Cholera in a Collapsed Society

[I'll be taking spring break this week.  Per the usual, all articles will be re-runs, hopefully useful refreshers.  I'll also be presenting at a conference and selling books in Utah and unable to check comments.  So everyone play nice.  OK?  (Yes, I know I haven't been very responsive to comments lately.  QOTPE is getting married at the end of the month.  'Nuf said.  I am extremely grateful to have nothing to do with the menu.  As the ceremony and reception are taking place several hours away from here, Doc's mother is doing everything.  And really, I did sincerely offer to help.  QOTPE and Doc say his mom and I are quite alike, so I let it go.)]

 

Before COVID arrived on the scene and got all the attention, there were other dread diseases ringing alarm bells at UNICEF, WHO, and other international organizations.  One of those was cholera. An outbreak began in Yemen in 2016 and is apparently still ongoing.  But, you know, it's only affecting a third world country, and it's a long way from here.  Besides, it came about at least partially as a result of a civil war.  Fighting damaged hospitals and water treatment facilities.  With a collapsing government, sanitation workers weren't being paid to haul garbage, so they quit working.  And the garbage started piling up.  And you know, because they weren't being paid, health care workers started quitting.  Or they could read the tea leaves and decided it was better to head for the hills. 

We don't need to learn about any of this because it couldn't happen here.  Right?

Yeah, most of us reading this blog happen to believe otherwise.  It wouldn't take much to turn the US into another third world country.  A majority of Americans now believe civil war is inevitable.  With the printing presses running at warp speed, hyperinflation is also just around the corner.  Garbage trucks will quit rolling when things fall apart.  Medical personnel will disappear, too.  Not that it will matter much when labs and pharmacies are shuttered.  So what's the difference between us and Yemen?  Probably just a few years is all.  We'd better be ready to deal with cholera.

Untreated cholera in large outbreaks might have a mortality rate of 50-60%.  That's pretty significant.  When cholera can be managed the mortality rate drops to 1-3%.  That's a lot better, but still pretty frightening. What if it's your family?  How are you going to treat it?  How are you even going to know it's cholera?

Cholera is extremely rare in the US, with an average of ten cases per year.  The overwhelming majority of physicians here have never even seen a case.  What's it take to change this (the number of cases, that is)?  Not much.

According to the CDC, Haiti had not had a cholera epidemic in at least 100 years when they were devastated by an earthquake in January 2010.  With crowded conditions and crappy sanitation, an epidemic was inevitable.  Of the 91,000 cases of cholera, over 43,000 were hospitalized.  That's a lot of hospital beds.  For the fatalities, the time from onset of symptoms to death averaged eight hours.

If you lack a laboratory for identifying the Vibrio cholerae bacteria, diagnosis will have to made according to the symptoms.  Cholera is not transmitted person-to-person, only through water (most often) or food (rarely) contaminated with the feces of infected individuals.  Cholera is a human disease; animals are not affected by it.  In addition, persons infected with cholera may have no symptoms or only mild symptoms.  Or it can be fatal.  Death comes from dehydration due to diarrhea, vomiting, and electrolyte loss.

Because we will lack laboratory equipment for definitive diagnosis, we need to know the symptoms of cholera to distinguish it from other diarrheal diseases and provide effective treatment.  Symptoms include:

• profuse diarrhea and vomiting of clear liquid
• diarrhea that looks like "rice water" and may smell like fish
• skin may turn bluish-gray
• typical signs of dehydration--sunken eyes, dry mouth, clammy skin, wrinkled hands and feet
• children may have seizures or lapse into a coma

Those at greater risk for developing cholera (beyond what happens with poor sanitation and hygiene) are:

• children, especially 2-4 year olds
• individuals taking proton-pump inhibitors (reduced gastric acidity)
• people with blood type O (doctors don't know why)
• immunocompromised and malnourished individuals

Physicians generally administer antibiotics to moderate and severely ill patients:

• doxycycline, 1 dose of 300 mg OR
• azithromycin, 1 dose of 1 gram OR
• ciprofloxacin, 1 dose of 1 gram OR
• tetracycline or erythromycin, 500 mg four times per day for three day

Do NOT administer anti-diarrheal medicines like Imodium (loperamide).  Cholera needs to get OUT of the body; Imodium works by keeping waste IN.

While just a few decades ago there were no reports of antibiotic resistance among cholera, now there are many strains resistant to most antibiotics.  Even though the above antibiotics were effective in Haiti, there is no guarantee they would work in an outbreak today.

So what do we do?  Can herbs help here?

Stephen Buhner, in his book Herbal Antibiotics, offers a few formulas:

• cryptolepis and berberine plant (equal parts) tincture: 1 teaspoon, 6 times per day
• geranium root strong decoction:  3 tablespoons every hour
• guava leaf or bark and pomegranate leaf or bark (equal parts) tea: as much as possible

Buhner also cites clinical studies showing that berberine (available on Amazon if you don't want to make your own) combined very well with tetracycline to reduce diarrhea due to cholera and enterotoxigenic E. coli infections.

Ginger and parsley have also been used historically to treat cholera.  Japanese honeysuckle (Lonicera japonica) leaves in a tea or infusion have been used in traditional Chinese medicine to manage cholera.  Unfortunately, there is no clinical research to back these treatments up.  However, we have clinical research on the use of berberines.  One of the berberines is Japanese barberry (directions for making Japanese barberry tincture are provided here). Other berberines are Oregon grape, goldenseal, and phellodendron (not to be confused with philodendron, an entirely different plant).

Related posts:
Ginger
Loperamide
Japanese barberry
Katadyn Micropur tablets
Japanese honeysuckle 


For further information:
https://www.webmd.com/a-to-z-guides/cholera-faq#2
https://www.medicinenet.com/cholera/article.htm#where_can_people_find_more_information_about_cholera
https://www.cdc.gov/cholera/pdf/haiticholera_trainingmanual_en.pdf
"The Broad Street Pump:  You Know Nothing, John Snow"  is an excellent Youtube by the people at Extra History.  Entertaining (and infuriating) for all; ideal for students.

 13 march 2019