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"Wall"ing Off Disease.

There are three aspects to the caravan: what is shown by the media; what is there to be seen; and what remains unseen.

The locus is on innocent children, as in the widely circulated photograph of an obese woman with two children lacking pants or shoes, purportedly fleeing tear gas sprayed by cruel law enforcement agents. They are far from home, in a very dangerous place, in violation of the laws of Mexico. If that were a U.S. citizen, would Child Protective Services accuse her of child abuse and neglect, and take the children into foster care?

Thousands of migrants are crammed together and about one-third of them are sick. Without sanitation, outdoors in the rain, many more will become ill. Several cases of tuberculosis, chicken pox, and HIV have been reported.

The unseen travelers also include measles, Chagas disease, hepatitis, and many other dangerous microbes. You can see the lice that serve as vectors of diseases, such as typhus, if you look closely. Workers in migrant reception centers have spent hours combing nits out of little girls' hair--but they could be fired for talking about it.

Then there is that mysterious polio-like illness--AFM for acute flaccid myelitis--that has struck hundreds of U.S. children. Some would be in "iron lungs" if we did not use a different kind of breathing machine today. AFM first was noted in 2014, just coincidentally in time and space with the dispersal of thousands of Central American children into U.S. schools. More prominent at that time was an outbreak of a deadly respiratory illness that sent hundreds of American children to intensive care units. Both types of symptoms probably can be caused by enterovirus D68, which happens to be endemic in Central America. Is there a connection? The Centers for Disease Control and Prevention claims not to know.

Chagas disease (American trypanosomiasis) afflicts around 8,000,000 people in Central America. An early symptom is to awaken with swelling of the eyelids on one side that persists for weeks, but most do not know they have Chagas until it destroys the muscles of their esophagus, colon, or heart. It is carried by the reduviid ("kissing") bug, already present in the U.S. Packrats are hosts to these bugs. A high rate of Chagas is being found in dogs in Texas.

Many migrants have latent tuberculosis, which can become active at any time. What happens if a case of active tuberculosis is diagnosed in the U.S.?--all of the patient's contacts must be identified, tested, and followed. The persons exposed while the patient was coughing on the bus will be impossible to locate. The patient requires treatment for at least a year, with careful followup.

How many patients with contagious diseases and their contacts can be followed effectively by U.S. public health departments? These agencies already are underfunded and stretched thin. How many patients with active TB can be treated safely in U.S. hospitals? Last time I checked, there only were a few negative-pressure isolation rooms in my city, and what if the disease is resistant to all antibiotics, as is occurring in many countries? In the old days, patients' lungs were collapsed by injecting air into the chest to cause a pneumothorax. A patient I cared for at Parkland Hospital in Dallas, Texas, had a caved-in chest from the removal of several ribs (a thoracoplasty) to keep his lung collapsed permanently. This will not help disseminated TB, such as meningitis.

The public health response to contagious diseases, especially deadly untreatable ones, is to make the diagnosis, isolate the patients, and trace the contacts. This means that, for migrants, we need a positive identification of the person, as well as that individual's country of origin and location--but while American citizens increasingly are under surveillance, illegals often disappear without a trace.

Public health cannot deal with a horde violently storming the border. What the mainstream press does not want to show is that 80% of the crowd are men, mostly of military age. The threats they pose to the health of our citizens (and that of other migrants) include violence; sexually transmitted diseases from rape (a large percentage of the women have been molested); and illicit drugs that pour through while Border Patrol agents may be changing diapers.

The suggestion of Rep. Alexandria Ocasio-Cortez (D.-N.Y.) for 5,000 case workers will not help, as I doubt that many would volunteer to serve. We need linguists to identify people who are lying on their asylum applications--observers from Judicial Watch identified Cuban accents. We need better laboratory facilities and public health surveillance throughout the country, and we need law enforcement to stop illegal entry. Children who were at least warm and dry in Honduras are being used as political pawns and human shields by those determined to trespass in or harm our homeland.

We need to protect children--especially our own. We need a wall.
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Title Annotation:MEDICINE & HEALTH
Publication:USA Today (Magazine)
Geographic Code:1USA
Date:Jan 1, 2019
Previous Article:An Epidemic of DENIAL.
Next Article:Fear and Loathing on the Caravan Trail.

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