Bedside Rounds 58 - The Original (Antigenic) Sin
Oct 26, 2020
Tony Breu, a practicing internist and co-host of The Curious Clinicians, delves into the intersection of health and race, tracing historical pandemics like yellow fever and polio to reveal enduring health disparities. He discusses the impact of social determinants on COVID-19 outcomes, particularly among Black and Native American communities. Breu also critiques the concept of 'original antigenic sin' and immunity passports, linking past inequities to contemporary challenges in healthcare. His insights shed light on the urgent need for systemic change in medical practices.
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Acclimation Became Social Capital In New Orleans
- New Orleans suffered repeated yellow fever waves with extraordinary mortality, especially among recent immigrants.
- Locals developed 'acclimation' where surviving yellow fever conferred social and economic advantages.
Ancestry, Not Race, Explains Some Disease Patterns
- Apparent racial differences in yellow fever mortality likely reflect ancestry and prior exposure, not race itself.
- Genetic explanations require evidence; analogies to sickle cell and CF show selection acts on ancestry, not 'race.'
Survival Conferred Valuable Social Rights
- Societies rewarded surviving infectious disease with status and opportunity, creating incentives to expose oneself.
- Acclimation parallels modern proposals like 'immunity passports' that would grant social mobility based on prior infection.