The Evening Report - Feb 3
Danish researchers get a better sense of the true extent of Omicron infections
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Denmark’s Staten Serum Institut has published a risk assessment of the Omicron sub-variant BA.2. The report says the variant is spreading like wildfire. From the last week of December until the third week of January, BA.2 has gone from 20% of all sequenced positive test results to 66%. At the same time, the parent BA.1 strain is going in the exact opposite direction. Matter of fact, the SSI threat assessment says BA.2 will completely replace the parent Omicron strain and account for nearly 100% of all cases in Denmark by mid-February.
The agency estimates BA.2 has a 30% growth rate advantage over the already hyper-contagious original Omicron strain. But it is also noting some odd variations in infection spread among age groups, by vaccination status, and in different countries.
The incidence rate per 100,000 people for the sub-variant is highest among 6 to 15 year olds at 11,000. The SSI says cases of BA.2 have also increased by nearly 140% each week among 5 to 17 year olds. But conversely, its growth rate is slower for those over 60 and for infants 4 years old and younger.
The institut also noted BA.2 is spreading slightly slower among unvaccinated people (90% weekly growth) than it is for people with two or three vaccine doses (120%). The SSI says the reasons for this are a bit of a mystery, but they are wondering if different behaviors might be playing a role.
While we now know BA.2 is more infectious than its parent Omicron strain, the SSI says the variant’s growth rate may also be indicative of an increased immune escape ability. But important questions remain unanswered including whether the variant causes more severe infections; does it pose a higher hospitalization risk, or if it is more deadly. The threat assessment says ancillary evidence seems to suggest there may be no difference in hospitalization risk. Researchers at the Staten Serum Institut are trying to grow BA.2 in the laboratory in order to get some answers, but they say that has proven to be very difficult.
The threat assessment concludes that the sub-variant will likely result in a much steeper infection curve, push the peak of that curve even higher, and extend this infection wave out a little longer. It also notes any temporary herd immunity will now require a larger portion of the population to have antibodies, either through vaccination or infection recovery.
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The first batch of findings are in, in the effort to try and determine the number of ‘dark’ COVID cases, infections that haven’t been caught in a PCR test. The Staten Serum Institut has been testing samples from blood donations and cross-referencing any with COVID antibodies against those who have a registered positive test result. It says the results so far show that one-third of the population has had a COVID infection since November.
SSI Director Henrik Ullum:
“We therefore do not know the figures for the total number of Danes who have had a COVID infection in the current wave. In other words, we do not know the so-called "dark number". We need to know the total number of infected and thus those who have immunity in order to be able to better predict how the epidemic will develop in the near future.”
The first results are based on blood donations made from January 18 to 23, a total of 4,722 blood donors.
Chief Physician of Immunology at Aarhus University Hospital Professor Christian Erikstrup:
“Overall, we have found that 15% of donors have formed antibodies since November 1, 2021. But there is a big difference between the regions. There were 22% of donors in the Capital Region who had antibodies, but only 10 to 13% in the other regions.”
Due to the time it takes antibodies to form after an infection and the recommendation not to donate blood for at least two weeks after testing positive, researchers pegged the numbers as a reflection of COVID cases in the first week of January.
“If we project the incidence in relation to positive PCR tests in general, we estimate that 32% of the healthy adult population between the ages of 18 and 72 have been infected between November 1 last year and January 28 this year. The incidence in the Capital Region is higher than in the rest of the country and is estimated to be 42%.”
Henrik Ullum says the first look at the data provides significant insight.
“The results indicate that the dark figure that is, the proportion of infected people who have not had a positive test, makes up between a third and a half of all infections.”
The agencies involved stress there are some “uncertainties” with the findings especially being just the first wave of results. Weekly testing of blood donations will continue for the next several months.
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Denmark is reporting 44,225 COVID infections, including 2,513 reinfections, and 21 more coronavirus deaths in the last day.
Yesterday there were 288,744 total corona tests done, of which 166,203 were PCR tests equaling a positivity percentage of very high 26.60%?
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COVID hospitalizations (1,116) continues to set new record highs (+24) while the number of severe infections in an ICU (27) inched up (+1) and of those on a ventilator (12) numbers dropped (-4) admissions to a psych ward (267) continue to climb (+11).
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On the COVID vaccination front, there were just 5,867 total inoculations yesterday including a mere 62 first doses, which might be the lowest of any day since vaccinations started.
To date, 82.5% of the total population have one dose, 80.8% have two, and 60.9% have a booster.
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Denmark is trying to get a clearer picture of COVID deaths and it is going deep in the weeds to do it. Excess mortality statistics have been a useful tool in the pandemic to assess the ‘true’ pandemic death rate, especially in countries where statistics can be manipulated, like Russia or Iran. For example, Russia had almost one-million excess deaths in 2021, a number far higher than the COVID deaths it ‘officially’ reports. Excess mortality is the number of deaths in any given year above the average. As you can imagine in the two years of the pandemic excess mortality has been, to varying degrees, experienced by just about every nation, including Denmark.
The Staten Serum Institut says Denmark saw “significant” excess mortality last year, especially at the end of the year when the then Delta variant wave took off. But, the agency says despite daily reported COVID fatalities increasing excess mortality has come down in the first month of 2020.
To explain the disparity, the SSI makes the differentiation between people dying ‘with’ COVID and those who die ‘of’ COVID. It says at the moment the WHO recommended method is to classify anyone dying within 30 days of a positive test as a COVID death. But the agency says this results in overestimating fatality numbers. It uses the example of someone testing positive then being killed in a car crash two weeks later, making the differentiation the person died ‘with’ COVID not ‘of’ COVID but it might count as a pandemic death. On the other hand, it also says deaths can be underestimated if the virus is the cause of death more than 30 days after testing positive, which by the WHO definition might not count as a COVID death.
Long story short, the Staten Serum Institut and the Danish Health and Medicines Agency are working together on how to better “supplement” pandemic death statistics. The agencies would use data from the Cause of Death Register and expect to provide regular updates, albeit with a bit of delay, that should provide a clearer picture of the actual number of people dying because of the virus.
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Sweden added 36,541 infections and another 72 corona deaths since yesterday’s update. The number of infections is likely very underreported due to the testing system being totally overrun.
The number of pandemic fatalities reported so far this week has really increased as you can see in the graph below. I would caution that Sweden has been dealing with a backlog of pandemic fatalities for quite a while, so while daily reported deaths are up there are likely quite a few that have been backdated by days or perhaps even weeks.
To date, 86.5% of the population 12 years old and older have one vaccine dose, 83.6% have two, and of those 18 years old and older 50.3% have a booster.
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Sweden is following Denmark’s lead and will remove the designation that COVID is a “socially dangerous disease” and abolish virtually all of its recommendations next week. Recommendations and not restrictions because there was never any enforcement in Sweden.
Sweden's Prime Minister Magdalena Andersson made the announcement in a press conference on Thursday morning.
The reasons why Sweden will largely stand down its COVID response are very similar to the ones laid out in nearby Denmark. High vaccination coverage across the population, Omicron causing less severe infection, and a decline in infection cases being admitted to intensive care.
“Even if the pandemic is not over, it is therefore possible to phase out most measures against COVID.”
Sweden will remove almost all of its COVID recommendations as of next Wednesday, January 9. Finland will follow on the 14th. That will make Europe’s Nordic region virtually restriction free by Valentines Day.
Swedish Public Health Agency CEO Karin Tegmark Wisell:
“Measures against the spread of infection must be proportionate and not more restrictive than necessary. The infection will continue to spread but, thanks to vaccinations, will no longer have as serious consequences for society as before. The Swedish Public Health Agency therefore requests the government to lift the classification of COVID as a socially dangerous disease. People still have a great responsibility not to pass on the infection by staying at home when they are ill and have COVID symptoms, and by also getting vaccinated.”
Beginning next Wednesday, the health agency says people can return to work, but it encourages the transition to be a gradual one in order to minimize any related infection activity. How the return to work is carried out has been left up to each employer.
While the agency made the announcement on a return to near-normal, it also revealed that infection spread among seniors in care is “extensive” and has never been higher. While vaccines are providing protection, it cautioned even mild symptoms among frail elderly people in care can have serious consequences. In order to address the situation “risk reducing” measures will remain for hospitals and care homes. Among them COVID testing and contact tracing will be prioritized for people in, and staff working at, both hospitals and care homes.
The health agency is also continuing to urge people who have not been vaccinated to go get their shots and for those who have two doses to go get a third.
“The pandemic has shown that a robust and resilient society can only be built on good and equal health across the entire population. As long as groups in society with a significant risk of serious illness and death have not been reached or accepted, the offer of vaccination, society is vulnerable.”
It is advising anyone who has not been vaccinated to take special precautions as they are most at risk. They should avoid crowds and crowded areas, especially indoors.
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COVID hospitalizations continue to mount in Sweden’s capital region. There are 655 coronavirus patients in hospital (+6) including 40 in intensive care (+1). As of Thursday afternoon, Region Stockholm had 127 empty care beds (-23) and the staff to man them.
On Wednesday, the region registered a positivity percentage of a whopping 52.20%.
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Norway has added 12,538 infections and had no new coronavirus deaths since yesterday’s update. Norwegian healthcare officials say daily infections are likely underreported and are no longer an accurate barometer of the pandemic situation. Instead, they are now looking at hospital numbers as a more accurate measure.
COVID hospitalizations (279) edged down (-1) while the number of severe infection cases in an ICU (48) also declined (-3) and of those on a ventilator (27) numbers also dropped (-4).
To date, 80.1% of Norwegians 12 years old and older have one vaccine dose, 74.1% have two, and 50.3% have a booster shot.
Norway’s national health institute has updated vaccination statistics across a number of groups.
12 to 15 year olds - 53% have one dose.
16 to 17 year olds - 83% have one dose and 39% have two.
18 years and older - 61% are vaccinated.
45 and older - 79%
65 and older - 89%
Among those 18 to 64 years old considered to be at high risk, about 78% have received a booster dose. Of those assessed as being a moderate risk, the number is 69%.
Primary healthcare workers - 67% have three doses
Specialist healthcare workers - 79% are boosted
School teachers and staff - 63% have had a booster shot.
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The Omicron-fueled infection wave continues to drive numbers upward in Norway, according to the latest weekly pandemic assessment. The Norwegian Institute of Public Health says COVID cases are less reliable as a barometer of the epidemic situation due in part to the proliferation of self-testing kits. It is now focusing on hospitalizations as a better measure of the situation.
The NIPH says there were 385 new COVID hospitalizations last week, of which 200 (52%) were admitted with the infection as the reason for being hospitalized. That is an increase from the 153 of the week previous. 31% of those admissions were unvaccinated people, 34% had two doses, and 32% had three doses. This also marks the 2nd week where hospitalizations directly due to a COVID infection have increased. Hospital admissions have increased across every age group except among those 30 to 44 years old. The largest increase by age was among seniors 65 years old and older.
The most concerning news on the hospital admissions front, according to the NIPH report, is an increase in the hospitalization of COVID-infected infants. 49% of all infants being admitted due to an infection are babies less than a year old. The agency stresses, hospital stays for infants are “generally short-lived and may be due to a lower threshold for infant admission.” It also notes the number of COVID admissions among infants is still “significantly lower” than there were during the recent RS virus infection wave.
“The wave can be a significantly increased burden on the health service as a result of many patients and increased absenteeism due to illness and isolation requirements. The municipalities and hospitals must use the next few weeks to vaccinate more people and prepare for large sickness absences and more patients.”
There were 24 pandemic deaths in Norway in the last week of January, a number the NIPH says has been “relatively stable.” The median age for coronavirus deaths in week 4 was 80.
On the infection numbers front, there were 133,055 COVID cases last week. That is an 11% increase from one week to the next and the highest number of cases of any week of the pandemic to date. An increasing number of Norwegians are using self-testing kits, with the proportion increasing from 32% to 60% from week 3 to week 4. But only 3.7% are reporting their test results.
The health institute says it is seeing a slight increase in cases of the Omicron sub-variant BA.2 ,while the parent BA.1 strain is declining. It also notes the first confirmed case of a 3rd Omicron strain, BA.3.
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The Norwegian Institute of Public Health says respiratory infection activity that is not pandemic-related are now at very low levels. Going from 8% in week 44 of 2021 down to 5.7% in the last week of January. To contrast, COVID rates are heading in the exact opposite direction going from 4% to 43.5% over the same time period. As for hospital admissions influenza accounted for 1%,; RS virus for 2%, and coronavirus at 41%.
The agency notes influenza rates were increasing in the weeks leading up to Christmas but then stagnated fairly quickly, likely to do with the rising infection wave, heightened caution across society, and restrictions. The proportion of seasonal flu cases has not increased since.
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Finland has registered 6,788 new infections and 29 more virus deaths in the last 24 hours.
COVID hospitalizations (655) are unchanged.
So far, 78% of the total population have one dose, 73.7% have two, and 45.1% have a booster dose.
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Finland is seeing dropping numbers of severe infection cases requiring hospitalization and/or admission to an intensive care unit. The Finnish Institute for Health says the number of COVID cases in special care wards has dropped from 350 to 343. In intensive care units, there were 38 infected people last week, a drop from 48 the week before. In primary care, just 23% of admissions who tested positive were hospitalized due to a coronavirus infection. In intensive care, that number is 21%.
In the last two weeks, Finland suffered 250 pandemic deaths, with 82% of those who died being over the age of 70.
The institute says the Omicron wave is driving up the number of infections among vaccinated people but vaccines are holding the line in protecting against severe infections, hospitalization, and death.
The Finnish wastewater COVID surveillance system seems to show an easing infection wave. The amount of coronavirus detected in wastewater has begun to decline after several weeks of intensified activity. The last five rounds of wastewater sampling and testing have shown decreasing coronavirus activity across most of Finland’s sewage treatment plants.
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Germany recorded another 236,120 infections and 164 more pandemic deaths in the last day.
There were 1,360 new hospitalizations and ICU numbers (2,307) have jumped (+50).
To date, 75.9% of the population have one dose, 74.2% have two, and 53.6% have a booster shot.
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The European Medicines Agency said in a Thursday media briefing it is reviewing an application from Pfizer/BioNTech for COVID vaccine booster shots for adolescents aged 16 to 17 years old. The agency says it is also expecting a similar application to arrive shortly for children 12 to 15 years old. The EMA says it will do accelerated reviews of these applications before rendering a decision.
The pharmaceutical watchdog says it is also still reviewing applications for use in Europe of COVID vaccines Valneva and Sanofi Pasteur. The EMA says at this point it cannot say if a decision could come on either application by Easter. Currently, five COVID vaccines have been approved for use across the European Union.
The EMA says it is also reviewing data on the possible administration of a second round of booster doses. But “at the moment, there is insufficient evidence that could support any recommendation.”
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Pfizer’s COVID treatment pill, Paxlovid, has been approved for use in Europe. The European Medicines Agency says the pill is for people who are at high-risk for severe infections who test positive. The pill is for early treatment and not prevention. It must be given as soon as possible after a positive test. The agency says Paxlovid can be used to treat Omicron infections, but as with other monoclonal antibody treatments, it will lose some effectiveness.
The EMA is sending out information to healthcare professionals on guidelines for use and treatment when using the pill on COVID patients.
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Canada reported 15,097 COVID infections yesterday while suffering the loss of another 179 lives to the coronavirus. Reminder: Infection cases are likely very underreported due to testing systems across the country being overrun.
The Canadian vaccination effort has so far administered 31,980,509 1st vaccine doses (83.64% of the total population) while 30,247,626 people (79.11%) have had two doses, and of those, 16,010,671 people are fully vaccinated with three shots.
Ontario saw hospitalizations (2,797) decrease (-142) while ICU numbers (541) were down (-13). The province lost another 75 lives to coronavirus. It has a positivity percentage of 14.38%.
Quebec has a positivity percentage of 11.82%. Hospitalizations (2,637) have declined (-93) while ICU numbers (191) have dropped (-13). The province lost another 42 lives to the pandemic.
In Newfoundland and Labrador, hospitalizations (20) are unchanged with 7 people in intensive care, a drop of two. Its positivity percentage is 16%. The province will begin to ease restrictions as of Monday.
Nova Scotia hospitalizations (97) rose (+5) and ICU numbers (13) remained unchanged. The province recorded four more pandemic deaths. It has a positivity percentage of 10.22%.
In New Brunswick hospitalizations remain at a record high with 165 and 14 people are in an ICU (-2). The province also saw four more deaths.
Manitoba saw hospitalizations (736) drop (-8) while ICU numbers (54) is unchanged. The province will begin easing COVID restrictions next week. Its positivity percentage is 27.1%.
Saskatchewan has yet to report, and it sounds like future COVID data reporting is about to be throttled. The province has announced it will do away with daily infection reports and will even retire its COVID dashboard. Instead, it will do a weekly summary. It is also restricting PCR tests to “priority populations at elevated risk.”
Alberta has yet to report, but Premier Jason Kenney has signaled his intention to lift restrictions by month’s end.
B.C. has yet to report.