The U.S. summer of 2022: Infectious outbreaks and vital vaccines
In the 21st century, in the wealthiest and supposedly most advanced nation on the planet, infectious diseases and vaccines continue to be major part of the news headlines.
Experts and regular folks are paying attention to the persistent coronavirus pandemic, a stubborn and apparently widening outbreak of monkeypox, and a startling spike of meningitis and listeria cases in or tied to Florida.
The coronavirus pandemic
Federal regulators, as they watch with increasing concern the steadily rising coronavirus cases and plan for potential responses if a fall surge turns bad, have ordered vaccine makers to make changes in their products. The coronavirus continues to mutate, with Omicron variants BA.4 and BA.5 now the predominant strains among diagnosed cases. This has led the federal Food and Drug Administration to order makers to adjust their shots to target Omicron and its increasingly infectious and vaccine-elusive variants.
The vaccine manufacturers have reported progress in adjusting their shots and they, too, have been preparing for the days ahead.
Researchers, health officials, and clinicians have expressed increasing worry about BA.4 and BA.5 variants because they not only seem less open to attack by existing vaccines but also because they seem to be responsible for greater rates of reinfections. These rebound cases seem to be recurring repeatedly and within weeks of each other. They may not be as severe as earlier cases involving other variants. But they still can be debilitating, and their harms can be cumulative, leaving vulnerable patients quite beat down.
A growing concern, too, continues to be the nation’s willingness to use and pay for safe, effective vaccines against the coronavirus. Uptake has been limited among adults for boosters. It has been pokey overall among younger people in the months since vaccines and boosters have been approved for them.
Parents are slowly getting babies and infants inoculated after federal regulators gave their approval for emergency shots for kids 6 months to five years old. The data are only trickling in, so it is difficult to accurately gauge the vaccine response in the littlest kids.
Republicans in Congress have refused to provide further funding requested by the Biden Administration to keep battling the pandemic. This has left the president and his aides to juggle money and, for now, to switch support from testing and other preventive steps to not only keep vaccinating reluctant members of the public but also to fund newer vaccines, such as those targeting the Omicron variants.
The coronavirus has killed more than 1 million Americans and infected more than 87 million of us. Those numbers are likely understated, especially as more people have access to and use home tests but do not report infections. As confirmed cases have continued to rise slowly, deaths have stayed at 300-plus on average daily — a tragic and still to high number. Hospitalizations also are climbing slowly, averaging more than 30,000 daily.
Problems with a pox
For doctors and public health officials, the imperative to quell outbreaks of infectious diseases can clash with the contemporary ethos to minimize the intrusion on or stigmatization of patients’ personal lives, especially their private sexual practices. This approach is getting yet another stern test with spikes of cases of monkeypox and meningitis — two infections whose spread has been tied to intimate contact among men who have same-sex relations.
Monkeypox, which had been mostly diagnosed in Africa, has moved in recent months through Europe and now is being diagnosed across the United States, the New York Times reported:
“As of June 28, there were 306 cases in 27 states and the District of Columbia, up from 156 cases a week earlier. The [federal Centers for Disease Control and Prevention or CDC] has activated its emergency operations center to better monitor and respond to the outbreak, Dr. [Rochelle] Walensky said. The reported numbers are likely to be underestimates, said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. ‘It’s pretty clear to me and I think many others that the epidemic is far larger in magnitude than what our official case counts suggest it is,’ he said.”
As for meningitis, CNN has reported this:
“The CDC said [on June 23] there have been 26 cases and seven deaths from meningococcal disease in Florida during the investigation period. Among those, 24 cases and six deaths were in men who have sex with men. The CDC says the outbreak is ‘primarily among gay, bisexual, and other men who have sex with men, including those living with HIV. Recent data show that about half of the cases associated with this outbreak are among Hispanic men. This outbreak is mostly affecting people who live in Florida but has also affected some people who have traveled to Florida.’”
The broadcast news organization said this of the infection, which can be debilitating and even deadly:
“Meningococcal disease includes meningitis — infections of the lining of the brain and spinal cord — and bloodstream infections. ‘Meningococcal disease can affect anyone and can be deadly,’ the CDC said in its statement. The bacteria are spread through sharing respiratory or throat secretions, such as saliva or spit. It normally takes close or lengthy contact, for example kissing or being close to someone who is coughing, to spread the bacteria. Symptoms include high fever, headache, stiff neck, nausea, or vomiting, or a dark purple rash, the CDC said. While they can first appear as flu like, they typically get worse very quickly. If someone has these symptoms, they should seek medical attention immediately.”
This is what Stat, a science and medical website, has reported about monkeypox as an illness:
“Monkeypox is a milder relative of the smallpox virus, a scourge that was declared eradicated in 1980 by the World Health Organization after a multi-year global campaign. Smallpox remains the only human virus to have been driven out of existence. The virus, which is contracted mainly through contact with infectious lesions, initially causes fever and fatigue. But after a few days, lesions develop. They can spread widely across the body, including on the palms of the hands and soles of the feet. But in this outbreak, many cases report lesions primarily in the anogenital area.”
Doctors have minimal treatment for viral infections, which both monkeypox and meningitis are. They can help patients deal with symptoms and try to avert complications that can add to the severity of the conditions.
Both infections can be prevented by vaccination. Officials are racing to increase supplies of shots, especially a newer vaccine effective against monkeypox. They are walking a careful line to prod those at risk and with potential exposure to get vaccinated — without creating negative narratives that these are “gay” diseases.
The preventive campaign is not without its challenges. It will take a few weeks, CDC officials have said, to ramp up production and availability of the monkeypox vaccine. In the meantime, Americans overall — and especially younger, more sexually active people — are traveling for the summer, with a vengeance and notably for events connected to gay pride festivities.
Photo credit: monkeypox lesion, shown above, from face of bicoastal actor, director, and singer Matt Ford, who has Tweeted and been interviewed by media outlets about his infection and diagnosis with the disease.
Sunshine State and a deadly food-borne illness
The CDC has warned that Florida appears to be the central factor tying in one death and 22 hospitalizations in 10 different states, with all the patients diagnosed with listeria. Federal investigators are blaming the outbreak on ice cream, made by family-owned Big Olaf creamery in Sarasota, Fla. The company sells and distributes its product, which it is now telling retailers to stop selling and discard, only in Florida. As the Miami Herald reported of this disease outbreak there:
“People usually become ill with listeria after eating food that was contaminated by listeria. An estimated 1,600 people get listeria each year, and about 260 die, the CDC said. The actual number of cases in the current outbreak is likely higher, according to the CDC. Recent illnesses may not be reported because it can take up to four weeks to determine if a patient was part of an outbreak. Listeria can cause severe illness as the bacterium Listeria monocytogenes spreads throughout the body, according to the CDC. Newborns, those over the age of 65, the immunocompromised, and pregnant women are at a higher risk for severe illness. Listeria can be transferred over to the fetus, which can cause miscarriage, stillbirth, premature delivery, or a life-threatening infection of the newborn. Symptoms of intestinal illness usually start within 24 hours of eating contaminated food, and usually last one to three days. Mild symptoms mimic food poisoning, like diarrhea and fever. Severe symptoms, which require immediate medical attention, include headaches, stiff neck, confusion, loss of balance, convulsions, and muscle aches, according to the CDC. Those who are pregnant typically experience only fever, fatigue, and muscle aches.”
Patients diagnosed with the illness and their doctors should report cases to federal officials, and pregnant women with the disease should take special care to seek medical care. Doctors typically treat the infection’s symptoms and patients recover. Antibiotics may be administered in severe cases.
Health officials said that consumers can protect themselves against this illness by taking special care with handling foods in which it has been detected, including queso fresco, strawberries, sprouts, melons, and raw milk.
The CDC estimates that each year 48 million people get sick from a foodborne illness, 128,000 are hospitalized, and 3,000 die. The summer, with its heat, humidity, and being a time for so many folks to eat outdoors, is a season for extra caution in the safe, hygienic storing, handling, and cooking foods of all kinds.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by major problems in the U.S. health care system — including medical error, misdiagnoses, as well as over testing and over treatment.
In pre-pandemic times, medical errors claimed the lives of roughly 685 Americans per day — more people than died of respiratory disease, accidents, stroke and Alzheimer’s. That estimate came from a team of researchers led by a professor of surgery at Johns Hopkins. It meant that medical errors ranked as the third leading cause of death in the U.S., behind only heart disease and cancer. (The coronavirus, of course, has risen has a leading killer of Americans.)
Under pandemic duress, wrong determinations about patient conditions, no doubt, occurred, likely with greater frequency. Just to remind of further pre-pandemic research findings in this area: Diagnostic errors affect an estimated 12 million Americans each year and likely cause more harm to patients than all other medical errors combined, studies have found. And misdiagnoses boost health costs through unnecessary tests, malpractice claims, and costs of treating patients who were sicker than diagnosed or didn’t have the diagnosed condition. Experts recently noted in a health care online report that inaccurate diagnoses waste upwards of $100 billion annually in the U.S.
In recent months, as the pandemic has ripped at this country, a terrible tidal wave of anti-science falsehoods has inundated us all. We’ve been barraged with disinformation about the safety and effectiveness of the coronavirus shots and, indeed, all vaccines — including those that have been around for decades and have revolutionized medical care and Americans’ well-being and longevity. Political partisans, in particular, also have espoused an unacceptable nonsense that individual rights trump all, especially with regular folks taking a little responsibility for their own common-sense conduct to ensure the health and good for greater society.
Vaccines are imperfect, but their benefits far outweigh their risks. Talk to your own doctors and others with real medical expertise and experience in a particular area of health care. But if they and public health officials recommend shots (and boosters) — for the coronavirus, monkeypox, or meningitis — and they can inform you appropriately of the risks and rewards, please get immunized. Encourage friends and loved ones to do so, too. If rigorous research also informs common health public health preventive measures, please heed these, too, whether to avoid risky sex to fight monkeypox and meningitis or face covering and distancing to battle the coronavirus.
We’ve got a lot of work to do to safeguard ourselves, our loved ones, and our society against debilitating, deadly, and preventable infections.