GVSU Expert: A Q&A on what disease outbreaks reveal about public health

Why was Michigan hit particularly hard by the cyclosporiasis outbreak, and what does that tell us about how foodborne outbreaks spread?

The case of a cyclosporiasis outbreak in Michigan has been linked to centralized food supply chains and localized distribution networks. While centralized supply chains and localized distribution networks are not inherently flawed, they are structurally unsuitable for fresh produce. The business model prioritizes efficiency and cost-effectiveness to maximize profit. Localized food contamination easily explodes into a public health crisis.

Another point of view is the biology of the parasite. Cyclosporiasis is produced exclusively by humans through feces and takes between one and two weeks in the human environment - soil or water before it becomes biologically infectious.

So, what really happened in this case? Public health experts would argue that this might have occurred due to poor treatment of human sewage overflows or contaminated agricultural irrigation systems - hygiene, food and water safety. Simply put, there is a lack of accountability and failure of the agricultural infrastructure.

Why has the current Ebola outbreak been so difficult to contain?

Lack of knowledge of the disease's epidemiology and etiology creates confusion, panic and fear. Left untreated, Ebola kills its human host very quickly. Survival depends on the context of the infected and access to supportive care to treat the symptoms presented.

In regions with recurring Ebola outbreaks, supportive care is primarily provided by family and social groups. Ebola thrives in social circles; it disrupts and often destroys social bonds. Transmission is controlled by isolating infected people in specially designed treatment units. As the late global health physician Dr. Paul Farmer would argue, Ebola is a caregiver's disease.

The current Ebola outbreak remains difficult to contain because there is no cure or approved vaccine. Survival depends heavily on early intervention and supportive care, including aggressive fluid replacement and symptom management, but chronic shortages of medical resources and countermeasures, delayed detection and treatment, and ongoing violence in the region continue to complicate the response.

Ultimately, it can be confidently argued that the outbreak reflects long-standing and growing inequalities of access to basic health care, support and services. The Democratic Republic of Congo does not have the staff, medical products or systems required to halt an Ebola outbreak on its own.

Are there connections you see between the Ebola response and the challenges facing public health in the United States?

Undoubtedly! The Ebola outbreaks in parts of West Africa and current public health challenges share strong connections. The most fundamental ones would be the lack of institutional trust and rigid dependence on a biomedical response approach. In the former, poor or limited public health education and health information and pre-existing social discontent opened the space for misinformation, confusion and fear. And in the U.S., lingering social and political differences and institutional skepticism, as witnessed during the Flint water crisis, continue to encourage widespread misinformation due to a lack of clear communication. The U.S. context is so rigid when it comes to strict biomedical modes of care and continues to treat infections as mere hops between bodies while ignoring the social, environmental and structural determinants of health.

Both contexts demonstrate how strict adherence to assumptions of biomedicine isolates individuals, resulting in social impacts and creating social suffering. The consequences of social isolation - both at home and in treatment facilities during the COVID-19 pandemic - has so much to teach us on the limitations of stringent public health policies, the most detrimental being their severe impact on socialization processes. Whether we are looking at resource-limited regions or those impacted by persistent violence, the lack of access to social infrastructures and services disrupts interventions and hurts people.

What lessons should Americans take from these two outbreaks - the cyclosporiasis in the United States and Ebola in Africa - about preventing disease and responding when an outbreak occurs?

Medical anthropologists would argue that medical and epidemiological responses alone are inadequate to treat and care for people during emergencies like Ebola and cyclosporiasis outbreaks, or a sudden natural disaster like the tsunamis.

Rather, a combination of two approaches, the explanatory model and the clinical medical anthropological approach, should be negotiated and integrated into developing treatment plans for managing disease epidemics. The integration of the clinical and medical anthropological approach produces the biosocial.

From cultural perspectives, caregiving is a collaborative and communal process, with on-going participation of extended family, neighbors and peers in Sub-Saharan Africa. Pain and loss as represented by disease and accompanying suffering are fundamentally a social experience in my research context. Whether the patient is admitted to the hospital or being cared for in the home setting, care is communal, a critical social capital for the sick and their families. While caring for the sick may include pain and laughter, it is experienced as collective suffering. In more recent times, Western cultures have begun prioritizing family involvement in caregiving, though a huge part of implementation still individualizes care.