Longform

THE HEP-C GENERATION

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And more than half of those who do know they're infected say they cannot identify a risk behavior, such as intravenous drug use, that led to their infection. Even taking into account the fact that people lie, researchers admit they simply don't know all the ways that hepatitis C is transmitted--a necessary step for at least controlling an epidemic they can't cure.

Another necessary step is public awareness. Widespread AIDS education helped stabilize the growth of that epidemic and even reduced the number of new infections in the two most affected groups: gay men and intravenous drug users. But outside of medical literature, there has been little note of hepatitis C.

From his New Jersey office, Maravel complains that he can't get the media to pay attention to liver disease in general or hepatitis C specifically. This, he says, despite the fact that last year more than 40,000 people died of liver disease.

Maravel can't say what percentage of that number can be attributed to hepatitis C. But he agrees with Everson's assessment that the first major wave of hepatitis C fatalities is just now appearing.

"We get about 50,000 calls a year," he says. "Starting two years ago, all of a sudden half of those calls were from people wanting to know about hepatitis C."

Separated by 2,000 miles, Everson and Maravel both refer to hepatitis C as the Silent Epidemic.

Mark was eighteen the first and only time he injected drugs. He and his friends had only one needle, but he figured it would be safe. Although he was aware from news reports that people could get that new disease--AIDS--by sharing needles, he lived in a small Vermont town and thought he knew his friends well enough to know if they were sick. It was 1984.

Two months after his drug experience--which he didn't like and had already decided to avoid in the future--Mark began to feel ill. His skin turned yellow, he was lethargic, he had difficulty keeping food down.

He went to his doctor, who took a blood sample. A few days later the doctor told Mark he had hepatitis non-A, non-B. His was a rare case in which the virus made its presence known immediately.

Mark breathed a sigh of relief. He'd feared AIDS, but the test for HIV was negative.

He had never heard of hepatitis, but the doctor didn't seem too concerned. The virus would remain in his body, the doctor said, and his liver enzymes would stay somewhat elevated. But the disease was unlikely to pose a significant danger.

Two weeks later, Mark's symptoms disappeared. A liver biopsy indicated no damage. Mark decided to forget that he had hepatitis C.

In 1986 Cathy was living in Florida when she was hired as operations manager for a medical-equipment company.

The firm leased the latest in medical technology to hospitals, including dialysis machines, incubators for premature babies and suction equipment for operations. According to the company's lease agreements, the hospitals were supposed to clean and decontaminate the equipment before returning it. But it often came back covered with dried--and sometimes not so dried--blood and other body fluids.

The company also guaranteed customers that they would have the requested equipment within an hour of placing an order. That meant that Cathy and her crew would often have to go to one hospital, pick up the machinery and, after the briefest of wipe-downs, take it to another hospital.

Cathy was aware that AIDS was a virus in the blood, but she also believed that the cleaning fluids she used would kill viruses. The company downplayed any risks and didn't even provide gloves for its employees, she says.

If the heart is the body's pump house for circulating blood, the liver can be thought of as its filtration system. All the blood that goes from the heart to the intestines drains into what is called the portal blood system, which feeds into the liver. In that organ the system branches out--like a tree--with the blood passing through the liver cells. The branches come back together on the other side of the liver, and from there the blood heads back to the heart. The liver regulates the body's metabolism, including energy levels. It takes toxic chemicals--among them alcohol and drugs--and changes them into nontoxic substances. The liver stores sugar and produces bile, which is necessary in digestion for nutrient and vitamin absorption. It also regulates cholesterol.

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Steve Jackson