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Weekly Digest: Researchers suggest gradual herd protection as a strategy to control COVID-19; Pandemic could last 18-24 months under likely scenarios; Report highlights gaps in US response to antibiotic resistance.

Weekly Digest: Researchers suggest gradual herd protection as a strategy to control COVID-19; Pandemic could last 18-24 months under likely scenarios; Report highlights gaps in US response to antibiotic resistance.


Researchers suggest gradual herd protection as a strategy to control COVID-19. In an editorial published in Indian Pediatrics, CDDEP director Ramanan Laxminarayan and T Jacob John discuss how gradual and staged herd protection could be a realistic control strategy for COVID-19. Because a large proportion of COVID-19 cases are asymptomatic, identifying and containing all cases is close to impossible, and even if comprehensive isolation and contact tracing were implemented, the world would need to maintain strict control measures until a vaccine is developed. The authors do not recommend letting the virus spread uncontrollably through a susceptible population to produce herd immunity as it would place a large burden on healthcare systems. However, they suggest implementing a dual strategy of slowing the spread of COVID-19 with periodic lockdowns while protecting vulnerable populations until herd immunity is reached. [Indian Pediatrics]

COVID-19 pandemic could last 18-24 months under likely scenarios. Researchers from the Center for Infectious Disease Research and Policy (CIDRAP) analyzed past influenza pandemics to forecast three possible global scenarios for the current COVID-19 pandemic. The report notes that COVID-19 appears to spread more easily than the flu, and the spread of the novel coronavirus likely will not stop until 60-70 percent of the population is immune. This could take 18 to 24 months. Three potential scenarios of the pandemic include a “peaks and valleys” epidemic curve, where the current wave is followed by similar waves that will gradually diminish over one to two years, a “fall peak”, where a larger wave of COVID-19 hits in late 2020, followed by smaller waves into 2021, and a “slow burn,” or ongoing transmission of COVID-19. The authors recommend government and health authorities to plan for the worst-case scenario, prepare health infrastructure for a surge in cases, develop plans to reinstitute mitigation measures as needed, and communicate to the public that this pandemic will not be over soon. [CIDRAP] 

Millions of US healthcare workers at increased risk for poor COVID-19 outcomes. A cross-sectional analysis using data from two nationally representative surveys found that nearly 27 percent of US healthcare workers with direct patient contact (3.66 million) were at elevated risk for poor COVID-19 outcomes, and of these, 7.5 percent (275,000) were uninsured and 30.5 percent (1.12 million) lacked paid sick leave. Elevated risk factors include chronic lung disease, moderate-to-severe asthma, serious heart condition, morbid obesity, diabetes, liver disease, and older age. Study authors note that depriving healthcare workers of adequate medical benefits threatens their own well-being as well as the public’s. [Annals of Internal Medicine]

Health disparities explain variation in COVID-19 impact across NYC. A research letter published in JAMA found that health disparities, rather than population density, may explain variation in COVID-19 hospitalizations and deaths across New York City boroughs. The lowest rates of COVID-19 hospitalizations and deaths were reported in Manhattan (331 and 122 per 100,000), the most affluent borough with a predominantly white population, while the highest rates were reported in the Bronx (634 and 224 per 100,000), the borough with the most racial/ethnic minorities, individuals living in poverty, and lowest education levels. Manhattan has the highest population density in NYC (71,434 persons per sq. mile), while both Manhattan and the Bronx have the most hospital beds per capita (534 and 336 beds per 100,000 population). The authors note that racial and socioeconomic inequities may explain the disproportionate burden of COVID-19 across NYC. [JAMA]

Cardiovascular disease, not hypertension drugs, tied to increased COVID-19 mortality. A study including nearly 9,000 COVID-19 patients across hospitals in Asia, Europe, and North America found that cardiovascular disease is linked to increased risk of in-hospital death, while use of common hypertension drugs is not. The researchers found that older age (>65), coronary artery disease, heart failure, cardiac arrhythmia, chronic obstructive pulmonary disease, and smoking were all independently associated with increased risk of in-hospital death among COVID-19 patients (p <0.05). Results did not confirm previous concerns that the use of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) was associated with increased risk of death. [NEJM]

Isolation and contact tracing reduces COVID-19 transmission in Shenzhen, China. In a retrospective cohort study of 391 COVID-19 cases and 1286 of their close contacts, researchers found that isolation and contact tracing reduced COVID-19 transmission in Shenzhen, China. On average, cases were isolated 4.6 days after symptom onset, and contact tracing reduced this time by approximately 1.9 days. The study found that household contacts and individuals traveling with a case were more likely to become infected than other close contacts (OR= 6.27 [95% CI 1.46, 26.33]; 7.06 [1.43, 34.91] respectively). Although less likely to present severe symptoms, children under ten had similar infection rates as the overall population (7.4 vs. 6.6 percent, respectively), which indicates that they should be included in all analyses of COVID-19 transmission.  [The Lancet Infectious Diseases]

Broadening case definition increased COVID-19 detection in China. Researchers in Hong Kong found that as the case definition of COVID-19 became broader over time in mainland China, the proportion of cases detected increased substantially. The study found that the proportion of SARS-CoV-2 infections detected as cases increased approximately 7.1 times from case definition version 1 to 2, 2.8 times from version 2 to 4, and 4.2 times from version 4 to 5. If case definition version 5 was used throughout the outbreak with sufficient testing availability, China could have detected 232,000 COVID-19 cases by February 20, 2020, compared to the 55,508 cases that were reported. [The Lancet Public Health]

Survey platform launched to collect information about the impacts of COVID-19. hosts web- and SMS-based mass surveys aimed at rapidly collecting information about the ongoing COVID-19 pandemic to assist public health officials to better address the needs of communities and healthcare workers. The platform is operated by CDDEP, funded by a Bill & Melinda Gates Foundation Grand Challenges Exploration Grant, and powered by Harvard Humanitarian Initiative’s KoBo Toolbox. is an interactive platform that allows the public to provide insights and thoughts on the current situation as well as watch COVID-19 related content. Information provided through these surveys will inform, support, and improve public health campaigns around the globe now and in the future. [COVIDsurveys]


Antibiotic Use and Drug Resistance

Report highlights gaps in US response to antibiotic resistance. The Government Accountability Office (GAO) released a report which highlights gaps in the United States’ response to antibiotic resistance and outlines recommendations to strengthen efforts related to surveillance, appropriate antibiotic use, diagnostic testing, and treatments for resistant infections. The GAO developed eight recommendations for the US Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services (HHS), and US Food and Drug Administration (FDA) to better estimate the magnitude and impact of antibiotic resistance. The HHS concurred with all recommendations except incentivizing the development of treatments for antibiotic-resistant infections, which the GAO notes is warranted due to the lack of such treatments currently in development. [GAO]

Antibiotics commonly prescribed to older adults without lab confirmation. A study in Australia found that antibiotics with a high resistance potential, classified as ‘watch antibiotics’ by the World Health Organization (WHO), are commonly prescribed among older adults, and only 19 percent of prescriptions are supported by microbiology tests. Patients with chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease were significantly more likely to receive watch antibiotics than other patients (adjusted incidence rate ratio: 1.59 [95% CI 1.52, 1.66]; 2.71 [2.48, 2.95], respectively), although the rate of microbiology testing was not significantly higher among these patients.  [BMC Infectious Diseases]

Molecular susceptibility test linked to improved MDR-TB treatment outcomes. Researchers in Shanghai and Stockholmfound that molecular drug susceptibility testing (DST) is linked to decreased time to culture conversion and improved treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB) compared to phenotypic DST. The study compared patient cohorts before and after implementation of molecular DST and found that time to MDR-TB diagnosis was significantly lower among patients in the post-implementation group. Molecular DST was significantly associated with a decrease in time to culture conversion as well as improved treatment outcomes in the post-implementation group compared to the pre-implementation group (12 vs 24 months; 68 vs 47 percent, respectively).    [International Journal of Infectious Diseases]

GARDP and Venatorx Pharmaceuticals to develop antibiotic for drug-resistant infections. The Global Antibiotic Research and Development Partnership (GARDP) and Venatorx Pharmaceuticals are developing a novel antibiotic aimed at treating drug-resistant nosocomial infections. The experimental antibiotic, cefepime-taniborbactam, targets carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA), two pathogens that urgently require new treatment options. The antibiotic is currently undergoing a phase 3 trial for the treatment of complicated urinary tract infections, and will later undergo clinical trials for the treatment of multidrug-resistant infections among adults and children. GARDP and Venatrox are committed to providing affordable access to the drug worldwide. [GARDP]