Monday Morning News & Notes

Omicron continues to pound Europe with no end in sight yet

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The Staten Serum Institut is keeping a sharp eye on a sub-variant of the Omicron strain called BA2, with the original Omicron variant labeled BA1. While the original Omicron strain seems to have more or less plateaued in Denmark, the BA2 strain is gaining ground rapidly. It made up 2% of all sequenced positive test results in week 50 (mid-December) and by the first week of 2022 it had grown to 28%.

Chief Physician, and Professor, Anders Fomsgaard spoke to Ritzau to say the big question is how different, or not, the sub-variant may turn out to be.

“We cannot yet see any significant differences in those infected with BA2 in terms of age, vaccine status, breakthrough infections, disease, or geographical spread.”

Graph courtesy of Australian Data Visualization Specialist Mike Honey (@Mike_Honey)/Twitter

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The coronapas has been tweaked. As of the weekend, the coronapas is only valid for five months with a previous coronavirus infection or having two vaccine doses. Getting a booster dose extends the validity of a coronapas. Danish health authorities have not yet put an expiration date on immunity after a booster dose. For 15 to 17 year olds who have a coronapas these changes have not applied and they remain under the old system.

Another change to remember is that the length a negative COVID test is valid has also been adjusted. A negative PCR test is only valid for 72 hours and for a rapid test it is 48 hours.

Denmark also began to phase out COVID restrictions. As of yesterday (Sunday) movie cinemas, indoor sporting events, theatres, concert venues, cultural facilities, and sports facilities have all reopened albeit with capacity limits of 1,500 attendees broken into three sections of 500 each with social distancing requirements between the sections and individual groups within them.

Also open again are højskoler, outdoor sporting events, aquariums, art galleries, activity centers, amusement parks, and zoos.

In all cases, mask requirements remain in place, as does the requirement for a coronapas to enter.

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Denmark continues to dodge the feared perfect storm of soaring coronavirus infections compounded by a huge influenza wave. Danish health authorities had warned last fall that such a dual infection wave could pose a major threat to the healthcare system. But so far the influenza season remains mild, with no sign yet of a massive infection wave to come. That said, the Staten Serum Institut cautions we are not out of the woods yet, even as the influenza season remains one of the lowest in years. It figures COVID restrictions, especially with masks, frequent hand washing, cautious social contact, and to some degree seasonal flu vaccine uptake are keeping a lid on things. But the SSI notes winter is not over and until it is influenza remains a concern.

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Denmark added 74,817 COVID infections and 41 more coronavirus deaths over the three day period covering the weekend. It reported 23,614 corona cases on Friday, 25,034 on Saturday, and another 26,169 on Sunday.

There were 346,389 total corona tests on Saturday, of which 187,175 were PCR tests equaling a positivity percentage of a very high 13.98%.

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All but three of Denmark’s 98 kommunes have a COVID incidence rate per 100,000 people of 1,000 or higher. Two of them, Glostrup and Albertslund, have an incidence rate of over 4,000. Even worse, all but four of the municipalities have an incidence rate that is trending upward.

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Since primary school students returned to class on January 5, there have been thousands of COVID infections recorded among young children. Data from the Staten Serum Institute shows that since schools reopened 18,485 kids 12 to 15 years old have tested positive. For the 6 to 11 year old age group, the number is 23,385. While younger children 3 to 5 years old have seen another 12,511 infections in the 13 days since back to school.

The numbers only show the difference in total infections by age group from January 5 to 17; obviously we don’t know how many of these infections are directly related to being in school.

For comparison here is infection numbers by age over just the last seven days.

Hospital admission numbers among young children remain a much smaller fraction of the number of infection cases. In the last seven days there have been a combined 71 hospitalizations of children aged 3 to 15 years old.

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COVID hospitalizations (734) have jumped again (+23) while the number of infected people in an ICU (59) is unchanged, and of those the number on a ventilator (41) crept up (+1).

Worth noting, the number of people in intensive care is the lowest it has been since December 11 of last year, when there were 60 infected people in intensive care.

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COVID-related staffing woes will keep the emergency clinic in Ringkøbing closed until at least February 4. Region Midtjylland closed the clinic on December 17 in order to use all available staff where they were most needed. It was hoped the clinic would reopen over the weekend, but critical staffing shortages have still not resolved themselves.

Council Chair Anders Kühnau:

“I know that many citizens are looking forward to the emergency clinic in Ringkøbing reopening and I apologize for the inconvenience caused by the temporary closure. Together with Hospitalsenheden Vest, we work from a political point of view to find immediate solutions so that the emergency clinic can reopen.”

The region is weighing some staffing alternatives but so far hasn’t managed to get anything concrete in place. It advises people in Ringkøbing who need emergency care to call their doctor and if it is outside the doctor’s opening hours then they should call Emergency Medical Services.

Possible solutions will be tackled in meetings planned for January 18 and on January 26.

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Denmark passed another vaccination milestone over the weekend as the number of people with two vaccine doses reached 80% of the total population as of Sunday’s report. So far, 82.3% have one dose and 56.7% have a booster shot.

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Denmark will reduce daily vaccination capacity as the number of inoculations everyday remains well under 100,000. The Danish National Board of Health says the current daily vaccination capacity of 400,000 doses will be trimmed down to 100,000 or less by mid-February.

Unit Manager Steen Jespersen spoke to Ritzau:

“There are already many people who have received a booster dose, so the need for a high capacity in the coming weeks will be less and less.”

That said, the health board insists there will still be enough vaccination capacity to get anyone a jab that wants one.

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Denmark’s Culture Minister Ane Halsboe-Jørgensen has tested positive. She made the announcement on her Facebook page.

“Unfortunately, I have received the same message that so many of you others also received during this time a positive corona test. I am betting on a mild illness with my three doses.”

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Sweden doesn’t update its pandemic numbers over the weekends and will table its first update of the week on Tuesday.

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Hospitalizations continue to rise in Sweden’s capital region as overall hospital capacity continues to diminish. Region Stockholm reported 463 COVID hospitalizations on Sunday; that is an increase of 44 from Saturday. 32 of those patients are in intensive care.

The region says as of Sunday afternoon it had 153 vacant beds and a few others that could be used outside emergency hospitals if needed. That is 74 fewer beds than were available on Saturday.

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The Swedish Public Health Agency has provided a roadmap for the regions to prioritize COVID testing should the massive Omicron infection wave overwhelm resources.

The agency says the national testing capacity has been “greatly expanded” noting almost 429,000 COVID tests being administered last week. That is fewer tests over an entire week than Denmark administers on most days. Sweden’s national health agency says testing capacity will be “expanded further in the coming weeks.” However, it also warns the Omicron-driven infection wave driving daily infection numbers to never before seen heights and “feared continued sharp increases” could quickly overwhelm testing efforts with the regions needing to prioritize access.

“In order to protect fragile people in healthcare and elderly care, where the spread of infection risks having serious consequences, the resources need to be used where they make the greatest difference.”

The agency recommends prioritizing health and senior care workers, and cases where a doctor has recommended testing for a patient’s continued care. Knocked to the bottom of the list are asymptomatic people.

It advises close contacts of an infected person and those living with an infected person to isolate at home, avoid social contacts, and be aware of symptoms.

The agency has also removed the recommendation for anyone who has been traveling outside of Sweden to get tested upon their return. It says due to the extensive spread of the Omicron variant “this is no longer justified.”

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Norway has added 22,265 infections and had no deaths since its update on Friday.

COVID hospitalizations (231) have dropped (-21) while the number of people in an ICU (76) declined slightly (-2) and of those the number on a ventilator (51) also fell (-7).

To date, 79.7% of Norwegians 12 years old and older have one vaccine dose, 73.4% have two, and 40.2% have had a booster shot.

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Norway has begun to vaccinate children aged 5 to 11 years old and green-lit the use of a second vaccine dose for those 12 to 15 years old. The Norwegian Institute of Public Health says while children have a small risk of serious illness from COVID, vaccines can have a positive benefit. It also adds that children and adolescents who have had a coronavirus infection have “broad and lasting protection.”

Chief Physician Margrethe Greve-Isdahl says the offer is primarily aimed at children who are in a vulnerable population, have chronic disease, or are in regular contact with someone who is a high risk. Outside of that it will be a choice.

“There is no doubt that vaccines can provide protection against serious illness also in children, but the protection against the spread of infection is poorer, especially with Omicron. We have seen in Norwegian data that reviewed infections in adolescents [that it] can provide very good protection against new infections, and it may therefore, be an advantage for protection against new virus variants in the future. Therefore, we have advised the government that vaccination of children and other doses to young people should be the individual choice, and not a strong recommendation from the authorities.”

The NIPH says the pediatric vaccine doses will be ready by the end of January and the second dose for older children can begin as soon as practically possible.

“The 12-15-year-olds already have high protection against serious illness after their first vaccine dose. Although there is a small additional benefit of other doses to these, we have weighed this against the risk of the rare but serious side effect myocarditis.”

Norway began giving 12 to 15 year olds their first dose in September. Some children 5 to 11 years old with severe underlying health conditions have been able to get vaccinated since December.

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Finland does not update its COVID numbers on weekends and will table three days worth of data later today.

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The Finnish government will meet early this week to discuss measures to try and wrestle down coronavirus infection numbers. One of the options on the table is to expand the use of the coronapas.

Finnish Prime Minister Sanna Marin told broadcaster MTV the function of the coronapas may also need to change.

“We must assess whether the use of the pass can be circumvented through testing. In that case, people who have not been vaccinated may be exposed to the illness.”

Finland was late to the game with its coronapas, which was put in place last October before largely being put back on the shelf by December.

Another area where restrictions are almost certain to be reimposed are on bars, restaurants, and the sale of alcohol.

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As Omicron infections soar in Finland, the Finnish Institute for Health has issued guidelines in the event testing systems or contact tracing efforts are overrun or extremely backlogged. The agency’s recommendations apply to both the vaccinated and the unvaccinated. It advises people who develop mild symptoms but are “basically healthy” to not bother getting tested. However, they should avoid any contact with people outside their household for at least five days. It does add the caveat that the rules of the local municipality, if different, trump those of the institute, as does advice to the contrary from a Doctor or other healthcare professional.

For those who have symptoms and opt for a self-test at home, the agency recommends the same five day isolation period even if the test comes back negative. If symptoms last longer than three days, the institute wants people to remain in isolation until they are symptom-free for at least 48 hours. If the self-test is positive, it says to just go with the result and not bother with PCR test to confirm it.

The five day isolation also applies to close contacts of an infected person, those living in the same household, and their children. Asymptomatic kids can return to school after the five days are over. People living with a sick person are advised to work from home and if they cannot, then wear a mask to work and limit contacts.

Lastly, it says, for a select group of people, COVID testing is required including if a doctor or healthcare professional recommends a person get tested, employees in health or social care, people working with seniors or the disabled, vulnerable at risk groups, and pregnant women.

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Austria has tightened entry restrictions and among the changes it has put in extra rules for travelers from Denmark, Norway, the Netherlands, and the United Kingdom. All of those countries have been classified by Austria as “virus variant regions.”

All travelers from virus variant regions must have either two or three vaccine doses, and even then a negative PCR test no more than 48 hours old is also required. For those with a Johnson & Johnson vaccination, a second vaccine dose is needed. Children under the age of 12 traveling with adults who meet entry requirements are exempt.

People who have had two vaccine doses and have recovered from a coronavirus infection, no matter which order that occurred, count as being boosted. The negative PCR test requirement still applies. A recovery certificate is only good for 180 days from a positive test. A medical certificate of a positive infection no longer suffices to enter Austria. This could provide a complication in cases where a previously infected person continues to test positive.

Austria’s entry rules in full can be found HERE.

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The Netherlands, which has had some of the European Union’s strictest coronavirus restrictions, is lifting some of those measures as it takes a cautious step out of a lockdown. On Sunday shops reopened, people could go get haircuts again, and sex workers returned to work. But Dutch Prime Minister Mark Rutte cautioned this is not a full reopening as bars, restaurants, and cafes will remain closed until at least months end.

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Life in France will soon become a lot more difficult for the unvaccinated. Over the weekend, the French parliament voted to approve a broader use of the vaccine passport system that drops the negative test option. The vote was 215 for and 58 against. This clears the way for vaccine passports that will check either vaccination status or previous infection to be required to go into restaurants, cafes, movie theatres, and long distance trains, among other things.

This means people who have chosen not to get vaccinated will have far fewer options as far as transport and social activities with the negative test option. The French legislature also included increased punishment for people caught with a fake vaccine passport. They could face up to five years in prison and a fine of up to €75,000 (about $107,000 Canadian). There are around 4.9 million people in France, about 7.3% of the population, who have refused to get vaccinated.

The new requirements are expected to come into force this week.

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France has lifted strict entry requirements on travelers from the United Kingdom it initially put in place on December 20. As the Omicron variant drives infection rates across Europe to record heights, it has deemed the entry restrictions it placed on British travelers to be redundant.

French Tourism Minister Jean-Baptiste Lemoyne made the announcement that as of January 14, the need for a “compelling reason for travel" and mandatory 48 hour quarantine were lifted for British travelers. Visitors from the UK will now face the same entry requirements as all other non-EU travelers coming to France.

Requirements dictate that travelers from outside the EU must be fully vaccinated and have a negative COVID test no more than 24 hours old to enter France. Those who are not vaccinated must register online with France prior to departure and must quarantine for ten days on arrival.

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As of January 13, the Omicron variant has been confirmed in every single European Union country and among nations in the wider European Economic Area. This is according to the European Centre for Disease Prevention and Control in its latest weekly assessment of the pandemic situation across the EU. Among countries across Europe, that have what the ECDC called adequate sequencing volume, 21 reported the Omicron as the dominant variant. The agency says the prevalence of the hyper-contagious variant has the epidemic situation considered as high or very high across 28 EU/EEA countries.

“Given the exponential growth advantage of Omicron variant of concern and the high numbers of cases, any potential benefits from a lower observed severity will be short-lived and outpaced by the sheer number of severe outcomes over time.”

The 14-day COVID incidence rate per 100,000 people was 2,008 in the first week of 2022 and the ECDC says it has been increasing for the last three weeks. Across Europe, it notes, rising infection numbers were highest in those 15 to 24 years old, followed by the 25 to 49 year old age group.

While the infection rate rises across Europe, the agency says the coronavirus death rate has been stable for seven weeks. In the first week of January, the pandemic fatality rate was 49.2 per million people. At a country level virus deaths were trending upward in nine European nations.

COVID hospitalizations have been increasing across the EU for two weeks, with six countries reporting a corona admission rate at 50% or higher compared to each country’s previous peak numbers. Narrowing it down to just intensive care, the ECDC is reporting numbers have been stable for six weeks across the EU/EEA. However, looking closer at each country, it notes ICU numbers are rising in four nations.

The centre expects the Omicron variant to keep pushing infection numbers up across Europe over the “coming weeks.” It warns this infection wave will lead to high levels of staff, including healthcare and essential workers, out sick. The ECDC also warns the infection wave will likely overwhelm testing and contact tracing “in many EU member states.”

“The sheer volume of COVID cases anticipated to occur are expected to place considerable strain on healthcare systems and society.”

It is worth noting as Denmark begins to phase out COVID restrictions that the ECDC is cautioning all European Union countries to do exactly the opposite and take “urgent and strong action” to reduce infection spread, prevent hospitals from being overrun, and protect the most vulnerable.

“Strengthening of non-pharmaceutical interventions [restrictions] is necessary to reduce ongoing Delta and Omicron transmission and keep the COVID-related disease burden manageable. These measures include avoiding large public or private gatherings, extended use of face masks, reduced contacts between groups of individuals in social or work settings, teleworking, and reduced inter-household mixing. Efforts should continue to increase full vaccination uptake in individuals who are currently unvaccinated or partially vaccinated and accelerate the roll-out of booster doses.”

WHO🌍💉

The World Health Organization says the international vaccine initiative, COVAX, hit a delivery milestone with over one-billion vaccine doses delivered. The vaccine collaboration is working to secure and deliver vaccines to the world’s low and middle income countries. While the one-billion figure is impressive vaccine inequity remains a glaring global problem. According to data from the World Health Organization, while 67% of the population of wealthier countries, on average, have been fully vaccinated, that number plummets to just 5% for poorer developing nations.

🇯🇵 🦠

Data from Japan has thrown a monkey-wrench into the move by a number of countries, including the United States, to cut COVID isolation down to five days. Preliminary findings from Japan’s National Institute of Infectious Diseases suggest people infected with the Omicron variant are infectious for two to three days longer than previous variants. The Institute suggests that someone with Omicron could be at their most infectious three to six days after diagnosis or the onset of symptoms.

As Omicron takes down a multitude of people triggering serious staffing challenges as people call in sick in droves, some countries have begun to shorten the isolation period.

University of East Anglia Medical Professor Paul Hunter says the Japanese data “muddy the waters.”

“I’m still working my way through the evidence for and against, given that the Japanese study has now shifted the balance.”

On the other hand, Hunter says the Omicron variant is infecting people so fast and in such high numbers that even top-notch testing systems are now missing cases and lesser set-ups are just collapsing outright. He says we are racing toward a tipping point where isolating becomes much less effective.

“It will have some value for people in healthcare settings who are managing really ill people, but we’re getting to the point, probably soon, if we’re not there already, where the value will be less.”

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COVID modeling tabled by Public Health Canada on Friday said the country is on track for between 100,000 to 250,000 infections a day. Canada’s Chief Public Health Dr. Theresa Tam noted current numbers have already eclipsed anything the country has seen before and could still “vastly exceed anything we have experienced to date during the pandemic.”

It will be hard to assess the ‘real’ number of coronavirus infections in Canada both now and in the days ahead due to overwhelmed or completely collapsed testing systems.

Along with the infections surge hospitalization numbers are forecast to reach record-breaking heights as well. Tam says while the Omicron variant seems to “have a lower severity profile” the sheer number of infections will put an intense strain on the hospital system. She warns impacts including an increasing backlog of delayed surgeries and procedures and the strain on healthcare workers could have long-lasting impacts.

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Due to an array of testing issues, we are now focusing on hospital numbers and the positivity percentage for the provinces as a more accurate assessment of the pandemic situation.

Of the provinces that report on the weekends:

Ontario reported 3,595 hospitalizations on Sunday (-362) and ICU numbers (579) were up (+21) and of those the number on a ventilator (340) also rose (+21). Not all hospitals in the province report on weekends so hospitalization numbers could correct themselves with the next report. The pandemic claimed 40 more lives in Ontario. The province has a positivity percentage of 11.07%.

Quebec’s hospitals are straining as hospitalizations (3,300) continue to rise (+105) while the number of infected people in intensive care (282) also mounts (+7). The province had another 21 deaths on Sunday. It has a positivity percentage of 16.89%.

Nova Scotia has 68 people in hospital, including 10 in an ICU. The average age of those admitted is 65.

Newfoundland and Labrador has the highest number of hospitalizations since October, with 12 COVID patients and three more people who have died.

New Brunswick saw four more deaths while hospitalizations jumped to 115 while there are 14 people in an ICU, and of those four are on a ventilator. 71% of those in intensive care have either one vaccine dose or none at all.

In Saskatchewan hospitalizations (162) increased (+12) while there are 12 people in an ICU (+1). The province has a sky-high positivity percentage of 35.3%.