United Kingdom, France, Spain and Denmark begin to treat the scenario of infections by Sars-CoV-2 as endemic; infectologists explain that change does not represent eradication
With the occasional decline in the rates of new cases, hospitalizations and deaths due to Covid-19, some countries and territories of the world resume part of the sanitary flexibilities. Among the changes adopted are: the removal of masks, the end of social distancing recommendations and even the waiver of the requirement of the vaccine passport for entry into closed environments. However, another determination has been gaining the world’s spotlight: the decision to UK, France, Spain and Denmark to update the Covid-19 classification to endemic. With the change, infections by Sars-CoV-2 are no longer a health emergency. But, in fact, what does this mean for coping with the disease? Before understanding how this change can reflect on the combat and eradication actions of the coronavirusit is necessary to establish the differences in the classification of the disease.
Pandemic vs endemic: what changes?
different from pandemic, which is characterized by the spread and generalized increase of a disease in several territories, endemic is the health situation in which it is assumed that a certain number of cases – and deaths – are expected from a disease. That is, in the endemic situation, there is a control in the statistics, as explained by the infectologist of the Pardini Group Marília Turchi. “Several infectious diseases reach a certain level and then, with a series of control measures, enter an endemic level. That is, with the number of cases that would be within the expected limit. But being in an endemic situation is not necessarily a comfortable or good situation”, says the doctor. She mentions that, in addition to representing a more positive and stable scenario, the change to endemic disease encompasses new strategies for coping with the disease.
However, while initially positive, the change in ranking also raises concerns for experts. The reason is that there are doubts as to which rates of infections, hospitalizations and deaths by Covid-19 will be considered “acceptable” by countries for the endemic moment. The concern is that this level of stability is high and, therefore, continues to represent high numbers of cases and deaths. “If we analyze data from countries that have announced a change in the epidemiological scenario from pandemic to epidemic, some of them are very high numbers of cases and deaths. So what would that necessary level be? Zero cases? We won’t make it either,” he says. To determine this estimated limit, infectious disease specialist Adelino de Melo Freire Júnior, medical director of Target Precision Medicine, explains that it will be up to each country to individually assess the epidemiological data. “The authorities classify pandemic levels according to a historical average, you look back and define. It is not possible to define general values, each location will have its value”, he mentions.
‘Endemia is not eradication of the disease’
Although it is the “expected path”, the change from classification to endemic is far from indicating the end of covid-19 and also far from being a comfortable epidemiological scenario, points out Júnior. “Endemia is not eradication of the disease. It’s just the opposite. When you assume that a disease is endemic, you assume that it will remain there. It doesn’t change anything regarding severity, prevention, the individual approach to treatment. You assume they’re going to keep having affairs, that it’s going to stay. This is what is expected of infection with the new coronavirus. The understanding is almost unanimous that we are not going to get rid of it, we are not going to eradicate it. It’s unlikely that we’ll get rid of it completely, that’s not going to happen.” The infectologist even mentions that in the same way that there was a change from a pandemic to an endemic disease in European countries, the reversal is also possible. “If we have a new variant like Ômicron that escapes immunity, that could change. Maybe a little early. I hope it works out, but only time will tell.”
Scenario in Brazil
While Denmark, the United Kingdom, Spain and France advance in understanding Covid-19 as an endemic disease, Brazil suffers from new records of infections and an increase in deaths. This Friday, 11, 144,240 cases and 1,135 deaths from the disease were recorded in the country, according to the Ministry of Health, which is still worrying. However, in some states, such as São Paulo and Rio de Janeiro, epidemiological data already indicate a decline in hospitalizations, which may indicate a decreasing moment of the wave caused by Ômicron. Even if the scenario is different and inaccurate, the understanding is that, in an optimistic forecast, the SARS-CoV-2 pandemic situation will come to an end in the first half of this year. “If we evolve to a disease that has balanced levels, that doesn’t have new waves, that’s what will happen. [classificação de endemia]. Now say when will it happen? Today, we are experiencing an extreme increase in cases. With Ômicron, we break records of cases every day, this is the opposite of an endemic disease. When will it reduce to stable levels and consecutive months to change the rating? Only time will tell”, concludes Adelino Júnior.
MARS Wildlife Centre closes due to avian influenza – Squamish Chief
The MARS Wildlife Centre north of Courtenay is closing to the public temporarily after avian influenza was found this week in a small poultry flock in the Comox Valley.
As of Monday, the visitor centre and gift shop will not be accessible to visitors.
“Our commitment to the safety and well-being of our resident ambassador birds (eagles, owls and crows) and wildlife patients is our first priority, and we hope that this additional precautionary measure will help reduce the risk of on-site transmission of the virus,” Gyl Andersen, centre manager of wildlife rehabilitation, said in a statement.
The Mountainaire Avian Rescue Society worries that needed donations to operate the centre will drop during the time the centre it is closed, at a time of year when expenses rise.
Andersen is asking supporters to donate to its animal care fund.
It is “baby season” and the influx of injured and orphaned baby birds, raccoon kits, and other small mammals has begun, Andersen said.
The largest expenses at this time of year are food and nursery supplies. Also needed are personal protective equipment and cleaning supplies to combat viruses.
The Canadian Food Inspection agency confirmed Wednesday that Vancouver Island’s first case of the H5N1 virus was found in the small flock.
This is the first reported case on the Island, which may have been caused by infected migrating wild birds.
Increased bio-security measures have been put into place to protect birds at the centre, where its wildlife hospital remains open, Andersen said.
Sanitizing footbaths, a separate patient admission building, quarantine zones for different species, and covering the ambassador enclosures are among safety measures implemented.
Anyone bringing an injured animal to the Merville centre must remain in their vehicle and call the hospital at 250-337-2021, extension zero to speak to rehabilitation staff, who will come and collect the animal.
The centre said dead birds can not be brought to the centre. Call the centre for advice. The bird hotline can be called at 1-866-431-2473.
Rise of acute hepatitis among kids: Find out what is causing it, symptoms to note and all about the role of vaccines – Times of India
Besides the adenovirus 41, scientists continue to investigate COVID-19 as a potential underlying cause of the rise in recent cases of acute hepatitis in children.
An Indian study conducted by a team of researchers from the Bundelkhand Medical College (BMC), Sagar, Madhya Pradesh and the Post Graduate Institute of Medical Research, Chandigarh found that of 475 children, who tested positive for COVID-19 from April-July in 2021, 37 were diagnosed with COVID Acquired Hepatitis (CAH).
“We observed a peculiar rise in hepatitis cases. Usually, the beginning of monsoon marks a rise in hepatitis cases. Last year (2021) we started to see this in April, or summer, in covid positive children who were part of follow-up. Most of them in fact had recovered from their covid,” said Sumit Rawat, Associate Professor, Microbiology, BMC, and one of the authors of the study.
“Hepatitis A and E are specific to certain villages or regions, B is present through the year and D is usually from a parent or from a blood transfusion. Last year, following the Delta wave we saw these cases from all over the state, defying the usual histories,” he added.
Another recent case study suggested a possible link between liver disease and COVID-19.
The study published in the Journal of Pediatric Gastroenterology and Nutrition observed a previously healthy three-year-old girl who developed acute liver failure a few weeks after recovering from a mild COVID infection.
Dr. Anna Peters, a pediatric gastroenterologist at the Cincinnati Children’s Hospital Medical Center and the lead author of the study said, “”The patient had liver biopsy findings and blood testing consistent with a type of autoimmune hepatitis which may have been triggered by COVID infection.”
“I think it’s important for physicians to be aware that this is a rare condition that may happen during or after COVID infection. It’s important to check liver tests in patients who aren’t improving as expected,” she added.
About 11 per cent of admitted COVID patients return to hospital or die within 30 days: study – CTV News
A new study offers a closer look at possible factors that may lead to some hospitalized COVID-19 patients being readmitted within a month of discharge.
At roughly nine per cent, researchers say the readmission rate is similar to that seen for other ailments, but socio-economic factors and sex seem to play a bigger role in predicting which patients are most likely to suffer a downturn when sent home.
Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults hospitalized for COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18 per cent — 8,496 patients — died in hospital between January 2020 and October 2021, which was higher than the norm for other respiratory tract infections.
Among those sent home, about nine per cent returned to hospital within 30 days of leaving, while two per cent died.
The combined rate of readmission or death was similar in each province, at 9.9 per cent or 783 patients in Alberta, and 10.6 per cent or 2,390 patients in Ontario.
For those wondering if the patients were discharged too soon, the report found most spent less than a month in hospital and patients who stayed longer were actually readmitted at a slightly higher rate.
“We initially wondered, ‘Were people being sent home too early?’ … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” co-author Dr. Finlay McAlister, a professor of general internal medicine at the University of Alberta, said from Edmonton.
“So it looked like clinicians were identifying the right patients to send home.”
The report found readmitted patients tended to be male, older, and have multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with home care or to a long-term care facility.
McAlister also found socio-economic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits, but “that wasn’t as good a predictor for post-COVID patients.”
“Including things like socio-economic status, male sex and where they were actually being discharged to were also big influences. It comes back to the whole message that we’re seeing over and over with COVID: that socio-economic deprivation seems to be even more important for COVID than for other medical conditions.”
McAlister said knowing this could help transition co-ordinators and family doctors decide which patients need extra help when they leave the hospital.
On its own, LACE had only a modest ability to predict readmission or death but adding variables including the patient’s neighbourhood and sex improved accuracy by 12 per cent, adds supporting co-author Dr. Amol Verma, an internal medicine physician at St. Michael’s Hospital in Toronto.
The study did not tease out how much socio-economic status itself was a factor, but did look at postal codes associated with so-called “deprivation” indicators like lower education and income among residents.
Readmission was about the same regardless of neighbourhood, but patients from postal codes that scored high on the deprivation index were more likely to be admitted for COVID-19 to begin with, notes Verma.
Verma adds that relying on postal codes does have limitations in assessing socio-economic status since urban postal codes can have wide variation in their demographic. He also notes the study did not include patients without a postal code.
McAlister said about half of the patients returned because of breathing difficulties, which is the most common diagnosis for readmissions of any type.
He suspected many of those problems would have been difficult to prevent, suggesting “it may just be progression of the underlying disease.”
It’s clear, however, that many people who appear to survive COVID are not able to fully put the illness behind them, he added.
“Looking at readmissions is just the tip of the iceberg. There’s some data from the (World Health Organization) that maybe half to two-thirds of individuals who have had COVID severe enough to be hospitalized end up with lung problems or heart problems afterwards, if you do detailed enough testing,” he said.
“If you give patients quality of life scores and symptom questionnaires, they’re reporting much more levels of disability than we’re picking up in analyses of hospitalizations or emergency room visits.”
The research period pre-dates the Omicron surge that appeared in late 2021 but McAlister said there’s no reason to suspect much difference among today’s patients.
He said that while Omicron outcomes have been shown to be less severe than the Delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.
“If you’re unvaccinated and you catch Omicron it’s still not a walk in the park,” he said.
This report by The Canadian Press was first published May 16, 2022.
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