September 1992 (vol. 8, #6)
1601 N Tucson Blvd #9, Tucson AZ 85716 c 1992
Physicians for Civil Defense
As a consequence of change in public mores, there is an epidemic of disease that produces no solid natural immunity, has no vaccine, and mutates rapidly. The disease already causes about 3.5 million casualties annually, worldwide, especially among children in Africa.
This description might fit AIDS,
although the mortality of AIDS is not yet so high (cumulative
deaths have reached 1.5 million). But this disease is malaria
one of the age-old infectious diseases now making a comeback largely
eclipsed by the publicity about AIDS. The resurgence is not caused
by the fantasized destruction of the ozone layer or a still more
fanciful ``AIDS-like immune deficiency'' in the Planet. Many
microbes are outwitting our antibiotics. More importantly, standard
public health measures are breaking down or being actively thwarted,
often in the name of a new Planetary morality.
Swamp-Borne Diseases
In a burst of optimism due to the remarkable effectiveness of DDT and chloroquine, malaria was once targeted for extinction. However, the US has banned or restricted DDT and substitute pesticides and outlawed or heavily regulated the drainage of swamps (``wetlands''). Chloroquine-resistant falciparum malaria is found throughout the world, except in the Dominican Republic, Haiti, Central America west of the Panama Canal, the Middle East, and Egypt. Resistance to the newer drug Fansidar is also reported from Thailand, Burma, Cambodia, the Amazon basin, and sub-Saharan Africa, and strains resistant to everything except quinine have been isolated in Cambodia. According to an AP report, 385 UN personnel contracted malaria in Cambodia last month. Returning home, they could spread resistant organisms throughout the world.
The scientific establishment is pinning its hopes on a malaria vaccine. A ``safe and effective'' synthetic vaccine has been announced (Infectious Disease News, Sept. 1992). A field trial in 15,000 subjects showed safety and antibody formation however, no data whatsoever were presented on the incidence of malaria (J Infect Dis 1992;166:139-44). As demonstrated by AIDS and various parasitic diseases, especially kala-azar, high titers of antibodies are not necessarily protective. Previous enthusiastic reports about malaria vaccines have been fraudulent (Robert Desowitz, The Malaria Capers, Norton, 1991). Perhaps the inherent difficulties have at last been overcome, but this remains to be proved.
Migratory birds resting in protected wetlands harbor mosquito-borne viral diseases, especially Western equine and St. Louis encephalitis. Chickens serve as ``sentinels'' for these diseases, and seroconversions have been occurring all over Southern California. WEE has also been isolated from mosquitoes in Arizona. Human outbreaks of the disease in Bakersfield were at first misdiagnosed as aseptic meningitis, which causes similar clinical findings but is spread by fecal-oral contact or droplets, not by mosquitoes.
Swamps in the southeastern US coastal plain are a major source of atypical Mycobacteria, which cause about 2000 human infections annually. A substantial fraction of AIDS patients have disseminated mycobacterial infections (Am Rev Respir Dis 1992;145:271-275).
Instead of draining swamps as
a public health measure, Planetary morality dictates ``wetlands''
protection and restoration, even at the expense of taking private
property or incurring public debt. The cost of the 850-acre Bolsa
Chica Wetlands Project in Orange County is estimated to be $102
million, including $29.7 million to buy out an oil reserve, $43.3
million to bring in fresh water, and $15.7 million for cutting
a new access to the sea (LA Times 8/16/92).
Water-Borne Disease
The cholera epidemic that began in Peru in 1991 continues unabated. More than 600,000 cases and 5,000 deaths have been reported from 20 countries, including 15 cases indigenous to the US (MMWR 9/11/92).
Many less serious illnesses are probably carried in water despite modern treatment standards. Coliform bacteria are monitored; viruses are not. In Montreal, persons drinking unfiltered tap water had a 30% higher incidence of gastroenteritis compared with those who used an $800 under-the-sink, reverse osmosis filter.
One obvious answer is to add more disinfectants such as chlorine. However, the EPA won't permit higher chlorine concentrations because chlorine reacts with organic matter in the water to form tiny concentrations of potential carcinogens. The EPA spends about $775,000 for research on protozoans, bacteria, and viruses and $20 million on chemicals.
``We may be spending millions...going after mice and letting the elephants get through,'' commented Betty Olson of the University of California Irvine (Sacramento Bee 8/16/92).
It is rumored that chlorine
disinfectants may be the next target of the Natural Resources
Defense Council.
Air-Borne Disease
The ``captain of all these men of death'' tuberculosis is literally stalking the streets again. About 33% of the world's population harbors Mycobacterium tuberculosis, and each year 2.9 million succumb to it. A steady decline in TB in the US was reversed in 1985, and 26,283 new cases were reported in 1991, an increase of 18%. The increase is not confined to groups at high risk for AIDS; TB cases in US-born children under the age of five increased by 34% from 1987 to 1990. The majority of patients with TB have acquired the infection from nonintimate contacts. It is spread by droplet infection, and there is no ``threshold.'' Animal studies have shown that one organism can cause infection; you can catch it on the bus.
There is an additional ominous note: the emergence of drug-resistant strains. One-third of all cases surveyed in New York City in 1991 were resistant to one or more drugs, and resistance has been reported from at least 36 states. The case fatality rate for multi-drug resistant TB is 40 to 60%, the same as for untreated disease.
The reemergence of TB follows decades of neglect of control measures. By 1989, only a single professional remained in the Tuber-culosis Unit of the World Health Organization. In the US, a generation of expertise has been lost. NIH funding for TB research dwindled in the 1970s. Special funding for HIV and TB demonstration projects-especially important because of the high incidence of resistant TB in HIV-seroposi-tive patients-totals $10.8 million. (For comparison, the EPA has a staff of 18,000 and a budget of $4,500 million.)
The most important reason for the surge in drug resis-tance is inadequate treatment. Multiple drugs must be given in proper dosage for many months. In New York between 1982 and 1984, 9.9% of bacteria from untreated patients were resistant, in contrast to 52% from patients who had been treated and relapsed. Nationwide, about 18% of patients fail to complete their treatment; in Washington, DC, Chicago, and New York, more than 40% of patients are noncompliant. Lack of funding and legal constraints against quarantine prevent adequate public health follow-up.
Patients with active, sputum-positive TB need to be isolated in negative-pressure facilities. Ultraviolet radiation is effective for decon-taminating droplets in the air but is not a CDC requirement. Standard surgical masks ap-proach zero effectiveness; infected droplets pass right through, especially after the mask has been worn for about 10 to 15 minutes. Respirators are needed but may not be tolerated by persons with chronic obstructive lung disease or asthma. BCG vaccine has been recommended for medical personnel, but its reported effective-ness ranges from 0% to 77%, and it destroys the usefulness of the PPD skin test. (REF: Science 1992;257:1055-1064).
Other Resistant Infections
Antibiotic resistance of common organisms has reached crisis proportions. To give just a few examples: In Mediter-ranean countries, the majority of isolates of Pneumo-coc-cus are resistant to penicillin, and many are also resistant to eryth-romycin, trimethoprim/sulfamethoxazole, and chloram-phenicol. In New York City, 42% of cases of gonorrhea are resistant to penicillin. Virtually all strains of Staphylococcus aureus were sensitive to penicillin in 1941, but 95% are resistant today. Worse, some strains of this organism have become resistant to virtually all substitutes, including vancomycin. Its resistance to the new drug ciprofloxacin increased from less than 5% to greater than 80% within one year (Science 1992;257:1050-1055 and 1064-1073).
Overuse of antibiotics and undertreatment (too little drug for too short a time) contribute to the development of resis-tance. But social factors and poor hygiene are crucial in the spread of the organisms. Outbreaks of resistant disease are much more common in institutional settings: day-care centers, nursing homes, hospitals (especially intensive care units), and homeless shelters. They can often be traced to a single source and poor handwashing or other hygienic practices.
The development of new antibiotics and vaccines is important. But more than 50 penicillins, 70 cephalosporins, 12 tetracyclines, 8 aminoglyco-sides, and at least five other classes of antibiotics have been no match for the mic-robes-and no substitute for isolation, quarantine, disinfectants, monoga-my, cleanliness, and pest control.
According to Intelligence Digest (17 Rodney Road, Chelten-ham, Glos, GL50 1HX, United Kingdom), China has become too powerful for the West to quarantine. A special report (9/2/92) outlines China's nuclear capabilities, which the West has consistently underestimated.
China currently possesses nearly 20,000 kg of U-235, enough for 1,133 Hiroshima-type explosions. It is likely to have enough Pu-239 for 2,533 Hiroshima-type bombs. Al-though this is 10 times previous Western estimates, it may understate China's capability by half.
At least two factories are manufacturing thermonuclear warheads (Qinghai Huangyuan and Qinghai Haiyan). China's strategic nuclear arsenal has 1,000 warheads and will increase to 1,200 within the next few years.
The Dongfeng-5 missile, put into service in 1981, can deliver more than 5 megatons in thermonuclear warheads and can carry up to 10 MIRVs. With a range of 15,000 km, the
Dongfeng-5 can reach any country in the world.
By the end of 1991, China had a total of 840 intermediate- and long-range missile carriers.
China has five submarines capable of launching ballistic missile, four of them nuclear-powered. More are being built.
Although China's air force is underdeveloped compared with that of the US, production of high-performance fighters and long-range supersonic bombers is being speeded up. The Hong-6 can probably carry four to six cruise missiles.
In addition to extending its own strategic and tactical nuclear capabilities, China has a ``third arm'' to its nuclear strategy-the dissemination of nuclear technology to potential enemies of its opponents.
Because of its extremely capable civil defense system, China is not susceptible to Assured Destruction.
The achievement and maintenance of superpower status also rests on economic strength, and China's economic reforms are for real (Intelligence Digest 9/9/92). In the first 6 months of 1992, China's GNP grew at 10%, and industry at 18.2%.
In contrast, the US economy is hardly growing at all (Intelligence Digest 15 July). In the four Bush years, ``the economy seems likely to crawl upward'' by 4.5% (Forbes 7/6/92). One of many reasons is the $1.4 trillion consumed in meeting EPA require-ments in its first 20 years.