SEDRIC and COVID-19 in low- and middle-income countries; what can we learn?
21 May, 2020
The current response to COVID-19 is highlighting the coordinated efforts made by hundreds of thousands of clinicians, decision-makers and researchers around the world. Until a vaccine is made widely available, global coordination is the only solution to slowing the spread of the virus while also ensuring minimal impact to communities and economies.
Since the new coronavirus has spread from China, many countries have implemented various measures such as lockdowns in a bid to slow its spread, with varying levels of success. Governments around the world hoped that this would reduce the mortality and buy time to rapidly build surge capacity within health systems to help cope with the pandemic.
The Surveillance and Epidemiology of Drug-Resistant Infections Consortium (SEDRIC) brings together a wide range of specialists, with expertise in microbiology, public health and policy. Many of our members are based in low- and middle-income countries (LMICs), where the burden of COVID-19 is likely to have long-lasting impacts. In this article, we hear from our board members how these measures have impacted low resource settings.
- Testing and surveillance. Maintaining laboratory services for the diagnosis and surveillance of other key infectious diseases, such severe and antimicrobial-resistant bacterial infections, need to be maintained during the COVID-19 pandemic. SEDRIC has been working to identify critical gaps in surveillance systems in LMICs and advocate for better use of data to inform the spread of resistant infections. Professor Iruka Okeke from the Department of Pharmaceutical Microbiology, University of Ibadan suggests that expertise and resources that have been built over the past couple of decades for the surveillance of key infectious diseases needs to be expanded now that much of the surveillance capacity has been leveraged for COVID-19.
- Resource supply issues. Dr. Jyoti Joshi Head-South Asia, Center for Disease Dynamics, Economics & Policy in New Delhi is concerned whether India’s health care system will be able to cope with the rapid surge of cases expected at peak transmission. As many high-income countries in Europe and the USA are struggling with demand for critical care the situation has become particularly critical in settings where infrastructures are less resilient. Professor Nick Feasey, a Clinical Microbiologist and Infectious Disease Physician based at Queen Elizabeth Central Hospital, Blantyre, Malawi shares the same concerns. Much of the testing materials, medicines (including antibiotics), PPE, etc in LMICs are imported, shortages are likely to have a long-term impact beyond SARS-CoV-2.
- Lockdowns. Self-isolating can help slow down cases within the community however getting people to comply with this can be challenging for several reasons, especially in resource-limited settings. “It is very difficult to self-isolate if you don’t have refrigeration and cannot store food at home, you have no toilet facilities or must share with others, or – as is true even for most of the middle class – you don’t always have running water in your home.” says Professor Okeke.
- Easing restrictions. In Thailand, as with many other countries, finding the balance between reducing the shutdown measures and identifying which sectors should reopen first is a challenge. Associated Professor Direk Limmathurotsakul, Head of Microbiology at Mahidol-Oxford Tropical Medicine Research Unit suggested mobile phone applications, similar to those seen in South Korea, could help people play a role in Thailand. The ‘Thai Chana’ platform and its mobile application was launched and enforced by the Thai government on 17th May 2020. The platform aims to record who visits which public gathering places in real-time while protecting individuals’ confidentiality and privacy rights. This kind of surveillance would be quick, support the contact tracing and easily show where there are high rates of transmission. It would be unprecedented mass surveillance for any country, but particularly useful in densely populated areas. Similar technology is also being used in India to support efforts for contact tracing and reduce transmission.
Good surveillance should inform policies on regional and national preparedness. Future infectious disease outbreaks will be shaped by the policies implemented during this pandemic. Drug-resistant infections will follow similar patterns to COVID-19, from spreading through travel to resource constraints on health systems.
In a post-COVID world, what will data sharing, and data collection capabilities look like for other infectious diseases?
As the attention of many surveillance systems has become COVID-related, our board members have identified some likely outcomes which could change the way SEDRIC works post-COVID:
- New technologies. Many HIC and some LMICs are already adopting new data collection systems to track the situation, for resources (e.g. PPE), number of severe infected cases in ICUs and symptom tracking. Professor Limmathurotsakul suggests that these new technologies may be used for surveillance and sharing Drug-Resistant Infections data in the future. It will also be important for these new data collection systems to be evaluated to ensure efficacious generation of data. Moreover, COVID-19 has highlighted the need for greater focus on diagnostics and innovations in devices to predict infectious disease outbreaks.
- Changing priorities. Early evidence is suggesting that SARS-CoV-2 is having an impact on antimicrobial resistance potentially through an increased use of antibiotics in hospitals to prevent or treat secondary bacterial infections in COVID-19 patients. Dr. Joshi has highlighted some potential positive consequences of the increased focus on infection prevention and control (IPC) in the current pandemic which could reduce the spread of AMR as a result of COVID-19:
- Increased attention IPC at healthcare facilities can help to decrease Healthcare-associated infections (HAIs);
- Improved access to soap-water and hand sanitizers availability and use may lead to lower HAIs;
- Increased awareness of IPC and healthy behaviours like hand washing, good diet, elderly care and change in personal behaviours washing hands, covering of the mouth, banning of spitting (gutka/paan in LMICs), use of tissue and regular cleaning of public spaces can help decrease transmission of resistant infections.
- Global cooperation is key. Without a vaccine, as long as the SARS-CoV-2 is present in any country, it is a threat to every country. Professor Okeke stresses that rich and poor countries face the same challenges in containing infectious diseases. Without global cooperation (including sharing surveillance, supply chain, vaccine development and treatment data) we will not learn lessons to help contain future pandemics. As Professor Feasey suggests “By 2050*, hopefully, COVID will be a matter of historical record, but AMR will continue to be a major problem”.
*If we do not act now, AMR is expected to kill over 10 million people a year by 2050.