The Health November/December 2021 | Page 33

Another pandemic-in-the-making has been slowly manifesting silently in the shadows and may become deadlier in future years if no measures are taken

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NOVEMBER-DECEMBER , 2021 | THE HEALTH

33

A tale of two

pandemics

Another pandemic-in-the-making has been slowly manifesting silently in the shadows and may become deadlier in future years if no measures are taken

IT IS MORE than one and a half years since the first case of Covid-19 was reported . The disease has since become a global pandemic , disrupting healthcare systems , global supply chains and “ normal , daily life ” in every continent of the world .

Unknown to many , another pandemic-in-the-making has been slowly manifesting silently in the shadows and may become deadlier in future years to come if no measures are taken to prevent it . This refers to the silent pandemic of antimicrobial resistance ( AMR ).
On the surface , it may seem that the two pandemics have nothing similar – one is caused by a virus , and the other is by germs ( bacteria , virus , fungus and parasites ) that are no longer susceptible to medicines designed to kill them .
Fear to seek medical consultation
In fact , during the first few weeks of the Covid-19 pandemic , outpatient clinics reported a decrease in the prescription of antibiotics . This decrease was later identified to be caused by the general public ’ s fear of seeking medical consultation in the early weeks of the pandemic .
Nevertheless , there was then subsequently an increase in antibiotic prescription across healthcare settings . Prior to the set-up of Covid-19 diagnostics , it could be difficult to differentiate Covid-19 from community-acquired pneumonia clinically .
In addition , there might have been delays in AMR testing as staff were pivoted to Covid-19 diagnostics , or labs experienced shortages in the global supply chain for test materials . Diagnostic uncertainty , coupled with increasing cases of secondary bacterial infection in Covid-19 hospitalisation , increased antimicrobial prescription compared to pre-Covid-19 times .
Even though a direct link between increased antimicrobial usage and an uptick in AMR germ infections have not been made , notably , sporadic outbreaks of AMR Acinetobacter ( an environment bacteria ) and Candida ( a fungus ) in Covid- 19 units have been reported .
Many patients are self-medicating
Even more alarming , in countries where antibiotics are available as over-thecounter drugs , many patients self-medicate with antibiotics without consulting a healthcare professional . This was done either in the mistaken belief to prevent Covid-19 infection or seek relief for their respiratory illnesses .
While this effect is not immediately visible , these actions , if left unchecked , will lead to precarious episodes of AMR infections in the community in the long run .
Nevertheless , it is not all gloom and doom . Prior to Covid-19 , AMR has been identified as an increasing public health threat .
Indeed , in May 2015 the World Health Assembly launched a global action plan to fight AMR . This coincided with an Executive Order from the Obama administration , and the formation of
SEPSIS ALERT
BY ASSOC PROF DR TAN TOH LEONG
AND ASSOC PROF DR NEOH HUI-MIN the Review on Antimicrobial Resistance Committee in the UK , all for the same purpose . Activities for these initiatives somewhat took backstage and might seem derailed when Covid-19 struck .
However , as the saying goes , “ to not let a crisis go to waste ”, there are many things we can learn from Covid-19 to prevent the next pandemic . Governments are now aware that healthcare systems of their countries are of the utmost priority .
Keeping abreast with correct information
This should hopefully lead to ongoing efforts to improve healthcare , and also to view health as interconnected locally and globally . Malaysian Health Minister Khairy Jamaluddin said that “ health budgets should be viewed as investments rather than expenditure ”. Besides investing to improve our healthcare human resources and facilities , it is equally crucial that budgets for preventing the AMR pandemic , such as research and development for rapid diagnostics of AMR , vaccines and antimicrobial agents ’ exploration , periodical germ surveillance , and public education on AMR awareness are created and approved .
And we , as the public , have our responsibility to keep abreast with correct information from validated sources to prevent the next pandemic , and as the theme for this year ’ s World Antimicrobial Awareness Week states , to “ Spread awareness , stop ( antimicrobial ) resistance ”. — The Health
Assoc Prof Dr Tan Toh Leong is Consultant Emergency Physician , Faculty of Medicine , Universiti Kebangsaan Malaysia ( UKM ) and Founder and President of Malaysian Sepsis Alliance ( MySepsis ) while Assoc Prof Dr Neoh Hui-min is Senior Research Fellow , UKM Medical Molecular Biology Institute ( UMBI ), UKM and Secretary of MySepsis .