The Evening Report - Jan 18
Danish hospitals have started to stand down from COVID emergency operations
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Denmark’s COVID contact number (reinfection rate or R0) has jumped. Last week, with a contact rate of 1.0, Health Minister Magnus Heunicke said “we have a stable epidemic” this week he revealed the R0 has increased to 1.2, indicating “a growing epidemic in terms of infection.” But Heunicke insists there are reasons for optimism, as record high coronavirus numbers have not been reflected in hospitalizations. He says this is due in large part to a huge vaccination uptake in Denmark and to the Omicron variant generally causing less severe disease.
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Denmark recorded two back to back days of record-breaking daily COVID numbers with 28,780 on Monday followed by 33,493 on Tuesday. This marks the first time ever daily coronavirus cases in the country have exceeded 30,000. There were also 14 more coronavirus deaths.
As measured by testing date, Denmark also saw a record-high 27,918 positive results for corona tests taken on Sunday, January 16.
There were 400,758 total corona tests done on Monday, of which 193,130 were PCR equaling a positivity percentage of 17.34%.
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According to Denmark’s Prime Minister, it might be time for a rethink on COVID restrictions. In an interview with Ekstra Bladet, Statsminister Mette Frederiksen said there is no longer a correlation like “there once was” between coronavirus infections and the number of patients in intensive care. Frederiksen said it is therefore time to reconsider restrictions as a whole. Matter of fact, the Prime Minister said those deliberations are already underway within the government.
“And then of course we are in a place and in a situation where we have to reconsider not only the current restrictions, of which there are not many left, but how we handle the situation in general. At least that is what we are doing in government right now.”
Falling numbers of seriously infected people needing intensive care has been noticed in the ICU at the Rigshospitalet in Copenhagen, where the number of patients has dropped like a rock.
Chief Physician Anders Perner spoke to DR:
“At the end of December, we were full to the brim and very worried about what a big wave of Omicron patients would do to our capacity. But in the last ten days we have seen a constant decline.”
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Denmark has determined that hospitals “are no longer critically challenged by COVID” and patient’s rights for a timely assessment and treatment of their medical needs, which are suspended, will now be restored. Patients rights were suspended on December 21 as hospitals moved to emergency mode due to the unprecedented Delta and then Omicron infection wave. But while hospitalizations are high stays are shorter and the numbers of intensive care patients and those on a ventilator continue to drop.
Health Minister Magnus Heunicke:
“The National Board of Health has assessed that it is medically justifiable to lift the current suspension of assessment and treatment rights as soon as possible. Therefore, we have decided to bring forward the reintroduction of patient rights so that they take effect as early as Friday January 21. Although we have high infection rates, the number of inpatients has not increased to the same degree, and in intensive care we have seen a decrease. That is positive news and why we can reintroduce patient rights.”
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It was a mixed bag of news on the hospitalizations front as COVID admissions (810) continued to rise (+8) while the number of infected people in an ICU (49) continues to drop (-3) and of those the number on a ventilator (29) also fell (-8). The number of corona patients admitted to a psychiatric ward (187) continues to increase (+12).
The Danish government is watching the intensive care numbers like a hawk and relying on those as an indicator that the pandemic picture is changing for the better.
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Hospitals in Region Sjælland are scaling down COVID-related emergency footing and beginning the transition back to near-normal operations. The region says there are now so few coronavirus patients that it no longer makes sense to have hospitals on emergency operations . As part of the transition, the number of beds reserved for pandemic patients is being scaled down.
Executive Vice President Jesper Gyllenborg:
“Right now it is going in the right direction, and contrary to what we expected, we are slowly moving towards more normal operation in our hospitals. So I am feeling confident.”
As part of COVID emergency operations hospitals in the region had pulled staff from other areas and departments to increase response. Now, as emergency operations ease those staff will be freed up to return to their usual assignments.
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Last week, the Danish School Administration Association was lobbying the government to try and make closing a school due to an outbreak a last resort. This week, the association is worried about the Omicron variant, not the government, that might force schools to take drastic action, possibly including closing their doors.
Deputy Chair Dorthe Torp Andreas spoke to DR to raise the alarm as the Omicron variant forces more and more teachers to call in sick.
“It is becoming a critical situation in some places where there are increasing staffing absences due to being sick. Therefore, schools are having a very hard time holding things together.”
Andreas says it is an emergency situation and there are no easy answers, with demand already exceeding supply on a diminished pool of substitute teachers. She is also worried about the impact on students and the quality of their learning as schools and teachers struggle to hold it together.
Of note, is Espergærde School south of Elsinore, where one out of every four teachers is out sick. Efforts to tackle the staffing shortage are getting frantic, with the school informing parents class times may be reduced and if things don’t improve quickly, students might have to be sent home. It isn’t the only school facing challenges as Strandby School in Frederikshavn has ten of its 45 teachers and the school headmaster off sick. Last week, COVID infections also began to spread among the student population.
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Students dealing with COVID shouldn’t be punished if they are absent from school. That is the message from Denmark’s Education Minister Pernille Rosenkrantz-Theil in a letter she fired off to high school education leaders this week. The minister was responding to stories about high school students who are in COVID isolation at home and who are afraid to miss school due to absence-related punishments.
In the letter the minister wrote:
“We must ensure that no students who are infected or in close contact show up at the schools for fear of being absent. Therefore, I would strongly urge that corona-related absence not be sanctioned.”
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As Denmark begins to phase out COVID restrictions, the Danish Ministry of Education is reminding people of the rules that still stand in schools. Those COVID measures will remain in place in schools until at least the end of the month.
School teachers and staff in primary schools and up can wear a visor or mask on schools and when they are walking around, but not when they are teaching or interacting with students. The reason given by the ministry for wearing a mask in one situation but not the other is “due to educational considerations.”
Parents, and any other visitors to daycares and all other schools, must wear a mask or a visor.
Students must show a coronapas to access continuing education classes and other youth and adult education facilities. Masks must also be worn when standing or moving around the school.
Education centers like the Experimentarium and the Wadden Sea Center have reopened and a coronapas and mask mandate remain in place.
COVID testing requirements for students and staff, twice a week either at school or with self-tests at home, also remain in place.
Classes must also continue not to mix and all school social events and gatherings should be cancelled.
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On the vaccination front, there were 38,148 total inoculations yesterday, with booster doses (33,348) continuing to drive the numbers.
To date, 82.4% of the total population has one vaccine dose, 80.2% have two, and 57.6% have a booster dose.
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The vaccination effort in Region Sjælland seems to be going well as it says it has vaccinated 90% of everyone in the region 12 years old and older who has been invited to get vaccinated.
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Sweden has added a whopping 97,248 infections and another 45 corona deaths since Friday’s update. Keep in mind Sverige doesn’t test as much as its Nordic neighbours so these numbers are very likely underreported.
So far, 86.4% of the population 12 years old and older have one dose, 82.9% have two, and of those with two doses over the age of 18, 37.7% have a booster dose.
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Sweden will abolish the requirement for a negative COVID test in order to enter the country by boat, land, or air as of January 21. It will then return to the entry restrictions that applied into December before the negative test mandate was issued. In a release, the Swedish government says the Omicron variant is now so widespread, test mandates at the border are redundant.
Travelers from within the EU and the wider European Economic Area will need an EU COVID digital certificate showing vaccination, recovery from a recent infection, or a negative test no older than 72 hours.
In Denmark’s case people traveling back and forth through Sweden to the Danish island of Bornholm retain their exemption to make the trip without any added requirements other than proof of journey.
For travelers coming to Sweden from outside of the European Union, they must have proof of vaccination via an accepted vaccination certificate or a negative COVID test no more than 72 hours old or be denied entry.
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COVID cases and hospitalizations in Sweden’s capital region continue to rise as hospitals strain under the workload amid staffing shortages. Region Stockholm says infections have increased by 28% week to week. While there are 495 patients in hospital, an increase of 99 from Tuesday of last week. The region had 179 beds available and the staff to cover them as of Tuesday afternoon.
But Chief Physician Johan Bratt notes staffing is stretched paper thin.
“There are still many people on sick leave with almost all care providers in the region, while the number of patients with COVID continues to increase. This creates a great strain on healthcare. But thanks to the great efforts of employees and care providers, the care is being administered.”
Five hospitals in the region are on varying levels of emergency footing, with in some cases non-emergency surgeries and procedures being postponed so all hands can be on deck.
Last week, the positivity percentage in Region Stockholm was an eye-catching 45.1%. It notes demand for corona testing has now outstripped supply and PCR tests are being prioritized for those who most need them.
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Testing woes in Southern Sweden are driving so many people from Region Skåne to Blekinge to get their hands on COVID self-testing kits that the region is now taking steps. As of January 7, only people who live in Region Blekinge can buy self-testing kits that are sold outside health centers.
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Finland registered 5,977 new infections and eight more virus deaths since yesterday’s update.
*Just a note: The Finnish Institute for Health has abandoned what was a pretty good COVID dashboard for what you see below.
COVID hospitalizations (701) are unchanged day to day.
To date, 76% of the total population has one dose, 73.1% have two, and 34.7% have a booster dose.
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A Finnish company has developed a COVID breathalyzer it says is capable of very quickly detecting a coronavirus infection. Deep Sensing Algorithms, based in Tampere, Finland, says its DSA BreathPass™ can turn around a positive or negative result within 45 seconds. The European Union has given the device a CE certification, the same designation given to approved COVID rapid self-testing kits.
DSA CEO Pekka Rissanen says the portable handheld device will make a real difference in the fight against COVID.
“It is low-cost, non-invasive, and highly scalable. We are driven to provide a COVID screening solution that helps individuals, families, and communities return to normal at work, school, and play.”
The company says people’s immune system kicks into gear very quickly after an infection and the “metabolic byproducts” of the immune response begin to appear in an infected person’s breath the same day they contract the virus.
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Having a COVID infection is equal to having at least one dose of a coronavirus vaccine in the eyes of the Finnish Institute for Health. The institute has now incorporated that assessment directly into its vaccination program.
Research Manager Merit Melin:
“If you have had COVID, this does not mean that you cannot be vaccinated. The immunity formed as a result of contracting the disease is preserved for at least 6 to 12 months, and it is likely that it also gives you at least partial protection against a severe disease caused by virus variants.”
The health agency says an infection recovery plus one vaccine dose provides protection against the coronavirus “at least equally good” as those who have two doses and have never been infected.
“When a person who has had two vaccinations contracts a COVID infection, this strengthens the immunity triggered by the vaccines. In those who have received two vaccinations, a COVID-19 infection probably affords protection that is even better and longer lasting against the variant that caused the disease than the current vaccines.”
The institute is now treating an infection recovery as on par with giving someone with two doses a booster shot. So people with two doses who have become infected “do not need a third dose to protect them, at least not for the time being” according to the agency. It says for someone having an infection recovery, a 3rd dose should be reserved for only those most at risk, those with severe immunodeficiency, or if necessary for travel “or some other weighty reason.”
It is also tweaking its timeline for when someone who has recovered from a coronavirus infection can get vaccinated. For those 18 years old and older who have been infected and have recovered, who are unvaccinated, the institute advises holding off on another dose for two months. For those younger than 18, the range should be four to six months. For seniors 60 years old and older who have had one dose and an infection, they too should wait four to six months for a second shot.
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As children returned to school from the Christmas break the Finnish effort to get children 5 to 11 years old vaccinated has switched into high gear. The Finnish Institute for Health has recommended children at increased risk, those with chronic illness, immunodeficiency, and kids who live with or have close contact with a vulnerable or high-risk person should be prioritized to be vaccinated. For all other children in the 5 to 11 year old age group, it said it is “offering the possibility” of getting vaccinated, wording that is causing some problems.
Chief Physician Hanna Nohynek says the wording is leading to misunderstandings.
“In public discussion, people have not been clear about what ‘offering the possibility’ means. They may have interpreted this to mean that vaccinations are not recommended at all for healthy children. This is a misunderstanding. The European Medicines Agency has also approved the Pfizer/BioNTech COVID vaccine for those aged 5 to 11. Getting vaccinated is not recommended as strongly for young children as for those aged 12 years old and older. The reason for this is that children aged 5 to 11 have a very small risk of having a severe COVID infection.”
The institute says there are no other adverse impacts or side effects outside the usual things that might happen when getting vaccinated like a sore arm, fever, fatigue, and aches and pains, all of which are short-lived.
“The information we have at the moment indicates that a severe infections and cases of long-COVID are rare in young children. This is why protecting with vaccinations older people and other groups who are at risk of contracting a severe infection has been a higher priority in a situation where resources are limited.”
Finland has 360,000 pediatric doses of the Pfizer/BioNTech vaccine, with the next delivery coming in March.
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Norway has added 6,517 infections and one more pandemic death in the last 24 hours.
COVID hospitalizations (238) are down (-2) while the number of those with severe infections in an ICU (74) edged down (-5) and of those the number on a ventilator (49) also dipped (-6).
To date, 79.8% of Norwegians 12 years old and older have one vaccine dose, 73.5% have two, and 42.3% have a booster dose.
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The jury is largely out on the need for a fourth round of vaccinations in Europe, according to the European Medicines Association. In a Tuesday press conference, the EMA said it has seen no data on whether a 4th vaccine dose, its need, or potential benefit. It said “currently, there is no evidence for the need for a 4th dose in the general population.”
The drug watchdog also said that the continued administration of repeated booster doses is not only not sustainable but might actually be counterproductive. The agency says having booster doses over and over again with short intervals in between might actually reduce the level of protective antibodies. The agency suggested that if more doses are needed, they might be timed for the winter cold season in order to increase antibody protection when everyone is inside, and COVID has an easier time jumping around.
The EMA does make an exception on 4th doses for those who have weakened immune systems and who already have two doses and a booster.
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On another vaccine-related topic, the EMA said the approval of vaccines with a different formulation will require clinical data that proves “a superior immune response than the one generated by the boosters currently available.” It said there is need for a long-term strategy around the types of vaccines needed to manage coronavirus. The agency says this will require global discussions bridging both science and public policy.
This comes as vaccine makers like Moderna, Pfizer/BioNTech, and others work on variant specific vaccines to target the Omicron strain. The big pharmaceutical companies have been vocal about their hopes that a variant specific formula could be piggybacked on existing vaccines that have already been approved for use. They are worried that a reformulation may need to go through an approval process starting from scratch.
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Pregnant women are at no risk from mRNA vaccines, according to a study from the European Medicines Agency’s COVID task force. The study found no pregnancy complications, no risk of miscarriages, premature births, or adverse effects for the expecting mother or the child they are carrying. Any side effects were all in line with the usual stuff we all might see like pain at the injection site, fatigue, aches and pains, or a fever, all of which quickly faded. The study examined 65,000 pregnancies across all three trimesters. The EMA says the findings are all in line with similar studies from around the world.
The EMA says this is great news and should reassure pregnant women to get vaccinated. It notes unvaccinated expecting mothers are at increased risk of a severe infection, especially in the second and third trimesters.
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On Monday, Health Canada approved the use of Pfizer’s COVID treatment pill paxlovid. The first shipments of the pill arrived in Canada on Monday morning, but supplies are limited and the next batch isn’t coming until March.
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Canada reported 26,606 COVID infections and another 135 pandemic deaths on Monday. Case numbers are likely very underreported due to huge testing issues across the country.
Over the last seven days, the average positivity percentage was 21.1%.
Hospitalizations continue to be a concern, with another 2,813 COVID admissions in the week running from January 3 to 10. This pushes total hospitalizations to 6,926 beds occupied. Another 290 infected people were also admitted to intensive care units for a total of 935 during the same week. Of those, 412 are on a ventilator, an increase of 104.
The Canadian vaccination effort has administered 31,699,698 1st vaccine doses (82.90% of the total population) while 29,681,341 people (77.63%) have two doses, and of those 12,627,779 are fully vaccinated with three shots.
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.
In Ontario, hospitalizations (4,183) have jumped (+296) while the number of people in an ICU (580) crept upward (+2). 199 of the infected people in intensive care were unvaccinated. 46.5% of hospital admissions were people admitted for a non-pandemic reason only to test positive. This is a very good indicator of a huge community spread. Ontario has a positivity percentage of 19.12%.
Quebec has yet to report on Tuesday but the day before it saw hospitalizations (3,417) keep rising (+36) while the number of people in an ICU (289) also edged up (+3). The province has a positivity percentage of 18.3%.
In Atlantic Canada, Newfoundland and Labrador has 14 hospitalizations (+1) and three people in an ICU. The positivity percentage is 20.7%. In Nova Scotia, admissions increased by 13 to 73 total hospitalizations and 15 people in intensive care. There has been one more fatality. The province has a positivity percentage of 22.5%. Hospital numbers in New Brunswick are treading water with 113 admissions and 16 people in an ICU. There have been two more deaths.
Manitoba saw hospitalizations (620) increase (+19) while ICU numbers (48) inched up (+1). The province has a five day positivity percentage of 34.2%.
Waste water monitoring in two Saskatchewan cities showed major increases in coronavirus spread. Activity was up 107% in Saskatoon and a jaw-dropping 810% in Prince Albert. Hospitalizations in the province (167) inched up (+5) while ICU numbers (13) also crept upward (+1). Saskatchewan has a positivity percentage of 40%.
Hospital admissions over the weekend in Alberta cracked the 1,000 mark with 1,007 hospitalizations, an increase of 185 since Friday. Intensive care admissions rose by 13 to 94. The province has a positivity percentage of 37.4%.
In a period covering three days over the weekend B.C’s corona hospital admissions (819) continued to surge (+173) and those in intensive care (99) also crept up (+4). The unvaccinated account for 33.7% of all hospitalizations, 47% of ICU patients, and 22.7% of all infections. The province has a positivity percentage of 15.46%.