The past few months have perhaps been the longest ones in our lives. We have learnt new things like how to wash our hands properly and have mastered working remotely. However, perhaps the most eye-opening learning so far has been how painfully ill-equipped we are when it comes to tackling emerging diseases.
Covid-19, caused by the novel coronavirus SARS-CoV-2, is not the first pandemic we have faced, and it is not likely to be the last. Microorganisms evolve and mutate to give rise to new strains continually, and some, unfortunately, happen to be more virulent and cause serious, often life-threatening diseases. The ability of the healthcare systems to deal with these emerging strains is dependent on key pillars like testing and rapid diagnosing, effective containment, and ongoing R&D to develop new treatments and vaccines.
In 2002-03, SARS coronavirus, a predecessor of the novel coronavirus, spread across 26 countries and infected over 8,000 people. However, it had a lower fatality rate and since its containment, has rarely re-emerged. Other viruses like Ebola, H1N1 (swine flu), and influenza have reared their deadly heads from time to time, causing casualties, disrupting lives, and overburdening our already stretched healthcare resources.
Race for Survival
Viruses are not the only microorganisms that are evolving into stronger, more dangerous variants. Bacteria, too, in their race for survival, are adapting to changing conditions and developing resistance to the antibiotics that are used to kill them. In fact, antimicrobial resistance (AMR) has been on the rise for a long time and has proven to be as deadly, if not more so, as novel virus strains.
In 2014, it was estimated that nearly 7,00,000 people die due to AMR each year across the world. In comparison, Covid-19 has caused 3,83,600 mortalities as of early June. While these statistics are frightening enough individually, the World Health Organization in its virtual public address on June 1 warned that the coronavirus pandemic is adding to the already high AMR burden.
WHO Director-General Tedros Adhanom Ghebreyesus stated that the consumption of antibiotics has increased during the pandemic, which could lead to higher resistance rates in bacteria and render existing antibiotics useless over the coming years and make it difficult to tackle treatable diseases and infections. This increased rate of antibiotic consumption can be attributed to lack of awareness about the appropriate use of these medicines and fear in the community, given the present crisis.
Some other studies have also shown convergence between the two statistics. A Lancet study on the ‘Clinical course and risk factors for mortality of adult inpatients with Covid-19 in Wuhan, China’ showed that nearly 1 in 7 patients who were hospitalised with Covid-19 and half of those who died of it had acquired secondary bacterial infections. Hospitals are one of the most common hotspots for the spread of antimicrobial resistant bacteria, and patients with suppressed immune response, such as those battling viral illnesses like Covid-19 are particularly susceptible to infection.
This further lengthens hospital stays, increases costs, complicates treatment and reduces the patients’ chances of survival. For patients with compromised immune systems, even an otherwise non-lethal bacterial infection, should it fail to respond to available antibiotics, may be the difference between life and death.
Despite the overwhelming toll that AMR takes on global healthcare systems, response by governments and experts has been slow. One of the reasons for this has been that AMR is not a disease unto itself but instead, is an umbrella term for resistant types of a vast variety of bacteria. An infection caused by a multi-drug resistant version of tuberculosis, for instance, will be registered as a case of tuberculosis, and not AMR, which makes both identifying and tracking cases a difficult task.
On the other hand, scientists and the medical community understand AMR better, and there exist avenues to slow down development of resistant bacteria, if not treat the ones that already exist. For instance, reducing use and misuse of antibiotics in humans and animals, and eliminating antibiotic pollutants from pharmaceutical manufacturing units and healthcare facilities will go a long way in bringing down the AMR burden. Similarly, instituting safe disposal mechanisms for expired and unused antibiotics will help ensure that the active pharmaceutical ingredients do not find their way into the environment, creating hotspots for resistant microbes to grow.
Much like Covid-19, resistant bacteria can and have spread across the world, taking countless lives. However, while vaccines have managed to eliminate a number of viruses, and a vaccine for the SARS-CoV-2 is expected to be a year or two away, AMR is here to stay.
Microorganisms of all kinds including bacterial, fungal, and even parasites – will continue to outgrow and outsmart available medicines, leaving health researchers and pharmaceutical R&D companies forever chasing after more potent treatment options, unless we can slow the advancement of AMR just as effectively as we spur our R&D to develop new drugs and vaccines. So far, the pipeline for new antibiotics remains empty, with very few drugs in advanced stages of testing. Unless the scenario changes drastically in the coming years, prevention may be the only viable option.
The present crisis has made it unquestionably clear that our healthcare systems are crucial to our existence and well-being. Phrases like “flattening the curve”, which would have been foreign to us a few weeks ago, now spark urgency in our hearts. As we pray for better days, our focus should remain on prevention, even as efforts are made to strengthen healthcare systems for the future. While we may be two steps behind on combatting both Covid-19 and AMR, slowing their spread, fast-tracking development of treatment options and instituting effective surveillance for both existing and emerging diseases will likely make it a winnable battle.
(The author is a public policy consultant)
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