Tuesday, May 24, 2022  |  Category: COVID-19, Eduvation Insider

A Storm of Flying Monkeys

Good morning, and welcome back from the Victoria Day weekend! (Or “National Patriots’ Day” for readers in Quebec.) Today the world recognizes and celebrates brothers, aviation techs, escargot and tiaras.

But it’s also a day to celebrate if you are safe, dry and warm! The deadly “derecho” windstorm that swept across southern Ontario and Quebec on Saturday knocked out electricity for 950,000 customers, and as of this writing, hydro crews are still working to restore half of them. The Ottawa region was particularly hard-hit, as 130-kmh winds toppled major steel transmission towers, disabling much of the electric grid.

I’ve already heard from Algonquin College that they have cancelled all Ottawa-campus classes and services – in-person and virtual alike – for today, and they warn “it is likely cancellations will be extended further into the week.” No doubt other CdnPSEs in the region will be grappling with similar disruptions. Our thoughts are with everyone affected.

Climate change is intensifying such extreme weather events, of course, from ice storms and flooding to wildfires and hurricanes. PSE campuses around the world have been impacted to varying degrees, often having to close their doors or suspend their operations (as at Tulane U after hurricane Katrina, Keyano College after the Fort MacMurray wildfires, or after regional flooding impacted Bow Valley College and uFraser Valley).

But those aren’t the only storms we’ll be weathering in the years ahead! Not only are geopolitical conflicts like the War in Ukraine decimating lives and livelihoods, but (as I said 2 weeks ago) the world is entering a “Pandemicene Era” and climate change is already accelerating zoonotic epidemics…

Pandemic Précis

Since I last addressed the COVID19 pandemic on May 10, May 11, and May 12, the story has of course refused to go away. In Canada, case counts, hospitalizations and deaths are dropping, the 2nd wave of Omicron has peaked, and PHOs are predicting a “calm summer” (despite the rise of a new sublineage, BA.2.20), but the same is not true everywhere…   

2M Cases in North Korea

2 weeks ago, North Korea imposed a nationwide lockdown in response to its first known outbreak of COVID19. After more than 2 years of claiming “COVID zero” success, despite having almost no vaccinations and rejecting offers of COVAX doses, North Korea has been rapidly overwhelmed by the Omicron BA.2 variant. “For Pyongyang to publicly admit Omicron cases, the public health situation must be serious.” In the first 72 hours, state media confirmed more than 1.2M cases of “fever” across the country, and at least 8 deaths. A week later, the official count was 1.98 million cases and 63 deaths. In a country of 26M, almost none of whom are vaccinated, with crumbling healthcare systems lacking ICU capacity or COVID19 tests, the disaster will likely be far worse, with perhaps 1M requiring hospitalization. (State television is helpfully recommending willow leaf tea or gargling with salt water.) Some experts believe cross-border smugglers defied the strict border lockdowns, and inadvertently introduced COVID19 to a completely unprotected population. It is also possible that a major Apr 25 military parade in Pyongyang served as a superspreader event. Even to stop a COVID19 catastrophe, Kim Jong Un may not welcome international vaccines or medicines: from 1994-98 the North Korean government allowed 3.5M to starve to death rather than accept external aid. (Although he is reportedly appealing to Beijing.)

Chinese Campus Lockdowns

Meanwhile, China has been battling its own COVID19 outbreaks, imposing lockdowns on major cities like Shanghai, and sparking rare protests among PSE students. In April, students at Tongji U and East China Normal U in Shanghai protested for access to showers and toilets. Last week, ~200 Peking U students gathered outside their dorms in Beijing to protest the “unfair” and “poorly communicated” lockdown measures, which forced them into isolation behind a purpose-built metal wall, while faculty and staff were free to come and go from campus. Students report they were confined to their dorms for weeks, needed appointments to use shared bathrooms, and were prevented from showering or ordering food. The government quickly censored protest videos and photos on Weibo and WeChat.  New York Times  |  Washington Post

Omicron Reinfection Likely

So long as it continues to circulate, the Omicron variant “seems to be one that will re-infect people over and over again,” explains a UBC medical genetics prof, since it targets the upper airways “where you tend not to develop strong immunity easily.” Despite extensive precautions, high-profile personalities Jimmy Kimmel and Stephen Colbert recently tested positive with Omicron reinfections. “A future where people get Covid several times per year could have major implications for the immune-compromised and anyone seeking health care in a perennially stretched system,” observes a writer for The New Republic. Not only will workers be off sick, but parents will struggle to care for kids sent home from schools or daycares. COVID19 is still far less seasonal than flu, and the potential for long-term organ damage from even mild cases is still being understood.

“The Omicron variant, in particular, seems to be one that will re-infect people over and over again.” – Kelly McNagny, medical genetics prof, UBC school for biomedical engineering

Protection Fades in Weeks

Disappointing new peer-reviewed research in JAMA Network Open concludes that immunity against the COVID19 Omicron variant fades within 3 months after 2nd or 3rd doses of the Pfizer BioNTech vaccine. The Danish study of 128 people found that Omicron-specific neutralizing antibodies fell from 76% at 4 weeks to 53% at 10 weeks and just 19% at 14 weeks. Neutralizing antibodies are not, of course, the sole immune mechanism, and T-cells may help protect against serious illness, if not infection.

“Mystery Hepatitis” in Kids

The WHO reports 348 probable cases of “severe acute hepatitis of unknown origin in children” in 20 countries, with dozens requiring liver transplants and even 6 deaths in the US. In the past 6 months, 10 Canadian casesrequired hospitalization, while 180 American cases have been reported, and 163 UK cases. Hepatitis A through E have been ruled out by lab tests, but the leading hypotheses involve “adenovirus… with also still an important consideration about the role of COVID as well, either as a co-infection or as a past infection.” (So it could be a consequence of “Long COVID,” a dormant virus given an opportunity to surge when COVID19 or adenovirus strikes, or something completely unrelated.) Most children did not report a previous COVID19 infection, although they could have been asymptomatic, and almost none were vaccinated due to their ages. Adenovirus doesn’t usually cause liver damage, and while the virus was detected in the children’s blood samples, it has not been found in their livers. “There’s a lot of things that don’t make sense,” observes one French researcher.

Flu on the Rebound

As Canadians toss aside their facemasks and race outdoors to enjoy summer, they’re driving an unseasonal surge in influenza A, “despite the opposite trends being expected this time of year.” COVID19 precautions suppressed the spread of other respiratory viruses too, interrupting transmission – but setting us up for a rebound. Hospitalizations for influenza among children and younger teens are rising, and there have been 5 lab-confirmed institutional flu outbreaks in the past week. (About 30% of Canadians aged 18-64 got a flu shot this year.) Australia shows us what we can expect this Fall: New South Wales has recorded 6,820 cases of influenza in just 3 weeks, compared to just 18 in May 2021 and 52 in May 2020, and reports that cases of RSV have tripled in the past month. (Children are particularly susceptible to the flu after 2 years of virtual eradication.) The state of Victoria has reported more flu cases so far this year than in the whole of 2020 and 2021 combined, while daily new COVID19 cases have been above 10,000. “The public health system is in crisis right now.” (Unsurprisingly, health experts are urging voluntary masking.)

A Pox on Monkeys

Truth is stranger than fiction, and Mother Nature is overachieving at making her point. On May 12, the same day I wrote about the pandemicene, the first case of Monkeypox was reported in Montréal. (Apologies to be bringing you this news via MailChimp!)

Sudden Global Spread

Monkeypox is a “neglected tropical infection” that has been endemic among animals in Central and West Africa since 1970, but drawn little attention elsewhere. (Congo and Nigeria have thousands of human cases every year.) But that all changed abruptly last week, as hundreds of cases erupted in countries from Europe to Australia, and the WHO called an emergency meeting on Friday. Another zoonotic virus was spreading globally, and to Canada: Quebec has reported 5 confirmed cases of Monkeypox and about 15 more suspected cases, many linked to international travel. Toronto reported its first case on Saturday, in a man who had contact with someone who recently travelled to Montréal. Global.Health has reported 250 confirmed or suspected cases to date, including 23 in Canada. Three years ago, experts were warning that an unintended consequence of smallpox eradication could be that “emergent or re-emergent human monkeypox might fill the epidemiological niche vacated by smallpox.”

“Has it evolved? Has it changed to something different in terms of mode of transmission? …We need to be open there may be something else evolving and changing.” – Howard Njoo, deputy chief PHO of Canada

“Finding it in Europe and Canada — almost at the same time — is very unusual. This does suggest that the virus has mutated for better human-to-human transmission; however, it is too early to know whether this virus will present a problem to the greater population.” – Stephanie DeWitte-Orr, virologist/immunologist, Wilfrid Laurier U

Sexually Transmitted?

Monkeypox is not nearly as contagious as airborne viruses like COVID19: normally, it spreads only through “prolonged and close contact,” via respiratory droplets, bodily fluids or open sores – and until recently, it was transmitted to humans mainly from wild rodents or primates. (So far, it is believed the virus is contagious only while lesions are visible; the WHO says “the extent to which asymptomatic infection may occur is unknown.”) Sexual transmission has never been documented, but its new pattern of human-to-human transmission is “not typical” and is raising serious questions. (One Wilfrid Laurier U virologist observes that it could be the virus has mutated.) Only a few of the global cases have been linked to travel to Africa; the rest appear to be spreading among men who have sex with men. In Britain, 20 cases are predominantly among gay and bisexual men. The first 14 cases in Portugal were reported by sexual health clinics, among LGBTQ men aged 20-40. Spain has reported 49 cases, largely linked to a sauna near Madrid. A WHO advisor says a single individual might have picked up the infection in Africa and spread it through international events, including a Gay Pride event in the Canary Islands, and “risky sexual behaviour” at 2 raves held in Belgium and Spain. So far there is no reason to link the disease itself to homosexual activity, however: that is merely where cases have been noticed first. As one CDC epidemiologist puts it, “by no means is the current risk of exposure to monkeypox exclusively to the gay and bisexual community.”

“The community of men who have sex with men has been historically incredibly stigmatized with relation to virus infection, so I want to be very careful to say that that link has not been finalized yet.” – Angela Rasmussen, virologist VIDO, uSaskatchewan

Low Risk?

PHOs around the world are trying to reassure the public that Monkeypox poses “a low risk to the general public at this time,” since it is believed to spread only through droplets, fluids and prolonged, very close contact. (Then again, early in 2020 we were assured repeatedly that COVID19 posed a “low risk” and was not transmitted via aerosols – only to learn otherwise after thorough scientific study.) Thankfully, we do have a proven vaccine that has been in global use for more than 50 years: smallpox vaccine appears to offer ~85% protection against Monkeypox (or at least the last-studied version). The bad news: we stopped vaccinating Canadians back in 1972 when smallpox appeared to be eradicated, and our stockpiles were really only intended to respond to isolated acts of bioterrorism or lab leaks. (Good news for those of us over age 50, who were vaccinated in infancy.) The UK has started vaccinating front-line healthcare workers and close contacts of confirmed cases, and PHAC is considering a similar strategy. Theresa Tam won’t say how many (or how few) doses of smallpox vaccine Canada has on hand, for national security reasons. (After pet prairie dogs sparked an outbreak of 70 US cases in 2003, a monkeypox vaccine was approved by the FDA in 2019, and 3 treatments have been approved for emergency use. The US has just 1,000 doses of that Jynneos vaccine, but 100M for smallpox. On May 18, it called in an existing order for 13M additional doses of Jynneos.)

The current outbreaks of Monkeypox might be a “random event” that all trace back to a single traveller, or it could be that the virus has somehow evolved for much more efficient spread (or both).

All I can say is, once again, keep wearing your masks!

#ICYMI

I’ve been sitting on this fun, upbeat video since early April, but somehow hordes of students tossing water balloons on campus seem like an apt metaphor of contagion…

Beer Bike?

Rice U (TX) cancelled its annual “Beer Bike” race in 2020, and held a “modified version” in 2021, but the week-long party returned this April “in largely pre-pandemic form” complete with water balloon fights, parade, and “joyous crowds” cheering on their residential college teams. This upbeat 3-min vid captures student enthusiasm and abandon on campus, with fast-paced editing and startlingly un-pandemic celebration. “It’s the moment at Rice that people remember more than anything.”  YouTube

Lest I sound like a total spoilsport, I am gearing up this week for my first in-person conference keynote in 26 months. I’ll be driving, thank goodness, not enduring the chaos at Pearson airport, but rest assured I’ll be wearing my KN95 and counting down the days until I’m eligible for a 4th dose.

It may mean, though, a curtailed publication schedule this week, so don’t be surprised if I’m not back in your inbox until next week.

However long until then, do stay safe and be well!