COVID-19 pandemic tied to worse stress, depression among US adults

Acute stress and depression rates rose in US adults as COVID-19 cases and deaths accumulated from mid-March to mid-April, largely related to preexisting mental and physical conditions and stressors such as job and wage loss, according to a study of 6,514 people from three large, nationally representative cohorts.

In the study, published late last week in Science Advances, researchers from the University of California at Irvine evaluated stress and depression symptoms using the NORC AmeriSpeak panel over three 10-day periods.

Before the pandemic, participants reported, on average, one physical illness, and 17.7% had been diagnosed as having a mental illness. During the pandemic, 23.5% of participants said that they or a close friend or family member had symptoms of or were diagnosed as having COVID-19, while 29.8% said they had been exposed at work.

Participants noted, on average, 1.4 secondary stressors such as job loss or waiting in long lines for supplies and reported consuming a mean of 7.1 hours of pandemic-related media coverage each day.

Compared with men, women reported higher stress, but not depressive symptoms, while older people and residents of suburban versus urban areas had lower levels of stress and depressive symptoms, respectively. Respondents who lived in the Midwest, South, and West reported lower acute stress, but not depression, than those in the Northeast. Respondents with higher incomes reported fewer depressive symptoms than low-income participants, but not less stress.

People with personal exposure to COVID-19 reported more stress and depressive symptoms than others, as did those with job and income loss, while those with work-related exposures or community-related issues such as lockdowns had no more depression symptoms than usual.

More hours spent consuming media coverage of the pandemic, higher media consumption than before the pandemic, and more exposure to conflicting information about COVID-19 were predictive of more severe stress and depression.

"The many potential downstream public health consequences of this unfolding, ambiguous pandemic stretch far beyond the number of cases and deaths directly due to the novel Coronavirus itself," the authors wrote. "Future research should address the long-term public health impacts of the multiple threats of pre-existing risk, ongoing, secondary stressors, and media-related psychological distress."
Sep 18 Sci Adv study


Experts suggest steps for creating better market for new antibiotics

A new report from a panel of experts in antimicrobial resistance and antibiotic development suggests that a series of incremental steps will be needed to create a sustainable market for antibiotics.

The report from the Duke-Margolis Center for Health Policy lays out the short-term, medium-term, and long-term post-market incentives needed to revive investment in innovative antibiotics, along with the limitations of those approaches. The incentives are intended to solve what has become the most significant challenge to antibiotic development: the lack of sufficient financial return on new antibiotics.

"Reinvigorating the market for antibiotics requires action immediately, but the most impactful changes may not be feasibly implemented in the short-term," the authors write. "As a result, the spectrum of needed incentives must be considered in the context of time and complexity to implementation; some incentives might be limited in impact, but can be put into action quickly and provide immediate relief."

Among the short-term incentives highlighted is the rule changes made in 2019 by the Centers for Medicare and Medicaid Services to increase hospital reimbursement for new antibiotics. An intermediate step is the Developing an Innovative Strategy for Antimicrobial Resistant Organisms (DISARM) Act, which was re-introduced in Congress this year but was ultimately removed from coronavirus relief legislation. Under DISARM, hospitals would be reimbursed for qualified antibiotics based on their average sales price, a move the authors say would mitigate the financial impact on hospital pharmacies that procure and dispense innovative antibiotics.

Long-term strategies include market entry rewards, which would involve large upfront payments of up to $1 billion to companies that develop innovative new antibiotics, and subscription payment models, in which antibiotic developers would receive recurring payments for antibiotics in exchange for the reliable availability of those antibiotics. The idea behind this type of model, variations of which are being tested in the United Kingdom and Sweden, is to create a reimbursement system for antibiotics based not on sales volume but on the drugs' medical value.

The authors say that implementing these steps, and overcoming their limitations, will require multiple stakeholders to design methods to determine the value of antibiotics; collaborate to improve data collection on antibiotic use, AMR, and patient outcomes; and align around common investment goals and post-market incentives.
Sep 18 Duke-Margolis Center for Health Policy report


DRC Ebola outbreak total grows by 1 to reach 124 cases, with 50 deaths

Tests confirmed 1 new Ebola infection in the Democratic Republic of the Congo (DRC) Equateur province outbreak, raising the total to 124, the United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) said today in a situation update.

The latest case was reported from Lotumbe health zone. No new deaths were reported, keeping the total at 50.

Marking the DRC's 11th Ebola outbreak, the event in Equateur province was first reported in early June and is affecting the same area as the country's 9th outbreak, which occurred in 2018. The latest outbreak is concerning because of stretched resources due to the COVID-19 pandemic, a wide area where cases have been reported, and some sick patients remaining in the community, raising the risk of further virus spread.
Sep 21 UN OCHA situation report


High-path avian flu strikes more poultry in Russia, Taiwan

Two countries reported more highly pathogenic avian flu outbreaks in poultry, Russia, with H5N8, and Taiwan, with H5N5, according to notifications today from the World Organization for Animal Health (OIE).

Russia reported six more outbreaks involving H5N8, part of a small but steady stream of activity that has occurred in late summer in southwestern Russia. The latest outbreaks began from Sep 11 to Sep 15 and involved two earlier affected oblasts and two newly affected ones: Saratov and Kurgan. Most of the earlier outbreaks involved backyard and village birds, but today's report notes that two poultry farms were hit. Taken together, the virus killed 1,290 of 4,734 susceptible birds, and culling is under way for the survivors.

In a related development, animal health officials in Kazakhstan said a recently reported outbreak in the north near the border with Russia involved the same H5N8 strain that caused the Russian outbreaks, Reuters reported. The source of the virus is likely waterfowl.

Taiwan, meanwhile, reported two more H5N5 outbreaks, both at poultry farms housing native chickens in Yunlin County. The outbreaks began on Sep 5 and Sep 11, killing 5,728 of 27,477 birds. The rest of the flocks were destroyed to curb the spread of the virus.
Sep 21 OIE report on H5N8 in Russia
Sep 21 Reuters story
Sep 21 OIE report on H5N5 in Taiwan

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