Flying to a City Near You: Pandemics in the 21st Century (Part 1)

What is the future of a pandemic? In Toronto do we need to worry about the diseases of Africa like Ebola or are other diseases more likely to attack the city? These important questions are on the minds on doctors that track the course of disease.
Wednesday night at Bar Italia in Toronto the CIHR and Saint Michael’s Hospital presented a Café Scientifique open to the public on “Pandemic Flight Path: How Infectious Disease Spread through the Global Airline Transportation Network”. I was able to attend the event. Radio personality Bob McDonald of CBC’s Quirks & Quarks hosted the forum that included discussions from Dr. Michael Gardam and Dr. Kamran Khan.

In part one we will be looking at the hows of a pandemic. The basic elements that are in place to give diseases the chance to spread like wildfire. Part two will deal with how these diseases will come to Canada.

Doctor Michael Gardam is the Director of Infectious Disease Prevention and Control at Ontario Agency for Health Protection and Promotion. He informed the audience that “you know I am an expert because I am wearing a suit,”
and thus started a two hour evening dealing with the issues of how and what will happen when a pandemic reaches Canada and more pointedly reaches Toronto. It’s not a matter of if, we know that at some point another pandemic will hit the city. If anyone questions that they only need to go back a few years and remember the SARS epidemic. That epidemic has taught Canada what is already working and what has to be in place in time for the next killer disease wave.

When it comes down to it pandemics have certain elements that make them famous. One is genetics. Take the flu, an ordinary little virus that researchers know quite a bit about. Every year they can make a vaccine that will protect most of the population against most influenza. Now the problem comes from the fact that the flu virus itself makes mistakes. As it constantly changes sometimes one of the mutations change in a way that makes it as a disease take off. This past year scientists saw that happen when a variant of the flu became able to survive Tamiflu. When that happens you have the chance of a major pandemic running wild.

Another disease that is fairly common that has caused over the course of time is the bacterium Clostridium difficile. It’s been around for decades and at one time was a fairly harmless little fella. That is not always the cause today, case in point; recently Hamilton, Ontario saw the closure of a hospital wing when two cases were discovered. C Diff and Staph viruses have been able to become immune to many antibodies and proved to be a heck of a fighter. When it attacks the body it can bring on its toxic elements and rapidly spiral out of control. Because it causes severe diarrhea it has the means to quickly move through a population if the elements are right.

Tuberculosis (TB) is an old name when it comes to pandemics but it’s a true contender. While the disease can be managed often by medicines those same medicines have created a disease that has been able to create an immunity. Scientists know how it happens and the whys even. Take the Russia of yesterday, old communistic Russia had one thing going for it, a decent medical plan for its comrades. Those who had TB had the means to the drugs and were getting better. Than came the fall of the Communistic Bloc and people who couldn’t rely on being able to get their TB drugs. TB will mutate if not kept in check and it did. The cases of TB that started to appear were resistant to antibiotics.

Researchers know where and when TB will emerge. War. War brings out TB like a back stabbing mistress. She enters into the refugee camps where people are packed in tightly and coughing on each other. Hello epidemic.

We also have the ultimate killer, Ebola Virus. If you want to set up a disease that could in theory wipe out the world Ebola is your baby. It kills almost everyone that it touches. Quickly. In Africa where it is most often seen it uses the simplest tools, man and how man responds to death. Much of Ebola’s spread has had to do with the burial rituals in Africa. Once it takes hold it goes quickly through a village and takes no prisoners. The one thing that makes it so frightening is the one advantage that man has. It is deadly but too deadly. It can’t keep going because once it starts no one escapes, and it stays where it is. Another factor is its location which will be gone into more depth in part two of this article.

Next we have to deal with the biological aspects of a pandemic. One of the more well known biological epidemics is Mad Cow Disease. Bovine Spongiform Encephalopathy is by no means a new disease. It’s been a fatal disease for decades in cattle and other animals. How it spread to humans though is because of man. Man farms cattle, man feeds cattle with cattle. That also isn’t new. What was new though was the processing that took place in the UK that lead to human cases. Old disease, little changes, epidemics. It’s simple math actually.

Next we have the social aspect of a pandemic. As the world becomes more modern more people move from rural settings into urban ones. That simply means more people in smaller places. In developed nations this isn’t a problem. The problem comes when you have all these people together and a lack of clean sanitation. It’s the perfect breeding ground for diseases like cholera.

As Dr. Gardam said Wednesday night, “Don’t put sewage and drinking water together.”

The cure to these epidemics is simple and yet it has not taken hold in countries that still have their drinking water and sewage plants next door to each other. Clean water, proper sewage and basic health care can stop many pandemics in their path.

The last step we have in a world-wide pandemic is politics. Political policies can help keep a disease alive or stop it in its tracks. When TB changed in Russia it wasn’t just the disease but the change in politics. When the Spanish Flu spread through Philadelphia in 1918 it wasn’t just the flu in charge, so was the return home of WWI vets and parades that the government wanted regardless of what doctors warned them could happen.

When all the factors are in place a pandemic will happen. In part two we will look at how it will come to Toronto and the rest of North America.

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