2024-01-10 20:48:28
If SARS-CoV-2 is not the only virus around, it is certainly one of those that continues to hit hard. New data on COVID-19 and respiratory diseases from the National Institute of Public Health of Quebec (INSPQ), published Wednesday, tends to confirm this.
Everyone talks about how they are constantly sick, their family and friends are sick. Yes, it can be a cold or RSV [virus respiratoire syncytial]but in many cases, it is probably COVID-19, says Dr. Raywat Deonandan, epidemiologist and associate professor at the University of Ottawa.
According to the INSPQ, in the week of December 24, there were 983,000 cases of respiratory infections, a number that has continued to increase since mid-October.
Among these infections (many of which are reinfections), there are estimated to be between 350,000 and 471,000 cases of COVID-19, which equates to approximately 50,000 to 67,000 new infections per day.
At least 3 million Quebecers contracted COVID-19 this fall, according to Quebec’s director of public health, Dr. Luc Boileau.
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Since the beginning of December 2023, there have been an average of 2,400 people hospitalized with a positive test for COVID-19. At the height of the first Omicron wave, in mid-January 2022, more than 3,900 Quebecers testing positive for COVID-19 were hospitalized.
Around fifty Quebecers are hospitalized every day due to COVID-19, specifies Dr. Boileau.
It’s high, but above all, what we see is that we have maintained a high level since December. It is not as catastrophic as at the beginning of 2022, but we must monitor what is happening, says Benoît Barbeau, professor of virology in the Department of Biological Sciences at UQAM.
Moreover, with the number of infections continuing to increase, it is very likely that the number of hospitalizations will also increase in the weeks to come.
It will continue to be difficult, said the Minister of Health, Christian Dubé, during a press conference Wednesday on the situation in emergencies.
Furthermore, 356 Quebecers died from COVID-19 in December and 51, since the start of 2024. In comparison, 450 Quebecers died from the disease in December 2022.
Around 2,300 Quebecers died from COVID-19 in 2023, and 19,475 since the start of the pandemic.
It’s still a lot, laments Dr. Deonandan. The epidemiologist would like to point out that even if the World Health Organization (WHO) has lifted the state of emergency, the pandemic is indeed still ongoing.
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In addition to the strong presence of SARS-CoV-2, Benoît Barbeau recalls that there is a range of other respiratory viruses circulating, including RSV and influenza. Let us point out that the flu peak is still to come, as it would be expected by the end of January.
Before the pandemic, people had colds and flus, but now COVID-19 is added to this storm of viruses.
It is therefore not surprising that many emergency rooms were overflowing during the holiday season, reaching occupancy rates of more than 200%.
Over the last 14 days, there have been 1,000 more visits per day to the emergency room than during the same period last year, said Minister Dubé.
Typically, a person develops symptoms between one and five days after being infected with SARS-CoV-2. About 20% of people are asymptomatic, 64% have mild symptoms, and 16% have severe symptoms requiring hospitalization.
Source : Nature (in English) (New window)
The JN.1 variant at the heart of the problem
Even if we say that we have vaccines, that we have learned, it is a virus that is young in its entry into the human population. There is still ground to cover before having a semblance of stability, a more normal cycle, recalls Mr. Barbeau, who adds that it will probably take a few more years before reaching this balance.
Ryan Gregory agrees. This professor of evolutionary biology in the Department of Integrative Biology at the University of Guelph believes that SARS-CoV-2 has not said its last word and that new variants will continue to disrupt people’s daily lives.
Moreover, just before the holidays, Dr. Luc Boileau mentioned that a new variant, JN.1, was starting to take up more and more space in Quebec. Shortly after, this variant became dominant in the province and around the world.
At the beginning of January, JN.1, which is highly transmissible, represented around 70% of cases in Quebec.
According to Professor Gregory, we must monitor JN.1 closely because this variant is very different from what has been circulating so far.
The more mutations a new variant has, the more likely it is to change the course of the pandemic, Gregory said. When the Omicron variant emerged in November 2022, it had 30 more new mutations in the spike protein than the previous strain of SARS-CoV-2. The mutations facilitated its transmission and caused a huge wave of infections and hospitalizations.
After Omicron, experts estimated the probability of seeing another new variant with numerous mutations in the following 24 months at 15 to 20%. Two variants with this characteristic have already appeared.
A range of Omicron sub-variants then appeared. Among them, BA.2.86, which also had 30 more mutations than its predecessor.
Then, this fall, the BA.2.86 mutated twice to become the JN.1. Ryan Gregory believes that because of its global dominance, any new variants that emerge in the coming months will be of this lineage.
For Mr. Gregory, the appearance of JN.1 with so many mutations is a sign that we need to monitor chronic infections more. These new variants with many mutations likely evolved while in the body of an immunocompromised individual who then infected someone else. This is probably also how we got the appearance of Omicron.
For Mr. Gregory, we must reduce infections in immunocompromised people to reduce the risks of new variants with many mutations emerging.
If we know that JN.1 is more transmissible than its ancestors, Mr. Gregory explains that it is difficult to say if the new variants are less virulent or if it is the immunity acquired through vaccination and infections which is decreasing. the total number of hospitalizations.
But it’s no longer just a question of hospitalizations. We are starting to see the impacts of reinfections and chronic symptoms, organ damage [causés par une infection].
He worries that wrongly, many people are relying too much on immunity acquired after infection to escape COVID-19 reinfection. The more infections there are, the greater the risk that a new variant will mutate in such a way as to evade this immunity. The more virus circulating, the better it is for the virus.
Vaccination, still one of the best tools
In Quebec, only 17% of the population has received the new vaccine. Just under half of those over 60 – who are among those most at risk – have been vaccinated. In children, it is less than 5%; among adults, just under 8%.
The fact that the vaccination rate is so low worries Dr. Deonandan and Mr. Barbeau.
According to Dr. Deonandan, everyone who is eligible for a new vaccine (six months after an infection or a dose of vaccine) should receive it, since the respiratory virus season is not over. In Quebec, vaccination is free for everyone.
The new vaccine [qui cible le XBB] is surprisingly effective. Recent data suggests there is a 60% chance of not being hospitalized if infected, Dr. Deonandan says, adding that, contrary to what many people think, vaccines help reduce transmission. Vaccines reduce the likelihood of infection. It’s not perfect, but you have a better chance of not getting infected if you’ve been vaccinated with the new formulation.
Dr. Deonandan believes there are several factors as to why Canadians have not received a new dose of the vaccine. People don’t know what’s out there [en termes de vaccins]. They don’t know that the vaccine exists and that it has been updated. They don’t know that the pandemic still exists.
He also criticizes doctors and experts who say that people who are not vulnerable do not need to be vaccinated because they have a low risk of complications.
There is a misunderstanding about the difference between individual risk and collective risk. Yes, an individual [en santé] may not have a high chance of dying from COVID-19, but the less disease circulating, the fewer vulnerable people become infected. And that’s one less burden on the health system. We must stop thinking only about the individual effect, but think at the population level.
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