Dexamethasone tied to lower risk of death, severe COVID-19

The corticosteroid dexamethasone was associated with a 56% lower risk of death and intensive care unit (ICU) admission among hospitalized COVID-19 patients and is safe to use in monitored diabetes patients, according to research presented at this week's Society for Endocrinology annual conference in Edinburgh, Scotland.

The unpublished observational study involved data from 1,372 COVID-19 patients admitted to Imperial College NHS Trust hospitals during the second pandemic wave (Nov 1, 2020, to Jan 31, 2021), when dexamethasone was routinely used in COVID-19 patients, and 889 patients admitted during the first wave (Mar 9 to Apr 22, 2020), before the anti-inflammatory drug was used in these patients.

Dexamethasone was tied to a 56% lower risk of death by 30 days and a 56% lower rate of ICU admission. And while patients with diabetes who take dexamethasone are at higher risk of high blood glucose (odds ratio, 22.5) and poor COVID-19 outcomes, the risk of death or ICU admission in the study was not higher in patients with these complications. These patients did, however, require the use of extra medications to control blood glucose and prevent serious diabetes complications.

The death rate was significantly lower in second-wave than in first-wave patients (18.8% vs 27.6%), for a 31.8% reduced risk. Risk factors for death included male sex, high blood pressure, frailty, and impaired kidney function.

Rates of ICU admission were not different between the two pandemic waves, which the authors said could be attributed to the emergence and dominance of SARS-CoV-2 variants during that time.

The researchers noted that dexamethasone has been used routinely in patients needing supplementary oxygen and mechanical ventilation since it was shown to improve their outcomes in the RECOVERY trial in 2020.

Senior author Victoria Salem, MB BS, PhD, said in a Society for Endocrinology news release that the team had been worried that dexamethasone could be a "double-edged sword" for diabetes patients.

"And while we did see an increase in steroid-induced diabetes and worsened diabetes, deaths were significantly reduced in wave two for all patients," she said. "We now feel confident using dexamethasone for patients with diabetes in the future, just with the caveat that it may result in a short-term worsening of their condition."
Nov 9 Society for Endocrinology abstract and news release

Previous SARS experience does not assuage healthcare COVID-19 stress

A study today in PLOS One shows that healthcare workers' (HCWs') previous experience with the 2003 SARS outbreak neither prevented them from experiencing emotional distress nor increased their distress during the COVID-19 pandemick.

The study was based on an online survey from May to July 2020 of 3,852 HCWs in the greater Toronto area, including 1,256 nurses, 345 physicians, 1,034 allied health staff, and 1,243 non-clinical staff. Almost 30% had worked in healthcare during the 2003 SARS (severe acute respiratory syndrome) outbreak in Canada.

Half of respondents (50.2%) exhibited signs of post-traumatic stress disorder (PTSD), and 31.5% had symptoms of depression. Those who worked during the SARS outbreak experienced lower scores of PTSD (P = 0.002) and depression (P < 0.001), but these differences were not significantly significant after adjusting for age and career experience.

Non-clinical staff were more likely to suffer PTSD, depression, and anxiety, a trend also seen in studies based on workers in Singapore and the United States.

"Non-clinical staff may experience less control over their work situations and lower self-efficacy as it relates to core medical knowledge and receive less dedicated education relating to the pandemic compared to clinical HCWs which may account for this observed difference," the authors wrote.

In an accompanying author interview, first author Rima Styra, MD, MEd, of University Health Network, Toronto, said survey respondents also reported new or increasing use of alcohol and sedatives, and new sleep disturbances.

"Sleep disturbances may signal that wellbeing is impacted," she said.
Nov 10 PLOS One study

Wisconsin probes CWD detection at another deer farm

Agriculture officials in Wisconsin yesterday reported that a white-tail deer at a deer farm in Eau Claire County has tested positive for chronic wasting disease (CWD).

In a statement the Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) said the 3-year-old buck that tested positive was part of an approximate 15-deer herd at the hunting ranch. Eau Claire County is in west central Wisconsin.

The other animals are under quarantine during the state and federal investigation. The farm received the animal from a deer farm in Waukesha County, which has also been placed in quarantine.

Earlier this year, CWD was detected at deer farms in other Wisconsin counties, but Waukesha wasn't one of them.

CWD is a fatal prion disease that affects cervids like deer, elk, and moose and is a growing threat to deer herds. No human cases have been reported, but health officials warn against eating meat from CWD-infected animals due to the risk of contracting an illness similar to bovine spongiform encephalopathy ("mad cow" disease), which is also caused by prions.
Nov 9 Wisconsin DATCP statement

High-path avian flu outbreaks strike poultry in Japan, South Korea, Europe

Japan and South Korea today reported their first highly pathogenic avian flu poultry outbreaks of the season, and Germany reported another highly pathogenic H5N1 outbreak in poultry, according to the latest official and media reports.

Japan's agriculture ministry said the outbreak occurred at a layer farm in Akita prefecture that had reported an increasing number of bird deaths, according to a statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The report didn't say what subtype was involved.

South Korea's outbreak involved H5N1 at a quail farm in North Chungcheong province, KBS News reported. The country had recently reported two H5N1 outbreaks in wild birds, in North Jeolla and South Chungcheong provinces.

In Europe, Germany reported another H5N1 outbreak, this time at a farm that housed backyard ducks and layers in Mecklenburg-Vorpommern state, according to a notification from the World Organization for Animal Health (OIE). And Italy reported two H5N1 outbreaks in wild birds, both in Lombardy province. In both instances the virus was detected in hunter-harvested waterfowl.

In an updated risk assessment today, the United Kingdom's Department for Environment, Food, and Agriculture (DEFRA) raised the risk of highly pathogenic H5 virus spread in wild birds from medium to high, based on an increased frequency of H5N1 detections in both wild birds and poultry since its last report in late October. For poultry, it put the risk at low to medium, based on biosecurity conditions.
Nov 10 AFD post
Nov 10 KBS News story
Nov 9 OIE report on H5N1 in Germany
Nov 9 OIE report on H5N1 in Italy
Nov 10 DEFRA update