Pandemic avoidance of medical care tied to more appendix rupture in kids

A JAMA Network Open study late last week suggests that a pattern of delayed medical care during the pandemic may be responsible for a greater incidence of a ruptured appendix related to appendicitis in children.

Doctors at Inova Children's Hospital in Virginia evaluated pediatric emergency department visits from Mar 16 to Jun 7, when Virginia public schools were closed. Patient volumes in the emergency department fell from 144 patients per day in 2019 (95% confidence interval [CI], 136 to 152) to 65 patients per day (95% CI, 39 to 90; P < 0.001), representing a 55% decrease.

The study authors suggest that fear of exposure to COVID-19 in healthcare settings was the likely explanation. "Parents displayed visible signs of anxiety when in the emergency department and openly expressed reluctance to visit the hospital for fear of contracting COVID-19," the authors wrote.

The researchers identified 90 children diagnosed as having acute appendicitis—inflammation of the appendix—which is often accompanied by nausea, vomiting, loss of appetite, fever, and chills. Of the 90 patients, 35 presented with perforation, or rupture, of the appendix—a life-threatening condition that can lead to pelvic abscess, bowel obstruction, or sepsis.

Compared with 2019 data, median patient ages were similar (10 years old for 2020; 11 years old for 2019), but the rate of acute appendicitis represents a 20% increase (P = 0.009). In 2020, 9% of children had a pelvic abscess that required additional intervention. In contrast, none of the 2019 control patients experienced pelvic abscess or other complications requiring medical management.

The study highlights delayed medical care as a downstream effect of the pandemic that could lead to poorer outcomes. "Broad avoidance of the emergency department may lead to increased morbidity and mortality in both children and adults," the authors wrote.
Dec 4 JAMA Netw Open study

With or without COVID-19, households have pets with COVID antibodies

During the first wave of the COVID-19 pandemic, 3.3% of tested dogs and 5.8% of tested cats tested positive for SARS-CoV-2 antibodies in northern Italy, with higher rates in COVID-affected households, according to a recent study published in Nature Communications. All had negative COVID-19 polymerase chain reaction (PCR) test results.

Out of households with confirmed COVID infections, 6 of 47 (12.8%) dogs displayed antibodies and 1 in 22 (4.5%) cats did. The researchers also found antibodies in 2 of 133 (1.5%) dogs and 1 of 38 (2.6%) cats in confirmed COVID-negative households.

The study, which collected blood samples from 451 dogs and 191 cats from Mar 15 to May 11, also found a positive trend between pets with antibodies and the viral burden in the Lombardy region. (Spearman's r was 0.771 for dogs, 0.696 for cats; a value of 1 is a perfect positive correlation.)

"This suggests that although pet animals can seroconvert, they may shed virus for relatively short periods of time," the researchers write. "Based on current knowledge, it is unlikely that infected pets play an active role in SARS-CoV-2 transmission to humans. However, animal-to-human transmission may be more likely under certain environmental conditions, such as the high animal population densities encountered on infected mink farms."

Among 494 pets tested using swabs and PCR, all had negative results, even those living in households with COVID-19–infected people. At the time of sampling, 12.1% of these dogs (38 of 314) and 21.1% of these cats (38 of 180) showed respiratory disease.
Dec 3 Nat Commun study

Patients with severe COVID-19 found to be infectious twice as long

A November Canada Communicable Disease Report suggests that patients with mild COVID-19 are no longer infectious 10 days after diagnosis, but patients with severe disease are generally infectious for at least 20 days.

Researchers with the Public Health Agency of Canada reviewed 302 studies of the COVID-19 infectious period, including reviews, peer-reviewed publications, and preprint articles through Aug 31.

Cell-culture studies suggest that patients with mild illness shed active virus for 8 to 10 days from symptom onset, while those with severe illness—typically people whose immune system is compromised or those with multiple underlying health conditions—shed viable virus for 18 to 32 days. The length of viral shedding from feces and potential for transmission remain unclear. In pre-symptomatic patients, respiratory samples grew viable virus 1 to 6 days before the patient to developed symptoms and as early as 3 days before symptom onset for rectal samples.

Reverse-transcription polymerase chain reaction (RT-PCR) tests of nasopharyngeal swabs show that most patients become negative for SARS-CoV-2, the virus that causes COVID-19, within 14 to 20 days after symptom onset, with prolonged positivity (up to 83 days) in older people and those with severe disease. Stool samples can remain positive up to 4 weeks longer than respiratory samples, and positive eye swabs have been detected up to 22 days after symptom onset. Respiratory samples from presymptomatic patients are RT-PCR–positive an average of 2.5 days before symptoms appear.

The authors identified two studies with evidence of reinfection—from different viral strains—suggesting that reinfection, while rare, can occur.  

Asymptomatic patients had viable virus and high levels of viral RNA during the first week of infection and declining thereafter, the researchers found. "Based on the current evidence, the total infectious period of asymptomatic cases appears to be similar to, or shorter than, mildly asymptomatic cases," the report authors note.
November Can Commun Dis Rep report