October 2014

Poughkeepsie Journal (Hudson River Valley, NY), 1797 (from the microfilm collection at Adriance Library, Poughkeepsie, NY).  


Yellow Fever invades Philadelphia.


This small item published in the Poughkeepsie Journal is the tale of what happened in Philadelphia, when the yellow fever struck it in 1797.  40,000 people fled the city in just days.  Once more ships infected with yellow fever struck New York, just as many fled the streets of its greatest city, finding refuse upstream and in the more rural settings of the Hudson River Valley in New York. According to the weekly reports that appeared in the papers about either of these disease outbreaks, deaths climbed from the hundreds to the thousands in a very short time.  


Much the same is happening right now or readying to take place for Ebola.  The article this image links to details how to deal with a global epidemic catastrophe ‘in just five steps.’

Source: www.vox.com

To understand human behavior during an epidemic, we need only turn to American history.  When yellow fever came to Philadelphia in 1797, deaths were in the thousands per week by the time the outbreak peaked within the urban proper.  Many of these deaths occurred at home or in the Almshouses. Much of this news was published by the weekly newspaper of the Hudson River Valley, the Poughkeepsie Journal, the major newspaper for lower New York State along the Hudson River Valley.  


According to this brief report, in just a few days to weeks, the City of Philadelphia experienced 40,000 departures as the residents left surviving escaped from the core of the city, creating congestion along the way as they relied upon local merchant ships and wagoneers to make their way to safe haven.  


At times, these passengers unknowingly brought the disease with them, or at least the means for infecting the next mosquito vector that consumed their blood before making its way to the next victim(s).  In this way, the yellow fever managed to spread from one town to the next, one city to the next, one poor neighborhood to the next, whether it be from hamlet to city, shipping port to shipping port, port city to countryside.  


The late 1790s yellow fever epidemic and the one or two that recurred later were all it took for doctors at medical schools in New York, and Philadelphia to implement and succeed in producing the first effective quarantine practice.  In New York City, they relied on the islands just outside New York City, in the harbor and adjacent riverways.    


These quarantine practices were put to the test over the next decade or two.  In the 1830s, they were no longer that effective when the next major epidemic made its way to the United States.  The famous Asiatic cholera, originating from large ports in India, made a brief stay in the U.S. in 1832.  In winter of 1848/1849, it began are more aggressive importation in February from India to the Mississippi River delta, just before the Gold Rush in lower California began.  


Since the Gold Rush pioneers were mostly boys and men, they did not bring the cholera with them westward as much as the later pioneers would do.  Re-emerging in Spring of 1850, and again in 1852, between April 15th and May 30th for each of these years, the experiences of the large numbers of deaths due to cholera were penned in Oregon trail diaries.  


Just west of Fort Kearney, these Oregon Trail pioneers wrote about the deaths that ensued following their brief stay at Fort Kearney, where thousands of people moved about on a busy day.   Departing Fort Kearney, they penned their experiences and observations and they witnessed dozens of people taken ill by the disease, many dying, except for young men and young boys.  


The reason for these "hot spots" west of the Fort were several.  Climate, distance travelled, close contact and population density were perfect for making this outbreak happen.  With each death, the remains left behind found new victims passing through.  It ended up, the environment was perfect for maintaining a steady culture of Vibrio cholerae within the alkaline waters filling freshly dug drinking wells.  "Dig your own well" was the saying for the time.


This outbreak was more deadly than any other diarrhea like contagious disease for the time, including the most likely dysentery to strike the people in Nebraska at this time.  Until vibrio came upon to the plains, a Salmonella intermedia (and perhaps Listeria) growing upon the rotting flesh of bisons was known to cause severe diarrhea.  For the pioneers, those who made it past Fort Kearney and a similar outbreak next to Fort Laramie, Wyoming, were often put at risk by the decaying carcasses of oxen and cattle that died while trying to ascend the eastern face of the Rockies.  (See my thesis page on this research, for more detail, at http://oregontrailcholera.wordpress.com/  .)


When an outbreak happens. human behavior becomes difficult to manage, almost impossible to control or predict.  If the Ebola outbreak were to reach the U.S., and if its severity were to reach the level that cholera reached during the 1850s, what we should expect to see is a disease that spreads like "wildfire" (taken from the Andromeda Strain).  The diffusion would be from neighborhood to neighborhood, one population setting to another, in a heterogenous, mixed radial-hierarchical diffusion process (using Gordon Pyle’s sense of the words, see https://brianaltonenmph.com/gis/historical-disease-maps/john-c-peters-and-the-asiatic-cholera/1960-pyles-cholera-diffusion-and-migration-patterns/ ).  


By keeping a close watch on this outbreak–were it to happen (I am trying to be rational about this)–spatial epidemiologists would no doubt have a very unique opportunity to map one of the most aggressive epidemics to take hold of its victims in fairly short time.  Due to its incubation time, this Ebola would always be a little ahead of them, by two or three weeks.  


My proposal is that this disease (see my July 7th ScoopIt!, personalblog, and map image: https://wordpress.com/post/7215587/41081 ), is that it will follow a dual path mathematically (nature’s common practical joke on us).  It will be opportunistic and appear very deterministic in its earliest habits, but demonstrate the more complex migration patterns (Pyle’s mixed models) as time passes for each setting;  transportation helps to define these stochastic (chaos theory) behavior of the disease, and will ultimately define whenever and where ever the Ebola decides to travel to next.  All of this makes prediction modeling a much tougher process.  The most likely routes, based on natural ecology, not human ecological impacts, are noted on this map.


It is important to note here that Ebola is a viral disease, not be spread by airborn vectors like the mosquito born yellow fever or more recent west nile (that is for not, it is not airborn).  Still, Ebola is more deadly than the west nile and yellow fever.  In terms of appearances, it may be as bad as or worse than the looks of the yellow fever and cholera victims during their dying hours.


But more importantly, Ebola is different from Yellow Fever and Cholera because it has a more distinctly landborn element as part of its natural ecology.  


Vibrio cholerae remain alive in deltaic brackish saline water, are dependent upon copepods, and from there enter into the higher animal portions of the food chain or web.  West Nile survives the winter due to its hibernation in surviving female mosquito bodies not destroyed by the coldness of winter, able to arise and infect their first animal or human victim of the year.


The spatial limits for each of these are the chemistry and zooecology of the aquatic environment, and the need for the right climate and water.  


Ebola lacks these restrictions to aquatic and shoreline settings.  Yet it still bears some other features of its own, that may even be foretelling.  


Ebolavirus can remain alive on land where certain mammals reside.  Its ability to survive within a supporting ecosystem, without incidence of human involvement, is very much possible.  Even in distant places, Ebola can reside for a considerable length of time, undetectable and unpredictable by contemporary surveillance programs.  Regions that are poorly managed, poorly funded, and otherwise forced to live with underfunded health surveillance programs are going to be the most impacted by this disease.  They also bear the population most at risk due to sanitation problems, their social disconnect, and their problematic lifestyles.  Regions that are rich in domestic and wild animal populations but lacking adequate disease surveillance programs for zoonotic diseases, are where this disease could most likely have its greatest impact on local public health.  


So can we really afford to prevent a disease like Ebola?  much less stop it in its tracks should it become an ecological phenomenon.


Due to the mobility of its hosts and carriers (mammals, esp. frugivorous bats), Ebola is capable of migrating where ever it needs to, given enough time and new victims.  It may not even be an immediate human threat, until its finds the right human ecological setting to establish its new domain.  According to the research of its hosts, carriers, vectors, zoonosis ecology, there are specific regions that exist, each with its own outbreak and nidus development potentials.  The way to define these regions and what the Russian geographer call their ‘metaxenotic potential’ and combined host-human spatial region, is defined by the works of Voronov and Pavlovsky. ( https://brianaltonenmph.com/gis/historical-disease-maps/zoonoses/ &nbsp😉

See on Scoop.itMedical GIS Guide


http://youtu.be/Yb4P_QM-Rjc IMG 1275 AFRICA

Source: www.youtube.com

I did these studies years ago about African health history, disease patterns, linked human behaviors, genetic, and culturally-bound disease patterns into the US.     


I broke down the African cultures in-migrating into the slavery era defined, post slavery and predominantly Muslim related in-migration periods.  These ICDs related to African heritage were then  reclassed into those groups,  and about 180 definitive ICDs for African influence defined.     


This 3D rotating map is one of the first I produced depicting my study results.  It was used to demonstrate the value of the Remote Sensing equations when applied to grid modeling techniques, the mathematical method I designed for implementing this detailed US epidemiological surveillance technique.   


Other examples of my cultural ICD 3D mapping studies are at [Topic: Inmigrating Disease Patterns]     https://www.youtube.com/watch?v=zQ60npQzdTk&list=PLWrApErk5bybFfsOWTXWjlwvIM7D4d6-h    


The primary, secondary and tertiary mapping developed begins with the basic in-migration patterns, followed by cultural-behavioral and then genetic diseases, all identified based upon ICDs.   


This Youtube site is also rich in sociological, zoonotic, genetic, V-code and numerous other foreign born and/or re-emerging disease patterns that I developed NPHGs for.   


See: https://www.youtube.com/watch?v=dSP6tOQs-RQ&list=PLWrApErk5byZnE0bWUqdfH4CYVmnETLg6    


My REGIONS & HEALTH pages provide specific applications for these techniques.  The Pacific Northwest issue for example was detailed and discussed extensively a few years ago, beginning with    


Regional Health Planning and the Pacific Northwest Medical GIS and Regions series    



I posted hundreds of examples of the 3D mapping in this series, 

with GIS applied specific to Pacific NW issues on the page at     http://wp.me/Puh6r-8l2    

See on Scoop.itNational Population Health Grid

CDC Confirms First Ebola Case Diagnosed in U.S.

Source: abcnews.go.com

We can rationalize it as much as we want to, but it still happened. Now we are left with an opportunity to look at the exact number of people possibly in direct, indirect and atmospheric to inferred indirect contact. Directly and indirectly infected places versus infected people can be documented. Right now it is only a case that is a loner within the lone star state. It is not how many cases there have been and how many of these were fatal that matters so much any more. The question might do become what stage in that exponential growth curve are we in? and what is the doubling time? Right now we are in the first stage of disease ecological development in a spatial diffusion process. Pure spatial features defining this outbreak make it a radial event to imagine. Hierarchical human diffusion pattern make us worry about whether there is (will be or could be) a direct flow of the contagion between airports impacting other latitudes in the US, or might it be restricted mostly to intrastate patterns? Due to incubation times, we may now have to wait two or three weeks to find out. Fortunately, seasonal climate changes are on our side, since the cooler months of winter are approaching in Texas. Geography and climate are in favor of the outbreak for the next month or two spatially. The lack of US engagement in this crisis several months ago means we are directly responsible for our own fate at this point. There was no reason or logic for our failure to engage in appropriate preventive health care practices two to three months ago. The outbreak status here has moved from prevention to containment stage. By now, if we are fully prepared in Atlanta, transportation analysts should know the flow patterns in and around this new potential nidus–by air, land and even water. If not, we’ve been caught with our guards down. By tomorrow we’d better know how a potential host-vector relationship might develop. Even once human cases are fully contained, an animal born ecological nidus can still develop. An eastward, northeastward flow pattern out of Texas is therefore favored. But I am really just looking at worst scenarios here. Let’s hope this Texas case remains on its own turf and hospital bed in the Lone Star state. History show us that it is nearly impossible to prevent foreign born diseases from coming to the U.S. We can delay entry, but if ecology is in favor of transmission and human behavior remains the same, nature simply waits until we let our guards down again. When it comes to man versus nature, we may first win out spatially. However, temporally, nature is not on our side.

See on Scoop.itMedical GIS Guide

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