OFFICES IN Washington D.C. & New Delhi

The Center For Disease Dynamics, Economics & Policy

Weekly Digest: Persistent COVID-19 symptoms common among patients following recovery; COVID-19 disproportionately impacts US prisoners; Antimicrobial resistance and use has increased in Canada, report finds.

Weekly Digest: Persistent COVID-19 symptoms common among patients following recovery; COVID-19 disproportionately impacts US prisoners; Antimicrobial resistance and use has increased in Canada, report finds.


Persistent COVID-19 symptoms common among patients following recovery. A study in Italy found that persistent symptoms and worsened quality of life were common among patients who had recovered from COVID-19. Researchers in Rome examined data from 143 patients and found that an average of 60 days following their first COVID-19 symptoms, 32 percent of patients reported persistence of one or two symptoms, while 55 percent reported persistence of three or more. Commonly reported symptoms included fatigue, shortness of breath, joint pain, and chest pain. [JAMA]

Moderna vaccine produces immune response against novel coronavirus in phase 1 trial. A phase 1 trial including 45 healthy adults indicated that an mRNA vaccine candidate, developed by US-based Moderna, induced an immune response against the novel coronavirus in all participants. Individuals received two doses of mRNA-1273 28 days apart. Results from the preliminary report suggest that antibody responses were positively correlated with dose level following the first vaccination, and this response increased following the second vaccination. Safety concerns were minimal, although three participants who received the highest dose experienced at least one serious adverse event. Results warrant further assessment of the vaccine. [NEJM]

HIV, TB, and malaria deaths could rise steeply in LMICs due to COVID-19. In a modeling study, researchers in London estimated that the COVID-19 pandemic could lead to substantial increases in deaths from HIV (up to 10 percent), tuberculosis (up to 20 percent), and malaria (up to 36 percent) in low- and middle-income countries over 5 years, although prevention measures could reduce these burdens. The study found that interruptions to HIV medication, TB diagnosis and treatment, and mosquito net campaigns due to overwhelmed health services would have the largest impacts on HIV, TB, and malaria deaths, respectively. Authors note the importance of maintaining core HIV, TB, and malaria services to minimize the indirect impacts of the pandemic in areas with a high burden of these diseases. [The Lancet Global Health]

COVID-19 disproportionately impacts US prisonersA research letter in JAMA revealed that COVID-19 is disproportionately impacting US inmates, with case and death rates 5.5 and 3 times higher, respectively, among federal and state prisoners compared to the general US population. Between March 31 and June 6, 2020, the COVID-19 case rate was 3,251 per 100,000 prisoners compared to just 587 per 100,000 among the general population, and the death rate was 39 per 100,000 prisoners compared to 29 per 100,000 population. COVID-19 cases are growing exponentially in prisons, with a mean daily case growth rate of 8.4 percent per day, while cases are growing at 3.4 percent per day in the general population. [JAMA]

Cases of pediatric inflammatory syndrome skyrocket during COVID-19 outbreak in UK. A multicenter observational study across pediatric intensive care units (PICUs) in the UK revealed that the rate of inflammatory multisystem syndrome in children was at least 11 times higher during the COVID-19 pandemic than compared to baseline trends. PICUs reported an average of one admission per week due to a pediatric inflammatory condition prior to the pandemic, compared to an average of 14 admissions per week of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) between April 1 and May 10, 2020. Of the 78 PIMS-TS cases analyzed, symptoms varied, but fever, shock, abdominal pain, vomiting, and diarrhea were common. [The Lancet Child & Adolescent Health]


Drug Resistance and Global Health

Antimicrobial resistance and use has increased in Canada, report finds. The Public Health Agency of Canada released the 2020 Canadian Antimicrobial Resistance Surveillance System (CARSS) Report, which details concerning trends in rates of antimicrobial resistance (AMR) and use across the country between 2014 and 2018. The report highlights an increasing rate of bloodstream infections caused by antimicrobial-resistant organisms, including vancomycin-resistant Enterococcus (VRE), which more than doubled, and methicillin-resistant Staphylococcus aureus (MRSA), which increased by 140 percent. The number of patients colonized with carbapenem-resistant organisms who did not show signs of infection increased by nine times and the proportion of multi-drug resistant gonorrhea cases doubled. Antimicrobial use in humans increased between 2014 and 2018, particularly for carbapenems and Reserve antibiotics. Authors suggest that results from the report should be used to support antimicrobial stewardship efforts and infection prevention and control strategies throughout Canada. [Public Health Agency of Canada]

Nationwide ASP leads to reduced outpatient antibiotic prescribing in China Findings from an interrupted time series analysis indicate that strict enforcement of a national antimicrobial stewardship program (ASP) at community health centers in Shenzhen, China was associated with a significant reduction in outpatient antibiotic prescribing. The percentage of outpatient prescriptions with antibiotics decreased by 74 percent two years following the implementation of the 2011 campaign, and the percentage of prescriptions with broad-spectrum and parenteral antibiotics decreased by 36.7 and 77.3 percent, respectively, immediately following the intervention. However, the proportion of broad-spectrum and parenteral antibiotics in antibiotic-containing prescriptions did not change significantly, and authors suggest implementing targeted interventions to foster appropriate antibiotic use. [Clinical Infectious Diseases]

Australian stewardship program linked to reduction in carbapenem resistance.  Researchers in Wollongong, Australia found that the implementation of an antimicrobial stewardship program (ASP) was tied to significant decreases in carbapenemase-producing Enterobacterales (CPE) isolates along with reduced carbapenem use across a health district in Australia. Following the district-wide implementation of the computer-supported ASP in 2012, average yearly consumption of carbapenems dropped by 20 percent. Authors note that prospective studies are needed to further evaluate the effect of ASPs on carbapenem resistance. [JAC-Antimicrobial Resistance]

HPV may be causally linked to prostate cancer. A systematic review of 26 case-control studies suggests that human papillomavirus (HPV) may be causally linked to prostate cancer. Researchers identified high-risk HPVs in 22.6 percent of prostate cancer cases compared to just 8.6 percent of controls. The study found that high-risk HPVs have been detected in prostate tissues prior to the development of the cancer, and can lead to inflammation and enlargement of the prostate gland, which may result in prostate cancer. Results further support universal HPV vaccination. [Infectious Agents and Cancer]