COVID-19 Update: Comparison With 1918 Flu, Secondary Transmission

Ellie Kincaid

August 14, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Comparison With 1918 Flu

A comparison of excess deaths in New York City during the beginning of the COVID-19 outbreak with excess deaths from the peak of the 1918 H1N1 influenza outbreak in the city found that the two pandemics are "in the same ballpark," said study author Jeremy Samuel Faust, MD, an emergency physician at Brigham and Women's Hospital in Boston, Massachusetts. 

Faust and colleagues took mortality data for the peak months of each pandemic in New York City and compared the number of deaths beyond what would normally be expected for that period based on prior years. The mortality rate per 100,000 people in a month was 287.17 in the 1918 influenza pandemic, and 202.08 in the spring COVID-19 surge. 

But because death rates have dropped by half over the last century with medical advances, the relative increase in excess deaths during the COVID-19 outbreak was substantially greater than the rate during the 1918 pandemic.

Secondary Transmission 

The risk for secondary transmission is less than 4% overall among close contacts of people diagnosed with COVID-19 and varies by settings and disease severity, according to a report on contact tracing in Guangzhou, China.  

The risk for secondary infection for 3410 close contacts of 391 COVID-19 index cases was highest for household contacts, at 10%, followed by those exposed in healthcare settings, at 1%, and on public transportation, at 0.1%.
 

Repurposed Drug News

Accumulating observational data suggest that metformin use in patients with type 2 diabetes might reduce the risk for death from COVID-19, but the randomized trials needed to prove this are unlikely to be carried out, according to experts.

In one recent study that has not yet been peer-reviewed, researchers found that, among more than 600 patients with diabetes and COVID-19, use of metformin was associated with a nearly 70% reduction in mortality after adjustment for multiple confounders.

However, "metformin users tend to do better in many different settings with respect to many different outcomes," one expert said. "To me, it is still unclear whether metformin is truly a miracle drug or whether it is simply used more often among people who are healthier and who do not have contraindications to its use."

In related news, physicians from University College London proposed in The Lancet Rheumatology that B-cell depletion with rituximab might benefit certain patients with severe COVID-19, targeting chronic adaptive host immune responses or inflammatory lung complications persisting beyond acute infection. They called for more research into the possibility.
 

Sick HCWs With COVID Feel Pressured to Work

Hospitals, clinics, and other healthcare facilities have pressured workers who contract COVID-19 to return to work sooner than public health standards suggest it's safe for them, their colleagues, or their patients, Kaiser Health News reports

Some employers have failed to provide adequate paid leave, if any at all, so employees felt they had to return to work — even with coughs and possibly infectious — rather than forfeit the paychecks they need.

The dilemma also strains health workers' sense of professional responsibility, knowing they may become vectors spreading infectious diseases to the patients they're meant to heal.

Pandemic Bad Behavior 

Rule-breaking is not a new phenomenon, but behavioral scientists say it is being exacerbated in the COVID-19 pandemic by cultural, demographic, and psychological factors.

Reuters rounds up some questions and answers on the science of human behavior during the COVID-19 pandemic, such as individualism vs collectivism.
 

Trending Clinical Topic: COVID-Linked Depression 

As the pandemic continues, concerns about lingering mental health effects are only increasing. A focus on mood changes in particular made COVID-linked depression this week's top trending clinical topic.

The Week That Wasn't

This week in COVID-19 news, scientists tested how well various face coverings, including a neck gaiter, blocked respiratory droplets coming from the wearer's mouth and nose, authorities detected SARS-CoV-2 genetic material on frozen chicken wings, and researchers described a nasal spray they say could block viral infection. But you didn't see these headlines in Medscape. Here's why.

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Thousands throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine. She can be reached at ekincaid@medscape.net or on Twitter @ellie_kincaid .

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