Just a quick news note. The Governor of Florida said yesterday that results from Florida’s drive-in testing sites, so not a random sample, indicated an antibody prevalence of over 20%. That is a possible explanation of why cases have dropped dramatically in Florida, the virus is having a harder time finding people who can become infectious.
This is a seroprevalence study from Oregon in which 10,000 health system workers were tested several times over April and May. (Medrxiv Paper) Overall antibody prevalence was about 2.5%. Interestingly, there was frequent mismatch between antibody positivity and the results of infection testing, leading to further questions about the accuracy of both kinds of testing.
This article in a CDC journal described hospitalizations for coronavirus disease among children. (CDC Article) The paper covered 576 hospitalizations for children under age 18, one of whom died. Infants, unfortunately, had the highest rate among sub-groups of children, which is to be expected, as they have immature immune systems. Children in this overall age group have a far lower hospitalization rate than the general population, at only about 8 hospitalizations per 100,000 children. Over 40% of those hospitalized had a pre-existing condition, with obesity and lung disease being the most common conditions. Median length of stay was only 2.5 days, implying a lot of stays that were merely observational.
This study in another CDC journal discusses the rate of asymptomatic infections in long-term care facilities. (CDC Article) These facilities have been the hottest of hot spots for this epidemic, with well over 50% of deaths occurring among residents. The study examined rates and characteristics of illnesses in 9 institutions in the Los Angeles area. The 9 facilities were identified as part of an effort to contain infections, and had a history of sustained transmission. While overall infection rates were very high at 67%, a substantial proportion of those infections were asymptomatic, 50% among residents, and interestingly, among staff it was only 25%. This is surprising, but agains suggests that many people are or have been “infected” and are unaware of that, even in these settings with very vulnerable populations.
Yet one more piece of research in a CDC journal is this study of contacts of an early case in Washington state. (CDC Article) There were 50 contacts, 38 were interviewed, 11 had extensive, unprotected face-to-face contact with the index patient. 37 had an infection test, 23 had a later antibody test. Not one had evidence of an infection. The index patient had a moderate illness, including a hospital stay. This is a strange virus, hard to figure out how and why it transmits in some settings and circumstances and not others.
Okay, some bad news about the effects of lockdowns and other mitigation measures. As predicted, serious domestic violence is up and physical injuries more common. A study from Boston describes this trend. (DV Study) 2020 was compared to 2017 to 2019. While total number of instances of people reporting domestic violence to a hospital was down, abuse involving physical injuries was up by 1.8 times and the type of injuries sustained were significantly worse. The likely interpretation is that there is more abuse occurring, but people were fearful of coming to the ER unless their injuries were quite severe, because of CV fear and having to continue to be at home more with the abuser. The rise was concentrated among Caucasians. You force people to be together for longer periods of time and some bad things can happen. But to the media and politicians, unless they also had coronavirus, these domestic violence victims don’t count.
But here is a paper with some potential good news on lockdown impacts. It claims that deaths from heart disease were actually down early in the epidemic. (Medrxiv Paper) The researchers used only states without large reported outbreaks of CV disease, on the assumption that people would be less likely to avoid seeking care in those states. That is a questionable assumption given the national hysteria. They looked at CDC statistics on deaths by cause and compared the period from the end of March to the end of April for 2020 to 2019. They found a slight decline in heart disease deaths in those non-outbreak states. In states which did have a significant outbreak, there was some indication of an increase in heart disease deaths. Since the authors did find a decrease in ER visits for symptoms of heart attack, it is hard to know how to explain the decline in deaths. There has been a trend for a number of years of a decrease in heart disease mortality, so 2020 could just be a continuation of that trend. Longer-term followup would also elucidate whether the avoidance of care ultimately led to more deaths, as some other research indicates.