© Josh Sager – June 2016
Hollywood loves pandemic movies and tends to base them on exotic or fictional diseases, involving some hemorrhagic fevers (e.g. Outbreak, Cabin Fever, etc.), super-flus (e.g. Contagion) or even the zombie apocalypse (World War Z, 28 Days Later, etc.). While these movies can be entertaining, they are extremely unrealistic and based around the most tenuous understanding of the disease threats that humanity currently faces—that said, they have a kernel of truth that should be listened to.
Unfortunately, the threat of super-bugs is a real, and growing, problem. Unlike in the movies however, the diseases that are most likely to give us significant trouble in the future are the ones that we have been treating for years. Bacterial infections like Escherichia Coli (e-coli), Staphylococcus (staph), Streptococcus (strep) and Tuberculosis (TB), which basically every human on earth has encountered, are developing increasing resistances to the antibiotics that we use to treat them.
Basic evolutionary theory explains how antibiotic-immune bacteria are more likely to survive and propagate than their vulnerable competition, thus are more likely to become the dominant strain. Over generations, the human overuse of antibiotics has bred extremely tough bacteria that can survive contact with all common antibiotics.
Just last month, a woman in Pennsylvania was confirmed to have a strain of resistant e-coli which is immune to Colistin, one of the most powerful (and dangerous) antibiotics. Fortunately, this e-coli strain was not immune to every antibiotic and the woman in question was successfully treated. That said, the mutation that rendered it immune to Colistin could (and likely will) spread to other bacteria (which can swap genes), reducing the effectiveness of one of our last-resort medicines.
During an interview about this situation, CDC director Tom Frieden delivered this terrifying statement:
“It basically shows us that the end of the road isn’t very far away for antibiotics. That we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics.”
Last month’s e-coli scare is in no way a unique situation. Super-bugs like MRSA (Methicillin-Resistant Staphylococcus Aureus) are appearing at an increasing rate and there is sign of this progression stopping. I personally had to deal with a relatively minor resistant staph infection a few years back (If you go to a MMA gym, make sure they clean their mats properly) and can say from experience that it is not something you want to have to deal with—also, save yourself the nightmares and don’t google pictures of MRSA.
For all intents and purposes, anybody infected with a mult-resistant infection is living in the dark ages for all the good our antibiotics will do—their body will fight off the disease naturally or they will die. We can help mitigate the lethality of certain bacterial infections through non-antibiotic means (e.g. hydration), but a pan-immune bacteria is something that modern medicine has no answer to. If antibiotics are no longer effective on a variety of bacterial infections, the results are extremely hazardous to human life. For example, resistant tuberculosis (MDR-TB and XMDR-TB) kills hundreds of thousands of people a year, largely contained to the developing world and the poorest of the poor in developed nations.
This problem requires global policy action—no one nation has the power to fix this alone. We must stop overusing antibiotics, both on humans and our food supply, and limit the use of antibiotics to cases where they are necessary. This will require some people with minor bacterial infections to deal with a stuffy nose for a couple days longer, but it will also slow the growth of resistance in bacterial populations long enough for use to develop new treatments that will work on super-bugs. Once these drugs are developed, it is absolutely vital to avoid overusing them so that bacteria do not rapidly gain a resistance to them.
Here is a link to the World Health Organization’s commentary on the reforms which are needed to mitigate this problem.
Good points Josh. We often forget that as human beings we are hosts to billions of microbes. Recent studies have found that only about 10% of the 100 trillion cells in the human body are “human” cells. 90% are bacteria, viruses and other microbes, I like your point that the process of evolution works at the cellular level just as it does at the organism and species levels. As we develop new ways of destroying carriers of potential problems, the process of natural selection insures that we can never destroy all potential problems.
Personally I think one of the problems may be the decline in breastfeeding over the last 50 years. Not only depriving the infant of the best source of nutrition, but also exposure to the mother’s bacteria, helping the infant develop immunity. Breastfeeding has only recently begun to improve in third world countries. A healthy human body can fight off many deleterious microbes without medication.