Patients long have dreaded the possibility that — when already seriously ill or hurt — they also would be hit with debilitating or deadly hospital- or health care-associated infections, aka HAIs. The most nightmarish of these cases involve bacteria or fungi difficult to subdue, even with powerful treatments.
Now, with care institutions overwhelmed by coronavirus pandemic cases, drug-resistant HAIs are increasing — and in worrisome fashion because they are so difficult on their own for patients, doctors, and hospitals to deal with, the New York Times reported:
“’Seeing the world as a one-pathogen world is really problematic,’ said Dr. Susan S. Huang, an infectious disease specialist at the University of California at Irvine Medical School, noting that the nearly singular focus on the pandemic appears to have led to more spread of drug-resistant infection. ‘We have every reason to believe the problem has gotten worse.’ A few data points reinforce her fears, including isolated outbreaks of various drug-resistant infections in Florida, New Jersey, and California, as well as in India, Italy, Peru, and France. Overall figures have been hard to track because many nursing homes and hospitals simply stopped screening for the germs as resources were diverted to Covid-19. When even modest screening picked up again early in the summer, the results suggested that certain drug-resistant organisms had taken root and spread. Particularly troublesome have been growing case counts of a fungus called Candida auris [shown in CDC photo, above], which authorities had tried to fight before the pandemic with increased screening, isolation of infected patients and better hygiene.”
Drug-resistant bugs imperil patients in many ways, because they can be stubborn to root out and hard to treat, the newspaper reported:
“These bacteria and fungi, like Covid-19, prey on older people, the infirm and those with compromised immune systems. They can cling tenaciously to clothing and medical equipment, which is why nursing homes and hospitals before the pandemic were increasingly focused on cleaning rooms and changing gowns to prevent their spread. That emphasis all but slipped away amid an all-consuming focus on the coronavirus.”
Instead, with shortages of personal protective equipment or PPE, doctors and nurses have been forced at times to re-use this infection-fighting gear. When hospitals have gotten overwhelmed, they have struggled to maintain the strict hygiene measures to prevent the spread, not only of the coronavirus but also drug-resistant infections, the New York Times reported. Doctors also say that heavy demand and high use of medical equipment like ventilators has made it harder to keep them at peak sterilization. Hospital cleaning crews, who have won high praise for their bravery and diligence in keeping up their crucial but often unsung toil during the pandemic, have not had their usual time and resources to sanitize facilities with the vigor that can be needed to quash outbreaks of HAIs.
Clinicians also have noted that steroids, commonly used to treat the excessive inflammation seen in coronavirus cases, can constrain the body’s infection-fighting mechanisms, further fueling opportunistic infections by drug-resistant bacteria and fungi.
Even before the pandemic, federal health officials sounded alarms about spiking HAIs and the now-ubiquitous presence and problems caused by drug-resistant infections, a menace worsened by global antibiotic over use and abuse.
“Drug-resistant germs sicken about 3 million people every year in the United States and kill about 35,000, representing a much larger public health threat than previously understood, according to a long-awaited report … by the Centers for Disease Control and Prevention. The new estimates show that, on average, someone in the United States gets an antibiotic-resistant infection every 11 seconds …Bacteria, fungi and other germs that have developed a resistance to antibiotics and other drugs pose one of the gravest public health challenges and a baffling problem for modern medicine. Scientists, doctors, and public health officials have warned of this threat for decades, and the new report reveals the top dangers and troubling trends. More pathogens are developing new ways of fending off drugs designed to kill them, and infections are spreading more widely outside of hospitals. No new classes of antibiotics have been introduced in more than three decades.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the common sense in their working to stay healthy and out of the health care system. That system not only is costly and inconvenient, it can prove to be all too risky, rife with medical error, hospital infections and deaths, and misdiagnoses. The pandemic has threatened to collapse the system, and, while recognizing its problems we need to give it — and the courageous folks laboring in it now —unstinting support.
We all need to take the politics and vitriol out of practical, evidence-based public health measures that seek to end the pandemic that has killed more than 430,000 Americans and infected more than 25 million. Those likely are underestimated and they increase daily, as do hospitalizations, especially in intensive care units, and deaths.
The availability of safe and effective vaccines will help, especially if officials can significantly improve the doses of them available and get around obstacles to get them into hundreds of millions of Americans’ arms. Until then, we all can do much to battle the coronavirus with aggressive hygiene (especially hand washing), face coverings (double masks may be need now with highly transmissible variants blowing up), avoiding of closed and poorly ventilated spaces, and our staying home as much as possible and keeping mostly to members of our single households.
We all want greater normality to rein anew. But it may be months before that can happen — and only if we redouble our shared altruism and collective focus on beating the coronavirus. And even if get this disease better in check, exhausted and overwhelmed doctors, nurses, hospitals, and their staff will then need to renew their obsessive efforts to slash HAIs, find new bug-fighting drugs, and reform how they prescribe existing antibiotics. No older patient — female or increasingly male — wants to be hospitalized for an increasingly common urinary tract infection or UTI, only to get sicker or even die from a drug-resistant HAI. We have got a lot of work to do to get our world to a better place, realizing, among other things, that major league infection fighting is and will be a key part of our new normal for the foreseeable future.