General update on COVID-19:
The peak of COVID-19 infections in many countries in Europe may be past, but numbers are increasing in some areas of Asia. The WHO is tracking more than 100 subvariants of Omicron, including BF.7, BA.2.75(.2), BQ.1(.1) and BA.4.6 now competing for dominance globally. Two are currently winning the race: XBB and BQ.1.1. However, with changing behaviours and differences in immune histories (timing and nature of waves, vaccine and booster uptake), country-to-country comparisons are getting harder than ever. (Sources: Airfinity, YLE).
BQ.1.1 continues to predominate in Europe and North America, with a 10-15% advantage over BA.5. In Germany, there has been a rising number of ICU patients and unusually, 30% of ICU patients are on a ventilator; excess deaths are also increasing. Some German hospitals have needed assistance because of the number of staff who are off sick. In Southeast Asia, the XBB subvariant is causing a substantial infection wave, notably in Singapore with a high rate of reinfections due to waning immunity. However, only 15 people total are in the ICU (out of 6 million people) – this low number attributed to: a highly vaccinated and boosted population, and also the history of a large BA.2 wave (more closely related to XBB than BA.1 which hit the USA). This is expected to continue to lead to death rates in Singapore which are well below those of Germany and USA, despite the high case numbers. (Sources: YLE, Airfinity).
China called for "patience" with its COVID policies and warned against any "war-weariness" as local cases soared ahead of the pivotal Communist Party congress – and some large population areas continue to be locked down to control spread in pursuit of China’s continued “dynamic COVID-zero” approach (Airfinity, various).
The WHO Emergency Committee on COVID-19 had its 13th meeting last week, and recommended to the Director-General of WHO that COVID-19 is still a PHEIC for the time being, recommending as priorities surveillance, vaccination, and therapeutics with preparedness planning. The committee considered that meaningful progress with implementing these measures would create a situation compatible with terminating the PHEIC related to the COVID-19 pandemic at a future meeting. The full statement is here: https://www.who.int/news/item/18-10-2022-statement-on-the-thirteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic
Several COVID-19 articles of relevance or interest – firstly relating to vaccination:
Useful study from the Qatar group on hybrid immunity and imprinting - their conclusion supporting the notion that prior infection with an earlier variant as well as Omicron, in addition to vaccination, enhances/broadens subsequent immunity. Chemaitelly et al: https://www.nejm.org/doi/full/10.1056/NEJMc2211055
The HEROES-RECOVER study published in JAMA looked comprehensively at vaccination and infection: https://jamanetwork.com/journals/jama/fullarticle/2797418
“In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, and viral load for some comparisons, although the precision and statistical significance of specific estimates varied.”
Similarly, Effectiveness and Durability of the BNT162b2 Vaccine against Omicron Sublineages in South Africa - Collie et al: https://www.nejm.org/doi/full/10.1056/NEJMc2210093
“… boosting maintains vaccine effectiveness against severe disease caused by the current omicron sub-lineages, although the evidence of rapid waning of durability indicates the need for regular boosting as early as 4 months after the last dose.”
On booster effectiveness in UK – Agrawal et al: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01656-7/fulltext
“Older people, those with multimorbidity, and those with specific underlying health conditions remain at increased risk of COVID-19 hospitalisation and death after the initial vaccine booster and should, therefore, be prioritised for additional boosters.”
Omicron sub-lineage BA.2.75.2 exhibits extensive escape from neutralising antibodies - Sheward et al: https://www.biorxiv.org/content/10.1101/2022.09.16.508299v2.full.pdf
Omicron BA.2 breakthrough infection enhances cross-neutralization of BA.2.12.1 and BA.4/BA.5 - Muik et al: https://www.science.org/doi/10.1126/sciimmunol.ade2283
There is not yet enough evidence to recommend Omicron-specific COVID-19 vaccines over the original versions, the World Health Organization's vaccine experts said recently.
However, two new pre-print articles support their effectiveness (referenced in Nature - https://www.nature.com/articles/d41586-022-03119-3)
Alsoussi et al: https://www.biorxiv.org/content/10.1101/2022.09.22.509040v1
Kaku et al: https://www.biorxiv.org/content/10.1101/2022.09.21.508922v1
COVID-19 considerations other than vaccines:
As interesting study from Kucharski et al (LSHTM), on the effectiveness of arrival screening as a “lead indicator” of infection waves, in French Polynesia: https://www.medrxiv.org/content/10.1101/2022.10.12.22280928v1
Long COVID symptoms, from a study by a big WHO collaboration group:
https://jamanetwork.com/journals/jama/fullarticle/2797443
In the modelled estimates, 6.2% of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% for persistent fatigue with bodily pain or mood swings, 3.7% for ongoing respiratory problems, and 2.2% for cognitive problems after adjusting for health status before COVID-19. The group found that of those with symptoms at 3 months, 15% had symptoms at the one-year point.
Also on long COVID, a Danish study showed that post-acute symptoms four months after SARS-CoV-2 infection were less severe during Omicron than during Delta, and also less severe amongst those boosted – Spiliopoulos et al: https://www.medrxiv.org/content/10.1101/2022.10.12.22280990v1
Life expectancy in the US is the lowest since 25 years ago following COVID: https://jamanetwork.com/journals/jama/fullarticle/2797214
A very interesting pre-print article with a suggestion that aspects of the viral genome of SARS-CoV-2 are consistent with a synthetic origin (propagated by the seafood market), rather than natural - https://www.biorxiv.org/content/10.1101/2022.10.18.512756v1
Finally, on other outbreaks:
This year’s global outbreak of monkeypox has seen cases in more than 100 countries, and deaths have occurred outside of the virus’ endemic countries in West and Central Africa for the first time. However cases appear to now be declining in USA and Europe.
Ebola in Uganda: In total there have now been 60 confirmed and 20 probable cases, with 44 deaths, and 25 people have recovered. There are 8 infections not connected to previous concerns – and WHO is concerned that there may be more chains of transmission and more contacts than known about in the affected communities. Some areas have been subject to lockdown.
Meanwhile in DRC: On 27 September 2022, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared the end of the Ebola virus disease (EVD) outbreak in the North Kivu province, 42 days (twice the maximum incubation period for Ebola virus infections) after the burial of the last and only confirmed case.
Best wishes,
David Powell
IATA Medical Advisor