Chapter 2234 - Drug Resistance

"Besides, never mind transport—a problem we can't solve anytime soon. Take my own work: disinfection and pest control. Guess what the most common cause of death is at the front-line medical stations?"

"What?"

"Bacterial dysentery—accounts for about a fifth." Fu Liangqi's face darkened. Since becoming head of Guangdong's sanitation and epidemic-prevention section, he oversaw the entire province's public-health work, including what he self-deprecatingly called "disinfection and extermination"—theoretically a far larger jurisdiction than his former superior Lei En in Lingao, but the resources he could muster for such a daunting task were pitiful.

Dysentery was widespread in this era, yet prevention wasn't difficult. A disease so obviously caused by unclean food and water killing at such a high rate meant the work was being done very poorly. That would make his performance report ugly—though in truth it wasn't a major problem: the Council's baseline was so low that any improvement looked impressive from the outside.

"That shouldn't be." Song Junxing was surprised. "Is disinfectant in short supply?"

"Disinfectant has never been sufficient. Mainly it's the old problem: execution gaps. We're actually short on logistics talent too—and since it gets less attention, the situation may be even worse." Fu Liangqi explained. "I can't follow every company and personally supervise their disinfection work. I can only convey directives and requirements—but setting standards too high is meaningless, because no single company can meet them."

"Forget the companies. Do you know how bad infection control is inside the medical stations?" Song Junxing snorted. "They're borrowing beds everywhere—the isolation protocol is a mess. Pneumonia patients, dysentery patients, and burn patients all crammed into one tent, bed to bed! If you ask me, this is what you get when the higher-ups demand Great Leap Forward–style speed: talent shortages everywhere, chaotic management. It has nothing to do with your disinfection work. Even if you distilled all the water, you couldn't stop it."

What Song Junxing called "infection control"—the full term was "nosocomial infection"—referred to infections acquired by hospitalized patients inside the hospital, including infections occurring during the stay and infections acquired in hospital but manifesting after discharge, excluding those already present or incubating on admission. Infection-control management was a critical function of modern hospitals, covering everything from hand-hygiene protocols for medical staff to specialized isolation wards.

The Council's hospitals naturally had infection-control work too, as did the front-line stations—though it was lumped into the grab-bag of "medical administration." But the medical-administration personnel—like the clinical staff—were largely products of crash courses. No matter how much Section Chief Deng boasted that Provincial-Hong Kong General Hospital was a "world-class hospital," it couldn't hide that ninety-nine percent of its staff were woefully undertrained.

And even if all the administrators met old-timeline standards, that wouldn't solve everything. Fu Liangqi could feel that the overall hygiene consciousness of the troops couldn't be built up by a handful of medics doing outreach for a year or two.

Fu Liangqi had come to Liangguang not as a front-line clinician but to guide camp and garrison sanitation and epidemic prevention—basically his self-described "disinfection and extermination" work.

Before coming to Liangguang, Fu Liangqi had "fully mentally prepared" himself for the state of public health. But after reading reports from the preceding Elders, he realized that carrying out epidemic-prevention work in a not-yet-pacified Liangguang faced layer upon layer of difficulties—even limited just to the military.

Liangguang was subtropical: humid, sweltering, densely forested, with complex terrain. It was an ideal breeding ground for disease-vector insects, animals, and microorganisms—mosquitoes, flies, horseflies, gnats, snakes, rats, leeches everywhere. The Little Ice Age didn't make summer here comfortable or hygienic.

From front-line reports, Fu Liangqi had summarized the disease profile of the semi-pacified zone: mainly malaria, bacterial dysentery, leptospirosis, typhus, scrub typhus, arboviral diseases, and parasitic infections—mostly infectious diseases, all with severe incidence. From a natural-environment standpoint, late-Ming Guangxi was a petri dish with all five "damp-heat-pest" poisons. Against the backdrop of the Ming-era chaos, these problems could only get worse. During the pacification campaign, front-line units often had to pursue remnant bandits for extended periods. Though combat intensity was low, physical exertion was high. Add inadequate food, clothing, and supplies compared to the rear, and resistance dropped markedly. Though martial law was being enforced as fully as possible, the Council's grip on the semi-pacified zone was weak, population movement was high, and combat units frequently had to enter natural foci and epidemic zones. Controlling sources of infection was extremely difficult.

Before officially entering Liangguang, Lin Motian had requested to join the first support wave, conducting health reconnaissance with several public-health Elders. They roughly mapped the sanitary situation, disease profile, endemic-disease prevalence, and water-source quality of the semi-pacified zone. The results were unsurprising: the main threats were enteric infections and malaria. With the ubiquitous transport bottlenecks, disinfection and pest-control supplies weren't always available on demand, and there were no adequate vaccines. Lin Motian could only devise stopgap measures—for example, borrowing from the old-timeline PLA, he instituted a "three-serve, two-separate, one-self-store" system: cooks serve meals, serve dishes, serve soup; separate water for hand-washing and bowl-washing; utensils self-stored. He also arranged unified health checks for cooks and re-screened relevant medical histories. And he pushed more intensive outreach emphasizing routine drinking-water disinfection and banning raw water—all to prevent enteric outbreaks.

But once fighting started, you couldn't be so careful. Thousands of small units were scattered across the province. Even garrison units in county seats had poor conditions. When executing search-and-patrol missions, dining and lodging were even worse—most of the issued sanitation protocols were dead letters. Even after the front-line hygiene-system overhaul, Fu Liangqi still faced the same situation.

Take bacterial dysentery, the most worrying epidemic. Due to drug shortages, treatment of patients couldn't be completed in time. Not only were there casualties, but a significant number of chronic patients accumulated—a hidden threat for secondary infections in the units. The conditions on the return march went without saying; contact transmission was unavoidable. Back at camp, only a fraction of patients could be isolated; the rest couldn't be, making re-infection and epidemic spread easy.

"And Song-ge, there's a new wrinkle in the epidemic situation. Take a look at this first." Fu Liangqi pulled a document from his coat.

Song Junxing took it—a telegram from the Guangdong Regional Health Commission:

1st Brigade Medical: Your noon message received. Sporadic dysentery also seen in Guangzhou. Front-line units should, per new central regulations, retain bacterial samples for drug-sensitivity testing and report promptly. Liu, Lin.

"Retain samples for drug-sensitivity testing per new regulations... Is that really necessary? There are only a handful of antibacterials we can use. Even if you run the test, is there any choice? We'd still use sulfa..." Song Junxing was puzzled. "Drug sensitivity"—the full term was "in vitro antimicrobial susceptibility testing"—was a standard test of the antibiotic era. Simply put, when you had a variety of antibiotics to choose from, you cultured bacteria from the patient's infection site and added different antibiotics to see which ones the bacteria were sensitive or resistant to. Obviously, for a Council that had almost nothing but sulfa, this wasn't a particularly useful test.

"I sent a telegram to Guangdong earlier, reporting the dysentery situation here." Fu Liangqi took back the telegram. "Now it seems Guangzhou is also seeing sporadic dysentery. But ordering us specifically to do drug-sensitivity testing—that's a first. Anyway, orders are orders, so I ran the test. And I did find a new problem..."

"What problem?"

"You said you thought drug-sensitivity tests were useless, right? After all, the only drug we really have is sulfa. Because of that, up to now, we've basically never run a drug-sensitivity test on any bacteria." Fu Liangqi's expression grew grimmer. "The dysentery strains I received were Sonnei and Flexneri groups. I ran sensitivity tests on the Flexneri. Guess the resistance rate? Average twenty percent. The highest—seventy-four percent."

"That high!" Hearing this, Song Junxing—who hadn't been paying much attention—was shocked.

The only antibiotics the Council was producing in quantity were sulfa and oxytetracycline—with sulfa as the mainstay. This pioneering antimicrobial that had once opened a new chapter in humanity's millennia-long war against bacteria had, in the old timeline, been gradually marginalized. There were reasons: sulfa-class drugs were generally considered bacteriostatic rather than bactericidal; in the old timeline, severe resistance problems had already formed. The Council's sulfa was of limited purity and lacked trimethoprim as a synergist, so everyone knew resistance was bound to come sooner or later. Bacterial dysentery was one of sulfa's primary indications; usage was heavy. Finding resistant strains in dysentery bacilli was no surprise.

What no one had expected was for this day to come so soon.

Though the proportion of resistant strains so far wasn't high, it was a very bad omen. With drugs already in short supply, the emergence of resistant strains was salt in the wound for an already dire dysentery epidemic.

(End of Chapter)