Latest knowledge on Covid-19

Dr Adrian Hyzler Chief Medical Officer at Healix International

Dr Adrian Hyzler
Chief Medical Officer

Developments from 17th June 2021

COVID-19 has resulted in the deaths of at least 3,839,934 people since the outbreak emerged in December 2019. So far, nearly 180 million cases of coronavirus have been registered, based on daily reporting by individual health authorities in each country. The World Health Organisation estimates that the pandemic’s overall toll could be two to three times higher than official records due to the excess mortality that is directly and indirectly linked to COVID-19. The US is the worst affected country having just surpassed 600,000 deaths from over 34 million cases. It took little more than a month for the toll to rise from 400,000 to 500,000 dead, but the climb from 500,000 to 600,000 occurred over four months. After the US, the hardest-hit countries are Brazil, with almost half a million deaths, India with 380,000 deaths, Mexico with 230,000 deaths and Peru with 190,000 deaths. Peru, having just last week revised the figure up by almost two thirds, has become the country with the highest number of deaths compared with its population with 564 fatalities per 100,000 inhabitants, followed by Hungary with 309, Bosnia-Herzegovina with 286, and the Czech Republic with 282. The total number of cases worldwide continues on a 2-month decrease, as does the number of deaths, which is down 10% on the previous week. All regions are reporting fewer cases except for South America that has recorded rises in cases and deaths of around 6 to 7%, and most alarmingly, the African continent with a 40% week-on-week rise in case numbers and a 20% rise in reported deaths.

The WHO continues to warn that the continent of Africa with a combined population of 1.3 billion people is facing a severe shortage of vaccines at the same time as a new wave of infections surging. Vaccine exports from India have ground to a halt with their latest domestic surge. In South Africa, which has Africa’s strongest economy and its biggest coronavirus caseload, less than 1% of the population is fully vaccinated, and hundreds of thousands of the country’s health workers are still waiting for their jabs – it looks like it may have been unwise to discard millions of AstraZeneca vaccines on insufficient data. The picture is similar in other African nations: in Nigeria, Africa’s most populous country with more than 200 million people, only 0.1% is fully protected; Kenya, with 50 million people, is even lower; Uganda has all but run out of COVID-19 vaccines and oxygen as the country grapples with another wave of the pandemic. Meanwhile things are even worse in some African countries: Chad has just administered its first vaccine shots; Burkina Faso has yet to vaccinate any of its citizens; while Tanzania, Burundi and Eritrea do not even recognise the need for vaccines – only North Korea and Haiti are yet to administer a single vaccine in the rest of the world. In China, an average of about 20 million people per day have been vaccinated against COVID-19 over the last few weeks. China now accounts for more than half of the 35 million or so people around the world receiving a COVID-19 shot each day. However, it should be noted that China has already supplied 350 million doses of the two WHO-approved vaccines to more than 75 nations. The nation aims to produce up to three billion doses of COVID-19 vaccines in 2021, and up to five billion per year after that. Israel remains the country with the most vaccinated of any significant population, with nearly 6 out of 10 people in the country fully inoculated against Covid. It is followed by Canada (59% of the population have had at least one jab, though very few of those have been fully vaccinated), the UK (58.3%), Chile (56.6%) and the US (51%). Six out of ten of all COVID vaccines have been administered in the world’s three most populous countries – China (704.8 million doses), the US (296.9 million) and India (221 million).

Novavax announced strong results today from a 30,000-person trial of its COVID-19 vaccine in the US and Mexico. The vaccine uses a synthetic protein of SARS-CoV-2, a different technology from the COVID-19 vaccines authorized so far, and delivered 90.4% overall efficacy against symptomatic COVID-19 infections, and 100% protection against moderate and severe disease. Against eight viral variants of interest and concern, its efficacy was 93.2%. There were no cases of moderate or severe disease among vaccinated people, nor were there deaths. The vaccine can be stored at normal refrigerator temperatures, making it ideal for distribution to more remote locations. There have been significant delays with manufacturing the vaccine and thus its primary US target market is unlikely to need the vaccine at this stage. Initially, it will probably have the largest impact overseas through programmes such as Covax, the World Health Organisation-sponsored campaign to distribute vaccines to countries that need doses. The secondary role of the vaccine is as a potentially promising technology to use for booster shots, with high efficacy and a low rate of side effects.

An experimental COVID treatment made by AstraZeneca, using a combination of two monoclonal antibodies (MAB), has failed in its main goal to treat symptoms in patients exposed to the virus. AZ reported that 1,121 unvaccinated adults in its Phase 3 clinical trial had been exposed to an infected person as part of the trial. The MAB combination, which has been funded by the US government, reduced the risk of developing symptoms by only 33%, which was ‘not statistically significant’. The company plans to continue trials to assess whether the drug can prevent COVID or treat more severe symptoms. In positive news, the Regeneron monoclonal antibody (previously only found to be effective in the pre-hospital setting) has been shown to save lives in some hospitalised COVID patients. The MAB treatment was successful in reducing mortality in hospitalised patients who hadn’t mounted their own natural immune response against COVID-19, according to new data from Oxford University’s RECOVERY trial. This marks the first time that a COVID therapy has been shown to reduce mortality by actually targeting the coronavirus. Other therapies, such as the steroid dexamethasone, work by suppressing the body’s immune overreaction to the virus, the so-called ‘cytokine storm’. In the 9,785-patient trial, the percentage of COVID-19 deaths in the group that received the antibody cocktail went from 30% to 24%. Thus, for every 100 such patients treated with the antibody combination, there would be six fewer deaths. The therapy, which is known as REGN-COV (an infusion of casirivimab plus imdevimab) is currently only authorized for outpatient use, but Regeneron now plans to ask the US FDA to expand the emergency use authorisation to hospitalised patients. It should be noted that production of this treatment is very limited and the cost will be prohibitively high in all but the richest countries.

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

  • Argentina
  • Bahrain
  • Chile
  • Colombia
  • French Guiana
  • Kuwait ↑
  • Paraguay
  • Maldives
  • Mongolia
  • Namibia ↑
  • Saint Martin
  • Seychelles
  • Suriname
  • Uruguay

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

  • Bolivia
  • Botswana
  • Brazil
  • Costa Rica ↓
  • Georgia
  • Malaysia
  • Oman
  • Panama
  • Reunion
  • Sint Maarten
  • St Kitts & Nevis ↑
  • Trinidad & Tobago
  • Tunisia ↑
  • UAE
  • US Virgin Islands

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

  • Andorra
  • Anguilla
  • Belarus
  • Cape Verde ↓
  • Cuba
  • Denmark
  • Dominican Republic
  • Fiji ↑
  • Greece
  • Guatemala ↑
  • Guyana
  • Honduras ↑
  • Iran
  • Iraq
  • Kyrgyzstan ↑
  • Latvia
  • Nepal
  • Netherlands
  • Peru
  • Russia ↑
  • South Africa
  • Sri Lanka
  • St Vincent & Grenadines ↑
  • Turkey
  • Ukraine
  • United Kingdom
  • USA + territories – Colorado, Florida ↑, Louisiana, Missouri, Tennessee ↑, Texas, Utah, Wyoming ↑
  • Zambia ↑

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

  • Afghanistan
  • Anguilla
  • Aruba ↓
  • Bahamas
  • Belgium
  • Cambodia
  • Canada
  • Croatia
  • Cyprus
  • Ecuador
  • Estonia
  • Falkland Islands
  • Faroe Islands ↓
  • France ↓
  • Guadeloupe ↓
  • India ↓
  • Indonesia ↑
  • Ireland
  • Italy ↑
  • Jordan
  • Kazakhstan
  • Lesotho
  • Libya
  • Lithuania ↓
  • Luxembourg ↓
  • Monaco ↑
  • Montserrat
  • Norway
  • Palestine Territories
  • Philippines
  • Portugal
  • Qatar
  • Saint Barthelemy ↓
  • Saudi Arabia
  • Slovenia ↓
  • Spain ↓
  • St Lucia
  • Sweden ↓
  • Thailand
  • Timor Leste ↓
  • USA + territories – Alabama, Alaska, Arizona, Arkansas, Delaware, Georgia, Hawaii, Kansas, Mississippi, Idaho, Indiana, Iowa ↑, Kentucky, Maine, Michigan, Montana ↓ , Nevada ↓, New Jersey, New Mexico, N Carolina, N Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, S Carolina, Texas ↓, Washington ↓, West Virginia, Guam
  • Uganda ↑
  • Venezuela

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