The US Department of Education and the Administration for Strategic Preparedness and Response (ASPR), part of the Department of Health and Human Services (HHS), yesterday announced a plan to distribute free COVID-19 tests to school districts.

Districts can order the tests directly from the government starting in early December. Roberto Rodriguez, the education department's assistant secretary for planning, evaluation, and policy development, said, "These self-tests are easy to use and can play an important role in preventing the spread of COVID-19. We encourage schools to make use of these free resources to safeguard students, parents, and staff throughout the 2023-24 school year."

Officials said they expect millions of tests to be sent out for stocking school nurses' offices, distributing at events, sending home with students or parents, and more.

HHS Assistant Secretary for Preparedness and Response Dawn O'Connell, JD, said making free tests available ensures that students and staff can test through the winter months, adding that a close relationship with school districts can help keep communities healthy.

So far, the federal government has distributed 1.6 billion free COVID tests to households, schools, long-term care facilities, community health centers, and food banks. It said it is sending out 4 million tests each week, a number expected to rise as school districts begin ordering tests. On November 20, HHS opened up another round of free COVID test ordering for households.

A review and meta-analysis of long-term cardiac complications of long COVID finds a high prevalence of chest pain and abnormal heart rhythms (arrythmias).

For the study, published this week in BMC Medicine, a University of Washington–led team reviewed 150 studies on 57 cardiac complications that persisted for at least 1 month after COVID-19 infection. They also conducted a meta-analysis of 137 studies on 17 complications. The studies were published from January 2020 to July 2023.

"Prior reviews synthesized findings of studies on long-term cardiac complications of COVID-19," the researchers wrote. "However, the reporting and methodological quality of these studies has not been systematically evaluated."

Chest pain in 10%, arrhythmias in 8%

Slightly over one quarter (25.3%) of studies were high-quality, according to a customized Newcastle-Ottawa scale. The most widely examined cardiac complications were chest pain and arrhythmias. When study quality and characteristics were disregarded, the estimated prevalence of chest pain and arrhythmias were 9.8% and 8.2%, respectively.

Less-examined complications were stroke (0.5%), heart abnormalities (10.5%), thromboembolism (1.4%), high blood pressure (4.9%), heart failure (1.2%), myocardial injury (1.3%), myocarditis (0.6%), abnormal ventricular function (6.7%), edema (2.1%), coronary disease (0.4%), ischemic heart disease (1.4%), valve abnormalities (2.9%), pericardial effusion (0.8%), atrial fibrillation (2.6%), and impaired diastolic function (4.9%). 

We found there were diverse manifestations of cardiac complications, and many can last for months and even years.

But stratified analyses found that low-quality studies with small sample sizes, unsystematic sampling methods, and cross-sectional designs were more likely to report higher complication rates. For instance, rates of chest pain were 22.2%, 11.1%, and 3.9% in low-, medium-, and high-quality studies. Similar trends were seen for arrhythmias and other less-examined cardiac complications.

"We found there were diverse manifestations of cardiac complications, and many can last for months and even years," the study authors wrote. "Reported findings from previous studies are strongly related to study quality, sample sizes, sampling methods, and designs, underscoring the need for high-quality epidemiologic studies to characterize these complications and understand their etiology."

As highly pathogenic avian flu outbreaks continue at a steady pace, the virus has turned up at another large egg producer, this time in at a facility in Iowa's Sioux County that houses 1.6 million layers, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). The event adds to other recent outbreaks at egg producers, including another in Iowa that had 1.2 million birds, a facility in Ohio that housed 1.3 million birds, and one in Minnesota that led to the loss of nearly 1 million birds.

The surge in H5N1 avian flu activity, which began in early October, has also hit turkey farms hard, as well as other commercial operations. In its latest updates, APHIS also reported outbreaks affecting poultry flocks in seven other states, several of them at commercial farms. They include a broiler farm in Arkansas and turkey producers in Minnesota, North Dakota, and South Dakota. Detections were also reported in backyard flocks in Colorado, Iowa, Nebraska, and Washington state.

Since the outbreaks began in early 2022, they have led to the loss of a record 67.8 million birds. In November alone, the outbreaks have affected 7.6 million poultry.

In related developments, APHIS also reported more than 150 H5N1 detections in wild birds over the past several days, mostly in hunter-harvested waterfowl as part of disease surveillance. Some of the reports also involve birds found dead, including geese, waterbirds, and birds of prey.

Developments overseas

Other countries are also reporting the reappearance of the virus, including Israel, where H5N1 struck a turkey farm in Zora that has 10,500 birds, according to a notification from the World Organization for Animal Health (WOAH). Germany reported an outbreak at a commercial farm in Lower Saxony state, and the United Kingdom has reported recent outbreaks at commercial farms in Devon and Northumberland.

The UK Veterinary Medicines Directorate and the UK Health Security Agency published their third report on One Health, covering antibiotic use, sales, and antimicrobial resistance during 2019 and finding that a total of 706 tons of antibiotics were consumed by people and animals in the country.

Of note, the use of critically important antimicrobials decreased by 75%, and overall use decreased by 28%, since 2014.

Sixty-eight percent of antibiotics were consumed by people, and 32% by animals in 2019. Food-producing animals saw a 52% decrease in antibiotic consumption between 2014 and 2019, whereas people had an 18% decrease.

The report also focused on resistance in key bacteria, including Salmonella, E coli, and Campylobacter.

Strong human-animal connections

Antimicrobial resistance (AMR) in certain pathogens showed strong connections between people and animals, notably chickens.

Similar patterns of AMR in Campylobacter spp. are reported across chickens, chicken meat, and human patients, suggesting strong linkages through the food chain.

"Similar patterns of AMR in Campylobacter spp. are reported across chickens, chicken meat, and human patients, suggesting strong linkages through the food chain," the report read. "High levels of fluoroquinolone resistance (>40%) have persisted across the sectors despite very low usage of these antibiotics in chickens."

In 2019, resistance in human isolates to ciprofloxacin, an antibiotic used to fight Campylobacter species, was 47.1%, and in retail chickens it was 51% in 2018 and 2019.

Also noted in the report is AMR trends in pets, including cats and dogs. Though antibiotic sales data indicates that, from 2014 to 2019, overall use of antibiotics for both animals decreased, cats were still accounted for high rates of critically important antimicrobials.