COVID-19 & AMR
The mysterious case of the missing hand sanitizers
The other day, Anum mentioned a colleague at work had cheekily pointed out the pointlessness of using hand sanitizer, an antibacterial agent, as a defense against coronavirus, a… virus. I thought about it for a second and responded with a confident “no, it’s not just antibacterial, it’s antimicrobial, silly!” (I may or may not have googled “is hand sanitizer antimicrobial?” a few minutes later. It is indeed, in case you were also wondering.) An antimicrobial is an antibacterial+; it kills bacteria, but also other microbes including viruses and fungi. Antimicrobials are much less discriminating about their targets than antibacterials. One way I distinguish antibacterial and antimicrobial agents is by thinking about whether I would swallow the agent. If yes — antibacterial (e.g. antibiotics); if no — antimicrobial (e.g. bleach, hand sanitizer.) It doesn’t always work that way, but it’s an easy shortcut. I am so glad my first two years of medical school have made me competent enough to explain the excruciatingly complex topic of hand sanitizer.
Hand sanitizer made its way back into my life a few days later in the form of a request — to go hunt some down. Aysha is getting married on March 28th. It’s been a beautiful cake of emotions, planning, and stress; what better icing than COVID-19? None, I tell you, not even butter pecan. So out I went, to find bottles of the stuff to decorate with bows and place around the wedding venue to provide guests with a source to take their anxiety out on every time a cough was heard. I checked aisles and aisles, stores and stores, but guess what? No hand sanitizer. Nada. Zilch. Diddly-squat. Every single bottle of hand sanitizer ever known to mankind had been purchased already. I was disappointed (but less than when we had to call off the reception itself — curses, covid!)
This hand sanitizer escapade did get me thinking though. A few years ago I did a bit of work around antimicrobial resistance (AMR). AMR is, in my opinion, the cancer of the future, with its ability to bring humanity back to a pre-antibiotic era, making us helpless against the very germs that we no longer take seriously due to our pharmaceutical advances. There has been a lot of momentum over the past few years amongst various sectors’ key players to take the threat of AMR into account in their decision making processes. So where does hand sanitizer fit into all this? Its use (along with bleach and Lysol and pretty much any other antimicrobial cleaning product) with a newfound aggression to prevent the spread of coronavirus may be placing selective pressure on all the other little buggers that live on our hands, doorknobs, elevators, and hospitals, similar to the one antibiotics place on the bacteria they target. Are there going to be long term consequences to the excessive disinfecting that is currently taking place around the world? Is there any data on the impact of sanitizers on the formation of resistant strains of pathogens? I didn’t know, so I did what I always do and clicked open a Google tab to find out.
Turns out there is some research that has been done on the subject. Science Translational Medicine came out with a study in 2018 that found that certain multidrug-resistant bacteria have become increasingly tolerant to alcohol based sanitizers which is making infection control more difficult in hospital settings; here is a NPR article that does a great job at elucidating the research and its implications further. There is also a 2019 study I found that ties disinfectant use in the poultry industry to the presence of multi-drug resistant foodborne pathogens, specifically Salmonella. Apparently, bacteria that are able to survive antimicrobial cleaning products are more likely to be resistant to multiple drugs. Drugs and disinfectants are some of our only defenses as humans against pathogens; if the usage of one is correlated to resistance of the other, we are in deep trouble, contributing to the presence and spread of superbugs everywhere.
So does this mean that we should stop disinfecting pronto? That hand sanitizers should be banned from existence? I definitely do not think so. Sanitization is one of few mechanisms we have to prevent the spread of COVID-19, to flatten the curve. We gotta do what we gotta do. That being said, hand-washing, gloves, and social distancing are also very effective measures to flatten that curve without having to pour bleach through the streets and perhaps contribute to problems for ourselves later down the road. So next time you have an urge to douse your hands in hand sanitizer, it might be a good idea to check and make sure washing your hands isn’t an option first.