The antimicrobial resistance crisis needs action now
journals.plos.org
journals.plos.org
Some competitions:
- https://dpcpsi.nih.gov/AMRChallenge/Finalists
Some previous work using various ML piplines:
- https://phastdiagnostics.com/
I mean, yes, there is a crisis. We need action now. Many people are offering solutions and new research directions. But money are simply not there.
The problem is that cost and risk of development and trials is too large for the current rewards, and hence there is very little new antimicrobials being developed. There are very many promising leads though, and either making development cheaper (by requiring smaller or fewer clinical trials) or ensuring good prices or bounties for successful development would likely create a plethora of antimicrobials in a quite short time frame.
I can't say if there's a plethora of drugs just waiting to be released after CT requirements are lowered, but definitely there is less of an R&D incentive currently because pts who take antimicrobials only take them temporarily and cases where you need an advanced antimicrobial to deal with an AMR case are thankfully uncommon.
Edit: I think this is the specific bill: https://www.congress.gov/bill/117th-congress/house-bill/3932...
I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.
Unfortunately, antibiotics are the tragedy of the commons writ large, and we’ve been wasting them for minimal gain because even minor private benefit generally outweighs long term consequences.
Modern cities are a huge disease vector. That kind of population density lets sickness run rampant. Untreated TB has something like a 25% mortality rate, and we've already seen drug-resistant (DR) and extreme drug-resistant (XDR) strains of TB. An outbreak of TB that we have no antibiotics for would be devastating.
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> I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.
This is true if you use them in isolation but I thought broad spectrum antibiotics, aka many at once, is what is typical now to slow down development of resistance? In this case you’d want to develop a few new ones and deploy them in batch.
1: https://en.m.wikipedia.org/wiki/Broad-spectrum_antibiotic
2: https://www.science.org/content/article/combining-antibiotic...
So ultimately the question becomes how many types of attack are possible?
The US does spend the most and that leads to output, but that doesn't mean it's the most efficient or does the best job of prioritizing the populations best interests over political or business concerns.
The selection process of awards like the Nobel Prize is also at risk of bias given that many of the people involved in picking the winners are themselves part of the national laboratory machine.
Regardless, my point was simply that we probably have a better chance at a Swedish effort leading to less biased and more efficient research than one from the US right now. I wasn't aiming for a debate on the relative political roots or leanings of publicly funded research labs.
That said, nationalisation is sometimes the correct move as the opposite of privatisation which is also sometimes the correct move, so attaching labels like 'socialist' to it to tar the policy is not productive (just as tarring something as 'capitalist' also does not beget good thinking about policy).
In fact Im very scared when I read that there are plans to use antibiotics "borrowed" from ants, or bees, because probably the antibiotic will be dumped by tons and become useless after 2-3 years, while all the ants or bees in the world die out.
Apart from third world countries giving antibiotics like candy, other problem are farmers, who also feed the livestock by the bucket. That's how we get bacteria resistant to everything.
The brutal reality is that new antibiotics cannot be sent to some countries, but that is very difficult to do.
Depending on the country and situation medecine can be pricy and in limited supply, wasting it away becomes a disaster in many more ways than long term resistance.
I think you mean first-world countries.
Humans inability to effectively organize doesn’t matter to the bacteria. As a species, we have the ability to understand that what happens in impoverished areas impacts us all. The smart move would be to rethink healthcare, globally.
Otherwise, those bacteria, who can’t argue, will just relentlessly keep evolving.
Anecdotally, from two (albeit leading) microbiologists, an additional risk if the cultural one. The thinking being, if you work on a semi-marginal anti microbial, it’s less important, but nobody will protest your margins. Versus if you develop something game changing, chances are the powers that be will take it from you.
https://blockclubchicago.org/2022/01/19/center-for-covid-con...
This kind of invesment has been traditionally done by governments. But with a reduction of taxation governments do not have animore money to do this. And for private companies it makes more sense to spend that kind of money in advertisment than in developing new products.
> ensuring good prices or bounties for successful development would likely create a plethora of antimicrobials in a quite short time frame.
If one woman has a child in 9 months. How many months takes to 9 women? More money may accelerate development, but there is a limit on how much faster one can go. Give a big enough reward and you will find more corporations cheating and lobbyng to get that money without delivering any actual antimicrobials.
Public research institutions seem a very good middle ground. Give pasionate scientist funding and they will come with solutions. Give passionate CEOs money and you get the next big scam.
I’m pretty sure government tax revenue is still at or near all time highs. As the population grows there’s more and more taxes to spend for this purpose. It’s just a matter of priorities.
but so does the cost to service that growing population.
This has been the case for decades, yet we still seem to have not learned this.
This is my observation, from having seen this happen in a couple of industries, and hearing of it happening in others.
There seems to be a "sweet spot," in new money-making stuff, where real value is produced, rewards are reaped, and scamming is low.
The industry starts off with small-scale passion projects, and relatively low rewards. Virtually no scamming, but also modest financial gains, as the passion-players start to establish the infrastructure.
Then it starts to "catch on," and a more professional approach is applied. The industry starts to scale, and the first folks on the upswing start to make some good money.
Then, after that, the scale goes up exponentially, the quality of the work nosedives, the rewards pile up, and the scamming becomes more prevalent. Many of the originators fall down, because they can't adapt to the new darwinian order.
Eventually, the whole thing becomes so corrupted, that it collapses under its own weight.
Rinse and repeat.
so often people entirely disregard passion for the work when theorizing that no one would be a ceo for less than $40million.
i haven’t ever seen studies done surrounding the issue, but i’d bet far more innovation comes from people doing something because they’re passionate than it does from monetary reward.
there’s a tipping point somewhere when innovation takes a backseat to greed.
often greed directly leads to a willingness to destroy a things essence or just chip away at the thing completely ignoring the passion which brought it about in the first place.
edit: forgive me if this seems a bit heavy handed—just watched Its a Wonderful Life with the family for Christmas so maybe i’m feeling a bit jaded towards greed.
If you have reasonably honest people who are not starting from scratch, and honest trials, you likely are going to get a real thing. Case in point: mRNA vaccines against COVID.
If that is so, then that research should be done by the state. The well-being of entire human race cannot be tied to monetary incentives of profiteering.
But the space program, and maybe the Manhattan project, actually had real, credible competition, even if it wasn't economic, so maybe were able to escape the bureaucratic trap. Something less urgent (even if it is on paper) like antibiotic resistance, I'm not convinced presents the kind of competition that would actually substitute for a competitive market.
Its a gigantic counterpoint. A large swath of the technology used today was developed by NASA and then turned over to the private corporations for them to profit. Socializing the costs. Privatizing the profits.
The Internet iself an argument. It was developed at DARPA with taxpayer money. Then turned over to the private corporations so that they could profit. Another case of socialism for the corporations.
Really. With all the tax breaks and ongoing lowering of the top tax bracked for corporate profit. Even as they offshore their legal entity to dodge taxes...
Even if the capital gains taxes were 90% like back in Eisenhower era and it was actually enforced, that still wouldn't justify handing over publicly funded research to private actors to profit. Publicly funded everything should be made publicly available and usable.
Same happened with all of those. The government created the tech, then paid private corporations to implement it, literally funding the everything from scratch while the private corps grabbed the profits.
> This sped up the process of having a viable, unified internet
That's false. Chile's Socialist president was at the point of launching their Internet in mid 70s. Which was ended by the US backed coup.
The large livestock operations keep their livestock in horrible unsanitary conditions to save money and they create a breeding petry dish for bacteria. They rely on antibiotics to kill the bacteria but in those conditions the bacteria have all the advantages and usually are able to create resistant stains pretty quick.
Hypothetically if we had globally enforced cycling of a sufficient amount of antimicrobials, the problem could likely be somewhat minimised.
If you have one country with lax or no antibiotic regulations then that country is going to continue breeding antibiotic-resistant pathogens. Those pathogens will pretty much inevitably escape out to more responsible countries.
This is theoretically doable, but as it stands you can't even get every country to abide by sanctions to discourage proliferation of nuclear weapons.
It's dangerous to think such problems can just be solved by throwing money at them...
Keyhole and robotic surgeries (already advancing rapidly) are going to be significant and useful.
We also need to investigate, understand and classify symbiotic organisms with the same zeal with which we've approached pathogens.
We've spent so long glaring at the invisible enemy that we've completely ignored the invisible allies (who we regularly nuke with broad spectrum soaps, gels and other microbicides).
All we're really doing is creating monopolies for pathogens.
Maybe it's me, but a lot of these article seem to advocate for magical solutions; when there's both enhancements to current technologies and unexploited low-hanging fruit that they aren't even bothering to consider.
Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):
1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.
2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.
3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it.
There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.
Some of the most interesting applications are currently combination antibiotic and phage therapy - it's much harder for bacteria to maintain resistance mechanisms for both simultaneously.
I’ve been hearing stuff like this for twenty years now. And yet the crisis hasn’t happened. Why is that?
An example: gonorrhea has no golden standard cure anymore. 40 years ago a single large dose of oral antibiotics was an effective cure. It made controlling it relatively easy. In the 90s, resistance to most of the common oral antibiotics became prevalent. Through the 2010s, a single dose of an intramuscular cephalosporin was effective. Now resistance to that is also common. Gonorrhea remains curable in almost all cases, but cultures and strain-specific targeting and second-line antibiotics in combination may be needed. Repeat testing to be sure it worked is necessary.
From one pill cure in 99%+ of cases, to something requiring multiple clinic visits and lots of lab work and possibly IV infusion antibiotics. The complications for public health, in terms of patient compliance, containing spread, as well as just the labour hours and case management complexity, are awful.
No matter how many new, different, or even radical antibiotics we develop, unless we get ahead of over-prescribing and under-treating (not taking all of a prescribed treatment course) we will continue to rapidly evolve more successful micro-organisms, to our own detriment.
Older or sicker folks who end up in a hospital or nursing home / rehab are very vulnerable to stuff like TB or c.diff. Cdiff is huge now as hospitals purge support staff and are filthy. If you’re old or immune compromised, you’re gonna pick up a severe, hard to treat infection if you spend time in the ER or general medical area of a hospital. The “money areas” of the hospital are usually better.
I used to think this, too (and this is coming from someone who worked at an antibiotic drug-discovery startup in the early 2000s).
I think it's not that there will be a comprehensive event in which "this bacterial pathogen is now unassailable by any antibiotic in our arsenal."
It's more that, if you are on the front lines of a hospital, you'll come across many (but not all!) patients with bacterial infections for whom antibiotics won't work.
If you are an MD with enough of those types of patients, it will fuck with your decision making process. It will also cause a lot of prolonged health issues as well as death. It just won't be a wall-to-wall comprehensive type of antibiotic resistance.
The gut flora of many people in the developing world is pan-resistance.
Childhood diarrhea is getting harder to treat.
Healthcare-associated infections are more dangerous, and the gains made against them slower.
Before COVID-19 hit, there were several emerging drug-resistant bugs that were the major concern for my sub-field (hospital epidemiology)
The challenge is: 1) finding something that kills mostly/only cells we don't want in or around our cells 2) kill them in such a ruthlessly efficient way that there are no survivors
As a sibling points out, the vacuum of space does #2 quite well. Actually we have a lot of stuff that handles #2 quite well. But #1, differentiating between "good" and "bad" with our murder machines, is pretty much an unsolved problem.
...In the sense we're here because an implementation evolved, however, the physics and minutiae of the problem domain are so numerous that even nature with billions of years of time, and the happy accident of intelligent tool using life haven't been able to make significant inroads on nailing down the problems space in an "ahead of the machine" sense yet.
eg space suits and whatever else needed to survive :p
In hindsight I wish I had ask him to clarify if he was talking about not working for me or in general. If he was talking about in general, I would have pushed harder for my drugs.
The hand is a complicated appendage. There’s a ton that can go wrong treating it or things that can be missed. Early intervention from a hand surgeon could potentially make a significant difference in long-term outcomes.
Honestly, you might take your X-rays & get a second opinion. Don’t mess around with injuries to your hands, especially if you use them to make your living.
We are back to medieval times if antibiotics stop working.
when
Best wishes to your wife and you in any case.
Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.
Btw this is what I learnt from reading a blog from someone who has worked with this stuff. I'm not a biologist and it's been a long time since I read that article so I can't seem to find it. So take the above stuff with a grain of salt
Many bacteriophages are not immunogenic, i.e. our immune system will ignore them. Others are very immunogenic, and are actually used as vaccine platforms.
The problem with phages is that they are finicky to administer. There is no "get this phage and it will kill all bacteria in and around you" treatment. They are specific. This of course has its own benefits too, but makes the process of administering harder.
With antibiotics the doctor comes to the conclusion that it is a bacterial infection. Then they write a prescription. And then you can buy the drug from any drug store. Antibiotics are largely shelf-stable and there is only a handful of different ones, so any drug store can keep all the major ones.
With phages the pipeline is more complicated.
You need to take a sample from the patient, you need to cultivate it, and then you need to check which phage or phage cocktail gets rid of that specific bacteria the best. That is a lot of lab work. Won't work at scale unless we automate it. And then there are questions like: How do they keep the phages healthy and happy? Are they working with a fixed selection of phages (a phage library if you will) or do they try phages based on the symptoms? Once they know which phage is the right one how does the patient get them? Can we stock them in our existing drug stores? Are they shelf-stable / can they be made shelf-stable? Which phages should the drug stores stock?
All of this can be of course answered and the problems ironed out. We put a man on the moon after all. We can do hard things if we want to. It is just a lot of faff.
Also as an aside, physics is easier than biology. Once you figure out a solution that works, it always works in the future. The moon is not actively changing its orbit to survive. Bacteria or cancer for that matter always end up finding a way to overcome
I genuinely believe that ideological and political stigma still stands in the way of phage research and use in the West as it did in the cold war when phages were considered "Soviet". More thoughts on this - https://www.theguardian.com/science/2019/may/09/cold-war-pol....
Soviets, Russian and Georgian scientists did a lot of good work; I'm ashamed to see it shunned in Western medicine when I know it can already be effective and save lives if an industry developed around the medical use of phages. Lives lost to antibiotic resistance in the West will be the price of politicizing science.
More on the normality of clinical phage use in the Soviet Union and Eastern Europe - https://www.tandfonline.com/doi/pdf/10.1586/14789072.2.6.815.
Furthermore, the process of breeding phages for each disease is something drug companies really do not want to do. They want to manufacture pills, ship them in boxes to hospitals and get their money. Doesn't work with phages. You have to take samples at the hospital from a patient of the bacteria, breed a phage that eats that bacteria and then send that phage back to the patient.
This kind of back and forth seems way to expensive and complicated to the modern drug company. They do not want to build infrastructure around all the country's hospitals to ship contagious samples and to have labs all over the country to breed and manufacture phages.
However, this Georgian phage producer does sell patentable boxed-up phages that consume common bacteria, like S. aureus, which has been discussed for its antibiotic resistance in academia a lot - https://phage.ge/products/pyo-bacteriophage/?lang=en. Years ago, I stumbled across some online stores that used to sell these products in Europe and the US, but now I can't find them.
This makes me think that a traditional distribution model for these drugs can work. But there is too much medical skepticism for phage demand. And phages are often slower to work than antibiotics, so the latter option is more practical in treatment... when it works.
Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):
1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.
2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.
3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it.
There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.
0: https://academic.oup.com/ofid/article/9/Supplement_2/ofac492...
Source: lived there with Peruvian partner for 18 months.
P.S. Note that the situation was unclear in 2020-2021 -- for instance from a quick lookup see https://pubmed.ncbi.nlm.nih.gov/34354682/. So patient management was different per region -- as it was a guess.
In the end it dwarfs against antibiotics in agriculture anyway, but if we want to fix the issue of antibiotic overusage on humans, we need to completely re-think our relationship to work and sickness.
The downside is that since they feel better from the anti-inflammatory effect, its supports their initial thought they needed antibiotics and in the future will always think they need them, even though they very likely only have a viral infection.
I knew someone who had a cold and said “but I asked my Dr for some antibiotics and I’m taking DayQuil so I’ll be better in a day or two”
Im always left open mouthed gaping at them like… even if YOU don’t know. But at least the Dr should …
- We encroach ever closer and closer to reservoirs of animal illnesses, which is how we got OG SARS, MERS and Covid.
- We give farm animals prophylactic antibiotics to promote growth or, worse, keep them alive in completely unsanitary conditions, and the conditions in slaughterhouses are often horrible as well. That is not just plain horrible from an animal welfare aspect, but risks breeding superbugs on one side and severe complications should someone not properly cook their meat and not kill off all the bacteria.
- We spread manure from farm animals over produce fields, which regularly causes e.coli / EHEC outbreaks
Antibiotic overuse in humans is only a small part of the problem, simply because the agriculture scale is so much bigger, and even people who go vegan/vegetarian because they want to avoid all the issues with meat production still can't avoid their produce being contaminated.
You do not want to stop this. Topsoil is a damn complicated thing, and bacteria and other decomposers are critical to freeing up and breaking down organic material to keep the nutrient cycle going. Try growing a plant in a sterile soil, and you end up having to maintain it on artificial fertilizers instead of being able to let microbiota do their thing.
I've got a hunch part of our degradation in crop nutrition and loss of topsoil quality is probably stemming from overuse of chemical fertilizer, as well as fundamental microbiome depletion from overuse of antibiotics in industrial farming processes. The unfortunate part being there may not be much to be done about it if there is a desire to maintain our current population carry capacity, because replenishing of it would require reversion to less short-term efficient agriculture, but more long term sustainable methods.
It absolutely crashed in some areas, and went up in others.
AMR is actually a SOLVED problem at this point. If we threw money at it like we threw them at Patriot missiles, we wouldn't run out. But... here we are.
Rant on why things are why they are:
1. Making antibiotics is hard and expensive. The "low-hanging fruit" are all gone, and in the last few decades we've just been rehashing different variations of the same classes of antibiotics. We're seeing bacteria become resistant to entire variations within classes so quickly that, it doesn't make sense to develop those variations anymore.
2. Making antibiotics is harder, and more expensive than it needs to be. This is because of regulations, and mostly it's a good thing. It protects us from getting sick(er), and from scams and grifts. Clinical trials are expensive: https://news.ycombinator.com/item?id=33545209
3. We expect antibiotics to be cheap to buy. We expect them to be cheap, and if the price gets jacked up, people (doctors, patients, ppl on social media) complain. Because it's a pill we think it should be free (and it should; gov't should subsidize) but it's not free to make. If we required iPhones to sell for $5 each by law, they wouldn't be around either.
4. New antibiotics are "not allowed" to be sold. This is because we're afraid of resistance developing against them, which makes sense! But this means no company is allowed to recuperate the hundreds of millions of dollars of up-front development costs it takes to new versions of these things.
5. No one expects to make profit. Few expect to recuperate costs in antibiotics, at this point. It's not profitable (or cost-recoverable). If we treated bacteria like the Russian invasion of Ukraine, and we called antibiotics "Patriot" then we'd get more funding. Yes there's GARD-P and CARB-X etc. but look... the total amount of money raised in antibiotics funding is like less than half what Bird scooters raised before getting acquired by their Canadian subsidy.
6. Gov't has "more important things to do": new funding for AMR didn't pass congress, and Pasteur Act in general has been in a holding pattern. Basically it introduces more funding and allows for new ways to sell antibiotics. (Higher ups call it a "Netflix model" but it really is a "Doordash model" because Netflix has near-zero distribution costs. But it didn't matter bc it didn't pass)
7. It's not a real crisis yet. It's not really anyone's problem. Since we're not staring down the barrel of a real crisis. It's like going to the gym or eating healthy — yes we should probably do it, but let's put it off til next year, and make a resolution for it. Kick the ball down the road.
Ending on a slightly happier note:
1. Old school antibiotics development take many years to develop. Hopefully with AI, ML, genome sequencing, we might be able to find new classes!
2. Phages definitely work. We work with them! We've been treating some very hard-to-treat patients at Phage Australia, as a five person team, out of Westmead Institute.
3. Does phage therapy work at scale? We're shifting our answer from "is this crazy? Will it even work?" to "will this be sustainable?" It costs around $70k+ AUD per patient (time, labor, equipment, for labs and paperwork) but we have no systems in place. Lots of room to bring it down.
4. Does it work at scale, with good unit economics (and to Western standards)? We TGA to figure out regulations, and we're figuring out how to get them reimbursed for the long run. Ideas include using them as compounding pharmacy ingredients (like "Magistral Phage" out of Belgium)
5. There's no money in phages - even with our success, it's hard, and we're always scrambling for money to keep the lights on. But hopefully the Aussie gov't will keep the project running for long enough that we can get a better understanding of running this with "lifestyle business" unit economics (it's probably not venture scale).
6. Going to market is very tricky. Phages are a service, not a drug. Each person's phage treatment is different than the other, so this doesn't fit the clinical trial pathways currently available. It's also different in each country, and we're open to ideas.
Final note:
What we REALLY want is to provide a "concierge service" to wealthy clients and hospital systems that always want "insurance" to treat some of the worst pathogens lurking around the hospital or their region. AMR infections can strike quickly, but usually it's strains that we've seen before — especially in hospitals. It's always the "most wanted" strains that have previously caused problems. We're able to create "countermeasures" for any bacterial threats using phages. Pretty much like Patriot missiles (and with similar costs). This would also follow the Tesla playbook for ("a rich people toy" before releasing a cheaper version).
This would really help us fund us to find ways to lower our production and get it into more hands.
We need help on that front! If you're able to help, or have ideas, please find me on my twitter (same as my handle here) or on the Phage Australia website)
Thanks everyone and merry xmas!
https://www.frontiersin.org/articles/10.3389/fmicb.2014.0055...
The problem is no pharmaceutical wants to spend money on qualifying an out of patent antibiotic that can be copied by any generics manufacturer.
We need a joint governmental founding initiative across the eu and us and any other countries to fund qualification of old antibiotics as well as developing new ones.
This is known as the "ecological fallacy".
> reversion to sensitivity is neither an immediate nor necessary outcome of selection simply because a resistant pathogen is no longer in an antibiotic-laden environment [1]
[1] "Why Do Antibiotics Exist" - https://journals.asm.org/doi/10.1128/mBio.01966-21
The Wikipedia entry for it gives the definition I've always seen: "An ecological fallacy is a formal fallacy in the interpretation of statistical data that occurs when inferences about the nature of individuals are deduced from inferences about the group to which those individuals belong."
The golden age of simple, broad-spectrum antibiotics is behind us.
I think the pandemic gave us a good reality check about how much is going to actually get done about an urgent crisis: not much.
There may be better language to attract people to get involved in your projects.
When I was a kid, cleaning oneself and your environment was emphasised. Scrub your nails, use hot water snd soap. You would smell lysol/dettol often. And bleach. Also, iodine and phisohex.
Now, not so much. Even the phisohex you buy today has no hexachlorophene in it. It's triclosan like ever other damn thing - due to a California law I believe.
I just don't believe these new green clothes and dishwashing liquids are as effective either.
I suppose I'm saying "an ounce of protection is worth a pound of cure"
and get off my lawn