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Fourth coronavirus wave plateaus in Spain, but hospitals remain under pressure

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The report released on Thursday by the ministry shows that the 14-day cumulative number of coronavirus cases per 100,000 inhabitants for the country as a whole remains high, at 232.55. But it barely rose three points on the day before, after two days with no change. The experts attribute this to the vaccination campaign and the ongoing social restrictions in most of the country, but they also warn that the situation in Spain is far from good – seven regions and the two North African exclave cities, Ceuta and Melilla, are at “extreme risk” levels, with an incidence above 250, and one in every five intensive care unit (ICU) beds is occupied by Covid-19 patients. Thursday’s report added 132 deaths to the official toll, which now stands at 77,496.

This wave can’t be compared with the previous ones and it appears to be stabilizing now

JESÚS MOLINA CABRILLANA, SPOKESPERSON FOR THE SPANISH SOCIETY OF PREVENTIVE MEDICINE, PUBLIC HEALTH AND HYGIENE

“Caution and prudence,” insists Daniel López-Acuña, a former director of emergencies at the World Health Organization (WHO). After more than a month that has seen the incidence rising – the curve started to go up on March 16 – the 14-day cumulative incidence has plateaued for the last week. On Monday it came in at 230, and by Thursday it had gone up by 2.55 points. “We are in a plateau phase, taking one step forward and one step back,” explains Toni Trilla, head of preventive medicine at the Hospital Clínic in Barcelona. “Perhaps the health system will not suffer so much and I hope that there is a consolidated fall, but we are a bit confused because this wave has not followed the pattern of other waves.”

Some epidemiologists point to the seven-day cumulative incidence, which also confirms the plateau. This data point has been hovering around 108 cases per 100,000 inhabitants in the last seven days, less than 50% of the 14-day figure. “If the seven-day incidence is below 50% of the 14-day incidence, that means that the curve is falling,” explains Jesús Molina Cabrillana, spokesperson for the Spanish Society of Preventive Medicine, Public Health and Hygiene. “This wave can’t be compared with the previous ones and it appears to be stabilizing now. In any case, if there is an uptick, it won’t be a big one. More than a week has now passed since Easter, which is when there could have been an increase in infections, and it is not expected to rise further.”

The speed of transmission of the virus in Spain – the R number, which measures on average how many people a person with the coronavirus infects – is also falling. On April 14, the last day for which there is data, the number had fallen below one for the first time in a month – that is the limit below which the health authorities say that the virus is under control. On that day, it came in at 0.98 – that’s to say, for every 100 positives, another 98 people will be infected. “It is good for this to continue like this,” explains López-Acuña. “But what should guide us is that, if we continue to have a plateau and incidences that are very high and intensive care units with such high occupation, we should be concerned.”

What is clear from the data is that the epidemiological situation varies greatly from region to region. Valencia, for example, is below 40 cases per 100,000 inhabitants, the lowest level in Spain. Galicia, the Balearic Islands and Murcia are also under 100. Madrid and Navarre, however, are as high as 400 cases per 100,000 inhabitants while the Basque Country exceeds 500 cases.

“The overcrowding of people can have a big influence,” explains epidemiologist Joan Caylà. The population density is not the same in Galicia as it is in the metropolitan area of Barcelona. In the case of the Valencia region, what they do very well there is contact tracing and that can be a determining factor for isolating cases and imposing quarantines.”

The toughness of the measures in place – each region can decide its own restrictions – and compliance with the rules, the experts say, constitute another of the determining factors that are seeing the epidemiological curves fluctuate. Valencia, for example, has taken very strict measures and is deescalating very slowly – bars have to close at 6pm, a restriction that is due to be lifted on Monday. Madrid, meanwhile, with an incidence that is 10 times higher, has been a lot laxer with restrictions. Restaurants, for example, are staying open until 11pm.

The experts also assume that the vaccination campaign has also played a key role in the progress of this wave, but there are several nuances here. With just 21.4% of the population so far protected with one shot of the Covid-19 vaccines being used in Spain, above all in the older age groups, the epidemiologists agree that the vaccine has not had such an influence on the infection curve, given that most of the new cases are being registered among young people who have not had the chance to get their shots yet. The big effect, they say, is in terms of the fall in deaths and hospitalizations, where age is a key factor. Vaccination “will have had an influence on the curve of infections,” explains Molina Cabrillana, “but where it has really contributed is with serious illness and mortality. There is currently not the kind of overloading [of hospitals] that we saw in November and January.”

Spain’s ICUs were facing this fourth wave from a starting point of high hospital occupation. On March 16, for example, 20% of beds were occupied by Covid-19 patients, and healthcare professions feared a wave of new cases after Easter week. However, admissions have not, for now, shot up. On Thursday, there were 2,283 coronavirus patients in a critical condition – that is 22.6% of the available ICU beds.

López-Acuña insists on the need for prudence in the current situation. “It is likely that the magnitude of the wave is not so pronounced because there is less mobility than at Christmas, fewer crowds and a segment of the population is protected [by vaccines]. But there are a few worrying elements: community transmission is not under control, and there is an ongoing high occupation of ICUs, with the most severe cases linked to the British strain, which leads to longer hospital stays.” This variant, which is more infectious and was first identified in England, has been predominant in Spain since March.

The experts all coincide with López-Acuña and call for the social restrictions in place and protection measures to be respected, and for people not to drop their guard ahead of time. “The impact on the healthcare system will have to fall if the speed of vaccination accelerates, but it will take time before we see this in terms of infections,” explains Trilla. The European Center for Disease Control (ECDC) has issued a recommendation stating that two people should be able to remove their masks in a closed space if both of them are vaccinated, as well as calling for a relaxation of quarantine and testing requirements for travel for those who have had their vaccine shots. Molina Cabrillana sees this as feasible, but Trilla and López-Acuña say that it is “premature” because it could convey a message of “false security,” and prompt an “excessive relaxation.”

As for the social restrictions, Trilla recommends “asymmetrical measures that are adapted to the scale of each region at any given time.” Molina Cabrillana is calling for people to “hold on a little longer, until we are below 50 cases per 100,000 [inhabitants].” López-Acuña, meanwhile, is insisting that “restrictions continue in closed spaces.” If there is one thing that all the experts consulted by EL PAÍS agree on, it is the major pending task: “Strict contact studies,” Caylà states.

 

Read from source: https://english.elpais.com/society/2021-04-23/fourth-coronavirus-wave-plateaus-in-spain-but-hospitals-remain-under-pressure.html

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NSW COVID-19 hospitalisations pass 1,000 as cases continue to balloon across Australia

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sbs– New South Wales has recorded another 18,278 COVID-19 cases and two deaths as the state’s outbreak continues to surge.

Sunday’s case numbers are slightly lower than Saturday’s 22,577.

The state recorded two deaths from the virus, while 1,066 people are hospitalised, up from 901 on Saturday. There are 83 in intensive care.

At the peak of the Delta outbreak, on 21 September, there were 1,266 people hospitalised with infections, and 244 in intensive care.

Testing numbers to 8pm on the first day of 2022 were down to 90,019, a drop from 119,278 on New Year’s Eve.

The high case numbers come as Premier Dominic Perrottet continues to focus on hospitalisation and intensive care numbers rather than the daily case total.

Despite comprising about six per cent of the population, unvaccinated people make up the majority of those in intensive care, Health Minister Brad Hazzard says.

To ensure hospital systems can cope, asymptomatic health workers who are in isolation due to being a close contact of a positive case will be permitted to leave isolation in “exceptional circumstances”, NSW Health announced on Friday night.

Victoria posts 7,172 cases, extreme heat closes testing sites

The first day of 2022 hasn’t been kind to 7,172 Victorians, the state’s latest residents to contract COVID-19.

A further three virus-related deaths have also been recorded for 1 January.

However the number of Victorian coronavirus patients in hospital care remains relatively stable at 472, up 19 on Saturday’s figure and 48 beyond the seven-day average.

Of them, 52 are classified as active ICU cases and 22 are in need of ventilation.

Chief Health Officer Brett Sutton’s daily update said on Sunday community sampling had revealed 76 per cent of all samples collected over the Christmas period were the Omicron variant. Further testing to confirm this is being undertaken over the next week.

In total, Victoria is managing 31,461 active COVID-19 cases.

Health authorities says virus testers managed to process 48,252 results in the 24 hours to Saturday evening.

The state is 93 per cent fully vaccinated for everyone aged 12 and over.

Some 7,442 infections were reported on Saturday, another pandemic record. There were 51 actively infectious patients in intensive care and 21 ventilated.

Extreme heat caused the closure of eight of the state’s testing sites on Saturday.

Queensland records 3,587 new cases

Queensland has added 3,587 infections to its COVID-19 caseload as a new indoor mask mandate comes into effect across the state.

Some 16,688 Queenslanders now have the virus. However, hospital numbers remain low with 112 patients in care, five of them in ICUs and none requiring ventilation.

Health authorities say testers processed almost 34,000 results in the 24 hours to 7pm on Saturday.

Queensland is 86.60 per cent fully vaccinated for everyone 16 and over.

Chief Health Officer John Gerrard says despite a jump of more than 1,300 cases in a day, he’s not surprised. In part, the increase is related to a change in reporting protocols which saw case figures taken from a 12-hour window on Friday.

“This number is probably a bit smaller than we had expected,” he said in Brisbane on Sunday of the latest figures.

“It probably (also) relates to testing over the holiday period and so it will not be a surprise at all that in the next couple of days we see a significant increase in cases as more samples are tested and more people come forward.”

Dr Gerrard said what experts were now seeing with the virus was that it was “a vastly different disease” to that which was spreading in the community last year and prior to vaccination.

“With a degree of contagiousness of this virus, we are going to be seeing very large numbers of cases, even though the severity is clearly going to be less,” he said.

“We are going to see very large numbers of cases and a small proportion of a very large number (who fall ill) is still a large number.”

Masks were declared compulsory in “virtually all indoor spaces” in Queensland from 1am on Sunday.

Previously masks were only required indoors at supermarkets, shops, on public transport and ride share as well as airports and planes, cinemas and theatres in Queensland.

They now need to be worn at workplaces unless unsafe to do so, pubs, clubs and cafes unless when seated, indoor stadiums and sport arenas, libraries, hair dressers and nail salons, and medical centre waiting areas.

Queenslanders were also urged to return to work-from-home arrangements where possible.

SA hospitalisations ‘very much within capacity’

South Australia, meanwhile, recorded 2,298 COVID-19 cases on New Years Day from 21,140 tests.

The newest caseload is up from 2,108, while hospitalisations have also risen by 11.

There are currently 82 people in hospital, Premier Steven Marshall said on Sunday, a number which he said was “still very much within our current capacity”.

Seven people are in ICU.

“We see a lot of admissions but also a lot of people are leaving hospital on a daily basis after their conditions have stabilised,” Mr Marshall told reporters on Sunday.

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US follows UK’s lead and shortens isolation for healthcare workers who test positive for Covid-19

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independent– Healthcare workers who test positive for Covid-19 and are asymptomatic only need to isolate for seven days, the Centers for Disease Control and Prevention (CDC) has said.

The CDC reduced the recommended isolation time from 10 days in part due to concerns that the highly transmissible Omicron variant could cause even greater staffing shortages at hospitals.

In new guidance released on Thursday, the CDC said infected healthcare workers could return to work after a week as long as they were asymptomatic and produced a negative test.

The US recorded 261,339 new cases on Thursday, according to data from Johns Hopkins University.

Earlier this week, the UK Health Security Agency announced that essential workers would be allowed to return after a seven-day isolation period amid a worsening staffing crisis in hospitals.

In a statement, CDC Director Rochelle Walensky said it was updating guidelines in response to an “anticipated surge” in patients due to the Omicron variant.

“Our priority, remains prevention—and I strongly encourage all healthcare personnel to get vaccinated and boosted.”

Dr Walensky added that health care workers who were fully vaccinated, including with a booster shot, did not need to isolate after a high-risk exposure.

On Friday, New York Governor Kathy Hochul announced that essential workers who tested positive could return to their jobs after five days if they were fully vaccinated and asymptomatic, and had not had a fever within the past 72 hours.

“This is not Delta, or the first variant,” Ms Hochul said during a live address.

“This is Omicron, and thus far it has demonstrated it’s not as severe in its impact, and therefore we want to make sure that our critical workforce, who we’ve relied on from the beginning, can get back to work.”

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Covid booster jab triggers immune response in days, not weeks, say scientists

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independent– Those who receive a Covid booster jab can expect to mount an immune response in a matter of days – not weeks, scientists say.

The boosters have been shown to restore the body’s immunological defences against Omicron, which appears capable of infecting those who are double-jabbed.

While it takes up to two weeks to prime the immune system against Covid after a first dose, the effects of a booster jab start to be felt within two to three days, experts believe.

“The immunity generated after a booster jab will rise much quicker than the first immune response,” said Gary McLean, a professor in molecular immunology at London Metropolitan University.

That’s because crucial memory cells activated after the first dose will still be present in the body, Prof McLean explained, and therefore “do not require the two-week activation and instruction phase they initially go through”.

These memory cells – T and B – are responsible for hunting down infected cells and producing antibodies that stop the virus from gaining entry in the first place.

Their continuing presence means the immune system is on high alert and ready to spring back into action at the earliest sight of the virus, or anything that mimics it.

“That can then translate into boosted antibody levels and other increases in active T cells within days of the booster,” said Prof McLean. “It is likely that maximal immune activity is reached seven days after the booster.”

Professor Charles Bangham, an immunologist and co-director of the institute of infection at Imperial College London, said that in a secondary or subsequent immune response, T cells and antibodies should start to be detectable within “two to three days” of a booster.

The boosters appear to be 70 per cent effective against omicron infection – and are thought to offer even higher protection from hospitalisation and death – but scientists are concerned that the UK rollout won’t be able to keep up with the spread of the variant.

Doubling at a rate of every two days, Omicron has fuelled a sudden lift in national cases. On Thursday, 88,376 new Covid cases were reported, setting a new pandemic record for the second day running.

However, infections are thought to be running at far higher levels. The UK Health Security Agency said it expects there to be more than one million infections a day by the end of the month.

The government, meanwhile, has set the ambitious target of rolling out one million boosters a day to counter Omicron, and intends to have offered all eligible adults one by the close of the year. Some 745,183 third doses were given on Thursday, bringing the national total to 25.4 million.

Recent research from Israel suggests that rates of infection, severe disease and death from Delta were reduced after three to seven days post-boost – but reduced more after 12 days post-boost – when using the Pfizer vaccine for all three jabs.

The UK’s Cov-Boost study, which investigated the benefits of a booster jab among people who had received doses of the Pfizer or AstraZeneca vaccine, also pointed to an increased immune response by day seven.

“This ‘secondary immune response’ is more rapid than observed following the ‘priming’ course of vaccination, when the body takes 14 days or longer to ‘prime’ the antibody-producing B cells to produce antibody against the virus,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London.

“However when virus antigens [an immune-triggering structure] are ‘re-encountered’ – either by a boosting shot of vaccine or by exposure to infection – these cells react very rapidly to produce antibody more quickly.”

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