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Three forgotten facts about infectious disease in our strange times

“You’re soaking in it”: three forgotten facts on infectious disease in the age of global pandemics that will give you some comfort and understanding.

Why does this one get sick and that one doesn’t?

Nearly every war movie has moment where the hero is running through field and an explosion temporarily blinds the camera. Will the smoke clear and show our hero has been wounded?

Not usually…

It’s the guy to the left or to the right that goes down. After all the hero has been written into the next act! This common movie scene gives us a visual image of the unexpectedness of the way “infection” behaves.

Imagine two workers at the same engineering desk for GM, of roughly the same age, weight, background and health status…And BOOM! An invisible Influenza bomb goes off in the office enveloping both Engineer A and Engineer B.

The smoke clears, the dust settles, and one engineer goes home with a body ache and fever and the other doesn’t.

Let’s say it’s Engineer A that gets sick. How do we explain this using what we commonly really know about bacteria, virus, and the human immune system?

The short answer is that we can’t.  At least not very well.

This was the subject matter of a recent report in the LA Times (1), where a reporter interviewed two infectious disease experts from UCLA and USC, and asked them why some people were so affected by the current virus, and others aren’t at all.

“Is it surprising that the virus would affect people so differently? Do other viruses do that too?”

And the answer:

“It actually is somewhat typical, I would say.”

The infectious disease doctors explain that underlying health conditions and age seem to be the biggest factor for who will get sick more than anything else. But that’s all they can say.

So, what could be going on? Let’s consider the possibilities by mixing in some uncommon facts about infectious disease and human immunity.

Uncommon fact #1: The plumber has saved more lives than the doctor

We might think that access to antibiotics and vaccines are the pinnacle of modern healthcare…But that’s not what public health experts really say.

A centennial review in the journal Pediatrics in 2000 concluded that access to clean water and a modernized sanitation system is what ended infectious disease pandemics in the early 20th century.

The major declines in child mortality that occurred in the first third of the 20th century have been attributable to a combination of improved socioeconomic conditions in this country and the public health strategies to protect the health of Americans. These public health measures included the establishment of local health departments in nearly all of the states. State and local health departments implemented these public health measures including water treatment,food safety, organized solid waste disposal, and public education about hygienic practices. These improvements in water and food safety and purity are linked to the major decline in diarrheal diseases seen in the early years of the century. Similarly, improvements in housing and decreased crowding in US cities are linked to the reductions in mortality from tuberculosis and other diseases attributable to person-to-person airborne transmission.(2)

Not to be too blunt: it all comes down to being able to wash your hands with soap several times per day, and not pooping or throwing out garbage near your own drinking water.

Sometimes we forget that indoor plumbing (including a shower and toilet) was a novelty barely 100 years ago, and that water purification didn’t become modernized in many, many places until the early to mid-20th century.

Doctors didn’t start washing their hands in between sticking their hands in dead patients and delivering babies until the late 1800s!

Perhaps that’s why it’s been over 100 years since a major flu outbreak (Spanish Flu) slowly crossed the globe and resulted in widespread death in our country.

Baby Boomers and generations above will remember childhood illness passing through communities. But many of these diseases (measles, mumps, polio) were already in decline (from the above hygiene measures) when antibiotics and vaccines were widely adopted.

(Older Gen Xers were the first generation who’s childhood included multiple rounds of antibiotics when Amoxicillin was introduced and became a popular prescription.)

And there were isolated outbreaks of some infectious disease in Europe after that, but that was usually during war time conditions when access to food, clean water, and good hygiene were really challenged.

Personal and community hygiene matters more than anything else because it limits viral and bacterial load of foreign/novel pathogens.

So, perhaps Engineer A and Engineer B just had slightly different hygiene practices that day that resulted in illness for Engineer A.

Uncommon fact #2: You’re already infected?

There’s a Palmolive commercial in the early 1980s where a nail salon owner soaks her clients’ hands in Palmolive Soap.

“You’re soaking in it” (referring to the Palmolive) she says  when they want to know what’s made their hands so soft. “You’re soaking in it” is a great phrase when we think about bacteria and viruses.

While we like to think that bacteria and viruses are just around when we’re feeling ill, the fact is, is that every square millimeter of our bodies are harboring all kinds of creatures, including our digestive tracts.

We are already infected. They are already all over us. And they are part of our own personal ecosystem.

When we shake hands, we exchange not just pleasantries, but ecosystems of viruses and bacteria, and 99% of the time this doesn’t create a noticeable disruption because we’re already infected or have been infected by what’s around us.

They’re just not new to us, so we’re used to them.

Single cell bacteria are the basic life form and we wouldn’t be around without the symbiotic relationship between more complex organisms (like animals and us) and more basic organisms like mold, fungi, viruses, and bacteria.

Traveler’s diarrhea is a real problem, not just because hygiene practices of people touching our food may be different than us, but because we’re encountering a new ecosystem of foreign critters that our body must respond to catalog and respond to with an immune response.

And this response is normal and expected.

Like the earth’s ecosystem is a balancing act, so is our own ecosystem.

Engineer A may have gotten Influenza symptoms that kept A at home. But that may only be because Engineer B was already exposed at some point in the past, and B’s body had already cataloged a response, maybe without Engineer B realizing it.

Uncommon fact #3 the immune system is like a muscle

On a trip to the California coast in 2008, I got a kick out of seeing the bodybuilders on Venice Beach. Huge bronzed bodies in tiny shorts were not something you usually see on our coasts here in Michigan.

When your immune system is healthy, ready, and primed for an effective response, exposing it to a novel bacteria or virus is like throwing a 60lb dumbbell to a Venice Beach body builder…

No problem. If it’s a properly coordinated response, you may not even notice it!

When your immune system is tired, distracted, and slow, that novel bacteria or virus is like a tossing that 60lb dumbbell to a former football player turned flabby couch potato.

He can do it, but he’s going to hurt for a while.

The immune system is like a muscle, and at different parts of our lives it flexes and responds to challenges at different capacity.

A lot of things can sap our muscle and immune “strength”: poor nutrition, lack of sleep, stress, depression, a poorly coordinated nervous system, and exposure to too high of a load of foreign bacteria and viruses (poor hygiene).

Other things can increase our muscle and immune strength: proper nutrition, adequate sleep, a positive outlook, a properly coordinated nervous system, and exposure to a tolerable load of foreign bacteria and viruses (good hygiene).

I remember reading our infectious disease textbook in chiropractic school and feeling my jaw drop when I read that most experience illness as a result of their own bacteria getting out of control.

Their own bacteria.

That’s right: most serious infections that most of us may face will not come from something like the current virus, but because stuff already living on us has an opportunity to get out of control because our immune system is weakened.

Clostridium difficile is a bacterium that’s in most peoples’ digestive tract, but it only really becomes a widespread problem in infant nurseries and nursing homes, where immune systems are immature or failing.

Likewise, it’s not usually the novel flu that ends in a life-threatening situation, but the pneumonia that comes after when local bacteria or viruses take advantage of the fact that the immune system is stressed!

Engineer A might have come down with the Influenza symptoms because A’s immune system was under more long term stress, despite having a similar health status as engineer B.

So what’s the takeaway from these facts?

Here are my own personal conclusions. These aren’t guidance for public policy or prescriptions for your behavior, but rather what makes sense to me given the information I have available.

  • At a time when most industrialized countries have access to clean, running water and a working sanitation system, we’re not going to see another Bubonic Plague scale pandemic. Novel viruses and bacteria will spread faster than eras past due to air travel, but modern hygiene will blunt the effect of disease because it lowers viral and bacterial load, and most consequences will be experienced by the immune compromised only. (If this wasn’t the case, we would have seen major outbreaks of pandemics as soon as international air travel became common)
  • We should do what we can to encourage a positive, well coordinated immune response, while limiting our exposure to foreign/bacterial loads, but within reason. There is a fine line between preventative and respectful and acting in an obsessive way.
  • We should have a nuanced (healthy) view of the germ theory of disease. We can acknowledge that new viruses and bacteria can bring out symptoms of illness (from a stimulated immune response), while realizing that we’re literally covered with them at every moment of our lives.

Therefore health under threat of infection is about strengthening the host (our own system) instead of attempting to erase the virus completely, as that gives us personal power to act on our own behalf, instead of waiting on others to solve a problem for us.

(1) Netburn, B. Coronavirus Kills some people and hardly affects others: how is that possible? LA Times April 4, 2020. https://www.latimes.com/science/story/2020-04-04/why-coronavirus-kills-some-people-and-not-others

(2) Guyer B, Freedman MA, Strobino DM, Sondik EJ. Annual Summary of Vital Statistics: Trends in the Health of Americans in the 20th Century. Pediatrics 2000;106;1307-1317.

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