COVID-19 Scan for Nov 09, 2022

News brief

COVID-linked kidney injury tied to higher risk of death in hospital patients

An observational study published this week in eClinicalMedicine suggests that COVID-19–related acute kidney injury (AKI) is tied to a greater risk of death, and that severe AKI may lead to poor recovery of kidney function.

Researchers with the Consortium for Clinical Characterization of COVID-19 by EHR (electronic health record) assessed AKI and subsequent recovery among 12,891 adult patients who tested positive for COVID-19 from Jan 1 to Sep 10, 2020, and were admitted to 15 hospitals in 11 healthcare systems in 5 countries.

Participants had at least one recorded serum creatinine value in the year before hospitalization up to Sep 10, 2021. The study took place during wild-type virus dominance before the COVID-19 vaccine rollout.

Of the 12,891 COVID-19 patients, 50.5% had at least one episode of AKI. Relative to non-AKI patients, those with an AKI diagnosis had a higher death rate (32.5% vs 10.4%), and 39.2% didn't recover total kidney function within 90 days or end of follow-up.

Risk factors for death were severe AKI (hazard ratio [HR], 4.22) and ischemic heart disease (HR, 1.26). Severe AKI was tied to worse kidney recovery, while the use of the antiviral remdesivir (HR, 1.34) was associated with better recovery.

AKI patients were more likely than those without the diagnosis to be men (77.8% vs 71.2%), aged 70 years and older (55.0% vs 35.9%; HR, 2.77), and to have severe COVID-19 (58.6% vs 27.8%; HR, 2.91).

Participants diagnosed as having COVID-19-linked AKI were more likely to have chronic kidney disease (CKD; 47.8% vs 28.6%), cirrhosis (3.2% vs 2.4%), high blood pressure (59.8% vs 42.4%), ischemic heart disease (22.4% vs 12.6%), chronic obstructive pulmonary disease (COPD; 14.8% vs. 9.6%), and previous venous thromboembolism (blood clot in a vein; 20.3% vs 13.4%).

Elevated baseline serum creatinine (indicating poor kidney function) was noted in AKI patients at 6 months (risk ratio [RR], 1.49) and 1 year (RR, 1.54).

"Further studies are warranted to identify therapeutic strategies to delay the onset and/or progression into chronic kidney disease after an inciting AKI event," the authors wrote.
Nov 7 eClinicalMedicine study

UK study shows few COVID-19 deaths in children, young adults

A study yesterday in PLOS Medicine conducted in England shows that the risk of death due to COVID-19 remains very low for children and young adults, with most deaths occurring in those with underlying health conditions.

Researchers from the UK Health Security Agency analyzed data on anyone in England under the age of 20 who died within 100 days of a confirmed COVID-19 infection between March 2020 and December 2021.

Of 185 total deaths that occurred, 81 were due to COVID-19. Of those 81, 75% of patients had significant underlying health issues, including severe disability (27 case-patients) or compromised immune systems (12 case-patients).

Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days, the authors said.

For the 22 months of the study, COVID-19 was responsible for 1.2% (81/6,790) of all deaths in people aged less than 20 years, with an infection fatality rate of 0.70 per 100,000 SARS-CoV-2 infections.

In a PLOS press release on the study, coauthor Shamez Ladhani, PhD, said, "Our national surveillance in England continues to show a very very low risk of death due to COVID-19 in children and teenagers, with most fatalities occurring in those with multiple and life-limiting underlying conditions."
Nov 8 PLOS Med study
Nov 8 PLOS press release

News Scan for Nov 09, 2022

News brief

Ebola spread to southern district adds to Uganda's challenges

At a World Health Organization (WHO) briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said Uganda's government is making progress in its battle against Ebola, but he raised concerns about case detections outside the main hot spots.

Over the past 2 weeks, most cases have been reported from the capital city Kampala, as well as Kassanda district. Tedros said one cases has also been reported from Masaka district in the south of the country, which appears to raise the number of affected districts to eight. "The detection of cases in several different districts is clearly concerning," he said.

Tedros said the main focus is strengthening contact tracing, community engagement, and infection prevention.

Uganda's health ministry has reported 136 confirmed cases, along with 53 deaths among patients with confirmed infections. Earlier in the outbreak, which began in September, the country reported 21 suspected cases, all of them fatal.

In other developments, in internal report from Uganda's health ministry, dated Oct 31, project that outbreak numbers could rise to as high as 1,200 cases and 500 deaths by April, sources told the United Kingdom-based Telegraph. The sources told the paper that the response has been hampered by a lack of transparency early in the outbreak and tension between the Uganda's authoritarian government and international health partners.
Nov 9 Tedros speech
Uganda health ministry Ebola page
Nov 8 Telegraph story

WHO: Weekly monkeypox cases up slightly

The number of monkeypox cases reported to the WHO rose slightly last week, with 19 countries reporting rises in cases, the head of the WHO said today at a briefing on a host of health issues.

Tedros Adhanom Ghebreyesus, PhD, said despite the small rise in cases, the number of weekly cases is down 80% from the peak reported in August. WHO tracking shows cases rose 2.5% for the week ending Nov 6. Most of the cases reported last week were from the Americas and European regions. Of the 19 countries reporting rises, Mexico reported the highest increase.

In another new development, he said the WHO this week signed an agreement with Siga Technologies, the company that developed the antiviral tecovirimat (Tpoxx) for a donation of 2,500 treatment courses. Tedros said WHO will invite low- and middle –income countries to express interest in receiving the donated doses.

Though the treatment isn't approved in most countries, the WHO has posted a protocol that researchers can use to design and conduct clinical trials. Tedros said in settings where trials are not in place, The WHO recommends that tecovirimat be considered for use under a different protocol to promote data collection on the treatment's effectiveness.

The global COVID total today is 78,924 cases, 42 of them fatal, from 110 countries, according to WHO tracking.
Nov 9 Tedros speech
Nov 9 WHO monkeypox update

WHO global vaccine market report identifies gaps, limitations

In its latest report on the global vaccine market—the first since the COVID-19 pandemic began—the WHO today called for more steps to provide equitable access and spelled out problems with supply and access.

The group said inequitable vaccine distribution isn't unique to the COVID-19 vaccine and is one of the drivers of health disparities. For example, the WHO said human papillomavirus (HPV) vaccine has only been introduces in 41% of low-income countries, though they bear much of the cervical cancer burden. In contrast, 83% of high-income countries have introduced the HPV vaccine.

Another obstacle is affordability, with middle-income countries often paying the same price as or more than wealthier countries.

The authors of the report also analyzed global vaccine manufacturing capacity. Market volume increased nearly threefold between 2019 and 2021, mainly due to COVID-19 vaccines. However, manufacturing capacity remains highly centralized, with 10 producers supplying 70% of vaccine doses. Several of the top 20 most commonly used vaccines are made by just two suppliers.

The WHO warned that the concentrated manufacturing base poses risk of shortages and insecure supplies at the regional level.

At a briefing today, WHO Director-General Tedros added that there are still no vaccines for diseases such as schistosomiasis and leishmaniasis that hit low-income countries hardest. "The bottom line is that market dynamics are failing the world’s poorest and most vulnerable people," he said. "WHO is calling on governments around the world to expand research and manufacturing outside its traditional centers."
Nov 9 WHO press release
Nov 9 WHO global vaccine market report
Nov 9 WHO Tedros speech