respiratory

Omicron sub-variant now sweeping India; The latest health stories from around the world

Lalita Panicker · Jul 19, 2022 · Leave a Comment

COVID-19 SARS-CoV-2 Coronavirus superspreaders blood test 2019-nCoV,SARS-CoV, MERS-CoV chinese infection blood test in Laboratory. COVID-19 cases concept. Illustration of first coronavirus death in India. Representation of coronavirus testing. Image credit: photovs / 123rf COVID-19 testing concept. Mutations illustration. antibodies concept. omicron — Image credit: photovs / 123rf

An Omicron sub-variant that is spreading rapidly in India and has been detected in several European countries may be more effective than other coronavirus strains at overcoming immunity provided by prior infection and vaccines. BA.2.75, which has been nicknamed Centaurus, appeared to have mutated in a way that could indicate “major immune escape”, said the World Health Organization (WHO)’s chief scientist Soumya Swaminathan, adding that it showed a “clear growth advantage” over other variants in India.
https://www.ft.com/content/e45c2b0d-5c7f-4ae4-ac26-64cf8819b58a

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City authorities in Beijing announced China’s first large-scale COVID-19 vaccine mandate on 6 July, only to scrap the plan a day later after social media posts questioned the measure’s legality and the vaccines’ effectiveness.

www.science.org/content/article/news-glance-beijing-s-vaccine-flip-eu-energy-flap-and-marburg-virus-west-africa

The mandate called for those entering libraries, museums, movie theatres, gyms, and other public facilities to show proof of COVID-19 vaccination, a policy enacted by many countries during the pandemic. Instead, Beijing reverted to requiring proof of a negative COVID-19 test taken in the previous 72 hours and a temperature check to visit facilities that attract crowds. Roughly 90% of China’s population has got vaccinated voluntarily, but only half of those older than 80 were vaccinated as of March, the last time national details were released.

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With an United States (US) Federal Drug Agency (FDA) authorization for Novavax’s Nuvaxovid, Serum Institute of India (SII) has scored the go-ahead to finally supply a COVID-19 vaccine to the United States (US). Wednesday’s emergency use authorization for Novavax’s recombinant protein-based vaccine means SII is able to supply the shot, also known as Covovax, to the US from India. The Novavax green light now makes SII the first Indian drugmaker to produce a COVID shot for the US market.

https://www.fiercepharma.com/manufacturing/astrazeneca-novavax-serum-institute-wins-fda-nod-supply-new-covid-shot-us-india

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A study of COVID-19 patients in the United Kingdom has found that loss of taste and smell were no longer among the most telling symptoms of the virus.

www.medscape.com/viewarticle/977322?src=wnl_edit_tpal&uac=398271FG&impID=4433963&faf=1

The recent survey of about 17,500 patients who were asked about their symptoms found that 58% reported a sore throat, 49% a headache, 40% a blocked nose, 40% a cough with no phlegm, and 40% a runny nose, the BBC reported. Loss of smell was ranked 20th among reported symptoms.

During the early days of the pandemic, loss of smell and taste were among the most distinct symptoms of COVID infection.
The symptoms may have changed because the coronavirus has mutated since the start of the pandemic, according to the study. The BA.4 and BA.5 variants now dominate COVID cases in the United Kingdom and many other nations.

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The European Union’s population shrank for a second year running last year, the bloc’s statistics office said last Monday. According to Eurostat, the population of the 27 countries that make up the bloc fell by close to 172,000 from the previous year and over 656,000 from January 2020.

www.medscape.com/viewarticle/976885?src=wnl_edit_tpal&uac=398271FG&impID=4420080&faf=1

“In 2020 and 2021 the positive net migration no longer compensated for the negative natural change in the EU and, as a consequence, the EU total population has been decreasing,” it said, pointing to impacts from the pandemic.
The number of deaths began outstripping births in the EU a decade ago, but immigration from outside the bloc helped offset the gap until the first year of the pandemic.

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Global childhood vaccination rates experienced the largest decline in about three decades amid COVID disruptions, putting a growing number of children at risk from devastating but preventable diseases. The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3) was set back to its lowest level since 2008, falling to 81% in 2021, according to official data published by the WHO and United Nations Children’s Fund on Friday. The decline means 25 million children missed out on at least one dose of DTP through routine services in 2021 alone, two million more than in 2020 and six million more than in 2019.

https://www.bloomberg.com/news/articles/2022-07-15/covid-fuels-worst-decline-in-childhood-vaccinations-in-30-years

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Soaring demand for the monkeypox vaccine caused the appointment system to crash in New York City, one of many places where supplies have been running out almost as soon as they arrive.

www.medscape.com/viewarticle/977135?src=wnl_edit_tpal&uac=398271FG&impID=4427270&faf=1

Infections now exceed 1,000 from the growing outbreak in the US Vaccine shortages have added to anxiety around the virus. Health officials say anyone can get monkeypox, but most cases in the US have been men who have sex with men. Scientists warn that anyone who is in close physical contact with someone who has monkeypox or their clothing or bedsheets is at risk of infection, regardless of their sexual orientation.
There is an antiviral treatment, tecovirimat (TPOXX), but it’s only available from the US Strategic National Stockpile at the moment. The US FDA approved tecovirimat to treat smallpox in 2018 over concerns that it might be used as a bioterrorism weapon someday.
Local health departments are working with the Centers for Disease Control & Prevention (CDC) and the US Department of Health and Human Services to request tecovirimat through a complicated, 120-page protocol. At the same time, monkeypox cases have risen to more than 11,000 worldwide, according to the CDC.

“If this is a trial run post-COVID to see if we are better, I don’t think it is going that well,” Amesh Adalja, MD, a senior scholar at the Johns Hopkins Bloomberg School of Public Health’s Centre for Health Security in Baltimore, said in an interview.
The slow response to growing monkeypox cases is even more puzzling, Adalja says, because we already had all the tools needed to contain the spread. “This should have been a home run after COVID-19: A not very transmissible disease for which we have off-the-shelf vaccines, off-the-shelf antivirals, and diagnostic tests that already existed,” he said.

www.medscape.com/viewarticle/977319?src=wnl_edit_tpal&uac=398271FG&impID=4433963&faf=1

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Meanwhile, as monkeypox cases in the US climb and the preferred vaccine remains in short supply, the CDC is pushing back against calls to provide people with a single shot of the vaccine, rather than the recommended two doses.

www.medscape.com/viewarticle/977330?src=wnl_edit_tpal&uac=398271FG&impID=4433963&faf=1

This strategy would extend the supply of the highly in demand JYNNEOS vaccine and hypothetically curb the spread by giving a greater number of people immunity against the virus in less time. This may seem logical, especially inasmuch as cases are expected to continue rising in the coming weeks; however, a single dose does not provide enough protection against the virus, officials said during a July 15 press call, and thus the strategy could risk further infections and spread of the virus.

The JYNNEOS vaccine is administered in two doses that are delivered 28 days apart. People typically have maximum immunity against monkeypox 2 weeks after receiving the second dose. As of July 14, 1,470 cases of monkeypox had been reported in the US. Of 700 cases for which demographic information was available, the median age of the patients was 36. The majority of cases have been in men who have sex with men.

US Federal officials announced that an additional 130,000 doses of JYNNEOS had arrived at the strategic national stockpile. These will be delivered to states as early as Monday, July 18. States can also request the ACAM 2000 vaccine, which is approved for protection against smallpox but can also protect against monkeypox. But this vaccine has more side effects and cannot be given to people with heart disease or those who are immunocompromised.

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The first known lab-confirmed case of monkeypox in India has been reported from the southern state of Kerala in a 35-year-old male who reached the state capital last week from the UAE.

www.thehindu.com/sci-tech/health/kerala-reports-indias-first-confirmed-monkeypox-case/article65640571.ece?

Kerala’s health minister Veena George, said that the National Institute of Virology, Pune had confirmed the disease.
The person has been isolated for treatment at the Thiruvananthapuram Government Medical College Hospital (MCH). His condition was stable.

He himself volunteered the information that a close contact of his in the UAE had been confirmed as having contracted monkeypox. He was referred to the MCH here.

His close contacts — father and mother — have also been isolated at the same hospital. Ms. George said a few other persons who might qualify as contacts — the driver who took the person from the airport to his home, the driver of the autorickshaw in which he travelled to a private hospital first, the healthcare personnel who attended to him at the first hospital as well as 11 persons who had occupied the seats near him on his flight from the UAE — have all been informed about the new development . They will also have to go into isolation and monitoring for the next 21 days.

There’s been an upswing in COVID-19 cases in the state for the past one month and mask mandates are in place with health workers also using PPE kits before attending to patients, thus minimising the risk of spread, Ms. George said.

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Two people infected with the Marburg virus have died in Ghana, the first ever detected cases of the deadly haemorrhagic fever in the country, health authorities report. Tissue samples collected from the people, in the Ashanti region in the south, have been sent to the Pasteur Institute in Senegal for confirmation, the WHO announced last week. Marburg is closely related to the Ebola virus, but outbreaks are rarer and typically smaller; the biggest one, in Angola in 2004–05, ended after 252 cases. There are no approved vaccines or treatments. It is only the second time a Marburg infection has been detected in West Africa. A single case was confirmed in Guinea in 2021, but no further cases were found and the outbreak was declared over after 5 weeks.

www.science.org/content/article/news-glance-beijing-s-vaccine-flip-eu-energy-flap-and-marburg-virus-west-africa

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Lalita Panicker is Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi

New COVID-19 variant emerges; the latest health stories from around the world

Lalita Panicker · Dec 21, 2021 · Leave a Comment

As we stagger towards 2022, the words of that old Carpenters’ song come back suddenly: “Its yesterday once more!” Unlike that song, this is a nightmare, not nostalgia. COVID-19 devastated the world back in 2020 when vaccines were a faint glimmer at the end of a seemingly endless tunnel. The vaccines arrived at the threshold of 2021, slowing down the pace and impact of the disease considerably. Now at the doorstep of 2022 its almost as if the vaccines didn’t exist thanks to COVID-19’s new avatar, the ancient “Greek variant” Omicron, sidestepping the jab and ignoring past bouts with the virus. It’s 2020 once more!

The Omicron variant of the coronavirus is spreading faster than the Delta variant and is causing infections in people already vaccinated or who have recovered from the COVID-19 disease, the head of the World Health Organization (WHO) said on Monday.

WHO chief scientist Soumya Swaminathan added it would be “unwise” to conclude from early evidence that Omicron was a milder variant that previous ones.

Less than a month after it was identified, Omicron has spread twice as fast in South Africa as the highly infectious Delta variant. In Britain, where nearly 70% of the population is fully vaccinated, officials have estimated that 200,000 people are becoming infected every day.

In Denmark, Omicron cases are doubling roughly every two days. Early data from the United States suggest that around 120,000 new Covid cases are being reported every day, a 40 percent increase from two weeks ago.

Breakthrough infections are common. This week, Denmark reported that three-quarters of its Omicron cases occurred in people who had received two vaccine doses.

A growing body of preliminary research suggests the Covid vaccines used in most of the world offer almost no defence against becoming infected by the highly contagious Omicron variant, according to a New York Times report (www.nytimes.com/2021/12/19/health/omicron-vaccines-efficacy.html)

All vaccines still seem to provide a significant degree of protection against serious illness from Omicron, which is the most crucial goal. But only the Pfizer and Moderna shots, when reinforced by a booster, appear to have initial success at stopping infections, and these vaccines are unavailable in most of the world.

The other shots — including those from AstraZeneca, Johnson & Johnson and vaccines manufactured in China and Russia — do little to nothing to stop the spread of Omicron, early research shows. And because most countries have built their inoculation programs around these vaccines, the gap could have a profound impact on the course of the pandemic.

If Omicron spreads rapidly and infects huge swathes of the population at once, it could still affect enough people to overwhelm health care systems, some of which are already struggling to manage a surge of Delta cases.

Despite very high vaccination rates, Denmark with 5 million people is now seeing more than 6,000 cases a day, roughly twice the number seen during the highest previous peak. Neighbouring Norway, which has about the same population, is now projecting more than 100,000 cases a day in a matter of weeks, unless people drastically reduce social contacts.

Omicron has been reported in 89 countries so far, and is spreading very fast, the World Health Organization said on Saturday. The number of cases is doubling in 1.5-3 days.

Cases have been spreading like “lightning” across Europe, in the words of the French Prime Minister, prompting governments to tighten travel restrictions and impose new curfews, causing frustration and triggering protests in places.

In India where over 100 cases of Omicron have been reported across 11 States, vaccination rates are behind target, and mask usage has drastically declined. While 87% of the adult population have got one dose of a COVID-19 vaccine, only 56% have got both. With less than two weeks left for the year to end, the Indian government is far from achieving its target of vaccinating the entire adult population by year-end.

In just a couple of weeks Omicron has become the predominant variant in several countries, including Britain, Denmark, Norway and parts of southern Africa, according to The Economist (www.economist.com/science-and-technology/2021/12/17/what-the-spread-of-omicron-means-for-the-world?). A spread this rapid leaves no doubt that Omicron will soon replace Delta, the variant that currently causes most COVID cases globally. Scientists from Imperial College in London explained what this means for the world in a pair of studies published on December 16th.

The first study rounded up data on Omicron’s spread in Britain. It found that each infection tends to produce at least three more. That is similar to the speed at which covid was spreading in Europe in the pandemic’s first wave in early 2020, before vaccines were available or countermeasures imposed. At this rate, cases are doubling every two days.

The researchers found that in Britain a two-dose course of the Pfizer or AstraZeneca vaccine was, at most, 20% effective against infection by Omicron. Having had covid in the past was also of little help, conferring only 19% protection—far less than the 85% against Delta found in other studies.

Boosters, however, can make a big difference. A third jab using Pfizer’s vaccine after an initial course of the AstraZeneca or Pfizer jab was between 55% and 80% effective against infection by Omicron. These results were the basis of the second study by the Imperial College team and their colleagues at several other institutes. In that study, they estimated how the layers of immunity in various countries—from previous COVID waves and vaccination—will stand up to Omicron. That analysis relies on estimates as to how protective the jabs might be against severe disease and how protection from boosters might wane over time. These estimates come with a lot of uncertainty because, for now, they are derived from data on how levels of antibodies in the blood correlate with protection from covid. The researchers reckon that after 60 days, boosters may be 80-86% effective against severe covid (and need for hospital admission) in an Omicron wave. That is encouragingly high but lower than the 97% efficacy for Delta. The researchers then used the data on Omicron’s transmission and national immunological profiles to estimate the number of cases and hospital admissions that countries might expect when Omicron spreads. They conclude that Omicron is likely to stretch hospitals in all countries, with peak deaths and hospital admissions similar to those in previous waves, if no restrictions to slow down its spread are put in place. This conclusion stands even if the severity of disease caused by Omicron is one-third the severity of Delta.

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A vaccine with a unique composition and production method worked in a large COVID-19 efficacy trial, its sponsor, Canada-based biotech company Medicago, announced in a press release last week. According to science.org (www.science.org/content/article/news-glance-bold-antitobacco-plan-updated-arctic-warming-rates-and-covid-19-infection-lab), the vaccine consists of SARS-CoV-2 spike proteins that self-assemble into virus like particles (VLPs). Already used in vaccines against human papillomavirus and hepatitis B, VLPs in theory stimulate robust immune responses because of the orderly way they pack many copies of the viral proteins into a particle that resembles a virus.

The vaccine had 71% efficacy against symptomatic disease in a 24,000-person trial in six countries, where many variants were circulating—although not Omicron. The company is now seeking authorisation in Canada and, pending success there, plans to submit data to U.S. and European regulators.

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New Zealand takes on tobacco

The government of New Zealand last week released an unprecedented proposal to outlaw sales of tobacco products to those turning 14, a prohibition that would last their lifetimes and gradually end sales entirely. The country’s Smokefree 2025 Action Plan would also make it the first in the world to only allow sales of low-nicotine smoked tobacco products. Authorities decided on bold action after modelling showed a diminishing effect of existing strategies, including high taxes and bans on public smoking. Parliamentary approval is expected next year, with the measures likely taking effect in 2023.

Doctors and other health experts in the country have welcomed the “world-leading” reforms, which will reduce access to tobacco and restrict nicotine levels in cigarettes.

However the crackdown has been met with mixed reactions with some warning that the move may create a black market for tobacco— something the health ministry’s official impact statement does acknowledge, noting “customs will need more resource to enforce border control”.

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A Taiwanese researcher contracted SARS-CoV-2 while working with infected mice in a biosafety level 3 laboratory at the Genomics Research Center of Academia Sinica in Taipei, in the first known case of laboratory transmission of the virus. Authorities suspect the vaccinated researcher was infected via a mouse bite. The genomic sequence of the variant infecting the researcher matched that of the lab’s mice and not strains in the surrounding community, Taiwan’s Central Epidemic Command Center reported on 11 December. More than 800 potential contacts have tested negative, and Academia Sinica has promised an investigation and a review of the lab’s safety procedures. The incident is likely to bolster claims that a lab leak could have sparked the pandemic.

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Late last month, India’s National Family Health Survey (NFHS), a periodic investigation of half a million households, announced a milestone: The country’s fertility rate had for the first time fallen below the widely accepted “replacement level” of 2.1 children per woman. Indian health officials say the task of defusing their population bomb is finally done.

However, according to science.org (www.science.org/content/article/india-defuses-its-population-bomb-fertility-falls-two-children-woman), India’s population growth is not over yet, however. Thanks to past high fertility rates, two-thirds of the population is under 35 years old, and a large cohort of people is now entering childbearing age. Even at replacement fertility rates, the children of these young people will continue to push up numbers, and India may exceed China as the world’s most populous nation as early as next year.

Still, India’s population is set to decline in about 3 decades, putting the country on the same track as a growing number of developing nations, such as its neighbour Bangladesh and Indonesia. India remains well behind China in falling fertility. In China, where the population may be at its peak, official figures put the fertility rate at 1.7 children per woman.

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Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi

Pandemic preparedness: better late than never

Lalita Panicker · Sep 16, 2021 · Leave a Comment

Billion-dollar plan

Almost as if to make up for the lost Trump year during the pandemic, the White House has put together an ambitious new plan with a $65.3 billion price tag that could transform the way the United States responds to pandemics by vastly accelerating vaccine development, testing, and production. But is the plan big enough?

A mortuary stretcher left sat outside a mobile mortuary vehicle

Announced on 03 September, the scheme hopes to launch with $15 billion set aside in a budget reconciliation bill now before Congress (but not certain to pass). It asks Congress to provide the rest of the funding over the next decade. It calls for an Apollo-like “mission control” centre to coordinate the many branches of government already involved with pandemic preparedness. Nearly 40% of the money would go towards vaccines, followed by just under 20% for treatments. The rest will support new diagnostics, early warning systems, improved public health and biosafety measures, and global health efforts.

Combining science with security, the 27-page plan has been signed by Eric S. Lander, Assistant to the President for Science and Tech and Jacob J. Sullivan, Assistant to the President for National Security Affairs. The security angle obviously comes into play because of lurking suspicions that anything of biological origin can be manufactured in laboratories for nefarious purposes.

(American Pandemic Preparedness: Transforming Our Capabilities)

Almost military-like in approach, the proposal envisages work organized across five pillars

Transforming medical defences
Ensuring situational awareness
Strengthening public health systems
Building core capabilities
Managing the mission

For vaccines, it calls for more research on 26 families of viruses known to infect humans. It will also lay the groundwork to develop, test, and approve vaccines against new emerging pathogens within 100 days—three times faster than COVID-19 shots—and produce enough vaccine for the United States within 130 days and for the world by 200 days. Vaccine-makers will be funded to maintain excess production capacity at their existing plants.

A clinical trials network will be at the ready, set up to enrol 100,000 participants within a few weeks, which will lead to answers more quickly than the 30,000-person studies staged for existing COVID-19 vaccines. New technologies such as skin patches or nasal sprays would simplify providing vaccines, and more effort will be made to develop animal models for all potential viral families.

The plan stresses that the cost of the COVID-19 pandemic to the United States alone has been an estimated $16 trillion, which makes $65.3 billion seem like bus fare.

The current pandemic has illustrated the seriousness of biological threats. As of mid-August 2021, COVID-19 has killed over 4.3 million globally, with excess mortality estimates suggesting a death toll exceeding 10 million. In the United States, the number of deaths directly attributed to COVID-19 has surpassed 623,000.

As devastating as the COVID-19 pandemic is, there is a reasonable likelihood that another serious pandemic will occur soon—possibly within the next decade—and maybe worse than COVID-19.

SARS-CoV-2, the virus responsible for COVID-19 disease, was relatively mild in certain respects. It is far less lethal than the 1918 influenza virus. It also belongs to a well-understood family: coronaviruses. It was possible to design vaccines within days of ascertaining the virus’s genetic code because nearly 20 years of federally-funded fundamental scientific research, spurred by the emergence of SARS and MERS had provided detailed knowledge about coronaviruses. Unfortunately, most of the 26 families of viruses that infect humans are less well understood or harder to control than coronaviruses. The plan document goes on to say: “While there are important lessons to be learned from COVID-19, we must not fall into the trap of preparing for yesterday’s war.”

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Covax – unprecedented achievements but not quite enough

The haves vs have-nots saga continues apace on the availability and distribution of COVID-19 vaccines for poorer countries with the rich ones being accused of hogging the show. The major bone of contention for the last couple of months has been booster vaccine doses being given or contemplated by the developed world for people who have already had two doses at least 8 months ago.

COVAX logo with the four alliance members

Meanwhile, a year after it was launched, the COVAX scheme has not yet reached its target of protecting at least 20% of the adult population in the less privileged world. It’s a year since the innovative scheme was born. “ Yet, the global picture of access to Covid-19 vaccines is unacceptable,” according to a UN statement released on 08 September. https://news.un.org/en/story/2021/09/1099422

“In the critical months during which COVAX was created, signed on participants, pooled demand, and raised enough money to make advance purchases of vaccines, much of the early global supply had already been bought by wealthy nations,” the statement went on to say, adding that “COVAX’s ability to protect the most vulnerable people in the world continues to be hampered by export bans, the prioritisation of bilateral deals by manufacturers and countries, ongoing challenges in scaling up production by some key producers, and delays in filing for regulatory approval.” 

It’s not that COVAX has been standing still and doing nothing. It has risen to the challenge of organising the most complex vaccine rollout in human history: “…more than $10 billion has been raised; legally-binding commitments for up to 4.5 billion doses of vaccine (secured); 240 million doses have been delivered to 139 countries in just six months”, said the UN statement. 

But according to its latest Supply Forecast, COVAX expects to have access to around 1.2 billion doses of vaccine for lower-income economies in 2021.  This is enough to protect 20% of the population, or 40% of all adults, in all 92 AMC economies, with the exception of India. However, the key milestone of two billion doses released for delivery is now expected to be reached only in the first quarter of 2022, late by several months. COVAX is now calling on donors and manufacturers to “prevent further delays to equitable access”, by ensuring that the following basic steps take place: 

That where countries are ahead of COVAX in manufacturer queues, and already have achieved high coverage, those nations give up their place in the queue to COVAX. 
That nations “expand, accelerate, and systematize dose donations from countries that are already well advanced in their vaccination programmes”, ensuring that doses are available in larger and more predictable volumes, with longer shelf lives – reducing the burden on countries trying to prepare for deliveries.

In a news briefing in Geneva, WHO Director-General, Tedros Adhanom Ghebreyesus, reminded journalists of his call, a month ago, for a global moratorium on booster doses, at least until the end of September, in order to prioritise the vaccination of the most at-risk people around the world who are yet to receive their first dose. 

“There has been little change in the global situation since then, so today I am calling for an extension of the moratorium until at least the end of the year, to enable every country to vaccinate at least 40 percent of its population,” he explained.   

Rich countries with large supplies of coronavirus vaccines should refrain from offering booster shots through the end of the year and make the doses available for poorer countries, Dr Tedros said last week, doubling down on an earlier appeal for a “moratorium” on boosters that have largely been ignored. https://globalhealthnow.us14.list-manage.com/track/click?u=eb20503b111da8623142751ea&id=0d29081ba0&e=5504a12b0d

The WHO chief who has so far remained silent on seeking a second and last term, also said he was “appalled” after hearing comments from a top association of pharmaceutical manufacturers that there are enough vaccine supplies to allow for both booster shots for people in well-supplied countries and first jabs in poorer countries that face shortages. The deadline for the declaration of candidature for the WHO DG’s position ends this month. Tedros has failed to explain why he was so “appalled”.