COVID-19 Scan for Dec 07, 2020

News brief

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

CDC report shows declines in healthcare-associated infections

A new report from the Centers for Disease Control and Prevention (CDC) shows some encouraging declines in healthcare-associated infections (HAIs) across four US healthcare settings, including one linked to antibiotic use.

The 2019 National and State HAI Progress Report, which covers data from acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term acute care hospitals, shows a 7% decrease in central line-associated bloodstreams infections from 2018 to 2019 and an 8% reduction in catheter-associated urinary tract infections. Compared with the 2015 baseline standardized infection ratio, 51 states performed better on at least two infection types in 2019, 40 states performed better on three infection types, and 30 states improved on at least four infection types.

The report also showed an 18% decline in Clostridioides difficile infections from 2018 to 2019. C difficile is the leading cause of hospital- and antibiotic-associated diarrhea in the United States.

But there remains room for improvement. The data showed a 2% increase in ventilator-associated events, no significant change in surgical-site infections related to 10 select procedures, and no significant change in methicillin-resistant Staphylococcus aureus bacteremia.

The CDC estimates that, on any given day, 1 in 31 US hospital patients has an HAI, a growing number of which are caused by antibiotic-resistant bacteria. The agency has placed an increased focus on reducing HAIs in US hospitals recent years, but it says more work on HAI surveillance and prevention is needed.

"While much progress has been made, more needs to be done to prevent healthcare-associated infections in a variety of settings," the report stated.
Dec 2 CDC HAI Progress Report


Four countries report more high-path avian flu in poultry and wild birds

Four countries reported more highly pathogenic H5 avian flu outbreaks in poultry and wild birds, with the Ukraine the latest country in Europe to report the virus in poultry, according to notifications from the World Organization for Animal Health (OIE) and other reports.

The Ukraine reported highly pathogenic H5 avian flu in backyard poultry in Nikolayev oblast in the south. The event began on Dec 2, killing all 10 susceptible birds.

Israel reported more H5N8 outbreaks in both poultry and wild birds. Officials reported two more outbreaks in poultry, both on turkey farms in Hazafon. The outbreaks started on Nov 13 and Nov 20, killing 660 of nearly 30,000 birds between the two locations. And the country's latest event in wild birds involved a duck found with neurologic symptoms on Dec 1 at a nature park in Hazafon.

In Asia, South Korea reported two more H5N8 outbreaks, both at farms. One in North Gyeonsang province began on Dec 1, and the other in South Jeolla province began on Dec 4. In the latter event, the virus was found in ducks before they were brought to a slaughterhouse. In the first event, the virus killed 300 of 188,000 susceptible birds.

Also, Japan's environment ministry reported another H5 outbreak at a farm, this time in Hiroshima prefecture, the sixth to be affected, according to an official statement translated and posted by Avian Flu Diary, an infectious disease news blog.
Dec 5 OIE report on H5 in Ukraine
Dec 6 OIE report on H5N8 in Israeli poultry
Dec 6 OIE report on H5N8 in Israeli wild birds
Dec 7 OIE report on H5N8 in South Korea
Dec 7 Avian Flu Diary post

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