COVID-19 Scan for May 04, 2021

News brief

Mortality rates for hospitalized COVID patients declined through 2020

In 2020, in-hospital mortality dropped from 19.1% in March and April to 10.8% in September through November in COVID-19 patients in the United States, according to a study yesterday in JAMA Network Open.

While some associations with age, male sex, high body mass index (BMI), and comorbidities were seen, overall, the researchers say that neither these factors nor COVID-19 severity fully explained the decline.

The researchers looked at 20,736 hospitalized COVID-19 patients in 107 hospitals. From March and April to September through November, the proportion of women increased from 43.6% to 48.4%, BMI increased from 30.4 to 31.6, and the mean age went from 62.1 to 61.4.

Average hospital length of stay also changed, going from 10.7 days to 7.5. As the study went on, patients were put on mechanical ventilation less (23.3% to 13.9%) but were prescribed supplementary oxygen on admittance more (23.0% to 35.9%). Overall, the mortality rate was 15.8% (3,271).

While mortality rates declined across all nine months, the largest drop was from March and April to May and June, going from 19.1% to 11.9% (adjusted odds ratio [aOR] for in-hospital mortality, 0.66; 95% confidence interval [CI], 0.58 to 0.76). The adjusted odds for in-hospital death were comparable the rest of the time (aOR, 0.58 for July and August, 0.59 for September through November).

"Our findings suggest that the decline in mortality could be due to overloaded hospitals and changes in treatment," lead author Gregory Roth, MD, MPH, said in an Institute for Health Metrics and Evaluation press release. Uses of azithromycin and remdesivir, for instance, spiked during the study, although no conclusive studies have been done on their benefits.

"[The study] speaks to a crucial need for information sharing and identifying hospital best practices that can prevent mortality rates from increasing again, particularly during possible future waves of COVID-19 infections."
May 3 JAMA Netw Open study
May 3 Institute for Health Metrics and Evaluation press release

Pandemic linked with mental health changes in older Americans

Almost 1 in 5 US adults ages 50 to 80 said they were experiencing worse depression or sadness since the start of the COVID-19 pandemic, and 28% reported worse anxiety or worry, according to a University of Michigan poll today.

About 46% of adults said they felt isolated, down from 56% in a spring 2020 poll but still up 28% from before the pandemic.

The poll's 2,023 respondents (who were weighted to reflect population figures) took the survey in January 2021. Since the pandemic started, mental health was more likely to be worse in women (22% vs 14% in men), people 64 or younger (20% vs 15%), White people (20% vs 17% of Hispanics and 15% of Black people), and those with a college degree or more (22% vs 18% in those with some college;16% with a high school degree or less).

People with fair or poor health were also more likely to say their mental health had worsened since the start of the pandemic (24% vs 17%).

Almost 90% (87%) said they are at least somewhat comfortable talking about their mental health, and most said they would talk to their primary care provider (31%) compared with a mental health professional (25%), spouse or partner (25%), or family and friends (11%).

Nearly one in three (29%) said they had made a lifestyle change to improve their mental health since the pandemic started, and 13% said they already had talked to a primary care provider about a new mental health concern. While 71% say they wouldn't hesitate to see a mental health provider in the future, 29% said they didn't think a professional would be helpful (21%), they were embarrassed (16%), or they had concerns about the cost (14%).

"With most older adults getting vaccinated, it's important to ensure adequate access to mental health screening and care to detect and address any lingering effects of this prolonged period of stress," said Lauren Gerlach, DO, MSc, in a press release. Gerlach worked with the poll team at the University of Michigan.
May 4 University of Michigan study and press release

News Scan for May 04, 2021

News brief

Bipartisan group of lawmakers urges more funding for AMR response

A bipartisan group of congressional representatives called on House appropriators last week to increase funding for the federal response to antimicrobial resistance (AMR).

In a letter signed by more than 60 lawmakers from both parties, Rep. Chellie Pingree, D-Maine, and Rep. Buddy Carter, R-Ga., said Congress must fully support the funding necessary to significantly reduce the burden of AMR. Among the requests was $672 million in Fiscal Year 2022 for the Centers for Disease Control and Prevention's (CDC's) Antibiotic Resistance Solutions Initiative, $100 million to expand AMR data collection through the CDC's National Healthcare Safety Network, and $600 million to improve AMR research capacity at the National Institute of Allergy and Infectious Diseases.

"Drug-resistant infections sicken at least 2.8 million and kill at least 35,000 people annually in the U.S.," the lawmakers wrote to the House Appropriations Committee. "Globally, over 700,000 people die each year accounting for a cost as high as $1.2 trillion. If we do not act now, by 2050 antibiotic resistant infections will be the leading cause of death—surpassing cancer—and could cost the world $100 trillion."

Citing the need for new antibiotics and the financial challenges of antibiotic development, the letter also requested $300 million for the Biomedical Advanced Research and Development Authority and CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) to boost development of innovative antibacterial products, and $200 million for the Project BioShield Special Reserve Fund for broad-spectrum antimicrobials.

"The pipeline of new antibiotics in development is insufficient to meet patient needs," Pingree and Carter wrote. "The imminent collapse of the antibiotic market is exacerbating this threat, and small companies that are responsible for nearly all current antibiotic innovation are facing bankruptcy because factors unique to antibiotics, including the need for judicious use, make it challenging for companies to earn a return on investments in antibiotic research and development."
Apr 28 Congressional letter

H9N2 avian flu infects 1 more person in China

China reported one more H9N2 avian influenza infection, this time involving a 30-year-old woman from Guangdong province, marking the country's 12th case of the year, according to an update from the World Health Organization (WHO) Western Pacific regional office.

The woman had mild symptoms that began on Apr 20. The report didn't say if she had contact with poultry or if illnesses were found in her contacts.

The H9N2 avian flu strain is known to circulate in poultry in China and other nations, and sporadic infections are reported in humans, especially those who have contact with poultry. Sustained transmission hasn't been known to occur. Infections are usually mild, and many of the cases have been reported in children.
Apr 30 WHO Western Pacific regional office update