Advances in medicine are continuously emerging, challenging all members of the interprofessional team to remain aware of important updates and how they may improve clinical practice. This is particularly true for the prevention and treatment of infectious diseases. However, increasing demands on the time and resources of healthcare practitioners make it difficult to stay up to date on the latest clinical research and guidelines, as well as the implications for patient care. This article highlights recent advances in our understanding of infectious diseases and strategies to prevent and treat these illnesses. 

STUDY OF HOSPITALIZATIONS IN CANADA QUANTIFIES BENEFIT OF COVID-19 VACCINE TO REDUCE DEATH, ICU ADMISSIONS

Coronavirus disease 2019 (COVID-19) is an infectious disease brought about by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has contributed to more than 6 million deaths globally.^[1] In a statement given on May 5, 2023, the World Health Organization declared that COVID-19 is now an ongoing and established disease that no longer constitutes a public health emergency of international concern.^[2]

A cohort study aimed to identify the trends in severe outcomes among adult and pediatric patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic.^[3]

Investigators analyzed 1.513 million admissions at 155 hospitals across Canada from March 15, 2020, to May 28, 2022. The study included 51,679 adult admissions and 4035 pediatric admissions for COVID-19. Although the share of COVID-19 admissions increased in the fifth and sixth waves, from December 26, 2021, to March 19, 2022 -- after the full vaccine rollout -- to 7.73% from 2.47% in the previous 4 waves, the proportion of adults admitted to the intensive care unit (ICU) was significantly lower, at 8.7% vs 21.8% (odds ratio, 0.35; 95% CI, 0.32, 0.36).

The study was able to quantify the benefit of vaccinations. Unvaccinated patients were found to be up to 15 times more likely to die from COVID-19 than fully vaccinated patients.

"The good thing about waves 5 and 6 was we were able to show the COVID cases tended to be less severe, but on the other hand, because the disease in the community was so much higher, the demands on the healthcare system were much higher than the previous waves," study author Charles Frenette, MD, director of infection prevention and control at McGill University Health Center in Montreal and chair of the study's adult subgroup, told Medscape Medical News. "But here we were able to show the benefit of vaccinations, particularly the boosting dose, in protecting against those severe outcomes."

The study, published April 20 in JAMA Network Open,^[3]  used the Canadian Nosocomial Infection Surveillance Program (CNISP) database, which collects hospital data across Canada. It was activated in March 2020 to collect details on all COVID-19 admissions, co-author Nisha Thampi, MD, chair of the study's pediatric subgroup, told Medscape.

"We're now over 3 years into the pandemic, and CNISP continues to monitor COVID-19 as well as other pathogens in near real time," said Thampi, an associate professor and infectious disease specialist at Children's Hospital of Eastern Ontario in Ottawa. That's a particular strength of this surveillance program as well. We would see this data on a biweekly basis, and that allows for to implement timely protection and action."

Tracing Trends Over Six Waves

The study tracked COVID-19 hospitalizations during 6 waves. The first lasted from March 15 to August 31, 2020, and the second lasted from September 1, 2020, to February 28, 2021. The wild-type variant was dominant during both waves. The third wave lasted from March 1 to June 30, 2021, and was marked by the mixed Alpha, Beta, and Gamma variants. The fourth wave lasted from July 1 to December 25, 2021, when the Alpha variant was dominant. The Omicron variant dominated during waves 5 (December 26, 2021, to March 19, 2022) and 6 (March 20 to May 28, 2022).^[3]

Hospitalizations reached a peak of 14,461 in wave 5. ICU admissions, however, peaked at 2164 during wave 4, and all-cause deaths peaked at 1663 during wave 2.

The investigators also analyzed how unvaccinated patients fared in comparison with the fully vaccinated and the fully vaccinated-plus (that is, patients with one or more additional doses). During waves 5 and 6, unvaccinated patients were 4.3 times more likely to end up in the ICU than fully vaccinated patients and were 12.2 times more likely than fully vaccinated-plus patients. Likewise, the rate for all-cause in-hospital death for unvaccinated patients was 3.9 times greater than that for fully vaccinated patients and 15.1 times greater than that for fully vaccinated-plus patients.

The effect of vaccines emerged in waves 3 and 4, said Frenette. "We started to see really, really significant protection and benefit from the vaccine, not only in incidence of admission but also in the incidence of complications of ICU care, ventilation, and mortality."

Results for pediatric patients were similar to those for adults, Thampi noted. During waves 5 and 6, overall admissions peaked, but the share of ICU admissions decreased to 9.4% from 18.1%, which was the rate during the previous 4 waves (OR, 0.47). "What's important is how pediatric hospitalizations changed over the course of the various waves," said Thampi. "Where we saw the highest admissions during the early Omicron dominance, we actually had the lowest numbers of hospitalizations with death and admissions into ICUs."

Doing More With the Data

Commenting on the study for Medscape, David Fisman, MD, MPH, a professor of epidemiology at the University of Toronto, said, "This is a study that shows us how tremendously dramatic the effects of the COVID-19 vaccine were in terms of saving lives during the pandemic." Fisman was not involved in the study.

But CNISP, which receives funding from Public Health Agency of Canada, could do more with the data it collects to better protect the public from COVID-19 and other nosocomial infections, Fisman indicated.

"The first problematic thing about this paper is that Canadians are paying for a surveillance system that looks at risks of acquiring infections, including COVID-19 infections, in the hospital, but that data is not fed back to the people paying for its production," he said. "So, Canadians don't have the ability to really understand in real time how much risk they're experiencing via going to the hospital for some other reason."

BEHAVIORAL THERAPY REDUCES LONG COVID FATIGUE: STUDY

Cognitive behavioral therapy, or CBT, is a structured talk therapy approach in which a trained therapist helps a person become aware of their own perspective and learn to change how they respond to situations and challenges. Studies have demonstrated the effectiveness of CBT in decreasing severe post-infectious fatigue.^[4]

In a new study led by researchers from Amsterdam University Medical Center, 114 people in The Netherlands who had experienced severe fatigue for at least 3 months after being infected with COVID were followed up. Half of the patients were randomly assigned to participate in 17 weeks of CBT focused on their fatigue, and the other participants received no special intervention and just continued their usual care for long COVID. People in the study who were assigned to CBT could do online or in-person therapy.^[4] 

People with long COVID significantly reduced their fatigue after completing 17 weeks of CBT, compared to people with similar long COVID fatigue levels who didn't participate in therapy, a new study shows.

The researchers tailored the therapy plan to the specific aspects of fatigue associated with long COVID.

The therapy plan addressed 7 areas:

1. A disrupted sleep-wake pattern
2. Unhelpful beliefs about fatigue
3. A low or unevenly distributed activity level
4. Perceived low social support
5. Problems with psychological processing of COVID-19
6. Fears and worries regarding COVID
7. Poor coping with pain

The CBT participants not only reduced their fatigue but also reported fewer concentration problems, less severe physical symptoms, and improved physical and social functioning. The findings were published Monday in the journal Clinical Infectious Diseases.^[4]

CDC data show that 11% of people in the United States who ever had COVID reported having long COVID, which is characterized by experiencing virus symptoms for an extended period of time.^[5] Long COVID is included as a covered condition under the Americans with Disabilities Act.^[6]

The authors noted that their study had limitations that could have influenced the findings, including that none of the participants had been hospitalized for COVID. Also, all of the participants had been self-referred and therefore may have been more motivated to participate in therapy than if people were selected for the study in a different way.

COVID DROPS TO FOURTH PLACE IN CAUSES OF DEATH IN UNITED STATES

COVID-19 has had a significant impact on the US healthcare system and economy.^[7] In 2020, more than 11 million people were estimated to be unemployed and the US economy shrank by 32.9% in the second quarter.^[8] Furthermore, the Centers for Disease Control and Prevention (CDC) reported 350,831 deaths attributed to COVID-19 in the same year.^[9]

The number of deaths caused by COVID was more than halved in 2022, compared with the toll the virus wrought in 2021, according to new CDC data. The decline drops COVID from third place to fourth place as a leading cause of death in the United States.^[10] 

Of the more than 3.2 million people who died in the United States in 2022, 186,702 died of COVID, the new data show.

The top causes of death in 2022 were:

• Heart disease: 699,659 deaths, compared to 695,547 in 2021
• Cancer: 607,790 deaths, compared to 605,213 in 2021
• Accidents and unintentional injuries: 218,064 deaths, compared to 224,935 in 2021
• COVID: 186,702 deaths, compared to 416,893 in 2021

When taking into account COVID (as not the underlying cause) but instead a contributing factor in a different cause of death, the virus would edge ahead of accidents for third place. Increases in drug overdose deaths were observed in the accidents and unintentional injuries category for 2022.

The overall death rate in the United States declined from 2021 to 2022 by 5.3%.^[11] The report presented 2 different ways of measuring the top killers in the United States -- total deaths by cause, and death rate. Sometimes the death rate is a better indicator for year-to-year comparisons because it takes into account changes in total population. In 2022, there were 833 deaths per 100,000 people, compared with 880 deaths per 100,000 people in 2021.

Men had a higher death rate than women for all age categories, and also men were more likely than women to die of COVID. The overall death rate for Black people and for Native American people rose from 2021 to 2022. The 3 groups with the highest death rates in the United States were males, older adults, and Black people. The highest death rates occurred during January and December. The rate of deaths caused by heart disease climbed for the third straight year.

The report authors also noted that data are provisional and could be adjusted as more information and death certificates are received.

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