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An antibiotic-resistant superbug is silently spreading through UK hospitals

There have already been outbreaks in Manchester, London, Edinburgh, and Birmingham, but deaths are not centrally recorded. 

Lying in a hospital bed, four months pregnant, Emily Morris felt only terror. She had caught a urinary tract infection and it was resistant to common antibiotics. Doctors needed to treat it as it could harm the baby, but the only drugs that could work hadn’t been tested on pregnant women before; the risks were unknown. Overwhelmed, Emily and her husband were asked to make a decision. A few hours later, gripping each other’s arms, they decided she should be given the drugs.

In Emily’s case, the medicine worked and her son Emerson (pictured below with Emily) was born healthy. But rising antibiotic resistance means people are now suffering infections for which there is no cure. Doctors have long warned that decades of reliance on these drugs will lead to a "post-antibiotic era"– a return to time where a scratch could kill and common operations are too risky.

It sounds like hyperbole – but this is already a reality in the UK. In the last four years 25 patients have suffered infections immune to all the antibiotics Public Health England tests for in its central lab, the Bureau of Investigative Journalism has discovered.

While these cases are rare, reports of a highly resistant superbug are rising, and infection control doctors are worried. Carbapenem resistant enterobacteriaceae (CRE) are not only difficult to pronounce, but deadly. These are bugs that live in the human gut but can cause an infection if they get into the wrong place, like the urinary tract or a wound. They have evolved to become immune to most classes of antibiotics – so if someone does become infected, there are only a few drugs that will still work. If CRE bacteria get into the bloodstream, studies show between 40 per cent and 50 per cent of people die.

These bugs are causing huge problems in India, certain parts of Asia, the Middle East and some countries in southern Europe. Until recently, most infections were seen in people who had travelled abroad, had family members who had, or had been in a foreign hospital. The boom in cheap cosmetic surgery in India was blamed for a spate of infections in Britain.

Now, doctors are finding people who have never boarded a plane are carrying the bug. There have already been outbreaks in Manchester, London, Liverpool, Leeds, Edinburgh, Birmingham, Nottingham, Belfast, Dublin and Limerick among other areas. Patients found with CRE have to be treated in side rooms in hospital so the bacteria does not spread and harm other vulnerable patients. But in many of Britain’s Victorian-built hospitals, single rooms are in sparse supply. Deaths from CRE aren’t centrally recorded by the government - but it is thought hundreds have already died. 

Across the country, doctors are being forced to reach for older, more toxic drugs to treat these infections. The amount of colistin – called the "last hope" antibiotic as it is one of few options still effective against CRE infections - rose dramatically in English hospitals between 2014 and 2015, the Bureau has revealed. Colistin was taken off the shelves soon after it was introduced, as it can harm the kidneys and nervous system in high doses, but was reintroduced when infections became immune to standard treatment. The more we use colistin the more bacteria develop resistance to it. It’s only a matter of time before it stops working too, leaving doctors’ arsenal near-empty when it comes to the most dangerous superbug infections.

Due to a kidney problem, Emily Morris suffers repeat urinary tract infections and has to be hospitalised most months. Her son Emerson comes to visit her, understanding his mummy is ill. If she catches a superbug infection, she can still be given intravenous antibiotics to stem it. But she worries about her son. By the time he is an adult, if he gets ill, there may be no drugs left that work.

Madlen Davies is a health and science reporter for the Bureau of Investigative Journalism

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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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