COVID-19
A summary of the COVID situation, based on various sources (Airfinity, BlueDot, YLE, WHO) follows:
Hospitalisations are increasing rapidly across Europe as a new wave takes hold going into winter (likely not only attributable to new variants). Cases and hospitalisations are forecast to increase further for at least 3 weeks. This rise in cases in Western Europe was predicted, on the basis of changing weather and behaviours (more time indoors, more crowds, fewer protections), and probably waning immunity. So far this wave is based on the dominant BA.5 strain, and not on new variants, although they may be added to the picture. The US is expected to follow Europe, as its trends have mirrored those in Europe throughout the pandemic. Notably, Israel, although neighbouring Europe, has not had a change in weather and has not experienced the same surge in cases.
This graphic is taken from “YLE-Your Local Epidemiologist” – noting that for the most part, this reflects admissions “with COVID” rather than “for COVID” but the German figures are actually the numbers of admissions where COVID-19 is the primary cause for admissions.
Based on the degree of immune evasion of the new sub-lineages, according to Airfinity, the coming European wave could be of a similar magnitude to previous Omicron waves. Cases are forecasted to reach >2500 per million in Germany over the next seven days and suggests the need for increasing booster coverage to protect the most vulnerable.
The picture regarding variants continues to become more complex. Multiple Omicron sub-lineages, including BF.7, BA.2.75(.2), BQ.1(.1) and BA.4.6 are now competing for dominance globally. In USA close to 50% of circulating cases sampled are BA.4.6. According to BlueDot, Preliminary investigation indicates that BA.2.75.2 and BQ.1.1 are the most immune evading strains identified to date – and some experts believe that BQ.1.1 is a top contender to drive an upcoming wave in Europe and North America. The strain has been detected in small proportions but is growing, with an eight-fold increase in England in the last week of August. Sequencing lags and insufficient testing provide challenges in tracking emerging variants. Initial modelling suggests a growth advantage of at least 10% per day over BA.5.
Meanwhile, the recombinant subvariant “XBB” has been detected in several locations (though in small numbers of cases); it is predicted to be the most immune-evasive variant, due to mutations escaping the majority of neutralising antibodies from those with breakthrough infections – suggesting it may outcompete both BA.2.75.2 and BQ.1.1. It is probably the reason infections in Singapore are now rapidly increasing.
OTHER OUTBREAKS
EPI-WIN webinar on influenza combined with COVID-19. The webinar will be live streamed on the EPI-WIN YouTube channel. To access previous webinars, please visit EPI-WIN website.
Regarding Ebola in Uganda: There have been over 60 cases and over 25 deaths reported in the Uganda Ebola outbreak. Reporting is currently sporadic, but both cases and deaths are expected to increase over the coming days, as they are reported retrospectively; there is also thought to be significant under-reporting. Note that some 20% of reported cases to date have been in health-care workers – some of them on the basis of inadequate infection control measures early in the outbreak. The vaccines against the Zaire strain of previous outbreaks is probably not effective against the current outbreak; vaccines for the Sudan viral strain of the current outbreak are still undergoing clinical trials.
A second case of Crimean-Congo Haemorrhagic Fever has been reported this year in South Africa despite being extremely rare in previous years. Further cases and deaths of Rift Valley Fever have been reports in Mauritania with a reported case fatality rate of 53.1%. Floods in the monsoon season in Pakistan are leading to disease outbreaks, dengue fever cases are rising fast in several provinces. Similarly neighbouring India is seeing increasing dengue cases.
Another case of Bornavirus, causing Borna Disease, is reported in Germany this year. Little is known about Bornavirus, likely transmitted by shrews, that has infected only about 20 people between 1996 and 2021. However, a second case has now been reported this year. Borna disease is associated with encephalitis (inflammation of the brain) and neurological disorders, which may be fatal.
Best wishes,
David Powell
IATA Medical Advisor