April 2020
COVID-19 Patients Need to Be Tested for Bacteria and Fungi, Not Just the Coronavirus
SCIENTIFIC AMERICAN
By Oliver Schacht
0/4/16/2020
In the midst of the global COVID-19 pandemic, hospitals are relying on tests capable of delivering reliable results, minimizing transmission risk and reducing time to treatment in the patients who need it most. Doctors are laser-focused on obtaining and using these tests to identify and treat patients with coronavirus. Yet the emerging risk of co-infections is pressuring hospitals to broaden their patient testing portfolios to address new mortality risks.
Many studies have already found that a significant number of hospitalized COVID-19 patients have and are continuing to develop dangerous secondary bacterial co-infections such as bacterial pneumonia and sepsis.Rapid diagnostic tests that identify the presence of bacterial or fungal infections and drug-resistant pathogens can and will play a critical role in the ongoing public health response to COVID-19.
A HIDDEN THREAT
Bacterial co-infections such as pneumonia pose a serious threat to high-risk COVID-19 patients, with many factors coming together to create severe, life-threatening and, in some cases, deadly complications that cannot be ignored by the health care community. Most at-risk are older adults and those with preexisting conditions as they’re more likely to be hospitalized for longer periods of time and require use of medical devices such as ventilators.
When these high-risk individuals end up in critical care, they are more likely to stay there for an extended period of time, increasing the risk for exposure to secondary bacterial infections. An estimated one in seven COVID-19 patients will develop a secondary infection while hospitalized. Further, a separate study found that only about 50 percent of patient deaths were due to the original viral infection, while the other 50 percent were caused by subsequent secondary infections.
Even when hospitals observe strict infection-control practices, it’s easy for viral and bacterial co-infections to make their way around, infecting multiple patients living in close quarters and attended to by the same staff. What’s more, the most severely ill coronavirus patients end up requiring mechanical ventilation, which, although a lifesaving procedure, will exacerbate the risk of bacterial infection when used over long periods.
This all boils down to a very dangerous situation for hospitalized patients. However, one way that health care professionals can get ahead of co-infections and improve patient outcomes is by adding testing for a broad spectrum of bacterial pathogens and antibiotic resistance markers when a COVID-19 test is administered.
DIAGNOSTIC ARSENAL
Time is critical when managing a novel virus and bacterial co-infections, which is precisely why rapid diagnostics are playing a crucial role in each phase of containing this pandemic. Readily available, FDA-cleared platforms can process patient samples in less than five hours with just two minutes of hands-on time, keeping pace with the urgency of care required for an outbreak like COVID-19. Samples gathered from any suspected coronavirus case should also be tested against a PCR-based panel capable of identifying a full spectrum of bacterial pathogens and antibiotic-resistance markers commonly known to cause co-infections and severe complications.
Incorporating these panels both during the initial testing process and throughout a patient’s entire hospital stay achieves several key goals.
- Avoiding misdiagnosis. More comprehensive testing rules out conditions that could be misdiagnosed during the fast-paced effort to provide care and ease patient suffering. This is even more crucial to patient care during a pandemic situation where symptoms are indicative of a variety of ailments.
- Administering faster treatment. With a full understanding of their patient’s condition, in a matter of hours instead of days, doctors can take appropriate action on antibiotic treatment faster.
- Preventing transmission. A study reported that, during the emergence of SARS in 2003, 76 percent of SARS-CoV infections were acquired in health care facilities, and patients with bacterial infections were found to be potential sources of superspreading. If doctors are able to identify other highly infectious diseases, including drug-resistant strains, they can isolate affected patients and reduce transmission rates.
- Preserving antibiotics. If other bacterial pathogens are detected, these tests also provide guidance on proper treatment, including informed use of antibiotics for patients who need them. Test results that encourage antibiotic stewardship can lower a patient’s risk of developing a drug-resistant infection and subsequent complications, while also preserving precious antibiotics by decreasing the depletion of intravenous antibiotics that are in short supply.
- Decreasing length of stay. If the above protocols and steps are taken, another result of effective testing and clear direction for the treatment of these co-infections can be reduction in time patients spend in critical care. Not only is this beneficial to the patients, it also frees up hospital beds and equipment for more urgent cases.
As health care workers focus on providing critically ill coronavirus patients and at-risk individuals with access to the best possible care, we must not underestimate the danger of bacterial co-infections that can arise during treatment or be exacerbated by preexisting conditions and hospital stays. If things continue at the current pace, these critically ill hospitalized patients are likely to be impacted by secondary infections, and many will die as a result.
Addressing the issue is simple. Fast and reliable testing panels and modern molecular diagnostic technologies already exist for these bacterial co-infections. Caregivers, doctors and advocates for the most at-risk populations should incorporate these into the COVID-19 care and treatment model moving forward to ease suffering and improve outcomes.
Note: The author is CEO of OpGen, which makes diagnostic panels that detect a broad range of bacterial pathogens and resistance markers, many of which are common co-infections for COVID-19 patients.
The views expressed are those of the author(s) and are not necessarily those of Scientific American.
