New Rules for Unvaccinated People, Delta Continues to Surge

These are the global coronavirus stories you need to know about this week.

As hospitalizations for Covid-19 continue to increase in Israel, with a significant share involving vaccinated patients, the country is considering a fourth confinement of the population in September, during the major Jewish holidays. The decision will largely depend on the impact of the third dose of the vaccine, which may soon be extended to the over 40s.

Despite a fall in infections in the UK, rates of COVID-19 remain high and scientists are still unsure as to whether the country is over the peak of the current wave.

Prof Sir Andrew Pollard, director of the Oxford Vaccine Group, claimed herd immunity was “not a possibility” with the current Delta variant. “Anyone who’s still unvaccinated, at some point, will still meet the virus”, he cautioned. There was also a possibility that the virus could “throw up” a more infectious variant for people already vaccinated, he said. To date, more than 75% of UK adults have now received both doses of COVID-19 vaccine, but Public Health England said there are early signs that people who have been vaccinated against COVID-19 may even be able to transmit Delta variant,

In France, on August 9th came the requirement for the health pass – showing evidence of COVID-19 vaccination or a negative test for entry into the majority of public establishments, and certain private places such as restaurants. The epidemic continues to rage in the southernmost regions of the country: Corsica, PACA, Occitanie and New Aquitaine. Overseas territories are totally overwhelmed. Reinforcements in health personnel have been sent to Martinique and Guadeloupe (French West Indies), Polynesia is now severely affected and the epidemic is resuming in French Guiana – all of these regions are united in having low vaccination rates. In addition, the CEO of Sanofi France called on citizens not to wait for the vaccine from the French firm – which won’t be available until the end of 2021 – to be vaccinated. Some French people who are vaccine hesitant have said they they prefer a “French” vaccine and not a mRNA one – a technology that is too recent and not reliable enough in their opinion – to protect themselves against the virus.

In Portugal, the Delta variant is already responsible for 95% of SARS-CoV-2 infections, so the country is speeding up vaccination. According to officials, only 2.5% of people contacted by the vaccination system have refused the invitation to be immunized. The country is now moving towards vaccinating teenagers, although there is still debate on this. Currently, the country has more than 57% of the population fully vaccinated and 70% vaccinated with the first dose. Considering its vaccination coverage, Portugal is now easing some restrictive measures adopted after the increase in the Delta variant, such as the night curfew (between 11 pm and 5 am). Continuing flexibility depends on the success of vaccination goals.

Following new decisions by the federal and state governments, it is clear that things will soon become more complicated for the unvaccinated in Germany. They will have to prepare themselves for increased testing obligations in everyday life – and from mid-October, unvaccinated people will generally have to pay for the rapid tests themselves. This was decided by Chancellor Angela Merkel together with the state premiers on Tuesday. The debate about the 2G rule, which, in contrast to the 3G rule, only includes freedoms for vaccinated and recovered persons and does not take tested persons into account, provides further material for discussion. These freedoms include for instance access to large events in clubs or halls. However, it is still unclear when this will be decided. The seven-day incidence continues to rise in Germany. In the district of Friesland more than 8,500 people may need to be immunized again, after a nurse has made vaccinations with saline solution.

Italy confirms the growth in the number of new cases, with an average weekly incidence of 62 cases/100,000 people. The R value is stable (1.56, according to the Ministry of Health). Sicily and Sardinia will move from the white to the yellow zone due to the large number of tourists that contribute to the growth of local cases. The number of people hospitalized has increased, both in non-intensive and intensive care units. 63% of the Italian population over the age of 12 have completed the vaccination scheme (64% of the adults), placing Italy above the United States, but also France, Germany and above the European average (60% according to the European Centre for Disease Prevention and Control).

Italy is discussing how to use the green pass for back-to-school: while the Minister of Education wants to use it to avoid quarantine for vaccinated students in case of COVID-19 contacts, opponents are going to court claiming that such a measure would be against the Constitution and the right to proper access to school.

In Switzerland, 55% of the population has had one dose of a COVID-19 vaccine. The approval of the Moderna vaccine has now been extended to 12 to 17 year olds.

According to army speaker Stefan Hofer, the vaccination rate is currently 60% for the first vaccination dose in the Swiss army, but this will not be made compulsory, in contrast to the US army.

In Austria, the seven-day incidence was 43 cases per 100,000 on August 9, compared with 36.6 at the beginning of the week.

The incidence of COVID-19 cases in Spain continues its downward trend. Although on August 10 the number of ICU beds occupied by COVID patients fell slightly for the first time in a month, it still exceeds 21%, which is still considered ‘high risk’, by the Government. 60.6% of the population is already fully vaccinated against COVID-19 (more than 28.7 million people), while 70.8% have at least one dose (33.5 million), according to the latest Health report. Only 5% of those aged 12 to 19 years have received both doses, while 27.4 % have had one dose. Some regions are already asking for the COVID-19 pass to enter bars and restaurants. On August 11 the Spanish Agency of Medicines and Health Products (AEMPS) authorized the first human clinical trial of a vaccine developed in Spain, the PHH-1V vaccine against COVID-19.

In Belgium, the largest vaccination centre in the capital has now closed, as the vaccination campaign winds down. In Brussels, 50% of 18 to 44-year-olds have received a first dose of the coronavirus vaccine so far and 41% are fully vaccinated. Brussels’ Common Community Commission (Cocom) says reaching younger people continues to be a challenge. The federal government has reached an agreement to subsidise visits to a clinical psychiatrist for anyone in Belgium whose mental health has suffered as a result of the COVID-19 crisis.

The U.S. is averaging about 124,000 new COVID-19 cases a day and hospitals are once again filled with COVID-19 patients, most of whom are unvaccinated by choice. This new surge is centered in the Southeast, which has some of the lowest community vaccination rates in the country. Several states, including Mississippi and Arkansas, are running out of ICU beds. Hospitals in Florida and Alabama are reporting difficulty getting enough oxygen to support the number of patients who need it. The crisis is also being driven by a severe shortage of nurses and other healthcare workers such as respiratory therapists. Several states are turning to the federal government and its military healthcare systems for help. Children are also being hospitalized in record numbers as Delta has coincided with the reopening of schools.

In Mexico, as of August 10, there have been almost 3 million confirmed cases of COVID-19, and 245,476 deaths associated with SARS-COV-2 as the country endures a third wave. Daily cases, hospitalisations and deaths continue to rise. The number of daily infections exceed those reported in the second epidemic peak in January 2021. However, officials have said that there is no evidence that face-to-face classes pose a risk of outbreaks of COVID-19 infection, so it should be possible to reopen schools.

Pan American Health Organization Director Dr. Carissa F. Etienne announced that more than 1.3 million cases of COVID-19 and more than 19,000 related deaths were reported last week in the Region of the Americas. The number of cases has increased in some places, but the data show that “where vaccines are available, the incidence of severe disease is reduced and lives are being saved”.

The number of deaths is increasing in almost all Central American countries, with a 30% increase reported in El Salvador. The number of cases is increasing in Cuba, Jamaica, Puerto Rico, Martinique and the Bahamas. In South America, there has been an overall decrease in the number of cases and deaths in the Andean Region and throughout the Southern Cone. The number of cases has decreased significantly in Colombia, Bolivia, Paraguay and Uruguay.

The R rate in Brazil, according to estimates by Imperial College London, is 0.90, which is the seventh week in a row in which the national rate is below 1. Almost 51% of the population has had a first dose of vaccine, while 22% are fully vaccinated. But the Delta variant is spreading, representing 45% of samples sequenced in Rio de Janeiro last week, and likely to become dominant, as in other countries all over the world. São Paulo, the richest state in the country, is threatening to take the federal government to Court to obtain more vaccines. In that state, 95% of hospitalized people were not vaccinated. The government of Rio asked the Ministry of Health for a 15% increase in the number of doses to be sent to the state, as a way of trying to contain the advance of Delta, but only a 5% increase was authorized.

The current lockdown in the state of Victoria, Australia which was supposed to end on August 12, has been extended until at least August 19. The state of New South Wales reported the largest single-day spike of 356 locally transmitted COVID-19 cases on August 10.

South Korea reported a record number of 2,200 daily COVID-19 infections on August 11. In a bid to vaccinate 70% of adults by September 2021, the country is now offering COVID-19 vaccination to all adults aged 18 years and above. Around 45% of its population have received at least one dose of the vaccine, while 15% have been fully vaccinated.

Bangladesh has initiated a vaccination drive for ~1 million Rohingya refugees living in camps in the border district of Cox’s Bazar. In the first phase, 48,000 refugees aged 55 years and above will be vaccinated using the Chinese Sinopharm vaccine. The majority of the country is currently under lockdown due to the surge in COVID-19 infections from the Delta variant of SARS-CoV-2.

India has approved Johnson & Johnson’s single-dose COVID-19 vaccine, making it the fifth vaccine to receive Emergency Use Approval in the country.

Iran reported a record number of daily COVID-19 infections and daily deaths on August 8, with over 39,600 cases and 542 deaths.

Authorities in Wuhan, China completed testing its entire population of 11.3 million, with the exception of college students on summer break and children below 6 years of age. Nine positive cases were recorded from the mass testing.

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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