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Impact of the COVID-19 pandemic on AMR: views of experts from 4 countries

Watch Regina Berba (Philippines), Patty Garcia (Peru), Raiva Simbi (Zimbabwe), Amal Al-Maani (Oman) speak on the impact of COVID-19 in their country.
DR REGINA BERBA: So, when the COVID pandemic happened and we were all under a lockdown here in the Philippines. And the health system was beginning to be overwhelmed, the same people actually who took care of most of the antimicrobial stewardship programmes were also the frontliners. So being so overwhelmed, we had to say OK, the EMS we just have to stop first. So we can concentrate on our efforts to be able to take care of the COVID patients. And we’ve been seeing that for those 20% who end up being hospitalised, many are actually on some, kind of, antibiotics already. So that was particularly true in the first months of the pandemic when there were no guidelines yet.
So people were just prescribing any kind of antibiotic particularly azithromycin, that’s true. But then even when the recommendations of the WHO came and they were seeing that for mild pneumonia or for COVID, for mild COVID, and we don’t think there’s a secondary infection and it’s purely viral pneumonia then we do need to give antibiotics to it. That’s really, really even more difficult to challenge. Like, many doctors would insist to anyway prescribe despite the recommendations from the WHO.
PROFESSOR PATRICIA GARCIA: Here in Peru, I will say that probably all the patients were receiving antibiotics, just in case. And when the patient was not getting better, or was going to the ICU, more antibiotics were added.
DR RAIVA SIMBI: COVID 19 when you started inducing until now, people are just given a whole array of antibiotics. And the prescriptions would be way, way overloaded with antibiotics. And some of the antibiotics that they are giving are the in our settings, they are like the last end antibiotics. Like azithromycin is one of the high end antibiotics. But now it’s given is the first line antibiotic. So this is the situation that we have now. I think also we had some negative impact because anyone in every way is prescribing anything. And also because the pharmacists are looking for money. They are supposed only to dispense if someone comes with a prescription from a clinician.
But the pharmacist because also they are probably for many reasons they were even prescribing you go with one prescription pad. They can prescribe it for the whole family. The same to say this is a COVID kit. And now, they are referring to as a COVID positive. And you can just go in the pharmacy and say, “I’m looking for a COVID kit.” And it includes the antibiotics which are not usually supposed to be given over the counter. But the antibiotics which are usually prescribed by a clinician.
DR AMAL SAIF AL-MAANI: Many of those patients in the COVID unit would run into health care associated infection because their fever is continuously going on. So, every time they think they might have sepsis, they put them on really because of antimicrobial and that’s not making the MR issuee getting fixed, rather getting worse. We have also noticed outbreaks of multidrug resistant organisms that we haven’t seen before in the country during the COVID era. And one organism that I would mention is VRE. In our land we hardly see VRE bacteraemia prior to COVID. During COVID, there were outbreaks of vancomycin resistant enterococcus bacterium. And I think that might be partly related to the overuse of antimicrobial.
But the other reasons, the kind of people who were admitted to host in these units usually they are the patients who have come before chronic issues, chronic diseases, like renal transplant, diabetes, patients who are immunocompromised. So as a host, they can be the victims of health care associated infection. And they can get it easily and can turn from colonisation to bacteremia or to disease very easily. The other thing which is really disappointing during the outbreak that we thought the infection prevention and control strategies is going to eliminate the health care associated infection. But in fact what happened that there was an overuse for the prolonged use of the PPE so that they save the stocks of the PPE.
For example, like gloves. People who are working in this unit as health care workers were basically wearing PPEs , personal protective equipment, head to toe they are covered. So, they tend to forget to do hand hygiene because they are covered with their gloves, with their boots, with their suits. And this is the excellent environment to transmit with their hands that is gloved an infection from one patient to the other patient. The other thing that was compromised in this unit is the environmental cleaning and decontamination. Usually during outbreaks, we go and we do meticulous evacuation of the units. And cleaning them, double cleaning, and then we use decontamination.
During COVID it wasn’t possible because of the pressure on those units for patient care, especially during the peak time. With the community transmission, there was many patients admitted. Very high turnover, staff overwhelmed, the amount of work tends to make people tend to forget about practicing the bundles were almost missed. The bundles of inserting central lines. Dependents of preventing VAP. The other thing that other than the antimicrobial, there was use of many drugs like steroids, interleukin inhibitors, and other immunosuppressive drugs which makes it very easy for this drug to cause– for this pathogens to cause disease rather than colonisation for the COVID patients.

COVID-19 has disrupted many country programmes.

In this video you will hear from four country experts on the impact of COVID-19 on their AMR programmes.

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