Rather, "there is no evidence to show that using insecticide to kill mosquitoes inside aircraft cabins is effective in preventing introduction and spread of mosquito-borne diseases."
As a kid (in the early 70s) I remember the air hostesses walking down the isles with a spray can. They don’t do that any more, but I wonder if or why they don’t add lower concentrations of the aerosol to the air conditioning at the end of the flight.
You could spend tens or hundreds of millions building an automatic system (certification for aircraft is not cheap or easy) or just hand the flight attendant a can of spray.
Sure, but I can imagine the more expensive airlines worrying that the ‘optics’ of spraying your passengers down aren’t great (to be clear - I’m not objecting and I’d rather they do it). I wasn’t suggesting they retrofit to existing aircraft of the period, but rather just build it in as they design the next generation airflow system. Or do you think it would still be way too expensive even then?
Adding systems to aircraft, whether retrofit or new design, is a horrifically complex and expensive thing.
What kind of disinfectant is used? How is it distributed? Does it do something bad at -80 degrees C? At +80 C? If it freezes, what happens? What if someone loads the wrong thing into the disinfectant bucket? Like fuel? Or oil? Where do we put the switch to isolate the cockpit from the disinfectant? Where does flipping that isolation switch go in the unknown-fume-event checklist?
What if it catches fire? It's not enough to say it can't catch fire, you must assume it will catch fire. The fire suppression system has to be aware of it. What if the fire suppression system erroneously thinks the disinfectant system is on fire? What if it was erroneously thought to be on fire, and then later _actually does catch fire_? How long can we fly with a flaming disinfectant system that someone in Terribadistan filled with kerosene?
You probably have more than one disinfectant module, probably attached to each pack. Is the plane "disinfected" if only one pack is operational? If your disinfectant module fails, does it bring the pack down with it? No? Now we have to certify the packs for both with-and-without disinfectant module operation.
They didn’t mention the strain. My understanding is that there are 5 strains. P. malariae is common and not particularly deadly while. When i visited Africa, all of the locals had had malaria multiple times. P. falciparum is extremely nasty and can kill quickly.
> Im Zusammenhang mit den bereits bekannten sechs Fällen von Malaria tropica bei Personen, die am Flughafen Frankfurt am Main tätig sind, sind zwei Erkrankte verstorben
And a quick search says that this is the most dangerous one. Of course it had to be...
I had dengue once. Fever was something else! Since then I've been scared shitless that there are 3 other major variants remaining and if the next time is one of those 3 I am most probably cooked. There are no vaccines here yet either.
Got it as well a couple years ago, it was no joke. :/
Luckily we could get vaccinated a year later. If you’ve had it and catch another variant mortality rate jumps to 10%. But usually those variants don’t overlap, it’s region based.
Kinda wild. I spent most of my childhood a couple hours drive from a malaria region and never heard of anyone getting sick locally that hadn’t travelled that way. So multiple people in Germany seems surprising.
I live in a mosquito ladden region and some mosquitoe individuals ingest blood until they can no longer fly (they die) Many mosquitoe individuals feed until full, not necessarily from only one human.
Now, some people are more resistant to some diseases than others. Sickle cell anemia heterozygote humans can live with plasmodium alright.
What surprises me is that someone around an airport in Germany (urban area) actually died of malaria. Malaria causes intervals of very high fever which lead to hospitalization and treatment.
Being a tropical disease makes it very unlikely and so a doctor will not even be considering it. By the time they’ve tried different therapies and start considering malaria, it’s too late. I’ve seen this happen to a couple of Africans who travel to Europe while gestation is ongoing and they’re dead 2 weeks later. As another thread said, it’s cheap to carry malaria meds when you travel, do it. If you start feeling offish - joint pain, fever, malaise, get a blood microscopic test for it and start the meds. Malaria is brutal
I got malaria twice in Africa. First time bad, second time REAL bad. I thought about death a little.
There was a good story of a Dutchman living in Mali who got malaria a few times (everyone does). It’s manageable with the meds.
Anyway he flies home, then develops symptoms. Goes to hospital and they freak. Full hazmat suits, isolation, doctors visiting from all over because they’d never seen it. Guy ends up dying because they wouldn’t give him the meds, because they didn’t know if it was safe, or what the right thing to do was.
Moral of the story is that for anyone spending time in malaria zones, take the meds home with you. If you get symptomatic, take the meds and maybe not go to hospital in the developed world.
Meds I took was “coartem” and an injectable.
I have a feeling this is exactly what happened in Frankfurt. It very glaringly points to some failure in the healthcare system.
Healthy working adults with access to healthcare don't just die of malaria. Two deaths means it's not some unique susceptibility in one individual either.
The more interesting investigation would be how the system let two people die of malaria, not how malaria got there.
> It very glaringly points to some failure in the healthcare system.
Does it? "Have you been near the equator recently?" is a rather common question that GPs ask when you go see them with high fever. Doctors in Germany are absolutely aware of malaria, given how much we like to travel to all those beautiful, but unfortunately malaria-ridden countries.
The only thing, of course, is: That question wouldn't have helped here. However, this[0] source says airport staff are made aware of the possibility of contracting malaria and are told to watch out for symptoms.
Kind of similar to rabies. If you get bit by a rabid animal in an area with lots of rabies, the doctors know what to do and you get meds immediately for cheap.
In the US it's a few thousand dollars for the treatment.
It's wildly inconsistent. Surgeries, hospitalizations and specialists are mostly ridiculous. You can find affordable general/nurse practitioners if you know where to look and what to ask for.
Call around and ask "What is your self cash pay cost?".
Most people don't know to ask that and if you don't speak the magic phrase then you get billed at the rate the office would normally charge insurance. Not all places have self pay discounts.
Some states have special programs for hospitals but they vary wildly by state and you have to know how to navigate that particular program and be very patient. Some are need based so if you are above a pretty low income threshold you won't qualify.
It's really not, for common/minor issues. I use a little cash-pay clinic in a MCOL area and mostly spend <$100, never over $200, per visit. Also, my wife recently had some major dental work done, and it was about $350. All of this without getting insurance involved.
There are definitely ways to rack up big bills fast, though, just by being unlucky.
It's not quite PE (yet); doctors are getting annoyed themselves at how healthcare is playing out. Picture things like electronically messaging your doctor now has convoluted billing behind each conversation now based on the level of effort the doctor has to put in. They're getting annoyed now that they've been bought out by hospital systems and been working underneath them for a while doing family practices and other healthcare services. The paychecks were good, but the red tape got annoying over the years.
So they exit the whole system and go to a direct "you pay me monthly for access" model. Hundred bucks a person or so per month, factor a ~25% discount for families. Doc gets to keep a cap on the limit of incoming patients to manage their own day pretty nicely while getting a recurring stream of cash paid direct to him.
Even better if your wife's also a doctor (hey, healthcare partners run together a lot!), you just band together, see 5-600 patients a month as a couple, and pull in a decent $million or so on a fairly light workload and selling extra things like GLP-1s and wellness programs for a year's work. Triple-points if you're doing this in rural America - that million might not be a lot to the big techies out there, but that's big bucks that go far in some really nice places tucked away in the trees and forests.
You still need insurance for the rest of the 'stuff' they don't do, but some of these DPCs are doing everything they can in house (like prescribing and dispensing generics at the office directly in a single visit to lower your extra out of pocket costs).
If you're on a high deductible healthcare plan with an HSA and an employer contributing healthily into it, these direct-patient-care clinics may be an attractive option if you're reasonably healthy and young.
It isn't a homogeneous experience, so you will get different stories. Most Americans get their healthcare provided by their employer, so their company determines what is covered and their financial exposure.
My United Healthcare plan limits my out of pocket expenses to $2,000 per year.
Like most Americans, "United Healthcare" is just the company that does the billing and adjudication. My Employer sets policy and pays for treatment at the end of the day.
How could two people die from it in Germany with modern medicine? Is malaria randomly fatal despite treatment, or did they not understand what the infection was or not seek treatment or something?
One question that gets asked is "have you traveled to another country?" When the answer is "no", then doctors no longer consider diseases that exist in other countries. So that is why they did not understand the parasitic infection until it was too late.
Some of the early symptoms resemble a bad cold.
The parasite that causes malaria (literally "bad air") can only survive in certain species of mosquitos. Those skeeters don't live in Germany. They used to live in the state I live in, but they were exterminated back in the 1950s & 1960s (thanks DDT!). And people from West Africa were naturally/genetically resistant, which was why slaves from that region were preferred over every other race in the southern US where malaria existed until the 1950s & 1960s. If you have 0 copies of the gene then you usually die (of malaria) before puberty. If you have 2 copies of the gene, then you die from sickle cell anemia (usually by your teen years). If you have 1 copy of that gene (another commenter used the term "heterozygote") then the parasite can't live in some of your red blood cells, so you survive to have children.
Germany never had it, and reported being malaria free in 1964. America, in 1970.
Some good info, but some kind of simplistic. I lived in Nigeria for the second half of my childhood in the 80s and 90s and got malaria several times. People come down with it all the time, and typically treat it, and you can recover without treatment also. Most people die from sickle cell anemia when young, but I know multiple outliers who have lived to middle age, and they might live longer yet.
It's easy to test for malaria, if you actually think to test for malaria. In the 90s, we used to hear wild stories from people we knew who would come down with malaria shortly after returning to the USA and doctors and nurses would freak out not knowing what to do about it, and the medication would be expensive to obtain, so the conventional wisdom was also to remember to take a few pills with you on the plane back to the USA!
It's sad but unsurprising that no one was able to treat these German workers in time. When I was a child, there was already talk of strains developing resistance, and this has gotten worse in the 21st century, and the airport workers caught the most deadly strain:
> It's sad but unsurprising that no one was able to treat these German workers in time.
Literally every pharmacy over here sells treatment against malaria – many have it in stock and even if they don't, they'll be able to get it for you within a few hours. Every major city (certainly every city with an airport where you could catch airport malaria) has a hospital with a department specifically for infectious and tropical diseases, where they'll happily take care of you. GPs ask you if you've been to the equator lately if you go see them with high fever. I'm not sure how a country where malaria is not common at all would be able to do any better?
Also, as I mentioned in another comment, airport staff are instructed to watch out for malaria symptoms precisely because airport malaria is a thing.
Something definitely went wrong here but from afar it surely doesn't look like a healthcare failure to me. Maybe the deceased stayed home, thinking they had caught a cold and would be able to sit it out?
"It [the Robert Koch Institute] said laboratory tests to determine the source of the infections were not expected to be available for several weeks. [...] The [Robert Koch] institute said malaria in Germany almost exclusively affects long-haul travellers who were infected in malaria-endemic areas, and that malaria transmitted within a German airport is rare. 'The lack of a travel history can lead to a delayed diagnosis. A delayed diagnosis increases the risk of a severe course of the diseases,' the institute said in its epidemiological bulletin."
Cerebral malaria is fatal with no treatment in many cases. For kids and elderly it’s fatal even with.
Likely this happened because they have no expertise and didn’t know what to do.
Imagine if you showed up in a hospital in the us with a sting from some super intense scorpion that only exists is some obscure part of the world. They’ll try to help, but likely can’t do much.
I'm asking about the Dutchman story the parent wrote. I can hardly believe it tbh. Even if the Netherlands don't have specialized personel, Hamburg is just a 5 hour drive away and Antwerp even closer.
And some of them have Super powerful side effects - I had a 3 day violent psychotic break I have no memory of, but I did get to wake up strapped to a bed!
Malarone? Interesting, because that's supposed to be the prophylactic therapy with the mildest side effects. I have taken it many times and have never had any, and – up until now – I had also never heard of anyone having some.
The author of the book Mother Nature is Trying to Kill You had a story like that; he managed to pick up a parasitic fly infection while abroad and had to convince health care workers to cut out the larvae from under his skin.
The proper solution is a thick layer of petroleum jelly over your skin. The larva has to come up to breathe eventually (~hours). Use tweezers and grab it. Gross, but perfectly safe.
I saw the same thing happen in Leeds. A friend came back to her public health program after Christmas in Zimbabwe. The NHS was dragging their feet, like, "oh, we need to get a specialists opinion before we can even draw blood, then it has to be sent to the school of tropical medicine, that will be a few days, etc". Her African friends (and a European friend that worked in Africa for MSF) had to explain malaria to the hospital and beg them to just get her started on an artemsin compound while they were wasting time wondering how to test for it.
Malaria was endemic in Finland until the beginning of the 20th century, the people used to lived inside smoke-heated chimneyless log cabins together with animals, mosquitoes... and Plasmodium vivax...
USA wiped out malaria in the 50s using DDT which also made the California condor go extinct in the wild. During the 70s-90s DDT became illegal to use in most countries around the globe.
I’m not sure the USA would have been successful eradicating malaria without using DDT or something similar.
DDT caused the Bald Eagle population to drop from about 400,000 birds to just 47 nesting pairs.
No. Malaria epidemics occurred in medieval Europe, both in warmer countries (Italy, Greece) and in France, Germany and England. It was also common in portions of the US until large-scale eradication efforts.
It's unlikely to become a problem again because the climate is not optimal and these countries are wealthy, have advanced healthcare systems, and can spray everything with DDT again if they feel like doing it.
Yes to everything but "the climate is not optimal". The climate was not optimal. I expect this year's weather in most of Europe must have been pretty spectacular for mosquitoes; if it becomes a regular occurrence, as scientists suggest, things might get pretty spicy. Places like Milan are already massive breeding grounds for the most aggressive types of mosquitoes.
> Yes to everything but "the climate is not optimal". The climate was not optimal. I expect this year's weather in most of Europe must have been pretty spectacular for mosquitoes.
You'd think that, but anecdotally there was much fewer this year in Germany than previous years.
At least where I live most of the places where they'd have usually spawned (wetlands) have dried up and shrunk considerably. So really the hot weather made it a worse year for mosquitos.
There were malaria epidemics in even quite temperate parts of Europe up to the mid 20th century, including Bavaria and even England, and it was endemic to parts of Italy and Greece. P. falciparum was found in bone samples of the Medicis.
Yes, I remember reading in Charles C. Mann's book 1493 an interesting chapter about how malaria was pretty common in preindustrial SE England, where it was known as "marsh fever" or "ague."
Only a few species of mosquitos can carry the parasite. None of them live in that part of Europe. The swamps around the city of Rome were historically infested with those skeeters which is why we use the Italian word for the disease (which means "bad air").
No, most probably the mosquitoes will not survive the winter. Besides, given enough effort, Malaria can be eradicated and even a poor tropical country like Sri Lanka has has done that where mosquitoes are quite common throughout the year
Malaria was endemic to the Deep South in the States up until the 1950s, at which point it was declared eradicated thanks to a miracle chemical called DDT. They should put that on everything (/s).
It is unlikely that malaria will establish itself, given that it gets cold and inhospitable to malaria-carrying mosquitos in Northern Europe. However, it is one of many things that could potentially be frog-boiled into existence in northern latitudes as a result of climate change.
I live in an area where mosquitos were unbearable this year. You couldn’t do outdoor activities without a mosquito net. It’s bad enough but I don’t want to imagine what it would be like if the threat of mosquito-borne illness was layered on.
I can not say anything about this incident, but what I have noticed
in the last some years is that mosquitos have become much more annoying
even in larger cities of mediate temperature. That has not been the case
say 30 years up to 10 years ago or so, give or take. The range of mosquito
attacks has definitely increased in every axis. Kind of almost miniature
mosquitos too - really small, like barely 0.5 cm at max in length or perhaps
0.6 cm, but annoying to no ends and very hungry for blood. One can speculate
but I think the increased temperature range induced this for the most part.
I'm pretty sure mosquito populations in India have been evolving in response to those electrified tennis rackets. Mosquitos now are much faster, smaller, and have more evasive flying patterns.
I still remember they used disinsect the aircraft cabin, before you land in Indian airports with an aerosol spray https://www.transportation.gov/airconsumer/spray
https://www.epa.gov/mosquitocontrol/aircraft-disinsection
They still do this when you land in Australia
Not in my experience. I have only flown international ten times or so in the past 20yrs but I have never seen that when returning to Aus.
They did that on our take off from Naples just a month ago, they said it's against insects.
They do but chances are it's not 100% effective.
Rather, "there is no evidence to show that using insecticide to kill mosquitoes inside aircraft cabins is effective in preventing introduction and spread of mosquito-borne diseases."
https://www.epa.gov/mosquitocontrol/aircraft-disinsection
Not sure where the idea came from that spraying the cabin aisle would penetrate the luggage bins, cargo hold, under the seats, or really anywhere.
1. Absence of evidence is not evidence of absence.
2. Risk is convex, so every risk increase by measures not taken is multiplicative, not additive.
The real question must be: does the disinfection do more harm than it provides reduction of risk.
> 2. Risk is convex, so every risk increase by measures not taken is multiplicative, not additive.
Wait. Is this true? f(x) = x^2 is convex but f(x+d) = f(x) + O(x). Are you saying that human risk assessment is estimated to be exponential?
It used to happen in NZ too. I don't know if it still does.
As a kid (in the early 70s) I remember the air hostesses walking down the isles with a spray can. They don’t do that any more, but I wonder if or why they don’t add lower concentrations of the aerosol to the air conditioning at the end of the flight.
You could spend tens or hundreds of millions building an automatic system (certification for aircraft is not cheap or easy) or just hand the flight attendant a can of spray.
Sure, but I can imagine the more expensive airlines worrying that the ‘optics’ of spraying your passengers down aren’t great (to be clear - I’m not objecting and I’d rather they do it). I wasn’t suggesting they retrofit to existing aircraft of the period, but rather just build it in as they design the next generation airflow system. Or do you think it would still be way too expensive even then?
Adding systems to aircraft, whether retrofit or new design, is a horrifically complex and expensive thing.
What kind of disinfectant is used? How is it distributed? Does it do something bad at -80 degrees C? At +80 C? If it freezes, what happens? What if someone loads the wrong thing into the disinfectant bucket? Like fuel? Or oil? Where do we put the switch to isolate the cockpit from the disinfectant? Where does flipping that isolation switch go in the unknown-fume-event checklist?
What if it catches fire? It's not enough to say it can't catch fire, you must assume it will catch fire. The fire suppression system has to be aware of it. What if the fire suppression system erroneously thinks the disinfectant system is on fire? What if it was erroneously thought to be on fire, and then later _actually does catch fire_? How long can we fly with a flaming disinfectant system that someone in Terribadistan filled with kerosene?
You probably have more than one disinfectant module, probably attached to each pack. Is the plane "disinfected" if only one pack is operational? If your disinfectant module fails, does it bring the pack down with it? No? Now we have to certify the packs for both with-and-without disinfectant module operation.
Coincidentally just watched the fascinating history of the deadliest thing ever: https://www.youtube.com/watch?v=BJYfSfh7eWs
They didn’t mention the strain. My understanding is that there are 5 strains. P. malariae is common and not particularly deadly while. When i visited Africa, all of the locals had had malaria multiple times. P. falciparum is extremely nasty and can kill quickly.
It's the Malaria tropica according to [0]:
> Im Zusammenhang mit den bereits bekannten sechs Fällen von Malaria tropica bei Personen, die am Flughafen Frankfurt am Main tätig sind, sind zwei Erkrankte verstorben
And a quick search says that this is the most dangerous one. Of course it had to be...
[0]:https://frankfurt.de/de-de/aktuelle-meldung/meldungen/gesund...
Malaria tropica (the disease) maps 1:1 to Plasmodium falciparum (the parasite that causes this disease)
I had dengue once. Fever was something else! Since then I've been scared shitless that there are 3 other major variants remaining and if the next time is one of those 3 I am most probably cooked. There are no vaccines here yet either.
I think Qdenga was approved in India very recently.
Is that the one where the degree of immunity is negative post infection
Yup. But OP is now eligible for a vaccine!
Got it as well a couple years ago, it was no joke. :/
Luckily we could get vaccinated a year later. If you’ve had it and catch another variant mortality rate jumps to 10%. But usually those variants don’t overlap, it’s region based.
Kinda wild. I spent most of my childhood a couple hours drive from a malaria region and never heard of anyone getting sick locally that hadn’t travelled that way. So multiple people in Germany seems surprising.
Cases are infrequent, but not extremely unlikely. There's even a term for it, airport malaria:
https://www.eurosurveillance.org/content/10.2807/1560-7917.E...
I guess this can still happen, depends for each person. Some people have higher immunity for certain bugs.
I live in a mosquito ladden region and some mosquitoe individuals ingest blood until they can no longer fly (they die) Many mosquitoe individuals feed until full, not necessarily from only one human.
Now, some people are more resistant to some diseases than others. Sickle cell anemia heterozygote humans can live with plasmodium alright.
What surprises me is that someone around an airport in Germany (urban area) actually died of malaria. Malaria causes intervals of very high fever which lead to hospitalization and treatment.
Being a tropical disease makes it very unlikely and so a doctor will not even be considering it. By the time they’ve tried different therapies and start considering malaria, it’s too late. I’ve seen this happen to a couple of Africans who travel to Europe while gestation is ongoing and they’re dead 2 weeks later. As another thread said, it’s cheap to carry malaria meds when you travel, do it. If you start feeling offish - joint pain, fever, malaise, get a blood microscopic test for it and start the meds. Malaria is brutal
Two months passed between the two deaths. This already happened once in Frankfurt in 2023, fortunately without fatalities.
https://www.n-tv.de/panorama/Zwei-Tote-durch-Flughafen-Malar...
I got malaria twice in Africa. First time bad, second time REAL bad. I thought about death a little.
There was a good story of a Dutchman living in Mali who got malaria a few times (everyone does). It’s manageable with the meds.
Anyway he flies home, then develops symptoms. Goes to hospital and they freak. Full hazmat suits, isolation, doctors visiting from all over because they’d never seen it. Guy ends up dying because they wouldn’t give him the meds, because they didn’t know if it was safe, or what the right thing to do was.
Moral of the story is that for anyone spending time in malaria zones, take the meds home with you. If you get symptomatic, take the meds and maybe not go to hospital in the developed world. Meds I took was “coartem” and an injectable.
I have a feeling this is exactly what happened in Frankfurt. It very glaringly points to some failure in the healthcare system.
Healthy working adults with access to healthcare don't just die of malaria. Two deaths means it's not some unique susceptibility in one individual either.
The more interesting investigation would be how the system let two people die of malaria, not how malaria got there.
> It very glaringly points to some failure in the healthcare system.
Does it? "Have you been near the equator recently?" is a rather common question that GPs ask when you go see them with high fever. Doctors in Germany are absolutely aware of malaria, given how much we like to travel to all those beautiful, but unfortunately malaria-ridden countries.
The only thing, of course, is: That question wouldn't have helped here. However, this[0] source says airport staff are made aware of the possibility of contracting malaria and are told to watch out for symptoms.
[0]: https://www.tagesschau.de/inland/regional/hessen/malaria-am-...
The irony is that Germany used to be a malaria ridden country.
Kind of similar to rabies. If you get bit by a rabid animal in an area with lots of rabies, the doctors know what to do and you get meds immediately for cheap.
In the US it's a few thousand dollars for the treatment.
I thought anything in the US is ridiculous amounts of money, when it’s related to health/hospital.
It's wildly inconsistent. Surgeries, hospitalizations and specialists are mostly ridiculous. You can find affordable general/nurse practitioners if you know where to look and what to ask for.
Call around and ask "What is your self cash pay cost?".
Most people don't know to ask that and if you don't speak the magic phrase then you get billed at the rate the office would normally charge insurance. Not all places have self pay discounts.
Some states have special programs for hospitals but they vary wildly by state and you have to know how to navigate that particular program and be very patient. Some are need based so if you are above a pretty low income threshold you won't qualify.
It's really not, for common/minor issues. I use a little cash-pay clinic in a MCOL area and mostly spend <$100, never over $200, per visit. Also, my wife recently had some major dental work done, and it was about $350. All of this without getting insurance involved.
There are definitely ways to rack up big bills fast, though, just by being unlucky.
> cash-pay clinic
I’ve never heard of this. Private practice? If so, count your blessings until they get hoovered up by PE and quadruple their prices overnight.
It's not quite PE (yet); doctors are getting annoyed themselves at how healthcare is playing out. Picture things like electronically messaging your doctor now has convoluted billing behind each conversation now based on the level of effort the doctor has to put in. They're getting annoyed now that they've been bought out by hospital systems and been working underneath them for a while doing family practices and other healthcare services. The paychecks were good, but the red tape got annoying over the years.
So they exit the whole system and go to a direct "you pay me monthly for access" model. Hundred bucks a person or so per month, factor a ~25% discount for families. Doc gets to keep a cap on the limit of incoming patients to manage their own day pretty nicely while getting a recurring stream of cash paid direct to him.
Even better if your wife's also a doctor (hey, healthcare partners run together a lot!), you just band together, see 5-600 patients a month as a couple, and pull in a decent $million or so on a fairly light workload and selling extra things like GLP-1s and wellness programs for a year's work. Triple-points if you're doing this in rural America - that million might not be a lot to the big techies out there, but that's big bucks that go far in some really nice places tucked away in the trees and forests.
You still need insurance for the rest of the 'stuff' they don't do, but some of these DPCs are doing everything they can in house (like prescribing and dispensing generics at the office directly in a single visit to lower your extra out of pocket costs).
If you're on a high deductible healthcare plan with an HSA and an employer contributing healthily into it, these direct-patient-care clinics may be an attractive option if you're reasonably healthy and young.
Yeah, private practice.
It isn't a homogeneous experience, so you will get different stories. Most Americans get their healthcare provided by their employer, so their company determines what is covered and their financial exposure.
My United Healthcare plan limits my out of pocket expenses to $2,000 per year. Like most Americans, "United Healthcare" is just the company that does the billing and adjudication. My Employer sets policy and pays for treatment at the end of the day.
It's not, you're being lied to.
You thought wrong
How could two people die from it in Germany with modern medicine? Is malaria randomly fatal despite treatment, or did they not understand what the infection was or not seek treatment or something?
> Globally in 2024, there were an estimated 282 million malaria cases and 610,000 malaria deaths in 80 countries
https://www.who.int/news-room/fact-sheets/detail/malaria
One question that gets asked is "have you traveled to another country?" When the answer is "no", then doctors no longer consider diseases that exist in other countries. So that is why they did not understand the parasitic infection until it was too late.
Some of the early symptoms resemble a bad cold.
The parasite that causes malaria (literally "bad air") can only survive in certain species of mosquitos. Those skeeters don't live in Germany. They used to live in the state I live in, but they were exterminated back in the 1950s & 1960s (thanks DDT!). And people from West Africa were naturally/genetically resistant, which was why slaves from that region were preferred over every other race in the southern US where malaria existed until the 1950s & 1960s. If you have 0 copies of the gene then you usually die (of malaria) before puberty. If you have 2 copies of the gene, then you die from sickle cell anemia (usually by your teen years). If you have 1 copy of that gene (another commenter used the term "heterozygote") then the parasite can't live in some of your red blood cells, so you survive to have children.
Germany never had it, and reported being malaria free in 1964. America, in 1970.
https://www.who.int/teams/global-malaria-programme/eliminati...
Some good info, but some kind of simplistic. I lived in Nigeria for the second half of my childhood in the 80s and 90s and got malaria several times. People come down with it all the time, and typically treat it, and you can recover without treatment also. Most people die from sickle cell anemia when young, but I know multiple outliers who have lived to middle age, and they might live longer yet.
It's easy to test for malaria, if you actually think to test for malaria. In the 90s, we used to hear wild stories from people we knew who would come down with malaria shortly after returning to the USA and doctors and nurses would freak out not knowing what to do about it, and the medication would be expensive to obtain, so the conventional wisdom was also to remember to take a few pills with you on the plane back to the USA!
It's sad but unsurprising that no one was able to treat these German workers in time. When I was a child, there was already talk of strains developing resistance, and this has gotten worse in the 21st century, and the airport workers caught the most deadly strain:
https://www.theguardian.com/world/2026/aug/27/malaria-outbre...
> It's sad but unsurprising that no one was able to treat these German workers in time.
Literally every pharmacy over here sells treatment against malaria – many have it in stock and even if they don't, they'll be able to get it for you within a few hours. Every major city (certainly every city with an airport where you could catch airport malaria) has a hospital with a department specifically for infectious and tropical diseases, where they'll happily take care of you. GPs ask you if you've been to the equator lately if you go see them with high fever. I'm not sure how a country where malaria is not common at all would be able to do any better?
Also, as I mentioned in another comment, airport staff are instructed to watch out for malaria symptoms precisely because airport malaria is a thing.
Something definitely went wrong here but from afar it surely doesn't look like a healthcare failure to me. Maybe the deceased stayed home, thinking they had caught a cold and would be able to sit it out?
Malaria covered the entire eastern US (creeping into parts of Canada) and most of Europe in the 19th century.
From the article:
"It [the Robert Koch Institute] said laboratory tests to determine the source of the infections were not expected to be available for several weeks. [...] The [Robert Koch] institute said malaria in Germany almost exclusively affects long-haul travellers who were infected in malaria-endemic areas, and that malaria transmitted within a German airport is rare. 'The lack of a travel history can lead to a delayed diagnosis. A delayed diagnosis increases the risk of a severe course of the diseases,' the institute said in its epidemiological bulletin."
> laboratory tests to determine the source of the infections were not expected to be available for several weeks
Note that this about DNA tests & analysis to determine the origin of the malaria/the mosquitos, not about simple tests for the disease.
Cerebral malaria is fatal with no treatment in many cases. For kids and elderly it’s fatal even with.
Likely this happened because they have no expertise and didn’t know what to do.
Imagine if you showed up in a hospital in the us with a sting from some super intense scorpion that only exists is some obscure part of the world. They’ll try to help, but likely can’t do much.
Nigerian here, cerebral malaria is very curable. It's very common and people survive.
Sorry I wasn’t more clear.
I meant with no treatment it is often fatal. Almost certainly do for kids and elderly with no treatment.
This is one of the reasons why diverse medical teams and having nurses/doctors/pharmacists etc from other countries is a great idea.
Doesn't the Netherlands have some sort of institute of tropical medicine which deals with exactly those cases?
If the airport workers had travelled to another country, their doctors would have looked for tropical/travel diseases.
Usually, it is through shipping containers where unwanted insects cross borders. That's how murder hornets and flying cockroaches got into the US.
I'm asking about the Dutchman story the parent wrote. I can hardly believe it tbh. Even if the Netherlands don't have specialized personel, Hamburg is just a 5 hour drive away and Antwerp even closer.
Maybe you're thinking about the The Institute of Tropical Medicine in Antwerp/Belgium?
If you go to a Malaria zone, talk to your doctor to get Malarone and use it prophylactic (depending on the region)
Doxycycline can also be used. I took doxycycline monohydrate daily for a month and had no observable impact on my digestion, which surprised me.
I was there for years, you can’t take malarias that long.
And some of them have Super powerful side effects - I had a 3 day violent psychotic break I have no memory of, but I did get to wake up strapped to a bed!
Malarone gave me insane almost-kindof-sortof waking dreams of concerning character. I have never had anything like that before or since.
Malarone? Interesting, because that's supposed to be the prophylactic therapy with the mildest side effects. I have taken it many times and have never had any, and – up until now – I had also never heard of anyone having some.
My snap was also on Malarone.
The author of the book Mother Nature is Trying to Kill You had a story like that; he managed to pick up a parasitic fly infection while abroad and had to convince health care workers to cut out the larvae from under his skin.
Botfly. Don't cut, they dig deeper.
The proper solution is a thick layer of petroleum jelly over your skin. The larva has to come up to breathe eventually (~hours). Use tweezers and grab it. Gross, but perfectly safe.
There are great YouTube videos documenting this process btw. :-)
I saw the same thing happen in Leeds. A friend came back to her public health program after Christmas in Zimbabwe. The NHS was dragging their feet, like, "oh, we need to get a specialists opinion before we can even draw blood, then it has to be sent to the school of tropical medicine, that will be a few days, etc". Her African friends (and a European friend that worked in Africa for MSF) had to explain malaria to the hospital and beg them to just get her started on an artemsin compound while they were wasting time wondering how to test for it.
Could these mosquitoes lead to malaria becoming endemic in Germany?
No. They only survive in tropical/subtropical regions.
A concerted effort to treat cases and reduce habitat can prevent it, too. The US wiped it out in the 50s; new cases largely come from travel.
Malaria was endemic in Finland until the beginning of the 20th century, the people used to lived inside smoke-heated chimneyless log cabins together with animals, mosquitoes... and Plasmodium vivax...
That's the "treat cases" element of the story.
No human cases means no reservoir for the spring's new mosquitos to draw from. It's why Florida's safe these days, despite the climate.
USA wiped out malaria in the 50s using DDT which also made the California condor go extinct in the wild. During the 70s-90s DDT became illegal to use in most countries around the globe.
I’m not sure the USA would have been successful eradicating malaria without using DDT or something similar.
DDT caused the Bald Eagle population to drop from about 400,000 birds to just 47 nesting pairs.
It's wild to watch old videos of DDT application and attitudes back then.
https://youtu.be/-UiCSvQvVys
Plenty more out there.
No. Malaria epidemics occurred in medieval Europe, both in warmer countries (Italy, Greece) and in France, Germany and England. It was also common in portions of the US until large-scale eradication efforts.
It's unlikely to become a problem again because the climate is not optimal and these countries are wealthy, have advanced healthcare systems, and can spray everything with DDT again if they feel like doing it.
Yes to everything but "the climate is not optimal". The climate was not optimal. I expect this year's weather in most of Europe must have been pretty spectacular for mosquitoes; if it becomes a regular occurrence, as scientists suggest, things might get pretty spicy. Places like Milan are already massive breeding grounds for the most aggressive types of mosquitoes.
> Yes to everything but "the climate is not optimal". The climate was not optimal. I expect this year's weather in most of Europe must have been pretty spectacular for mosquitoes.
You'd think that, but anecdotally there was much fewer this year in Germany than previous years.
At least where I live most of the places where they'd have usually spawned (wetlands) have dried up and shrunk considerably. So really the hot weather made it a worse year for mosquitos.
I don’t think DDT works for the new strains of Malaria mosquitoes we have nowadays.
There were malaria epidemics in even quite temperate parts of Europe up to the mid 20th century, including Bavaria and even England, and it was endemic to parts of Italy and Greece. P. falciparum was found in bone samples of the Medicis.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8277918/
Yes, I remember reading in Charles C. Mann's book 1493 an interesting chapter about how malaria was pretty common in preindustrial SE England, where it was known as "marsh fever" or "ague."
Sadly, maybe wait 5 to 10 decades then it could exist in many areas were it does not now.
Only a few species of mosquitos can carry the parasite. None of them live in that part of Europe. The swamps around the city of Rome were historically infested with those skeeters which is why we use the Italian word for the disease (which means "bad air").
No, most probably the mosquitoes will not survive the winter. Besides, given enough effort, Malaria can be eradicated and even a poor tropical country like Sri Lanka has has done that where mosquitoes are quite common throughout the year
Malaria was endemic to the Deep South in the States up until the 1950s, at which point it was declared eradicated thanks to a miracle chemical called DDT. They should put that on everything (/s).
It is unlikely that malaria will establish itself, given that it gets cold and inhospitable to malaria-carrying mosquitos in Northern Europe. However, it is one of many things that could potentially be frog-boiled into existence in northern latitudes as a result of climate change.
I live in an area where mosquitos were unbearable this year. You couldn’t do outdoor activities without a mosquito net. It’s bad enough but I don’t want to imagine what it would be like if the threat of mosquito-borne illness was layered on.
I can not say anything about this incident, but what I have noticed in the last some years is that mosquitos have become much more annoying even in larger cities of mediate temperature. That has not been the case say 30 years up to 10 years ago or so, give or take. The range of mosquito attacks has definitely increased in every axis. Kind of almost miniature mosquitos too - really small, like barely 0.5 cm at max in length or perhaps 0.6 cm, but annoying to no ends and very hungry for blood. One can speculate but I think the increased temperature range induced this for the most part.
I'm pretty sure mosquito populations in India have been evolving in response to those electrified tennis rackets. Mosquitos now are much faster, smaller, and have more evasive flying patterns.
I've experienced the opposite so YMMV.