New Coronavirus News from 3 Mar 2022

WHO Responds to Growing Humanitarian Crisis in Ukraine [WebMD, 3 Mar 2022]

By Damian McNamara

March 3, 2022 -- The World Health Organization has called on top-level officials involved in the Russian invasion of Ukraine to ensure access for delivery of essential medical, surgical, and trauma supplies to help the Ukrainian people and refugees in neighboring countries.

A shortage of oxygen, insulin, cancer therapies, and other essential supplies will continue to grow more dire in the weeks and months ahead, WHO officials predicted Wednesday. Setting up a secure “corridor” to get these supplies into Ukraine is needed, particularly as pre-positioned supplies placed in 23 hospitals around the country remain largely out of reach at the moment.

The COVID-19 pandemic is making the situation more challenging. Many cities in Ukraine are isolated, and so are their hospitals. At the same time, an estimated 65% of the population in Kyiv is fully vaccinated, but the rate varies considerably, down to only 20% of people in cities of Donetsk and Luhansk.

Add to that an estimated 1 million people who already fled Ukraine into neighboring countries, potentially spreading the coronavirus as they move or find themselves in crowded situations.
The situation inside and around Ukraine means coronavirus transmission is likely to rise, WHO officials said during a media briefing.

"WHO is deeply concerned by the unfolding humanitarian emergency in Ukraine," said WHO Director-General Tedros Adhanom Ghebreyesus, PhD.

The first shipment of trauma kits and other supplies is scheduled to leave Dubai in the United Arab Emirates and land in Poland on March 3. On the plane will be 6 metric tons of supplies for trauma care and emergency surgery to meet the needs of 100,000 patients, as well as enough general health supplies to help 150,000 more.

In addition to 5.2 million in U.S. dollars released from contingency funding so far, the WHO plans on spending another $45 million in Ukraine and $12.5 million in neighboring countries supporting the refugees over the next 3 months.

Attacks on Health Care Workers
"We are also deeply concerned about reports of attacks on health facilities and health workers," Adhanom Ghebreyesus said. "We have received several unconfirmed reports of attacks on hospitals and health infrastructure, and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers."

"In the past few days, my main discussions with the [Ukrainian] minister of health is how to ensure that health care workers are protected … the health care workers who have gone through last 2 years treating COVID," said Jarno Habicht, MD, from the WHO Head of Country Office in Ukraine.

"Many of them with whom I talked yesterday are working from the shelters or have repurposed their hospitals," he said.

International law protects access to health care during times of conflict, Adhanom Ghebreyesus said. "The sanctity and neutrality of health care, including of health workers, patients, supplies, transport, and facilities, and the right to safe access to care must be respected and protected."

Supporting Ukraine's Health System
The WHO's primary purpose now is to sustain and preserve the health system so it can serve the people of Ukraine, said Michael Ryan, MD, executive director for the WHO Health Emergencies Program. "We will do everything in our power to make that happen."

The WHO engaged in mass casualty management and major surgical training in hospitals all over Ukraine in the months before the military conflict.

"WHO is not going into Ukraine. We have always been in Ukraine," Ryan said. "We've been in Ukraine for years, working with the government on the health system."

But the WHO cannot support the health system unless it can bring in supplies and distribute the supplies already in the country, he said.

"Right now, in the chaos of what's happening there, it's very hard to see how that can be achieved in the coming days," Ryan said. "The tragedy unfolding for the people of Ukraine is so avoidable and so unnecessary."

Don’t Forget the People Behind the Numbers
Many WHO officials are used to addressing humanitarian crises during conflicts, Ryan said. "Some of us have been in this a long time and developed very thick skins. But when you see nurses mechanically ventilating infants in the basements of hospitals, you know even the toughest of us have struggled to watch this."

And it’s hard to carry adults receiving intensive care down to a basement. "So many patients in the ICU are being cared for by doctors and nurses while the bombs fall around them," he said.
Throughout the conflict, it will be important to not just speak in terms of supplies, Ryan said.
"This is people's bodies and people's bones that have been broken. People's lives are being lost, and there isn't a health service available to deliver lifesaving care. So something's got to change."

There is only one simple answer, said Bruce Aylward, MD, senior adviser to the WHO director-general.

"What can we do about it? Number one: Stop the war," he said.

"Second thing you do as it unfolds is you protect your health care system. You've got to protect services. The third thing that is you try and prioritize your vaccinations for your vulnerable people, including for your health care workers," he said.

COVID-19 Concerns Grow
Just before the conflict, Ukraine had a surge of cases of COVID-19, Adhanom Ghebreyesus said.

"There is likely to be significant undetected transmission, coupled with low vaccination coverage, that increases the risk of large numbers of people developing severe disease,” he said.

And it's not just a concern inside Ukraine.

"Anytime you disrupt a society like this and put literally millions of people on the move, infectious diseases will exploit that," Ryan said.

Refugees are highly vulnerable to infection, he said, because they're not eating or sleeping properly, and they are packed together.

This increases their risk for infection and the risk that infection will spread.

"A mild variant could be a very different experience for someone who is in that situation,” Ryan said, adding that refugees should be offered proper vaccination.

The WHO is working on providing antivirals to people in the region.

"This may be one situation where the available therapeutics may be more lifesaving than in other situations," Ryan said. "We've been prioritizing Ukraine over the last 48 to 72 hours for extra supplies of therapeutics for COVID-19, including the newer antivirals."

Not Enough Oxygen
A shortage of oxygen will make it harder to treat patients with COVID-19 and many other conditions. Part of the shortage stems from closure of three major oxygen plants in Ukraine.

In addition, "it's difficult to find drivers who are willing to drive and to bring oxygen from some of the factories, which still have reserves," Habicht said.

An estimated 2,000 people in Ukraine rely on oxygen therapy.

"That's 2,000 people that need oxygen to survive," Ryan said. That number is likely to increase "because we have people with injuries, people undergoing surgery, in addition to the children with pneumonia and women having difficulties during labor."

"And you need it when you need it," he continued. "You can't wait till tomorrow for oxygen. You can't wait till next week. You can't be put on a waiting list for oxygen."

Without enough oxygen or other lifesaving supplies, people will die needlessly, Ryan said.

"In those territories, where the military offensive takes place, and where hospitals are getting isolated and where we don't have access, it's also about electricity, it is also about the medicines," Habicht said.

Addressing Other Health Concerns
The WHO plans to help neighboring countries address key health issues among refugees and forcibly displaced people, including mental health and psychological assistance, as well as treatment for chronic diseases like diabetes, HIV, and cancer.

Insulin, blood pressure medications, and goods and medicines related to sexual and reproductive health and children and maternal health also are needed, Habicht said.

Refugees will also need access to primary health care, said Heather Papowitz, MD, an emergency management specialist for the WHO. Surveillance and vaccination for COVID-19, measles, and polio are paramount, she said.

"But also looking at water sanitation and hygiene to prevent diarrheal diseases.” Everything happening in Ukraine is affecting other countries, Papowitz said.

"It's just a real regional crisis."

What the Future Looks Like
Going forward, it will be important to shift from providing general supplies to supplies specific to wartime injuries, Ryan said. This will include equipment for doing major surgery "and, unfortunately, equipment for doing amputations, bone grafting, and bone wiring."

"I think this gives you the graphic nature of what's happening," he said.

"If the military offensive continues, then the situation that we will see when we meet in a week to weeks, months, or 2 months' time will be much worse that we discussed today," Habicht said.

"Every single life matters, every single life," said Maria Van Kerkhove, PhD, technical lead on COVID-19 for the WHO. "We need to work as hard as we can to not only end the conflict, but to end COVID-19."

Russia-Ukraine crisis replaces coronavirus pandemic as top risk to global supply chains, Moody's says [CNN, 3 Mar 2022]

By Matt Egan

The coronavirus pandemic drove global supply chains to the breaking point, causing shortages and sending prices skyrocketing. Just as the pandemic has calmed down, Russia’s invasion of Ukraine threatens to further scramble fragile supply chains.

Russia is a major producer of commodities, everything from oil and natural gas to palladium and wheat. Ukraine is also a major exporter of wheat as well as neon. The crisis is casting doubt on at least a chunk of those vital supplies.

“The greatest risk facing global supply chains has shifted from the pandemic to the Russia-Ukraine military conflict and the geopolitical and economic uncertainties it has created,” Moody’s Analytics economist Tim Uy wrote in a report on Thursday.

Moody’s warned that the Russia-Ukraine crisis will “only exacerbate the situation for companies in many industries,” especially those reliant on energy resources.

Europe, in particular, will feel the most pain from the energy price spike because it is dependent on Russia for natural gas. Oil prices have surged worldwide, driving up prices for gasoline and raising the cost outlook for airlines and industries like plastics that use petroleum.
The Russia-Ukraine crisis could pile further pressure on the worldwide computer chip shortage, which began during Covid and has been at the heart of the spike in new and used car prices.

Moody’s pointed out that Russia supplies 40% of the world’s supply of palladium, a key resource used in the production of semiconductors. Moreover, Moody’s said Ukraine produces 70% of the world’s supply of neon, a gas used in making computer chips.

“We can expect the global chip shortage to worsen should the military conflict persist,” Uy wrote.

Neon prices skyrocketed during the 2014-2015 conflict in Ukraine. Even though chip-makers have stockpiled resources, Uy said that inventories can only last for so long.

“If a deal is not brokered in the coming months, expect the chip shortage to get worse,” Uy said, adding that this will pose significant risks to automakers, electronics companies, phone makers and other companies.

The combination of high energy prices and more pressure on computer chip supply will complicate the inflation picture. Consumer prices soared in January at the fastest pace in nearly 40 years. Although many economists anticipated inflation would cool off significantly later this year, that is now in doubt.

“The near-term effects on the U.S. economy of the invasion of Ukraine, the ongoing war, the sanctions, and of events to come, remain highly uncertain,” Federal Reserve Chairman Jerome Powell told Congress on Wednesday.

Beyond computer chips, Moody’s pointed out that the Russia-Ukraine crisis has the potential to raise costs in the transportation industry, the most energy-intense of all industries.

The next COVID subvariant is here and may be even more contagious than Omicron [Fortune, 3 Mar 2022]

BY TRISTAN BOVE

Just when we thought we were out, could we be headed back in?

A new variant of the virus that causes COVID-19 has now been detected in every U.S. state. Its high transmissibility has led to it being dubbed “stealth Omicron.”

Stealth Omicron, also known as the Omicron BA.2 variant, was first detected in Europe in late January and has since made its way around the world, becoming the leading strain behind new coronavirus infections in at least 18 countries.

Research is trickling in about just how concerning the new variant is.

How deadly is the new COVID strain?
A study from Denmark, where stealth Omicron rapidly became the dominant lineage of the virus, sampled 263 cases of COVID reinfection from stealth Omicron in the country, and found that reinfections were nearly four times as common for people who had recovered from the Delta variant than those who had come down with Omicron.

The good news from the Danish study is that prior infection with Omicron and vaccination seemed to be enough to provide abundant protection to the new strain.

Other studies have also found that antibodies from the original Omicron strain were able to provide strong protection against stealth Omicron. This survey cataloging COVID reinfections in the U.K. from early February did not identify any cases where a stealth Omicron reinfection followed an Omicron infection.

Eric Topol, a genomicist at Scripps Research in La Jolla, Calif., said the new research was “reassuring” to him. “Instead of thinking that [stealth Omicron] is the new bad variant, I think we can put that aside. I see it as not a worry,” Topol told Nature.

How contagious and transmissible is it?
But while initial data is still spotty on whether stealth Omicron can cause more serious disease than its parent strain, it is very likely more transmissible. A study in Japan released at the end of February found that the BA.2 strain could be as much as 30% more transmissible than the original Omicron variant, which was already the most contagious form of the disease we have encountered so far during the pandemic.

Some scientists have argued that stealth Omicron deserves its own Greek letter name in the coronavirus lexicon. But while BA.2 exhibits some divergent mutations from the original Omicron variant, scientists have been more comfortable calling it a subvariant, as it still has many similar characteristics to its parent strain.

The similarities to Omicron have made it more difficult to sequence and trace BA.2, hence its moniker as stealth Omicron. It was relatively easy to differentiate the Omicron variant from Delta infections through PCR tests and genetic sequencing, but the similarities between Omicron and stealth Omicron have made it much more difficult to trace the latter’s spread.
By the last week of February, the Centers for Disease Control and Prevention estimated that stealth Omicron was causing 8% of all new COVID infections, at a rate doubling every week.

New Coronavirus News from 2 Mar 2022

Why Ukraine's COVID-19 Problem Is Everyone's Problem | Time [TIME, 2 Mar 2022]

BY ALICE PARK

Refugees from Ukraine arrive in Medyka, Poland after crossing the border from Shehyni, Ukraine on Feb. 25, 2022.

Ukraine was struggling to control the COVID-19 pandemic even before Russian troops advanced on the country. It was slower to launch its COVID-19 vaccination campaigns than other European countries, and while the government encouraged citizens to get immunized, most people struggled to find a way to get the shot, didn’t feel the need to get vaccinated, or didn’t trust the safety and efficacy of the vaccine.

Just before the invasion on Feb. 24, only 35% of the Ukrainian population had been vaccinated. That puts it in line with most of its neighboring countries, although some, including Poland and Hungary, have achieved higher vaccination coverage. While different health systems and varying attitudes about vaccination in those countries are contributing to those contrasting rates, Ukraine’s relatively low vaccination rate could have implications for how large additional surges of cases, both in the country and in the region become as a result of the war. Like many other countries, Ukraine experienced a surge in cases due to the Omicron variant in November and another peak in the first week of February—most likely due to its low level of vaccination. By the middle of February, 60% of COVID-19 tests conducted in the country were positive.

Such low vaccine coverage isn’t enough to control a highly transmissible virus like SARS-CoV-2, say public health experts. Add in a war—with the political and social upheaval it causes—and not only are spikes in infections inevitable, but there is also the potential for new variants to emerge, which puts the whole world at risk.

Vaccination and mitigation measures such as mask-wearing, social distancing, and basic hygiene are critical for curbing spread of SARS-CoV-2, but are impossible to maintain when a country is under siege. The humanitarian group Doctors Without Borders has been distributing trauma kits and training health care providers in Mariupol, Ukraine—a target of the Russian attack—as well as providing shelter and basic health needs for those crossing the border into other countries like Poland. But it’s not enough.

“War is an infectious disease’s best friend,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It challenges every public health program you can possibly have. It limits the medical care available for those who might be seriously ill, and often fosters transmission when so many people are crowded into bomb shelter locations and on trains. This is going to be the perfect storm of one serious challenge after another.”

A decade and a half ago, World Health Organization researchers found that 65% of major infectious disease outbreaks occurring in the 1990s were among refugee populations or in conflict zones. Les Roberts, professor emeritus of Columbia University’s Mailman School of Public Health who has spent time in war zones addressing outbreaks, notes that these populations are especially vulnerable to viral diseases like COVID-19. “It turns out when you are under stress, your immune system does not work as well. You are not eating as well, and you cannot fight disease as well,” he says. “And in times of conflict, you move around a lot, and end up in bomb shelters or basements or on trucks that are way more crowded than normal and have bad air circulation. I don’t think people fully understand how war is like the breeding ground of disease.”

More than 670,000 people have left Ukraine since the war began, and this increased travel will almost certainly lead to a spike in cases in the country and those bordering it—like Poland, Hungary, Slovakia, Romania, and Moldova—while straining their health care systems. Health experts are particularly concerned about the situation in Poland, where almost half of the Ukrainians have fled, according to the U.N. High Commissioner for Refugees. “SARS-CoV-2 spreads like lightning right now,” says Jeffrey Shaman, professor of epidemiology at Columbia University Mailman School of Public Health. “For places like Poland and places in western Ukraine where people are fleeing, there is enormous opportunity for this virus to do damage that it wouldn’t have had the opportunity to do otherwise.” Prior to the influx, nearly 60% of Poland’s population was vaccinated, which will help protect it against a surge, but new infections will likely spike there as well, increasing demand for health care services.

“We have warned for years about the potential convergence of conflict and epidemiology—bad things happen when those things converge,” says Dr. Eric Toner, senior scholar at the Johns Hopkins Center for Health Security. “Certainly, in the dire circumstances in which the population is right now, mask-wearing, distancing, and quarantine are not going to be possible. As people flee the affected parts of the country, crowding on buses, trains, and cars and ending up in hotels or living with relatives or in refugee settlements—those are not conditions for good control of a transmissible disease like COVID-19.”

Hospitals will likely be hit hardest by the influx of refugees during the pandemic, say public health experts. War-related injuries will take precedence over COVID-19 care, which will only make it easier for the virus to spread. That disruption will in turn lead to more health care workers who will get infected, and won’t be able to perform their duties.

“There will be runs on hospitals and facilities and resources because of injuries associated with the conflict,” says Shaman. “In the longer term, I imagine it will result in deterioration of the ability to deliver health care at the level that people in the Ukraine are used to having.” And if surges occur in neighboring countries as well, that puts additional pressure on health care services in the entire region. “The world community would be advised to provide supplies and facilities to buffer the displaced Ukrainians and Polish populations from those consequences.”

Shaman and other public health experts are also concerned about longer term effects of the conflict on COVID-19 control. Studies consistently show that vaccine-based immunity starts to wane after about five to six months. Booster shots are essential to maintaining protection against disease so severe that it requires hospital care; if the conflict in Ukraine continues, that would mean even vaccinated citizens will not be able to get boosted as trauma care and war-related injuries will take priority over vaccination efforts.

The situation exposes the weaknesses in the global biodefense network against threats like highly infectious coronaviruses. Even without a military conflict, stark inequities in health resources have led to profound differences in countries’ ability to control COVID-19; developed nations have been able to purchase and distribute vaccines, while poorer countries, mostly in Africa and parts of Asia, still struggle to contain the virus since they lack access to the shots.
When a conflict like that occurring in Ukraine right now hits during a pandemic, the lack of global coordination of public health resources becomes more tragically obvious. “I can’t begin to tell you where the solution is,” says Shaman. “The World Health Organization doesn’t have the authority or the resources in terms of money to deal with this. This is a very large issue that involves development, nation sovereignty, and the ability of nation states to get along and support one another in a trusting way rather than in ways that we’ve seen the world devolve into over the last 20 years.”

What’s truly needed is a global coordinating body for public health, Toner says, which isn’t likely, given challenges posed by issues of national sovereignty. But the principles behind global coordination might still be implemented in more limited ways.

The global vaccination distribution program COVAX, through which developed nations purchase vaccines in order to drive prices down for developing countries, represented such an effort, but is falling short of meeting its promise. It failed to deliver the 2 billion doses it had guaranteed by the end of 2021, and the group estimates that it will take until well into 2023 to provide enough vaccines to immunize the world. “After the pandemic is over, I think we need to take a real look into COVAX and why it didn’t work as well as we had hoped, and what we could have done to make it better,” says Toner.

Some public health experts have proposed alternatives, like supporting vaccine makers to set up manufacturing facilities in countries that have historically struggled to get the latest vaccines, as well as encouraging more shared intellectual property to enable poorer countries to access the technology they need to produce shots on their own.

Roberts points out that there are also ways to control and reduce the likelihood of viral spread as Ukrainians gather in shelters and flee to other countries. Vaccinating and boosting people who enter these communal settings—especially those who are particularly vulnerable, such as the elderly or people with underlying health conditions—is an important start.

However, that’s still mostly out of reach. The World Health Organization doesn’t have enough resources to quickly direct vaccine supplies and personnel to crisis zones such as Ukraine, and lacks political authority to address questions of national sovereignty. Organizations such as Doctors Without Borders and other humanitarian groups also play critical roles, but are equally restricted to more localized aid efforts. “If we continue to be reactive in crisis after crisis, then we will not get at the systemic, underlying issues that need to be solved,” says Shaman.

Antigenic differences between Omicron BA.1 and BA.2 SARS-CoV-2 variants [News-Medical.Net, 2 Mar 2022]

By Dr. Priyom Bose

The global healthcare system and economy have suffered massively throughout the ongoing coronavirus disease 2019 (COVID-19) pandemic, which emerged as a result of the rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Owing to the evolution of the virus due to mutations, several SARS-CoV-2 variants have emerged, some of which are more virulent and transmissible than the original strain.

SARS-CoV-2 variants have been classified as variants of concern (VOC) and variants of interest (VOI) by the World Health Organization (WHO) based on their increased virulence, changes in epidemiology and/or clinical presentation, increased transmissibility and decreased effectiveness of social measures or COVID-19 diagnostics. Recently, the SARS-CoV-2 Omicron variant has become the dominantly circulating strain that replaced the previously dominant Delta variant in many countries across the world.

Background
To date, all available COVID-19 vaccines and therapeutics have been developed against the spike (S) protein of the original SARS-CoV-2 strain. Therefore, mutations in the S domain could pose a threat to the effectiveness of current COVID-19 vaccines.

Previous studies have reported that the efficacy of existing COVID-19 vaccines is reduced against some SARS-CoV-2 variants, such as the Omicron variant. Furthermore, several reports have also found that the Omicron BA.1 variant almost completely escapes neutralizing antibodies, which has resulted in a high number of breakthrough infections. However, the BA.1 lineage has been determined to be less virulent as compared to other SARS-CoV-2 variants.

According to recent studies, Omicron variants BA.2 and BA.1 are genetically different. In many countries, BA.1 has already been replaced by the new BA.2 strain. To date, no study on the antigenic characteristics of BA.2 and BA.1 is available.

A new study published on the bioRxiv* preprint server identifies the antigenic differences that exist between the Omicron BA.2 and BA.1 variants. Herein, the researchers also quantified the extent to which human post-BNT162b2 immunization sera neutralized Omicron BA.2.

Study findings
In this study, researchers used antigenic cartography to estimate and visualize antigenic differences between SARS-CoV-2 variants using hamster sera, which was collected after primary infection. Scientists found it difficult to obtain human sera post-primary Omicron infection; therefore, they selected Syrian golden hamsters’ sera for this study.

Hamsters are highly susceptible to SARS-CoV-2 infection and are ideal for collecting well-defined sera. Furthermore, previous studies have reported that human and hamster serum responses to SARS-CoV-2 infection are similar, as they develop similar topological maps.

In the current study, scientists inoculated hamsters with several SARS-CoV-2 variants including 614G, Alpha, Beta, Gamma, Zeta, Delta, Mu, and Omicron (BA.1) to generate antisera.

Antigenic cartography allows for the quantitative analysis of antigenic drift and visualization of new antigenic clusters. Utilizing this technique, early SARS-CoV-2 variants have been found to be antigenically similar, as they were found to cluster closer to each other in antigenic space.

This is comparable to Omicron BA.1 and BA.2, which have evolved as two distinct antigenic outliers.

Plaque reduction neutralization titers resulted in a 50% reduction in infected cells associated with authentic SARS-CoV-2, as well as pseudotyped viral infection. The researchers reported that sera from Omicron BA.1-infected hamsters poorly neutralized all other variants, which implies that this variant induces different antibody responses as compared to other SARS-CoV-2 variants.

Antigenic maps were developed by a multidimensional scaling algorithm. To this end, the scientists reported that the map constructed by Calu-3 cells was highly similar to the VeroE6 map because the same antigens were plotted within one two-fold dilution from each other in the two maps. This finding demonstrates that the choice of the cell line for the neutralization assay had no substantial effect on the topology of the map.

The Omicron BA.1 formed a distinct antigenic outlier in the map that was 10- to 38-fold dilutions away from the nearest virus.

The researchers also reported that a single BNT162b2 vaccination exhibited a low neutralizing titer against all variants with an addition 13-fold and 8-fold reduction in neutralizing titers observed against Omicron BA.1 and BA.2, respectively. Both Omicron variants were also found to evade vaccine-induced antibody responses as a result of their unique antigenic characteristics.

Conclusions
The emergence and rapid spread of the highly mutated BA.1 and BA.2 variants was an indicator that population immunity is employing robust selective pressure on SARS-CoV-2 in favor of the emergence of new antigenic variants.

The researchers of the current study anticipate that SARS-CoV-2 will eventually attain endemicity and is likely to cause annual or biannual infection waves, similar to influenza and seasonal coronaviruses. Therefore, it is imperative to monitor the antigenic changes of SARS-CoV-2, as this information will be important in the selection of future vaccine strains.

*Important notice
bioRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
• Mykytyn, Z. A., Rissmann, M., Kok, A., et al. (2022) Omicron BA.1 and BA.2 are antigenically distinct SARS-CoV-2 variants. bioRxiv. doi:10.1101/2022.02.23.481644. https://www.biorxiv.org/content/10.1101/2022.02.23.481644v1.

New Coronavirus News from 1 Mar 2022

Ukraine conflict could spark surges of covid, polio, other diseases, say experts [The Washington Post, 1 Mar 2022]

By Loveday Morris and Dan Diamond

Hospitals are running out of supplies. Health workers and patients are hiding in makeshift shelters. And some fear the flight of millions of people could worsen pandemic.

Victoria, 33, as she holds her three month old baby boy named Mark in an underground shelter for sick children a hospital in Kiev on March 1. (Heidi Levine for The Washington Post)
LVIV, Ukraine — At the main train station in this western Ukrainian city, where the internally displaced jostle to get on trains to Poland or change for other destinations in Europe, few among the heaving crowd wore masks. As night fell, hundreds bedded down across crowded stone floors or curled up on the stairs, inhaling thick, muggy air.

FAQ: What to know about the omicron variant of the coronavirus
For these Ukrainians, the focus is escaping the Russian invasion bearing down on their country — not on dodging diseases such as covid-19.

But as more than half a million people have fled Ukraine to neighboring countries, global health officials fear that Russia’s invasion of Ukraine will be the latest reminder of a grim lesson — that war and disease are close companions, and the humanitarian and refugee crises now unfolding in Eastern Europe will lead to long-lasting health consequences, exacerbated by the coronavirus pandemic.

As Russia’s military campaign accelerates, Ukraine’s hospitals are running out of critical medical supplies as travel is increasingly choked off by the conflict. The country’s health workers and patients are relocating to makeshift shelters, seeking to escape explosions.
Meanwhile, officials at the World Health Organization, United Nations, U.S. State Department and other organizations warn of rising civilian casualties and new pressures on the region’s fragile health-care systems.

“What we’re dealing with now in Ukraine is a double crisis,” said Máire Connolly, a global health professor at the National University of Ireland Galway who has studied the link between conflict and disease. In an interview, Connolly said she was worried not just about threats from the coronavirus pandemic but also those from Ukraine’s polio outbreak, which global experts had sought to quell for months. She also said she fears the potential resurgence of tuberculosis during the current conflict.

“As we’ve seen in wars over the years, viruses and bacteria are happy to exploit those situations where human beings are put under pressure,” Connolly added, citing how refugees fleeing armed conflict can end up in overcrowded conditions and without sufficient water, food and sanitation. “These factors increase the risk of outbreaks among a population that are already dealing with the trauma of forced displacement.”

While covid cases in Eastern Europe have plunged in recent weeks, experts such as Connolly say they’re worried that the regional conflict will trigger new spikes. Ukraine experienced some of the world’s highest rates of coronavirus late last year, and is flanked by countries with some of the lowest vaccination rates in Europe — raising the prospect that the movement of thousands if not millions of refugees could lead to surges of illness in neighboring countries.

“I am heartbroken and gravely concerned for the health of the people in Ukraine in the escalating crisis,” Tedros Adhanom Ghebreyesus, director general of the WHO, said in a statement as the conflict began last week. The WHO leader also shared a video on Twitter of newborns in Ukraine being cared for in a makeshift bomb shelter, calling the images “beyond heartbreaking.” On Sunday, he warned that Ukraine is now dealing with a dangerous shortage of oxygen supplies needed to treat covid and other conditions.

“The majority of hospitals could exhaust their oxygen reserves within the next 24 hours. Some have already run out,” the WHO said in a statement. “This puts thousands of lives at risk.”

U.S. officials, Ukraine’s health minister and others have also accused Russian military forces of firing on the country’s ambulances and hospitals, and experts remain concerned the conflict could disturb radioactive waste being stored at the Chernobyl nuclear plant, sparking additional health and environmental disasters.

Global humanitarian organizations have moved to shore up Ukraine’s health safety net. The WHO, which began positioning additional medical supplies in Ukraine in November after Russian military forces began to mass on its borders, on Thursday made $3.5 million available in additional emergency funding. The U.S. Agency for International Development deployed a disaster response team to nearby Poland, intended to help coordinate the regional humanitarian response, and along with the State Department, will provide nearly $54 million in additional assistance. The White House also is seeking $6.4 billion for emergency aid to the region, much of which would go toward humanitarian assistance.

U.S. officials and outside experts say they’re bracing for further shocks. “Despite the immense, multinational efforts to prepare for this scenario, we know that many Ukrainians will needlessly suffer at the hands of Russian aggression,” USAID Administrator Samantha Power said in a statement on Friday.

Power, who spent time at the Poland-Ukraine border this weekend, said Monday that as many as 5 million refugees could flee Ukraine in coming weeks.

Humanitarian and health groups also had not anticipated an invasion from multiple directions; they expected it to be concentrated on the country’s eastern border, where they had positioned emergency supplies in advance, said Simon Pánek, CEO of People in Need, a humanitarian organization working to deliver aid.

“Until a few days before the war started, my colleagues and I didn’t talk about the possibility that there would be a direct offensive on Kyiv from the north, for example,” Pánek said in an interview from Prague, where he is based. “What we need most is safe transport to central and eastern Ukraine, but no one from outside can provide it,” Pánek added, saying his group had sent five trucks filled with supplies on Sunday and had planned to send more aid on Tuesday.

Meanwhile, the accelerating Russian military campaign has posed mounting challenges, with explosions across Ukraine’s major cities and more military forces pouring into the country.

A “health system cannot function during an active bombing campaign,” Rachel Silverman, a policy fellow at the Center for Global Development, wrote in a series of text messages from Germany. “They must evacuate patients from hospitals, all routine services will be put on hold, many facilities will be damaged and health workers will flee.”

Russia’s invasion of Ukraine also comes on the heels of a coronavirus outbreak that skyrocketed late last year and saw the region become a global hot spot. While Ukraine’s case numbers have fallen sharply, public health experts say large movements of people could spark new infections in Eastern Europe, where vaccination rates trail countries to the west. Only one-third of Ukrainians have received at least one dose of a coronavirus vaccine, according to the University of Oxford’s Our World in Data tracking project, compared with more than three-quarters of people in countries like France, Germany and Britain.

“Covid is understandably not top of mind for anyone” during an armed conflict, Silverman wrote in a message. “But having people in crowded subways, with no real access to health services, is a terrible situation. Even the mildest covid cases can be very problematic if you have no place to isolate/get care, and/or if you need to flee on foot.”

Many Ukrainians are now seeking shelter in neighboring Poland, which has waived its standard coronavirus quarantine and testing requirements for those refugees.

.@a_niedzielski: Persons crossing the border of the Republic of Poland with Ukraine in connection with an armed conflict on the territory of this country are exempt from the quarantine obligation and showing covid test results. https://t.co/8HILs1IDn9
— US Embassy Warsaw (@USEmbassyWarsaw) February 25, 2022

Poland’s health minister also announced free coronavirus vaccinations for Ukrainians on Friday.

But like Ukraine, Poland has had a severe covid outbreak in recent weeks, and officials say its health system is dealing with a significant workforce shortage that has sparked walkouts and protests. About 59 percent of Poland’s population has received at least one vaccine shot.
Poland is set to lift many of its remaining coronavirus restrictions on Tuesday.

Jarno Habicht, the WHO’s representative to Ukraine, told reporters that he was worried that the conflict would set back months of progress to vaccinate Ukrainians while escalating other regional health crises, such as the polio outbreak.

Russia’s invasion “will have implications across the whole country,” he said, adding that his team was rapidly pivoting to address a brand-new set of health challenges. “Our priorities have shifted to trauma care, ensure access to services, continuity of care, mental health and psychosocial support.”

The rapid spread of Omicron BA.2: What studies say [Medical News Today, 1 Mar 2022]

The Omicron variant, which researchers first sequenced in South Africa and Botswana in November 2021, was found to be more transmissible but cause less severe disease than its predecessor — the Delta variant.

Owing to being more contagious, Omicron rapidly supplanted Delta as the dominant variant worldwide. Currently, it accounts for 99%Trusted Source of all sequenced cases.

Moreover, since it emerged, scientists have categorized Omicron’s subvariants or lineages into three groups: BA.1, BA.2, and BA.3.

Although the BA.1 subvariant started as the dominant Omicron lineage across the globe, since December 2021, the proportion of COVID-19 cases linked to the BA.2 variant has been rapidly increasing.

This has raised concerns about the severity and transmissibility of BA.2. Here’s what researchers have found so far:
Omicron subvariant BA.2 overtakes BA.1

BA.2 has been especially prominent in countries in Southeast Asia, Africa, and Europe. Recent analyses have indicated that it has displaced BA.1 as the dominant Omicron sublineage in Denmark, Singapore, India, South Africa, and Austria. The rapid ascent of BA.2 is illustrated by the increaseTrusted Source in its prevalence from 20% in the last week of December 2021 to 66% by the third week of January 2022 in Denmark.

The proportion of BA.2 cases in the United States remains low at 3.8% so far, but health experts expect it to rise.

Preprint studies that are yet to be peer reviewed have characterized differences between the BA.1 and BA.2 subvariants, which may explain why the latter is outcompeting its sibling variant.
Although BA.2 shares many of BA.1’s mutations, the two subvariants differ by 28 mutations, some of which are responsible for the rapid surge in BA.2 cases.

Notably, the mutations unique to these subvariants are also present in the spike protein, which mediates the entry of SARS-CoV-2 into cells and is the target of COVID-19 vaccines.
Specifically, BA.2 carries eight new mutations in the spike protein but lacks 13 mutations that the BA.1 spike protein harbors.

BA.2 seems to be more transmissible
The rapid surge in the prevalence of BA.2 in multiple countries suggests that this variant is more contagious than BA.1. One study estimates that BA.2 is up to 33% more transmissible than BA.1 and considers that its spread could be a serious issue for global health in the near future.

Moreover, a nationwide study comparing the spread of the BA.1 and BA.2 variants in Danish households in late December 2021 and January 2022 suggested that the latter was more contagious. The study found that the secondary attack rate, which measures the probability of transmission of the virus to household members, was 39% for BA.2 and 29% for BA.1.

The study also reported that fully vaccinatedTrusted Source and booster-vaccinated individuals were less likely to pass on or contract an infection due to either subvariant compared with unvaccinated individuals.

In addition, unvaccinated individuals were more likely to spread the BA.2 subvariant to their household members than BA.1.