Antibiotics cannot cure COVID. They don’t help at all against the virus. Despite this, new data reveals that COVID patients were given antibiotics extensively during the pandemic.

This is problematic because the overuse of antibiotics can lead to the development of superbugs that are resistant to medications. The repercussions of this pandemic-induced overuse continue to affect us even as the pandemic recedes.

So, how did this happen? A series of recent reports and papers shed light on the situation.

Globally, around 75% of patients hospitalized with COVID received antibiotics, despite only 8% having a bacterial coinfection where antibiotics would be medically necessary. This information comes from data collected through the World Health Organization’s Global Clinical Platform across 65 countries between January 2020 and March 2023, and published in late April.

“It’s sobering to see these data,” says Dr. Helen Boucher, dean of Tufts University School of Medicine in Boston, who specializes in antimicrobial resistance and was not involved in the study.

The WHO indicates that antibiotics were often used “just in case” they might help. Boucher suggests several factors contributed to this. First, early in the pandemic, clinicians lacked knowledge about COVID and were concerned about secondary bacterial infections, which sometimes require antibiotics. Second, the hospital personnel who typically oversee the proper use of antibiotics were diverted to handle the surge of COVID patients.

The data vary globally. The region with the lowest antibiotic use during the pandemic was the Western Pacific, from Australia to China, at 33%. The highest use was in the Eastern Mediterranean and parts of Africa, at 83%. Antibiotic prescriptions decreased in Europe and the Americas between 2020 and 2022 but increased in Africa.

“In low- and middle-income countries, there was significantly less access to diagnostic tests and vaccines early in the pandemic. Thus, antibiotics were often the only tool available to healthcare providers,” Boucher explains. “That’s not an excuse, but it might be an explanation.”

A Sweeping Global Toll

Globally, at least 1.2 million deaths are directly caused by drug-resistant pathogens. According to a series of papers published this month in The Lancet, 750,000 of these deaths in low- and middle-income countries could be avoided with practices such as improved hand washing, better sanitation, and the sterilization of healthcare equipment.

Antibiotic resistance is also a significant issue in high-income countries like the U.S. Boucher recalls patients who died due to antimicrobial-resistant infections, stating she has had to send hospital patients to hospice care because no effective antibiotics were available—a situation unheard of 30 years ago.

Antibiotic practices during the pandemic reversed progress made before it. New data show a continued increase in infections caused by superbugs in U.S. hospitals. Between 2012 and 2017, deaths caused by resistant bugs in hospitals dropped by nearly 30%, according to the U.S. Centers for Disease Control and Prevention. However, during the pandemic, infections from resistant bugs like carbapenem-resistant Acinetobacter significantly increased.

Researchers from the National Institutes of Health found that hospital-acquired antibiotic-resistant infections jumped 32% during the pandemic compared to pre-pandemic levels, rising from 28 cases to 38 cases per 10,000 hospitalizations. Although this number has decreased, it remains more than 12% above pre-pandemic levels as of late 2022.

“That’s worrisome,” says Dr. Sameer Kadri, an antibiotic resistance epidemiologist at the NIH and an ICU physician. “That tells me that we’re not back to our baseline. And considering the status quo as the new normal is a colossal mistake.”

The causes of these elevated levels are unclear. It may be due to ongoing short-staffing in hospitals affecting infection control, but one thing is certain: When antibiotics fail, patients suffer.

“The antibiotic resistance problem in the U.S. and globally is one of our greatest healthcare challenges today,” Kadri asserts.

In September, the United Nations General Assembly will convene a high-level meeting to address antimicrobial resistance and discuss strategies to prevent it from worsening.