people to use vancomycin very carefully and sparingly, I think we can maintain it as a powerful drug. But if you misuse a drug like that, you overuse it, you're going to stimulate antibiotic resistance.
Q. Why can't we just come up with new antibiotics to combat new strains?
A. Well, it's never been easy to develop antibiotics, and it certainly is not so easy that you can always have one ready to go as soon as you get another resistant bacteria. Organisms can change very rapidly.
Q. What can people who are not in the medical field do to protect themselves?
A. Obviously immunization is No. 1. By the way, there are still people who don't get their booster shots for tetanus, diphtheria, things like that. . . A second thing people can do is make sure they use antibiotics appropriately. Don't insist on an antibiotic when what you have is a virus, like the common cold.
Q. Isn't it also true that if you have a recommended course of treatment, and you stop taking the antibiotic early, you are encouraging the growth of drug-resistant bacteria?
A. That's what happened with tuberculosis. That's one of the reasons we have so many cases of drug-resistant TB. It requires a six- to nine-month course of therapy. And it's especially difficult when you're dealing with homeless people and people who use drugs. You know what New York had to do? They had to implement what we call directly observed therapy. They would watch them take their medicine. In some cases, they incarcerated them to protect the rest of society.
Q. What else can we do to protect ourselves?
A. Cooking the meat. It might be fashionable to eat raw meat. We also know it's dangerous.
You need to wash your hands. Just basic stuff - we need to get back to that. It's very important for protecting against the spread of disease. And of course, sexual behavior. Look at AIDS - sex is nothing to play with. If you are having unprotected sex, then you are putting yourself at risk. ILLUSTRATION: Color photo
Dr. David Satcher
by CNB