Hot Topics in Infection Prevention: Unstoppable Delta, Lockdown v. Reopen, Antibiotic Overprescribing in Nursing Homes

Delta Variant Marches Through Our Lives

This more transmissible variant is gaining more traction in the United States as it accounts for 83% of new cases. This number grew from 50% in early July, underscoring the critical need for vaccines right now. Rochelle Walensky, MD, director of the Centers for Disease Control and Prevention (CDC) stated this week in CIDRAP, a publication out of the University of Minnesota, that “‘this is a dramatic increase, up from 50% for the week of July 3,’ Walensky said. ‘In some parts of the country the percentage is even higher, particularly in areas of low vaccination rates.’ Walensky explained that the pandemic in the United States was not affecting the unvaccinated.” As the Delta variant is estimated to be around 50% more transmissible than the original strain, the CDC has been emphasizing the need to improve stagnated vaccine rates. Currently, 48.7% of the United States is fully vaccinated and 57% of those 12 and up.

While Some Lock Down, Others Reopen

As Iran currently experiences a surge in cases triggering lockdowns, many countries are also seeing spikes in cases causing public health interventions. As CIDRAP noted “Today, the country [Iran] reported a record 27,444 new cases, topping the previous high from mid-April, according to Reuters. The steep rise in cases prompted a lockdown for Tehran and Alborz provinces, where

only essential businesses are allowed to stay open. Iran is among the countries experiencing a slow vaccine rollout. Only about 2.7% of the country is vaccinated, and country officials have blamed US sanctions for limited supplies of vaccine and medical materials.”

Meanwhile, the United Kingdom takes a different approach. The UK has fully reopened despite surging cases and a worrisome third wave. Most of the COVID-19 restrictions have been lifted despite cases up 41% and a wave of Delta variant surging through the country.

NPR reports that “the move to phase four of the country's reopening plan means there are no limits on the size of social gatherings or events, and social distancing is no longer required. The government still recommends meeting outdoors when possible.

“Requirements to wear face coverings have been lifted, though masks are still recommended in crowded areas such as public transport. They are required on the London Tube. And the government is no longer instructing people to work from home if possible, though it anticipates a gradual return to the office.”

Nursing Homes Residents Prescribed Too Many Antibiotics

Vulnerable patients in nursing homes require additional interventions to avoid unnecessary antimicrobial use. CIDRAP reports that “according to the Centers for Disease Control and Prevention, an estimated 70% of nursing home residents receive one or more courses of antibiotics a year. The primary reasons for such frequent antibiotic use in long-term care is that residents are often frail and have underlying conditions that make them more vulnerable to bacterial infections, especially those involving the skin, urinary tract, and respiratory tract.” Despite this, over half of antibiotics being prescribed in these facilities are likely not needed and can increase the risk for infections like C diff or antimicrobial resistance. More work should be focused on identifying successful interventions and ensuring access across all facilities.