COVID mortality in US ICUs fell during first wave of pandemic
Twenty-eight–day in-hospital mortality rates decreased from 29.9% to 19.7% for adult COVID-19 intensive care unit (ICU) patients over the first wave of the pandemic, according to an Annals of Internal Medicine study published yesterday.
The study's retrospective cohort consisted of 468 critically ill coronavirus patients at five hospitals in the University of Pennsylvania Health System from Mar 1 to May 11, 2020, and rate changes over time were measured in 15-day blocks.
Overall, the 28-day in-hospital all-cause mortality rate was 29.9%, and 10.8% of patients required hospital readmission for any reason within 30 days. Patients' median age was 65 years, and 71.8% had a high comorbidity burden. More than half (52.8%) were black.
While 68.2% of patients received mechanical ventilation, procedure rates decreased from 85.7% of those in the first time block to 54.2% in the last, in part due to updated guidelines. Other treatment methods included high-flow nasal cannula (HFNC) (51.5%), vasopressors (25.9%), and noninvasive ventilation (22.9%).
"Our results support the notion that outcomes improved during the pandemic independent of patient-level factors," the researchers write. "One potential mechanism for improved mortality over time in the face of unchanging acuity was better adherence to evidence-based standard-of-care therapies for critical illness—such as HFNC to avert intubation, as well as prone positioning—which initially proved challenging in the setting of isolation precautions, including personal protective equipment requirements for bedside clinicians."
The researchers add that the low readmission rate for patients may have been affected by increased use of acute rehabilitation and home health services, additional caretaking support at home due to the pandemic, and "a new phenotype of sepsis survivors who may have fewer subsequent infections." However, they add, more research is needed in this area, particularly in regard to the latter reason, as 10.2% of discharged patients had severe and persistent lymphopenia.
Jan 19 Ann Intern Med study
Most US adults report high motivation for using, relaying COVID self-tests
Motivation to use or distribute self-test COVID-19 kits among US adults is high, according to survey results published in JAMA Network Open today.
Of 586 survey respondents, 90.1% said they would be motivated to distribute a self-test kit to contacts, 86.1% said they would take a kit given to them by a contact who may be positive, and 82.8% said they would be motivated to order a free kit online for themselves if they thought they were exposed to COVID-19.
The researchers also looked at how sociodemographic factors could be associated with motivation. According to the survey results, people were more likely to indicate higher motivation across all three topics if they had above-average income (adjusted odds ratio [aOR] vs below-average income, 3.04 to 4.7, with the largest 95% confidence interval [CI] ranging from 2.25 to 10.10).
Respondents who completed college were 3.43 times more likely than those with a high school education or less to distribute a self-test kit (95% CI, 1.12 to 10.50), while those of Hispanic ethnicity were 2.36 times more likely than white respondents to take a self-test kit after receiving it (95% CI, 1.25 to 4.44) and 1.93 times more likely to order one for themselves (95% CI, 1.07 to 3.48).
Median respondent age was 35 years.
While motivation is necessary for voluntary behavior, the researchers note that no behavioral outcomes were assessed and that the survey's self-reporting method may have increased bias.
"Nonetheless, measures of motivation have been shown to more accurately predict health behavior than alternative variables," the authors wrote. "Future research may help determine whether COVID-19 self-testing and secondary distribution of self-test kits are associated with increased testing coverage."
Jan 20 JAMA Netw Open study
Iraq, Sweden, and France report more avian flu in poultry
Iraq today became the latest country to report highly pathogenic H5N8 avian flu in poultry, and Sweden reported more outbreaks involving H5N8 and H5N5, according to the latest notifications from the World Organization for Animal Health (OIE).
Iraq's outbreak began on Jan 21 at a commercial farm in the city of Samarra in Saladin governorate in the central part of the country. The virus killed 63,700 of 68,000 susceptible birds, and the event marks Iraq's first outbreak since May 2020. So far, the source of the virus isn't known. Earlier this month, neighboring Iran reported an H5N8 outbreak in poultry, the first appearance of the virus in nearly a year.
Sweden reported an H5N8 outbreak at a turkey farm in Skane County in the far south that began on Jan 13, killing 750 of 2,350 birds at the facility. Also, the country reported an H5N5 outbreak at a layer farm in Kalmar County in the south, which began on Jan 17 and killed 2,200 of 510,000 birds.
Jan 20 OIE report on H5N8 in Iraq
Jan 18 OIE report on H5N8 in Sweden
Jan 20 OIE report on H5N5 in Sweden
In low-pathogenic virus outbreak developments, France reported two outbreaks involving H5N3 at duck farms in Gers department in the country's southwest. The events began on Jan 9 and Jan 13, and, taken together, there were 1,144 susceptible birds, which were culled to curb the spread of the virus, which was found during routine surveillance before slaughter. The outbreaks are France's first involving the strain since December 2019.
Jan 19 OIE report on low-path H5N3 in France