Drowning in Coronavirus Research, Part 30

An article in the Journal of the American Medical Association looked at skilled nursing facility admissions and deaths during the pandemic in three cities, Cleveland, Detroit and NYC.  A timely topic considering that the majority of coronavirus deaths are coming from these facilities.   (JAMA Article)   189 SNFs were included.  There were 3853 all-cause, in-facility deaths in the study period in 2020 compared to 1765 in 2019.  In Cleveland the increase was not statistically significant, but it was in the other cities.  Weekly admissions also declined in the study period, especially in Cleveland.

The agency that administers Medicare released data on the extent of cases among Medicare beneficiaries and those beneficiaries’ outcomes.   (CMS Data)   There are 62 million Americans in Medicare, 60% in traditional Medicare and 40% enrolled in Medicare Advantage plans.  According to data received by June 11, for dates of service from January 1 to May 16, among Medicare beneficiaries there have been 326,674 cases, with a high concentration in the northeast.  People covered by both Medicare and Medicaid had over four times that rate of cases than those covered by Medicare alone.  African-Americans had twice the overall population rate.  The infection rate increased with age.  There were 109,607 hospitalizations among this group, peaking in mid-April.  28% of those hospitalized died, 27% were discharged to home, 21% to a skilled nursing facility and 11% to home health.  Median length of stay was 7 or 8 days.  A very high prevalence of comorbidities existed among these patients.

This paper is another looking at the potential role of vaccines in preventing coronavirus infections.   (Medrxiv Paper)   The researchers looked at whether receiving an influenza vaccine is associated with lower coronavirus risk of death.  After adjusting for a large variety of variables they found that it was.  Astoundingly, only 45% of people over age 65 were getting a flu vaccine. I don’t understand that given the high risks of serious illness from flu among that group.  The results do suggest that vaccines may confer some general boost to immune system capability.

The Agency for Healthcare Research and Quality conducts general reviews of the evidence to support various health care interventions or policies.  It conducted a rapid review of the evidence regarding mask use in the community or in health care settings.  (AHRQ Study)   Primarily due to methodological issues, the evidence is generally considered weak.  In general the prior studies on masks and influenza-like illnesses have shown little or no benefit.  Masks have two potential uses.  One is to keep the wearer protected from infection.  The second is if the wearer is infected, to keep the wearer from potentially infecting others.  The problem is what you would really like to see is a randomized study that tests whether mask wearers versus non-mask wearers are more likely to either get infected or not infect others, given the same exposure to virus particles or same viral load and shedding.  I think the answer is probably yes in both cases, but how much difference masks make is even less certain.  Even advocates can’t point to any convincing evidence that they make a significant difference.  And mask use rarely occurs in isolation from other mitigation tactics, like keeping your distance and washing your hands.  Also, and a recent survey confirms this, people very often don’t use masks properly.  And as the report points out, there can be harms from mask-wearing, including breathing difficulties.