The Evening Report - June 23
Denmark’s epidemic keeps rising. A historic day for Ukraine.
🦠Pandemic🦠
🇩🇰
Denmark has announced a new COVID strategy for the months ahead. It will focus on limiting as much as possible the most severe impacts of COVID infections but won’t include strict restrictions to limit infection spread.
The new strategy is built around four pillars. Prevent hospitals from being overwhelmed. Protect seniors and the most vulnerable. Keep the Danish economy going. And avoid lockdowns and COVID restrictions of the past unless in the most dire circumstances.
On Wednesday, Danish Prime Minister Mette Frederiksen said with another COVID wave almost certain to arrive this fall and winter, and with the BA.5 variant increasing infections, it is time to fall back on vaccines for protection. Frederiksen says this is the best way to prevent severe infections, hospitalizations, and deaths.
“Infections have been increasing for the past three weeks. A new Omicron variant is spreading in Europe and here at home. In addition, health authorities expect a new wave of infections in Denmark during the autumn. That is why we must be prepared. And vaccines are our strongest protection against COVID. Here and now we need to focus on our particularly vulnerable, who will have better opportunities to be vaccinated. We must do everything we can to keep the infection out of elderly care. And by the autumn, more than 2.4 million Danes will be offered revaccination.”
With cases rising and the BA.5 variant spreading quickly beginning next week, vulnerable and high-risk groups will again be able to get another vaccine dose.
Then in the fall, a fourth dose of COVID vaccines will be offered to everyone in Denmark who is 50 years old and older. It will begin mid-September, when the most vulnerable and high-risk populations will be offered another vaccine dose. Then, on October 1, a larger combined COVID/influenza vaccination campaign will be carried out. Health officials said the timeline for the vaccination campaign could be moved up if COVID activity picks up sooner than expected.
The vaccination campaign will again rely on the two mRNA vaccines from Moderna and Pfizer/BioNTech. The Danish National Board of Health says updated variant specific vaccines from both countries could also be used provided they are proven safe and effective for use.
Danish National Board of Health Director Søren Brostrøm says protection efforts need to be focused on older age groups and the most vulnerable citizens.
“Old age is the overriding risk factor for becoming seriously ill with COVID, and the risk increases, especially from around the age of 60-70. But because we can not fully predict the development of the epidemic and can not know exactly how disease-causing the dominant variant will be, we have chosen to apply a precautionary principle and recommend vaccination from the age of 50 and up.”
Vaccinations will be available at regional vaccination sites along with vaccine availability in medical centers and private vaccination clinics around the country.
“We got through last winter in good shape because we advanced the third dose at the right time. Therefore, Denmark was in a position to remove all restrictions in the middle of the Omicron wave. The strategy for the coming winter is also that the vaccines should get us through a new wave without using restrictions. We know that immunity declines over time. Therefore, it is important to be ready with a vaccination effort before winter is upon us.”
Health Minister Magnus Heunicke says they are planning around three different possible scenarios for the months ahead. Heunicke says it is anyone’s guess which of the scenarios could become a reality.
Scenario 1: A winter infection wave with a variant that doesn’t increase infection severity with no threat of inundating hospitals.
Scenario 2: A variant arrives like the Delta strain that does cause more severe infections and increasing hospitalizations. This will require safeguards for seniors and vulnerable populations.
Scenario 3: A new, even more threatening variant arrives that can evade immunity to a much higher degree. “Then it becomes more unpredictable.”
He says the other tool in the toolbox is COVID testing and plans are in place to be able to rapidly scale back up to 200,000 tests per day this fall and winter if the situation calls for it.
-
The Statens Serum Institute has released a new risk assessment for the BA.5, BA.2.12.1, and BA.4 variants. It says while the Omicron sub-variants have developed a higher degree of immune evasion leading to increasing infection numbers, there is no sign from data either in Denmark or abroad they cause any increase in severity. Although, it noted there isn’t enough data yet to say that is 100% certain and studies on severity are ongoing. Of the three, the SSI says the BA.5 variant is spreading much faster than the other two, with infection numbers doubling each week. It is now the dominant strain in Denmark.
As part of an improved ability to evade immunity, the agency notes, all three have a higher chance of slipping by antibody protection not just from vaccination but also from previous infection. This is why we are seeing a marked increase in reinfections.
The SSI note the BA.5 variant is taking over across Europe and elsewhere. The proportion of BA.5 in Portugal is 84% (week 22); Israel 40% (week 23); Austria 33.9% (week 21); France 24% (week 22); Germany 24% (week 22); and Scotland 20% (week 22).
Looking at Portugal and South Africa, two countries already dealing with BA.5 infection waves, the institute notes while infection numbers rose the infection waves in both countries were lower than any previous one. Hospitalizations also stayed well below previous peaks. However, both counties also saw increasing death rates.
In Denmark, the SSI says its concern is on older and more vulnerable populations, with the COVID incidence rate and positivity percentage highest among older age groups. It says there are also continuing signs that infection numbers are rising among healthcare staff. The institute says the reinfection rate for the BA.5 variant is 11.7% so far. While the reinfection rate is increasing the agency says its calculations show people with a previous Omicron infection have a lower risk of BA.5 infection. It says hybrid immunity with vaccination and a previous Omicron infection appears to offer the best protection. It also cautions there is still a lot we don’t know about BA.5 and that our knowledge base is a little fluid and will likely continue to change and evolve as more data is gathered.
“A new major wave of infections could therefore lead to a secondary increase in hospitalizations among the elderly and vulnerable, and could lead to excess mortality as is currently seen in other countries around Europe.”
The hospitalization rate for a BA.5 infection is 1.7% but, again “there is still too little data to estimate the severity of BA.5 in Denmark.”
“In recent weeks, there have been signs of an increasing excess mortality in some European countries, including Portugal, Germany, and Sweden, even though in these countries 2nd booster vaccination has been offered to the older part of the population.”
-
Denmark’s epidemic continues to head in the wrong direction. COVID cases jumped by 42% last week compared to the week before, according to the latest weekly assessment from the Statens Serum Institute. Keep in mind, due to the low testing numbers, the ‘true’ case count is unknown but likely much higher. The positivity percentage, a better pandemic barometer, also continued to rise, going from 17% to 19% from one week to the next. The bad news is that the percentage is increasing even though testing numbers are also rising, up 22% last week.
Metro Copenhagen (Region Hovedstaden) has the highest COVID incidence rate with 171 per 100,000 residents. Region Sjælland, which covers the rest of the island around Copenhagen, is right behind with an incidence rate of 134. Both the incidence rate and positivity percentage are rising in all five Danish regions. Region Midtjylland has the highest positivity percentage with 21.6%. Regions Nordjylland and Syddanmark are right behind, each with 18%.
The bad news continues when you switch the focus to infection activity by age group. The COVID incidence rate increased in every single age group last week. It was highest among those 40 to 79 years old, ranging from 171 to 225 per 100,000 people. The same trend can be seen with the positivity percentage, which increased in almost all age groups; the one exception being 3 to 15 year olds where the rate was stable. The highest positivity percentage, 23%, is among those 50 to 79 years of age.
Hospitalizations are a very good pandemic barometer, but there is no good news there either, as admissions increased by 43% last week. Seniors 70 to 89 years old continue to make up the largest number of new COVID patients. Intensive care admissions dropped from nine to just four new patients last week. The number of people being admitted to hospital specifically because of a severe infection has increased, going from 46% to 52% from week 21 to week 22.
Pandemic fatalities declined, with a preliminary 15 COVID deaths last week, down from 25 the previous week.
Among Denmark’s most vulnerable population, elderly seniors in care, testing increased by 3% and the positivity percentage dipped to 4.5%. But confirmed infection cases crept upward, going from 50 to 55 from one week to the next. Five seniors in care died from an infection last week; there were seven lives lost the week before.
COVID testing rates didn’t change among healthcare workers in hospitals or working in senior care homes, but the positivity percentage rose from 8.7% to 12.3% for those on the social services side. While healthcare workers saw it increase by almost a point to 19.2%.
With the caution that a large number of sequencing results have yet to come back for positive tests last week, the SSI says BA.5 is clearly dominant now, making up 59% of all cases last week. That compares to being 46.70% of cases the week prior.
Ward Doctor Rebecca Legarth:
“This pattern, both in Denmark and internationally, continues to support that there are currently no signs that BA.5, despite increased infectivity, seems to cause more serious infections.”
COVID wastewater surveillance, another reliable pandemic barometer also shows rising infection activity both nationally and across all five Danish regions. The institute says coronavirus concentrations in the wastewater are now roughly equivalent to where we were at the end of April.
From the SSI report:
“There is still a high probability that infection with SARS-CoV-2 will increase in parallel with the continued growth of BA.5. However, there is uncertainty about the extent of a new wave of infection. There is still a risk that increasing infections may lead to a secondary increase in admissions in the coming weeks.”
-
COVID hospitalizations (265) are up (+16) while the number of severe infections in an ICU (8) crept upward (+2) of those the number on a ventilator (4) also inched up (+2). Infection admissions to a psych ward (43) dipped (-2).
-
Denmark has reported 1,766 COVID infections (underreported), including 296 reinfections, and two more coronavirus deaths in the last day.
There were 8,585 PCR tests taken yesterday for a positivity percentage of 20.57%, 7-day is 21.29%. In both cases the percentages have increased again, albeit slightly.
-
On the vaccination front, with news of a new fall vaccination campaign to come, to date, 81.8% of the total population have one vaccine dose, 80.4% have two, 61.8% have a booster dose, and 0.7% have a 2nd booster shot.
-
The Director of the Danish National Board of Health admitted this week that in hindsight vaccinating children aged five to 11 years old last fall was “a mistake.”
Søren Brostrøm was asked on a TV2 program this week if it was a mistake to vaccinate the young children.
“With what we know today, yes. With what we knew then. In retrospect, we did not get much out of the expansion of the vaccination program for children when it comes to epidemic control. But that it is seen in hindsight.”
University of Southern Denmark Clinical Professor Christine Stabell Benn also spoke to TV2 and said the vaccination program aimed at the young kids was “unjustifiable” and a “hard pressure on parents.”
“We had some vaccines with a very unknown side effect profile, and at the same time we had some children who had nothing to gain by being vaccinated. In addition, children were made responsible for the health of their parents and grandparents. That, I think, is unreasonable.”
In Denmark, a country with towering rates of social trust, only 40% of parents chose to get their young children vaccinated.
Søren Brostrøm offered a message on TV2 to parents who got their child vaccinated and those who did not.
“I want to look all parents of children who have vaccinated their child in the eye and say: "You did the right thing and thank you for listening". But at the same time, and this is the important thing to maintain confidence, I will admit and say that we have become wiser, and we would not do the same today. And we will not do that in the future either.”
-
The Staten Serum Institute’s sentinel monitoring shows that in week 23 (the week before last) the most common viruses other than COVID that were coming back in testing were parainfluenza and rhinovirus.
🇸🇪
Sweden has added 2,916 infections (wildly underreported) and another 18 corona deaths in the last week.
To date, 87.2% of the population 12 years old and older have one vaccine dose, 85.1% have two, and of those 18 years old and older 65.9% have a booster dose.
-
Infection cases continue to rise again in Sweden as the BA.5 variant wave arrives. The Swedish Public Health Agency’s latest pandemic picture shows a 37% week-over week increase in coronavirus infections. With Sweden restricting the general public from being tested, its case numbers are likely wildly underreported, with the ‘real’ case counts probably being much higher.
That said, COVID testing increased by 11% last week, with a meager 16,200 tests administered all week. The positivity percentage has grown to 13%.
There were three new intensive care admissions last week. Pandemic fatalities continued to ease, with 22 reported deaths. The agency notes “there is some delay in reporting” as it blandly refers to a backlog of processing COVID deaths that has been a persisting problem for many months.
Department Head Britta Björkholm says the protections offered by vaccines are holding.
“The BA.5 virus variant, a sub-strain of the Omicron variant, is increasing in proportion compared with other variants and there is data showing that it is spreading more efficiently. However, BA.5 does not appear to cause any more severe infection or death than previous variants. For those who have not been vaccinated, or are waiting to get a booster dose, it is important that you do it now. It is also important that you stay at home and avoid contact with others if you are ill and have symptoms that may be a coronavirus infection.”
-
COVID infections weee the fifth most common cause of death in Sweden last year. The Swedish National Board of Health and Welfare says that the annual number of deaths had been trending down for years until the pandemic arrived in 2020 sending numbers back upward. It says last year the declining trend reasserted itself despite 5,319 coronavirus deaths.
Looking at it by gender, a COVID infection was the third most common cause of death for men and the seventh for women.
Cancer was leading cause of death in Sweden last year followed by cardiovascular diseases.
-
The concern about possible side effects from COVID vaccines has been reflected in the number suspected adverse reactions reported to the Swedish Medical Products Agency. It received just over 99,000 reported side effects last year, a ten-fold increase from the year before. Of those, 90,732 were people concerned with possible side effects from the COVID vaccine. Of the 11,951 reports deemed to be legitimate and serious, 8,895 (9.8%) were related to COVID vaccines.
🇳🇴
Norway has added 907 infections in the last day.
Over the last week it has 30 more coronavirus deaths.
There were 108 COVID hospitalizations in the last week (+46).
To date, 80.5% of Norwegians 12 years old and older have one vaccine dose, 75% have two, and 55.8% have a booster dose.
-
Infection numbers and COVID hospitalizations are rising again in Norway. According to the latest weekly assessment from the Norwegian Institute for Public Health, who says the BA.5 variant wave has arrived. It says the new variant and waning vaccination immunity are contributing to increasing pandemic numbers.
The NIPH says while infection-related general admissions have increased so far, there is no increase in either ICU admissions or fatalities. It says this is a pretty good indicator that the BA.5 variant doesn’t cause any increase in severity and that vaccine protection against severe infection and death is holding.
“There is also a risk that completely new, more virulent varieties may emerge that may also evade current vaccines to a greater extent than now. This emphasizes the need for continued monitoring, preparedness, and plans to meet any changes in the situation.”
The NIPH says COVID Hospitalizations are also on the rise for a fourth straight week, with 174 new admissions last week, an increase from the 139 the week before. The median age for infections admissions over the last four weeks has been 77 years old.
ICU numbers also crept upward, with 11 people with severe infections being admitted into intensive care last week, up from the seven the week prior.
There was a slight decline in pandemic fatalities, with three fewer reported last week with 30 lost lives. 60% of infection deaths last week were in a health institution that was not a hospital, primarily in senior care homes.
Wastewater monitoring backs up all the other indicators as it shows virus activity trending upward from week to week.
The health institute says there has been a slight increase in COVID-related visits to a doctor’s office or emergency room. While coronavirus outbreaks in hospitals almost doubled from week to week, going from 11 to 21 from week 23 to 24.
🇫🇮
Finland has registered 8,255 infections and 61 more virus deaths in the last week.
COVID hospitalizations (396) are up (+45).
So far, 80.3% of the total population have one dose, 77.2% have two, 53.3% have a 3rd dose, and 5.3% have a 4th dose.
🇦🇹
Austria has abolished its controversial mandatory vaccination law. The legislation had been in place since early February with random checks beginning mid-March. Anyone unable to show proof of vaccination was handed a hefty fine. Challenge the fine and lose? Then you get fined again. Those checks were suspended pretty quickly and now the law itself is toast. Just 62% of people in Austria are fully vaccinated, one of the lowest vaccination rates in Europe.
🇩🇪
Germany recorded 119,360 new infections in Thursday’s update along with 98 more pandemic deaths.
It added 1,256 COVID hospitalizations while ICU numbers (780) dipped (-15). As a percentage of total intensive care beds in the country COVID patients were using 3.6%.
To date, 77.8% of the population have one dose, 76.2% have two, and 61.6% have a booster dose.
.🇪🇺💉
A sixth COVID vaccine has entered the fray in Europe. The European Medicines Agency has recommended the Valneva vaccine be approved for use in the EU. The European Union Commission must still make a final decision but to date it has quickly rubber-stamped the EMA’S vaccine recommendations. The vaccine, given in two doses four weeks apart, is recommended for people 18 to 50 years old.
Clinical trials of the more traditional vaccine showed it provoked an anti-body response against COVID similar to AstraZeneca.
🇨🇦
Canada only updates its COVID statistics once a week on Fridays.
🦠Monkeypox🦠
🇩🇰
Make it 13. The Statens Serum Institute says another case of monkeypox has been confirmed in Denmark. All 13 cases so far were men. In all cases there was either a link to travel to Germany, Spain, Belgium, or Portugal, or there was close contact with an infected person in Denmark.
The SSI says Danish health authorities are keeping a close eye on the situation.
Ward Doctor Anders Koch:
“So far we have only seen a few cases in Denmark and in all cases we know how people have been infected. Therefore, we continue to assess that there is a low probability that monkey pox will spread in the broader population.”
That said, the institute warns there is an increased risk for gay or bisexual men who have multiple sexual partners.
The Staten Serum Institute also updated the monkeypox outbreak situation across the European Union. It says there are 2,746 cases so far in 29 European countries, with almost 85% of all confirmed cases in either the UK, Spain, Germany, Portugal, or France. The United Kingdom had the most infections, with 793, followed by Spain, with 518.
🇺🇦/ 🇷🇺 War
A historic day for Ukraine as it has been granted candidate status to join the EU with 27 member nations voting to support the country’s candidacy. Technically, this triggers a one year process with some hurdles for Ukraine to clear to officially become an EU member state. But, that process is rarely so easy with some countries having been in candidate status for a decade or longer and still have yet to officially be admitted to the EU.
🇬🇧 🇹🇷 🇺🇦
With Russia blockading Ukrainian Black Sea ports and both preventing Ukraine from exporting its grain by sea while Russia forces steal it by land, efforts continue to get the grain to market. Millions of tonnes of grain is stuck in Ukraine as Putin weaponizes food but but now Turkey and Britain are working together to try and get the grain out of the country.
British Foreign Secretary Liz Truss spoke to Reuters:
“If we do not solve the grain problem, it could lead to enormous hunger throughout the world.”
The minister underlined the point that the grain problem is so acute that it absolutely must be solved within the next month. Ukraine is one of the world’s leading exporters of wheat and maize something desperately needed by poorer countries right now.
🇱🇹 🇷🇺
The French army conducted impromptu paratrooper exercises in the Baltics this week in a thinly veiled warning to Moscow as it continues to bluster and posture along its borders with Latvia, Lithuania, and Estonia. Moscow is angry that Lithuania has enforced EU sanctions prohibiting a range of sanctioned goods from entering the Russian enclave of Kaliningrad. It has promised a not diplomatic response that “the entire population of Lithuania will feel.”
🇩🇪/ 🇷🇺
The energy crunch, caused by Russia turning off the taps to Europe in retribution for its support of Ukraine, is beginning to sink its teeth in. Germany has triggered the “alarm stage” in its emergency gas plan. The move is largely symbolic but stands out because Germany had such strong energy bonds with Russia. It also acts as a signal to companies and citizens that trouble might be coming. The reduced flow of gas into Germany, and the rest of Europe, could push the country into a recession and potentially lead to energy costs spiking even higher and potentially if things get really bad, gas rationing.