29 January 2021

Coronavirus in Romania: new year, new issues

Contrary to my concerns, the rate of infections in Romania has steadily dropped since my last update, except for a spike in the first week of January that may be a consequence of the Christmas celebrations. Indeed, a similar spike appears in the case evolution of several European countries I regularly check: Poland, Italy, Germany and the UK all reported increases on that week. The current weekly average of new cases is around 2500 here in Romania.

Some people speculate that this reduction is caused by people performing home tests – recently antigen tests have become available for individual purchase – and then not reporting positive results to the authorities to avoid isolation. A disturbing possibility, and a reason why rapid home testing is not a silver bullet against the pandemic – it does not matter if people know they are infected if they do not take proper measures to contain the spread. Nevertheless, daily deaths have also decreased these past two months, to a weekly average of about 80/day, half the average values recorded during November. The number of patients in critical condition has also declined from the November peak of nearly 1300, recently dipping below 1000, although for a single day on January 22.

Daily new confirmed COVID 19 cases 2021 January Europe
Daily new confirmed COVID-19 cases in January 2021 (Europe)

Speaking of antigen testing, a short follow-up about the situation in Slovakia. The country was hailed as a pioneer by using a massive testing program to try to contain the pandemic. Needless to say, it has not quite worked out as expected: after a temporary reduction, the virus has started spreading again, returning and surpassing the levels before the testing campaign.

The pace of news about the pandemic has only increased these past two months, focusing on two major topics: vaccinations and new viral mutations. After the approval of the Pfizer vaccine, deliveries started across the European Union, and most countries began vaccinating medical staff immediately after Christmas. So far, vaccination campaigns in the EU have been slow and fraught with manufacturing and distribution issues, but it still seems premature to pass judgement. France for example was among the last EU nations to start but has since caught up. By some unlikely constellation of circumstances, Romania is leading at doses administered per 100 people – unfortunately not something to be too proud about, because at the current rate it would take until December 2022 to vaccinate enough adults to eliminate the pandemic.

Covid vaccination doses per capita 2021 January Europe
Daily new COVID-19 vaccination doses administered per 100 people (Europe)

Elsewhere around the world, Israel is leading the efforts to vaccinate its population – with the unfortunate caveat that vaccines have been administered to Israelis exclusively, ignoring the Palestinian population. Ironically, cases are on the rise again in Israel and the country entered a third lockdown, a preview perhaps of the effects of vaccine euphoria. Data collected in Israel offers indications on the efficacity of the Pfizer vaccine at large scale: the first dose alone is only partially effective, reducing infections by an estimated 30% among targeted age groups, but the effect after the booster dose are much more encouraging, confirming phase III trial results.

Which brings me to the UK… It has also managed a fast rate of vaccination, but at the expense of proper protocols. Their medical authority signed off unproven changes in the vaccination schedule, allowing the second dose of any vaccine to be delayed up to 12 weeks to reach more people with the initial dose, and in rare cases even mixing vaccines from different manufacturers… Multiple specialists have reacted with disapproval and dismay at this approach, condemned by Pfizer but supported by AstraZeneca (on which basis nobody can tell), and I am similarly worried. Allowing the virus to circulate and multiply in a partially vaccinated population, with weak and unpredictable immune responses, is the perfect recipe for breeding resistant viral strains. The worst case scenario, now that multiple vaccines are rolling out, is to have their effects abruptly negated by a viral mutation. It would be a massive setback in terms of managing the pandemic. The UK decision feels motivated by desperation, not by clear strategic thinking.

What’s the upshot likely to be for Britain? The entire country’s vaccination program is likely to fail. There are going to be a whole lot of people who get one dose, but not the second in time, and most of those people will not develop immunity. Do you know what happens when you cross a halfway vaccinated population with a fast evolving virus? That’s right, vaccine resistance. Britain already made itself a perfect petri dish for new strains of Covid — but what Britain’s doing right now is making it the perfect petri dish for deadlier, more infectious, and much, much more vaccine resistant strains of the virus. If that makes you shudder, it should, because that is how Covid never goes away, and become a seasonal illness like the flu, only with an astronomically higher mortality rate.

Umair Haque

The United Kingdom had already identified the first coronavirus mutation before vaccinations began, with greater transmissibility and apparently slightly higher mortality than the wild type. The government has not missed the opportunity to blame the resurgence of the disease on this new variant, but I suspect lifting the second lockdown too early and lax restrictions around Christmas contributed just as much, if not more – the country has since instituted a third lockdown. Despite closing borders, this mutation is rapidly spreading in other European countries and the US – in fact, it was probably there already before travel restrictions. There are already 5 confirmed cases in Romania. As a side note, it never ceases to amaze and terrify me how many people are still flying all around the world as if everything is normal, and how few testing and quarantine measures are in place.

Other, potentially more dangerous mutations have been identified in South Africa and Brazil, both of which have since spread to other countries. For now, vaccine manufacturers have been cautiously optimistic that current vaccines can induce immune responses against these new variants. Two vaccines in the final stages before approval, from Novavax and Johnson & Johnson, show reduced effectiveness, but that may be enough to prevent serious disease and at least relieve the pressure on the medical system.

Daily new confirmed COVID 19 cases 2021 January world
Daily new confirmed COVID-19 cases in January 2021 (world)

The dire situation in Manaus should be serve as a stark warning to the rest of the world and incentivize everyone to keep the virus as contained as possible. After the first wave in spring 2020, studies showed the virus had infected a substantial portion of the population in Manaus, leading many to conclude the city had reached natural herd immunity. Nevertheless, the area is experiencing another massive wave, sick people overwhelming the already strained hospitals. There are several possible reasons, from waning immune protection after initial exposure to reinfection with the Brazilian mutation of the virus. But in each case, the best solution is to vaccinate as fast as possible, therefore establishing a more consistent immune response across populations, and to better contain the virus, reducing the opportunities for further mutations.

Between delays in vaccination campaigns, antivaxxers and saboteurs, public unrest and new mutations spreading all over the globe, the near future looks as bleak as ever. With lower case numbers, Romania is already considering opening restaurants and sending children back to school as soon as February 8, a decision that may prove the most damaging for our country yet. Hopefully, it will be delayed, at least until schoolteachers can get a chance to receive both vaccine doses, although many are still reluctant…

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