News Scan for May 10, 2022

News brief

High antimicrobial use observed in NYC hospitals in first pandemic year

A study of three hospitals in New York City found that antimicrobial use in COVID-19 patients during the first year of the pandemic far exceeded the incidence of coinfections, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The study, conducted at three tertiary-care hospitals, found that, among 7,209 patients (median age, 65 years) admitted with a confirmed COVID-19 infection from Jan 1, 2020, to Feb 1, 2021, 663 (9.2%) had a positive culture from the respiratory tract or blood sometime during their initial hospitalization. Positive respiratory cultures were found in 449 patients (6.2%), and blood culture positivity occurred in 334 (4.6%). Staphylococcus aureus was among the most common pathogens isolated from both blood and respiratory cultures.

Despite the low incidence of coinfections, antimicrobials were administered to 5,056 patients, or 70.1%, with a median of 6 antimicrobial days per patient. Third-generation cephalosporins the most frequently used antimicrobial agent (3,311 patients, 45.9%), followed by azithromycin (3,130 patients, 43.4%). A higher proportion of patients received antimicrobials in the first wave of the pandemic compared with the later period (82.4% vs 52%). Infection-free survival decreased over the course of hospitalization.

"With the COVID-19 pandemic continuing to significantly affect various parts of the world, resource utilization and overuse of antimicrobials warrant continued focus," the study authors wrote. "Our data, obtained through the period of peak COVID-19 activity in New York City, may be used to guide the process of diagnostic decision making, optimizing resource utilization, and antimicrobial stewardship."
May 10 Antimicrob Steward Healthc Epidemiol study

Several states report more avian flu in poultry and wild birds

In its updates on highly pathogenic avian flu in poultry flocks, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported outbreaks in six more states, mostly involving backyard birds.

In the Midwest, Michigan and Minnesota reported more outbreaks in backyard birds, Michigan's in Oakland County near Detroit and Minnesota's in Anoka County near the Twin Cities. Also, Wisconsin reported an outbreak at a commercial turkey farm that houses 20,100 birds in Barron County in the western part of the state.

In the western United States, Idaho and Montana also reported new outbreaks in backyard birds, Idaho's in Canyon County near Nampa and Montana's in Fergus County in the central part of the state. The USDA also noted Washington's second outbreak, which the state had earlier reported. So far, the ongoing outbreak activity has led to the loss of 37.5 million birds across 34 states, affecting nearly 292 poultry flocks.

Meanwhile, APHIS also reported 77 more H5N1 detections in wild birds, raising the total to 1,112. Most are from Wyoming, North Dakota, Montana, and Colorado. However, there are a few from eastern states, including Florida, Maryland, and New York.
USDA APHIS poultry avian flu update
USDA APHIS wild bird avian flu update

At the global level, avian flu outbreak activity is declining, but outbreaks persist in some parts of the world, according to the latest update from the World Organisation for Animal Health (OIE), which covers most of April.

During the reporting period, 128 new poultry outbreaks were reported by 12 countries, which include Bulgaria, Canada, Germany, Hungary, Japan, South Korea, Mexico, Netherlands, Nigeria, Poland, United Kingdom, and the United States. Poultry losses were significant in the Americas during the latest outbreaks.

The OIE said continuing reports of infected wild birds and the first detection of H3N8 in a human, reported from China, are a reminder that countries should maintain surveillance and biosecurity practices. It said the H3N8 virus found in China's human case is a low pathogenic avian flu reassortant of viruses that had previously been detected in poultry and other birds.
May 2 OIE avian flu situation report

COVID-19 Scan for May 10, 2022

News brief

Study details risk factors for maternal COVID-19 death in Latin America

An observational study using a multinational database of 447 maternal COVID-19 deaths in Latin America reveals that over 90% were attributed to acute respiratory failure after severe infection and that 35% of the women who died were never admitted to an intensive care unit (ICU), possibly due to lack of capacity.

The analysis, led by researchers at the Universidad de Cartagena in Colombia, involved 447 maternal deaths attributed to COVID-19 in eight Latin American countries from Mar 1, 2020, to Nov 29, 2021.

The investigators obtained data on COVID-related maternal deaths in Costa Rica (11 deaths), Ecuador (55), Honduras (126), Paraguay (86), the Dominican Republic (30), Colombia (84), Bolivia (21), and Peru (34).

At maternal death, median age was 31 years and median gestational age was 31 weeks. A total of 86.4% of the women tested positive for COVID-19 before delivery, with 60.3% of cases identified in the third trimester.

The most common symptoms at hospitalization were shortness of breath (73.0%), fever (69.0%), and cough (59.0%). Of the women who died, 90.4% had organ dysfunction at admission, nearly half were obese, 9.2% had a history of diabetes, 8.4% had a history of high blood pressure, and 25.3% were older than 35 years. Overall, 64.8% of women were admitted to an ICU for a median of 8 days. Eight deaths occurred among healthcare workers.

Median time from symptom onset to death was 14 days, Most deaths occurred in the first 6 weeks after delivery, with a median of 7 days between childbirth and death. The most common perinatal complication was preterm delivery (76.9%), and 59.9% of infants were of low birth weight.

The researchers called for increasing ICU capacity for severely ill pregnant women in Latin America by defining protocols and adding beds.

"Efforts should be directed to increase awareness for early detection of the COVID-19 severity in the pregnant population throughout the region," they wrote. "Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays."
May 6 Lancet Reg Health Am study

Pandemic caused global increase in loneliness, meta-analysis reveals

Two years into the COVID-19 pandemic, research published yesterday by the American Psychological Association (APA) in American Psychologist shows a small but significant worldwide increase in loneliness.

While lockdown measures and school closures led to dramatic headlines about increased rates of loneliness and subsequent mental health problems—including depression—researchers from Johannes Gutenberg-University Mainz in Germany said some reports may have been overblown, but even small increases in loneliness constitute a risk for premature death and mental and physical health.

The meta-analysis sought to separate loneliness—a feeling of despair—from the inevitable social isolation of the pandemic, and the investigators looked at 34 longitudinal studies from four continents involving more than 200,000 total participants, which tracked loneliness scores before and during the pandemic. Most of the studies used a 20-item University of California, Los Angeles (UCLA) loneliness scale.

Based on the pooled effect sizes of 19 studies, the authors found about a 5% overall increase in loneliness since the start of the pandemic (standardized mean differences, 0.27; 95% confidence interval, 0.14 to 0.40). In all studies, loneliness was more pronounced in young adults and the elderly.

"Other variables associated with changes in loneliness included participants' living situation or relationship status, gender, and mental health. Women were more likely to report increases in loneliness than men," the authors wrote.

In an APA press release on the study, first study author Mareike Ernst, PhD said, "We think that loneliness should be made a priority in large-scale research projects aimed at investigating the health outcomes of the pandemic."
May 9 Am Psychol study
May 9 APA press release