With the coronavirus pandemic surging anew due to the highly infectious Omicron BA.5 variant, federal authorities reported recent data that should give Americans plenty of reason to heed public health warnings and avoid hospitalization if they possibly can.
That’s in part because institutions, overwhelmed by the pandemic, have taken giant steps backward in preventing patients in their care from acquiring nasty bacterial and fungal infections in addition to the coronavirus, and from overusing and misusing lifesaving antibiotics, further fueling the rise of virulent super bugs, the federal Centers for Disease Control and Prevention says. As the New York Times reported:
“The spread of drug-resistant infections surged during the coronavirus pandemic, killing nearly 30,000 people in 2020 and upending much of the recent progress made in containing the spread of so-called superbugs, according to an analysis by the Centers for Disease Control and Prevention. Deaths caused by infections impervious to antibiotics and antifungal medications rose 15% during the first year of the pandemic compared to 2019, federal health officials found. Much of the increase was tied to the chaos wrought by the coronavirus as doctors and nurses struggled to treat waves of grievously sick patients whose illness they did not fully understand before vaccines and treatments were widely available. About 40% of the deaths were among hospitalized patients, with the remainder occurring in nursing homes and other health care settings, the CDC report found. Early on, many frontline hospital workers mistakenly administered antibiotics for viral lung infections that did not respond to such drugs, according to the study. Many of the sickest patients spent weeks or months in intensive care units, increasing the chances for drug-resistant bugs to enter their bodies through intravenous lines, catheters, and ventilator tubes.”
The CDC said the toll from hospital acquired infections (HAIs) likely has been under-reported. The challenges with the cases, particularly those involving the most destructive bugs, were worsened by much-publicized problems with medical resources of many different kinds, the New York Times reported:
“[O]utbreaks of drug-resistant infections were likely abetted by a nationwide shortage of face masks, gloves, and gowns — the vital armor that protects health workers and helps limit the spread of pathogens as they travel from room to room. Because of staff shortages and overwhelmed wards at many hospitals, infection control specialists were often reassigned to provide basic patient care rather than carry out their usual duties of promoting the appropriate use of antibiotics, hand washing and other safety measures, the [CDC] report said.”
Experts have urged hospitals to be aggressive in cracking down anew on HAIs, as well as antibiotic misuse and abuse. The bacteria and fungi that cause them can be nightmarish to eradicate. Hospitals were making progress on these problems, which not only debilitate and kill hospitalized patients but also puts many others at risk if bacteria and fungi, overexposed to antibiotics, become resistant to important drugs that have served as the modern equivalent of medical miracles, the New York Times said:
“Federal officials were especially concerned about the increased spread of some of the most dangerous pathogens. They found a 78% spike in infections of Acinetobacter, a bacteria that is resistant to the antibiotic carbapenem and that often spreads among intensive care patients, and a 60% rise in Candida auris, a deadly fungus that often stalks nursing homes and long-term care facilities. The analysis highlights what public health experts have long described as a slow-moving pandemic. More than 700,000 people across the world die each year from infections that no longer respond to antimicrobial drugs, and health experts warn that the death toll could climb to 10 million by 2050 without a concerted effort to reduce the overuse of antibiotics and to develop new medications …
“The CDC’s [latest] findings are a marked contrast to previous reports that had charted slow but steady progress in combating the hospital-acquired infections that kill 35,000 Americans a year and sicken 2.8 million. Between 2012 and 2019, drug-resistant infections dropped by 18%, according to the agency’s 2019 report, which found that the improvements were tied to greater investment in programs to reduce the inappropriate use of antibiotics at hospitals.”
Preventable pneumonia cases
Hospitals, nursing homes, and other long-term care facilities don’t need to spend big money or undertake grand efforts to slash cases in which patients who are not on a ventilator get infected with pneumonia, the independent Kaiser Health News (KHN) service reported, separately.
Institutions are not required to report non-ventilator hospital-acquired pneumonia (NVHAP) cases to federal regulators, KHN reported. But this is a “blind spot” in oversight, especially considering that hundreds of thousands of patients get this illness and it kills a third of them — even though this could be prevented relatively simply, inexpensively, and easily, experts say. As the news service reported, quoting among others Karen Giuliano, a nursing professor at the University of Massachusetts Amherst:
“Hospital patients not getting their teeth brushed, or not brushing their teeth themselves, is believed to be a leading cause of hundreds of thousands of cases of pneumonia a year in patients who have not been put on a ventilator. Pneumonia is among the most common infections that occur in health care facilities, and a majority of cases are … NVHAP, which kills up to 30% of those infected, Giuliano and other experts said. But unlike many infections that strike within hospitals, the federal government doesn’t require hospitals to report cases of NVHAP. As a result, few hospitals understand the origin of the illness, track its occurrence, or actively work to prevent it, the experts said. Many cases of NVHAP could be avoided if hospital staffers more dutifully brushed the teeth of bedridden patients, according to a growing body of peer-reviewed research papers. Instead, many hospitals often skip teeth brushing to prioritize other tasks and provide only cheap, ineffective toothbrushes, often unaware of the consequences, said Dian Baker, a Sacramento State nursing professor who has spent more than a decade studying NVHAP.”
How can a common and easy prophylactic step be so helpful? As KHN reported:
“Pneumonia occurs when germs trigger an infection in the lungs. Although NVHAP accounts for most of the cases that occur in hospitals, it historically has not received the same attention as pneumonia tied to ventilators, which is easier to identify and study because it occurs among a narrow subset of patients. NVHAP, a risk for virtually all hospital patients, is often caused by bacteria from the mouth that gathers in the scummy biofilm on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.”
To be sure, health workers have performed valiantly in dire circumstances while inundated with treating patients with a novel, highly contagious, and lethal virus that has killed more than 1 million and infected almost 90 million of us. Those numbers are understated, and experts say it is hard to convey the calamitous strain the pandemic put on medical personnel and facilities.
Once more, the pandemic isn’t over …
Regular folks should keep this in mind as the pandemic surges anew. The Washington Post captured the mismatch in public attitudes versus reality about current conditions, reporting this:
“America has decided the pandemic is over. The coronavirus has other ideas. The latest omicron offshoot, BA.5, has quickly become dominant in the United States, and thanks to its elusiveness when encountering the human immune system, is driving a wave of cases across the country.”
This is how the New York Times summarized the rising tide of infections and deaths — a surge that, for example, may lead Los Angeles officials to reinstate a requirement for mask wearing indoors:
“Following a long period in which new reports of cases were relatively consistent, the number of cases announced in the U.S. each day is again on the rise. The daily case average grew to more than 129,000 on [July 13], and cases are rising in more than 40 states. Since cases have always been an undercount, it is likely that the true number of cases is far higher — particularly since test positivity rates are also increasing sharply nationwide. These increases come as the BA.5 variant, believed to be the most transmissible variant yet of the coronavirus, is emerging as the country’s dominant virus strain. Hospitalizations are also rising in the U.S. That pattern is similar to hospitalization surges seen earlier this summer in countries where BA.5 first began to circulate. More than 37,000 people are in American hospitals with the coronavirus on an average day, an increase of 17% since the start of the month. Reporting on deaths tied to the coronavirus is volatile at the moment, partly because of gaps in reporting over recent holidays. About 400 deaths are being reported each day nationwide, down from more than 2,600 a day at the height of the Omicron surge.”
In my practice, I not only see the harms that patients suffer while seeking medical services, but also the clear benefits they may enjoy by staying healthy and far away from the U.S. health care system. It is fraught with medical error, preventable hospital acquired illnesses and deaths, and misdiagnoses. Patients also suffer far too many harms due to bankrupting and dangerous drugs
In pre-pandemic times, medical errors claimed the lives of roughly 685 Americans per day — more people than died of respiratory disease, accidents, stroke and Alzheimer’s. That estimate came from a team of researchers led by a professor of surgery at Johns Hopkins. It meant that medical errors ranked as the third leading cause of death in the U.S., behind only heart disease and cancer. (The coronavirus, of course, has risen has a leading killer of Americans.)
Under pandemic duress, wrong determinations about patient conditions, no doubt, occurred, likely with greater frequency. Just to remind of further pre-pandemic research findings in this area: Diagnostic errors affect an estimated 12 million Americans each year and likely cause more harm to patients than all other medical errors combined, studies have found. And misdiagnoses boost health costs through unnecessary tests, malpractice claims, and costs of treating patients who were sicker than diagnosed or didn’t have the diagnosed condition. Experts recently noted in a health care online report that inaccurate diagnoses waste upwards of $100 billion annually in the U.S.
Vaccines are imperfect, but their benefits far outweigh their risks. Talk to your own doctors and others with real medical expertise and experience in a particular area of health care. But if they and public health officials recommend shots (and boosters) — for the coronavirus, monkeypox, or meningitis — and they can inform you appropriately of the risks and rewards, please get immunized. Encourage friends and loved ones to do so, too. Long covid is real and a major, debilitating problem for far too many. Avoid it, if possible.
The Biden Administration is pressing to expand the availability of booster shots, and experts see a likely fall campaign for widespread inoculation with vaccines targeting the Omicron variants. Federal regulators also have approved another late-arriving vaccine that was developed not in expedited, high-tech fashion but using more traditional means. It will offer an alternative to those who, for whatever reason, have regarded the shots given to hundreds of millions now as somehow riskier.
If rigorous research also informs common health public health preventive measures, please heed these, too, whether to avoid risky sex to fight monkeypox and meningitis or face covering and distancing to battle the coronavirus.
We’ve got a lot of work to do to safeguard ourselves, our loved ones, and our society against debilitating, deadly, and preventable infections.