Desperation Towards COVID-19 may Lead to AMR Pandemic
The current pandemic will be remembered as a momentous event in the history of humankind. However, among the emerging infectious diseases, AMR will persist over and above the COVID-19 pandemic.
World is in the middle of a pandemic caused by SARS-COV-2 virus (COVID-19) which is a significant global health crisis after Spanish influenza in the beginning of 20th century. Progressive drastic steps are being enforced to minimize the transmission of the disease. In recent years, antimicrobial resistance (AMR) has been referred to as one of the potential perils to the global economy and health. However, it is now veiled under the present pandemic. AMR can be defined as an increasing resistance of microbes to frontline lifesaving antibiotics that undermines the ability to treat common and serious infectious diseases. AMR to available frontline antibiotics may prove fatal and life threatening to bacterial infections during routine procedures like elective surgery, C-sections. Nevertheless, the global outbreak of COVID-19 also offers some important ramifications for developing antimicrobial drug resistance. This article aims to highlight the impact of management and mismanagement of COVID-19 crisis on the antimicrobial drug resistance in the hospital settings, community, and environment.
Evidence reports that as the COVID-19 pandemic moves across the world it may drag with itself a new slow-motion killer pandemic (AMR) which is already a crisis and is estimated to kill approximately 700,000 people annually.
Evidence reports that as the COVID-19 pandemic moves across the world it may drag with itself a new slow-motion killer pandemic (AMR) which is already a crisis and is estimated to kill approximately 700,000 people annually. Assuming that the given is accurate, a rough comparison evaluates that death rates for COVID-19 will stay fixed for the remaining year, however, AMR will kill over 130,000 people this year alone. Moreover, AMR deaths are expected to rise by 10 million every year by 2050, whereas COVID-19 may hopefully be controlled in a much briefer period. Eventually, COVID-19 would be an important comparison for defining the development of AMR and illustrating the challenges to contain it once it has evolved. Unfortunately, a widespread misconception seen among the common masses is that antibiotics like azithromycin, amoxicillin, amoxiclav etc., are effective in treating COVID-19. Additionally, suspected self-isolating COVID-19 cases and confirmed asymptomatic ones are reported to use antibiotics. Therefore, it is pertinent to create greater awareness among the public about the consequences of overuse and misuse of antibiotics. The reasonable understanding of appropriate usage of antibiotics would be instrumental in preventing the occurrence of AMR.
Another important issue is the secondary bacterial infections among COVID-19 patients. Until now 1-10% of cases have been recorded to obtain secondary infections. However, regardless of the proportionally low recognition of secondary infections, relatively more usage of antibiotics has been recorded during the treatment of COVID-19 patients. This is being practiced even after the World Health Organization recommended contrary to the consumption of antibiotics for COVID-19 treatment. Instead, great discretion is needed for the fact that improper use or abuse of antibiotics is recognized to be a potential operator for the occurrence of AMR. This is the reason that a significant approach on AMR focusses around minimizing the inappropriate utilization of antibiotics by clinicians. Many countries which have relatively made advancement in this field, may easily confront reduced AMR secondary bacterial infections compared to the nations which have achieved little or no success in minimizing the antibiotic consumption. The antibiotics by clinicians should be considered very critically and carefully, as frequent prescription of antibiotics makes the public believe that all antibiotics are effective for the treatment of viral infections in general and SARS-COV-2 in particular.
Ultimately, these microbicidal products are found in most of the disinfectants and surface cleaners that may also lead to development of AMR, because increased concentrations of biocides usually find their way into waste-water treatments plants and other water bodies.
Beyond the clinic almost all the nations are exercising measures intended at reducing the spread of COVID-19 that vary from physical distancing to complete lock-down. However, the constant instructions from the beginning has been regular hand washing with soaps and/or the use of sanitizers. Nevertheless, the use of disinfectants and antimicrobial soaps has exponentially increased over the period of this pandemic and is likely to continue. Undoubtedly such practices may help in combating the spread of virus, however it has an adverse effect that could emerge from increased usage of products that are mainly microbicidal. Ultimately, these microbicidal products are found in most of the disinfectants and surface cleaners that may also lead to development of AMR, because increased concentrations of biocides usually find their way into waste-water treatments plants and other water bodies. Most importantly if the concentration of biocide is very high, possibly the maximum inhibition of bacteria will take place, however, if the concentration increases but does not reach the minimum inhibitory concentration required for varying microbial flora, this would in turn offer an opportunity to the emergence of AMR. Moreover, preventive treatment for bacterial secondary infection among COVID-19 patients may also lead to elevated levels of antibiotics in the water bodies and the receiving environments may result in the evolution of AMR.
The health management system throughout the globe is under immense burden, heading towards several modifications in clinical practice that may lead to an impact on AMR. Regarding the COVID-19 management in health care settings, most of the world governments have recommended some measures for the prevention and control of infection through droplets, aerosols and direct contact with potentially contaminated surfaces. These strategies like extra vigilance of hygiene, sterilization techniques may lower down the circulation of AMR bacteria within clinical settings. However, it would be of paramount importance to collect the data on the prevalence of prior and post AMR infections during the current pandemic, to evaluate and contain the AMR menace at local and thereby at global level. Clinicians and researchers need to work hand in hand for the study and comparison of whole genome sequences of clinical pathogens before, during and after the COVID-19 pandemic which is one of the promising techniques to interpret the changes in the transition of AMR mechanisms.
Undoubtedly, AMR presents a lesser immediate impact on everyday life, though it has potentially greater and far reaching adverse effects on humankind. Therefore, management strategies to reduce the emergence of AMR should be investigated and implemented at local and global level.
The current pandemic will be remembered as a momentous event in the history of humankind. However, among the emerging infectious diseases, AMR will persist over and above the COVID-19 pandemic. Likewise, the current and other pandemics, AMR too is a problem that knows no borders and is considered a more intriguing problem. Undoubtedly, AMR presents a lesser immediate impact on everyday life, though it has potentially greater and far reaching adverse effects on humankind. Therefore, management strategies to reduce the emergence of AMR should be investigated and implemented at local and global level.
Concluding remarks: Apart from the current pandemic, the clinicians in Kashmir have been heavily prescribing antibiotics even for the common cold where they are least or not effective at all. Furthermore, other factors which are considered as a criminal offence in other parts of the world, for example, over the counter usage of antibiotics and their prophylactic consumption, are a normal practice in this part of the world. This abuse of antibiotics is an additional challenge that needs action from policy makers at state and national institutional level.
Dr Suriya Rehman is an Asst Prof in the Department of Epidemic Disease Research at Imam Abdulrahman Bin Faisal University. She can be reached at firstname.lastname@example.org
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