Macrocosm: How COVID-19 Could Heighten the Antibiotic Resistance Crisis

Radoslav Zilinsky

Antibiotics have often been described as “miracle drugs” or “magic bullets”. Before they were discovered in 1928, people regularly died from minor bacterial infections and life expectancy topped off at 48. Since then, they have saved countless lives and almost doubled the human life span.

As antibiotic use has become widespread, so has antibiotic resistance. Many bacterial species, both pathogenic and benign, have developed immunity against the only known means of defeating them. Every 11 seconds someone in the United States is infected by an antibiotic resistant microbe and every 15 minutes someone dies. In the US alone, antibiotic resistance is responsible for 2.8 million infections and 35,000 deaths each year.

Antibiotics are one of the greatest health advancements in modern history, so it would be a shame to lose them in the face of emerging diseases. The COVID-19 pandemic shocked the world, leading to unprecedented changes and claiming the lives of 1.4 million people worldwide (and counting). It has also been a stark reminder that there still a lot we don’t know about infectious diseases. The choices we make now could determine whether we can continue to select antibiotics from our arsenal of therapeutics in the face of another deadly illness.

How and Why Do Bacteria Become Resistant?

Genetic mutations are extremely rare and random. At the same time, most mutations are silent meaning they don’t cause any observable changes. Bacteria reproduce, or as we like to say “grow”, at impressive rates. E. coli, for example, divides as quickly as once every 20 minutes. This may not seem like much, but in just 8 hours, or over the course of a typical workday, a single bacterium could produce 16,777,216 bacteria. At such a rapid proliferation rate, mutations become a more common occurrence. Although most are still silent, every so often, a beneficial mutation will arise.

Our bodies are packed and coated in bacteria, about 39 trillion microorganisms, give or take. Most are harmless; they even protect us from disease by outcompeting pathogenic bacteria for resources. By chance, one of these microbes could have a beneficial mutation that renders it tolerant of a specific antibiotic. When we take a round of that antibiotic, bacteria that are sensitive to the medicine will die. Without any competition, the antibiotic resistant strains can divide unchecked; becoming the dominant species within the microbiome.

The antibiotic resistance crisis is mainly the result of over-prescription. According to the Centers for Disease Control and Prevention (CDC), 1 in every 3 antibiotic prescriptions is unnecessary resulting in 47 million superfluous prescriptions each year. Even when patients receive an appropriate prescription, they may misuse it. People will often stop taking antibiotics before completing the full course of treatment. Using antibiotics in less than therapeutic amounts is unwise because it may not eliminate pathogenic bacteria and will only accelerate the growth of resistant strains.

Antibiotic Resistance and COVID-19

You can probably find a few bottles of disinfectants in almost every household. This has proven especially true in the face of the COVID-19 pandemic when everything from disinfecting wipes to hand sanitizers have been flying off the shelves. Historically, antibacterial cleaning agents were used exclusively in hospitals to protect patients with compromised immune systems from acquiring additional infections. Over the years, manufacturers and marketing companies have convinced us that we need to use them in our own homes.  

Like antibiotics, antibacterials simultaneously eliminate susceptible bacteria and encourage the growth of resistant ones. Resistance genes are found on circular pieces of DNA called plasmids. Bacteria reproduce asexually, simply dividing in half to produce two identical copies of themselves. In order to increase genetic variation, they pass off genes to one another in the form of plasmids. In the presence of antibacterials, the surviving microbes can use this process to share their antibacterial resistance genes with disease-causing bacteria. This includes those with an existing antibiotic-resistance gene, a phenomenon known as cross-resistance. In simpler terms, when we use antibacterial cleaning agents, we unknowingly promote the growth of double resistant bacteria and create difficult, and even impossible, to treat diseases.

It doesn’t stop there; it seems the COVID-19 pandemic has fueled the over-use of antibiotics. Early on, very little was known about the SARS-CoV-2 virus. Doctors, overwhelmed and overworked, administered antibiotics to COVID-19 patients in the hopes of preventing bacterial superinfections. Over 70% of patients were given antibiotics even though recent studies have revealed there was only a 7% rate of co-infection. Additionally, multiple experimental treatments have included antibiotics as combination therapies. This includes teicoplanin, an antibiotic used to treat the respiratory symptoms associated with coronaviruses, and azithromycin, an immunomodulator. There is zero scientific evidence supporting the use of these drugs to treat COVID-19. Azithromycin has even shown to provide no benefits in the treatment of COVID-19, according to some studies.

What Now?

When everyone is worried about the possibility of contracting a deadly virus, it makes sense that many people would err on the side of using the most powerful disinfectants they can find. There are two issues here: (1) antibactierals do not kill viruses and (2) there is no evidence to support the use of antibacterials to prevent infection. In reality, regular soap and warm water, are just as effective at preventing illness.

 If anything, now is the best time to be antibiotic smart. Use antibiotics only when you have a bacterial infection and don’t pressure your health workers into writing unnecessary prescriptions. Family doctors in particular rely on return visits to keep their practices running. Sometimes they will prescribe antibiotics because they fear you’ll be unhappy, and less like to come back, if they don’t.

Although completing a full course of antibiotics is important, it isn’t always necessary. Ask your doctor if your infection can be treated with a shortened course. This goes without saying, but antibiotics should not be shared or stockpiled; they are prescription drugs for a reason. Frankly, the best method to prevent infection is also the easiest: regularly wash your hands, prepare food hygienically, and avoid contact with sick people.

Healthcare facilities and policy makers should also take steps to limit the spread of resistance such as cycling antibiotics in hospitals and improving surveillance of antibiotic-resistant infections. Antibiotic resistance is a deadly issue; one that will most likely intensify in the aftermath of the COVID-19 pandemic. We are going to need all hands on deck, and soon, if we want to save a crucial weapon against the agents of disease.