News Scan for Nov 04, 2020

Efficient COVID-19 spread in children
;
Disparities in COVID and rheumatic disease
;
Predictors of COVID-19 death
;
H5N8 avian flu in Israel, Korea

Infected siblings, Hispanic ethnicity raise COVID-19 risk in kids, data show

A Duke University study yesterday in Clinical Infectious Diseases found a 77% infection rate in children who were close contacts of a COVID-19 case, providing evidence for efficient viral transmission in children. Hispanic ethnicity and having a SARS-CoV-2–infected sibling were risk factors, but asthma was associated with reduced risk.

Current epidemiologic data suggest children are less susceptible to SARS-CoV-2 infection than adults, having milder illness and lower attack and hospitalization rates. It is unclear whether these differences are due to differential exposures or age-related biological differences, and data are limited on transmission efficiency in children.

The authors conducted a prospective cohort study of 382 non-hospitalized children (< 21 years of age) in North Carolina from Apr 7 to Jul 16 with a COVID-19–positive close contact—defined as unprotected exposure within 6 feet to a confirmed case between 2 days before and 7 days after symptom onset or laboratory-confirmed infection.

The authors found that 77% (293 of 382) of children with an infected close contact were themselves positive for SARS-CoV-2, the virus that causes COVID-19. Infected children were more likely to be Hispanic (88% vs 57%, P < 0.0001), less likely to have asthma (6% vs 17%, P = 0.005), and more likely to have an infected sibling contact (49% vs. 29%, P = 0.001) than uninfected children.

The researchers identified age-related variability in symptoms, with children ages 6 to 13 years frequently asymptomatic (39%), and presenting with respiratory symptoms less often than younger children (29% vs 48%, P = 0.01) or adolescents 14 years and older (29% vs 60%, P < 0.0001). Adolescents had more prolonged illness than younger children (median duration 7 days vs 4, P = 0.01), but no age-related differences in viral load were observed between symptomatic and asymptomatic patients.

The increased risk for Hispanic children is consistent with national data showing that 42% of 161,387 school-aged children who tested positive for SARS-CoV-2 were of Hispanic ethnicity.

"The factors underlying the racial and ethnic disparities in SARS-CoV-2 infection rates and outcomes will require further study, though they are likely linked to structural inequities, including higher prevalence of essential workers, dense living conditions, and socioeconomic factors," the authors wrote.
Nov 3 Clin Infect Dis study

 

Racial disparities found in COVID-19/rheumatic disease outcomes

A look at 1,324 patients with both COVID-19 and rheumatic disease showed that minority patients were up to 2.74 times more likely to be hospitalized as white patients, according to a study yesterday in Arthritis and Rheumatology.

Of the study's population, 51% of black patients, 43% of Asian patients, 37% of Latino patients, 35% of mixed/other race patients, and 29% of white patients were hospitalized. Translated into odds ratios, that means, compared with white patients, black patients were 2.74 times more likely to be hospitalized, Asians 2.69 times more likely, Latinos 1.71 times more likely, and other/mixed races 2.59 times more likely.

Although the researchers found more racial/ethnic disparities when looking at ventilation needs and mortality rates—including the fact that Latinos were 3.25 times more likely to need ventilator support than white patients—those findings were not statistically significant.

Senior author Jinoos Yazdany, MD, MPH, said in a press release from Wiley, which publishes the journal, "These data suggest that the current pandemic will further exacerbate the health disparities that already exist for many patients with rheumatic disease," which often puts patients at greater risk for severe infection, regardless of the pathogen.

In total, 36% of all patients were hospitalized (26% of who required mechanical ventilation) and 6% died. Data were pulled from the COVID-19 Global Rheumatology Alliance physician registry from Mar 24 through Aug 26. Outcomes were measured to control for sex, age, and characteristics and comorbidities including hypertension/cardiovascular disease, lung disease, and diabetes. The researchers say limitations of the study include potential self-reporting biases, missing information, and racial misclassifications.
Nov 3 Arthritis Rheum
study
Nov 4 Wiley
press release

 

Review shows age, sex, underlying conditions predict COVID-19 mortality

A PLOS One study yesterday showed that age, sex, and health conditions are robust predictors of COVID-19 mortality in hospitalized patients, highlighting the need to stratify epidemiologic data for more accurate prognostication of clinical outcomes.

Data showing consistent associations between age, male sex, comorbidities and worse COVID-19 prognosis have so far failed to capture the predictive value of other factors, such as smoking, clinical symptoms, or laboratory parameters and how these may vary between populations with different sociodemographic and epidemiologic profiles. The meta-analysis used data from 60 hospital studies in 13 countries from Dec 24, 2019, to May 17, including 51,225 COVID-19 patients, of whom 12,458 (24.3%) died.

Higher in-hospital mortality risk was found for all patients with shortness of breath (pooled odds ratio [OR], 2.5), a smoking habit (OR, 1.6), and several comorbidities, including pulmonary, cardiovascular, cerebrovascular, kidney and liver diseases; hypertension; diabetes; and malignant cancers. The findings, though, reveal substantial age-related variability in the predictive value of clinical conditions for COVID-19 mortality.  

Increased mortality risks due to shortness of breath and smoking were higher in studies with patients 60 years or younger than in studies with older adults (OR 4.3 vs 1.6 and 2.8 vs 1.2, respectively), suggesting the need for specific attention to younger patients who have pulmonary impairment. The most important mortality predictors in older patients were liver function–related indicators, urea nitrogen, and inflammatory factors, pointing to the potential to identify elderly patients with worse prognosis using elevated biochemical markers.

Previous studies have found associations between obesity and increased risk of severe outcomes, but the meta-analysis found increased mortality in obese patients only in studies with fewer chronic or critically ill patients. The researchers suggest that body mass index is a more reliable prognostic factor in patients with fewer comorbidities.

The authors conclude, "Epidemiological data stratified by age, sex, and baseline chronic conditions are required to allow for more accurate decisions considering predictors of COVID-mortality."
Nov 3 PLOS One study

 

More H5N8 avian flu outbreaks noted in poultry, wild birds in Israel, Korea

Veterinary officials in Israel reported another highly pathogenic H5N8 avian flu outbreak in poultry, part of a pattern that began in the middle of October, according to a notification today from the World Organization for Animal Health (OIE).

The event began on Nov 1 at a broiler farm in Hazafon, a region where other recent outbreaks occurred. The virus killed 1,420 of 133,000 susceptible birds, and all surviving ones were culled.

Elsewhere, South Korea today reported two H5N8 outbreaks in wild birds, one in South Chungcheong province and the other in Gyeonggi province, both in the west. The events began on Oct 21 and Oct 24 affecting mandarin ducks, with the virus confirmed in wild bird feces as part of avian flu surveillance.

The outbreak in Gyeonggi province occurred in an area where nearly 3,000 migratory birds of 38 different species were present.
Nov 4 OIE report on H5N8 in Israel
Nov 4 OIE report on
H5N8 in South Korea

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