Chilblains unrelated to COVID-19 infection, 2 studies conclude

Chilblains—which in this pandemic have been referred to as “COVID toes”—are not a sign of COVID-19 infection but rather a result of sedentary lifestyles linked to community lockdown measures and a lack of warm footwear, two small studies published today in JAMA Dermatology have found.

In a study involving 31 patients with chilblains, 11 of them teenagers, from Apr 10 to 17 at a Brussels hospital, none tested positive for SARS-CoV-2, the virus that causes COVID-19, on reverse-transcription polymerase chain reaction (RT-PCR) or had antibodies against the virus on serologic testing.

Biopsies of 22 skin samples showed no evidence of the virus. Twenty of 31 patients (64%) reported mild symptoms characteristic of coronavirus, and 3 (10%) reported contact with a person who tested positive for COVID-19.

Nine of 31 patients (29%) had a history of chilblains, and 4 (13%) had Raynaud’s syndrome. Twenty patients (64%) said they had been less physically active than normal while in lockdown, and most said they remained in socks or barefoot most of the day.

A separate study of 20 pediatric patients hospitalized in Spain from Apr 9 to 15 with acral lesions (on the hands and feet) had no clinical signs of COVID-19, tested negative on RT-PCR, and had no antibodies against the virus on serologic testing. Histologic testing revealed that the lesions were chilblains.

Nine of 20 patients (45%) had a history of Raynaud’s syndrome or chilblains, and 15 (75%) said they walked barefoot around their house during quarantine. Only 2 lived in a home with heat. “Other studies with improved microbiologic tests or molecular techniques aimed at demonstrating the presence of SARS-CoV-2 in the skin may help to clarify this problem,” the authors wrote.

Chilblains are a painful inflammatory response of small blood vessels in the hands and feet caused by repeated exposure to cold air. Raynaud’s syndrome is a narrowing of the small arteries that supply blood to the skin in response to cold temperatures or stress, limiting blood flow and causing feelings of numbness and cold.
Jun 25 JAMA Dermatol chilblains study and acral lesions study


Study shows high all-cause death rates at nursing homes in pandemic

A Harvard University study has revealed significant clinical burden and high death rates at skilled nursing facilities (SNFs) in Cleveland, Detroit, and New York City during the COVID-19 pandemic.

According to a research letter published yesterday in JAMA, 3,853 residents of 189 SNFs died from any cause from March to May 2020, versus 1,765 during the same period in 2019.

In Cleveland facilities, a mean of 6.3 of 1,000 residents died each week in 2020, compared with 4.9 per 1,000 residents in 2019, but the difference was not statistically significant. In Detroit facilities, a mean of 7.9 per 1,000 residents died each week in 2020, versus 3.5 in 2019, while a mean of 13.8 per 1,000 residents died in 2020 in New York City, compared with 4.1 in 2019.

During the peak of the outbreak in Detroit skilled SNFs in April, 17.4 per 1,000 residents died, compared with 4.0 in the same week in 2019, while in New York City, those figures were 36.3 versus 3.7.

Weekly admissions and patient census fell from March to May 2020 compared with the same period in 2019 at facilities in all three cities (mean, 91 vs 105 in Cleveland, 103 vs 130 in Detroit, and 235 vs 284 in New York City).

“These results suggest that SNFs experienced substantial clinical challenges during the COVID-19 pandemic,” the authors wrote. “Mortality increased quickly, raising concerns about the capacity of SNFs to respond to outbreaks. Compounding the challenge, decreased patient census may lead to reductions in revenue at a time when SNFs have the greatest need for additional resources to manage and prevent future outbreaks.”
Jun 24 JAMA research letter


CDC notes sharp rise in Salmonella infections linked to backyard poultry

One person has died and more than 368 additional people have been infected with Salmonella from live backyard poultry, according to a Centers for Disease Control and Prevention (CDC) update yesterday.

The new infections bring the outbreak total to 465 infections in 42 states. The CDC first reported the outbreak on May 20.

Illness onset dates range from Jan 14 to Jun 1, with patients ranging in age from less than 1 year to 88 years, with a median age of 31, the CDC said. Eighty-six patients have required hospitalization, and one death has been reported in Oklahoma.

“In interviews with 226 ill people, 179 (79%) reported contact with chicks and ducklings,” the CDC said. “People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries.”

The CDC said people who tend to backyard flocks must be vigilant about hand hygiene and should supervise children around the animals. Children under the age of 5 shouldn’t touch backyard poultry, as young children are more susceptible to Salmonella.
Jun 24 CDC update

May 20 CIDRAP News scan on initial notice

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