A new report dispels accounts that Americans drank bleach to cure or prevent COVID-19, a practice even the Centers for Disease Control and Prevention (CDC) warned against during the early months of the pandemic. The report was published yesterday in PLOS One.

In June 2020 the CDC shared results from an online survey that showed 39% of Americans engaged in at least one cleaning practice not recommended by the CDC since April of 2020, with 4% of respondents saying they were drinking or gargling diluted bleach to prevent a COVID-19 infection. Those responses coupled with increased reports in calls to the CDC poison control center created a narrative that bleach drinking was occurring among worried Americans.

The study authors surveyed 600 respondents during the summer of 2020 and applied several analyses that address multiple known characteristics of problematic respondent bias. The subsequent survey revealed "problematic respondents" made up 23.3% to 33.0% of CDC survey respondents.

"Across two studies with nearly 1,300 respondents, we replicated the CDC's findings showing that around 4% of respondents reported engaging in each of the three highly dangerous behaviors: drinking or gargling household cleaner, soapy water, and diluted bleach," the authors said. "However, we also observed that 3–7% of respondents reported having never used the Internet while taking the survey online and having suffered a fatal heart attack."

Researchers should rigorously check for problematic respondents, particularly when the survey aims to measure rare events.

After removing survey responses from all participants who provided inattentive, acquiescent, and careless answers, there was no evidence anyone drank cleaning products during the early months of the pandemic.

"Problematic survey respondents pose a fundamental challenge to all survey research and threaten the validity of public-health policy," the authors concluded. "To mitigate against these threats, researchers should rigorously check for problematic respondents, particularly when the survey aims to measure rare events."

Some countries continue to report high COVID-19 burdens, based on markers that include cases, hospitalizations, and deaths, the World Health Organization (WHO) said today in its latest weekly update. The agency has said tracking COVID trends remains challenging, since a declining number of countries regularly report cases, with hospitalizations and deaths becoming more reliable indicators.

At the regional level, Africa reported a rise in COVID deaths, though fatalities have been at a relatively low baseline.

Of 19 countries that regularly report hospitalizations, 2 reported rises of 20% or more during the current 28-day reporting period: Bangladesh and Malta. Of 16 countries that regularly report intensive care unit (ICU) admissions, 2 reported rises of 20% or more, Lithuania and Mexico.

In its variant proportion update, the WHO said Omicron XBB.1.5 levels continue to decline steadily, falling from 30.1% to 16.3% of sequences over the past month. Meanwhile, XBB.1.16 levels continue to rise, up from 18.1% to 21.2% over the reporting period. The WHO said proportions vary by region, with XBB.1.5 dominant in the Americas and XBB.1.16 most common in Europe, Southeast Asia, and the Western Pacific.

Of the other subvariants that the WHO monitors, only three increased: XBB, XBB.1.9.2, and XBB.2.3.

A case report published yesterday in Emerging Infectious Diseases highlights the increased risk of multidrug-resistant (MDR) organism transmission and infection posed by the conflict in Ukraine.

The report describes the analysis of blood and surveillance cultures from a service member from Ukraine who suffered multiple traumatic injuries, including full-thickness burns. After transfer to a US military hospital in Germany, doctors obtained blood, urine, respiratory, and peri-rectal surveillance cultures from the patient, which grew Acinetobacter baumannii, Enterococcus faecium, Klebsiella pneumoniae, and three distinct strains of Pseudomonas aeruginosa. The gram-negative pathogens were nonsusceptible to most antibiotics tested, while the E faecium isolate was nonsusceptible to vancomycin.

Whole-genome sequencing identified an array of antibiotic resistance genes, including multiple carbapenemase and extended-spectrum beta-lactamase genes.

The study is one of several in recent months that have described MDR infections among soldiers and hospitalized patients in Ukraine since the Russian invasion in February 2022. The study authors note that European healthcare networks now consider prior hospitalization in Ukraine to be a critical risk factor for colonization with MDR organisms.

Healthcare practitioners treating citizens of Ukraine need to be cognizant of the increased risk for MDR organism transmission and infection.

"Gaps in such services as infection control, caused by limited resources and personnel, are exacerbating the transmission of MDR organisms in Ukraine," researchers from Walter Reed Army Institute of Medical Research and Landstuhl Regional Medical Center wrote. "Healthcare practitioners treating citizens of Ukraine need to be cognizant of the increased risk for MDR organism transmission and infection imposed by the conflict in Ukraine and implement appropriate infection control measures to mitigate their spread." 

A study conducted at four hospitals in Kenya found that antibiotic use, invasive devices, and several days of hospitalization were significantly associated with carriage of multidrug-resistant bacteria, researchers reported yesterday in Clinical Infectious Diseases.

For the study, a team of US and Kenyan researchers collected and analyzed stool samples from randomized patients at one urban and three rural hospitals in Kenya from January 2019 to March 2020. Their aim was to evaluate the potential risk factors for colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE), which commonly precedes infection for many patients.

"These bacteria can cause untreatable infections," lead author Sylvia Omulo, PhD, MPH, of Washington State University, said in a university press release. "We have to use surveillance to make sure we understand what causes these bacteria to colonize and, later, resist certain antibiotics."

Analysis of 840 stool samples revealed that 66% and 11% of patients harbored an ESCrE and/or CRE isolate, respectively. Seventy-six percent of patients had received one or more antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%) and metronidazole (28%).

The risk factors for colonization identified in this study—limiting the use of invasive devices, judicious use of antibiotics, and reducing the transmission risk—are similar to those associated with nosocomial infections.

In the logistic regression models that controlled for ceftriaxone use as a potential risk factor, ESCrE colonization odds were higher among patients hospitalized for 3 or more days (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.60 to 3.37), intubated patients (OR, 1.73; 95% CI, 1.03 to 2.91), and people with HIV (OR, 1.70; 95% CI, 1.03 to 2.8). CRE colonization odds were higher among patients receiving ceftriaxone (OR, 2.23; 95% CI, 1.14 to 4.38) and for every additional day of antibiotic use (OR, 1.08; 95% CI, 1.03 to 1.13).

"In conclusion, the risk factors for colonization identified in this study—limiting the use of invasive devices, judicious use of antibiotics, and reducing the transmission risk—are similar to those associated with nosocomial infections," the study authors wrote. "This emphasizes not only the importance of infection prevention and control activities but also the utility of colonization data—rather than data on nosocomial infections—in evaluating the effectiveness of hospital interventions."

• A UNICEF and World Health Organization (WHO) analysis of gender inequalities related to issues with household drinking water, sanitation, and hygiene found that women and girls bear the biggest burdens, which can affect their safety and education. The report looked at trends from 2000 to 2022 and found that females are twice as likely as males to be responsible for fetching household water, detracting from play, learning, and safety. Also, females were more likely to feel unsafe using a toilet outside the home and disproportionately felt the impact of hygiene gaps, such as limited ability to safely and privately manage their periods.
• The US Centers for Disease Control and Prevention reported 24 more mpox cases over the past week, according to an update yesterday. Health officials have braced for a potential spike in cases with increased social gatherings over the summer, but so far, the 7-day average for new daily cases remains low. The new cases raise the national total since early 2022 to 30,555. No new deaths were reported, keeping the fatality count at 43.
• Denmark's pertussis cases have shown a spike since May, according to a statement from the country's Statens Serum Institut, translated and posted by Avian Flu Diary, an infectious disease news blog. Health officials said about 80 to 100 cases are detected each month, but cases rose to 104 in May and at least 284 in June. They said that, as with other respiratory diseases, pertussis cases were low during and right after pandemic restrictions were in place, that pertussis levels rise every 3 to 5 years, and that it's too early to say if cases will remain at epidemic levels.