Pandora’s Box

Archived in the ever-rich and exotic mythologies of the Greeks is the story of Pandora’s Box. It was actually a “jar”—which is strangely close to a “test tube” in my opinion. Pandora was given a wedding gift, a beautiful jar, with instructions not to open it under any circumstances. Curiosity killed the cat, so to speak, and she finally couldn’t resist. When she opened it, all the evil contained in the jar escaped and spread over the earth. She tried to close it but too late—the contents had already escaped. Only one thing remained in the jar at the very bottom—the Spirit of Hope.

I’m not sure the World Health Organization would agree with me, but “Pandemic” is very close to “Pandora.” In a world where international travel is commonplace the spread of contagious disease is a major concern. Rats on ships carrying plague may be a thing of the past, but viral-loaded passengers on an international flight happen every hour of every day. Think of all the headlines in the past decade that have highlighted international health risk issues. It seems that Pandora has unleashed a few additional mutated “evils,” and I doubt we’re through with all her mischief.

As laboratory professionals, we are essential to solving the public health issues confronting our world today. Rapid diagnosis, evidence-based research, viral load monitoring, susceptibility and pharmacological validation, managing toxicity—familiar territory for us, and just think of how much relies on our expertise? We are called on daily to be the platform and framework for “pandemic control” measures. Sitting in our clean, efficient, well-lit, safe and busy laboratories throughout our country it’s easy to forget there are bacterial and viral war zones not far from our shores…all it takes is a small rat on a creaky ship (or a young child on a red-eye international flight) to initiate a modern day plague world-wide.

Next time you hear “pandemic”, remember Pandora. Wash your hands, put on a mask, and peer inside that jar of hers and shake out some Spirit of Hope. Sprinkle it liberally around our laboratories and colleagues, and let’s roll up our lab coat sleeves—we have a lot of work to do!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

Laboratory Response to the Ebola Outbreak

You may have heard in the news over the past few months that there has been an outbreak of Ebola in West Africa. The first registered case was in Guinea in February of 2014. Reports have since noted the spread of the virus to other areas in Guinea, as well as Liberia and Sierra Leone. As of June 24, the CDC noted on their website that ministries of health in the three countries have reported 390 cases in Guinea (this includes 270 fatalities and 260 laboratory confirmed cases); Sierra Leone had 147 laboratory confirmed cases with 34 fatalities; and Liberia reported 34 laboratory confirmed cases and 34 fatal cases.

Genetic analyses of the confirmed cases show that this strain of the virus is closely related (97 percent) to variants of the virus that have been previously identified in Gabon and the Democratic Republic of the Congo.

Response to the outbreak is difficult for many reasons, including the lack of medical and laboratory resources in the regions where it has been discovered. The WHO and other partners have deployed laboratory experts to staff mobile field laboratories in order to provide accurate testing to confirm cases. Other specialized medical personnel have been deployed to treat affected patients and provide education to local communities. There are reports, however, of local medical personnel in Liberia not showing up at work due to fear of contracting the virus because they say they lack the appropriate personal protective equipment (PPE) in order to adequately protect themselves.

Spread of the virus has been attributed to the ease of contagion in densely populated cities (such as Conakry, Guinea), local traditions and beliefs that have resulted in lack of quarantine and/or removing patients from medical care, and the porous borders and ease of border crossings in the West African region. However, some countries have taken various measures to close borders or restrict movement across borders. The CDC, WHO and MSF (known as Doctors Without Borders in the US) are working with partners on the ground to lead the response to the outbreak.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

 

 

 

 

The African Century

“In demographic terms, it seems, the Asian century could be followed by the African century…Whether Africa is able to prepare for its coming population boom may well be one of the most important long-term challenges the world faces right now.” So says Max Fisher in the Washington Post article “The amazing, surprising, Africa-driven demographic future of the Earth, in 9 charts.” I found these charts and Fisher’s commentary incredibly interesting and well-worth exploring (especially with the future of health care resources in mind).  As he points out, the next century being the ‘African century’ will have good, bad, and unforeseen consequences. Even if it is does not turn out to be the ‘African century,’ continued population growth seems to becertain and will put increasing burdens on resources in African countries. With more people, there is need for more water, more food, more jobs, more sources for transport, etc. More people also mean the need for more health care and thus, increased capacity for laboratory services.  Yet another argument for the importance of expanded and improved laboratory (and all health care) services in the next decade.

Another interesting statistic from Max Fisher’s charts is that life expectancy in Africa in the next 80 years is expected to increase by 50%. However, in 2090, it will still not be equivalent to that in the U.S., Europe, South America or Asia. From a health care perspective this is interesting both in the reasons why it will still be the lowest life expectancy in the world, and, in how health care is affected by a growing aging population (much like challenges we are beginning to see and expecting to see expand in the coming years in the U.S.). However, with this in mind, take a close look at his chart number 9 on dependency ratios (the ratio of the population under age 15 and over age 64 and thus ‘dependent’ on others and the government to provide for them). Africa’s dependency ratio is projected to decrease from 80% today to 60% by 2055, while the dependency ratios in the rest of the world are projected to increase. This could mean a more productive work force, and more people to take care of a population that is living longer. As Mr. Fisher points out, however, a large younger population can result in increased political instability.

While these charts are all projections and any number of factors could completely alter the course of these projections, it is fascinating to think about and study, and certainly worthwhile preparing for.

I originally stumbled across Mr. Fisher’s charts through a different article of his in the Washington Post called “40 more maps that explain the world.”  This one is equally fascinating and I could have spent hours absorbed in the various maps.

On an unrelated note, a quick update to my post from last month: President Obama nominated Dr. Deborah Birx to become the next Global AIDS Coordinator. Dr. Birx has spent her career focusing on immunology, vaccine research, and global health. From the laboratory-strengthening perspective she is an exciting choice for this role. Her nomination still needs to be approved by the Senate. Her bio on the CDC website.

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.