SNAKEBITE!

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ANECDOTES, FACTS AND ADVICE FOR BEING SAFE AROUND VENOMOUS SNAKES

We have had a plethora of medical alarms and concerns in the United States this past year, including measles, plague-infested fleas, devastating new STD infections and several mosquito-borne illnesses. Yet, curiously, still low as priorities go in the U.S. this past summer has been snakebites. By many accounts, these are exponentially increasing and at a steady rate.

The Wall Street Journal devoted a major story to that issue on August 5, 2019. It highlighted reports that rapid urbanization and heavy rains had led to more snake attacks in the Carolinas and Georgia, copperheads especially.

These reports are borne out by information provided by various health authorities, almost all of which maintain that there have been 10 percent more snakebites in 2019 than 2018 and the majority blamed on urban areas that tend to encroach on “traditional snake country.”

Effectively, this forces the reptiles to find new habitats, often in leafy-covered domestic back gardens.

SNAKEBITES ON THE RISE

Still more worrying was one report from Texas that stated that snakebites in Texas were a quarter more prevalent than five years ago, the majority of strikes coming from rattlesnakes.

That said, it is not a nationwide problem, not yet anyway, with most Southeastern states as well as Texas featuring most prominently in the snakebite stakes.

The single biggest problem apparently is that many of the more dangerous snakes are able to camouflage themselves very effectively. If someone, a child especially, is not specifically aware of the danger of, for example what a copperhead with its brown or tan triangular markings actually looks like in the brush, the snakes can and often will strike without warning.

With rattlers, most potential victims usually get a sounding from their namesake rattle beforehand: that is not so with most of the more venomous serpents.

What is important is to be aware that, while not the longest, the most venomous snake in North America is the eastern diamondback rattlesnake, found in Florida, North Carolina, Alabama, Mississippi, and Louisiana. The venom is injected through what feels like two hot hypodermic needles.

If you get bit, you can expect to experience bleeding, a ton of pain, and possibly death.

Its cousin, the western diamondback rattlesnake is one of the most famous in North America, so common in the American Southwest that it has even found its way onto the logo of Arizona’s Major League Baseball team.

What is extremely important is to realize that snakes are not naturally aggressive. There are very few of these creatures that will not flee if confronted by a human. Most strike only when cornered or when placed in a position where the only way out is to lunge in an attack. Most times, they are stood on before they react.

I recall travelling in East Africa when I was younger and spending months along some of Kenya’s famous beaches, which are also notorious for the number of mambas that live there. There are so many of these venomous beasts, in fact, that some villages devote good time to capturing them and then selling them to laboratories where the snakes are milked for their venom: trappers are paid by the foot-length.

At the time I was broke and spent many a night sleeping out on the beaches in the open. More often than not I would be awakened by snakes rustling in the undergrowth near to where I was stretched out but they were never aggressive. They kind of got used to my presence and I to them, though I doubt whether I would like to repeat the experience today.

I would not have done that had I been aware at the time that a single black mamba has enough venom in it to kill 10 people and always bites multiple times. As a result, it injects higher doses of venom than most other poisonous snakes

SNAKEBITE FACTS 

Globally, more than 5 million snakebites occur each year, resulting in roughly 2 to 2.5 million cases of envenomings (poisoning from snakebites).

Few people heading out into Third World countries on vacation — especially if they are hiking — are aware that there are between 80,000 and 140,000 deaths and around three times as many amputations and other permanent disabilities suffered each year as a result of snakebites.

Most of these occur in Africa, Asia and Latin America. In Asia, up to 2 million people are envenomed by snakes each year, while in Africa there are an estimated 435,000 to 580,000 snakebites annually that need treatment. With the increased deployment of American military forces in some of the trouble spots in North and Central Africa, this issue is now getting serious attention in the U.S.

For the record, though, envenoming affects women, children and farmers in poor rural communities in low- and middle-income countries much more than in First World countries. The highest burden occurs where health systems are weakest and medical resources sparse.

Bites by venomous snakes can cause acute medical emergencies involving severe paralysis that may prevent breathing, or bites can cause bleeding disorders that can lead to fatal hemorrhaging. Otherwise, this might result in irreversible kidney failure and severe local tissue destruction that can cause permanent disability and limb amputation.

Children usually suffer more severe effects, and can experience the consequences of snakebite much sooner than adults due to their smaller body mass.

In contrast to many other serious health conditions, a variety of highly effective treatments do exist and are available in all major and most rural American clinics.

It is also essential to be aware that most deaths and serious consequences from snakebites are entirely preventable by making safe and effective antivenoms more widely available and accessible.

High quality snake antivenoms are the only effective treatment to prevent or reverse most of the venomous effects of snakebites. They are included in the World Health Organization (WHO) Lists of Essential Medicines and should be part of any primary health care package where snakebites occur.

Also, if you thought you could avoid venomous snakes by simply keeping your distance, the Philippine cobra will prove you wrong because it can accurately shoot its toxic venom up to 10 feet away. If the venom comes in contact with any body fluids or blood, it can cause headache, nausea, vomiting, diarrhea and dizziness.

In truth, snakebite is a neglected public health issue in many tropical and subtropical countries. Even in the United States not everybody is aware how serious the threat might be.

SOBERING SNAKE STORIES

In rural Texas, for instance, there are eight species of rattlesnakes that are almost a way of life, crawling up toilets or battling it out in the backyard. In fact, there are many more of these serpents than most people realize. Poke into just about any hole beyond the big cities and a rattler might emerge.

In March 2019, USA Today ran a story about Nathan Hawkins, owner of Big Country Snake Removal, who responded to a call from a homeowner who suspected that he might have a snake or two in his basement of his home outside Abilene, Texas. He found and extracted 45 rattlers on what he called just another day. His record for the most snakes removed from a home is 88.

I recall staying at a house some years ago owned by my old buddy Garth Choate, of Bald Knob in Arkansas. This was his vacation home, perched as it was right on the banks of the Mississippi; I would emerge each morning and see any number of cottonmouths along the edge of the water.

A few months ago I lost a friend I’d got to know quite well several years ago to snakebite.  Anton Steenkamp, a high-profile South African judge was on vacation with his wife in Zambia when he was struck by a black mamba. National Geographic tells us that the mamba is one of the deadliest snakes in the world; they are native to East and Southern Africa and arguably host the most poisonous venom known to man, though Australians argue that their taipan is even more lethal and there are two categories, both deadly.

The inland taipan is a smaller snake that is located in Australia and some sources maintain that it is even more deadly than the mamba. Also, every strike delivered by Australia’s inland taipan delivers a deadly mixture of neurotoxins, mycotoxins and hemotoxins. That means it will begin to attack your nervous system, muscles and blood simultaneously. Its nearest relative, the coastal taipan, might be small but it holds enough venom to kill up to 100 people.

While comparisons are odious it is important to know that the fatality rate from an untreated mamba bite is 100 percent and unless you’re injected with an antivenom serum within 20 minutes, you will die.

The death of Anton Steenkamp was particularly tragic because it was uncommon: mambas do not seek out their victims and generally these reptiles only attack when provoked.  But there are always exceptions when encountering snakes in the wild, whether in Africa or the Americas.

Somebody else whom I briefly met while traveling through Africa was Bobby Wilmot, whose death some years ago after he had been struck by a mamba while hunting crocodiles was even more bizarre. In his day, Bobby was a legend in Botswana’s Okavango Swamps where he would head into the bush with a small team, set up camp and search for crocs after dark: he was selling their skins on the international market.

On returning to camp one day and while clearing a small patch of bush, Bobby was bitten.  Aware of the potential threat, he was meticulous about safety and always carried a small glass vial of antivenom in his bags. After instructing his trusted aide to help him, he prepared to fill a syringe so that he could inject himself.

At that crucial moment he dropped the vial and it broke, spilling the anti-venom into the sand at his feet. Bobby succumbed to the snake’s bites half an hour later.

By all accounts, his death came quickly because the venom is neurotoxic and its infusion results, among other things, in blurred vision, an absent gag reflex, drowsiness and ultimately the inability to breathe, or what is called in medical argot, respiratory paralysis.

To my mind, I don’t regard the mamba as the most dangerous snake if it is Africa you are visiting. I was on South Africa’s Wild Coast for a couple of weeks last summer and there were regular sightings of mambas.

Instead, that label belongs to the notorious puff adder, of the viper family, and a distant relative of the American rattlesnake.

This reptile is found all over Africa, so American military specialists sent to East or West Africa to fight al-Qaeda need to be especially cautious.

Unlike swift-moving mambas or cobras, puff adders are relatively short — 3 feet on average — and sluggish: they rarely move when they sense your approach and most people are struck in the leg or foot. This killer is responsible for causing the most snakebite fatalities in Africa because of its frequent occurrence in highly populated regions and a notably aggressive disposition.

While the bite is not as deadly as that of the mamba, it results in more fatalities largely because of massive tissue damage that often results in the loss of a limb. Most noteworthy, puff adder venom has a cytotoxic effect. In humans, bites from this species can produce severe local and systemic symptoms and if left untreated could cause gangrene-like afflictions. In brief, the puff adder is extremely dangerous.

DEALING WITH SNAKEBITES

While snakebites may not strike the average individual living in areas where there are poisonous snakes, including the American regions already mentioned as being a major public health problem, they are a daily risk in some parts of the world. They can also be lethal or life-changing because victims sometimes do not get the treatment they need in time, if at all.

In other cases, they are given medicine to treat an injury caused by a different snake, which is an important factor because venomous bites typically cause three main types of life-threatening symptoms: uncontrollable bleeding, paralysis and irreversible tissue destruction. Proper identification of the attacking snake is necessary to provide the appropriate treatment.

It is essential for snakebite victims to get the correct medicine as soon as possible following a snakebite and the reason is fundamental. For instance, if someone is bitten by a snake that has cytotoxic effect and is injected (in an attempt to save his or her life) with a neurotoxic antivenom — or vice versa — the result could be fatal.

For this reason it is essential to correctly identify the snake that has bitten you, even if it means killing it and taking its body along to the clinic or hospital so that somebody who is familiar with such things can make the right decision.

It is worth mentioning that antivenom treatment is made in the same way that it has been for more than 100 years. This is a costly and laborious process and involves antibodies harvested from horse blood to make antivenom. The horses are given very low doses of snake venom over long periods of time, so it does not harm the animals.

But even so, it is estimated that the international community produces only about a third of all the antivenom that it needs.

Dr. Philip Price, the leading authority on snakebites at the Wellcome Trust in London, reckons that there is a “spiral of decline” when it comes to dealing with snakebites: “The treatments are expensive, the people who need them often can’t afford them, and in some cases people can’t make it to the hospital in time.”

“Bites by venomous snakes can cause acute medical emergencies involving severe paralysis that may prevent breathing or cause bleeding disorders that can lead to fatal hemorrhage.”

Price warned that even when people do get to a hospital, the doctors treating them are not adequately trained in these disciplines.  Or treatments are sometimes not available. He said patients may instead turn to traditional healers, meaning they fly under the radar so most countries aren’t even aware they have a snakebite problem.

Yet, things can get worse. The only thing scarier than a venomous land snake is a sea snake that can sneak up on you while you’re swimming. These are found along the coasts of Southeast Asia and throughout the Pacific Ocean. Sea snakes are actually more venomous than some of their land cousins, but luckily, snakebites from them aren’t very common and the snakes are generally mild-tempered.

PRODUCING ANTIVENOMS

A significant challenge in the manufacturing of antivenoms is the preparation of the correct immunogens (snake venoms that are injected after a bite in a bid to neutralize the poison).

At present there are few countries that have the capacity to produce snake venoms of adequate quality for antivenom manufacture, and many manufacturers rely on common commercial sources. These may not properly reflect the geographical variation that occurs in the venoms of some of the more widespread species.

In addition, the lack of regulatory capacity for the control of antivenoms in countries with significant snakebite problems can result in an inability to assess the quality and appropriateness of the antivenoms.

“There are very few of these creatures that will not flee if confronted by a human. Most only strike when cornered, or when placed in a position where the only way out is to lunge in an attack.”

A combination of factors has led to the present crisis in many areas. Poor data on the number and type of snakebites have led to difficulty in estimating needs, and deficient distribution policies have further contributed to manufacturers reducing or stopping production or increasing the prices of antivenoms to prohibitive levels.

Poor regulation and the marketing of inappropriate or poor-quality antivenoms have also resulted in a loss of confidence in some of the available antivenoms by clinicians, health managers, and patients, which has further eroded demand.

SUMMARY

An awareness of the snake population and the possibility of receiving a snakebite in areas you will be can go a long way to reducing your exposure to this potentially lethal threat. Once you determine which species to be wary of and how to avoid their likely habitats, your risk should be significantly reduced. Further, know how to identify the species you may encounter so if you are bitten, you will be able to help medical personnel provide proper treatment.

Knowing where to receive appropriate and effective treatment of venomous snakebites in areas you explore will also pay big dividends if you find yourself the victim of such an attack.

 

 

Editor’s note: A version of this article first appeared in the February, 2020 print issue of American Survival Guide.

The post SNAKEBITE! appeared first on American Survival Guide.

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