The rising threat of superbugs

How the use of antibiotics against COVID accelerates danger of resistant bacteria

In the midst of a raging COVID19 pandemic with its growing variants, why in the world should we pay any attention to “superbugs,” bacteria that resist antibiotics? After all, COVID19 is a virus, and superbugs are bacteria. For good reason: These rogue bacteria can seize on COVID’s weakened victims, and in many cases, become their final cause of death.

So COVID’s rise has directly accelerated the use of the few, stillpotent antibiotics we have to treat these bacteria. The more such antibiotics circulate, the more chance that resistant mutations will occur, curtailing their effectiveness. In effect, COVID19 has given superbugs a true shotinthearm, cementing their place as a health crisis equal and parallel to its own.

Until recently, only the scientific community really registered the increasing danger of superbugs. Slowergrowing and less noticed than viruses, resistant bacteria account for an annual death toll of about 35,000 in the U.S., and 700,000 worldwide. When their part in COVID deaths are counted, these figures will soar. More, superbugs also imperil modern medicine. Successful medical procedures heavily depend on antibiotics. Add their role as COVID’s accomplices, and it’s clear: superbugs demand a highpriority, highlevel battle strategy.

But not at the expense of beneficial bacteria, our ancestral parents. Over eons, they evolved to produce us, and stayed on, cohabitating our bodies. Today in the average adult, they outnumber human cells by roughly 2 to 1. Each individual’s ecosystem, our microbiome, contains this mix. In our superbug fight, we can’t jeopardize the health of these essential bacteria.

This distinction has helped us resurrect the caution of Alexander Fleming, the father of antibiotics. A century ago, soon after discovering penicillin, he warned that antibiotics must be restricted to keep resistance at bay.

But in the 1940s, during and after World War II, government funding of penicillin and other “miracle drugs” led to their broad prescription, ushering in an Age of Antibiotics. By the ’60s, that era ended, and since the ’80s, antibiotic discovery has been in serious decline.

Simultaneously, pharmaceutical companies fed this process, finding more attractive alternatives. Without sufficient return on their long, costly investment in antibiotic R&D, they turned to drugs that were easier to discover, cheaper to produce, and prescribed longer term, in short, much more profitable.

Now, however, superbugs’ ascendency may be in the first stages of check, if concerted global efforts across several fields continue to bear fruit.

Science is still its base, moving ahead with prevention (including faster diagnostics), new and renewed antibiotics, and therapies beyond antibiotics. Diagnosis, done in the field now as well as the lab, can identify diseases in minutes rather than days, speeding treatment by instantly linking them to appropriate antibiotics. Artificial intelligence exponentially advances this matching process. Uncharted areas (caves, sea floors) are yielding new antibiotics, and adjuvants are rejuvenating older ones. Companion aides to antibiotics, like bacteriophages, have recently come on scene. And in development are ingenious biological engineering techniques, e.g., CRISPR, either supporting antibiotics or stemming superbugs on their own.

In addition, global efforts across economic, political and pharmaceutical lines are coming into play. They may originate in leading capitals, but coalesce in the world marketplace. This farreaching work — begun in the past decade — reached a milestone in 2016 when all of the UN’s 193 members adopted a breakthrough UK report about how to tackle microbial resistance.

With input from pivotal players such as the pharmaceutical industry, this report includes novel publicprivate schemes to meet antibiotics’ unique economics. Along with encouraging more R&D and supporting new drugs coming to market, it recommends that drug companies help ration antibiotics to preserve their potency for the acutely ill, equalize their global distribution, and keep prices universally low. Recently, the G20 adopted the successful Netflix subscription model: antibiotics in quantity will be paid for by governments and stockpiled in advance, ready for any type of selection: high need (“binging”) or single choice.

Whatever the future curve of superbugs, the average citizen — now savvy to pandemics — must continue all the familiar preventions: handwashing, filtered masks, distancing. But as progeny of beneficial bacteria, we may hope to hang our hats on this: Superbugs’ cunning meets its match in our collective will and wisdom.

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