Is this third wave coming to Kuwait, and should actions have been taken earlier? The former is vexing many and there is no easy answer. Vaccination rates per population are promising. Changes in behaviour in Kuwait started meaningfully by the end of summer and it was always planned that the timing of relaxation of lockdown would coincide with an increase of cases. At the moment, more people are positive about Kuwait’s future than negative, but it will be a nervous few months. It is slightly remarkable that once again, despite all we know about this disease, countries are facing seemingly uncontrolled waves despite having effective vaccines, proven measures that reduce transmission and no major new variants.
But many countries recently identified a new variant of COVID-19 named as OMICRON which has almost 32 to 50 mutations in the spike protein. This mutation makes this virus the most vulnerable one till date, as this Omicrons spike might evade antibodies which we have from the vaccination or from a previous infection. The variant was seen mostly in young who were not properly vaccinated. Kuwait should focus on finishing the booster dose vaccination at the earliest.
The WHO and the European Observatory on Health Systems and Policy have produced a fascinating and non-political review of health system resilience in the pandemic. It looks like not all the lessons have been learned. There has been some excitement over the past week about AY.4.2, which is a sub-lineage of the Delta variant. The most recent UKHSA technical briefing, gives lots of useful information for the obsessive and paranoid alike. AY.4.2 is known as VUI-21OCT-01 and remains a ‘variant of interest’ rather than a ‘variant of concern (VOC)’. Delta now accounts for 99.8% of UK cases and AY.4.2 makes up 15% of these. AY.4 lineages have been predominating since May and have a mutation in the Nsp3 protein involved in replication. The additional mutations for AY.4.2 are on the spike protein and there has been some evidence, shown through secondary attack rate data and household transmission risk data, that this variant is more transmissible. However, this is by no means certain and not of the order of increased risk seen in previous VOCs.
The bad news we can expect is the currently available vaccines may not give us an immunity against OMICRON.
The good news is that current vaccines are no less effective against AY.4.2 than other Delta lineages based on both in vitro and in vivo data. In vitro studies look at post-vaccination sera antibody titres needed to neutralise live virus and, if anything, lower levels are needed than for other Delta variants.
In vivo data are from hospitalised cases, and sadly there are lots of unvaccinated cases to act as a control group.
Many of us will have been watching the rapidly increasing number of COVID-19 cases in Europe – Austria and Germany in particular – which has been described by some as the fourth wave.
The rates of increase in Germany and Austria are frightening and it is understandable that lockdown measures are being introduced. However, this may be too late, as the data on ICU patients shows that there are over three times as many patients per population in ICU beds in Austria compared with other European countries. It seems likely the ICU capacity will be exceeded soon.
When we speak to doctors working in COVID units, the pressures on these doctors are writ large. The challenges that face COVID team doctors are pretty consistent. Trainees as a whole feel very supported by consultant colleagues and relentless workload is the theme for both groups.
Reconfiguration of services is common and causes much angst.
It was shocking to see some data that suggested that vaccination uptake remains low in pregnant women and that those ending up on ICU are almost all unvaccinated – 98% to be exact.
The reasons behind this are related to fear about adverse effects of the vaccine and mixed messaging during the rollout. Both have travelled through the airwaves and word of mouth in the absence of clear data.
However, we now have good evidence that vaccines are safe for both mother and baby. There is no increase in adverse events for the mother, and as well as there being no difference in stillbirth rates for vaccinated versus unvaccinated, babies born to unvaccinated mothers have a lower birth weight.
We all have a part to play in trying to dispel the myths around vaccination in this setting. It’s unfortunate enough to end up on ICU when pregnant, it is something to be avoided.
By Dr Rajesh Rajan
Cardiologist, Sabah Al Ahmad Cardiac Center, Al Amiri Hospital