H5N1

China’s zero-Covid policy is a pandemic waiting to happen

An op-ed in The New York Times: China’s Zero-Covid Policy Is a Pandemic Waiting to Happen. Much as I respect Drs. Emanuel and Osterholm, I'm nervous about their use of terms like "have to live with it" and "endemic." They sound at this point like acceptance of high mortality and morbidity rates, which will be endured much more by working-class people and people of colour. Excerpt:

As the Winter Olympics approach and some 3,000 athletes, their retinues and the media converge in and around Beijing, the Chinese government has gone to extraordinary lengths to prevent the 24th version of the games from becoming a Covid super spreading event. 

Though athletes and coaches will be required to be vaccinated, they will face severe restrictions. Those who receive a medical exemption from vaccination are being required to quarantine for 21 days after entering the country. Even the vaccinated will have to present two negative tests. Olympic participants must submit to daily Covid tests and will be restricted to an Olympic bubble where they will be confined to prevent spread to the local population.  

These extreme measures are in line with China’s zero-Covid policy. President Xi Jinping and his government seem to believe that the country can be sealed off until the virus is eradicated around the world.  

But that goal is unattainable with the highly transmissible Omicron variant and has set the nation up for disaster. The coronavirus is not going to disappear — the world will have to live with it. Making matters worse, China’s vaccines are much less effective against Omicron. And the Chinese health care system simply is not equipped to care for millions of people sickened by the virus.  

Yes, China has weathered the pandemic well so far. Even with about four times the population of the United States, China has had fewer than 140,000 confirmed Covid cases and fewer than 6,000 deaths since January 2020, according to the World Health Organization. A vast majority of factories continued to operate. Early in the pandemic, China added thousands of hospital beds to its health care system in days.  

All of this seems like an enormous success when compared with the messy and often chaotic response to the virus in the United States, where more than 860,000 people have died and some 2,000 more die each day. Many hospitals are under siege. The economy has been disrupted.  

But this may very well be the future China is facing. Its pursuit of zero Covid will prove to be a huge mistake. The policy has left it wholly unprepared for what will become endemic Covid.

New Zealand not prepared for Omicron outbreak expected in ‘matter of weeks’, experts warn

Via The Guardian: New Zealand not prepared for Omicron outbreak expected in ‘matter of weeks’, experts warn. Excerpt:

Two of New Zealand’s most prominent Covid-19 experts have warned that the country is unprepared to prevent the health system from being overloaded by an Omicron outbreak, with likely fatal consequences.  

Otago University’s Dr Nick Wilson and Dr Michael Baker also said it was only a “matter of weeks” before the highly transmissible variant seeped into the community due to border failures.  

Wilson said that despite New Zealand’s high vaccination rates, the number of adults who had received a booster dose of the vaccine – essential for minimising the effects of Omicron – remains dangerously low, and noted that the vaccine rollout for children between five and 11 still had not begun.

New Zealand received its first shipment of Pfizer’s paediatric vaccine only at the weekend, and intends to begin child vaccinations from 17 January, despite some comparable countries beginning their child vaccine rollout late last year.  

Omicron’s short incubation period also means New Zealand’s system for identifying and containing new community cases would be much less effective.  

Wilson panned the country’s traffic light system – which replaced the more stringent alert-level system last year – as “not fit for purpose” with Omicron due to its tolerance for relatively significant social interaction for vaccinated people when Covid is in the community.  

Baker agreed, calling for the government to rapidly reinstate an amended version of the alert level system. “The traffic light system won’t help us very much because it was never designed to dampen down transmission, it was only designed to nudge people towards vaccination,” Baker said.  

Until these weaknesses were fixed, he said, “we need to hugely turn down the tap of people arriving in New Zealand”. Wilson agreed: “The priority is to have a tighter border so that we don’t have to vaccinate kids and conduct a booster program during an outbreak.”  

The pair called for a “significant tightening” of the number of New Zealanders entering the country.  

Over the weekend, 64 positive Covid cases were recorded within New Zealand’s oversubscribed managed isolation facilities (MIQ) for incoming travellers, many of which were expected to be Omicron.  

Wilson said he was “perplexed” that poor ventilation and shared spaces within MIQ had not been fixed and that the resulting “high risk” of an Omicron outbreak was “unacceptable”.

To relieve the pressure on MIQ, Wilson said, the government ought to require rapid antigen testing for travellers immediately prior to allowing them on flights, and cap the number of travellers coming from high-risk countries such as the UK, where Omicron rates have skyrocketed.

CHP provides latest information on COVID-19's Variant of Concern, Omicron

Via the Centre for Health Protection: CHP provides latest information on COVID-19's Variant of Concern, Omicron.

The Centre for Health Protection (CHP) of the Department of Health (DH) today (November 27) said that since it announced on November 25 two confirmed cases carried viruses which belonged to a newly emerged lineage, B.1.1.529, the CHP has been closely monitoring and following up the latest development of the mutant strain concerned.  

In view of the latest announcement by the World Health Organization (WHO) concerning the Omicron variant, the Government implemented last night (November 26) the most stringent boarding and quarantine requirements for eight places in southern Africa. 

Starting tomorrow (November 28), the CHP will further strengthen the quarantine and testing requirements for Hong Kong Special Administrative Region (HKSAR) residents arriving from the relevant places, including arranging them to stay in quarantine centre for seven days. 

The WHO has designated B.1.1.529 as a Variant of Concern and named it Omicron on November 26 (Geneva time). The mutant strain possesses a large number of mutations and it was first reported to the WHO from South Africa on November 24. In addition, according to the European Centre for Disease Prevention and Control, this mutant strain is the most divergent variant during the COVID-19 pandemic so far. This raises concerns that it may be associated with increased transmissibility, reduction in vaccine effectiveness and increased risk for reinfections.

According to official sources, apart from the information on mutant strain involving two cases provided by the HKSAR Government, the Omicron variant has been detected in a number of places including Botswana, South Africa, Israel and Belgium. To facilitate further risk assessment, the CHP has contacted the health authorities of Israel and Belgium for details about the imported cases there.

Locally, according to the whole genome sequencing conducted by the DH's Public Health Laboratory Services Branch, there are so far two cases which had been announced earlier (cases 12388 and 12404) detected to be carrying the Omicron variant. The CHP has earlier arranged for persons who had stayed from November 11 to 14 in the three rooms to the left and to the right of the two rooms concerned (Rooms 5111 and 5112) of Regal Airport Hotel to undergo compulsory quarantine at the Penny's Bay Quarantine Centre for 14 days. No new related case was detected so far.

The Government has been closely monitoring the latest scientific data on mutant strains as well as the epidemic situation of various places and will adjust the boarding, quarantine and testing requirements for persons arriving at Hong Kong from relevant places based on the risk levels as the situation warrants. 

In view of the latest developments of the Omicron variant, started from 0.00am today, along with South Africa which was already a Group A specified place, the Government also specified Botswana, as well as the adjacent Eswatini, Lesotho, Malawi, Mozambique, Namibia and Zimbabwe as Group A specified places. Non-Hong Kong residents who have stayed in these places within 21 days will not be allowed to enter Hong Kong. Details on the relevant boarding and compulsory quarantine requirements for respective specified places can be found at www.coronavirus.gov.hk/eng/inbound-travel.html.             

Under existing requirement, persons who have stayed in high-risk Group A specified places on the day of boarding for/arrival at Hong Kong or during the 21 days before that day can only board flights for Hong Kong if they are HKSAR residents who are fully vaccinated and hold a recognised vaccination record. Upon arrival, they have to undergo compulsory quarantine for 21 days in a designated quarantine hotel and undergo six tests during compulsory quarantine, followed by self-monitoring for the subsequent seven days, and have to undergo compulsory testing in a community testing centre on the 26th day of arrival at Hong Kong.

To enhance the surveillance on the Omicron variant, starting from 0.00am tomorrow, the CHP will require HKSAR residents arriving from the eight places in southern Africa concerned to undergo quarantine at the Penny's Bay Quarantine Centre for seven days, during which they have to undergo testing every day and their health conditions will be monitored by healthcare professionals. Upon completion of the seven-day quarantine at quarantine centre, they will be allowed to finish the rest of the compulsory quarantine requirement at the designated quarantine hotel which they have reserved. They are also required to undergo testing on the 9th, 12th, 16th and 19th day and another compulsory testing in a community testing centre on the 26th day of arrival at Hong Kong.

The Government has also stepped up its surveillance on designated quarantine hotels and will ensure their compliance to the infection control requirements at all times. Persons undergoing quarantine are reminded again that they must keep the windows in the hotel room closed and wear the surgical masks when they open the room door.

The spokesman for the CHP said, "Although there are not any direct passenger flights arriving Hong Kong from the eight places in southern Africa concerned currently, we noticed the presence of the Omicron variant in a number of places globally. We must stay vigilant and implement the most stringent anti-epidemic measures to prevent the mutant strain from entering the local community. We will review the effectiveness of those anti-epidemic measures from time to time."

Omicron in Hong Kong: CHP investigates four additional confirmed cases of COVID-19

A November 26 release from the Centre for Health Protection: CHP investigates four additional confirmed cases of COVID-19. This appears to report on three, and possibly four, imported cases involving the Omicron strain. Excerpt and then another report: 

The Centre for Health Protection (CHP) of the Department of Health (DH) announced that as of 0.00am, November 26, the CHP was investigating four additional confirmed cases of coronavirus disease 2019 (COVID-19), taking the number of cases to 12 422 in Hong Kong so far (comprising 12 421 confirmed cases and one probable case).      

The newly reported cases are imported cases. Three of the cases involved mutant strains while the mutation test result of the remaining case is pending. The patients comprise three males and one female, aged 9 to 43. All of them arrived in Hong Kong from Group B specified places (medium-risk). Two patients tested positive during the "test-and-hold" arrangement upon arrival at the Temporary Specimen Collection Centre (TSCC) at Hong Kong International Airport and the remaining two tested positive during quarantine. Among them, case 12427, being a close contact of case 12424 who tested positive at the TSCC, tested positive at the Penny's Bay Quarantine Centre.

A total of 40 cases have been reported in the past 14 days (November 12 to 25) and all of them are imported cases.

Meanwhile, via the Hong Kong Free Press: 4 imported COVID-19 cases found. Excerpt and then a comment:

The Centre for Health Protection today said it is investigating four additional imported COVID-19 cases, three of which involve the L452R mutant strain while the remaining case's mutation test result is pending.

The new cases involve three males and one female, aged nine to 43. All of them arrived from medium-risk places.

Two of the patients tested positive upon arrival at Hong Kong International Airport while the other two were confirmed infected with the virus during quarantine.

The centre noted that the patient of case number 12424 tested positive at the airport and his close contact, case number 12427, tested positive at the Penny's Bay Quarantine Centre. I don't know about the other two cases, but we will likely learn more over the weekend.

Case 12427 is probably the Canadian reported to have contracted the Omicron strain while in quarantine. 

'Until Proven Safe': Book on quarantine before, after COVID

Via The Los Angeles Times: 'Until Proven Safe': book on quarantine before, after COVID. Excerpt:

“The Coming Quarantine” sounded like a good book title back when Geoff Manaugh and Nicola Twilley sold their idea to publishers. The journalists even had a dramatic opening: a pandemic simulation, Manaugh says, “looking at what might happen if a disease takes hold of the U.S.” 

But, well, you know ... Their new book, retitled “Until Proven Safe: The History and Future of Quarantine,” still explores quarantine through the centuries. But while their initial research involved a mission to find someone who had experienced a quarantine (they found a physician from Doctors Without Borders), the authors wrote the bulk of the book during the lockdown, with abundant evidence close to hand.  

The history lessons in “Until Proven Safe” help illuminate where things went wrong in 2020 and what needs to change before the next lockdown, which they say is definitely coming. Last year’s “shelter in place” mandates were attempts at large-scale quarantine but, according to one expert they quote, if America had introduced stringent lockdowns as a broad-based quarantine early on, it could have saved many lives. “We just didn’t have the grit for it in the United States,” the expert tells them. “It’s quite humbling.”  

The term “quarantine” experienced mission creep in 2020, used for everything from closed-off hospital wards to healthy people working from home. Manaugh and Twilley define it more classically as what happens when someone has been exposed to illness but is not yet confirmed to have it — as opposed to isolation, which comes for the already infected. “Typhoid Mary came up all the time but she was isolated, not quarantined,” Manaugh says. Twilley adds that there are a lot of similarities in how we should handle both during a pandemic.  

The couple, who spoke recently by video from Los Angeles, started thinking about the topic back in 2009 on a picnic in Australia, where they saw a spa and hotel repurposed from an old quarantine station. “Quarantines seemed like a practice from a different age, an obsolete technique,” says Manaugh. “But we quickly realized that was not the case. We chose that original title because we thought quarantine would become more common, not less common.”  

The interview has been edited for length and clarity. 

Why were you sure there was going to be a need for a book about quarantine?  

Manaugh: Humans are going into landscapes and encountering microbes and diseases they wouldn’t have previously encountered. They hop on a plane and bring them to Moscow or Los Angeles. We don’t have vaccines for those new diseases. Quarantine will be the one thing that will allow us to control these outbreaks.  

Twilley: And it hadn’t been rethought since earlier eras. We wanted to be the people who warned this was coming. And then it came.  

Who is the reader for this book?  

Twilley: We hope it will reach a popular audience. The way quarantine has shaped the world was fascinating and now that we’ve all been through it, the book is interesting in a different way. But I also want people who make policy to read it so we can redesign quarantine better for next time.

You mention Hoffman and Swinburne Islands in New York, the sites of quarantine for immigrants arriving through Ellis Island. The setup successfully kept diseases out of the city but unfairly crammed people together in unsafe conditions. Have we learned to do better?

Twilley: We have not learned the lessons. The difficulty is really thinking about individual versus mass quarantine. People we spoke to had thought about how to reform quarantine for a few individuals, to make it safe and fair and give them legal rights. What hasn’t happened is thinking through how mass quarantine would work. We toured the new federal facility in Omaha before it opened and it hadn’t crossed their mind that the United States would need to quarantine more than 20 people.

Manaugh: As a society I don’t think we’ve learned to do it any better at all. The hope would be that COVID-19 lets us take a moment and think about quarantine and do it better the next time.

Chinese city of Guangzhou to build giant Covid-19 quarantine facility with 5,000 spaces for international travellers

Via the South China Morning Post: Chinese city of Guangzhou to build giant Covid-19 quarantine facility with 5,000 spaces for international travellers. If Dr. Zhong Nanshan is backing this, it will happen. Excerpt:

The southern Chinese city of Guangzhou is planning to build a massive quarantine complex for international travellers and local residents from high-risk areas because local hotels cannot cope with highly transmissible Covid-19 mutations such as the Delta variant, according to leading respiratory expert Zhong Nanshan. 

“There will be 5,000 isolated spaces and the people there will be isolated according to strict rules to make sure they do not infect each other,” Zhong told a group interview on Friday. 

Zhong said that after observing the transmissibility of the Delta variant in Guangdong province during the past month, he was convinced that using hotels as quarantine facilities would not be enough to stop the spread of the disease given it was a lot more transmissible than other pre-existing variants. 

The mutations of the coronavirus also mean that other transmissible variants may also emerge in future.  

“In the long term, Guangzhou and Shenzhen must build these kinds of facilities. Otherwise when there are lots of cases in the future and we have to quarantine them in hotels, it will affect the economy and we cannot isolate them in a real sense.” 

Zhong said the new facility would cover 250,000 square metres, or 25 hectares – about the size of 46 football pitches. 

China has assigned Guangdong as the major portal to receive and quarantine international travellers before they go on to other parts of the country. Zhong said 80 to 90 per cent of international travellers entered the country via the southern province. 

Guangdong had also been asked to prevent the Delta variant from spreading to other provinces during the recent outbreak by reducing the number of travellers, Zhong said. People travelling from several cities in Guangdong have been asked to produce negative test results before they were allowed to leave. 

Zhong, who also played a leading role in tackling the severe acute respiratory disease outbreak in 2003, said so far no local cases of the Delta variant had been found outside Guangdong, but it was hard to guarantee there would be no cases outside the province because of the transmissibility of the variant. 

Zhong said the definition of “close contacts” and how they should be isolated should be revised. 

China has pursued a zero-tolerance strategy towards tracking and testing all close contacts of a positive case. Expanding the definition means the number of people being tested and quarantined would be increased after a positive case is found. 

“In the past, close contacts were defined as the families of a patient, or people who had meals or meetings with the patient in an office or within one metre in the two days before the symptom onset,” Zhong said. 

“But with the Delta variant, close contacts should be defined as those who stayed in the same space, same unit, or even in the same building in the four days before the onset of symptoms.”

COVID-19 outbreak declared in Iqaluit

Via Nunatsiaq News: COVID-19 outbreak declared in Iqaluit. Excerpt:

Iqaluit is experiencing a COVID-19 outbreak, the Government of Nunavut announced Friday. 

The announcement was made during a news conference on Friday morning, after 12 new cases were reported in the community overnight, bringing the total number of infections to 13. 

“It has been declared an outbreak as it involves multiple households and we have not determined the source of infection at this time,” said Dr. Michael Patterson, Nunavut’s chief public health officer. 

“While this is a serious situation, it is one that we can gain control of, contain and, in time, end.” 

Patterson said that all of the infected residents are now isolating in their homes. 

Although some, such as the initial case, are experiencing symptoms, Patterson said others are not. Symptoms include fever, cough and difficulty breathing, among others, according to a list the Health Department published. 

On Thursday, less than a day after the first case was announced, the government identified the Storehouse bar and grill as a site of “potential COVID-19 exposure” and encouraged anyone who had been to the establishment since April 8 to monitor themselves for symptoms and schedule a test if they showed any. 

When asked why more specific dates and times couldn’t be given for possible exposures at the Storehouse, Patterson said that on all of those nights there was at least one person, if not more, who would have been in their infectious period and providing more details would have created confusion. 

Despite this, Patterson says the outbreak still does not meet the criteria for community transmission. 

“The definition of community transmission is we’re having cases pop up that we can’t establish links between,” he said. 

“Right now, in Iqaluit, every individual who’s had a positive result, we know where they are on that chain of transmission.” 

 In addition to those who have tested positive, Patterson said that, to the best of his knowledge and prior to the news conference, there were more than 70 individuals who have been identified through contact tracing.

‘Critical’ COVID-19 situation in Iceland

Via Iceland Monitor: ‘Critical’ COVID-19 Situation.

A total of six new domestic cases of COVID-19 have been confirmed in Iceland since Friday, three of which were outside quarantine, mbl.is reports. 

The people diagnosed who were not in quarantine are members of the same family in the capital area, and the origin of the infection is unknown. It is estimated that more than 200 people will have to be placed in quarantine in connection with those three cases.   

Chief Epidemiologist Þórólfur Guðnason and Director of Health Alma Möller expressed their worries about the situation at a press conference this morning. 

“Domestically, this is a critical time with respect to COVID-19,” Þórólfur stated. 

He was asked whether the infected individuals had attended parties or gatherings over the weekend, to which he responded, “Yes, that is possible, and we know about that.” 

Þórólfur stated that if the number of cases outside quarantine continues to rise in the coming days, he will have to recommend that stricter measures be enacted domestically. 

In addition to the domestic cases, 19 people tested positive at the borders, 15 of whom turned out to have an active infection. Ten of the active infections were those of a ship’s crew that arrived in Reyðarfjörður harbor, the East Fjords, yesterday. 

The ship, Taurus Confidence, with a crew of 19, came from Sao Luis in Brazil, carrying alumina for the Alcoa Fjarðaál aluminum smelter in the town. All the infected crew members are in isolation on board the vessel. Þórólfur stated at the press conference that he expected the whole crew to be infected. 

Three patients with an active infection of COVID-19 are currently in the hospital. 

Þórólfur stated that people in quarantine will have to be monitored better, since it is clear that some have violated quarantine rules.

New Zealand: 4 cases of COVID-19

A news release from the Ministry of Health: 4 cases of COVID-19. Excerpt:

There is one new case of COVID-19 in the community linked to the existing Auckland February cases, a household contact of previous cases D, E and F. 

The case (case G) is a household contact of cases D, E and F which we announced on Wednesday. This person had previously returned a negative test, taken on Monday 15 February and has been isolating at home and is in the process of transferring to the Auckland quarantine facility. 

There is one additional member of this household, who has returned a negative test result, but is also being transferred to the Auckland quarantine facility. 

Genome sequencing has been completed for case F and shows a clear link to other cases in the cluster. 

There are three new cases in managed isolation. One of the cases in managed isolation is classified as historical and deemed not infectious.

New Zealand: Probable case of COVID-19 in a returnee

A news release from the New Zealand Ministry of Health: Probable case of COVID-19 in a returnee. Excerpt:

The Ministry of Health is investigating a positive test result in a person who recently travelled from overseas and completed their stay in managed isolation in a facility in Auckland. 

In the case we are investigating and reporting today, the person had travelled in Spain and the Netherlands late last year for work. While in the Netherlands she was in contact with family members, who subsequently tested positive for COVID-19.  

The person left the United Kingdom en route to New Zealand, travelling via Singapore, arriving in Auckland on 30 December. 

She carried out the required 14 days in managed isolation at the Pullman in Auckland and returned two negative tests as part of routine testing – one on 2 January and one on 10 January. 

After meeting the final health assessment for release, she left managed isolation on 13 January and travelled home to the Northland region. She lives with one other person who has not been symptomatic, who has been tested and is also isolating while awaiting results.  

The person started developing mild symptoms on 15 January and these progressively got worse. The person had a test taken on Friday 22 January and self-isolated at home. 

Late last night the result was returned as positive for COVID-19. Further testing is needed, including a serology blood test, to confirm whether the case is new or historical. However, the CT value from the initial test suggests that it is new and we are treating it as such. 

We are undertaking rapid genome sequencing to see if there’s a match to other cases in the managed isolation facility as well as to whether the person has one of the more transmissable variants we’ve seen reported recently.   

Importantly, we are working on the assumption any case might be a more transmissible variant and are taking appropriate precautions.   

It is too early to say where this infection has occurred — we hope further testing and investigation will helpt to confirm this.   

This is a reminder to us all of how COVID-19 is an extremely difficult virus to manage, as we’ve seen overseas and here in New Zealand.