SUPERBUGS 

(Robinson/Banerjee)

Superbugs have been the hot topic in public health for a couple of decades now, and seemingly will continue to gain momentum unless we change our current course of action. 

Sustainability thinking is often about re-thinking our approach to things, and issues in public health--like any other discipline, are certainly in need of some rethinking.

One of the questions that I have felt that has been largely unanswered is the propagation of superbugs in the partner of the affected person.  I think almost everyone in western democracies must have heard the current theory of how superbugs are supposedly mutating, adapting, and becoming immune to prescription antibiotics and penicillin. 

The chief culprit in the propagation of superbugs is “apparently” because people are simply not finishing their full course of treatment, and that antibiotics are being over-prescribed.

I wonder though…

Sustainability asks us to think of ourselves as “not” separate from our environment, and it asks us to image all things connected, and interrelated.

Applying that same thinking to relationships with our partners and close relations; I ask the question, perhaps our partners are playing a larger role in the transfer, reintroduction, and less threatening incubation space required for some of these bugs to thrive?

This theory seems to have been corroborated by a number of my colleagues, my research and from personal experience. 

Let’s look at the specifics of my theory,

ASSUMPTIONS

If Person A – has the bug, and IS on antibiotics, and

their Partner B – doesn’t have the bug, and is NOT on antibiotics.

First of all, what is there to stop the introduction of the bug transferring from A to B if people are swapping bodily fluids, and those simply living in close proximity? 

I would argue – nothing

So quite simply, while spouse A is being treated, the bugs could be “hiding out” (i.e., lying dormant) in spouse B.

The bugs living in A who have had “some” exposure to the antibiotics (but not enough to kill them), may get swapped to partner B, where they can live out their day in virtual immunity, passing on the knowledge of survival in a hostile environment to their progeny.

Of course when partner A is finished the course of antibiotics, the bugs could simply move back to A and learn to survive in the even more hostile but quickly fading antibiotic environment.. This leads to the development of “mixed infections,”  where multiple superbugs can reside  and thrive in the same “reservoir.” 

The premise of my whole argument here is two-fold.  Eradication of any superbug treatment must follow two basic rules:

1) A & B must be treated at the same time.

2) A & B should be self-quarantining from each other until both courses of antibiotics are completed – CONCURRENTLY.

* Of course if there are multiple partners then extending to C,D,E must also be undertaken.

Otherwise, are we not simply wasting our time and allowing the bugs the perfect “training” opportunities for how to breed their way out of hostile situations and for the subtle reintroduction when the antibiotic defenses are down?

AN ANALOGY:

If we think about our own lives I’m sure almost everyone has seen the dynamic played out in their own family at one time in their lives at least.  One person, sometimes a child gets a cold, gives it to the parent, and the parent gives it back to the child, and so on…

To ensure optimal public health we should really consider adopting:

1) SELF-QUARANTINE - a nationwide policy for those who are contagious.

2) SUPPORT - government, employer, employee, and family support (both financially and emotionally) for those who are sick - to not return to work until they are better and stop infecting everyone else everyone around them.

3) EDUCATION - enhanced public education with regards to hand-washing,  when to self-quarantine, elbow coughing techniques, safe sex, non-promiscuity,  proper  nutrition, and general health promotion tips (which are all really a subset of #4).

4) PREVENTION – this is the big one.  We need to move our thinking with respects to health, and especially Public Health to one of prevention (which is much more aligned with the principles of Sustainability).  This should pervade our thinking including the obvious areas like planning, educating, policy, responses, and funding priorities, and the not so obvious to many like the connection with air, soil and water quality, housing, etc.

And when we’re dealing with superbugs and the global village the stakes are getting much much higher..