one genetic trick ( gene reassortment ) underlying IAV pandemic emergences ; however , like human IAVs , SARS-CoV-2 can be expected to evolve by mutation as it spreads through human populations , and it has the additional capacity of evolving by genetic recombination . Enzootic evidence supports a very high degree of recombination of SARS-like CoVs in nature . Will these capacities allow SARS-CoV-2 to escape from population immunity elicited by natural infection or future vaccination ? Only additional time , and much important research , will begin to answer these questions .”
While researchers attempt to answer some of these important questions , a One Health approach to public health remains a viable way to better understand the transmission of emerging infectious threats . As Morens and Fauci ( 2020 ) conclude , “ SARS-CoV-2 is a deadly addition to the long list of microbial threats to the human species . It forces us to adapt , react , and reconsider the nature of our relationship to the natural world . Emerging and re-emerging infectious diseases are epiphenomena of human existence and our interactions with each other , and with nature . As human societies grow in size and complexity , we create an endless variety of opportunities for genetically unstable infectious agents to emerge into the unfilled ecologic niches we continue to create . There is nothing new about this situation , except that we now live in a human-dominated world in which our increasingly extreme alterations of the environment induce increasingly extreme backlashes from nature .”
They add , “ Science will surely bring us many life-saving drugs , vaccines , and diagnostics ; however , there is no reason to think that these alone can overcome the threat of ever more frequent and deadly emergences of infectious diseases . Evidence suggests that SARS , MERS , and COVID-19 are only the latest examples of a deadly barrage of coming coronavirus and other emergences . The COVID-19 pandemic is yet another reminder , added to the rapidly growing archive of historical reminders , that in a human-dominated world , in which our human activities represent aggressive , damaging , and unbalanced interactions with nature , we will increasingly provoke new disease emergences . We remain at risk for the foreseeable future . COVID-19 is among the most vivid wake-up calls in over a century . It should force us to begin to think in earnest and collectively about living in more thoughtful and creative harmony with nature , even as we plan for nature ’ s inevitable , and always unexpected , surprises .”
Although Pandora ’ s box may have been opened , Morens and Daszak , et al . ( 2020 ) observe , “ With luck , public health control measures may be able to put the demons back in the jar . If they do not , we face a daunting challenge equal to or perhaps greater than that posed by the influenza pandemic of a century ago . As the late Nobel laureate Joshua Lederberg famously lamented about emerging infectious diseases , ‘ It ’ s our wits versus their genes .’ Right now , their genes are outwitting us by adapting to infectivity in humans and to sometimes silent spread , without — so far — revealing all their secrets . But we are catching up . As we push ahead , we should take heart in the Hesiod version of the Pandora myth , in which Pandora managed to prevent a single escape : ‘ Only Hope was left …, she remained under the lip of the jar , and did not fly away .’”
Antibiotic / Antimicrobial Resistance
As Lacotte , et al . ( 2020 ) remind us , “ Bacteria will always evolve resistance to antibiotics . Yet , this evolution can be hindered through a broad set of interventions combining surveillance , antibiotic stewardship , infection prevention and control ( IP & C ) and ensuring appropriate access to antibiotics while maintaining efforts to bring new innovative antibiotics ( or alternative therapeutics ), diagnostics , and vaccines to the market .”
While much progress is still needed , in late 2019 , a report from the Centers for Disease Control and Prevention ( CDC ) showed that prevention efforts in hospitals are working but additional research and coordinated efforts inside and outside hospitals are needed to contain the growing threat of antibiotic resistance .
“ This data is exciting because it shows that we are not powerless against antibiotic resistance . SHEA members , which include hospital epidemiologists , infection prevention specialists , researchers and pharmacists , are running critically important infection prevention and antibiotic stewardship programs that save lives and help protect patients , making hospitals safer for everyone ,” said Hilary Babcock , MD , MPH , past-president of the Society for Healthcare Epidemiology of America ( SHEA ), in a statement . “ We must continue to fund and support effective infection prevention and antibiotic stewardship programs in every healthcare setting and use every tool we have to prevent the spread of antibiotic resistance .”
The CDC report , Antibiotic Resistance Threats in the United States ( 2019 ), underscored the continued threat of antibiotic resistance . The data show that the burden of antibiotic resistance is greater than initially understood and attributes the decline in deaths to infection prevention practices , vaccinations , and improved use of antibiotics , especially in hospitals . Antibiotic stewardship programs use multiple strategies to improve the way antibiotics are prescribed and used and according to SHEA , are “ an important defense against the development of antibiotic resistance . These approaches help preserve the effectiveness of the antibiotics currently available .”
While prevention and containment efforts are demonstrating an impact in hospital settings , infection rates in other healthcare facilities and in the community are not showing the same gains . For example , the report notes that the vast majority of ESBL-producing Enterobacteriaceae begin in the community ( 47 percent ), after a recent healthcare exposure ( 34 percent ), or in a long-term care facility ( 14 percent ). Additionally , cases of Clostridioides difficile are decreasing in hospitals , but community-associated cases are not .
“ The evidence base for preventing infections was primarily developed in hospitals . Targeted investments are needed for research to increase our understanding of effective strategies to prevent and contain infections in other settings , and for studies of the best ways to maximize implementation of those strategies once identified . These evidence-based strategies must be adapted and spread across settings so that all patients can benefit from this life-saving science ,” said Babcock .
In the foreword of the report , Antibiotic Resistance Threats in the United States , CDC director Robert Redfield indicated that to stop antibiotic resistance , the U . S . must “ Stop referring to a coming post-antibiotic era — it ’ s already here . You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy . The time for action is now and we can be part of the solution . Stop playing the blame game . Each person , industry , and country can affect the development of antibiotic resistance . We each have a role to play and should be held accountable to make meaningful progress against this threat . Stop relying only on new antibiotics that are slow getting to market and that , sadly , these germs will