Lecture 2: Plagues and Epidemics

Ergot Poisoning

• kind of mold typically found growing on stale rye bread

• discharges an alkaloid toxin that causes hallucinations

What historical events could Ergot Poisoning possibly explain?

• responsible for mass hallucinations in medieval Europe

  • Witch Trials

  • Werewolf Trials

What is Ergot Poisoning and example of?

Scapegoat: when the cause of a condition, death etc. is unknown we find someone or a group of people to blame it on.

Examples of how we name epidemics shows scapegoats.

• named based on cities, groups, and countries

  • Ebola

  • Toronto was Plague City

  • The China virus

  • Monkey Pox

• Shows economic issues and discrimination

MERS

Middle East Respiratory Syndrome

• viral respiratory illness

• first reported in Saudi Arabia in 2012

• Now in many countries

Effects of Plagues and Epidemics on Social Order

• panic and breakdown

  • social order is destroyed

  • Crime becomes rampant

  • Codes of behaviour are abandoned

  • Giving priotry shots and taking shots home for H1N1

What was the issue with HIV/AIDS?

• used gay men as a scapegoat becuase it was showing up in them

• ignored men who had sex with men and their partners

• they were not looking at the wider picture that this was spreading to the non-gay populations of American

Jews were blamed for….

Black Death

• demonized

• massacre of Jews in Germany in 1349

Who were the scapegoats during the plague in Europe?

• ‘village idiots’, beggars, vagrants, Jews witch women

• and vulnerable populations who could not defend themselves

Common outbreaks

Cholera, diphtheria, typhoid fever, TB and influenza

What was the response of the Boards of Health to outbreaks?

• quarantine to limit outbreaks

• race, class and gender analysis

Typhoid Mary

• A healthy person who gave people typhoid 

• People who ate her food would get sick 

• Healthy carrier of the typhoid fever (asymptomatic carrier)

• made her live on her own and die by herself

• Racist against the Irish in NY

• Disobeyed because cooks made more than laundresses, and she was her only source of income

COVID-19 has highlighted fact that epidemics tend

to sharpen existing social inequalities

1800: Cholera Epidemics

• reportedly killed victims within 8 hours of developing symptoms

• had a fatality rate so high that locals struggled to bury all the dead

• Quarantine was one of few tools

• So… interconnectedness of Africa, Europe, North America etc.

HIV/AIDS was seen as…

• God’s retribution for Homosexuality - Gerry Falwell

• Gay plague

• Poorly understood at the outset

• Haitians, IV drugs, hemophiliacs and heterosexuals

• Lack of gender analysis

Examples in history when disease would spread through travel, trade and transportation.

• 18thC: travel for 1 year by ship from England to Australia

  • a lot of infectious outbreaks and deaths that would spread when people come off

• Mid-19thC: Steamships would take 3m voyages and when they arrive they would have incubating diseases

• Air travel today: how SARS came to Toronto

  • viruses move faster, especially through the air

• Move with humans and goods

Bubonic Plague

• caused bacterial infection

• to humans, from fleas of infected rodents

• Sick were incarcerated in their homes

• doors marked and dead bodies collected at night

• ‘Flee early, flee far, return late’

  • people who had money and social status could do this

• mass torture and murder of thousands of Jews and others who were accused of poisoning wells and spreading the plague

Influenza

• flu

• highly infectious viral disease

• affects the respiratory tract

• many people died but mostly the vulnerable older people, they why it goes unnoticed

1918 Influenza- Spanish Flu

• 1918-1919

• did not start or rage in Spain

• images of death here were not censored by the government like they were in other countries during WW1

• Originated in the rural west US

• transported to Europe in trope trains and cargo ships that brought Americans to Europe

Why are opioid toxicity deaths occurring every day not discussed?

• blame them for taking drugs so we don’t feel the need to discuss them

H1N1- Swine flu

• strain of influenza virus

• only affected pigs but then it emerged in people

• panic because people did not know how it spread

• humans have little to no immunity to this virus meaning it can be a serious and widespread illness

• spread like seasonal influenza

• infected person coughs or sneezes and their germs enter the nose, eyes, throat of another person

• can be on surfaces and picked up by hands and then into the respiratory system

• not possible to get it from eating pork

GlaxoSmithKline pulled swine flu vaccines. Why and what effects did this have.

• higher than expected number of severe allergic reactions

• actions like these get people worked up

• it probably wasn’t something to do with the vaccine and rather the plant but something like this will shock the populations and send them into scapegoats behaviours and panic

Advances in outbreak management

• emergency preparedness training, teams

• Precautions for H1N1 reduced cases of normal influenza

• Learn from outbreaks and deaths

  • leprosy epidemics led to public health standards for water and waste management

Prions- Mad cow Disease

• mis-folded protein that acts as an infectious agent

• No known treatments

• slaughters 4.4 million cows in the UK to eradicate

Anaphylaxis

• severe (life-threatening) allergic rans

• prevalence has doubled over 10 years

  • hygiene hypothesis: homes are clean that we have not developed a tolerance

  • late exposure vs early exposure

Sabrinas Law

• every school in ON have to have a plan to deal with anaphylaxis

• teacher, students, bus drivers, sub-teachers and parents on trips all should be aware

Legionnaires Disease

• There was an outbreak at convention of legion members in 1976 in Philadelphia

• unknown strain of bacteria: Legionella

Who are the scape goes of the Legionnaires Disease?

• Legion members

• Named after where ti broke out but then they named it after people or places it has nothing to do with

What was Ebola?

• 2014-2016 epidemic in West Africa (esp. Guinea, Liberia, Sierra Leone)

• Infection came from bats

• Spread through contact with bodily fluid (vomit, blood etc.)

Issues with Containment Efforts of Ebola

• not enough money

• WHO would give some money

• Weak surveillance systems, poor public health infrastructure

• People from cities would go to the village 

• Wash the body and wrap them, spreading ebola when preparing the body 

  • burying bodies was spreading

When did Ebola become known to countries apart from Central Africa?

• DOC with ebola returns to USA 2014 

  • Working in Liberia for Samaritans Purse 

  • Headlines that ebola was coming to the shore 

    • Great interest in Ebola

    • Canada and the US are only concerned about this when it comes close to them 

Why is there no vaccine for Ebola?

• Families lose faith in med. experts and go home to healers in their villages (thus spreading the disease)

• Breakouts in Africa

  • Seen as far away

  • not our problem

• Docs need a steady supply of electricity to heat + cool the blood samples

• No money incentives

  • Who will buy these?

Issue with Medical Manpower in Africa

• 24% of the global disease burden but only 3% of the worlds workforce

• Not enough health professional

• Ebola cases are doubling

• 117 Liberian physicians in the country prior to outbreak and now there are 56 Liberian trained physicians in US

  • taking their professionals for our health because we have a shortage

Epidemics because:

• Extreme poverty; years of armed conflict

• dysfunctional healthcare systems

• Lack of HC personnel

• Delayed response (several months)

• local burial customs of washing the body

• spread to densely populated cities

How does Religon play a role in epidemics?

• Believe that a higher power will protect them if they go to mass or these religious gatherings

• The authorities can’t help them the way God will

• Groups are suspicious of the government because they have persecuted them in the past 

• You have to repent if you get sick 

  • shows you have done something wrong

• Economics and politics