News Scan for Jun 16, 2021

News brief

Study: Nursing homes with predominant minority populations bore bigger COVID impacts

An analysis of data from 211 Connecticut nursing homes found that facilities that cared for mainly racial and ethnic minority residents had higher levels of COVID-19 illnesses and deaths. A team based at the University of Rochester in New York reported their findings today in Infection Control & Hospital Epidemiology.

The 10-week time span they focused on was Apr 12, 2020, to Jun 19, 2020. Authors noted that Connecticut is one of the few states that kept weekly counts of COVID cases and deaths back to April 2020. In addition to state department data on nursing home cases and deaths, they also used Brown University data on nursing home characteristics to categorize the nursing homes as having low, medium, medium-high, and high proportions of ethnic and racial minorities.

Aside from finding that facilities caring for predominantly minority residents had more COVID illnesses and deaths, the study showed that differences became more pronounced over time. Differences between low and high minority proportions increased by 25% to 30% from week 1 to week 10, and in week 10, incidence was 54% higher in facilities with high proportions of minority residents, with the fatality rate 117% higher.

Researchers said their results confirm the findings of earlier studies and that similar disparities have been noted before the COVID pandemic, a sign that systemic disparities still exist. They said nursing homes serving minority populations can have resource challenges, such as lack of testing and limited capacity to respond to outbreaks. Also, the team said workers in the facilities are people of color and immigrants, who are known to contract COVID at higher rates than the rest of the population.

"The increasing racial and ethnic disparities in COVID-19 outcomes documented in our study can serve as an important benchmark for future studies that continue to track nursing-home COVID-19 outcomes as the pandemic evolves," the group wrote.
Jun 16 Infect Control Hosp Epidemiol abstract

 

Parents, women medical faculty more likely to suffer during pandemic

Parenting and gender are each associated with a higher likelihood to leave, reduce hours, or pass on leadership opportunities, according to a survey of academic medical faculty yesterday in JAMA Network Open conducted during the COVID-19 pandemic.

From Sep 1 to 25, 2020, 1,186 medical, graduate, and health professional school faculty at the University of Southwest Texas in Dallas responded to the survey about their thoughts before and after the COVID-19 pandemic started. Most respondents were women (54.7%) or White (57.5%). Parents of those 18 or younger made up 55.0% of the cohort, of which 55.7% had to help with distance learning during the pandemic on their own or with a partner. The researchers note that not all respondents answered every question.

Overall, the pandemic is correlated with an increased consideration of leaving (23% vs 14%) and reducing work hours (29% vs 22%). Women were more likely than men to consider reducing their hours before the pandemic began (28% vs 12%); after the pandemic began, they were more likely to consider leaving or reducing their hours (28% vs 15% and 40% vs 13%, respectively). Faculty who were parents were more likely to consider leaving or reducing employment after the pandemic started than before (29% vs 17% and 40% vs 24%, respectively). Women with children versus women without were also more likely to consider leaving since the pandemic began (35% vs 17% before COVID-19).

The researchers add that faculty who were parents or women were more likely to decline leadership opportunities before and after the pandemic, with point percentage differences ranging from 14 to 24.

"The association of both gender and parenting with increased perceived work-life stress may disproportionately decrease the long-term retention and promotion of junior and midcareer women faculty," the researchers write. "Without true change in the culture of medicine to support work-life integration and family-friendly work policies, further disillusionment in academic careers may occur and threaten the future of academic medicine as an institution."
Jun 15 JAMA Netw Open study

 

H5N8 strikes birds in Albania and China

Two countries reported more detections of highly pathogenic H5N8 avian influenza in birds, Albania in backyard poultry and China in waterfowl, according to the latest notifications from the World Organization for Animal Health (OIE).

Albania reported outbreaks on three farms that began between May 21 and Jan 4. The events occurred in Tirana County in the central part of the country, Kukes County in the northeast, and Durres County in the west. Taken together, the virus killed 158 of 590 susceptible birds. The source of the virus isn't known, but contact with wild species is suspected.

Elsewhere, China reported an H5N8 outbreak in wild birds at a nature park in Shaanxi province in the country's northwest. The outbreak started on May 28, and the virus has killed 4,249 black-necked grebes.
Jun 16 OIE report on H5N8 in Albania
Jun 15 OIE report on
H5N8 in China

Stewardship / Resistance Scan for Jun 16, 2021

News brief

US lawmakers re-introduce the PASTEUR Act

US lawmakers today re-introduced a bill to reinvigorate the antibiotic development market.

Originally introduced in September 2020, the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act would establish a subscription-style payment model for new antibiotics, under which companies that develop innovative, critically-needed antibiotics for drug-resistant infections would receive a contract from the federal government ranging from $750 million to $3 billion. In return, the drug would be made available for patients covered by federal insurance programs, and the companies would be required to support appropriate use and post-marketing studies.

The model would be fully de-linked, so companies that receive contracts would not receive income based on sales volume. The sales-based model has hindered antibiotic development because antibiotics are expensive to develop but are used for short periods of time and need to be used judiciously to maintain their effectiveness, and therefore don't generate enough revenue for companies. Many large pharmaceutical companies have abandoned antibiotic development, while smaller companies struggle to survive.

The aim of the bipartisan legislation, which was re-introduced by Sen. Michael Bennet (D-Colo.), Sen. Todd Young (R-Ind.), Rep. Mike Doyle (D-Pa.), and Rep. Drew Ferguson (R-Ga.), is to help address the broken market for new antibiotics and ensure domestic availability when needed.

"Tens of thousands of Americans die each year from antimicrobial-resistant infections," Rep. Doyle said in a press release. "Infectious disease experts agree that antimicrobial resistance is an urgent public health threat that requires a comprehensive, effective solution now. The PASTEUR Act will help scientists and researchers bring better antimicrobials to market, and it will help hospitals and doctors ensure these drugs are used properly."    

Antibiotic resistance and development experts say the legislation is necessary for fixing the antibiotic pipeline and addressing the growing threat of drug-resistant infections.

"The bipartisan PASTEUR Act would establish a new avenue of federal support for the development of new antibiotics that are critically needed for patient care and public health," the Infectious Diseases Society of America (IDSA) said in a statement. "IDSA will continue to urge Congress to advance the PASTEUR Act and the important solutions to a national health crisis that it provides."
Jul 16 Senate press release
Jul 16 IDSA statement

 

WHO supports shorter regimen for drug-susceptible TB

The World Health Organization (WHO) said this week that, based on data from a recent phase 3 clinical trial, it will recommend a shorter treatment regimen for drug-susceptible tuberculosis (TB).

In a rapid communication intended to inform national TB programs, technical partners, and other stakeholders, the WHO said a review of Study 31 findings by members of the Guideline Development Group indicated a 4-month regimen composed of rifapentine, isoniazid, pyrazinamide, and moxifloxacin was non-inferior to the standard 6-month regimen for drug-susceptible pulmonary TB and was equally well tolerated.

The trial, which involved more than 2,500 newly-diagnosed TB patients from 13 countries, compared two 4-month regimens, one with moxifloxacin and one without, to the standard 6-month regimen. The results were published May 6 in the New England Journal of Medicine.

The 6-month regimen has been the standard for drug-susceptible TB for decades, but the TB treatment community has long sought a shorter regimen that could improve treatment adherence and reduce drug costs and adverse effects.

"The 4-month regimen, which is shorter, effective and all-oral, would be a preference for many patients and also national TB programmes, allowing faster cure and easing the burden on both patients and the healthcare system," the WHO said, adding that the implementation and uptake of the regimen will be more feasible if the cost of rifapentine is reduced. The agency also noted that appropriate use of the regimen will need to be ensured, since moxifloxacin is usually used for treatment of drug-resistant TB.

The WHO said updated guidelines for drug-susceptible TB treatment will be released later in 2021.
Jun 14 WHO rapid communication
May 6 N Engl J Med study

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