ED mortality higher in COVID-19 patients

In the last COVID Catch-Up for the year, we also look at corpses, vaccinating the mentally ill, and a new cluster in Sydney.

Welcome to The Medical Republic’s COVID Catch-Up: the last one for 2020!

It’s been a white-knuckle 39 weeks of COVID-19 news reporting. I hope this blog has helped keep you informed and up-to-date – perhaps even entertained – on the COVID-19 pandemic. Thanks for joining me, stay safe and healthy, and I look forward to the company of your eyeballs in 2021.

17 December

• COVID-19 associated with more than two-fold higher mortality in patients presenting to the ED.
• Infectious SARS-CoV-2 hangs around for days post-mortem.
• MBS service use dropped 10% in first wave of pandemic.
• Individuals with severe mental illness should also be prioritised for COVID-19 vaccine, experts say.
• Latest confirmed COVID-19 infection rates from around Australia.

• In Australia’s second wave of the COVID-19 pandemic, one in 20 of those who tested positive in the emergency department received mechanical ventilation, according to data published in Emergency Medicine Australasia.
  The study reviewed 106,000 presentations to 12 emergency departments across Australia, 12,000 of which were tested for SARS-CoV-2 and 255 (2%) of which tested positive.
  The rate of mechanical ventilation was more than double among SARS-CoV-2-positive presentations compared to those who tested negative, and COVID-19 presentations were five times more likely to end up in intensive care.
  The in-hospital mortality rate was also more than two times higher among those who tested positive: 7% compared to 3%.
  “Although the rates of mechanical ventilation and death were relatively low in both groups, especially when compared to data from overseas settings, this study demonstrates that ED patients diagnosed with COVID-19 have worse outcomes than comparable patients who return a negative SARS-CoV-2 test result,” the authors wrote.
• Infectious SARS-CoV-2 RNA can be isolated from nasopharyngeal swabs for more than a day after death, according to a post-mortem study in people who had died from COVID-19.
  The study, published in Emerging Infectious Diseases, involved analysing nasopharyngeal swab samples collected from 79 individuals both before their deaths and for up to seven days after death.
  This revealed that individuals’ SARS-CoV-2 viral load didn’t change post-mortem, viral RNA was consistently isolated even up to seven days after death, and infectious viral loads were evident at 35 hours after death.
  “Taken together, our data indicate potentially high infectivity of human corpses, requiring hazard assessments in professional fields concerned and careful and conscious handling,” they wrote.
• Use of Medicare Benefits Scheme services dropped by more than 10% and benefit payouts by nearly 8% during the peak of the first wave of COVID-19 in Australia in April 2020, compared to the April 2019.
  A report from the Australian Institute of Health and Welfare found that GP attendances remained fairly stable across the pandemic, which the authors suggested may be due to the introduction of telehealth services. However MBS services for specialists and elective surgery plummeted during the first wave, although these have since recovered to pre-pandemic levels.
  The pandemic peak in March also saw a 23% increase in the number of PBS prescriptions dispensed, compared to March 2019, with the most significant increase seen in medications for respiratory conditions such as asthma and COPD.
  Total PBS benefits paid in the first eight months of 2020 are 7.5% higher than for the same period in 2019.
• Individuals with severe mental illness should be prioritised for COVID-19 vaccination because of their greater risks of infection and severe outcomes, experts say.
  In an article in JAMA Psychiatry, Australian and Canadian authors argue that this group are at risk of worse outcomes because they have poorer general health, comorbidities, reduced access to medical care, and a greater likelihood of lower socioeconomic status, living in overcrowded environments, smoking or obesity.
  However they also acknowledged the challenges in getting vaccinations to this population, and there is generally low uptake of recommended vaccines among those with severe mental illness.
  “It is vital to commence planning and development of appropriate policies to ensure rapid delivery of a COVID-19 vaccine when it becomes available,” they wrote.
• A bus driver who transported air crew to and from their hotels in Sydney has tested positive for COVID-19, and while infectious attended a sporting event in Peakhurst in south Sydney on Friday 11 December.
  He is one of five locally acquired cases of COVID-19 reported in the last 24 hours, but all eyes are on Sydney’s northern beaches where four new cases have been identified. NSW Health has issued a public health alert for a list of venues in Avalon, Palm Beach and Mona Vale, asking anyone who has attended those venues to isolate and get tested.
  Here are the latest confirmed COVID-19 infection numbers from around Australia to 9pm Wednesday:
  National – 28,059 with 908 deaths
  ACT – 117 (1)
  NSW – 4657 (7)
  NT – 66 (0)
  QLD – 1229 (1)
  SA – 563 (0)
  TAS – 234 (0)
  VIC – 20,351 (0)
  WA – 842 (4)