California healthcare industry had highest COVID-19 death rate of all occupations early in pandemic

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Healthcare worker taking temperature — UN Women Asia & Pacific / Flickr cc

In the first 2 years of the COVID-19 pandemic, Californians who worked in healthcare, "other services," manufacturing, transportation, and retail trade industries had higher death rates than the professional, scientific, and technical industries, which had some of the lowest rates, finds a study published today in the Annals of Epidemiology.

California Department of Public Health researchers used death certificates to identify COVID-19 deaths that occurred from January 2020 to May 2022 among 17.7 million residents ages 18 to 64 years. They also used the Current Population Survey to estimate the number of working-age adults at risk of COVID-19 death.

Pandemic waves were categorized as wave 1 (March to June 2020), wave 2 (July to November 2020), wave 3 (Epsilon and Alpha variants, December 2020 to May 2021), wave 4 (Delta, June 2021 to January 2022), and wave 5 (Omicron, February to May 2022).

Disparities, increased exposure noted

COVID-19 made up 12.2% of all 176,845 working-age deaths, with the highest death count (8,759) in wave 3 (Epsilon and Alpha variants). Healthcare (wave 1 mortality rate ratio [MRR], 2.49), other services (wave 4 MRR_,2.89), manufacturing (wave 2 MRR_,2.01), transportation (wave 4 MRR_,2.64), and retail trade industries (wave 5 MRR_,1.87) had higher death rates than the professional, scientific, and technical industries, which had some of the lowest mortality rates.

Industries that consistently had disproportionate burden of the COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.

Healthcare saw the highest relative death rate earlier in the pandemic, which declined over time, while other services, utilities, and accommodation and food services saw substantial increases in MRR in later waves.

Workers in certain industries accounted for a greater percentage of COVID-19 deaths than expected given their share of the workforce, including men (74% of COVID-19 deaths, 54% of workforce), workers aged 50 to 64 years (70%, 27%), those without a college degree (64%, 33%), foreign-born workers (52%, 33%), and Latinos (61%, 40%).

"Industries that consistently had disproportionate burden of the COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes," the study authors wrote.

Study shows value of wastewater surveillance for early detection of flu, RSV

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Stephanie Soucheray, MA

Today in Morbidity and Mortality Weekly Report, researchers in Wisconsin show how during the 2022-23 respiratory diseases season, high concentrations of influenza A virus and respiratory syncytial virus (RSV) in wastewater samples in three Wisconsin cities preceded virus-associated emergency department (ED) visits.

The authors say the study provides more evidence that wastewater surveillance can detect viral signals earlier than other surveillance methods.

Samples from 40 treatment plants

Wastewater testing rose in prominence during the COVID-19 pandemic, as detections accurately predicted spikes in viral activities in communities. In the present study, researchers collected wastewater samples from 40 treatment plants in Wisconsin’s biggest cities—Milwaukee, Madison, and Green Bay—at least once per week from August 2022 through March 2023.

ED visit data was linked to patients with a Green Bay, Madison, or Milwaukee residential zip code. A total of 6,271 flu-associated ED visits and 1,518 RSV-associated ED visits were reported from August 2022 to March 2023.

Wastewater surveillance might help supplement established clinical surveillance for these viruses.

The authors found a positive correlation between wastewater surveillance and ED visit data, with detections increasing in the 1 to 2 weeks before a rise in clinical cases was observed. Moreover, viral shedding occurred in wastewater samples for up to 3 weeks after the viruses peaked in communities.

"RSV peaked in early November, and influenza peaked approximately 1 month later," the authors wrote. "The positive correlation between wastewater surveillance and ED visit data for both influenza and RSV, along with the detection of the two pathogens in wastewater before increases in associated ED visits, suggests that wastewater surveillance might help supplement established clinical surveillance for these viruses."

Nipah virus infections in India's Kerala state rise to 5

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Jim Wappes

Nipah virus particles — NIAID / Flickr cc

In the latest in a deadly outbreak of Nipah virus infections in Kerala, India, a 24-year-old healthcare worker who was exposed to a Nipah patient has tested positive, according to the Hindustan Times and other media sources. The newest infection in Kozhikode district raises the outbreak total to five cases, two of which have proved fatal.

Officials are tracking as many as 706 people on the contact list, with 77 listed as high risk and 153 as healthcare workers who are not in the high-risk category. The government has advised high-risk contacts to remain inside their homes, and 13 people are hospitalized under observation with mild symptoms, NewsBytes reports.

Avian Flu Diary, an infectious disease blog, says tests on 11 people are pending.

Young boy in ICU

Kerala Health Minister Veena George said officials have ordered monoclonal antibody therapy to treat a 9-year-old boy with Nipah who is on a ventilator in the intensive care unit in Kozhikode district. It is the only available antiviral treatment for Nipah virus infection, though it has not been clinically proven, George said.

"We have ordered the monoclonal antibody with the ICMR (Indian Council of Medical Research) and it would be brought to Kozhikode soon. The imported medicine is already available with the ICMR," she said.

We are focusing on tracing contacts of infected persons early and isolating anyone with symptoms.

The outbreak, which began August 30, is Kerala's fourth Nipah outbreak since 2018 and has resulted in authorities' declaring containment zones in at least eight Kozhikode villages.

"We are focusing on tracing contacts of infected persons early and isolating anyone with symptoms," George told reporters. She said the virus detected in Kerala is the same as one confirmed earlier in Bangladesh, and it spreads from human to human with a high death rate but is typically less infectious.