Evidence of Omicron taking over and even breaking through lockdowns has led to cases rising ‘everywhere’

Evidence of Omicron taking over and even breaking through lockdowns has led to cases rising ‘everywhere’

The UK released vaccine efficacy data against Omicron hospitalisations this week, showing an estimated efficacy of 88% 2 weeks after a booster dose, 72% 2 to 24 weeks post the second dose, 52% >25 weeks post the second dose, and 52% after a single dose. This compares with an efficacy of 98% against Delta after a booster or 90% after two doses. This data demonstrates the importance of a booster dose for reducing the pressure on health systems from Omicron. The UK also released updated data on the risk of Omicron hospitalisation showing that: (1) the risk of hospital admission was approximately one third of that for Delta and (2) the risk of an emergency visit or hospitalisation was half of that for Delta. This data continues to highlight that the impact of Omicron is comparatively more mild than previous variants.

This builds on the evidence from South Africa, where the Omicron wave has peaked and cases are falling. In the UK, despite another substantial rise in cases (up 54% to 1.15million) and in hospitalisations up 68% to ~15,500, hospital occupancy is still only 1/3 of the last winter peak (12,657 average for the week) and ventilator occupancy remains relatively low at 19%. Although there are likely to be further rises in hospitalisations, cases could potentially be peaking in London which could be a lead indicator suggesting a peak in hospitalisation the next 2-3 weeks, with high rates of boosting leading to the relatively limited cases of severe disease compared to other countries.

In the rest of Europe, evidence of Omicron taking over and even breaking through lockdowns (potentially with the help of lower adherence of the population to measures over Christmas) has led to cases rising ‘everywhere’. In countries with lockdown measures, cases rose in Austria by 41%, the Netherlands by 19%, Belgium by 29% and Germany by 1%. In the rest of the EU5, cases rose in Italy by 164%, France by 131%, Spain by 88%. Outside the EU5, cases rose in Denmark by 40%, Switzerland by 61% and Sweden by 3%. In terms of hospitalisations, Germany fell by 18%, bring the weekly total to ~6,264. In France, hospitalisations rose by 32% this week to around 11,297.

For the UK it seems to be a high rate of boosting, is tipping the balance and allowing the government to manage the situation with only Plan B measures. However, for countries with low booster numbers and high hospitalisations from Delta already (such as France), further lockdown measures may be required in the coming weeks. Although there is the first evidence this week that lockdown measures might not be able to fully stop Omicron’s spread, we will need a few weeks data to more fully assess this, given the potential confounding of Christmas. This is reflective of the situation, South Africa to London:

The share of the population having received a first shot stands at 85% in Spain, 83% in Canada, 80% in Japan and Italy, 79% in Australia, 78% in Brazil and France, 76% in the UK, 74% in Germany, 73% in the US, 61% in India, and 51% in Russia. The daily pace of new doses administered (7DMA) increased to 13mn in China and 5.8mn in India and decreased to 32mn globally, 0.4mn in the US, and 1.9mn in the EU. The share of the population having received a booster shot stands at 57% in Chile, 50% in the UK, 46% in Israel, 38% in Germany, 36% in South Korea, 33% in France, 32% in Italy, 29% in Spain, 27% in Turkey, 21% in the US, 20% in Canada, 19% in Malaysia, 12% in Brazil and Argentina, 11% in Singapore, 9% in Thailand and Australia, 7% in New Zealand, 5% in Russia and Hong Kong, and 2% in Philippines. Over the past week outbreaks have worsened in Ghana, Australia, Argentina, China, Italy, the US, as mentioned the UK, France, Italy, Spain, Canada, and Switzerland and improved in Kenya, South Korea, Russia, South Africa, and Nigeria. In developed markets virus spread surged in the US, Canada, France, Italy, Spain, and the UK, picked up in Germany, and remained low in Japan:

There’s going to be a lot of this now we have much better almost real time genomic surveillance, this from Raoult’s group, of hydroxychloroquine fame:

“For twelve SARS-CoV-positive patients living in the same geographical area of southeastern France, qPCR testing that screen for variant-associated mutations showed an atypical combination. The index case returned from a travel in Cameroon. The genomes were obtained by next-generation sequencing with Oxford Nanopore Technologies on GridION instruments within ≈8 h. Their analysis revealed 46 mutations and 37 deletions resulting in 30 amino acid substitutions and 12 deletions. Fourteen amino acid substitutions, including N501Y and E484K, and 9 deletions are located in the spike protein. This genotype pattern led to create a new Pangolin lineage named B.1.640.2, which is a phylogenetic sister group to the old B.1.640 lineage renamed B.1.640.1. Both lineages differ by 25 nucleotide substitutions and 33 deletions. The mutation set and phylogenetic position of the genomes obtained here indicate based on our previous definition a new variant they named “IHU”. These data are another example of the unpredictability of the emergence of SARS-CoV-2 variants, and of their introduction in a given geographical area from abroad”:

Looking at only the amino acids on the spike protein, 14 changes and 9 are missing. The key sites found included N501Y and E484K. This change from the mutated location is expected to have an immune escape effect similar to that of omicron. But the virus is thought to have likely been ingested with omicron because data in France have been found for nearly two months now. It’s more similar to Delta:

https://www.medrxiv.org/content/10.1101/2021.12.24.21268174v1

UK cases confirmed using Taqpath PCR assay. S-gene target failure (SGTF) in purple is a surrogate for Omicron:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044522/20211231_OS_Daily_Omicron_Overview.pdf

The CDC is looking at adding a negative test to its five-day isolation restrictions for asymptomatic Americans who catch the coronavirus, NIAID Director Anthony Fauci said yesterday, after fallout from its updated recommendations last week.

I do not understand this distinction. Isolation and quarantine are the same thing and using two words to make them seem like different things is confusing. Maybe it’s for legal reasons? In Germany if you’re infected or called by the tracers you’re put in quarantine. Then the government pays your income somehow because it prevented you from working. However, if you’re isolating there’s no legal force behind it (maybe you know that you have been exposed but tracers are overwhelmed and there’s no one mandating you stay at home). No legal force = no income. Maybe something similar applies in the US?

Novavax announced that it has completed the data package required for the EUA application for ‘2373 in the US. Specifically, the company submitted the CMC data module providing visibility on the EUA request, which according to FDA guidance, needs to be provided “not less than one month prior to submission of an EUA request”. This is the first protein based COVID-19 vaccine that may receive authorisation in the US. The EUA submission will be based on clinical data from two large P3 studies including the trial of 15K volunteers in the U.K. and the ~30K subject P3 PREVENT-19 study based in the US/Mexico. As a reminder, the P3 UK study showed efficacy of 96.4% against the original virus strain, 86.3% against the Alpha (B.1.1.7) variant and 89.7% efficacy overall, as well as a favourable safety and tolerability profile. The PREVENT-19 study showed 100% protection against moderate and severe disease and 90.4% efficacy overall. In addition to the efficacy of ‘2373, according to the recent PREVENT-19 clinical data published in NEJM:

https://www.nejm.org/doi/full/10.1056/NEJMoa2116185?query=featured_home

Novavax recently announced initial data evaluating the immune response of ‘2373 against the omicron variant, as well as additional data from its adolescent cohort of the P3 PREVENT-19 and its ongoing P2 booster study. There’s a robust immune response from the booster dose vs. what was observed from peak responses after the two-dose primary vaccination. Furthermore, the improvement in immune response was noticeably robust against the omicron variant. It’s fridge stable too.

Today worth singling out India and Canada. First, India’s daily case counts have increased sharply – from around 6,500 a day on Dec 26 to 33,650 on Jan 3. Cases in Mumbai increased from under 900 on Dec 26 to more than 8,000 on Jan 2 (Mumbai recorded a peak of 11,000 cases early April during the second wave). Delhi is witnessing a similar spike as well. The high levels of mobility and the example of other countries suggests infections can spread from Mumbai / Delhi to other parts of India as well – driving national totals higher rapidly. More than 60% of India's adult population has had both vaccination shots. While vaccinations have not prevented the spread of infection, the hope is that hospitalisation and fatality rates are reduced now. Yet, India's large size can create problems. As an example: Mumbai had 8000 odd active COVID-19 cases on Dec 29 of which 157 (2%) were medically critical (54% were asymptomatic and 44% were symptomatic but stable). The city has 1965 ICU beds and 1148 beds with ventilators. If the percentages of criticality hold, then crossing 150,000 active cases in the city could lead to full utilisation of ICU/ventilator beds. This is where the pace of infection growth becomes critical – despite vaccinations, Mumbai likely cannot afford the near vertical spikes in cases seen in other global cities. This is a good India twitter feed:

https://twitter.com/hemantrajora_/status/1477979390042525697?s=21

The latest wave in South Africa (where the Omicron variant was first detected) peaked in 24 odd days. The previous wave in that country had peaked in about 65 days. Coincidentally, Mumbai's first and second waves had peaked when cumulative reported infections had reached 175-200 thousand. At current rates, the new wave can hit this milestone in around 20 days (fewer if daily cases continue to rise). Other parts of the country may lag – meaning total Indian cases might peak slower, but markets may take a cue from trends in early infection cities such as Mumbai. Mobility metrics remain elevated in contrast to Ontario further below:

Second, Canada’s most populous province has announced new restrictions, including closing down schools and shops operating at 50% capacity as officials warned of a “tsunami” of new Covid cases. Pupils in Ontario will move to online learning as all schools were ordered to shut down, while shops and indoor shopping malls were ordered to restrict operations to 50% capacity. Outdoor services will be limited to a number where people can maintain 2 metres of physical distance:

This is interesting:

https://covid19-sciencetable.ca/ontario-dashboard/

UK: Hospitalisations rising faster this week, but Hospital occupancy rising at a much slow rate still gives cause for cautious optimisim

Over the week December 27 – January 2 the new infection count increased significantly again by 54% to 1,154,416 (a new high level of cases recorded in a week during the pandemic), of which 86,848 were official Omicron cases identified this week (prev. week 122,831). Testing levels were down 8% and so the rate of positive tests was up significantly 10.9% (prev. 7.3%); with the rate above 5%, the wave in the UK is going exponential. Per day infections were between 97,579 and 188,508 with the majority of infections in the 20-49 year olds (see Figure 1 & 2). Cases in 5-14 year olds remain broadly flat, with cases in the 15-19 year olds continuing to rise (see Figure 1). Cases in 50-59 year olds are rising significantly as well, but in the above 60s there has only been a small rise thus far (See Figure 3 & 4).

Figure 1: England Daily Cases for 0-29 year olds showing the significant impact of Omicron on the 20-29 year olds

Figure 2: England Daily Cases for 30-49 year olds showing a significant rise in cases as Omicron hits

Figure 3: England Daily Cases for 50-69 year olds showing the impact of Omicron in the last few weeks

Figure 4: England Daily Cases for 70+ year olds showing a small rise in cases in the last weekSource: UK.gov

Regionally cases in London look like they might be coming towards a peak (See Figure 5), but cases in other regions continue to rise significantly (See Figure 6). If London is peaking, this could suggest a peak in each region in about 4-5 weeks. with London cases starting to rise in early December due to Omicron. With cases in the other regions starting to rise about two weeks later, this suggests we could see a peak in mid to late January. Although the return to school could lead to a sustained peak.

Figure 5: London Daily COVID-19 CasesRegionally cases in London look like they might be coming towards a peak (See Figure 5), but cases in other regions continue to rise significantly (See Figure 6). If London is peaking, this could suggest a peak in each region in about 4-5 weeks. with London cases starting to rise in early December due to Omicron. With cases in the other regions starting to rise about two weeks later, this suggests we could see a peak in mid to late January. Although the return to school could lead to a sustained peak.

Figure 6: Northern England Daily COVID-19 Cases

Source: UK.gov

With this large rise in cases, hospitalisations grew this week by 68% to 15,482. The rate of hospitalisation increased slightly to 1.3% (prior week 1.2%). The rise in hospitalisations continues to be worrying; however, the rise in hospital occupancy continues to be lower with a 53% increase this week, to 12,657 bed occupied on average, with is 1/3 of bed occupied at the peak of last January’s wave (for the week ending Jan 24, 2021). The occupancy of ventilators continues to be the most encouraging datapoint with occupancy still relatively stable at ~19.3% (last week 18.8%), which equates to ~866 people (though this is more of a lagging indicator). So far the impact of Christmas mixing has been to nearly double hospitalisations to over 16,000 and one would anticipate a further rise this week and for the next couple of weeks. That said if London is a leading indicator and cases are peaking, this could suggest that the situation will remain manageable in the UK without further restrictions as the rise in hospitalisations and occupancy would be expected to also peak in the next 2-3 weeks naturally at a level significantly below last year’s peak. While the situation in the UK has clearly got worse over Christmas, the lack of a significant increase in severely ill patients, highlighted by the limited increase in ventilator occupancy for COVID-19 and lower rates of hospital occupany seems to suggest that the UK could still avoid a major lockdown.

Figure 7: UK Weekly Infections Aug 2, 2020 – Jan 2, 2022 Actual vs. Projected

Figure 8: UK Weekly Hospitalisation Aug 2, 2020 – Dec 26, 2021 Actual vs. Projected at 1.5% of cases

 

Figure 9: UK Weekly Hospitalisations Aug 2, 2020 – Jan 2, 2022 Actual vs. Projected at 1% of cases

Figure 10: UK Weekly Hospital Occupancy Aug 2, 2020 – Jan 2, 2022 Actual

Source: UK.gov; J.P. Morgan estimates

Figure 11: UK Weekly Ventilator Occupancy Aug 2, 2020 – Jan 2, 2022 ActualSource: UK.gov; J.P. Morgan estimates

Source: UK.gov; J.P. Morgan estimates

Figure 12: UK Weekly Deaths Aug 2, 2020 – Jan 2, 2022 Actual vs. Projected at 0.2% of infections (3wks prior)Source: UK.gov; J.P. Morgan estimates

Omicron continues to drive the surge in cases in the UK, with UK cases up 54% this week to an average of 164,917 cases per day. A total of 246,780 Omicron cases have now been confirmed in the UK, an increase of 86,848 cases compared to last week, with a further suspected 600,041, a weekly increase of 246,563 cases. Total hospitalisations have also risen by 68% this week to 2,158 new admissions per day, a hospitalisation rate of 1.3% (prev. week: 1.2%), still lower than the rate seen with Delta of 2-3%. 25% of unvaccinated Omicron hospitalisations were hospitalised (prev. week: 28%).Omicron UK hospitalisations data continues to look encouraging, South Africa seems to have peaked 6 weeks after the outbreak

The UK has also reported vaccine efficacy against Omicron hospitalisations for the first time this week with vaccine efficacy against hospitalisation estimated at 88% 2 weeks after a booster dose, 72% 2 to 24 weeks after dose 2 (52% after 25+ weeks), and 52% after a single dose. This compares with an efficacy of 98% against Delta after a booster dose or 90% after two doses, with limited waning seen against Delta hospitalisations. The two-dose data is in line with the data already reported by Discovery Health in South Africa, where a vaccine efficacy of 70% against hospitalisations after two doses was seen, with the improvement through a booster expected but still encouraging. The comparatively 10pp lower efficacy against Omicron vs. Delta after boosting is in-line with our expectations, given Omicron carries a lower risk of hospitalisation. Updated data from the UK shows that the risk of emergency care visits or hospital admission with Omicron was approximately half of that for Delta (HR: 0.53, 95% CI: 0.50 to 0.57). The risk of hospital admission alone with Omicron was approximately one-third of that for Delta (HR: 0.33, 95% CI: 0.30 to 0.37).

Vaccine efficacy data against cases is unchanged from last week (n= 147,597 Delta cases; 68,489 Omicron cases). In those who received an Astra primary series, vaccine efficacy against symptomatic disease after either a Pfizer or Moderna booster was around 60% 2-4 weeks after receiving the booster (compared to the previous estimate of 71.5%), dropping after 10 weeks to 35% in those with a Pfizer booster and 45% in those with a Moderna booster. Among those who received a Pfizer primary course, vaccine effectiveness was around 70% after a Pfizer booster, dropping to 45% after 10+ weeks and remaining at 70-75% after a Moderna booster up to 9 weeks after the booster. While it is still too early to definitively assess, this data potentially suggests the need for a 4th dose (or a second booster) in those most at risk of hospitalisation (i.e. 65+ year olds) in the coming months.

Israel is also seeing an Omicron surge with cases rising by 242% this week to 4,263 cases per day. New severely ill admissions also rose by 16% this week to an average of 11 new admissions per day, equating to a new severely ill rate of 0.2% (prev. week: 0.7%), which is the lowest level we have seen in Israel. A real world Israel study, currently underway, should inform whether a 4th dose is needed, particularly to protect against hospitalisations, with Israel having already started a rollout of a 4th dose in over 60s.

For South Africa our colleague Alex Comer is monitoring cases and hospitalisations (here). Cases declined this week by 44% to 58,896 weekly cases (prev. week: 105,466 weekly cases), albeit still higher than prior to the Omicron outbreak, continuing to highlight that the week-ending 19th December 2021 was the peak of Omicron cases in South Africa, 6 weeks into the outbreak (4 weeks post first confirmed case). Hospital admissions fell by 22% this week to 1,873 weekly admissions, with the slower decline relative to cases resulting in an increase in the hospitalisation rate to 3.2% (prev. week: 2.3%), still lower than the Delta peak of 5.3%.

Figure 13: Latest cases in South Africa

Figure 14: Weekly hospitalisation rates in South Africa vs. cases

Source: South African Health Ministry

Moderna released booster data last week showing that the Moderna 50µg booster increased neutralising antibodies against Omicron by 37 fold, compared to Pfizer’s increase by 25 fold. Using the primary series dose of a 100µg booster increased neutralising antibodies against Omicron by 89 fold, suggesting potentially superior efficacy of the Moderna booster relative to Pfizer against Omicron cases, with this data coming through in the UK real-world data highlighted above, where the 50 µg booster dose is currently being used. AstraZeneca also reported data last week showing that an Astra booster restored neutralising levels against Omicron to the levels seen for Delta after two doses, highlighting that T-cell response should provide durable protection against severe disease and hsopitalisations, although this data is still pending.

Table 1: Pfizer Vaccine Efficacy against different variants on Cases, Reduction in Neutralising Antibodies and Hospitalisations


A deeper look at German infections & hospitalisationsSource: Lancet, NEJM, PFE Company data, UK gov

Over the week December 27 – January 2 the daily new infection count was up 1% to 199,156 potentially as Omicron starts to breakthrough the lockdown measures for the unvaccinated. New case numbers were between 12,636 and 41,820 per day compared 10,158 and 45,858 per day the week before. Hospitalisations fell by 18% to 6,264. ICU occupancy for COVID-19 also decreased by 10% to 4,011, 18.0% of beds, and total ICU occupancy also fell to 83.3% (from 83.5%). Potentially this week could be the first signs of Omicron infections outweighing the effects of the lockdown for the unvaccinated.

Figure 15: Germany: Change in Daily New Infections since Feb 26, 20

Figure 16: Germany: Change in Daily New Deaths since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 17: Germany: Weekly Hospitalisations since Feb 26, 2020

Figure 18: Germany: Weekly ICU Occupancy since Feb 26, 2020Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 19: Latest booster % over 50s for EU5 and US (% adults)Development in Vaccinations in the EU5, Israel & the US

Figure 20: Fully vaccinated % for EU, US and SA (% population)Source: CDC, UK, French, Germany, Spain, Italy governments. *Note Italy restated booster data by age group this week.


Figure 21: Latest vaccination % for EU5 and US (% adults)Source: CDC, UK, Netherlands, Austria, French, Germany, Spain, Soufth Africa and Italy governments.

Figure 22: % Natural Immunity due to prior infection

Source: CDC, UK, French, Germany, Spain, Italy governments.

The UK has now boosted 64.7% of its adult population (prev. week: 61.6%). Full vaccinations are now at 88.7% of adults (prev. week: 88.6%) while first doses have been administered to 94.1% of adults (prev. week: 94.0%). Looking at vaccination by age, one can estimate 54% of 12-15 year olds (prev. week: 53%) and 71% of 16-17 year olds (prev. week: 70%) have now received at least one dose. This compares with 77% of 18-24 year olds (prior week: 76%), 78% of 25-29 year olds (prev. week: 78%) and 96% of those aged 30 and over. Full immunisation has been achieved in 45% of 16-17 year olds (prev. week: 42%), 69% of 18-24 year olds (68% in the prior week), 71% of 25-29 year olds (71% in the prior week) and 80% of 30-34 year olds (80% in the prior week) compared with 94% in the 35+ population. Booster doses have been administered to 87.1% of over 50s (prev. week: 85.9%), 91.2% of over 60s (prev. week: 90.5%) and 91.9% (prev. week: 91.4%) of over 65s, the age groups most vulnerable to hospitalisation. The booster rollout saw a significant 62% decline this week to an average of 233k doses per day due to holidays over the Christmas and New Year’s period. I expect this to recover in the coming week as adults who have not yet taken up their offer of a booster start to come forward for their booster vaccine post the Christmas break.

Looking across the EU4 on booster doses, important for protection against Omicron cases, Germany continues to lead the way in Europe, having boosted 46.3% of adults (prev. week 43.0%). France is on 46.1% (prev. week: 41.6%), Italy is on 38.9% (prev. week: 33.7%) and Spain is on 34.8% (prev. week: 33.0%). For over 50s, more at risk from hospitalisation, France is on 62.8% (prev. week: 59.3%), Germany is on 62.0% (prev. week: 59.3%), Spain is on 62.0% (prev. week: 58.3%) and Italy is on 54.0% (prev. week: 49.1%).

For the primary series, France has fully vaccinated 91.0% of its adult population, Spain is on 90.7%, Italy is on 82.5% and Germany is on 82.0%. Spain has partially vaccinated 95.0% of its adult population, France is on 93.0%, Italy is on 88.4% and Germany is on 85.1%. Germany reported a 34% decline in first doses, 33% decline in second doses and 38% decline in booster doses administered this week due to holidays over the festive period. Comparatively, France reported a 2% rise in first doses, 9% decline in second doses and 11% rise in booster doses. Italy reported a 43% rise in first doses, 35% rise in second doses and 15% rise in booster doses

We expect uptake of first doses, second doses and booster doses to rise in the coming weeks across the EU, driven by concerns over Omicron as well as the implementation of measures to curb the Omicron outbreak. Specifically, in Germany, STIKO shortened the recommended period for booster doses this week to 3 months for individuals who received a two-dose course (prev. 6 months), with timing for booster doses post the one-shot JNJ vaccine maintained at 4 weeks. Additionally, the introduction of mandatory vaccination (or confirmation of recovery from COVID-19) for all healthcare workers at hospitals, doctors’ offices and nursing homes will be enforced by mid March. France have shortened the timing for the booster dose to 3 months (from 4) and are expected to convert the COVID-19 Green Pass to requiring proof of vaccination by January 15th (currently vaccination or negative test). Italy has also followed other EU countries in shortening the time for the COVID-19 booster dose to 4 months (from 5 months), effective from January 10th and is expected to consider their COVID-19 Green Pass to vaccination only (currently vaccination or negative test result).

The US has fully vaccinated 72.8% of adults (prev. week: 72.7%). First doses have been administered to 85.5% of its adult population (prev. week: 85.2%). Booster doses have been administered to 36.3% of all adults (prev. week: 35.2%) and to 48.2% of over 50s (prior week: 47.7%).

Figure 23: EU 5, Israel & US Cumulative 1st doses administered


Figure 24: EU 5, Israel & US Cumulative fully vaccinatedSource: UK, France, Germany, Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.


Figure 25: EU 5, Israel & US % of Population received 1 doseSource: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.


Figure 26: EU 5, Israel & US % of Population fully vaccinatedSource: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.


Figure 27: EU 5, Israel & US Cumulative Booster doses administeredSource: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.


Figure 28: EU 5, Israel & US Cumulative Boosters % of PopulationSource: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.


Examining the impact of the Vaccine in the UK, US and IsraelSource: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.

Israel, which has fully vaccinated ~90% of its adult population and has administered booster shots to ~72% of its adult population, reported a 242% rise in infections this week to 4,623 cases per day, with cases in the last few days above 6,500, the highest level since mid September. New severely ill admissions saw a 16% rise this week to 11 new admissions per day, equating to a new severely ill rate of 0.2% (prev. week: 0.7%), the lowest level we have seen in Israel throughout our monitoring. As evidenced in the case numbers, Omicron is now the dominant variant in Israel, accounting for 90% of all new cases. Israel is now offering 4th doses to those over 60, 4 months post the third dose.

US cases rose by 76% this week to an average of 421k cases per day, the highest level, with Omicron having now fully taken hold in the US, with the CDC estimating that Omicron now accounts for 58.6% of US cases (95% CI: 41.5-74.0%), compared with CDC's estimate of ~73% last week. Hospitalisations also rose by 46% this week to 13,126 new admissions per day or 91,885 weekly admissions, the highest level since late January 2021. The hospitalisation in the US is now at 3.1% (prev. week: 3.5%), the lowest level one has seen throughout monitoring.

In the UK, cases rose by 54% this week to an average of 164,917 new cases per day, with testing levels down 8%, i.e. an underlying increase of 62%. Hospitalisations were up 68% to 2,158 new admissions per day, a hospitalisation rate of 1.3% (prev. week: 1.2%), still lower than the average seen in the Delta wave of 2.0-3.0%. Omicron cases confirmed in the UK is now 246,780 (as at 31 December) with suspected cases at 600,041.

Data on vaccine efficacy against hospitalisations has now been released by the UK with vaccine efficacy against hospitalisation estimated at 88% 2 weeks after a booster dose, 72% 2 to 24 weeks after dose 2 (52% after 25+ weeks), and 52% after a single dose. This compares with an efficacy of 98% against Delta after a booster dose or 90% after two doses, with limited waning seen.

Data on vaccine efficacy against cases is unchanged from last week. In those who received an Astra primary series, vaccine efficacy against symptomatic disease after either a Pfizer or Moderna booster was around 60% 2-4 weeks after receiving the booster (compared to the previous estimate of 71.5%), dropping after 10 weeks to 35% in those with a Pfizer booster and 45% in those with a Moderna booster. Among those who received a Pfizer primary course, vaccine effectiveness was around 70% after a Pfizer booster, dropping to 45% after 10+ weeks and remaining at 70-75% after a Moderna booster up to 9 weeks after the booster.

In those without boosters, protection against Omicron is minimal after 20 weeks – for AstraZeneca, no protection is seen whereas for Pfizer/Moderna efficacy against Omicron wanes from 65-705 to around 10% by 20 weeks after the second dose.

The latest 3 week data on COVID-19 hospitalisations by vaccination status as at December 23, 2021 (no update since Christmas), highlight that 45% (prev. week: 43%) of hospitalisations (total of 8,190 hospitalisations) were in unvaccinated individuals with 55% of hospitalisations in fully vaccinated individuals (prev. week: 57%). 76% of fully vaccinated hospitalisations were in over 50s (prev. week: 79%), compared with 89% of hospitalisations in over 40s (prev. week: 91%). The hospitalisation rate for unvaccinated over 40s was 6.0% based on the latest data (prev. week: 6.5%) with a rate of 0.9% in fully vaccinated over 40s (prev. week: 1.2%) with the reduction in hospitalisation rate in both unvaccinated individuals by 7% and fully vaccinated individuals by 24% potentially reflective of the relatively milder disease caused by Omicron compared to Delta. Seroprevalence estimates for 17+ in England are at 98.4% using the Roche S assay (both infection and vaccination) as at 28 November 2021 and ~22.7% using Roche N assay (prior infection).

Figure 29: Israel Vaccinations compared to Daily Infections

Figure 30: Israel Vaccinations compared to Daily Severely Ill PtsSource: Israel government, worldometer, J.P. Morgan estimates.

Figure 31: US Vaccinations compared to Daily InfectionsSource: Israel government, worldometer, J.P. Morgan estimates.

Figure 32: US Vaccinations compared to hospitalisationsSource: CDC, worldometer, J.P. Morgan estimates

Figure 33: UK Vaccinations compared to Daily InfectionsSource: CDC, J.P. Morgan estimates

Figure 34: UK Vaccinations compared to Daily Hospital AdmissionsSource: UK government, worldometer, J.P. Morgan estimates.

Development in New Infections in the EU5Source: UK government, J.P. Morgan estimates

  • Looking at the new infection data on a weekly basis over the last week (December 27 – January 2), the EU5 new infections rose by 87% to 3,863,985 a new high week of the pandemic so far. Cases rose in all five countries with Germany seeing a 1% rise despite the lockdowns to 199,156. Cases rose in Italy by 164% to 680,774, in France by 131% to 1,134,290, in Spain by 88% to 695,349, and the UK by 54% to 1,154,416.

Figure 35: Weekly New Infections Development since Feb 23, 2020 for the EU5 Countries

Development in DeathsSource: WHO, Worldometer; J.P. Morgan estimates.

  • For the week ending January 2, the total death count in EU5 increased by 5% week on week to 5,523, with deaths increasing in 4 out of 5 countries. Deaths rose in France by 13% to 1,300, Spain by 22% to 422, by 3% in Italy to 1,013 and by 54% in the UK to 991. Deaths were only down in Germany they were down by 20% to 1,797.

Figure 36: Weekly New Deaths Development since February 2020 for the EU5 Countries

Table 2: Death Rate of Cases during different wavesSource: WHO, Worldometer; J.P. Morgan estimates.


Development in HospitalisationsSource: WHO, Worldometer, J.P. Morgan

  • Daily Hospital Admissions: Hospital admissions in France were up 32% at 11,297 for the week ending January 2. In Germany hospital admissions were down 18% to 6,264 and in the UK, hospital admissions were up 68% at ~15,482.
  • UK hospitalisations by Age: The data was updated on December 9, 2021 for the period up from Nov 3, 2021 to Nov 30, 2021. During November the proportion of people hospitalized above the age of 75 fell, as hoped as a result of the administration of boosters. Increases in hospitalisations in the 55-64 year olds shows that boosters are needed in this age range. The proportion of hospitalisations from the age group 18-54 also rose which fits with the government decision to boost all adults even before concerns about Omicron were raised. One would expect the hospitalisation rates to trend down with boosting through our December.

Figure 37: Daily Admissions to Hospital since Feb 23, 2020 for EU4

Figure 38: Daily Hospital Admissions/New Cases since Mar 22 for EU4

Source: UK.gov; ecdc.europa.eusalute.it

Figure 39: England Monthly Hospital Admissions by Age Oct 20 – Nov 21 (Data up to Nov 02)

Figure 40: UK Hospital Admission as % of cases in the week & % of cases 1 wk priorSource: NHS England

Hospital Occupancy: Occupancy rose in France by 13%, in Italy by 24% and by 53% in the UK.Source: UK gov

Figure 41: Hospital occupancy since Feb 23, 2020 for EU3 (# of beds)

Figure 42: Hospital occupancy since Feb 23, 20 for EU3 (% of beds)Source: UK.gov; ecdc.europa.eusalute.it

Source: UK.gov ecdc.europa.eu; salute.it
ICU Occupancy: In Germany ICU occupancy fell by 10% to 18.0 % or 4,011 beds on average occupied. This takes the overall occupancy in Germany to 83.3% (prev. 83.5%). Occupancy in the UK increased by 2% this week to 18.8% (prev. 19.6%). ICU occupancy in France increased to 46.0% (prev. 42.1%) of beds occupied and an average of 3,486 beds occupied. In Paris occupancy also rose to 62% (last week 53%). In Italy occupancy increased by 18%, with the percentage of beds occupied at 16.2% (prev 13.7%).Source: UK.gov; ecdc.europa.eusalute.it

Figure 43: ICU Occupancy since Feb 23, 2020 for EU3*

* UK data is Ventilator Bed Occupancy Source: UK.gov; govu.frsalute.it
Figure 44: % ICU Beds Occupied by COVID-19 since Mar 22 for EU3** UK data is Ventilator Bed Occupancy Source: UK.gov; govu.frsalute.it

* UK data is Ventilator Bed Occupancy Source: UK.gov; govu.frsalute.it

Development in New Infections in other EU Countries* UK data is Ventilator Bed Occupancy Source: UK.gov; govu.frsalute.it

  • Among the smaller European countries, new infections increased in all countries regardless of lockdown measures as Omicron transmissibility combined with Christmas mixing seems to resulted in the measures being less effective. In Austria cases rose by 41%, in the Netherlands cases rose by 19% and in Belgium infections rose by 29%. Infections increased again in Denmark by 40%, Switzerland by 61% and Sweden by 3%.

Figure 45: Other EU Countries: Weekly New Infections Development since Jul 5, 2021

Figure 46: Other EU Countries: Weekly % Change in New Cases

Source: WHO, Worldometer; J.P. Morgan estimates.

Detailed Country Analysis

  • Italy: Over the week December 27 – January 2 the daily new infection count rose for the eleventh week in a row by 164% to 680,774, with testing levels up 24% this week with total tests at 6,192,041 and so the rate of people testing positive rose to 12.6% (from 5.2%). The daily new infection count ranged from 30,797 to 144,237 per day (prev. 16,198 to 54,761 per day). The level of deaths increased by 3% to 1,013 (prev. 981). The average number of people in hospital with COVID-19 during the week increased by 24% to 11,998 (prev. 9,700). ICU average occupancy increased to 16.2% for the week (last week 13.7%). Although cases are rising significantly due to Omicron, the low ICU occupancy suggests that Italy does not need a lockdown at this point.

Figure 47: Italy: Change in Daily New Infections since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates

Figure 48: Italy: Change in Daily New Deaths since Feb 26, 2020

Figure 49: Italy: % of COVID-19 tests positive (weekly)

Source: salute.gov.it.

Figure 50: Italy: Wkly % Change in Tests & % Change in New Cases

Source: salute.gov.it.; J.P. Morgan analysis.

  • France: Over the week December 27 – January 2 new infections increased for the twelth week in a row by 131% to 1,134,290, as Omicron spread rapidly (with the daily increases between 30,383 and 232,200 compared to between 15,075 and 104,611 per day for the previous week). The rate of testing positive was up to 13.9% (prev. 8.1%) which means that the French outbreak is still exponential based on WHO terms (i.e., a positive test rate of 5% or above). Deaths were up 13% at 1,300 for the week. Hospitalisations increased by 32% to 11,297 for the week and ICU occupancy increased by 9%, with COVID-19 patients now occupying on average 3,486 beds 46% of France’s ICU capacity on average for the week (last week 42.1%). In Paris ICU occupancy increased to 62% (prev. 53%). France ICU occupancy continues to rise and with another increase likely this week more lockdown measures are likely to be introduced.

Figure 51: France: Change in Daily New Infections and Hospital Admissions since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 52: France: Change in Daily New Deaths since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 53: France: % of COVID-19 tests positive (weekly)

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 54: France: Weekly % Change in Tests & % Change in New Cases

Spain: Over the week December 27 – January 2 the infections were up by 88%, suggesting weekly infections are around 700k for the week. Deaths in the first 5 days of the last week were up 22% week on week at around 422 deaths. Spain continues to look concerning given the significant rise in cases, though deaths are remaining low so far.

Figure 55: Spain: Change in Daily New Infections since Feb 26, 2020

Figure 56: Spain: Change in Daily New Deaths since Feb 26, 2020

Figure 57: Spain: Weekly % Change in New Cases

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 58: Spain: Weekly % Change in New Deaths

Source: WHO, Worldometer; J.P. Morgan estimates.

The UK:

Figure 59: UK: Change in Daily New Infections since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 60: UK: Change in Daily New Deaths since Feb 26, 2020

Source: WHO, Worldometer; J.P. Morgan estimates.

Figure 61: UK: % of COVID-19 tests positive (weekly)

Source: UK government J.P. Morgan estimates.

Figure 62: UK: Weekly % Change in Tests & % Change in New Cases

Source: UK government J.P. Morgan analysis

Figure 63: England % of cases by Age since Nov 2020

Source: UK government

Figure 64: England % of cases hospitalized by age since Nov 2020

Source: UK government

Figure 65: UK: Weekly deaths (as of 17 Dec) – 5yr avg. vs. 20/21

Source: ons.gov.uk

Figure 66: UK: Deaths by age (as of 17 Dec) – avg. 2015-19 vs. ‘20/21

Source: ons.gov.uk

 


Justin Stebbing
Managing Director

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