INTERNATIONAL AIRLINE MEDICAL ASSOCIATION

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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).

Once again greetings to the MCG.

You probably will have seen that the US mask mandate on aircraft/airports/transportation is being extended 15 days from 18th April. 

Some documents of interest today:

A State Letter from ICAO relating to knowns and unknowns about the Omicron variant.

The WHO COVID-19 Emergency Committee met again, for the 11th time since the start of the COVID-19 outbreak, and again advised WHO, agreed that this remains a Public Health Emergency of International Concern.  Their report with advice to States is here (including only slight changes to the advice relating to international travel):

https://www.who.int/news/item/13-04-2022-statement-on-the-eleventh-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic and it is also discussed in the most recent WHO press briefing (at about 11:42 here https://www.who.int/emergencies/diseases/novel-coronavirus-2019). 

Deaths per capita globally from COVID are now at their lowest since the end of March 2020 (source: Ourworldindata.org).  This is even while the BA.2 subvariant is dominant in at least 50 countries. Based on what occurred in UK, it is expected that numbers of cases and hospitalisations in the US will surge over the coming weeks (source: Airfinity).  Separately, WHO has estimated that infection numbers in Africa have been close to 100 times greater than detected and reported officially.

Last week the US FDA authorised second booster for older (over 50) and immunocompromised individuals, as other jurisdictions have also done https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-second-booster-dose-two-covid-19-vaccines-older-and

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