COVID-19 Scan for Mar 10, 2022

News brief

Non-COVID post-hospital deaths highlight pandemic consequences

While Medicare beneficiary hospitalizations for non–COVID-19 diagnoses fell sharply in March and April 2020 and stayed low through September 2021, death rates after hospitalization rose substantially—particularly for Black and Hispanic patients, finds a study yesterday in JAMA Network Open.

University of Texas and Johns Hopkins researchers analyzed claims data from 8,448,758 Medicare admissions to 4,626 US hospitals for non-COVID indications from January 2019 through September 2021. Average patient age was 73.7 years.

A multilevel logistic regression analysis showed that the death rate in the 30 days after hospitalization rose from 9.4% in 2019 to 11.5% from Apr 1, 2020, to Mar 31, 2021 (odds ratio [OR], 1.20).

The higher death rate, which held throughout the first 18 months of the pandemic, varied by race (ORs, 1.27 for Black, 1.25 for Hispanic, and 1.18 for White participants), Medicaid eligibility (OR, 1.25 for Medicaid-eligible vs 1.18 for noneligible patients), and hospital quality score (1 to 5 stars, with 1 being the worst) (OR, 1.27 for 1 star vs 1.11 for 5 stars).

Greater increases in the odds of death from the prepandemic to pandemic periods were associated with greater hospital COVID-19 prevalence. For example, when comparing deaths in October through December 2020 with those in the same period in 2019, the OR was 1.44 for hospitals in the top quartile of COVID admissions vs 1.19 for admissions to those in the lowest.

"The prolonged elevation in mortality rates after hospital admission in 2020 and 2021 for non–SARS-CoV-2 diagnoses contrasts with reports of improvement in hospital mortality during 2020 for SARS-CoV-2," the study authors wrote. "The results of this cohort study suggest that, with the continued impact of SARS-CoV-2, it is important to implement interventions to improve access to high-quality hospital care for those with non–SARS-CoV-2 diseases."

In a related commentary, Laura Myers, MD, MPH, and Vincent Liu, MD, both of Kaiser Permanente Northern California, said the findings underscore the far-reaching consequences of COVID-related strain on hospitals.

"Prior work has shown that during periods of high hospital strain, borderline patients with common illnesses like sepsis and acute respiratory failure are far less likely to be admitted to the intensive care unit compared with periods of low strain," they wrote.
Mar 9 JAMA Netw Open study and commentary

Study: Booster mRNA doses offer good protection against severe Omicron

The New England Journal of Medicine (NEJM) has published a study from Qatar showing good protection of mRNA booster vaccines against Omicron variant infection but much better protection against severe Omicron disease and the Delta variant.

Researchers compared vaccine effectiveness of standard two doses against symptomatic SARS-CoV-2 infection and COVID-19–related hospitalization and deaths from Dec 19, 2021, through Jan 26, 2022, with that of the standard series and a booster. The time period covered the Omicron surge.

A total of 2,239,193 people, all vaccinated with either the Pfizer/BioNTech or Moderna vaccine series, were included in the study. Among those who also had a Pfizer booster dose, protection against symptomatic infection caused by the Omicron variant was 49.4% (95% confidence interval [CI], 47.1% to 51.6%). The Pfizer boosters were 76.5% (95% CI, 55.9% to 87.5%) protective against hospitalizations and death.

Pfizer booster effectiveness against symptomatic infection with the Delta variant, compared with the primary series, was 86.1% (95% CI, 67.3% to 94.1%). Moderna booster effectiveness against symptomatic Omicron infection, compared with the primary series, was 47.3% (95% CI, 40.7% to 53.3%).

"Cases of severe Covid-19 were rare in both the booster and nonbooster cohorts despite the large number of infections. These findings affirm the durability of vaccine protection against hospitalization and death several months after receipt of the second dose," the authors concluded.
Mar 9 NEJM study

News Scan for Mar 10, 2022

News brief

Study: Young kids with simple pneumonia fare well without antibiotics

A study of children 3 years old or younger who were hospitalized for uncomplicated community-associated pneumonia (CAP) found that a significant proportion did well without a full course of antibiotics, researchers reported yesterday in Open Forum Infectious Diseases.

In the retrospective observational study, researchers from the University of Alabama at Birmingham analyzed data on previously healthy children ages 3 to 36 months who were treated at Children's of Alabama for uncomplicated CAP from September 2011 through December 2019. They compared outcomes in children treated with antibiotics—defined as treated for more than 2 days with an antibiotic or discharged home with an antibiotic prescription—versus those who received 2 days of antibiotics or less or were discharged home with no antibiotics.

The outcomes of interest were illness severity, length of hospital stay, and readmission after discharge.

A total of 322 children were included in the study, and 266 (83%) received more than 2 days of antibiotics or were discharged with antibiotics. Fifty-six children received 2 days or less of antibiotics and none at discharge, with 32 receiving no antibiotics at all. There were no statistically significant differences in sex, race, or ethnicity between groups. Similar proportions of patients in both groups required intensive care unit admission, and there were no statistically significant differences between the groups in median hospital length or 30-day readmissions.

The proportion of patients treated with antibiotics decreased from 88% in the early part of the study period (2011 through 2013) to 66% from 2017 through 2019.

"It appears that a substantial proportion of previously healthy children less than 3 years of age hospitalized with uncomplicated CAP will do well without antibiotic treatment," they concluded. "This conclusion is also relevant for the outpatient setting, where most young children with community-acquired pneumonia are managed. Better tools for identifying those that require antibiotics will make it possible to achieve a significant advance in antibiotic stewardship."
Mar 9 Open Forum Infect Dis abstract

Global flu activity continues to decline

A new global flu update from the World Health Organization (WHO) shows declining activity in most world regions but increased H3N2 activity was reported in parts of South America.

Of respiratory samples that tested positive at national flu labs in the middle 2 weeks of February, 68.6% were influenza A. Of subtyped influenza A viruses, 88.9% were H3N2. Of the type B viruses for which lineage was determined, 100% belonged to the B-Victoria lineage.

In North America and Europe, influenza detections remained low and were predominantly A (H3N2) among those detected and subtyped. Respiratory syncytial virus (RSV) activity also decreased in the United States and Canada, the WHO said, with very little RSV noted in Europe.

Influenza B detections continued to drop in China and other parts of East Asia, though RSV activity was elevated in Mongolia and the Republic of Korea.

"The current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic has influenced to varying extents health seeking behaviors, staffing/routines in sentinel sites, as well as testing priorities and capacities in Member States," the WHO warned.
Mar 7 WHO update