Europe has broken through its all-time high for Covid cases, and is seeing sharp increases in infections right across the continent. The Covid superwave that started in Eastern Europe just one month ago has now spread to all corners of the continent, and doesn’t look like it’s about to break anytime soon.
Virtually every part of Europe is now seeing increases in infections as the winter superwave rolls in.
Virtually every government in Europe has pinned its hopes on Covid vaccines preventing further large waves of the disease, a tactic that we have repeatedly warned wouldn’t work. It has been obvious for months that vaccine waning and vaccine breakthroughs would make vaccines a poor first line of defence.
Europe needs to regroup, rethink, and redraw its lines of defence quickly. Greater defence in depth is needed by using mitigations that are proven to work.
Our estimation of the winter wave of 2020 shown in the diagram below suggests that a wave peak of around 13 – 15 million biweekly cases might have been reached had it not been for the mitigations imposed in Europe and North America in early November 2020.
The 2020 winter wave was broken in half by strong mitigations. It may already be too late to reintroduce them this to year to prevent the worst of the damage from the wave impact.
What was the lesson we all learned from earlier waves? Go in hard, go in strong?
With the half-hearted mitigations that Europe has put in place for the winter wave, it looks as though we are about to find out just how bad things can really get with Covid.
Updatable chart for Europe below – press your refresh button to update:
This isn’t the most difficult prediction we have ever had to make, but there is no doubt that, despite huge vaccination campaigns across the continent, the winter wave now breaking over Europe will be their worst wave of the pandemic so far.
The difference this year is that, despite raging infections in many European countries, despite vaccine waning, vaccine breakthroughs and reinfections, no government is yet considering measures that are strong enough to contain the tide.
Measures including lockdowns and working from home were imposed in many countries across Europe and North America in early November 2020 to prevent the winter wave worsening. Despite their huge unpopularity, the measures, particularly lockdowns, DID work.
The chart below shows our estimation of what the winter wave would have looked like in 2020 without lockdowns. The global winter wave of 2020 was broken in half by lockdowns in key European countries and in North America which made up the bulk of cases.
Our estimation of the size of the Covid global winter wave in 2020. The winter wave was smashed by lockdowns in Europe and North America:
In 2021, however, many countries in Europe have abandoned the use face masks, social distancing and working from home. Lockdowns have been also been ruled out by many governments, fearful of their unpopularity.
The chart below shows what the European Covid winter wave looks like on the 4th November 2021. The wave that is forming is virtually identical to the wave of 2020. The difference in 2021 is that there are no mitigations in reserve to prevent previous wave records being broken. Without urgent mitigations, this wave could be bigger than the one that engulfed India in the spring of 2021
Europe needs to take its head out of the sand, and do it quickly. There are very few tools left in the toolbox to deal with large waves, and every one of them will be needed this year.
We are still waiting for more data to come in to be able to make a prediction on the size of the global winter wave, but it’s not impossible that Europe alone could carry almost the entire burden of the winter wave this year.
Just to be crystal clear then:
- Vaccines won’t be enough to stop the wave
- Antivirals won’t be enough to stop the wave
- Vaccine passports won’t be enough to stop the wave
- Face masks won’t be enough to stop the wave
- Locking up the unvaccinated won’t be enough to stop the wave
“The current pace of transmission across the 53 countries of the European Region is of grave concern,” said regional WHO head Hans Kluge.
Kluge warned earlier that if Europe followed its current trajectory, there could be 500,000 COVID-related deaths in the region by February.
“We must change our tactics, from reacting to surges of COVID-19, to preventing them from happening in the first place,” he said.
Covid has surged across large parts of Europe again as a winter wave rolls across the continent:
“At the country-level, there appears to be no discernable relationship between percentage of population fully vaccinated and new COVID-19 cases in the last 7 days. In fact, the trend line suggests a marginally positive association such that countries with higher percentage of population fully vaccinated have higher COVID-19 cases per 1 million people.
Notably, Israel with over 60% of their population fully vaccinated had the highest COVID-19 cases per 1 million people in the last 7 days. The lack of a meaningful association between percentage population fully vaccinated and new COVID-19 cases is further exemplified, for instance, by comparison of Iceland and Portugal. Both countries have over 75% of their population fully vaccinated and have more COVID-19 cases per 1 million people than countries such as Vietnam and South Africa that have around 10% of their population fully vaccinated.”
Latest Care Home (CH) COVID death data (to last Friday) unfortunately shows a significant increase (doubled in a fortnight) after several low weeks.
This is a population that is ~99% fully vax'd, although staff are only around 77% fully vax'd.
— John Roberts (@john_actuary) July 27, 2021
Please check your care home lockdown plans now, this could escalate quite quickly.
In the past four days in Portugal, three out of four Covid-19 deaths have occurred in the over 70-year-old age bracket. Experts explain that the increase in cases in older age groups is a reflection of the situation that the country is going through. In care homes, there are no significant outbreaks, but those responsible do not hide their concern.
RTP.pt report (with video report in Portuguese)
In another sign that the effectiveness of the various coronavirus vaccines is waning quickly, Covid-19 infection rates are now rising fastest amongst the over 80s age group, with a rise of 54% in two weeks in that cohort in Portugal. The over 80s, of course, were the first group to be vaccinated against Covid-19 earlier this year as they were deemed to be the most vulnerable to the disease.
RTP.pt report (in Portuguese)
Europe has seen major changes in coronavirus case rates over the last two months. In many areas of Europe covid case rates have dropped sufficiently to allow restrictions to be eased, but there are notable exceptions. The Covid-19 rate in Spain now appears to be as bad, if not worse, than two months ago, and the Netherlands has seen a dramatic increase in numbers recently.
In the case of both Spain and the Netherlands, the rates increased following the decision to unlock their countries too quickly, and in both cases those decisions have had to reversed within weeks. Greece too appears to be seeing a new wave, and these areas now represent the largest threat to Europe’s strategy to keeping infection rates down.
The Portuguese government establishes that citizens “should refrain from circulating in public spaces and streets and remain at their respective homes during the period between 11:00 pm and 5:00 am”. The restrictive measures on circulation, which will be carried out every day, will take effect this Friday.
Mariana Vieira da Silva clarifies that this measure to limit circulation has no exceptions. Even for those with negative covid-19 tests or for vaccinated people. “This is a measure to reduce crowds”, argued the Minister of the Presidency , justifying it with the increase in cases of infection in the younger layers of the population. Instead of what happens in “ages already vaccinated”. Which, he concluded, “means the vaccine works.”
There are currently 19 municipalities, the majority in the Metropolitan Area of Lisbon (AML), which are at very high risk of infection , meaning that they have already reached twice the 240 cases of infection per covid-19 per 100,000 inhabitants (or 480 in low-density territories). From AML are the municipalities of Almada, Amadora, Barreiro, Cascais, Lisbon, Loures, Mafra, Moita, Odivelas, Oeiras, Seixal, Sesimbra, Sintra and Sobral de Montagraço. Albufeira, Constância, Loulé, Mira and Olhão are also in this situation.
Last week were only in the red zone, Lisbon, Albufeira and Sesimbra.
There are also 26 other municipalities that have reached a high risk of infection , that is to say that twice surpassed the 120 cases per 100 thousand inhabitants (or 240 in low-density territories). They are Alcochete, Alenquer, Arruda dos Vinhos, Avis, Braga, Castelo de Vide, Faro, Grândola, lagoon, Lagos, Montijo, Odemira, Palmela, Paredes de Coura, Portimão, Porto, Rio Maior, Santarém, São Brás de Alportel, Sardoal, Setúbal, Silves, Sines, Sousel, Torres Vedras and Vila Franca de Xira.
Diario de Noticias report (in portuguese)
Through routine scanning of variation in Delta, a small number of sequences were detected which had acquired the spike protein mutation K417N. Information suggests that there are at least 2 separate clades of Delta with K417N. One clade is large and internationally distributed with PANGO lineage designation AY.1. A second clade found in sequences uploaded to GISAID from the USA, now designated AY.2.
As of 16 June 2021, 161 genomes of Delta-AY.1 have been identified on GISAID. from Canada (1), India (8), Japan (15), Nepal (3), Poland (9), Portugal (22), Russia (1), Switzerland (18), Turkey (1), USA (83).
There are currently 38 cases of Delta-AY.1 in England (36 confirmed sequencing and 2 probable genotyping). Cases have been detected in 6 different regions in England. Delta-AY.2 has not been detected in England.
UK Variants of Concern Technical Briefing 15 (PDF download)
According to Bani Jolly of the Institute of Genomics and Integrative Biology, the phylogeny of Delta has two separate clades. While AY.1 is found in a few countries including the UK, India and Nepal, the other clade (AY.2), is largely from the sequences from California (USA).
“The split between the two clades seems to be based on two spike mutations — A222V and T95I. While all sequences in the California cluster share spike A222V, all sequences in the larger international cluster share spike T95I,” Jolly tweeted.
Stating that AY.1 has arisen independently a number of times and could be more prevalent than observed in countries with limited genomic surveillance, she tweeted that given that Delta is a variant of concern, it is important to take note of any sub-lineages that may emerge.
Of the 36 cases of Delta-AY.1 (mountaineers) variant, 27 cases were known to have a vaccination status within the National Immunisation Management System (NIMS).
“Through routine scanning of variation in Delta a small number of sequences were detected which had acquired the spike protein mutation K417N. Information suggests that there are at least 2 separate clades of Delta with K417N. One clade is large and internationally distributed with PANGO lineage designation AY.1. A second clade found in sequences uploaded to GISAID from the USA. There is limited epidemiological information available at present.
As of 7 June 2021, 63 genomes of Delta with K417N have been identified on GISAID. from Canada (1) Germany (1), Russia (1), Nepal (2), Switzerland (4), India (6), Poland (9), Portugal (12), Japan (13), USA (14).
There are currently 36 cases of Delta-AY.1 in England (35 confirmed sequencing and 1 probable genotyping) plus an additional 10 sequences which include some cases in other UK nations and some genomes for which case data is being sought. The first 5 cases were sequenced on 26 April 2021 and were contacts of travellers to Nepal and Turkey. All these cases were detected in the West Midlands. Cases have been detected in 6 different regions in England (Table 21, Figure 26). The majority of cases are in younger individuals, with 2 cases of age 60 or over (Figure 27). Out of the 36 cases, there were 11 travel associated cases (6 travellers and 5 cases amongst contacts of travellers). Twelve cases have no history of travel or contact with travellers. Countries of travel included red-list countries (Nepal and Turkey), amber-list countries (Malaysia) and green-list countries (Singapore).
Of the 36 cases, 27 cases were known to have a vaccination status within the National Immunisation Management System (NIMS), when linked on NHS number. Of these, 18 cases occurred in people who were not vaccinated, 2 cases in people who had received their first dose within 21 days of specimen date, 5 cases in people who had received their first dose more than 21 days after specimen date. There was a total of 2 cases where there were more than 14 days between the second dose of vaccine and a positive specimen. No deaths have been recorded amongst the 36 cases.”
PHE download – SARS-CoV-2 variants of concern and variants under investigation in England – Technical briefing 15 (PDF)
The Delta variant with the K417N mutation, also known as the “Mountaineers” variant, has cropped up 14 times in Japan, and 13 of those samples were in travellers from Nepal – mostly climbers from Everest expeditions. At least 100 cases were reported at the Everest base camp, it is believed that the variant could have been spread by climbers ascending the mountain despite widespread national lockdowns across the globe. Cases have also been identified in India, Japan, Portugal, and the UK.
According to Dr Jeff Barrett, director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute in the UK, at least one case has been found in the US.
The mountaineers variant B.1.617.2 + K417N has also been blamed for the axing of Portugal from the UK’s green travel list. See this report
Portugal is axed from UK’s green list and relegated to the Amber list. No countries are set to be added to the Government’s green list. Seven countries will be added to the red rating, they are: Egypt, Sri Lanka, Costa Rica, Bahrain, Sudan, Trinidad and Tobago and Afghanistan
“UK government Ministers and their medical advisers will meet on Thursday to decide whether Portugal should be dropped from the green list and instead rated amber, requiring holidaymakers to quarantine for 10 days on their return and pay for two PCR tests. Scientists from the Joint Biosecurity Centre (JBC) are concerned about rising infection rates and the emergence of variants in Portugal, which was the first of 12 countries and territories to be rated green just three weeks ago.”