Prof Salim Abdool Karim Weekly COVID-19 UPDATES
On Friday, Dr Tedros, WHO Director-General, announced that COVID-19 is no longer a public health emergency of international concern (referred to as PHEIC). It was an acknowledgement that the pandemic has entered a new phase where there are low numbers of severe cases and deaths. When I was interviewed by Nature on this announcement, I was asked what the criteria are for declaring or ending a PHEIC? Well, there are no hard and fast criteria as each situation is unique requiring a judgement. I pointed out to Nature that we currently have far more Covid-19 cases, hospitalisations and deaths each day than we had on the day that the PHEIC was initially declared. So, it is not based the situation getting to a point pre-PHEIC. Waiting to reach that point may take many years or may never happen and so ending the PHEIC is a judgement call taking many factors into consideration.
The WHO decision is momentous. But it does not indicate that the pandemic has ended – indeed, we are still living in the midst of a pandemic with thousands of cases each day. Since SARS-CoV-2 is going to be with us for a long time, a pragmatic decision was needed as the Covid-19 pandemic emergency has been steadily receding and a new variant of concern has not emerged in the last 17 months. But the risk of a new variant of concern is ever-present, even if it is getting progressively smaller with time. The public is also tired of the pandemic and many have simply put it out of sight and out of mind.
By coincidence, today email is the last Update of Covid-19 in South Africa, as the funding for this initiative comes to an end in a few days. It has been a privilege to write this weekly missive and share with you both local and global progress in the Covid-19 pandemic and, more recently, on other infectious disease threats around the world. If I am able to secure new funding for this initiative, I will aim to provide a broader perspective on global infectious disease threats well beyond coronaviruses.
The situation at global level has changed little from last week with a continuing downward trend in cases and deaths (Figure 1). Importantly testing rates are now very low across the globe, leading to under-reporting of Covid-19 cases.
The situation in South Africa has similarly shown little change (Figure 2). The number of cases and deaths remains low.
The 5 countries with the most reported cases in the last week are South Korea, Japan, USA, France and Russia (Figure 3). It is striking to compare case fatality rates in South Korea and the other 4 countries in this list. Notwithstanding these differences, the overall number of deaths in each of these countries is quite low compared to the situation a year before. Lifting the PHEIC, is an acknowledgement of this drop in cases with severe disease and deaths.
In early 2020, a hypothesis grew rapidly that Africa is being protected from the clinical ravages of severe Covid-19 and deaths by widespread BCG vaccination in childhood. Several trials were initiated to address this question of whether BCG vaccination contributes to lowering the risk of severe Covid-19; one of these trials has just published their results in the New England Journal of Medicine (Figure 4). The clinical trial showed that BCG vaccination in adult health care workers provided no benefit in preventing either mild or severe cases of Covid-19. It lays to rest the BCG hypothesis and points to the importance of focusing on Covid-19 vaccination as well as treatments that we know work, like Paxlovid.
Many thanks to the South African Department of Science and Innovation, the National Research Fund, the Medical Research Council and GIZ for having funded the work of the CAPRISA Epidemic Intelligence team that makes this missive possible for certain periods between now and its inception about 3 years ago. To the readers - thanks for all your helpful feedback over the last 3 years.
Have a great week.