The time had finally come to start my final immersion at Duke University Hospital in Durham, NC. I was excited, but mostly nervous about what I would experience. This immersion would be like no other because we were facing the early stages of the COVID-19 pandemic. PPE was running low at most hospitals, screening was not being done enough around the country, and more people were becoming hospitalized due to COVID-19. I was worried for my own health, but I knew Duke had taken great measures and precautions for the safety of not only the patients, but healthcare workers as well.
On my first day arriving at Duke, I immediately saw signs for wearing masks on campus everywhere. At Duke everyone on campus even outside of the hospital were required to wear masks at all times. As soon as I entered the hospital my temperature was taken, I was asked questions regarding my symptoms, and was given a new sticker each day to wear to show that I was healthy. My first month of rotations was in cardiology. One concern in cardiology, was the resemblance of certain classic symptoms such as shortness of breath and cough for heart failure being similar to COVID-19. Fortunately, all patients were screened rapidly for COVID-19 when admitted, so the chances of these symptoms being COVID-19 were relatively low. Since I was doing my clinical direct patient care immersion, typically this would require rounding in patients’ rooms with the team to decide on diagnosis and treatment. However, with COVID-19 pharmacy students were not allowed to enter patient rooms, but we were able to still round with the team going door to door to make recommendations. I remember seeing some interesting patient cases such as a patient who was diagnosed with Takotsubo cardiomyopathy, otherwise known as broken-heart syndrome. This patient was a previously healthy female and had a normal ejection fraction until her husband unexpectedly passed away. Her ejection fraction in the hospital was around 20% and was immediately classified as a heart failure patient due to this syndrome.
During my second month at Duke I rounded in the pediatric floor. I loved working with and seeing all the children. It was devastating to see children in the hospital, however their resiliency and braveness at such a young age inspired me. All of the children I met from afar had such a positive attitude no matter what their diagnosis or illness was, which was truly astonishing to me. Some unfortunate few cases we saw at the hospital, which was new to all of the medical providers was MIS-C in regards to COVID-19. MIS-C otherwise known as multisystem inflammatory syndrome in children is a rare complication that can occur in this case due to an exposure to COVID-19 and can cause different parts of the body to shut down if not treated properly. I was able to present this new syndrome to the pharmacists along with treatment options.
Although my last immersion was not exactly how I expected it to be, I am prouder than ever to be a part of a healthcare team in a time like this when healthcare workers are vital in defeating this pandemic. My appreciation for all medical providers and frontline workers definitely heightened as they dealt with the most difficult challenges this pandemic offered. I hope to one day become a strong and resilient healthcare provider as they are.
Written by: Sarah Mouna
Are we to look forward to a future where people succumb to infections as they would have prior to the 1900s?
In the 1920s, Alexander Fleming’s discovery of penicillin kickstarted a whole new era of medicine. The impact was such that penicillin was used to treat pneumonia in soldiers on the battlefields during World War 2. And yet a century later in 2020, over 12,000 people die in the UK due to antibiotic resistance with the number increasing to over 700,000 worldwide. So how did antibiotics go from a “miracle drug” that could cure illnesses previously feared by physicians, to a source of concern for doctors worldwide?
After the discovery of penicillin in 1928, infections which previously resulted in loss of life were now being adequately treated by antimicrobials. Antimicrobials include antibiotics, antivirals and antifungals. They are vital in preventing and treating infections. An infection arises when a pathogen enters your body and begins to multiply, with a pathogen being a microorganism (such as bacteria) that causes disease. Antimicrobial resistance occurs when microorganisms no longer respond to the antimicrobials designed to kill them. When antimicrobials lose efficacy as a result of antimicrobial resistance, people can succumb to any number of infections. It has become increasingly apparent that antimicrobial resistance poses a real threat to mankind. In fact, antimicrobial resistance has recently been reported by the World Health Organization (WHO) as one of their top 10 threats to global health.
Antibiotics are an example of antimicrobials which are used very widely. They have applications in hospitals, community, food production and in veterinary production. The problem is that the more often antibiotics are taken, the less effective they are. This is because bacteria replicate very quickly- for example, E. coli undergoes mitosis every 20 minutes. During this process, mutations can occur. In general, the change is inconsequential but sometimes, the mutation can benefit the bacteria and give it characteristics that prevent it from being affected by an antibiotic. This trait is then favored via natural selection and the mutated strain quickly outnumbers the original strain. This means that when more people use antibiotics, different species of bacteria have a greater chance at developing these resistant traits. When doctors and GPs inappropriately prescribe patients with antibiotics for conditions like sore throat and sinusitis, it puts patients who genuinely need antibiotics at greater risk of harm. A study found that in general around 1 in 5 antibiotic prescriptions are issued inappropriately in the UK and considering how around 18 in 1000 inhabitants are prescribed antibiotics annually, one can imagine how great the number of people misusing antibiotics is.
Antimicrobial resistance requires urgent attention. If action is not taken to combat this phenomenon, many modern medicines could become obsolete. Overcoming antibiotic resistance has been a priority for WHO since 2015. World Antimicrobial Awareness Week is an organized effort by WHO to increase awareness of antimicrobial resistance globally and to encourage practices among the general public, health workers and policy makers, which will prevent further emergence and spread of antimicrobial resistance. Antibiotic Guardian is another initiative that is being undertaken to slow the spread of antimicrobial resistance, specifically that of antibiotic resistance. It is a campaign that was launched by Public Health England in 2014 and aims to encourage health and social care professionals, students, educators in the human and animal health sector as well as members of the public to take action against the spread of antibiotic resistance. By pledging to become an Antibiotic Guardian, you choose to perform a simple action which protects antibiotics against the threat of antibiotic resistance.
We can all do our part to stop antimicrobial resistance from spiraling out of control. Prescribers, such as doctors, should ensure that they are appropriately prescribing antibiotics and other antimicrobials, whilst patients should ensure that they take these medicines correctly and finish the full course of treatment. Good hygiene and infection control practices, particularly in healthcare settings, can also prevent infection and reduce the need for antibiotics in the first place. Immunization such as vaccinations are also very useful in preventing infections, further reducing the need for antimicrobials. These measures could reduce the use of antimicrobials and in turn, their misuse, such that we can avoid a future where people succumb to infections as they would have prior to the 1900s.
Authors: Amelia Ryan and Nusayba Ali