Virus World

Urgent measures are needed now to stop further spread, the World Health Organization says. Health chiefs are warning that cases are still rising and "urgent measures" are needed to prevent further spread. Some 42,200 people were infected in 2023, compared to 941 during the whole of 2022. The WHO believes this is a result of fewer children being vaccinated against the disease during the Covid pandemic. In the UK, health officials said last week that an outbreak of highly contagious measles in the West Midlands could spread rapidly to other towns and cities with low vaccination rates. More than 3.4 million children under the age of 16 are unprotected and at risk of becoming ill from the disease, according to NHS England. Millions of parents and carers are being contacted and urged to make an appointment to ensure their children are fully vaccinated against measles. The measles, mumps and rubella (MMR) vaccine is given in two doses - the first around the age of one and the second when a child is about three years and four months old. The vaccine is very effective at protecting against measles, but only 85% of children starting primary school in the UK have had both jabs.

Speaking about the situation in Europe, Dr Hans Kluge, regional director at the WHO, said: "We have seen, in the region, not only a 30-fold increase in measles cases, but also nearly 21,000 hospitalisations and five measles-related deaths. This is concerning. "Vaccination is the only way to protect children from this potentially dangerous disease." Measles can be a serious illness at any age. It often starts with a high fever and a rash, which normally clears up within 10 days - but complications can include pneumonia, meningitis, blindness and seizures. Babies who are too young to have been given their first dose of vaccine, pregnant women and those who have weakened immune systems are most at risk. During pregnancy, measles can lead to stillbirth, miscarriage and a baby being born with a low birth weight. All countries in the European region are being asked to detect and respond to measles outbreaks quickly, alongside giving vaccines to more people. The WHO said measles had affected all age groups last year - young and old alike. Overall, two in five cases were in children aged 1-4, and one in five cases were in adults aged 20 and above. Between January and October 2023, 20,918 people across Europe were admitted to hospital with measles. In two countries, five measles-related deaths were also reported.

Pandemic effect

Vaccination rates for the first dose of the MMR vaccine, which protects against measles, slipped from 96% in 2019 to 93% in 2022 across Europe. Uptake of the second dose fell from 92% to 91% over the same period. That seemingly small drop in vaccination take-up means more than 1.8 million children in Europe missed a measles vaccination during those two years. "The Covid-19 pandemic significantly impacted immunisation system performance in this period, resulting in an accumulation of un-[vaccinated] and under-vaccinated children," the WHO reported. With international travel booming once again, and social-distancing measures removed, the risk of measles spreading across borders and within communities is much greater - especially within under-vaccinated populations, it said. Even countries that have achieved measles elimination status are at risk of large outbreaks, the WHO warned. It says that 95% of children need to be vaccinated with two doses against measles in all communities to prevent the spread of the highly-contagious disease.

Here’s another growing problem with climate change that politicians and business leaders can ignore—the spread of CCHF. CCHF is not a rock band. That would be CCR or Creedence Clearwater Revival. Instead, CCHF stands for Crimean-Congo Hemorrhagic Fever. And it’s not like cowbell fever. It’s a potentially deadly fever caused by a virus that’s on the list of World Health Organization (WHO) priority pathogens that can cause outbreaks and pandemics. The problem is that the Earth is essentially warming up to the spread of this virus. Rising temperatures around the world have been expanding the habitat of the ticks that can carry and transmit the nairovirus that causes CCHF into more temperate regions such as Europe. For example, Spain had its first cases of CCHF in 2011 and 2016. Yes, folks this is yet another ticking time bomb from climate change. Before you claim that CCHF is not a big deal. Go to the bathroom. Put down your G.I. Joe doll. Open one of your hands. And slap yourself on the face. CCHF is absolutely, positively not like a cold. It’s fun thing to have. That’s unless you find the sudden onset of headaches, high fevers, back pain, joint pain, stomach pain, and vomiting to be a fun things. Oh, and there’s all the well-red stuff, so to speak, like the red eyes, flushed face, red throat, and red spots on your palate, according to the Centers for Disease Control and Prevention (CDC). You can also suffer jaundice. Hmm, what else? You could possibly have changes in your mood. That’s beyond the fact that you’re upset that you have freaking CCHF.

The tip off that CCHF is really bad is the “hemorrhagic” in its name. Very few things with this word—which means a lot of bleeding—are good. For example, if you happen to see “hemorrhagic ice cream” as one of the flavors in an ice cream shop, avoid that flavor. In fact, you may want to avoid the ice cream shop all together. After about four days of symptoms, CCHF can progress to some bloody awful problems such as severe bruising, severe nosebleeds, and uncontrolled bleeding at any part of the skin that may be penetrated with something like a needle. This bleeding can last for two weeks. Death has resulted in 9% to 50% of hospitalized patients during CCHF outbreaks. That’s a pretty high risk of death. Even if you do survive CCHF, recovery can take a long time because bleeding all over the place is not something you simply walk off when it subsides. Here’s some more great news. There no real specific treatments for CCHF. The antiviral drug ribavirin may help. But the jury is still out on that. The main things to do is stay well hydrated, have your electrolytes closely monitored and corrected where needed, and receive extra oxygen and blood when needed. Of course, things could spiral down, requiring ventilator and other types of cardiopulmonary support. You’ve got to beware of getting secondary bacterial infections as well. Yeah, all of this really bites and sucks. Speaking of bites and sucks, Ixodid (hard) ticks such as the Hyalomma ones can carry the CCHF virus. These ticks can bite and transmit the virus to all sorts of animals besides humans such as cattle, goats, sheep and hares. So if you are planning that sheep and hare rave for this Saturday night and a tick brings along the virus, you may have a Saturday night fever situation. The tick can transmit the virus among humans and other animals through biting and sucking. You know what else sucks? Infectious blood or other body fluids can transmit the virus as well. So, you’ve got to make sure that medical equipment and other supplies are properly sterilized.

In a recent study published by the European Center for Disease Prevention and Control, researchers assessed the prevalence of post-coronavirus disease 2019 (COVID-19) condition symptoms. To make it easier to document clinical side effects following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the World Health Organization (WHO) developed the International Classification of Disease (ICD) codes in September 2020. The WHO used the Delphi approach to produce a consolidated clinical case definition, using the terminology "post-COVID-19 condition" in response to the wide variety of symptom constellations included in the various definitions for "long COVID." The post-COVID-19 condition's management continues to be challenging for healthcare providers, and it may threaten healthcare systems that the pandemic has already overburdened.

About the study

In the present study, researchers identified symptoms of post-COVID-19, quantified their prevalence, and ascertained whether COVID-19 disease severity affected symptom prevalence for patient cohorts. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) protocols were used for conducting the present systematic review. This meta-main analysis estimated the prevalence of post-COVID-19 condition symptoms as a proxy for illness severity, classified according to recruitment setting into community, hospital, and intensive care units (ICU). Only retrospective and prospective cohort studies performed in Europe, the United Kingdom, the United States, Australia, Canada, and New Zealand were deemed eligible if they satisfied the following conditions: (a) the study assessed patients having a confirmed SARS-CoV-2 diagnosis in one of the community, hospital, or ICU settings, and (b) the study described the post-COVID-19 condition as occurring a minimum of 12 weeks after SARS-CoV-2 infection. Within Medline (OVID) and EMBASE, peer-reviewed articles published between January 2020 and February 2022 were identified. A thorough search strategy was created using terms related to the post-COVID-19 condition and cohort trial design. In order to find more pertinent studies, the reference lists of all included studies and reviews were also checked. The degree of certainty in the evidence obtained for each relevant outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). According to GRADE recommendations, all study outcomes were given an initial score of high certainty before being rated down for flaws like inconsistency, evidence of publication bias, indirectness or inaccuracy of results, or rated up for methodologically robust studies with significant observed effects.

Results

Thorough electronic searches across EMBASE and Medline resulted in 7,125 peer-reviewed studies. Following a full-text evaluation, it was determined that 272 studies met the inclusion criteria and were subsequently further assessed for eligibility. With a sample size ranging between 13 and 57,748 SARS-CoV-2 infected patients within each study, 61 cohort studies contained 74,213 cases of post-COVID-19 conditions that were evaluated a minimum of 12 weeks after SARS-CoV-2 infection. In addition, 58 papers used reverse transcription–polymerase chain reaction (RT-PCR) to diagnose COVID-19, three studies employed clinical diagnosis or serological/antibody assays, and nine studies used clinical and serological methods in addition to RT-PCR. The prevalence of any symptom associated with the post-COVID-19 condition was 50.6% among community-recruited cohorts, 66.5% among hospital-recruited cohorts, and 73.8% among ICU-recruited cohorts. The most widely documented symptoms from patients enrolled in the community setting, taking into account only prevalence estimates having high or moderate certainty, were general weakness, shortness of breath, fatigue, depression, headache, concentration issues, dizziness, and body aches. The most common symptoms reported by patients enrolled in the hospital setting, taking into account only prevalence estimates having high or moderate certainty, were cough, constipation, dizziness, depression, diarrhea, fatigue, hair loss, headache, joint pain, nausea, palpitations, rash, shortness of breath, stomach upset, and vomiting. Evidence with a high or moderate degree of certainty supported the prevalence estimates corresponding to five symptoms of post-COVID-19 conditions, namely depression, fatigue, dizziness, shortness of breath, and headache in the community and hospital settings. Each of these symptoms was found to be more common in hospitalized patients than in patients from the community setting.

Conclusion

The study findings identified a broad spectrum of physical and psychological symptoms experienced by SARS-CoV-2-infected people at least 12 weeks after contracting the SARS-CoV-2 virus. Overall, it was estimated that among cohorts recruited in the community, post-COVID-19 condition symptoms were more prevalent in hospital and ICU settings compared to individuals recruited from the community.

European CDC Study (Oct. 31, 2022) available at: 

https://www.ecdc.europa.eu/en/publications-data/prevalence-post-covid-19-condition-symptoms-systematic-review-and-meta-analysis

Health ministry says cases yet to be confirmed and come after the viral infection detected in UK and Portugal.  Health authorities in Spain have issued an alert over a possible outbreak of monkeypox after eight men showed symptoms compatible with the viral infection, which has already been detected in the UK and Portugal. In a statement, the health ministry cautioned that the eight suspected cases – all in the Madrid region – had yet to be confirmed, but said a nationwide alert had been issued “to guarantee a swift, coordinated and timely response”. A spokesperson for Madrid’s regional health department said the suspected cases were being analysed by the National Microbiology Centre to obtain a definitive diagnosis.  “Generally speaking, monkeypox is spread by respiratory transmission, but the characteristics of the eight suspected cases point towards fluid contact,” the spokesperson said. “The eight suspected cases in Madrid are among men who have sex with men. They are doing well but this illness can require hospital treatment.” Fernando Simón, an epidemiologist who heads Spain’s health emergencies centre, said while it was unlikely that monkeypox would spread significantly, “that can’t be ruled out”.

Portuguese authorities have confirmed five cases and are investigating another 15 suspected cases. In a statement on Wednesday, Portugal’s health ministry said the cases it had detected – all in the Lisbon and Tagus Valley region – had all involved men whose symptoms included ulcerative lesions. “The UK has reported similar cases of ulcerative lesions, with confirmed monkeypox virus infection,” it said. “We are monitoring the situation at national level and in conjunction with European institutions.” The first of the seven cases logged in the UK involved a person who had recently been to Nigeria, where they are believed to have contracted the infection. According to the UK Health Security Agency, all four of the most recent cases are men who identify as gay or bisexual or other men who have sex with men. The health body is asking these groups “to be alert” to possible symptoms, which include rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns.  Early symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes and chills. A rash that can look like chickenpox or syphilis can also develop and spread from the face to other parts of the body, including the genitals. Most people recover within a few weeks. A handful of cases of monkeypox, which has two forms and is typically found in central and western Africa, have been diagnosed in the UK in the past. It is thought the seven UK cases involve the west African strain, which is milder than the more severe central African, or Congo, strain.

In the past couple of weeks, UK, Germany, France and others are experiencing a new wave. The US should get ready.  When it comes to Covid, the United States specializes in denialism. Deny the human-to-human transmission of the virus when China’s first cases were publicized in late 2019. Deny that the virus is airborne. Deny the need for boosters across all adult age groups. There are many more examples, but now one stands out – learning from other countries. In early 2020, with the major outbreak in the Lombardy region of Italy that rapidly and profoundly outstripped hospital resources and medical staffing, Americans expressed confidence that it won’t happen here. That it couldn’t happen here. And then it did. Fast forward two years of the pandemic: the United Kingdom and Europe have provided five unmistakable warnings to America that a new surge was occurring. Within weeks, each time, the United States experienced a new wave, some not as severe (such as with the Alpha variant), some worse (Delta and Omicron variants). From this Covid track record over two years, it is palpable: what happens in the UK and Europe doesn’t stay in the UK and Europe.  In the past couple of weeks, the UK and several countries in Europe, including Germany, France and Switzerland, are experiencing a new wave. At least 12 countries, geographically extending from Finland to Greece, are experiencing new increases in cases, some quite marked, such as Austria exceeding its pandemic peak, and Finland with an 85% increase from the prior week. Many of these countries are also showing a rise in hospital admissions. This is the sixth warning from the UK and Europe to the United States.

Indications within the United States support the idea that new wave is already getting started. Wastewater surveillance is relatively sparse in the United States, but 15% of the 410 sites where it was conducted between 24 February to 10 March 2022 showed a greater than 1000% increase compared with the prior 15-day period. Also, the BA.2 variant is gaining steam in the United States and is now accounting for more than 30% of new cases. The root cause for the new wave is hard to pin down. Certainly, the BA.2 variant is known to have increased transmission, at least about 30% more than its sister lineage, Omicron BA.1. With the concomitant reduction of mitigation restrictions and waning immunity protection of vaccines, that transmission advantage will increase. This “BA.2 triad” of factors is thus hard to dissect, as they are clearly interdependent. Rather than focusing on what precisely is driving the new wave, the imperative is to drive some preventive action. As with the first five warnings from the UK and Europe, the United States did not take heed. Instead of proactively gearing up with non-pharmaceutical interventions (masks, quality of masks, distancing, air filtration, ventilation, aggressive testing, etc.), it just reacted to the surges when they were manifest. Now we are at a point with very low vaccination and booster rates, only 64% of the populations has had two shots, and 29% three shots. That puts the United States at 65th and 70th in the world ranking of countries, respectively.

Indeed, the people who need protection the most, besides those who are immunocompromised, are the 65-plus group. The US has a booster rate of 65% in this age group, whereas the UK and many European and Asian countries exceed a 90% booster rate for people 65 and over. This is a critical issue, because there is a substantial dropdown of protection, from 90-95% with a third shot to 75-80% without a booster, versus Omicron hospitalization and death. The problem of lack of adequate vaccination in the United States is compounded by not having any plan for a fourth dose. The Israeli study of over 1 million people age 60 and over showed a 4.3 fold enhanced protection versus severe illness from Omicron compared with those receiving three shots. Not only is there a gaping hole in our immunity wall, but the $58bn budget of the American Pandemic Prepared Plan (AP3) advanced by the White House to comprehensively address the deficiencies was gutted by the Senate, reduced to $2bn, now threatening to cancel the order of more than 9.2m Paxlovid pills, the Test-to Treat program announced at the State of the Union address, along with better data, wastewater surveillance, efforts to develop a pan-coronavirus vaccine, research on long Covid, and many other critical public health measures. We haven’t even seen a new, major variant yet, but there are too many reasons to believe that is likely in the months ahead, owing to extensive animal reservoirs and documented cases of spillover to humans, a large number of immunocompromised people in whom the virus can undergo accelerated evolution, rare but increasingly seen co-infections, and lack of containment of the virus globally. That, in itself, requires preparedness. Unfortunately, we have a mindset that the pandemic is over, which couldn’t be further than the truth, as I wrote about in the epidemic of Covid complacency. Add to all this is what is happening in China, which has fully relied on a zero-Covid policy, resulting in very little natural immunity, and vaccines that have weak efficacy against Omicron. Now this country is facing major outbreaks in two of its most populous cities, Shanghai and Shenzhen, and undoubtedly the whole country will be affected. We learned in 2019 that what happens in China doesn’t stay in China.

Austria is placing millions of people not fully vaccinated against the coronavirus in lockdown as of Monday to deal with a surge in infections to record levels and the growing strain on intensive-care units, the government said on Sunday. Europe is the epicentre of the COVID-19 pandemic again, prompting some governments to consider re-imposing unpopular lockdowns. Austria has one of the continent's highest infection rates, with a seven-day incidence of 815 per 100,000 people. Austria is the first European country to reinstate the same restrictions on daily movements that applied during national lockdowns before vaccines were rolled out, though this time they only affect a minority of the population. "We are not taking this step lightly but it is necessary," Chancellor Alexander Schallenberg told a news conference announcing the new measure, under which the unvaccinated can only leave their homes for a limited number of reasons like going to work or shopping for essentials. Roughly 65% of Austria's population is fully vaccinated against COVID-19, one of the lowest rates in western Europe. Many Austrians are sceptical about vaccines, a view encouraged by the far-right Freedom Party, the third biggest in parliament. The measures on Monday will extend those brought in a week ago which banned the unvaccinated from places including restaurants, hotels, theatres and ski lifts.  While the Netherlands is dealing with its surge in cases by imposing a partial lockdown that applies to all, Austria's conservative-led government wants to avoid imposing further restrictions on those who are fully vaccinated.

"In reality we have told one third of the population: you will not leave your apartment anymore apart from for certain reasons. That is a massive reduction in contacts between the vaccinated and the unvaccinated," Schallenberg said. In Germany, the federal government and leaders of Germany's 16 states are due to meet next week to discuss tightening measures. Germany has already classified Austria as a high-risk area, meaning people arriving from there have to go into quarantine, a blow to Austria's winter tourism industry. Targeted measures have recently been introduced in Australia, where 83% of people aged 16 and above have been fully inoculated. Some states have mandated vaccinations for some occupations and barred the unvaccinated from activities such as dining out, leading to demonstrations. Singapore, where 85% of the population has been fully vaccinated, has said those who remained unvaccinated by choice would have to foot their medical bills from next month. Austria's lockdown, which does not apply to the under-12s or people who have recently recovered from COVID-19, will initially last 10 days, Health Minister Wolfgang Mueckstein said. Europe is the epicentre of the COVID-19 pandemic again, prompting some governments to consider re-imposing unpopular lockdowns. Austria has one of the continent's highest infection rates, with a seven-day incidence of 815 per 100,000 people. read more. Austria is the first European country to reinstate the same restrictions on daily movements that applied during national lockdowns before vaccines were rolled out, though this time they only affect a minority of the population.

"We are not taking this step lightly but it is necessary," Chancellor Alexander Schallenberg told a news conference announcing the new measure, under which the unvaccinated can only leave their homes for a limited number of reasons like going to work or shopping for essentials. Roughly 65% of Austria's population is fully vaccinated against COVID-19, one of the lowest rates in western Europe. Many Austrians are sceptical about vaccines, a view encouraged by the far-right Freedom Party, the third biggest in parliament. The measures on Monday will extend those brought in a week ago which banned the unvaccinated from places including restaurants, hotels, theatres and ski lifts. read more While the Netherlands is dealing with its surge in cases by imposing a partial lockdown that applies to all, Austria's conservative-led government wants to avoid imposing further restrictions on those who are fully vaccinated. read more

"In reality we have told one third of the population: you will not leave your apartment anymore apart from for certain reasons. That is a massive reduction in contacts between the vaccinated and the unvaccinated," Schallenberg said. In Germany, the federal government and leaders of Germany's 16 states are due to meet next week to discuss tightening measures. Germany has already classified Austria as a high-risk area, meaning people arriving from there have to go into quarantine, a blow to Austria's winter tourism industry. read more Targeted measures have recently been introduced in Australia, where 83% of people aged 16 and above have been fully inoculated. Some states have mandated vaccinations for some occupations and barred the unvaccinated from activities such as dining out, leading to demonstrations. Singapore, where 85% of the population has been fully vaccinated, has said those who remained unvaccinated by choice would have to foot their medical bills from next month.  Austria's lockdown, which does not apply to the under-12s or people who have recently recovered from COVID-19, will initially last 10 days, Health Minister Wolfgang Mueckstein said.

It comes after a review of all currently available evidence into extremely rare cases of unusual blood clots in some vaccinated people.

• The Oxford-AstraZeneca shot has been dogged by safety concerns in recent weeks, with several European countries briefly suspending their use of the vaccine last month.
• The World Health Organization, the U.K.’s medicines regulator and the International Society on Thrombosis and Hemostasis have all said that the benefits of administering the Oxford-AstraZeneca shot far outweigh the risks.
• AstraZeneca has previously said its studies have found no higher risk of blood clots as a result of its vaccine.

LONDON — Europe’s medicines regulator on Wednesday announced a possible link between the coronavirus vaccine developed by AstraZeneca and the University of Oxford and rare blood clotting issues in adults who received the shot. It comes after a review of all currently available evidence into extremely rare cases of unusual blood clots in some vaccinated people. The Oxford-AstraZeneca shot has been dogged by safety concerns in recent weeks, with several European countries briefly suspending their use of the vaccine last month. The European Medicines Agency said on March 31 that it had found the shot to be safe and effective, but added it could not rule out the possibility of a causal link between the vaccine and clotting events so would continue to investigate. The World Health Organization, the U.K.’s medicines regulator and the International Society on Thrombosis and Hemostasis have all said that the benefits of administering the Oxford-AstraZeneca shot far outweigh the risks. AstraZeneca has previously said its studies have found no higher risk of blood clots as a result of its vaccine. Most countries have since resumed use of the shot but many have suspended inoculations across certain age groups. A senior official at Europe’s medicines regulator reportedly said Tuesday that there is a clear “association” between the Oxford-AstraZeneca vaccine and very rare blood clots in the brain, though the direct cause was not yet known. In an interview with Italian newspaper Il Messaggero published Tuesday, Marco Cavaleri, chair of the EMA’s vaccine evaluation team, said: “In my opinion we can now say it, it is clear that there is an association with the vaccine. However, we still do not know what causes this reaction.” The EMA subsequently denied it had established any link between the Oxford-AstraZeneca shot and rare blood clots in a statement to Agence France-Presse.

UK vaccine trial in children paused

In a landmark collective undertaking, the bloc is poised to start distributing shots to all 27 member nations and their 410 million citizens.  From Stockholm to Athens and from Lisbon to Warsaw, European Union governments are gearing up to receive a coronavirus vaccine later this week, even as cases keep rising in some parts of the continent. The bloc formally approved the Pfizer-BioNTech vaccine on Monday, setting off a logistical marathon the likes of which most of the authorities in the region have not had to contend with before. The operation to buy, approve and distribute the shots across the European Union has been complex and politically charged, and the stakes could not be higher. The pandemic’s second wave is still raging in parts of the region, most Europeans are spending the holidays in some type of lockdown, and the bloc’s economies are in tatters. To further complicate matters, a highly contagious variant in England led many European countries over the weekend to block travelers from Britain, although scientists say it has already reached the continent. If the vaccine mission is successful, it may bolster the credentials of the European Union, establishing its administration as a real force with executive powers and capabilities that can take on important tasks on behalf of its members. If not, the failure may spread acrimony and disaffection.

The European Medicines Agency, the bloc’s drug authority, gave its approval on Monday, after coming under intense scrutiny for the pace at which it reviewed the Pfizer-BioNTech vaccine. Britain granted the vaccine emergency approval weeks ago and then started rolling out its inoculation program, with the United States following not far behind. In the end, the European agency decided to speed up the process, moving forward an approval meeting that had been set for Dec. 29. The United States has also approved a vaccine from Moderna, but the European agency will not address the application for authorization of that company’s shots until Jan. 6. The agency’s authorization for the Pfizer-BioNTech vaccine was followed a few hours later by the final step, when the European Commission, the executive arm of the European Union,gave its approval, giving the green light for Pfizer to start distributing vaccines across the region.  “As we have promised, this vaccine will be available for all European countries at the same time, under the same conditions,” said Ursula von der Leyen, the European Commission president. “Let me say how proud I am that the first Covid vaccine available in Europe is a true product of the European innovation.”

The World Health Organization (WHO) has warned that coronavirus cases are surging alarmingly in Europe, as a "very serious situation" unfolds across the continent. As Covid-19 infections spike to record numbers, European governments are imposing strict local measures and weighing up further lockdowns in a bid to halt a second wave of the pandemic. But WHO regional director Hans Kluge said at a Thursday news conference that the increase in cases should serve as a warning of what is to come. "Weekly cases have now exceeded those reported when the pandemic first peaked in Europe in March," Kluge said. "Last week, the region's weekly tally exceeded 300,000 patients."

Lockdowns have saved more than three million lives from coronavirus in Europe, a study estimates.The team at Imperial College London said the "death toll would have been huge" without lockdown. Another study argued global lockdowns had "saved more lives, in a shorter period of time, than ever before".

The Imperial study assessed the impact of restrictions in 11 European countries - Austria, Belgium, Denmark, France, Germany, Italy, Norway, Spain, Sweden, Switzerland and the UK - up to the beginning of May. By that time, around 130,000 people had died from coronavirus in those countries. The researchers used disease modelling to predict how many deaths there would have been if lockdown had not happened. And the work comes from the same group that guided the UK's decision to go into lockdown. They estimated 3.2 million people would have died by 4 May if not for measures such as closing businesses and telling people to stay at home. That meant lockdown saved around 3.1 million lives, including 470,000 in the UK, 690,000 in France and 630,000 in Italy, the report in the journal Nature shows. "Lockdown averted millions of deaths, those deaths would have been a tragedy," said Dr Seth Flaxman, from Imperial.

Their equations made several assumptions, which will affect the figures. They assume nobody would have changed their behaviour in response to the Covid threat without a lockdown - and that hospitals would not be overwhelmed resulting in a surge in deaths, which nearly happened in some countries. The study also does not take into account the health consequences of lockdowns that may take years to fully uncover. The model also predicted that the outbreak would be nearly over by now without lockdown, as so many people would have been infected. More than seven in 10 people in the UK would have had Covid, leading to herd immunity and the virus no longer spreading. Instead, the researchers estimate that up to 15 million people across Europe had been infected by the beginning of May. The researchers say at most, 4% of the population in those countries had been infected.

Original Study Published in Nature (June 8, 2020):

https://doi.org/10.1038/s41586-020-2405-7

Warning issued by European Food Safety Authority after 24 cats test positive for virus in Poland. Cats should be kept indoors to avoid catching bird flu, European health officials have told pet-owners as the continent battles its worst-ever outbreak of the virus. The warning has been issued by the European Food Safety Authority (EFSA) after 24 cats tested positive for the virus in Poland, sparking fear that avian influenza could be evolving to spread among certain mammals. Since late 2021, bird flu has killed millions of birds across Europe and beyond. Last year, 67 countries in five continents reported highly pathogenic H5N1 outbreaks, with more than 131 million domestic poultry lost due to death or culling in affected areas. But the rising number of infections in mammals – outbreaks have been reported in 26 species, including farmed mink in Spain – has generated particular concern. Calling for increased surveillance of bird flu in wild and domesticated mammals, the EFSA said on Thursday that “it is recommended to avoid exposure of domestic cats and dogs, and in general carnivore pets, to dead or diseased animals”. It added: “Possible measures are keeping dogs on a leash, and confining cats indoors in areas where extensive circulation of HPAI [highly pathogenic avian influenza] viruses in wild birds has been confirmed.”

In Poland, the deaths of around 70 domestic cats since June 23 are being investigated, according to local media reports.  At least 24 tested positive for H5N1, with the source of the infections yet to be determined. Reports have linked the outbreak to raw poultry meat contaminated with the virus. Elsewhere, five dogs and a cat have been infected with bird flu in Italy. The EFSA has also called for research to investigate the role that farmed and domesticated mammals could be playing in harbouring the bird flu virus and potentially driving its ability to spread beyond avian species. “Prompt generation and timely sharing of sequence data is highly recommended to promptly identify the emergence of variants with a possible increased ... potential” to jump into humans, the agency said. Earlier this week, the World Health Organisation (WHO) said that “some mammals may act as mixing vessels for influenza viruses, leading to the emergence of new viruses that could be more harmful to animals and humans.” In a statement released on Wednesday, it said that the recent surge in bird flu outbreaks among mammals could help the virus spread in humans. “Avian influenza viruses normally spread among birds, but the increasing number of H5N1 avian influenza detections among mammals – which are biologically closer to humans than birds are – raises concern that the virus might adapt to infect humans more easily.” In April, the virus was also found to “efficiently” spread between ferrets in a laboratory, the first study confirming that the virus can spread from mammal to mammal.

The “Avian influenza overview” report is published quarterly and provide an update of the developments of avian influenza viruses in EU/EEA and worldwide, in particular with a view to describe the evolution of virus spread from certain regions towards the EU. In case of significant changes in the epidemiology of avian influenza, these reports could be needed more frequently.  The report is published jointly by the European Food Safety Authority (EFSA), the European Centre for Disease Prevention and Control (ECDC) and the European Union Reference Laboratory for Avian influenza (EURL). Avian influenza is an infectious viral disease in birds, including domestic poultry. Avian influenza is mainly found in birds, but under certain circumstances infections can also occur in humans even though the risk is generally very low.

There is a risk that monkeypox could become endemic in Europe if the current outbreak isn’t brought under control and the virus spills back into susceptible animal species, the European Centre for Disease Prevention and Control said Monday  as it issued a risk assessment of the unprecedented event. The health agency said that if person-to-person transmission continues and if the monkeypox virus were to make its way into animal species in the region, it could become entrenched, though it suggested the risk is thought to be “very low.” “Currently, little is known about the suitability of European peri-domestic (mammalian) animal species to serve as a host for monkeypox virus,” the risk assessment stated, noting that rodents and squirrels are likely to be suitable hosts for the virus and transmission from people to pets is theoretically possible. “Such a spill-over event could potentially lead to the virus establishing in European wildlife and the disease becoming an endemic zoonosis.”  The agency noted that after a 2003 outbreak in the United States, public health authorities in this country did extensive surveillance looking for instances where the virus might have made its way into animals. But they found no evidence it had happened. The 2003 outbreak was traced back to infected small mammals imported from Ghana as pets — two rope squirrels, a Gambian rat, and three dormice. The animals infected nearby prairie dogs at a wholesale pet store and the prairie dogs infected 47 people in six states. As of yet, the virus is considered endemic only in a dozen countries in West and Central Africa, where human infections occur sporadically. Prior to this year, there have been only a few exported cases of monkeypox detected outside of the endemic countries — in the United States, the United Kingdom, Israel, and Singapore.

The natural reservoir — the animal or animals that are the source of the virus — is not known. “If human-to-animal transmission occurs, and the virus spreads in an animal population, there is a risk that the disease could become endemic in Europe,” the ECDC said in a statement. “As such, there needs to be a close intersectoral collaboration between human and veterinary public health authorities to manage exposed pets and prevent the disease from being transmitted to wildlife.” The number of cases in the current outbreak is changing rapidly as countries search for cases. Maria Van Kerkhove, who leads the emerging diseases and zoonoses unit in the World Health Organization’s Health Emergencies Program, said Monday that to date there are fewer than 200 confirmed and suspected cases. Eleven countries in Europe, as well as the United States, Canada, Israel, and Australia have reported confirmed cases. The virus currently appears to be spreading among men who have sex with men, though Van Kerkhove warned that surveillance is currently focused on finding cases through sexual health clinics. Casting a broader net will likely bring other cases to light, she and others have said.  Monkeypox is a pox virus and is related to the variola virus, which caused smallpox. That once dreaded disease was declared eradicated in 1980. The symptoms of monkeypox are similar to but milder than smallpox. Infected people develop flu-like symptoms — fever, body aches, chills — but also swollen lymph nodes. With one to three days of the onset of fever, a distinctive rash appears, often starting on the face.

Many conditions can cause rashes, but the monkeypox rash has some unusual features, notably the fact that vesicles can form on the palms of the hands. In this outbreak, a number of people have reported having had lesions on their genitals. In countries where it is endemic, the virus is believed to mainly spread to people from infected animals when people kill or prepare bushmeat for consumption.  Monkeypox is a pox virus and is related to the variola virus, which caused smallpox. That once dreaded disease was declared eradicated in 1980. The symptoms of monkeypox are similar to but milder than smallpox. Infected people develop flu-like symptoms — fever, body aches, chills — but also swollen lymph nodes. With one to three days of the onset of fever, a distinctive rash appears, often starting on the face. Many conditions can cause rashes, but the monkeypox rash has some unusual features, notably the fact that vesicles can form on the palms of the hands. In this outbreak, a number of people have reported having had lesions on their genitals. In countries where it is endemic, the virus is believed to mainly spread to people from infected animals when people kill or prepare bushmeat for consumption.

Researchers suspect an adenovirus may be involved, but are still searching for the cause of illness.   Puzzled scientists are searching for the cause of a strange and alarming outbreak of severe hepatitis in young children, with 74 cases documented in the United Kingdom and three in Spain. Clinicians in Denmark and the Netherlands are also reporting similar cases. And in the United States, the Centers for Disease Control and Prevention (CDC) said late yesterday it is investigating nine cases in Alabama. Viruses can cause hepatitis, an inflammation of the liver, but otherwise-healthy children rarely become seriously ill. As of 12 April, none of the U.K. or Spanish children have died, but some are very sick: All have been admitted to hospitals and seven required liver transplants, six of them in the United Kingdom, according to a World Health Organization (WHO) statement issued today. Two of the nine affected children in Alabama have required liver transplants, the state’s Department of Public Health announced this afternoon. The leading theory is that an adenovirus, a family of viruses that more typically cause colds, is the culprit—up to half of the sickened children in the United Kingdom tested positive for such a virus, as did all the children in Alabama. But so far, the evidence is too thin to resolve the mystery, researchers and physicians say. “This is a severe phenomenon,” says Deirdre Kelly, a pediatric hepatologist at Birmingham Children’s Hospital in the United Kingdom. “These [were] perfectly healthy children … up to a week ago.” Not all the news is bad, however. “Most of [the children] recover on their own,” Kelly notes. “This should be taken seriously,” WHO’s Regional Office for Europe wrote in an emailed statement.

“The increase is unexpected and the usual causes have been excluded.” Scottish investigators first identified the outbreak on 31 March, when they alerted Public Health Scotland to a cluster of 3- to 5-year-olds admitted to the Royal Hospital for Children in Glasgow in the first 3 weeks of March. Each was diagnosed with severe hepatitis of unknown cause. Typically, Scotland sees fewer than four such cases annually, the investigators wrote in a paper published yesterday. But there have been 13 cases in Scottish children as of 12 April, all but one in March and April.  Kelly, who works at one of England’s three centers for pediatric liver disease and transplantation, says that since the start of this year, her unit has seen 40 cases of childhood hepatitis of uncertain cause. Over the same January to April period in 2018, her unit saw only seven such children. Most of the U.K. children are 2 to 5 years old, according to a statement issued on 8 April by the UK Health Security Agency. The European Centre for Disease Prevention and Control issued a public alert on 12 April about the U.K. outbreak, noting that vomiting and jaundice—yellowing of the skin and the whites of the eyes—are common symptoms. Early hypotheses about what might be making the children sick included a toxic exposure from food, drinks, or toys, but suspicion now centers on a virus. None of the U.K. or Spanish kids had the hepatitis A, B, C, or E viruses, typical infectious causes of the disease. But a handful of children tested positive for SARS-CoV-2 infection shortly before or upon hospital admission; none had received a COVID-19 vaccine. In addition, as many as half had adenovirus, a common virus passed by respiratory droplets and from touching infected people or virus on surfaces. It can cause vomiting, diarrhea, conjunctivitis, and cold symptoms but rarely causes hepatitis. “The leading hypotheses center around adenovirus—either a new variant with a distinct clinical syndrome or a routinely circulating variant that is more severely impacting younger children who are immunologically naïve,” the Scottish investigators wrote.

Isolation of the youngest children during the pandemic lockdown may have left them immunologically vulnerable because they haven’t been exposed to the multiplicity of viruses, including adenoviruses, that typically attend toddlerhood. “We are seeing a surge in typical childhood viral infections as children come out of lockdown, [as well as] a surge in adenovirus infections”—but can’t be sure that one is causing the other, says Will Irving, a clinical virologist at the University of Nottingham. Researchers continue to study other possibilities. For example, the immunological effects of a prior episode of COVID-19 might have left children more vulnerable to infection or the illness could be a long-term complication of COVID-19 itself. An unidentified toxin has also not been ruled out. All the cases might not have a single cause, cautions Jim McMenamin, an epidemiologist who heads the infection service of Public Health Scotland. “It’s awfully important that we ensure we are looking for everything, that we are not confining ourselves to saying this is simply one viral cause.”

In the United States, CDC is helping the Alabama Department of Public Health investigate nine cases of hepatitis in children ranging in age from 1 to 6 years old and who also tested positive for adenovirus. The cases have occurred since October 2021, Kristen Nordlund, a CDC spokesperson, wrote in the statement emailed to ScienceInsider last night.  “CDC is working with state health departments to see if there are additional U.S. cases, and what may be causing these cases,” she wrote. “Adenovirus may be the cause for these, but investigators are still learning more—including ruling out the more common causes of hepatitis.” Wes Stubblefield, a district medical officer with the Alabama Department of Public Health, said in an interview today that the most recent case in Alabama occurred in February, and that five of the nine children tested positive for adenovirus-41, a strain that commonly causes gastroenteritis.

Meanwhile, in Spain, the government of the Madrid region announced on 13 April that three regions—Madrid, Aragón, and Castilla-La Mancha—had each reported a case of severe hepatitis of unknown origin in young children. One child has received a liver transplant. Physicians at major pediatric liver centers in the Netherlands and Denmark told ScienceInsider yesterday they are seeing similar trends. “There are children that are very sick and have been referred for transplantation,” says Ruben de Kleine, a pediatric liver transplant surgeon at University Medical Center Groningen. “We have assessed a similar number of kids for transplantation within the first 4 months of 2022 [to what we] normally do in a whole year.” At Copenhagen University Hospital, too, “we have more cases with [acute liver failure] than we normally have,” says pediatric hepatologist Marianne Hørby Jørgensen. No children there have needed transplants. Hørby Jørgensen and de Kleine both stress that parents should not panic. To date, clinicians have identified small numbers of cases in their countries where, combined, more than 230,000 infants are born each year.

GENEVA, Nov 23 (Reuters) - The World Health Organization (WHO) said on Tuesday there could be a further 700,000 deaths from COVID-19 in Europe by March, taking the total to above 2.2 million, as the world body urged people to get vaccinated. Total cumulative deaths from the respiratory disease in the 53 countries of the WHO's European region have already surpassed 1.5 million, it said, with the daily rate doubling from late September to 4,200 a day. The WHO's European region also includes Russia and other former Soviet republics as well as Turkey. "Cumulative reported deaths are projected to reach over 2.2 million by spring next year, based on current trends," it said, adding that COVID-19 is now the top regional cause of death. High or extreme stress on intensive care units is expected in 49 out of 53 countries by March 1, the WHO added.

The Netherlands started transporting COVID-19 patients across the border to Germany on Tuesday as pressure rises on hospitals and infections jump to record levels. Austria began its fourth lockdown on Monday. Beyond prevention measures such as masks and hand-washing, the WHO's Regional Director for Europe, Hans Kluge, urged people to get primary vaccines doses and a booster "if offered". WHO officials have previously advised against COVID-19 vaccine boosters until more people around the world have received primary doses. "All of us have the opportunity and responsibility to help avert unnecessary tragedy and loss of life, and limit further disruption to society and businesses over this winter season," said Kluge.

Reporting by Emma Farge Editing by Gareth Jones

The European Commission said on Monday it had launched legal action against AstraZeneca (AZN.L) for not respecting its contract for the supply of COVID-19 vaccines and for not having a "reliable" plan to ensure timely deliveries. AstraZeneca (AZN.L) said in response that the legal action by the EU was without merit and pledged to defend itself strongly in court. Under the contract, the Anglo-Swedish company had committed to making its "best reasonable efforts" to deliver 180 million vaccine doses to the EU in the second quarter of this year, for a total of 300 million in the period from December to June. But AstraZeneca said in a statement on March 12 it would aim to deliver only one-third of that by the end of June, of which about 70 million would be in the second quarter. A week after that, the Commission sent a legal letter to the company in the first step of a formal procedure to resolve disputes. read more AstraZeneca's delays have contributed towards hampering the bloc's vaccination drive, as the vaccine developed by Oxford University was initially supposed to be the main one in an EU rollout in the first half of this year. After repeated cuts in supplies, the bloc changed its plans and now relies mostly on the Pfizer-BioNTech (PFE.N), (22UAy.DE) vaccine. "The Commission has started last Friday a legal action against AstraZeneca," the EU spokesman told a news conference, noting all 27 EU states backed the move. "Some terms of the contract have not been respected and the company has not been in a position to come up with a reliable strategy to ensure timely delivery of doses," the spokesman said, explaining what triggered the move.

"AstraZeneca has fully complied with the Advance Purchase Agreement with the European Commission and will strongly defend itself in court. We believe any litigation is without merit and we welcome this opportunity to resolve this dispute as soon as possible," AstraZeneca said. Under the contract, the case will need to be resolved by Belgian courts. "We want to make sure there is a speedy delivery of a sufficient number of doses that European citizens are entitled to and which have been promised on the basis of the contract," the spokesman said.  EU officials confirmed the purpose of the legal action was to ensure more supplies than what the company has said it would aim to deliver. The move follows months of rows with the company over supply issues and amid concerns over the efficacy and safety of the vaccine. Still, while the shot has been linked to very rare cases of blood clots, the EU drugs regulator has recommended its use to contain the spread of COVID-19. "We had to send a message to (Pascal) Soriot," an EU official said, referring to AstraZeneca's chief executive. Germany, France and Hungary were among EU states that were initially reticent to sue the company, mostly on the grounds that the move might not speed up deliveries, diplomats said, but eventually they supported it. After the announcement of the legal action, AstraZeneca said it was in the process of delivering nearly 50 million doses by the end of April, a goal which is in line with the revised-down target of supplying only 100 million shots by the end of the quarter. The EU wants AstraZeneca to deliver as many as possible of the promised 300 million doses, but would settle for 130 million shots by the end of June, one EU source familiar with the discussions told Reuters, adding the EU had launched an urgent legal procedure and was invoking financial penalties in case of non-compliance. In a further sign of its irritation towards the company, it has already forgone another 100 million shots that it had an option to buy under the contract signed in August. The spat with AstraZeneca has also stoked a dispute over supplies with former EU member Britain. AstraZeneca said it was prevented from exporting doses from UK factories to make up for some of the shortfalls in the EU, EU officials have said. Now the EU is opposing the export of AstraZeneca shots to Britain from a factory in the Netherlands.

The European Union drugs regulator has recommended granting Moderna's Covid-19 vaccine a conditional marketing authorization, a move that will soon pave the way for the drug to become the second coronavirus vaccine to be distributed in the bloc.  Following the recommendation by the European Medicines Agency (EMA), the shot now must be formally authorized by the European Commission, which is expected to do so quickly. On Wednesday, the European Parliament Committee on Environment, Public Health and Food Safety said on Twitter that they are "expected to follow the (EMA) recommendation and grant the authorization shortly after which the roll-out of the vaccine in the EU can begin. "Emer Cooke, EMA executive director, said on Wednesday that "this vaccine provides us with another tool to overcome the current emergency."  "It is a testament to the efforts and commitment of all involved that we have this second positive vaccine recommendation just short of a year since the pandemic was declared by WHO," she said. Ursula von der Leyen, president of the European Commission, said in a tweet that the EMA had found that the Moderna vaccine is "safe and effective" and that their decision is "Good news for our efforts to bring more #COVID19 vaccines to Europeans!" "Now we are working at full speed to approve it & make it available in the EU," she said. The EU has secured the purchase of up to 160 million doses of the Moderna vaccine -- enough to vaccinate 80 million people of its 448 million citizens -- as part of a joint vaccine strategy aimed to ensure equitable access across the bloc.  It has also purchased up to 300 million doses of the Pfizer/BioNTech vaccine, which was authorized for use on December 21 and rolled out to all EU countries days later.

BioNTech and Pfizer have started a rolling submission of their COVID-19 vaccine BNT162b2 to the European Medicines Agency (EMA). The news comes days after EMA named AstraZeneca's AZD1222 as the first COVID-19 vaccine to start the rolling review process. The EMA uses rolling reviews to start assessing data on an experimental candidate before all the evidence needed to make a final decision is available, cutting the time it takes to decide whether to approve a prospect once the pivotal clinical trial results are submitted to the agency. The pressing need for COVID-19 vaccines potentially makes the mechanism important to the current crisis. After receiving the first part of a rolling submission, the EMA’s Committee for Medicinal Products for Human Use has begun evaluating the preclinical evidence on mRNA vaccine BNT162b2. The rolling review format provides opportunities to file additional data before the complete application. Each cycle typically requires a two-week review. The duration of the review of the final application will depend on the proportion of data already assessed by EMA under the rolling review. 

The EMA accepted BNT162b2 for rolling review on the strength of the preclinical and early clinical data on the vaccine. BioNTech and Pfizer have linked BNT162b2, which encodes a SARS-CoV-2 spike glycoprotein, to antibody and T-cell responses in people dosed in early-phase trials. The data led the partners to start a phase 3 clinical trial. That trial has now enrolled around 37,000 participants at sites in countries including the U.S., Brazil, South Africa and Argentina, with centers in Turkey coming online to help push BioNTech and Pfizer to their enrollment target of 44,000 subjects. More than 28,000 participants have received their second dose. BioNTech and Pfizer originally planned to enroll 30,000 subjects. The enrollment figures suggest BioNTech and Pfizer are closing in on the release of top-line data from the trial. Exactly how long the partners need to wait for efficacy data will depend on the extent to which participants have been exposed to the virus and the effectiveness of the vaccine. BioNTech and Pfizer are set to perform interim efficacy analyses when there are 32, 62, 92 and 120 COVID-19 cases in the trial...

Two European patients are confirmed to have been re-infected with COVID-19, raising concerns about people's immunity to the coronavirus as the world struggles to tame the pandemic. The cases, in Belgium and the Netherlands, follow a report this week by researchers in Hong Kong about a man there who had contracted a different strain of the virus four and a half months after being declared recovered - the first such second infection to be documented. That has raised fears about the efficacy of potential vaccines against the virus, which has killed hundreds of thousands of people, though experts say there would need to be many more cases of re-infection for these to be justified. Belgian virologist Marc Van Ranst said the Belgian case was a woman who had contracted COVID-19 for the first time in March and then again with a different coronavirus strain in June. Further cases of re-infection were likely to surface, he said. Van Ranst told Reuters TV the woman, in her 50s, had very few antibodies after the first infection, although they might have limited the sickness. Re-infection cases were probably limited exceptions, he said, although it was too soon to tell and many were likely to surface in coming weeks.  He added that the new coronavirus appeared more stable than the influenza virus, but it was changing. 

“Viruses mutate and that means that a potential vaccine is not going to be a vaccine that will last forever, for 10 years, probably not even five years. Just as for flu, this will have to be redesigned quite regularly,” he said. Van Ranst, who sits on some Belgian COVID-19 committees, said vaccine designers would not be surprised. “We would have loved the virus to be more stable than it is, but you can’t force nature.”

Genetic Testing

The National Institute for Public Health in the Netherlands said it had also observed a Dutch case of re-infection with a different strain of the virus. “It is clear there has been a first and a second infection with a substantial quantity of virus. Enough to be able to determine the genetic code of the virus, that is what showed they were indeed different,” said Marion Koopmans, a leading virologist in the Netherlands and a member of the World Health Organization’s scientific advisory group. She added the elderly Dutch patient had a weakened immune system, which explained the patient’s situation. “People are worried and ask if re-infection is ‘standard’. I don’t think it is,” she added. WHO spokeswoman Margaret Harris told a U.N. briefing in Geneva regarding the Hong Kong case that, while there were anecdotal reports of re-infections, it was important to have clear documentation.