The word "Read" written in black paint on a colorful watercolor washed background.

Pandemic- a book review

Pandemic by Sonia Shah

a review

 

Genre-non-fiction, science, medical, history, politics, geography, sociology, international relations

 

Sonia Shah is a science journalist, not a scientist or physician, who has built a career  writing about medical science. She explains the “what”  of her book in the subtitle-

 

Tracking contagions from cholera, to Ebola, and beyond

 

And she answers the “why” in the introduction-

 

“By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.”

 

Pandemic by Sonia Shah

 

 

 

Let me back up and define some terms.

 

Pathogen– any disease producing agent, but especially referring to a living  microscopic organism, such as a virus, bacteria, or  parasite; this includes the organisms that cause Lyme disease, Ebola, West Nile, HIV, bird flu, even the common cold

 

Pandemic– a disease outbreak that spreads throughout a country, continent, or the world, as opposed to an epidemic, which is localized.

 

map of the world

In a pandemic, an infectious disease may spread all around the world.

 

 

 

With current focus on chronic diseases like heart disease, diabetes, cancer, and dementia, even I as a physician can get lulled into thinking that infectious disease has been conquered and no long a serious medical threat. This book reminded me that is not the case.

 

Ms. Shah recounts the history of cholera, which has caused epidemics on every continent except Antarctica, focussing on the epidemics which devastated London, New York City, and more recently Haiti.

 

Cholera is little known in the United States now, but in the past it has been deadly both here and throughout the world. Cholera, an infection due to a bacteria Vibrio cholerae causes severe uncontrollable diarrhea which quickly renders its victims helpless, dehydrated and critically ill. The bacteria lives in and is spread by contaminated water, but for many years physicians did not know this; and even when some doctors proposed this as the method of spread, others refused to believe it. Thus the opportunity to control it and prevent thousands of deaths was delayed .

bacteria under the microscope

photo of the Vibrio cholera bacteria under a microscope; used courtesy of CDC/ Dr. William A. Clark

 

 
The author explains how cholera and other infectious diseases cause so much human suffering by detailing “How disease spreads” in these  chapter titles

 

Locomotion– Humans and pathogens travelling from place to place spreads disease.

Filth-Waste management and in some cases mis-management, leads to contamination of drinking water by human waste.

Crowds-People living in crowded slums creates perfect conditions to spread disease person to person.

Corruption– Public officials and business people who place profit and power above public health.

Blame No one willing to take responsibility for making hard choices, and too willing to blame someone else.

 

Ms. Shah uses examples from her personal life, like her annual family trips to India to visit relatives who lived in less than clean and sanitary neighborhoods. She also shares her and her sons’ battle with skin infections due to  MRSA, a form of staph (staphylococcal) that is resistant to many antibiotics and can be difficult to eradicate.

 

Pandemic includes extensive footnotes and a glossary of terms used in the book.

 

If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.

 

Here are other resources that address  the risk of global spread of infections.

 

For a visual lesson on how pandemics occur, watch this video.Warning: it is rather graphic. 

 

“How Pandemics Spread”

created by Mark Honigsbaum (http://www.markhonigsbaum.co.uk) and animated by Patrick Blower (http://www.patrickblower.com)

 

When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed

by Howard Markel

“Medical historian and pediatrician Howard Markel, author of Quarantine! tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.”  (quote from Goodreads)

 

In this article from the New York Times, Gina Kolata reports  how scientists use genetics to discover and track bacteria and viruses .

 

The New Generation of Microbe Hunters

 

In this  TED talk Dr. Larry Brilliant explains how new pandemics may be prevented.

 

 

 

 

Weekend Words- The Lord’s Prayer

give us this day our daily bread

Matthew 6:9-13, NIV 

This, then, is how you should pray:

“‘Our Father in heaven,
hallowed be your name,
10 your kingdom come,
your will be done,
    on earth as it is in heaven.
11 Give us today our daily bread.
12 And forgive us our debts,
    as we also have forgiven our debtors.
13 And lead us not into temptation,[a]
    but deliver us from the evil one.[b

Weekend words is a regular feature of watercress words. At the end of the work week we pause exploring strictly medical topics to consider words of faith, hope and love from the Bible and other carefully selected writings.

6 things you need to know to get through the flu season

This week autumn begins in the northern hemisphere. Where I live, fall brings brilliant orange,yellow and red to our trees and shrubs,  the start of the school term and football season. Unfortunately,  fall also brings the cold and flu season.

 

This is usually the busiest time of the year in physician offices, urgent care clinics, emergency rooms and hospitals. This information may make this season easier for you and for your doctor.

 

 

1. If you think you have the “flu”, you probably don’t. 

To many people “the flu” is any respiratory illness characterized by  fever, cough, congestion, fatigue and aches. That term has become so nonspecific even we doctors use it that way. But flu refers to influenza,  one of many viruses that cause illness. The other viral illnesses  are “colds”, upper respiratory infections, aka URIs, bronchitis, pharyngitis, sinusitis and pneumonia.

The human respiratory system

The respiratory tract including the nose, sinuses, mouth, throat, trachea, bronchi in blue and the lungs (pink). Infections can involve the breathing organs from the nose all the way down to the lungs. (photo complimentary from Pixabay)

  1. If your doctor thinks you have “the flu”, you probably do.

Prior to the  “rapid flu” test, we doctors diagnosed influenza by the characteristic symptoms,  exam, and knowing there was an outbreak in the community. The test is helpful for confirmation and patients have come to expect it now.

 

3. The best way to prevent influenza is by vaccination.

The World Health Organization (WHO), Centers for Disease Control and Prevention(CDC) , the National Foundation for Infectious Disease and  other reputable medical organizations recommend vaccination against influenza.

 

People refuse vaccination because they believe it is ineffective, unnecessary, dangerous, toxic, unnatural, subversive, and who knows what else.  I don’t think I or anyone else are going to change their minds.

My family and I always get vaccinations which have successfully protected us without side effects or adverse reactions. There are risks, just like there are with any medical procedure, or lots of other things we do in life. In this case we have decided the benefit outweighs the risk.

If you don’t want a “flu shot”, just say no. Your doctor doesn’t need or want to hear a speech; we’ve already heard them all.

  1. If you want to avoid getting influenza, avoid being around people who may be infected.

This means everyone, since one may be contagious 2 to 3 days before symptoms. It’s not a coincidence that influenza outbreaks coincide with the American holiday season (approximately November through January). So to protect us all,

  • Stay home if you are sick, and ask your family, co-workers and employees to do the same.
  • Cover your nose and mouth when coughing or sneezing
  • Wash your hands frequently.
  • Wash frequently touched surfaces frequently.
Hand hygiene saves lives.

a common sight now in public restrooms

  1. If you do get sick, don’t ask your doctor for an antibiotic.It will not help. 

    Antibiotics attack bacteria. Influenza and 99% of all respiratory illnesses are due to viruses.

There are 2 antiviral drugs that will “shorten the duration and severity of symptoms” by 1-2 days, if started early. The effectiveness is uncertain for an illness that will resolve within 10-14 days regardless. But if it gets you back to school or work a day earlier, it may be worth the cost-they are not cheap drugs.

Otherwise, the treatment is“symptomatic” or “supportive” care:

  • Rest; eat and drink as normally as possible; extra fluids if running a fever 
  • Non-prescription cough/congestion /pain/fever meds

Here are  general guidelines  on what to do if you get a respiratory illness.

  1. You can die from influenza, but you probably won’t.

I cringed last year when a friend wrote on her social media page, “My doctor said, ‘No one dies of the flu’.” And, technically, that is true. People die from complications of influenza, and infants, young children and the elderly have greatest risk.The most common fatal complication is bacterial pneumonia, infection in the lung. Influenza can also attack the nervous system causing brain inflammation (encephalitis and/or meningitis) and paralysis in the form of Guillain Barre syndrome .

an xray of healthy lungs with no signs of pneumonia.

Healthy lungs with no signs of pneumonia.

Persons with chronic illnesses like diabetes, lung disorders, depressed immune systems and cancer are at greater risk of complications and should always consult a physician if feeling ill. If you are not sure if you fall into that category, ask your doctor.

Influenza is a disease to take seriously; consider my suggestions, talk to your doctor, and stay healthy this season.

Here are some other posts about winter illness you may find helpful.

 

Get Smart About Antibiotics

6 smart facts about antibiotics

Sorting out sinusitis

 

Weekend Words from Amy Carmichael

 

 

you cannot love without giving. Amy Carmichael

 

Amy Carmichael (1867-1951) was an Irish woman who moved to India to serve God.

Her work there involved rescuing young girls  forced into prostitution, even though doing so put her  at risk of arrest and imprisonment. She established an orphanage for them.

Her health declined in her later years, and she became essentially bedridden; but she continued to direct the mission she founded and wrote prolifically.

 

 

(This is an affiliate link, this blog will earn a commission if used for a purchase. Thank you. )

 

 

 

Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.

Working Stiff -a book review to remember 9/11

Working Stiff: Two Years, 262 Bodies,

and The Making of a Medical Examiner,

by Judy Melinek, M.D.and T.J. Mitchell

 

 

 

Working Stiff, a book

Genre and topics- non-fiction, memoir, history, medical, marriage, parenting, physicians, New York City, September 11, 2001

 

The author, Judy Melinek, M.D., wrote this  account of her training as a forensic pathologist, a physician specialist who investigates sudden, unexpected or violent deaths. Her husband, T.J. Mitchell co-authored.

When she applied for a position in New York City at the NYC Office of the Chief Medical Examiner (OCME), she never imagined that decision would plunge her into the nightmare of September 11, 2001. She was at the ME office that day when the Twin Towers were attacked and fell, killing thousands of people.

The main job of a medical examiner is to investigate death by examining a corpse- an autopsy. They look for evidence of cause of death, was it due to disease or trauma, and time of death, was it recent or remote. They hunt for signs that the death was self or other inflicted. Sometimes they may even need to establish the identity of the corpse.

Such was the case after Septembers 11. She and the other staff collaborated with the team of investigators who worked night and day identifying remains of the victims, a task she vividly describes in the book. This was basically their only job, since the cause of death was for the most part irrelevant, and impossible to determine. Sometimes they had only a small body part, as little as a finger, to extract DNA to identity a victim. Such identification was critical to bring closure to the families who lost loved ones, people who left for work that day, and never came home.

Dr. Melinek describes not only the science of what she was doing, but also the emotion behind it; how she and the other medical examiners and staff felt about their work. She describes how it affected her relationship with her husband and young son, the problem of explaining to him what she was seeing and experiencing on a daily basis. She didn’t have the heart to tell him how many trailers full of partial bodies there were, after he saw just one and was shocked.

 

 

She also discusses other cases she worked on.  As a forensic pathologist, Dr. Melinek  understands why and how people die, and therefore also knows how people can avoid dying unexpectedly. Pathologists tend to be blunt, straightforward and to the point, as when she writes,

“So don’t jaywalk.

Wear your seat belt when you drive.

Better yet, stay out of your car and get some exercise.

Watch your weight.

If you’re a smoker, stop right now. If your aren’t, don’t start.

Guns put holes in people. Drugs are bad.

You know that yellow line on the subway platform? It’s there for a reason.

Staying alive, as it turns out, is mostly common sense.” 

 

 

Working Stiff moves at a quick pace, in a conversational style. When she uses medical jargon, she explains it in simple terms. She describes the cases she investigated in detail so those with weak stomachs (no pun) may want to skip this read.

Having experienced her father’s unexpected death when she was 13 years old, she was no stranger to it, and she learned more from the 262 autopsies she did during her training. As she says in this engaging memoir,

To confront death every day, to see it for yourself, you have to love the living.” 

 

Here is a link to Dr. Melinek’s blog

Forensic Pathology Forum 

 

Statue of Liberty

Lady Liberty lifting her torch in New York harbor

Links to other  literature about the medical consequences of the terrorist attacks of 9/11/2001

City of Dust: Illness, Arrogance, and 9/11

by Anthony DePalma

 

“In City of Dust, Anthony DePalma offers the first full accounting of one of the gravest environmental catastrophes in United States history. The destruction on 9/11 of two of the world’s largest buildings unleashed a vortex of dust and ash that blotted out the sun and has distorted science, medicine and public policy ever since. The likely dangers of 9/11’s massive dust cloud were evident from the beginning, yet thousands chose not to see. Why? As the sickening results of exposure became evident, many still refused to recognize them. Why? The consequences are still being tallied in the wasted bodies and disrupted lives of thousands who gave their all when the need was greatest, but whose demands for justice have been consumed by years of politics and courtroom maneuvers. Why?, separating reality from myth – and doing so with exceptional literary style and grace. DePalma covered Ground Zero for The New York Times for four years. DePalma introduces heroic firefighters, dedicated doctors and scientists, obsessive city officials, partisan politicians, aggressive lawyers, and compassionate judges and reveals the individual decisions that destroyed public trust, and the desperate attempts made to rebuild it. The dust that was the World Trade Center has changed everything it touched. This is the story of that dust, the 9/11 disaster after the disaster, and what it tells us about ourselves and our future.”

(Amazon review)

 

mounted police officer

a New York City police officer and his horse represent the city proudly

 

 

 

 

 

Project Rebirth: Survival and the Strength of the Human Spirit from 9/11 Survivors

by Dr. Robin Stern and Courtney E. Martin

 

“Written in conjunction with the documentary Rebirth, a full decade in the making, an uplifting look at the lives of nine individuals whose lives were forever changed by the largest tragedy our nation has ever faced.

 

In Project Rebirth, a psychologist and a journalist examine the lives of nine people who were directly affected by the events of September 11, 2001. Written concurrently with the filming of a forthcoming documentary, it is uniquely positioned to tackle the questions raised about how people react in the face of crippling grief, how you maintain hope for a future when your life as you knew it is destroyed, and the amazing ability of humans to focus on the positive aspects of day-to-day living in the face of tragedy.”

(Amazon review)

 

NYFD engine

honoring the brave NYFD firefighters who rescued survivors and those who lost their lives doing so

 

 

 

 

At Morgue, Ceaselessly Sifting 9/11 Traces

 

“Outside the chalk-white tent, the whistle of traffic along the Franklin D. Roosevelt Drive signals the forward movement of a city. But inside, 16 refrigerated trailers hum in a ceaseless chorus, giving voice to the dead whose remains are contained in their hold.

The trailers hummed as time separated the city from the 11th of September: as the smoking mountain of what had been the World Trade Center became a yawning hole; as 1.6 million tons of debris were sifted through on a Staten Island landfill; as commemorative services caused heads to bow. They hummed and they continue to hum, a mantra-like reminder that talk of closure is premature.”

(excerpt from newspaper article)

 

Public health and medical disaster responses: The untold story of 9/11

By Kelly B. Close, MD

former National Coordinator of Disaster Volunteers for the American Red Cross

“You never know when your life is going to change.

My red business suit was almost buttoned, and I was rehearsing my presentation for the Milford, Connecticut Red Cross board of directors, even though my mind kept wandering to my wedding just nine days earlier in Walt Disney World. An urgent call from my new husband to come to the television interrupted my wedding day dreams. As soon as I saw the images of the first plane hitting the World Trade Center, I knew that my plans for the day – maybe even my life – had changed.”

(excerpt from article at ems1.com)

 

 

Triumph Over Terror

by Bob Ossler with Janice Hall Heck

“What do Ossler’s insights reveal about finding meaning and purpose in the thick of chaos and personal tragedy? Chaplain Ossler chronicles the best of humanity—acts of courage and goodness in the midst of unimaginable devastation. As terrorist attacks continue to assault humanity, “Triumph Over Terror” reveals how your spirit can triumph over terror’s reign, and how you can help others suffering from trauma and loss.”

(Amazon review)

 

(This blog post contains several affiliate links, a commission is paid if used to make purchase. Thank you.)

One World Trade Center

One World Trade Center, photo taken 8/16/2013

 

Weekend Words to remember 9/11

 

 

Blessed are those who mourn, for they will be comforted. Matthew 5:4

 

Church of Our Lady of the Rosary
Shrine of St. Elizabeth Ann Seton

Manhatten, New York

 

Through the efforts of Charlotte Grace O’Brien, it was originally established as a mission for female Irish immigrants coming to America during the late 19th century.

 

In 2015, the Parish of the Our Lady of the Rosary was merged back into St Peter’s Parish to form St Peter -Our Lady of Our Rosary Parish.

 

(I took this photo in August 2013, the only time I have ever visited New York City)

 

Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.

How To Letterpress

How to cope with winter illness

 

School has started and fall has arrived, which means the start of  the cold and flu season- that time of the year when we see widespread respiratory illness. By this, I means illnesses which cause some combination of

Sneezing, coughing, stuffy nose, sore throat, fever, body aches and headache.

We call these by various names but they have much in common, including symptoms and treatment. Let’s talk about what you can do to cope when they hit your family.

diagram of the nose and sinuses

Winter illnesses commonly affect the nose, throat, sinuses, ears and lungs.

Don’t panic.

Most otherwise healthy people recover from common respiratory illnesses. You may be miserable for several days, and need several weeks to feel back to normal, but you won’t suffer any permanent harm.

Fever ,especially in children, alarms parents. Don’t ignore it but don’t panic either. Reading this post should help you keep calm about fever .

 

Some  people are at risk of developing  severe symptoms and serious complications, so seek medical help sooner, rather than later. These include

 

Infants, especially under one month old

Elderly,  now a relative term, advanced age, especially combined with chronic disease

Those with chronic lung disease, like asthma, COPD, emphysema, cystic fibrosis

People on drugs that suppress the immune system

Other chronic diseases – diabetes, liver disease, kidney disease, heart disease, cancer 

If you are not sure if you fit into one of these categories, ask your doctor.

 

Check here for tips on

the difference between a cold (acute rhino-sinusitis) and flu (influenza)

 

 

rhinoceros

“Rhino” obviously means NOSE. 

 

 

 

 

What you need to know about influenza. 

 

Stay home.

This is when you shouldn’t share- germs that is. These illnesses spread person to person, so minimize contact.

Keep your kids home from school and stay home from work, at least the first few days, when you are  the most contagious. When  there is widespread illness in your community, avoid crowds and public gatherings.

Resting, getting extra sleep, drinking fluids and staying warm and dry  make staying at home therapeutic.

 

Wash hands.

Speaking of person to person contact, the best way to avoid getting or giving germs is to wash your hands often, but especially after being with others ,using a restroom,  and before cooking or eating. Cleaning household surfaces helps too, as well as clothing and linens.

Hand hygiene saves lives.

a common sight now in public restrooms

Use medication wisely.

Some of these illnesses have a specific medication that clear it faster- strep throat, influenza, pneumonia. The others will “run their course” and meds are used to help relieve symptoms.

Many people assume that any illness with fever, sore throat and cough will improve with an antibiotic. The fact is, most will not. Antibiotics only treat infections caused by bacteria, and most of these are caused by viruses. To learn more read about

How to navigate the antibiotic highway 

 

These illnesses cause the greatest overuse of antibiotics, contribute to the cost of health care, and the development of antibiotic resistance. Please do not insist on an antibiotic if the doctor says you don’t need it; if offered an antibiotic, ask why.

 

Does nasal drainage and congestion need treatment with an antibiotic? Maybe not. Learn how to sort out sinusitis.

WebMD offers this advice on choosing non-prescription cold remedies

Be patient

 

The “24 hour virus” is for the most part a myth. Expect to be ill anywhere from 3 to 10 days; some symptoms, especially cough, can linger for weeks.

 

But if after 3-5 days you are getting progressively worse, instead of better, something more may be going on, so it’s wise to seek professional medical help.

Weekend Words from Psalms

Psalm 108:4 quote on lovingkindness

from the social graphic collection of Lightstock

 

 

Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.

"faith, hope, love"

“noble beyond her years”- the story of Kayla Mueller

 

On February 11, 2015 I wrote the following about a young woman, Kayla Mueller, who had died-

I cannot think of anything else worth saying today other than to express my sadness  for and sympathy to the family of Kayla Mueller. On  the evening news last night I heard Kayla’s aunt describe her as “noble beyond her years.” I had never heard of Kayla until a few days ago, but her story touches my heart. I have a son about the same age; and like her, his work and passions take him all over the world. I cannot imagine getting an email like the one her parents received confirming her death. At only 26 years old, Kayla had already traveled to India, Israel, Palestine and Syria on humanitarian endeavors and in Arizona worked at a women’s shelter and with AIDS patients, In a letter  to her family from captivity, she expressed regret that she was causing them pain. I hope the memory of this beautiful young woman brings some comfort to their grieving hearts.

 

Her complete story is now known, and reported publicly by ABC News.

American hostage Kayla Mueller was tortured, verbally abused, forced into slave labor for ISIS commanders in Syria and raped by the group’s top leader,

but her fellow hostages say she never surrendered hope, she selflessly put the welfare of fellow captives above her own and

she even stood up to executioner “Jihadi John” to defend her Christian faith.”

 

 

Here is a link to video of her and her family , interviews with those who knew her in captivity, and the details of the inhumane way she was treated.

 

the girl left behind– Brian Ross investigates

 

She was amazing. She was a really strong girl,” Chavez said of Mueller.

For Saide, the younger Mueller at 25 years old had a surprisingly positive personality and “a strong faith that gave her a lot of strength.

As a person, she was a very good friend. She was smart. She was fun to be with. She was very kind, extremely generous.”

“She was always considerate of others, even though she herself was in a very difficult situation,” Saide added.

“She was always concerned for other prisoners. She never stopped being concerned for the Syrian population living through just horrible things in this war and still are.

She never stopped caring for others.”

 

"faith, hope, love"

Weekend words from Isaiah and a Southern woman

“The Spirit of the Lord GOD is upon me, because the LORD has anointed me to bring good news to the poor;

he has sent me to bind up the brokenhearted,

to proclaim liberty to the captives,

and the opening of the prison to those who are bound;

to proclaim the year of the LORD’s favor, and the day of vengeance of our God;

to comfort all who mourn;

to grant to those who mourn in Zion— to give them a beautiful headdress instead of ashes, the oil of gladness instead of mourning, the garment of praise instead of a faint spirit;

that they may be called oaks of righteousness, the planting of the LORD, that he may be glorified.

They shall build up the ancient ruins; they shall raise up the former devastations; they shall repair the ruined cities, the devastations of many generations.”

(Isaiah 61:1-4 ESV)

 

 

 

In All the Pretty Things, Edie Rudder Wadsworth explores the “heart of health” by telling

“the story of a Southern girl who went through fire to find her way home.”

Edie is a medical doctor who escaped poverty, a dysfunctional family, physical and emotional abuse only to find that wasn’t enough to cure the pain in her heart. In this memoir, she explains how she searched to find relief and to bring peace, hope and wholeness to  her heart and  her family.

“We have been snatched out of the fire of our brokenness in order to serve and love and bless the dear ones God has placed right in front of our eyes, the ones who need our very meager gifts and offerings the most-

the fatherless, the misfits, the prostitutes, the jailbirds-

and all those whose despair has rendered them hopeless.”

 

(By joining the book launch team, I received a free PDF copy of the book to review )

 

Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.