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.
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.