News Scan for Oct 01, 2020

COVID and loss of taste or smell
Psychiatric diagnosis and COVID-19
DRC Ebola deaths rise
HPV vaccine and cervical cancer
Monkeypox in DRC
Avian flu in Vietnam

Loss of taste or smell accurately predicts COVID-19, study finds

A study shows four out of five people with recent loss of smell and/or taste tested positive for COVID-19 antibodies, and 39.8% of those did not have a cough or fever.

COVID-19 is known to cause a loss of taste and/or smell, but the SARS-CoV-2 antibody status of people experiencing these symptoms was previously unknown. A PLOS Medicine study today sought to explore the significance of loss of taste/smell as a predictor of COVID status.

Researchers enrolled 590 people during the peak of the COVID-19 outbreak in London who self-reported a loss of taste/smell via telemedicine consultation in the previous month. Of the participants with loss of smell and/or taste, 76.6% were seropositive (carried antibodies for SARS-CoV-2), with participants experiencing smell loss alone nearly three times as likely to be seropositive than participants experiencing taste loss alone (odds ratio 2.86; 95% confidence interval, 1.27 to 6.36; P < 0.001), suggesting that loss of smell is a highly specific symptom of COVID-19.

The authors conclude, "In a community-based population, the vast majority of participants with new onset loss of smell were seropositive for SARS-CoV-2 antibodies. Acute loss of sense of smell needs to be considered globally as a criterion for self-isolation, testing, and contact tracing in order to contain the spread of COVID-19."

Significantly, 39.8% of the COVID-19–positive participants had neither cough nor fever. An over-reliance on cough and fever as the main symptoms of COVID-19 may be misguided, and the researchers advocate for urgent recognition of loss of smell as a key symptom of COVID-19. The authors wrote, "Counterintuitively, people with minor symptoms, such as isolated smell loss, who remain systemically well pose the highest public health threat."

"Our findings suggest that people who notice a loss in their ability to smell every day house-hold odors such as garlic, coffee, and perfumes should self-isolate and seek PCR [polymerase chain reaction] testing," senior author Rachel Batterham, PhD, MSc, of the University College London, said in a PLOS press release. "Loss of sense of smell needs to be recognized globally by policy makers as a key symptom of COVID-19."
Oct 1 PLOS Med
Oct 1 PLOS press release


Higher risk of COVID-19 death found in psychiatric patients

In the first known study of COVID-19 psychiatric patients and mortality, a JAMA Network Open study yesterday showed that patients with diagnosed psychiatric disorders have significantly higher risk of death.

The cohort study of 1,685 patients at Yale New Haven Health System, a five-hospital system in the Northeast, studied patient mortality data from Feb 15 through May 27 using a Kaplan-Meier statistical analysis to compare survival rates. The study identified 473 patients (28%) previously diagnosed as having psychiatric disorders.

The overall mortality rate for all patients was 18.9%, with 318 hospital deaths. COVID-19–positive patients with psychiatric diagnoses had a significantly higher risk of hospital death, with a 4-week mortality rate of 44.8%, versus 31.5% for non-psychiatric patients.

Patients with psychiatric diagnoses tended to be older, female, white, non-Hispanic, with other medical comorbidities. After adjusting for demographic characteristics, comorbidities, and hospital location, psychiatric patients had a 1.5 times higher risk of death (hazard ratio, 1.5; 95% confidence interval, 1.1 to 1.9; P = 0.003).

"The finding is similar to previous findings: individuals with concurrent psychiatric and medical diagnoses had poorer outcomes and higher mortality," the study authors wrote.

The authors noted that psychiatric disorders are associated with shortened life expectancy in general—by as much as 10 years—but it is unclear why psychiatric illness predisposes patients to COVID-19–related mortality. There may be an association of psychiatric disorders with inflammatory processes, immune function, or an increased risk from psychotropic medications, the authors suggest.
Sep 30 JAMA Netw Open study


Three more fatal Ebola cases reported in DRC outbreak; 128 cases, 53 fatal

Three retrospective probable Ebola deaths from July have been added to the total in the Democratic Republic of the Congo (DRC) Equateur province, the United Nations Office for the Coordination of Human Affairs (UN OCHA) said in a statement today.

The development lifts the outbreak total to 128 cases and 53 deaths. The three additional probable cases are all in Bolomba health zone, including one in Boyenge health area, which had not previously reported any confirmed or probable cases. UN OCHA also said response teams and medical supplies arrived in Lusengo health zone, the newest affected area in the outbreak.

The outbreak in Equateur province was first detected in June in the same area where an Ebola outbreak in 2018 sickened 54 people, 33 of them fatally.
Oct 1 UN OCHA report


HPV vaccine shown to help prevent cervical cancer

While human papillomavirus (HPV) vaccinations have been linked to lower cervical cancer rates for years, researchers from the Karolinska Institutet in Solna, Sweden, say their study is the first population study looking at not only pre-cancer indicators but also actual, invasive cervical cancer.

The results, published today in the New England Journal of Medicine, suggest a rate of 47 cases of cervical cancer per 100,000 vaccinated women versus 94 cases per 100,000 in unvaccinated women, with an overall risk reduction of 63%—88% in those vaccinated earlier in life.

From 2006 through 2017, the researchers followed almost 1.7 million Swedish girls and women between the ages of 10 and 30, of whom more than 500,000 were vaccinated against HPV. After adjusting for all covariates such as age, residential area, follow-up time, and parental factors, including income and disease history, the study found the incidence rate ratio was 0.12 in women who had been vaccinated before age 17 and 0.47 in those who had been vaccinated between age 17 and 30.

Overall incident rate ratio was 0.37, which translated to a 63% lower risk of cervical cancer—but among those who were vaccinated before age 17, the incidence rate ratio noted above translates to an 88% lower risk of cervical cancer.

"Girls vaccinated at a young age seem to be more protected, probably because they are less likely to have been exposed to HPV infection and given that HPV vaccination has no therapeutic effect against a pre-existing infection," senior author Pär Sparén, PhD, said in a Karolinska press release.
Oct 1 N Engl J Med study

Sep 30 Karolinska Institutet news release


WHO sounds alarm about monkeypox outbreak in DRC

The World Health Organization (WHO) today detailed a monkeypox outbreak in the DRC, with 4,594 suspected cases reported so far this year, 171 of them fatal, with illnesses spread across 17 of the country's 26 provinces.

Monkeypox is endemic in the DRC, but the number reported so far this year has already outpaced the country's totals for this time of year for 2019 and 2018. Tests confirmed monkeypox in 39 of 80 samples sent to the lab at Institut National de Recherche Biomédicale (INRB).

Hardest-hit provinces include Sankuru, Mai-Ndombe, and Equateur, with the latter province also battling and Ebola outbreak and all of the country grappling with the COVID-19 pandemic. The WHO said one of the areas it's most concerned about is Inongo health district in Mai-Ndombe province, where a fourth of the territory is affected.

More than half (58%) of the suspected cases involve people over age 5, but the case-fatality rate for children younger than 5 is 4.2%, compared with 3.4% in the older age-group.

The WHO warned that many of the provinces are juggling other disease outbreaks with stretched financial resources, along with armed conflict and violence. And it notes that proximity to forests puts many residents, including hunters, in contact with animal reservoirs. It said it is gathering more information about cases and lab capacity and that the support of partners such as the US Centers for Disease Control and Prevention (CDC) is critical.
Oct 1 WHO statement


Vietnam detects more H5N1 and H5N6 avian flu in poultry

Vietnam today reported more highly pathogenic avian flu outbreaks in poultry, one from H5N1 and three from H5N6, according to the latest notifications from the World Organization for Animal Health (OIE).

The H5N1 outbreak struck village birds in Ca Mau province in the far south of the country. It began on Sep 3 and killed 63 of 243 birds. The source of the virus isn't known, and culling and vaccination were among the response steps. Vietnam reported its last H5N1 outbreak on Sep 11 in village birds in Tra Vinh province, also in the south.

Meanwhile, three more H5N6 outbreaks were detected in village birds in two different provinces, two in Nghe An in the north and one in Kon Tum in the central part of the country. The outbreaks began from Aug 26 to Sep 24, and, taken together, the virus killed 377 of 1,422 birds. The survivors were culled, and vaccination was ordered for birds in the area. Vietnam is among the Asian countries that have reported sporadic H5N6 outbreaks, with the last one reported on Sep 11.
Oct 1 OIE report on H5N1 in Vietnam
Oct 1 OIE report on H5N6 in Vietnam

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