13 September 2016

Viruses and you

“A crappy virus is one that kills its host.” —Agnes Cadieux of the Ottawa Hospital

At our Can-Con 2016 infectious diseases panel, Dr. Anatoly Belilovsky, a paediatrician and SF writer from Brooklyn, explained that the most virulent viruses have jumped from animals to humans, killing the host before figuring out how to be less destructive. (You can imagine that a dead human isn’t as effective at passing on the vector when the body is buried inside the ground.)
Dr. Belilovsky said, “Rabies is not a human infection. It’s happy on bats. When it jumps to dogs or humans, it doesn’t do so well.”
“It’s a virology drive by,” said Dr. Dylan Blaquiere, a neurologist in New Brunswick.
Agnes Cadieux talked about how herpes simplex, herpes zoster, and even HIV are evolving to co-exist with humans.
Dr. Anatoly Belilovsky, Dr. Dylan Banquiere, Agnes Cadieux, Dr. Alison Sinclair, Dr. Melissa Yuan-Innes, Pippa Windsong 

Pippa Wysong pointed out that often a flu virus will kill the very young and the old. With Spanish flu, the cytokine storm was what killed people. This targeted people with strong immune systems.
The Spanish flu killed over 50 million people, and that was in 1918. If a virus struck like that today, the consequences would be absolutely devastating.
One audience member asked about superbugs and antibiotic resistance. One key problem is patients asking for unnecessary antibiotics. I can tell you that I’ve spent many cumulative hours explaining that no, you don’t need antibiotics.
Them: But I’ve lost my voice!
Me: Yes. I hear your hoarse voice. And 90 percent of the time, laryngitis is viral.
Them: I’m coughing up yellow and green stuff!
Me: Those are just old white blood cells. You have bronchitis. Seventy-five percent of the time, it’s viral.
Them: My throat is red!
Me: Most of the time, your sore throat is viral. Strep throat only causes ten percent of cases. And even if it is strep throat, a normal immune system will kill the bacteria almost as quickly with or without antibiotics. The strep strain in our area does not attack the kidneys (glomerular nephritis) or heart (rheumatic fever).

There are exceptions, of course. For example, I prescribe antibiotics to people who have emphysema and two out of three of the following: more cough, shortness of breath, and/or a change in mucous, because they may go on to develop a devastating pneumonia. You always have to watch out for premature babies, transplant patients, people on steroid medication, HIV patients, and so on.
But most people are healthy, with perfectly good immune systems, that can and will fight off infection. As my friend Dr. Michael Sanatani pointed out, “What’s the one thing bacteria have never developed a resistance to?”
Answer: Our immune system.
Voltaire put it this way: “The art of medicine consists in amusing the patient while nature cures the disease."
Of course, we have many more powerful weapons than in Voltaire’s age, but the problem is that, as one doctor put it when he was trying to convince us not to use a too-strong class of antibiotics when we don’t need them (fluoroquinolones), “We’re using bulldozers when we can use shovels.” Because patients are demanding them. Because patients don’t want to hear “Suck it up.” Because it’s faster to write a prescription than explain over and over again that you should save antibiotics for when you need them, or else they won’t work when you do need them. Plus they cause diarrhea and other problems.
Viruses and bacteria are a normal part of our environment. In fact, viruses make up 8 percent of our DNA. I, personally, avoid antibacterial soap, which kills the “good” bacteria and allow the more dangerous ones to propagate. Thank goodness the FDA agrees with me.
It's time to stop the fear. Dr. Alison Sinclair said, "When have you ever heard the word 'virus' in the media without it being preceded by the word 'deadly'?"
The solution to fear is education.

I'll be writing more about Zika on my own personal blog, http://melissayuaninnes.com/the-zika-page/, so please follow me there if you want to know more.
To your health!


  1. It's hard to take notes while participating on a panel, so I apologize in advance for any misquotes and welcome corrections.

  2. I'm curious to know what at cytokine storm might be

  3. When Hillary was diagnosed with pneumonia a couple of days ago, she said she figured it was no big deal & that she would power through it. I'm glad she decided to take a few hours off & rest up a bit. I had pneumonia in the spring of 2014 & was given antibiotics but I never found out what the pathogen was.

  4. Pippa kindly passed along the following link about vaccination, where people kindly dress up like diseases: http://sci-why.blogspot.ca/2014/07/quarantine-tent-looks-to-past-in.html

    "Meet diphtheria. She is 19 and from 1913 when there was an outbreak in Toronto. She‘ll tell you how she lost her kid sister from the disease just a few days ago, how a younger brother is struggling, and will describe the symptoms of “The Strangling Disease."

  5. @Janet, I'll link to the Wikipedia article: https://en.wikipedia.org/wiki/Cytokine_storm#Role_in_pandemic_deaths
    Basically, your immune system is *over*activated and causes your death.

  6. Oh, I'm sorry. I meant @Janice.

    @Elizabeth, we don't usually do sputum cultures to find out your exact pathogen. It's an extra cost that's not necessary because the focus is on treatment. If you're curious, you could probably pay for the test in the unfortunate event if it ever happened to you again.

  7. Excellent post. I lost count of the times I used to say (to patients) "It's a virus. Not a bacterial infection."
    I had a bad case of MRSA that was resistant to almost everything. Finally, Sulfa drugs took it out. But we were running out of options, thanks to overuse.

  8. Loved the Voltaire quote and I never knew phlegm was dead white blood cells. Thanks, Melissa.

    I’m also glad the FDA will have banned the most common antibacterial ingredients in ordinary hand soaps. It’s been long overdue.

  9. @Melodie, thanks for fighting the good fight, both in education and in killing MRSA. Horrible. Thankfully, sulfa is still pretty effective here too. Periodically, one of the nurses we'll say, "We're all infected," and I'll sigh deeply. Occupational hazard.

  10. @Leigh, I'm glad you learned something.

    And yes, a small victory banning the useless and harmful anti-bacterial soap.

    'The arc of the moral universe is long, but it bends towards justice.'—Martin Luther King Jr. That's why we write crime fiction, right?


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