Friday, December 2, 2016

Antibiotic Resistant Superbugs Set To Wreak Havoc Under Trumpies

Superbugs exposed by special stain..

Imagine the U.S. in the throes of a massive superbug epidemic, perhaps MRSA or C. Diff. sometime in the next four years. It is possible, even probable, as Trump and his hired henchmen go about disbanding the Affordable Care Act, a point made clear by his appointment of Tom Price (R, GA) to the Dept. of Health and Human Services. This degenerate, Price, wants to not only abolish the Medicaid coverage for over 14 million but also remove the pre-existing conditions provision (i.e. that enables those with pre-existing conditions to get insurance under the ACA or "Obamacare"). In addition,  he along with Paul Ryan wants to replace Medicare with a "voucher" system where each person gets a small amount per year ($10k is often cited) to buy whatever insurance possible - and to cover all medical incidents, emergencies. If I'd been reduced to such a yearly voucher I'd have had to file for bankruptcy since getting cancer treatment 4 years ago and having gall bladder surgery (which came to $28,000 ) this year.

These dastardly moves would be bad in a normal environment but that's not the one we're approaching.  Nightmare superbugs, including c. diff.(which I'd written about before - that knocked Janice down in 2006-07 and hospitalized her twice) are on the rise and getting worse.  This is as antibiotic resistance rises, predicted to fell more than 2 million Americans this year, with 23,000 killed.

In Janice's case, by her second hospitalization in January, 2007, it was clear that the usual antibiotics were not stopping her c.diff - a severe bowel infection caused by the gram negative bacterium, clostridium difficile. By the time of the 2nd emergency room visit she'd lost over twenty pounds and one ER physician compared her condition to cholera. He shook his head and said in wonder: "It is a good thing she has Medicare and a good supplemental insurance. Without it, she'd have either had to fend for herself or be charged a lot of money for the ER visit."  The only antibiotic that finally rid Janice of her c.diff. superbug was the strongest then available, vancomycin.

We couldn't help but think at the time of others who might demur going to the ER, and thence spread the infection to dozens of people outside any controlled environment.  (In Janice's case, this second time around she had to be housed in a special separate, isolated room and those coming to treat her had to be specially outfitted.)

As I'd written about in a number of posts on mutation and evolution in 2010-11, bacteria like all living things evolve and adapt to survive.  Some develop cell walls that actually keep antibiotics out, while others pump antibiotics out when they get in. In other words, bacteria like c. diff. have developed many ways to deactivate or neutralize the action of these drugs.  As this resistance becomes ever more successful and adaptive, the superbugs get more virulent.

How serous is it? By mid-2015 the most powerful antibiotic used at that point was colistin. But in November of that year, specialists isolated bacteria that carried a single gene that made them resistant to colistin. In April of this year, the same gene showed up in bacteria in the U.S. According to Jean Patel based at the CDC and quoted in the recent AARP Bulletin (November, p. 31):

"And now we're beginning to get reports of bacteria that are resistant to virtually every antibiotic we have."

What are the political and health implications of these developments in the context of a Trump presidency? First, his anti-regulatory stance and advocated policies mean little or nothing will be done to staunch the widespread use of antibiotics, say in agriculture. This means that antibiotic resistance will continue to grow with each passing month.   This is especially worrying given that "approximately 80 percent of antibiotics sold in the U.S. are used in animals raised for food." (Ibid.)

Second, health care cuts, especially to Obamacare, will put millions of our fellow citizens at risk of infection - and infecting others. If their ACA insurance coverage or Medicaid is taken away, and they deem it too costly to seek care outside it  - they may well just try to sit out a bout of c.diff. diarrhea (going up to 20x a day) or a MRSA skin infection. The results could be catastrophic. As opposed to 23,000 dying in a year, 2 million infected, we could well see 200,000 dying each year and 20 million infected.  On the positive side, a recent survey conducted by the Kaiser Family Foundation showed that only 1 in 4 Americans favor repeal of the ACA. One hopes that these are mostly anti-government Trumpeters.

Third, Trump Co. may well gut or repeal Obama's $1.1 billion, earmarked earlier this year to fight resistant bacteria. This was a definite acknowledgement of just how serious the situation has become but its continuation is contingent on the generosity of the Trump administration. If they cut it completely, citing the need for more tax cuts for corporations and plutocrats, the antibiotic resistant battle may well be over.

One of the scientists quoted in the AARP piece, says at the end:

"I think everyone is finally beginning to recognize the deadly seriousness of the threat posed by antibiotic resistant bacteria."

Maybe, most of us do  - those who respect scientific facts and research. But those who invent facts on their own, like Trump and company, may not. In that case we are all likely for the high jump.

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