In 1900 the top three killers in the world were pneumonia/influenza, tuberculosis and diarrhea.
Within 100 years, the only one of these still on the list of top ten killers was pneumonia/influenza. At number seven, its total attributable deaths are a fraction of 100 years before. The main drivers for the collapse in mortality rates caused by infectious diseases include vaccination, improved sanitation and hygiene practices, and the advent of antibiotics which in many cases turned potential killers into minor discomforts.
We have long heard the drumbeat from the medical community warning of the dangers of irresponsible over prescription of antibiotics, and the potential for certain strains of bacteria to develop resistance to the various categories of antibiotics, the arrival of the so-called superbugs. As the bacteria have evolved, the medical community has turned to more and more powerful antibiotics to fight back. However, it now seems that the arsenal is empty as the U.S. has joined the growing list of countries where a patient has become infected by a bacteria resistant to an antibiotic of last resort, in this case by a strain of E coli1.
Doctors in the U.S. write over 11.4 million needless prescriptions every year.
“It is the end of the road for antibiotics unless we act urgently,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), said in Washington. Already the cost to the American healthcare system of dealing with infections resistant to one or more antibiotics is $20 billion a year.
We are seeing a growth in the number of cases of Sepsis in the U.S. According to the CDC the total number of cases almost doubled between 2000 and 2008, rising to 1.14 million, of which just over 200,000 were fatal. The two most frequently diagnosed causes were the gram negative bacteria E. coli and MRSA, the methicillin resistant gram positive strain of Staphylococcus aureus.
Surgery will become less safe.
Some of the old perils are making a comeback too, with current deaths from drug-resistant infectious diseases and parasites estimated at 700,000, of which 200,000 are caused by a resistant strain of TB. Procedures such as commonplace surgeries will become much more risky, and the immuno-suppressed in the intensive care unit (ICU), burn victims or those undergoing cancer treatments will be much more vulnerable.
The “antibiotic apocalypse” may already be upon us, according to Dame Sally Davies, chief medical officer for England. She considers the threat posed by resistant strains of bacteria on a par with global warming and terrorism and can foresee a reversal in the long term trend of extending lifespans
A 1 percent reduction in effectiveness of antibiotics could impose costs of $3 trillion globally in lost human health.
A recent report by Lord (Jim) O’Neill, the economist charged by the prime minister with finding solutions to the crisis, forecasts that if current trends continue, 10 million people may die of a variety of previously treatable diseases by 2050.
What can we do to help protect ourselves against this reemerging threat? The gains in public health including quality housing, and water quality and treatment are likely to continue to extend across the globe so it is not likely that we will return to the endemic state regarding the diseases of yesteryear, but the threat of an elevated level of untreatable infection within both the healthcare environment and in the community is very real.
Old ways, new technologies.
Possibly the most understated and simplest solution in hospitals and the home is to dial up the emphasis on environmental hygiene and handwashing. Germs move from one host to another, frequently catching a ride on someone’s hands, who may touch another person directly, or may touch a surface that is in turn touched by another person who then picks up the germ. To prevent a successful transmission, the germs must be physically removed or killed either on the skin, or on the surface.
This can be done by frequent and timely hand hygiene, through handwashing or the use of alcohol hand gel, or by properly cleaning or disinfecting a surface with an effective disinfectant that can quickly kill both gram negative and gram positive bacteria. Modern disinfectants offer the combination of excellent efficacy without compromising the safety of those using them, or damaging surfaces or clothes. They also have the benefit of not creating "antimicrobial resistance" that we have witnessed with antibiotics as they work to kill the bacteria in a completely different way.
We may not be going back to the future in terms of diseases, but the remedies to combat their spread are grounded in learnings around hygiene that pre-date antibiotics by millennia, and fought by the latest technologies in the cleaning and disinfection space that minimize the risk of transmission.