At the end of each year, we all turn back to reflect on the events that made the most impact in our lives. In the context of microbes, this has been, to paraphrase the Queen of England, an annus horribilis. Granted, the last 52 weeks have seen some stories demonstrating the benefits of microbes in our lives, from the potential discovery of a breast-cancer resistant microbiome to the identification of microbes capable of reducing nuclear waste. Yet the most memorable stories of the year reveal just how much we need germs relationship therapy.
The Ebola epidemic was without a doubt the most prevalent story of the year. For the entire span of 2014, the virus ravaged several countries in West Africa and even put the United States on high alert. From the World Health Organization to the Centers for Disease Control and Prevention, governmental and international organizations were left reeling. The unprecedented numbers of infections and death even prompted the formation of the United Nations Mission for Ebola Emergency Response (UNMEER) and brought in unexpected partners such as the International Monetary Fund to help stave off potential non-medical consequences.
This was the face of the epidemic in the media but it wasn’t the whole story. What was for the most part left out of the headlines was the actual nature of Ebola at the microbiological level and how easy it can be to stem the tide of infection. The virus isn’t spread unless an infected individual is quite ill or has passed on. When a patient does shed, the pathogen can be killed with routine disinfection. Not to mention it is quite unstable in the environment unless it is surrounded by bodily fluids. Proper prevention can quickly put an end to any outbreak as it had dozens of times before.
While microbiologists may have known the nature of Ebola and why everyone should remain calm, the public did not. As a result, people turned to concern and at times panic. In the United States, where only a few people actually caught the virus, the rise of Fearbola led many to call for extreme actions ranging from shutting down the borders to unnecessary quarantine procedures. Only when the nature of the virus manifested through the lack of any spread in the public, the tide turned and the panic eventually died down.
Ebola may have been the most talked about story, another truly highlighting our lack of appreciation, respect and commitment to a relationship with microbes was shared this year. On April 30th the World Health Organization released their first global report on antimicrobial resistance. Though media attention was significantly less robust than that of Ebola, when it comes to the long term impact on our lives, this issue is far more concerning. The report clearly stated without proper interventions to stop the misuse, abuse and overuse of antibiotics, we will soon find ourselves in a post-antibiotic era in which we can no longer use our most trusted defense to fight off infections.
The rise of antimicrobial resistance has been decades in the making. Despite calls for more prudent use of these life-saving drugs, the world has not listened. Even today, antibiotics are prescribed for everything from viral infections such as colds and flu – for which they are completely useless – to mild bacterial infections which can be handled by the body’s own immune system. In addition, the agricultural community continues to use these weapons not to fight disease, but to prevent it. Though the amounts are reducing, the trend may not be fast enough to stop the eventual rise of resistance.
There may be a light at the end of the tunnel. A number of microbiologists are looking towards forming a better relationship with other microbes, such as bacteriophages and fungi, to find novel routes to fight infections. Moreover, research into the benefit of probiotics in preventing infections, such as Clostridium difficile, continues to be published. The combined efforts of these researchers reveal we may prevent the post-antibiotic era by forming better relationships with good germs.
As to the epitome of our dysfunctional relationship, there is only one winner: MERS. The Middle East Respiratory Syndrome (MERS) is caused by a coronavirus not unlike the same viral agent that causes a form of the common cold. But this particular virus is different, infecting people with incredible virulence and causing significant rates of fatalities. Like Ebola, the MERS virus ravaged an entire region, this time the Middle East, and caused significant concern for public health.
Microbiologically speaking, the virus is easier to contract than Ebola yet is still completely preventable. It’s not very stable in the environment and can only spread through close contact with another person. But due to poor infection prevention and control measures, the virus infected a large number of healthcare workers; at one time, they made up two-thirds of the cases. Only through strengthening of the basic skills of hygiene and protective equipment was this spread stopped.
But this aspect of the outbreak was not entirely indicative of the poor relationship. That came about when researchers revealed the illness may be spread through dromedary species. In this case, the most important means to stay safe would be to prevent close contact with camels. However, as these animals represent an important part of the Middle East lifestyle, there was a backlash against the public health authority. Not only did farmers ignore the advice, they flouted it by sharing photos in which they kissed the animals. Although no one knows if any of these actions led to infection, the response revealed how little humans cared for microbial health. Now another wave of MERS appears to be underway. Only time will tell if anyone has learned.
There is little doubt more needs to be done to improve our relationship with microbes. Microbiologists and public health officials will continue to expend their energies to improve our knowledge base and provide us with the information we need to improve our bond with the microscopic world. Some of the most interesting and relevant will appear in this column in the hopes of bridging the gap between the researcher and the public. Hopefully, more people will come to realize they have a relationship with our microbial co-inhabitants and unlike what many may believe; it can be good and prosperous. In this way, 2015 may turn the tide such that it will be an annus mirabilis.