New Coronavirus News from 30 Apr 2022

Los Angeles County COVID Cases Up 40% Over Past Week [WebMD, 30 Apr 2022]

By Carolyn Crist

April 29, 2022 -- Coronavirus cases in Los Angeles County increased 40% during the past week, and hospitalizations have begun to rise as well, according to the Los Angeles Times.

Health officials aren’t yet sounding alarm bells about the numbers, the newspaper reported, though they indicated that the trends show an ongoing rise in virus transmission.

“Since the beginning of the pandemic, we’ve all had to make choices about how to best protect ourselves and others from COVID-19,” Barbara Ferrer, the county’s public health director, told reporters on Thursday.

Ferrer called the latest increase “pretty significant” and encouraged people to take actions to limit the spread of the virus.

“With cases on the rise, the potential for more contagious variants, and lots of opportunities to be exposed, this is a great time to make a choice to get vaccinated or boosted and to wear a mask or respirator when you’re indoors and around others,” she said.

During the past week, the county has reported an average of about 1,765 new cases per day, which is up from about 1,260 daily cases a week ago and double the 880 daily cases reported in early April.

Per capita, the county’s case rate has risen to 122 cases a week per 100,000 residents, the newspaper reported. The case rate exceeded 100 during the previous weekend, meaning that the nation’s most populous county now has a high rate of transmission again for the first time since early March.

The number of hospitalized COVID-19 patients has also increased during the past week after months of decline. On Friday, 253 patients were hospitalized, according to state data, up from 209 the week before.

The BA.2 subvariant accounts for about 88% cases in Los Angeles, the newspaper reported. The more recent Omicron subvariant, known as BA.2.12.1, accounts for a majority of cases in New York and New Jersey and will likely become dominant in California in the coming days, Ferrer said.

Wastewater surveillance also shows that coronavirus levels have doubled across large parts of Los Angeles during the past two weeks, the newspaper reported. Nursing homes, workplaces, and schools have also reported an increase in the number of outbreaks in the past two weeks.
“So let’s continue to be cautious,” Ferrer said.

‘Much stronger’ Covid variants detected [news.com.au, 30 Apr 2022]

by Holly Hales

Two “much stronger” strains of Covid-19 have been detected in Australia, sparking fears of another spike in new cases.

Authorities have discovered two new Covid variants in Australia, with one expert labelling them “much stronger” than the current dominant strain.

The shock finding came when a traveller from South Africa to NSW was detected to have the BA. 4 sub-variant of Omicron – a first known case of its kind in Australia.

Victorian testing facilities also detected the BA. 2.12.1 Omicron strain in Melbourne wastewater.

The initial Omicron variant has been Australia’s dominant strain since its arrival in November 2021.

However, University of South Australia epidemiologist Adrian Esterman said the newly detected strains were “more dominant” than their predecessor and could cause a new spike in cases.

“What we know about BA. 4 is that it appears to escape the immune system a bit better than BA. 2, so that means that people who’ve already been infected can be reinfected more easily, and people who are vaccinated can be infected more easily,” he told 7 News.

“This comes just at the stage we’re removing all our public health measures. That’s the bad news.”

However, Prof Esterman said the huge surplus in positive cases over the past six months had given Australians good immunity against the new strains.

“Many people have been infected now and those who haven’t been infected probably have quite good immune systems from being vaccinated, so we have got a bit of protection from major increases in cases from these two sub-variants,” he said.

The case was discovered through a PCR test on Thursday after the traveller arrived in Australia in the first week of April.

“This is not a random sample, therefore the proportion of variants identified is not necessarily reflective of their distribution in the community,” NSW Health said.

“NSW Health continues to closely monitor the evolving situation with COVID-19.”

Australian has recorded tens of thousands of cases every day since Omicron was first detected in November 2021.

It has since been discovered to be wildly more infectious, but less severe than previous Covid strains.
•

New Coronavirus News from 29 Apr 2022

State health leaders warn new COVID variant is more transmissible than past variants [KOMO News, 29 Apr 2022]

by Jackie Kent

State virologists are warning the newest COVID-19 variant in Washington is even more transmissible than previous variants. There’s still a lot researchers still don’t know about the new BA.2.12.1 subvariant.

Take a walk near downtown Seattle and people have mixed reaction to hearing about the new, highly transmissible omicron subvariant.

For the first time, the state department of health’s latest variant report shows BA.2.12.1 accounts for about 5-percent of sequenced cases.

The U.W. Virology lab does its own sequencing for King County.

“It’s just another reminder that although sometimes it feels like it COVID is not done with us yet,” said Dr. Pavitra Roychoudhury with the UW Medicine Virology Lab.

She warns it’s proving to be even more transmissible than previous variants and says scientists are also trying to figure out how effective vaccines are against it.

“We’ll have to wait to get that kind of data," Roychoudhury said. "For example, we know that prior infection with BA.1 does confer some amount of protection towards BA.2 so that kind of data will come slowly for this particular subvariant."

Officials are hoping some of the immunity gained from the Omicron wave back in January, and the protection from the vaccine will prevent another big spike in cases.

“We’re not seeing that same level of surge," Roychoudhury said. "With that being said, we are seeing a rise in cases so we're definitely watching and waiting and hoping that it's not as bad."

She added it’s still too soon to know how severe COVID-19 symptoms may be with this new subvariant, or how it might impact hospitals. They expect to have have a lot more data soon as they continue their research.

The U.W. Virology Lab dashboard shows there have been no cases of this new subvariant found in King County as of the most recent reporting period two weeks ago.

Another COVID variant is rapidly spreading in California. Should you worry about BA.2.12.1? [San Francisco Chronicle, 29 Apr 2022]

by Erin Allday

A new omicron subvariant is rapidly spreading in California. The COVID variant is more infectious than its predecessors and could make up half of new COVID cases “in a matter of days,” health officials said. Nurses at Adventist Health hospital in Sonora, Calif. put on PPE before checking on a COVID patient in March, 2022.

Max Whittaker/Special to The Chronicle
Yet another omicron offspring, once again more infectious than its predecessors, is climbing rapidly in California and could make up half of new cases “in a matter of days,” health officials said.

It’s unclear whether the coronavirus subvariant — known as BA.2.12.1 — will hasten the rising swell of cases across the state, including in the Bay Area. But it’s believed to be driving a surge in the New York region and other parts of the Northeast, where it already makes up nearly 60% of cases, according to estimates by the Centers for Disease Control and Prevention.

The most recent CDC estimates, through the week ending April 23, show the BA.2.12.1 subvariant making up about 15% of cases that undergo genomic sequencing in the Western United States; the California Department of Public Health reports a similar breakdown for the state.

According to disease modeling by the state, “BA.2.12.1 is likely to account for 50% of positive cases in California within a few days,” said Barbara Ferrer, director of public health for Los Angeles County, in a briefing Thursday.

BA.2.12.1 is a subvariant of BA.2, which is itself a subvariant of the original omicron variant that swept over the globe last November and December and drove the United States’ winter surge.

The BA.2 subvariant replaced the original omicron as the dominant strain in the United States toward the end of March; BA.2 now makes up about 80% of cases in the Western United States, according to the CDC. The original omicron makes up less than 5% of cases in the Western U.S. now and has essentially disappeared in the Northeast.

Coronavirus cases have climbed about 70% in California since the beginning of April, and they’ve increased 155% in the Bay Area over the same time period. Health experts believe the recent increases are largely because of the more infectious variants now circulating.

The BA.2 subvariant is thought to be about 1.5 times more infectious than the original omicron variant, and BA.2.12.1 may be 20% to 30% more infectious than BA.2.

Neither subvariant appears to cause more serious illness than its predecessor. But with a rapid climb in cases in New York and surrounding states, COVID hospitalizations are rising there too.
Hospitalizations remain low in California, though they have begun creeping up over the past week.

The Bay Area has reported a more pronounced spike in cases than most of the rest of California, though it’s unclear why. As of last week, the Bay Area was reporting roughly 23 cases per 100,000 residents a day, compared with 14 cases per 100,000 for the state as a whole.

Dr. Sara Cody, the Santa Clara County health officer, suggested that the more infectious variants may have gotten a foothold in this region before other parts of the state, giving the Bay Area a head start on the next swell. “It’s possible that BA.2 emerged here first,” Cody said.

Proving whether one or both of the subvariants took off in the Bay Area ahead of the rest of the state is difficult. The state does not break down variant data by county, and not all counties report their own data. For those counties that do report variants, most identified their first BA.2.12.1 cases in the past week or two.

Cody added that the huge omicron wave led to “pretty good community-wise immunity,” due to so many people being infected and therefore somewhat protected against the next variant. “But it’s not enough. We’re still seeing a swell.”

Dr. Benjamin Pinsky, head of the Stanford Clinical Virology Laboratory, which does genomic sequencing of the coronavirus for several Bay Area counties, said the BA.2.12.1 variant and its sibling, BA.2.12, made up about 10% of sequences in his most recent report, from about two weeks ago.

He noted that one reason scientists are keeping a close eye on BA.2.12.1 is because it has a mutation — called L452Q — that was also found in a highly infectious variant called lambda that circulated widely in South America. A similar mutation, called L452R, was the defining trait of the California variant, known as epsilon, that drove the winter 2020 to 2021 surge in the Western United States.

Pinsky’s lab also recently found its first case of the variant known as XE, which is a combination of the original omicron variant and BA.2.

“There’s not a ton of (XE) in the United States, but that is the one that folks were concerned about in the United Kingdom,” Pinsky said.

Ferrer said that although it does not appear that BA.2.12.1 causes more severe illness, the speed at which the subvariant and its parent, BA.2, have taken over parts of the country — and so soon after omicron roared across the globe — signals that the coronavirus remains an unpredictable threat.

“With so many new variants cropping up, we just don’t know if we’re on this trajectory where we’re going to see milder and milder illness. I would suggest we not ... be overly optimistic,” Ferrer said. “Recognize this is a virus that mutates fairly rapidly and fairly dramatically.”

Indeed, yet another subvariant, BA.4, appears to be driving up cases in South Africa — among the first countries to identify omicron last November. So far, like the rest of its family BA.4 seems to be somewhat more infectious than its predecessor but not causing more severe illness.

New Coronavirus News from 28 Apr 2022

'We're in another wave': Wastewater dats shows how fast COVID is spreading across Bay Area [KGO-TV, 28 Apr 2022]

By Luz Pena

SAN FRANCISCO (KGO) -- As COVID-19 infections grow across the state all eyes are on our wastewater. For the past four weeks, COVID levels have been increasing.

"The concentrations right now are similar to what they were during the delta surge back in the summer of 2021," said Prof. Alexandria Boehm, Civil and Environmental Engineering at Stanford University.

We went inside Stanford's environmental engineering lab to see firsthand how wastewater samples are processed everyday.

"Here is a wastewater sample where you have the solids in the wastewater that have been settled," described Suzy Kim, PhD student at Stanford University.

Professor Boehm and her network are relying on a commercial lab to detect where the most infections are coming from.

"We look at waste water from about 11 different waste wastewater treatment plants around the greater Bay Area from Sacramento to Yolo, San Francisco and Santa Clara County and San Mateo County," said Professor Boehm.

Luz Pena: "Out of all those how many are experiencing high levels of COVID?"

Professor Boehm: "Almost all them we are seeing high levels."

Berkeley infectious diseases professor Emeritus John Swartzberg says new waves tend to happen every 4-6 months.

"By every metric we are using it is pretty clear that right now we are in another wave of the pandemic," said Prof. Swartzberg and added, "This one looks more like a hill. It's sort of gradually going up and up over the last several weeks. What we don't know is it going to continue to go up?"

The latest wastewater data shows how fast this new wave is going.

"At a slow rate maybe doubling every four weeks," said Prof. Boehm.

As more people are testing at home wastewater is crucial to detect new variants.

Prof. Boehm said her team just detected the latest subvariant of omicron believed to be more transmissible than BA.2.

"The wastewater data does tell us that BA.2 is the variant that is circulating. There is basically no more BA.1. It's all BA.2. The wastewater is also telling us that we do have BA.2.12.1 which is the newer variant that is causing a lot of cases in the East Coast and we have that in the Bay Area," said Prof. Boehm.

What's giving medical experts hope is that despite this new wave hospitalizations are not increasing.

"This time we are starting in a position where our hospitalizations are essentially as low as they've ever been since the beginning of the pandemic. So we got a lot of flexibility and people don't have to worry there won't be a hospital bed or an ICU for them," said Prof. Swartzberg.

China's Covid Wave Is Another Speedbump To Recovery [Seeking Alpha, 28 Apr 2022]

Stocks churned most of yesterday, leaving the major market averages relatively unchanged, but it is too early to call that a successful test of the lows from earlier this year. It is a start, and solid earnings reports after the close could tilt the scale in favor of the bulls. This is clearly a stock pickers market. Companies that were the largest beneficiaries of the pandemic are facing exceedingly difficult comparisons now, while others that are benefiting from the reopening of the economy are thriving. Some have been able to navigate supply chain issues, labor shortages, and rising input costs more effectively than others. The one consistent theme is that valuations for expensive growth names continue to compress, which is bringing the multiple for the broad market in line with the current interest rate and inflationary environment. That is a needed reset for a bull market that came charging out of the gates in March 2020.

The most recent of a myriad of concerns on investor minds has been the impact that the latest wave of Covid in China will have on the already distressed global supply chain, inflation, and Fed monetary policy. Lockdowns in Beijing and Shanghai will undoubtedly result in more shortages of goods and adverse impacts on assembly lines, but these have been going on for weeks in many cities across the country as the government implements President Xi’s no-Covid policy. The greatest impact will likely be on China’s economic growth, which is why estimates have been coming down from 6% last year and 4.8% in the first quarter of this year to just 4.2% in the second, according to economists at Bank of America.

A slowing rate of economic growth is not necessarily a bad thing, as it should help bring the rate of inflation down, which gives the Fed room to not tighten as aggressively as markets currently anticipate. Meanwhile, the government is already announcing stimulus plans to recover. This week Xi called for an “all-out” infrastructure splurge to head off the rise in unemployment. I don’t see this wave of Covid as any different than the others we have seen around the world over the past two years. It will inevitably be contained, sooner more likely than later, and pent-up demand will be met.

This wave is also impacting the operations of U.S. multinational companies that have business in China to varying degrees. Procter & Gamble (PG) management said during their earnings conference call that two of their Shanghai-based plants were shut down temporarily and about 25% of their China demand was being impacted due to the inability to deliver products to stores. Yet the company beat profit estimates for the first quarter and raised guidance.

Coca-Cola (KO) management told investors that its momentum in China turned negative in February and March, resulting in a decline in volumes during the first quarter. Again, the company crushed earnings expectations for the first quarter, fueled by a surge in sales growth in other regions of the globe.

Sherwin-Williams (SHW) noted during its upbeat earnings call that it was seeing an easing in raw material and logistic constraints. CEO John Morikis said, “we believe we are through the worst of the industry supply chain challenges.”

Kimberly-Clark (KMB) beat profit expectations and raised guidance, asserting that Omicron was having less of an impact on its business, allowing it to improve its supply chain compared to its situation in January.

Johnson & Johnson (JNJ) acknowledged that there are still shortages of everything from materials to labor, but that supply chain issues are expected to ease during the second half of the year.

The management team at Fastenal (FAST) was less optimistic than other multinationals but stated that where supply chain issues are not improving, the responses to it by companies are getting better. I think that is clearly being shown in aggregate by first quarter earnings results.

The Technical Picture

The S&P 500 was able to close up modesty yesterday and hold its February low, as investors continue to rotate out of growth and into value. The remainder of the week will be crucial, as heavyweights Apple and Amazon report after the close.

Lots of services offer investment ideas, but few offer a comprehensive top-down investment strategy that helps you tactically shift your asset allocation between offense and defense. That is how The Portfolio Architect compliments other services that focus on the bottom-ups security analysis of REITs, CEFs, ETFs, dividend-paying stocks and other securities.

Are We in the Middle of an Invisible COVID Wave? [The Atlantic, 28 Apr 2022]

By Yasmin Tayag

No one’s actually sure.

Over the past month, the number of new COVID cases in my social circle has become impossible to ignore. I brushed off the first few—guests at a wedding I attended in early April—as outliers during the post-Omicron lull. But then came frantic texts from two former colleagues. The next week, a friend at the local café was complaining that she’d lost her sense of smell. My Instagram feed is now surfacing selfies of people in isolation, some for the second or third time.

Cases in New York City, where I live, have been creeping up since early March. Lately, they’ve risen nationally, too. On Tuesday, the national seven-day average of new COVID cases hit nearly 49,000, up from about 27,000 three weeks earlier. The uptick is likely being driven by BA.2, the new, more transmissible offshoot of Omicron that’s now dominant in the United States. BA.2 does seem to be troubling: In Western Europe and the U.K. in particular, where previous waves have tended to hit a few weeks earlier than they have in the U.S., the variant fueled a major surge in March that outpaced the Delta spike from the summer.

At least so far, the official numbers in the U.S. don’t seem to show that a similar wave has made it stateside. But those numbers aren’t exactly reliable these days. In recent months, testing practices have changed across the country, as at-home rapid tests have gone fully mainstream. These tests, however, don’t usually get recorded in official case counts. This means that our data could be missing a whole lot of infections across the country—enough to obscure a large surge. So … are we in the middle of an invisible wave? I posed the question to experts, and even they were stumped by what’s really happening in the U.S.

For a while, COVID waves were not all that difficult to detect. Even at the beginning of the pandemic, when the country was desperately short of tests, people sought out medical help that showed up in hospitalization data. Later, when Americans could easily access PCR tests at clinics, their results would automatically get reported to government agencies. But what makes this moment so confusing is that the COVID metrics that reveal the most about how the coronavirus is spreading are telling us less and less. “Why we’re seeing what we’re seeing now is one of the more challenging scientific questions to answer,” Sam Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundation, told me.

Not only is our understanding of case counts limited, but all the epidemiological data we do have in the U.S. is rife with biases, because it’s collected haphazardly instead of through randomized sampling, he said. The data sets we rely on—case counts, wastewater, and hospitalizations—are “blurry pictures that we try to piece together to figure out what’s going on,” Jennifer Nuzzo, an epidemiologist at Brown, told me.

An invisible wave is possible because cases capture only the number of people who test positive for the virus, which is different from what epidemiologists really want to know: how many people are infected in the general population. That’s always produced an undercount in how many people are actually infected, but the numbers are becoming even more uncertain as government testing sites wind down and at-home testing becomes more common. Unlike during past waves, each household can request up to eight free rapid tests from the federal government, and insurance companies are required to reimburse Americans for the cost of any additional rapid tests they purchase. These changes in testing practices leave even more room for bias.

Sheer pandemic fatigue probably isn’t helping, either. People who are over this virus could be ignoring their symptoms and going about their daily lives, while people who are getting reinfected may be getting milder symptoms that they don’t recognize as COVID, Nuzzo said. “I do believe we are in a situation where there’s more of a surge happening, a larger proportion of which is hidden from the usual sort of sensors that we have to detect them and to appreciate their magnitude,” Denis Nash, an epidemiologist at the City University of New York, told me. He was the only expert I spoke with who suggested that we might be in a wave that we’re missing because of our poor testing data, though he too wavered on that point. “I wish there was a clear answer,” he said.

Instead of relying solely on case counts to gauge the size of a wave, Nash said, it’s better to take into account other metrics such as hospitalizations and wastewater data, to triangulate what’s going on. Positivity rate—the percent of tests taken that have a positive result—can be more informative than looking at the raw numbers, too. And right now, the nationwide positivity rate is telling us that an increasing number of people are getting sick: Nationwide, 6.7 percent of COVID tests are coming back positive, versus 5.3 percent last week.

Unlike traditional COVID testing, wastewater surveillance, which is a process of detecting SARS-CoV-2 in public sewage, doesn’t reveal who exactly might be infected in a particular community. But by analyzing sewer data for evidence of the coronavirus, it can provide an early signal that a surge is happening, in part because people may shed virus in their feces before they start feeling sick. Nationwide levels of COVID in wastewater have climbed steadily in the past six weeks, suggesting more of a wave than the case counts indicate, though they vary greatly by region and can’t account for the chunk of the population who doesn’t use public utilities, says Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. Scarpino noted a rise in certain areas, including Boston and New York, but he didn’t characterize them as a wave. “Multiple data sets are showing [a] plateau in some places,” he said. “It’s that combined trend across multiple data sets that we’re looking for.”

If America is indeed not experiencing a big wave at all, that would be breaking with our recent history of following in Europe’s path. One possibility is that “the immunological landscape is different here,” Scarpino said. At the peak of Omicron’s sweep across the U.S., in January, more than 800,000 people were getting infected each day, partly a function of the fact that just 67 percent of eligible Americans are fully vaccinated. Most of those who recovered got an immunity bump from their infection, which might now be protecting them from BA.2. Even with all the data issues we have, the relatively slow rise in new cases “does raise the possibility of there being less population vulnerability” in the U.S., Nuzzo said. But, she noted, this doesn’t mean people should think we’re done with the pandemic. States in the Northeast and Midwest are seeing far more cases than the South and the West. As this wide regional variation suggests, many pockets of the country are still vulnerable.

In all likelihood, we’re seeing elements of both scenarios right now. There could be many more COVID infections than the reported numbers indicate, even while the situation in the U.S. may be unique enough to prevent the same pattern of spread as in Europe. Regardless, the course of the pandemic would be far less uncertain if we had data that truly reflected what was happening across the country. All the experts I spoke with agreed that the U.S. desperately needs active surveillance, the kind that involves deliberately testing representative samples of the population to produce unbiased results. It would tell us what percentage of the general population is actually infected, and how trends differ by age and location. Now that “we’re moving away from blunt tools like mandates, we need data to inform more targeted interventions that are aimed at reducing transmission,” Nuzzo said.

In some ways, not knowing whether we are in an invisible wave is more unsettling than knowing for certain. It leaves us with very little to go on when making personal decisions about our safety, such as deciding whether to mask or avoid indoor dining, which is especially frustrating as the government has fully shifted the onus of COVID decision making to individuals. “If I want to know what my risk is, I just look to see if my friends and family are infected,” Scarpino said.
“The closer the infection is to me, the higher my risk is.” But we can’t continue flying blind forever. It’s the third year of the pandemic—why are we still unable to tell how many people are sick?

But our inability to nail down whether we’re in a wave is also an indication that we’re closer to the end of this crisis than the beginning. An encouraging sign is that COVID hospitalizations aren’t currently rising at the same rate as cases and wastewater data. Nationally, they’re still close to all-time lows. Hospitalization data, Nuzzo said, is “one of our more stable metrics at this point,” though it lags behind the real-time rise in cases because it usually takes people a few weeks to get sick enough to be hospitalized.

Even if BA.2 is silently infecting large swaths of the country, it doesn’t seem to yet be causing as much severe illness as previous waves, thanks to immunity and perhaps also antiviral drugs.
If that trend holds, it may mean we are seeing a decoupling of cases and hospitalizations (and, thus, with deaths too). “This is the kind of thing we really want to see—we can absorb a big surge without a lot of people having severe infection and dying,” Nash said. Still, it’s impossible to say for certain. For that, yet again, we’d need better data.

New Coronavirus News from 21 Apr 2022

Covid BA.2 Being Quickly Overtaken In US By Its Subvariant BA.2.12.1 [Deadline, 21 Apr 2022]

By Tom Tapp

Just as most Americans have caught wind of the BA.2 variant of Omicron — which overtook the original Omicron as the dominant strain in the U.S. less than a month ago — another possibly faster-growing version of Omicron is quickly making inroads.

The new Omicron sublineage BA.2.12.1 now accounts for 19% of all new cases specifically sequenced for variants in the country, according to data released Tuesday by the U.S. Centers for Disease Control. That means the strain — barely on the national radar two weeks ago — is now being identified in close to 1 in 5 newly-sequenced cases, up from 1.5% less than a month before on 3/19. Given that, Americans trying to keep up may be experiencing a form of variant whiplash.

Last week, when Deadline first reported on BA.2.12.1, the variant was tied to the parallel rise of another BA.2 sublineage, BA.2.12. Both are sublineages of the BA.2 variant, and thought to have a 23%–27% growth advantage over BA.2, according to the New York State Department of Public Health. BA.2 is thought to have an estimated 30% growth advantage over the original Omicron.

New York officials announced last week, seemingly out of nowhere that “For the month of March, BA.2.12 and BA.2.12.1 rose to collectively comprise more than 70% prevalence in Central New York and more than 20% prevalence in the neighboring Finger Lakes region. Data for April indicate that levels in Central New York are now above 90%.”

Then: “State health officials have determined that these highly contagious new variants are likely contributing to the rising cases.”

At the end of the first week of March, the 7-day average number of daily new cases in the state was well under 2,000. By April 13, it was over 5,000, according to the New York Times, with the total number of new positive cases that day, according to state data, at 6,546. Since then, while case numbers have risen and fallen with fluctuating daily test numbers, the 7-day average test positivity in New York has risen from 4.6% to 5.9%.

BA.2.12 is said to be made up of North American and European lineages, while BA.2.12.2 is said to derive its lineage from the USA and Canada, with some speculating the first case was identified in Canada. That may explain why it has taken off more quickly in the Northeast.

CDC data released this week indicate that, for the three-state region comprised of New York, New Jersey and Connecticut, BA.2.12.2 already accounts for the majority of new cases (52%). It’s fellow subvariant, BA.2.12, has not kept pace. Its numbers are now being folded in with those cases attributed to BA.2. The two together are estimated to be causing 46% of new cases, down from about 85% in data released just one week ago on the region.

In the southwestern region made up of California, Nevada and Arizona, the new CDC data indicates that BA.2.12.2 is responsible for about 9% of new cases.

Some states such as California, however, do not break Omicron data out into sublineages, a practice that made it hard to track the rise of BA.2 and is now making it hard to chart BA.2.12.1.

But that state’s largest metropolis has released data that shows, as of April 2, BA.2.12.1 only accounted for 2% of its sequenced cases. That number is more than two weeks old, however.

Since that date, cases attributed to the variant have more than doubled nationally. Given trends with the new sublineage, it’s a fair guess the same has happened in Los Angeles, especially since cases have been rising steadily in the same period.

New Coronavirus News from 26 Apr 2022

Why North Korea and Eritrea do not have Covid vaccine programmes [Buzz.ie, 26 Apr 2022]

By Clara Murray

Just two out of 195 states are yet to start vaccinating their citizens – here’s why

It feels like a long time since the Covid-19 vaccine rollout dominated the conversation. In Ireland, 85 per cent of eligible people have now been fully vaccinated against the virus, while nearly two-thirds of the global population have got at least one jab.

But for some parts of the world, the conversation has not even begun.

Just two countries have not given out a single Covid vaccine to their populations through an official programme: the dictatorships of North Korea and Eritrea.

North Korea
As one of the world’s most politically and economically isolated countries, it is not surprising North Korea has rebuffed the global vaccination push.

The UN-backed Covax program, which aims to share vaccines with poorer countries, said this week it would stop offering the jabs to North Korea after they were repeatedly refused.

Its official reason? Other countries needed the doses more. Perhaps thanks to its closed borders and a strict lockdown regime, North Korea claims to have prevented any serious outbreak of the disease – and has not officially recorded any cases.


However, a recent UN report said this was “likely at considerable cost to the wider health situation and further exacerbating economic deprivation”.

Leader Kim Jong-un has also berated officials for not planning its response to the “great crisis” of Covid properly, according to Sky News.

But while you might think beggars can’t be choosers, the Washington Post reported North Korean officials may be holding out for donations of mRNA vaccines like Pfizer or Moderna over the AstraZeneca and Sinovac shipments which have already been offered.

Eritrea
Located on Africa’s east coast, this impoverished state broke away from Ethiopia in 1993 after a decades-long war. (The two nations are still embroiled in a conflict.)

Nearly 10,000 Covid infections have been reported among its population of six million. But to date no official Covid vaccine programme has been set up and Eritrea is refusing to share data on the virus with the world.

However, the head of African Centres for Disease Control said last year, “we are not giving up” on rolling out jabs in the war-torn country, which does not have any elections, free press or parliament.

Eritrea’s government has not made any statement on its Covid policies and its reasons for shunning the jabs are not yet clear.

President Isaias Afwerki, who has held power since independence, has been described as an “all-powerful despot” and one of the world’s most authoritarian rulers. In his 30 years in power, he’s overseen tight restrictions on foreign influence, particularly from the United States. This may explain his reluctance to accept overseas aid.

Another possible reason put forward by Vice is WHO Director-General Tedros Adhanom Ghebreyesus' former membership of the Tigray People's Liberation Front, which Eritrea is currently at war with.
What is bizarre is that Eritrea has made vaccination for other diseases such as measles, polio and TB a major priority – and has accepted Western aid to do so.
Bigger picture
Even leaving aside these outliers, the world has still not achieved vaccine equality. Low income countries have administered just 22 jabs per 100 people compared to nearly 200 among high income nations.
In part this is due to high prices charged by manufacturers and restrictive contracts which favour richer nations. Meanwhile, donated vaccines often go unused due to supply chain issues and short shelf lives. A lack of health infrastructure, training and medical staff also play a role in some countries.
It matters because low vaccination rates worldwide leave the door open to new variants, like Omicron XE, cropping up.
“Until we get the globe vaccinated up to as high a point as we can, we'll be going through this a number of times again,” Michael McCarthy Flynn, lead convener of People’s Vaccine Alliance Ireland, told Buzz last year.

COVID-19 rates are on a steady rise in California. Has the fifth wave of virus begun? [Sacramento Bee, 26 Apr 2022]

BY MICHAEL MCGOUGH

A steady increase in coronavirus transmission has continued across most of California during April, recent state health data show, likely fueled by more contagious offshoots of the COVID-19 omicron variant that are gaining ground throughout the U.S. California’s daily case rate is now 8.7 per 100,000 residents, with test positivity at 2.7%, the California Department of Public Health said in a Tuesday update. Each metric is up about 40% in the past two weeks. CDPH last Friday reported positivity at 3.1% but in Tuesday’s update revised that day’s figure to 2.8%. It still marked the state’s highest measurement since Feb. 25, after falling as low as 1.2% in late March.

Wastewater monitoring data has shown potentially steeper increases in some well-populated parts of California. The amount of virus detected in wastewater increased by about 192% in Davis between April 1 and April 17, and by about 140% in Sacramento in the same period, according to CDPH’s wastewater network data dashboard.

During the same stretch, Yolo County’s test positivity rate doubled and Sacramento County’s increased by about 50%. There have also been significant increases in the Bay Area. Napa, San Francisco, Marin, Sonoma and Contra Costa counties all have test-positivity rates more than double the state average, ranging from 5.7% to 6.7%. In San Jose, virus levels rose 150% in the wastewater from March 31 to April 16; test positivity spiked nearly 60% in the same stretch, CDPH infection numbers show. Hospital numbers at the moment remain on a plateau.
California on Tuesday reported 950 COVID-positive patients in hospital beds and has fluctuated between about 950 and 1,000 since April 15, state data show. The number of virus patients in intensive care units slid Tuesday to an all-time low of 112. Both are tiny fractions of the omicron peak in early January, when California saw COVID-19 hospitalizations soar above 15,000 virus patients including 2,600 in ICUs. $2 for 2 months Subscribe for unlimited access to our website, app, eEdition and more CLAIM OFFER Hospital trends throughout the pandemic have tended to lag behind case trends by a couple of weeks, though, meaning hospitalizations could begin to elevate soon given the increase in case rate. ICU numbers typically trail behind overall hospitalizations by an additional week or so. BA.2 SUBVARIANTS STILL ON THE RISE U.S. health officials have estimated that BA.2 is roughly 40% more transmissible than the original omicron variant, BA.1; and that a related strain called BA.2.12.1 is about 25% more transmissible than BA.2, which would make it about 75% more contagious than BA.2. The U.S. Centers for Disease Control and Prevention in a weekly update Tuesday said the two subvariants combined for 97% of U.S. virus cases last week, up from 93% the prior week. Of sampled cases nationwide, 68% were BA.2 and 29% were BA.2.12.1, compared to 74% and 19% one week earlier, respectively. For the CDC region that comprises California, Arizona, Nevada, Hawaii and Pacific island territories, BA.2 made up 82% and the more contagious BA.2.12.1 comprised 15% last week, shifting from 85% and 9%, respectively, the previous week.

The precise prevalence of the two subvariants in California is not yet clear because the CDPH data dashboard for variants does not distinguish between BA.1, BA.2 and BA.2.12.1. All three subvariants remain lumped together as “omicron,” which the state last week said made up 99% of recent specimens sequenced for variants. One Sacramento-area testing network that does monitor for BA.2, the Healthy Davis Together project in Yolo County, reported BA.2 comprised 93% of positive cases for the week ending April 16, with the remaining 7% BA.1. BA.2 has increased from 83% on April 9 and 68% on April 2 in Yolo County. The rate of Healthy Davis Together tests returning positive increased by just over double between April 2 and April 16, according to the project website. Healthy Davis Together data does not yet distinguish BA.2 from BA.2.12.1. Experts are still working to understand BA.2 and BA.2.12.1, especially the latter, and how they may influence factors like vaccine efficacy and immune protection from previous infection.

Health officials across the U.S. have said in recent weeks that it does not appear that BA.2 causes more severe illness than the original omicron variant. SACRAMENTO-AREA NUMBERS BY COUNTY Sacramento County’s latest case rate is 6.2 per 100,000 residents, state health officials said in a Tuesday update, a 35% increase from one week earlier. CDPH reported Sacramento’s test positivity rate at 3.2% as of Tuesday, up from 2.7% last week. Hospitals in Sacramento County were treating 48 virus patients Monday, state data show, down from 55 one week earlier. The ICU total halved, to four from eight.

The CDC classifies Sacramento County in the “low” level of COVID-19 activity. Placer County’s latest case rate is 5.2 per 100,000 residents, state health officials said in a Tuesday update, a 26% increase from one week earlier. CDPH reported Placer’s test positivity rate at 3.7% as of Tuesday, up from 3.5% last week. Hospitals in Placer County were treating 22 virus patients Monday, state data show, down from 33 one week earlier. The ICU total moved to four from three. The CDC classifies Placer County in the “low” level of COVID-19 activity.

Yolo County’s latest case rate is 7.0 per 100,000 residents, state health officials said in a Tuesday update, a 9% increase from one week earlier. CDPH reported Yolo’s test positivity rate at 1.5% as of Tuesday, up from 1.2% last week. Hospitals in Yolo County were treating one virus patient Monday, state data show, compared to two one week earlier. The ICU total held at zero. The CDC classifies Yolo County in the “low” level of COVID-19 activity. El Dorado County’s latest case rate is 4.6 per 100,000 residents, state health officials said in a Tuesday update, a 35% increase from one week earlier.

CDPH reported El Dorado test positivity rate at 4.3% as of Tuesday, up from 2.4% last week. Hospitals in El Dorado County were treating one virus patient Monday, state data show, compared to zero one week earlier. The ICU total held at zero. The CDC classifies El Dorado County in the “low” level of COVID-19 activity. Sutter County’s latest case rate is 3.2 per 100,000 residents and Yuba County’s is 5.0 per 100,000, state health officials said in a Tuesday update, respective increases of 17% and 100% in the past week. CDPH reported Sutter at 3.3% test positivity, up from 2.4% last week. Yuba’s positivity was 3.1% as of Tuesday, up from 3% last week. The only hospital in Yuba County, which serves the Yuba-Sutter bi-county area, was treating zero virus patients Monday, state data show, compared to two one week earlier. The ICU total decreased to zero from one. The CDC classifies Sutter and Yuba counties in the “low” level of COVID-19 activity. This story was originally published April 26, 2022 10:22 AM.

South Korea’s economy slows in Q1 on COVID curbs, inflation [Al Jazeera English, 26 Apr 2022]

Economic growth nearly halves in first quarter to 0.7 percent amid lower spending due to COVID curbs and inflation.

South Korea’s economic growth nearly halved in the first quarter from the previous three months as consumers and companies cut spending amid coronavirus curbs and surging inflation.

Gross domestic product grew a seasonally-adjusted 0.7 percent in the first quarter from the last quarter of 2021, the Bank of Korea (BOK) said on Tuesday, down from 1.2 percent in October-December, but slightly ahead of market expectations.

Private consumption shrank 0.5 percent, the worst in five quarters, as the government forced bars, restaurants and other businesses to close early to combat a surge in Omicron variant cases.

Capital investment fell 4 percent, the fastest decline in three years, while construction investment lost 2.4 percent.

From a year earlier, the economy grew 3.1 percent, compared with economists’ forecast of 2.8 percent growth.

“From the current quarter, the growth engine is expected to shift from exports to domestic consumption,” ING economists said in a note. “We are already seeing early signs of a recovery in private consumption as the government lifts most restrictions while the trade balance is going to record a deficit for a couple of months in the near future.”

The BOK is expected to revise down this year’s growth forecast from the current 3 percent estimate in its next review in May, as the country faces headwinds from the Ukraine war, US monetary policy tightening and COVID-19 lockdowns in China.

New BOK Governor Rhee Chang-yong said last week that economic growth is expected to weaken further from earlier projections, highlighting that monetary policy will aim to balance growth and inflation.

The BOK this month raised its benchmark rate to 1.50 percent, the highest since August 2019, in a surprise move as it ramped up the fight against inflation.

The International Monetary Fund recently lowered its 2022 growth projection for the country to 2.5 percent from 3 percent while upgrading its inflation projections to 4 percent from 3.1 percent.

Moody’s has forecast growth of 2.7 percent this year, while ING sees a 2.8 percent expansion.

S. Korea logs over 80,000 new COVID-19 cases [The Korea Herald, 26 Apr 2022]

By Shim Woo-hyun

Total COVID-19 caseload surpasses 17m

South Korea added over 80,000 new COVID-19 cases during the 24 hours of Monday, bringing the total caseload to 17 million, government data showed Tuesday.

According to the Korea Disease Control and Prevention Agency, the country’s daily COVID-19 infections on Monday reached 80,361, while the total caseload came to 17,009,865.

The daily tally increased from the previous day’s 34,370 as they tend to fall on Mondays due to fewer tests over the weekend.

But, the daily count reported on Tuesday was still down from 118,504 cases a week ago and 210,755 cases two weeks’ prior, reflecting the recent downward trend.

The number of deaths from COVID-19 also decreased to 82 on Monday, down 28 from the previous day’s 110. It was also the first time in around eight weeks for the COVID-19 related deaths to drop to two digits.

The death toll from COVID-19 came to 22,325, and the fatality rate stood at 0.13 percent.

The number of critically ill patients also went down to 613, from the previous day’s 668. The hospital bed occupancy rate for seriously ill COVID-19 patients came to 33.4 percent as of midnight Monday.

The number of COVID-19 patients who are under at-home treatment, however, increased by 70,881 to 461,401 due to the jump in daily COVID-19 cases from a day earlier.

New Coronavirus News from 25 Apr 2022

Here's what we know about the BA.2 Omicron subvariant now driving a new wave [National Geographic, 25 Apr 2022]

BY SANJAY MISHRA

BA.2 infections aren’t as mild as once thought and even newer versions of Omicron are circulating and spreading fast

After a brief two-month plateau, COVID-19 cases are rising again in the United States, propelled by the Omicron BA.2 subvariant and its more transmissible descendants. The uptick has experts worried, as more people are shedding their masks and returning to pre-pandemic activities.

Between April 1 and April 24, new COVID-19 cases have jumped by 75 percent, mostly due to BA.2; this subvariant now accounts for almost 75 percent of COVID-19 cases in the U.S. While hospitalizations are still at their lowest levels since the start of the pandemic, they are also trending upward nationally. And COVID-19 cases among nursing home residents and staff are rising again after falling for roughly three months.

“Ongoing transmission of BA.2 is probably related both to the increased transmissibility of the virus together with the reduction of pandemic restrictions,” says Dan Barouch, an immunologist at Harvard Medical School who directs the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center. “Clearly both are contributing to the current surge.”

At the same time, national vaccination rates have stalled out. Only 45.6 percent of the U.S. population has received a booster dose, and in at least 10 states, mostly in the South, more than a third of the population remains unvaccinated. This is especially troublesome because early data suggest BA.2 may cause more severe disease than the original form of Omicron.

The first Omicron wave arrived when many people in the U.S. were already vaccinated, so it seemed to cause less severe illness and got the reputation of being mild, says Ben Cowling, an epidemiologist at the University of Hong Kong. But “mild” was only relative to the very severe disease that previously dominant Delta variant had caused.

Melinda Maldonado, a communications strategist in Toronto, was triple vaccinated when she got a breakthrough infection in December 2021, during the peak of the Omicron wave in Canada. It left her bedridden for weeks, and three months later she still suffers with debilitating fatigue, brain fog, and cognitive disorientation.

“When people say ‘mild,’ they mean you're not dying, like you don't end up in the ICU,” Maldonado says. “For me, this was not mild.”

Now, evidence is building that the BA.2 subvariant is even more infectious than the first form of Omicron, produces more virus particles upon infection, and causes longer-lasting cases of COVID-19.

Why would BA.2 cause more severe disease?
The earlier form of Omicron, called BA.1, was more contagious than previous variants, but it caused less lung damage than Delta because it stayed mostly in the upper airways, says Guowei Wei, a mathematician and molecular biologist at Michigan State University, whose artificial intelligence model had predicted Omicron would be highly infectious. Still, the current crop of vaccines guarded against BA.1, which in most cases caused less severe disease than previous variants among the vaccinated and those who had some immunity from a previous infection.

Studies have shown that the overall risk of severe outcomes from an Omicron infection was lower than it was for Delta. But the risk of hospitalization among children younger than 10 did not significantly differ between Omicron and Delta, and Omicron infections led to a rise in hospital admissions of very young children.

Another study showed that in children, Omicron caused three times as many hospitalizations for respiratory infections compared with prior variants.

Now it seems BA.2 may be even more worrisome. In the U.K. the number of cases being recorded during the current BA.2 surge is much lower than what they saw during the Omicron wave in late December 2021—but the number of hospitalizations is almost equal.

One study that is yet to be peer reviewed suggests why BA.2 might be more severe. A team led by Kei Sato, a virologist at the University of Tokyo, created a synthetic version of BA.2 in the lab, and found that it grows faster in cells lining the nasal passage and has greater propensity to attack the lungs. This BA.2 look-alike virus also caused more severe disease in hamsters than its BA.1 counterpart.

The research suggests that mutations in BA.2’s spike protein—the part of the virus that binds to cells—enable it to dodge antibodies from a previous BA.1 infection.

Another study by Cowling and his team that has not yet been peer reviewed shows that in Hong Kong, the severity of a BA.2 infection is as bad as it was for the original SARS-CoV-2 variant for unvaccinated people of any age.

“In Hong Kong, and right now in Shanghai, I don't think [BA.2] is as mild as maybe people thought,” says Cowling.

Do vaccines still work for BA.2?
Available data show that the currently approved vaccines will prevent severe infection and hospitalization from COVID-19, more so in cases of BA.2 than BA.1.

Both Denmark and South Africa currently have high levels of immunity in their populations stemming from vaccination and infection, respectively. But data from both countries has shown there’s not much difference in severity between BA.2 and BA.1 infections. Reinfection with different subtypes of Omicron is possible, although in highly vaccinated Denmark, it was rare and mainly affected younger unvaccinated individuals.

Booster doses are also showing a lot of promise at protecting people from all forms of Omicron.

Various studies have shown that a third dose of a vaccine, or a breakthrough infection, can rekindle the immunity system’s memory to produce antibodies that work well against all variants, including Omicron. Harvard’s Barouch led a study showing that a third dose of the vaccine is a must for producing sufficient antibody levels against BA.2, just as is required for full protection against BA.1.

The Centers for Disease Control and Prevention (CDC) now recommends a fourth dose of vaccine for people age 50 and older, four months after the third dose; and additional dose for those with compromised immune systems, such as cancer patients. In a study not yet peer reviewed, a fourth dose substantially reduced breakthrough infection among healthcare workers with high exposure risk, even at the peak of the first Omicron wave. In addition, booster doses substantially reduce a person’s chances of transmitting the virus.

By contrast, the Hong Kong study revealed that the outcomes can be severe among unvaccinated people infected with any of the Omicron variants, including BA.2.

More variants on the horizon
As SARS-CoV-2 continues to spread and mutate globally, facilitated by pandemic fatigue, recombinants of variants keep forming; the recently discovered XE subvariant is a hybrid of BA.1 and BA.2 that is starting to spread; XE cases are relatively rare but have grown high enough that the U.K. Health Security Agency estimates it’s about 10 percent more contagious than BA.2.

Meanwhile, a new BA.2 descendent called BA.2.12.1 is spreading even more rapidly, causing 20 percent of all cases in the U.S. within a month of its discovery in early March. Earlier estimates show that BA.2.12.1 spreads faster than earlier strains and could be better at dodging the immune system’s antibodies.

“There are actually many new versions of Omicron, not just two. And in some cases, they do appear to be outcompeting even BA.2,” says Harvard’s Barouch.

This all means the U.S. “needs to recharge its vaccination program” to avoid a likely surge in the fall and winter, says Saad Omer, an epidemiologist who directs the Yale Institute for Global Health in Connecticut.

In addition to vaccines, masks have been shown to be effective in limiting the risk of COVID-19, both by reducing the spread of viral materials from an infected person and by reducing the chances of getting an infection. And avoiding an infection really should be the goal, experts stress: The aftereffects of COVID-19, including the array of symptoms collectively known as long COVID, can be debilitating.

“I thought if I got COVID, it would be the sniffles because that's the predominant narrative,” says Maldonado. “I want people to consider the risk when they think about things opening and not using a mask, because you don't know if it could be you.”

An uptick in COVID cases left Beijing scrambling to avoid a Shanghai-style lockdown [Fortune, 25 Apr 2022]

BY NICHOLAS GORDON

Panicked shoppers stripped supermarket shelves bare in Beijing after local health authorities ordered 3.5 million people in the city's largest district to undergo three rounds of mandatory COVID tests this week.

“The situation is grim”, a member of Beijing’s municipal party committee said on Sunday, saying the whole city needed to “act immediately” to prevent a surge in cases. Local officials have placed several buildings on lockdown and have suspended some in-person social activities to prevent the virus spreading. But Beijing health authorities believe the virus may have been “spreading invisibly” for a week.

Beijing authorities reported 19 new COVID cases on Monday morning, with almost 60 cases recorded since Friday. Reported cases have been traced mostly to Beijing's Chaoyang district, home to the capital's central business district as well as several of the city's foreign embassies.
Although Beijing's daily case number is low compared to infection levels in other major world cities, the capital is desperate to prevent its minor COVID spike from spiralling into an uncontrollable crisis, like the COVID outbreak currently gripping Shanghai.

Some Beijing residents, perhaps mindful of how a compulsory testing order in Shanghai evolved into an indefinite period of citywide lockdown that has left Shanghaiers desperate for food, are preparing for a prolonged lockdown in the capital. Shoppers are stockpiling food and other household supplies even as local officials pledge to ensure adequate supplies in order to avoid the food shortages seen during Shanghai’s lockdown.

Shanghai's lockdown tightens

A COVID outbreak in Beijing would further strain China’s COVID zero policy, which uses mass testing and lockdowns to completely suppress outbreaks when they emerge. While the policy has successfully controlled earlier outbreaks, it has not been able to control Shanghai's current outbreak of the Omicron variant.

Shanghai, a city of 26 million, is now in its fourth week of lockdown—though some parts of the city have been isolated for far longer. On Monday the financial hub reported almost 19,500 new COVID cases as well as 51 COVID deaths, marking a record high COVID fatality rate for the city.

Facing mounting COVID cases, Shanghai officials vowed to strengthen their COVID quarantine measures on Thursday evening. Soon after, social media posts showed authorities in several districts had erected wire fences around entrances to buildings with confirmed COVID cases, caging locked-down residents inside.

Public frustration is building over Shanghai's lockdown. A video clip compiling audio snippets from Shanghai's lockdown, including recordings of people pleading with local authorities to provide food and medical treatment, went viral on Chinese social media over the weekend, leading to a cat-and-mouse game between social media users sharing the video and China's internet censors attempting to block it.

Shanghai's COVID outbreak has roiled global supply chains too. The city is home to the world's largest port but COVID control measures have forced factories to close and prevented truckers from travelling across the city, leading to a severe backlog of container ships waiting to dock and unload their cargo.

Authorities have permitted some factories to reopen under a "closed-loop system", where workers live on-site and where entry is tightly controlled, but operations remain unstable. On Monday, the South China Morning Post reported that two factories owned by iPhone supplier Foxconn in Kunshan, a city that borders Shanghai, have been closed since Wednesday due to reported COVID cases among its staff.

COVID zero continues
Despite growing evidence of the economic and social costs of maintaining a COVID-zero policy, President Xi Jinping has called for the country to continue its zero-tolerance approach to managing COVID, leaving little room for his political underlings to waver.

Vice Premier Sun Chunlan, who is overseeing Shanghai's COVID response, said Sunday that the city would need to take “the strongest measures” to fight the outbreak, arguing that a prolonged coronavirus outbreak—ignoring that the current outbreak has lasted over a month—will only "cost more social resources.”

Beijing races to contain 'urgent and grim' Covid outbreak as Shanghai lockdown continues [CNN, 25 Apr 2022]

By Simone McCarthy

Hong Kong (CNN)Beijing is racing to track a Covid-19 outbreak that may have been spreading in the capital for a week, city authorities said over the weekend, raising the prospect more stringent restrictions could soon be implemented in line with other Chinese cities.

Chaoyang, one of the city's largest districts, announced Sunday that it would launch three rounds of mass testing of those who work and live in the district, some 3.5 million residents, according to the latest census.

The announcement came after 11 cases were detected in a 24-hour period, sparking panic buying in the district, which includes the business center and a number of foreign embassies, as residents rushed to stock up on basic goods in case of a lockdown, despite authorities' assurances there were ample supplies.

Beijing officials said over the weekend they were tracking cases across multiple districts and involving students, tour groups, and interior decoration workers. The capital recorded 19 new local cases on Sunday, bringing the total in the city since April 22 to 60, according to national health data released Monday morning.

"The city has recently seen several outbreaks involving multiple transmission chains, and the risk of continued and undetected transmission is high. The situation is urgent and grim," municipal official Tian Wei told reporters Saturday. "The whole city must act immediately."

The pressure to contain the outbreak in the capital comes as cases continue to grow in Shanghai, despite a failed weeks-long lockdown that has brought the financial hub to a halt. The city reported more than 19,000 new cases and 51 deaths on Sunday, according to official figures released Monday morning.

The daily death count marks a record high since city officials first reported fatalities in the city's ongoing outbreak last Monday, though questions have been raised about whether the numbers account for all fatalities.

In Beijing, authorities mobilized to curb transmission, placing several residential communities in Chaoyang under "control management," according to state media, using a term that typically means residents are barred from leaving the area while they undergo testing. A district official on Sunday warned that disruptions to business and work were inevitable in the course of fighting the outbreak.

Screening would be upped in tour groups in the city, after cases were detected among a group of mainly elderly tourists who were now under quarantine, officials said on Saturday. At least one village in a suburban district of Beijing linked to a positive case was also closed down as mass testing was carried out.

The rush to contain the outbreak comes as fears grow across China that more stringent measures could be in store as the country sticks with a stringent "zero-Covid" policy to eliminate the spread of the virus in each outbreak.

That policy has faced its most stark challenge since March 1 as the highly transmissible Omicron variant sparked several simultaneous outbreaks. Case counts have ballooned to unprecedented levels in China, driven by large outbreaks in northeastern Jilin province and Shanghai.

Lockdowns and enforced quarantines in Shanghai have sparked anger and desperation among citizens, who have struggled to access to food and medical care. The city had earlier said it was not going to implement a full, citywide lockdown, leaving many unprepared when officials rapidly changed course late last month.

Restrictions have also spilled over into other areas with several dozen cities rolling out some form of lockdown restrictions, according to a count earlier this month.

New Coronavirus News from 24 Apr 2022

COVID-19: Germany, France, South Korea report highest cases globally; check full list here [Free Press Journal, 24 Apr 2022]

The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,971,925 and 991,231, respectively, according to the CSSE.

The global coronavirus caseload has topped 509.1 million, while the deaths have surged to more than 6.21 million and vaccinations to over 11.23 billion, according to the Johns Hopkins University.

In its latest update on Sunday morning, the University's Center for Systems Science and Engineering (CSSE) revealed that the current global caseload and the death toll stood at 509,166,036 and 6,216,725, respectively, while the total number of vaccine doses administered increased to 11,233,194,944.

Meanwhile, according to COVID-19 tracker Worldometer, there are several countries that are still reporting a huge amount of cases. Germany, France, South Korea and Italy have reported the maximum cases on Saturday, April 24.

Check out the list below:
Germany - 89,665
France - 80,571
South Korea - 75,414
Italy - 70,520
Japan - 42,808
Australia - 41,754

Check the full list here.

The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,971,925 and 991,231, respectively, according to the CSSE.

India accounts for the second highest caseload at 43,052,425.

The other countries with over 10 million cases are Brazil (30,345,808) France (28,435,100), Germany (24,180,512), the UK (22,106,306), Russia (17,864,332), South Korea (16,895,194), Italy (16,079,209), Turkey (15,016,210), Spain (11,736,893) and Vietnam (10,554,689).

The nations with a death toll of over 100,000 are Brazil (662,855), India (522,116), Russia (367,203), Mexico (324,033), Peru (212,724), the UK (173,985), Italy (162,609), Indonesia (156,040), France (146,057), Iran (140,952), Colombia (139,771), Germany (134,179), Argentina (128,344), Poland (115,948), Spain (103,721) and South Africa (100,298).

China Covid death toll rises as Beijing warns of 'grim' situation [FRANCE 24 English, 24 Apr 2022]

Shanghai (AFP) – Shanghai reported 39 Covid deaths Sunday, official data showed, its highest daily toll since a weeks-long lockdown started, while China's capital Beijing warned of a "grim" situation with rising infections.

The world's second-largest economy has been struggling to stamp out its worst Covid-19 outbreak in two years with a playbook of harsh lockdowns and mass testing as it sticks to a strict zero-Covid policy, taking a heavy toll on businesses and public morale.

The cosmopolitan business hub of Shanghai has been almost entirely locked down since the start of the month, snarling supply chains, with many residents confined to their homes for even longer as it became the epicentre of the outbreak.

China's biggest city only announced its first fatalities on April 18, despite reporting thousands of cases each day in recent weeks.

It reported 39 more deaths on Sunday, National Health Commission data showed, bringing its total toll to 87, while the country logged nearly 22,000 new local virus cases.

Shanghai's previous highest daily toll since lockdown was 12, reported a day earlier.

The city of 25 million has struggled to provide fresh food to those confined at home, while patients have reported trouble accessing regular medical care as thousands of health staff were deployed for Covid testing and treatment.

Censors have battled to scrub the online backlash against the prolonged lockdown.
Meanwhile 22 new infections were reported in the capital Beijing, after warnings from an official on Saturday that the city must take urgent action.

Health official Pang Xinghuo said preliminary observations suggested Covid had been "spreading invisibly" within the capital for a week now, affecting "schools, tour groups and many families".

"The risk of continued and hidden transmission is high, and the situation is grim," Tian Wei of Beijing's Municipal Party Committee told a press briefing.

"The whole city of Beijing must act immediately."

North Korea: COVAX scraps the reclusive country's vaccine allocations [The Washington Post, 24 Apr 2022]

By Michelle Ye Hee Lee and Min Joo Kim

SEOUL — As mask mandates and social distancing requirements lift around the world, North Korea remains one of two countries that have not administered any coronavirus vaccines, with no sign of how it can ever begin to reopen despite a brewing humanitarian crisis for its people.

The vaccines that were allocated for North Korea through a United Nations-backed global vaccination effort are no longer available, officials said this month, after Pyongyang repeatedly rejected the initiative’s offers of millions of doses.

North Korea, already one of the most closed societies in the world, remains in a strict pandemic lockdown and has shuttered its borders except to a minimal level of trade with China, with grave implications for the health and food security of its population.

The pandemic closure has exacerbated the food crisis, said Tomás Ojea Quintana, the United Nations’ special rapporteur on North Korean human rights. In a recent report, Quintana said the country’s “covid restrictions, including border closures, appear to have prevented an outbreak inside the country, though likely at considerable cost to the wider health situation and further exacerbating economic deprivation.”

No one is clear on the exact situation inside the country, however, because North Korea’s retreat inward in the pandemic has restricted remaining channels of information — with diplomats, humanitarian aid groups and tourists no longer able to enter.

In light of the impending crisis, Quintana urged the international community to find some way to get the needed 60 million doses into the country to immunize its population of 25 million.

Last year, North Korea rejected nearly 3 million doses of China’s Sinovac vaccine, saying shipments should go to other countries that need them more. North Korea also rejected 2 million doses of the AstraZeneca-Oxford University vaccine out of apparent concerns about potential side effects.

North Korean officials have privately indicated that they would prefer mRNA vaccines, such as Pfizer or Moderna, according to a report by a panel of experts convened by the Washington-based Center for Strategic and International Studies. The panel concluded that North Korea probably would be interested in a high-volume offer of an mRNA vaccine.

With no vaccines at all, North Korea risks becoming the epicenter of new variants as a result of the population’s low immunity to the virus, the panel found.

“It is inevitable that they will have to reopen the border, and when they do, the best way to protect their population — which is what they’re already interested in — is to vaccinate the population as much as possible, which they are capable of doing,” said Kee Park, a global health expert at Harvard Medical School who has worked on health-care projects in North Korea.

“They have to take a different strategy at this point. Zero covid strategy is starting to crumble,” Park said.

Officials at the North Korean Mission to the United Nations did not respond to a request for comment on whether the country intends to accept vaccines or what it hopes to see before moving forward on an immunization program.

North Korea and Eritrea are now the only two countries in the world that have not administered vaccines.

The Gavi Alliance, part of the Covax initiative that aims to deliver vaccines to the world’s most vulnerable people, said this month that it no longer has vaccine doses allocated for North Korea but that they could be made available again if the country changes its mind and starts an immunization program and meets technical requirements.

North Korea had completed some of the requirements for accepting Covax deliveries, but there were ongoing negotiations on whether North Korea is willing to indemnify the vaccine manufacturer against unexpected side effects.

Two years since North Korea’s declaration of a “national emergency response” to the coronavirus, the lockdown shows no signs of letting up, with state media this week urging the public to “strengthen the anti-epidemic work in preparation for the prolonged emergency.” A piece published in the state newspaper Rodong Sinmun warned against “sloppiness and idleness” in anti-epidemic work.

Still, at the year-end party plenum in December, North Korea announced it will shift from a “control-based anti-epidemic work” to an “advanced and people-oriented” measure that seeks to “strengthen the anti-epidemic stronghold while overcoming circumstances that ignore convenience for our people,” according to state media.

“Such a change in the basis of their anti-virus approach is a confession that there are limitations to fundamentally solving the problem with control and restriction alone, and that the long-term restrictions caused fatigue and discontent among the people,” said Kim Ho-hong, a researcher at Seoul-based Institute for National Security Strategy, in a report.

Ahn Kyung-su of the Seoul-based research center dprkhealth.org said Pyongyang’s “people-oriented” slogan was probably an effort to alleviate pandemic fatigue, and he noted that the restrictions remain in place partly because of the virus resurgence in China, which is being closely tracked in state media.

“North Korea showed signs of reopening earlier this year in January, when trains briefly ran across the Chinese border, but the virus spike in mainland China led North Korea back into a strict isolation,” he said.

Anti-viral drugs could be a potential route for North Korea to reopen without needing to accept outside monitoring of its technical capabilities, the CSIS panel suggested. While the mRNA vaccine requires a sophisticated cold-chain and other logistics, anti-viral pills can be distributed more easily.

In light of what could possibly be an unfolding humanitarian crisis, the international community needs to find some way to persuade Pyongyang to reopen, U.N. special rapporteur Quintana asserted.

“A new way of thinking needs to take hold. This will require vision and initiative, driven by the needs of the North Korean people rather than any other agenda,” he said in his report.

Shanghai authorities fence off COVID-hit areas, sparking outrage [Al Jazeera English, 25 Apr 2022]

China’s most populous city, Shanghai, is battling the country’s biggest COVID-19 outbreak.
Shanghai authorities have erected fences outside residential buildings in the city to contain a COVID-19 outbreak, sparking renewed outrage over a lockdown that has forced many of the Chinese city’s 25 million residents to remain indoors.

China’s most populous city and most important economic hub is battling the country’s biggest COVID-19 outbreak by closing off areas of the city and forcing all those who test positive into quarantine centres.

The lockdown in Shanghai, which for many residents has lasted more than three weeks, has fuelled frustration among the public over lost wages, family separations, poor conditions in quarantine, and lack of access to medical care and food.

China reported 21,796 new community-transmitted COVID-19 infections on Sunday, with the vast majority being asymptomatic cases in Shanghai. Across the country, many cities and provinces have enforced some version of a lockdown in an attempt to slow the spread of the coronavirus.

The latest outbreak in Shanghai, driven by the highly contagious Omicron variant, has seen hundreds of thousands of cases detected in the city but fewer than 100 deaths since the outbreak began nearly two months ago.

On social media, images of government workers wearing hazmat suits have gone viral as they sealed off entrances to housing blocks in the city and closed off entire streets with green fencing, prompting questions and complaints from residents.

“This is so disrespectful of the rights of the people inside, using metal barriers to enclose them like domestic animals,” a user of the social media platform Weibo said.

One video showed residents shouting from balconies at workers who tried to set up fencing before relenting and taking the barricade away. Other videos showed people trying to pull the fences down.

“Isn’t this a fire hazard?” asked another Weibo user of the policy to fence people into homes.
Many of the fences have been erected around locations designated as “sealed areas”, which are residential buildings where at least one person has tested positive for COVID-19, meaning those inside are forbidden from leaving their front doors.

A notice on Saturday, reportedly from a local authority and shared online, said “hard quarantine” was being imposed in some areas.

The Shanghai government did not respond to a request for comment.

Beijing braces for rise in Covid cases amid outcry over Shanghai blockade [The Guardian, 24 Apr 2022]

by Vincent Ni

Official says Covid ‘spreading invisibly’ within capital as Shanghai residents complain about barriers at residential buildings

Authorities in Beijing are on high alert for a surge in coronavirus cases amid a fresh outcry in Shanghai over buildings blockaded under China’s zero Covid policy.

The number of new cases in the capital rose by 22 on Sunday – all locally transmitted – compared with six the day before, according to official reports. Beijing authorities have so far not taken steps to lock down the capital, but they have ordered a number of gyms and after-school activity providers to suspend in-person classes.

Residents rushed to stockpile food amid rumours of tougher measures in the coming days. Inhabitants of Chaoyang district – the city’s largest area with 3.45 million people – will also have to undergo three coronavirus tests this coming week.

Food hoarding is somewhat underway in #beijing, these pics are shared in my Wechat moments. Slim pickings for fresh veggies at my neighborhood Walmart as well. Of course gov't is assuring the public today theres a healthy supply of necessities https://t.co/wrktetdaWY pic.twitter.com/VzoRbl5m3E— Yang Liu (@yangliuxh) April 24, 2022

Health official Pang Xinghuo said preliminary observations suggested Covid had been “spreading invisibly” within the capital for a week, affecting “schools, tour groups and many families”.

“The risk of continued and hidden transmission is high, and the situation is grim,” Tian Wei of Beijing’s municipal party committee told a press briefing. “The whole city of Beijing must act immediately.”

The outbreak in Beijing came as Mainland China’s most crucial financial hub, Shanghai, enters its fourth week of city-wide lockdown. Thirty-nine new deaths were reported on Sunday, compared with 12 the previous day and by far the most during the current outbreak.
‘Hard isolation’

As the situation did not seem to have improved following three weeks of stringent lockdown in Shanghai, desperate officials erected mesh barriers outside some residential buildings on Saturday. This move – described in the official directive “hard isolation” – sparked a fresh public outcry over a lockdown that has forced many of the city’s 25 million people to stay home.

Images of white hazmat suit-clad workers sealing entrances of housing blocks and even closing off entire streets with 2-metre-tall green fencing went viral on social media on Saturday, prompting questions and complaints from residents.

“Isn’t this a fire hazard?” said one user on the social media platform Weibo. “This is so disrespectful of the rights of the people inside, using metal barriers to enclose them like domestic animals,” said another.

Most of the barriers appeared to have been erected around compounds designated as “sealed areas”, which are buildings where at least one person has tested positive for Covid and so its residents are forbidden from leaving their front doors.

The move from the local government, as some Shanghai residents pointed out, appeared to have contradicted an earlier advisory from China’s top legislative body that was issued during the first round of Covid outbreak in March 2020.

In that advisory, as was reported by state news agency, Xinhua, a spokesperson at the Legislative Affairs Commission of the Standing Committee of the National People’s Congress said that measures to enforce “hard isolation” were “illegal” and “unreasonable”.

The Shanghai government did not respond to a request for comment.

Shanghai Covid Stories: Barriers are being installed all over the city. Meanwhile their purpose hasn't been fully explained.

A thread. pic.twitter.com/Vhnojz2cOR
— chris pc (@chris__pc) April 24, 2022

Fast, precise, too tough? Lockdowns risk stalling China’s economy
Read more

In the past three weeks, the lockdown in Shanghai has fuelled frustration over difficulties accessing food and medical care as well as over lost wages, family separation, conditions at quarantine centres and censorship of efforts to vent online.

It has also exacted a toll on the world’s second-largest economy, with factory efforts to resume production disrupted by snarled supply chains and difficulties faced by locked-down residents returning to work.

Authorities did not report any deaths from Covid during the first few weeks of its latest case surge, fuelling doubt among residents about the figures. It has since reported 87 fatalities from the virus, all in the past seven days.

New case numbers fell slightly for Saturday, but remained in the tens of thousands. Shanghai recorded 19,657 new local asymptomatic cases, down from 20,634 a day earlier, and 1,401 symptomatic cases, down from 2,736.

Nationwide, China reported 20,285 new asymptomatic coronavirus cases for Saturday, down from 21,423 a day earlier, with 1,580 symptomatic cases, down from 2,988.

New Coronavirus News from 19 Apr 2022

Correlation Between Mask Compliance and COVID-19 Outcomes in Europe [Cureus, 19 Apr 2022]

by Beny Spira

Abstract
Masking was the single most common non-pharmaceutical intervention in the course of the coronavirus disease 2019 (COVID-19) pandemic. Most countries have implemented recommendations or mandates regarding the use of masks in public spaces. The aim of this short study was to analyse the correlation between mask usage against morbidity and mortality rates in the 2020-2021 winter in Europe. Data from 35 European countries on morbidity, mortality, and mask usage during a six-month period were analysed and crossed. Mask usage was more homogeneous in Eastern Europe than in Western European countries. Spearman's correlation coefficients between mask usage and COVID-19 outcomes were either null or positive, depending on the subgroup of countries and type of outcome (cases or deaths). Positive correlations were stronger in Western than in Eastern European countries. These findings indicate that countries with high levels of mask compliance did not perform better than those with low mask usage.

Introduction
Universal masking has been introduced during the coronavirus disease 2019 (COVID-19) pandemic at an unprecedented global scale as an important tool to curb viral transmission among potential susceptible persons. Face masks still are one of the most significant and controversial symbols in the fight against COVID-19. Two large randomised controlled trials about mask effectiveness performed during the pandemic came out with mixed results [1,2].

Several studies that analysed the effect of masks on the general population (ecological studies) have concluded that masks were associated with a reduction in transmission and cases [3-7]. However, these studies were restricted to the summer and early autumn of 2020. From March 2020 onwards, country after country instituted some form of mask mandate or recommendation. The stringency of these measures varied among the different countries and they, therefore, resulted in different proportions of mask compliance, ranging from 5% to 95% [8]. Such heterogeneity in mask usage among neighbouring countries provided an ideal opportunity to test the effect of this non-pharmaceutical intervention on the progression of a strong COVID-19 outburst.

Materials & Methods
Study design
This analysis aimed to verify whether mask usage was correlated with COVID-19 morbidity and mortality. Daily data on COVID-19 cases and deaths and on mask usage were obtained for all European countries. The rationale behind the choice of European countries for comparison was fourfold: (1) availability and reliability of data; (2) a relative population homogeneity and shared history of epidemics (comparing countries from different continents may bring too many confounding factors); (3) similar age stratification and access to health assistance; and (4) divergent masking policies and different percentages of mask usage among the different populations, despite the fact that the entire continent was undergoing an outburst of COVID-19 at the time period analysed in this study.

Inclusion criterion
Data were collected from the following Eastern and Western European countries: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Hungary, North Macedonia, Poland, Romania, Serbia, Slovakia, Slovenia, Belarus, Estonia, Latvia, Lithuania, Republic of Moldova, Ukraine, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, and Northern Ireland. The inclusion criterion was a population size higher than one million people.

Data retrieval
Data on morbidity, mortality, and mask usage were retrieved from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington [8]. Data from IHME were downloaded on 14th February 2022. IHME mask data sources are the Delphi Group at Carnegie Mellon University and the University of Maryland COVID-19 Trends and Impact Surveys, in partnership with Facebook, Kaiser Family Foundation, and YouGov COVID-19 Behaviour Tracker Survey (https://www.healthdata.org). Data on vaccination were obtained from Our World in Data (OWID) [9] on 4th April 2022.

Statistical analysis
Data from 35 European countries on morbidity, mortality, and mask usage during a six-month period were collected and analysed. Spearman’s correlation analyses and Shapiro-Wilk normality checks were in JASP (version 0.15; University of Amsterdam, Amsterdam, Netherlands) [10] and linear regressions in Wolfram Mathematica 13.0 (Wolfram Research, Inc., Champaign, Illinois) [11].

Results
This brief communication reports the correlation between the proportion of mask usage in the population and the number of cases (per million) and deaths (per million) from October 2020 to March 2021 in 35 European countries (Table 1). For this analysis, all European countries, including West and East Europe, with more than one million inhabitants were selected, encompassing a total of 602 million people. All analysed countries underwent a peak of COVID-19 infection during these six months (Figures 1, 2). The average proportion of mask usage in the referred period was 60.9% ± 19.9%, slightly higher in Eastern than in Western Europe (62.1% and 59.6%, respectively). However, the level of mask compliance was considerably more homogeneous in East (SD = 13.4%) than in West European countries (SD = 25.4%).

Surprisingly, weak positive correlations were observed when mask compliance was plotted against morbidity (cases/million) or mortality (deaths/million) in each country (Figure 3).
Neither the number of cases nor the proportion of mask usage followed a Gaussian distribution (Shapiro-Wilk p-values were 0.004 and 0.0536, respectively). A Spearman’s rank test was applied to quantify the correlation between mask usage, cases, and deaths (Table 2).
The positive correlation between mask usage and cases was not statistically significant (rho = 0.136, p = 0.436), while the correlation between mask usage and deaths was positive and significant (rho = 0.351, p = 0.039). The Spearman’s correlation between masks and deaths was considerably higher in the West than in East European countries: 0.627 (p = 0.007) and 0.164 (p = 0.514), respectively. This difference could be associated with the fact that the most populous countries are located in West Europe. However, the correlations did not significantly change when the seven countries with populations > 20 million were excluded from the analysis (cases rho = 0.129 (p = 0.513); deaths rho = 0.375 (p = 0.049)). Analyses of other sub-groups, such as countries with populations smaller or higher than six million, higher than 10 million, or higher than 15 million, were also evaluated. None of these tests provided negative correlations between mask usage and cases/deaths.

Discussion
Mask mandates were implemented in almost all world countries and in most places where masks were not obligatory, their use in public spaces was recommended [12]. Accordingly, the World Health Organization (WHO) as well as other public institutions, such as the IHME, from which the data on mask compliance used in this study were obtained, strongly recommend the use of masks as a tool to curb COVID-19 transmission [8,13]. These mandates and recommendations took place despite the fact that most randomised controlled trials carried out before and during the COVID-19 pandemic concluded that the role of masks in preventing respiratory viral transmission was small, null, or inconclusive [1,2,14,15]. Conversely, ecological studies, performed during the first months of the pandemic, comparing countries, states, and provinces before and after the implementation of mask mandates almost unanimously concluded that masks reduced COVID-19 propagation [3-7,16]. However, mask mandates were normally implemented after the peak of COVID-19 cases in the first wave, which might have given the impression that the drop in the number of cases was caused by the increment in mask usage. For instance, the peak of cases in Germany's first wave occurred in the first week of April 2020, while masks became mandatory in all of Germany's federal states between the 20th and 29th of April [5], at a time when the propagation of COVID-19 was already declining. Furthermore, the mask mandate was still in place in the subsequent autumn-winter wave of 2020-2021, but it did not help preventing the outburst of cases and deaths in Germany that was several-fold more severe than in the first wave (Figure 2).

The findings presented in this short communication suggest that countries with high levels of mask compliance did not perform better than those with low mask usage in the six-month period that encompassed the second European wave of COVID-19. It could be argued that some confounding factors could have influenced these results. One of these factors could have been different vaccination rates among the studied countries. However, this is unlikely given the fact that at the end of the period analysed in this study (31th March 2021), vaccination rollout was still at its beginning, with only three countries displaying vaccination rates higher than 20%: the UK (48%), Serbia (35%), and Hungary (30%), with all doses counted individually [9]. It could also be claimed that the rise in infection levels prompted mask usage resulting in higher levels of masking in countries with already higher transmission rates. While this assertion is certainly true for some countries, several others with high infection rates, such as France, Germany, Italy, Portugal, and Spain had strict mask mandates in place since the first semester of 2020. In addition, during the six-month period covered by this study, all countries underwent a peak in COVID-19 infections (Figures 1, 2), thus all of them endured similar pressures that might have potentially influenced the level of mask usage.

Conclusions
While no cause-effect conclusions could be inferred from this observational analysis, the lack of negative correlations between mask usage and COVID-19 cases and deaths suggest that the widespread use of masks at a time when an effective intervention was most needed, i.e., during the strong 2020-2021 autumn-winter peak, was not able to reduce COVID-19 transmission. Moreover, the moderate positive correlation between mask usage and deaths in Western Europe also suggests that the universal use of masks may have had harmful unintended consequences.
________________________________________
References
1. Abaluck J, Kwong LH, Styczynski A, et al.: Impact of community masking on COVID-19: a cluster-randomized trial in Bangladesh. Science. 2022, 375:eabi9069. 10.1126/science.abi9069
2. Bundgaard H, Bundgaard JS, Raaschou-Pedersen DE, et al.: Effectiveness of adding a mask recommendation to other public health measures to prevent SARS-CoV-2 infection in Danish mask wearers: a randomized controlled trial. Ann Intern Med. 2021, 174:335-43. 10.7326/M20-6817
3. Adjodah D, Dinakar K, Chinazzi M, et al.: Association between COVID-19 outcomes and mask mandates, adherence, and attitudes. PLoS One. 2021, 16:e0252315. 10.1371/journal.pone.0252315
4. Lyu W, Wehby GL: Community use of face masks and COVID-19: evidence from a natural experiment of state mandates in the US. Health Aff (Millwood). 2020, 39:1419-25. 10.1377/hlthaff.2020.00818
5. Mitze T, Kosfeld R, Rode J, Wälde K: Face masks considerably reduce COVID-19 cases in Germany. Proc Natl Acad Sci U S A. 2020, 117:32293-301. 10.1073/pnas.2015954117
6. Rader B, White LF, Burns MR, et al.: Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021, 3:e148-57. 10.1016/S2589-7500(20)30293-4
7. Van Dyke ME, Rogers TM, Pevzner E, et al.: Trends in county-level COVID-19 incidence in counties with and without a mask mandate — Kansas, June 1-August 23, 2020. MMWR Morb Mortal Wkly Rep. 2020, 69:1777-81. 10.15585/mmwr.mm6947e2
8. Institute for Health Metrics and Evaluation. COVID-19 estimate downloads. (2020). Accessed: February 14, 2022: https://www.healthdata.org/covid/data-downloads.
9. Our World in Data. Coronavirus pandemic (COVID-19). (2022). Accessed: April 4, 2022: https://ourworldindata.org/coronavirus.
10. JASP. JASP (version 0.16.1). (2022). https://jasp-stats.org/.
11. Wolfram Research Inc. Mathematica, version 13.0.0. (2022). https://www.wolfram.com/mathematica.
12. What countries require or recommend masks in public?. (2020). Accessed: April 9, 2022: https://masks4all.co/what-countries-require-masks-in-public/.
13. World Health Organization. When and how to use masks. (2022). Accessed: April 9, 2022: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks.
14. Xiao J, Shiu EY, Gao H, Wong JY, Fong MW, Ryu S, Cowling BJ: Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings—personal protective and environmental measures. Emerg Infect Dis. 2020, 26:967-75. 10.3201/eid2605.190994
15. Jefferson T, Del Mar CB, Dooley L, et al.: Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2020, 11:CD006207. 10.1002/14651858.CD006207.pub5
16. Ford N, Holmer HK, Chou R, Villeneuve PJ, Baller A, Van Kerkhove M, Allegranzi B: Mask use in community settings in the context of COVID-19: a systematic review of ecological data. EClinicalMedicine. 2021, 38:101024. 10.1016/j.eclinm.2021.101024

Hunger and anger in Shanghai's unending lockdown nightmare [CNN, 19 Apr 2022]

by Steven Jiang

(CNN)When my 73-year-old father raised concern about his shrinking food supply late last week, the catastrophe brought by Shanghai's citywide Covid lockdown suddenly hit home.

"Will be running out in a few days if no government handout soon," he messaged me Thursday.

Then, as if anticipating my inevitable worry, he added: "Still have some rice and crackers -- and plenty of coffee."

It was a startling revelation on the grim reality in China's biggest city and financial hub -- from a member of the generation that lived through the Great Famine and the tumultuous Cultural Revolution that killed millions during the first few decades of the People's Republic, founded in 1949 by Communist revolutionary Mao Zedong.

Even during the darkest days in Mao's China, my parents -- Shanghai-born and bred -- used to remind me that, unlike many in the countryside, they were fortunate enough not to fear the prospect of starvation.

Now, with lockdown measures turning increasingly draconian, a once almost-unthinkable topic has struck a chord with residents in the city and beyond, more so than anything else: people going hungry in Shanghai in 2022.

What’s happening in China and what does it mean for the rest of the world?

By the authorities' own acknowledgment, the food shortage has been a largely man-made disaster owing to a lack of planning and coordination.

Despite official pledges, government handouts have been unreliable in many parts of the city, including my father's apartment complex in northeastern Shanghai filled with retirees like him. The elderly crowd had mostly failed to secure supplies through online bulk-purchases,
practically the only way to buy anything in Shanghai at the moment, due to their relatively small demand and lack of tech-savviness.

I set out to help but never had I thought online grocery shopping would be such an emotional rollercoaster.

Armed with a membership for a retail warehouse club -- presumably allowing me to face less stiff competition than those using a general online grocer -- I quickly realized it was impossible to grab one of the coveted delivery slots, which are assigned at 9 p.m. daily, even with food still available on the virtual shelves.

The retailer's app simply crashed each night -- and would only come back online a few hours later with a glaring "no more delivery slots for the day" message.

As frustration and anxiety built up, my hope dwindled along with my father's supply. On Day 2 of my futile attempts, a friend tipped me off about a "boutique" online retailer that was still offering a grocery package with next-day delivery slots. Elated to find out she was right, I immediately ordered for my father.

When I broke the good news in the online family group chat, however, uncles and aunts -- all facing their own food shortage to various degrees -- jumped in to express their shock that I willingly paid 398 yuan ($62) for five kilograms of vegetables and 60 eggs.

"Highway robbery!" cried one uncle, while an aunt stressed the price was more than four times what she would normally pay for the same amount of food in the market.

"But these are boutique eggs," my dad deadpanned.

I was relieved that my father's fridge was replenished in time but, hearing relative's comments, felt a sense of "survivor's guilt": What about the countless residents who can't afford price-gouged groceries?

An indefinite lockdown
Literal survival wasn't a concern for most of Shanghai's 25 million residents before April.

For the past two years, the city had bolstered its status as the most important international gateway to China -- for both people and goods. It had prided itself on its more targeted and lenient approach to Covid containment, despite Beijing's strict zero-Covid policy.

With Shanghai shunning citywide mass testing and adopting less restrictive quarantine rules, it once looked like a potential role model for the whole country as the rest of the world had largely chosen to live with Covid with an emphasis on vaccination.

Then came Omicron, with the highly contagious Covid variant sweeping through the city and infecting more than 390,000 residents since March, according to government statistics.

After repeatedly denying the city would be locked down -- with police even announcing a probe into alleged online rumormongers -- Shanghai authorities abruptly changed course in late March and sealed off the entire metropolis at the beginning of April.

The government initially billed it as a four-day "temporary pause" -- claiming they would promptly test the entire population, isolate positive cases and then re-open the city. As a result, many residents never bothered to stock up.

Despite widespread panic buying before the lockdown, my father was among the unfazed. A retired electric engineer who enjoys travel, photography and coffee, he had recently strained his back muscles -- and wasn't going anywhere in any case.

Still, his home confinement turned out to be much longer -- and more precarious -- than he ever envisioned.

With tens of thousands of new infections reported daily, the government has continued to extend the lockdown -- ordering any residential community with a single new positive case to be sealed for an additional 14 days.

My father's apartment complex is currently slated to be locked down until May 2. But even that date remains uncertain, as the authorities continue to retest residents, meaning the lockdown clock could reset at any time.

For once, millions of people in Shanghai -- young and old, rich and poor, liberal and conservative -- seem united by their rising anger.

Despite the censors' ferocious effort to erase all traces of bad news, social media users keep recounting and re-posting heartbreaking stories, increasingly disgusted by highly choreographed state media images showing an orderly and effective lockdown.

Among my friends and family, almost everyone has a personal story to share about the lockdown chaos and misery: from sneaking out in darkness to barter some food with a neighbor, to learning harrowing experiences of a friend dumped into to a hastily built isolation ward with leaking roofs and overflowing toilets, and hearing the wailing of an old woman next door whose children were unable to see their newly deceased father one last time.

Propaganda adds insult to injury
People are also seeing Chinese propaganda czars double down, painting Omicron as a potentially lethal threat while stressing that only zero-Covid can save China from the deaths and havoc caused by the virus in the West.

Officials have made it clear the policy has the personal stamp of approval from the country's strongman leader, Xi Jinping, who has yet to visit Shanghai -- a city he once led -- amid the deepening crisis. Xi is expected to assume an almost unprecedented third term later this year, paving the way for him to rule for life.

Outside Shanghai, that message still seems to resonate with many, though debates have started to emerge and intensify. Inside the eerily quiet metropolis, the lockdown and its ensuing calamity have become a watershed moment for locals and expatriates.

With state media headlines screaming "it's not the flu!" against government statistics showing only about two dozen severe cases among the infected in Shanghai so far, nearly everyone seems to agree on the apparent absurdity of "the solution being worse than the problem" -- particularly as stories surface on social media about deaths relating to those unable to receive medical care for non-Covid causes due to the lockdown.

Some residents have questioned online why the authorities appear more keen to attack critics of zero-Covid than to convince residents aged over 60 in the fast-graying city -- the most vulnerable group with a disappointing vaccination rate of 62% -- to get the shot.

Others reflect on the current tragedy and contemplate their next steps.

"How did Shanghai fall like this?" has been the line I have heard most often lately. It's mostly a rhetorical question -- the real question seems to be "Shall I stay, or shall I go?"

For expats, many have been voting with their feet -- undaunted by the bureaucratic and logistical hoops they must jump through to just exit their residences.

For locals, it involves more soul-searching but, echoing sentiment online, a growing number of Shanghainese -- native or adopted -- have told me they have decided to put their foot down to emigrate.

Entrepreneurs and bankers alike say the brutal lockdown has demonstrated money means nothing in a world where anyone can instantly become collateral damage in plans instigated by a distant and unaccountable leadership.

For most people in Shanghai, especially of the older generations like my father, they will always call the city home. They remain focused on surviving the ongoing nightmare, trying their luck with bulk-purchasing online.

My father said someone in his community recently initiated a coffee group-buy attempt -- but quickly failed due to lack of interest.

"No one seems to be in the mood for coffee right now," he said.

New Coronavirus News from 20 Apr 2022

Ever-increasing ever-increasing corona cases increased concern, 65% cases increased again in 24 hours [News Track English, 20 Apr 2022]

By Shruti Wilson

New Delhi: Corona cases are increasing rapidly across the country. In the last 24 hours, 2067 cases of corona infection have been reported. Earlier on Monday, 1247 cases were found.
Meaning, in 24 hours, about 65 percent cases have increased in the country. In the last 24 hours, 40 people have died due to corona in the country. However, due to this 1,547 people have become healthy. So far, a total of 4,30,47,594 cases of corona have been reported in the country. At the same time, active cases have increased to 12,340. So far 4,25,13,248 people have recovered from corona. So far 5,22,006 people have died due to corona in the country.

The situation in the national capital Delhi is very worrying. Here in the last 24 hours, 26 percent corona cases have increased. On Tuesday, 632 new cases of corona were reported in Delhi.
Earlier on Monday, 501 cases were reported. Active cases have increased to 1,274. However, on Tuesday, 414 people have recovered. However, no one has died from Corona in the last 24 hours. The positivity rate has gone up to 4.42 percent.

Apart from Delhi, there is a huge increase in the cases of corona in Uttar Pradesh too. 163 cases have been registered in the last 24 hours. Active cases have increased to 798 cases. 55 people have been cured in the last 24 hours. In the same Maharashtra, the cases of corona have increased very rapidly on Tuesday. In the last 24 hours, 137 new cases have been reported here. Whereas a day earlier, on Monday, 59 cases were reported.

Corona cases rise again globally [Uttarakhand News Network, 20 Apr 2022]

The uncontrollable pace of Corona continues in Germany, France and Italy. In Germany, about 2 lakh cases have been reported in a day. In China’s financial center Shanghai, the government has decided to extend the lockdown as the situation in the city regarding Corona has not eased. Meanwhile, India has registered a 66 percent increase in corona cases in 24 hours. A record 1009 cases of corona have been reported in the capital Delhi.

Corona’s new sub-variant XE has created panic all over the world. This variant is a sub-variant of Omicron. As per reports, this variant is more infectious and dangerous than all the variants of corona so far. The new sub-variant of Corona has once again stalled the powerful countries of the world. The pace of corona has become uncontrollable in western countries. Corona cases in Germany, France and Italy are scary. Whereas, cases of corona are increasing continuously in South Asian countries as well. Corona cases are increasing in China and India.
On Tuesday, 1.98 lakh new cases of corona were reported in Germany. After which the corona cases have increased to 23,658,211. The news agency Reuters also reported 348 new deaths, citing data from the Robert Koch Institute. At the same time, France has reported 181 new deaths from Corona on Tuesday. While 25,465 new infection cases have been reported. France is currently battling with the once again escalation of the Corona epidemic.

On the other hand, 27,214 cases were reported in Italy on Tuesday. Italy’s health ministry said deaths had risen to 127, up from 79 the previous day. The Health Ministry said that 174,098 COVID tests were conducted on Tuesday as compared to the previous 105,739.

95 percent corona cases reported from Shanghai
On Wednesday, 19927 new cases of corona were reported in China. Whereas in Shanghai city alone, 18902 cases were reported with 95 percent cases. While 2495 of these people had symptoms of corona. Strict curfew is currently in force in Shanghai regarding Corona. Earlier this week, the government allowed 40 lakh people to step out of the house, easing the lockdown slightly. This permission was only for buying essential items.

2000 new cases of corona in India, scary situation in Delh
On Wednesday, 2000 new cases of corona were reported in India. Whereas, in the evening, 1009 new cases of corona were reported in the capital of the country. With these cases, the risk of corona in Delhi has increased again. In such a situation, the government has again made it mandatory to wear masks in public places. Failure to comply with the order will attract a fine of Rs 500.

Nearly 2 Lakh Covid cases in Germany, Shanghai eases more curbs: Global updates [Hindustan Times, 20 Apr 2022]

By Ishika Yadav

1.98 lakh cases in Germany, Shanghai eases curbs: Global Covid updates in 8 points

Confirmed Covid cases in Germany went up by 1.98 lakh. Italy witnessed a single-day spike of 27,214 cases on Tuesday. In Shanghai, the Chinese government has decided to lift the lockdown further. Here are the top global Covid-19 updates.

Germany, France and Italy continue to fight a rise in daily infections and Covid-linked deaths, with Germany reporting nearly 2 lakh cases in a day. In China’s financial hub Shanghai, the government has decided to lift the lockdown further as it intensifies Covid-19 testing in the city. Meanwhile in India, a 66 per cent rise in cases was recorded in 24 hours as daily cases crossed the 2,000-mark for the second time this week to break a downward trend.

Here are the top global Covid-19 updates:
1. Confirmed Covid cases in Germany went up by 1.98 lakh to reach 23,658,211 on Tuesday. 348 new deaths were also reported by Reuters citing Robert Koch Institute data.

2. France reported 181 new deaths - a sharp increase from recent daily figures - and 25,465 new infections on Tuesday. France is currently struggling with a surge in the number of Covid-19 patients needing intensive care.

3. Italy witnessed a single-day spike of 27,214 cases on Tuesday, the health ministry said, while deaths rose to 127 as against 79 the previous day. 174,098 Covid tests were carried out on Tuesday, compared with a previous 105,739, the health ministry said.

4. Shanghai allowed an additional four million more people out of their homes Wednesday as curfew rules eased. A total of almost 12 million people in the city of 25 million are allowed to go outdoors following the first round of easing of restrictions last week, health officials said as per news agency AP.

5. On Wednesday, China's mainland witnessed 19,927 new cases. Shanghai accounted for 95% of the total, or 18,902 cases, of which only 2,495 had symptoms.

6. US President Joe Biden said on Tuesday that "it's up to them" when asked whether people should keep wearing masks on aeroplanes. Cab service providers Uber and Lyft have also scrapped face mask mandates for their riders and drivers in the United States.

7. The BA.2 sub-variant of Omicron and its sublineage BA.2.12.1 is estimated to make up more than 90% of the coronavirus cases in the US as of last week, the US' Centers for Disease Control has said.

8. British prime minister Boris Johnson on Tuesday apologised to parliament after he was fined by police for breaking lockdown rules, saying he did not know a birthday gathering at the height of the pandemic was in breach of the rules he had set.

COVID-19: Germany, South Korea, Australia report highest cases globally; check full list here [Free Press Journal, 20 Apr 2022]

The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,732,919 and 989,328 respectively, according to the CSSE.

The global coronavirus caseload has topped 505.8 million, while the deaths have surged to more than 6.20 million and vaccinations to over 11.19 billion, according to Johns Hopkins University.

In its latest update on Wednesday morning, the University's Center for Systems Science and Engineering (CSSE) revealed that the current global caseload and the death toll stood at 505,893,847 and 6,202,920 respectively, while the total number of vaccine doses administered increased to 11,191,789,391.

Meanwhile, according to COVID-19 tracker Worldometer, there are several countries that are still reporting a huge amount of cases. South Korea, Japan, Australia have reported the maximum cases on Monday, April 18.

Check out the list below:
Germany - 130,759
South Korea - 118,445
Australia - 38,608
USA - 33,193
Japan - 28,282

Check the full list here.
The US continues to be the worst-hit country with the world's highest number of cases and deaths at 80,732,919 and 989,328 respectively, according to the CSSE.

India accounts for the second highest caseload at 43,045,527.

The other countries with over 10 million cases are Brazil (30,275,272) France (28,010,387), Germany (23,658,211), the UK (22,033,383), Russia (17,829,009), South Korea (16,583,220), Italy (15,758,002), Turkey (15,003,696), Spain (11,627,487) and Vietnam (10,489,319).

The nations with a death toll of over 100,000 are Brazil (662,396), India (521,966), Russia (366,436), Mexico (323,949), Peru (212,654), the UK (172,498), Italy (161,893), Indonesia (155,937), France (145,425), Iran (140,877), Colombia (139,754), Germany (133,308), Argentina (128,344), Poland (115,838), Spain (103,104) and South Africa (100,195).

New Coronavirus News from 18 Apr 2022

Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19 [nejm.org, 18 Apr 2022]

Authored by Carolyn T. Bramante, Jared D. Huling, Christopher J. Tignanelli, John B. Buse, David M. Liebovitz, Jacinda M. Nicklas, Kenneth Cohen, Michael A. Puskarich, Hrishikesh K. Belani, Jennifer L. Proper, Lianne K. Siegel, Nichole R. Klatt, et al., for the COVID-OUT Trial Team*

Abstract
BACKGROUND
Early treatment to prevent severe coronavirus disease 2019 (Covid-19) is an important component of the comprehensive response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS

In this phase 3, double-blind, randomized, placebo-controlled trial, we used a 2-by-3 factorial design to test the effectiveness of three repurposed drugs — metformin, ivermectin, and fluvoxamine — in preventing serious SARS-CoV-2 infection in nonhospitalized adults who had been enrolled within 3 days after a confirmed diagnosis of infection and less than 7 days after the onset of symptoms. The patients were between the ages of 30 and 85 years, and all had either overweight or obesity. The primary composite end point was hypoxemia (≤93% oxygen saturation on home oximetry), emergency department visit, hospitalization, or death. All analyses used controls who had undergone concurrent randomization and were adjusted for SARS-CoV-2 vaccination and receipt of other trial medications.

RESULTS
A total of 1431 patients underwent randomization; of these patients, 1323 were included in the primary analysis. The median age of the patients was 46 years; 56% were female (6% of whom were pregnant), and 52% had been vaccinated. The adjusted odds ratio for a primary event was 0.84 (95% confidence interval [CI], 0.66 to 1.09; P=0.19) with metformin, 1.05 (95% CI, 0.76 to 1.45; P=0.78) with ivermectin, and 0.94 (95% CI, 0.66 to 1.36; P=0.75) with fluvoxamine. In prespecified secondary analyses, the adjusted odds ratio for emergency department visit, hospitalization, or death was 0.58 (95% CI, 0.35 to 0.94) with metformin, 1.39 (95% CI, 0.72 to 2.69) with ivermectin, and 1.17 (95% CI, 0.57 to 2.40) with fluvoxamine. The adjusted odds ratio for hospitalization or death was 0.47 (95% CI, 0.20 to 1.11) with metformin, 0.73 (95% CI, 0.19 to 2.77) with ivermectin, and 1.11 (95% CI, 0.33 to 3.76) with fluvoxamine.

CONCLUSIONS
None of the three medications that were evaluated prevented the occurrence of hypoxemia, an emergency department visit, hospitalization, or death associated with Covid-19. (Funded by the Parsemus Foundation and others; COVID-OUT ClinicalTrials.gov number,

India Is Stalling the W.H.O.’s Efforts to Make Global Covid Death Toll Public [The New York Times, 18 Apr 2022]

By Stephanie Nolen and Karan Deep Singh

The agency has calculated that 15 million people have died as a result of the pandemic, far more than earlier estimates, but has yet to release those numbers.

An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that vastly more people died than previously believed — a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually.

But the release of the staggering estimate — the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the pandemic to date — has been delayed for months because of objections from India, which disputes the calculation of how many of its citizens died and has tried to keep it from becoming public.

More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count of about 520,000. The W.H.O. will show the country’s toll is at least four million, according to people familiar with the numbers who were not authorized to disclose them, which would give India the highest tally in the world, they said. The Times was unable to learn the estimates for other countries.

The W.H.O. calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for deaths that were missed. Most of the difference in the new global estimate represents previously uncounted deaths, the bulk of which were directly from Covid; the new number also includes indirect deaths, like those of people unable to access care for other ailments because of the pandemic.

The delay in releasing the figures is significant because the global data is essential for understanding how the pandemic has played out and what steps could mitigate a similar crisis in the future. It has created turmoil in the normally staid world of health statistics — a feud cloaked in anodyne language is playing out at the United Nations Statistical Commission, the world body that gathers health data, spurred by India’s refusal to cooperate.

“It’s important for global accounting and the moral obligation to those who have died, but also important very practically. If there are subsequent waves, then really understanding the death total is key to knowing if vaccination campaigns are working,” said Dr. Prabhat Jha, director of the Centre for Global Health Research in Toronto and a member of the expert working group supporting the W.H.O.’s excess death calculation. “And it’s important for accountability.”

To try to take the true measure of the pandemic’s impact, the W.H.O. assembled a collection of specialists including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has been collaborating across countries to try to piece together the most complete accounting of the pandemic dead.

The Times spoke with more than 10 people familiar with the data. The W.H.O. had planned to make the numbers public in January but the release has continually been pushed back.

Recently, a few members of the group warned the W.H.O. that if the organization did not release the figures, the experts would do so themselves, three people familiar with the matter said.

A W.H.O. spokeswoman, Amna Smailbegovic, told The Times, “We aim to publish in April.”
Dr. Samira Asma, the W.H.O.’s assistant director general for data, analytics and delivery for impact, who is helping to lead the calculation, said the release of the data has been “slightly delayed” but said it was “because we wanted to make sure everyone is consulted.”

India insists that the W.H.O.’s methodology is flawed. “India feels that the process was neither collaborative nor adequately representative,” the government said in a statement to the United Nations Statistical Commission in February. It also argued that the process did not “hold scientific rigor and rational scrutiny as expected from an organization of the stature of the World Health Organization.”

The Ministry of Health in New Delhi did not respond to requests for comment.

India is not alone in undercounting pandemic deaths: The new W.H.O. numbers also reflect undercounting in other populous countries such as Indonesia and Egypt.

Dr. Asma noted that many countries have struggled to accurately calculate the pandemic’s impact. Even in the most advanced countries, she said, “I think when you look under the hood, it is challenging.” At the start of the pandemic there were significant disparities in how quickly different U.S. states were reporting deaths, she said, and some were still collecting the data via fax.

India brought a large team to review the W.H.O. data analysis, she said, and the agency was glad to have them do it, because it wanted the model to be as transparent as possible.

India’s work on vaccination has won praise from experts globally, but its public health response to Covid has been criticized for overconfidence. Mr. Modi boasted in January 2021 that India had “saved humanity from a big disaster.” A couple of months later, his health minister declared that the country was “in the endgame of Covid-19.” Complacency set in, leading to missteps and attempts by officials to silence critical voices within elite institutions.

Then, in April 2021, a devastating second wave hit. Hospitals had to turn patients away and oxygen ran out. But many deaths went uncounted.

Science in India has been increasingly politicized over the course of the pandemic. In February, India’s junior health minister criticized a study published in the journal Science that estimated the country’s Covid death toll to be seven to eight times the official number. In March, the government questioned the methodology of a study published in The Lancet that estimated India’s deaths at four million.

“Personally, I have always felt that science has to be responded with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. “If you have an alternative estimate, which is through rigorous science, you should just produce it. You cannot just say, ‘I am not going to accept it.’”

India has not submitted its total mortality data to the W.H.O. for the past two years, but the organization’s researchers have used numbers gathered from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least five to six times as many deaths as a result of Covid-19.

Jon Wakefield, a professor of statistics and biostatistics at the University of Washington who played a key role in building the model used for the estimates, said an initial presentation of the W.H.O. global data was ready in December.

“But then India was unhappy with the estimates. So then we’ve subsequently done all sorts of sensitivity analyses, the paper’s actually a lot better because of this wait, because we’ve gone overboard in terms of model checks and doing as much as we possibly can given the data that’s available,” Dr. Wakefield said. “And we’re ready to go.”

The numbers represent what statisticians and researchers call “excess mortality” — the difference between all deaths that occurred and those that would have been expected to occur under normal circumstances. The W.H.O.’s calculations include those deaths directly from Covid, deaths of people because of conditions complicated by Covid, and deaths of those who did not have Covid but needed treatment they could not get because of the pandemic. The calculations also take into account expected deaths that did not occur because of Covid restrictions, such as those from traffic accidents.

Calculating excess deaths globally is a complex task. Some countries have closely tracked mortality data and supplied it promptly to the W.H.O. Others have supplied only partial data, and the agency has had to use modeling to round out the picture. And then there is a large number of countries, including nearly all of those in sub-Saharan Africa, that do not collect death data and for which the statisticians have had to rely entirely on modeling.

Dr. Asma of the W.H.O. noted that nine out of 10 deaths in Africa, and six out of 10 globally, are not registered, and more than half the countries in the world do not collect accurate causes of death. That means that even the starting point for this kind of analysis is a “guesstimate,” she said. “We have to be humble about it, and say we don’t know what we don’t know.”

To produce mortality estimates for countries with partial or no death data, the experts in the advisory group used statistical models and made predictions based on country-specific information such as containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.

Besides India, there are other large countries where the data is also uncertain.

Russia’s ministry of health had reported 300,000 Covid deaths by the end of 2021, and that was the number the government gave the W.H.O. But the Russian national statistics agency that is fairly independent of the government found excess mortality of more than one million people — a figure that is reportedly close to the one in the W.H.O. draft. Russia has objected to that number, but it has made no effort to stall the release of the data, members of the group said.

China, where the pandemic began, does not publicly release mortality data, and some experts have raised questions about underreporting of deaths, especially at the beginning of the outbreak. China has officially reported fewer than 5,000 deaths from the virus.

While China has indeed kept caseloads at much lower levels than most countries, it has done so in part through some of the world’s strictest lockdowns — which have had their own impact on public health. One of the few studies to examine China’s excess mortality using internal data, conducted by a group of government researchers, showed that deaths from heart disease and diabetes spiked in Wuhan during that city’s two-month lockdown. The researchers said the increase was most likely owing to inability or reluctance to seek help at hospitals. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.

India’s effort to stall the report’s release makes clear that pandemic data is a sensitive issue for the Modi government. “It is an unusual step,” said Anand Krishnan, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi who has also been working with the W.H.O. to review the data. “I don’t remember a time when it has done so in the past.”

Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Dataset and who has been working with the W.H.O. on the figures, said they are challenging for governments when they show high excess deaths. “I think it’s very sensible for the people in power to fear these consequences.”

Vivian Wang contributed reporting.