Healing Politics by Abdul El-Sayed

Author:Abdul El-Sayed
Language: eng
Format: epub
Publisher: Abrams
Published: 2020-03-31T00:00:00+00:00

CHAPTER 16

Insecure places.

In Michigan in August 2016, days of heavy, humid heat alternated with days of torrential rain—as if the atmosphere were wringing itself out like a giant wet sponge. Over time, these cycles have gotten more severe—not just in Detroit but across the country. For residents of Detroit’s East Side, these cycles usually mean one thing: flooding—and 2016 was a particularly bad year. Although I usually had to pay more attention to the heat side of the equation rather than the rain side, this year was different.

That month I learned that two men had been diagnosed with hepatitis A, the least serious of the forms of hepatitis, though still deadly. Hepatitis literally means inflammation of the liver, and that’s exactly what it does, causing abdominal pain, vomiting, stomach upset, and the characteristic dark urine and yellowing of the eyeballs that indicate liver disease. Rather than being transmitted by blood or sexual intercourse, the hepatitis A virus moves from victim to victim via what scientists call “fecal-oral” transmission, cloaking it in scientific terms to spare listeners the gut-churning (both literally and figuratively) implications. A bout of hep A usually only lasts for a few weeks, and most healthy people recover without any lasting complications—but it can be far more serious in seniors or people with underlying liver diseases.

Hepatitis A is a reportable disease, meaning that providers who diagnose it are required to contact their local health department. And given the route of transmission, the first thing I wanted to know was if they had come in previous contact with anyone who had had the disease. Neither man had any known contacts. In fact, the only potentially relevant history—one they shared in common—was that they had both been cleaning basements that had been flooded with sewage because of the rains.

According to the CDC, contact with sewage is not a risk factor for hepatitis A, meaning that the incidence of the disease does not increase among those who have been in contact with it. While that may be true at the population level, it certainly remains plausible that contact with raw sewage could transmit the disease; it’s just that hep A is so uncommon in the United States, the chances of someone introducing the virus into the sewage system are exceedingly low.

Considering that contact with raw sewage was the only plausible exposure for two different people, I was concerned. The implications were daunting. Hundreds of homes had flooded. That meant that potentially thousands of people might have come in contact with hepatitis A–infested waste.

Hepatitis A has a long incubation period, meaning the symptoms don’t appear right away. Instead, the virus has to make its home in your liver before it starts to cause its characteristic problems. That can take up to fifty days but averages about twenty-eight. And critically, if the hep A vaccine is administered during that period, it can avert the onset of symptoms. If we assumed that the two men were in fact exposed while cleaning sewage out of

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