Malaria in Armageddon, and America?

[I posted the following article two years ago.  Crazy thing is, we didn't have to experience an economic collapse or other disaster for malaria to start rearing its ugly head here.  Florida and Texas both reported cases of domestic transmission of the disease at the end of last month.]

Spending most of yesterday working in the yard and planting vegetable seeds provided a lot of time to ponder the awful situation this country is in.  As I watch the slow collapse initiated by COVID, I wonder what comes next.  I read of lumber shortages, but also of massive stocks of all kinds of boards sitting next to train tracks.  Gas stations that have no gas.  Appliances still in short supply.  Increasing numbers of people opting to collect government money instead of work.  Businesses reducing hours because they can’t hire and keep employees. 

Just yesterday I ordered some wire racks for my freeze dryer.  I received an email from the company stating that “due to COVID” it would be 2-3 weeks before my order shipped.  Is it due to difficulty in procuring supplies, or because they can’t get enough people to work?  Anyway, I was reading a forum thread about air conditioners, and people debating the wisdom of acquiring a backup.  (Apparently, it’s not a good idea.  Something about an essential part going bad in storage.)  And I got to thinking about window screens, box fans, mosquito netting, and all the other items that contributed to eliminating malaria in the United States in previous decades.  And what happens when people can’t get those items any more.

I think malaria will make a comeback. 

The vast majority of malaria cases in the US occur in people who have recently traveled to foreign countries where malaria is endemic and then returned here.  The open borders policy will have even more travelers and immigrants bringing more malaria here.  But because malaria is still such a rare occurrence, most doctors haven’t ever seen or treated a malaria patient.  Most labs don’t have tests for it.  And that is now, when our medical system hasn’t yet collapsed.  What happens when the train really leaves the tracks?

While less than 200 people die from malaria each year in the US, more than a million, most of them children, die from malaria each year worldwide.  The industrialized world advantages of air conditioning and medical care will evaporate in a collapse, and with it malaria will eventually spread like wildfire here and become again the bane it once was. 

Because there are so few cases of malaria in the US, most of us don’t know much about it, beyond the fact that it is carried by mosquitoes and is associated with fever and chills.  While most cases are not fatal, death is always a possibility, and the risk of death increases if the patient is not treated.  The flu-like symptoms are periodic, with the time intervals varying depending on the individual species involved.  Over time, the patient becomes anemic as more red blood cells are destroyed.  The periods between episodes decrease and permanent organ damage may occur.[1]

What is your risk?  The CDC has posted the following map at their website.  I’m pretty sure it will be impossible for many to read here on the blog, so I’ve included a link to it below.  In a nutshell, the Anopheles mosquito is found in the eastern half of the United States, the West Coast, and the southern border.  The states of Nevada, Idaho, Montana, Utah, Wyoming, and Colorado have zero risk.  At least for now.

Signs and symptoms

The signs and symptoms vary somewhat depending on the exact species of malaria the patient is infected with.  Because Plasmodium ovale and P. vivax have a reproductive phase in the liver, the immune system may eliminate malaria from the blood, but it then reoccurs several weeks later when the parasites in the liver mature. 

Frequent, episodic high fevers with headache and severe muscle and joint pain are the primary symptoms of all malaria infections, regardless of the particular species of parasite.  P. falciparum is the species more likely to be fatal and causes what is known as cerebral malaria.  Additional symptoms include:

• Altered mental state
• Jaundice
• Reduced urination
• Respiratory distress
• Unable to sit without assistance

Children who have been breast fed are less likely to contract malaria.  Additional symptoms in young children include the following:

• Anemia and paleness may begin within 1-2 days
• In cerebral malaria, episodes may be followed by periods of unconsciousness.
• The palms may be blue-gray.
• Breathing may be rapid and deep.[2]

The following comes directly from The Ship’s Medicine Chest:

Incubation Period:  10-30 days.

Isolation Period:  None.

One of the most common and important of all the infectious diseases, malarial fever is both an acute and a chronic disease.  There is destruction of red blood cells and interference with the normal functioning of vital body processes.  Chronic malaria may last for years.  The symptoms may interfere greatly with the patient’s well-being and with his ability to function normally, or they may not be severe enough to keep the patient in bed all or even a part of the time.

The geographic distribution of malaria depends on the species of mosquito that transmits it.  Females of the Anopheles group of mosquitoes act as intermediary hosts for the Plasmodium protozoal parasites that cause malaria.  These live part of their life in the mosquito and part in the blood of the infected person.  When a female Anopheles mosquito bites a person who has malaria, she sucks in some of these parasites with the blood on which she is feeding.  The parasites go through a stage of development in the body of the mosquito.  It takes at least two weeks before the mosquito can pass the parasites to another person.  When the young parasites are ready to start the part of their life cycle that takes place in a human host, they enter the mosquito’s saliva and are injected into the blood of any person bitten by the mosquito.  In the blood of the new victim, the parasites go through another stage of development which takes about 10 to 14 days.  Then the parasites are ready to cause the chills and fever typical of malaria.  These attacks occur every day, every other day, or every third day, depending upon the type of infecting parasite.

Malaria may occur as a relatively mild or as a severe and fatal disease.  In the mild type, the temperature rises above normal and falls below normal with each attack.  In the severe type, it rises higher above the normal but does not drop back to normal before the next attack.  To distinguish between these two types, the temperature should be taken at least every four hours for several days.

The typical attack of malaria has three stages.  The first or cold stage, usually is ushered in by a preliminary period of malaise (feeling ill and tired), chilliness, headache, aching in the bones, loss of appetite, nausea, and possibly vomiting.  Sometimes the chills begin without any of these warning symptoms.  In the cold stage, the patient feels cold, shakes all over, his teeth chatter, and he has accompanying pains in the head and body.  He yawns, usually is nauseated, may vomit, and the pulse is rapid and feeble.  Despite his chilliness, the temperature will be above normal, sometimes as high as 104°F or 105°F (40°C to 45.5°C [sic]).  The patient will get into bed and pile covers over himself, but he will not get warm.  This stage lasts for a half hour or longer.

In the second or hot stage, the patient loses the chilliness, becomes uncomfortably warm, and throws off the bedclothing.  The skin is hot and dry, the temperature remains elevated, the face is flushed, the pulse is rapid and full, and respirations are quickened.  The patient becomes very thirsty, headache increases (often becoming agonizing), and frequently there is vomiting.  This stage lasts from one to four hours or longer.

Then the fever begins to fall.  The patient enters the third or sweating stage.  He begins to perspire freely, first on the face and then over the entire body.  Perspiration may be so profuse that the sheets are literally soaked.  A feeling of comfort takes the place of the acute misery of the first and second stages.  Headaches and other symptoms disappear and he may fall into a deep sleep.  Afterwards, he feels fairly well until the next attack.

The patient should be watched for the following complications:  (a) excessively high temperature 108°F to 110°F (42.2°C to 43.3°C); (b) coma, or delirium followed by coma; (c) heart failure following sudden exertion; and (d) severe distress in the stomach region, a tender abdomen, incessant vomiting, and collapse.

Some forms of malaria follow an unusual pattern.  One form simulates heatstroke, acute mania, or an acute alcoholic mental disturbance.  Headache, mental excitement, and/or prostration are prominent.  All symptoms are relieved by antimalarial treatment.  In another form, there is dimness and clouding of vision with headaches of long duration, usually over the temporal or frontal areas.

Treatment

Chloroquine phosphate remains the drug of choice for terminating acute attacks caused by the parasites Plasmodium vivax, P. malariae, or P. ovale.  1000 mg (four 250 mg tablets) of chloroquine phosphate should be given at once, followed by 500 mg six hours later; then 500 mg once daily for the next two days.  Chloroquine phosphate ends acute attacks of malaria fairly quickly and may be given for P. falciparum strains that are not resistant.  If some parasites develop resistance to a drug, then another drug must be tried.

For patients with a chloroquine-resistant P. falciparum infection, or any patient developing clinical malaria while on chloroquine prophylaxis, 600 mg (two 300 mg tablets or capsules) of quinine sulfate should be administered orally every eight hours for 14 days.  On each of the first three days of treatment, 50 mg of pyrimethamine should be administered concurrently with the quinine sulfate.

Before treating any malaria patient, medical advice by radio should be obtained.

Prevention

To prevent malaria, travelers should take 500 mg of chloroquine phosphate by mouth, weekly on the same day each week, beginning two weeks before possible exposure, and continuing for eight weeks after the last possible exposure to malaria.

This concludes the entry in The Ship’s Medicine Chest.

Brucellosis may be mistaken for malaria.

Other preventative measures

• Using mosquito repellent
• Sleeping under a mosquito net
• Wearing long sleeves and pants, especially at dawn and dusk when the Anopheles mosquitoes are feeding.
• Removing areas of standing water where mosquitoes could breed
• Placing screens on windows and doors and repairing holes

Essential oils that repel mosquitoes

• Catnip
• Clove
• Cinnamon
• Citronella
• Geranium
• Lemon eucalyptus
• Peppermint
• Rosemary

Conventional pharmaceuticals used in treating malaria include

• Chloroquine sulfate
• Quinine, 200 mg tablets, adult dosage is 500 mg, 3x per day, for 5 days.[3]
• Hydroxychloroquine
• Doxycycline is used prophylactically, beginning 3 days before going into an area endemic for malaria and continuing for 3 weeks after leaving.[4]  

All of the above pharmaceuticals are normally stocked and sold by All Day Chemist.  However, at the moment (18 May 2021), hydroxychloroquine is the only one in stock. 

The following herbs and foods may be of benefit in treating malaria:

• Alum
• Cinnamon
• Echinacea
• Elderberry
• Feverfew
• Ginger
• Grapefruit
• Lemon
• Lime juice
• Rosemary
• Sweet annie

Links to related posts:

Hydroxychloroquine

Tetracycline

Permethrin

DIY mosquito trap

Preventing mosquito bites

Quarantine and Isolation

Mosquito-borne diseases—yellow fever

The Ship’s Medicine Chest and Medical Aid at Sea

 

References:

https://www.cdc.gov/malaria/about/biology/mosquitoes/map.html

Adegoke, S.A., et al., “Effects of lime juice on malaria parasite clearance,” Phytother Res. October 2011; 25(10): 1,547-50, https://www.doctorshealthpress.com/food-and-nutrition-articles/zap-harmful-bacteria-with-this-juice/ (accessed 11 May 2021). 

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[1] Joseph Alton, Survival Medicine Handbook, 2013, 199.

[2] David Werner, Where There Is No Doctor, 1996, 186.

[3] Survival and Austere Medicine, 3^rd Edition, 2017, 106.

[4] Survival and Austere Medicine, 3^rd Edition, 2017, 106.