News Scan for Mar 21, 2022

News brief

Fewer antibiotics for non-COVID patients with fever, respiratory symptoms

Researchers at a hospital in China found an 8.3% decline in antibiotic use among patients with non-COVID fever and respiratory symptoms during the pandemic, likely because of heightened awareness of viral pathogens, according to a study published late last week in the Journal of Infection.

The retrospective study of 4,589 patients with fever and respiratory symptoms treated in the outpatient service at a hospital in Shanghai compared antibiotic use in the 2,617 patients treated in the pre-pandemic period (May 2019 to October 2019) with 1,972 treated in the peri-pandemic period (May 2021 to October 2021). The researchers hypothesized that there might be reduced antibiotic use under China's "dynamic zero-COVID policy," in which physicians were recommended to perform SARS-CoV-2 PCR tests, chest computed tomography (CT) scans, and C-reactive protein (CPR) and complete blood count (CBC) tests on all patients who had fever and respiratory symptoms.

The study found that rates of chest CT scans (45.3% vs 4.1%), CPR (60.3% vs 0.2%), and CBC (89.4% vs 63.5%) tests were higher in the peri-pandemic period than in the pre-pandemic period, and the rate of antibiotic use was lower (67% vs 73.1%). Receipt of combination antibiotics (11.5% vs 24.3%) and intravenous antibiotics (37.8% vs 52%) was also lower.

But multivariable logistic regression analysis found that neither CT scans (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.83 to 1.22) nor CRP (OR, 0.93; 95% CI, 0.78 to 1.11) tests were associated with the decrease in antibiotic use. Only treatment during the peri-pandemic period (OR, 0.76; 95% CI, 0.64 to 0.92) was associated with decreased antibiotic use.

"Therefore, reducing antibiotic use in the peri-pandemic cohort might be primarily explained as the increased awareness of viral pathogens through the education of COVID-19," the study authors wrote. "In conclusion, from the perspective of antimicrobial stewardship, only adding CRP test and chest CT scan on fever patients with respiratory symptoms cannot reduce the rate of antibiotic use in outpatient settings in mainland China."
Mar 18 J Infect study

Iowa, Delaware, Kansas report more high-path avian flu outbreaks

Three states reported more highly pathogenic avian flu outbreaks in poultry, including Iowa, where the virus struck a layer farm housing 5.3 million birds.

Iowa agriculture officials reported two more outbreaks in poultry, raising the state's total to five, according to separate announcement from the Iowa Department of Agriculture and Land Stewardship (IDALS). One involved a massive layer farm in Buena Vista County, which had reported an outbreak at a turkey farm earlier this month. The county is in the northwestern part of the state. The other outbreak occurred in a backyard flock in Warren County, which is just south of Des Moines.

The US Department of Agriculture (USDA) also noted outbreaks in two other states that reported earlier events in poultry settings. Delaware reported its third outbreak, which affected a commercial broiler farm in Kent County near Dover that houses 156,800 birds. Also, Kansas reported its second outbreak, again in a backyard flock. The location in Sedgwick County, which includes Wichita, has six birds.

The outbreaks involve the Eurasian H5N1 strain that has turned up on farms in a number of world regions. Outbreaks in US poultry, which began following detections of wild birds in the middle of January, have led to the loss of roughly 9.5 million chickens and turkeys.
Mar 18 IADLS statement on Buena Vista outbreak
Mar 20 IADLS statement on Warren County outbreak
USDA Animal and Plant Health Inspection Service poultry outbreak page

In international developments, Romania reported a new H5N1 event in poultry, which began on Feb 10 in backyard poultry in Ialomita County, located in the southeast, according to a notification from the World Organisation for Animal Health (OIE). The virus killed 49 of 65 birds.
Mar 21 OIE report on H5N1 in Romania

COVID-19 Scan for Mar 21, 2022

News brief

Alcohol deaths increased during first year of COVID-19 pandemic

Alcohol-related deaths increased by 25% in the United States during the first year of the COVID-19 pandemic, according to a new study in JAMA based on data from the National Center for Health Statistics.

Several studies have shown that alcohol use increased during the first month of COVID-19 lockdowns, but this study showed that deaths related to overconsumption of alcohol jumped from 2019 to 2020, from 78,927 to 99,017 [relative change, 25.5%]), as did the age-adjusted rate (from 27.3 to 34.4 per 100,000 [relative change, 25.9%]).

Alcohol-related deaths accounted for 2.8% of all deaths in 2019 and 3.0% in 2020. The findings echo previous studies on opioid use during the pandemic, which found that opioid overdose deaths increased 38% in 2020.

Though rates of alcohol-related deaths increased similarly among men and women, there were significant increases for people aged 35 to 44 years (from 22.9 to 32.0 per 100,000 [39.7%]) and 25 to 34 years (from 11.8 to 16.1 per 100 000 [37.0%]).

"The rate increase for alcohol-related deaths in 2020 outpaced the increase in all-cause mortality, which was 16.6%," the authors wrote. "Deaths involving alcohol reflect hidden tolls of the pandemic. Increased drinking to cope with pandemic-related stressors, shifting alcohol policies, and disrupted treatment access are all possible contributing factors."
Mar 18 JAMA study

Accuracy of second SARS-CoV-2 rapid antigen test estimated at 94%

The estimated overall accuracy of a second COVID-19 rapid antigen test among asymptomatic New York City workers was 94% in a comparative effectiveness study published late last week in JAMA Network Open.

The study authors noted that while the gold-standard diagnostic test for COVID-19 is real-time quantitative polymerase chain reaction (RT-qPCR), rapid antigen tests are often used to screen asymptomatic populations because they produce results faster and are less expensive.

"Although rapid antigen tests have been criticized for poor sensitivity and specificity when screening asymptomatic patients, a knowledge gap still remains regarding the utility of these tests for screening," they wrote.

Led by a Weill Cornell Medicine researcher, the team tested 179,127 participants in a workplace screening program using Sofia2 SARS Antigen Fluorescent Immunoassay, LumiraDX, and BinaxNow tests at an international service company from November 2020 through October 2021. Median employee age was 36 years, and 58% were men.

Of the 179,127 antigen tests performed, 623 (0.35%) yielded positive results, of which 238 (38%) were confirmed to be positive through RT-qPCR, and 385 (62%) were found to be false-positive.

Among the 623 positive antigen test results, 569 (91%) were followed by a second such test. Of 224 pairs of consecutive antigen tests with positive results, RT-qPCR results were positive for 207 (92%). In the 345 cases with a first positive antigen test followed by a negative test, 328 (95%) were negative on RT-qPCR. Total estimated accuracy of a repeat antigen test was 94%.

"The results of this study demonstrated that when a repeated rapid antigen test was offered to participants of an employee screening program, the estimated accuracy increased from 38% to 92% for true-positive results as determined by RT-qPCR for SARS-CoV-2," the authors wrote.

A second antigen test may be useful for guiding COVID-19 interventions, the researchers said. "These findings may have important implications for how rapid antigen tests can be deployed for more accurate results, especially in a setting where the time to results is important and where widespread PCR testing may be cost prohibitive," they concluded.
Mar 18 JAMA Netw Open research letter