Respiratory Care Currents

 Published: April 13, 2021

By: Debbie Bunch

 

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What Makes RSV Worse?

Some children hospitalized with RSV are ready to go home in a day or two, but others end up getting sicker and needing a more extended hospitalization. What makes the difference? 

According to researchers from Washington University School of Medicine in St. Louis, children with worse outcomes may be more likely to have high levels of defective copies of the virus. They reached that conclusion after building on their previous discovery that RSV makes some nonfunctional copies of its genome as it multipliesWhile these defective copies cant form new infectious viruses, they can trigger a strong antiviral immune response.  

In this new study, they collaborated with colleagues from Imperial College London and the Childrens Hospital of Philadelphia to analyze viral RNA in nasal washes from 122 children under age two hospitalized with RSV. Defective viral genomes were found in 82% of the children, and those children ended up getting worse during their hospitalization and having more extended stays 

However, further studies in infants and young adults showed that timing mattered. When the defective genomes showed up early on in the course of the disease, the patients fared significantly better than when they came later or didn’t come.  

The defective genomes are kind of a proxy for the immune response, explained senior author Carolina B. López, PhDA strong immune response very early after infection is good because it prevents the virus from multiplying. But if the immune response comes too late, when the virus has already multiplied, it is likely very damaging and leads to more severe illness. 

The study was published on Apr. 1 by Nature Microbiology 

COVID Vaccines Dramatically Reduced Infections in Health Care Workers

Respiratory therapists, along with other health care workers, were among the first to receive the COVID-19 vaccine late last year. Researchers from UT Southwestern found these vaccines significantly impacted their hospital system. They reduced the number of required isolations and quarantines by more than 90%.  

The study, published by The New England Journal of Medicine in late March, looked at the first 31 days after the vaccinations became available. During that time, UT Southwestern provided a first dose to 59% of their 23,000 employees. Thirty percent were fully vaccinated. Overall, 1.5% of staff became infected, with the highest infection rates, at 2.6%, seen among nonvaccinated employees. Among those who were vaccinated, the infection rate was .05%. 

UT Southwestern has now vaccinated about 70% of its workforce and is turning its attention to vaccine hesitancy by hosting educational outreach programs for community groups and businesses and developing extensive online resources on the vaccine. A multilingual public service announcement campaign is in the works as well.  

It is important to reach out across multiple platforms to effectively address peoplequestions so that we can continue to make progress on vaccine hesitancy, said Marc NivetEdD, executive vice president for institutional advancement at UT Southwestern. 

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New Hope for Patients with Scleroderma

Lung disease is the leading cause of death among patients with the most severe form of scleroderma, but new research suggests something can stop the progression of lung damage in these patients. 

Michigan Medicine investigators publishing in last month’s Arthritis & Rheumatology found that the FDA-approved anti-inflammatory drug tocilizumab preserved lung function in patients diagnosed five years ago or less. Tocilizumab is typically used in rheumatoid arthritis treatment. 

Some people have minimal lung disease; some people have life-threatening disease. The amount of lung scarring plays a major factor in those health outcomes, said study author Dinesh Khanna, MBBS, MSc, director of Michigan Medicines Scleroderma Program. When used in patients early in their disease course, those that usually have had the disease five years or less, our study found that tocilizumab preserved lung function over the course of 48 weeks. 

Race Didn’t Factor into ICU Outcomes for COVID-19 Patients in Detroit Hospital

According to statistics, Black and Hispanic people are more likely to get COVID-19, be hospitalized with it, and die from it. Researchers from Henry Ford Hospital in Detroit, MI, decided to see whether those differences held up once patients were actually in the ICU. The short answer is, they didnt. 

The 28-day death rate for people of color was lower than that seen for Whites. However, the investigators note that several deaths in people of color were simply delayed beyond the 28 days, making the death rate among Whites and people of color about the same. The need for mechanical ventilation and length of ICU stay were about the same as well.  

The retrospective study looked at 365 COVID-19 patients 18 and older admitted to the ICU between Mar. 13 and Jul. 31 of last year. Among that group, 219 were Black, 129 were White, eight were Hispanic/Latino, seven were Arab, and two were Asian. There were more men in the group as a whole than women, 205 vs. 160, and on average, people of color were younger, 62.8 years on average vs. 67.1 years. Comorbidities such as COPD, asthma, hypertension, diabetes, and coronary artery disease were common.  

Overall the mortality rate in the two groups was 50%, and nearly 75% required mechanical ventilation. Most of the patients were treated with steroids early in their stay, but that was not a significant predictor of mortality. The study was published by Critical Care Medicine at the end of March.  

TB Diagnoses Often Delayed in the U.S.

Harvard Medical School investigators who analyzed data from nearly 19 million medical insurance claims between 2008 and 2016 have found that tuberculosis (TB) diagnoses are often delayed in the U.S. Among the 3,389 people whose records had diagnostic codes suggestive of TB738 were eventually diagnosed with active TB.  

The median delay in diagnosing an active case of TB was 24 days, with the majority ranging between 10 and 45 days. But some delays were even longer, in certain cases up to 250 days. Delayed diagnoses were linked to the higher likelihood of transmission to household members. The researchers also found a concerning link between delays in diagnosis and the risk for disease progression. 

The authors believe much of the problem lies in the fact that TB is a rare disease in this country and suggest lack of awareness among clinicians is driving the problem.  

The delays we found would be concerning under any circumstances, but they are unacceptable in a well-resourced health care system such as the United States, said senior investigator Maha Farhat. Our findings point to the key importance of continuing education of providers.  

The study was published by The Lancet Infectious Diseases on Mar. 22. 

Email newsroom@aarc.org with questions or comments, we’d love to hear from you.

Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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