June 2021: Global COVID Update

COVID-19, predictably, continues to hog the headlines. In the UK, talk is dominated by whether the delta variant, formerly called the "Indian variant", and a recent uptick in cases, is threatening to derail the roadmap out of lockdown. For now, the Prime Minister is standing by his plans and, buoyed up by impressive vaccination rates with over half the UK adult population now double vaccinated, says he currently "sees nothing in the data" to suggest we should do otherwise. The US is also in an equivalently good place. Elsewhere around the world, though, things are not looking so bullish, especially in countries that, early in the pandemic, appeared to have gotten off relatively lightly. It's also turning increasingly political, with pressure mounting on China as world leaders and intelligence agencies join ranks to ask for more transparency around where COVID came from. Chris Smith asked Columbia University infectious diseases epidemiologist Maureen Miller for her view on the current global situation…

Maureen - Right now developed countries are in an amazing situation. I mean, in New York City today, it was our first non COVID death day since the pandemic began. And I understand that the UK also had no COVID deaths yesterday. We should celebrate that, but we should also be aware that the pandemic right now is at its worst phase ever because it is impacting heavily in Asia, as well as in Latin America. Systems are being overwhelmed, healthcare is not available, and unfortunately there's not enough vaccine or infrastructure to really start heavy duty vaccination in those countries, which is exactly what needs to happen right now.

Chris - Let's unpack that a bit. Then, first of all, the point you made first developed countries are in a brilliant position, less developed countries, less so. Why is that?

Maureen - We recognized and experienced the pandemic early and hard. And we also have kind of monopolized the vaccine availability once it became available. The idea that there would be global sharing has not been realised as much as was hoped. I also think in less developed countries, there was belief that it was under control because so many of these cases are asymptomatic and that's what fuels the spread. People were not testing as much. So they just assumed they had it under control. And with this virus, that is a very, very bad mistake.

Chris - Is that really going to be the cycle then? Do you think going forward, unless we change something radically, we're just going to keep seeing cycles of lockdowns, disease suppression, reopening, disease surging, probably fueled by variants that stem from some corner of Earth.

Maureen - I think until we get a large percentage of the population, the global population vaccinated, that is a likely scenario. Ideally, we would want to disrupt transmission in a big way. That will happen through the vaccination. And it is kind of a race against the virus because most of the vaccines work against most of the variants right now. There will be more breakthroughs. And that's what we're seeing, the variants are breaking through. But because the vaccines are effective at the outcomes they were designed to prevent, which is death and serious disease that causes hospitalization. So we may see people getting more minor disease, but that won't kill them as long as they've been vaccinated.

Chris - To do what is being proposed, which is to keep up on the vaccine front with what the virus is doing, so update the vaccine to make sure that it can prevent against whatever changes are being accrued in the virus. That needs some kind of surveillance system, presumably doesn't it. A bit like the network we have to surveil normally what flu is doing.

Maureen - Exactly. And I worry that we are not putting as much energy into that kind of surveillance as we should. The United States has made a decision not to monitor mild or asymptomatic cases that breakthrough should they be discovered. And I think that's a mistake. I think we need to really understand what is causing infection in previously vaccinated people. And that keeps me up at night.

Chris - Because one of the other points that's often made is that if we had a surveillance system like that, we wouldn't be in the position we're in now because we would have found coronavirus in its present incarnation before it became this big headache.

Maureen - Yes, I think it's a little bit more challenging than that because by the time it was discovered in Wuhan, it had probably been circulating for quite some time and mutating to become transmissible between humans. Really, we need to identify it before it becomes pandemic.

Chris - I guess you're arguing that if we have surveillance that's rooted in hospital that is triggered by a person pitching up in an extreme situation, it's already too late. So we'd need some kind of on the ground network that's spotting these things that are a threat waiting in the wings that hasn't actually realized its pandemic potential yet.

Maureen - Absolutely. Yes. And I have been working on a syndromic surveillance system that can be implemented in communities where spillover animal to human virus spillover is most likely to occur.

Chris - But it's not just as simple as, as people boots on the ground, collecting samples and looking at presentations to healthcare services to spot these things, is it? It needs political buy-in and that's been the other major criticism and a big news story this week as well, isn't it, with cooperation. With the Chinese government actually buying in to cooperate and be transparent because it would appear that they are not terribly good at that. At least for the moment.

Maureen - That's a really big deal because China is a hotspot. It is the hotspot. The area in Southern China in particular is extremely fertile for viruses that can become pandemic. It's not a weakness. It's a reality. The weakness is not communicating and not being a global health citizen to monitor this area to ensure that this never happens again.

Chris - Why is China so resistant to doing this? The WHO went in, they made it difficult for them to get into the country in the first place. There were long delays and they were refused access to certain specimens they asked for. It led to a lot of distrust internationally to the extent you've now got world leaders saying, 'We want independent inquiries'. Why don't China want to join the party?

Maureen - I think they're embarrassed that they have this situation. I think it is to save face. They do not want to acknowledge that their country is a source of pandemic viruses.