A Killer is on the loose

Right now, today, as you read this, a killer is loose that threatens your life. The murderous cowards of ISIS pale in comparison to this killer and we all need to know about it. It is receiving some attention, but I fear not enough to promote the kind of rapid reaction that is so obviously required. Once in awhile, a touch of panic can be useful.

The one thing it has in common with ISIS is a name that is uninformative in itself and deceptively simple. – MRC-1.  It is only now becoming public and there is coverage from some responsible publications.  However, I fear the coverage is too low-key to promote the sort of immediate action required.  I hope that changes soon.  First, let me give you a basic description of MRC-1 and a few links.

MRC-1 is a new gene.  It has been found in the E. Coli bacteria that causes plenty of trouble already, including killing its host if untreated.  But now, E. Coli  is far more formidable and this gene can spread to the genomes of other bacteria relatively rapdily, salmonella for example.  It was first found in China, but there are indications that it has already spread to Laos and Malaysia, and no reason to expect it to stop there.  The problem is simple.  We have nothing to defend ourselves from it or cure it.

Like so many people, I have long feared the rise of a “killer virus” against which we have no defense or cure and which spreads easily.  But there has always been an alternate route for such a deadly organism and that is a bacterial infection, not a viral infection.  Well, here we go.

I first heard of this new gene today at KurzweilAI.net, Ray Kurzweil’s website.  News sites are beginning to pick the story up.  Here is an article at BBC’s website and another at the English-language version of Deutsche Welle.  These are more than sufficient to get the point across, but they have one “weakness”.  Their presentations are too technical.  Yes, that is a responsible approach under most circumstances, but in this case, it also means less reading, less comprehension, and less demand for action.

Is action really required?  Here are a few quotations from the above sources.

  • Prof Timothy Walsh, who collaborated on the study, from the University of Cardiff, told the BBC News website: “All the key players are now in place to make the post-antibiotic world a reality.  If MCR-1 becomes global, which is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era. At that point if a patient is seriously ill, say with E. coli, then there is virtually nothing you can do.”
  • Dr. Walsh, “an expert in antibiotic resistance, is best known for his discovery in 2011 of the disease-causing antibiotic-resistant superbug in New Delhi’s drinking water supply” again – “MCR-1 is likely to spread to the rest of the world at an alarming rate unless we take a globally coordinated approach to combat it. In the absence of new antibiotics against resistant gram-negative pathogens, the effect on human health posed by this new gene cannot be underestimated.”
  • “The transfer rate of this resistance gene is ridiculously high, that doesn’t look good,” said Prof Mark Wilcox, from Leeds Teaching Hospitals NHS Trust.  His hospital is now dealing with multiple cases “where we’re struggling to find an antibiotic” every month – an event he describes as being as “rare as hens’ teeth” five years ago.  He said there was no single event that would mark the start of the antibiotic apocalypse, but it was clear “we’re losing the battle”.
  • Prof Laura Piddock, from the campaign group Antibiotic Action, said the same antibiotics “should not be used in veterinary and human medicine”.  She told the BBC News website: “Hopefully the post-antibiotic era is not upon us yet. However, this is a wake-up call to the world.”

For those interested in the actual study, an abstract (and a full copy if you are a subscriber) can be found here.  It was published last Wednesday.

As you read the articles, you will find that considerable emphasis is placed on the misuse of antibiotics.  I agree.  There is also some emphasis on the technical aspects, the sort of thing most of the public will not understand or care about, frankly.  Fine, but it waters down the impact of these findings and, perhaps worst of all, the lack of any real knowledge as to how far this gene-based infection has spread.

Actually, I would expect more on that topic if governments and health agencies were on top of this as, after all, the study wasn’t written and published overnight.  As they write at the Lancet, “The prevalence of mcr-1 was investigated in E coli and Klebsiella pneumoniae strains collected from five provinces between April, 2011, and November, 2014”, so this is something that has been known for awhile, but only now has reached a level that triggers a serious response.

This is science.  It takes time and you need to be sure you have it right before you publish.  And if you are part of the general media, it is best to downplay it or simply ignore it if it is just a possible problem, not a real threat.  There is no need to cause “unnecessary panic”, they might say.  That phrase bothers me in this case.  I have experience with that.

Although my graduate work at Cornell was in nutrition policy planning when I was an active consultant on public health and nutrition problems in the “developing world” of the last century, I was very much concerned with SARS in China back in 2003 when it suddenly appeared in the news.

In those days, I had a blog called Global Angst, no longer in operation, which drew hundreds of daily readers and, as SARS developed, thousands.  I had raised a question about the fatality (mortality) rate of the SARS virus.  Some of the statistical information available in the press didn’t make sense.  The World Health Organization (WHO) was stating that the fatality rate was 4% or less, but stats I had seen indicated it was much higher.   It seemed to be a question of how you determine a fatality rate.  Let me give you a very simple example.

You have 100 cases of a deadly disease.  90 patients are in process, 10 have completed their course.  Two patients have died so far.  You can say that the fatality rate is 2% as only 2 of 100 cases have resulted in death.  Or you can say that, since 90 of them are not yet determined, the rate is 2 out of 10, or 20%.  That’s a pretty big difference.

One man who read my blog wrote me, Dr. Johan Karlberg, both a physician and a PhD, the Director of the Clinical Trials Centre at the Faculty of Medicine of the University of Hong Kong.  He was collecting the real-time stats and publishing them, but very few people were aware of that as his center’s site was not at all well-known.  His stats suggested the fatality rate, as a percentage of those who had completed the course of the disease, was around 16%.

This really upset me.  Global “authorities” were not providing the whole story.  indeed, they were distorting it, so I did my best to spread the word of Dr. Karlberg’s work as far and wide as I could.  He and I began a correspondence by email and phone on the topic, discussing a possible project to deal more effectively with the reality on the ground.  We were concerned that the virus might be easily transferred and thus a true global threat.

As it turned out, that was not the case, so we put the project aside and went our separate ways, but I will always think well of him.  He reported the reality, despite working in what was already part of the PRC which was not interested in bringing any more bad publicity to its failure to alert the world to SARS until it was too big to ignore.  If you remember that period, you will remember how seriously China was criticized on that point.

Some months later, when pushed by journalists, the WHO did finally admit that it had used the lower statistic to avoid “unnecessary panic”. The truth did eventually come out, but if SARS had turned out to be highly infectious, that admission would still haunt WHO today.

I was very much impressed with the professionalism and honesty of Dr. Karlberg 12 years ago and, although he has surely long forgotten me, I have not forgotten him and I am pleased to note that he is now a Vice President of ACRES, the Alliance for Clinical Research Excellence and Safety in Cambridge, Massachusetts.

Forgive me if I feel a twinge of déjà vu today.  Yes, I know.  This is 2015, not 2003.  Yes, the danger has been announced and the articles do express some serious concern, but I am going to be watching it carefully.  “Authorities” have already gotten a bad name for themselves in many nations for their failure to deal with problems before they got out of hand.  We cannot afford that with this deadly threat.

I think the need for considering the worst scenario is extremely urgent.  This is a gene that can spread rapidly to multiple bacteria beyond E. COli, not a virus like SARS that spread slowly and with difficulty from person to person.   MRC-1 has the real potential to be a global disaster.  It deserves not just immediate attention, but the resources required to deal with it immediately too.

Warned of a +potential “perfect storm”, this is not a good time to treat MRC-1 as a “tempest in a teapot”.

——-

This is a personal blog, more of a personal notebook, unadvertised and without promotion. I try to post on a weekly basis, but there is no guarantee. Should you stumble across it and wish to be notified of new posts, just enter your email address at the upper-right of this page. I have no other use for email addresses. Rest assured, yours will be kept private. I also now tweet to share articles and essays that I think are important, but do not have room for here. You are welcome to make comments, if they are on topic and polite. I have no time or space for insults, foul language, or anything I judge to be offensive to readers.

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