In her regular job, Priya Nori runs Montefiore Medical Center’s antibiotic stewardship program, and spends most of her time ensuring that the Bronx-based hospital doesn’t overuse the drugs and allow bacteria resistant to them to thrive. But like many physicians, Nori is now spending all of her time helping treat COVID-19 patients at her New York City hospital, which like other medical centers in the pandemic hot spot, is crowded with 50% more patients than normal. As part of that care, she and other doctors are administering many more antibiotics than normal, which is a recipe for the rapid rise or spread of resistant bacteria, especially given the crowded conditions.

Antibiotics do not directly affect SARS-CoV-2, the respiratory virus responsible for COVID-19, but viral respiratory infections often lead to bacterial pneumonia. Physicians can struggle to tell which pathogen is causing a person’s lung problems. “We tend not to hold back on antibiotics in these patients,” Nori says, especially when that decision could mean life or death. “Is that a bad thing right now? I have trouble saying that it is.” But she and others worry the surge of COVID-19 patients could ultimately lead to a surge in antibiotic-resistant bacteria—a concern serious enough that the U.S. Department of Defense (DOD) is assembling a group of at least 10 medical centers to study “secondary” bacterial and fungal infections in these patients and the antibiotics being used to prevent them.

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