International COVID-19 Megathread

[urutzizu]

Markus Söder becomes the first to put his state into Hard Lockdown. Stay-at-Home order for all of Bavaria like in March, Curfew for Hotspots, de facto border closure (although he tried avoiding the word), switch to partial online learning for many schools. It seems however that due to Pressure from his coalition partner (whose leader is the Economy Minister and has clashed with Söder before on this) unlike in Austria non-essential retail stays open for the christmas season, and people can leave home for all shopping, which kind of undermines the Idea of a Stay-at-Home order.

Pushing ahead like this is very reminiscent of March, an approach that won him a huge popularity, both in Bavaria and outside, and effectively forcing the rest of Germany to follow with more stringent measures. Of course you don't have to be hugely cynical to figure that his ambitions for the Chancellery next year might have played a role going ahead like this.

The interesting counterpoint to this that doesn't really get mentioned that often, is what one could call the California paradox: Bavaria has done really badly as a empirical fact, both in the first and the second wave. Bavarias contact tracers were among those most quickly overwhelmed, the situation in the Hospitals and Care homes is worse there than possibly anywhere outside Saxony. As States in northern Germany (esp. Bremen, Niedersachsen, Hamburg) have reduced Infection by about half since the beginning of November, Bavaria's is the second worst in the Country. Despite having had consistently policy-wise the strictest approach and regularly chiding the other states for not doing so.

Yet Söders popularity remains unbroken. Of course there is the possibility that Bavaria may be at a disadvantage due to factors outside of their control. Dependency on Workers from Czechia, especially in the Care sector, similarly to Saxony, and the Border with Austria, both of which were at a time Countries with the highest infection rate in Europe. Bavaria also has less strict standards for testing and aspects of Bavarian/South German culture may be more "advantageous" towards the viral spread compared to North Germany (similar to the debate around Southern Europe <-> Northern Europe). But it is still a very interesting development that flies in the face of the popular narrative. I guess many people really do just want a strong leader.

[urutzizu]

Hm, one of the things I found quite interesting is that the reaction on the European Mainland and the US to the UK Vaccine Approval has been quite a contrast. Here the Media coverage is pretty...well not negative necessarily, but...sceptical. Some quite serious commentators such as Peter Liese even suggesting that it was essentially a political decision. Whereas in the US almost all the Media Coverage and scientist talking heads are taking a very different tone: saying that the UK's approval is a great thing and that the US will surely follow soon. Fauci even went to apologise after suggesting it may have been a bit to fast. I wonder why that is.

[urutzizu]

New Corona mutation in the UK seems extremely problematic. If it is indeed up to 70pct more transmissible and increases R by about 0.4, has become the dominant strain so fast, and the infection rates from SE England during the Lockdown are an Indication, it is essentially infectious to the point that even harsh lockdown measures are not able to contain it. In that case only possibility would seem to vaccinate yourself out of it as fast as possible, or essentially abandoning containment entirely and just try to Isolate vulnerable.

European Mainland is scrambling to contain the mutation as much as possible. NL and Belgium have already closed Borders to UK, Germany likely to do the same, it seems possible much of Europe will follow quite fast. It has already been Identified in a few other countries (incl. NL), not yet in Germany, but considering the sheer amount of travel between SE England/London and Europe, even during the Pandemic, and the dominance this strain already has there, it would appear improbable that it isn't prevalent at at least a low level in much of Europe already. The Question is more likely how prevalent, and how long it will take until a situation like in the UK is reached.

[urutzizu]

In Germany all Measures to be extended through January. In Addition the Prohibitions on Gatherings of more than of 5 Persons from 2 Households is tightened to 2 People from 2 Households, the same rule we had in late March. And where Incidence is over 200 per 100k all nonessential Movements outside of 15km radius from Home banned. Plus Travel into Germany from almost anywhere only allowed with negative Test before arrival (in addition to the already mandatory Quarantine and Test after 5 Days).

Truly becoming like Gillette razor blades. This was already supposed to be a hard lockdown, so what is this, ultrahard Lockdown?
The Motivation is understandable, there is still alot of Household mixing going on and there have been big problems in the last few days of large amounts of people from Urban Areas flooding rural areas such as Winterberg or the Alps, much to the (justified) anger of the Locals.  

But this increasingly seems like just throwing the Kitchen sink. What difference is, beyond cosmetics, going from 5 from 2 Households to 2 from 2 supposed to make? What is the 15km limitation supposed to achieve when the Areas where the Day-tourists are coming from (Munich, Rhein/Ruhr) are not going to be affected, as their Incidence is not above 200?

One good thing Merkel pledged was more genome sequencing, which has been lacking in almost all European Countries except UK and Denmark. Because of this it is very difficult to ascertain the extent of the spread of the British Variant. It does seem that it is overall nowhere near as common as in the UK yet, one of the few reliable estimations that I have read is that in Ireland they say it is found only in about 5-17% of new Cases. It can be expected to be less on the Continent due to the fact that Ireland is one of the Countries with the highest amount of Interaction with the UK.

[urutzizu]

In Ireland they have now announced that currently 25% of positive tests sequenced (week ending Jan 3rd) are linked the British Variant. Friday *last week* the announcement was that it was 10% of positive tests sequenced, from which they estimated 5-17% of current infections in the Community. Ireland is currently going through a quite extreme surge in infection rates generally, which is surely at least partially responsible, but that is still one hell of an increase.

In Denmark this is what an Epidemiologist says in an Interview with Danish Public Television:

We have about 75 new cases per day with B117 right now, but only 12% of them have been found as we only sequence about 12% of the positive samples.

Provided I am interpreting this correctly, Denmark was recording about 3000 positive tests daily a week ago (adjusting for data lag, it is about 2k now), of these they sequence about 12%, so about 360, and of these about 75 are of the British Variant. So one week ago they were finding the British Variant in roughly *20%* of sequenced positive tests?

(EDIT: I think I may have misinterpreted/translated this, I think he is saying that they estimate 75 new daily cases, but they only find 12% of those due to sequencing, so the percentage of new cases linked to new variant is likely much smaller than 20%.)

Not to be a doomer but this seems really problematic to me. The main Issue is we have very little Idea of the extent of the Problem we are facing because except the Danes barely anyone in mainland Europe sequences. If the above numbers and the progression in the UK are applicable across Europe (big if), I could genuinely see the British strain being the dominant one across much of Western Europe as early as mid February and being in a similar Situation regarding the Hospitals not long after. This should really be an reason to accelerate Vaccine rollout.

[urutzizu]

In Ireland they have now announced that currently 25% of positive tests sequenced (week ending Jan 3rd) are linked the British Variant. Friday *last week* the announcement was that it was 10% of positive tests sequenced, from which they estimated 5-17% of current infections in the Community. Ireland is currently going through a quite extreme surge in infection rates generally, which is surely at least partially responsible, but that is still one hell of an increase.

https://m.independent.ie/news/ireland-records-highest-covid-19-infection-rate-in-the-world-over-past-seven-days-39954862.html

It is 45% now. Gone from 10% to 45% in barely two weeks.

[urutzizu]

Things have the potential to get very ugly on the Vaccine front soon, I fear. There is a lot of anger in Europe at Pfizer and AstraZeneca, as both companies have now said that they are not going to be able to deliver as many doses to the EU as originally agreed. So far so bad, but what riling distrust particularly, is the fact that AstraZeneca at least is both refusing to give a proper reason (only blaming vague "problems in the European supply chain") and only cutting commitments to the EU - other Countries, in particular the UK, are not affected for some reason. Making things worse is simmering anger/distrust over Brexit. The EU will now introduce a advance registration requirement for all exports to third countries, and some member states, such as the German Health Minister and many in the EU parliament are for calling for restricting or banning the exports of Vaccines entirely.

Clearly it is unacceptable for AstraZeneca to not keep it's commitments to the EU but to other countries without a proper reason, and if they cannot, they should be held legally accountable considering how much the EU invested in them for research and production capacity. But doing things like this is extremely irresponsible in my view. Mixing politics and vaccines is never a good idea, but especially not like this. If Europe would block the export of Biontech/Pfizer from it's European plants, other Countries would (such as the UK with AstraZeneca) respond entirely tit-for-tat, and crucial supply chains for the Vaccine distribution everywhere would be disrupted. It is a lose-lose for everyone. And it's feels like a cheap attempt to distract for the failures of the Government in the Vaccine rollout in many European countries, especially in Germany.

[urutzizu]

People here are refusing to take the Astrazeneca Vaccine now that it's available. In Saarland for instance 54 percent of medical workers registered for a vaccination did not show up, without canceling their appointment. Similar across Germany, and Austria also:

Rebellion at Vienna General Hospital against AstraZeneca vaccine

https://www.diepresse.com/5935875/aufstand-am-wiener-akh-gegen-astrazeneca-imfpstoff
Innsbruck also:

2000 doses of the AstraZeneca vaccine are expected next week, but most clinic employees would not want to be vaccinated with the vaccine.

https://www.diepresse.com/5936355/auch-in-klinik-innsbruck-regt-sich-impf-protest

Turns out the big brain idea of dog-whistling unfounded safety concerns to justify your failures in rolling out vaccines, has some unintended consequences.

Whereas in UK 89% (!) now want to take Vaccine.
https://www.ipsos.com/ipsos-mori/en-uk/global-attitudes-to-covid-19-vaccines-wef

[urutzizu]

Yes, I have been very critical of Anglo-American Individualism (as opposed to the German or Chinese models), especially during this crisis, I even wrote it off at one point. But I'll admit that whatever it's deficiencies and failures at containing the Virus during the first wave have been, it has compensated for with it's Vaccination programs. Their model stimulates creativity, efficiency and open mindedness and we'd be wise to learn from those things for the future competition of systems.

All models have shown both strengths and weaknesses over this last period and to identify any one as superior, as was done prematurely in Europe during the summer and is being done in China now, is probably misguided. The French statist model might need the greatest introspection though, having performed badly by most metrics and being the only major power not to have developed a vaccine, with both Sanofi and Pasteur disappointing. In fact French entrepreneurs and scientists have made great achievements, take Stéphane Bancel for instance, but mostly, well, not in France or not for French companies.

[urutzizu]

Germany now the most negative of all polled countries towards it virus handling. RKI warns of 100k+ cases per day and health care system overload in April, Spahn says we need "massive countermeasures". However, even if there were the political will among state leaders (there isn't, despite Merkels attempts to force them yesterday), we've already been in basically a hard-ish lockdown for three months. Shops are mostly closed, Restaurants and culture is closed, Schools depend on the State but at least here in BW are closed except for the lowest years. I don't think any neighboring country except perhaps Czechia has harsher measures, so there really isn't that much of a brake to pull. Someone said were are like a country entering a recession with interest rates already at zero. Political trust is simply necessary for people to adhere to the restrictions. Or fear perhaps, if the cases keep rising.

[urutzizu]

I'm somewhat puzzled now. With J&J on the hook now alongside AstraZeneca for apparently having vaccines that cause blood clots, why hasn't this been an issue in the UK? From what I've read, they both use the adenovirus vector technology. If any country would be seeing significant side-effects, wouldn't it be the UK on account of massive use of the AZ vaccine?

UK has the Issue too (79 blood-clotting cases, 19 Deaths). But compared to rest of Europe is much less per AZ dose, correct, because UK (very rightly in my view) has a strict age based rollout with only very limited exceptions. That + very high vaccine acceptance means that in UK practically everyone over 50 has gotten a dose, but only few people below. On the other hand In US most states have opened to all age groups, or here in Germany for instance (and in most mainland European countries I know) certain essential workers were also vaccinated very early. That, plus the fact that AZ was not used for +65 in Germany for a long time, meant that most people who got AZ intitially here were Teachers, Medical/Senior home staff etc., i.e. Groups that are disproportionately young and female. So we vaccinated AZ right into the groups most at risk of blood clots, while UK did the opposite, hence in Germany people started panicking. Maybe also the fact that there was distrust in AZ already before contributed to finding/reporting more blood clots in Europe in the initial phase.

[urutzizu]

https://m.dw.com/en/coronavirus-germany-opens-up-astrazeneca-covid-vaccines-for-all-adults/a-57453351

Germany will offer the AstraZeneca vaccine to all adults without prioritisation. This is happening because aside from take-up issues, most above 60 have been offered their first dose, so the AZ vaccine would be wasted otherwise, and because Germany is lifting many restrictions for vaccinated people, which inevitably would otherwise result in de facto age discrimination against younger people, especially because they are still quite strict especially compared to the rest of Europe/US.
 
So the approval of AZ in Germany has been:
Not allowed for anyone-->Not allowed over 65-->Allowed for Everybody-->Not allowed for anyone-->Not allowed under 60-->Allowed for Everybody.

Nonetheless a very good decision. I'll see if I can get an appointment.

[urutzizu]

This is creating quite a stir in Portugal:

She isn't wrong, because the EU agreed to have a ban on non-essential travel on third countries with exception of those with good epidemiological situations (Israel, Japan, South Korea and now US but explicitly not UK). Many MS went against that, but Portugal was the only unfortunate enough to be put on the UK quarantine-free list too.

But it is also stupid because the situation isn't exactly that much better in Germany. Delta varient is already at 25% of new infections in places like Munich, because Germany's restrictions against travel from those countries (UK and India) are a joke too. While there is a ban on non-citizens except with residence in Germany, if you meet the criteria all you need is a test before boarding (the antigen self-test crap will do) and then you go home (public transport is fine) where you are supposed to self-isolate for 14 days. Especially because most people returning from places like India are students, and you can self-isolate really well in student accommodation.

The cost-benefit ratio if all MS could just agree to a universal hotel-isolation system for anyone travelling into (mainland) Europe, and then being able to drop all the restrictions to internal European travel plus having to worry much less about the variants, but it doesn't work if only some states do it.

[urutzizu]

Spread of delta variant in Germany week by week:



In the week 14.06.2021 - 20.06.2021 the delta variant made up 37% of new infections, more than doubling week on week. So it is almost certainly the dominant variant now and means that the trajectory is following the UK by about 4 week delay. That does not necessarily have to be a problem, because the Vaccination program should be just as advanced by then, but it is a bigger problem with other European countries that have much higher vaccine hesitancy, especially in Eastern Europe (such as Romania, where less than 25% of the population have had the first dose but nobody can be found anymore to take the vaccine) but also France.

[urutzizu]

The first doses beginning to slow in many European countries now due to beginning to reach the limits of those who do not need convincing to get vaccinated. France is the western European country with the most anti-vaccine sentiment, and is therefore most at risk from the delta variant surge likely to happen soon (only 53% of population with at least 1 dose). So Macron announces that France is going to be the first European country to my knowledge to make life much harder for the unvaccinated:
-mandatory vaccines for care workers
-Health certificate (negative test, recovered or vaccinated) mandatory for most aspects of public life including long distance trains, bars, restaurants, Shopping centers und Hospitals
-PCR tests will cost money unless prescribed

https://www.lefigaro.fr/politique/covid-19-variant-delta-pass-sanitaire-vaccination-des-soignants-ce-qu-il-faut-retenir-des-annonces-de-macron-20210712

I wonder if this is going to be necessary across Europe to stay open. Other western European countries however don't have such high levels of vaccine skepticism (will likely reach about 80% of adults vaccinated). And while in France the vaccine skepticism is high, it is not high enough where Macron's risk of losing votes from anti-vaxxers (which presumably won't vote for him in large numbers anyway) will be a greater risk to him, than not keeping the pandemic under control. That is possibly a different equation in places like Romania or Poland where Governments have more to lose from losing the votes of anti-vaxxers. Which is a problem of course, because in a Europe that is integrated that presents a health risk to the rest of Europe as well.

[urutzizu]

As we can see with the new Infection control law, the only substantive measure that there seems to be enough political support/consensus for is reintroducing free tests for the unvaccinated. Even the oh so tough Söder et al are not actually putting their money where there mouth is on "2G" (which in Bavaria is just a pcr-test obligation which they are introducing). Despite there being a majority in the population for even much more radical measures such as in favour mandatory vaccinations. But the political class is simply not willing to risk the unvaccinated all going AFD.

Fundamentally in my view there are two ways here really, you can be like the UK and just Ignore the Virus which means a high number of deaths, but now also an infection rate similar to or lower than much of Europe which is implementing measures, or you can do what Macron or Draghi have done, and have the balls to take the necessary measures to push the anti-vaxxers into the cold water, with the risk that, yes, sociatal polarisation will increase and many will go further down the rabbit hole.

The problem for Germany is that our societal mentality won't allow us to do the first, while our political system cannot give us the second. For all the positives about a compromise oriented system, the result of a lowest possible denominator simply is not good enough in a pandemic. Especially if it means in practical terms that the only measure we can all agree on is the one that will actually decrease the incentive to get vaccinated (and being deeply insulting to the Idea of personal responsibility, something that has not stopped the FDP of being the loudest advocate for it of course.)

[urutzizu]

https://orf.at/stories/3236982/
Full Lockdown for *everyone* in two Austrian states and looks like the entire country could follow suit. Schools closed, shops closed, no leaving home for non-essential reasons no matter vaccination status. As if the Vaccines didn't even exist.

Apparently some parts of industry actually support it, because of Austria's situation with being dependant on the winter season and the reasoning that it's less bad to take the hit now, and get numbers down that so foreign tourists can/will come, but it's still nuts. Who is going to get vaccinated if you have to stay home anyway?

[urutzizu]

https://www.berliner-zeitung.de/news/corona-staerkerer-anstieg-der-todesfaelle-bei-auslaendern-li.202055

From 2019 to 2020 the number of deaths among the Ages 45-64 increased by
1.1% among Germans
9.0% among Immigrants

In Switzerland
2.6% among Swiss people
12.5% among Immigrants

Sadly the stats for other age groups is not disclosed in the article. But it indicates a massive, probably even greater disparity of the effects of the virus than the racial disparity in the US (which for black, hispanic and native americans according to the CDC is about a factor 2x the death rate of whites). It's interesting, because unlike in the US it is not spoken about much at all in the public debate around the pandemic/restrictions.

[urutzizu]

I heard only 30% of elderly Hong Kongers are vaccinated even while the overall population rate is much higher. I'm not sure what causes that weird phenomenon, but it would explain the death rate. New Zealand did the elimination strategy right with less than 5% of over 12s unvaccinated and Omicron didn't really take off until a majority were triple vaccinated. This is how the elimination strategy is supposed to work, buying time for science to make the virus milder.

The problem is not just the low rate of vaccination among the elderly, but also the vaccine used. The older you are the more likely you are to use Sinovac (Chinese vaccine) and refuse Biontech (Pfizer vaccine). The younger, the more likely you are to use Biontech and refuse Sinovac. The problem is, while Sinovac was ok-ish until the Alpha variant, it has become almost totally ineffective as the virus has mutated, in a way the mrna vaccines have not.



The reason for this specific effect are generally seen as political polarization in pro-china and anti-china. Also information sources, young people are more likely to use western social media/media sources in which the Chinese vaccines were from the start questioned. While the older generations (if at all) more use Chinese social media/media sources, where there was a huge amount of anti-western vaccine disinformation (state-endorsed), especially at the start of 2021.

But low vaccination rate among elderly overall (Sinovac or no sinovac) does not really have political reasons: older generations of Chinese just tend to have more superstitious beliefs on medicine and science than their western counterparts. There are good ways to reconcile and compliment traditional Chinese medicine with modern, but older generations are particularly recalcitrant.

This can be seen in that Hong Kong's vaccination problem is a actually remarkably similar to mainland China, just it doesn't notice there due to the lower number of cases. But China has the same problem, with in some provinces those over 70 have only a 50% vaccination rate, and over 80 even lower. Macau has the same problem even more extreme than HK, and it can even be seen a little bit (a much, much lesser level though) in other ethnic Chinese countries like Taiwan and Singapore.

The problem is that the central Government sees this current outbreak as a direct threat to the entirety of China as it is putting elimination on the mainland in danger, and the inability to get it under control as the fault of the insubordinance of the local population and the inadequacy of (the remnants of) Hong Kongs "western" political system and autonomy. The risk is that they for this reason decide to destroy the remaining parts of Hong Kongs difference (which, aside from democracy, are still significant) and fully incorporates it into the mainland.

[urutzizu]

A major issue in China is also just the incoherence of the response. On the one hand you have this extreme lockdown in Shanghai, Guangzhou likely following suit in a few days over 27 new cases. On the other hand you have in Jilin (aside from Shanghai the other major outbreak) essentially abandoning, with easings now taking place. They are saying Jilin has "achieved dynamic (?) zero covid", despite almost 1000 new cases per day (counting asymptomatic). You have people like Sun Chunlan (Vice Premier) visiting Shanghai and saying "Lockdown has to continue and even get harsher (?) in certain areas" while at the same time local authorities are easing (admittedly only slightly). China is politically extremely centralized, administratively not so much.

In terms of what is happening in Shanghai forcing a shift away from zero covid (the strategy, not "zero covid" itself which will never be achieved), I wouldn't bet on it anytime soon. If anything what happened in Shanghai, will do the opposite. Shanghai was actually, initially, a test for shifting to a new strategy. Because zero covid was so costly in places like Xian, in Shanghai (which for Chinese standards even when it had cases always had a relatively "liberal" covid policy) local authorities were allowed to try a new strategy which only locked down certain neighborhoods. Of course, as we know now, this didn't work and later the whole city was locked down. Whereas at the same time with similar circumstances in Shenzhen a full lockdown was implemented almost immediately, the outbreak was contained and the city opened up. Which is why they seem to be about to do the same in Guangzhou. This reading is in theory correct (FTR I oppose zero covid), but in practice long-term unsustainable.

I don't think however that major unrest or "collapse" is likely. It is important to keep in mind that 95% of China is not in a insane Shanghai-style lockdown (discounting Jilin, counting Guangzhou whichever way you want). Under annoying restrictions in many cases, yes, like restrictions of internal travel in China and arbitrary mass-testing, but not actual lockdown.

[urutzizu]

Shanghai update: So, Shanghai has apparently "achieved social zero covid". It seems zero zero and dynamic zero didn't quite cut it, so social zero means that on Friday there were no new infections (symptomatic or asymptomatic) outside quarantine areas (on Thursday that number was still 108 and around 200 for the rest of the week). There are still some 16,000 quarantine areas in Shanghai with 4 Million people banned from leaving home. Overall, there were in "social zero" Shanghai 10,181 new infections yesterday, but according to official data every single one if these is in quarantine. Seems like Shanghai, at least parts of it, will open up now (so far even for people in non-quarantine areas movement has been very restricted).

Smaller outbreaks in other cities such as Beijing or Guangzhou are not (yet) being dealt with full Shanghai-style lockdown, but still with quite severe restrictions. Practically, many businesses are closed/working remotely many streets are empty, and a full lockdown looks possible. A change in this looks totally impossible, as vaccination of elderly groups has taken even less priority. For instance in Shanghai most vaccinations are closed, and overall while it is still urged officially, it is de facto not really psychologically communicated as so important anymore as opposed to mass testing and quarantine, and sometimes even things like Lianhua Qingwen (traditional Chinese medicine). It seems that for the Chinese authorities, the risk of political backlash from forcing vaccinations and potential side effects is viewed as much more risky than the risks from zero-Covid, and if that's true, that is a massive problem.

[urutzizu]

In Shanghai the number of officially reported cases has been below 200 the last days (compared to ~25000 at the peak) and in Mainland China overall about 300. Beijing is next with around 20 cases, where authorities now also say that the outbreak has been fully controlled, an otherwise there are officially no major outbreaks any more.

Questions:
(1) Can the data be trusted? A: Yes, at least the direction of it can. It is clear from anecdotal evidence that deaths were underreported. However, in general as the strategy is zero covid, than any broad falsifications in cases cannot hold up long term, because if the outbreak is not actually under control, people will on masse, well, get sick that are not officially not supposed sick, see North Korea. This is the reason why despite the widespread distrust after reporting the Wuhan outbreak eliminated, there was no major outbreak again until Shanghai.
(2) What does this mean? A: Zero covid "works", if one implements harsh (Chinese harsh, not western harsh) measures immediately, and at a huge economic cost. For Xi Jinping however this is irrelevant because the political cost of losing control or allowing foreign vaccines is much greater (a poll recently showed only 30% of Chinese people would accept a western vaccine).
(3) What will the future look like? A: Brutal zero covid until at least either 13th NPC early next year or Chinese mrna vaccine. Looking like the former will probably be first anyway. And even after that it is not certain that something will change. Sad situation if you have family in China.