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Superbugs Could Usher in a Frightening, Post-Antibiotic World
If new kinds of drugs aren’t developed soon superbugs or antibiotic resistant bacteria could erase all the gains modern medicine has made. Even simple infections would become life-threatening. Fortunately, government plans are tackling the issue and some scientists have already found a few things that can take superbugs out.
A 49-year-old Pennsylvania woman was recently diagnosed with a rare form of E.coli, one that can be killed by only one antibiotic and soon perhaps by none of them, according to the Department of Defense. This is what public health officials have feared, a so-called superbug, or a bacteria which could reasonably mutate beyond all current antibiotics, including colistin which is considered a last resort. The military clinic in Pennsylvania who treated the woman sent samples to Walter Reed Medical Center. Military researchers there confirmed the superbug.
Before the advent of antibiotics, a common infection could be life-threatening, and many children lost their lives to strep throat. That time could be upon us once again, at least where industrialized nations are concerned. 700,000 currently die from antimicrobial resistance worldwide each year.
CDC Director Dr. Tom Frieden made the grim announcement regarding the Pennsylvania woman at the National Press Club in Washington, D.C. “It basically shows us that the end of the road isn’t very far away for antibiotics…” Frieden told the Washington Post later on. The woman said she has not traveled outside of the U.S. within the last five months. Currently, no one knows how she acquired the superbug. Previous infections have been reported outside the U.S., which have stoked fears of a global epidemic. So how big of a threat are superbugs? Are they manageable? And how are governments and other organizations responding?
The woman is well again. Even so, the CDC reports that each year, a minimum two million in the U.S. are infected with some kind of bacteria most antibiotics cannot cure. 23,000 succumb to their infection. According to the WHO, superbugs are the biggest threat to world health in modern times.
CDC Director Dr. Tom Frieden.
Frieden urged the hastening of drug development by researchers and pharmaceutical companies. The CDC director has warned in the past of the overuse of antibiotics. Bacteria and antibiotics naturally go through an arms race. As bacteria become resistant to certain drugs, newly developed ones must replace them, which the bacteria will too eventually overcome.
Antibiotics are also widely used in the food supply, given to livestock and poultry en masse to prevent infection. On another front, a trend of patients not finishing a full course of antibiotics, but stopping when they feel better, has led to some bacteria to survive, mutate, and develop resistance.
The biggest fear is that these superbugs will transfer their immunity to other bacteria who are already resistant to other forms of antibiotics, as bacteria are able to share loose genetic material with one another. According the CDC’s Dr. Beth Bell, this E. coli case is a wake-up call, signaling that they will soon acquire the last component needed to resist all forms of antibiotics.
Antibiotic resistance test. Here bacteria are streaked on petri dishes containing white antibiotic filled discs. Those who have grown indicate resistance. The bacteria on the right are susceptible to only three of seven antibiotics total.
Unfortunately China’s pork and poultry industries use colistin as their go-to antibiotic. It was there that a colistin-resistant gene was first discovered back in November. It has now been identified in Europe, Canada, Africa, and South America. The most dangerous superbugs are those resistant to a class of drugs called carbapenems. Carbapenem-resistant bacteria (CREs) have been identified in 44 states and today cause 600 deaths per year, according to the CDC. Dr. Frieden warned of a “post-antibiotic world,” which could affect everything from pneumonia to cancer treatment. Minor infections could become life-threatening, and minor operations could turn deadly.
Luckily, for the Pennsylvania woman, though the bacteria culture from her infection was found to resist colistin and other antibiotics, it was receptive to carbapenems. It is still a mystery how the woman came into contact with the bacteria. Experts say that in some cases, up to 50% of those infected with superbugs may die from them. Antibiotics have been one of the greatest advancements in medical science in all of human history. Yet, researchers have been heralding their shortfall in the face of superbugs for years now, some even for decades.
So what is being done? The Obama administration has unveiled a national plan to tackle such bacteria, which includes incentives for drug companies to develop new medications, a new diagnostic tool, stricter controls on the use of antibiotics, and more. Few new antibiotics have been developed in recent decades since pharmaceutical companies find they offer insufficient returns, another aspect that has made us vulnerable to superbugs. The diagnostic being developed would allow physicians to quickly determine whether a patient has a viral or bacterial infection, and so if antibiotics are warranted.
Collaboration with the WHO and the ministries of health of many other nations, is in the works too. The Obama administration plans to invest $1.2 billion in the effort. Some experts in infectious diseases say it doesn’t go far enough. The plan calls for more infection controls in hospitals, Medicare and Medicaid reporting prescription patterns, and the CDC screening new arrivals from countries known to have resistant strains of tuberculosis. Some activists are calling for antibiotic free meat in the food supply. According to one consumer protection activist group, 70% of the antibiotics in the U.S. are given to livestock and poultry. But the government’s plan does not address this issue.
Antibiotics given ubiquitously at factory farms have been blamed for the rise of superbugs.
Internationally, British Prime Minister David Cameron is promoting a $1.2 billion plan to confront the superbug menace. Cameron will outline it before the next G7 summit. This is a piece of a larger $16 billion program to be rolled out over ten years. The plan, created by former Goldman Sachs chief economist Lord Jim O’Neil, states that if nothing is done, superbugs could take the lives of 10 million per year by 2050.
A couple of solutions are being shopped around. According to two microbiologists at the University of British Columbia, a certain kind of clay found in Kisameet Bay north of Vancouver, used for healing by the Heiltsuk First Nation for centuries, has been shown to kill drug-resistant bacteria. The scientists claim it may be used as a binding agent when coupled with certain antibiotics. An Arizona State University study found similar properties in a certain clay found in Oregon, due to the minerals within it. Meanwhile, Yale University researchers have discovered a bacteria eating virus in a pond in East Lyme, Conn. Known as OMKO1, researchers say this virus could be used to weaken a superbug, while antibiotics are given to deal the final blow.
To learn how antibiotics in livestock and poultry raising contributes to superbug developed click here:
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
With just a few strategical tweaks, the Nazis could have won one of World War II's most decisive battles.
- The Battle of Britain is widely recognized as one of the most significant battles that occurred during World War II. It marked the first major victory of the Allied forces and shifted the tide of the war.
- Historians, however, have long debated the deciding factor in the British victory and German defeat.
- A new mathematical model took into account numerous alternative tactics that the German's could have made and found that just two tweaks stood between them and victory over Britain.
Two strategic blunders<p>Now, historians and mathematicians from York St. John University have collaborated to produce <a href="http://www-users.york.ac.uk/~nm15/bootstrapBoB%20AAMS.docx" target="_blank">a statistical model (docx download)</a> capable of calculating what the likely outcomes of the Battle of Britain would have been had the circumstances been different. </p><p>Would the German war effort have fared better had they not bombed Britain at all? What if Hitler had begun his bombing campaign earlier, even by just a few weeks? What if they had focused their targets on RAF airfields for the entire course of the battle? Using a statistical technique called weighted bootstrapping, the researchers studied these and other alternatives.</p><p>"The weighted bootstrap technique allowed us to model alternative campaigns in which the Luftwaffe prolongs or contracts the different phases of the battle and varies its targets," said co-author Dr. Jaime Wood in a <a href="https://www.york.ac.uk/news-and-events/news/2020/research/mathematicians-battle-britain-what-if-scenarios/" target="_blank">statement</a>. Based on the different strategic decisions that the German forces could have made, the researchers' model enabled them to predict the likelihood that the events of a given day of fighting would or would not occur.</p><p>"The Luftwaffe would only have been able to make the necessary bases in France available to launch an air attack on Britain in June at the earliest, so our alternative campaign brings forward the air campaign by three weeks," continued Wood. "We tested the impact of this and the other counterfactuals by varying the probabilities with which we choose individual days."</p><p>Ultimately, two strategic tweaks shifted the odds significantly towards the Germans' favor. Had the German forces started their campaign earlier in the year and had they consistently targeted RAF airfields, an Allied victory would have been extremely unlikely.</p><p>Say the odds of a British victory in the real-world Battle of Britain stood at 50-50 (there's no real way of knowing what the actual odds are, so we'll just have to select an arbitrary figure). If this were the case, changing the start date of the campaign and focusing only on airfields would have reduced British chances at victory to just 10 percent. Even if a British victory stood at 98 percent, these changes would have cut them down to just 34 percent.</p>
A tool for understanding history<p>This technique, said co-author Niall Mackay, "demonstrates just how finely-balanced the outcomes of some of the biggest moments of history were. Even when we use the actual days' events of the battle, make a small change of timing or emphasis to the arrangement of those days and things might have turned out very differently."</p><p>The researchers also claimed that their technique could be applied to other uncertain historical events. "Weighted bootstrapping can provide a natural and intuitive tool for historians to investigate unrealized possibilities, informing historical controversies and debates," said Mackay.</p><p>Using this technique, researchers can evaluate other what-ifs and gain insight into how differently influential events could have turned out if only the slightest things had changed. For now, at least, we can all be thankful that Hitler underestimated Britain's grit.</p>
The next era in American history can look entirely different. It's up to us to choose.
- The timeline of America post-WWII can be divided into two eras, according to author and law professor Ganesh Sitaraman: the liberal era which ran through the 1970s, and the current neoliberal era which began in the early 1980s. The latter promised a "more free society," but what we got instead was more inequality, less opportunity, and greater market consolidation.
- "We've lived through a neoliberal era for the last 40 years, and that era is coming to an end," Sitaraman says, adding that the ideas and policies that defined the period are being challenged on various levels.
- What comes next depends on if we take a proactive and democratic approach to shaping the economy, or if we simply react to and "deal with" market outcomes.
A new MIT report proposes how humans should prepare for the age of automation and artificial intelligence.
- A new report by MIT experts proposes what humans should do to prepare for the age of automation.
- The rise of intelligent machines is coming but it's important to resolve human issues first.
- Improving economic inequality, skills training, and investment in innovation are necessary steps.