Latest knowledge on Covid-19

Dr Adrian Hyzler Chief Medical Officer at Healix International

Dr Adrian Hyzler
Chief Medical Officer

Developments from 13th May 2021

Case and death incidences, however, have plateaued at the highest levels since the beginning of the pandemic. There were more cases globally in the past two weeks than in the first six months of the pandemic, with more than half of all the new cases arising from Brazil and India. New weekly cases decreased in the regions of Europe and the Eastern Mediterranean, while the South-East Asia region continued an upward trajectory that has persisted for nine weeks and with a further increase of 6% in the last week. The highest numbers of new cases were reported from India with a 3% decrease, Brazil with a slight increase on the previous week, the US with a 21% decrease, Turkey with a 43% decrease, and Argentina with much the same numbers. COVID cases are increasing rapidly across the APAC region with over 5.9 million new confirmed infections in the past two weeks, more than in all other regions combined, pushing hospitals and health systems to the brink of collapse. Seven out of ten countries globally that are doubling their infection numbers the fastest are in the region. Laos took just twelve days to see its cases double, and the number of confirmed infections in India has doubled in under two months to more than 23 million, although official figures for much of the region are widely believed to be wildly undercounted. According to the Pan American Health Organisation, nearly 40% of all global deaths related to COVID-19 over the last week happened in the Americas, and nearly 80% of the region’s intensive care units are filled with COVID-19 patients. India’s B.1.617 predominant coronavirus variant, classified as a variant of concern globally by the WHO for its increased transmissibility, has been detected in at least six countries of the Americas. Cuba continues to drive most new infections in the Caribbean, while Canada is seeing higher rates of infections in the east and across the northern territory, home to a majority indigenous population.

More than 1.36 billion jabs have now been administered, and 8.9% of the global population are fully vaccinated, but the distribution is hugely skewed towards high income countries. The COVID vaccine from the Chinese state-owned drug maker Sinopharm became the fifth WHO-approved COVID vaccine, on an Emergency Use Listing (EUL). This means that it can now be rolled out globally and be used as part of the WHO’s COVAX scheme to provide coronavirus vaccines to poorer countries. Up to now the scheme has relied heavily on the Covishield vaccine from AstraZeneca comprising over 95% of all vaccines distributed. The WHO commission did express some “evidence gaps” in its review of Phase 3 clinical trials in China, Bahrain, Egypt, Jordan and the United Arab Emirates, citing a lack of data on protection against severe disease, duration of protection and safety for use in pregnant women and in older adults. Health officials in Bahrain are to offer a third dose of the Sinopharm jab to people who have already been vaccinated against coronavirus as international calls grow for “booster jabs” to ensure continued protection. Government officials said that a third shot would be given six months after the second dose to people over 60, those with chronic diseases and frontline medical workers, while all other adults could receive it a year later. It comes after varying reports of the efficacy of Chinese-made vaccines, and reports from the United Arab Emirates and the Seychelles that booster doses or mixing vaccine types might be necessary to provide lasting immunity. A separate group of WHO technical experts is currently reviewing the other major Chinese vaccine, Coronavac from Sinovac Biotech Ltd, for possible WHO EUL, which would not only pave the way for its use in the global COVAX vaccine sharing platform but also provide a crucial international endorsement for a vaccine developed in China. The European Medicines Agency (EMA) also announced the beginning of a rolling review of the Sinovac vaccine. This allows the agency to assess data as it is collected until there’s enough evidence to file a formal conditional marketing authorisation application. Similar reviews are underway for Russia’s Sputnik V vaccine and the CureVac and Novavax jabs. In real world data Coronavac is wiping out COVID-19 among health workers in Indonesia, an encouraging sign for the dozens of developing countries reliant on the controversial Chinese shot, which performed far worse than western vaccines in clinical trials. Indonesia tracked 128,290 health workers in capital city Jakarta from January to March and found that the vaccine protected 98% of them from death and 96% from hospitalisation as soon as seven days after the second dose. The cohort included a working age population and thus data from the more elderly group was not included.

The variant has three lineages, of which the B.1.617.2 is the fastest growing. It does not have the E484Q mutation seen in the other two India variants that might help it to escape the body’s immune response, but it has other novel mutations, including one called T478K. Following a rise in cases in the UK and evidence of community transmission, Public Health England (PHE) has also reclassified the variant, as a Variant of Concern (VOC). PHE stated that this re-categorisation is based on evidence that suggests this variant is at least as transmissible as the Kent variant (B.1.1.7). There is insufficient evidence to indicate that any of the variants recently detected in India cause more severe disease or render the vaccines currently deployed any less effective. The B.1.617 variant has been detected in more than 4,500 samples in at least 49 countries in all six WHO regions. Outside of India, the UK has reported the largest number of COVID cases caused by the variant, but that may be a result of the huge amount of genomic sequencing that the UK performs. The emergence of different variants, including those from Kent, South Africa, Brazil and India demonstrates that the virus has multiple routes to increase ‘fitness’ and to evade immunity and that there is no evidence that there is any kind of plateauing for SARS-CoV-2 at the moment.

Amongst the locations with highest number of per-capita new cases this week, are three small countries with very high vaccination rates: the Seychelles with 70% of the population having had at least one vaccine dose; the Maldives with 50%; and Bahrain with 45%. The Seychelles is of particular interest, being closely connected to South Africa where the B.1.351 variant predominates. The two vaccines being used in Seychelles vaccination program (the Chinese Sinopharm and the Indian-produced AstraZeneca vaccine, Covishield) have both displayed reduced efficacy against B.1.351. The surges in cases have followed lifting of social restrictions, although the most recent surge, in the context of higher vaccination rates, has not so far been followed by a corresponding surge in the death rate. Similar issues are being observed in Bahrain and the Maldives. The Seychelles’ government has closed schools and banned household mixing. To date, 62.9% of its population has received at least two doses of the vaccines, yet active cases more than doubled in the week to May 7, with 37% of infections in people who were fully vaccinated. It is not yet known whether these were symptomatic or asymptomatic infections, which vaccine was implicated in these ‘breakthrough infections’, or whether the B.1.351 variant has become established on the island nation. If the Sinopharm vaccine is proving ineffective, that’s bad news for countries such as Zimbabwe, Indonesia and Venezuela, all of which are using the shot in their vaccination programs. If the breakthrough infections were in the Covishield group, that means the AstraZeneca inoculation that forms the vast bulk of the vaccines being shipped to the world’s poorest countries through the COVAX program could be problematic. Meanwhile the government is blaming the surge in cases on over-indulgence in Easter celebrations with those who have been vaccinated letting their guard down and taking fewer precautions. The WHO is working on large-scale genetic sequencing to identify the origin of the outbreak, and whether it was caused by dominance of the B.1.351 variant or a novel variant, yet to be sequenced.

What do we know about Covid-19?

The current coronavirus pandemic is an evolving situation that Healix International is monitoring closely. Our regularly updated Covid-19 advisory has been developed to bring your organisation the latest insight from our medical experts, to better enable you to stay abreast of the most recent developments and help plan for a future beyond the pandemic.

Covid-19 country band categorisations

Extreme

>250 cases per 100,000 over 7 days

  • Anguilla
  • Argentina
  • Bahrain
  • Cape Verde
  • Costa Rica ↑
  • Cyprus
  • French Guiana
  • Georgia ↑
  • Lithuania
  • Maldives
  • Netherlands
  • Seychelles
  • Uruguay

Severe

>50-250 cases per 100,000 over 7 days

  • Andorra ↓
  • Armenia
  • Aruba
  • Austria
  • Azerbaijan
  • Bahamas
  • Belarus
  • Belgium
  • Bermuda ↓
  • Bolivia
  • Bosnia & Herzegovina
  • Botswana ↑
  • Brazil
  • British VI ↑
  • Bulgaria
  • Canada
  • Cape Verde
  • Chile
  • Colombia
  • Croatia ↓
  • Cuba
  • Czech Republic
  • Denmark
  • Ecuador
  • Estonia
  • Eswatini
  • France ↓
  • Germany
  • Greece
  • Guadeloupe
  • Guyana
  • Honduras
  • Hungary
  • India
  • Iran
  • Iraq
  • Ireland
  • Italy
  • Jordan
  • Kazakhstan
  • Kuwait
  • Latvia
  • Lebanon
  • Liechtenstein
  • Luxembourg
  • Malaysia
  • Martinique
  • Mongolia ↓
  • Montenegro
  • Nepal
  • North Macedonia
  • Norway
  • Oman
  • Palestinian Territories
  • Panama ↑
  • Paraguay
  • Peru
  • Poland
  • Qatar
  • Reunion
  • Saint Barthelemy ↑
  • Saint Martin/Sint Marten ↑
  • San Marino
  • Serbia
  • Spain
  • Slovenia
  • Sri Lanka ↑
  • St Lucia ↑
  • Suriname
  • Sweden
  • Switzerland
  • Timor-Leste ↑
  • Trinidad & Tobago
  • Turkey ↓
  • Tunisia
  • Ukraine
  • UAE
  • USA – Alabama, Alaska, Arizona, California, Colorado, Delaware, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan ↓, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, N Carolina, N Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Vermont, Rhode Island ↓, S Carolina, S Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, Wyoming

High

>20-50 cases per 100,000 over 7 days

  • Anguilla
  • Barbados ↑
  • Cambodia ↑
  • Dominican Republic
  • Equatorial Guinea
  • Falkland Islands
  • Finland
  • Guatemala
  • Jamaica
  • Japan
  • Kosovo ↓
  • Kyrgyzstan
  • Lesotho
  • Libya
  • Malta
  • Moldova ↓
  • Monaco ↓
  • Montserrat
  • Namibia
  • Philippines ↓
  • Portugal
  • Romania ↓
  • Russia
  • Saudi Arabia
  • Slovakia ↓
  • South Africa ↑
  • St Vincent & Grenadines ↑
  • Thailand ↑
  • Turks & Caicos ↑
  • United Kingdom
  • USA – Arkansas, California, District of Colombia ↓, Guam, Hawaii, Kansas ↓, Mississippi ↓, Puerto Rico, US Virgin Islands
  • Venezuela

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