Antimicrobial resistance will change the way we live

It will affect the designs of our homes and our cities, as it did a hundred years ago.

The future, from the wonderful graphic novel Surgeon X

Happy Victoria Day to Canadians who celebrate. Things feel positively Victorian if you read the Guardian; It’s full of articles on antimicrobial resistance, or resistance to infections caused by bacteria, viruses, fungi and parasites, with dire headlines like Rise of drug-resistant superbugs could make Covid pandemic look ‘minor’, expert warns. The expert is Professor Dame Sally Davies, who has been saying this for years; I read her book, The Drugs Don’t Work: A Global Threat, in 2014. The Guardian editorializes:

As apocalyptic horror stories go, it’s up there with the scariest. Yet it’s not fiction writers but top scientists who are warning of how the world could look once superbugs develop resistance to the remaining drugs against them in our hospital pharmacies. Patients will die who can currently be cured; routine surgery will become dangerous or impossible.

In 2016 I wrote Antibiotic resistance will change the way we live, deleted with all my other posts on the subject by Treehugger owners who didn’t think I was qualified to write about such things, but I have remained obsessed with the issue, writing during the pandemic about how we could fight disease with design. It’s one of the reasons I started the series, The new manual of the dwelling, which I am going to get serious about again.

In an earlier post in that series, Light, Air, and Openness, I described how architects in the 1920s were influenced by the sanitarium movement and how “many of the features of modernist classics, and much of the furniture and the trends in interior design, are a direct response to disease and a belief in the healing power of light, air, and openness.” Here, from my archives, is the 2016 original. It was written long before COVID-19 and feels strangely prescient. Note how, in the end, I promised a series on this subject; I still am promising this and will finally deliver.

Antibiotic resistance will change the way we live

When writing about bathrooms in an earlier post, I suggested that Le Corbusier put a sink in the front hall of the Villa Savoye as an historical allusion. In fact, there is a much simpler and more straightforward reason: His client, like the clients for the Maison de Verre and the Lovell Health House, was a doctor and was obsessed about germs. [UPDATE: I was wrong about this; Pierre Savoye was in the insurance business. It was Le Corbusier who was obsessed.] People had known about germ theory since 1882, when Robert Koch identified that tuberculosis was caused by a bacillus, but they didn’t have antibiotics until after World War II.

Architecture, planning and public policy were surprisingly effective at dealing with disease, once it was figured out what caused it; in her book The Drugs Don’t work, Professor Dame Sally Davies writes:

Almost without exception, the decline in deaths from the biggest killers at the beginning of the twentieth century predates the introduction of antimicrobial drugs for civilian use at the end of the Second World War. Just over half the decline in infections diseases had occurred before 1931. The main influences on the decline of mortality were better nutrition, improved hygiene and sanitation, and less dense housing with all helped to prevent and to reduce transmission of infectious diseases.

Then we got penicillin and other antibiotics and life became much easier and safer, until now, when the bugs are developing resistance to those drugs. Sally Davies notes:

We are now at a crossroads in the journey towards the defeat of infection as a cause of disease, as our use of these valuable drugs is not only becoming threatened by the spectre of resistance among the bugs they are used to treat, but also as we recognize that their injudicious use can cause harm in its own right.

In the New York Times recently, Ferris Jabr explains how this happened.

The world indulged in the existing array of antibiotics in such a reckless fashion that it’s hard to know where to place blame. Physicians are just as guilty of overprescribing antibiotics — even to mollify hypochondriacs — as patients are of demanding the drugs too often. Farmers grew accustomed to overmedicating livestock because a steady supply of antibiotics supposedly pre-empted infection and encouraged vigorous growth.

In the Varsity, the University of Toronto newspaper, Ian T. D. Thompson describes the scope of the problem, and how it is bigger than just finding new drugs.

“We must understand that microbes will always be able to evolve resistance to whatever we throw at them. Microbes have been found that can survive in extreme conditions like boiling acid,” explains Dr. William Navarre, Associate Professor in Molecular Genetics at the University of Toronto. “Any drugs we develop will only buy us a window of a few years before we start seeing resistance emerge.”… He paints a rather stark outlook for our society, if the problem of antibiotic resistance is not adequately addressed: “First of all — the future is already here. People are dying today of antibiotic-resistant microbes — not in small numbers either. More people die of antibiotic-resistant microbes each year in the US and Canada than… of AIDS.

This is not just a medical issue, but is an economic and a planning and a design issue that will affect all of us. I live in Toronto, which was hit hard by Severe acute respiratory syndrome (SARS) in 2003, and which had a huge economic impact on the City. Conferences were cancelled, nobody would go out to restaurants, the tourist industry was traumatized, and knocked 1.5 percent off the entire economy’s growth for the year. We all learned to never shake hands, something I still feel strongly about. Imagine this on a much larger scale, in a world without antibiotics.

Villa Savoye/ photo Lloyd Alter

100 years ago, fear of infection was an important influence on design and planning. Beatriz Colimina writes in X-ray Architecture: Illness as Metaphor

Modern architects offered health by providing exactly such a change of environment. Nineteenth-century architecture was demonized as unhealthy, and sun, light, ventilation, exercise, roof terraces, hygiene, and whiteness were offered as means to prevent, if not cure, tuberculosis. The publicity campaign of modern architecture was organized around contemporary beliefs about tuberculosis and fears of the disease. In his book The Radiant City of 1935, Le Corbusier dismisses the "natural ground" as "dispenser of rheumatism and tuberculosis" and declares it to be "the enemy of man." He insists on detaching buildings, with the help of pilotis, from the "wet, humid, ground where disease breeds" and using the roof as a garden for sunbathing and exercise.

But now, as the risk of living without antibiotics returns, what are architects and planners going to do about it? In our recent post on healthy houses, the long list of things to worry about in living in a healthy home didn’t even touch on it.

This is the first of a series where we are going to look at how infection affects architecture, how it was such a big part of the modern movement, and how we should be thinking about it and planning for it now. It will be critical in building and maintaining healthy homes and healthy cities.

Wash your hands and stay tuned.