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Weekly Digest: African countries have limited critical care capacity to handle COVID-19; Antimicrobial use common among coronavirus patients despite low rates of co-infections; Breastfeeding poses risk for mother-to-child Ebola transmission.

Weekly Digest: African countries have limited critical care capacity to handle COVID-19; Antimicrobial use common among coronavirus patients despite low rates of co-infections; Breastfeeding poses risk for mother-to-child Ebola transmission.


 Lower-income African countries have limited critical care capacity to handle COVID-19 surges. Researchers at CDDEP compiled data on number of ICU beds, number of ventilators, and number of physician anesthesia providers (PAP) and non-PAP, across 54 African countries and found that most low and lower-middle-income African countries currently have limited critical care capacity available to cope with potential surges in demand due to COVID-19 outbreaks. Across all 54 countries included in the analysis, there was an average of 3.10 ICU beds and 0.97 ventilators per 100,000 people, and an average of 2.42 total (physician and non-physician) anesthesia providers per 100,000 people. Results are intended to inform and assist policymakers and public health officials in equipping and preparing African countries to tackle the COVID-19 pandemic. [CDDEP, MedRxiv]

Antimicrobial use common among coronavirus patients despite low rates of co-infectionsResearchers from Imperial College London conducted a review of over 1,000 studies and found that use of broad-spectrum antimicrobials is common among patients with coronavirus infection, despite low rates of bacterial or fungal co-infections. Among studies that focused on COVID-19, 72 percent of patients received antimicrobial therapy, while only 8 percent of patients experienced a bacterial or fungal co-infection during hospital admission. For studies that focused on other coronaviruses, including severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV), bacterial or fungal co-infections were reported in 11 percent of patients. The development of evidence-based guidelines are urgently needed to support antimicrobial stewardship interventions specific to COVID-19.  [Clinical Infectious Diseases]

 Climate not linked to reduction in COVID-19 growth, study finds. In a global prospective cohort study, researchers found that climate was not linked to a reduction in COVID-19 growth. The study found that epidemic growth was not significantly associated with latitude or temperature, and was weakly associated with relative and absolute humidity (ratio of rate ratio [RRR] per 10 percent: 0.91, [95% CI 0.85–0.96]; RRR per 5 g/m3 0.92 [0.85–0.99]). In contrast, public health interventions, including restrictions on mass gatherings, school closures, and social distancing measures, were strongly associated with a reduction in the epidemic growth of COVID-19 (RRR: 0.65 [0.53–0.79]; 0.63 [0.52–0.78]; 0.62 [0.45–0.85], respectively). [CAMJ] 

COVID-19 may lead to rare inflammatory disorder in children. In an observational cohort study in Italy, researchers found that COVID-19 may be linked to a rare inflammatory syndrome in children, similar to Kawasaki Disease. Less than 20 cases of Kawasaki-like disease were diagnosed at a hospital in Bergamo, Italy in the five years preceding the COVID-19 pandemic, while 10 cases of the inflammatory disorder were reported in just two months (February-April 2020). Of the ten recent diagnoses, eight tested positive for the novel coronavirus. Children diagnosed with Kawasaki-like disease after February 18, 2020 presented more frequently with severe symptoms than children diagnosed before the pandemic, including heart complications (60 vs. 10 percent) and toxic shock syndrome (50 vs. 0 percent). Results of the analysis indicate a 30-fold increase in Kawasaki-like disease diagnoses, although findings are limited to a small sample size. [The Lancet]

Hydroxychloroquine shows no impact on risk of poor COVID-19 outcomes in observational study. In an observational study including 1,446 patients hospitalized for COVID-19 in New York City, researchers found no association between the use of hydroxychloroquine and risk of intubation or death (hazard ratio: 1.04 [95% CI 0.82 to 1.32]). The antimalaria drug has been used widely among COVID-19 patients despite a lack of supporting evidence. Study authors note that randomized controlled trials are needed to further assess the impact of hydroxychloroquine on COVID-19 outcomes. [NEJM]

Trial demonstrates effectiveness of triple antiviral therapy for treating COVID-19.  A hospital-based study in Hong Kong demonstrated that triple antiviral therapy was safe and effective at shortening duration of viral shedding and length of hospital stay among 127 patients hospitalized for COVID-19. The treatment group, assigned to receive interferon beta-1b, lopinavir-ritonavir, and ribavirin, had a significantly shorter median time to recovery compared to the control group, assigned to lopinavir-ritonavir alone (7 vs. 12 days, respectively). Adverse events did not differ significantly between groups. Results support future trials of triple antiviral therapy among patients with mild to moderate COVID-19.  [The Lancet]

Novel coronavirus may lead to blood clotting complicationsAutopsy results from the first12 confirmed COVID-19 deaths at a medical center in Hamburg, Germany revealed that more than half of patients (7/12) had undiagnosed deep vein blood clots, and one-third (4/12)  reportedly died from pulmonary embolism. Although the sample size of the cohort was limited, results suggest that the novel coronavirus may lead to blood clotting complications. [Annals of Internal Medicine]

Fewer childhood vaccines administered during COVID-19 pandemic. A CDC Morbidity and Mortality Weekly Report (MMWR) reported that fewer childhood vaccines have been administered during the COVID-19 pandemic compared to January-April 2019. Using data from the US Vaccine Tracking System and Vaccine Safety Datalink, researchers noted a substantial reduction in vaccine orders for non-influenza childhood vaccines and measles-containing vaccines recommended for children by the Advisory Committee on Immunization Practices (ACIP) between January 7-April 21, 2019 and January 6-April 19, 2020. The decline in vaccine orders began the week after the US declared a national emergency related to COVID-19 (March 13, 2020). Authors note the importance of reminding parents that protecting their children against vaccine-preventable diseases in the midst of a pandemic is essential. [CDC MMWR]

COVID-19 could indirectly lead to increases in maternal and child deaths in LMICs. In a modeling study, researchers found that in the most severe scenario, indirect effects of COVID-19 could lead to an additional 1.16 million and 56,700 child and maternal deaths in low- and middle-income countries (LMICs) over the next six months, respectively. The least severe scenario would lead to an additional 253,500 and 12,200 child and maternal deaths across the 118 countries included in the analysis. Scenarios were based on a 9.8-51.9 percent reduction in coverage of essential maternal and child health interventions and a 10-50 percent increase in the prevalence of wasting. Results should be used to inform guidelines and the allocation of resources before health care systems and access to food in LMICs are disrupted. [The Lancet Global Health]


Other Infectious Disease

Rapid diagnostics linked to antibiotic stewardship benefits. Researchers found that rapid diagnostic and antibiotic susceptibility testing (AST) were linked to faster antibiotic prescription change among patients with Gram-negative bloodstream infections. Median time to first change in antibiotic therapy was significantly faster among patients randomized to receive rapid organism identification (ID) and phenotypic AST compared to the control group (8.6 vs. 14.9 hours, respectively). Median time to antibiotic escalation was also significantly faster among the rapid ID and AST group compared to control (18.4 vs. 61.7 hours, respectively). Results support the use of these rapid blood culture diagnostics for improved antibiotic stewardship among patients with Gram-negative bloodstream infections. [Clinical Infectious Diseases]

Breastfeeding poses risk for mother-to-child Ebola transmission. A systematic review led by researchers at the World Health Organization (WHO) emphasized that breastfeeding is likely a route of transmission for Ebola virus. Across the 52 studies included in the review, mortality was not higher among pregnant women with Ebola (72 percent) compared to the general population with the disease. However, almost all women with Ebola experienced adverse pregnancy outcomes, including fetal loss (52 percent) and maternal death while pregnant (33 percent). The study found that Ebola virus RNA persisted in amniotic fluid and breast milk for approximately one month after the mother cleared the virus from her blood and after symptom onset, respectively. Study authors note the importance of taking precautions to reduce the risk of Ebola transmission from mother to child. [The Lancet Infectious Diseases]

Rabbi-led measles vaccination campaign successful in Jerusalem. A measles outbreak with over 2,200 cases in Jerusalem District, Israel between March 2018 and May 2019 was fueled by lack of vaccination and high population density. The highest rate of measles cases occurred among children less than one year old (1,174 cases per 100,000 population) who had not yet been vaccinated (children in Israel receive two doses of measles-containing vaccines at ages one and six).  Of cases 1-14 years old, 88.4 percent were unvaccinated. An investigation into the outbreak revealed low adherence to self-isolation recommendations, as many cases exposed themselves to crowded settings. A vaccination campaign supported by rabbis proved successful, increasing first-dose measles vaccination coverage from 76.3 to 96.1 percent between June and November 2018, subsequently reducing caseload.  [CDC MMWR]