Connecticut is now seeing a COVID-19 spike, and mpox cases have more than doubled this year. Lyme disease remains a problem, as does Powassan. Flu season is coming up again, but RSV and strep have unexpectedly spread beyond its typical fall stretch.
It's enough to make even the healthiest of residents to become obsessed with sanitizing every surface or consider living in an isolation chamber. But should it be?
Ask Ridgefield's Art Caplan if we're more at risk from infectious diseases now than in past generations, and he might give two answers.
"I think we are a little bit more at risk than we were at least within, let's call it the past century," Caplan, a professor of bioethics at New York University's Grossman School of Medicine said. "We were certainly at a big risk back in medieval times when the plague and many other infectious diseases were all over the place."
There's a famous quote often, and probably mistakenly, attributed to 1960s-era Surgeon General William H. Stewart: "It is time to close the book on infectious diseases, and declare the war against pestilence won."
While that quote did not age well, it demonstrates the hope the medical community had after antibiotics were invented. Caplan, who founded NYU's medical ethics department, said the big advancement came with the advent of vaccines, which go all the way back to the Colonial era when smallpox was raging.
"Better hygiene, that helped a lot. Cleaner water, cleaner bodies. We started to do medicine that was sterile, so you didn't have all those terrible infectious diseases moving around," he said. "I would say we had a march forward maybe, roughly from World War II up until the 1990s or so, with many, many diseases disappearing, dropping away."
The advent of antibiotics and vaccines signaled a seismic shift, after which there were tools to fight infectious disease.
"We'd been through one enormously long period of time from the Middle Ages, almost up to that 1930s where if you didn't die of measles or mumps, or smallpox or pneumonia, some horrid polio, something, you were lucky. You might have even been the exception," Caplan said. "Then we begin to get the field of bacteriology, virology, we begin to understand microbes, the germ theory of disease, leading to solutions for even things like rabies."
The Threat of 'Rapacious Globalization'
With advancements in technology came risks, like a double-edged sword. Bubonic plague emerged in Mongolia in 1346, and it took decades to spread across the continents of Asia and Europe.
"It took the bubonic plague, I think, 10 years to kill (much of) Europe because it was going town-by-town, slowly," as transportation was a major endeavor back then, Caplan said. "Now you have airplane travel, train travel, bus travel, boat travel, all spreading diseases more quickly."
By contrast, COVID-19 spread around the world "almost instantaneously," said Frank Snowden, professor emeritus of the history of medicine at Yale University and author of several books on the subject of infectious disease.
"If something breaks out in Mumbai today at breakfast, by dinner it's in Seattle," he said.
If you ask Snowden what he is worried about, he might say that his primary concern is emerging diseases.
"Almost all of the real threats to us are these spillover microbes from animal reservoirs," he said. "They're so dangerous because we have no immunity to them, they're entirely new to the human population. That's what happened with HIV AIDS, and it's what's happened with COVID, and the list runs from A to Z, from avian flu to Zika."
It's not just "globalization" that's the problem, Snowden said, but "unregulated, rapacious globalization, which is what we seem to have."
"That means that we're destroying, willy-nilly, wildlife habitats, and therefore bringing human beings into closer and closer relationships with animals that carry lots of microbes we've never seen before, and so we have no resistance against them," he said. "The number of threats are becoming more and more numerous, not less numerous."
Antibiotic Resistance
It's difficult to estimate the percentage of Dr. Ulysses Wu's patients who are infected with antibiotic-resistant bacteria, but it's not an insignificant number and it's getting larger.
"The percentage of people coming in with what we call 'multidrug-resistant infections' is definitely increasing in Connecticut," said Wu, an infectious disease specialist and head of infection prevention at Hartford HealthCare.
Wu said it's "a microorganism's world."
"There are trillions of microorganisms in and on your body as we speak, 60 trillion, 100 trillion. There's so many microorganisms, and we pretty much live in happy harmony," he said. "The problem with antibiotics is, once we actually start taking antibiotics we throw that happy harmony out of place, and sometimes good and bad bacteria are killed. And because of that, it allows other, bad bacteria to proliferate."
The first antibiotic, salvarsan, was released in 1910 with penicillin following 18 years later. They were game-changers, though a century after that, doctors like Wu try to prescribe antibiotics as seldom as possible. Over-prescription of antibiotics is a major concern for Wu and many other infectious disease specialists.
"When we start taking antibiotics, those 60 trillion, 200 trillion microorganisms we have, we start putting on selective pressure, and we start eliminating different good ones as well as the bad ones, and then we start allowing the other ones to proliferate," he said "There are things to combat this, but the best way to do it is to not take antibiotics at all" if it's unnecessary.
"A lot of the antibiotics that we give now, unfortunately, are contributing to the rise of what we call these 'multidrug-resistant organisms,'" making most, if not all antibiotics ineffective, he said.
It's a multi-layered problem. Yes, "probably up to 50 percent of antibiotics that are given are probably given inappropriately, whether it shouldn't have been given at all, whether it's the wrong dose, whether it's the wrong antibiotic, wrong length of time, whatever it may be," Wu said.
But that's not what Wu sees as the primary issue. "All that is a drop in the bucket to all the antibiotics we put in our livestock feed," he noted.
"What we're seeing is these multidrug-resistant infections, where people come in, they have an infection, and we have no antibiotics left to give to them," Wu said. "One of our biggest fears is the spread of what we call 'multidrug-resistant' tuberculosis."
Wu likened antibiotic use to a game of whack-a-mole, "except before you had moles that would just pop their heads up and annoy you and you just whack it." Yes, the hammers have gotten bigger, but the moles have evolved.
"Now, the mole that's popping up is fire-breathing," he said. "Selective pressure has made more dangerous things, and it's become an arms race."
Doomsaying
The good news, Snowden said, is that "science is developing the possibility now of patrolling the frontier," manning the metaphorical walls between us and the ever-growing list of dangerous microorganisms.
But Snowden said there are also inherent challenges. The fight against infectious disease "requires the deployment of scientists," but also the willingness of public health officials across the globe to work as a team.
"It implies bringing together public health as not just infectious disease specialists, it also means veterinarians. It means environmentalists being involved, geographers, even, dare I say it, historians. It really is a big project to keep the world safe," Snowden said. "It's not just a technological factor, it's also overcoming disciplinary silos of people in different aspects of this really complex puzzle that's the threat of infectious diseases."
Snowden insists he's not a doomsayer, though he does recognize not only the complexity of the problem but of the solution. The burden of public health, after all, rests with the public and their adherence to advice given by public health officials.
Emerging diseases are a problem, but there are also diseases that are reemerging or never fully went away, like Lyme and dengue and malaria, to name a few.
"We mustn't in any way underestimate the danger, while at the same time, I don't want to spread panic, because it's not written in the stars that these will cause another pandemic on the scale of the Spanish flu or plague or something," Snowden said. "But there's always that possibility, and we need to really address it and address it now, rather than waiting and hoping that science will save us like the cavalry."
(c)2024 the New Haven Register (New Haven, Conn.) Distributed by Tribune Content Agency, LLC.
