You’re going to want to wash your hands after you read this post. Author Maryn McKenna, or “Scary Disease Girl,” as she’s known to her colleagues, talks about MRSA — a potentially lethal bug that has jumped from hospitals into the wider population and now kills 19,000 Americans a year.
McKenna’s book Superbug: The Fatal Menace of MRSA explains where methicillin-resistant staphylococcus aureus came from (factory farms are a big part of the problem) and what we can do to protect ourselves from it (wash, but don’t use antibacterial soaps).
MRSA is a sneaky bug. It once circulated mainly in hospitals and infected the elderly and ill, but over the past several years it’s been found outside the medical setting, especially in locker rooms (in schools, in the NFL, at your local gym), and has killed or sickened healthy children and adults. People can develop a life-threatening and sometimes incurable infection within hours. Survivors can be sickened for months at a time.
McKenna talks more about the “scary disease.”
What exactly is MRSA?
It’s a very common strain of bacteria that has become resistant to almost all of the antibiotics used in medicine. It is resistant to most antibiotics you would be given for an infection if you went to a primary care doctor’s office. The problem with MRSA is that it’s been a slow-drip problem like climate change, which many, many inputs created, and there is no one action we can take that will walk us back.
Are there any drugs that work?
For the most serious infections only one or two drugs work and there are no new drugs coming onto the market because it is not considered lucrative [to develop antibiotics].
What can we do about it?
There are some things we can do ourselves and some things we have to ask our institutions to do for us.
The first are simple thing that your grandmother told you. Wash your hands a lot because MRSA lives in our environment. It lives on people’s skin and survives on surfaces. Your hands are the last bridge between the environment and you. Keep them as clean as possible.
The Centers for Disease Control and Prevention (CDC) has identified certain situations that you can live or work under that make MRSA more likely, called the 4 C’s: Crowding, skin Contact, low levels of Cleanliness and Contaminated surfaces.
In most of our lives, [the four C's] are most likely are in places like gyms and school sports. If you have a family member in the military or incarcerated, that also describes barracks and jails and prisons. There’s an enormous epidemic in jails and prisons. But there are plenty of stories of women getting MRSA from gym equipment and children from playing sports.
Why are school gym classes particularly risky?
Kids don’t shower after sports in school any more. Everyone in the boomer generation remembers that experience and it scarred us all for life. So that doesn’t happen anymore.
But staph happens to like warm, damp, salty places. There are plenty of cases in which children have an average sports [injury] and four days later they are in the intensive care unit struggling for their lives.
Another situation that is relevant to every day life is that when people are in the health-care system, it’s sort of stunning how bad the hygiene is.
Why are doctors and nurses so bad at this?
It’s not because they are evil or careless, but because they have incredibly packed, pressure-filled and technical, distracting jobs. They also come with the bias of “I’m someone who heals,” so it’s hard for them to embrace the notion that they might also be dangerous to patients.
If we are having a medical encounter, we have to be aware and be aggressive. Ask, “Have you washed your hands?” Say, “I want to see you wash your hands or use gel.” If people did that consistently, I’m confident that the rate of health-care infections will go down.
Should we use antibacterial products, or do they really increase germs’ antibiotic resistance?
We have a bias toward the idea that if some is good, more is better. So if you’re telling me to wash my hands and keep clean, wouldn’t it be better [to use antibacterial soap]? The answer unfortunately is no. It’s really important to keep clean but what you should use is simple soap or a hand sanitizer with alcohol in it and not much else.
Just as bacteria have evolved mechanisms that allow them to resist the actions of antibiotics, they are also evolving mechanisms that allow them to resist the actions of antibacterial soaps. Triclosan [which often used in antibacterial products] is the poster child for that. We are making the problem worse because we are giving the organisms another chance to get resistance. But they can never become resistant to soap or alcohol.
Soap doesn’t actually kill bacteria. What it does through different chemical reactions is lift bacteria and other debris off our skin. It has to do with negatively and positively charged ions. Friction moves them around and rinsing washes them off.
What alcohol does, it’s not like an antibiotic. It’s like hitting them over the head with a sledgehammer. It bursts the membranes. You can’t become resistant to sledgehammers.
Does the need for friction mean that paper towels are better than hand driers?
The problem with hand driers is that they often don’t get your hands really dry. If moisture remains on your hands, that’s a more friendly environment than dry skin. A towel or paper towel really gets hands dry and gives more friction. A really hot hand drier might work.
How does agricultural use of antibiotics affect the problem of resistance?
While people talk about agriculture and sustainability and local food, they often don’t realize that it’s antibiotics that created confinement agriculture [in which farm animals are raised in close quarters]. Without antibiotic use, confinement agriculture would go away overnight because you couldn’t keep the animals alive. [That is, disease would rapidly spread and kill them.] It’s the player behind the curtain.
Of all the antibiotics sold every year, 80% go to agricultural use. That’s 29 million pounds of antibiotics a year. The science is not challenged anymore: the overuse of antibiotics in agriculture is the driver of an international epidemic of drug resistance.
When you use antibiotics [this way], they don’t stay on the farm. They leave the farm in the systems of animals and leave the animals in manure. [Modern agriculture] generates a lot of manure. Those big lagoons are enormous petri dishes for the breeding of resistant organisms.
[And the bacteria] leave in groundwater, in the dust in the wind, on the feet of insects and in farm workers themselves. It’s an occupational issue because farm workers come down with resistant infections. If we seriously want to dial back the international epidemic of resistance, we really have to look at how antibiotics are used in agriculture.
Is there any effort underway to change the system? It seems obvious that it could endanger human health.
At the very least, we ought to be setting up better surveillance. The reason that we don’t get movement is because this is now a fight happening in the economic and political spheres. There is very significant opposition to touching agricultural antibiotic use both from very big producers and frankly from the pharmaceutical industry because the veterinary market is enormous.
A piece of legislation has been introduced for the last several Congresses. It will soon be introduced in the new Congress. It’s called PAMTA, the Preservation of Antibiotics for Medical Treatment Act. Rep. Louise Slaughter is the author. She is Congress’s only microbiologist. It calls to remove or reduce agricultural use of seven classes of antibiotics. If we use those drugs in agriculture and resistance develops there, because it moves with incredible speed, that means we are making them ineffective for humans and we don’t have a lot of drugs left.
Once a really complex system gets going, it’s really hard to change. Agriculture is a big complex system with a lot of money involved.
It seems to me that there should be money now in new antibiotics then.
In the 1950s, there were more than a dozen companies that made antibiotics. Now there are five. We need truly new compounds — there are some in the pipeline, but not many.
If you are pharma shareholder, and [R&D says to you]: “We’ve decided to make a new antibiotic because the market really needs it. It is generally accepted that it takes 10 years to get a new drug from bench to bedside. It costs about $1 billion. We’re going to get a compound that people will only take for a couple of weeks and then you’ve cured them. If they are very sick or get recurrent infections, they may take it twice or intravenously. Once the drug is in the marketplace, there will be resistance to it, probably within a year and once that resistance in any area rises to 20% of bacteria, doctors will probably start to not want to use it any more. Will you make this investment?”
[You'd probably say], “Couldn’t you please make Viagra or insulin or statins instead?”
So should the government be developing antibiotics, or paying companies to do it?
This is an active area of debate. People flinch at the idea of giving pharmaceutical companies free money but the reality is that the current market model isn’t working. What sort of incentives we can create that would work and not be inappropriate or unfair is still an open question.