Category: COVID

Liquor Industry Questions Alcohol Ban Effectiveness

Representatives from the liquor industry have said that the South African government must consider data from a new report that shows little alcohol ban effectiveness on trauma cases. However, other studies show negative effects of alcohol during lockdown, and a surge in violent trauma in Cape Town after alcohol bans were lifted.

In a statement on Thursday, the South African Liquor Brand owners Association (Salba) referenced a new report showing that, compared to other countries, South Africa saw similar trauma cases with its lockdown and alcohol ban to those that only had a lockdown.

The report had financial support from Distell, led by independent data expert Ian McGorian of Silver Fox Consulting, in collaboration with professor Mike Murray from the University of KwaZulu-Natal.

The report found that trauma cases in South Africa under lockdown dropped 60%. But other countries also saw the same drop with no alcohol ban, including the UK (57%), Ireland (62%), Italy (56.6%) and the USA (54%), casting doubt over the effectiveness of alcohol bans in curbing trauma. The researchers also commented that curfews may have explained more of a reduction in trauma cases than alcohol bans.

While members of the liquor industry recognised the impact of alcohol on South African society, they said that government needs to be more objective with its lockdown regulations.

Salba chairperson Sibani Mngadi said the alcohol ban over Easter Weekend, while simultaneously allowing larger gatherings, made even less sense in reducing COVID transmission. This suggests that government was not considering science in its decision making, he said.

However, a multicentre study from Colorado, USA showed that even while trauma cases during lockdown fell by 33%, alcohol screens increased from 34% to 37%, and alcohol positive patients rose from 32% to 39%.

A study of Cape Town trauma admissions saw a dramatic drop of 53% in trauma admissions during the hard lockdown and an immediate rebound coinciding with the resumption of alcohol sales, with a 107% increase in gunshots wounds compared to pre-lockdown conditions.

The researchers noted that in South Africa the trauma demographic is much younger, with much higher rates of violence, with about half of homicide victims in SA testing positive for alcohol.

Distell chief executive Richard Rushton said the industry was merely asking that the data should be viewed objectively to improve dialogue with decision makers.

“We are all on the same side, and we want to help find solutions. We are very clear that alcohol abuse is unacceptable and causes harm. Our view is that the focus must be on finding ways to deal with high-risk drinkers, rather than using blunt instruments that penalise all South Africans.

“Any proposed new regulations need to be evidence-based, rational and target problem areas,” he said.

Business Leadership SA chief executive Busisiwe Mavuso said that lockdown could have been better managed, as 220 000 jobs had been lost along billions of rands in tax to the fiscus, while uncertainty still plagued alcohol producers.

“The decisions made to confront the health crisis should not have unintended consequences for the economy, and that is exactly what has happened with the bans on alcohol,” she said.

Mr Mavuso added that, since the start of the pandemic, business has been a willing partner to government and “needs to be part of the solution to ensure we fight this pandemic with the least possible damage to the economy”.

“The data analysis by the alcohol industry is an important intervention and must be taken seriously as we move forward.”

Source: BusinessTech

Smartphone Tracking in COVID Shows Movement Linked to Case Rise

According to a new study which used mobility tracking of cell phone data, a greater movement of people is a strong predictor of increased COVID cases rates.

Until people are widely vaccinated against SARS-CoV-2, the array of nonpharmaceutical public health interventions such as physical distancing and limiting travel and social contacts will remain the most effective means of controlling COVID. Capturing the interrelationship between human behaviour and infectious diseases is one of the hardest problems in epidemiology.

“Mobility measures capturing human activity through anonymized tracking of smartphones are believed to be reasonable proxies of contact rates outside of one’s own home; these measures can provide more timely and reliable sources of information on contact rates compared with time-use surveys or contact tracing,” the authors wrote.

Researchers looked at anonymised smartphone mobility data from nearly 12 months from March 2020 to March 2021, both at a national and provincial level, while controlling for date and temperature. A 10% increase in the mobility of Canadians outside their homes was found to be associated with a 25% increase in subsequent SARS-CoV-2 weekly growth rates. They investigated at the mobility threshold (the level needed to control the virus) and the mobility gap (the difference between the threshold and actual movement).

“The mobility threshold and mobility gap can be used by public health officials and governments to estimate the level of restrictions needed to control the spread of SARS-CoV-2 and guide, in real-time, the implementation and intensity of nonpharmaceutical public health interventions to control the COVID-19 pandemic,” wrote the authors.

Source: News-Medical.Net

Journal information: Brown, K. A., et al. (2021) The mobility gap: estimating mobility thresholds required to control SARS-CoV-2 in Canada. Canadian Medical Association Journal. doi.org/10.1503/cmaj.210132.

South African Volunteers Battle Vaccine Misinformation

Man with LED mask reading a burning newspaper. Photo by Connor Danylenko from Pexels.

As the long-delayed vaccine rollout in South Africa has begun, the government has run a public campaign to tackle prevalent health myths. But there are also volunteers who are waging an online battle against COVID and vaccine misinformation, as reported by the BBC.

Sarah Downs, who is studying molecular biology and infectious diseases, debunks false claims under the alias Mistress of Science and is fighting a surge of misinformation in South Africa. A relatively small collection of Facebook groups and users are responsible for promoting this misinformation. When she tweeted about her grandmother’s passing, a COVID denier questioned whether an autopsy had been performed. 
“We estimate that it’s about 20 000 South Africans who are actually active on anti-vax Facebook pages,” said Prof Hannelie Meyer, a pharmacist and adviser to the South African Vaccine and Immunisation Centre (Savic).

Most anti-vaccine claims in South Africa actually originate in the United States, according to a 2015 study. Anecdotal evidence, such as the spread of false claims about vaccines and DNA by an American osteopath, show this trend still holds in the pandemic.

Prof Meyer said that while data on vaccine hesitancy in SA are limited, studies indicate that more wealthy and educated groups, particularly among whites, are less willing to be vaccinated.

Leading virologist Prof Jeffrey Mphahlele has also pushed back against rumours, such as COVID and its vaccines being a Western plot to reduce Africa’s population and control its natural resources. He called the misinformation “mind boggling” – pointing out the supposed plot would require the West to create a virus that killed millions of its own people.

Even authority figures have promulgated falsehoods: South Africa’s top judge was recently criticised after a video showed him linking vaccines to a “Satanic agenda.”

One of the most prominent groups on Facebook, with some 10 000 members, seeks to spread “awareness” about vaccines but the members’ hard-line anti-vaccine attitude is very clear, ridiculing or dismissing vaccines. One video posted in the group – originally aired on an evangelical US Christian television programme – suggested getting a jab could lead to “a lifetime of illness”.

Sarah Downs stepped in to help answer questions amidst the deluge of misinformation, and one person she helped was Sheona Lottering, a swimming teacher.

“I had a friend that forwarded me a German article,” Sheona said. “She was trying to convince me that death was one of the side-effects [of a COVID vaccination].

“And I was a little bit freaked out about that.”

Sarah explained the subtleties around adverse events to her, and now Sheona keeps in contact with Sarah over difficult vaccine-related questions.

Lisa (not her real name) spends hours lurking in Facebook groups to guide people towards trusted sources of health information.

“The claims are so bizarre I could hardly believe there are people believing these things,” she said. “I don’t like misinformation, so when I see something, I just try to correct it.”

Doing this for over a decade, she’s seen communities grow and knows their tactics. She said that young mothers are a particular target in Facebook groups, where posts are coordinated to try and convince them not to vaccinate their children., which is when Lisa steps in. She keeps her inbox open and believes gentle communication works best – asking about people’s concerns rather than shouting statistics at them.

But Sarah, Lisa and other volunteers we spoke to risk exposing themselves to online abuse, and the prospects of persuasion can often seem slim. It’s difficult, pro-health work – that isn’t paid. So do they judge success?

“I think if I can just help one person be a little bit less terrified… that’s what I aim to get out of it,” Sarah says. “And if they’re willing to take the vaccine, even more so.”

Source: BBC News

South African Variant Escapes Sputnik Vaccine

A study on COVID variants using in vitro tests, available on the preprint server medRXiv, has shown that the South African variant escapes the Sputnik V vaccine.

This study is the first of its kind to show Sputnik V vaccine recipients had reduced neutralising capacity against the B.1.351 and E484K mutant spikes.

When it comes to vaccine design, the most effective vaccines use a stabilised form of the spike protein, while others use the wildtype spike, protecting against severe disease but not infection because of lower levels of neutralising antibodies. A number of SARS-CoV-2 variants of concern (VOC) have mutations on the spike protein, or the E484K mutation, which allows it to escape vaccines and prior immunity. 

In South Africa, where 93% of infections are due to B.1.351, the AstraZeneca vaccine, based on the wild-type spike, failed to prevent mild-to-moderate COVID. The Sputnik V or Gam-COVID-Vac vaccine is also based on the wild-type spike. Interim Phase 3 trial results reported an efficacy of 92%, but this excludes current variants and any lineage containing E484K. 
The current study examined serum neutralisation activity in samples obtained from 12  recipients of the Sputnik V vaccine in Argentina. This country has already detected many independent variants with E484K, with or without N501Y substitutions.

The researchers found that pseudoviruses bearing either the wildtype D614G spike, and the B.1.1.1.7 spike were effectively neutralised by the vaccine sera, in live virus plaque reduction neutralisation assays. The geometric mean titer of neutralising titers was 49, similar to that of the phase III trial.

However, these sera showed moderate to a marked reduction in neutralisation titers against spike protein bearing E484K, and the UK variant. Even at the highest serum concentration used, 9 of the 12 serum samples could not inhibit 50% of B.1351 viral particles, and only half the sera did so against the E484K mutant.

The researchers concluded that, relative to the wildtype spike virus neutralising titers, were reduced by seven-fold against the B.1.351 lineage and three-fold against the E484K spike. They also found that the VOCs with the different spikes showed different modes of escape from antibody-mediated neutralisation by sera elicited by the Sputnik V vaccine. This means that resistance to neutralisation offered by the South African variant occurs by a different mechanism than that of the E484K mutant.

The UK VOC has low resistance to pre-existing or vaccine-induced antibodies, but the B.1.351 variant shows marked resistance. In fact, 8 of 12 samples were unable to reach IC90 at the highest possible serum concentration.

One neutralised the UK variant but none of the other three variants. These findings are of particular concern because all three VOCs carry the N501Y RBD substitution that confers increased affinity for the ACE2 receptor.

This resistance is competitive and is not present at higher serum concentrations. However, this is not true for the mutations in the B.1.351 variant, which escapes neutralisation with undiluted serum.

Though the Sputnik V vaccine likely protects against severe COVID from VOCs, it is troubling that B1.351, as well as all E484K-bearing mutants, is resistant to neutralisation by sera elicited by this vaccine.

However, antibody functions may be different in vivo, and this study does not cover cell-mediated immunity to multiple antigen sites.
“Taken together, our data argue that surveillance of the neutralizing activity elicited by vaccine sera will be necessary on an ongoing basis,” the authors wrote.

The knowledge of which variants can still spread among vaccinated and naturally immune individuals will help decide how to contain them with vaccine upgrades.

Source: News-Medical.Net

Preprint information: Ikegame, S. et al. (2021). Qualitatively distinct modes of Sputnik V vaccine-neutralization escape by SARS-CoV-2 Spike variants. medRxiv preprint. doi: https://doi.org/10.1101/2021.03.31.21254660. https://www.medrxiv.org/content/10.1101/2021.03.31.21254660v2

COVID Surges Driven by New Variants

A study of SARS-CoV-2 genomes and epidemic case data has shown that COVID outbreaks emerge with new variants.

“As variants emerge, you’re going to get new outbreaks,” said Bart Weimer, professor of population health and reproduction at the UC Davis School of Veterinary Medicine. The study combined classical epidemiology with genomics, providing a tool for public health authorities to predict the course of pandemics.

SARS-CoV-2  only has 15 genes, but is mutating constantly. The majority of these changes have little impact, but occasionally they result in the virus becoming more or less transmissible.

Together with graduate student DJ Darwin R Bandoy, Prof Weimer at first analysed the genomes of 150 SARS-CoV-2 strains, mostly from outbreaks in Asia prior to March 1, 2020, along with epidemiology and transmission information on those outbreaks. 

The classified outbreaks by stage: index (no outbreak), takeoff, exponential growth and decline. Virus transmissibility is set by the value R, or reproductive number, where R is the average number of new infections caused by each infected person.

They combined all this information into a metric called GENI, for pathogen genome identity. Comparing GENI scores with epidemic phases showed that an increase in genetic variation immediately preceded exponential growth in cases, for example in South Korea in late February. In Singapore, however, bursts of variation were associated with smaller outbreaks that were quickly brought under control.

Prof Weimer and Bandoy then looked at 20 000 sequences of SARS-CoV-2 viruses collected over February to April 2020 in the United Kingdom, and compared them with COVID cases data.

They found that the GENI variation score rose steadily with the number of cases. When a national lockdown was imposed in late March, the number of new cases stabilised but the GENI score continued to rise. This shows that control measures such as banning gatherings, mask mandates and social distancing are effective in controlling spread of disease in the face of rapid virus evolution.

It could also help explain “superspreader” events when large numbers of infections result from relaxed precautions at an event.

Prof Weimer said he hopes that health authorities will adopt this method of measuring virus variation and linking it to the local transmission rate, R.

“In this way you can get a very early warning of when a new outbreak is coming,” he said. “Here’s a recipe for how to go about it.”

Source: Medical Xpress

Journal information: Scientific Reports (2021). DOI: 10.1038/s41598-021-86265-4

As Lockdowns Ease, Masks and Social Distancing are Still Needed

A new model suggests that as lockdowns ease, other control measures such as mask use must be enhanced in order to prevent additional COVID outbreaks.

The mathematical model, developed by scientists at the Universities of Cambridge and Liverpool, provides general insights about how COVID will spread under different potential control scenarios.

They considered ‘non spatial’ control measures involving facemasks, handwashing and metre-scale social distancing can all limit the number of virus particles being spread between people. The other, ‘spatial’ control measures included lockdown and travel restrictions, which reduce how far virus particles can spread. Different combinations of COVID control measures showed that non-spatial control needs to be ramped up as lockdown is lifted.

“More effective use of control measures like facemasks and handwashing would help us to stop the pandemic faster, or to get better results in halting transmission through the vaccination programme. This also means we could avoid another potential lockdown,” said Dr. Yevhen Suprunenko, a Research Associate in the University of Cambridge’s Department of Plant Sciences and first author of the paper. The authors stress that their predictions rely on such non-spatial control measures being implemented effectively.

Their model took into account the socio-economic impact of the measures. The costs of spatial measures of lockdown increased over time, while costs for non-spatial measures decreased due to falling prices and greater availability of items such as masks, and usage becoming a habit.

“Measures such as lockdowns that limit how far potentially infected people move can have a stronger impact on controlling the spread of disease, but methods that reduce the risk of transmission whenever people mix provide an inexpensive way to supplement them,” explained co-author Dr Stephen Cornell at the University of Liverpool.

The model was derived from identifying control strategies for plant diseases threatening staple crops. Instead of the usual computer simulation model, mathematical approach allowed the authors to identify insights on how to control newly emerging infectious diseases of plants and animals.

“Our new model will help us study how different infectious diseases can spread and become endemic. This will enable us to find better control strategies, and stop future epidemics faster and more efficiently,” said co-author Professor Chris Gilligan in the University of Cambridge’s Department of Plant Sciences.

Source: Medical Xpress

Journal information: Analytical approximation for invasion and endemic thresholds, and the optimal control of epidemics in spatially explicit individual-based models, Journal of the Royal Society Interface,rsif.royalsocietypublishing.or … .1098/rsif.2020.0966

Sunlight Vulnerability of SARS-CoV-2 not Just from UV-B

A team of researchers have found that the sunlight vulnerability of SARS-CoV-2 cannot be explained by the effect of UV-B rays alone.

Most of the COVID management concepts remain as true as in the first days of the pandemic, such as handwashing with soap and social distancing, though some have changed such as the notion of the virus mainly transmitted through droplets whereas evidence showed it can linger suspended in aerosol.

The researchers, from UC Santa Barbara, Oregon State University, University of Manchester and ETH Zurich. examined the well-known vulnerability of SARS-CoV-2 to sunlight. They concluded that exposure to UV-B radiation doesn’t completely account for its inactivation by sunlight.

The idea that an additional mechanism might be in play came when the team compared data from a July 2020 study that reported rapid sunlight inactivation of SARS-CoV-2 in a lab setting, with a theory of coronavirus inactivation by solar radiation that was published just a month earlier.

“The theory assumes that inactivation works by having UV-B hit the RNA of the virus, damaging it,” said lead author Paolo Luzzatto-Fegiz, UC Santa Barbara mechanical engineering professor. “Judging from the discrepancies between the experimental results and the predictions of the theoretical model, however, the research team felt that RNA inactivation by UV-B “might not be the whole story.”

Experimentation showed 10-20 minutes to reach virus inactivation—much faster than the theory’s predictions. Viruses in simulated saliva were inactivated over eight times faster when irradiated by UV-B lamps than would have been predicted by the theory, while those cultured in a complete growth medium before exposure to UV-B were inactivated over three times faster. In order to match theory, SARS-CoV-2 would then have greater UV-B sensitivity than any currently known virus.

“The theory predicts that inactivation should happen an order of magnitude slower,” Prof Luzzatto-Fegiz said.

There might be another mechanism involved besides UV-B effects on RNA; such as the synergistic effect of the less energetic UV-A rays.

“People think of UV-A as not having much of an effect, but it might be interacting with some of the molecules in the medium,” he said. Such reactive intermediate molecules could be hastening virus inactivation, a concept known in wastewater treatment and other environmental science fields.

“So, scientists don’t yet know what’s going on,” Luzzatto-Fegiz said. “Our analysis points to the need for additional experiments to separately test the effects of specific light wavelengths and medium composition.”

These findings could help develop ways to control the virus with widely available UV-A and UV-B sources. Sources which emit UV-C, which is otherwise blocked by the atmosphere, has proven effective in certain settings such as air filtration but its high energy limits applications and raises safety concerns.

“UV-C is great for hospitals,” said co-author Julie McMurry. “But in other environments—for instance kitchens or subways—UV-C would interact with the particulates to produce harmful ozone.”

Co-author and UCSB mechanical engineering professor Yangying Zhu added that UV-A’s possible effectiveness meant that inexpensive UV-A LEDs many times brighter than UV-A in normal sunlight could be used. UV-A could be used more for air filtration for example, but the specifics of each setting warrant consideration, said co-author Fernando Temprano-Coleto.

Source: Medical Xpress

Journal information: Paolo Luzzatto-Fegiz et al. UVB Radiation Alone May Not Explain Sunlight Inactivation of SARS-CoV-2, The Journal of Infectious Diseases (2021). DOI: 10.1093/infdis/jiab070

CDC Director Fears ‘Impending Doom’ as COVID Cases Rise Again

Rochelle Walensky, MD, the Centers for Disease Control (CDC) Director, says that she fears “impending doom” as COVID deaths in the US edge upwards as people increasingly ignore health restrictions and start to travel.

Beginning her usual COVID status update,  Dr Walensky spoke as she often did of “concerning trends in the data.”

Dr Walensky spoke about the country surpassing 30 million COVID cases; of a 10% increase in the 7-day average of COVID-19 cases over the past week, to slightly below 60 000 cases; and of an uptick in hospitalisations, from a 7-day average of around 4600 per day to around 4800 per day.

“And deaths, which typically lag behind cases and hospitalizations, have now started to rise,” she said, pointing to a nearly 3% increase to a 7-day average of “approximately 1000 deaths per day.”

“I’m going to pause here,” she said. “I’m going to lose the script and I’m going to reflect on the recurring feeling I have of impending doom.”  

At the start of her tenure, Walensky said she had pledged to always tell the truth even if it wasn’t something Americans wanted to hear.

“We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope. But right now I’m scared,” she said.

She recalled her time caring for COVID patients, saying: “I know what it’s like as a physician to stand in that patient room, gowned, gloved, masked, shielded and to be the last person to touch someone else’s loved one because their loved one couldn’t be there.

“I know what it’s like when you’re the physician, when you’re the healthcare provider, and you’re worried that you don’t have the resources to care for the patients in front of you.” 

She also recalled “that feeling of nausea, when you read the ‘Crisis Standards of Care’ and you wonder whether there are going to be enough ventilators to go around and who’s going to make that choice.”

She emphasised that she was speaking “not only as your CDC director, but as a wife, as a mother, as a daughter, to ask you to just please hold on a little while longer.”

She sympathised, she said, with those “wanting to be done” with the pandemic.

“We are just almost there, but not quite yet. And so I’m asking you to just hold on a little longer, to get vaccinated when you can. So that all of those people that we all love will still be here when this pandemic ends.”

Dr Walensky warned that the US pandemic trajectory was looking dangerously similar to that of European countries like Germany that were still struggling to contain the virus.

“We are not powerless. We can change this trajectory of the pandemic,” she said.

“But it will take all of us recommitting to following the public health prevention strategies consistently while we work to get the American public vaccinated.”

According to the New York Times’  COVID vaccination tracker, 146 million vaccinations have been administered in the US to date, with 2.76 million doses being given daily. At this rate, 70% of the adult population will have been vaccinated by June 16.

She urged community and religious leaders, officials, and other influencers to help support the vaccination programme.

“For the health of our country, we must work together now to prevent a fourth surge.”

Source: MedPage Today

Pandemic Steals the Enjoyment of Terminally Ill Patients’ Last Years

Welsh grandmother Maggie Shaftoe has a terminal brain tumour and doctors have told her she has less than two years to live.

Life with a terminal illness during the coronavirus pandemic and being in lockdown has caused difficulties for one couple making final memories.

Macmillan Cancer Support calls it an “acutely challenging time” for people living with a terminal diagnosis.

In 2017, the 63-year-old great-grandmother was diagnosed with an Anaplastic Pleomorphic Xanthoastrocytoma (APXA) brain tumour, which is very rare and most commonly occurs in children and young people with an average age for diagnosis at 12 years old. Her cancer was discovered by chance through a regular epilepsy check up and an MRI scan.

Mrs Shaftoe said that she has not seen her 11 grandchildren and great-granddaughter and she’s “just waiting for things to get back to normal”.

Together for more than 50 years, Mrs Shaftoe and her husband Chris first met as teenagers in a church choir in London. Mr Shaftoe said at this stage they “should be making the most of the time she has left and making memories with our family”.

“I think we’d like to go somewhere like Disneyland, or Lapland to see the northern lights or she’d love to go to the Cheddar Gorge,” said Mr Shaftoe, 65.

“But the pandemic has buried us in a great big hole and I don’t expect the situation to change.

“We’re noticing that Maggie’s memory is fading quite quickly now and she is getting worse day by day, and we understand what is coming,” he said.

In 2017 Mrs Shaftoe had an operation to remove the tumour and the following year had radiotherapy.

But Mr Shaftoe said this has only “delayed the inevitable” and his wife’s life expectancy “hangs on the effectiveness” of two anti-cancer drugs.

Since the operation, she has suffered difficulty with her memory, impaired speech, balance problems and is partially blind.

Doctors have told the couple that typically life expectancy for a patient with APXA would be five years.

Cancer Research UK said that the pandemic has had a “devastating impact on the lives of cancer patients”.

“Dealing with a cancer diagnosis and treatment is extremely difficult at any time, but the pandemic has added the stress of uncertainty, delays and shielding for some cancer patients,” said Martin Ledwick,  head information nurse at the charity.

Mrs Shaftoe remains positive despite the situation, saying it helps to laugh.

“If you can make a joke of something, make a joke of it,” she said, speaking during Brain Tumour Awareness month.

“You go out to make a cup of tea and you end up peeling potatoes, and come back in and wonder why I haven’t got a cup of tea – you have to laugh at silly little things.”

However managing during lockdown has been “very difficult” and mundane tasks could be a “major headache”, according to her husband, who has medical conditions of his own.

Mr Shaftoe says they now have a carer who comes for an hour each morning.

But he said: “We need more care. We have spent most of the pandemic without a carer and it has been absolutely nightmarish trying to get Maggie one.”

Macmillan Cancer Support in Wales said it has heard from many people in isolation, which makes “a challenging situation even more difficult”.

“We know this is an acutely challenging time for people with cancer, the NHS and cancer care, and particularly for people who are living with a terminal diagnosis,” said Richard Pugh, Macmillan’s head of partnerships.

Source: BBC News

Despite COVID, Cancer Screenings in the US Picked Up

Woman Receives Mammogram. An Asian female technician positions an African-American woman at an imaging machine to receive a mammogram. Creator: Rhoda Baer

In an encouraging sign, the RAND corporation reports that despite COVID, cancer screenings in the United States rebounded in the wake of the first wave.

There has been concern since the COVID pandemic was keeping people from going in for routine cancer screening, resulting in more undetected cancers to progress unchecked and an increase in cancer deaths. As some 600 000 Americans were expected to die of cancer in 2020, any impact on screening is a considerable health concern.

In a statement, Ryan McBain, PhD, of the RAND Corp. in Santa Monica, California, said: “These are the first findings to show that, despite real fears about the consequences of drop off in cancer screens, health facilities figured out how to pick this back up after the initial pandemic restrictions. Our study shows that health systems were able to recalibrate resources and protocols in a relatively short interval to deliver these important services.”

In Spain, cancer diagnoses were down 38% in the first half of 2020, according to one study. The pandemic’s impact on cancer screening that required in-person examinations, such as mammography and colonoscopy, were a particular concern, McBain and co-authors noted. Moreover, little was known about the magnitude of the decline in screening rates or longer-term trends in screen.

Using data on Castlight Health beneficiaries from January 15 to July 31, 2020, the researchers calculated weekly screening rates per 10 000 eligible beneficiaries. Before the declaration of national emergency in the US on March 13, screening mammography weekly rate was 87.8 per 10 000, falling to a low of 6.9 per 10 000 in April. Thereafter, screening rates began a steady recovery, to 88.2 per 10 000 at the end of July.

Over the same time period, weekly colonoscopy screenings fell from 15.1 to 0.9 per 10 000, before rebounding to a weekly median of 12.6 per 10 000 by July 31, 2020.

Multivariable regression analyses confirmed the significant declines in screening mammography and colonoscopy. A larger decline in colonoscopy was observed in high-income counties. Otherwise, the analyses showed no significant demographic variations.

Laura Makaroff, DO, of the American Cancer Society in Atlanta, said that the pandemic’s ultimate impact on cancer screening and cancer care is still largely unknown.

“We have seen similar data showing some rebound in cancer screening rates last summer and fall, but even those turnarounds show an approximate 30% decrease in cancer screening compared with pre-pandemic rates,” she said to MedPage Today in an email. “We also don’t yet know the full impact of the late fall and winter surges on disruptions in cancer screening and diagnosis.”

“The COVID-19 pandemic has had numerous consequences secondary to the disease itself, including reduced access to care for other illnesses,” Dr Makaroff added. “While these measures were necessary, delays in cancer screening, diagnosis, and treatment due to reduced healthcare access will likely result in a short-term drop in cancer diagnoses followed by increases in late-stage diagnoses and preventable cancer deaths.

“The full impact of the COVID-19 pandemic on cancer prevention and early detection will not be known until population-based nationwide data become available in the years to come,” she said.

Source: MedPage Today

Journal information: McBain RK, et al “Decline and rebound in routine cancer screening rates during the COVID-19 pandemic” J Intern Med 2021; DOI: 10.1007/s11606-021-06660-5.