Patterns of pharmaceuticals use during the first wave of COVID-19 pandemic in Athens, Greece as revealed by wastewater-based epidemiology

Abstract

Since 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), impaired public health with considerable morbidity and mortality due to the lack of vaccines and effective treatment. The severe disease mainly harmed adults with predisposing medical comorbidities (such as heart disease, hypertension, chronic lung disease), while it can occur in healthy individuals that may be asymptomatic. Wastewater-based Epidemiology (WBE), a non-invasive, objective, chemical tool was used to monitor and estimate the changes in consumption and prescription patterns under normal conditions (2019) and under COVID-19 pandemic conditions (2020). NSAIDs, antihypertensives, diuretics, antiepileptics, antilipidemics, antibiotics, analgesics, antivirals, anticancer drugs, contrast iodinated drugs, antidiabetics, antiallergic drugs, antiulcers and other pharmaceuticals were studied in wastewater and revealed the application of various treatments during the first wave of the pandemic in Athens, Greece. Data were correlated with COVID-19 infection therapeutical plans. The result of the analysis revealed a remarkable increase for antiviral drugs (170%), hydroxychloroquine (387%), and antibiotics (57%), which were the most applied treatments against COVID-19 during its first wave in Greece. In agreement with related authorities urge, NSAIDs presented decrease (27%) during the first lockdown, while paracetamol demonstrated a remarkable increase (198%). The use levels for Angiotensin II receptor blockers such as valsartan, and co-administrated diuretics, such as hydrochlorothiazide, were reduced during 2020, by 32% and 26% respectively.

Quantitative Determination and Environmental Risk Assessment of 102 Chemicals of Emerging Concern in Wastewater-Impacted Rivers Using Rapid Direct-Injection Liquid Chromatography—Tandem Mass Spectrometry

“…With respect to the aquatic environment, a significant analytical challenge exists for the chemical characterisation, measurement, and environmental risk assessment (ERA) of many compounds with high spatiotemporal coverage. Multiresidue analysis methods currently exist for hundreds to thousands of compounds in water samples [4], but these often rely on analyte concentration steps such as solid phase extraction (SPE) to achieve the required sensitivity. For chemicals of emerging concern (CECs), this can prove challenging in terms of achieving sufficient chemical selectivity to ensure the widest range of compounds present in a sample can be extracted and enriched for instrumental measurement.…”

COVID-19 drugs in aquatic systems: a review

“…In Togo, 34.2% of survey participants ( n = 955) reported that they self-medicated after experiencing COVID-19-like symptoms with 2.0% using chloroquine and hydroxychloroquine (Sadio et al 2021 ). In Greece, there was a significant decrease in the consumption of antihypertensive, diuretic, and antilipidemic drugs during lockdown (Galani et al 2021 ). Hence, the strict lockdowns enacted by various countries across the globe may have decreased access to medical facilities such as clinics, hospitals, and pharmacies to non-COVID-19 patients, which could result in a decrease in consumption of non-COVID-19 related pharmaceuticals (Galani et al 2021 ; Oikonomou et al 2020 ).…”

“…In Greece, there was a significant decrease in the consumption of antihypertensive, diuretic, and antilipidemic drugs during lockdown (Galani et al 2021 ). Hence, the strict lockdowns enacted by various countries across the globe may have decreased access to medical facilities such as clinics, hospitals, and pharmacies to non-COVID-19 patients, which could result in a decrease in consumption of non-COVID-19 related pharmaceuticals (Galani et al 2021 ; Oikonomou et al 2020 ). Additionally, the COVID-19 pandemic has contributed to the disruption of the supply chain of generic drugs sourced from countries with strict lockdown procedures and shift in consumption of branded drugs towards COVID-19 drugs leaving non-COVID-19 patients untreated ( https://cen.acs.org/business/outsourcing/COVID-19-reshaping-pharmaceutical-supply/98/i16 ).…”

“…Several pharmaceuticals such as antibiotics, antiretroviral drugs, and antimalarial drugs have been repurposed for treating COVID-19, although the efficacy of some remains contended (Kuroda et al 2021 ). In addition, several old drugs such as nonsteroidal anti-inflammatory drugs and analgesics are widely used to treat COVID-19 related symptoms such as fever, acute pain, and inflammation (Galani et al 2021 ). Hence, global consumption of pharmaceuticals has probably increased during the COVID-19 pandemic and will continue to do so with the advent of highly transmissible variants.…”

Implications of COVID-19 pandemic on environmental compartments: Is plastic pollution a major issue?

“…Wastewater samples collected from the wastewater treatment plant (WWTP) of Athens (Greece), before (2019) and during the COVID-19 pandemic (2020), revealed a remarkable increase in antiviral drugs (170%), antibiotics (57%), and hydroxychloroquine (387%), which are most pharmaceutical drugs applied to treat COVID-19, along with paracetamol (198%) ( Galani et al, 2021 ). In addition to the pharmaceuticals potential ecotoxicity ( Galani et al, 2021 ), it can increase microorganism's antidrug resistance (ADR) ( Kumar et al, 2021 ), thus imposing a severe threat to human and animal health.…”