‘Another outbreak is a certainty’: are we ready for a superbug epidemic?: Fifteen years ago, Sars spread through Hong Kong like wildfire. With antibiotic resistance on the rise, how many cities are prepared for a superbug outbreak?

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It has been 15 years since an outbreak of severe acute respiratory syndrome (Sars) in Hong Kong killed 299 people and infected 1,755. The wildfire spread of the deadly virus through densely packed housing estates stunned the city’s health authorities and traumatised residents. Now the city’s top microbiologist thinks more deaths are on the way.

“It’s very likely we’ll see an epidemic on the scale of Sars,” says Professor KY Yuen, chair of infectious diseases at the University of Hong Kong. He cites two key reasons for this, both applicable to cities around the world. The first is population density. “Our population is increasing. The number of people living in subdivided flats is now at least 200,000, maybe as high as 600,000,” says Yuen.

The second is the rise of antibiotic-resistant superbugs. One new superbug infection is reported every 18 minutes in the city’s public hospitals. “The level of antimicrobial resistance in Hong Kong far exceeds that in other developed countries, with resistance to some antibiotics over 20 times higher than in the UK or Sweden,” says Yuen.

That situation is “very likely to get worse” without urgent action to tackle overuse of antibiotics, he says. A government survey revealed half of Hongkongers had taken antibiotics in the past year, with 2% admitting sourcing them illegally. Some argue that pressure to free up hospital bed space leads to oversubscription of antibiotics, as doctors try to shift patients out the door.

A 2016 report backed by the British government found that drug-resistant infections cause 700,000 deaths globally each year. The same report projected that death toll could rise to 10 million a year by 2050 – more people than die annually from cancer. The authors put the economic cost of such a catastrophe at $100tn (£75tn). The World Health Organisation (WHO) has described rising resistance levels to antibiotics as a “global crisis”, while England’s chief medical officer has warned of a coming “post-antibiotic apocalypse”.

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