Issue No. 13: Superbug Preparedness Must Begin Now

Last month, President Joe Biden announced an ambitious strategy for protecting the nation “against future and potentially catastrophic biological threats.” His plan includes a range of priorities, from advancing new vaccines, treatments, and diagnostic tools to expanding our capacity to detect and monitor outbreaks.

The Covid-19 pandemic has made clear that confronting infectious disease risk should be a high priority. As the White House plan observes, there have been 11 serious viral outbreaks in the last century, and “There are compelling reasons to expect that the frequency will increase further in the years ahead.”

Any pandemic preparedness plan needs to take into account the ongoing crisis of antimicrobial resistance (AMR). Policymakers need to launch a full-scale attack against this public health threat — as it could be one of the most serious of our time.

Covid-19’s Consequences for AMR

Covid-19 has fueled a spike in secondary infections, with a significant number resistant to antibiotics. In a February report, the Centers for Disease Control warned that Covid-19 can create “a perfect storm” for drug-resistant infection due to a number of factors. These include the lengthy hospital stays that became common during the height of the pandemic, the increase in patients visiting hospitals, increased antibiotic use, and new challenges to implementing infection-prevention efforts.

According to that report, the CDC dealt with 20 outbreaks of antibiotic-resistant pathogens in Covid-19 treatment units between April 2020 and February 2021. For instance, a New Jersey hospital saw an outbreak of 34 cases of carbapenem-resistant Acinetobacter baumannii, and a Florida specialty care unit experienced an outbreak of 39 cases of Candida auris.
Two new academic studies — one from researchers at the CDC, and a second published in the journal Clinical Infectious Diseases — have now added to the concern. Both reports look at data on infections acquired in healthcare settings during the Covid-19 pandemic. In both cases, the authors conclude that the coronavirus crisis corresponded with increased rates of other infections.
The CDC study found significant increases in bloodstream infections associated with central intravenous lines, catheter-associated urinary tract infections, ventilator-associated events, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus (also known as MRSA) across the United States in 2020 as compared with 2019.
These findings offer a vivid reminder of how one public health threat — in this case, Covid-19 — can contribute to a separate emergency — in this case, AMR. Indeed, any event involving mass hospitalizations, and especially high levels of ventilator use, would carry significant risk of secondary drug-resistant infections, thus making AMR a central component to pandemic preparedness. While Covid-19 is a viral public health emergency, the next pandemic could be bacterial or fungal in nature, and the world is woefully unprepared. Any national strategy for pandemic preparedness must include a plan to combat antimicrobial-resistant pathogens.

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