HOW COVID-19 MAY GIVE A SILENT PANDEMIC ITS VOICE
So here we are in May already, the month that celebrates spring, fertility and new life. It sure doesn’t feel very festive.
This year, the May bank holiday in the UK and other European countries has been moved from Monday 4th to Friday 8th May, to coincide with the 75th anniversary of VE day.
Huge celebrations were planned to commemorate the end of the Second World War in towns and villages across the UK, with churches holding special services including a national Ringing Out for Peace, processions down The Mall, traditional maypole and morris dancing and pubs making the most of a three-day weekend.
None of these gatherings will now take place thanks to a different kind of battle: our fight against the coronavirus pandemic.
There will, of course, be virtual events. But as we reflect on a war that changed the course of history, so too will we reflect on the long-lasting impacts of this global health emergency.
As of 5th May, the WHO dashboard shows 3,517,345 cases and a global death count of 243,401. Europe accounts for 45% of total cases. The United States for 33%. The big questions remain unanswered:
When will this be over? What will the world look like after COVID-19?
Could this virus come back?
On the plus side, this crisis has catalysed cross-border collaboration and transparency on an unprecedented scale. The development of rapid diagnostic tests and the quest to find an effective vaccine and cure have united governments, scientific & medical institutions, philanthropic foundations and corporates in a common purpose.
Thanks to their efforts and investment, and global sharing of data and solutions, some processes that would normally take decades have been accelerated to a matter of months or years.
But this is still far from over. And, I hate to say it, but it’s not just COVID-19 we need to worry about. The numbers are still being interrogated but, as with previous viral pandemics, it is not the virus alone that is responsible for all these deaths.
Secondary infections, like pneumonia and sepsis, take advantage of compromised immune systems, particularly in crowded environments like hospitals and care homes. Without effective drugs to treat those infections, the COVID-19 numbers could get one heck of a lot worse.
In an earlier blog, I referred to early reports from China that a significant number of deaths had been linked to secondary infections. Since then, further studies have revealed other microbial opportunists.
In Paris, 33% of COVID-19 patients were infected with aspergillus: a fungus that takes advantage of weakened immune systems, causing breathing difficulties, and which can be extremely drug-resistant. In another French cohort, 20% had bacteria and fungus in their lungs.
Studies during the 2009 SARS pandemic showed secondary bacterial pneumonia was present in 29% to 55% of patients who lost their lives. And now scientists believe the majority of deaths from the Spanish flu back in 1918 were caused not by the virus itself, but by secondary lung infections.
There were no antibiotics back then. Estimates vary widely but it’s believed up to one in five people infected, died.
Many of the antibiotics currently being used in intensive care units or prescribed by doctors in surgeries are already battling against resistant strains, such as the extremely common streptococcus pneumoniae which defeats first-choice antibiotics in some US regions more than half the time.
“The challenge of antibiotic resistance could become an enormous force of additional sickness and death across our health system as the toll of coronavirus pneumonia stretches critical care units beyond their capacity.”
Early studies show that antibiotics are being used at rates ranging from 45% to 100% of COVID-19 patients in hospitals around the world. The use of these drugs on such a vast scale, both as treatment and as prevention, means that drug resistance will escalate further as the bacteria that survive adapt and proliferate.
As Adam Roberts, an expert in antimicrobial resistance says:
“We do not expect healthcare workers to go into hospital situations without the correct protective equipment. Nor should we expect clinics to do their job without the appropriate antibiotics. It is part of our defence for any pandemic situation.”
And for that, we need sufficient supplies of antibiotics that work.
“In the context of Covid-19, antibiotics should be considered as important as protective gowns or facemasks.”
Unfortunately, this is all happening as our antibiotic pipeline continues to stall. As I discussed in another blog, the current market model simply does not work for antibiotic research and development. Consequently, we are facing a serious deficit in investment in new drugs at a time when we need them more than ever and our arsenal is seriously depleted.
And yet we have seen what can happen when countries come together with rescue packages of billions; we have seen the power of collective action to address a global health emergency.
The mortality count for this coronavirus is shocking. But the deaths each year from antibiotic-resistant infections are nearly three times as high and predicted to escalate dramatically if nothing is done. Surely this is the time to add investment in new antibiotics to each nation’s rescue list? To bring what WHO calls ‘the silent pandemic’ out into the open, for all to see and hear?
In the words of science gurus Claas Kirchhelle, Adam Roberts & Andrew C Singer:
“But in this crisis, we can dare to hope; let the global unity of purpose and research that is tackling COVID-19 become a roadmap for solving one of the most pernicious and long-running crises in global medicine—the issue of increasing antibiotic resistance and a stuttering pipeline of solutions.”
I’ll certainly be raising a toast to that this bank holiday.
The Waiting Rooms, my speculative thriller set in the advent and aftermath of an antibiotic crisis, is available as an ebook now. The paperback, out in July, is available for pre-order. A limited edition, signed hardback, exclusive to Goldsboro Books is now also available for pre-order.
