COVID-19 Scan for Feb 07, 2022

News brief

High-risk COVID outpatients least likely to receive monoclonal antibodies

Nonhospitalized COVID-19 patients at highest risk for severe outcomes are often the least likely to receive monoclonal antibodies (mAbs), finds a study of more than 1.9 million Medicare beneficiaries published late last week in JAMA.

A team led by a Harvard Medical School researcher examined a sample of outpatient, emergency department, and laboratory insurance claims for fee-for-service Medicare beneficiaries who received a new diagnosis of COVID-19 or had a confirmed exposure from November 2020 to August 2021. mAbs were first available for use in COVID-19 patients in November 2020.

Among the 1,902,914 participants, 7.2% received mAbs. Patients with fewer underlying illnesses were more likely than those with more conditions to receive the treatment (23.2% with 0 chronic conditions vs 6.3%, 6.0%, and 4.7% with 1 to 3, 4 or 5, and 6 or more chronic conditions, respectively; adjusted odds ratio [aOR], 7.43 for 0 vs 6 or more).

Black patients were less likely than their White peers to be given mAb (6.2% vs 7.4%; aOR, 0.77), as were those who were also enrolled in Medicaid (4.6% vs 8.1%; aOR, 0.74). Participants 85 years and older were 42% more likely to receiving mAbs than those 65 to 74.

Administration of mAb also varied widely by US region, with Rhode Island (24.9%) and Louisiana (21.2%) administering the most, while Alaska (1.1%) and Washington (0.7%) had the lowest rates. Southern states had the highest rates of mAb use (10.6%), with the lowest rates in the West (2.9%).

The study authors said that patients at highest risk may have had problems navigating the multiple steps required to access mAb, including a timely COVID-19 diagnosis and referral and booking an appointment for an infusion within 10 days. "In addition, mAb supply may have been low or less used by clinicians in some regions of the country," they wrote.

In a Harvard press release, lead author Michael Barnett, MD, said that geographic mAb differences may have been influenced by supply levels in different parts of the country. "We need new approaches to prevent these inequities from happening again with newer treatments on the horizon," he said.
Feb 4 JAMA research letter
Feb 4 Harvard
press release


COVID-19 patients at increased risk for cardiovascular complications

A new study suggests patients with COVID-19 are at an increased risk for a variety of cardiovascular complications between 30 days and 1 year after infection. The study, published today in Nature Medicine, is based on data from the US Department of Veterans Affairs.

In total, 153,760 veterans with COVID-19 were compared to two cohorts of controls. Risk for cardiovascular complications occurred for all patients, including those not hospitalized, but non-hospitalized veterans were at less risk than hospitalized patients, and hospitalized patients were at less risk than those admitted to intensive care units.

Strokes, dysrhythmias, inflammation of the heart muscle, and ischemic heart disease were all more frequent in COVID-19 patients.

People who survived the first 30 days of COVID-19 exhibited increased risk of stroke (hazard ratio [HR],1.52; 95% confidence interval [CI], 1.43 to 1.62), for a burden of 4.03 (95% CI, 3.32 to 4.79) per 1,000 persons at 12 months. The risks and burdens of ischemic heart disease outcomes, including myocardial infarctions, were 1.66 (95% CI, 1.52, 1.80) and 7.28 (95% CI, 5.80 to 8.88), respectively. The HR for myocarditis was 5.38 (95% CI, 3.80 to 7.59).

"Our study shows that the risk of incident cardiovascular disease extends well beyond the acute phase of COVID-19," the authors concluded. "Because of the chronic nature of these conditions, they will likely have long-lasting consequences for patients and health systems and also have broad implications on economic productivity and life expectancy."
Feb 7 Nat Med study


Omicron strain much less likely to cause severe outcomes, study finds

The first peer-reviewed US study of COVID-19 outcomes in patients infected with the Omicron (B.1.1.529) variant shows that, relative to patients infected with previous variants Delta (B1617.2) and Alpha (B117), Omicron patients were younger, had significantly higher vaccine breakthrough rates, and were significantly less likely to be hospitalized.

The study, published late last week in the American Journal of Pathology, also found that, when hospitalized, Omicron patients needed less intense respiratory support and had shorter stays, consistent with early reports of the generally milder nature of cases caused by the highly transmissible strain.

Houston Methodist Hospital researchers led the study, which mined the electronic health records of 4,468 COVID-19 patients infected with Omicron from late November to early January 2022. Omicron took only 3 weeks to make up 90% of COVID-19 cases after it emerged in Texas in November, accounting for 98% of new infections by January, the authors said.

Median Omicron patient age was 44.3 years, compared with 50.0 for Alpha and 48.3 for Delta. Length of hospital stay was 3.2 days for Omicron, versus 5.1 days for Alpha and 5.4 days for Delta; and Omicron resulted in 55.4% of breakthrough cases in vaccinated patients, compared with 3.2% and 24.3% of those infected with Alpha and Delta, respectively.

Of all Omicron cases during the study period, 55.9% met the Centers for Disease Control and Prevention criteria for a vaccine breakthrough infection. There was no clear-cut relationship between time since receipt of the final primary vaccine dose and breakthrough infection.

Two asymptomatic COVID-19 patients were found to be infected with the Omicron subvariant BA.2, commonly called the Omicron "stealth" variant because it can evade detection by some commonly used COVID-19 tests.

"The present study highlights the importance of analyzing SARS-CoV-2 genome data integrated with patient metadata and stresses the need to continue to do this in near-real time as the Omicron surge continues, the virus evolves, and new variants with potentially altered fitness and biomedically relevant phenotypes are generated," the researchers wrote.
Feb 3 Am J Pathol study

News Scan for Feb 07, 2022

News brief

Louisiana becomes 29th state to confirm CWD after deer tests positive

Chronic wasting disease (CWD) has been confirmed for the first time in Louisiana, the Louisiana Department of Wildlife and Fisheries (LDWF) said late last week.

The fatal prion disease was detected in an emaciated white-tail buck harvested by a hunter in Tensas Parish, across the border from where the diseases was detected in 2018 in Mississippi, and again during the 2021-22 hunting season. The number of CWD-affected states is now 29, following the first detection of the disease last month in Alabama.

The LDWF first reported a positive finding in the Tensas Parish deer on Feb 2, and after confirmation of CWD by the National Veterinary Services Laboratory in Ames, Iowa, the department announced a feeding and carcass-export ban on deer in Tensas, Franklin, and Madison parishes on Feb 4. The ban took effect today.

"This is what we have feared," said LDWF Secretary Jack Montoucet in the Feb 2 news release. "We will count on the diligence of our hunters, property owners, deer processors, and taxidermists in monitoring and helping to control the spread of CWD."

Referring to the ban on supplemental feeding, including mineral or salt licks, and on exporting deer carcasses, Montoucet added in a Feb 4 news release, "This is the best option that we have at this time. We will provide updates on our response in the coming months."

CWD has also been detected in four Canadian provinces and can infect other cervids as well, such as moose and elk. CWD-infected deer may show signs of weight loss, excess salivation, frequent drinking and urination, coordination problems, and a lack of fear of people.

CWD has yet to be detected in people, but the Centers for Disease Control and Prevention (CDC) warns against eating cervid meat that tests positive for the disease.
Feb 2 LDWF news release
Feb 4 LDWF news release


H5N1 avian flu infects more US waterfowl, strikes Canadian turkey farm

The US Department of Agriculture (USDA) has reported 87 more highly pathogenic H5 or H5N1 avian flu detections in hunter-harvested birds on the East Coast that were tested as part of surveillance efforts. In a related development, Canada—which has reported recent similar detections—confirmed the first outbreak involving the Eurasian strain at a commercial farm.

In the middle of January, the USDA Animal and Plant Health Inspection Service (APHIS) had reported three H5N1 detections involving hunter-harvested waterfowl in North Carolina and South Carolina.

The 87 new reports include two detections in Palm Beach County in Florida, but most involve detections in the Carolinas, including several more from Colleton County in South Carolina and reports from three more counties in North Carolina: Beaufort, Bladen, and Pamlico.

The reports also include two detections in Virginia's Henrico County, previously reported by Virginia officials, as well as a detection from Virginia Beach.

All of the locations are on the Atlantic Flyway for migratory birds.

APHIS said though it's not unusual to detect avian flu in wild birds, which can spread the virus without symptoms, the recent Eurasian H5 detections serve as a warning for poultry owners in the United States to step up their biosecurity practices. Eurasian H5 outbreaks this winter have caused major poultry losses, especially in Europe.
USDA APHIS high-path avian flu page
Feb 2 CIDRAP News scan on earlier Virginia detections

Canada's H5N1 outbreak occurred at a commercial turkey farm in the western part of Nova Scotia, according to a notification from the World Organization for Animal Health (OIE).

The outbreak began on Jan 30, killing 6,146 of 11,800 susceptible birds. Officials said the virus is similar to the strain recently detected in waterfowl and other birds in Newfoundland and Nova Scotia and is of the same lineage circulating in European birds.
Feb 4 OIE report on H5N1 in Canada


Study finds high rates of antimicrobial resistance in Benin hospital

A study of blood cultures collected at a semi-rural hospital in Benin found unexpectedly high rates of antimicrobial resistance (AMR) among gram-negative bacteria, researchers reported last week in BMC Infectious Diseases.

From October 2017 to February 2020, 3,140 blood cultures were collected from 3,082 suspected bloodstream infection (BSI) episodes at Boko Hospital, a secondary hospital in Benin, and a nearby university hospital. Isolates retrieved from the blood cultures were processed locally and later shipped to Belgium for reference identification and antimicrobial susceptibility testing. Most of the cultures (78.7%) were from children under 15 years of age.

Pathogens were recovered from 383 blood cultures (12.4%), corresponding to 381 confirmed BSIs. The most common pathogens were Klebsiella pneumoniae (15.6%), Salmonella Typhi (15.3%) and Staphylococcus aureus (13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins found in 77.6% of K pneumoniae isolates, 12.8% of Escherichia coli isolates, and 70.5% of Enterobacter cloacae isolates. Carbapenemase production was detected in two E coli and two E cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S aureus isolates.

The study authors say the findings highlight the feasibility and importance of having clinical bacteriology laboratories at secondary hospitals in low- and middle-income countries (LMICs), particularly those in sub-Saharan Africa, where AMR data are scarce.

"Unbiased estimates for AMR are difficult to obtain in LMIC, but our experiences highlight the potential for surveillance of AMR in the community through strengthening of clinical microbiology laboratories in remote, non-tertiary settings," they wrote.
Feb 3 BMC Infect Dis abstract

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