‘Pandemic far from over’ even as global death toll crosses five million

The global death toll from COVID-19 crossed five million on November 1 and yet the the global number of reported cases and deaths from COVID-19 is now increasing for the first time in two months. The first million deaths were recorded on September 8, 2020, nearly nine months after the first death occurred, while the two-million mark was breached three and a half months later on January 15, 2021. Three million deaths were registered in just three months on April 17, while the four-million mark was crossed on July 7.

Nearly 22 months after the first COVID-19 death of a 61-year-old man in Wuhan, China on January 9, 2020, the total number of reported deaths globally has crossed five million on November 1. And each week, more than 50,000 people are continuing to die due to COVID-19. At 0.75 million, the U.S. has reported the greatest number of deaths in the world, followed by Brazil (0.6 million), India (0.45 million), Mexico (0.28 million) and Russia (0.23 million).

Effects of vaccination

The speed at which the virus had killed people slowed down a bit since summer this year — it took nearly four months to add one more million deaths after the toll crossed four million on July 7. This despite the Delta variant still being the dominant strain across the world. The reason: vaccines have been effective in preventing deaths in most countries where a large number of people have been immunised.

The first million deaths were recorded on September 8, 2020, nearly nine months after the first death occurred, while the two-million mark was breached three and a half months later on January 15, 2021. Three million deaths were registered in just three months on April 17, while the four-million mark was crossed on July 7.

Rising trend in cases

Even with large-scale vaccination in many countries, the death rate is witnessing a sudden rise now in Europe and Southeast Asia. In the last week of October, the weekly increase in deaths in European and Southeast Asian regions has been 14% and 13%, respectively, as compared with the previous week; last week, 56 countries from all WHO regions reported an increase in COVID-19 deaths of more than 10%.

“The global number of reported cases and deaths from COVID-19 is now increasing for the first time in two months,” the WHO Director-General Tedros Adhanom Ghebreyesus said on October 28. “It’s another reminder that the COVID-19 pandemic is far from over.”

Despite the availability of vaccines that could prevent deaths, the increase in deaths across the world is due to inequitable distribution of vaccines to many low- and middle-income countries and vaccine hesitancy in those countries where vaccines are available in plenty. According to the WHO chief, 30 times more vaccines have been administered in high-income countries than low-income countries.

“Since the first COVID-19 vaccines were authorised for use, more people have died from COVID-19 than before they were available. That’s because Delta is a more formidable foe and because far too many people globally haven’t had access to vaccines that could have saved their lives,” former Director of CDC Dr. Tom Frieden said in a tweet.

According to a BMJ News, “only 1.3% of people in low income countries have received their jabs. Seventy countries have yet to vaccinate 10% of their populations, and 30 countries — including much of Africa — have vaccinated fewer than 2%. In Latin America, only one in four of the population has received a dose of covid vaccine.” The reason: despite the WHO extending the moratorium on booster doses till the end of the year, to enable every country to vaccinate at least 40% of its population, vaccine inequity continues to persist.

Deaths undercounted

Reacting to five million COVID-19 deaths, WHO’s Chief Scientist Dr. Soumya Swaminathan tweeted the gross undercounting of deaths globally: “Grim statistic. WHO estimates the real number of deaths closer to 15 million.” The WHO Chief too mentioned about the undercounting of COVID-19 deaths. “More than five million deaths have now been reported, and we know the real number is higher,” said Dr. Tedros.

The actual global toll could be twice the reported figure, Dr. Denis Nash, an epidemiologist at the City University of New York Graduate School of Public Health and Health Policy told The New York Times.

Two researchers — Ariel Karlinsky from Hebrew University, Jerusalem, Israel and Dmitry Kobak from the University of Tübingen, Germany — have compiled the World Mortality Dataset. This dataset contains all-cause mortality data from over 100 countries to specifically track excess mortality across countries during the COVID-19 pandemic.

Based on data available in the World Mortality Dataset, a team of researchers calculated the excess deaths in 103 countries during the pandemic period; the results are published in the journal eLife.

Gross underreporting

The eLife authors estimate that several of the worst affected countries such as Peru, Ecuador, Bolivia and Mexico have excess deaths more than 50% above the expected annual mortality rate. In the case of Nicaragua, Belarus, Egypt and Uzbekistan, the underreporting of deaths is more than 10 times.

In the case of India, the underreporting of COVID-109 deaths is estimated to be huge. Based on the Civil Registration System (CRS) data from eight States, The Hindu has estimated excess deaths during the pandemic to be 8.22 times the recorded COVID-19 deaths toll; in absolute numbers that figure will be 3.78 million excess deaths. All excess deaths may not be due to COVID-19, but during a pandemic, a bulk of them could be due to it. This “figure will rank [India] the highest among nations with the most recorded fatalities due to the virus”.

Based on all-cause mortality data from civil registration systems of 12 Indian States comprising around 60% of the national population, Murad Banaji from Middlesex University London and Aashish Gupta from Harvard University have estimated the excess deaths in India during the COVID-19 pandemic to be “around 8-10 times” the officially recorded COVID-19 deaths. The results have been posted on a preprint server medRxiv on October 1. Preprints are yet to be peer-reviewed and published in a scientific journal.

Merck’s antiviral drugs

On November 4, the fight against COVID-19 to reduce the number of deaths got another booster shot with Britain’s Medicines and Healthcare products Regulatory Agency (MHRA) recommending the drug, molnupiravir, for use in adults with mild to moderate COVID-19 and at least one risk factor for developing severe illness, such as obesity, older age (over 60 years), diabetes, or heart disease. The oral drug can be taken at home as soon as possible following a positive COVID-19 test and within five days of the onset of symptoms. The drug showed 50% efficacy in reducing risk of hospitalisation or death.

“This will be a gamechanger for the most vulnerable and the immunosuppressed, who will soon be able to receive the ground-breaking treatment,” said Health and Social Care Secretary Sajid Javid in a release.

Merck has been producing molnupiravir at risk and expects to produce 10 million courses of treatment by the end of 2021, with at least 20 million courses to be produced in 2022, the company said in a release.

In addition to entering into agreements with several governments to supply the drug, including 1.7 million doses to the U.S. government and nearly 0.5 million doses to the U.K. government, the company has entered into a licensing agreement with the Medicines Patent Pool to make the drug widely accessible to low- and middle-income countries. It has also entered into non-exclusive voluntary licensing agreements with eight Indian generic manufacturers to accelerate availability of molnupiravir in more than 100 low- and middle-income countries following approvals or emergency authorization by local regulatory agencies, the release says.

Pfizer’s antiviral drug

Meanwhile, on November 5, Pfizer announced via a press release that its oral antiviral PAXLOVID showed 89% efficacy in reducing the risk of hospitalisation or death in non-hospitalised settings in high-risk adults with COVID-19 when treatment was started within three days of symptom onset. In the phase-2/3 trial, through day 28, no deaths were reported in patients who received the drug while 10 deaths were recorded among patients who got a placebo. Similar results were seen when treatment was started within five days of symptom onset. Due to “overwhelming efficacy demonstrated”, the trial was stopped midway by the independent Data Monitoring Committee in consultation with the FDA.

Pfizer “plans to submit the data as part of its ongoing rolling submission to the FDA for emergency use authorization as soon as possible”, the release said

Published in The Hindu on November 6, 2021