COVID-19: WHO reports that new weekly COVID-19 cases and deaths globally have continued to decrease. There are early indications in North America of rising cases, following from Europe's recent wave. Due to immune evading variants currently circulating and the drop in temperature driving changes to behaviour, a new wave is possible. In Asia, cases continue increasing in Indonesia, but have been falling in China, Singapore and Taiwan. Note that China now has a number of cities with lockdowns imposed.
Meanwhile it is postulated that the recent European wave, which was not severe, is NOT likely to have been driven by new immune-evading sub-variants. This means that the effect of those variants may still be to come in Europe; France is predicted to become the first country to have the BQ.1.1 sub-variant dominate. Spain is currently experiencing increasing cases (up 34% in a week) and death numbers. Wastewater testing in Europe shows a mixed picture. Sources: Airfinity and various.
The COVID-19 trends in Singapore and Germany are interesting, and suggest that the global epidemiological situation can be characterized as a “variant soup” where multiple immune-evasive subvariants may co-circulate rather than one variant outcompeting another. Both countries had high booster coverage (Singapore ranking 9th, and Germany ranking 16th globally), and both had a recent summer wave, which may have helped mitigate severity. Each country has one of the two most immune-evading subvariants (XBB and BQ.1.1) in increasing proportions. This is from a BlueDot analysis.
Singapore:
- On 25 October, daily new cases were 7,218, down 15% from a week earlier. It is now speculated that the wave has peaked and will subsequently end earlier than forecast. The current wave of COVID-19 is driven by the XBB variant (54% of local cases in the first week of October).
- As of 23 October, hospital admissions were 936 (down from the peak of 1116 the previous week), ICU admissions 17 (down from peak of 23), and deaths 14 (down from 20). Average deaths remains lower than in previous waves.
- According to the Singapore Ministry of Health, 92% of the population have received two doses of a COVID-19 vaccine and 80% had received a booster shot, as of October 24, 2022. Singapore has authorised the Pfizer bivalent vaccine as well as the Moderna BA.1 subvariant-targeted vaccine, and have a vaccination campaign for children aged six months to four years old. Public health measures have been lifted in Singapore, with the country reopening to travel and tourism.
Germany:
- Germany’s seventh wave of COVID-19 has an incidence rate of cases which is high (> 350 cases per 100,000 population), with a stable or increasing trend, at the same level for the majority of days since early September. Although BA.5 is the dominant variant driving the current wave, the BQ.1.1 variant has been reported to be circulating in increasing prevalence. The increase in cases may be attributed to loosening of public health restrictions in Germany prior to October, and recent mass gatherings event such as Oktoberfest (September 17 to October 3) with minimal public health measures in place.
- Germany is currently reporting an all-time high number of new hospital admissions (17,000 weekly in mid-October) which may be due to a plateau in booster uptake and overall waning immunity. Also increasing are ICU admissions (1700 in mid October) and deaths (137 on 25 October, up 32% from the previous week).
- As of 25 October, 76% of the population had received two doses of a COVID-19 vaccine and 73.5% of the population at least one booster dose. The EU has approved three new Omicron vaccines: the Moderna BA.1 subvariant-targeted vaccine, the Pfizer-BioNTech BA.1 subvariant-targeted vaccine, and the Pfizer-BioNTech BA.4/BA.5 bivalent vaccine. On 1 October Germany implemented public health measures including masks on long-distance trains, FFP2 masks for all hospital and nursing home employees and visitors, and testing of hospital visitors and staff.
A few articles of interest:
On transmission associated with flight, an Editorial by Freedman: https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm/taac123/6775351
On relative ineffectiveness of border closures, Basseal et al: https://www.sciencedirect.com/science/article/pii/S2666606522002310
And on possible usefulness of traveller testing, Kucharski et al: https://www.medrxiv.org/content/10.1101/2022.10.12.22280928v1
Finally an article on a hybrid virus RSV and flu - https://www.nature.com/articles/s41564-022-01242-5
Ebola: The Ebola outbreak in Uganda continues to grow, putting it among the largest on record, with 121 confirmed cases and 32 confirmed deaths (up to 44 including probables) across seven affected districts (up from five last week). The cordon sanitaire (lockdown of areas with cases) was extended to three more districts. Local transmission is now occurring in the capital city of Kampala, with at least 14 reported cases in the metropolitan area, including schoolchildren - concerning, as Kampala is a large and dense city and a regional transportation hub. No cordon measures have been announced for the Kampala, but it has been recommended by the President of the Uganda Medical Association. (Source: YLE)
Monkeypox: 77,501 cases have been reported in 108 non-endemic countries to date, with 33 confirmed deaths but overall global cases appear to be declining. It is reported that most of the severe cases have been among the immunosuppressed including those with HIV disease (Source: Airfinity). A good summary article in NEJM is here if you are interested: https://www.nejm.org/doi/full/10.1056/NEJMra2208860
Wild Polio: Several cases of wild poliovirus have been reported from four of sixteen health zones in the province of Haut-Lomami in the DRC. Public health actions are being taken in order to control the spread the virus. According to media reporting, three people with symptoms of paralysis have died; it is unclear if these deaths are related to wild poliovirus infection. (Source: GPHIN)
Tuberculosis: WHO reports that the estimated number of deaths from TB increased between 2019 and 2021, reversing years of decline between 2005 and 2019. An estimated 10.6 million people fell ill with TB in 2021, an increase of 4.5% from 10.1 million in 2020. The net reduction from 2015 to 2021 was 10%, only halfway to the first milestone of the End TB Strategy.
Dengue Fever: Dengue incidence remains high in Bangladesh, Pakistan, and India following floods (source: Airfinity).
Cholera: A number of African countries (including Nigeria, Kenya, Cameroon and Malawi) are experiencing cholera outbreaks, along with some Middle Eastern countries (source: Airfinity).
Bird Flu: Cases amongst birds are at a high level as reported in Nature here: https://www.nature.com/articles/d41586-022-03322-2
Best wishes,
David Powell
IATA Medical Advisor