Lancet: Covid-19 Pandemic ‘Far From Over’ In 2023

An editorial from The Lancet says the more worrying Omicron subvariant and one to watch closely is XBB1.5 that has spread rapidly in the US, and had a doubling time of 1 week.

KUALA LUMPUR, Jan 17 – The Covid-19 pandemic is “far from over” three years since the World Health Organization (WHO) first declared the coronavirus outbreak a pandemic, as it enters a new and dangerous phase that requires urgent attention, according to The Lancet.

An editorial published by the medical journal on January 14 pointed to Covid infections in China and the XBB1.5 Omicron subvariant, which has rapidly spread in the United States, as risk factors that require everyone to remain vigilant.

“Rather than hoping for the end, letting our guard down, and thinking that the problem is somewhere else, everyone needs to remain alert; encourage maximum transparency in reporting cases, hospital admissions, and deaths; and accelerate collaborative surveillance of variant testing and vaccinations,” the editorial read.

Following Beijing’s decision to drop most of its restrictive controls in December, millions of Chinese people have been infected with Covid, with many older people dying.

However, The Lancet noted that official figures did not capture these deaths as Covid-related because Chinese authorities applied a very narrow definition and stopped information on numbers of infections, hospital admissions, and intensive care admissions.

It further warned that although infections might have peaked in Beijing, China, its population is entering a precarious and difficult phase due to its insufficient vaccination rate, increased movement during Chinese New Year, and “counterproductive” measures imposed by the international community against Chinese travellers.

According to figures from the Chinese National Health Commission, at the end of November, 69 per cent of those 60 years and older and only 40 per cent of those 80 years or older had a course of two vaccinations and a booster with Chinese-licensed vaccines, which are not specifically aimed against the prevailing Omicron variants. 

A vaccination drive, especially aimed at older people, is underway. 

Several Chinese companies are working on a bivalent mRNA vaccine, but it will take some time for these more effective vaccines to be licensed.

Meanwhile, the Lunar New Year and the expected travel wave across China to see relatives will mean spread of infections to rural areas where the health-care system is weaker, and where many older people with comorbidities and poor health live, The Lancet wrote.

On travel restrictions and requirements of a pre-travel negative Covid-19 test for Chinese people, the editorial noted that while precaution is understandable and variant monitoring and data sharing should be widely encouraged, singling out Chinese travellers is counterproductive and might have unintended consequences.

“This move was regarded as unnecessary by the European Centre for Disease Prevention and Control as the variants seen in China, the omicron subvariants BA.5.2 and BF.7, are the ones that have been circulating in Europe and elsewhere in populations that now have high levels of immunity.”

Apart from the situation in China, The Lancet also pointed to the “more worrying” Omicron subvariant XBB1.5 that should be closely monitored.

The US Centers for Disease Control and Prevention (CDC) data showed that the XBB1.5 variant comprised 40·5 per cent of cases at the end of December 2022, and had a doubling time of 1 week.

“Maria Van Kerkhove, WHO’s COVID-19 technical lead, called it the most transmissible yet with mutations in the protein spike that allow a closer binding to the ACE-2 receptor and facilitate immune evasion, although so far there are no signs that it causes more severe disease,” wrote The Lancet. 

In Malaysia, according to the KKMNow website, daily confirmed Covid-19 cases have begun plateauing since January 1, hovering at 460 cases on a seven-day average last January 11. Hospital admissions, ventilated Covid-19 patients, and Covid-19 patients in intensive care have been declining since early last month.

Despite the decline in Malaysian Covid cases, the WHO has recorded a steady increase in confirmed Covid-19 cases in the Western Pacific region, which Malaysia is a part of.

The regional data on the number of confirmed cases reported a decline from 3.37 million confirmed cases on August 1 last year, to 770,402 confirmed cases on October 3. However, the case trend has been rising since, increasing to 1.75 million cases on January 9, 2023.

Malaysia’s health director-general Dr Noor Hisham Abdullah, in a statement published on January 2, 2023, held that the XBB strain to be the dominant strain in Malaysia. This statement comes from the findings of the latest SARS-CoV-2 genomic surveillance that was conducted throughout December 2022. 

The surveillance showed that 55.4 per cent of the sample that successfully underwent genome sequencing was the XBB variant. This was followed by the BA.2.75 (20.8 per cent) and the BQ.1 variant (10.8 per cent). 

“This shows that variant XBB is still the primary contagious variant in the Malaysian population, since October 2022. Both the XBB and BA.2.75 are variants under WHO’s Lineage Under Monitoring (LUM),” Dr Noor Hisham said.

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