Schizophrenia, but not mood or anxiety disorders, tied to COVID-19 death
COVID-19 patients diagnosed as having schizophrenia spectrum disorder—but not those with mood or anxiety disorders—were linked to an increased risk of death, according to an observational cohort study published today in JAMA Psychiatry.
Researchers at New York University (NYU) Langone Medical Center led the study, which involved monitoring adult COVID-19 patients with psychiatric conditions at their center from Mar 3 to May 31, 2020. Of the 7,348 patients, 75 (1.0%) had a schizophrenia spectrum disorder, 564 (7.7%) had a mood disorder, and 360 (4.9%) had an anxiety disorder.
After adjustment for demographic and medical risk factors, schizophrenia spectrum disorder was tied to an increased risk of COVID-19 death (odds ratio [OR], 2.67). However, mood disorders and anxiety disorders weren't associated with death (OR, 1.14 and 0.96, respectively). Schizophrenia spectrum disorder was outranked only by age as a risk factor for coronavirus-related death.
Of the 7,348 patients, 864 (11.8%) died or were released to hospice within 45 days of a positive coronavirus test result.
The authors noted that at least two US cohort studies have identified a link between COVID-19 infection risk and depression and schizophrenia, which they said could be caused by biological factors related to psychiatric disorders (eg, impaired immune function) or socioeconomic and environmental factors such as crowded living conditions, congregate care settings, and lack of personal protective equipment.
"Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of COVID-19," said lead author Katlyn Nemani, MD, with NYU Langone Health, in a university news release. "With this newfound understanding, health care providers can better prioritize vaccine distribution, testing, and medical care for this group."
Jan 27 JAMA Psychiatry study
Jan 27 NYU Langone Health news release
COVID-19 outbreaks associated with summer camp, high school wrestling
COVID-19 outbreaks at an overnight camp in Georgia and a high school wrestling tournament in Florida last year involved attack rates of at least 56% and 30%, respectively.
Yesterday researchers in Pediatrics detailed the summer camp outbreak, noting that, of 627 staff, trainees (who left before camp officially began), and campers, 12 community-associated COVID infections (1.9%) led to 339 camp-associated infections (54.1%). The mean effective case reproduction number, or the number of secondary people infected per case, was as high as 4.0 during orientation, and instantaneous reproduction peaked at 10.0 the first day all the campers arrived.
From Jun 17-20, 2020, staff and trainees attended orientation, and the camp ran from Jun 21 through 27. Pre-arrival COVID test results were mandated, and while cabin cohorts were created to reduce potential transmissions, mask usage was not enforced. Follow-up interviews revealed that 88% of attendees were still in close or direct contact with people outside their cohorts and that only 15% of trainees and staff and 5% of campers wore masks all the time.
No cases involved hospitalization. "Testing should not be used as the sole mitigation measure," the investigators write.
The 2-day wrestling tournament, meanwhile, was linked to 79 total cases, according to yesterday's Morbidity and Mortality Weekly Report. The first case, from a school in "County A," was reported to local public health officials on Dec 7, 2020, 2 days after the tournament ended. The 130 event attendees included wrestlers, coaches, and referees across 10 high schools and three counties.
Thirty-eight cases were directly linked to the event, with 70.4% of 54 tests coming back positive. Out of 446 close contacts from households and schools, 95 (21.3%) received testing, revealing 41 additional cases. Secondary cases were most common among household members (60.0% of tested close contacts) and wrestlers who were not at the tournament (54.2%). The minimum attack rate (percent of those infected) was 30.2%
The investigators calculated that approximately 1,700 in-person school days were lost because of quarantine and sickness, which was lower than it could have been because of the proximity to the end of the semester. After the outbreak was detected, all winter high school sports in County A were suspended. One adult above age 50 died, but the report did not list the cause.
Jan 26 Pediatrics study
Jan 26 MMWR study
Strategies noted to address HPV vaccine shortages in low-resource areas
Amid a shortage of human papillomavirus (HPV) vaccines that Gavi, the Vaccine Alliance, provides to low- and middle-income countries, scientists implementing Tanzania's national vaccination program highlight difficulties in outreach and tracking that were caused or exacerbated by the lack of vaccines, according to a commentary yesterday in Vaccine.
Because of a shortage of the two-dose quadrivalent (four-strain) HPV vaccine, the Tanzania government was not able to target all girls ages 9 to 14 for its national HPV vaccine program, which is what the World Health Organization recommends. Instead, the 2018 program began by 14-year-old girls to promote equity and maximum coverage, as 15-year-old girls were not eligible. The only exception was the Kilimanjaro region, where a prior pilot program targeting 9-year-old girls had begun in 2014.
The administration integrated vaccine campaigns into routine delivery strategy with fixed health facilities, outreach sites, and school sites, but because 14-year-old girls were in primary school, secondary school (often moving locations for enrollment), or out of school, the administration has had to expend more human resources and finances than expected.
By the end of 2019, coverage of the first HPV vaccine dose was 78%, but second-dose coverage was only 49%.
Tanzania expected to be able to switch to a multiple-age cohort within 2 years of the program's start and then again to solely target 9-year-old girls across the country, but the lack of supply has made this impossible. Currently the HPV vaccine shortage for low- and middle-income countries is expected to last at least to 2024 because of a mismatch of supply and demand, even as 16 additional countries are expected to start HPV national campaigns by 2022.
"Given their country situation," the authors write, "decision-makers will need to balance equity concerns with the feasibility of reaching the selected target population and achieving high vaccination coverage."
"While additional vaccine manufacturers and single-dose vaccination strategies might relieve the supply constraints in the future, country programs and the global community must work together now to align efforts," they add.
Jan 26 Vaccine study