December 07, 2020
COVID-19
Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening. Given that many COVID-19 cases are pre-symptomatic or asymptomatic, robust population screening will be central to re-opening societies. Polymerase chain reaction (PCR) tests, considered the gold-standard, are more expensive and have a longer turnaround time than point-of-care and rapid antigen tests, which have lower sensitivity. Researchers modeled individual and population impacts of different screening regimes, varying test sensitivity, frequency, and turnaround time. In a simulation of 10,000 individuals using test sensitivities analogous to point-of-care and rapid tests, they observed a large reduction in infectiousness when testing daily or every three days, a 62-66% reduction when testing weekly, and a 45-47% reduction when testing every two weeks. In population models, testing 75% of individuals every three days drove the epidemic toward extinction within six weeks, reducing cumulative incidence by 88% compared to no intervention. Findings indicated that testing frequency had a greater impact than testing sensitivity in population-level epidemic control screening efforts. [Science Advances]
Repurposed antiviral drugs for Covid-19 — Interim WHO Solidarity Trial Results. Recent data from the WHO Solidarity Trial (NCT04315948) revealed little, or no effect from remdesivir, hydroxychloroquine, lopinavir, and interferon regimens on hospitalized COVID-19 patients with COVID-19, with regards to overall mortality, initiation of ventilation, and duration of hospital stay. The Solidarity Trial spanned across 30 countries and recruited 11,330 adults randomized to receive remdesivir (2750), hydroxychloroquine (954), lopinavir alone (1411), interferon (2063; where 651 were also given lopinavir) and no trial drug (4088). None of the trial drugs had an effect on the primary outcome, overall mortality (P>0.1), or in any subgroups defined by categories such as age and ventilation status at entry. The authors remarked that the appreciably greater proportion of lower-risk patients in the remdesivir group as compared to the placebo group in the ACTT-1 trial, may have contributed to the ACTT-trial findings which implied that remdesivir may have prevented progression to severe disease. The authors concluded that the search for treatments for COVID-19 patients should continue and that immune modulators or anti–SARS-Cov-2 monoclonal antibodies should be tested by the Solidarity Trial. [NJEM]
Risk of COVID-19 in health-care workers in Denmark. To investigate the risk of SARS-CoV-2 infection among health-care workers, researchers in Denmark conducted an observational cohort study comparing serologic screening test results from 28,792 health-care workers and 4672 blood donors in the Capital Region of Denmark. Seroprevalence was found to be higher in health-care workers (1163, 4.04%) than in blood donors (142, 3.04%); risk ratio (RR) 1.33 (95% CI 1.12 to 1.58). Furthermore, seroprevalence was higher in male health-care workers (RR 1.49, 1.31 to 1.68), and in frontline health-care workers working in hospitals (RR 1.38, 1.22 to 1.56), among which, the risk was higher in those working in designated COVID-19 wards (RR 1.65, 1.34 to 2.03). Loss of taste or smell was the symptom found to be most strongly associated with seropositivity (RR 11.38, 10.22 to 12.68). Findings from the study emphasized the risk of infection in healthcare workers working with COVID-19 patients, and the need for health-care policies aimed mitigating this risk. [The Lancet]
Symptoms and Transmission of SARS-CoV-2 Among Children — Utah and Wisconsin, March-May 2020. Researchers in the US investigated infection rates and clinical characteristics among pediatric household contacts (< 18 years old) of individuals with COVID-19 and revealed that infection rates were similar between adults and children, with children having less frequent and severe symptoms. Among the 188 contacts from 58 households enrolled in the study, secondary infection rates were 30% for adults and 28% for children. While fever consisted one of the symptoms with the highest predictive value in children, (100%, 95% CI 44% to100%), they were less likely to report cough [odds ratio (OR) 0.15, 95% CI 0.04 to 0.57], loss of taste (OR 0.21, 95% CI 0.06 to 0.74), and loss of smell (OR 0.29, 95% CI 0.09 to 0.96) and more likely to report sore throat (OR 3.4, 95% CI 1.04 to 11.18), than symptomatic adults. Despite the limitations related to the small sample size and potential selection bias, the authors concluded that infection rates may be similar between adults and children, and more studies are needed to examine pediatric transmission patterns, especially outside the households. [Pediatrics]
A 50-State COVID-19 Survey Report #26: Trajectory of COVID-19-Related Behaviors. Researchers repeatedly polled over 135,000 individuals from all 50 United States and the District of Columbia between April and November 2020 and assessed national and state-level trends in social distancing behaviors. Since the spring, the proportion of people spending time indoors with others outside their immediate family had doubled, and those going to restaurants had tripled. Mask wearing had increased; however, hand washing had decreased. Sub-populations with the highest levels of social distancing behaviors included women, Asian Americans and African Americans, older people, more educated people, and Democrats. Partisan divides increased drastically according to a 100-point Social Distancing Index: In spring 2020, both Democrats and Republicans scored over 80 points, whereas in November 2020, the score for democrats was reported ~60 and for republicans ~40. States with the lowest levels of social distancing behaviors and mask-wearing were also experiencing the worst outbreaks. [The COVID State Project]
Drug Resistance and Global Health
Leapfrogging laboratories: the promise and pitfalls of high-tech solutions for antimicrobial resistance surveillance in low-income settings. Although the antimicrobial resistance (AMR) crisis continues to escalate globally, it’s magnitude is inadequately captured by existing surveillance systems, particularly in lower-income settings. Experts suggest that leapfrog technologies, representing innovations that move away from using only culture-based methods, may eliminate multiple steps in the traditional pathway to surveillance and have a dramatic impact on AMR surveillance capacity. Technologies such as point-of-care tests, molecular biology-based methods, and data digitalization, may be the answer to many of the barriers stemming from lack of access to high-quality culture, quality-assured diagnostic laboratory networks, and data dissemination. However, various challenges including cost, expertise in molecular sciences, and logistical hurdles need to be addressed. Next-generation of AMR surveillance technologies should be encouraged and supported, and where immediate adoption of these technologies may not yet be feasible, active preparation to integrate cost-effective technologies should be an immediate priority. [BMJ]
Antibiotic prescribing in general practice during COVID-19. The National Health Service (NHS) England reported a 51.5% decrease in face-to-face appointments and a 270.45% increase in telephone appointments five months after the first national lockdown (March 23, 2020) compared to the same period in 2019. The number of antibiotic prescriptions made during this time was lower than the previous year, however, given the decrease in appointments, the number of prescriptions was 6.71% higher than expected (p<0.0001). The data suggested antibiotic prescribing rates were higher in remote consultations, compared to in-person appointments. Research on COVID-19 and antibiotic use has focused on antibiotic misuse among COVID-19 patients. Given telephone appointments may be a driving factor in antibiotic misuse, addressing telehealth in stewardship programs is crucial in efforts to curb antimicrobial resistance. [The Lancet Infectious Diseases]
Increase in hospital-acquired Carbapenem-Resistant Acinetobacter baumannii infection and colonization in an acute care hospital during a surge in COVID-19 admissions — New Jersey, February–July 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) cause healthcare-associated infections that are challenging to contain, and are often linked to infection prevention and control (IPC) breaches. During a time with a surge of COVID-19 hospitalizations, a CRAB outbreak was observed in a hospital in New Jersey; 34 patients were identified as having multidrug-resistant CRAB infection or colonization during February–July 2020, including 21 (62%) treated in COVID-19 dedicated intensive care units. Changes to conventional IPC practices due to shortages in personnel, personal protective equipment (PPE), and medical equipment, were considered as important factors leading up to the outbreak. Hospitals receiving surges of patients with COVID-19 might be vulnerable to outbreaks of multidrug-resistant organism (MDRO) infections and efforts to maintain IPC best practices to the extent possible could mitigate spread. [MMWR]
Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa. Sulfadoxine-pyrimethamine (SP), despite widely reported resistance levels, is still the drug of choice for intermittent preventive treatment in both pregnancy and infancy. In a systematic analysis to assess Plasmodium falciparum resistance to SP, researchers analyzed molecular, clinical, and endemicity data covering malaria-endemic African countries from January 1998 to December 2018. By measuring mutations that drive resistance, increases in both mid-level and high-level resistance were measured in several countries across Africa. Specifically, in Malawi, Kenya and Tanzania, high-level resistance increase by 5.5% (1.0%–20.0%), 4.7% (0.5%–25.4%), and 2.0% (0.1%–39.2%), respectively from 2000-2020. The authors concluded that given the high resistance rates, under WHO protocol, SP is no longer effective for intermittent preventive treatment in most of eastern Africa and parts of central Africa. [BMJ Global Health]
Colonization with multiresistant bacteria in acute hospital care: the association of prior antibiotic consumption as a risk factor. A case-control study examining the impact of prior antibiotic consumption on multiresistant bacteria (MRB) colonization, revealed that the prevalence of ESBL-producing Enterobacteriaceae (ESBL-E) colonization was related to fluoroquinolone, macrolide, and penicillin consumption. Among 256 patients colonized with MRB and 4763 controls recruited in the study, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002) in the 2 years prior to study inclusion. The most frequently prescribed antibiotics were penicillins (68% of MRB cases versus 60% of controls; P = 0.012) and macrolides (25.4% of MRB cases versus 18.2% of controls; P = 0.004). The risk of colonization with ESBL-E increased if penicillins (OR = 1.58–1.65) or fluoroquinolones (OR = 2.25–6.15) were prescribed 2 years prior to enrolment. Findings from the study showed a clear link between commonly use antibiotics and an increased risk of MRB colonization, stressing the need for antibiotic stewardship in primary healthcare. [Journal of Antimicrobial Chemotherapy].
