H5N1

UK almost ‘flying blind’ on Covid this autumn, experts say

Via The Guardian: UK almost ‘flying blind’ on Covid this autumn, experts say. Excerpt:

The UK is nearly “flying blind” when it comes to Covid this autumn, experts have said, amid an increase in cases.  

While the UK Health Security Agency (UKHSA) continues to track some metrics of Covid, including hospitalisation numbers, many of the community surveillance studies tracking infection levels have finished.  

Now experts have said the situation is leaving the country in the dark about how Covid may play out in the months ahead.  

Christina Pagel, a professor of operational research at University College London, said a new wave of Covid appeared to be under way – possibly driven by waning immunity, new variants of Omicron, and factors including poor weather keeping people inside.  

With the autumn coming on and people returning to school and work, Covid pressures may increase, Pagel added.  

“We might see the wave continue to grow, and grow faster, in September,” she said.  

As well as public health measures including reintroducing high-quality masks within healthcare settings, Pagel said she would support bringing back the nationwide infection survey published by the Office for National Statistics for autumn and winter, as well as expanding it to cover flu and RSV.  

Failing that, she said, wastewater monitoring should be reinstated across the UK as a cheaper alternative that is used in many countries to track Covid prevalence and variants. Such schemes have recently been cut in England and Wales.  

“What worries me most is if we get a repeat of the last winter NHS crisis this winter again, with Covid, flu and RSV all hitting around the same time,” said Pagel. “We are definitely flying near blind.”  

Prof Rowland Kao, an epidemiologist at the University of Edinburgh, also highlighted the decline in surveillance.  

“With seasonal flu, we have of course a certain amount of predictability with the many years of data. However, with Covid, now that we don’t have those multiple data streams to rely on, it’s harder to say what is happening [in the general population],” he said.  

Kao added that the variant emergence patterns for Covid were largely unknown and Covid was not simply following seasonal patterns.

COVID-19 infections spreading fast in Japan’s Okinawa prefecture

Via The Japan News: COVID-19 Infections Spreading Fast in Japan’s Okinawa Pref.

COVID-19 is spreading rapidly in Okinawa Prefecture, with 48.39 cases reported per medical institution during the weeklong period of June 26-July 2, representing the highest figures across the nation. 

Hospital bed usage in the prefecture had risen to 78% as of Wednesday. “If the infection spreads nationwide, there’s a risk of the nation’s medical care system becoming strained,” said a member of an advisory body to the Health, Labor, and Welfare Ministry at a meeting on Friday.  

According to the Okinawa prefectural government, there were an estimated 12,260 cases in the prefecture, surpassing the 10,472 cases registered during the peak of the eighth wave of the coronavirus (from Jan. 2-8), when all cases were reported under a related law.  

As of Wednesday, the number of hospitalized patients, including those being treated at general wards, stood at 1,099 — nearly double the number 579 beds reserved to deal with the disease.  

At Okinawa Hokubu Hospital in Nago, the 25 beds secured for COVID-19 patients have remained almost fully occupied, forcing the hospital to use beds in a general ward.  

An increase in the number of medical staff unable to come to work due to personal or family-related infection has made it difficult for the hospital to maintain its normal system operations.  

“We’re asking inpatients to leave when their symptoms improve,” a doctor at the facility said. “The hospital is in the midst of the harshest ever situation.”  

On Thursday, the hospital announced a limit on nonemergency hospitalizations and surgeries until July 31.  

According to the prefectural medical association, an increasing number of medical institutions have been forced to restrict treatment or postpone surgeries.  

Previously, the prefectural government and public health centers would ascertain the status of infected individuals before assigning them to medical institutions. However, following the downgrading of COVID-19 to a Category V disease, patients have become concentrated at certain medical institutions due to lack of the coordination, severely stretching the prefecture’s medical care services.  

“The rise in the number of patients being hospitalized and an increase in cluster infections in hospitals have exacerbated the burden on medical services,” said a member of the ministry’s advisory body.  

The figure for confirmed cases reported by around 5,000 prefecture-designated medical institutions across the nation stood at 7.24 per institution, a 18% increase on the previous week.  

Takaji Wakita, chair of the advisory body and director general of the National Institute of Infectious Diseases said: “At the moment, infections are primarily spreading in western Japan. We need to keep an eye on whether this trend will spread nationwide.”

Health officials won't publicly admit scale of 'crisis' at Surrey Memorial Hospital ER, doctors' letter says

Via CBC News, yet more evidence of our health system's failure—and not just in one city or province, but nationwide: Health officials won't publicly admit scale of 'crisis' at Surrey Memorial Hospital ER, doctors' letter says. Excerpt:

Dozens of physicians working inside the busiest emergency room in British Columbia have released a scathing letter describing an unrelenting "crisis" at the department, claiming the local health authority has "repeatedly" asked them to keep details of the situation from the public.  

The medical professionals at Surrey Memorial Hospital said it's become necessary to speak out in violation of communications protocol because health-care leaders have not been transparent about the dire reality of overcrowding and inadequate staffing in the facility.  

More than 35 emergency physicians at the hospital backed the page-long letter that says patients are suffering and, in some cases, dying in hallways as a result of "steadily worsening" problems.  

"We have been repeatedly sounding the alarm to our regional and provincial leaders; these alarms have been ignored," read the letter dated Friday and obtained by CBC News.  

"Additionally, these conditions have been poorly and incompletely communicated to the public. We feel that patients and the public deserve honesty. Fraser Health has repeatedly told ER physicians to not openly discuss our 'challenges' with the public."  

CBC News is withholding the physicians' identities as they fear professional repercussions for releasing the letter.   

"It's scary, and we know we're going to get blowback on this. All we want to do is go to work and look after our patients in a reasonable way — and we feel like there's an incomplete truth that's been told," one physician said in an interview.  

"When a patient comes into the emergency department, and they see how busy it is, they see patients in hallways and corridors, there's a natural feeling that the emergency department is failing — and, truly, the emergency department is failing," they added.  

"But the failure is not because of your frontline emergency physicians, nurses, allied staff ... It's actually the system that's failing your emergency providers, and we don't have the resources to provide safe and appropriate care for all patients."

3 key issues, letter says  

The letter said three critical issues are contributing to the problem.  

First, a lack of acute care beds means patients who have already been admitted are taking up room usually reserved for incoming emergencies.  

"This bed-block forces us to routinely treat strokes, heart attacks, traumas, miscarriages and palliative patients in the hallway," the letter read.  

Second, the physicians said there are not enough hospitalists to admit patients from the emergency room to other wards, meaning patients linger in the emergency department for days. Doctors said some die while waiting.  

Third, the letter said elected leaders have failed to provide any "meaningful solutions" to the problem.   

The physician who spoke in an interview said the doctors decided to release the statement Monday after previous letters sent "all the way up the food chain," including to the B.C. Ministry of Health did not result in accountability or transparency.

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.

China records almost 60,000 Covid-related deaths after abrupt shift in policy

Via the South China Morning Post: China records almost 60,000 Covid-related deaths after abrupt shift in policy. I wish I could believe it. Excerpt:

China said on Saturday it had recorded almost 60,000 Covid-related deaths between December 8 and January 12, and the current wave has already peaked.   

It is the first time China has released a death toll since its abrupt pivot away from the zero-Covid policy last month.  

Jiao Yahui, director of the National Health Commission’s medical affairs department, said medical institutes had recorded 5,503 deaths as a result of respiratory failure triggered by Covid infection and 54,435 deaths of people infected with Covid-19 but with underlying conditions, such as cancer or cardiovascular diseases.  

The average age of those who died was 80.3, and 90 per cent of fatalities were aged 65 or over.  

Jiao also said the current wave of cases had peaked. “The number of fever clinic visitors is generally on a downward trend after peaking, both in cities and rural areas,” she added.  

Jiao said the number of emergency patients was also declining and the ratio of patients who had tested positive for Covid-19 was steadily falling as well.  

Jiao said there had been 128,000 patients with severe Covid-19 on January 5, but the number had dropped to 105,000 by January 12.  

The use rate for intensive care hospital beds was 75.3 per cent, she added.  

Among the critically ill Covid-19 patients on January 12, there were 97,000 patients with severe underlying conditions, accounting for 92.8 per cent. The remainder, some 7,357 people, had Covid only.

‘It’s insane’: China’s doctors struggle to cope amid COVID surge

Via Sixth Tone: ‘It’s Insane’: China’s Doctors Struggle to Cope Amid COVID Surge. Excerpt:

Just weeks after China ended its “zero-COVID” policy, Dr. Xu Zuping and her outpatient department find themselves confronting an unprecedented crisis.  

The team in Shanghai is treating up to 600 patients a day — almost 20% more than the same period last year, Xu estimates. And they’re having to do so with four out of six doctors infected with COVID-19.  

“I’ve worked at this hospital for over 30 years, but I’ve never seen the emergency room as busy as it is now,” says Xu, who spoke with Sixth Tone using a pseudonym to protect her privacy. “Ambulances keep arriving with people in a critical condition. When I treat my patients, I constantly worry about whether there are enough seats in the infusion center.” 

Hospitals all over China are struggling to cope as a wave of COVID-19 infections rips through the population. Doctors describe shocking levels of overcrowding, shortages of key supplies, and medical teams weakened by mass infections.  

China abruptly dismantled its strict “zero-COVID” system in early December, and since then the virus has spread at breakneck speed. It’s unclear how many people have been infected, but local authorities estimate that case numbers in Shanghai alone have surpassed 10 million.

A surge in hospitalizations soon followed. According to China’s health commission, around 8% of COVID-19 patients in China developed pneumonia in 2022. Though this appears to be a relatively low ratio, it translates into a huge number of people with lung infections due to China’s vast population.   

By the end of December, Xu’s department was already receiving record numbers of patients. The team is based at one of two major hospitals in Chongming — an island on the northeastern tip of Shanghai, where the Yangtze River bleeds into the East China Sea.  

Most of the patients are in their 80s and 90s, and the vast majority have pneumonia, Xu says. The hospital’s emergency room has been completely overrun.  

“Given the crisis at the emergency room, we can no longer transfer patients for hospitalization,” she says. “The few remaining beds in the inpatient department are reserved for patients from the emergency room.”

Up to 70% of Shanghai population infected with COVID-19: Top doctor

Via Channel NewsAsia: Up to 70% of Shanghai population infected with COVID-19: Top doctor. That means about 17.5 million people in Shanghai alone have COVID-19.

SHANGHAI: A senior doctor at one of Shanghai's top hospitals has said 70 per cent of the megacity's population may have been infected with COVID-19 during China's huge surge in cases, state media reported Tuesday (Jan 3).  

The steep rise in infections came after years of hardline restrictions were abruptly loosened last month with little warning or preparation, and quickly overwhelmed hospitals and crematoriums.  

Chen Erzhen, vice president at Ruijin Hospital and a member of Shanghai's COVID-19 expert advisory panel, estimated that the majority of the city's 25 million people may have been infected.  

"Now the spread of the epidemic in Shanghai is very wide, and it may have reached 70 per cent of the population, which is 20 to 30 times more than (in April and May)," he told Dajiangdong Studio, owned by the Communist Party mouthpiece People's Daily.  

Shanghai suffered a gruelling two-month lockdown from April, during which over 600,000 residents were infected and many were hauled to mass quarantine centres.  

But now, the Omicron variant is spreading rampantly across the city and experts predict infections there will peak in early 2023. In other major cities, including Beijing, Tianjin, Chongqing and Guangzhou, Chinese health officials have suggested that the wave has already peaked.  

In neighbouring Zhejiang province, disease control authorities said Tuesday that there had been one million new infections in recent days and that the province was entering a peak plateau for COVID-19.  

Chen added that his Shanghai hospital was seeing 1,600 emergency admissions daily - double the number prior to restrictions being lifted - with 80 per cent of them COVID-19 patients.  

"More than 100 ambulances arrive at the hospital every day," he was quoted as saying, adding that around half of emergency admissions were vulnerable people aged over 65.  

At Tongren Hospital in downtown Shanghai, AFP reporters saw patients receiving emergency medical attention outside the entrance of the overcrowded facility on Tuesday.  

The corridors overflowed with dozens of elderly patients lying on beds crammed together, hooked up to IV drips. Some patients wore oxygen masks attached to bedside canisters.

China’s President Xi battles to save face as Covid U-turn weakens his grip on power

Via The Guardian: China’s President Xi battles to save face as Covid U-turn weakens his grip on power. Excerpt and then a comment:

China’s leader Xi Jinping told his country it stands on “the right side of history” in a new year address on Saturday, but experts have warned that the president starts 2023 diminished by his chaotic U-turn on Covid strategy.  

He may struggle to deflect blame for the human and economic costs of zero-Covid’s failure, and control the national narrative, even if public signs of dissent are crushed.  

Officially, China has registered just over 5,200 deaths from Covid, but there is a yawning gap between the picture presented by the usually efficient communist propaganda apparatus and the reality reflected in social media posts and anecdotes from across China.  

Hospital emergency wards are overflowing with desperate patients. Medical supplies are running low, with pharmacies selling out of drugs ranging from anti-viral to basic painkillers. Police patrolled one Beijing crematorium where Reuters reported long queues of hearses last week.  

In his first public comments to the Chinese people on Covid since his government changed course three weeks ago, Xi used his speech on Saturday to claim the government and Chinese Communist party (CCP) had “put the people first and put life first all along”.  

For many in China, that phrase will ring hollow, particularly those fighting for medical care for loved ones newly struck down by the disease.  

Questions about why the country clung so long to zero-Covid, at such heavy cost, and did so little to prepare for opening up are likely to undermine Xi, even if the damage to his authority isn’t visible beyond the walls of the secretive leadership compounds.  

“The fact that the CCP’s posture towards the pandemic has now completely reversed after a popular uprising can only mar Xi Jinping’s carefully cultivated air of infallibility,” said Orville Schell, director of the centre on US-China relations at the Asia Society in New York.  

“Xi is virtually immune from public expressions of criticism within China,” he added. “But my Chinese friends are all shaking their heads in incredulity at the contrariness of Xi’s policies.”

Foreign analysts, scouring the internet and official pronouncements for clues, estimate there are already thousands of deaths a day, with more to come.  

A first wave in urban areas is expected to peak in January, but a second, bigger wave will race through rural areas – where health systems are even weaker – in February and peak in early March, according to British health analytics firm Airfinity.

In a recent Tyee article, I argued that COVID-19 is only one of China's looming problems; economic uncertainty and climate disasters, especially water security, are making matters even worse.

Some hospitals in China overwhelmed in national COVID-19 wave

Via CBC News, an AP report: Some hospitals in China overwhelmed in national COVID-19 wave. Excerpt:

Yao Ruyan paced frantically outside the fever clinic of a county hospital in China's industrial Hebei province, 70 kilometres southwest of Beijing. Her mother-in-law had COVID-19 and needed urgent medical care, but all nearby hospitals were full.  

"They say there's no beds here," she barked into her phone.  

As China grapples with its first national COVID-19 wave, emergency wards in small cities and towns southwest of Beijing are overwhelmed. Emergency rooms are turning away ambulances, relatives of sick people are searching for open beds, and patients are slumped on benches in hospital corridors and lying on floors for a lack of beds.  

Yao's elderly mother-in-law had fallen ill a week ago with the coronavirus. They went first to a local hospital, where lung scans showed signs of pneumonia. But the hospital couldn't handle serious COVID-19 cases, Yao was told. She was told to go to larger hospitals in adjacent counties.  

As Yao and her husband drove from hospital to hospital, they found all the wards were full. Zhuozhou Hospital, an hour's drive from Yao's hometown, was the latest disappointment.  

Yao charged toward the check-in counter, past wheelchairs frantically moving elderly patients. Yet again, she was told the hospital was full, and that she would have to wait. 

'Terrified' over elderly woman's condition  

"I'm furious," Yao said, tearing up as she clutched the lung scans from the local hospital. "I don't have much hope. We've been out for a long time and I'm terrified because she's having difficulty breathing."  

Over two days, Associated Press journalists visited five hospitals and two crematoriums in towns and small cities in Baoding and Langfang prefectures, in central Hebei province. The area was the epicentre of one of China's first outbreaks after the state loosened COVID-19 controls in November and December. For weeks, the region went quiet, as people fell ill and stayed home.  

Many have now recovered. Today, markets are bustling, diners pack restaurants and cars are honking in snarling traffic, even as the virus is spreading in other parts of China. In recent days, headlines in state media said the area is "starting to resume normal life."  

But life in central Hebei's emergency wards and crematoriums is anything but normal. Even as the young go back to work and lines at fever clinics shrink, many of Hebei's elderly are falling into critical condition. As they overrun intensive care units and funeral homes, it could be a harbinger of what's to come for the rest of China.

'Living with COVID': Where the pandemic could go next

Via Reuters: 'Living with COVID': Where the pandemic could go next. Excerpt:

LONDON/CHICAGO, Aug 1 (Reuters) - As the third winter of the coronavirus pandemic looms in the northern hemisphere, scientists are warning weary governments and populations alike to brace for more waves of COVID-19.  

In the United States alone, there could be up to a million infections a day this winter, Chris Murray, head of the Institute of Health Metrics and Evaluation (IHME), an independent modeling group at the University of Washington that has been tracking the pandemic, told Reuters. That would be around double the current daily tally.  

Across the United Kingdom and Europe, scientists predict a series of COVID waves, as people spend more time indoors during the colder months, this time with nearly no masking or social distancing restrictions in place.  

However, while cases may surge again in the coming months, deaths and hospitalizations are unlikely to rise with the same intensity, the experts said, helped by vaccination and booster drives, previous infection, milder variants and the availability of highly effective COVID treatments.  

"The people who are at greatest risk are those who have never seen the virus, and there's almost nobody left," said Murray.  

These forecasts raise new questions about when countries will move out of the COVID emergency phase and into a state of endemic disease, where communities with high vaccination rates see smaller outbreaks, possibly on a seasonal basis.  

Many experts had predicted that transition would begin in early 2022, but the arrival of the highly mutated Omicron variant of coronavirus disrupted those expectations.

"We need to set aside the idea of 'is the pandemic over?'" said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. He and others see COVID morphing into an endemic threat that still causes a high burden of disease.  

"Someone once told me the definition of endemicity is that life just gets a bit worse," he added.  

The potential wild card remains whether a new variant will emerge that out-competes currently dominant Omicron subvariants.  

If that variant also causes more severe disease and is better able to evade prior immunity, that would be the "worst-case scenario," according to a recent World Health Organization (WHO) Europe report.