The Interim Case Fatality Rate (ICFR) of the COVID-19 Pandemic for Europe and the United States from March 1, 2020 to August 15, 2021. Does the ICFR Regress to the Final CFR?

OBJECTIVE: The true case fatality rate (CFR) of a disease outbreak can only be ascertained after all cases and deaths have been tabulated at the end of the epidemic. We define a metric, the interim case fatality rate (ICFR) which is the incremental change in the ratio of cases to deaths. To examine longitudinal changes in the ICFR of the COVID-19 pandemic and to evaluate the likelihood that the ICFR can predict the final CFR. METHODS: Publicly available databases were used to gather data on the number of cases and deaths in Europe and the United States (USA). These data were gathered over the period from Mar.1, 2020 to Aug. 15, 2021, on four regions of the USA and four regions of Europe on a bi-weekly basis. Statistical methods were utilized to evaluate changes over the final month of the study (July 15, 2021 to August 15, 2021). Stability of the ICFR was based on acceptance of the null hypothesis that no significant difference (p>0.05) was observed over that period. RESULTS: In all regions studied, the early months of the pandemic were marked by very high ICFRs. By late 2020, these began to stabilize at levels well below 5%. During the final month of the study, only one (Northeast USA) of the eight regions evaluated showed a statistically significant difference in ICFR. Mean ICFR projections, based on weighted values of cases are 1.8% (95% CI: 1.2% to 2.3%) for the USA and 2.1% (95% CI: 1.5% 2.7% for Europe. CONCLUSION: After an early peak, very little change was observed in the ICFR, and by summer 2021, the rates had stabilized. Weighted ICFR for all regions may well reflect the final ICFR.

Impact of routine methicillin-resistant Staphylococcus aureus (MRSA) surveillance and cohorting on MRSA-related bloodstream infection in neonatal intensive care unit.

OBJECTIVE: To study the impact of methicillin-resistant Staphylococcus aureus (MRSA) surveillance on the incidence of MRSA-related bloodstream infection (BSI) in neonatal intensive care unit (NICU) and to evaluate cost-effectiveness of MRSA surveillance. STUDY DESIGN: MRSA surveillance policy was introduced in our NICU in April 2008. Pre-MRSA surveillance period (P1, April 2006-March 2008) was compared with the surveillance period (P2, April 2008-April 2010) for MRSA-related BSI (MRSA BSI). RESULTS: During P1 and P2, 1,576 and 1,512 neonates were enrolled. Of these, 3.8/1,000 and 5.3/1,000 developed MRSA BSI, respectively. During P2, 100% MRSA-related BSI occurred in MRSA-colonized neonates, as compared with zero in noncolonized group (p < 0.0001). Overall, 7 (30%) of the 23 neonates colonized during hospitalization developed MRSA BSI as compared with 1 of the 31 (3%) neonates colonized at admission (p = 0.007). Direct screening cost was $208 per patient. Since 28 neonates had to be screened to detect one colonization, $5,824 estimated per detection, excluding indirect costs. CONCLUSIONS: MRSA surveillance may protect non-MRSA colonized neonates from becoming colonized. This is of considerable importance because the acquisition of colonization during hospitalization was associated with a 10-fold increase in risk of developing MRSA BSI. Cost-effectiveness of MRSA surveillance remains debatable and further studies are needed to delineate cost-benefit ratio.

Fluconazole prophylaxis is associated with a decreased rate of coagulase-negative Staphylococcal infections in a subset of extremely low birth weight neonates.

Fluconazole prophylaxis is being used efficaciously in the neonatal intensive care unit (NICU) for fungal prophylaxis in very low birth weight and extremely low birth weight (ELBW) neonates. Little is known about the effect of fluconazole prophylaxis on bacterial infections. The purpose of this study was to examine that issue in a subset of ELBW, those weighing ≤900 g at birth. This is a retrospective study conducted in a level III NICU at state-designated children hospital in New Jersey (USA). We examined the data from our records of neonates ≤ 900 g birth weight during the period March 1, 2007-February 28, 2011. Inclusion in the study was all infants ≤ 900 g before (n = 67) and after (n = 81) the institution of fluconazole prophylaxis. Fluconazole prophylaxis was accompanied by a significant decrease in both the rate and number of days of bacterial infections as well as co-infections. We found that the incidence of coagulase-negative Staphylococcus (CONS) decreased from 46.2 to 24.7 % (OR 2.63; 95 % CI 1.31-5.27). Similarly, days of infection also decreased significantly (p < 0.0001). These data suggest that fluconazole prophylaxis may be associated with a reduction in CONS infections in that subset of ELBW neonates.