- - Monday, February 24, 2020

Last week, I cared for a patient with coronavirus who we will call Jane. When she entered my emergency room on the Upper East Side of Manhattan, Jane was exhausted and gasping for air. She was battling a severe infection — and it was my job to save her. 

I am an infectious disease specialist at Weill Cornell Medical Center. My co-author is Dr. Andrew Tomaras, a microbiologist who has dedicated his career to antibiotic drug discovery and advanced diagnostics. We are accustomed to these situations. But when I told Jane the diagnosis, she flinched. “That can’t be. I’ve never been to China.”

Jane was infected with coronavirus, but not the one from Wuhan, China, known as Covid-19. She had contracted another strain, one common to the United States and most of the industrialized world. Shortly after rendering the diagnosis and initiating treatment, something was wrong: She was not getting better.

Jane’s breathing became more labored and her heart rate had spiked. Soon after, her lungs filled up with fluid. Like many patients with coronavirus — both here and in China — Jane had a superimposed bacterial infection. Our experience is that often these secondary bacterial infections are what kill patients rather than the initial virus that first makes them sick. 

Antibiotics were in order, but unlike her viral infection, doctors and infectious disease specialists usually do not have a precise diagnosis to guide their drug selection. There is no rapid test available to tell us what bacterium had invaded Jane’s lungs. So we are forced to guess which antibiotic to use. And, this time I guessed wrong.  

Like many of those infected with Covid-19, Jane was suffering from a secondary lung infection, one that was far more dangerous than the coronavirus she was coughing up. She needed a more powerful antibiotic, one that could eradicate the aggressive bacteria and potentially save her life. But options were limited. 

As leaders in the field of infectious disease, we find this unfortunate conundrum is all-too familiar. Diagnostic uncertainty and the emergence of drug-resistant superbugs complicate treatment options. Had there been a rapid, multi-purpose diagnostic test available, therapy could have been initiated sooner and potentially prevented the worsening of Jane’s condition. If that test had also provided accurate identification of the invading pathogen and guidance on which antibiotic to prescribe, we could have minimized guesswork and improved the quality of her care. 

At the bedside, I struggled to find the right antibiotic as she struggled for air. As a second antibiotic — one that was created in the 1950s — dripped into her vein, I realized that something was very wrong: Jane was infected with a multi-drug resistant superbug. 

Stories like this are unfortunately becoming more common, and the threat is expanding. Antibiotic resistance is poised to become our greatest threat to public health: The World Health Organization predicts that by 2050, superbugs will kill 10 million people worldwide every year. 

Antibiotic stewardship efforts can help protect our drug armamentarium, yet clinicians are too often caught between a rock and a hard place, seeking to withhold antibiotic prescriptions for uninfected patients, but often erring on the side of a prescription due to diagnostic uncertainty.

Health officials across the country are currently confronting these realities as they react in real-time to the Covid-19 outbreak while policymakers work in a bipartisan way to address this threat. Earlier this month, House Appropriations Committee Chairwoman Nita Lowey and Rep. Rosa DeLauro urged Health and Human Services Secretary Alex Azar to submit a request for emergency funding to increase investments in new drugs and diagnostics.  

As Congress considers how to address the coronavirus, we believe it should also examine how to increase funding for new antibiotics and improved diagnostics. These two issues go hand-in-hand: Support for new antibiotics and diagnostics would not only improve the ability of the medical community to respond to health threats as they arise, but also catalyze stewardship efforts that protect our current antibiotic arsenal.

The recent coronavirus outbreak should serve as a wake-up call for our domestic biopreparedness for future epidemics, whether disseminated naturally or intentionally. The potential to weaponize biowarfare agents such as plague, anthrax or other virulent/multi-drug resistant pathogens should not be taken lightly. They not only threaten Americans nationwide, but also our military personnel deployed in combat zones across the globe. Better antimicrobial agents and improved diagnostics would transform medicine and prove critical in the event of a biological attack. This time, Jane survived. Others might not be so lucky.

Dr. Matt McCarthy is an assistant professor of medicine at Weill Cornell Medical College and author of “Superbugs.” He serves as editor-in-chief of Current Fungal Infection Reports. Dr. Andrew Tomaras leads R&D at BacterioScan and serves as a member of the National Institutes of Health Drug Discovery and Mechanisms of Antibiotic Resistance review panel.

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