Covid-19 news and latest advice

Dr Adrian Hyzler Chief Medical Officer at Healix International

Dr Adrian Hyzler
Chief Medical Officer

Developments from 8th October 2021

Global cases of COVID continue to fall by around ten percent week-on-week and are down by almost a quarter over the last month. This downward trend is across all regions except Europe where eastern European countries are showing some alarming rises in case numbers, notably in countries such as Bulgaria, Romania, Poland and Ukraine, where vaccination rates are also amongst the lowest in Europe. Russia, is also recording record daily tallies of positive cases as well as near record death rates – the government continues to battle a high rate of COVID vaccine resistance. However, the decline seen across the Americas, Africa and Asia is set to continue in much the same way that the Alpha variant showed an equally dramatic rise followed by a precipitous fall. Some countries such as Denmark, Chile and Singapore that seemed close to moving to an endemic state of living with COVID-19 have experienced unexpected surges in cases in recent months. However, their high vaccination rates across the population, and especially in the vulnerable groups, have meant that the relatively high case numbers have not resulted in high hospitalisations or deaths. Out of more than 181 million people in the United States who had been fully vaccinated by mid-September, only 14,643 (or about 0.008 percent) were reported to be hospitalised with a non-fatal breakthrough infection, and 4,493 others died, according to data from the Centers for Disease Control and Prevention. Emerging research shows people who are vaccinated are eight times less likely to get COVID-19 and 25 times less likely to have a case resulting in hospitalisation or death, according to the CDC. Many of the high income countries with high vaccination rates are moving to supplement their more vulnerable populations with ‘booster’ or ‘third’ doses. Though prevention of severe disease appears to have held up very well over time, there have been numerous studies that have demonstrated both a reduction in neutralising antibody levels as well as a significant waning of immunity against infection. Israel has given a third dose of the ‘Comirnaty’ (Pfizer/BioNTech) vaccine to over one million people over 60 years of age. Their data show that these people are 11 times less likely to be infected. Antibody levels are increased in number following the ‘booster’ but also in breadth of protection against all the variants. It’s impossible to know at this stage whether further doses will be required to counter further waning of protection but the hope is that a three dose vaccine will be sufficient to produce long-lasting protection in a similar way to the Hepatitis B three dose vaccine.

More than 6.41 billion doses of COVID vaccines have been administered, enough to fully vaccinate over 40 percent of the global population. The latest rate of about 28.7 million doses a day is down week-on-week. Distribution remains uneven, with countries and regions with the highest incomes getting vaccinated more than 20 times faster than low income countries. Only nine African countries have met a target of vaccinating 10 percent of their populations against COVID-19 by the end of September, lagging far behind global vaccination rates. The World Health Organisation set the benchmark this year as part of a push for countries to vaccinate at least 40 percent of their populations by the end of the year. So far, just 4 percent of Africa’s population is fully vaccinated, and the more advanced economies on the continent have outpaced their poorer neighbours. The WHO continues to push for greater supplies to be directed towards the COVAX initiative that aims to vaccinate those countries without the means to procure vaccines for their populations. Manufacturing capacity is steadily increasing, and new vaccines by additional manufacturers are coming to market. Additionally, India has emerged from the overwhelming Delta wave and has announced that it will resume vaccine exports in the coming month and this will hopefully replenish supplies to lower income countries.

An antiviral tablet called ‘molnupiravir’ has been shown to cut the risk of hospitalisation or death by 50 percent for people newly diagnosed with COVID-19, according to the Merck announcement. Merck and Ridgeback Biotherapeutics collected data from more than 700 people who had laboratory-confirmed mild to moderate COVID-19 and at least one risk factor associated with poor disease outcomes. Among those who received molnupiravir within 5 days of infection, 7.3 percent were hospitalised or died within 29 days, compared with 14.1 percent of those who received a placebo. Currently the only treatments for COVID-positive people out of hospital are the relatively expensive IV-administered monoclonal antibodies. Merck claims that the incidence of drug-related adverse events was similar in the group that took the placebo, without giving further details. The results were so positive that Merck and Ridgeback consulted the independent trial monitors and the US Food and Drug Administration and they agreed to stop enrolling patients and begin the process of gaining regulatory clearance, initially in the US and then worldwide. Merck has also agreed licensing agreements for the drug with five generic manufacturers in India in a bid to accelerate availability in more than 100 low- and middle-income countries following approvals or emergency authorisation by local regulatory agencies. Merck anticipates the production of 10 million ‘courses of treatment’ by the end of the year. In June, the company agreed to a $1.2 billion supply deal with the US government, under which it would provide 1.7 million courses of the treatment at a cost of $700 per course. The company has said it plans a tiered pricing approach worldwide based on country income criteria.

The European Medicines Agency (EMA) approved booster shots from Pfizer/BioNTech or Moderna at least 28 days after their second dose, for people with weakened immune systems. It also said a booster shot of the Pfizer/BioNTech vaccine could be considered for adults with normal immune systems around six months after the second dose, but left it to individual countries to decide if the wider population should get a ‘third dose’. Several EU member states had already launched their own booster campaigns, although they vary widely over who is eligible. The EU joins the US, UK and Israel where regulators have approved the use of Pfizer/BioNTech boosters, although there is no consensus among scientists about how broadly they should be deployed. Israel has announced that boosters would be advocated across the whole population. The vaccine coverage across the EU is widely divergent with Portugal and Spain boasting 85 and 79 percent population coverage while Romania and Slovakia have only 28 and 41 percent of their populations fully vaccinated, respectively. The WHO has warned that the region’s coverage of vaccines was still too low and there was a risk of a significant surge in cases, hospitalisations and deaths over the next six weeks. A study by Leumit Health Services, an Israeli healthcare provider, showed that those over the age of 60 who had been vaccinated more than five months previously were three times more likely to be infected than those vaccinated more recently. The first data evaluating the early impact of the third dose programme were published last week in the New England Journal of Medicine (NEJM). It showed that two weeks after more than 1.1 million over-60s had received their third dose, they were 11.3 times less likely to become infected with the Delta variant. Third doses stimulate the production of neutralising antibodies that are both higher in number and have greater breadth against viral variants than those elicited by the two-dose course.

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 ↑
  • Antigua and Barbuda
  • Barbados ↑
  • Bermuda
  • Bonaire ↑
  • Brunei ↑
  • Cuba
  • Dominica
  • Estonia
  • French Guiana
  • Georgia
  • Israel
  • Lesotho ↑
  • Lithuania
  • Mongolia
  • Montenegro
  • New Caledonia
  • Romania ↑
  • Sint Maarten
  • Serbia
  • Singapore ↑
  • Slovenia
  • St Kitts & Nevis
  • St Lucia
  • St Vincent & the Grenadines
  • Suriname
  • United Kingdom
  • USA – Alaska, Arizona ↑, Delaware, Guam, Indiana, Iowa, Idaho, Kentucky, Maine, Michigan ↑, Minnesota, Montana, Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Washington, West Virginia, Wisconsin, Wyoming

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

  • Albania
  • Andorra ↑
  • Armenia
  • Aruba
  • Austria
  • Bahamas
  • Barbados Belarus
  • Bosnia & Herzegovina
  • Botswana ↓
  • Bulgaria
  • Costa Rica ↓
  • Croatia
  • Curacao
  • Faroe Islands ↑
  • Gibraltar
  • Greece
  • Grenada ↓
  • Guadeloupe
  • Guyana
  • Iran
  • Ireland
  • Latvia
  • Liechtenstein
  • Malaysia ↓
  • Moldova
  • North Macedonia
  • Russia ↑
  • Saint Barthelemy
  • Seychelles ↓
  • Slovakia ↑
  • Thailand
  • Turkey
  • Ukraine ↑
  • USA – Alabama ↓, Arkansas ↓, California, Colorado, District of Colombia, Florida ↓, Georgia ↓, Hawaii, Illinois, Kansas ↓, Louisiana, Maryland, Massachusetts, Mississippi ↓, Missouri, Nebraska ↓, Nevada, New Jersey, New Mexico, New York, Oklahoma ↓, Rhode Island, Texas ↓, US Virgin Islands, Vermont ↓, Virginia ↓
  • West Bank/Gaza Strip ↓

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

  • Australia ↑
  • Belgium
  • Brazil ↓
  • Cayman Islands
  • Canada
  • Cyprus ↓
  • Denmark ↑
  • Djibouti ↑
  • Equatorial Guinea ↑
  • Falkland Islands
  • Finland
  • Gabon
  • Germany
  • Guatemala ↓
  • Iceland
  • Jamaica ↓
  • Jordan
  • Kazakhstan ↓
  • Lebanon
  • Libya
  • Luxembourg
  • Maldives ↓
  • Martinique
  • Mauritius
  • Netherlands
  • Norway
  • Philippines ↓
  • Reunion
  • Saint Martin ↓
  • San Marino
  • Switzerland ↓
  • Trinidad & Tobago
  • Turks and Caicos Islands ↓
  • USA – Connecticut ↓

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

  • Argentina
  • Azerbaijan ↓
  • Bahrain
  • Bolivia ↑
  • Cambodia
  • Cameroon ↑
  • Cape Verde ↓
  • Chile ↑
  • Colombia
  • Czech Republic
  • Dominican Republic ↑
  • El Salvador
  • Eswatini
  • Fiji ↓
  • France ↓
  • Greenland ↓
  • Honduras ↓
  • Hungary
  • Iraq ↓
  • Italy
  • Laos
  • Malta
  • Mayotte
  • Mexico
  • Monaco
  • Montserrat
  • Namibia
  • Panama
  • Poland ↑
  • Portugal ↓
  • Qatar
  • South Korea
  • Spain
  • Sri Lanka ↑
  • Sweden ↓
  • Tunisia
  • Uganda
  • USA – Puerto Rico ↓
  • Venezuela
  • Vietnam ↓

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