We are currently waging a world war. This global conflict is amassing casualties in the millions, eclipsing those fallen in the First and Second World wars combined. The enemy is infection. The victims are innocents from all over the globe, from 1st to 3rd world, including school children. Infection is not fussy who, when and where it attacks.
We live quite happily with most microorganisms. In fact they are pretty much vital to our existence. However some of them are not so kind to us, causing us to be ill and even causing death. There is a great irony in all of this. Whereas pathogens are poisonous to us, in most cases our bodies actually need to sample some of them in order to teach itself how to fight them and keep us healthy. As it is not possible to rid the globe of all harmful microorganisms our strategy is based upon living with them and keeping the most harmful at bay.
Our body's ability to learn and adapt in order fight harmful germs is reciprocated by the germs themselves. As we adapt, so do they. As we find medicines and treatments that will aid the body's fight against them, so they also adapt and find ways around our defenses.
So, is the answer to allow the germs to spread in order to allow our bodies to 'learn' how to fight them? By and large the answer to this is a resounding 'yes'. We cannot possibly hope to catalogue and find medical defences for every pathogen and its mutants and dynasties let alone treat each occurrence. However, we must also consider the context of a given infection. The strategy of fighting infection is multi-faceted and based on the following variables:
1. Is pathogen one of the more serious ones?
2. Is the subject vulnerable?
3. What is the source of the infection? In what environment was the pathogen found?
The Pathogen
We are fighting skirmishes with germs all the time although we don't notice it. On rare occasions these skirmishes turn into little wars being fought in our bodies and occasionally the body is overwhelmed to the point that we do indeed notice that we are not well. Even at this point in most cases a fairly healthy body will bring more resources to bear often meaning that it starts to send signals to the brain to slow down and take a rest. We feel sick and we generally obey the body's 'request' that we take a day off and perhaps lay in bed for while. In the vast majority of cases we would not need a doctor and, if you were to visit the doctor, you may well be told to rest and forget it.
However different pathogens will result in different symptoms and the doctor will be looking out for those symptoms that point to more serious infections. If, for example, symptoms include vomiting, excessive nausea, diarrhoea or excessive abdominal pains, the doctor will take the situation more seriously as this may be a clue to a more severe pathogen. When this happens, it cannot be assumed that the body will always cope on its own: it may need some outside help. Doctors are wary of using antibiotics too freely. Once again irony comes into play. As antibiotics become more prevalent, eventually some germs use natural selection as a way of minimising or eliminating the effect of antibiotics. Natural selection is the process whereby a mutant strain of a microbe is found to have qualities that help it to survive more successfully in its environment. Whereas most mutants are not successful over generations, mutants that just happen by chance to be well suited to their environment will propagate, sometimes eclipsing the ancestor strain. Whereas this process can take many years in large mammals which have a longer life cycle, the process is much faster in micro-organisms that can spawn many generations in a short space of time. The more antibiotics that are out there, the more opportunities there are for pathogens to adapt and side-step their effect. Under-prescribing may be bad for an individual patient whereas over-prescribing can be bad for wider society over time. Doctors must face this dilemma on a case by case basis.
Vulnerability
Pathogens that are considered to be less serious to most healthy people can be inherently more serious for older people, or people who already have another illness or young children or pregnant women. Although, once again, the decision about prescribing antibiotics is controversial. However, it is unlikely that those people who are considered to be vulnerable will be denied antibiotics.
Source and Environment
Doctors must sometimes play detective. If an infection was contracted in another country then this may be treated differently than if it appeared to be contracted in the patient's home. More effort may be required to diagnose the exact nature of the infection and treatment may be more vigorous. However a locally sourced infection may require a healthy patient to allow their own body to do more work in order to be able to fight the same infection more effectively next time around. Unfortunately this aspect of the fight against infection requires a great deal of resources from the medial establishment. In truth, patients will not know for certain where they had contracted an infection and there is often not the medial resources to do the required detective work. There are also more opportunities for infection from 'foreign' or 'exotic' pathogens without the need to go to another country. As the human race has become more mobile pathogens are travelling great distances and are making these journeys more frequently. Thus, places where the general public gather in large numbers, such as in subways, airports, concert halls, hospitals or schools, or even in highly populated workplaces, the chance of a more serious infection is all the greater, especially in more cosmopolitan areas.
In this situation, the problem of over-prescribing antibiotics becomes a little academic since we are dealing less with a pathogen that has adapted to its environment but rather with a pathogen whose victims have not adapted to it whereas, in many cases, the local population from wherever the infection was originally sourced may be largely immune to it. In addition, because these infections can come from far and wide, we cannot expect the body to sample each one in order to build up a vast and varied bank of defences. Our bodies are built to deal with infections acquired locally and not a varied array of exotic infections.
This has resulted in a major problem in many countries where public areas have been a major swapping point for infections, some of which are serious to its victims as their bodies do not have the tools to deal with them. This is most noticeable in hospitals where we see headlines about 'hospitals killing their own patients'. The fact that the media focuses on hospitals may be understandable since they are places that are meant to make people well and not do the opposite. However, this attention on hospitals has pushed the problem of infections from other public places to one side. Most hospitals around the world have been forced into improving hygiene standards, introducing hand gels, sprays, wipes etc and ever stricter hand washing regimes. This has gone some way to mitigate the problem in hospitals. However other public places are also hotbeds of potentially serious infection. It is true, of course, that public places do not contain a concentration of unwell, and therefore, by definition, vulnerable people. However this is not true of schools, especially those teaching younger pupils. Young children also fall into the 'vulnerable' category. It is only a matter of time before we see serious outbreaks of disease caused by infections sourced in schools.
Infections from School
The ever increasing effort that has gone into hygienic practice in hospitals is not being reflected in schools, especially junior schools. These also contain vulnerable people. Society may need to face up to the potential for serious infection and resulting illnesses that will result if we do not provide at least the same protections and hygiene standards that are employed in hospitals.
There is a difference, of course. Despite the great challenges of drilling hospital staff, patients and visitors of the need to wash hands and keep clean, we are usually dealing with adults. Children may wash their hands one minute and the next minute will be getting them dirty. Children are far more tactile than adults; many children confined in one space results in a lot of physical contact. Washing hands kills harmful bacteria for that instant. In the next instant the protection is gone.
Some school bursars are beginning to take preventative measures. Increasingly schools are introducing biocidal hand-gel applications that children, staff and visitors are encouraged to use. However, even using powerful biocidal solutions, the protection is not lasting. We obviously cannot ask children to wash their hands every 5 minutes quite apart from the fact this would do even more harm. The answer is to use a stay-active solution that deals with medium/high level contamination and crucially prevents subsequent contamination and recolonisation of harmful microorganisms for at least 3 hours. This revolutionary cleaning product is new to the market and will certainly become an increasing feature in schools.
Dealing with infections is something our body does all the time. Dealing with infections in schools is a more serious business. It is a war that must be won and requires our immediate attention.
Vernon Stent is a marketing author bringing new and innovative ideas to market such as Steri7 biocidal hand sanitizer which provides 3 hours of protection from re-infection to hands. Arkay Hygiene also sells other Steri7 products such as the trigger biocidal spray which provides 7 days of protection