Increase in infections, Vaccine Mandatory for Children, and Restrictions for the Unvaccinated: COVID-19 Global Weekly Highlights

Medscape, Univadis, & MediQuality Staff

November 12, 2021

These are the global coronavirus stories you need to know about this week.

In the UK, despite criticism from the doctors' union the British Medical Association (BMA), the Government is making the COVID-19 jabs mandatory for NHS staff in England from April. The move follows compulsory vaccination in England’s care sector. This is coming at a time that a majority of health leaders are worried about the NHS reaching a "tipping point." They believe staff shortages across the NHS are putting patient safety and care at risk. Earlier in the week, the regulator MHRA has approved the first oral antiviral for COVID-19, molnupiravir (Lagevrio), which is recommended to be taken immediately after a positive COVID-19 test and within 5 days of symptoms onset. A gene that doubles the risk of respiratory failure and death from COVID-19 has been identified in 60% of South Asians but only 15% of Europeans, which might help explain the excess deaths in some ethnic groups over others. In another study, around 1 in 5 people infected with SARS-CoV-2 don’t develop anti-N antibodies. Also, in patients with non-valvular atrial fibrillation, the use of warfarin compared with direct oral anticoagulants (DOACs), was shown to be associated with a lower risk of developing SARS-Cov-2 infection. COVID-19 cases remain high and stand at around 33,000 per day at a rate of 379.4 per 100,000 population. Deaths have continued to rise but there has been a 7.8% decrease in hospital admissions. So far, 79.8% of over-12s are fully vaccinated and there has been a 3.9% increase in those who have received a third vaccine dose or booster. 

Belgium's Federal Health Minister Frank Vandenbroucke has issued an "urgent" plea to workers and businesses to go back to working from home where possible. With more than 7000 newly confirmed infections per day (up 4% compared to last week), Mr Vandenbroucke said it was everyone's responsibility to limit their close contacts with immediate effect. In vaccination news, anybody living in Belgium who has received both AstraZeneca coronavirus doses or the one-dose Johnson & Johnson vaccine could soon receive an extra dose. Currently, booster doses are being administered with Pfizer and Moderna vaccines to vulnerable groups. This strategy is expected to be adopted before the end of the week. 

While the incidence rate of COVID-19 climbs in France (75 per 100,000 population), President Emmanuel Macron announced that from December 15, people over 65 and the those that are most vulnerable will need to show proof of a booster dose. Their health pass will no longer be valid if the booster dose has not been completed within 6 months and 5 weeks following the injection of their second dose. In addition, noting that more than 80% of people admitted to intensive care are over 50 years old, he indicated that a vaccination booster campaign would be organized for those aged 50-64 years.

Also, the French National Authority for Health has indicated that it does not recommend the administration of the Spikevax vaccine from Moderna as a primary vaccination or as a booster dose in people under 30 years of age. This recommendation follows the latest data from the Epi-PHARE pharmacovigilance study , which confirms the risk of very rare cases of myocarditis occurring in the youngest age groups. On the other hand, the Moderna vaccine will remain as the primary vaccine for the over 30s, as data show it is slightly more effective than Pfizer.

On a therapeutic level, the COVID-02 system for home care and remote monitoring of COVID-19 positive patients under oxygen therapy has been a success. The study, conducted in three waves, included 381 patients and avoided 7005 days of hospitalisation.

In Portugal, there is concern about the resurgence of COVID-19. According to an report published on Monday by professors at the Faculty of Sciences of the University of Lisbon (FCUL), the most recent indicators show that the number of new cases "is expected to double every 30 days, approximately, which means that we could reach 2000 cases a day in the first half of December". For researchers, the pandemic activity in early November in the country suggests the occurrence of a possible fifth wave. However, because of the high amount of vaccinations and the booster dose, less pressure on the hospital system is expected.

According to the joint epidemiological bulletin of the Directorate-General for Health and the National Institute of Health, Dr Ricardo Jorge, released on November 8, the national incidence rate rose from 106.1 to 116.9 cases of infection per 100,000 population. The transmissibility index (R number) went from 1.04 to 1.08.

On November 4, Portugal delivered to Mozambique, Africa, another 187,200 vaccines from Oxford/AstraZeneca. With this fourth batch of delivery, a total of 547,000 doses were made available to the country. In total, Portugal has already donated 1,616,600 vaccines and syringes under the Action Plan for the Health Response to the COVID-19 Pandemic between Portugal and the Portuguese Speaking African Countries (PALOP) and Timor-Leste.

In Italy, the incidence at a national level has exceeded the threshold of 50 cases per 100,000 inhabitants. Intensive care units occupancy rose, from 3.8% to 4.2%, while that of the COVID-19 hospitals rose from 4.5% to 5.2%.

The vaccination campaign seems to have reached a limit: the percentage of eligible people aged over-12 immunised with at least one dose has in fact increased only slightly this week, from 86.33% to 86.53%. Records show 76.3% of the entire population is fully vaccinated. On the other hand, the campaign for additional doses and boosters, which in total exceeded two million doses, is proceeding swiftly. 

On Tuesday, after a rise in the number of infections among protesters from no vax and no Green pass groups, President of the Republic Sergio Mattarella supported limiting the rights of those groups to demonstrate.

Saxony is the first federal state in Germany to introduce '2G' nationwide. This means that only people vaccinated and who have recovered from infection are allowed to enter restaurants, pubs, or clubs. A negative test alone will not be enough. Other federal states could follow suit. For Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians, this is a medically understandable step. What is questionable, he said, is the feasibility of this regulation.

The health offices reported an increase in new COVID-19 infections to the Robert Koch Institute (RKI), highest since the beginning of the pandemic. As of Wednesday, there were 39,676 new cases within one day, according to the RKI. The last peak was 37,120 cases on Friday last week (previous week: 20,398). The 7-day incidence is 232.1, according to the RKI - the third day in a row with a peak (Monday 201.1 and Tuesday 213.7).

With the increase of COVID-19 cases, more operations are being postponed as hospitals have to once again restrict routine surgery. Currently, according to Intensive Care Medicine, about 10% of intensive care beds in Germany are still vacant - which is relatively few, since an intensive care unit consists on average of 12 beds. So, there would usually be only one bed free "for all emergencies that are not just COVID-19," said intensive care physician Dr Christian Karagiannidis.

At the moment, in Switzerland, both the Federal Office of Public Health (FOPH) and the president of the cantonal doctors, Rudolf Hauri, see no reason to introduce the 2G rule- but it cannot be ruled out completely, given the rising infection figures. The number of new infections has doubled in Switzerland in roughly within 2 weeks. Young adults are the most affected. The number of hospitalisations is also rising.

On Tuesday, the FOPH reported 2986 new infections within one day and 64 new hospitalisations - seven died of, or with, a SARS-CoV-2 infection. The number of deaths in elderly and nursing homes is also a concern. This rose significantly by 16.3% during 2020, the first year of the COVID-19 pandemic. In the last 5 years, the number of deaths in these institutions had risen by an average of only 0.2%.

In Austria, 73.1% of the vaccine-eligible population have received an active vaccination certificate as of Monday, 75.8 % have been vaccinated against COVID-19 with at least one dose. The 7-day incidence on November 8 was 655. Broken down by age group, it shows that those between 15- 24 years are the most affected, and those under 5 years is the weakest age group (1029.4 and 191.4). 

The President of the Government in Spain told Congress: "The evolution of the pandemic in our country is positive compared to neighboring countries. We have an incidence far below that of other European countries (52 on Wednesday). Vaccination was "a collective success," he said, and "unparalleled vaccination levels" had been achieved on time.

According to the latest report published on November 10 by the National Institute of Statistics, deaths grew in Spain by 17.9% in 2020 compared to the previous year: 493,776 people died, and the largest increases occurred in March (59.3 %) and April (81.9 %), just at the beginning of the COVID-19 pandemic.

On vaccination , 90.5 % of the target population has received at least one dose, and 88.8 % the full regimen. The phase 1 results of a clinical trial, published on Tuesday in the New England Journal of Medicine, show that a COVID-19 vaccination regimen consisting of two 10-μg doses of BNT162b2, Pfizer, administered 21 days apart was found to be safe, immunogenic, and efficacious in children 5 to 11 years of age.

The pandemic continues in Russia with 38,000 new infections on November 9. On Wednesday, Russia reported a record 1239 deaths from COVID-19 in the previous 24 hours. Health Minister Mikhail Murashko told parliament the same day that oxygen reserves at hospitals in 12 of Russia's regions would last for 2 days or less, unless they were replenished, according to Reuters.

COVID-19 contaminations also continue to break records in some Eastern Europeuan countries such as Ukraine (20,149 new cases), Slovenia (3352 cases), and Croatia (4966 new cases).

Over the last week, 700,000 new cases and 13,000 COVID-related deaths were reported in the Americas. COVID-19 infections are increasing in some countries in the region after 2 consecutive months of decline.

After falling for 2 months, new cases of COVID-19 are inching up once again and some experts have predicted that the US will see another surge in cases over the winter. With roughly 1 in 3 Americans still unvaccinated, modeling experts say there’s still a lot of human "tinder" to fuel COVID’s fire. That’s why it was big news this week that Pfizer’s new antiviral pill is 90% effective at preventing severe outcomes from COVID-19 infection. The company has asked the FDA to grant emergency authorisation for the medication. Drug regulators are also considering another antiviral pill made by Merck. There’s hope that these pills could prevent surges of the virus from overwhelming the healthcare system. The nation began vaccinating children ages 5 to 11 this week, and so far, one million doses have been given to an estimated 28 million American children in this age group.

COVID-19 cases are rising in some parts of Colombia and Bolivia, in the Dominican Republic, Trinidad and Tobago, Barbados, the Cayman Islands, and Dominica.

A reported 48% of people in Latin America and the Caribbean have been fully immunised against COVID. Meanwhile, PAHO has signed supply agreements with three manufactures of WHO EUL listed vaccines and it is in final negotiation with a fourth supplier.

Costa Rica is the first country to make the COVID-19 vaccine mandatory for children and teenagers. A reported 55% of its population is fully vaccinated and 73% of the population between 12 and 19 years of age have received at least one dose of the vaccine.

On Monday, eight of the 27 units of the Brazilian federation recorded no COVID-19 deaths.

The 7-day moving average of deaths remains below 250. It was the first time since the beginning of the pandemic that Minas Gerais and São Paulo had no COVID-19 deaths.

On the same day, the country registered 118 deaths by COVID-19 and 6152 new cases of SARS-CoV-2 infection. In total, since the beginning of the pandemic, Brazil has lost 609,602 lives and 21,883,980 infected people. As for vaccination, 56.52% (120,558,047 people) of Brazilians have complete their vaccination schedule and 73.16% of the population took the first dose (156,060,719 people). Booster doses were given to 10,432,072 people (4.89% of the population).

On Saturday, in an open letter, 21 Brazilian scientists refused to receive one of the highest honours in the country, the National Order of Scientific Merit, after the President of the Republic withdrew two names from the list. One of those excluded was researcher Marcus Lacerda, author of one of the first studies on the ineffectiveness of chloroquine against COVID-19. The other exclusion was Adele Benzaken, who was fired as head of the Ministry of Health's HIV/AIDS department when the president took office in 2019, after the publication of a health education booklet aimed at trans men.

In Africa so far there have been 8,614,000 reported infections and 220,000 reported deaths due to COVID-19.

In partnership with the Pandemic Action Network, the African Union Office of the Youth Envoy, African Youth Front on Coronavirus, Resolve to Save Lives, and over 70 other organisations, Africa CDC has launched a campaign "Africa Mask Week 23-30 November 2020" to encourage and increase consistent and proper mask-wearing across Africa.

According to Africa CDC, the African continent has administered at least one vaccine dose to 8.90% of its population, while 5.88% have the complete regimen.

On Wednesday, malls and shops in Auckland, New Zealand re-opened for the first time in 3 months. However, the hospitality sector remains closed and is likely to re-open only after the city has met a certain vaccination target. On Tuesday, thousands participated in a protest against COVID-19 restrictions outside the parliament in Wellington. 

On Monday, Sydney, Australia, further eased COVID-19 restrictions after nearing the 90% full vaccination milestone. The limits on house guests and outdoor gatherings have now been lifted for vaccinated individuals. 

In response to the increasing number of serious and critical COVID-19 cases, South Korea has urged its citizens to have COVID-19 boosters. Individuals aged 60 and above account for 93% of the serious/critical vaccine breakthrough infections in the country. The country is also set to purchase 70,000 courses of Pfizer's experimental antiviral drug against COVID-19.

In a bid to counter vaccine hesitancy, Singapore has announced that unvaccinated COVID-19 patients will have to meet their own medical expenses next month. 

On November 7, Japan recorded zero daily COVID-19 deaths for the first time in over a year.

Vietnam has approved India's COVID-19 vaccine, Covaxin for emergency use, making it the 9th vaccine to receive approval in the country. Earlier in July, the government announced plans to procure 15 million doses of Covaxin.

Beximco pharmaceuticals, based in Bangladesh, will soon begin selling the first generic version of Merck's oral COVID-19 drug, molnupiravir. 

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.


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