Unarmed against a killer

We’re losing our most powerful weapon against the new killer lurking among us, says Susan Erasmus.

It has happened: six years ago doctors identified a strain of tuberculosis that is multi-drug resistant. MDR-TB is difficult and costly to treat, and can be fatal.

Tuberculosis used to be called 'consumption' - and anyone can get it. The virus is airborne and is spread by infected people coughing or sneezing. Most often TB infects those who spend much time around someone who is infected, and you are not very likely to get it from a once-off contact in a public space such as a bus or a train.

In the year 2009, tuberculosis was listed as the cause of death of over 82 000 South Africans. 24 March is SA TB Day.

In the last few decades we have come to rely on antibiotics to sort out all secondary infections caused by viruses. If these antibiotics no longer work, we are in serious trouble.

While going into panic mode is never recommended in the majority of instances, the human race is faced with losing one of its major weapons in the fight against disease. So a bit of panic would be in order. When diseases strike, they’re a lot less dramatic than a plane falling, or dying soldiers on a battlefield. But they kill many more people and they don’t necessarily get the same coverage.

The days after antibiotics

Our collective memories can be very short. In 1918, the avian flu that ravaged the world killed more people (22 million is a conservative estimate) than World War I did. It is estimated that 2 million South Africans died, roughly a tenth of the population. Those were in the days before antibiotics. Essentially we could soon be living in the days after antibiotics. A similar fate could befall us if a major disease broke out.

Antibiotics changed the world of medicine. It must have seemed like a miracle to people who were alive at the time: suddenly there was a medicine that could treat many previously fatal infections. People no longer died in their thousands from flu and infected wounds and hundreds of other diseases, that for centuries had heralded a quick, but often unmerciful end. It must also be remembered that in most wars, more soldiers died from infected wounds, than on the battlefields.

We have forgotten the very real threat posed by a nasty cough or a quick rise in temperature. We laugh it off, and if it isn't gone in a day or so, we trot off to the doctor and get some antibiotics. In fact, many people have been popping these like Smarties, instead of giving the body a chance to fight its own battles where it can. Then there's the bad habit of stopping treatment when you feel better, and abandoning the last couple of tablets of the course. If the bug has not been beaten, it reappears in drug-resistant form, and is passed on. And it is now more virulent than before.

Dense populations

We live in the kind of societies most beneficial to bacteria: densely populated and sometimes not very hygienic. Just think of how many people touch a stair railing or a lift button or a bus door handle in one day. Or how quickly a few planeloads of infected people could spread a nasty bug across the globe.

One thing we do have in our arsenal against bacteria is knowledge. The discovery of how germs are spread is an astonishingly recent one. As recently as 1854 the British Parliament rejected Dr John Snow's allegation that cholera was spread by drinking water that was infected with faecal matter.

At that time dirty hands of medical practitioners and unsterilised instruments merrily passed on infections between patients. Many women died of something called puerpureal fever after giving birth. It turned out that problem was simply that doctors had not washed their hands in between dealing with patients.

But merely to be armed with knowledge of hygiene seems a bit ineffectual when faced with a superbug that is spreading fast. We want to know that there are tablets and injections out there that can help us. The problem is there might not be. There have been few developments in the world of antibiotics research. It might be down to hand washing.

So what can you do to protect yourself?

• Bolster your immune system by eating healthy foods, and getting enough sleep and exercise.
• Minimise contact with people who are infected.
• Don't abuse antibiotics, as you could be contributing to this serious problem facing the world. Follow instructions on all medication to the letter.
• And wash your hands regularly.

Bacteria are wily things. They have been around for millions of years, they are becoming drug-resistant, and it looks as if they might just win this round of the battle. Don't make it easy for them.

(Susan Erasmus, Health24, updated March 2012)

(Portions of this column appeared on Health24 and News24 in September 2010)

(Sources: Health24, WebMD.com, Bill Bryson, At home (a history of domestic life), published 2010)