Zoonotic swine Flu News since 13 Oct 2021

District remains a swine flu hotspot with maximum deaths, cases in state [The Tribune India, 1 Dec 2022]

By Nitin Jain

10 succumb to H1N1 influenza, 154 test positive, 701 suspected cases
Ludhiana, December 1

Ludhiana district remains the hotspot for H1N1 influenza, commonly known as swine flu, with maximum deaths and cases in the state this season so far, the government has confirmed.

Health infra robust

To minimise public health risk, quality surveillance in both animal and human populations, thorough investigation of every human infection and risk-based pandemic planning are ensured. Besides, the health infrastructure has been made robust to deal with any eventuality. — Surabhi Malik, DC

With as many as 10 patients already succumbing to the infection caused by swine influenza virus (SIV) or swine-origin influenza virus, and 154 persons, including 58 local residents and 96 outsiders, testing positive, besides 701 suspected cases, comprising 271 local residents and 430 from outside, reported till Wednesday, Ludhiana has turned out to be the worst-hit district in the state, official figures have revealed.

Civil Surgeon Hitinder Kaur Sohal told The Tribune here on Wednesday that another fresh positive and one more suspected case of swine influenza virus subtype A (H1N1) were reported in the district on Wednesday and both cases were of local residents.

She said the district Health Department had made elaborate arrangements for the test, treatment and prevention of human infections that were primarily acquired through direct contact with infected animals or contaminated environments as these viruses have not acquired the ability of sustained transmission among humans. “We have set up exclusive isolation wards for swine flu patients and ensured adequate availability of drugs required for the treatment,” the Civil Surgeon said.

Dr Sohal said the condition of all positive cases of influenza virus disease ranging from mild upper respiratory tract infection (fever and cough), early sputum production and rapid progression to severe pneumonia, sepsis with shock and acute respiratory distress syndrome, was stable and recuperating at their own places while only two serious patients were still hospitalised in the district till this evening.

The H1N1 influenza virus, with the vast silent reservoir in aquatic birds, which was impossible to eradicate, has so far claimed 10 lives in the district. However, the Health Department had not yet confirmed the exact cause of these deaths and had classified them as suspected swine flu casualties.

In the state, as many as 41 swine flu deaths had been reported so far, of which 25 had been reviewed and confirmed as H1N1 casualties while the rest were still under review.

While Ludhiana topped the chart with the maximum of 10 deaths, Patiala had reported five casualties, four of which had been confirmed, Ropar also five with three confirmed, Moga three confirmed deaths, Malerkotla and Sangrur two each confirmed, Bathinda, Gurdaspur and Nawanshahr two each with one each confirmed, Amritsar, Faridkot, Fatehgarh Sahib, Ferozepur, Jalandhar, Mansa, Pathankot and Mohali had logged one confirmed swine flu death each so far.

Of the total 193 confirmed H1N1 virus cases reported across the state till date, Ludhiana had reported the maximum of 58 cases, followed by Mohali 21, Sangrur 13, Patiala 12, Jalandhar 11, Gurdaspur and Hoshiarpur seven each, Bathinda, Malerkotla and Nawanshahr six each, Ferozepur and Mansa five each, Amritsar, Fatehgarh Sahib and Kapurthala four each, Barnala, Faridkot and Muktsar three each and Fazilka and Pathankot had logged two swine flu cases each so far.

Signs & symptoms
Swine influenza infections in humans may cause disease ranging from mild upper respiratory infection (fever and cough) to rapid progression to severe pneumonia, acute respiratory distress syndrome, shock and even death.

Diagnosis
Laboratory tests are required to diagnose human infection with zoonotic influenza.

Treatment

Evidence suggests that some antiviral drugs, notably neuraminidase inhibitors (oseltamivir, zanamivir), can reduce the duration of viral replication and improve prospects of survival.

In suspected and confirmed cases, neuraminidase inhibitors should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximise therapeutic benefits. Treatment is recommended for a minimum of five days but can be extended till there is satisfactory clinical improvement.

Prevention
Besides antiviral treatment, the public health management includes personal protective measures such as regular hand washing with proper drying of the hands, good respiratory hygiene — covering mouth and nose when coughing or sneezing, using tissues and disposing of them correctly, early self-isolation of those feeling unwell, feverish and having other symptoms of influenza and avoiding close contact with sick people.

One Step Closer to a Universal Flu Vaccine? [The New York Times, 29 Nov 2022]

By Apoorva Mandavilli

Scientists have tested in animals a vaccine that may protect against 20 strains of influenza, helping to prevent another pandemic.

Imagine a single dose of vaccine that prepares your body to fight every known strain of influenza — a so-called universal flu vaccinethat scientists have been trying to create for decades.

A new study describes successful animal tests of just such a vaccine, offering hope that the country can be protected against future flu pandemics. Like the Covid vaccines made by Pfizer-BioNTech and Moderna, the experimental flu vaccine relies on mRNA.

It is in early stages — tested only in mice and ferrets — but the vaccine provides important proof that a single shot could be used against an entire family of viruses. If the vaccine succeeds in people, the approach could be used against other virus families, perhaps including the coronavirus.

The vaccine would not replace annual flu shots but would provide a shield against severe disease and death from potential pandemic threats.

“There’s a real need for new influenza vaccines to provide protection against pandemic threats that are out there,” said Scott Hensley, an immunologist at the University of Pennsylvania who led the work.

“If there’s a new influenza pandemic tomorrow, if we had a vaccine like this that was widely employed before that pandemic, we might not have to shut everything down,” he said. He and his colleagues described the vaccine last week in the journal Science.

By the age of 5, most children have been infected with the flu multiple times and have gained some immunity — but only against the strains they have encountered.

“Our childhood exposures to influenza lay down long-lived immune memory that can be recalled later in life,” Dr. Hensley. But “we’re sort of living the rest of our life dependent on the random chance of whatever we got infected with as a kid.”

Current influenza vaccines protect against seasonal flu but would provide little protection against a new strain that may emerge as a pandemic threat. During the 2009 H1N1 swine flu pandemic, for example, the conventional vaccine offered little defense against the virus. But older adults who had been exposed to H1N1 strains in childhood developed only mild symptoms.

Scientists have long tried to create a vaccine that would introduce children to every possible strain of flu they may encounter later in life. But researchers have been constrained by technical hurdles and by the diversity of the flu virus.

Broadly speaking, there are 20 subgroups of influenza that each represent thousands of viruses. Current vaccines can target four subgroups at most. But the experimental vaccine contains all 20, and it would be faster to produce.

The vaccine elicited high levels of antibodies to all 20 flu subtypes in ferrets and mice, the researchers found — a finding that several experts said was unexpected and promising.

If the vaccine behaves similarly in people, “we’ll have a more broad coverage of influenza viruses — not only those that are circulating, but those that might spill over from the animal reservoir that might cause the next pandemic,” Alyson Kelvin, a vaccinologist at the University of Saskatchewan in Canada, said.

Packing 20 targets into one vaccine does have a downside: Antibody levels in the test animals were lower than when they were given vaccines aimed at individual strains. But the levels were still high enough to be effective against influenza.

Because a new pandemic strain of influenza might differ from the 20 targets included in the experimental vaccine, the researchers also tested it against viruses that were imperfectly matched. The vaccine still provided strong protection, suggesting that it would prevent at least severe illness, if not infection, from a novel pandemic flu virus.

This phenomenon is akin to that with the current Covid vaccines: Although the latest Omicron variants are so different from the ancestral virus that the original vaccine does not prevent infections, it continues to help safeguard most people against severe illness.

This quality may be a particular advantage of mRNA vaccines, Dr. Kelvin said. Conventional flu vaccines target only the specific viruses they are designed for. But mRNA vaccines seem to produce antibodies that defend the body against a broader range of viruses than those included.

The experts noted some important caveats and questions that must be answered before the vaccine becomes a viable candidate.

The animals in the study built defenses against all 20 flu strains equally. But “these animals have not seen flu before,” said Richard J. Webby, an expert in influenza viruses at St. Jude Children’s Research Hospital in Memphis.

Such a complete lack of immunity against flu is only true of very young children, Dr. Webby noted. Older people are exposed to many different strains over their lifetimes, and it’s not clear whether their immune responses to a universal vaccine would be quite so uniform.

“The proof of the pudding will be what happens when it goes into humans and how going into a preimmune population skews the response to it,” Dr. Webby said.

Designing universal vaccines for varying age groups, if necessary, would be a challenge. It would also be important to see how long protection from such a vaccine lasts, some experts said.

“The biggest issue about universal flu is what you need to target and how long you can continue to use the same vaccine,” Ted Ross, director of Global Vaccine Development at the Cleveland Clinic, said. “If you have to keep updating it, it may not increase the advantage of how we do vaccines today.”

The next step for the vaccine would be to test it in monkeys and in people. But proving its effectiveness might be challenging. “How do you evaluate and regulate a vaccine where their targets aren’t circulating, and so you can’t really show effectiveness?” Dr. Kelvin said.

Perhaps the vaccine could be tested in small sporadic outbreaks, or in poultry workers who are at risk of becoming infected with an avian flu virus, she said: “Those are questions that I think we need to answer before we have our next pandemic.”

US flu hospitalization rate highest its been since 2009 swine flu pandemic, experts say [FOX 13 Tampa, 4 Nov 2022]

What is the difference? COVID-19, the flu, the common cold

Health experts advise getting tested by a health care provider but here are some key differences between COVID-19, the flu and the common cold as told by a nurse educator.

The U.S. flu season is off to an unusually fast start, adding to an autumn mix of viruses that have been filling hospitals and doctor waiting rooms.

Reports of flu are already high in 17 states, and the hospitalization rate hasn’t been this high this early since the 2009 swine flu pandemic, according to the Centers for Disease Control and Prevention. So far, there have been an estimated 730 flu deaths, including at least two children.

The winter flu season usually flu ramps up in December or January.

"We are seeing more cases than we would expect at this time," the CDC's Dr. José Romero said Friday.

A busy flu season is not unexpected. The nation saw two mild seasons during the COVID-19 pandemic, and experts have worried that flu might come back strong as a COVID-weary public has moved away from masks and other measures that tamp the spread of respiratory viruses.

Community Montessori school in New Albany, Indiana, switched to virtual teaching at the end of the week because so many students were out sick with the flu. Beginning Monday, the school's 500 students will go back to wearing masks.

"Everybody just wants kids on campus, that is for sure," said the school's director, Burke Fondren. "We will do what we need to do."

There may be some good news: COVID-19 cases have been trending downwards and leveled off in the last three weeks, Romero said.

And in a few parts of the country, health officials think they may be seeing early signs that a wave of another respiratory virus may be starting to wane. RSV, or respiratory syncytial virus, is a common cause in kids of coldlike symptoms such as runny nose, cough and fever. While RSV continues to rise nationally, preliminary data suggest a decline in the Southeast, Southwest, and in an area that includes Rocky Mountain states and the Dakotas, CDC officials said.

Experts think infections from RSV increased recently because children are more vulnerable now, no longer sheltered from common bugs as they were during pandemic lockdowns. Also, the virus, which usually affects children at ages 1 and 2, is now sickening more kids up to age 5.

At the University of Chicago Medicine Comer Children’s Hospital, beds have been full for 54 days straight.

"The curves are all going up for RSV and influenza," said Dr. John Cunningham, Comer's physician-in-chief.

RSV illnesses seem to be unusually severe, he added.

Comer has had to turn down transfer requests from other hospitals because there was no room. Chicago-area hospitals had been able to transfer kids to Missouri, Iowa, and Wisconsin, but that's stopped. "They have no more beds, either," Cunningham said.

There’s not yet a vaccine against RSV, but there are shots for flu and COVID-19. Health officials say flu vaccinations are down in both kids and adults compared to before the pandemic, although up in children from last year.

So far this season, there have been an estimated 1.6 million flu illnesses and 13,000 hospitalizations. Flu activity is most intense in some of the areas where RSV is fading, including the Southeast, according to CDC data.

CDC confirms variant flu case in Michigan agricultural fair attendee [CIDRAP, 2４ Oct 2022]

Late last week, the Centers for Disease Control and Prevention (CDC) reported a further rise in US flu activity, particularly in the southeast and south central regions, along with another variant H3N2 (H3N2v) flu case, this time in a Michigan resident who had indirect exposure to swine at an agricultural fair.

The variant flu case occurred in a child who was not hospitalized and has recovered from his or her illness. No person-to-person transmission of H3N2v associated with this patient has been identified, the CDC said.

This is the ninth variant flu case detected in the United States this year, including 4 H3N2v cases (Michigan, 1; West Virginia, 3), and 5 H1N2v infections (Georgia, Michigan, Ohio, Oregon, and Wisconsin).

As flu activity rises across the country, clinical labs are reporting a 4.4% positivity rate for the past week, and 3% of outpatient visits have been for respiratory illnesses. Nonvariant H3N2 is the dominant strain this season, representing 79.5% of all cases detected thus far. The 2009 H1N1 strain represents 20.5% of cases.

“First time” achievements in pandemic influenza preparedness in two regions with high humanitarian and public health vulnerabilities, 2014-2021 [World Health Organization, 2１ Mar 2022]

The African (AFR) and Eastern Mediterranean (EMR) regions suffer a large burden of humanitarian vulnerabilities. Nine out of the 10 United Nations system-wide scale ups in response to emergencies occurred in these two regions since 2014. The two regions also have 21 out of the 28 (75%) countries with active health clusters highlighting the considerable challenges for addressing population health needs.

Since the beginning of PC implementation in 2014, investments were made in laboratory and surveillance capacities for strengthening pandemic influenza preparedness including in AFR and EMR. Despite the multiple emergencies experienced in these two regions, significant gains were made as shown below. The gains represent global solidarity to ensure that populations everywhere, regardless of context, are supported to strengthen their preparedness for a future influenza pandemic. The work operationalizes equity, which is at the heart of the PIP Framework, and WHO’s mandate to serve the vulnerable.

Increasing the number of National Influenza Centres (NICs) to facilitate global influenza monitoring and public health risk management

Four NICs were newly recognized by WHO in 3 African countries and 1 Eastern Mediterranean country, bringing the total number to 33 NICs in 31 countries in these two regions. Increasing the number of NICs was recognized, by the PIP Advisory Group in 2013, as the first objective for use of PC funds. Increasing the participation of countries in GISRS means that data and viruses shared are more representative for risk assessment and public health action. It will also facilitate a timely and effective response to an influenza pandemic as more countries will be able to rapidly detect a novel influenza virus.

Sharing influenza viruses to contribute to global surveillance and vaccine development
Fifteen countries started sharing influenza viruses or clinical specimens with WHO CCs since 2014 in AFR and EMR (respectively 12 and 3 countries). By sharing seasonal influenza viruses, countries increase the geographic representativeness of viruses available to inform the yearly composition of influenza vaccines. Through the sharing of seasonal influenza viruses, countries also show their capability to share influenza viruses with pandemic potential when the need arises.

Participating in WHO yearly EQAP to accurately detect emerging influenza viruses
Due to the continuous threat of pandemic influenza, quality laboratory diagnostics are essential. EQAP helps laboratories monitor, sustain and improve influenza virus detection capacity and performance standards. Since 2014, 5 African and 3 Eastern Mediterranean countries started participating in the WHO EQAP. EQAP helps WHO and GISRS institutions to focus capacity-strengthening initiatives to where they are most needed, and to ensure confidence in the underlying systems providing critical data for decision-making.

Sharing data to monitor influenza activity and inform risk assessments Fifteen countries from AFR and EMR started reporting epidemiological data to WHO’s influenza surveillance platform “FluID”, 6 started reporting virological data to “FluNet”, and 6 started reporting data to both platforms. The participation of more countries increases the geographical representativeness of the data in these two global systems. Routine data availability also means that situational analyses and risk assessments are up to date. These are critical for national and global preparedness.

Reporting influenza severity indicators to enable timely severity assessments and associated response recommendations
WHO’s pandemic influenza severity assessment (PISA) platform was developed to monitor and assess the severity of yearly influenza epidemics, so that when the time comes, it can also be used for pandemic influenza monitoring. Since its launch in 2017, 13 countries from AFR and EMR (respectively 10 and 3) have started reporting to the PISA platform. Country participation will streamline monitoring during the next pandemic, and the historical data will assist countries to determine the timing, scale, emphasis, intensity and urgency of the pandemic response actions needed.

Building resilient systems
WHO congratulates countries for these gains. However, the work is not done. Due to the humanitarian and fragile contexts in many countries, time is needed to stabilize participation in influenza preparedness systems. The COVID-19 pandemic also shed light on existing gaps in preparedness and the need to revisit surveillance platforms and approaches to be resilient within a broader acute respiratory disease context.

Denmark reports 'steep' increase in influenza cases - Outbreak News Today [Outbreak News Today, 2１ Mar 2022]

Since large parts of Danish society were shut down on 12 March 2020 due to Covid-19, the incidence of influenza has been at a very low level until the beginning of 2022. Now the number of people infected with influenza A is doubling from week to week.

In Denmark, the incidence of influenza tends to increase at the end of December. But this season, the flu has started very late, after being almost completely absent for the last two years during covid-19.

Currently, however, there is a steep increase in the number of flu cases in most of the country. In recent weeks, the number of infected has thus doubled from week to week and in week 10 reached 1,179 infected.

A total of 2,533 cases of influenza have been detected this season. The vast majority of cases – a total of 2,459 – are caused by the type of influenza virus called A / H3N2.

It is a well-known flu type, which is also circulating in other countries. H3N2 is included in the seasonal vaccine, but it is known to change and this may mean that the effect of the vaccine is reduced.

This season, changes have been seen in the H3N2 viruses in circulation, which may mean that the vaccine has a reduced effect.

Influenza has been detected in all age groups. At present, however, a predominance of children and the younger part of the population aged 15-44 as well as +85 year olds are affected by influenza.

It is now more than five months since seasonal flu vaccines became available. The late onset of influenza prevalence is therefore a challenge, as it is well known that the effect of vaccines decreases over time.

In the age group 2-6 years, the effect of the influenza vaccine, which is targeted at children, is calculated at 71% against influenza A. In the age group 7-44 years, the effect is calculated at 43%, while in the age group 45 years and over, no effect against the circulating influenza A type.

“Despite the fact that the vaccine effectiveness against influenza infection is not measurable in the age group 45 and above, the vaccine will probably still have some effect against serious illness if you become infected with influenza,” says section leader Ramon Trebbien from Stans Serum Institut ( SSI).

It is not so surprising that the best effect of the flu vaccine is seen among the children, as children generally have a good ability to form antibodies after being vaccinated.

In addition, vaccinated children aged 2-6 years have received two doses of the live attenuated childhood vaccine, which was introduced in the Danish vaccination program for the influenza season 2021/22.

The other age groups have received a single dose of the inactivated influenza vaccine known from previous flu seasons.

What happened when the 1918 flu pandemic met WWI [PBS NewsHour, 10 Mar 2022]

By Dr. Howard Markel

When it comes to the Russian invasion of Ukraine, it is safe to say that no one wins if the conflict helps spread the coronavirus.

Before Russia’s forces began attacking its neighbor, both countries had just hit records in new daily cases, peaking at an all-time high in Ukraine in early February. On Feb. 24, the day Russian President Vladimir Putin launched the assault, there were more than 25,000 new confirmed cases in Ukraine, according to the World Health Organization. While infections had begun to fall before Russia’s invasion, for multiple days in the past week the global health agency had reported no official data from the country – perhaps a reflection of the chaos and violence that has sent more than 2 million refugees to flee to other countries and scrambled its health infrastructure. No one has any real idea of how the virus may be spreading now.

“Low rates of testing since the start of the conflict mean there is likely to be significant undetected transmission,” WHO Director-General Tedros Adhanom Ghebreyesus said during a news briefing on March 2. “Coupled with low vaccination coverage, this increases the risk of large numbers of people developing severe disease.” Just 35 percent of Ukrainians are fully vaccinated against COVID, while 50 percent of Russians are – both below the worldwide average.

On every level, it is unwise to declare war during a pandemic. Infectious diseases have typically followed lines of humans engaged in travel, commerce and war. From the Civil War up until World War II, more soldiers died of infections than from bullets. Cholera, typhus fever, bubonic plague and other deadly microbes were all spread because germs also travel.

This was certainly the case with the influenza pandemic of 1918-1919, which was one of the worst contagion crises in the history of humankind. Around the world, anywhere from 40 to 100 million people died, according to various estimates, with 500,000 to 750,000 deaths in the United States alone. It was a particularly virulent and novel strain of influenza that attacked young adults most severely, in contrast to seasonal influenza’s typical victims, the very young and the elderly.

The United States entered World War I in 1918, four years into the conflict. In the months leading up, more than 4 million young men were sent to U.S. Army camps all over the country, traveling by train, cheek by jowl. They arrived to discover far-less-than-deluxe accommodations of crowded tents, dormitories, sloppy mess halls and poorly dug latrines. And when they were ready to ship out, they traveled—again by crowded trains—to the Atlantic seaboard where they boarded crowded troop ships taking them to the European theater, where many million more were already fighting. En route, many became seasick and vomited profusely; all of them slept in ridiculously close quarters, with the bunks resembling bookshelves stuffed with human cargo. Their destination was often the grimiest, filthiest trenches ever dug. To say troop conditions were not exactly sanitary is a gross understatement. Many of these young men were not only victims of influenza but terrific vectors for spreading microbes to others.

There were three waves across the 1918-1919 pandemic, and another in the winter of 1920. During the second wave, which lasted from September to December of 1918, soldiers, sailors and even ambulance drivers were among the hardest hit groups on both sides of the Atlantic Ocean. In recent years, some have claimed to pinpoint the outbreak’s origin to this Army camp in Kansas or that foxhole in Marne, but such microbe-gazing is a parlor game and impossible to prove. When discussing the coronavirus in 2022, however, origin stories no longer matter nearly as much as asking where the virus is spreading now and how it continues to make millions of people ill, or worse.

Unlike our current era, nobody knew much about virology at all back in 1918, and didn’t know exactly what caused the flu. Scientists had a better hand on bacteriology, but many experts incorrectly thought influenza was caused by the bacterium Haemophilus influenzae (hence, the quaint Latin last name). They had no medications yet that would work against bacteria – no antibiotics, let alone antivirals that could have helped in the pandemic. There were no intravenous fluids, respirators or intensive care units; nurses and doctors were in short supply; and medical care was more a form of warehousing these young men and women than what we would expect today. Working at these overcrowded base hospitals, let alone finding yourself in one, was a nightmare.

The ill soldiers were “placed on cots until every bed is full and yet others crowd in.”

Modern medical knowledge has greatly advanced, but the conditions on the ground are still dire. The United Nations has warned that Ukraine’s health care system is in grave danger. “As increasing numbers of people are displaced, the increased risk of COVID-19 contagion, combined with growing numbers of injured people in need of emergency medical services, will put additional pressure on the country’s already-stretched health system,” the U.N.
humanitarian agency wrote in a Feb. 26 report. On Wednesday, Ukrainian officials reported that Russia had bombed a maternity hospital in Mariupol, killing three and wounding more than a dozen people, including women waiting to give birth. Russia has attacked at least 18 medical facilities in two weeks, according to WHO.

During WWI, most of the soldiers who died from the pandemic did not just die of influenza but of secondary bacterial pneumonia. As these poor souls’ lungs filled up with fluid, immune cells, and bacterial detritus, they turned blue from the lack of oxygen, often bled from the nose and mouth and ultimately suffocated.

The ill soldiers were “placed on cots until every bed is full and yet others crowd in. The faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood,” recalled a doctor named Victor C. Vaughan. Years after witnessing influenza among “the stalwart young men” under his care at Camp Devens, Vaughan graphically recalled the carnage in his 1926 autobiography, “A Doctor’s Memories.”

Then the dean of the University of Michigan Medical School, Vaughan knew what he was talking about when it came to epidemics and combat. He had toured Army hospitals in 1898 during the Spanish American War and even contracted the dreaded yellow fever while doing so.

But Vaughan never forgot the horror he experienced in 1918 as a helpless doctor with nothing in his black bag, save morphine, to alleviate suffering. “This picture was painted on my memory cells,” he later wrote, “the deadly influenza virus [that] demonstrated the inferiority of human inventions in the destruction of human life… This infection. like war, kills the young, vigorous, robust adults …The husky male either made a speedy and rather abrupt recovery or was likely to die.”

A weakened or ill fighting force does not help anyone’s cause. When mated with 21st century technology, the incursion could spread infection from COVID far more quickly than tanks can travel, not only among soldiers but also among the civilians victimized by war.

Researchers getting closer to a “universal” flu vaccine [pnas.org, 1 Feb 2022]

Authored by Carolyn Beans

With new vaccine targets and more powerful delivery platforms, researchers are making inroads toward an influenza vaccine that could offer better, longer-lasting protection.

When urgent coronavirus disease 2019 (COVID-19) vaccine development efforts began in earnest in early 2020, researchers were by no means starting from scratch. That’s in part attributable to the decades of research dedicated to creating better influenza vaccines. Indeed, many flu vaccinologists pivoted to COVID-19 two years ago, bringing to bear the knowledge and tools they’d developed to fight a seasonal menace that has the potential to spark pandemics.

But these vaccinologists haven’t turned away from their longstanding goal: an influenza vaccine that protects against all strains. Such an achievement could save hundreds of thousands of lives every year. And COVID-19 vaccine efforts may end up helping to accelerate that work.

A universal influenza vaccine represents a game changer that could take the threat of both seasonal and pandemic influenza “off the table,” according to a November 2021 report, one of four from the National Academy of Medicine (NAM) on how to prepare for an influenza pandemic with lessons learned from COVID-19. As defined by the National Institute of Allergy and Infectious Diseases (NIAID) in 2018, a “universal” vaccine implies at least 75 percent effectiveness protecting all age groups for a minimum of one year against all strains of influenza A (1). Ideally, says the NAM report, a universal vaccine could also work against influenza B and offer protection for three to five years.

Seasonal flu vaccines—although valuable tools in mitigating flu—protect against only the narrow range of strains projected to be most problematic in a given year. When projections are off, the mismatch has led to vaccine effectiveness as low as 10 percent; even in a good year, vaccine effectiveness barely reaches 60 percent (2). There’s plenty at stake: Each year, influenza results in an estimated 290,000 to 650,000 deaths globally despite seasonal vaccines (3). A novel flu virus for which there’s no vaccine could lead to a pandemic that kills millions more.

A broadly protective flu vaccine has been a goal for decades, but it’s become more attainable in recent years thanks to new vaccine targets and more effective delivery platforms. When the coronavirus pandemic hit, influenza researchers were already making progress with platforms such as mRNA and viral vectors that have led to successful coronavirus vaccines.

All this means there’s good reason to believe that a universal flu vaccine is possible within a decade. But hurdles remain—from regulations designed to evaluate more traditional flu vaccines, to overcoming puzzling quirks of the human immune system.

A Moving Target An influenza virus particle looks much like the now infamous image of coronavirus. Proteins point outward from a sphere of lipids, forming a spikey ball. The most abundant of these protruding proteins is hemagglutinin, which, along with another surface protein called neuraminidase, is where influenza A viruses get their “H” and “N” designations (see Fig. 2).

Hemagglutinin is the key that unlocks host cells, letting the virus in. That makes it a main focus of the human immune system and the primary target of most flu vaccines. Flu vaccines aim to elicit long- and short-term immune responses, including antibodies that recognize specific locations on the hemagglutinin and attach to those spots, blocking the virus.

But hemagglutinin is a moving target. It consists of a stalk topped by a head that is especially prone to evolve, causing small changes to accumulate within each circulating strain. Since the 1970s, the World Health Organization has tried to stay ahead of these changes by recommending, months in advance, which of the circulating strains to include in seasonal flu vaccines (4). In recent years, those recommendations have included two influenza A and two influenza B strains, which are all incorporated into the single “quadrivalent” vaccine given in the United States (5).

In the late 2000s, several research groups made a key discovery that suggested it might be possible to end the race against evolving strains: Humans, it turned out, can generate flu-neutralizing antibodies against parts of the virus that remain largely unchanged (6). Since then, the search was on for the best of these “conserved” regions.

Viruses contain many proteins, all covered in antigenic sites, or epitopes, that trigger matching antibodies. But although hitting one antigenic site may deal the virus a lethal blow, hitting another may leave it relatively unscathed. “Your immune system doesn’t know the difference between what’s protective and what’s not,” explains immunologist Jenna Guthmiller, a postdoctoral fellow at the University of Chicago, IL, and an incoming assistant professor at the University of Colorado Anschutz Medical Campus in Aurora. Vaccination, she says, can teach our antibody-generating B cells to focus more on attacking critical regions of the virus. But first you have to get the cells’ attention.

Redirecting Attention
Many researchers developing vaccines against conserved parts of the flu virus have focused on the hemagglutinin stalk, which typically changes less than the head. Unfortunately, the stalk doesn’t generate as strong an immune response. The reason for the head’s “immunodominance” is not entirely clear, explains virologist and vaccinologist Florian Krammer of the Icahn School of Medicine at Mount Sinai in New York.

But Krammer, along with fellow virologist collaborators, is developing hemagglutinin proteins that attract the immune system’s attention to the stalk. They do so by taking advantage of another immune system tendency: to respond most readily to what it already knows. Even the strains included in seasonal flu vaccines from year to year, which may have sufficiently different hemagglutinin heads to evade antibodies tailored to a past version, also include many of the same or similar antigenic sites. So, the head is both immunodominant and very familiar. “The head domain has all of the advantages,” says Krammer.

Krammer’s group takes a hemagglutinin protein and swaps the familiar head for one from a distantly related strain. The head of this chimeric hemagglutinin is still immunodominant, but the stalk is the only familiar portion. “So you redistribute the advantages,” says Krammer. By delivering a second vaccination with the same stalk and another unfamiliar head, the stalk’s advantage grows.

The team recently designed a vaccine to protect against group 1 influenza A viruses—one of two groupings within influenza A based on the relatedness of their hemagglutinins (7). To make the H1 stalk the most familiar target presented in the vaccine, they topped their chimeric hemagglutinins with heads from avian H5 and H8 viruses. The results of their phase 1 clinical trial, published in January 2021, showed the vaccine induced a broad, durable immune response against the stalk (8). The team is similarly developing vaccines to protect against the more distantly related influenza A group 2 viruses and against influenza B, with the ultimate goal of creating a trivalent universal flu vaccine.

Despite much potential in the stalk, the head may hold some promise yet, says Guthmiller. She recently isolated antibodies produced by volunteers vaccinated against the 2009 H1N1 virus. Structural virologist Julianna Han of The Scripps Research Institute in La Jolla, CA, then used electron microscopy to reveal precisely how and where each antibody attached to the hemagglutinin head. Of the 66 individual antibodies identified, fully half targeted conserved head regions (9). In an in vitro study, these antibodies blocked nearly all human H1N1 viruses. And in mice, a representative sample of the antibodies provided 100% protection against weight loss and death from a mouse-adapted 2009 H1N1 virus.

Others are bringing computational brute force to the search for the best epitopes in an effort to “build” a better hemagglutinin for use as a vaccine antigen (10). Vaccinologist Eric Weaver, director of the Nebraska Center for Virology at the University of Nebraska–Lincoln, mines public databases to collect hemagglutinin gene sequence data for flu strains recorded over time. He and his team enter those data into the Epigraph vaccine designer, a computer algorithm that builds a new hemagglutinin based on the most common variations in the structure of the protein. To fill in potential gaps in protection, the algorithm can create another hemagglutinin protein using the most frequently occurring forms of each variable region not captured in the first protein, and so on for additional designs.

Working in pigs, which can serve as mixing vessels for avian, human, and pig strains to swap genome segments, Weaver’s team recently developed a vaccine aimed at protecting North American swine from H3 strains—a diverse influenza A subtype that circulates in both humans and pigs (11). Pigs vaccinated with a mixture of three synthetic hemagglutinin proteins generated antibodies that protected against 11 of 13 North American H3 swine strains tested. “If we can protect swine from humans, and if we can protect humans from swine,” Weaver says, “we’ll eliminate this mixing vessel.”

More than Packaging
In the United States, most influenza vaccines contain inactivated or weakened influenza viruses, which can require high doses to generate a sufficient immune response (12). But as researchers reveal new, more specific vaccine targets, they are also finding that the vaccine platform itself—the way an antigen is delivered to the body—can have huge impacts on the strength and quality of immune responses to those targets.

Lynda Coughlan, a vaccinologist at the University of Maryland School of Medicine in Baltimore, develops vaccines that harness another virus as a delivery tool (13). Adenoviruses naturally infect humans, causing a range of illnesses (14). Researchers can turn these adenoviruses into a “vector” for flu vaccines by deleting the genes that allow the adenoviruses to replicate. Inside this viral shell, researchers insert DNA sequences encoding whatever flu antigens they’d like to present.

A big advantage of these DNA viruses as vaccine vectors is that they use the vaccine recipient’s own gene-transcription and translation machinery to generate the antigen protein. And, in principle, the vaccine can keep producing antigen for weeks or longer, which researchers hypothesize could extend the immune response (15). Additionally, the way these vectors enter cells more closely mimics some real viral infections, which more actively engage the immune system.

COVID-19 vaccines currently on the market produced by AstraZeneca, China’s CanSino Biologics, Russia’s Gamaleya Institute, and Janssen (Johnson & Johnson) also use this adenoviral-delivery strategy, although interest in the technology long predates the pandemic. The University of Oxford’s (United Kingdom) Jenner Institute, where researchers developed the AstraZeneca COVID-19 vaccine, has tested its chimpanzee adenovirus vector against a range of diseases, including flu, although none had made it to market until the COVID vaccine.
Coughlan says that the precedent set with the use of adenovirus-vector vaccines against COVID-19 in humans may help pave the way for the flu field. And despite safety issues raised by the Centers for Disease Control and Prevention (CDC) in December regarding Johnson & Johnson's adenovirus-based COVID-19 vaccine as compared with mRNA products,* Coughlan says she’s confident that researchers can make modifications to adenoviral vectors to increase safety in the future.

In one recent study, Coughlan and colleagues at Mount Sinai and other institutions created a vaccine that triggered production of the hemagglutinin protein from the 2009 H1N1 virus; it protected mice from that strain (16). They also tested whether this adenoviral vaccine protected mice exposed to another virus—this one with a stalk that matched the hemagglutinin antigen in the vaccine but an entirely different head. All the mice survived, says Coughlan, compared with only a few animals that received a traditional H1N1 vaccine. When the team repeated the experiment with a still more distantly related virus, the difference was even more stark. Adenoviral-vaccinated mice survived, whereas none of the others did (16).

Messenger RNA (mRNA), a platform now famous for its use in the Moderna and Pfizer-BioNTech COVID-19 vaccines and the powerful immune responses they induce, was also in development by those companies as a flu vaccine before the coronavirus pandemic hit (17, 18).
The success of mRNA coronavirus vaccines is a testament to how well the platform can work, says vaccinologist Norbert Pardi of the University of Pennsylvania in Philadelphia, who in 2015, along with mRNA vaccine pioneers Katalin Karikó and Drew Weissman, and others, demonstrated that packaging mRNA within a protective coating of lipids prevents it from degrading too quickly and helps it enter cells (19).

mRNA vaccine technology enables researchers to quickly swap mRNA encoding for different antigens and include multiple antigens at once. In a 2020 study, Pardi, Coughlan, and others tested an mRNA vaccine that combined four influenza proteins. One of these proteins was a special hemagglutinin that contained only the stalk—another strategy for directing the immune response away from the head. In addition, the team included neuraminidase and two other viral proteins that tend to be more conserved. The idea is that incorporating multiple targets offers broader protection and also helps hedge bets. If one of these viral regions evolves to evade the immune system, says Pardi, the other targets could still potentially provide protection.

The vaccine protected mice from a broad range of group 1 influenza A viruses (20). Ultimately, the team plans to include about 10 to 12 antigens spanning influenza A and B. “This is how we believe that we can really develop a globally protective vaccine,” says Pardi.

"You want people to have some level of protective immunity, even if it’s not perfect, as quickly as possible without the lag phase of waiting for manufacturing of a perfectly matched vaccine." —Lynda Coughlan

Others are similarly combining multiple antigen targets into novel platforms with the goal of ramping up both the breadth and strength of the immune response. Researchers at NIAID’s Vaccine Research Center (VRC) in Bethesda, MD, are using nanoparticles to build multi-antigen influenza vaccines (see Fig. 1). It’s a “very strong way to stimulate the immune system,” says VRC vaccine immunologist Masaru Kanekiyo.

The team designs a genetic sequence encoding an antigen plus a nanoparticle piece at one end. They then mix this new protein with another nanoparticle piece whose shape is complementary to the first. The nanoparticles click into place like a three-dimensional puzzle, forming an “immunogen” sphere with antigens pointing outward.

In a recent test, Kanekiyo and collaborators showed that a vaccine nanoparticle displaying a total of 20 copies of four hemagglutinin proteins—one from each of the strains in a seasonal flu vaccine—generated strong immune responses in multiple animal models against these specific strains as well as or better than the commercial vaccine (21). But the nanoparticle vaccine also offered greater protection against more distantly related influenza strains, including avian strains with pandemic potential.

Kanekiyo suspects the physical spacing between antigens in the nanoparticle may create a structure that hits within the immune system’s “strike zone.” Whatever the mechanism, the nanoparticle platform seems to enhance the immune response, while also directing attention to the hemagglutinin stalks. The team is currently testing a similar vaccine in a phase 1 clinical trial.

Understanding the different types of immune responses induced by different vaccine platforms is a big research area, says Coughlan. Trials with COVID-19 vaccines have demonstrated that mixing and matching different platforms can provide the benefits of each while strengthening overall responses (22). Coughlan envisions that a truly universal influenza vaccine may similarly require multiple platforms. People might, for example, receive a two-shot “universal” flu vaccination with an adenoviral-based “prime” and then an mRNA “boost.”

Original Sin and Other Hurdles
Despite these advances, the winning formula for a universal flu vaccine is far from certain. The NAM report states that it “remains a difficult scientific problem with no guarantee that a vaccine can be developed that will provide long-term protection in people of all age groups" (23).

One major challenge is posed by a phenomenon sometimes called “original antigenic sin,” or imprinting (24). For reasons that are still not totally clear, the immune response to any influenza strain is launched in large part by the same B cells that developed upon a person’s first flu exposure, even when the strain is mismatched (unless the new strain is so significantly different that it’s beyond recognition). Guthmiller says that it’s not that subsequent exposures don’t matter; she likes to imagine a pyramid, with each exposure adding another level, although the B cells from that first exposure—the foundation of the pyramid—remain the most dominant.

A recent study by Guthmiller, Coughlan, Krammer, and others suggests that vaccination can sway the immune system more toward generating protective antibodies, whereas infection tends to result in more nonprotective antibodies linked to childhood infection (25). But it remains to be seen how universal vaccine candidates will perform in large numbers of people who have unique histories of exposure. Based on what we know right now, Han says, “even if you try to broaden an individual’s response to multiple strains of flu, you can only get so far based on the biases already present in that individual’s immune system.” One possible workaround, she suggests, might be to develop different universal flu vaccines for different age groups.

Another wildcard is durability—both in terms of how long vaccine-induced immune memory will remain active, and how long a particular vaccine formulation remains “universal” enough. “In a perfect world, you would get vaccinated at the age of six months or one year and then you wouldn’t need it again until you were 50,” says Weaver. “It’s more likely that evolution would continue to occur and that these would need to be updated.”

Given that a flu vaccine that is at once long lasting, broadly protective, and highly effective could prove a tall order, at least in the short term, Coughlan also sees a place for a vaccine that could limit the severity of illness for a broad range of flu strains—even if it does not prevent infection. This stopgap vaccine could be freeze-dried, stockpiled, and rolled out only in the event of a pandemic. “You want people to have some level of protective immunity, even if it’s not perfect, as quickly as possible without the lag phase of waiting for manufacturing of a perfectly matched vaccine,” she says.

Universal flu vaccines could face some regulatory hurdles (26). Most candidates would be sufficiently different from existing seasonal vaccines, meaning that getting them approved under current regulatory guidelines would require more than just showing so-called correlates of protection; vaccine developers would have to perform the extra step of demonstrating that the vaccine prevents people from getting sick, says Krammer. “That might be many million dollars’ difference in the cost of the clinical trial.”

But momentum is building and the pace of discovery may increase with fresh funding for efforts like NIAID’s Collaborative Influenza Vaccine Innovation Centers (CIVICs). Launched in fall 2019, CIVICs support collaborative research, vaccine manufacturing, and clinical trials—all at facilities within the CIVICs network. “I think that a lot of interesting vaccine approaches will come out of that structure,” says Krammer, who is co-principal investigator for one of three vaccine research centers within the network.

Like much influenza research, early work out of CIVICs was slowed by the coronavirus pandemic and supply chain issues. “That has impacted a lot of lab work,” says Krammer, adding that many influenza researchers—including himself—also shifted their attention to the new coronavirus for a time.

Still, he’s hopeful that the coronavirus pandemic may yet play some role in advancing a universal flu vaccine, both by renewing public enthusiasm for vaccines and by demonstrating how much can be accomplished with enough political will and financial support. “The public learned that pandemics happen and we need to be prepared,” says Krammer—but, he adds, researchers in the flu field “didn’t need that reminder.”

Footnotes
•↵*On December 16, 2021, the CDC endorsed updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for the prevention of COVID-19. The agency expressed a “clinical preference for individuals to receive an mRNA COVID-19 vaccine over Johnson & Johnson’s COVID-19 vaccine.” The agency cited ACIP’s unanimous recommendation based on “the latest evidence on vaccine effectiveness, vaccine safety and rare adverse events, and consideration of the U.S. vaccine supply.”
https://www.cdc.gov/media/releases/2021/s1216-covid-19-vaccines.html

References
1. ↵National Institute of Allergy and Infectious Diseases, Universal influenza vaccine research. https://www.niaid.nih.gov/diseases-conditions/universal-influenza-vaccine-research. Accessed 7 December 2021.
2. ↵Centers for Disease Control and Prevention, Past seasons vaccine effectiveness estimates. https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html. Accessed 7 December 2021.
3. ↵World Health Organization, Influenza (Seasonal) (2018) https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal). Accessed 7 December 2021.
4. ↵Influenza Research Database, World Health Organization recommendations for composition of influenza vaccines. https://www.fludb.org/brc/vaccineRecommend.spg?decorator=influenza. Accessed 7 December 2021.
5. ↵Centers for Disease Control and Prevention, Quadrivalent influenza vaccine. https://www.cdc.gov/flu/prevent/quadrivalent.htm. Accessed 7 December 2021.
6. ↵D. C. Ekiert et al., Antibody recognition of a highly conserved influenza virus epitope. Science 324, 246–251 (2009).
7. ↵Centers for Disease Control and Prevention, Types of influenza viruses. https://www.cdc.gov/flu/about/viruses/types.htm. Accessed 7 December 2021.
8. ↵R. Nachbagauer et al., A chimeric hemagglutinin-based universal influenza virus vaccine approach induces broad and long-lasting immunity in a randomized, placebo-controlled phase I trial. Nat. Med. 27, 106–114 (2021).
9. ↵J. J. Guthmiller et al., First exposure to the pandemic H1N1 virus induced broadly neutralizing antibodies targeting hemagglutinin head epitopes. Sci. Transl. Med. 13, eabg4535 (2021).
10. ↵J. Glanville et al., A general solution to broad-spectrum vaccine design for rapidly mutating viruses. https://doi.org/10.21203/rs.3.rs-100459/v1 (29 December 2020).
11. ↵B. L. Bullard et al., Epigraph hemagglutinin vaccine induces broad cross-reactive immunity against swine H3 influenza virus. Nat. Commun. 12, 1203 (2021).
12. ↵Centers for Disease Control and Prevention, How influenza (flu) vaccines are made. https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm. Accessed 7 December 2021.
13. ↵L. J. Kerstetter, S. Buckley, C. M. Bliss, L. Coughlan, Adenoviral vectors as vaccines for emerging avian influenza viruses. Front. Immunol. 11, 607333 (2021).
14. ↵Centers for Disease Control and Prevention, Adenoviruses.
https://www.cdc.gov/adenovirus/index.html. Accessed 7 December 2021.
15. ↵S. Rauch, E. Jasny, K. E. Schmidt, B. Petsch, New vaccine technologies to combat outbreak situations. Front. Immunol. 9, 1963 (2018).
16. ↵C. M. Bliss et al., A single-shot adenoviral vaccine provides hemagglutinin stalk-mediated protection against heterosubtypic influenza challenge in mice. Mol. Ther., 10.1016/j.ymthe.2022.01.011 (2022).
17. ↵R. A. Feldman et al., mRNA vaccines against H10N8 and H7N9 influenza viruses of pandemic potential are immunogenic and well tolerated in healthy adults in phase 1 randomized clinical trials. Vaccine 37, 3326–3334 (2019).
18. ↵BioNTech, BioNTech signs collaboration agreement with Pfizer to develop mRNA-based vaccines for prevention of influenza.
https://investors.biontech.de/news-releases/news-release-details/biontech-signs-collaboration-agreement-pfizer-develop-mrna-based. Accessed 7 December 2021.
19. ↵N. Pardi et al., Expression kinetics of nucleoside-modified mRNA delivered in lipid nanoparticles to mice by various routes. J. Control. Release 217, 345–351 (2015).
20. ↵A. W. Freyn et al., A multi-targeting, nucleoside-modified mRNA influenza virus vaccine provides broad protection in mice. Mol. Ther. 28, 1569–1584 (2020).
21. ↵S. Boyoglu-Barnum et al., Quadrivalent influenza nanoparticle vaccines induce broad protection. Nature 592, 623–628 (2021).
22. ↵M. E. Deming, K. E. Lyke, A ‘mix and match’ approach to SARS-CoV-2 vaccination. Nat. Med. 27, 1510–1511 (2021).
23. ↵National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine, Countering the Pandemic Threat through Global Coordination on Vaccines: The Influenza Imperative (The National Academies Press, Washington, DC, 2021).
24. ↵A. Zhang, H. D. Stacey, C. E. Mullarkey, M. S. Miller, Original antigenic sin: How first exposure shapes lifelong anti–influenza virus immune responses. J. Immunol. 202, 335–340 (2019).
25. ↵H. L. Dugan et al., Preexisting immunity shapes distinct antibody landscapes after influenza virus infection and vaccination in humans. Sci. Transl. Med. 12, eabd3601 (2020).
26. ↵R. Nachbagauer, P. Palese, Is a universal influenza virus vaccine possible? Annu. Rev. Med. 71, 315–327 (2020).

Dangerous Flu Comeback Expected atop COVID This Winter [Scientific American, 25 Jan 2022]

By Tara Haelle

COVID shutdowns limited the spread of influenza in 2019–2020. Several factors could mean this season will be more severe

A feared “twindemic” of influenza and COVID never came to pass last year, but the outlook for such a confluence this winter is resurfacing similar concerns among epidemiologists and other infectious disease experts. Flu cases started to tick up in October and November, and those months saw an outbreak at the University of Michigan at Ann Arbor. These early signals suggest that, in the coming weeks, seasonal flu could wreak some havoc—especially in hospitals—simultaneously with the national surge of the novel coronavirus, or SARS-CoV-2.

Public health officials agree that last year’s flu season was a no-show because of COVID mitigation measures, including less travel, increased working from home and remote schooling, mask wearing and social distancing. The combined restrictions and limits on social interactions prevented flu from gaining a foothold, says Lynnette Brammer, the U.S. Centers for Disease Control and Prevention’s team lead for domestic influenza surveillance. This winter many pandemic restrictions have loosened or been lifted entirely, creating an opening for influenza and other respiratory viruses.

Current flu infection rates nearly match the expectations of the CDC for this time of year, Brammer says. “This looks like a regular start of a flu season,” she adds, noting that most outbreaks so far have been in young adults (particularly on college campuses) and that now the virus now is spreading to older adults. U.S. influenza mortality rates vary from season to season. The viral disease caused an estimated 20,000 deaths and 380,000 hospitalizations in 2019–2020. The most recent severe season, 2017–2018, is estimated to have killed 52,000 people and hospitalized 710,000.

Like COVID, flu can have serious long-term effects, says Melissa Andrew, an associate professor of medicine at Dalhousie University in Nova Scotia. “Influenza is an important trigger for heart attacks and strokes. And in older people, it can cause delirium,” she says. Delirium, also a risk factor for dementia, can lead to cognitive decline and can increase the risk of falls and hip fracture. “So it’s really important to remember not just the short-term impacts of an infection like influenza but the longer-term ones,” Andrew says.

Speculations about “flurona” emerging as a Frankenstein-like single pathogen combining flu- and COVID-causing viruses are nonsense—but it is possible to develop flu and COVID infections at the same time. “Either one of these diseases can be very bad in people who are susceptible, and if you put them together, it can only be worse. But we know very little about it,” says Edward Belongia, director of the Center for Clinical Epidemiology & Population Health at the Marshfield Clinic in Wisconsin. “Sadly, we may find out this winter.”

Some looming concerns could pertain more to larger systems instead of individuals. Before the pandemic, hospitals and their emergency departments would fill up annually during the winter viral season, Andrew says. “Now we’re seeing hospitals getting overwhelmed with these waves of COVID, but everybody else still needs their regular care, too. If we get a wave of influenza on top of that,” she adds, “we could be in for quite a ride.”

Even a mild flu season, Belongia says, could take a “health care system that is already at the tipping point and tip it over even further,” with severely ill flu patients competing for resources with very sick COVID patients.

One emerging trend signals a potentially severe flu season, Belongia says: During most seasons, influenza A subtypes dominate at the beginning, and influenza B subtypes dominate at the end. Right now, he says, an influenza A subtype called H3N2—which is causing nearly all flu infections—is one that tends to dominate during the most severe flu seasons.

A positive note is that flu appears to have returned without one of the four subtypes that typically circulate every season. A lineage of influenza B viruses, called Yamagata, has been missing in action for nearly two years. Unlike influenza A viruses, influenza B viruses almost exclusively infect humans, so researchers think the Yamagata lineage may have gone extinct.

There is another early signal of possibly milder outcomes: Current flu infections are hovering a little above those seen in the 2015–2016 season, which had one of the lowest death counts from influenza in the past nine years. Flu seasons vary greatly in how they play out, Belongia says.

Flu vaccination campaigns took a back seat to COVID-19 vaccinations this past fall. And while flu vaccine uptake is currently similar to what it was at this time last year in most of the country, it is lower in some jurisdictions, according to the CDC’s flu vaccination dashboard. Officials are most concerned about coverage among the most vulnerable groups, including children and pregnant people, whose vaccination rates are currently lower than they were at the same time last year. By the end of October just more than a third of older adults on Medicare had been vaccinated, compared with 49 percent at that time in 2020 and 42 percent in 2019.

Manufacturers reformulate the flu vaccine each year to include the four viral strains that the World Health Organization and U.S. Food and Drug Administration anticipate will predominate in the coming season. It is still unclear whether this season’s vaccine strains will closely match the viruses that are circulating. A December 2021 preprint study identified changes in the currently circulating H3N2 strain that differ enough from the expected one used for this year’s flu vaccine to potentially reduce the effectiveness of the shot.

The slight mismatch is unsurprising because the committees that selected the vaccine’s flu strains had limited data on the latest strains—a result of minimal influenza circulation for almost two years—says Kawsar Talaat, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

On top of that, flu vaccines have historically provided less protection against H3N2 than other strains, and H3N2 evolves faster than H1N1 and B strains, Talaat says. “But even in very mismatched years, being vaccinated still protects you against severe disease and hospitalization,” she adds. “So it’s still better than not being vaccinated.”

The flu-season gap year in 2020–2021 also may have left our immune system less prepared, setting us up for a more severe season this time around, some experts say. Typically, each season, millions of people produce antibodies after encountering that season’s flu strains. But much of that immunologic priming did not happen last year.

“We have a population of people who are more susceptible and whose immune systems haven’t really seen a flu virus for a couple of years or more,” Belongia says. “In that setting, you want all the protection you can get and to give your immune system a head start with the vaccine.”

Higher rates of flu vaccination can also help reduce the burden on the already severely strained health care system, Brammer says. “That’s one of the many reasons we want to encourage people to get vaccinated against flu,” she says.

It bears repeating that behaviors aimed at lowering the risk of a SARS-CoV-2 infection also help prevent flu, Talaat says. “Do the things that we know work against all of these viruses,” she adds. That means ensuring you have received the COVID and flu vaccines and, if eligible, the COVID booster shot and the pneumonia vaccine, Talaat says. The CDC recommends the pneumonia vaccine to adults age 65 and older and children younger than age two, as well as others with certain medical conditions.

Although flu is not as contagious as SARS-CoV-2, social distancing and mask wearing still reduce flu transmission, as does frequent and meticulous hand hygiene. If people develop the symptoms common to flu and COVID (such as fever, cough, congestion and body aches), most clinics can run tests that look for COVID and flu at the same time. The main reason to test for flu is to treat it with antivirals and thereby reduce the risk of severe disease, hospitalization and death, Brammer says.

If nothing else, like the past two years, the 2021–2022 flu season will be a learning experience. “Just like COVID, nobody really knows what's going to happen next” because the past six months alone have been unprecedented, Belongia says. “It really has given us a lot of humility that, for all of our knowledge of immunology and virology, really nobody had a clue what was going to happen next.”

Penn Vet opens institute to study diseases spread from animals to humans [witf.org, 6 Dec 2021]

Saying that 75 percent of all newly emerging infectious diseases are zoonotic – meaning passed from animals to humans – the University of Pennsylvania School of Veterinary Medicine has established an Institute for Infectious and Zoonotic Diseases. Is Covid-19 one of them?

Many, and probably most researchers, believe the virus came from bats and that humans may have come into contact with infected bats at a wet market in Wuhan, China.

There are other examples of zoonotic diseases – Ebola, Zika, swine flu, avian flu and West Nile virus to name a few from last twenty years.

Appearing on Tuesday’s Smart Talk are Christopher Hunter, PhD, Mindy Halikman Heyer Distinguished Professor of Pathobiology; director, Institute for Infectious and Zoonotic Diseases and Dr. Lisa Murphy, DVM, associate professor of Toxicology; resident director of the Pennsylvania Animal Diagnostic Laboratory System at New Bolton Center (Kennett Square, PA); co-director, Wildlife Futures Program; and associate director, Institute for Infectious and Zoonotic Diseases.

2nd Swine Flu Case Confirmed [PrecisionVaccinations, 29 Nov 2021]

(Precision Vaccinations)
The U.S. CDC FLUView reported today a new human infection with a novel influenza A virus was reported by the state of Oklahoma. The infection occurred in an adult who was hospitalized for an unrelated illness and has since been discharged.

The patient had direct swine contact at home and an agricultural event. No ongoing human-to-human transmission has been identified associated with this case.

This is the second human infection with a novel influenza A virus during the 2021-22 influenza season.

The previous infection was an influenza A (H3N2) variant reported by Ohio that occurred in a child.

Influenza is a contagious respiratory illness caused by various influenza viruses such as the seasonal flu, avian influenza, swine influenza, and pandemic influenza.

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant influenza virus,” says the CDC.

Most human infections with variant influenza viruses occur following proximity to swine, but human-to-human transmission can occur. It is important to note that variant influenza viruses have not shown the ability to spread quickly and sustainably from person to person in most cases.

During the 2020-21 influenza season, 14 human infections with novel influenza A viruses were reported in the U.S., including two H3N2v (I.A., WI), four H1N2v (I.A., IN, OH (2)), and eight H1N1v (IA (3), N.C., ND, WI (3)) virus infections.

Coimbatore reports two cases of H1N1 infections [DTNext, 25 Nov 2021]

Coimbatore, already battling to control COVID and dengue cases, is now faced with a fresh challenge—H1N1 virus

Coimbatore:
Two H1N1 infections were reported in the district on Monday, reportedly for the first time this year. The infected persons, women aged 63 and 68, are undergoing treatment in a private hospital and said to be recovering well.

Officials suspect that the spread could have originated from Kerala as a relative of one of the patients had visited her from the neighbouring state recently. The other patient has no recent travel history and the source of infection is yet to be ascertained. The infected women’s family members were tested but were negative for the flu.

Meanwhile, the Coimbatore Corporation advised the public to wear masks while going out to prevent the spread of the flu. “People should wash their hands frequently and approach the nearby Primary Health Centre (PHC) in case of any symptoms like fever, cough or headache,” said Corporation Commissioner Raja Gopal Sunkara.

As it is the rainy season, 64 medical camps are being conducted in the Corporation on a daily basis.

Influenza H1N1 alert issued following recent spike in cases in SA [The South African, 17 Nov 2021]

By Corné van Zyl

An increase in influenza H1N1 cases, or incorrectly referred to as “swine flu”, has been reported in five provinces.

WHAT DO WE KNOW ABOUT IT INFLUENZA H1N1?

In addition, private laboratories have reported an increase in influenza case detections, and the NICD has received reports of clusters of cases in schools and workplaces.

The NICD said influenza A(H3N2), influenza A(H1N1)pdm09, and influenza B are seasonal virus strains that are common in human populations.

“Influenza A(H3N2), influenza A(H1N1)pdm09 and influenza B are seasonal influenza virus strains that are common in human populations. Influenza A(H1N1)pdm09, which is sometimes incorrectly referred to as “swine flu”, has been one of the circulating seasonal influenza strains following its emergence in 2009,” NICD said.

It said the term “swine flu” should not be used as it causes unnecessary panic.

“The clinical course of infection with this influenza strain and clinical management is similar to that of other influenza strains,” it said.

The NICD said even though the detection rates for influenza in its surveillance programme exceeded previous seasonal thresholds, absolute numbers remained relatively low compared with previous years, possibly as a result of reduced health-seeking behaviour following the SARS-CoV-2 pandemic.

“Though most people with influenza will present with mild illness, influenza may cause severe illness which may require hospitalisation or cause death, especially in individuals who are at risk of severe influenza complications,” said Dr Sibongile Walaza, a medical epidemiologist at the Centre for Respiratory Diseases and Meningitis (CRDM) at the NICD.

WHO IS MOST AT RISK?

The NICD said groups at an increased risk of severe complications of influenza H1N1 include pregnant women, HIV-infected individuals, those with chronic illnesses or conditions such as diabetes, lung disease, tuberculosis, heart disease, renal disease, and obesity, those 65 years and older and children under the age of two years.

It cautioned that these groups should be encouraged to seek medical help early.

Prof Cheryl Cohen, Head of the CRDM said the increase in influenza in the summer, which is not the typical time for the influenza season, is likely the result of relaxation of non-pharmaceutical interventions to control COVID-19. Combined with an immunity gap due to influenza not circulating for two years (2020 and 2021) in South Africa

HOW TO PREVENT CONTRACTING OR SPREADING IT:
• avoid close contact with sick people,
• stay home when you are sick,
• cover your mouth and nose when coughing or sneezing,
• wear your mask, clean your hands regularly,
• avoid touching your mouth, eyes, and nose
• clean and disinfect common places.

SYMPTOMS OF INFLUENZA H1N1:
• The most common symptoms in infected patients are sudden onset of:
• fever,
• muscle pains and body aches,
• dry cough,
• sore throat,
• runny nose,
• feeling tired or unwell,
• and headache.

The symptoms develop anywhere from 1 to 4 days after infection and last for 2 to 7 days. For the majority of people, the symptoms commonly resolve without treatment.

Complicated influenza infections can cause serious illness and in some cases, death.

Severely ill patients with influenza should be admitted to the hospital. The commonest complication of influenza is pneumonia.

Swine Flu in the USA [PrecisionVaccinations, 6 Nov 2021]

By Karen McClorey Hackett & Holly Lutmer

(Precision Vaccinations)

The U.S. Centers for Disease Control and Prevention (CDC) confirmed on November 5, 2021, three human infections with novel influenza A viruses occurred during the 2020-21 influenza season.

However, no human-to-human transmission was associated with these 'swine flu' patients.
The CDC confirmed one human infection with novel influenza A(H1N2) variant (A(H1N2)v) in Indiana.

And two human infections with influenza A(H1N1)v were reported by Iowa.

All three patients were adults ≥ 18 years of age, were not hospitalized, and recovered from their illness.

Furthermore, these patients had attended an agricultural event where swine were present and/or visited a farm where swine were present.

During the 2020-21 influenza season, 14 human infections with novel influenza A viruses were reported in the United States, including two H3N2v (I.A., WI), four H1N2v (I.A., IN, OH (2)), and eight H1N1v (IA (3), N.C., ND, WI (3)) virus infections.

So far in the 2021-22 influenza season, one human infection with a novel influenza A virus (H3N2v) has been reported in Ohio.

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a "variant influenza virus."

Most human infections with variant influenza viruses occur following proximity to swine, but human-to-human transmission can occur.

It is important to note that in most cases, variant influenza viruses have not shown the ability to spread efficiently and sustainably from person to person.

Additional information on influenza in swine, variant influenza virus infection in humans, and strategies to interact safely with swine can be found at www.cdc.gov/flu/swineflu. Further details regarding human infections with novel influenza A viruses can be found at http://gis.cdc.gov/grasp/fluview/Novel_Influenza.html.

If needed, the U.S. FDA approved one vaccine against the 2009 H1N1 influenza virus for persons ten years of age and older. The successful 2009 vaccine rollout helped to end the H1N1 influenza pandemic in 2010.

A study published in 2017 found that adjuvanted and unadjuvanted monovalent influenza A(H1N1)pdm09 vaccines were effective in preventing this type of influenza. Overall, the vaccines were also effective against influenza-related hospitalization.

For both outcomes, adjuvanted vaccines were more effective in children than in adults.

For current, updated information on seasonal flu, including information about H1N1, see the CDC Seasonal Flu website.

Mumbai: Swine flu cases increase by 38.63% this year; 61 cases reported till October in 2021 [Free Press Journal, 2 Nov 2021]

By Swapnil Mishra

The cases related to the swine flu have increased by 38.63 per cent until October compared to last year. According to the data, there were 44 cases of H1N1 in 2020 which has now increased to 61 until October. Health officials said there is no doubt that cases of H1N1 and H3N2 have increased in the city. But experts have advised doctors to think of H1N1 if a patient doesn’t respond to Covid-19 treatment.

Senior doctors from civic-run hospitals said they have come across many patients exhibiting the symptoms and most of them are testing positive for influenza A. They said last year there were hardly any cases of swine flu or influenza.

Last month, a doctor from KEM Hospital said that seven to eight patients have shown symptoms of fever, cough and sore throat, similar to Covid-19. “If I test 10 people with these symptoms, the majority are turning positive for influenza and swine flu,” the doctor said.
Another doctor said there are cases of other viral infections and respiratory syncytial virus (RSV), too. “Doctors should keep this in mind, especially when a patient is not responding to Covid treatment,” he said.

Senior doctors from the civic-run hospitals said they have seen three cases of swine flu and two cases of H3N2, also a subtype of influenza A this year. Moreover, recently a patient who recovered from Covid-19 tested positive for H1N1.

“I have recently treated two patients who presented with cold, fever and headache. One of the patients, in his 30s, had recently recovered from Covid-19. Since it is rare for a patient to get a Covid-19 re-infection within 90 days, he was suggested to take an H1N1 test. The result of the test came positive,” said a doctor.

Infectious diseases expert Om Shrivastav said influenza A is the most dominant infection currently. “H1N1 and Covid-19 are from the same family. Rt-PCR cannot differentiate between any of them. Any diagnosis is based on clinical parameters and not lab testing,” he said.

Dr Pinak Pandya, Consultant, department of Critical Care Jaslok Hospital and Research Centre, said for the past two to four months there has been a rise in new variants of H1N1 in China.
As per researchers, the new variant is different and the disadvantage is that this new variant is initially mild and many remain asymptomatic so initial studies in pigs have shown that it doesn’t get detected until it has infected a majority of the herd.

“In Mumbai we have still not seen presentation of the new mutated variant of H1N1 in any patients but the overall swine flu cases have increased from the past one-and-a-half-year.
Importantly, care should be taken if anyone is showing respiratory symptoms , cough, breathlessness, joint pain, vomiting even if you tested negative for Covid19 and consult your physician immediately if symptoms persist,” he said.

Doctors urge people to get vaccinated against the flu [Live 5 News WCSC, 13 Oct 2021]

By Bill Sharpe

CHARLESTON, S.C. (WCSC) - There is good and bad news about the upcoming fall virus season. The number of COVID-19 cases is dropping nationwide, especially in South Carolina.

But doctors like Willie Underwood with the American Medical Association are worried the flu could be worse, and perhaps much worse, than last year.

He says that is partly because of the safety steps we took last year to prevent COVID-19, which worked to help stop the flu, as well.

Underwood listed some of the safety practices that worked, including social distancing, not interacting with others, wearing a mask, and children learning from home.

Dr. Leandris Liburd with the Centers for Disease Control and Prevention says it’s especially important for those in the Black and Hispanic communities to get flu shots because there is a historic pattern of fewer people in these two groups getting vaccinated.
She worries about underlying conditions like heart disease, lung disease, diabetes and other conditions that have compromised the immune system could make the flu worse or even deadly.

In the meantime, Underwood recommends getting a “twofer,” both a flu shot and COVID vaccine at the same time.

“So, if you’re getting one, get the other if you can, because we’ve tested it, they’ve looked at it and it’s extremely, extremely -- and I’m going to say it again -- extremely safe to do so,” Underwood says.

Liburd also says it’s really important for Black parents to make sure their kids get the flu shots because right now in the Black community, flu vaccine coverage is under 50 percent across the country.

New Coronavirus News from 7 Jan 2022

COVID-19 and Influenza Surveillance - Coronavirus [Virginia Department of Health, 7 Jan 2022]

How does COVID-19 relate to the flu?

People with COVID-19 and people with influenza (the flu) can have similar signs and symptoms or even none at all. Even though individual infections may look the same, there are some important differences between the two diseases.
• Both COVID-19 and flu can cause severe illness and even death, but a larger proportion of COVID-19 cases result in hospitalization or death.
• More severe outcomes of COVID-19 tend to increase with age, while negative outcomes for the flu affect the very young and the very old.
• The reproductive number, R0 (pronounced R naught), is a value that describes how contagious a disease is. For the flu, the R0 tends to be between 1 and 2, which means that for every person infected with the flu, they will infect one to two more people. For the original COVID-19 variant, the R0 is higher than the flu, between 2 and 3.
• Between July and December 2021, more than 97% of sequenced samples in Virginia have been identified as the Delta variant. Delta is more than twice as contagious as previous variants of COVID-19, with an R0 that is estimated to be between 5-7. To learn more about COVID-19 variants, visit the Variants web page.
• As of January 1 2022, the Omicron variant accounts for 95% of testing for variants of concern in the US according to the Centers for Disease Control and Prevention (CDC). A recent study estimated Omicron to be about 3 times as infectious as the Delta variant, and both variants are more contagious than previous variants.
• The incubation period, or the time between infection and when you have symptoms, and the length of illness are both shorter for the flu than they are for COVID-19.

It’s important for public health and healthcare providers to be able to tell the difference between the flu and COVID-19.

How does VDH track and measure COVID-19?
Surveillance is the practice of tracking and measuring the burden and trend of a disease’s impact on a community. VDH conducts surveillance for many diseases and conditions, but the specific methods can vary by disease or condition. For some diseases, including COVID-19, VDH conducts surveillance by counting every case and trying to measure the exact impact of the disease. The benefits of counting individual cases include:
• Identifying health behaviors and risk factors that may be associated with more severe illness. Interviewing individual people with COVID-19 allows us to do this. . For COVID-19, we’re asking questions about living conditions, symptoms, underlying health conditions, and travel history.
• Uncovering outbreaks. Interviewing people with COVID-19 also allows us to ask questions about exposure that may help uncover outbreaks. Asking each person about where they work or where they go to childcare or school may identify a cluster of illnesses that are connected.
This can help prevent more people from getting sick at those locations.

Helping public health prevent spread of COVID-19. Knowing who is sick with COVID-19 can help public health to contact them to give steps on how to isolate (stay home) to prevent further spread. It also allows public health to do contact tracing. Contact tracing notifies people of their exposure and provides quarantine (stay home) recommendations and support.
VDH is using the “Box It In” strategy to try and control the spread of COVID-19. This strategy is how countries like New Zealand, South Korea, and Singapore are able to control their outbreaks. This strategy requires that we count individual cases of COVID-19.

While there are benefits to counting individual cases, there are also challenges:
• The process of interviewing individual cases is very time-consuming for public health staff.
• The process of entering data for each case of a common disease can be time-consuming for healthcare providers.
• Individual case counts need a large data infrastructure for exchanging, storing, and processing a high volume of data very quickly. It also needs a large workforce to analyze the data and ensure data quality.

How does VDH track and measure the flu?
For some diseases, the benefits of counting individual cases outweigh the challenges. For others, they don’t. The flu is an example of a disease where VDH does not count individual cases. All the challenges above apply to flu surveillance as well as the others below:
• For people who do seek care, most are diagnosed with a rapid influenza diagnostic test (RIDT) or by their symptoms alone. Diagnosing flu like this works well in the clinical setting. It can provide access to antiviral medication that treats the flu. Unfortunately, neither RIDTs nor symptom-based diagnoses are consistent or detailed enough to meet the case classification. Because of this, public health cannot “count” the case.
• The confirmatory tests that are available (PCR, viral culture, and DFA [direct fluorescent antigen]) for the flu are more expensive and are not used for most cases. Counting cases based on these tests alone would introduce bias. This is because people who are wealthier, better insured, or sicker, or certain healthcare systems, may more often use these test types.

So instead of counting each case of flu, VDH uses other data sources to track each flu season.
These variables include:
• Influenza-like illness (ILI)
VDH receives data about every visit to an emergency department (ED) and a lot of visits to urgent care centers (UCCs) through its syndromic surveillance program. These data include some demographics and a chief complaint, or why the patient is seeking care. The chief complaint may include their specific symptoms, a specific disease, or a known exposure. VDH can track which of these visits meet the criteria of having an influenza-like illness (ILI). An ILI is a specific mention of flu, or as a fever with either a cough, a sore throat, or both.

This surveillance system is voluntary, and some healthcare systems have started participating in the last few years. Because more ED visits are being analyzed, VDH reports out the percentage of total ED and UCC visits that have an ILI .This data source is not a count of cases and not everyone who meets ILI criteria will have the flu. This source does provide a good estimation of the intensity and timing of the flu season.
• Confirmatory lab reports

As mentioned, some tests available for the flu are confirmatory tests. One of the major benefits to these test types is that they can provide more detailed information about what type of flu virus a person has. Knowing whether we’re experiencing a flu season with a certain type of flu can be important for identifying what communities are at highest risk for complications and negative outcomes. This information also helps us to evaluate the effectiveness of the vaccine each year.

This data source is not a count of cases. Instead, it’s intended to provide insight into which viruses are circulating at a given time.
• Outbreaks
Outbreaks of flu are common. VDH counts any cluster of illness with two or more lab-confirmed cases of flu as an outbreak. Reported outbreaks can be a good indicator of how much flu is spreading within a community.
• Geographic Spread

The geographic spread of the flu, sometimes called the activity level, calculates how many of the five health regions in Virginia are experiencing spread of the flu. This is a calculation based on ILI, confirmatory lab reports, and outbreaks. This isn’t a measure of intensity or severity.
Instead it answers a yes/no question of whether flu is circulating in a specific area of the state.
This can help make the data more local. Before the COVID-19 pandemic, some healthcare systems based their mask-wearing and visitation policies on the geographic spread of flu to avoid introduction of a deadly virus into communities at higher risk.
• Pneumonia and Influenza (P&I) Deaths
Patients who die from the flu most often die from a complication rather than from the infection itself. They could develop pneumonia, which is a bacterial co-infection. Or, their underlying conditions could get worse. Public health tracks deaths coded as pneumonia and/or influenza (flu) together to avoid underestimating deaths associated with the flu.
• Influenza-Associated Pediatric Mortality
Influenza-associated pediatric mortality is a flu-associated death of a child. It is a nationally notifiable condition. This means that VDH reports every case we receive to CDC. This data source helps to measure the severity specific to the younger population. While the numbers are usually small in most states, CDC analyzes data from around the country and reports on findings from these cases.

There are two conditions related to influenza where the benefits of counting individual cases outweigh the challenges. These are:
• Influenza-Associated Pediatric Mortality
It’s a tragedy when a child dies from a preventable disease. VDH counts individual cases of children who die from the flu. This helps to better define the risk factors and complications that result in this outcome. Since we started counting flu-associated deaths in children, there have been between one and six deaths each flu season.
• Novel Influenza A Infections
Flu viruses, especially flu A strains, are always changing or mutating. Human infections with novel (new) flu viruses can happen in three ways:
• spillover: where a sick animal infects a human,
• genetic drift:where small mutations in the viral genome result in a new virus, or
• genetic shift: (where two different flu viruses swap parts of their genomes to create something completely new).

All three of these instances can result in a new virus that the human population does not have any immunity to, potentially leading to a pandemic. The global community is very concerned about flu pandemics so we closely monitor for these situations, perform contact tracing, and investigate the circumstances. In the United States, there have been two cases of human infection with a novel flu A virus in the past two years. Neither of these occurred in Virginia and neither resulted in additional infections.

Both of these conditions are important, but relatively rare, so the time VDH spends investigating and counting these cases is worthwhile.

What does our data tell us about the 2021-2022 flu season so far?
For surveillance purposes, each flu season in the United States begins during week 40 and lasts until week 20 of the following year. For the 2021-2022 season this is October 9, 2021 to May 21, 2022. As of January 1, 2022, Virginia is at the ‘Widespread’ geographic activity level.

This means that there was elevated influenza activity in at least three out of five health regions in Virginia. All five regions are above ILI threshold, and six outbreaks have been identified to date. For the most up-to-date information, see the Weekly Influenza Activity Report.

Looking at the Southern Hemisphere’s previous flu season can help us know what to expect in the Northern Hemisphere for the upcoming flu season. This process does not allow us to predict the future, but it can provide context and clues. During the Southern Hemisphere’s 2021 winter, they observed almost no flu activity. You can see the World Health Organization’s data on flu surveillance.

There are a few factors that could contribute to seeing such low levels of flu activity:
• Lower attention or shifted priorities among healthcare providers. This could result in decreased testing and differences in coding behavior.
• Decreased public health capacity could result in delays in reporting data.
• Prevention measures put in place to stop the spread of COVID-19, such as physical distancing, mask wearing, hand hygiene, and staying home when sick, have also been effective in limiting the spread of flu..

Of these three possibilities, the third is the most likely to have a large impact, followed by the first. We know that the Southern Hemisphere did not test as many people for flu as they would have during a typical flu season. We also know that among those who were tested, a much smaller percentage were positive than we would have normally expected.

VDH will continue to track flu and publish the Weekly Influenza Activity Report throughout the 2021-2022 flu season.

As we face rising case counts of COVID-19 coming out of the holiday season, it’s very important to make sure there are hospital beds available for those who need them. This means taking all the recommended steps to protect ourselves and our families against COVID-19 and the flu:
• Get your flu vaccine and/or your COVID-19 vaccine (or booster) if you haven’t already done so! It’s not too late to vaccinate. Find a flu vaccine site near you. You can also find a COVID-19 vaccine near you.
• Wear a well-fitting mask. Limit close contact with others you do not live with, in both indoor and outdoor spaces.
• Practice good respiratory etiquette. Cough or sneeze away from other people into your elbow or a tissue.
• Practice good hand hygiene. Wash your hands with soap and water for 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water aren’t available.
• Get tested if you have symptoms or think you’ve been exposed.
• Follow isolation recommendations if you test positive and quarantine recommendations if you’ve been exposed to someone who tested positive.

New Coronavirus News from 30 Jan 2022

Israel’s global coronavirus diplomacy efforts are bearing fruit [The Jerusalem Post, 30 Jan 2022]

By DANIEL MERON

Israel is eager to join hands with the international community in order to effectively address the current global pandemic challenge, as well as the ones to come.

Two years into the pandemic, nations across the globe are still struggling to cope with the profound challenges that coronavirus poses. Israel is proud to be one of the countries on the front lines of responding to this unprecedented public health crisis.

Israel’s unique ability to deal with emergencies, improvise, and respond quickly and flexibly have all factored into its success in coping with the pandemic. With its rapid vaccine rollout last year, Israel was widely praised for delivering the world’s fastest vaccination campaign in the first half of 2021 and as the first country to give booster shots to the public, Israel has important lessons to share. Therefore, it makes sense that the world looks to Israel as a go-to expert on how to manage the pandemic. Moreover, a core Jewish value teaches we must help the needy during difficult times, as well as those in need of medical care. Consequently, it is natural that Israel has gone to great lengths to support its friends in the international community.

Israel has been heavily involved on the international coronavirus diplomacy scene, collaborating and exchanging information with countries around the world in order to save lives and help its partners cope with the public health crisis. The Ministry of Foreign Affairs has been at the forefront of this effort, leading the push to donate masks, respirators, and other essential medical equipment to countless countries. When India was being ravaged by a severe wave of coronavirus in April of last year, Israel sent entire planeloads filled with respirators and medical aid. When Romania was grappling with a crisis in November, we sent a team of five of our top medical experts to share Israel’s experience in coping with similar such crises it had experienced in its hospitals. In Ghana, the Israeli embassy mobilized to produce and distribute masks to local medical teams. At the initiative of Foreign Minister Yair Lapid, Israel has also committed to donate over a million vaccine doses to African nations.
The Israeli Foreign Ministry Agency for International Cooperation (MASHAV) has several aid and cooperation campaigns currently active around the world. It is in the midst of its Better Together initiative, which has seen assistance packages containing hundreds of kilos worth of personal protective equipment (PPE) gear, syringes, medications, and more sent to medical staff in 52 countries across the globe, including Kenya, Peru and Bulgaria. MASHAV has brought medical staff and administrators from Tanzania, Rwanda, Guatemala, and many others to Israel for world-class seminars and lectures. Israel’s not-for-profit sector has similarly mobilized to assist the international community. IsraAID, one of Israel’s leading NGOs, just finished a six-month project in Eswatini, where an Israeli team set up and managed an operations center for distributing vaccines, training medical staff and more.

Exchanging information is key to managing the pandemic and the information that Israel has shared on its vaccine campaign and booster shots has undoubtedly saved lives. Dr. Anthony Fauci, chief medical adviser to the US government, praised Israel’s vaccine rollout and named Israel as the leading example of where you should want to be on coronavirus vaccines, and often refers people to how successful the Israelis have been in getting virtually every age group to receive booster shots. Senior Israeli Health Ministry officials have played a key role in the effort to exchange information and to this end the Ministry of Health and the Ministry of Foreign Affairs have held joint discussions with Germany, South Korea, the United States and several state health commissioners on Israel’s insights and best practices on the latest outbreak, including its experience with administering vaccine boosters. As well, Australia shortened its waiting period for the booster shot and its mandatory quarantine period following information shared by Israel during a briefing with senior officials down under.

As well, Israel’s innovative digital healthcare and telehealth systems have served as an example for others. Israel has been widely credited with revolutionizing the way the world thinks about health and has positioned itself at the forefront of the effort to create a data-centric system of medicine. In fact, the Israeli national healthcare system’s already-sophisticated level of digitization was one aspect that helped make the country’s ambitious vaccination drive so successful. Moreover, the emergence of COVID-19 brought the topic of telemedicine to the fore of the global tech discourse and Israel has made it a priority to be a leader in this field.
HealthIL is a non-for-profit digital health innovation ecosystem, a joint venture of the Israel Innovation Institute, Israel’s Ministry of Economy and Digital Israel at the Ministry of Social Equality, and seeks to improve healthcare by supporting innovation in the field, bridging the gap between the tech community and the public health sector. By centralizing I
Israel’s global healthcare innovation ecosystem, HealthIL is bringing Israeli health tech to the world by collaborating across organizations, connecting demand and supply, and streamlining innovation change management.

Israel is eager to join hands with the international community in order to effectively address the current global pandemic challenge, as well as the ones to come. Ultimately, the world will only succeed in collectively overcoming this pandemic if we work together and cooperate.
Moreover, health cooperation during the coronavirus crisis has served as an important bridge between nations and for peace. It is Israel’s hope that Omicron will be the last of the pandemic and we are looking forward to continuing to share our insights and experiences with the world in all spheres of crisis management and public health.

Israeli boy, 11, has caught 3 different coronavirus strains [The Times of Israel, 30 Jan 2022]

Alon Helfgott has officially been infected with Alpha, Delta, and now Omicron; says he’s been in quarantine 3-4 times since start of school year

In a relatively rare case, an 11-year-old Israeli boy has been infected with three different coronavirus variants.

After it was confirmed this week that Alon Helfgott from the central Israel city of Kfar Saba is positive for the virus, he has now officially been infected with the Alpha, Delta and Omicron strains.

“I’m fine, feeling pretty healthy, without so many symptoms,” he told Channel 12 news on Sunday.

Compared to the previous strains, which Helfgott said he experienced with pretty serious symptoms, this time he does not feel that sick.

“In the Alpha [infection], I suffered from a high fever,” he said.

Despite his thorough experience with quarantine, the 11-year-old stated that boredom manages to overcome everything.

“My mother bought me some sweets at the supermarket and I hope I get more things,” Helfgott said, adding that around 10 out of his 27 classmates are also currently ill with COVID-19.

“I miss being with friends, because the truth is there is nothing to do. You’re shuttered at home and do nothing.”

Helfgott said that since the start of the school year, he was forced to enter quarantine “between three and four times.”

“I try to pass the time in bed or on the phone. There are really no things to do,” he said.

With his birthday coming up on Wednesday, the day in which he is expected to be released from quarantine, Helfgott made a wish to “stay healthy and not get infected again.”

New Coronavirus News from 30 Nov 2021b

Hope for Carnival comeback amid Brazil’s COVID-19 success [DW (English), 30 Nov 2021]

After being battered by the COVID-19 pandemic, infections in Brazil are falling due to high vaccination rates. Some here are even hoping the country can hold its iconic Carnival again.
But, experts urge caution.

Brazil has vaccinated over 75% of its population at least once, the seven-day incidence rate has dropped to just 30 and some intensive care units (ICUs) in major cities don't have a single COVID-19 patient. All this comes at a time when Carnival celebrations are set to begin in February with pressure building on the government not to skip the iconic event after it was cancelled last year.

Brazil's fight against the coronavirus is impressive and it shows that countries like Germany can learn a lot from it about tackling the pandemic. That's despite the fact that Brazil has been hit harder by the coronavirus than almost any other country, with more than 614,000 COVID-19 deaths — the third-highest death toll in the world after the US and India.

First Carnival cancellations, others still hopeful
It's because of that painful experience that 58 cities in the state of Sao Paulo have now pulled the plug and canceled Carnival celebrations yet again over fear of COVID-19 outbreaks. They include Salvador, Botucatu, Sorocaba, and Poá e Suzano.

But many Brazilians are still hoping all is not lost. In Recife, Belo Horizonte and Rio De Janeiro, a newly created committee is to take a final decision in the next few weeks on whether to go ahead with celebrations for Brazil's annual highlight.

"In countries like Germany, the vaccine arrived very quickly and now there are problems getting it to all parts of the population. Here it was the opposite: We had no access to the vaccine in Brazil at first and then a population that wanted to be vaccinated as soon as possible," epidemiologist Ricardo Palacios said. "But we're watching the anti-vaccination protests in Europe with great concern, because they could present us with a new wave when they come to Brazil for Carnival."

More than two million tourists usually descend on Rio for the festivities, partying at close quarters.

High trust levels in the vaccine
Palacios, who was born in Colombia, is one of Latin America's leading epidemiologists and is well known for his work at the Butantan Institute, a prominent, state-owned research center. Palacios also led the internationally acclaimed "Project S." The title refers to an experiment in the small town of Serrana in southern Brazil — population 45,000 At the beginning of the year, Serrana became the first town in the world to be completely vaccinated.

Now, the whole of Brazil is in the process of becoming a model — with a 98% rate for first-time vaccinations among adults in Sao Paulo and 95% in Rio. Moreover, neither of the two megacities have recorded a single COVID-19 death in days.

"Brazil has had a vaccination program for more than five decades that delivers an enviable amount of vaccines to the population," Palacios said. "Brazil's success has to do with government research facilities such as Butantan or Fiocruz on the one hand, and a population that trusts the vaccine on the other. And we have a society here that thinks more collectively, rather than individualistically, as is the case in Europe."

Vaccine success despite Bolsonaro
Brazil's vaccination success is all the more astonishing given that its 212 million inhabitants have one the world's biggest COVID-19 skeptics as their president, Jair Bolsonaro. He has downplayed the pandemic, he's said COVID-19 is a "sniffle," he's made fun of mask wearers and seriously claimed that vaccinations could turn people into crocodiles. The far-right president also blocked contracts with vaccine manufacturer Pfizer for months.

"Since the beginning of the pandemic, unfortunately, the coronavirus has been politicized here," said epidemiologist Julival Ribeiro. "We have made great improvements in vaccination in recent months but we also have a president and many authorities and doctors who still doubt the effectiveness of the vaccine," he said.

Expert urges caution
The epidemiologist works at the Brazilian Society of Infectious Diseases (SBI) and has been tirelessly fighting science deniers like Bolsonaro since the beginning of the pandemic.

Ribeiro seems to have won the battle: In Brazil, even theaters, museums and supermarkets are being converted into vaccination centers and roads are being closed for this purpose. With a death rate of one for every 350 inhabitants, almost every Brazilian has lost someone close to him or her. Ultimately, that has even led supporters of the president to now seek vaccination in droves.

"Now we need the vaccine to be quickly approved for 5-to-11-year-olds," Ribeiro said. Brazil, unlike Germany, has been planning booster vaccinations for a long time and problems with scheduling are unheard of.

Year after year, the country manages to vaccinate 80 million people against influenza in a record six weeks. But the epidemiologist nevertheless warns that Carnival should not be allowed to ruin the hard-won successes in the fight against the pandemic.

Party only if you're vaccinated
"As long as all the countries of this world do not understand pandemic control as a joint task, we will always have to respond to new waves of the coronavirus,” Ribeiro said. "My fear is that at some point a variant will emerge that can evade our vaccines. And then we'll have to start all over again."

The future of Rio's Carnival in 2022 is hanging by a thread, even if politicians like the city's health minister, Daniel Soranz, are determined to maintain hope. He recently announced the biggest carnival celebration in history.

But Soranz made one thing unmistakably clear: If the party actually takes place, every visitor will need something more than a costume — a vaccination certificate.

Petition: Stop Tiger Temple from Reopening [One Green Planet, 30 Nov 2021]

By Jareb Gleckel

While drama-seeking Americans were trapped at home during the height of the COVID-19 pandemic, Tiger King became all the rage in the United States. But before people became obsessed with nefarious U.S. breeders like Joe Exotic and Doc Antle, Tiger Temple in Thailand was known as the epicenter of cruelty.

In 2016, Time magazine called Thailand’s Tiger Temple a “special sort of gruesome.” Despite its claims of being a sanctuary, owners kept Tigers locked in cages for 20-21 hours a day. Many suffered from zoochosis. And it took years to rescue 147 tigers from the facility.

In April 2015, following widespread allegations of illegal Tiger breeding and trafficking, a team of 400 department staff, police and soldiers retrieved several moon bears that Tiger Temple was keeping without permits. Then, in 2016, Thailand’s Department of National Parks (DNP) began a drawn-out raid. On the first day, the department successfully rescued 5 out of 147 tigers. On the third, the Department found forty frozen dead baby tigers, a baby bear and a baby binturong, all under a week old. The remainder of the rescue revealed 1,500 amulets and a myriad of other trinkets.

Sadly, even after the rescue, the government retained the tigers in captivity, unable to find adequate sanctuaries for so many animals. After living in such poor conditions, the majority of the tigers continued to suffer—many from genetic defects due to inbreeding. Eighty-six died from a disease outbreak two years ago.

Despite the evidence of cruelty and the years of heinous publicity, the owners of Tiger Temple are planning to reopen a new facility. Please sign this petition to stop the gruesome business before it starts.

South Korea reports daily record of over 5,000 new Covid-19 infections [CNBC, 30 Nov 2021]

South Korea reported a new daily record of 5,123 new coronavirus cases, as the country battles to contain a sharp rise in patients with severe symptoms and stave off the omicron, the Korea Disease Control and Prevention Agency (KDCA) said on Wednesday.

The government on Monday shelved plans to further relax Covid-19 curbs due to the strain on its healthcare system from rising hospitalizations and deaths as well as the threat posed by the new variant.

Hospitals were treating a record number of 723 patients with severe Covid-19 that require ICU beds, as the authorities scrambled to secure more. The severe cases have seen a steep rise compared to just under 400 in early November.

Over 84% of the severely ill Covid-19 patients were aged 60 and above. Experts had pointed to waning antibody levels from the vaccines and urged the elderly to get booster shots.

Authorities will mobilize the administrative structure to secure hospital beds, at least an additional 1,300 by mid-December, Interior and Safety Minister Jeon Hae-cheol told a Covid-19 response meeting.

He also called for tighter virus prevention measures to head off omicron, after suspected cases entered the country from Nigeria.

South Korea has not reported any confirmed omicron cases so far.

Tuesday's new cases bring the coronavirus infections in the country to 452,350 cases, with 3,658 deaths. Despite the rising hospitalization rate, the mortality rate remains relatively low at 0.81%, KDCA data showed.

South Korea has fully vaccinated nearly 80% of its 52 million people, while the boosters for adults aged 18 to 49 only begin this Saturday.

Omicron variant was detected in the Netherlands before S. Africa flights [Reuters, 30 Nov 2021]

AMSTERDAM, Nov 30 (Reuters) - The COVID-19 Omicron variant was detected in the Netherlands before two flights arrived from South Africa last week carrying the virus, Dutch health officials said on Tuesday.

At least 14 people on flights from Johannesburg and Capetown arrived at Amsterdam's Schiphol airport on Nov. 26 carrying the new variant, the National Institute for Public Health (RIVM) said.

"We have found the Omicron coronavirus variant in two test samples that were taken on Nov. 19 and Nov. 23," the RIVM said. "It is not clear yet whether these people have visited Southern Africa."

The discovery of Omicron has sparked worries around the world that it could resist vaccinations and prolong the nearly two-year-old COVID-19 pandemic.

Some 61 out of the more than 600 passengers on the South Africa flights tested positive for COVID-19 and went into quarantine after arriving last Friday.

Dutch authorities are also seeking to contact and test some 5,000 other passengers who have travelled from South Africa, Botswana, Eswatini, Lesotho, Mozambique, Namibia or Zimbabwe.

In the Netherlands, tougher COVID-19 measures went into effect on Sunday to curb record daily infection rates of more than 20,000 and ease pressure on hospitals.

What Could Be The Economic And Political Cost Of Omicron Spread In India? [Outlook India, 30 Nov 2021]

Omicron scare is already visible in the industry with many customers cancelling their flights scheduled for December as state governments mull stricter travel rules to stop the variant’s spread.

There is panic all around the world due to the emergence of the Omicron variant of COVID. In the coming days, if it turns out to be as dangerous as the Delta variant, the world economy could face another recession, impacting India as well.

Is there enough fiscal and monetary space available with the policymakers to deal with another lockdown-inducing situation in the coming months?

Let’s first look at the areas that the Omicron variant will hit if it leads to another lockdown. Supply Chain Bottlenecks

COVID-related lockdowns have led to stranded cargo ships around the world, leading to a shortage of several important goods and commodities.

India has struggled to source semiconductors or chips for its automobile industry which, in turn, has forced automakers like Maruti Suzuki and others to bring down their production capacity. In October, passenger vehicle sales stood at 2,58,774 units—21 per cent lower on a year-on-year basis. India’s largest carmaker, Maruti Suzuki, registered a 33 per cent decline in sales.

The other area where the supply chain constraints have hit India the most is the price of crude oil which has hovered around $70 a barrel. High fuel and other commodity prices took India’s wholesale price inflation to 12.54 per cent in October and it will eventually begin to spill over to consumer price index inflation as well.

Impact on Travel Industry
So far, the biggest impact of COVID-19 has been on the travel and tourism industry. The sector employs 31.8 million people or 7.3 per cent of total employment in India.

The fear of Omicron is already visible in the industry with many customers cancelling their flights scheduled for December as state governments mull stricter travel rules to stop the variant’s spread. InterGlobe Aviation (operator of IndiGo, India’s largest domestic airline) saw its stock price touching a 52-week high of Rs 2,380 on November 16, 2021, crashed by 18 per cent by 29 November.

In a recent interview with Outlook Business,Associated Chambers of Commerce and Industry of India (ASSOCHAM) President Vineet Agarwal said that the travel and tourism industry will be the most impacted in case of a third wave in the country even as other industries have learnt to deal with lockdowns in the previous waves.

Revision of GDP Growth And Fiscal Deficit Targets
There have been quite a few revisions of the GDP growth projections this year. The RBI recently maintained its GDP growth forecast for FY22 at 9.2 per cent. RBI Governor Shaktikanta Das, however, has also cautioned against the downside risks to these projections. “The impact of elevated input costs on profit margins, potential global financial and commodity markets volatility and resurgence in COVID-19 infections, however, impart downside risks to the growth outlook," Das had said in October this year.

In case India witnesses a third wave due to the spread of the Omicron variant in the coming months, it can lead to a downward revision of India’s growth projections in the last quarter of the current financial year.

Nobel Prize-winning economist Abhijit Banerjee had said in August that a third wave of COVID-19 will pull India’s GDP growth down by two and a half percentage points to around 7 per cent.

Political Disruption
The BJP-led central government was at the receiving end in April this year when hospitals were choking with patients and crematoriums with dead bodies during the second wave of COVID-19. Its immediate impact was visible in the West Bengal assembly elections where the BJP lost in a one-sided electoral fight.

The coming months will see two important elections in the states of Uttar Pradesh and Punjab. In case the Omicron variant leads to casualties like the ones witnessed during the last COVID-19 wave in India, its immediate cost could come in the form of the BJP’s defeat in Uttar Pradesh, a state that sends 80 MPs to the Parliament.

How delicate the BJP’s position in Uttar Pradesh is can be gauged from the fact that Prime Minister Narendra Modi had to repeal the farm laws passed in the Parliament last year as opinion polls in the state suggested anti-BJP sentiment among the farmers.

No case of Omicron in India yet, Health minister Mansukh Mandaviya tells Parliament [The Indian Express, 30 Nov 2021]

Mandaviya also said that the central government has issued an advisory based on the global developments related to the new variant and is keeping a keen watch on ports.

The new Covid-19 variant Omicron has not been reported in India yet, Union Health minister Mansukh Mandaviya informed Parliament on Tuesday.

“The Omicron variant has been detected in 14 countries so far. There is no case of Omicron in India yet. We are immediately checking suspicious cases and conducting genome sequencing. We are also taking all possible precautions,” he said in the Rajya Sabha during the Winter Session of Parliament.

Mandaviya also said that the central government has issued an advisory based on the global developments related to the new variant and is keeping a keen watch on ports.

Speaking during the Question Hour in the Rajya Sabha, the minister added that studies are being conducted on the Omicron.

Stressing on the need to take all precautions, Mandaviya said, “We have learnt a lot during the pandemic. We have resources and labs to check. All measures have been taken to ensure this variant does not reach the country”.

Earlier in the day, Union Health Secretary Rajesh Bhushan held a review meeting with states and UTs and advised them to ramp up testing for early identification and management of cases.

While underlining that the new variant doesn’t escape RT-PCR and RAT tests, Bhushan asked states and UTs to ensure adequate infrastructure and supervised home isolation.

The ministry has asked all states and UTs to focus on intensive containment, active surveillance, enhanced testing, monitoring of hotspots, increased coverage of vaccination and augmentation of health infrastructure.

In a letter to states and UTs on November 28, Bhushan also stressed on rigorous surveillance of international passengers, ensuring prompt dispatch of samples for genome sequencing and strict enforcement of Covid-appropriate behaviour to effectively manage this variant of concern (VoC).

The B.1.1.529 Covid variant or Omicron, first detected in South Africa last week, was designated by the World Health Organization as a ‘variant of concern’, the health body’s top category for worrying coronavirus variants.

WHO has further said that it is likely to spread internationally and poses a very high risk of infection surges that could have “severe consequences” in some places.

Omicron blows off all itineraries, fliers and travel companies left stranded [Economic Times, 30 Nov 2021]

ByAnirban Chowdhury

The government’s announcement on resuming international flights and subsequent retrieval of it on concerns about a new coronavirus variant have got travellers, airlines and travel companies in a tizzy even as airlines have started flights to Singapore under a new deal.

Portals such as Cleartrip and Ixigo said they are flooded with passenger queries on new testing and quarantine rules in India and possibilities of travel bans by other countries.

“We have seen a spurt in queries on international travel over the last few days,” Prahlad Krishnamurti, chief business officer at travel portal Cleartrip, told ET. “We expect this to persist over the next few weeks as governments adapt their rules based on the impact of the new variant being reported.”

The World Health Organisation (WHO) has termed the Omicron mutation, first detected in South Africa, as ‘variant of concern’ that poses “very high” global risk, prompting several countries to impose travel restrictions.

Meanwhile, IndiGo, Air India, Vistara and Singapore Airlines on Monday resumed daily flights between India and Singapore under the new ‘vaccinated travel lane’ (VTL) agreement – a Singapore initiative that allows vaccinated travellers to enter both countries quarantine- free. Singapore, though, deferred VTL deals with Qatar, Saudi Arabia and the United Arab Emirates on concerns about the Omicron.

The travel industry has adopted a wait and watch stance over the new development.

“This is a reality, the new normal that we will all have to accept. As not enough data is available on the new variant, we are awaiting more details from our health authorities,” said Madhavan Menon, chairman and managing director of Thomas Cook, India. “While we have received a couple of cancellations, this is clearly not a trend.”

Rajesh Magow, group CEO of Makemytrip, said it is too early to assess and quantify the potential impact on international travel from India. “At MakeMyTrip, we are continuing to keep a close watch on the evolving travel guidelines and we would encourage travellers to adhere to all travel protocols and practice COVID-safe behaviour at all times,” he said. “Our teams are working closely with airline partners to ensure that guidelines for domestic and international travel are updated real time on the website and the app.”

An executive working for a travel and tours company said they were getting cancellations for South Africa and queries on protocol changes for other countries. “Travellers are asking us for updates and about changes in protocols in other countries. We are trying to apprise them of our flexible terms and policies in case they would like to change their plans.”

On Sunday, the government tightened rules for incoming international passengers and decided to review its plan to resume international flights from December 15 that it had announced on Friday.

According to the latest guidelines, all incoming passengers will have to submit travel plans for the next 14 days and upload a negative Covid-19 report on a state-run portal that maintains real-time air travel data.

Passengers from 14 countries including the UK, South Africa, Brazil, Bangladesh, Botswana, China, Mauritius, New Zealand, Zimbabwe, Singapore, Hong Kong and Israel will have to undergo RT-PCR test on arriving.

Meanwhile, Japan has shut its borders on air travel, while many countries including Mauritius have tightened restrictions on travellers from South Africa.

SINGAPORE DEAL
Under the new VTL agreement with Singapore, Air India will operate seven flights a week from Delhi and two from Mumbai, Vistara will operate two flights from Mumbai, and Indigo will operate seven flights from Chennai. Singapore Airlines will start daily VTL services from Chennai, Delhi and Mumbai.

SIA will also resume non-VTL services daily from Kolkata, four times weekly from Bengaluru, three times weekly from Hyderabad and Kochi, and once a week from Ahmedabad, an airline spokesperson said.

Airline executives reported a rise in bookings and “healthy loads” on flights.

FINGERS CROSSED
Detection of the Omicron variant comes at a time when travel demand has been on the rise.

“Pent up travel demand continues to be strong despite high occupancy and rates/air fares, and our domestic demand is even higher than pre-pandemic levels,” said Menon of Thomas Cook. “With a calibrated reopening of international commercial flights, we look forward to increased capacity and rationalisation of fares – creating a healthy pipeline towards recovery in 2022.”

Top India executive at a European carrier that operated more than 50 weekly flights to India before the pandemic said, “Demand has been consistently growing since August.” He said the government is “being prudent” in restricting travel instead of shutting it down again. Even if international travel were to resume today, going back to pre-Covid capacity would take more than a year, he said.

An executive working for a top hotel chain that runs hotels in India and overseas locations such as Maldives, the UK, South Africa and the UAE said considering the year-end season, the demand was exceeding even pre-Covid levels in some destinations over the last weekend.


"We don't know what happens to that demand now,” the person said. “We will probably get more clarity in the next 48 hours if more countries announce curbs or more Indian states revise guidelines.”

Vishal Lonkar, general manager for brand development at Renest Hotels & Resorts, said it was hoping that IT companies will open up in January and expats will return to Bengaluru where the chain owns and operates Howard Johnson by Wyndham hotel under a franchising arrangement with Wyndham Hotels & Resorts. “We do not see that happening now in December-January, till we have more information on this new variant and its spread,” he said.

Renest runs hotels under other arrangements in locations such as Jaipur, Shirdi, Tirupati, Bandhavgarh and Kolkata.

Rohit Chopra, regional director for sales and distribution at Accor for India and South Asia, said the chain has been vigilantly monitoring the situation evolving around the new Omicron variant for the last 72 hours, and has witnessed no direct impact in terms of cancellations or changes in bookings in India so far. “Travelers are going to be watchful of quarantine requirements which may be put in place again for interstate travel within India,” he said. “The situation is still evolving and we will know more in the next week or so.”

Quixplained: Why Omicron is high risk, what you should do [The Indian Express, 30 Nov 2021]

The World Health Organization has classified a new variant of the novel coronavirus, which belongs to a lineage named B.1.1.529, as a ‘variant of concern’, and named is Omicron. This variant was first identified by scientists in South Africa, but has spread to nearly a dozed countries including Australia, Italy, Germany, the Netherlands, Britain, Hong Kong, Botswana and Belgium.

So, what is different about Omicron and why is it deemed a high risk? Do vaccines work against it? What should you do? Take a look:

The emergence of the new variant shows once again that the pandemic is far from over — and Covid-appropriate behaviour is critical for breaking the chain of transmission: masking, social distancing, good ventilation in all shared spaces, and washing or sanitising hands and surfaces regularly.

The missing 'S' in Omicron can help India avoid disaster [Economic Times, 30 Nov 2021]

A complete RT-PCR report for Covid-19 includes that of the 'N', 'S', 'E', and 'ORF' genes. An indirect way of knowing whether someone has the new variant Omicron is to check for the absence of the 'S' gene while other genes being present, Maharashtra state task force member Dr Shashank Joshi told TOI.

Health experts want laboratories to conduct RT-PCR tests in whole for all the three genes amid the emergence of the Omicron variant, especially for international travellers. Unfortunately, not all laboratories conducting RT-PCR tests are checking for the ‘S’ gene, Joshi said.

The task force member says a directive may come for all laboratories soon to check for the 'S' gene in particular, as its deletion is a red flag for Omicron ahead of genome sequencing.

“PCR tests are under development to test for this variant without the need for full sequencing” a World Health Organisation (WHO) statement read.

The Centre on Tuesday extended the nationwide COVID-19 containment measures till December 31 in view of the emergence of Omicron in some countries and asked States to be vigilant.

Dr Rahul Pandit, a member of the state task force and also the national Covid task force, told TOI that with Omicron being stated as a 'cause for concern' across the world, maintaining caution was instrumental.

India logged 6,990 new coronavirus infections, the lowest in 551 days, taking the country's total tally of COVID-19 cases to 3,45,87,822, while the active cases have declined to 1,00,543, the lowest in 546 days, according to the Union health ministry data updated on Tuesday.

Omicron variant may have reached Europe earlier than thought [The Seattle Times, 30 Nov 2021]

By CARLA K. JOHNSON

BRUSSELS (AP) — Brazil and Japan joined the rapidly widening circle of countries to report cases of the omicron variant Tuesday, while new findings indicate the mutant coronavirus was already in Europe close to a week before South Africa sounded the alarm.

The Netherlands’ RIVM health institute disclosed that patient samples dating from Nov. 19 and 23 were found to contain the variant. It was on Nov. 24 that South African authorities reported the existence of the highly mutated virus to the World Health Organization.

That indicates omicron had a bigger head start in the Netherlands than previously believed.
Together with the cases in Japan and Brazil, the finding illustrates the difficulty in containing the virus in an age of jet travel and economic globalization. And it left the world once again whipsawed between hopes of returning to normal and fears that the worst is yet to come.

The pandemic has shown repeatedly that the virus “travels quickly because of our globalized, interconnected world,” said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health. Omicron demonstrates that until the vaccination drive reaches every country, “we’re going to be in this situation again and again.”

Brazil, which has recorded a staggering total of more than 600,000 COVID-19 deaths, reported finding the variant in two travelers returning from South Africa — the first known omicron cases in Latin America. The travelers were tested on Nov. 25, authorities said.

Japan announced its first case, too, on the same day the country put a ban on all foreign visitors into effect. The patient was identified as a Namibian diplomat who had recently arrived from his homeland.

France likewise recorded its first case, in the far-flung island territory of Reunion in the Indian Ocean. Authorities said the patient was a man who had returned to Reunion from South Africa and Mozambique on Nov. 20.

Much remains unknown about the new variant, including whether it is more contagious, as some health authorities suspect, whether it makes people more seriously ill, and whether it can thwart the vaccine.

But a WHO official said that given the growing number of omicron cases in South Africa and neighboring Botswana, parts of southern Africa could soon be witnessing a steep rise in infections.

“There is a possibility that really we’re going to be seeing a serious doubling or tripling of the cases as we move along or as the week unfolds,” said Dr. Nicksy Gumede-Moeletsi, a WHO regional virologist.

Cases began to increase rapidly in mid-November in South Africa, which is now seeing nearly 3,000 confirmed new infections per day.

As of Tuesday, 44 cases of omicron were reported across 11 European Union nations, said the EU’s European Center for Disease Prevention and Control, adding that the majority involved a history of travel to Africa. Outside the EU and southern Africa, omicron infections have turned up in such places as Australia, Canada, Britain and Israel.

American disease trackers said omicron could already be in the United States and probably will be detected soon.

“I am expecting it any day now,” said Scott Becker of the Association of Public Health Laboratories. “We expect it is here.”

While the variant was first identified by South African researchers, it is unclear where and when it originated, information that could help shed light on how fast it spreads.

The announcement from the Dutch on Tuesday could shape that timeline.

Previously, the Netherlands said it found the variant among passengers who came from South Africa on Friday, the same day the Dutch and other EU members began imposing flight bans and other restrictions on southern Africa. But the newly identified cases predate that.
NOS, the Netherlands’ public broadcaster, said that one of the two omicron samples came from a person who had been in southern Africa.

Belgium reported a case involving a traveler who returned to the country from Egypt on Nov. 11 but did not become sick with mild symptoms until Nov. 22.

Many health officials tried to calm fears, insisting that vaccines remain the best defense and that the world must redouble its efforts to get the shots to every part of the globe.

Emer Cooke, chief of the European Medicines Agency, said that the 27-nation EU is well prepared for the variant and that the vaccine could be adapted for use against omicron within three or four months if necessary.

England reacted to the emerging threat by making face coverings mandatory again on public transportation and in stores, banks and hair salons. And one month ahead of Christmas, the head of Britain’s Health Security Agency urged people not to socialize if they don’t need to.

After COVID-19 led to a one-year postponement of the Summer Games, Olympic organizers began to worry about the February Winter Games in Beijing. Chinese Foreign Ministry spokesperson Zhao Lijian said omicron would “certainly bring some challenges in terms of prevention and control.”

World markets seesawed on every piece of medical news, whether worrisome or reassuring. Stocks fell on Wall Street over virus fears as well as concerns about the Federal Reserve’s continued efforts to shore up the markets.

Some analysts think a serious economic downturn will probably be averted because many people have been vaccinated. But they also think a return to pre-pandemic levels of economic activity, especially in tourism, has been dramatically delayed.

New Coronavirus News from 31 Jan 2022

BA.2 Subvariant Known as ‘Stealth Omicron' Detected in Wisconsin [NBC Chicago, 31 Jan 2022]

The World Health Organization classifies omicron overall as a variant of concern, but it doesn’t single out BA.2 with a designation of its own.

The new BA.2 omicron subvariant, regularly referred to as "stealth omicron," has been reported in Wisconsin, according to a Milwaukee County health official.

Dr. Ben Weston, chief health policy adviser for Milwaukee County tweeted Monday that BA.2 had been detected in the state, noting it is 1.5 times more transmissible than the original omicron strain but doesn't appear to be more severe.

It's unclear where exactly in the state the case was reported.

This version of the coronavirus has been detected in more than 40 countries and is widely considered stealthier than the original version of omicron, BA.1, hence its name. Particular genetic traits make BA.2 somewhat harder to detect, health officials have said.

The World Health Organization classifies omicron overall as a variant of concern, but it doesn’t single out BA.2 with a designation of its own. Given its rise in some countries, however, the agency says investigations of BA.2 “should be prioritized."

An initial analysis by scientists in Denmark shows no differences in hospitalizations for BA.2 compared with the original omicron. Scientists there are still looking into this version's infectiousness and how well current vaccines work against it. It's also unclear how well treatments will work against it.

Doctors also don’t yet know for sure if someone who’s already had COVID-19 caused by omicron can be sickened again by BA.2. But they’re hopeful, especially that a prior omicron infection might lessen the severity of disease if someone later contracts BA.2.

Different Takes: Will Covid Follow In Footsteps Of 1918 Influenza?; How Linked Is Race To Covid Outcomes? [Kaiser Health News, 31 Jan 2022]

The New York Times: What We Can Learn From How The 1918 Pandemic Ended Most histories of the 1918 influenza pandemic that killed at least 50 million people worldwide say it ended in the summer of 1919 when a third wave of the respiratory contagion finally subsided. Yet the virus continued to kill. A variant that emerged in 1920 was lethal enough that it should have counted as a fourth wave. In some cities, among them Detroit, Milwaukee, Minneapolis and Kansas City, Mo., deaths exceeded even those in the second wave, responsible for most of the pandemic’s deaths in the United States. This occurred despite the fact that the U.S. population had plenty of natural immunity from the influenza virus after two years of several waves of infection and after viral lethality in the third wave had already decreased. (John M. Barry, 1/30)
The Atlantic: Race-Based Rationing Of COVID Treatment Is Real—And Dangerous In a series of articles this month, The Washington Free Beacon’s Aaron Sibarium reported that hospitals in Minnesota, Utah, New York, Illinois, Missouri, and Wisconsin have been using race as a factor in which COVID-19 patients receive scarce monoclonal-antibody treatments first. Last year, SSM Health, a network of 23 hospitals, began using a points system to ration access to Regeneron.
The drug would be given to patients only if they netted 20 points or higher. Being “non-White or Hispanic” counted for seven points, while obesity got you only one point—even though, according to the CDC, “obesity may triple the risk of hospitalization due to a COVID-19 infection.” Based on this scoring system, a 40-year-old Hispanic male in perfect health would receive priority over an obese, diabetic 40-year-old white woman with asthma and hypertension. (Shadi Hamid, 1/30)

NBC News: Covid-19 Omicron Variant Might Be Weaker, But 'Letting It Rip' Is Not A Smart IdeaHave you reached your breaking point with the pandemic? Are you ready to throw up your hands, let down your guard and accept that you’ll probably get Covid-19? Many Americans are openly wondering if this is the way to go. The U.K., Netherlands, France and several other E.U. countries are rolling back most of their Covid restrictions, and Australia, until now a global model for Covid mitigation, has flipped its approach from a “zero Covid” strategy to just “let it rip.” Many pundits, politicians and others are publicly saying that they are “over” Covid. You know who else is over Covid? The nearly 16,000 people who died from the virus between Jan. 19 and Jan. 25. (Brian Castrucci and Beth S. Linas, 1/28)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Israeli Covid expert panel recommends expanding 4th vaccine to all adults over 18 [Jewish News, 31 Jan 2022]

Health Ministry announced the preliminary results of a study which showed the fourth vaccine tripled protection against serious illness and doubled protection against Omicron

A panel of experts that advises Israel’s Health Ministry on matters related to the coronavirus is recommending that all adults over the age of 18 be offered a fourth dose of the coronavirus vaccine, The Times of Israel reported on Tuesday.

On Sunday, the Health Ministry announced the preliminary results of a study which showed that the fourth vaccine dose tripled protection against serious illness and doubled protection against an infection with the Omicron variant compared to those who received only three shots. The study included 400,000 adults who received a fourth dose and 600,000 who received three doses.

Those results contrasted with a less promising announcement last week from the Sheba Medical centre, which is studying the effects of a fourth dose of the vaccine.

“We see an increase in antibodies, higher than after the third dose,” Gili Regev-Yochay, a top researcher from the hospital, said, according to The Times of Israel. “However, we see many infected with Omicron who received the fourth dose. Granted, a bit less than in the control group, but still a lot of infections,” she added.

The advisory panel’s recommendation would have adults over the age of 18 receive a fourth shot at least five months after receiving their third shot or recovering from the virus. The recommendation is subject to approval by the Health Ministry’s director-general.

Israel is believed to be reaching or approaching the peak of its Omicron wave, with over 83,000 new cases reported on Sunday alone. More than half a million people in Israel are currently infected with the virus.

Israel began offering a fourth dose of the vaccine to adults over the age of 60 earlier this month despite minimal data showing that a fourth dose would increase immunity to the virus.

Israel was also the first country to administer a third coronavirus vaccine, a practice which became widespread in the face of waning immunity and the lowered effectiveness of just two shots in preventing an infection from Omicron.

More than 600,000 Israelis have received a fourth coronavirus vaccine and nearly 4.5 million have received a third vaccine dose.

What is the future of the pandemic? Experts weigh in [Israel Hayom, 31 Jan 2022]

In a post-pandemic world, will the Green Pass and other measures such as airport PCR testing still be necessary?

Public health and policy experts predict how society will function after we exit coronavirus emergency

The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on March 11, 2020, and eventually the UN public health agency will announce that the illness has entered an endemic stage.

This will happen when there is enough confidence that Covid-19 has become more predictable and manageable.

It can be hard to imagine what a post-pandemic world will look like as casualties continue to mount with 373 million cases and 5.66 million deaths over the past two years, according to the website Our World in Data.

Public health and policy experts gave i24NEWS some perspective on what the endemic phase of the coronavirus in Israel and beyond could entail while cautioning that the fight against the disease will continue long after the pandemic is officially over.
Will we still wear masks?
Once only common in certain east Asian countries, face coverings have become ubiquitous in Western societies as protection against airborne viral spread.

But will masks still be used in the months and years after the pandemic?
"I am sure that 'normality' and closeness which are so important for us will drive us eventually to throw away the masks and to give up social distancing," said Dr. Itzchak Levy, head of Sheba Medical Center's Infectious Disease Institute and post-corona clinic.

However, Levy predicts that mask-wearing won't entirely disappear as the public has increased its level of awareness of the dangers of infectious diseases and pandemics, so during the winter months masks could still be worn in closed spaces.

Prof. Nadav Davidovitch, an epidemiologist and head of Ben-Gurion University of the Negev's School of Public Health, told i24NEWS that masks could still be used for people at elevated risk of respiratory illness when local outbreaks occur.

"When you don't have widespread community transmission it doesn't make sense to wear masks," Davidovitch said.

Will the Green Pass go away?
Amid the spread of the highly contagious omicron variant, Israel's Health Ministry is mulling reducing or removing entirely the Green Pass rules that allow entry to many public places to those who are vaccinated or recovered from COVID-19.

In a post-pandemic world, will the Green Pass and other measures such as airport PCR testing still be necessary?

"I don't think that in the future [the Green Pass] is something that is going to be used," Davidovitch said.

However, Davidovitch emphasized that digitally storing vaccination status and other medical information on a mobile device could still be presented in certain situations, especially when traveling and in need of emergency medical care.

"It will be great that people will have the vaccination status on their cellular phone. We can maybe use these applications to introduce all our vaccination history," the professor said.

What about other public health measures?
Israel recently shortened the COVID-19 quarantine period from seven to five days and ended isolation for children exposed to a coronavirus carrier despite concerns over pediatric inflammatory multisystem syndrome (PIMS).

Experts interviewed by i24NEWS agreed that in the eventual post-pandemic world, the isolation and testing schemes will not be as prominent.

"The moment is indeed coming soon where we will no longer feel the need for special rules about isolating people who have been merely exposed to Covid, or for testing people for Covid. The need for such isolation and testing was real, but it may be getting less relevant as time goes on," said Adam Rose, associate professor at the Hebrew University of Jerusalem's Braun School of Public Health.

Will the massive temporary PCR testing complex at Ben Gurion Airport be dismantled during the endemic phase?

"Airport PCR tests will go away very soon I believe," Levy said.

So, if there is no going back to life before Covid, what can society do to better manage the disease during the endemic phase and prevent another pandemic?

"An endemic is very tricky because if we mean by it that we are going to return to be very passive like we were against influenza and other upper respiratory infections, I think this will be really frustrating," Davidovitch said.

Demand for at-home rapid antigen tests has surged during the omicron outbreak, and Davidovitch doesn't see why home testing cannot be a regular feature of post-pandemic societies to help prevent local transmission so when people are sick, they stay home.

"There might be the option for us buying home tests and when we don't feel well staying at home and maybe we can have a kit that can be used not just for Covid but also for influenza and other illnesses."

Historically societies have changed after experiencing a pandemic, according to Meir Rubin, executive director of the Jerusalem-based Kohelet Policy Forum, and he believes that we are on the cusp of a major change after we exit the Covid pandemic.

For example, the coronavirus pandemic has exposed the need for advanced indoor air filtration systems, and this presents a massive opportunity to clean the air we breathe.

"We have a chance to change for the better with clean water, food and air. Clean air is a necessity – every house should have HEPA (high-efficiency particulate air) filters. Cleaning the air that we breathe will help against other viruses," Rubin explained.

"Also have compassion for each other," Rubin added. "And care about kids."

COVID-19: 74,312 new cases, 1,099 in serious condition [The Jerusalem Post, 31 Jan 2022]

By SHIRA SILKOFF

Serious cases now stand at 1,099, with 241 people on ventilators and 20 on ECMO machines. 332 people are in critical condition.

A total of 74,312 new daily coronavirus cases were recorded on Sunday, a significant increase from the previous day’s total of 49,371. Of some 250,000 tests taken on Sunday, both PCR and antigen, 29.73% returned positive results.

Serious cases now stand at 1,099, with 241 people on ventilators and 20 on ECMO machines. 332 people are in critical condition. To date, 8,724 people have died of COVID-19 in Israel since the start of the pandemic.

Of those currently hospitalized in serious condition, 520 are vaccinated, 117 are partially vaccinated, 427 are unvaccinated, and the status of the remainder is unknown. The majority of serious cases are being reported in people age 60 and over.

There are currently 421,490 active cases in Israel, according to a Monday morning update from the Health Ministry. Overall, there have been 2,852,995 reported cases in Israel since the start of the pandemic, approximately 31% of the population.

Currently, around 108,000 people are self-isolating, roughly 7,500 of whom are health workers.

Coronavirus Czar Prof. Salman Zarka held a press conference on Monday afternoon, answering questions relating to the new school testing system, Israel's fight against the virus, and the overcrowding in hospitals.

Asked if the government would consider putting new restrictions in place given the high number of serious cases and the pressure the current wave is putting on the healthcare system, Zarka answered in the negative.

"I don't want to stop the lives of everyone on the outside [of the hospital]," he said, adding that the number of serious cases is expected to soon peak and then gradually decrease. "We want everyone to be aware of the high danger that the virus presents. The way to protect ourselves is by wearing masks, over the mouth and over the nose, to avoid crowded spaces...these are the steps that we should be taking these days to prevent high infection rates."

Zarka continued, explaining why he did not believe that harsher restrictions would be the right choice at this stage in the pandemic.

"I believe in finding the middle ground between the pandemic and our lives. God forbid that two years into the pandemic we should be in lockdown...we must learn to live alongside it.

"I think that the new system implemented in schools is exactly that, learning to live alongside the coronavirus."

Brazil’s battle against Covid quack remedies [Financial Times, 31 Jan 2022]

by Bryan Harris and Carolina Ingizza

Misinformation on remedies, seeded by officials and fuelled via social media, has had dire consequences for public health

The darkest moment of Brazil’s Covid-19 crisis struck a year ago. Just days after Latin America’s largest nation celebrated the start of 2021, a new strain of coronavirus took hold in the Amazonian city of Manaus, triggering a surge in cases that overwhelmed hospitals and cemeteries. As oxygen supplies ran out, television cameras captured patients gasping for breath and succumbing to asphyxiation. It was as if “they were drowning”, President Jair Bolsonaro said at the time. Although the Brazilian air force was dispatched to deliver oxygen cylinders to the stricken rainforest city, government health officials in Brasília offered an alternative recommendation promoted on social media: patients should take what they called “early treatment” medicines, including anti-parasitic drugs such as chloroquine, hydroxychloroquine and ivermectin. The official recommendation to adopt the drugs, which have no proven effectiveness against Covid-19, was among the most egregious promotions of quack remedies by Brazilian authorities to date — but it was not the first nor the last. Ever since Covid-19 began to spread, the Bolsonaro administration has promoted the cocktails of medicines — known locally as the “Covid Kit” — as part of a misinformation campaign aimed at downplaying the risks of the pandemic. The rightwing populist leader has twice used speeches at the UN General Assembly to tout the drugs. When Bolsonaro himself contracted Covid-19, he posted videos to millions of followers on social media of him taking chloroquine, which is typically used as an antimalarial. He fired one health minister who refused to promote the drug, while another quit less than a month into the job. The campaign’s results have been clear, health experts say: it caused the death of tens, possibly hundreds, of thousands of Brazilians.

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“Brazil is a tragic case. We had misinformation being blatantly spread by our authorities,” says Caio Machado, head of the Vero Institute, which tracks misinformation in Brazil. “Bolsonaro was the source of many of the main conspiracy theories that went around. But he brought in all the institutions, he orchestrated the campaigns from the high ranks. It was part of the official narrative. That is why Brazil is one of the worst Covid cases.” More than 600,000 Brazilians have died from Covid-19 — the second-highest number in the world, after the US. Researchers say the bulk of these deaths should not have occurred. In testimony to a congressional inquiry on the government’s handling of Covid-19, Pedro Hallal, an epidemiologist from the Federal University of Pelotas, said that as many as 80 per cent of deaths could have been avoided if the government had supported conventional measures, such as social distancing and mask use, and had not propagated quack treatment theories. “We know many of the 600,000 deaths are mainly due to these kinds of things. It is not just the disease [killing us],” says Luana Araujo, a public health consultant at Albert Einstein hospital in São Paulo, who testified at the congressional inquiry.

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Bolsonaro latched on to the Covid Kit at the beginning of the pandemic because he refused to countenance lockdowns, which he said curtailed liberties and would cause hardship for many people. Drugs such as chloroquine would allow the economy to remain open, he claimed. The message was spread publicly, often in official speeches. But it took root in social media, particularly messaging apps such as Telegram, which critics say do little to regulate misinformation. A multitude of groups sprang up, often with thousands of members, to discuss where to buy “early treatment” drugs and what the side effects were. Covid pinpointed our education problems and showed how easy it is to manipulate a desperate population Luana Araujo Decoupled from science, the issue became a political banner for Bolsonaro’s millions of supporters. “You have to remember that Bolsonaro and his camp had really worked to delegitimise the mainstream press in recent years,” says David Nemer, a Brazilian assistant professor of media studies at the University of Virginia. “So, when the press reported that these drugs were ineffective, they said it was just the media lying again. They create their own truths. They only believe what comes from channels they trust.” Daniela Braga, a 39-year-old baker from Rio de Janeiro, is one such believer. She says she trusts the drugs because the president vouched for them. She takes ivermectin for three consecutive days every two months because she believes it is a prophylactic. She took chloroquine when she contracted a mild case of Covid-19. Her mother and stepfather use both drugs as prophylactics. “They go everywhere — they enter supermarkets, malls, everything. And they didn’t get contaminated,” Braga says. Public health experts say this mentality is often the real risk of the drugs, not necessarily the side-effects, which in the case of chloroquine can include heart rhythm problems. Having taken the medicines, users feel emboldened to disregard other precautionary measures. “They don’t use masks, they go to crowded places — it is even to the point where they don’t take the vaccine,” says Luiz Henrique Mandetta, who was Brazil’s health minister at the beginning of the pandemic but was fired following tensions with Bolsonaro over how to respond to the disease.

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Speaking to local media, Christos Christou, international president of medical aid charity Médecins Sans Frontières, said no other country had demonstrated the same predilection towards quack remedies as Brazil. His message is borne out in research on the impact of misinformation. In a comparative study of 70 countries, Caio Machado found that in Brazil — as well as India — misinformation lingered longer and resonated more in the public debate. “Brazil and India were way out there — completely separated,” he says. “While other countries had peaks with misinformation — things appeared and would move on — in Brazil we kept fighting chloroquine.” He adds that it was because “people had a political affiliation to chloroquine”. Araujo says Brazil is fertile ground for misinformation because of decades of neglect of investment in education. “Our education was never a priority for any government,” she says. “The Covid crisis only pinpointed how deep our educational problems are and how difficult it is for many people to understand basic concepts. Worse than that, it highlighted how easy it is to manipulate a desperate population. “Bolsonaro was elected in 2018 as a saviour figure because most people were not satisfied with the previous governments. When you have a figure of power like that, and add it to a population with a low education, along with a global crisis, which naturally generates a lot of questions, that is a very complicated scenario.”

Despite the impact of misinformation on the country’s Covid-19 response, experts have been heartened by the failure of the anti-vaccination movement in Brazil — widely attributed to the nation’s longstanding prowess in not only distributing jabs, but promoting their use through public campaigns. Although Bolsonaro has himself publicly refused to be vaccinated, the number of doses administered in Brazil is the fourth-largest of any country, according to Our World in Data figures. The city of São Paulo says it has vaccinated its entire adult population. “Brazil had a long culture of getting people vaccinated. It is something that society embraced well,” says Nemer. “Even those who aligned themselves with the right saw the amount of fake news circulated about [this] and saw there was something wrong here. That helped create some media literacy towards misinformation. [But] I don’t think it is enough to change ideology.” Thatyana Borges Machado, a nurse in Manaus, says sometimes the pregnant women she cares for are unvaccinated because they are “afraid that the vaccine will alter their DNA”.

“Usually, they don’t have much education and have little access to information,” she says. “I tell them that they have to be afraid of not taking the vaccine — the baby doesn’t choose whether to take it or not, but they can choose to save their own life and the baby’s life. In the next appointment, they come back vaccinated.”

New Coronavirus News from 1 Feb 2022

U.S. CDC warns against travel to Mexico, Brazil, Singapore over COVID-19 [Reuters, 1 Feb 2022]

by David Shepardson & Jonathan Oatis

WASHINGTON, Jan 31 (Reuters) - The U.S. Centers for Disease Control and Prevention (CDC) on Monday advised against travel to a dozen destinations, including Mexico, Brazil, Singapore, Ecuador, Kosovo, Philippines and Paraguay.

The CDC now lists nearly 130 countries and territories with COVID-19 cases as "Level Four: Very High." It also added Anguilla, French Guiana, Moldova and Saint Vincent and the Grenadines on Monday to its highest level.