SUPERBUG CRISIS IS ALREADY HERE

More deaths, huge costs, report warns

Hundreds of thousands of lives lost from infections that have been treatable for the last century. Fewer organ transplants and joint replacements because they’re just too risky to perform. Stigma against “carriers” or “the infected.” A shrinking economy.

A new report is raising the stark possibility of Canada returning to an almost pre-antibiotic era — the prospect of a future where antibiotics against common infections no longer work.

“There have been few health crises on this scale in Canadian history,” warns the Council of Canadian Academies expert panel report, When Antibiotics Fail.

While it’s not quite the apocalyptic world others have warned of, if the overuse of antibiotics isn’t slowed, “Canada will be greatly changed within a few decades,” the report warns.

Already, 26 per cent of bacterial infections in Canada are resistant to the firstline drugs generally used to treat them, according to the panel’s estimates.

In 2018, there were 250,000 resistant bacterial infections in Canada, and more than 5,400 directly related deaths, only slightly fewer deaths than from Alzheimer’s disease.

If the resistance rate hits 40 per cent by 2050 — a scenario the panel deems “highly plausible” — 13,700 people would die each year from resistant bacterial infections.

The panel found that antibiotic resistance costs the health-care system $1.4 billion a year, and that Canada’s economy has already begun to shrink as a result of drug-resistant superbugs due to more deaths and fewer sick people able to work.

Overall, the panel estimates drug resistance reduced Canada’s GDP by $2 billion in 2018. If the resistance rate reaches 40 per cent, the GDP would fall by $21 billion per year.

“The prospect of a world where antimicrobials no longer work is alarming,” the 13-member panel warns. In extreme cases, now curable, run-of-the-mill infections would be impossible to treat. “Illnesses would be longer and more severe, treatments more expensive and the risk of death higher,” the panel warns. Routine procedures that rely on giving antibiotics prophylactically to prevent infection — kidney dialysis, chemotherapy, organ transplants, surgery for joint replacements and caesarean sections — “would be too risky to be made widely available.”

Infections causing pneumonia, gonorrhea, urinary tract infections and gastrointestinal illnesses are already becoming exceedingly difficult to treat as the drugs become less effective, the panel says. Produced at the behest of the Public Health Agency of Canada, which is set to release a federal plan next year, the report estimates that roughly one in 19 deaths in Canada are attributable to resistant infections.

“If climate change wasn’t here this would probably be the No. 1 pressing issue facing humanity,” said panel chair and University of B.C. microbiologist B. Brett Finlay.

The problem has been coming for decades, “but it’s coming harder and faster and more real, and it’s going to confront everyone,” Finlay said.

“I’ve been working in this area since the 1980s and I didn’t think it could get this dark.”

Globally, the World Health Organization has called drug-resistant bacteria among the top 10 health threats on the planet.

After the heydays of the 1980s, drug companies are no longer investing in finding new antibiotics, because it’s largely a whack-a-mole game. “As soon as you make an antibiotic, everyone uses it, bugs become resistant and it’s no longer useful,” Finlay said.

The panel included diverse expertise ranging from epidemiologists and doctors to agriculture experts, modellers and economists.

It uses the cases of the SARS outbreak in 2003 to ask, what might a future of increasing drug resistance look like?

With SARS, “people stopped going out. They stayed home, they avoided unnecessary contact with other human beings,” said panel member Amélie Quesnel-Vallée, a professor in epidemiology and sociology at McGill University. The infected were isolated and quarantined.

“You could imagine that daycares (or university dormitories) might not be so popular; everything that involves a social gathering might be perceived as risky,” she said.

SARS was a point in time, a scare that came and went. However, if rampant drug resistance became the new normal, the broader social impacts could far outweigh the economic costs, the panel said. We might become less open and trusting, Quesnel-Vallée said, with people thought to be a risk to others becoming the targets of discrimination.

“We are a social species,”

Quesnel-Vallée said. ” Any threat to that socialization would be very troublesome for people’s well-being, and society’s functioning.”

There are already examples of resistant strains spreading like SARS. In one case, a woman became infected with resistant bacteria while in India and brought the strain back to an Edmonton hospital, where it spread across three surgical units, killing at least one person.

“We need to move the agenda forward and not be thinking that it’s 50, 80 or 100 years out,” said University of Calgary infectious disease physician and panel member Dr. John Conly.

The report includes some rather terrifying scenarios if we were to truly return to the pre-antibiotic era. Doctors might be forced to use toxic drugs, “or, if possible, removal of the source of infection (e.g. through amputation).” “The actual delivery of care itself may change, as increasing (antibiotic resistance) may bring about conversations about the duty to care versus risk to those providing care,” the panel added.

While it’s unlikely we would ever reach 100 per cent resistance to infection, “the risk of a post-antimicrobial era in the 21st century is no longer remote,” the report warns.

POSTMEDIA NEWS FILES A staff member at York Central hospital in Richmond Hill glances out the doors of the closed facility after fears the 2003 SARS outbreak was spreading further. At its peak, the outbreak caused people to avoid human contact, one epidemiology professor says,