15 July 2020

Universal face-masks in hospitals linked to lower infection rates

Communicable Disease COVID-19 Live blog

Welcome to The Medical Republic‘s COVID Catch-Up.

It’s the day’s COVID-19 news into one convenient post. Got any tips, comments or feedback? Email me at bianca@biancanogrady.com.

15 July

  • The introduction of mandatory face masks for all healthcare workers and patients at 12 US hospitals was associated with a significantly lower incidence of COVID-19 among healthcare workers, according to a study published in JAMA.
    The study looked at the incidence of positive SARS-CoV-2 tests among staff at Mass General Brigham’s 12 Massachusetts hospitals, before and after the introduction of an infection reduction strategy that included universal masking for all healthcare workers and patients and systematic testing of symptomatic staff.
    Before the policy was introduced, the SARS-CoV-2 positivity rate had been doubling every 3.6 days, and over the first three weeks of March had increased from 0% to 21.32%. After masking was introduced in early April – and allowing for a lag period – the rate of positive tests decreased in a linear fashion at around 0.5% per day from mid to late April.
    The authors acknowledged that the decrease in infections could also have been influenced by other interventions, such as restrictions on elective procedures, social distancing and increased masking in the general public. However they pointed out that case numbers in Massachusetts during the study period continued to increase, suggesting that the decline in infection rate in these hospitals preceded the later decrease seen in the general community.
    An accompanying editorial used the study findings to call for universal masking, saying the study provided “practical, timely, and compelling evidence that community-wide face covering is another means to help control the national COVID-19 crisis.”
    “At this critical juncture when COVID-19 is resurging, broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19.”
  • Australian cardiologists have raised concerns about the significant number of patients with ST-segment elevation myocardial infarction who may not be seeking treatment during the COVID-19 pandemic.
    Writing in Heart, Lung and Circulation, clinicians from the Prince of Wales Hospital in Sydney reported a 32% reduction in the number of STEMI cardiac catheterisation performed at their lab from 15 March to 15 May 2020 compared to the same period last year.
    They wrote that restrictions, cancellations of elective surgeries, a tightening of the criteria for acute cardiology admissions, and intensive media coverage of the pandemic have created a culture of fear of seeking medical care, which has led avoidance and delayed presentations that have significant health consequences. This avoidance has also been seen in other countries such as Italy and the United States.
    “Understanding the collateral damage issue is critical as health care services move forward and prepare for the second wave of cardiovascular disease in the postCOVID-19 era, aptly termed ‘the impending tsunami’,” they wrote.
  • Current guidelines on PPE use in healthcare workers in Australia are not adequate to protect them against COVID-19, say a group of Australian researchers who are calling for N95 respirators to be considered because of possible airborne transmission.
    A non-peer-reviewed article published in the Medical Journal of Australia, lead authored by Professor Raina McIntyre, argues that current guidelines requiring respirators only for aerosol-generating procedures – and medical masks otherwise – are not up to date with the growing body of evidence suggesting airborne transmission.
    The group also called for national reporting of healthcare worker infections with COVID-19.
    “We must make the occupational health and safety of our health workers a national priority,” they wrote.
  • The first COVID-19 vaccine candidates are beginning to publish their preliminary phase 1 data on safety and immunogenicity. The latest report comes from a vaccine developed with support from the National Institutes of Health (and – because she’s a legend – the Dolly Parton COVID-19 Research Fund, among others) which aims to generate an immune response against the SARS-CoV-2 spike protein.
    According to a paper in the New England Journal of Medicine, the vaccine has been trialed in 45 healthy adults (although who were not screened for SARS-CoV-2 before enrolment), who were given two injections on day 1 and day 29, with different dosing regimens.
    While no serious adverse events were seen, one to two-thirds of participants reported systemic and localised adverse effects such as pain, chills, fatigue, localised reactions and headache. After the second injection 40%-57% of those in the two higher-dose arms reported fever.
    However the study did find ‘robust’ binding antibody responses suggesting the vaccine was immunogenic. The study has so far only followed participants for 57 days, so data on durability is yet to come.
  • The number of COVID-19 infections in Australia since the pandemic began has topped 10,000, as Victoria reports another 270 cases on Tuesday and the number of cases now linked to the Crossroads Hotel in Sydney increases to 30.
    In a press conference today, federal health minister Greg Hunt described the situations in both NSW and Victoria as ‘stable’, although said the growing numbers of cases in Victoria were deeply concerning.
    The federal government is now providing military support to help with contact tracing, and two private hospital wards in Victoria are being set up to receive COVID-19 patients from aged care homes as 32 facilities now report either patients or staff with the disease. Two more lives have been lost in Victoria to COVID-19 – a man and woman in their 80s – and 26 people are in intensive care.
    In NSW, two cases have been reported from Planet Fitness Gym in Casula, and the NSW health department is urging anyone who has attended the gym between 4-10 July to self-isolate and get tested. Huge queues have been reported at the pop-up testing facility at the Crossroads Hotel, but testing clinics can also be found at the Victoria Park site at Picton; Liverpool, Fairfield, Campbelltown and Bowral hospitals; and the Ash Road Sporting Complex at Prestons.
    Here are the latest confirmed COVID-19 infection figures around Australia:
    National – 10,251, with 108 deaths
    ACT – 113
    NSW – 3505
    NT – 31
    QLD – 1071
    SA – 443
    TAS – 228
    VIC – 4224
    WA – 636
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