On Monday, Italy placed its 60 million residents under lockdown, as the number of cases of the COVID-19 virus throughout the country continues to rise.
In less than a month, Italy has gone from having only three cases of the coronavirus to having the highest number of cases and deaths outside of China, with 463 deaths and at least 9, 172 of people infected throughout all 20 regions of the country. The number of cases rose by 50% on March 8 alone. Italy also faces an above average mortality rate of 4%.
“We all must give something up for the good of Italy,” Italian Prime Minister Giuseppe Conte said in a televised address on Monday while announcing the nationwide lockdown. “There is no more time.”
The nationwide lockdown is expected to have major economic repercussions on the country, where growth was already stagnating. While the government has not specified exactly how long the ban will last, it says it will remain in place until April 3.
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Here is how the virus spread across the country — and why it is so much worse in Italy than any other European country:
How did coronavirus start spreading in Italy?
Officially it began in Feb. 20, when a 38-year-old man checked himself into a local hospital in the town of Codogno in Lombardy. He tested positive with the virus, becoming the first recorded patient with the COVID-19 virus in Italy.
Yet some health officials believe that the virus arrived in Italy long before the first case was discovered. “The virus had probably been circulating for quite some time,” Flavia Riccardo, a researcher in the Department of Infectious Diseases at the Italian National Institute of Health tells TIME. “This happened right when we were having our peak of influenza and people were presenting with influenza symptoms.”
Before the first case was reported, there was an unusually high number of pneumonia cases recorded at a hospital in Codogno in northern Italy, the head of the emergency ward Stefano Paglia told the newspaper La Repubblica, suggesting it is possible patients with the virus were treated as if they had a seasonal flu. Health facilities hosting these patients could have become sites for infection, helping proliferate the spread of the virus.
The northern regions of Lombardy, Veneto and Emilia-Romagna, have been most affected by the outbreak. 85% of infected patients are in the region which is home to 92% of deaths so far. But the virus has been confirmed in all 20 regions of the country.
Why does Italy have such a high number of cases and deaths?
Because the virus spread undetected, some officials believe this is the reason for such a high number of cases in the country. “This started unnoticed which means by the time we realized it, there were a lot of transmission chains happening,” Riccardo says, noting that this may be why Italy has seen such a high number of cases.
Some officials also believe Italy, which has already tested over 42, 000 people, may have a higher number of cases as a result of performing more rigorous tests than their European counterparts.
Italy, however, is also reporting an above average mortality rate at 4%. The average age of coronavirus patients who have died because of the virus in Italy is 81, according to the National Health Institute. Italy, which has one the world’s oldest populations, could be facing a higher mortality rate as a result of its above-average elderly population. “Italy is the oldest country in the oldest continent in the world,” says Lorenzo Casani, the health director of a clinic for elderly people in Lombardy told TIME. “We have a lot of people over 65.”
Casani also suggests the mortality rate might be higher than average because Italy is testing only the critical cases. “We are not doing enough,” he said.
Casani says that pollution in northern Italy could be a factor in higher death rates. According to a report by the Swiss air monitoring platform IQAir, 24 of Europe’s 100 most polluted cities are in Italy. “Studies have shown a high correlation between mortality rates from viral respiratory conditions and pollution,” Casani says. “This could be a factor.”
Was the Italian government prepared for the outbreak?
The outbreak in Italy has come as a surprise to some, given the stringent measures Italy imposed to protect itself from the virus. A month before the first case was reported, the Italian Health Ministry created a task force to manage coronavirus. Italy was the first European Union country to ban flights to and from China.
The travel ban, however, may have encouraged travellers to come in on connecting flights without disclosing their country of departure. Some experts also believe the virus could have entered the country before the government took action, spreading undetected throughout the country.
How is the government responding now?
The Italian government has taken the biggest steps outside of China to curb the spread of the disease.
Under the new lockdown legislation, people can be issued fines for traveling within or outside the country without a permit, though foreigners still can travel to Italy. All public events are banned and schools have been cancelled throughout the country. Public spaces, such as gyms, theatres and cinemas, have also been closed by the government. Individuals who defy the lockdown could face up to three months in jail or a fine of $234. The new rules prohibit inmates from having visitors or day releases, which set off protests at 27 prisons throughout the country.
Why Overreacting to the Threat of the Coronavirus May Be Rational
The problem with COVID-19 is that it’s unclear what to do.
Many have applauded Italy’s actions. In a tweet, the Director-General of the World Health Organization commended Italy for its “bold, courageous steps” and for “making genuine sacrifices.”
The government & the people of 🇮🇹 are taking bold, courageous steps aimed at slowing the spread of the #coronavirus & protecting their country & 🌍. They are making genuine sacrifices. @WHO stands in solidarity with 🇮🇹 & is here to continue supporting you.https://t.co/Y2rkgUihtA
Some infectious disease and public health experts, however, have concerns about the effectiveness of the lockdown.
“These measures will probably have a short-term impact,” John Edmunds, a professor at the London School of Hygiene & Tropical Medicine told Reuters, noting that the measures were “almost certainly unsustainable.” He added, “if they can’t be sustained for the long term, all they are likely to do is delay the epidemic for a while.”
How is the Italian healthcare system handling it?
Italy’s current national health service, known as Servizio Sanitario Nazionale (SSN), provides free universal care to patients yet remains under-funded. Investments in public healthcare make up only 6.8% of the country’s gross domestic product (GDP), which is lower than other countries in the European Union including France and Germany.
“The continuous cuts—to care and to research—are obviously a problem right now,” Casani says. “We were not prepared. We do not have enough doctors for the people. We do not have an organized plan for pandemics.”
With the number of coronavirus cases on the rise, the Italian health ministry has doubled the number of hospital beds in infectious disease wards. The Governor of Lombardy Attilio Fontana has requested that universities grant degrees earlier this school year in order to increase the number of nurses in Italy. Yet some health officials fear these efforts will not be enough.
“Right now in Lombardy, we do not have free beds in intensive care units,” Casani says. He added that doctors “have to make this horrible choice and decide who is going to survive and who is not going to survive…who is going to get a monitor, a respirator and the attention they need.”
What impact will the lockdown have on the Italian economy?
The lockdown could push Italy into a recession. Berenberg bank, which before the outbreak estimated that Italy’s GDP would contract by 0.3%, now forecasts it will fall by 1.2% this year.
Conte said on March 9 that the government would deploy a “massive shock therapy” in order to protect the economy. Italy’s Deputy Economy Minister, Laura Castelli said in an interview with Rai Radio 1 today that “mortgages, taxes, everything is suspended” as a result of the lockdown. The government has also created a support package of $8.5 billion for families and businesses affected by virus.
Italy’s Deputy Economy Minister, Laura Castelli @LaCastelliM5s from the Five Star Movement saying decree tomorrow will suspend mortgages and taxes:
“ Mortgages suspended? Mortgages, taxes, everything is suspended.
But we need to look at the situation of the municipalities” https://t.co/fR6vwMl9T0
Some experts are concerned about the long-term implications of this spending.
Before the coronavirus outbreak, Italy was already struggling with a public debt that is at 134% of the country’s GDP. In the Europe Union, countries are not supposed to have debt that is higher than 60% of their country’s GDP. “With the increased spending that comes with having to support people and businesses, the deficit might explode,” says Pepijn Bergsen, a Europe Research Fellow at Chatham House.
An economic slowdown in Italy, a country in the Eurozone, will have impacts on the rest of the continent.
“It is likely there will be a Eurozone wide recession this year,” Bergsen says, citing both an Italian recession and potential future lockdowns in other European Union countries as contributing factors. “It will be difficult for authorities to come up with any measures that would avoid a recession.”
Eleven people have now died in the United States after contracting the novel coronavirus. Ten of the U.S. deaths have been in Washington state and one has been in California, with the latest two fatalities confirmed on Wednesday.
At least 159 people have been diagnosed with the coronavirus—known as COVID-19—in the U.S. so far, according to a virus tracker from researchers at Johns Hopkins University. The infections are scattered across at least 16 U.S. states.
Pence said that all travel coming from Iran has been suspended and “even foreign nationals who visit either [China or Iran] are barred from coming into this country for 14 days.”
Pence also said that the Center for Medicaid and Medicare Services has issued new guidelines for nursing homes nationwide aiming to improve infectious disease control and ensure those operating these facilities are complying with federal standards. Many of the cases in Washington State have been linked with a nursing home.
At a press conference on Tuesday, Pence had said the U.S. is now “screening 100% of all travelers taking direct flights from all airports in Italy and South Korea” to the U.S and that Medicaid and Medicare would cover the cost for Americans who can’t afford COVID-19 testing. He added that new guidance would quickly be issued “to make it clear that, subject to a doctor’s orders, anyone can be tested.”
Federal officials noted that the American public should prepare for “more cases in the community” as the country improves its ability to track and diagnose the disease.
Outside Washington and New York, at least 14 other states have recorded confirmed COVID-19 cases. A number of these cases are Americans evacuated from the virus-stricken Diamond Princess cruise ship in Japan, where over 620 passengers and crew were diagnosed with the virus.
Globally, more than 94,000 cases of COVID-19 have been diagnosed or clinically confirmed as of March 4 and more than 3,200 people have died, according to Johns Hopkins University researchers. The vast majority of cases are in China, but diagnoses in the U.S. are expected to increase over the coming days and weeks, according to the CDC.
U.S. Citizens Document A Day In The Life On Lockdown In Wuhan
On early Wednesday morning, a U.S. plane evacuated around 240 Americans from Wuhan. Justin Steece and Priscilla Dickey were not on that plane with their families.
Here’s what to know about COVID-19 cases in the U.S.
California announced the state’s first COVID-19 death and State Gov. Gavin Newsom declared a state of emergency on Wednesday.
Local and federal health officials are now working to contact other cruise passengers as they “may also have been exposed,” according to Placer County health officials. Newsom said about 2,500 passengers traveled on the same voyage as the Placer Country victim.
As of Wednesday, 53 people had tested positive for COVID-19 in California. Of these, 24 were cases related to repatriation flights and 29 cases were not related to these flights; 12 were travel-related. 10 more involved person-to-person spread, four involved community transmission and three were “currently under investigation.”
Officials in Washington State confirmed a tenth coronavirus death on Wednesday and the state currently has 39 COVID-19 cases.
Nine of the deaths are in King County, and an additional death is in Snohomish County. The most recently reported deaths in King County include a woman in her eighties who was never hospitalized and died at her family home, and a man in his 50s who was hospitalized at Harborview Medical Center. Both of them died on Feb. 26 and were residents of Life Care Center in Kirkland, a long-term residential facility where more than 50 people have reported symptoms of possible COVID-19 infection.
On Tuesday, Acting U.S. Department of Homeland Security Secretary Chad Wolf said that he had ordered the facility to close “out of an abundance of caution” and “directed those employees to telework, if possible, in order to reduce the threat of community spread of the coronavirus.”
The center said in a statement Wednesday that there are several confirmed COVID-19 cases connected to the facility. It added that current residents and associates continue to be monitored closely” and that it is following the infection control recommendations from the CDC. The center had previously said all visits from family and volunteers are suspended for the time being, and new residents are currently not being admitted to the center.
King County announced an additional seven new COVID-19 cases on Tuesday. Thirty-one cases in the state, including those who died, are in King County. At least another nine are in Snohomish County, according to Washington State’s Department of Health. About 230 people at risk of having been exposed to the coronavirus are under medical supervision.
King County signed an emergency declaration on Sunday allowing it to take extra steps to respond to the COVID-19 outbreak. “Among the first actions: purchasing a motel and setting up modular housing units on publicly-owned parking lots and other available land,” the county said in a statement.
Health officials say the first patient who succumbed to the virus had no known history, travel or contact with a known COVID-19 case, suggesting he was infected by human-to-human transmission (often referred to as community transmission).
The results of a study published by Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center in Seattle, suggests that the true number of infections in the state is “a few hundred.”
The study “strongly suggests that there has been cryptic transmission in Washington State for the past six weeks,” Bedford tweeted.
Washington Governor Jay Inslee declared a state of emergency on Saturday in response to the new cases, and directed state agencies to use “all resources necessary to prepare for and respond to the outbreak.”
The first case of COVID-19 in the U.S. appeared in Washington on Jan. 21. A 35-year-old man presented himself to an urgent care clinic in Snohomish County, Wash., after four days of cough and fever, according to the New England Journal of Medicine, which reported that he had recently been visiting family in Wuhan.
The man was released from a Washington hospital on Feb. 4, according to the Associated Press.
Cruise ship evacuees
On Feb. 17, the U.S. State Department evacuated more than 300 American citizens from a quarantined cruise ship in Japan. The Diamond Princess has the largest outbreak of the novel coronavirus outside China, with at least 621 confirmed cases so far.
During the evacuation process, American officials learned that 14 of the Americans being repatriated were infected with COVID-19, according to a joint statement from the U.S. State Department and U.S. Department of Health and Human Services.
After consulting with HHS, officials with the State Department decided to allow the 14 individuals, “who were in isolation, separated from other passengers, and continued to be asymptomatic, to remain on the aircraft to complete the evacuation process,” the statement said.
CDC spokesperson Richard Quartarone told TIME hospitalized patients are at facilities in Sacramento and San Antonio, Texas, or at the Nebraska Medical Center.
Evacuees who were not hospitalized were held in quarantine for 14 days after departing planes at Travis Air Force Base in Sacramento, Calif. and Joint Base San Antonio-Fort Sam Houston in San Antonio, Texas, officials said.
Most, if not all, of these evacuees have since been released from federal quarantine.
More than 100 American citizens who had been on the Diamond Princess remained in Japan, including in hospitals, the CDC said on Feb. 18. The CDC specified that these citizens will only be allowed to fly back to the U.S. if they test negative for and don’t show any symptoms of the virus during the 14-day period.
“If an individual from this cruise arrives in the United States before the 14-day period ends, they will still be subject to a mandatory quarantine until they have completed the 14-day period with no symptoms or positive coronavirus test results,” the CDC said.
The CDC also highlighted concerns with the quarantine process on board the ship, saying that it may have slowed the spread of the disease but that it “may not have been sufficient to prevent transmission among individuals on the ship.”
On Thursday, New York Gov. Andrew M. Cuomo confirmed 11 additional cases of COVID-19, bringing the total in the state to 22. Of the new cases, eight are in Westchester, two are in New York City and one is in Nassau County. “We are trying to contain as much as possible the spread of each case we find – but we expect more cases,” Cuomo said.
Thursday’s cases in New York City include a man in his 40s and a woman in her 80s; neither had traveled to areas with known outbreaks or are connected to other individuals already diagnosed with the disease, according to New York City Mayor Bill de Blasio.
On Wednesday afternoon, Cuomo confirmed five new cases, all in a single family from New Rochelle: a wife and husband in their 40s and three of their children. The entire family is under self-quarantine, Cuomo said.
On Wednesday morning, Cuomo had confirmed an additional four cases of coronavirus. All four are tied to the state’s second case of COVID-19, announced Tuesday — a man in his 50s who lives in Westchester County and works in Manhattan. Those four cases included his wife, two of his children and a neighbor who drove him to the hospital, Cuomo said.
The female child attends SAR Academy and High School in the Bronx and the male child attends Yeshiva University in Manhattan and has not been on campus since Feb. 27, according de Blasio. The children and their mother remain isolated at their home in Westchester, de Blasio said.
Cuomo noted on Tuesday that the man in his fifties had not traveled to regions with increasing COVID-19 cases, but had recently been to Miami. However he noted “that is not a place we have known there is any cluster of coronavirus.”
On Sunday, Cuomo confirmed New York’s first case of the coronavirus. He said on Twitter that a woman in her late 30s contracted the virus while traveling in Iran. She has mild respiratory symptoms but is not in serious condition, and is currently isolated in her home.
Cuomo said there is “no reason for anxiety” as the “general risk remains low in New York.” Still, residents rushed to purchase masks and hand sanitizers at pharmacies, which saw long lines out the door, according to the New York Times. Many said they were out of stock.
Doctors in Nebraska have treated 13 COVID-19 patients — all of whom were on the Diamond Princess cruise ship in Japan, according to the New York Times.
Eleven involve evacuees who were infected overseas before arriving at the San Antonio Lackland Air Force Base for quarantine. The only case identified outside of the site is a man in his 70s who lives in the Houston area. He recently returned from travel abroad and is currently isolated in the hospital, according to Texas Health and Human Services.
The City of San Antonio Metropolitan Health District and the CDC announced Feb. 13 that the first person testing positive for COVID-19 in Texas was one of the Americans evacuated from Wuhan and transported to the military base on Feb. 7, after leaving Wuhan the previous day.
On the morning of Feb. 11, the patient exhibited signs of a fever, Jennifer McQuiston, a CDC division deputy director, said. The person was transported to a hospital that morning, where samples were gathered and sent to the CDC overnight. Officials received the positive diagnosis the following day.
“[That patient is] receiving excellent medical care,” McQuiston said at a Feb. 13 press conference. “They were, of course, not happy to learn of their diagnosis last night, and they do have loved ones in the United States that they are in contact with by phone, and we wish this individual well.”
Dr. Anita Kurian, assistant director at the San Antonio Metropolitan Health District, also said at the press conference that “the risk for us at this time to the community here is still considered low.”
Illinois officials said it has four “presumed positive” cases on Tuesday. The third and fourth cases are a married man and woman in their seventies.
The first case in Illinois was a woman in her 60s who had returned to the U.S. from Wuhan on Jan. 13, health officials said at a press briefing on Jan. 30. Her husband then contracted the virus, becoming the first confirmed case of person-to-person transfer of the virus in the U.S.
The Illinois Department of Public Health announced Feb. 12 that it became the first state in the U.S. to begin in-state testing for the virus.
Oregon has confirmed three “presumptive positive” cases of COVID-19 in the state. One of those cases was confirmed by the CDC on Wednesday.
State officials confirmed a third case on Tuesday: an adult Umatilla County resident who is hospitalized in Walla Walla, Wash. Initial reports suggest that the resident recently went to a youth basketball game at a middle school. Athena-Weston School District officials closed the gym in question and would “conduct a deep cleaning out of an abundance of caution,” health officials said in a statement.
The state’s first and second COVID-19 cases are adults in Washington County who live together. Neither person has “ a history of travel to a country where the virus was circulating, nor is believed to have had a close contact with another confirmed case,” health officials said in a statement. “As such, public health officials are considering it a likely community-transmitted case, meaning that the origin of the infection is unknown.”
The CDC confirmed two cases of COVID-19 in Florida, the Florida Department of Health said on Monday. Officials said on Tuesday that a third person in the state had tested positive; she is the sister of a person already confirmed to have the virus.
The agency had said in a previous statement on Sunday that the first patient is an adult resident of Manatee County who has not traveled to countries identified for restricted travel by the CDC; the second patient is an adult Hillsborough County resident who had traveled to Italy. Both individuals would continue to “remain isolated until cleared by public health officials,” the Florida Department of Health said.
Georgia Gov. Brian Kemp confirmed the state’s first two cases of COVID-19 on Monday evening.
Both individuals are residents of Fulton County who live in the same household; one recently returned from Italy and both are isolated at home with mild symptoms, according to a statement from the governor’s office.
“We knew that Georgia would likely have confirmed cases of COVID-19, and we planned for it. The immediate risk of COVID-19 to the general public, however, remains low at this time,” said Dr. Kathleen E. Toomey, Commissioner of the Georgia Department of Public Health.
Rhode Island announced its first COVID-19 “presumptive positive” case on Sunday: a person in their 40s who had traveled to Italy in mid-February.
Dr. Nicole Alexander-Scott, Director of the Rhode Island Department of Health, said in a statement that the agency has been “preparing for weeks” and “fully anticipated having a first case of COVID-19.”
“We are not seeing widespread community transmission in Rhode Island, and the general level of risk for Rhode Islanders is still low,” Alexander-Scott said.
The agency announced a second COVID-19 “presumptive positive case” later the same day: a teenager who is “at home with mild symptoms.” She had been on the “same trip to Europe in mid-February as the male in his 40s,” according to the Rhode Island Department of Health.
“All 38 of the people who went on this trip will be self-monitoring for symptoms at home for 14 days with public health supervision, the department said in a statement. “They have been instructed to not go to school or work and to remain at home for these 14 days.”
Arizona confirmed on Tuesday its second “presumed positive” case of COVID-19, in a man in his twenties.
“This individual is a known contact of a presumed positive case outside of Arizona who had traveled to an area with community spread of COVID-19,” the Arizona Department of Health Services news release.
The first case of COVID-19 was confirmed in Arizona by the CDC on Jan. 26. The person had also recently returned to the U.S. after visiting Wuhan. The Arizona Department of Health Services said in a public statement that the person is “a member of the Arizona State University community who does not live in university housing,” and added that they were not severely ill but would be kept in isolation.
The infected man was subsequently released from isolation 26 days after testing positive for COVID-19, according to the Associated Press.
The state’s first case was announced Monday in a hospital employee who had recently traveled to Italy. Health officials later learned this person broke quarantine to attend a social event on Feb. 28 and said they would contact attendees who “had close contact with the person.”
New Hampshire announced its second “presumed positive” case of COVID-19 on Tuesday. State officials said the person, an adult male from Grafton County, had close contact with the first case and is currently isolated at home.
At this time, there is no evidence of more widespread community transmission in New Hampshire,” said state Epidemiologist Dr. Benjamin Chan in a statement after the first case was announced.
On Wednesday, New Jersey announced its first “presumptive positive case” of COVID-19 — a man in his 30s who has been hospitalized in Bergen County.
Health officials maintained that “most New Jersey residents” are still at low-risk.
On Monday, state health officials announced a presumptive case: a woman who had recently traveled to Italy.
On Feb. 1, the CDC announced that a man in his 20s who lives in Boston was diagnosed with COVID-19; he had recently traveled to Wuhan.
The Massachusetts Department of Public Health said the man sought medical care soon after his return to Boston. He has since been in isolation, and those who came in contact with him have been identified and are being monitored for symptoms, the agency said in a public statement.
“We are grateful that this young man is recovering and sought medical attention immediately,” said Monica Bharel, Massachusetts Public Health Commissioner, in the statement. “Massachusetts has been preparing for a possible case of this new coronavirus, and we were fortunate that astute clinicians took appropriate action quickly. Again, the risk to the public from the 2019 novel coronavirus remains low in Massachusetts.”
The Wisconsin Department of Health Services and the CDC announced the first case of COVID-19 in the state on Feb. 5. The person was only identified as “an adult with a history of travel to Beijing, China prior to becoming ill and was exposed to known cases while in China.”
Wisconsin health officials said in a public statement that the person is isolated at home, and is doing well.
North Carolina announced its first “presumed positive” case of COVID-19 on Tuesday. According to state officials, the person traveled to Washington state and was exposed at a long-term care facility where there is currently a COVID-19 outbreak.
Topline: Facebook will begin taking down any ads that promise a cure for the coronavirus, as the platform battles the rapid spread of conspiracy theories and fake cures—including drinking bleach to cure the disease—that have erupted in panic and confusion over the epidemic on social media.
A Facebook spokesperson told Forbes it will remove ads for products “that refer to the coronavirus and create a sense of urgency, like implying a limited supply, or guaranteeing a cure or prevention.”
The spokesperson added that, for example, “ads with claims like face masks that are 100% guaranteed to prevent the spread of the virus will not be allowed.”
Health experts warn the spread of misinformation, fake cures and conspiracy theories about coronavirus can actively cause harm and undermine trust in government institutions. “We need a vaccine against misinformation,” said Mike Ryan, head of the WHO health emergencies program, in a meeting this month.
A number of false cures have spread on Facebook in the past few months, including one claiming that drinking bleach can cure the virus, according to FactCheck.org.
Facebook already said in January it will outright remove posts flagged by global health organizations and local health authorities with potentially harmful false cures or prevention methods for the coronavirus.
But the company also said last month it won’t remove other false claims about the virus, opting instead to fact-check, demote them in the news feed and point users to reliable information from the World Health Organization.
Key background: Facebook has struggled to contain disinformation since the 2016 election and has faced criticism for not removing ads from politicians that contain lies. But misleading or untrue medical claims have been a particularly thorny issue for the platform. Facebook banned misleading ads about vaccines last year, but private Facebook groups have become hotbeds of medical misinformation, and some ads expressing skepticism about vaccines haven’t been taken down. CEO Mark Zuckerberg has repeatedly said that Facebook shouldn’t be an arbiter of truth, and company policy is to be usually reluctant to remove posts and ads at all.
News peg: More than 81,000 people globally have been infected with the virus as of Wednesday, and more 2,700 have died. The World Health Organization hasn’t declared the virus a pandemic, but Europe, the Middle East and the U.S. are preparing for an outbreak as cases outside China continue to surge.
I’m a San Francisco-based reporter covering breaking news at Forbes. Previously, I’ve reported for USA Today, Business Insider, The San Francisco Business Times and San Jose Inside. I studied journalism at Syracuse University’s S.I. Newhouse School of Public Communications and was an editor at The Daily Orange, the university’s independent student newspaper. Follow me on Twitter @rachsandl or shoot me an email email@example.com.
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The World Health Organization earlier this year called antimicrobial resistance—pathogens’ ability to evade medical interventions—one of the 10 largest threats to global health. In the U.S. alone, according to a recent Centers for Disease Control and Prevention (CDC) report, 35,000 people die each year due to antibiotic-resistant infections.
A new study published in the BMJ points to one major propagator of the problem: doctors are prescribing antibiotics when they shouldn’t. In fact, up to 43% of U.S. antibiotic prescriptions may be “inappropriate,” according to the research.
Antibiotics either kill bacteria or keep them from multiplying. By definition, they work only against bacterial illnesses—and yet, research shows they’re often needlessly prescribed for viral illnesses like the flu and common colds. That’s not only a waste of resources; it may also contribute to antibiotic resistance, since bacteria get better and better at evading drugs each time they encounter them.
The authors of the BMJ paper analyzed data from the National Ambulatory Medical Care Survey, which asks a representative sample of U.S. physicians to describe patients’ office visits during a specified period of time. The authors examined data from more than 28,000 medical visits that took place in 2015, which can be statistically extrapolated to represent almost 991 million visits nationwide.
Antibiotics were prescribed during 13.2% of these visits. Based on the medical office reports, the researchers concluded that 57% of those prescriptions were appropriately written for treating conditions known to respond well to antibiotics. A quarter were written for explicitly inappropriate reasons, such as for “treating” viral illnesses, with upper respiratory tract infections being among the most common.
The final 18% were not documented well enough to assess the prescription’s validity—itself a problem that needs fixing, and one that makes it difficult for researchers to accurately analyze how and how often improper prescriptions occur.
Specialists were more likely than primary care physicians to write an inappropriate prescription, the researchers found.
The health community is already seeing the consequences of these improper prescriptions. In addition to the deaths detailed in the CDC’s recent report, an estimated 2.8 million Americans contract and survive antibiotic-resistant infections each year, the agency says. As illnesses get more and more difficult to treat, patients may suffer longer, and doctors might be forced to turn to increasingly powerful drugs, which can come with harmful side effects.
Doctors all over the world are rushing to keep up with infections that are getting increasingly good at resisting antibiotic treatment, such as gonorrhea, tuberculosis, and bacterial pneumonia.
Biology Professor (Twitter: @DrWhitneyHolden) describes some of the most common antibiotic-resistant bacteria, including MRSA, VRSA, KPC, and antibiotic-resistant C. difficile. She also discusses four common mechanisms through which bacteria acquire antibiotic resistance and discusses what you can do to limit the development of new strains of antibiotic-resistant bacteria. Great for MCAT review! To see Biology Professor’s video on conjugation, visit: http://youtu.be/YycVGqBs1p0