But...
Malaria can be detected by modern hematology automated analyzers. I'm talking about ordinary hematology analyzers, not the ones specialized for malaria. All hospitals do at least one CBC+DIFF for all patients. If anyone cares to look at the warning flags and scattergrams [1], they could have seen that something's wrong, do a blood smear and confirm malaria in 30 minutes. It is a bit difficult, to be honest. Only a lab doc/tech would know how to interpret a scattergram, and some of the flags are extremely unreliable (not iRBC), but that doesn't mean they can be simply ignored.
Unfortunately, in most labs, doctors who check and validate results, do that from the lab software app, not directly from the analyzer, and - devs, take notes! - most hospital/laboratory software I saw (and I saw many) ignore all flags and graphics send by the analyzers. They just take the numbers and that's it. When doctors look at a report, they don't see flags or scattergrams, just the numbers. Can't even tell if the numbers are reliable or not. And this is how malaria diagnosis, and lots of others, are missed.
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.
https://www.eurosurveillance.org/content/10.2807/1560-7917.E...
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.
> 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...
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.
https://www.n-tv.de/panorama/Zwei-Tote-durch-Flughafen-Malar...
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.
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.
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-...
In the US it's a few thousand dollars for the treatment.
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...
"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."
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.
Usually, it is through shipping containers where unwanted insects cross borders. That's how murder hornets and flying cockroaches got into the US.
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.
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.
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.
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 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.
Note that this about DNA tests & analysis to determine the origin of the malaria/the mosquitos, not about simple tests for the disease.
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.
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?
I just looked up my test report from years ago and it just says NS1 rapid antigen test and that one doesn't find which of DENV-1(-2, -3, -4) it was.
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.
I meant with no treatment it is often fatal. Almost certainly do for kids and elderly with no treatment.
Plenty more out there.
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.
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.
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...
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?
10% of all people who were on it now have permanent psychosis.
Oh yeah.
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.
There are definitely ways to rack up big bills fast, though, just by being unlucky.
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.
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.
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.
or 2km away: https://pmc.ncbi.nlm.nih.gov/articles/PMC4318208/