COVID-19 Scan for Jun 14, 2021

News brief

US physician COVID deaths hit international grads harder, data show

International medical graduate physicians, or IMG physicians, make up about 25% of the practicing physicians in the United States, but they have made up 45% of COVID-related physician deaths, according to a JAMA Network Open research letter late last week. After stratifying data by state, however, only New York showed a significant difference between the proportion of international and US medical graduate (USMG) physician deaths.

The researchers used investigations conducted by MedPage Today, MedScape, and a collaboration between The Guardian and Kaiser Health News to identify COVID-related physician deaths through Nov 23, 2020. Data showed 132 deaths in 28 states. IMG physicians made up 59 of these deaths (44.7%), 1.80 times higher than the national average (95% confidence interval [CI], 1.51 to 2.21). New York, New Jersey, and Florida accounted for 66.1% of IMG physician deaths but only 45.2% of USMG physician deaths.

Overall, the researchers note that all states except New York had statistically insignificant differences between their proportion of IMG versus USMG physician deaths. "However, the authors add, "67% (89 of 132) of physician deaths occurred in states where the proportion of practicing IMG physicians is greater than the national proportion of 25%."

Almost 60% of deceased physicians were in primary care (59.8%), which is 1.62 times higher than the national average of primary care physicians (95% CI, 1.39 to 1.84), the researchers write. Additionally, 38 deceased primary care physicians were IMGs, which is 2.90 times higher than the proportion of primary care IMG physicians in the country (95% CI, 2.13 to 3.65). USMG physicians in primary care, on the other hand, saw statistically insignificant COVID death rates compared with their proportion in the workforce (risk ratio, 1.15; 95% CI, 0.89 to 1.48).

"A possible reason for [these results] is the observation that the majority of physician deaths occurred in states with relatively larger proportions of IMGs, which were also the states with higher incidence of COVID-19 at the onset of the pandemic," write the researchers. "It is also possible that IMGs in a few states (eg, New York) had higher exposure to COVID-19 because of their practice settings; 40% of IMGs work in primary care. These findings mirror a report from the UK on the high proportion of immigrants among 18 physicians who died of COVID-19."
Jun 11 JAMA Netw Open study

Health workers should wear N95s in community surges, researchers say

Healthcare providers should wear N95 respirators when COVID-19 rates are high in the community, not just if they're dealing directly with COVID-19 patients, as recommended by the Centers for Disease Control and Prevention.

The commentary, published in Clinical Infectious Diseases late last week, outlines three reasons. First, the Harvard University researchers point to evidence that patients are most contagious just before and immediately following symptom onset as well as studies that show that asymptomatic and pre-symptomatic people account for the most secondary transmissions. If unsuspected patients are still incubating or acquire COVID-19 infection after healthcare admittance, the researchers write, they might more easily spread the disease since their contagiousness will peak while in the healthcare setting.

Second, patients with known or suspected COVID-19 are often treated in settings with stricter safety protocols (eg, negatively pressurized, ventilated rooms), and healthcare workers tend to better adhere to personal protective equipment (PPE) guidelines. The researchers write, however, that providers are generally more lax when they assume their patients are not infected with COVID-19, putting them at increased risk for infection.

And third, compared with medical masks or less protective respirators, N95s would better prevent healthcare providers from transmitting the virus from infected COVID-19 patients to non-infected patients, according to the authors.

"If N95s are appropriate to protect healthcare workers seeing patients with confirmed Covid-19 then it follows that they are also appropriate to protect healthcare workers seeing asymptomatic patients in outpatient and inpatient settings when the incidence of Covid-19 is high," the researchers write. They add that vaccinating healthcare workers and patients is "ultimately the most powerful way to reduce the risk of transmission."
Jun 11 Clin Infect Dis commentary

Kids and adults with symptoms found to have more SARS-CoV-2 viruses

SARS-CoV-2 RNA levels were significantly higher in symptomatic than asymptomatic patients, but there were no significant differences in children versus adults, according to a study in JAMA Pediatrics late last week.

The researchers looked at positive SARS-CoV-2 reverse transcription-polymerase chain reaction results from 123 children and 432 adults in King County, Washington, Mar 23 to Nov 9, 2020. Most were healthy: Seasonal allergies (7.3%) were the most frequent health condition, followed by asthma (4.1%). Of the children, 40.7% were younger than 5 years, 36.6% were between ages 5 and 11, and 22.8% were 12 to 17. The researchers add that, in this convenience-based sample, children had fewer and shorter symptoms than adults (average, 1.6 vs 4.5 symptoms; 3.8 vs 4.9 days, respectively). They were also more likely to be asymptomatic (38.2% vs 7.2%).

The team used cycle threshold (Ct) values as a proxy for viral load; the lower the Ct value, the higher the viral RNA load. After adjusting for swab type, the average Ct values for symptomatic versus asymptomatic patients showed no statistical significance when stratified by age. Overall, symptomatic individuals had lower Ct values than asymptomatic ones (adjusted for children, -3.0; 95% CI, -5.5 to -0.6; P = 0.02; versus adults, -2.9; 95% CI, -2.2 to 0.9; P = 0.01).

An editorial by Christina A. Rostad, MD; Satoshi Kamidani, MD; and Evan J. Anderson, MD; contextualize the findings within discussions of in-person schooling. The say the study "underscores the potential transmission risk of symptomatic children and the importance of isolating while symptomatic," and add, "Extracurricular activities are important in SARS-CoV-2 transmission, and measures to prevent transmission should be used."

The editorial authors advocate for COVID-19 vaccination of children, educators, and school staff, as well as multi-layered mitigation strategies to prevent transmission.
Jun 11 JAMA Pediatr study and editorial

News Scan for Jun 14, 2021

News brief

Afghanistan launches 3-day polio vaccination campaign

Today officials from UNICEF, the World Health Organization (WHO), and the Ministry of Public Health of Afghanistan launched a 3-day polio vaccination campaign targeting 9.9 million children younger than 5 years, the third national campaign this year.

Polio remains endemic in Afghanistan, and outbreaks increased in 2020 due to disruptions to vaccination efforts caused by the COVID-19 pandemic. The country reported both wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks last year.

According to the WHO, so far in 2021, 1 WPV1 and 40 cVDPV2 cases have been confirmed in Afghanistan, all in areas that vaccinators have been unable to access.

"We remain committed to eradicating polio," said Luo Dapeng, PhD, the WHO representative to Afghanistan. "We learnt valuable lessons during the initial stages of the COVID-19 pandemic last year. These combined with the polio programme's experience of managing health emergencies are important in helping us to safely continue delivering polio vaccination as we head towards a third wave of COVID-19."

In addition to polio vaccines, the campaign will include distribution of albendazole deworming tablets.
Jun 14 WHO notice

Cholera vaccination campaign targets Ethiopia's Tigray region

Ethiopian health officials and the WHO today launched a preventive oral cholera vaccination campaign targeting 2 million people in the Tigray region, where conflict has displaced more than 2 million people, most of them within the region.

In a statement, the WHO's African regional office said the region is prone to cholera outbreaks, with crowded unsanitary camps and the upcoming rainy season putting the community at greater risk.

Health officials from Ethiopia are leading the campaign, with support from the WHO and its partners. The vaccine was provided by the International Coordinating Group on Vaccine Provision with funding from GAVI, the Vaccine Alliance.

The campaign is targeting those ages 1 and older in 13 of Tigray's priority districts.
Jun 12 WHO African regional office statement

CDC warns of RSV increase in southern states

The US Centers for Disease Control and Prevention (CDC) recently issued a Health Alert Network (HAN) advisory about an increase in interseasonal respiratory syncytial virus (RSV) activity in parts of the South.

RSV activity declined in April 2020, likely due to COVID-19 measures, and activity stayed low until late March 2021, when RSV detections started to rise. The CDC noted increases in two of its regions: the one that covers most of the Southeast and the mid-southern region, which extends as far west as New Mexico.

The interseasonal activity makes it difficult to predict disease spread, the CDC said. It also noted that Australia reported a similar spike at the end of 2020, as did South Africa in early 2021. "Still, RSV did not reach seasonal peak levels in most regions or result in widespread circulation," it added.

The CDC encourages broader testing for RSV among those who test negative for COVID-19. It warned that, because of decreased circulation during earlier pandemic months, older infants and toddlers might be at increased risk of severe RSV illness, since they probably haven't been exposed in the past 15 months. The CDC also urged healthcare providers, childcare workers, and long-term care workers with symptoms to stay home when sick, even if they test negative for COVID.
Jun 10 CDC HAN notice