Covid: what new wave of cases in Europe means for Brazil

“Although we are not in the same situation as we were a year ago, it is clear that the Covid-19 pandemic is not over. Unfortunately, we see the indicators rising again in Europe, which suggests the beginning of a new wave of infections.”

This is the first paragraph of a joint statement published on October 12 by leaders of the European Center for Disease Control and Prevention (ECDC) and representatives of the World Health Organization (WHO) on this continent.

Now, however, the concern comes in a double dose: with the arrival of autumn and, later on, of winter in the Northern Hemisphere, authorities in the region also predict a season of high transmission of influenza, the virus that causes the flu.

“The potential co-circulation of Covid-19 and influenza will put vulnerable people at greater risk of serious illness and death, with likely increased pressure on hospitals and healthcare workers, already depleted for nearly three years on the front lines of the pandemic. “, previews the text.

The best strategy to deal with these threats, the institutions point out, is to reinforce vaccination, especially for the most vulnerable groups.

But what do the current numbers of Covid-19 on the European continent reveal? And what can they represent for Brazil and the rest of the world?

In summary, the situation requires care and reinforcement of immunizers, especially in the elderly and other more vulnerable groups. The researchers fear that the wave that begins in the European autumn will reach Brazil between December and January, causing a new increase in cases and deaths from Covid. This phenomenon, by the way, happened in previous periods.

Up and down

Every week, the WHO releases a report in which it updates the situation of Covid-19 in the world.

The latest edition of the document, published on October 19, shows that the situation in Europe is unstable: in the three weeks of October, the numbers of cases and deaths rose and then fell.

An 8% increase in infections was recorded in 5/10, with two declines in a row in 12/10 (-3%) and 19/10 (-11%).

Even so, of the five countries that detected the most cases of Covid-19 in the last seven days, three are European: Germany (583 thousand new infections), France (337 thousand) and Italy (288 thousand). The other two are China (328,000) and the United States (251,000).

Currently, nations located in the central and Mediterranean region of the continent are among those with the highest relative rate of Covid-19 cases compared to the rest of the world.

“This increase in cases observed not only in Europe, but also in Asia, lights up a warning and there is no doubt that it is something important”, says epidemiologist Paulo Petry, a professor at the Federal University of Rio Grande do Sul.

The change in epidemiological scenarios even motivates discussions about the return of certain preventive measures.

With an increase in cases and even hospitalizations, some states in Germany, for example, are considering the reintroduction of the mandatory use of masks in closed places or the reinforcement of testing campaigns.

According to Deutsche Welle, German Health Minister Karl Lauterbach considers that the country is “well prepared for autumn and winter, thanks to up-to-date vaccines and medicines”.

“Even so, the direction we are heading is not good,” he says.

For infectious disease specialist Raquel Stucchi, a professor at the State University of Campinas (Unicamp), it is necessary to follow this wave for longer to understand the effects it will have.

“The trend, and our desire, is for it to be less impactful than the previous ones, even due to vaccination and the number of people who have already had Covid-19”, he points out.

“But it will be necessary to check this in practice to be sure if these infections will cause hospitalizations and, unfortunately, deaths”, he adds.

But what explains this possible new wave that is beginning to form in Europe?

New variants?

The latest WHO report points out that, in the last month, 98,700 genetic sequences of the coronavirus were shared in public databases.

The analyzes show that the omicron variant BA.5 continues to be dominant and appears in 78.9% of the samples.

Next, other lineages of the omicron that are “sister cousins”, such as BA.4 (6.7%) and BA.2 (3.9%) are observed.

A new variant that is starting to attract the attention of the authorities is the XBB, which merges mutations from BA.2.10.1 and BA.2.75.

It has already been detected in 26 countries – and some early work suggests that the new version has a great ability to evade immunity, obtained through vaccination or previous infections.

But it is necessary to consider that, for now, the number of samples from XBB is small: we are talking here about just over 800 genetic sequencing of it carried out around the world.

“Although this recombinant strain shows signs of an advantage compared to the descendant variants of the omicron, there is still no evidence that it leads to a greater severity of the disease”, clarifies the WHO.

With the evidence available to date, therefore, the increase in perceived cases in Europe appears to be caused by the omicron “family”.

Virologist Fernando Spilki, a professor at the Feevale University, in Rio Grande do Sul, explains that “a new variant has not yet been found” to help explain the current scenario.

“But this could be a matter of time if we look at what is happening, especially in countries like Germany”, he evaluates.

In other words, the more the coronavirus circulates, the more chance it has to undergo mutations that are beneficial to it. And that, in turn, opens the way for more transmissible, aggressive variants or those with the ability to evade the immune system.

The situation in Europe, for now, seems to be related to the complete relaxation of restrictive measures – as was natural to happen with the improvement of the pandemic situation.

But the proximity between people at work, at events and on social occasions – which are increasingly taking place indoors because of the cold – facilitates the exchange of respiratory viruses.

And this leads to an increase in community transmission of the pathogen, which can generate complications and even kill, especially the most vulnerable individuals, such as the elderly and immunosuppressed.

The counter attack

Spilki points out that even with this rise in cases in the early fall in the Northern Hemisphere, “there is currently no room for debate about major restriction measures.”

In the assessment of local authorities, with vaccines and medicines widely available on the continent, it seems impractical and even unnecessary to rescue the drastic measures of the past, such as the lockdown.

“The concern should be to complete the vaccination schedule of those with late doses”, suggests the virologist.

The ECDC estimates that 72.6% of Europeans have completed the initial immunization course. Only 53.9% of them took the third vaccine, considered essential to protect against the most serious forms of infection caused by the Ômicron variant.

With vaccination as the main public health policy, many European countries have already started to apply the fourth dose — or the second booster dose — to part of the population.

The immunizer that has been offered in recent weeks brings an important novelty: the product formulation has been updated to better protect against the latest variants, such as the Omicron BA.1.

The same process even happens every year with influenza vaccines.

“Our message is simple: vaccination saves lives. It reduces the chances of being infected and the risk of suffering from the most severe consequences of Covid and seasonal flu”, write the representatives of the WHO and the ECDC.

“There is no time to waste. We encourage everyone who is eligible, especially the most vulnerable, to take their doses as soon as possible.”

Each country in the region adopts its own criteria to define the target audience of the current vaccination campaign against covid.

In the UK, for example, the second booster dose is now available for everyone over 50, pregnant women, immunosuppressed individuals, caregivers of the elderly and health and social care professionals.

Stucchi, who is also a member of the Brazilian Society of Infectious Diseases (SBI), highlights the need to educate people, so that they understand when they are at risk or if they are part of those groups in which Covid-19 can be more serious.

“With this, the individual can assess the situation, wear masks in closed places, take vaccine doses and isolate themselves if they have any symptoms of respiratory infection”, he proposes.

And Brazil?

For now, the situation in the country seems to be heading towards a decrease in the most important indicators related to the health crisis.

Since July, the moving average of Covid cases has been decreasing and went from 59,800 on 7/15 to 4,900 on 10/23 – a proportional drop of twelve times.

Something similar happens with deaths. The last peak was recorded in February, with a moving average of 951 deaths on 2/11. The number plummeted to 60 on 10/23.

The data comes from monitoring carried out by the National Council of Health Secretaries, Conass.

For Petry, this Brazilian plateau should also be viewed with caution. “We are not in a comfortable situation. Behind these numbers, we have people’s lives and the impact on families”, she assesses.

The moment of greater calm, however, should be seen as an opportunity to plan for the coming months, with the objective of keeping the numbers in this downward trend, according to experts.

“Our fear is that the scenario of other years will be repeated, in which the wave of cases in the European autumn was reflected in an increase in infections and deaths by Covid in December and January in Brazil”, analyzes Spilki.

“To avoid this, we need to observe the effects of updated vaccines in countries that have already adopted this strategy and think about the booster campaign here for the beginning of 2023”, proposes the virologist.

Stucchi ponders that phenomena are not always imported from abroad and have the same effect in the country. “The delta variant was bad in Europe and we were afraid of what it would do when it arrived. But the impact here was much smaller”, he compares.

So far, however, there is no sign that the issue of updating vaccines is being discussed in the country.

A report published by BBC News Brasil on September 22 pointed out that the Ministry of Health did not hold public meetings with experts about the vaccine strategy for next year – and no news has been released on the subject since then.

The researchers also draw attention to the lack of specific drugs to treat Covid – some of them already released for use in the country.

At the beginning of October, SBI released a technical note in which it expresses “concern regarding the processes of incorporation, indication and distribution of medications already approved by Anvisa for the treatment and prevention of Covid-19, but which are not available to date. for use in the public sector”.

The document states that, “although the number of hospitalizations and deaths from Covid-19 has been reduced with the advancement of vaccination, in September alone 7,321 Brazilians” died from Covid, “with many of them could benefit from therapeutic medications or preventive strategies against infection”.

The institution points out that drugs such as nirmatrelvir/ritonavir, baracitinib, molnupiravir and rendesivir have already received a positive evaluation from the Brazilian regulatory agency, but they have not been distributed in the public network and there is no clarity on when they can be prescribed in practice.

BBC News Brasil contacted the Ministry of Health to request a position on the points presented on vaccination and medicines. No responses were sent until the publication of the report.

Finally, Spilki highlights the need to “better monitor cases”.

“We need to work with active search and do a tracking to have early warning of a new wave”, he says.

“The diagnosis and monitoring of Covid remains at a very low level in the country”, he laments.

Stucchi agrees and says that Brazil “is a terrible student”.

“We do not learn from the mistakes of the past. We still need a surveillance system that can detect in advance the circulation of respiratory viruses in order to plan health actions”, he concludes.

This text was originally published here.