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  1. Opinion

Perspective: Politics, and public health

The growing mosquito-transmitted Zika outbreak in Florida — with more than 400 confirmed cases, dozens of them locally transmitted, not travel-related — reminded us of a similar threat to the public health when we were young doctors, and the politics that put people at risk.

In February 1973, the mayor of Miami Beach drank a glass of water in front of a bank of network cameras and basically said "come on down, the water's fine" — except, it wasn't. Then, there was a different disease brewing, water-borne typhoid fever.

February is prime tourist season in Miami, and the fact that we and other physicians were seeing very sick patients in a typhoid fever epidemic, the largest in the United States since the 1930s, made little difference — mainly because those affected were migrant farm workers. Then, as now, money, politics and scientific ignorance trumped public health.

We were resident physicians at the University of Miami's Jackson Memorial Hospital, staffing the South Dade Community Health Center, a collection of double-wide trailers 25 miles south of Miami that served the poor, minority and migrant farm worker population. One of the trailers functioned as one of the few emergency rooms between Key West and Miami, and we covered the nights.

We were seeing more gastrointestinal illness than usual, and a few nights later, the waiting room was filled with extraordinarily sick people. After examining four or five patients, it became clear they had the same illness, and they came from the same migrant labor camp 10 miles farther south. Entire families were ill, most were Mexicans on the migrant farm worker trail, here for one harvest, then heading off to another.

They had high fevers, 101 and above, but instead of an expected tachycardia, or rapid pulse, they had bradycardia, slow pulses, known as Faget's sign, and a characteristic of typhoid fever. We called our lab tech for a consult. He had recently fled Cuba, where he'd been a physician, and he'd seen more typhoid than we had. He concurred in our diagnosis, and we started collecting blood and stool samples.

In the morning we called the Miami Health Department and the Centers for Disease Control.

At first, the Miami Health Department didn't take us seriously, but the CDC did. We watched, weeks later, as epidemiologists poured dye in one of the canals crisscrossing the migrant camp, and when they turned on the faucets, we saw the water turn blue with the same dye. By that time, the people had left their slum housing. Typhoid is a food- or water-borne disease, and in several later reports about the outbreak, "faulty plumbing and sanitation" was the euphemistic explanation for gross incompetence and neglect.

Later that spring, a raid on a migrant camp resulted in charges of peonage or debt slavery, and involuntary servitude brought against the labor contractor who ran it and kept people virtual prisoners, particularly if they owed "the company store." Several cases of active TB were found among the workers.

All told, there were at least 225 confirmed cases of typhoid. Families were separated among Miami area hospitals, already at full capacity. The CDC remained busy tracking folks throughout the country who might have been exposed before they left the camp. And in early March, after the mayor drank his glass of water and invited everybody down, a test of the Miami Beach water supply didn't find typhoid. Instead, it revealed a history of very high levels of fecal e-coli, ostensibly due to a faulty chlorinator.

We would hope that by now, post-Ebola and HIV/AIDS, the U.S. Congress would know that infectious diseases can spread at more than 500 miles an hour, or like Zika, by both jets and the inexorable migration of insect and other vectors north with climate change. But Congress, bickering over what should go in a Zika bill and seemingly indifferent to the serious challenge, went home for recess without acting even as the problem grew worse. And while berating the feds for their inaction, Gov. Rick Scott, a former health system executive who should know better, still has not admitted the threat that climate change poses to his state, including its role in the spread of Zika by expanding the carrier mosquito's habitat.

Our public health guardians — the CDC, the U.S. Public Health Service, other federal and state agencies, and most of all, the awareness of front-line practitioners — have kept our country relatively safe from scourges affecting the rest of the world. They've been doing this in spite of bare bones funding for public health. The public health community in Florida is working overtime, trying to stop a potentially devastating epidemic. So far, we've been lucky.

Many years ago, during the Typhoid epidemic, we inadvertently learned about the almost inseparable toxic mix of health, politics and power. We've watched the same poisonous combination frustrate and delay the treatment of AIDS, Ebola, H5N1 virus and so many other diseases.

Recently, politicians sipped Flint River water in Michigan and said it's safe, and thousands of kids' lead levels are being monitored because it wasn't. Others say the mosquitoes are under control, just restricted to a couple of blocks. The stories hardly change, but the climate has, and the diseases already have, and will continue to do so.

One small step that could separate science and health from the mire of politics and power would be to deny our votes to those politicians who deny science. They should not be making critical decisions about our health and our future.

Dr. Ben Daitz is professor emeritus of Family & Community Medicine at the University of New Mexico School of Medicine. Dr. John Frey is professor emeritus of Family Medicine & Public Health at the University of Wisconsin School of Medicine.

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