More than 600 US doctors died than expected early in COVID pandemic

News brief

Early in the COVID-19 pandemic, 622 more US physicians died than expected, but no excess deaths occurred after April 2021, when vaccines were broadly available, finds a study yesterday in JAMA Internal Medicine.

Stanford University researchers led the analysis of American Medical Association monthly death data from January 2016 to February 2020 among active and nonactive physicians aged 45 to 84 years. The team used this model to estimate expected deaths from March 2020 to December 2021 and then calculated excess deaths.

Older working physicians most at risk

From March 2020 to December 2021, 4,511 physicians died, representing 622 excess deaths among a monthly average roster of 785,631 physicians, and 43 excess deaths per 100,000 person-years. Of the physicians who died, 65.3% were men.

Of note, however, physicians of all age-groups had substantially lower excess death rates than the general population. There was a steep age gradient among working physicians providing direct patient care, with 10 excess deaths per 100,000 person-years in the youngest age-group and 182 in the oldest.

The findings suggest that personal protective equipment use, vaccine requirements, infection prevention protocols, adequate staffing, and other workplace-based protective measures were effective.

Nonworking physicians had the highest excess death rate (140 per 100,000 person-years), compared with 27 among active physicians providing direct patient care and 22 among active physicians not providing direct patient care. Among all active physicians, excess deaths peaked at 70 per 100,000 person-years in December 2020 and then rapidly declined. No excess deaths occurred after April 2021.

"The findings suggest that personal protective equipment use, vaccine requirements, infection prevention protocols, adequate staffing, and other workplace-based protective measures were effective in preventing excess mortality," the researchers wrote.

The authors noted that their findings could be underestimates due to unreported physician deaths and older physicians choosing early retirement.

"During COVID-19 surges, these conditions may strain hospitals, resulting in excess deaths in the general population," they wrote. "Preventing excess deaths among physicians is an important component of mitigating excess deaths in the general population."

Antibiotic sales rose with increase in COVID-19 cases, study finds

News brief

An analysis of data from 71 countries shows that over the first 2 years of the pandemic, antibiotic sales increases were linked with increases in COVID-19 cases, researchers reported last week in eClinical Medicine.

Using the IQVIA MIDAS database, researchers with One Health Trust, GlaxoSmithKline, and the Harvard TH Chan School of Public Health obtained monthly sales volume data on broad-spectrum antibiotics (cephalosporins, penicillins, macrolides, and tetracycline) in 71 countries from March 2020 to May 2022. They then combined those figures with country-month-level COVID-19 case and vaccination data to estimate the association between antibiotic sales volumes and COVID-19 cases and vaccinations per 1,000 people over the same period.

Sales of all four antibiotics fell sharply during April and May 2020 compared with the pre-pandemic period (January 2018 to March 2020), followed by a gradual rise to near pre-pandemic levels through May 2022. In fixed-effects regression models, a 10% increase in monthly COVID-19 cases was associated with 0.27% higher sales of cephalosporins, 0.33% higher sales of penicillins, 0.45% higher sales of macrolides, and 0.32% higher sales of all four antibiotics combined per 1,000 people. No associations were observed with tetracyclines.

Across continents, a 10% increase in monthly COVID-19 cases was associated with 0.78%, 1.33%, and 1.48% higher macrolides sales in Europe, North America, and Africa respectively. Sales of other antibiotics across continents were also positively associated with COVID-19 cases, although the estimated associations were smaller in magnitude. No consistent associations were observed between antibiotic sales and COVID-19 vaccinations.

Opportunity for stewardship

The authors note that while the findings indicate a level of antibiotic overuse and misuse for COVID-19, pandemic-associated lockdowns and other non-pharmaceutical interventions likely kept the increase in antibiotic sales modest by reducing non-COVID infections that drive antibiotic use.

Preventing unnecessary treatment of COVID-19 cases with antibiotics remains essential.

"However, preventing unnecessary treatment of COVID-19 cases with antibiotics remains essential," they wrote. "COVID-19 will likely become endemic eventually and similarly virulent as the common cold, and medical guidelines and government policies must stop it from becoming another influenza-like illness for which antibiotics are continually and inappropriately prescribed."

Bangladesh reports more Nipah virus cases and deaths

News brief

Two more Nipah virus cases have been reported in Bangladesh's outbreak, and 2 more people have died from their infections, raising the total to 10 cases, 7 of them fatal, according to a recent update from the country's Institute of Epidemiology, Disease Control, and Research (IEDCR).

The virus activity is up sharply from the handful of annual cases the country has typically reported over the past few years. Bangladesh is one of three countries, alongside India and the Philippines, that reports sporadic cases. In earlier announcements, Bangladeshi officials have warned people to avoid drinking raw date juice, which can be contaminated by the saliva or feces of bats known to harbor Nipah virus.

According to the IEDCR, the patients are from six districts, most of them in the west or west-central part of the country. Six patients are male, and four are female.

Nipah virus often causes severe or fatal infections, and human-to-human infections have been reported. There are no approved treatments or vaccines. The World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI) consider Nipah virus a high-priority pathogen because of its pandemic and bioterrorism potential.

This week's top reads