Another pandemic-in-the-making has been slowly manifesting silently in the shadows and may become deadlier in future years if no measures are taken
BY ASSOC PROF DR TAN TOH LEONG
AND ASSOC PROF DR NEOH HUI-MIN
IT IS MORE than one and a half years since the first case of Covid-19 was reported. The disease has since become a global pandemic, disrupting healthcare systems, global supply chains and “normal, daily life” in every continent of the world.
Unknown to many, another pandemic-in-the-making has been slowly manifesting silently in the shadows and may become deadlier in future years to come if no measures are taken to prevent it. This refers to the silent pandemic of antimicrobial resistance (AMR).
On the surface, it may seem that the two pandemics have nothing similar – one is caused by a virus, and the other is by germs (bacteria, virus, fungus and parasites) that are no longer susceptible to medicines designed to kill them.
Fear to seek medical consultation
In fact, during the first few weeks of the Covid-19 pandemic, outpatient clinics reported a decrease in the prescription of antibiotics. This decrease was later identified to be caused by the general public’s fear of seeking medical consultation in the early weeks of the pandemic.
Nevertheless, there was then subsequently an increase in antibiotic prescription across healthcare settings. Prior to the set-up of Covid-19 diagnostics, it could be difficult to differentiate Covid-19 from community-acquired pneumonia clinically.
In addition, there might have been delays in AMR testing as staff were pivoted to Covid-19 diagnostics, or labs experienced shortages in the global supply chain for test materials. Diagnostic uncertainty, coupled with increasing cases of secondary bacterial infection in Covid-19 hospitalisation, increased antimicrobial prescription compared to pre-Covid-19 times.
Even though a direct link between increased antimicrobial usage and an uptick in AMR germ infections have not been made, notably, sporadic outbreaks of AMR Acinetobacter (an environment bacteria) and Candida (a fungus) in Covid-19 units have been reported.
Many patients are self-medicating
Even more alarming, in countries where antibiotics are available as over-the-counter drugs, many patients self-medicate with antibiotics without consulting a healthcare professional. This was done either in the mistaken belief to prevent Covid-19 infection or seek relief for their respiratory illnesses.
While this effect is not immediately visible, these actions, if left unchecked, will lead to precarious episodes of AMR infections in the community in the long run.
Nevertheless, it is not all gloom and doom. Prior to Covid-19, AMR has been identified as an increasing public health threat.
Indeed, in May 2015 the World Health Assembly launched a global action plan to fight AMR. This coincided with an Executive Order from the Obama administration, and the formation of the Review on Antimicrobial Resistance Committee in the UK, all for the same purpose. Activities for these initiatives somewhat took backstage and might seem derailed when Covid-19 struck.
However, as the saying goes, “to not let a crisis go to waste”, there are many things we can learn from Covid-19 to prevent the next pandemic. Governments are now aware that healthcare systems of their countries are of the utmost priority.
Keeping abreast with correct information
This should hopefully lead to ongoing efforts to improve healthcare, and also to view health as interconnected locally and globally. Malaysian Health Minister Khairy Jamaluddin said that “health budgets should be viewed as investments rather than expenditure”. Besides investing to improve our healthcare human resources and facilities, it is equally crucial that budgets for preventing the AMR pandemic, such as research and development for rapid diagnostics of AMR, vaccines and antimicrobial agents’ exploration, periodical germ surveillance, and public education on AMR awareness are created and approved.
And we, as the public, have our responsibility to keep abreast with correct information from validated sources to prevent the next pandemic, and as the theme for this year’s World Antimicrobial Awareness Week states, to “Spread awareness, stop (antimicrobial) resistance”. — The Health
Assoc Prof Dr Tan Toh Leong is Consultant Emergency Physician, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) and Founder and President of Malaysian Sepsis Alliance (MySepsis) while Assoc Prof Dr Neoh Hui-min is Senior Research Fellow, UKM Medical Molecular Biology Institute (UMBI), UKM and Secretary of MySepsis.