Monday Morning News & Notes
The Omicron wave may be easing in Denmark and across Europe
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As of today, children in daycare, primary schools, and youth and adult education are no longer recommended to undergo twice-weekly COVID testing. Denmark’s Ministry of Education says the requirement to get tested as a close contact remains. It says parents, students, and staff will also continue to have access to free COVID self-testing kits, at least for now.
Education Minister Pernille Rosenkrantz-Theil:
“I am so happy that we have come so far in dealing with the pandemic that we can drop the weekly screening tests. It is another step towards a more normal everyday life. The virus is still among us, and many are infected at the moment, but thanks to the great efforts of both students and staff, we can see the light at the end of the tunnel.”
The ministry says self-testing kits will remain available for parents, students, and staff as long as the Danish Health and Medicines Authority continues to recommend close contacts be tested. It says availability of the kits will be reassessed by no later than March 31.
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The Staten Serum Institut says the sheer infection saturation in the population due to the hyper-contagious Omicron variant means more people are dying - with - COVID, but not - because - of COVID. It says the daily fatalities metric continues to count virtually any death within 30 days of a positive test as a coronavirus death. But now, because Omicron has increased cases exponentially, it says the daily fatality count “has become less accurate.”
The institut continues to review records of deaths and scour the death registry to try and provide clarity on how many lives the pandemic is actually stealing. It reports these results, on a lag, every Thursday. In its last update, it continued to find that deaths - with - COVID have been increasing, as they have since the beginning of the year, whereas the number of deaths - because - of COVID “have been fairly stable.”
SSI Director Henrik Ullum:
“The daily monitoring figures from SSI supplement the registration of coronavirus deaths in the Cause of Death Register. Often, however, there will be several contributing causes of a death, especially if the person in question already suffers from one or more underlying diseases. Therefore, the indication of the primary and the contributing causes of death will often depend on a certain degree of discretion on the part of the doctor who fills in the death certificate.”
The agency also emphasizes that the Omicron variant has been a game-changer, with the death registry and 30-day fatality reporting having been generally in sync prior to the variant arriving. The SSI says it will continue to use both systems, reporting the daily pandemic deaths under the 30 day rule and, as reviewed by agency staff, separating those who died of other causes but with an infection and those who died directly because of an infection.
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The Omicron sub-variant continued its upward march in Denmark, accounting for 62.22% of all sequenced positive test results, but it has some company. Another variant BA.2_H78Y, is also gaining ground. It accounted for 20.12% of all positive tests in week 3, a share that has grown to 29.37% as of last week.
The BA.2_H78Y variant may have originated in Denmark, but it has since spread to other countries including nearby Sweden. Early data doesn’t seem to show a growth advantage over the already hyper-infectious parent BA.2 variant. That said, as with all new mutations, we have significant knowledge gaps that will be filled in over the coming weeks and months.
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In Denmark, COVID hospitalizations had an up and down weekend falling by 61 on Saturday and then rising by 41 on Sunday to sit at a very high 1,587 admissions. The number of severe infection cases in an ICU (40) inched upward over the last two days rising by four Saturday and then another three on Sunday. Of those in intensive care and on a ventilator (18) numbers remained almost static over the last 48 hours, with a drop of one on Saturday.
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The number of COVID infections among infants fell last week compared to the week before going from 6,318 down to 4,410. However, the number of hospitalized infants barely changed from one week to the next, going from 201 to 200.
The number of infections among those 3 to 19 years old dropped significantly over the last seven days but hospitalizations have remained almost identical for those in the age groups 3 to 5 and 16 to 19 years old. Admissions among those 6 to 15 years old fell by about half from one week to the next.
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In the last three days, Denmark has lost another 105 lives in the pandemic. February 13 stands as the deadliest day in the epidemic so far, with 43 fatalities. .
There were 120,200 total tests done on Saturday, of which 86,917 were PCR tests equaling a positivity percentage of 29.55%. While still very high, that marks a slight decrease.
Over the weekend, Denmark added another 94,652 infections. Reporting 35,658 cases on Friday, followed by another 33.304 on Saturday, and then another 25,690 on Sunday. These numbers are likely underreported.
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There is some good news on the kommune level, with the COVID incidence rate trending downward in all but two of Denmark’s 98 municipalities. Just one kommune, Brønderslev in North Jutland, has an incidence rate above 7,000, a significant decrease from the situation just last week.
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The COVID vaccination campaign continues to sputter with just 876 booster doses administered on Saturday. That is incredibly low even by the usual weekend slump standards. The Danish National Health Board has said it will announce a winding down of the mass vaccination effort by month’s end.
To date, 82.4% of the total population have one vaccine dose, 80.9% have two, and 61.6% have a booster shot.
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The Danish Agency for Patient Safety is on the hot seat after dismissing 600 contact tracing staff. The agency trimmed its workforce on February 7, as it wound down the contact tracing department that it had mass-hired to fill when the pandemic began two years ago. However, Danish trade union HK Privat is calling foul. It says the firings were in violation of the Mass Dismissal Act and it has filed a lawsuit against the temp agency who supplied the workers.
It says the temp agency, Moment, was legally obligated to negotiate with the workers or their union representation, but did neither before they were fired. The agency in turn is blaming the Danish Agency for Patient Safety (STPS) for landing them in this situation. The STPS for its part, is hanging the temp agency out to dry, saying it is on the hook and must pay any potential bill, which could be as high as DKK 15-million depending on the outcome of the legal process.
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Sweden doesn’t update COVID numbers on the weekend and it will provide its first update of the week on Tuesday.
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The hospital admissions situation in Sweden’s capital region continues to improve. As of Sunday afternoon, there were 481 COVID patients in Region Stockholm hospitals and while that is an increase of 41 day over day, it is much lower than the over 600 patients of a week or two ago. The number in intensive care (22) saw no change from Saturday to Sunday. The region has 206 empty and staffed care beds, down slightly from the 220 empty beds from the day before.
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In Southern Sweden, hospitals remain strained as COVID admissions remain high in Region Skåne.
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Strained but not catastrophic. That is how Region Gävleborg is describing its COVID hospitalization situation.
Health and Medical Care Director Johan Kaarme spoke to SVT:
“Many regions see a decrease in the number who are cared for in hospitals and almost no patients in an ICU, but unfortunately we do not. I hope that we will have a decline in the coming weeks..”
Kaarme notes that the region’s hospitals have been hit hard on two sides with a crush of COVID patients along with increasing numbers of healthcare staff out due to a coronavirus infection or caring for their sick children.
“The number of staff who are absent has not increased recently and we are starting to see more and more people returning to work, which is a relief.”
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The number of children being hospitalized in Sweden, either due to a coronavirus infection or for some other reason but who have an infection is climbing rapidly. Swedish news organization Dagens Nyheter is reporting that since the last week of January, COVID hospitalizations for children nine years old and younger have almost quintupled. There were 32 hospital admissions in week 52, then 74 in the first week of January, 117 in the second week, 163 in the third, and then 187 in last week of the month. An almost six-fold increase. According to Dagens Nyheter, during previous infection waves in Sweden there were no more than 23 children hospitalized in any given week. However, statistician at the National Board of Health and Welfare, Erik Wahlström, says about half of the hospitalized children are being admitted for treatment for non-pandemic reasons but tested positive on arrival.
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The Swedish Public Health Agency things the massive Omicron-driven infection wave may have peaked. However, because the country has eliminated access to COVID testing to the general public, its ability to assess the pandemic situation is severely handicapped. The agency continues to say the epidemic in Sweden has entered “a new phase.”
Department Head Britta Björkholm says the Swedish population now has a high level of immunity.
“Both because many have been vaccinated and many have undergone COVID infections. Which has created a high level of immunity and thus led the pandemic into a new phase here in Sweden.”
The Omicron variant is king in Sweden, accounting for almost 100% of all sequenced positive test results.
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Women’s sex hormones may provide some protection against serious infection and death from the coronavirus, according to a Swedish study. Researchers at Umeå University were trying to figure out why men have a higher chance of dying from COVID than women do. They zeroed in on the hormone estrogen and established a test group. There were almost 15,000 women involved between the ages of 50 to 80 who had tested positive between February 4 and September 14, 2020. 2,500 had taken estrogen supplements to treat menopausal symptoms. 200 took estrogen lowering drugs due to cancer treatments. While the control group had no drugs linked to estrogen at all.
The study found the group who took estrogen supplements had a risk of dying from a COVID infection of less than half compared to the control group, which had a mortality rate of 4.6%. The group that took estrogen-reducing drugs had the highest risk of severe infection and death. But, with the age of the women and the fact they had undergone cancer treatment, which in itself increased infection risk, any causal relationship with estrogen could not be established.
Umeå University Professor, and study first author, Malin Sund:
“The results are so interesting that it is justified to continue with clinical studies. However, it is absolutely inappropriate to start experimenting with supplements yourself because estrogen can also cause a number of more or less severe side effects and should only be taken in consultation with a doctor.”
The other study caveat was that because it was conducted before there was a coronavirus vaccine, it remains unknown how much estrogen might reduce COVID risk for vaccinated women.
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In Norway, COVID hospitalizations (442), ICU numbers (54), and those on a ventilator (20) are unchanged over the weekend.
Norge also saw no new pandemic deaths over the last three days while adding 17,205 infections (underreported) over the last three days.
So far, 80.3% of Norwegians 12 years old and older have one vaccine dose, 74.5% have two, and 53% have a booster dose.
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Pandemic aside, the Norwegian Institute of Public Health says respiratory infections that are not the coronavirus are at extremely low levels. Other than COVID and influenza, the agency says all other respiratory infections account for only 1% of all test results. Most active among non-pandemic respiratory infections is the Rhinovirus, but the agency also notes the common cold is also making the rounds. The proportion of common cold cases rose from 8.6% to 10.5% from the first to second week of February.
Respiratory-related hospital admissions have remained stable for the last three weeks, according to the NIPH. That said, it adds, hospitalization levels are higher than they were a year ago but are still far below the numbers usually seen in the years before the pandemic. In the first week of February, COVID infections accounted for 52% of all respiratory-related hospitalizations, while lower respiratory infections were 40%, upper respiratory cases 7%, and the influenza and RS virus were each at 1%.
Influenza cases remain extremely low with a 0.3% prevalence among those tested. It is beginning to look like it will be a third year in a row where the flu season is missing in action due to the COVID pandemic.
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Finland does not update its COVID numbers over the weekends. It will table three days worth of COVID data later today.
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The government should have much less of a role in managing the COVID epidemic going forward, according to one expert in Finland. Liisa-Maria Voipio-Pulkki, a leading expert within the Finnish Ministry of Social Affairs and Health, said that the government should step back now in dealing with the day to day matters of the pandemic and “turn its attention to other matters.” Speaking to Helsingin Sanomat on the weekend, she made the case that local governments should be given more powers to manage the epidemic working with the Finnish Institute for Health.
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Another interesting tidbit from the Finnish news agency IIta-Sanomat over the weekend as it reports that Pfizer/BioNTech increased the price of its COVID vaccine last August to €19.50 Per dose (about $28 Cdn or DKK 145). This will mean any excess doses that surpass their shelf life, as mass vaccination campaigns near there end will be that much more money wasted should they have to be junked.
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Medical check-ups for children in the Finnish school system have fallen by the wayside in the last two years during the COVID pandemic. In Finland, students are supposed to get a health check-up with a nurse every year and a full medical examination by a doctor in grades 1, 5, and 8. For secondary students they get a check-up with a nurse in year one and and a medical examination in year two.
However, the Finnish Institute for Health found the COVID crisis led to nurses and doctors being pulled away in such numbers to treat coronavirus patients or shore up short staffing in other areas that students were left in the lurch. According to the institute, in the 2020/21 school year about half the health checks were missed. Just 54% of children in 4th grade had one, compared to 56% in grade 9, 56% in upper secondary schools, and 60% in vocational schools.
Medical examinations fared even worse, with just 8% of kids in grade 8 getting one. It wasn’t much better for students in year two of secondary school where 24% had their medical exams. For vocational schools, just one-fifth (21%) of students had their medical exam.
Chief Physician Marke Hietanen-Peltola:
“The situation in preventive services for children and young people is worrying. Personnel transfers due to the corona pandemic have weakened services at the same time as we know that children and young people need more help and support.”
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The Omicron wave in Europe appears to be easing although some countries are still in the thick of it. The latest pandemic snapshot from the European Centre for Disease Prevention and Control shows while coronavirus cases still remain very high, numbers have declined slightly for a second straight week across the European Union. The declines are being driven by falling infection rates among those under the age of 50. While the overall situation is improving slightly, the ECDC notes, 15 European nations have reported a worsening epidemic, especially among those 65 years old and older. It is forecasting infection numbers will continue to fall over the next two weeks, while hospitalization numbers will remain stable, but COVID fatalities will rise.
The overall case notification rate last week was 2,962 per 100,000 population, a drop from the previous week’s 3,586. The COVID death rate across Europe was stable at 54.7 per million population last week compared to 54.8 the week before. This marks the 12th week in a row fatalities have been stable. Of the 27 countries reporting data on hospitalizations and ICU admissions, 14 reported increasing numbers in one or both categories.
Looking at the individual European countries, 25 nations have a pandemic situation rated by the ECDC as of high or very high concern, while the epidemic picture improved in 12 countries. The seven countries that rate as a very high concern are Denmark, Estonia, Iceland, Ireland, Latvia, Norway, and Slovakia. 18 countries are considered a high COVID concern and they include Austria, Belgium, Czech Republic, Finland, France, Germany, the Netherlands, and Poland. Five countries Italy, Luxembourg, Portugal, Spain, and Sweden, are a moderate concern.
As of the end of week 6, the cumulative vaccination uptake for two doses across the EU/EEA was 71% of the total population while 48.3% have a booster dose.
Across Europe, the Omicron variant was king, dominant in all European countries, accounting for 98% of sequenced positive tests, while the share testing positive for Delta has diminished to 1.5%.
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Queen Elizabeth has tested positive for COVID according to the British Court. The 95 year-old British regent is experiencing “mild cold-like symptoms.” The Queen has had three vaccine doses.
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COVID restrictions will be further eased in the United Kingdom. As of next week, people who test positive will no longer need to isolate at home. Prime Minister Boris Johnson also announced that COVID testing will be reduced as numbers continue to fall.
Prime Minister Boris Johnson:
“COVID will not suddenly disappear, and we need to learn to live with this virus and continue to protect ourselves without restricting our freedoms.”
The BBC asked the Prime Minister how the country would be able to monitor the pandemic situation and detect any emerging variants if COVID testing was being scaled back.
“We need to be resilient but when it comes to testing, for example, we do not need to continue to do so at a cost of 2 billion pounds per month, which we did in January.”
Last month, a number of restrictions were also lifted including mask mandates everywhere except inside hospitals.
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Israel will throw open its doors to all tourists, whether they are vaccinated or not, as of March 1. Currently, Israel only allows tourists who are vaccinated to enter the country.
Prime Minister Naftali Bennet:
“We are seeing a steady decline in the number of new cases, so it is time to gradually open what we were the first in the world to close.”
Travelers heading to Israel from March 1 and onward will have to have two negative PCR testing results. One is required before departure and the other on arrival.
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A study from South Africa suggests the Omicron BA.2 variant, while more infectious than its parent strain, doesn’t cause more severe infections or any higher risk of hospitalization. The new coronavirus strain arrived in South Africa when its fourth wave was dropping and researchers noted BA.2 was associated with a brief increase in infections among school age children while slowing the overall decline of the infection wave. Researchers found a slight uptick in hospitalization rates after the new strain became dominant, going from 3.4% to 3.6%. After analyzing hospitalizations and accounting for different factors, the study concludes.
“The odds of being admitted to hospital did not differ between individuals with BA.2 infections compared to BA.1 infections.”
Getting deeper into the data, the study found geographic, gender, age, and wealth all factored into the chances of being severely infected and hospitalized. The chances of a severe infection from BA.2 requiring hospitalization were higher among women, children under five years old, people over 40 years old, and those using the public healthcare system as opposed to private care. Being vaccinated with even just one dose also decreased the odds of a severe infection.
The study was a preprint and has not been peer-reviewed. It was published on the scientific journal site medRvix.
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The Omicron-fueled infection has peaked in Canada and the country is ready to wind down its pandemic crisis response, according to Canada’s Chief Public Health Officer. In a COVID update on Friday, Dr. Theresa Tam says she is hopeful that Canadians will soon be able to return to a near-normal life.
In the update, Tam presented epidemiological and modeling data showing the infection wave is in decline according to positivity percentages, wastewater surveillance, and the less reliable reported cases. Tam did caution that infection numbers are still high and hospital infrastructure is stretched very thin right now. She also cautioned that lifting measures would have consequences in terms of infection spread and hospitalizations.
The modeling showed that a moderate easing of restrictions could see a “limited resurgence” of COVID infections and a “slight increase” in hospitalizations. With a more substantial relaxing of restrictions, those would become large resurgences “potentially exceeding prior peaks.”
“While a resurgence of cases is not unexpected given the characteristics of the Omicron variant, the good news is that current levels of immunity in the Canadian population are expected to reduce the impact of Omicron infections going forward.”
She says this puts Canada on a much better footing to manage the pandemic without the need for some of the more restrictive COVID measures. Tam also emphasized people need to take personal responsibility to limit their own infection risk including avoiding crowded places and masking up should they feel they need.
“The cases might go up, but as long as that wave of hospitalizations isn't as high, we can probably cope with that. And with that comes a better balance."
Backing up Tam’s assessment is that both of Canada’s two most populous provinces, Ontario and Quebec, have seen hospitalizations drop. With both beginning to lift restrictions.