Q: You write that “health officials are concerned that we may run out of medications altogether that can treat infections.” How imminent is that threat?
A: I don’t know how imminent, it’s hard to predict that. But we have seen cases, thankfully rare cases, of individuals who are infected with certain strains of bacteria that are resistant to every antibiotic we have available. The other side of it is that we haven’t put a lot of time and effort into developing new antibiotics. We went through this period where we felt that infectious diseases were no longer a threat. Pharmaceutical companies aren’t developing new antibiotics because they don’t make as much money off them. So that combination of an increasing level of resistance in the bacteria, plus not a lot of new antibiotics, could put us in a place where we have infections that can’t be treated.
Q: Superbugs are drug-resistant bacteria; H1N1 is a virus, but could it become a superbug?
A: We don’t have drugs that actually kill viruses very well, so viruses can develop resistance to these few medications available to treat viral infections. There are two classes of drugs that can treat influenza viruses specifically. H1N1 is resistant to one of those, and it’s susceptible to the other. But we worry that it can develop a mutation that will make it resistant to this drug, which is called oseltamivir, or Tamiflu. If that happens then there will be nothing that will actually treat that virus.
Q: You’re leading the emergency preparedness measures for the Vancouver Olympics. What are the risks ahead?
A: We’ve always made plans for making sure that we could detect if there was influenza circulating in the athletes’ village, for example, or among spectators, and that we would provide immunization for the volunteers, and staff. We’ve also put in measures to make sure that there are lots of handwashing sinks and hand hygiene products. We’ve been working on messages for what to do if people get signs of influenza. The athletes and their medical teams know the effect influenza can have on their ability to participate, so there’s a very high rate of immunization. We expect it to be the same this year.
Q: There really is no escaping bacteria or bugs. Is there any truth to the old notion that eating a few germs—say unwashed fruit—is good to build up your immune system?
A: I don’t think it’s good to eat dirt.
Q: You say organic doesn’t mean bug-free, that it may be riskier than non-organic?
A: Most of the pesticide agents and fertilizers that are used in organic farming are natural, which in most cases means manure. It is really imporant, even with organic—or especially with organic produce—to make sure that you wash it carefully.
Q: How can sports turf spread infection?
A: This is about an antibiotic-resistant infection called methicillan-resistant Staph aureus. There is a community-associated strain of this bug that can cause skin infections. There was a professional football team where a number of the players had scrapes on their skin from the Astroturf and were infected with this strain of CA-MRSA, and they had passed it between each other by sharing whirlpool baths and towels. So it’s important to cover up wounds and not to share equipment.
Q: And the produce-misting machine at the grocery store?
A: Legionella causes a type of severe pneumonia called legionnaire’s disease. It is a bug that has adapted to our urban water systems and can grow in warm water. Legionella has gotten into some of the misting systems in grocery stores. For most of us, we breath in a bit of the bug and our immune systems are able to fight this off. But for some people, if they get a high dose or their immune systems are compromised, they can get very sick.
Q: You recommend not shaving or waxing 24 hours before a pedicure. Or if you’re having both services, get the pedicure first. Why?
A: The thing about pedicures is you tend to soak your feet in a water bath first and there have been occasions where that water has been contaminated with unusual bacteria that usually don’t cause us a problem. But if you just shaved or waxed your legs you have tiny little cuts around the hair follicles and these can get infected.
Q: You’ve battled SARS in Toronto, Ebola in Uganda. What impact did that have on you?
A: Probably the first is that there’s an element of fear around infectious diseases, particularly with an outbreak. Battling that fear is just as important as curing the infection. The second thing is that every time there is an outbreak there are incredibly heroic people involved in stopping it. I’ve always been amazed by other health care professionals who put their lives on the line.
Q: Have you had any nasty infections?
A: The sickest I ever got was when I was doing some work in Pakistan, and got infected with, I think, E. coli 15787, so I was wiped out for a number of days. I ate something that I shouldn’t have, and became infected. I learned my lesson, that’s for sure.
Q: What was it you ate?
A: It was probably sugar cane from a market that had been kept fresh by being splashed with local water. Just a small amount can make a huge difference. It can make you ill.
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