COVID-19 Scan for Sep 20, 2022

News brief

Fallout continues over Biden's 'pandemic is over' comments

At a routine press briefing today, two White House officials fielded questions about President Joe Biden's recent off-the-cuff comment during a news program that the pandemic is over, while acknowledging that COVID is still a problem.

When a reporter asked if Biden would carry the "pandemic is over" message to the world stage in his address tomorrow at the United Nations General Assembly, Jake Sullivan, Biden's National Security Advisor, said Biden will tell world leaders that the core goal is to be better prepared for the next pandemic, such as finalizing a funding facility at the World Bank, improving vaccine manufacturing capability across a wider range of regions, and needing to learn lessons from COVID-19 to avoid repeating mistakes.

Journalists also asked Biden's press secretary, Karine Jean-Pierre, about the president's comments and a letter from Sen. Richard Burr, R-North Carolina, the ranking member of the Senate Health, Education, Labor, and Pensions (HELP) committee that juxtaposes the comments with the need to extend the health emergency and add more funding. She said Biden was clear in the interview that COVID remains a problem.

"What he believes is we can acknowledge the massive amount of progress that we have made," she said. "Now we are in a place where it is much more manageable."

Jean-Pierre also pressed Congress to approve funding to better prepare the nation to respond for future threats from COVID and other epidemics.
Sep 20 White House press briefing
Sep 19 Burr letter obtained by CNN
Sep 19 CIDRAP News story

Helmet-style oxygenation didn't lower death rate in severe COVID-19

Noninvasive ventilation delivered through an oxygen helmet didn't significantly lower 28-day death rates among adult COVID-19 pneumonia patients with respiratory failure beyond that of masks, high-flow nasal cannulas, or other standard methods, but interpretation of the results was limited by an imprecise effect estimate, finds a randomized, controlled trial in Saudi Arabia and Kuwait.

The research, published today in JAMA, involved 187 men and 133 women with respiratory failure due to COVID-19 pneumonia randomly assigned to receive supplemental oxygen through either a helmet or a mask, high-flow nasal cannula, or other standard methods at eight sites from Feb 8 to Nov 16, 2021. Some patients had both treatments for a time because of medical necessity. Median patient age was 58 years.

The researchers noted that helmet ventilation has been used in COVID-19 patients under the premise that it is better able to deliver prolonged oxygen because of fewer air leaks, improved fit, and less risk of skin pressure injury, eye irritation, and aerosol generation, although supporting data in COVID-19 patients are lacking.

At 28 days, 27.0% of 159 patients assigned to the helmet group died, compared with 26.1% of the 161 standard-care patients, a statistically nonsignificant difference. A total of 47.2% of the helmet group needed endotracheal intubation, compared with 50.3% in the standard-care group (relative risk, 0.94; 95% confidence interval, 0.75 to 1.17).

Barotrauma, or tissue damage related to pressure differences inside and outside the body, occurred in 18.9% of the helmet group and 15.5% of the standard-care group. A total of 3.1% of the helmet group and 6.2% of standard-care patients experienced skin-pressure injury. One and two serious adverse events occurred in the standard-care and helmet groups, respectively.

Helmet ventilation has been used for 20 years in some countries, the authors said, and in March 2020 the US Food and Drug Administration authorized it for COVID-19 patients with respiratory failure.

Although helmets didn't appear to confer a survival advantage, because of limitations such as a small sample size and unblinded treatment allocation, the researchers said that they can't exclude potential clinical benefit or harm.
Sep 20 JAMA study

News Scan for Sep 20, 2022

News brief

Boston public schools reports first monkeypox case

Boston public schools (BPS) yesterday announced the first monkeypox case in an "adult member of the BPS community," according to a letter sent to parents. The school district said the person was isolating at home, and the district was working to identify exposed individuals.

Also yesterday, the Centers for Disease Control and Prevention (CDC) reported 394 more monkeypox cases, raising the national total to 23,893. Currently fewer than 25 cases in the country have been in children.

The CDC maintains that the risk of monkeypox exposures in a school setting is low.

A new meta analysis published in the European Journal of Internal Medicine shows that, across 14 studies conducted during the current outbreak, the prevalence of monkeypox cases involving men was 99.9%, and 98.7% of cases were in men who have sex with men. A total of 37.9% of monkeypox patients also had HIV, and 22.1% had another concurrent sexually transmitted infection at the time of monkeypox diagnosis.

In other news, Virax Biolabs, a London-based diagnostics company, launched a new rapid test kit for monkeypox detection to be used at point-of-care sites in the European Union. The swabs, which can be used in the throat or on lesions, can detect an infection within 15 minutes.

Also today, Bavarian Nordic, maker of the Jynneos vaccine, announced a new 10-year contract valued at $434 million for the supply of both smallpox and monkeypox vaccines to Canada.
Sep 19 Boston Herald story
Sep 19 CDC update
Sep 17 Eur J Intern Med study
Sep 20 Virax press release
Sep 20 Bavarian Nordic press release

Using Tamiflu in hospitalized children tied to shorter stay for flu

A study across 36 US pediatric tertiary hospitals finds that early use of the antiviral oseltamivir (Tamiflu) in hospitalized children was associated with a shorter hospital stay, lower odds of 7-day readmission, and lower rates of severe outcomes. The study was published yesterday in JAMA Pediatrics.

Included in the retrospective cohort study were 55,799 encounters for pediatric influenza, with the median age of patients being 3.6 years. Of the patients, 56% were boys and 44% were girls. Patient encounters from Oct 1, 2007, to Mar 31, 2020, were included.

Early exposure to oseltamivir was defined as administration within 24 hours after hospital admission. Main outcomes measures were length of hospital stay, readmission, intensive care unit (ICU) transfer, and death.

A total of 3,207 patients (59.5%) received early oseltamivir. Children in this group had lower median length of stay (LOS; 3 days compared with 4 days), a lower 7-day readmission rate (3.5% vs 4.8%), late ICU transfer (2.4% vs 5.4%), and lower in-hospital mortality (0.9% vs 1.3%) compared with children not treated with early oseltamivir.

High-risk patient subgroups and lower-risk subgroups benefitted equally from early oseltamivir administration, the authors said.

"The reduction in length of illness seems to apply to severe illness in addition to mild illness and is independent of where care is delivered. In fact, the group with the largest reduction in LOS in our study were the patients initially admitted to the ICU," the authors concluded.
Sep 19 JAMA Pediatr study