23 September 2021

Coronavirus in Romania: tsunami warning

After a quiet summer, in early autumn the coronavirus has returned to Romania with a vengeance. In the first half of July, the case numbers had dropped under 50 daily, and the total for the entire month was just shy of 2400, the lowest case number since the beginning in March 2020. For a good portion of July, Romania was recording daily deaths caused by coronavirus in the lower single digits, and the monthly total was slightly under 500.

Since then, the situation has changed drastically. Beginning with the second week of July, cases have climbed at a remarkably steady pace, on average 57% each week – except for last week, when the percent increase from the previous week was even higher, almost 90% – bringing us back to a daily count of 7000 cases. Compared to the earlier stages of the pandemic, this growth rate is unprecedented, likely attributable to the more contagious Delta variant, coupled with the lack of restrictions over the summer and the low vaccination rate. Between people returning from holidays, from countries like Greece with higher infections rates, recent large festivals with high attendance, and children returning to school in person last week, the outlook for the next months (even weeks!) is grim.

Deaths have followed a similar pattern of exponential growth, on a two-week delay compared to infections. Weekly growth rates have been more inconsistent, ranging from 6% to 100%, but averaging slightly higher than cases, at 62%. In recent days, the death toll has climbed to 130 a day, which is already half of our all-time high recoded in April 2021 – a record we may shatter in the next two–three weeks if current trends remain unchanged.

The number of patients in intensive case is also climbing fast, surpassing 1000 again this week for the first time since early May. I noticed with worry that the number of ICU admissions has started increasing almost at the same time as infections, in the latter half of July, which to me suggests either the increased severity of the Delta variant, or a significant undercounting of cases. At that point, official daily case numbers were around 50 on average, with around 30 ICU patients, so it seems a bit suspicious to have so many critical cases for so few active infections.

Daily new confirmed COVID-19 cases September 2021 Sep Europe, logarithmic scale
Daily new confirmed COVID-19 cases mid-September 2021 (Europe)

The status of vaccination is also rather poor, to put it kindly: only around 30% of eligible adults are fully vaccinated, and the daily numbers of first doses dropped as low as 2700 in early September. On a slightly brighter note, the vaccination drive has picked up slightly since, and over the past week the number of Pfizer first doses administered has noticeably been higher than second doses, an indication of renewed interest – or at least that people started worrying about the disease again after the summer lull. Let’s hope this trend will continue, although getting vaccinated now will not fully protect people until weeks after the second dose. Better late than never, I guess…

As I mentioned in the previous update, many are choosing the single-dose Johnson & Johnson vaccine, which can be administered by family physicians. But there is a considerable dark side here: rumors circulated that people opposing vaccination were bribing their doctors to throw away the dose and register them as vaccinated with Johnson & Johnson. The story was confirmed as some people admitted to the hospital in serious condition admitted to faking their vaccination status this way.

It certainly doesn’t help that our government is distracted by a political crisis between the parties forming the government. Authorities finally introduced restrictions tied to the EU digital COVID certificate last week, but the conditions are rather lax (only in areas with incidence higher than 3 per 1000 inhabitants) and its enforcement highly questionable. Many feel the measure comes too late and it’s too apathetic to make a difference to the ongoing wave – if this would have been announced months ago, people would have more time to vaccinate and businesses to prepare to inspect certificates. But, considering that the majority of Romanians remain unvaccinated, promoting restrictions based on vaccination status will certainly prove unpopular and an up-hill battle. Hopefully it will become one more incentive pushing people to vaccinate sooner rather than later/never.

Around the world, the situation is as volatile as ever. Outbreaks are happening all over, even in places that managed to keep the virus at bay last year, such as Australia, or in countries with high vaccination rates, such as Israel. The UK, having removed most restrictions in July, stayed at an elevated level of cases, and the disease is spreading unchecked through children. The US has also seen surges in states where the population is refusing to vaccinate, following their hasty decision to lift mask mandates. In France, mandatory vaccination has proven a success in driving vaccinations forward, and the Unites States is finally introducing similar requirements, after they lagged behind many other counties. Owing to the high spread, the virus keeps mutating, and one of the newer variants, labeled Mu, seems the most resistant yet to existing vaccines, a bad omen for future months.

Most of the recent conversation revolves around booster shots for vaccines, with some studies suggesting that efficacy is starting to wane after six months, while others reinforcing that efficacy is still high, except in older age groups. In fact, just yesterday Romania has given the green light for administering a third vaccine dose, primarily in high-risk groups, but anyone is eligible six months after the second dose. People vaccinated with AstraZeneca will also receive mRNA boosters, while those vaccinated with Johnson & Johnson will have to wait a bit longer for a decision.

While I understand that a third dose would further increase antibody levels against the virus, I get the impression that this debate is more politically than scientifically driven. Drug companies are obviously interested in selling more vaccines to the richer countries, the Biden administration trying to deflect attention from the stubborn resistance in Republican ranks. As much as mRNA vaccines are highly effective, they are not full proof, and people should stop acting as if they are; a minimal level of precautions, such as wearing masks indoors, should still be the default until the pandemic is well under control. I would prefer a booster tweaked against the Delta variant, which would probably offer better protection against future variants derived from Delta as well. It seems to me that public opinion in many places is splitting into two radical sides: vaccine opposers, who deny and dismiss the risk posed by COVID to their health and the wellbeing of others, versus worrywarts, who will jump at the opportunity to get a third shot, even though the benefits for them and society are marginal at best. The right way to end the pandemic is to convince more people to get vaccinated, while keeping sensible protections in place, not to keep vaccinating the willing repeatedly.

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