News Scan for May 12, 2021

News brief

Waiting room video cuts antibiotic expectations but not prescriptions

Watching a brief video about antibiotic treatment prior to a family practitioner visit reduced patients' expectations about receiving antibiotics for upper respiratory tract infections (URTIs) but had no influence on physician prescribing, according to a randomized controlled trial published this week in the Annals of Family Medicine.

In the three-armed trial, conducted by researchers at the University of Auckland in New Zealand, patients at two family practices in Auckland were randomly allocated to watch one of three video presentations on a tablet device immediately before their consultation. One video was on the futility of antibiotic treatment for URTIs, the other described the adverse effects associated with antibiotics, and the third was on the benefits of healthy diet and exercise. Before and after viewing the videos, patients filled out a questionnaire and were asked to rate, using a Likert scale, the strength of their belief that antibiotics are effective for treating URTIs and their desire to receive an antibiotic.

A total of 325 patients participated in the trial. Likert scores for patients' agreement with the statement "I wish to receive antibiotics for my/my child's cold/flu" before viewing the presentations was similar across all three groups, with a mean score of 3. After viewing the presentations, the mean reduction in Likert score for those who viewed the futility video (1.1; 95% confidence interval [CI], 0.8 to 1.3) or the adverse-effects video (0.7; 95% CI, 0.4 to 0.9) was significantly greater than that for those who viewed the control video (0.1; 95% 0.0 to 0.3). The effect was also observed when the analysis was restricted to the parents of 91 child participants.

Among the 306 patients who completed the post-presentation questionnaire, 30% received an antibiotic prescription. There was no significant difference in the proportion between the futility group (31%), adverse-effects group (28%), and control group (32%).

"Although we reduced patients' expectations for an antibiotic prescription, doing so did not reduce antibiotic prescribing by family practitioners," the study authors wrote, while noting that the study was not primarily designed to examine prescribing. "This finding is surprising given that patients' expectations to receive antibiotics are stated to be the main driver of antibiotic prescribing for URTIs."

The authors suggest it's possible that participants provided socially desirable responses on the questionnaires but made their real expectations clear in the consultation with family practitioners.
May 10 Ann Fam Med study

Spanish study finds high rate of inappropriate antibiotics in COVID patients

A study of COVID-19 patients in Spain during the early months of the pandemic found frequent inappropriate antibiotic use, Spanish researchers reported yesterday in PLOS One.

Of the 13,932 COVID-19 patients treated at Spanish hospitals from Mar 1 through Jun 23, 2020, 10,885 (78.1%) received systemic antibiotics other than macrolides, with 6,116 (43.9%) appropriately prescribed antibiotics and 4,769 (34.2%) inappropriately prescribed antibiotics.

Analysis of independent risk factors for inappropriate antibiotic prescribing identified admission from February through March (odds ratio [OR], 1.54; 95% CI, 1.18 to 2.00), younger age (OR, 0.98; 95% CI, 0.97 to 0.99), absence of comorbidity (OR, 1.43; 95% CI, 1.05 to 1.94), dry cough (OR, 2.51; 95% CI, 1.94 to 3.26), fever (OR, 1.33; 95% CI, 1.13 to 1.56), dyspnea (OR, 1.31; 95% CI, 1.04 to 1.69), flu-like symptoms (OR, 2.70; 95% CI, 1.75 to 4.17), and elevated C-reactive protein levels (OR, 1.01 for each mg/L increase; 95% CI, 1.00 to 1.01) as leading risk factors.

The analysis also found that patients who received antibiotics were more likely to have drug-related complications than those who didn't (4.9% vs 2.7%; OR, 1.84; 95% CI, 1.45 to 2.32).

The authors note that the percentage of COVID-19 patients who received antibiotics is similar to what's been found in other studies, and that the high prescribing rate contrasts with the low incidence of bacterial coinfection or superinfection in the cohort; only 10% of patients had confirmed pulmonary superinfection, and 2% had superinfection of another origin.

"Widespread antibiotic prescribing carries an increased risk of adverse reaction and probably other unwanted effects (such as possible increased bacterial resistances), without benefit," they wrote. "It is therefore essential to integrate antibiotic use optimization programs in patients with SARS-CoV2 infection. More research is needed to identify patients which warrant antibiotic prescription."
May 11 PLOS One study

Sierra Leone launches preventive Ebola vaccine drive near Guinea border

An Ebola vaccination campaign using the Johnson & Johnson vaccine launched yesterday in Sierra Leone near the Guinea border, a preventive step targeting 16,000 people in high-risk groups, the World Health Organization (WHO) African regional office said in a statement.

Immunization began in Kambia district, an important border crossing between Guinea and Sierra Leone. In the coming days, the effort will extend to eight other border districts. Guinea has had a recent outbreak that has not yet been declared over.

No Ebola cases in Sierra Leone have been detected since West Africa's massive outbreak that occurred from 2014 to 2016, but health officials want to ensure that frontline workers are protected. Included groups include those who would most likely have contact with an infected Ebola case: health workers, traditional healers, and commercial motor bike taxi drivers.

Sierra Leone's health ministry is leading the effort, with help from the WHO and the US Centers for Disease Prevention and Control.

The WHO and Johnson & Johnson donated the vaccine, which was recommended by the WHO vaccine advisory group in 2019. Known as Ad26.ZEBOV/MVA-BN, the vaccine is a prime-boost product designed to offer long-lasting protection and is given in two doses 56 days apart.
May 11 WHO African regional office statement

COVID-19 Scan for May 12, 2021

News brief

Postpartum depression associated with COVID-19 lockdown

Twice as many mothers with babies 6 months or younger reported postpartum depression during the first UK COVID-19–related lockdown, according to a Frontiers in Psychology study yesterday.

University College London (UCL) researchers surveyed 162 London mothers in May and June 2020 (about 1.5 to 3 months into the lockdown) and found that 47.5% met the Edinburgh Postnatal Depression Scale (EPDS) criteria (11 points or higher). That compares with previous research that found a prepandemic baseline of 23% in European mothers.

Mothers discussed four major themes surrounding lockdown: appreciation for the bonding time the nuclear family had, the burden of constant mothering, the inadequacy of virtual contact, and the sadness over lost social opportunities for themselves and their infant. Quantitative data from the survey support this need for social connection, as well: Depression symptoms had a negative association with seeing support system members in person (relative risk ratio [RRR], 0.950 to 0.974) or remotely (RRR, 0.995).

Most mothers reported 11 members in their support system, which on average was 47.8% relatives and 14.7% mommy friends, or women who were at a similar stage in motherhood. On average, women had seen one family member other than their partner, three total support system members, and no mommy friends in the last few weeks. Remote communication, on the other hand, was high.

"Our survey shows that lockdowns leave new mothers more vulnerable to postnatal depression, and that digital solutions might help but they are not the answer," lead author Sarah Myers, PhD, MPhil, said in a UCL press release. "Policy makers must take this into account as we continue to deal with COVID-19, for the sake of mums, babies, and whole families."

Mothers were aged 19 to 47 years, with an average of 34.6 years. Half were caring for their first child (50.6%), followed by 40.1% on their second. Mothers who had partners who were unable to help, especially in regards to home schooling, were more likely to report depression symptoms.
May 11 Front Psychol study
May 11 UCL press release

Home-based hospital care shown effective during pandemic

One in five COVID-19 patients enrolled in the Atrium Health Hospital at Home (AH-HaH) program had to be transferred back to a brick-and-mortar facility within 14 days, making the home-based care an "attractive innovation" that could help hospitals manage resources, according to an Annals of Internal Medicine research letter yesterday.

Patients were eligible for the single-center program if they had had a safe living situation and showed clinical stability. At home, they would have 24/7 telephone access to nurses, at least daily visits from paramedics, daily virtual visits with a hospitalist, and therapy treatments such as intravenous fluids, noninvasive oxygen, and respiratory medications.

Of the 391 patients from March to November 2020, 53% were female, 46% were White, and their median age was 56 years. The median length of program enrollment was 3 days, and the 84 patients who required transfer back to a traditional healthcare site (21.5%) did so within a median of 2.2 days. Thirty-three of these required intensive care, 11 needed mechanical ventilation, and 11 died, for an overall 2.8% mortality rate.

Higher oxygen saturation was negatively associated with transfer (odds ratio [OR], 0.87); whereas, higher comorbidities were linked to a higher risk (OR, 1.12). The researchers note that rapid heart rate or respiratory issues such as low oxygen saturation were observed among patients who needed immediate care escalation, but chronic conditions such as diabetes and high blood pressure were more common among patients who needed nonimmediate care escalation.

While neither old age nor obesity was associated with higher transfer risks, the researchers say this could be because doctors were more hesitant to enroll patients with these conditions into the program.
May 11 Ann Intern Med study

UK COVID-19 contact tracing app may have reduced cases 24%

The United Kingdom's National Health Services app for COVID-19 contact tracing may have reduced England's and Wale's cases from 13.1% to 23.9%, or by almost 300,000 to 600,000 patients, according to a study in Nature today.

The app was launched Sep 24, 2020, and through the end of December, 16.5 million people regularly used it, or about 28% of the total population. Besides monitoring proximal exposures, the app also automatically updated any COVID-19 diagnosis test results and sent them to applicable contacts, provided a platform for venues to conduct contact tracing, and gave localized COVID-19 quarantine, symptom, and testing information.

The researchers estimate that 6.02% of individuals who were notified about possible exposures from the app ended up testing positive for COVID-19, which is comparable to the proportion identified via manual contact tracing. Overall, modeling indicates that 284,000 cases were prevented with the app (95% confidence interval [CI], 108,000 to 450,000), while statistical comparisons project the number to be even higher, at 594,000 (95% CI, 317,000 to 914,000). In other words, for every percentage point increase in app users, cases could be reduced by 0.8% (modeling) to 2.3% (statistical comparison).

"This suggests that on average, each confirmed case who consented to notification of their contacts through the app prevented one new case," the researchers write, adding that the app may have averted 4,200 (modeling) to 8,700 (statistical comparison) deaths. "These findings provide evidence for continued development and deployment of such apps in populations that are awaiting full protection from vaccines."

Still, they caution, "The app is best understood as part of a system of non-pharmaceutical interventions, not in isolation. It is not a substitute for social distancing or face masks: Control of the epidemic requires all available interventions to work together."
May 12 Nature study

Blood analysis shows cats contact COVID-19 at higher rates than dogs

COVID-19 seroprevalence—or the prevalence of SARS-CoV-2 antibodies in blood—is higher in cats than in dogs and higher in general in pets living with people who have the disease, according to a study yesterday in Emerging Infectious Diseases.

Italian scientists analyzed 198 serum samples, 130 from dogs and 68 from cats, collected during March through June of 2020, as well as 100 serum samples, 65 from dogs and from 35 cats, collected in different regions of Italy before 2019 to use as prepandemic controls.

The researchers detected 14 cases in animals, representing a 16.2% SARS-CoV-2 seroprevalence in cats and 2.3% in dogs. Symptomatic people were more likely to have pets test positive.

"We found the proportion of serologic positivity increased with increasing length of exposure," the authors said. "We recorded the first SARS-CoV-2–positive animals 10 days after owners' diagnoses and all 14 seropositive cases were classified as positive after >54 days of exposure."

The authors said that, among 5 of the 14 positive animals, owners reported that their pets had experienced clinical signs at the same time as their own illnesses.
May 11 Emerg Infect Dis study