The following look at the history of public health and infectious diseases was submitted by Barrie resident Peter Bursztyn.
*****************************
Public health began with doctors discovering causes of disease and how diseases spread through a community.
One example is cholera. A young doctor, John Snow, assembled the known facts and, correctly, pinned the blame on drinking water contaminated with sewage. He famously removed the handle from the Broad Street pump, the contaminated well, stopping the outbreak.
However, the cholera problem was solved by engineers. Joseph Bazalgette built underground sewers and pumping stations to carry London’s human wastes down river to tidewater. The sewers were completed some 20 years after John Snow’s discovery.
By then, it became clear that waste could not just be dumped into the sea. This led to the development of sewage treatment facilities – more engineering.
Malaria is a killer disease; more than one million people die from it every year. We tend not to notice because most victims live in Africa and South-East Asia.
However, in the 19th century, malaria was endemic throughout Europe, south of Siberia, and along the East Coast of North America from Quebec and Ontario on south.
One thousand men died during the construction of the Rideau Canal, completed in 1832. Half of the deaths were due to malaria!
The last Canadian victim of malaria died in the 1920s. A drug to cure malaria was discovered by traditional South American healers. They found that the boiled bark of the cinchona tree yielded a bitter beverage which cured malaria.
By 1570, Catholic monks brought this treatment to Europe. However, treatment was costly and available only to the wealthy. Accordingly, this drug (quinine) had no impact on Europe’s malarial plague.
In 1894, Patrick Manson, a British doctor suggested that malaria could be carried by mosquitoes. In 1897, his student, Dr. Ronald Ross, proved this was true and in 1902 was awarded the Nobel Prize for medicine.
Then malaria control shifted away from doctors. In 1901, John Smith, state entomologist for New Jersey, abandoned the agricultural pests he had been studying to work on mosquitoes. (Unofficially, New Jersey was then known as “The Mosquito State”!) Within a dozen years a combination of bullying regulations and draconian enforcement virtually eradicated malaria from New Jersey. A victory for bureaucrats!
Malaria and cholera were not the only infections limiting the lifespan of 19th-century Europeans to around 40 years. Other
killer diseases at that time include pneumonia, tuberculosis, childbed fever and diarrhea.
Toward the end of the 19th century, the link between disease and bacteria was made by Louis Pasteur and Robert Koch, and methods to keep bacteria at bay were devised by Ignaz Semmelweis for hospital delivery wards, and Joseph Lister for hospital operating theatres.
Once that was established, sanitation systems were devised for hospitals, clinics and doctor’s offices. City-wide sanitation focused on water treatment, garbage removal, more thorough sewage treatment, and rodent eradication. (Rats spread bubonic plague, also called Black Death).
We take all these things, operated by engineers, laboratory technicians and bureaucrats, for granted in the western world today.
Most of our public health today like street cleaning, proper operation of garbage dumps, water filtration and chlorination is in
the hands of scientists and technicians. Some of these unrecognized public-health workers, particularly those keeping our public
buildings (hospitals, restaurants, grocery stores, etc.) clean, are paid at or near minimum-wage rates.
Their efforts are the “heavy lifting” that keeps our societies healthy.
Another factor controlling infectious disease is vaccination. Discovered in 1797 (a century before the role of bacteria was
understood) by Edward Jenner, an English country doctor, vaccination protected against smallpox, a killer disease. Vaccines have been developed against yellow fever, mumps, measles, chicken pox, diphtheria, whooping cough, rubella, pneumonia, influenza, shingles, and other diseases.
Today, vaccination is delivered largely by pharmacists, nurses, and specifically trained technicians, yet another group of public health workers!
The current pandemic has revealed weaknesses in our “western societies." We prize personal liberty over the general welfare of society. That attitude makes quarantine or even the milder “social distancing” a hard sell to Europeans, Americans, and others who share our culture. Societies like Italy and Spain, where close contact between friends, neighbours and family are particularly important, have suffered particularly heavy losses.
The U.S.A., where most medicine is delivered under a fee-for-service model, is being hit hard. Where you must pay to visit a doctor, many people simply cannot afford it. Unfortunately, many of them will be serving you at a restaurant or grocery store.
Some may work at long-term care homes for the elderly, or hospital cleaning staff. If they become infected, they are well-placed to pass it on to others, even those who can afford to visit a doctor!
Fee-for-service medicine makes no provision for public health, which is considered a government responsibility. In the interest of keeping taxes low, governments are often tempted to defund public health. This is unfortunate, because the modern role for
public-health doctors and bureaucrats is to watch for infectious disease epidemics.
In theory, they should begin testing people for signs of the new disease immediately.
When they find a positive test result, that person’s contacts are identified, and agents are sent into the community to test these contacts, and quarantine them, while waiting for their test results.
South Korea and Taiwan set such schemes in motion rapidly and also restricted cross-border travel. Instead of shutting down whole sectors of their economy, they quarantined individuals. As a result they contained and controlled their COVID-19 epidemics far more successfully than Europeans, Americans, or we have done.
The key is testing, and focusing on obtaining rapid results, not treatment, followed by chasing all the contacts a sick individual may have had. Giving public-health officials the power to issue and enforce quarantine orders has been key.
We seem reluctant to grant our public health such powers. Moreover, we have been cutting their budgets in the interests of “finding efficiencies” and keeping taxes low; relatively easy to do because our public-health bureaucracies are largely hidden from our citizens, who seem easily fooled by political spin.
The Centres for Disease Control (CDC), the American agency responsible for overseeing public health lost around 35 per cent of the budget it had under the Obama administration. Just one year ago, in the interests of “efficiency” and “trimming the fat," the Ontario government cut funding to its public-health agency by a similar amount.
The agency lost about 10 per cent of its staff between that announcement and the (temporary) restoration of that funding.
Our hospitals have been underfunded for decades. Much of the equipment in Barrie’s Royal Victoria Regional Health CEntre (RVH) was bought with donations from people like myself. Some 800 people (including myself) work as volunteers at RVH. We were told that the hospital could not run without us.
Make no mistake, I am delighted to help out, and was saddened when RVH sent us all home in an effort to control COVID-19.
Before the current epidemic, the government talked about “hallway medicine," but failed to do anything about it. Our hospital
normally operates close to 100 per cent capacity. That leaves few spare beds or staff to handle the seasonal rise in admissions related to influenza, let alone the extraordinary load caused by our current outbreak of COVID-19.
In 2014, and again in 2019, RVH was stressed by multi-vehicle pile-ups on Highway 400 near Barrie. All these are “handled” by delaying less urgent cases.
This is not wise. All of us hope never to call the fire department, but most of us understand that we need these well-equipped, well-trained people to be ready for the moment we do need them!
Similarly, our hospitals and public-health bureaucracies should not be run at 100 per cent capacity in the interests of “efficiency."
These agencies must have the spare capacity of trained people to deal with the emergencies we all know will occur.
