While there are many good articles out there on preparing for pandemics, there is little information that really breaks down infectious diseases and how to alter your actions depending on the disease. There are also conflicting reports on exactly what actions to take and if/when to take antibiotics and in what dosages. I hope this article will provide you with the tools you will need to decide what actions to take. This article will cover some basic infectious disease terms and patterns and then two resources you can use to decide what actions to take and when.
Infectious Diseases
When talking pandemics, you’re really talking about the spread of infectious diseases, as opposed to the other types of diseases, such as deficiency, genetic, and physiological. Infectious diseases are caused by bacteria, viruses, fungi, or parasites. While many of these organisms live in and on our bodies at all times, rarely causing problems, some can cause a range of minor irritations all the way up to death. Bacteria are single-celled organisms responsible for illnesses such as strep throat, urinary tract infections, and tuberculosis. Viruses are smaller than bacteria, causing a range of diseases from the common cold up to AIDS. Fungi induce many skin diseases such as ringworms, athletes’ foot, and can infect your lungs or nervous system. Parasites can be transmitted through bites or feces, such as Malaria obtained from a mosquito bite. Knowing which of the four ways a disease spreads can be important when stopping an infection.
The Spread of Infectious Disease
Infectious disease can be spread through direct or indirect contact. Direct contact is what you would expect: person to person, animal to person, or mother to unborn child. Indirect contact can include germs lingering on a surface, insect bites, or food/water contamination.
Endemic, Epidemic, or Pandemic
We usually hear of diseases in terms of endemic, epidemic, or pandemic. An endemic disease is something that exists naturally in an environment, for instance Malaria in Africa. Something becomes an epidemic when a statistically significant number of people (more than normal) catch a disease within a short period of time. It reaches pandemic levels when it jumps to multiple countries and is spreading worldwide.
The Waves of an Infectious Disease
Another important fact to know when dealing with infectious diseases is that they generally come in three waves. The first wave is the initial number of cases which climbs to a certain number and then starts to diminish. Everyone generally becomes aware, takes action, cases get fewer, and people breathe a sigh of relief. The problem then is that, in about 1-6 months after the first wave, a second much stronger wave of cases will break out. The disease has now become used to humans and human-to-human transmission and is generally stronger and lasts longer.
This second wave is then followed by a smaller and weaker third wave. Most infectious disease cases, and indeed all three major influenza pandemics of the twentieth century, follow this three-wave pattern. So, when you hear of disease X spreading in country Y and immediately the governments, WHO, CDC, et cetera leap into action and assure everyone the disease is under control, watch and wait for that second wave, then after the second wave things should start to calm down.
Responding to the Spread of Infectious Disease
So now that disease X is spreading, what are you to do? There are two references I go to immediately when I hear something might be spreading. One is a reference manual, which is a bit pricey at just under $60, but it’s worth it.
Reference Manual
The reference manual I use is Control of Communicable Diseases Manual, edited by David Heymann, MD, from APHA Press. Mine is the 20th edition. This reference manual has all the major (and many minor) infectious diseases listed and includes everything you’ll need to know about them. It lists clinical features (how the disease presents in the form of symptoms, et cetera), agents (how it spreads, where it lives normally), how to diagnosis it, transmission, incubation periods, prevention, and treatment.
Another important tidbit to know is the incubation period. A person will become infected, there will be an incubation period where the disease will spread and react with the person, and then at some point that person will start showing signs of being sick and will also start being contagious. You need to know how long that incubation period is (i.e. how long should someone stay isolated before you know if they’re sick), at what point and for how long they will become contagious, and how long do you need to treat them. This manual will tell you all of this.
Siegel Table
The second reference is what I call the Siegel table. It’s officially titled “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007”. (Mine is the 2007 version.) This table lists the diseases, what precautions need to be taken, and for how long. There are four types of precaution categories possible: airborne, droplet, contact, and standard.
Standard Precautions
These are the minimum precautions recommended at all times in management of patients in healthcare settings. These include washing hands, good hygiene/cough/sneeze etiquette, safe handling of contaminated equipment, safe injection practices, and the basic Personal Protective Equipment (PPE), which includes gloves, gown, and mask.
Contact Precautions
Contact precautions are taken for diseases that spread by touching the patient or items in the room, such as MRSA, diarrheal illnesses, open wounds, et cetera. These precautions include wearing a gown and gloves while in the room, removing these items before leaving the room and washing hands or using sanitizer afterwards. This also requires a strict awareness of what items might be contaminated and then cleaning and controlling those items.
Droplet Precautions
Droplet precautions are needed when a disease is spread via tiny droplets from coughs, sneezes, or other body fluids. This includes wearing a surgical mask and cleaning hands before and after working with the patient.
Airborne Precautions
Airborne precautions are the most restrictive and are needed for very small germs spread through the air. This requires a patient be in a room where the airflow is strictly controlled. In a medical setting, this would be a negative pressure room, where air can come in but not go out. In a home setting this would be hard to do in a standard house with normal air flow. This is also where you would need a N95 or higher rated respirator while in the room. Clean hands and ensure the patient wears a mask while around others or leaving the room.
Madagascar Plague
Now that you are aware of these resources and basic information on infectious disease, let’s walk through a currently ongoing, real-world example. This past fall certain news sources started reporting on a plague outbreak in Madagascar. I was somewhat surprised this didn’t become bigger news, especially in prepper circles. I realized, reading through comments, that many people didn’t have a good grasp of the information in this article. Frequently, when they got to the point in the news article about the plague being endemic to Madagascar, they moved on and wrote it off as no big deal. Let’s examine the situation a little closer.
Endemic Plague Spreads to Epidemic Level
The plague, Yersinia pestis, is indeed endemic to the jungles of Madagascar, where the bubonic form is spread via flea from animal to animal. Incidentally, the bubonic form was what kicked off the Black Death. Madagascar normally has a small bubonic plague season, on a yearly cycle, much like the American flu season. It is usually the bubonic form spread to villagers who live near the jungles and is usually tracked and controlled. This past fall, however, their normal plague cycle became an epidemic and caught international attention due to several deviations from normal. The bubonic form did infect patient zero, but it then transformed into the pneumonic form. If you check the Heymann manual, you will learn that the plague has three forms: bubonic, pneumonic, and septicemic.
Bubonic Form Transformed Into Pneumonic Plague and Spread
Bubonic is what is stereotypically thought of when thinking of the plague, spread by fleas. Pneumonic plague can be transferred human to human via droplets. Septicemic is when the disease gets into the blood and spreads to other body parts.
In this case, the pneumonic form started spreading and made it all the way to the capital city of Antananarivo, where it spread like wildfire. Incidentally, Antananarivo is where their international airport is and has been operating daily flights in and out of the country throughout this whole time. While the local news was reporting on schools closing, university closings, prison lock downs, and so forth, the international community and the World Health Organization (WHO) was assuring everyone that the situation was totally under control.
Controlled Treatment With Antibiotics and Vaccines
They’re partially right, in today’s modern world the plague, if caught in time, can be treated with antibiotics and is no longer the deadly nightmare that it was centuries ago. China made big news by working with the WHO to donate 1.2 million doses of a vaccine within the first month of the outbreak. The World Bank released $5 million to help with the response, and the Red Crescent started running dedicated ambulances just for plague victims. Here’s a fun fact: The U.S. does not currently have an FDA-approved plague vaccine, though one is apparently in the works.
First Wave Subsiding and Second, More Severe Wave Expected
Recently, the news surrounding the plague has subsided, because as mentioned above the first wave of cases is subsiding. Since August 1, 2017, Madagascar has recorded 2,348 confirmed cases with a fatality rate of 8.6%. If you look at the WHO chart of cases here, you will see that the first wave has certainly peaked, and we are on the low swing.
Those of us with infectious disease knowledge are patiently waiting for the second, more severe wave that should be coming sometime within the next few months. I won’t say I’m worried but rather just alert. While there are certainly antibiotics and vaccines readily available and existing, with a pneumonic spreading plague I have to wonder, if we have enough antibiotics and vaccines to treat every person in our very globalized world. Do we? I don’t know. I also wonder how fast will the pneumonic plague develop antibiotic resistance like many other diseases are currently doing? Will it take 10 years? 20 years?
What Do We Do?
What I am doing in this situation, as with any infectious disease situation, is checking my two references. By checking the Heymann text, I familiarized myself with the disease’s transmission, symptoms, incubation period, and most importantly treatment.
Treatment
The manual tells me that I can treat the plague with several different antibiotics: streptomycin (adults 2g/day in two equal doses), gentamicin (3mg/day in three equal doses), or tetracycline (2g/day in four equal doses) for seven days. It also tells me how long the incubation period is and how long a person is contagious for (48 hours after the start of antibiotics). By checking the Siegel table, I learn that droplet precautions should be taken and that chemical prophylaxis should also be provided to members living in the same household. (Heymann also tells me which antibiotics and dosages for those family members.) With this information, I can be informed and forewarned about what actions I might need to take to protect my family and what antibiotics I might need to procure before any possible panic or run on medication.
Other Situations
These types of precautions can and should be taken with any situation that might arise in today’s connected world. Some other current examples include Marburg and Ebola viruses in Africa and several different influenza strains that are currently circulating. (Heymann covers various kinds.)
Hopefully, this article gives you some more background on infectious diseases and some tools that you can use to protect your family.
