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News Scan for May 07, 2021

Experts estimate global COVID-19 deaths may actually be double

Direct COVID-19 deaths may be more than double previous estimates, according to a report yesterday by the University of Washington’s Institute for Health Metrics and Evaluation (IHME).

The researchers say that, by May 3, global COVID-19 deaths numbered 6.93 million, compared with the reported 3.24 million. They also calculate that the cumulative total COVID-19 death rate was 89.5 per 100,000 patients, going from 0.1 per 100,000 in Vietnam to more than 400 per 100,000 in 12 countries, led by Azerbaijan, Bosnia and Herzegovina, and Bulgaria.

The researchers applied IHME’s Global Burden of Disease method, which includes comparing all-cause deaths per week or month with the expected totals, adjusting for mortality factors (eg, less flu or traffic deaths, more deaths due to disrupted healthcare), and creating a weekly ratio model to fill any data gaps. The researchers say that 56 countries and 198 subnational units had sufficient data and that supplementary publications added 12 more national or subnational locations.

The ratio of total-to-reported deaths is high in many Eastern European and Central Asian countries, according to the researchers. In sub-Saharan Africa, which has reported lower COVID-19 deaths, the data indicate ratios are between 1.6 to 4.1; in India, which is currently being ravaged, the ratio is 2.96. High-income countries tended to have lower ratios.

The new data change the top five countries in COVID deaths, with Russia (109,334 reported; 593,610 total) surpassing the United Kingdom (150,519 reported; 209,661 total) and Italy (121,257 reported; 175,832 total). The United States has the most deaths, with 905,289 (574,043 reported), followed by India with 654,395 (221,181 reported), Mexico with 612,127 (217,694 reported), Brazil with 595,903 (with 408,680 reported), and then Russia.

“Many countries have devoted exceptional effort to measuring the pandemic’s toll, but our analysis shows how difficult it is to accurately track a new and rapidly spreading infectious disease,” Chris Murray, MD, DPhil, IHME director, said in an IMHE press release. “We hope that today’s report will encourage governments to identify and address gaps in their COVID-19 mortality reporting, so that they can more accurately direct pandemic resources.”
May 6 IHME report and press release


Obesity tied to higher COVID-19 death rates in men

Hospitalized men with COVID-19 had higher in-hospital death rates if they were in obesity classes 2 and 3 (body mass index [BMI] of 35 to <40 kg/m2 and >40 kg/m2, respectively) compared with men in a normal-weight group, according to a study yesterday in the European Journal of Clinical Microbiology & Infectious Diseases.

The researchers looked at a retrospective cohort of 3,530 adults hospitalized with COVID-19 at Montefiore Medical Center in New York from Mar 10 to May 1, 2020. Most (55.3%) were men. Almost a third (32.9%) were overweight, 22.9% were obese, and 18.8% had either class 2 or 3 obesity. Morbidities included high blood pressure (62.9%), hyperlipidemia (47.4%), and diabetes (39.8%).

Overall, class 2 and 3 obesity were linked to adjusted increased risks of in-hospital mortality (odd ratios [ORs], 1.44 and 1.92, respectively), severe pneumonia (ORs, 1.97 and 2.10), and intubation (ORs, 2.26 and 2.43). When the researchers stratified the data by sex, however, in-hospital mortality associations for women were seen only in those with class 3 obesity, while men with both class 2 and 3 obesity showed the association.

No link was found between interleukin-6 (IL-6), a cytokine linked with systemic inflammation, and BMI, but the data showed that higher IL-6 levels were associated with in-hospital death, male sex, and increasing age.

Because of this, the researchers suggest that BMI could affect COVID-19 outcomes because of how obesity can impede lung function or lead to more ACE2 receptors, the virus’ common cell entry. They add that the variation between male and female fat patterns may also help explain the differences between the two sexes.

Underweight people also showed increased risk for adverse COVID-19 outcomes, but there was not sufficient data to draw any conclusions.

“Particular attention should be paid in protecting the population living with severe obesity from SARS-CoV-2 with priority to vaccination access, remote work, telemedicine, and other measures given the higher risk of adverse outcomes once they are diagnosed with COVID-19,” write the researchers.
May 6 Eur J Clin Microbiol Infect Dis study

Two countries report more vaccine-derived polio cases

Senegal and South Sudan reported more polio cases this week, both involving circulating vaccine-derived poliovirus type 2 (cVDPV2), according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

Senegal reported one new case, in Diourbel, raising its total for the year to four. And South Sudan reported a new case in Jonglei, bringing its 2021 total to six.
May 6 GPEI weekly update

BARDA exercises option for more monkeypox-smallpox vaccine

The US Biomedical Advanced Research and Development Authority (BARDA) has exercised the final $12 million option in its contract with Bavarian Nordic for more doses of the company’s new vaccine that targets both monkeypox and smallpox, the company said today in a statement.

The option covers doses of the liquid-frozen Jynneos vaccine, which will be made at the company’s new fill-and-finish facility this year.

Jynneos was approved in 2019, marking the first vaccine for monkeypox and the first nonreplicating smallpox vaccine. The option is part of a $200 million contract to supply doses for the Strategic National Stockpile for front-line responders in the event of a bioterror incident or lab accident.
May 7 Bavarian Nordic statement
Dec 17, 2020, CIDRAP News scan “BARDA adds more monkeypox-smallpox vaccine to federal stockpile

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