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Weekly Digest: Study supports social distancing as effective COVID-19 mitigation measure in US; COVID-19-related inflammatory syndrome leads to serious illness among children; Flu virus with pandemic potential emerges among pigs in China.

Weekly Digest: Study supports social distancing as effective COVID-19 mitigation measure in US; COVID-19-related inflammatory syndrome leads to serious illness among children; Flu virus with pandemic potential emerges among pigs in China.

COVID-19

Study supports social distancing as effective COVID-19 mitigation measure in US. A new modeling analysis suggests that individual decisions to stay at home prior to local and state lockdown orders may have slowed the spread of COVID-19 in the United States. Researchers from Johns Hopkins University analyzed mobility data captured from mobile phones and found that reduced mobility patterns in the US were linked to decreased rates of COVID-19. In a majority of counties most impacted by the virus (21/25), mobility slowed before local stay-at-home orders were implemented, and in all counties, mobility slowed 6 t0 29 days before state-wide orders were implemented. Authors suggest that social distancing has played an important role in slowing the spread of COVID-19, and the burden of disease may have been worse if individuals had not decided to modify their behavior prior to local and state orders. [The Lancet Infectious Diseases]

COVID-19-related inflammatory syndrome leads to serious illness among children. In an analysis across 26 US states, researchers found that COVID-19-related multisystem inflammatory syndrome (MIS-C) led to serious illness and poor clinical outcomes among previously healthy children. A majority of patients experienced inflammation affecting at least four organ systems including the gastrointestinal (92 percent), cardiovascular (80 percent), hematologic (76 percent), mucocutaneous (74 percent), and respiratory systems (70 percent). The study found that 80 percent of patients required intensive care, 20 percent received mechanical ventilation, 4 percent received oxygen support, and 2 percent died; Some of whom were previously healthy. Results suggest that MIS-C develops in some children one to two weeks following infection with the novel coronavirus, although further research is needed to understand why the rare syndrome only impacts certain age groups. [NEJM]

“COVID toes” unrelated to novel coronavirus. A surge in cases of chilblains, lesions on the hands and feet, recently described as “COVID toes,” may be linked to lifestyle changes due to lockdown measures rather than the novel coronavirus itself. A case series of 31 patients who recently developed chilblains revealed that all of them tested negative for COVID-19 through nasopharyngeal swabs, biopsy samples of skin lesions, and antibody tests. Findings suggest that these cases were not directly associated with SARS-CoV-2, but instead may be linked to a decrease in physical activity and increased time spent barefoot or in socks, which most patients reported as a result of stay-at-home orders. [JAMA Dermatology]

Neurological and psychiatric complications identified among COVID-19 patients. Researchers in the UK developed a portal for clinicians across disciplines to report clinical syndromes associated with COVID-19 and found that neurological and psychiatric complications were common among patients. Of 125 case reports, cerebrovascular events (62 percent), including stroke and hemorrhage, and altered mental state (31 percent) were the most common COVID-19 complications identified. The study also found that 23 patients had neuropsychiatric disorders including a dementia-like syndrome, and half of the COVID-19 patients with altered mental states were younger than 60 years old. Authors note the importance of interdisciplinary research during the COVID-19 pandemic where manifestations of the novel virus are largely unknown. [The Lancet Psychiatry]

Trial suggests colchicine may provide clinical benefits to severe COVID-19 patients. Colchicine, an anti-inflammatory drug routinely used to prevent gout, showed clinical promise among patients hospitalized for COVID-19 in Greece. In the randomized trial including 105 COVID-19 patients across 16 hospitals, individuals randomized to receive colchicine had a significantly lower rate of clinical deterioration compared to those randomized to receive placebo (1.8 vs. 14.0 percent; p=0.046). Findings suggest that the gout drug could play a role in COVID-19 treatment and warrant further research. [JAMA Network Open]

Nursing homes see increase in all-cause mortality during pandemic. Researchers at Harvard reported an increase in all-cause mortality among residents at skilled nursing facilities that aligned with the COVID-19 pandemic. Overall mortality was higher across nursing homes between March and May 2020 compared to the same time period in 2019 in Cleveland, Ohio (6.3 vs. 4.9 mean deaths per 1,000 deaths), Detroit, Michigan (7.9 vs. 3.5), and New York, New York (13.8 vs. 4.1), although differences were not statistically significant in Cleveland. The death rate in the Detroit and NYC nursing homes was 7-9 times higher during peak mortality in April 2020 compared to the same week in April 2019. Although not generalizable to all US cities, findings suggest that nursing homes lack capacity to respond to outbreaks. [JAMA]

Drug Resistance and Global Health

Flu virus with pandemic potential emerges among pigs in China. Scientists have identified an emerging influenza virus with pandemic potential among pigs in China. Using surveillance data from 2011 to 2018, researchers in Beijing reported a genotype 4 reassortant Eurasian avian-like H1N1 virus, which has been prevalent among pig populations since 2016. Of concern, the virus has acquired human infectivity, with 10.4 percent of 338 swine workers testing positive. Humans are not believed to have pre-existing immunity against the novel strain, which raises concerns over the possibility of another pandemic. [PNAS]

Rapid diagnostic test linked to improved antibiotic management at US children’s hospital. An analysis at a US children’s hospital revealed that the implementation of rapid diagnostic testing along with antibiotic stewardship notifications was tied to improved antibiotic therapy among hospitalized children with gram-positive blood cultures. The intervention was associated with a reduction in time to optimal therapy as well as decreased time to stopping vancomycin among patients with gram-positive cultures. No differences were identified among those with gram-negative cultures.  [Infection Control and Hospital Epidemiology]

Delaying antibiotics for URTI linked to increased risk of hospitalization. A population-based study in the UK found that delaying antibiotic treatment for upper respiratory tract infections (URTIs) was tied to an increased risk of hospitalization (adjusted hazard ratio 1.52). Nearly two million patients with a URTI were included in the study, of whom, 91.7 percent received immediate antibiotic treatment, and 8.3 percent received delayed treatment (1-30 days following diagnosis). The study found that the link between delayed treatment and hospitalization risk was highest among adults 18-59 years old (aHR: 1.61). Authors suggest that delayed antibiotic prescribing should be targeted only to those with lower complication risks. This conclusion differs from current UK guidelines which recommend either no antibiotics or delayed treatment except in severe URTIs. [Clinical Infectious Diseases]

Household exposure poses significant risk for C. diff infection. Results from a case-control study conducted by researchers at the University of Iowa suggest that household exposure is a significant risk factor for Clostridioides difficile infection. The study included 224,818 cases of C. diff infection derived from insurance claims data between 2001 and 2017 and found that prior exposure to a family member with C. diff was linked to a significantly increased risk of acquiring the infection(incidence rate ratio: 12.47). Hospital exposure was also significantly associated with an increased risk of C. diff infection (IRR:16.18). Findings emphasize the importance of testing and prevention strategies for the transmission of C. difficile in shared environments. [JAMA Network Open]