COVID Omicron carries 4 times the risk of death as flu, new data show

News brief

woman at gravesideThe risk of death from SARS-CoV-2 Omicron infection was four times higher than that from influenza in late 2022 and early 2023 in France, a Harvard Medical School researcher reports today in Epidemiology & Infection.

Biostatistician Edward Goldstein, PhD, estimated the contribution of flu and Omicron variant infections to all-cause death in France for the 2014-15 through the 2018-19 influenza seasons, as well as from week 33, 2022, through week 12, 2023.

"For many deaths associated with influenza and Omicron infections, those viruses are not detected, or listed as a contributing cause of death," he wrote.

Higher flu vaccine uptake needed

After the emergence of the Omicron variant in 2022, France saw a high proportion of intensive care unit admissions and deaths from causes other than COVID-19 compared with previous variants.

Flu was tied to a yearly average of 15,654 deaths during the 2014-15 through 2018-19 seasons and 7,851 deaths from week 33, 2022, to week 12, 2023. During the latter period, 32,607 people died of COVID-19, or their deaths were related to the disease.

Omicron infections weren't recorded as a contributing cause for many deaths attributed to cardiac disease, mental disorders, and other underlying causes. For instance, there were an estimated 23,983 SARS-CoV-2–associated deaths from week 33 to week 52 in 2022, compared with 12,811 deaths listing COVID-19 on the death certificate and 8,639 in-hospital COVID-19 deaths.

For many deaths associated with influenza and Omicron infections, those viruses are not detected, or listed as a contributing cause of death.

In France, rates of flu vaccination among nursing home staff are low, despite vaccination leading to a significant reduction in all-cause death among residents during flu seasons, Goldstein noted.

The results "suggest the need for boosting influenza vaccination coverage in different population groups in France, and for wider detection of influenza infections in respiratory illness episodes (including pneumonia) in combination with the use of antiviral medications," he wrote. "For future Omicron epidemics, wider detection of Omicron infections in persons with underlying health conditions is needed."

Study: China saw almost 2 million excess deaths just after zero-COVID policy ended

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Mask wearing Hong Kong airportIn JAMA Network Open, authors describe how the all-cause mortality rate in China increased after the nation lifted its "zero COVID" policy, resulting in an estimated 1.87 million excess deaths during the first 2 months following the end of the policy.

The study was based on obituary reports of employees at three major Chinese universities in December 2022 to January 2023, and the authors built a model that took the relative increase in mortality in Beijing and Heilongjiang and extrapolated it to the rest of China.

Far more deaths than officially noted

Using the model, the researchers estimated 1.87 million excess deaths (95% confidence interval [CI], 0.71 million to 4.43 million; 1.33 per 1,000 population) among people 30 years and older.

Among those deaths in Beijing, 76% (95% CI, 65% to 84%) were men, and 80% (95% CI, 70% to 87%) were 85 years and older. Death counts peaked in the fourth week of December 2022.

"The number of deaths in universities in Beijing showed a substantial increase compared with expected deaths, with a rise of 403% (95% CI, 351% to 461%) and 56% (95% CI, 41% to 73%) during December 2022 and January 2023," the authors wrote.

The authors acknowledge their estimate far exceeds what China reported, which was 60,000 excess deaths in December 2022.

Updated guidelines highlight strategies for preventing catheter-associated urinary tract infections

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Gram-negative Enterococcus
CDC / Janice Haney Carr

New guidelines from a coalition of US medical experts recommend avoiding the use of indwelling catheters and promptly removing catheters that are no longer needed as the first steps in preventing catheter-associated urinary tract infections (CAUTIs) in acute care hospitals.

The updated recommendations, published today in Infection Control & Hospital Epidemiology, also call for daily review of continued catheterization, which is responsible for up to three quarters of all healthcare-associated UTIs, and identifies alternatives to indwelling catheters. The document notes that 12% to 16% of adult hospital patients will have an indwelling urethral catheter at some point during hospital admission, but up to half may not have an appropriate indication.

A multidisciplinary approach

"Urinary catheters can be associated with infection and also with non-infectious harms like trauma and obstruction," Payal Patel, MD, an infectious disease physician at Intermountain Health and lead author of the updated guidelines, said in a press release. "Prevention of infection related to use of typical indwelling urinary catheters is multidisciplinary. Many members of the healthcare team, including doctors and nurses, have a role."

CAUTIs have been associated higher hospital mortality and longer hospital stays, with an estimated cost of up to $1,000 per patient.

Many members of the healthcare team, including doctors and nurses, have a role.

Other new recommendations for essential practices include educating healthcare professionals about urine culture stewardship and requiring clinicians to provide an appropriate indication when ordering a urine culture.

The guidelines are the product of a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with contributions from other societies and organizations.

WHO bolsters antimicrobial resistance surveillance in Ukraine

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Firefighter in Ukraine war
UNDP Ukraine, Oleksandr Ratushniak / Flickr cc

The World Health Organization (WHO) said this week that its Country Office in Ukraine has donated antimicrobial resistance (AMR) surveillance equipment to laboratories around the country.

The move comes amid an increase in multidrug-resistant (MDR) infections linked to the Russian invasion of Ukraine. Several studies and case reports published in recent months have described MDR infections among soldiers and hospitalized patients in Ukraine since February 2022, when the invasion began. Experts have attributed the rise in MDR infections in part to suboptimal surgical and antibiotic treatment in the often unsterile and low-resource conditions of a war zone.

Neighboring countries that have taken in Ukrainian refugees and hospital patients have also reported seeing an increase in MDR organisms (MDROs). In March, the European Centre for Disease Prevention and Control recommended that hospitals screen for MDROs in patients transferred from Ukrainian hospitals or with a history of hospital admission in Ukraine.

Technical assistance also offered

The WHO says the AMR surveillance equipment was donated primarily to labs in regions close to the frontline and will help increase the speed and accuracy of microbial identification. The agency has also offered to visit microbiologic laboratories and provide onsite technical assistance upon request.

"AMR is one of the top public health threats globally, as it hinders effective prevention and treatment of infections, Jarno Habicht, MD, PhD, WHO Representative in Ukraine, said in a news release. "WHO developed the Global Action Plan on AMR in 2015, and will continue to provide material resources and learning opportunities to help healthcare workers combat AMR and protect the lives and health of their patients." 

Polio remains emergency as 3 African countries report new cases

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Polio antigen testing

The World Health Organization's polio emergency committee met again last week and recommended that, although encouraging progress has been made, the situation still warrants a public health emergency of international concern. The news comes as more cases are confirmed in Africa.

The concern stems from activity in a handful of countries. In Afghanistan, a large pool of unvaccinated "zero dose" children could reintroduce wild-type poliovirus into the southern region. The WHO also noted suboptimal immunization coverage during campaigns in southeastern Africa, in Malawi, Mozambique, Zambia, and Zimbabwe.

There may be insufficient population immunity to halt transmission.

"There may be insufficient population immunity to halt transmission," the WHO wrote. "Many countries have weak immunization systems that were further impacted by the COVID-19 pandemic but are gradually recovering."

New cases in Chad, DR Congo, Kenya

Three African countries—Chad, the Democratic Republic of the Congo (DRC), and Kenya—reported more polio cases this week, all vaccine-derived types, according to the latest Global Polio Eradication Initiative report.

In Chad, 2 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported, in Ouaddai and Mayo Kebbi Est. The country has had 25 cases this year. In the DRC, 3 cVDPV2 cases were reported in Mongala and Haut Lomami; there have now been 65 cVDPV2 cases reported in the DRC this year, compared with 368 such cases in 2022.

The DCR also confirmed a circulating vaccine-derived poliovirus type 1 (cVDPV1) case, raising the year's total to 48.

Finally, Kenya recorded one cVDPV2 case, the third this year.

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