Monday Morning News & Notes
Denmark tables BA.5 threat assessment. Lack of COVID testing a concern.
🦠Pandemic🦠
🇩🇰
In a risk assessment of the new BA.4 and BA.5 COVID variants, Denmark’s Statens Serum Institute is warning that seniors and vulnerable populations are most at risk.
“Currently, the older age groups have the highest positive percentage, in addition, the older age groups have not been infected to such an extent during the Omicron wave with BA.2 as the rest of the population. This means that the level of hybrid immunity in this group is lower, and in addition, the probability of declining protection against serious illness is higher among the older age groups, as they were vaccinated with the 3rd dose before the rest of the population.”
While cautioning that there is still a lot we don’t know yet about these two variants, the SSI threat assessment finds a concern over preliminary data showing the two strains are better able to dodge antibody protections.
“Overall, several neutralization studies show that BA.4 and BA.5 are less sensitive than both BA.1 and BA.2 to antibodies after vaccination alone and hybrid immunity (vaccination and infection).”
The institute also estimates that the BA.5 variant will become dominant within the next three weeks. That may also have some consequences. The SSI notes that for the first time since mid-February, infection numbers are increasing again.
“The incidence and positive percentage are highest among especially the older age groups, where the proportion who have achieved hybrid immunity is lowest. There are also signs of increasing positive percentage among healthcare staff.”
The SSI report says that the BA.5 variant is spreading quickly across Europe, including in Germany, France, Austria, and the United Kingdom. But the report focuses heavily on Portugal due to how close its vaccination rates are to Denmark. In Portugal, the BA.5 variant accounts for 48% of all positive sequenced test results as of week 20. It also registered a record-high positivity percentage of approximately 54% in week 21. The assessment notes ‘Our World in Data’ has the number of COVID hospitalizations in Portugal almost on par with the first coronavirus wave. But, it also notes the data doesn’t differentiate between hospital admissions directly due to an infection or people admitted for other reasons but with an infection. The European Centre for Disease Prevention and Control also shows a “possible small increase” in COVID deaths in Portugal, but the SSI adds there are some data “irregularities.”
“In Portugal, a declining vaccine immunity, and a poorer immunity to BA.4 / 5 in previous BA.1 infection (compared to BA.2) are mentioned as some possible causes to the current increase in infection. In addition, the abolition of the mask order in April and the Easter holidays are mentioned as possible contributing factors.”
Looking at what data we have on the new variant so far in Denmark, the institute notes a preliminary 14% reinfection rate for BA.5. Of those, the institute’s preliminary data shows 25% of those reinfections were people who had a prior infection during the Omicron variant wave, which began last November.
The Statens Serum Institute says very few COVID-related hospital admissions, nine so far, have been people with a proven BA.5 variant infection. That would be a preliminary hospitalization rate of 1.7%, or nine admissions out of 517 cases. Again, it is early days for BA.5 and these numbers are going to be very fluid.
Getting down to brass tacks, the SSI says another infection wave is coming, but to what extent remains a question mark.
“It is estimated that there is a high probability of a general increase in the incidence of COVID driven by BA.5. A new major wave of infections can therefore lead to a derivative increase in hospitalizations among the elderly and vulnerable. However, there is uncertainty about the extent of a new wave of infection with BA.5 at present, i.a. given the expected seasonal effect and reduced activity in the community over the summer.”
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Denmark’s Ministry of Health convened a meeting of health representatives from all the parliamentary political parties this past Friday. They were briefed on the new BA.5 variant and the risk it posed.
Unity List's Health spokesman Peder Hvelplund was there and spoke to DR:
“I think we can see that we are now moving into a new reality, where new COVID variants are something we have to get used to. This does not mean that it should set off the alarm bells every time. But it is, of course something we must be aware of.”
Hvelplund says based on the briefing they received, the risk posed by the BA.5 variant is “not alarming.” But he adds that it “makes good sense” to protect seniors and vulnerable populations, especially in making sure they are properly vaccinated.
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“It’s out of the question.”
Despite a new, more infectious variant driving COVID case numbers up for the first time in four months, Denmark’s Health Minister is ruling out reintroducing any restrictions.
Magnus Heunicke spoke to DR:
“Yes, it is more contagious than it has been in the past. But we are at a very low level here in Denmark and still have a high immunity in the population. One should always be aware when coronavirus mutates, and it often does. What we are seeing now is a new sub-variant, which is more contagious. Probably 10% more. Of course, one has to be aware of that. But there is nothing to suggest that it causes more severe infections nor any excess mortality.”
Heunicke is banking on the high vaccination rates along with the seasonal effect keeping any new infection wave in check. He says the threat from the BA.5 variant, especially with all the returning music festivals, would be much greater if this was the late fall or winter.
But what about the coming fall and winter?
“Our strategy is about avoiding shutdowns and of course taking care of our vulnerable citizens and using our strongest tools. Primarily vaccination, but also testing.”
Keeping in mind Denmark’s COVID testing regime is a pale shadow of what it once was unless it is ramped back up at the end of the year. Heunicke did reiterate that people in Denmark can expect another vaccination campaign in the fall. But he wouldn’t yet provide any specifics saying a COVID strategy will be tabled by the government within a few weeks.
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The Statens Serum Institute did not update Denmark’s COVID numbers over the weekend. But as you can see from the last release of data on Friday that new infections over the previous seven day period were heavily concentrated among the age groups from 20 to 79 years old.
COVID hospitalization data over the same seven day span also shows that it is seniors 65 years old and older who are by far seeing the most infection-related hospital admissions.
🇳🇴
Norway’s influenza wave is receding. The positivity percentage for the seasonal flu has fallen from around 21% in week 14 to 2.4% in week 22.
Influenza-related hospital admissions are also dropping, with 89 new patients the week before last, a drop from the 97 the week before that and the 132 in week 20. The Norwegian Institute of Public Health says there haven’t been any influenza-related intensive care admissions for two weeks straight.
Other than COVID and a late resurgence of the seasonal flu, the NIPH says it is rhinovirus and metapneumovirus cases that are the most common.
🇪🇺🦠
So far the COVID numbers in the European Union as a whole continue to improve, at least until the week ending June 5th. That is the week covered in the latest weekly pandemic assessment from the European Centre for Disease Prevention and Control.
The ECDC says by the end of week 22, overall coronavirus numbers are declining as shown by overall infection numbers and cases among seniors 65 years old and older. That said, the agency notes, two EU countries are reporting increasing infection activity among their oldest populations.
Of the 28 countries reporting hospitalization data to the ECDC, seven have registered increasing numbers of COVID hospital admissions.
The 14 day coronavirus death rate has been falling for seven straight weeks and as of week 22 it was 7.5 deaths per million population across Europe, down from 10.2 the previous week. At the country level, the number of infection deaths increased in Estonia for the 2nd week, while Ireland and Portugal saw numbers rise in the last week.
The European health watchdog is forecasting that across the European Union over the next two weeks, infection rates will remain stable, hospitalizations will decrease, and deaths will also decline. Although it adds that it should be noted “that forecasts of cases are considered to be increasingly unreliable due to changes in testing criteria and reporting procedures. All current forecasts, in particular case forecasts, should be treated with caution.”
As of week 22, 72.6% of the total EU population had at least two vaccine doses and 52% had a booster dose.
On the variant front in Europe, 99.6% of all positive sequenced test results are an Omicron variant. Of those, 83.5% tested positive for BA.2, 12.2% came back as BA.2 with the L452X mutation, 8.1% were BA.5, and 2.7% for BA.4.
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The European Centre for Disease Prevention and Control is stressing that COVID surveillance, testing, remains very important as new variants of interest and of concern continue to pop up. The agency says testing and the sequencing of those test results provide crucial data for, among many other things, the evaluation of vaccine efficacy and development.
The problem is that COVID testing rates across Europe are dropping like a rock. Even Denmark, once a global leader in COVID testing, is now testing at rates the ECDC says result in “insufficient data available” to determine the pandemic situation. You can see below the number of countries and regions across the EU that have been “greyed out” by the ECDC for low testing numbers that result in “insufficient data.”
WHO🦠
In its latest update on the global COVID situation, the World Health Organization says the number of infections and deaths continues to drop, which it says is encouraging. But WHO Director General Dr. Tedros Adhanom Ghebreyesus advised taking those numbers with a grain of salt.
“This is clearly a very encouraging trend; increasing vaccination rates are saving lives, but the WHO continues to urge caution. There is not enough testing, and not enough vaccination.”
Dr. Tedros says global vaccine supply is no longer an issue, but demand now is.
“On average, about three-quarters of health workers and people aged over 60 globally have been vaccinated. But these rates are much lower in low-income countries. Almost 18 months have passed since the first vaccine was administered, and 68 countries have still not achieved 40% coverage.”
He also continues to urge people to remain vigilant and not let their guards down.
“The perception that the COVID pandemic is over is understandable, but misguided. More than 7,000 people lost their lives to this virus last week. A new and even more dangerous variant could emerge at any time, and vast numbers of people remain unprotected.”
🇺🇸
The United States has lifted the requirement for international travelers to have a negative COVID test within 24 hours of boarding a flight, or show proof of a prior infection, in order to enter the country. This ends one of the last remaining COVID-related travel restrictions in the United States.
The American Centre for Disease Control did reserve the right to restore the test restriction should the pandemic take another turn for the worse.
🇨🇦
The Trudeau government is pressing pause on random COVID testing for all incoming fully vaccinated travelers. The practice will be suspended until at least June 30. However, unvaccinated travelers will still be tested on arrival, albeit the government is moving that testing “off-site” by July.
🦠Monkeypox🦠
Late on Friday afternoon, the Staten Serum Institute confirmed another case of monkeypox in Denmark, the country’s 4th infection case.
Health Minister Magnus Heunicke:
“We have now found another case of monkeypox in Denmark. However, there is still no evidence that smallpox infection has occurred within this country, as all cases are related to travel abroad. The Danish Agency for Patient Safety is in the process of tracing the infected person's close contacts in Denmark.”
Technically, this would be the 5th monkeypox case in Denmark but one of the cases was a person who is a Swedish resident who tested positive while in Denmark, so technically they aren’t included in the running total.
WHO🦠
In its latest update, the World Health Organization says, as of June 8, there are 1,285 confirmed cases of monkeypox across 28 countries that don’t usually see outbreaks from this virus. We know from the European Centre for Disease Prevention and Control that 704 of those confirmed infections have been in 18 countries within the EU or broader, European Economic Area. The WHO says so far there have been no fatalities.
WHO Director General Dr. Tedros:
“[Monkeypox] cases have been reported mainly, but not only, among men who have sex with men. Some countries are now beginning to report cases of apparent community transmission, including some cases in women. The sudden and unexpected appearance of monkeypox in several non-endemic countries suggests that there might have been undetected transmission for some time. How long, we don’t know.”
Dr. Tedros says there is concern about the health risks posed by the virus.
“The risk of monkeypox becoming established in non-endemic countries is real. WHO is particularly concerned about the risks of this virus for vulnerable groups including children and pregnant women.”
He says impacted countries do have the tools to mitigate the spread of the virus.
“There are effective ways for people to protect themselves and others. People with monkeypox symptoms should isolate at home and consult a health worker. Those who share a household with an infected person should avoid close contact.”
Dr. Tedros adds there is a vaccine and other medication, but they are in short supply.
“There are antivirals and vaccines approved for monkeypox, but these are in limited supply. WHO is developing a coordination mechanism for the distribution of supplies based on public health needs and fairness. In the few places where vaccines are available, they are being used to protect those who may be exposed, such as healthworkers and laboratory personnel.”
He also asks people to keep things in perspective.
“It’s clearly concerning that monkeypox is spreading in countries where it has not been seen before. At the same time, we must remember that so far this year there have been more than 1,400 suspected cases of monkeypox in Africa, and 66 deaths. This virus has been circulating and killing people in Africa for decades. It’s an unfortunate reflection of the world we live in that the international community is only now paying attention to monkeypox because it has appeared in high-income countries.”
🦠Mystery Hepatitis🦠
The World Health Organization says mystery hepatitis cases among children are continuing to crop up, with over 700 confirmed cases across 34 counties and another 112 cases under investigation.
WHO Director General Dr. Tedros says so far 38 children have had such severe cases they have required a liver transplant while ten others have lost their lives.
Dr. Tedros says the cause remains a mystery.
“WHO continues to work with countries to investigate the cause of hepatitis in these children. So far, the five viruses that commonly cause hepatitis have not been detected in any of these cases.”
So far any link to COVID vaccines has been ruled out, but the virus itself has not. In some of the cases, but not all, the children have had a previous coronavirus infection.
🇺🇦/ 🇷🇺 War
Turkey continues to try and leverage Sweden and Finland’s NATO applications into some kind of bargaining chip. All 30 NATO countries must vote unanimously for any new member country to join. Right now, Turkey seems to be the lone country who is balking at voting yes.
NATO Secretary General Jens Stoltenberg, who had guaranteed both country’s would be welcomed into NATO very quickly and with open arms now says the Turkish problem may not be resolved before the end of June’s NATO summit. Stoltenberg made the comment at a press conference with Finnish President Sauli Niinistö.
Turkey initially said it would support both Sweden and Finland’s NATO bid before suddenly changing its tune. It now opposes the memberships because it is accusing both countries of housing members of the Kurdish Workers Party, which Turkey classifies as a terrorist organization.
At Sunday's press conference in Finland, the NATO chief described the Turkish objections as "legitimate concerns.”
“It's about terrorism. It's about arms exports. We must understand and remember that no other NATO ally has suffered more terrorist attacks than Turkey. And also that Turkey is an important ally with a strategic geographical location.”
In comments made to Svenska Dagbladet after the press conference, Finnish President Sauli Niinistö said Finland will not join NATO unless Sweden does as well. He says that is a message he conveyed to NATO Secretary General Jens Stoltenberg on Sunday.
Sweden and Finland both made the historic decision to join NATO, abandoning a long history of neutrality, due to Russia’s invasion of Ukraine.