Pandemicia coronavirus report #60

 

Verknipt Festival, Netherlands July 2021

Pandemicia coronavirus report #60

FAR FROM OVER 

Epidemic - Delta disaster

One of the lesson that might have been learned from the Spanish Flu epidemic 1918-20 has come home to roost. The trouble with allowing a pandemic to rage through a large country is that it will almost certainly mutate into a more serious variant. Thus we have British variant (Alpha), South African variant (Beta), Brazilian variant (Gamma) and Indian variant (Delta), plus others. The more infectious Delta variant in particular is responsible for the next wave that is now occurring in countries where the disease was already widespread. 

Accompanying the new outbreaks are outbreaks of 'Covid exhaustion' in countries that have been partially in lockdown for a year and a half. This is particularly manifest in 'rogue countries' like Brazil, the United Kingdom and parts of the USA, where from the beginning leaders have taken a libertarian stance - and even in compliant countries like Australia.

Global report

Daily confirmed cases worldwide have risen by over a third in three weeks, mostly driven by the Delta variant - passing half a million cases a day globally, though still well short of the November-January maximum. The disease is still most active within the wealthy and better-networked countries, though it is beginning to move into less developed countries. 

Total deaths by continent, to July 2021

The 4.1 million deaths so far from the coronavirus have occurred about a quarter each in Europe, North America, South America and Asia/Africa, as the figure  shows. New deaths are about 10,000 a day, with more than a third in South America.  Together Asia and Africa hold about three-quarters of the world's population, so Covid mortality there is only a third of that in other continents - partly due to lower incidence of the virus, partly due to much younger populations. 

Vaccine distribution is now widespread, with over 4 billion doses administered and some countries over 50% fully vaccinated. The countries presently suffering a third or fourth wave of the epidemic fall into two classes, according to their vaccination status:

• In the wealthy countries that have vaccinated most of their old people, substantial rises in cases are being recorded without a spike in deaths;
• In South-east Asia and the Pacific, an epidemic of the highly infectious Delta variant is raging, with hundreds of thousands of cases and thousands of deaths.

In Australia, which had succeeded twice in eliminating standard outbreaks, and where the vaccine rollout has been slow, a Delta outbreak appears poised to overwhelm conventional lockdown and contact-tracing measures for the first time. The situation is so complex we will handle it in a separate article in the next few days.

Africa also has record numbers of cases, a situation which Pandemicia will cover in the next edition. 

Europe - rapid rises, few deaths

In the EU, cases have tripled in a fortnight, mostly due to massive expansions in Spain (where cases have increased nine-fold in a month,) the Netherlands (20-fold in two weeks), and Britain (20 fold in two months) almost reaching January record daily levels in these countries. Hospitalisations and deaths have not increased much, supporting the "Singapore doctrine" that cases do not matter once the population is vaccinated. 

Netherlands cases and deaths

Spain cases and deaths

Generally, 'Lockdown 2' provisions still apply in the Netherlands (advisory social distancing, masks, work from home, no live or nightclub entertainment) - but many shops have remained open for the full duration of the crisis. Rock festivals are beginning to be held and more are scheduled. Despite the repeated runaway 'waves', the popular impression of the way the government has handled the crisis has been excellent. About 90% of people over 70 are fully vaccinated, (but only about 20% of those under 40). 

In Spain, a substantial outbreak is linked to students returning from vacation in Mallorca, where they attended nightclubs and festivals. About 52% of the population are fully vaccinated, mostly with the Pfizer vaccine, Vaccinations of people under 40 only began in July. As elsewhere, most of the new cases are among unvaccinated people, especially the young.

In France, cases have risen ninefold in a month, and 96% of the 100,000 new cases a week are unvaccinated. President Macron has tried to reignite the flagging vaccination drive by introducing a vaccination passport. It is necessary to show this or a recent test result to gain admission to cultural and leisure facilities. More than 100,000 people took to the streets across France in protest, some wearing a yellow Star of David as Nazis required of Jews. Two vaccination centres have been physically attacked.

 In the United Kingdom daily cases are around 55,000 - by far the highest in Europe, and the highest in the world per million people. Deaths have crept up from 20 a day to 80 a day, tiny next to the 1800 a day recorded in January, but still significant. Nevertheless PM Boris has Johnson gone ahead with a plan to declare "Freedom Day", removing all social distancing restrictions. Revellers jammed nightclubs for the first time in months, commuters can ride the train mask-free and diners are eating out without seating and capacity limits. 

In the United States cases are also rising sharply, up by a factor of five in a few weeks. New cases are occurring most strongly in Florida (where cases are close to the January peak), Texas and Missouri. The Delta variant is now responsible for over 80% of new cases - showing how much more rapidly it spreads than other variants. In LA County, 20% of new cases were 'breakthroughs' in the fully vaccinated. California and Missouri have mandated masks indoors. 

Missouri is the home of 'redneck anti-vaxxers', to the point that some people have tried to disguise their appearance while being vaccinated, as they "don't want their friends to know.' Some Republicans have done everything they can to block vaccination programs and declare masks unconstitutional. According to one sufferer holding office,No we didn't get vaccinated, we're Republican.

South East Asia 

(this continues the previous edition of 4 July).

SE Asia, daily new infections (calculated from Our World in Data)

Eight countries in South East Asia now have near-record levels of coronavirus. From the previous maximum daily confirmed cases of about 15,000 in January and April across the region, cases have risen exponentially to over 90,000 a day on 23 July, with deaths running at about 3000 a day. In the Table below,  previously largely uninfected countries have new cases rising exponentially at up to 30% per day (similar to rises found in Western countries in the early part of the pandemic, when case doubled every three days). However they still have some way to go to meet the rates of infection presently occurring in European countries, and deaths will rise to perhaps three times the present 130,000.

Country	New cases/m (av)	Total deaths/m	Status of new cases
Cambodia	49	75.0	Climbing, record levels
Indonesia	154.1	299.8	Climbing rapidly (about 2%/day)
Laos	26.0	0.7	Climbing exponentially (11% /day)
Malaysia	399.6	244.1	Climbing exponentially (6%/day)
Myanmar	105.8	124.2	Stationary, record levels
Philippines	53.3	247.6	Climbing, 50% of max
Thailand	184.2	56.3	Climbing rapidly (3%/day)
Timor Leste	25.7	19.7	Climbing exponentially (15%/day)
Vietnam	64.4	3.8	Climbing exponentially (30%/day)
Fiji	962.8	197.4	Maximum reached, falling rapidly
EUROPE
UK	651.5	1906.4	Probably falling rapidly from 80% max
Netherlands	427.0	1055.3	Probably falling rapidly from 90% max
Spain	550.6	1737.2	Rising rapidly, 60% of max
USA	155.4	1845.4	Rising rapidly, 40% of max

Source: Our World In Data.
Note: per million population. Averages are over 7 days. 1000/m was highest daily case rate in UK

Indonesia 

Indonesia cases and deaths

Until recently Indonesia was almost the only large country not heavily infected. Now it has passed 3 million infections. and it is regarded as the new 'epicentre' of the virus. Recognised cases are increasing by 50,000 a day - four times the previous daily maximum in January.

Although 30 million doses of vaccine have been delivered - mostly the Sinopharm vaccine - the Indonesian archipelago is regarded as largely unvaccinated. In the Figure, deaths have followed cases with the usual one week lag, and since 11 July are now over a thousand deaths per day.

As in Brazil in January and India in late April and May, hospitals in Indonesia began running out of oxygen around 10 July, causing the immediate suffocation of intubated patients. With hospitals full, as in India many ill people sat outside the hospital with oxygen bottles, hoping for admission or trying to get refills.

About 350 'fully vaccinated' doctors and medical workers have contracted Covid-19 , casting further doubt on the efficacy of the Sinopharm vaccine. Overall, 945 health workers are said to have died. Sri Redjeki, one of the inventors of an improved portable ventilator, is among this week's casualties - following Novilia Sjafri Bachtiar, lead scientist on the Sinovac trials in Indonesia, who died on 8 July. 

The Indonesian government has been repeatedly criticised for ignoring medical advice. In the early part of the epidemic, the Indonesian PM planned to introduce big discounts for tourists rather than restricting entry, the Health Minister attributed the absence of Covid in Indonesia to prayer, while the Interior Minister recommended broccoli and bean sprouts. Now, as cases surge, the authorities have resisted national lockdowns. 

Indonesia has been vulnerable to 'fake news' and many Indonesians still think Covid-19 is a global conspiracy. For many others, going hungry is a much greater fear than the virus. Ingredients for the traditional herbal drink jamu (recommended by the PM) have been selling fast, while Bear Brand milk and ivermectin (a veterinary compound of doubtful efficacy) have been widely promoted.

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Gravediggers in Java working around the clock

Malaysia

Malaysia daily cases and deaths

Malaysia's cases have also been rising very rapidly since April, and the country has reached a million total cases, joining 30 other countries. A full national lockdown from June 1, shutting almost all economic and social sectors, brought cases down by 50% over three weeks. But then cases immediately began to rise, reaching a new maximum by 13 July. About 16000 new cases a day are being recorded, mostly in the Klang Valley area around Kuala Lumpur.

Malaysia has many doctors under contract, and they have been agitating to improve their conditions as they risk their lives during the pandemic. A group of MPs and activists has lodged police reports against Health Minister Dr Adham Baba and other relevant ministers for their 'negligence' in handling the worsening Covid-19 pandemic. 

Other SE Asia-Pacific countries

Thailand's epidemic has continued upward since the last report at an extraordinary, exponential rate for a country that once seemed to have avoided the epidemic entirely through firm action. From 23 May to 10 June new cases stalled under 3000, but in 6 weeks they have risen to 15,000 a day. The government encouraged people to return to their home provinces to take the pressure off Bangkok's hospitals, but of course this spread the disease throughout the country.

Vietnam has announced its first lockdown in the capital Hanoi as cases begin to rise, mostly emanating from the Mekong Delta. Vietnam was one of the world's success stories with virtually no cases until a few began to appear in May. From mid-May daily cases hovered around 300, then at the end of June they took off exponentially at 30% increase a day (see table) and are now over 10,000 a day. There has been almost no vaccination and the whole population are vulnerable. Neighbouring Cambodia and Laos have also commenced serious epidemics.

Myanmar's cases have shot up to 6000 a day, three times the value in the first wave in Oct 2020. 

The Philippines has banned travel from Malaysia and Thailand to try to limit exposure, but this is not unlikely to have much effect as daily cases in the Philippines have been over 5000 a day since March.

Cases in Bangladesh have been over 10,000 a day for several weeks, despite its strictest lockdown, and have now reached 16,000. Unfortunately the country withdrew restrictions for a week during the Eid festival. More than 10 million people left Dhaka for villages on overcrowded buses and ferries. Public experts have said that handling of lockdown has been bizarre, and much worse is to come.

The Fiji epidemic maxed out at 1800 new cases a day on 15 July - very high for a small island community with a population of only 900,000. Many "did not see" that the deaths throughout the community were caused by the virus and refused vaccination. There was no lockdown (apart from a few weeks in May) but curfews and containment areas were introduced. Police announced from 6 July they would be arresting people with no mask inside mandated containment areas. A very rapid mandated vaccination program was instituted with donated Astrazeneca stock - described as 'no jab no job'. 

The "Singapore doctrine

Singapore, the highest income country in Asia, announced a much-publicised roadmap to 'Covid-normal' at the end of June. As per the previous Pandemicia report #59, senior Singapore officials declared that once vaccination was at a sufficient level, no restrictions or social distancing would be necessary, and only outcomes such as hospitalisation and death would need to be measured.

However three weeks later on July 21, with 181 cases in a day, Singapore returned to a partial lockdown for a month. Growing clusters surrounding nightclub venues and a fishing port lifted cases to the highest level since August 2020, and with only 46 per cent of the population fully vaccinated, the roadmap has had to be delayed. 

 

WHO’s emergencies head, Mike Ryan, urged countries on 7 July to use extreme caution when lifting restrictions so as “not to lose the gains you’ve made” as the global death toll from the pandemic passed four million. “The idea that everyone is protected, and it’s ‘Kumbaya’ and everything goes back to normal, I think right now is a very dangerous assumption anywhere in the world,” he said

The major psychological impact of lockdown seems to have fallen on young people in the 'prime mating bracket' in Western countries, who have found it difficult to be denied congregating at nightclubs and music festivals. Despite near-record infections, the United Kingdom declared 'Freedom Day' on 19 July and threw nightclubs open, with long queues anticipating entry. The relexation of curbs  appears to be based on the 'Singapore doctrine'.

The low numbers of deaths in vaccinated countries are encouraging but may be shortsighted. The problems with the "Singapore doctrine" of allowing the disease to rampage among the young while vaccinating the elderly to prevent deaths are considerable:

• the toll from 'long Covid' that troubles about 10 to 15 per cent of those infected, and which ultimately may be the major legacy of Covid. Extreme symptoms such as "fatigue, post-exertional malaise, and cognitive dysfunction” can persist for a year or more. Few sufferers are ill enough to be hospitalised. The effect of vaccination in preventing 'long Covid' is not yet known, though it may help to reduce existing symptoms
• the good chance that a variant will be produced that can overcome vaccines. When a disease continues to pass through very many unvaccinated people in a partly vaccinated population, it generates many mutated variants. If one of these by chance happens to be capable of ignoring the vaccine barrier, it will enjoy an immense advantage in spreading through the vaccinated half of the population and will rapidly become dominant
• Unlike previous variants, the Delta variant can be spread by the fully vaccinated. In breakthrough cases they carry a heavy load of virus, enough to infect others. Children may also infect others with Delta.   
• If half the medical workforce is off sick, there will be no-one to treat other complaints

Other events

A fire from an oxygen tank explosion on 13 July in Iraq killed 44 people and injured 60. A larger explosion occurred at another Iraqi hospital in April. Another in Iran killed 44 people on 13 July.  

A far-right party took the national 2020 lockdown to Spain's highest court, where it was declared unconstitutional. 

A fiery clash between conservative Senator Rand Paul and Dr Fauci, NIAID Director, took place in which each accused the other of lying over whether the US National Institutes of Health had funded "gain of function" research in the Wuhan Institute of Virology.

Lorna Jane, an actionware clothing company that opportunistically marketed clothing claimed to eliminate Covid-19 and stop it spreading has been fined $5 million and labelled as 'predatory and exploitative' by the Australian Federal Court. The company claimed its products had been sprayed with “LJ Shield”, which protected people against pathogens.

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