Karl Klose, Professor of Microbiology at University of Texas San Antonio, talks about the dangers of developing antibiotic resistance and the ability to fight of Superbugs or secondary infections in COVID patients.
Let’s talk about the over-use of hand sanitizer to kill the coronavirus. What’s that doing to the superbugs?
KLOSE: There was a time where marketing was driving the addition of unnecessary antimicrobials in hand sanitizers, but after the incidents of increased antibiotic resistance, there was a lot of backlash against that. Specifically, it was triclosan, which a lot of people remember was in everything. The negative side effects of triclosan began to become apparent, and that is antibiotic resistance in microbes. So, alcohol-based hand sanitizers are effective at removing and inactivating the transient microbes that are in your hands. You may be aware that your body hosts a whole bunch of microbes. The washing of the hands and the hand sanitizers really don’t do much against your permanent microbiome, but they’re very effective at removing the transient things. For example, the coronavirus, if you should happen to get it on your hands, washing your hands and using hand sanitizers is actually a very effective way to get rid of that. The bottom line is that, because the hand sanitizers have been sort of reformulated, there’s no additional concern about the induction of antibiotic resistance with those hand sanitizers because there’s no more triclosan in it anymore. That doesn’t mean that it won’t start to creep in, so maybe when you’re buying hand sanitizer, check to make sure that the basis is alcohol and not what they call antimicrobials, which would be triclosan or other chemicals that are put in there for marketing purposes. If they add it to hand sanitizer or soap, it’ll say something about antibacterial or antimicrobial. You can look on the product information to see if there’s any additives that aren’t necessarily supposed to be there or even effective.
Can a superbug spread like a virus? Can bacteria spread the same way?
KLOSE: Potentially. The key to this virus and the spread of this pandemic is the airborne transmission. It’s spread through the air and you breathe it into your lungs. There are bacteria that can be spread in that manner as well, but in general, when you see these large pandemics, they tend to be viral. For example, a new virus crops up and jumps from a species like a bat to a human, and when it’s spread rapidly, it’s an airborne transmission. Of course, there is pandemic bacterial diseases, like the plague. The plague was a large pandemic that occurred in the Middle Ages and spread very rapidly. That is very dependent on the conditions that were present at that time because it spread through fleas. My laboratory studies pandemic diseases, and pandemics have been going on since the 1800’s. Cholera is a pandemic disease that is bacterial in nature and spread through contaminated water sources. So just like viruses, other microbes can spread. Really, the word pandemic just means that the infection is spreading around the globe. There are diseases that can be spread that are not viral in nature. Microbes that are infectious can be spread in a pandemic fashion, you just have to have the means to spread them easily. So, airborne transmission is the easiest way to quickly spread microbes around. If a microbe infects the lungs, then you’ll see very rapid airborne transmission, just like with the coronavirus and then the flu every year. Some bacterial diseases spread through the air as well. You must remember that bacteria are living organisms and share certain commonalities, so we have an arsenal against bacterial diseases. Every virus tends to be very different than the last virus. The antivirals that are pre-existing tend to be specific. This is the reason why you notice there’s this lack of any effective medications against coronavirus. The reason why is because it’s a new virus and not the same as other viruses before it. So, antivirals tend to be specific. What they’re doing right now is digging into the arsenal of antivirals that were developed for other viruses and seeing if they might work against the coronavirus. The Remdesivir that everyone’s talking about was an antiviral that was developed against Ebola. And apparently, my understanding is it’s very effective against Ebola, but the Ebola pandemic died out before there was widespread usage of Remdesivir. Now they’re trying to repurpose it, taking that drug and seeing if it might work against the coronavirus because there are some commonalities between viruses. But then again, there’s a lot of differences as well. My understanding is that it works somewhat. It’s not as if it was made specifically against coronavirus, but it does have some effect against some of the more severe cases of COVID-19.
I don’t think some people understand the basic differences between viral and bacterial disease and why antibiotics work against one and don’t work against the other. In this case, where it starts with a virus, sometimes the doctors are treating a corresponding bacterial infection that enters in. Can you address that a little bit?
KLOSE: Yes, that’s an important point. Viruses are a type of microbe and bacteria are a totally different type of microbe. Antibiotics were designed and developed to work against bacteria. They don’t work against viruses at all. In other words, people are familiar with different antibiotics like tetracycline or penicillin which are designed to work against bacteria, but a virus is not a bacteria. So those types of antibiotics will not work against the viral diseases because they were never designed to work against them. What makes a virus a virus is its inability to replicate itself. Viruses must infect a host. They’re completely incapable of replicating themselves otherwise. So, that’s the one unique thing about a virus is that it’s very dependent on its host. The reason why is because the virus doesn’t have all the information it needs to be able to replicate itself. It’s like parasitizing the host to allow it to replicate itself because they’re real simple biological entities. That’s what makes a virus unique and also makes it difficult to have a general broad type of medication against it because every virus is different. There’s some debate in the biological world as to whether you should classify them as a living organism. But in the strictest sense of the word, if you want to define life as being able to self-replicate, they can’t do it, so therefore they’re not really living, and you have to have a very special type of medication against them which tends to be specific for each virus. This is not true for viruses. You must have a very specific medication in order to be able to treat these diseases. Sometimes, a viral disease will lead to a bacterial infection. Under those circumstances, the doctor may prescribe an antibiotic. The antibiotic works against the disease that you’re experiencing, but not against the virus. A good example of this is the flu. Many people who get the flu end up getting a bacterial infection in their lungs, and a lot of the people who die of the flu every year, aren’t really dying of the flu. What they’re dying of is the pneumonia that’s caused by a bacterium that got into their lungs after they had the flu. Pneumonias that are caused by bacteria will follow the flu, and then an effective treatment would be antibacterial, or antibiotics. Lots of times people will go to the doctor and if the doctor prescribes them with an antibiotic and they take it and then get better, they somehow think that that antibiotic cured the disease when, in fact, a lot of times there is no real treatment for a viral disease. You just have to wait and then you’ll get better. You can treat some of the symptoms, but you really can’t treat the disease itself.
I read the other day where the coronavirus is a blood vessel disease and not necessarily a respiratory element. What do you know about the latest cause about COVID-19?
KLOSE: Like most new diseases, the coronavirus is kind of a mystery and we’re learning about it as time goes on because more and more people get infected. What you’re seeing is the broad spectrum because so many people have been infected by this virus all at once, and you’re seeing every possibility of what can possibly happen when this virus gets inside of a human being. In general, the virus is spread through the respiratory tract. That’s how it’s passed on from person to person. A lot of the symptomology that you hear about with the disease is associated with the lungs. The virus can cause a lot of additional symptomology and problems in people who get it and we’re just learning about that right now. It’s still not clear why some people are immune to the virus and don’t see any symptoms at all. They never even know they were infected. Then, there’s other people who have extremely severe disease and end up dying from it. Older people, in general, do not have as effective immune systems. When you’re older, it’s harder to fight off disease because your immune system’s been working for 70, 80 years. Then, there’s also people who are sort of in the prime of their lives or very healthy and still come down with extremely severe disease. There’s a lot of cardiac issues associated with this virus, and there are some blood vessel issues in some individuals. One of the things you must remember is this virus just popped up in December. The underlying mechanisms are still not clear. Those things will become clear over time for sure because there’s a lot of scientists studying it right now and trying to figure out exactly why some people come down with severe disease and some don’t. Why cardiac involvement is involved with some people and not with others? Why do you see some of these clotting issues in some people and not others? One of the things you must remember is that it’s the same virus with minor modifications. It’s the same virus that’s infecting everybody, but very differently. Over time, my prediction is that there will be therapeutics. They’re going to find some kind of drug that will minimally help ameliorate some of the symptoms and prevent some of the deaths that are going on. In fact, they already have that right now, which is convalescent serum. So, someone who survived and recovered from the disease, they have high levels of antibodies in their blood that will attack the virus when they see the virus. Let’s say I recovered from COVID-19 and now I’m healthy and there’s no virus in me. What’s changed is now I have a lot of antibodies inside of my blood. Those will recognize the virus anytime in the future when the virus shows up. So, take my antibodies and put them into someone who’s never seen the virus before, then those antibodies will attack the virus itself. You’re going to see that coming up very soon. They’ve already been doing large clinical trials on convalescent serum and the preliminary results look promising. Meanwhile, in the background, what’s happening is scientists are developing vaccines. I think that the fastest vaccine will probably be rushed into the market to try and help tamp down that disease and death. Then, after that will be a better vaccine that will have more efficacy. I would predict probably in two years from now we’ll have both. We’ll probably have a therapeutic and an effective vaccine.
Are the bacteria in the background scrambling and saying, quick they’re studying viruses let’s get a better hold on things?
KLOSE: Oh, of course! The living world doesn’t take a break like humans do. So, all the same stuff that was going on before is going on now in the background. But our focus is lasered into COVID right now that nobody is paying attention to literally anything else. We’re extremely privileged in the United States and in developed countries where the coronavirus came out of the blue. It has caused death and disruption, but there’s other parts of the world where they have equally problematic infectious diseases on a regular basis. So, this is just one of many. And, not to minimize it at all. Coronavirus is terrible for everybody on the Earth. But, there’s other places on Earth where they deal with infectious diseases daily. So, that stuff has not taken a break. You go to any developing country in the world and they’re worried about parasitic diseases, other viral diseases, and bacterial diseases. It’s more part of their way of life. In the United States, we don’t really think about infectious diseases too much until there’s a global pandemic because reality is, we don’t have a whole heck of a lot of infectious diseases to worry about all the time.
Since many universities, where research is based are closed, are you focused on any bacterial studies or are you looking to what you could do for COVID-19? How does that impact you directly?
KLOSE: We work on vaccines in my laboratory. We’ve been developing a vaccine for the last decade against tularemia. It’s at a relatively advanced stage where we are working with the Southwest Research Institute here in San Antonio on formulations for the eventual use in humans. Because we have a lot of experience with vaccine development and we have what we like to call a platform, we have a vaccine that we know is safe and that can induce immune responses in various hosts. What we’re trying to do is adapt it towards COVID-19. If you look at all the different vaccines that people are trying to come up with against this disease, one thing that’s very clear is that a virus cannot replicate itself. It must get into a host cell in order to be able to replicate. So, what that means is when the virus gets into your lungs, it must get inside one of your cells in order to replicate itself. The way the viruses do this is on their surface, they have these spike proteins that stick out. When you see pictures of the coronavirus, you see that they call it the coronavirus because they look like crowns. There are those little things that stick out that look like a ball with pin cushions. Those are the spike proteins. It uses those spike proteins to attach and get inside of cells. The assumption is that if you make antibodies in your body against the spike protein, then you will be able to prevent the virus from getting inside of cells. These are called neutralizing antibodies. You can imagine the virus is trying to attach to your cells, but your body has an antibody that will block it. That virus can’t get inside of the cell and it can’t replicate and cause disease. This is the reason one of the therapies against corona is to take antibodies from an individual who already experienced the disease and move them into another person who’s never seen the virus. If you ever hear the term neutralizing antibodies, that’s what they’re talking about because they’re antibodies that can block that interaction. There are different ways to trick your body into making those types of antibodies, but your body must see the spike protein first in order to make antibodies against it. In the future, when we have a vaccine against the coronavirus, what it will be is some mechanism to induce antibodies against the spike. Some of the vaccines that are being developed right now are basically trying different ways to make your body make antibodies against the spike protein. Our vaccine approach is to use the vaccine that we already have and trick it into making spike so that when we vaccinate animals or humans, they will see the spike as well and make antibodies. Then, if you ever see the coronavirus after you’ve been vaccinated, you will have those neutralizing antibodies in your cells. So, in general, everyone’s trying to achieve the exact same thing which is drive up neutralizing antibodies against spike protein inside of you and then you will be protected against the virus.
Do you see superbugs gaining the upper hand in relation to corona because the immune system is already weakened?
KLOSE: There have been reports of individuals in severe health, after or during the infection with this virus, that their bodies become weakened and a secondary infection sets in because it’s a pulmonary disease. The pulmonary area of your body is very sensitive. When you have a weakened lung system, you can’t fight them off as well. When people die of the flu, they typically died of bacterial pneumonia that they get after their lungs have been weakened. There have been some reports of this also happening during COVID. That isn’t necessarily one of the major causes, but there absolutely have been some reports of people getting secondary infections because they were infected with the virus.
Where we are with superbugs now compared to six months ago?
KLOSE: We’re about in the same place. The rise in antibiotic-resistant bacteria is a serious health emergency that we’re facing and hasn’t really changed much in the last six months. With the preoccupation of COVID, a lot of people have maybe not thought much about superbugs and antibiotic resistance, but it’s a lingering problem in the background and appears to only be getting worse. The bottom line is that there needs to be large initiatives to inhibit the emergence of these superbugs and do something about them once they do emerge. The real problem is, it’s multifactorial. Doctors prescribe antibiotics for things that are related to bacteria, so the bacteria that are around become resistant, and then they pass on those traits to other bacteria that they meet. Most of those strong antibiotic-resistant bugs are opportunistic. What that means is that they’re just looking for the opportunity to cause disease when the host is in a weakened state. So, you pick up these bugs in the hospital and end up getting a secondary infection because you’re not able to fight off disease anymore, then there’s no antibiotics that can treat you because the bugs are resistant to the antibiotics. This is the problem that we’re facing. The numbers and the incidence haven’t really gone down in the last six months. Again, it’s multifactorial. We must address it from multiple aspects because if we don’t, it’s just going to get worse. One of the best things that we can do is to come up with new treatments for the short-term because trying to reduce the amount of antibiotic resistant bacteria is a tough thing to achieve because they’re already out there. I think it’s within our grasp in the short-term to come up with new antibiotics, but in the meantime, be more judicious about using antibiotics in a better way so that we don’t induce antibiotic resistance in all the bacteria that we come in contact with.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Courtney Clevenger
University of Texas San Antonio
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