COVID-19 Scan for Apr 13, 2021

News brief

COVID disrupts healthcare in low- and middle-income countries

The COVID-19 pandemic has negatively affected healthcare programs in low- and middle-income countries (LMICs) that work to protect populations against HIV, tuberculosis (TB), and malaria, according to a new report by the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The fund found that, from April to September 2020, HIV testing fell 41%, TB referrals declined 59%, and malaria diagnoses fell 31% among 502 health facilities in 32 LMICs in Africa and Asia.

According to 85% of the surveyed facilities, COVID-19 was the main reason patients no longer sought healthcare, with most reporting fear of transmission (28%), disruption to public transit (20%), lockdown or stay-at-home orders (20%), and general delayed care-seeking behaviors (15%). For instance, antenatal care visits fell 43%, and in seven Asian countries, they fell 66% while consultations for children under 5 dropped 74%.

During the pandemic, 45% of health facilities reported having sufficient personal protective equipment, and across 24 countries in Africa, only a minority of facilities could conduct COVID-19 antigen rapid diagnostic tests (11%) and polymerase chain reaction tests (8%).

Staffing was also a problem, and 67% of African facilities and 69% of facilities in seven Asian countries said that 10% of staff were not working during this period. Looking ahead to COVID-19 vaccinations, the researchers found that 7% of African facilities had no working refrigerators or adequate equipment to store traditional vaccines and that 23% did not have the minimum quantity of needles or syringes.

Some healthcare facilities, however, have been able to more easily adapt to the pandemic. The most common practices were reassigning staff to different units (70%), transferring staff to different facilities as needed (34%), extending drug prescription fills (71%), prioritizing patient consultations by risk (64%), and providing care for multiple conditions in one visit (39%).

“To regain the ground lost on the three epidemics in 2020 and to step up the fight against COVID-19, we have to massively scale up adaptation programs, increase access to COVID-19 tools, and shore up systems for health so they don’t collapse,” Peter Sands, MPA, Global Fund executive director, said in a press release.
Apr 13 The Global Fund report and press release


Commission Planning Group aims to integrate COVID lessons

More than two dozen of the nation's leading scientists, sponsored by Schmidt Futures, the Skoll Foundations, the Rockefeller Foundation, and Stand Together, are creating the Covid Commission Planning Group (CPG), the University of Virginia's Miller Center of Public Affairs announced today in a news release emailed to journalists.

The goal of the commission is, according to the press release, to "seize this once-in-a-century opportunity to help America—and the world—begin to heal and safeguard our common future from new existential threats." Already, the team has debriefed nearly 100 experts and defined nine task forces in areas such as COVID-19's origins and the prevention of future pandemics, national readiness and initial responses, communities at risk, care for the sick (including COVID-19 long-haulers), data solutions, and diagnostics, therapeutics, and vaccines.

The CPG will be directed by Philip Zelikow, JD, PhD, MA, former executive director of the 9/11 Commission and the earlier Carter-Ford Commission on Federal Election Reform. Other members include former Food and Drug Administration Commissioner Margaret Hamburg, MD; former Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH; Center for Infectious Disease Research and Policy Director Michael Osterholm, PhD, MPH; and other experts in vaccine development, biodefense, patient care, and more.

"A nonpartisan National Covid Commission could unite Americans to call upon their knowledge and practical skills across and beyond political parties," the release said. "Although it cannot provide the last word, a commission can build a healthier foundation for common understanding and future work, including on issues of equity and the way the seismic shock of this pandemic has exposed so many fault lines in our society." It added that the commission will offer its work to the federal government if Congress and the Biden administration establish a government commission.
Apr 13 University of Virginia press release
Covid CPG website


ECMO may improve survival in severely ill COVID-19 patients

Extracorporeal membrane oxygenation (ECMO) treatment for COVID-19 resulted in a 45.9% in-hospital mortality rate for those hospitalized with COVID-19 and acute respiratory distress syndrome (ARDS)—roughly half the rate reported in previous publications—according to a study late last week in the Annals of Surgery.

The researchers looked at 11,182 US patients hospitalized with COVID-19 and ARDS between April and September 2020. The average length of stay was 36.8 days, including 29.1 days in the intensive care unit. Most patients (57.9%) were younger than 50 years, while roughly 37% were 51 to 64, and about 5% were 65 and older.

In-hospital mortality increased with age, from 25.2% for those 30 and younger to 73.7% for those 65 and older. In a subset analysis of those 18 to 64 years, 1,113 patients with ECMO had a 44.6% in-hospital mortality rate, versus 37.9% of 16,343 patients who did not receive ECMO.

"Although ECMO therapy appears to show a benefit, it is a costly and resources intensive therapy including long length of hospitalization that is not readily available at most medical centers," said Ninh T. Nguyen, MD, in a Wolters Kluwer Health press release. "In the setting of a pandemic when the number of severely ill patients outpaced the availability of limited resources, then this therapy will require appropriate selection of patients that would be most likely to benefit."

Wolters Kluwer Health publishes the Annals of Surgery.
Apr 9 Ann Surg abstract
Apr 12 Wolters Kluwer Health press release

News Scan for Apr 13, 2021

News brief

Antibiotic prescribing fell in British Columbia during pandemic

Overall and respiratory tract infection (RTI)-specific antibiotic prescribing fell significantly in British Columbia during the first few months of the COVID-19 pandemic, according to a study today in Open Forum Infectious Diseases.

Researchers from the British Columbia Centre for Disease Control and the University of British Columbia collected data on antibiotic prescriptions, diagnoses, and physician office visits in the Canadian province from January 2016 to Jul 21, 2020. They calculated monthly prescription rates stratified by age-group, sex, profession, and diagnosis type, and looked at the monthly prescription rate as a moving average over time. They also conducted an interrupted time series analysis to determine if there was a significant change in prescription rates after March 2020.

The results showed that moving average of monthly prescribing rates from January to June 2020 were below the minimum of the pre-pandemic years' moving averages. In addition, researchers observed a more than 30% reduction in monthly prescription rates in April, May, and July of 2020 compared with the same months in 2019. The interrupted time series analysis showed overall monthly prescription rates experienced a significant level change of -12.79 after COVID-19 restrictions were put into place in March 2020, with the greatest level change (-18.02) observed in children ages 1 through 4.

When looking at prescriptions matched to diagnoses, the researchers found that RTI-associated prescriptions decreased significantly during April to July 2020 compared with the same 4 months during the pre-pandemic years, and the interrupted time series analysis found an estimated level change of -5.94 in RTI-associated monthly prescription rates after March 2020. Monthly prescription rates for amoxicillin, amoxicillin and enzyme inhibitors, azithromycin, clarithromycin, and sulfamethoxazole during January to July 2020 all fell compared with the same period in 2019.

The study authors speculate that the implementation of COVID-19 restrictions in the province, the subsequent reduction in opportunities for infectious disease transmission, and a shift to telemedicine all played role in the abrupt decline in antibiotic prescribing. 

"These radical changes in tandem likely led to a multitude of overlapping potential scenarios, all of which resulted in the decreased use of antibiotics in BC," they wrote.
Apr 13 Open Forum Infect Dis abstract


USAID addresses AMR in animal production in Africa, Asia

The US Agency for International Development (USAID) yesterday announced the launch of a project to address emerging infectious diseases and antimicrobial resistance (AMR) in animal production in Africa and Asia.

The Transformational Strategies for Farm Output Risk Mitigation (TRANSFORM) project is a 5-year, $33 million effort that will engage companies involved in animal production and marketing systems and partner with country governments to develop, test, and scale innovative solutions to sustainably improve animal health, strengthen animal production systems in animal agriculture value chains, and enhance global health security. USAID says the public/private partnership will explore strategies to improve safety and production practices, develop and implement antimicrobial stewardship policies across the industry, and establish a comprehensive animal health surveillance and data analytics platform to reduce infectious disease and AMR.

"USAID understands that human health is inextricably linked with the health of animals and the environment, and TRANSFORM represents a new and innovative way to protect human health by improving policies and practices related to animal production," the agency said in a press release.

TRANSFORM will be implemented by a consortium that includes Cargill, Ausvet, Heifer International, and the International Poultry Council.
Apr 12 USAID press release


Global groups: Suspend sale of live wild mammals at food markets

The World Organization for Animal Health (OIE), along with the World Health Organization (WHO) and the United Nations Environment Program (UNEP), today called for countries to suspend the sale of live-caught wild mammals at food markets as a step to reduce the spread of zoonotic diseases.

In an 8-page guidance document yesterday, the groups acknowledged that traditional food markets are a main source of affordable fresh food for many low-income groups and are a livelihood source.

They note, however, that most emerging infectious diseases have wildlife origins, and though the source of SARS-CoV-2 hasn't been definitively identified, at some point the virus may have jumped to humans though one or multiple animal species. A food market that sold wild animals was at the center of China's early outbreak, though it's still not clear what role the market played in the dynamics of virus spread.

Along with suspension in market sale of wild mammals, the group recommended five other steps: strengthening hygiene and sanitation regulations for traditional markets, conducting risk assessments, ensuring that food inspectors are properly trained, shoring up animal health surveillance, and developing food safety information campaigns for market traders, stall holders, consumers, and the general public.
Apr 12 OIE, WHO, UNEP guidance document


High-path avian flu outbreaks hit birds in China and South Africa

China's agriculture ministry yesterday reported a highly pathogenic H5N6 avian flu outbreak involving wild birds in Liaoning province in the northeast, according to Xinhua, China's state news agency.

The outbreak occurred at a forest park near the city of Shenyang, killing 11 of 291 birds. H5N6 outbreaks in poultry have occurred in a number of Asian countries, and sporadic human infections have been confirmed, all but one in China. Laos is the only other country to report a human H5N6 case.

In other outbreak developments, South Africa reported a highly pathogenic H5 outbreak at a poultry farm in Gauteng province, according to an OIE notification. The event began on Apr 9, killing 300 of 29,000 birds. So far, the source of the virus isn't known. Gauteng is a highly urbanized province in the country's northeast and is home to Johannesburg.
Apr 13 Xinhua story
Apr 13 OIE report on H5 in South Africa

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