The “next global health crisis” is not new news

This morning in the Daily Maverick – it’s been going downhill for a while – was this opinion piece:

Gosh. Really?

It’s 2026. Microbiologists have been watching this happen for 30 or more years already, and we’ve been telling you about it for almost as long.

Even on this blog, which isn’t a microbiology blog, we’ve covered all of this in some detail. Some repeated detail.

In 2012:

The time will come (soon), when we run out of antibiotics and we’ll be at the mercy of what are – at the moment, at least – minor infections. Advanced surgery like transplantation, will become impossible – immunosuppressed patients will simply not survive the inevitable infections without prophylactic (preventative) antibiotic treatment. Even “basic” surgery will be impossible for the same reasons. Anything around the abdomen – appendicitis, for example – will effectively mean game over.

In 2013:

Dame Sally Davies (the Chief Medical Officer in the UK) thinks that “…the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s national risk register of civil emergencies.”
And that puts it alongside threats like “explosive volcanic eruptions” and “catastrophic terrorist acts”.

Twice, actually:

The Centers for Disease Control and Prevention (CDC) in the US revealed (just before the Federal Shutdown) that of the 2 million plus Americans affected by antibiotic resistant bugs each year, around 23,000 will die.

And then 2014:

“We risk going into a post-antibiotic era, and that could start any time in the next 10 or 20 years, when modern medicine becomes impossible. Routine surgical procedures – hip replacements, caesarean sections, modern cancer treatments – all are based on using antibiotics to prevent or treat infections. Without them, people will die.”

I was still banging the drum in 2015:

This is not a futuristic scenario … it is being played out right here, right now, in South Africa and other countries across the globe. Decisions to withhold surgery based purely on the patient being colonised by pan-resistant bacteria are being made, and people are dying of untreatable infections in our hospitals and communities. Quite simply, our abuse of antibiotics is destroying modern medicine as we know it. 

And then again six months later:

But it seems that a lot of people simply don’t understand what antibiotic resistance and superbugs are. Research has shown that there are two main categories of misunderstanding here. Both are bad, but you can completely understand the confusion of the 20% of people who have simply misheard the word and believe that it’s actually a “Superb Hug”. That wouldn’t be bad at all. It would be… well… superb. And a hug. Everyone loves hugs. Especially superb ones.

That’s not going to kill you.

Sadly, the other 80% of those who don’t get what antibiotic resistance is, think that it’s the patient who becomes resistant to the antibiotic:

2016. Ten whole years ago:

And again, just before 2017 as the UK Government announced their War on Superbugs:

It’s not a bad idea. It’s just a 15-years-too-late idea.


Apparently, I gave up on being a stuck record after that, because what’s the point in warning people if no-one is listening? It’s all too easy to become apathetic, and there are plenty of other things to be worried about since then, like Covid, like Trump, like numerous attempted World Wars and like the baggage retrieval system they’ve got at Heathrow.

Because there is no focus to this problem, because it is just a slow, ongoing, insidious issue, no-one is taking it seriously. Sure, there are a lot of words from scientists and doctors, but until the public get on board, there won’t be any action, because all too often, policy decisions are made on popular things, not on important things.

As Rowan Govender notes in the not-quite-as-good-as-it-used-to-be Daily Maverick (link way back up there):

Antimicrobial resistance does not trigger the same urgency as an explosive outbreak. It spreads across hospitals, farms, communities and borders without a single dramatic moment of recognition. Yet its cumulative impact could rival or surpass many traditional pandemics.

Yes, it’s happening now. It’s been happening for the last 30 years. But mostly, we’ve been able to avert the crisis by moving to a different drug when the first one didn’t work. And more recently, sometimes even to a third or fourth drug if the second or third didn’t work.

Sadly, this can’t continue, because we’re using up our drug options far faster than we can make new drug options. We’re running out of options. And so, increasingly, when a patient has an infection, there are times when none of the drugs that we can use are effective in treating that. And yes, we all have immune systems that might be able to help out, but we had those before we discovered antibiotics, and the data very clearly shows that they’re not able to do it all by themselves.

That’s why global deaths from infectious diseases decreased by over 70% after penicillin was first used in 1942.

The first outbreak of fully resistant bacterial disease is really not that far way, and ironically, the current world geopolitical situation might exacerbate the problem. Food shortages and inflation will lead to increased poverty, poor living conditions and malnutrition, and a larger number of people immediately vulnerable to infectious diseases.

Even after learning a lot through the Covid pandemic, we’re still hugely underprepared for this eventuality. And it will end in disaster.

You can’t say that you weren’t warned.

Microbiology helps out (finally)

It’s no wonder that the beagle has been feeling a bit rough.

We got the lab results back from her specimen – it’s only taken A WHOLE WEEK – and it turns out that her resident Escherichia coli is rather resistant to everything

Certainly to the three antibiotics she’s been on so far, anyway. (That’s post-op Co-amoxyclav, then Clindamycin and thenTrimethoprim, for my microbiological readers.)

So now we move onto the Fluoroquinolones (Enrofloxacin, for my microbiological readers.)

And the good news is that we know that it’s sensitive to this. And that means that she can finally get mended.

I can’t believe that it’s taken 7 days to get this result. Back in my day, we would have got this done overnight. Yes, even for a beagle.

It’s been a really unfortunate run for Colin, but I think we finally have the answer to our question about how to get her healthy again.

Don’t snog your pet – rocket surgery research

We’ve covered the dangers of antibiotic resistance on the the blog many times before.
We’ve covered the dangers of unhygienic pets on the blog many times before.
Now, some rocket surgeons at Glasgow Poly Caledonian University have put the two together with some groundbreaking research:

I hope you are all sitting down, because the advice in this article is pretty shocking stuff, and may make you immediately rethink how intimately you’ve been living your life with your household pet.
I’m talking about near-incredible recommendations like:

Avoid kissing pets on the mouth

Seriously, just avoid kissing pets full stop.

Don’t let them pets lick your mouth or nose

This is basically french-kissing pets. It’s also to be avoided full stop.
And the nose fetish thing? Eww. No.

Pet owners should wash hands after stroking animals, particularly before meals

WHO KNEW?!?!?
WHO?!?!? KNEW?!?!?

Make sure pets eat from their own bowls and don’t use household utensils

I’m going to be a bit sick now.
And this from a guy whose beagle can’t even use a knife and fork anyway.

At least they stopped short of suggesting that you also always use a condom.
(At least, I hope they did: I haven’t read the whole paper yet.)

It really seems like these things shouldn’t need to be said to humans. We’re literally the most intelligent species on earth, and that’s why we really shouldn’t need to be reminded or warned not to snog our canines who were literally chewing on some faeces they found on the pavement just five minutes ago.

It’s also why household pets shouldn’t be allowed into establishments serving or selling food. It’s not about me being mean to your French Bulldog, it’s just about basic common sense and decent hygiene. It’s about your poor choices putting other people’s health at risk.

Honestly, you people disgust me.

Normally, I’d put this sort of thing into the Darwin Awards category: removing oneself from the gene pool through one’s own stupidly reckless behaviour. But that doesn’t work here, because sadly, this might – might – not actually finish you off, but it will lead to the proliferation of antibiotic-resistant bacteria which – as I mentioned above – might finish other people off.

Now, thanks to this “new” research from Dr Adele Dickson et al., we’re able to actually demonstrate that your disgusting behaviour is bad for the human race in general.

Thus, for the good health of humanity, please stop this sort of stuff immediately. Ugh.

Antibiotic resistance apocalypse predicted

Yes, according to the front page of today’s (poorly-named) Independent:

Fullscreen capture 2016-05-19 083721 AM.bmp

“OMG!” I hear you saying. “You’re a microbiologist, 6000. Why didn’t you warn us about this?”

Yeah, you’re absolutely right.

I
Should
Have
Said
Something

Sorry.

 

(please enjoy the full 84 page report here)

Superbugs

While the events of the past few days may make the apocalypse seem to be coming via other means, I still feel that climate change and the terrorists won’t knock us off quickly enough for us to avoid death by the scourge of antibiotic resistance.

Here’s a Cape Talk interview with the WHO’s Dr Marc Sprenger on the pisspoor Kieno Kammies show this morning.

But it seems that a lot of people simply don’t understand what antibiotic resistance and superbugs are. Research has shown that there are two main categories of misunderstanding here. Both are bad, but you can completely understand the confusion of the 20% of people who have simply misheard the word and believe that it’s actually a “Superb Hug”. That wouldn’t be bad at all. It would be… well… superb. And a hug. Everyone loves hugs. Especially superb ones.

That’s not going to kill you.

The other 80% of those who don’t get what antibiotic resistance is, think that it’s the patient who becomes resistant to the antibiotic:

The researchers asked them about it and got blank faces in response. When probed—and here’s the bit that really shocked me—almost everyone assumed that it’s the person who becomes resistant to antibiotics, not the microbes. You take enough of something, they reasoned, and your body gets used to it and builds up a tolerance. It’s such an intuitive idea that even after they read simple descriptions that explained how bacteria become resistant, they reverted to the resistant-patient idea.

I hope his probe was properly sterilised between interviews.
The implication of this misconception is:

…a pretty serious one, because some people reasoned that if they don’t finish their courses, they’re less likely to become “resistant.” Ironically, that decision could increase the odds of developing an actual drug-resistant infection by leaving a pool of surviving microbes that have experienced and withstood the antibiotics.

Even the term “Superbugs” was described as misleading. Oh dear. I’ve buggered up the title of my post. Properly.

The issues here seem to be much greater than merely the apparent apathy over the dangers of antibiotic resistance, or, as we’re now suggested to describe it: “drug-resistant infection”.

If you change the noun to infections or germs, and make resistant the adjective, you make a huge difference to people’s ability to work out what’s going on. It’s opened my eyes to how much more research we need to be doing on public-health communication.

The problem is that people don’t even understand the concept of what they supposed to be apathetic about. And if we’re ever going to get them to be apathetic about it (and don’t worry, yes, this is merely the first step of my master plan), then we, as microbiologists and healthcare professionals, need to remedy that.

Even though, soon, we’re not going to be able to remedy anything else.