# 5039
When I began this blog nearly 5 years ago, it was with a simplistic and single-minded intent of covering H5N1 – hence the name Avian Flu Diary. Had I thought about it more, I’d have realized that bird flu wasn’t the only threat worthy of covering, and I would have come up with a more encompassing name.
But it didn’t take long for me to begin to branch out. In April of 2007 I posted a blog called It Isn't Just Bird Flu, where I wrote about a number of possible pandemic and epidemic threats. I opened with:
In this increasingly crowded world of ours, where there are large areas of poverty and poor medical care, there are literally scores of deadly pathogens that could spark the next epidemic, or pandemic.
Bird flu, or the H5N1 virus, is high on the list of diseases we watch, but it is by no means the only one out there.
When we prepare for a bird flu pandemic, we are also preparing for any other disease outbreak.
Since then, I’ve expanded my coverage to such diverse pathogens as tuberculosis, dengue, malaria, plague, hendra, nipah, enteroviruses, adenoviruses, C. gattii, coronaviruses, acinetobacer, NDM-1, C. difficile, MRSA, and more.
It has been quite an education for me along the way.
Of course, not all of these diseases are thought capable of sparking a pandemic, but all are certainly capable of having a major (albeit, sometimes localized) impact.
Many already are.
But with the pandemic of 2009 officially behind us, many people around the world have let down their guard, convinced that global pathogenic threats are rare, manageable, and for the most part . . . overblown.
Admittedly, for those who get their medical news and information from the tabloid press, or from some of the more hyperbolic mainstream media outlets, it is hard to argue that these stories aren’t sensationalized.
But as far as being manageable, or rare, I guess that depends on your definition.
We got very lucky with SARS in 2003 and swine flu in 2009. SARS wasn’t as contagious as influenza, and so containment was possible. Swine flu, while very transmissible, was less lethal than first feared.
Other threats - like cholera, dengue, and malaria - get less media and public attention because - while they are killers - they tend to infect mainly poor people in far-away developing countries.
But the pathogenic landscape is changing.
With increasing global populations, man’s encroachment into undeveloped regions, misuse of antibiotics and antivirals, climate change, and nature’s laboratory open 24/7 working on some new viral, fungal, or bacterial mash up . . . the safe harbor we assume today may not hold tomorrow.
After all, it was more than 40 years ago (1969) when the Surgeon General of the United States, William H. Stewart, famously (and prematurely) declared, "The war against diseases has been won."
Since then, we’ve seen the resurgence of tuberculosis, the emergence of HIV and AIDS, the global spread of MRSA, an explosion in worldwide dengue, SARS, the persistence of malaria, outbreaks of Ebola, Lyme disease, and on average – have discovered one new zoonotic threat a year over the past three decades.
We live in a world teeming with pathogens, many of which are continually changing and evolving to become more efficient at infecting their hosts.
And sometimes, that means us.
In October of 2008 (6 months before swine flu emerged) Lloyd's issued a pandemic impact report for the Insurance industry, which can be downloaded here.
The Lloyds report takes pains to point out that while we worry about an influenza pandemic the most, there are other candidates out there that could spark a pandemic (or at least an epidemic).
They list:
- Hendra Virus
- Nipah Virus
- Cholera
- Small Pox
- HIV/AIDS
- Bubonic Plague
- Tuberculosis
- Lassa fever
- Rift Valley fever
- Marburg virus
- Ebola virus
- Bolivian hemorrhagic fever
- MRSA
- SARS
I could add Dengue, Chikungunya, the newly emerging NDM-1, and of course Pathogen X, the one we don't know about yet, to this list.
Even seasonal flu can abruptly take a deadly turn, by way of a simple mutation. I’ve discussed the infamous Liverpool Flu several times – which for a few weeks turned extremely virulent in 1951 (including here and here).
Could it happen again? Absolutely.
While flu gets a lot of attention, it is worth noting that HAIs (Hospital Acquired Infections) kill nearly 100,000 Americans each year. That’s 4 times more than the CDC estimates are killed in an average year from influenza.
MRSA, C. Diff, various pneumonias, and other infections cost thousands of lives and add billions of dollars to healthcare costs each year.
This from the CDC on HAI’s (Hospital Acquired Infections)
A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:
- 32 percent of all healthcare-associated infection are urinary tract infections
- 22 percent are surgical site infections
- 15 percent are pneumonia (lung infections)
- 14 percent are bloodstream infections
If we had a flu season that claimed 99 thousand lives in the US, we’d be calling it a catastrophe. But HAIs do their work out of sight, behind closed hospital doors, so most people go forth unaware of its impact.
Without a doubt, the best coverage of HAIs and the threat of growing antimicrobial resistance in Flublogia has come from Maryn McKenna editor of the Superbug blog.
All of this means that there is far more to pay attention to, and follow, than just influenza.
Which is why Flublogia – our little flu-centric corner of the Internet – has been branching out over the past few years to encompass practically all emerging infectious diseases.
Crof at Crofsblog was one of the first to devote heavy coverage to dengue and malaria, and has led the way on cholera in Haiti.
Arkanoid Legent and Chen Qi both do a terrific job picking up on neglected tropical diseases, outbreaks of dengue, chickungunya, encephalitis, `mystery fevers’ and other epidemics in remote areas of the world.
Ian York’s Mystery Rays and Vincent Racaniello’s Virology blog bring us in depth, and insightful coverage of the hard science behind many different pathogens that cause disease outbreaks.
And the volunteer newshounds of the flu forums (I frequent FluTrackers & The Flu Wiki) work around the clock and around the globe, digging out and translating the latest disease news from hundreds of diverse news sources.
I can’t predict what the next `big’ emerging disease story is going to be. It may be flu, or it could be some rising (or re-emerging) fungal, bacterial, or viral threat.
But I am confident that given the complex dynamics of the world we live in today, we won’t lack for some pathogenic threat to study, write about, and yes . . . prepare for.
Fortunately, just as pathogens have the ability to evolve and change over time, so does Flublogia.
