Malaria is one of the world’s oldest and deadliest diseases. Although it is most prevalent in Africa, everyone is susceptible. Around fifteen hundred cases develop yearly here in the United States. Malaria is a global problem, systematically wreaking havoc on countries’ health cares and economies.

But there’s good news. Just this week, California-based scientists made a huge breakthrough in attempting to eradicate malaria for good. Scientists concluded that genetically modified mosquitoes released into the wild might be the answer. The science gets a little tricky, but the inevitable goal is that the global mosquito population in its entirety will no longer be able to pass on malaria to humans. The method is proactive versus reactive, and hits the source instead of medicating already infected people.

Recent Events

On November 4, researchers reported a medical breakthrough. Scientists had mutated and bred a specific strain of mosquito in order to eradicate malaria globally, according to a report from the Proceedings of the National Academy of Sciences.

Biologists used a gene-editing technology called CRIPR-Cas9. The technology allows scientists to remove segments of DNA from an organism and replace it with new ones. In this specific case, the California-based scientists added a set of malaria-resistant genes that could rapidly eradicate the disease from the mosquito population. The gene causes the mosquito to produce antibodies that kill the malaria parasite, making the mosquito unable to transmit the disease. The scientists used a genetic modification technique called gene drive, which ensures that the malaria-killing gene is effectively passed on to future generations.

So how does the gene drive work? Normally, an offspring receives half its traits from each parent, but the researchers found a way around that. With gene drive, the mutant mosquito passes its genes to both of the offspring’s chromosomes. In other words, one mutated mosquito parent will supply all the inherited traits to its offspring when it mates with another wild mosquito, ensuring that the malaria-resistant gene is passed on. In studies, the mutated mosquitoes with gene drive passed on their malaria resistance to 99.5 percent of their offspring. This kind of results can have enormous potential to spread rapidly in the wild. According to the New York Times, spreading genes at this rate could nearly eradicate malaria from mosquitos in as few as 10 generations. This means that a disease that causes about 600,000 deaths each year could be marginalized in just one season.

Anthony A. James from the University of California Irvine Campus led the development of the malaria-resistant genes while Valentino M. Gantz and Ethan Bier of the San Diego Campus led the research on gene drive. But despite their recent success, the scientists all agree that going forward they must tread carefully when implementing their research. Dr. James, Dr. Gantz, and Dr. Beir plan to further refine the mosquito’s genetics in isolated trials before conducting experiments out in the field. They hope that a malaria-endemic country will eventually invite then to conduct trials in the area.

Although the researchers don’t yet have evidence, there could be adverse health effects to releasing the genetically modified mosquitos into the wild. It remains to be seen what would actually happen when a genetically modified mosquitos bit a human or how the population of mosquitoes will be affected in a much larger trial. The most significant fear is that the created mutations would change in the wild. Natural selection could also favor other genes and the mutated the genes may not be passed down through generations. If biologists needed to keep going back and re-modifying the genes it would become uneconomical and possibly unsustainable.

In the mean time, the research remains under ethical review by a committee elected by the National Academy of Sciences.

Overview of Malaria

How is Malaria Transmitted?

Interestingly, only the female mosquitos of the genus group Anopheles can transmit malaria to humans–it’s actually quite a small group. Altogether, there are 3,500 species of mosquitos categorized into 41 different genera. In the Anopheles genus, there are around 430 species. And of these, only 30-40 species have the ability to transmit malaria.

These specific mosquitoes may transmit the disease if they carry the malaria parasite. The transfer happens when a parasite-carrying mosquito consumes the blood of a human. The maturation of the parasite inside of a mosquito host involves several factors, including temperature, humidity, and the life duration of the host. For example, the parasite generally must reside in the mosquito for 10 to 21 days–this is called the extrinsic incubation period. If the mosquito dies before the culmination of this period, the parasite cannot be transferred. The parasite does not negatively affect the mosquito’s health as it would a human.

Mosquitoes either prefer to feed on humans or animals, designated anthropophilic and zoophilic, respectively. Most Anopheles tend to be neither 100 percent anthropophilic nor zoophilic, meaning that they often don’t have a preference for humans over animals or vice versa. However, two species, An. gambiae and An. funestus, are strongly anthropophilic. This makes them extremely adept as malaria vectors for humans. Since they both reside in Africa, it makes sense that Africa is where we see the most malaria cases in the world.

Sub-Saharan Africa and parts of Oceania are prime locations for the malaria parasite to survive. The climate conditions are optimal–tropical and subtropical locations allow anthropophilic mosquitos to easily reach maturation and breed. For example, the parasite’s growth cycle will stop, preventing transmission, if the temperature is lower than 68 F degrees. High altitudes and deserts will kill the parasite as well. In some endemic areas, transmissions will be more seasonal if the region has a cooler climate.

Symptoms

The malaria parasite is called Plasmodium. Four different species of Plasmodium cause human malaria: P. falciparum, P. malariae, P. ovale and P. vivax. The P. falciparum species causes the most severe symptoms.

Symptoms can occur anywhere from a week to three months after exposure. In very rare cases, symptoms will occur later than three months. Initial symptoms can be relatively mild, including fever, chills, headache, muscular aching, weakness, vomiting, cough, diarrhea, and abdominal pain. These milder symptoms may or may not preface more severe ones, including renal failure, pulmonary edema, generalized convulsions, and circulatory collapse, followed by coma and death. Death can result if P. falciparum is not treated within one week of the beginning of clinical symptoms.

The other three parasites are rarely as life threatening but can still cause extreme distress. P. vivax and P. ovale can reside dormant in the liver for years, and may cause sporadic relapses months, or even years after the first exposure.

A typical malaria attack can last between six and ten hours. At first, a cold stage will bring on cold-like symptoms with shivering. This is followed by a hot stage consisting of fever, headaches, vomiting, and seizures in young children. The attack ends with excessive sweating, followed by the normalization of temperature and tiredness. These attacks will occur every other day or every third day with the P. malariae parasite.

People with weaker immune systems are at a greater risk of infection. These groups usually tend to be young children, pregnant women, people who are immunosuppressed, and elderly travelers. Infected pregnant women are at risk of maternal death, miscarriage, stillbirth, and neonatal death.

Treatment

Treatment for malaria is an ongoing battle. Scientists create a new drug, only for the parasite to alter itself and become resistant. Scientists go back and modify that drug, only for it to happen again. For example, chloroquine (common antimalarial drug) is, for all intents and purposes, useless in many endemic regions due to resistance. Other common antimalarial drugs include Quinine sulfate, Hydroxychloroquine, Mefloquine, and a combination of atovaquone and proguanil.

The recommended drug and the length of use both depend on the specific malaria parasite, symptoms, age, and whether the patient is pregnant.

Worldwide and the United States

Each year, there are 300 to 500 million clinical cases of malaria reported worldwide; 90 percent of these cases originate in Africa and approximately one million cases result in death. There are over 90 endemic countries globally, putting 40 percent of the world population at risk of malaria infection.

On average, a child dies from malaria in Africa every 30 seconds. The most common age of death is just four years old. Malaria kills 5 percent of African children. This equates to nearly 3,000 deaths each day. An estimated 23 percent of African infants are born with the malaria parasite. Many families simply cannot afford to be sick. A single malaria attack can cost approximately 10 to 20 working days in India and Africa.

Although most cases occur in Africa, the West is not immune. The Centers for Disease Control (CDC) reports 1,600 to 2,000 cases in the United States each year. But CDC believes only half of malaria cases in the United States are actually reported.

Americans that travel to endemic countries are also at high risk of contracting the disease. Biting an infected person who has previously traveled to an endemic country can infect a local mosquito, which can then continue to transmit the virus. In the past five years, there have even been cases of local transmissions in California, Texas, Michigan, and the greater New York City area.

Conclusion

This is exciting news! But this research still faces several challenges and will remain controversial. We do not yet know how introducing genetically modified mosquitos will affect the current population and many people are wary of manipulating genetics to this extent. Introducing anything into the wild could have unforeseen consequences to the environment and fragile ecosystems. But if this research continues its success, these scientists may have found the cure to one of the deadliest diseases in the world.

Resources

Primary

PNAS: Highly Efficient Cas9-Mediated Gene Drive for Population Modification of the Malaria Vector Mosquito Anopheles stephensi

WHO: Malaria

CDC: Anopheles Mosquitoes

CDC: About Malaria

CDC: Where Malaria Occurs

Additional

The National Academies of Science: Project Information

The New York Times: Engineering Mosquitoes’ Genes to Resist Malaria

Mayo Clinic: Malaria

The Washington Post: Scientists create a mutant mosquito that could help eradicate malaria

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

The post Malaria: Did Scientists Finally Find a Solution? appeared first on Law Street.

Treating people when they’re already sick is like beating back invaders who have already breached your defenses. In either scenario, prevention through good defense saves money, time, and lives. But when it comes to boosting our nation’s wellness defenses through public health spending, America falls short.

When it comes to health, concerns abound that we’re wasting money, time, and lives by spending too much on treatment and recovery and not enough on prevention. Public health interventions like smoking cessation programs and disaster preparedness initiatives save lives. The more we learn about the power of these interventions, the more experts call to keep them afloat with better funding. Spending a few dollars to get a person to quit smoking makes more sense than spending thousands of dollars to try to treat their lung cancer several years down the road. Preparing for a natural disaster beforehand is preferable to picking up the pieces afterwards.

So what is public health? It’s something that aims to keep you alive as long as possible. From preventing diseases to preparing for disasters, public health programs keep a wary eye out for threats and then help populations avoid or mitigate them. For example, if data shows a high diabetes risk for a certain population, public health programs will target that population with preventative messages about diet and exercise. Public health departments might also help local school systems prepare for potential natural disasters, like Florida does with its Children’s Disaster Preparedness Program.

Read on to learn about public health spending in the United States, and where we might need to invest some more time and money.

Where’s the money?

In April, the Trust for America’s Health (TFAH) released its report Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts. The report highlights many ways America falls short on public health spending. They say America’s public health system “has been chronically underfunded for decades.” In Why We Don’t Spend Enough on Public Health, author David Hemenway says this is because the benefits of public health spending today aren’t seen until potentially far in the future. Governments and politicians want to see the benefits of their investments in the present day, so they favor spending on medical treatment and other immediately fulfilling initiatives.

Here are some of the key findings:

Public Health Spending is Actually Shrinking

According to TFAH, when you adjust for inflation, public health spending in 2013 has sunk 10 percent from 2009. Many simply don’t see the benefits of spending on public health programs that yield intangible, future benefits when money could be spent on initiatives that produce immediate results like transportation or construction projects.

All States are Not Created Equal

States vary widely in what they spend on public health as funding is determined by the set-up of each state’s unique public health department. Indiana came in at a low of $15.14 per person, while Alaska spends $50.09 per person. This could be why health levels also vary widely from state to state.

Communities Aren’t Prepared for Public Health Emergencies

Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding helps communities respond to natural disasters, epidemics, and outbreaks. It was backed by $919 million in 2005. In 2013, it was supported by just $643 million.

Hospitals Aren’t Prepared for Public Health Emergencies

The Hospital Preparedness Program (HPP) gives healthcare facilities funding to beef up their preparedness measures. Funding for this program has been slashed by almost half, dropping from $515 million in 2004 to $255 million in 2015.

It’s estimated that 2/3 of all deaths in the United States result from chronic diseases typically linked to behaviors like diet or substance abuse. These diseases could be prevented by well funded intervention programs to decrease the behaviors that eventually lead to chronic diseases. Public health spending could save Americans millions in treatments for preventable diseases. Likewise public health under-spending could be costing us more than we’re saving.

In this video, the American Public Health Association outlines financial returns on every dollar of public health spending for different activities:

The above video states that every dollar spent on fluoride in our water supply could save $40 in dental care costs and that a dollar spent on nutrition education could save $10 in health care costs. The main point? Public health programs make for a smart investment.

The Consequences of Meagre Public Health Budgets

So, America spends too much money on treatment and not enough on prevention. The results aren’t pretty. In Integrating Public Health and Personal Care in a Reformed US Health Care System, authors Chernichovsky and Leibowitz write,

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access.

The State of U.S. Health, 1990-2010 report put the U.S. up against other members of the Organization for Economic Cooperation and Development (O.E.C.D.), a program that advocates to improve economic and social outcomes. Since 1990, the U.S. has fallen in rankings for both life expectancy and healthy life expectancy. In 1990, the U.S. stood at the number 20 spot for life expectancy.  By 2010, it was down to number 27.  In 1990, the U.S. also enjoyed the number 14 spot for healthy life expectancy. The year 2010 found us in the 26th spot.

Under-spending in public health doesn’t just lead to generally poor health, it also impedes our ability to respond to emergencies. Assistant professor at the Harvard Business School, Gautam Mukunda, referred to Ebola as a “wake-up call” for the state of U.S. health preparedness. In Ebola as a Wake-Up Call he wrote,

Ebola may serve as a badly needed wake-up call about something the public health and biosecurity community has been banging the drum about for years: the U.S. has massively underinvested in public health.

Mukunda says the Ebola situation highlighted the measly number of extreme disease cases our U.S. hospitals can handle. Hospitals have decreased their capacity for extreme cases to increase their efficiency, only to lose the ability to treat patients when rare diseases strike. Although the need for extreme treatments arises only occasionally, hospitals should always be prepared for them. But with limited funding, it’s hard to be prepared for the unlikely “worst case scenarios.”

How does the future look?

The good news: The Senate finally passed a joint budget resolution after a five year absence of agreement.

The bad news:  Their budget slahes non-defense government spending by about $500 billion over the next 10 years.

The budget cuts spell trouble for discretionary educational public health programs. From disease prevention to health care worker training, programs to promote good health may suffer across the board.

In an APHA press release opposing the measure, Georges Benjamin, executive director of APHA, says,

Simply put, our federal, state and local public health agencies will not be able to do their jobs to protect the health of the American people if these drastic cuts are enacted.

The budget would also annihilate the Affordable Care Act, including the Prevention and Public Health Fund, a program that focused on moving America towards a preventative health model by funding prevention communications, research, surveillance, immunizations, tobacco cessation programs, health-care training, and more.

The resolution isn’t yet a binding law, but indicates a set of collective and alarming priorities that steer America farther from the path of an integrated, preventative public health system. The Appropriations Committee still has to draft the spending bills, so there’s room for opposition. President Obama for one said he’ll veto bills following the restrictive budget.

Evidence to Inform the Future

According to the article, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths, published in Health Affairs, mortality rates fall anywhere from 1.1 – 6.9 percent for every 10 percent uptick in public health spend. The researchers made observations over thirteen years and found that the localities with the highest upsurges in public health spending had the most significant reductions in preventable deaths. The relationship held true in multiple causes of death and across different demographics. While the study is only a correlation, the linkage presents compelling evidence for the death-decreasing value of public health spending. The researchers believe a lack of substantial evidence for the ROI of public health campaigns may have hindered spending in the past, and their report takes one step towards getting that evidence.

The Trust for America’s Health (TFAH) advocates for an America with increased core public health spending. They also recommend ways to spend the money correctly. They call for a solid public health foundation for all populations in all states so everyone can be healthy no matter where they live. After that’s established, they advise investing in strong, evidence-backed public health programs and efforts to fortify emergency preparedness. Finally, they believe public health expenditures should be completely transparent and accessible to the American public.

Experts at a recent forum of National Public Health Week looked past mere spending to consider the future of public health and consider novel ways of approaching health to make America a healthier nation. The speakers want to stretch health thinking beyond the doctor’s office to focus on environmental and lifestyle factors that promote well-being like employment, housing, education, and even racism.

These experts dream of an improved, 360 degree view of public health. But sadly, their dreams need funding to become reality. If we continue on this path, it will be very hard to become a more healthful nation.

Resources

Primary 

U.S. Department of Health and Human Services: Prevention and Public Health Fund

Additional

American Journal of Public Health: Integrating Public Health and Personal Care in a Reformed US Health Care System

The New Yorker: Why America is Losing the Health Race

Harvard Business School: Ebola as a Wake Up Call

Public Health Newswire: NPHW Forum: Creating Healthiest Nation Requires Addressing Social Determinants of Health

The Trust for America’s Health: Investing in America’s Health

The Washington Post: Senate Passes Budget Even as Impasse on Spending Continues

Public Health Newswire: House Adopts ‘Devastating’ Budget Agreement

Public Health Newswire: Senate Passes Budget that Batters Public Health

American Public Health Association: APHA Calls Budget Agreement Devastating

The Trust for America’s Health: Investing in America’s Health: A State-by-State Look at Public Health Funding & Key Health Facts

Health Affairs: Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths

The National Priorities Project: Military Spending in the United States

New England Journal of Medicine: Why We Don’t Spend Enough on Public Health

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Are We Spending Enough on Public Health? appeared first on Law Street.

Like anything with a life, survival is a germ’s end game. When it faces a challenge, it will adapt. Some germs adapt alarmingly well to the challenge of modern medicine. They’re called superbugs because they’ve evolved to survive the challenges we throw at them, including antibiotics.

Do we have a counterattack against these superbugs? Let’s find out.

Superbugs in the News

Superbugs have been making headlines lately. Here’s what’s happening in case you missed it.

CRE Outbreaks

CRE stands for carbapenem-resistant Enterobacteriaceae, a type of bacteria resistant to carbapenem antibiotics. CRE resists nearly all antibiotics and can cause death in about 50 percent of infected patients because most people who become infected are already sick and have weakened immunity. Most recently, CRE killed two people in an outbreak at the Ronald Reagan UCLA Medical Center in Los Angeles and one person in a Charlotte, North Carolina hospital.

A duodenoscope, a device that drains fluids from the pancreatic and biliary ducts, stands out as the main suspect in the UCLA outbreak. Duodenoscopes probe the body, making infection easier for hitchhiking germs, especially superbugs like CRE. The particular duodenoscope implicated in the UCLA outbreak boasts an intricate design that unfortunately makes it difficult to clean properly even through reprocessing, the multi-step sanitation process designed for reusable devices. So this particular model of duodenoscope picked up some potent CRE that withstood reprocessing and infected several patients.

C.difficile Infections on the Rise

C. difficile infections happen when the harmful bacterium Clostridium difficile (C.diff) overpowers the otherwise harmless and helpful bacteria living in the intestines. Antibiotics kill bacteria, including the good kind that help fight off C.diff, so sick people who have taken antibiotics for long periods of time become especially vulnerable to C.diff. Since C.diff resists antibiotics, once good bacteria succumbs, zero defenses stand between it and the multiplication that causes deadly intestinal infections. C.diff preys on the sick and spreads wildly through hospitals. It ranks as one of the three most common infections acquired in hospitals and still cases are growing. Confirmed C. difficile infections doubled from 2000-2009 according the Centers for Disease Control and Prevention.

In Short, Superbugs Threaten Hospitals

As you can see from the cases above, superbugs thrive in hospitals where sick people with weakened immune systems squeeze together in close contact. Our usual sanitation tricks don’t stop them. Even when healthcare workers practice sanitation that could kill the flu virus, these superbugs stick around, hiding out in bathrooms, hospital beds, and on medical equipment. Since superbugs resist antibiotics, once the inevitable infection does occur, it’s extremely hard to fight and could lead to death. For example, CRE kills almost half the people it infects.

Public health officials working on the UCLA outbreak have sprung to action to contain the spread. They’re finding people who might have been exposed to CRE via use of the potentially faulty duodenoscope. They’ve issued warnings about the devices so other hospitals don’t run into similar problems.

But after two deaths in California and one in North Carolina in 2015 so far, many have asked: how can we prevent superbug outbreaks in the first place?

Preventing Superbug Outbreaks

To fight superbugs, experts recommend combating the antibiotic resistance that produced them in the first place, becoming better at monitoring and controlling them, and developing innovative techniques for prevention and control.

Combating Antibiotic Resistance

The CDC’s report Antibiotic Resistance Threats in the United States, 2013, inspired government action that fights the antibiotic resistance that produces threats likes superbugs. Their recommendations include prevention, tracking, changing antibiotic use, and developing new drugs and diagnostics.

In actual practice, the CDC has encouraged hospital antibiotic stewardship programs, which combat overprescribing and incorrect prescribing of antibiotic drugs. The programs push for evidence-based assurance that antibiotics are necessary and effective for the condition in question. For example, in antibiotic “time-outs,” doctors revisit the need for antibiotics after receiving diagnostic lab results. Often antibiotics are prescribed as a precaution while waiting for medical tests, but this practice encourages doctors to reassess the need for the drugs with medical test results in hand. These programs are voluntary, and so far California is the only state that requires antibiotic stewardship programs by law. Experts, including President Obama’s science advisers, are pushing to make stewardship programs a requirement for hospitals and nursing homes that want to receive Medicare payments.

Additionally, President Obama’s FY 2016 budget shoots to double federal spending to fight antibiotic resistance that would help move the National Strategy for Combating Antibiotic Resistant Bacteria along.

Read More: Are We Doing Enough to Prevent Antibiotic Resistance?

Monitoring the Spread of Superbugs

Tracking is crucial to understanding where superbug infections might happen and what efforts might be needed to control them.

One recommended control measure requires all patients admitted to hospitals be screened for CRE. CRE squats in the guts of many people, but only creates problems when they’re weakened by sickness or too many antibiotics. Knowing who carries CRE would help control potential problems before they happen.

In terms of general tracking, there’s no requirement that state health agencies track and monitor antibiotic-resistant bacteria, but luckily, many of them do. According to an Association of State and Territorial Health Officials survey of antibiotic resistance-related state health agency activity, about half of them collect surveillance data about occurring infections. Federal requirements could lead to all states performing valuable surveillance activities.

Implementing Innovative Practices

Superbugs challenge our sanitation practices and antibiotic use. The race is on to develop new techniques to fight them so we can replenish our defenses instead of relying on old practices. Here are a few new interventions considered for fighting superbugs. Warning…don’t read this while eating.

• Fecal transplants: Nope, that’s not a typo. This procedure is exactly what it sounds like. Fecal matter is collected from an ideal donor and placed into the gut of another individual whose population of good bacteria might have been compromised through antibiotic use. In the case of C.diff, a fecal transplant can replace good bacteria that keep infection at bay. It might seem strange, but the procedure has proven 90 percent effective at curing C.diff infections. These unorthodox transplants work better than many other cures.
• Sanitizing robots: A concentrated hydrogen peroxide solution poses a threat to superbugs. It can be toxic to humans, so at Johns Hopkins University Hospital they’ve enlisted impervious robots to help them sanitize hospital rooms. After a human technician seals the room, a bot blasts the air with 35 percent hydrogen peroxide solution that reaches every inch of the room, even cracks and crevices. A second bot dries up the room so no residue remains. This results in a completely pristine hospital room, medical equipment and all.

• New antibiotics and alternative therapies: Superbugs grow accustomed to existing drugs and we haven’t created new ones that shock their systems. This is partly because 99 percent of living species (plants and fungi) that produce promising new antibiotics will not grow in lab conditions. If they can’t grow in a lab, scientists can’t study them to make them into medicine. Recently, scientists tapped into this 99 percent horde of potential antibiotics by tricking the microbes into thinking they were in a natural environment by stuffing dirt in between two membranes. The extracted antibiotic is known as Teixobactin and has proved successful in battling antibiotic resistant MRSA and TB in mice. It hasn’t been tried on humans yet, but the methods scientists used to grow “ungrowable” cultures in laboratory conditions hold promise for the future.

Antibiotics are also overused in agriculture to treat animals raised in conditions that lead to persistent infection. Hyun Lillehoj, an avian immunologist at the Beltsville Agricultural Research Center, has discovered promising new treatments for diseases affecting poultry that would render antibiotics unnecessary. She’s found promise in using food supplements, probiotics, and phytochemicals to enhance a bird’s natural immunity and ward off infection in the first place.

On a sweeter note, Lund University found promise in the lactic acid bacteria hiding in honey bee stomachs. Lactic acid bacteria contains antimicrobial properties and has proven effective in fighting resistant MRSA. Honey processing kills the good bacteria, so store-bought honey has no antibiotic properties. The researchers reintroduced the natural bacteria into honey and used it on horse wounds. All horses were healed when no other antibiotics or steroids had worked.

Legal Challenges of Superbugs

Superbugs involve a liability hotbed because they’re changing the rules. Healthcare professionals adhere to strict rules and protocols proven to prevent the spread of infection. Unfortunately, following those rules doesn’t prevent the spread of infection from superbugs. So when something goes wrong, who is liable? The new proliferation of superbugs presents a legal problem without precedence. Courts will look at whether a hospital has taken reasonable actions to promote safety, unfortunately with a lack of history in the case of antibiotic resistance laws, what actions might be considered reasonable are not yet clear. Upcoming decisions might afford more clarity.

California Congressman Ted W. Lieu requested a hearing from the Committee on Oversight and Government Reform (OGR) to discuss the sterilization issues with duodenoscope that led to the UCLA CRE outbreak. Family members of affected patients are also filing suits against the manufacturer of the duodenoscope that led to their infections, citing grievances like negligence and fraud. Decisions in these cases could influence future arguments.

Are superbugs under control?

As alarming as recent superbug growth might be, so far the situation is under control. However, the outbreak and C.diff growth calls attention to the need to prepare our defenses for the growing threat of superbugs. Antibiotic resistant germs prey on the weak, making hospitals and nursing homes vulnerable targets for devastation.

The government and medical professionals have jumped on the case with their efforts to combat antibiotic resistance, stop the spread of superbugs, and develop new treatments. While antibiotic resistance presents a challenge, consider how antibiotics themselves have been around for less than a hundred years. While their invention was considered a medical miracle, we surely have more miracles up our sleeves to get past this new challenge.

Resources

Primary

CDC: Lethal, Drug-Resistant Bacteria Spreading in U.S. Healthcare Facilities

FDA: Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning

U.S. National Library of Medicine National Institutes of Health: Clostridium Difficile Infection: New Insights Into Management

CDC: Vital Signs: Preventing Clostridium Difficile Infections

California Department of Public Health: The California Antimicrobial Stewardship Program Initiative

CDC: Core Elements of Hospital Antibiotic Stewardship Programs

USDA ARS: Alternatives to Antibiotics in Animal Health

Additional

Network for Public Health Law: Superbug Prevention and Hospital Liability

Kaiser: UCLA Bacteria Outbreak Highlights the Challenges of Curbing Infections

USA Today: Dangerous Infections Now Spreading Outside Hospitals

International Business Times: Drug-Resistant Bacteria A ‘National Security Risk’

US News & World Report: Patients File Lawsuit Against Medical Scope Maker in Hospital Superbug Infection

Washington Post: New Class of Antibiotic Found in Dirt Could Prove Resistant to Resistance

CNN: Superbug Cases Reported in North Carolina; One Dead

Food Safety News: The Search For Alternatives to Antibiotics

Food Safety News: White House Wants to Nearly Double Funding for Antibiotic Resistance Fight

Nature: A New Antibiotic Kills Pathogens Without Detectable Resistance

ASTHO: State Strategies to Address Antimicrobial Resistance

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Superbugs: How to Fight the Evolving Menaces appeared first on Law Street.

Out of context, the words “climate change” don’t sound very scary at all. Here’s the context that makes it scary.

The earth’s climate has been in flux since it burst into existence some 4.5 billion years ago. It’s been hot and cold and everywhere in between. Carbon dioxide in the atmosphere danced between 200-300 parts per million (ppm) during the earth’s long lifespan. But starting in the 1900s, carbon dioxide  pushed past the 300 ppm marker and kept climbing. Today, carbon dioxide levels “weigh in” at about 400 ppm. So what? Well, carbon dioxide and other greenhouse gases trap heat and send average temperatures climbing. Even worse, experts believe human activities like burning fossil fuels and deforestation increased carbon dioxide and caused climate change.

We’ve only been on the earth for a fraction of its lifetime. We’ve evolved based on certain conditions, and now those conditions are changing. In other words, we’re not well adapted for the world we’re creating. The changing climate is a crucible of possible human health complications.

Here’s what the future of health looks like if we don’t combat and adapt to climate change.

 Climate Change: What’s Happening?

Before I run away with how climate change will kill us all (just kidding!), let’s do a quick overview.

Greenhouse gases like carbon dioxide hang out in our atmosphere and absorb heat from the sun. Since these gases don’t occur naturally, the extra heat they absorb causes temperatures to increase above normal levels. As of 1900, carbon dioxide emissions from human activities have billowed up by 40 percent and global temperatures keep creeping upward too.

In our interconnected world, increased temperatures have implications beyond needing more A/C. Increased heat warms our oceans, melts polar and alpine ice, and drives up the sea level, which in turn facilitates stronger and more devastating storms.

Why is climate change bad for our health?

Ripples from climate change impact things directly related to your health, like the water and food supply. The World Health Organization predicts that climate change will cause 250,000 additional deaths a year between 2030 and 2050 because of heat stress, malnutrition, malaria, and diarrhoeal disease. Areas with fewer resources to adapt will suffer the most.

Here are some startling health scenarios of the future, and how climate change might cause them.

Diseases Will Become More Virulent

Climate change will make it easier for existing diseases to infect more people by altering their geographic range and lengthening the infection season. For example, ticks carrying Lyme Disease will cover more ground as more regions warm to temperatures where they can survive. Mosquitoes, which carry many diseases like Malaria and Dengue, will also flourish in warmer temperatures. High temperatures increase their reproduction rate, grow their breeding season, and enable them to bite more people. In general, all bacteria multiply faster in warmer temperatures, so many pathogens will find our warming climate suitable for proliferation.

Climate change might also encourage emerging and shifting diseases. Experts at the University of Nebraska-Lincoln say climate change makes it easier for diseases to switch to new hosts. Many assume that the co-evolution of pathogens and specific hosts will make it harder for pathogens to shift and infect a new host with different biological makeup. Alarming evidence has shown that pathogens can shift to new hosts rather quickly when necessary. The researchers offer Costa Rica as an example, where humans decimated the population of capuchin and spider monkeys. A parasite once exclusive to these monkeys was unphased and latched on to howler monkeys, a different genus of monkey. If pathogens need to make rapid shifts, humans might find themselves facing several for which they have no immunity. Climate change threatens to uproot habitats and living patterns, bringing humans, animals, and insects into closer contact with each other–and their unfamiliar pathogens.

More Will Die From Extreme Heat

Heat stroke and heat-associated dehydration are the most common causes of weather-related deaths. People with existing cardiovascular issues are especially vulnerable to extreme heat. Furthermore, heat complications have a cumulative effect; your vulnerability to heat stroke increases after one episode. Cities have been heating up at a higher rate than rural areas in recent years. This leaves some of the world’s most populated areas in danger.

Basic Hygiene Won’t Be Guaranteed

As rainfall becomes less predictable, it will compromise our safe water supply. With less safe water, it won’t be nearly as easy to do simple things that prevent disease, like washing hands. People take hand-washing for granted, but it reduces risk of diarrhoeal disease by 20 percent, which actually kills 760,000 children five and under annually.

Too much water, brought from the climate change risks of severe flooding, also wreaks havoc on sanitation. Floods contaminate freshwater, spread waterborne disease, and create ideal living conditions for mosquitoes–one of the most prolific disease carriers.

Breathing Won’t Be as Easy

Warmer temperatures bring more ground-level ozone, a miasma of pollutants like carbon dioxide and nitrous oxide. Ground-level ozone is also called smog, a term you’re probably more familiar with. It’s been known to damage lung tissue and aggravate respiratory systems. Increased smog will make breathing an excruciating task for people with existing lung diseases and Asthma. It might even encourage the development of Asthma in otherwise healthy people.

People with allergies should also be very afraid of climate change. The spring allergy season has already grown in the United States and it threatens to continue expansion. Ragweed allergies? Tests show that more carbon dioxide and higher temperatures increases the yield of ragweed pollen.

More People Will Go Hungry

Climbing temperatures, patchy rainfall, droughts, and floods will devastate staple crop yields in the world’s poorest regions. Malnutrition and undernutrition will burgeon as a result. By as early as 2020, crop yields in some African countries could be halved.

Increasingly severe weather already destroys crops. Pollinators disappear while pathogens and pests flourish to chomp through human crops. For example, soybean rust, a fungal infection caused by the pathogen P. pachyrhizi, spreads easily in warm, moist environments. Soybean rust has been a scourge in Asia and Africa for years and was introduced to the United States by a hurricane. Winds carry the spores for miles, leaving behind crop devastation. Similar diseases will most likely plague crops in new climates.

911 Might Not Be Working

Scientists believe climate change will lead to much stronger storms. The World Health Organization says that natural disasters reported globally have tripled since 1960, resulting in over 60,000 deaths.

Strong storms and natural disasters destroy medical facilities, cut the electricity that powers medical equipment, interferes with emergency communications tools like 911, and hinders transportation. Many injuries will happen in times when disaster strikes, even though our responsive capabilities will be restricted.

We Gotta Do Something

It’s pretty clear that we have to do something before things get out of hand. Do something…but what?

We’re flooded by climate change recommendations, but here are some key points from the 2014 National Climate Assessment. The assessment distills climate change responses into two main categories:

• Adaptation: Reducing negative impacts of climate change through infrastructure and preparedness planning. An adaptation example is the creation of the State, Local, and Tribal Leaders Task Force on Climate Preparedness and Resilience that aims to prepare communities for the challenges of changing weather.
• Mitigation: Attempting to reduce the climate change itself through updated policies and practices. A mitigation example is the Appliance and Equipment Standards Program, which pushes for energy efficiency.

While these two categories encompass different approaches, we need both to achieve the greatest effect. If you’re interested in reading about more climate change adaptation and mitigation initiatives, check out this fact sheet on President Obama’s Climate Change Action Plan. In terms of public health, however, we’ll stick to a few health-related initiatives, most of which fall under the adaptation category.

The Sustainable and Climate-Resilient Healthcare Facilities Initiative

As the name suggests, this plan aims to prepare healthcare facilities for climate change and related complications. The Department of Health and Human Services released an intensive guide with a framework designed to help healthcare facilities revamp their infrastructure and technology. The initiative includes an online planning toolkit that serves as an interactive guide to walk professionals through these steps of resilience:

1. Identify the problem.
2. Determine vulnerabilities.
3. Investigate options.
4. Evaluate risks and costs.
5. Take action.

So far, healthcare industry leaders like Kaiser Permanente have committed to use the guides to help in their resilience planning.

The BRACE (Building Resilience Against Climate Effects) Framework

The Centers for Disease Control and Prevention developed a framework of preparedness geared more toward public health professionals working locally. Their framework involves projecting the impacts of climate change and assessing effectiveness of interventions. The evidence of effectiveness will be especially useful for people planning future interventions. Click here to see a chart made by the CDC to explain the BRACE framework.

NYC Cool Roofs

The NYC Cool Roofs initiative presents a perfect real-world example of an initiative already underway. Reflective surfaces are added to New York City roofs, which mitigate further climate change by reducing cooling energy needed, consequentially lowering greenhouse gas emissions. They’re also adaptive as they’ll help cool the city, and hopefully reduce heat-related deaths.

Controversy in Congress

Many look at the Keystone XL pipeline decision to judge the climate change temperature in Congress. To the dismay of environmentalists, the Senate rejected two amendments related to the Keystone XL pipeline bill that admitted the human role in climate change and called for more government interventions. The President just vetoed the bill and many believe Congress will not override it.

Still, many climate change advocates are alarmed that the bill went as far it did, saying it would contribute to climate change because of the sheer amount of extra energy it would require and carbon pollution it would make. According to this NRDC Issue Brief, building the pipeline would create the same carbon dioxide emissions as Americans driving 60 billion more miles this year.

Conclusion

If you’re frustrated with the accuracy of forecasts now, be prepared. While climate change poses a new challenge without guiding evidence or precedent, the health complications from climate change have already begun. We see more cases of Lyme disease. Allergies grow in severity. We’re not sure what will work, we’re not sure what the future will bring, but we’re sure we need to brace ourselves for coming changes and meet current changes head on. We all need to work together to make sure that we stay healthy in coming years.

Resources

Primary

World Health Organization: Climate Change and Health

Environmental Protection Agency: A Student’s Guide to Climate Change 

U.S. Global Change Research Program: National Climate Assessment 2014

White House: Strengthening the Climate Resilience of the Health Care Sector

City of New York: NYC Cool Roofs

World Health Organization: Diarrhoeal disease

Additional

Emergency Management: How a Warming Climate Impacts Public Health

Science Daily: More Infectious Diseases Emerging in Animals as Climate Changes

Nature: Climate Variation Explains a Third of Global Crop Yield Variability

Nature: Delays in Reducing Waterborne and Water-Related Infectious Diseases in China Under Climate Change

Science Daily: Heat Waves Becoming More Prominent in Urban Areas

Science Daily: Preparing for Hell and High Water: Research Advocate for Climate Adaption Science

New England Journal of Medicine: Climate Change and Human Health

American Meteorological Society: Climate Change Risk Management

American Phytopathological Society: Soybean Rust

The New York Times: Senate Rejects Human Role in Climate Change

Natural Resources Defense Council: Climate Impacts of the Keystone XL Tar Sands Pipeline

BBC News: Obama Vetoes Keystone Oil Pipeline Bill

Politico: President Obama Vetoes Keystone Bill; GOP Plans Override Vote

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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Mankind’s greatest enemy is not war or hunger but infectious disease. Throughout history it has cost countless deaths, and even in the twenty-first century our defenses against it remain limited. Above all, it is the threat of outbreak that unsettles us so; it is not just suffering and death, but fear. Whether it’s the Black Plague, Cholera, Spanish Influenza, H1N1, or Ebola, disease is a dark cloud looming over our lives.

Most of the microscopic killers with which we contend have been transmitted to us through animals. In the early ages of settled agriculture, close contact with domesticated chickens, pigs, cows, and others exposed humans to pathogens to which their immune systems had no previous exposure and consequently minimal means by which to combat them. There are two primary behavioral patterns of diseases. Some ascribe to the category of “chronic.” In this case, as geographer and ornithologist Jared Diamond explains, “…the disease may take a very long time to kill its victim; the victim remains alive as a reservoir of microbes to infect other[s]…” The other category is “epidemic.” In this case, Diamond continues, there might be no cases for a while, followed by a large number in an affected area, and then none for a while more. Such behavior is a consequence of the intensity of the disease’s manifestation; it strikes with such force that it basically burns itself out because the potential hosts all either die or become immune.

“Epidemic” is a widely feared term. Rather than consider the fact that they can and have been occurring on very small scales throughout human history, many people associate epidemic with things like the Black Plague in Europe, Smallpox in the New World, or a global zombie apocalypse. Since people naturally fear most what they do not understand, insufficient knowledge of disease vectors and behavior results in widespread fear and panic.

Ebola is a relatively late arrival on the scene. Originally suspected to be yellow fever, it was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Samples extracted from an ill nun who had been working in the region came to doctors and scientists in an Antwerp, Belgium laboratory. They eventually discerned that the infection behaved differently from what would be expected of the original diagnosis. After sending samples to the Center for Disease Control in Atlanta, their conclusions were confirmed and a new disease had been discovered. Shortly thereafter, another outbreak occurred relatively far away in Sudan. While knowledge of the initial source and starting location of the disease is still vague, it was determined that it had spread via unsterilized syringes and contact with bodies during funerals. Therefore a lack of knowledge of the nature of the disease lent itself to its spread.

Ebola in large dropped off the radar screen until the recent epidemic began in West Africa. Going hand in hand with lack of knowledge of the disease are incomprehensive and underdeveloped means of addressing it. On a recent edition of Global Public Square, the insightful international news show hosted by CNN’s Fareed Zakaria, international relations PhD Chelsea Clinton declared that the disease is spreading exponentially, necessitating exponential containment measures. This is very difficult to achieve, due to the poor technological and economic infrastructures of the region. As Dr. Paul Farmer — another guest on Zakaria’s show — expanded, the Liberian healthcare system is also very weak. Liberian Foreign Minister Augustine Ngafuan detailed how Liberians have deeply ingrained burial practices that involve close contact with bodies; this is an important aspect of cultural values in the region and not easily relinquished in the face of something that foreign experts, much less locals, barely understand.

A Liberian village, courtesy of jbdodane via Flickr.

Globalization and increased interconnectedness between individuals, societies, and locations has exacerbated the rate at which diseases spread. Many Americans cried out when infected aid workers were brought home to be treated. Appropriate measures were taken in this instance, with sanitary transportation vehicles bringing the patients to the Emory hospital in Georgia. Due to its affiliation with the CDC, this is one of the few facilities truly equipped to accommodate infectious diseases of this nature. Both those patients recovered, though they would likely have died if they were forced to remain in Africa. The situation was handled intelligently and effectively, without resounding negative consequences. Yet the outcry and fear demonstrates people’s lack of knowledge and tolerance of the unknown and perceived dangers. This was in fact the first occasion in which Ebola was present on American soil.

The situation changed with the death of Thomas Duncan. Having arrived from Liberia in late September, Duncan provided a new first by being the first patient diagnosed with Ebola in the United States. His illness was unknown during his transit, and so new fears arose as to the likelihood of Ebola crossing the ocean with traveler hosts. Now in a complete state of fear, Americans want more and more action taken in defense of the nation’s health, yet do not know what those measures ought to be because we do not know enough about the disease. Many airports have begun taking travelers’ temperatures. The CDC initially cited 101.4 degrees as the point at which one must be quarantined, but lowered it after some supposedly ill people were cleared. This demonstrates the uncertainty of the disease’s nature; in what ways does Ebola affect a person’s body temperature? At what point in their illness are they contagious? Is a body temperature an effective indicator of this? These questions have yet to be answered for the disease of whose existence we have known for less than 40 years.

Specialists clean up a Hazmat area, courtesy of sandcastlematt via Flickr.

The second set of problems that are causing fear are the alleged breaches of protocol that have enabled several other people to catch the disease in the United States. The Dallas hospital in which Duncan died was not equipped to handle this disease and consequently could not treat him effectively. Furthermore, the staff did not have the proper training insofar as interacting with Ebola, and this has been cited as the reason why nurse Nina Pham, who was treating him, became ill as well. A recent video surfaced wherein a patient is being transferred from one vehicle to another by four workers in “hazmat,” or hazardous material, uniforms. A fifth person, dubbed “clipboard man,” stands with them completely unprotected. Finally, CDC Director Dr. Tom Frieden has come under fire for making statements and then retracting them. Pennsylvania Republican Congressman Tom Marino has even called for him to step down. We have quickly forgotten, though, that in the early 1990s Frieden was instrumental in developing awareness and programs to combat a rising Tuberculosis epidemic in New York City. In addition to other stellar career highlights, Frieden is a highly capable leader experienced in engaging these concerns.

We are too wrapped up in fear of the unknown to do anything but demand immediate results. Ebola is a newcomer on the scene and will take some time to understand effectively. As we continue to discern our relationships with our surrounding environments, we do know that ebola is not nearly as contagious as other diseases. It requires direct contact with bodily fluids of infected patients. As we continue to learn how it works, and how our actions, societies, and cultures interact with it, we will become more effective at addressing it. In the meantime, we annually face airborne foes which are far more dangerous and contagious; do not forget to get your flu shot in the coming weeks.

Franklin R. Halprin

Franklin R. Halprin holds an MA in History & Environmental Politics from Rutgers University where he studied human-environmental relationships and settlement patterns in the nineteenth century Southwest. His research focuses on the influences of social and cultural factors on the development of environmental policy. Contact Frank at staff@LawStreetMedia.com.

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