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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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Can Britain’s new powers to investigate unexplained wealth prevent real-life McMafias?

The government is waking up to the fact that global criminals are fond of London. 

The BBC’s McMafia, a story of high-flying Russian mobsters and international money launderers woven into the fabric of London, ended this month. Despite the dramatic TV twists, the subject matter has its basis in reality. As a barrister dealing with cases that involve Russia and former Soviet states, my experience is that politicians and business people use the apparatus of the state to put rivals out of business by any means possible.

In McMafia, previously straight-laced fund manager Alex Godman (played by James Norton) begins transferring money under the cover of a new investment fund. With a click of a button, he can transfer a shady partner’s money around the world. As the Paradise Papers underlined, money can indeed be hidden through the use of complex company structures registered in different countries, many of which do not easily disclose the names of owners and beneficiaries. One company can be owned by another, so the owner of Company A (in Panama) might be Company B (in the Cayman Islands) which is owned by Company C (in the Seychelles) which owns property in London. To find out who owns the property, at least three separate jurisdictions must be contacted and international co-operation arranged – and that’s a simple structure. Many companies will have multiple owners, making it even more difficult to work out who the actual beneficiary is.

I represent individuals before the UK extradition and immigration courts. They are bankers, business people and politicians who have fled persecution in Russia and Ukraine or face fabricated charges in their home country and face extradition or deportation and will often be tortured or put on show trial if we lose. Their opponents will deploy spies, who may pay visits to co-defendants in Russia for “psychological work” (aka torture). Sometimes the threat of torture or ruin against a person’s family is enough to make them confess to crimes they didn’t commit. I have seen family members of my clients issued with threats of explicit violence and the implicit destruction of their life. Outside their close relatives’ homes in Russia, cars have been set on fire. Violence and intimidation are part of the creed that permeates the country’s business and political rivalries.

As in McMafia, London has long played a bit part in these rivalries, but the UK government has been slow to act. In 2006, Alexander Litvinenko, a former Russian security agent turned defector, was killed in London using Polonium 210 – a radioactive substance put into a cup of tea. Although Russian state involvement was suspected from the beginning, the UK government tried to block certain material being released into the public domain, leading his family to complain that the UK’s relations with Russia were being put before the truth. In 2016, a decade after his death, the inquiry finally delivered its verdict: there was a “strong probability” Litvinenko was murdered on the personal orders of Vladimir Putin. Yet in the same breath as condemning the act, David Cameron’s spokeswoman said the UK would have to “weigh carefully” the incident against “the broader need to work with Russia on certain issues”.

The government of Cameron’s successor has however been quick to use McMafia as a spring-board to publicise its new Unexplained Wealth Orders (UWO). These new investigatory powers are purportedly to be used to stop the likes of Alex from hiding money from the authorities. Anyone with over £50,000 of property who is politically exposed or suspected of a serious crime, will be forced to disclose the source of their wealth on request. While most British homeowners would own more than £50,000, the individuals are likely to be high profile politicians or under investigation already by the authorities. If they fail to respond punctually, they risk forfeiting their property.

The anti-corruption organisation Transparency International has long campaigned for such measures, highlighting cases such as the first family of Azerbaijan owning property in Hampstead or senior Russian politicians believed to own flats in Whitehall. Previously, confiscating hidden assets has been a lengthy and complex process: when the High Court confiscated an £11m London house belonging to a Kazakh dissident, the legal process took seven years.

The new Unexplained Wealth Orders mean that the onus is shifted to the owner of the property to prove legitimacy and the origin of the wealth. The authorities will have much greater power to investigate where finance and investment originated. But in order for them to work effectively, they will have to be backed up by expert prosecutors. The government still has a long way to go before it makes London a less attractive place to hide money.

Ben Keith is a barrister at 5 St Andrew’s Hill specialising in extradition, immigration, serious fraud, human rights and public law.