Carvings May 1, 2023

In the News

Why is there a rise in “strep” infections?

            Nearly everyone has experienced a “strep throat” during childhood, although that infection, caused by a common bacterium, can occur at any age. The throat is the most likely target but it can invade the skin through a thorn or splinter. Before the availability of penicillin it was not unusual for a local skin infection to march up the arm or leg and then to invade the bloodstream, so-called “blood poisoning” that was almost always fatal.

            This germ is quite sensitive to penicillin and similar antibiotics. It’s a relief to know that after more than 75 years, strains resistant to penicillin have not emerged, in contrast to many other bacterial invaders. In the pre-antibiotic era vast numbers of children developed the late complications of a strep infection, heart-damaging rheumatic fever, and kidney inflammation that eventually resulted in kidney failure.

            In rare instances some strains of this bacterium, Streptococcus pyogenes, are highly invasive, leading to the terrible-sounding flesh-eating condition that invariably leads to loss of limbs or death. Unfortunately there has been a dramatic rise in these invasive infections in several countries, including the United States. Compared to prior years the numbers have doubled or tripled; scores of children have died.

            There are two factors that may be contributing to the rise in strep throat as well as deep infections. Several viruses, including influenza, measles and chickenpox weaken the immune system, making a child more susceptible to bacterial infections, such as strep. We have seen that children are falling behind in receiving recommended vaccines since the onset of the COVID-19 pandemic. A deeper concern is the refusal of parents to immunize their children, a trend that has already resulted in outbreaks of preventable diseases such as pertussis (whooping cough) and measles. It’s critical for parents to ensure that  their children have received the vaccines that are indicated for their age, including the influenza vaccine.

            There is another possible reason for the recent increase in streptococcal infection: natural periodicity. Before childhood vaccines came into general use, epidemiologists observed that some disease-causing organisms occur in cycles. For instance, measles had a periodicity of two years, rubella (German measles) came in nine-year cycles. For the streptococcus that cycle appears to be about 75 years. As a consequence, the incidence of rheumatic fever began to decline in the early twentieth century, decades before penicillin became available. That lull has not persisted. A few years ago more cases of rheumatic fever began to appear, especially in developing countries. To be sure, other factors such as nutrition and sanitation may play a role, but if we are indeed in a rising cycle of strep infections, it behooves us to be more vigilant, to seek treatment early for a sore throat and to maintain an appropriate immunization schedule for both children and adults.


Running is not exercise, it’s a sport. For all you runners, I do not suggest that you stop if you enjoy it. It’s a great calorie-burner but it really isn’t all that much better than brisk walking.

            One issue is that a person can be injured in a sport but not in exercise that is being performed properly – with a few exceptions. Humans are evolutionarily designed for running so that it is a very efficient means of locomotion. Brisk walking is actually not as efficient so that we end up burning even more calories over a given distance.

            The pace for walking should be fast enough so that you are breathing rapidly but not so hard that you can’t keep up a conversation. After you have been walking regularly for a few weeks consider taking a route that includes some hills. That will increase your fat burn and it will also improve your heart and lung reserve.

            Aerobic activity such as running, walking, biking, swimming, etc. are important for good health and we should partake of them several times a week. However, resistance exercises, using weights and machines, are equally important because they strengthen the entire body, not just the legs, and because they stress bones, making them thicker and stronger.

            In other words, there is no “best” exercise. All activity matters and we are programmed to enjoy a variety of them.

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