Saturday, January 03, 2009

It's A Smaller World After All


# 2617




My generation, the Baby Boomers (those of us born between 1946-1964) were the first generation of Americans to be born into an age where the vast expanses of the Atlantic and Pacific oceans offered little protection against foreign attack.


An ICBM, launched from just about anywhere in the world, could strike our country in less than an hour.  And once the atomic genie was let out of the bottle, the payload of a single missile could destroy an entire city.


I grew up indoctrinated with Bert the Turtle  civil defense cartoons, CONELRAD testing on the radio and TV ("This was a test. Had this been a real emergency, you'd have been instructed to turn to your local CONELRAD broadcaster for more information. This was only a test"), and of course duck and cover drills practically every day in elementary school (mostly 1962-1964).



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For my parents, who grew up in an age where wars could rage in Europe, or Asia, and have little direct effect on the United States, this was an abrupt and frightening change. 


What had been a mostly a weapon of terror during WWII, the V1 and V2 rockets developed by Germany in the early 1940's, had become effective war machines in the decade that followed. 


Instead of being blindly lobbed in the general direction of the enemy, they could now be targeted with great precision from half a world away.


Suddenly, the world became a much smaller place.


Growing up, all of this seemed perfectly natural of course.  I'd never known the world to be different.   Incineration from thermonuclear war was just another background threat,  one that we had little control over. 


If it happened, it happened.


Remarkably, the cold war has faded away, and remains mostly a bad memory for those my age, and is probably as unexplainable to the those born after 1990 as the rise of Nazism was to my generation.


No longer are there thousands of ICBMs, poised ready to launch on warning, if either side got the least bit twitchy.   A nuclear holocaust today seems unlikely, although the threat of a terrorist nuke remains.


But the world still remains a small planet.  


Instead of nuclear warheads carried by ICBMs, we now worry about International Airliners carrying passengers with incubating pathogens.


It's a legitimate concern.


London's Heathrow Airport saw 68 million passengers pass through their gates in 2007, and they were only the third busiest airport in the world.  The ten most active airports worldwide handled well over a half billion passengers last year.


You can literally travel from just about any two cities (with airports) anywhere in the world in 24 hours or less.


No longer are the oceans, or distance, a protection against diseases normally seen only in remote areas of the world.  


They are only a short airplane ride away.


A good example is Chikungunya.



In 2007, Chikungunya spread rapidly across the Indian Ocean, hitting Reunion Island particularly hard.  It is essentially a tropical disease, spread by the Aedes mosquitoes, and until recently was found only in Africa and parts of the Indian Ocean.




It is hard to see, but if you look closely, you'll also see that Italy is colored in as an effected country.   Yes, Italy.


A traveler, returning from India, brought the virus to Italy in 2007 with more than 290 cases reported in the province of Ravenna, which is in northeast Italy.  


You see, while the virus isn't normally found in Europe, the vector, the Aedes mosquito, is.  All it took was one infected person to arrive with the virus, and the chain of transmission began, ultimately infecting nearly 300 people.



Given the current large chikungunya virus epidemics and the worldwide distribution of Aedes aegypti and Aedes albopictus mosquitoes, there is a risk of importing chikungunya virus into new area through infected travelers. - CDC Website


The incubation period of Chik can be up to 12 days (avg 3-7), allowing infected, but asymptomatic travelers, plenty of opportunity to spread the virus.


This outbreak was contained, and the travel advisories have been lifted to this area.  But the threat of another introduction of Chikungunya to Europe, and to the Americas, remain.  


And you can believe that Australia is watching the virus closely as it moves steadily in their direction, as well.


Old scourges like Dengue, Malaria, and even Yellow Fever are once again potential threats to many areas of the world that have long believed themselves immune.


In the bad old days of the cold war, we spent hundreds of billions of dollars (back when that was real money) protecting ourselves from a sudden attack by the `other side'.  


We considered it a matter of national security.


Today, the threat comes not from nations, but from nature.   We need to think of our public health system, and our rapid response to disease outbreaks, as a matter of national security as well.


In 2003, SARS moved from China to Toronto, Canada on a single overseas airline flight.   One infected patient brought the virus to a  new continent. 


Before it was contained, 432 Canadians would become infected, and of those 44 would die.  Worldwide, more than 8,000 would become victims of this first major epidemic of the 21st century.


As bad as it was, we got lucky with SARS.   The next time, we may not be as fortunate.


Isolationism is no longer possible in this interconnected world of ours.  Disease outbreaks India, or Africa, or Indonesia do matter, even in the  United States and Europe.   


We probably won't be able to keep the next SARS, or influenza virus from crossing our border.  The best we can hope for is that we can deal with it when it arrives.


 And that means a robust, and well funded, public health system.   


At a time when budget cuts are almost inevitable, and a realignment of priorities is likely, we need to remember the old adage.


If you don't have your health . . . you don't have anything.