Last week, Robby Bitting '11 ate a Z-pack, slept diligently, and drained at least a keg of water. This week, he's quarantined in Brunswick Apartments with both H1N1 and a sinus infection. Despite the waves of vaccines rolling through campus and his best efforts to ward off sickness, the Swine didn't seem to care, and carried him off without a hesitation. Who knows when we'll see him again?
Infectious disease doesn't respect our efforts to limit its spread. Because microbes move from host to host so easily, any measures short of vaccination are probably unlikely to seriously limit transmission. Even the quarantine policy is susceptible, because H1N1 is contagious even before the patient exhibits symptoms.
This case study in epidemiology at Bowdoin is even more interesting because the student body represents a conglomeration of diverse geographic backgrounds. As a result, this campus acts like an airline hub for the transmission of disease throughout the world. Our bodies shuttle diseases from our homes to college, and then from college back home, exchanging pathogen passengers along the way. Not only do these diseases disregard our quarantines and masks, they also seem to disregard all the demographic and geographical divisions of the greater society we represent. Because of transmission centers like Bowdoin, an underprivileged student from Los Angeles could contract an illness from an affluent student from Hong Kong.
We live in an age of novel diseases. Every couple of months, we hear of a pathogen: E. coli in our food, avian flu, eastern equine encephalitis, and more. Part of this burgeoning is due to the increasing interconnectedness of society, which facilitates global transmission. Other causes are more preventable.
The transfer of avian flu to humans, for example, probably resulted from both the poor conditions of poultry farms in Asia and the proximity in which workers and chickens lived. While the origin of H1N1 is still unknown, it has shown the susceptibility of human society to novel diseases, especially when a vaccine does not exist. This is hardly news, considering the epidemics that once ravaged societies before advances in scientific medicine. What is more scary is the thought that more of these easily transmitted diseases are lurking in animals, isolated populations, or have yet to appear. One of these threatening microbes is an old pest, tuberculosis.
With the introduction of the tuberculosis vaccine in the early 20th century, affluent societies were able to cure their populations of the disease. Antibiotic treatments are now available to those who come down with the rare case. What many people don't know is that while tuberculosis disappeared from wealthy societies, incidence didn't drop appreciably in poor populations. In 1900, tuberculosis killed 400 in 100,000 black Americans, twice the number of white Americans. Through the century, tuberculosis has continued to afflict the poor. Tuberculosis also remains a growing problem in Russia and Latin America.
Tuberculosis persists in poor populations because poverty restricts access to the standard six-month antibiotic treatment, which carries a high cure-rate. If a patient has a drug-resistant strain, treatment can be longer, but must change to include effective antibiotics. Because incomplete treatment generates drug-resistant strains, poor communities are breeding grounds for multi-drug resistant tuberculosis (MDRTB).
It's only a matter of time before MDRTB begins to reemerge in affluent societies. In 2007, an American infected with MDRTB reentered the U.S. from the Czech Republic. The event caused a Congressional debate over controlling the passage of diseased people crossing borders, but the incident shows how difficult it is to control the flow of pathogens across borders.
The spread of H1N1 at Bowdoin shows how easily and rapidly a disease can proliferate through an unvaccinated community. But H1N1 is not a normally fatal disease. Multi-drug-resistant tuberculosis is, and when it's not fatal, it's thanks to broad (and expensive) antibiotic cocktails.
As we hide our coughs and isolate ourselves in Brunswick Apartments, let's recognize that H1N1 is an easy opponent in this age of disease generation. As "survivors" of a hard-hit campus, we should better understand the threat of reemerging infectious diseases like MDRTB, and support policies that help improve health care systems in developing countries. This isn't charity; it's perhaps the most self-interested health policy we could pursue, but it has the added benefit of being humane. It's never too soon to start caring, either. A novel strain of H3N2 was just identified in east Asia. [Editor's note: Bitting was released from quarantine on Thursday.]
Jonathan Coravos is a member of the Class of 2011.