There will be many discussions over the next few years about what we have learned from the COVID-19 pandemic and how to respond to it. There also needs to be a discussion of the things we missed when we focused on the virus itself, among them the growing problem of antimicrobial resistance (AMR). AMR has major implications for our healthcare system: A new report from the Centers for Disease Control and Prevention (CDC) found that infections and deaths attributed to AMR increased by 15% in 2020, nearly erasing the 18% decline seen between 2012 and 2017.
As a reminder, AMR occurs when bacteria adapt to antibiotics and evolve to such an extent that they no longer respond to drugs. AMR is exacerbated by the misuse and overuse of antibiotics, accelerating the evolution of bacteria beyond our current ability to treat them. This process has disastrous consequences for humans: Supposedly “superbugsare threatening to wreak havoc across the world.
What has led to this massive increase in RAM-related infections and deaths? This was largely due to the lack of knowledge about COVID-19 and the many adjustments our medical system had to make to deal with it at the start of the pandemic. Between March and October 2020, nearly 80% of patients hospitalized with COVID-19 received antibiotics, likely due to the similarity of symptoms of the virus to those of pneumonia during initial patient assessments. Rapid tests were not widely available for much of 2020, so cases of COVID-19 could not be identified easily and quickly.
Other drivers of RAM noted by the CDC include overwhelmed labs and reduced testing for non-COVID infections. Bacterial submissions to the CDC’s network of testing labs fell 21% in 2020, and some of the network’s labs were repurposed to test for COVID-19, resulting in backups.
The hospital’s infection protocol also took a hit during the early days of the pandemic. Personal protective equipment (PPE) was scarce and infection protocol staff were often redirected to help COVID patients. Worse still, hospitals had to deal with a deluge of patients staying longer in hospital requiring more frequent use of items such as catheters and ventilators, creating greater exposure to hospital-acquired infections (HAIs). Among the more than 29,400 people died of AMR infections in 2020, 40% were due to nosocomial infections.
Adding to all of this, the CDC States that many people with bacterial infections who would otherwise have gone to hospital for treatment have avoided doing so, allowing the infection to run its course. With mild infections this is usually not a problem, but with serious infections such as tuberculosis it can be fatal. Although not fatal, bacterial infections can grow and mutate inside a person and spread through a community if left untreated, potentially resulting in bacteria that are harder to eradicate.
Finally, the RAM problem could be even worse than we know: for nine of the 17 identified RAM threats, 2020 data is delayed or unavailable, meaning we don’t yet know the extent of the problem. To be clear, the growth in AMR threats – and certainly the increase in cases and deaths – is both alarming and tragic; it would also have been incredibly difficult to avoid. Doctors followed standard protocol when prescribing antibiotics to patients who had pneumonia-like symptoms, and hospitals faced a rush of patients, so normal protocols had to be quickly adjusted to accommodate. under current conditions. And decisions had to be made with the information available at the time, even information as scarce as we had at the start of the pandemic.
Unfortunately, there are no easy answers, as it is impossible to guess the exact needs of patients during the next health crisis. It’s nonetheless worth making sure we learn all we can about what went right – and what went wrong – in the response to the COVID-19 pandemic. One of the lessons to be learned is the importance of ensuring that our health care system remains flexible enough to meet various challenges. The CDC suggests this will require a more secure medical supply chain, investments in lab networks for greater capacity so they can continue to test for bacterial infections simultaneously with new diseases, and foresight from health officials. public health, hospitals and providers to continue to report collateral events during major health emergencies. It’s a tough challenge, but with the next one health crisis always around the corner, this is the one we have to face.
Review of the charts: Hospitals’ adherence to the final price transparency rule
Evan Turkowsky, Health Care Policy Intern
On July 1, the final rule on coverage transparency issued by the Centers for Medicare and Medicaid Services (CMS), which requires health insurers to publish the prices paid for hospital and physician services, went into effect. The rule aims to increase the transparency of healthcare prices for patients. Still, initial compliance with the similar final rule on hospital price transparency that required hospitals to disclose their prices starting in January 2021 offers a cautionary tale. In a recent report by the Journal of the American Medical Association (JAMA) network, researchers found that only 5.7% of 5,239 hospitals registered with CMS signed up to the hospital price transparency final rule over the past few years. first nine months. As shown in the table below, the majority of hospitals assessed (51.8%) were classified as small – those containing less than 100 beds – and only 3.1% initially adhered to the transparency rule. Similarly, 1.6% of the hospitals assessed were classified as medium and fully adherent to the rule in the first nine months and 1.1% were large and fully adherent. The main reasons for non-adherence included the lack of a purchasable display and/or the absence of machine-readable files. According to a report by PatientRightsAdvocate.org, only 14.3% of all hospitals had fully adhered to the rule after the first 12 months.
Data Source: The JAMA Network and PatientRightsAdvocate.org