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India stalls global COVID-19 death toll estimates; the latest health stories from around the world

April 19, 2022 By Lalita Panicker Leave a Comment

pandemic preparation waving colorful national flag of india on a gray background with text coronavirus covid-19 . concept.. COVID-19 cases in India illustration. Indian COVID-19 cases concept. Cases of COVID-19 crisis in India concept. Image credit: luzitanija / 123rf. Used to illustrate one million deaths due to the pandemic. covid-19 vaccine supplies in india, oxygen shortage. Long COVID concept. Omicron
Image credit: luzitanija / 123rf

India is stalling an ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic. Like some other such efforts (less authoritative perhaps) before it, the WHO study has found that vastly more people died than previously believed — a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually. (www.nytimes.com/2022/04/16/health/global-covid-deaths-who-india.html)

But the release of the staggering estimate — the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the pandemic to date — has been delayed for months because of objections from India, which disputes the calculation of how many of its citizens died and has tried to keep it from becoming public.

More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count of about 520,000. The WHO will show the country’s toll is at least four million, according to people familiar with the numbers who were not authorized to disclose them, which would give India the highest tally in the world, they said. The Times was unable to learn the estimates for other countries.

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Global COVID-19 cases surpassed 500 million on Thursday, according to a Reuters tally, as the highly contagious BA.2 sub-variant of Omicron surges in many countries in Europe and Asia. (www.reuters.com/business/healthcare-pharmaceuticals/worldwide-covid-cases-surpass-500-mln-omicron-variant-ba2-surges-2022-04-14/)

The rise of BA.2 has been blamed for recent surges in China as well as record infections in Europe. It has been called the “stealth variant” because it is slightly harder to track than others. read more

South Korea leads the world in the daily average number of new cases, reporting more than 182,000 new infections a day and accounting for one in every four infections globally, according to a Reuters analysis.

New cases are rising in 20 out of more than 240 countries and territories tracked, including Taiwan, Thailand and Bhutan.

Shanghai is fighting China’s worst COVID-19 outbreak since the virus first emerged in Wuhan in late 2019, with almost 25,000 new local cases reported, although the city’s quarantine policy is criticized for separating children from parents and putting asymptomatic cases among those with symptoms. read more

Some European countries are now seeing a slower uptick in new cases, or even a decline, but the region is still reporting over 1 million cases about every two days, according to the Reuters tally.

In Germany, the seven-day average of new infections has fallen and is now at 59% of its previous peak in late March. New cases are also falling in the United Kingdom and Italy, while they are holding steady in France.

Overall, COVID-19 cases in the United States have dropped sharply after hitting record levels in January, but the resurgence of cases in parts of Asia and Europe has raised concerns that another wave could follow in the United States.

The US national public health agency said on Monday the BA.2 sub-variant of Omicron was estimated to account for nearly three of every four coronavirus variants in the country. read more

The BA.2 variant now makes up about 86% of all sequenced cases globally, according to the WHO. It is known to be more transmissible than the BA.1 and BA.1.1 Omicron sub-variants. Evidence so far, though, suggests BA.2 is no more likely to cause severe disease.

Scientists continue to emphasize vaccines are critical for avoiding the devastation the virus can cause.

Roughly 64.8% of the world population has received at least one dose of a COVID vaccine, although only 14.8% of people in low-income countries have received at least one dose.

While cases have flared in Europe and Asia recently, the US still has the highest total COVID infections since the start of the pandemic with 80.41 million, followed by India with 43.04 million and Brazil with 30.14 million.

Since 2020, about 37% of the world’s COVID cases have been in Europe, 21% in Asia and 17% in North America.

About 6.5 million people have lost their lives to COVID since the pandemic began. The US has reported the highest number of deaths, followed by Russia, Brazil and India.

Russia overtook Brazil to have the world’s second-highest death toll from COVID-19, data from Russia’s state statistics service and Reuters calculations showed on Thursday.

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The U.S Food & Drug Administration has given its authorisation for the first Covid-19 breath test. The device, known as the InspectIR Covid-19 Breathalyzer, was granted emergency use authorization Friday and can give results in less than three minutes. It is about the size of a piece of carry-on luggage and can be used in medical offices and mobile testing sites, the FDA said. The system works by separating and identifying chemical mixtures to detect five compounds associated with the virus. A study of the InspectIR Breathalyzer found it accurately identified more than 91% of positive samples and nearly 100% of negative samples.

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www.npr.org/sections/goatsandsoda/2022/04/14/1092812456/two-new-omicron-variants-are-spreading-in-n-y-and-elsewhere-heres-what-we-know?

On Wednesday, health officials in New York said that two new omicron variants are spreading rapidly in the state. The variants appear to be causing a small surge in cases in central New York state, the department of health said.

Known as BA.2.12 and BA.2.12.1, the variants are closely related to the BA.2 variant – a version of omicron that has caused surges across Europe and is now dominant across the US.

Together the two new variants now comprise 90% of cases in central New York.

But one of them, BA.2.12.1, contains a mutation that appears to give the variant an advantage, computational biologist Cornelius Roemer wrote on Twitter. The mutation resides on the part of the virus that binds to human cells. And in previous variants, this mutation has helped the virus infect cells, studies have found. The BA.2.12. variant appears to have a growth advantage of about 30% to 90% per week over BA.2, Roemer estimates.

But it’s early days for this virus. Scientists have detected this variant in six countries, including Canada, the United Kingdom, Australia, Israel and Luxembourg, but the vast majority of cases are in the US Those are localised primarily to central New York.

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Scientists in more than 20 countries, on every continent save Antarctica, have started to gather data for the largest ever vaccine safety project. (www.science.org/content/article/pandemic-propels-global-effort-study-rare-vaccine-side-effects)

Members of the effort, called the Global Vaccine Data Network (GVDN), fruitlessly sought funding after conceiving the project more than 10 years ago. But the mass vaccinations during the COVID-19 pandemic breathed new life into the project. With the ability to draw on data from more than 250 million people, the network will investigate rare complications linked to COVID-19 vaccines in hopes of improving prediction, treatment, and potentially prevention of these side effects.

Doing this research comes with steep scientific hurdles, among them the rarity of serious problems. The largest vaccine studies have included about 1 million people, and even that can be too small to nail down side effects. “If you had something that happened normally to one in 100,000 people, and you wanted to see if the vaccine doubled the risk, you’d need a study with about 4 million people,” says Helen Petousis-Harris, a vaccinologist at the University of Auckland who jointly heads GVDN with Steven Black, a paediatric infectious disease specialist formerly at Cincinnati Children’s Hospital.

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A single dose of vaccine against human papillomavirus (HPV) protects children and teens against later incidence of cervical cancer as well as two doses do, a WHO panel said this week—a finding that could allow health workers to stretch vaccine supplies and boost the number of people inoculated. (www.science.org/content/article/news-glance-second-boosters-climate-protests-and-elusive-woodpecker?)

In 2019, only 15% of girls worldwide had received two doses. Boys also receive the vaccine because HPV is linked to other kinds of cancers, but girls should receive priority, WHO’s Strategic Advisory Group of Experts on Immunization said. Sexually transmitted HPV causes more than 95% of cervical cancer, the fourth most common type of cancer in women globally; 90% of these women live in low- and middle-income countries.

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

Food supplies run low in Shanghai COVID-19 lockdown; the latest health stories from around the world

April 12, 2022 By Lalita Panicker Leave a Comment

A citywide COVID-19 lockdown in China’s financial capital of Shanghai has disrupted food supplies badly, causing a wave of anxiety as residents ration dwindling stores of vegetables and staples. COVID-test requirements for truckers entering Shanghai have caused delays in the delivery of foods and other commodities. Within the city, many food delivery workers have been confined to their homes or choose not to work for fear of catching the virus, leaving fewer people to distribute food once it makes it into the city. Local authorities have banned private deliveries because they fear infected drivers might spread the virus in her residential compound.

https://www.wsj.com/articles/shanghai-in-lockdown-struggles-to-feed-itself-11649353336

Shanghai is transforming conference centres and conscripting neighbouring provinces to create isolation facilities for hundreds of thousands of people, a sign of its commitment to a zero-tolerance approach to COVID-19 amid China’s worst outbreak to date. The Chinese financial hub is adding tens of thousands of beds to what are already some of the world’s biggest isolation sites as it sticks to a policy of quarantining all those positive for the virus, regardless of severity, plus everyone they interacted with while infected. Nearly 150,000 people have been identified as close contacts and put into isolation. More than 100,000 others are considered secondary contacts and are being monitored, according to the government. It’s a strategy that grew out of the original outbreak in Wuhan, which China successfully quelled, but is proving more challenging to maintain in the face of ongoing outbreaks and more transmissible variants.

https://www.bloomberg.com/news/articles/2022-04-07/shanghai-racing-to-build-hundreds-of-thousands-of-isolation-beds

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India’s first case of Coronavirus variant XE was reported in Mumbai last week. One case of the Kappa variant has also been detected. The patients with the new variants of the virus don’t have any severe symptoms so far (www.reuters.com/business/healthcare-pharmaceuticals/india-reports-first-case-Covid-variant-xe-report-2022-04-06/)

The new mutant may be more transmissible than any strain of Covid-19, the World Health Organization (WHO) had said earlier this month. The Indian government, however, disagreed, saying the present evidence does not suggest that it is XE variant.

The Mumbai patient is a 50-year-old costume designer who returned from South Africa in February. She tested positive for COVID on March 2.

The new strain was detected in the United Kingdom at the start of the new year. Britain’s health agency said on April 3 that XE was first detected on January 19 and 637 cases of the new variant have been reported in the country so far.

XE is a “recombinant” which is a mutation of the BA1 and BA.2 Omicron strains. Recombinant mutations emerge when a patient is infected by multiple variants of COVID. The variants mix up their genetic material during replication and form a new mutation, UK experts said in a paper published in British Medical Journal.

The WHO had said that the new mutation XE appears to be 10 per cent more transmissible than the BA.2 sub-variant of Omicron.

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The WHO last week suspended shipments through UN channels of a COVID-19 vaccine made in India after an inspection revealed manufacturing deficiencies. (www.science.org/content/article/news-glance-sobering-climate-alert-research-beagles-and-fast-radio-bursts)

WHO said Bharat Biotech, maker of the Covaxin vaccine, which uses an inactivated virus, promised to stop exporting it to any customer until the firm addresses the problems. But the company said it will continue to sell doses from the plant for use in India. The country is the largest consumer of Covaxin, with 308 million doses administered so far. India’s drug regulatory body, the Central Drugs Standard Control Organization, has not taken regulatory action or commented on WHO’s move. WHO’s action is significant because it authorized Covaxin’s use in November 2021, and several low-income countries have also authorized it; the vaccine is easier for them to distribute than messenger RNA vaccines because it does not need to be stored at low temperatures.

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An online advertisement created by political scientists and economists that featured former President Donald Trump recommending COVID-19 shots led to increased uptake of the vaccines in US counties that had low vaccination rates, an analysis has concluded. COVID-19 vaccine hesitancy is higher in US regions that voted heavily for Trump in the 2020 election, so the research team targeted them by creating a 30-second YouTube ad that featured a Fox News TV interview in which Trump recommends the vaccine. The team spent nearly $100,000 on Google Ads to place it online in 1,083 US counties in which fewer than 50% of adults were vaccinated; an additional 1,085 similar counties that did not receive the ads served as a control group. Compared with control counties, the study found an increase of 104,036 people receiving first vaccinations in areas that observed the ad, a statistically significant difference. The intervention’s cost was just under $1 per vaccinated person. In contrast, US locales that used lottery tickets as a reward spent $60 to $80 per vaccination, according to the preprint study posted at the National Bureau of Economic Research.

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www.science.org/content/article/new-crop-COVID-19-mrna-vaccines-could-be-easier-store-cheaper-use

The two COVID-19 vaccines based on messenger RNA (mRNA) have been the breakout stars of the pandemic. Both trigger impressive immune responses with minimal side effects, and both did exceptionally well in efficacy trials. But the vaccines, produced by the Pfizer-BioNTech partnership and Moderna, have also split the world. Because of their high prices and their need to be stored at extremely low temperatures, few people in lower and middle-income countries have had access to them.

That might soon change. More than a dozen new mRNA vaccines from 10 countries are now advancing in clinical studies, including one from China that’s already in a phase 3 trial. Some are easier to store, and many would be cheaper. Showing they work won’t be easy: The number of people who don’t already have some immunity to COVID-19 because of vaccination or infection is dwindling. But if one or more of the candidates gets the green light, the mRNA revolution could reach many more people.

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https://view.e.economist.com/?qs=d5c7801119a97100e0c224d518039be5f31048b5b3b370015eb4c3014317c6d084b8a9b90b063a6ceaf14e2a3bb471a5e534212c59f7752710f41e0b7cf94b8fddaf2b3bd815e2144f8a341fc33e2959

In 2020, around 240m people contracted malaria. More than 627,000 of them died, the vast majority of them children in Africa.

Malaria has been afflicting people since ancient times: Cleopatra was known to sleep under a bed net to keep herself out of reach of night-time mosquitoes. Chinese texts going back to the fourth century talk about treating fever with artemisia, a plant that nowadays is the basis of artemisinin, one of the most important drugs in the fight against malaria.

Throughout the middle of the 20th century, people found success in eradicating malaria in specific countries and regions—wherever they could afford campaigns to get into homes and spread insecticides such as DDT. In the first decade of the 21st century, thanks to cheap, effective interventions such as bed nets, antimalarial drugs and insecticides, the dreaded disease seemed to be in something of a decline. “This kickstart of our eradication efforts really worked,” says Jennifer Gardy, deputy director for surveillance, data and epidemiology in the malaria team at the Bill and Melinda Gates Foundation. “We estimate that we’ve saved something like almost 11m lives, preventing close to 2bn malaria cases since the year 2000.”

Fortunately, hope is on the horizon, in the form of two new scientific tools. The first of these is vaccines: last year the world’s first vaccine for malaria was approved. Known as RTS,S and made by GlaxoSmithKline, it came after work on malaria vaccines had faltered for decades. The vaccine is by no means perfect, only reducing the number of severe malaria cases by 30 per cent, but it is a start. The better news is that there are already better vaccines in the works. 

One of those new vaccines is being designed at the University of Oxford, by the same team that developed the AstraZeneca vaccine for COVID. In phase 2 clinical trials, the Oxford malaria vaccine was around 77 per cent effective. And further down the line, BioNTech, a German pharmaceutical company and co-creator of another COVID vaccine, is planning to develop a malaria vaccine based on its highly successful mRNA platform.

The second tool is genetic modification. Vaccines will help prevent illness but one thing they cannot do is tackle the mosquitoes that are transmitting parasites in the first place. Scientists at Imperial College London have taken up that part of the challenge. In their labs they have been genetically modifying mosquitoes in two ways: in one experiment they make female insects sterile; in another trial they push females to produce more male offspring when they reproduce. (Male mosquitoes do not spread malaria.)

The idea is that, over the course of several generations, the vast majority of the mosquitoes in a population will be either sterile females or male. Their number should thus quickly collapse and those that remain will not be able to spread the disease. So far these ideas have only been trialled in laboratories, but field trials could be on their way in just a few years.

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

Shanghai becomes COVID-19 hotspot; the latest health stories from around the world

April 4, 2022 By Lalita Panicker Leave a Comment

Stock Photo - Inscription COVID-19 on blue background. World Health Organization WHO introduced new official name for Coronavirus disease named COVID-19. COVID-19 outbreak concept. Image credit: nunataki / 123rf
Image credit: nunataki / 123rf

COVID-19 cases in China’s largest city of Shanghai have risen again as millions remain isolated at home under a sweeping lockdown ̐(www.theguardian.com/world/2022/apr/03/covid-cases-rise-in-shanghai-as-millions-remain-in-lockdown)

Health officials on Sunday reported 438 confirmed cases detected over the previous 24 hours, along with 7,788 asymptomatic cases, up slightly from the day before.

While small by the standards elsewhere in the world’s large countries, the daily case numbers are some of China’s largest since the virus was first detected in the central city of Wuhan in late 2019.

Shanghai with its 26 million people last week began a two-stage lockdown, with residents of the eastern Pudong section supposed to be allowed to leave their homes Friday, while their neighbours in the western Puxi section underwent their own four-day isolation period.

Despite that assurance, millions in Pudong continue to be confined to their homes amid complaints over food deliveries and the availability of medications and health services.

Notices delivered to residents said they were required to self-test for COVID-19 daily and take precautions including wearing masks at home and avoiding contact with family members — measures not widely enforced since the early days of the pandemic.

Meanwhile, residents of the city of Jilin were be able to move about freely starting Friday for the first time in more than three weeks, state broadcaster CCTV said, citing a notice issued by the city. They will be required to wear masks and, when indoors, stay one meter (three feet) apart. Public gatherings in parks and squares are prohibited.

https://apnews.com/article/covid-business-health-china-shanghai-ef1a875b77200fb005b10aaa1fac0c0b

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www.nytimes.com/live/2022/04/01/world/covid-19-mandates-cases-vaccine?

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Senate Democrats and Republicans in the United States have neared an agreement to slash an emergency coronavirus response package to $10 billion from $15.6 billion, as they worked to break a logjam over a stalled package of federal money urgently requested by President Joe Biden for vaccines, therapeutics and preparation against future variants.

The day after Mr. Biden pleaded with Congress to approve the money, senators on Thursday were discussing removing as much as $5 billion in aid for the global vaccination effort as they scrambled to resolve disputes over how to finance the package. Republicans have refused to devote any new funding to the federal pandemic response effort, arguing that unspent money that has already been approved should be used, but the two parties have been unable to agree on which programs should be tapped.

Without that consensus, it was not clear that they would have the votes to move forward in the evenly divided Senate, where 60 votes — including at least 10 Republicans ones— would be needed. The package now under consideration would be less than half the White House’s original $22.5 billion request.

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www.nytimes.com/2022/04/02/health/covid-testing-uk-denmark.html?

The British government on Friday shut down or scaled back a number of its Covid surveillance programs, curtailing the collection of data that the United States and many other countries had come to rely on to understand the threat posed by emerging variants and the effectiveness of vaccines. Denmark, too, renowned for insights from its comprehensive tests, has drastically cut back on its virus tracking efforts in recent months.

As more countries loosen their policies toward living with COVID rather than snuffing it out, health experts worry that monitoring systems will become weaker, making it more difficult to predict new surges and to make sense of emerging variants.

Since the Alpha variant emerged in 2020, Britain has served as a bellwether, tracking that variant as well as Delta and Omicron before they arrived in the United States. After a slow start, American genomic surveillance efforts have steadily improved with a modest increase in funding.

At the start of the pandemic, Britain was especially well prepared to set up a world-class virus tracking program. The country was already home to many experts on virus evolution, it had large labs ready to sequence viral genes, and it could link that sequencing to electronic records from its National Health Service.

In March 2020, British researchers created a consortium to sequence as many viral genomes as they could lay hands on. Some samples came from tests that people took when they felt ill, others came from hospitals, and still others came from national surveys.

That last category was especially important, experts said. By testing hundreds of thousands of people at random each month, the researchers could detect new variants and outbreaks among people who didn’t even know they were sick, rather than waiting for tests to come from clinics or hospitals.

By late 2020, Britain was performing genomic sequencing on thousands of virus samples a week from surveys and tests, supplying online databases with more than half of the world’s coronavirus genomes. That December, this data allowed researchers to identify Alpha, the first coronavirus variant, in an outbreak in south-eastern England.

A few other countries stood out for their efforts to track the virus’s evolution. Denmark set up an ambitious system for sequencing most of its positive coronavirus tests. Israel combined viral tracking with aggressive vaccination, quickly producing evidence last summer that the vaccines were becoming less effective — data that other countries leaned on in their decision to approve boosters.

But Britain remained the exemplar in not only sequencing viral genomes, but combining that information with medical records and epidemiology to make sense of the variants.

Even in the past few weeks, Britain’s surveillance systems were giving the world crucial information about the BA.2 subvariant of Omicron. British researchers established that the variant does not pose a greater risk of hospitalization than other forms of Omicron but is more transmissible.

On Friday, two of the country’s routine virus surveys were shut down and a third was scaled back, baffling many researchers, particularly when those surveys now show that Britain’s Covid infection rates are estimated to have reached a record high: one in 13 people. The government also stopped paying for free tests, and either cancelled or paused contact-tracing apps and sewage sampling programs.

The cuts have come as Prime Minister Boris Johnson has called for Britain to “learn to live with this virus.”

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The highly contagious Omicron subvariant known as BA.2, which led to a surge of coronavirus cases in Europe, is now the dominant version of the virus in new US cases, according to estimates from the Centers for Disease Control and Prevention (CDC) on Tuesday.

Last week, the World Health Organization reiterated that BA.2 was the dominant version of Omicron around the world, and Dr. Rochelle Walensky, the director of the CDC, said she anticipated it would soon become dominant in the United States.

Scientists have been keeping an eye on BA.2, one of three genetically distinct varieties of the Omicron variant of the coronavirus, which was discovered by South African researchers in November 2021.

BA.2 was first identified in the United States in December, and it accounted for about 55 percent of new U.S. cases in the week ending Saturday, according to C.D.C. estimates on Tuesday. The figures are rough estimates subject to revision as more data comes in, as happened in late December, when the agency had to significantly decrease its estimate for the nationwide prevalence of the BA.1 Omicron variant. Before that, the Delta variant had been dominant.

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

China announces city wide lockdown to curb COVID-19; the latest health stories from around the world

March 29, 2022 By Lalita Panicker Leave a Comment

Coronavirus, Wuhan Image ID: 108296823 (L) Image credit: keitma / 123rf
The epicentre of the coronavirus outbreak was Wuhan, China. Image credit: keitma / 123rf

Sticking to its “zero COVID” policy, China has announced its biggest city-wide lockdown since the COVID outbreak began more than two years ago. The city of Shanghai will be locked down in two stages over nine days while authorities carry out COVID-19 testing.

( www.bbc.com/news/world-asia-china-60893070)

The important financial hub has battled a new wave of infections for nearly a month, although case numbers are not high by some international standards.

Authorities had so far resisted locking down the city of some 25 million people to avoid destabilising the economy. But after Shanghai recorded its highest daily number of cases on Saturday since the early days of the pandemic, authorities appear to have changed course.

The lockdown will happen in two stages, with the eastern side of the city under restrictions from Monday until 1 April, and the western side from 1-5 April.

Public transport will be suspended and firms and factories must halt operations or work remotely, authorities said. The city government published the instructions on its WeChat account, asking the public “to support, understand and cooperate with the city’s epidemic prevention and control work”.

Other lockdowns during the pandemic have affected entire Chinese provinces, though people could often still travel within those regions. But Shanghai, due to its high population density, is the largest single city to be locked down to date. It is China’s commercial capital and by some calculations the biggest city in the country – but is now one of the worst-hit areas as China fights to contain a resurgence of the virus with Omicron, leading to a spike in new cases.

Officials had until now said the eastern Chinese port and financial hub must keep running for the good of the economy. The staggered approach to this lockdown means half the city will remain functioning at a time.

Millions of residents in other Chinese cities have been subjected to citywide lockdowns, often after a relatively small number of Covid cases.

Wuhan was sealed off at the very outset of this pandemic. Before Christmas it was Xi’an. Now China’s commercial and financial capital is being shut.

Just a few days ago officials here said Shanghai was too big and too important to lock down. The question now on many residents’ lips will be whether nine days is enough.

The recent surge in cases in China, although small compared to some countries, is a significant challenge to China’s “zero-Covid” strategy, which uses swift lockdowns and aggressive restrictions to contain any outbreak.

The policy sets China apart from most other countries which are trying to live with the virus.

But the increased transmissibility and milder nature of the Omicron variant has led to questions over whether the current strategy is sustainable in the long run.

Some Shanghai residents have complained about the seemingly endless cycles of testing, suggesting that the cost of zero-COVID had become too high.

China’s national health commission reported more than 4,500 new domestically transmitted cases on Sunday. China reported almost 5,000 COVID-19 cases on Friday, as authorities continued to battle an outbreak of the highly transmissible Omicron variant. Following the death of a nurse in Shanghai who was denied hospitalization after an asthma attack, many are angry that China’s COVID responses appear to be causing more deaths than the virus itself.

Domestically acquired COVID-19 infections jumped from 175 on 7 March to 3507 on 14 March. Asymptomatic infections, which China tracks separately, surged as well. The government has put 37 million people in the southern city of Shenzhen and the north-eastern province of Jilin under lockdown orders, with many elsewhere facing travel and other restrictions. www.science.org/content/article/news-glance-asia-s-covid-19-surge-melting-winter-sea-ice-and-inflammatory-arxiv-papers

Meanwhile in Hong Kong the “zero covid” policy seems to be having an impact exactly opposite to what’s expected. Nearly half the foreign businesses are planning to relocate. Foreign businesses have for decades reaped the benefits of setting up shop in Hong Kong, a historically stable, expat-friendly finance hub at the doorstep of mainland China. But lately, as Beijing has tightened its grip on the former British colony, those firms are increasingly eyeing the exits. Nearly half of all European businesses in Hong Kong are considering relocating in the next year, according to a new report. Companies cite the local government’s extremely strict COVID-19 protocols that mirror those on the mainland. Among the firms planning to leave, 25% said they would fully relocate out of Hong Kong in the next 12 months, while 24% plan to relocate at least partially. Only 17% of the companies said they don’t have any relocation plans for the next 12 months.

www.cnn.com/2022/03/24/business/hong-kong-expats-covid-restrictions/index.html

Elsewhere, South Korea and Vietnam, which managed to keep cases very low during the first 2 years of the pandemic, have also seen explosions due to Omicron, with South Korea now reporting more than 300,000 cases daily and Vietnam more than 200,000. Many European countries that recently relaxed or abandoned control measures are recording COVID-19 rebounds as well, with double-digit percentage increases in infections over the past 2 weeks.

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The virus is up to its old tricks, as it has the world at large  ever since the pandemic hit more than two years ago. It’s mutating pretty effectively. Barely two months after the Omicron wave, U.S. epidemiologists are already warning of another swell in the pandemic.

Though COVID case numbers are falling in many countries, scientists warn that the quiet may soon give way to another surge, driven by an Omicron subvariant, BA.2. It is already fuelling an increase in cases in 18 countries, including Britain, France, Germany and Italy.

BA.2 is more contagious than the version of Omicron that spread through last winter. And BA.2 is quickly becoming more prevalent in some places. But whether that turns into a wave — as some countries in Europe are seeing — is hard to know for sure.

Some experts in the U.S predict that a BA.2 wave could come as soon as April, or perhaps later in the spring or in the early summer.

Another possibility is that BA.2 slows down a decline in cases or produces only a slight uptick — but not a big wave. That could be because so many Americans got infected with the first version of Omicron over the winter, so there’s more immunity in the population.

There’s also some optimism that even if there is a more sizable bump in cases, because of all the immunity in the population, hospitalisation rates may not go up so much, according to The New York Times. That’s been true for some European countries where cases have been rising for a few weeks, but so far it hasn’t been accompanied by a surge of hospitalisations.

There have been some lab studies that suggested that vaccinated people infected with Omicron produce reasonably high levels of antibodies that probably protect against BA.2. And estimates out of the U.K. suggest that vaccines seem to protect about as well against BA.1 as they do against BA.2. The big variable is how long that protection, especially from a previous infection, is going to last.  

Biogen last week published data from two pivotal clinical trials of its controversial Alzheimer’s drug, Aduhelm, more than 2 years after it first announced their outcomes. The company faced criticism for both the long delay and its choice of outlet—the low-profile Journal of Prevention of Alzheimer’s Disease. The journal’s editor-in-chief, Paul Aisen, is also the second author on the study and has consulted for Biogen. (Aisen says he was not involved in the review of Biogen’s manuscript or the publication decision, and the company is one among many he has consulted for.) The U.S. Food and Drug Administration (FDA) approved the drug against the recommendation of an independent advisory group. FDA cited evidence that the treatment removes Alzheimer’s-associated protein plaques from the brain, even though only one of the two large trials showed clinical benefits from Aduhelm over a placebo. www.science.org/content/article/news-glance-webb-telescope-looking-sharp-omicron-s-burden-and-statues-female-scientists/////

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

Using Fewer Antibiotics Isn’t Always the Best Way to Curb Resistance

March 28, 2022 By admin Leave a Comment

This article is taken from European Biopharmaceutical Review April 2022, pages 23-26. © Samedan Ltd

While the over-prescription of antibiotics is causing increasing levels of antimicrobial resistance  (AMR) within the developed world, the lack of access to treatments in lower income countries is just  as much of a global concern 

By Mark Chataway at Hyderus 

Most discussion of AMR focuses on the overuse or  inappropriate use of broad spectrum antibiotics. But  too little diagnosis and inadequate treatment is just as  important. The lack of access to antibiotics is the cause  of 5.7 million deaths annually, the majority in low- and  middle-income countries. We have to find ways to reduce  these deaths and to limit treatment-linked resistance. 

Today’s Burden 

Low-resource countries are worst affected by limited  access to antibiotics. This is, in part, because people  in these countries are more vulnerable to infections.  

For example, infections associated with ventilators and catheters in low-resource countries are up to 13 times  higher than in the US, while hospital infections amongst newborns in low-income countries are up to 20 times  higher than in high-income countries. The antibiotics  needed to treat these infections are often difficult or  impossible to access. 

antibiotics

However, deaths are on a downward trend, thanks to  antibiotics. A 2018 paper in the Proceedings of the  National Academy of Sciences of the USA said, “The  worldwide mortality attributable to infectious agents  dramatically decreased from around 13 million deaths in  1990 to around 10 million deaths in 2016. This decrease  was mainly driven by the yearly decline of mortality  caused by antibiotic-susceptible bacterial infections,  including lower respiratory tract infections, especially  in [lower-middle income countries] (1).” In context, this  decline is not, maybe, as “dramatic” as the article says  or as it might have been: deaths from malaria and HIV,  

two other infectious diseases, over roughly the same  two decades fell far faster. And we should not forget  that resistance to medicines to combat parasitic and  viral infections are an often-neglected part of the AMR agenda – one we will neglect here as well. 

Back in 2010, a Duke University literature review of  Sub-Saharan African papers showed that nearly one in  13 hospitalised patients across Africa may have had a  bacterial bloodstream infection (2). Many were never  treated with antibiotics, either because the illness was  never diagnosed or because there were no treatments.  

Barriers to accessing antibiotics are complex, particularly  in low- and middle-income countries. A 2018 Access To  Medicines Foundation (ATMF) report said, “Shortages  of generic antibiotic products have been reported on  a global and national scale and many formulations of  antibiotics for specific populations, including children,  have limited availability (3).” Things were so bad that in  2017, only four companies were producing the active  pharmaceutical ingredient (API) for penicillin; three were  in China (4). Brazil’s tough and respected drug regulator  gave permission for its producers to buy the API from  a Chinese producer that European regulators said had  falsified data and posed a high risk of contamination.  There was, apparently, no alternative.  

These shortages are getting worse. “The increasingly  common shortages of antimicrobials are an additional  threat to the emergence of AMR. While the threat of  such drug shortages is most acutely experienced in low income and middle-income settings, their consequences impact the quality and effectiveness of antimicrobials worldwide,” Shafiq et al. said in a November 2021 article in BMJ Global Health (5).
Stockouts in resource-poor countries happen sometimes because there just isn’t enough money to buy medicines; more usually, for generics, they are caused by bureaucratic bottlenecks in tendering, awarding contracts, releasing payments, import clearances, or distribution. That ATMF report explained another cause: “Governments with high purchasing power are using increasingly stringent tendering processes focused on price, creating competition among producers that puts further pressure on already slim margins.” Fewer and fewer companies are involved in producing active product ingredients and finished antibiotic treatments.


The orthodox view that intellectual property is the biggest hindrance to medicines availability is clearly wrong, at least in this context. The lack of availability in the public sector along with steep out-of-pocket costs often pushes patients or parents into the private sector. In many countries, prescribers and dispensers in this sector have strong incentives to use more expensive products, rather than the ones indicated by clinical guidelines. A 2021 paper in Antibiotics reported that “although the per-capita consumption of antibiotics in India is lower than that in several other countries, the proportion of broad-spectrum antibiotic consumption which are recommended for restricted use by the WHO is high (6).” Patients cannot afford the full course, and the paper reported that, according to interviews involving 36 pharmacies in two states, pharmacists often dispensed antibiotics – including ones on WHO’s watchlist for resistance – without a prescription and with only enough pills for one or two days of treatment.

“In many countries, prescribers and dispensers in this sector have strong incentives to use more expensive products, rather than the ones indicated by clinical guidelines”

To conserve the antibiotics we have, we need to make sure that professionals working in the public sector can reliably get the antibiotics they need. This will mean challenging some shibboleths of activist groups and building sustainable public private partnerships to produce and distribute high-quality medicines.


Resistance Is Already a Major Problem


Treating bacterial infections with medicines that are not ideal in courses that are too short is accelerating antibiotic resistance. So is the widespread and unnecessary use of broad spectrum antibiotics, especially in courses or at doses that are too low.

AMR is already an issue in resource-poor countries. Elsewhere in this special edition, there are many references to a 2019 paper in The Lancet. It is a complex piece of modelling, but overall it is clear that low-resource countries are disproportionately affected by deaths associated with and attributable to AMR.


The authors of that The Lancet paper conclude: “Many might expect that with higher antibiotic consumption in high resource settings, the burden of bacterial AMR would be correspondingly higher in those settings. We found, however, that the highest rates of death were in Sub-Saharan Africa and South Asia. High bacterial AMR burdens are a function of both the prevalence of resistance and the underlying frequency of critical infections such as lower respiratory infections, bloodstream infections, and intra-abdominal
infections, which are higher in these regions. Other drivers of the observed higher burden in [resource-poor countries] include the scarcity of laboratory infrastructure making microbiological testing unavailable to inform treatment to stop or narrow antibiotics.


“The higher burden in low-resource health systems highlights the importance – both for the management of individual patients and for the surveillance of AMR – of well-developed national action plans and laboratory infrastructure in all regions and countries.”


Lab facilities are very unlikely to be available to most treaters and, where they are, treaters face the same dilemmas as their counterparts in advanced economies: Do they wait for a sample to be cultured and analysed? Or do they treat the patient now, with no risk of loss to follow up, based on the pathogen probably involved and what professionals know about resistance patterns in the area?


A doctor treating a patient with a potentially life-threatening infection will, of course, not wait and will use whatever is available. However, even in those circumstances, they might prescribe differently if the full range of essential antibiotics were available. The Shafiq et al. paper reported: “Global antimicrobial supply chains are inefficient and fragmented… scarcely available and poorly functioning forecasting systems [in resource-poor countries] contribute to the problem of disrupted supply chains (5).” 

Preparing for the Future 

Medicine will have to work harder because resistant microbes have changed the world in which patients are treated. Julian and Dorothy Davies pointed out in 2010: “The planet is saturated with these toxic [antibiotics used since the 1940s], which has of course contributed significantly to the selection of resistant strains. The development of generations of antibiotic-resistant microbes and their distribution in microbial populations throughout the biosphere are the results of many years of unremitting selection pressure from human applications of antibiotics, via underuse, overuse, and misuse. This is not a natural process, but a man-made situation superimposed on nature; there is perhaps no better example of the Darwinian notions of selection and survival (7).”


New antibiotics must only be used in those infections which cannot be cured, at therapeutic doses, with older antibiotics. As Davies and Davies put it, “If well-considered restrictions and rules for usage were supported by a pipeline of structurally novel antibiotics and semi-synthetics designed to be refractory to resistance mechanisms, one could expect some significant and lasting improvements in the treatment of infectious diseases (7).” The restrictions do not work well in some advanced economies or in some resource-poor ones. Some of the causes are similar, but the solutions are very different.

In advanced economies, patients often demand medicines that are tolerable and virtually certain to work or refuse to wait for the outcome of lab testing to determine the best treatment for a specific infection. Doctors in resource-poor countries face very similar dilemmas. A 2021 paper in Antibiotics looked at the prescription of broad spectrum antibiotics (BSAs) in South Africa, Sri Lanka, and the UK (8). In all, doctors said that they recognised the need to restrict use of broad-spectrum antibiotics but, “universally across settings, participants described how using BSAs provided a solution to diagnostic uncertainty, reassured them that their patients would be safe, and reduced their own risk of censure from colleagues or of litigation.”


If patients don’t like what they are prescribed, they can buy something else in much of the world. Periodic efforts by national governments and WHO to limit over-the-counter dispensing of antibiotics have met with very limited success in resource-poor countries. For example, India introduced a new H1 schedule, which was designed to require that pharmacists keep a copy of antibiotic prescriptions, thus reducing sales without prescriptions. A 2020 study in the Indian Journal of Pharmacology found that mystery shoppers in one state were still able to buy antibiotics, mostly broad-spectrum ones, in almost eight out of ten attempts (9). There is no reason to think that regulation will be any more effective in the future.


Many patients will get antibiotics in the private sector for many years to come and planning that does not include private pharmacies and hospitals is an exercise in dangerous wishful thinking. It would, of course, be completely invidious to make new antibiotics available only to those rich enough to afford them in the private sector. There have to be solutions that work in every setting.


What needs to be done is often painfully obvious; the challenge lies in how to do it. Initiatives such as SECURE – led by the Global Antibiotic Research and Development Partnership and WHO – use pilots to generate real-world experience on issues such as:

• Surveillance and developing a flow of reliable data on resistance, susceptibility and clinical practice
• Country-specific (or even locality-specific) guidelines, based on good data, to use the narrowest-possible antibiotics • Access to fast, affordable, reliable lab facilities to help clinicians to prescribe better
• Access to the right antibiotics at affordable prices, or at no cost, in these high-burden countries
• Mechanisms for access to broad-spectrum and novel antibiotics that actually restrict their use to cases known, or strongly suspected, to be resistant to other agents
• Public-private partnerships to assure supply at fair but sustainable prices

Much more must be done, though. Abstract discussions about how to conserve new agents need to become honest
discussions about the real challenges. The diagnostics industry must be given a central role in developing new ways to test quickly and easily for pathogens and for the susceptibility of those pathogens to treatments.


COVID-19 has reminded us that we share one planet; unless our approach to managing infectious diseases is global, it will fail.

References
1. Abat C, Gautret P, Raoult D, Benefits of antibiotics burden in low-income countries. Proc Natl Acad Sci
U S A. 115(35):E8109–E8110, 2018. doi:10.1073/
pnas.1809354115
2. Visit: globalhealth.duke.edu/news/bacterial-infections common-cause-illness-death-africa
3. Visit: accesstomedicinefoundation.org/media/atmf/Antibiotic Shortages-Stockouts-and-Scarcity_Access-to-Medicine Foundation_31-May-2018.pdf
4. Visit: www.aljazeera.com/features/2017/5/21/why-is-the world-suffering-from-a-penicillin-shortage
5. Shafiq N et al, Shortage of essential antimicrobials: a major challenge to global health security, BMJ Global Health, 6: e006961, 2021.
6. Kotwani A, Joshi J, Lamkang AS, Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States. Antibiotics (Basel), 10(9): p1,123, 2021. doi:10.3390/antibiotics10091123
7. Visit: Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev, 74(3): pp417–433, 2010. doi:10.1128/MMBR.00016-10
8. Tarrant C et al, Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa. Antibiotics, 10(1): p94, 2021. doi.org/10.3390/antibiotics10010094
9. Chadalavada V, Babu SM, Balamurugan K, Nonprescription sale of schedule H1 antibiotics in a city of South India. Indian J Pharmacol, 52(6): pp482–487, 2020. doi:10.4103/ijp. IJP_244_19

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