Health
Study Suggests a Third of COVID-19 Hospital Patients May Die – Medscape
A third of patients in hospital with COVID-19 may be dying, according to preliminary UK research.
The preprint also found that being male or obese reduced chances of survival from the disease.
More than half of patients mechanically ventilated are dying, the authors said.
The prospective observational cohort study, which has not been peer reviewed, was carried out by a consortium of researchers, known as ISARIC4C, and was led by the University of Liverpool, University of Edinburgh, and Imperial College London (ICL).
They set out to discover who was most severely affected by the virus, what happens to them in hospital, and why some people have better outcomes than others.
A pre-approved questionnaire adopted by the World Health Organisation was used to gather information in 166 UK hospitals between 6th February and 18th April 2020.
A total of 16,749 people with COVID-19, with a median age of 72, were involved in the research.
Main Findings
Overall, the findings showed that:
Of the 17% of patients admitted to High Dependency or Intensive Care Units because of COVID-19:
Of patients requiring mechanical ventilation:
The study also cast light on the role that age and sex might play in patient outcomes.
More men (60.2%) than women (39.8%) had been admitted to hospital with COVID-19.
Only 2.0% of patients admitted to hospital were under 18 years.
Six percent of women of reproductive age were pregnant.
Increased age was a strong predictor of in-hospital mortality.
The Role of Obesity
The research found that after adjusting for other medical problems already known to cause poor outcomes, being obese was a significant factor associated with hospital deaths.
Obesity was recognised as a risk factor in 2009 for pandemic A/H1N1 influenza, the authors write, although not in 2016 Middle East respiratory syndrome coronavirus (MERS-CoV).
They speculate that obese people with COVID-19 could have reduced lung function and possibly more inflammation in adipose tissue, which might contribute to an enhanced ‘cytokine storm’.
Comorbidities
According to the Department of Health and Social Care, COVID-19 can be more severe in older people and those with chronic heart, lung, and kidney disease, a weakened immune system, diabetes, and some cancers.
The study found that the commonest comorbidities among patients were:
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Chronic cardiac disease (29%)
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Uncomplicated diabetes (19%)
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Non-asthmatic chronic pulmonary disease (19%)
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Asthma (14%)
However, 47% of patients had no documented comorbidity.
Symptoms
The main symptoms found among patients with COVID-19 were:
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Respiratory (cough, sputum, sore throat, runny nose, wheeze, and chest pain)
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Systemic (fever, myalgia, joint pain and fatigue)
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Enteric (abdominal pain, vomiting and diarrhoea)
Out of 11,326 patients, the most common symptoms were cough (70%), fever (69%), and shortness of breath (65%). Fatigue and confusion also featured quite prominently.
Only 4% of patients reported no symptoms.
Professor Calum Semple, from the University of Liverpool, who led the study, said: “We must do everything humanly possible to understand this disease, so that we are better prepared for the next wave of this pandemic.”
Professor Peter Openshaw, from the National Heart & Lung Institute at ICL, said: “Our research provides an exceptional picture of the illness and risk factors and will underpin a huge range of research.”
‘Helpful Insights’
Derek Hill, professor of medical imaging at University College London, described the research as “extremely impressive”.
He told the Science Media Centre: “This is an especially large study so it provides helpful insights into the symptoms of COVID-19 patients admitted to hospital.
“As has been reported many times, this is not like flu in who gets seriously ill or in mortality: young children seem to have low risk and pregnant women do not have a increased risk of serious illness, and it is deadlier than flu.
“There are several distinctive clusters of symptoms, with a significant number of patients not having the characteristic cough and fever symptoms. If extrapolated to the community this might suggest some deaths due to COVID-19 might be missed in untested people.
“This work also highlights the link between obesity and poor outcome from COVID-19.”
Prof Hill pointed out that the findings only cover people with COVID-19 who were admitted to hospital.
Also, many people are still undergoing treatment, and so mortality and survival figures might change.
Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol, doi: https://doi.org/10.1101/2020.04.23.20076042 Paper
Health
RCMP warn about benzodiazepine-laced fentanyl tied to overdose in Alberta – Edmonton Journal
Article content
Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.
The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.
Article content
Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.
The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.
Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”
From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.
Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.
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Health
CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture
The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.
Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.
The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.
Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.
As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.
This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.
Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.
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Health
Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star
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Canada has seen a concerning rise in measles cases in the first months of 2024.
By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.
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