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The Untimely Reporting of Drug-Resistant Outbreaks in the United States

The Untimely Reporting of Drug-Resistant Outbreaks in the United States
*This Op-Ed does not reflect the views of CDDEP.

The unconscionable delay and coverup of the novel coronavirus by China’s government has spurred worldwide condemnation.  For almost a month after the outbreak was suspected,(1) the information was hidden from their citizens which inflamed public unrest and mistrust in their government. (2)  An outcome that no major world power should desire.

Unfortunately, it appears that public reporting of COVID-19 cases by the Chinese government is more timely compared to what the average citizens in the United States are experiencing regarding drug-resistant bacteria.  The US Centers for Disease Control and Prevention (CDC) estimates at a minimum, that these pathogens cause 47,800 deaths each year(3).  According to Michael Craig, MPP, at the CDC, “Every 11 seconds someone in the United States gets a resistant infection and someone dies every 15 minutes.”(4)  However, only a few of these infections are publicly reported and when they are, the delayed reports do far too little to safeguard the public.

As a retired country doctor from Appalachia, I remember back in 2013 when a USA Today reporter called me regarding a dangerous outbreak in a nearby hospital.  A highly virulent form of the dangerous soft tissue infection, MRSA, was killing patients within a few hours. (5)  The State Health Department quickly responded and controlled the outbreak.  But the public was not notified.  The reporter who investigated the story came across a government slide presentation which was mistakenly posted in a public website folder and indexed by Google.  Only then and too late for the public to respond, did we find out about the danger.

But MRSA is not the most dangerous drug-resistant bacteria we need to be aware of.   Carbapenem-resistant Enterobacteriaceae (CRE) is a deadly pathogen which has a 50% fatality rate once it invades the bloodstream .  The CDC describes this organism as the “Nightmare Bacteria,” and it has landed on the CDC’s list of the six most Urgent Threats.  Two outbreaks of this organism in Kentucky became known to the public only after being reported in the CDC’s Morbidity and Mortality Weekly Report.  The first incident almost six months after its occurrence,(6) and the second almost a year and a half later.(7)

A New York Times investigative report focused on the delayed reporting of the second incident and compared it to a much faster report that the CDC had made of an outbreak of deadly bacteria in a hospital in Mexico.(8)   Not only was the Mexican threat report faster and identified the facility, but it also involved a bacteria classified as a lower-level “Serious Threat”.

Of the CDC’s five most urgent biological threats of 2019, four are becoming common healthcare-acquired infections but only one, Clostridioides difficile, is publicly reported.   And the reporting of this data is delayed by at least 9 months.

The dangerous organism Candida auris is also on the CDC’s Urgent Threat list, but it is not required to be publicly reported on a national basis.  After pressure by the New York Times in November 2019, New York became the first state to publicly report this pathogen, but in much of the rest of the nation, the public is kept in the dark. (4)

There is also important data which is collected by the United States government, but shielded from the public.  For example, data on the rates of community MRSA bloodstream infections, as determined by infections that occur in the first three days after hospital admission, would provide important insights into the extent that MRSA has taken hold in the communities.  This data could even be used to give guidance into when all facility admissions should be screened for MRSA.  But as with the occurrence of infections from the most dangerous pathogens, the public is shielded from this data.

The reasons often given to justify this obfuscation is not to panic the public and that these organisms primarily infect only the frail and elderly, implying that these infections, and some of us, do not matter.  Being over 65, I fall into these categories and life to me is just as precious.  The acceptance of this argument and the status quo equates with the acceptance of the shortening of the human life span.

Over the course of the last few decades, the United States has fallen into the dark abyss of secrecy: if truth is inconvenient, just cover it up and don’t disclose it.  The United States needs to implement mandatory real-time public reporting of the CDC’s dangerous biological threats.

For anyone in the United States to criticize another country for not warning their public regarding dangerous pathogens is the pinnacle of hypocrisy.  As my mother would say, it is the pot calling the kettle black.   Let’s first put our own house in order before criticizing the house of others.

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References:

(1)  Huang C, Wang Y, Li X, Et. Al.   Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.  Lancet, 395 (10223), 497-506.  2020 Feb 15.   https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

(2)  Zhong R.  As Virus Spreads, Anger Floods Chinese Social Media.  New York Times.  Jan 28, 2020.   https://www.nytimes.com/2020/01/27/technology/china-coronavirus-censorship-social-media.html

(3) Centers for Disease Control and Prevention 2019 Threat Assessment.   https://www.cdc.gov/drugresistance/biggest-threats.html

(4)  Richtel M., Jacobs A.   New York Identifies Hospitals and Nursing Homes With Deadly Fungus.  New York Times.  Nov. 13, 2019.   https://www.nytimes.com/2019/11/13/health/candida-auris-resistant-hospitals.html

(5)   Eisler P.  Dangerous MRSA bacteria expand into communities.   USA Today.   Dec. 16, 2013.  http://www.usatoday.com/story/news/nation/2013/12/16/mrsa-infection-community-schools-victims-doctors/3991833/

(6)  Yaffee AQ, Roser L, Daniels K, Humbaugh K, Brawley R, et al.  Verona Integron-Encoded Metallo-Beta- Lactamase–Producing Carbapenem-Resistant Enterobacteriaceae in a Neonatal and Adult Intensive Care Unit — Kentucky, 2015.  Centers for Disease Control and Prevention MMWR Morbidity and Mortality Weekly Report.  Vol. 65 / No. 7 February 26, 2016   https://pubmed.ncbi.nlm.nih.gov/26914726-notes-from-the-field-verona-integron-encoded-metallo-beta-lactamase-producing-carbapenem-resistant-enterobacteriaceae-in-a-neonatal-and-adult-intensive-care-unit-kentucky-2015/

(7)  Chae S, Yaffee AQ, Weng MK, D. Cal Ham, Daniels K, Wilburn AB, et. al.   Investigation of Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Among Patients at a Community Hospital – Kentucky, 2016     Centers for Disease Control and Prevention MMWR Morbidity and Mortality Weekly Report.  January 5, 2018 / Vol. 66 / Nos. 51 & 52.   https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a5.htm

(8)  Jacobs A & Richtel M. Culture of Secrecy Shields Hospitals With Outbreaks of Drug-Resistant Infections.  New York Times.  April 8, 2019.  https://www.nytimes.com/2019/04/08/health/candida-auris-hospitals-drug-resistant.html