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COVID-19's shifting impact: the changing relationship between infections and severe outcomes – News-Medical.Net

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A recent study published in the PLOS Biology Journal explored the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalization (IHR) and fatality (IFR) ratios in England over 23 months.

Study: Dynamics of SARS-CoV-2 infection hospitalisation and infection fatality ratios over 23 months in England. Image Credit: AlexanderSteamaze/Shutterstock.com

Background

SARS-CoV-2 has globally increased morbidity and mortality rates. England witnessed a massive surge in hospitalizations and deaths after SARS-CoV-2 Alpha emerged.

Consequently, a national lockdown was imposed in January 2021 to curb social contact, with the concurrent implementation of a mass vaccination program.

As a result, coronavirus disease 2019 (COVID-19) cases, hospitalizations, and deaths declined sharply in early 2021. Restrictions were gradually eased after March 2021, and the pandemic re-entered a growth phase with the emergence of the SARS-CoV-2 Delta in April 2021.

All domestic restrictions were removed in July 2021, with society reopening to an extent unseen since the start of the pandemic.

Restrictions were not since re-introduced at a large scale, even when the prevalence was high late in 2021 and during the Omicron waves.

Evaluating the trends between infection levels and hospitalization rates can help inform public health agencies and governments to implement proportionate and appropriate restrictions. When IHR and IFR are accurate, severe outcomes could be forecast over the short term.

The study and findings

In the present study, researchers explored the dynamics of SARS-CoV-2 IHR and IFR in England over 23 months. They used data from the real-time assessment of community transmission (REACT)-1 study that conducted 19 cycles of surveys from May 2020 to March 2022. Persons aged five or older were contacted for participation and sent a self-administered swab test.

Data on COVID-19 cases, hospitalizations, deaths, and vaccinations were accessed from an official government website. The time lag from swab positivity to the occurrence of severe outcomes declined throughout the study.

There was a time lag of 19 days to hospitalization and 26 days to death during REACT-1 cycles 1-7 (May 1 to December 3, 2020).

During cycles 14-19 (September 9, 2021, to March 31, 2022), time lags were shorter at seven days to hospitalization and 18 days to death. Contrastingly, time lags were extremely long during cycles 8-13 (December 30, 2020, to July 12, 2021) at 24 days to hospitalization and 40 days to death. The IHR and IFR were estimated to be 2.6% and 0.67%, respectively, during cycles 1-7.

IHR was 0.76%, and IFR was 0.09% during cycles 14-19. The IHR and IFR were far lower for participants aged 64 or younger than those aged 65 or above during cycles 1-7 and 14-19.

The team compared the average IFRs and IHRs over four-week intervals to a baseline period (May 1 to November 11, 2020).

The average IFR was 1.68 and 1.31 times greater than the baseline in late November 2020 and January 2021, when SARS-CoV-2 Alpha accounted for 15% and 86% of cases, respectively. The average IHR and IFR reduced to 0.51 and 0.25 of baseline in April 2021, when 47% of the population had received at least one vaccine dose.

The average IHR and IFR were 0.84 and 0.43 of baseline in June-July 2021, respectively, when the Delta variant accounted for 99% of infections and 50% of the population had been double vaccinated.

IHR and IFR showed a steady decline from September 2021 and were sharply reduced in December 2021, when the proportion of booster vaccine recipients increased.

The mean IHR was 0.62%, and the average IFR was 0.06% by March 2022, when the Omicron variant caused over 99% of cases. The time lag between swab positivity and daily case numbers varied throughout the study and was three days, -7 days, and one day during cycles 1-7, 8-13, and 14-19, respectively.

The case ascertainment rate, defined as the proportion of cases identified with a positive test through mass testing, was 36.1% overall and varied throughout the study.

It increased from around 20% in July 2020 to 30% during August-December 2020, with a sharp surge between May and July 2021 and a steep decline between December 2021 and March 2022.

Conclusions

The researchers illustrated the temporal relationship between community prevalence of SARS-CoV-2 infection and severe outcomes.

They estimated SARS-CoV-2 IHR, IFR, and case ascertainment rates by assessing the differences in the swab positivity estimates and the time lag of COVID-19 cases, hospitalizations, and deaths.

The findings revealed a decline in SARS-CoV-2 infection severity over time in England. Community-based studies like REACT-1 can provide unbiased temporal estimates of infection levels, allowing for rapid detection of IHR or IFR changes.

Appropriate interventions can be implemented with early warnings when they are highly effective.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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