COVID-19 Scan for Jun 15, 2020

News brief

Coronavirus spread among close, casual contacts in China

An investigation by Chinese and US scientists of a cluster of COVID-19 infections in China provides evidence that the coronavirus can spread through casual contacts at social gatherings.

The case-contact investigation, published late last week in Open Forum Infectious Diseases, looked at transmission events from a cluster of seven COVID-19 cases in Jiaxing, China, that occurred from mid-January to early February. The cluster involved four confirmed cases from a family and three confirmed cases thought to be linked to the family through social events, which included a birthday party on Jan 19 and a 2-day wedding party on Jan 22-23.

Extensive case tracking was performed on a total of 539 people who had contact with two members of the family cluster at the wedding and the birthday party. All 539 were contacted by phone and subsequently quarantined in centralized locations for 14 days.

Close contacts were defined as people who had close, prolonged, and repeated interactions with the source cases (cases 2 and 3), who had been in Wuhan, China, 1 week prior to being diagnosed. Those included the son-in-law of the source cases (case 1) and the grandchild (case 4). All other contacts were defined as casual.

Of the 539 people who had close contact with the source cases, four tested positive for COVID-19, for an attack rate of approximately 0.7%. Based on detailed contact information, the researchers estimated the secondary attack rate among close contacts to be 29% (2 of 7), while the attack rate among the casual contacts to be 0.6% (3 of 473). All three of the casual contact cases either sat at the same table or were near case 3 at the wedding.

"In conclusion, our investigation of a cluster of infections associated with COVID-19 demonstrates that person-to-person transmission among casual contacts can and does occur at social gatherings with congregation of large groups of susceptible individuals," the authors wrote. "Importantly, from an individual perspective, the attack rate from casual contact was much lower than through close contact."
Jun 12 Open Forum Infect Dis abstract

COVID-19 associated with increased mortality rates, complications

A matched cohort study from Italy shows that surgical mortality and complications are higher in patients with COVID-19 compared to those without COVID-19. The findings, published in JAMA Surgery, suggest that, when possible, surgeries should be delayed for patients infected with the novel coronavirus.

The study was based at the Spedali Civili Hospital in Brescia, Italy, and involved patients from general, vascular and thoracic, orthopedic, and neurosurgery units from Feb 23 to Apr 1. Brescia is located in the Lombardy region, which had the most COVID-19 activity in Italy.

Surgical outcomes from 41 patients with COVID-19 and 82 matched control patients without COVID-19 were compared. The COVID-19 patients had positive test results for COVID-19 either before or within 1 week after surgery.

The authors found that 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53), with pulmonary complications the most common (OR, 35.62; 95% CI, 9.34-205.55). In total, 8 patients from the COVID-19 cohort died (19.5%), compared with 2 (2.4%) from the matched cohort.

"This matched cohort study documents that surgical mortality and complications are significantly higher in patients with COVID-19. Pulmonary and thrombotic complications are significantly associated with it," the authors concluded.
Jun 12 JAMA Surg study

News Scan for Jun 15, 2020

News brief

Five more illnesses reported in new DRC Ebola outbreak

Officials reported five more illnesses and three more deaths in a new Ebola outbreak in the Democratic Republic of the Congo (DRC), according to figures reported today by the country's multisectoral Ebola response committee (CMRE).

The new developments raise the outbreak total to 17 cases, 14 of them confirmed and 3 listed as probable. The new deaths raise the fatality count to 11.

The World Health Organization (WHO) said last week in its latest situation report that the outbreak has affected six health areas in three health zones: Mbandaka, Wangata, and Bikoro. Sequencing suggests that it is not related to the larger ongoing outbreak in the eastern part of the country, where the total stands at 3,463 cases, 2.280 of them fatal. If no new cases are reported by Jun 25, the larger outbreak will be declared over.
Jun 14 CMRE report
Jun 8 WHO situation report

PAHO warns of the COVID-19's impact on malaria control in the Americas

A new report from the Pan American Health Organization (PAHO) says malaria cases are on the decline in several South American countries, but warns that the COVID-19 pandemic is having an impact on the region's malaria elimination efforts.

Overall, the region saw a decline in the number confirmed cases from the first 18 weeks of 2019 through the first 18 weeks of 2020, led by a 58% reduction in Venezuela. Brazil, Colombia, Peru, Guyana, Ecuador, Guatemala, and Mexico have also seen decreases. But while a decline in malaria was being observed in those countries prior to the pandemic, the arrival of the coronavirus may be reducing case-detection activities and care-seeking for suspected malaria.

In addition, PAHO reports that several malaria-endemic areas, such as the State of Amazonas in Brazil, have been hit hard by COVID-19, with high incidence and mortality rates.

Based on a recent WHO analysis in sub-Saharan Africa of the potential effects of COVID-19 on malaria incidence and mortality, the group estimates that. in the worst-case scenario of a 75% disruption in access to malaria services and treatment, there could be a 20% increase in cases and a 100% increase in deaths compared with 2018.

"As the dispersion of COVID-19 transmission increases, the situation in all the mostly rural malarial areas will become more critical, given the high vulnerability of the populations and the weaknesses of the healthcare systems," the report said.

Despite the overall reduction in malaria cases observed in the region, Haiti, Nicaragua, Panama, Dominican Republic, Honduras, Costa Rica, and Suriname all saw an increase in malaria, with cases in Panama rising by 238%.

The report urges countries in the region to "maintain continuity of actions against malaria in line with national pandemic response arrangements."
Jun 10 PAHO report

PAHO: Dengue, other arbovirus infections down a bit from 2019

In the first half of 2020, dengue and other arbovirus illnesses in the Americas have declined about 10% compared with the same time in 2019, which was an epidemic year, PAHO said in a recent update.

Of 1,645,678 cases, 97.3% were dengue infections. The total also includes 37,279 chikungunya cases and 7,452 Zika infections. Brazil has the highest proportion of dengue case, with 65%. Others affected areas are Paraguay, Bolivia, Argentina, and Colombia, with Honduras, Colombia, and Brazil having the highest number of severe cases.

All four serotypes are circulating in Brazil, Colombia, and Mexico, with six countries or territories reporting the circulating of three serotype combinations. So far, the Americas region has reported 553 dengue deaths.

For chikungunya, 11 of 24 countries reported cases, but 95% of the cases and all 8 deaths were in Brazil. Among all Zika cases, 86% this year have been in Brazil.
Jun 10 PAHO epidemiologic update