COVID-19 Scan for Dec 07, 2021

News brief

Pandemic stresses tied to more anxiety, depression in Black US adults

The stresses of the COVID-19 pandemic have been particularly detrimental for the mental health of Black adults, finds a new US study in the Journal of Gerontology.

Georgia Institute of Technology and North Carolina State University (NCSU) researchers analyzed the daily symptom diaries of 526 US adults aged 21 to 79 years (54% White, 46% Black) kept for 21 days during October and November 2020. In a total of 3,605 diary entries, participants responded to questions about their anxiety and depression symptoms, stresses experienced in the prior 24 hours, and expected stresses in the next 24 hours.

Among White participants, older people reacted more to COVID-19–related stresses than their younger counterparts, but those stresses were consistently more detrimental for Black participants' anxiety levels, regardless of age.

Age was less negatively tied to depressive symptoms for Black than for White participants. Higher levels of stress were also more strongly linked to more depressive symptoms among Black rather than White participants.

Imminent expected stresses were associated with a jump in anxiety symptoms, particularly among older White adults. Black adults aged 21 to 30, however, had more anxiety and depressive symptoms than older White adults facing comparable stresses.

The study authors noted that systemic inequities—especially limited access to healthcare and a tendency to work in occupations with no work-from-home option—have put racial minorities at higher risk for COVID-19 infection and death.

"Although White older adults experienced an increase in daily anxiety when forecasting COVID-19 stress, the co-occurring pandemic of systemic racism may be more powerful than age-related vulnerabilities for Black adults," the researchers wrote.

In an NCSU news release, senior author Shevaun Neupert, PhD, said the findings suggest the need for culturally competent interventions that address the needs of both Black and White adults.

"Much of the existing literature on how older adults cope with stress has focused largely on older white adults," she said. "More research needs to be done to understand and address stress management processes and mental health in Black adults in general, and in older Black adults in particular."
Dec 5 J Gerontol study
Dec 6 NCSU
news release


Study reveals pandemic-related delays in cancer-related diagnoses

The COVID-19 pandemic has likely caused delays in new cancer diagnoses, which in combination with disrupted cancer treatment could lead to poor patient outcomes, according to a national study of more than 9 million Veterans Affairs (VA) Healthcare System patients published yesterday in Cancer.

Led by University of Maryland at Baltimore researchers, the study measured decreases in patient visits related to prostate, lung, bladder, and colorectal cancers, related diagnostic procedures, and new cancer diagnoses before and after the emergence of COVID-19. The median age of patients having diagnostic or screening procedures for the four cancers was 67 years, 92% were men, 22% were Black, and 6.1% were Latino.

Relative to yearly averages in 2018 and 2019, colonoscopies fell by 45%, and prostate biopsies, chest computed tomography (CT) scans, and cystoscopies (bladder and urethra tests) dropped 29%, 10%, and 21%, respectively, in 2020.

New cancer diagnoses fell 13% to 23%, and cancer-related patient visits dropped in April and May 2020 compared with the same period in 2018 and 2019. Prostate cancer visits fell from an average of 63,496 in April 2018 and 2019 to 46,938 in April 2020, a 26% decrease.

Also, in April 2020, visits related to cancers of the lung, bladder, and colorectum declined by 10%, 27%, and 19% from baseline, respectively. Prostate biopsies, chest CT scans, cystoscopies, colonoscopies, and fecal occult blood tests (FOBTs, for detecting colorectal cancer) dropped by 80%, 64%, 74%, 93%, and 54%, respectively, from the same month in 2018 and 2019.

While cancer-related visits rebounded in summer, procedure volumes remained low throughout 2020. This decline resulted in an estimated deficit for 2020 of 133,231 colonoscopies (down 45%), 7,838 prostate biopsies (–29%), 62,793 chest CT scans (–12%), 20,680 cystoscopies (–21%), and 49,334 FOBTs (–13%). Screening chest CT scans showed no deficit for 2020.

The researchers created a chart for determining the time and resources needed to work through the pandemic-related procedure backlog.

"We hope that our work will help physicians, hospitals, and health care organizations anticipate the extent to which they have fallen behind in their efforts to diagnose new cancers," senior author Brajesh Lal, MD, of the Maryland VA and University of Maryland, said in a Wiley news release.
Dec 6 Cancer study
Dec 6 Wiley
news release

Study finds high level of inappropriate testing for fungal disease

A study conducted at a large teaching hospital in Tokyo found that most tests used to diagnose invasive fungal disease were inappropriate, Japanese researchers reported yesterday in Open Forum Infectious Diseases.

The retrospective study, conducted at University of Tokyo Hospital, looked at data on patients who underwent testing with three different types of non–culture-based fungal assays (NCBFAs): beta-D glucan (BDG), galactomannan antigen (GMA), or cryptococcal antigen (CRAG). Testing was deemed appropriate if the clinical presentation was compatible with a fungal infection and there was a predisposing host factor at the time of ordering. The researchers also examined factors that increased risk of inappropriate NCBFA use.

A total of 1,159 patients underwent testing with either serum BDG, GMA, or CRAG tests during the study period. Among the 470 patients included in the analysis, roughly 80% of NCBFAs conducted were deemed inappropriate. Nearly 17% of patients underwent three separate unnecessary NCBFAs simultaneously.

Ordering by transplant medicine physicians, repetitions of the test, the absence of predisposing factors for fungal infections, and the absence of recommendations from infectious diseases (ID) consultants were associated with an increased risk of inappropriate NCBFA use.

The study authors say that while avoidable fungal testing doesn't get as much attention as inappropriate urine cultures or Clostridioides difficile testing, the results suggest fungal diagnostic stewardship is needed to prevent unnecessary cascades of care in patients at low risk of fungal infection.

"Our findings suggest that stewardship efforts engaging transplant physicians, clinical decision support tools to guide ordering practices, and involvement of ID physicians as stewards may be important strategies to improve fungal testing practices," they wrote.
Dec 6 Open Forum Infect Dis abstract


CDC keeps threat assessment moderate for H5N6 avian flu

The US Centers for Disease Control and Prevention (CDC) last week updated its risk assessment for H5N6 avian flu, which follows a concerning doubling of human cases in China this year. Last month the agency announced that a new risk assessment was under way.

In an update of its Influenza Risk Assessment Tool (IRAT), the CDC said that, for its latest assessment, it looked at a recent virus from Sichuan province. It put the risk of potential emergence as a pandemic-capable virus at 5.3, which is in the middle range of the moderate risk category and a little higher than for the 2015 version of the H5N6 virus. For public health impact, it put the risk at 6.3, also in the moderate range, which was a little lower than earlier virus.

The CDC said sequence data from the latest sample shows that H5N6 is still adapted to poultry, with no evidence of increase adaptation to mammals or increased transmissibility. Earlier recommended candidate vaccine viruses are expected to be effective against the H5N6 viruses that are currently circulating in China. Also, the CDC said its recent analysis suggests the viruses are susceptible to current recommended antiviral medications.

It notes that the H5N6 clade that has caused human illnesses has only been reported in birds in four Asian countries.

Since 2014, 52 human infections have been reported, all but 1 in China. Earlier this year, Laos reported a case. So far this year, 26 human cases have been reported, with most involving contact with poultry or poultry environments. Most cases were severe, and 9 people died from their infections.
Dec 2 CDC IRAT update
Nov 2 CIDRAP News scan


CDC ends probe of Salmonella outbreak tied to fish after 115 cases

The CDC yesterday said its investigation of a Salmonella Thompson outbreak tied to fish sold by a Denver company is over after 115 cases in 15 states —with 13 more cases and 1 additional state than when the outbreak was first reported 2 months ago.

Twenty people were hospitalized, and there were no deaths recorded in this outbreak linked to seafood products from Northeast Seafood Products of Denver. Illness-onset dates ranged from May 11 to Oct 16, and 93 of the case-patients were Colorado residents.

Among 81 people interviewed, 67 (83%) reported eating seafood, including raw seafood in sushi and cooked seafood, the CDC said. Sick people ranged in age from less than 1 to 85 years, with a median age of 39, and 53% were female.

"Sick people reported eating a variety of raw and cooked seafood from restaurants and grocery stores. Investigators identified Northeast Seafood Products as a common supplier and found the outbreak strain in the company’s production facility," the CDC said.

Northeast Seafood Products recalled several fish products on Oct 8.
Dec 6 CDC


French lab worker dies from CJD; lab moratorium extended

A retired French lab worker who had worked with prions and was diagnosed as having Creutzfeldt-Jakob disease (CJD) has now died, and a moratorium on prion research in France has been extended, according to a French media report cited by ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

An investigation is still under way to determine if the woman was exposed to prions during her work. It's not known if her CJD infection is related to her work or some other cause, such as sporadic or genetic.

The woman had worked at the National Research Institute for Agriculture, Food and Environment lab in Toulouse, and reports of her illness surfaced in July.

Her death marks the second involving a French lab worker from CJD. In 2019, a 33-year-old lab technician died after pricking her thumb while conducting an experiment on prion-infected mice.

According to the media reports, the research moratorium has been extended 2 more months.
Dec 6 ProMED Mail post
Jul 28 CIDRAP News scan

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