The Long Road to End Tuberculosis
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asimov.press
He's also publishing a book about it https://www.penguinrandomhouse.com/books/312472/everything-i...
Recently, John Green lobbied to get certain pharma companies to lower the price of tests and vaccines
https://www.scientificamerican.com/article/how-advocates-pus...
Tuberculosis is not a medical problem, it's an inequality and access problem. Tuberculosis is fully solved in advanced countries yet less developed countries still suffer from it. Pakistan has 260 death per 100k capita, the US has 2.6. The highest 5 countries have at least 600 per 100k capita.
I was/am otherwise healthy and must have just drawn the short straw (or it was a very long dwelling infection from a trip abroad years earlier). I really wish we vaccinated for it like Europe. I'd have taken the little scar on my arm for reducing the already small chance of dealing with that shit.
In countries with widespread BCG vaccination, substantial percentages of population are latently infected, and a smaller percentage of those will still become actively infected one day.
(Citing my sources
https://en.wikipedia.org/wiki/BCG_vaccine
https://thispodcastwillkillyou.com/2018/02/10/episode-9-tube...)
Wouldn’t be surprised if it broke something that shows up later but so far everything is fine 8 years on.
Only chronic symptom so far is I got into functional programming while quarantined and it stuck, so maybe it’s a sign of mental illness.
As I mentioned elsewhere in this thread, I've got a nonzero chance of getting it one day. I'm not afraid, just hoping I'd be able to contribute to eradicating it from the world in some way.
There's also the nebulous but very nice-sounding "non-specific effect" with it. Who knows.
One of my first projects at my development consulting job was a site build for an org working on vaccine candidates, which a decade later, unfortunately haven't crossed the finish line.
So with a fairly personal connection with the disease, and the nonzero chance I could one day develop it myself, I have a personal interest in seeing progress in the space.
I saw an IAVI update the other day stating TB research is currently only funded to the tune of 1 billion a year when they need 6. 10.5 million infections a year reported. Remember the countries where the disease have the biggest impact have limited diagnostic abilities outside of cities and politically, these countries are very quick to pretend the problem is solved when the reality is that TB started speeding up again in the covid days because the care programs for patients then was put on pause.
If you wanna change the world and aren't just out for VC cash, go design a mobile X-Ray unit to take into villages, work on an AI model to diagnose from imagery, and work on figuring out how to speed up the testing because a MGIT machine needing power 24/7 is not the type of equipment you can always get in the places the disease impacts.
Figure out how to get those little mycobacteria suckers to divide quicker in agar (my limited biology education tells me mess up the mycoic acid synthesis without killing it?) and then get people a positive result in 3 days instead of 3 weeks. Remember: the very good blood test (quantiferon gold) is banned in the largest country in the world because it comes back positive for the 1/3 of the population latently infected.
There’s a lot of other diseases there a blood test can diagnose immediately, and I don’t blame health workers for the confusion, quantiferon is a unique test, but a countrywide education campaign could have worked to keep it as part of the diagnostic tools.
Living on top of each other, especially in childhood & adolescence, combined with other environmental and health factors explains almost all of it. If you’re malnourished and your immune system is in bad shape, you’re at risk. If you have HIV, you’re at risk and so on.
Unhealthy people are more vulnerable to TB, absolutely. Infections in general are more prevalent in people who are underfed, or living in bad conditions. Other risk factors are exactly what you would expect: smoking, drinking, bad fitness level, and being young or old.
TB rates are basically a function of 1. how immune compromised your population is, and 2. How much access to healthcare there is in the country (poverty, basically).
[1] https://www.longbeach.gov/press-releases/official-city-of-lo...
A proper study [1] shows mean infection rate of ~20% in the worst regions (Far East and North) with the highest rate up to 47%. The situation should be better in the western regions. For comparison, in the US studies show ~4% infection rate [2], so situation in Russia is relatively bad, but improves steadily since 90s and it's far from being catastrophic as the 80% number paints it.
[1]: https://www.tibl-journal.com/jour/article/view/1706
[2]: https://www.cdc.gov/tb/hcp/clinical-overview/latent-tubercul...
All children and professionals working with children are receiving yearly TB testing ("Mantoux test"). Prisons used to be a major vector, but that was reduced by doing TB prevention (antibiotics).
Nobody likes getting TB.
I’m no expert but I also suspect access to medical care is also a big part, as typically only active cases spread the disease. If you are symptomatic and get some antibiotics, you might not spread it to very many people. If you’re symptomatic and go without treatment for ages, then you might spread it to loads of other people.
As we learned during covid, small differences in R value massively change the prevalence over time.
I was not surprised to have been exposed. I volunteered a lot of hours in the Children's ED so I had much greater exposure than other people my age who were doing whatever you do when you're 30. I think the doctors and nurses were surprised that I did not freak out and docs to this day are a little surprised I didn't. It was inactive and I was diligent taking the meds.
All this said, the point is that more needs to be done in the US, particularly when we know where the greatest exposure happens.
In the 19th century when spittoons were a thing in the US, TB ran rampant.
There's also the widespread antibiotic use. The widespread prescription of Doxycycline for everything inadvertently does a lot.
There are number of correlations with unhealthy activities like smoking, drinking, fitness, etc... but the best indicator is if you live in poverty, and/or if you're country is poor. Poor areas of rich countries have higher TB, and poor countries in general have higher incidences of poverty. Basically, less access to healthcare and bad living conditions.
This is a good study here that explain the individual risk factors, but the available maps also show a pretty clear pattern: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s...
The US healthcare system is tuned into TB cases and will alert local health officials to do contact tracing, outreach, and follow up with confirmed cases when they pop up.
Healthcare and childcare workers are routinely tested for TB in areas with recent spread.
Doing screening on the general population doesn't seem necessary, given the low estimated % of people with latent infections and the low estimated % of latent infections that will develop into active infections. It may make sense to screen more people that have a higher risk if they develop active TB or are at a higher risk of exposure.
Certainly, increased screening or vaccination would result in improved outcomes for people whose TB infection was averted. But those have to be weighed against the negative outcomes from side effects of screening/treatment and vaccination.
- working in TB control since 2006
Another idea could be "better climate" but it's not obvious when I look on the world map of TB incidence.
“However, environmental bacteria complicate the picture. If present before vaccination, memory immune cells primed to destroy the environmental relatives might cross-react with and neutralize the BCG strain before it has a chance to set up an immune response against itself and M. tuberculosis.”
Nobody cared if one already had covid before administering the vaccine and since the vaccine came late many have had a previous infection already. The new mRNA vaccine utilities the body to produce the actual pathogen and with already existing immunity from a previous infection one’s immune system starts to attack the mRNA modified cells and pathogen product.
New vaccines in development aim to include multiple proteins and improved delivery methods, which could lead to longer-lasting immunity. For now, hybrid immunity (infection plus vaccination) offers broader protection, while vaccines safely boost antibody levels without the risks of infection.
mRNA doesn't stay in the injection area. Most of it ends up in the liver, and that was known since before the mRNA vaccine development.
That's also why the first mRNA gene therapies are targeting inheritable liver diseases.
Defending the jab in a Stockholm syndrome manner is getting quite boring by now.
I would guess, in 2024 Covid killed more than 1.2 million people. I guess many people are assuming that Covid was a temporary disturbance, and will attenuate in the coming years. But what if it doesn't but will keep at about the current levels from year to year for a long time.
[1] https://covid.cdc.gov/covid-data-tracker/#trends_totaldeaths...
[2] https://jamanetwork.com/journals/jama/article-abstract/28235...
EDIT: I got curious and looked up the CDC guidelines https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf
> based on sound medical judgment drawn from clinical training and experience, as well as knowledge of current disease states and local trends
> the disease or injury which initiated the train of morbid events leading directly to death
It goes on to suggest that if Covid was present they strongly recommend including it. And even if you did not diagnose Covid it can be a good assumption to make.
Which honestly I can’t think of a better way for mass data collection.
But with TB it was laying waste to people who were supposed to be in their prime. That's why it was so insidious.
"Death by a thousand cuts"
But this figure also includes cases without significant activity limitation. Significant activity limitations from long COVID across all adults for younger adults is slightly above 1%. Which is not negligible I think.
Here is a chilling possibility it may be closer to 25% already: https://neurosciencenews.com/ai-long-covid-28003/
Answer is a bit more of 1% young adults have significant limitations caused by long COVID if I read it well. 2024 data.
Maybe, you know, there is a middle ground between "as impactful or dangerous as TB" and "negligible"? Especially when so much is unknown about the SARS-CoV-2, a virus that infects the whole body (not just the lungs)?
For reference, almost all the victims of SARS-CoV-1 are still suffering from complications almost two decades later, between permanent fatigue, pulmonary damage, osteoporosis and bone necrosis, immune system deregulation, cognition impairment... Which is, you know, less worse than death and therefore TB, but still
We do not yet know what the long term impacts of acquiring COVID repeatedly will be, but we're going to find out.
It's my suspicion that those healthy young people will have lungs like chain smokers, higher rates of certain cancers, and a much higher propensity for certain cardiovascular ailments in a few decades.
We are heavily undercounting until we can definitively link it. That requires families to consent to an autopsy and for biomarkers to be finalized and used to confirm.
Researchers are pretty close to that nowadays though with micro clots, viral rna persistence assays, and even pathology studies which are all showing results this year and will be for years to come.
Why? Seems extremely speculative.
1. You don't develop an immunity to infection by them, but you do become less likely to be made severely ill from subsequent infections.
2. The severity of illness from the first infection is generally less if you are very young.
With the others it is thought that they probably did cause deadly pandemics when they first crossed over to humans, but did not cause much harm to babies or very young children, and so by the next generation they were no longer a big deal.
Nowadays we don't even bother to have a name for infection by them. We just lump them in with around 200 other viruses and call what happens when we get sickened by any of them a "common cold".
Pretty much everybody alive now was exposed to those viruses as a baby, got mildly ill and got that first infection out of the way, and then it is just a routine common cold to them when they get older.
I don't think it is yet known if COVID-19 will fully follow that path of those others. It still does cause severe illness far more often than the common cold viruses even in people who have been infected multiple times.
We probably won't know for sure until we see what happens over several years with people who were very young during the pandemic or were born after it.
For people older than that is is probably going to be something that is more like a severe flu, where we'll have a vaccine each year for the strains expected to be most common that year, and while the vaccine won't stop you from getting sick it will greatly increase you chances of not getting severely sick.
We are already seeing that. COVID-19 fell from the 4th highest cause of death in the US in 2022 to the 10th highest in 2023, with 76000 deaths. Compare to 246000 deaths in 2022 and 462000 in 2021.