COVID-19 Scan for Feb 04, 2021

News brief

ED visits for overdose, mental health, child abuse rose during COVID-19

Except for a slight decrease from Mar 29 to Apr 11, 2020, emergency department (ED) visits involving drug and opioid overdoses (ODs) were 1% to 45% more frequent than in 2019, according to a JAMA Psychiatry study published yesterday.

The researchers also found that the median number of ED visits per 100,000 involving mental health conditions (MHCs), suicide attempts (SAs), and suspected child abuse and neglect (SCAN) cases also increased during the COVID-19 pandemic despite the decrease in overall visits.

Intimate partner violence (IPV) was the only measured category that did not show an increase (28.3 vs 27.5 per 100,000 visits).

The researchers looked at ED visits from Dec 30, 2018, through Oct 10, 2020, to compare pandemic visits with a 2019 baseline. The National Syndromic Surveillance Program, which looks at approximately 70% of the country's ED visits, showed that total weekly visits decreased from Mar 8 to 28, 2020, but rates for all six outcomes increased. (The national emergency was declared Mar 13, 2020, followed by "15 Days to Slow the Spread.")

Overall, median ED visit counts from Mar 15 to Oct 10, 2020, were significantly higher for SAs (4,940 vs 4,656 in 2019), all ODs (15,604 vs 13,371), and opioid ODs (5,502 vs 4,168). They were lower for IPV visits (442 vs 484) and SCAN cases (884 vs 1,038), but the rate of SCAN cases among all ED visits rose.

Near the end of the study period, the rate of the measured outcomes began to decrease even as total visits continued to rise. The researchers write, "This decrease could be indicative of a number of issues: the public resuming normal health-seeking behaviors, the lifting of stay-at-home orders and a perception of increased safety and reduced risk of COVID-19 spread, or the public's adjustment to mitigation measures or ability to identify coping strategies (eg, telehealth or telemental health services and consolation from widespread messaging)."

The authors conclude, "This study demonstrates that people still visited EDs for these outcomes and that, for the most part, visits for these outcomes decreased to a lesser extent than overall ED visits."
Feb 3 JAMA Psychiatry study


Study highlights evidence for airborne cruise ship COVID spread

Mean estimates of short-range, long-range, and fomite (contaminated surface) COVID-19 transmissions on the Diamond Princess cruise ship were respectively 35%, 35%, and 30%, according to a modeling study published yesterday in Proceedings of the National Academy of Sciences.

Of the airborne transmissions, 41% and were estimated to be from larger respiratory droplets and 59% from smaller respiratory aerosols, the investigators note.

The Diamond Princess outbreak began from one passenger who was on the ship Jan 20 to 25, 2020, and in the following weeks (2 of which passengers were in quarantine), 712 out of 3,711 (19.2%) passengers and crew were infected. Once released, at least 57 people had positive polymerase chain reaction samples collected within 3 days.

To create transmission models, the researchers adapted Markov chain, dose-response, and Reed-Frost epidemic models and found that 132 of 21,600 possible scenarios met acceptability criteria based on the recorded cases. Smaller aerosols were defined as less than 5 micrometers (µm) in diameter, and larger droplets as between 5 and 10 µm in diameter.

Quarantine, the researchers note, did affect infection spread: Fomite transmission went down after quarantine began because of the limited indoor public areas as well as an increased amount of handwashing. Contribution of large droplets vs small aerosols changed, too, going from median estimates of 40% and 60%, respectively, to 15% and 85%, suggesting that most quarantine transmissions were from short-ranged, small aerosols.

"Our results demonstrate that aerosol inhalation was likely the dominant contributor to COVID-19 transmission among the passengers, even considering a conservative assumption of high ventilation rates and no air recirculation conditions for the cruise ship," the researchers write. "This model approach has broad applicability beyond COVID-19 and cruise ships and can be used for estimating the contribution of transmission pathways of other airborne infectious diseases such as measles, tuberculosis, and influenza in other infection outbreaks."
Feb 3 Proc Natl Acad Sci abstract

News Scan for Feb 04, 2021

News brief

Scientists identify always fatal disease in chimpanzees

An international team of researchers has identified a new and always lethal neurologic disease in chimpanzees living in a sanctuary in Sierra Leone. The scientists, including researchers from the University of Wisconsin-Madison, reported their findings yesterday in Nature Communications.

Since 2005, 56 western chimpanzees in Sierra Leone's Tacugama Chimpanzee Sanctuary have suffered from the disease, despite medical treatment.

Now genetic analysis has helped the researchers identify the pathogen and name the disease, which they call "epizootic neurologic and gastroenteric syndrome" (ENGS), caused by a novel Sarcina bacterium now known as Sarcina troglodytae. The scientists isolated the bacterium from the chimps' brain and lung tissue samples.

The researchers do not yet know how the animals got infected, but they describe neurologic and gastrointestinal symptoms for an average of 6 days before apparent recovery or death. All animals that appeared to recover later suffered a recurrence of infection and died.

Because of the genetic similarities between chimpanzees and humans, the authors are concerned ENGS could jump to people, but so far no staff with close contact to the infected chimps have gotten sick. A literature review showed only 44 people have been known to be infected with Sarcina bacteria, all successfully treated with antibiotics.
Feb 3 Nature Comm


H5N8 avian flu strikes more poultry farms in Europe

European countries continue to report more highly pathogenic H5N8 avian flu outbreaks in poultry, including 34 more events in France's hard-hit southwestern region, according to the latest notifications from the World Organization for Animal Health (OIE).

France's latest outbreaks mainly involve duck farms in the foie gras producing region. The outbreaks began from Dec 29 to Jan 30, and, taken together, the virus killed 5,819 of 236,031 birds. The survivors were culled to curb the spread of the outbreaks. Also, France reported a low-pathogenic H5N3 outbreak at a duck farm in Pyrenees-Atlantiques department. The event began on Jan 25, and the 3,140 birds at the facility were destroyed.

Also, Germany reported an H5N8 outbreak at a turkey farm in Brandenburg state that started on Jan 31, killing 7,166 of 14,332 birds. Poland reported five more outbreaks affecting four provinces. The outbreaks began from Jan 28 to Jan 30, affecting commercial farms, including some raising turkeys, and among all of the events, the virus killed 9,819 of 187,545 birds.
Feb 4 OIE report on H5N8 in France
Feb 3 OIE report on low-path H5N3 in France
Feb 3 OIE report on H5N8 in Germany
Feb 3 OIE report on H5N8 in Poland's Wielkopolska province
Feb 3 OIE report on H5N8 in three Polish provinces

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