An unseen threat in the race against the COVID-19 pandemic

ECS member Binod Rayamajhee talks about AMR in the context of the COVID-19 pandemic.

Nearly the entirety of humanity is being threatened by the global pandemic COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). People are losing their life in large number every day. COVID-19 is the most challenging public health crisis of our generation since world war II. Since the first case of SARS-CoV-2 was reported in Wuhan, China in late 2019, the virus has reached all territories around the world except Antarctica. Cases are being reported each day from different countries. Due to the lack of a specific drug for the treatment of COVID-19, management of patients is the toughest job in clinical settings. The global efforts of all concerned stakeholders and researchers are in place to gain victory over this pandemic. Amid the global COVID-19 pandemic, we shouldn’t forget another major issue of our modern medical era - antimicrobial resistance (AMR). Global attention is not as much focused on AMR as on COVID-19. Antibiotics, crucial life-saving medicines that were ‘miracle drugs’ of the 20th century, are now ceasing to be effective for curing pathogens. Microbes (bacteria, parasites, viruses or fungi) that develop antimicrobial resistance (also known as “superbugs”) are creating a global problem with varied resistance rate in every country of the world. If the race of AMR goes in the same speed as it is now then it will be responsible to kill nearly 10 million people annually worldwide by 2050 and a decrease of 2 to 3.5% in gross domestic product (GDP), which would cost the world about 100 trillion US dollars. AMR is slower than COVID-19 but the efficacy of antibiotics is failing every hour and turning back modern medicine. 

The majority of COVID-19 patients are suffering from secondary bacterial infections like pneumonia, fever, cough, diarrhoea among others and because of COVID-19 more immune-compromised patients are being hospitalized where resistant pathogens can circulate widely. Studies have reported that rate of secondary infections has sharply increased among hospitalized COVID-19 patients which has increased the disease severity and duration of hospital stay of patients. More than 50% of COVID-19 patients are dying because of secondary bacterial infections. According to the Centres for Disease Control and Prevention (CDC), bacteria like Streptococcus pneumoniae can worsen the viral infections like the COVID-19 and flu. Bacterial infections have heavily increased the patient mortality in earlier viral pandemics like in the 1918 and 2009 flu pandemic. A viral infection can weaken the immune system of patients which can lead to drug resistant bacterial infections. Published data suggests that more than 90% of COVID-19 patients are receiving antibacterial treatment at some point of infection course. Overuse and widespread use of antibiotics can boost up the resistance rate of pathogens. Not only the overuse of antibiotics intensifies the spread of AMR but also the extensive use of disinfectants and antibacterial soaps accelerate the drug resistant mechanism in microbes. 

However, different studies are underway to better monitor the types and amount of antibiotics being used for the treatment of COVID-19 patients, which is a pressing need to establish a standard protocol for the medication strategy of COVID-19 associated patients. Overuse of antibiotics during a pandemic can cause selective pressure on bacteria to develop resistance against the used antibiotics which will increase the spread and prevalence of drug-resistant infections in our surroundings. 

Bells of caution are ringing louder over the rise in AMR, so researchers are turning to different avenues to attack the pathogens such as phage therapy (Bacteriophages, viruses that infect bacteria), and use of antimicrobial peptides. Effective antibiotic stewardship policy can reduce the spread of bugs in the clinical environment, prescription of antibiotics for treating viral disease must stop completely, awareness among people towards the rational use of antibiotics, prescription of antibiotics delayed until after an antibiotic susceptibility test, and good health hygiene practices in the health care system will help to reduce the burden of AMR globally. Despite all of the medical advancements of recent decades, the entire world remains extremely susceptible to COVID-19 infection where we don’t have an approved drug for the treatment, so we have to learn a big lesson from SARS-CoV-2 pandemic. As per statements of health care experts, disease pandemic is an inevitable phenomenon of our nature which can happen any time at any place, but we can mitigate the risk factors associated with a disease pandemic. The global outbreak of SARS-CoV-2 has shown the real power of invisible pathogens, so all scientific communities should be united globally to enhance and develop the better and effective treatment drugs and diagnostic tools. We can’t assure where and when the next pandemic will occur but its certain that AMR microbes will be there in an even more complex and deadly form. In context of growing gap between superbugs and drugs on hand to treat them, the demand of new antibiotics is a pressing need of today and tomorrow. 

Mr. Binod Rayamajhee1,2 
1PhD Student, School of Optometry and Vision Science (SOVS), Faculty of Science, 
Rupert Myers Building (North Wing), Level 3, Kensington NSW 2033, UNSW, Sydney
2Research Faculty, Department of Infectious Diseases and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal