New Coronavirus News from 28 Nov 2022

Global markets fall after protests erupt in China over Covid lockdowns [CNN, 28 Nov 2022]

By Laura He

Hong KongCNN Business — Global markets fell on Monday after widespread protests in China against the country’s stringent Covid-19 restrictions roiled investor sentiment.

European markets opened broadly lower, tracking the performance of Asian shares. The FTSE 100 (UKX) dropped 0.7%, the CAC 40 (CAC40) fell 0.6%, and the DAX (DAX) was down 0.5%.
Earlier, Hong Kong’s benchmark Hang Seng (HSI) Index had finished the day 1.6% lower, after paring some losses. It had started the session down as much as 4.2%. The Hang Seng (HSI) China Enterprises Index, which tracks the performance of mainland Chinese companies listed in Hong Kong, lost 1.7% at the market close.

In mainland China, the benchmark Shanghai Composite briefly fell by 2.2%, before trimming losses to end 0.8% lower than Friday’s close. The tech-heavy Shenzhen Component Index settled down 0.7%.

The Chinese yuan, also known as the renminbi, tumbled against the US dollar on Monday morning. The onshore yuan, which trades in the tightly controlled domestic market, briefly weakened by 0.9%. It was 0.5% lower at 7.213 per dollar by the afternoon. In offshore dealing, the currency slipped 0.3% to 7.213 per dollar.

The weakening yuan suggests that “investors are running ice cold on China,” said Stephen Innes, managing partner of SPI Asset Management, adding that the currency might be “the simplest barometer” to gauge what domestic and overseas investors think.

The markets tumble comes after protests erupted across China in an unprecedented show of defiance against the country’s stringent and increasingly costly zero-Covid policy.

In the country’s biggest cities, from the financial hub of Shanghai to the capital Beijing, residents gathered over the weekend to mourn the dead from a fire in Xinjiang, speak out against zero-Covid and call for freedom and democracy.

Such widespread scenes of anger and defiance, some of which stretched into the early hours of Monday morning, are exceptionally rare in China. Economic growth has slumped and unemployment has been rising as a consequence of the lockdowns.

Oil falls nearly 3%
Asian markets were broadly lower. South Korea’s Kospi lost 1.2%, Japan’s Nikkei 225 (N225) shed 0.4%, and Australia’s S&P/ASX 200 also fell by 0.4% by the market’s close.

US stock futures — an indication of how markets are likely to open — fell, with Dow futures down 0.3%, or 108 points. Futures for the S&P 500 were down 0.5%, while futures for the Nasdaq dropped 0.6%.

Commodities also slid on China concerns. Oil prices dropped sharply, with investors concerned that surging Covid cases and protests in China may sap demand from one of the world’s largest oil consumers.

US crude futures fell 2.7% to trade at $74.22 a barrel. Brent crude, the global oil benchmark, lost 2.9% to $81.25 per barrel.

On Friday, a day before the protests started, China’s central bank cut the amount of cash that lenders must hold in reserve for the second time this year. The reserve requirement ratio for most banks (RRR) was reduced by 0.25 percentage points.

The move was aimed at propping up an economy that had been crippled by strict Covid restrictions and an ailing property market. But analysts don’t think the move will have a significant impact.

“Cutting the RRR now is just like pushing on a string, as we believe the real hurdle for the economy is the pandemic rather than insufficient loanable funds,” said analysts from Nomura in a research report released Monday.

“In our view, ending the pandemic [measures] as soon as possible is the key to the recovery in credit demand and economic growth,” they said.

Economy in a tug-of-war?
Innes from SPI Asset Management said China’s economy is currently caught in the midst of a tug-of-war between a weakening economy and hopes of reopening.

“For China’s official institutions, there are no easy paths. Accelerating reopening plans when new Covid cases are rising is unlikely, given the low vaccination coverage of the elderly,” he said. “Mass protests would deeply tilt the scales in favor of an even weaker economy and likely be accompanied by a massive surge in Covid cases, leaving policymakers with a considerable dilemma.”

In the near term, he said, Chinese stocks and the currency will likely price in “more significant uncertainty” around Beijing’s reaction to the ongoing protests. He expects social discontent could increase in China over the coming months, testing policymakers’ resolve to stick to its draconian zero-Covid mandates.

But in the longer term, the more pragmatic and likely outcome should be “a quicker loosening of [Covid] restrictions once the current wave subsides,” he said.

Goldman Sachs, in a research report published late on Sunday, predicted that China could scrap its zero-Covid policy earlier than previously expected, with “some chance of a forced and disorderly exit.”

Chinese Unrest Over Lockdown Upends Global Economic Outlook [The New York Times, 28 Nov 2022]

By Patricia Cohen

Growing protests in the world’s biggest manufacturing nation add a new element of uncertainty atop the Ukraine war, an energy crisis and inflation.

The swelling protests against severe pandemic restrictions in China — the world’s second-largest economy — are injecting a new element of uncertainty and instability into the global economy when nations are already struggling to manage the fallout from a war in Ukraine, an energy crisis and painful inflation.

For years, China has served as the world’s factory and a vital engine of global growth, and turmoil there cannot help but ripple elsewhere. Analysts warn that more unrest could further slow the production and distribution of integrated circuits, machine parts, household appliances and more. It may also encourage companies in the United States and Europe to disengage from China and more quickly diversify their supply chains.

Millions of China’s citizens have chafed under a tight lockdown for months as the Communist Party seeks to overcome the spread of the Covid-19 virus, three years after its emergence.

Anger turned to widespread protest after an apartment fire last week killed 10 people and comments on social media questioned whether the lockdown had prevented their escape.
It is unclear whether the demonstrations flaring across the country will be quickly snuffed out or erupt into broader resistance to the iron rule of its top leader, Xi Jinping, but so far the most significant economic damage stems from the lockdown.

“The biggest economic hit is coming from the zero-Covid policies,” said Carl Weinberg, chief economist at High Frequency Economics, a research firm. “I don’t see the protests themselves being a game changer.”

“The world will still turn to China for what it makes best and cheapest,” he added.

Asked how the Biden administration assessed the economic fallout from the latest unrest, John Kirby, coordinator for strategic communications at the National Security Council, said Monday, “We don’t see any particular impact right now to the supply chain.”

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Concerns about the economic impact of the spreading unrest in China, nonetheless, appeared to be partly responsible for a decline in world markets. The S&P 500 index closed 1.5 percent lower, while the dollar, often a haven in turbulent times, moved higher. Oil prices began the day with a sharp drop before rebounding.

The sheer magnitude of China’s economy and resources makes it a critical player in world commerce. “It’s extremely central to the global economy,” said Kerry Brown, an associate fellow in the Asia-Pacific program at Chatham House, an international affairs institute in London. That uncertainty “will have a massive impact on the rest on the world.”

China now surpasses all countries as the biggest importer of petroleum. It manufactured nearly 30 percent of the world’s goods in 2021. “There is simply no alternative to what China offers in terms of scale and capacities,” Mr. Brown said.

Delays and shortages related to the pandemic prompted many industries to re-evaluate the resilience of their supply chains and consider additional sources of raw materials and workers.

Apple, which recently announced that it expected sales to decline because of stoppages at its Chinese plants, is one of several tech companies that have shifted a small portion of their production to other countries, like Vietnam or India.

The tilt by some companies away from China predates the pandemic, reaching back to former President Donald J. Trump’s determination to start a trade war with China, a move that resulted in a spiral of punishing tariffs.

Yet even if business and political leaders want to be less reliant on China, Mr. Brown said, “the brute reality is that’s not going to happen soon, if at all.”

“We shouldn’t kid ourselves that we can quickly decouple,” he added.

China’s size is a lure for American, European and other companies looking not only to make products quickly and cheaply, but also to sell them in great numbers. There is simply no other market as big.

Tesla, John Deere and Volkswagen are among the companies that have bet on China for future growth, but they are likely to suffer some setbacks at least in the short run. Volkswagen announced last week that its sales in China had stagnated this year, running 14 percent below expectations.

The protests highlight the political risks associated with investing in China, but analysts say the recent wave doesn’t reveal anything that investors didn’t already know.

“Many investors will be looking ahead and positioning their portfolios now for the reopening,” said Nigel Green, chief executive of deVere Group, a financial advisory firm. They will be “seeking to take advantage of the country’s transition from an export economy to a consumption one,” he added.

Luxury brands continue to stake their future on growth in China.

As interconnected as the global economy is, one way in which China’s slowdown may be helping other nations is by keeping down the price of energy. Over the last 20 years, the growth of the Chinese economy has been a primary driver of global demand for oil and hydrocarbons in general.

Energy experts say rising numbers of Covid infections and growing doubts that China will ease restrictions in major cities are a major reason that oil prices have dropped over the last three weeks to levels last seen before the Russian invasion of Ukraine in late February.

“Chinese demand is the largest single factor in world oil demand,” said David Goldwyn, a senior energy diplomat in the Obama administration. “China is the swing demander.”

As the Chinese economy has softened in the grip of the Covid lockdown, fewer oil tankers have sailed into Chinese ports in recent weeks, forcing the major Middle Eastern and Russian oil producers to lower their prices. Now spreading protests create another uncertainty about future demand.

As for supply chain disruptions, Neil Shearing, chief economist at Capital Economics, a research firm, said he thought excessive blame had been heaped on China. “Everything has been framed around supply shortages,” he said, but in China, industrial production increased during the pandemic. The problem was that global demand surged more.

For now, the biggest economic impact will be within China, rather than on the global economy. Sectors that depend on face-to-face contact — retail, hospitality, entertainment — will take the biggest hit. Over the past three days, measures of people’s movements have drastically fallen, Mr. Shearing said.

He added that more people were quarantined now than at the height of the Omicron epidemic last winter. The wave of infections and the government’s response to it — not the protests — are what’s having “the biggest impact on China’s economy,” he said.

New Coronavirus News from 27 Nov 2022

China reports nearly 40000 Corona cases in 1 day [Uttarakhand News Network, 27 Nov 2022]

As the world has started opening up is borders by learning to live with Corona, the opposite situation prevails in China. As the number of cases increase, panic and anxiety has started increasing among the people. A record high of 39,791 new infections of COVID-19 has been recorded in China on 26 November. China’s National Health Commission said on Sunday, of which 3,709 were symptomatic and 36,082 were asymptomatic.

A day before this, 35,183 new cases of Covid-19 were registered in China. Of which 3,474 were symptomatic and 31,709 were asymptomatic infections, which China counts separately.

China registered 39,506 new local cases, excluding cases of Covid infection from outside. Of which 3,648 were symptomatic and 35,858 were asymptomatic, which were 34,909 a day earlier.

A day before, there was a new death in China from Corona. Due to which the total number of people who died of corona in the country became 5,233. As of 26 November, mainland China had confirmed 307,802 symptomatic cases. China has implemented Zero Covid policy to deal with the Covid-19 pandemic. According to this, strict lockdown is imposed in any city where the number of cases of Covid-19 infection increases. Due to this, the citizens are facing huge problems.

Corona cases are booming again!! [India Herald Group of Publishers P LIMITED, 27 Nov 2022]

China has introduced lockdown to the world. Now with that lock down, it is facing rebellion from the people. In China, people are screaming about the lockdown. Protesting the actions of the government, they took to the streets together and rebelled against the government. With this, the Chinese Communist government was shocked. Corona cases are booming again in China. Due to this, the Chinese government is again imposing a lockdown in many places.

Due to the increase in corona cases in the Jinjiang region, the government has imposed a lockdown and implemented strict restrictions for the past 100 days. Now the same Chinese government is sinking its horn. The people who are fed up with this lockdown are protesting against the government and coming to the streets. Ten people lost their lives in a fire in a residential apartment in Urumqi, the largest city in northwest China's Xinjiang region. This incident made people angry there.

People think that they lost their lives because of the imposition of the lockdown. Due to the lockdown, the relief measures were delayed and so many people lost their lives. Demanding immediate lifting of this lockdown, the people of the place came to the streets together with the lockdown restrictions and rebelled against the government. Thousands of people took to the streets demanding an immediate lifting of the lockdown. People lit large candles and prayed for the souls of the dead to rest in peace. Surprised by this unexpected incident, the Chinese government tried to disperse the people there with its forces. Police used pepper spray to disperse the crowd.

South Korea’s new COVID-19 cases in 50,000 range amid winter resurgence worries [INQUIRER.net, 27 Nov 2022]

SEOUL — South Korea’s new COVID-19 cases came in the 50,000 range on Saturday for the third day in a row, continuing the recent mild resurgence on the back of the winter virus wave.
The country reported 52,788 new COVID-19 infections, including 62 cases from overseas, bringing the total caseload to 26,890,488, the Korea Disease Control and Prevention Agency (KDCA) said.

Saturday’s figure is down from 53,698 posted the previous day but increased by more than 2,000 compared with a week earlier, indicating that the virus curve is on a modest uptrend with the onset of the winter season.

The KDCA reported 52 more deaths from the disease, bringing the total death toll to 30,330.
The number of critically ill patients came to 478, up 25 from Friday. The average number of critically ill patients stood at 460 in the week till Saturday.

Health authorities have been bracing for what has become the seventh wave of the novel virus in the country.

The COVID-19 infection reproduction index, an indicator showing the ability of the coronavirus or any other disease to spread, has stayed above 1 for the past five weeks, meaning cases are on the rise.

South Korea’s new COVID-19 cases came in the 50,000 range on Saturday for the third day in a row, continuing the recent mild resurgence on the back of the winter virus wave.

The country reported 52,788 new COVID-19 infections, including 62 cases from overseas, bringing the total caseload to 26,890,488, the Korea Disease Control and Prevention Agency (KDCA) said.

Saturday’s figure is down from 53,698 posted the previous day but increased by more than 2,000 compared with a week earlier, indicating that the virus curve is on a modest uptrend with the onset of the winter season.

The KDCA reported 52 more deaths from the disease, bringing the total death toll to 30,330.

The number of critically ill patients came to 478, up 25 from Friday. The average number of critically ill patients stood at 460 in the week till Saturday.

Health authorities have been bracing for what has become the seventh wave of the novel virus in the country.

The COVID-19 infection reproduction index, an indicator showing the ability of the coronavirus or any other disease to spread, has stayed above 1 for the past five weeks, meaning cases are on the rise.

S. Korea's new COVID-19 cases below 50,000; worries remain high on resurgence [The Korea Herald, 19 Nov 2022]

South Korea's new COVID-19 cases fell below 50,000 on Sunday, but health authorities remained on edge over a possible spike in transmissions in the winter season.

The country reported 47,028 new COVID-19 infections, including 70 cases from overseas, bringing the total caseload to 26,937,516, according to data from the Korea Disease Control and Prevention Agency.

This marked the first time in six days that the daily cases have fallen below 50,000. The latest reading was down from the previous day's 52,788 but increased over 1,000 compared with a week earlier.

Daily cases tend to go down over weekends due to fewer coronavirus tests.

Health authorities are worrying that transmissions could be spiking in time for winter, bracing for the possibility of the daily infections spiking to as many as 200,000.

Concerns are growing, in particular, about senior citizens as they account for a large proportion of daily deaths from the coronavirus.

The KDCA reported 39 deaths from COVID-19, raising the total death toll to 30,369. Of the latest figure, 35 people, or nearly 90 percent, were aged 60 or older.

The number of critically ill patients came to 481, up three from the previous day, the data showed. (Yonhap)

Protests erupt across China in unprecedented challenge to Xi Jinping's zero-Covid policy [CNN, 27 Nov 2022]

BeijingCNN — Protests erupted across China on Saturday, including at universities and in Shanghai where hundreds chanted “Step down, Xi Jinping! Step down, Communist Party!” in an unprecedented show of defiance against the country’s stringent and increasingly costly zero-Covid policy.

A deadly fire at an apartment block in Urumqi, the capital of the far western region of Xinjiang, which killed 10 people and injured nine on Thursday has acted as a catalyst for searing public anger, as videos emerged that seemed to suggest lockdown measures delayed firefighters from reaching the victims.

On dozens of university campuses, students held gatherings or put up posters to grieve the dead from the Xinjiang fire and speak out against zero-Covid. In several cities, residents in locked-down neighborhoods tore down barriers and took to the streets, following mass anti-lockdown protests that swept Urumqi on Friday night.

Such widespread scenes of anger and defiance – some of which stretched well into Sunday –are exceptionally rare in China, where the ruling Communist Party ruthlessly cracks down on all expressions of dissent. But three years into the pandemic, many people have been pushed to the brink by the government’s incessant use of lockdowns, Covid tests and quarantines.

The ratcheting-up of restrictions in recent months, coupled with a series of heartbreaking deaths blamed on an over-zealous policing of the controls, has brought matters to a head.

Protests in Shanghai
The anger led to remarkable acts of defiance in the financial hub of Shanghai, where many of the city’s 25 million residents hold deep rancor against zero-Covid after being subjected to a two-month lockdown in the spring.

Late on Saturday night, hundreds of residents gathered for a candlelight vigil on Urumqi Road, which was named after the city, to mourn the victims of the Xinjiang fire, according to videos widely circulated – and promptly censored – on Chinese social media and a witness account.

Surrounding a makeshift memorial of candles, flowers and placards, the crowd held up blank sheets of white paper – in what is traditionally a symbolic protest against censorship – and chanted, “Need human rights, need freedom.”

In multiple videos seen by CNN, people could be heard shouting demands for China’s leader Xi Jinping and the Communist Party to “step down.” The crowd also chanted, “Don’t want Covid test, want freedom!” and “Don’t want dictatorship, want democracy!”

Some videos show people singing China’s national anthem and The Internationale, a standard of the socialist movement, while holding banners protesting the country’s exceptionally stringent pandemic measures.

Rows of police officers, who initially looked on from the outside, started to move in to push back and divide the crowd around 3 a.m., sparking tense face-offs with the protesters, according to a witness.

The witness told CNN they saw several people arrested and taken into a police vehicle next to the makeshift memorial after 4.30 a.m. They also saw several protesters being grabbed by the officers from the crowd and taken behind the police line. The protest gradually dispersed before dawn, the witness said.

China Covid: Shocking protests are huge challenge for China's leaders [BBC, 27 Nov 2022]

By Stephen McDonell

Acts of dissent are not unusual in China.

Over the years, sudden, local explosions of defiance have been triggered by a range of issues - from toxic pollution to illegal land grabs, or the mistreatment of a community member at the hands of the police.

But this time it's different.

There is one subject at the forefront of Chinese people's minds, and many are increasingly fed up with it - prompting widespread pushback against the government's zero-Covid restrictions.

This has come in the form of residents smashing down barriers designed to enforce social distancing, and now large street protests in cities and university campuses across the country.
In a way, it is hard to explain just how shocking it is to hear a crowd in Shanghai calling for China's leader Xi Jinping to resign.

It is extremely dangerous here to publicly criticise the Communist Party's general secretary. You risk being put in prison.

And yet there they were on the Shanghai street (Wulumuqi Lu) which carries the name of the Xinjiang city where a fire had killed 10 residents, and zero-Covid restrictions were blamed for hampering the rescue effort.

One protester calls out: "Xi Jinping!"

And hundreds reply: "Step down!"

Again and again: "Xi Jinping! Step down! Xi Jinping! Step down!"

The chant also went out: "Communist Party! Step down! Communist Party! Step down!"

For a political organisation with no greater priority than remaining in power, this is as big a challenge as they come.

The government appears to have drastically underestimated growing discontent towards the zero-Covid approach - a policy inextricably linked to Mr Xi, who recently pledged there would be no swerving from the policy.

What's more, there is no easy way out of the corner the Party appears to have painted itself into.

It has had three years to prepare for an eventual reopening, but instead of building more hospital ICU units and emphasising the need for vaccinations, it has poured enormous resources into mass testing, lockdown and isolation facilities designed to win a war against a virus which is never going away.

New Coronavirus News from 25 Nov 2022

One year since the emergence of COVID-19 virus variant Omicron [World Health Organization, 25 Nov 2022]

What has changed, and why there hasn’t been a new variant of concern

It was 26 November 2021 that WHO declared that the world was facing a new variant of concern: Omicron. It would go on to change the trajectory of the COVID-19 pandemic.

Emerging evidence was quickly shared by scientists from Botswana, Hong Kong and South Africa and discussed in a special meeting of WHO’s Technical Advisory Group for Virus Evolution (TAG-VE).

Experts at the meeting worried about the large number of mutations present in this variant, which differed greatly from the other variants that had been detected so far. Early data showed Omicron’s rapid spread in some provinces in South Africa and an increased risk of reinfection compared to the previously circulating variants.

Just hours later, WHO declared this new variant a variant of concern: we were dealing with something new, something different, and something that the world had to quickly prepare for.

The Omicron effect
Omicron was quickly identified as being significantly more transmissible than Delta, the preceding variant of concern. Within 4 weeks, as the Omicron wave travelled around the world, it replaced Delta as the dominant variant.

Countries which had so far been successful in keeping COVID-19 at bay through public health and social measures now found themselves struggling. For individuals, the greatest price was paid by those who were at risk of severe disease but not vaccinated, and we saw hospitalizations and deaths rise in a number of places around the world.

By March 2022, WHO and partners estimate that almost 90% of the global population had antibodies against the COVID-19 virus, whether through vaccination or infection.

Overall, though, this new variant caused less severe disease than Delta on average. Scientists worked to understand why this was so. A number of factors likely played a role. For example, the virus replicated more efficiently in the upper airway, and population immunity had been steadily increasing worldwide due to vaccination and infections.

While vaccines reduced the impact of Omicron, they themselves were impacted: studies have shown that vaccine effectiveness against infection, disease, hospitalization and death waned (though at different rates) over time. However, protection against hospitalization and death have remained high, preventing millions of people from dying.

The next variant of concern?
Since the emergence of Omicron, the virus has continued to evolve. Today, there are over 500 sublineages of this variant circulating, but not one has been designated as a new variant of concern.

So far, these sublineages of Omicron have much in common: they are all highly transmissible, replicate in the upper respiratory tract and tend to cause less severe disease compared to previous variants of concern, and they all have mutations that make them escape built-up immunity more easily. This means that they are similar in their impact on public health, and the response that is needed to deal with them.

If the virus were to change significantly – like if a new variant caused more severe disease, or if vaccines no longer prevented severe disease and death – the world would need to reconsider its response. In that case, we would have a new variant of concern, and with it, new recommendations and strategy from WHO.

WHO, together with scientists and public health professionals around the world, continues to monitor the circulating variants for signs of the next variant of concern. However, there is apprehension because testing and sequencing are declining globally and the sequences that are available aren’t globally representative (most sequences are shared from high-income countries).

WHO and partners also remain concerned that surveillance at the human-animal interface is limited, where the next variant of concern could come from.

While it might be difficult to stop a new variant from emerging, quick detection and information sharing means its impact on our lives can be minimized.

WHO remains grateful to public health professionals around the world for their continued surveillance of the COVID-19 virus and the sharing of sequences and analyses.

China COVID cases at record high as iPhone city on lockdown [Axios, 25 Nov 2022]

By Rebecca Falconer

China has recorded the highest number of COVID-19 cases since the pandemic began, as Beijing authorities lock down more areas this week — including parts of the central city Zhengzhou, where Apple's main iPhone factory is located.

The latest: China hit a new daily record for a second straight day on Friday as authorities moved to enforce restrictions in an attempt to control outbreaks across the country, per Reuters.

State of play: Beijing eased some pandemic measures earlier this month, including reducing quarantine periods, in an attempt to cause less disruption to the world's second-largest economy.

• However, authorities are now moving to cordon off major cities "block by block" and introducing other curbs while conducting mass testing in an attempt to curb surging COVID cases, Bloomberg reports.
• It's triggered panic-buying in parts of Beijing, and grocery stores the capital's largest district, Chaoyang, have stopped accepting orders due to delivery apps being inundated with requests, according to Bloomberg.

Meanwhile, some 6.6 million Zhengzhou residents were affected by five-day stay-at-home orders that began Thursday — including the area where Apple manufacturer Foxconn's factory is located and where police in hazmat suits clashed with workers following a pay dispute Tuesday and Wednesday, AP reports.

Of note: Chinese President Xi Jinping's zero-COVID policy has already increased wait times for Apple's newest iPhone 14 Pro models as fresh restrictions in China hamper production during the tech giant's most crucial time of the year, the holiday quarter, Axios' Hope King writes.

• Foxconn issued a statement earlier this month that it was "operating at significantly reduced capacity."

By the numbers: China's National Health Commission said Thursday 31,454 local COVID cases were recorded within the past 24 hours.

• That broke the previous record set in April when financial hub Shanghai was on lockdown when 29,390 COVID cases were recorded, AFP notes.
• On Friday, Reuters reports that the NHC recorded 32,695 domestic infections.

The big picture: Nearly three years into the pandemic, China is the last major economy to have retained the strategy of trying to keep out the virus by imposing strict measures such as lockdowns and quarantines.

• Outbreaks of defiance from citizens against the sustained strict measures first emerged earlier this year, with spasmodic protests erupting in the face of food shortages, family separations and lost wages from lockdowns.
• It's also impacted the country's economy, along with global business, though China's gross domestic product grew 3.9% from a year earlier in the third quarter of the year.

Yes, but: Activity is slumping and growth is set to fall far short of the ruling Chinese Communist Party's 5.5% target, AP notes.

China Covid Latest: Beijing Scenes Show Residents Fear of Going Out [Bloomberg, 25 Nov 2022]

Fear of Quarantine Camps, Not Covid, Is Shutting Beijing Down
• Stores are fully stocked but residents fear in-person shopping
• People voluntarily stay home to reduce their risk of exposure

There are serious ramifications to being exposed to Covid-19 in China -- and not just infection.

As the country confronts its biggest outbreak ever, residents in major cities are hunkering down because of the prospect of being sent to a quarantine camp or locked down at home.

Going out in the capital of Beijing means having to scan a QR code to enter venues like shops and restaurants, or to even take public transportation. Under the country’s ubiquitous contract-tracing surveillance system, visiting the same places as someone who later turns up infected can land you in a government isolation facility, where conditions can be so poor that some people say they are buying chamber pots and portable tents in preparation.

Omicron BQ Covid variants, which threaten people with compromised immune systems, are now dominant in U.S. [CNBC, 25 Nov 2022]

By Spencer Kimball

• The omicron BQ coronavirus subvariants have risen to dominance in the U.S. as people gather and travel for the Thanksgiving holiday, putting people with compromised immune systems at increased risk.
• BQ.1 and BQ.1.1 are causing 57% of new infections in the U.S., according to CDC data.
• The BQ subvariants are likely resistant to key antibody medications used by people with compromised immune systems, putting them at increased risk.
• The more immune-evasive XBB subvariant is also circulating at a low level.

The omicron BQ coronavirus subvariants have risen to dominance in the U.S. as people gather and travel for the Thanksgiving holiday, putting people with compromised immune systems at increased risk.

BQ.1 and BQ.1.1 are causing 57% of new infections in the U.S., according to data published by the Centers for Disease Control and Prevention on Friday. The omicron BA.5 subvariant, once dominant, now makes up only a fifth of new Covid cases.

The BQ subvariants are more immune evasive and likely resistant to key antibody medications, such as Evusheld and bebtelovimab, used by people with compromised immune systems, according to the National Institutes of Health. This includes organ transplant and cancer chemotherapy patients.

There are currently no replacements for these drugs. President Joe Biden, in an October speech, told people with compromised immune systems that they should consult with their physicians and take extra precautions this winter.

“New variants may make some existing protections ineffective for the immunocompromised. Sadly, this means you may be at a special risk this winter,” Biden said.

The XBB subvariant is also circulating at a low level right now, causing about 3% of new infections. Chief White House medical advisor Dr. Anthony Fauci, in a briefing Tuesday, said XBB is even more immune evasive than the BQ subvariants.

Fauci, director of the National Institute of Allergy and Infectious Diseases, said the new boosters, which were designed against omicron BA.5, probably aren’t as effective against infection and mild illness from XBB. But the shots should protect against severe disease, he said. Singapore saw a spike in cases from XBB, but there wasn’t a major surge in hospitalizations, he added.

Moderna and Pfizer said last week that their boosters induce an immune response against BQ.1.1, which is a descendent of the BA.5 subvariant.

Fauci, in the press briefing, said public health officials believe there is enough immunity from vaccination, boosting and infection to prevent a repeat of the unprecedented Covid surge that occurred last winter when omicron first arrived.

New Coronavirus News from 24 Nov 2022

China's iPhone City Locks Down Urban Areas as Covid Cases Rise [Bloomberg, 24 Nov 2022]

by Jacob Gu and Foster Wong

• Zhengzhou’s moves mark a step back toward China’s tough curbs
• iPhone factory workers clashed with guards Wednesday over pay

Zhengzhou, home to Apple Inc.’s largest iPhone manufacturing site, will be largely locked down for five days as officials in the Chinese city resort to tighter curbs to quell a swelling Covid-19 outbreak.

Mobility controls -- a euphemism for lockdown -- will be imposed in the main urban areas of Zhengzhou from Friday through Nov. 29 because of rising virus cases, Zhengzhou’s pandemic task force said in a statement late Wednesday. The city reported 996 infections on Wednesday, up from 813 a day earlier.

China imposes new lockdowns as local Covid cases hit record high [The Guardian, 24 Nov 2022]

Country reports 31,444 new locally transmitted cases, the highest daily figure since pandemic began

China has imposed a fresh series of Covid lockdowns, including in a city where workers at the world’s largest iPhone factory clashed with police this week, as a record daily high in coronavirus cases tests its commitment to follow the rest of the world in easing pandemic restrictions.

The national health commission reported 31,444 new locally transmitted Covid cases on Wednesday, the highest daily figure since the coronavirus was first detected in the central Chinese city of Wuhan late in 2019.

The government responded by tightening Covid restrictions in cities, including Beijing, Shanghai and Guangzhou, and ordering mass testing.

In Zhengzhou, in the central province of Henan, where there were clashes on Tuesday and Wednesday between police and protesting workers from Foxconn’s iPhone factory, authorities announced a five-day lockdown for approximately 6 million people. Residents were ordered to stay at home and carry out daily PCR tests in a “war of annihilation” against the virus.

One worker told the AFP news agency that the protests had begun over a dispute about promised bonuses at the Foxconn factory and “chaotic” living conditions.

Foxconn, the Taiwan-based owner of the factory, which employs about 200,000 people in Zhengzhou, has been desperate to keep operations going after a handful of Covid cases forced it to lock down the facility, and it recruited new workers from across the country on favourable packages to replace the thousands who last month walked away. Employees said protests started after the company changed the terms of their pay.

Videos online showed thousands of people in masks facing rows of police in white protective suits with plastic riot shields. Police kicked and hit one protester with clubs after he grabbed a metal pole that had been used to strike him.

Many employees accepted payoffs from the company and went home on Thursday. Some said on social media that they had received bonuses of 10,000 yuan (£1,150) in return for terminating their contracts.

Foxconn apologised on Thursday for what it called “an input error in the computer system” and said it would guarantee that the pay was the same as was promised in official recruitment posters. “As for the violent incident, the company would continue to communicate with the staff and government to prevent similar incidents from happening again,” a company statement said.

The strict enforcement of China’s “dynamic zero Covid” policy for almost three years has weighed on its economy and stoked frustration among the population.

On 11 November, the government announced it would shorten quarantines and ease other restrictions, a move seen to be aimed at alleviating economic pressures and cooling public discontent. But at the same time, senior officials warned cadres not to let down their guard.

Among the new measures, Guangzhou imposed a five-day lockdown in the Baiyun district from Monday to curb the surge in cases. Residents are required to stay at home and public transport has been suspended, although areas that have not reported infections for three consecutive days could lift restrictions.

The government of the north-eastern city of Changchun, in Jilin province, urged its residents to halt non-essential movement and avoid going to public places, restaurants and public gatherings.

Shanghai tightened restrictions for arrivals to the city. A notice on the city’s official WeChat account said people travelling to the city from Thursday would be tested for Covid and barred from going to restaurants and shopping centres, among other public venues, for five days after their arrival.

Beijing has imposed new testing requirements for incoming travellers and residents. It requires a negative PCR test result within 48 hours for those seeking to enter public places such as shopping malls, hotels and government buildings. Schools across the city have moved to online classes.

Although the case numbers are relatively low compared with global figures, even small outbreaks in China often lead to lockdowns of districts and cities. Authorities this week reported China’s first Covid deaths in six months, bringing the total to 5,232.

A Zhengzhou resident who was among those scrambling to buy food in a market before the lockdown said on the social media platform Sina Weibo: “All the stalls were full of people and the prices have rocketed … no one was smiling.”

While China’s borders remain largely closed, the government has drawn up measures to facilitate the exit and entry process for foreign business executives, a foreign ministry spokesperson said.

Universal Masking Policies in Schools and Mitigating the Inequitable Costs of Covid-19 | NEJM [nejm.org, 24 Nov 2022]

By Julia Raifman and Tiffany Green

Nearly 3 years into the Covid-19 pandemic, the United States leads high-income nations in Covid-19–related mortality.1 Millions of persons now have long-term neurologic, cardiopulmonary, and other disabling conditions. Essential workers continue to face high workplace exposure to Covid-19 with few protections. To prevent Covid-19 transmission, 40 states and Washington, DC, implemented universal indoor masking policies in 2020.2 Most maintained these policies until May 2021, when the Centers for Disease Control and Prevention (CDC) replaced guidance that everyone wear masks with guidance according to vaccination status.3 Understanding the effects of universal masking policies as compared with individual masking is critical to minimizing the inequitable harms caused by Covid-19 and maximizing our ability to learn, work, and socialize during the pandemic.

Universal masking and individual masking are distinct interventions.4 Universal masking lowers the amount of virus exhaled into shared air,5 reducing the total number of cases of Covid-19 and making indoor spaces safer for populations that are vulnerable to its complications.

Individual masking lowers the amount of virus that a masked person inhales from shared air, but only in environments with a relatively high amount of circulating virus and when others are unmasked. Furthermore, individual masking has little effect on population-level transmission.

Public schools are an important context in which to understand the ramifications of moving from universal to individual masking. Although quasi-experimental studies indicated that universal masking was associated with reduced Covid-19 transmission before the availability of vaccines,6,7 we previously had little causal-inference evidence regarding the effect of universal masking in schools or as part of a layered risk-mitigation strategy with vaccination, testing, and ventilation.

A study by Cowger and colleagues, the results of which are now reported in the Journal,8 provides new evidence that the removal of universal school masking policies in Massachusetts was associated with an increased incidence of Covid-19. The study used difference-in-differences methods, a rigorous form of causal inference for policies that are infeasible or unethical to assess in a randomized trial. During a 15-week period (March to June 2022), Covid-19 cases in school districts that had ended universal school masking policies (70 districts for most of the 15-week period) were compared with cases in school districts that sustained universal masking policies (2 districts for most of the 15-week period). The removal of universal school masking was associated with an additional 2882 Covid-19 cases among 46,530 staff (an estimated 81.7 cases per 1000 staff) and an additional 9168 Covid-19 cases among 294,084 students (an estimated 39.9 cases per 1000 students) during the 15 weeks. In school districts that had ended universal masking, approximately 40% of 7127 staff cases and 32% of 28,524 student cases were associated with the removal of universal masking policies.

These findings have implications for federal and state decision making regarding universal masking policies. First, most of the benefits of universal masking accrued before county Covid-19 levels reached high CDC Covid-19 Community Levels, a metric that has been used for policy decisions. Second, school districts that ended masking policies had excess cases despite being more likely to have newer buildings and ventilation systems than school districts that sustained universal masking policies.8,9 These observations highlight the importance of universal masking as a layer of protection early in Covid-19 surges. Masking policies were associated with reduced transmission despite the transmissibility of the omicron (B.1.1.529) variant and without the type of mask specified, although specifying high-quality masks could plausibly further reduce transmission.

The findings also expose a fundamental logical flaw of individual masking: assuming that individual persons will fully absorb the costs of their own masking decisions, rather than assuming that such costs will be shifted onto others and society. Cowger et al. estimated that excess cases implied a minimum of 6500 days of staff absence and 17,500 days of student absence. These absences create costly disruptions for schools and families. Much has been made of the social costs of masking and speculation about language development. Yet strategic implementation of masking policies requires consideration of the costs of not masking — and who will bear those costs. Poor and rich school districts were “differentially equipped to respond to the Covid-19 pandemic,”8 with harms concentrated in low-income and Black, Latinx, and Indigenous communities.8,9 Participatory decision making that includes parents from these communities,9,10 as well as essential workers and persons at high risk for severe Covid-19, can strengthen consideration of societal trade-offs and center equity and inclusion.

The Covid-19 pandemic will not be without continuing costs. A prepandemic normal is unattainable in the short term, no matter how urgently we desire it. The questions for policymakers are these: how high will we allow the societal costs to be, and who will bear the greatest costs? Universal masking policies distribute a small cost across society, rather than shifting the highest burdens of Covid-19 onto populations that have already been made vulnerable by structural racism and other inequities. Strategic use of universal masking policies could include community-level implementation early in surges of new Covid-19 variants and throughout the year in select classrooms to protect higher-risk children and staff. Visionary leadership that centers the populations that are most affected and prioritizes evidence, equity, and inclusion can help us navigate policy decisions that reduce the costs and inequities of Covid-19 in the years ahead.

Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.

This editorial was published on November 9, 2022, at NEJM.org.

Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff | NEJM [nejm.org, 24 Nov 2022]

Authored by Tori L. Cowger, Eleanor J. Murray, Jaylen Clarke, Mary T. Bassett, Bisola O. Ojikutu, Sarimer M. Sánchez, Natalia Linos, and Kathryn T. Hall

Abstract

BACKGROUND
In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts — the Boston and neighboring Chelsea districts — sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools.

METHODS

We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021–2022 school year. Characteristics of the school districts were also compared.

RESULTS
Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.

CONCLUSIONS
Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

New Coronavirus News from 8 Nov 2022

Covid, flu, RSV: Here are the best masks and masking methods for protection against the 'tripledemic' [CNBC, 8 Nov 2022]

By Renée Onque

As we get deeper into fall season, experts are warning of a potential ‘tripledemic’ – the circulation of Covid-19, the flu and respiratory syncytial virus (RSV), all at the same time.

Infections from the new “Scrabble” variants are increasing, hospitalizations from RSV are skyrocketing at a terrifying pace, and the Centers for Disease Control and Prevention warns that there are early increases of seasonal flu activity.

“Wearing a high-quality mask…when you’re indoors in public places, will certainly reduce your risk,” Dr. Céline Gounder, an infectious disease specialist and epidemiologist, told CNBC Make It.

But the type of mask you use and how you wear it are also significant and can determine how protected you will be from the viruses that are spreading, says Bill Taubner, president of Bona Fide Masks Corporation.

Here’s what Taubner says you should consider when masking.

The best masks for the most protection
The CDC ranks protective face masks in this order:
• Highest level of protection: N95s and other respirators approved by the National Institute for Occupational Safety and Health
• Great protection: KN95s
• Great protection: Well-fitting disposable surgical masks
• Decent protection: Layered finely woven products
• Least protection: Loosely woven cloth products

Similar to the CDC, Taubner recommends N95 and KN95 masks, especially in high-risk settings like hospitals or mass transit.

“The KN95 and N95 [masks] have a particulate filtration efficiency of 95% or above,” Taubner explains.

“Cloth masks [without filters], which don’t have a minimum threshold, probably test in the neighborhood of 20% or 30%.”

But it’s important to keep in mind that, depending on where you purchase your KN95 and N95 masks, you could be receiving less protection than you think, he says.

“People started testing them in labs, and they found out that the vast majority of these KN95s weren’t even coming close to meeting any of these standards,” Taubner says.

When purchasing masks, he suggests:
• Buying from a reputable company
• Seeking out companies that are transparent about their supply chain, including listing their manufacturer
• Referring to the CDC’s guidance for masks

Masking methods for the most protection
Once you have a high-quality mask, you want to also make sure that you’re wearing it correctly to reduce your risk.

Taubner recommends these masking methods for optimal use:
• Avoid leakage which are open areas at the top, bottom or sides of your mask
• Make sure your hands are clean before touching your mask
• Only touch the outside of your mask
• If applicable, push the metal nose piece down for a snug fit

Here’s when to keep and when to toss your mask
Taubner also advises against using the same mask two days in a row.

The CDC reports that “data from surface survival studies indicate that a 99% reduction in infectious SARS-CoV-2 and other coronaviruses can be expected under typical indoor environmental conditions within 3 days.”

After one use, you should store a KN95 mask in a paper or plastic bag, note the date, and reuse it after at least four days have passed, says Taubner.

When in doubt, you should look to the manufacturer’s specific recommendations for the product.

But if you’ve visited a high-risk area, it’s probably best to toss your mask after one use, he notes.

And if your mask ever becomes difficult to breathe in after multiple uses, you should throw it away as well.

N95 masks are technically single-use products, says Taubner, but the CDC offers guidance on the best way to reuse them when they’re in short supply.

Another important reminder is that certain masks, including KN95 and N95, lose their efficiency when they’ve been washed, he adds.

“Let’s put it this way, a cloth mask is better than no mask. A three-ply mask is better than a cloth mask. An N95 and a KN95 would be better than the other masks,” Taubner says.

“Some just may not give you as much protection as you’d like. But in some cases, there’s no choice.”

New Coronavirus News from 22 Nov 2022

HHS-authorized report recommends masks, distancing for 'long COVID' [New York Post , 22 Nov 2022]

By Emily Crane

Not this again.

Masks and social distancing should be mandated or encouraged in public to protect people from possible “long COVID”, according to a new report commissioned by the Department of Health and Human Services.

The report by the independent research agency Coforma, published Monday, was based in part on interviews with more than 60 people — including patients dealing with lingering COVID-19 symptoms, as well as their caregivers and health care providers.

The recommendations included establishing public policies that purportedly protect “everyone from long COVID” – including the reinstatement of a mask mandate.

According to the document, jurisdictions dropping mask mandates some two years into the pandemic has made life difficult for those struggling with long COVID.

“The lifting of mask mandates and indifferent attitude towards masking and social distancing typical in many public and private places further isolates people with long COVID,” the report says.

“Many people with long COVID avoid public spaces and events due to a fear of reinfection and the potential worsening of their long COVID symptoms and health impacts. Some may experience PTSD symptoms as a result of trauma they incurred during their acute infection.”

As a result, the report says, policymakers should “encourage or mandate policies and protocols regarding masking and social distancing in public spaces that protect people from infection or reinfection and possible long COVID.”

While President Biden declared in a September “60 Minutes” interview that the “pandemic is over,” his administration asked Congress for an addition $10 billion last week to fight COVID, including $750 million specifically for long COVID.

“Listening to and learning from the experiences of long COVID patients is essential to accelerating understanding and breakthroughs,” said assistant secretary for health, Rachel Levine.

She said the new report was “evidence of our commitment to engaging communities to provide patient-led solutions.”

In a statement to The Post Tuesday, a department spokesperson insisted that the report did not amount to a request by HHS to bring back mandatory face covering.

What do you think? Post a comment.

“A ‘mask mandate’ is NOT a recommendation HHS made,” the spokesperson said. “All the recommendations included in the report were derived from the research participants ([people with] Long COVID, their caregivers, health care providers, advocates, and other subject-matter experts.)”

Coronavirus Morning News Brief – Nov. 22: Study Identifies Changes to the Brain in Long Covid Patients, Japan Approves Homegrown Antiviral [Frequent Business Traveler, 22 Nov 2022]

By Jonathan Spira

Good morning. This is Jonathan Spira reporting. Here now the news of the pandemic from across the globe on the 957th day of the pandemic.

A new study identified significant changes to the brainstem and frontal lobe in some Long Covid patients.

“Serious long-term complications may be caused by the coronavirus, even months after recovery from the infection,” according to the study, which was released Monday by the Radiological Society of North America.

“Neurological symptoms associated with Long Covid include difficulty thinking or concentrating, headache, sleep problems, lightheadedness, pins-and-needles sensation, change in smell or taste, and depression or anxiety, the society said in a news release announcing the findings. “However, studies have found that Covid-19 may be associated with changes to the heart, lungs or other organs even in asymptomatic patients.”

The researchers analyzed the data of 46 COVID-recovered patients and 30 healthy control patients and found that patients with long COVID commonly recorded symptoms such as fatigue, sleeplessness, lack of attention, and memory issues.

In other news we cover today, conditions continue to worsen in major Chinese cities, and Japan approved its first homegrown Covid antiviral.

UNITED STATES
Oregon Governor Kate Brown announced that she and her husband have tested positive for the coronavirus after attending the Vietnam-U.S. Trade Forum in Ho Chi Minh City, formerly known as Saigon.

“After returning from Vietnam, Dan and I have tested positive for Covid-19,” she said in a tweet. “We are recuperating at home and, while this changes our Thanksgiving plans, we are grateful for effective vaccines and boosters that are helping ensure our symptoms don’t become serious.”

GLOBAL
The pandemic situation continued to worsen in China. Beijing officials shuttered parks and museums on Tuesday and more Chinese cities resumed mass Covid testing.

Beijing reported 634 new local coronavirus cases for the 15 hours to 3 p.m. local time on Tuesday, the deputy director of city’s municipal Center for Disease Control and Prevention, Liu Xiaofeng, said at a news briefing.

Meanwhile, in Shanghai, the country’s financial hub, officials said they would tighten pandemic-related rules for people entering the city starting on November 24.

Japan approved the first Covid-19 antiviral pill developed locally. Shionogi, an Osaka-based drugmaker, is currently seeking U.S. approval for the drug, which is called Xocova.

TODAY’S STATISTICS
Now here are the daily statistics for Tuesday, November 22.

As of Tuesday morning, the world has recorded 643.6 million Covid-19 cases, an increase of 0.4 million cases, and over 6.62 million deaths, according to Worldometer, a service that tracks such information. In addition, 622.7 million people worldwide have recovered from the virus, an increase of 0.3 million.

Worldwide, the number of active coronavirus cases as of Tuesday at press time is 14,223,527, an increase of 72,000. Out of that figure, 99.7%, or 14,187,386, are considered mild, and 0.3%, or 36,141, are listed as critical. The percentage of cases considered critical has not changed over the past 24 hours.

The United States reported 42,983 new coronavirus infections on Tuesday for the previous day, compared to 3,329 on Monday, 3,497 on Sunday, 52,365 on Saturday, 71,311 on Friday, and 85,283 on Thursday, according to data from the U.S. Department of Health and Human Services. The 7-day incidence rate is now 43,290. Figures for the weekend (reported the following day) are typically 30% to 60% of those posted on weekdays due to a lower number of tests being conducted.

The average daily number of new coronavirus cases in the United States over the past 14 days is 41,530, an increase of 4% averaged over the past 14 days, based on data from the Department of Health and Human Services, among other sources. The average daily death toll over the same period is 294, a decrease of 2% over the same period, while the average number of hospitalizations for the period was 27,547, a decrease of 2%. In addition, the number of patients in ICUs was 3,357, an increase of 6%.

In addition, since the start of the pandemic the United States has, as of Tuesday, recorded over 100.2 million cases, a higher figure than any other country, and a death toll of 1.1 million.

India has the world’s second highest number of officially recorded cases, almost 44.7 million, and a reported death toll of 530,591.

The newest data from Russia’s Rosstat state statistics service showed that, at the end of July, the number of Covid or Covid-related deaths since the start of the pandemic there in April 2020 is now 823,623, giving the country the world’s second highest pandemic-related death toll, behind the United States. Rosstat reported that 3,284 people died from the coronavirus or related causes in July, down from 5,023 in June, 7,008 in May and 11,583 in April.

Meanwhile, France is the country with the third highest number of cases, with just under 37.4 million, and Germany is in the number four slot, with 36.2 million total cases.

Brazil, which has recorded the third highest number of deaths as a result of the virus, 689,064, has recorded 35.1 million cases, placing it in the number five slot.

The other five countries with total case figures over the 20 million mark are South Korea, with over 26.6 million cases, Italy with 24 million, placing it in the number seven slot, and the United Kingdom, with 24 million cases, as number eight, as well as Japan, with 23.9 million, and Russia, with over 21.5 million.

VACCINATION SPOTLIGHT
The Centers for Disease Control and Prevention said that, as of last Thursday, 267.5 million people in the United States – or 80.6% – have received at least one dose of the coronavirus vaccine. Of that population, 68.7%, or 228.1 million people, have received two doses of vaccine, and the total number of doses that have been dispensed in the United States is now 650.8 million. Breaking this down further, 91.6% of the population over the age of 18 – or 236.4 million people – has received at least a first inoculation and 78.5% of the same group – or 202.7 million people – is fully vaccinated. In addition, 13.1% of the same population, or 33.8 million people, has already received an updated or bivalent booster dose of vaccine.

Starting on June 13, 2022, the CDC began to update vaccine data on a weekly basis and publish the updated information on Thursday by 8 p.m. EDT, a statement on the agency’s website said.

Some 68.4% of the world population has received at least one dose of coronavirus vaccine by Tuesday, according to Our World in Data, an online scientific publication that tracks such information. So far, 12.97 billion doses of the vaccine have been administered on a global basis and 1.92 million doses are now administered each day.

Meanwhile, only 24.5% of people in low-income countries have received one dose, while in countries such as Canada, China, Denmark, France, Italy, the United Kingdom, and the United States, at least 75% of the population has received at least one dose of vaccine.

Only a handful of the world’s poorest countries – Bangladesh, Bhutan, Cambodia and Nepal – have reached the 70% mark in vaccinations. Many countries, however, are under 20% and, in countries such as Haiti, Senegal, and Tanzania, for example, vaccination rates remain at or below 10%.

In addition, with the start of vaccinations in North Korea in late September, Eritrea remains the only country in the world that has not administered vaccines.

New Coronavirus News from 21 Nov 2022

The COVID-19 Pandemic & More: Respiratory viruses on the rise (again), mask mandates work, and more [Colorado School of Public Health, 21 Nov 2022]

The Colorado COVID-19 update is no longer quick and reassuring. Hospitalizations rose to 379 for the week of November 15, up from 218 for the week of November 1. For context, recall that April’s low was 77 and that previous peaks reached above 1,800. Other indicators have moved in an unfavorable direction as well: test positivity is at 11.8% and wastewater concentrations of virus are trending up across the state. The mix of variants is changing with declining BA.5 and rising BQ.1. The variant alphabet soup will inevitably change as SARS-CoV-2 continues to cause infection, to replicate, and to mutate.

And, respiratory syncytial virus (RSV) remains a critical concern, particularly for infants and children as the unprecedented RSV epidemic continues. Hospitalizations for RSV have risen at a breath-taking pace, far steeper than in prior years. Hospitalizations for influenza are also going up at a trajectory matching those of recent years with high peaks, but we are still early in the influenza epidemic’s course. While there is great uncertainty at present, simultaneous peaking of the epidemic curves for influenza, RSV, and COVID-19 would stress hospital capacity, particularly for the pediatric age range. As always, more time will bring greater certainty about the potential threat from a “tripledemic.”

The use of mandated respiratory protection in schools—“mask mandates”—has been a politicized flashpoint in the public health efforts to control the COVID-19 pandemic. Masks are one of the key tools in the toolbox for controlling transmission of airborne infectious agents in schools, along with improving ventilation, air cleaning, and ultraviolet C. Previously, I described discussions at a workshop of the National Academies of Science, Engineering, and Medicine concerning management of the indoor environments in schools. Workshop participants took mask use as an effective option and commented on the barriers to successful implementation of the full toolkit.

A just-published paper in the New England Journal of Medicine provides real-world evidence on the effectiveness of school mask mandates. The investigators took advantage of the patchy discontinuation of mask mandates in Massachusetts after the lapse of a statewide mandate in February 2022, comparing infection rates across 72 school districts to assess the effect of the mandate. Of these school districts, two (Boston and Chelsea) maintained mask mandates while the remainder dropped their mandates over a three-week period. The researchers used a difference-in-differences approach to document the effectiveness of school-wide mask mandates. With this approach, the rates of infection in the two “treatment” school districts (Boston and Chelsea) are compared with those in the remaining 70, before and after the three weeks over which the mandates were relaxed. The infection rates were comparable in the two groups prior to the relaxation of the statewide mandate but diverged afterwards—staying lower in the two school districts that maintained mandates. With this design, time-varying factors that might influence the infection rate are controlled, providing an estimate of the causal effect of mask mandates on infections in children and staff in school districts.

The findings are striking in showing the effectiveness of the mask mandate. During the 15 weeks after the statewide mask mandate was dropped (before the end of the school year), the incidence of COVID-19 infection was 44.9 additional cases per week among students and staff. For context, this avoidable excess amounted to 29.4% of the total cases over the post-mandate interval. This credible evidence provides guidance for the future if the toolbox for controlling airborne transmission in schools needs to be reopened.

Sadly, we once again find ourselves mourning the victims of another horrific shooting; this one carried out in Colorado Springs over the weekend and targeting the LGBTQ+ community. Five people were killed at Club Q and at least 25 others were injured as a gunman carrying a semiautomatic weapon walked in and opened fire. The Colorado School of Public Health stands in solidarity with the LGBTQ+ community across all of our campuses and programs. I urge anyone who needs support to use campus resources at CU, CSU and UNC; please see the resources and messages from CU Anschutz Chancellor Elliman, CSU Interim President Rick Miranda, and UNC's President Andy Feinstein. Our Injury & Violence Prevention Center addresses firearms, but science-driven policies to protect public health from gun violence have long failed to advance. Nonetheless, we need to continue our work.

Every year on the Monday before Thanksgiving, the American Public Health Association and Research!America recognize the public health professionals who work tirelessly to protect the health of all people and all communities as part of Public Health Thank You Day. The resiliency and dedication of the public health workforce is something to be thankful for every day, but a special day is well-deserved—particularly at this moment of intense pressures on those working in public health. Reach out to colleagues and say thanks “just because”—we could all use some support amidst all that is going on at the moment worldwide.

Jonathan Samet, MD, MS
Dean, Colorado School of Public Health

How infectious disease experts are responding to Covid nearly three years in [STAT, 21 Nov 2022]

By Helen Branswell

The world is fast approaching the third anniversary of those days when we got our first inkling that a new disease was spreading in China. In the months that followed, normal life was suspended, then upended. At this point, everyone is well and truly sick of Covid-19 and the accommodations we have had to make to co-exist with it.

So sick of it, in fact, that many people appear to have given up trying to avoid the SARS-CoV-2 virus. Restaurants are packed, airports are hopping. Once-ubiquitous masks are now an increasingly rare sight.

With Thanksgiving only days away, STAT asked infectious diseases experts how they’re handling the risk of catching Covid at this point. We’ve done this twice before, you may recall, when the Delta wave was surging in August 2021, and a few months later, just before Thanksgiving.

This time we wondered if people who work in the infectious diseases sphere are still taking steps to try to avoid catching the virus, and if so, which ones. We also wondered whether — maybe even hoped — they are feeling less stressed about Covid and are starting to lower their guard.

The short answer: Some appear to be, a little. But most are still using multiple measures to try to avoid Covid.

We polled epidemiologists, virologists, immunologists, and related experts, asking a series of “yes” or “no” questions; 34 replied. It quickly became apparent “not applicable” had to be an option for some questions; some of our respondents created a “maybe” category for a few.
One person who is battle-scarred from fighting the Covid wars begged off. “Between the militant zero-Covid crowd on one side and the ‘it’s just a cold’ crowd on the other, there is a lot of vitriol waiting to be fired,” this individual explained. Another answered, but asked not to be named, for the same reason.

Let’s dive into their answers to our questions.

Despite the fact that most of the people we polled are still taking precautions, those with young kids or grandkids reported the children are pretty much back to living pre-Covid-style lives. That’s both a terrific development for the children themselves and a welcome sign of how far we’ve come.

Twenty of 21 people who answered this question reported their kids or grandkids are taking part in after-school activities, having playdates, and the like. Esther Choo, an associate professor of emergency medicine at Oregon Health and Science University, noted her kids are still wearing masks in school and in other indoor settings. Grace Lee, professor of pediatrics at Stanford University School of Medicine, also said her kids mask up for group activities indoors.

Craig Spencer, an emergency room physician and associate professor at Brown University’s School of Public Health, acknowledged putting more limitations on the interactions of his two young children, saying “given the panoply of viruses circulating (flu, RSV and Covid) we are still limiting indoor playdates for them.” His 4-year-old daughter, for example, will have an early birthday party, before the weather gets too cold to hold it outside.

We found there’s a lot more willingness to eat in restaurants or attend indoor concerts or sports events than last year. Uché Blackstock, an emergency physician and CEO of the consulting firm Advancing Health Equity, has dined indoors in restaurants twice, but “it wasn’t crowded.” Megan Ranney, deputy dean of Brown’s School of Public Health, saw a Harry Styles concert in the summer, “albeit with a mask.”

Katelyn Jetelina, author of the popular Substack column “Your Local Epidemiologist,” said she’d go to a concert without a mask, as long she didn’t have an upcoming visit with grandparents or something critical at work that she couldn’t miss due to illness. “I care about transmission. However, I also care about enjoying a beer and shouting my favorite songs and, quite frankly, masks are just not welcome culturally at country concerts — so there is some social pressure at work as well,” she admitted.

When we asked about restaurant dining in August 2021, two-thirds of the respondents said they would not eat indoors; this time, nearly three-quarters said they would. Last Thanksgiving, 44% of respondents said they would not attend a large indoor event, even if masked. That figure went down to 32% this time. On concerts or sporting events, Ziyad Al-Aly is a holdout. “Noooooooooo,” replied the chief of research at the VA St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis.

Marion Pepper, chair of the department of immunology at the University of Washington, is the only one of the respondents who doesn’t wear a mask while flying — though she dons one during take-off and landing. William Hanage, an infectious diseases epidemiologist at Harvard’s T.H. Chan School of Public Health, doesn’t mind taking his mask off to eat while in flight “because colleagues who know tell me that the ventilation mid-flight should be very good.”

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, was specific. “Not just a mask … an N-95,” he said.

The majority of respondents still wear masks while they are shopping; only four of the 33 said they don’t. Most of the rest have a hard rule about masking in stores, both for their own protection and the protection of staff and other shoppers. For a few, the rule isn’t set in concrete. “I sometimes pop into the store to pick up a few things without a mask, but I wear a mask if I’m expecting it to be busy or if I will be there a while,” said epidemiologist Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security.

All our respondents have either had a bivalent booster or are waiting to get one. Some put off getting the shot because they’d recently had Covid. Of the 10 who haven’t yet had a bivalent booster, nine planned to get one before Thanksgiving. Kristian Andersen, a professor of immunology and microbiology at the Scripps Research Institute, plans to wait a little longer “since I’m only 4.5 months out from my previous booster.”

All but Pepper — who had Covid earlier this year — report that they are still taking additional measures to avoid catching the virus. Many, though, stressed they take the measures as much to protect others as to protect themselves. “I’d say I’m more focused on reducing my risk of spreading respiratory illness than reducing my risk of contracting it,” said Natalie Dean, a professor of biostatistics at Emory University.

Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama in Birmingham, avoids shaking hands whenever possible. Sarah Cobey, associate professor of viral ecology and evolution at the University of Chicago, carries a device that monitors carbon dioxide levels, as does Shweta Bansal, a Georgetown University researcher who studies how social behavior affects infectious disease transmission. Vineet Menachery has a device that alerts his phone if the CO2 levels around him rise above a set point, a sign ventilation isn’t adequate to lower the risk of Covid transmission. If that happens, the coronavirus researcher at the University of Texas Medical Branch in Galveston puts on a mask.

For most of our experts, though, attempting to avoid Covid doesn’t mean forgoing a traditional Thanksgiving this year. Most report they’re hosting or attending a large, multi-generational Thanksgiving feast. Last year, the experts we polled were virtually split on the idea of a large family gathering for the holiday.

Twenty-seven of our experts will be celebrating Thanksgiving with a crowd this year and most of the ones who aren’t said their decision to forgo a big gathering wasn’t Covid-related. Two are expats without extended family in the United States, and two will be traveling out of the country over Thanksgiving. Only Saskia Popescu, an assistant professor in the biodefense program at George Mason University’s Schar School of Policy and Government, scaled back her plans because of Covid concerns.

“My older and more vulnerable family [members] aren’t interested in the booster (sigh) and we all felt it best to avoid travel and larger events, so sticking with just immediate family and a couple of friends who are all fully vaccinated and are frequently tested for work,” Popescu wrote in an email.

There was an even split on the issue of whether unvaccinated relatives would be allowed to attend the family gatherings, with eight respondents saying they would and eight saying they would not. “Yes, with a negative Covid test,” said Akiko Iwasaki, an immunologist at Yale University. Syra Madad, senior director for NYC Health + Hospitals’ special pathogens program, said being unvaccinated is not a dealbreaker for entry to her gathering. “But I always share the number of people who are coming and the overall venue, so guests can decide if they have young, unvaccinated children or elderly individuals to make their own personal decision.”

Eleven respondents, the largest group on this question, said the vaccination status of their Thanksgiving guests isn’t an issue. “I don’t have any unvaccinated family members!” said Ellen Foxman, an immunologist at Yale. “All of my close and distant family members are vaccinated and boosted,” said Andrew Pavia, chief of pediatric infectious diseases at the University of Utah.

Of those hosting Thanksgiving feasts, a clear majority will use rapid Covid tests to lower the risk someone might leave with more than just a Tupperware container filled with leftovers. Eighteen said they would likely be using rapid tests. “Leaning in that direction to protect a brand-new baby and a 99-year-old great-grandmother,” said Jesse Goodman, a professor of internal medicine at Georgetown University. Eight said they won’t require it, though “… there will be lots of voluntary testing,” said Saad Omer, director of Yale’s Institute for Global Health.

Robert Wachter, chair of the University of California, San Francisco’s department of medicine, still isn’t sure. “Depends on case rates,” he said.
•

New Coronavirus News from 19 Nov 2022

Ringleaders in massive COVID fraud extradited to US [ABC News, 19 Nov 2022]

A Los Angeles couple who fled to Europe after being convicted of running a ring that stole $18 million in coronavirus aid money have been extradited to the United States

LOS ANGELES -- A Los Angeles couple who fled to Europe after being convicted of running a fraud ring that stole $18 million in COVID-19 aid money were returned to the United States to face prison, authorities announced Friday.

Richard Ayvazyan and his wife, Marietta Terabelian, were extradited from the Balkan country of Montenegro, where they were living in a luxury seaside villa before their arrest in February.

They arrived in Los Angeles on Thursday, according to the U.S. Department of Justice.
While they were on the run last year, a court in Los Angeles sentenced Ayvazyan to 17 years in federal prison, and Terabelian to six years.

Prosecutors said the couple and six accomplices fraudulently applied for about 150 relief loans intended to help businesses and employees struggling during the COVID-19 pandemic and lockdown.

They applied using fake identities or names belonging to dead or elderly people and foreign exchange students, prosecutors said.

To back up the applications, they submitted phony tax documents and payroll records for fake businesses to lenders and the U.S. Small Business Administration, prosecutors said.

The money was used for down payments on luxury homes in the Tarzana area of Los Angeles, suburban Glendale and the Palm Desert and to buy “gold coins, diamonds, jewelry, luxury watches, fine imported furnishings, designer handbags, clothing and a Harley-Davidson motorcycle," said a statement from the U.S. Department of Justice.

Ayvazyan and Terabelian were convicted in June 2021 of conspiracy to commit bank fraud and other federal crimes. Two months later, while free on bond, the couple cut off their ankle monitors and fled, leaving behind their three teenage children, authorities said.

Unemployment fraud was a nationwide problem during the pandemic, as benefit applications overwhelmed state unemployment agencies. Criminals were able to buy stolen identity data on the dark web and use it to file a heap of phony claims.

The federal Labor Department has said that about $87 billion in pandemic unemployment benefits could have been paid improperly nationwide, with a significant portion attributable to fraud. An Associated Press review in March 2021 found that estimates ranged from $11 billion in fraudulent payments in California to several hundred thousand dollars in states such as Alaska and Wyoming.

The COVID variants dominating this fall mean 'we're still in the Omicron era' [Fortune, 19 Nov 2022]

BY ERIN PRATER

Omicron spawn BQ.1 and BQ.1.1 now lead U.S. COVID variants, dwarfing the previously dominant BA.5 two to one, the CDC reported Friday.

As Dr. Jake Lemieux, a Harvard Medical System assistant professor of medicine and infectious disease specialist at Massachusetts General Hospital, said Thursday, “The bottom line is we’re still in the Omicron era, or Omicron-plus era.”

BQ.1, a spin-off of fellow Omicron BA.5, leads the nation in infections, comprising a projected 26% of national cases, according to the agency’s Nowcast report, valid through Saturday. On its heels is its child, BQ.1.1, estimated to fuel just under a quarter of infections.

Former global leader BA.5, which drove a majority of cases this summer, came in third, comprising 24% of infections. Last week it was first, responsible for an estimated 34% of infections.

“The major thing that is notable is that BA.5 has largely been out-competed by BQ.1 and BQ.1.1,” Lemieux said at a Thursday press conference regarding COVID.

For most people, that’s a relatively good thing, given previous fears that newer, more immune-evasive Omicron variants like the ones we’re seeing now could cause a large wave of infections, with the potential to challenge hospital capacity late this year.

In fact, nationally, the number of COVID cases appear to be holding steady—not rising as some, including White House officials, had feared this spring. But with testing at an all-time low and most testing that is occurring happening in homes, data obtained and provided by public health officials is “increasingly less useful,” Lemieux said.

Still, U.S. hospitalizations and deaths—once considered poor indicators of the virus’ progress due to their lag time behind a rise in cases—are also holding steady, and that’s relatively good news. They’re now some of the pandemic’s most reliable indicators, he said.

The bad news in this week’s forecast is for those who are immunocompromised and rely on monoclonal antibodies, hospital administered IV treatments given to those who are most at risk of severe disease from the virus.

New variants like BQ.1 and BQ.1.1 have rendered useless “our last functional monoclonal antibodies,” Lemieux said. That means that existing treatments used for people who have been infected with previous variants aren’t effective.

This week the CDC added another variant to the list of those it’s tracking: BF.11, yet another descendent of BA.5. While the latest Omicron strains have greater immune evasion abilities than previous strains, they all seem fairly similar to their current competitors. And symptom-wise, they seem almost identical to the versions of Omicron that dominated this spring and summer, like BA.4, BA.5, and BA.2.12.1.

An ever-growing list of Omicron variants are in the race for dominance this winter, Dr. Moritz Gerstung, a professor of computational biology at the German Cancer Research Center, tweeted Thursday.

“Whoever wins, though, is very likely to have predictable characteristics,” he said.

New Coronavirus News from 20 Nov 2022

With COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates [The Conversation, 20 Nov 2022]

By Catherine Clase, Charles-Francois de Lannoy and Ken G. Drouillard

The number of children and babies with respiratory illnesses currently exceeds the capacity of our health system to care for them. More adult Canadians will die directly of COVID-19 this year than died last year or in 2020.

Eight per cent of vaccinated people with COVID infections that don’t require hospitalization end up with long COVID, with each subsequent infection repeating the risk. COVID increases the risk of cardiovascular and other health problems, enough to cause a stark rise in excess deaths and to shorten life expectancy.

In 2020, when adult intensive care units were at risk of being overwhelmed, we wore masks and accepted restrictions. With pediatric intensive care now at risk, will leaders follow the evidence and tell us to mask up? While federal officials and several provinces are now recommending masks in all indoor public settings — although Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party — there are no returns to mandates for the public yet.

Wear the best mask available
We now know that masks prevent the spread of respiratory diseases; some better than others.
The most effective masks, and the only ones recognized as respiratory protection by formal standards, are respirator masks: N95s, CaN99s, FFP3s and reusable elastomeric respirators. In workplaces, respirators are fit-tested to the individual, resulting in greater than 99 per cent protection.

Even without fit testing, respirator masks prevent more than 90 per cent of particles smaller than one micron from reaching the wearer (submicron particles, the smallest among those thought to be relevant).

Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are available and there are no longer concerns about supply chains for front-line workers. They can be safely reused, with good retention of their filtration. New designs are comfortable and fit most faces.

N95s are secured with overhead attachments, providing a good seal at the edges. KN95s and KF94s have excellent filtration material, but their ear loops do not provide as secure a seal, and their filtration is around 70 per cent. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides comparable filtration at lower cost.

Certified Level 1 medical masks alone do not fit well, which affects their filtration ability because unfiltered air passes around the edges with every breath. In tests on humans, these have typically filtered at around 50 per cent, similar to well-designed two-layer cotton cloth masks, ideally with overhead ties; both are around 50 per cent.

Poorly fitting cloth masks and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “Make wearing a mask a normal part of being around other people,” to which we would add: wear the best mask available.

The filtration data above are mirrored by epidemiologic data showing that protection correlates with mask type. In studies of source control (prevention of contamination of the air by respiratory particles), the same hierarchy of efficiency is seen, with N95s at the top. N95s with exhalation valves are an exception and should not be used to prevent spread of respiratory diseases.

Masks protect against COVID-19 and other respiratory infections. They are also an ideal tool to counter COVID variants, as well as RSV and influenza. Working on basic physical principles — impaction, sedimentation and diffusion — they protect regardless of the variant or strain.

Staying home when sick is helpful, but many people are infectious before they have symptoms, or never have symptoms. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source.

Wearing a mask to protect the individual, once controversial, is now settled by filtration science and epidemiology. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.

Why people aren’t wearing masks
Why aren’t people wearing masks? Some remember the inconsistency of the advice early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — stigma, peer pressure or concern about virtue signalling — countries outside Asia do not have a mask-wearing culture.

Under these circumstances, it will likely take more than strong recommendations to achieve the high uptake of mask use that will be most effective in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.

Bringing back mask mandates with unequivocal signalling from governments about the effectiveness of both masks and mask mandates would be the best immediate response to our current crisis. Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask: in time, we hope knowledge will change culture. Strong communication from political and public health leadership would increase community understanding that the minor inconvenience of wearing a mask in public indoor spaces is justified by the death and disability prevented.

In North America, the strategy of using masks according to personal judgment has predictably failed, the strategy of strongly recommending masks is unproven, and it’s too late to experiment. Mask mandates, however, are backed by strong evidence of effectiveness in both Canada and the United States.

Mask mandates are less damaging to a recovering economy than physical distancing and capacity limits, and less damaging to learning than a return to remote schooling.

Schools and universities represent a particularly important opportunity. COVID spreads between children in schools to infect the whole population; this is mitigated by mask wearing. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: transmission was higher among students and staff where mandates were liftedcompared with where they were still in place.

There is no convincing evidence to date that masks reduce social or language skills.

Decreasing spread in schools would increase learning by reducing student and teacher sick days and preserving in-person instruction. Keeping children in schools keeps parents at work.

Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a whole-of-society approach that recognizes that COVID is airborne, mask mandates offer us the best immediate opportunity to preserve our health-care system, mitigate death and disability from respiratory viruses, support the economy and safely maintain social contacts in our private lives.

New COVID variants BQ.1, BQ.1.1 dominate; what're omicron's symptoms? [USA TODAY, 20 Nov 2022]

By Adrianna Rodriguez Karen Weintraub

The virus that causes COVID-19 is bringing more variants our way, requiring a few changes to the fight against it.

The BA.5 variant of omicron, which has dominated the U.S. since early summer, is fading fast. According to data released Friday, half the cases in the U.S. are now due to two descendants of BA.5, called BQ.1 and BQ.1.1.

Not much is known about those two variants, but the severity and duration of disease seem similar to the other omicrons, and milder than the original and delta variants.

The biggest challenge from the new variants will be for people who are immunocompromised because of disease or medications. Treatments designed to prevent and treat infection in the immunocompromised won't work against BQ.1 and BQ.1.1.

Here's what we know:
What is the current COVID variant and what happened to omicron?
The omicron variant that caused so many infections last winter is still around, but it has split into many subvariants. The two subvariants – BQ.1 and BQ.1.1 – now account for half of COVID-19 cases in the U.S., according to the Centers for Disease Control and Prevention.
BA.5 now accounts for 24% of cases.

Are the BQ.1 and BQ.1.1 more dangerous?
Lab studies suggest the viral descendants of BA.5 and BA.2, which includes all the new dominant variants, might cause slightly more severe disease than BA.1 or the original omicron, said Jeremy Luban, a professor of molecular medicine, biochemistry and molecular biotechnology at UMass Chan Medical School.

But it's not clear whether that's true in the real world, he said, as lab studies can't capture factors like human behavior.

The new variants are clearly more transmissible because they are taking over and making people sick despite previous vaccinations and infections, he said in a Thursday news conference with other members of the Massachusetts Consortium on Pathogen Readiness.

Will vaccines and the bivalent booster still work against omicron variants?
Yes.

"Any kind of boost really reduces your chances of getting very sick from COVID," said Dr. Kathryn Stephenson, an infectious disease expert at Beth Israel Deaconess Medical Center in Boston.

People who got the bivalent booster will be more protected against a severe COVID-19 infection compared with those who are unvaccinated or got a vaccine long ago.

In a study posted Friday, Pfizer and its vaccine partner BioNTech say that the latest booster increases the level of neutralizing antibodies against both BQ.1 and BQ.1.1, which protect against infection.

Moderna reported similar results for its booster earlier in the week, and it said last week that its bivalent shot also showed “robust neutralizing activity” against the BQ.1.1 variant, suggesting it offers some protection against the newest strains.

What does BQ stand for?
The World Health Organization uses the Greek alphabet as a classification system to simplify understanding and avoid stigmatizing countries where strains of the SARS-CoV-2 virus that causes COVID-19 are identified.

The WHO named the original B.1.1.529 variant after the 15th letter, omicron. Within variants, the agency assigns numbers to sublineages.

BA.5 was classified as an omicron variant but has mutations that distinguish it from other omicron subvariants, such as BA.1 and BA.2. BA.5 is the parental strain of BQ.1 and BQ.1.1.
What are the symptoms of the new omicron variants?

The symptoms of BQ.1 and BQ.1.1 appear to be the same as for other COVID-19 variants. The most common symptoms include exhaustion, fever, a cough, congestion, shortness of breath, sore throat, nausea, diarrhea, and muscle aches or headache. Loss of smell, which originally characterized COVID-19 infections, is no longer as common.

Before you get sick:Have these essentials at home to ease cold, flu and COVID symptoms

Can I get BQ.1 or BQ.1.1 if I've had BA.5?
Yes. Theoretically anyone is vulnerable if exposed to enough viral particles. But people who have been boosted or infected within the last three to six months are less likely to be infected again and certainly less likely to suffer severe disease, Stephenson said.

What to do if I get infected by BQ.1 or BQ.1.1?
If you test positive for the coronavirus or feel sick with related symptoms, the CDC recommends:
• Stay home for at least five days and isolate from other household members
• Wear a well-fitted mask around others in the home

If you're fever-free for 24 hours and symptoms improve after the five days, the CDC says you can end isolation, but take precautions for five additional days. This includes wearing masks and avoiding travel.

What if I have a compromised immune system?
This is a "pretty scary" time for people who don't have good working immune systems, either because of older age, diseases like cancer, or treatments that reduce immunity, Luban said.

The last two protective monoclonal antibodies don't work against the BQ.1 and BQ.1.1 variants, said Jake Lemieux, an infectious disease specialist at Massachusetts General Hospital.

That includes Evusheld, which was used to prevent severely immunocompromised people from getting very sick with COVID-19. It's a big loss, he said: "I do hope there will be a replacement drug for prophylaxis that retains activity against circulating variants."

Flu, RSV and COVID: What to know about the 'tripledemic'
Doctors are saying we're currently in a "tripledemic" with three respiratory viruses, including COVID-19, flu and RSV circulating simultaneously.

Vaccinating against both flu and COVID-19 will help limit severe infections, said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine.

There are currently no vaccines or specific treatment for respiratory syncytial virus, or RSV, which can infect people repeatedly and are particularly dangerous for the very young and very old, he said.

It's not clear why, but both flu and RSV are circulating much earlier this year than they did before the pandemic, said Dr. Tina Tan, vice president of the Infectious Diseases Society of America, which held a news conference Friday that included her and Schaffner.

"Whether or not these will go back to normal (in future years), nobody knows," she said.

Tan, a pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, said she knows everyone is ready for a "new normal," but she worries that not enough people are getting COVID-19 boosters and annual flu shots, and that children and adults have fallen behind on other routine vaccinations as well.

"Vaccines need to be part of that new normal to prevent individuals from becoming ill with the viruses and bacteria that are circulating," she said. "That is the new normal."

Can we have a COVID-free Thanksgiving? Here are some tips.

Extreme precautions are no longer needed, experts say. But Lemieux said people should be careful if they have very young, very old or immunocompromised people at their holiday gatherings.

He suggests guests use a home COVID-19 test before sitting down together in an enclosed space and that people who are sick shouldn't go at all.

"I don't want to say 'cancel Thanksgiving,' but I also don't want to say 'don't worry about respiratory viruses,'" said Lemieux, who also worries about the flu and RSV getting passed around along with the turkey.

Some things to keep in mind:
►If you develop cold symptoms, get tested for COVID-19: Take a test right away because the antiviral Paxlovid, which can help prevent severe disease in high-risk people, works only if given within five days of infection.
►If you're traveling, wear a mask: Masking while traveling to celebrations also makes sense, said Dr. Lael Yonker, a pediatrician at Massachusetts General Hospital. She's had her children wear masks leading up to the holiday.
►Get vaccinated against the flu and COVID-19: For Schaffner's family gathering, everyone must be vaccinated against flu and boosted against COVID-19, he said. "No one wants to be a dreaded spreader," he said.

When can we stop worrying about new variants?
Experts have been waiting for the virus that causes COVID-19 to settle into a seasonal pattern and stop mutating so much, but it hasn't happened yet. While current vaccines are considered safe and very effective against severe disease, they do not prevent all infections.

Next-generation vaccines, currently under development, could provide broader or longer-term protection against COVID-19. Companies are also exploring delivering the vaccine through the nose rather than by shots, which might provide more protection against infection.

Pfizer and BioNTech announced Wednesday that they have started a 180-person early-stage trial of a new candidate vaccine they hope will broaden and extend protection against the virus. The new vaccine will target the "spike" protein on the surface of the original virus plus the version of spike on the BA.5 variant, as well as a nonspike protein that doesn't seem to be mutating as much.

The trial will include three different doses and variations to see if the candidate vaccine is better than the current one.

New Coronavirus News from 18 Nov 2022

Human case of swine-origin influenza A virus detected in Denmark, according to CDC study [News-Medical.Net, 18 Nov 2022]

By Neha Mathur

In a recent study published in the Emerging Infectious Disease Journal, researchers detected a swine influenza A virus (IAV)-infected patient in routine surveillance at the National Influenza Center in Denmark. The detected influenza variant appeared distinct from any variant found previously in Denmark.

Background
As per official records, during the 2021–22 influenza season, 16,160 cases in Denmark were due to the influenza A virus, predominantly the H3N2 subtype. During this time, no cases of swine-origin influenza virus occurred in humans. Since the 2009 influenza A(H1N1) pandemic, no reports of persistent human-to-human IAVs transmission have come to light. Also, there have been only sporadic reports of human infections with swine IAVs. Yet, the zoonotic potential of IAVs is highly concerning.

Case report
A young man in his 50s, working at a swine abattoir in Denmark, was hospitalized after acute onset of illness on November 24, 2021. He had dizziness in the night, followed by chest pain, pain radiating toward the left arm, diarrhea, and malaise, but no fever. The patient suffered repeated convulsions and had to be admitted to the intensive care unit (ICU) and put on ventilation to cease seizures and manage declining oxygen levels.

He had no cardiovascular, kidney, neurological, or other impairment, including pneumonia, that could rationalize his sudden bout of severe illness. However, a pharynx swab sample of the patient tested positive for IAV. Notably, no other coworker at the patient's workplace reported the incidence of influenza.

With antiviral medication (oseltamivir) and supportive treatments, the patient's clinical condition improved over the next two days, so he was discharged from the hospital. The researchers submitted the remaining sample material to the Danish National Influenza Center, which confirmed it was positive for the pandemic H1N1 strain.

Further analysis by whole-genome sequencing revealed its consensus sequence to be of the H1N1 subtype. Notably, the virus was more similar to swine IAVs than human influenza strains. The team uploaded this sequence to the global initiative on sharing all influenza data (GISAID) database.

The sequence had no match to IAV sequences in GISAID, as revealed by the Basic Local Alignment Search Tool (BLAST) searches; however, a comparison to in-house sequences of swine influenza viruses from Denmark showed a close resemblance to 2021 swine IAVs. This viral strain had several genetic and antigenic differences from other influenza A viruses detected in Denmark. Also, it had poor reactogenicity to the currently used human seasonal influenza vaccines. Furthermore, its phylogenetic analyses revealed that most gene segments were similar to the H1N1 subtype. On the contrary, its neuraminidase and non-structural segments belonged to the clade 1C avian-like swine influenza A(H1N1) found in Eurasia.

Conclusion
Earlier in Denmark, an elderly patient with comorbidities experienced classical influenza-like illness (ILI). However, the reported case in this study was unique because a previously healthy adult experienced severe and sudden illness. Another distinct observation was that this patient experienced convulsions, which are rare in adults and typically accompanied by fever or encephalitis. Therefore, the infecting viral strains in these two cases are likely genetically distinct.

Detection of a variant IAV via routine surveillance highlighted the importance of continuous monitoring of both human and swine IAVs with zoonotic potential. Additionally, it underscored the need to promptly take countermeasures for those who come in contact with swine owing to their occupation and experience ILI.

Journal reference:
• Andersen KM, Vestergaard LS, Nissen JN, George SJ, Ryt-Hansen P, Hjulsager CK, et al. (2022). Severe human case of zoonotic infection with swine-origin influenza A virus, Denmark, 2021. Emerging Infectious Diseases. doi: https://doi.org/10.3201/eid2812.220935 https://wwwnc.cdc.gov/eid/article/28/12/22-0935_article

What does the COVID-19 'variant soup' mean for the Asia-Pacific region as travel ramps up? [ABC News, 18 Nov 2022]

By Erin Handley

As Australia anticipates a fourth wave the Asia-Pacific region has been served up what is been dubbed a "COVID variant soup".

Key points:
• New COVID variants are competing for dominance in the region
• Singapore recently had a rise in hospitalisations due to XBB
• Countries like Japan and South Korea are bracing for a "twindemic" of COVID and flu in winter

This soup is a mix of sub-variants vying for dominance according to Sanjaya Senanayake from the Australian National University Medical School.

"It's all still Omicron, but it's these new sub-variants. So they're going to challenge our immune system, and we will see an increase in cases," Dr Senanayake said.

"But hopefully, because of our hybrid immunity, it should be a short, sharp wave in terms of both cases and hospitalisations."

The COVID variant "swarm" or soup adds a complexity that makes waves harder to predict, according to the science journal Nature.

The current state of the virus is varied across our region; as Singapore comes down from the crest of a wave fuelled by the variant XXB, Japan is seeing an uptick in cases.

Case numbers appear to be fairly stable in South-East Asian countries, where many Australians might travel over the upcoming holiday period.

Meanwhile, many Pacific countries are reporting low or no COVID cases despite experts saying transmission is still occurring, highlighting that the quality of data collection varies drastically between nations.

Global health researcher at the University of Sydney School of Public Health Meru Sheel said it's no longer fruitful to draw comparisons at this stage.

"We're definitely way past that phase of the pandemic where we should be comparing countries … I think it's arbitrary," Dr Sheel said.

"The borders are open, people are moving, viruses are circulating … whether we like it or not, infection is inevitable."

Still, there are some lessons to be learned from outbreaks abroad.

And there are measures people can take to protect themselves and their communities, which can also have an impact at a population level.

Winter is coming in Japan
Australia is bracing for a fourth COVID wave, but Japan is looking at its eighth.

The Japanese health ministry's experts panel warned it could be the biggest surge in case numbers for the country since the pandemic began.

Last month Japan lifted travel restrictions for foreigners welcoming almost half a million overseas travellers in October — more than double the previous month.

It is also entering winter, like other northern-hemisphere countries South Korea and Taiwan — although for now Taiwan's cases are declining.

Dr Senanayake said COVID was perennial but can pose more of a problem in winter, in part due to behavioural reasons – such as people gathering together closely indoors to escape the cold.

"They also have to worry about the 'twindemic' with the flu resurgence, as we saw in Australia," he said.

The twindemic is something nearby South Korea is expecting too, according to Kim Woo-joo, a professor of infectious diseases at the Korea University Guro Hospital and one of the country's leading COVID experts.

"From late October, the daily number of newly confirmed COVID-19 cases are increasing," Dr Kim said.

The resurgence has several causes; the proliferation of sub-variants from abroad, mass gatherings for events and the easing of restrictions, although indoor mask-wearing is still required and a seven-day isolation period is still recommended.

"Government does not want to enforce social distancing measures anymore," Dr Kim said.

There is also some degree of complacency from individuals, as well as low vaccination rates for the fourth dose and Omicron bivalent vaccines, he said.

"Increasing vaccination rates among people is necessary, but the acceptance rate is very low, even compared to that of the United States."

Cases are climbing and Dr Kim said he expected an increasing wave, with BQ.1 and BQ.1.1 emerging as the dominant sub-variants.

Singapore's 'short, sharp' XBB wave
The BQ.1 offshoots are also expected to lead to rising infections in Europe, North America and Africa, but it was a different story in Singapore recently.

The city-state is seeing a decline after a spike in cases and hospitalisations fuelled by the highly-transmissible XBB variant.

"XBB is what we call a recombinant strain, so it's two different COVID strains or sub-variants coming together," Dr Senanayake said.

"But the good news is that Singapore had a short, sharp rise in cases – it wasn't anything as bad as their worst peak by any means.

"And it started to come down very quickly, both in terms of cases and hospitalisations."

Both BQ.1 and XBB are present in Australia and could become dominant here.

Singapore is one of the busiest aviation hubs in Asia, which could aid its spread.

Although Singapore saw an increase in hospitalisations and XBB is reported to be more transmissible than previous sub-variants, it is also less severe.

Some reports describe XBB as a kind of "escape artist", but the Institute for Health Metrics and Evaluation said it "does not appear to have immune escape with BA.5 [an Omicron sub-variant], meaning individuals who were previously infected with BA.5 will maintain their immunity against the new sub-variant".

Dr Senanayake said Singapore had a very high vaccination rate of more than 90 per cent.

Dr Sheel said although XBB is spreading faster and indicates a level of immune evasion from the original Omicron variant, vaccines were key and there were lessons from looking at Singapore.

"What the experience of Singapore is showing is that, despite the vaccine coverage, despite the national immunity, we can still see an increase in cases and that new variants are coming and still causing these, I guess it could be a blip, or a wave of infection," she said.

"We need to be alert from a public health response perspective. We can't just stop, because we still have elderly and immunocompromised people at risk in the population.

"If your health workers start getting reinfected, then it becomes a challenge for your healthcare system."

Vaccinate before you travel
In South-East Asia, Indonesia has just wrapped up its hosting of the G20 in Bali.

One of the attendees – Cambodian Prime Minister Hun Sen – tested positive for COVID and left the country.

Cases in the world's fourth largest country are seeing a slight rise, but COVID measures recently re-introduced in Bali appeared to be more about the global summit than stopping the spread.

Epidemiologist Jane Soepardi said the XBB variant had arrived in Indonesia but was not dominant in the country yet.

Another consideration was the quality of surveillance, with cases under-reported globally.

"The tests in Indonesia are very low. It's very under diagnosed, under reported," Dr Soepardi said.

"High cases are always in Jakarta — this is very biased here, because in Jakarta there are so many tests and you can easily get tested for free, while in other provinces, it's not so."

Dr Soepardi said there should be more testing in tourist areas for peace of mind, adding that the isolation period in the country is 10 days.

She said government officials had to remind people of current restrictions.

"Now we have seen more cases, it's arising. So people are forgetting about this pandemic," she said.

Dr Senanayake said Indonesia had a lower vaccination coverage than some other countries.

But he said the development of their own vaccine – which has been declared halal for Muslims – might help.

"That's a good thing for Indonesia – their own homegrown vaccine, something they can be proud of, and less suspicious of, and that might help vaccine cases," he said.

Thailand too has recently developed its own vaccine – a homegrown mRNA shot.

Dr Senanayake said Thailand had good public health messaging during the pandemic and a robust health system.

"They've got pretty good public health infrastructure … the way they look after certain infections like dengue," he said.

For many countries in the region, travel and tourism are key to their economies.

"When you're not a rich country, it does come down to an important decision between tourism and health," he said.

"A lot of other countries, it's a matter of being able to feed your family by having the borders open versus not having COVID but dying from starvation. They're the realities."

Dr Sheel said we now have Omicron-specific vaccines available.

"I think the best thing people can do is make sure they're vaccinated before they travel," Dr Sheel said.

"The key is we know the vaccines work against more severe forms of disease, and the vaccine was always meant to protect people from dying, essentially."

Other steps include hand hygiene, isolating if you have a respiratory illness, wearing a mask in crowded places, and gathering outside over Christmas.

"It offers individual protection, community level protection to some extent Those are the key things that people can do at an individual level, that then contributes to population health."