08 April 2021

Coronavirus in Romania: troubled times

As I have feared when writing my previous update, cases of coronavirus disease in Romania started climbing again following the partial reopening of schools and restaurants. Since the last week of February, cases have increased by 20–25% each week, reaching a peak of around 6650 on March 25th. Naturally, new restrictions were put in place, stricter curfews in the larger cities during weekends, followed by rounds of street protests and online complaints, and schools will again be closed for the duration of April – officially an extended Easter break. Fortunately, we are already seeing some positive signs, with cases declining slightly last week, by 4%.

This smaller wave has brought with it increased death counts as well, climbing again above 100 deaths daily to a peak of 174 on March 23rd and 196 on April 6th. While numbers have remained slightly below the highs recorded during the autumn wave, the mortality rates look worse than before. I am using a rough estimation comparing deaths to cases from three weeks ago, as their evolution appears to track cases with a three-week delay. Calculated this way, mortality in December and January based on official coronavirus deaths dropped to 1.8–2%, while in March 2021 it is back up in the 3.3–3.4% range. Not entirely surprising, considering the increased load on the medical system (the number of ICU patients is constantly climbing and has recently surpassed 1450, above the previous record of almost 1300 in November), and the spread of the new, more lethal UK mutation of the virus.

Daily new confirmed COVID-19 cases in April (world)
Daily new confirmed COVID-19 cases in April (world). Despite rapid vaccination, US cases are slowly climbing again

On the vaccination side of things, the daily numbers are consistent, averaging above 50k shots daily for the past month, up to a record of 64k on March 30th – although many, myself included, hoped that it would pick up the pace already. In total we have vaccinated almost 2.2 million people, nearly 1.3 million fully and 900k with the first dose only. Unlike other Eastern European countries (and Austria) who opted predominately for the AstraZeneca vaccine and are now falling behind because of delivery delays, Romania appears to have purchased plenty of Pfizer supplies.

It is remarkable how well Romania is adhering to the recommended vaccination schedule for the different available vaccines: charting the number of second doses administered shows an almost identical graph to the first doses, with a 3-week delay for Pfizer and 4-week delay for Moderna. As for AstraZeneca, health authorities decided to administer the doses at an 8-week interval, so the second phase should start after April 15th.

Romania COVID-19 vaccinations daily
Romania COVID-19 vaccinations daily

On March 15th Romania opened vaccination for all adults (ironic how Americans are bragging about the number of doses administered, but many states still have various age restrictions in place). This triggered a short and frenzied rush to get appointments, with people driving from large cities to small remote towns where few places were available. Around the same time, there were press revelations that some officials and military personnel skipped the line for their family members during phase II, when only the elderly and people with preexisting medical conditions should have been eligible. The actual numbers were negligible at best: around 7000 people skipped the line from a cumulated amount of 700k vaccinations at that time.

Share of the population fully vaccinated against Covid-19 in Europe, April 2021
Share of the population fully vaccinated against COVID-19 in Europe, April 2021

I have waited patiently for this initial excitement to pass – after all, I am working from home and in no particular risk to get infected – and I am currently scheduled for my first dose this week. The online reservation process was simple and straightforward, for me at least: you select a vaccination site and get a place in the queue, then you get notified by email and SMS as places become available – in my case, the waiting period was 6 days. You then have 24h to select a day and time slot for vaccination, after which you can immediately book the second dose as well. I was pleasantly surprised to see the portal has a feature to add appointments to Google or Outlook calendar, making it easier to keep track of it – in my case, the first available slots were 10 days after I received the notification.

There are several other ways to get on the waiting list, either through the family physician or by calling a helpline. Looking ahead at coming months, I have seen optimistic projections about vaccine deliveries in the EU, but I am more concerned that the gap between people willing to receive the vaccine and available doses will start to move in the opposite direction. I think our rural population will be much harder to reach with this program, and there are plenty of skeptics in cities as well. Currently, people who are anxious to get back to travelling abroad and partying freely are driving demand for vaccination. After this initial surge of demand is exhausted, I fear it will be much harder to convince the rest to do the right thing for their fellow citizens – and themselves. This seems to be happening already in China, India and Russia, who, despite having a domestic supply of vaccines, are administering it at a relatively slow pace.

News from around the world has been as hectic as ever these past months. Most of the drama continued to center around AstraZeneca, from their delayed and ever-shrinking deliveries to the EU to their problematic trial results in the US. On the EU side, the news cycle culminated with the discovery of 29 Million doses stashed at an Italian finishing site, presumably for shipment to UK or elsewhere. If I am up to date, AstraZeneca is restricted from exporting doses produced in the EU until the company meets its contractual promises.

In the US, AstraZeneca got another round of bad press when it released a statement about its trial results, only to be quickly contradicted by authorities, who challenged the data the company chose to present as ‘outdated’. Another recent issue was a manufacturing screwup at a facility producing both AstraZeneca and Johnson & Johnson vaccines, resulting in 15 Million doses being discarded. The US has since removed AstraZeneca from this production line, handing it over completely to Johnson & Johnson. At this rate, I would not be surprised if the AstraZeneca vaccine never gets US approval…

Speaking of the US, they are continuing the ‘America First’ policy around vaccination, preventing exports from their manufacturing sites – with a small token exception they labeled a ‘loan’ to Canada and Mexico. I fully expect that in some six months’ time we will see the US opening exports and pretending they are some sort of hero saving a hapless world, while this whole-time others (the EU, China, India) have produced and supplied vaccines to basically everyone, including to US’ neighbors Canada and Mexico. It is still unclear if and how this ban may affect Johnson & Johnson deliveries to the EU, but some reports indicate that the company has found alternative sites for finishing the vials in the EU.

A recent article claims this US ban is because contracts signed by the Trump administration forbid drug companies from ever exporting doses produced in the US. I personally think that blaming a past government is a weak excuse for continuing the same policy – around here, it is one of the favorite excuses when a new party comes to power. I am quite sure that, given political will, it should be possible for the most powerful government in the world to bring companies back to the negotiating table and change the terms of these agreements.

The UK is in an interesting, but different, predicament, as they announced a possible reduction of vaccine supplies in April, just as they are about to start administering second doses. Despite boasting about securing a local supplier in AstraZeneca, around half of their doses were arriving from the European Union (the Pfizer supplies), with an additional 10 Million doses contracted in India, where the Serum Institute is producing under license for the local market and developing world. As India is experiencing a new wave of infections, they will likely keep these vaccines for themselves. The UK diverting vaccines intended for the developing world for their own needs must be one of the more egregious examples of egoism and entitlement during this pandemic.

The prospect of rare side-effects of the AstraZeneca vaccine has also generated a lot of headlines and Twitter outrage, as during March many countries paused vaccinations to investigate links to cases of atypical blood cloths in recently vaccinated people. The UK media has particularly vocal against this decision, painting the move as some sort of political retaliation against the UK, others repeated that the cases are too rare to raise concerns. I do wish people online would stop imagining they are suddenly experts in a field after reading a couple of tweets on the subject, and that their opinion and personal risk assessment are the only valid ones. Uncovering rare side-effects is to be expected with any new medicine, and it is better to investigate them and offer proper advice to doctors and people, to prevent more serious complications.

Since then, this syndrome received a complicated designation (VIPIT) and recommendations for treatment, should people experience symptoms after vaccination. While they kept quiet weeks ago, the UK health authorities have since acknowledged similar cases in Britain (30 patients with blood cloths and 7 deaths), and, just yesterday, recommended that the vaccine should not be given to people under 30. Much stricter age restrictions are in place in Canada, France, Germany, Denmark, as well as several other European countries.

On a more positive note, Pfizer and Moderna are conducting trials in adolescents with encouraging results, so we may soon have approved vaccines for these age groups, substantially reducing their risks and the spread of the virus to their families and teachers. The manufacturing capacity in the EU is expanding, as Pfizer has reached deals with Novartis and Sanofi to use their existing facilities to produce the BioNTech vaccines. There are reasons for hope, provided we can keep infections down for the next few months.

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