As we round out the year, the triple threat of RSV, flu, and COVID are claiming headlines and filling hospital beds. The all-important infectious disease clinicians who are the experts in treating these and other viruses, are often tasked with working in an environment of unpredictability, moving quickly to advocate for their patients and public health, many times with limited information and resources. With an ongoing shortage of ID physicians, it’s important to pause, reflect, and look towards improving the future of infectious disease and antimicrobial stewardship.
To find out what is on the horizon for the field of ID in 2023, Infectious Disease Connect looked to experts and clinicians working in the field to weigh in. A few themes emerged, including an increase in telemedicine, a focus on antimicrobial stewardship, and COVID-19’s transition from pandemic to endemic. Read their full predictions below.
The ideas expressed in this blog belong entirely to their authors. They do not represent any form of an endorsement for ID Connect’s services and/or its software nor do these ideas do not characterize business plans for ID Connect, its affiliates, or employees.
John Mellors, M.D.
Chief, Division of Infectious Diseases, University of Pittsburgh Department of Medicine
- SARS-CoV-2 (COVID-19) will continue to evolve and spread but not cause tsunami-like waves of illness as the Omicron variant did a year ago because of immunity from vaccines and prior SARS-CoV-2 infection.
- Immunocompromised patients, who often do not respond to vaccines, will have limited options to prevent SARS-CoV-2 infection because of increasing viral resistance to the long-acting monoclonal antibodies (tixagevimab + cilgevimab or Evusheld). This change is very unfortunate but other combinations of monoclonals to prevent infection are in development and may provide another means of protection for immunocompromised patients.
- SARS-CoV-2, influenza, RSV and other respiratory viruses will continue to cause frequent symptomatic infections and serious illness in the elderly and those with chronic lung disease or immunocompromise until late spring.
- At least one outbreak, hopefully limited, of a new infectious disease or resurgence of an “old” infectious disease will occur.
- Fiscal strain on healthcare systems and facilities will delay the adoption of new technologies to rapidly diagnose serious infections and prevent their spread.
- Pressure to improve antimicrobial stewardship will increase through regulatory oversight requirements but the impact on antimicrobial resistance will vary depending on the effectiveness of stewardship program. Overall, antimicrobial resistance will continue to grow and spread.
- The number of licensed and practicing ID physicians will continue to decrease, fueling the growth in remote (tele) ID care.
Thomas File, Jr., M.D. MSc MACP FIDSA FCCP
Chair, Infectious Diseases Division, Co-Director, Antimicrobial Stewardship Program, Summa Health
- The COVID-19 Pandemic will “officially” be over as a public health emergency as it transitions to an endemic respiratory Infection and will continue to be a seasonal respiratory infection for which immunization will still be recommended. While other variants of SARS-CoV-2 may emerge, the global immunity from natural infection and vaccines will have an impact.
- Molecular diagnostic testing will continue to develop and be increasingly available to allow more rapid identification of microorganisms, which will allow better antimicrobial stewardship with pathogen-directed therapy rather than the usual use of broad-spectrum empirical antimicrobials.
- There will be better pandemic preparedness (but not likely as high-level as we should have). This will benefit from congress passing the PREVENT Pandemics Act, which addresses many of the needs for better preparedness. Better global surveillance will likely identify more outbreaks but hopefully within an earlier time period.
- Antimicrobial resistance will continue to be a great concern and limit optimal clinical management of patients. This threat continues to call for the need of better surveillance data, antimicrobial stewardship, and a better method of antimicrobial development. Hopefully, congressional passing of the PASTEUR Act will provide better support for stewardship and antimicrobial development.
- Safer and better vaccines will be under development based on newer technologies.
Matt Davis, PharmD
Infectious Disease Connect
- As COVID-19 shifts towards an endemic threat, neglected pathogens of concern will re-emerge and remind the clinical community as to their importance. We are seeing this currently with the problematic influenza and RSV seasons but will be reminded of other pathogens such as Candida auris and multi-drug resistant gram-negatives.
- The antifungal armamentarium will begin to expand allowing us to better address infections from the WHO’s priority pathogen list. Several novel antifungal agents are in mid- to late-stage clinical development and will hopefully begin to sit for FDA approval for various indications in 2023, 2024, and beyond.
- Data science, artificial intelligence, and machine learning tools will continue to be incorporated into healthcare technology services and augment clinicians’ ability to predict and respond to antimicrobial resistance threats.
- The footprint of telehealth and tele-stewardship will continue to expand rapidly, connecting underserved populations with experts across the nation. Tele-stewardship programs will aid resource-limited institutions meet the new standards for antimicrobial stewardship which go live in 2023.
Rima Abdel-Massih, M.D.
Chief Medical Officer & Co-Founder, Infectious Disease Connect
- The field of Infectious Diseases will continue to see an exodus of physicians from traditional in-person jobs due to burnout and low compensation.
- A shortage of ID physicians will start becoming prominent in urban areas, larger health systems, and even academic institutions.
- ID physicians will look to shift from busy private practice and hospital-employed practices to less busy academic centers or telemedicine positions to focus on work-life balance.
- The demand for ID care will continue to increase as more physicians are retiring and there will be increased adoption and acceptance of telemedicine modalities for ID care.
- E-consults or asynchronous consultation will become more widely accepted and used in the inpatient settings.