Biocide-tolerance and antibiotic-resistance in community environments and risk of direct transfers to humans: Unintended consequences of community-wide surface disinfecting during COVID-19?

Abstract

During the current pandemic, chemical disinfectants are ubiquitously and routinely used in community environments, especially on common touch surfaces in public settings, as a means of controlling the virus spread. An underappreciated risk in current regulatory guidelines and scholarly discussions, however, is that the persisting input of chemical disinfectants can exacerbate the growth of biocide-tolerant and antibiotic-resistant bacteria on those surfaces and allow their direct transfers to humans. For COVID-19, the most commonly used disinfecting agents are quaternary ammonium compounds, hydrogen peroxide, sodium hypochlorite, and ethanol, which account for two-thirds of the active ingredients in current EPA-approved disinfectant products for the novel coronavirus. Tolerance to each of these compounds, which can be either intrinsic or acquired, has been observed on various bacterial pathogens. Of those, mutations and horizontal gene transfer, upregulation of efflux pumps, membrane alteration, and biofilm formation are the common mechanisms conferring biocide tolerance in bacteria. Further, the linkage between disinfectant use and antibiotic resistance was suggested in laboratory and real-life settings. Evidence showed that substantial bacterial transfers to hands could effectuate from short contacts with surrounding surfaces and further from fingers to lips. While current literature on disinfectant-induced antimicrobial resistance predominantly focuses on municipal wastes and the natural environments, in reality the community and public settings are most severely impacted by intensive and regular chemical disinfecting during COVID-19 and, due to their proximity to humans, biocide-tolerant and antibiotic-resistant bacteria emerged in these environments may pose risks of direct transfers to humans, particularly in densely populated urban communities. Here we highlight these risk factors by reviewing the most pertinent and up-to-date evidence, and provide several feasible strategies to mitigate these risks in the scenario of a prolonging pandemic.

Locked on salt? Excessive consumption of high-sodium foods during COVID-19 presents an underappreciated public health risk: a review

“…Thirteen months after the World Health Organization (WHO) declared it a pandemic, more than 150 million infections have been reported to date, including over three million deaths worldwide (WHO 2021 ). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infectious agent of COVID-19, is believed to spread easily between people via droplets and droplets nuclei from human respiratory activities such as sneezing, coughing, talking, or breathing (CDC 2020 ; Sun et al 2021 ; WHO 2020 ) as well as virus-laden atmospheric fine particulates (Chen et al, 2021b ; He and Han, 2021 ) and contact surfaces (Chen et al, 2021a ; Wang et al, 2021a , 2021b ). As a common response to the situation, governments and public health authorities enforced containment measures (Han and Zhang 2020 ), including social distancing, travel restrictions, and lockdowns.…”

“…Numerous studies provided ample evidence that excessive dietary sodium intake is strongly linked to an array of human diseases, such as hypertension, cardiovascular diseases, and kidney diseases (de Wardener and MacGregor 2002 ; He and MacGregor 2007 ). As an integral part of public health management in COVID-19 (Chen et al 2021a ; Han and He 2021 ; Han et al 2020 ), advising the public to maintain a healthy diet during confinements is equally important as infection control and prevention measures to reduce health risks in the population. As the world is still struggling to tackle the COVID-19 pandemic (Chen et al 2021b ; Dai et al 2020 ; He et al 2021 ), and lockdowns are expected to continue in many countries and regions, it is important to evaluate the key driving factors of people’s dietary changes and the underlying health risks associated with such behavior.…”

Environmental impacts of the widespread use of chlorine-based disinfectants during the COVID-19 pandemic

“…However, it is still practiced in several parts of the world, especially in and around medical facilities. Concerns regarding the application of CBDs for mass disinfection have been arising ever since the COVID-19 outbreak (Bhat et al, 2021 ; B. Chen et al, 2021a , b ; Z. Chen et al, 2021a , b ; Chu et al, 2021 ; Collins and Farmer, 2021 ; Dhama et al, 2021 ; Liu et al, 2021 ; Luan et al, 2020 ; Mohanan et al, 2021 ; Pan et al, 2022 ; Zhang et al, 2020a , b ; T. Zhang et al, 2021c , a , b ). Experiments were conducted by applying chlorine to wastewater and waterbodies to determine the extent to which DBPs were formed (Cui et al, 2021; Zhang et al, 2022 ).…”

Cropping Up Crisis at the Nexus Between COVID-19 and Antimicrobial Resistance (AMR) in Africa: A Scoping Review and Synthesis of Early Evidence

“…These are antiseptics or disinfectants which often act via some biological or chemical mechanisms. The most commonly employed active agents in those widely used biocides -particularly in Africa -include ethyl alcohol (denatured), hydrogen peroxide, sodium hydrochloride, triclosan, chlorhexidine, quaternary ammonium compounds, and surfactants, among others [69]. In a recent editorial article published in the Bulletin of the WHO, scientific research studies were called for on the short-and long-term impacts of the rising use of biocides on fueling cross-resistance to antimicrobials during this season of the COVID-19 pandemic [22].…”