The case of anti-microbial resistance: Adding worry to the woes of COVID-19 pandemic

The WHO, in 2019, said AMR is one of the top 10 threats to health, with speculation emerging of it having the potential to become a global epidemic

By Sughosh Madhav
Published: Wednesday 26 August 2020

The current novel coronavirus disease (COVID-19) pandemic brought attention to the large-scale negative consequences of uninhibited human interference in natural ecosystems. Humans’ desire to obtain quick gains and fullfil monetary benefits destroyed several of these ecosystems.

Water is essential for our survival, growth and development. The proper upkeep of the aquatic system is key to our survival. Several human activities, however, interfere with the health and functioning of the aquatic ecosystem, resulting in conditions harmful for human health and survival.

While the common effects of water pollution are well-known, there are a few hidden, more dangerous impacts critical for our overall health as well.

One of them is the development of anti-microbial resistance (AMR), the opposition of a microbe to the drug designed to kill it. This occurred due to a particular type of pollution that emerged from pharmaceutical waste from several sources. The World Health Organization (WHO), in 2019, said AMR was one of the top 10 threats to health, with speculation since then of it having the potential to become a global epidemic.

This is relevant for the current situation where — even though SARS-CoV-2 is a virus — affected people are likely to develop secondary bacterial infections. The presence of AMR, thus, makes treatment harder in this case.

Emergence of NDM-1 enzyme

India’s connection with AMR is rather infamous: One of the widely known reasons for this was the New Delhi metallo-beta-lactamase-1 (NDM-1) enzyme, that made bacteria resistant to a broad range of beta-lactam antibiotics.

The naming of this enzyme after the country’s capital city happened after it was detected from a Swedish patient of Indian origin in 2008.

More than 10 years later, the gene responsible for this enzyme was isolated from the Arctic’s Svalbard region. This signified its ability to spread far and wide: A common characteristic of a precursor to global epidemics.

This event again brought the importance of antibiotic stewardship and implementation of the law related to the responsible consumption of antibiotics, to the notice of health practitioners.

In his latest book, Biography of Resistance: The Epic Battle Between People and Pathogens, Muhammad Hamid Zaman, Howard Hughes Medical Institute Professor at Boston University, said the presence of AMR can aggravate complications from COVID-19. He said this will be a significantly difficult situation to manage.

Antibiotic resistance

Antibiotic resistance refers to the phenomenon when common disease-causing bacteria stop responding to regular antibiotic drugs. It was earlier thought that an incomplete treatment routine for diseases such as tuberculosis was commonly responsible for the emergence of resistant strains of bacteria.

Recent research, however, showed contamination of water sources to be a major cause of the emergence of antibiotic resistance. The development of antibiotic resistance in pathogens emerged as a public health issue in recent years and was said to be responsible for the death and morbidity of a large number of people.

A 2014 report published by the WHO described antibiotic resistance as a major and serious threat to human health at the global level.

Considering the seriousness of the issue, the World Health Assembly adopted the Global Action Plan on AMR in 2015. This was soon followed by India’s National Action Plan for AMR released April 2017 by the Union Ministry of Health and Family Welfare.

Antibiotic resistance due to the contamination of the water sources gives rise to a super-powerful strain of bacteria, commonly known as a superbug. The process of the development of superbugs involves a gradual mixing of low concentration of antibiotics with bacterial communities in water sources.

With time, a certain fraction of resident bacterial communities develops immunity (resistance) to the antibiotics in their surroundings. This immune bacterial community later transforms into superbugs through repeated reproduction.

The NDM gene has been responsible for the current antibiotic resistance across India. The spread of the NDM gene and, thus, antibiotic resistance has been linked with large-scale human movements, such as pilgrimages.

Treating wastewater

There are several ways through which antibiotics get mixed in the water. Major sources are effluent waste from pharmaceutical companies, untreated households’ sewage and large-scale deposition of organic matter in water sources and streams. Waste material from pharmaceutical companies are the primary reason for the development of antibiotic resistance in India.

Traditional wastewater treatment methods have not been effective in removing these compounds. Water sources near manufacturing plants were some of the hotspots for the development of antibiotic resistance. Indiscriminate consumption of antibiotics by humans contributed significantly to the development of superbugs in many countries.

A large proportion of the active compounds in an antibiotic is excreted and flushed down after human consumption. When sewage from households enters water sources, it contaminates the sources with a mixture of antibiotics, creating conditions for the development of antibiotic resistance.

Apart from this, organic wastes from animals on which antibiotics are tested are also one of the sources of antibiotic resistance.

Containment of antibiotic resistance is one of the top management priorities in the water sector. Several management options, including nutrient management, runoff control and infrastructure upgrades for efficient water treatment were identified to reduce the development of antibiotic resistance.

Stopping open defecation along the stream of rivers is one of the possible ways to reduce microbe load in the stream.

A more mechanical process

We also need to establish an adequate number of advanced sewage treatment plants for the treatment of domestic sewage. It is the need of the hour for sewage treatment plants to involve a mechanical process with fewer human inputs.

The use of manual labor inputs can expose vulnerable individuals to resistance microbes and lead to the emergence of disease. Across system-transmissions — including, for example, human-to-animal, natural to human systems — are major causes of global pandemics. Our attention should, thus, be on decreasing such transmissions.

Sewage treatments need to be more mechanised to limit such transmission. There is a need for strong political will and strong coordination between different sectors to implement these strategies.

There is also a need for large-scale public awareness measures where people are made aware of these issues. This is critical because the presence of antibiotic resistance is not reflected by any symptoms that make us even less aware of this problem.

About 60 per cent of healthy Indians showed signs of one or more types of antibiotic resistance, according to a study conducted by the Indian Council for Medical Research. We should, thus, pay more attention to practices we follow that contribute to this phenomenon.

Views expressed are the author’s own and don’t necessarily reflect those of  Down To Earth.

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