News Scan for Jul 20, 2021

News brief

COVID-19 erased Latino mortality advantage in LA County

While Latino people have lower rates of mortality despite their higher rates of poverty compared with White people in the United States, the COVID-19 pandemic erased it, at least in Los Angeles County, according to a JAMA research letter yesterday.

Los Angeles County has the largest Latino population in the United States, with 49% of the county's 10 million people identifying as Latino versus 28% of non-Hispanic White people. The researchers examined annual age-adjusted mortality (AAMR) and found that, in 2019, Latinos had 516.0 deaths per 100,000 people while White people had 630.3 deaths per 100,000 (AAMR, 0.82; 95% confidence interval [CI], 0.80 to 0.83). In 2020, however, prevalence increased to 741.7 deaths per 100,000 Latino people versus 699.0 deaths per 100,000 in White people (AAMR, 1.06; 95% CI, 1.04 to 1.08).

COVID-19 was the leading cause of death in 2020 for Latino individuals, with 160.1 deaths per 100,000 people versus 51.7 deaths per 100,000 in White people (AAMR, 3.10; 95% CI, 2.93 to 3.27). The researchers also noted that, from 2019 to 2020, AAMR increased among Latinos for heart disease and for diabetes (AAMRs, 1.19 and 1.22, respectively) without statistically significant increases among Whites.

"The findings may reflect increased risks of SARS-CoV-2 infection among Latino individuals associated with crowded living conditions and low-wage employment in unsafe work settings, as well as increased risks of disease progression associated with a higher prevalence of comorbidities," the researchers write. "The increases in mortality from heart disease and diabetes among Latino individuals may in part reflect reduced access to medical services, including preventive services."

Overall, the researchers looked at 465,389 deaths from 2011 to 2020, 37.5% of which were among Latinos and 62.5% were among White people.
Jul 19 JAMA study


Real-world study shows good COVID results for monoclonal antibodies

A real-world Mayo Clinic study shows similarly low hospitalization rates among 3,596 high-risk US adults with mild to moderate COVID-19 treated with one of two monoclonal antibodies.

The observational study, published yesterday in the Journal of Infectious Diseases, used electronic health records to compare 28-day all-cause death rates and COVID-19–related hospital admissions in 2,747 patients who received an infusion of bamlanivimab and 849 given casirivimab-imdevimab from Nov 19, 2020, to Feb 11, 2021. The drugs were started within 10 days of symptom onset.

Median patient age was 62 years, half were women, 93.2% were White, all had at least one underlying illness, and 55% had multiple medical conditions.

The overall all-cause 28-day death rate was 3.98% (five bamlanivimab recipients and three casirivimab-imdevimab recipients), and 2.56% were hospitalized for COVID-19. After adjustment for underlying diseases, all-cause death rates and coronavirus-related hospitalizations did not differ between the bamlanivimab and casirivimab-imdevimab groups (adjusted hazard ratios, 1.4 and 1.6, respectively).

Patients who had chronic kidney, respiratory, and cardiovascular diseases, high blood pressure, or were immunocompromised were at higher risk of hospitalization (odds ratios [ORs], 6.10, 1.67, 2.20, 1.67, and 2.78, respectively). Men and divorced participants were more likely to be hospitalized (ORs, 1.49 and 1.84, respectively).

"The rates of 28-day all-cause and COVID-19-related hospitalization appeared higher among patients who received bamlanivimab monotherapy compared to casirivimab-imdevimab combination, although this did not reach statistical significance, and may be accounted for by the higher medical comorbidity in the bamlanivimab cohort," the authors wrote.

The Food and Drug Administration issued an emergency use authorization for bamlanivimab and casirivimab-imdevimab in November 2020 for the treatment of high-risk patients with mild to moderate COVID-19.

In a commentary in the same journal, Valentina Stosor, MD, and Michael Angarone, DO, both of Northwestern University, said the study adds to mounting evidence that monoclonal antibodies work in COVID-19 outpatients and should be offered to eligible patients.

"Future studies should focus on newer monoclonal antibodies more resistant to viral change, comparisons of treated and untreated populations, and the utility of these therapies in inpatient populations and as a prophylactic measure," they wrote.
Jul 19 J Infect Dis study
Jul 17 J Infect Dis commentary


ECDC notes alarming healthcare rise of OXA-244–producing E coli

In an update on a healthcare-related outbreak of OXA-244–producing Escherichia coli in Norway, the European Centre for Disease Prevention and Control (ECDC) said today that cases have doubled in the main cluster, and three new countries have reported cases.

Following its original risk assessment on Feb 18 after Norway reported 12 cases, health officials asked countries to submit samples for sequencing. Of 458 E coli ST38 isolates, 370 carried the blaOXA-244 gene encoding for the OXA-244 carbapenemase, which has the potential to confer resistance to the class of antibiotics known as carbapenems.

The isolates included several clusters, including a large one with 225 closely related isolates. Of those, 210 were from 11 countries in Europe and the United Kingdom. Fifteen were from other countries. People in the large cluster have a median age of 51, with a high proportion from women and samples frequently isolated from urine.

The ECDC said so far the source is unclear, and community transmission seems to be the main route of spread. Travel data are sparse but hint at North Africa or the Middle East as possible sources, consistent with the regions with previous links to OXA-48–like carbapenemases. It added that travel alone can't explain the rapid spread to 13 different European countries. A common animal or food source is also a possibility that requires further investigation, the agency said.

Little is known about the clinical consequences of carbapenems for OXA-244 E coli infections, but ECDC said the situation is concerning, given that OXA-48 like carbapenemases have been linked to treatment failures.
Jul 20 ECDC update

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