There were more than 1,500 more deaths in Australia between 1 January and 28 April 2020, compared to the baseline average for that period over the past five years.
Welcome to Allergy & Respiratory Republic‘s COVID Catch-Up for this week.
- There were more than 1,500 more deaths in Australia between 1 January and 28 April 2020, compared to the baseline average for that period over the past five years, according to data from the Australian Bureau of Statistics.
During that period, there were just over 44,000 doctor-certified deaths, compared to the five-year average of around 42,500. From 17 March to 7 April alone, there were 624 excess deaths compared to historical averages. The peak coincides with the first peak of COVID-19 infections in Australia, and at that stage there were only around 90 official COVID-19 deaths recorded.
In particular, deaths from pneumonia were particularly high during the last week of March, and were above historic maximums from mid-March to mid-April. There were also 115 more deaths from diabetes from the last week of March and throughout April compared to the historical average. - Around the world, SARS-CoV-2 has beaten the Spanish flu for excess deaths. A comparison of excess all-cause mortality in New York City during the 1918 Spanish flu and during the COVID-19 pandemic has found that the Spanish flu epidemic was associated with 30% lower excess mortality.
The year 1918 was hardly a high point for public health, and came at the tail-end of a world war that would have left a huge number of otherwise healthy individuals in a damaged and battered state. So the fact that COVID-19 has still claimed more lives suggests it really is the nasty of nasties, at least of the respiratory variety.
The study, published in JAMA Network Open, found that the peak of the 1918 H1N1 was associated with a 2.8-fold higher rate of all-cause mortality compared to corresponding periods from 1914-1917. The peak of the COVID-19 pandemic is associated with a greater than four-fold higher rate of all-cause mortality than the same period from 2017-2019. - A significant number of individuals with mild COVID-19 have low or undetectable levels of the neutralising antibodies that would normally be a marker of recovery and protection against further infection, a study has found.
A paper published in JAMA Internal Medicine looked at the levels of neutralising antibodies to SARS-CoV-2 at hospital discharge in 175 patients who had experienced mild COVID-19. Thirty percent of these patients had low levels of neutralising antibodies, and one in five of these had levels below the limit of detection. Those who did not generate detectable levels of antibodies were younger and most were female, but otherwise showed no significant differences in disease duration or severity.
“It is not clear how these patients recovered without developing detectable virus-specific Nabs [neutralising antibodies],” the authors wrote. “Whether other immune responses, including T cells or cytokines, contributed to the recovery of these patients and whether these patients are at risk for reinfection is not known.”
The authors also saw that median antibody levels were significantly lower two weeks after discharge, and those who had undetectable levels at discharge didn’t show any increase even two weeks later.
They noted that this had implications for use of convalescent plasma in treating severe COVID-19, and also raised questions about whether these neutralising antibodies played a role in COVID-19. - Non-invasive ventilation using a firm-fitting face mask can be considered for COVID-19 patients with hypoxaemia who are in negative pressure rooms, according to the latest update from Australia’s National COVID-19 Clinical Evidence Taskforce.
However the advice comes with an emphasis that it should be used with caution and with ‘strict attention’ paid to the safety of staff. - Children have accounted for just over 1% of all COVID-19 cases reported in the UK from January to May, according to a paper published in the Archives of Disease in Childhood.
Of 540,305 people who tested positive for SARS-CoV-2 in England during that period, 1.1% were aged under 16 years, with the median age of childhood cases being 5.9 years.
Among the 1408 cases there were eight deaths, four of which were directly attributed to COVID-19 and three of those were in children with multiple comorbidities. The authors pointed out that the positivity rate among children tested for SARS-CoV-2 was only 4% – significantly lower than the 50% seen in adults aged 80 years and over. “Consistent with other countries, children account for a very small proportion of confirmed cases and have very low case-fatality rates,” they wrote. - Australia’s National COVID-19 Clinical Evidence Taskforce wants to hear from Australian healthcare professionals about the guidelines and flowcharts produced by the taskforce, and the website for these resources. If you have 15 minutes free, the survey is here.
- It’s hardly news any more, but a large population-based UK study has highlighted BMI and waist-to-hip ratio as risk factors for COVID-19 hospitalisation, but with an emphasis on the key role that HDL cholesterol and blood sugar play in mediating this interaction.
Analysis of data from 334,329 adults in the UK Biobank study, published in PNAS, found around 0.2% were hospitalised with COVID-19. There was a linear relationship between BMI and risk of COVID-19 even from those with modestly elevated weight, compared to normal weight. However this association was significantly reduced after accounting for HbA1C and HDL cholesterol levels, such that higher HbA1C was associated with a greater risk, and higher HDL was associated with a lower risk.
Get Bianca’s daily COVID Catch-Up at medicalrepublic.com.au.
