Swine flu was first identified in 1930 as a common and sometimes fatal respiratory disease in pigs caused by type A influenza virus (H1N1). Human are said to have infected the pigs and now the virus has returned to infect humans. Influenza A (H1N1) virus resistance to oseltamivir was reported by WHO in July 2008 and has spread all over the world. These antiviral treatment is expensive and does not kill the virus but reduce viral sheading and spreading. Some beleive the treatment may reduce infection if taken as prophylaxis. The treatment must be given as soon as the symptoms occur but it is very difficult to diagnose clinically. Indiscriminate use will also make the virus develop resistance.
The European Centre for Disease Prevention and Control said that the infection of humans with influenza ‘A’ virus of animal origins is a concern “because of the risk that this could represent the appearance of viruses with pandemic potential.”
Swine and human H1N1 viruses are not the same, which means that seasonal flu vaccines for humans will not work against the animal variant. The impact of a new influenza pandemic has grossly been estimated at 1-2 billion cases of flu, 5-12 million cases of severe illness, and 1.5-3.5 million deaths worldwide. It could result in 1 million to 2.3 million hospitalizations and 250 000 to 650 000 deaths in industrialized nations alone.
Patients with Swine flu will have poor immune response to prevent bacterial infections. This will help entry of CA-MRSA (colonised in our nostrils) through the mucus membrane and spread rapidly to lung producing pneumonia. In hospitals, very sick patients will be subjected to practical procedures like IV drips and catheter insertion. These devices will help MRSA enter circulation resulting in invasive MRSA (severe septicaemia and death).
HIV was taken seriously but not MRSA as a major threat in 1980s. In UK, MRSA was rapidly spreading in neonatal units. Infected babies were not even isolated and the callus attitude of nurses and doctors helped these bacteria multiply and spread. The first report of invasive CA-MRSA was reported in USA was reported in JAMA (2007 highlighted in CNN. Since then various countries have come forward to accept they have a problem. This bacteria has been spreading their plasmid and educating other bacteria to resist antibiotics. Now we have almost ten different bacteria and fungus that are resistant to treatment.
In 1980s, we noticed babies who were subjected to various practical procedures (inserting IV cannula, intubation or inserting catheters) were getting MRSA. We could not get any funding to organise studies to prove my hypothesis nor a device to compare. JAMA published information sheet in 2007, which include invasive procedure as the risk factor.
To help me prove my hypothesis, I developed two devices, tested my technique and proved we could reduce invasive practical procedures. I hoped the manufacturers would help develop new devices to help us perform practical procedures and reduce contaminated hospital waste that breed bacteria. The results of my study were published in medical journals but the cannula manufacturers did not bring in changes because they felt my technique would de-skill doctors. Unfortunately, this simple mistake has now escalated to catastrophic proportion, and difficult to manage.
NHS (UK) spent billions () cleaning the hospitals in 2004 but the infection rate increased. Antiseptics and strong chemicals used to clean must have killed the good bacteria in the sewer and drains resulting in resistant strains now colonized. We must clean our act and take meticulous care when we perform practical procedures. Studies published by Dept of Health, state “Dirty hospitals did not have higher incidence of MRSA when compared to very clean hospitals, the result was puzzling”. They are now pointing their fingers at IV access & urinary catheters.
CA-MRSA is said to be colonised in sewers, rivers and soil and is said to infect healthy adults and children. One in three of us carry these bacteria in our hands and nostril. This bacteria is also said to be resistant to antiseptic lotions used to clean skin before performing blood tests, inserting needle or cannula. More than 50% of nurses who wash hands more than 10 times were found to develop dermatitis and are colonized with MRSA. Our stethoscope, swipe cards and mobile phones are colonized with CA-MRSA. White blood cells in our body cannot kill them because the bacteria is said to carry an enzyme that destroy immunoglobulins. We must make sure the health care workers wash their hands and clean their equipment.
We feel ethically uncomfortable to subject patients to practical procedures knowing this could potentially introduce bacteria that kill the very patient we try to revive or treat. We also feel very sad to when we read about these spreading infections in our community because these major corporations could have averted this problem long time ago. Over enthusiastic protection of their medical devices and preventing advances in developing new technique has made people loose faith in doctors and is likely to end of our medical profession.
