How the pandemic is fuelling antimicrobial resistance
For years, a growing number of infections that are resistant to antimicrobials have offered us a grim glimpse into a future of increasingly untreatable diseases. COVID-19 has made antimicrobial resistance so much worse.
24 June 2021 – by Priya Joi
Right before the pandemic started, antimicrobial resistance (AMR) was high on the global health agenda. The prediction that AMR could cause ten million deaths a year by 2050 had spurred calls to be prudent when using antibiotics, and to reduce their use in livestock. Fast-forward to a year later, and the world is facing a far more devastating challenge of drug resistance than ever before.
Bacterial and fungal infections rising
COVID-19 infection can massively weaken the immune systems of infected people, which is why secondary bacterial infections have been extremely common. India has recently reported an outbreak of a deadly ‘black fungus’, or mucormycosis, that can lead to blood clots and affect the eyes, nose and sometimes the brain.
The pandemic also halted many immunisation programmes, putting millions of lives at risk from deadly diseases such as measles.
Now the country is seeing a rise of other deadly fungal infections such as Candida auris, which infects the bloodstream but also the respiratory system, central nervous system and internal organs, killing as many as 70% of people. The problem is that many of these infections are resistant to antibiotics, which means they are virtually untreatable.
And, even as COVID-19 greatly weakens their immune systems, the process of putting patients on mechanical ventilation to treat COVID-19 in packed intensive care units can fuel secondary infections. As the pandemic continues, overworked staff in crowded hospitals may be forced to compromise infection prevention and control measures that would normally eliminate most bacteria and fungi that could cause infections.
The pandemic is fuelling antimicrobial resistance
Treating COVID-19 is also spurring a massive spike in the unnecessary use of antimicrobials. Since secondary infections were known to be an issue with COVID-19, health care workers have often prescribed antimicrobials to their patients to be on the safe side. The result is that in Asia, for example, 70% of patients were given antimicrobials when fewer than 10% actually had a secondary bacterial or fungal infection.
In some parts of the world, people have been given antivirals normally used against influenza, Ebola or even HIV, despite the lack of any evidence that they work against COVID-19.
After reports last year that hospitals stretched to capacity were not able to follow protocols designed to reduce antimicrobial resistance, such as diagnosing an infection before prescribing antibiotics, the Wellcome Trust launched a study across 11 hospitals to investigate how widespread the breaks from protocols have been, and how much antimicrobial resistance has gone up as a result. That research is ongoing.
Halting vaccination against drug-resistant diseases
The pandemic also halted many immunisation programmes, putting millions of lives at risk from deadly diseases such as measles. As well as making people vulnerable to serious infectious diseases, disruptions to vaccination programmes have delivered a double blow when those vaccines prevent highly drug-resistant diseases.
For example, countries like Zimbabwe and Pakistan have XDR (extremely drug resistant) typhoid that is invulnerable to many antibiotics, and is consequently hard to treat. That means preventing disease with the typhoid conjugate vaccine is critical. The vaccine is an improved version of older typhoid vaccines that are increasingly ineffective against drug-resistant strains, and Zimbabwe’s recent Gavi-supported roll-out of the conjugate vaccine to three million children under-15 was an important step to keep the disease in check. The fact that this campaign was able to happen despite the pandemic was the result of months of hard work by the government and its partners. Similar campaigns must continue worldwide.
And typhoid is just one of many diseases that are increasingly resistant to antimicrobials. Although the pandemic is far from over, returning to a prudent, considered use of antimicrobials is likely to be the only way to preserve the efficacy of the medicines we currently have.