Antibacterial Resistance

"There have been few health crises on this scale in Canadian history. [If the overuse of antibiotics is not countered and if effective drugs continue to run short], Canada will be greatly changed within a few decades."
"The prospect of a world where antimicrobials no longer work is alarming. Illnesses would be longer and more severe, treatments more expensive and the risk of death higher."
"[Prophylactic antibiotic routine use in the prevention of infection such as in kidney dialysis, chemotherapy, organ transplants, joint replacement surgery and caesarian section] would be too risky to be made widely available."
Council of Canadian Academies expert panel report: When Antibiotics Fail

"If climate change wasn't here this would probably be the number one pressing issue facing humanity."
"[The problem of overuse of antibiotics has been known for decades, its consequences anticipated], but it's coming harder and faster and more real, and it's going to confront everyone."
"I've been working in this area since the 1980s and I didn't think it could get this dark."
"As soon as you make an antibiotic, everyone uses it, bugs become resistant and it's no longer useful [for the purpose intended, to stave off infections]."
Dr.B.Brett Finlay, microbiologist, University of British Columbia, Chair, Council of Canadian Academies

"[With SARS], people stopped going out. They stayed home. They avoided unnecessary contact with other human beings."
"You could imagine that daycares [or university dormitories] might not be so popular; everything that involves a social gathering might be perceived as  risky."
"We are a social species. Any threat to that socialization would be very troublesome for people's well-being, and society's functioning."
Dr.Amelie Quesnel-Vallee, professor in epidemiology and sociology, McGill University

A staff member at York Central hospital in Richmond Hill, Ont., glances out the doors of the closed facility after fears the 2003 SARS outbreak was spreading further. At its peak, the outbreak caused people to avoid human contact, one epidemiology professor says.   Postmedia/File

Sounds dire, and potentially it is all of that. If drug resistance, with bugs rapidly evolving to evade the effectiveness of over-used antibiotics does become the norm -- which appears to be the direction matters have been heading toward -- the foreseen economic costs to society could be outweighed by far-reaching social impacts. The panel, whose report was produced at the behest of the Public Health Agency of Canada, ventured a scenario where people would be less trusting, the social civil contract dissolved as people viewed by others as a risk becoming targets for discriminatory isolation. The social fabric of society would, in effect, be rent asunder.

 The expert panel calculated 5,400 deaths attributable to infections. (Kai Pfaffenbach/Reuters)

The issue and its potential consequences has been raised repeatedly in the past decades by medical scientists disturbed by outbreaks of infection that fail to respond to the must commonly-prescribed and -used antibiotics. And the habitual use of products billed as 'antibiotic' as a testament to their cleaning and hygienic capabilities was identified as one of the culprits. Dishwashing detergents, hand soaps, cleaning solutions, advertising as a plus their antibiotic-infused ingredients were on store shelves everywhere and used with enthusiasm.

Until they fell out of favour thanks to a public awareness campaign informing of their potential harmfulness leading to antibacterial resistance. And then there was the issue of patients insisting their doctors prescribe antibiotics for viral infections that don't respond to antibiotics, and their family physicians, knowing better, still acceded under pressure, prescribing medication with no value, a decision that added to the exposure and needless use of a preventive medication. The result giving bacteria ample opportunity in taking on different properties of resistance.

At the present time, 26 percent of bacterial infections have become resistant to first-line drugs most frequently in use in the treatment of infections. Canada logged 250,000 resistant bacterial infections in 2018 with over 5,400 deaths attributable to antibiotic-resistant bacteria. Should that rate reach 40 percent in thirty years' time, considered "highly plausible" by the panel of 13 experts from various scientific and health fields, including epidemiologists, doctors, agricultural experts, modellers and economists, it is anticipated that up to 13,700 people would die annually as a result of resistant bacterial infections.

This is not a Canadian problem; it is universal in nature.

Nurse Maricel Teodoro, in an isolation room, Mount Sinai Hospital (Canadian Press)

The public health care system is burdened by $1.4 in related costs yearly, shrinking the Canadian economy through the social effects of superbugs causing more deaths and leaving fewer people in the workforce, disabled by illness related to antibiotic drug resistance. For 2018 the panel estimated a cost to Canada's GDP of $2-billion; should the resistance rate soar to 40 percent, GDP would decline by $21-billion annually, and quality of life would be hugely affected.

As it is, among the various types of infection such as those that cause pneumonia, gonorrhea, urinary tract infections and gastro-intestinal illnesses have rapidly become more difficult to treat with the current crop of drugs, having lost effectiveness. Roughly one in 19 deaths in Canada, according to the report, are now attributable to resistant infections. The World Health Organization speaks of drug resistant bacteria as being within the top ten health threats on the globe.

Included in the report are scenarios beyond disturbing, where circumstances might lead doctors, in a return to the era of medical treatment before the advent of antibiotics, to use toxic drugs, "or, if possible, removal of the source of infection [through amputation]", all other avenues seen as riskier or too difficult to attain. "The actual delivery of care itself may change, as increasing [antibiotic resistance] may bring a bout conversations about the duty to care versus risk to those providing care", the panel advised.

Jean Lee, a PhD student at Melbourne's Doherty Institute, inspects the antibiotic-resistant superbug Staphylcocus epidermidis on an agar plate. A Canadian expert panel cautions the percentage of bacterial infections resistant to treatment is likely to grow from 26 per cent in 2018 to 40 per cent by 2050. (William West/AFP/Getty Images)