This post was first published on PME’s September 2020 digital magazine.
The World Health Organisation (WHO) states that antimicrobial resistance (AMR) is a global concern. AMR threatens our ability to treat common infections and increases the risk of medical procedures such as transplants, chemotherapy, chronic disease management and major surgery. This has not only serious implications for the health of individuals but also for the healthcare system, as well as many other areas of the economy.
The COVID-19 pandemic has similarly created a number of challenges for the entire world with the healthcare system and the economy locally and globally being heavily burdened. While COVID-19 is heavily reported on, there is little awareness of AMR yet it continues to be a major concern globally. A Nature article published in May this year, highlights that many COVID-19 patients are unnecessarily receiving antibiotic treatment and highlights that antibiotic stewardship needs to be emphasised now more than ever. The British Society for Antibiotic Chemotherapy (BSAC) highlights that AMR needs to be addressed with the same urgency as has COVID-19.
In the last 6 months there has been a large increase in the use of social media, and in particular healthcare professionals (HCPs) have been posting online at more than double their usual rate. Between March and June 2020 there have been over 800 posts in English by HCPs in Europe about AMR and COVID-19. This article digs deeper into the content HCPs are sharing online about the current COVID-19 pandemic and AMR, what the implications are and the actions needed to tackle this silent pandemic.
Antimicrobial resistance threatened by the COVID-19 pandemic
A consistent thread in the conversation of HCPs about antimicrobial resistance is the link between COVID-19 and drug resistant infections. HCPs are sharing articles and reports of many patients with COVID-19 being treated with antibiotics for suspected secondary bacterial infections, which could accelerate AMR. They shared resources from academic journals such as the BMJ, independent news sources like The Conversation and HCP authored blogs sharing their knowledge. The top sources used by HCPs however were articles or posts written by popular organisations who aim to fight against AMR. This included the Global Antibiotic Research and Development Partnership (GARDP) and the The British Society for Antimicrobial Chemotherapy (BSAC).
HCPs are using language like the “silent-crisis”, “silent and slower pandemic”, and the “silent pandemic” when talking about AMR being accelerated by the COVID-19 pandemic. As a secondary implication and threat, many HCPs shared that now is not the time to “produce” more superbugs, as there could be no treatment for COVID-19 patients who are also infected with a drug resistant infection.
This threat is more than a double edged sword with HCPs highlighting that not only has there been an increased use of antimicrobials for patients who may not need them and the risk of more drug resistant infections, there is also the concern that efforts to fight AMR are slowing down or coming to a complete halt.
Antimicrobial stewardship should not be neglected
With HCPs showing concern about the acceleration of AMR, posts raising awareness about AMR and encouraging antimicrobial stewardship was the main driver in the HCP online conversation. Trisha Greenlagh, an internationally recognised primary care professor, posted on Twitter in early April pointing out the NICE guidelines about the use of antibiotics for mild COVID pneumonia. This post also highlighted “Antimicrobial resistance is still a problem; stewardship is still important.” and received over 140 retweets and almost double that in likes, about a third of this engagement was from HCPs.
In other posts shared by HCPs about antimicrobial stewardship, many highlighted that it was important to not overreact with the antibiotic prescribing during COVID-19 and to continue following good stewardship practices to prevent larger problems in the future. A call from the organisation AMR Insights, in the Netherlands, was shared encouraging HCPs to implement antimicrobial stewardship particularly for those treating COVID-19 patients. Other organisations across Europe also called HCPs to not neglect antibiotic stewardship. Some of the organisations most engaged with by HCPs included the Royal Pharmaceutical Society (RPS) and the UK Clinical Pharmacy Association (UKCPA).
HCPs in Europe used a number of resources to get their point about antimicrobial stewardship across. An article from the financial times highlighting the parallels of AMR and COVID-19 stressed the importance of antimicrobial stewardship as a key learning from the COVID-19 pandemic. This article was shared online by HCPs and the group Target Antibiotics, a resource organisation run by the Royal College of General Practitioners (RCGP) and Public Health England (PHE). In a time where face-to-face meetings and sessions are not occuring, HCPs encouraged their peers to join webinars which discussed the topics of AMR, antimicrobial stewardship and COVID-19. HCPs also used this opportunity to call out specific roles involved at the frontline of the pandemic to attend webinars on antimicrobial stewardship and COVID-19.
Be prepared for the potential long-term impact on antimicrobial resistance
An HCP in Switzerland shared her frustration that there is little discussion happening about AMR in the times of the COVID-19 pandemic, and calls for her peers to plan in advance and be prepared. HCPs responded to and agreed with this post, aware of the potential long-term impact. A pharmacist in the UK echoed this sentiment, expressing that he could not sense the urgency about AMR right now.
Less than 5% of the HCP conversation in Europe about AMR focused on being prepared for the long-term or future impact due to COVID-19. HCPs again shared webinars that focused particularly on the long-term impact of COVID-19 on AMR research and AMR health policy. These posts were well engaged with but compared to the webinars focused on antimicrobial stewardship there was less activity online. Towards the end of May an article about the potential long-term impact on AMR was published by the Journal of Antimicrobial Chemotherapy. While this article calls for continued efforts in antimicrobial stewardship it also highlights that now is the time to be considering and preparing for the long-term impact. Generally we see this type of content receiving large engagement by HCPs however, this article was shared by less than 10 HCPs in Europe.
One HCP in the study shared a post stating that “now is an important time to consider how we can prepare for the next public health emergency: Antimicrobial resistance (AMR).”
Where to next?
CREATION has been tracking the HCP COVID-19 conversation globally. We have noticed that HCPs are posting online more than double their usual rate. We have also noticed that there is an increase in the different views, perspectives and information being shared. There is little consensus and no clear voice. As HCPs are being overwhelmed with the noise online (AMR conversation contributes to less than 0.001% of the COVID-19 conversation) and increased pressure for quick decisions to be made in treating their patients, is the threat of AMR actually being heard loud enough?
In this analysis there were a few key HCP voices and organisations that stood out, this provides an opportunity for health stakeholders including pharmaceutical companies to collaborate with those who are already active and being heard. This collaboration could help to focus the conversation to raise the profile (and volume) of AMR during the COVID-19 pandemic as well as preparedness for the long-term impact.
As HCPs have shared, there is a threat of COVID-19 to accelerate AMR, and antimicrobial stewardship needs to be upheld. There also needs to be more awareness about the long-term impact. This is where healthcare organisations and pharmaceutical companies that are at the heart of providing antibacterials and research should consider getting involved. As HCPs engage well with digital media such as webinars during this time, this could be an important tactic to engage them and drive antibiotic stewardship and awareness.
With much of the global audience now regularly online and the ease of which to communicate digitally this provides the perfect opportunity to make sure the threat of AMR is heard. Even when heard, there is still much to be done, but working together and collaborating will be key to overcoming the current challenges.