Some Like It Hot! A Century-Old Disease on Our Southern Shores – The Health Care Blog


Naomi Orestes PhD, Professor of the History of Science at Harvard, didn’t mince words  as she placed our predicament in context when she said, “If you know your Greek tragedies you know power, hubris, and tragedy go hand in hand. If we don’t address the harmful aspects of human activities, most obviously disruptive climate change, we are headed for tragedy.”

At the time, as a member of the Anthropocene Workgroup, she and a group of international climate scientists were focused on defining and measuring nine “planetary boundaries,” environmental indicators of planetary health. At the top of the list was Climate Change because, one way or another, it negatively impacts the other eight measures.

Not the least of these “human perturbations” is the effect of global warming on access to clean, safe water, and the impact of violent weather cycles and rising sea levels on concentrated urban populations along coastal waters.

A less recognized, but historically well documented threat, is exposure to migrating vectors of disease as they contact unprepared human populations beyond their traditional camping grounds. The threat of avian flu among migratory birds has been well covered. Equally, over the past decade, North America has seen a range of novel infections, especially along our southern borders, from dengue, to chikungunya, to Zika.

The southern United States and its coastal populations are firmly in the cross-hairs. Their seas are rising at an alarming rate, and fouling fresh water supply with invasive sea water. Their soaring temperatures are only exceeded by record setting atmospheric river rainfalls and flooding events, and their “extreme poverty throughout Texas and the Gulf Coast states, where inadequate or low-quality housing, absent or broken window screens, and a pervasive dumping of tires in poor neighborhoods,” as reported in this weeks New England Journal of Medicine, assures a reemergence of one of this countries most significant, but now long forgotten killer diseases.

In 1853, the disease killed 11,000 in New Orleans, some 10% of the population. Twenty-five years later, it overwhelmed Mississippi Valley cities killing 20,000. Its latest major foray in the United States was in 1905 with 1000 deaths. Its’ absence over the past century is credited to public health and structural and engineering advances. But that was then, and this is now.

The disease is Yellow Fever, and red lights are blinking in a range of southern coastal cities from Galveston, TX, to Mobile, AL, to New Orleans, LA and Tampa, FL.. Experts say they may soon be in the same boat as Brazil was between 2016 and 2019 when it experienced a threefold increase in the historic prevalence of the disease among its population.

Public Health sleuths have uncovered that the 1878 epidemic in the Mississippi Valley was triggered by an El Nino spike the year prior. The warmer and wetter conditions are believed to have supported a large increase in Aedis aegypti mosquitos, the vector for the Yellow Fever virus.

Are we prepared? Recent experience in fighting Dengue fever in the southern statesis not encouraging, with WHO chief scientist Jeremy Farrar warning that Dengue might soon “take off” absent better mosquito eradication and screening prevention. U.S. Public Health experts say a Dengue foothold is nearly secured and the disease is fast on its way to becoming endemic in southern coastal states.

As for Yellow Fever, there is an effective vaccine, but it is also associated with rare but serious side effects. Antivaccine activism post-Covid would be a significant barrier now say experts. Adding to the challenge, no Yellow Fever vaccine is currently available from the U.S. Strategic National Stockpile. Mosquito surveillance programs are currently marginal, and response capabilities for mass vaccination in affected areas are severely limited.

The Anthropocene Workgroup is fully aware of these human instigated crises. In the prior Holocene Epoch of 11,700, we prided ourselves with being able to co-exist with other lifeforms and in equilibrium with a healthy planet. But beginning in 1950, the new Anthropocene Epoch has aggressively chipped away at planetary health, disrupting stabilizing cycles, and critically raising the temperature and acidity of oceans that cover and buffer 70% of the planet.

The return of Aedes aegypti, and the Yellow Fever virus it carries, is a dramatic harbinger of additional challenges to come if we are unable to limit “human perturbations” of our planetary cycles.


Mike Magee MD is a Medical Historian and regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex.

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