Covid 19 Resources Center

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.

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). 

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.  

Since the last update around 10 days ago, we have seen US President Biden announced his view that the pandemic was over, although adding that we are still contending with the problem of COVID-19.  At the time the US death rate was running at 400 per day, around 3-4x more than the typical average for influenza.  Others including leaders of WHO have responded saying that it is not over but the trend is in that direction.  In essence they are expressing the same observation, that we are on the journey from emergency to a more stable situation of an established virus with ongoing evolution.  The WHO Emergency Committee on COVID-19 (which considers its classification as a Public Health Emergency of International Concern) will meet again on 13 October.  

Some commentary on variants and sub-variants, drawn principally from BlueDot and Airfinity:   Variants continue to evolve and there are a number of countries, notably in Europe, seeing an upturn in case numbers and hospitalisations.  Currently, it is unclear which variant may be the predominant strain circulating over the next few months, and how effective the updated boosters may be at mitigating impacts. BA.4.6 shows some signs of outperforming BA.5 (with an additional spike protein mutation) but is considered unlikely to cause a wave of infections because of lacking certain spike mutations.  

COVID-19:

There are declining hospitalisations and deaths in Japan and South Korea now, along with most locations.  Still surging cases in Russia, and lockdowns in China to control local outbreaks.

A useful summary article from NEJM on Immunity, Variants and Boosters is here – D Barouch:  https://www.nejm.org/doi/full/10.1056/NEJMra2206573

There is an “EPI-WIN” webinar tomorrow “BA.5 What do we know about new variants?” which will be watchable afterwards on the WHO  EPI-WIN YouTube channel.

 Monkeypox:  

The first monkeypox-related death in the United States has been reported in an individual described by officials as "severely immunocompromised" according to Airfinity;  global cases have gone beyond 50,000 now.  However as noted earlier the growth in global cases appears to be on the decline.  UK HSA reported a second strain of monkeypox in the UK, in one person who recently travelled to West Africa. 

Other:

You may have seen news reports of a worrying cluster of atypical pneumonia cases connected to a healthcare facility in Argentina – there were initially nine cases (later 11) and three fatalities (see for example https://www.lemonde.fr/en/international/article/2022/09/02/mysterious-pneumonia-kills-three-in-argentina_5995580_4.html) – and there were concerns that this may be due to a novel organism. However over the weekend, four of the cases tested positive for Legionella species, which are not transmitted directly from person to person but are found in contaminated water and potting mixes.  Infection can occur from contaminated building air conditioning systems of certain types.  Full details published by the WHO are here: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON407#

Best wishes,
David Powell
IATA Medical Advisor

COVID-19

COVID numbers have been surging in both Russia and also in China (>500% increase in two weeks in China, although absolute numbers are still low).

A pre-print publication from Maryland, showing that viral shedding (measured as RNA copies) into exhaled breath aerosol was significantly greater during infections with Alpha, Delta, and Omicron than with other variants (such as the ancestral Wuhan strain, and Gamma).  For participants with Delta and Omicron, their fine aerosol contained on average five times the amount of virus that was detected in their larger, coarse aerosol. There were no statistically significant differences in rates of shedding between Alpha, Delta, and Omicron infections. (However the highest shedder, who had an Omicron infection, and shed 1000 times more viral RNA copies than the maximum observed for Delta and Alpha).   Lai et al:  https://www.medrxiv.org/content/10.1101/2022.07.27.22278121v2.full

Study of unawareness of infection:  In this study in Los Angeles of adults with evidence of seroconversion during a regional Omicron variant surge, 56% reported being unaware of any recent Omicron infection; low rates of Omicron variant infection awareness may be a key contributor to rapid transmission of the virus within communities.  Joung et al: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795246