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Weekly Digest: Physical distancing, face masks & eye protection prevent COVID-19 transmission; Study highlights racial disparities related to poor COVID-19 outcomes; A majority of US adults plan to get flu shots next season.

Weekly Digest: Physical distancing, face masks & eye protection prevent COVID-19 transmission; Study highlights racial disparities related to poor COVID-19 outcomes; A majority of US adults plan to get flu shots next season.

COVID-19

Physical distancing, face masks & eye protection prevent COVID-19 transmission. Findings from a systematic review and meta-analysis of 172 observational studies spanning 16 countries show that physical distancing of at least one meter can prevent the transmission of coronaviruses, including SARS-CoV-2. The study found that protection against coronaviruses increases with distance (RR: 2.02 per meter), and the use of face masks and eye protection reduces risk of infection (aOR: 0.15, 0.22, respectively), although with low certainty. Respirator masks were more protective against virus transmission than disposable surgical or cloth masks (aOR: 0.04 vs. 0.33). Results suggest that physical distancing, face masks, and eye protection are effective prevention tools in community and healthcare settings, and should be used to inform guidelines on preventing COVID-19 transmission. [The Lancet]

Study highlights racial disparities related to poor COVID-19 outcomes. Researchers found that Black non-Hispanics comprised a majority of infections, hospitalizations, and deaths related to COVID-19 in a cohort of nearly 3,500 COVID-19 patients within the Ochsner Health System in Louisiana. Approximately 70 percent of all patients, 77 percent of hospitalized patients, and 71 percent of patients who died from COVID-19 were black, while only 31 percent of the overall population is comprised of black individuals. The study found that black race, older age, greater burden of illness measures, use of public insurance such as Medicare or Medicaid, living in a poor area, and obesity were all linked to increased odds of hospital admission for COVID-19. After adjusting for sociodemographic and clinical factors, black race was not significantly associated with higher COVID-19 mortality compared to white race. [NEJM]

Lung complications and death common among COVID-19 patients following surgery. In an analysis spanning 235 hospitals across 24 countries, researchers found that among patients who tested positive for COVID-19 within 7 days before or 30 days following surgery, nearly one-fourth died within a month, and more than half experienced lung complications. Male sex, older age, poor physical status, malignant diagnoses, emergency surgeries, and major surgeries were all significantly linked to increased odds of 30-day mortality (aOR: 1.75, 2.30, 2.35, 1.55, 1.67, and 1.52, respectively). Results suggest that postponing surgeries and utilizing non-operative therapies should be considered during the COVID-19 pandemic, especially among high-risk patients. [The Lancet]

COVID-19 patients with cancer more likely to develop severe disease. In a retrospective study including approximately 750 COVID-19 patients across nine hospitals in Wuhan, China, researchers found that those with cancer were nearly four times more likely to develop severe disease than those without (OR: 3.61). Among the cancer patients, advanced tumor stage, and other clinical characteristics including reduced CD4+ T cells, served as risk factors for severe COVID-19 and should be monitored. [The Lancet Oncology]

Negative COVID-19 outcomes common among diabetics. In a French study of 1,317 diabetics with COVID-19 across 53 hospitals, researchers found that nearly 30 percent were intubated and/or died within one week of hospital admission. The study found that BMI was significantly associated with increased odds of intubation and/or death (OR: 1.28). Older age, obstructive sleep apnea, and microvascular or macrovascular complications were also independently associated with increased odds of death (OR: 2.48, 2.80, 2.14, and 2.54, respectively) within a week of hospital admission. [Diabetologia]

 A majority of COVID-19 patients experience loss of smell or taste. Researchers in Europe reported that a majority of patients with mild to moderate COVID-19 across 18 hospitals experienced loss of smell or taste (87 and 56 percent, respectively). Patients who reported olfactory dysfunction lost their sense of smell for a median of 8.4 days. More than half of whom were diagnosed with anosmia (complete loss of smell) or hyposmia (partial loss of smell), although over one-third showed no signs of olfactory dysfunction. Authors note that more studies are needed to explore the mechanisms behind these unexlained COVID-19 symptoms. [Annals of Internal Medicine]

Drug Resistance and Global Health

Post-surgery antibiotics not linked to reduction in surgical site infections. In a systematic review and meta-analysis of 52 randomized controlled trials between 1990 and 2018, researchers found that continuing antibiotic prophylaxis post-surgery did not significantly reduce the risk of surgical site infections compared to immediate discontinuation (RR: 0.89, 95% CI [0.79, 1.00]). Results support the World Health Organization’s recommendation against postoperative antibiotic prophylaxis. [The Lancet Infectious Diseases]

Antibiotics commonly prescribed for viral respiratory infections in French children. An analysis of more than 220,000 pediatric healthcare visits revealed high rates of antibiotic prescribing for viral respiratory infections among French children. Between 2015 and 2017, viral respiratory infections accounted for 40.8 and 23.6 percent of all antibiotic prescriptions from general practitioners and pediatricians, respectively. Antibiotic prescribing rates for respiratory tract infections were highest for pneumonia (80.0 and 99.2 per 100 visits by GPs and pediatricians, respectively), otitis media (68.1 and 79.8), sinusitis (67.9 and 77.3), pharyngitis (67.3, 53.3), and bronchitis (65.2, 47.3). The study also found that antibiotic prescription rates were significantly higher among GPs over 50 years old, showing us that in Europe, older practitioners may benefit most from revised training through antimicrobial stewardship programs. [Journal of Antimicrobial Chemotherapy]

Rates of MRSA and VRE bloodstream infections increase in Canadian hospitals. Using data collected from 70 Canadian hospitals between 2014 and 2018, researchers reported increasing rates of bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) (59 percent) and vancomycin-resistant Enterococci (VRE) (143 percent). Conversely, rates of Clostridioides difficile infection decreased by 12.5 percent, and rates of carbapenemase-producing Enterobacteriaceae infection remained stable throughout the study period. Authors note that antimicrobial stewardship programs are essential to reduce the increasing burden of nosocomial infections, including those resistant to treatment. [CCDR]

A majority of US adults plan to get flu shots next season. A Reuters/Ipsos poll of 4,428 adults in the US found that approximately 60 percent of respondents plan to receive a flu shot this upcoming fall amid the COVID-19 pandemic. The US Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of six months receive the vaccine, although only 45.3 percent of adults received the flu vaccine last season. The poll found that individuals with democratic political views, white race, high household income, college education, or those living in suburban areas were more likely than their counterparts to seek out a flu vaccine next season. [Reuters, CDC]