By Marie Rosenthal, MS, and Ethan Covey
Using rapid antigen testing for SARS-CoV-2 helped reduce COVID-19 incidence by 65% in a rural Alaskan community because positive patients could be isolated faster with quicker contact tracing. Hispanic people were more likely to have an asthma exacerbation after exposure to COVID-19. Many people are concerned about the possibility of myocarditis from vaccination, but a new study showed that patients with COVID-19 are nearly 16 times as likely to develop myocarditis than with those without COVID-19 infection. Even dogs and cats can get myocarditis from COVID-19. And finally, please listen to your spouse, and close the toilet lid.
Rapid COVID-19 Testing May Aid in Controlling Outbreaks in Rural Areas
The introduction of rapid antigen testing for SARS-CoV-2 helped reduce COVID-19 incidence by 65% in a rural Alaskan community.
The findings highlight the benefit that rapid testing can have in areas without local access to laboratory-based nucleic acid amplification testing (NAAT) (MMWR Morb Mortal Wkly Rep 2021;70[33]:1120-1123).
Use of the rapid antigen test, which has a turnaround time of 15 minutes, “means we can get our people who are infected into isolation faster, conduct appropriate case investigation, complete contact tracing and quarantine the exposed persons much faster,” said Ellen Hodges, MD, the chief of staff at Yukon-Kuskokwim Health Corp., in Bethel, Alaska. “This helps control the outbreaks by boxing in the virus much sooner than if we waited seven days, nearly the end of the infectious period, to get them isolated and close contacts quarantined.”
Due to its rural location, the Yukon-Kuskokwim Delta region, located in southwestern Alaska, faced challenges related to conducting COVID-19 testing. Specifically, SARS-CoV-2 test results often took a long time to process, as specimens needed to be flown to laboratories that were able to process NAAT. In Bethel, the central area community, the turnaround time for NAAT averaged 5.7 days. Residents of villages located outside of Bethel needed to wait even longer, with testing results averaging 7.9 days.
To evaluate the impact that the introduction of rapid antigen testing had on the community, Dr. Hodges and her colleagues examined the results of 54,981 antigen and molecular tests for SARS-CoV-2, which were conducted from Sept. 15, 2020, through March 1, 2021.
They found that after the Abbott BinaxNOW COVID-19 Ag rapid antigen test was put into use on Nov. 9, 2020, the median turnaround time for testing results fell by greater than 30%, and case rates fell threefold: from 342 cases per 100,000 population during the week of Nov. 9 to 119 during the week of Dec. 13, 2020.
“In regions with crowded housing and limited access to sanitation, stopping outbreaks before they get started is essential to protecting the health and well-being of a community,” Dr. Hodges said.
Rapid antigen testing also may assist in congregate living settings such as schools, correctional facilities and group homes where social distancing and masking are challenging. “There’s room for research into that,” she said, “especially in schools to keep our kids who cannot be vaccinated safe.”
COVID-19 Greatly Increases Risk for Myocarditis
A large CDC study found that patients with COVID-19 are nearly 16 times as likely to develop myocarditis than with those without COVID-19 infection.
The risk, however, varied significantly by sex and age, with the highest rates of myocarditis found among men, children younger than 16 years of age and adults older than 50 years of age (MMWR Morb Mortal Wkly Rep 2021;70[35]:1228-1232).
“This large U.S.-based study adds to the growing body of evidence pointing toward an increased risk of myocarditis among people who have had COVID-19,” said Tegan K. Boehmer, PhD, the lead of the CDC’s Healthy Community Design Initiative and a member of the COVID-19 Rapid Response Team. “While myocar-ditis is uncommon, there is consistent evidence of a strong and significant association between COVID-19 and myocarditis.”
The study focused on data from the Premier Healthcare Database Special COVID-19 Release, and assessed monthly numbers of COVID-19 cases and myocarditis inpatient encounters from January 2019 through May 2021.
The epidemiologists noted a drastic jump in myocarditis following the beginning of the COVID-19 pandemic. In 2020, rates of myocarditis inpatient encounters were 42.3% higher than in 2019. From March 2020 through January 2021, the risk for myocarditis was 0.146% among patients diagnosed with COVID-19 during an inpatient or hospital-based outpatient encounter and 0.009% among patients who did not have COVID-19.
Upon adjusting for both patient and hospital characteristics, patients with COVID-19 during March 2020 through January 2021 had, on average, a 15.7 times greater risk for myocarditis than those without the disease. Among patients with COVID-19, the risk for developing myocarditis was higher among males than females, and was highest among older adults and children.
“While the relative risk for myocarditis associated with COVID-19 was elevated across all age groups, it was lowest among young adults aged 25 to 39 years and increased for both younger and older age groups,” Lucy Kompaniyets, a CDC postdoctoral research fellow and member of the COVID-19 Rapid Response Team, told Infectious Disease Special Edition. “For example, children and adolescents younger than 16 years with COVID-19 were 36 times as likely to develop myocarditis compared to those without COVID-19. Adults age 50 to 64, 65 to 74, and 75-plus years had 17, 23 and 32 times the risk of myocarditis, respectively, if they had COVID-19 compared to those who did not have COVID-19.”
The study authors noted that the reasons for these vast differences in risk among age groups remain unclear and warrant further study.
“It’s possible that the increased risk of myocarditis we observed among children under 16 years and adults over 50 years could be partially explained by undercounting COVID-19 cases among younger adults with mild COVID-19 symptoms,” Dr. Boehmer said. “However, this new finding needs confirmation. Further investigation using other study designs and different populations can help us better understand the relationship between myocarditis and COVID-19. In addition, research comparing the risk of myo-carditis following infection with SARS-CoV-2 with the risk of myocarditis following COVID-19 vaccination could shed light on the benefits and risks of vaccination.”
What remains very clear is that preventing further COVID-19 spread will keep cases of myocarditis from rising.
“The best way to reduce the risk of myocarditis is by preventing COVID-19,” said Aaron Harris, MD, a medical epidemiologist with the COVID-19 Rapid Response Team. “People should get vaccinated if they have not already, social distance and wear a mask in areas of high or moderate community transmission,” he said.
“These findings inform our understanding of COVID-19 complications and can be used when weighing the benefits and risks of COVID-19 vaccination,” Dr. Boehmer added.
Latinos With COVID-19 More Likely to Have Asthma Attacks
Latinos with asthma were 4.6 times more likely than Blacks to develop asthma exacerbations following COVID-19, and 2.9 times more likely than whites, according to a study being presented at this year’s American College of Allergy, Asthma and Immunology Annual Scientific Meeting (abstract A032).
“We examined 174 adult COVID-19–positive patients with a history of asthma between February and April of 2020,” said Katharine Foster, MD, lead study author. “What we found is that Latinos had significantly higher odds of developing asthma flares, and the length of time of their asthma exacerbations was longer compared to non-Latinos.”
The results showed uncontrolled asthma symptoms lasted longer for Latinos with asthma who suffered with COVID-19. For Latinos with a COVID-19 infection, their asthma symptoms lasted 3.2 weeks compared with 1.5 weeks for non-Latino whites and 1.4 weeks for non-Latino Blacks.
“Despite the differences in symptoms we found in the study participants, we didn’t see a differ-ence in the likelihood of starting steroids for symptom relief, nor for starting asthma step-up thera-py (more aggressive treatment when asthma is uncontrolled) between Latino, non-Latino white and non-Latino Black populations,” said Mahboobeh Mahdavinia, MD, PhD, study co-author. “All the groups sought a similar number of asthma-related provider visits, including in clinic, the emergency departments or via telehealth.”
Respiratory viruses are the most common trigger for asthma exacerbations, although not all virus-es affect asthma patients equally. Some viruses such as influenza and rhinovirus are more likely to trigger asthma flares than others. Studies do not indicate that those with asthma are at any higher risk for contracting COVID-19 than those who don’t have asthma.
SARS-CoV-2 Variant Detected in Dogs and Cats With Suspected Myocarditis
Pets not only can develop COVID-19, but they can also develop cardiac symptoms, including myocarditis, according to a study in the United Kingdom (VetRecord 2021 Nov 4. https://doi.org/10.1002/vetr.944).
Dog with myocarditis. Image courtesy of Dr. Luca Ferasin.Veterinarians found the alpha variant (B.1.1.7) in domestic pets; two cats and one dog were positive on polymerase chain reaction tests, while two additional cats and one dog displayed antibodies two to six weeks after they developed signs of cardiac disease. Many owners of these pets had developed respiratory symptoms several weeks before their pets became ill and had also tested positive for COVID-19.
All of these pets had an acute onset of cardiac disease, including severe myocarditis.
“Our study reports the first cases of cats and dogs affected by the COVID-19 alpha variant and highlights, more than ever, the risk that companion animals can become infected with SARS-CoV-2,” said lead author Luca Ferasin, DVM, PhD, of The Ralph Veterinary Referral Centre, in Marlow, England. “We also reported the atypical clinical manifestations characterized by severe heart abnormalities, which is a well-recognized complication in people affected by COVID-19 but has never been described in pets before. However, COVID-19 infection in pets remains a relatively rare condition and, based on our observations, it seems that the trans-mission occurs from humans to pets, rather than vice versa.”
Close That Toilet Lid Before Flushing!
Although handwashing and sanitizing are now second nature, thanks to COVID-19, we also should be look-ing at open toilet lids, uncovered garbage bins and defective plumbing drains in spreading infections in public bathrooms (Sci Total Environ 2021;803:149932).
A global review of the risks for bacterial and viral transmission in public bathrooms found that bioaerosols can be potentially transmitted throughout a multistory building by defective plumbing and that leaving toilet lids open after flushing can disperse contaminated droplets beyond a meter.
Uncovered garbage bins in public bathrooms also were flagged as a risk, especially if located under or close to electric hand dryers.
Researchers from the Australian National University and University of South Australia assessed 38 studies from 13 countries that investigated the risk for infectious disease transmission in public bathrooms in restaurants, workplaces, commercial premises and universities.
The results showed widespread evidence of contaminated surfaces as a cause of fecal–oral transmission, but no documented instances of airborne-related infectious disease transmission. A wide range of intestinal, skin, and soil bacteria and respiratory viruses were identified in public bathrooms, posing risks for transmission. Open-lid toilet flushing, ineffective handwashing or hand drying, poor surface cleaning, blocked drains, and uncovered garbage bins all contribute to heavy bacterial and viral loads in bathrooms.
Six studies investigated bacterial dispersal in public bathrooms, showing jet air dryers can potentially spread droplets as far as 3 meters, and toilet flushing can spread particles as far as 1.5 meters and remain in the air for more than 30 minutes.
One 2021 study estimated that the number of particles from a toilet flush was equivalent to droplets from a person talking loudly for just over 6.5 minutes.
“While there is limited evidence of COVID-19 transmission via public washrooms, they are rife with bacte-ria, especially those that are used frequently and not cleaned properly,” said Erica Donner, PhD, a UniSA environmental scientist.
“Some people have been worried about using public washrooms during the pandemic, but if you minimize your time in the bathroom, wash and dry your hands properly, and don’t use your mobile phone, eat or drink, then the risks should be low, especially if the bathroom is well maintained,” Dr. Donner said.
