COVID-19 has reminded us all of the fragility of modern medicine. It’s 2020 yet in our fight against a worldwide pandemic, we’ve relied entirely on century old techniques for controlling infectious disease like keeping our distance from each other and frequent hand washing.
It was only 70 years ago that a person could stub his finger on a rose bush in the garden and be in hospital dying of septicaemia five days later. A person could cut their toe on a piece of glass and be buried in a cemetery a week later. It wasn’t unusual for influenza pandemics or outbreaks of measles or diphtheria to grip communities and cause illness and death. Smallpox was feared by all.
Last year, in what seems a long-time ago now, we faced a situation where measles vaccination rates had fallen to such a point that New Zealand was faced with a deadly outbreak. This disease kills and it went on to have tragic consequences in the Pacific Islands.
Prior to last century we didn’t have vaccines or antibiotics, which today are the mainstays of modern medicine. Yet, I hear from patients who have chosen not to vaccinate as if they can outrun measles or polio or somehow have ‘natural immunity’ to life-threatening diseases (they don’t). The measles epidemic taught us that diseases such as measles, or whooping cough, diphtheria and polio still exist and can kill. We have become immune to the potential of harm from these diseases because we have, at our peril, forgotten about a world where these defences did not exist. The tennents on which modern first world medicine and health are built – vaccines, antibiotics, and for that matter sewerage systems – are fragile and need looking after.
While vaccination rates have fallen, it’s the opposite for antibiotics but with similar results. In New Zealand we consume an estimated 36 tonnes a year of common antibiotics. It’s not uncommon in East Porirua where I work, to now see resistance to antibiotics used to treat common infections in skin and urine.
Multi-resistant strains of bacteria that stalk our hospital corridors causing infection are becoming part of the everyday landscape of modern medicine. We are in crisis and there is a continual fight to counter these tricky organisms. In New Zealand we now see situations where patients are faced with skin infection and lung infections that are resistant to all antibiotics and cannot be treated.
Alexander Fleming, who invented penicillin, which is the base for antibiotics, did so accidently. Imagine a world where Fleming, notoriously messy, hadn’t been eating a cheese sandwich over his petri dishes, scattering cheese fragments over them, then noticing only six weeks later when he returned from holiday in the Scottish Highlands that bacteria had not grown around the now mouldy cheese. If Fleming weren’t so messy the course of modern medicine wouldn’t have changed.
It wasn’t until 10 years later when an English policeman was dying in an Oxford hospital bed after stabbing his finger with a rose thorn that Fleming’s new discovery (the mould penicillin), was used. The man, Albert Alexander, miraculously recovered, surviving certain death, and went on to live a long life. We are lucky indeed that Fleming was both messy and had a fondness for cheese sandwiches.
The reality is most infections, especially respiratory ones like COVID-19, are viral so antibiotics will never work. Yet patients often view (and request) antibiotics as they do paracetamol, a cure for all ills, not as a precious limited resource.
COVID-19 has remined us that a world did exist where viruses and bacteria were deadly and although often hidden continue to be deadly. They lurk beneath the surface of our awareness and are prepared to strike at us individually or on a global level.
Unlike accidentally spilling cheese, the search for a COVID-19 vaccine is complex and costly with billions of dollars being spent in investigation and trialling. More than 20 trials are now underway around the world. However, it is most likely it will be the middle of 2021 before a vaccine is ready and can be rolled out. Billions of doses will be required and an effective, well-managed delivery system will be needed for timely delivery to New Zealanders.
A vaccination will prevent infection, not cure COVID-19. It will work in a similar way the vaccines for polio and smallpox worked and will halt the pandemic, which is what we most need.
Vaccination, not overusing antibiotics and respecting the advances we have made are the only way forward. Do not lose sight that vaccinations and antibiotics are there for a reason and need respect.