THUNDER BAY – COVID-19 Update – Ontario has seen COVID-19 numbers spike on Christmas Eve. Ontario has reported 9,571 new COVID-19 cases as well as six deaths as a result of the virus.

This is the largest number of single day cases reported in Ontario since the start of the pandemic.

Globally similar massive increases in Coronavirus

Italy reports 50,599 new coronavirus cases, representing the biggest one-day increase on record.

Britain is reporting 122,186 new coronavirus cases, again the biggest one-day increase on record.

Australia reported 9,119 new coronavirus cases, the biggest one-day increase on record.

There are now 70.000 Americans who are hospitalized with COVID-19 the largest number since October 3rd.

U.S. COVID update: Cases continue to surge, highest since January – New cases: 270,271 – Average: 185,303 (+17,827) – States reporting: 43/50 – In hospital: 69,871 (+988) – In ICU: 16,602 (+152) – New deaths: 1,112.

Update on Omicron

The Enhancing Readiness for Omicron (B.1.1.529): Technical Brief and Priority Actions for Member States, issued on 23 December, is an update to the last version published on 17 December 2021.

Overview

• On 26 November 2021, WHO designated the variant B.1.1.529 a variant of concern (VOC), following advice from the WHO’s Technical Advisory Group on Virus Evolution.  The variant has been given the name Omicron.  Omicron is a highly divergent variant with a high number of mutations, including 26-32 mutations in the spike protein, some of which may be associated with humoral immune escape potential and higher transmissibility.
• As of 22 December 2021, the Omicron variant had been identified in 110 countries across all six WHO Regions.  Current understanding of the Omicron variant continues to evolve as more data become available.  This technical brief provides updated early evidence on key aspects of Omicron related to transmission, severity and impact on interventions such as diagnostics, therapeutics and vaccines, and outlines a set of priority actions for Member States.
• The overall threat posed by Omicron largely depends on four key questions:(1) how transmissible the variant is; (2) how well vaccines and prior infection protect against infection, transmission, clinical disease and death; (3) how virulent the variant is compared to other variants; and (4) how populations understand these dynamics, perceive risk and follow control measures, including public health and social measures (PHSM).  Public health advice is based on current information and will be tailored as more evidence emerges around those key questions.
• There is consistent evidence that Omicron has a substantial growth advantage over Delta.  It is spreading significantly faster than the Delta variant in countries with documented community transmission, with a doubling time of 2-3 days.  Growth rate estimates in South Africa are now declining, driven largely by the declining rates in Gauteng province.  It remains uncertain to what extent the observed rapid growth rate since November 2021 can be attributed to immune evasion or intrinsic increased transmissibility, but is likely a combination of both.  At the time of writing, estimates of generation times for Omicron are still needed to better understand the observed dynamics.
• Data on clinical severity of patients infected with Omicron is growing but is still limited.  Early data from South Africa, the United Kingdom and Denmark suggest a reduced risk of hospitalization for Omicron compared to Delta.  However, the risk of hospitalization is only one aspect of severity, which may be altered by admission practices.  More data across different countries are needed to understand how clinical markers of severity – such as the use of oxygen, mechanical ventilation and deaths – are associated with Omicron.  At the present time, it is still unclear to what extent the observed reduction in risk of hospitalization can be attributed to immunity from previous infections or vaccination and to what extent Omicron may be less virulent.
• Preliminary data from several non-peer reviewed studies suggest that there is a reduction in neutralizing titers against Omicron in individuals who have received a primary vaccination series or in those who have had prior SARS-CoV-2 infection. In addition, the increased risk of reinfection reported in England, the United Kingdom , as well as a growing trend of reinfection cases in Denmark and Israel, can be potentially attributed to immune evasion against Omicron.
• To date, there are still limited available data, and no peer-reviewed evidence, on vaccine efficacy or effectiveness for Omicron.  Preliminary findings of vaccine effectiveness studies (test-negative design) have been released from South Africa and the United Kingdom.  Available preliminary data should be interpreted with caution because the designs may be subject to selection bias and the results are based on relatively small numbers.  Results from the United Kingdom indicate a significant reduction in vaccine effectiveness against symptomatic disease for Omicron compared to Delta after two vaccine doses of either Pfizer BioNTech-Comirnaty or AstraZeneca-Vaxzevria vaccines.  There was, however, higher effectiveness two weeks after a Pfizer BioNTech-Comirnaty booster, which was slightly lower or comparable to that against Delta.  A non-peer-reviewed study by South African researchers using private health insurance data reported reductions in vaccine effectiveness of the Pfizer BioNTech-Comirnaty vaccine against infection, and to a lesser degree against hospitalization.  Details about the methods or results were not available at the time of writing.
• The diagnostic accuracy of routinely used PCR and antigen-based rapid diagnostic test (Ag-RDT) assays does not appear to be impacted by Omicron; studies of the comparative sensitivity of Ag-RDTs are ongoing.  Most Omicron variant sequences reported include a deletion in the S gene, which can cause an S gene target failure (SGTF) in some PCR assays.  Although a minority of publicly shared sequences lack this deletion, SGTF can be used as a proxy marker to screen for Omicron.  However, confirmation should be obtained by sequencing, since this deletion can also be found in other VOCs (e.g. Alpha and subsets of Gamma and Delta) that are circulating at low frequencies worldwide.
• Therapeutic interventions for the management of patients with severe or critical Omicron-associated COVID-19 that target host responses (such as corticosteroids, and interleukin 6 receptor blockers) are expected to remain effective.  However, preliminary data from non-peer reviewed publications suggest that some of the monoclonal antibodies developed against SARS-CoV-2 may have decreased neutralization against Omicron.  Monoclonal antibodies will need to be tested individually for their antigen binding and virus neutralization, and these studies should be prioritized.

Being Safer – World Health Organization Update

By Dr Soumya Swaminathan, Chief Scientist, World Health Organization

Whether it is the family gatherings for Christmas or people congregating in city centres as the bell strikes midnight on New Year’s Eve, there is concern that large numbers of people mixing during the holiday season could result in spikes of COVID-19 infections. Indeed, many people who will be celebrating are asking how best to stay safe over the festive period.

With the new variant, Omicron, showing exponential growth and high transmissibility, there are certain things you can do to keep yourself and loved ones safe during this period.

The first line of defence is vaccination. Although vaccines appear to be less effective in preventing infection with Omicron, they still offer significant protection against a severe form of the disease that may necessitate hospitalization. So if you have not gotten vaccinated, this is a great time to do so. And if you’re immunocompromised or at-risk, getting boosted can help boost your immunity to the virus.

While wealthier countries have over 70% of their populations vaccinated and are rushing to offer booster shots, low-income countries have not even been able to vaccinate all their health workers and most at-risk populations. The vaccines have not been shared fairly, which WHO has consistently said leaves us open to new variants appearing, which could undermine our current health tools and drive further waves of the virus.

Vaccine nationalism and hoarding of vaccines by some countries has undermined equity, and created the ideal conditions for the emergence of the Omicron variant in a region which has low vaccination coverage.

Perhaps this holiday season, we can reflect on the injustice of vaccine inequity and increase public pressure on governments and manufacturers to do more to share licenses and transfer technology and know-how, especially with the new WHO-led mRNA Tech Transfer Hubs, the first of which has been established in South Africa. In the midst of the worst pandemic in 100 years, it seems ludicrous that all barriers, including to intellectual property have not been shared.

While vaccination is crucial to combatting the pandemic, it is not enough. The last two years have been tough and although we are tired of the pandemic, the virus is not tired of us. While it is critical for our mental and physical health to see loved ones, the gathering of large crowds is where the virus can be particularly prolific. We are starting to see examples from aeroplanes, nightclubs and even hotel quarantine where the Omicron is spreading more efficiently than ever.

The new variant appears to be the most transmissible so far and able to breakthrough vaccine protection more easily than Delta or other variants preceding it. Although immunity conferred not only by antibodies but by B and T cells (which are harder to measure) reduces risk of severe illness and death, clearly the threat remains and so public health and social measures remain critical tools to reducing the number of infections.

Given that COVID-19 is a respiratory virus, which spreads mainly through the air via aerosols (small droplets) and larger droplets, it is important to know how best to keep oneself safe. By talking, singing and even just breathing, people with COVID-19 can easily pass the virus to others. Obviously the closer you are and longer time you spend with someone that is sick, the more likely you are to get the virus.

Viral transmission is further optimized in indoor settings where windows and doors are closed, ventilation is poor and where people are not wearing masks. When cases are spiking, there is always the option to work and connect on digital platforms, but I understand the fatigue with using video sharing platforms for far too many aspects of our lives. We often need that physical connection for all aspects of our health.

And it is possible to minimize risk and keep yourself and loved ones safe. For example, if you are going to meet friends or family, try to do so outside and in as small a group as possible. If it is inside, try and keep windows open so that there is a regular exchange of air from outside. If it is too cold, open them regularly so fresh air can circulate. Good quality, well-fitting masks worn correctly can really help reduce infection and the latest evidence suggests that universal mask wearing can reduce chances of infection significantly. In fact, masks have been described as a vaccine in your pocket and the WHO has detailed guidelines on how to make high quality masks.

Everyone who is eligible should get vaccinated as soon as possible. However, even if you are vaccinated and you try your best to stay safe, Omicron is still so transmissible that you could come into contact with the virus at some point. If you start to feel symptoms, it is important to test as quickly as possible. While you await results, try and isolate from other people so you can break the chain of transmission.

The importance of testing early is also linked to the effectiveness of administered treatment, so the sooner people know whether they are sick, the easier it is to determine when they need to be treated or whether they need hospitalization. Luckily, new oral treatments which reduce the severity of COVID-19 are becoming available.

Festive seasons are difficult to navigate during a pandemic but through vaccination and public health measures, there are ways to minimize risk and still spend time with loved ones. As this year ends and another starts, I am as optimistic as ever that if governments and citizens work together, we can get through the acute stage of this pandemic together and use that momentum to tackle the other challenges of our time.