Dr Chris Ellis, clinical director of infection and tropical diseases at Heartlands Hospital, has come across it all during more than 30 years in his job.
That includes the emergence of HIV, tackling the first UK outbreak of the H1N1 Swine Flu virus in Birmingham, anthrax contaminated heroin and even Lassa fever, where victims literally bleed out of their orifices.
But there are many new emerging worries on Dr Ellis’s list – like a new form of tuberculosis (TB) that is multi-drug resistant coming in from Latvia and the former Soviet Union countries and needs a vigorous drug regime to treat.
Then there is controlling the rising rates of general TB and HIV in the country’s second largest city and hoping that the “scariest” virus he has ever seen, SARS, does not make a return.
“These infections come out of the blue and then disappear,” said Dr Ellis.
“We look to infections in animals as viruses often develop there first before adapting to strike humans, like Avian flu, which only needs a few mutations to become more lethal.
“HIV started life in primates and mankind got it by hunting them and then it mutated to become infectious in people.
“We don’t know what the next SARS or HIV might be. It could be somewhere happening in the jungles of Borneo that could mutate into a virus that affects people.
“The next epidemic we are fearful of is avian flu getting into domestic birds and affecting us all.
“It is found from time to time in south east Asia but not mutated into a contagious flu yet.”
With fatal bacteria doubling every 20 minutes, the infection team at Heartlands have a race against time to diagnose patients.
They are aided by having the regional Health Protection Agency laboratory on-site, in Bordesley Green, carrying out microbiology tests to determine infections and pick up any worrying trends.
It was here that the first English outbreak of deadly Swine Flu was handled in 2009 when it struck at Welford Primary School, in Handsworth, and within four days spread to five schools.
Swine flu’s danger to pregnant women and young people led to Heartlands taking in more suspected swine flu cases than anywhere in the country.
There with 70 patients admitted over three weeks at its peak and the medical teams experiences are being highlighted internationally in medical journals.
“The hospital managed to cope brilliantly as we had very sick patients and particularly pregnant women affected,” said Dr Ellis.
“Babies survived by giving them oxygenated blood that wasn’t from their mother.
“If we hadn’t handled it so well and kept things so tight, we would have had more deaths and the hospital wouldn’t have been able to function. We just managed to contain the thing.”
Birmingham suffered numerous tragedies at the hands of swine flu with 60 deaths in the West Midlands from April 2010 to 2011 along and young and middle-aged adults particularly vulnerable to the H1N1 strain.
Among the death toll were three-year-old Lana Ameen, whose Quinton parents Gemma and Dr Zana Ameen were devastated when she died two days after developing the deadly virus on Christmas Eve 2010.
Another was 42-year-old Birmingham singer Trish Keenan, from the band Broadcast, which was championed by DJ John Peel. She contracted swine flu and died at Warwick Hospital in January last year.
“Swine flu was particularly big in the Pakistani community,” added Dr Ellis.
“Immigration to some way explains increases in infections.
“The main reason to a large part is because of people coming to this country from places where these infections are prevalent, like sub-Saharan Africa, where they are more likely to have HIV and TB.
“TB has unexpectedly come back because of people arriving from the Indian subcontinent.
“Nationally, infections are on the increase, like TB, HIV, hepatitis B and C but antibiotics is making them harder to treat. The more they are used, the more the bacteria will get immune to it. Having people use antibiotics more responsibly is one way to prevent this but you can’t put limits on antibiotics – it’s the medicine that can make a difference between life and death.”
Despite facing so many deadly contagions, Dr Ellis has only been scared by one virus – Severe Acute Respiratory Syndrome or SARS.
Emerging in China in 2003, it spread, killing patients, doctors and nurses alike.
“In my lifetime, the most frightening thing has been SARS because the people who did know about it, the medical staff, still caught and died from it and that’s unique,” said Dr Ellis.
“We were sent patients that could have SARS and our nurses just got on with it even though they were at same risk of catching it. They never made a fuss and they don’t even get danger money for it.
“We had 16 potential SARS victims and thankfully none of them had the virus.
“I haven’t been worried about other infections. I was never worried about HIV because it was clear from the start how it was transmitted and if you were careful, you knew you weren’t going to get it.
“When it was first diagnosed in 1981, people were frightened and there were hospitals including private ones saying they won’t take anyone with HIV and that was wrong.
“Our job is to determine an infection. Infections can affect any system in the body and a lot of them show as fevers. I have to determine a pattern that points in one direction or the other to diagnose and treat it, however dangerous it is.”