Immaculate Infection

Immaculate Infection*

by Marco M. Pardi

*Title provided by Dana

“Like any other major experience, illness actually changes us. How? Well, for one thing we are temporarily relieved from the pressure of meeting the world head-on…We enter a realm of introspection and self-analysis. We think soberly, perhaps for the first time, about our past and our future…Illness gives us that rarest thing in the world – a second chance, not only at health but at life itself.” Louis E. Bisch MD. 1937

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Disease. Dis-ease. The harmonious state of the body is disturbed. One is not at ease. There are eleven major categories of disease, enough to make one feel ill. But we are currently concerned with infectious disease.

Before we start, however, it is interesting to note the history, and pre-history of human perceptions of disease in general. My early years as an Anthropology student happened to coincide with a growing popular interest in Non-Western medicine and the therapies among societies of Early Man. I collected several excellent books on the subject. But, failing to anticipate writing this piece in the current year 2021 I gave most, if not all those books to my older granddaughter as she excelled her way through a preparatory high school dedicated to medical science, an undergraduate college degree centered on Nutrition, a Masters of Medical Science, and now medical school in which she is in the top 10% of her class. Conversations with her are electric, even if bystanders drift away. (No, I don’t have one of those bumper stickers: Let me tell you about my grandchildren)

As we look at some of the interpretations of disease and the recommended therapies of long ago it is easy, too easy, to dismiss previous generations as ignorant or even primitive. In some cases it is certain that practitioners did not know why a therapy worked; but they knew it did work. Trial and error? Well, life was often pretty brutal for most of human existence. But one of the early practices which never made sense to me was bloodletting, slitting open a vein to allow the “bad humors” to drain away. Practiced in the West until the late 19^th century, it possibly killed as many patients as it “cured”, though the “cure” was likely the mild euphoria felt from blood loss. Fortunately, we no longer do that except for very rare conditions. But terms and concepts have a way of hanging on.

One term which is still with us, and unlikely to leave, is Malaria. Derived from Latin roots, it is literally Mal (bad) aria (air) and originated during a period when people associated the fetid air of warm weather swamps with disease. They had no concept of mosquitoes carrying a parasitic organism and transmitting it through a bite.

Another concept with a long history, even a pre-history, is the idea that disease is a consequence of displeasing the god or gods. Surely this is not believed anywhere in modern societies? In fact, since the advent of HIV/AIDS it has been and is now a constant drumbeat in fundamentalist churches throughout the United States. The “SIN” of homosexuality hath wrought God’s vengeance upon the evil ones. How about that “loving God”? Real cuddly, no?

Those of us who grew up in the 1940’s and 1950’s remember when cancer was thought to be contagious. And, even today, a cancer diagnosis often elicits the question, What did the person do wrong? My daughter had a kitten who died of lung cancer. No one in the home smoked, and she never caught the kitten smoking.

After a few years, during which the Reagan/Bush administration tried to maintain the myth that HIV/AIDS was a “homosexual disease” (question: “What does gay mean? Got AIDS yet?”), it became obvious it was easily and commonly transmitted by needle sharing, heterosexual sex, blood transfusion, and even organ donation. Yet the churches persist in disinformation to this day. Magical thinking finds a ready audience in the United States. But there was nothing magical in the discovery that HIV/AIDS was hitting hardest in the African-American and Latino communities. Still, the Reagan/Bush administrations stifled any efforts to develop prevention programs and funding for development of treatment was scant to non-existent.

That lack of funding didn’t stop those of us Feds assigned to state and local health departments. I handed condoms to STD patients like they were Halloween candy. In some cases, they were – flavored. But I continuously ran into resistance to accept the message: safer sex. I told HIV positive patients that they must use condoms to reduce the likelihood of transmitting what was then a fatal disease. I then explained that if I saw them in the clinic with another STD such as primary or secondary syphilis or gonorrhea I would know they had not used a condom. Of course, I saw them again. Over and over. Many of them explained their disease by claiming, “It must have jumped back on me.” Okay, I did walk further from the bushes lining the clinic sidewalk. Never can tell where an STD might be hiding. But without meaningful prevention resources there was not much I could do.

In those years, decades ago, we knew something else about minority communities, especially the African-American: Many of them held deep and erroneous beliefs and suspicions regarding government provided public health. These beliefs were based on misinformation about a long term practice conducted in Tuskegee, Alabama many years previously. In a horrendous betrayal of trust White researchers identified African-American men already infected with syphilis and, instead of treating them, followed them through the course of this often fatal disease. The misinformation was that the researchers actually infected the men with syphilis, an almost impossible feat without sexual contact. The Treponema pallidum spirochete is remarkably fragile as I learned by watching living specimens under Darkfield microscopy.

Ignorance of this medical fact coupled with centuries of being treated as disposable property cemented this belief into the population. I often had it thrown in my face when confronting patients and their sexual contacts. As a consequence, this population, among others, became what is known in epidemiologic circles as a “hard to reach” population.

A change of political party, to Democrat, in the White House brought a much needed stimulus to disease prevention and management. In fact, it was only under this other party that the federal Centers for Disease Control was able not only to add and Prevention to its title but also to develop strong prevention programs based on years of developed science.

But a return to the previous political party, Republican, brought the Dark Ages back. The ascendancy of the second Bush, son of the first mentioned above, ushered in another “gag” order on sexual health, especially in overseas outreach by Foreign Service Officers but also to suppress support for Planned Parenthood clinics in the U.S.. STDs, including HIV, climbed again. No surprise there. And, while federal funding for many prevention programs once again dried up, a new “evangelically based” effort to discredit science altogether swept onto the federal science establishment. Senior scientists, with cumulative centuries of experience and institutional memory, left in droves rather than have their names attached to “science papers” massively edited and skewed by the White House. The CDC faced serious succession planning problems. Who would be skilled enough to replace those scientists? Who could be trusted enough to practice actual science? In the meantime, a swarm of infectious diseases such as H1N1 and SARS swept the globe, complicated by the desperate movements of people displaced by climate change and a disastrously stupid invasion of Iraq and the consequences elsewhere.

Yet another change, to Democrat, of presidential administration brought in eight years of restoration of science and prevention programs across the board. Real progress was made. But eight years add up to less than an eye blink in the evolutionary march of disease. Disaster struck with the 2016 election of the Village Idiot or, as the Russians called him, the Useful Idiot as the Republican president. The man was so broadly ignorant, even stupid, that it would be erroneous to charge him with the planet destroying efforts of his administration. In every area but weapons development and fossil fuel extraction science was rolled back, sidelined, and openly scoffed at. The lasting damage to the environment and thereby all living beings on this planet has yet to be calculated largely because the momentum of those four years is still in motion.

But an immediate human toll can be calculated, the loss of life to the Corona virus. Dr. Deborah Birx, formerly the White House Corona Virus Response Coordinator, recently said publicly that, after the first 100,000 American deaths the rest (now well over 500,000) were largely preventable. So why did they happen? First, the incoming administration disposed of the thorough and complete pandemic response plan developed by the previous administration. Then the political party in power during the first year of the pandemic claimed: It was a hoax perpetrated by the Democrats to discredit the Republicans; it was nothing more than a flu; it would go away “like magic” with a change of weather; common safeguards would only bankrupt the U.S. economy; the then president mused it could be managed with ingestion and/or injection of bleach; invested tax money in millions of doses of an ineffective drug intended for malaria, boosting the stock market value for unnamed administration members; called for vaccine development with scant plans for distribution; called for States which had put lockdowns in place to “be freed”; and, the then president exhorted his mob rallies to call for the firing of Dr. Anthony Fauci, the world’s leading expert on Infectious Diseases. Having deja vu? It quickly became clear the Corona virus was taking a far more serious toll on the African-American and Latino communities. Could anyone miss the implication that the slow walk adopted by the administration was a replay of the Reagan/Bush approach to HIV/AIDS? After all, this was the same administration tearing children out of the arms of immigrant parents.

The tactic of slow walking a response is not singular to the American Republican party. Readers will remember my efforts in the early 1990’s to address cholera in Latin America. As I was driving to various remote clinics in a particular country I asked the local physician with me why the government seemed to be unconcerned about the mounting death toll. His answer: “Well, only the Indians are dying of it anyway.”

Looking around the world we can easily see the almost unparalleled level of expenditure on military arms, not on beneficial and readily accessible medicine. If humans could ever realize their greatest enemy is ignorance and disease, not each other, we could reduce suicidal population growth, destruction of our natural environment, and control of diseases. Even after this pandemic is brought under control there will be another unless we wake up. In frank terms, the next pandemic will not be announced by an angel, nor will it “jump back on you”. It will come simply because our greed and ignorance have us looking in all the wrong places. It may come to you from an idiot who thinks not taking precautions is a political statement, an assertion of a “god given” right.

Speaking of looking, near where I did scuba diving off the coast of Oahu there’s a promontory that encapsulates a myth common throughout Polynesia: “The leaping place of souls”, from which the souls of the dead or near dead leap. The “good” souls leap to the right, into the night where they live among the stars; the “bad” souls to the left, into the “pit of eternal blackness”. We are standing on the promontory. We don’t have to be dead or dying to realize we have an ultimate choice before us. Leap for the stars.