In this article an infectious diseases anpharmacist discusses five inconvenient truths to know about infectious diseases.
Authored By: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
with an introduction by ChatGPT
AI-Generated Summary: This article outlines five fundamental truths about infectious diseases, emphasizing their complexity and the importance of vigilance. It highlights how pathogens operate without regard for human constructs, the delays inherent in disease monitoring, and the harm caused by mismanagement. By acknowledging that infectious diseases are not going away and require nuanced, evidence-based responses, the piece encourages thoughtful and coordinated public health strategies.
Posted 31 May 2025
Infectious diseases have shaped human history, influenced global economies, and altered the course of civilizations. Yet, despite the scientific advancements of the modern age, they remain a persistent threat, often catching societies off guard. From seasonal influenza to emerging pandemics, the spread of infectious agents challenges public health systems and tests our collective resilience. While medical progress has helped reduce mortality and improve detection, the reality is far more complex—and often uncomfortable.
This article explores five inconvenient truths about infectious diseases that may be overlooked or misunderstood. These truths highlight the fragility of our defenses, the unpredictability of outbreaks, and the socio-political factors that can hinder effective responses. By confronting these difficult realities, we can better prepare for future threats—not by fear, but through informed vigilance and a commitment to global cooperation.
1. Infectious pathogens do not care about human opinions
Pathogens do not pick sides. Pathogens do not observe the boundaries on man-made maps. Pathogens do not have political affiliations. While managing an infectious disease can be highly complex, the pathogens themselves are pretty basic. When they get an opportunity, they try to take it. The less opportunities we give them, the less tries they get to do harm.
Infectious pathogens impact populations differently, which is influenced by factors such as resources, exposures, and customs. While personal choice is an important component of a functional society, managing infectious diseases includes considering both the individual and society as a whole.
2. Infectious diseases require monitoring with coordination to fight them
A patient becomes infected on day one. On day three they have a fever. On day four they see a provider and have a lab test performed. On day five the lab test comes back and the patient is managed by the provider. On day six the positive lab test populates onto a report for someone to evaluate it. On day seven the lab test is reported in an analysis to leaders for epidemiological purposes.
This is not the exact way everything plays out, but it provides a general example of how it takes time for us to be able to know an infectious pathogen is spreading. It is extremely important to recognize that by the time we know there is a problem because of an epidemiology report, we are already pretty far behind the eight-ball, which is is an inevitable outcome.
So, when we look at a report of infection rates for a pathogen that is circulating in the community, remember that the data is not real time. The present infection rates are days ahead of the report you are reviewing. This means the current situation could be much better or worse and that is why trends are so important for monitoring infectious diseases.
This timeline example additionally emphasizes the importance of having proactive approaches for monitoring and subsequently coordination for mitigating the threats infectious pathogens pose. Data is king and communication is key. Avoidable delays in implementing mitigating strategies can lead to avoidable negative consequences.
3. Incorrectly managing infectious diseases causes harm
Inappropriate use of antibiotics in someone with an active infection can lead to a worse clinical outcome for that patient. Inappropriate and appropriate use of antibiotics in thousands of people (or in agriculture) over prolonged periods of time can produces worse outcomes for society, because the more we use antibiotics the more we lose antibiotics due to causing antibiotic resistance to develop. Both are bad.
In considering what is a reasonable approach to managing an infection, it is important to be mindful to differentiate what is an anecdote versus what is real evidence. It is good to be curious and question routine practices, but it is not good to constantly chase unicorns or allow yourself to be misled by quackery or cherry-picked data.
4. Infectious diseases are not going anywhere
Infectious pathogens have been with us since the beginning and there are no mitigating strategies coming any time soon which are going to allow us to win the war against them. Ignoring them is not an option. Fumbling their management will harm people.
There are not a slew of new antibiotics coming to the market to help us. There are not any major mitigation strategies on the short horizon that are going to revolutionize our ability to stop infectious pathogens. For now the best we can do is learn how to live with them while leveraging the tools we do have to the best of our ability.
5. Infectious diseases are extremely complicated and dynamic
People want to keep things simple, but this is often not possible for the area of infectious diseases. After all ID does not just stand for infectious diseases, it also stands for it depends!
The more over-simplified things are, the more inaccurate they become. One virus or bacteria is not the same as another, no matter how much we want them to be. When we talk about infections it is incredibly important to be transparent about what we do not know.
The current status of an infectious pathogen is like a 500-piece puzzle that is constantly shifting. There are always knowns, known unknowns, and unknown unknowns. Beware anyone who tells you they have the answers, as all we can really have is an interpretation of current evidence based on that person’s expertise. If someone lacks expertise, they are probably going to have a hard time putting together a valid opinion. In fact, the best opinions come from a group of people with the right expertise working together to try to adjust a picture into focus.
Also beware that a reasonable opinion at one point in time may be completely unreasonable at a later point in time as factors change and a situation evolves. Even if you were right about your thoughts on something in January, by March or April that could be partially or totally wrong.
The current state of an infectious disease can rarely be explained without lots of context and qualifying statements. That means it is never simple, even for the experts!
Closing comments
I hope this discussion on fundamentals of infectious diseases has been helpful, especially for the junior pharmacists and pharmacy students who read the IDstewardship blog!
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