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Member's blog - Other
President's summer message July 2022: COVID-19 carrying on unchallenged
Author: John Middleton
Figure 1. Pressure outside UK hospital, week of July 14th – Ambulances backed up as COVID, heatwave and general summer emergencies take off.
We are again seeing the take-off of new subvariants of the Omicron family, B.A.4 and 5 and B.A.2.75. Waves of B.A.5 may have reached their peak in Portugal, Malta, UK and South Africa. B.A.5 is rising vertically in Japan, and sharply in Australia and New Zealand. It is also the dominant sub variant in the USA. Thus far vaccines remain effective against the new sub-variants. Pressures on health care services are widespread, compounded by Europe’s heat wave. ASPHER’s position on the current state of the pandemic in Europe is shown in the box. You can find more from ASPHER in our weekly Covid-19 situation reporting.
The WHO weekly epidemiological update on COVID-19 highlights that the number of new weekly cases increased globally for the fifth consecutive week, a 6% increase compared to the previous week. The number of new weekly deaths was similar to the previous week.
The ECDC country overview report highlights those cases among people aged 65 years and over increased in 22 of the 24 countries, corresponding to a 23% increase, and has reached 78.2% of the pandemic maximum across the EU/EEA. The increasing transmission among older age groups is starting to translate into increased rates of severe disease. In 12 countries increasing trends in hospital or ICU admissions and occupancy rates are increasing. The 14-day COVID-19 death rate has been stable for five weeks. Increasing trends in the COVID-19 death rate were observed in seven countries.
The IHME projections indicate a decline in daily estimated infections by mid-September. They also project high or extreme stress on hospital and ICU beds in Estonia, France, Latvia, and Romania between July and September 2022.
UK Freedom Day- July 19th 2022
July 19th was the first anniversary of the UK’s ‘Freedom Day’, when virtually all protections against Covid-19 were lifted. Many governments followed the UK lead and threw away all protections against COVID-19. As a result, the pandemic has continued without any efforts to control it. UK commentators have taken the moment to reflect on the terrible handling of the pandemic. The mantra of the conservative government, and particularly those apologists for outgoing Prime-minister Johnson’s record, is ‘He got the big calls right’. A claim challenged by the health community without exception, and exemplified in Stephen Reicher’s tweet Figure 2.
Since Freedom Day, the UK has had nearly 18 million extra cases of COVID-19 and 54000 deaths (Figure 3).
The UK’s Independent SAGE have proposed a seven-point plan for addressing the continuing pandemic (Box 2). This will have resonance for many countries. New Zealand has already implemented similar measures as it continues to lead global action on the pandemic.
1. Clear and consistent messaging concerning covid risk and risk mitigation, reinforced by public statements by those in positions of authority;
2. Increased efforts to promote vaccine uptake, among all age groups, and with particular emphasis on groups among whom uptake has been low, in particular ethnic minority communities. This should be coupled with a clear long term plan to address waning immunity and immune escape by new variants;
3. Installing and/or upgrading ventilation/air filtration in all public buildings, with schools an urgent priority over the summer holidays7;
4. Provision of free lateral flow tests to enable everyone to follow existing public health guidelines;
5. Financial and other support for all workers to self-isolate if infected;
6. Systematic promotion of the use of FFP2/FFP3 masks in indoor public spaces and public transport when infection rates are high;
7. Increased support for the equitable global provision of vaccines and anti-virals.
If implemented, these measures will make it possible for people to make informed decisions that will reduce the risk of illness to them, their families, and the communities in which they live and work. By reducing infections they will also reduce the disruption to the lives of individuals and society.
Masking remains a key component of any strategy (Figure 4).
The evidence on ventilation continues to mount and the fight for clean indoor air is the public health revolution of the 21st century, certainly ignored and neglected in my country. University authorities will also find it gives a learning advantage. Evidence for the long term damage caused by Covid-19 also grows. COVID-19 is a multi-system disease, affecting many target organs, and mental health (see Figure 5 from Lopes-Leon and colleagues).
As Flavia Beccia and ASPHER colleagues explain in their recent paper on long Covid and inequalities, long Covid also impacts unequally on the economy, poorer social groups and vulnerable people (Figure 6).
Figure 6. Relationship Between Structural Inequalities and COVID-19, from: Berger Z, Altiery DE Jesus V, Assoumou SA, Greenhalgh T. Long COVID and Health Inequities: The Role of Primary Care. Milbank Q. 2021;99(2):519-541. doi:10.1111/1468-0009.12505
Bitter-sweet success of vaccination
A major study published June 23rd 2022, suggests vaccination has prevented around 14 million deaths worldwide. This figure rose to 19 million where the prevention was modelled on excess mortality. This is a major confirmation of the benefits of vaccination against COVID-19 and should be a reason for great celebration. However, in low-income countries an additional 45% of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and an additional 111% of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021. This is a failure by the wealthy countries of the global community and should be a cause of continuing shame for all of us.
Failure to manage the pandemic continues to cause major disruption to economies, to international travel, and to essential public services. While we continue to accept repeat infection and fail to control new virus infections, we will continue to see disruption to economies. The burden of morbidity will rise and we will again be badly unprepared for winter. ECDC and WHO have launched new guidance for respiratory illness and vaccination strategies for the winter 2022. As a member of the ECDC Advisory Forum, on behalf of ASPHER, I have been party to the preparation of the ECDC report. ASPHER’s winter planning statement will follow this month. Have a great summer! But be prepared for winter!
John Middleton, President ASPHER,
July 23rd, 2022