Category Archives: Health Care

COVID-19 false-positive rate for “asymptomatic infected individuals” during screening estimated at up to 80%???

G H Zhuang, M W Shen, L X Zeng, B B Mi, F Y Chen, W J Liu, L L Pei, X Qi, C Li. [Potential False-Positive Rate Among the ‘Asymptomatic Infected Individuals’ in Close Contacts of COVID-19 Patients] Zhonghua Liu Xing Bing Xue Za Zhi, 41 (4), 485-488

Objective: As the prevention and control of COVID-19 continues to advance, the active nucleic acid test screening in the close contacts of the patients has been carrying out in many parts of China. However, the false-positive rate of positive results in the screening has not been reported up to now. But to clearify the false-positive rate during screening is important in COVID-19 control and prevention.

Methods: Point values and reasonable ranges of the indicators which impact the false-positive rate of positive results were estimated based on the information available to us at present. The false-positive rate of positive results in the active screening was deduced, and univariate and multivariate-probabilistic sensitivity analyses were performed to understand the robustness of the findings.

Results: When the infection rate of the close contacts and the sensitivity and specificity of reported results were taken as the point estimates, the positive predictive value of the active screening was only 19.67%, in contrast, the false-positive rate of positive results was 80.33%. The multivariate-probabilistic sensitivity analysis results supported the base-case findings, with a 75% probability for the false-positive rate of positive results over 47%.

Conclusions: In the close contacts of COVID-19 patients, nearly half or even more of the ‘asymptomatic infected individuals’ reported in the active nucleic acid test screening might be false positives.

Novel Coronavirus incubation period is 14 days; Breathing trouble 5 days later

“The illness appears to be less severe outside China, but a new study reports that this virus often looks benign to start with. It begins with a mix of mild symptoms that can look like the common cold, or resemble gastro. But some patients go on to develop breathing trouble five days later, and may need the ICU (Intensive Care Unit) by day 8. Sometimes people get released from medical care, but then have to return the next week. So not only must we wait 14 days for the incubation period, there may be another 8 days (or more) before we know how many will need emergency life support and we can begin to calculate the fatality rate.” click here

Clinical characteristics of people infected by the 2019 novel coronavirus, Wuhan, China

Dawei Wang, MD; Bo Hu, MD; Chang Hu, MD; et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585

Key Points

Question  What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) in Wuhan, China?

Findings  In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients.

Meaning  In this case series in Wuhan, China, NCIP was frequently associated with presumed hospital-related transmission, 26% of patients required intensive care unit treatment, and mortality was 4.3%.

Abstract

Importance  In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

Objective  To describe the epidemiological and clinical characteristics of NCIP.

Design, Setting, and Participants  Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020.

Exposures  Documented NCIP.

Main Outcomes and Measures  Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked.

Results  Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0).

Conclusions and Relevance  In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.

Trump healthcare reforms a step forward

“A White House Council of Economic Advisers (CEA) study released on Friday found that Americans will save $450 billion through Trump’s Obamacare reforms. The CEA suggested that Trump’s repeal of the Obamacare individual mandate and the expansion of short-term insurance plans and Association Health Plans (AHPs) will save Americans billions over the next ten years.” click here

Thank you President Donald Trump

“We must build a culture that cherishes the dignity and sanctity of innocent human life. All children, born and unborn, are made in the holy image of God,” he said. “Every life is sacred, and every soul is a precious gift from Heaven.” click here

Obamacare was unconstitutional from the start

“O’Connor’s decision is, indeed, broadly within the range of Trump administration policy; back in June, the Justice Department argued that provisions of Obamacare were unconstitutional.  ” click here

US suicide rates increase from 1999-2016

Deborah M. Stone, Thomas R. Simon, Katherine A. Fowler, Scott R. Kegler, Keming Yuan, Kristin M. Holland, Asha Z. Ivey-Stephenson, Alex E. Crosby. Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015 MMWR Weekly / June 8, 2018 / 67(22);617–624

Introduction: Suicide rates in the United States have risen nearly 30% since 1999, and mental health conditions are one of several factors contributing to suicide. Examining state-level trends in suicide and the multiple circumstances contributing to it can inform comprehensive state suicide prevention planning.

Methods: Trends in age-adjusted suicide rates among persons aged ≥10 years, by state and sex, across six consecutive 3-year periods (1999–2016), were assessed using data from the National Vital Statistics System for 50 states and the District of Columbia. Data from the National Violent Death Reporting System, covering 27 states in 2015, were used to examine contributing circumstances among decedents with and without known mental health conditions.

Results: During 1999–2016, suicide rates increased significantly in 44 states, with 25 states experiencing increases >30%. Rates increased significantly among males and females in 34 and 43 states, respectively. Fifty-four percent of decedents in 27 states in 2015 did not have a known mental health condition. Among decedents with available information, several circumstances were significantly more likely among those without known mental health conditions than among those with mental health conditions, including relationship problems/loss (45.1% versus 39.6%), life stressors (50.5% versus 47.2%), and recent/impending crises (32.9% versus 26.0%), but these circumstances were common across groups.

Conclusions: Suicide rates increased significantly across most states during 1999–2016. Various circumstances contributed to suicides among persons with and without known mental health conditions.

Implications for Public Health Practice: States can use a comprehensive evidence-based public health approach to prevent suicide risk before it occurs, identify and support persons at risk, prevent reattempts, and help friends and family members in the aftermath of a suicide.