The OP Travel-Health archives | “While we wait for the COVID vaccine roll-out to ramp up (and just get going!), ‘hanging in there’ is a real thing we non-healthcare workers can do to help.”
By Deborah Sanborn | Outpost Travel Media | Jan. 2021
What can we say about 2020? What a dreadful year. For me, it started in January, with the shocking news that my former boss of my first professional job after university had passed away. I didn’t even know he had been ill. That job was at a five-county public health unit in Eastern Ontario, and my boss—a true mentor—was Dr. Robert Bourdeau. For 21 years, he was its formidable Medical Officer of Health, of which I was there for a few.
Then the pandemic came, and everything changed—well, maybe for those of us in parts of the world not so impacted by such events. In fact, infectious disease outbreaks, epidemics, and pandemics—they are distinct classifications—have erupted several times over the last century. And as goes travel, so goes their spread.
Like COVID-19, many of these diseases are zoonotic—born in non-human animals, their pathogen hops from them to us. Ebola—a highly infectious, painful and very deadly disease—has killed thousands of people in Central Africa over the 45 years it’s been identified. Scientists have only recently traced the Eloba virus to bats, and bats that scatter contaminated droppings as they fly.
Bats can fly very high and very far and are great asymptomatic carriers: they host many deadly viruses but never get sick themselves. Which means they can easily infect other animals who come in contact with them or their droppings, who then come in contact with humans. An Ebola vaccine only emerged for widespread use in late 2019—welcome news, as over the past two years outbreaks have erupted in the Democratic Republic of the Congo, where according to the World Health Organization, almost 2,300 have died. Outbreaks between 2014 and 2016 in just three African countries killed more than 11,300 people.
There’s still no therapeutic “to neutralize the virus,” as the WHO describes it—meaning supportive care like IV fluids is the range of treatment options. (“Potential treatments” like drug therapies are apparently “being evaluated.”) Identifying and quarantining infected people and their contacts has been till this year the only weapon to lessen Eloba’s deadly spread.
Yet likely the most deadly infectious disease event in the past half-century has been the HIV/AIDS pandemic—a tragedy of terrible proportion, in part because governments across the globe initially ignored its devastation and lost valuable time in containing it. It was thought only a sexually transmitted disease (it’s also bloodborne and can be contracted through contaminated instruments like needles)—and, let’s face it, one that only affected the gay male population (it didn’t; it doesn’t). Ironically, we have that community to thank for mobilizing and forcing governments (and more health authorities) to take the threat of HIV seriously. And in forcing our societies to just deal with it as a modern health crisis.
Scientists now believe that HIV—human immunodeficiency virus—originated in primates in Africa (in primates, it’s called SIV) and made the leap to humans possibly 50 or more years before it began travelling around the world by the late 1970s. UNAIDS estimates anywhere from 56 to 100 million people have been infected with HIV since that time, and about 25 to 42 million have died. (Exact numbers are hard to pin down because identifying all infected has been difficult and inadequate.)
In 1996, antiretrovirals to treat HIV in humans came on the scene and proved effective in taking it from a death sentence to a survivable condition.
This year, seeing COVID-19 spread like wildfire from one continent to another (every one except Antarctica) to infect so many so fast (according to the Coronavirus Resource Center at John Hopkins University, as of this writing, approximately 92,100,000 people and counting), and to kill more than 1.97 million, with likely thousands more by the time it’s done—well, it’s been astounding.
“And microbes are great travellers. Which means travellers have a role in mitigating risk and transmission. Transmission is a microbe’s act of survival—ours is to stop it.”
Yet this is what the toll infectious diseases can take looks like in real-time—on countries and communities, on families and people; the toll they’ve taken all over the planet for much of human history.
The thing for non-healthcare workers (like me or maybe you) to keep in mind is that diseases are great travellers. The flu pandemic of 1918-20 that killed 50 million was spread by all the travel that took place at the end of the First World War. In the aftermath of the Second World War, gonorrhea and syphilis were rampant and travelled across continents with returning soldiers.
The other thing to keep in mind is that healthcare workers are always the ones on the frontlines. In 2003, SARS (severe acute respiratory syndrome, caused by a strain of coronavirus) killed 44 people in Canada—two nurses and a doctor among them, with 164 healthcare workers getting severely ill. (I remember that in real-time.)
I learned a lot about health history after my former boss asked me to write the story of the Eastern Ontario Health Unit, an agency he was immensely proud of and dedicated much of his talent to. The EOHU started as a pilot project in Ontario in 1935—it was the first fulltime rural public health agency staffed with a fulltime medical officer of health and crew of nurses. Stationed in the hamlet of Alexandria, it served a tri-county area for a five-year pilot period.
In 1935, that pocket of eastern Ontario had an alarming infant mortality rate, and tuberculosis—an infectious and then often-deadly disease—was devastating families. Poverty had always been a regional problem and the Depression was making it decidedly worse.
When the nurses hit the ground, one of their priorities was to find every person infected with TB in the region, and every person in contact with someone with TB. They fanned out, driving down dusty or snow-packed rural routes, making visits to schools, homes and workplaces, getting to know the people in their territories and on the lookout for any sign of the disease’s presence, especially in families.
They helped organize and operate the travelling diagnostic clinics (vans with X-ray machines; TB was mostly a pulmonary infection) that were taking place to fight TB at the time. I interviewed Ola Dancause, a nurse on staff in those early years, who told me they spent days at county clerk’s offices looking for people who might’ve died from TB, so they could trace their contacts and have them brought in and “checked.”
There were no drugs to treat TB then; antibiotics, which eventually proved effective, had yet to be invented. The only option was restorative care—getting rest, eating healthy, hoping the body could heal itself. Quarantining those afflicted was core to the strategy of reducing the disease’s prevalence in the region.
By far, the hardest part of the job was convincing people to quarantine: asking men to cease working, including on their family farms; asking women to isolate from their children. And when necessary, persuading them to enter a sanatorium (a rehab hospital that specialized in TB) for months, sometimes even a year or two.
It was arduous work, and took enormous diplomacy and relentlessness by that pioneering group of women. (The pilot unit also worked with local authorities to get a sanatorium built nearby, and in 1937 one went up along the St. Lawrence River in Cornwall—that building is still there.)
But it paid off—over the five pilot years, the local TB rate began to plummet. By 1940, the provincial government decided the project had proved worthy and it moved to Cornwall to become permanent. That’s where I worked with Dr. Bourdeau, who was long retired at the time of his passing.
I’ve been thinking about him during the COVID-19 crisis; he was an early advocate for making health education and disease prevention top priorities, and it was a tough fight at times. (People were not happy when local public health nurses stopped checking for lice in schools.) He was a dedicated public servant, and would’ve offered to join the fight, if needed.
When outbreaks (like Ebola or SARS) or epidemics (like TB) or pandemics (like HIV and COVID-19) happen, healthcare workers all over the world put their lives at risk to help victims and sufferers. This year brought home just how insidious microbial diseases are, can be, have been, and likely always will be to the human population—we will always interact, commune, play, have sex, and travel.
And microbes are great travellers. Which means travellers have a role in mitigating risk and transmission. Transmission is a microbe’s act of survival—ours is to stop it.
We do that by listening to the experts and respecting the science. By cooperating in fair asks of prevention—social distancing, quarantining, wearing a face mask (I mean, how hard is that?!)—and by adapting to changing circumstances. We do it because events like this happen often in human history, but take comfort in knowing we’re getting better at navigating them every passing century.
The takeaway for travellers (because not travelling is not an option; travelling makes people better) is simple: go immunized; beware your hygiene habits in-country (take hand-sanitizer/alcohol, wash hands often); add face masks to your travel kit (don’t be shy about wearing one); take direction from local authorities and tour guides. Be adaptable, amendable, a good global citizen. And don’t argue with flight attendants.
There’s no doubt healthcare workers worldwide are the heroes this year. Compared to putting your life on the line in the service of others, what’s the hardship in getting vaccinated to achieve herd immunity, or in wearing a mask? I mean, really?
Deborah Sanborn is Editor-in-Chief of Outpost magazine