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The Agent is Not the Issue 2020-03-13

Friday the 13th of March has been an interesting day, both here in Texas and globally.

Essentially, Italy is closed for business. At least some people in Italy have had family members die, recently, yet no one has come to pick up the body for preparations for burial (or whatever approach the family desires). This is a problem both culturally and hygenically (the virus can use the decomposing tissue to manufacture more virus, magnifying the potential harm).

Texas and Drive Thru Testing

Texas has had nearly forty new cases of Covid19 infection. This led Governor Greg Abbott to institute several measures, including declaring Texas a “disaster” due to the outbreaks here and opening a “drive through testing center” in San Antonio with more to follow in other parts of the state, presumably starting with Dallas, Houston, and Austin.

Certain key items were stripped from the shelves of grocery stores and similar vendors of grocery items, particularly loaves of bread. I ventured into a local bread store; all the shelves had been stripped of loaf bread, buns, and rolls. Cookies and condiments remained.

Philadelphia and the Megalopolis

This evening, I read that the city of Philadelphia, and its suburbs, had almost as many infections as the entire state of Texas. I can only wonder how bad “things” will become in the megalopolis, the region from Washington, DC (starting in Northern Virginia) and stretching into Boston. Transmission of disease in an outbreak is a function of population density, sanitation, and hygiene, as well as the nature of a given agent. Given the population density of the megalopolis, disease will likely spread quickly.

The Agent is Not the Issue

Which brings me to a statement in my previous entry: “The Agent is Not the Real Issue.”

The agent is not the issue. How can I say that? Isn’t Anthrax considerably more deadly than the common cold?

The answer to that question, the second one, is that Anthrax is more deadly than the common cold. However, the annual influenza season yields far more deaths than Anthrax. Why? Because, the agent is NOT the key issue.

Key Issue with an Agent: How Fast Can It Mutate (and Adapt)

The key characteristic of the agent is not what part of the body it attacks, whether it is “T1 cells” (as HIV does) or causes a “cytokine crisis” (as did H1N1 allegedly did, according to some sources, in the “Spanish Flu” Pandemic of 1918) or such things. Those factors are important, no doubt. But, for any agent, the single most important factor is how fast can, or does, the agent mutate. Agents that mutate quickly and that are “growing” in crowded conditions with poor sanitation among people who have poor hygenic practices are agents that can become more lethal than they are in the beginning.

It Does Not Have to Be a Virus; It Does Not Have to Be Novel

And, it does not have to be a virus, and it does not have to be “novel.”

An example, or counter-example if you prefer, is Tuberculosis (TB).

TB is not novel. TB has been recognized by the medical community for centuries under various names including “consumption.” It is particularly lethal, killing approximately 50% of the people who become infected. This far exceeds any death rate of Covid19 calculated so far.

TB is not a virus. It is a bacterium.

Antibiotics, three of them, have been developed to treat the disease.

Poor Hygenic Practice (Including Non-Compliance) and Drug Resistance

But, a problem exists. In modern societies, the people who tend to contract TB have poor hygenic practices (IV drug abusers who “share needles”) or are “immuned compromised” (HIV infections, often) or both. Once identified and given treatment, they often fail to complete their treatment course of antibiotics.

The result has been that certain strains (“mutations”) have become drug resistant. So far, in all cases, at least one of the three recognized antibiotics will treat the disease, killing the bacterium that is the cause of the disease.

But if TB enters a setting of crowded conditions with poor sanitation, poor hygiene, and individuals who do not complete prescribed courses of treatment, it could become drug resistant to all three current antibiotics.

Multi-Drug Resistant TB Can Kill 50% of Those Infected

In that case, we would likely have a pandemic of an old disease, caused by a bacterium, that would kill 50% of all who become infected. We would be without protection.

So, once again, it is not about the agent. It does not have to be novel. It does not have to be a virus. It only has to be “sufficiently” lethal (perhaps not even that in the beginning) and be able to mutate, under crowded conditions with poor sanitation and poor hygiene, into a monster that can decimate us.

It is not about the agent.

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