04.15.19 | Drug-Resistant Superbugs

There are times when nature, even if temporarily, mocks our attempt to control her. Take public health. The ebola outbreak provided a glimpse of the skull beneath the skin of post-industrial civilization. That was preceded by the AIDS epidemic. Before that, poliomyelitis infected 600,000 Americans, ten percent fatally. The epidemic of Spanish influenza in 1918-19 killed more than half a million in this country alone. And so on, back to fourteenth century Europe where "Ring around a rosie!" described the telltale symptom of the Black Death which wiped out half of that entire continent.

Yet a plague or a full scale epidemic is more than a numbers game. It's a mindset, one of extreme paranoia in that, unlike a siege mentality where the enemy awaits outside the walls, the enemy here resides intimately within. Consider this splendid description of the onset of a plague mentality written by essayist Lance Morrow several decades ago: 

"An epidemic of yellow fever struck Philadelphia in August 1793. Eyes glazed, flesh yellowed, minds went delirious. People died, not individually, here and there, but in clusters, in alarming patterns. A plague mentality set in. Friends recoiled from one another. If they met by chance, they did not shake hands but nodded distantly and hurried on. The very air felt diseased. People dodged to the windward of those they passed. They sealed themselves in their houses. The deaths went on, great ugly scythings. Many adopted a policy of savage self-preservation, all sentiment heaved overboard like ballast. Husbands deserted stricken wives, parents abandoned children. The corpses of even the wealthy were carted off unattended, to be shoveled under without ceremony or prayer. One-tenth of the population died before cold weather came in the fall and killed the mosquitoes."

No one knows exactly where the latest so-called superbug -- a fungus called Candida auris -- is going but this drug-resistant germ is now considered, per our feature NYT article, the world's most intractable health threat (see "A Mysterious Infection, Spanning the Globe in a Climate of Secrecy").

What makes C. auris so tenacious is its imperviousness to major anti-fungal medications.

Why this is so reflects an admixture of the hubris and ignorance responsible for the rise of other drug-resistant infections. The term ignorance is not meant in the sense of unknown facts as would apply to (say) the role of the mosquito in 1793 Philadelphia. 

No, per the article, the underlying causation is basically understood and the ignorance arises from our collective failure to respond in kind i.e. our continued "gluttonous overuse" of antimicrobial drugs in hospitals, clinics and farming. It's one thing to use antibiotics and antifungals to combat infections in people; it's quite another to casually apply antibiotics for disease prevention in farm animals or fungicides to prevent plants from rotting. These bugs have ambition and that which does not kill them makes them stronger.

But, even more unconscionable, is the wall of silence surrounding resistant infections. This "cloak of secrecy" regarding outbreaks -- per agreement between the states and the  C.D.C ! --  is justified on the grounds of avoiding public alarm and the fear of an institutions being seen as an infection hub. Whatever happened to the patient's right to make an informed decision?

And we thought hospital billing was the ultimate exercise in non-transparency.  

Ian ReidComment