OFFICES IN Washington D.C. & New Delhi

The Center For Disease Dynamics, Economics & Policy

Weekly Digest: Ethnic and socioeconomic inequities impact COVID-19 mortality in Brazil; Novel coronavirus more transmissible and harder to contain than similar viruses; GLASS report highlights progress on global AMR surveillance systems.

Weekly Digest: Ethnic and socioeconomic inequities impact COVID-19 mortality in Brazil; Novel coronavirus more transmissible and harder to contain than similar viruses; GLASS report highlights progress on global AMR surveillance systems.


Ethnic and socioeconomic inequities impact COVID-19 mortality in Brazil. In a cross-sectional study, researchers found that regional and ethnic inequities had a significant impact on hospital mortality among COVID-19 patients in Brazil. Findings showed that Pardo and Black Brazilians hospitalized for COVID-19 were significantly more likely to die than White Brazilians (hazard ratio: 1.45; 1.32, respectively). Risk of hospital mortality was also higher in northern regions and Rio de Janeiro, which may be driven by high rates of comorbidities and socioeconomic inequities in those areas. Authors note the importance of better protecting Pardo and Black Brazilians as well as those in poor areas from negative COVID-19 outcomes. [The Lancet Global Health]

Novel coronavirus more transmissible and harder to contain than similar viruses. A Personal View published in The Lancet Infectious Diseases notes that SARS-CoV-2, the virus that causes COVID-19, has higher transmissibility, longer incubation period, and causes a greater proportion of deaths among older individuals than other epidemic viruses. The article reports that SARS-CoV-2 has a higher average reproductive rate (R0=2.5) than SARS-CoV-1 (2.4), 1918 pandemic influenza (2.0), and 2009 pandemic influenza (1.7), and a shorter interval between symptom onset and peak infectivity, making the novel coronavirus harder to control. A greater proportion of those with SARS-CoV-2 require hospitalization and admission to the intensive care unit compared to those with 2009 pandemic influenza, which raises concerns about healthcare system capacity. [The Lancet Infectious Diseases]

High proportion of asymptomatic COVID-19 cases reported in Belgian nursing homes. In a cross-sectional analysis of nearly 300,000 residents and staff at long-term care facilities in Belgium, three-quarters of individuals who tested positive for COVID-19 were asymptomatic. A total of 8,343 individuals tested positive in the analysis, which accounted for 2.1 percent of staff and 3.8 percent of residents. The study found that individuals who presented symptoms were significantly more likely to test positive for COVID-19 compared to those who were asymptomatic (OR: 8.5). [The Lancet Infectious Diseases]

Extensive novel coronavirus contamination detected in London hospital. Researchers in the UK detected extensive novel coronavirus contamination of surfaces and air across several sites in a London hospital. SARS-CoV-2 RNA was detected in 52.3 percent of surface samples and 38.7 percent of air samples in the analysis, although no virus was cultured. Viral RNA was significantly more likely to be detected in samples obtained from areas near COVID-19 patients compared to other areas of the hospital (63.8 vs. 45.3 percent). Findings emphasize the importance of infection prevention and control measures to decrease the risk of environmental contamination and the spread of COVID-19. [Clinical Infectious Diseases]

Limited COVID-19 transmission reported on flight across China. According to findings from an epidemiological investigation of a flight from Singapore to Hangzhou in late January, COVID-19 transmission was limited. Of 335 passengers on the flight, 16 were diagnosed with COVID-19 (attack rate: 4.8 percent), although a majority of cases were likely exposed to the virus prior to flying. Only one passenger did not have a history of exposure prior to the flight; He was seated near four infected passengers and reported that he did not wear his mask properly. [Travel Medicine and Infectious Disease]

Countries face shortages of HIV medications amid COVID-19 pandemic. Findings from a survey conducted by the World Health Organization (WHO) indicate that 24 countries are experiencing HIV medication supply shortages, and 73 countries may be at risk for shortages. Antiretroviral (ARV) medications control and prevent the transmission of HIV, and if supplies are disrupted for six months, it is estimated that AIDS-related deaths could double in sub-Saharan Africa this year. HIV infections and deaths have fallen 39 and 51 percent respectively between 2000 and 2019, although recent progress is stalling and COVID-19 is making the situation worse. The WHO has encouraged countries to prescribe HIV medications for longer periods of time to limit disruptions in treatment access during the pandemic. [WHO]


Drug Resistance and Global Health

GLASS report highlights progress on global AMR surveillance systems. The World Health Organization (WHO) released its third Global Antimicrobial Resistance and Use Surveillance System (GLASS) report highlighting progress in national antimicrobial resistance surveillance systems since 2016. The report notes that as of July 31, 2019, 82 countries/territories were enrolled in the AMR module, which collects data on resistance among high-priority pathogens, and 65 countries/territories reported data on the status of their surveillance system as well as data on AMR for 2018. GLASS plans to continue collecting AMR data and incorporate antimicrobial consumption data into their surveillance system to better understand drivers of resistance across the globe. [GLASS Report]

Mycoplasma genitalium becomes increasingly resistant to some antibiotics. A systematic review and meta-analysis including 59 studies across 21 countries estimated that the sexually transmitted infection, Mycoplasma genitalium is becoming increasingly resistant to some antibiotics. The study found that among M.genitalium samples, the overall prevalence of mutations linked to macrolide or fluoroquinolone resistance was 35.5 and 7.7 percent, respectively; The prevalence of dual resistance to both antibiotic classes was 2.8 percent. The prevalence of macrolide resistance increased significantly between 2010 and 2016/17 from approximately 10 t0 51.4 percent. Authors note the importance of global surveillance strategies and the development of new treatments to prevent the spread of Mycoplasma genitalium resistance. [The Lancet Infectious Diseases]

Antimicrobial stewardship program linked to decreased vancomycin use in NICU. The implementation of a quality improvement initiative at a US neonatal intensive care unit (NICU) was linked to a 66 percent reduction in vancomycin use over one year. The initiative consisted of physician education, 48-hour antibiotic time-outs, and standardized antibiotic choices with clinical pathways, which were tied to a 29 percent reduction in vancomycin use. Subsequent feedback audits from the antimicrobial stewardship program were linked to an additional 52 percent reduction in vancomycin use. Results from the intervention have been sustained for one year. [Pediatrics]

Neurological abnormalities common among children exposed to Zika. A cohort study of 219 children in Rio de Janeiro, Brazil indicated that babies exposed to Zika virus in utero frequently experienced anatomical and neurodevelopmental abnormalities. Children exposed to Zika with and without microcephaly commonly experienced failure to thrive (71.7 and 51.0 percent, respectively), cardiac malformations (41.3 and 20.0 percent), and excess skin at the back of the fetal neck (72.7 and 37.6 percent), as well as auditory (26.0 and 9.9 percent) and eye abnormalities (79.2 and 17.7 percent). More than two-thirds of children born with normocephaly (a normal head shape) experienced neurologic abnormalities, including overactive reflexes and abnormal brain imaging results. The study also found that among babies with normocephaly, smaller head circumference at birth was significantly associated with below-average cognitive and language scores. Findings may inform early intervention, evaluation, and care among Zika-exposed babies. [JAMA Network Open]