[HN Gopher] The Long Road to End Tuberculosis
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The Long Road to End Tuberculosis
Author : tintinnabula
Score : 85 points
Date : 2024-11-04 21:38 UTC (7 days ago)
(HTM) web link (www.asimov.press)
(TXT) w3m dump (www.asimov.press)
| sampo wrote:
| > TB remains the deadliest infectious disease on Earth, killing
| about 1.2 million people every year.
|
| 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.
| mauricioc wrote:
| The WHO [0] reports 60 thousand Covid deaths this year so far,
| and around 250 thousand deaths in 2023.
|
| [0] https://data.who.int/dashboards/covid19/deaths
| sampo wrote:
| US CDC has about 40k deaths for 2024 so far [1] for United
| States, and 76k for the year 2023 [2]. Maybe the WHO
| dashboard is left unmaintained, or maybe many countries have
| stopped reporting Covid deaths to WHO.
|
| [1] https://covid.cdc.gov/covid-data-
| tracker/#trends_totaldeaths...
|
| [2] https://jamanetwork.com/journals/jama/article-
| abstract/28235...
| dgfitz wrote:
| Or it's accurate.
| tightbookkeeper wrote:
| How is the _cause_ of death determined for 250k people?
|
| 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.
| robertlagrant wrote:
| There were upper and lower bound stats that accounted for
| many discrepancies. The high numbers were "death with
| covid", which means the covid might not've done it, and
| the low numbers were "death by covid" where we were
| (fairly) sure Covid did it due to lack of other factors,
| but missed things where Covid tipped someone over the
| edge.
| tightbookkeeper wrote:
| That sounds right. Based on my reading the CDC numbers
| are basically death with Covid test or symptoms, with the
| exception of an obvious distinct cause.
|
| Which honestly I can't think of a better way for mass
| data collection.
| thenerdhead wrote:
| This isn't even considering the latest being found about Covid
| either for long term illness/disability, virus on tumors making
| certain cancers grow faster, and sudden stroke/cardiac events.
|
| 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.
| Yeul wrote:
| The difference is that TB kills young people. Old people have
| to die from something it's irrelevant what eventually knocks
| them out.
|
| But with TB it was laying waste to people who were supposed to
| be in their prime. That's why it was so insidious.
| giraffe_lady wrote:
| Covid turns young people into disabled people. Then we can
| say "well they had preexisting conditions, it's irrelevant
| what eventually knocks them out."
| tightbookkeeper wrote:
| Based on the percentage of young people who got Covid (very
| high) and were disabled (very few), this doesn't seem
| significant.
| aredox wrote:
| The difference with TB being that COVID infects 95% of
| the population several times per year, turning those low
| relative rates into higher and higher absolute numbers...
|
| "Death by a thousand cuts"
| tightbookkeeper wrote:
| Can you estimate those absolute numbers for us?
| giraffe_lady wrote:
| Can you? You were the first to bring in a concrete claim
| about them, that they are "very small."
| tightbookkeeper wrote:
| I'm not the one claiming Covid is as impactful or
| dangerous as TB, a very unusual claim. Please make your
| case.
| aredox wrote:
| Me neither, despite your flagrant attempt at putting a
| strawman.
|
| 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
| Krssst wrote:
| The CDC has measurements: https://data.cdc.gov/NCHS/Post-
| COVID-Conditions/gsea-w83j/da...
|
| Answer is a bit more of 1% young adults have significant
| limitations caused by long COVID if I read it well. 2024
| data.
| Krssst wrote:
| For reference, recent figures seem to be around 5% of
| younger adults currently experiencing long COVID:
| https://data.cdc.gov/NCHS/Post-COVID-
| Conditions/gsea-w83j/da... (need to filter on the columns
| quite a bit to reach the figures : "currently
| experiencing long COVID, all adults" + "time period end
| date" set to the latest)
|
| 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.
| stevenAthompson wrote:
| We know that infection with COVID causes permanent
| changes to the body, and that those changes are damaging
| to health. There have been studies that indicate this
| damage might be cumulative.
|
| 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.
| bryanrasmussen wrote:
| young people have to die from something also, even if it's
| just getting old. So it's irrelevant what eventually knocks
| them out as well I guess.
| alexey-salmin wrote:
| Years of life lost from mortality (YLL) is a concrete and
| reasonable metric, not just some hand-waiving about
| everyone dying anyway.
| ywvcbk wrote:
| > I would guess, in 2024 Covid killed more than 1.2 million
| people
|
| Why? Seems extremely speculative.
| tzs wrote:
| COVID-19 appears to act similarly to the other coronaviruses
| that are endemic in humans. There are two key properties.
|
| 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.
| sharpshadow wrote:
| It's relieving that at least other branches of vaccine
| development are not under the information regime as with COVID.
|
| "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.
| thenerdhead wrote:
| Previous COVID infection enhances immunity, creating what we
| call hybrid immunity. This happens because current vaccines
| mainly target the spike protein, while natural infection
| exposes the immune system to other parts of the virus.
|
| 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.
| sharpshadow wrote:
| An infection exposes the immune system to the whole virus
| while the mRNA vaccine triggers the synthesis of the viral
| spike protein which would be a specific part of the virus. It
| can be called hybrid since it is a combination of a original
| and novel technique but the underlying immune system still
| deals with the invaders the same way and creates immunity
| against them. Naturally an infection would be temporary but
| with the mRNA technique it's a constant stream of spikes
| which the immune system attacks to the source. One of the
| issues here are the byproducts from the immune activity,
| especially dangerous if the mRNA dosen't stay around the
| injection area. Hybrid immunity without looking at the cons
| is not the full picture and seeing some counterpoints about
| vaccines was refreshing.
| stevenAthompson wrote:
| I would really love to see your peer reviewed study! Where
| was it published?
| amluto wrote:
| A mystery not mentioned in the article: why is TB so unusual in
| places like the US? The US does almost nothing to control TB. We
| don't vaccinate. We don't routinely test (except in special
| cases, but those cover very little of the population). We don't
| treat latent cases unless they somehow get noticed. And yet the
| incidence of symptomatic TB is low, and there's no sign of TB
| developing resistance to whatever the US is accidentally doing
| right.
| alexey-salmin wrote:
| Less public transport perhaps? I remember studies showing
| strong correlation even though causation can be questionable
| (less protected member of society in the first place). And
| anecdotally the only person I know with TB never had known
| cases neither at home nor at work, which basically leaves the
| public transportation (which he was using 2-4 times a day at
| the time) as the most likely source.
|
| Another idea could be "better climate" but it's not obvious
| when I look on the world map of TB incidence.
| noodlesUK wrote:
| TB is almost the archetypal disease of poverty.
|
| 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.
| dyauspitr wrote:
| That's still not an explanation. Kids in the US spend a lot
| of time with other kids at daycare and school. It's a
| transmittable bacterial disease. Why aren't people in the US
| getting it more? Are you saying you have to be
| mal/undernourished to get it?
| noodlesUK wrote:
| Malnourishment is a big part according to the WHO [1]
|
| 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.
| dghlsakjg wrote:
| https://bmcpublichealth.biomedcentral.com/articles/10.1186/
| s...
|
| 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).
| valarauko wrote:
| The majority of healthy people develop a latent infection,
| and won't manifest symptoms in their lifetimes. The
| bacteria are encapsulated into nodules by the immune
| system, which weaken if the immune system weakens. The
| bacteria escape and active symptomatic infection occurs.
| dyauspitr wrote:
| Yeah but the US has very low levels of latent TB in the
| population at only 4%. Compared that to places like
| Brazil where 40% of the population has latent TB. It's
| not the climate because in Russia 80% of the population
| has latent TB.
| valarauko wrote:
| Yes, and it's a self-perpetuating cycle. If so few people
| have latent TB, fewer people develop active TB that will
| go on to infect others. As other comments have mentioned,
| poverty and its resultant poor health is the biggest
| correlation for developing active TB. I wonder if most of
| the Russian latent infections happened during the
| Soviet/Post Soviet collapse era, with newer latent
| infections falling off as quality of life improved over
| time?
| skirge wrote:
| quality of life improving in Russia is a very risky
| statement. Soviets manipulated statistics and so does
| current Russian government.
| toast0 wrote:
| In order to get latent TB, you need exposure to someone
| with active TB. If someone with active TB meets the
| healthcare system, you get a rapid response from health
| departments. In May 2024, the Long Beach, CA declared a
| public health emergency [1] based on a cluster of 14
| cases. This kind of reaction is typical and makes it
| difficult to spread to others, and keeps the levels of
| latent TB low.
|
| [1] https://www.longbeach.gov/press-releases/official-
| city-of-lo...
| fuoqi wrote:
| 80% sounds like a BS number. It's cited on Wikipedia, but
| references are either "opinions" or do not contain such
| information at all.
|
| 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...
| toast0 wrote:
| My understanding is that TB doesn't spread while latent, it
| needs to develop into active TB to spread.
|
| 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.
| classichasclass wrote:
| While I can't deny the argument that US national anti-TB
| efforts have become fragmented, possibly as a result of lower
| incidence, BCG isn't an especially protective vaccine against
| pulmonary disease and can interfere with TB skin testing, which
| even in this age of generally available blood QuantiFERON
| testing is still not uncommon. BCG does have greater value in
| high-risk countries, and it may be most useful for kids in
| those regions where TB meningitis is a bigger threat. It
| doesn't make a lot of sense in a low-burden country, but
| perhaps one day we'll have a better one.
|
| - working in TB control since 2006
| dghlsakjg wrote:
| Overlay TB with poverty (or more accurately, per capita GDP) on
| the map.
|
| 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...
| John23832 wrote:
| Spitting has become socially unacceptable in the US. This is
| due to large scale "anti-spitting" campaigns in the early 1900.
|
| 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.
| susiecambria wrote:
| I was exposed to TB at Children's Hospital in Washington DC and
| it was only because I was seeking a part-time job at another
| hospital while in grad school that I became aware. Got the
| bubble at the public health department and by the time I drove
| 40 minutes home, I was clearly positive, so off to Children's I
| went to have the test read. Because I was a volunteer, I was
| able to be xrayed immediately and prescribed drugs to take for
| 9 months. And then, of course, the hospital came after me for
| the cost of the xray, arguing that I could have been exposed
| shopping at Talbot's.
|
| 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.
| senadir wrote:
| This lecture from John Green is a great full summary on the
| history of TB https://www.youtube.com/watch?v=7D-gxaie6UI
|
| 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.
| BWStearns wrote:
| Oh hey, I had TB. It sucked. I had to be proper quarantined for 3
| months, felt like shit for a whole year and a half, and nearly
| died because I didn't realize I had any symptoms. I thought I was
| just tired and depressed all the time because I hated my job, and
| then one day I collapsed from what I thought was a heart attack.
|
| 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.
| kylehotchkiss wrote:
| BCG doesn't really do much beyond childhood, and even then,
| just reduces the impact of the disease if you do get it.
| kylehotchkiss wrote:
| I almost lost a former partner to this disease. Totally changed
| my life.
|
| 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.
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