Antimicrobial resistance (AMR) has been declared one of the top 10 global public health threats to humanity, and it didn’t disappear once the COVID-19 pandemic appeared. Instead, it’s gotten worse, as infection control measures and hand hygiene using antimicrobial gels have become ubiquitous.
AMR causes about 700,000 deaths globally every year, but researchers estimated in mid-2020 that an additional 130,000 AMR deaths would occur in 2020 due to the COVID-19 pandemic. The number of AMR deaths will likely surpass the number of COVID-19 deaths by at least threefold — annually — by 2050, with some estimates suggesting AMR deaths may reach as high as 10 million deaths per year.
Antibiotics Given to COVID-19 Patients ‘Just in Case’
Now remember that COVID-19 is caused by the SARS-CoV-2 virus, which means antibiotics are useless against it. Despite this, antibiotics have been used prophylactically throughout the pandemic for COVID-19 patients, typically using the logic that it could prevent bacterial co-infections.However, the rate of secondary bacterial co-infections has generally been low, while the use of antibiotics has remained high. This isn’t a case of antibiotics being used strategically for patients who develop bacterial infections, but rather using them “just in case.” In a study of 38 Michigan hospitals, 56.6% of patients with COVID-19 were given antibiotics early in their stay, but only 3.5% of them turned out to have a bacterial infection.
“For every patient who eventually tested positive for both SARS-Cov2 and a co-occurring bacterial infection that was present on their arrival, 20 other patients received antibiotics but turned out not to need them,” Dr. Valerie Vaughn, the study’s lead author, said. Other studies have revealed similar signs of rampant antibiotic overuse.
Antibiotics Considered ‘Routine’ Part of COVID-19 Treatment
Despite decades of efforts to reduce the unnecessary use of antibiotics, one of the largest studies of antibiotic use in hospitalized COVID-19 patients revealed that such drugs are being used indiscriminately and inappropriately for COVID-19. More than half (52%) of the approximately 5,000 patients included in the study received antibiotics, and in 36% of cases, more than one antibiotic was given.“It is noteworthy to be highlighted that the inappropriate use of antibiotics could considerably and silently lead to AMR development during this global outbreak. Unfortunately, recent studies reveal that, in several countries, common and extensive use of antibiotic treatment for COVID-19 hospitalized patients is considered as a part of the routine treatment package.”Even the World Health Organization made it clear that countries were at risk of the accelerated spread of AMR due to the COVID-19 pandemic. They cited data showing antibiotic use increased throughout the pandemic. About 79% to 96% of people who reported taking antibiotics didn’t have COVID-19 but were taking them in the hopes of preventing infection, even though antibiotics don’t work against viral infections.
Antimicrobial Overuse Could Damage Immunity
Antibiotics can cause a number of serious adverse effects, a little-known one being damage to your mitochondria, which are genetically closely linked to bacteria. Your mitochondria are responsible for most of your cellular energy production and also play a role in antibacterial and antiviral immune responses — and they’re an off-site target of certain antibiotics, which are known to inhibit mitochondrial activity, DNA synthesis and biogenesis.“ … mitochondria are vulnerable to antibacterial treatments, interrupting their physiology. Inhibition of these processes by antibiotics might render the immune system less capable of fighting acute COVID-19 viral infections.”
Gut Microbiome Influences Immune Response to COVID
Antibiotics disturb your gut microbiome, which has far-reaching effects on your overall health, including your immune system’s ability to fight COVID-19 — marking yet another way that indiscriminate antibiotics usage is counterproductive.When researchers with The Chinese University of Hong Kong analyzed gut microbiome compositions from 100 patients with COVID-19, they found gut commensals known to modulate the immune system were low compared to people without the infection. The makeup of patients’ gut bacteria — including both the volume and variety — affected the severity of COVID-19 infection as well as the immune response.
“In light of reports that a subset of recovered patients with COVID-19 experience persistent symptoms such as fatigue, dyspnea and joint pains, some over 80 days after initial onset of symptoms, we posit that the dysbiotic gut microbiome could contribute to immune-related health problems post-COVID-19.”In the study, 50% to 75% of patients received antibiotics, while less than 7% had bacterial infections. While the researchers found no difference in outcomes with or without antibiotics, the drugs were not linked to improved patient outcome and, they noted, “it is still possible that a higher prevalence of antibiotic administration in severe and critical patients could worsen inflammation.”
Isolation Disturbs Your Immune Response
Of all the negative effects of social isolation endured during the pandemic, those experienced by your immune system may be the last that come to mind, despite being among the most significant for your future health. What does staying home have to do with your immune system?It alters your 24-hour light/dark cycle, on which your body is built to respond. With more time spent indoors, you have less sunlight exposure and less opportunity to produce vitamin D, which activates macrophages in your lungs that act as a first line defense against respiratory infections, among other immune activities.
It’s true that taking vitamin D supplements can somewhat compensate for this, provided your levels are optimized, but other ill effects of lockdown are less easily remedied. Take exercise, another crucial component of a well-oiled immune response, that can reduce stress levels and diseases like heart disease and Type 2 diabetes, which are linked to worsened outcomes from COVID-19.
But even beyond that, staying indoors means you lose out on regular exposures to the natural world, which come with their own set of immune benefits. Trees release phytoncides, which people inhale and are known to alter natural killer cells. This is why, in Japan, shinrin-yoku, or forest bathing, is said to enhance immune function — but it’s difficult to spend much time immersed in the forest if you’re locked down at home.
The other factor that cannot be ignored is the lack of exposure to everyday dirt and germs that is missed when people stay home, socially distanced and sanitized. “Our immune system needs a job,” Dr. Meg Lemon, a Denver dermatologist, told The New York Times. “We evolved over millions of years to have our immune systems under constant assault. Now they don’t have anything to do.”
What is perhaps most disturbing is that this comment was made in March 2019 — prior to the pandemic. Now, it’s exponentially worse, and your immune system is likely missing out on interactions with bacteria and other microorganisms that teach it, train it how to respond and keep it primed throughout your life.
Without proper “training” at regular intervals, your immune system can overreact when triggered by ordinarily harmless substances, leading to allergies and inflammation. Might a generation of children, kept isolated and masked, have immune repercussions when exposed to ordinarily routine childhood viruses post-pandemic?
New Antibiotics Are Unlikely to Save Us
There are 43 antibiotics in clinical development, but none of them shows much promise for solving rapidly rising AMR, as innovation is stagnant — most “new” antibiotics brought to the market are variations of drug classes that have been around since the 1980s. Further, according to WHO’s annual Antibacterial Pipeline Report, antibiotics currently in development are insufficient to tackle AMR:“The 2020 report reveals a near static pipeline with only few antibiotics being approved by regulatory agencies in recent years. Most of these agents in development offer limited clinical benefit over existing treatments, with 82% of the recently approved antibiotics being derivatives of existing antibiotic classes with well-established drug-resistance. Therefore, rapid emergence of drug-resistance to these new agents is expected.”Also at issue, hospital reimbursement systems discourage the use of expensive new antibiotics, because they are only reimbursed up to a point. This means patients may be given older drugs that won’t work as well to protect the hospital from financial losses.
Legislation to reform this — the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act — has been introduced to help open up the use of new targeted antibiotics for superbug infections. Preserving the efficacy of existing antibiotics is also important, and agricultural antibiotics overuse cannot be ignored in this equation.
Worldwide, most antibiotics are used not for human illness or companion pets, but for livestock. Writing in the International Journal of Antimicrobial Agents, researchers stated, “the ongoing pandemic is stretching the limits of optimal antibiotic stewardship” and called for an end to unnecessary use of antimicrobial agents.
So, be sure you always avoid antibiotics unless they are absolutely necessary. Additionally, choosing organic foods, including grass fed meats and dairy products, can help you avoid exposure to antibiotic residues in the food supply, while also supporting food growers who are not contributing to AMR.
Resources:
- WHO, Antimicrobial Resistance
- Front Microbiol. 2020; 11: 1020. Public Awareness
- NewStatesman June 2, 2021
- Front Microbiol. 2020; 11: 1020
- CDC, Core Elements of Hospital Antibiotic Stewardship Programs
- Front. Microbiol., 15 December 2020
- University of Michigan Health Lab August 27, 2020
- Clinical Infectious Diseases, Volume 72, Issue 10, 15 May 2021, Pages e533–e541, https://doi.org/10.1093/cid/ciaa1239
- University of Michigan Health Lab August 27, 2020
- The Lancet February 15-21 2020, Volume 395, Issue 10223, Pages 507-513
- Front. Microbiol., 15 December 2020. Antimicrobial resistance/antibiotics
- The Pew Charitable Trusts March 2021
- Front Microbiol. 2020; 11: 1020
- World Health Organization November 18, 2020
- Preprints.org April 16, 2020
- Preprints.org April 16, 2020
- Front Microbiol. 2020; 11: 1020
- Preprints.org April 16, 2020
- Front. Microbiol., 15 December 2020
- Front Microbiol. 2020; 11: 1020
- Front Microbiol. 2020; 11: 1020
- Journal of Antimicrobial Chemotherapy, Volume 75, Issue 11, November 2020, Pages 3411–3412, https://doi.org/10.1093/jac/dkaa338
- Journal of Antimicrobial Chemotherapy, Volume 75, Issue 11, November 2020, Pages 3411–3412, https://doi.org/10.1093/jac/dkaa338
- Gut 2021;70:698-706
- BMJ November 1, 2021
- Gut 2021;70:698-706
- Gut 2021;70:698-706
- BBC May 21, 2020
- Environ Health Prev Med. 2010 Jan; 15(1): 9–17
- Environ Health Prev Med. 2010 Jan; 15(1): 9–17
- The New York Times March 12, 2019
- The Guardian June 9, 2021
- World Health Organization April 15, 2021
- STAT March 23, 2020
- Science September 20, 2019
- Int J Antimicrob Agents. 2021 Apr; 57(4): 106324
- Int J Antimicrob Agents. 2021 Apr; 57(4): 106324