Death rate 68% lower in COVID outpatients sent text message check-ins
An automated text messaging system for adult COVID-19 outpatients developed at Penn Medicine saved two lives a week during the first US pandemic surge, and users were 68% less likely than controls to die, finds a study today in the Annals of Internal Medicine.
The text messaging system, COVID Watch, sent twice-daily automated text check-ins to outpatients who tested positive for COVID-19 from Mar 23 to Nov 30, 2020, at the Penn Medicine health system. Patients could report worsening symptoms to a small team of registered nurses 24 hours a day, 7 days a week.
The researchers compared the outcomes of 3,488 patients enrolled in COVID Watch with those of 4,377 controls who received usual care. Of the intervention patients, 86.8% responded to at least one text (average, 23 responses), and 14.3% triggered an escalation to a registered nurse (average response time, 24 minutes).
Thirty days after enrollment, 3 (0.09%) of intervention patients had died, compared with 12 (0.27%) of control patients. None of the COVID Watch deaths occurred outside the hospital, versus 6 among control patients. At 60 days, 5 COVID Watch patients (0.14%) had died, compared with 16 control patients (0.37%).
COVID Watch participants' odds ratio for death was 0.32 (95% confidence interval [CI], 0.12 to 0.72), with 1.8 fewer deaths per 1,000 patients (95% CI, 0.5 to 3.1). At 60 days, there were 2.5 fewer deaths per 1,000 patients (95% CI, 0.9 to 4.0) in the COVID Watch group.
COVID Watch patients had a 68% lower death rate than control patients, which the authors said could be because they had more telemedicine and emergency department (ED) visits and hospitalizations and visited the ED sooner than control patients (average number of days sooner, 1.9 [95% CI, 0.9 to 2.9]).
Lead author M. Kit Delgado, MD, said in a University of Pennsylvania news release that the text messaging system benefitted all patients, including those at high risk for poor outcomes. "It's crucial that we found all major racial and ethnic groups benefited because non-white and low-income communities have had disproportionately higher infection rates, lower access to care, and higher death rates," he said.
Nov 16 Ann Intern Med study
Nov 15 University of Pennsylvania news release
IDSA issues advice for COVID-19 PPE use in healthcare workers
An Infectious Diseases Society of America (IDSA) guideline panel published eight evidence-based recommendations for the use of personal protective equipment (PPE) to protect healthcare workers against COVID-19, according to a paper yesterday in Clinical Infectious Diseases.
The panel, led by a University of Washington at Seattle researcher, conducted a systematic review of the literature to determine the standards of PPE use in conventional, contingency, and crisis situations.
The panel recommended that healthcare personnel caring for patients with confirmed or suspected COVID-19 don a medical/surgical mask or N95 respirator and eye protection but made no recommendation about the use of double gloves or shoe covers.
The group also recommended that healthcare workers involved in aerosol-generating procedures wear an N95 respirator rather than a medical/surgical mask and that if N95s are in short supply, wear a reprocessed N95 and a face shield to allow for extended respirator use and/or reuse.
The panel cautioned that the guidance will continue to evolve with new knowledge.
"There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence," the researchers wrote. "These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies."
Nov 15 Clin Infect Dis report
Multistate E coli outbreak linked to organic spinach sickens 10
The Centers for Disease Control and Prevention (CDC) yesterday announced an Escherichia coli O157:H7 outbreak linked to Josie's Organics fresh baby spinach that has sickened 10 people from 7 states.
No one has died, but two people have required hospitalization, the CDC said. The outbreak is concentrated in the Midwest, with cases reported in Minnesota, Iowa, Missouri, South Dakota, Michigan, Indiana, and Ohio. Illness-onset dates range from Oct 15 through Oct 27.
Five of the seven case-patients reported eating spinach in the week before they got sick, and one person reported eating Josie's Organics brand. The CDC also said Minnesota health officials found E coli O157:H7 in a package of leftover Josie's Organics baby spinach collected from a sick person's home. So far no recalls have been issued.
Patients range in age from 2 to 71 years, with a median age of 26. Seven are female.
In other foodborne pathogen news, there are now 155 cases identified as part of a Salmonella Thompson outbreak traced to seafood from a Denver company, Food Safety News reports. The majority of people sickened have been identified in the Denver area, but 14 states have reported cases.
CDC, Michigan officials investigate large university flu outbreak
The CDC is working with health officials in Michigan to investigate a large and sudden spike in flu infections caused by the H3N2 influenza strain at the University of Michigan, the CDC said yesterday.
Since Oct 6, the school's University Health Services (UHS) has recorded 528 cases, with respiratory test positivity rising steadily over the past 2 weeks. About 77% of people with confirmed infections were unvaccinated, according to the University of Michigan press office.
Lindsay Mortenson, MD, UHS medical director, said the investigation will help shed light on how the flu season may unfold regionally and nationally against the backdrop of the COVID-19 pandemic. The school also said the spike's timing comes as many students prepare to return to their homes for Thanksgiving break.
The investigation goals are to look at flu vaccine uptake, vaccine effectiveness, and risk factors for spread, the university said.
The CDC said in its statement that it has received anecdotal reports of flu outbreaks in young adults, possibly attending colleges and universities in several states. It added that flu viruses are known to spread in close quarters like common living spaces, classrooms, and shared social activities; however, young adults regularly have the lowest flu vaccine uptake.
During the 2020-21 flu season, US flu levels were historically low, probably owing to COVID-19 measures, the CDC said. With relaxed measures, circulation of other respiratory viruses has resumed, and health officials are watching to see if flu takes a similar track. CDC surveillance over the past 3 weeks shows that flu activity is starting to resume, mainly due to H3N2, which has been linked to more severe flu seasons, with the biggest impacts on seniors and young children.
Nov 15 CDC statement
Nov 15 University of Michigan press release