A Tour of A Hidden Universe

“Most of life is invisible. Everything that you can actually see with your eye is just the smallest sliver of life on this Earth,” says Bonnie Bassler, professor of microbiology at Princeton University.

But here’s the thing: we’re immensely affected by this hidden universe of tiny creatures. Look no further than the front page news these past few months and witness the effect that the Ebola virus is having on us.

The Tree of Life depicts every living organism that we know about on Earth. The only ones we are able to see, however, are depicted at the top right – the animals (that’s us), the plants, and a few of the molds and fungi. For all the rest we need magnified pictures.

But those magnified pictures can fool us because they typically don’t provide contrast. Instead, they represent all micro-creatures to be roughly the same size. Which is akin to showing a child similar size pictures of ants and elephant’s, thus leaving the impression they’re roughly the same dimension! What you need of course is contrast, i.e. a picture of the ant (standing!) beside the elephant.

The same holds true for us and our understanding of the Hidden Universe. So here’s a really neat animation that solves the problem. It lets us peek into the unseen universe of bugs and things and see not only what they look like and how they compare in size to each other but – and here’s the trick – it lets us compare them to something we’re very familiar with as all the various life forms are sitting side-by-side on the head of a pin.

So explore the secret world of Ebola, E. coli, staph aureus, blood cells, and so on, and notice how many thousands of times bigger, or hundreds of thousands of times bigger, one is from the other.

Click on “Start the Animation …” and enjoy the tour!

The Hospital’s Duty of Care

Arlene Wilgosh admits that hospitals have a duty to protect their patients from acquiring "super bacteria."

Twenty people died in Canada today – but they didn’t have to. They were all in healthcare facilities, hospitals mostly, and the reason they died had nothing to do with what brought them there. They died because of an infection they picked up while in care. And they picked up the infection because the hospital wasn’t following its own hygiene rules – and they admit it.

These preventable deaths happen every day in Canada, all across the country. By the end of the year – and every year — more than 8,000 people die in care, making Hospital-Acquired Infections (HAIs) Canada’s fourth leading cause of death. But it doesn’t stop there as more than 200,000 people are made sick by these infections, often seriously, as lifelong scars or a missing limb attest to.

This past Tuesday, Winnipeg’s Health Sciences Center held it’s (18th) annual “Bug Day,” an event that brings together experts from across the country who publicly address various aspects of HAIs. It played to an attentive and overflow crowd of healthcare workers. The take-home message was the same as it was last year: “Wash your damn hands,” as Winnipeg Regional Health Authority CEO Arlene Wilgosh put it, as 80% of these infections are spread by healthcare workers, or patients and their visitors.

But there’s a problem: the golden rule of washing your hands between every patient visit isn’t followed. Around 70% of nurses comply and a paltry 38% of doctors – if that. It’s been suggested that even these numbers are inflated because staff know when the hand washing police are watching and will thus “buckle up.”

Then came the stunning bit: Arlene Wilgosh said she didn’t know why these compliance numbers are always so low. The admission was stunning because even the nursing student seated next to me said: “We just don’t have the staff. There’s too many patients for each nurse to look after and there’s just too much to do.”

And that’s the dirty little secret that none of the presenters at the day-long event were willing to give voice to.

Not even Arlene Wilgosh, who seemed so compassionate. A former frontline nurse herself, she admitted that staff have a duty of care to their patients and candidly asked the audience: “If these patients were our loved ones, would we still not wash our hands and take proper precautions?”

According to Ms. Wilgosh, the hospital infection issue “poses a … very significant risk to those we care for,” and therefore “Something new has to be done to address it.”

But what is that “something new”? Because if our healthcare leaders aren’t even willing to acknowledge a major cause of HAIs, then where are we supposed to look for a solution?

Is this where we're headed?

How about the law. A sharp-eyed CBC report filed this month put it this way:

Our concern about the WRHA … is the lack of acknowledgement of the systemic nature of the true solutions, apparently devoid of a plan to marshal the required resources.

Under the Manitoba Workplace Safety & Health Act, Sec. 43(1): “A worker may refuse to work or do particular work at a workplace if he or she believes on reasonable grounds that the work constitutes a danger to his or her safety or health or to the safety or health of another worker or another person.”

Who … will be the first health care provider to draw the line and say, “I have too many patients, and

not enough time to follow proper hand hygiene protocols. I am refusing this work on the grounds that it constitutes a danger to the health of another person.”

Will it then be labor legislation that ultimately compels the minister of health and the WRHA to properly resource a systemic solution that will keep patients safe?

The CBC may be on to more than it knows. When professionals breach their duty of care to their patients, and serious, foreseeable, and preventable harm results, year in and year out, there’s a name for what happens next – it’s called a lawsuit. And a class action suit filed on behalf of close to 250,000 patients would not be out of the question for an imaginative and resourceful law firm.

Arlene Wilgosh began her address to us with these words about hospitals and infections: “It’s like going to war every day,” she said. She, too, may be on to something. Because if hospitals carry on shirking their duty to their patients, they will find themselves engaged in yet another theater of war, only this time they’ll be the ones in need of help. And they will dearly hope that the legal professionals in whose hands they’ll be in will properly discharge their duty of care.

Look at it this way. Suppose Ebola was killing 8,000 Canadians a year, every year. And on top of that our healthcare leaders publicly admit we could avoid those deaths if only hospital staff would bother to follow their own hygiene protocols. Yet they don’t, and so the deaths of innocent people continue to pile up. How would we feel about a lawsuit in that case? And so to our issue – how is the runaway train of hospital-caused/associated infection any different than that?

The MRSA Map

Dr. Joan Casey

Green acres may not be the place to be.

When Joan Casey was a PhD student she started reading up on the idea that antibiotic use in our farm animals might be making us sick. Research over in Europe told her that MRSA was traveling from pig farms to people, and she wanted to know if the same thing was happening here. Five years later, and now on staff at the UCSF School of Medicine, she believes it is.

Her research (on FRONTLINE) led to Pennsylvania farm country. Using data from about 160 million electronic records on about 450,000 patients in the region, her team found that (1) total MRSA from 2001 to 2009 went up every year, and by as much as 34% (2) people living closer to these farms and to the crop fields that are located nearby were about 38 percent more likely to have a MRSA infection than people living farther away, and (3) the people getting MRSA are not like the ones who used to get it. They’re not old and sick; they’re young and they’re healthy.

Casey’s team put together a map of their findings. Each red dot is the home address of a person that had a MRSA infection. The blue bits are the pig farms.

Now for the tricky part. Industrial farms are an easy target. We know they ply our food animals with antibiotics, not to cure disease, but because antibiotics accelerate growth. So you have a ready to slaughter animal in much quicker time thus saving owners money on feed and care, which in turn keeps the price of our (expensive protein) food down – just the way we like it.

But at what cost? Joan Casey says innocent children in rural Pennsylvania are getting hurt (google “MRSA infection” images) so you can eat cheap meat.

Sacrificing others so we can live comfortably is nothing new. The link between child labor, sweatshops, and affordable goods and clothing, for example, is well documented.

As population numbers rise and land and fresh water become scarce, the demand for cheap food will increase, implicitly egging on whatever our industrial farms can do to provide us with affordable meat. As if that isn’t enough, our new global inconvenient fact, climate change, portending even less arable land due to drought and flooding leading to food shortages, will put further pressure on this industry to cut corners.

Dr. Joan Casey has shown us where that leads. The question for us is whether we will follow.

The Global Village of Infectious Disease: The Beat Goes On

Ever since it became known that Ebola virus disease was in Dallas, Texas, it has been front page news. That remains the case even though health authorities agree it won’t spread to any significant degree, for example, outside of the patient’s immediate family.

But authorities agree on something else too, something vastly more important, because, unlike Ebola, it’s likely to affect you and me: the fact that infectious diseases of all kinds are growing – and moving – worldwide. That is the real takeaway from the Ebola outbreak; from the SARS outbreak before that, and from HIV/AIDS before that – we in North America are not only not immune from the trend, we’re in the crosshairs.

Scientists figured this out at least 6 years ago, and just 3 graphics help us understand the story. The first is a map of the regions of the world where there is a high risk for future or emerging infectious disease events to occur. Notice the prominent role of the US and Europe:

The next point is that not only are infectious diseases on the move, they’re becoming increasingly resistant to standard antibiotic treatment; for example:

And what’s one of the biggest reasons for all this? Global air travel:

Where we and our air cargo go, the bugs go, as we witnessed with the man who brought Ebola from Africa to Texas. We saw the same thing happen with the spread of SARS in 2003 and the pandemic influenza of 2009, where the rapid global spread of disease occurred through major travel hubs.

Today, our world population is just over 7 billion people; by 2050 it’s estimated to be 9 billion, suggesting these disease trends will continue. But there’s one more thing that we haven’t even touched on that may have the greatest impact of all: climate change. Our best scientists agree it will affect the spread of infectious disease – but exactly in what ways, is the (epic?) story yet to be told.

Ebola Lands in Dallas, Texas: Welcome to The Global Village of Disease

Okay, the Ebola virus is here, and yes, that really matters – but probably not for the reason you’re thinking.

It landed in Dallas, Texas, on a flight from Africa on Friday, September 20th. The person in whose body Ebola hitched a ride began showing symptoms on September 24; on September 28 he was hospitalized and is reported to be in critical condition.

The crucial medical fact about Ebola is this: it can only be transmitted when the patient is sick and showing symptoms and even then only though direct contact with that person’s body fluids, notably blood, vomit, or excrement. Healthcare workers, therefore, need to be very careful, as the African experience shows. But the rest of us will be okay: “I have no doubt that we’ll stop this in its tracks in the U.S.,” says Tom Frieden, Director of the Centers for Disease Control and Prevention. So a local, internal spread of the virus isn’t really the issue.

There is, however, a deeper concern: Is the fact that Ebola made its way here a one-off, or does it portend a future where all bugs, especially those resistant to to antibiotics, although once geographically limited, now have a global reach?

The evidence overwhelmingly supports the latter view. Disease, like us, and because of us, is on the move everywhere; thus: “A disease outbreak anywhere is a disease risk everywhere,” says Dr. Frieden. That is because international travel has grown dramatically and it’s estimated that one billion people are travelling every year, most of them by air. In fact, worldwide tourist travel alone is expected to almost double over the next 15 years:

Since flights take people half way around the world in less than a day, that is well within the incubation period of many infectious diseases. That is why long-distance travel of persons and materials has long been recognized as a factor that drives the emergence of infectious disease; and now, increasingly so, as population levels rise.

The other thing is that germs don’t just attach themselves to people. Like you and me they hitch rides on airplanes too. For example, MRSA, the flu virus, E Coli, and diarrheal bugs are found throughout a plan, as this CNN report tells us. Moreover, the bugs will hang out in the plane for days: MRSA, which kills more than 11,000 Americans every year, was found to last 7 days on the seat pocket, 6 days on the armrest and seat, 5 days on the window shade and tray table, and 4 days on the toilet handle of planes.

The upshot of all this is well put by Dr. Cesar Arias, professor of medicine at the University of Texas: “Bugs don’t have passports. They don’t respect borders. They can travel very easily. And, in fact, this has been shown for MRSA.”

Notice that it’s not just MRSA that’s a frequent flyer. All the bugs on the graphic below – and many more – are joining the club every day.  Welcome to the Global Village of infectious disease.

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