It is now two years since reports first started emerging from Wuhan in China about a new virus causing a severe respiratory illness. The COVID-19 pandemic has affected virtually every country worldwide with more than 330 million cases and over 5.5 million deaths reported at the time of writing. (1)
The past two years have seen people living through lockdown regimes, travel restrictions and the curtailing of normal everyday life. Already over-stretched hospitals have been brought to their breaking points all around the world.
In the world of science research into both vaccines and treatments for COVID-19 developments has moved apace showing what is possible when there is a collective effort.
We have become familiar with terms such as social distancing, R numbers, PCR & lateral flow testing and learnt many letters of the Greek alphabet as they are used to denote successive variants of the virus.
So where is the world at now? Are there any glimmers of hope that the pandemic might be entering its final phase?
The current course of the pandemic
Omicron is spreading across the globe and is now on course to become the dominant variant worldwide.
First identified by scientists in South Africa in November 2021, at least a third of all countries are known to have Omicron. With so many countries unable to carry out the genetic sequencing required to identify specific variants, the reality is that it will be much more wide spread.
Nigeria has re-examined some of its COVID-19 cases and shown that the variant was there from as early as 18 October 2021. By mid-November 2021 we now know it was present in France, India, and Canada. Given the location of these three countries this means Omicron was already in three continents by last autumn: Europe, North America and Asia.
Worldwide spread was inevitable and it was soon being picked up in other parts of Europe, the US and Australia. Many countries reacted by closing their borders and re-instituting lockdowns for their citizens.
The fear at the time was that two variants would run concurrently, Delta and Omicron, causing hospital admissions, serious illness and deaths at far higher rates than seen before.
Omicron emerged as many countries were still dealing with severe Delta outbreaks.
However, Omicron quickly displaced Delta and by December 2021 South Africa was reporting that more than nine out of ten of its COVID-19 cases were caused by Omicron and crucially that Omicron seemed to be causing less severe illness.
Here in the UK Omicron has been traced back to at least mid-November 2021 and by mid-December the same pattern as South Africa was emerging; namely that Omicron was highly infectious and displacing Delta with more than nine out of ten cases here caused by Omicron.
In South Africa, which had already weathered a severe Delta wave, Omicron cases fell just as quickly as they had risen. At the time of writing they continue to fall there and also in the UK too. (2) (3) (4)
Europe
The WHO’s Europe director Hans Kluge has warned that 50% of Europeans will be infected with Omicron over the next two months. Even if Omicron is causing less severe disease, the concern is that hospitals will still be overrun simply by the sheer volume of cases who still need medical support. (5)
Omicron is moving steadily from the east to the west across Europe. Cases in Poland and several eastern European countries are beginning to plateau whilst case rates in countries such as France, Italy and Spain continue to rise rapidly. Most of Europe is seeing an associated increase in deaths although not as severe as with previous variants. (6)
Although the UK is in the far west of Europe it is following a different trend. Admissions to intensive care units and deaths from COVID-19 have remained steady despite the exponential rise in cases through December 2021. Case rates have levelled off and are now dropping to the extent that Dr David Nabarro of the WHO (World Health Organisation) has stated, “The UK can see ‘light at the end of the tunnel’ in tackling Covid and will be one of the first countries to reach the end of the pandemic.” (7)
Hospital admissions have fallen steadily across the UK since peaking on 4 January 2022. The UK is thought to have one of the highest levels of immunity of any country, both from vaccination and previous infection, and this is helping. Professor David Heymann, the former chair of Public Health England and a global health expert, describes the UK as having: “One of the highest levels of population immunity of any country, with over 95 per cent antibody prevalence, and as a result is probably among the closest to having the virus as endemic.”
The downward trend in cases and hospital admissions in the UK means some measures, such as working-from-home and vaccine passports, have now been dropped earlier than anticipated. (8)
Many central and eastern European countries have much lower vaccination rates than those in western Europe and with researchers in Denmark finding that unvaccinated COVID-19 patients are six times more likely to need hospital admission than those who are fully vaccinated the outlook elsewhere in Europe is unfortunately not as optimistic.
North America
Both the USA and Canada are seeing rapid rises in both cases and deaths fuelled by Omicron. The Central American countries are experiencing similar soaring case rates but their death numbers are remaining steady. (9)
The USA accounts for just 4% of the world’s population but 15% of the world’s COVID-19 deaths (although paucity of data from some countries means all statistics must be interpreted with a degree of caution.) We know COVID-19 death rates are 10 times higher in countries where more than half of the adult population is classified as overweight. 67.9% of the USA’s population are classed as overweight or obese as are 64% in Canada. (For reference, the UK fares no better with 63% of the population classed as overweight or obese and it too has a high overall COVID-19 death rate.)
Overweight people are more susceptible to all respiratory diseases and also have higher levels of associated conditions such as high blood pressure and diabetes, both of which are markers for worse outcomes from COVID-19. (10)
Countries such as Japan and South Korea, which have very low levels of obesity, also have very low COVID-19 death rates. These countries release reliable and comprehensive data collection allowing direct comparisons to be made. (11)
Vaccination rates for the USA and Canada are significantly lower than for the UK. In the UK 84% of people age 12 and over have received two doses of vaccine and 64% have received a booster dose. These same figures for the USA are 63% and 24% respectively, substantially lower. In Canada, 78% have received two doses and 31% have received a booster dose. (12) (13) (14)
Within the USA there is a lot of variation in vaccine uptake between states. In the New England states around 75-78% of the population have received two vaccine doses. In the Southern states of Alabama and Louisiana less than 50% of people have had two doses. (15)
South America
Across the whole of South America every country is reporting rapidly rising rates of COVID-19 cases as Omicron spreads. (16)
Having been badly hit in previous waves many health officials across the continent were hoping the worst was over. Unfortunately Omicron has seen case rates reach their highest yet and they are still climbing. Argentina is the country worst hit by Omicron closely followed by Brazil. These two countries account for more than 50% of South America’s daily case figures. Authorities in the different countries are not instigating new restrictions, instead they are relying on vaccination as the most important control measure.
Around 65% of South Americans have received two doses of vaccine which compares favourably with the US and much of Europe. Rates vary significantly between countries though, 87% of the population in Chile and 74% in Argentina have received two vaccine doses compared to just 42% in both Bolivia and Paraguay. (17)
Death rates are staying steady across the continent at the time of writing but, even if Omicron is less severe than previous waves, the sheer numbers involved may still mean hospitals will become overwhelmed. (18) (19)
Africa
In South Africa, where Omicron was first identified, case rates have dropped substantially to pre-Omicron levels. Although there was a small uptick in the number of deaths this was much smaller than that seen in previous waves. This downward trend in cases has been sustained for the last four weeks. (20)
For the continent as a whole the WHO has reported that new cases fell by 20% in the week ending 16 January 2022 and deaths dropped by 8%. However some North African countries, in particular Egypt, Algeria and Tunisia, are still seeing an increase in cases. (21)
The WHO’s Regional Director for Africa, Dr. Matshidiso Moeti, when discussing the situation said, “The acceleration, peak and decline of this last wave has been unmatched, but its impact has been moderate, with fewer deaths and lower hospitalizations.”
She also warned that the pandemic is far from over in Africa saying, “So long as the virus continues to circulate, further pandemic waves are inevitable. Africa must not only broaden vaccinations, but also gain increased and equitable access to critical COVID-19 therapeutics to save lives and effectively combat this pandemic.” (22)
Just 10% of the continent’s population have been fully vaccinated. The UN-backed COVAX Facility expects no more than 45% of Africa’s population to have been fully vaccinated by mid-2022.
Asia
Most countries in Asia and the Middle East, from Saudi Arabia and Turkey in the west through India and its neighbours in central Asia to Indonesia and Japan in the east, are experiencing surges in infection rates because of Omicron. (23)
With the emergence of Omicron many Asian countries re-introduced restrictions. For example, Japan banned entry to the country for all non-Japanese travellers and Thailand reintroduced quarantine measures for foreign travellers. Such measures have had little impact on the spread of Omicron but most Asian countries are still closed to overseas travellers although the entry rules for different countries frequently change.
Death rates across Asia have remained much lower than those seen in the USA and Europe, although such statements always carry the caveat that lower rates may also reflect less reporting.
Vaccination rates vary across Asia. Japan has one of the highest rates, 80% of the population are fully vaccinated compared to 50% in India and 43% in Indonesia. (24)
Conclusion
The director general of the WHO, Tedros Adhanom Ghebreyesus, has made clear that: “While Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be categorised as mild. Just like previous variants, Omicron is hospitalising people and it is killing people." (25)
The inequitable roll out of vaccines means that 109 countries will miss the WHO's target for 70% of the world's population to be fully vaccinated by July 2022, a target it was hoped would bring about the end of the pandemic.
Continually boosting people in wealthy countries against new variants - whilst billions of people remain completely unvaccinated - will simply allow the pandemic to rumble on and on.
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