Is MRSA a Security Threat?

The conventional security threat.

If you’re a writer or a filmmaker in search of a fresh storyline then look no further than the 172 page thought-packed report just released by Britain’s Ministry of Defence, “Global Strategic Trends – Out to 2045,” which warns us of emerging security threats over the next 30 years.

It features our usual suspects: climate change driving millions from coastlines creating havoc, and the increasing threat of cyber-attack as information and communication goes digital. Trending upwards, for example, are the rise of robots, drones and corporate armies, e.g., Blackwater, that will change how we do war, and; as a predicted 3.9 billion people are likely to suffer water shortages, it will replace, or complement, oil, as a primary cause of global conflict.

Then we’re introduced to the new kid on the block: for the first time in its 5 year reporting history the MoD lists antibiotic-resistant pathogens as a “security threat.” The reason is two-fold. First, as antibiotics are rendered useless, infections caused by battlefield wounds will result in more lost lives and limbs than is the case now.

Second, and more compelling, is the effect of the anticipated combination of 4 events: (1) an increase in world population from the current 7.2 billion to 10 billion, (2) the fact that the fastest growing segment of the population will be the elderly – the number of people over 60 will be 2 billion in 30 years, representing a quarter of the globe’s population, (3) urbanization – by 2045, the proportion of people living in cities will increase from the current 50% to around 70% of the world’s population, and (4) poverty – 1 billion people throughout the world already live in slums, lacking basic amenities, and there could be almost 3 billion people living in these conditions by 2045.

The best economic evidence we have says inequality is rising to unprecedented levels, especially in the United States. The MoD report says if we don’t handle the coming economic and demographic shift properly the result will be the overcrowding of a vast and vulnerable (elderly & poor) population. That, in turn, will drive an increase in communicable disease where “social unrest or even violence could ensue.”

The emerging security threat: The enemy within - a million of these guys fit on the head of a pin but they kill & wound us more than our recent wars have.

But if framing infectious disease as a security threat is where we’re headed, take a look at where we are right now using just 1 disease-causing microbe, MRSA, as a case study. In the US alone it kills at least 11,000 people a year and blinds, amputates, and disfigures, etc. more than 80,000. Compare those numbers to a known and conventional security threat, the Vietnam War. Over its 20 year history ending in 1975 it killed roughly 3,000 US military members a year and blinded, amputated, and disfigured, etc. just over 7,500 more.

And that’s just a comparison to MRSA. All known antibiotic-resistant pathogens in the US result in about 23,000 killed and 2 million wounded every year. Over a 20 year period, that’s 460,000 dead and 40 million injured. The Vietnam totals are 58,300 dead and just over 150,000 wounded.

So here’s the question. If you are wounded or dying does it matter whether the cause is bullets or bacteria? We can even take it one step further. If a security threat infiltrated the US killing and wounding 23,000 and 2 million people respectively, every year, we would call that domestic terrorism and we would be living under a state of emergency. So looking at the current infectious disease carnage in this way, and given that the British Ministry of Defence is framing the rising global crisis of antibiotic resistance as a coming “security threat,” why aren’t we calling it that right now?

Do the Right Thing

Margaret Riley, Ph.D.: When we use an antibiotic it is like using an H-bomb because we are decimating the majority of our body's microbial cells. Antibiotics are not "smart bombs," they're indiscriminate killers.

We expect a lot from our doctors. So when something comes along telling us they’re not doing what they should, it’s both surprising and disappointing.

Such was the case 2 weeks ago with the release of a survey that found that doctors prescribe antibiotics even when they shouldn’t, and do so for reasons that are highly questionable. For example, 28% of doctors will give an antibiotic simply because the patient asks for one, and 15% will prescribe them out of malpractice concerns – yikes!

But it’s another finding that’s even more worrisome: 11% of clinicians say their reason for prescribing an antibiotic when it’s not indicated is that, well, it won’t cause any harm and, besides, maybe it will do some good, perhaps in the way that a placebo will.

Oops. The problem with this “it will do no harm” school of thought is that it’s not only flat-out wrong, it’s also dangerous.

So says Margaret Riley, Ph.D., professor of biology at the University of Massachusetts, Amherst. She analogizes the taking of antibiotics to the ingestion of a hydrogen bomb on the basis that it kills everything, all of your body’s bacteria, the good and the bad. Antibiotics, she says, are not like a laser-guided missile that kill only the bad bacterial cells. Sound familiar? Think cancer.

Because in this sense, the effect on your body of a course of antibiotics is similar to the effect of a course of radiation to treat cancer: in both cases you’re using a shotgun to kill a fly and so you end up with “collateral damage,” examples of which are well-known in the case of radiation therapy – hair loss, fatigue, decreased appetite, radiation sickness, and so on.

The collateral damage caused by inappropriately prescribed antibiotics puts patients at risk for allergic reactions, super-resistant infections, and deadly diarrhea caused by Clostridium difficile, according to the US Centers for Disease Control and Prevention.

But remember, at least with radiation treatment there are cancer cells to be destroyed. But what this survey is saying is there are no disease-causing bacterial cells around to kill – but nevertheless 11% of clinicians write these collateral-damage-inducing scripts for antibiotics on the basis that, in their misguided view, it does no harm.

One more thing: it’s this over-prescription of antibiotics that drives the growing global crisis of antibiotic resistance. A problem so severe that even the Prime Minister of Great Britain, David Cameron, got on board this month publicly warning us that “We are in danger of going back to the dark ages of medicine to see infections that were treatable not be treatable and we would see many thousands of people potentially die from these infections.”

So back to our survey. The explanation for the physician-poor result, according to Russell Steele, MD, head of pediatric infectious diseases at the Ochsner Health Center for Children in New Orleans, Louisiana, is that “Education wears off in 5 years.” Residents and interns, he says, get it right when it comes to prescribing antibiotics, “but once they’re out in practice, they start sliding, and use antibiotics indiscriminately.”

Okay, that’s a start. And while we may appreciate this honest admission of indiscriminate use of antibiotics by physicians, on this critical issue at least, we expect more from our doctors – we expect them to do the right thing.

Here is Dr. Margaret Riley’s interesting (she has puppets!) lecture:

Why We Need Technology

Dr. Spellberg: Antibiotic resistance and the collapse of the antibiotic research-and-development pipeline continue to worsen. If we're to develop countermeasures that have lasting effects, new technologies that complement traditional approaches will be needed, he says.

Our last post featured Brad Spellberg, MD, a leader in the field of infectious disease, and his claim that the root cause of antibiotic over-prescription is fear among physicians. Namely, when they’re not sure whether to prescribe an antibiotic or not they will too often go ahead and do so, typically caving in to the demands of their patients. This drives antibiotic resistance, the phenomenon that is rendering our antibiotics increasingly useless.

But what, exactly, are these physicians afraid of? What is this fear based on? Perhaps not surprisingly, the answer seems to be income security – theirs.

This brutally honest admission came to us last month by way of NPR’s On Point, in their show titled “A Wake-up Call on Antibiotics Resistance.” A guy who has been an ER physician for over 20 years, in addition to being a private practitioner, called in (at the 25:35 mark) and explained what I will call the Doctor’s Dilemma. It goes like this. A “major issue,” he said, “is that a patient will come into the ER and demand from the physician an antibiotic. And if they don’t get it they’ll complain to the administration who’ll complain to the doctor and say either make our patient happy or you’re fired!”

He described a similar circumstance faced by doctors in private practice. The pattern is that “a patient will come in to the office and say ‘I’ve got a cold, the sniffles,’ or whatever, looking for antibiotics. So you try to educate them and say sinus infections are usually viral, and they will go to some other physician and may not come back to your office, and so it becomes a business issue.”

Dr. Michael Bell, from the US Centers for Disease Control was a guest on the program and said this is common behavior across the board. Unfortunately, Bell went on to say, we live in a “pill for every ill” society, and made the interesting observation that while we trust doctors when they say we should take something, we apparently don’t trust them when they say we don’t need something – like an antibiotic.

And so the systemic failure of physicians to properly resolve the Doctor’s Dilemma is what led Spellberg to offer this solution in his address last month at the Institute of Medicine:

“How do we deal with that fear? [i.e. the Doctor’s Dilemma]. We need technology. Relying upon asking people to behave differently [think hand washing] in a sustainable way is not going to get the job done. [W]e need regulators and payers, especially payers, to help us push these technologies into the clinic so that doctors don’t have the fear that creates the inappropriate antibiotic prescription. We need to hold these healthcare systems accountable for implementing these technologies as they become available.”

Writing in the New England Journal of Medicine earlier this year, Spellberg was more specific about what we need technology to do: “Infection prevention eliminates the need to use antibiotics. Traditional infection-prevention efforts must be buttressed by new technologies that can more effectively disinfect environmental surfaces, people, and food”.

Canada’s Vancouver General Hospital is ahead of the curve on using technology to “disinfect” people. They’re the first hospital in the world to adopt a new light-activated disinfection method that is expected to reduce infections in surgical incisions by 39 per cent and save almost $2 million a year. A trial of 5,000 patients reduced average re-admissions for surgical site infections to 1.25 cases a month from 4 and shortened hospital stays for surgical patients.

“What we’re doing now isn’t working,” says Spellberg. “If we want to have a future state where we’re not living with a crisis of antibiotics resistance we need to think disruptively. Incrementally tweaking what we’re doing is not going to get the job done.”

Vancouver General leading the way:

The Fear Factor: A Leader in the Field of Infectious Disease Says Doctors Habitually Over-Prescribe Antibiotics Because They’re Too Afraid Not To. What is it They’re Afraid of?

Brad Spellberg, MD: Physicians need to stop being afraid to do the right thing. Sometimes you have to just say no.

Yesterday we reported on the Harvard School of Public Health’s plea to the public to please stop asking their physicians for antibiotics. In their view “They [the public] need to be a partner in using antibiotics properly,” and “We’re all in this together.”

Fair enough. But of course there’s someone else involved in this illicit relationship of over-prescription – our friendly neighborhood physician. And so the question arises: Why are they doing it? Why are they giving out antibiotics when they shouldn’t? Presumably they know better, so what’s going on?

Enter Brad Spellberg, MD; physician, researcher, and a leader in the field of infectious disease and antibiotic resistance. As far as doctor’s go this guy is not your average bear. Extremely well-credentialed, he stood in front of a select audience this year at the prestigious Institute of Medicine and revealed this uncomfortable truth:

The root cause of why antibiotic [over] prescriptions occur is simply fear. Fear of the unknown. We as treating physicians do not know what our patients have with certainty. We make our best guess. And that guess is haunted by the fear that we could be wrong. And that’s what leads to this ‘Well, what if it’s bacterial, how much harm could one prescription do?’ And so we need to deal with that fear. Everything else is putting a band aid on the problem.

Ouch.

Here’s what he’s talking about. Antibiotics don’t work for the common cold, the flu, most ear infections and respiratory problems, because they’re typically viral-based illnesses. Physicians know this. But they’re overrun with patients pleading for antibiotics, often-times for their sick kids. So the physician has a choice. She can order a diagnostic test to see what germ they’re dealing with, knowing that it will take 3 days to get the result. Or she can take 10 minutes to explain bacterial vs. viral-based disease, which the patient may or may not understand, and if they don’t they’ll leave the office disappointed and may well change doctors. Or she can cave in to the demand on the basis of “What’s the harm? Besides, who knows, maybe it’ll do some good.” It’s this faulty last choice that Spellberg is saying is too often made.

And we know that that choice does damage. An inappropriately prescribed antibiotic puts patients at risk for allergic reactions, super-resistant infections, and deadly diarrhea caused by Clostridium difficile. These practices also drive antibiotic resistance, further endangering the future of antibiotics and the patients who need them.

Notwithstanding this huge downside a report in the New England Journal of Medicine estimates that 50% of antibiotic prescriptions may be unnecessary. Health care providers prescribed 258.0 million courses of antibiotics in 2010, which translates into over 8 prescriptions for every 10 people. Prescribing rates were higher with kids under 10 years of age and persons 65 years of age or older. In other words, we’re getting it wrong half the time and it’s the vulnerable among us that are most hurt by this.

All we want to do is give the right antibiotic to the right people and not give it when it’s not necessary. However, before we can realistically think of getting there, Spellberg is saying his colleagues need to first fill this prescription: Physician, heal thyself.

Here is Dr. Spellberg’s talk:

A Message From the Harvard School of Public Health: Please Stop Asking for Antibiotics!

Dr. Stuart Levy: Because of antibiotic resistance "We're in danger of not being able to save lives. I think that's the issue," he says.

So now we know. Antibiotics are not what we thought they were, a miracle drug with no downside. As it turns out antibiotics have a huge downside. And that’s the message a panel of infectious disease experts wanted to get across in a public forum, “Battling Drug – Resistant Superbugs: Can We Win?” held at the Harvard School of Public Health this year.

Here’s the thing. Antibiotics don’t work for the common cold, the flu, most ear infections and respiratory problems, because they’re typically viral-based illnesses. So not only does the antibiotic not help, it turns out there’s an unintended consequence we didn’t anticipate: antibiotic use drives resistance. That means the more we use them the less effective they become, not just for the person taking them but for everybody else too. In that sense antibiotics are a “societal drug,” because individual use affects others in the community. No other class of drugs does that.

The upshot is a lot of unnecessary harm. In the US alone, for example, over 2 million people a year succumb to infections that are resistant to antibiotics ; over 23,000 of whom die, almost half of them because of MRSA. Even when MRSA doesn’t kill it does very bad things to you . You may face having to amputate a limb as happened to this NFL player, or it could leave you blind as happened to this robust teenage boy from north Detroit.

The reason for the “resistance movement” by bacteria – the ability to render antibiotics ineffective – is that they are “born” with the ability to fight antibiotics. Their only job in life is to survive, and they’re done that quite well now for some 3 billion years. In order to have survived that long they had to develop ways – “resistant mechanisms” – to fight the people in their world that threaten them; other bacteria, viruses, fungi, and so on. And that they did. Then along we come in the 1940s and try and knock them off with what we naively think are these invincible antibiotic drugs, and their response is like, “Whatever dude, we’ve seen all this stuff before.”

These critters are clever. Not only will the bug fight off the antibiotic you’re taking, penicillin say, but at the same time the bug will develop the ability to fight off other antibiotics too; for example, methicillin, amoxicillin, and tetracycline. The bug will then transfer the resistances it developed to those 4 antibiotics, to all his little bug buddies. This transfer will take place not just within a single species, E. coli to E. coli for example, but also between species, say from E. coli to Salmonella to Shigella (a bug that causes dysentery). In other words, when you take an antibiotic a whole other world of bugs that become resistant to multiple antibiotics develop inside you, thus leaving you more vulnerable to disease than ever.

But here’s the wicked part. Guess what you do with all these bugs you’re growing that are resistant to multiple antibiotics? You give them away, although not just to anybody. You’re most likely to give them to those closest to you, your family and friends. So when they get sick and need an antibiotic it won’t work for them. And it’s because of you: you’ve given your family and friends bugs that are already resistant to multiple drugs – you have effectively “immunized” them against antibiotics. That is not a good thing.

Dr. Aaron Kesselheim: The number 1 thing his patients say to him is "I want an antibiotic." That public sentiment has to change, he says, because it drives the rising threat of antibiotic resistance.

So what’s the answer? Stop asking for antibiotics. One of the panelists, Aaron Kesselheim, MD, of the Brigham and Women’s Hospital, Boston, says his number 1 patient complaint is “I want an antibiotic.” That is the very attitude the HSPH is trying to change. So if your doctor prescribes an antibiotic for you be sure to ask her why. Ask how she knows you have a bacterial-based illness and not a viral-based illness. Because unless she has swabbed for the bug and taken it to the lab for analysis you cannot know for sure what germ is making you sick.

Stuart Levy, MD, another panelist, and author of the book “The Antibiotic Paradox,” (the paradox is that the more you use them the less effective they become), wound up the discussion with this thought: If I had $800,000 to spend on fighting infectious disease, he said, I’d spend $700,000 of it on educating the community: “They need to be a partner in using antibiotics properly.”

As Kesselheim points out, “We’re all in this together.”

Here’s the video of the enlightening panel  discussion:

A Date With Brad Pitt

Sometimes words just aren’t enough. Such is the case with the landmark report released 5 weeks ago by the World Health Organization that warned us we’re entering a post-antibiotic era in which common infections and minor injuries will once again kill us. The WHO says this is not an apocalyptic fantasy, it is now a very real possibility.

But reading about a “post-antibiotic era” is one thing, actually seeing it play out right in front of you is quite another. This is where Brad Pitt comes in. He narrates the Emmy-winning 6-part PBS documentary series, “RX for Survival – A Global Health Challenge,” that makes you an eyewitness to a world without antibiotics.

Watch, how without antibiotics, a simple scratch to a policeman’s face turns into a horribly disfiguring life-threatening condition where the bacteria eats through his body like a worm eating through an apple. Watch the raw emotion in Seattle teen Ryan Woerth as both antibiotics and surgery fail to fight his stomach infection and how his only option is to try an experimental antibiotic only available for “the most desperate patients.” Watch live footage of a 10 month old infant with pneumonia struggle to breathe, while his mother and doctors rush to find an antibiotic that could save the child’s life.

The Youtube video below is part 3 of the series, “Rise of the Superbugs.” Just after the 36 minute mark Brad Pitt says “Perhaps the most alarming threat is from the common Staph aureus.” We’re then introduced to Ricky Lannetti, a star college football player in Pennsylvania who just 1 week after winning his ninth game of the year is in the hospital fighting MRSA with heart, kidney, and critical care specialists at his side. And his disbelieving father who tells us, “He’s Ricky Lannetti. No little bug is gonna kill him. Not a bug. Not something that we can’t see.”

It’s harsh viewing. But it’s real. And it’s exactly what the WHO says we’re headed for because we’re losing our antibiotics.

Here’s the video:  Rise of the Superbugs

The Bronchitis Affair

Martin Blaser, M.D., of New York University, on our overuse of antibiotics: "Has any health-care professional ever told you that taking antibiotics would increase your susceptibility to infection?"

In Tuesday’s blog we addressed the emerging topic of how antibiotics leave you more vulnerable to infection. The reason is that antibiotics work more like a shotgun than a target rifle: they kill all bacteria in sight. So the “good” bacteria that help us fight infection are killed too, leaving us more vulnerable to the next microbial invader. So the lesson is only use an antibiotic when you absolutely have to and for goodness sake don’t use them for something they don’t work on.

The trouble is we’re not doing that. As the Centers for Disease Control points out antibiotics do not fight infections caused by viruses like colds, most sore throats and bronchitis, and some ear infections. And a study just released tells us we’re getting this wrong more than we thought.

When you go to a doctor’s office or the emergency room and are diagnosed with acute bronchitis, 71% of the time you will be prescribed an antibiotic. The only problem is you should never be given that script because bronchitis is a viral-based illness not bacterial. So aside from the usual harm associated with a wrongly prescribed antibiotic – diarrhea, rashes, and stomach distress – we’re creating a huge pool of people who are more vulnerable to disease.

Oh, and as for the 15 year program the CDC has engaged in trying to educate doctors about the appropriate use of antibiotics, how’s that working out? The bronchitis study was over 14 years ending in 2010. It found that the number of antibiotic prescriptions for bronchitis actually increased over that period.

Can Taking Antibiotics Increase Your Chances of Getting an Infection?

Martin Blaser, M.D., is the Director of the Human Microbiome Program and a Past President of the Infectious Diseases Society of America. He asks an important question about our overuse of antibiotics: "Has any health-care professional ever told you that taking antibiotics would increase your susceptibility to infection?"

The utterly counterintuitive answer is “yes,” as Dr. Martin Blaser, an infectious disease specialist at New York University, tells us in his superb just-released book “Missing Microbes: How the overuse of antibiotics is fueling our modern plagues.”

First, some quick background. Dr. Blaser’s concern is with the huge overprescription of antibiotics. In 2010, 258 million courses of antibiotics were prescribed in the United States – that’s 833 prescriptions for every 1,000 people. What Blaser and others such as the U.S. Centers for Disease Control contend is that far too many of these prescriptions aren’t necessary. For example, only 20% of upper respiratory tract infections are caused by bacteria. Yet patients demand and doctors routinely prescribe antibiotics for sore throats, runny noses, chest colds, pneumonia’s, and so on, without first checking to see if the cause is viral or bacterial. So what happens then, if you take an antibiotic when you shouldn’t? Or perhaps worse, what happens if you have simply taken too many courses of antibiotics over the years? The answer in both cases is that you make yourself more susceptible to infections.

Dr. Blaser offers us 3 pieces of evidence to explain this unintended consequence of antibiotic use.

As usual we begin with our animal friends, the mice. Researchers fed normal mice a species of Salmonella that causes disease in them and us. Although infection occurred, it took 100,000 Salmonella organisms injected into a mouse to infect half the population.

But the researchers wanted to know what would happen if you first gave the mice an antibiotic, in this case streptomycin. Since antibiotics kill bacteria, the mice should be immune. But that’s not what happened. Instead they found that it now took only 3 Salmonella organisms – not 100,000 – to infect half the mouse population: that’s a thirty thousand-fold difference.

Subsequent research substituting Staphylococcus bacteria and penicillin for Salmonella and streptomycin showed the same results: i.e. taking an antibiotic before being exposed to a germ greatly increases your risk of infection.

Next up is the Chicago Salmonella outbreak of 1985 where at least 160,000 people became ill and several died. Scientists tracked down the origin of the Salmonella to contaminated milk from a single grocery store chain. The health department asked people who became sick a simple question: Have you received any antibiotics in the month prior to becoming ill? They found that those who had taken antibiotics got sick at a rate five and half times greater than those who hadn’t taken antibiotics. So just like with the mice, the taking of antibiotics before being exposed to a germ increased your risk of that germ making you sick.

Then, in 2001, researchers wanted to know whether people who received a one week regime of antibiotics would exhibit an increase in the quantity of their bacterium Staphylococcus epidermidis, which is naturally found on your skin. The result: subjects given an antibiotic had a “dramatic” increase in the Staph skin bacteria; whereas the “controls,” the people not treated with antibiotics, showed no increase in their Staph count. What’s more, the increased amount of Staph remained on the skin for 4 years, which is when the experiment ended. So we don’t know how much longer the organism would have persisted.

So how do we account for the result in these 3 cases – the mice, the milk, and the skin Staph – where taking an antibiotic before being exposed to a germ actually increases your chance of that germ making you ill? It’s that seemingly innocuous phrase in paragraph 5 above: “Since antibiotics kill bacteria.” Antibiotics kill ALL bacteria, the “good” and the “bad.” Good bacteria operate in conjunction with your immune system to protect you from disease. So if you knock them out with an antibiotic and are then exposed to a disease-causing germ, your chances of that germ making you sick go up – way up.

One more thing. That alarm sounding mouse experiment that showed a thirty thousand-fold reduction in the number of germs it took to infect you after being inoculated with an antibiotic – - it was done in 1954. But at that time the study came as an inconvenient truth. That’s because antibiotics had only been available for 10 years and they had just served a noble purpose in World War 2, warding off countless infections in soldiers due to battlefield wounds. So antibiotics were a good thing and we didn’t want to hear anything different.

But now, some 60 years later Dr. Blaser says it’s past time that we confront this inconvenient truth. As he puts it: How manydoctors ever tell you that antibiotic use can increase your risk of infection?

MSSA- A Common Bacteria that Threatens Surgical Outcomes

A common bacteria, Methicillin Susceptible Staphylococcus aureus (MSSA), and its antibiotic resistant counterpart, Methicillin Resistant Staphylococcus aureus (MSSA) continue to plague patients who are undergoing major surgeries. MSSA is found on 25-30% of the population and is found typically in the warm and moist parts of the body.
When patients are immunocompromised and weakened following surgery, they are more vulnerable to bacterial infections from the bugs that they carry. Weakened by surgery, MSSA and MRSA often breach the body’s defences leading to surgical site infections.

MSSA inhabited in the nose has been typically treated with antibiotics) and the bacteria in the groin, armpit and anus areas are commonly treated with Chlorhexidine and/or alcohol wipes and baths. Studies have demonstrated that decolonizing the nose from bacteria such as MSSA and MRSA have resulted in significant reductions to the surgical site infection rate. A decolonization protocol is well worth implementing since the cost of an MSSA surgical site infection is greater than $34,000 per patient and the cost of an MRSA surgical site infection is over $100,000 per patient, representing a huge cost burden to health care providers.

The underestimated cost of surgical site infections, however, is the impact on the patient, their work and their families. Unfortunately, there are no good estimates to measure the impact on families for surgical site infections, making it difficult for health care administrators and policy makers to generate support for infection prevention therapies. Until there is greater visibility to the true costs of surgical site infections to our society, there will not be the adequate speed to development or adoption of important new technologies that can meaningfully reduce the rates of these hospital acquired infections.

What the MERS Virus can tell us About Life in a Post-Antibiotic World

Dr. Sally Davies, Britain’s Chief Medical Officer, says resistance to antibiotics is one of the greatest threats to modern health and poses an “apocalyptic threat.”

The World Health Organization released a major report 2 weeks ago warning us that we’re on the cusp of a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill. That’s because after 70 years of chronic overuse of antibiotics in medicine and agriculture the bacteria have evolved ways to fight back rendering the drugs impotent – hence a “post-antibiotic era.” But what exactly that means seems hard to fathom. However, another disease story unfolding right now offers us timely and uncommon insight into a world without antibiotics. That story is the global threat of the MERS (Middle-East Respiratory Syndrome) virus .

It has been front page news lately because the first 2 cases of this untreatable viral infection have struck the United States. The first was in Indiana 2 weeks ago, then yesterday we learned of a second case in Orlando, Florida. More cases are expected because of the recent surge of cases in Saudi Arabia, the source country.

MERS is a severe respiratory illness. As of Monday, 538 confirmed cases had been reported to the World Health Organization; 145 have been fatal. It’s spread to those with whom you have close contact. Health care workers are especially at risk; in fact the 2 patients in the U.S are health care workers who returned from working in Saudi. The symptoms are easily confused with the flu: fever, body aches, diarrhea, cough, and shortness of breath.

So what we have is that for the first time ever the virus has left the Middle-East where it has been contained until now. The reason for the escape is the emerging new rule of infectious disease, based on a growing and growing mobile world population: “Disease is just a plane trip away, and an outbreak anywhere is a threat everywhere,” says Dr. Thomas Frieden, Director of the Centers for Disease Control in the U.S. Or, as Dr. Cesar Arias, an infectious disease specialist at the University of Texas, puts it: “Bugs don’t have passports. They don’t respect borders. They can travel very easily.”

But there’s a more telling story at work here. You can see it if you take a moment to think about the elaborate efforts we have undertaken in response to the virus.

Remember, the response is to just 2 cases of MERS in the entire country. Yet disease detectives from the Centers for Disease Control in Atlanta went to Indiana and then Florida to assist in treatment of the quarantined patients and to retrace their contacts to see how many others are showing signs of MERS. Anyone showing such signs will be quarantined to prevent further spread of the virus. The tracing effort means getting in touch with about 500 people in each case. All those who had contact with the victims during their flights from Saudi to London, then to Chicago and Indiana in the first case; and from London to Boston, Atlanta, and Orlando in the second case. Passenger lists will be used to contact everyone who sat near the 2 men. Authorities in London are doing the same thing for passengers who disembarked there.

The CDC will also try to find everybody the patients were in contact with after they got off the plane but before they went to the hospital: family, friends, and co-workers, as well as all hospital treatment staff because the closer the contact the easier the virus spreads. That’s why 20 Orlando hospital workers who came in contact with the man before he was put in isolation are being quarantined in their homes for 14 days. The CDC has asked all American doctors to be “vigilant” about watching for new cases. And some hospitals have instructed triage nurses in emergency rooms to ask all patients with pneumonia symptoms where they traveled in the previous two weeks.

An Orlando medical hotline has been set up to field concerns from the public, and to receive tips about people who might be infected. The local authorities are relieved their patient did not go to any of the local tourist attractions thus avoiding contact with people who will eventually disperse worldwide.

So, we’re going through all this for 2 cases of a virus that can’t be treated. Now compare the bacterial case: Each year in the United States at least 2 million people become infected with bacteria that are resistant to first-line antibiotics and at least 23,000 people die each year as a direct result of these infections. MRSA alone is responsible for almost 12,000 of those deaths. Now imagine the carnage if second-line antibiotics and antibiotics of “last resort” also failed to help them – which they already do in the 23,000 fatal cases. Actually, we don’t have to imagine it because there is precedent, and there is also a prediction about what it would be like that comes to us from a very informed source.

The precedent comes to us from Martin J. Blaser, MD, an infectious disease specialist at New York University and author of the just published book: “Missing Microbes: How the overuse of antibiotics is fueling our modern plagues.” Dr. Blaser reminds us of the destructive force of pathogens, those disease-causing invisible creatures, so tiny that a million of them can fit on the tip of a needle, and so deadly that during World War 1, dysentery and typhus took a greater toll than combat. In 1918 and 1919, the great Spanish Flu spread across the globe to infect 500 million people, about a quarter of the world’s population, killing between 20 and 40 million of them, frequently from complications due to bacterial infection.

Why nothing like that since then? Antibiotics. World War 2 was on the horizon. No one wanted a re-occurrence of what happened in WW1, or during the Spanish Flu. Penicillin had been discovered in the 1930s but nobody could figure out how to make it in large quantities: until 1942 only drops at a time could be made. So the Americans, knowing full well that battlefield wounds could once again turn into a worldwide spread of infections, went full-court press and solved the problem. Penicillin thus became available for everyone, military and civilians alike, thereby avoiding the WW1 epidemics.

Germ Jail: Dr. Davies warns us that in a post-antibiotic world, the criminal law will be used to lock up mass 'colonies' of people with untreatable infections.

The prediction comes to us from the Chief Medical Officer of Britain, Dr. Sally Davies, in her recently published book “The Drugs Don’t Work: A Global Threat,” in which she imagines life in a post-antibiotic world. She says we’re headed toward a world where infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. This is the scenario she envisions:

[T]he government passed new laws making it a criminal offense for the infected to be in public. There were talks of random tests in the street. If you were contagious you would be committed to one of the isolation sanatoriums that were being built on the edge of all major towns. This was a death penalty. They were referred to as ‘colonies’.

Is this just the stuff of science fiction or is she onto something? Remember, the 2 MERS patients in the U.S. were quarantined as were the 20 hospital workers in Orlando who were exposed to that patient before he was diagnosed and precautions taken. Disease detectives in the States are on the hunt for about 1,000 more people there, and British authorities are tracking down however many disembarked from the Saudi flight in London. Anyone found with MERS will be quarantined as will anyone exposed to that person before they were diagnosed, especially people with whom the patient lives and health care workers. How close is quarantine to arrest? How many people do you quarantine in a locale before you have a ‘colony’ of them? A tip line has been set up to inform on people suspected of being MERS-positive. The CDC has warned all doctors in the U.S. to be on the lookout – read: an APB – for anyone with MERS-like symptoms. And all this for 2 known cases.

So, multiply what’s happening in these 2 cases by 500,000 or a million cases of bacterial infection at a time when antibiotics no longer work and where are we? We are in a post-antibiotic world: MERS may be just the taste test.

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