Medicare patient care-seeking for severe mental illness down in COVID-19
Significantly fewer adult Medicare beneficiaries with schizophrenia or bipolar 1 disorders had mental health-related outpatient, emergency department (ED), and hospital visits, as well as fills for antipsychotics and mood-stabilizing drugs in the first 8 months of the COVID-19 pandemic.
The findings, published late last week in JAMA Network Open, suggest that people with serious mental illness experienced substantial disruptions in care amid the pandemic, especially among the disadvantaged, the researchers said.
Led by Harvard Medical School investigators, the study included more than 650,000 Medicare beneficiaries diagnosed as having schizophrenia or bipolar 1 disorders. The researchers compared care patterns from January to September 2020 with those in the same period in 2019.
Relative to 2019, outpatient mental health visits during the first month of the pandemic fell from 265,169 (36.7%) to 200,590 (29.2%), a 20.3% decrease. In the same period, fills of antipsychotics and mood stabilizers dropped from 216,468 (29.9%) to 163,796 (23.9%), also a 20.3% decline. Similarly, ED visits fell from 12,383 (1.7%) to 8,503 (1.2%), a 27.7% decrease, and hospitalizations declined from 11,564 (1.6%) to 7,912 (1.2%), a 27.9% decrease.
From Aug 3 to 30, 2020, visits rebounded somewhat but were still lower than in 2019, ranging from a relative decline of 2.5% for outpatient visits to 12.9% for hospital admissions. From Mar 16 to Sep 27, 56.7% of outpatient mental health visits were provided via telemedicine.
Multivariable analyses showed that outpatient visits were slightly lower among those with a disability (odds ratio [OR], 0.95) from Mar 16 to Jun 21 and among Black versus White people (OR, 0.97) and those dual-eligible for Medicare and Medicaid (OR, 0.96) from Jun 22 to Sep 27.
The study authors noted that people with serious mental illness may be susceptible to care disruptions because they often have a disability, lack homes, live in poverty, are socially isolated, lack the ability to access telemedicine, have higher rates of chronic conditions, and may delay seeking in-person care because of their elevated risk of COVID-19 infection and death.
"Additionally, the pandemic may exacerbate preexisting disparities among individuals who belong to racial or ethnic minority groups or rural residents," they wrote.
Jan 28 JAMA Netw Open study
Denmark reports case of variant swine flu in slaughterhouse worker
A single case of variant swine flu was detected in a Danish slaughterhouse worker in November, authorities from the Statens Serum Institut (SSI) announced over the weekend. The case is isolated.
"It is estimated that the patient has been infected in connection with his work at a Danish pig slaughterhouse," the SSI said. "Furthermore, it is not estimated that there is no risk of further human-to-human transmission."
Last year an unrelated case of variant swine flu was detected in Denmark, and authorities said the most recent case is similar to a virus detected in three pig herds. The SSI did not share the subtype of the most recent swine flu case.
According to Avian Flu Diary, an infectious disease tracking blog, in 2021 variant swine influenza cases were detected in the United States (17), France, Taiwan, Canada (4), Brazil, Germany, Denmark (2) and the Netherlands.
Jan 29 SSI report
Jan 29 Avian Flu Diary post
H5N1 avian flu hits poultry in Ivory Coast and Nepal
Animal health officials in Ivory Coast and Nepal reported highly pathogenic H5N1 avian flu outbreaks in poultry, according to the latest notifications from the World Organisation for Animal Health (OIE).
Ivory Coast reported two separate events, both linked to the introduction of new poultry into flocks. One of the outbreaks began on Nov 10 at a layer farm in Grand-Bassam, about 25 miles east of Abidjan. The virus killed 174 of 11,000 susceptible birds. The other event started on Nov 21 at a poultry breeding farm in Abidjan, killing 5,000 of 32,000 susceptible birds.
Nepal reported an H5N1 outbreak that began on Jan 17 at a layer farm in Morang district in the eastern part of the country, killing 3,510 of 5,160 susceptible chickens. Officials said wild birds at an irrigation canal near the farm may have passed the virus to birds at the facility.
Jan 27 OIE report on H5N1 in Ivory Coast (Grand-Bassam)
Jan 27 OIE report on H5N1 in Ivory Coast (Abidjan)
Jan 28 OIE report on H5N1 in Nepal
In its latest situation update on avian flu, the United Nations Food and Agriculture Organization (FAO) said since its last report on Dec 23, 2021, a total of 1,050 avian flu outbreaks have been reported across Africa, the Americas, Asia, and Europe. A vast majority (998) involved H5N1, but other highly pathogenic subtypes were reported, as well, including H5N2, H5N3, H5N5, H5N8, and unsubtyped H5.
Jan 26 FAO situation update