The dangerous treatment

Two years into the pandemic, right after Christmas, I tested positive for Covid-19. I am fully vaccinated and had gotten my booster shot a few weeks ago. Fortunately, my symptoms were not severe and no different from a cold. During the days of isolation, I considered myself extremely fortunate and privileged. I felt fine, had plenty to eat, a place to rest, and no anxiety about losing a job or seeing a nosedive in my wages. I know I am incredibly lucky and among the few who have been spared both by the full onslaught of the virus and its economic impact.

By a strange coincidence, a number of my close family members also tested positive for the virus in December. As I was recovering, they asked me what medicines I was getting for my treatment. None, I said. I thought that was the universal experience, except in cases of hospitalisation or development of other infections. I learned that my assumption was incorrect. Everyone in my family and in our network of friends and acquaintances who tested positive got on a serious dose of antibiotics — Azomax in particular. This experience was shared by family in Islamabad and Rawalpindi and friends in Lahore and Karachi.

Initially I felt that perhaps it was a small sample size, or a mere coincidence that people in my circle all got antibiotics for an infection that had nothing to do with bacteria. But I was wrong. I spoke to several infectious disease doctors in Pakistan, and all of them (with no exception) told me that this has become a routine, and a standard practice. None of them were happy about it, and expressed their deep frustration and anger at the practice of their colleagues, which was ill-informed and outright dangerous. Even people in the ministry of health acknowledged that this is the prevailing treatment and one that was clinically misguided.

From a scientific and clinical perspective, there is absolutely no reason to prescribe antibiotics for Covid-19. Antibiotics work for bacterial infections, not viral. Covid-19 is not caused by bacteria. Giving antibiotics is not simply giving a placebo — it is actually creating a monster in the near future. Taking antibiotics for non-bacterial infections leads to development of resistance, whereby the drugs fail to act on disease causing pathogens. Drugs, which at one point worked, no longer remain potent against these superbugs.

So why do our doctors do it? When I probed, I could not get one straight answer. Some said there is a demand for it by the patients who want to feel better, others gave a typical response “everyone else is doing it”. Some simply had no idea about antibiotic resistance. All of these reasons are deeply troubling. Lack of knowledge is problematic; doing something because others are doing it while you know better is even worse. The ministry of health (in April 2021) had tried to run a social media campaign to inform the public and the practitioners on the do’s and don’ts of Covid-19 treatment. Taking antibiotics was prominently displayed in the ‘do not’ section. Yet the ground reality is different and one that is reminiscent of the gulf between theory and practice.

I have spent the last decade of my career in studying antimicrobial resistance, in the lab and in communities around the world. I wrote a book about the topic for a broad general audience. During the course of my research, I have met policymakers and doctors, nurses and patients, historians and social scientists. Everyone agrees that this is one of the most complex and urgent public health challenges of our time. Everyone also agrees that the single most important thing we can do to protect ourselves is to change our own behaviour. Yet, we seem to be doing the exact opposite. Our politicians propose and implement solutions that are neither remedies nor placebos — and are in fact nothing but a recipe for a troubled tomorrow. Our doctors should not do the same.

Published in The Express Tribune, January 11^th, 2022.

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