Managing Infectious Diseases in a Post-Covid World

 

From news stories about real-world outbreaks to fictional scenarios in TV shows like The Last of Us, our media channels are filled with cautionary tales of just how quickly an infectious disease can spread – and the dire consequences it can bring. The COVID-19 pandemic has changed the way we think about infectious diseases,^1,2 and the world remains alert for threats that could lead to future outbreaks.^1,2 So what are the biggest healthcare threats causing the spread of disease right now? And how can in vitro diagnostic (IVD) testing help to combat them? 

Several key factors have been driving the spread of infectious diseases for many years, including:³  

• International travel and commerce 
• Microbial adaptation and change  
• Environmental changes  
• Breakdown in public health measures and surveillance  

In this article, we’ll discuss each of these factors in more detail. 

 

Global Challenges Affecting Infectious Disease Control

International travel and commerce 

For decades now, scientists have been discussing how factors like international travel can contribute to the spread of disease.^3,4 A paper published in 1995 predicted that:  

“New infections will continue to emerge, and known infections will change in distribution, severity and frequency. Travel will continue to be a potent factor in disease emergence. The current world circumstances juxtapose people, parasites, plants, animals, and chemicals in a way that precludes timely adaptation. The combination of movement at many levels and profound change in the physical environment can lead to unanticipated diseases spread by multiple channels. In many instances, the use of containment or quarantine is not feasible.” 3

The COVID-19 pandemic is the most widespread recent example of how travel causes disease to spread.⁵ In this case, the world was forced to suspend travel and enforce quarantines, and we saw how profoundly such a widespread lockdown can impact the global economy and healthcare sector.^6,7  

However, even before COVID, air travel in particular was a major factor in the spread of disease, including respiratory diseases (such as SARS, MERS and influenza) and tropical diseases (such as Ebola, dengue, Zika and chikungunya).⁴ Animals and plants being transported can also spread diseases to new locations.⁴ 

How IVD can help: Setting up temporary IVD testing centers at international airports can prevent infected passengers (including those who don’t have symptoms yet) from spreading a disease.⁸  

 

Microbial adaptation and change 

We can’t talk about infectious diseases without discussing antimicrobial resistance (AMR). AMR happens when microbes (bacteria, viruses, fungi and parasites) gradually stop responding to the medications that are supposed to kill them.⁹ This occurs when those medications are incorrectly used or overused.⁹ Other causes of AMR may include lack of sanitation and poor disease control measures, which cause microbes to spread.⁹ 

Resistant microbes are spreading further around the world, and international air travel is again a big reason for this.⁴ Travelers returning from areas with high AMR rates can easily bring these organisms back to their home country.⁴ In this way, resistant bacteria, viruses, fungi and parasites start to spread diseases far from where they originally started.⁴  

AMR makes it harder to treat infections effectively, and the World Health Organization recognizes it as a major global health threat.⁹ The spread of ‘superbugs’ (microbes that are resistant to multiple medications) is especially concerning.⁹  

How IVD can help: Rapid and accurate diagnosis can prevent the over prescription of medications like antibiotics and can also improve disease control.¹⁰ 

 

Environmental changes 

Certain diseases are more likely to break out in areas affected by climate change, where higher temperatures and precipitation levels create an environment that promotes the spread of vector-borne diseases.¹¹ Examples include malaria, cholera and rotavirus.¹¹ 

Climate change is also linked to natural disasters.¹² Extreme weather events like floods and earthquakes may kill hundreds or even thousands of people immediately, but many more lives are lost later, due to infectious disease outbreaks caused by issues like poor sanitation, overcrowding, lack of healthcare access, and exposure to disease-carrying organisms.^13,14 

Read more about natural disasters and infectious diseases. 

How IVD can help: After a natural disaster, hospitals and clinics are quickly overwhelmed with patients, and many people in need can’t access healthcare facilities due to infrastructure problems.¹⁵ IVD tests are extremely valuable in this scenario, because they can be used in point of care (PoC) situations, where testing is done at or near the site of patient care, using mobile equipment to quickly detect a range of infectious diseases.^15,16 PoC testing makes it easier to diagnose, effectively treat and monitor diseases under these challenging conditions.^15,16 

Breakdown in public health measures and surveillance 

Recently, we’ve seen diseases that were previously under control start to re-emerge.¹⁷ This re-emergence can be caused by breakdowns in healthcare access and delivery, for example when conflict or natural disasters lead to forced migration and/or reduced vaccination coverage.^13,14,17 The rise in cases of a disease can also be the result of factors like low vaccination rates, microbial adaptation, human population growth and planned migration.^17,18  

Notable examples of diseases re-emerging or rising in prevalence because of healthcare disruptions include the following: 

Measles outbreak caused by lower vaccination rates: Over the course of 4 decades, immunization programs helped to reduce measles-related deaths by 96%.¹⁸ But since 2017, countries around the world have been experiencing a resurgence in measles.¹⁸ During the first half of 2019, the number of reported cases was at its highest point in 13 years.¹⁸ This has been caused by a drop in the number of people being vaccinated against measles, mumps and rubella (MMR).¹⁸ 

In some countries, the lower rate of vaccination is caused by lack of access to healthcare, which can happen in times of war, political conflict and socio-economic collapse.¹⁸ In other countries, it can be caused by vaccine hesitancy.¹⁸ 

Cholera outbreak caused by ecological changes/natural disaster: Haiti experienced an outbreak of cholera in October 2010, after an earthquake devastated the country nearly 10 months earlier.¹⁹ This was a resurgence after more than 3 years with no reported cholera cases in Haiti.¹⁹ The outbreak caused over 820 000 cases of cholera and killed nearly 10 000 people.¹⁹ 

Rising STI rates caused by limited healthcare access: The COVID-19 lockdown disrupted routine healthcare and had a major impact on screening and care for sexually transmitted infections (STIs).²⁰ This was partly because shelter-in-place/lockdown orders meant many patients stopped going to clinics for testing and partly because STI program resources were redirected to COVID-related activities.²⁰ Data shows that, between 2019 and 2021, gonorrhea cases increased by 15% and primary and secondary syphilis cases increased by 38%.²⁰ 

How IVD can help: IVD point of care tests help with disease diagnosis and control in unstable or resource-limited scenarios, like natural disasters.^15,16 IVD testing also makes at-home diagnosis easier – for example, home COVID testing has become second nature to people around the globe.²¹ We can expect to see an increase in demand for home diagnostic testing, most likely for respiratory infections like RSV (respiratory syncytial virus) and influenza.²¹ This would mean fewer patients would need to go into a clinic or urgent care for testing, which in turn would reduce the risk of spreading infections.²¹ At-home STI testing would also be beneficial to patients who are worried about stigma or embarrassment associated with their condition.²¹ 

Medix Biochemica's Covid Response and Pandemic Preparedness

During the pandemic, Medix Biochemica was faced with high demand for excellent IVD products, in large quantities and at a rapid rate.²¹ We delivered, expanding on our existing materials to provide a range of sensitive, specific reagents for use in COVID testing.²¹ We constantly worked to improve our products during this time, keeping up with emerging COVID variants to produce suitable testing reagents.²¹ 

Medix Biochemica is also able to offer a quick turnaround time on products, to meet urgent customer needs.²¹ 

We believe in being prepared, and keep a broad range of products in our portfolio in the event of future outbreaks when quick, accurate diagnosis might be crucial:²¹  

• Since the pandemic, we’ve seen an increase in demand for products like influenza antibodies, as many companies expect respiratory diseases to continue to pose a major healthcare threat.²¹  
• Our products include a number of inflammation biomarkers and respiratory antibodies that can be used to differentiate between viral and bacterial infections.²¹  
• Proper differentiation prevents instances where doctors will treat an infection with antibiotics unnecessarily, ‘just in case’.²¹ By reducing improper use and overuse of antibiotics, we can help to combat the threat of AMR.²¹  

Read more about the importance of differentiating between bacterial and viral infections.

COVID has changed the face of healthcare forever, and the Medix Biochemica team brings a spirit of innovation and adaptation to this new on-alert-for-infections world. We look forward to partnering with present and future customers, to make IVD testing more accessible and beneficial than ever before. 

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References:  

1. Industry innovation: how has COVID-19 changed global healthcare? World Economic Forum. Accessed May 2, 2023. https://www.weforum.org/agenda/2020/11/healthcare-innovation-covid-coronavirus-pandemic-response-health/. 
2. Lessons learned from COVID-19 pandemic: virtual regional consultation with informal expert group. World Health Organization South-East Asia. 2021. Accessed May 2, 2023. https://www.who.int/publications-detail-redirect/sea-whe-6. 
3. Wilson ME. Travel and the emergence of infectious diseases. Emerg Infect Dis. 1995;1(2):39-46. doi: 10.3201/eid0102.950201.
4. Findlater A, Bogoch II. Human mobility and the global spread of infectious diseases: a focus on air travel. Trends Parasitol. 2018;34(9):772-783. doi:10.1016/j.pt.2018.07.004.
5. Khanh NC, Thai PQ, Quach HL, et al. Transmission of SaRS-CoV 2 during long-haul flight. EID - CDC. 2020;(26):11. doi:10.3201/eid2611.203299.
6. The economic costs of restricting international mobility. OECD. Accessed May 2, 2023. https://www.oecd.org/publications/the-economic-costs-of-restricting-international-mobility-dcad4c73-en.htm.
7. Wenger NS, Stanton AL, Baxter-King R, et al. The impact of COVID-19 on routine medical care and cancer screening. J Gen Intern Med. 2022;37(6):1450-1456. doi:10.1007/s11606-021-07254-x.
8. Wong SC, Leung M, Lee LLY, et al. Infection control challenge in setting up a temporary test centre at Hong Kong International Airport for rapid diagnosis of COVID-19 due to SARS-CoV-2. J Hosp Infect. 2020;105(3):571-573. doi:10.1016/j.jhin.2020.05.006.
9. Antimicrobial resistance. World Health Organization. Accessed May 2, 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. 
10. Expert opinion. Interview with Gerben Zuiderveld, Sr. Global Product Manager, Medix Biochemica. March 2023. 
11. Climate change: fires, floods, and infectious diseases. Lancet Microbe. 2021;2(9):e415. doi:10.1016/S2666-5247(21)00220-2. 
12. Anderson J, Bausch C. Climate change and natural disasters: scientific evidence of a possible relation between recent natural disasters and climate change. Policy brief for the EP Environment Committee IP/A/ENVI/FWC/2005-35. 
13. Quintanilla N. Outbreaks of vector-borne infectious disease following a natural disaster. Georgetown Medical Review. 2022. doi:10.52504/001c.38768. 
14. Charnley GEC, Kelman I, Gaythorpe KAM, et al. Traits and risk factors of post-disaster infectious disease outbreaks: a systematic review. Sci Rep. 2021;11(1):5616. doi:10.1038/s41598-021-85146-0. 
15. Tran NK, Godwin Z, Bockhold J. Point-of-care testing at the disaster-emergency-critical care interface. Point Care. 2012;11(4):180. doi:10.1097/POC.0b013e318265f7d9.
16. Li C. Special topic: point-of-care testing (PoCT) and in vitro diagnostics (IVDs). J Anal Test. 2019;3(1):1-2. doi:10.1007/s41664-019-00095-y.
17. Ka-Wai Hui E. Reasons for the increase in emerging and re-emerging viral infectious diseases. Microbes Infect. 2006;8(3):905-916. doi:10.1016/j.micinf.2005.06.032.
18. Hotez PJ, Nuzhath T, Colwell B. Combating vaccine hesitancy and other 21st century social determinants in the global fight against measles. Current Opinion in Virology. 2020;41:1-7. doi:10.1016/j.coviro.2020.01.001.
19. Cholera in Haiti. Centers for Disease Control and Prevention. Accessed February 17, 2023. https://www.cdc.gov/cholera/haiti/index.html.
20. Impact of COVID-19 on STDs. Centers for Disease Control and Prevention. Accessed May 2, 2023. https://www.cdc.gov/std/statistics/2021/impact.htm. 
21. Expert opinion. Interview with Amy Moore, Product Manager, Medix Biochemica. April 2023. 

22. Laura-Leena Kiiskinen. Email communication. April 26, 2023.