Virus World

SHANGHAI, March 27 (Reuters) - China's financial hub of Shanghai said on Sunday it would lock down the city in two stages to carry out COVID-19 testing over a nine-day period, after it reported a new daily record for asymptomatic infections. Authorities said they would divide Shanghai into two for the exercise, using the Huangpu River that passes through the city as a guide. Districts to the east of the river, and some to its west, will be locked down and tested between March 28 and April 1. The remaining areas will be locked down and tested between April 1 and 5. Public transport, including ride-hailing services, in these areas will be suspended when they are locked down, the city government said on its official WeChat account, adding that unapproved vehicles will not be allowed on the roads. It also said that all firms and factories will suspend manufacturing or work remotely during the lockdown, apart from those involved in offering public services or supplying food.

"The public is asked to support, understand and cooperate with the city's epidemic prevention and control work, and participate in nucleic acid testing in an orderly manner," the government added. Shanghai has battled a new COVID-19 surge for nearly a month and for Saturday it reported its highest daily number of cases since the initial outbreak in China receded. The city recorded 2,631 new asymptomatic cases, which accounted for nearly 60% of China's total new asymptomatic cases that day, plus 47 new cases with symptoms. While the number of cases in Shanghai remains modest by global standards, the city of 26 million people has become a testing ground for China's "zero-COVID" strategy as it tries to bring the highly infectious Omicron variant under control. Shanghai authorities have previously resisted a broad lockdown of the city to avoid destabilising its economy and opted for a more bespoke "slicing and gridding" approach, which involves screening neighbourhoods one by one.

The French capital and various other areas will have movement restricted as cases rise.  Some 21 million people in 16 areas of France will be placed under the measures from midnight on Friday. These measures will not be as strict as the previous lockdown, Prime Minister Jean Castex said, with people allowed to exercise outdoors. France has recorded more than 35,000 new infections within the past 24 hours. Mr Castex said a "third wave" of infections in the country was looking increasingly likely. The situation in Paris is particularly worrying with 1,200 people in intensive care there, more than at the peak of the second wave in November, Health Minister Olivier Véran said. Under the new measures, non-essential businesses will be forced to close, but schools will remain open, along with hairdressers if they follow a "particular sanitary protocol". Government spokesman Gabriel Attal stressed there would be differences with the two earlier lockdowns and said further details would be given of which business could stay open or would have to shut. People will be allowed to exercise outdoors within 10km (6 miles) of their home and are not allowed to travel to other parts of the country unless they have a valid reason. Those in the affected areas will have to fill out a form to explain why they have left their homes.

Belgium becomes another European country to announce a national lockdown.  With surges accelerating in the United States and Europe, the global COVID-19 case total today passed 45 million with a record single-day high as the World Health Organization (WHO) reports 505,756 new cases so far. Also, Belgium—one of the European countries reporting a surge of infections—today became that region's latest to announce another national lockdown.

Panel experts tweak WHO guidance

At a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said the agency's COVID-19 emergency committee wrapped up its fifth review of COVID-19 developments and unanimously agreed that the situation still warrants a public health emergency of international concern (PHEIC) under the International Health Regulations (IHR). As part of its review, the committee also tweaked its temporary recommendations. Didier Houssin, MD, who chairs the panel, said the main recommendations were for the WHO to update its travel recommendations as more countries make use of testing to assist with safe travel and for member countries to avoid politicizing the virus. In another development, WHO officials said an international expert group met virtually with Chinese counterparts today in advance of a joint effort to investigate the origin of SARS-CoV-2, the virus that causes COVID-19. The WHO also emphasized the importance of addressing the long-term effects of the virus in "long haulers" who have ongoing symptoms and featured testimony from three patients who have faced difficult recoveries. Tedros said their experiences reinforce how dangerous COVID-19 infection can be and how pursuing a herd immunity strategy could lead to a significant number of people facing long roads to recovery.

Belgium announces lockdown

With Europe well into its second COVID-19 surge, Belgium today announced a new national lockdown, which comes just 2 days after France and Germany announced similar measures. On Oct 19, Ireland announced a 6-week lockdown, the first European Union country to do so. Belgium, with the highest infection rate in Europe, ordered nonessential shops and businesses to close starting on Nov 2 through the middle of December, the BBC reported. It also limited gatherings in public spaces to four people and extended the fall school holidays until Nov 15. The country already has a night curfew and has closed restaurants and bars. More than half of Belgium's intensive care unit beds are occupied by COVID-19 patients. Prime Minister Alexander de Cross said the country is in a public health emergency and that the new measures are the last chance to drive down its infection numbers. Elsewhere, COVID-19 activity continued at a brisk pace in other European hot spots, with several reporting more single-day highs, including Spain, Italy, the Netherlands, and Poland. The global total today reached 45,426,712 cases, and 1,185,200 people have died from their infections, according to the Johns Hopkins tracker.

In China, a key metric of epidemics called the serial interval shrank drastically soon after the new coronavirus’s arrival — a finding that underscores the success of China’s testing and isolation efforts. The serial interval is the average time between the onset of symptoms in a chain of people infected by a pathogen. Benjamin Cowling at the University of Hong Kong and his colleagues modelled the spread of SARS-CoV-2 in China and found that the serial interval plummeted from 7.8 days to 2.6 days over a 5-week period starting on 9 January (S. T. Ali et al. Science http://doi.org/gg5mpc; 2020).

The researchers say that early isolation of cases prevented transmission that would otherwise have occurred later in an infectious period, leading to fewer cases and slowing the spread of the virus. As a result, most of the remaining transmissions occurred either before infected people showed symptoms or early in the symptomatic phase, and the serial interval shrank. The authors suggest the serial interval distribution be used in real time to track the changing transmissibility of the virus.

Original study published in Science (July 21, 2020):

https://doi.org/10.1126/science.abc9004

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

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.

A year after the virus began spreading in Europe, things feel unnervingly the same.  A year after Italy became the first European country to impose a national lockdown to contain the spread of the coronavirus, the nation has fallen eerily quiet once again, with new restrictions imposed on Monday in an effort to stop a third wave of infections that is threatening to wash over Europe and overwhelm its halting mass inoculation program. As he explained the measures on Friday, Prime Minister Mario Draghi warned that Italy was facing a “new wave of contagion,” driven by more infectious variants of the coronavirus. Just as before, Italy was not alone. “We have clear signs: The third wave in Germany has already begun,” Lothar Wieler, head of the Robert Koch Institute for Infectious Diseases, said during a news conference on Friday. Prime Minister Viktor Orban of Hungary predicted that this week would be the most difficult since the start of the pandemic in terms of allocating hospital beds and breathing machines, as well as mobilizing nurses and doctors. Hospitalizations in France are at their highest levels since November, prompting the authorities to consider a third national lockdown.  Officials in the United States are watching those developments with wary eyes. At a White House news briefing on Monday, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, pleaded with Americans not to let their guard down as case numbers have dropped from their peak. She pointed to images of young people crowded onto Florida beaches, though generally people are safer outside than inside, and to European nations as a warning.

“Each of these countries has had nadirs like we are having now, and each took an upward trend after they disregarded no mitigation strategies,” she said. “They simply took their eye off the ball. I’m pleading with you for the sake of our nation’s health. These should be warning signs for all of us.”  The U.S. death rate remains at nearly 1,400 people every day. That number still exceeds the summer peak, when patients filled Sun Belt hospitals and outbreaks in states that reopened early drove record numbers of cases, though daily deaths nationwide remained lower than the first surge last spring. The average number of new reported cases per day remains comparable to the figures reported in mid-October. Across Europe, cases are spiking. Supply shortages and vaccine skepticism, as well as bureaucracy and logistical obstacles, have slowed the pace of inoculations. Governments are putting exhausted populations under lockdown. Street protests are turning violent. A year after the virus began spreading in Europe, things feel unnervingly the same. In Rome, the empty streets, closed schools, shuttered restaurants and canceled Easter holidays came as a relief to some residents after months of climbing infections, choked hospitals and deaths.

“It’s a liberation to return to lockdown, because for months, after everything that happened, people of every age were going out acting like there was no problem,” said Annarita Santini, 57, as she rode her bike in front of the Trevi Fountain, a popular site that had no visitors except for three police officers. “At least like this,” she added, “the air can be cleared and people will be scared again.” For months, Italy had relied on a color-coded system of restrictions that, unlike the blanket lockdown of last year, sought to surgically smother emerging outbreaks in order to keep much of the country open and running. It does not seem to have worked. “History repeats itself,” Massimo Galli, one of Italy’s top virologists, told the daily Corriere della Sera on Monday. “The third wave started, and the variants are running.” “Unfortunately we all got the illusion that the arrival of the vaccines would reduce the necessity of more drastic closures,” he said. “But the vaccines did not arrive in sufficient quantities.”

The new coronavirus tears through areas where residents generally keep to their own small, close-knit communities. But the virus takes its time spreading in crowded cities where residents of different neighbourhoods tend to intermingle, ultimately infecting more people than in the relatively isolated areas. Moritz Kraemer at the University of Oxford, UK, and his colleagues modelled the spread of SARS-CoV-2 through communities of various sizes and population densities(B. Rader et al. Nature Med. https://doi.org/fcjk; 2020).

The researchers validated their model by comparing its output with known data on individual movements and infection rates in crowded Chinese cities such as Wuhan and less densely packed provinces in Italy. The team’s model predicts relatively short, intense spikes in COVID-19 cases in relatively uncrowded cities where residents stick to their own neighbourhoods rather than mingling freely. In crowded cities, however, people are more likely to have to cope with outbreaks that last longer than do those in the countryside. The researchers applied their model to 310 cities worldwide, and predict that those with relatively even population distributions, such as Ulaanbaatar in Mongolia, could expect a short-term explosion in cases. But more densely settled urban centres, such as Madrid, can expect more protracted outbreaks.

Published in Nature Medicine (October 5, 2020):

https://doi.org/10.1038/s41591-020-1104-0

In a major step back from reopening measures in June, California Governor Gavin Newsom closed indoor dining, bars, and entertainment venues statewide, and also closed churches, hair and nail salons, gyms and malls in 31 counties. The 30 “monitoring list” counties contain approximately 80 percent of the state’s population, including Alameda (Oakland), Napa, Sonoma, Sacramento, Marin, Fresno, and Monterey counties in the northern and central parts of the state and most counties in Southern California, including Los Angeles and San Diego.

Newsom’s actions were taken in the midst of troubling developments in the Golden State: Coronavirus hospitalizations have risen by about 28 percent over the last two weeks, from 5,077 on June 29 to 6,485 as of Sunday. In the last week, the state’s seven-day average of positive coronavirus tests rose from 7,876 on July 6 to 8,211 on Monday. The state’s positivity rate has also continued trending north of 7 percent even as the number of tests across the state has surpassed 100,000 per day. In the early days of the pandemic, California was among the toughest states in imposing restrictions on activities associated with the spread of the coronavirus. But last month it began allowing local governments to relax restrictions, as the Los Angeles Times points out:  The setback comes after the state said June 12 that dine-in restaurants, retail stores, bars, religious services, and gyms could reopen with modifications in counties that met the state’s guidelines. Newsom said the move Monday to resurrect tough restrictions was a response to a rise in COVID-19 hospitalizations in the state. 

The governor ordered tougher restrictions ahead of the July 4 holiday on indoor activities for counties experiencing a spike in infections. Counties are placed on a watch list when they experience a rise in hospitalization rates, community transmission or declining hospital capacity, with three consecutive days of troublesome trends requiring the area to add the restrictions.

How Covid-19 has affected health and economics around the world? Nearly every nation on earth is struggling to reopen its economy safely while continuing to battle the coronavirus. But some are doing better than others. We’ve mapped the performance of 30 leading countries by plotting their health and economic outcomes and grouping them based on whether they have instituted light, moderate or severe restrictions on commerce and social interactions. The coronavirus pandemic has spread across countries at different times, and each has responded differently depending on their health and political systems, as well as their economies. Despite some bright spots, nearly every country presents a mixed picture.

This matrix considers countries' bottom lines when it comes to infections, deaths, GDP and unemployment, as well as how those metrics were shaped by specific government interventions. Germany, for example, has diverse but relatively bad outcomes overall. Its economy is sinking at the same rate as its neighbors, but its death rate is significantly lower than theirs, thanks to widely lauded testing and health care.That said, Berlin’s official count of Covid-19 deaths in nursing homes is both slow and patchy. Some countries test widely (Iceland) and count all possible Covid-19 deaths (Belgium), skewing their numbers compared to less transparent countries (Russia). New Zealand and Sweden took opposite approaches to restricting their populations’ movement and have very different health outcomes, but nearly identical recessions. Several countries have similar GDP numbers but starkly different unemployment rates (the U.S., the U.K. and Japan), a function of whether the government guarantees workers’ salaries. 

India avoided overwhelming its fragile health system via the world’s biggest lockdown, but that, in turn, tanked its economy, which might contract 45 percent this quarter. Taiwan, meanwhile, did nearly everything right in terms of its response to the health crisis, but can’t escape the fact that 70 percent of its GDP comes from hard-hit export sectors.....