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Linking superbugs to the Ganges

The Ganges/Ganga is known as a wondrous river of legend and history whose epithets in Sanskrit texts includeeternally pure’, writes Victor Mallet in the introduction to his new book, River of Life, River of Death: The Ganges and India’s Future. “Yet the river whose waters and fertile silt have supported the densest populations of humans on earth for millennia is now under threat.” Drawing on four years of reporting and research, The Financial Times Asia News Editor writes a fascinating account of a trip down this historic river, taking in waters “befouled by sewage and poisoned by pesticides... and bacterial genes that make lethal infections resistant to modern antibiotics.” An extract:

 

It is no secret that visitors to India and other countries in south Asia are frequent victims of stomach bugs — jokingly described as ‘Delhi belly’. We also know that the immediate cause of the sometimes violent vomiting and diarrhoea that results is poor hygiene. Half of India’s 1.3 billion people have no access to even primitive toilets, they defecate in the open, and infections often find their way into food and water; in fact little of the sewage generated by those who do have toilets is treated in any case; that waste, too, ends up in the Ganges and other waterways. One of my favourite illustrations of the dangers of poor hygiene comes from Atul Gawande, the Indian-American surgeon and writer.

He describes in Being Mortal — his best-selling book on ageing and death — how he came to Varanasi to commit his father’s ashes to the Ganges in keeping with Hindu tradition. Since he is a doctor, and since he knew both the ritual actions he would have to perform and the unhygienic state of the river, he carefully dosed himself with antibiotics, hoping to avoid illness from the three spoonfuls of bacteria-filled river water he was made to drink by the pandit presiding over the ceremony. Instead, he caught Giardia, a parasitic infection not susceptible to his precautionary antibiotics.

What few visitors or residents know, however, is that by travelling or living in India they are also liable to pick up a recently discovered bacterial gene that can make various diseases highly resistant to antibiotic drugs. I stumbled upon reports of this gene — of which the first version is known to scientists as bla NDM-1 and codes for a defence protein called New Delhi metallo-beta-lactamase (NDM-I) — while I was researching the ‘normal’ pollutants such as sewage and industrial waste that sully the Ganges and its tributaries. ‘It only takes a short visit and exposure to acquire such genes in your gut,’ I was told by David Graham, a Canadian environmental engineering professor at the UK’s Newcastle University, who has studied NDM-I in India. ‘I’m pretty confident I now carry the gene’. Not surprisingly, he was confident that after four years of living and travelling across south Asia I would be a carrier too.

Vipin Vashishtha, a paediatrician in Bijnor, a town in Uttar Pradesh on the Ganges, described his horror when babies started dying in his hospital in 2009 because bacterial acquisition of bla NDM-I had made infections resistant to antibiotics.

Tales of child deaths in developing countries are distressing enough. But it would be quite wrong to assume that sick people in wealthy, industrialised countries are being spared the trauma of antibiotic resistance or will be only mildly affected in the future. Many will have heard of dreadful superbugs that spread among hospital patients, including MRSA (Methicillin-resistant Staphylococcus aureus), which can cause death from septicaemia or blood poisoning.

Spreading wide

What might a patient’s death from a superbug infection in a hospital in New York or London have to do with India, let alone the Ganges? The answer is that the NDM genes that make bacteria highly drug-resistant are being spread across the country in humans and other animals, and through sewers, streams and rivers, and are ultimately transported onwards in people’s guts to every part of the world.

Of all the academic papers on antibiotic resistance that I examined, the most arresting on the subject of the Ganges was written by scientists based in India and the UK. It confirms that NDM-I genes are found in the Yamuna River, a Ganges tributary that runs through Delhi, and in the main stream of the Ganges River. It also shows that high levels of the gene are associated with high levels of faecal coliform bacteria and therefore with the flow of human waste into rivers.

More significantly, the samples demonstrate that the (relatively) pristine reaches of the upper Ganges near Haridwar suffer surges of bacterial pollution and, in turn, bla NDM-I pollution during visits by thousands of urban Indians during the May-June pilgrimage season. Devout Hindus, in other words, are unwittingly spreading diseases, and antibiotic resistance to diseases, in the very river to which they have come to pay homage. For Ma Ganga (Mother Ganges) is worshipped as a goddess and is sacred to Hindus worldwide, which is why towns and cities that lie on the river, from Rishikesh and Haridwar to Calcutta by way of Allahabad and Varanasi, have an elevated status in Indian history and culture.

Extracted with permission from Oxford University Press

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Printable version | Apr 17, 2021 12:00:25 AM | https://www.thehindu.com/opinion/op-ed/linking-superbugs-to-the-ganges/article19988362.ece

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