cynics4bettertomorrow.org

I’ve posted previously about the possibility for future pandemics. I’ve predicted that the next deadly pandemic would come from am “old” well-understood disease, possibly one with an already-known and tested prevention, cure, or treatment. I mention TB as one of several things high on my list of possible culprits. Current events though give a very high risk of drug-resistant, or multiple-drug-resistant, or extensively-drug resistant strains of TB emerging from North Korea.

North Korea has a number of public health problems and issues. These include widespread malnutrition which lowers immune systems making people more vulnerable to TB and other diseases, problems obtaining a steady source of medications. Amnesty International reports in their 2010 report The Crumbling State of Health Care in North Korea that “Hospitals in North Korea no longer have medicines. Medical personnel either don’t receive any or if they do, they sell them in the markets.” Doctors write down what medicines to give the patient, and the patient or their family must figure out how to procure them. Often the hospital or clinic doesn’t have any to give. In North Korea, officially, medication cannot be purchased in a pharmacy. It is officially freely provided in hospitals, but they may not have any, or they may require a “gift” of cigarettes or alcohol to get them, or the healthcare providers sold what they have to vendors at the market. So, often they are purchased in the markets. However, these markets are filled with counterfeit drugs along with real ones. Sometimes, if they have a family member who has left North Korea, and is in China or some such place, their family member may send them through the mail – which takes time and is subject to confiscation . Or, they do not have the money to get drugs at some point, and may stop them. Sometimes, due to side effects – and the drugs used to treat MDR TB have severe side effects, they may decide to let the patient’s body “rest” for a month or longer before resuming medication. Or, in the absence of any clear directions from a medical provider, may take them wrong – like without food instead of with food, with food rather than without food. Of course, this is compounded by the fact that many people in North Korea can only afford or obtain one meal per day. In any event, this involves taking the drug for an insufficient period of time, stopping the drug, then restarting it.

This is an instant way of creating a drug resistant strain! If it’s done with an already resistant strain with another medication that the strain is not yet resistant toward, this will give it resistance to the new drug as well – creating the XDR type of TB strain – which is mostly untreatable. According to Doctors Without Borders:

“Resistance can also develop if the bacteria are underexposed to drugs, because of under-dosing or if the treatment is interrupted or not continued for long enough. In all of these cases, treatment is likely to fail and the disease will re-emerge in a more resistant form, meaning that fewer drugs will be effective against the bacteria.”

Since the end of the Korean war in 1954, North Korea has very effectively closed its borders to the outside world.In effect, they have quarantined themselves to everyone outside of North Korea.  During the 1960s and 1970s, they had state manufacturers of pharmaceutical products. North Korea made big inroads in the number of tuberculosis cases during that time. However, “it “lost momentum” during the economic crisis of the 1990s when pharmaceutical and medical equipment factories shut down”  See more in The Crumbling State of Health Care in North Korea from Amnesty International.

To compound this problem, the North Korean Military, which has the largest standing army in the world, treats its soldiers who are discovered to be ill with tuberculosis by giving them the drugs for a few weeks or a few months until they are feeling better, discontinues treatment, and sends the soldier back to his unit. This not only makes drug-resistant strains come into being, but army life in any army is an effective way to spread tuberculosis.

Indeed, health care has crumbled to the point that it’s no longer useful or usable, nor effective at treating or preventing these types of diseases.

I was unable to find the actual infection rate of TB in North Korea. According to The Crumbling State of Health Care in North Korea , 5% of the population have currently-active tuberculosis, and many more are infected. That is a HUGE number! Furthermore, they also state that among those previously-treated for tuberculosis, a whopping 23% of them have TB-MDR! It is held by Voice of America and Global Security to be just under the rate found in sub-Saharan Africa. The World Health Organization states that approximately 1/3 of the earth’s living inhabitants are currently infected with tuberculosis. It is reasonable to believe that the rate in North Korea is much higher. 23% of all previously-treated cases of TB in North Korea currently have Multiple Drug Resistant TB.

Currently, as of this writing, there are some huge issues going on regarding North Korea. For one thing, the populace is starving. A desperate, hungry population will do almost anything, or take any risk, to feed themselves. They literally have nothing to lose. People from North Korea sometimes get across the demilitarized zone into South Korea, which takes them in and assimilates them into their society. China and Russia get immigrants across their borders from North Korea, even though it is an arduous trip over some rugged mountains. If they are discovered in those countries, they are returned to North Korea, with the migrant being imprisoned in North Korea. China gets the most migrants, and is North Korea’s closest political ally.

However, if a lot of such people begin pouring over the borders at once, especially if a significant portion of them are carrying drug resistant, multiple drug resistant, extensively drug resistant, and poly drug resistant strains of TB – the latter two being nearly impossible to treat and being effectively a death sentence for anyone who contracts these, they are going to do everything they can to keep carriers of such airborne communicable, expensive-to-treat or untreatable deadly diseases out of their country. It is no accident that Global Security, a private organization giving information and opinion about world military concerns, has this issue on their Weapons of Mass Destruction (WMD) page. Indeed, the North Korean populace – as well as their armies – are weapons of mass destruction in and of themselves! Even if they don’t intend to be, and no one deliberately put them up to it. They are carrying a deadly disease. TB would not make a good bioweapon, in the conventional sense, because it takes too long to make someone ill or to kill them.

The Chinese, Russians, and South Koreans – with United Nations aid, can effectively guard their borders from the few people who try to cross. A few get through anyway. If, things change, as it appears that they might, and millions of people come pouring across their borders, there is no way their conventional border patrols and military units on those borders can combat it. Russia and China may have to use weapons to kill everyone in some zones – including some of their own military – to keep these infected people from entering their country. South Korea, with it’s 50,000 troops and 3,000 UN troups, would be quickly overwhelmed by millions of unarmed people flooding at them.. plus the gigantic North Korean army. They could only machine-gun down so many, and grenades would only stop some. These are desperate people, without food or other requirements for life.

Assuming that everyone in the world agrees it’s a good idea to stop the spread of widespread DR, MDR, XDR, and PDR Tuberculosis from North Korea, and to go to any lengths we have to in order to protect ourselves from this threat endangering lives throughout the world, this would still not be simple. With that many people pouring out, there may not be enough conventional weapons which could be deployed in the immediate timeframe. Many more military personnel and equipment could be brought there with all of the aircraft carriers and ships belonging to everyone nearby, but with millions of people, that might not be enough to stop it. Of course, getting everyone to agree on anything is nearly impossible, especially in light that the majority of these people would not be the Korean military, but Korean refugees seeking food and medical care. Even if their disease is likely to be deadly to much of the world, there is the ethical dilemma over killing civilians.

Tuberculosis is an “orphan disease” – one which is not seen as effecting the wealthy of the world, and not being particularly profitable for a pharmaceutical company to develop, test, manufacture, and market a new drug – e.g., antibiotic – that would treat these drug-resistant strains of tuberculosis. The customers for these drugs are typically governmental entities and charitable entities with limited funds. The profit motive has prevented such a thing from being marketed, and it probably cannot be after TB-MDR, TB-XDR, or TB-PDR start effecting the masses.

Of note, the Korean War has never been declared officially over. We’ve merely been in a cease-fire since 1954. If this happens, the Korean War is back ON. Seoul, the capital of South Korea, is only 30 KM (~20 miles) from the demilitarized zone. Other countries might not be able to offer their assistance to the Koreans. The US nearly always has an aircraft carrier nearby, or often more. The end of the Korean-War cease-fire, in effect since 1954, could be jeopardized further from the fact that North Korea pulled out of that armistice in 2010…. Were they planning to leave North Korea in search of the necessities of life?

The North Korean government, although it’s down to nearly nothing as far as resources, does indeed have enough stocks of food and weapons to supply their army for several months. Additionally, it’s got short-range and medium-range missiles, and it is working on or may even have, intercontinental missiles. They also have a dirty nuclear bomb. As the North Korean government is likely desperate for its own survival as are its individual people, and as unstable as their government leadership is, they would likely to have few qualms about deploying these weapons – at South Korea, Chinese cities, Japan, or possibly the United States if they actually do have intercontinental missiles. That would be a huge nuclear disaster! No matter who sets off a nuclear device in Korea, it will not sit well with Japan which is set to get their fallout… they had “their share” of nuclear fallout at the end of World War 2!

Depending on how this is handled, this could become World War 3 with a “quick and dirty” end involving weapons of mass destruction, or it could be a slow destruction of mankind through pandemic and bleeding all worldwide money available to provide healthcare dry shortly with much of the world being suddenly exposed to, then infected with, these drug resistant strains of tuberculosis. Neither way is good.

In 1951, President Harry Truman fired General Douglas Macarthur because General Macarthur wanted to keep fighting the North Koreans until North Korea was completely defeated. President Harry Truman wanted to keep it a “limited” war, so fired General Macarthur. This was unpopular among US citizens. In retrospect, didn’t perhaps General Macarthur have the right idea, and if this scenario, or anything like it happens, Harry Truman, a “folk hero president”, might end up being the cause of world destruction decades after his death?

There is good news: No one from any worldwide health organization has reported any incidence of AIDS in North Korea. They haven’t let their citizens leave North Korea since 1954 – well before AIDS was on the scene. Homosexuality and drug abuse carry the death penalty in North Korea. People who are allowed to leave North Korea, as are foreigners who are allowed to enter North Korea have government minders with them at all times – they are not going to abuse drugs or have gay sex under those conditions! The North Koreans have proven that quarantine works.

However, tuberculosis is now considered an AIDS-defining disease – if you’ve got TB, it’s AIDS, along with numerous other diseases – common and uncommon, regardless of the results of an HIV test or the absence of such test results. Maybe it seems more palatable to people to gun-down hoards of people coming your way with AIDS, than it is to gun down starving refugees with tuberculosis.

Blood tests designed to detect active tuberculosis are inaccurate and should be banned according to the World Health Organization.

http://www.bbc.co.uk/go/em/fr/-/news/health-14234575

This is a frightening concept. These tests give accurate results 50% of the time and false positives and false negatives 50% of the time. They are mainly manufactured in first world countries including the USA and Western Europe, and mainly used in poor third world countries, including both India and China, which have high percentages of TB cases. See World Health Organization TB statistics. Put in simpler terms, they’re no better than a coin flip being used to diagnose TB. “Heads you have TB and need treatment. Tails you do not have TB.” The World Health Organization wants to ban these tests as a threat to health and as unethical.

False positives cause people to be treated with powerful drugs – with risks including death when they do not need it. It also causes the real cause of their feeling ill to not be diagnosed and allowing it to progress. False negatives allow people with active TB to be in the community spreading their disease without realizing it, and with a false belief that they are “safe”.

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For a long time, I’ve been predicting that the next bad, global pandemic will not be due to some new, unknown disease which requires research into its cause, its prevention, or its cures and which requires trillions of dollars in research grants. Rather, it will be an old, well-understood disease which has been known for hundreds, if not thousands of years, having killed or disabled millions or billions of people before us. The research community, in a combination of pride, quest for research dollars, will likely overlook this mundane cause and waste precious time searching for a new, exotic cause. Mainly, they will believe it, although it is possible that some of the institutions behind the research, including corporations and governments, will know that the researchers are on a wild-goose chase.

I’ve written in this blog about pandemics before, and never in human history has anyone prepared for any global pandemic. We won’t be any better prepared for the next one. Fortunately, in the case of such a thing as tuberculosis, the disease-causing organism, its effects, diagnosis, procedures to reduce the spread, and drugs to cure it are already known. Yes, even in the case of drug resistant tuberculosis – it’s just that the drugs are not as old, are more expensive, more dangerous, and take longer. However, even in light of everything that can be used to prevent, diagnose, treat, and cure this disease, I am quite cynical of it being recognized in time… by anyone.

The next pandemic may or may not be tuberculosis. It could be any number of old, well-understood diseases with known effects, diagnostic criteria, diagnostic aids, procedures to reduce the spread, drugs to mitigate or cure, and/or vaccinations. Polio is high up there on my list of possible causes for the next global pandemic. It fits that bill well. It is highly contagious, and kills its victims faster than does tuberculosis – and just as gruesomely. It can be tested for. It can be prevented either by ensuring fecal matter from an infected person does not become someone else’s drinking water without first going through a process to kill the virus. Sewage treatment, water treatment, chlorination, and boiling will all work for this. So will other measures like not getting your water out of a water source that is contaminated with sewage. It is typical to hear communities having “boil orders” after discovery of Fecal Coliform or E. coli in their drinking water. How it got there is often someone upstream not adequately treating their sewage before dumping. E. coli have gotten in other things, like manufactured foods, meat or vegetable handling plants, and even in bean sprouts. If E. coli can get through our sewage treatment plants, our water collection sources, water treatment plants, so can polio. If you think you’re safe if you drink bottled water, think again. The Food Safety Authority has confirmed that a survey in 2007 found that 1% of samples of bottled water had E. coli. Furthermore, it was proven that some bottled water was made merely by a plant bottling tap water from the water system in the city in which they are located according to Corporate Accountability International, a U.S. watchdog group, as reported by CNN.

There are areas in the world where polio has not been eradicated. Two such regions are the oil-rich Niger Delta region of Africa, and Afghanistan. As few people have been vaccinated against polio over the past 25 years or so, partly from complacency partly from that vaccines, including the polio vaccination, cause autism”>false beliefs spread widely by Dr. Wakefield “>that vaccines, including the polio vaccination, cause autism, partly from the false belief in some areas of the world that vaccines are a western plot to sterilize Muslim women and is endemic in such areas as Afghanistan, Tajikistan, and Pakistan With the NATO forces fighting in Afghanistan, and the Taliban pouring over the boarders to surrounding counties, all it will take to get another polio epidemic started is one tourist, military member, refugee, missionary, NGO relief worker, or business person to come back infected, who may not even be showing symptoms, use the toilet as they normally would, and it all takes off again. Another consideration is that people travel both inside and outside the US or other home countries much more often now than they did in the 1950s, the time of the last epidemic. This will just speed things up.

Syphilis is also high on my list for old diseases becoming pandemic. Long nicknamed “The Great Imitator”, it can be mistaken for many other diseases – or it could be mistaken for a new and unknown disease. The NIH still says that congenital syphilis is underdiagnosed and a major problem in other countries. There are some ideas floating about that what we call “AIDS” is actually tertiary syphilis. There may be something to it, in at least some cases. Some of the defining syndromes that are associated with AIDS were first documented in the early 1900s with syphilis patients. Both are said to be spread the same ways. The “HIV causes AIDS” belief has yielded nothing in 30 years in the way of curing the disease, stopping the spread of the disease, preventing death from the disease. Billions, if not trillions of dollars of research money has been used, and it’s been by lots of very bright people in many countries, working with governments, hospitals, Nongovernmental organizations, universities, pharmaceutical companies, and we’ve got nothing for it. Perhaps it’s time to look for something else, but that will be a future blog post.