State of Emergency in Japan, High Mortality Rates in Brazil and India: COVID-19 Global Weekly Highlights

Medscape, Univadis, & MediQuality Staff

April 23, 2021

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

More COVID-19 cases were reported worldwide last week than in any other 7-day period during the pandemic, according to data published on Tuesday by the World Health Organization.

Also on Tuesday, the European Medicines Agency's safety committee said a warning about unusual blood clots with low platelets must be added to the Janssen/Johnson & Johnson/vaccine's labels. However, the EMA said the benefits of the one-dose vaccine outweigh its risks and European countries prepared to resume delivering the vaccine.

In Germany, the government is planning a nationwide 'emergency brake'. Whenever the number of newly reported COVID-19 infections per 100,000 inhabitants in a district exceeds 100 for 3 days in a row within 7 days, stricter measures are taken. Measures are planned until the end of June, and controversially include curfews. Meanwhile, scientists have come up with a new benchmark for assessing the severity of the pandemic. The number of new admissions to intensive care units would be a better measure than weekly infections, they said.

On Tuesday, Portugal had fewer than 25 people admitted to hospital for COVID-19 and one patient was in intensive care. On Monday, the country's health authority, DGS, updated standards for the diagnosis of children. Symptoms such as headache, vomiting and diarrhoea should now be considered. Portugal has delivered around 2 million first vaccine doses.

Brazil is currently the country with the highest mortality rate per 100,000 population, passing the United States. The current number is 175.6 deaths per 100 thousand inhabitants. The largest country in Latin America continues to see high pandemic numbers. The moving average of deaths in the country in the last week was 2860 per day. The indicator remains above 2000 deaths per day for the past 24 days. There have been increases in hospitalisation and ICU bed use by younger patients. There's still a shortage of medication for intubation. As of April 19, there have been 13,977,713 diagnosed cases and 375,049 COVID-19 deaths since the start of the pandemic.

Vaccination remains slow with only a third of the priority groups were immunised with a first or second dose. In total, 12.59% received a first dose of a vaccine and 4.78% a second dose. Nine out of 10 doses administered are the Chinese CoronaVac vaccine. The National Health Surveillance Agency (Anvisa) authorised emergency use of the cocktail Regn-CoV2 (casirivimab and imdevimab) to treat mild or moderate COVID-19.  

Last Tuesday in Spain the number of people that had received at least one dose of the vaccine passed the number of those infected. Now 98.8% of the people 80 or over have already received at least one dose of a vaccine, and a 62.1% have had both doses. Minister of Health, Carolina Darias, expects the number of new cases will slow down this week. However, incidence at 14 days is still high, above 200 cases per 100,000 population.

The Public Health Commission did not approve measures to increase the gaps between  mRNA vaccine doses to reach more people sooner. The Pfizer/BioNTech vaccine will continue to be given within 21 days and Moderna's by 28 days. After the EMA's statement on the Janssen (J&J) vaccine, Spain began to administer 146,000 doses to people aged 70-79. Spain will also study the effects of mixing different coronavirus vaccines in response to safety concerns over the AstraZeneca vaccine.

In hospitals in Belgium, the number of new patients admitted to hospital, sent to intensive care units, or put on a ventilator as a result of the coronavirus has decreased, according to the latest official figures published by the public health institute on Wednesday. If this trend continues, the relaxation of restrictions s planned for 8 May should go ahead, including the lifting of curfews. As of 19 April, a total of 2,341,297 people in Belgium have received at least one dose of a COVID-19 vaccine, that's 25% of the over-18 population.

Mexico's Ministry of Health issued an alert about an increase in the number of cases reported in at least 10 states of the republic, probably due to the Easter holiday. The Mexican President had the AstraZeneca vaccine this week.

In Argentina, cases are increasing after the detection of new variants. The federal government announced new restrictions that will last until the end of the month for the capital and surrounding area, including a curfew and school closures. Argentina has started production of the Russian Sputnik V vaccine.

Despite Chile having one of the highest vaccination rates in the world, the country has recorded a new record in the number of daily cases due to the relaxation of lockdown measures.

Meanwhile, Guatemala and Colombia announced new measures to reduce the number of infections.

Half of adults — 130 million people — in the United States have received at least one COVID-19 vaccine dose, according to the latest tally from the Centers of Disease Control and Prevention. About 84 million adults, or 32.5% of the adult population, are considered fully vaccinated. In addition, 81% of adults ages 65 and older have received at least one dose, and 66% are considered fully vaccinated.

Federal health officials are due to make a decision by Friday about whether to end the pause on the use of the Johnson & Johnson COVID-19 vaccine, said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The pause has not substantially affected confidence in COVID-19 immunisation, a new poll revealed. In fact, 76% of 1000 registered voters surveyed nationwide said the pause didn't decrease the likelihood that they would get vaccinated. 

The US opened its vaccination programme to all adults this week, after first restricting it to the most vulnerable.  So far, half of all Americans over the age of 18 have been vaccinated. Despite that good news, experts are worried the pace of vaccinations could slow if people lose confidence in the safety of the shots. One of three vaccines authorised in the US, the single dose, adenovirus vector vaccine made by Johnson & Johnson (Janssen), has been temporarily pulled from circulation. It has been linked to at least 8 cases of unusual blood clots that occur with low platelets. The complication appears to be extremely rare, and may be related to similar cases reported with the AstraZeneca vaccine, which is also an adenovirus vector vaccine, in Europe. Scientists are racing to determine whether this may be a class effect with these types of vaccines.

Even with the rapid pace of vaccination, daily cases are steadily and slowly increasing here. Deaths from COVID-19 are also ticking up slightly. Public health leaders are urging people to fight pandemic fatigue and keep up personal safety strategies like wearing masks and social distancing for a few more months to keep the epidemic from surging for a fourth time.

The UK passed the 10 million milestone for second COVID-19 vaccine doses delivered as vaccination advisers said pregnant women should be offered a vaccine at the same time as the rest of the population. The regulator MHRA said there have now been 168 major blood clots following a dose of the AstraZeneca vaccine, that's 7.9 clots per million doses. However, it said the benefits of the vaccine still outweigh the risks for most people. The NHS Providers group estimated it could take 3-5 years to clear the backlog of non-COVID cases that have been building-up during the pandemic. India was added to the 'red list' of travel destinations as cases rose there and the B.1.617 variant under investigation first identified in India was detected in the UK. 

In France, the epidemic remains on a 'high' plateau. As of April 20, 2021, nearly 17,850,000 injections of anti-COVID vaccines have been administrated and vaccination is opening up to new groups. After teachers, childminders and law enforcement professionals around 400,000 workers over the age of 55, from around 20 professions (bus drivers, truck drivers, cashiers, or funeral directors) will benefit from vaccination appointments, announced yesterday the Ministry of Labour. Facing the threat of Brazilian and South African virus variants, the French government has decided to put in place a mandatory 10-day quarantine for travellers coming from Brazil, Argentina, Chile, Guyana, and South Africa. Other countries could be added to this list, such as India where the situation is deteriorating.

On April 16, Australia reported a third case and the first fatality from blood clots involving a 48-year-old woman who received AstraZeneca's COVID-19 vaccine. The Therapeutic Goods Administration said there was a likely link between the woman's death and the vaccine and it was 'carefully reviewing' other such instances in the country. The Pfizer/BioNTech vaccine remains the preferred choice for people under 50. 

India reported more than 295,000 COVID-19 cases in a single day on Wednesday, with the daily death toll passing 2000 for the first time since the start of the pandemic. At least 24 COVID-19 patients in western India died when the oxygen supply to their ventilators ran out. The capital Delhi which has been badly hit by the second wave, has implemented a week long lockdown in the city. On Monday, the Government announced a 'liberalised and accelerated' phase 3 COVID-19 vaccination strategy, under which all individuals above 18 years of age will be eligible to be vaccinated from May 1.

Israel dropped the outdoor mask mandate on Sunday, as the country continues to slowly regain normality following its successful mass vaccination campaign against COVID-19. About 81% of Israeli citizens/residents aged 16 and above have received both doses of COVID-19 vaccines to date.

Japan is considering a state of emergency in Tokyo, Osaka and Hyogo prefectures amidst a surge in COVID-19 infections. Experts believe highly contagious SARS-CoV-2 variants could account for 80% of infections in Osaka and Hyogo prefectures and a rapid growth of cases in Tokyo as well.

Turkey reported a record 63,082 new COVID-19 daily cases on April 16. The country has implemented special measures for the first two weeks of the holy month of Ramadan to curb the surging infections.

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

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....