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The Hidden Toll of Drug-Resistant Superbugs

Just 17 days old, Josiah Cooper-Pope died in the hospital after he was infected with a drug-resistant bacteria, but no one added his death to the toll from the deadly bug.

As Reuters reported earlier this month, hospital officials told Josiah’s mom about the infection, but not that her son was the fourth patient out of 12 who would eventually become infected during an outbreak. The hospital also didn’t notify public health officials as the law required. And the final record, Josiah’s death certificate, did not report the superbug as a cause of death. As the story said, it’s as if the killer got away.

The Reuters investigation, "The Uncounted: The Deadly Epidemic America is Ignoring," details how drug-resistant superbugs like methicillin-resistant Staphylococcus aureus, better known as MRSA, are quietly killing tens of thousands of Americans a year. Part one of the series reveals that the government agencies entrusted to protect our health are unwilling, or unable, to accurately track the problem – and that the medical community too often keeps it from public view.

On this week’s ProPublica podcast, we talk with the reporters behind the investigation, Ryan McNeill, Deborah Nelson and Yasmeen Abutaleb.

Kelly and Ryan Breaux stand holding a portrait of their deceased daughter Emma. The husband and wife lost twins, Emma and Talon, to different superbugs that they contracted while in the neonatal unit. (Reuters/Edmund Fountain)

Here are a few highlights from our conversation, edited for clarity and length:

Tell us about these superbugs.

Yasmeen Abutaleb: There are infections that are resistant to antibiotics, and we focused on 18 that the Centers for Disease Control and Prevention included in a report they issued in 2013. They're basically bacterial infections, and one of them is fungal, that have developed resistance to the drugs that are commonly used to treat them. Doctors are quickly running out of options in how they treat these infections when they crop up in hospitals, or even in the community.

How common are they?

Abutaleb: As the story lays out, we don’t know exactly how many people are getting infected, and how many are dying. The CDC estimates that 23,000 people a year die from these infections, and an additional 15,000 from an infection called Clostridium difficile. But, we don't really know.

How is it possible to leave a superbug that led to a baby’s death off of the death certificate?

Ryan McNeill: There can be several reasons why death certificates are flawed. Doctors don't get a whole lot of training in medical school on how to fill out a death certificate. Some doctors just don't think it matters, as one told us. In some cases, the cause of death can be obscured by something else. These are very sick patients. There's also the possibility that sometimes they don't want to wait for the labs to come back to confirm an infection, before signing the death certificate.

How did our country handle the HIV/AIDS crisis and how does it compare to this situation?

Abutaleb: When HIV first emerged, the CDC identified the first cases in 1981. There quickly was a mobilization to track these diseases well, to understand where they were spreading. Within just a couple of years, all the states required reporting of AIDS. They had to name each newly diagnosed AIDS case, and death. That allowed everyone to see where the cases were spreading, so you could see that places like San Francisco, and New York were hot spots. They could see that the disease was spreading through needles, and men having sex with men, and that allowed them to better understand it.

Because of all of that, there was really broad mobilization, in activism, in raising money to develop drugs for AIDS. By the '90s they had this drug cocktail that allowed people with HIV, and AIDS to live for a very long time. That only happened because they understood, and kept close track of where and how the disease was spreading. We have nothing like that for superbugs. There really is no understanding of where a particular superbug is happening, where there are outbreaks, where infections are increasing, or decreasing. Or, who's doing well, or who's not. It's hard to know where to target resources.

It seems from your story like the medical community doesn’t have a sense of urgency about solving this problem.

Abutaleb: It seems pretty mixed. I think there are certainly people who view this as a pressing public health issue, but there isn't the broad mobilization that's needed to tackle a public health crisis. That's really the difference between what's happening with superbugs, and what happened with AIDS. There needs to be really good communication, and an understanding of how, and where the infections are spreading, who the bad actors are and where resources need to be allocated. None of that is happening right now.

Is there a willingness to carefully track these infections?

Deborah Nelson: There certainly is an aversion that I find mysterious. There are many ways to count deaths: Through surveillance, through hospital reporting, through the state, and federal government, on death certificates. You could collect data on people who die of superbug infections. Or, if that's too onerous, those who die with them. There are lots of ways to do it, but state and federal governments don't.

Listen to this podcast on iTunes, SoundCloud or Stitcher. For more, read the Reuters investigation, The Uncounted: The Deadly Epidemic America is Ignoring.

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