Drug-resistant “superbugs” are spreading — but your hospital doesn’t have to tell you
Originally published on Vox
As doctors and farmers have indiscriminately doled out antimicrobial drugs (such as antibiotics and antifungals), harmful bacteria and fungi that can outsmart these drugs have proliferated. These superbugs threaten modern medicine, the safety of our food system — and us. Experts warn that as early as 2050, the death toll from drug-resistant infections will rise to 10 million.
Yet many superbug outbreaks largely remain hidden from public view.
In a breathtaking Saturday feature in the New York Times, reporters Matt Richtel and Andrew Jacobs shined a light on one such hidden outbreak: the spread of a drug-resistant fungus, Candida auris, around the world.
This pathogen, which typically sickens people with weakened immune systems, causing fever and chills, is “so invasive” hospitals have had to bring in special equipment to eradicate it, even removing ceiling and floor tiles. And they also document the stunning lack of transparency around reporting outbreaks:
With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.
This means, amazingly, that US states and the federal government have no public system for tracking and naming current outbreaks. It also means patients and their family members have no way of knowing whether they’re potentially being exposed to superbugs at a hospital they’re going to.
So far, we have done terrifyingly little to curb the drug-resistance crisis
Around the world, we are already seeing a number of different bugs — gonorrhea, CREs, strains of tuberculosis to name a few — that no longer respond to any of the drugs we have available.
Experts have warned that superbugs are likely to become more common in the near future. And without antimicrobials that work, common medical procedures like hip operations, C-sections, or chemotherapy will become more dangerous, and some medical interventions — organ transplants, chemotherapy — would be impossible to survive.
It’s not just medicine: The modern agricultural practices that give us our abundant food supply also depend on these drugs.
So far, we have done terrifyingly little to curb the resistance crisis at the global level, and the problem has been deemed “a classic ‘tragedy of the commons’” on par with climate change.
In low- and middle-income countries, like India, the major driver of infections — and the need for antimicrobials — is still poor sanitation. Many people live in areas that have been contaminated by human and animal waste, which is why ensuring clean water and sanitation for all are key to preventing the need for antimicrobials. On the flip side, uncontrolled antibiotic use or the lack of access to the drugs when people need them are also drivers of the superbug problem.
What would public notification about superbug outbreaks look like?
Some health officials told the Times that it’s exceedingly difficult to inform the public about ongoing superbug outbreaks, and that they don’t want to unduly scare patients who then can’t do anything about their exposure. Meanwhile, others pointed out the public wouldn’t tolerate secrecy around food-borne illness outbreaks, which raises the question of why superbug outbreaks should be any different.
Either way, being transparent isn’t as simple as it may seem, Jason Burnham, an infectious disease specialist at Washington University School of Medicine in St. Louis, told Vox. “First, when to report is challenging. Should a single case mandate public reporting? At one case, it’s possible that no other patients would be affected. So do you wait for two? Or three? If you report too soon and it turns out not to be an outbreak, then the public gets scared for nothing.”
Notifying the public could even be counterproductive, Burnham continued. “If people are too scared to go to the hospital, they may delay their care, becoming sicker and sicker until their situation is an emergency.” When health problems become emergencies, people are more likely to be hospitalized and more likely to die, he added.
At the very least, Burnham thinks patients have a right to know about the health risks they’re being exposed to. “We just have to be cognizant of who to tell what, when,” said Burnham, “in order to avoid undue panic while simultaneously protecting patients.”
With the spread of dangerous pathogens, like Candida auris, it’s about time we start thinking seriously about what such a system could look like, and whether the potential risks of public reporting (scaring patients, delaying care) might outweigh the benefits (increased accountability, transparency, and awareness of the problem).