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The Center For Disease Dynamics, Economics & Policy

Child mental health and COVID-19 lockdown; Subway use and COVID-19 incidence and deaths in New York City; Origins of mobile antibiotic resistance genes; Novel 6-Month treatment for drug-resistant Tuberculosis in United States.


Child mental health in England before and during the COVID-19 lockdown. Very few studies have measured the effect of the COVID-19 pandemic on children’s mental health. In a letter to The Lancet Psychiatry, researchers presented initial results from the follow-up of England’s Mental Health of Children and Young People (MHCYP) survey and considered clinical and policy implications. Among 5-16 year olds, the incidence of reported mental health problems increased from 10.8% in 2017 to 16.0% in 2020. Mental health problems were more likely among children with a parent in psychological distress; children with probable mental health problems were over two times as likely to live in households struggling to pay bills, rent, or mortgage payments. Twelve percent of children did not have reliable internet access at home. Findings from the MHCPY are crucial in providing evidence to back policies providing support for parents, strengthening social protection systems, and keeping schools safely open.   [The Lancet Psychiatry]

Correlation of subway turnstile entries and COVID-19 incidence and deaths in New York City. Researchers looked at turnstile entries at Metro Transit Authority subway stops in New York City as a predictor for the severity of the COVID-19 outbreak in the area, and revealed a strong correlation between turnstile entries and COVID-19 cases and deaths when adjusting for incubation and symptom onset. The findings illustrated how densely packed public transit systems can become important catalysts for infectious disease transmission. The first reported case of COVID-19 in NYC was on February 29, 2020. However, due to limitations in testing at the time, it is suspected that most likely, there were many more undetected cases in the population. The researchers concluded by showing that their model predicted that COVID-19 cases may have been present in NYC as soon as a month earlier, on Jan 28. [Infectious Disease Modelling]

Duration and key determinants of infectious virus shedding in hospitalized patients with COVID-19. Understanding the kinetics of infectious virus shedding is critical to guide infection prevention and control strategies. Researchers assessed duration and key determinants of infectious SARS-CoV-2 shedding among 129 severe and critical hospitalized COVID-19 patients. The median duration of shedding infectious virus was 8 days post onset of symptoms (IQR 5 to 11) and dropped below 5% after 15.2 days post onset of symptoms (95% CI 13.4 to 17.2). The probability of isolating infectious SARS-CoV-2 was less than 5% when the viral load was below 6.63 Log10 RNA copies/mL (95% CI 6.24 to 6.91), whereas, a serum neutralizing antibody titre of at least 1:20 (OR 0.01, 95% CI 0.003 to 0.08) was independently associated with non-infectious SARS-CoV-2. Findings from the study warranted the use of quantitative viral RNA load assays and serological assays in test-based strategies to discontinue or de-escalate infection prevention and control precautions. [Nature]

Excess body weight is an independent risk factor of severe form of COVID-19. A retrospective observational monocentric study was conducted among 131 hospitalized COVID-19 pneumonia patients in France, aimed at evaluating whether body weight was a risk factor for developing a severe form of COVID-19.  Two thirds of the patients had excess body weight, defined by a BMI > 25kg/m2. The study revealed that the number of serious events (high debit oxygen requirement over 6L/min, admission to ICU or death), was significantly higher in excess body weight patients compared to normal body weight (25% vs 8% respectively, P = 0.03). The study reported that excess body weight was a strong predictor of severe forms of COVID-19 and that patients with excess body weight were 5.6 times more likely to develop a severe form of the disease than normal weight patients. The study concluded that excess body weight was significantly associated with severe forms of the disease, and that was independent of any associated comorbidities. [Metabolism]

Drug Resistance and Global Health

A framework for identifying the recent origins of mobile antibiotic resistance genes. A study published in Nature Communications evaluated evidence for 37 proposed origins of mobile antibiotic resistance genes (ARGs) in bacteria. Although mobile ARGs have been the subject of much research, their origins (the bacterial taxa from which these genes were mobilized), remain still largely unknown. Authors analyzed 43 articles for the term “recent origin”, which describes the bacterium belonging to the most recent evolutionary taxon where the ARG is widespread and found that based on certain criteria, 81% of the proposed origins could be confirmed for their respective ARG groups, and of 22 origins identified at the species level, 95% have been isolated from humans or domestic animals. Findings suggested that the potential of a bacterial species to contain an ARG of recent origin is linked to its ability to colonize humans or domesticated animals, as those species may experience severe antibiotic selection pressure. The authors noted that most of the origins described in the study relate to genes that confer resistance to β-lactams and may not apply to other classes of antibiotics. They conclude that further explorations of the origins of ARGs may provide valuable insights to inform mitigation efforts and slow the emergence of novel ARGs. [Nature Communications Biology]

Impact of pneumococcal vaccination in the nasopharyngeal carriage of Streptococcus pneumoniae in healthy children of the Murcia region in Spain. A recent study in Vaccines analyzed the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on the status of nasopharyngeal carriage, circulating pneumococcal serotypes, and antibiotic susceptibility to frequently used antibiotics in Spanish children. Researchers compared outcomes in 1821 one-year-old and four-year-old children with or without PCV13 vaccination. The study found that 71.9% of the children had received at least one dose of PCV13 vaccine and 67.8% had received at least two doses of the recommended three-dose schedule. Nasopharyngeal colonization was 18.6% in children aged one year and 20.7% in children aged four years. Furthermore, 14.4% of serotypes analyzed were PCV13-specific serotypes. Among 255 carriage isolates, 35.7% were resistant to penicillin, 32.1% were resistant to erythromycin, and 28.2% were resistant to trimethoprim sulfamethoxazole. The low proportion of PCV13-specific serotypes indicates a benefit of childhood vaccination with the PCV13 vaccine, but authors conclude it is necessary to monitor evolution of the serotypes and resistance of S. pneumoniae to commonly used antibiotics to enable the design of new vaccines that target additional serotypes. [Vaccines]

Novel 6-Month Treatment for Drug-Resistant Tuberculosis in United States. A research letter to Emerging Infectious Diseases, describes the case study of an Eastern European woman in her late 40s undergoing treatment for stage III cervical adenocarcinoma diagnosed with extensively drug-resistant TB. As resistance was detected for pyrazinamide but not for ethambutol, bedaquiline, or linezolid, a regimen consisting of 6-month bedaquiline, pretomanid, and linezolid (BPaL) was identified as the best treatment option. BPaL was approved by the US Food and Drug Administration on August 14, 2019, based on results from the Nix-TB trial in South Africa, showing that the combined activity of BPaL enabled cure in a far shorter period compared with currently recommended 18- to 24-month MDR TB regimens. The patient received outpatient BPaL treatment 7 days a week and completed 182 doses of BPaL over 26 weeks without treatment interruptions. Other than mild nausea that responded to pantoprazole, there were no adverse events or notable changes in laboratory values or electrocardiographs. Nine months after treatment completion, the patient remained well, indicating that the 6-month, all oral, highly effective BPaL regimen may be a notable advancement toward reducing global TB deaths. [CDC]

Virtual care beyond the COVID-19 pandemic. The COVID-19 pandemic has forced healthcare systems to rapidly expand their virtual care offerings. Health systems are now challenged to further develop and integrate useful, usable, and sustainable virtual care tools.  Virtual care can reduce costs, improve outcomes, increase access and allow pooling of resources across multiple hospitals and clinics. Establishment of virtual care which is easy to use and meets real needs (of patients and clinicians), requires “multi-channel” strategies and reconfiguration of care teams. Virtual care could be sustained by an alternative risk-based payment model which creates incentives and increases flexibility to develop patient-centric care. Though it may initially require as much, or even more staff time than in-person care, efficiency is expected to improve over time, and a shift to more self-service could drive productivity. However, while developing virtual care, safeguards against user induced demand, under-utilization by key segments of the population, misuse, and clinician burnout would need to be considered. Health systems should evaluate the virtual care they deliver to ensure it is safe, timely, efficient, effective, equitable, and patient-centered. [Nature]

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. Public health concerns associated with COVID-19 extend beyond viral transmission. With hospitals being pushed to capacity due to an influx of severe COVID-19 cases, there is greater risk of hospital-acquired infections, and of co-infection with a bacterial or fungal pathogen. Considering the increased morbidity of patients with severe respiratory infections, there may be a drive to over-prescribe antimicrobials to prevent co-infection, which then risks increasing the prevalence antimicrobial resistant pathogens. Researchers evaluating antimicrobial use in Scottish healthcare facilities found that antimicrobial stewardship protocols were preserved for COVID-19 hospitalizations, leading to a relatively low prevalence of antimicrobial prescribing and highlighting the importance of infection prevention and control and stewardship initiatives in this context. [Journal of Infection]

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