COVID-19 Scan for Jul 08, 2021

News brief

US COVID vaccination program may have saved 279,000 lives

The US COVID-19 vaccination program may have saved almost 280,000 lives and prevented 1.25 million hospitalizations, according to the results of a modeling study published yesterday by the Commonwealth Fund.

The researchers already had a COVID-19 transmission model that took into account US demographics, age stratification and related COVID-19 risks, and pandemic mobility patterns, but to look at epidemiologic trajectories, they included variants of concern in addition to the original Wuhan, China–identified strain. Simulations ran from Oct 1, 2020, to Jun 28, 2021, and were validated with hospitalization rates and death trends.

The model showed that without the vaccination program, 279,000 more deaths, 1.25 million more hospitalizations, and 26 million more cases would have occurred. If the vaccination program had been half as fast, about 121,000 more deaths, 450,000 more hospitalizations, and 22 million more cases might have occurred.

While the difference in the number of prevented cases is smaller under the slower-rollout scenario, the researchers say this is most likely because of the vaccines' effectiveness in reducing severe disease and death.

The researchers note that if there had been no vaccination program, the country may have seen a second "2021 spring surge" of 4,500 daily deaths driven by the Alpha (B117) variant. This would have surpassed the 2021 winter surge, which peaked at 4,000 daily deaths.

"A renewed commitment to expanding vaccine access will be crucial to achieving higher levels of vaccination necessary to control of the pandemic and prevent avoidable suffering, particularly for those in historically underserved groups and areas of the U.S. with low vaccination rates," the researchers write. Of particular concern, they add, is the Delta variant (B1617.2), which may be more transmissible than Alpha and already makes up more than 40% of US cases.
Jul 7 Commonwealth Fund study

 

Heart rate might remain abnormal for 79 days during long COVID-19

For 234 COVID-19 patients, resting heart rates (RHRs) did not return to baseline until a mean of 79 days, reports a JAMA Network Open research letter yesterday. Step counts and sleep duration both took about a month to return to normal.

The researchers derived their COVID cohort from the Digital Engagement and Tracking for Early Control and Treatment (DETECT) study and analyzed data from Mar 25, 2020, to Jan 24, 2021. As a comparison, they also looked at 641 participants who had acute respiratory illness but not COVID-19.

COVID-19 patients had a mean age of 45.3 years, and 70.9% were women, whereas those without COVID-19 had a mean age of 44.7 years, and 71.1% were women. No information about severity of illnesses was given.

Overall, people diagnosed as having symptomatic COVID-19 took longer to return to their RHR, sleep, and activity baselines. The largest difference was seen in RHR, in which the researchers note that COVID-19 patients experienced a transient slow heartbeat followed by a prolonged relatively fast heartbeat, affecting RHR until a mean of 79 days post-symptom onset. Step counts and sleep durations were back to normal at 32 and 24 days, respectively.

Of the COVID-19 patients, 32 (13.7%) had a RHR more than 5 beats per minute above baseline that did not return to normal until more than 133 days post-symptom onset. This group also experienced more frequent symptoms than those whose RHR increased 0 to 5 beats per minute, including coughing, body aches, and shortness of breath during the acute phase.

"We found a prolonged physiological impact of COVID-19 infection, lasting approximately 2 to 3 months, on average, but with substantial intraindividual variability, which may reflect various levels of autonomic nervous system dysfunction or potentially ongoing inflammation," the researchers conclude.
Jul 7 JAMA Netw Open study

News Scan for Jul 08, 2021

News brief

Urine culture stewardship linked to reduced catheter infections

A urine culture stewardship initiative at a teaching hospital in Michigan reduced overuse of urine cultures and was associated with a significant decline in catheter-associated urinary tract infections (CAUTIs), researchers reported today in Infection Control & Hospital Epidemiology.

The analysis by researchers with the Henry Ford Health System in Detroit looked at the impact of a urine culture stewardship program implemented at the hospital in 2015 to complement a urinary catheter best-practice bundle that emphasized appropriate use of urinary catheters and optimization of catheter-insertion and maintenance protocols. The stewardship program emphasized obtaining urine cultures from intensive care unit (ICU) patients only if a urinary source of sepsis was suspected.

Previous research has shown that minimizing use of urinary catheters has been one of the most effective interventions for reducing CAUTIs, while inappropriate urine culture testing in catheterized patients can lead to overdiagnosis of CAUTIs and result in antibiotic overuse.

To assess the impact of the complementary programs, the researchers reviewed the urine culture utilization rate (UCUR), the catheter utilization ratio (CUR), and CAUTI incidence in the hospital's ICU from 2015 through 2017.

They found that UCUR decreased from 3,081 in 2015 to 2,158 in 2016 and 1,218 in 2017, while CAUTIs decreased from 78 in 2015 to 60 in 2016 to 28 in 2017. Regression analysis over time showed statistically significant decreases in UCUR and CAUTI rates, a modest decline in CUR, and a correlation between declines in UCUR and the CAUTI rate. No cases of unrecognized pyelonephritis or CAUTI were identified.

"Urine-culture stewardship programs in combination with standard best practices could significantly influence CAUTI rates in ICUs," the study authors concluded.
Jul 8 Infect Control Hosp Epidemiol abstract

 

Cashew cheese Salmonella outbreak probe wraps up

The US Centers for Disease Control and Prevention (CDC) yesterday reported 7 more illnesses in a multi-serotype Salmonella outbreak that has now sickened 20 people in four states.

In a final outbreak update, the CDC said the outbreak, first announced in April, appears to be over. The trace-back investigation linked the illnesses to Jule's cashew brie. It involved four Salmonella serotypes: Chester, Duisburg, Typhimurium, and Urbana. The latest illness onset was May 9, and five patients were hospitalized for their infections. No deaths were reported.

Health officials used the PulseNet subtyping network to identify infections tied to the outbreak. Testing on Jule's cashew cheese samples from California and Tennessee yielded three of the involved strains. An investigation by the Food and Drug Administration (FDA) and its partners in California found one of the outbreak strains in raw cashews at the Jule's Foods facility. Other Salmonella strains were found in the food and environmental samples, but they weren't the ones involved in the outbreak.

Genetic sequencing to assess antibiotic resistance found that, of 17 bacterial samples from sick people and 29 from food sample, 8 were predicted to be resistant to one or more antibiotics.

In a separate statement, the FDA said the cashews used by Jule's Foods are the likely source of contamination and that its scientists worked with the cashew supplier to ensure that potentially contaminated products were removed from the market. The agency said the cashew supplier has implemented corrective actions.
Jul 7 CDC final outbreak update
Jul 7 FDA update

 

H5N8 avian flu strikes Danish layer farm

Denmark this week reported a highly pathogenic H5N8 avian flu outbreak in poultry, according to a notification from the World Organization for Animal Health (OIE).

The event began on Jul 4 at a layer farm in southern Denmark, killing 198 of 38,000 susceptible birds. So far, the source of the virus hasn't been determined. The surviving birds are slated for culling, and animal health officials have put a 3-kilometer (km) protection zone around the facility, as well as a 10-km surveillance zone.

In related developments, Sweden reported highly pathogenic H5N4 avian flu in a wild bird, the country's first detection of the subtype. Test results on a dead peregrine falcon found in Blekinge County in the south came back positive for the strain on Jun 27. The falcon was found in March.
Jul 6 OIE report on H5N8 in Denmark
Jul 2 OIE report on
H5N4 in falcon in Sweden

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