H5N1

Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023

Via AJPH: Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023. The full article is paywalled, but the abstract confirms some earlier studies:

Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation.  

Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures.  

Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures.  

Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded.

Compound mortality impacts from extreme temperatures and the COVID-19 pandemic

Via Nature Communications: Compound mortality impacts from extreme temperatures and the COVID-19 pandemic. The abstract:

Extreme weather and coronavirus-type pandemics are both leading global health concerns. Until now, no study has quantified the compound health consequences of the co-occurrence of them. We estimate the mortality attributable to extreme heat and cold events, which dominate the UK health burden from weather hazards, in England and Wales in the period 2020-2022, during which the COVID-19 pandemic peaked in terms of mortality. 

We show that temperature-related mortality exceeded COVID-19 mortality by 8% in South West England. Combined, extreme temperatures and COVID-19 led to 19 (95% confidence interval: 16–22 in North West England) to 24 (95% confidence interval: 20–29 in Wales) excess deaths per 100,000 population during heatwaves, and 80 (95% confidence interval: 75–86 in Yorkshire and the Humber) to 127 (95% confidence interval: 123–132 in East of England) excess deaths per 100,000 population during cold snaps. 

These numbers are at least ~2 times higher than the previous decade. Society must increase preparedness for compound health crises such as extreme weather coinciding with pandemics.

WHO: Global technical consultation report on proposed terminology for pathogens that transmit through the air

WHO attempts to settle a toxic dispute: Global technical consultation report on proposed terminology for pathogens that transmit through the air. Click or tap through to download the full report. The overview:

Terminology used to describe the transmission of pathogens through the air varies across scientific disciplines, organizations and the general public. While this has been the case for decades, during the coronavirus disease (COVID-19) pandemic, the terms ‘airborne’, ‘airborne transmission’ and ‘aerosol transmission’ were used in different ways by stakeholders in different scientific disciplines, which may have contributed to misleading information and confusion about how pathogens are transmitted in human populations.   

This global technical consultation report brings together viewpoints from experts spanning a range of disciplines with the key objective of seeking consensus regarding the terminology used to describe the transmission of pathogens through the air that can potentially cause infection in humans.   

This consultation aimed to identify terminology that could be understood and accepted by different technical disciplines. The agreed process was to develop a consensus document that could be endorsed by global agencies and entities. Despite the complex discussions and challenges, significant progress was made during the consultation process, particularly the consensus on a set of descriptors to describe how pathogens are transmitted through the air and the related modes of transmission.  

WHO recognizes the important areas where consensus was not achieved and will continue to address these areas in follow-up consultations.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic

A major report in The Lancet: Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. The summary:

Background  

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.

Methods

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

Findings

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019.

 

An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends.

 

Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

Interpretation

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

Welcome to the Canadian Covid Society

Via its home page, the Canadian Covid Society introduces itself. Excerpt:

Our Mission  

At the Canadian Covid Society, we strive to protect the health and safety of people in Canada against the harms of COVID-19 and long Covid, through education, engaging and empowering the public and organizations with scientific knowledge.  

The Stakes  

Covid is the 3rd leading cause of death, behind heart disease and cancer.  There have been nearly 30 million excess deaths worldwide since the start of the pandemic.  While the acute phase of the pandemic has ended, the virus continues to cause significant chronic illness.

Cognition and memory after Covid-19 in a large community sample

Via NEJM: Cognition and Memory after Covid-19 in a Large Community Sample. The abstract: 

BACKGROUND  

Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear.  

METHODS  

We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”).  

RESULTS  

Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no–Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (−0.23 SD [95% confidence interval {CI}, −0.33 to −0.13] and −0.24 SD [95% CI, −0.36 to −0.12], respectively); larger deficits as compared with the no–Covid-19 group were seen in participants with unresolved persistent symptoms (−0.42 SD; 95% CI, −0.53 to −0.31).  

Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., −0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, −0.20 to −0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, −0.35 SD; 95% CI, −0.49 to −0.20). Results of the analyses were similar to those of propensity-score–matching analyses.  

In a comparison of the group that had unresolved persistent symptoms with the no–Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (−0.33 to −0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported.  

CONCLUSIONS  

Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.

Hospital stays for respiratory illnesses increase among Canadian children

A news release from the Canadian Institute for Health Information: Hospital stays for respiratory illnesses increase among Canadian children.

February 22, 2024 —  The data confirms the anecdotal evidence from across the country last year: in 2022–2023, Canada’s hospitals saw a significant increase in stays due to respiratory illnesses among people younger than 18.  

In particular, data from the Canadian Institute for Health Information (CIHI) shows a rebound in hospitalizations for seasonal flu among children age 0 to 4 — the number of stays jumped to 2,444, a return to pre-pandemic volumes. The most common respiratory illnesses among children age 0 to 4 accounted for 32% of all hospitalizations in this group, increasing from 20% the previous year.   

In addition to seasonal influenza, hospitalizations for pneumonia tripled for Canadians age 0 to 17 and almost doubled for asthma. Among children age 0 to 4, hospitalizations doubled for lower respiratory infections, and stays for COVID-19 rose by 43%.  

“Having a baby or young child in hospital for any reason is tremendously difficult on families, and this increase in hospitalizations for respiratory illnesses among Canada’s youngest patients presented additional challenges for hospitals,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We will continue to monitor and report on these trends to equip health system planners and decision-makers with the data required to continue to meet the needs of Canada’s pediatric population.”  

“Last year was unprecedented for all pediatric hospitals in this country and highlighted key gaps in our system. We know from experience that viral seasons will continue to affect our young patients, and this is why it is so important that we invest in our pediatric health system and adopt public health measures to help reduce the risks,” said Dr. Lindy Samson, Chief of Staff and Chief Medical Officer, Children’s Hospital of Eastern Ontario (CHEO), and pediatric infectious disease specialist.  

Quick facts  

• The respiratory illnesses that are in the top 10 reasons for hospitalizations accounted for 32% of all hospitalizations for Canadians age 0 to 4 in 2022–2023.  

• Hospitalizations for seasonal influenza among children age 0 to 4 increased to 2,444 in 2022–2023, similar to 2019–2020 volumes.  

• Large increases were also observed in this age group for other respiratory illnesses:  

* Hospital stays for lower respiratory infections such as acute bronchitis increased from 9,501 to 19,909.  

* Hospitalizations for pneumonia almost tripled, rising from 3,447 to 9,871.  

* Asthma hospital stays increased by 61%, from 3,474 to 5,607.  

* COVID-19 accounted for 3,310 hospitalizations, up 43% from the previous year.  

* Acute upper respiratory infections saw a 32% increase in hospitalizations, going from 2,114 to 2,797.

Notes from the field: Long COVID prevalence among adults — United States, 2022

Via MMWR: Notes from the Field: Long COVID Prevalence Among Adults — United States, 2022. The summary:

What is already known about this topic?  

Long COVID encompasses a range of health problems that emerge, persist, or recur following acute COVID-19 illness.  

What is added by this report?  

Age- and sex-standardized prevalence of reporting ever having experienced Long COVID among Behavioral Risk Factor Surveillance System survey respondents in U.S. states and territories ranged from 1.9% (95% CI = 0.9%–4.1%) in the U.S. Virgin Islands to 10.6% (95% CI = 9.5%–11.8%) in West Virginia; prevalence of Long COVID exceeded 8.8% in seven states.  

What are the implications for public health practice?  

Ongoing assessment of jurisdiction-specific prevalence of Long COVID could inform policy, planning, or programming to support U.S. adults experiencing Long COVID.

Long COVID is associated with severe cognitive slowing: A multicentre cross-sectional study

Via eClinical Medicine: Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study. The summary:

Background  

COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing.  

Methods  

To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK.  

Findings  

We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention.  

Interpretation  

Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC.

Global pandemic agreement at risk of falling apart, WHO warns

Via The Guardian: Global pandemic agreement at risk of falling apart, WHO warns. Excerpt:

Plans for a global pandemic preparedness agreement risk falling apart amid wrangling and disinformation, according to the chief of the World Health Organization, who has warned that future generations “may not forgive us”.  

Shaken by the Covid-19 pandemic, the WHO’s 194 member states decided more than two years ago to start negotiating an international accord aimed at ensuring countries are better equipped to deal with the next health catastrophe, or to prevent it altogether.  

The plan was to seal the agreement at the 2024 World Health Assembly, the WHO’s decision-making body, which convenes on 27 May.  

However, Tedros Adhanom Ghebreyesus, the WHO’s director-general, said the momentum had been slowed down by entrenched positions and “a torrent of fake news, lies, and conspiracy theories”.  

He warned that if nobody was prepared to seize the initiative or give ground, the whole project risked going nowhere.  

Tedros told the WHO’s executive board in Geneva on Monday: “Time is very short. And there are several outstanding issues that remain to be resolved.”  

Failure to strike an agreement would be “a missed opportunity for which future generations may not forgive us”, he said.  

Tedros said all countries needed the capacity to detect and share pathogens presenting a risk, and timely access to tests, treatments and vaccines.  

He called for a “strong agreement that will help to protect our children and grandchildren from future pandemics”.  

Tedros said claims that the accord would cede sovereignty to the WHO or give it the power to impose lockdowns and vaccine mandates were “completely false”.  

“We cannot allow this historic agreement, this milestone in global health, to be sabotaged.”  

WHO member states decided in December 2021 to create a new international instrument on pandemic prevention, preparedness and response, aimed at ensuring the flaws that turned Covid-19 into a global crisis could never happen again.  

The WHO emergencies director, Michael Ryan, reminded countries how the pandemic “ripped apart our social, economic and political systems and became a multi-trillion dollar problem”.  

In the midst of major geopolitical conflicts, “this is one thing the world agrees on”, he said.  

Roland Driece, who is co-chairing the negotiations, said the project had condensed a seven-year process into two years.  

He said the accord should be ambitious, innovative and with clear commitments