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Outbreaks and Pandemics

25 years of diseases, data, and why talking to people is so important

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I want to talk to you about diseases. Specifically, I want to talk to you about how they sometimes become outbreaks. Outbreaks happen when we start seeing more of a disease than we should. When an outbreak gets really bad within a community, we call it an epidemic. When it goes global, we call it a pandemic. In 1995, we were emerging from a deadly pandemic. HIV (human immunodeficiency virus, in case you’ve always wondered what it stood for), the virus that causes AIDS (acquired immune deficiency syndrome, in case you’ve always wondered what that stood for) had ravaged the world. In the US, we were finally seeing an effective treatment, HAART (highly active antiretroviral therapy), roll out. HAART turned what had been an incredibly deadly virus into a chronic illness that could be controlled.

Outbreaks of new diseases often follow a similar pattern: people start getting sick and we don’t know why. Then, we discover the “why” is new: a new virus, a new bacterium, etc. Broad panic then ensues. But there is good news. In the 21st century, we’ve been very successful at combating infectious diseases through prevention and treatment efforts, as the story of HIV demonstrates.

Outbreaks and pandemics come and go. They’re one of the few constants of being alive and existing in the world; you’re going to get sick at some point. Probably several times if we’re being realistic. Luckily for us, our preparedness for outbreaks and pandemics includes some incredibly effective tools: disease identification techniques, testing capacity, and the development of vaccines and treatments. But, pause the celebrations because the nature of outbreaks and pandemics themselves has also changed in the last 25 years. While we are still battling new diseases (like the new coronavirus that is responsible for the COVID-19 disease), those diseases are only half of the outbreak and pandemic story. They’re the half that get reported on because they’re scary.

But, the other half of this story should be reported on too. The other half of the story is reemerging diseases—diseases that were defeated but have made a comeback due to lowered vaccination rates. I think this half of the story is scarier because I’ve never existed in a US ravaged by some of the diseases that were already defeated by the time I hit the scene (roughly the mid ‘80s). They’re the comeback story you don’t want to root for. Let’s talk measles for example. In 1995, the US had a total of 301 measles cases.1 At the time, this was the lowest number of cases reported in one year since we started keeping track.1 In 2000, the US declared measles eliminated.2 By the time measles was officially declared eliminated, it had been on the decline for years with each successive year seeing fewer cases than the year before. Fast forward to 2020. We are now seeing an increase in cases every year. In 2019 there were nearly 1,300 cases of measles across the country.3 And it gets worse. Measles is not the only vaccine-preventable disease planning its comeback tour. Our home state of Colorado is currently in the midst of a mumps outbreak.4 If you’ve never heard of mumps, there’s a reason for that. The reason is the vaccine. The vaccine made mumps a disease of the past…until now.

While new diseases will continue to dominate media attention, these reemerging, previously defeated diseases are a side to outbreak and pandemic preparedness that is novel to the here and now. If you don’t know what I’m talking about yet, I’m about to hit you over the head with it: disinformation campaigns regarding vaccines, aka people saying wrong stuff about vaccines on the internet (mostly). The battle against disinformation and reemerging diseases starts with conversations, and really this is no different than battling outbreaks of newly emerging diseases. One of the first steps involved in the effort to contain an outbreak is called contact tracing. Bear with me because this sounds obscure and boring but I promise to bring this back around. Contact tracing involves identifying all people known to have interacted with someone who has tested positive for a disease. The only way to do that is to talk to people. Talking to people is key. The best way for us to address these reemerging diseases is similar: talking to people. By talking to people, listening to their concerns, and understanding their perspectives we can begin to chip away at disinformation and reestablish trust. However, these conversations must go both ways. Health care providers must take the time to listen to concerns and questions, but people must be willing to voice their questions and concerns.

Make no mistake, disinformation impacts all areas of life. I just happen to be talking about diseases and pandemics. But my suggestion of asking questions and having conversations can be helpful for all areas of life and not just your health care. Ask questions. Have conversations. Actively listen. Do these things like your life depends on it because it’s not a stretch to say that it does.

References

  1. Measles — United States, 1995. https://www.cdc.gov/mmwr/preview/mmwrhtml/00040890.htm.
  2. Measles | History of Measles | CDC. https://www.cdc.gov/measles/about/history.html (2019).
  3. CDC. Measles Cases and Outbreaks. Centers for Disease Control and Prevention https://www.cdc.gov/measles/cases-outbreaks.html (2020).
  4. Mumps outbreak rises to 26 cases at Colorado ski resort. https://www.thedenverchannel.com/news/mountains/mumps-outbreak-rises-to-26-cases-at-colorado-ski-resort.