For decades, infectious diseases were not the leading cause of ICU admittance—only about 20% of cases were due to an infectious cause. But that is likely to change in the coming years as infectious diseases skyrocket in the United States and globally, predicted Hannah Wunsch, MD, MSc, FCCM, a plenary speaker at the 2023 Critical Care Congress, held in San Francisco.
The reasons are multifactorial, she said. War, multidrug resistance, climate change, emerging diseases and reduced confidence in vaccination will be among the factors that influence this increase.
The war in Ukraine will lead to a surge of infectious diseases, not only in Ukraine but also countries where the refugees flee.
“War is obviously a major factor. And I think that this is going to lead to a surge of infectious diseases—HIV, tuberculosis, COVID-19, you name it,” said Dr. Wunsch, who is a professor of anesthesiology and critical care medicine at the University of Toronto and a practicing intensivist at Sunnybrook Hospital, also in Toronto.
Even without a war, countries are seeing a resurgence in infectious diseases, and many are recalcitrant to treatment. China, for instance, is not only battling COVID-19 but is projected to have increasing rates of untreated multidrug-resistant tuberculosis.
The CDC listed multidrug-resistant TB as a serious threat in its “Antibiotic Resistance Threats in the United States 2019,” which chronicles more than 20 bacteria and fungi that are concerning because of resistance.
“I fear that we are going to see more things like multidrug resistance in units that traditionally have not been taking care of such patients,” Dr. Wunsch said.
Climate change and the encroachment of development on habitats will also see the spread of infectious diseases. She said it was fascinating to watch progression of topics at major clinical meetings like the Critical Care Congress. Many are including presentations about the effects of climate on diseases.
“And I think we’re going to see more and more talks about climate change and its impact,” she said.
She gave an example: the expected projection of Valley fever in the United States. In 2007, the Coccidioides fungi were pretty much confined to the Southwest, but by 2095, the fungi will likely comprise almost the entire Western half of the United States.
“You can pick your equatorial disease, and it’s going to increase, and we’ll be seeing them in places that we never expected to before,” she predicted.
As COVID-19 has shown, emerging diseases will continue to threaten populations and could significantly affect the ICU.
Unfortunately, lower vaccination rates will also bring back diseases that the medical establishment thought it had conquered decades ago in most countries. The CDC recently reported that routine childhood immunizations are down. This year alone, the United States has reported polio in New York and measles in Ohio.
“I think that we’ve had huge advances in care that have been incredibly exciting. I think we’ve lived through a period of trust in vaccination that isn’t there anymore and is going to be a major problem for us going forward and is going to change the face of critical care,” Dr. Wunsch said.
“And I think we’ve lived through an era of noninfectious diseases being the predominant focus for much of our care in the ICU. We are going to see infectious diseases again—much, much more of them over the next 20 to 50 years,” she said.
This article is from the March 2023 print issue.