Tag: lockdowns

Caesarean and Induced Deliveries Fell During Pandemic

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During the first few months of the COVID pandemic, premature births from caesarean and induced deliveries fell by 6.5% – and remained consistently lower throughout, according to research reported in the journal Pediatrics. This is likely a result of fewer prenatal visits due to lockdown and social distancing rules, the researchers suggested, and call into question how many such interventions are necessary.   

The study, the first to examine pandemic-era birth data at scale, raises questions about medical interventions in pregnancy and whether some decisions by doctors may result in unnecessary preterm deliveries, according to Assistant Professor Daniel Dench, the paper’s lead author.

“While much more research needs to be done, including understanding how these changes affected fetal deaths and how doctors triaged patient care by risk category during the pandemic, these are significant findings that should spark discussion in the medical community,” A/Prof Dench said.

In effect, the study begins to answer a question that never could have been resolved in a traditional experiment: What would happen to the rate of premature C-sections and induced deliveries if women didn’t see doctors as often, especially in person, during pregnancy?

Doing such a study would be unethical, but lockdown had a side effect of reducing prenatal care visits by more than a third, according to one analysis. That gave A/Prof Dench and colleagues an opportunity to evaluate the impacts, after all.

The researchers took records of nearly 39 million US births from 2010 to 2020, and compared them to expected premature births (born before 37 weeks) from March to December 2020. 

The researchers found that in March 2020, when lockdowns began in the US, preterm births from C-sections or induced deliveries immediately fell from the forecasted number by 0.4%. From March 2020 to December 2020, the number remained on average 0.35% below the predicted values. That translates to 350 fewer preterm C-sections and induced deliveries per 100 000 live births, or 10 000 fewer overall.

Before the pandemic, the number of preterm C-sections and induced deliveries had been rising. Spontaneous preterm births also fell by a small percentage in the first months of the pandemic, but much less than births involving those two factors. The number of full-term caesarean and induced deliveries increased.

“If you look at 1000 births in a single hospital, or even at 30 000 births across a hospital system, you wouldn’t be able to see the drop as clearly,” said A/Prof Dench. “The drop we detected is a huge change, but you might miss it in a small sample.”  

The researchers also corrected for seasonality, for example, preterm births are higher on average in February than in March, which helped them get a clearer picture of the data.

The research comes with caveats. Up to half of all preterm C-sections and induced deliveries are due to a ruptured membrane, which is a spontaneous cause. But in the data Dench and his team used, it’s impossible to distinguish these C-sections from the ones caused by doctors’ interventions. So, Dench and co-authors are seeking more detailed data to get a clearer picture of preterm deliveries.

Still, these findings are significant because the causes for preterm births are not always known.

“However, we know for certain that doctors’ interventions cause preterm delivery, and for good reason most of the time,” A/Prof Dench said. “So, when I saw the change in preterm births, I thought, if anything changed preterm delivery, it probably had to be some change in how doctors were treating patients.”

The researchers’ findings raise a critical question: Was the pre-pandemic level of doctor intervention necessary?

“It’s really about, how does this affect foetal health?” said A/Prof Dench. “Did doctors miss some false positives – did they just not deliver the babies that would have survived anyway? Or did they miss some babies that would die in the womb without intervention?”  

A/Prof Dench plans to use foetal death records from March 2020 to December 2020 to answer this question. If he finds no change in foetal deaths at the same time as the drop in preterm births, that could point to “false positives” in doctor intervention that can be avoided in the future. Learning which pregnancies required care during the pandemic and which ones didn’t could help doctors avoid unnecessary interventions in the future.  

“This is just the start of what I think will be an important line of research,” A/Prof Dench said.

Source: Georgia Institute of Technology

Living with COVID: SA’s New Approach

Image by Quicknews

South Africa’s easing of COVID regulations at the end of 2021 set a new trend in how countries are choosing to manage the pandemic. In an article for The Conversation, Wits University’s Professor Shabir Madhi and colleagues reflect on the boldness – and the risks.

In a significant departure, the government is choosing a new, more pragmatic approach while keeping an eye on severe COVID and threats to health systems. This reflects a willingness to “live with the virus” without causing further damage to the economy and livelihoods, especially in a resource-constrained country.

Prof Madhi and colleagues hope that “the government continues to pursue this approach and doesn’t blindly follow policies that are not feasible in the local context, and ultimately yield nominal benefit.”

This more nuanced approach is a stark contrast to reflexive restrictions in response to rising case rates, suggesting the government has listened to commentary saying that the focus should be on whether health systems are under threat.

A high level of population immunity guides this approach. A sero-survey in Gauteng, just prior to the onset of the Omicron wave indicated that 72% of people had been infected over the course of the first three waves. Sero-positivity was 79% and 93% in COVID unvaccinated and vaccinated people aged over 50: a group that had previously made up a high percentage of hospitalisations and deaths.

The sero-survey data show that immunity against severe COVID in the country has largely evolved through natural infection over the course of the first three waves and prior to the advent of vaccination. This has, however, come at the massive cost of 268 813 deaths based on excess mortality attributable to COVID

Antibody presence is a proxy for underlying T-cell immunity which appears to play an important role in reducing the risk of infection progressing to severe COVID. Current evidence indicates that such T cell immunity, which has multiple targets and even more so when induced by natural infection, is relatively unaffected even by Omicron’s many mutations and likely lasts more than a year. This sort of underpinning T-cell immunity protecting against severe disease should provide breathing space for at least the next 6–12 months, and possibly further.

Despite Omicron’s anti-spike evasion, vaccine and natural infection induced T-cell immunity has been relatively preserved. This could explain the uncoupling of case rate to hospitalisation and death rates. Omicron’s mutations also appear to make it predisposed to infecting the upper rather than the lower airway, reducing the likelihood of progressing to severe disease.

In the meantime, they stress that greater vaccine uptake is ensured, along with boosters for high-risk groups.

Additionally, since low test rates mean only 10% of infections are actually documented in SA , isolation and quarantine are ineffective and a more pragmatic approach is necessary, the authors argued.

As the average person in South Africa could have 20 close contacts per day, contact tracing is of little value, and even symptomatic cases are most infectious in the pre-symptomatic and early symptomatic phase. The fact that three quarters of the SA population were infected over the course of the first three waves demonstrates how ineffective contact tracing and quarantine is.
They recommend that certain non-pharmacological interventions should be gradually dropped, especially hand hygiene and superficial thermal screening, while outdoor events should be allowed. Rather, government focus should remain on masking in poorly ventilated spaces and ensuring proper ventilation.

Mandatory vaccinations are still on the radar, since as well as the added risk to others that unvaccinated pose, there is the greater pressure they place on the health systems when they are hospitalised for COVID.

Attention also needs to be given to the management of incidental COVID infections in hospitals. The Department of Health guidance needs to be adapted to manage these patients with the appropriate level of care for the primary reason they were admitted. And patients with severe COVID disease require additional care and expertise to improve their outcomes.

Finally, an evaluation of both vaccination status and underlying immune deficiency needs to become a key element of the workup of hospitalised patients with severe COVID.

The authors stressed the need to minimise hospitalisations and deaths, without damaging livelihoods. SA’s Omicron wave death rate is about a tenth that of Delta, on par with pre-COVID seasonal influenza deaths – 10 000 to 11 000 per annum. TB caused an estimated 58 000 deaths in 2019.

While future variants are unpredictable, there is a trend towards lower rates of hospitalisation and death, especially if vaccine coverage can be increased to 90%, particularly in the over-50 age group. Omicron’s high infection rate will likely also contribute to future protection against COVID.

They note that while there is a risk of new variants, failure to change the pandemic mindset is another risk, as Omicron signals the end of COVID’s epidemic phase.

Past practices have had little effect, the authors concluded, and it is something that the SA government appears to have realised. Despite all the severe lockdowns, SA still suffered a high COVID death rate of 481 per 100 000.

Source: The Conversation

WHO Criticises Omicron Travel Bans as SA Stays at Level 1

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The emergence of the Omicron SARS-CoV-2 variant which has resulted in renewed lockdowns and travel bans around the world, which have been criticised by the WHO. In contrast, South Africa will stick to an adjusted Level 1 lockdown for the time being, though pushing for mandatory vaccinations. Business and civil society groups had warned that increasing restrictions would have provoked backlash as recent election campaign events had effectively ignored them.

Many nations around the world have reacted quickly to the new variant, which has a large number of mutations compared to the Delta variant. The UK’s decision to suspend flights from South Africa as well as nine other African countries has provoked criticism from a number of quarters, including President Cyril Ramaphosa. The sudden move has caught many travellers by surprise, including a Welsh rugby team which had two members test positive, one of which was for Omicron. They will have to self-isolate before they are able to return, depending on flight availability.

Japan and Israel have taken the more extreme steps of closing their borders to foreigners. The first cases of Omicron that were recorded in Botswana were revealed to be in visiting diplomats, although which country they came from has not been revealed. 

The World Health Organization criticised the imposition of travel restrictions, acknowledging that although they may play a role in slightly reducing the spread of COVID, they still place a heavy burden on lives and livelihoods. It pointed out that if restrictions are implemented, they should not be unnecessarily invasive or intrusive, and should be scientifically based, under international law, the International Health Regulations. It notes South Africa followed International Health Regulations, and informed WHO as soon as its national laboratory identified the Omicron variant. 

“The speed and transparency of the South African and Botswana governments in informing the world of the new variant is to be commended. WHO stands with African countries which had the courage to boldly share life-saving public health information, helping protect the world against the spread of COVID,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “On the eve of a special session on pandemic preparedness I urge all countries to respect their legal obligations and implement scientifically based public health actions. It is critical that countries which are open with their data are supported as this is the only way to ensure we receive important data in a timely manner.”

Although a full picture of the new variant’s severity is still two or three weeks away, Angelique Coetzee, chair of the South African Medical Association, told the AFP she had recently seen around 30 patients at her Pretoria practice who tested positive for COVID but had unfamiliar symptoms.

“What brought them to the surgery was this extreme tiredness,” she said, something she said was unusual for younger patients. Most were men under 40, and just under half were vaccinated. Other symptoms included mild muscle aches, a “scratchy throat” and dry cough, she said. Just a few had a slightly high temperature. These very mild symptoms stand in contrast to other variants, which typically result in more severe symptoms.

1 in 7 Cancer Patients Missed Surgery Due to Lockdowns

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One in seven cancer patients around the world have missed out on potentially life-saving operations during COVID lockdowns, according to a new study led by the University of Birmingham.

Planned cancer surgery was impacted by lockdowns regardless of the local COVID rates at that time, especially in lower income countries.
Though lockdowns have protected the public from COVID, they have had collateral impact on care for other patients and health conditions. Researchers in this study showed that lockdowns resulted in significant delays for cancer surgery and potentially more cancer deaths.

Researchers are calling for major global reorganisation during the pandemic recovery to provide protected elective surgical pathways and critical care beds that will allow surgery to continue safely, as well as investment in ‘surge’ capacity for future public health emergencies.

‘Ring-fenced’ intensive care beds would support patients with other health conditions and those with advanced disease (who are most at risk from delays) to undergo timely surgery. Investment in staffing and infrastructure for emergency care would mitigate against disruption of elective services.

The COVIDSurg Collaborative involved 5000 surgeons and anaesthetists around the world working together as part of the to analyse data from the 15 most common solid cancer types in 20 000 patients in 61 countries. The findings were reported in The Lancet Oncology.

The researchers compared cancellations and delays before cancer surgery during lockdowns to those during times with light restrictions. During full lockdowns, one in seven patients (15%) did not receive their planned operation after a median of 5.3 months from diagnosis – all with a COVID related reason for non-operation. However, during light restriction periods, the non-operation rate was very low (0.6%).

Patients awaiting surgery for longer than six weeks during full lockdown were less likely to have their planned cancer surgery. Frail patients, those with advanced cancer, and those waiting surgery in lower-middle income countries were all less likely to have the cancer operation they urgently needed.

Researchers analysed data from adult patients suffering from cancer types including colorectal, oesophageal, gastric, head and neck, thoracic, liver, pancreatic, prostate, bladder, renal, gynaecological, breast, soft-tissue sarcoma, bony sarcoma, and intracranial malignancies.

Lockdowns directly impact hospital procedures and planning, as health systems change to reflect stringent government policies restricting movement. The researchers found that full and moderate lockdowns independently raised the likelihood of non-operation after adjustment for local COVID case notification rates. They hope that this information will help guide future lockdowns and restrictions by governments.

Source: University of Birmingham

Gender Behavioural Differences Strengthened in Lockdown

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‘Stereotypical’ gender behaviour differences were exaggerated during the COVID lockdown in Austria, according to a recent study published in Scientific Reports

Men and women conducted themselves differently in the wake of the COVD lockdown in Austria, with women spending more time on the phone while men returned to crowded and public areas more quickly.

Using mobile phone data from 1.2 million devices in Austria (representing 15% of the population) across the first phase of the COVID pandemic, researchers quantified gender-specific patterns of communication intensity, mobility, and circadian rhythms. They noted the resilience of behavioural patterns with respect to the shock imposed by a strict nation-wide lock-down that Austria experienced in the beginning of the crisis with severe implications on public and private life. They found significant differences in gender-specific responses during the different phases of the pandemic. They found that following lockdown, gender differences in mobility and communication patterns increased massively, while circadian rhythms tended to synchronise.

In particular, women had fewer but longer phone calls than men during the lock-down. Phone calls involving women lasted significantly longer on average, with big differences depending on who was calling whom. After the first lockdown in Austria was imposed on March 16, calls between women were up to 1.5 times longer than before the crisis (140% increase), while calls from men to women lasted nearly twice as long. Conversely, when women called men, they talked 80 percent longer, while the duration of calls between men rose only by 66 percent.

“Of course, we don’t know the content or purpose of these calls,” says Georg Heiler, a researcher at CSH and TU Wien, who was responsible for data processing. “Yet, literature from the social sciences provides evidence — mostly from small surveys, polls, or interviews — that women tend to choose more active strategies to cope with stress, such as talking with others. Our study would confirm that.”

Mobility declined massively for both genders, however, women tended to restrict their movement stronger than men. Women also showed a stronger tendency to avoid shopping centres and more men frequented recreational areas. 

After the lockdown, males returned back to normal quicker than females; and young and adolescent age-cohorts returned much quicker. An age stratification highlights the role of retirement on behavioural differences. They found that the length of a day for men and women is reduced by one hour. 

Source: Complexity Science Hub Vienna

Positivity Rate at 25% as Lockdown Upgrades Expected

President Cyril Ramaphosa is expected to meet with the National Coronavirus Command Council (NCCC) to discuss the government’s response to the third COVID wave, which includes the possibility of new restrictions. 

Several bodies have strongly urged upgrading to a harder lockdown, including the South African Medical Association, the Gauteng Provincial Government, medical professionals, and now the Ministerial Advisory Committee on Covid-19.

Earlier this week Ramaphosa indicated that the government will have to increase its COVID containmant measure – especially in Gauteng province. He noted that the country’s first hard lockdown in March 2020, one of the strictest in the world, did help cut infection rates at the start of the pandemic.

South Africa recorded 17 493 new cases, a new daily high for the third wave, of which 10 806 were in Gauteng. Case positivity rate increased to 24.92%. A report released on Wednesday by the South African Medical Research Council showed that 1349 excess deaths in Gauteng for the week ending 13 June, of which 431 were due to COVID/

Warnings and failure to act

In an interview with The Money Show with Bruce Whitfield this Monday, Netcare CEO Richard Friedland had warned that the numbers of Covid-19 patients “are overwhelming facilities at the moment”.

Since Wednesday last week, Gauteng’s hospitals had been battling with a “mass casualty situation” , not unlike the aftermath of a train accident, or the collapse of a sports stadium, with “injuries on a massive scale”. But, with COVID, he said, the crisis is not over in a couple of hours, but remains ongoing.

With no evidence of a peak in case numbers, Friedland said that, “I’m afraid that these numbers are demonstrating that [without] a Level 5 lockdown in Gauteng, we may not see the end of this surge for some time.”

Professor Koleka Mlisana, co-chairperson of the Ministerial Advisory Committee on Covid-19, says that tighter restrictions are likely needed to help curb infections.

Prof Mlisana said that the other major crisis is making sure that there are sufficient hospital beds in Gauteng. This includes additional facilities, staffing members and beds to ensure the system is not overwhelmed, she said.

Prof Mlisana said that this was down to a lack of preparation by the government, despite warnings from the advisory committees. 

Source: BusinessTech

WHO Urges Equitable Travel Requirements

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The WHO has urged that as air travel is restored, vaccinations should not be a prerequisite for travellers, potentially locking out those in poorer regions, especially Africa.

In a virtual press briefing on Thursday, Dr Matshidiso Moeti, World Health Organization Regional Director for Africa said that the WHO believes that schemes to remove quarantine and entry restrictions for travellers that have been vaccinated, are discriminatory and could deepen already existing inequalities even further.

Meanwhile, she warned that Africa’s third wave, already underway in 12 countries, with cases rising in another 14, threatens to be the worst yet with 5.3 million cases across the continent. It is projected that in three weeks the third wave will surpass the previous wave’s peak.

Public fatigue and new variants are driving this surge across Africa, with Delta the variant  detected in 14 countries. She stated that Africa can “blunt this third wave” but “the window of opportunity is closing”.

The WHO aims to strengthen variant surveillance in Africa by reinforcing the regional laboratory hub have a 8 to 10 fold increase in next 6 months for genome sequencing

Though vaccination rates remain low in Africa, there is nevertheless a great demand for vaccines, with 18 countries having used over 80% of the vaccines received through COVAX. Fortunately only mild side effects from the vaccines have been seen in African communities, she said.

Mr Kamil Alawadi, Regional Vice President for Africa and Middle East, International Air Transport Association (IATA) said that inconsistent requirements added additional complications in travel, increasing cost for the passenger and the airline. For travellers, PCR testing can range from $100 up to $400 for a single, one direction trip.

The key requirement for the recovery of the airline industry is the lifting of restrictions, said Alwadi, citing a survey that showed that 84% of passengers will not fly if there were quarantines in place. However, demand still existed for air travel, as evidenced by travel bookings spiking as soon as governments relaxed their border restrictions.

Alawadi said that the IATA agreed with the WHO that only lifting quarantine requirements for vaccine individuals was inequitable, and that “a robust and flexible testing system” was needed in place of quarantine, using systematic testing at the point of departure such as rapid antigen tests which are cheaper, faster and more accessible.

Graphic from Skyscanner.net showing countries with major travel restrictions from South Africa (red, 83 countries), moderate (orange, 29) and low restrictions (green, 42)

The situation was urgent for the African aviation industry as it had lost USD7.8 billion in 2020, with eight airlines filing for bankruptcy, he noted. This was against a background of USD430 billion global loss for the industry, though he noted that some countries are seeing a rebound to 2019 numbers for domestic travel. However, it is projected that losses will only stop by 2023 and return to profit by 2024.

The IATA has developed protocols in concert with the  International Civil Aviation Organization (ICAO) and WHO that will be non-discriminatory not require vaccinations, said Alwadi. However the aviation industry is sinking very rapidly without governmental support.

Lockdowns Loom as COVID Spreads Again in SA Provinces

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The Western Cape provincial government has said it is actively preparing for a resurgence of COVID cases while three other provinces have now declared they are in a third wave.

The province’s premier Alan Winde said in a statement on Sunday that based on current trajectories, the province is likely to officially enter its third wave two to three weeks from now.

Gauteng premier David Makhura confirmed that his province officially entered into a third wave more than a week ago. This was followed by similar declarations in the Free State and the Eastern Cape.

“The Western Cape is currently facing a resurgence as it has seen increases in its case numbers every day, over the past 12 days. While this is not yet a third wave, it is the first sign that we are moving towards one,” Winde said.

“Our guiding principle remains that no person will be denied access to life-saving medical treatment. We must make sure we have enough beds, staff and oxygen to respond effectively in the month ahead.”

He added that in the meantime South Africans should continue to follow the level 1 lockdown restrictions, adhering to social distancing and avoid social gatherings to help flatten this curve. But health experts have warned that the rise in cases could require further lockdown restrictions.

Head of the Western Cape Health Department Dr Keith Cloete told EWN that it is a national competency to put lockdown restrictions in place, but they are highly likely to appear given that the number of cases is on the increase countrywide.

Health minister Dr Zweli Mkhize has likewise warned of likely additional restrictions in South Africa due to rising COVID numbers.

He said that the government has discussed the rising numbers. “At some point we are going to have to start looking at additional restrictions,” he said.

“We are going to be recommending that there should be more focus on the size of gatherings, and look at the focus on some of the measures that were actually released when we thought the situation was much more improved.”

He highlighted the importance of trying to maintain a balance to ensure that people continue to be able to work. “We do need to send a strong message still, that people can’t be complacent.”

As of 23 May, there were 2894 new cases in South Africa and the COVID test positive rate stood at 9.86%. Data collected up to 15 May showed the highest positive rate was in the Northern Cape (24.1%), Free State (17.5%) and North West (15.1%) provinces. The percentage testing positive was <10% in all other provinces. (Source: NICD PDF, note this is a 10 MB size)

Source: BusinessTech

Chinatowns around the World Battle COVID and Xenophobia

The BBC explores how the various Chinatowns around the world have been battling loss of business caused by COVID lockdowns, along with fear and xenophobia.

Sam Wo’s, a restaurant in San Francisco’s Chinatown, had been hit hard by COVID just like other businesses there.

The lockdowns had not yet happened but anti-Asian sentiment kept customers away. “All the Italian restaurants in North Beach were still busy and packed and then you went through the tunnel to Union Square and those guys had lines waiting to get in. And then you drive around Chinatown and it’s completely empty,”  Sam Wo’s co-owner Steven Lee told the BBC.

“So we know that xenophobia was affecting small businesses. Why would other districts be busy and we’re not?”

In the 12 months since, it has been forced to cut its staff numbers from 23 to three due to a lack of customers.

“People wouldn’t show up, they were just scared,” Mr Lee tells the BBC. “We had to rally and tell people to fight the virus, not the people and all this kind of stuff – but it didn’t help much.”

In the Japanese city of Yokohama, this went beyond mere avoidance; anti-Chinese notes were left on the doors of restaurants in March. Sales had plummeted to 10% of what they were the year before. The mayor of Yokohama railed against these notes, and locals voiced their support for their Chinatown, telling businesses to “hang in there” and promising to visit again.

In many Chinatowns, the lockdowns then worsened an already dire situation. 

“I know many businesses in Chinatown have closed. It’s terrifying,” Ying Hou, who runs Shandong MaMa in the Australian city of Melbourne, told the BBC. “There are gift houses where tourists come to buy souvenirs – most of them didn’t make it and have closed down.”

Ms Ying says her business is down 50%, but fortunately the shop is the only one in Chinatown to sell fish dumplings. Melbourne gave rent relief to many businesses, but this is now coming to an end. And now Melbourne is about to be plunged into a new five day lockdown surrounding the Australian Open. 

However, many are finding new answers to the problems posed by COVID. In New York, after Chinatown turned into a “ghost town” with the lockdowns closing down even essential businesses by May, Karho Leung took a page out of Hong Kong barber shops’ reactions to COVID and installed dividers and other measures. He advertised these safety enhancements, which went viral and resulted in a surge of business from pent-up demand.

Mr Leung added to his business and others that were struggling by embracing social media and online delivery companies such as Uber Eats. 
Organisations made up of ordinary citizens are also helping to keep their cities’ Chinatowns afloat as well. Send Chinatown Love is helping Chinatown businesses there with their online and social media presence to help generate business, creating “food crawls” to drum up foot traffic.

“Everything started happening around January, February of last year, which is the most lucrative and joyous and festive times for Chinatown. They took a hit with that business and lost most of it,” said Louise Palmer, who is a representative for the group. “So they ended up going into lockdown in March at a deficit, which kind of set a really terrible precedent for what the rest of the year would look like.”

Meanwhile, in San Francisco, in a hopeful development, business is picking up again since outdoor dining became allowed. Mr Lee said that Chinatown is booming again, and is planning to open a nightclub.

“We’re the oldest Chinatown in the country. We’re the tourist attraction that everybody comes to when they come to San Francisco. So we have to preserve it,” Mr Lee said.

Source: BBC News