Covid-19 reader: 11 March

Small signs of Covid decline at global level, but hotspots remain

World Health Organization, epidemiological update

At a global level, the Covid-19 virus does appear to be in a slow retreat, although maybe only temporarily. In its weekly update, the World Health Organization said that in the week to 6 March, new cases and deaths continued to decline by 5% and 8% respectively, compared with the previous week. However, this still amounted to more than 10 million new cases across the six WHO regions and more than 52,000 deaths.

The decrease in cases was seen in five of the regions, with just the Western Pacific region reporting an increase of 46%. Europe reported an 18% decrease. Deaths also increased in the Western Pacific (29%) and in the Eastern Mediterranean (2%), but reduced in all other regions (by 15% in Europe).

WHO director general Tedros Adhanom Ghebreyesus said that more than six million people have now died as a result of Covid in the last two years. ‘Although reported cases and deaths are declining globally and several countries have lifted restrictions, the pandemic is far from over – and it will not be over anywhere until it’s over everywhere.’

He highlighted the surges in cases and deaths in Asia and the Pacific and raised concerns about the drastic reducing of testing in several countries. ‘This inhibits our ability to see where the virus is, how its spreading and how its evolving,’ he said.

The WHO has published new guidance on self-testing for Covid-19, recommending that self-tests should be offered in addition to professionally administered testing services. It said that self-testing was reliable and could reduce inequalities in access to testing.

‘How countries use self-testing will need to be adapted according to national priorities, local epidemiology, and the availability of resources, with community input,’ said Dr Tedros (pictured). The guidance is clear that the costs of self-testing in schools and workplaces should not fall on students or workers. And access to affordable self-testing should be prioritised for settings where there is limited access to lab-based tests.

The WHO has also reinforced its commitment to the use of current Covid-19 vaccines, which have been shown to offer high levels of protection against severe disease associated with the Omicron variant of the virus. However, it also recognises that vaccines may need to be updated to keep up with the virus’s evolution and that ideally vaccines should prevent infection and transmission, as well as protecting against severe disease. It said the development of pan-Covid vaccines would be desirable options, although the timeframes for development are uncertain.

According to the WHO, 5.9 million deaths have been reported globally to date – based on deaths resulting from confirmed Covid cases. However, a new study published in The Lancet this week, estimated the real death toll at more than 18 million, measured by excess mortality since the beginning of January 2020.

Infection levels still high, despite fall in prevalence

Imperial College and Ipsos Mori, REACT study

The prevalence of Covid-19 in England fell significantly in February compared to January, according to the latest round of the REACT-1 study.

The study, run by Imperial College London and Ipsos Mori, involved 94,000 volunteers and found that prevalence between 8 February and 1 March was 2.88%. This was ‘significantly down’ on the 4.41% reported in the last round in January. However, it was still the second highest recorded rate of infection since the study began in 2020. The prevalence rate equates to one in 35 people being infected with the virus.

Prevalence rates fell among children and younger adults (under the age of 54), but were flat or possibly rising in those aged 55 and above. Rates were also higher in the South.

‘It’s encouraging that infections have been falling across England, but they are still very high and the possibility that they are rising in older adults may be cause for concern,’ said Paul Elliott, director of the REACT programme and a professor from Imperial’s School of Public Health. ‘The good news is that this is a highly vaccinated group. However, a high number of infections will lead to more people becoming ill, so it’s important that people continue to follow public health guidance to avoid fuelling further spread of the virus.’

The Imperial team also determined the genetic codes of the virus from 1,200 positive samples. All but one were the Omicron variant or a sub-variant, including the recent BA.2 ‘stealth variant’. The remaining one was Delta. And, as of 21 February, it was estimated that nearly half of the positive samples were the BA.2 variant, which is currently a variant under investigation. The rapid increase in this sub-variant suggests it spreads more easily than other circulation variants.

The reproduction number (R) was estimated to be just below 1 at 0.94 – which indicates a slightly shrinking epidemic.

According to Jenny Harries (pictured), chief executive of the UK Health Security Agency, the data confirmed that cases have declined substantially following the peak of Omicron. ‘However, the increasing presence of the BA.2 sub-lineage of Omicron and the recent slight increase in infections in those over 55 shows that the pandemic is not over and that we can expect to see Covid-19 circulating at high levels,’ she said. She added that vaccination remained the best way to protect everyone from severe disease and hospitalisation.

Scottish hospitalisations on the rise

Public Health Scotland, statistical report and government dashboard

The number of people in hospital with Covid in Scotland reached a 13-month peak this week, according to official figures.

The government’s Covid dashboard showed that, on Wednesday, there were 1,636 Covid patients in Scottish beds, 127 up on the day before and a more than 80% increase on a month ago. The last time there were this many Covid patients in the country’s hospitals was in February 2021.

The latest statistical report from Public Health Scotland said that in the week to 6 March, there were more than 56,000 Covid cases identified by polymerase chain reaction or lateral flow tests. This represents an increase of nearly 24% on the previous week. However, from the 1 March, Scotland is now including reinfections in its Covid-19 reporting. Both England and Northern Ireland have already made this change, recognising that reinfections are much more common with Omicron than they were with the Delta variant. More than 9% of cases identified in the week in Scotland were determined to be reinfections.

The most recent figures show that 14,387 cases were reported on Thursday – the highest number since the beginning of the year.

There are also increases in the patients in intensive care, but the absolute numbers remain small. There were just 22 patients in mechanical ventilation beds as of Thursday – a third of the level at the start of the year. And while the seven-day average has risen from 11 to 18 in the last two-and-a-half weeks, this does not currently appear to be putting undue strain on hospitals. However, the rise in Covid-occupied general beds is impacting on hospitals’ recovery programmes.

In England, the Nuffield Trust’s Sarah Scobie (pictured), deputy director of research, also highlighted a ‘concerning uptick in hospitalisations, suggesting things are going in the wrong direction after many weeks of hospitalisations falling’. The government’s Covid dashboard shows a small increase in the seven-day average since the end of February. It is a similar story in terms of the numbers of Covid patients in hospital beds.

The Scottish statistical bulletin also reported that 5,043 babies have been born in Scotland to date (from March 2020 up to the end of January) following the mother having confirmed Covid-19 at any stage during pregnancy. Some 5,026 of these were live births. Of the 3,754 women delivering babies in January, 63% had received at least one dose of Covid vaccination prior to delivery. Some 54% had received at least two doses, with 28% having received three doses.

Meanwhile, new analysis from Oxford Population Health at Oxford University, which includes the National Perinatal Epidemiology Unit, has found that pregnant women who are 30-years-old or more, overweight, of mixed ethnicity, or with gestational diabetes have a greater risk of contracting severe Covid-19, which poses significant risks for both mother and baby.

There is already evidence that severe Covid infection significantly raises the risk of adverse outcomes for mother and baby. The new research identifies a range of further risk factors.