Disease Burdens More Than Just the Patient

Often, when we talk about infectious diseases and outbreaks, the focus tends to be on those who got sick: the symptoms they experienced, how likely they might have been to infect others and so forth. We may talk about whether or not they were vaccinated, what complications they may have suffered and the costs that they bore through lost work/school days or how much treatment cost. Only occasionally do people think about the effects of an infection or outbreak on the government. After all, infections only have a direct impact on the person who has the disease and maybe those around them, right? How could a disease have any significant impact on a government. They're big, faceless things that just kind of exist in the background, except when there's a problem or it's election season.

The fact of the matter is, outbreaks of infectious disease actually have quite an impact on governments, particularly local ones. As just one example, I recently received the following from an anonymous reader:

From the onset of the outbreak on March 19, 2011 through July 13, Utah has had 15 confirmed cases of measles. Nine cases occurred in Salt Lake County, five cases occurred in Cache County, and one case occurred in Millard County.

After June 6, two additional Utah residents have been confirmed to have measles by CDC testing. One of these persons resided in Cache County, and the other resided in Millard County. Both of these affected persons were close contacts of a person with a previously identified case in Cache County. Both had unknown vaccination histories and had been vaccinated post-exposure on June 6. On June 16, both affected persons developed rash. The Cache County resident reported limited contact with anyone during the infectious period. The Millard County resident traveled from northern to central Utah, attended church, and worked in Millard County during the infectious period. Approximately 100 work contacts received a measles, mumps, and rubella (MMR) vaccine dose within three days of exposure. Any work contacts that could not provide documentation of two doses of MMR had titers drawn. Those without immunity were quarantined.

Two probable measles cases are also being investigated. One probable case occurred in a Cache County resident with no history of vaccination. This resident has a possible epidemiological link to the Millard County resident. Rash onset was June 22. Commercial IgM testing was positive; the sample will be run at CDC for confirmation. This resident had limited contact with others during infectious period.

The other probable case occurred in a California resident with a rash onset of July 4. On July 5, this person traveled by airplane to Utah. DGMQ was notified because the travel occurred during the infectious period. States with residents who were identified as contacts were also notified. Commercial IgM testing was positive; the sample will be run at CDC for confirmation. The affected person had one documented dose of MMR.

Take a moment to think about what you've just read. What kind of resources were required to deal with this outbreak? How much time is involved working on each case to try to prevent the spread of the disease?

It all starts with a case being reported: patient 1. Public health officials need to track down the person, interview them and, probably, their doctor(s) to find out as many details as possible about when they first showed any symptoms of infection, when new symptoms appeared, anything they can about the course of the patient's illness. They also need to find out where the patient has been during the days or weeks they were contagious and with whom they may have had contact. All this time, the patient needs treatment and may be forced into quarantine, along with any close contacts, like family members, who have potentially been infected.

When the officials get all this information, then they need to track down identifiable individuals (coworkers, classmates, family, etc.) to inform them and take measures to try to beat the infection before it has a chance to set up residence. Notices are sent to local businesses that the patient may have visited and press releases sent out to warn those the officials may not be able to track down and notify directly. If the patient traveled between states or to another country while infectious, then those regions also need to be notified.

Finally, they need to keep vigilant watch for any additional cases popping up. If someone else was infected by patient 1, it could be days to weeks before they surface. But what about the person that infected the patient 1 to begin with? Did they infect any others? There may be more patients cropping up earlier than might be expected.

Speaking of the person that infected the patient 1, the health officials also need to try to track down that individual and run the same investigation they did with patient 1. If the case was reported, then things are a bit easier, but if it went unreported? Then things get a bit trickier. By this time, weeks may have passed. Memories are likely hazy, but the officials must do their best to get as much information as possible. Who else might be incubating or spreading the disease?

A lot of time is spent on the ground, investigating, interviewing. But information alone won't stop a disease from spreading. Vaccines need to be distributed and administered to those suspected to be at risk of infection due to contact with the patient and incomplete or no immunization history at all. Placing people under quarantine can help, as long as the individuals comply with the quarantine, which, let's face it, doesn't always happen.

Everything I've described above is just for one case. A single person infected with a highly contagious disease like measles. Hundreds of man-hours and hundreds (if not thousands) of dollars will have been spent on just a single confirmed, or even suspected, case. Multiply that by every case in the outbreak and the strain on the local government becomes readily apparent. Every case eats up valuable time and your tax dollars as the local government does what it is meant to do: protect its citizens.

Bare bones.

And that is something that during sound economic times we may not think about a great deal. But what happens when finances are tight? What would happen in Utah if the state government ran out of money or, like Minnesota recently, shut down, leaving the department of health to run on bare bones? Would they be able to stop the spread of the disease? How many people would become ill?

The amount of time, money and other resources that go into the efforts to investigate and head off outbreaks before they can spread wildly is nothing to laugh at. The simple reality is that so much of that could be saved and used for other projects through the maintenance of herd immunity, and one of the safest, most reliable methods we have of achieving that is vaccination.

If you care about public health, vaccination should be a cause you support. If you care about how your taxes are used, vaccination should be a cause you support. If you have any thought or compassion for those around you, vaccination should be a cause you support, vocally.

Protect yourself, protect your family, protect your community. Get vaccinated.