COVID‐19 Therapies in Brazil: Should We Be Concerned with the Impacts on Aquatic Wildlife?

Abstract

Brazil is currently the Latin American epicenter of the coronavirus disease 2019 (COVID-19) pandemic, whose impacts have permeated the economic, social, and healthcare spheres. Amid its worst health crisis, the country has also been struggling with antiscience political narratives that promote the widespread use of chloroquine, hydroxychloroquine, and, more recently, the antiparasitic ivermectin. As a result, an increased demand for these pharmaceuticals has been observed across the country, with a sales increase of >50% in comparison to 2019 (Conselho Federal de Farmácia 2020). This steep increase in the use of such drugs, however, may pose risks to Brazil's highly biodiverse biomes-an issue that overlaps with the country's precarious wastewater-treatment situation. Data from 2018 indicated that almost half of the Brazilian population does not have access to sewage collection; the northern and northeast regions (historically at economic disadvantage) are particularly vulnerable because only 10.49 and 28.01%, respectively, of their inhabitants have access to adequate sanitation (Figure 1). Nationwide, 46% of collected sewage is treated, but high treatment rates (>80%) are observed in only 21 of the 100 largest cities (Instituto Trata Brasil 2018). Such poor sanitation conditions have detrimental effects on human health and the environment. Many contemporary pollutants are pharmaceuticals, which is concerning because of their toxicity to aquatic organisms, ever increasing amounts, and relative chemical stability. Organ damage, reproductive toxicity, hormonal disruption, behavioral changes, mutagenicity, and carcinogenicity are some of the reported effects of widely used drugs on various amphibian, fish, and invertebrate species (Organisation for Economic

Changes in Sewage Sludge Chemical Signatures During a COVID‐19 Community Lockdown, Part 1: Traffic, Drugs, Mental Health, and Disinfectants

“…We detected endocrine‐disrupting compounds including triclocarban, oxybenzone, and sertraline that can have negative impacts on marine organisms and cycle back to humans via consumption of local seafood (Arpin‐Pont et al, 2016 ; Karthikeyan et al, 2019 ). Much concern has been expressed about the potential ecological impacts of increased pharmaceutical loads in wastewater, particularly in developing areas where wastewater treatment is limited and access to antibiotic and antiviral medications is not controlled by prescriptions (Espejo et al, 2020 ; Farias et al, 2020 ; Horn et al, 2020 ; Usman et al, 2020 ); and modeling studies have demonstrated the potential for high risk from environmental releases of antiviral drugs used to treat COVID‐19 (Kumari & Kumar, 2021 ; Kuroda et al, 2021 ). Spread of resistance to antibiotic and antiviral medications is also a potential concern (Horn et al, 2020 ; Usman et al, 2020 ).…”

Photo-mediated and advanced oxidative processes applied for the treatment of effluents with drugs used for the treatment of early COVID-19: Review

“…Thus, considering the significant increase in the use of CQ, HCQ, AZI, IVM and their likely release and entry into aquatic environments, what are the effects of these drugs and their metabolites on the environment? ( Farias et al, 2020 ).…”

“…In addition to the possibility of the occurrence of individual adverse effects with the use of medications, such drugs can also pose a risk to biomes ( Farias et al, 2020 ). Many substances of pharmaceutical interest generate ecotoxicological effects when released into the environment.…”

Traffic, Drugs, Mental Health, and Disinfectants: Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown

“…We detected endocrine disrupting compounds including triclocarban, oxybenzone, and sertraline that can have negative impacts on marine organisms and cycle back to humans via consumption of local seafood (62,63). Much concern has been expressed about the potential ecological impacts of increased pharmaceutical loads in wastewater, particularly in developing areas where wastewater treatment is limited and access to antibiotic and antiviral medications is not controlled by prescriptions (64)(65)(66)(67). Spread of resistance to antibiotic and antiviral medications is also a potential concern (64,67).…”