WE LIVE IN A WORLD WHERE THERE IS A VACCINE FOR CANCER , but even supermodern methods, technologies and innovations can not slow down the development of viruses: every month we hear about new or treatment-resistant old infections – and it is difficult not to panic in such conditions. We are looking into why we are so scared of the idea of an epidemic, what threats exist in reality, and how to protect ourselves.
Outbreak, epidemic, pandemic – what’s the difference
An outbreak occurs when doctors report more cases than expected in a given location. An outbreak can last from several months to several years, and the consequences can be the most unpredictable when it comes to an unknown, new to the community or absent for a long time disease. One example is the outbreak of smallpox in Moscow in 1959-1960 , which the famous surgeon Yuri Shapiro talks about in his memoirs.
Returning to Moscow from a creative business trip a day earlier, the artist Kukarekin went to the apartment of his mistress, with whom he spent the night – after which, after checking the arrival of the flight from Delhi, he “officially” arrived at his wife’s house. At night, Kukarekin felt unwell, and an ambulance took the artist to the infectious diseases department of the Botkin Hospital, where he died after some time. A pathologist from Leningrad, who came to visit one of his colleagues, looked at the corpse and said that it was nothing more than smallpox – a disease seemingly defeated in the USSR. First, quarantine was imposed on the infectious diseases department, then on the entire hospital, and after the competent authorities learned that both Kukarekin’s wife and mistress had taken his Indian gifts to the consignment shop , it was decided to inoculate the entire population of Moscow against smallpox. During this time, however, forty-six people managed to become infected, three of whom died.
An epidemic occurs when an infectious disease spreads very quickly so that the maximum number of people is at risk of infection. In 2003, an epidemic of Severe Acute Respiratory Syndrome (SARS) killed about 800 people: it all began with an intense outbreak of SARS, later called SARS , in China’s Guangdong province in November 2002 ; later, similar outbreaks were reported in other provinces and cities in mainland China, including Shanxi, Beijing, and then Hong Kong.
Fear is literally –
and science has confirmed it – is contagious. In connection with the “raging” Ebola virus, US residents were seized by such a massive panic that the American media came up with a special term – fearbola
The epidemic caught public attention when an American businessman on a flight from China to Singapore fell ill. The plane landed in Hanoi, where the businessman died shortly after hospitalization. He was examined by the Italian doctor Carlo Urbani, who was the first to realize that there was something new and dangerous in front of him , and immediately reported this to the WHO and the government of Vietnam. Urbani himself died in March 2003 at the age of forty-six as a result of an infection from a patient; the action taken by WHO on its recommendation has allegedly saved millions of lives. If we talk about modern epidemics, WHO is worried about cholera in Yemen ( mainly due to a lack of quality drinking water and medicines, since in general, intestinal infection, the causative agent of which is cholera vibrio, is easily cured) and Ebola in the Congo.
Finally, a pandemic is a global outbreak of disease, of which HIV / AIDS is one of the most devastating examples. It is believed that the virus originates from the Congo and could have been transmitted to humans from monkeys through contact with blood while hunting. Research is ongoing, but an effective vaccine against HIV does not yet exist. On the other hand, highly active antiretroviral therapy slows the progression of the disease and allows people infected with HIV to lead fulfilling lives while scientists try to figure something out. This should be helped by a complete decoding of the structure of HIV and the structural features of the gp41 protein involved in the infection process, as well as the infection process filmed for the first time on video . Scientists at Harvard University have already successfully tested a drug designed to save them from infection in monkeys – and more recently demonstrated the safety of a potential vaccine in healthy volunteers.
An epidemic of fear: why we are afraid of epidemics
Joseph Ledoux , professor of psychology and neuroscience at New York University, is confident that we learn the patterns of fear in the same way as many others – from childhood. In other words, in order to be afraid not of everything in a row, but only of real dangers, you need to get some experience, information and an example of others. Fear is literally – and science has confirmed it – is contagious. In connection with the “raging” Ebola virus, US residents were seized by such a massive panic that the American media came up with a special term – fearbola. According to Paul Slovich, Ph.D. from the University of Oregon, reports of a potential threat “hit all the red buttons at the same time “: the virus can be deadly, it is invisible, it is difficult to defend against it, the mechanisms are not clear and it is not known who controls the situation and how.
Studying how people perceive risks, psychologists came to an interesting conclusion: we, as a rule, react more strongly to epidemics, terrorist attacks and other extreme events, even when personal risk is minimized, but to things that are dangerous specifically for us, like the flu, we may not react at all. Research shows that the amygdala may be responsible for what is happening – an area of the brain that is simultaneously associated with fear and novelty, which is more active in responding to something unfamiliar. In addition, more prone to panic are the people who in general do not tolerate uncertainty.
The media and flashy headlines, of course, don’t help either . Research on the topic allows us to say that the more informational coverage of a particular event, the stronger people’s anxiety in connection with what is happening. Experts believe that it is possible to prevent fear from taking control by at least getting the maximum amount of weighted information about the virus or the epidemic itself. Governments are encouraged to actively engage the media when it comes to vaccinations or necessary precautions.
The most dangerous is the mysterious “X virus”
The history of epidemics and pandemics is dauntingly varied . In the 430 year to BC smallpox has killed more than 30 thousand people in Athens, reducing the population of the city at least 20%. The Justinian plague, which lasted from 541 to 750 in the form of isolated outbreaks, killed almost 50 million people in total. From 1347 to 1351, there was a “black pestilence”, a plague pandemic, as a result of which, according to various estimates, up to 200 million people died. In 1918-1919, almost 30% of the world’s population was infected with the Spanish flu , and the most massive influenza pandemic claimed 50-100 million lives. In 1952, almost 60 thousand American children were infected with polio, of which more than 3 thousand died (the vaccine was invented three years later).
From the moment of identification of HIV as the cause of AIDS deaths of more than 25 million people. In 2016 the WHO has expressed concern in connection with the spread of the virus Zika, is transmitted through the bites of mosquitoes in tropical regions and causes serious neurological disorders. These are just excerpts from a much more extensive list, to which can be added cases of mass psychogenic illness , when a group of people experience the same symptoms without an obvious physical or environmental cause. Such, for example, was the dance plague of 1518 in Strasbourg, the epidemic of laughter in Tanganyika in 1962, or the epidemic of koro , associated with the fear of the penis being pulled into the abdominal cavity, in 1967 in Singapore.
The next pandemic could start from a disease that we don’t know about, and it could be caused by a pathogen that has not yet been discovered at all . It can be created by nature, or it can be in the laboratory.
In addition to the ubiquitous Ebola virus and HIV that has not yet responded to treatment, among the most dangerous viruses on the planet is the Marburg virus , which causes hemorrhagic fever, the rabies virus that destroys the brain without timely treatment, the hantaviruses that spread through rodents, the dengue virus , also known like bone crusher fever, and the influenza virus , from which, according to WHO, about 50 thousand people die during the season around the world. The list of potential epidemics in 2018 , compiled annually by WHO, also includes ” virus X “. In contrast, from other listed pathogen, not of it know nothing.
WHO officials explain that they added “Virus X” to the list of threats, acknowledging the fact that the next pandemic could start from a disease that we do not know about, and it could be caused by a pathogen that has not yet been discovered at all . It can be created by nature, or it can be in the laboratory; synthetic biology allows the creation of deadly new viruses that spread very quickly. In any case, scientists did not want to scare anyone by adding the ” X virus ” to this list – they only wanted to draw attention to the fact that the world needs to be ready for something like that. Researchers, for example, already know for sure that humanity is facing another global flu epidemic. Another question is how serious it will turn out to be.
Vaccination as a solution
WHO notes that in 2017, 25 countries immediately reported a decrease in vaccination volumes compared to 2010 , and recalls that vaccinations are extremely important, even if we are talking about the seemingly eradicated deadly diseases – they, alas, have a tendency to return. The most recent example is a measles outbreak in Europe , believed to be related to suboptimal vaccination coverage.
It is wrong to think that only children need vaccinations. Understandably, you may need vaccinations for travel (in Saudi Arabia, say, pilgrims are strongly advised to get vaccinated against meningococcal meningitis and some other infections). But it also makes sense to update the standard “childhood vaccines” in adulthood; for example, the whooping cough vaccine is recommended for pregnant women and anyone planning to come into contact with babies. During infectious outbreaks, vaccination is not only beneficial, but absolutely necessary – therefore, it is recommended to get a flu shot every year.
As a reminder, two of the most common fears about vaccines — their association with autism and that they might impair immunity — are unfounded. A controversial article on the link between vaccination and autism was withdrawn , and its author was stripped of his medical license. As for the suppression of immunity , it is also imaginary, as stated by American researchers who tested 944 children aged 2 to 4 years on this score . In addition, if in the first months after birth the baby is really protected by natural parental antibodies, then very soon he becomes vulnerable to most diseases. Natural immunity against dangerous diseases such as measles, whooping cough, diphtheria or tetanus can only develop after an illness – and, unfortunately, it can lead to serious consequences or death. Obviously, there is no point in exposing the little person to such danger when there is an effective vaccination.
Doulas, Midwives and Gynecologists: Who is Responsible for Pregnancy and Childbirth
Many people take seriously the choice of a SPECIALIST who will LEAD THE PREGNANCY AND CHILDBIRTH , but sometimes confusion in concepts prevents them from making a decision: the same word in different countries can mean people with different education. Some women, having moved to Europe, are outraged that it is so easy not to get to a gynecologist and for all matters related to pregnancy, they are referred to a midwife. Others, living in Russia, avoid doctors, or even choose to give birth at home with a midwife or even a doula, arguing that “the whole world is doing this.” We figure out how an obstetrician differs from an obstetrician-gynecologist, what are the powers of midwives in different countries and what actions of a doula are beyond the law.
How pregnancy management works in Russia
Now in our country, only a doctor has the right to conduct pregnancy, and most often it is an obstetrician-gynecologist. This is a person who, after six years of study at the medical faculty of the university, received a diploma in the specialty ” General Medicine ” or “Pediatrics”, and after an internship or residency – in the specialty “Obstetrics and Gynecology”. It is worth clarifying that the official nomenclature does not include, for example, a gynecologist-endocrinologist – in fact, this is an obstetrician-gynecologist who has undergone professional training in endocrinology. Reproductologists are doctors of the same specialty, but they also trained in assisted reproductive technologies.
The doctor makes all strategic decisions, and he is assisted by an obstetrician or, more often, a midwife – a medical worker with a secondary education in the specialty “midwifery”. You can learn to be an obstetrician in three years after eleven grades of school – or four after nine. With good preparation, the midwife should be able to manage an uncomplicated pregnancy from start to finish and deliver, but at present the doctor is still responsible for these processes.
How it works in other countries
Higher medical education in Europe is expensive, and in the USA it often implies a loan, which needs to be repaid for many years. Therefore, there are relatively few gynecologists: in the United States in 2016, there were 2.7 practicing gynecologists for every 10,000 women (and 5.5 for every 10,000 women of reproductive age). Moreover, in recent years, there have been fewer people wishing to get this specialty – and by 2020, in some states , a serious shortage of obstetricians and gynecologists is expected . The Japanese Medical Association studied the situation in fifteen different countries – and it turned out that in eleven of them these specialists are too few, and they work much more than forty hours a week (in Japan and Israel – up to 80 hours).
With a well-built practice, the doctor does not do what a nurse, paramedic or midwife can handle – in particular, he does not weigh patients, does not measure their blood pressure and does not administer vaccines. In addition, narrowly specialized doctors in many countries do not treat patients with typical chronic diseases that may not progress and complicate for many years. If a person comes every few months for an examination to make sure that everything is in order and there is no need to change therapy, then a general practitioner can examine him. To ensure that professionals can treat patients who cannot be helped by others, the burden of managing a normal pregnancy falls on the shoulders of midwives (for example, “midwife” in English-speaking countries and “comadrona” in Spanish-speaking countries).
Is it necessary to revive the system of obstetric points
It is sometimes said that in Russia the approach “a midwife can cope with an uncomplicated pregnancy” is irrelevant, because thanks to the cheap or free education of gynecologists, we have a lot. According to Rosstat data for 2012, almost 44 thousand obstetricians and gynecologists worked in state health care institutions alone – this is about six specialists per 10 thousand women, and taking into account those who work in private clinics, this is more. The problem is not in the absolute number of doctors, but in their distribution: if in large cities there are gynecological clinics at every step, then in villages and villages there are big problems with specialists .
Attempts are now being made to revive the FAP system – feldsher-obstetric points, which would ensure the availability of medical care for everyone; however, there are obvious difficulties with financing these items . Just yesterday, the head of the Ministry of Health Veronika Skvortsova promised to build 315 new FAPs (and upgrade 1200) by the end of 2021: “By the end of 2021 we will fully ensure the completion of primary health care, including in the countryside … We have a clear line: each year we know what we will do, in 2021 the problem will cease to exist ”.
According to gynecologist Oksana Bogdashevskaya, the system of such first-aid posts where midwives could conduct pregnancy is simply necessary – otherwise, in a huge country, it is impossible to provide assistance to everyone. “There is evidence of how the FAP service has reduced the risks of maternal and child mortality simply due to the fact that a midwife with a tonometer was planted under almost every bush,” the doctor notes. It is clear that vocational training also needs to be improved so that women are not afraid to entrust their pregnancy to a midwife. In the same USA, study takes eight years (four of them are spent on obtaining a bachelor’s degree, without which it will not be possible to study further).
What doulas are entitled to
Unfortunately, people who call themselves doulas can mislead women. There is no certified doula medical specialty – however, there are organizations, such as the Association of Professional Doulas, that monitor the ethics of their members. Being a partner in a hospital birth is the only function of a law-abiding doula. She can only take a non-medical part in childbirth, providing moral support and making the experience in general more pleasant (in fact, this is the same partner childbirth ).
Unfortunately, not everyone listens to the law – and among those who call themselves doulas, there are those who campaign for home births, including solo births, during which the assistant is not even present, but gives recommendations via Skype. At the same time, childbirth at home is associated with a very high risk of complications, and even mortality of children and mothers – and in Russia they are also illegal for a doctor.