Health Issues in Africa

Health Issues in Africa

covid

China reiterates commitment to “zero-COVID”; The latest health stories from around the world

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Confirmed cases of COVID-19 concept. a covid-19 blood test tube with result of positive on yellow background the X has clipping path and can be removed. COVID-19 testing concept. Antibody tests concept. Image credit: 罗 宏志 / 123rf. COVID-19 cases now number at one million: concept. Testing illustration. Symptomatic COVID-19 illustration. Cases of COVID-19 in India concept. COVID-19 clusters concept.. new covid-19 variant mutant strain long covid. COVID-19 cases concept. Even after recovery from COVID-19, long-COVID symptoms may persist. Image credit: 罗 宏志 / 123rf. B.1.617 concept. black fungus. Delta plus variant concern. Delta variant concept. Excess mortality illustration. Fresh COVID-19 cases illustration.
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Xi Jinping reiterated China’s commitment to zero-COVID, declaring “persistence is victory”, as Shanghai and Beijing were hit with new lockdowns, shutdowns, and mass testing drives just a week after the cities celebrated the easing of restrictions. (www.theguardian.com/world/2022/jun/10/xi-jinping-says-persistence-is-victory-as-covid-restrictions-return-to-shanghai-and-beijing)

In response to China’s worst outbreak of the pandemic, Shanghai spent months under an arduous and strict citywide lockdown, while Beijing authorities imposed localised lockdowns, venue and public transport shutdowns, and work-from-home orders. In the last week both had begun easing restrictions, with authorities praising the containment of the community outbreaks of the Omicron variant.

But last Thursday both cities went back on high alert for Covid cases, with new lockdowns in Shanghai districts, home to millions of people, and the shutdown of entertainment venues in Beijing’s populous Chaoyang district. The return to restrictions sparked alarm and frustration among residents.

Experts predict that China will struggle to meet its economic growth target of about 5.5% this year as virus lockdowns force business shutdowns and snarl supply chains.

Half of Shanghai’s residents, about 14 million people, were this week ordered to undergo testing. All residents of the affected districts have been ordered to stay inside until it is completed.

Officials on Thursday traced three Shanghai infections to the Red Rose, a popular beauty salon in the trendy former French Concession area of the Xuhui district. The shop, which reopened in 1 June when the city did, had served 502 customers from 15 of Shanghai’s 16 districts in the past eight days, a local media outlet, The Paper, reported.

China reported 73 new local infections on Friday, including eight in Beijing and 11 in Shanghai, according to the National Health Commission.

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A team of international scientists tasked with understanding how the coronavirus pandemic began released their first report on Thursday, saying that all hypothesis remain on the table, including a possible laboratory incident. https://edition.cnn.com/2022/06/10/china/who-covid-pandemic-origins-report-intl-hnk/index.html?

The 27-member scientific advisory group convened by the World Health Organization (WHO) said available data suggests the virus jumped from animals to humans but gaps in “key pieces of data” meant a complete understanding of the pandemic’s origins could not be established.

The team, called the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), was formed last year to recommend further areas of study to better understand the pandemic’s origins and as well as the emergence of future pathogens.

Here are key takeaways from the report.

Animal origins

Current data suggests a zoonotic origin of SARS-CoV-2 — which means the virus originated in animals and jumped to humans.

The most closely genetically related viruses were found to be beta coronaviruses identified in bats in China and Laos, according to SAGO.

“However, so far neither the virus progenitors nor the natural/intermediate hosts or spill-over event to humans have been identified,” the report said.

The seafood market

Another area the group identified for further study is the Huanan Seafood Market in Wuhan, which investigations suggest “played an important role early in the amplification of the pandemic.”

However, it is not clear how the source of the virus was introduced to the market and where the initial spill over to humans occurred, the group said, adding that follow-up studies have not been completed.

The lab-leak theory

SAGO’s preliminary report said it “remains important to consider all reasonable scientific data” to evaluate the possibility that COVID-19 spilled into the human population through a laboratory incident.

However, the group said there “has not been any new data made available” to evaluate this theory and recommended further investigation “into this and all other possible pathways.”

The team also had access to unpublished blood samples from 40,000 donors in Wuhan between September and December 2019, and reported to have been tested for COVID antibodies. Their samples could contain crucial signs of the first antibodies made by humans against the disease.

According to the report, more than 200 samples initially tested positive for the antibodies but when tested again were not found to be positive.

Similarly, the group recommended further study of 76,000 COVID patients identified in the months before the initial outbreak in Wuhan in December 2019 and who were later discounted.

On Thursday, WHO Director-General Tedros said it has been two-and-a-half years since Covid-19 was first identified but “we do not yet have the answers as to where it came from or how it entered the human population.”

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The United States Food and Drug Administration’s (FDA’s) vaccine advisory panel this week recommended nearly unanimously that the agency authorize a protein-based COVID-19 vaccine from Novavax, which would be the first of its kind available to U.S. adults. FDA doesn’t have to abide by its advisers’ recommendations but usually does. In a 30,000-person trial in the US and Mexico, the vaccine was 90.4% efficacious at preventing symptomatic infection by early strains of SARS-CoV-2. www.science.org/content/article/news-glance-african-swine-fever-vaccine-low-dose-radiation-and-bees-fish?

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Eleven days after being bitten by one of her pet prairie dogs, a 3-year-old girl in Wisconsin on 24 May 2003 became the first person outside of Africa to be diagnosed with monkeypox. Two months later, her parents and 69 other people in the United States had suspected or confirmed cases of this disease. which is caused by a relative of the much deadlier smallpox virus. The monkeypox virus is endemic in parts of Africa, and rodents imported from Ghana had apparently infected captive prairie dogs, North American animals, when an animal distributor in Texas housed them together. (www.science.org/content/article/concern-grows-human-monkeypox-outbreak-will-establish-virus-animals-outside-africa?)

The outbreak now underway has affected more people outside of Africa than ever before—nearly 1300 cases as of 7 June, on multiple continents. But like the 2003 episode, today’s surge has raised a possibility that makes researchers gulp: Monkeypox virus could take up permanent residence in wildlife outside of Africa, forming a reservoir that could lead to repeated human outbreaks.

No animal reservoir currently exists outside of Africa, but the US outbreak of 2003 was a close call, some scientists suspect, especially because nearly 300 of the animals from Ghana and the exposed prairie dogs were never found. In the end, however, surveys of wild animals in Wisconsin and Illinois never found monkeypox virus, none of the infected humans passed on the disease to other people, and worries about this exotic outbreak evaporated.

Will North and South America, Europe, Asia, and Australia—all of which have reported monkeypox cases in this outbreak—be similarly fortunate this time?

Viruses frequently ping-pong between humans and other species. Although COVID-19 is widely thought to have resulted from SARS-CoV-2 jumping from a bat or other host into people, humans have, in “reverse zoonoses,” also infected white-tailed deer, minks, cats, and dogs with the virus. One study in Ohio found antibodies to SARS-CoV-2 in more than one-third of 360 wild deer sampled.

Public health officials in several countries have advised people who have monkeypox lesions to avoid contact with their pets until they heal. Some 80% of the cases have occurred in Europe, and the European Food Safety Authority said no pets or wild animals had been infected as of 24 May. But it added that “close collaboration between human and veterinary public health authorities is needed to manage exposed pets and prevent the disease from being transmitted to wildlife.”

Studies have yet to pinpoint the African reservoir of the monkeypox virus. Although a lab in Copenhagen, Denmark, in 1958 first identified it in research monkeys from Asia, scientists now believe the primates caught it from an African source. All human cases since the first one was reported in 1970, in the Democratic Republic of Congo (DRC which was then Zaire), could be tied to the virus spilling over from animals in Africa.

www.science.org/content/article/monkeypox-threat-grows-scientists-debate-best-vaccine-strategy?

In 1959, German microbiologist Anton Mayr took a strain of vaccinia, a poxvirus used to inoculate against smallpox, and started to grow it in cells taken from chicken embryos. After several years of transferring the strain to fresh cells every few days, the virus had changed so much it could no longer reproduce in most cells from mammals. But it could still produce an immune response that protected against smallpox.

Mayr had set out to study how poxviruses evolve, but by accident he had produced a potentially safer smallpox vaccine. Dubbed Modified Vaccinia Ankara (MVA) because the original viral strain came from that Turkish city, the vaccine had a short career. “With smallpox eradicated in 1980, it disappeared into the freezer,” says Gerd Sutter, a virologist at the Ludwig Maximilian University of Munich, who has studied Mayr’s vaccinia strain for decades.

Now, this virus, further weakened and brought to the market by the Danish pharma company Bavarian Nordic, may become key to arresting the largest outbreak of monkeypox ever seen outside Africa, which has already sickened more than 1000 people. It is the only vaccine licensed anywhere for use against monkeypox, although other, riskier smallpox vaccines also appear to offer some protection.

But what role the vaccine will ultimately play depends on a host of factors: whether those most at risk from infection can be identified and vaccinated, whether the vaccine is as effective as hoped, and whether enough is available to stop the burgeoning outbreak.

Hundreds of millions of doses of smallpox vaccine are stored around the world, insurance against a possible release of the dreaded virus by terrorists or in war, and they are known to offer some protection against monkeypox. A study in the DRC in the 1980s found that household contacts of people sick with monkeypox were seven times less likely to contract the disease if they had been vaccinated against smallpox. Yet the vast majority of existing smallpox vaccines consist still replicating vaccinia. These can cause rare but life-threatening side effects such as encephalitis or progressive vaccinia, the spread of the vaccine virus to the whole body, to which immunocompromised people are vulnerable.

Although 66 people have already died of monkeypox this year in African countries, the recent cases in nonendemic countries have mostly been mild. And many contacts of those infected are living with HIV, which could make them more likely to suffer from vaccinia side effects. Given the risks and benefits, “using these vaccines is out of the question,” Sutter says.

Bavarian Nordic’s nonreplicating vaccine, marketed as Jynneos in the United States and as Imvanex in Europe, sidesteps some of the risk. So does a vaccinia-based vaccine named LC16m8, licensed for smallpox only in Japan, which also appears to cause fewer side effects.

WHO’s Strategic Advisory Group of Experts on Immunization is set to release guidance in the next few days that will back MVA, but it will also recommend using earlier vaccines in certain scenarios.

How well MVA really protects humans from monkeypox is uncertain. The license for MVA in Canada and the US is based on animal studies, where it was shown to protect macaques and prairie dogs, plus data in humans showing a strong antibody response.

That is why WHO has urged countries that deploy monkeypox vaccine to study how well it works and how best to use it. One question is whether a single dose of the vaccine, which is normally given as two doses 4 weeks apart, may suffice. That could encourage more uptake and stretch supplies.

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

China COVID-19 cases double in a day; the latest health stories from around the world

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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.
Image credit: photovs / 123rf

China reported nearly 3,400 daily COVID-19 cases on Sunday, double the previous day, forcing lockdowns in virus hotspots as the country contends with its gravest outbreak in two years www.theguardian.com/world/2022/mar/13/china-battles-worst-covid-outbreak-for-two-years-as-cases-double-in-24-hours?

A nationwide surge in cases has seen authorities close schools in Shanghai and lock down several north-eastern cities, as almost 19 provinces battle clusters of the Omicron and Delta variants.

The city of Jilin has been partially locked down, with hundreds of neighbourhoods sealed up, an official announced Sunday, while Yanji, an urban area of nearly 700,000 bordering North Korea, was fully closed off.

China, where the virus was first detected in late 2019, has maintained a strict zero-COVID policy enforced by swift lockdowns, travel restrictions and mass testing when clusters have emerged.

But the latest flare-up, driven by the highly transmissible Omicron variant and a spike in asymptomatic cases, is challenging that approach.

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Hong Kong is paying a heavy price for the vaccine hesitancy among its older residents, as a comparison with New Zealand underscores. (www.science.org/content/article/news-glance-hong-kong-s-high-covid-19-death-rate-biden-s-test-and-treat-and?)

Both countries minimized COVID-19 cases until the Omicron variant spread in February, but are now enduring big surges. Although New Zealand’s deaths from COVID-19 have remained flat—at 65 for the whole pandemic as of 7 March—Hong Kong’s have skyrocketed, with the weekly average nearing 200 per day, among the world’s highest recorded fatality rates. The key difference seems to be vaccination: New Zealand authorities say 100% of residents 75 and older are fully vaccinated (and 96% of those ages 12 and up), but in Hong Kong only about 30% of those 80 and older have received two doses of a COVID-19 vaccine. (The figure is 70% for all adults and children ages 3 and above.)

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The United States government this week began to ship antiviral pills for a program of free testing and immediate, free drug treatment for those with COVID-19 at hundreds of pharmacy clinics and long-term care facilities. (www.science.org/content/article/news-glance-hong-kong-s-high-covid-19-death-rate-biden-s-test-and-treat-and?)

The “test to treat” plan—one of several new proposals announced last week by President Joe Biden’s administration to manage the pandemic as U.S. caseloads drop—is aimed at helping people who lack ready access to a physician. The antiviral pills being dispensed work best if given quickly after diagnosis. Many public health officials and scientists applauded the proposal. But the American Medical Association complained that COVID-19 drugs could interact harmfully with drugs for other conditions and that physicians, who don’t typically staff pharmacies, are best equipped to prescribe them safely.

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In March 2020, the Austrian ski town of Ischgl suddenly became infamous as the site of one of the first COVID-19 superspreading events. Hundreds of infected skiers took the virus home and seeded outbreaks all around Europe.

As the pandemic progressed, however, Ischgl was on the vanguard for a more positive reason: Health officials and scientists in the state of Tyrol were among the first to monitor levels of the pandemic coronavirus in sewage—and base health policy decisions on them (www.science.org/content/article/pandemic-signals-sewer-what-virus-levels-wastewater-tell-us?)

Because the region is so dependent on tourism, officials were eager to know whether the virus was truly on the decline so they could lift key restrictions. They also wanted to catch the earliest possible signals that it might be coming back. Wastewater analysis, which picks up fragments of virus shed in faeces, was invaluable, says Stefan Wildt, a wastewater expert at the state’s department of water management. Following Tyrol’s lead, a national program has recently expanded to cover more than half of Austria’s population.

Although wastewater monitoring has been used to track polio and other pathogens for decades, the COVID-19 pandemic has led to an explosion of interest. The technique takes advantage of the fact that SARS-CoV-2 replicates in the digestive system and is shed in high quantities, often before symptoms appear. 

That provides an inexpensive way to monitor infections in thousands or even millions of people without annoying nose or throat swabs, or to predict where cases might be about to surge and hospitals risk getting overburdened. The genetic sequences of the shed virus can also provide hints about how it is evolving.

Scientists in the Netherlands, which has had a nationwide network of wastewater monitoring for decades, were among the first to show fragments of SARS-CoV-2 virus in wastewater samples could accurately reflect its levels in the community. Since then, monitoring projects for SARS-CoV-2 have sprung up in at least 58 countries, according to a dashboard set up by Colleen Naughton and colleagues at the University of California (UC), Merced. The European Union recommended all member countries establish monitoring systems for SARS-CoV-2 by October 2021, and 26 of 27 have complied, says Bernd Manfred Gawlik, who is helping coordinate efforts through the European Commission. 

In the United States, the National Wastewater Surveillance System includes 400 sites in 19 states. Last month, the U.S. Centers for Disease Control and Prevention added a national dashboard of wastewater data, and on 2 March, President Joe Biden’s administration said the monitoring system will be part of the effort to detect new variants. In India, a successful project in Bengaluru is expanding to half a dozen new cities.

Still, the jury is out on just how useful the technology is. Reliably determining viral levels in wastewater has posed logistical and technical challenges, and interpreting the data can be difficult. (For one, a good downpour will send dilute virus concentrations in sewers). Establishing collection, testing, and reporting systems can be time consuming and expensive as well. And although policymakers have welcomed the results of wastewater monitoring, few have used them to take action; typically, they have waited for cases to rise and intensive care units to fill up.

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As the Omicron coronavirus surge subsides, researchers are keeping an eye on a highly transmissible subvariant known as BA.2. Although it doesn’t appear to have the capacity to drive a large new wave of infections, the variant could potentially slow the current decline of Covid cases and make treatments more difficult.

Scientists first discovered the Omicron variant in November, and it quickly became clear that the viral lineage already existed as three genetically distinct varieties. Each branch of Omicron had its own set of unique mutations. At the time, the most common was BA.1, which quickly spread across the world. BA.1 was almost entirely responsible for the record-shattering spike in cases this winter.

At first, BA.1 was a thousand times as common as BA.2. But in early 2022, BA.2 started to be found in a larger proportion of new infections.

All versions of Omicron are highly contagious, which is why the variant swiftly crowded out earlier forms of the coronavirus, like Delta. But a number of studies have found that BA.2 is even more transmissible than BA.1.

In Denmark, for example, scientists examined the spread of both subvariants in households. They found that people infected with BA.2 were substantially more likely to infect people they shared a house with than those with BA.1. In England, researchers found that it took less time on average for someone with BA.2 to infect another person, accelerating its spread through communities.

In early 2022, BA.2 was growing more common in a number of countries. By February, it had become dominant worldwide, driving down the once-dominant BA.1. In the United States, the Centres for Disease Control and Prevention estimated that BA.2 jumped to 11 percent in early March from 1 percent in early February. It could soon become dominant in this country as well.

But that does not mean that Americans are riding a new BA.2 wave that is infecting a lot of new people. As BA.2 became more common in the United States, the total number of new cases fell by about 95 percent. Worldwide, the number of daily new cases had fallen to half of what they were at their peak in late January.

As many countries relax their protections against the spread of Covid, they may make it easier for BA.2 to drive a new increase in cases. A March 10 report from British researchers suggests that may be happening there now.

But there are a number of reasons that epidemiologists doubt that BA.2 will drive a massive new surge.

One of Omicron’s most striking features was its ability to partly evade the protection of vaccines. “Breakthrough” infections became more common, helping to drive the case surge to its record high. But the vaccines continued to protect people against severe disease, especially those who received a booster. Throughout the Omicron surge, vaccines remained highly effective against hospitalization.

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

COVID-19 sourced to a market in Wuhan? The latest health stories from around the world

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Test and sample virus crown covid virus 19. COVID-19 tests illustration. Image credit: ambrozinio / 123rf
Image credit: ambrozinio / 123rf

Scientists released a pair of extensive studies on Saturday that point to a market in Wuhan, China, as the origin of the coronavirus pandemic. Analysing data from a variety of sources, they concluded that the coronavirus was very likely present in live mammals sold in the Huanan Seafood Wholesale Market in late 2019 and suggested that the virus twice spilled over into people working or shopping there. They said they found no support for an alternative theory that the coronavirus escaped from a laboratory in Wuhan (www.nytimes.com/interactive/2022/02/26/science/covid-virus-wuhan-originsl)

“When you look at all of the evidence together, it’s an extraordinarily clear picture that the pandemic started at the Huanan market,” said Michael Worobey, an evolutionary biologist at the University of Arizona and a co-author of both studies.

The two reports have not yet been published in a scientific journal that would require undergoing peer review.

Together, they represent a significant salvo in the debate over the beginnings of a pandemic that has killed nearly 6 million people globally and sickened more than 400 million. The question of whether the coronavirus outbreak began with a spill over from wildlife sold at the market, a leak from a Wuhan virology lab or some other way has given rise to pitched geopolitical battles and debates over how best to stop the next pandemic.

But some outside scientists who have been hesitant to endorse the market origin hypothesis said they remained unconvinced. Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center, said in an interview that there remained a glaring absence of direct evidence that animals at the market had themselves been infected with the coronavirus.

In their new study, Dr. Worobey and his colleagues present evidence that wild mammals that might have harboured the coronavirus were being sold in December 2019. But no wildlife was left at the market by the time Chinese researchers arrived in early 2020 to collect genetic samples.

The authors of the new study include researchers who previously published smaller reports that had pointed toward a similar conclusion, but were based on much less detail. Their earlier analysis suggested that the first known case of the coronavirus was a vendor at the Huanan market.

In a separate line of research, scientists at the Chinese Center for Disease Control and Prevention carried out a new analysis of the genetic traces of coronaviruses collected at the market in January 2020. Previous studies have shown that the viruses sampled from early cases of Covid belonged to two main evolutionary branches. The Huanan market samples included both branches, the scientists reported in a study they posted online last weekend.

Dr. Worobey, who said he was not aware of the study until it was made public, said that their findings are consistent with the scenario he and his colleagues put forward for two origins at the market.

The Huanan Seafood Wholesale Market was an early object of suspicion when Covid first swept across Wuhan. Towards late December 2019, a few people who worked at the market developed a mysterious form of pneumonia. On Dec. 30, public health officials told hospitals to report any new cases of pneumonia linked to the market.

It also became clear at the end of December that a new coronavirus was to blame for the mysterious pneumonia. Coronaviruses have a disturbing history in China: In 2002, another coronavirus sparked the SARS epidemic, which killed 774 people. Scientists later concluded that the virus originated in bats, spread to wild mammals, and then jumped to humans at markets where the mammals were sold.

Fearing a replay of SARS, Chinese officials ordered the Huanan market closed. Wuhan police shut it down on Jan. 1, 2020. Workers clad in hazmat suits washed and disinfected the stalls.

Chinese scientists said they found the virus in dozens of samples taken from surfaces and sewers in the market, but not in any swabs taken from animals in the market.

The link to the market seemed to weaken as the coronavirus spread. Meanwhile, questions arose about the research carried out at a lab in the city, the Wuhan Institute of Virology, where scientists studied coronaviruses.

For the new studies, Dr. Worobey and his colleagues estimated the latitude and longitude of 156 cases of Covid in Wuhan in December 2019. The highest density of cases centred around the market.

The researchers then mapped cases in January and February. They used data collected by Chinese researchers from Weibo, a social media app that created a channel for people with Covid to seek help. The 737 cases drawn from Weibo were concentrated away from the market, in other parts of central Wuhan with high populations of elderly residents.

The patterns pointed to the market as the origin of the outbreak, the studies found, with the coronavirus then spreading to the surrounding neighbourhoods before moving out farther across the city. The researchers ran tests that showed it was extremely unlikely that such a pattern could be produced merely by chance.

“It’s very strong statistical evidence that this is no coincidence,” Dr. Worobey said.

The researchers also presented evidence that in late 2019, vendors at the market were selling raccoon dogs and other mammals known to be potential hosts of coronaviruses. Genetic samples collected from floors, walls and other surfaces at the Huanan market in January 2020 reveal traces of SARS-CoV-2 in the southwest corner of the market, where the vendors were clustered.

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At least 5.2 million children globally have lost a parent, grandparent or family caretaker to Covid-19, a new study says. The study, published on 24 February in The Lancet Child & Adolescent Health, said this “heart-breaking hidden pandemic” is nearing the total number of Covid-19 deaths, which currently stands at about 5.9 million people, according to latest World Health Organization totals. While plummeting Covid-19 case counts across the US are leading to a lifting of mask mandates, data shows more people are dying of Covid-19 now than during most points of the pandemic. More than 2,000 Covid-19 deaths have been reported in the US each day for the past month as the Omicron variant remains a heightened concern.

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The drive to help African countries produce vaccines with messenger RNA (mRNA) technology got big boosts last week from the World Health Organization (WHO) and the company BioNTech (www.science.org/content/article/news-glance-african-vaccine-n)

The success of mRNA COVID-19 vaccines made by the Pfizer-BioNTech collaboration and Moderna led to intense global demand, but African countries have had little access because of limited supply and high prices. Campaigns by several governments and nongovernmental organizations failed to convince the companies to freely share their technologies with economically strapped countries. So last year WHO launched a hub in South Africa to produce mRNA vaccines independently. The agency, which hopes the hub licenses a product by 2024, last week announced plans to train scientists from South Africa, Egypt, Kenya, Nigeria, Senegal, and Tunisia. BioNTech, which has been criticised for trying to undermine the WHO effort, separately announced that later this year it will train local scientists and send modular, shipping container–size vaccine factories to Ghana, Rwanda, and Senegal.

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In a setback to the global polio eradication campaign, a wild poliovirus has leapt from Pakistan to the African continent, where it has paralyzed a 3-year-old girl in Malawi(www.science.org/content/article/news-glance-african-n)

The case, announced on 17 February by the Malawi government, is the first wild polio case in the country since 1992. Pakistan and Afghanistan are the last two countries where the wild virus is endemic, which means circulation there has never stopped. Occasionally, however, the virus spills over from these entrenched reservoirs. Africa’s last known case of wild polio occurred in 2016 in Nigeria’s Borno state. The continent is still battling big outbreaks of vaccine-derived polio, however, which occur in areas of low immunization when the live but attenuated virus in the oral polio vaccine regains its ability to paralyse and spread.

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As people across the world grapple with the prospect of living with the coronavirus for the foreseeable future, one question looms large: How soon before they need yet another shot?

Not for many months, and perhaps not for years, according to a flurry of new studies (www.nytimes.com/2022/02/21/health/covid-vaccinel)

Three doses of a Covid vaccine — or even just two — are enough to protect most people from serious illness and death for a long time, the studies suggest.

“We’re starting to see now diminishing returns on the number of additional doses,” said John Wherry, director of the Institute for immunology at the University of Pennsylvania. Although people over 65 or at high risk of illness may benefit from a fourth vaccine dose, it may be unnecessary for most people, he added.

US Federal health officials have said they are not planning to recommend fourth doses anytime soon.

The Omicron variant can dodge antibodies produced after two doses of a Covid vaccine. But a third shot of the mRNA vaccines made by Pfizer-BioNTech or by Moderna prompts the body to make a much wider variety of antibodies, which would be difficult for any variant of the virus to evade, according to the most recent study, posted online last week.

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

5.5 million fatalities attributed to COVID-19; the latest health stories from around the world

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coronavirus Abstract lab tube with tag coronavirus in secret laboratory with red led-light. Novel coronavirus 2019-nCoV on blue background. Novel coronavirus outbreak concept. Image credit: 138814545_l / 123rf
Image credit: 138814545_l / 123rf

Virtually two years since the World Health Organisation (WHO) declared it a pandemic, COVID-19 has already accounted for close on 350 million cases and more than 5.5 million fatalities. The “good” news is that the faster it spreads these days, the lower its deaths. The Omicron variant appears to be a more benevolent avatar though even more infectious than ever before.

And some countries are going to extraordinary lengths, Canute-like, to keep the virus wave at bay. Not the least of them is China with its “zero-COVID” policy.

Anyang, with a population of 5.5 million — was locked down because of a coronavirus outbreak. Residents are already in lockdown in the cities of Xi’an and Yuzhou, bringing the number of people confined to their homes to about 20 million. 

As the 13 million residents of the city of Xi’an endure a third week of lockdown after a December 2021 outbreak, many Chinese are losing patience with the country’s “zero COVID” strategy. People expressed outrage on social media after a graphic 4 January post about a woman in her last month of pregnancy whose admission to a Xi’an hospital for abdominal pain was delayed because her most recent COVID-19 test was no longer valid; she had a stillbirth at the hospital entrance, blood pooling at her feet. (The original post has disappeared.) Authorities say the tough measures have nearly ended Xi’an’s outbreak, the worst in China since the disease broke out in Wuhan, in early 2020. Since 9 December 2021, Xi’an has logged more than 2,000 Delta variant infections, but on 10 January, it reported just 13 new cases. China has now detected its first community cases of the Omicron variant, sending more cities into lockdown and raising concerns about the impact on the Winter Olympic Games, starting on 4 February in Beijing. 

China’s COVID absolutism is making it a no-go zone for airlines;

China’s unbending approach to Covid-19 has left the world’s second-largest economy all but shut off from international travel, with fewer than 500 inbound flights scheduled this week, compared with about 10,000 this time two years ago. Capacity cuts are intensifying as China tries to snuff out virus flareups with aggressive lockdowns. Since mid-December, airlines have eliminated almost 1,000 flights that would have arrived in the country between now and Feb. 1, the start of the Lunar New Year — typically the busiest time for travel anywhere on the planet.

https://www.bloomberg.com/news/articles/2022-01-13/china-s-covid-absolutism-is-making-it-a-no-go-zone-for-airlines

Meanwhile Norway is scaling back some of its infection restrictions as it moves into a new phase of the pandemic. The Omicron variant has pushed infection rates to record highs, and the country now needs to ready itself to tolerate living with the virus, Prime Minister Jonas Gahr Store told reporters on Thursday. It isn’t possible to stop an Omicron-driven wave, but the likelihood of hospitalization is lower and vaccination provides adequate protection against serious sickness, he said. https://www.bloomberg.com/news/articles/2022-01-13/norway-eases-measures-as-it-prepares-to-live-with-omicron-wave

India has eased its COVID-19 rules on testing, quarantine and hospital admissions in a bid to free up resources for its neediest people, a strategy hailed by experts even though it carries the risk of a heavy undercount of infections and deaths. The moves will offer some breathing space for health care facilities, often overstretched in a nation of 1.4 billion, as they battle a 33-fold surge in infections over the past month from the highly contagious Omicron variant.

https://www.reuters.com/world/india/indias-new-covid-19-rules-aim-free-up-resources-carry-risks-2022-01-13/

And new COVID-19 infections in Indian cities such as capital New Delhi and Mumbai could peak very soon after rising rapidly, experts said on Thursday, as the country reported the highest number of daily cases since late May. The 247,417 new infections were more than 30 times higher daily cases from a month ago, rising as the more transmissible Omicron variant replaced Delta across the country. Total infections reached 36.32 million, behind only the United States. “Our modelling, and those of others, suggests that the big Indian cities should see their peaks in cases close to Jan. 20, while the overall peak in India may be shifted a bit later, to early February,” said Gautam Menon, professor of physics and biology at Ashoka University near the capital.

https://www.reuters.com/world/india/indias-daily-covid-19-cases-rise-by-247417-highest-since-may-2022-01-13/

With World No 1 Novack Djokovic finally deported for refusing to vaccinate, the Australian Open will have a winner that isn’t him or Roger Federer for the first time in eight years.

Federer is not attending while he recovers from a knee injury. Rafael Nadal is now the only member of “the big three” players to be at this year’s tournament.

Crowds at the main Australian Open tennis stadiums will be capped at 50% capacity under updated COVID-19 restrictions, organisers said on Thursday, as authorities battle a surge of cases in Melbourne. Face masks will also be mandatory for all patrons, except when eating or drinking, and there will be density limits of one person per two square metres at indoor hospitality venues. 

https://www.reuters.com/lifestyle/sports/australian-open-crowds-capped-50-capacity-due-covid-2022-01-13/

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Cuba’s prestigious biotech sector has developed five different COVID vaccines to date, including Abdala, Soberana 02 and Soberana Plus — all of which Cuba has said provide upwards of 90% protection against symptomatic Covid when administered in three doses. The country of roughly 11 million remains the only country in Latin America and the Caribbean to have produced a homegrown shot for COVID. The WHO’s potential approval of Cuba’s nationally produced COVID vaccines would carry “enormous significance” for low-income nations, John Kirk, professor emeritus at the Latin America program of Dalhousie University in Nova Scotia, Canada, said

https://www.cnbc.com/2022/01/13/why-cubas-extraordinary-covid-vaccine-success-could-provide-the-best-hope-for-the-global-south.html

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The history of the pandemic and more importantly the vaccines has been a tale of sharp contrasts with better-off countries accounting to much more than their fair share and the poorer ones barely getting a look in. The figures look impressive: 61% with one vaccine, accounting for 4.7 billion people and 52% with two shots. But looked at from the bottom end of the spectrum, only 14.4% of Africa has taken just one jab, the remaining 85.6% has had none at all! The risk of getting reinfected continues to remain as long as this gap isn’t narrowed or better still closed. Remember that Omicron grew in Southern Africa. 

So, hundreds of millions of COVID-19 vaccine doses purchased by wealthy countries are at risk of going to waste, a new analysis shows, while large parts of the world remain unprotected amid the spread of the Omicron variant. About 240 million doses purchased by the U.S., U.K., Japan, Canada and the European Union are expected to go unused and expire by March, London-based analytics firm Airfinity Ltd. said Thursday in a report. The number of potentially wasted doses could climb to 500 million by that point if other countries receiving donated doses don’t have enough time to administer them, it said. 

www.bloomberg.com/news/articles/2022-01-13/hundreds-of-millions-e

And at the other end of the spectrum, poorer nations last month rejected more than 100 million doses of COVID-19 vaccines distributed by the global programme COVAX, mainly due to their rapid expiry date, a UNICEF official said on Thursday. The big figure shows the difficulties of vaccinating the world despite growing supplies of shots, with COVAX getting closer to delivering 1 billion doses to a total of nearly 150 countries. “More than a 100 million have been rejected just in December alone,” Etleva Kadilli, director of Supply Division at U.N. agency UNICEF told lawmakers at the European Parliament. The main reason for rejection was the delivery of doses with a short shelf-life, she said.

www.reuters.com/business/healthcare-pharmaceuticals/more-than-100-million-covid-19-vaccines-rejected-by-poorer-nations/

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Surgeons announced last week they had performed the first transplant of a pig heart to a human. The 7 January surgery was a milestone for research on transplants between species, known as xenotransplantation. It’s still unclear how well or how long the heart will function, but researchers hope the technique can someday make up for a shortage in human organs for ailing patients. (www.science.org/content/article/news-glance-warmest-oceans-yet-pig-human-heart)

The procedure, done by a team at the University of Maryland School of Medicine (UMSOM), was a major test for several experimental innovations designed to keep the pig heart functioning in a human chest, including 10 genetic changes in the pigs, a novel immunosuppressant given to the recipient, and a cocaine-laced solution used to incubate the heart. 

The transplant recipient, 57-year-old David Bennett, had advanced heart failure and a type of arrhythmia called ventricular fibrillation. Because he had not taken steps to control his high blood pressure and other health problems, physicians at the University of Maryland Medical Centre and nearby institutions deemed him ineligible for a human heart transplant, says Muhammad Mohiuddin, director of the cardiac xenotransplantation program at UMSOM. 

Instead, with Bennett’s consent, the UMSOM team sought a “compassionate use” authorization from the U.S. Food and Drug Administration (FDA) to give him a heart from a genetically modified pig created by Revivicor, a biotech company. Mohiuddin and colleagues have worked with pig organs provided by Revivicor for years. In 2016, they reported that pig hearts could remain healthy for more than 2 years when transplanted into a baboon’s abdomen, and have since done transplants into baboons’ chests, where the hearts sustain life. In recent experiments, baboons relying on Revivicor’s pig hearts survived up to 9 months, Mohiuddin says. (Those primates died with functioning hearts after contracting lung infections unrelated to the transplant, he says.)

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

EU putting weight behind Ethiopia’s Tedros for a second term in WHO DG role

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Tedros 2.0?

German government sources told Reuters on 23 September that Berlin would officially nominate Tedros as the Director General (DG) of the World Health Organization (WHO) for the second time around and was seeking support from other European Union (EU) member states.

Geneva, Switzerland, 2020. World health organization (WHO) landing page & emblem. Specialized agency of United Nations responsible for public health

At least 17 EU states have said they would also submit his name for nomination, a Western diplomat said, adding: “I understand he is being nominated by other regions.”

As the deadline for nominations elapsed, diplomats said that they were unaware of any other names being put forward, suggesting that Tedros could stand unopposed in the May (2022) election.

Dr Tedros Adhanom Ghebreyesus, a former health and foreign minister of Ethiopia, elected as WHO’s first African DG in May 2017, has led the global fight against the seemingly relentless COVID-19 pandemic.

He has been shunned by his native Ethiopia due to friction over the Tigray conflict, making it necessary for other countries to step into the breach and submit his name for a second five-year term.

African countries broadly support Tedros who has championed their access to vaccines, but have not wanted to break ranks with Ethiopia, diplomats said. However, it is unlikely that they will desert his cause in the ultimate analysis, ending up being seen to have let down Africa’s first WHO chief.

Notably Dr Tedros has steered the UN agency through attacks on its handling of the crisis, which was sparked by COVID-19 that emerged in China in late 2019 and that has killed 4.75 million people so far.

While the Trump administration in the US accused Tedros of being “China-centric” all of last year, relations warmed with the Biden administration, especially after Tedros publicly said that further investigations were needed into the origins of the virus, including audits of China’s laboratories, diplomats said.

The United States has not opposed a fresh term for him, they add.

However, under the WHO process, envelopes are to remain sealed until after October 29, meaning it cannot be ruled out that a country might nominate another candidate. This is designed to limit campaigning too early.

The DG is the WHO’s chief technical and administrative officer.  The appointment of the next DG will take place at the Seventy-fifth World Health Assembly (WHA75) in May 2022. 

The election process began in April when the WHO secretariat invited the 194 member states to submit proposals for candidates for the DG’s position. The deadline for proposals was 23 September 2021. (www.who.int/about/governance/election)

Information on candidates, including the curricula vitae and other particulars of their qualifications and experience as received from member states, will be published following the closure of the last regional committee meeting of the year, shortly after 29 October 2021.

If there is more than one candidate, a second forum will be convened in March 2022, prior to WHA75 to allow for an interactive panel discussion between the candidates and member states.

At WHA75, the World Health Assembly will appoint the next DG by secret ballot.

A DG can be re-elected once. Therefore the incumbent (Tedros) is eligible to be proposed for a second term of five years. (510)

Upping the ante

The Director of the US Centers for Disease Control and Prevention (CDC) has set the proverbial cat among pigeons, reversing a recommendation of her panel of experts on COVID-19 booster shots. The Director, Dr Rochelle Walensky, went along with the experts endorsing booster shots for millions of older or otherwise vulnerable Americans, opening a major new phase in the US vaccination drive against COVID-19. However, she decided to make one recommendation that the panel had rejected. The panel on Thursday (23 September) voted against booster jabs to the 18-64 age group who are health care workers or have other jobs that puts them at increased risk of being exposed to the virus. (https://www.npr.org/2021/09/24/1040348413/cdc-director-backs-covid-booster-plan-and-makes-an-additional-recommendation?)

Walensky disagreed and put that recommendation back in, noting that such a move aligns with an FDA booster authorization decision earlier this week. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said in a statement late Thursday night.

Experts say getting the unvaccinated their first shots remains the top priority, and the panel wrestled with whether the booster debate was distracting from that goal.

All three of the COVID-19 vaccines used in the US offer considerable protection against severe illness, hospitalization and death, even with the spread of the extra-contagious Delta variant. But only about 182 million Americans are fully vaccinated, just 55% of the population and hospitals are full because people are not vaccinated.

Thursday’s decision represented a dramatic scaling back of the Biden administration plan announced last month to dispense boosters to nearly everyone to shore up their protection.

The booster plan marks an important shift in the nation’s vaccination drive. Britain and Israel are already giving a third round of shots over strong objections from the WHO that poor countries don’t have enough for their initial doses.

The CDC advisers expressed concern over the millions of Americans who received the Moderna or Johnson & Johnson shots early in the vaccine rollout. The government still hasn’t considered boosters for those brands and has no data on whether it is safe or effective to mix-and-match and give those people a Pfizer shot.

About 26 million Americans got their last Pfizer dose at least six months ago, about half of whom are 65 or older. It’s not clear how many more would meet the CDC panel’s booster qualifications.

CDC data show the vaccines still offer strong protection against serious illness for all ages, but there is a slight drop among the oldest adults. And immunity against milder infection appears to be waning months after people’s initial immunization.

An Indian Rebound?

And now here’s what could be a real role reversal with Indians coming to the aid of the Cowboys! There could be some consolation for vast swathes of unvaccinated people the world over amidst what seems to be vaccine profligacy on the part of the US and other countries plugging booster doses. Back in the reckoning after a crushing second COVID-19 wave that left thousands dead and hundreds of thousands of others seriously ill earlier this year, India says its vaccine manufacturers will resume exporting COVID-19 shots in October, potentially eliminating a major roadblock for global vaccine equity. Indian officials said the country’s producers could churn out one billion more coronavirus vaccine doses by the end of the year, but did not specify how many would be exported. (https://www.science.org/content/article/news-glance-india-s-covid-19-vaccine-exports?

The Serum Institute of India and other local producers had stopped exports at the government’s behest in the spring, when only about 2% of India’s population had been fully vaccinated and daily reported cases in the country soared to nearly 400,000. That deprived the COVID-19 Vaccines Global Access Facility of hundreds of millions of doses it had planned to distribute in lower and middle-income countries. (So far, India has exported fewer than 70 million doses.) Now some 15% of India’s population has become fully vaccinated, and daily new cases have fallen to about 30,000.