Data show homeless people didn't have higher COVID death, hospitalization rates

News brief

Unhoused man with suitcase — *Mongkolchon Akesin / iStock*

People experiencing homelessness (PEH) in Canada had similar COVID-19 death and hospitalization rates as their counterparts living in permanent housing, the Network of Canadian Emergency Researchers reported yesterday in CMAJ.

The team analyzed data from the Canadian COVID-19 Emergency Department Rapid Response Network registry on 52,883 COVID-19 patients seeking care at 50 emergency departments in eight provinces starting in March 2020 to compare rates of in-hospital death, hospitalization, critical care admission, and mechanical ventilation among PEH (901 patients) versus matched housed patients (51,982).

Rates of COVID-19 vaccination were 20.9% among PEH and 22.9% among their housed peers.

"Congregate living conditions frequently encountered by PEH were associated with increased transmission of SARS-CoV-2 and incidence of COVID-19," the investigators wrote. "However, it remained unclear whether PEH were more susceptible to severe illness than housed patients. Previous research on the topic has been contradictory and limited by sampling bias and unaddressed confounders."

Lower rates of critical care admission

The two groups had comparable rates of death (3% each; odds ratio [OR], 0.87) and hospital admission (44% in PEH vs 45% in housed patients), but PEH had lower rates of critical care admission (OR, 0.66).

A signal for reduced critical care admission among PEH may reflect differential treatment unrelated to clinical characteristics that we matched for.

"A signal for reduced critical care admission among PEH may reflect differential treatment unrelated to clinical characteristics that we matched for," the study authors wrote. "Homelessness is associated with not only differing clinical characteristics, but also different sociodemographic factors such as race and income, which we have not adjusted for, as despite these factors’ association with health outcomes, clinicians would not typically take them into consideration when deciding treatment course."

They called for future research on resource allocation during pandemics to gauge potential inequities among vulnerable populations and how best to remedy them.

NIH cuts research grants on vaccine hesitancy—with mRNA vaccine studies the next target

News brief

Lisa Schnirring

The National Institutes of Health (NIH) yesterday terminated at least 33 research grants studying vaccine hesitancy and strategies to increase vaccine uptake and scaled back 9 others on the topic, Science reported, based on information from a person with direct knowledge and a review of the cancellation letter that researchers received.

child vaccination — *Ran Kyu Park / iStock*

According to Science, acting NIH Director Michael Memoli, MD, last week asked NIH institutes for a list of current and future grants addressing vaccine hesitancy. Scientists connected to the grants were set to receive termination letters last night.

The termination letter seen by Science said their awards "no longer effectuates agency priorities. It is the policy of NIH not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment."

New Department of Health and Human Services (HHS) secretary Robert F. Kennedy Jr. is a known vaccine skeptic, and when President Donald Trump nominated him, he gave Kennedy the green light to make major policy changes that align with his personal health beliefs. The cuts come amid one of the nation's biggest measles outbreaks in recent years, an event on the Texas–New Mexico border that has so far sickened at least 253 people, 2 of them fatally. Most were unvaccinated. (See related CIDRAP News story today.)

Some studies geared toward boosting uptake in minorities

Of the terminated grants, 14 were made by the NIH's National Institute for Allergy and Infectious Diseases (NIAID) and involved vaccines for diseases such as mpox, human papillomavirus (HPV), chickenpox, COVID, and a hypothetical gonorrhea vaccine. Some addressed increasing uptake in racial minority groups, while others included vaccine hesitancy as one of several variables in disease outbreak modeling.

Science also reported that Memoli last week asked the NIH's institutes for similar lists of planned or current grants related to mRNA vaccine research, as well as a list of international research collaborations.

Study shows evidence of mixed kindergarten developmental trends during pandemic

News brief

Stephanie Soucheray, MA

A study yesterday in JAMA Pediatrics shows varying developmental health trends among US kindergartners immediately prior to and during the COVID-19 pandemic.

Though several studies have shown school closures and pandemic-era shutdowns had negative effects on elementary and high school students, the developmental impact of the pandemic has been less studied on the youngest schoolchildren.

In this study, the authors used data from the Early Development Instrument (EDI), among a sample of 475,740 US kindergarteners from 2010 to 2023. The kids attended schools in 19 states and represented 398 school districts. Participants were an average 6 years of age, and 51.1% were boys.

Outcomes were EDI scores in five categories: physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication and general knowledge.

Language, cognitive development declined

In contrast to what has been documented in older children and teens, no changes were found in physical health and well-being scores among kindergartners before and during the pandemic.

However, communication and general knowledge, language and cognitive development, and social competence all saw significant drops in EDI scores during COVID-19 (2021 to 2023). These scores were significantly lower compared with the immediate prepandemic period (2018 to 2020) for communication and general knowledge (mean change, −0.21; 95% confidence interval (CI), −0.24 to −0.17), language and cognitive development (mean change, −0.47; 95% CI, −0.49 to −0.45), and social competence (mean change, −0.03; 95% CI, −0.06 to −0.01), the authors wrote.

Our findings underscore the need for early childhood policies that address these preexisting challenges and the additional stressors introduced by the pandemic.

"Our findings underscore the need for early childhood policies that address these preexisting challenges and the additional stressors introduced by the pandemic," the authors concluded.

Osceola County, Michigan, reports first CWD case in farmed deer

News brief

Mary Van Beusekom, MS

The first case of chronic wasting disease (CWD) in a farmed white-tailed deer in Osceola County, Michigan, has been identified, the Michigan Department of Agriculture and Rural Development (MDARD) reported today.

The 7-year-old deer tested positive for the fatal neurodegenerative disease as part of the state's CWD surveillance program for deer farms. Osceola County is in the west-central part of Michigan's Lower Peninsula.

"While regular CWD surveillance testing is central to accomplishing this goal, MDARD's continued partnership with herd owners, hunters, and other state and federal partners is also crucial to effectively managing this disease," State Veterinarian Nora Wineland, DVM, said in the news release. "Ensuring the health of Michigan's farmed cervid population has been and continues to be a team effort."

15 other state deer farms have had cases

The farm joins 15 other CWD-positive deer farms discovered in the state since 2008 in Kent, Lake, Mecosta, Montcalm, and Newaygo counties. CWD was first discovered in free-ranging deer in 2015, with cases detected across 14 counties in Michigan's Upper and Lower Peninsulas.

While regular CWD surveillance testing is central to accomplishing this goal, MDARD's continued partnership with herd owners, hunters, and other state and federal partners is also crucial to effectively managing this disease.

Nora Wineland, DVM

CWD, which affects cervids such as deer, elk, and moose, is transmitted through infectious misfolded proteins called prions. It can be spread through direct contact or the environment. No people have been diagnosed as having the disease, but the US Centers for Disease Control and Prevention and the World Health Organization caution against consuming meat from infected animals.