Polio-like disease

This is a post relevant to something happening now in California. Over a period of eighteen months, we've had an increase in children how are experiencing an acute chronic, focal (isolated or localized, such as to a limb) paralysis. Described as 'Polio-like disease' because of its clinical presentation, we know that this is NOT Polio because all of the afflicted children have been vaccinated, Polio no longer circulates naturally in the US, and no Polio samples have been recovered from any of the kids. The paralysis is, as of yet, of an unknown cause, and has afflicted around twenty children.[2] Two of the children have tested positive for a Picornavirus (same family as Polio) that's been known to be circulating since the 60's- Enterovirus 68. Stanford doctors suggest that they're suspicious for this virus as the causative agent, since three children were known to have respiratory illness before developing paralysis, and EV68 is a respiratory pathogen. Also, two of the children were found to have EV68 in their stool.

Personally, I'm not convinced that EV68 is the culprit here. There've been multiple outbreaks of EV68 as a respiratory pathogen since we've known about it, with no neurological effects reported in any of them.[1] It's true that viruses mutate, but I'm sure that we would've seen neurological effects before now in some of the other outbreaks. We know the EV68 circulates naturally in California, and that the virus must be spreading through a population in order to not go extinct. No epidemiological control measures have been taken to my knowledge. What that means is that the virus should still be circulating. If the virus did mutate to become neurovirulent, we should be seeing a lot more cases of the 'Polio-like disease' very soon. I don't expect that to happen, but we'll see.

What's more is that the sample size is very small- only 20 kids- and the sample size with EV68 is even smaller- only two kids. The evidence is so circumstantial, and I think it would be almost as solid to blame influenza. Not to mention that the CDC is presently investigating, and has not spoken to the EV68 hypothesis at all. I'm not saying that it's not EV68, but I'm saying that we don't need to prematurely jump on a pathogen and end up barking up the wrong tree, especially if this does turn into a pandemic- which the numbers seem to argue against by their slow accumulation. 

Vincent Racaniello, host of This Week in Virology and Virology professor at Columbia University has had extensive experience working with Polio and Picornaviruses. On his blog at Virology.ws he argued that California normally has about 70 cases of 'polio-like disease' per year, and that the present number of cases mentioned in the alleged outbreak don't exceed the normal background caseload. For a much more informative article, his blog is worth your time, check it out. If you're concerned about this illness, watch your kids for any signs of sudden, enduring, limp limb paralysis or weakness and report to your doctor immediately if you see anything. If your kids need the polio vaccine, continue receiving it, since Polio is still out and about in the world. There are no special precautions or actions that should be taken otherwise.

As always, if you want to make a difference, do your own research, share with others what you've learned here, and support those who support funding research, science, and public health agencies. If you like what you've read here, share this on facebook or among your friends. Feel free to leave questions, comments, and concerns here on the blog, or to address them directly to me.

[3]Virology.ws

[2]http://healthier.stanfordchildrens.org/q-rare-polio-like-disease-emerges-california/

[1]http://www.medscape.com/viewarticle/751032_1

Labor

They're coming to take your jobs, devaluate your labor, and avoid paying taxes. Since the late 1800's, the number of Americans working in farms has dwindled. In fact, while agriculture was a major employer in the 1940's, it's been far surpassed for American employment by other industries. I'm talking, of course, of robots. That's right, robots. Two MIT professors, for example[1], insist that the automation and computerization of various industries is what's behind the de-coupling of wealth generated compared to labor put in (hint: it's not the labor that's increasing). It's happened in the past, with Detroit replacing numerous, expensive workers with relatively infragile, inexpensive machines on the factory floor. Other examples include the infamous automated phone operator to replace human phone operators, and eBay and Amazon replacing the flea market (to an extent).

It's happening now, with food and retail service companies replacing checkout clerks with self-checkout machines. Even emergency dispatch centers can run with fewer people thanks to the help of computer aided dispatching. The picture seems bleak for the near future, with Google's fleet of self-driving cars.[3] In fact, where most industries have made significant recovery since the 2008 recession, the transportation industry's unemployment rate is still hovering above 9%.[4] Drivers make mistakes, they get tired, they have to take breaks for food and rest, and they require payment, insurance, and workman's comp if they're injured. A fleet of self-driving trucks, busses, and taxis, however, would require neither recompense nor rest, save for maintenance. Ask yourself, with today's technology, is your job really irreplaceable? Is there really a good reason that a machine can't do your work? One must wonder, if a computer can drive a car, how long before we let one make a life or death decision in war-time, and if it would make the right call.

Don't worry, through. Not yet, anyway. Technology's been replacing people in the workforce since the late 1800's, with the invention of the cotton gin, followed by the farm tractor, steam engines and the electric motor. There's simply no way people can compete against machines in brute force labor and computations. Each time machines take over a sector, though, it frees up both money that was being spent on the labor force, and the labor force to move on to more meaningful, productive work. Would life in the developed world be even half as convenient and easy as it is today if a little under half of America still worked on farms[2] just to keep the country fed? I doubt it severely. The growth is a little painful at first, but it generally seems to pay out to society as a whole in the long run.


So, yeah, that's it. Sorry, folks, I ran kind of short on time, here. I'll likely re-visit the subject in the future. Please feel free to share this blog, share what you've learned, and do your own research. You are welcome to share any questions, comments, or concerns both on the blog, and on my facebook page.

[4]http://data.bls.gov/pdq/SurveyOutputServlet
[3]http://en.wikipedia.org/wiki/Google_driverless_car

[2]http://www.census.gov/1940census/then_and_now/index.html

[1]http://www.technologyreview.com/featuredstory/515926/how-technology-is-destroying-jobs/

Viruses

Ebola, Dengue (hemorrhagic and not), Measles, HIV, Smallpox, Polio, Influenza, Coronaviruses (SARS/MERS), Caliseviruses (Rotavirus), Hanta virus, Rabies, these are all killers. Viruses are, perhaps, the least well understood pathogens by the general public, and handily the most feared. You only need to turn on the TV to see various plots starring novel superviruses that threaten to obliterate the population, dastardly villain optional, to take my point. They're fundamental horror at its finest, an invisible agent that turns those closest to you into death machines that shed millions of patent virus particles during the course of their infection. Only very recently, with vaccines and improvements in hygiene, nutrition, and medical care, have we begun to curb the viral threat to the population.

So, what is a virus? What makes them distinct from those other, dastardly, deadly microbes, bacteria? First off, they're not generally considered to be living organisms. That's right, because living organisms have metabolic processes, they take in nutrients and put out waste, they synthesize proteins, replicate genomes, and respond to their environment. Viruses don't do any of these things- at least, not on their own. Viruses don't have a proper nucleus, nor do they come with organelles, or much more than their genetic data and what's required to get it in a cell and replicating. Outside the cell, a virus is not much more than a static particle, floating about in Brownian motion, waiting to encounter its target cell. Once inside the cell, however, the viral proteins, enzymes, and genetic data get to work hijacking the cell's transcription (sometimes, with DNA and Retroviruses) and protein synthesis machinery to do one thing: make more virus.

The scary bit is that there's evidence to suggest that the diversity of species offers a barrier against pathogen spread into human populations by offering ectoparasites (mosquitoes, ticks, fleas, etc) and other vectors choices besides people. [3] With biodiversity falling, and human populations rising, it may only be a short time before we experience our next major pandemic. There are antiviral therapies available, but acute infections are often too far progressed by the time severe symptoms manifest for the antivirals to make a difference, and some viruses can easily select for escape mutants that aren't at all effected by the pharmaceutical therapy.

How do viruses make you sick? The mechanisms vary, but for the most part, it's not actually the virus making you feel sick, it's you. That's right, your symptoms- aches, chills, fever, feeling crappy- are all the result of your immune system trying to reign in the viral infection. The only problem is that it sometimes goes a bit overboard, and ends up carpet bombing the city to catch the thief, so to speak. For example, there's a hypothesis circulating that type 1 Diabetes Mellitus is actually the product of an autoimmune response secondary to a viral infection. The hypothesis implies that the infection itself is either fairly minor (such as a cold) or completely inapparent. The immune system successfully controls and clears the virus, but, possibly due to a similarity between viral antigens and surface proteins on the insulin secreting cells of the pancreas, the immune system goes on to attack and destroy the body's insulin factory. Take it with a grain of salt, since there's been no peer reviewed research that I'm aware of that positively identifies a viral culprit, but the hypothesis is sound, in my opinion.

All viruses are bad, right? Not quite. There's evidence to suggest that roughly 8% of our genome is viral in origin.[1] That is to say that, at some point, a virus managed to successfully insert its genome into ours, and get its genetic data incorporated and passed from generation to generation. So what, you may ask. Placenta, I will answer. There's evidence that suggests that mammals gained placental function secondary to a retroviral integration event. That's right, you may have a virus to thank for not laying eggs. While it is a very good thing that we've managed to save millions of lives through successful vaccination programs, the eradication of smallpox, and the near-eradication of Polio, one can't help but wonder what they might have become in time. Given another ten thousand years, could we have gained a gene from the virus, or through the natural selection caused by the virus? It's hard to speak to anything on it past the level of conjecture, and it's hardly worth the tragic loss of life that would need to occur.

What's more is that we're moving forward with clinical trials in using genetically modified human viruses as cancer killers- and they're pretty darn good at it. The risk of the virus spontaneously mutating into a pandemic monstrosity is generally pretty low. Conjecturally, I'd reckon that it's about the same odds as Rabies becoming a toenail disease and elephants giving birth to sharks. The point is that biological entities don't easily and rapidly become things that they aren't. Nature has a collection of literature on the matter, available for free here: http://www.nature.com/mt/webfocus/oncolytic/index.html
Viruses also show promise as antimicrobials, since they already naturally parasitize bacteria. For more on phage therapy, please visit my article on evolution.

Just remember, just because you haven't found your match yet, doesn't mean you won't meet the virus that's been waiting for you its whole life with your next handshake. Happy valentines day.


[3]http://www.abc.net.au/science/news/stories/s587071.htm
[2]http://www.pnas.org/content/106/29/11827.full
[1]http://www.uta.edu/ucomm/mediarelations/press/2010/01/genome-biologist-reports.php

Disaster preparation

In recent years, 'preppers'- people who are overly zealous in preparing for whatever absurd twist will bring about the global apocalypse- have gotten a good amount of media attention. Images of secret bunkers buried in the mountains with stockpiles of guns, ammunition, twinkies, and tin foil hats are conjured when one thinks of disaster preparation. Some of the people interviewed seem absurd, their personalities ranging from the slightly unnerving paramilitary type to the outright laughable. It's so outright intriguing that National Geographic's 'Doomsday Preppers' has run for three seasons now. So let's talk about disaster- not doomsday- preparation (there's a difference). 

In 2009, only 57% of Americans identified as having set aside any supplies for a disaster. Of that, a little over 70% of the time, those supplies were only food and/or water, and were often found to be inadequate on the whole. [1]That number's going to vary depending on where you live, but that means that roughly half of the households in your neighborhood are not at all equipped for a disaster. How many people per household does your neighborhood average? What are those people going to do hours to days after a large-scale disaster? Images of post-katrina New Orleans with looting and disorder, the superdome burgeoning with tens of thousands of people, all in need of food, water, and shelter come to my mind. 

Of those surveyed, many people stated that they didn't prepare for a disaster because they felt that the established infrastructure with police, fire, and EMS, or a federal or state response will help them. As a paramedic who works in the emergency field, I can tell you from personal experience that EMS systems often operate at the verge of their capacity (and are often well below the NFPA recommendation of 1 emergency ambulance per 14,000 citizens), and even relatively small mass casualty incidents such as highway pileups can rapidly overwhelm available resources. While fire and police departments generally have more manpower and resources, they too can be readily stretched thin or overwhelmed by incidents that are much smaller than a disaster level event. Even neighboring systems may be too overwhelmed, or even unwilling to render aid, as was the case when an adjoining town blocked New Orleans residents entry at gunpoint. Federal and state level responses often take a day or more to mobilize, and may not be present if the disaster is ongoing. While public safety and government infrastructure are great resources, you have a responsibility to yourself and those around you to make sure that you can at least take care of yourself, so as not to suffer from the lack of those resources, and to avoid contributing to their scarcity. 

Having a disaster kit ready isn't hard, or all that expensive. You don't have to buy a $300, 500-piece kit to be prepared, and you don't need a bunker in the mountains. In all likelihood, you already have most of the supplies on hand at your house. Ready.gov has a list of the most important items you'll need in the event of any disaster. The most important thing about these supplies is that they must be set aside just for a disaster, and you need them in one place, in a bag or two, stored so you can grab them and leave quickly if you need to. 

The list goes like this: 

-1 gallon (or 4 liters) of water per person per day. If you're sedentary, you'll need a little under 2 liters for drinking, and the rest for hygiene. Have at least a three day supply. 

-3 day supply of non-perishable food. MREs are great, but they're far too bulky, and too expensive since the prepper fad, in my opinion. If you do use MREs, don't skip on the sugarless gum, it'll keep you regular. Dehydrated food requires that you pack extra water with which to rehydrate it. Canned or jarred goods, peanut butter and other nut products, and dehydrated or smoked meats such as jerky would be my recommendation. Don't forget salt, instant coffee or tea, some chocolate and hard candy. It'll be the little things like those that will help keep you feeling good. Also, you can trade these items in a pinch. 

-A hand-crank or battery-op radio and a NOAA capable radio. This is so you can receive instruction on where to seek shelter, get food and water, and be notified of impending dangerous weather conditions. 

- A flashlight with extra batteries. You get what you pay for. If you buy a cheap light and never change the batteries in it, expect a cheap light with dead batteries. You can use this as a weapon in a pinch, and to signal for help. 

-First aid kit. Please, please, please do not buy a pre-assembled first aid kit, especially from your local department store. '100 piece' kits usually turn out to have 99 band-aids and a set of tweezers. I would ask a friend in the healthcare field to help put one together. FEMA also has a list of recommended first aid items here 

http://m.fema.gov/first-aid-kit 

The only things I'd add is that the sterile dressings they mention should be in the form of roll gauze, pack ibuprofen, pack female sanitary pads (even if you're male, they can be used to stop bleeding, or at least make some poor lady feel a little better), and pack ACE wraps.

-A dust mask, plastic sheeting, and duct tape. The idea is to seal off your shelter in the event of a chemical or biological incident, but these can also be used to construct a makeshift shelter in the field. 

-A whistle, for signaling for help. 

-Moist towelettes, garbage bags, and twist ties for personal sanitation. I can say from personal experience that you can use moist towelettes for a dry bath in a pinch. 

-Can opener

-Local map

-Wrench or pliers

- Cell phone charger or solar charger. 

My personal recommendations extend to include: 

-A water procurement method. Iodine tablets, bleach solution, a life straw device, etc. 

-A tool/weapon of some sort. A hatchet, axe, or sturdy blade of some kind would be best, in my opinion. Firearms are good for personal defense, but generally aren't great for general utility purposes. If you want a firearm to be part of your kit, do it. My advice is that you don't turn yourself into a target by looking like a walking arsenal. 

-A good backpack in which to keep your kit. It's okay to assign extra backpacks to other family members. 

-Games, like a pack of playing cards or a set of dice. 

-Consider your region's conditions, terrain, and weather, adjust your kit as appropriate. 

-Pet food for your animal. Bear in mind that a FEMA shelter may ask you to relinquish the animal. 

Really, this stuff is all recommended to make your life easier, and keep you from becoming a victim. None of it's going to do you any good if you don't have a plan, don't know how to use it, or don't obey common sense or instruction. No amount of stuff can replace a little bit of good training and practice. No amount of post-event efforts can replace a little prevention. It really is easy to be ready for anything- if you can go camping, you can be prepared. Start getting organized today, check your house for leftover supplies that would go into your kit. Get your family and friends in on it. Go meet those neighbors you don't know yet, and learn you can rely on them for and vice-versa. 

If you want to help disaster relief efforts, FEMA recommends starting with this site: http://www.nvoad.org/states  

FEMA also recommends donating only cash, as it provides relief organizations with the flexibility they need to help those who need it. As always, you can help by supporting politicians who support disaster preparedness, by doing your own research, and by sharing what you've learned here. 

As always, feel free to leave questions, comments, concerns, and suggestions on the blog, on my google + account, or on Facebook. 

[3]http://m.fema.gov/first-aid-kit

[2]www.ready.gov

[1]https://s3-us-gov-west-1.amazonaws.com/dam-production/uploads/20130726-1859-25045-2081/2009_citizen_corps_national_survey_findings___full_report.pdf