COVID-19 Scan for Oct 03, 2022

News brief

Study: Paxlovid effective for COVID-19, not tied to higher risk of rebound

The oral antiviral drug Paxlovid is safe and effective for treating COVID-19 and carries no additional risk of viral rebound beyond other treatments, according to a meta-analysis published late last week in the Journal of Infection.

Paxlovid is recommended for treating patients who have mild or moderate COVID-19 and are at high risk for severe illness. Cases of viral rebound after Paxlovid treatment have been widely reported, including that of US President Joe Biden, who tested positive for COVID-19 after Paxlovid treatment in July.

Researchers from Guizhou Medical University in Guiyang, China, led the meta-analysis of 13 controlled trials that included 186,306 patients published from Dec 1, 2021, to Sep 20, 2022. The studies compared the use of Paxlovid with either usual care or a placebo and/or another drug (eg, a different antiviral, monoclonal antibodies).

Of the 13 studies, 3 found no difference in the risk of viral rebound in the Paxlovid and control groups (odds ratio [OR] of rebound among Paxlovid patients vs controls, 0.99). Five studies on adverse-event rates identified no difference between the Paxlovid and control groups (OR, 1.07).

Among the seven studies on the effectiveness of Paxlovid in preventing death or hospitalization, the OR of death in the Paxlovid versus the control group was 0.12, indicating an 88% reduction. The OR of hospitalization in the two groups was 0.32, a 68% reduction after Paxlovid.

The study authors said that COVID-19 rebound is not unique to Paxlovid. "There has been more attention to COVID-19 rebounds following Paxlovid treatment, which may be attributable to more people being treated with Paxlovid," they wrote. "However, the phenomenon of rebounds following Paxlovid treatment reinforces the importance of testing for individuals with recurrent symptoms after Paxlovid treatment."
Sep 30 J Infect research letter

Healthcare workers experienced 3 times as much burnout during pandemic

New research from the Queen Mary University of London and other UK researchers shows that even when rates of mental health issues are similar, healthcare professionals who worked during the COVID-19 pandemic were 3.3 times more likely to experience burnout than other professionals. The research is published in BJPsych Open.

The study was based on online surveys of UK professionals, which assessed anxiety, depression, insomnia, burnout, and low emotional wellbeing. A total of 1,574 healthcare workers and 147 non-healthcare professionals completed the survey. Seventy percent of participants were female, and 70% were over the age of 35. Two-thirds identified as White (66%) and just under a quarter identified as Asian (22.3%).

The surveys were conducted in July through September of 2020, in November and December of 2020, and in early spring 2021, during a second UK national lockdown.

There were no significant differences in rates of anxiety or depression during each phase, but healthcare workers had a 2.5-fold increased risk of burnout during the second phase of surveys (emotional exhaustion: odds ratio [OR], 2.50; 95% confidence interval [CI], 1.15 to 5.46; P = 0.02), which increased to a 3.3-fold increased risk during the second UK lockdown (OR, 3.32; 95% CI, 1.40 to 7.87; P = 0.006).

Burnout decreased over time across the three periods, but healthcare workers directly treating patients still had a 2.7-fold increased risk of burnout by the second UK lockdown—the highest level among subgroups.

"Unless we can stop the burnout trend, we could see more mental health and physical consequences such as cardiovascular and metabolic diseases in our doctors, nurses, and other healthcare workers," said Ajay Gupta, MD, senior author of the study, in a Queen Mary University press release.
Sep 30 BJPsych Open study
Sep 30 Queen Mary press release

News Scan for Oct 03, 2022

News brief

CDC, FDA investigate multistate Listeria outbreak

The US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are investigating a multistate Listeria outbreak linked to brie and camembert cheeses.

In a food safety alert issued late last week, the CDC said six people in six states—Massachusetts, New Jersey, Michigan, Georgia, Texas, and California—have been infected by the outbreak strain of Listeria, with five hospitalizations and no reported deaths. The sick people range in age from 56 to 83 years, and patient samples were collected from Aug 6, 2017, to Aug 5, 2022. Whole-genome sequencing (WGS) showed that bacteria from the samples are closely related genetically, suggesting a common source of infection.

Of the five people interviewed, four reported eating camembert or brie, and one person reported eating Lidl Premium Brand Brie, which is one of multiple brands manufactured by Old Europe Cheese of Benton Harbor, Michigan. The FDA said an inspection of the Old Europe Cheese facility found that environmental samples were positive for Listeria monocytogenes, and WGS determined that the strain matched the outbreak strain.

Old Europe Cheese has voluntarily recalled multiple brands of brie and camembert produced at the Michigan facility and has halted production and distribution of brie and camembert products. Consumers, retailers, and restaurants are advised not to eat, sell, or serve Old Europe Cheese products with best-by dates ranging from Sep 28, 2022, to Dec 14, 2022.
Sep 30 CDC Food Safety Alert
Sep 30 FDA outbreak investigation

Study: Hospital floors, healthcare workers' shoes may spread MRSA

A study conducted at a Veterans Affairs (VA) hospital in Ohio suggests that hospital floors and shoes of healthcare workers are potential sources for dissemination of methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated pathogens, researchers reported late last week in the American Journal of Infection Control.

Although hospital floors and shoes of healthcare workers are frequently contaminated, there is limited evidence of their potential to serve as a vector for pathogens. To assess the frequency of MRSA transmission from floors to adjacent rooms, researchers with Louis Stokes Cleveland VA Medical Center and Case Western Reserve University School of Medicine enrolled 12 MRSA-colonized patients at a long-term care facility and defined their rooms as the index rooms.

They then cleaned and disinfected the floors of two adjacent rooms, ensured that no MRSA was present immediately after cleaning, and had healthcare personnel (with disinfected shoes) walk first into the index rooms and then the two adjacent rooms. Three to four simulations were completed for each room, and afterward the researchers measured the number of MRSA colony-forming units (CFUs) on the floors of adjacent room 1 and 2.

The researchers also performed a similar experiment with water containing the bacteriophage MS2, looking at contamination of floors and high-touch surfaces in adjacent rooms and nursing stations.

Overall, MRSA was transferred in 47.4% (18 of 38) of assessments in adjacent room 1 and in 31.6% (12 of 38) of assessments in adjacent room 2. For both rooms, significantly greater numbers of MRSA CFUs were transferred from index rooms containing heavy MRSA contamination versus rooms with medium or light contamination. In addition, bacteriophage MS2 was recovered from more than half of floor cultures in adjacent rooms and nursing stations and was recovered from 33% to 70% of high-touch surfaces in index rooms, adjacent rooms, and nursing stations.

"These findings build upon evidence suggesting that contaminated floors and shoes could be an underappreciated source for pathogen dissemination in healthcare facilities," the study authors wrote. "Future studies are needed to assess the impact of interventions such as floor or shoe disinfection on transfer of pathogens."
Oct 1 Am J Infect Control abstract

Avian flu strikes more US poultry farms as Europe's total climbs

Highly pathogenic avian flu outbreaks struck more commercial US poultry farms, this time in Utah and Wisconsin, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

In Utah, the virus struck three turkey farms, all in Sanpete County. Combined, the locations housed 63,600 birds. Also, Wisconsin reported an outbreak at a commercial duck farm in Racine County that has 10,000 birds.

Elsewhere, the Oregon Department of Agriculture (ODA) reported another outbreak in backyard birds, this time in Douglas County.

Outbreaks involving the Eurasian H5N1 strain that began in poultry in February have now led to the loss of 46.8 million birds in 40 states.

In Europe, the virus continues to circulate in wild birds and poultry, with nearly 2,500 outbreaks in poultry and the loss of 48 million birds, the largest epidemic of its kind so far, the European Centre for Disease Prevention and Control (ECDC) said today in an update. It said the risk to humans remains low but is slightly higher in people who are directly exposed to infected birds.

The ECDC also released new guidance covering occupational safety and health measures at workplaces where animal contact can't be avoided.
USDA APHIS poultry avian influenza updates
Sep 30 ODA statement
Oct 3 ECDC statement and avian flu guidance