18thNovember marks the start of World Antimicrobial Awareness Week. Health workers, scientists and global institutions like the World Health Organisation will be doing their best to increase awareness of global antimicrobial resistance (AMR), and urging policy makers to take swift and firm action to avoid the ongoing emergence and spread of drug-resistant infections.
I have similar calls for action in my novel, The Waiting Rooms, in the decades leading up to the antibiotic crisis. Calls that, despite the very real evidence of an impending disaster, fall on deaf ears. As one of my characters, Mary, says: ‘It’s like watching a plane crash, in slow motion.’
Of course, the misery that coronavirus has inflicted on so many people over the past year has highlighted the cataclysmic impacts of health emergencies, that even our advanced technologies and sophisticated minds cannot overcome. And those impacts will continue, long after the virus has gone. Which gives me hope that governments worldwide may be a little more receptive to calls for action on other health emergencies, like AMR, as opposed to focusing on the next short-term vote-winner or burying their respective heads in the sand.
Because we do need action. Now.
As I have said in previous blogs, the coronavirus pandemic is unfortunately accelerating the rise of antimicrobial resistance. The huge volumes of antibiotics and other drugs being prescribed to treat primary and secondary infections in COVID-19 patients are giving bacteria and viruses the opportunity to develop resistance, spread further and leach into our waste water systems, rivers and oceans.
What’s more, the disruption to health services caused by the pandemic, and delays in the diagnosis and treatment of other infectious diseases are allowing those diseases to spread too, including that age-old foe that triggers a pandemic in my novel: Tuberculosis.
Before COVID-19, over 4,000 people were dying from TB every day. According to new estimates published in the European Respiratory Journal, that number could rise significantly if there is substantial health care disruption and social distancing measures aren’t adequate. Models predict between 100,000 and 200,000 additional TB deaths over the next five years in India, China and South Africa alone, undoing the good work that has been painstakingly achieved to stem the growth of this increasingly drug-resistant disease.
TB has always been an opportunist, taking advantage of compromised immune systems, and natural disasters since the Ancient Egyptians. As Mary says, in The Waiting Rooms: ‘Let’s face it, anything that can flourish for three million years must be pretty adept at survival.’
Current thinking is that having pulmonary TB does not make you more likely to contract COVID-19, but if you do fall ill, the severity of the infection is likely to be worse because of existing damage in the lungs. And if your treatment for TB is disrupted, especially if it’s a drug-resistant strain, then the predicted outcomes are not good.
I appreciate this isn’t very cheery. But then, if you have read The Waiting Rooms, you wouldn’t expect it to be. After all, the realm I inhabit is dystopian thrillers. But at least this one hasn’t happened. Yet.
By illustrating the very real horrors of a world where antibiotics no longer work, the hard choices inflicted on society when infections run rampant, and showing just how easily that could happen, I am hoping that, in its own small way, The Waiting Rooms will contribute to awareness about antimicrobial resistance, and may even nudge a few of those actions further along. Because this story needs to remain fictional. We’ve got more than enough dystopia to cope with in our lives.
Eve Smith is author of The Waiting Rooms.
