COVID-19 Scan for Apr 27, 2021

News brief

Shift work may increase risk of COVID-19

People who work irregular or permanent shifts were associated with double the risk of COVID-19, according to findings from a Thorax study published yesterday. The study looked at 27,056 irregular and 21,836 permanent shift workers between ages 40 to 69, as well as 235,135 non-shift workers, all identified in the UK Biobank.

When compared with non-shift workers—those who worked regular daytime hours—irregular shift workers were associated with a 2.42 odds ratio (OR; 95% confidence interval [CI], 1.92 to 3.05) of contracting COVID-19, while permanent shift workers had an OR of 2.50 (95% CI, 1.95 to 3.19), both after adjusting for age, sex, deprivation index, and ethnicity. After further compensation for body mass index (BMI), chronotype (eg, are they a morning person?), alcohol intake, smoking, and prior disease, ORs were 2.29 and 2.68 for irregular and permanent shift workers.

The researchers reported that shift workers experienced increased risk for COVID-19 diagnosis regardless of job type (nonessential, essential, healthcare) and physical proximity to coworkers and the public. Instead, they write, the disparity may be driven by the amount of people in the workspace within a 24-hour period, reduced cleaning time, fatigue leading to less mitigation adherence, and the possibility that shift work may alter immune response.

"The size of effect of shift work as a risk factor for COVID-19 is comparable with other reported risk factors for COVID-19, such as being non-white, being most socioeconomically deprived and having a BMI >40 kg/m²," they conclude.

"We do believe it should be possible to substantially mitigate these risks through good handwashing, use of face protection, appropriate spacing, and vaccination," said co-author Hannah J. Durrington, PhD, in a BMJ press release.

Most shift workers were younger, male, and of non-White ethnicity, and they were more likely to have a higher BMI, smoke more, drink less, and experience higher levels of sleep deprivation..
Apr 26 Thorax study
Apr 26 BMJ press release

Study: Common inflammatory bowel drug blunts COVID-19 vaccine response

A UK study yesterday in the journal Gut found that the common inflammatory bowel disease (IBD) drug infliximab blunts COVID-19 vaccine response after one dose.

The findings come from the CLARITY study, which assessed COVID-19 infection and vaccination in 6,935 patients who have IBD, including Crohn's disease and ulcerative colitis, from 92 hospitals from September to December 2020.

The study measured antibody response in patients who took infliximab, an anti-tumor necrosis factor (anti-TNF) biologic drug, and had one dose of either the Pfizer or AstraZeneca COVID-19 vaccine. Researchers found that only 31.4% of participants (103 of 328) treated exclusively with infliximab produced enough antibodies to offer adequate protection against COVID-19.

When a patient took infliximab with immunomodulator drugs, such as azathioprine or methotrexate, the levels of antibodies were even lower: Only 125 of 537 (23.3%) met the threshold of a positive antibody test after one dose.

Patients who had a previously documented COVID-19 infection, however, produced sufficiently protective antibodies after one dose. And of 20 infliximab-treated patients who received two doses of the Pfizer vaccine, 17 (85%) developed protective antibodies.

"Although we know that this has been an incredibly difficult time for people with IBD, our research indicates that people treated with infliximab should consider that they are not protected from COVID-19 until they have had both doses of a vaccine and should continue to practice enhanced physical distancing and shielding if appropriate," said co-author Nick Powell, PhD, of Imperial College London, in a University of Exeter press release.
Apr 26 Gut study
Apr 26 University of Exeter press release

Pediatric diabetes complications rose during pandemic in LA hospital

Pediatric rates of diabetic ketoacidosis (DKA), a complication of type 2 diabetes that can lead to death, rose during the pandemic at Children's Hospital Los Angeles (CHLA), according to a study published yesterday in Diabetes Care.

The researchers compared medical records from March to August in 2018, 2019, and 2020, and found that DKA in new-onset type 2 diabetes increased by 20% in 2020, compared with 9% in 2018 and 3% in 2019. Overall, 44, 66, and 82 children had new-onset type 2 diabetes in 2018, 2019, and 2020, respectively, and DKA was found in 4, 2, and 16, respectively. Age at diagnosis, sex, and high BMI were not significant variables.

In 2020, no patients with DKA had a positive COVID test on admittance, but two of six tested positive for antibodies and another was presumed to have an asymptomatic infection. The researchers believe that factors such as change in care-seeking behaviors, access to healthy foods, and physical activity may have affected the increase in DKA, as well as an undetermined, possibly bidirectional, relationship between COVID exposure and diabetes.

"It's critical for pediatricians to recognize that when a child presents with symptoms of diabetes, the child needs to be evaluated right away," said Lily C. Chao, MD, in a CHLA press release. "The sooner we see these kids, the better chance we have to prevent DKA."
Apr 26 Diabetes Care study
Apr 26 CHLA press release

News Scan for Apr 27, 2021

News brief

CARB-X to fund development rapid diagnostic test for sepsis

CARB-X announced today that it is awarding up to $3 million to GenomeKey of Bristol, United Kingdom, to develop an innovative rapid diagnostic test for sepsis.

GenomeKey's diagnostic project uses technology that combines innovative methods to separate bacterial DNA from human DNA in whole blood with next-generation DNA sequencing and machine learning to interpret antimicrobial susceptibility. The aim is determine, within 4 hours, what bacteria are causing the infection in sepsis patients and which antibiotics would be most effective. Conventional laboratory tests take 24 to 73 hours to produce results.

Globally, an estimated 11 million people die each year from sepsis, which occurs when the immune system has an overwhelming reaction to an infection that has entered the bloodstream. Quick, appropriate treatment is considered vital.

GenomeKey could be eligible for up to $6.5 million in additional funding from CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) if the project achieves certain milestones.

"Prompt diagnosis and treatment provide the best chance for reducing death rates and improving recovery from sepsis," CARB-X Research and Development Chief Erin Duffy, PhD, said in a CARB-X press release. "GenomeKey's innovative technology aims to accelerate diagnosis and deliver vital antibacterial susceptibility information that could take the guesswork out of treatment decisions in the first critical hours of illness."
Apr 27 CARB-X press release

Study: Variation in clinic visits drives differences in antibiotic prescribing

Differences in antibiotic prescribing rates between high-prescribing areas of Massachusetts and low-prescribing areas were primarily due to variation in outpatient visits for respiratory conditions, rather than provider prescribing practices, researchers reported today in the Journal of Infectious Diseases.

In the study, researchers at Harvard University and the Massachusetts Department of Public Health examined medical and pharmacy claims data from the Massachusetts All-Payer Claims Database from January 2011 through September 2015 to determine geographic variation in outpatient visit rates and antibiotic prescribing rates per visit for 20 medical conditions. They defined high-prescribing census tracts as those with a per capita prescribing rate above the state median rate per 1,000 people per month, and low-prescribing census tracts as those with a prescribing rate below the state median rate.

The mean antibiotic prescribing rate in high-prescribing census tracts was 71.7 per 1,000 people per month, compared with 54.9 prescriptions in the low-prescribing tracts. In an age-stratified analysis, geographic differences in outpatient visit rates accounted for 45.2% of the gap in antibiotic prescribing between high- and low-prescribing tracts, while differences in prescribing practices accounted for just 25.8% of the gap.

In particular, geographic differences in outpatient visit rates for sinus infection, sore throat, and ear infection with pus accounted for 30.3% of the gap, a greater contribution than visits for the other 17 conditions combined (14.9%). The contributions from sore throat and ear infection were mostly attributable to higher outpatient visit rates among children under 10 in high-prescribing tracts.

When the researchers looked at predictors of outpatient visits for respiratory illness, they found fewer outpatient visits in census tracts with a higher social deprivation index (i.e., lower socioeconomic status).

"Taken together, our findings suggest that the variation in antibiotic prescribing rates across Massachusetts census tracts is not primarily due to variation in prescribing practices, but rather to variation in outpatient visit rates that may be associated with reduced healthcare access in the most impoverished areas of Massachusetts and/or an inflated tendency to seek medical care for respiratory illness in wealthier areas," the study authors wrote.

They add that interventions to reduce antibiotic consumption should address the drivers of outpatient visits for respiratory illness.
Apr 27 J Infect Dis abstract