COVID-19 Scan for May 26, 2021

News brief

Low testosterone concentration associated with men's COVID severity

Low testosterone concentrations in men with COVID-19 are associated with a greater likelihood of COVID-19 infection severity, artificial ventilation or intensive care unit (ICU) treatment, and death, according to a study yesterday in JAMA Network Open.

The researchers looked at the hormone levels in an observational cohort of 152 men and women with symptomatic COVID-19 at the Barnes-Jewish Hospital in St. Louis from March to May 2020 (mean age, 63 years). Of the 143 who were admitted, hormones were also measured at days 3, 7, 14, and 28 as long as they were still hospitalized.

Women had no correlation between COVID-19 outcomes and hormone levels of testosterone, estradiol (a form of estrogen), or growth hormone insulin growth factor 1 (IGF-1). Men with low testosterone concentrations, however, had an inverse association with the odds of severe COVID-19 (odds ratio [OR], 0.11), ICU admittance (OR, 0.15), artificial ventilator use (OR, 0.29), and a statistically insignificant link with mortality.

At admission, testosterone concentrations were 64.9% lower in severe male patients versus mild male patients (median 53 nanograms per deciliter [ng/dL]), and the gap only increased at days 3 and 7 post-hospitalization (82.9%, with 19 vs 111 ng/dL, and 84.1%, 20 vs 126 ng/dL, respectively). The study's reference testosterone concentration level is defined as 250 ng/dL, although the researchers note that they didn't have pre-infection testosterone levels for the patients. Additionally, the data showed that lower testosterone concentrations in the male COVID-19 patients were linked with higher inflammation and the body's increased ability to detect and use the hormone.

Because of the study's observational format, the researchers say they do not know if lower testosterone levels are a causal factor or simply a biomarker indicator. They also note that while this association was found independent of COVID risk factors such as age, body mass index, comorbidities, and race, low testosterone concentrations in general are associated with increasing age, obesity, and diabetes.

"During the pandemic, there has been a prevailing notion that testosterone is bad," said senior author Abhinav Diwan, MD, in a Washington University press release. "But we found the opposite in men. ... And if testosterone levels dropped further during hospitalization, the risk increased."
May 25 JAMA Netw Open study
May 25 WashU press release

Long COVID affects families, not just survivors, study notes

Long haul COVID-19 affects not only the survivor but also their partners and close family, according to a UK study yesterday in BMJ Open.

In a self-reported survey from May 30 to Aug 30, 2020, 735 long-haul COVID-19 survivors and 735 of their partners and close family members were surveyed. Most survivors (86.6%) still had symptoms 4 weeks post-diagnosis, and 63.5% still had symptoms after 12 weeks. Their quality of life was measured primarily on the EuroQol group five dimensions three level (EQ-5D-3L) scale, which rates five areas from 1 to 3, with 3 being the worst. The average score was 8.65 out of 15.

The most affected outcome was doing usual activities (2.06), and most frequently reported ailments were pain and discomfort (81.1%), effects on usual activities (79.5%), and anxiety and depression (68.7%).

As for their partners and close family members, they answered questions on the Family Reported Outcome Measure (FROM-16) scale and had an average score of 15 out of 32. FROM-16 measures 16 areas, each on a scale of 0 to 2, with 2 being the worst; the worst outcome was for feeling worried, which had a value of 1.46.

Most said their loved ones' lingering symptoms caused them to feel worried (93.6%), affected family activities (83.3%), and made them feel frustrated (81.7%) or sad (78.4%). Many also said their sleep (68.9%) and sex life (68.1%) were affected, too.

"Our study reveals a domino effect from the COVID patient themselves through to all those closest to them," said lead author Rubina Shah, MSc, MPH, in a Cardiff University press release. "The impact of COVID can be profound and long lasting; there needs to be a holistic support system that is sensitive to the needs of both survivors and their families to help ease this burden."

Overall, 76.6% of the survivors were women, and the mean age was 48 years. Comparatively, their partners and family members had a mean age of 47, and 33.5% were women. About half (50.6%) of the responses came from Europe, and 38.5% came from North America.
May 25 BMJ Open study
May 25 Cardiff press release

Health worker survey shows concerns, fear during COVID-19

In a May to June 2020 survey, about 1,200 US health workers relayed frustrations with unsafe and devaluing working conditions, according to a George Washington University press release.

Most respondents worked in a hospital setting, and many were nurses.

While some said they had employers who were trying their best to provide adequate personal protective equipment (PPE), more said that they felt unsafe because of the lack of it, and many reported retaliation or bullying in response to any workplace concern. Additionally, the constantly changing guidelines from their employer or federal agencies left them frustrated.

Among the health workers' suggestions for moving forward were: an increase in the national stockpile of PPE, better communication and evidence-based worker protection policies, and improved labor rights such as time off, mental health care, and a zero tolerance policy for bullying or retaliation.

"This survey was anonymous and health care workers said they appreciated having a safe space to share their concerns," lead author Brenda M. Trejo Rosas, MPH, said. "Our report exposes the impact of power dynamics in the work environment."
May 25 GWU press release

News Scan for May 26, 2021

News brief

More US nursing homes using antibiotic stewardship elements

An analysis of US nursing home surveys shows substantial progress in antibiotic stewardship element implementation, researchers with the Centers for Disease Control and Prevention (CDC) reported today in Infection Control & Hospital Epidemiology.

Looking at 7,506 National Healthcare Safety Network (NHSN) Long-Term Care Facility Component annual surveys conducted from 2016 through 2018, the researchers found that 1,323 nursing homes (71% of those enrolled in NHSN) reported implementing all seven of the CDC's core elements of antibiotic stewardship in 2018, a 28% increase from 2016.

Among the core elements, the greatest increases in implementation were in education of staff, residents, and families ( 19%); reporting information on antibiotic use (18%), and access to drug expertise (15%)—all of which had the lowest reported implementation in 2016. Pharmacist involvement in improving antibiotic use increased by 27% since 2016.

A multivariable analysis found that nursing homes that reported at least 20 hours of infection prevention control activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation.

The study authors say the increase in implementation of the core elements was likely driven by antibiotic stewardship requirement imposed by the Centers for Medicare & Medicaid Services in November 2017 but may also reflect greater awareness and additional resources.

"Further research should evaluate the barriers facing nursing homes in implementing successful antibiotic stewardship policies and should identify the stewardship activities that are most feasible, sustainable, and effective in improving prescribing practices and resident outcomes in nursing home settings," they wrote.
May 26 Infect Control Hosp Epidemiol abstract

Minnesota confirms more deer farm CWD, with more farms quarantined

The Minnesota Board of Animal Health (BAH) confirmed the presence of chronic wasting disease (CWD) in 12 deer and discovered illegal carcass disposal at a deer farm in Beltrami County, leading to more farm quarantines across the state.

MBAH first detected CWD on that farm in April, and earlier this month, 54 animals in the herd were depopulated and samples from each animal were collected and then tested at the National Veterinary Services Laboratories.

"Of the 12 additional CWD positive animals most recently identified, nine were born on the Beltrami County farm and three were moved to the farm from other Minnesota herds. These herds are considered to be CWD exposed since there is a possibility the animals could have been infected with the disease prior to being moved to Beltrami County," BAH said in a press release.

A BAH agent discovered that several deer carcasses, including dead fawns, had been moved by the owner to nearby county land.

The Minnesota Department of Natural Resources (DNR) also released a statement emphasizing the seriousness of the situation, and said the situation at the Beltrami County deer farm "significantly changes the risk assessment and concern about CWD in Minnesota."

"Based on the findings in Beltrami County, last week BAH quarantined five additional farmed deer herds because of possible CWD exposure," the DNR said. "These additional herds are located in the following Minnesota counties: Hennepin, Kanabec, Mille Lacs, Morrison, and Mower."

CWD is a fatal neurologic prion disease that affects cervids such as deer, moose, and elk.
May 25 Minnesota BAH news release
May 25 Minnesota DNR statement
CIDRAP News scans from Apr 8 and May 19 on earlier detections