Dousing a fire with the gasoline that started it?

Now that MRSA (methicillin resistant staphococcus aureus) is reported to be spreading among gay men (the Inquirer had this, and Glenn Reynolds linked the Times version) I'm sure that one demagogue or another will claim it's time to round up the homos, and quarantine them.

Why? Because they are more likely to have it, that's why. From the Times:

A separate part of the study found that gay men in San Francisco were about 13 times more likely to be infected than other people in the city.

The San Francisco researchers suggested that scrubbing with soap and water might be the most effective way to stop skin-to-skin transmission, particularly after sexual activities.

MRSA, for methicillin-resistant Staphylococcus aureus, was once spread chiefly in hospitals. But in recent years, a number of healthy people have acquired it outside hospitals.

Nearly 19,000 people died in the United States from MRSA infections in 2005, the Centers for Disease Control and Prevention has reported.

Demagogic remarks about quarantining people with HIV got presidential aspirant Mike Huckabee in trouble in 1992, and while he has revised his thinking, they still haunt him. Or do they? Might they account for at least some of his support? Is there really any way to know?

Unlike AIDS, which is blood-borne, the problem with trying to contain a disease like MRSA in such a manner is that it's already well-established in the general population. The culprit is the overuse of antibiotics, plus the natural evolution of an organism that will simply do what it can to survive.

From the Wiki entry:

A 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), estimated that the number of MRSA infections treated in hospitals doubled nationwide, from approximately 127,000 in 1999 to 278,000 in 2005, while at the same time deaths increased from 11,000 to more than 17,000.[3] Another study led by the CDC and published in the October 17, 2007 issue of the Journal of the American Medical Association estimated that MRSA would have been responsible for 94,360 serious infections and associated with 18,650 hospital stay-related deaths in the United States in 2005.[4][5] These figures suggest that MRSA infections are responsible for more deaths in the U.S. each year than AIDS.
It's evolution, and it will not stop.

Ron Bailey speculated about using quarantines back in 2003:

Infectious diseases like SARS and MRSA raise the question of how to balance public health and individual liberty. Prior to the advent of modern medicine, coercion was often used to stop the spread of disease. During the Black Death, city officials would often wall up houses in which an infected person was found, trapping healthy family members with them. In the wake of the Black Death, Venice invented quarantine, designed to protect the city from plagues by requiring ships to anchor offshore for 40 days before their crews were allowed to land. It may well have been in the individual interest of each sailor to get off his ship as soon as possible, especially if some shipmates were infected, but it was in the community's interest to protect itself against infectious disease.

Today the United States still runs a quarantine service and has the power to detain persons suspected of carrying dangerous communicable diseases. Throughout history people resisted quarantine, but hopefully today people are more likely to go along with it because they realize that they will have access to the benefits of modern medicine.

Quarantine may become more relevant if a serious bioterror attack occurs or if a highly infectious disease for which there is no good treatment emerges naturally. Protecting the majority from death and disease can and should override a person's right to freedom of movement.

Yes, but whose freedom of movement?

Let's play the Machiavellian game and assume that a fascist superstate has the power to simply round up "at risk" populations in order to protect those who are not deemed at risk. Yes, I know that sounds like circular reasoning, but let's try. Who is at risk? Obviously, people with compromised immune systems are going to be the first to get sick. That includes those with HIV, the elderly and infirm, those who have been taking a lot of antibiotics. These resistant organisms evolved in hospitals, where there are a lot of sick people on antibiotics, so I suppose that hospitals could also be locked down, and no one allowed to leave unless certified "MRSA-free." (As if such a designation would prevent them from just getting sick again from the bacteria still lying around.)

But there's another culprit: the healthy carrier. Because this is a family of bacteria which spreads invisibly, there are doubtless innumerable silent cases which are not "cases" at all, but simply people whose strong immune systems keep the staph at bay. Their bodies may have it, but it never manages to get a toehold, and they never take antibiotics because they are not sick. Before antibiotics, that was why some people got sick while others didn't. Yet these strong healthy carriers are fully capable of spreading the disease to the less healthy (the weak).

Warns the Mayo Clinic web site:

If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected with MRSA. Healthy people can be colonized with MRSA and have no ill effects. However, they can pass the germ to others.
The idea (which I'm sure will be proposed) of quarantining those with weaker immune systems is little more than a feelgood approach, which will do nothing in terms of the long term evolution of MRSA.

On the other hand, I'm not sure that massive treatment programs would work either. They'd only be helping MRSA evolve into SUPER MRSA.

One doctor argues that quarantine measures don't work, because MRSA is caused by exposure to antibiotics!

....our worse fears are true, it is in the water. Quarantine measures can be expected to be useless against MRSA. This has been borne out by observation. The hospitals in Syracuse, where I used to practice Medicine, immediately instituted quarantine measures to limit the spread of MRSA. The quarantine wards got larger and larger. This method was not effective. While hand washing is nice, it can backfire. The doctor who is vigorously washing their hands between patients will develop breaks in his skin where bacteria can enter and infect him. Further, this infection is spread by the presence of the antibiotic, not by the transfer of organisms.

To make it very clear: Normal bacteria that are present on the skin convert to MRSA when exposed to antibiotics. Put another way, people who do not have MRSA develop MRSA by being exposed to antibiotics.

If she is right, then quarantining and treating MRSA patients might cause evolution to accelerate, and thus make the problem worse.

Not that such concerns would matter to a bureaucracy that loves unsolvable problems, or demagogues who enjoy pitting people against each other.

My advice would be to avoid antibiotics, bureaucrats and demagogues like the plague.

MORE: Not to give fascist superstaters any ideas, but it occurred to me that if the theory is that antibiotic treatment helps MRSA, then draconian restrictions on the use of antibiotics would be the most effective way to slow or stop the spread of the bug. At the risk of sounding darkly utopian and hysterically dramatic, to really play this out, those sick with MRSA would have to be denied all antibiotic treatment. (Fortunately or not, few doctors would cooperate in refusing to treat sick people -- even if told it was in the overall interests of public health.)

AND MORE: I think it needs to be stressed that Staphylococcus aureus is a very common bacteria -- so much so that 25% to 30% of the population is considered "colonized" (that is, they have staph, but they're not infected.) According to the CDC, "approximately 1% is colonized with MRSA." In order to determine whether a given individual is colonized with MRSA, he'd have to first be found to have staph, then that would have to be further tested to determine whether it is antibiotic-resistant.

I don't see any practical way to identify healthy colonized people. Furthermore, any testing is only going to be a snapshot of what that individual has at that point in time, and at the swabbed location. You might test negative today, then visit someone in the hospital and get it on you tomorrow, and become "colonized" without knowing it.

And even if colonized healthy carriers could be identified, would it really make sense to "treat" them with antibiotics for a disease they do not have?

UPDATE (01/16/08): Well that didn't take long for my prediction to come true. As if on cue, regular emailer Matt Barber sprang into action, blaming homosexuality -- and liberal "promotion" thereof -- for MRSA:

"The human body is quite callous in how it handles mistreatment and the perversion of its natural functions. When two men mimic the act of heterosexual intercourse with one another, they create an environment, a biological counterfeit, wherein disease can thrive. Unnatural behaviors beget natural consequences.
Skin-to-skin transmission does not require sexual intercourse, whether of the natural or "unnatural" varieties! (But maybe I shouldn't say that, lest Barber read it and refuse to shake hands with homos. Heaven forfend!)
"In recent years our culture has adopted a laissez faire attitude toward sexual deviancy. Television shows like Will and Grace glorify the homosexual lifestyle while our children are taught in schools that homosexuality is a perfectly healthy, alternative sexual 'orientation.' 'Stay out of our bedrooms!' we're often commanded by militant 'gay' activists.

"Well, now the dangerous and possibly deadly consequence of what occurs in those bedrooms is spilling over into the general population. It's not only frightening, it's infuriating.

"Citizens, especially parents, need to stand up and say, 'No More! We will no longer sit idly by while politically correct cultural elites endanger our children and larger communities through propagandist promotion of this demonstrably deadly lifestyle.'

"Why does it take a potentially deadly Staph epidemic for people to acknowledge reality? Will that even do it? Enough is enough!" concluded Barber"

The assumption seems to be that gays caused the bacteria to "break out" into the "general population." In reality, HIV infected people are more vulnerable to MRSA, which has existed for years, but continues to evolve as it grows ever more resistant to treatment.

For years the general population was overmedicated with antibiotics, MRSA developed, elderly patients and the chronically ill sickened and died from MRSA, and no one claimed it was their fault. But now that gays are discovered getting it from having sex (or skin-to-skin contact), suddenly they become responsible not just for their own illnesses, but for the disease "spilling over into the general population."

You'd almost think MRSA -- and staph -- had suddenly became a STD, and therefore evil.

Do they know that the common cold can be sexually transmitted?

posted by Eric on 01.15.08 at 10:24 AM










Comments

MRSA is not resistant to all antibiotics - the M is for methicillin. Though I'm not a scientist or doctor, the claim that exposure to any or all antibiotics turns SA in MRSA seems a bit overboard.

Don't get me wrong, I'm not advocating the overuse of antibiotics... but - when they are needed, they are generally needed before the 2 or 3 days that labs take to find out exactly what little bacteria is eating away at you. Those with pneumonia or meningitis risk death or permanent lung or brain damage before the lab results get back.

Donna B.   ·  January 15, 2008 12:53 PM

That article headline gave us chills over in the public health office. I'm pleased that you wrote it up in such detail, Eric. Given that I'm one of the faceless bureaucrats who will eventually be called upon to do something about it, its good to have this kind of stuff to reflect on before the hysteria begins.

urthshu   ·  January 15, 2008 7:31 PM

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