As Mpox continues to hit African nations hard, here at home we are dealing with bird flu and a rise whooping cough.
Dr. David Pate, former CEO of St. Luke's Health System, joined Idaho Matters to talk more about these issues.
Idaho Matters
Idaho Matters Doctors Roundtable: October 9, 2024
[MUSIC PLAYING] From the studios of Boise State Public Radio News, I'm Gemma Caudette. This is Idaho Matters. As epochs continues to hit African nations hard, here at home, we are still dealing with the bird flu, and whooping cough is on the rise in our region. Dr. David Pate, the former CEO of St. Luke's Health System, and the co-author of the book preparing for the next global outbreak is joining us today to talk more about all of this. Hi, Dr. Pate. Hi, Gemma. And folks, remember, if you have a public health question, send us an email, Idaho Matters, at BoiseState.edu. OK, Dr. Pate, lots of issues to get to when it comes to public health today. So I want to start with some updates on epochs. You actually wrote on your blog this past weekend, and you said there's some good news, but there's some bad news. So do we want to start with the good news first? I always start with good news these days. OK. So the good news is that finally-- and it's taken us way too long-- but finally, our vaccines that we've donated to Africa and vaccines that are coming from other international groups and countries have arrived and those vaccinations have begun. So there's not enough vaccine yet to vaccinate everybody they need to, but this is a key strategy to contain the outbreak there. And as we've talked about before, from 2022, just two years ago, we should learn that an outbreak of impacts in Africa can become an outbreak in the United States, just as it did. So it's always best to contain the disease where the outbreak is instead of letting it go on. Now that we have this more dangerous variant of impacts that seems to be disproportionately involving children, this is really, really a good thing that we're getting the vaccine to Africa. So that's the good news. The bad news is that Australia has reported as much of-- as 40% of the recent cases in their country occurred in people that were fully vaccinated, likely back in '22 or '23. And so what that tells us is that there is apparently waning immunity. And we weren't quite sure because with the smallpox vaccine, which this is related to, we got a very long term, if not lifetime, protection. So it wasn't sure, but now with their report, that is concerning that there may be a need for a booster. And then I also referenced in my blog a study that recently came out showing that antibody levels wane and that people that got infected with impacts developed high levels of neutralizing antibodies. But those vaccinated didn't. Not sure of the significance of that. But I think what this means is we're going to have to re-examine this and consider the potential that we may need to recommend those that got vaccinated over a year ago that they might need to get a booster dose now. So that's not the end of the world. But obviously, when you're talking about vaccinating people in Africa, the more shots it is, the more difficult it becomes. So, Dr. Pan, I want to turn now to bird flu and some concerning news about that. The first thing I want to talk about, though-- and you wrote about this as well in your blog-- and this is the fact that this is a brand new virus, right? Or a strain. And so we don't have immunity to bird flu. You wrote about it more eloquently than I am saying. But can you kind of explain that aspect of it? Because what you also wrote about was that this is what these avian influences have the ability to actually contribute to the development of human pandemics, and we've seen that already. Yes, so the point that I try to make in the blog is that our response to this latest H5N1 avian influenza outbreak, which for our purposes began around two years ago, has really been lethargic. And it's difficult to explain why we're being so lackadaisical about this, because as you just pointed out, bird flu is very different than human flu. And most people in our country have not been exposed to avian influenza. And therefore, we don't have a level of existing immunity. And so when you have a highly contagious virus and you have a population that doesn't have immunity, and this virus can be spread, we believe, through the air, then you've got the recipe for a pandemic. And as you pointed out, the bird flu was instrumental in the famous 1918-1919 Spanish flu, and also we saw it again in 1957 with an outbreak in 1968. So it can lead to pandemics, and my big concern is that this virus is presenting in very different ways. We have not seen outbreaks in dairy cattle before. We have not-- even though we've been working on this for almost seven months now, six and a half-- we have not been able to contain the spread of this virus. And now, we have 17 people infected just this year that we know about, and we're not really testing people, so there could be a lot more. And it just seems that if this was another country handling it this way, we would be severely criticizing them for not getting this under control and not being more aggressive. And now, with a recent outbreak in California, among dairy herds, we're seeing if the information we've been getting from the government has been correct about the previous farms, it appears something has changed about the virus because veterinarians are reporting a higher proportion of herds infected, a longer length of illness, and a significantly higher mortality rate among the cattle. So something appears to be changed, and we're just not doing enough fast enough to give me confidence that we could contain this. And I think we could contain it if we put the effort forth. So something else you've been watching as well is the Marburg virus outbreak. So first, Dr. Pate, I had not heard about this. So let's start with what this Marburg virus is, or Marburg virus. So Marburg virus is a virus that was discovered if my memory serves me in the mid to late '60s, 1967, I think. And it was named that because it was an outbreak in laboratory workers who were working on African green monkeys. And it caused an outbreak in two different labs because we didn't know about this virus. But the monkeys had been infected with the virus, and then one of the outbreaks was nearby, Marburg, Germany, and that's where it got its name. Marburg virus is one of the deadliest viruses that we know of. And it is in a group of viruses that we call hemorrhagic fevers. Some people will remember Ebola virus. This is kind of a cousin to Ebola virus. And this is transmitted by being in either coast contact with an infected animal or in close contact with an infected person, including for a period of time after they die. And so what we have seen over the years is periodic outbreaks. What is notable about this outbreak is this is the first time it has occurred in Rwanda. And the initial case, the index case, is a gentleman from Belgium that traveled apparently to Rwanda, and he died just about a month ago. And fortunately, his wife did not get infected. And we need to know more about that. But what has happened is, although it wasn't recognized in his case because he also had malaria, and when the doctors diagnosed the malaria, which would explain a lot of the symptoms he had, they didn't look further. And they hadn't ever seen a case in Marburg before, so I don't fault them. But what happened is, patients can't transmit malaria, but they can transmit Marburg. And what happened is, after he was in the ICU, a number of ICU health care workers started falling ill. That's when it was discovered it was Marburg. And now, 70% of the cases that we know about are in health care workers. So this is quite concerning. Now, this is a good news story, because even though it's a much scarier virus, the response by the country of Rwanda and the response by the United States, this is one case where I would give us exemplary marks as opposed to-- I'm critical of a number of other responses. But in this case, within seven days of the country of Rwanda making a request, we had vaccines showing up in their country. And so they've already begun administering vaccines. That's a really, really short turnaround. These are experimental vaccines that we developed, but they haven't been tested. So I think the US is doing exactly the right thing. What we told them is, we'll give you the vaccines, but you have to do the clinical trials. That is perfect, because we need to take all of these opportunities to learn from it. We need to study the effects of these things so that we can be prepared if there's a bigger threat in the future. And right now, this is the third largest outbreak of Marburg that's ever occurred. But I'm so proud of how the country of Rwanda is handling this and how well the United States has responded to this. In addition to vaccine, we've also sent monoclonal antibodies. So we're very hopeful we can get this under control in short order. In order to pay one thing that we've talked about over the years is the fact that we really live in a global society now. And so it doesn't matter if there's an outbreak in Rwanda. We should pay attention to it. It's not like, let's say it was 30, 40, 50 years ago when people didn't travel to the extent that they travel now. How much should people really at least have some knowledge about what's going on? Because I think it's very easy to kind of not pay attention to these outbreaks that have happened in places like Africa. Gemma, you said it perfectly. We have to realize the world is different, just as you said. And in fact, what's a little scary about this outbreak in Rwanda is it's involving their capital city and a place where they have an international airport. And you take those factors, and then you add the fact that the incubation period for this virus can be up to three weeks, meaning someone could get infected but not start showing symptoms for up to three weeks. It is easy for someone to travel to the country, then get on a plane, come to the United States, still be feeling well when they arrive here, and then a week or two later, become ill, present to a hospital. And just like Rwanda was not prepared for a case of Marburg, we likely wouldn't be either. And in fact, that's exactly what happened with the case of Ebola that showed up in the Dallas hospital. So you're right, we have to realize we are a very interconnected world. There are people from the United States going to African countries for business, to visit family, whatever, and then coming back. And so we have to take these things seriously. Even though not all of them will turn in to be pandemics, what we should do is realize that every one of these opportunities is an opportunity for us to learn, to learn about how do we make more effective vaccines, how do we come up with more effective antivirals, how do we understand the biology of the disease so that if it or a related virus becomes a problem in the future, now we have a lot more knowledge. That's why we could advance the science on SARS-CoV-2, which caused the COVID-19 pandemic, because we'd already done so much study about SARS-CoV-1 and MERS virus that are related. And so we already had a lot of ideas about ways that we could pursue therapeutics and vaccines. So that's important, but they can. And we should learn from Monkeypox in 2022, nobody had that on their bingo card. And we had a big outbreak in the United States. We've got to realize things are different. - So I want to talk about whooping cough next, Dr. Pei. This is something that we have talked about numerous times. In particular, over the last couple of months, there was an outbreak in North Idaho. It was in the news again when Boise State almost had to not play a football game because there was an outbreak on the opposing team. And then you got to deal with me the other night when I found out that there had been possible exposure at one of my children's schools. And this kind of led me down a rabbit hole because we have an ongoing outbreak in our region when it comes to pertussis whooping cough. So what was surprising to me is that we did, as a station, reach out to Central District Health because the note that I received from my son's school was basically a template from Central District Health. And they acknowledged there is an I'm reading from an email from their communications manager saying there is an ongoing pertussis outbreak in the region with Central District Health communicating, including two news releases to the media, the most recent one on September 5th. They go on to say as part of the outbreak in the community, we have had students from many high schools in the area test positive for pertussis. We are not aware of a disproportionate number of cases that any one high school. With that said, Dr. Bate, I was a little fit to be tied when I learned about all of this because if there's an ongoing issue and the last information from Central District Health was more than a month ago, and now we are seeing this in area high schools, even if there's not a disproportionate number, should we not know about this? - Well, we should, Gemma, and certainly it's very concerning what the last numbers I could find from Central District Health. So for those people that may not be very familiar with our public health system, so that is Ada County and kind of some of the surrounding counties. So it's just, I think there's seven public health districts in Idaho, so we're not talking about the whole state, we're talking about our particular region, and the last numbers I saw were 171 cases. I'm sure it's much more than that, but that was in contrast if my memory serves me to 10 cases in 23. So that's 17-fold increase of cases, and so yes, anytime there is an outbreak of a communicable disease affecting our public, and especially our children, I do think that we should know and people should be put on alert. And so I certainly thought I understood completely while you're upset about that, but the thing that got me when I then asked you, could you forward me, the communication that you received, was a sentence in the announcement saying that if your child has whooping cough, that check with the school, because they may not be wanting the kid to return to school. Then my head exploded, kind of like yours does from time to time, and I'm like, wait a second. The answer is you never send a child with a highly contagious disease who is sick to the school, and because schools is where we spread disease. So I do think that number one, we have got to improve our public health communication. For example, I've already expressed my frustration about the bird flu stuff. We have not gotten enough of the details of things that we need to know. On the impacts, the new clade, we're not getting information, we're getting information about number cases, but we're not getting information about, okay, what was the epidemiology behind it? Was that a sexual contact? Was that a close contact? Was somebody known to be sick? Was it somebody working in a hospital? The problem is they're being so guarded with information that those of us that need to know so that we can advise the public or our friends when they call us in panic, we need that information to be able to know, okay, tell me basically what's going on. And so my advice to public health is when you communicate about these outbreaks, just ask the public health leaders in your organization. If somebody was telling you about this outbreak, what would be the information that would be critical to you in knowing the scope and scale and the risk of this outbreak and give us that information? We don't wanna know about specific persons, we don't want their personal information, we don't want any information we don't need to have, but give us that kind of key information so we can know the extent of what's going on and we can make decisions and provide advice. And so that's the first thing, but the second thing is ever since COVID, we have all of a sudden when it was previously not a matter of debate that sick children should stay home, that didn't mean they always did, but that wasn't really a matter of debate, especially when they were contagious. Now apparently we're kind of just throwing out that out the door and we're doing it in our hospitals because we're telling healthcare employees, well, even if you're sick, come back to work. I mean, these are the exact opposite of our infection control principles. - Thanks so much for listening to Idaho Matters. Boise State Public Radio and Idaho Matters are members of the NPR Network. 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