Variants of concern, lottery, and zero COVID deaths: COVID-19 Global Weekly Highlights

Medscape, Univadis, & MediQuality Staff

May 20, 2021

Despite a decline in daily cases over the past few days, India hit yet another record for daily COVID-19 deaths on May 19, with 4,529 fatalities recorded in the last 24 hours.

Singapore will shut most schools starting May 19 after the Education Minister Chan Chun Sing warned that new SARS-CoV-2 variants, including the B.1.617 variant first detected in India, were affecting more children. Additionally, the country is also preparing plans to vaccinate youngsters.

On May 14, Japan widened its state of emergency to 3 more prefectures, Hokkaido, Okayama and Hiroshima are hit badly by COVID-19. On May 18, the number of seriously ill COVID-19 patients in the country hit a record high of 1,235. Meanwhile, public opposition to the summer Olympics in Tokyo continues to grow. A new survey found that 43% of respondents wanted the games to be canceled, while 40% wanted them to be postponed further.

Taiwan has reported a surge in domestic cases of COVID-19, leading to new restrictions being implemented. The nationwide alert level has been raised to Level 3 within a 4-tier system, which mandates wearing masks outdoors and limits public gatherings to 5 indoors and 10 outdoors.

The PanAmerican Health Organization (PAHO) confirmed that the four variants of concern have been detected in the Americas region: B.1.1.7, B.1.352, P.1 and B.1.617.

In the US, COVID cases and deaths continue to decline as vaccines are now available to anyone age 12 and older.  With more than one-third of Americans fully vaccinated, the CDC issued controversial new mask guidance last week, saying that people who are at least two weeks past their last vaccine dose can remove their mask in most settings.  Some states have used the new guidance to drop mask mandates. Despite America’s good fortune to have a glut of highly effective vaccines, the pace of vaccination has slowed there, prompting some states to offer incentives to try to convince people who are hesitant to get the shots. Ohio, for example, is offering 5 prizes of $1 million each in a lottery people can enter if they get vaccinated. It seems to be working. President Biden said he would send 20 million more vaccine doses to other countries, bringing the total number pledged to international aid to 80 million.  Critics say America is not doing nearly enough to help the rest of the world.

In Mexico, on Sunday, May 16, the Ministry of Health reported that infections have been declining for 17 consecutive weeks. On May 18, vaccination of educational personnel began with the CanSino vaccine, as part of the plan to immunize the entire Mexican population before the end of October. The Mexican Chancellor announced that the first batch of AstraZeneca's COVID-19 vaccine packaged in Mexico is expected to be ready by May 24 or 25.

In Bolivia, Colombia, Venezuela and Ecuador, a nighttime curfew has been declared to reduce the number of infections. Meanwhile, on May 17, Panama reported its second consecutive day without any deaths from COVID-19.

In Paraguay, on May 18, the Ministry of Health reported the highest number of deaths due to COVID-19 since the beginning of the pandemic: 110 deaths. On the same day, vaccination of persons 65 years of age and older began. In Chile, elections were held on May 15 and 16 to elect the members of the convention that will draft the new Constitution. During that weekend, the Minister of Health reported a total of 6,769 new cases of COVID-19. So far, 39.78% of the population in the country has been vaccinated.

In Argentina, Tuesday, May 18 saw the highest record number of cases since the pandemic began in 2020: more than 35,000 confirmed cases of COVID-19 and 72-76% occupancy of intensive care units.

In the past two weeks, Brazil has recorded a 19% drop in the moving average of deaths from COVID-19, according to the consortium of press outlets that monitors the pandemic in the country. But experts are concerned because on Sunday (16th May) the average death rate rose again. Vaccination remains slow. According to a recent projection by The University of Washington Institute for Health Metrics and Evaluation, the country could reach more than 750,000 deaths by the end of August if the pace of vaccination does not improve. To date, 18.54% of the population (39,263,416 people) have taken the first dose of a vaccine and 9.17% (19,423,560 people) have been fully vaccinated.

A new document with guidelines for in-hospital treatment of patients with COVID-19, prepared by the Ministry of Health, is under analysis by the commission that approves technologies and drugs for the Unified Health System (SUS). Made from a review of studies and guidelines, the document does not recommend hydroxychloroquine – proven to have no effect against COVID-19. The document also does not indicate other drugs that are part of the so-called “COVID kit” for an alleged “early treatment of COVID-19”, such as ivermectin and azithromycin. Surprisingly, the Ministry’s movement goes in the opposite way from the policy adopted by the federal government and disseminated by the former Minister of Health, general Eduardo Pazuello. The use of these drugs causes indignation in most physicians, but the country’s Federal Council of Medicine has not been opposed to this fact so far.

In Belgium, COVID-19 figures are finally heading in the right direction, and 33% of the population got at least one shot of the vaccine so far.  Belgium has decided to administer third vaccine doses to boost immunity as of Q4 2021.  People who have received just one shot of a coronavirus vaccine may be able to use proof of vaccination on the Digital Green Certificate to travel between the European Union member states this summer.

In Portugal, experts discuss the impact of COVID-19 on the health of recovered patients. In an interview with Agência Lusa, the president of the Portuguese Association of General and Family Medicine (APMGF), Nuno Jacinto, MD, acknowledged that the long-term effects of infection by the SARS-CoV-2 virus are ʺa very gray areaʺ, over which Portugal “does not yet have fully defined guidelines'' with regard to the follow-up of patients.

According to the report of the General Directorate of Health (DGS) of 18 May, new cases are rising and hospitalizations are decreasing. On Tuesday (18), a decree was published regulating access to the beaches from June 12. Those who do not comply with the rules may now be fined. According to one of the rules, it is mandatory to wear a mask until you reach the sand area if it is impracticable to maintain the recommended social distance.

Portugal administered 4,515,124 doses of an anti-COVID-19 vaccine (in absolute numbers) until May 18. The total number of deaths from the beginning of the pandemic to that date is 17,009 and the total confirmed cases of infection are now 842,381 (DGS data). On the 14th, the Portuguese government announced that it would make 24,000 doses of COVID-19 vaccines available to Cape Verde because of the worsening pandemic in that archipelago.

In France, on Wednesday 19th May, terraces, cafes, theaters, cinemas and monuments reopened with limitations. As of May 18, 17,210 new cases of COVID-19 have been identified. The incidence rate has decreased to 148.87 cases per 100,000 inhabitants. Regarding vaccination, 31.5% of the total population received one dose of vaccine and 13.6% of the total population had received two doses.

About pharmacovigilance, four new atypical thromboses associated with the AstraZeneca vaccine, two of which resulted in death, were reported in France between April 23 and May 6. The people affected were two men in their fifties, and two women, in their sixties and seventies. A total of “34 cases, including 11 deaths” of rare thrombosis occurred in France out of more than four million injections performed as of May 6, said the French Medicines Agency (ANSM). The French Health Authority (Haute Autorité de Santé) has maintained the indication of the AstraZeneca vaccine, for those over 55 years old only.

Italy is revising its roadmap for easing the COVID-19 restrictions. The Italian government on Monday overhauled its reopening schedule, as the health situation continues to improve across the country. Changes include allowing gyms to reopen earlier than scheduled and pushing the curfew to 11 PM. The country started relaxing restrictions from April 26th. Schools, museums, cinemas and shops are now open in Italy’s lower-risk yellow zone (19 out of 20 Italian regions). Starting from May 22, shopping centres will be allowed to reopen on weekends and not only on weekdays. By May 24, gyms will also reopen – a week earlier than planned. They will have to follow safety guidelines, including limiting the number of people, requiring face masks in communal areas and asking to book training in advance. By June 1st, bars and restaurants without outdoor seating will reopen with indoor service at lunchtime.

The Minister of Health, Roberto Speranza, has signed a document allowing entry from the countries of the European Union and the Shengen Area, as well as from Great Britain and Israel, with a negative swab test, taken in the 48 hours prior to arrival in Italy, without compulsory quarantine. However, the restrictions against Brazil have been extended until 30 July 2021. The Minister has also ordered the extension of trials of ‘COVID-19-tested’ flights-- already operating at Rome and Milan airports--to Venice and Naples. Passengers on those flights must take a molecular or antigen test before departure and, upon arrival, they are authorised to enter and travel in Italy without having to quarantine. Until now, COVID-19 -tested flights have only been available between the United States and Italy but will be extended to departures from Canada, Japan and the United Arab Emirates.

Austria will stop using the AstraZeneca vaccine due to vaccine delivery issues and bad press. This decision follows those of Norway and Denmark, which had justified their choice by the rare but serious risks of atypical thrombosis.

In Germany, the 3rd wave of the pandemic is now considered to be waning. One reason for this seems to be the advancing vaccination campaign. Ten percent of people have been vaccinated twice, and one third have been vaccinated once.

At the beginning of the week, an alleged scandal shook the public: In the so-called “Divigate”, a group of authors accused the German Society for Intensive Care Medicine (DIVI) of having lied in its presentation of the pandemic. By exaggerating the seriousness of the situation during the first and second wave they allegedly made financial gains. However, the authors' claims are hardly tenable and easily refuted. The criticized association speaks of a “slap in the face of intensive care personnel”. 

Spain has left behind the “high risk” level and has returned to “medium risk” for the first time since the end of March, with an incidence at 14 days of ~ 130 per 100.000 habitants. The central and regional governments will discuss on Wednesday the road map for the return to non-university classrooms. The syndicates have denounced that Spain needs 9,500 general practitioners to reach the European ratio.

Regarding the vaccination campaign, the last report confirms that 1 in 3 citizens have already received at least one dose of the COVID-19 vaccine, which represents 32.2% of the Spanish population. The Public Health Commission of the Ministry of Health has approved administering the Pfizer vaccine to those people under 60 years of age who had already received the first dose of AstraZeneca. This decision comes after the publication of the preliminary results of the Combivacs study: the administration of the AstraZeneca vaccine followed by a Pfizer dose is safe and effective.

In the UK, COVID-19 restrictions were further eased from May 17th, so that millions of people in England, Scotland and Wales are now allowed to socialise indoors in limited numbers, have close contact, and visit pubs and restaurants. Cinemas, museums, and other indoor attractions can open their doors too. As step 3 of the UK government’s roadmap to a return to normality took effect, Prime Minister Boris Johnson urged a “heavy dose of caution”, largely due to uncertainties about the B.1.617.2 'Indian' variant of concern.

Consequently, Johnson advised anyone eligible for a vaccine who has not yet had one to take up the offer, and said that second doses for the over 50s-- currently set to be 10-12 weeks from the first dose-- would be moved forward so that the gap is only 8 weeks. More than 36 million people have now had one dose of a COVID-19 vaccine in the UK and over 20 million have had both doses. The vaccine rollout continues this week with people in their 30s being invited to book a first dose. 


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.