The Evening Report - Feb 22
Denmark seeing more signs for some cautious optimism
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Denmark’s Health Minister Magnus Heunicke says the COVID contact number (reinfection rate or R0) has edged downward, going from 0.9 last week to 0.8 this week. But Heunicke notes uncertainties with the R0 calculation due to reduced coronavirus testing capacity.
As a more reliable barometer of the epidemic in Denmark, the health minister points to COVID wastewater surveillance. Heunicke says it shows that coronavirus activity is declining in several Danish regions. However, he also says wastewater testing shows increasing infection activity in Metro Copenhagen over the past week. COVID numbers had been dropping in the capital region up until now. He says the highest infection rates across the country continue to be in North Jutland.
“There are still regional differences in the spread of infection. The highest infection was found in Region North Jutland, where approximately 10% of the population is assumed to have been infected in the last week.”
Heunicke notes the 10% calculation includes the “dark number” or true infection spread.
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A new study from the Staten Serum Institut has found that reinfections with the Omicron variant, either BA.1 or BA.2, can happen albeit very rarely. The study tried to determine if someone infected with Omicron could be reinfected and if so, how quickly after recovering. Researchers scoured genome sequencing results for positive PCR test outcomes and found 67 people who had two Omicron infections. The gap between recovery from the first Omicron infection and being reinfected was between 20 and 60 days.
According to the study, a majority of those who were infected were young and unvaccinated. Most also experienced mild symptoms with “the difference between the severity during their first and second infections being negligible.” The study notes none of the 67 had to be hospitalized. 47 of those who suffered reinfection caught the parent BA.1 first, and then were infected with the BA.2 strain.
The study concludes:
“The study shows that infection with two different Omicron subtypes is possible. This seems to occur relatively rarely in Denmark, and reinfections have mainly affected younger unvaccinated individuals.”
The study is a preprint and has not yet been peer-reviewed. It can be found HERE.
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COVID hospitalizations continued to push to new record highs (1,759) as numbers rose (+42) but the number of severe infections in an ICU (34) dropped (-10) and of those the number on a ventilator (12) also declined (-5) while psychiatric ward admissions (412) kept rising (+8).
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While hospitalizations soar to record highs, the case is being made that they aren’t quite as concerning as they look at first blush.
Søren Ørskov is a Guest Researcher at the PandemiX Center at Roskilde University and he has been spending four days a week in one of Denmark’s regional hospitals in Copenhagen.
“In the Danish capital region throughout the month of February, around 40% of those COVID patients in hospital at a given time were actually admitted with a COVID diagnosis. The percentage of patients with COVID as the primary reason for admission is even lower.”
He says anyone with a positive PCR test in the two weeks before being admitted to hospital to the two days after admission all count statistically as a hospitalized COVID patient, even if the reason for being hospitalized has nothing to do with being infected. Ørskov says this is backed up by data from the Staten Serum Institut.
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Denmark reported 30,480 COVID infections (underreported), including 1,707 reinfections, and 34 more coronavirus deaths in the last day.
Yesterday, there were 145,622 total corona tests done, of which 100,005 were PCR tests equaling a positivity percentage of 30.47%.
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At the kommune level, the pandemic picture continues to improve. While there isn’t a single Danish municipality with a COVID incidence rate of less than 2,000 per 100,000 residents, just one municipality, Brønderslev, has an incidence rate of more than 6,000. A majority of kommunes also continue to see incidence rates trending downward. There is even some orange emerging on Sjælland in a map that has been solidly high-infection risk crimson for weeks.
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The COVID vaccination effort continues to sputter with just 1,149 booster doses administered on Monday.
To date, 82.4% of the total population have one dose, 81% have two, and 61.7% have a booster shot. The proportion of 1st doses as a percentage hasn’t increased since January 17.
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Sweden has added another 81 corona deaths, pushing its to date total pandemic fatalities to 16,933, and 8,509 infections (wildly underreported) since its last update on Friday.
ICU numbers (86) crept up (+2).
So far, 86.7% of the population 12 years old and older have one vaccine dose, 84.2% have two, and of those 18 years old and older 58.6% have a booster.
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The number of COVID hospitalizations in Sweden’s capital region edged upward over the last 24 hours, rising from 481 to 512 infected people hospitalized as of Tuesday afternoon. The number of severely infected people in intensive care in Region Stockholm crept up from 22 to 23. The number of empty staffed care beds also diminished day to day, dropping from 206 down to 113.
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The Swedish Public Health Agency has done new modeling on possible pandemic scenarios over the next couple of months. But the agency is emphasizing that there is much more uncertainty in these modeling forecasts than in previous ones. It says the uncertainty is due to unknowns around the long term impacts of the Omicron variant and its mutations. It also notes, that with COVID testing being limited to just hospital patients and those in senior care, the “dark figure” or true infection spread is much more of a mystery. The third reason is that one of the two scenarios tabled is built around the assumption of a new hypothetical variant emerging and posing a major threat.
State Epidemiologist Anders Tegnell:
“We are in a new situation in the pandemic where there is a broad immunological protection in the population, because many are vaccinated and have had the infection. Even if the infection were to increase again, it is unlikely that many would suffer from a serious illness.”
In scenario one, the Omicron variant continues to spread, but the infection wave steadily declines and then flattens out in March to “lie at very low levels” through the summer months.
In scenario two, a hypothetical new variant emerges as contagious as Omicron but with a better ability to evade immunity via vaccination or by previous infection. This would drive another infection wave in the spring, reaching a peak sometime in May. The health agency notes it “does not consider the development in this scenario to be probable, but it cannot be ruled out.”
“Therefore, it is important to have a continued high level of preparedness in health care. Good adherence to hygiene routines is the basis for preventing the spread of infection. By continuing with national monitoring and testing in healthcare, we can see changes in the spread of infection and care needs, and also discover new virus variants.”
It is again worth noting that Sweden’s COVID surveillance is seriously hampered by removing testing access to the general public.
Regardless of how things develop, the health agency considers “probable” that there will need to be another mass vaccination effort in the fall to administer another booster dose as the seasonal affect turns against us.
“Since we know that the vaccine provides good protection, but that the effect diminishes over time, I really want to encourage everyone to take their recommended doses. Unvaccinated people are still overrepresented both when it comes to those hospitalized and those in an ICU.”
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The Swedish Public Health Agency is laying out the ground rules for how the Novavax COVID vaccine can be used when doses begin to arrive within a month. The agency says the protein-based vaccine will act as a complimentary one to the two primary mRNA vaccines from Pfizer and Moderna that have been widely used.
State Epidemiologist Anders Tegnell:
“It is important that everyone who is covered by the recommendations and can be vaccinated against coronavirus does so. It is and remains the most important tool for keeping the pandemic under control, and the vaccine protects both yourself and others. Now we have both the mRNA vaccines and a protein-based vaccine, they are all safe and effective.”
The Folkhälsomyndigheten says while vaccination uptake is very high in Sweden, there are still just over one-million people over the age of 18 who remain unvaccinated.
The health agency says the Novavax vaccine can be used to vaccinate adults who have not yet been vaccinated as a first, second, or third dose. Novavax must be administered with a three to seven week gap between the 1st and 2nd doses, and a booster dose can be administered three months after a second dose. It is recommended people with two doses of an mRNA vaccine get a third for a booster, but they can also choose this new vaccine as well. Novavax can also be used for adults with an immunodeficiency and for those who for medical reasons cannot use an mRNA vaccine.
The Swedish Public Health Agency recommends that pregnant women do not get vaccinated with the Novavax vaccine. They should use only Pfizer or Moderna.
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The return to near-normal in Sweden has sparked a run on the Swedish passport office, leading to increased wait times. TT is reporting that Swedes who need a valid passport to travel will need to plan their trip well in advance.
Administrative Law Police Unit Manager Linda Ahlén:
“I think it is a combination of three factors that have resulted in increased pressure on passport offices. On the one hand, we are entering a high season, on the other hand, people have not renewed their passports during the pandemic, but have waited and then the restrictions have been released.”
The longest waiting times are in the big cities, where population density is the highest.
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Finland has registered 2,746 infections and had no more virus deaths since yesterday’s update.
COVID hospitalizations (723) are unchanged.
To date, 79.4% of the total population have one vaccine dose, 75.2% have two, and 49.1% have a booster dose.
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The Finnish government has some decisions to make. The government’s ministerial pandemic working group has proposed that all restrictions on moderated opening hours, alcohol sales, and capacity limits on restaurants and bars be lifted by March 1. On the other hand, the working group is also recommending that hygiene rules remain in place for at least another month.
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In Norway COVID hospitalizations (534) increased (+34) while the number of severe infections in intensive care (58) dipped (-5) and of those the number on a ventilator (26) also edged downward (-3).
It had no new corona deaths and added 16,657 infections (underreported).
To date, 80.3% of Norwegians 12 years old and older have one vaccine dose, 74.5% have two, and 53.2 have a booster shot.
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Germany recorded 125,902 infections and another 306 pandemic deaths since yesterday.
It added 1,762 COVID hospitalizations while ICU numbers (2,436) declined (-35). As a percentage the number of intensive care beds in Germany occupied by infected patients is 10.9%.
So far, 76.2% of the total population have one vaccine dose, 75.2% have two, and 56.4% have a booster.
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Italy has followed other European countries in recommending that people with severely compromised immune systems should get a fourth COVID vaccine dose. Italian health authorities say the 2nd booster dose should be administered a minimum of four months after a third dose.
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Austria has adjusted entry rules applying what it calls the “3-G rule.” This means people can enter the country as long as they can prove they are vaccinated, have recovered from a recent COVID infection, or can present a negative test. The EU COVID digital certificate or equivalent digital certificate for travelers from outside the EU will be accepted. A negative PCR test cannot be anymore than 72 hours old and an antigen (rapid) test can be no more than 24 hours old. A COVID recovery certificate is valid for 180 days.
For those who are not vaccinated, do not have proof of a recent recovery, or can’t produce a recent negative test, they will face mandatory quarantines upon arrival. Quarantine can only be broken with a negative test result.
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Portugal is set to ease COVID restrictions. The Portuguese government will end the coronapas requirement for attending large events, eating in restaurants, going to bars, and in other public venues. Capacity limits will also be scrapped. Portugal also plans on lifting all remaining restrictions by mid-March.
Currently, Portugal requires all incoming travelers to prove that they have recovered from a recent infection, have a negative test, or have been vaccinated, and those rules remain in place.
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As of Tuesday, the EU COVID digital certificate is able to show proof of a recent COVID infection based on a positive rapid test result.
Commissioner for Justice Didier Reynders:
“The EU’s digital COVID certificate is evolving according to the situation. In order to facilitate the free movement, in particular of citizens infected during the Omicron wave, Member States are now able to issue recovery certificates also based on high-quality rapid antigen tests.”
Previously, the EU COVID digital certificate would only recognize an infection recovery with a positive PCR test. While the certificate now recognizes rapid tests, they must be administered by a healthcare professional so a positive self-test does not qualify.
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The EU Commission expects deliveries of the Novavax vaccine to begin arriving this week. The EU approved Novavax, the fifth vaccine to be approved in Europe, on December 20. Doses were supposed to begin arriving in January but were delayed due to regulatory issues. The European Union has ordered 27 million doses of the more traditional protein-based vaccine for the first quarter of this year as part of its deal with Novavax for up to 200 million vaccine doses. EU health officials are hoping the vaccine will be more palatable for vaccine holdouts who are skeptical of the two mRNA vaccines that are widely used across Europe.
WHO/BA.2
The World Health Organization’s Technical Advisory Group on COVID met Monday to review the latest evidence on the Omicron variant and its sub-lineage, BA.2. In a statement released on Tuesday, the WHO said BA.2 clearly has a growth advantage over its parent Omicron variant but the difference in transmission is smaller between BA.1 to BA.2 than it was between the Delta and Omicron variants. It also emphasized that while BA.2 is more contagious globally, cases continue to decline.
The WHO advisory group also looked over the available studies on reinfection, noting there have been confirmed cases of people being infected with BA.1, recovering, then being infected with BA.2 but those instances are rare.
“Initial data from population-level reinfection studies suggest that infection with BA.1 provides strong protection against reinfection with BA.2, at least for the limited period for which data are available.”
In reaching that determination, the group reviewed preliminary laboratory data from Japan, where a study on hamsters found BA.2 to cause more severe disease. While it also examined studies from South Africa, the UK, and Denmark that all concluded there is no severity difference between BA.1 and BA.2.
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A new review from the United Kingdom is warning that long-COVID is emerging as a major challenge for global healthcare systems, a challenge that could last long after the pandemic ends. Researchers, led by Oxford University, examined health impacts from COVID infections including myocarditis (inflammation of heart muscles), other severe heart conditions, and long term effects like fatigue and mental health.
Thomas Lüscher from the Royal Brompton and Harefield Clinical Group:
“Long-COVID is, besides its huge impact for the affected individual, of great societal and economic importance as it leads to leave of absence from work, reduced work performance, and hence unforeseen costs.”
The review was published in the European Heart Journal.
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For the first time in the two year-long COVID pandemic Australia is opening its doors to tourists, as long as they are vaccinated. Tourists who have their doses no longer face a quarantine requirement on arrival. Australia has had extremely strict entry requirements during the pandemic, even blocking Australians abroad from returning home.
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The wheels have come off of Hong Kong’s COVID zero strategy as infection numbers rocket upwards to record high levels. Now the government is going to launch an ambitious plan to test all 7.4 million residents. Hong Kong Chief Executive Carrie Lam said mandatory testing would start in the middle of March, with residents being tested three times. Lam says the goal is to administer one million COVID tests per day.
Exponentially increasing infection rates are threatening to overwhelm healthcare facilities, and it is now a top priority to wrestle the infection curve down. On Tuesday, Hong Kong reported 7,533 new infections and 12 more deaths. Health officials say modeling is forecasting a worst case scenario that could see daily COVID infections reach 180,000 per day within a month.
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Moderna says it is in the early stages of researching an all-in-one vaccine that would act as a COVID booster dose, a flu shot, and vaccinate against the RS virus all with one dose. There is currently no vaccine against the RS virus, a respiratory infection that poses the greatest threat to the elderly and the very young.
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The COVID hospitalization picture continues to improve in Canada, although numbers remain high. In the second week of February, the total number of hospital beds used for infection cases dropped from 8,502 down to 7,153. The number of general virus admissions decreased by 1,147 to sit at 6,348 beds occupied. For severely infected people in an ICU numbers also declined, going from 1,007 down to 805. And of those, the number on a ventilator stuck with the trend and also decreased by 114 to 423 people.
Canada reported five more pandemic deaths yesterday, pushing the total to date COVID fatalities to 36,046. It also added 1,654 infections, a number that is likely extremely underreported.
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On the Canadian COVID vaccination front so far, 32,138,320 1st vaccine doses (84.05% of the total population) while 30,772,165 people (80.48%) have two doses, and of those 17,332,567 people are fully vaccinated with three doses.
All changes in hospitalization numbers below are reflective of the difference from our last report on all the provinces on Thursday of last week.
In Ontario, COVID hospitalizations (1,038) have dropped (-304) while the number of severe infections in intensive care (319) has declined (-37). Another 24 pandemic deaths were reported. The province has a positivity percentage of 8.34%.
Quebec saw hospitalizations (1,742) drop (-160) while the number of severe infections in an ICU (107) also fell (-17). There were 30 more corona deaths. The province has a positivity percentage of 8.38%.
Newfoundland and Labrador has 16 COVID patients in hospital with 5 people in an ICU. In both cases numbers are unchanged. There have also been two more pandemic deaths making February the deadliest month of the entire pandemic for the province, with 23 fatalities so far. The province has a positivity percentage of 21%.
In Nova Scotia hospitalizations (53) are down (-13) while there are 12 people in intensive care, which is an increase of one. It also reported three more corona deaths. The province has a positivity percentage of 11.5%.
New Brunswick saw hospitalizations (78) edge down (-1) while ICU numbers (8) increased (+8). The province reported two more pandemic deaths.
Manitoba saw COVID hospitalizations (553) decline (-34) with 31 people in intensive care. It has suffered 11 more pandemic deaths over the extended long weekend. The province has a five-day positivity percentage of 17%.
Saskatchewan only updates COVID numbers on Thursdays.
Alberta has suffered some kind of an IT issue, with the provinces only reporting “ballpark” figures today. It has a positivity percentage of about 20%. COVID hospitalizations (1,380) dropped (-111) while the number of people in an ICU (95) dipped (-21)?
B.C. saw COVID hospitalizations (688) fall (-56) while the number of people with severe infections in an ICU (108) also dipped (-12). There have been 44 more pandemic deaths over the last 96 hours due to the family day long weekend.