News Scan for Dec 23, 2020

News brief

Study finds 12.6% mortality among hospitalized COVID-19 patients

A multistate analysis of hospitalized COVID-19 patients in the American Journal of Epidemiology yesterday found that 12.6% of patients died, with blacks especially hard hit.

Researchers used electronic health record data from 15 facilities in a St. Louis-region hospital network to evaluate outcomes among a diverse group of 1,577 adults (49.9% male, median age 63 years, 58.8% black) hospitalized for COVID-19 from Mar 15 to Jul 25.

The study is one of the first to longitudinally describe COVID-19 hospitalization trajectories, showing patient transitions between clinical care states and providing valuable information for health system planning purposes.

Overall, 34.1% of patients required intensive care unit (ICU) admission (95% confidence interval [CI], 26.4% to 41.8%), and 12.3% received invasive mechanical ventilation (IMV) (95% CI, 8.5% to 16.1%). At 28 days after admission, 12.6% of patients had died (95% CI, 9.6% to 15.6%), with 11.2% remaining in the ICU (95% CI, 5.2% to 17.2%). A higher percentage of patients receiving IMV had died by day 28 than patients in the overall sample (16.2%).

Black patients tended to be younger, were less likely to be male, and were likely to have more comorbidities, but notably, race was not significantly associated with poorer outcomes.

"Black patients comprised a greater proportion of those admitted with COVID-19 disease, but, once hospitalized, there were no significant different in outcomes in adjusted models," the study authors said.

The study results provide useful information to guide health system pandemic planning, the authors wrote. "In particular, detailed data on the time spent in various clinical states can parameterize disease models to better project needs for staffing, hospital beds, critical care beds, and mechanical ventilators," they said.
Dec 22 Am J Epidemiol study


CDC declares leafy greens E coli outbreak investigation over

A Centers for Disease Control and Prevention (CDC) report yesterday confirms the end of its probe into a multistate Escherichia coli outbreak responsible for 40 cases and 20 hospitalizations in 19 states but no deaths.

Leafy greens of unknown type were the likely source of the outbreak, which led to illnesses reported from Aug 10 to Oct 31. Case-patients were 1 to 85 years old, with females accounting for 60% of patients. No new cases have been reported since the CDC's Nov 23 outbreak update.

Public health investigators used the PulseNet system—a national network of public health and food regulatory agency laboratories—to perform DNA fingerprinting of E coli bacteria isolated from people stricken with illness, finding close genetic relationships between bacterial strains and suggesting a common source of infection.

Investigators were unable to identify a specific type or brand of leafy greens, although 22 of the 23 people interviewed reported eating a variety of leafy greens in the week before becoming ill, including spinach (16) and romaine lettuce (15). Leafy greens are often grown, harvested, and processed together and although several farms were identified as possible sources of the outbreak, no single location was positively linked. Investigations to identify the source of the outbreak continue.
Dec 23 CDC report
Nov 24 CIDRAP News scan on CDC outbreak update


Avian flu outbreaks strike more poultry and wild birds in Europe, Japan

Highly pathogenic avian flu outbreaks continued to strike poultry and wild birds across parts of Europe and Asia, according to the latest updates from the World Organization for Animal Health (OIE).

The H5N8 strain was the culprit in the latest poultry events. Germany reported two outbreaks at turkey farms in Lower Saxony state in the country's northwest. They began on Dec 20 and Dec 21, killing 280 of 29,300 susceptible birds. Poland reported one more H5N8 outbreak, which started on Dec 17 at a layer farm in West Pomerania province in the northwest, killing all 320 birds at the location.

Japan reported five more H5N8 outbreaks, which began between Dec 1 and Dec 2, at broiler and layer farms in Miyazaki and Kagawa prefectures. Taken together, the virus killed 119 of 439,000 birds at the two locations. Agriculture officials in Japan recently said that the H5N8 strain infecting birds is similar to the one triggering outbreaks in South Korea and that it is distinct from the H5N8 strain circulating in Europe's birds.

Meanwhile, Germany reported more avian flu detections in wild birds, mostly H5N8, but it also reported an H5N5 outbreak in waterfowl in Schleswig-Holstein state.
Dec 22 OIE report on H5N8 in Germany
Dec 22 OIE report on H5N8 in Poland
Dec 22 OIE report on H5N8 in Japan
OIE outbreak notification page

In low-pathogenic avian flu developments, Belgium reported an H5 outbreak in poultry in West Flanders province. The outbreak began on Dec 14 at a commercial farm where 5,000 deaths in chicken were reported among 78,900 susceptible birds.
Dec 22 OIE report on low-path H5 in Belgium

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