Coronavirus - Part 19
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Hooray, this is the penultimate
update in this series of Coronavirus articles. These days
there is decidedly less to report. The pandemic is
retreating, at least in the UK, for the moment. The picture
does look rosy, certainly less gloomy. Even so, much of the
world is still battling the wretched virus. Just because we
talk less about it and wash our hands less frequently does not
mean that the pandemic is over.
But ponder these UK figures – they do look encouraging.
During May, there has been a record drop in the number of reported
Covid-19 infections. According to the latest estimates from
the Office for National Statistics (ONS), 1.08 million people
tested positive for Covid-19 during a week in late May – that is
down 15% from the previous week. In other words, Covid-19
had infected only about one in 60 people – in late April, that
figure was one in 17.
Hospitalisations have decreased too. Admissions currently
continue at about 4,200 with 130 patients on ventilators.
During April, the equivalent figures were 14,000 admissions with
320 patients ventilated. Deaths have also plummeted to
approximately 60 each day – the equivalent April figure was
330. Nevertheless, the total of Covid-19 related deaths in
the UK since the pandemic began now stands at a cheerless 178,000.
Vaccination rates have inevitably also been slowing down after the
rush to get jabbed earlier in the year. The UK totals for
the whole pandemic now amount to 44.9, 42.0 and 33.0 million for
first, second and third doses respectively. The latest
weekly numbers were 40,000, 55,000 and 64,000 for first, second
and third jabs.
Globally, the picture remains mixed and mobile. The total
cases have reached almost 530 million. Total reported deaths
have reached 6.2 million (though this figure is disputed by the
WHO, see below) and 11,400 million vaccinations have been
administered. The USA is still top of the table for total
cases at 84 million, followed by India (43 million) and Brazil (31
million). The current ‘hot spots’ with the highest infection
rates (as opposed to totals) are the USA, Taiwan, Germany and
Australia. And the USA is also the leader in Covid-19 deaths
at 1.005 million, trailed by Brazil (666,000) and India
(525,000). The UK hovers around tenth place in most global
These bald statistics tell a story, or rather, part of a
story. Such numbers do little to convey the monumental
suffering and loss that have been (and will yet be) caused by
Covid-19. Personal accounts and pictures help fill out the
dimensions of that human cost. History will perhaps better
recall what we have lived through. But in the meantime, the
refrain is unremitting – this Covid-19 pandemic is not over.
Much of the world is still in its grip.
15 million Covid-19 deaths worldwide
Counting the total number of deaths caused by Covid-19 has long
been a source of dispute. Of course, it could never be a
precise total because of the complexities of poor reporting,
gathering data from isolated areas, time lags plus deliberate, as
well as unintentional, underreporting. Another major cause
of discrepancy has been because people have died either ‘from’, or
‘with’ Covid-19 and it has been impossible to separate the two
cohorts. In other words, patients dying in hospitals and
elsewhere have often been suffering from fatal comorbidities that
have included Covid-19.
Nevertheless, according to a recent report from the World Health
Organization (WHO), the pandemic has caused nearly 15 million
deaths worldwide. On that basis many countries must have
undercounted because only 5.4 million deaths have been officially
registered. For instance, in India, the WHO says that 4.7
million Covid-19 deaths have occurred, 10 times the authorised
figure and almost a third of the worldwide deaths.
Similarly, the WHO maintains that Russia and Indonesia have beaten
the USA beyond its much-publicised 1 million mark.
Using its favoured statistical method called ‘excess death counts’
the WHO reckoned that 13% more deaths occurred than would normally
be expected over the two-year period from January 2020 to December
2021. Some countries with zero Covid-19 strategies, such as
Australia, Norway and Japan, actually saw fewer deaths than would
normally be expected. Whether it is 15, or 5.4, or 6.2
million, or whatever, as Samira Asma, the WHO assistant
director-general, has said, ‘It's a staggering number and it's
important for us to honour the lives that are lost, and we have to
hold policymakers accountable.’
A fourth jab
Among high-income countries, doses of booster vaccines were always
going to be intermittently offered, primarily because Covid-19
antibodies wane over time and therefore patients lose their
immunity. Millions in the UK have already had their third
shot, now the talk is of number four.
According to a recent UK trial, a fourth dose will increase
protection against Covid-19, especially among the over-70s age
group. Already from April, the UK has started a fourth dose
roll-out for the over-75s and the vulnerable. The extent of
that new strategy will depend upon whether new variants emerge and
whether hospitals are under excessive pressure.
This recent UK trial, conducted at the University of Southampton,
involved 133 participants with a median age of 70. They were
vaccinated with either a dose of Pfizer-BioNTech or a half dose of
Moderna vaccines about seven months after having had their third
dose. The results showed that two weeks after their fourth
dose, these vaccines were ‘well-tolerated’ and ‘boosted
immunity’. In fact, the peak antibody responses were as good
as, or even better than, their third doses.
The study has been reported as, ‘Safety, immunogenicity, and
reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given
as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or
BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre,
blinded, phase 2, randomised trial’ by Alasdair Munro et al.,
and published in Lancet Infectious Diseases on 9 May 2022.
The researchers concluded that, ‘The strengths of this study
include it being the first to report on mixed-schedule fourth-dose
data from a randomised trial and on populations who had received
vaccines other than BNT162b2 [Pfizer-BioNTech] as their first,
second, or third dose. This study provides important data to
help guide policy makers in decisions on how to use fourth doses
of COVID-19 vaccines.’
However, this was only a small study. More research over a
longer period is needed. And not all scientists are
enthusiastic about the prospect of an extra jab. The recent
Omicron surge means that many people will already have high
antibody levels and are unlikely to benefit from a fourth
dose. Yet some countries, such as Israel and Germany, have
already started offering all their adults a fourth dose.
The question is, will a fourth dose benefit the wider
population? In late May, the UK government declared its
hand. A mass booster campaign this autumn will offer about
20 million UK adults the extra jab aimed at curbing a winter wave
of Covid-19. All over-65s will be eligible. And
over-75s, who are currently being offered a spring booster, will
get the chance to roll up their sleeves for a fifth dose.
The NHS has been asked to prepare the necessary roll-out plans.
As data pile up from two years of the pandemic, our knowledge of
that wily Covid-19 virus is growing. It is now six months,
from November 2021, since the Omicron variant was first identified
in South Africa. It has since surged around the world.
Currently, the focus is on its sub-lineages, BA.4 and BA.5, still
highly transmissible and less susceptible to neutralisation by
antibodies derived from either previous vaccines or
infections. These variants are presently surging in South
Africa, with hospitalisations for severe cases still low but
What is next? More variants, more sub-lineages, more
surges? Some scientists see a predictable pattern of new
variant waves. Tulio de Oliveira, a professor of
bioinformatics at Stellenbosch University in South Africa, has
said, ‘These are the first signs that the virus is evolving
differently’ compared with the first two years of the pandemic,
when variants seemed to appear out of nowhere.
BA.4 and BA.5 currently account for between 60% and 75% of
Covid-19 cases in South Africa. In addition, they have
spread to more than a dozen countries, mainly in Europe.
From about 1,500 South African cases in March to 5,000 in April,
these variants are reckoned to be spreading faster than the BA.2
sub-lineage. Increased transmissibility looks like a viral
advantage. But why? Are they inherently better at
spreading? Or are they better at dodging antibodies?
Or both? This, in the eyes of some experts, looks like the
prelude to a new and sizeable infection on the horizon.
Indeed, as immunity to Omicron and its new variants increases
around the world, there is the possibility that another variant,
perhaps of the apparently outmoded Delta, which has not yet
disappeared, could make a comeback. It seems as though such
surges are appearing roughly every six months. This is not
good news. What is good news, is that the vaccinated combat
new and old variants better than the unvaccinated. But maybe
this wily virus simply does not follow predictable patterns of
mutation and emergence. Put another way, a Covid-19 surge
can be expected anytime soon, or otherwise.
Spreading the IP
Covid-19 vaccines are complex entities and expensive to
manufacture. Their makers have invested heavily in their
production and expect a reasonable return on their financial
outlays as well as protection of their skilled know-how, called
intellectual property (IP). This raises two problems – how
can low-income countries afford the vaccines and, without access
to the necessary hush-hush technology, how can they attempt to
localise and master cheaper production? Some biotech
companies have sold vaccines to poor countries at cost. But
they have been reticent to give away or share their trade secrets,
especially their IP patents. Yet vaccination rates in
wealthy countries are now as high as 90%, but in poorer countries
they are as low as 10% or even less. In other words, has
production in wealthy countries passed its peak? Will
profits now dwindle?
In early May, members of the World Trade Organization (WTO)
proposed a waiver on the IP rights for Covid-19 vaccines in the
hope of speeding up roll-outs worldwide. The plan, approved
by the so-called Quadrilateral Security Dialogue (QSD),
colloquially known as the Quad, an informal strategic forum
including Australia, Japan, India and the United States, will
still have to be approved by the full council of the WTO. If
that hurdle is cleared, it will allow developing countries to make
Pfizer-BioNTech, Moderna and other pharmaceutical companies’
vaccines without paying the hefty licencing fees. It is
hoped that final approval will come in June.
Not all are in favour. Some in the pharmaceutical industry
have lobbied against the Quad proposal. Others maintain that
waiving IP rights will not solve vaccine inequity in the
short-term. Maybe that is true, but the launching of such
huge potential global agreements has to start somewhere,
somehow. But last month this looked an unpromising prospect
as three of the world’s largest Covid-19 vaccine producers refused
to share their IP. Despite billion dollar profits from
Covid-19 vaccines, shareholders at the AGMs of Pfizer-BioNTech,
Johnson & Johnson and Moderna voted down such plans.
Covid-19 in the USA
In mid-May, the White House announced that the USA Covid-19 death
toll had passed one million. This is generally considered to
be the highest official total of any country anywhere in the
world. President Joe Biden said the country was marking ‘a
tragic milestone’ and each death was ‘an irreplaceable
loss’. He ordered flags across the US to be flown at half
mast to demonstrate the nation’s grief.
It has been a momentous, even disastrous, two years for the USA
and Covid-19. The first confirmed case was reported on 20
January 2020, when a man flew home to Seattle from Wuhan in
China. Now, besides its seven-figure death toll, the USA has
also recorded more than 80 million Covid-19 cases out of a 330
And more is predicted to come. While the Covid-19 pandemic
is showing signs of slowing in many countries, others are
experiencing surges. Among the developed countries, the US
is suffering badly. During May, health officials in some
cities have been calling for a return to mask-wearing and social
distancing. For instance, Covid-19 cases have recently
surged across most counties of New York State putting them on
‘high’ alert. Why? Did the Land of the Free abandon
such precautions too readily? Moreover, why are only 67% of
American adults fully vaccinated, compared with 73% in the UK, 77%
in Germany and 82% in Canada?
The fear is that the USA might be about to experience a sixth
wave. The White House is forecasting a US wave of up to 100
million infections in the autumn. By late May, cases were up
by 26% and hospital admissions by 19%. Yet each day only
about 3,000 Americans were being hospitalised and 275 deaths were
being announced – figures that are much lower than during the
fifth wave. So, is a sixth wave really on the cards?
Is the US ready to fight it? Certainly the US Congress is
reluctant to fund the colossal sums required for purchasing
supplies of the next generation of Covid-19 vaccines and testing
kits to meet such a new wave.
Americans like to do things differently. The Covid-19
pandemic in the US has been highly politicised and subject to
numerous zany conspiracy theories so that mask-wearing, social
distancing and vaccination uptake have been largely
neglected. Most Americans are averse to any governmental
mandates and would be prone to more lockdown angst. And so
the population remains apparently unconcerned about the current
rise in cases. Recent polling showed that only about 30% of
US adults are concerned about catching Covid-19, the lowest
proportion recorded since July 2021. They may be in for a
shock later this year.
Covid-19 in the Americas
According to the World Health Organization (WHO), Covid-19 case
and death rates have been rising in May across the Americas.
During one week in mid-May, more than 918,000 cases were recorded
– that is a 27% increase on the previous week – together with over
3,500 deaths. The Pan American Health Organization (PAHO)
has reported that 18 nations saw upsurges in hospitalisations,
while admissions to intensive care rose in 13 countries.
On 18 May, Dr Carissa Etienne, the PAHO Director, declared that,
‘The rise in cases should serve as a wake-up call. When
people get sick, hospitals get overwhelmed, health systems are
challenged, and the number of deaths rise.’
North America, principally the USA and Canada, accounted for more
than half of the new infections. Central America saw the
largest rise in cases when infections soared by 80%. In
South America, Brazil recorded more than 120,000 cases – a 9%
rise. Argentina reported almost 34,000 cases – a staggering
92% increase on the previous week. Other countries in the
sub-region also experienced surges of cases, while Venezuela,
Paraguay and Brazil all recorded increases in deaths. The
Caribbean experienced a 9% increase of cases and a 49% increase in
deaths during May.
Much of this bad news can be attributed to many national and local
authorities abandoning mask-wearing and social distancing
requirements. In addition, only 14 of the 51 PAHO countries
and territories have reached the WHO’s target of vaccinating 70%
of their citizens. The general public have an obligation to
adopt protective measures, including vaccinations.
Governments have an obligation to protect their people, especially
their most vulnerable. But they must also invest in
healthcare systems, maintain surveillance programmes, including
testing, and respond to adverse trends. As Dr Etienne has
stated, ‘The truth is this virus is not going away anytime soon.’
Covid-19 in North Korea
The Democratic People’s Republic of North Korea (DPRK), the
so-called hermit kingdom, is a spooky place at the best of
times. Transparency is certainly not one of its key
attributes. No cases of Covid-19 have been announced since
it closed its borders two years ago. Moreover, its response
to the Covid-19 pandemic has been suitably scary – it has
organised no public vaccination programme, despite the virus
emerging from its next-door neighbour China and despite offers of
vaccines from China and Russia via the COVAX vaccine-sharing
scheme. Instead it has recommended the use of analgesics,
antibiotics and traditional Korean medicines, such as drinking
willow leaf tea and gargling with salt water.
In mid-May, the country’s official news agency, KCNA, reported
‘deaths and a large number of people with fever.’ Covid-19,
mislabelled as ‘fever’, has apparently reached almost 2.5 million
with as many as 200,000 cases each day. It was only a few
days earlier that the State had announced its first Covid-19
death. A few days later, Kim Jong-un, the North Korean
supreme leader, ordered a nationwide lockdown, calling the
outbreak the ‘gravest national emergency’ that demanded ‘maximum
emergency measures’. At the same time, he also berated
government officials for the ‘immaturity in the State capacity for
coping with the crisis.’ He is indeed the archetypal despot
looking for scapegoats. Experts believe that North Korea is
standing on the brink of a Covid-19 catastrophe.
Certainly, North Korea is not in good shape to resist and treat
the pandemic. Its 26 million citizens can access few, if
any, vaccines and antiviral drugs, and they suffer from a
dilapidated medical system, scarce intensive care facilities,
widespread malnourishment and a rundown economy – the very marks
of a vulnerable population doomed to low Covid-19 immunity.
Even testing for Covid-19 has been rudimentary. According to
the World Health Organization (WHO), only 64,200 tests have been
carried out since the start of the pandemic compared with 172
million in adjacent South Korea. The North Korean situation
looks grim, even beyond grim.
Long Covid singalong
Long Covid is the Cinderella of the pandemic. Lots suffer
from it, but there are few successful, evidence-based
interventions available. Since breathlessness is a common
symptom of long Covid and opera singers are experts in breathing
exercises, the two have joined forces in a trial undertaken by the
Imperial College Healthcare NHS Trust and English National Opera
The report of the trial, entitled, ‘An online breathing and
wellbeing programme (ENO Breathe) for people with persistent
symptoms following COVID-19: a parallel-group, single-blind,
randomised controlled trial’ by Keir Philip et al.,
was published on open access in the Lancet on 27 April
A total of 158 long Covid patients were randomly assigned either
to participate in the English National Opera (ENO) Breathe
programme, or to continue with their usual care.
Participants in the former cohort underwent a 6-week online
breathing and wellbeing programme, developed by the ENO for people
with long Covid that focused on breathing retraining by using
singing techniques. After six weeks, the volunteers were
assessed by a cluster of subjective and objective tests.
Overall the programme’s singing and music was enjoyable and
beneficial. The ENO Breathe volunteers reported three
health-related quality-of-life (HRQoL) enhancements. They
were, ‘(1) improvements in symptoms; (2) feeling that the
programme was complementary to standard care; and (3) the
particular suitability of singing and music to address their
However, don’t rush to sign up. Potential participants do
need to be referred from their NHS post-Covid assessment
clinic. In the meantime, if you are suffering from long
Covid, and specifically breathlessness, why not turn on the radio
and sing along? Apparently, it does not need to be Mozart or
even Bernstein – the Beatles will do. Sounds good to me!