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A Looming Public Health Crisis

Every year, antimicrobial resistance (AMR) becomes more of a threat to global public health. As such, one might expect there already to be a handful of solutions backed by government initiatives along with global health strategies and interventions. This, however, is not the case.

As the prevalence of AMR and its associated morbidity rates increase worldwide, experts have noticed the ways in which COVID-19 has complicated the ongoing challenge of AMR. AMR has received neither the media coverage nor the urgency it requires, hindering progress toward a solution by limiting the public’s awareness of the issue. Governments and the media need to become more involved in combatting AMR, fostering the gradual advancement of novel approaches and treatments that will save millions of lives.

AMR has been a consistent, prominent threat to the health of citizens globally, and the enduring COVID-19 pandemic has caused the number of cases to escalate. In 2014—2015, England dealt with 64,300 admission cases of AMR, and that number jumped to 93,700 in 2019—2020. Leading experts in infection prevention and health care are warning the public about the increase in AMR. With a climbing incident rate and neglect of the issue due to COVID-19, Professor Colin Garner, the chief executive of Antibiotic Research UK, warns, “We may be facing another pandemic, this time without the possibility of a vaccine.”

Like COVID-19, AMR leads to the spread of disease and has the potential to create a global outbreak. However, Garner cautions, “While COVID-19 is treatable through vaccination, there are no vaccines to treat the most common resistant infections.”

AMR occurs when bacteria build a substantial resistance to the treatments designed to fight the infections that the bacteria cause. In other words, an antibiotic that was once effective against a specific bacterium is rendered useless. Dr. Bruce Hirsch, an infectious disease specialist at Northwell Health®, says that AMR is an ongoing issue in his practice in New York: “The germs are just so much smarter than they used to be. Our patients are sicker, more immunosuppressed, with frequent antibiotic exposure.”

The occurrence of AMR is a serious concern due to the development of superbugs that follow. These superbugs—such as methicillin-resistant Staphylococcus aureus (MRSA) and Candida auris (C. auris)—are resistant to all antibiotics and complicate broader aspects of health care. Cancer treatment, for example, may be stalled as patients affected by these superbugs become increasingly vulnerable to infection, making surgery risky.

Coronavirus’s takeover of the global news

The COVID-19 pandemic has undoubtedly overwhelmed global news coverage. The constant breaking news leaves little room for coverage of other world events. Therefore, despite the seriousness of the issue, this article may be the first time some readers are learning about the prevalence of AMR. The COVID-19 pandemic has hindered the treatment of AMR not only by overwhelming the global news sphere but also through the complex limitations that the related shortages of personal protective equipment (PPE) pose for health care staff and patients.

Case increases in Virginia: Candida auris

In a Virginia Mercury article, Kate Masters reports on an ongoing incident involving C. auris—an emerging fungus that causes severe infections—in the Virginia medical sphere, labeled by the U.S. Centers for Disease Control and Prevention (CDC) as a “serious global health threat.” C. auris poses a significant risk to patients with pre-existing conditions that have weakened their immune systems. Even for those with adequate immune systems, the infection is still a significant concern due to its longevity and resistance to antifungal drugs.

There have been only 37 infections from C. auris in Virginia since July of 2020. However, Virginia State Health Commissioner Dr. Norman Oliver warns in a clinician letter released on May 7, 2021, that this is more than a tenfold increase in cases compared with the previous two years. According to the CDC, 30%–60% of patients infected with C. auris will die.

Shaina Bernard, the antimicrobial resistance coordinator for the Virginia Department of Health’s health care-associated infections program, warns that the cases in Virginia are “consistent with what we’ve seen in neighboring states. One of the hypotheses is that it’s due to personal protective equipment and the conservation strategies during the COVID-19 pandemic.”

For decades, public health officials have expressed worry about the growing number of bacteria labeled as multidrug-resistant organisms (MDROs). With the emergence of COVID-19, experts have grown concerned with how the unique behaviors surrounding the pandemic, such as isolation indoors and the extensive use of cleaning products, have allowed MDROs to spread with ease. For instance, for those living in long-term care facilities, the shortage of PPE has eased the spread of C. auris and other MDROs. A limited supply of N95 masks and gowns has forced staff to reuse PPE designed to be disposable. Dr. Jim Wright, medical director of Canterbury Rehabilitation & Healthcare Center in Virginia, warns that the low supply and reuse of PPE have staff spreading infections from patient to patient. Sarah File Lineberger, manager of the Virginia Department of Health’s health care-acquired infections program, notes that, similarly, the change to using cleaning products intended to eliminate the coronavirus neglects prevention of MDROs.

Case increases in England

Royal Bolton Hospital in England recorded a rise in admissions related to antibiotic resistance. As it has in the United States, increased incidence of AMR has sparked warnings from British health care experts. Researchers have warned that without urgent action toward prevention, the increase in AMR could pose an even greater health risk than what the world saw with the COVID-19 pandemic.

According to data released by the National Health Service (NHS), there was a 5% increase in AMR-related admissions at Royal Bolton Hospital in the past year. In England, there were around 93,700 admissions in 2019—2020, a significant increase from the 90,200 of the previous year. At the University Hospitals of Morecambe Bay NHS Foundation Trust in 2019—2020, NHS data recorded an increase from 1,240 AMR-related admissions in the previous year to around 1,515. More shockingly, the number had increased by nearly 1,200 cases from the recorded 310 in 2014—2015.

Long-term outlook

It is estimated that by the year 2050, AMR could be responsible worldwide for one human death every three seconds. Yet despite this projection, very little has been done on the path toward combating AMR in patients.

Wellcome, a charitable foundation that aims to solve global health challenges, warns that with infectious disease escalation aided by AMR, the world needs to gain control of the issue, especially in communities that face higher prevalence and risk due to illness and social factors such as socioeconomic status, race, and ethnicity. The organization emphasizes that drug-resistant infection is a global crisis that kills hundreds of thousands annually. In low- and middle-income countries, many of the complexities that emerged during the COVID-19 pandemic were not a recent phenomenon but a long-existing reality. The quicker that action is taken to address AMR, the more lives will be saved.

Original Article written by Michael Diamond

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