Antibiotic resistance worsens COVID-19 outcomes

Kenneth E. Thorpe (Photo: Twitter)
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By Kenneth E. Thorpe

Hospitals across the globe are overwhelmed with coronavirus patients. Many of those patients ultimately develop viral pneumonia, one of the most common symptoms.

But a subset of patients must fight another, more terrifying enemy: drug-resistant bacteria, or “superbugs.”

These secondary bacterial infections are largely immune to our current antibiotics arsenal. And as a result, patients who might have survived if we had more effective treatments are dying instead. If lawmakers don’t learn from this quickly — and jumpstart antibiotics development — we’ll be woefully unprepared when the next pandemic strikes.

The outbreak of COVID-19 has brought the threat of antibiotic resistance front and center. But it’s far from a new public health challenge.

Every time a patient takes any antibiotics to treat an infection, some bacteria survive. These surviving strains can multiply and evolve into deadly, treatment-resistant superbugs. Last year, superbugs infected one American every 11 seconds and killed one every 15 minutes.

Today, amid the COVID-19 crisis, superbugs pose an exponentially greater threat. In one Lancet study of 41 hospitalized coronavirus patients, 10 percent developed secondary infections.

A different Lancet study of 99 COVID-19 patients with secondary infections identified five types of bacteria in their systems, one of which — A baumannii — was antibiotic-resistant. This particular superbug can cause septic shock, resulting in severe organ damage and, in some cases, death.

Unfortunately, the widespread use of antibiotics has an unintended effect – it inevitably fuels the evolution of superbugs. Every patient in the first Lancet study, even those without secondary infections, received antibiotics.

Solving the challenge of antibiotic resistance requires a two-part solution. First, we need to make sure patients are receiving the right antibiotics for their particular infections — but only when appropriate. Second, we need to develop new, more potent antibiotics.

Drug development is a challenging, expensive venture. On average, innovators can expect to spend 10 to 15 years and up to $2.6 billion to create just one new medicine. Companies accept these risks because if they succeed, there’s a good chance they’ll be able to sell enough of their treatments to recoup their research dollars.

This sales model works for most types of drugs, but not for antibiotics. Unlike treatments for many chronic diseases, antibiotics are intended for extremely selective use. Such restrictions make sense, medically speaking — but they make it difficult for antibiotics developers to earn back their investments.

It’s time lawmakers fixed the broken antibiotic market and catalyzed the creation — and responsible use — of new treatments to save lives.

Lawmakers could consider policies that increase reimbursements for hospitals that appropriately administer novel antibiotics. In turn, demand would likely increase and it would become viable for firms to develop antibiotics.

Governments could also offer “market entry rewards” to companies working to produce novel antibiotics. This would provide companies the opportunity to recoup research and development capital. In turn, this would incentivize more investment in antibiotic research projects.

COVID-19 offers a stark warning to every lawmaker and health policymaker. Unless we get serious about fighting antimicrobial resistance, we’ll remain woefully unprepared in future pandemics.

(Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.)


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