Covid 19 Resources Center

 Monkeypox:

The first WHO Emergency Committee on monkeypox met Thursday, Geneva time (https://www.who.int/news/item/23-06-2022-ihr-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox) and a statement is awaited, including advice on the question of whether this is a PHEIC (public health emergency of international concern).  I plan to forward an update after this is received. 

A good summary on monkeypox was meanwhile published in JAMA - Guarner et al: https://jamanetwork.com/journals/jama/fullarticle/2793516

A comprehensive recent WHO update on the outbreak is here: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON393

(And an earlier one from WHO is here:  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390)

And one from the ECDC (noting that the majority of the cases in non-endemic countries have been in Europe) is here: https://monkeypoxreport.ecdc.europa.eu/

Monkeypox cases continue to increase, with well over 3000 confirmed cases in over 50 non-endemic countries. Ring vaccination, in which close contacts of a case are offered a vaccination, has been adopted as a strategy to contain the outbreak, but this strategy relies on efficient diagnosis and contact tracing. Recent data from the UK highlights the challenges of implementing the strategy, with 14% vaccine uptake for community contacts and 72% of sexual contacts from a recent cluster of cases not contactable. If these difficulties are replicated in other regions, alternative vaccination strategy targeting all high-risk groups may be considered more effective.

WHO notes (in the risk assessment, see above reference) that the risk to the general public is low – and “ does not recommend that Member States adopt any  measures that interfere with international traffic for either incoming or outgoing travellers.”  In spite of that you may have seen reports of an airline crew placed in to quarantine for three weeks in Singapore after one was confirmed as a case.

An article looking at the nature of spread of the illness, and factors behind it disproportionately affecting men who have sex with men, is here from Science:

https://www.science.org/content/article/why-the-monkeypox-outbreak-is-mostly-affecting-men-who-have-sex-with-men

with an underlying modelling study from LSHTM here – Endo et al: https://www.medrxiv.org/content/10.1101/2022.06.13.22276353v1

And a further article on spread in mass gatherings (from multiple close contacts) – Sypsa et al: https://www.medrxiv.org/content/10.1101/2022.06.21.22276684v1

Some update items on COVID-19 in brief:

The US has announced that the requirement for pre-travel COVID-19 testing of inbound passengers will cease imminently; similarly, Canada will end its random COVID-19 testing of arriving passengers. 

In India: COVID-19 infections have increased by 110% (maybe attributable to the more transmissible BA.4 and BA.5 variants), however deaths reduced by ~64% in the last two weeks.   In Mexico: similarly an increase in infections (possibly due to increase in BA.2.12.1) but a reduction in deaths by 31%.   And in Austria, a slight (15%) increase in cases (probably due to BA.4 and BA.5) but decrease in deaths (44%).    In Brazil, the last two weeks saw increases in both cases (43%) and deaths (13%).   In China, there were decreases in cases in Beijing and Shanghai.  North Korea lifted its lockdown in the capital, although there were continued high numbers of fever cases.

COVID-19:

Some articles on COVID-19, mostly confirming the picture of vaccine protection which wanes but remains significant against severe infection consequences.  As time goes on the hybrid immunity (which will become the norm), from having been both vaccinated and infected, is proving to be superior to that from either pathway alone. 

On hybrid immunity vs “natural” immunity - Suryawanshi et al: https://www.nature.com/articles/s41586-022-04865-0   “Our results demonstrate that Omicron infection enhances pre-existing immunity elicited by vaccines but, on its own, may not confer broad protection against non-Omicron variants in unvaccinated individuals.” 

UK Office of National Statistics study on self-reported symptoms showed that chance of long COVID symptoms decreased after vaccination, and evidence suggested sustained improvement after a second dose – Ayoubkhani et al:  https://www.bmj.com/content/377/bmj-2021-069676However, note that there was no control group which is an important weakness of the study (as acknowledged by the authors). 

An earlier update than planned, mainly because of the concerns that some of you have expressed about monkeypox. 

Firstly regarding COVID-19:

• A rise in hospitalisations is reported in a number of countries including Canada, USA, Australia, France, and Italy.

• Indonesia now sees a sudden dramatic increases in cases;   infections have risen 55.6% over the last two weeks, but the absolute number of cases per million still remains very low.  Indonesia will drop requirements for people to mask outdoors and for vaccinated travellers to show negative pre-departure tests.

• In the USA, COVID-19 infections have increased by around 60% led by increases in the Midwest and Northeast. Inversely, deaths have declined around 50% over the last two weeks, however this number will likely rise in the coming months, given the lag in deaths behind overall disease burden.

• South Africa cases have risen 43% over the last two weeks, and then started to decline over the last 7 days. Deaths have increased dramatically by 360% over the same time period. 

• Brazil’s deaths have reduced by about 10% over the last two weeks, and in April Brazil reported 1,104 Covid deaths, the lowest number since March 2020. However, cases have increased over the last two weeks.

• Japan’s cases increased by ~24%, and deaths by around 10%, over the last two weeks. However, Japan announced it would start "test tourism" in the form of limited package tours in May as a way of gathering information prior to a full re-opening of the country.

Firstly, a request for your input please – for those of you who are airline medical advisors, would you please be able to complete a very short survey which has been compiled by Dr Rui Pombal at TAP, on your role within the airline:  https://www.surveymonkey.com/r/XH95JLG  

WHO reports that COVID-19 cases are increasing in 50 countries, despite rapidly declining rates of testing, but that so far deaths and hospitalisations are increasing much less, and remain at much lower levels than in previous waves.  Areas with low levels of vaccination remain vulnerable, and a number of concerns remain over access, especially in low-middle income countries, to vaccines and anti-viral treatments. 

EASA and ECDC have published an updated version of the Aviation Health Safety Protocol (AHSP), found at the following link: https://www.easa.europa.eu/document-library/general-publications/covid-19-aviation-health-safety-protocol

There is in particular, modified advice on mask wearing and distancing, in parallel with reduced recommendations for cleaning and dinsinfection.  You may find more information at the following link: https://www.easa.europa.eu/newsroom-and-events/press-releases/easaecdc-take-first-steps-relax-covid-19-measures-air-travel

WHO estimates, in keeping with some previous published estimates, that global COVID-19 deaths are at least 15 million to date.

 Vaccines and Variants

Recent studies indicate that vaccines remain highly effective against severe disease and death from the BA.2 Omicron subvariant, and vaccine effectiveness against BA.2 is similar to the effectiveness against BA.1.   A large study on COVID-19 vaccine safety indicated that most adverse events after receiving a COVID-19 vaccine have been non-serious. Additionally, there was found to be an overall low risk for immediate allergic reactions after a second dose of an mRNA vaccine in adults who had a reaction following their first dose (source: BlueDot).