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Care of fever cases, with antimicrobial prescribing and diagnostics, in face of COVID-19

By Heidi Hopkins

A few months into the pandemic, it’s become clear that we’ll have to find ways of accommodating the presence of the new coronavirus in our health care systems, societies, and economies for some time to come. This perspective presents some especially pragmatic challenges for colleagues – clinicians and/or researchers – whose work focuses on the care of febrile and respiratory illnesses, including antimicrobial prescribing and use. For the AMR Centre’s multidisciplinary readership, I thought it might be helpful to highlight a few relevant reviews that can provide a baseline understanding on which to build, as developments move ahead for SARS-CoV-2 therapeutics and diagnostics.

As noted in the two previous editions of this biweekly newsletter, patients suffering from Covid-19 may also be subject to bacterial and fungal co-infections (or secondary infections), with the potential for increased use of broad-spectrum antimicrobials, and the related need for an updated evidence base for antimicrobial stewardship programs. Two recent papers in CID provide a useful summary of our current understanding on this topic (Rawson, et al; Clancy & Nguyen).

Secondly, a silver lining of the coronavirus crisis is a wider appreciation of the importance of diagnostics for infectious diseases, for individual patient care, infection control, and to guide antimicrobial prescribing. A recent narrative review summarises the current status of SARS-CoV-2 diagnostics, some of which may eventually be incorporated into decision support tools in various clinical contexts around the world including middle- and lower-income countries. Also, the African Society for Laboratory Medicine hosts an excellent series of seminars and resources on this topic, in partnership with FIND and LSHTM.

Finally, as we are all too painfully aware, as yet there are no effective specific therapies for SARS-CoV-2, but what do we know from past experience with other viral pathogens (including SARS and MERS coronaviruses) that provides a basis for evaluation and development of antivirals, as well as a framework for considering the potential for future development of resistance?  Three papers from the pre-Covid-19 era offer some general background on therapeutics for emerging respiratory diseases and respiratory viruses in particular, and for environmental control of coronaviruses.

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