H5N1

Lockdowns and face masks ‘unequivocally’ cut spread of Covid, report finds

Via The Guardian: Lockdowns and face masks ‘unequivocally’ cut spread of Covid, report finds. Excerpt:

Measures taken during the Covid pandemic such as social distancing and wearing face masks “unequivocally” reduced the spread of infections, a report has found.  

Experts looked at the effectiveness of non-pharmaceutical interventions (NPIs) – not drugs or vaccines – when applied in packages that combine a number of measures that complement one another.  

The Royal Society report, called Covid-19: examining the effectiveness of non-pharmaceutical interventions, reviewed the evidence gathered during the pandemic for six groups of NPIs and their effectiveness in reducing transmission.  

These included masks and face coverings, social distancing and lockdowns, test, trace and isolate, travel restrictions and controls across international borders, environmental controls, and communications.  

When assessed individually, there was positive – if limited – evidence of transmission reduction from many of the NPIs used in the pandemic, the review found. However, evidence of a positive effect was clear when countries used combinations of NPIs.  

Additionally, evidence showed NPIs were most effective when the intensity of transmission was low, supporting their use early in a pandemic and at first sign of resurgence.  

During the early stages of responding to an emerging infectious disease, NPIs tend to be the only controls available before the development of drug treatments and vaccines.  

However, as was seen during the pandemic, their use can have adverse personal, educational and economic consequences – making assessment of their effectiveness essential.  

Prof Sir Mark Walport, the foreign secretary of the Royal Society and chair of the report’s expert working group, said: “There is sufficient evidence to conclude that early, stringent implementation of packages of complementary NPIs was unequivocally effective in limiting Sars-CoV-2 infections.  

“That does not mean every NPI was effective in every setting, or at all times, but learning the lessons from the wealth of research generated in this pandemic will be key to equipping ourselves for the next one.”  

The review found social distancing and lockdowns were the most effective category of NPIs. Stay-at-home orders, physical distancing and restrictions on gathering size were repeatedly found to be associated with significant reduction in Sars-CoV-2 transmission. The more stringent the measures were the greater the effect they had, the experts found.  

In care homes, measures such as cohorting and visitor restrictions were associated with reduced transmission and reduced outbreaks.  

Additionally, the report found that in school settings, closures and other distancing measures were associated with reduced Covid-19 cases, but the effectiveness varied depending on a range of factors, including adherence and pupils’ ages.

California COVID Delta variant cases vs. Florida and Texas

Via the Los Angeles Times: California COVID Delta variant cases vs. Florida and Texas. Excerpt:

SAN FRANCISCO — Despite a significant surge in both coronavirus cases and hospitalizations this summer, California so far has managed to avoid the sky-high infection rates and increasingly overcrowded hospitals some other states are now experiencing. 

California’s coronavirus case rate remains below the national average and significantly less than that of Florida and Texas: two common points of comparison given their population size and distinctly different pandemic responses. 

Experts say California’s better-than-average vaccination rates and newly implemented mandatory mask policies in parts of the state have helped prevent a more grim situation. 

While governors in Florida, Texas and other states have opposed allowing local governments to mandate the wearing of masks, California has allowed counties to enact such orders in indoor public spaces for everyone age 2 and older, regardless of vaccination status. 

“I am hopeful for California and Los Angeles, because of the fact that we have higher levels of vaccination, and we have increased numbers of people stepping up to the plate and getting vaccinated,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health. “However, we still have a ways to go to achieve a higher level of community immunity, or herd immunity, because of the increased transmissibility of the Delta variant.” 

California is reporting 141.1 new coronavirus cases for every 100,000 residents over the last seven days — a rate half that of Texas, 297.8; and less than one-fourth that of Florida’s rate of 653.8, according to data from the U.S. Centers for Disease Control and Prevention. California’s rate is also less than the national average of 232.1. 

The flood of COVID-19 patients newly admitted to Florida hospitals is now far worse than at any point during its winter surge. In early January, Florida was reporting more than 1,150 new COVID-19 patients admitted a day. But over the last week, the state saw an average of 2,071 new COVID-19 hospital admissions daily. 

By contrast, California is reporting 772 new COVID-19 hospital admissions daily, just 32% of its winter peak of 2,380. On a per capita basis, Florida’s rate of new daily hospitalizations is five times worse than California’s. 

Texas is now reporting 1,403 new COVID-19 hospitalizations daily, 75% of its winter peak of 1,873. 

There are also some signs that California’s Delta surge is slowing after public officials in many counties instituted universal masking in indoor public settings. Some businesses have also started demanding proof of vaccination as a condition of employment or entry. 

During the week that ended Sunday, L.A. County reported a total of 20,979 new coronavirus cases — a modest 6.5% increase from the previous week, Public Health Director Barbara Ferrer said Tuesday. By comparison, the county saw a 22% increase the week before.

‘Forget herd immunity’: Hong Kong experts say better to prepare to live with Covid-19, but more must get their jabs

Via the South China Morning Post: ‘Forget herd immunity’: Hong Kong experts say better to prepare to live with Covid-19, but more must get their jabs. Hong Kong's experts have seen it all, right from H5N1 in 1997. I give their opinions a lot of weight. Excerpt:

“I don’t think we will be able to achieve herd immunity in Hong Kong through vaccination alone,” said Professor Benjamin Cowling, a leading University of Hong Kong epidemiologist who recently published findings that Sinovac induced much lower levels of antibodies, the protein in the blood that fights the virus. 

He said herd immunity could be achieved through inoculation only if everyone was vaccinated with the highly effective mRNA jabs, such as BioNTech’s. 

But the 7.5 million doses of BioNTech available are enough for only half the population, with vaccines not yet available to children aged below 12. 

“If a location has a high vaccination coverage but has not yet reached herd immunity, one choice is to reopen and prepare for an ‘exit wave’,” he said, referring to a final, inevitable rise in infections when the community opens up and discards social-distancing measures.

England, for example, declared July 19 its “Freedom Day” from virus restrictions. With about 68 per cent of its citizens having received at least one dose of vaccine, the country lifted most pandemic restrictions and is now expected to see more than a million infections in the coming months. 

That option is considered impossible for Hong Kong, whose leaders have clung to the goal of “zero local infections” in the hope of meeting tough requirements set by Beijing for resuming cross-border travel. 

The city has logged a 47-day streak of no local infections as of Saturday, although there have been imported cases. 

Cowling said: “Another policy choice would be to continue with a ‘zero Covid’ strategy to protect public health until additional rounds of booster doses can be administered to further increase population immunity.”  

But that could end up a moving target if more coronavirus variants emerged, he added. 

“I expect that most locations in the world will learn to live with the virus, managing it in a similar way to the seasonal flu,” he said. Assistant Professor Kwok Kin-on of Chinese University’s school of public health said the original goal of a 70 per cent vaccination rate assumed that one infected person could spread the virus to three others – the transmission rate of the original virus strain – and that the two available vaccines would maintain 60 to 95 per cent efficacy rates. 

But the arrival of variants changed all that. Scientists estimate that a person infected with the Delta variant can pass it on to at least five others.

Instead of chasing herd immunity, Kwok said it might be better to focus on whether vaccinated people had severe symptoms when infected with Covid-19 or the variants. 

“Covid-19 has a much higher mortality rate than flu. We hope to bring down the mortality rate of Covid-19 through vaccination,” he said. 

“If one is infected but will recover after resting for two days, can we accept that? If we find it acceptable, the problem is solved.” 

Hong Kong has so far seen 23 imported cases of fully vaccinated people who fell ill with Covid-19, of which 19 were infected with variants. But the severity of their symptoms and mortality rates were lower in general.

Kwok said if the mortality rate of Covid-19 could be brought down to a level comparable to the flu, normality could be resumed. 

“Would we impose lockdown or social-distancing measures because of the flu?” he asked. 

Professor Lau Yu-lung, chairman of the Centre for Health Protection’s scientific committee on vaccine preventable disease, said the city should be prepared to live with the virus once it had hit a high vaccination rate. 

He said: “Achieving a zero-infection status is just to let society continue to operate and have time to reach at least an 80 per cent full vaccination rate. When we have reached that state, we will not see a large number of deaths and a high hospitalisation rate.” 

Cowling said Hong Kong could start planning to reopen and relax pandemic measures once vaccinations pass the 70 per cent mark, even without herd immunity.

Moscow’s coronavirus infections hit record high

Via The Moscow Times: Moscow’s Coronavirus Infections Hit Record High.

Moscow reported its highest-ever number of new coronavirus infections Friday, as the city’s health authorities warned “new, aggressive mutations” of the virus were spreading at an alarming pace. 

Russia’s national coronavirus task force confirmed 9,056 new Covid-19 cases in Moscow over the last 24 hours — a 46% surge on the previous day. 

Mayor Sergei Sobyanin moved Friday to extend a limited number of restrictions in the capital in an attempt to stop the spread of the virus. Among other measures, Sobyanin ordered the Euro 2020 fan park to close, cancelled mass events with over 1,000 participants, and extended an 11 p.m. curfew for bars and restaurants. 

The previous highest number of cases reported in Moscow was 8,203 on Dec. 24, during the midst of the country’s second wave of the virus. 

Moscow has started to rapidly reprofile hospitals to increase the number of beds available to coronavirus patients. The number of designated Covid-19 beds is now almost back at levels seen during the first peak of hospitalizations last spring.

“It's most likely we are facing new, more aggressive variants which spread more quickly,” said Sobyanin during a video conference with government officials battling the pandemic. 

“It's tripling, there's an enormous dynamic that we have not seen during the previous waves.” 

Later Friday, Sobyanin said that the Delta variant first detected in India accounted for nearly 90% of new infections. 

Alongside new restrictions on mass events, Sobyanin ended a non-working week in the capital, which had seen workers sent on a week-long paid vacation in an attempt to stop the spread of coronavirus among the capital’s working population, who health authorities said accounted for the bulk of infections. 

A mandatory vaccination campaign for service sector workers has also been announced, and Deputy Mayor Anastasia Rakova said Friday there had been a fourfold increase in the number of vaccination appointments scheduled. Some 1.8 million Moscow residents have been vaccinated with at least one dose of a coronavirus vaccine, Sobyanin said Thursday — around 15% of the population. 

But leading health figures have warned that the impact of accelerated vaccinations will take weeks to have any impact on the spread of infections, and Moscow is still far from hitting the kind of vaccination levels needed to approach herd immunity.  

Nationwide Russia reported 17,262 new coronavirus cases Friday — a 23% increase and the highest daily figure since Feb. 1.

Vietnam: Social distancing returns to Ho Chi Minh City

From Mike Tatarski's excellent Vietnam Weekly: Social Distancing Returns to Ho Chi Minh City. Excerpt:

Government officials have generally avoided the term ‘lockdown’ throughout the pandemic, but just about the next closest thing came into force in HCMC at midnight. 

City-wide social distancing measures are now in place for two weeks. This policy is called Directive 15, and it “requires suspension of social events, bans gatherings of 20 people or more in one place and of 10 people or more outside workplaces, schools and hospitals. A minimum distance of two meters between people in public places should be ensured.” 

Non-essential businesses are also closed, and the streets this morning were certainly quieter than normal, though not exactly dead. 

Densely populated Go Vap District, as well as one ward in District 12, have been placed under Directive 16, which restricts gatherings to two people and asks residents only to leave home for essential work or to buy food or medicine. That covers almost 720,000 people - and this announcement sent thousands of people rushing to supermarkets, though officials had asked residents not to panic buy. Those areas have recorded numerous COVID-19 cases linked to the Revival Ekklesia Mission over the last week. 

Overall, the city has recorded 157 cases, almost entirely traced to that cluster, and the group is now facing a criminal investigation for not complying with pandemic prevention measures. 

This is the first time such steps have been taken in HCMC since April of 2020, which gives you a sense of how serious the situation is. 

Thankfully, massive testing is going on, with 50,000 samples taken in one ward of Go Vap alone on Friday night. To my knowledge, this is the first time an entire city ward has been tested, and more cases are certainly expected in the coming days. 

 City officials said last night that they plan to test all residents of areas where members of the Revival Ekklesia Mission lived, with the goal of taking 100,000 samples per day - an effort that could expand to the entire city. (Last night VnExpress had a headline about testing the whole population of 13 million, but that has vanished. It would take 130 days to test everyone at a rate of 100,000 per day.) 

The other big news from the weekend is the Ministry of Health’s announcement that genetic sequencing on current COVID-19 patients found a new, highly transmissible (their words) variant of the virus with characteristics of both the previously known Indian and UK variants. 

This was quickly picked up internationally, and has probably freaked people out, though experts I’ve spoken to advised against overreacting until more research is done on the clinical impact of this variant. 

Nationally, the outbreak remains serious: 34 provinces and cities have now been detected at least one case (over half of Vietnam’s localities), while this wave has accounted for 4,096 cases (up from 3,295 on Friday) and 12 deaths, including the country’s youngest virus-related fatality yet. The total pandemic case total is now 7,107, with a death toll of 47.

Coronavirus: The latest news about the outbreak in Sweden

Via The Local: Coronavirus: The latest news about the outbreak in Sweden. Excerpt:

• As of April 21st, 13,863 people have been confirmed as having died after testing positive for the coronavirus in Sweden (up from 13,825 on April 20th). The increase is not all from the past 24 hours, due to a delay in how the regions report their data. Sweden updates its data Tuesday-Friday at 2pm. 

• Since the start of the outbreak, 6,653 coronavirus patients have been in intensive care as of April 21st, which also includes fatalities and patients who have recovered and been discharged (up from 6,613 on April 20th). 

• There have been 924,340 confirmed cases of the coronavirus according to data reported on April 21st (up from 916,830 reported on April 20th).    

• 1,943,109 people had been given at least one dose of a vaccine against the coronavirus by April 21st, and 693,437 had been given both doses (up from 1,895,912 and 687,609 reported on April 20th). 

• Everyone in Sweden is urged to stay at home and get a coronavirus test if they are at all sick (even a mild cough or sore throat), practice social distancing, work from home if possible, avoid public transport as much as possible, and socialise with as few people as possible

Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: A comprehensive analysis

Via The Lancet Global Health: Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. The summary:

Background 

COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). 

Methods 

From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. 

We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. 

Findings 

The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. 

Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs. 

Interpretation 

In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. 

Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.

Brazil: Senator Major Olímpio, 58, dies after 16 days in hospital with covid-19

Via BBC News Brasil: Senator Major Olímpio, 58, dies after 16 days in hospital with covid-19. Excerpt from the Google translation:

Senator Major Olímpio (PSL-SP) had brain death on Thursday afternoon (18), in São Paulo, after spending 16 days in hospital with covid-19. Next Saturday, he would be 59 years old. 

Olímpio had been hospitalized since March 2 at Hospital São Camilo. The brain death information was confirmed on the politician's official Twitter account. 

"With a lot of pain in the heart, we report the brain death of the great father, brother and friend, Senator Major Olímpio. By law the family will have to wait 12 hours for confirmation of the death and is checking which organs will be donated. Thank you for everything you did for us, for our Brazil,", said the note on the social network.

According to the journalist Bela Megale, of the O Globo newspaper, Olímpio participated in a crowded protest against the lockdown in Bauru (interior of SP) two weeks before being hospitalized with covid-19. During the act, he even took pictures embracing with supporters.

COVID-19 fight hits defiance, suspicion in rural California

Tehama County. Google Maps

A discouraging report from The Los Angeles Times: COVID-19 fight hits defiance, suspicion in rural California. Excerpt:

RED BLUFF, Calif. —  Jeremiah Fears sat beneath an elk head mounted on the wall of the volunteer fire department in his little city and rolled up his sleeve for what he hopes is a step toward normality: his first dose of Moderna’s COVID-19 vaccine. 

“If we can get vaccinated and do our thing to protect one another and ourselves, we can hurry up and open and go from there,” said Fears, chief of the Corning Police Department. “I know there’s controversy behind it. But it is what it is.”  

Fears had come to a vaccination clinic in Corning — population 7,600 — aimed at firefighters and police officers. But in that fire station was a hint of the pandemic skepticism that runs deep in rural Northern California: two elderly people, both on dialysis, who were coming to get their shots.  

They had been put on standby because Tehama County health officials, who only brought two small vials containing 20 doses, suspected they might not attract enough firefighters or police officers to use them all. 

In the battle against COVID-19, health officials in Northern California face the daunting task of vaccinating more than 683,300 people spread across a mountainous, heavily forested region where calamity — either from illness or physical trauma — can mean hours-long drives to the nearest medical facility. 

Among their biggest obstacles: overcoming widespread skepticism that the virus is a serious threat in far-flung towns, fear that the new vaccine is unsafe, and open rebellion against health orders. The pushback in rural parts of California is emblematic of the challenge in many parts of the United States, particularly outside more liberal urban centers.  

“We’re getting very frustrated here in Northern California,” said Dr. Richard Wickenheiser, the Tehama County health officer. “We have a lot of anti-vaxxers and a lot of independent people who just feel that COVID was a hoax, that it was going to go away when the election was over. And that didn’t happen. ... The excuses just go on and on.” 

Public health messaging, he said, “isn’t working.”

PAHO Director says new variants and acceleration of COVID-19 virus make continuing public health measures urgent

A news release: PAHO Director says new variants and acceleration of virus make continuing public health measures urgent. Excerpt:

Washington, D.C., January 13, 2021 (PAHO)— The appearance of new variants of the COVID-19 virus in several countries of the Americas, combined with an acceleration in the virus’s spread in virtually every country in the Americas, makes it critical to continue public health measures such as social distancing, wearing masks, and washing hands often, Pan American Health Organization Director Carisa F. Etienne said today.   

“Our collective ability to keep up with these measures has the power to determine the trajectory of this year. If we remain diligent, we have the power to control this virus; if we relax, make no mistake, 2021 could well be far worse than 2020," Etienne told a press briefing today.    

She said, “Since the start of this pandemic, over 39 million people across the Americas have become infected by COVID-19 and over 925,000 of them have succumbed to the virus. In the last week alone, 2.5 million people were infected with COVID-19 in our region – the highest weekly cases since the virus first reached our shores. “ 

PAHO's genomics surveillance network of 21 laboratories has been tracking the spread of the virus and mutations, she highlighted, and the variant first seen circulating in the United Kingdom has now been reported in eight countries: Brazil, Canada, Chile, Ecuador, Jamaica, Mexico, Peru, and the USA. In addition, Brazil and Canada have reported seeing another variant that was first reported in South Africa.  

“At this time, there is no evidence to suggest that these variants affect patients differently, but early data does suggest that the virus can spread more easily, accelerating the threat to our health systems at a time in which they are already close to capacity,” Etienne said.   

One vaccine has been approved by WHO to date and more are underway. Some countries in the region have started vaccinating health workers and vulnerable groups, but “as long as doses remain limited, we can’t rely on vaccinations to flatten the pandemic curve,” she said.   

PAHO’s priorities in 2021 include ensuring equitable access to protective equipment for health workers, medications and hospital care when required, and vaccines.    

“With the arrival of vaccines, we must ensure not just that doses are produced quickly, but that they’re equitably delivered and swiftly across every country – regardless of income. This will require global and regional collaboration and solidarity, with donors pitching in resources through mechanisms like the COVAX Facility,” the Director noted.