COVID-19 Scan for Jun 14, 2021

COVID-19 physician deaths
N95 advice during COVID-19
SARS-CoV-2 levels in kids, adults

US physician COVID deaths hit international grads harder, data show

International medical graduate physicians, or IMG physicians, make up about 25% of the practicing physicians in the United States, but they have made up 45% of COVID-related physician deaths, according to a JAMA Network Open research letter late last week.  After stratifying data by state, however, only New York showed a significant difference between the proportion of international and US medical graduate (USMG) physician deaths.

The researchers used investigations conducted by MedPage Today, MedScape, and a collaboration between The Guardian and Kaiser Health News to identify COVID-related physician deaths through Nov 23, 2020. Data showed 132 deaths in 28 states. IMG physicians made up 59 of these deaths (44.7%), 1.80 times higher than the national average (95% confidence interval [CI], 1.51 to 2.21). New York, New Jersey, and Florida accounted for 66.1% of IMG physician deaths but only 45.2% of USMG physician deaths.

Overall, the researchers note that all states except New York had statistically insignificant differences between their proportion of IMG versus USMG physician deaths. "However, the authors add, "67% (89 of 132) of physician deaths occurred in states where the proportion of practicing IMG physicians is greater than the national proportion of 25%."

Almost 60% of deceased physicians were in primary care (59.8%), which is 1.62 times higher than the national average of primary care physicians (95% CI, 1.39 to 1.84), the researchers write. Additionally, 38 deceased primary care physicians were IMGs, which is 2.90 times higher than the proportion of primary care IMG physicians in the country (95% CI, 2.13 to 3.65). USMG physicians in primary care, on the other hand, saw statistically insignificant COVID death rates compared with their proportion in the workforce (risk ratio, 1.15; 95% CI, 0.89 to 1.48).

"A possible reason for [these results] is the observation that the majority of physician deaths occurred in states with relatively larger proportions of IMGs, which were also the states with higher incidence of COVID-19 at the onset of the pandemic," write the researchers. "It is also possible that IMGs in a few states (eg, New York) had higher exposure to COVID-19 because of their practice settings; 40% of IMGs work in primary care. These findings mirror a report from the UK on the high proportion of immigrants among 18 physicians who died of COVID-19."
Jun 11 JAMA Netw Open study


Health workers should wear N95s in community surges, researchers say

Healthcare providers should wear N95 respirators when COVID-19 rates are high in the community, not just if they're dealing directly with COVID-19 patients, as recommended by the Centers for Disease Control and Prevention.

The commentary, published in Clinical Infectious Diseases late last week, outlines three reasons. First, the Harvard University researchers point to evidence that patients are most contagious just before and immediately following symptom onset as well as studies that show that asymptomatic and pre-symptomatic people account for the most secondary transmissions. If unsuspected patients are still incubating or acquire COVID-19 infection after healthcare admittance, the researchers write, they might more easily spread the disease since their contagiousness will peak while in the healthcare setting.

Second, patients with known or suspected COVID-19 are often treated in settings with stricter safety protocols (eg, negatively pressurized, ventilated rooms), and healthcare workers tend to better adhere to personal protective equipment (PPE) guidelines. The researchers write, however, that providers are generally more lax when they assume their patients are not infected with COVID-19, putting them at increased risk for infection.

And third, compared with medical masks or less protective respirators, N95s would better prevent healthcare providers from transmitting the virus from infected COVID-19 patients to non-infected patients, according to the authors.

"If N95s are appropriate to protect healthcare workers seeing patients with confirmed Covid-19 then it follows that they are also appropriate to protect healthcare workers seeing asymptomatic patients in outpatient and inpatient settings when the incidence of Covid-19 is high," the researchers write. They add that vaccinating healthcare workers and patients is "ultimately the most powerful way to reduce the risk of transmission."
Jun 11 Clin Infect Dis commentary


Kids and adults with symptoms found to have more SARS-CoV-2 viruses

SARS-CoV-2 RNA levels were significantly higher in symptomatic than asymptomatic patients, but there were no significant differences in children versus adults, according to a study in JAMA Pediatrics late last week.

The researchers looked at positive SARS-CoV-2 reverse transcription-polymerase chain reaction results from 123 children and 432 adults in King County, Washington, Mar 23 to Nov 9, 2020. Most were healthy: Seasonal allergies (7.3%) were the most frequent health condition, followed by asthma (4.1%). Of the children, 40.7% were younger than 5 years, 36.6% were between ages 5 and 11, and 22.8% were 12 to 17. The researchers add that, in this convenience-based sample, children had fewer and shorter symptoms than adults (average, 1.6 vs 4.5 symptoms; 3.8 vs 4.9 days, respectively). They were also more likely to be asymptomatic (38.2% vs 7.2%).

The team used cycle threshold (Ct) values as a proxy for viral load; the lower the Ct value, the higher the viral RNA load. After adjusting for swab type, the average Ct values for symptomatic versus asymptomatic patients showed no statistical significance when stratified by age. Overall, symptomatic individuals had lower Ct values than asymptomatic ones (adjusted for children, -3.0; 95% CI, -5.5 to -0.6; P = 0.02; versus adults, -2.9; 95% CI, -2.2 to 0.9; P = 0.01).

An editorial by Christina A. Rostad, MD; Satoshi Kamidani, MD; and Evan J. Anderson, MD; contextualize the findings within discussions of in-person schooling. The say the study "underscores the potential transmission risk of symptomatic children and the importance of isolating while symptomatic," and add, "Extracurricular activities are important in SARS-CoV-2 transmission, and measures to prevent transmission should be used."

The editorial authors advocate for COVID-19 vaccination of children, educators, and school staff, as well as multi-layered mitigation strategies to prevent transmission.
Jun 11 JAMA Pediatr study and editorial

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