The COVID-19 Outbreak Warns Us About the Impending Effects of Antimicrobial Resistance

One of the ongoing secondary effects of the novel coronavirus is a decrease in hospital admissions of non-COVID patients. Due to fear of exposure to the coronavirus, Americans with pre-existing conditions are not visiting the hospital, even for health issues that may warrant a trip to the emergency room. As we learn more about the novel coronavirus, these fears continue to diminish, but this pandemic is just a glimpse of what will occur when antibiotics are no longer effective against common infections that healthcare providers currently consider nonlife-threatening and treatable. Just as there is currently no cure for COVID-19, there isn’t an easy cure to bacterial infections without antibiotics. While viruses and bacteria are very different in their biological composition, they are not very different in the detrimental consequences they can have on our economy, health, and social interactions.

Since the discovery of penicillin, antibiotics have been essential to healthcare for everything from preventing infection during surgical procedures to treating urinary tract infections, strep throat, and staph infections. However, the surge in popularity of antibiotics has been accompanied by alarming rates of antibiotic resistance. Last year, the Center for Disease Control reported over 2.8 million cases of antibiotic-resistant infections in the U.S. alone, which resulted in over 35,000 deaths. Many of these resistant infections are hospital-acquired infections, and prior to COVID-19, patients often neglected the risk of such infections when deciding whether to visit the hospital. However, COVID-19 has reintroduced this fear of hospital-acquired diseases, and a similar fear will arise over time as antibiotics become less effective against hospital-acquired bacterial infections.

Similar to COVID-19, antibiotic-resistant infections disproportionately affect immuno-compromised individuals. We have seen how this pandemic has destroyed millions of jobs and taken hundreds of thousands of lives, but even common illnesses could become just as dangerous. When left untreated, strep throat in young children can result in life-threatening complications, such as rheumatic fever and heart damage. This is just one example of the many diseases that we perceive as simple and treatable today that could become far more deadly in a post-antibiotic world. COVID-19 is a single virus, and on its own it has turned the world upside down for the past seven months. Antibiotic resistance opens the door to far more death than we have seen from COVID-19 with a host of bacterial infections becoming more threatening to human health. Wound infections, throat infections, and several sexually transmitted diseases would become untreatable without effective antibiotics. Childbirth would become far more dangerous. Furthermore, as more antibiotic-resistant bacterial infections show up and spread, treating the infections becomes more expensive. As COVID-19 has shown us, everyone will experience the social, economic, or medical consequences of a healthcare crisis.

It’s easy to see antibiotic resistance as a problem for the future. However, that was our attitude toward a pandemic like COVID-19 not long ago, and as a global health community, we all faced the consequences of our poor preparation as we panicked and rushed to acquire ventilators in March. There is no question that antibiotic resistance is a growing problem. It’s not just a distant problem decades away. Resistant infections like MRSA, one of the most rampant hospital-acquired infections, show that antibiotic resistance is a very real problem today. Luckily, thus far we have been able to research new antibiotics to use when older, overused ones become ineffective. We have last-line antibiotics that are rarely used and heavily regulated as a last resort. However, we have to consider and prepare for a world in which these new antibiotics are deemed entirely ineffective. 

COVID-19 mandates have encouraged everyone to “do their part” by wearing a mask and social distancing. Similarly, we can do our part to prevent antibiotic resistance by taking precautions now. For example, the CDC reports that at least 30% of antibiotics prescribed are not required for treatment. The same clinicians who are promoting masks and hygiene to prevent the spread of COVID-19 should be practicing better antibiotic stewardship. As the providers signing the prescriptions, it is their responsibility to provide the best healthcare possible. Handing out antibiotics to every patient with a sore throat is careless and irresponsible. We have diagnostic testing to determine not just if the patient has a bacterial infection, but what type of bacteria it is. However, some of these diagnostics can take days to get results. The novelty of COVID-19 has shown the panic that arises with testing supply shortages and inaccurate tests. Now is the time to invest resources into designing effective and accurate rapid diagnostics to determine the most appropriate antibiotic for physicians to prescribe for bacterial infections. Having accurate rapid diagnostics will empower the physicians to confidently and responsibly prescribe appropriate treatments. There’s no excuse for practicing medicine that is not based on data and the best practices for public health. 

The effects of the COVID-19 pandemic on Americans’ lifestyles are vast. Social distancing, wearing masks, and limiting capacities indoors are just a few of the guidelines that have been in place to “slow the spread.” As a consequence of these restrictions, American healthcare has changed. Throughout the COVID-19 pandemic, many women have gone to prenatal appointments without their husbands, and some have even given birth alone. Weddings have been postponed. Funerals have limited attendance. Restaurants, if they are open, have limited seating. Large, revenue-generating festivals like Austin City Limits have been cancelled. With Thanksgiving just a few weeks away, we can expect the holidays will be different as well. As we enter this holiday season, it’s important to consider the effort we should put into preventing the fear that has kept us far apart. If we continue to recklessly overprescribe antibiotics, these unpopular social distancing measures could return if resistant bacterial infections became a widespread reality.

Life has been put on hold for COVID-19. It continues to impact us socially and economically. Unless we want to relive the horrors of 2020, we need to re-evaluate the clinical standards in place and reduce the overprescription of medications contributing to the growth of antibiotic resistance. It may not seem like an immediate problem, but after this year, we are all familiar with what happens when we are not prepared for an outbreak. Furthermore, the impending inefficacy of antibiotics reminds us that it is vital to learn from our COVID-19 response. We need to realize that being proactive and self-aware in healthcare is crucial. Antibiotic stewardship is an easy way to delay antibiotic resistance. Public health isn’t just a matter of curing existing diseases but considering how to avoid these outbreaks in the first place. We must predict, plan, and act now against foreseeable threats. When we develop an effective vaccination and treatment for COVID-19, and we finally return to normal, we should be careful to not dismiss the pandemic as a one-time event. We ought to consider other ways that diseases can infiltrate our societies and prepare to address them. Antibiotic resistance is not a question of “if,” but rather of “when,” and thanks to COVID-19, we know what a world of untreatable disease looks like. Now we need to prevent and prepare for it in the future.

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