22 July 2009

New England Journal editorial: MRSA, H1N1 parallels

There's a very interesting piece in a recent New England Journal of Medicine (unfortunately, only the abstract is online) that draws parallels between MRSA and public expectations for pandemic flu. Written by Dr. Kent Sepkowitz, chief of infection control at Memorial Sloan-Kettering Cancer Center in New York and one of the authors of the "Medical Examiner" column at Slate, it's an exploration of microbial sleight of hand: We were looking in one direction for a problem to develop, and — like Wile E. Coyote staring after the Road Runner but missing the Acme anvil — the problem came around and socked us in the back of the head.

In the case of flu, Sepkowitz writes, we concentrated on the threat of H5N1 avian influenza — the focus, until H1N1/swine flu arrived, of billions of dollars and years of effort in pandemic preparation — but were surprised by the sudden catastrophic emergence of seasonal flu strains resistant to oseltamivir (Tamiflu), one of the few antiviral drugs that can reduce illness and death from flu if taken early enough. In the case of MRSA, medicine focused on containing the spread of hospital MRSA and its rare transformation into VRSA, vancomycin-resistant staph — and mostly discounted, until far too late, the enormous threat of community MRSA strains:
The intensity of our concern and the frequency of the doomsday dispatches were appropriate. We were simply chasing the wrong microbe. It is community-acquired MRSA, not VRSA... that now occupies the center of the public health stage. And just about everything predicted for VRSA has come true for community-acquired MRSA. It's everywhere; it's deadly; it has changed the day-to-day management of skin infections and pneumonia in clinics, emergency rooms and intensive care units. It's a true public health disaster. It's just a different disaster from the one we were exercised about.
As we wrangle the new threat of H1N1, Sepkowitz warns that it is vital to remember how many millennia of practice microbes have in foiling our expectations:
We should marvel at the raw, restless power of microbes. They have the numbers — trillions and quadrillions and more that replicate wildly, inaccurately and disinterestedly. Nothing microbes do, whether under the duress imposed by antimicrobials or from some less evident pressure, should surprise us. It's their world; we only live in it.
(Image courtesy Sansceo Design)


germ killer said...

I was on the Hill yesterday offering a plan to cut $30B from the the cost of healthcare delivery annually. yes. you read that right, annually.

It is a means to virtually end hospital acquired infections which afflict over 3M patients per year, of which 100,000 die. Those that live, have to suffer through fighting off the infection for an average of 21 extra days in the hospital, some return for a second visit.

The plan lowers material costs to the hospitals of close to $2B per year upfront and then saves the hosptials and insurers up to $30B each year. It is a win for patients, a win for nurses, a win for hospital CEOs, a win for insurers, and a win for the CDC, and the federal government.

Do the democrats want a political win? talk to Senators Menendez and Lautenberg, they have the plan or contact www.germgardlighting.com

tmullins said...

I've been asking questions since 2004 concerning MRSA. Seems my elected officials have more excuses, pass me on to someone else or do not reply at all. MRSA will be the next AIDS and will even be more of a problem when it starts mixing with flu. I've worked in health care and later as an embalmer. Where's the preventative care ? Sadly, our health care system is infecting our communities and it's deemed, defended and supported as acceptable standards of health care in Tennessee and Virginia.