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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, if the number of effective drugs continues to run out, “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 first-line 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 healthcare 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.”

"If climate change wasn’t here this would probably be the number one pressing issue facing humanity."

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 number one 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 SARS outbreak in 2003 to ask, what might a future of increasing drug resistance look like?

With SARS, “peopled 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 wellbeing, and society’s functioning.”

There are already examples of resistant strains spreading like SARS. In one case, a 62-year-old woman became infected with resistant bacteria while treated in India for a fractured femur and brought the strain back to an Edmonton hospital, where it spread across three surgical units, killing 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.

"Everything that involves a social gathering might be perceived as risky."

An image of methicillin-resistant Staphylococcus aureus. The resistant strain, MRSA was first discovered in the U.K. in 1961 and is now widespread. 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 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, “The risk of a post-antimicrobial era in the 21 st century is no longer remote,” the report warns.

The panel describes how a 17-year-old Ontario high school student and his family visited relatives in Houston, Texas, in 2016. One of those relatives had recently suffered from an infection with methicillin-resistant Staphylococcus aureus, or MRSA. A few weeks later, the previously healthy teen arrived at a Scarborough hospital with a fever, dry cough and shortness of breath. Five days later he was dead. Despite aggressive intensive care, he died of necrotizing pneumonia, which caused tissue in his lungs to virtually dissolve. Six antibiotics failed to stop it.

The single greatest driving force of resistance is the overuse and misuse of antibiotics, Conly said.

During each of the last two flu seasons, Calgary had the largest number of hospitalizations due to influenza in the last two decades. Antibiotic prescriptions spiked, and so, too, did Clostridium difficile infections of the colon. Not only are antibiotics not useful for treating viral infections like the flu, they can destroy healthy bacteria in the gut, making it easier for harmful bacteria like C. difficile to flourish. “We had a secondary wave of C. difficile” because of inappropriate antibiotic use, Conly said.

People need to understand that antibiotics don’t work for viral infections, but also that the drugs, when prescribed, should be taken for the full course and not stopped early, and that no one should take antibiotics prescribed for someone else.

Other strategies include better infection control in hospitals, stepped up surveillance (one of the panel’s major findings was that Canada’s surveillance of “priority pathogens” is seriously weak compared to other countries) and investing in alternative therapies like vaccines or phage therapy — using viruses to kill bacteria.

Copyright Postmedia Network Inc., 2019