Covid 19 Resources Center

COVID-19:

WHO’s Emergency Committee on COVID-19 met again, and once again advised that this is still a PHEIC. The Committee’s report is here:
https://www.who.int/news/item/12-07-2022-statement-on-the-twelfth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic.

Travel-related recommendations are essentially unchanged, calling for continued adjustment of international travel-related measures based on risk assessment, and against vaccination being obligatory for travellers.

New guidance from WHO on travel came out a few days prior, although some of the referenced data and some of the text is far from new:

https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy-Brief-Risk-based-international-travel-2021.1

https://www.who.int/publications/i/item/WHO-2019-nCoV-Risk-based-international-travel-2021.1

According to Airfinity, vaccine effectiveness against BA.4/.5 may remain similar to BA.2:

While the impact of Omicron on vaccine effectiveness is well documented, it remains unclear whether the recent BA.4/5 Omicron sub-lineages have an additional impact relative to previous sub-lineages. Preliminary data from UKHSA suggests this is not the case, with broadly equal odds of infection of BA.4/5 vs BA.2, in the vaccinated, suggesting similar effectiveness. While further analysis is required, currently there is no evidence to suggest BA.4/5 significantly further impacts the effectiveness of current vaccines.

A few points on COVID-19:

Infection rates have been increasing globally as BA.4 and BA.5 become dominant.  BA.5 in particular shows a higher transmissibility and growth rate, with high numbers of re-infections.  These increases are now being reflected in increasing hospitalisations and deaths in certain countries including:  Brazil (highest death rates since March), USA (over 20% increase in deaths in last 2 weeks), India (deaths more than doubled in 2 weeks but absolute numbers low), and Japan (deaths up a third in last 2 weeks).   In China, Beijing and Shanghai cities both reported getting back to zero new COVID cases after battling for months, but cases flared up in the Yangtze Delta region.

The US FDA called for BA.4/.5 based boosters (bivalent BA.4/5 plus wild type), following positive immunogenicity data from Moderna and Pfizer-BioNTech BA.1 vaccines

(as mentioned earlier, Sanofi/GSK also released data on their bivalent Beta vaccine suggesting it is 72% effective against Omicron infection).

A quick note, on the outcome of the emergency committee meeting on monkeypox convened by WHO under the International Health Regulations. 

The consensus recommendation of the committee, agreed to by the DG of WHO, was AGAINST declaring monkeypox to be a PHEIC.  The Committee’s deliberations are detailed here:   https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak#:~:text=The%20Committee%20recognized%20that%20monkeypox,access%20to%20essential%20supplies%20worldwide.

The committee listed a number of potential developments which it considered should prompt a re-assessment, including increased growth rate of cases in the next few weeks, involvement of vulnerable groups, increased severity/virulence, enhanced transmissibility, and immune escape. 

 The Singapore Statement on Global Health Security was agreed and released today, building on the Sydney Statement of 2019, and launched at the Singapore Global Health Security Conference: https://gh.bmj.com/content/bmjgh/7/6/e009949.full.pdf

Best wishes,
David Powell
IATA Medical Advisor

 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).