Study looks at US counties' non-COVID excess deaths
US counties with more excess deaths not attributed to COVID-19 had less health insurance coverage and primary care as well as more at-home deaths, according to a research letter today in JAMA Network Open.
The researchers looked at 2020 data from the US National Center for Health Statistics for 2,096 counties with 319.1 million residents and divided county characteristics into quartiles.
Overall, 17% of 2020 excess deaths were not attributed to COVID-19. In counties with the most uninsured people, that share rose to 27%, and counties with the fewest primary care physicians per capita attributed 20% of their excess deaths to non-COVID reasons. Those who reported the least deaths in nursing homes also attributed 23% of excess deaths to non-COVID causes.
The highest share of non-COVID excess deaths (34%) was found when looking at counties in the top quartile of more at-home deaths, which the researchers say could be due to a higher frequency of coroner examinations, a lack of patient healthcare history, and more deaths indirectly related to COVID disruptions, such as drug overdoses.
Counties with more insured people, more primary care physicians per capita, more nursing home deaths, and fewer at-home deaths attributed no more than 17% of excess deaths to non-COVID causes. For two metrics, data indicated negative percentages (fewer uninsured individuals, –5%; more deaths in nursing homes, –8%).
Sep 13 JAMA Netw Open study
COVID vaccine protects from severe COVID, study says
COVID-19 vaccines appeared to protect patients from severe illness leading to emergency department (ED) visits and hospitalization, according to a pre-Delta (B1617.2) variant study published late last week in The Lancet Regional Health - the Americas.
The researchers looked at 11,834 ED visits to a Michigan hospital system from Dec 15, 2020, to Apr 30, 2021. About 92%, 7%, and 1.1% of US adult patients involved were unvaccinated, partially vaccinated, and fully vaccinated, respectively, which means the rate of COVID-related ED visits and hospitalizations was 96% lower in those fully vaccinated than those unvaccinated. Similarly, ED visits peaked at 22.6, 12.9, and 1.3 visits per 100,000 people per unvaccinated, partially vaccinated, and fully vaccinated patients, respectively.
Propensity-score matching weight analysis showed that people who were fully vaccinated had a statistically insignificant lower risk of composite disease compared with those unvaccinated (hazard ratio, 0.84; 95% confidence interval, 0.52 to 1.38).
While the researchers say the results show how the Pfizer/BioNTech, Moderna, and Johnson & Johnson vaccines provide protection from severe illness, if hospital treatment is required, elderly people with many comorbidities appeared to have similar risk of severe illness compared with unvaccinated people. Still, the researchers write, in the fully vaccinated group (129), all 8 deaths and 6 intubations occurred in patients 65 years or older, whereas in the unvaccinated group, patients as young as 21 years died and patients as young as 19 needed mechanical ventilation.
At the time of the study, the Alpha (B117) variant was the predominant strain, but the researchers say Michigan had identified 10 variants in the 2-week period ending Apr 24, 2021. The study period also included Michigan's new daily cases peak up until that point—more than 7,000 new cases per day from Apr 5 to 12.
Sep 10 Lancet Reg Health Am study
Chronic wasting disease reported in another Tennessee county
Wildlife officials in Tennessee recently reported chronic wasting disease (CWD) in a sick deer in Henry County, the state's ninth county to report the disease, triggering control measures in a neighboring part of Kentucky.
The Tennessee Wildlife Resources Agency (WRA) said in a Sep 8 statement that it responded to a call from Henry County about a 3½-year-old doe who was emaciated and showing strange behavior. Multiple tests confirmed CWD. It said the finding adds Henry County to the state's positive list and Weakley County to the high-risk list. The action bars carcass transport, feeding, and mineral placement in both counties. Henry County is in the northwest part of the state on the border with Kentucky.
In a related development, the Kentucky Department of Fish & Wildlife (DFW) said it is taking steps to monitor deer and elk herds following Tennessee's recent CWD positive, including increased surveillance in Calloway, Fulton, Graves, Hickman, and Marshall counties, according to a statement. So far, CWD has not been detected in Kentucky. The area where the sick deer was found in Tennessee is 8 miles from the Kentucky border.
CWD is a fatal prion disease, similar to bovine spongiform encephalopathy, that affects deer, elk, and other cervids. So far, no cases have been reported in humans, but the Centers for Disease Control and Prevention recommends that people avoid eating meat from CWD-affected animals.
Sep 8 Tennessee WRA news release
Sep 8 Kentucky DFW news release