Our slow motion pandemic

    “We keep fantasizing about what will be the next biothreat, the next pandemic. It’s actually already here! We’re going to save our grandparents with triple bypass, but they’re going to die from pneumonia, because we will not have the right antibiotics to save them.”

Dr. Joanne Liu, International President of MSF, on Here’s the Thing.

Today the CDC releases it’s latest edition of Vital Signs, which is dedicated to the problem of antibiotic resistance (AR) among healthcare-associated pathogens. Using data from NHSN, CDC investigators estimate that the likelihood an HAI is caused by a targeted AR pathogen is one in seven in acute care facilities, and one in four in long term acute care.

There's good news in the report—the figure below shows impressive progress in reducing CLABSI rates, and to a lesser extent SSI and C. difficile. CAUTI, though, is a mixed bag (pun intended), and Mike’s covered this ground before. For reasons that Eli and our colleague Dan Livorsi outline here, it’s a shame that CAUTI has become such a prevention focus. Ironically, an unhealthy focus on CAUTI can drive testing and treatment practices that can result in antibiotic overuse, worsening the AR epidemic.

Today the CDC is also releasing the “AR Patient Safety Atlas”, a new web app with interactive data on HAIs caused by AR bacteria. I am about to post a more detailed item from Scott Fridkin about this exciting new development. Stay tuned!

The Ebola War

Things are just awful in Liberia, and getting worse elsewhere as well. The problem now clearly outpaces the response, resulting in shortages of everything from barrier protection to hospital beds. Worse, there is a breakdown in civil order and trust that makes it impossible to do the hard work of case identification, contact tracing and education--which is what ultimately brings epidemics under control. 

The latest, and somewhat controversial, call is for a large-scale military or quasi-military response to the outbreak. Although there are clearly downsides, experts from Peter Piot to MSF leaders to Mike Osterholm are calling for military involvement. 

The need for such involvement is based simply on the scale of this disaster—WHO, CDC, non-governmental groups like MSF, no group has anything close to the logistical capability of the military to quickly deploy personnel and supplies almost anywhere in the world. If, as MSF suggests, military assets are “not…used for quarantine, containment, or crowd control measures”, which have backfired (particularly in Liberia), such a response could help bring essential capacity where it is needed most. The chart below provides a comparison of the total budgets for the US military, CDC, WHO and MSF. I realize that the military is not designed for infectious diseases outbreak response, but we’ve invested in a massive military complex (to the exclusion of investment in many other areas, including infectious diseases prevention), so I’m not sure we have any choice: the United Nations to coordinate, UN member nations' military assets to move materials and people, and the CDC, WHO, MSF and others to provide expertise.