Cost of COVID-19 among health workers in less affluent nations high

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Health workers in PPE — Hospital Clinic / Flickr cc

Scientists estimate a high economic and societal burden of COVID-19 infections in healthcare workers (HCWs) in four low- to middle-income countries—Kenya, Eswatini (formerly Swaziland), Colombia, and South Africa—during the first year of the pandemic, according to a study today in Nature Communications.

HCWs were infected at high rates, and these infections came at high societal costs, the authors found.

In all the countries analyzed, HCWs had significantly higher rates of COVID-19 infections than the general population, almost 10 times higher in Kenya and 7 to 8 times higher in South Africa. Only in Colombia were HCWs infected at a comparable rate to the general population.

At all the study sites, HCW infections led to care disruptions that had a direct effect on maternal and child mortality. Kenya had an estimated 243 excess maternal deaths and 1,499 excess deaths in children under 5 years, the highest toll across all study sites.

Unsurprisingly, SARS-CoV-2 infection in HCWs resulted in enormous societal costs.

The economic burden of HCW infections ranged from $2 million in Eswatini to $163.47 million in South Africa. Secondary infections among HCWs' close contacts also were costly, with an estimated burden of the total cost of $9.94 million in Eswatini, $14.95 million in Kenya, and more than $200 million for the other study sites.

In total, economic losses as a share of total health expenditure varied from 1.51% (95% confidence interval, 1.39% to 1.68%) in Colombia to more than 8% of annual total health expenditure in the two provinces of South Africa.

"Unsurprisingly, SARS-CoV-2 infection in HCWs resulted in enormous societal costs," the authors said. "The scale of economic losses mostly reflects onward infectious transmission from infected HCWs and disruptions in essential maternal and child health services as a result of HCW illness, isolation, or death."

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COVID public health measures may have led to RSV resurgence

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Mary Van Beusekom, MS

A lack of exposure to respiratory syncytial virus (RSV) in the first 2 years of the COVID-19 pandemic may have led to the global resurgence of the virus in 2022 and 2023, finds a study published yesterday in JAMA Pediatrics.

The study, led by University of Colorado researchers, involved comparing age distributions and illness severity in children hospitalized for RSV in Colorado from 2018 to 2023. The 2020-21 period was excluded because only one hospitalization occurred during that time.

The team analyzed data from the Centers for Disease Control and Prevention's Emerging Infections Program RSV Hospitalization Surveillance Network on 2,809 infected children. The average patient age was 21.6 months, and 53.3% were boys.

Older age-groups affected in 2022-23

During 2021-22 and 2022-23, 97.5% and 98.8% of hospitalizations, respectively, were RSV-related. The median patient age was 18.5 months in the first 6 weeks of the 2022-23 season, compared with 11.0 months in previous seasons.

Relative to previous years, a greater proportion of 2022-23 patients were aged 2 to 4 years (34.2% vs 23.4%) and 5 to 11 years (9.7% vs 5.0%). The proportion of children admitted to the intensive care unit was 27.1% in 2021-22 and 36.0% in 2022-23, and median lengths of stay were 3.0 and 3.8 days, respectively.

The authors said the results support the hypothesis that lack of exposure to RSV during pandemic public health mandates was behind the resurgence.

"Similarly, the data suggest that waning immunity in children and pregnant mothers without repeated exposure to RSV may contribute to more severe disease in infants and older children compared with previous periods," they wrote. "It is also possible that the RSV strain in the 2022-2023 period was more virulent or that immune dysregulation from prior SARS-CoV-2 infection was associated with increased susceptibility to subsequent RSV infections."

It is also possible that the RSV strain in the 2022-2023 period was more virulent.

The researchers called for multicenter studies to confirm the results. "These data may help inform the introduction of imminent new RSV prevention strategies, including vaccines and monoclonal antibodies, to minimize disease burden in this age group," they concluded.

Report highlights G7 progress, gaps in efforts to boost antibiotic development

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Chris Dall, MA

Pill assembly line A joint report from the World Health Organization and the Global AMR R&D Hub urges G7 countries to push harder for innovative financing mechanisms and other incentives to ensure a "robust and sustainable" supply of new antibiotics.

The report is an update on the progress that's been made by G7 finance and health ministers on commitments made in 2021 and 2022 to expedite implementation of antimicrobial resistance (AMR) strategies, take additional steps to address the broken market for novel antibiotics, strengthen AMR research and development (R&D), and bring novel antibiotics and other products addressing AMR to market. It concludes that while G7 countries have been engaging in a range of activities to create the economic conditions that would encourage new antibiotic development, more is needed.

Among the accomplishments highlighted are the United Kingdom's subscription model for new antibiotics and Japan's recent announcement of a revenue guarantee program for novel antibiotics, set to begin this year.

The report also notes that the United States, Canada, Japan, and the European Union are all in the process of evaluating and implementing pull incentives and other innovative economic models that would encourage the development of high-value antibiotics. It adds that G7 countries continue to invest in partnerships that support early-stage antibiotic development, such as CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) and GARDP (the Global Antibiotic Research & Development Partnership).

The G7 can build on past and ongoing achievements to collaborate and unify in action against the devastating impacts of AMR.

To build on that progress, however, the report says that G7 nations must work toward "tangible and specific" commitments and targets for incentivizing the development of and equitable access to new antibiotics over the next 2 years, provide sustainable and predictable financing for antibiotic R&D, build on successful pull-incentive pilot programs and explore the possibility of formulating international collaborative mechanisms on pull incentives, and support initiatives to improve global and equitable access to new and existing antibiotics.

"The G7 can build on past and ongoing achievements to collaborate and unify in action against the devastating impacts of AMR and ensure a robust and sustainable supply of antibacterials and other health technologies addressing AMR," the report concludes.