Doctors Battle Drug-Resistant Typhoid Outbreak

We can see the train bearing down on a crowd of people packed upon the tracks, but real action won't happen until it plows through them. If then.

If vaccination campaigns and modern sanitation systems don’t outpace the pathogen, they anticipate a return to the pre-antibiotic era when mortality rates soared.

“This isn’t just about typhoid,” ...“Antibiotic resistance is a threat to all of modern medicine — and the scary part is, we’re out of options.”

Typhoid is endemic to Pakistan, where poor infrastructure, low vaccination rates and overpopulated city dwellings persist.

Experts are also reinforcing hygiene habits for prevention: washing hands frequently, boiling drinking water and eating well-cooked foods. In the longer term, modern sanitation infrastructure is needed.

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We aren't out of options. The article itself provides options: Fix the infrastructure problems. Make sure people stop living in filth and have access to clean water and modern sanitation.

This is handwringing and it also amounts to justifying not fixing the infrastructure problems, which I frankly find not only disingenuous but also disgusting.

Furthermore, in the pre-antibiotic era, people went to "the baths" -- usually located at a natural hot spring -- where they took hot and cold treatments. It's harder to kill infection that way and it really helps to have access to modern water infrastructure, but it is possible to kill infection that way.

There are other options for treating infection beyond that, such as herbal remedies. For decades, antibiotics have been the slam dunk, sure fire answer that is convenient because you can pop a pill and head off for your job while recuperating, but they aren't the only means we have to kill infection.

There is also research on reversing antibiotic resistance. But those studies get largely ignored while the public focuses on these kinds of dramatic stories because, in the minds of most people, news means bad news, a point I have made many times before and don't feel like harping on by giving my same tired examples involving Y2K and the Kuwaiti oil well fires.

There are myriad other options. We just don't really like hearing that for various reasons.

I would much rather see the world focus on how to get the infrastructure built and how to come up with effective solutions rather than more dystopian fiction indulging macabre fantasies of a future without antibiotics where we can't really be arsed to solve it because we are such drama llamas.

The previous types lasted 60 years. The new set lasted ~6 years, or 10 years if you count until we found diseases resistant to both the new and all old types. They're resistant, so the antibiotics still help, but they only slow it down, they don't actually cure anymore. We probably have months until they're fully immune all types.

The issue is that bacteria regularly exchange genes outside of their particular species, so given historical data we have ~2 years time before there are outbreaks of every known disease which fully ignore all types of antibiotics.

This means that (assuming it is verified, and if it isn't, some other outbreak will be verified soon) at this point it is utterly too late for any attempt at restricting antibiotics (which governments are only doing to save money anyway, which is why it is only restricted for human patients and not or very little for agriculture. Besides, it doesn't matter unless every government does it). Worse: at this point restricting antibiotics is counterproductive: we should immediately switch to a different regimen, to maximize the remaining utility. When a patient gets infected with an unknown disease, and there's even slight reasons to suspect resistant strains, they should immediately get a cocktail. A high dose of the 5 known general antibiotics. Especially children.

We all know it won't be done. Firstly, governments move slowly, and never admit mistakes or failure (although you have to appreciate just how slow: outpaced by evolution. I mean ... seriously ?). Admitting failure will be the bigger problem no doubt.

Secondly, it is slightly expensive. It will save many lives, maximize the remaining utility and prevent outbreaks, but it will be somewhat more expensive.

Result will, inevitably, be that in 2 years, half a dozen (common) diseases will require extremely expensive "long-tail" medicines. In a decade, every disease will require it. We need to get started on developing hundreds, and then thousands of individual medications, requiring much more money for medical research than is currently being spent.

And we all know we won't do that. First victim will be sex. Why ? Because when a disease gets called "sexually transmitted" that mostly means only sexually transmitted (the only more restrictive form is blood-transmitted. Only gets transmitted from mother to child or through blood transfusions). Sex will transmit pretty much every disease known with only a few exceptions. When we have 5 common incurable diseases, sex with many partners becomes Russian roulette. When we have 50 ...

This is a terrifying statement, and implies that whatever we do to combat this will not be enough. It would be so stupid if it took a global pandemic of XDR Typhoid to start changing things around abuse or antibiotics in livestock and humans. Actually, I wonder if that would actually lead to change? I would have thought so when I was younger, but now I think deaths might not move the kinds of people pumping livestock with drugs we need to live.

It’s just so frustrating! Life without antibiotics would be a nightmare, hospitals would become charnel houses again, and we’d have to be terrified of every cut and scrape. All for cheap dairy, eggs, and milk?