US wildfires associated with excess COVID-19
US wildfires were associated with excess COVID-19 cases and deaths from mid-August to mid-October 2020, according to a study published late last week in Science Advances.
The researchers looked at 92 counties in California, Oregon, and Washington—the states most affected by 2020 US wildfires—creating a distributed lag model from synthesized county- and daily-level data on fine particulate air pollution, wildfire days, and COVID-19 cases and deaths. After accounting for weather, population size, and physical distancing data, they say that an average daily increase of 10 micrograms of particulates per cubic meters each day for 28 days was tied with an 11.7% increase in COVID-19 cases and an 8.4% increase in deaths.
In absolute numbers, the data projected that US wildfires were associated with 19,700 more cases and 750 more deaths from Aug 15 to Oct 15, 2020.
During this peak time of wildfire activity, daily levels of fine particulate air pollution were significantly higher during wildfire than non-wildfire days (median, 31.2 micrograms per cubic meter vs 6.4). Some days had much higher concentrations, they noted, such as the Creek Fire in Mono County, California, which had fine particulate air pollution reaching over 500 micrograms per cubic meter for 4 consecutive days.
Sonoma, California, and Whitman, Washington, saw the largest change in COVID-19 cases, with a 65.3% and 71.6% increase, respectively, while Calaveras, California, and San Bernardino, California, saw the largest rise in deaths, with a 52.8% and 65.9% increase, respectively.
"Climate change will likely bring warmer and drier conditions to the West, providing more fuel for fires to consume and further enhancing fire activity. This study provides policymakers with key information regarding how the effects of one global crisis—climate change—can have cascading effects on concurrent global crises—in this case, the COVID-19 pandemic," said senior author Francesca Dominici, PhD, in a Harvard T.H. Chan School of Public Health press release.
Aug 13 Sci Adv study
Aug 13 Harvard press release
Most COVID-associated ARDS patients have symptoms 8 months later
Four out of five patients with COVID-19–associated acute respiratory distress syndrome (ARDS) had lingering symptoms 8 months later, according to a study published late last week in the Journal of Infection.
The researchers looked at 113 patients with COVID-associated ARDS who were admitted to a Barcelona, Spain, hospital from Feb 28 to Apr 15, 2020 (median age, 64 years; 70% male).
At a median of 240 days (8 months) after the initial COVID-19 diagnosis, 81% still had persistent symptoms, most commonly shortness of breath (55%), joint and muscle pain (50%), weakness/lack of energy (45.5%), memory loss (42.5%), and lack of concentration (40.7%). Additionally, 57% had not returned to baseline physical health, including an inability to complete 80% or more of their theoretical 6-minute walking distance (53.5%). Almost all (93%) developed a new mental health condition, including moderate to severe post-traumatic stress disorder (49.5%), depression (36%), and anxiety at or above the 75th percentile (34%).
Overall, average SF-36 Health Assessment scores were worse than in the general population. Age was associated with a better prognosis, while being female, not White, or having a Charlson comorbidity index score greater than 2 was associated with a worse mental health component summary score. Being female or having chronic obstructive pulmonary disease was associated with a worse physical component summary score.
A subanalysis suggested that, while Latino patients in the cohort were younger (52 vs 67 years) and had lower rates of high blood pressure and dyslipidemia, they had worse outcomes at 8 months, including mental composite score on the SF-36, 6-minute walking time results, and exercise capacity.
"COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and [health-related quality of life]. Strategies addressed to prevent these sequelae are needed," the researchers conclude.
Aug 13 J Infect study
COVID-19 saliva testing appears less sensitive each week post-infection
COVID-19 diagnosis via saliva samples was most sensitive during the first week of infection and was never higher than 60% in asymptomatic people, according to a research letter published late last week in JAMA.
The researchers looked at nasopharyngeal and saliva samples collected every 3 to 7 days up to 4 weeks from people exposed to household members who had COVID-19. Of the 889 paired samples from 404 participants, 58.9% of nasopharyngeal swabs were positive for COVID-19, whereas 35.7% of saliva samples were. Both types of samples in the pair were positive 29.0% of the time.
The peak of saliva sensitivity was 71.2%, during the first week of COVID-19 infection (95% confidence interval [CI], 62.6% to 78.8%). The researchers note that those who were symptomatic during their first week of infection had an 88.2% saliva sensitivity, while those who were asymptomatic had 58.2%.
Overall, the odds ratio for saliva detection was 0.94 compared with the previous day (95% CI, 0.91 to 0.96). Symptomatic people had a 2.8-fold higher likelihood of having saliva detection than those who were asymptomatic, and those with high nasopharyngeal viral loads had a 5.2-fold higher likelihood than those with low viral loads.
"Saliva was sensitive for detecting SARS-CoV-2 in symptomatic individuals during initial weeks of infection, but sensitivity in asymptomatic SARS-CoV-2 carriers was less than 60% at all time points," the researchers write. "This study suggests saliva-based RT-PCR should not be used for asymptomatic COVID-19 screening."
All participants were recruited from the Los Angeles area from Jun 17, 2020, to Feb 15, 2021.
Aug 13 JAMA study