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“ROLLING THE PINK EYE DICE”

Dear Editor,

 

I would like to offer an observation regarding some comments concerning pink eye, or conjunctivitis, that recently appeared in the Samoa News web edition. These comments were made by a certain doctor (who shall remain unnamed in this letter) working within the pediatrics clinic at the LBJ medical center.

 

I would also like to offer some observations on the failure of those individuals working at the Department of Health responsible for communicable disease control to adequately perform their jobs and fulfill their duty to protect the people of American Samoa from a highly contagious yet preventable disease. Apparently, they rolled the “pink eyed dice” hoping to come up a winner, but instead lost their entire bet.

 

To begin with, I should say that while the doctor in question may be a wonderful pediatrician and may have treated many individual patients for pink eye, judging from his comments on the Samoa News web site, I find it doubtful that he has had any formal training in public health and/or epidemiology nor does he appear to possess an in-depth understanding of the factors involved in the rapid spread of a disease, such as pink eye, through a population.

 

I should preface my remarks here by stating that while I myself am not a medical doctor, I did study public health and epidemiology at the Graduate School of Public Health (GSPH) at San Diego State University back in the mid-1990s.

 

One of the courses I took (as required) was in infectious diseases. I still have one of my books from that course, entitled the Control of Communicable Diseases Manual (CCDM) edited by Dr. Abram Benenson (who was a professor emeritus at GSPH while I was studying there). This book was, and as far as I know still is, the official report of the American Public Health Association and was considered throughout the known world to be the “bible” of epidemiology.

 

Therefore, I believe that the information contained in the CCDM regarding an epidemic of pink eye (such as American Samoa is currently experiencing) may be of a bit more relevance and importance than the well-meaning but rather misguided advice given by the good doctor at LBJ.

 

Assuming that the present outbreak of conjunctivitis (pink eye) in American Samoa is of viral origin then the following selected information from the CCDM applies:

 

“1.            Identification – An acute viral disease of the eye…Onset is sudden, with pain, photophobia (i.e., sensitivity to light), blurred vision, and occasionally low-grade fever, headache, malaise (i.e., feeling of tiredness and lethargy) and tender pre auricular lymphadenopathy (i.e., swelling of and pain in the lymph nodes just in front of the ears).

 

Duration of acute conjunctivitis is about 2 weeks, although the keratitis (i.e., inflammation of the corneas of the eyes) continue to evolve, leaving…opacities that may interfere with vision for a few weeks (i.e., spots on your eyes that partially block your vision). In severe cases permanent scarring may result.

 

5.            Mode of transmission – Direct contact with secretions of an infected person and, indirectly, through contaminated surfaces…

 

7.            Period of Communicability – From late in the incubation period (incubation period is anywhere from 5 to 12 days before the onset of symptoms) to 14 days after onset. Prolonged shedding of the virus has been reported.

 

9.            Methods of control…Investigation of contacts and source of infection. In outbreaks (note: American Samoa is now suffering from a severe outbreak), the source of infection should be identified and precautions taken to prevent further transmission.”

 

So taking this information from the CCDM into full consideration (and contrary to the good doctor’s advice) this outbreak of pink eye in American Samoa:

 

A)            Should be taken seriously as pink eye is not an entirely "benign disease" (the doctor’s own words), benign meaning that it can cause no harm, serious or otherwise.

 

I doubt if those who must suffer through and from the effects of this “benign disease” consider it to be harmless, and I am certain that anyone who might suffer more serious complications (e.g., scarring of the eyes) would definitely not consider it to be "benign".

 

B)            Since they failed to make any effort to contain the disease early on when it was possible to do so, the only proper response by the government health authorities once it had become an epidemic was to then close the schools and instruct all employees who exhibited any symptoms whatsoever of this disease to stay home from work to “prevent further transmission”. (Private employers should have done the same.)

 

Ordinarily when faced with a potential epidemic (i.e., the presence of and possible outbreak of a highly contagious disease) the proper authorities to listen to would be those working within public health, which would have been the local Department of Health (DoH).

 

Unfortunately, those people let American Samoa down when it mattered most and failed to provide the proper advice and do something when it could have made a huge difference. For it was then that something substantial could have been done to prevent the current epidemic of conjunctivitis, an outbreak that has now led to the closing of schools, many days of lost work, and untold misery and suffering for hundreds of residents of the territory (and, for some, potentially serious complications).

 

Therefore, I believe it would be most prudent to call for an investigation into why those at DoH failed so miserably in their duty to protect American Samoa from pink eye. Why did they fail to make even the most basic attempt to stop a disease that they were alerted to from its earliest manifestations in neighboring Samoa? If they would have just acted sooner rather than later, then perhaps this current epidemic could have been largely contained, if not outright prevented.

 

It appears to me that they just didn't care enough to bother with doing their jobs to protect the public from infectious disease. Instead they preferred to take a chance and roll the dice, betting that they wouldn’t come up “pink eyes” when the odds were stacked against them.

 

Unfortunately, they lost that bet, and it is the people of American Samoa who must now suffer and pay the price for the incompetence, lack of concern, and/or pure laziness of those at DoH who should have known better than to roll the “pink eye dice”.

 

Sincerely,

Bryan M. Jackson