Pandemicia coronavirus report #66

 

Pandemicia coronavirus report #66

Epidemic

Global report

Globally, close to 6 million people have died since the onset of the pandemic. Global deaths have remained between about 50,000 and 100,000 per week since November 2020, with peaks in Jan 2021, May 2021, and the present outbreak. The death rate has actually been worse since the introduction of vaccines. This is because reductions in mortality following vaccination caused countries and individuals to drop their vigilance, allowing greatly increased numbers of cases - reaching 23 million per week at the end of January. 

The Omicron outbreak peaked out about six weeks ago in southern Africa, a month ago in US, Canada, France, Spain, India, Australia, Philippines and most of Latin America, and about two weeks ago in most of Europe and North Africa, except Netherlands, Germany, Denmark, Ukraine and Russia where it is peaking now. In most of Asia Omicron cases are still rising. Deaths are still high everywhere.

Cases in the USA have been a record 10 million over the past 28 days, and in France 7 million. Deaths in the USA passed 900,000 several weeks ago and will reach a million in the next few months. 

As a general rule one may say regarding the present Omicron outbreak:
a) places that vaccinated some time ago, and places that have not previously had large Covid outbreaks, have been the worst hit
b) It appears less developed countries had bigger outbreaks in 2020-21 than are shown on official figures, since the present Omicron outbreaks are not so great, indicating a build-up of immunity.

There continues to be new forms of misinformation from semi-official sources reported in the media. It has become common to speak of Covid-19 "becoming endemic" - which actually means a low steady flow of cases with no outbreaks; when according to Raina MacIntyre coronavirus will always be an outbreak disease like influenza.

In Britain there have been up to 600,000 reinfections in total, as antibodies from earlier infections wane.

In Australia's most populous State NSW, there have been 1.1 million Covid-19 cases since Omicron was first detected on 26 November. Over the period (less than three months) there have been 1200 deaths, compared with 56 in the first 15 months of the pandemic, and 530 in the next 5 months, when the more dangerous Delta variant was active.

Aged-care homes continue to be particularly hard hit, with about a quarter of Covid-19 deaths occurring there. In Australia at 28 January there were 555 aged-care outbreaks, involving 9600 residents and 14,200 staff. Some 73% of aged care homes have been involved. There have been 566 deaths nationally since the start of the Covid outbreak to end January. Deaths have been about 0.7% of age care beds - a mortality very much less than in some other countries such as Canada.

Africa The apparently low incidence of Covid-19 in Africa has remained an ongoing puzzle. Has it been due to under-counting, a young population, or some other factor? A preprint meta-analysis of seroprevalence studies has found that Sars-COV2 antibodies rose from an estimated 3% in Q2 2020 to 65% in Q3 2021. The results were very heterogeneous across regions - but indicates Covid-19 has spread widely without being tested or detected. This does not change the basic appreciation that wealthy countries have been the hardest hit by the pandemic.

Variants

It looks as if the 1887 "Russian Flu" was actually a coronavirus, as it had most of the same characteristics as Covid-19 - affecting the elderly, loss of smell, and extended symptoms. The 1887  variant may be one of the four CVs that today 'harmlessly' cause the common cold. In fact, it is possible that all these 'old' coronoviruses are the remnants of earlier pandemics. Scientists are investigating, as this may figure as a possible 'endgame' for Covid-19.

As was discussed in the last report #65Omicron is similar to ancestral Covid-19 in terms of virulence, but it is more infectious and more resistant to the current vaccines. There is certainly no reason for 'Omicron triumphalism' or to claim that the virulence of Covid-19 is 'falling' because the variant is 'not as bad as Delta'. Mortality is varying enormously between jurisdictions, which is due largely to the proportion of the population vaccinated and the duration since vaccination.

Response

Mandates

The following jurisdictions have mostly removed social distancing, mask mandates, vaccination mandates, singing and dancing restrictions, check-ins and border controls, or will do so by mid-March, despite high numbers of cases.

- most of USA (157,000 cases per day)
New South Wales (10,000 cases per day)
- UK (since 19 Jan, with 95,000 cases per day)
- Ireland by 22 January and Denmark by 1 February (with cases still rising at the time). 
- France (with up to 243,000 cases per day, proof of vaccination rules continue)

Mask mandates generally continue on public transport and in nursing homes and medical facilities.

Treatments

Monoclonal antibodies tailored to work against other variants do not work against Omicron, with the possible exception of sotrovimab. 

Long Covid

There are promising signs that antihistamines may help some sufferers of long-term symptoms after Covid infections. 

Geopolitical

Hong Kong
For two years Hong Kong managed to maintain 'zero Covid', even longer than Australia. Borders were closed so tight, isolation periods were so long and snap lockdowns so likely that there was a 'brain drain' with many leaving for good and Hing Kong's role as an international hub threatened. The province has not used the time to prepare. 

Hospitals are now overloaded with a tenfold increase in cases. There is an eight-hour wait at hospitals and a five-day wait for test results. 100 health workers a day are infected. Less than half of those over 70 are vaccinated. 

China faces a much greater danger than Hong Kong from a massive death surge should Omicron run loose. Trying to maintain the world's most populous country as the last bastion of zero-Covid in the face of global opposition is proving a real dilemma.

Social

Aggrieved entitlement

Despite the abandonment of restrictions, "Freedom convoys" have continued to take place in Canada, Australia and France. They appeal in part to people with a much wider and long-standing set of 'aggrieved entitlement' issues than just Covid restrictions. Many of them centre around a 'growing white alienation' in the face of better access by non-European people to opportunities.

The Canadian blockades that have set the current wave of protests off appear superficially to be due to a call for vaccination of truckers crossing the US border - but actually seem to be part of a far-right occupation. While the trucking industry does have a number of long-standing grievances, the present blockades do not appear to actually relate to trucking, as 90% of truckers are vaccinated and oppose and are being greatly inconvenienced by the blockages. After three weeks of protests evoked minimal responses from government to clear the highways, the Trudeau government has finally implemented the Emergencies Act for the first time.

Nurses' strike

 

For the first time since 2013 nurses, midwives and paramedics voted to strike after 15 February in 150 hospitals across NSW. With massive numbers of Omicron patients, a third of staff off due to exposure or infection, chaotic scenes outside hospitals and in ICU, and many nurses working dangerous double shifts, nurses are seeking minimum patient-staff ratios, a Covid allowance and a modest payrise. 

Vulnerable people

A number of countries are now almost completely discontinuing social distancing, case tracing etc although daily cases have just fallen off an all-time high and are far above any previous level almost everywhere. While vaccines and other treatments have certainly lowered the infection and mortality rates, one wonders why the countries spent so many billions on Covid lockdowns in the first place, just to surrender into what could well be wave after wave of ongoing infections. 

One thing we did learn during the 'zero Covid' period was that restrictions should continue or even intensify while cases were falling. This was essential in driving cases down to a low level where social normality could resume. However, for those opposed to social controls, who consider restrictions should only be there to take pressure off the medical system, falling case numbers and hospitalisations are the perfect excuse to relax restrictions.

It is encouraging that society at large chose to put such a huge, altruistic effort into saving vulnerable people from a killer disease, but it appears that after two years, Covid fatigue has set in and the public and government's patience is exhausted. 

This leaves the elderly and those with "associated conditions" in a difficult bind. It has been long-term government policy In Australia to encourage older people to 'stay in their own homes'. With deaths and cases still at such a high level, most people at risk in the community must now choose to retreat into long-term self-managed isolation, minimising their exposure to ensure their survival. Boosters are apparently going to be required at four-month intervals in order to reduce their chances of infection, hospitalisation and death. 

Jobs

Unemployment in Australia hit a 13 year low in January and is still falling, while job advertisements are at a record high - though the new jobs are all part time or temporary. It has become increasingly difficult to find workers in low-paid occupations such as home help. Hours worked has fallen, due to high Covid-related sick leave - translating into artificially high productivity figures for those who do work.

EFFECT OF AGE AND VACCINATION ON CASES AND SEVERITY

The data available for New South Wales are very good and permit a better analysis of cases than in most jurisdictions. 

Age and cases

Data on population by age group in NSW are available from the Census, while the NSW Weekly Surveillance Report provides a great deal of other data, including confirmed cases by age for different time periods 
 
Table 1. Per cent Covid-19 cases in NSW age groups, four time periods, and percentages of population in each age group, with odds ratios (which compare infection rates).

 

Population

Confirmed cases % (sit)

Age group

% (ri)

To Jun 2021

Jul-Nov

Dec-Jan 2022

Week to Jan 29

0-19

24.5

10.6

32.9

22.2

28.5

20-39

27.4

40.7

36.7

43.2

35.7

40-59

26.1

26.3

21.3

23.7

24.3

60-69

10.7

12.1

5.1

6.4

6.6

Over 70

11.1

10.3

4.1

4.6

5.0

ODDS RATIO

 

0-19

 

0.37

1.51

0.88

1.23

20-39

 

1.82

1.54

2.02

1.47

40-59

 

1.01

0.77

0.88

0.91

60-69

 

1.15

0.45

0.57

0.59

Over 70

 

0.92

0.34

0.39

0.42

Note: The odds ratio  sit/(1-sit) / ri/(1-ri)  gives the probability of being infected in that age group (incidence)
relative to the average, for each age group i at time t.

Source: Derived from Covid-19 Weekly Surveillance Report, NSW 29 January 2022, Table 3. 

Children Until the Delta outbreak, the numbers of children infected were relatively low - the incidence of Covid-19 among under 20s was only about 40 per cent of the average. From July to November 2021 however, the incidence was about the same as 20-39 year olds, due partly to vaccination of adults and partly to the stronger Delta variant, which could penetrate defences more easily. During the school holidays, incidence fell by half, but revived quickly in late January 

Older people At first, infections with Covid-19 occurred at the average rate in all over-40s age groups, while infections were 80% higher in 20-39 year olds due to higher numbers of social contacts. 
The various strategies protecting older people were working much better by mid 2021. However, in the second half of 2021, the 40-59 year group had about half the incidence of younger groups, 60-69 year olds had 30 per cent, and over 70s only 22 per cent. The incidence among older people has crept up somewhat, but is still less than half of the comparative incidence prior to June 2021, which has helped to lower death rates. 

Vaccination 

A similar odds ratio approach may be tried to estimate the effectiveness of vaccination in reducing clinical severity. Here, matters are complicated by the increasing presence of children, very few of whom have severe reactions or are hospitalised, and most of whom have not been vaccinated. 

We are seeking to verify a press report on January 14 which states "Older people who had not received two doses were 13 times more likely to experience severe illness than those who were boosted, with more than one in 10 cases requiring intensive care or dying." Unfortunately there is something peculiar about the data presented which I am investigating with the Department (this happens very often with administrative data). 

As a beginning, we can reasonably state 
  • While the case fatality rate in 2020 was initially as high as 15%, falling to about 1% in 2021, it is now about 0.09% across all cases, 0.12% in adults, and 1.75% in over 70s. 
  • Severity for elderly While over-70s comprise 11% of the population and 4.5% of cases, they comprise 40% of the hospitalised and 80% of deaths. They are 17 times as likely to die as the average case.
  • Vaccination status At January 29, the vaccination status of various age groups was as follows.
    Vaccination status NSW Jan 29 2022, by age

    So around 60% of over 60s had a booster, but considerably fewer in younger age groups. About 60% of under-20s and 12% of 20-39-year-olds were unvaccinated, 6% of age 40-59 year-olds and 2.8% of 60-69 year olds.

    Once we resolve the data issues we will present more figures.

Comments