News Scan for May 05, 2021

COVID-19 recurrence
Medicaid expansion during COVID
Guinea's fragile Ebola situation
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Study says COVID-19 recurrence could be less than 0.1%

Less than 0.1% of all COVID-positive patients in the Intermountain Healthcare system had probable or possible recurrence of SARS-CoV-2 infection, according to a PLOS One study yesterday.

The full cohort of 23,176 COVID-19 patients was pared down to 1,301 patients who had at least one additional SARS-CoV-2 test 60 or more days after the initial diagnosis. Almost 10% (122) had a positive test, of which 114 had sufficient data for recurrence evaluation (median test interval, 85.5 days).

Using both clinical and cycle threshold (Ct) values, the researchers found that four patients had probable and six had possible COVID-19 recurrence. Taken together, that's 4.3 people with probable or possible COVID recurrence per 10,000 patients (95% confidence interval [CI], 2.1 to 7.9), or 0.04%. Of the four patients with probable recurrent infections, all had symptoms and three required a higher level of medical care than with the initial illness.

The researchers note that using the adjudication standard adapted from Abu Raddard et al (Clinical Infectious Diseases, 2020) resulted in a probable or possible COVID-19 recurrence in 31.9 per 10,000 patients (95% CI, 25.1 to 40.1). Probable and possible recurrence numbers also increased to 44 COVID-19 patients if patients were assessed via purely clinical means.

"Neither clinical criteria nor Ct assessment alone appeared sufficient to accurately categorize likelihood of COVID-19 recurrence," the researchers write. "Although reinfection seems more likely in these immunocompetent patients, reactivation is also possible."
May 4 PLOS One study


Medicaid enrollment increased 5 million during pandemic

About 5 million more Americans enrolled in Medicaid by September 2020 compared with January 2020, a research letter today in JAMA Network Open reports. The data showed that enrollment was flat until March 2020, where expansion and nonexpansion states eventually increased enrollment by 1.4 and 1.6 percentage points, respectively. 

The researchers found that enrollment increases were associated with Medicaid expansion states (0.68 percentage point, adjusted; 95% CI, 0.07 to 1.29, P = 0.03) but not with steps to simplify the application process.

What was surprising, the researchers say, was that enrollment growth was lower in states with unemployment increases (-0.20 percentage point, adjusted; 95% CI, -0.34 to -0.06). The results were similar when the researchers were looking at September 2019 to September 2020 data.

"This may indicate that Medicaid growth is associated with factors other than job loss," the researchers write, "including reduced work hours making more people eligible, greater focus on health care during the pandemic, and the maintenance of effort requirement passed by Congress in March 2020, which offered states more funding in exchange for a requirement that they not disenroll anyone from Medicaid during the public health emergency."
May 5 JAMA Netw Open study


Guinea's Ebola outbreak still fragile, as country probes suspected cases

Though Guinea hasn't reported any confirmed Ebola cases in more than 3 weeks, its situation remains fragile, with 19 new suspected cases and 3 currently hospitalized, the World Health Organization (WHO) African regional office said in its latest weekly outbreaks and health emergencies update.

Three patients have been sampled, and 16 have refused testing. The outbreak centered in N'Zerekore prefecture currently remains at 23 cases, 16 of them confirmed, and 12 deaths. So far, 8,638 people have been vaccinated, and a "sweep vaccination" approach is being used in the remaining hot spots to prevent possible transmission chains.

The WHO warned that Guinea's situation still isn't stable, with some contacts lost to follow up and one confirmed case remaining in the community, which raises the risk of further spread. It added that the appearance of 19 new suspected cases is also concerning. The response plan is only 17% funded, a gap that needs to be urgently filled, the WHO said.

Guinea's outbreak began in early February. It marked the country's first since West Africa's massive outbreak of 2014-2016, and appeared in the same area where the earlier outbreak began. An Ebola outbreak in the Democratic Republic of the Congo was declared over on May 1.
May 4 WHO African regional office weekly report

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