Wednesday, October 24, 2007

Cincinnati Schools Report a 'Superbug'

Districts Report a ‘Superbug’
Drug-resistant form of staph found in some area schools

According to this morning’s Cincinnati Enquirer, at least four school districts are reporting cases of staph infection. These seem to be the drug resistant variant, methicillin-resistant Staphylococcus aureus (MRSA). School officials stated that this is not indicative of an outbreak. The district disinfected 124 schools to reduce the spread of infection.

MRSA is a bacterium most commonly colonizing around the nostrils and open wounds on the skin. MRSA was first discovered in the United Kingdom in 1961 but has now spread worldwide. It is termed a ‘superbug’ because it has mutated to the point where it can survive treatment with antibiotics to include penicillin and methnicillin.

It is most prevalent in hospitals and schools were there is the greatest incidence of human to human contact. Sanitation is a key in preventing further spread of the disease.

The outbreak here in Cincinnati provides us with an opportunity to evaluate our response to an epidemic and the eventual pandemic outbreak predicted once avian flu (H5N1) mutates into a sustainable, human to human virus. Yes, I know staph is a bacterium while the flu is a virus but the response by the community will involve some of the same factors.

Too often homeland security experts base their analysis on an intentional introduction of a pathogen by a terrorist organization (for example, anthrax). While important, such scenarios miss that Mother Nature is far more successful at introducing contagious diseases than anything think a group of humans can conjure up. The method of introduction gets more attention sometimes that what is being introduced. Infection, whether introduced artificially or naturally, creates the same response challenges for the infected community. For instance, the current MRSA outbreak has caused school officials to send kids home. Good, excellent, remove the vector and reduce the chance of the infection spreading. However, an important question we should be asking is what impact do sending sick kids home have on our economy? Tending to a sick child may require a parent to miss work if other family care arrangements cannot be made. This becomes problematic for those households where both parents work or for single parent households. Right now, the outbreak of MRSA is small enough that the economic impact will be negligible. What if though it continues to spread? More adults will be required to stay at home and also face becoming infected themselves. Work will begin to get disrupted. Services will begin to become impacted. Now adults with kids won’t be the only ones required to stay home, many families have elderly parents at home or other family members that my have compromised immune systems. Those adults may not want to come into work and risk infecting their family members.

Employers are going to have to insure that their workplace is clean and infection free (at least to the degree possible). The challenge will be for those businesses that have customers coming into the workplace, each of these people could potential bring in the infection or take it out of the workplace. Think about the next time you are driving on I-75 or I-71 and see all of the different license plates on the vehicles. You regularly see Michigan, Kentucky, Pennsylvania, Indiana even plates from Canada. All of those vehicles carry people who could potentially either introduce a disease or spread the outbreak to beyond the Cincinnati area. Employers will have to figure ways to minimize the spread of infection without compromising customer service. In addition, some employers may have to accomplish all of this with a reduced workforce.

Granted some business, particularly information technology based industries, will be able to utilize telecommuting and other technologies to allow employees to work from home. But the increased workload on the Internet backbones could cause slower speeds or even failure depending on the magnitude of the crisis. Even in high-tech businesses, some things still have to be accomplished on site. Insuring the safety on their employees will be a major part of successfully navigating the outbreak of a epidemic or pandemic illness.

Hospitals right now can meet the medical needs without any concerns. However, this could change should MRSA (or some other infection) begin to spread. Hospitals could become overrun with ill patients and will have to start sending patients to other hospitals creating a surge at neighboring facilities. Patients already admitted to the hospital for other conditions will now be at risk of exposure to the disease (and most likely these patients will have compromised immune systems). Hospital staff will be challenged with extended shifts and family care issues of their own. Staffing shortages will begin to happen as healthcare workers become sick, tired or just unable to come into work because of family care challenges.

This all assumes an actual outbreak of some kind, however we need to remember that even the threat of an outbreak can create similar challenges. Imagine even people believed avian flu was spreading or that someone had started to send anthrax laced mail again? People would stay away from areas they feel are high-risk (think of the recent flap created when Congressional staffers were advised to get a litany of vaccinations before attending a NASCAR race). Regardless the sanity of the guidance given to the staffers, it does remain valid that a large sporting event such as a NASCAR race could be a terrorist target. The methods that don’t need to involve an actual agent, a simple threat to use such an agent could create the same effect (panic and mass hysteria).

Now is the time to evaluate your procedures at work. We can’t ever stop someone (including Mother Nature) from introducing some type of pathogen into our community, but we can prepare now to reduce the impact to our business and families.

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