September 5, 2020

John Snow removing the handle of the Broad Street Pump – 1854

It’s another exciting Saturday Evening chez Andy. I sat out on my terrace after dinner and watched the sun go down in a flurry of lavender and tangerine while sipping a warm weather concoction I just invented with a tumbler full of ice, limeade, ginger ale, and a generous dollop of gin. Not quite watching the sun set over the rift valley in Eastern Africa, especially as the only nearby wildlife were my two obnoxious cats complaining that they hadn’t yet had their evening kitty treats. The yowls of felis domesticis cannot be interchanged with the roaring of the big cats of the Savannah in any way, shape or form.


Going to be a quiet long weekend. I don’t feel like going anywhere and rubbing elbows with crowds as I am still taking Covid-19 seriously and don’t want to be the one that brings it into the UAB and Birmingham VA clinical geriatrics programs. I do get out some but I try to do it at non-peak times and I’m still not really comfortable going into indoor spaces I don’t have to be in when they are filled with a lot of other people I don’t know. I’m fine with small group/outdoor socializing but nothing much has presented itself recently. I do have a dinner with Tommy’s family coming up on Monday and it will be good to catch up with them.


What to say for the accidental plague diaries this evening? I’m just perplexed at the number of highly educated and supposedly rational people out there who seem determined to throw out centuries of careful study of epidemic disease, microbiology and virology in favor of politically expedient puffery. The tried and true mechanisms for dealing with pandemics weren’t invented out of whole cloth. They come from a series of brilliant minds – giants standing on the shoulders of giants, to get us to the point where the deadliest of diseases can be corralled through time honored principles. As recently as a decade ago, Ebola, a much more deadly disease than Covid was contained with US CDC leadership and beaten back. The number of US fatalities – two.

The Broad Street Pump Today


Now we are approaching 200,000 American fatalities and, at current trends, that’s expected to have doubled before the end of the year and will easily top 500,000 by inauguration day when there may be a political class in this country that relies on evidence and rationality rather than feeling and expediency. The journey of knowledge of microbiology is a long one, beginning in the 1640s with the invention of the microscope by Kircher, later perfected and popularized in the 1670s by Anton van Leeuwenhoek. Their discovery of a plethora of living things, previously invisible to the human eye led to a revolution in the understanding of the mechanisms of disease. By 1700, physicians were beginning to postulate that some of these newly discovered micro-organisms were responsible for infectious disease, but it wasn’t proven until experiments done by Agostino Bassi around 1810. Once the germ theory of disease took hold, Holmes and Semmelweis demonstrated how unwashed hands caused puerperal fever in OB wards in 1843 and John Snow traced a cholera outbreak in London to the handle of the Broad Street pump in 1854.


By the late Victorian period, the need for hygiene in medicine and society was well recognized and various social campaigns began to modernize sewer systems, provide for indoor plumbing, and create aseptic nursing and surgery in health care settings. The result? Life expectancy sky rocketed as more and more of us were able to avoid what were previously common infectious diseases. In 1900, life expectancy in the USA was 42 years. Today, it’s 79 years (and we’re low on the international totem pole – in most of Western Europe it’s well over 80 years). The biggest contributor to that? Your ability to access a flush toilet and sink for hand washing pretty much anywhere you go.

Microbes are everywhere


The brains of the late 19th and early 20th centuries recognized the importance of public health measures, the importance of understanding the epidemiology of disease, and the importance of educating the populace in good health habits like regular bathing and giving average people the ability to do so. They gifted us with our much longer life spans and, unfortunately, took away our general fear of epidemic disease. As we live in a culture where there hasn’t been much of serious epidemic striking the general population in several generations, we collectively forgot the lessons of the past and haven’t adequately funded the institutions needed to protect us en masse. Nature doesn’t care. Let down your guard and cease your vigilance and she’s always there with her rules which have nothing to do with our political, economic, or sociologic structures.


More of us are going to die. As we drift towards some sort of mythic herd immunity, we’ll do it at the expense of hundreds of thousands, if not millions of individuals that didn’t have to die at this time. We have no way of knowing what the long term morbidity will be in addition. A recent study showed that something over a third of college athletes that developed Covid-19 and recovered have residual myocarditis (inflammation of the heart muscle). If that continues, will that lead to a weakening of heart tissue and early onset congestive heart failure twenty or thirty years from now when they should be in the prime of life? Will it interfere with their cardiac conduction system greatly raising their change of sudden cardiac death in the future? No one knows. We’ll be studying and learning from this virus and its effects of decades, likely the rest of my personal life span.

The one thing we can all do is follow the playbook that’s been around for the last couple of hundred years for dealing with epidemic disease. Good hygiene, isolate, and break transmission chains – in this case wearing a mask to contain aerosol and droplet transmission. There’s an old saying that when you save one life, you save the world entire. Doing the basics will do that many times over.

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