Apryl Gleespen and Christian John Lillis
Imagine becoming sick from an infection youíve never heard of. Within a week, your intestines are failing. Then imagine that doctors and nurses you counted on to treat the disease lack the know-how or tools to save your life.
This unsettling scenario is familiar to us, and to thousands of Americans who become ill each year from bacteria called Clostridium difficile, or C. diff. Despite its ravages, with more fatalities each year than gun violence or traffic deaths, less than 30 percent of Americans know its name.
The past seven years, the Centers for Disease Control and Prevention (CDC) has made progress in raising awareness of this infection, increasing diagnoses and effective interventions. Now, however, progress could end and infections worsen if Americans lose a section of the Affordable Care Act devoted to fighting C. diff. and other deadly scourges.
Itís called the Prevention and Public Health Fund. And itís one of the most vital but least discussed components of the landmark health law. It establishes and directs funding to detect, study, treat and prevent the most serious threats to public health. The latest proposal in Congress to scrap the law takes away the fund. One-eighth of the CDC budget comes from such funding.
The American Medical Association cited the loss of the prevention fund as a major problem with the new bill, and one basis of doctorsí strong opposition to it.
C. diff. kills, and it canít be wished away. The infection stems from a noxious bacteria normally kept in check by other bacteria in the gut. Common antibiotics prescribed for nuisance infections and after minor surgery can kill those countervailing bacteria, unleashing C. diff. The infection can take over the intestines within days and prove fatal within a week. Even when caught and controlled, it can recur and cause painful chronic conditions or prompt removal of portions of the colon.
C. diff. first emerged in the 1980s, in several countries, and widened its suffering during the next two decades. In Ohio, a lethal outbreak of C. diff. in Cleveland in 2002 led to a state law to require more reporting of cases at hospitals, but not at nursing homes, where infections can also surface and spread.
Because C. diff. symptoms include painful diarrhea, weight loss and fever, squeamishness has long inhibited informed debate. Silence is the epidemicís worst accomplice. The Prevention and Public Health Fund is one of its best antidotes. It has helped clinicians recognize infection symptoms and save lives in many cases where ordinary people did not know what was killing them.
Smart and sustained vigilance is crucial, because the epidemic is preventable. Health care facilities, the very places where Ohioans seek cures for disease, can be hotbeds for this deadly bug. Because the fecal-oral pathway is one key method of transmission, killing C. diff. spores on surfaces in hospitals and nursing homes reduces infections.
Cleaning solutions that contain chlorine are one way to curb exposure among patients and caregivers. Measured and more strategic use of antibiotics also limits infections.
Ohio has benefited from the lifeline provided by this federal funding. Clinical experts leading the fight here against C. diff. secured nearly $23 million in direct public-health investment from the CDC in the 2016 fiscal year (https://www.cdc.gov/funding/documents/cdc-pphf-funding-impact.pdf).
The investment in Ohio appears to be paying off. State residents are suffering C. diff. infections at a rate about 8 percent lower than the national average, according to CDC data (https://www.cdc.gov/hai/pdfs/stateplans/factsheets/oh.pdf).
Costs of treating C. diff. stretch into the billions of dollars annually. We can tell you how that translates for individual lives and families. But calculating the lost productivity from workers and breadwinners, women and men in their prime, is impossible. Nor can we calculate the grief from lives lost cruelly soon, such as Peggy Lillis, a healthy kindergarten teacher in her 50s who died in about a week. This disease proves the adage that an ounce of prevention can preempt compounding sums spent on a cure.
At a time of growing resistance by dangerous pathogens like C. diff. bacteria to antibiotics, and the emergence of new and deadly superbugs that defy treatment, including some strains of C. diff., cutting back on public health funding is a dangerous step back.
Taking that step deliberately does harm and raises questions of conscience. Last week, on a party-line vote in Congress, an amendment to preserve the Prevention and Public Health Fund went down to defeat. But itís not too late to prevent this irreparable reversal for prevention.
We ask Ohioans of conscience, and friends of public health across our country, to take a stand against deadly and preventable infections like C. diff. and stop any so-called replacement of the Affordable Care Act that subjects this crucial lifeline of funding to the unkindest cut of all.
Gleespen lives in Akron and advocates for awareness and prevention of C. diff. infections, one of which she survived four years ago. Lillis is executive director of the Peggy Lillis Foundation, named for his late mother, which works to end the C. diff. epidemic that sickens 500,000 Americans each year and kills at least 30,000.