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Center For Disease Dynamics, Economics & Policy

Weekly Digest: AI-based mobile application to fight antibiotic resistance; Covid-19 deaths in Africa; Provisional life expectancy estimates for January through June, 2020; Economic burden of urinary tract infections from antibiotic resistant E.coli.


Covid-19 deaths in Africa: prospective systematic postmortem surveillance study. In a recent study in the BMJ, researchers studied COVID-19 mortality at the University Teaching Hospital (UTH) in Lusaka, Zambia. UTH was chosen for the study as it is the primary tertiary care referral hospital and Lusaka and registers over 80% of deaths in the city. Leveraging infrastructure and protocol from the Zambia Pertussis RSV Infant Mortality Estimation study, researchers conducted PCR testing for SARS-CoV-2 for deceased people who died in the community or a facility in Lusaka. From June 15 to October 1, 2020, 372 deceased participants were enrolled in the study, representing about 10% of deaths that passed through the UTH morgue during that time. Of the samples, 19.2% were positive for SARS-CoV-2, and 73% of these deaths occurred in the community. None of the individuals who died in the community had been tested for SARS-CoV-2 before death, while only 32% of the individuals who died in facilities had been tested, indicating that COVID-19 deaths in Zambia are likely underreported. [The BMJ]

Provisional life expectancy estimates for January through June, 2020. The National Center for Health Statistics (NCHS) published provisional data showing the effects of excess mortality due to COVID-19 on the estimated life expectancy in the United States. The report used provisional death counts from January to June 2020 to estimate life expectancy for the entire country, by sex, and by ethnicity (Hispanic, non-Hispanic white, and non-Hispanic black populations). Life expectancy declined from 78.8 in 2019 to 77.8 in 2020 (1.0 year) for the total US population, from 76.3 to 75.1 (1.2 years) for males, and from 81.4 to 80.5 (0.9 years) for females. Data reflected worsening racial and ethnic mortality disparities as the gap between non-Hispanic black and white populations increased 46% from 4.1 years in 2019 to 6.0 years in the first half of 2020. [National Center for Health Statistics, CDC]

Exhaled SARS-CoV-2 quantified by face-mask sampling in hospitalised patients with COVID-19. While it has been established that person-to-person transmission of COVID-19 can occur through the respiratory route, it is difficult to quantify the amount of virus that gets exhaled. Yet, it is necessary to properly parameterize this transfer route to inform models that predict transmission and potentially as a means to predict virus severity in incoming patients. Researchers at the University of Leicester measured exhaled SARS-CoV-2 captured in face masks worn by hospital patients and found that detecting the virus was harder from face masks than nasal swabs, but still possible. Viral genetic material of varying magnitudes (<10-3.3 × 106 genome copies/strip) was detected by RT-PCR in 37% of the collected masks. Furthermore, the authors showed that viral load from the facial masks was highest in early disease and in those with active respiratory symptoms. [medRxiv]

Early high-titer plasma therapy to prevent severe COVID-19 in older adults. Researchers conducted a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against SARS-CoV-2 in 160 older adult patients within 72 hours from onset of mild Covid-19 symptoms. In the intention-to-treat population, severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% CI, 0.29 to 0.94; P=0.03). Further, the anti–SARS-CoV-2 serum IgG titers were significantly higher in the convalescent plasma group patients than those in the placebo group 24 hours after infusion. The findings indicated that early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults could reduce the progression of COVID-19. [The New England Journal of Medicine] 

Longer duration of acute infection with SARS-CoV-2 variant B.1.1.7 may lead to higher transmissibility. Researchers at Harvard T.H. Chan School of Public Health assessed longitudinal PCR tests performed in a cohort of 65 individuals infected with SARS-CoV-2, including seven infected with the B.1.1.7 variant, revealing more prolonged infections from the variant. The mean overall duration of infection among patients infected with B.1.1.7 was 13.3 days [10.1-16.5], compared to 8.2 days [6.5-9.7] among non-B.1.1.7 patients. The authors concluded that infection with B.1.1.7 might be associated with an extended duration of infection, contributing to its increased transmissibility. [Harvard SPH Articles]


Drug Resistance and Global Health

AI-based mobile application to fight antibiotic resistance. Researchers unveiled an artificial intelligence (AI) based offline smartphone application for disk-diffusion antibiogram analysis. The application captures images with a mobile phone camera, an embedded expert system measures and categorizes zones of inhibition, validates coherence of the antibiogram data, and provides interpreted results. The application’s reading system achieved an overall agreement of 90% on susceptibility categorization against a hospital-standard automatic system and 98% against the manual measurement (gold standard). The researchers concluded that automatic reading of antibiotic resistance testing was entirely feasible on a smartphone. Further, the application was reported to be suited for resource-limited settings and can significantly increase patients’ access to AST worldwide. [Nature Communications] 

Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among us hospitals. Researchers evaluated the implementation of the Agency for Healthcare Research and Quality Safety Program (AHRQ) antimicrobial stewardship program (ASP) in 402 hospitals across the United States from December 1, 2017, to November 30. The program consisted of 17 webinars over 12 months with educational content to improve frontline clinicians’ antibiotic decision-making. Adherence to key components of ASPs improved from 8% to 74% (p<0.01), antibiotic use decreased by 30.3 days of antibiotic therapy per 1000 patient days (95% CI, −52.6 to −8.0 DOT; P = .008), and the incidence rate of hospital-onset Clostridioides difficile decreased by 19.5% (95% CI, −33.5% to −2.4%; P = .03). The authors concluded that the publicly available AHRQ program could help hospitals establish ASPs and increase antibiotic self-stewardship among frontline clinicians. [JAMA]

Economic burden of urinary tract infections from antibiotic-resistant Escherichia coli . Urinary tract infections (UTIs) caused by Escherichia coli resistant isolates are increasing worldwide, and E. coli is the most frequently isolated bacterium associated with UTIs. Despite increased attention to the high prevalence of AMR in developing countries, the economic burden of resistant E. coli remains mostly unknown. Researchers conducted a study of clinical and economic outcomes in 10 hospitals across Lebanon to quantify the economic burden of resistant UTIs. They collected clinical, microbiological, and economic data from each hospital, including all patients’ direct medical costs and sociodemographic characteristics. Patients with resistant infections had a significantly higher length of stay in the hospital and nearly 29% higher median hospitalization costs, suggesting that optimizing appropriate antibiotic use in the community can reduce avertable health care costs. [Value in Health Regional Issues]

Application of UV-LEDs for antibiotic resistance genes inactivation – Efficiency monitoring with qPCR and transformation. Ultraviolet radiation is an effective means of preventing antibiotic resistance because it can effectively damage DNA and prevent the genetic material transfer from a resistant organism to a susceptible one. UV disinfection has predominantly been done with mercury lamps, however, LED lamps are emerging as safer alternatives. LED lamps can also be more efficient because the light emitted is more easily tuned for better absorption by DNA and repair proteins. The authors found that UV LEDs can effectively destroy antibiotic resistance genes, but more research is needed to investigate the effect of water matrix on its efficiency, and the connection between UV-LED wavelengths and repairable DNA damages. [Journal of Environmental Chemical Engineering]

Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK. Researchers at the London School of Hygiene and Tropical Medicine in the UK conducted a population-based study using de-identified electronic health records between 2017 and 2020. They calculated weekly primary care contacts for selected acute physical and mental health conditions. They disclosed that primary care contacts for almost all conditions dropped considerably after the introduction of population-wide restrictions. The largest reductions were observed for contacts for diabetic emergencies (OR 0.35, 95% CI 0.25 to 0.50), depression (0.53, 0·52 to 0·53), and self-harm (0·56 0.54 to 0.58). By July 2020, with very few exceptions, contacts had not recovered to pre-lockdown levels, indicating substantial reductions in primary care contacts for acute physical and mental conditions. [The Lancet Digital Health] 

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