News Scan for Sep 14, 2020

COVID-19 death counts
Marriage and pandemic well-being
CWD expansion in Norway
Three more Ebola cases
H5N8 avian flu in Russia

Experts: Using death certificates alone undercounts COVID-19 fatalities

A group of experts from Stanford and Harvard universities, as well as the Dana-Farber Cancer Institute, propose a new model for measuring direct, indirect, and excess deaths from COVID-19 in the United States, and they say relying solely on death certificates likely undercounts the true death toll COVID-19 has taken in the United States. Their proposal is published in the Annals of Internal Medicine.

The authors write that, before a standardized case definition was published in early April and testing rates were very low, practitioners likely did not attribute all deaths in patients infected with SARS-CoV-2 to COVID-19. Also, COVID-19 deaths are coded manually, resulting in reporting delays and frequent updates to the official count, with substantial variation across states.

The authors suggest that state and federal public health officials adopt the Centers for Disease Control and Prevention's (CDC's) "but for" principle, commonly used when assessing the death toll of natural disasters: "But for the [pandemic], would the person have died when he/she did?"

To estimate the direct and indirect death rate, the authors then suggest counting all deaths from pneumonia, influenza-like illness, and COVID-19, then subtracting the expected seasonal number of cases of pneumonia and influenza computed from trends in the previous 5 years per the CDC.

"Correct attribution of direct and indirect deaths and estimation of excess mortality are complementary goals that are critical to our understanding of the pandemic and its effect on human life," the authors write.
Sep 11 Ann Intern Med


Good personal relationships may protect against COVID-19 lockdown stress

People with high-quality marriages reported greater mental health and well-being than singles or those with a low-quality relationship during COVID-19 lockdowns in Austria, a study published late last week in PLOS One found.

Researchers at Danube University Krems conducted an online survey of a representative 1,005-person sample 4 weeks after lockdowns were instituted in Austria on Mar 16. The 543 respondents with solid marriages scored better on all mental health scales for depression, anxiety, stress, well-being, sleep quality, and quality of life than the 272 singles and the 190 with shaky marriages. Singles scored better than those with weak relationships.

Depressive and anxiety scores varied by strength of respondent relationship, from 13% to 35% for depression and 12% to 32% for anxiety. The mean score on the Quality of Marriage Index was 36.95 among the 733 respondents in a relationship. Scores above 34 are considered to indicate strong relationships. The mean score in those with poor relationships was 24.15, while it was 41.43 in those with good marriages.

Those with weak relationships were 3.5 more likely than those with strong relationships to generate scores indicating depression on the Patient Health Questionnaire-9. They were also 3.4 times more likely to have high scores on the Generalized Anxiety Disorder-7 scale and 2.0 times more likely to demonstrate impaired sleep quality on the Insomnia Severity Index.

The authors noted that their findings back those from previous studies that showed that solid marriages are protective against depression and anxiety and that no relationship is better for mental health than a weak one.

"Relationship per se was not associated with better mental health, but the quality of the relationship was essential," the authors wrote. "It underlines the fact that not only but especially in times like this, the choice of partner should be carefully considered."
Sep 11 PLOS One study


Norway reports chronic wasting disease in wild reindeer in new area

Norwegian health officials have confirmed a wild reindeer hunted in central southern Norway earlier this month has tested positive for chronic wasting disease (CWD), a deadly prion disease found in cervids like deer and elk.

This is the first time a reindeer in that part of Norway has been found to be CWD-positive and indicates disease spread. Material from a lymph node tested positive, while brain tissue was found negative.

The wild reindeer has classical CWD, which is contagious to other cervids, as opposed to atypical CWD, which can be seen in older animals. The animal was hunted in Hardangervidda, a southern mountain plateau region home to between 8,000 and 10,000 wild reindeer.

"Since 2016, more than 100,000 cervids have been tested for CWD in Norway. From Hardangervidda, 3520 wild reindeer have been tested and found to be CWD negative. Of these, 518 have been tested already in 2020 without positive findings," the Norwegian Veterinary Institute said in a press release.
Sep 11 Norwegian Veterinary Institute press release


With 3 new infections, DRC Ebola outbreak rises to 121 cases, 48 deaths

Three more Ebola cases were reported in the Democratic Republic of the Congo (DRC) Equateur province outbreak, including one in a newly affected health area, the United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) said recently in its latest situation update.

The newly affected area is Bontole, bringing the number of health areas that have reported cases to 39, though just 10 currently have active cases. he 3 new cases, reported on Sep 10, bring the outbreak total to 121. No new deaths were reported, keeping the fatality count at 48.

OCHA said free health care is an essential tool for battling the outbreak, and though doctor's visits are free, patients are still expected to pay for treatment, forcing some to self-medicate or seek care from traditional healers, raising the risk of virus spread. It also said population movements are worrying in Equateur province, and stepped efforts are underway to better track the movement of contacts and understand the reasons for population displacements in the area.
Sep 12 UN OCHA update


H5N8 avian flu strikes more poultry in Russia

Russia today reported eight highly pathogenic H5N8 avian flu outbreaks in poultry in two neighboring western Siberia oblasts that had recently reported a spate of high-path H5 outbreaks, according to a notification from the World Organization for Animal Health (OIE).

All of the outbreaks occurred in backyard birds, four in Tyumen oblast and four in Omsk oblast. The events began between Sep 1 and Sep 7, killing 483 of 1,560 susceptible birds. Culling is under way.

So far, the source of the virus isn't known. H5 was recently detected in waterfowl found dead in Tyumen oblast. In In early August, Russia reported two H5N8 outbreaks in village and backyard birds in Chelyabinsk oblast, west of the two latest locations.

In a recent risk assessment on the avian flu situation in Russia, the UK Department for Environment, Food, and Rural Affairs (DEFRA) noted that large outbreaks in Europe in 2016 involving H5N8 were heralded by summer outbreaks in Russia, and it urged poultry owners to remain vigilant.
Sep 14 OIE report on H5N8 in Russia
Sep 4 DEFRA report

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