As health-care systems around the world fight to contain Covid-19, they may be inadvertently opening the door wider to another killer that is just as dangerous.
I’m talking about the spread of pathogens that are resistant to treatment, such as antibiotic-resistant bacteria. The death toll from Covid is staggering, but so is that from antibiotic resistance: Nasty superbugs such as Clostridium difficile, or C. diff, currently kill some 700,000 people globally each year — that’s twice the number of Americans who died of Covid last year. Left unchecked, antibiotic resistance may kill up to 10 million more people yearly and cumulatively cost patients and health systems up to $100 trillion by the year 2050.
Most patients presenting with symptoms related to Covid-19 are receiving antibiotics for additional infections, such as bacterial pneumonia. While this may save some lives, data show that antibiotics are being rampantly overused during the pandemic. What’s more, health-care workers who have to reuse gowns, gloves and other kinds of personal protective equipment (PPE) due to ongoing shortages risk spreading resistant bacteria between patients.
This trend is scary — but presents an opportunity to address these twin issues in tandem.
The increase in unnecessary use of antibiotics during Covid is not a theoretical concern: A study published last August in Clinical Infectious Diseases found that of some 1,700 hospital patients in Michigan, more than half on average received early antibiotic treatment. Yet only 3.5 percent arrived at the hospital with bacterial infections. In May, a review of studies from the US and Asia reported that 72 percent of patients diagnosed with Covid-19 (1450 of 2010) were given antimicrobials. In the papers where researchers reported whether or not patients actually had other infections, only 8 percent (62 of 806) of people with Covid were also diagnosed with bacterial or fungal infections.
Data show that antibiotics are being rampantly overused during the pandemic.
All this stands to be exacerbated by the concerning fact that, more than one year after Covid-19 emerged, health workers still don’t have enough PPE. A survey last summer from the American Nurses Association found that 68 percent of nurses had been required to reuse PPE due to a shortage of supplies. That could very well increase the risk that health practitioners will inadvertently spread resistant pathogens, especially if there are also errors in following the recommended PPE removal steps: A 2019 study found that about 30 percent of providers who cared for infected patients had traces of these deadly bugs on their PPE.
Even if providers have plenty of gear, the PPE itself can pose risks: Recently, researchers in England found that when providers wore long-sleeved gowns, per Covid protocols, surfaces in patient areas were more likely to be contaminated with potentially deadly bacteria.
Not surprisingly, reports of problems from the field have been coming in. As early as May, after two months of PPE shortages, a hospital in New Jersey reported that 34 patients were infected with Acinetobacter baumannii, a pathogen resistant to the antibiotic carbapenem that usually caused two or fewer cases per month. Once Covid caseloads dropped, lessening the impact of supply shortages, the bacterial infection rates returned to baseline. During a two-week period in August, half of Covid patients in one Florida hospital tested positive for a drug-resistant strain of yeast ( Candida auris); after providers made changes to PPE protocols and boosted cleaning practices, no further cases were reported.