Prof Salim Abdool Karim Weekly COVID-19 UPDATES

17 March 2022
Regarding Covid-19, we are covering 3 things today:
1. The rise in cases reversing the decline at a global level (slide 2) – mostly driven by BA.2 in the UK and several other countries, including in Europe (slide 3).  This mimics the rise in cases I talked about in January when cases of BA.2 led to a rise at the tail end of the omicron wave in South Africa. So, the effect of BA.2 in causing a second small peak towards the end of the omicron wave that occurred in South Africa is now being seen across several countries, with global impact. In South Africa, it was the opening of schools that spurred the BA.2 mini-wave. In other countries, the reasons varied – but one theme persists, complacency due to people being fed up with the restrictions plus governments removing restrictions. An example of this situation is the UK, where daily cases have risen beyond 100,000 now following the lifting of all restrictions. The situation in Denmark provides some important lessons – Angelique Coetzee sent me the attached blog on Denmark from “Your local epidemiologist…”. Since the dropping of all public health measures, Denmark has seen cases rise to new highs (almost 8 times higher than past peaks) and with it, admissions and deaths (slide 4). Daily deaths from omicron in Denmark have reached highs seen in the Delta wave. So, what is the right thing to do? There is no easy answer as each country has different circumstances. But it seems that throwing in the towel against Covid-19 is as bad a decision as maintaining very high levels of restrictions. But a few countries have found a mixture of vaccine coverage plus some public health measures to keep the virus at bay for now. It is sad that many countries have got it so wrong…
2. Low immunity levels see a devastating impact of omicron in Hong Kong and a few other countries in south-east Asia (slide 5). Dr Ntinginya, who is a Scientific Advisor on Covid-19 in Tanzania recently wrote to me to ask why a “mild” virus is causing so many deaths in places like Hong Kong. I borrowed an article in The Economist (slide 6) as it provides a succinct account of the challenges in Hong Kong – they have run out of gravesites, coffins and the hospital beds, reminiscent of scenes of Italy in Feb/March 2020. The Economist article explains the challenges in a country with low levels of vaccine and natural immunity against SARS-CoV-2, especially in the elderly. While South Africa is now close to 50% of adults vaccinated, this is too low if Pi comes into existence as Pi will almost certainly have immune escape from natural immunity (otherwise, it will not become Pi).  Unfortunately, the South African government seems to be caught in one step forward – two steps back, when it comes to vaccine requirements (mandates) in workplaces. While previous regulations related to workplace vaccination requirements nudged workers to get vaccinated by placing the onus on the employee to provide acceptable reasons for not being vaccinated, the new regulations remove this onus and compel employers (the regulations use the word “must”) to find reasonable accommodation for unvaccinated employees eg. work from home or in a separate office, etc. With this retrogressive step (using “must” instead of “should” in the regulations), I anticipate that workplace vaccinations are going to grind to trickle, creating a huge risk group if and when a new variant emerges. 
3. How many have died from Covid-19 globally? As the world crossed the 6 million mark for the number of reported deaths, it has become more important to get a more accurate estimate of the total number of deaths due to Covid-19, especially as people on social media have challenged the 6 million estimate claiming that it is a gross over-estimate because people dying “with Covid” are being counted as dying “from Covid”.  One way to resolve this is to use excess deaths ie. the number of deaths actually occurring minus the number of deaths expected based on averages of past deaths at the same time each year. An article in Nature (slide 7) shows that estimates of excess deaths are 3 times the number of reported Covid-19 deaths. There are 2 major groups involved in deriving the estimates of the actual number of deaths due to Covid-19. The Economist (slide 8) provides a country by country estimate of excess deaths on their website and they estimate that 18 million people have died due to Covid (though it has a wide confidence interval). The Seattle-based institute (IHME) has also generated an estimate of 18.2 million Covid-19 deaths – based on excess deaths and used satellite images of cemeteries in countries with poor reporting (The IHME estimate was published in The Lancet last week). Since IHME produces most of the estimates of the global burden of disease, they are well placed to produce a reliable estimate – and so, it is likely that about 18 million people have died from Covid-19 in the last 2 years. For comparison, there were only 774 deaths from the first SARS in 2002 and that there have been an estimated 40 million deaths due to AIDS over the last 40 years. 
Salim S. Abdool Karim, FRS
Director: CAPRISA
CAPRISA Professor of Global Health: Columbia University