Things aren't necessarily all bad. Antibiotics become more effective again if they haven't been used for years. The earlier penicillins are an example. There are various new categories of antimicrobials under development, and they should become online in the next few years.
As the world becomes smaller and smaller due to increased travel, a spread of resistant stains of microorganisms is to be expected. More worrisome than STDs is resistant tuberculosis because it is super contagious. This is not avoidable with a condom.
It's usually staph (lives everywhere, you probably have some on you) that's the problem. This has been an issue for years (MRSA) with 2M getting infected and 23k dying annually just in the US.
The first case of a bacterial infection (49yo woman from PA) in the US that was resistant to all 26 antibiotics in the US inventory was in 2016(%). This was an E. Coli strain that was later identified in pigs in IL. Whenever you bring lots of compatible "flesh" close together for quick transmission in e.g. a barn, a school, a prison, a cubicle farm,... there's the possibility for quick evolution/spread. Other than trying to outpace evolution (a bacterial generation is less than 30 minutes) the other way is to figure out how to reduce population density of the biggest contributors: humans, chicken, ducks, pigs, and cattle---or the diseases will eventually do it for you. There are other reservoirs, like bats, monkeys, rats, mice, deer, and insects (malaria, another bacterial diseases), but the former by far outweighs the latter. Infectious diseases are mostly a human problem and many infectious diseases are only several hundred years old and didn't really catch on and become an issue until a couple of thousand years ago. The human population density was simple too low(*).
(%) However, strains resistant to some or many of the antibiotic battery goes back decades. It's just only in the past years that the capacity has been maxed out.
The greater danger of an epidemic is viral though (faster mutation rates). Same applies as above.
(*) For example, infectious diseases were not really a problem amongst the thinly populated Native Americans until Europeans showed up. The Natives had zero resistance because genetically they'd had never encountered what had already been going around in the much more densely populated Europe.
I could imagine changes in health policy as a result of losing the antibiotic battle. Early in US history, health used to be a personal responsibility (much like it is today again). However, with the epidemics (like TB) in NYC, the rich realized that diseases don't really care about whether you can afford a doctor... and if you live in the same city as the poor (who are more susceptible because they can't afford heat, food, clean water, sewerage), you can get infected just as well. So eventually, people were convinced that paying for public measures, such as sanitation, was a good idea. This solved much of the problem. Later antibiotics were developed and the culture started shifting back to "me and my family"-first/everybody else is on their own. This is also partially why infectious diseases are a bigger problem in countries, like the US, with more "health-poverty", than in other highly developed countries.
Now that mechanisms are better understood, a huge proportion of 19th century childhood deaths from bacterial infections can be prevented through simple hydration. IOW, when the body is attempting to rid itself of the infection or toxin through diarrhea or vomiting, anything like unto a Pedialyte solution can prevent much needless death. That said, given what I know about just-in-time-inventory and front-of-store marketing mechanisms, I was kind of freaked out recently when I saw that the small check-out lane refrigerator cases at a major retailer were well-stocked with Pedialyte.
Simplest general solution, as one could learn from brief survey of many older works of children's literature such as "Heidi" or "The Secret Garden" is that it would be best to raise your child in a rural location with relatively high exposure to soil microbes and low exposure to human microbes. Also, home school or hire a private tutor.
Also, I have been drinking two large mugfuls of very strong mix of fermented ginger and lemon juice every evening lately, and it seems to be increasing my resistance.
The disease and pollution vectors are so much higher in urban locations, I have decided that I am going to ultimately locate my "grandma cottage" up north near a large fresh source of water. Hopefully, I will at least survive long enough to wrap up my urban-permaculture project by goal date of Harvest 2022. Property values are going up in the city, so will likely be able to profit through sale to some hardy soul stout body in 20s or 30s.
I got staph in a cube farm. We had a filthy engineer spread it all over the department. Our product used a touch screen and buttons that got all sticky.
I thought it was just acne but it started spreading to everyone.
Nobody really talked about it. I started wiping down my stuff with isopropyl alcohol and keeping my laptop closed (from guys trying to show me something they found online with my setup). I think I got a really oddball trackball that discouraged people from sitting down and browsing through my pc. Yuck.
It just blew over. I watched everyone break out then clear up. I think people knew because they started getting really fastidious about wiping down their cubes after a certain individual touched things. Being a hardware guy I had an excuse to have a solvent pump and wipes in my cube. I used it more on keyboards and mice than on circuitry.
No antibiotics required. I prolly have those bugs living in my skin today but my immune system keeps them beaten down. Yuck. I hated that filthy guy.
Older children can also at least communicate concepts such as "My neck hurts." It seems not unlikely that the age of reasonable vigor and the age of ability to group socialize might have evolved sensibly in conjunction. IMO (not likely to be popular), nobody below the age of 4 should be in daylong same-age large group situation.
It is scary when babies become seriously ill. My DS29 was hospitalized for a week with raging fever when he was an infant due to crimped ureter leading to massive infection. My "ex" and I both had severe allergies and asthma, so I was a fairly early adopter of the breast-feed but let them play in the mud school-of-practice with my kids. I only rarely had to take either of them for medical treatment after infancy, except for the occasional bead up the nose incident. MMV.
Best personal health practice -- avoid the hospital.
Best public health practice -- only use antibiotics to treat illness (get them out of livestock, soaps, etc).
It's going to become more of a problem because (1) more drugs are losing their ability to fight off bacteria, and (2) these types of infections strike the health-compromised the hardest, and more adults fall into that category every day because of the explosion in lifestyle diseases.
In terms of resistance gonorrhea is one that picks it up quickly and because of the nature of how it spreads between people really lends itself to to picking up resistance fast. Very resistant cases have been an issue for some time in various parts of the world.
Resistant TB is really nasty to because some of the second and third line antibiotics are not very human friendly. Someone needing treatment for MDR let alone XDR TB is gonna be open to having some pretty damn nasty side effects. This is going to become more and more of an issue where it currently isn't in the developed world because of global cities (London has a TB rate much closer to SS Africa than much of the UK). See Jacob's population density + travel issue.
I have treated plenty of patients where the antibiotics that a bug is sensitive to are generally older, more renal toxic ones (because no one used them where more human friendly drugs worked and so there is less resistance). I have seen chloramphenicol used in the UK systemically where for a long time it wasn't used outside the developing world because while cheap and effective has a ~1/25000 chance of bone marrow suppression. There are (finally after decades) a few more antibiotics in the pipeline so there is hope. I don't imagine them coming in cheap though.
It isn't just resistance that is an issue supplies can be surprisingly unstable like last year when there was a Global shortage of Tazocin That required immediate redrawing of hospital guidelines and in the UK the government to release strategic reserves of certain antibiotics. This sort of thing is more immediately scary.
Resistance makes any sort of operation or procedure far more risky. And as people of said extremes of age are where the biggest problems will arise.
Hopefully public policy will mean things change but without stopping antibiotics use in agriculture which will increase food costs along with global better stewardship the problem isn't going to go away.
@Augustus - I think what you're looking for is a plasmid exchange which is a horizontal gene transfer between different bacteria. They don't even need to belong to the same species because the transferred DNA doesn't belong to the chromosome. The two bacteria just need to be in contact.
As for STDs, all the viral ones are already untreatable(?!)---that is, treatments are comprised of a delaying action that makes the diseases tolerable/make you live longer (AIDS, Herpes). So you're left with syphilis and gonorrhea. One of the great things about STDs is that they've been with us for long enough to have lost their power to infect. I think I read somewhere that STDs used to infect large parts of the body and not just genitals. However, these days they require either cuts or lots of close contact to infect someone after contact. This means they have neither reach (don't infect at a distance) nor force (requires quite a bit of exchange).
Compare to Ebola which has almost no reach (you can walk past an Ebola patient and be safe as long as you stay at the other side of the street(*)) but tremendous force (it only requires a few viral particles, which is why live patients are treated wearing full protective gear and dead patients are double bagged and burned) or measles which has tremendous reach (put an infected person in a large room and non-immune people at the other end are susceptible) and some force (a droplet will do).
(*) During the Ebola epidemic (did it qualify as a pandemic?) a few years ago, some villages literally had a line drawn down the middle of the street with sick people on one side and healthy people on the other side.
@Jacob I wouldn't say Viral STDs are untreatable. Untreatable HIV is what it was in the 80s. Now it is treatable but not curable (Case reports aside).
STDs can and still do cause issues with virulence but we normally treat infections before they get to that stage. I will probably never see a case a neurosyphilis.
@Augustus It doesn't quite work like that. For TB partly because we are talking about totally different antibiotics generally. But also having resistance to all the antibiotics will have fitness costs. Producing efflux pumps, enzymes, modified cell walls etc. All come with a cost. If you are not putting bacteria under selection pressure it isn't going to automatically win out. So it doesn't spread immediately necessarily. Also add on the sexual health clinic will be obsessively contact tracing in this sort of case. I probably have some fairly resistant bacteria growing in my nose by din't of working in a hospital. It doesn't mean they will cause me any disease because resistance =/= virulence. But they might result in a more difficult to treat infection if they were to start causing more problems.
There won't be 'the day the antibiotics stopped working'. It will be closer to a rising tide effect. More bacteria gradually become more resistant and more people not being successfully treated with antibiotics as a result. Much like peak oil that won't suddenly mean no oil and oil will be around for a long time after.
Bacterial infections are not primarily deadly because of poor oxygenation. That isn't to say that isn't a problem but if you have a hideously bad pneumonia me giving you oxygen isn't going to stop you dying of sepsis.
This isn't the same a diarrhoea illnesses for kids where the issue is generally a virus that will pass but kids can't keep themselves hydrated so you have to give them a helping hand.
@Crazylemon - Yeah, I'm still/noobishly climbing Mt Stupid in the [microbiology] domain. Whatever I read (mostly nonfiction---hard to know where to start) is plastered onto the SIR-model which is simple to me insofar as it comes to its basic structure; of course I'm approaching this as a physicist not knowing the terminology which might turn into complete FUBAR was far as I know (biology is more complicated than nuclear physics). To me cured is a matter of kind and treated is a matter of degree. I can work the parameters/structure intuitively from another field... but I'm still in the process of adding detailed technical/technician-level stuff.
Of greater concern remains the matter if it's possible ... to use the analogy of rising tides ... that rising tides make storm surges more likely and that such a [storm] surge would overwhelm the levee system. IOW, the possibility of paradigm shifts ...
@Augustus - For all I know, the main professional concern (see Osterholm ref by @JP above) is vira and zoonosis. That is, the emergence of diseases due to humans having more babies (---> 8 billion already = enough to achieve close proximity globally) and moving into nature to make room for new development thus bringing nature-DNA into close contact with human DNA=> lots of "interesting" evolution, not necessarily favoring human interest. IOW, emergent diseases due to human encroachment(*) on nature or living next to (literally) their/our livestock (birds and pigs for flu, also camels) is the bigger worry. Because vira. Bacteria exchanging DNA is still minor, relatively speaking?????
(*) Lyme disease is exploding because humans like to cut down nature to build McMansions in wooded areas while other humans like to buy those houses to get away from it all. Then those resident ticks of those [former nature, now McMasion] areas bite the humans who moved into them. Then it goes from there ...
I'll just add that one element to keeping drug resistant bacteria under control is having a healthy microbiome. Think of it as a massively complex system in its own right (there are 1000+ species of bacteria, fungi, protists, etc on your skin and in your gut), and maintaining a stable, resilient ecology is extremely helpful. If your gut microbiome is totally out of whack because you eat bizarrely or take antibiotics (of course, take antibiotics if a doctor says you should), you are at a greater risk of developing an subsequent issue because it is easier for the pathogenic strain to take hold (think weeds trying to grow in a mature forest vs. in a freshly tilled field). Simply put, you probably already have nasty bugs in and on you right now... but they are held in check by the huge number of other benign bugs that are competing against them for resources.
@jacob - Not so fun fact: Ebola is an STD now. I suspect that the virus isn't completely cleared from the testes because they are immunologically privileged. IIRC, virus can also remain in the eye.
@bsog - Yeah, I knew that Ebola stayed active in survivors and could infect sexual partners for months after. Endemic(*) AIDS is a big issue in parts of Africa (so far) thus keeping longevity down. Pretty hard to create/grow a stable system if longevity is decreasing. (What kind of country obtains if the average longevity is 50 due to a significant fraction not living long enough to get sufficient experience.) It's unfortunate that US support to quench this effort is politically biased, but it is what it is.
(*) Passing it onto their children who are born with it and thus don't live long.
PS: Technical question: Does Lyme disease qualify as privileged because it survives in the joints because the immune system has a hard time getting there because there's not much blood circulation towards the joints? Hmm.. I really need to get a good text book sometime these days ...
I'm not confident in hospital prevention measures. Whenever my son is in the hospital, they put an isolation sign up on the door. Everyone who comes into the room is supposed to put on one of those hazmat-looking yellow suits before entering. Most do but occasionally one doesn't, which completely compromises the room. It only takes one person to miss the sign or (as was the case last time) not understand what it means to contaminate the room. I'm not criticizing -- I know they mean well. It's just so easy slip up and pass something along. They also don't require me to wear one, which makes no sense since I visit the restroom and other places in the hospital while I'm there.
This is a very good explanation of what's happening from a hands on treatment perspective. From a system-wide top down perspective US hospitals are taking the resistance problem very seriously. Any patient coming from any situation in which the more common varieties of drug resistant bacteria (MRSA, VRE, ESBL, etc) are frequently transmitted, are immediately placed in isolation until testing "clean". From a practical standpoint this means large percentages of hospitalized patients are in isolation.
It seems to me, the livestock issue should be our initial, primary concern; it has the best cost to benefit ratio and we have barely scratched the surface.
@Classical_Liberal:
Wow... that's a very idealistic view for someone who works at a hospital. Where I work there are no isolation units (require a separate ventilation system) and infection control consists of a sign on the door and a stack of yellow gowns by the door. There are always people who ignore the gowns, which are totally insufficient anyway. Everyone is being at mercy of his own immune system.
As a person, your best bet is improving your immunity.
I also think that a livestock issue has the best cost-to-benefit ratio for the society as a whole. I doubt a livestock industry would agree.
@Jacob Yeah knowing where to start is difficult. I should try and have a think about what sort of texts might be useful. Certainly my route wouldn't be efficient. My knowledge of nuclear physics is definitely more lacking.
On 'storm surges' as you mentioned viruses and zoonosis are probably bigger concerns for 'overwhelm the healthcare service'. Flu is probably the most obvious and most likely due to how it can mutate. Add in any pandemic isn't super fast (over in a week or less) or massively long to aid preparation in real time. This mean it can get very nasty very fast in terms of 'oh actually there are no more ventilators in the country available' kinda bad. No one has as far as I am aware made public 'if shit gets this bad who do we selectively save' extreme triage scenarios because it wouldn't be pretty and I don't think there is a nice ethical solution anyone has thought of. But that sort of pandemic isn't particularly related to resistance other than if resistant bacteria are already putting a strain on the service it would make it worse.
I can't really comment much on lyme disease as it isn't something I have majorly looked into because in the UK it really isn't all that common.
How good a hospital is at isolating cases of a given disease depends generally on a factor of 1) How terrible is it immediately if it gets out and 2) Financial penalties for too many cases (basically 1 again) 3) Staff numbers/education
Livestock antibiotic use really should be tackled but will make meat more expensive which isn't exactly a popular thing to do.
From an individual point of view being health is probably the best useful hedge people can make. Being healthy so not developing diabetes/having it well controlled so not increasing your risks of wound infection obviously helps to give one example.
First, pneumonia isn’t a single bacteria. Huge numbers of different bugs can cause it, the helpfully named strep pneumoniae being one of the most common
Not every pneumonia kills even without antibiotics. Not every pneumonia treated with antibiotics is survivable. Antibiotics obviously tilt massively in favour of survival.
Assuming a nightmare scenario where all pneumonia causing bugs are totally resistant to all antibiotics present and future (which as mentioned would be unlikely) then yes that would be a total disaster. Back to 1900 is probably unlikely given better nutrition/hygiene/etc. That we have currently.
Are bacteria going to become more resistant and more people die as a result? Most probably. The exact numbers...much harder to quantify. Would I want to try and fight off a bacterial
Pneumonia without antibiotics? Heck no!
XDR TB is already becoming a problem in certain countries and survival is going to be worse than regular vanilla TB.
I presume you are talking about ‘phage therapy’ Was something done in former USSR more than the west as far as I recall and I think research did take a major knock with the breakup. Generally I put in the cool but not likely to become used in western medicine soon category. I am happy to be proved wrong on that one.
These super bugs are everywhere in meat, it's really not hard to see where people are contracting this stuff when you look at how animals are being raised. Below video is under 5 minutes long; on C-Diff and MRSA:
Keep in mind this is an old video, and things are getting much worse. The last count I saw on C-diff was 453,000 cases in the US, 2015; and that was a doubling from a few years back, according to the CDC.
If you eat meat you probably have this in your gut right now, but it generally won't be a problem until you take some form of antibiotic. Then the antibiotic kills your natural immune cells, and C-diff (which is immune to antibiotics) goes on a rampage, that or another super bug.
Many of the animal documentaries like "Earthlings", "Dominion", etc., clearly show the problem.
Everyone is being at mercy of his own immune system. 
