A study published yesterday in JAMA Network Open suggests that listening to music significantly lowered stress levels and improved mood among Austrian and Italian adults during lockdowns early in the pandemic.

University of Vienna researchers used a smartphone app to prompt 711 adults to report data on their mood and stress levels while listening to music during strict lockdowns 5 times a day from Apr 1 to May 8, 2020. Participants used visual analog scales to report their emotions on a scale of 0 to 100, with 0 indicating "not at all" and 100 indicating "very much."

Median respondent age was 27.0 years, and 69.9% were women. Participants provided 19,641 total data points, including 4,677 music-listening reports.

'An easily accessible tool'

Listening to music was tied to lower momentary stress levels (β, −0.92) and improved mood (β, 1.90), particularly if listeners viewed the music as happy, even in those reporting higher levels of chronic stress (β, 0.12).

The authors noted that lockdown-linked social and economic disruption has been tied to stress, worry, and mental illness in the general population. "This disruption was aggravated by the fact that many leisure activities that were previously pursued to regulate stress and mood (eg, meeting friends, attending cultural events) were banned because of the lockdown," they wrote.

Music listening may be a means to modulate stress and mood during psychologically demanding periods.

Music, they said, is an easy, low-cost way to improve health and well-being during a crisis such as COVID-19.

"The present findings suggest that music listening may be a means to modulate stress and mood during psychologically demanding periods," the researchers wrote. "Individuals experiencing heightened momentary and/or chronic stress because of the challenges brought about by COVID-19 pandemic–related restrictions might consider music as an easily accessible tool for the management of stress and mood in daily life."

In the wake of H5N1 avian flu detections in wild birds and poultry in South America over the past few months, Ecuador's health ministry yesterday reported the country's first human infection involving H5 avian influenza.

The patient is a 9-year-old girl from Bolivar province, an Andes Mountain area in the central part of the country, according to a ministry statement translated and posted by Avian Flu Diary, an infectious disease news blog.

The report had few details about the case, but it said the girl presumably had contact with birds that carried the virus. So far, investigators haven't found any other human cases.

Her illness marks the world's seventh infection from the circulating H5 clade. The others were from the United Kingdom, the United States, Spain, Vietnam, and China. All involved exposure to sick poultry. Four of the cases were mild, but the ones from Vietnam and China were severe, according to a recent risk assessment from the World Health Organization, which said the overall threat remains low, but the virus bears close watch.

Three H9N2 cases in China

Meanwhile, China confirmed three more H9N2 avian flu cases in different provinces, according to a regular avian flu update from the Hong Kong Centre for Health Protection.

The illness onsets occurred in October and November. The patients include a 58-year-old man from Hunan province, a 5-year-old girl from Gansu province, and a 3-year-old boy from Anhui province.

H9N2 is known to circulate in poultry in parts of Asia, with most human cases reported in China. Infections are typically mild and affect children. The country's most recent cases involved two children, one from Guangdong province and the other from Gansu province, who became ill in August and September, respectively.

A systematic review and meta-analysis of studies published during the first 18 months of the COVID-19 pandemic provides further evidence that antibiotic use far exceeded the prevalence of bacterial co-infection, researchers reported this week in BMC Infectious Diseases.

The review included 85 studies, mostly from China (29) and the United States (16), involving more than 30,000 patients. Of the 70 studies that reported on the prevalence of bacterial co-infection, the meta-analysis showed an overall prevalence of bacterial co-infection of 12%. But among the 20 studies that gave a clear definition of bacterial co-infection, the overall prevalence was only 4%. Meta-analysis of the 52 studies that included data on antibiotic use showed that the overall antibiotic use rate was 60%, and the empiric antibiotic use rate was 62%.

The study authors note that the results are similar to other meta-analyses that have been conducted on antibiotic use and bacterial co-infections in COVID-19 patients, although their results showed a slightly lower rate of antibiotic use. They suggest this could reflect changes in empiric antibiotic use as clinicians gained more experience in managing COVID-19 and more data became available to inform evidence-based practice regarding antibiotic use. 

There is currently insufficient evidence to support the empirical use of antibiotics in most hospitalised patients with COVID-19.

"Our results show that there is currently insufficient evidence to support the use of empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection in these patients is low," they wrote. "Furthermore, as the use of antibiotics in COVID-19 appears to have been largely empirical, it is necessary to identify clinical and laboratory markers and to formulate guidelines to promote more targeted administration of antibiotics in patients admitted to hospital with COVID-19."

The authors say they hope the study can help clinicians "reflect on and understand the initial response to a global pandemic of a novel respiratory virus."