H5N1

China’s rolling COVID waves could hit every six months — infecting millions

Via Nature: China’s rolling COVID waves could hit every six months — infecting millions. Excerpt:

The latest surge in COVID-19 cases in China is not surprising to researchers, who say that China will see an infection cycle every six months now that all COVID-19 restrictions have been removed and highly infectious variants are dominant. But they caution that rolling waves of infection carry the risk of new variants emerging.  

“Unfortunately, a new reality with this virus [is that] we will have repeated infections,” says Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “The fear is that this virus will produce a new variant that can compete with the current ones and is more severe.”  

The current surge is caused mainly by a highly infectious subvariant of Omicron called XBB.1.5, first identified in India last August. According to Nanshan Zhong, a prominent respiratory physician in China, as many as 65 million people could become infected per week by the end of June.  

This is the first major reinfection wave that China has seen since the central government dropped all its COVID-19 control measures in December, prompting a widespread Omicron outbreak.  

China has vaccinated more than 90% of its population, and the outbreak in December infected at least 85% of its people, says Zhong. But immunity is waning, and XBB can evade protection from vaccines and prior infections. Mokdad says that, although XBB has not caused a major rise in hospitalizations and deaths, the sheer number of infections could put pressure on China’s health-care system.  

XBB is also causing minor waves in other parts of the world, such as Singapore and the United States.  

“This is what we see everywhere, but with a large population such as China, it is more apparent,” says Mokdad.  

Yunlong Cao, an immunologist at Peking University in Beijing, and his team have found that antibodies generated against Omicron variants BA.5 and BF.7, the dominant strains during the December wave in China, can provide about four months of protection against strains such as XBB.  

Kayoko Shioda, an epidemiologist at Boston University in Massachusetts, says that previous COVID-19 surges in other countries have shown that XBB is more transmissible than earlier forms. “Once it enters the population, XBB spreads and becomes the predominant variant much quicker than other variants,” she says.  

Last December, more than 200 million people in China contracted COVID-19 in 20 days. This time, the wave is spanning several months, owing to the differences in people’s immune backgrounds, such as antibody levels, says Cao.  

“The peak of COVID-19 waves will generally become flatter and more stretched out after each cycle, which is a pattern we see in countries like the US. People are still getting infected in the US, just not all at once,” he adds. A flatter wave would also lessen the burden on health-care systems, Cao says.

WHO: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals

A WHO news release: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals. Excerpt:

WHO is releasing the 2023 edition of its annual World Health Statistics report with new figures on the impact of COVID-19 pandemic and the latest statistics on progress towards the health-related Sustainable Development Goals (SDGs).  

The report with data up to 2022 underscores a stagnation of health progress on key health indicators in recent years compared with trends seen during 2000-2015. It also alerts us to the growing threat of noncommunicable diseases (NCDs) and climate change, and calls for a coordinated and strengthened response.  

COVID-19 cost in lost lives and health progress  

The report documents updated statistics on the toll of the pandemic on global health, contributing to the ongoing decline in progress towards the SDGs. During 2020-2021, COVID-19 resulted in a staggering 336.8 million years of life lost globally. This equates to an average of 22 years of life lost for every excess death, abruptly and tragically cutting short the lives of millions of people.  

Since 2000, we saw significant improvements in maternal and child health with deaths falling by one-third and one-half, respectively. The incidence of infectious diseases such as HIV, tuberculosis (TB) and malaria also declined, along with a lowered risk of premature deaths from NCDs and injuries. Together, these contributed to an increase in global life expectancy from 67 years in 2000 to 73 years in 2019.  

However, the pandemic has put many health-related indicators further off-track and contributed to inequalities in access to high-quality health care, routine immunizations and financial protection. As a result, improving trends in malaria and TB have been reversed, and fewer people were treated for neglected tropical diseases (NTDs).  

“The World Health Statistics is WHO’s annual check-up on the state of the world’s health. The report sends a stark message on the threat of noncommunicable diseases, which take an immense and increasing toll on lives, livelihoods, health systems, communities, economies and societies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “The report calls for a substantial increase in investments in health and health systems to get back on track towards the Sustainable Development Goals.”

COVID's future: Mini-waves rather than seasonal surges

Via Nature: COVID's future: mini-waves rather than seasonal surges. Excerpt:

Whether you call it a surge, a spike, a wave or perhaps just a wavelet, there are signs of a rise in SARS-CoV-2 infections — again. A growing proportion of tests in some countries are coming back positive, and new variants, most notably a lineage called XBB.1.16, are pushing aside older strains, fuelling some of the uptick in cases.  

Welcome to the new normal: the ‘wavelet’ era. Scientists say that explosive, hospital-filling COVID-19 waves are unlikely to return. Instead, countries are starting to see frequent, less deadly waves, characterized by relatively high levels of mostly mild infections and sparked by the relentless churn of new variants.

Wavelets don’t always create a dramatic spike in hospitalizations and deaths; their effects on health vary between countries. But the relentless series of wavelets looks very different from the slower, annual circulation patterns of influenza and cold-causing coronaviruses, and it seems increasingly unlikely that SARS-CoV-2 will settle into a flu-like rhythm anytime soon, say scientists.  

“We haven’t slowed down in the last year, and I don’t see what factors would cause it do so at this point,” says Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Center in Seattle, Washington. “It will be a continually circulating respiratory disease. It may be less seasonal than things we’re used to.”  

Victorious variant  

In March, scientists in India started seeing signs that a new SARS-CoV-2 variant was causing a rise in infections. The XBB.1.16 lineage has displaced others that drove case surges in India several months ago, says Rajesh Karyakarte, a microbiologist at Byramjee Jeejeebhoy Government Medical College in Pune, India. “We see that it has almost replaced all other variants in India, and we think the same thing will be followed everywhere.” 

In a study posted to the medRxiv.org preprint server, Karyakarte and his colleagues analysed more than 300 cases, from last December to early this month, and found that XBB.1.16 infections tend to cause mild symptoms similar to those from earlier Omicron variants, with few hospitalizations and deaths. “We didn’t see much,” Karyakarte says. The study has not yet been peer reviewed.

The World Health Organization declared XBB.1.16 a ‘variant of interest’ on 17 April. But whether it or another new variant will cause a spike in infections in a particular country will probably depend on the size and timing of the country’s earlier waves, says Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven in Belgium.

Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic

Via the Canadian Institute for Health Information: Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic. Excerpt:

The second year of the pandemic saw a surge of hospitalizations for COVID-19 and other infections among Canadian children age 0 to 4. Data from the Canadian Institute for Health Information (CIHI) shows that COVID-19 was the sixth most common reason kids in this age group were hospitalized in 2021–2022. This represents an increase of more than 600%, with a total of 2,315 COVID-19 hospitalizations among this cohort in 2021–2022 compared with 325 hospitalizations in 2020–2021. See Inpatient Hospitalization, Surgery and Newborn Statistics, 2021–2022 (XLSX).  

CIHI’s report shows that in addition to an increase in hospitalizations for COVID-19, respiratory infections (including pneumonia) and other viral infections returned as top 10 diagnoses that required hospitalization for Canadians age 0 to 4 in 2021–2022. The increase in hospitalizations for virus-related illnesses coincided with the easing of public health measures across the country.  

“This uptick in hospitalizations for COVID-19, respiratory infections and other viral illnesses seen among the youngest Canadians in the second year of the pandemic is concerning both for the health of our youngest and most vulnerable, and for the additional strain placed on health systems and health care workers that were already stretched thin,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We are continuing to monitor hospital activity in this third year of the pandemic to understand the ongoing impacts of COVID-19 on Canadians.”  

COVID-19 continued to present challenges for Canadians of all ages and was the second most common reason for hospitalization in Canada in 2021–2022, jumping from seventh in 2020–2021. This represents an increase of more than 60%, with a total of 77,344 hospitalizations in 2021–2022 compared with 47,715 hospitalizations in 2020–2021.

Long Covid in the United States

Via NBER: Long Covid in the United States. Click through to download the full report as a PDF. The abstract:

Although yet to be clearly identified as a clinical condition, there is immense concern at the health and wellbeing consequences of long COVID. Using data collected from nearly half a million Americans in the period June 2022-December 2022 in the US Census Bureau’s Household Pulse Survey (HPS), we find 14 percent reported suffering long COVID at some point, half of whom reported it at the time of the survey.  

It peaks in midlife in the same way as negative affect. Ever having had long COVID is strongly associated with negative affect (anxiety, depression, worry and a lack of interest in things). The effect is larger among those who currently report long COVID, especially if they report severe symptoms.  In contrast, those who report having had short COVID report higher wellbeing than those who report never having had COVID.  

Long COVID is also strongly associated with physical mobility problems, and with problems dressing and bathing. It is also associated with mental problems as indicated by recall and understanding difficulties. Again, the associations are strongest among those who currently report long COVID, while those who said they had had short COVID have fewer physical and mental problems than those who report never having had COVID.  

Vaccination is associated with lower negative affect, including among those who reported having had long COVID.

How deadly was China’s Covid wave?

Via The New York Times: How Deadly Was China’s Covid Wave? Excerpt:

After China relaxed the world’s most stringent Covid-19 restrictions in December, the virus exploded. Hints of the surge were everywhere: Hospitals turned away patients. Crematories were overwhelmed with bodies. A wave of top scholars died.  

But China’s official Covid death toll for the entire pandemic remains strikingly low: 83,150 people as of Feb. 9. That number is a vast undercount, researchers believe, in part because it only includes infected people who died in hospitals, excluding anyone who died at home.  

While a precise accounting is impossible, epidemiologists have been working to piece together the mystery of the outbreak that accelerated in December. Four separate academic teams have converged on broadly similar estimates: China’s Covid wave may have killed between a million and 1.5 million people.  

All of the researchers consulted by The New York Times cautioned that without reliable data from China, the estimates should be understood as informed guesses, with significant uncertainty — although the estimates fit the evidence far better than the official figures do.  

The question of how many people died has enormous political relevance for the ruling Communist Party. Early in the pandemic, China’s harsh lockdowns largely kept the coronavirus at bay. Xi Jinping, the top leader, has portrayed that earlier success as evidence of China’s superiority over the West, a claim that would be hard to maintain with a high death toll.  

The differences between China’s figures and researchers’ estimates are dramatic. The official numbers would give China the lowest death rate per capita of any major country over the entirety of the pandemic. But at the estimated levels of mortality, China would already have surpassed official rates of death in many Asian countries that never clamped down as long or as aggressively. 

At the same time, China would rank below Germany, Italy, the United States and other countries where outbreaks accelerated before vaccines became available.  

Two of the estimates were in papers published in academic journals or posted for peer review, while two other analyses were shared by epidemiologists in response to queries from The Times.  

Researchers used a variety of approaches to gauge how many people may have been infected and — a crucial question — how effective China’s homegrown vaccines were at preventing death. Some drew on how the virus behaved in past outbreaks in Hong Kong and Shanghai, where data was more reliable, and a few used detailed computer models to simulate the epidemic.  

Still others turned to official sampling data, based on China’s systematic testing of hundreds of thousands of people, to develop a model that estimated deaths to be far beyond the government's tally.  

“If the data say what we think they say, this was an explosive wave,” said Lauren Ancel Meyers, a professor of biology and statistics at the University of Texas at Austin.

Goodbye, Johns Hopkins covid tracker

Via The Washington Post: Goodbye, Johns Hopkins covid tracker. Excerpt:

When the pandemic hit, the federal government struggled to publish snapshots of the virus’ spread.  

So, academics and journalists quickly filled the void, creating new tools with near real-time estimates of the unfolding pandemic. Since January 2020, Johns Hopkins University has operated one of the most prominent resources for tracking covid-19 case counts and deaths across the world.   

After more than three years, the university will stop updating its tracker on March 10 as the country has moved into a different stage of the pandemic with a different data flow. But the story of the online dashboard — a $13 million project that’s been viewed over 2.5 billion times — is more than just about a tool to track the pandemic. It underscores the country’s fragmented public health systems and its decentralized and underfunded reporting system, which hobbled the U.S. pandemic response.    

“The thing that became the biggest surprise was the importance and reliance on it by everyone: by the general public and decision-makers and everyone in between,” said Lauren Gardner, the director of the Johns Hopkins Center for Systems Science and Engineering who started the global tracker with one of her PhD students.  

“Hopkins filled a gap that nobody else was able to do,” Ali Mokdad, a professor of health metrics sciences at University of Washington’s IHME. “So all of us, reporters, us in academia, we went to Hopkins to get the data.”  

Why now?  

The Johns Hopkins researchers point out that they don’t believe the pandemic has ended — and the move to stop updating the tracker shouldn’t be conflated as such. Instead, the decision comes amid a different phase of the pandemic and was made for two main reasons.   

The first: The Centers for Disease Control and Prevention and the World Health Organization have built up their capacity to share covid data with the general public, which Gardner called the “appropriate” entities to be providing this information long term.   

The second: The quality of the tracker depends on the quality of publicly available data. At the beginning of the pandemic, states, counties and even cities were providing daily covid updates, which scrapers for the tracker could collect data from. But that’s not the case anymore, and that has a direct impact on what the dashboard can do.   

Looking forward  

The country has made some improvements on its data collection efforts, but there’s still a ways to go, according to several experts.   

Beth Blauer, an associate vice provost at Johns Hopkins University who helped run the Coronavirus Resource Center, said that many states closed up their covid reporting with little information on any next steps.  

“Our big question is whether or not they’re making long-term investments in critical public health data infrastructure to navigate lots of challenges that they face,” Blauer said, citing the opioid epidemic and economic mobility. 

Fixing the crisis in public health

The Tyee has published my article Fixing the Crisis in Public Health. Excerpt:

After three years of pandemic and the turmoil it’s generated, Canada is looking a little the worse for wear. We may want to think it’s over, but 50,344 Canadians have died of COVID — 18,920 of them in 2022. As well, the winter of 2022-23 has put a brutal strain on health-care workers and their patients.

Meanwhile, Ottawa and the provinces have been growling at one another about health-care funding. Given the mess in the health-care system, they seem likely to come up with some kind of cost-sharing formula on Feb. 7, which may improve the situation.  

Dr. Theresa Tam, Canada’s chief public health officer, has made some excellent suggestions for improving the health-care system in her annual reports for 2021 and 2022. But I expect the politicians will ignore her.  

Health spending has been enormous since the pandemic began in 2020. According to the Canadian Institute for Health Information, total health spending in 2022 was expected to reach $331 billion, or $8,563 per capita. Hospitals got 24.6 per cent, physicians received 13.6 per cent, and 13.6 per cent of all health spending was for drugs.  

Strikingly, only 5.3 per cent of that was for public health.

‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip

Via The Guardian: ‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip | Coronavirus. Excerpt:

When Sunny[not her name] thinks back to March last year, she laughs ruefully at the ordeal. The 19-year-old Shanghai student spent that month locked in her dormitory, unable to shop for essentials or wash clothes, even banned from showering for two weeks over Covid fears. In April, the entire city locked down.  

It was the beginning of the chaos of 2022, as local Chinese authorities desperately tried to follow President Xi Jinping’s zero-Covid decree while facing the most virulent strain of the virus yet: Omicron. “Everyone was panicking, no one was ready,” she tells the Observer.  

By the end of the year, zero-Covid was gone. Sunny says she felt instantly “relieved” that lockdowns were over but her feelings soon turned to anger as it became clear China’s government had opened up the country, knowing it wasn’t ready. “I felt it was all for nothing,” Sunny says.  

Over the last two months, the virus has rapidly spread through the country. Up to 10,000 critical cases were registered in hospitals every day. Morgues were overwhelmed, pharmacies reported shortages of basic medications, and supply of antiviral drugs was held up by protracted negotiations with foreign suppliers. Online and in the streets, people spoke of almost everyone they knew having caught Covid, and of elderly relatives dying.  

Sunny’s grandfather was among those who died in that wave. “It was the morning, and my mum walked into my room and said: your grandpa is in the emergency room,” she recalls. “A few hours later, he passed away. My grandmother was in tears, saying he had left her behind.”  

Xi’s extraordinary backflip left analysts alarmed and confused. China was not the only country to choose a zero-Covid strategy, and certainly not the only one to “let it rip” once it dropped it. But it was the last, and global health experts say there were plenty of lessons it could have heeded – primarily, making sure vaccinations and health resources were high before the tsunami of cases hit.  

“All governments had to decide to open up at some stage or risk the consequences of lockdowns far outweighing the problems of Covid,” says Professor Emma McBryde, an epidemiologist at James Cook University, Townsville, Queensland, Australia. 

 “Most models suggest that it would be better for the health system to open up slowly. Although there would be little change in how many people get infected, it could mean some lives are saved if the health system can function well.”  

But Xi threw the gates open. Right up until the day of repeal, local governments were still developing and enforcing zero-Covid measures and infrastructure. The city of Chongqing was building a 21,000-bed quarantine centre.  

Experts on health and Chinese politics have told the Observer they believe the local authorities were hamstrung. Any preparations for ending zero-Covid would be seen as a vote of no confidence in both the policy and Xi – an act of political suicide.

China says peak COVID-19 infections exceeded 7 million daily, deaths more than 4,000 daily

Via CNA: China says peak COVID-19 infections exceeded 7 million daily, deaths more than 4,000 daily.

HONG KONG: China's daily new COVID-19 infections hit a peak of more than 7 million per day around Dec 22, while deaths reached a daily peak of more than 4,000 on Jan. 4, the country's Centre for Disease Control and Prevention said on Wednesday (Jan 25).  

The figures, published on the centre's website, come after a prominent government scientist said over the weekend that 80 per cent of China's 1.4 billion population have already been infected, making the possibility of a big COVID-19 rebound over the next two or three months remote. 

"Around Dec 22, 2022, the number of infected people and the number of fever outpatient consultations reached a peak," it said, with the number of new infections "exceeding 7 million per day and the number of daily fever outpatient consultations peaking at 2.867 million".

China has passed the peak of COVID-19 patients in fever clinics, emergency rooms and with critical conditions, a National Health Commission official said last week.  

Nearly 60,000 people with COVID-19 had died in hospital as of Jan 12, roughly a month after China abruptly dismantled its strict zero-COVID policy, according to government data.  

But some experts said that figure probably vastly undercounts the full impact, as it excludes those who die at home and because many doctors have said they are discouraged from citing COVID as a cause of death.