Return of Covid-19

Singapore reported more than 50,000 cases of Covid-19 in first week of Dec

German Chancellor Olaf Scholz has recently announced that he is positive for Covid-19 with mild symptoms. According to Germany’s Robert Koch Institute, around 10% of the country’s population is sick with flu-like symptoms and coughs. As Covid-19 testing is pretty much nonexistent across the globe, the indirect way to look for infection prevalence is wastewater surveillance. Recent wastewater tests show the highest level of Covid-19 since this testing was started in June 2022. Singapore reported more than 50,000 cases of Covid-19 in the first week of December, and given the tiny population of Singapore, this is a significant number, and masks have been mandated again. A new subvariant, JN.1, is rapidly increasing its presence globally, from 4% in November to 30% in December. More than 40 countries, including China and India, have already reported its presence. It is a subvariant of BA.2.86.

Though the predominant recent cases with flu-like symptoms are probably due to Covid-19, other respiratory infections are also on the loose, including respiratory syncytial virus, flu and other respiratory infections. Persistent cough is a major symptom of many patients with a running nose and, in some cases, a sore throat. Some countries are reporting a significant rise in ‘100-day cough’ in children. Whopping cough, another bad infectious disease is called ‘100-day cough’ due to its long-term persistence. England and Wales have reported a 230 % rise as compared to the same period last year.

The surge of respiratory infections in winter is not a new phenomenon, but its intensity has worried global health experts. It started in China when there were reports of hospital overloads due to the unprecedented number of young children getting extremely sick with many cases of pneumonia. The situation became so worrisome that the WHO formally asked China to explain the situation. China accepted an increase in pediatric cases of respiratory diseases needing hospitalisation but also informed that this is due to known viruses and bacteria and not an unknown virus or a new variant of Covid-19. Then we started seeing an increase in respiratory infections across the globe. There are some valid questions about this surge. Why is there such an unprecedented surge of infections this winter? One probable answer is that this year most countries lifted Covid-19 restrictions. The winter season, when people sit closer to each other in houses and offices with windows closed, provides an excellent opportunity for the spread of infections, especially among young children who were kept protected for the preceding three years due to the pandemic. Covid is also a new contributor to this increased number of cases, as it is churning out its newer and better-adopted variants at quite a pace. According to one hypothesis, infection with Covid-19 may also make a person more vulnerable to other infections, at least for the short term.

In Pakistan, every house is complaining about cough, fever, flu and sore throat. As no Covid-19 testing is going on, we could just make a wild guess. But in some offices where Covid testing is still mandated for employees with a few days of coughing, most of these cases are Covid positive. So how can we still stay safe in this era of surges of multiple respiratory infections? No one is wearing masks, and it would be difficult to bring them back. But a much more powerful intervention is improved ventilation in our buildings. Anyone with cough or flu symptoms should wear a mask and try to stay away from others as much as possible. Get your vaccine not only for Covid-19 but also for flu in case you are in a high-risk group.

The coming years will be challenging for us as multiple known and unknown microorganisms could simultaneously start epidemics. We need to have a long-term and comprehensive strategy for multiple pandemics in coming years. Until then keep your windows and doors open. Improved ventilation is a long-term, sustainable and effective intervention to stay protected from most respiratory diseases.

Published in The Express Tribune, December 30^th, 2023.

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