COVID-19 Scan for Sep 08, 2020

News brief

Study: Acute kidney injury common in adults hospitalized with COVID-19

A new study published in the Journal of the American Society of Nephrology shows that 46% of hospitalized adults with severe COVID-19 suffer from acute kidney injury (AKI), and AKI was associated with a 50% mortality rate.

The study was based on 3,993 hospitalized patients with COVID-19 admitted to the Mount Sinai Health System in New York City from Feb 27 to May 30. Of those patients, 1,835 (46%) had AKI, and 347 (19%) of the patients with AKI required dialysis. According to the authors, in-hospital mortality was 50% among patients with AKI, versus 8% among those without AKI (adjusted odds ratio, 9.2; 95% confidence interval, 7.5 to 11.3).

Of those who survived AKI and COVID-19, only 30% recovered with complete kidney function by the time of discharge. Risk factors associated with developing AKI include older age, being a man, and having chronic kidney disease, hypertension, congestive heart failure, or diabetes.

"This study is the first study in the United States to report the persistence of kidney dysfunction (lack of recovery) in survivors of COVID-19–associated AKI," the authors said. "Given the high incidence of AKI and lack of full recovery at and after discharge, identification of potential mechanisms of COVID-19–related AKI would allow for potential interventions to reduce this devastating complication."
Sep 3 J Am Soc Nephrol study

No benefit found from treating COVID patients with azithromycin

A randomized controlled trial in Brazil found that adding azithromycin to standard of care treatments did not improve clinical outcomes in patients with severe COVID-19, according to a study published late last week in The Lancet.

In the open-label, randomized clinical trial, investigators at 57 Brazilian hospitals enrolled patients admitted to the hospital with COVID-19 and at least one indication of severe disease, including the use of supplemental oxygen or invasive or non-invasive mechanical ventilation. All patients in the study were randomly assigned 1:1 to treatment with the standard of care, which included the antimalaria drug hydroxychloroquine, or standard of care plus azithromycin (500 milligrams once daily for 10 days).

The primary outcome of the trial was clinical status at day 15 after randomization, assessed by a six-point ordinal scale, with higher scores indicating a worse condition and an odds ratio [OR] of greater than 1.00 favoring the standard-of-care group. The investigators also assessed safety.

A total of 447 patients were enrolled from Mar 28 to May 19. The modified intention-to-treat (mITT) population consisted of 397 patients with COVID-19 confirmed by molecular or serologic testing. In the mITT population, the primary end point was not significantly different between the azithromycin and standard-of-care groups (OR, 1.36; 95% CI, 0.94 to 1.97; P = 0.11). In the safety population, which consisted of 439 patients, there was no significant difference in rates of adverse events, including clinically relevant ventricular arrythmias, resuscitated cardiac arrest, acute kidney failure, and corrected QT-interval prolongation.

"In conclusion, in patients admitted to hospital with severe COVID-19, adding azithromycin to a standard of care (a regimen that included hydroxychloroquine) did not result in clinical improvement or mortality reduction," the authors of the study wrote. "These findings do not support the routine use of azithromycin in combination with hydroxychloroquine for this patient population and can inform clinical practice and guidelines."
Sep 4 Lancet study

News Scan for Sep 08, 2020

News brief

Ebola sickens 2 more in DRC outbreak; 112 total, 48 fatal

Two more Ebola cases were confirmed in the Democratic Republic of the Congo (DRC) Equateur province outbreak, raising the total to 112, the World Health Organization (WHO) African regional office said today in a Twitter update.

One more death was recorded, lifting the fatality count to 48. The outbreak in the country's northwest began in early June, just as a large outbreak centered in North Kivu province in eastern DRC was declared over. The latest event affects the same province where a small outbreak in the summer of 2018 occurred, sickening 54 people and killing 33.

The WHO's African regional office said today in its weekly outbreaks and health emergencies report that the developments are worrisome, given the continued increase in cases with spread to new health areas and health zones. Responders are struggling with inadequate resources for risk communication and community engagement in hot spots, and lack of funding requires urgent attention. So far, about 27,300 people have been vaccinated, and three health workers have been infected.

In a related development, yesterday the US Agency for International Development (USAID) announced more than $15 million in additional humanitarian assistance to help end the outbreak. The funds will help with actions such as disease surveillance, patient transportation, the promotion of safe and dignified burials, and community engagement.
Sep 8 WHO African regional office tweet
Sep 8 WHO African regional office weekly report
Sep 7 USAID press release

Wisconsin and Massachusetts report more EEE cases, 1 fatal

Wisconsin reported its second eastern equine encephalitis (EEE) case of the year, involving a woman in her 60s who died from her infection, and Massachusetts reported its fourth human infection involving the mosquitoborne virus.

The Wisconsin Department of Health Services (WDHS) said the patient had lived in Chippewa County, which is in the west central part of the state and borders Eau Claire County, where the state's first case of the year—in a girl—was recently reported. Of nine EEE cases in horses this year, four were in Chippewa County.

The Massachusetts Department of Public Health (MDPH) said the state's fourth human case also involves a woman in her 60s. She was exposed to EEE in Plymouth County, which prompted health officials to raise the area's EEE risk to high.

Both states said though the weather is cooling and mosquito populations are declining, the risk of illness continues throughout the fall, and the best prevention is to avoid mosquito bites.

EEE cases are rare, but infections can be fatal. The US Centers for Disease Control and Prevention (CDC) said the nation averages about 11 EEE cases a year, but 38 were reported in 2019. Transmission is most common in and around freshwater hardwood swamps in Atlantic and Gulf Coast states and in the Great Lakes region.
Sep 4 WDHS press release
Sep 4 MDPH press release
CDC background information

Chikungunya outbreak in Chad sickens more than 10,000

In Sudan, a chikungunya outbreak in the city of Abeche that began in April has sickened 10,631 people as of the end of August, the WHO African regional office said in its weekly outbreaks and health emergencies update today. Abeche, Sudan's fourth-largest city, has a population of 76,500 and is located in the southeastern part of the country.

No deaths have been reported, and the most affected group are those older than 15 years, with illnesses more common in females than in males. The WHO said the outbreak's rapid growth is a sign of a heavy vector load in an area that has challenges with sanitation.

The health ministry has deployed an expert mission, and a response plan is being finalized. Active case finding is already under way, as is vector control, which has reached 377 households. The WHO said community engagement, highlighting the importance of emptying all water containers, needs to be strengthened and that the outbreak response needs to be stepped up to prevent the outbreak from spreading to other areas.
Sep 8 WHO African regional office weekly report