H5N1

COVID: Omicron is unstoppable now

Via Deutsche Welle: COVID: Omicron is unstoppable now. Excerpt, with my bolding:

So, that's that: It won't be a Merry Christmas after all.  

It's only a matter of time before we're hit by the full force of omicron infections — a case of, "not if, but when." And that when won't take long. That's what three of Germany's top researchers said during a virtual nationwide press briefing Wednesday (15.12.2021).    

Christoph Neumann-Haefelin, an immunologist at the University Medical Center Freiburg, said omicron will likely become the dominant variant of the coronavirus, SARS-CoV-2, by mid-January — superseding the delta variant, which until now has been one of the most infectious strains since the COVID-19 pandemic began.  

Neumann-Haefelin predicts that infection rates will shoot up dramatically — possibly to hundreds of thousands per day.   

That dark prognosis is based on international data that German researchers have been studying. Take for instance the United Kingdom, where omicron infection rates are doubling every two to three days.  

Dirk Brockmann, a physicist at Humboldt University of Berlin, says that's a factor of three-to-four-times higher than infection rates with previous variants.  

Experts in the UK estimate new omicron infections could shoot up to as many as 400,000-to-700,000 cases per day.  

They think it's possible that 20-34 million people could become infected with omicron between now (December 2021) and April 2022 — that's about half of the UK population — despite reinforced rules on social distancing, medical masks, school closures and more.  

"I'd be surprised if we didn't see a similar situation here in Germany," said Brockmann.  

Governments must act now  

Brockmann says politicians have to act immediately, setting up emergency plans for a range of scenarios and then putting them into action.  

"We have to slow the spread of the virus to limit the damage," according to Brockmann. But, he admits, it will be impossible to stop it outright.  

Germany's experts say communities will have to reduce social contacts and people's movements drastically, similar to what they did in the very first lockdowns.  

"But we'll have to do a whole lot more given the speed with which this variant is spreading," Brockmann said.

Growth, population distribution and immune escape of Omicron in England

Via the MRC Centre for Global Infectious Diseases: Report 49 - Growth, population distribution and immune escape of Omicron in England. If I'm reading this correctly, Omicron is no "milder" than Delta. That is very worrying news. The summary, with my bolding:

To estimate the growth of the Omicron variant of concern (1) and its immune escape (2–9) characteristics, we analysed data from all PCR-confirmed SARS-CoV-2 cases in England excluding those with a history of recent international travel. We undertook separate analyses according to two case definitions. For the first definition, we included all cases with a definitive negative S-gene Target Failure (SGTF) result and specimen dates between 29/11/2021 and 11/12/2021 inclusive. For the second definition, we included cases with a positive genotype result and specimen date between 23/11/2021 and 11/12/2021 inclusive. We chose a later start date for the SGTF definition to ensure greater specificity of SGTF for Omicron.  

We used logistic and Poisson regression to identify factors associated with testing positive for Omicron compared to non-Omicron (mostly Delta) cases. We explored the following predictors: day, region, symptomatic status, sex, ethnicity, age band and vaccination status. Our results suggest rapid growth of the frequency of the Omicron variant relative to Delta, with the exponential growth rate of its frequency estimated to be 0.34/day (95% CI: 0.33-0.35) [2.0 day doubling time] over the study period from both SGTF and genotype data. The distribution of Omicron by age, region and ethnicity currently differs markedly from Delta, with 18–29-year-olds, residents in the London region, and those of African ethnicity having significantly higher rates of infection with Omicron relative to Delta.  

Hospitalisation and asymptomatic infection indicators were not significantly associated with Omicron infection, suggesting at most limited changes in severity compared with Delta.  

To estimate the impact of Omicron on vaccine effectiveness (VE) for symptomatic infection we used conditional Poisson regression to estimate the hazard ratio of being an Omicron case (using SGTF definition) compared with Delta, restricting our analysis to symptomatic cases and matching by day, region, 10-year age band, sex and ethnicity. We found a significant increased risk of an Omicron case compared to Delta for those with vaccine status AZ 2+weeks post-dose 2 (PD2) , Pfizer 2+w PD2, AZ 2+w post-dose 3 (PD3) and PF 2+w PD3 vaccine states with hazard ratios of 1.86 (95%CI: 1.67-2.08), 2.68 (95%CI: 2.54-2.83), 4.32 (95%CI: 3.84-4.85) and 4.07 (95%CI: 3.66-4.51), respectively, where PD3 states are categorised by the dose 1/2 vaccine used. Depending on the Delta VE estimates used (10), these estimates translate into Omicron VE estimates of between 0% and 20% PD2 and between 55% and 80% PD3 against Omicron, consistent with other estimates (11). Similar estimates were obtained using genotype data, albeit with greater uncertainty. 

To assess the impact of Omicron on reinfection rates we relied on genotype data, since SGTF is associated with a higher observed rate of reinfection, likely due to reinfections typically having higher Ct values than primary infections and therefore being subject to a higher rate of random PCR target failure.  

Controlling for vaccine status, age, sex, ethnicity, asymptomatic status, region and specimen date and using conditional Poisson regression to predict reinfection status, Omicron was associated with a 5.41 (95% CI: 4.87-6.00) fold higher risk of reinfection compared with Delta. This suggests relatively low remaining levels of immunity from prior infection.

With too few nurses, it won't take much to overwhelm hospitals this winter

Via The Pew Charitable Trusts: With Too Few Nurses, It Won't Take Much to Overwhelm Hospitals This Winter. Excerpt:

Nurse Hannah Drummond routinely must watch patients for hours as they lie in the emergency department, waiting for a hospital bed upstairs. That includes patients so ill they use breathing machines or need hospice or intensive care, she said.    

There often aren’t enough nurses to staff every bed at the Asheville, North Carolina, hospital where she works, Drummond said.  

“We are barely holding it together now,” she said. “If we have an uptick in [COVID-19] cases—yeah. I have to honestly not think about it, or I cannot sleep at night.”  

Even as a new COVID-19 variant starts to spread in the United States, staff shortages have made it impossible for many hospitals to operate at full capacity. That means they’re less prepared to manage an influx of patients this winter, whether those patients have complications from COVID-19 or other significant health problems.  

Hospitals nationwide are canceling nonemergency surgeries, struggling to quickly find beds for patients and failing to meet the minimum nurse-patient ratios experts recommend. Some even have had to turn away critical patients. While hospitals are under the most strain in Midwestern and Northeastern states where COVID-19 cases are surging, workforce shortages also are creating problems in Southern states where cases are relatively low—for now.  

Hospitals employ about 2% fewer people today than they did in March 2020, according to the federal Bureau of Labor Statistics. That may not seem like much, but for many facilities, it makes a big difference. Crucially, experienced nurses have been quitting in search of better pay, less stressful jobs and more time with their families. In some cases, they've also sought to avoid required COVID-19 vaccinations.  

Last month, about 4% fewer hospital beds were staffed in Michigan than in November 2020, when 21,071 were staffed, according to the Michigan Health and Hospital Association, which advocates for hospitals in the state.   

In upstate New York, hospital capacity has shrunk by 10%, The New York Times recently reported. And about 9% fewer intensive care beds were staffed in Colorado last month than the same time last year, according to state data.  

A travel nurse at a Midwestern hospital, who asked to remain anonymous for fear of retaliation from her employer, said that as she moves around the facility, she passes scores of beds that have been blocked off.  

“Every single floor, at least, has like five beds that are blocked,” she said. Rooms will be closed even when many people are waiting in the emergency room for admission to that unit, she said, because the hospital doesn’t have enough nurses to staff every bed.   

Short-staffed hospitals will be less able to add beds during a surge of COVID-19 or other respiratory viruses this winter.

ECDC: Assessment of the further emergence of the SARS-CoV-2 Omicron VOC in the context of the ongoing Delta VOC transmission in the EU/EEA, 18th update

ECDC has published an Assessment of the further emergence of the SARS-CoV-2 Omicron VOC in the context of the ongoing Delta VOC transmission in the EU/EEA, 18th update. Excerpt from the executive summary:

Although current data on the severity of the infection associated with the Omicron VOC remain limited, evidence to date raises concern that the Omicron VOC may be associated with a significant reduction in vaccine effectiveness against SARS-CoV-2 infection. Even in the case of lower infection/disease severity with the Omicron VOC, a steep, exponential increase in cases caused by the Omicron VOC will result in a growing number of cases with severe disease.  

As EU/EEA countries are still facing the severe impact of the Delta VOC wave, a further rise in hospitalisations could quickly overwhelm healthcare systems. We therefore assess the impact of the spread of the Omicron VOC as VERY HIGH.  

Based on the limited evidence currently available, and given the high level of uncertainty, the overall level of risk to public health associated with the further emergence and spread of the SARS-CoV-2 Omicron VOC in the EU/EEA is assessed as VERY HIGH.

Our long night of the virus

The Tyee has published my long review of four important new books about the pandemic: Our Long Night of the Virus. Excerpt:

The pandemic and climate change, combined, have triggered what [Adam] Tooze calls a “great acceleration,” when events outrun earlier predictions and solutions. We will therefore have to improvise new solutions — or, like the populists, stick to a very old non-solution of anti-science white supremacy in the hope of returning to the “before times.” 

The imperial infection  

Rupa Marya, an American physician of Indian descent, and Raj Patel, a British academic, journalist and author, offer a solution from the before times in their book Inflamed: Deep Medicine and the Anatomy of Injustice. They argue that this pandemic, like countless disease outbreaks before it, is a consequence not just of a virus but of an imperialist world order that triggered disease and then built a medical system to serve the rulers, not the victims.  

This is not some radical Marxist spin, but established medical history. In the early 19th century, British development turned wetlands into farmlands in what is now Bangladesh, and brought a marine bacterium called Vibrio cholera into human guts. Cholera rapidly migrated on trade routes to London and beyond.  

In London, Dr. John Snow founded modern epidemiology by spotting the precise well that was infecting the neighbourhood. His medical colleagues dismissed his idea, but eventually Britain rebuilt its water supply system and greatly improved its workers’ health. Travellers from India were screened at Suez to try to stop further outbreaks from reaching Europe. But like Omicron, cholera was all over the planet by the time it was recognized.  

Meanwhile, cholera was left to ravage India itself, and we are now in the seventh cholera pandemic, which began in Indonesia in 1961 and most recently exploded in Haiti in 2010.  

Marya and Patel are by far the most radical analysts of this pandemic. They have no interest in blaming Donald Trump or the CDC; they are just the agents of a system created to serve the interests of 19th century empires, and which now protects the white heirs of those empires while ignoring the “essential” workers who serve those heirs.  

The authors have strong confirmation from others like Alex de Waal, whose recent book shows how Louis Pasteur’s germ theory defeated the German scientist-politician Rudolf Virchow, who had long argued for social and economic inequality as the root of disease outbreaks. Pasteur had blamed individual microbes, which could be isolated, fought and defeated like rebellious tribesmen in some remote colony. We still fall back on war metaphors to describe our response to the pandemic.

Tracking universal health coverage: 2021 global monitoring report

Via ReliefWeb: Tracking Universal Health Coverage: 2021 Global Monitoring Report. Excerpt:

DUBAI/GENEVA/WASHINGTON DC — 12 December 2021 — New evidence compiled by the World Health Organization and the World Bank shows that the COVID-19 pandemic is likely to halt two decades of global progress towards Universal Health Coverage. The organizations also reveal that more than half a billion people are being pushed into extreme poverty because they have to pay for health services out of their own pockets.  

The findings are contained in two complementary reports, launched on Universal Health Coverage Day, highlighting the devastating impact of COVID-19 on people’s ability to obtain health care and pay for it.  

In 2020, the pandemic disrupted health services and stretched countries’ health systems beyond their limits as they struggled to deal with the impact of COVID-19. As a result, for example, immunization coverage dropped for the first time in ten years, and deaths from TB and malaria increased.  

The pandemic also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for care. Even before the pandemic, half a billion people were being pushed (or pushed still further) into extreme poverty because of payments they made for health care. The organizations expect that that number is now considerably higher.  

“There is no time to spare,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.”  

He added: “Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage.”  

The new WHO/World Bank reports also warn that financial hardship is likely to become more intense as poverty grows, incomes fall, and governments face tighter fiscal constraints.

At least one person in UK has died with Omicron, says Boris Johnson

Via The Guardian: At least one person in UK has died with Omicron, says Boris Johnson. Excerpt:

At least one person in the UK had died with the Omicron variant, Boris Johnson has said as he refused to rule out imposing further restrictions across England in the run-up to Christmas. 

Following a warning from Britain’s top health officials revealed by the Guardian that the government has been advised “stringent national measures” needed to be imposed this week, the prime minister said he would “take whatever steps are necessary to protect public health”.  

Concern is mounting among scientists and in Whitehall that the Omicron variant could soon become the dominant Covid strain, weakening the defences two vaccines offer against the virus.  

Pressed several times about whether a “plan C” of further restrictions would be necessary, Johnson said: “Throughout the pandemic I’ve been at great pains to stress to the public that we have to watch where the pandemic is going and we take whatever steps are necessary to protect public health.  

“We think the steps that we are taking – so plan B, combined with a hugely ambitious acceleration of the booster campaign, bringing it forward by a month so we offer a booster to every adult by the end of the year – we think that’s the right approach.”

UK has Omicron Covid patients in hospital, government confirms

Via The Guardian: UK has Omicron Covid patients in hospital, government confirms. Excerpt:

People have been admitted to hospital with the Omicron variant in Britain, a government minister has confirmed, as a senior public health adviser said further curbs may be needed.  

The education secretary, Nadhim Zahawi, said he could confirm there were “cases in hospital with Omicron”. “We’ve been able to test people who are in hospital over the past two weeks, and so there is a lag to hospitalisation,” he told Trevor Phillips on Sky News.  

Speaking to the BBC, Susan Hopkins, the chief medical adviser of the UK Health Security Agency, said hospitals were diagnosing Omicron in an increasing number of people coming into emergency departments and that the numbers in hospital were expected to increase.  

No deaths have been reported so far from Omicron, although it is just over two weeks since the variant was first detected in the UK, and there is normally a time lag of three to four weeks between infection and death, should that happen. “I think it’s too early to make any assumption at this point in time,” Hopkins said.  

Hopkins said it was “inevitable that we’re going to see a big wave of infections” but that it was not yet clear how many of these cases would be severe.  

The reports follow a warning on Saturday from leading scientists that a failure to impose tougher Covid restrictions could lead to a further 25,000 to 75,000 deaths – or 175,000 to 492,000 hospital admissions – over the next five months. The researchers, based at the London School of Hygiene and Tropical Medicine, predicted that a massive wave of infections was likely to sweep the nation in January.