Issue No. 10: What the experts are saying on AMR

Even as the world grapples with Covid-19, another infectious disease threat — one fueled by drug-resistant microbes like bacteria and fungi — looms on the horizon. The Biden administration has a unique opportunity to prepare for this health challenge now, before it becomes a full-blown crisis. 

Many policy experts, scientists, and doctors have already discussed the root causes of antimicrobial resistance — and laid out policy proposals that could help solve the problem.

Worrying trends demand a strong AMR response

According to the latest evidence, the trends driving the antimicrobial resistance (AMR) crisis have only accelerated in recent years. For instance, the overuse of antibiotics remains rampant. With every dose of an antibiotic administered, some bacteria are killed, but others survive. As these remaining pathogens evolve and multiply, antimicrobials grow less effective.

As a new report from The Center for Disease Dynamics, Economics & Policy (CDDEP) makes clear, antibiotic use is on the rise around the world, particularly in low- and middle-income countries. Consider those antibiotics falling into the World Health Organization’s “Watch” category. These are agents that should be administered only in very specific instances. Yet their use increased by 90 percent between 2000 and 2015. In low- and middle-income countries, it rose by 165 percent, the CDDEP report finds.

Covid-19 fuels the use of antibiotics 

Unsurprisingly, drug-resistant bacterial infections pose a unique risk to Covid-19 patients. An analysis of 4,267 patients hospitalized with Covid-19 in New York City found that, for those who contracted a secondary fungal or bacterial infection, 74 percent were intubated and 57 percent died.

Data is still sparse, so the link between secondary infections and death is not clear. But a new review in Science indicates a strong correlation between Covid-19 and death from a common fungal infection. While usually harmless in people with healthy immune systems, the fungus Aspergillus attacks Covid-19 patients. A recent study found that a quarter of critically-ill German patients also had the fungal infection. Another small study found that half of 186 patients with Covid-19 and Aspergillus died. 

More worrying still is the alarming rate at which antimicrobials have been used since the emergence of Covid-19. A new study by the Pew Charitable Trusts finds that antibiotics may have been vastly overprescribed to Covid-19 patients in the early days of the pandemic. 

Between February and July 2020, 52 percent of patients admitted to a hospital with Covid-19 were prescribed at least one antibiotic, even though only 20 percent of those patients were diagnosed with bacterial pneumonia.

In a sad irony, the pandemic contributed to antimicrobial overuse, thus hastening the evolution of lethal bacteria and fungi that pose such a threat to Covid-19 patients.

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