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SITUATION UPDATE 20 July, 2021 Back

Situation Update - COVID-19 status report from the Anvil Medical Team

Dr Juliane Kause

Covid-19 globe

Summary

  • COVID-19 restrictions gradually easing across the globe.
  • Respiratory infections amongst children unseasonably high in the Southern hemisphere.
  • There remains a high level of general uncertainty which can have significant impact on mental and consequently physical health.
  • There is a global backlog of cancer treatment, and other causes of disease and death for which the prevention, diagnosis and management has been delayed due to COVID.
  • Fake vaccines and fake vaccine certificates pose unique challenges with potentially international consequences.

Situation

With restrictions gradually becoming more permissive across the globe in relation to COVID, it is an opportune time to reflect on the situation at hand.

There is an unprecedented level of general uncertainty globally, leaders in different countries all claim to be adopting an approach led by scientific evidence with regards to their COVID restrictions, but all impose different restrictions. People are therefore understandably uncertain as to what life ‘post COVID’ will look like.

After a long period of change from our usual ways of life there are several aspects of uncertainty which can impact on an individual. Concerns for their own health and welfare, concern for the health and welfare of others, concerns about returning to the workplace after a period of working from home. The mental burden of these factors added to our already increasingly busy lives can be difficult. Individuals’ mental health can suffer and consequently physical health leaving them more vulnerable to COVID.

Pre pandemic, 1 in 6 deaths globally were due to cancer (1). The effect the pandemic has had on this will not be immediately evident as generally cancer deaths are not as acutely measurable as COVID-19 deaths. But as we emerge from the pandemic it will be important, as part of the recovery, to return focus to causes of disease and death which affect significant number of people and are not COVID-19.

With the number of countries adopting vaccine passports growing, there are numerous reports about fake vaccines, particularly from the Indian subcontinent and Africa. Globally, vaccine supply, is largely managed through government channels and is heavily regulated in terms of availability and accessibility. The opportunity therefore exists for fakes to be introduced to the market and elaborate scams have been identified across the globe.

Fake vaccine certificates are also readily available online, with travellers’ eagerness to resume international travel, and an element of mistrust in vaccines this could lead to potentially damaging consequences. With fake vaccines, the risk to the affected individual occurs on many levels. Not only is what is being injected unregulated and potentially damaging to the person receiving the injection, but also highly unlikely to confer any protection to the individual who may modify their behaviour thinking they are protected, potentially making themselves even more vulnerable as well as impacting those with whom they come into contact.

Another trend being observed in the Southern hemisphere currently is that there are increasing numbers of children becoming unwell with respiratory infections, compared to what they would expect usually at this time of year. (2)

The measures put in place to slow spread of COVID-19 have been effective, but they have also slowed the spread of other respiratory viruses.

Children have not been exposed to many respiratory viruses due to this, and what is now being seen is that their immune systems are not able to counter these infections as effectively as if they had been continuously exposed, and as such are becoming more unwell.

Analysis 

We can all take responsibility for our health. The immune system can be thought of like a muscle, if not exercised for a prolonged time it cannot then be expected to be as strong as it once was immediately.

Simple measures such as sufficient sleep, healthy diet and exercise can all help with ensuring our immune systems are in their best possible form when they are then challenged. A further recommendation is to stay at home when you are ill (not just COVID-19), as we recover fastest by resting.

COVID-19 is now a vaccine preventable disease, and globally countries are making good progress with vaccination programmes. The data demonstrates vaccines significantly change the correlation between case rates and death rates. While this is generally very positive, consideration must be given to other causes of disease and death for which the prevention, diagnosis and management has been delayed due to COVID-19. Be that due to social distancing and isolation or simply because the focus of health services has been on COVID-19.

Globally, restrictions of some form are likely to continue for some time. There are essential workers who have worked throughout the pandemic and whose working lives have changed the least. When other workplaces reopen, there is evidence of hesitancy returning to the office, after more than a year of working remotely. A variety of psychological factors drive this behaviour and include continued fear of infection from COVID-19, deteriorating confidence and motivation, as well as languishing, a term recently popularized to describe the sense of stagnation and emptiness. This will either resolve in time or result in deterioration of mental health and a formal diagnosis.

During the summer season, the spread of respiratory viruses is lower. Even though it is currently summer in the Northern hemisphere, reported COVID-19 case numbers are rising, whilst there has been dissociation between those who test positive, those who experience symptoms, and those who are admitted to hospital and those who die.

In the countries where successful vaccination programmes have been implemented, the number and impact of COVID-19 infection has significantly reduced. We are now seeing far fewer COVID-19 illnesses and deaths. Prior to vaccination programmes, about 1 in 10 people testing positive for COVID-19 required hospital treatment and 1 in 100 required intensive care treatment. Now, despite the more transmissible variants of COVID-19, it is approximately 1 in 50 people who require hospital treatment with only 10% of those admitted requiring respiratory support. Death rates in countries with vaccination programmes have also been reduced considerably.

The vaccination programme has, however, not been uniform and there remains large disparities in vaccination rates between countries. This contributes to remaining travel restrictions.

Due to scarcity of vaccination coverage in some countries, and reliance of others for vaccination or proof of vaccination for entry there is opportunity for forgeries of vaccination certificates and administration of fake vaccines. The consequence of this is significant as it can facilitate spread of what is now considered a vaccine preventable disease across borders.

Implications

The mental health implications of this period of prolonged uncertainty will potentially be long lasting. Access to psychological support for individuals will be beneficial and potentially limit the damage done, reduce absences from work, and provide better employee satisfaction. It is estimated that about a quarter of all sickness absences globally are related to mental health conditions. This is going to worsen considerably unless mental health conditions receive the same priority treatment as other medical emergencies.

Research shows that even 10 minutes a day of meditation can calm your nervous system, make you less stressed, improve your performance and your mood. An even greater benefit is achieved when this done as a group.

While vaccine procurement and delivery globally are largely government run, it is important to encourage and support safe and legal routes of continuing the global vaccination programme.

Some of us will retain COVID behaviours for longer, others can’t wait to get back to normal. Both are right and we can help each other navigate through this unusual time.

The Anvil medical team are always here to provide additional support.

References
1. https://www.who.int/health-topics/cancer#tab=tab_1
2. https://www.theguardian.com/world/2021/jul/08/new-zealand-children-falling-ill-in-high-numbers-due-to-covid-immunity-debt?CMP=Share_iOSApp_Other 
3. https://edition.cnn.com/2021/07/05/india/india-fake-covid-vaccine-scam-intl-hnk/index.html
4. https://www.nytimes.com/2021/04/19/well/mind/covid-mental-health-languishing.html