Myat Nyein - Turning around

The worst period of syphilis (a sexually transmitted disease) in Baltimore was in the mid-1990s. In one year, from 1995 to 1996, the number of babies born with syphilis increased by 500 percent compared to the previous year. The syphilis rate in Baltimore had been flat for many years. But in 1995, the line started to rise like a vertical line.

What drove Baltimore's syphilis situation to a boiling point?

According to the Centers for Disease Control and Prevention, the increase in the use of cocaine is due to an increase in risky sexual behavior. This in turn leads to an increase in the spread of diseases such as HIV. People in slums are using drugs more. They are therefore more likely to contract the disease through sexual contact. They are bringing the disease into their homes. They are bringing it into their neighborhoods. In fact, the alarming rate of syphilis is only a small push, say CDC experts. That small push, they point to, is the increase in the use of cocaine.

John Zinnelmin, an expert on sexually transmitted diseases at Johns Hopkins University, said the cuts were due to cuts in funding for treatment in the city's poorest neighborhoods. The cuts have reduced the number of health workers from 17 to none. The number of patients treated has dropped from 36,000 a year to 21,000. The number of health workers providing outpatient care has also decreased. As a result, the syphilis epidemic has spiraled out of control, Zinnelmin said.

There is another perspective. In the 1990s, the physical changes in the population of the densely populated neighborhoods of East and West Baltimore were due to the population. He meant that the neighborhoods had public housing, including the East and West Sides, which were being built by the public. The buildings were old and dilapidated, and there were plans to demolish them and build new ones. The blocks were home to hundreds of families. The people were a crime scene and a center for the spread of infectious diseases. Now that the blocks where they lived were being demolished, they moved to other neighborhoods. This is the reason for the spread of infectious diseases, according to scholar John Potter.

One interesting thing to note about these explanations is that none of them are particularly significant. The Centers for Disease Control and Prevention (CDC) believes that cocaine use is the main problem. But cocaine has been in Baltimore for many years, not just since 1995. What they are talking about is not the drug use, but the increase in the number of children. This small change is the turning point in the spread of the epidemic.

Because of the cuts in medical care, there were not enough health workers in hospitals and clinics. So John Zinnelman's explanation that the syphilis epidemic had a turning point is not entirely accurate, as he says, "What else is there?" The number of health officers has only decreased from 17 to 10. It is not that there are no health officers left.

Similarly, in Potter's explanation, the destruction of residential homes was not the entire city of Baltimore. Compared to the size of Baltimore, the number of homes destroyed was a mere handful. Ultimately, this small change tipped the balance of infection.

If we look closely, we can see that there is more than one reason for the turning point in the spread of infectious diseases. When an infectious disease breaks out, it is because something has changed. This change has occurred in one or two or all three of the following areas. I have named the three factors that cause this change as the law of smallness, the cause of attachment, and the power of context.

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Started by a handful of boys from the East Village, the puppy shoes became a fashion trend. The shoes also became incredibly popular and sold out.

And we've already talked about how the implementation of a few housing projects led to a rapid spread of syphilis in Baltimore.

I'm talking about these things because I want to say that in a process or system, some people are more important than others.

Economists often use the 80/20 principle. It means that in any given situation, 20 percent of the people who do 80 percent of the “work” commit 80 percent of the crimes. 20 percent of the drivers commit 80 percent of the accidents. 20 percent of the beer drinkers drink 80 percent of the beer.

When it comes to the spread of infection, the above-mentioned imbalance becomes even more extreme. It is found that almost all of the work is done by a tiny minority of people, the size of a kidney.

For example, Potter studied the spread of gonorrhoea in Colorado Springs. He looked at every patient who came to the health center over a six-month period. He found that half of all cases came from four contiguous neighborhoods. The four neighborhoods covered only 6 percent of the city’s total area. And in that half-area, the patients were found to be consistently frequenting only six bars.

Potter then interviewed a total of 768 people in that minority. Of these, 600 were found to have never infected anyone with the disease. He called these people “non-spreaders.” The remaining 168 were those who had spread the disease, those who had spread it to five other people.

In other words , the spread of gonorrhea like wildfire in a Colorado city of over 100,000 people was due to the behavior of 168 people. What's more, they lived in four contiguous neighborhoods and regularly frequented six specific bars.

Who are these 168 people? They are not like you or me. They are people who go out every night. They have many more friends than the average person. Their lives and behaviors are extraordinary.

For example, in Missouri, there was a man named Danelle McGee from East St. Louis. He was also known as “Bossman.” This man was a very good skateboarder. He was big, over six feet tall. He was strong and popular with girls. He met girls at the rink and they were all around him. His favorite girls were girls who were thirteen or fourteen years old. He bought them jewelry. He took them for rides in his Caddy. He kept them high on drugs. And then he started having sex with at least 100 women between 1995 and 1997. He was then shot and killed by an unknown gunman. It was later revealed that he had infected at least 30 of the girls he had sex with with HIV.

During those two years, fifteen thousand miles away in the small town of Jamestown, there was a man called “Boss Man.” His name was Nathan Williams. He had many other nicknames. He also had many girls, and he had three or four apartments around town. He made his living by importing and distributing drugs from the Bronx. (An infectious disease expert who was familiar with William’s case said…

"That man is a genius, if I had William's talent, I would never have to work another day in my life."

That is.)

Like the Boss, William was a very attractive young woman. He would buy his girls roses. He would let them braid his long hair. He would entertain them all night with marijuana. He would also have drunk and had wild, bloodthirsty parties in his apartments. William, who eventually went to prison, is said to have infected at least sixteen of the women he had sex with with AIDS.

There was a French-Canadian airman named Tan Du Gav. He is said to have slept with over 2,500 women across North America. At least 40 of the initial AIDS cases were women who had slept with Du Gav.

It is people like them who create infectious diseases that spread like wildfire overnight.

Social contagions happen in a similar way. They are created by a unique group of people. What sets them apart from others is not their intense passion. It is how much they socialize, how energetic they are, how knowledgeable they are, how influential they are.

Consider the story of the dog-scratch shoes. The story of how a group of hippies from Manhattan, who wore ragged clothes, became shoes that were sold in fashion stores across the country is a fascinating mystery. So what is the connection between the East Village where the hippies started and the Middle America?

The minority lawmaker explained that one of these unique individuals saw the trend. He used his enthusiasm, energy, and personality to spread the word about the dog-scratch shoes through social media. He was like the Tendugabs and Nathan Williams who spread HIV.