CORONAVIRUS AND “THE SILENT PANDEMIC”
COVID-19 is bothering me a lot, right now. It’s not just the fact that we are teetering on the edge of a worldwide pandemic, with case numbers exceeding 90,000, deaths escalating above 3000, and WHO moving the global threat level to “very high” for both spread and impact.
Or that, according to the OECD, coronavirus will present the global economy with its greatest danger since the 2008 financial crisis.
It’s also the realisation that an alarming number of scenes from a speculative thriller I finished writing several months ago appear to be coming true.
Obsessive handwashing and hygiene; masks worn in public places. Handshaking being a thing of the past. Emergency hospitals and quarantine. Restrictions on travel and large gatherings. Stockpiling. Isolation of the elderly, as ‘social distancing’ and ageism take hold. Political scapegoating by the far right.
My novel, The Waiting Rooms, isn’t about a viral pandemic. It dramatises what Mariangela Simao from the World Health Organisation calls “the silent pandemic”, because it spreads largely unnoticed: antimicrobial resistance. Whilst my book is set in a fictional world, in the advent and aftermath of an antibiotic crisis, the links between these real public health emergencies are unsettling.
Let’s look at some numbers. Deaths from COVID-19, as of 3rd March are 3,110. The lowest global death rate estimated was about 1% of cases, which doesn’t sound much, but is actually ten times the rate of seasonal flu. And WHO just updated their global mortality estimate to 3.4%.
Deaths from flu vary widely each year depending on the influenza strain, but global numbers, according to WHO, range from 290,000 to 650,000.
We don’t know the exact number of deaths from antibiotic-resistant infections, because they are not consistently reported, but WHO estimates there are at least 700,000 deaths each year. “At least” suggests it is a conservative projection. Resistant strains of tuberculosis alone account for almost a quarter of a million fatalities.
So why isn’t antibiotic resistance making the headlines?
The truth is, sometimes it does. And the fact that people are more concerned about COVID-19 than the flu or antibiotic resistance is no surprise. This coronavirus is new and spreads fast, it has no vaccine or cure. There are still a lot of unknowns.
Flu is an annual event; we’ve become accustomed to it even though its numbers dwarf COVID-19. And antimicrobial resistance? Well, it has many faces, depending on which resistant infection presents: TB, MRSA, C-Diff, pneumonia: take your pick. So it slips under the radar.
Which is why WHO have dubbed it “the silent pandemic”.
So how does all this relate to COVID-19?
A World Bank report called Pandemics: Risks, Impacts, Mitigation says antibiotic resistance is a threat that "could amplify mortality during pandemics of bacterial diseases such as tuberculosis and cholera and even viral diseases, especially for influenza, in which a significant proportion of deaths is often the result of bacterial pneumonia coinfections."
These coinfections are developing with the current coronavirus. Most of the people who have died either had pre-existing conditions, like autoimmune diseases, or they developed secondary infections, such as severe pneumonia. These secondary infections can become much more prevalent once our immune systems are busy fighting a virus. As virologist Christine Tait-Burkard of the University of Edinburgh says: “That’s why the important thing is to treat people for comorbidities and give them antibiotics to stop bacterial infections taking hold.”
But what if there aren’t any effective antibiotics to stop them taking hold?
The Center for Disease Dynamics, Economics and Policy reported last year that, in the event of a significant influenza pandemic, secondary infections caused by prevalent pan-drug resistant bacteria could be catastrophic. But their report doesn’t seem to be having much impact on America’s farming methods, which still use vast quantities of antibiotics. 80% of antibiotics in the US are used on animals.
The uncomfortable fact is that antimicrobial resistance will increase both the frequency and the severity of pandemics.
So where do we go from here?
The good news about coronavirus (and there is, at least, some good news) is that many of the precautionary measures being adopted, such as washing our hands and good hygiene in the home and workplace, will help in the battle against antibiotic resistance, too.
But here’s the thing: even on handwashing, people are still confused. Shops have been running out of antibacterial hand gel as people rush out to stockpile it, despite the fact it is totally ineffective against COVID-19 because coronavirus is, guess what? A virus. Not a bacterial strain. A distinction which still appears to be largely misunderstood.
Such behaviour is underpinned by research that shows two out of three Europeans are unaware that antibiotics are ineffective against viruses. When it comes to educating people about the appropriate use of antibiotics as a precious resource, we still have a long way to go.
So please, stick to the alcohol-based gels and good old-fashioned soap! And keep washing those hands, even when all this is hopefully over.
I’ve seen enough scenes from The Waiting Rooms become our new reality. I don’t want to see any more.