AMR Voices: Bacterial co-infections in Covid-19 patients

16 Feb 2021

Guest blog by Dr Abdul Ghafur.

“They are two devils working together. Covid-19 kills patients and AMR helps Covid-19 to kill patients,” these are the words I shared in an interview shortly after I had recovered from Covid-19. I continue to stand by them.

In June 2020, I was admitted to the intensive care unit at the hospital where I work. I had contracted Covid-19. It’s strange to go from frontline medical professional to vulnerable patient, and I won’t ever forget the experience. At the time, I was worried about complications that come with this novel coronavirus – they range from pneumonia to cardiovascular shock and even sepsis. However, I was especially worried about the need to be ventilated if my condition deteriorated and how this increased my risk of getting a hospital-acquired drug-resistant infection.

I have been working in the field of antibiotic resistance for most of my medical career. As a consultant in infectious diseases, I have been campaigning for action on AMR, advising decision-makers in India that a perfect strategy for controlling antibiotics in developing countries like ours may not exist, but that there are many levers of change that we can pull to stem the tide and save lives.

Antibiotic misuse was prevalent in India well before the pandemic was declared.

In 2012, I convened a meeting of the medical societies of India and this resulted in the creation of the Chennai Declaration, a roadmap to action on drug-resistant infections across India. Again, it wasn’t perfect but it was practical. It consisted of a series of recommendations aimed at the national government and state-level policymakers, including measures on the better stewardship of antibiotics and greater public awareness of the issue.

Antibiotic misuse was prevalent in India well before the pandemic was declared. Unfortunately, it continues during these troubling times too. We know that taking antibiotics when they are not needed can change bacteria so much that, ultimately, antibiotics don’t work against them. This is the driver of AMR, or as they are more colloquially known, ‘superbugs’.

Dr. Ghafur is the primary author and coordinator of the “ Chennai Declaration”, a document and initiative to tackle the challenge of antimicrobial resistance from an Indian perspective. He is also a Consultant and Adjunct Associate Professor in infectious diseases and Clinical Microbiology at the Apollo Hospitals, Chennai, India.

An Indian man wearing a dark suit and a white shirt, looks off to the left of the camera

While much is being done to better research and explore the prevalence of bacterial co-infections in Covid-19 patients (and there’s still a lot more to learn), it’s increasingly clear to me drug-resistant infections make the prognosis of Covid-19 cases worse. They are indeed two devils working together. The Covid-19 virus can kill patients and antimicrobial-resistant bacteria help Covid-19 to do it.

Emergent data from the pandemic indicates that patients with mild Covid-19 respiratory infections are being treated with antibiotics even though, as a viral infection, they should not be getting them. Indeed, if you look at the published data from a few countries, it seems that patients don’t need antibiotics in the early stages of the infection but at the later stage.

Overall, 7% of hospitalised Covid-19 patients have had a bacterial co-infection. Yet, when Covid-19 patients have severe pneumonia and develop complicated secondary infections, antibiotics are essential. Without them, lives can be lost.

We owe it to our patients to act on this “slow-moving pandemic” and to turn the tide on AMR.

Before the outbreak of the Covid-19 pandemic, AMR was considered one of the most important health and economic challenges that the healthcare field and the world is facing. Will the experience of this “super virus” finally convince policymakers, politicians, business leaders, and the public to act on superbugs? The clock is ticking. Unlike so many healthcare workers across the world who succumbed to disease exposure and infection, I am one of the lucky ones to have recovered. We owe it to their memory and to our patients to act on this “slow-moving pandemic” and to turn the tide on AMR.

Covid-19 must be a wake-up call to governments to increase their spending on healthcare, improving both the public healthcare system and the infrastructure that supports localised community care. All too often, villages and rural communities are on the sharp end of exposure to the worst of a health crisis, lacking the infrastructure in their communities to manage the spread and to care for those who are sick.

SARS, Ebola, and now Covid-19, are all messages from nature, showing us what happens when we don’t listen to what she is trying to tell us. The good news is that change is possible and that action on AMR today could really transform our future. Just think about how changes in behaviour – increased handwashing, wearing masks, observing social distancing, etc. – have helped to reduce transmission of Covid-19. Equally, think about how the role of rapid testing for the virus has shown us how localised outbreaks can be identified and, in many cases, brought under control.

From improving public understanding and funding innovation to strengthening measures around antibiotic stewardship, the sentiments underpinning these Covid-19 response measures must be brought to bear on AMR. Without them, I’m afraid to say that the devils will continue to have their day. 

AMR VOICES

AMR Voices

Between July and November 2020, the Longitude Prize reached out to contacts around the world to connect with people living with – or who have experienced – drug-resistant infections, to better understand how the Covid-19 pandemic is shaping their lives. The team also spoke to medical professionals, doctors and pharmacists, to capture their perspectives. Combined, the stories shared in this report provide the reader with a first-hand look at how the antimicrobial resistance (AMR) and Covid-19 agendas meet and what people living with resistant infections or have overcome them think needs to be done. We will be sharing this as a series for the next few months. You can find all the stories published thus far here.

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