A health crisis is rapidly unfolding worldwide. It causes suffering and death, costs billions and threatens to overwhelm health-care systems, patients and their families.
No, it's not the coronavirus pandemic. It's that other disastrous health crisis: drug resistance. Bacteria and other microbes that cleverly change and evolve are outsmarting the antimicrobials once hailed as miraculous cures. Worldwide, 700,000 people die each year due to drug-resistant diseases, according to the World Health Organization.
Until a few months ago, drug-resistant disease was one of the world's top health concerns. Now it takes a back seat to the coronavirus pandemic. Muhammad Hamid Zaman is a Howard Hughes Medical Institute Professor at Boston University. His book, Biography of Resistance: The Epic Battle Between People and Pathogens, was released by Harper Wave on April 21.
We talked to Zaman about these two epic health crises.
For years, there has been concern about infectious diseases becoming resistant to the drugs that have successfully treated them ... and then wham! COVID-19 hit, utterly dominating the world's attention. How should we think about these two crises?
The urgency right now is this viral disease. But we have to think of antimicrobial resistance not as detached but as something that's going on simultaneously with this pandemic. We know from history that the majority of deaths during the great 1918 flu pandemic were from secondary bacterial pneumonia. That was shown in work from Dr. Tony Fauci. People didn't die from the virus, they died of pneumonia. Today, our best arsenal against that infection is antibiotics, so if antibiotics stop working against secondary infections in this pandemic, that's a significant challenge.
Is it possible COVID-19 patients are dying not of the virus but of secondary bacterial infections, like pneumonia or staph infections, just as they did in 1918?
We don't know that yet. Early data from China and a recent report in the Lancet suggest that a significant percentage of hospitalized patients are also developing secondary bacterial infections. We certainly need more data and more analysis, but we have to be concerned. With the advantage of hindsight, we can be better prepared. We know from the epidemic of 1918 that those secondary bacterial infections are a risk, and now we have antibiotics. But we can't overuse them if there's no secondary infection. Remember, antibiotics don't do anything for viruses themselves.
Antibiotic resistance is caused by overuse of the drugs, the use of antibiotics in farming and the use of poor quality drugs, particularly in the developing world. What else makes bacteria fight back?
There's a constant tug of war. Some bacteria naturally produce antibiotic to gain the advantage of wiping out their competition,. Other bacteria at the same time produce resistance to antibiotics in a race to also gain a survival advantage. Our overuse and abuse, in the human and the farming sector, has tipped the scale in favor of drug resistant bacteria gaining an upper hand. Also, the prevalence of substandard and counterfeit drugs have added fuel to this fire, and increased drug resistance [to fake or substandard drugs with some but not enough real drug content so the bacteria aren't destroyed but learn to recognize and resist].
But antibiotic resistance has been going on for millions of years. Most of our antibiotics originally came from bacteria in the soil. Here's an example of how long this has been going on. Scientists discovered antibiotic resistant bacteria in a cave in New Mexico where humans had never been. So our overuse is a major driver of antibiotic resistance, but not the originator. Antibiotic resistance has been going on as long as we've had bacteria.
What's the difference between bacteria and viruses like the coronavirus?
The main difference is that viruses have to be in living cells to replicate. Bacteria are larger, more sophisticated and don't require a living host to replicate.
They're different, but what do the two types of infections have in common?
We have to recognize that nature is interconnected in many ways — animals, humans, the environment. The coronavirus likely originated in a wet market selling live [animals] in China. There is also an interaction between animals and humans in bacterial disease. This comes not only in the form of bacteria carried by animals that affect humans, like plague that goes from animals to humans via fleas, but also through the passing of drug-resistant bacteria, such as salmonella or E. coli, through the food chain from farm animals.
Also, for both bacterial and viral infections, it takes time to come up with new and effective therapies. But as we wait, social distancing measures, face masks, hand washing and hygiene measures are very important, and they're the same for both.
In your book, you describe bacteria as "clever." What's so clever about them, and are viruses also "clever?"
The cleverness of bacteria is their ability to over time resist our best arsenal of drugs. Viruses are clever in that they can mutate in ways that are significant. That's why we need a new flu vaccine every year, because of the ability of the virus to change and adapt. If new strains of coronavirus emerge, we'd have to develop multiple vaccines.
Are there lessons we failed to learn from the drug-resistance crisis that are now hampering efforts in controlling the coronavirus pandemic?
One of the lessons we have not learned very well is that antibiotic resistance is a global problem. We have not had much global cooperation. That's a lesson we need to learn much better because we're seeing how quickly disease travels the globe.
What's your advice on the right way to tackle global health crises?
The best response is a combination of science and empathy. Good science dictates hygiene, but we also need empathy for those who have been affected disproportionately—the elderly, the economically disadvantaged. Lockdown is important, but government has to step up to see that people get the food they need, the mental health care they need when they're isolated and lonely. We have to let both science and our humanity lead the way.
Do you think science is up to the challenge of responding to the coronavirus?
Science is a process. It's about facts, but it's also about uncertainty. It's a process of figuring things out in a way that's robust and rigorous and evidence based. If we do that, we're in good shape.
Susan Brink is a freelance writer who covers health and medicine. She is the author of The Fourth Trimester and co-author of A Change of Heart.