H5N1

COVID-19 cases in Japan top 200,000 for first time

Case counts up to July 22.

The surge in Japanese COVID cases has been sudden and alarming. Via The Japan Times: COVID-19 cases in Japan top 200,000 for first time. Excerpt:

Japan reported more than 200,000 new COVID-19 cases for the first time Saturday, shattering the daily record for the fourth straight day with 200,954 infections amid a seventh wave of infections driven by the BA.5 omicron subvariant.  

Single-day record caseloads were reported in 17 of the country's 47 prefectures, including Tokyo, which posted a daily figure above 30,000 for the third day in a row.  

The number of patients with severe symptoms rose by 12 from Friday to 203 across the country, the first figure at 200 or higher in three months, according to the health ministry. New deaths totaled 72, including nine each in Kanagawa, Osaka and Kumamoto prefectures.  

In Tokyo on Saturday, medical staff and elderly care workers also began receiving their fourth COVID-19 vaccinations after the government expanded its eligibility criteria in response to Japan's seventh wave of infections.  

Last week's decision to begin the vaccinations was aimed at ensuring enough medical and care workers are available when Japan is seeing record numbers of new cases driven by the BA.5 strain.  

Some medical institutions in the capital have been forced to limit the number of emergency patients they accept and scale back surgical procedures they conduct due to staff shortages caused by a spate of COVID-19 infections.  

Previously, the fourth dose was only available to people aged 60 and over and those between 18 and 59 with pre-existing conditions who are considered at higher risk of developing severe symptoms when infected with the virus.  

A study shows the fourth inoculation has relative efficacy for elderly people but may only provide marginal protection for younger people.  

The fourth vaccination is available at three mass vaccination sites, including the Tokyo Metropolitan Government building, for residents of the capital or people who commute into the city.  

A panel of health experts working under the health ministry said Friday fourth shots are effective to some extent in preventing the spread of the subvariant, citing clinical data.  

In the capital on Saturday, the daily count totaled 32,698 new cases, growing by 13,779 from a week before.  

The seven-day average of new infections rose to 23,068, the metropolitan government said. Seven deaths were reported.  

The number of coronavirus patients with severe symptoms under the metropolitan government's criteria came to 14, falling by one from the previous day.

Is the Covid pandemic finally nearing its end?

In The Guardian, Aris Katzourakis writes: Is the Covid pandemic finally nearing its end? Excerpt:

More than two years on from the realisation that we are dealing with a novel pandemic, we are still nervously wondering what comes next. In the UK, Covid infection rates appear to have fallen to their lowest level since the summer of 2021, as has the number of deaths the virus is causing, but we know that new variants are still likely to emerge. So when will the end of this pandemic come, and what might it look like?  

This is a very difficult question, because we won’t know we have passed the end of the pandemic until some time has elapsed. The expectation is that eventually the disease will reach endemic levels, meaning immunity in the population will balance out the reproduction of the virus, resulting in a stable level of infection year on year. That stability could include regular, repeatable fluctuations such as seasonality, but we won’t know that stability has been achieved unless the same pattern of infections is observed for more than one consecutive year.  

There are two big unknowns in attempting to determine how soon the end of the pandemic may arrive and what it might look like. The first is: how durable will our immunity be, particularly against severe disease but also against infection? And the second is: how fast will the Sars-CoV-2 virus evolve, in particular with respect to overcoming our immune defences? To answer these questions, we need to look at the lessons the pandemic has taught us so far.  

The year of the Sars-CoV-2 virus was very much 2020, when it caused high levels of mortality and disease, and changed lives around the world. We saw a virus transmit into humans and began to observe some evolution, but thanks to the relatively slow rate of evolution of Sars-CoV-2 compared with other RNA viruses, we did not observe much change beyond the immediate public health impact until the very end of the year, with the emergence initially of the Alpha, Beta and Gamma variants.  

Looking back, 2021 appears to have been the year of the variant. The Alpha variant rapidly displaced the initial strain of the virus: it was more transmissible and more likely to cause severe disease and death, necessitating far more robust public health responses including the reimposition of restrictions in the UK and elsewhere. The degree of adaptation was staggering; the Alpha variant was more than 50% more transmissible in humans compared with the original virus, a leap of adaptation that has never previously been observed in real time.  

The Beta and Gamma variants also displayed a degree of immune escape, a brief glimpse into the possibility that these viruses might be able to, at least in part, evade defences we had built against previous forms of the virus, whether by infection or vaccination. And of course, these variants were succeeded by the Delta variant, which was about 50% more transmissible than the Alpha variant, and also more severe, bringing another wave of disease and devastation.

Towards the end of 2021 we were hit by another variant, Omicron, which brought its own unique challenges and lessons in viral evolution. Omicron is highly evasive of the antibodies that vaccination and prior infection confer, and thereby can breach our immune defences. Fortunately, protection against hospitalisation and disease is not eroded to the same extent, though protection against severe disease has declined. And of course, Omicron is capable of reinfecting individuals who have previously been exposed to other forms of the virus. The idea that viral infection is a “one and done” risk – that you can get it over with by being infected – has well and truly been dispelled by Omicron. Thus, if 2021 was the year of the variant and the vaccine, 2022 so far appears to be the year of reinfection.

COVID-19 in North Korea: Workers' Party of Korea Central Committee Politburo Conference held

Via the Korea Central News Agency: Workers' Party of Korea Central Committee Politburo Conference held. Excerpt:

The Politburo of the Central Committee of the Workers' Party of Korea convened a meeting on May 14 at the headquarters of the Central Committee of the Workers' Party of Korea to check the operation status of the maximum emergency quarantine system and to reinforce practical political measures.  

Comrade Kim Jong -un, who is the general secretary of the Workers' Party of Korea , led the council. Members of the Standing Committee of the Politburo of the Central Committee of the Workers' Party of Korea and members of the Politburo of the Party Central Committee and candidate members participated in the meeting.  

Officials from the national emergency quarantine department and senior officials from the Ministry of Health attended.  

The Politburo first listened to the report of the National Emergency Response Command on the spread of the epidemic as of May 13.  

On May 13, 174,440 new cases of fever were reported nationwide, 81,430 recovered, and 21 died.  

From the end of April to May 13, the total number of sick people nationwide was 524,440, of which 234,630 were fully recovered, 288,810 were receiving treatment, and the number of deaths so far is 27.  

In the report, data on the spread of infectious diseases by region and unit and disease course characteristics were mentioned, and in most cases, it was notified that human casualties were caused due to negligence, including drug overdose, because scientific treatment methods were not well known.  

The Politburo discussed practical political measures to quickly suppress and manage the spread of infectious diseases across the country and secure strategic initiative.

Modeling transmission of SARS-CoV-2 Omicron in China

Via Nature Medicine: Modeling transmission of SARS-CoV-2 Omicron in China. The abstract:

Having adopted a dynamic zero-COVID strategy to respond to SARS-CoV-2 variants with higher transmissibility since August 2021, China is now considering whether and for how long this policy can remain in place. The debate has thus shifted towards the identification of mitigation strategies for minimizing disruption to the healthcare system in the case of a nationwide epidemic. 

To this aim, we developed an age-structured stochastic compartmental susceptible-latent-infectious-removed-susceptible (SLIRS) model of SARS-CoV-2 transmission calibrated on the initial growth phase for the 2022 Omicron outbreak in Shanghai, to project COVID-19 burden (i.e., number of cases, patients requiring hospitalization and intensive care, and deaths) under hypothetical mitigation scenarios. The model also considers age-specific vaccine coverage data, vaccine efficacy against different clinical endpoints, waning of immunity, different antiviral therapies, and non-pharmaceutical interventions. 

We find that the level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an Omicron wave that would result in exceeding critical care capacity with a projected intensive care unit peak demand of 15.6-times the existing capacity and causing approximately 1.55 million deaths. 

However, we also estimate that protecting vulnerable individuals by ensuring accessibility to vaccines and antiviral therapies, and maintaining implementation of non-pharmaceutical interventions could be sufficient to prevent overwhelming the healthcare system, suggesting that these factors should be points of emphasis in future mitigation policies.

COVID-19: It ain’t over ’til it’s over

Via Science, an editorial by Editor in Chief H. Holden Thorp: It ain’t over ’til it’s over. Excerpt:

The Biden administration is sheepishly waving a checkered flag on the pandemic. If you look closely, you can see its members cringing as they do so. 

Chief Medical Advisor Anthony Fauci told the PBS Newshour that the United States was “out of the pandemic phase” and then walked it back, saying he meant that the “acute compo­nent” of the pandemic phase was over. President Biden attended the likely superspreading White House Corre­spondents’ Dinner last weekend but skipped cocktails and the meal, opting to just give his talk. Fauci avoid­ed the whole affair. 

Meanwhile, Vice President Harris continued to isolate after her positive COVID-19 test, and many members of Congress and the administra­tion announced positive test results as well. All of this happened while the White House allowed a renegade federal judge in Florida (where else?) to end the nationwide mask mandate without much of a fight. 

These mixed messages have been emanating from the administration for months now, and although those with resources have tools to manage COVID-19, care needs to be taken that those without such means are not forgotten. 

When Biden pledged to “follow the science,” it was hard to imagine that the country could have ended up here. But the administration made a big bet that vaccines would provide sterilizing immunity and end the pandemic, allowing it to move on to other priorities. 

Leaving behind the insanity of ivermectin, hydroxy­chloroquine, and bleach was certainly a great step forward. However, evolution has had other plans, and variants of severe acute respiratory syndrome corona­virus 2 (SARS-CoV-2, the virus that causes COVID-19) have kept the pandemic going. This left the White House in a very tight spot: There was little political will to keep pushing nonpharmaceutical interven­tions, yet the pandemic was far from over. Add to this mounting inflation worries and concerns about the war in Ukraine, and the response has been a clumsy pivot to a message that politicians always turn to: personal responsibility. 

Get vaccinated, get boosted, wear a mask, get a prescription for the antiviral Pax­lovid—if you want to. This may be fine if you have a healthy immune system, great health insurance, and the ability to navigate the US health care system. But what about everyone else? 

COVID-19 is at a similar place to where the HIV/AIDS global pandemic was when the antiretroviral drugs came along. Yale epidemiologist Gregg Gonsalves told me about important parallels between both pandem­ics. “The HIV epidemic didn’t go away,” he said. “It just went to where people could ignore it. It went into the rural South, it went to communities that were already facing disparities in health.” 

At that time, confusion between medicine and public health was also an im­portant factor. “The discourse shifting to private choice and private adjudication of risk is really not what public health science is,” he said. “We work in populations. And if we’re talking about medicine, it’s about private risk and private choices.”

Coronavirus: Zhong Nanshan writes of eventual return to normal, but article deleted at home

Via the South China Morning Post: Coronavirus: China’s top expert writes of eventual return to normal, but article deleted at home.

This is a big deal. Zhong Nanshan is the grand old man of Chinese medicine, a veteran of H5N1 and SARS. His advice carries a lot of clout, but even he seems to have crossed a line. Excerpt:

China’s top Covid-19 expert Zhong Nanshan has said the country cannot pursue “dynamic zero-Covid” in the long term and should reopen to bring social and economic development back to normal, and adapt to global reopening.  

The editorial titled “Strategies for reopening in the forthcoming Covid-19 era in China” was published in the English-language National Science Review journal on April 6. A Chinese translated copy of the article was published on mainland news sites on Monday but has since been deleted.  

“China needs to reopen so as to normalise socio-economic development and adapt to global reopening. Prolonged dynamic zeroing cannot be pursued in the long run,” Zhong wrote with co-author Guan Weijie, an associate researcher with the State Key Laboratory of Respiratory Disease in Guangzhou.  

They said the community-based dynamic zero-Covid policy had been key in minimising Covid-19 cases and deaths in mainland China.  

“The rapid roll-out of vaccinations, as well as herd immunity, have formed the fundamentals of the ‘total opening’ of some developed countries. This, however, does not necessarily justify rapid and total opening in mainland China,” they wrote.  

“Omicron confers a considerably higher mortality risk than seasonal influenza, and would likely result in social instability and the emergence of other novel variants with a greater infectivity.”  

The scientists said that for China to “reopen in an orderly and effective manner”, the country should enforce nationwide vaccination, especially to protect the elderly, and boost with vaccines of different technologies, a method that has been used to “markedly enhance protection against the Omicron variant”.

COVID-19 in South Korea, March 2022

Here's a screenshot of the Johns Hopkins dashboard taken on February 28:

South Korea then ranked 8th in case counts, with 3.273 million cases and 1,303 deaths.  But 2.228 million cases had been recorded in the preceding 28 days. Something was already going wrong in a country that had done a pretty good job through 2020 and 2021.

And here's a screenshot taken this evening, after the March 31 case counts had been posted by the KDCA:

South Korea now ranks first in the world with 13,375,518 cases, of which 16,505 resulted in death. So an advanced, prosperous nation of 52 million has seen 10,102,069 of its citizens fall ill in 31 days. As well, 15,202 of them died in the same 31 days.

And this was the result of deliberate policy, as pointed out in a devastating article in The Korea Herald today. An excerpt: 

The rationale for the omicron plan is that the intensive social distancing of the delta days is “no longer viable nor cost-efficient,” according to the Health Ministry spokesperson on March 2. And as omicron is milder, doing so would pose little threat to the population.

Similarly, Jeong Eun-kyeong, commissioner of the Korea Disease Control and Prevention Agency, said at a March 21 briefing that “as there already has been substantial exposure in the community due to omicron’s high transmissibility, controlling the outbreak with social distancing alone will have significant limits.”

But the focus on social distancing eclipses what health officials should do without having to ask people to stay home and relive the intense isolation of the early pandemic days, according to public health professor Dr. Oh Ju-hwan of Seoul National University.

By using social distancing as a “blanket term” for pandemic control measures, health officials sold people on the idea that we no longer had to sacrifice freedoms to contain the virus, he said. “The narrative that social distancing is the only approach is misleading, and it’s been used as an excuse for authorities to do less of what they ought to be doing.”

With omicron’s rise, first to be abandoned were measures that exact the most administrative burdens, like extensive contact tracing and testing that Korea had prided itself on, he said. While quick to remove the no-cost testing-for-all policy and contact tracing, health officials kept social distancing restrictions, though eased, for the public. The cap on the size of personal gatherings and nighttime curfews for stores are still in effect, though they are anticipated to be removed soon.

Google mobility trends shows movements have been on a decline in Korea after omicron took over as the dominant virus in late January. Visits to retail and recreation facilities especially have fallen considerably compared to when the delta variant was raging across the country in the fall of 2021.

“When cases soar and hospitals fill up, people exercise caution voluntarily,” Oh said. “The mobility trends data demonstrates that the surge we’re seeing now is not in fact attributable to the lack of social distancing, as some officials and experts suggest.”

Although health officials like to emphasize the pains of social distancing, and how they are no longer sustainable, what was glaringly absent were efforts to test and trace cases and grasp the true scale of the outbreak, he said.

Active tracing was also crucial to “monitor variants, as letting the virus run amok in the community gives it more opportunities to evolve,” he said.

This policy seems to be what most governments are adopting now, including the US and Canada. I think we are going to see case counts on a Korean scale well before summer—and like South Korea, the true numbers will be even higher, because we won't be testing or contact tracing either.

Nor will we consider that 10 to 20 percent of these COVID-19 cases will evolve into long COVID, with consequences for millions of people who are now celebrating the end of "restrictions" like mask mandates.

Policy missteps, population density cause worst Omicron wave in Korea

I've been stunned by the COVID numbers coming out of South Korea this week, and now we have an explanation from The Korea Times: Policy missteps, population density cause worst Omicron wave in Korea: experts. The full report with my bolding, and then a comment:

The country's numbers of daily new COVID-19 infections, critical cases and deaths are ballooning to unprecedented levels as Korea enters the peak of the Omicron wave.  

The number of daily new infections for Wednesday hit an all-time high at 621,328, a 55-percent jump from 400,741 the previous day, according to the Korea Disease Control and Prevention Agency (KDCA). The agency added 429 COVID-19-related deaths ― also an all-time high ― while 1,159 patients were in critical condition.  

The health ministry viewed that the spike in infections was attributable to aggressive testing using rapid antigen tests conducted by medical personnel at clinics, which have identified "hidden infections" that have not been detected using only PCR tests.  

Until this Monday, only PCR tests conducted at screening centers had been included in the official daily infection tally, but now rapid antigen tests conducted by doctors and reported to the ministry are also recognized.  

The daily figures have gone far beyond the level the health ministry had anticipated, as it had previously projected that infections would peak at around 370,000 only.  

"We view that the wave is heading toward the peak, and will be reached within this week or early next week," said health ministry spokesman Son Young-rae during a briefing, Thursday.  

While yet to reach its peak, Korea's COVID-19 situation is already far worse than that of other countries during the worst of the Omicron waves there in January, according to figures from Our World in Data.  

In Korea, as of March 15, the number of daily new cases per 1 million people stood at 6,370.47, which is more than double of that of the United States when the Omicron wave there peaked at 2,423.66 on Jan. 16, and that of the United Kingdom (2,607.06 on Jan. 9), as well as higher than that of France at the pinnacle of the Omicron wave (5,356.76 on Jan. 24).

Local medical experts said there are multiple factors that led Korea into the current disaster, but pointed out that the government's quarantine measures in the last few weeks have been heading in the wrong direction.   

"The government began easing quarantine measures substantially as the March 9 presidential election drew nearer. There was no scientific or medical basis for these decisions. Rather, they were driven by political intentions," said Choi Jae-wook, a professor of preventive medicine at Korea University.  

He added, "It seemed like they were trying to appeal to the voters, who were tired of the social distancing measures, by giving them more freedom."  

Choi also criticized the authorities for continuing to downplay the severity of the Omicron variant, comparing it to the seasonal flu.  

"Omicron cannot be considered similar to the flu when the former is five to 10 times more contagious. And let me make something clear: the flu does not take the lives of 2,000 people in just three weeks, nor does it infect over 500,000 people per day," he explained.  

Chon Eun-mi, a respiratory disease specialist at Ewha Woman's University Mokdong Hospital, said there were two main reasons for the explosive number of infections here: the population density and the government's complacency.  

"Omicron has spread like wildfire, especially throughout the Seoul metropolitan area, where about half of population lives. Also, the government made a critical mistake at the beginning of the Omicron wave, relying too much on the high vaccination rate," she said.  

"It should have taken lessons from other countries that vaccines are not a panacea against Omicron. They may prevent patients from falling into critical condition, but the vaccines developed to this date have proven to have little effect in preventing Omicron infections," she said.

Unlike the health authorities who projected that the infections would peak by next week, the experts were more cautious.

"It's becoming more difficult to predict when the infections will peak because the government continues to relax the quarantine measures," Choi said, expressing deep concerns that the sheer numbers of new infections added each day will result in hundreds of daily fatalities in the next couple of weeks.

"To prevent further unnecessary suffering and deaths, the government must immediately admit its failure and provide accurate information about the severity of the current situation," he said.

Chon said, "As a doctor treating COVID-19 patients at the hospital, I don't understand why the government is not actively using oral antiviral treatments to prevent those in vulnerable groups from falling into severe condition. With more supplies to come, Paxlovid should be distributed to as many patients as possible in a timely manner."

The soaring Korean numbers are a prediction of our own in a few weeks. We may not live as densely packed together as they do, but many governments have relaxed "restrictions" when there is little or no evidence that it's wise to do so. 

It's going to be a very bad spring and summer, and it will be worse because of our governments' stupidity.

South Korea reports all-time high of 549,854 daily COVID-19 cases

Via Yonhap, an update to last night's post just below: S. Korea reports all-time high of 549,854 daily COVID-19 cases. Excerpt and then a comment:

SEOUL, March 16 (Yonhap) -- South Korea reported 549,854 new COVID-19 cases on Wednesday, setting a new daily record as the country battles through the worst wave of the virus sparked by the omicron variant.  

The all-time high was reported as of 9 p.m., with three hours left until the daily tally ends. The total will be announced the following morning.  

Seoul reported 128,385 cases, breaching 100,000-mark for the first time.  

Earlier Wednesday, the Korea Disease Control and Prevention Agency (KDCA) said the country added 400,741 daily COVID-19 infections, mostly locally transmitted, raising the total caseload to 7,629,275.  

It was an all-time high since South Korea reported the first COVID-19 case on Jan. 20, 2020, and a big jump from Tuesday's 362,338. The previous record high was 383,659 reported last Saturday.  

The daily count differs from 441,423 reported by South Korean media last night quoting a private data tracker, as the number had not removed overlapping and erroneous data that appears to have been caused after the government began to allow virus tests conducted at local clinics as official results, the KDCA said.  

The death toll from COVID-19 rose 164 to 11,052, with the fatality rate standing at 0.14 percent.  

The number of critically ill patients, seen as a key indicator in the pandemic response, reached another record high of 1,244, up 48 from the previous day.  

South Korea has seen its COVID-19 caseload spike since early this year, with the daily tallies surging from four digits to six digits in about three weeks last month.  

Despite the fast spread of the omicron, the government has been trying to take steps to regain normalcy to the most possible extent while keeping up the fight against the virus.

The omicron wave is heading toward its peak, which will be a critical point in the fight against the virus, Sohn Young-rae, a senior health ministry official, said.  

"If the peak is formed as predicted and the medical system can respond within the prepared range, I think this crisis will be the last major crisis in the overall response to COVID-19," Sohn said.  

"Either this week or next week, at the latest, will be the peak," Sohn added.

On Saturday, South Korea hit a record number of cases with 383,664. On Tuesday, another record, the country saw 441,423. And now over half a million. I expect that in the next few weeks we will see a comparable spike in cases here in North America. 

COVID-19 is in for the long haul

Here's a screenshot of this evening's Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

It's notable for several reasons. First, the US is now far back in the 28-day case count—seventh, behind Germany, South Korea, Russia, Vietnam, France, and Brazil.

 

Second, almost all the case and mortality numbers are likely severe undercounts, since so many countries have simply abandoned any pretence of testing and contact tracing. I would not be shocked if the true number of cases were around 1.5 billion, and deaths close to 20 million.

 

The numbers for Russia (3.7 million cases in the last 28 days, 20,000 deaths) and Ukraine (458,000 cases, 3,800 deaths) are especially implausible, given the events of the past 15 days. But we'll surely see an explosive growth in cases as over 2 million Ukrainians move through Europe in search of refuge.

 

The early-success countries have largely succumbed to Omicron. While China pursues its zero-COVID policy, it's still recorded 539,000 cases and 2,600 deaths. Hong Kong has seen 533,000 cases in 28 days, and 2,600 deaths. Vietnam racked up 26 million cases in the last 28 days, and 2,400 deaths. New Zealand had 267,000 cases and 12 deaths; it had only 38,900 cases in the previous 23 months of the official pandemic.

 

The graphs on the right tell us that the Omicron spike has fallen sharply from its peak of 23,333,000 in the week ending January 23; we're now at 10,706,000 as of the week ending March 6. That looks impressive, but it's still about 5 million more than the three previous waves.

 

Omicron also drove a spike in deaths, peaking at 75,000 in the week of February 13 and now fallen to 50,400. Meanwhile, vaccinations have fallen from a recent high of 257,000 in the week of February 6 to 105,600 in the week ending March 6.

 

Yet many countries are effectively declaring the pandemic over, making masks and distancing optional, junking vaccine passports, and dropping regular reports by public health officials. Governments seem to think COVID-19 can now sink back into the background noise with other diseases, while we turn our attention to war and inflation and the next election.

 

On February 1, Johns Hopkins reported 381,232,070 cases, so we have seen almost 72 million cases of COVID-19 in the past six weeks alone. Even if the Omicron spike continue to drop, the next six weeks will see tens of millions more cases, and likely another 40 or 50 thousand people now alive will be dead before May 1. 

 

We are nowhere near the end of the pandemic. In fact, I expect it will in many ways get worse as healthcare systems really do collapse, and as sequelae like Long COVID affect more and more cases. The pandemic that began two years ago really is in the for long haul.