H5N1

Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic

Via the Canadian Institute for Health Information: Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic. Excerpt:

The second year of the pandemic saw a surge of hospitalizations for COVID-19 and other infections among Canadian children age 0 to 4. Data from the Canadian Institute for Health Information (CIHI) shows that COVID-19 was the sixth most common reason kids in this age group were hospitalized in 2021–2022. This represents an increase of more than 600%, with a total of 2,315 COVID-19 hospitalizations among this cohort in 2021–2022 compared with 325 hospitalizations in 2020–2021. See Inpatient Hospitalization, Surgery and Newborn Statistics, 2021–2022 (XLSX).  

CIHI’s report shows that in addition to an increase in hospitalizations for COVID-19, respiratory infections (including pneumonia) and other viral infections returned as top 10 diagnoses that required hospitalization for Canadians age 0 to 4 in 2021–2022. The increase in hospitalizations for virus-related illnesses coincided with the easing of public health measures across the country.  

“This uptick in hospitalizations for COVID-19, respiratory infections and other viral illnesses seen among the youngest Canadians in the second year of the pandemic is concerning both for the health of our youngest and most vulnerable, and for the additional strain placed on health systems and health care workers that were already stretched thin,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We are continuing to monitor hospital activity in this third year of the pandemic to understand the ongoing impacts of COVID-19 on Canadians.”  

COVID-19 continued to present challenges for Canadians of all ages and was the second most common reason for hospitalization in Canada in 2021–2022, jumping from seventh in 2020–2021. This represents an increase of more than 60%, with a total of 77,344 hospitalizations in 2021–2022 compared with 47,715 hospitalizations in 2020–2021.

Bilateral pneumonia outbreak in Tucumán, Argentina

Thanks to Giuseppe Michieli for tagging me in a tweet about this news release from the Ministry of Public Health in the province of Tucumán, Argentina: El ministerio de Salud Pública informó sobre la situación sanitaria del brote de neumonía bilateral (Ministry of Public Health reports on the health situation of the outbreak of bilateral pneumonia). Excerpt from the Google translation, lightly edited:

In a new press conference, the head of the Health Portfolio, Dr. Luis Medina Ruiz, reported the death of a 70-year-old patient and the identification of 3 employees of the sanatorium experiencing the same outbreak.

In this regard, the minister announced: “The sanatorium informed us of the death of a 70-year-old patient who was hospitalized there, we needed the family to know first to be able to communicate it. In addition, we identified 3 more employees of the private agent who began with symptoms around August 20 to 23 (that is, they correspond to the same outbreak and place of contagion in principle). That is why at this moment 3 more people are added to the 6 initial patients”.

Regarding the 70-year-old patient who died today, the minister stated: “She was hospitalized and she underwent surgery for a gallbladder problem. She was re-operated twice. From then on, an infectious pulmonary disease took place, the date of which coincides with the onset of symptoms in the other patients, around August 20. Although it is not yet clear which came first, at first she was considered patient zero, but she is under study based on the deepening of the analyses that are being carried out”.

At the same time he added: “We informed about the 3 identified employees. One of them is a 40-year-old pharmacy assistant and she was hospitalized a few days ago in a public hospital with a fever. In the active search that we are carrying out, especially in health personnel, we detected that it is a person who has non-severe bilateral pneumonia with an oxygen requirement under study. The other person is a 44-year-old nurse; she is at her home and we are following her evolution, since her clinical condition does not warrant hospitalization. The third case is a 30-year-old nurse with comorbidities, who was admitted to hospital this morning. His symptoms began around the same days and on the date he was present to be evaluated, at which time we decided to hospitalize him."

Following this line, the official explained that these three people have bilateral pneumonia as a clinical characteristic and have in common the origin of the focus, the epidemiological link with the 6 initial patients. The criterion of incorporating them as suspected patients to the outbreak in principle is based on the employment relationship with the sanatorium, bilateral pneumonia and that with all the study panels its etiology has not yet been found.

“Last night and this morning we had information from the Malbrán Institute and so far all the studies that we had as negative -for Covid, Hantavirus and some strains of Legionella- are also giving negative results there. We continue to carry out the research protocol for blood cultures, sputum cultures, urine cultures and all the viruses and bacteria that we have available in the province. We are in direct communication with Minister Carla Vizzotti, who is available, as well as all the epidemiology and infectious disease teams of the Nation, we are working as a large medical board in which we all participate with the information we have, there are hypotheses of the etiology that are being put on the table, although what we have specifically is the common origin and evolution of the disease”, he added.

Kazakhstan's great 'unknown pneumonia' scare

Via Kazinform, a July 9 report: Nur-Sultan sees almost 4-fold rise in beds for COVID-19 patients. The full report and then a comment:

NUR-SULTAN. KAZINFORM - The total number of beds at infectious hospitals in Nur-Sultan has been increased from 1,000 to over 3,700 since the start of the pandemic, Kazinform reports. 

According to the capital's administration press service, there are 13 hospitals to treat COVID-19 patients in the city.  

The National Scientific Medical Center has opened an infectious unit for 240 COVID-19 patients, while the city's multi-purpose hospital No.1 has been converted into an infectious hospital. The Ramada Plaza hotel has also provided 500 more beds to receive COVID-19 patients.  

The press service said a perinatal hospital for pregnant women diagnosed with the coronavirus infection had been opened as well as the number of medical facilities treating pneumonia patients had risen from 1 to 7 in the capital.  

According to Altai Kulginov, Nur-Sultan mayor, 1.5 thousand beds are on standby to prepare for the possibility of a surge in COVID-19 cases. 800 more equipped medical beds are being obtained to that end.  

It is also said that the city administration is working on expanding the availability of CT scans for the citizens to prevent severe pneumonia cases.

The Great Unknown Pneumonia Scare drew a lot of attention to Central Asia today. It started with a report on a statement by the Chinese embassy to nationals living in Kazakhstan. Granted the uncertainty of Google translation from Chinese to English, a careful reading of the statement doesn't say anything about an unknown pneumonia; it simply refers to the "new coronary virus," which currently spiking in the country. It clearly means COVID-19.

But the Global Times, an official Chinese government news outlet, published a story on a "local pneumonia of unknown cause" with a "much higher" fatality rate. Here's an excerpt:

The unknown pneumonia in Kazakhstan caused 1,772 deaths in the first six months of the year, including 628 people in June alone, including Chinese citizens, the embassy said in a statement on its WeChat platform on Thursday.

"The fatality rate of the disease is much higher than COVID-19," read the embassy's statement.

Organizations including Kazakhstan's health department are studying the "virus of this pneumonia", the embassy said.

There hasn't been any indication whether this disease is related to the COVID-19.

Some Chinese experts said that measures should be taken to prevent the pneumonia from spreading into China. Kazakhstan borders Northwest China's Xinjiang Uygur Autonomous Region.

The embassy is reminding Chinese citizens in Kazakhstan to raise their awareness of measures to prevent the spread of the virus.

The embassy quoted local media as saying that since mid-June, almost 500 people have been infected with the pneumonia in three regions of Kazakhstan.

Kazakhstan's healthcare minister said on Wednesday that the number of patients sickened by the pneumonia is two to three times more than those who have been infected with COVID-19, Kazakh news agency Kazinform reported.

I don't use WeChat, but it's strange that the embassy would release such news on a social-media platform but not on its own website. Moreover, I don't find any reference in Kazinform to this "unknown pneumonia."

It also seems highly unlikely that this pneumonia had been distinguished for six months from routine COVID-19 cases, and had killed precisely 1,772 unlucky Kazakhs and Chinese nationals, without having been identified as a distinct virus, without mention of a test for it, and without reporting it to WHO. And how many non-fatal cases have been identified as "unknown pneumonia"? WHO's Kazakhstan office has nothing about it. Its most recent article, dated February 27, has to do with improving care for patients with chronic diseases.

But the Global Times story also has this to say, with my bolding:

The unknown pneumonia has stirred heated discussions among Chinese netizens who remain anxious about the coronavirus pandemic.

As of press time, more than 370 million netizens read posts with the hashtag "pneumonia of unknown cause reported in Kazakhstan" on China's Sina Weibo. "What has happened to earth in 2020? First, the COVID-19 and now another pneumonia? All we want for the year is to live safely," wrote a netizen.

So a quarter of China's population picked up this report, which in itself should have made it a big international story. But only Reuters carried it, in a brief article repeating the Global Times without any additional information or confirmation.

Both Kazakhstan and China make dire threats against anyone passing along false information over social media, but this looks like a genuinely bogus report from a major Chinese news medium. Maybe the Kazakh government will confirm it within a day or two, with explanatory details. I'm not holding my breath.

A very little more on Kazakhstan/Kyrgyzstan 'pneumonia'

I've just checked the websites of the health ministries of Kazakhstan and Kyrgyzstan. The latter at least has reports as recent as yesterday on the COVID-19 pandemic. Kazakhstan  has some documents dated as recently as July 8 that refuse to download. Maybe someone who reads Cyrillic better than I can tell what they're about.

We can certainly hope that this "unknown pneumonia" is a scare and not a whole new virus. But it's common for outbreaks to start and flourish in countries with bad health-ministry websites.

‘Unknown pneumonia’ deadlier than COVID-19 sweeping Kazakhstan, Chinese embassy warns

Thanks to Nina Diamond for tweeting the link to this report in the South China Morning Post: ‘Unknown pneumonia’ deadlier than coronavirus sweeping Kazakhstan, Chinese embassy warns. Excerpt:

The Chinese embassy in Kazakhstan has warned of a deadly “unknown pneumonia” after the former Soviet republic reported a spike in pneumonia cases since June. 

“The death rate of this disease is much higher than the novel coronavirus. The country’s health departments are conducting comparative research into the pneumonia virus, but have yet to identify the virus,” the embassy said in a warning to Chinese citizens in the country. 

While the Chinese embassy described the illness as an “unknown pneumonia”, Kazakhstani officials and media have only said it is pneumonia.  

It was not clear why the Chinese embassy had described the illness as “unknown” or what information it had about the pneumonia.  

The embassy’s website, citing local media reports, said the provinces of Atyrau and Aktobe and the city of Shymkent have reported significant spikes in pneumonia cases since the middle of June. 

Shymkent and the capital city of Atyrau are 1,500km (930 miles) apart, while the distance between the capital cities of Atyrau and Aktobe is 330km (205 miles). 

The Chinese embassy said that so far there have been nearly 500 pneumonia cases in the three places, with over 30 people in a critical condition. 

The country as a whole saw 1,772 pneumonia deaths in the first part of the year, 628 of which happened in June, including some Chinese nationals, the embassy continued.   

“The Chinese embassy in Kazakhstan reminds Chinese nationals here to be aware of the situation and step up prevention to lower the infection risks,” the embassy statement said. 

Saule Kisikova, the health care department chief in the capital Nur-Sultan, told the news agency Kazinform: “Some 300 people diagnosed with pneumonia are being hospitalised every day.” 

The agency also said there had been 1,700 pneumonia cases nationwide in June – more than two times the number in the same month last year. 

Kazakhstan announced a state of emergency on March 16 to tackle the spread of Covid-19. The lockdown was lifted on May 11, but restrictions and quarantine measures have been reimposed in some areas following the surge in pneumonia cases.

FluTrackers also has the story, with additional details. The outbreak seems to have spread to Kyrgyzstan as well.

COVID-19 in Florida: 5,507 new cases

The US collapse in the face of COVID-19 continues today, with  4 states reporting record single-day case counts. A screenshot from Rebeka Jones's Florida's Community Coronavirus Dashboard:

But Jones has also tweeted today that the number of COVID-19 deaths may actually be "well-above 8,000."

Almost 700 people have died in Dagestan of 'pneumonia'; 40 were doctors

Via JAM News: Almost 700 people have died in Dagestan of 'pneumonia'; 40 were doctors.

The minister of health of Dagestan, Jamaludin Hajiyibragimov, told reporters that since the outbreak of the epidemic in the republic, 657 people have died from “pneumonia.” 

The coronavirus, he said, killed 27 people. 

Journalists and bloggers believe that in fact all these people died from the coronavirus. And they also say that these figures are underestimated, and the situation is actually even worse. 

According to official information, 3,280 cases of coronavirus infection were recorded in Dagestan. But the minister said that more than 13 thousand people were hospitalized with ‘pneumonia’ in hospitals in Dagestan.

Seven time zones of Siberia and Russian Far East are almost clear of COVID-19 - but why?

Via The Siberian Times, a March 14 report: Seven time zones of Siberia and Russian Far East are almost clear of coronavirus - but why? Excerpt:

On the face of it Siberia and the Russian Far East has defied the odds and currently only two confirmed cases of Covid-19 according to reports of locations of coronavirus infections. 

Russia has registered low numbers with a total on Saturday of 47, a figure which includes those now clear of the virus.  

Two of these were in Siberia: a man named Wan Yunbin, 30, in the city of Chita, and a female student called Lesley in Tyumen. Both were certified as having recovered from the illness by 13 February. 

Today two separate cases were confirmed in Kemerovo city in western Siberia, with one more suspected in Novokuznetsk.  

And in the country’s most easterly region Chukotka, a miner who flew back to Russia from an Italian holiday, is suspected to have caught coronavirus.  He has been hospitalised as a precaution but his infection is not yet confirmed.   

Even so, some see Siberia the go-to place in the world to avoid coronavirus. The low numbers of infection are exceptional.

We spoke to Dr Alexander Chepurnov, a leading virologist who previously headed research into ebola at the world famous Russian State Research Centre of Virology and Biotechnology, Vector, in Koltsovo, Novosibirsk region. 

‘I'm not that sure that all is so safe here,’ he said. ‘I cannot find any explanation [to the fact that a low number of people have been diagnosed with the virus in Russia] and that is why doubts gnaw at me.’  

He said: ‘What is worrying, in my opinion, is that I do not understand why they do not take samples from all people with pneumonia.   

‘All these cases are now ascribed to seasonal flu.’  

Moscow, for example, appears to show a spike in pneumonia cases of 37% in January compared with a year earlier.   

‘We have a lot of pneumonia cases, and I see that in hospitals they do not take samples,’ Chepurnov said, evidently fearing that these patients might suffer from coronavirus.  

'That means that maybe the web is not cast very wide. 

‘I cannot quite understand the situation, and I am not sure that the conclusion about the safety of our region is right.   

‘In general it looks rather strange: the part of the country that directly borders with China, with a large number of people that cross the border here and there, has such a calm situation in terms of coronavirus. It is quite surprising.’

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China

Via The Lancet Respiratory Medicine: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The summary:

Background 

An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. 

Methods 

In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. 

Findings 

Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. 

Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. 

Interpretation 

The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.

Branswell: Confusion over coronavirus case count in China muddies picture of spread

Via STAT, Helen Branswell writes what a lot of people are thinking: Confusion over coronavirus case count in China muddies picture of spread. This is a long excerpt, but you'd better read the whole article:

Infectious diseases experts are losing confidence in the accuracy of China’s count of cases of the novel coronavirus, pointing toward health officials’ shifting definition of cases over time.  

Confusion over how China is counting cases of infections is making it harder to know how coronavirus is spreading, even as China is officially reporting that the numbers of new cases reported in recent days have fallen sharply. Many suspect the decline may be attributed in part to shifting case definitions. Earlier this month, China broadened the criteria for newly diagnosed cases in Hubei province, the epicenter of the outbreak, then reversed itself.  

“Every time you change the case definition, that then means you have a reset in terms of what you’re actually looking at,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “I think between the inability to determine the actual number of people infected and how cases are now being called a case means at best you can get trend data, possibly, but not more than that.” 

China reported 74,675 cases and 2,121 deaths to the World Health Organization as of Thursday morning, the agency’s director general, Tedros Adhanom Ghebreyesus, said during a daily briefing for reporters. Another 1,076 cases have been reported from 26 other countries, including seven deaths. 

From a few dozen cases in early January, China’s daily increase in cases exploded later in the month. The rapid increase of cases in the lead-up to the Lunar New Year led Chinese authorities to impose a quarantine of the entire city of Wuhan, where the outbreak appears to have started, on Jan. 22. 

In the days that followed, the quarantine extended to other cities in Hubei province, leaving tens of millions of people under the largest “social distancing” effort of modern times. And still the country’s case count for Covid-19, the disease caused by the coronavirus, rose by between 2,500 and 3,400 cases a day.  

On Feb. 12, the national health committee announced that it was changing the way cases were counted in Hubei province. People with symptoms of the disease and with evidence of pneumonia on a CT scan but who had not been tested for presence of the virus — in other words, people who had a clinical diagnosis — would be added to the list of cases. 

That day, the country reported a massive increase in cases — over 15,000. But since then, the daily numbers have tumbled. On Wednesday, China announced it was reverting to reporting laboratory-confirmed cases only. When the National Health Committee issued its update for Wednesday, it reported a net increase of only 394 cases — the first time in weeks the daily case increase was under 1,000 cases.

It is not unusual for the case definition to change during an infectious diseases outbreak caused by a new virus. In fact, they have to change as more information becomes apparent. For too long in this outbreak, for example, China only counted people with pneumonia as cases — a fact that blocked their ability to detect people with mild infections. But the relatively rapid about-face on the inclusion of clinically diagnosed cases has amped up the uncertainty about the published numbers.