Humanigen Inc (HGENQ)

[DonDonDonDon]

Covid cases are surging in Europe. America is in denial about what lies in store for it

Eric Topol

https://www.theguardian.com/commentisfree/2021/nov/12/covid-cases-surging-europe-america-denial

It’s deja vu, yet again. The pandemic first hit Europe in March 2020, and Americans were in denial, thinking it wouldn’t happen here. Then, later in the year, the Alpha variant wave took hold in the United Kingdom and the United States was unprepared. This recurred with Delta in the summer of 2021. Now, in the fall of 2021, Europe is the outlier continent on the rise with Covid, with approximately 350 cases per 100,000 people and many countries are soaring to new records. This not only involves eastern and central Europe, where there are some countries with low vaccination rates (such as Georgia, only 24% fully vaccinated) and caseloads as high as 160/100,000 (Slovenia), but also western Europe, such as Austria, Belgium, Ireland and several others. Indeed, in Germany, leading virologist Christian Drosten recently warned their death toll could be doubled if more aggressive mitigation and vaccination strategies were not quickly adopted.

Why is this happening again in Europe after the Delta wave passed through and high rates of vaccination were achieved? There are a few important reasons. First, there are a large proportion of unvaccinated individuals in each country, and only countries such as Spain at 80% and Portugal at 88% that fully vaccinated their total populations have set a high bar and have thus far withstood the continental trend of rise in cases. Noteworthy is Belgium with 74% fully vaccinated and one of the hardest-hit countries in the world, now at 79/100,000, currently 10th highest caseload globally. That alone tells us 74% isn’t enough, and that prior Covid (without vaccination, what some refer to as “natural immunity”) is unreliable for representing a solid immunity wall against the Delta variant. In fact, it has been projected for Delta that any country needs to achieve 90-95% of its total population fully vaccinated (or with recent Covid) in order to have population-level immunity that covers, providing relative protection, for the others.

Key among the unvaccinated are teenagers and children. For European countries, the UK was slower in starting their vaccination program for teens and that has been suggested as one of the reasons their cases started rising again. There is compelling data from both the UK and United States that children and teens have been a key driver of spread in recent months.

It is noteworthy that we are not dealing with just cases or a “casedemic”. For example, Greece’s cases have now quickly soared to 650/100,000 people and so has their death rate increased. While many countries have “uncoupled” their rise in cases from hospitalizations and deaths, that is incomplete at best, and many infected individuals are getting seriously ill, no less the risk of long Covid which remains under-recognized as to its importance and potential of durable disabling effects.

Second, there is evidence of waning of immunity on top of the hyper-contagious Delta strain. Even though much of Europe got a later start in vaccination, a recent study showed that with the Astra Zeneca vaccine the decline in anti-spike antibody occurred quite early and there was a clear relationship between antibody levels and breakthrough infections. Decline below the anti-spike antibody threshold of 500 U/ml was reached at 96 days for AstraZeneca’s vaccine compared with 257 days for Pfizer’s. The impact of waning, and the opportunity to restore very high (~95%) effectiveness of mRNA vaccines (specifically Pfizer/BioNtech) with booster (third) shots has been unequivocally proven from the Israeli data. Yet the adoption of boosters, even in the highest-risk groups such as age 60 plus, has been very slow.

Third, there has been relaxation or abandonment of mitigation measures. Countries such as Denmark and Norway completely reopened and have seen resurgence of cases since that occurred. Throughout the world, the profound pandemic fatigue has led to the irresistible notion that the pandemic end is nigh, that masks, distancing, and other measures have run their course, essentially that enough is enough. It is hard to imagine fighting a foe as formidable as Delta that a vaccine-only strategy can be effective. We’ve seen a dramatic improvement in Japan, with full return to baseline after their worst outbreak, by the combination of high level of vaccination and the continued use of masks and mitigation measures.

That brings us to the United States, sitting in the zone of denial for the fourth time during the pandemic, thinking that in some way we will be “immune” to what is happening in Europe. That somehow the magical combination of mRNA vaccines with only 58% of the population fully vaccinated, a relatively low proportion of booster shot uptake, a start to vaccinating teens and children, and a lot of prior Covid, and little in the way of mitigation, will spare us. That’s no magic. Add to that the complete lack of availability of cheap, rapid home tests to screen for infectiousness. Unlike Europe, the US was not capable of uncoupling cases from hospitalizations and deaths during its initial Delta wave – fully 75% of hospitalizations and 66% of deaths occurred compared to its third wave peak before vaccinations were available.

We are already seeing signs that the US is destined to succumb to more Covid spread, with more than three weeks sitting at a plateau of ~75,000 new cases per day, now there’s been a 10% rise in the past week. We are miles from any semblance of Covid containment, facing winter and the increased reliance of being indoors with inadequate ventilation and air filtration, along with the imminent holiday gatherings.

Now is the time for the US to heed the European signal for the first time, to pull out all the stops. Promote primary vaccination and boosters like there’s no tomorrow. Aggressively counter the pervasive misinformation and disinformation. Accelerate and expand the vaccine mandates that unfortunately became necessary and have been proven effective, and mass distribute medical quality masks and rapid home testing kits at no cost. Soon enough potent pills (Molnupiravar and Paxlovid) that take down the Sars-CoV-2 virus will get authorized and should also be made widely available to help prevent hospitalizations and deaths. Otherwise, we will probably face a fifth wave. Now is not the time for happy talk, but to instead show we can persevere, run this marathon, make it to the finish line. We can acknowledge and accept endemicity – that a low level of Covid will remain in the background, but that is not >75,000 new cases a day. Instead of succumbing to yet another major rise in cases and their sequelae, this is a chance for America to finally rise to the occasion, showing an ability to lead and execute.