In her latest column, Adjunct Associate Professor Lesley Russell reports on a stack of new research and publications, covering recent developments in antimicrobial resistance, a well-received article on the complexities of COVID, and insights into how war in Ukraine is affecting people’s health and healthcare systems.
She also reports on a comprehensive plan to end homelessness (in the United States), the importance of strong legs as women grow older, what can be learnt from ageing dolphins, and shares an uplifting interview with two astronomers who also happen to be mother and daughter.
Lesley Russell writes:
A new report from the CSIRO and the Australian Academy of Technological Sciences and Engineering describes growing antimicrobial resistance (AMR) – such as bacteria developing antibiotic resistance, or fungi becoming resistant to antifungal medicines – as a “looming global health crisis” with the ability to render some of the most critical drugs to modern medicine ineffective.
A previous report, published by the CSIRO and the Australian Antimicrobial Resistance Network in November last year, estimated that superbugs now result in 1,000 deaths in Australia each year.
It is shocking to realise that such microbial infections are the second biggest cause of deaths in cancer patients.
The new report finds: “There is a lack of coordination in the efforts against the rise of antimicrobial resistance, significant data siloes across states and sectors, and a need to increase community understanding about the issues and impacts of antimicrobial resistance”.
It also says the impacts of climate change are accelerating the emergence and spread of AMR.
AMR is an international crisis. In 2019 the United Nations predicted that without urgent intervention, drug-resistant microbes would result in 10 million deaths each year globally by 2050.
The Global Research on Antimicrobial Resistance (GRAM) report, published in January 2022 by The Lancet, estimated deaths linked to 23 pathogens and 88 pathogen-drug combinations across 204 countries and territories in 2019. (I wrote about this in report in the first edition of The Health Wrap for 2022.)
The analysis shows AMR was directly responsible for an estimated 1.27 million deaths worldwide, and associated with an estimated 4.95 million deaths, in 2019. HIV/AIDS and malaria have been estimated to have caused 860,000 and 640,000 deaths, respectively, in 2019.
While AMR poses a threat to people of all ages, young children were found to be at particularly high risk, with one in five deaths attributable to AMR occurring in children under the age of five.
The GRAM report highlights an urgent need to scale up actions to combat AMR, and outlines immediate actions for policy makers that would help save lives and protect health systems. These include optimising the use of existing antibiotics, taking greater action to monitor and control infections, and providing more funding to develop new antibiotics and treatments.
Obviously this is an issue that should be tackled globally.
In 2019, Dame Sally Davies, who was then England’s Chief Medical Officer, called for efforts to combat the problem of common illnesses becoming untreatable by antibiotic medicines to be coordinated at a worldwide level in a similar way as the Intergovernmental Panel on Climate Change, the body of scientists set up in 1988 to tackle global warming.
Dame Sally, now the United Kingdom’s special envoy on antimicrobial resistance, said in response to the GRAM report that AMR is “one of the greatest challenges facing humanity… We must use this data as a warning signal to spur on action at every level.”
Australia has had a National AMR Strategy since 2015. The Morrison Government released Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond (the 2020 Strategy), which was endorsed by the Council of Australian Governments, in March 2020.
The 2020 Strategy has seven objectives:
- Clear governance for antimicrobial resistance initiatives
- Prevention and control of infections and the spread of resistance
- Greater engagement in the combat against resistance
- Appropriate usage and stewardship practices
- Integrated surveillance and response to resistance and usage
- A strong collaborative research agenda across all sectors
- Strengthen global collaboration and partnerships.
The One Health Master Action Plan for Australia’s National Antimicrobial Resistance Strategy – 2020 and beyond was released in 2021.
A draft action plan from the Department of Agriculture, Fisheries and Forestry was not released for public consultation until December 2022 (clearly it was not a priority of the Morrison Government). The final action plan is scheduled for release in early 2023.
Although the prescribing of antibiotics in Australia has decreased since the highs of 2008, it is consistently higher than that of many other similar countries. For example, in 2018, antibiotic use in medicine was double that of Sweden.
However, research from the Murdoch Children’s Research Institute and UNSW Sydney has shown a decline in PBS antibiotic prescriptions during 2020 (the early months of COVID-19 lockdowns).
This was attributed to the concomitant reduction in respiratory viral infections as the biggest reductions in prescription rates were for antibiotics predominantly used for respiratory infections. There were no reductions in prescribing of antibiotics generally used to treat non-respiratory infections.
The drop in antibiotic dispensing continued into winter, in contrast to the seasonal nature of antibiotic prescribing before the pandemic. This implies that antibiotics are widely (and inappropriately) used for viral respiratory infections in primary care. It also indicates that there is much more work that can be done to address inappropriate antibiotic use in medicine.
As acknowledged by the amr.gov.au website, much of the education of healthcare professionals and patients around appropriate antibiotic use was done by NPS MedicineWise and Choosing Wisely – now defunded by the Albanese Government.
It’s good to note that the Medical Research Future Fund is currently advertising the availability of $6 million for research into antimicrobial resistance and reducing the incidence of hospital infections.
Read more in this previous Croakey story: New report urges action on antimicrobial resistance amid concerns about salmon farming.
Facing the new COVID reality
The 2 February edition of The New England Journal of Medicine has a perspective piece, entitled ‘Facing the new COVID-19 reality’, that I found very persuasive.
It makes the point that while most communities and most people have moved on from those first terrifying months of the pandemic, life is far from back to normal for many people and for healthcare systems.
In the United States COVID-19 currently results in about 300 to 500 deaths per day (in Australia the figure is about 11 deaths per day). In addition, many people continue to face severe short- or long-term COVID-19 illness (in Australia there are now some 2,600 cases of COVID-19 reported per day).
The ever-looming threat of the evolution of a new variant that could evade current vaccines and antivirals remains very real.
The article makes the point that SARS-CoV-2 will continue to play a major role in our lives for the foreseeable future.
“The current moment in the COVID-19 pandemic is a pivotal one,” the authors write, as they catalogue both the progress made and the challenges that still loom.
“This new reality compels us to navigate a more complex social, economic, political, and clinical terrain and to take to heart the lessons learned from the COVID-19 response thus far — both the successes and the missteps.”
Several salient points made in the article stand out for me. These include the breadth of the pandemic’s effects, beyond its obvious health effects, including loss of employment or housing, disruption of educational systems, and increased rates of food insecurity. Many of the negative social and economic effects are not evenly borne across population groups.
As well, health equity and anti-racist principles and insights from the fields of health communication and behavioural science must be taken into account in the development and implementation of future programs and policies.
Fit legs and fit brains
There’s plenty of research to show that physical activity can help brain health as people get older. I’m always on the lookout for evidence to support my obsessions with hiking and skiing.
Recently I found some good data to justify all those lunges my exercise physiologist says will help my skiing – and, it seems, keep my brain cells firing.
A paper published in 2015 in Gerontology, on a decade-long study of more than 300 twins, found that older women who have strong legs are likely to fare better when it comes to ageing of the brain.
The researchers found that leg strength was a better predictor of brain health than any other lifestyle factor looked at in the study.
“It’s compelling to see such differences in cognition and brain structure in identical twins, who had different leg power 10 years before,” they wrote. “It suggests that simple lifestyle changes to boost our physical activity may help to keep us both mentally and physically healthy.”
The link between fit legs and fit brains was taken further in a paper published in 2018 in Frontiers in Neuroscience. It found that using the legs, particularly in weight-bearing exercise, sends signals to the brain that are vital for the production of healthy neural cells. The paper is summarised here.
This study offers new clues as to why patients with motor neuron disease, multiple sclerosis, spinal muscular atrophy and other neurological diseases often rapidly decline when their movement becomes limited.
Related research from the University of Sydney, published in 2020, show that lifting weights can slow and even halt brain degeneration in older people at high risk of Alzheimer’s disease due to mild cognitive impairment. People with mild cognitive impairment are at a one-in-10 risk of developing dementia within a year.
The research is summarised here.
What dolphins can teach us about ageing
While we are on the theme of ageing (and doing it well), the New York Times recently published a very interesting article about US Navy research into ageing in dolphins.
The US Navy has long had a Marine Mammal Program (MMP) training bottlenose dolphins and California sea lions to locate underwater mines, recover submerged objects and intercept rogue swimmers (not something many of us would endorse).
But it’s fascinating to read about the geriatric veterinary medicine program they are also running, looking after dolphins who are now quite old (the median age at death for MMP dolphins is over 10 years greater than that reported in free-ranging dolphins, and one animal is 57 years).
Even the older dolphins remain very playful, but they do slow with age. Their energy levels flag, their joints stiffen and they put on some extra pounds. Some develop heart disease, kidney stones or vision problems, which can require surgical intervention.
In a series of studies, researchers found that ageing in dolphins is associated with some familiar conditions, including chronic inflammation, high cholesterol and anaemia.
War, health and healthcare in Ukraine
As the 12-month anniversary of the Russian war on Ukraine was marked recently, medical journals have reminded us of the dreadful and long-term impact on Ukrainians’ health.
See:
The Lancet: The war in Ukraine 1 year on: the need to strategise for the long-term health of Ukrainians.
The Lancet: Russia’s invasion of Ukraine: and attack on health.
There has been horrendous suffering and deaths among Ukrainian civilians and massive loss of life in the military on both sides.
There are about 5·4 million internally displaced persons in Ukraine, and more than eight million refugees, most of whom have temporary protection status throughout Europe.
There have been 707 documented attacks on Ukraine’s healthcare system between February 24 and December 31, 2022 and nearly nine percent of Ukraine’s hospitals have been directly damaged from Russian attacks.
A recent meeting at the European Parliament was told that 171 health facilities have been completely destroyed and at least 1,200 damaged. A former Ukrainian Minister for Health told the meeting that, despite this, the health system is functioning surprisingly well.
At the same time, she highlighted how international help has been crucial while the logistics of supplying Ukraine with necessary items such as medicines, electric generators and food remains very challenging.
Earlier articles have also highlighted the assaults on health and human rights.
See NEJM: Russia’s War in Ukraine — The Devastation of Health and Human Rights.
This article makes the point that a substantial proportion of civilian morbidity and mortality in Ukraine is attributable to diseases resulting from forced displacement and damage to food and water supply systems, health care and public health facilities, and other civilian infrastructure.
The UN High Commission for Refugees estimates that about 17.6 million Ukrainians (about 43 percent of the population) will need humanitarian assistance in the year 2023.
See also this previous Croakey story: New report calls for Russian attacks on Ukraine healthcare to be investigated as war crimes.
Homelessness
In Australia, the Albanese Government has been facing some criticisms for the inadequacies of its housing plans, especially in the face of the push to increase migration.
So it’s wonderful to see the statement “Housing is health care” in All In: The Federal Strategic Plan to Prevent and End Homelessness, recently released by the US Interagency Council on Homelessness (USICH), which offers a blueprint to reduce the number of people experiencing homelessness in the US by 25 percent by January 2025.
The plan is built around six pillars: three foundations – equity, data and evidence, and collaboration – and three solutions: housing and supports, crisis response, and prevention.
It builds on the proven “Housing First” model – an approach where housing is the first step to better, safer, and healthier lives and which serves as a platform for the ongoing provision of services so that people can stay housed.
A Canadian fact sheet about “Housing First” is here. A US evaluation of “Housing First” programs is here.
Back in 2017, I wrote an article for Inside Story on how Australia’s approach to “Housing First” – initially pushed by Kevin Rudd as Prime Minister, was never close to being implemented.
The best of Croakey
Croakey has recently had a focus on music. Read:
Songs from the pandemic: Australian musicians share their COVID stories
Music is such a powerful tool, it can help us.
The good news story
Five papers in the 15 February edition of Nature highlight work done on exoplanets (the distant worlds that orbit stars other than the Sun) using NASA’s James Webb Space Telescope (JWST) which was launched in December 2021 and now orbits the Sun, some 1.5 million kilometres from Earth.
This work helps explain how planets are formed.
A mother and daughter astronomer team were among the papers’ authors, and Nature published an interview with them, available here.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
