News Scan for Mar 09, 2021

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Online self-reported COVID-19 symptom checkers may delay treatment

The US and UK digital COVID-19 symptom checkers consistently suggest less healthcare contact than Singapore's and Japan's, which may cause more serious outcomes, according to a study released yesterday by BMJ Health & Care Informatics.

While all four checkers failed to appropriately triage neutropenic sepsis, or sepsis in those with low white blood cell count, the US and UK checkers consistently suggested no or delayed medical care for severe COVID-19, bacterial pneumonia, and sepsis.

The researchers evaluated the four symptom checkers using 52 simulations involving common COVID-19 symptoms, age, symptom duration, and health conditions. Singapore's and Japan's checkers advised contacting healthcare providers for 88% and 77% of the cases, respectively, around double the rate of those from the United States (38%) and United Kingdom (44%). Singapore and Japan were chosen because of their low COVID case-fatality rate (less than 0.1% and 2.7%, respectively), in contrast with the United States (5.6%) and United Kingdom (13.6%).

The Singapore COVID-19 symptom checker, which the researchers deem the best tool, acts more like an online risk calculator, automatically referring patients to medical care if they are older than 65, have any health condition, or have symptoms for longer than 4 days. If the patient has shortness of breath, it recommends visiting the emergency department.

In contrast, the UK symptom checker attempts to make rudimentary clinical assessments, according to the study. The researchers bring up a case example of a 72-year-old with a 7-day fever and cough: While the person could have sepsis, bacterial pneumonia, or COVID-19 pneumonia, the symptom checker advises a stay at home with no healthcare follow up.

"If symptom checkers are being used to replace the assessment of patients by trained personnel and are programmed to try and prevent further healthcare contact, then, as our case simulation study highlights, there are real concerns about the potential risk of harm from such an unproven approach," the researchers write. "Our results support the recommendation that symptom checkers should be subjected to the same level of evidenced-based quality assurance as other diagnostic tests prior to implementation."
Mar 8 BMJ Health Care Inform study


Higher pollen concentrations correlate with COVID-19 cases

Higher pollen concentration is correlated with an increase in COVID-19 cases in early spring 2020, reports a study published yesterday in the Proceedings of the National Academy of Sciences. While the data indicate that high pollen concentrations could add an extra 10% to 30% to SARS-CoV-2 infection rates, the researchers reiterate that viral transmissions will not occur unless you are exposed to someone with COVID-19.

Previous studies have shown that pollen exposure can impair immunity against some seasonal respiratory viruses, and so the researchers tried to identify a relationship with SARS-CoV-2. From early- to mid-March through Apr 8, 2020, they looked at data from 130 regions in 31 countries across all inhabited continents, synthesizing pollen concentration (in density and taxa classifications) and weather conditions such as temperature and humidity with COVID-19 data, population data, and lockdown effects.

According to the study, the relationship could explain, on average, 44% of infection rate variability in 9 out of 14 countries that experienced lockdown. Lockdowns themselves appeared to halve the daily infection rates correlated with pollen. While the taxa of the pollen did not seem to have any effect, the researchers say that those with allergies, asthma, or chronic rhinosinusitis may be more likely to experience the "pollen effect" than the general population. Overall, a 4-day lag was observed between high–pollen-concentration days (240 pollen grains per cubic meter) and an exponential increase of COVID-19 cases.

Some countries did not have any significant correlation between pollen concentration and cases, although the researchers point out that seven had low pollen concentrations during the study period.

"As there can be no preventive measures against airborne pollen exposure, we suggest wide dissemination of pollen–virus coexposure dire effect information to encourage high-risk individuals to wear particle filter masks during high springtime pollen concentrations," the researchers write.
Mar 8 Proc Natl Acad Sci study


CARB-X to fund development of Staphylococcus aureus vaccine

CARB-X today awarded up to $3.5 million to biotechnology company Affinivax, of Cambridge, Massachusetts, for preclinical development of a vaccine against Staphylococcus aureus infections.

The vaccine being developed by Affinivax, using its Multiple Antigen Presenting System (MAPS) technology, will include multiple staphylococcal protein antigens designed to elicit B cell antibody and Th17 and Th1 cell-mediated immune responses. It offers the potential for protection against mucosal colonization and invasive staphylococcal infections. Company leaders believe this approach could help them overcome hurdles that have thwarted other attempts at developing an S aureus vaccine.

"Data from our group and others support the view that, in addition to antibodies, Th1 and Th17 responses to S. aureus proteins are critical to achieve broad protection against this pathogen," Richard Malley, MD, scientific founder of Affinivax and a professor of pediatrics at Harvard Medical School, said in a CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) press release. "Our MAPS technology is ideally suited for this purpose."

S aureus can cause a range of disease, from minor skin infections to life-threatening bloodstream infections, and methicillin-resistant S aureus (MRSA) infections have limited treatment options. MRSA is labeled a serious threat by the US Centers for Disease Control and Prevention.

The project could be eligible for an additional $18.5 million in funding if it reaches certain development milestones.
Mar 9 CARB-X press release

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