News Scan for Sep 18, 2020

COVID-19 hospitalization factors
SARS-CoV-2 in wastewater
UK antibiotic resistance response
New polio cases in 6 nations

Certain underlying conditions stand out as COVID-19 hospitalization risk factors

Increased age, male sex, non-Hispanic black ethnicity, and certain underlying health conditions are associated with a greater risk of hospitalization from COVID-19, according to an analysis of data from more than 5,000 hospitalized adults. A group based at the Centers for Disease Control and Prevention (CDC) reported its findings today in Clinical Infectious Diseases.

To sift out the main risk factors for COVID-19 hospitalization, the team used data from a multistate COVID-19 surveillance system and compared it with that from one of the CDC's mainstay health condition surveys of adults. The study period ran from Mar 1 to Jun 23 and included 5,416 people.

Of the underlying conditions that put people at high risk, the ones with the greatest magnitude were severe obesity, chronic kidney disease, diabetes, obesity, and hypertension. Each was independently association with triple the risk or more of hospitalization. And the magnitude of risk was lower for coronary artery disease, stroke, asthma, and chronic obstructive pulmonary disease (COPD) than the other conditions they assessed.

Regarding age, the magnitude of risk was greatest for people age 65 and older. Men were 30% more likely to be hospitalized, which the authors said might be related to greater exposure, delayed care seeking, or biological factors. And the four-times-higher hospitalization risk they saw in blacks held true, even after they adjusted for underlying health conditions, which they said could be related to increased exposure or other factors such as less access to healthcare.

The authos said the results they found will help clinicians flag high-risk patients for closer monitoring and management.
Sep 18 Clin Infect Dis abstract


Study finds sewage surveillance may help predict community COVID

Analyzing wastewater may give advance notice of COVID-19 in communities before positive tests are reported, according to a study today in Nature Biotechnology that reveals SARS-CoV-2 detection in sewage in New Haven, Connecticut.

Yale University researchers conducted a 10-week analysis of "primary sludge"—the solids that settle out during wastewater treatment—in the New Haven metro area. They collected daily samples from Mar 19 through Jun 1 and compared SARS-CoV-2 RNA concentrations in the sludge to publicly available infection data. They analyzed the numbers and percentages of positive SARS-CoV-2 tests by specimen collection date, the numbers of positive SARS-CoV-2 tests in the community by reporting date, and COVID-19 hospital admissions.

The authors found that viral RNA concentrations in sewage sludge were up to 2 days ahead of findings from specimens collected from people. They also found that the sludge data were 1 to 4 days ahead of hospital admissions and 6 to 8 days ahead of reported positive tests, which was likely caused by delays in reporting of test results.

Because sludge and epidemiologic data are both susceptible to variability, the authors did not correlate the level of SARS-CoV-2 RNA in sludge and the number of community COVID-19 cases, but they write, "Our data show the utility of viral RNA monitoring in municipal wastewater for SARS-CoV-2 infection surveillance at a population-wide level. In communities facing a delay between specimen collection and the reporting of test results, immediate wastewater results can provide considerable advance notice of infection dynamics."
Sep 18 Nat Biotech abstract


Report highlights ideas to improve UK government's AMR response

A report today from a British think tank says critical gaps remain in the United Kingdom's efforts to address antimicrobial resistance (AMR), and it calls for more focus on vaccines, diagnostic, and public awareness.

While the acknowledging that the UK government has been at the forefront of efforts to battle AMR, highlighted by its recent adoption of a novel reimbursement model to accelerate investment in antibiotic development, the report from Reform argues that a multifaceted approach is needed to build on that momentum and ensure that commitments translate into concrete action. The group suggests that the government should harness the lessons learned from the COVID-19 pandemic as it responds to the growing threat of drug-resistant pathogens.

"As attention turns to building back our health systems and economies from COVID-19, we must also build our resilience to tackle AMR," Dame Sally Davies, UK special envoy on AMR, writes in the foreword. "Without sufficient and timely action worldwide, drug resistance will have deeper and even farther-reaching consequences for all countries' health systems and the world economy than COVID-19 is having."

The report lays out seven key ideas to bolster the government's AMR response. These include greater focus on the role of vaccines and point-of-care diagnostics in combating AMR, closing gaps in clinical care, enhanced surveillance of AMR and antibiotic prescribing, and the creation of an awareness and education campaign that highlights the experiences of people living with drug-resistant infections.

It also calls for the creation of a national fund to pilot, evaluate, and develop community engagement approaches to tackle AMR.
Sep 18 Reform news release and full report


Six countries report more polio cases

Six countries—Afghanistan, Pakistan, and four African nations—reported more polio cases this week, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

Afghanistan reported two new wild poliovirus type 1 (WPV1) cases, plus nine more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. The WPV1 cases are in Khost and Paktika provinces, raising the total for the year to 46. The cVDPV2 cases were in seven difference provinces, lifting the year's total to 78.

Pakistan reported 2 new WPV1 cases, one in Balochistan province and the other in Sindh province, putting the 2020 total at 70. It also reported 7 more cVDPV2 cases from Punjab and Sindh provinces, making 59 so far for the year.

In Africa, the Democratic Republic of the Congo (DRC) reported 9 more cVDPV2 cases in three different provinces, including 7 from Equateur province, where an Ebola outbreak is under way. The country has now reported 50 such cases this year. Somalia reported one more cVDPV2 case, which involves a patient from Banadir district, lifting its total to two for the year.

Meanwhile, Sudan reported 1 more cVDPV2 case, in a patient from Kassala province, raising the country's total to 22 so far. And the Central African Republic reported one more case, which affects a patient from Region Sanitaire 3 and is the country's second case in 2020.
Sep 17 GPEI weekly update

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