Speaking Of Which

For the second time in a row, I’ve rescheduled a post to air something else. If you didn’t catch Friday’s post, it closed with:

By letting the pandemic run riot in much of the world, we set ourselves up for waves of follow-on health problems. We don’t have to let this run riot too. But wrestling it down is going to take some work.

It's coming home to roost, so many countries failing to have or to carry out good pandemic response plans. SARS-CoV-2 damages T-cells and B-cells in the immune system. What else damages T-cells? HIV.

Everybody has heard about the mysterious outbreak of hepatitis in children, and now the mysterious outbreak of monkeypox. Those led me to connect the dots I had overlooked. I said we should expect more surprising outbreaks. I hoped it would be at least a matter of weeks before the next one popped up.

You and I won’t panic. We’re expecting it. We know to continue our standard protective measures.

We’re going to take a look at the next round of this type of news before it’s all over mainstream media. By the time everyone else catches up, we will have done our analysis and made any changes we want to make.

What Turned Up?

Pediatricians in the Netherlands report an outbreak of Group A streptococcus. Pediatrician Michiel van der Flier (UMC Utrecht) says:

Here in Utrecht alone we had ten cases, and group A streptococcal infection was determined as the cause of death in two deceased young children who came to our hospital for examination.

Medical microbiologist Elske Sieswerda, a colleague, adds that it is alarming:

I've seen a few very serious cases already. It is striking that we also see necrotizing fasciitis, in which the bacterium affects skin and muscles.... We never actually see that in children.

Necrotizing fascitis is what gives Group A strep the nickname flesh-eating bacteria.

The Dutch doctors say they normally have 7 cases of serious Group A strep among young children in a year. We're less than five months into the year and they've had 11 cases so far.

Already, the usual downplaying narratives are circulating. Van der Flier speculates that this outbreak is a catch-up effect after pandemic constraints were loosened. The Dutch doctors say chickenpox began to circulate again late last year. Research group Nivel reports that in the Netherlands, so far this year chickenpox cases are up by a factor of 5 in children up to age 4, and are up by a factor of 2 in children aged 5 to 15. Group A strep is known to be able to take advantage of chickenpox to become a follow-on infection. But blaming this on post-lockdown rebound glosses over the amount of escalation to necrotizing fascitis when the doctors say the bacterium itself has not changed.

We should note we’re taking the doctors’ word for it that the pox which began to surge in the Netherlands is chickenpox. In each country where some monkeypox cases have turned up this year, including the Netherlands, Google searches about chickenpox have gone to historic highs about a month before monkeypox was recognized. Monkeypox tends to make deeper lesions that are a friendlier invitation to Group A strep.

It will take time to go back and check the chickenpox diagnoses. But we don’t need to wait for that before we can decide whether it affects what we should do. As I’ve mentioned before, we often have to make decisions with imperfect information. We know enough to make solid, rational decisions.

Solutions?

You and I expected more news like this. Our task now? Consider what we might add to the usual basic solution of doing what we can to avoid exposure.

There is a vaccine against chickenpox. In the UK it is not offered by the NHS, but parents can arrange it privately. It won’t protect against monkeypox. However, it will protect children from chickenpox.

Most people think of chickenpox as simply unpleasant, but it can have serious complications and can reactivate later in life as acutely painful shingles. Vaccination is a good idea on those grounds alone. As a bonus in these times, if a child vaccinated against chickenpox turns up with a pox, getting to the correct diagnosis should go faster. It won’t be dismissed as chickenpox when maybe it needs more attention.

We may also want to think twice before choosing what over-the-counter painkillers to take. Acetaminophen (biggest brand Tylenol in the USA, paracetamol in the UK) doesn’t tinker with immune response. Ibuprofen and aspirin are anti-inflammatory, so it’s best to avoid them when something like Group A strep may be trying to take advantage. Acetaminophen (paracetamol) is safer when we’re sick.

Two tweaks to our bag of tools, and we’re as prepared as we can be.

Postscript

If you had chickenpox as a child, like I did, you may want to make a third tweak. At the recommendation of a cousin who is a doctor, all of my family aged 50+ have been vaccinated against shingles. We all caught chickenpox as children when there was no protection against it.

The virus that causes chickenpox stays in your body forever. Most of the time, your immune system forces it to stay latent, causing no symptoms. If your immune system becomes weakened, the virus can reactivate as shingles. Reactivation involves the nervous system more, which is why shingles can be so painful.

COVID is not the only thing that can weaken the immune system and allow shingles to flare up. Chemotherapy, certain immune system diseases, age, periods of high stress or injury (one friend got shingles after being hurt in a car accident), and some vaccinations can knock your immune system off balance and let shingles arise.

In the UK, the NHS vaccinates against shingles when people reach age 70. The vaccine used by the NHS is the older cheaper single-jab version. Its protection begins to wane after about 5 years. Shingrix is newer, requires two jabs a couple of months apart, costs twice as much, is much more effective and lasts so much longer that scientists suspect it may never need a booster. It can be difficult to obtain privately outside London. Let me know if you are in Great Britain and need it, and I’ll help you find it.