COVID-19 Scan for Nov 02, 2020

News brief

UK study shows kidney injury in 26% of COVID-19 patients, mortality risk

A PLOS Medicine study late last week found double the incidence of acute kidney injury (AKI) in hospitalized COVID-19 patients and a threefold higher mortality than in COVID-19–negative patients. Men, nonwhite patients, and those with comorbidities were at increased risk of developing AKI with COVID-19.

The retrospective cohort study examined the relationship between COVID-19 and AKI in 1,161 SARS-CoV-2–positive patients admitted to two acute care hospitals in Derby, United Kingdom, from Mar 5 to Mar 12. Clinical outcomes were tracked through May 13, including AKI, in-hospital mortality, mechanical ventilation, intensive care unit admission, and length of stay.

The authors found that COVID-19 patients developed AKI at more than double the rate of patients who tested negative for COVID-19 (26.2% vs 12.4%). Older (aged 65 to 84) patients, men, those of nonwhite ethnicity, and those with comorbidities such as cerebrovascular disease, diabetes, and chronic lung and kidney disease were at an increased risk of developing AKI with COVID-19.

The researchers found significantly higher mortality higher in COVID-19 patients with AKI than in COVID-19–negative patients (60.5% vs 27.4%, P < 0.001), and AKI was an independent predictor of a threefold higher risk of death (odds ratio [OR], 3.27, 95% confidence interval [CI], 2.39 to 4.48). Patients with COVID-19 and AKI had a nearly fourfold higher risk of death than patients with AKI due to other causes (OR, 3.80, 95% CI, 2.62 to 5.51).

AKI in hospitalized COVID-19 patients appears to develop later than non-COVID-19 AKI, and may be due to direct effects of SARS-CoV-2 kidney damage or inflammatory effects of high cytokine levels (cytokine storm), the authors suggest, although the mechanism of kidney injury remains unclear.

"The practical implication of this observation is that patients with COVID-19 who do not have AKI on admission should have daily monitoring to detect [hospital-acquired] AKI," the authors suggest.
Oct 30 PLOS Med study

Global study finds consistent COVID death rates in all but elderly

A multi-country modeling study in Nature today confirms that the age-dependent risk of COVID-19 death is consistent for people below the age of 65, but the relative risk in older individuals varies considerably between nations.

Differences in rates of nursing-home outbreaks and variable reporting of deaths in elderly populations make cross-country comparisons of infection and fatality patterns difficult to quantify. The study authors developed a model using age-specific COVID-19 death data from 45 countries and 22 seroprevalence studies that measured the blood serum level of SARS-CoV-2, the virus that causes COVID-19, in a population to estimate epidemic size and patterns.

The estimated infection-fatality ratio (IFR, or the ratio of deaths per infection) for all countries was lowest among those 5 to 9 years of age, with a predictable mean increase in IFR of 0.59% (95% credible interval [CrI], 0.51% to 0.68%) with each 5-year increase in age for ages 10 years and older, and a risk of death significantly higher for men, particular those 80 and older (10.8% IFR vs 5.8% for women).

The authors estimate a total average 5.3% population rate of infection by Sep 1 (95% CrI, 4.5% to 6.2%) ranging from 0.06% in South Korea to 62.4% in Peru, and demonstrating high variability in the level of transmission across countries.

The model shows promise in identifying countries with lower-than-expected COVID-19 deaths among those older than 65, finding 220 fewer reported deaths in Ecuadorans older than 65 (per 100,000), consistent with under-reporting of COVID-19 deaths amongst elderly individuals (95% CrI, 200 to 240). The model was also able to identify areas where excess transmission in nursing home populations had likely occurred, showing a 22.3% IFR (95% CrI, 19.1% to 25.7%) in French nursing home residents, and highlighting the high COVID-19 burden of these communities in many higher-income countries.

"The results and modelling framework we present demonstrate how age-specific death data can be used to robustly reconstruct the underlying level of transmission," the authors write, "and may be of particular use in settings where there do not exist the resources to carry out large, representative seroprevalence studies."
Nov 2 Nature study

News Scan for Nov 02, 2020

News brief

Study highlights role of hospital floors in spread of healthcare pathogens

Hospital room floors could be an underappreciated source of healthcare-associated pathogen spread, including those resistant to antibiotics, according to a study today in Infection Control and Hospital Epidemiology.

In the abstract from the March 2020 Decennial International Conference on Healthcare-Associated Infection, researchers from the Northeast Ohio Veterans Administration (VA) Healthcare System and Cleveland VA Medical Center observed the interactions of patients, hospital workers, and portable equipment in thoroughly cleaned hospital rooms of 17 newly admitted patients who had tested negative for carriage of methicillin-resistant Staphylococcus aureus (MRSA). They then collected cultures from patient skin and room surfaces, including the floors, one to three times a day, focusing on surfaces in contact with personnel and portable equipment.

One or more environmental cultures were found to be MRSA-positive in the rooms of 10 patients (59%), while Clostridioides difficile and vancomycin-resistant Enterococci were each found in the rooms of two patients. Patients interacted with an average of 2.4 hospital workers and 0.6 portable devices per hour of observation. In a subset of patients, MRSA appeared on the hospital room floors within hours of admission, and was subsequently found on patient beds, high-touch surfaces, and patient socks within 24 hours.

Molecular typing conducted in several patient rooms found that the spa type of the MRSA isolates on the floors was the same as isolates recovered from other sites, but the direct transfer of pathogens to personnel or equipment to high-touch surfaces was not detected.

"Hand hygiene is critical, but we need to develop practical approaches to reduce under-appreciated sources of pathogens to protect patients," senior author Curtis Donskey, MD, an epidemiologist at the Cleveland VA Medical Center, said in a press release from the Society for Healthcare Epidemiology of America (SHEA), which sponsors the journal.
Nov 2 Infect Control Hosp Epidemiol abstract
Nov 2 SHEA press release

Avian flu detected in Russia, Israel, Germany, and UK

In the latest avian flu outbreak developments, Russia and Israel reported more highly pathogenic H5N8 outbreaks in poultry, German detected H5N8 and H5N8 in a few wild birds, and the United Kingdom reported an event involving low-pathogenic H5N2 in poultry.

A small but steady stream of H5N8 outbreaks have been occurring in Russia and Kazakhstan over the past few months, and officials have feared that migratory birds would spread to virus to other locations in Europe.

Russia's latest outbreak began on Oct 19 at a commercial poultry farm in Rostov oblast in the far southwestern part of the country, killing 1,011 and sickening 52,179 of more than 1.1 million susceptible birds. The survivors were slated for culling as part of the outbreak response measures.

Meanwhile, Israel reported two H5N8 outbreaks at turkey farms, one in Hazafon and the other in Haifa. The events began on Oct 29 and Oct 30, respectively, killing 170 of 18,870 birds at the locations. The rest were destroyed.

erman government veterinary officials said avian flu has been detected in wild birds, apparently found dead, in three different states. They include a wild duck in Hamburg, a buzzard in Mecklenburg-Western Pomerania, and various wild birds in Schleswig-Holstein. The virus types included H5N8 and H5N5.

Also, the UK Department for Environment, Food, and Rural Affairs (DEFRA) today said low-pathogenic H5N2 has been identified in an outbreak at a small commercial poultry farm near the city of Deal in Kent. All 480 birds will be euthanized to curb the spread of the virus. An investigation is under way into the source of the virus, and DEFRA said wild birds migrating from mainland Europe during the winter pose a risk of spreading the disease to poultry and other captive birds.
Nov 2 OIE report on H5N8 in Russia
Nov 1 OIE report on H5N8 in Israel
Oct 31 German government statement
Nov 2 DEFRA update