Adult COVID-19 patients exposed to air pollution spent an average of 4 extra days in the hospital, further overwhelming health systems, concludes a Belgian study published yesterday in the European Respiratory Journal.

For the study, experts collected blood and urine from 328 unvaccinated COVID-19 patients admitted to one of two hospitals in Belgium from May 2020 to March 2021, 29% of whom required intensive care. The team modeled daily exposures to particulate matter (PM), nitrogen dioxide (NO₂), and black carbon (BC) from 2016 to 2019 and measured BC particles in the blood using pulsed laser illumination.

Patients diagnosed as having COVID-19 from May 2020 to mid-February 2021 were infected with the wild-type virus, while most patients recruited from mid-February 2021 to March 2021 were infected with the Alpha variant. Average age was 65.7 years, and 43.6% were women.

Pollution equivalent to being 10 years older

All levels of exposure were below the European Union pollution threshold. The average hospital length of stay was 16.9 days. An interquartile range (IQR) increase in exposure in the week before hospitalization was tied to a roughly 4-day longer stay (4.2 days for PM and 4.3 days for NO₂. Comparable findings were seen for long-term NO₂ and BC exposure.

The effects of pollution on hospital length of stay were equivalent to the effect of a 10-year increase in age, and an IQR rise in blood BC concentrations increased the likelihood of requiring intensive care by 36%.

People who were exposed to air pollution, even at relatively low levels, were sicker and needed more time in hospital to recover.

Each 10-year increase in age correlated with an extra 2.4 days of hospitalization, and men were hospitalized for an average of 4.0 days longer than women. Conversely, reducing pollution exposure was an estimated 40% to 80% as effective in shortening hospitalization as some of the best available treatments.

"Our findings indicate that people who were exposed to air pollution, even at relatively low levels, were sicker and needed more time in hospital to recover," senior author Tim Nawrot, PhD, of Hasselt University, said in a European Respiratory Society press release.

The rate of eating disorder diagnoses among UK girls 13 to 16 years old during the first 2 years of the pandemic was 42% higher than expected, according to a study yesterday in The Lancet Child & Adolescent Health. The study also found that rates of self-harm increased 38%.

The study was based on health record from 9,184,712 patients aged 10 to 24 years (52.7%  female and 47.3% male) from January 1, 2010, to March 31, 2022. Using models, the study authors predicted the expected rates of eating disorders and self-harm, had the pandemic not occurred, from March 2020 to March 2022.

The authors found that, among 13- to 16-year-old girls, the rate of eating disorder diagnoses was 42.0% higher than expected (95% confidence interval [CI], 25.7% to 61.3%), with 3,862 observed cases compared with 2,713 projected cases. In the same cohort, the rate of self-harm diagnoses was 38% higher than expected, with 9,174 observed cases and 6,631 projected cases.

Rates were also 32.0% (95% CI, 13.3% to 53.8%) higher than expected for girls aged 17 to 19 years, whereas other age-groups showed little difference between observed and expected incidence, the authors said.

Rates for boys for both eating disorders and self-harm were lower than expected, by as much as 22.8% (95% CI, 9.2% to 34.4%) for eating disorders and 11.5% (95% CI, 3.6% to 18.7%) for self-harm.

The authors conclude that their findings indicate an urgent need for intervention.

Maintaining vigilance

In a related commentary, psychiatrist Tamsin Ford, MB BS, at the University of Cambridge, wrote, "All individuals who work with children, young people, and families should be alert to both eating disorders and self-harm in their clientele, as young people frequently conceal both these difficulties."

Young people frequently conceal both these difficulties.

"Although children and young people's services might currently bear the burden of the increased incidence, these data are a warning signal for adult mental health services, as both eating disorders and self-harm frequently persist and co-occur with other mental health conditions."

The World Health Organization (WHO) today announced that it has certified Belize as free of malaria, a culmination of a more than 70-year effort to stamp out the disease.

In its announcement, the WHO said Belize went from a peak of 10,000 cases in 1994 to 0 indigenous cases in 2019. It said the country took strategic steps to dramatically reduce its malaria burden, which included strong surveillance and vector control, which in 2015 were reoriented to focus on high-risk areas. The agency also added that trained health workers have played a key role in timely diagnosis and treatment.

This is an extra-ordinary achievement for Belize.

Jarbas Barbosa, MD, PhD, MPH, director of the WHO's Pan American Health Organization (PAHO), said Belize is the fourth country in the Americas to be certified as malaria-free and is the second in Central America to achieve the status in the past 5 years.

"This is an extra-ordinary achievement for Belize, and will also serve as inspiration for the other endemic countries in the Americas," he said. To be certified as free of malaria, a country must provide strong evidence that the chain of transmission from Anopheles mosquitoes has been interrupted nationwide for 3 consecutive years.

Possible El Nino impact on mosquito-borne illness

In related news, at a WHO media briefing on a host of global health issued today, Director-General Tedros Adhanom Ghebreyesus, PhD, said Peru is battling its worst dengue outbreak, with about 150,000 suspected cases so far, about half of them lab-confirmed. Peru has declared a state of emergency, and the outbreak has put a heavy burden on the country's health system.

Tedros said the WHO is preparing for a very high probability that 2023 and 2024 will be marked by an El Nino event, which could increase the transmission of dengue and other arboviruses such as Zika and chikungunya viruses. He added that the effects of climate change are also fueling mosquito breeding and the spread of mosquito-borne viruses.

A systematic review of studies on neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) infections indicates the pathogen is emerging as a severe threat to hospitalized newborns, particularly those in low- and middle-income countries (LMICs), researchers reported yesterday in PLOS Medicine.

The review by UK and Chinese researchers included 128 studies involving 127,583 neonates in 30 countries, including 21 LMICs, and documented 2,057 CRKP isolates collected from infected or colonized infants from 2005 to 2020. The most common sample type from infected newborns was blood (37.3%), suggesting that bloodstream infection is the main type of neonatal CRKP infection.

Among the 23 studies that reported on prevalence, the pooled prevalence of CRKP infection in hospitalized newborns was 0.3% (95% confidence interval [CI], 0.2% to 0.3%), with a significantly higher prevalence observed in Asian countries (0.7%; 95% CI, 0.4% to 1.0%) than African countries (0.3%; 95% CI, 0.1% to 0.4%). Among the 21 studies that reported on outcomes, the pooled mortality was 22.9% (95% CI, 13.0% to 32.9%).

Analysis of 535 neonatal CRKP genomes identified 146 sequence types (STs) for CRKP strains and found that ST17, ST11, and ST15 were the three most common, with ST17 documented in newborns in eight countries across four continents. Most neonatal CRKP strains (75%) carried a metallo-beta-lacatamase (MBL) gene, with New Delhi metallo-beta-lactamase the most common (64.3%) carbapenemase type, which suggests that treatment options for many neonatal CRKP infections could be limited.

Substantial global burden

The study authors say the findings indicate that neonatal CRKP infections poses a significant health burden worldwide.

"Global data on neonatal admissions are not available, but when considering these early or premature neonates only, there could be at least 60,000 estimated cases of neonatal CRKP infections with at least 5,880 estimated deaths worldwide," they wrote.

There could be at least 60,000 estimated cases of neonatal CRKP infections with at least 5,880 estimated deaths worldwide.