Omicron is “not the same disease we were seeing a year ago”

Omicron is “not the same disease we were seeing a year ago”

In South Africa, the UK and Israel, plenty of evidence is building that an Omicron wave is manageable. In South Africa the Omicron wave has have peaked, and in the UK, despite a substantial rise in cases, and now an increase in hospitalisations, hospital and ventilator occupancy remains under control. Although there could still be a further rise in hospitalisations in the UK associated with Christmas Day and New Year’s Eve mixing, I anticipate the milder disease caused by Omicron together with the efficacy of boosters means that even with hospitalisations may increase considerably for the next two to three weeks, the Omicron wave could still be manageable without significant lockdown measures. After all, the hospital churn will be so much higher. As we face a tridemic of flu, Delta and Omicron, I note that a preprint shows Omicron infection enhances neutralisation against Delta:

https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2021/12/MEDRXIV-2021-268439v1-Sigal.pdf

At the moment the 4th wave in Europe now consists of two waves on top of each other a Delta wave and an Omicron wave. Restrictions in Germany and Austria seem to have brought the waves in these countries to a peak, with the continuing deterioration in the situation in France leading to further restrictions being implemented this week. Last week (December 20 - December 26) infections levels rose in most EU countries, with infections continuing to only fall in countries who have introduced lockdown measures Austria (by -31%), the Netherlands (by -15%) which are both in full lockdown, Germany (by -30%) which has a national lockdown for the unvaccinated and Belgium (by -31%) with local lockdown measures. In the EU5 cases rose in Italy by 58%, France by 34%, Spain by 100% and the UK by 39%. Outside the EU5 cases rose in Denmark by 31%, Switzerland by 6% and Sweden by 2%.

In terms of hospitalisations, Germany fell by 26%, bring the weekly total to ~7,619. In France hospitalisations fell by 2% this week to around 8,542. In the UK hospitalisations were rose by 44% this week at 9,102. Again, hospitalisations in the next 10 days post-Christmas combined with hospital staff absences might lead to some more social distancing measures being required. For countries with low booster numbers and high hospitalisations from Delta already (such as France and now potentially Italy) I remain of the view that further measures are likely to be required in the coming weeks though hard to use the term lockdown as curfews or circuit-breaker may be more apt.

As the CDC cuts isolation times in half to 5 days, China has closed another city as it follows its ‘zero Covid’ policy. Fauci said the U.S. should consider a vaccination mandate for domestic air travel, signalling a potential embrace of an idea the Biden administration has previously eschewed. Omicron is “not the same disease we were seeing a year ago” and high death rates in the UK are “now history”, Sir John Bell has said. The disease “appears to be less severe and many people spend a relatively short time in hospital”. Fewer patients were needing high-flow oxygen and the average length of stay was down to three days, he said. “The horrific scenes that we saw a year ago of intensive care units being full, lots of people dying prematurely, that is now history, in my view, and I think we should be reassured that that’s likely to continue,” Bell told BBC Radio 4’s Today programme.

Weekly infections increased ~25% in the U.S. last week, but hospitalisations increased by only 3%. In addition, the rate of conversion of new cases to hospitalisations declined to negative 1, which is the most favourable rate since early November. The potential impact of Omicron on the U.S. healthcare system is still evolving and it remains too early to draw hard conclusions, however these early data and trends are encouraging. The % of the U.S. population having received at least one dose of a vaccine reached 73% last week, up from only 55% July 1st. No doubt this has had a significant effect on hospitalisations for Delta, less transmissible than Omicron, but with more severe symptoms. This shows the relationship between total immunisations by state (vaccinated + naturally immunised) and the % of hospital beds in each state occupied by COVID patients:

There’s always some kind of fly in the ointment. Here, researchers report the persistence of viable SARS-CoV-2 in patients treated with sotrovimab and the rapid development of spike gene mutations that have been shown to confer high level resistance to sotrovimab, the one mAb that work(ed) with Omicron:

https://www.medrxiv.org/content/10.1101/2021.12.18.21267628v1

Back to the UK, Nic Freeman posted this but it’s pre-Xmas, with testing positivity down in London:

With the usual hospital admission point, scale right to left:

The thing Omicron might do, because it might well infect 40% of the entire world in the next two months, is it will raise population-wide immunity for a while. After a massive Omicron wave passes through, transmission should drop to very low levels. Ongoing rollouts of vaccines should help keep it that way.  But forecasting is hard and gets harder the further out you go. And the one big caveat to every far-out-future scenario is how the coronavirus will evolve next. The long-term prospects for 2022 and beyond are very much a function of what the next variant that comes along. But guessing where exactly the next variant will arise and what problematic properties it will have is pretty much impossible, even for the sharpest Covid minds. Back in September, Trevor Bedford predicted that whatever came next would almost certainly be a twist of the then-dominant variant, Delta. But then Omicron materialized almost out of nowhere, its closest evolutionary relatives versions of the virus not seen since summer of 2020, leading some scientists to hypothesise that it might have come from an animal host. Getting a firm answer might require enormous luck. Scientists are looking at numerous animal species to see if they can be infected with SARS-2; were they to find viruses like Omicron in any, that would swing the needle.

If it could happen with Omicron, it could certainly happen again. SARS-CoV-2 is what’s known as a promiscuous virus. It gets around, and not just in humans. Scientists have found it in dogs, house cats, tigers, lions, gorillas, mink of course. And it’s really taken off in white tail deer.

Last month, researchers reported that up to 40% of deer populations in Illinois, Michigan, Pennsylvania, and New York had antibodies to the coronavirus:

https://www.pnas.org/content/118/47/e2114828118

Another group found active SARS-CoV-2 infections in at least 30% of deer tested across Iowa in 2020:

https://www.biorxiv.org/content/10.1101/2021.10.31.466677v2

The findings suggest that the animals could become a long-term reservoir: a safe haven where the virus can circulate and evolve indefinitely, spilling back mutated versions of it to humans from time to time. While the virus doesn’t have infinite capacity to mutate I think (!), it still needs to be able to bind to human receptors to get into our cells; this promiscuity will certainly complicate efforts to manage SARS-CoV-2 in the coming years and decades. And yes, you heard that right: decades. Whether or not it becomes endemic in six months or a year or five years from now, this virus is sticking around on Planet Earth, probably forever. As long as humans and animals and rodents are around it will continue to evolve and change and probably won’t be the threat it is today, but it’s not going away. Even if we accept that permanence, we still hunger to see around the corner. At the beginning of the pandemic, many attempted to predict its future course, using historical influenza pandemics as a guide. They envisioned three possible futures: a monster-wave followed by mini-waves every few months with placid times between; recurring small outbreaks, and constant crisis. What we’ve had in reality is something that doesn’t look exactly like any of these.  

In the United States, SARS-CoV-2 was never really brought under control, so the successive viral surges of spring, then summer, then winter of 2020 weren’t really waves so much as humps in an ever-building coronavirus current. Vaccines brought a precipitous drop in the first few months of 2021, but then Delta emerged, and then Omicron, and now 2021 is looking like 2020 again, but bigger, with even more infectious energy behind it. These all became interchanged:

At the time, we had no way to understand the power of these variants. What has made this such a challenging pathogen to predict is that its mutational changes are really different than what we see with the flu virus. We thought it would behave somewhat like influenza but it’s turned out to be a very different animal.

In one of the most comprehensive forecasts to date, researchers from the Covid-19 Modeling Consortium at the University of Texas, played out 18 different scenarios for how the new variant might hit the U.S. 

Using a stochastic compartmental model that tracks population-level immunity against the Delta and Omicron variants derived from infections, primary vaccines, and booster vaccines, they project COVID-19 cases, hospitalisations and deaths over a six month period beginning on December 1, 2021 under 18 different scenarios. Their projections suggest:

  • Under a pessimistic scenario in which Omicron is as transmissible as Delta and more evasive of infection-acquired and vaccine-acquired immunity than Delta (with 85%, 32%, and 22% reduced protection against infection, hospitalisation, and death, respectively), Omicron could lead to the largest healthcare surge to date, unless measures are taken to slow spread. In this extreme scenario, they project a wave that peaks on February 3, 2022, with cases, hospital admissions, and deaths reaching levels that are 2.2 (95% CrI: 1.3-3.2), 1.8 (95% CrI: 1.2-2.5), and 1.2 (95% CrI: 0.8-1.5) times higher than the January 2021 peak.
  • Under an optimistic scenario in which Omicron is 50% more transmissible than Delta, but far less immune evasive (with only 10% reduction in protection against infection and no reduction in protection against severe outcomes), they project a significantly milder Omicron surge that peaks in January 18, 2022 with cases, hospital admissions, and deaths reaching levels that are 0.92 (95% CrI: 0.41-1.61), 0.57 (95% CrI: 0.28-0.98), 0.46 (95% CrI: 0.32-0.64) times the January 2021 peak.
  • If 80% of previously vaccinated individuals are boosted by March 1, 2022, rather than our baseline assumption of 57%, they project that reported cases, hospital admissions, and deaths would be reduced by 5%, 12%, and 13%, respectively. In our most pessimistic Omicron scenario, this translates into averting an expected 1.3 million UT COVID-19 Consortium 1 December 16, 2021 reported COVID-19 cases, 168,000 hospitalisations, and 39,000 deaths between December 1, 2021 and May 1, 2022.

https://covid-19.tacc.utexas.edu/media/filer_public/20/b0/20b055db-78da-41e6-a1e4-d3afaad6167b/omicron_emergence_-_us_scenarios_-_ut.pdf

Elsewhere, the University of Washington Institute for Health Metrics and Evaluation released new projections, showing approximately 3 billion infections globally between now and the end of February. “We believe it will reach all countries quite soon,” the institute’s director, Chris Murray, told reporters. If the numbers are to be believed, critics have previously assailed the institute’s Covid-19 modelling as unreliable, then we’re talking about two years’ worth of infections cresting in the next two months. Murray’s team is projecting comparatively modest deaths during that staggering surge, fewer than the number caused by Delta, owing to a vast number of the infections being mild or asymptomati~But stealth spread coupled with Omicron’s rapid replication rate causes other sorts of problems; traditional public health strategies like testing, contact tracing, isolation, and quarantine start to fall apart:

https://www.healthdata.org/sites/default/files/files/Projects/COVID/2021/1_briefing_Global_25.pdf

The New York DoH is closely monitoring an upward trend in pediatric hospitalisations associated with COVID-19. The sharpest rise is in New York City, with admissions rising 4-fold from the week, based on data from December 5, 2021 to the week starting December 19, 2021. Approximately half of the admissions are <5 years of age and thus vaccine ineligible. But 25% of hospitalized patients 12-17 yr age were fully vaccinated. Some say this is a case for authorizing boosters (which other countries already do) for this age group.

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

Over the week December 20 – December 26 the new infection count increased significantly again by 39% to 751,433 (a new high level of cases recorded in a week during the pandemic), of which 122,831 were official Omicron cases identified this week (prev. week 33,964). Testing levels were up 6% and so the rate of positive tests was up significantly 6.7% (prev. 5.2%); with the rate above 5%, the wave in the UK is going exponential. Per day infections were between 90,094 and 121,730 (prev. week between 53,923 and 92,288). This week the rise in cases was again mainly due to 20-49 year olds catching Delta and Omicron at Christmas parties (see Figure 1 & 2). Cases in 5-14 year olds were broadly flat this week, with an increase in the 15-19 year olds (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 week

Source: UK.gov

With some rise in cases in the older age groups and a doubling of overall cases in the last two weeks, hospitalisations grew this week by 44% to 9,102; up only 51% in the last two weeks (based on the first 6 days of the week [with extrapolated data for Scotland, Wales and Northern Ireland]). The rate of hospitalisation remained stable at the lower rate of 1.2% (prior week 1.2%). Importantly even though the rise in hospitalisations is somewhat worrying, the data potentially shows the milder Omicron variant leading to shorter stays in hospital, with hospital occupancy only up 9% this week and only 12% up compared to two weeks ago (though with the majority of the cases in the young this could also be driven by the age of those infected as well) The occupancy of ventilators is also encouraging with occupancy still falling to ~18.8% (last week 19.6%), which equates to ~844 people (though this is more of a lagging indicator). While the impact of Christmas mixing will only become visible in the next week to 10 days, so far, despite hospitalisations rising significantly this week, the situation in the UK seems manageable, with hospital occupancy rising by a much lower rate than hospital admissions suggesting potentially less pressure on the system than previous waves.Source: UK.gov

While it is still too early to definitively assess vaccine protection against hospitalisations in the UK, JPM are encouraged by initial data showing a 50-70% reduction in hospitalisations due to Omicron in the UK. While this data is still early, this fits with what we have seen in South Africa, where the peak hospitalisation rate due to Delta was 5.3% and the peak for Omicron to date has been 2.3% i.e. a 57% reduction in hospitalisations. For the UK, where the hospitalisation rate has trended at 2.0% to 3.0% for Delta, they infer a hospitalisation rate of 1.0-1.5%, although this could be lowered further with the rollout of boosters over the last two months.

In terms of the development of cases in the UK from here the data from South Africa where their Omicron wave seems to have peaked in 4-6 weeks (4 weeks from 1st identification on Nov 23, 2021; 6 weeks from rise in case trajectory from Nov 14, 2021), suggests that the UK could see a natural peak by the middle to end of January without more measures. While the time to peak in the UK could be slowed by level of booster vaccination, this could be balanced out by the greater indoor mixing related to winter, compared to summer in South Africa. Certainly, JPM anticipate cases rising in the next few weeks due to Christmas and New Year’s Eve celebrations, but the increases from there should be more limited, given work from home and less mixing post-Christmas. For hospitalisations JPM believe we could see these in range of 10,000-15,000 for the next 2 to 3 weeks, we believe this could also represent the peak. However, with patients requiring shorter hospital stays, no significant increase in hospital and ventilator occupancy for COVID-19 thus far, they remain cautiously optimistic and still do not believe the UK needs a major lockdown.

Figure 5: UK Weekly Infections Aug 2, 2020 – Dec 26, 2021 Actual vs. Projected

Figure 6: UK Weekly Hospitalisation Aug 2, 2020 – Dec 26, 2021 Actual vs. Projected at 1.5% of cases

Figure 7: UK Weekly Hospitalisations Aug 2, 2020 – Dec 26, 2021 Actual vs. Projected at 1% of cases

Figure 8: UK Weekly Hospital Occupancy Aug 2, 2020 – Dec 26, 2021 Actual

Figure 9: UK Weekly Ventilator Occupancy Aug 2, 2020 – Dec 26, 2021 Actual

Figure 10: UK Weekly Deaths Aug 2, 2020 – Dec 26, 2021 Actual vs. Projected at 0.2% of infections (3wks prior)

Many continue to monitor Flu cases and hospitalisations in the UK. Take up of the flu vaccine increased slightly to 82.4% (prior week 80.1%) of above 65 year olds in the UK currently and flu cases and hospitalisations remain very low. The rate of positivity for flu remained stable at 1.1% (last week 1.2%) compared to COVID-19 at 6.7%, and significantly below the level seen in 2019/20. Therefore, at the moment they don't see flu impacting the decision making around the need for a return of more social distancing measures in the UK.

Omicron UK hospitalisations data continues to look encouraging; South Africa seems to have peaked 6 weeks after the outbreakMany continue to monitor Flu cases and hospitalisations in the UK. Take up of the flu vaccine increased slightly to 82.4% (prior week 80.1%) of above 65 year olds in the UK currently and flu cases and hospitalisations remain very low. The rate of positivity for flu remained stable at 1.1% (last week 1.2%) compared to COVID-19 at 6.7%, and significantly below the level seen in 2019/20. Therefore, at the moment they don't see flu impacting the decision making around the need for a return of more social distancing measures in the UK.

Omicron continues to drive the surge in cases in the UK, with UK cases up 39% this week to an average of 107,348 cases per day. A total of 159,932 Omicron cases have now been confirmed in the UK with a further suspected 353,478 cases (based on S-gene dropout), with 122,831 cases confirmed this week and an increase of 254,031 suspected cases. Total hospitalisations have also risen by 44% this week to 1,276 new admissions per day, a hospitalisation rate of 1.2%, which continues to be the lowest level we have seen for the UK throughout our monitoring. Omicron hospitalisations data have also been released for the first time, showing that 28% of unvaccinated Omicron patients were hospitalised.

Updated data on efficacy of boosters against Omicron has now been released (n= 147,597 Delta 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.

Additionally, while it is still too early for data on vaccine efficacy against Omicron hospitalisation, initial analysis in the UK highlights a lower risk of hospital admission for Omicron compared to Delta, with Omicron patients 31-45% less likely to attend A&E and 50-70% less likely to be admitted to hospital, although this analysis is preliminary and uncertain due to a small sample size (132 confirmed Omicron hospitalisations as at 20 December 2021, 17 of which had received a booster, 74 had received both doses and 27 were unvaccinated). 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.

Israel is also seeing an Omicron surge with cases rising by 80% this week to 1,354 cases per day. New severely ill admissions also accelerated by 126% this week to an average of 10 new admissions per day, equating to a new severely ill rate of 0.7% (prev. week: 0.6%), which continues to remain 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.

For South Africa our colleague Alex Comer is monitoring cases and hospitalisations (here). Cases declined this week by 25% to 105,466 weekly cases (prev. week: 140,577 weekly cases), albeit still higher than prior to the Omicron outbreak, continuing to suggest that last week was likely the peak of Omicron cases in South Africa, 6 weeks into the outbreak. The hospitalisation rate for Omicron this week rose to 2.3% (prev. week: 1.9%), still lower than the Delta peak of 5.3%. Preliminary data from Discovery Health this week also suggested two-dose vaccine efficacy of ~70% against Omicron severe illness, likely to rise with a booster. We await further data from the UK, Israel and/or the vaccine manufacturers to confirm this and to more definitively assess the impact of boosters and of waning protection on hospitalisations.

Figure 11: Latest cases in South Africa


Figure 12: Weekly hospitalisation rates in South Africa vs. cases

Moderna released booster data this 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 this 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 hospitalisations, although this data is still pending.Source: South African Health Ministry

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

Pfizer Efficacy

 

WT Primary

Alpha Primary

Beta Primary

Delta Primary

Delta 6m (Primary)

Delta Booster

Omicron 6m (Primary)

Omicron Booster (2-4w)

Cases

95%

93%

75%

78%

63.5%

93.1%

34-37%

70%

Antibody reduction

-

2.6

4.9

5.8

ND

ND

25.0

-

Hospitalisation

99%

98%

97%

96%

90%

96%+

?

?

                 

Source: Lancet, NEJM, PFE Company data, UK gov

A deeper look at German infections & hospitalisations

Over the week December 20 – December 26 the daily new infection count was down 30% to 196,898 as local lockdowns and a lockdown for the unvaccinated reduced transmission. New case numbers were between 10,158 and 45,858 per day compared 24,190 and 55,650 per day the week before. Hospitalisations fell by 26% to 7,619. ICU occupancy for COVID-19 also decreased by 7% to 4,438, 19.9% of beds, and total ICU occupancy also fell to 83.5% (from 85.6%). Given the national lockdown of the unvaccinated, we would expect cases to continue falling for the next few weeks regardless of the spread of Omicron, although Omicron could lead to cases rising again unless the booster rollout is accelerated.

Figure 13: Germany: Change in Daily New Infections since Feb 26, 20

Figure 14: Germany: Change in Daily New Deaths since Feb 26, 2020

Figure 15: Germany: Weekly Hospitalisations since Feb 26, 2020

Figure 16: Germany: Weekly ICU Occupancy since Feb 26, 2020

Figure 17: Latest booster % over 50s for EU5 and US (% adults)Development in Vaccinations in the EU5, Israel & the US

Figure 18: 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 19: Latest vaccination % for EU5 and US (% adults)Source: CDC, UK, Netherlands, Austria, French, Germany, Spain, South Africa and Italy governments.

Figure 20: % Natural Immunity due to prior infectionSource: CDC, UK, French, Germany, Spain, Italy governments. *Shifted to focus on booster % for adults given the importance of boosters in protecting against Omicron cases

The UK has now boosted 61.6% of its adult population (prev. week: 53.3%). Full vaccinations are now at 88.6% of adults (prev. week: 88.3%) while first doses have been administered to 94.0% of adults (prev. week: 93.7%). Looking at vaccination by age, they estimate 53% of 12-15 year olds (prev. week: 51%) and 70% of 16-17 year olds (prev. week: 69%) have now received at least one dose. This compares with 76% of 18-24 year olds (prior week: 76%), 78% of 25-29 year olds (prev. week: 77%) and 96% of those aged 30 and over. Full immunisation has been achieved in 42% of 16-17 year olds, 68% of 18-24 year olds (67% in the prior week), 71% of 25-29 year olds (70% in the prior week) and 80% of 30-34 year olds (79% in the prior week) compared with 94% in the 35+ population. Booster doses have been administered to 85.9% of over 50s (prev. week: 82.1%), 90.5% of over 60s (prev. week: 88.0%) and 91.4% (prev. week: 90%) of over 65s, the age groups most vulnerable to hospitalisation. Based on data for the first 5 days of this week i.e. adjusting for a natural slowdown over the Christmas weekend, the booster rollout accelerated by 31% to an average of 831k doses per day. Second doses and first doses also rose by 35% and 34% respectively to an average of 48k doses per day and 37k doses per day respectively, driven by the implementation of a COVID-19 green pass in the England (negative PCR/lateral flow test or fully vaccinated) for large event (indoors > 500 people, outdoor >4,000 people) and nightclubs.

Looking across the EU4 on booster doses, important for protection against Omicron cases, Germany now leads the way in Europe, having boosted 43.0% of adults (prev. week 34.7%). France is on 41.6% (prev. week: 33.3%), Italy is on 33.7% (prev. week: 28.6%) and Spain is on 33.0% (prev. week: 27.3%). For over 50s, more at risk from hospitalisation, France and Germany are both at 59.3% (prev. week: ~51%), Spain is on 58.3% (prev. week: 44.4%) and Italy is on 49.1% (prev. week: 42.2%).

For the primary series, Spain has fully vaccinated 90.7% of its adult population, France is on 91.0%, Italy is on 82.2% and Germany is on 81.6%. Spain has partially vaccinated 94.7% of its adult population, France is on 92.0%, Italy is on 88.2% and Germany is on 84.8%. Germany reported a 19% decline in both first and second doses this week (based on data for first 5 days) along with a 38% decline in booster doses. Comparatively, France reported a 15% rise in first doses, 19% decline in second doses and 25% rise in booster doses, while Italy reported a 2% decline in first doses, 1% decline in second doses and 24% rise in booster doses.

JPM expect uptake of first doses, second doses and booster doses to rise in the coming weeks across the EU, following the natural Christmas-break and New Years' driven slowdown, 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.

The US has fully vaccinated 72.7% of adults (prev. week: 72.4%). First doses have been administered to 85.2% of its adult population (prev. week: 85.0%). Booster doses have been administered to 35.2% of all adults (prev. week: 31.6%) and to 47.7% of over 50s (prior week: 43.8%).

Figure 21: EU 5, Israel & US Cumulative 1st doses administered


Figure 22: EU 5, Israel & US Cumulative fully vaccinated

Figure 23: EU 5, Israel & US % of Population received 1 dose

Figure 24: EU 5, Israel & US % of Population fully vaccinated

Source: UK, French, German Spain, Italy and Israel governments; CD~Note, country-level data frequently restated for Germany, Italy and Israel.

Figure 25: EU 5, Israel & US Cumulative Booster doses administered


Figure 26: EU 5, Israel & US Cumulative Boosters % of Population

Source: 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 Israel

Israel, which has fully vaccinated ~90% of its adult population and has administered booster shots to ~71% of its adult population, reported an 80% rise in infections this week to 1,354 cases per day, the highest level since mid October. New severely ill admissions also rose by 126% this week to an average of 10 new admissions per day, equating to a new severely ill rate of 0.7% (prev. week: 0.6%), which continues to remain lower than the new severely ill rate we have seen in Israel throughout our monitoring (since 28th Dec 2020). Omicron has fully taken hold in Israel, as evidenced in the case/new severely ill numbers but also in total confirmed cases, with a total of 1,118 confirmed Omicron cases in Israel as of Saturday (prev. week: 134 Omicron cases). A real-world study in Israel is currently underway to assess the safety and efficacy of a 4th dose, which should aid in informing whether a 4th dose is necessary.

US cases rose by 67% this week to an average of 234k cases per day, the highest level since the first week of January, with Omicron having now fully taken hold in the US, with the CDC estimating that Omicron now accounts for 73% of US cases (95% CI: 34.0-94.9%), compared with CDC"s estimate of ~15% last week. Hospitalisations, however, remain under control at a daily average of 8,212 new admissions per day, a weekly rise of 3%. The hospitalisation rate in the US is now at 3.5%, the lowest level JPM have seen throughout their monitoring of the situation in the US (since 28th Dec 2020). While no specific measures have been implemented in the US to contain Omicron, beyond increased testing and reinforcements, thousands of flights have been cancelled over the last four days and Dr. Fauci has advised against large New Years' gatherings. They expect a continued surge in both cases and hospitalisations in the coming weeks, with hospitalisations expected to catch up with the case surge already seen (1-2 week lag) and cases expected to continue to rise as a result of increased social mixing over Christmas and New Years'.

In the UK, cases rose by 39% this week to an average of 107,348 cases per day, with testing levels up 6%, i.e. an underlying increase of 33%. Hospitalisation admissions were also up this week by 44% to 1,276 new admissions per day, a hospitalisation rate of 1.2%, which continues to be the lowest level we have seen for the UK. Early data on booster vaccinations in adults aged 50 and older indicate that after a booster dose of the Pfizer/BioNTech vaccine, vaccine effectiveness against Delta symptomatic disease rises to 93.8% among those who received the AstraZeneca vaccine as their primary course and 94.3% among those who received the Pfizer/BioNTech vaccine as their primary series. On Delta hospitalisations, a booster dose of the Pfizer vaccine increases the efficacy to 98.8% in over 50s who have received either the AstraZeneca or Pfizer vaccine as their primary course.

Against Omicron, latest data from the UK (147,597 Delta cases, 68,489 Omicron cases) has been released, now including data on both Pfizer and Moderna boosters. 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.

The latest 3 week data on COVID-19 hospitalisations by vaccination status as at December 23, 2021, 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 27: Israel Vaccinations compared to Daily Infections


Figure 28: Israel Vaccinations compared to Daily Severely Ill Pts

Figure 29: US Vaccinations compared to Daily Infections

Figure 30: US Vaccinations compared to hospitalisations

Figure 31: UK Vaccinations compared to Daily Infections

Figure 32: UK Vaccinations compared to Daily Hospital Admissions

Development in New Infections in the EU5

- Looking at the new infection data on a weekly basis over the last week (December 20 – December 26) the EU5 new infections rose by 34% to 2,067,014 a new high week of the pandemic thus far. Cases rose in 4 out of 5 countries with only Germany seeing a fall by 30% to 196,898 due to the national lockdown for the unvaccinated. Cases rose in Italy by 58% to 258,155, in France by 34% to 490,219, in Spain by 100% to 370,309, and the UK by 39% to 751,433.

Figure 33: Weekly New Infections Development since Feb 23, 2020 for the EU5 Countries

Development in Deaths

For the week ending December 26, the total death count in EU5 decreased by 7% week on week to 5,215, with deaths increasing in 3 out of 5 countries. Deaths rose in France by 8% to 1,149, Spain by 10% to 345 and by 20% in Italy to 960. In the UK deaths were down 17% at 643 and in Germany they were down by 20% to 2,118.

Figure 34: Weekly New Deaths Development since February 2020 for the EU5 Countries

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

Table 2: Death Rate of Cases during different waves

Death Rate

Italy

France

Spain

Germany

UK

EU 5

23 Feb to 28 Jun

14.4%

19.0%

10.6%

4.7%

15.0%

12.6%

             

5 Jul to 30 Aug

2.1%

0.7%

0.3%

0.7%

2.2%

0.7%

1 Sept – 27 Sept

0.9%

0.4%

0.8%

0.4%

0.5%

0.6%

28 Sept – 25 Oct

0.7%

0.5%

0.9%

0.4%

0.7%

0.7%

26 Oct – 27 Dec

2.3%

2.0%

1.9%

1.7%

1.8%

2.0%

28 Dec- 28 Mar

2.4%

1.7%

1.8%

4.1%

2.7%

2.1%

29 Mar – 5 Jun

2.6%

1.1%

1.2%

1.4%

0.7%

1.3%

6 Jun – 26 Dec

0.7%

0.4%

0.4%

0.7%

0.3%

0.4%

             

Development in Hospitalisations

  • Daily Hospital Admissions: Hospital admissions in France were down 2% at 8,542 for the week ending December 26. In Germany hospital admissions were down 26% to 7,619 and in the UK, hospital admissions were up 44% at ~9,102.
  • 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 we 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. We would expect the hospitalisation rates to trend down with boosting through our December.

Figure 35: Daily Admissions to Hospital since Feb 23, 2020 for EU4

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

Figure 36: Daily Hospital Admissions/New Cases since Mar 22 for EU4

Figure 37: England Monthly Hospital Admissions by Age Oct 20 – Nov 21 (Data up to Nov 02)

Figure 38: UK Hospital Admission as % of cases in the week & % of cases 1 wk prior

Hospital Occupancy: Occupancy rose in France by 8%, in Italy by 17% and by 9% in the UK.

Figure 39: Hospital occupancy since Feb 23, 2020 for EU3 (# of beds)

Figure 40: Hospital occupancy since Feb 23, 20 for EU3 (% of beds)

ICU Occupancy: In Germany ICU occupancy fell by 7% to 19.9% or 4,438 beds on average occupied. This takes the overall occupancy in Germany to 83.5% (prev. 85.6%). Occupancy in the UK was down this week at 18.8% (prev. 19.6%). ICU occupancy in France increased to 42.1% (prev. 37.7%) of beds occupied and an average of 3,187 beds occupied. In Paris occupancy also rose to 53% (last week 48%). In Italy occupancy increased by 14%, with the percentage of beds occupied at 13.7% (prev 12.0%).

Figure 41: ICU Occupancy since Feb 23, 2020 for EU3*

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

Figure 42: % ICU Beds Occupied by COVID-19 since Mar 22 for EU3*

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

Development in New Infections in other EU Countries

  • Among the smaller European countries, the new infections decreased in Austria by 31% due to the full lockdown, in the Netherlands the partial lockdown lead to 15% fall in infections and in Belgium infections fell by 31%. Infections increased again in Denmark by 31%, Switzerland by 6% and Sweden by 2%.

Figure 43: Other EU Countries: Weekly New Infections Development since Jul 5, 2021

Figure 44: Other EU Countries: Weekly % Change in New Cases

Detailed Country Analysis

Italy: Over the week December 20 – December 26 the daily new infection count rose for the tenth week in a row by 58% to 258,155, with testing levels up 14% this week with total tests at 4,986,419 and so the rate of people testing positive rose to 5.2% (from 4.0%). The daily new infection count ranged from 16,198 to 54,761 per day (prev. 12,700 to 28,625 per day). The level of deaths increased by 20% to 960 (prev. 798). The average number of people in hospital with COVID-19 during the week increased by 17% to 9,700 (prev. 8,276). ICU average occupancy increased to 13.7% for the week (last week 12.0%). Although cases and hospitalisations continue to rise Italy still seems at least 2-3 weeks from needing to control the 4th wave with a lockdown.

Figure 45: Italy: Change in Daily New Infections since Feb 26, 2020

Figure 46: Italy: Change in Daily New Deaths since Feb 26, 2020

Figure 47: Italy: % of COVID-19 tests positive (weekly)

Figure 48: Italy: Wkly % Change in Tests & % Change in New Cases

France: Over the week December 20 – December 26 new infections increased for the eleventh week in a row by 34% to 490,219, the worst week of the entire pandemic from a case perspective (with the daily increases between 15,075 and 104,611 compared to between 12,036 and 65,713 per day for the previous week). The rate of testing positive was up to 7.2% (prev. 5.8%) 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 8% at 1,149 for the week. Hospitalisations fell by 2% to 8,542 for the week, But ICU occupancy increased by 12%, with COVID-19 patients now occupying on average 3,137 beds 42.1% of France's ICU capacity on average for the week (last week 37.7%). In Paris ICU occupancy increased to 53% (prev. 48%). France ICU occupancy is now above the upper end of the threshold the government used for reopening. With another increase in ICU occupancy this week on the cards, France has introduced more measures today, but has stopped short of a full lockdown.

Figure 49: France: Change in Daily New Infections and Hospital Admissions since Feb 26, 2020

Figure 50: France: Change in Daily New Deaths since Feb 26, 2020

Figure 51: France: % of COVID-19 tests positive (weekly)

Figure 52: France: Weekly % Change in Tests & % Change in New Cases

Figure 53: Spain: Change in Daily New Infections since Feb 26, 2020Spain: Over the week December 20 – December 26 the infections were up by 100%, suggesting weekly infections are around 370k for the week. Deaths in the first 5 days of the last week were up 10% week on week at around 345 deaths. Spain continues to look somewhat concerning given the significant rise in cases, though deaths are remaining low so far.

Figure 54: Spain: Change in Daily New Deaths since Feb 26, 2020

Figure 55: Spain: Weekly % Change in New Cases

Figure 56: Spain: Weekly % Change in New Deaths

Figure 57: UK: Change in Daily New Infections since Feb 26, 2020The UK:

Figure 58: UK: Change in Daily New Deaths since Feb 26, 2020

Figure 59: UK: % of COVID-19 tests positive (weekly)

Figure 60: UK: Weekly % Change in Tests & % Change in New Cases

Figure 61: England % of cases by Age since Nov 2020

Figure 62: England % of cases hospitalized by age since Nov 2020Source: UK government

Figure 63: UK: Weekly deaths (as of 10 Dec) – 5yr avg. vs. 20/21

Figure 64: UK: Deaths by age (as of 10 Dec) – avg. 2015-19 vs. ‘20/21Source: ons.gov.uk


 

 

Justin Stebbing
Managing Director

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