Boils aren’t a popular topic for discussion, but they’re horrible for many people. A long conversation with…

Boils aren’t a popular topic for discussion, but they’re horrible for many people. A long conversation with an afflicted friend made me think much wider things, about Covid and infection more generally. About microbes as an ecology. We medicalise them. /1

My friend got regular boils, mostly on the back, buttocks and upper legs. All of the advice they were given focused on trying to eliminate the staph - antiseptic soaps, for example. Reading about boils, one thing that struck me is where they’re most commonly found. /2

Buttocks, between the butt cheeks, torso, sometimes behind the ears, the navel etc. A lot of these areas are places that people don’t always dry throughly after showering or bathing. They may also be people (like my friend) with a significant amount of body hair. /3

I don’t know how thoroughly people with a lot of body hair dry that hair, I suspect often not. So they throw clothes on after a shower with a not insignificant amount of damp still on their bodies, in different areas, including in their body hair. It made me wonder. /4

Wouldn’t this be fertile ground for the growth of staph or other organisms? My friend also had occasional fungal skin infections, often where their body hair was thickest. I suggested they focus on really drying all of these areas of their body after showering, including hair. /5

More than a year later, they haven’t had a single boil. N=1, I know, and also perhaps advice already given to patients with boils, I don’t know. @lisa_iannattone ? But the wider way of thinking of this as an ecosystem thing is pure public health, in miniature. /6

With Covid it’s interesting how little of the discussion is ecological. That’s what public health measures mostly are, ecological interventions. Even a vaccine is an ecological intervention, an attempt to steer an ecosystem. Not a medicine. Antibiotics the same. /7

I often mention the work of Paul Ewald, because that’s his focus, though he overlays evolutionary biology on it too. I think we can do a lot with ecology before we even need to dip into evolutionary theory. One of the founding tenets of public health is that much disease…/8

…is contextual. Social, and I would say also ecological. Difficult to even make a distinction between those things. Covid for example would likely never have been a pandemic, if we’d ventilated our spaces properly. If we’d paid attention to our own ecology. /end