Andrew Morris is an Infectious Diseases Physician at Sinai Health, University Health Network and the University of Toronto. Gerry Wright is the Scientific Director of the M.G. DeGroote Institute for Infectious Disease Research and the D. Braley Centre for Antibiotic Discovery at McMaster University.
The coronavirus pandemic caught the world by surprise, advancing at a speed and magnitude beyond most people’s initial imaginations. Misinformation about causes and treatments has already led to tragic outcomes. In their desperation, doctors and patients have been using an array of antimicrobial products in a manner that will lead to more harm than good.
U.S. President Donald Trump has now taken centre stage, giving medical advice after first dismissing the virus. Recently, he used his pulpit to recommend wide-scale treatment of COVID-19 with hydroxychloroquine (HCQ) and azithromycin based on a “feeling.” The implications of these recommendations are dangerous. Like any pharmaceutical product, these drugs should not be used without actual medical advice. Now there are reports of overdose deaths of people who have followed his advice and deaths of others who cannot access essential medications for existing conditions.
But it could get worse.
The widespread, inadvertent use of antimicrobial drugs in this pandemic could leave us with another, more dangerous legacy: a dramatic increase in drug-resistant infections.
Drug-resistant infections (often referred to as “superbugs”) emerge through a complex interplay of humans, animals and the environment. Excessive and increased use of antibiotics over several decades has led to a growing list of organisms that no longer respond to treatment. It’s called antimicrobial resistance, or AMR. It costs us $1.4-billion annually and, before this pandemic, it was predicted to cause the loss of 256,000 Canadian lives by 2050.
Today, we are watching the alarming spread of the new coronavirus. With no proven treatment, it marches, unbridled, across the globe. In the same way, drug-resistant bacteria could lead to the frightening spread of bacterial infections that would no longer respond to currently reliable antibiotics.
For example, Canadians may recognize azithromycin – one of the drugs recently highlighted by Mr. Trump – as a common treatment for bacterial pneumonia. There are now reports that it is being stockpiled and arbitrarily prescribed. Misuse of antibiotics like this can lead to AMR, leaving us without options to cure common conditions that are currently treatable.
Because COVID-19 is a viral infection that appears as either a mild cough or cold, a pneumonia or even severe sepsis, most patients will receive antibiotics during their treatment, often unnecessarily. As the documented global burden of coronavirus infections nears one million cases (and counting), the consumption of antibiotics will likely rise proportionately. We can safely predict that this will lead to a rise in antimicrobial resistance, which will affect all aspects of health care long after COVID-19 has left us. If there is no second wave of this drug-resistant virus, there will almost certainly be a second wave of drug-resistant bacteria.
It doesn’t have to be that way.
First, we need to return to the core principles of antibiotic stewardship: Use antimicrobials to treat infection based on science, not emotion, and don’t use antibiotics to treat viral infections.
Second, we need to revisit investment strategies for anti-infective drug discovery and development, not based on current need, but based on an informed view of what we are likely to need in the future. We needed funding for effective coronavirus treatment yesterday, just like we need funding now for effective treatment of other important drug-resistant infections.
In the meantime, we’re assembling a network to help bring AMR into the public discourse. We intend to keep surveillance, public health, and infection prevention and control in Canada’s collective conscience well after this pandemic is over. Because if we don’t, we may just find ourselves in a similar situation not too far down the road.
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