How Austerity Is Making You Sick: The Whooping Cough Edition

Because costs money to have a public health system that can actually protects the public’s health (boldface mine):

MOUNT VERNON, Wash. — Whooping cough, or pertussis, a highly infectious respiratory disease once considered doomed by science, has struck Washington State this spring with a severity that health officials say could surpass the toll of any year since the 1940s, before a vaccine went into wide use.

Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.

The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts.

Here in Skagit County, about an hour’s drive north of Seattle — the hardest-hit corner of the state, based on pertussis cases per capita — the local Public Health Department has half the staff it did in 2008. Preventive care programs, intended to keep people healthy, are mostly gone.

The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.

…“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”

State health officials estimate that because of incomplete testing and the assumption that many people with mild cases are not seeking medical treatment, perhaps as few as one in five pertussis cases is being recorded and tracked, suggesting that the outbreak is far more widespread than the numbers indicate

“It’s the largest epidemic I’ve ever seen,” said Becky Neff, the only registered nurse in the 3,700-student Burlington-Edison School District, in Skagit County. Ms. Neff said she had seen 142 suspected and confirmed cases, or about 3.8 percent of the student population from kindergarten through 12th grade.

But with only two nurses processing the disease reports she sends over to the county, down from five a few years ago, Ms. Neff said she had stopped even trying to ask for confirmation.

They don’t have time to call and say who’s positive and who’s negative,” she said.

Unlike the federal government, states and municipalities are not currency issuers, they are currency users–they can run out of money (or have to borrow at prohibitive rates). Because the U.S. public health system is largely a state run and funded system, states are cutting budgets. With all due respect to Dr. Leibrand, who is being asked to do an impossible job, he should not buy into the false choice of understanding who is sick versus treating ill patients. He should be telling reporters, “We don’t have enough money to respond to this crisis the way a developed nation should.” If nothing else, the non-diagnostic approach means some people will be exposed to pertussis carriers.

What’s truly dreadful is that public health departments, even in flush times, receive pissant amounts of money: we’re talking about restoring a couple of hundred public health workers across the entire state (if that) and a few million dollars for outreach and vaccination.

Instead of arguing about sequestration in Congress (the coming mandatory ~8% budget cuts across the board), they should tear up that stupid debt agreement and supplement cash-strapped states and local governments. And for those who say that it’s hard to figure out how to spend the money, I’m pretty sure that public health workers in Washington state have some ideas about that.

Decades from now, historians are going to look back at us and wonder how we could be so fucking stupid. And so irresponsible towards our children.

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6 Responses to How Austerity Is Making You Sick: The Whooping Cough Edition

  1. Newcastle says:

    We have pertussis problems here too but the cause is not lack of public health funding. Many of the kids with pertussis are fully insured, double insured often, but they are not vaccinated because all vaccines are loaded with mercury and cause autism. The abject stupidity on the part of intensely misinformed yuppie parents is the root of the problem in this district. I personally know of three children who had pertussis this year, the net income in each case was well over $500K.

  2. Cactus Wreni says:

    Newcastle, there’s an error in your posting. Allow me to offer the correct information:

    “Many of the kids with pertussis are fully insured, double insured often, but they are not vaccinated because THEIR PARENTS ERRONEOUSLY BELIEVE that all vaccines are loaded with mercury and cause autism.”

    Thank you.

    • Newcastle says:

      That’s quite the wizz-bang sarcasm detector you’ve got going there.

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  4. I’d like to point out a mutated pertussis has been spreading in other countries for years and we have no idea if the vaccine works against the mutated version, or even the length of protection afforded by the vaccine against it’s intended version.

    I was actually discussing this last year and again the year before during the California outbreaks. I will try to find my citations on this and post them later on this week.

  5. Hey, I actually had it on my laptop so I don’t have to go turn on my tower. Yay! I originally posted this in response to some silly FB status updates about non-vaccinated children. I’m just going to copy and paste since folks are already commenting about the same. Also, I’d like to point out that pertussis isn’t always or even usually this horrible thing. Many, many adults get low-grade pertussis and never even realize that they have something more than the standard crud-that’s-going-around, esp. since the characteristic cough is less likely in adults. You may have had it and passed it on to six people without ever knowing, even if you were vaccinated as a child and got your booster as an adult.

    “Several people have mentioned the recent California outbreaks, and attempted to link these outbreaks to people who deliberately choose not to vaccinate. Now, first, the pertussis vaccine does not confer a life-long immunity. The CDC recommends boosters for pre-teens and adults, so it’s silly to say that people who deliberately choose not to vaccinate are any more responsible than those who simply forget to or were unable to get their boosters. (Note: Newcastle, did you get your booster?)

    Anyway, I digress. There is some evidence that pertussis is adapting to the vaccine. I find this very interesting. Here is where I found information about this:
    “Adaptation may have allowed B. pertussis to remain endemic despite widespread vaccination and may have contributed to the reemergence of pertussis in The Netherlands.”
    “In Taiwan, as in other countries, an epidemic trend in pertussis has in part been attributed to the antigenic divergence in B. pertussis strains due to vaccine-driven selection as a result of using whole-cell pertussis vaccines for long periods”
    B. pertussis is dynamic and is continuously evolving, suggesting that the bacterium may use gene loss as one strategy to adapt to highly immunized populations.”

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