Person in coat and hat at a protest holding a sign saying, “Gun Violence- A Public Health Issue”

Ivermectin treatment for COVID-19 has no impact on hospitalization rates. In a double-blind, randomized, placebo-controlled, adaptive platform trial involving SARS-CoV-2–positive adults (recruited from 12 public health clinics in Brazil) who had had symptoms for up to seven days and had at least one risk factor for disease progression, 3,515 patients were randomly assigned to receive ivermectin once daily for three days (n= 679), a placebo (n= 679), or another intervention (n= 2,157). The primary composite outcome was hospitalization due to Covid-19 or an emergency department visit due to increasing disease severity within 28 days after randomization. Overall, 100 patients (14.7%) in the ivermectin group had a primary-outcome event, compared with 111 (16.3%) in the placebo group. There were no significant effects of ivermectin use on secondary outcomes or adverse events. [New England Journal of Medicine]

Multisystem inflammatory syndrome in Children (MIS-C) during the Omicron wave was less severe than in earlier waves of the pandemic. To assess cardiac involvement and admission to the intensive care unit (ICU) for children (patients under 18 years) with MIS-C, a prospective study was conducted in 12 Israeli hospitals over 16 weeks of each pandemic wave: Alpha (December 20, 2020, to April 10, 2021), Delta (July 18, 2021, to November 13, 2021), and Omicron (November 21, 2021, to March 12, 2022). Overall, 171 patients with a median age of 8 (5-12) years were diagnosed with MIS-C: 59 during the Alpha wave, 79 during the Delta wave, and 33 during the Omicron wave. None of the vaccinated patients required admission to the ICU or treatment with vasopressors: 6.3% of patients during the Delta wave and 15.1% during the Omicron wave, had received two SARS-CoV-2 vaccine doses at least two weeks prior to hospital admission. Admission to the ICU occurred in 57.6% of patients during the Alpha wave, 49.4% during Delta, and 21.2% during Omicron, with one patient dying during the Delta wave. The median length of hospital stay was two days shorter during Omicron than other waves. [JAMA]

Equity in Global Health requires equity in research. To address inequities impacting health outcomes, the disproportionate influence of high-income countries (HICs) on how and what is researched in Global Health must be confronted. Researchers in low- and middle-income countries (LMICs) should be included in Global Health leadership to prevent the omission of cultural context, include LMIC priorities, and increase the benefits of Global Health research in LMICs. To address power imbalances and the drivers of inequity, researchers must practice both reflexivity (examining one’s beliefs, judgments, and practices and their influences on research) and positionality (the stance of researchers on the sociopolitical contexts of people who are the focus of research). This also requires reassessing the management of research financing, strengthening infrastructure and human research capacity in LMICs, and valuing the voices of LMIC researchers. [The Lancet]

SARS-CoV-2 vaccines offer limited protection against long COVID. The largest cohort study to date, including more than 13 million people, shows that vaccination against SARS-CoV-2 lowers the risk of long COVID after infection by only about 15%. The limited protection provided by vaccines against the long-term impacts of COVID-19 means that ending measures like mask mandates and social-distancing restrictions may put more people (especially those with compromised immune systems) at risk. [Nature]

Opensource database of patient metadata can be used to find patterns of antibiotic resistance. Researchers sought patterns of antibiotic resistance in the Antimicrobial Testing Leadership and Surveillance (ATLAS) database, which holds 6.5 million minimal inhibitory concentrations (MICs) for 3,919 pathogen-antibiotic pairs isolated from 633,000 patients in 70 countries between 2004 and 2017. They found that most pathogen-antibiotic pairs display higher frequencies of resistance than other databases (OHT’s ResistanceMap, ECDC, and ESPAUR), with no systematic bias towards including more resistant strains. ATLAS is the only open access MIC database where patient data are stored with clinical metadata, making it a potentially important resource for assessing patterns in the dynamics of resistance. [Nature Communications]

The impact of global socioeconomic disparity on Monkeypox outbreaks. Monkeypox has caused regular outbreaks in communities in Central and West Africa for years. However, as seen with other infectious diseases, global attention has only been granted since outbreaks appeared in high-income countries (HICs). This exemplifies inadequacies in epidemic preparedness and disparities in how people’s health is valued between HICs and low- and middle-income countries (LMICs). Monkeypox illustrates the dangerous combination of zoonotic spillover and anthropogenic drivers that comprise the majority of epidemic potential on the globe. Epidemic preparedness requires immediate action to address ongoing outbreaks where and when they occur, not waiting for when they might spill over in HICs. It’s vital to avoid stigmatizing where the monkeypox comes from, who gets it, and how, as the main cause of this outbreak is the neglect of diseases that primarily affect LMICs. [BMJ]

A global One Health index (GOHI) to assess One Health approach performance. After multiple rounds of panel discussions with an expert advisory committee, a GOHI with a weighted indicator scheme was developed to scientifically evaluate One Health approach performance and identify gaps where One Health capacity building is needed. Using data from more than 200 countries/territories and consistent with previous findings, the calculated GOHI scores were low: the highest score (out of 100) was 65, with considerable variations among different countries/territories (31.8–65.0). Analysis of the results is consistent with the results from a literature review.[Infectious Disease of Poverty]

Firearms as the leading cause of death in children in the U.S. is unacceptable and avoidable. According to the Centers for Disease Control and Prevention (CDC), in 2022, firearms are the leading cause of death among children (0-19 years) in the United States. Almost 60% of firearm deaths in children since 2010 have been homicides. While firearm fatality rates began increasing in 2014, societal changes during the COVID-19 pandemic likely accelerated the increase with growing mental health stressors in the absence of prevention efforts in recent decades to decrease firearm injuries and deaths. Firearm death prevention infrastructure requires robust data systems for firearm injuries and deaths; increased research funding to advance scientific understanding around firearm injury prevention; funding to develop, implement, and evaluate firearm injury prevention interventions at the individual, hospital, community, and policy levels; and informed government policy. [The Lancet Child & Adolescent Health]

Attaining Social Determinant of Health data (SDOH) in Health Information Systems (HIS) is complex. Current approaches to data collection can obtain many SDOH factors from both primary and secondary sources. However, social communication processes ingrained in data collection are associated with inequalities that HIS attempts to measure and remedy. To achieve equity, it is vital that healthcare-providers, researchers, technicians, and administrators address power dynamics in HIS standards and practices. HIS systems would benefit from investment in interdisciplinary and intersectoral knowledge generation and translation; development of novel methods for data discovery; participatory research; and channeling information into upstream evidence-informed policy. [Health Systems]

Travel-time to hospitals influences maternal mortality in Nigeria. In a facility-based retrospective cohort study, researchers extracted socio-demographic, travel, and obstetrical data from case notes regarding pregnant women that gave birth in 24 public hospitals in Lagos between November 2018 and October 2019. Participants’ travel data were exported to Google Maps, where driving distance and travel time data were extracted to determine the influence of distance and travel time on maternal death. Of 4,181 pregnant women with obstetrical emergencies, 182 (4.4%) resulted in maternal deaths. Among those who died, 60.3% travelled ≤10 km directly from home, and 61.9% arrived at the hospital ≤30 mins. The median distance and travel time was 7.6 km and 26 minutes. For all women, traveling 10–15 km was significantly associated with maternal death. However, distance and travel time had a greater impact on maternal mortality among referred women compared to those who were not. [BMJ Global Health]