IATA Medical Contact Group - COVID-19, Monkeypox, other outbreaks

A few points on COVID-19:

Infection rates have been increasing globally as BA.4 and BA.5 become dominant.  BA.5 in particular shows a higher transmissibility and growth rate, with high numbers of re-infections.  These increases are now being reflected in increasing hospitalisations and deaths in certain countries including:  Brazil (highest death rates since March), USA (over 20% increase in deaths in last 2 weeks), India (deaths more than doubled in 2 weeks but absolute numbers low), and Japan (deaths up a third in last 2 weeks).   In China, Beijing and Shanghai cities both reported getting back to zero new COVID cases after battling for months, but cases flared up in the Yangtze Delta region.

The US FDA called for BA.4/.5 based boosters (bivalent BA.4/5 plus wild type), following positive immunogenicity data from Moderna and Pfizer-BioNTech BA.1 vaccines

(as mentioned earlier, Sanofi/GSK also released data on their bivalent Beta vaccine suggesting it is 72% effective against Omicron infection).

Both Paxlovid and molnupiravir have a low but appreciable rate of rebound infections (5% and 8% respectively) – these are associated with transmission risk in about 20% of cases, commonly with symptoms, but hospitalisation rates remain low.  The CDC currently say no further treatment is required for rebound but individuals should isolate for a further 5 days.

Young males have a higher risk of myocarditis following a second Moderna vaccination:  Two recent studies reported that young males aged 18-24 years old are at higher risk of developing myocarditis following second mRNA vaccination (the crude rate of 300 cases per million second doses of Moderna is the highest reported thus far, compared with 10-100 per million in previous analyses).

(Sources: BlueDot, Airfinity, Global Health Security Conference). 

Here’s a graphic on long distance airborne transmission of SARS-CoV-2, published in the BMJ: 

https://sandpit.bmj.com/site_images/2022/duvd06874.va.png - this highlights exactly the considerations which we have considered important in keeping the transmission risk on aircraft (air replacement rate, airflow direction, and behaviour on board) low.   There is also a related editorial which advocates for an “indoor air quality revolution”:   https://www.bmj.com/content/377/bmj.o1408 calling for airflow characteristics to be enhanced in the ways that are already in place in airliner cabins.

An analysis by Imperial College London estimates around 20 million lives saved by vaccination -  Watson et al: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext  - but the authors note that 2-3 times more lives could have been saved if the WHO’s vaccine delivery targets had been met. 

And on a related note, mortality from COVID-19 in low income countries is estimated to have been much greater (1.7 to 2.7 times, depending on age) in lower-income countries:  early in the COVID-19 pandemic, before vaccines were available, the fatality rate was 2.7 times higher for 20-year-olds living in lower-income countries than for young people in rich nations. 

In a study of Italian health workers diagnosed but not hospitalised with COVID-19, long COVID symptoms (self-reported) were 4x less likely in those who had received two vaccine doses, and 6x less likely in those who received three doses.   https://jamanetwork.com/journals/jama/fullarticle/2794072

There are a range of studies on this question and the estimates vary but they consistently find an apparent reduction in long COVID amongst the vaccinated.

A detailed modelling analysis of the pandemic on spread suggests that the home environment is the primary driver of transmission - Gutiérrez-Jara et al: https://www.nature.com/articles/s41598-022-14155-4

You may see an report on Twitter of COVID cases inbound to Hong Kong, showing where those people sat on the aircraft.  https://twitter.com/BDDataplan/status/1543870488631541761?s=20&t=GJ68M0UQAkbYODRKpk3YMw

It appears to show increased numbers of cases in window seats and around the mid-section of the aircraft.  While this is interesting, it is not accompanied by an analysis of which seats are most often occupied by passengers, and without this, no meaningful conclusions can be drawn.  Given that most inbound passengers would already have been infected before they boarded, their seating pattern really doesn’t reveal anything about transmission.


Other infections:

Monkeypox (MPX) – around 7000 confirmed and suspected cases have now been reported by 60 non-endemic countries, with the UK seeing a 243% in

cases over the past two weeks.  Monkeypox may be undergoing accelerated evolution according to characterisation of genome sequences, which means that containment could be difficult and total cases could surpass 140,000 by end of year if cases continue to increase at the current rate, Airfinity reports. There is also an increase in cases in previously endemic areas of Africa.  The US has activated its emergency operations unit (which was last activated for COVID-19) and launched its national vaccine strategy that aims to vaccinated 0.8 million people by the end of the year, which will likely have a large impact on infection rates in the coming months.  An ECDC report (https://monkeypoxreport.ecdc.europa.eu/) of cases in Europe notes that of the cases in the analysis, 99.5% were male, almost half were aged in their 30’s, and among the subset (about 20% of the total) with known HIV status, some 39% were HIV-positive. 

The incidence of Crimean-Congo haemorrhagic fever in Iraq is nearly 7 times higher than it was in 2021.

Dengue fever (see previous update) is rapidly spreading in Panama, which has 1,800 cases so far, and in Vietnam and the Philippines, which have 77,000 and 40,000 cases to date. Unseasonably high temperatures and humidity are suspected to be factors driving the spread of dengue. 

The Democratic Republic of Congo (DRC) has declared the end of its 14th Ebola outbreak after less than three months, the WHO said on Monday.

Finally, some of you may have seen in media a chart claimed to be from Boeing, and claiming to show that employees who retired later had been found to have reduced life expectancy.  I have consulted with senior medical personnel at Boeing, employed for decades there, who are unaware of any study to support the findings of this chart. Furthermore, a Director of Actuarial Services at Boeing is quoted in Forbes as confirming that the chart has no basis in fact, and that “our data show that the life expectancy of a Boeing retiree does not depend on the age at retirement.”    No, Delaying Retirement Won't Cause You To Die Sooner (forbes.com)

Best wishes,
David Powell

IATA Medical Advisor