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One world, one health: The interconnected web of antimicrobial resistance

Tackling antimicrobial resistance (AMR) requires a one health approach that joins the dots between the human, animal, and
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Tackling antimicrobial resistance (AMR) requires a one health approach that joins the dots between the human, animal, and environmental drivers, consequences, and data.

AMR threatens to undermine “almost a century of health gains” and marshalling a response to such a problem “requires cooperation at many levels”.

That’s according to a newly published report from the US National Academies of Sciences, Engineering, and Medicine, which calls for a One Health approach that recognises the scale of the challenge, and the interconnectivity of its potential solutions.

“The COVID-19 pandemic has forced society to confront human vulnerability to microbial pathogens … in a way that has not been necessary in much of the world for a century,” said the authors, pointing to high levels of mortality linked to illnesses such as pneumonia, as well as surgery and childbirth, before the mass production of penicillin in the 1940s.

“The extent to which antimicrobial medicines changed these risks, though hard to overstate, is easily taken for granted.”

Growing threat of AMR

According to the Centers for Disease Control (CDC), antimicrobial-resistant pathogens cause 2.8 million human infections and 35,900 deaths every year in the US. And it costs $4.6 billion to treat just six of the most common resistant infections.

These stark figures are only set to get worse, with the World Health Organization predicting 50 million deaths a year by 2050, if the problem continues unheeded.

Yet efforts to mitigate the emergence and spread of resistant pathogens face a raft of challenges.

Progress is complicated by AMR being notoriously difficult to measure, and, although most obvious in human health, resistance emerges in animal health and in the environment.

“Better estimates of the burden of antimicrobial resistance in humans and animals depend on better microbiological data and more clarity on the appropriate design of epidemiological research.

“There are also challenges related to the complex adaptive nature of the problem. The same resistant infection can have drastically different consequences in humans and animals, depending on whether it is acquired in hospital or outside of it, in a high-income country or a low-income one.”

Success, then, will rely on an integrated response that focuses on surveillance, stewardship, and intervention accessibility across the spectrum of human, animal, and environmental health, said the report, which was commissioned to assess the progress of the 2014 National Strategy for Combating Antibiotic-Resistant Bacteria.

Surveillance

Among its raft of recommendations to governmental agencies, the report makes several aimed at strengthening and expanding surveillance processes.

“Surveillance systems are critically important for understanding the burden of antimicrobial resistance, detecting the emergence and spread of resistant pathogens, targeting interventions, and measuring their effectiveness,” it states.

Combining the AMR data collected by national and international organisations, including private industry, academic researchers, and disease-specific programmes, could offer “valuable insight into trends”.

It recommends the National Library of Medicine, which has already published “considerable information” on resistance genes, genome sequences, antimicrobial susceptibility data, and bacterial genomes, establish an open-source, unified AMR database.

“This database should support automatic importation from hospitals, laboratories and surveillance networks and link to genotypic data when available.”

Increasing the environmental isolates that are collected, and incorporating these into the proposed database, would contribute to a “more holistic understanding of AMR”.

“The Environmental Protection Agency should provide guidance and funding to states for testing point source discharge at wastewater treatment plants for AMR traits and integrating these data with other surveillance networks,” recommended the committee.

Stewardship

Effective stewardship is often cited as a key defence against AMR, and almost 90% of US hospitals now have CDC-inspired stewardship programmes in place – up from 40% in 2014.

Said the report: “Such rapid progress is heartening, but there are still many practice settings where the need for antimicrobial stewardship is pronounced.

“Nursing homes, dialysis centres, and long-term acute care hospitals all see considerable misuse and overuse of antimicrobials among patients who are, by definition, immunocompromised or infirm.”

As such, the report recommends that the Centers for Medicare and Medicaid Services require all such settings to implement stewardship programmes and publish the details on their Care Compare websites.

“Better estimates of the burden of antimicrobial resistance in humans and animals depend on better microbiological data and more clarity on the appropriate design of epidemiological research.”

In addition, while many of the basic principles of antimicrobial stewardship are the same in human and animal medicine, the practice differs considerably in the two sectors, it said.

“The ability to track antimicrobial use is a key part of any stewardship programme, but the United States does not have a strong system to track antimicrobial use in animals.”

The FDA should, then, establish a process and clear metrics to facilitate better tracking of antimicrobial consumption in animals.

“This information would support the design and implementation of stewardship programmes.”

New agents: Development and accessibility

According to the report, the “mismatch between society’s need for new antimicrobials and industry’s willingness to invest in them” is an important barrier to tackling the growing threat of AMR.

“The medicines needed to treat resistant infections are complicated to develop and have a relatively small market both in terms of duration of use, usually only a few days, and need,” it said.

“When new antimicrobials are brought to market, good stewardship requires that older drugs be used first, even if there were no difference in price.”

The US’s current framework of ‘push’ and ‘pull’ incentives, designed to aid pharmaceutical companies to develop new antimicrobials, has contributed to a 10% increase in agents in the development pipeline, between 2014 and 2019.

“While this is a promising development, most of these products… do not appear to be meaningfully different from existing medicines,” said the report.

“Only six of the 50 anti-bacterials currently in the pipeline meet even one criterion for being innovative. Most of the antimicrobials approved recently offer little to no added clinical value over existing treatments.”

To incentivise the more targeted development of new agents, a Department of Health and Human Services (HHS) interagency committee should establish “objective criteria” to identify novel antimicrobials with the potential to fill critical, unmet needs.

“HHS should then support trials to establish the additional clinical benefit and optimal use of these drugs,” recommended the consensus report.

One health

In all, the report makes 14 recommendations, which together make up a global solution to a global problem.

Taking them from theory into practice will require large scale coordination across an increasingly large group of stakeholders, both in the US and overseas.

“By supporting a truly systemic, One Health response, the recommended programme may be able to drive progress on a range of health indicators, including, but not limited to, the burden of resistant infections,” concluded the authors.

About the author

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, HCPs and the public.

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Survey Shows Declining Concerns Among Americans About COVID-19

Survey Shows Declining Concerns Among Americans About COVID-19

A new survey reveals that only 20% of Americans view covid-19 as "a major threat"…

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Survey Shows Declining Concerns Among Americans About COVID-19

A new survey reveals that only 20% of Americans view covid-19 as "a major threat" to the health of the US population - a sharp decline from a high of 67% in July 2020.

(SARMDY/Shutterstock)

What's more, the Pew Research Center survey conducted from Feb. 7 to Feb. 11 showed that just 10% of Americans are concerned that they will  catch the disease and require hospitalization.

"This data represents a low ebb of public concern about the virus that reached its height in the summer and fall of 2020, when as many as two-thirds of Americans viewed COVID-19 as a major threat to public health," reads the report, which was published March 7.

According to the survey, half of the participants understand the significance of researchers and healthcare providers in understanding and treating long COVID - however 27% of participants consider this issue less important, while 22% of Americans are unaware of long COVID.

What's more, while Democrats were far more worried than Republicans in the past, that gap has narrowed significantly.

"In the pandemic’s first year, Democrats were routinely about 40 points more likely than Republicans to view the coronavirus as a major threat to the health of the U.S. population. This gap has waned as overall levels of concern have fallen," reads the report.

More via the Epoch Times;

The survey found that three in ten Democrats under 50 have received an updated COVID-19 vaccine, compared with 66 percent of Democrats ages 65 and older.

Moreover, 66 percent of Democrats ages 65 and older have received the updated COVID-19 vaccine, while only 24 percent of Republicans ages 65 and older have done so.

“This 42-point partisan gap is much wider now than at other points since the start of the outbreak. For instance, in August 2021, 93 percent of older Democrats and 78 percent of older Republicans said they had received all the shots needed to be fully vaccinated (a 15-point gap),” it noted.

COVID-19 No Longer an Emergency

The U.S. Centers for Disease Control and Prevention (CDC) recently issued its updated recommendations for the virus, which no longer require people to stay home for five days after testing positive for COVID-19.

The updated guidance recommends that people who contracted a respiratory virus stay home, and they can resume normal activities when their symptoms improve overall and their fever subsides for 24 hours without medication.

“We still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses, this includes vaccination, treatment, and staying home when we get sick,” CDC director Dr. Mandy Cohen said in a statement.

The CDC said that while the virus remains a threat, it is now less likely to cause severe illness because of widespread immunity and improved tools to prevent and treat the disease.

Importantly, states and countries that have already adjusted recommended isolation times have not seen increased hospitalizations or deaths related to COVID-19,” it stated.

The federal government suspended its free at-home COVID-19 test program on March 8, according to a website set up by the government, following a decrease in COVID-19-related hospitalizations.

According to the CDC, hospitalization rates for COVID-19 and influenza diseases remain “elevated” but are decreasing in some parts of the United States.

Tyler Durden Sun, 03/10/2024 - 22:45

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Rand Paul Teases Senate GOP Leader Run – Musk Says “I Would Support”

Rand Paul Teases Senate GOP Leader Run – Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump…

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Rand Paul Teases Senate GOP Leader Run - Musk Says "I Would Support"

Republican Kentucky Senator Rand Paul on Friday hinted that he may jump into the race to become the next Senate GOP leader, and Elon Musk was quick to support the idea. Republicans must find a successor for periodically malfunctioning Mitch McConnell, who recently announced he'll step down in November, though intending to keep his Senate seat until his term ends in January 2027, when he'd be within weeks of turning 86. 

So far, the announced field consists of two quintessential establishment types: John Cornyn of Texas and John Thune of South Dakota. While John Barrasso's name had been thrown around as one of "The Three Johns" considered top contenders, the Wyoming senator on Tuesday said he'll instead seek the number two slot as party whip. 

Paul used X to tease his potential bid for the position which -- if the GOP takes back the upper chamber in November -- could graduate from Minority Leader to Majority Leader. He started by telling his 5.1 million followers he'd had lots of people asking him about his interest in running...

...then followed up with a poll in which he predictably annihilated Cornyn and Thune, taking a 96% share as of Friday night, with the other two below 2% each. 

Elon Musk was quick to back the idea of Paul as GOP leader, while daring Cornyn and Thune to follow Paul's lead by throwing their names out for consideration by the Twitter-verse X-verse. 

Paul has been a stalwart opponent of security-state mass surveillance, foreign interventionism -- to include shoveling billions of dollars into the proxy war in Ukraine -- and out-of-control spending in general. He demonstrated the latter passion on the Senate floor this week as he ridiculed the latest kick-the-can spending package:   

In February, Paul used Senate rules to force his colleagues into a grueling Super Bowl weekend of votes, as he worked to derail a $95 billion foreign aid bill. "I think we should stay here as long as it takes,” said Paul. “If it takes a week or a month, I’ll force them to stay here to discuss why they think the border of Ukraine is more important than the US border.”

Don't expect a Majority Leader Paul to ditch the filibuster -- he's been a hardy user of the legislative delay tactic. In 2013, he spoke for 13 hours to fight the nomination of John Brennan as CIA director. In 2015, he orated for 10-and-a-half-hours to oppose extension of the Patriot Act

Rand Paul amid his 10 1/2 hour filibuster in 2015

Among the general public, Paul is probably best known as Capitol Hill's chief tormentor of Dr. Anthony Fauci, who was director of the National Institute of Allergy and Infectious Disease during the Covid-19 pandemic. Paul says the evidence indicates the virus emerged from China's Wuhan Institute of Virology. He's accused Fauci and other members of the US government public health apparatus of evading questions about their funding of the Chinese lab's "gain of function" research, which takes natural viruses and morphs them into something more dangerous. Paul has pointedly said that Fauci committed perjury in congressional hearings and that he belongs in jail "without question."   

Musk is neither the only nor the first noteworthy figure to back Paul for party leader. Just hours after McConnell announced his upcoming step-down from leadership, independent 2024 presidential candidate Robert F. Kennedy, Jr voiced his support: 

In a testament to the extent to which the establishment recoils at the libertarian-minded Paul, mainstream media outlets -- which have been quick to report on other developments in the majority leader race -- pretended not to notice that Paul had signaled his interest in the job. More than 24 hours after Paul's test-the-waters tweet-fest began, not a single major outlet had brought it to the attention of their audience. 

That may be his strongest endorsement yet. 

Tyler Durden Sun, 03/10/2024 - 20:25

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The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While “Waiting” For Deporation, Asylum

The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While "Waiting" For Deporation, Asylum

Over the past several…

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The Great Replacement Loophole: Illegal Immigrants Score 5-Year Work Benefit While "Waiting" For Deporation, Asylum

Over the past several months we've pointed out that there has  been zero job creation for native-born workers since the summer of 2018...

... and that since Joe Biden was sworn into office, most of the post-pandemic job gains the administration continuously brags about have gone foreign-born (read immigrants, mostly illegal ones) workers.

And while the left might find this data almost as verboten as FBI crime statistics - as it directly supports the so-called "great replacement theory" we're not supposed to discuss - it also coincides with record numbers of illegal crossings into the United States under Biden.

In short, the Biden administration opened the floodgates, 10 million illegal immigrants poured into the country, and most of the post-pandemic "jobs recovery" went to foreign-born workers, of which illegal immigrants represent the largest chunk.

Asylum seekers from Venezuela await work permits on June 28, 2023 (via the Chicago Tribune)

'But Tyler, illegal immigrants can't possibly work in the United States whilst awaiting their asylum hearings,' one might hear from the peanut gallery. On the contrary: ever since Biden reversed a key aspect of Trump's labor policies, all illegal immigrants - even those awaiting deportation proceedings - have been given carte blanche to work while awaiting said proceedings for up to five years...

... something which even Elon Musk was shocked to learn.

Which leads us to another question: recall that the primary concern for the Biden admin for much of 2022 and 2023 was soaring prices, i.e., relentless inflation in general, and rising wages in particular, which in turn prompted even Goldman to admit two years ago that the diabolical wage-price spiral had been unleashed in the US (diabolical, because nothing absent a major economic shock, read recession or depression, can short-circuit it once it is in place).

Well, there is one other thing that can break the wage-price spiral loop: a flood of ultra-cheap illegal immigrant workers. But don't take our word for it: here is Fed Chair Jerome Powell himself during his February 60 Minutes interview:

PELLEY: Why was immigration important?

POWELL: Because, you know, immigrants come in, and they tend to work at a rate that is at or above that for non-immigrants. Immigrants who come to the country tend to be in the workforce at a slightly higher level than native Americans do. But that's largely because of the age difference. They tend to skew younger.

PELLEY: Why is immigration so important to the economy?

POWELL: Well, first of all, immigration policy is not the Fed's job. The immigration policy of the United States is really important and really much under discussion right now, and that's none of our business. We don't set immigration policy. We don't comment on it.

I will say, over time, though, the U.S. economy has benefited from immigration. And, frankly, just in the last, year a big part of the story of the labor market coming back into better balance is immigration returning to levels that were more typical of the pre-pandemic era.

PELLEY: The country needed the workers.

POWELL: It did. And so, that's what's been happening.

Translation: Immigrants work hard, and Americans are lazy. But much more importantly, since illegal immigrants will work for any pay, and since Biden's Department of Homeland Security, via its Citizenship and Immigration Services Agency, has made it so illegal immigrants can work in the US perfectly legally for up to 5 years (if not more), one can argue that the flood of illegals through the southern border has been the primary reason why inflation - or rather mostly wage inflation, that all too critical component of the wage-price spiral  - has moderated in in the past year, when the US labor market suddenly found itself flooded with millions of perfectly eligible workers, who just also happen to be illegal immigrants and thus have zero wage bargaining options.

None of this is to suggest that the relentless flood of immigrants into the US is not also driven by voting and census concerns - something Elon Musk has been pounding the table on in recent weeks, and has gone so far to call it "the biggest corruption of American democracy in the 21st century", but in retrospect, one can also argue that the only modest success the Biden admin has had in the past year - namely bringing inflation down from a torrid 9% annual rate to "only" 3% - has also been due to the millions of illegals he's imported into the country.

We would be remiss if we didn't also note that this so often carries catastrophic short-term consequences for the social fabric of the country (the Laken Riley fiasco being only the latest example), not to mention the far more dire long-term consequences for the future of the US - chief among them the trillions of dollars in debt the US will need to incur to pay for all those new illegal immigrants Democrat voters and low-paid workers. This is on top of the labor revolution that will kick in once AI leads to mass layoffs among high-paying, white-collar jobs, after which all those newly laid off native-born workers hoping to trade down to lower paying (if available) jobs will discover that hardened criminals from Honduras or Guatemala have already taken them, all thanks to Joe Biden.

Tyler Durden Sun, 03/10/2024 - 19:15

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