COVID-19 Scan for Sep 01, 2020

High cost of COVID-19 response
Death rate in obese COVID patients

US government has spent trillions on COVID-19 health, economic relief

In response to COVID-19, the US government sold $1.5 trillion in obligations such as bonds and spent $1.3 trillion on public health, homeland security, and economic relief by Jun 30, according to an update yesterday from the Government Accountability Office (GAO).

As of Jul 31, the government had allocated roughly $2.6 trillion for coronavirus relief efforts, of which about $2.2 trillion (85%) was earmarked for Business Loan Programs, Economic Stabilization and Assistance to Distressed Sectors programs, unemployment benefits, Economic Impact Payments, the Public Health and Social Services Emergency Fund, and the Coronavirus Relief Fund. These six spending areas reported selling debt securities worth $1.4 trillion and spending the same amount.

The GAO said it has identified four indicators to monitor the US healthcare system's response to the pandemic and its preparedness for future outbreaks. The benchmarks and how the country currently measures up against them are:

  • Rate of positive COVID-19 test results: The World Health Organization advised in May that governments aim for a test positivity rate of less than 5% over a 2-week period. As of Aug 12, only 12 states and Washington, DC, had met that threshold.
  • Contract tracing: Several organizations, including the Centers for Disease Control and Prevention (CDC), recommended contact tracing as a way to monitor and contain the outbreak. But there are no national data on how many contact tracers have been deployed.
  • Proportion of available intensive care unit (ICU) beds: The CDC urges states and cities to ensure a surge capacity of 30% of ICU beds, but the percentage of hospitals reporting this data was unclear as of Jul 30.
  • Excess all-cause deaths: This indicator can show how many people have died from COVID-19, as well as how it may have contributed to deaths from other causes. From Jan 1 to Jun 13, the CDC reported about 125,000 more deaths from all causes than would normally have occurred.

On the basis of its findings, the GAO said it has issued recommendations to the government on unemployment insurance, economic impact payments, the Paycheck Protection Program, aviation preparedness, full access to death data, and financial assistance through Medicaid.
Aug 31 GAO update


Obese COVID-19 patients have more severe disease, higher death rate

Upwards of half of COVID-19 patients requiring ICU care and mechanical ventilation at a French hospital were obese, according to a news release on a presentation at the virtual European and International Congress on Obesity, held today through Sep 4.

The presentation, by Francois Pattou, MD, of the University of Lille in France, describes how obese patients at Lille University Hospital had more severe coronavirus illness and a higher death rate than normal-weight patients and how areas of France with a higher prevalence of obesity had longer lockdowns than other areas because the virus continued to circulate there.

Pattou and colleagues compared data from 124 ICU patients with COVID-19 with those of 306 ICU patients without coronavirus. Half of the COVID-19 ICU patients were either obese or severely obese, and 40% of the remaining patients were overweight. About 10% of the patients were of normal weight. But only a quarter of the non-coronavirus ICU patients were obese or severely obese, a quarter were overweight, and about half were in the healthy weight range.

Obesity was defined as a body mass index (BMI) of more than 30 kg/m2, while severe obesity was considered 35 kg/m2 or above.

More than half of the 89 COVID-19 patients requiring mechanical ventilation were obese or severely obese, and most of the remaining patients were overweight. Less than 25% of the 35 ICU patients who did not require mechanical ventilation were obese or severely obese.

Eighty-seven percent of severely obese, 75% of obese, and 60% of overweight COVID-19 ICU patients needed mechanical ventilation, versus 47% of normal-weight patients.

"Several months into the COVID-19 pandemic, the increased risk posed by this virus to people living with obesity could not be clearer," Pattou said in the release. "Our data show that the chances of increasing to more severe disease increases with BMI, to the point where almost all intensive care COVID-19 patients with severe obesity will end up on a ventilator."
Aug 31 European Association for the Study of Obesity news release

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