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Antibiotic Reduction Project

Health Care Providers Guide

I. Intro

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We are the Antibiotic Reduction Project, or ARP and we seek to bring attention to a very

serious problem of antibiotic resistance. This occurs when bacteria change genetically in

ways that make current drugs or methods in-effective. The process also allows for more

resistant strain of bacteria to proliferate and weaken our immune system. The CDC(Center

for Disease Control) reports that 154 million prescriptions for antibiotics are written each

year. This high frequency of prescriptions is leading to more strains of bacteria becoming

resistant and the need for new drugs. We also began to find that the concept of resistance

involves more than just the phenomena of an antibiotic, antifungal or antiviral being

ineffective in combating a specific microbe. As we have learned from studying C.diff, the

concept of resistance can also incorporate the process whereby the administration of a

medication can actually cause an infection or even an outbreak.

An Unexpected Finding; The Situation is Now Impacting Our Flora

A factor which we believe has taken the field of Medicine by surprise is the observation

that this situation is currently impacting our natural flora as shown. 1 This impacts our

physiology and susceptibility to pathogens, and affects us in ways that are not well

understood. Our natural flora are millions of microbial bacteria that are within our food and

water supply, in both bottled and tap water. Our natural flora is also found in our bodily

fluids and our essential organs, including the brain. We are learning that our natural flora

can also impact our nervous system and muscle tissue. Unfortunately, we are learning this

due to the onset of new diseases in children. This disruption of the flora, may be responsible

for increases in neurological related illnesses in children (AFM)2 paralysis. In immuno-

comprised children adeno-virus has been seen to spread rapidly leading to death. There was

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643114/,

https://www.microbiologyresearch.org/content/journal/micro/10.1099/mic.0.040618-0;jsessionid=YCCiGPhHa6lBbqOzWawi3hdz.mbslive-10-240-10-110 2 https://www.cdc.gov/mmwr/volumes/66/wr/mm6628a4.htm

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an outbreak in Wanaque, NJ.3 The edlerly also appear more vulnerable, where outbreaks

leading to deaths are becoming more frequent. This fall in the United States a major outbreak

of Candidiasis Aurea occurred in over 125 nursing homes and hospitals, in New York alone.

Patients experienced over a 50% fatality rate when contracting the illness.4

This disruption of the flora, may be responsible for increases in neurological related

illnesses in children. Many States in the US are reporting greater incidents of learning

disabilities and autism, according to an article by WebMD.5 Autism and developmental

disabilities have increased from 16% to 18% between 2009 and 2017.

There are currently 42 new antibiotics in Phase three development and clinical trials.6 Due

to the experiences mentioned above we can see how these new medications are likely to

create greater resistances.

3 https://time.com/5432220/adenovirus-outbreak-new-jersey/ 4 https://www.nytimes.com/2019/11/13/health/candida-auris-resistant-hospitals.html 5https://www.webmd.com/add-adhd/childhood-adhd/news/20190926/more-us-kids-being-diagnosed-with-

autism-adhd 6https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2014/antibiotics-currently-in-clinical-

development

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Note: Prophylaxis should be avoided to reduce resistance.

FLASH NOTE- If the water has a high bacteria level, should dentists be asking patients to

rinse with it, or even diluting antiseptics rinses with it. Notices from the Water Company

warn pregnant women and imuno-comprimised patients to boil water. Do these warnings

pertain to dental or medical patients having ungone procedures or surgeries. Is an oral

novocaine injection site more vulnerable if rinsing with water flagged by the local Water

Company?

Our goal is to educate and provide a resource for doctors and patients to identify

alternatives to antibiotics. Our focus is on prevention and health promoting behaviors. Our

main topics are broken down into 8 chapters: an outline of the problem, proper nutrition and

its benefits, the importance of rest and relaxation, how to deal with work and or school

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absences, alternative treatments or preventatives, research and finally an explanation of

vectors and vaccines.. There will also be hyperlinks accompanying this booklet that connects

doctors to things such as an API that focuses on developments of new microbes and

antibiotic news, as well as a companion pamphlet to give to patients that will summarize

points and address concerns they may have. Our website has a video which you may want

patients to watch that could help them reduce the use of antibiotics.

The chart above points to an example of what is occurring in our hospitals and nursing

facilities.7 It indicates that as superbugs increase in frequency and antimicrobial resistance,

or AMR is also increasing. Antimicrobials fall under the category of hand sanitizers, spray

cleaners , UV light, scrubbing and even full strength beach. In other words, our strongest

cleaning products are often found to be ineffective in killing microbes and could even cause

7 http://blogs.nottingham.ac.uk/makingsciencepublic/2016/01/22/60301/

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infections to spread to others faster/easier. This is especially true during an outbreak and in

fact contributes to the outbreak.

FLASH NOTE-CALCIUM: Calcium is a mineral so essential that blood levels are

monitored by the parathyroid. When it detects that levels are low then the parathyroid

releases a hormone PTH and breaks down calcium from our bones It is also a common

supplement. However we are learning when a person contracts C.diff consuming calcium,

can make the person much sicker. High levels might make a patient more vulnerable to a

C.diff infection. Researchers from the University of Michigan School of Medicine

conducted a study showing that calcium enhances C.diff’s ability to germinate and spread.8

We aren’t advising to completely cut out calcium, but it might be a potential avenue to

explore with your patients that are experiencing dizziness, imbalance,vertigo or hearing loss.

It seems that C.diff has become so advanced that it is surreptitiously interfering in our

underlying bodily functioning, critical to heart, kidney and even brain functioning. Our

concern is that it C.diff may be getting even more advanced and more dangerous. It is

believed that C.diff is no longer only associated with GI symptoms and according to the CDC

microbes are beginning to share genetic materials so that it is difficult to determine the true

nature of the contagion affecting patients and our bodies.9 One way to look at this is as

antibiotics become more advanced the microbes follow in a similar level of sophistication of

genetic gene based resistance. We question whether new antibiotics could make things

better or possibly much worse. This is why we are writing this text!

8 https://www.google.com/amp/s/labblog.uofmhealth.org/lab-report/study-calcium-levels-could-

be-key-to-contracting-and-stopping-c-diff%3famp 9 https://www.cdc.gov/drugresistance/about/how-resistance-happens.html

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Vitamin C, or alpha lipoic acid, may have the opposite effect as calcium, whereby it may

increases an immune response. Scenarios like this demonstrate that this shift in the normal

flora may be causing a series of mystery diseases, with more than one contagion and a

combination of microbes with share genetic material, similar to the concept of cross

contamination. Some of which are quite serious such as childhood paralysis, as in AFM,

which causes polio type symptoms and sometimes death.

Our publication and news feed will also cover issues pertaining to Clinical Trials and the

inherent limitations of this form of study. Clinical trials are required by the FDA, with the

results often being published in medical journals which validates the indications for the

products. However, they have downsides, they are very expensive to perform and foods,

vitamins and diets that are healthy, are often not good candidates for clinical trial research.

In this way, behaviors that truly impact a person's health both positive and negative can’t

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always be studied with a clinical trial. It may be necessary at times for physicians to look at

cross sectional and observational studies to evaluate the best approach to treat their patients

health.

II. Problem

Your patient woke up with a sore throat. He or she calls their doctor in hopes of getting a

prescription, since they believe it will relieve their symptoms. It’s common when feeling ill

to worry about missing school, work and disrupting your daily routine. One billion cases of

colds are reported each year, and 22 million school days are missed due to the common cold

according to WebMD10; as well as 20 million work days lost to a cold or other illnesses,

according to a report11 in the Journal of Occupational and Environmental Medicine. Our

approach is to encourage patients to stay home rather than ask their doctor for an antibiotic;

we believe this would prevent a protracted illness and also reduce the spread to others

including family members. We would like to encourage doctors to target patients who need

to change their health behaviors before getting sick and learn to avoid colds, thereby

avoiding missing work and avoiding the need for requesting antibiotics.

The United States pharmaceutical industry advertises directly to the consumer. A lot of

the products have break-through status with the FDA and the ads help patients realize that

new treatments are available. Today, chronically ill patients where cures were once

unreachable or required difficult and protracted treatment regimens, can now be relieved

10 https://www.webmd.com/cold-and-flu/common_cold_overview 11 https://www.ehstoday.com/news/ehs_imp_35845

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from their suffering. Well known examples are new and highly effective treatments for

hepatitis, HIV and most recently cystic fibrosis.

But now we understand that introducing new meds also brings with it the responsibility of

not prescribing them when there maybe other choices available. Especially if it’s causing

diseases, such as the case of some antibiotics and C.diff. Exactly how new super antiviral

drugs are affecting our flora is not well known. However, the cycle of mutant strains in the

course of treatment with an antiviral medication is an integral part of the complex treatment

regimen.12 We just don’t know how this is affecting our normal flora, but it is a good guess

that it is, and may be very much responsible for at least part of the changes we are

experiencing. The same may be true for antifungal agents. Doctors should keep in mind

when they treat a patient with such a medication that it’s not just the mutant strains of viruses

12 https://www.cdc.gov/drugresistance/about/how-resistance-happens.html

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or resistances from antibiotics, they are likely to encounter but also this new phenomena of

cross-contamination. Our observations indicate that microbes like C.diff function now

function to weaken the immune system and creating a vulnerability which is exploited by

microbes produced by other classes of antibiotics or antiviral or antifungal agents. This is

why the intake of calcium, which has been shown to precipitate c.diff can cause much worse

infections such as viral infections and fungal infections. It probably a good idea to eliminate

the calcium in sick patients and to determine if possible whether a person's parathyroid is

functioning property. Calcium draw out of our bones from PTH could make patients a lot

sicker, without calcium supplements, if the parathyroid is not working properly. A medical

group based in Tampa, Florida conducts research relating to parathyroid. 13

Perhaps the message needs to be “let’s first try to find out if our patients can be treated

without meds known to cause resistance.'' Advertisements in the media are great for

notifying sick patients that new treatments are available for their conditions. But let's be

sure they are prescribed after we make every effort not to cause a progression in resistances

and determining, if there are any other choices. For some patients, staying at home may not

be a choice they want to make to start feeling better. But their doctor will make the final

decision to prescribe antibiotics and figuring out how not to cause further resistances.

Additionally if the doctor recommends that the patient stays home, then that is what they

need to do. Compliance with physician instructions must be a high priority. Unfortunately,

although we believe that we will solve this problem with resistances, there won’t be a quick

fix. In this regard, patients must be motivated to carefully follow doctors orders.

13 https://www.parathyroid.com/about-parathyroid.htm

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Antibiotics aren’t effective against viruses, and some studies show that taking antibiotics

could do more harm than good, especially if you’re taking them with the hopes of curing a

virus. Taking antibiotics as a prophylactic is also very common prior to dental procedures or

joint replacement. However, this practice could be responsible for at least some of the

resistances we are seeing as shown in these studies..14

Creating resistant strains is a serious issue. According to the World Health Organization,

700,000 people die each year from antibiotic resistance. The infections they cause are tend

to be much more serious and much harder and much more expensive to treat than those

caused by non-resistant bacteria.

Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased

mortality. The world urgently needs to change the way it prescribes and uses antibiotics.

Even if new medicines are developed, without behaviour change, antibiotic resistance will

remain a major threat. Behaviour changes must also include actions to reduce the spread of

infections through vaccination, hand washing, practising safer sex, and good food hygiene.”

As well as the reality that doctors must reduce the use of antibiotics, and understand that

using new ones could make things much worse.

Flash Note: The extent to which patients who refuse to give their children vaccines are

contributing to the problem of resistance, is unknown. However, it probably makes things

much worse, less immunity and a greater number of asymptomatic carriers causing disease,

is the likely outcome caused by families refusing to vaccinate their children. Children and

14 https://kidshealth.org/en/parents/antibiotic-overuse.html https://www.cdc.gov/antibiotic-

use/community/about/antibiotic-resistance-faqs.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159373/

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adults who experience these illnesses which were eradicated decades ago, such as measles15,

could be impacting our flora treated which much more powerful antiviral medications such

as ribavirin, and resistance strains could develop due to there negligence. In addition,

ribavirin is often used in combination with other medications such as interferon. Clinical

trials have also been completed which concluded that all adult measles patients should be

treated with ribavirin16. In an environment that is already impacted by the phenomena of

cross-contamination and the combining of genetic material in microbes, according to the

CDC.17

There is also an economic component when bacteria becomes more powerful and resistant.

“When infections can no longer be treated by first-line antibiotics, more expensive medicines

must be used. A longer duration of illness and treatment, often in hospitals, increases health

care costs as well as the economic burden on families and societies. This is why prevention

is cost effective.

Antibiotic resistance is putting the achievements of modern medicine at risk. Organ

transplantations, chemotherapy and routine surgeries such as caesarean sections become

much more dangerous when doctors fear that many antibiotics won’t work or they could

initiate an outbreak if treating a single patient unleashes a resistant strain by killing off the

weaker strains. Recently, news reports indicated that during outbreaks of Candidiasis in

nursing homes, the fungus covered the entire patient room, beds chairs walls and doors were

covered with active candidiasis fungus. These outbreaks which occurred in the fall of

15 https://www.cdc.gov/measles/cases-outbreaks.html 16 https://www.ncbi.nlm.nih.gov/pubmed/22480102 17 https://www.cdc.gov/drugresistance/about/how-resistance-happens.html

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2019,had a 70% mortality rate. 18 These microbes are also activated by a humidity gradient

which doctors need to understand.

Recently it has been noticed that some diseases are being expressed in the fall months.

This has been reported for AFM a form of childhood paralysis. Also a major outbreak that

resulted in the deaths of 12 children in a nursing home in Wanaque New Jersey occurred in

October of 2018. The contagion was traced back to Adeno-Virus. Now a year later, 2019

more disease and more outbreaks of in and around New Jersey and in Nursing Homes around

the country, such as California. - major outbreaks in Candidiasis are being reported during

the fall months. We have studied and reported that these outbreaks seem to correspond to a

phenomena of lower temperatures and high humidity. Lower temperatures mean high

pressure which actually causes much greater concentration of moisture in the air than would

be available with higher temperatures. It appears that the microbes are specific to the

moisture levels causing devastating outbreaks and disease in immuno-compromised patients.

In nursing homes patients can get much sicker if the are prescribed calcium for osteoporosis.

To summarize it’s not the humidity that is contributing to the illness it is a combination of

humidity in the presence of lower temperatures, or high ambient pressure with high humidity.

The absence of a basic conceptualization of the impact of resistance on our natural flora is

leading the intermingling of microbes and the spread of illnesses where no specific contagion

can be isolated, such as AFM in children. This could mean that microbes that cause illnesses

18 https://www.healio.com/infectious-disease/nosocomial-infections/news/online/%7Bc03e5793-1183-49d9-ac03-

a9c3caf008e0%7D/c-auris-outbreak-spreads-in-9-california-health-facilities-after-single-introduction#:~:targetText=October%205%2C%202019&targetText=WASHINGTON%20%E2%80%94%20A%20single%20introduction%20of,known%2C%20a%20researcher%20said%20here.

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and vulnerability to illnesses due to a weakening immune system, may be spreading in our

food and water supply. Our food and water supply is where our natural flora reside.

III. Nutrition

This well known information is being mentioned in order to emphasize that poor patient

health behaviors contribute to the problem of resistances. Practicing these suggestions below

is critical to combating resistances and is often overlooked.

Poor nutrition can lead to weakened immune systems and poor overall health. Lack of

vitamins and minerals in one’s diet can lead to vitamin deficiency and weakened immune

systems as well as disease. You don’t have to hang out in a gym to practice good nutrition,

although those who do, tend to eat better. It’s a good idea to check your diet every so often

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to make sure you are getting the required nutrients. It’s a good idea to encourage patients to

include whole, plant-based foods in your diet and proteins while using multivitamins and

other supplements to fill the gap if necessary.

While enjoying a fast food meal a few times a year is ok, patients should be

discouraged from making fast food a regular component of their diet. Instead they should be

encouraged to replace fast food with healthy home cooked meals. According to women's

health magazine, fast food is usually higher in calories, cholesterol and sodium and can lead

to depression and general poor health. This can lead to high blood pressure, heart disease and

obesity and early death. Doctors should read the article below in the Washington Post as it

shows the dangers of a consistent fast food diet.19 Other nutritional considerations involves

finding out if your patient is receiving sufficient amounts of vitamin D. Depending on a

person's geographic location and lifestyle, vitamin D may not be obtained in sufficient

quantity in low sunshine areas, such as our Northern States and time of the year. A study

done by the Canadian government links vitamin D deficiency to a greater risk of infections

and chronic illnesses. Certain patients with a gene polymorphism in their vitamin D

19 https://www.washingtonpost.com/lifestyle/wellness/sneaking-a-little-junk-food-doesnt-mean-all-is-

lost/2018/02/26/828b75fa-1b36-11e8-9de1-147dd2df3829_story.html

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receptors can cause a greater vulnerability.20

Sugar is shown to place white blood cells into a comatose state. This effect causes your

body’s immune system to respond more slowly to illness such as the common cold.

demonstrated that our immune system needs nutrients and vitamins, and it is not unusual to

find individuals lacking basic nutrients. The Harvard study suggests that your immune

system is affected by poor nutrition and that the eldery, and people who live in poverty are

consequently more vulnerability to infectious diseases. If you feel that your diet is off or

20 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178695

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you’re lacking certain micronutrients, taking a multivitamin or other supplements could be a

good option to look into.

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IV. Rest and Relaxation

The overall message our project is trying to convey is overall wellness. Our immune

system is an extremely powerful and complex system, if we give it care and support, it will

keep us healthy and strong. Rather than immediately look to an antibiotic, patients should try

to take a day or two off from their normal routine to rest and let their body heal. Solid rest,

hydration and as little exposure to others and the outside world as possible. One of the

biggest problems and contributing factors to the spread of illness is the fear of taking a day

off from people’s regular scheduled lives to stay home, rest and recuperate. This project

helps to alleviate that burden by offering a standardized absentee note that is recognized by

the patient's work/school that excuses them from work. The note helps to restore the patient’s

faith in their company or place of work that they care about their employees and alleviates

the pressure of taking time off. Our special medical excuse notes are designed to motivate

employers to help alleviate the problem of over-prescribing antibiotics.

Stress is a daily part of our lives for most of us. Traffic in the morning, a hard day at

work/school, or family situations, there are a multitude of things that can cause us stress

daily. The hormone corticosteroid is produced by stress as well as anxiety and can suppress

the effectiveness of our immune system. This leads to triggering chronic illnesses that may

have been in remission and or leaving us more vulnerable to things like the flu or a cold. If

you find yourself getting stressed during the day, take a moment to collect yourself and work

out what’s causing you the issue.

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Rest and relaxation is different for each person. What one person might find relaxing

might not be true for another. Activities that can help reduce stress can be anything from

taking a walk, working out, a hobby, drawing, reading or meditation/yoga.

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V. Work and School

The vast majority of people either go to work or attend some form of school. It’s not

always practical to take a day off or you just might feel you aren’t able to, it’s a common

fear. However, sometimes it’s in both your own and your peer’s best interest for you to take a

day off and stay home. Find out from a boss or teacher about your organization’s sick

policies and use them when you need to.

With such advanced medicine at our disposal, it can be extremely easy to just take an

antibiotic, feel better, and then return to one’s daily work routine after a brief period of time.

But as highlighted in this text, this is severely impacting the problem of resistances. In the

long run, it is much better to simply take off from work for a few days, rest, and let your

body do what it was designed to do when confronting an illness. The last chapter delivers a

strong message: rest is a powerful tool in the effort of combating illnesses and resistance. It is

in our best interest to use it effectively.

Now, despite this, you may be saying, I am simply too busy to take multiple days off of

work or school in order to rest and recover. However our team has devised a multitude of

ways and methods in order to make this process easier.

For one, we’ve been making progress right here at the university the ARP was based out of:

the New Jersey Institute of Technology. At NJIT we have kickstarted a school-wide policy in

an effort to keep sick students in their beds, resting. Coined, ‘The NJIT Buddy Program’,

professors are now advised to assign a specific note taker for any given semester-long class.

With a constant stream of notes being consistently present, students will no longer feel the

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stress of missing a day of school- therefore, less motivated to come into school sick due to

fear of missing critical information.

It would be well-advised to use the NJIT ‘Buddy Program’ as a prototype for other

companies as its structure is very simple: keep the necessity of workers coming in sick to an

absolute minimum via a ‘buddy system’ where the sick individual’s responsibilities are taken

care of by their peers.

Another excellent method of allocating proper time for rest is via a doctors note. Our team

at the ARP has devised an excellent template in which physicians may be able to implement

into their practices. The template (as seen below) would give any employer or school all the

relevant information they’d need in order to excuse an employee or student from their duties.

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VI. Alternative Treatments

Instead of always expecting an antibiotic from a doctors visit, look for an alternative. Try

herbal teas, multivitamins or soothing nutritionally fortified foods. Even a good night's sleep

can make you feel like a new person. An important aspect of good health is hydration. Not

sports drinks or coffee, but water. People forget to drink water sometimes for long periods of

time and that can lead to clinical symptoms, such as headache and fatigue. If your ailment

isn’t viral or bacterial, try changing your routine purchase a juicer and use it and join a gym

to encourage a diet/lifestyle change.

As previously described, too often when we catch a cold we impulsively run to the doctor

for a quick fix when there are several alternative treatments at our disposal. In this chapter

we will be breaking down the many health benefits found in everyday items such as herbal

teas, multivitamins, and fortified foods such as whey protein. Also one should consider

changes in lifestyle to improve quality of life and overall health.

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First, we will be looking at the benefits provided from a very simple and easy-to-find item;

tea. A study provided by the Pharmacognosy Publication Journal breaks down their

naturally-present antioxidant properties into detail. “For green teas, TPC and AEAC ranged

from 205 mg GAE/g extract and 420 mg AA/g extract in Sea Dyke to 363 mg GAE/g extract

and 781 mg AA/g extract in Boh, respectively. For black teas, values were 172 mg GAE/g

extract and 269 mg AA/g extract for Boh Cameron Highlands, and 209 mg GAE/g extract

and 215 mg AA/g extract for Boh Bukit Cheeding, respectively. Values of Ho Yan Hor

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herbal tea were 125 mg GAE/g extract and 185 mg AA/g extract, respectively.”21 See the

chart below for a breakdown:

Strengthen chart definitions

As you can see, just about every kind of tea yields an extremely high rate of antioxidants

which makes it a powerful combatant of disease. A study conducted by Istanbul University

21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249787/

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of Turkey in 2017 aimed to further prove this. What they found was that “when [they]

examined the antimicrobial activities of various herbal teas, alone and in

combination with antibiotics, [their] findings showed that herbal teas have antimicrobial

activities against gram-positive and -negative bacteria and yeast when they were used alone.

The combinations of herbal teas with antibiotics showed synergistic, additive, or antagonistic

effects, depending on the antibiotic or type of tea. Consequently, using herbal teas alone or

with some chemical antimicrobials could be an effective alternative treatment strategy

against various pathogenic microorganisms. Furthermore, herbal teas alone or in combination

may help to reduce the severity of disease; however, some combinations with antibiotics

could reduce the efficacy of the primary antibiotic and thus should not be used together.”22

VI. Research

22 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533155/

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In this chapter we are trying to broaden the definition of the term “resistance”. Normally

resistance refers to the use of one medication, and patient and physician finding that it is

ineffective at fighting the infection. However, we believe that included in the term “resistance”

should also include the possibility that prescribing certain antibiotics, antivirals or antifungal

could actually cause disease in a patient and under some circumstances an outbreak. As such we

try to make the point that high frequency of prescribing of such medication is the root cause of

the resistance in the first place. The suggested solution is for doctors to go from a pattern of

over prescribing of medication to a greatly reduced pattern of prescribing, to reduce the effects of

resistance. Another well known expression for this is iatrogenic disease. We believe it is

important for us to include in the definition of resistance the concept of Drug Related Iatrogenic

Disease, or DRID. Understanding DRID allows us to broaden the concept of resistances and

separates the issue of a previously effective drug losing its ability to resolve an infection and a

related situation, where the drug is actually causing an infectious disease when prescribed. DRID

can potentially cause an outbreak and ultimately a new form of an infection, which is difficult to

treat.23

23 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526889/

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During an outbreak, physicians should investigate previous medication given and create

a timeline, and also look at humidity and how it relates to the incubation period.

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VPD was high during September and October, and through Dr. Ohayon’s research the

charts show a correlation between the high humidity in those months and an increase in

deaths/illnesses. The high humidity, seen with VPD readings between 1.2-1.5 creates the perfect

conditions for vegatative “flowering”, which could be an analogue leading to the spread of

fungal infections. In cooler months in nursing homes and hospitals air conditioners should be

left on, as a way to combat the humidity in a building.

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As a result of the temperature influencing outbreaks, scientists are looking into global

warming as a possible cause for the increase of outbreaks and ultimately resistances24. The BBC

in an article 25 cites a study called Nature Climate Change that explains how climate change is

accelerating AMR, mainly by providing the high temperature environments that bacteria

generally thrive in. This lets them multiply and develop far quicker.

Part of the great fungal outbreak of 2019, the CDC has a section about Candida Auris, or

C-Auris which causes severe illness or death in most cases.26 The map below shows the cases of

C-Auris in the United States and their severity.

24 https://www.sciencedaily.com/releases/2019/04/190414111454.htm 25 https://www.sciencefocus.com/the-human-body/antibiotic-resistance-is-it-really-as-bad-as-climate-change/

26 https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html

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Patients can remain colonized with C. auris for a long time and C. auris can persist on surfaces

in healthcare environments increasing the rate at which it spreads between patients in facilities.

Most C. auris cases in the United States have been detected in the New York City area, New

Jersey, and the Chicago area. Strains of C. auris in the United States have been linked to other

parts of the world and are generally a result of inadvertent introduction into the United States

from a patient who recently received healthcare in a country where C. auris has been reported.

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VII. Vectors

Antibiotic resistance spreads through people, animals, and the environment. A vector is a

way or means in which something is guided. Improving antibiotic use, including reducing

unnecessary use, can help stop resistance from spreading. Among the most common way

germs are spread are coughing, sneezing, saliva and person-person contact. People can touch

their face up to 3,000 times per day, but in between those we touch doorknobs, desks,

handles and many more things that are most likely covered with germs. We could also have

contact with others such as handshakes, hugging, holding hands or other forms of physical

contact. The best way to prevent the spread of germs to yourself and others is to wash your

hands thoroughly with soap and warm water. If necessary, use hand sanitizer as well.

Your hands may look clean, but a quick rinse under the faucet a lot of the times isn’t

enough. Lather for a good 15-20 seconds with soap and warm water. Although you should

wash your hands whenever using the bathroom, other times to do so would be after

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wiping/blowing your nose, before/after meals, before handling food and after using

communal things like doorknobs, just to name a few. According to the CDC handwashing

awareness helps reduce: diarrhea sickness by 23-40%, respiratory illnesses by 16-21% and

absenteeism in schoolchildren by 29-57%.

Another major vector is through our environment. The spreading of germs can be

greatly reduced by making sure water is coming from a clean and treated supply. One of the

biggest crises right now is the lack of clean drinking water in parts of the world. We all need

water to live, and if that water is compromised or coming from a bad source then germs will

spread freely. Another major environmental vector is waste management. Street cleaning

helps to keep drains clear and prevents stagnation so that bacteria and insects do not breed

while waste collection and disposal helps reduce the spread of germs. Household/community

waste should be collected and disposed of in a way that it doesn’t cause a pest problem or

uncleanliness.

Food cleanliness is also a huge part of stopping antibiotic resistance. The bacteria can get

into food when animals are slaughtered and processed and or their waste, which contains the

resistance bacteria, gets into the surrounding environment. Fruits and vegetables that come

into contact with the fertilizer/soil are susceptible as well. The CDC has a few tips to keep

you and others safe; Take antibiotics only when needed, and take them exactly as prescribed,

wash your hands after touching raw meat, poultry, seafood, or their juices, or uncooked eggs,

wash your work surfaces, cutting boards, utensils, and dishes before, during, and after

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cooking and be mindful of temperatures, keep food chilled at appropriate temperatures and

make sure the food is prepared to appropriate temperatures.27

27 https://www.cdc.gov/features/antibiotic-resistance-food/index.html