What Could Be Worse (than Coronavirus)?

This year has been pretty frustrating, all around - there has been so much death, disappointment, disgust, fragility, pain & suffering - and as well as all that, we also have the coronavirus plague. But, let's look on the bright side, it could be worse...
I can already hear you: "But, Absurd Word Nerd, what could be worse than Earthquakes, Ebola, Economic Crashes, Explosions, Fascists, Fire, Hong Kong Persecution, Human Rights Violations, Ignorance, Impeachment, Locusts, Murder, Neo-Nazis, Protests and Trump?"
And wow, you really have been keeping track of the news, it would probably take me an hour of research to memorize all of that, so well done you. But, rest assured that whilst, yes, we do have... all of that, at least COVID-19 isn't as bad as it could be. Yes, I know, it's absolutely devastating, and at time of writing it's killed over over a million people and rising, and even those who survive can suffer from long term affects, which at best may be some post-traumatic stress, but at worst could be long-term physiological effects including damage to the lungs, kidneys, heart and/or brain.
Sure, all of that definitely sucks, but see, there are actually worse diseases out there, which you and I could get right now. Okay, maybe not "right now", since some of them you need to go outside for - but there are real diseases, and you can get them, and yes they are worse than coronavirus. So, don't you see, it's not so bad? It could be so much worse.

Y'know what, you don't seem convinced, so let explain this in detail. I just did a little bit of research, and I found eight diseases which are way worse than coronavirus, which you could have, but don't... actually, you might now that I think about it, since some of these are horrifyingly common - BUT! I can guarantee that you definitely don't have all of them, because most of them are very deadly, so even if you do have one of these (and genuinely, I am sorry, I hope your family is at peace), just cross that one off the list and begin with these:

Dishonourable Mentions

i. Fatal Insomnia
What is that, exactly? This is a prion disease, caused by a mutation of gene-encoding proteins in the brain which causes a reduction in glucose production by the thalamus, and a mild hypo-metabolism of the cingulate cortex. As the thalamus is a part of the brain important in regulating sleep, these imbalances cause an inability to sleep.
And how is that worse? Well, this diseases takes away your ability to sleep, at all, and you kind of need to sleep. What research I've been able to do says that symptoms come in four stages. In stage one, which lasts for about four months, symptoms include bouts of insomnia that worsens over these months, which causes panic attacks, paranoia and agitation. In stage two, which lasts five months, insomnia worsens, panic attacks become more frequent, and the patient begins experiencing hallucinations. In stage three, which lasts just three months, the patient will become chronically insomniacal, unable to sleep at all, which causes hypnagogia, and is followed by rapid weight loss. In stage four, the final stage, the patient suffers from dementia, and in the last six months may become unresponsive or mute, catatonic or with involuntary muscle movements until their inevitable death.
Can I really get this? Technically, yes... but, it's not likely. This is a rare disease, which has two types. The most common familial fatal insomnia (fFI) is passed down genetically, and there are 40 families which have been known to share this gene, in the entire world. However, the second kind, sporadic fatal insomnia (sFI), appears to be caused by a random mutation of the same proteins, and there have only been 24 people (that's single persons, not whole families) recorded as catching this disease in medical history. So, yeah, you can get it, but it's not likely, which is why this doesn't make the list proper.

ii. Alzheimer's Disease
What is that, exactly? This is a neurodegenerative disease which is believed to be caused by abnormal amounts of amyloids and other proteins in the brain to encroach upon otherwise healthy brain cells. These protein deposits, known as "neuritic plaque" inhibit the normal function and chemistry of the brain, which causes a neurotransmitter deficit, inevitably resulting in a progressive loss of brain function.
And how is that worse? You need your brain to remember, to think, to feel, to choose - this disease takes that away from you, very slowly. Culturally, people think of Alzheimer's as Chronic Senile Forgetfulness, but it's so much more than that. People with Alzheimer's disease can live for approximately 3-9 years before their brain function is inhibited to the point that they cannot take care of themselves, feed themselves, speak, move or even think with any kind of coherency. Technically, Alzheimer's itself doesn't kill, however patients become much more vulnerable to accidents, choking, dehydration, infection, malnutrition & stroke. The disease itself doesn't kill you, but in a way it does kill you, by taking away everything of who you are until you're little more than a shadow of your former self. Even though this is a long-lasting illness, to me the very first symptom, memory loss, is already a horrifying thought, but add onto that the fact that you lose motor function, sensory perception, speech & self-awareness, and it sounds like a waking nightmare. And of course, there is no cure, because we don't even understand what causes this in the first place, There may be genetic factors, but they aren't the only cause, leading some researchers to propose all kinds of causes and risk factors from head injury and mental illness to poor diet and exercise.
Can I really get this? Definitely, and your chance of suffering through this disease goes up significantly with age. Early-Onset Alzheimer's is not unheard of, but it is uncommon, with just one in every forty-thousand people under the age of 65-years who have it. However, one in ten 65-year-olds have it; and, one in three 85-year-olds have it. The only reason this doesn't make the list is because, although more research needs to be done, there's little to no reason to believe that Alzheimer's is an infectious disease.

iii. Vibrio Vulnificus Infection
What is that, exactly? Vibrio vulnificus is a species of curved, rod-shaped, pathogenic bacteria, whose natural habitat is brackish or salt-water. The most common cause of infection is ingestion of infected seafood, and V. vulnificus is responsible for 95% of seafood-related death, killing 16 people every year. This bacterium releases defensive toxins which can cause shock syndromes and bacterial dissemination which leads to sepsis, and death due to organ failure, or blood infection.
And how is that worse? Whilst it is most commonly caused by ingestion, which is pretty horrific, causing abdominal pain, diarrhea & vomiting. However, what makes this bacterium so horrifying, to me, is that it doesn't need to get into your stomach. If you just have a little cut, or a little scratch on your skin, this begins as redness, pain and swelling around the site of the infection as well as a fever, but in as little as three days it progresses into  either dermatitis, cellulitis or sepsis, but rapidly progresses to a necrotic infection in your skin with rapid and severe tissue destruction. That means it starts killing and rotting away your skin from the inside. it's most dangerous for those with a compromised immune system, or with a weakened liver.
Can I really get this? Yes, but it's not likely to hurt you. Whilst this does naturally occur in ocean water (meaning, yes, you can get this if you go to the beach), it has a low chance of harming you. To begin with, this one is sexist... 85% of victims are male, as oestrogen has a protective effect against the bacteria; so, half the population has a natural protection from it. Also, even if you eat raw, ocean seafood such as oysters (which I don't recommend), stomach acid is usually strong enough to kill this bacterium, that's one of the reasons we have stomach acid, after all. And of course, whilst this can cause horrifying infections if it gets in a wound, even a small cut, most people avoid swimming at the beach even with small cuts because ocean water is very, very salty, and that tends to hurt like all hell. For a long while, this was on the list proper since a flesh-eating bacteria that you cn get at the beach sounds pretty scary; but as it says above, only sixteen people a year die from this, and the infection has so many things holding it back, I couldn't justify it over the much more deadly diseases on offer.

I felt it necessary to include these horrible diseases because, although they didn't make the list due to mortality, rarity and cause, I wanted to show you just how horrible even non-infectious, non-deadly diseases can be. But, without further ado, let's continue with the proper list of...

THE A.W.N.'s TOP 5 INFECTIOUS DISEASES (SOMEHOW) WORSE THAN COVID-19

5. Naegleriasis
What is that, exactly? Also known as Primary Amoebic Meningoencephalitis (or PAM), Naegleriasis is caused by an infection by Naegleria fowleri, a unicellular eukaryote which thrives in warm water, which has three stages. Without adequate food or heat N. fowleri enters a cystic stage, where it shrinks to a  spherical shape with a protective membrane. In the flagellate stage, the N. fowleri grows two flagella to allow it to swim easily through water and spread throughout the environment. In the trophozoite stage, N. fowleri cells grow pseudopodia to navigate, and in warm temperatures can procreate through fission, and feed on bacteria, as well as other organic matter.
And how is that worse? Naegleria fowleri is more commonly known by the colloquial name "brain-eating amoeba"; but that name is a little misleading - it's not actually an amoeba, it's really a shapeshifting amoeboflagellate excavate. However, yes, it does eat brains. In its flagellate form, this critter spreads throughout warm water, but if it enters your nose, within a few hours, it can transform into its trophozoite stage where it attaches to your olfactory epithelium and uses its pseudopodia to traverse your nasal cavity and up into your brain. It is believed that it does this because your brain is, on average, kept at 40°C, which is the optimal temperature for procreation, and provides plenty to feed on. Once this reaches the brain, patients suffer from confusion, fever, hallucinations, headache, nausea, seizures, stiff neck & vomiting. Symptoms worsen quickly in as little as five days, and leads to death at most two weeks later. There are no known cures, and of the over 450 cases of naegleriasis on record, only seven people have ever survived infection.
Can I really get this? Unfortunately, yes. This microorganism is typically found in bodies of warm, fresh water; these include hot springs, ponds, lakes, rivers, and (damp) soil, but can include geothermal well water; warm water discharge from power plants; water heaters & dirty or minimally chlorinated swimming pools or spas. However, it must be said that this is very rare, and less rare in subtropical parts of the word. Although over 400 people are on record as contracting naegleriasis, that's over a period of 60 years of recorded medicine, globally, which basic maths tells us is an average of 7~ people a year, which is why it is so low on this list. It is, however, a devastating illness I'd wish on no one that kills quickly, horribly and painfully... just make sure your water is cold and clean, especially if it goes anywhere near your nose.

4. Influenza
What is that, exactly? Influenza, also known as "the flu" is an infectious disease caused by three or four genera of the Orthomyxoviridae family of viruses, namely Alpha-, Beta-, Gamma- & Deltainfluenzavirus. (although Deltainfluenzavirus hasn't yet been known to affect humans). An influenza virion is pleomorphic, which means it can alter its morphology based on the environment, but it is generally ellipsoidal with particles 80-120 nanometres in diameter, with a viral envelope composed of a lipid bilayer, covered with glycoprotein spikes. This means it has great potency to invade and infect host cells, especially lung cells, and to procreate within and spread throughout the host body.
And how is that worse? Originally, I wanted to include Swine Flu or perhaps even Spanish Flu, but neither of them seemed virulent or deadly enough... that was, until I did some research and discovered that they're the same disease - "Influenza A virus subtype H1N1" That's right, the same virus responsible for the Spanish Flu pandemic in 1918 had a resurgence in 2009. Although they're caused by different subtype, it's also responsible for the Hong Kong Flu pandemic in 1968, the Asian Flu pandemic in 1957 and the Russian Flu pandemic in 1889. Influenza Pandemics are common, as the Seasonal Flu is endemic among several species, giving the virus ample opportunity to replicate and mutate, evolving into more virulent and deadly strains.
Can I really get this? Not only can you get this, you probably already have had it several times, which is the only reason it's not higher on this list. Flu does have a a significant death toll, but that's mostly due to its spread - and those aged 65+ years old account for 80% of deaths due to influenza. I'm not dismissing those losses, but even including those, less than 0.5% of people who get the flu will die. The reason why I include is because whilst it's general numbers are low, it is responsible for several deadly outbreaks and pandemics, and currently researchers are keeping a close eye on Avian flu, as it has a high risk of human transmission, and without close scrutiny could result in another influenza pandemic in the near future. So, whilst it's not currently a high-mortality disease, it has every potential to become one, again, in the future.

3. Cholera
What is that, exactly? Vibrio cholerae is a species of curved, comma-shaped, pathogenic bacteria, whose natural habitat is brackish or salt-water. The most common cause of infection is ingestion of infected seafood, although V. cholerae also spreads through unclean water, and kills ~75,000 people every year. This bacterium releases endotoxin & exotoxin which causes profuse, watery diarrhea and bacterial dissemination which leads to colonization of the small intestine, and death due to organ failure, or dehydration... if any of that sounds familiar, it's because this bacteria is related to Vibrio vulnificus, they're from the same family and genus, but this one is much more deadly...

And how is that worse? Without water, you will die very quickly. Always keep in mind the "Rule of 3 for Survival", for how long you can survive without life essentials? Air, 3 Minutes; Shelter, 3 Hours; Water, 3 Days & Food, 3 Weeks.
This virus causes severe, watery diarrhea which is not only quite gross, but it often means you lose water faster than your body can process it. So, even though this infection typically only lasts for a few days, that's more than enough time to kill you. For this reason, this disease is most deadly among young children, as they can lose enough water to become dehydrated very quickly. Oral rehydration with liquids high in electrolytes is recommended, as well as continuing to eat and keep up calorie and vitamin intake; but in more extreme cases, antibiotics and intravenous fluids are necessary to prevent people from dying of extreme starvation which leads to headaches, confusion, delirium & seizure.
Can I really get this? Yes, but unless you live somewhere without easy access to clean drinking water and/or healthcare, you are less likely to both contract this disease and die from it. This adversely affects those in poor or rural communities, with a 50% chance of death, however even in regions with cleaner water, sanitation and adequate healthcare, mortality still sits as high as 15%; mostly children and the elderly, but also the immune compromised, or those with sudden and severe infections. That's the craziest thing about Cholera to me, I look at it like Smallpox or Rickets, old-timey diseases that we don't have to worry about anymore thanks to modern medicine. However, this disease never went away, it's just mostly prevalent in Africa, Asia & South America.

2. HIV/AIDS
What is that, exactly? HIV-1 or human immunodeficiency virus 1 refers to a species of Lentivirus, a kind of retrovirus which severely hinders the immune system. It does this by infecting several elements of the immune system - CD4 T Cells, which release cytokines to alert other elements of the immune system; macrophages, a kind of white blood cell that consumes invasive cells & dendritic cells which capture antigens and use them to activate elements of the adaptive immune system. AIDS is a complication of HIV where the immune system is severely compromised.
And how is that worse? Your immune system prevents you from getting sick by constantly removing, destroying and fighting off foreign matter that gets into your body. You need to breathe, drink and eat to survive, so it's important that you can fight off any of the nasties that can hijack their way into your body on a pretty much daily basis. For this reason, people with AIDS often suffer from opportunistic infections caused by bacteria, viruses, fungi and parasites, causing prolonged fever, a persistent cough & weakness. Some of the most common symptoms of AIDS are cachexia (also known as HIV wasting syndrome), diarrhea & unintended weight loss. Left untreated, someone with AIDS has a life expectancy of around 10 years.

Can I really get this? If you have unprotected sex, then yes. Whilst it may seem simple enough to just "avoid having sex with HIV-positive partners", the problem is the way acute HIV affects you. Two-to-three weeks after initial exposure, the patient may suffer from nonspecific fever-like symptoms, but many have no symptoms at all. The second stage of HIV, called 'clinical latency', is a stage that can last for three to twenty years when the patient shows no symptoms at all, but can still pass the disease through unprotected sex or exposure to infected blood. The third stage is AIDS itself, which lasts until the patient dies from one of those opportunistic infections, most often as a result of organ failure. Although data is limited, according to my research, the leading cause of death amongst those with HIV appears to be pneumonia, suicide & tuberculosis.

1. Rabies
What is that, exactly? Rabies is a disease caused by infections by the Rhabdoviridae Lyssaviruses. Rabies viruses is transmissible through saliva.

Trimeric spikes of the virus exterior membrane interact with cell receptors, of a host's muscle or nerve cells, pinching the host cell via pinocytosis and essentially merging with the cell wall, releasing its RNA genome via five proteins: nucleoprotein, phosphoprotein, matrix protein, glycoprotein & polymerase. These proteins interact with the low pH within the endosome, activating the RNA replication and allowing the virus to reproduce within the new cell. This allows the virus to propagate and spread copies of itself through the host's nervous system. Within the nervous system, rabies is capable of affecting behaviour to make its host more aggressive and causing inflammation of the brain.

And how is that worse? Because it's slow, painful, incurable and very, very deadly - of those who have contracted rabies, 97% of symptomatic patients do not survive. Rabies is most commonly spread via a bite from a rabid animal. After initial infection, the first stage is an incubation period which is often one to three months, but there have been cases of the incubation period being as short as four days, or as long as six years, usually due to the location of the infection, the severity of the wound and the patient's health prior to infection. The second stage is the symptomatic stage, and patients may have nonspecific flu-like symptoms such as fever and headache. This progresses to severe symptoms of viral encephalitis and meningitis, and often includes abnormal behaviour, agitation, anxiety, confusion, hallucinations, insomnia, paranoia, partial paralysis, terror & in several cases an irrational fear of water leading to severe dehydration and frothing at the mouth. Two to ten days after first symptoms appear, the disease will progress to delirium, coma and inevitably death.

Can I really get this? Yes. There are several lyssaviruses that cause rabies, at least seven genotypes identified so far, most of which are endemic to bats but can spread to humans if they are bitten, or ingest/inhale aspirated bat saliva, urine or feces. Not only are bat species found in every country (except Antarctica and those in the Arctic circle), but rabies lyssavirus has been shown to be evolving, such that it can now infect raccoons and skunks, giving it greater transmissibility among mammalian carnivores... such as dogs and cats. There are treatments for rabies, but they are preventative. Pest control and vaccination are the most effective methods, as after infection there is only a ten-day window where vaccine treatment after exposure is effective - but since early symptoms are non-specific, many tests are inconclusive or unreliable, and some later symptoms can be confused for irritability and other viral infections, it makes it much harder to diagnose and treat rabid patients within that timeframe.

So, you see? COVID-19 doesn't seem so bad now, does it? At least you don't have these diseases [unless you do, of course], so hey, it could be worse...
Of course, that begs the question of what exactly I mean by "worse". I chose these because the symptoms are painful or scary, the diseases are deadly and they are highly infectious, meaning that you can get them. However, that being said, are these "worse" because they have a higher mortality rate? Are they "worse" because the symptoms are more painful? I mean, if you're asking which injury is worse, most people would say that getting shot in the foot with a shotgun is worse than getting stabbed in the foot with a pencil. But, which is worse, the pain from a pencil that is currently stabbed through your bleeding foot, or having a shotgun pointed at you, threateningly? How can anything be worse than something you're currently dealing with.
Sure, these diseases exist, most of them have existed for all of your life (whilst the current COVID-19 pandemic only mutated into existence recently) but the coronavirus is the disease that's currently threatening most people's lives, at time of writing. Of course, that's also assuming that you don't currently suffer from asthma; or bipolar; or cancer; or diabetes; or epilepsy; or fibromyalgia or any of the hundreds of other diseases, disabilities and afflictions out there that can make life harder than that of the average, healthy person.

It makes you think... or, at least, it makes me think, because I wrote this all tongue-in-cheek, but looking back at it, whilst I do think it would be worse to suffer from a disease that eats your brain; spreads worldwide; dehydrates you through diarrhea; destroys your immune system or deletes your memories, that's only because I've never had coronavirus, and so to me this is an entirely intellectual exercise, like the one before: pencil vs. shotgun. But that's easier to say before they pull the trigger.

I'm the Absurd Word Nerd, and until next time, I'm going to go sharpen my pencil.