COVID-19 Scan for Dec 09, 2021

News brief

Low staff COVID vaccine uptake tied to more nursing home cases, deaths

In US counties with high COVID-19 case rates, nursing homes with low staff vaccine uptake saw more infections and deaths among residents than those with high staff vaccination rates, according to a research letter yesterday in the New England Journal of Medicine (NEJM).

Led by a University of Rochester researcher, the team mined national data, primarily from the Centers for Medicare & Medicaid Services COVID-19 Nursing Home Public File database. The investigators grouped 12,364 nursing homes, representing 81% of all US nursing homes, into quartiles by staff COVID-19 vaccine coverage by Jun 13, 2021.

From Jun 13 to Aug 22, nursing homes with the lowest COVID-19 staff uptake in counties with the highest case counts were tied to an additional 1.56 resident infections per 100 beds, 1.50 more cases among staff, and another 0.19 resident deaths, relative to nursing homes in the same county with the highest levels of staff vaccination.

The study authors said these values represent outcomes 132%, 58%, and 195% higher, respectively, than may have been seen if all facilities had high staff vaccination uptake. In counties with the lowest case rates of COVID-19, broad staff vaccination was linked with small differences in infection outcomes.

"Estimates from our model suggest that if all the nursing homes in our sample had been in the highest quartile of staff vaccination coverage (82.7% on average), 4775 cases among residents (29% of the total during the study window), 7501 cases among staff (29% of the total), and 703 COVID-19–related deaths among residents (48% of the total) could possibly have been prevented," the researchers wrote.

The results highlight the reason behind the federal government's nursing home staff vaccination mandate, which requires all staff of facilities participating in Medicare and Medicaid to be fully vaccinated by Jan 4, 2022. "These findings show the extent to which staff vaccination protects nursing home residents, particularly in communities with high COVID-19 transmission," they concluded.
Dec 8 NEJM research letter

After-birth hospital stays significantly shorter during COVID pandemic

A study of electronic health records in the United States shows that short hospital lengths of stay (LOS) after birth were 51% more common in the COVID-19 era, yet infant rehospitalization within a week did not increase. The study is published in Pediatrics.

Short hospital stay was defined as one or two nights for vaginal births and three or fewer for cesarean births. Infant rehospitalization within 1 week of discharge was also compared from the pandemic period (Mar 1 to Aug 31, 2020) to prepandemic periods (Mar 1 to Aug 31 in 2017, 2018, 2019).

The study included records from 202,385 infants born at 35 health systems across the country. A total of 57,110 infants were born in the COVID-19 era. Short birth hospitalization length of stay increased from 28.5% to 43.0% for all births (vaginal, 25.6% to 39.3%; cesarean, 40.1% to 61.0%), but there was no change in rehospitalization diagnoses between eras.

During the pandemic, short LOS were 51% more common than in the 3 years prior.

"This natural experiment suggests shorter birth hospitalization LOS among family- and clinician-selected, healthy term infants may be safe with respect to infant rehospitalization, although examination of additional outcomes is needed," the authors said.
Dec 10 Pediatrics study

News Scan for Dec 09, 2021

News brief

Report: Funding for tuberculosis research falling far short of goals

A new report shows that global funding for tuberculosis (TB) research is at less than half the goal set by United Nations (UN) member states, with countries falling far short of funding commitments.

The report by the Stop TB Partnership and Treatment Action Group finds that global funding for TB research totaled $915 million in 2020 and has been flat since 2018. At the 2018 UN High-Level Meeting on TB, UN member states committed to raising $2 billion annually in funding to help meet the goals of the End TB Strategy, which aims to reduce TB incidence by 80% by 2030. From 2016 to 2020, cumulative funding for TB research totaled $4.2 billion, less than half of what the Stop TB Partnership has estimated is necessary.

Overall, public sector funding accounted for 70% of overall TB research funds, at $641 million, while private philanthropies accounted for 15%, and private companies and multilateral organizations represented 10% and 5%, respectively. The number of countries meeting their fair-share target of investing 0.1% of their research budget into TB has declined since 2017, with only one country—the United Kingdom—meeting its target in 2020.

Although funding for TB did not fall off in 2020 as much as some had feared with the arrival of the COVID-19 pandemic, the groups note that the disease, which still kills roughly 1.5 million people a year and is the world's second-leading infectious disease killer, received only 1% of the amount invested in COVID-19 in 2020.

The groups say the unprecedented amount of money poured into the COVID-19 response provides a blueprint for how critical research into infectious disease can be rapidly advanced.

"The mobilization of over US$100 billion for COVID-19 research and development in the first 11 months of the pandemic shows us just how powerful a coordinated effort against a disease can be," Lucica Ditiu, MD, executive director of the Stop TB Partnership, said in a press release. "We can and must harness this impressive commitment to global health toward the fight to end TB."
Dec 9 2021 report on TB research funding
Dec 9 Stop TB Partnership press release

Belgium, Pakistan, UK report more H5 avian flu outbreaks in poultry

Belgium and Pakistan reported new highly pathogenic H5 avian flu outbreaks in poultry, as the United Kingdom reported more H5N1 events and the country's chief veterinarian warned about the country's heavy burden this season.

In Belgium, animal health officials reported two H5N1 outbreaks on farms in Flanders region. The events began on Dec 3 and Dec 7, killing 1,684 of 65,438 susceptible birds, according to a notification today from the World Organisation for Animal Health (OIE).

Elsewhere, Pakistan reported four H5 outbreaks in North-West Frontier Province, including two on farms and two in backyard flocks, according to an OIE report. The outbreaks started from Nov 17 to Nov 25, and among the four events the virus killed 430 of 6,700 poultry.

Meanwhile, UK officials reported two more H5N1 outbreaks, including at an eighth location in North Yorkshire and a location in South Suffolk, according to an update from the Department for Environment, Food, and Rural Affairs (DEFRA). Britain has reported 38 outbreaks this season, and the country's Chief Veterinarian Christine Middlemiss, DVM, told the BBC that avian flu is occurring at a "phenomenal level" this season.
Dec 9 OIE report on H5N1 in Belgium
Dec 9 OIE report on H5 in Pakistan
Dec 8 DEFRA report
Dec 9 BBC report