Staying healthy in a post antibiotic world

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Augustus
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Staying healthy in a post antibiotic world

Post by Augustus » Fri May 31, 2019 12:10 pm

jacob wrote:
Fri May 31, 2019 8:55 am
Recall that antibiotics have only been in general use since the 1940s (when the human population---and presumably correspondingly the livestock population----was 3x smaller than it is today at almost 8 billion). This has allowed us to move the "balance of power" far in our favor. Certainly it is not against the laws of physics that it could/would snap back as fast or faster than it moved in our favor. It's somewhat tragic that humans are using antibiotics to boost yields (both animals and pesticides/fungicides for plants) rather than keeping them in reserve for last-stands. However, this is not much different than how we're burn oil for transportation and heating instead of reserving it for the far more valuable role as chemical feedstock.

Basically, the average/majority of humans are ridiculously short-sighted but will happily cook up self-serving stories/worldviews. The current use of antibiotics will be defended based on economic theory while people worrying about it will be called alarmists and those who make personal efforts will be made fun off for not eating bacon, etc.
I've been intrigued by this for a while, I've read from many sources that eventually antibiotics will probably stop working. Is that a valid assumption? I'm talking medium to long term here, 10-200 years. I'll stop caring after I'm dead of course, but it will be someone elses problem.

If so, what lifestyle behaviors would one have to change to reduce risk in that scenario? Living in a high population area seems like a big problem.

I had also asked about this about a year ago, and was informed that medicine has advanced significantly, I guess my counterpoint to that would be that medical resources would be spread incredibly thin if there were ever a pandemic scenario, and advances in medicine probably wouldn't help you all that much.

Thoughts? Mostly I'm interested in behavior changes. The ones that spring to my mind the fastest are homeschooling my kid, and trying to insulate myself from high population areas. Seeing as my wife would think that's crazy talk, I'd either need to convince her to go on an extended vacation if bad things happened, or figure out how to reduce exposure while living in a high population area.

If there were a pandemic, and medical resources were overwhelmed, I suppose one ought to know how to provide self care at home?

Is it correct to say that infections in a non pandemic/medical resources overwhelmed scenario, are not something to worry about given that you check yourself into a hospital quickly? I wonder what the mortality rate on a random infection would be, like a paper cut, etc without antibiotics.

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jennypenny
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Re: Staying healthy in a post antibiotic world

Post by jennypenny » Fri May 31, 2019 12:39 pm

Augustus wrote:
Fri May 31, 2019 12:10 pm
Is it correct to say that infections in a non pandemic/medical resources overwhelmed scenario, are not something to worry about given that you check yourself into a hospital quickly? I wonder what the mortality rate on a random infection would be, like a paper cut, etc without antibiotics.
I'd say the last place you'd want to be is a hospital. My advice in a post-antibiotic world is to avoid the hospital, mostly by avoiding injuries but also staying healthy and knowing basic first aid.

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Dream of Freedom
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Re: Staying healthy in a post antibiotic world

Post by Dream of Freedom » Fri May 31, 2019 12:48 pm

I would think you would want to take the opposite approach to isolating yourself. Doesn't your immune system adapt to new microbes when it encounters them?
There are times when it is necessary to take antibiotics like with surgery, but taking antibioticsweakens your microbiome and leads to the antibiotic resistance you mentioned. So you should avoid them if possible.

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Ego
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Re: Staying healthy in a post antibiotic world

Post by Ego » Fri May 31, 2019 2:14 pm

MRSA is a good example of what we may see in the future. One strain of MRSA started out as a simple human staph infection that was treatable with antibiotics. Then it jumped to livestock. In the US we treat cattle with low-dose tetracycline and methicillin because it encourages growth. DNA analysis of the strain showed that it became resistant to antibiotics while infecting livestock. Tetracycline and methicillin are the first drugs used for staph infections in humans.

As individuals we cannot control the use of antibiotics in other humans or livestock, so what can we do? It's a catch-22. Limiting personal exposure to all antigens will diminish the likelihood of getting infected with a superbug but an immune system that does not experience sufficient exposure may not learn to calibrate a correct response to infection.

Personally, I err on the side of exposure. YMMV

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Re: Staying healthy in a post antibiotic world

Post by jacob » Fri May 31, 2019 2:23 pm

I read somewhere that the average metropolitan hospital only has on the order of 150-300 body bags on hand. Why that number? It's what would be handy in case of a plane crash. In terms of pandemics---and unless something has changed in the past few years which is probably doubtful---the US is rather unprepared($). The total number of people who can be treated simultaneously for something like Ebola in the US is about 10ish(*) insofar all procedures are followed and the proper hightech equipment is used. The key-resource on this is Michael Osterholm at CIDRAP. He's written a bunch of books for mainstream consumption as well.

(*) If you ever catch Ebola (ha!), you'll definitely want to be in one of those units ASAP.
($) The idea of paying to maintain excess capacity in case of a rare event goes rather against the mantra of health care profit maximization and individual freedom of choice. For starters, it would cost a lot of money ...

This of course pertains to what happens AFTER people get infected. The primary defense is to avoid getting infected. This means avoiding vectors. Very common vectors are other [sick] humans. This means achieving herd immunity for vaccinations and if nothing else then definitely be vaccinated oneself. Unfortunately, there's an increasing number of yahoos (first progressive Luddites on the left who believe in getting sick naturally or something ... and now low-educated far-righters who avoid modern medicine in the name of freedom) choosing not to be vaccinated. Well, in general, having the disease rarely if ever makes you stronger although it does in some cases make you immune. IOW, the idea that "as long as it doesn't kill you ..." is misguided. Preferably you'd always want to avoid the disease. Unfortunately, it seems the social maturity is not there. If no vaccination is possible, it means eliminating the vectors. This can be as simple as proper sanitation. This, in fact, is a big reason why cities are no longer the death traps they once were. But if your city is demonstrating an inability to keep sewage from flowing in the streets (e.g. during extreme rainfalls) it's time to leave. Here I'm mainly thinking major cities with sewerage systems inadequate for the combination of extreme weather + increased population, but also see comment about LA below.

On the personal level ... don't touch your face. Wash your hands frequently. Don't inhale other people's exhalations. Wearing a mask is dorky but it works. Do all that, and you'll probably be one of the last people to catch it :) Other vectors are harder to stop, e.g. mosquitoes and ticks. Still, window screens has done wonders (malaria used to be endemic on the entire eastern seabord prior to screening residential buildings and draining most/all of the swampland. Ticks are on the increase practically all over the US now. This is because of humans constructing homes in "natural surroundings". This, in turn, means eliminating predators (gotta keep people safe) which causes a runaway of the carriers (deer, mice) that the ticks feast on. Much of this can be avoided by staying away from nature. Yes, I realize that this is now a choice between getting infected in the city or in the countryside, but there are simply too many humans around or rather too little nature left.

Staying overall healthy is a good move. Aside from barnyards being zoonotic breeding grounds, another source, not mentioned that often ... are older folks on immune-suppressant drugs (lots of drugs will do that as a side-effect, so check into it). Yeah, fun stuff ... if you're one of those who had measles because you weren't vaccinated, whether intentionally or because it just wasn't available at the time, taking one of those drugs could lead to shingles. Whereas if you were smart enough to be vaccinated ...

General antibiotic resistance is a professional problem. Hard to say what individuals can do about it. It's a tragedy of the commons problem perhaps best attacked at the regulatory level whether professional orgs or government. Incidentally, the first case of a superbug resistant to the entire battery of US antibiotics happened a few years ago. People already die from this ... but not en masse. It's mostly MRSA stuff ... I think this was discussed in a previous thread around here.

Basically, like with oil, we've enjoyed a couple of generations of massive prosperity thanks to largely eliminating diseases and food and energy shortages. And then we'll go back to normal ... Point being, "health" will probably have to be somewhat redefined at some point lest there be some massive evolution in the social dimension either morally (voluntarily) or regulatory. For example, the Soviets did reasonably well until things collapsed.. then it was all tuberculosis and HIV from there.

It might surprise you to know that there are now regular cases of typhus in Los Angeles these days... or that hookworm is rather widespread in the poorer areas of the deep south once again (about 10M+ Americans infected).

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Re: Staying healthy in a post antibiotic world

Post by chenda » Fri May 31, 2019 2:56 pm

Is anyone else left with a sense of existential despair after reading Jacob's posts ? :(

Crazylemon
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Re: Staying healthy in a post antibiotic world

Post by Crazylemon » Fri May 31, 2019 3:14 pm

@jacob small thing but shingles is caused by varicella (chickenpox) not measles.

In terms of is a post antibiotic world possible and scary? Yes. Although there Is now a realisation and some action being taken. There are a few new antibiotics coming out the pipeline now.

In terms of individual actions...

1) Make sure you are fully vaccinated. No brainier to make yourself immune to as many diseases a possible. Have all the vaccines you are supposed to have

2) Be healthy. Puts you in a better position not to get an infection or to survive it. Antibiotics are not going to suddenly stop working. Gradually more toxic (older not as good) agents might end up needing to be used (particular problem with MDR TB). Having physiological reserve lets you more easily take any particular hit.

This also helps in pandemic situations. Yeah, pandemic airborne Ebola is like everyone’s nightmare scenario but if something as easily spread as flu and as leathal as some forms of Ebola ‘goes global’ basically gonna be game over for most. Not a scenario I would really want to ruminate on. But something like pandemic flu is far more likely. In this case being healthy is again the main goal. Because a healthcare system under that sort of super stress is not going to manage other medical problems well. Middle of a pandemic is a really bad time to have a heart attack.

I don’t think any country is (properly) prepared for a pandemic Spanish flu and up. They might say they are prepared but that normally means ‘we have lots of tamiflu on standby’. You can’t efficiently run a health system with spare hospitals on standby

3) hygiene. Basically what Jacob said on an individual and population level. Although most pandemic modelling shows things get to a rural area ‘eventually’ which is when a healthcare system you are hoping to deal with it has been put through the wringer


Personally in the immediate to medium term pandemics worry me much more than antibiotic resistance.

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Ego
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Re: Staying healthy in a post antibiotic world

Post by Ego » Sat Jun 01, 2019 3:02 am

Crazylemon wrote:
Fri May 31, 2019 3:14 pm
3) hygiene. Basically what Jacob said on an individual and population level.
During an outbreak it certainly makes sense to practice hyper-vigilant hygiene. In non-pandemic times is it wise to use the opposite approach?

The 1918 Spanish flu pandemic was unusual in that it attacked young people but left the elderly relatively unscathed.

https://news.nationalgeographic.com/new ... h-science/
People born after 1889 were not exposed as kids to the kind of flu that struck in 1918, leaving them uniquely vulnerable. Older people, meanwhile, had been exposed to flu strains more closely related to the 1918 flu, offering some immunity.
Today we have a similar window of vulnerability.

https://www.healthline.com/health-news/ ... -strains#2
Researchers found that people infected with these viruses fell into two groups — based on when they were born.

The shift occurred in 1968 with the Hong Kong flu pandemic, when a new type of virus swept away the virus that had dominated before.

People born before 1968 had likely been exposed as children to a flu virus that scientists place into “group 1.”

Researchers found that as adults, these people were less likely to become severely ill or die from H5N1, which is also in group 1. But they were more likely to get sick from H7N9, a “group 2” flu virus.

People born after 1968 were likely exposed to a group 2 virus. They showed the reverse trend — less susceptible to H7N9, and more vulnerable to H5N1.
While we cannot go back and childhood-imprint immunity for different versions of the flu, we can expose ourselves to the current non-pandemic versions (and to all manner of antigens), build antibodies, preserve the B-cells that create the antibodies through continuous exposure to antigens and then use the antibodies to provide partial resistance to whatever new bug evolves. We can also die from whatever we catch, but that's another story.

Hyper-vigilant hygiene in non-pandemic times may eliminate the immune system workout.
Last edited by Ego on Sat Jun 01, 2019 3:27 am, edited 2 times in total.

Crazylemon
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Re: Staying healthy in a post antibiotic world

Post by Crazylemon » Sat Jun 01, 2019 3:25 am

@Ego

Well known phenomenon of pandemic flu that it does that. Because it tends to occur from antigenic shift (as opposed to drift) that makes it more different from recently circulating flu and more like viruses circulating decades ago.

Personally don’t feel catching flu every year to maybe be slightly more likely to be ok with pandemic flu given regular flu is no joke either. I do get vaccinated annually, via work.

I am not suggesting people live in sterile bubbles just standard hygiene with vigilance wrt outbreaks.

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Ego
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Re: Staying healthy in a post antibiotic world

Post by Ego » Sat Jun 01, 2019 3:36 am

Crazylemon wrote:
Sat Jun 01, 2019 3:25 am
I am not suggesting people live in sterile bubbles just standard hygiene with vigilance wrt outbreaks.
Understood. But today's standard hygiene is a sterile-bubble when compared to our ancestors.

Cleanliness comes with both benefits and cost. The benefits are obvious from both an individual and a public health perspective. The costs for both are more obscure.

Also, I agree that regular flu is no joke, but the severity is diminished if I get the flu every year (unless there is a drastic change in the flu). It is those who are rarely exposed who get it bad.

classical_Liberal
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Re: Staying healthy in a post antibiotic world

Post by classical_Liberal » Sat Jun 01, 2019 4:35 am

You want to get exposed to a variety of potentially harmful microbes, go work in patent care at a hospital. Web of goals people.

On a more on topic note, if society doesn't collapse phage viruses will be the key in dealing with antibiotic resistance. The defenses bacteria build against antibiotics actually make them more vulnerable to phages. It works in reverse as well. So any approach using both phage and antibiotics will win the day. I estimate less than a decade before regular use in the US, clinical trials already underway. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205996/

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Re: Staying healthy in a post antibiotic world

Post by RealPerson » Sat Jun 01, 2019 7:32 am

The most important health strategy is to avoid becoming a type 2 diabetic. Even relatively innocent microorganisms can kill a type 2 diabetic. With the rapidly increasing prevalence of diabetes, keeping yourself at a healthy weight and exercising regularly are far more important than any radical strategies.

Hospitals are a breeding ground for resistant bugs. Avoiding them is a good idea.

I agree with the hygiene suggestion, as in mainstream hygiene. Hand washing with regular soap for example. Don't buy those antibacterial soaps, gels, wipes etc. They are not necessary and promote bacterial resistance.

Be completely up to date on immunizations. Vaccines are medicine's greatest gift to humanity.

Nomad
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Re: Staying healthy in a post antibiotic world

Post by Nomad » Sat Jun 01, 2019 8:15 am

Life in a post antibiotic world would be very different, life expectancy and the world population would probably drop quite a bit.
There are natural antibiotics like garlic, you can even rub that on a graze.

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Re: Staying healthy in a post antibiotic world

Post by mustafayacoob » Tue Jun 04, 2019 3:23 am

Tips for Staying Healthy

A healthy lifestyle can help you thrive throughout your life. Making healthy choices isn't always easy, however. It can be hard to find the time and energy to exercise regularly or prepare healthy meals. However, your efforts will pay off in many ways, and for the rest of your life.

Steps you can take:
  • Be physically active for 30 minutes most days of the week. Break this up into three 10-minute sessions when pressed for time. Healthy movement may include walking, sports, dancing, yoga, running or other activities you enjoy.
  • Eat a well-balanced, low-fat diet with lots of fruits, vegetables, and whole grains. Choose a diet that's low in saturated fat and cholesterol, and moderate in sugar, salt, and total fat.
  • Avoid injury by wearing seatbelts and bike helmets, using smoke and carbon monoxide detectors in the home, and using street smarts when walking alone. If you own a gun, recognize the dangers of having a gun in your home. Use safety precautions at all times.
  • Brush your teeth after meals with a soft or medium bristled toothbrush. Also brush after drinking and before going to bed. Use dental floss daily.
  • Drink in moderation if you drink alcohol. Never drink before or while driving, or when pregnant.
    Ask someone you trust for help if you think you might be addicted to drugs or alcohol.

Augustus
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Re: Staying healthy in a post antibiotic world

Post by Augustus » Tue Jun 11, 2019 10:34 pm

Staying healthy is always good advice, but if a paper cut can kill, would we all start wearing gloves? Changing cooking practices and eating habits? Death by infection was pretty common historically as far as I can tell? It kind of boils down to don't get poked by non sterile implements. Right now you get antibiotics to save you, if they stop working then you die from things you don't die from today, so it makes sense to avoid said things.

For instance, cat bites. I recently was bitten by a cat, it got spooked, apparently their teeth carry crazy bad bacteria, so bad that if it wasn't for antibiotics amputation would be called for in many instances. Definitely won't be picking up a cat any time soon. I've been around cats all my life, never got a real bite, researching it was an eye opener.

Come to think of it, amputations would probably become a lot more common post antibiotics.

Campitor
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Re: Staying healthy in a post antibiotic world

Post by Campitor » Tue Jun 11, 2019 11:22 pm

Eating a variety of fruits and vegetables will impart some protection from bacteria and cancer - the polyphenols in plants help the body fight off disease. Honey is hygroscopic and can be used as a topical antibacterial agent; the hygroscopic properties causes bacteria to explode as moisture is sucked out of it.

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