Taking Stock of 2018 and Setting New Goals for 2019: Public Health Watch

A year ago, we had the temerity to propose 4 New Year’s resolutions for infectious disease and public health specialists.

As 2018 draws to a close, we’ve decided to take a look at just how much has been accomplished in these key areas in the months since and also set some new goals for the coming year.

This time last year, we noted the growing threat of opioid abuse/misuse and its relationship to case clusters of various infectious diseases—most notably, HIV and hepatitis C. At the time, we urged infectious disease clinicians to get involved in efforts to track illegal opioid use, help spearhead initiatives to educate those at risk for addiction, and treat those who become addicted.

The past year has shown that much still needs to be done to address the so-called “opioid epidemic” and the health-related collateral damage it has caused. In September, for example, Contagion® reported on an HIV case cluster in Seattle, Washington, linked with drug use within a homeless community there. Similarly, in June, we documented a number of hepatitis C case clusters across the country that were attributed to opioid abuse among the affected populations.

It’s clear that the United States is still in the throes of a crisis related to opioid abuse/misuse, and that this seemingly intractable problem will not go away unless health care professionals remain engaged.

Our second resolution for 2018 involved tick-borne diseases in general and, specifically, the over-prescribing of antibiotics for so-called “chronic” Lyme disease. We urged ID specialists to get involved in educating other clinicians on appropriate treatment of Lyme and tick-borne diseases.

The use of antibiotics in some Lyme disease cases remains controversial, and the United States may soon be battling even more tick-borne diseases with the recent reports that, essentially, the country is at risk of being invaded by a particularly aggressive species of tick not native to our shores: the Asian longhorned tick. What’s clear is that clinicians need to be especially vigilant about all tick-borne diseases, and ensure that they are administering proactive and proper treatment for them. As Contagion® reported in September, climate change has led to increases and geographic changes in tick populations across the United States—meaning, a rise in diseases transmitted by these ticks can be expected.

Like the opioid crisis, the issue at the heart of our third 2018 resolution, antibiotic resistance, doesn’t appear to be going away anytime soon. A report by the Organization for Economic Co-operation and Development (OECD) released in November predicted that, by 2050, as many as 1 million Americans will die from antibiotic-resistant infections unless new drugs are developed and enhanced measures are taken to ensure that they are properly prescribed. Spoiler alert: Our 2019 resolutions will include recommendations on this issue.

Finally, we urged infectious disease and public health specialists to get involved in politics by advocating for certain needs and causes relevant to the field. Unfortunately, the political discourse in the United States remains sensitive, making it all the more challenging for those of varying political ideologies to work together to address fundamental challenges—such as, for example, the opioid crisis. Unfortunately, we do not have a solution here. However, as the recently passed crime legislation called the First Step Act illustrates, politicians and activists with opposing viewpoints can find common ground. Here’s to hoping we can cite a public health-related example of such coming together at the end of 2019.

And speaking of next year, what are we suggesting should be the priorities for infectious disease specialists on the public health front? Well, as we hinted above, tackling antibiotic resistance likely remains Job No. 1. On the positive side, the aforementioned OECD report notes that tried-and-true approaches such as hand hygiene and stewardship programs can save tens of thousands of lives and hundreds of millions of dollars by reducing the spread of resistant bacteria. It seems strange to still be pushing for widespread adoption of these strategies in 2019, but as the underlying problem persists, so we must.

In addition, for our second and last resolution for the coming year, we’ll let you decide. Some suggest that we should take a page from the Lancet and the American Public Health Association, which, as Contagion® reported recently, called on all health care professionals to take a leadership role in efforts to address climate change by emphasizing the public health consequences of warming global temperatures and rising sea levels (among other factors) including, notably, the spread of vector-borne diseases.

Ambitious? Perhaps. However, we know the infectious diseases community embraces challenges. Here’s to hoping we have some more accomplishments to tout a year from now.

In the meantime, Happy New Year!