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Farm to Table: How Antibiotic Use in Agriculture Affects Human Health

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

Diagnostic manufacturer MeMed announced the completion of its multiyear development of MeMed BV Flex, a test designed to expand the reach of MeMed BV into decentralized, CLIA-waived settings. MeMed BV Flex simultaneously measures multiple host proteins, paired with machine learning, to deliver highly accurate results in 15 minutes from just a few drops of blood.

“Running MeMed BV Flex from a simple finger stick will make advanced host-response testing more widely accessible, not just for pediatric patients, but also in decentralized settings,” Adam Singer, MD, vice chairman for research, Department of Emergency Medicine at Stony Brook University, said in a statement. “It means fewer venipunctures for children, faster answers for seniors, and smarter antibiotic use across the board. This breakthrough will empower care providers to distinguish bacterial from viral infections in real time.”

This new test was verified in a prospective analytical study, demonstrating performance comparable to advanced laboratory methods. In a preprint of a study published on 

, capillary and venous blood measurements showed high concordance across all host proteins as well as the MeMed BV score, indicating strong agreement between sample types. 

The test runs on an enhanced version of MeMed’s existing platform, designed to support rapid, near-patient use. Following initial dialogue with the FDA, a multi-center pivotal study is underway to confirm clinical accuracy and support regulatory submission.

From Pathogen to Infectious Disease Diagnosis: Test Determines Between Bacterial and Viral Infections in 15 Minutes



The company explains it could make advanced infection testing accessible outside hospitals, in decentralized care facilities like community clinics and nursing homes. It can also reduce discomfort for vulnerable patients like children and seniors and help improve antibiotic use/stewardship.

’s podcast, MeMed's cofounder and CEO Eran Eden, PhD, detailed the overarching goal for creating these diagnostics.

"It [the MeMed BV test] tries to solve the following seemingly simple problem: a patient, a kid, or adult comes to urgent care or to an ED [emergency department] with a suspected acute infection. Broadly, we're trying to discern the etiologies of a bacterial or viral infection. Do we treat or not treat with antibiotics?” Eden said.

References
1. MeMed Completes Development of First-Ever Fingerstick Host-Response Test for Rapid Differentiation of Bacterial and Viral Infections. Businesswire. July 24, 2025. Accessed July 29, 2025. 


https://www.businesswire.com/news/home/20250724691308/en/MeMed-Completes-Development-of-First-Ever-Fingerstick-Host-Response-Test-for-Rapid-Differentiation-of-Bacterial-and-Viral-Infections


2. Rohde R. From Pathogen to Infectious Disease Diagnosis: Test Determines Between Bacterial and Viral Infections in 15 Minutes. 

. April 14, 2025. Accessed July 29, 2025.
https://www.contagionlive.com/view/from-pathogen-to-infectious-disease-diagnosis-test-determines-between-bacterial-and-viral-infections-in-15-minutes



Company Develops First-Ever Fingerstick Host-Response Test for Rapid Differentiation of Bacterial and Viral Infections

Antibiotic treatment requires not only the right drug but also an appropriate duration—a common source of error. Approximately 30% of antibiotic orders are unnecessarily prolonged, even for infections with well-established guideline-recommended durations of therapy, such as community-acquired pneumonia, urinary tract infections, and skin and soft tissue infections.

 These prolonged courses often result from outdated habits, poor guideline awareness, miscommunication upon transitions of care, or misinterpretation of the electronic medical record (EMR). Although prospective audit and feedback (PAF) is recognized as a notably effective method of intervention, it often occurs after patients have already received excessive therapy.

 Ideally, PAF would be performed proactively, but this is complicated by intended durations of therapy rarely being elucidated within the EMR. Recognizing this, a team of pediatric clinicians from Vanderbilt University Medical Center in Nashville, Tennessee, proposed a technological change that may offer a timely and effective solution to this long-standing issue.

In February 2025, Wright et al published a pre- to postintervention study evaluating an EMR change that required clinicians to enter antibiotic duration (in doses, hours, or days) at the time of order entry for all pediatric inpatients. The study focused on 4 indications—empiric treatment, respiratory tract infection, intra-abdominal/gastrointestinal infection, and skin and soft tissue infection—that account for approximately 60% of antibiotic use at the study site.

 The primary outcome was days of therapy (DOT) per 1000 patient days (PD), as defined by the National Healthcare Safety Network (NHSN).

 Secondary outcomes assessed DOT per 1000 PD by the following NHSN classifications: community-onset antibiotics, hospital-onset antibiotics, resistant gram-positive antibiotics (aside from vancomycin, which was independently analyzed), and other.

A total of 4827 patients were included; case mix index and patient demographics each remained consistent throughout the study period. Analyzed data for primary and secondary outcomes can be found in the 

. A nonsignificant decrease in overall DOT was observed; a significant decrease was noted for empiric treatment, whereas other indications showed mixed trends. Among secondary outcomes, significant reductions were observed in hospital-onset antibiotics and vancomycin use, and community-onset and resistant gram-positive antibiotics showed a nonsignificant increase.

 DOT Per 1000 Days Present by Indication and NHSN Classification

In addition, unpublished institutional data from the same time period as the study showed improved accuracy in indication selection. This was presumably due to increased clinician attentiveness, which, in turn, likely led to the trend observed in the primary outcome (less empiric treatment DOT and increased site-specific DOT). Furthermore, greater thoughtfulness around indications appeared to have had a translational effect on prescribing patterns, as reflected in the secondary outcome trend showing reduced use of hospital-onset antibiotics and increased use of community-onset antibiotics. For example, confidence in diagnosis may have subsequently helped clinicians better conceptualize cases in which empiric treatment with hospital-onset antibiotics was not indicated (ie, community-onset infections without risk factors for gram-negative resistance or 

A key limitation of this study was the use of DOT per 1000 PD as a marker of duration of therapy, which is intrinsically susceptible to inflation. For example, the observed increase in DOT for intra-abdominal/gastrointestinal infections may be attributed to a shift in prescribing behavior noted by the authors: Single-agent therapy (piperacillin/tazobactam, 1 DOT) was preferred in the preintervention period, whereas combination therapy (cefepime plus metronidazole, 2 DOT) was favored in the postintervention period, thus leading to an inflation in DOT despite similar clinical intent. A comparable trend was seen in the respiratory tract infection indication, with more dual methicillin-resistant 

 coverage ordered in the postintervention period. The effects of this specific practice change were compounded by an increased number of patients in the postintervention respiratory tract infection subgroup. However, after evaluating duration of therapy in a more traditional fashion (days), the authors noted a decrease from a median of 6 days (IQR, 3-13) to a median of 4 days (IQR, 2-8), suggesting more intuitive use of antibiotics despite higher DOT values.

The antimicrobial stewardship (ASP) team, who continued to perform daily audit and feedback, did not identify any harm from unintentional antibiotic discontinuation. Additionally, a modest (2%) decrease was observed in 30-day readmission rates over the study period. Not only did the studied intervention seem to make clinicians more intentional with their treatment, but it also uncovered the previously unelucidated duration of therapy within the EMR, making it easier for the ASP team to proactively identify and intervene on improper durations. Ultimately, requiring clinicians to enter stop dates at the time of antibiotic order entry—combined with an active ASP team—was associated with decreased and more targeted antibiotic utilization.

The adaptation of such practices should certainly be considered within each health care system.

Core Elements of Hospital Antibiotic Stewardship Programs: 2019

. Centers for Disease Control and Prevention. 2019. Accessed July 28, 2025. 

https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf

2. Morrill HJ, Caffrey AR, Gaitanis MM, LaPlante KL. Impact of a prospective audit and feedback antimicrobial stewardship program at a Veterans Affairs medical center: a six-point assessment. 

. 2016;11(3):e0150795. doi:10.1371/journal.pone.0150795

3. Yamaguchi R, Yamamoto T, Okamoto K, et al. Prospective audit and feedback implementation by a multidisciplinary antimicrobial stewardship team shortens the time to de-escalation of anti-MRSA agents. 

. 2022;17(7):e0271812. doi:10.1371/journal.pone.0271812

4. Wright MR, Gillon J, Katz SE, Banerjee R. Requiring durations of therapy at the time of antibiotic order entry reduces antibiotic use. 

. Antimicrobial Use and Resistance (AUR) Module

. National Healthcare Safety Network. January 2025. Accessed June 7, 2025. 

https://www.cdc.gov/nhsn/pdfs/pscmanual/11pscaurcurrent.pdf

Can duration of therapy requirements at the time of antibiotic order entry decrease antibiotic use?

Clinical Corner 

Ordering With Foresight 

Airborne Fungal Spores May Predict Surges in COVID-19 and Influenza

Researchers from Puerto Rico’s RIPLRT Institute presented data that potentially linked spikes in airborne fungal spores with short-term increases in respiratory viral infections. Machine learning models analyzing data from San Juan and Caguas between 2022 and 2024 found strong correlations between spore levels and case surges of COVID-19 and influenza, especially during the fall. Notably, no such association was found with airborne pollen. This predictive capability points to the potential of fungal spore monitoring as a public health surveillance tool, providing early warning signals for seasonal outbreaks in high-risk areas.

A Group of Antimicrobial Compounds Shows Novel Action Against Multidrug-Resistant Gonorrhea

Ajit Parhi, PhD, chief scientific officer of TAXIS Pharmaceuticals, discussed the company’s promising dihydrofolate reductase inhibitors (DHFRIs), including TXA 15054, for treating multidrug-resistant gonorrhea. Unlike trimethoprim, which targets the same enzyme but has no effect on gonorrhea, TXA 15054 binds differently and avoids interaction with human DHFR, reducing toxicity. With a $2.9 million NIAID grant supporting development, TAXIS aims to identify a clinical candidate by 2026. As global rates of ceftriaxone-resistant gonorrhea continue to rise, including recent US cases, this class of compounds offers a potential solution to a looming public health threat.

How Genomic Sequencing Can Aid in Diagnosing Fungal Infections

Shaun Yang, PhD, of UCLA’s Department of Pathology, described a next-generation sequencing–based fungal ID test developed to improve accuracy in diagnosing complex fungal infections. Traditional morphology-based methods can fail to identify 5% to 10% of fungal isolates, particularly from emerging or environmental species. Yang’s team applied whole-genome sequencing targeting ITS regions and additional gene markers to identify pathogens in transplant and cancer patients. Case studies demonstrated how genomic precision guided correct diagnoses, enabled treatment changes, or ruled out hospital-acquired infections. The technology offers a powerful diagnostic advance for immunocompromised populations.

Considering the Value of Antiviral Resistance Testing in Certain Populations

Meghan Starolis, PhD, of Quest Diagnostics, discussed the role of genotypic and phenotypic antiviral resistance testing in supporting immunocompromised patients. Genotypic testing is faster and less labor-intensive but limited to known resistance markers; phenotypic testing detects resistance even from unknown variants but requires laborious virus cultivation. Starolis emphasized the importance of these tools in managing chronic antiviral exposure, especially in patients receiving stem cell transplants or chemotherapy. She also called for wider access to FDA-approved resistance assays, which could reduce delays in treatment and improve outcomes for vulnerable populations.

Pelumi Oladipo, a PhD candidate at Wayne State University School of Medicine, presented 2 novel diagnostic methods capable of distinguishing 

, closely related species with nearly identical phenotypes. The team identified the first confirmed human infection with 

 in North America by combining a TaqMan PCR assay targeting uidA and uidB with a MALDI-TOF-MS biomarker that revealed nonoverlapping spectral peaks between the species. Although current MALDI-TOF-MS systems misclassify 

 with 99.1% IVD confidence, whole genome sequencing reveals a 10% divergence between the two. They also identified a unique spectral peak (m/z 7260-7268) absent in 

 by 10%, with implications for treatment resistance and infection tracking. This study calls attention to the need for updated diagnostic protocols in clinical microbiology and demonstrates the clinical significance of cryptic clades.

From predicting viral outbreaks via fungal spores and combating drug-resistant gonorrhea to advancing fungal detection through genomic sequencing and improving antiviral resistance testing for vulnerable patients, and more.

Conferences

Microbe Moments from ASM 2025: Superbug Threats, Diagnostic Breakthroughs, and Environmental Clues 

In the second part of an interview with Andrea Prinzi, PhD, MPH, SM(ASCP), she talks about the significance of how that foundation played such a significant role against the disease as well as the remain hurdles to its eradication and how polio’s vaccine are a lesson applied to medical science. 

What We Can Learn From Polio

In 1938, President Franklin D. Roosevelt founded the National Foundation for Infantile Paralysis, the name of which he later changed to the March of Dimes Foundation. Roosevelt, himself experiencing paralysis from polio as an adult, became deeply involved in this cause.

 He experienced paralysis in 1921 at the age of 39 years as a result of polio.

With the creation of the foundation, Andrea Prinzi, PhD, MPH, SM(ASCP), field medical director of US medical affairs in clinical and translational science at bioMérieux, says Roosevelt came up with a unique plea that was designed to apply to all Americans. 

“He said every single person in the country, no matter what your status or your wealth, can donate one dime to this cause, and everybody felt like they could relate to that,” Prinzi says. “It reached people who maybe had been excluded from conversations before or people who didn't come from wealth and didn't feel like they could make a donation toward the cause." 

This was a novel way to increase philanthropy that is still being used today, with people giving what they can to causes.

Prinzi says this mobilized the fundraising, and people were sending dimes to the White House. With these monies raised, it helped fund the work of Jonas Salk, MD, who developed his polio vaccine.

“There were a lot of other things that came from this. The power of unifying behind a single cause and getting the public to have a shared responsibility for the wellness of the whole of people. It was also that polio was very, very frightening for people and impacting children heavily. So there's a lot of emotion tied [to] children—a lot more mobilization there. You also had a lot of public figures and celebrities getting behind this cause as well, which was really helpful."

Today, there are only 2 countries in the world where polio is endemic: Pakistan and Afghanistan.

 Although these countries are still dealing with polio, Prinzi says the progress made throughout the rest of the world has come to the point where most countries do not have to think about it and that what has happened in recent years is cases of vaccine-derived polio.

“In some cases, very rarely, but in cases, it can mutate to end up causing paralysis or severe disease in people who come in contact with that, and this is specifically true for the type 2 vaccine–derived polio virus,” Prinzi says. “It's responsible for greater than 90% of cases when this occurs.... Work has been done to develop vaccines that address that type of polio virus…. A vaccine was authorized by [the] World Health Organization that essentially makes the type 2 vaccine–derived polio virus less likely to mutate into something that can cause serious disease.”

She says this is a good example of the evolution of science and making changes to adapt to differing circumstances. This is the reality compared with what some in the public believe, which is that science is supposed to be perfect from the beginning. This can certainly be seen as a good example as it relates to COVID-19 public health policy and the vaccines.

“There's likely, very rarely, one single answer to a problem, and the public has to remember that things change and adapt, and we change and adapt and learn with those things, and then hopefully we evolve our science to match that,” Prinzi said. “That's something that I think has gotten a little lost on the public in recent years. We expect science to be perfect all the time and fix the problem right away, and that's just not really how these things work."



In the next installment of this series, we will discuss Roosevelt’s battle with polio and how he did not let the disease prevent him from living his life, including becoming president. 

References
1. Franklin Roosevelt founds March of Dimes. History. Updated May 27, 2025. Accessed July 28, 2025. https://www.history.com/this-day-in-history/january-3/franklin-roosevelt-founds-march-of-dimes
2. Poliomyelitis. World Health Organization. Accessed July 28, 2025.
https://www.who.int/health-topics/poliomyelitis

In the second part of an interview with Andrea Prinzi, PhD, MPH, SM(ASCP), she talks about how the March of Dimes played such a significant role against the disease, how the polio oral vaccine is a singular lesson that can be applied to medical science as a whole, and the understanding of the need to adapt to changing circumstances. 

What We Can Learn From Polio and Its Vaccines

How infectious diseases may fuel global instability, a conversation with psychiatrist Robert C Bransfield, MD.

Infectious Disease, Violence, and Global Instability: Exploring the Hidden Link

In episode 2 of our series with psychiatrist Robert C. Bransfield, MD, we explore the powerful yet often overlooked connection between infectious diseases, violence, and global instability. Drawing from decades of clinical experience and historical research, Bransfield outlines how certain infections can impair brain function, disrupt emotional regulation, and contribute to aggressive or violent behavior, both in individuals and across societies. From neuroinflammation and impaired empathy to the manipulation of host behavior by microbes, this episode investigates how biological and environmental forces can shape the trajectory of conflict, instability, and even history itself.

Bransfield begins by reflecting on a pivotal moment in his career, a medical presentation delivered in Paris, before the COVID-19 pandemic changed the world. “In 2017, I gave a presentation at a medical meeting in Paris. The presentation was titled 'If Ever We Have a Pandemic at Some Point in the Future That Causes Mental Impairments Associated With Violence, It Could Result in Global Instability

' That was the title of my paper. I really hoped that would never happen. But then the pandemic came.”

After the onset of COVID-19, Bransfield returned to that earlier hypothesis with renewed urgency. “Then I took a look back at that hypothesis and questioned it: Did that, in fact, occur or not? And if it did occur, what was the support for it? What would be the implication of it, beyond the pandemic itself?”

COVID-19 and the Spike in Global Violence

Bransfield points out several behavioral and psychiatric effects observed during the COVID-19 pandemic, each of which can increase the risk of violence. “Looking just at the pandemic, with COVID-19, was there an association between violence and global instability? There were different ways to look at that. One is [that] COVID-19 did result in emotional impairments—of a number of different sorts. It resulted in cognitive impairments. It resulted in increased substance abuse. Those 3 things collectively increase the risk of violent behavior.”

“If we looked at monitors, particularly violence, there were studies that looked at it. After the pandemic, there was an increase in child abuse. There was an increase in domestic violence. There was an increase in elder abuse. And there was an increase in gun-related violence. Different studies showed that.”

The impact extended beyond individual cases. “Also, when we looked at global statistics, there was a 45% increase in violent behavior—and that was before the 2 wars, before the Ukraine war and before the Middle East war broke out. There was also the Global Peace Index, which looked at peace in different countries and throughout the world, and that declined following the pandemic.”

The takeaway, Bransfield argues, is clear. “So when you add all that together, it was clear that the pandemic resulted in increased violence and increased global instability. And we’re living in a global community now, where violence isn’t isolated to one small corner of the world; it spreads.”

This observed link between one viral outbreak and heightened violence prompts a broader, more unsettling question. “If the pandemic of COVID-19 increased violence, what about other infections? Could other infections do that too? And if so, how can we look at that in a methodical way to understand it—and then what can we do to prevent it?”

Bransfield identifies World War I as a historical example where widespread infections may have shaped future instability. “One way to look at it is historically—looking at other infectious diseases, looking at other pandemics. The initial reference point was World War I. In World War I, there was a huge number of infections related to the war that caused a lot of brain injury in a very large number of people and in specific individuals who then became leaders in World War II, such as Hitler.”

Cycles raise deeper philosophical questions. “If we look at it historically, we have these cycles. When we’re working together, we can achieve great things—we can conquer polio, we can fly to the moon, come up with new inventions that improve the quality of life. But then there are other times when history shows a predominance of conflict. And that gets us into a certain philosophical question of, is man just violent, and are we on a path of self-destruction? Or is violence a pathological process?”

Understanding Violence as a Pathological Process

If violence is not innate but pathological, then the outlook becomes more hopeful. “If it’s a pathological process, then we can understand it, we can treat it, we can prevent it—and we’re not doomed to follow a path of violence.”

That understanding requires examining all contributing factors. “In order to do that, we have to look at every contributor to violence. If you look at the formula for violence, there are multiple contributors and multiple deterrents—and it’s the balance between the two. Some of those contributors are acute, and some are chronic. Some of those contributors are very well understood, and some aren’t.”

And finally, he returns to the central question raised by the pandemic experience. “And when we look at what happened with the COVID-19 pandemic—where there was an indication that the infection associated with that pandemic did increase the risk of violent behavior and global instability—might that also be associated with other infections?”

How infectious diseases may fuel global instability in a conversation with psychiatrist Robert C. Bransfield, MD.

Emily L. Heil, PharMD, BCPS-AQ ID

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