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What you need to know about the coronavirus right now

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Here’s what you need to know about the coronavirus right now, writes Linda Noakes.

India’s daily virus cases breach 100,000

India reported a record rise in COVID-19 infections on Monday (5 April), becoming the second country after the United States to post more than 100,000 new cases in a day, as politicians stage massive election rallies raising fears of further spreading the virus.

Hospitals in the worst affected state, Maharashtra, are being overrun by patients. India’s richest state, home to its commercial capital Mumbai and numerous industries, reported a record 57,074 new cases overnight.

The country’s daily infections have risen about 12-fold since hitting a multi-month low in early February, when authorities eased most restrictions and people largely stopped wearing masks and following social distancing.

China reports biggest daily case jump in over two months

China reported its biggest daily jump in new COVID-19 cases in more than two months, as a city on the border with Myanmar in south-western Yunnan province accounted for all new local cases.

Ruili’s local government put residents in its urban area under home quarantine, launched a massive testing drive and began restricting people from leaving and entering the city from last week after reporting COVID-19 patients.

The city accounted for all of the 15 new local cases reported on April 4. The total number of new infections, including imported infections originating from overseas, stood at 32, the highest total since Jan. 31.

Japan fears variants are behind possible fourth wave

Japanese health authorities are concerned that variants of the coronavirus are driving a nascent fourth wave in the pandemic with just 109 days remaining until the Tokyo Olympics.

The variants appear to be more infectious and may be resistant to vaccines, which are still not widely available in Japan. The situation is worst in Osaka, where infections hit fresh records last week, prompting the regional government to start targeted lockdown measures for one month from Monday.

A mutant COVID-19 variant first discovered in Britain has taken hold in the Osaka region, spreading faster and filling up hospital beds with more serious cases than the original virus.

UK’s Johnson launches mass testing programme

British Prime Minister Boris Johnson said on Monday everyone in England will be able to take a COVID-19 test twice a week in a new drive to track the pandemic as society reopens and the vaccine roll-out continues at its rapid rate.

Johnson, who is expected to confirm plans to relaunch international travel and open sections of the economy later on Monday, said the new mass testing programme would break the chain of transmissions and spot cases without symptoms.

As much of Europe enters new lockdowns to tackle surging cases, Johnson has set out a staggered plan to ease restrictions in the coming months.

Tourism first! Phuket in vaccination drive

In Thailand, it’s the all-important tourism sector that has jumped to the head of the vaccination line, with the country’s most popular resort island embarking on a mass inoculation programme two months ahead of the rest of the country.

The island of Phuket aims to deliver shots to at least 460,000 people - most of its population - as it gears up for July 1, when vaccinated overseas visitors will no longer be required to quarantine.

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European Medicines Agency says Janssen vaccine safe to use - despite very rare incidence of blood clots

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At its meeting of 20 April 2021, EMA’s safety committee (PRAC) concluded that a warning about unusual blood clots with low blood platelets should be added to the product information for COVID-19 Vaccine Janssen. PRAC also concluded that these events should be listed as very rare side effects of the vaccine.

In reaching its conclusion, the Committee took into consideration all currently available evidence including eight reports from the United States of serious cases of unusual blood clots associated with low levels of blood platelets, one of which had a fatal outcome. As of 13 April 2021, over 7 million people had received Janssen’s vaccine in the United States.

All cases occurred in people under 60 years of age within three weeks after vaccination, the majority in women. Based on the currently available evidence, specific risk factors have not been confirmed.

PRAC noted that the blood clots occurred mostly at unusual sites such as in veins in the brain (cerebral venous sinus thrombosis, CVST) and the abdomen (splanchnic vein thrombosis) and in arteries, together with low levels of blood platelets and sometimes bleeding. The cases reviewed were very similar to the cases that occurred with the COVID-19 vaccine developed by AstraZeneca, Vaxzevria.

Health-care professionals and people who will receive the vaccine should be aware of the possibility of very rare cases of blood clots combined with low levels of blood platelets occurring within three weeks of vaccination.

COVID-19 is associated with a risk of hospitalisation and death. The reported combination of blood clots and low blood platelets is very rare, and the overall benefits of COVID-19 Vaccine Janssen in preventing COVID-19 outweigh the risks of side effects.

EMA’s scientific assessment underpins the safe and effective use of COVID-19 vaccines. Use of the vaccine during vaccination campaigns at national level will take into account the pandemic situation and vaccine availability in individual Member States.

One plausible explanation for the combination of blood clots and low blood platelets is an immune response, leading to a condition similar to one seen sometimes in patients treated with heparin called heparin induced thrombocytopenia, HIT.

PRAC emphasizes the importance of prompt specialist medical treatment. By recognising the signs of bloods clots and low blood platelets and treating them early, health-care professionals can help those affected in their recovery and avoid complications. Thrombosis in combination with thrombocytopenia requires specialised clinical management. Healthcare professionals should consult applicable guidance and/or consult specialists (e.g., haematologists, specialists in coagulation) to diagnose and treat this condition.

As for all vaccines, EMA will continue to monitor the vaccine’s safety and effectiveness and provide the public with the latest information.

similar signal evaluation was recently finalized for another COVID-19 vaccine, Vaxzevria (previously COVID-19 Vaccine AstraZeneca).

Information for the public

  • Cases of unusual blood clots with low platelets have occurred in people who received Janssen’s COVID-19 vaccine in the United States.
  • The risk of having this side effect is very low, but people who will receive the vaccine should still be aware of symptoms so they can get prompt medical treatment to help recovery and avoid complications.
  • Individuals must seek urgent medical attention if they have any of the following symptoms in the three weeks after being vaccinated with COVID-19 Vaccine Janssen:
    • Shortness of breath;
    • chest pain;
    • leg swelling;
    • persistent abdominal (belly) pain;
    • neurological symptoms, such as severe and persistent headaches or blurred vision, and;
    • tiny blood spots under the skin beyond the site of the injection.
  • Speak to your healthcare professional or contact your relevant national health authorities if you have any questions about your vaccination.

Information for healthcare professionals

  • EMA has reviewed eight cases of thrombosis in combination with thrombocytopenia in people who received Janssen’s COVID-19 vaccine in the United States.
  • These very rare types of thrombosis (with thrombocytopenia) included venous thrombosis mostly in unusual sites such as cerebral venous sinus thrombosis and splanchnic vein thrombosis, as well as arterial thrombosis, and fatal outcome in one case. All cases occurred in people below 60 years of age, and most were in women, within three weeks of the person being vaccinated.
  • The cases reviewed were very similar to the cases that occurred with the COVID-19 vaccine developed by AstraZeneca, Vaxzevria.
  • As for the mechanism, it is thought that the vaccine may trigger an immune response leading to a heparin-induced-thrombocytopenia like disorder. At this time, the pathophysiological mechanism has not been established, and it is currently not possible to identify specific risk factors.
  • Healthcare professionals should be alert to the signs and symptoms of thromboembolism and thrombocytopenia so that they can promptly treat people affected in line with available guidelines.
  • Thrombosis in combination with thrombocytopenia requires specialised clinical management. Healthcare professionals should consult applicable guidance and/or consult specialists (e.g., haematologists, specialists in coagulation) to diagnose and treat this condition.
  • Healthcare professionals should tell people receiving the vaccine that they must seek medical attention if they develop:
    • symptoms of blood clots such as shortness of breath, chest pain, leg swelling, persistent abdominal pain
    • neurological symptoms such as severe and persistent headaches and blurred vision
    • petechiae beyond the site of vaccination after a few days.
  • The benefits of the vaccine continue to outweigh the risks for people who receive it. The vaccine is effective at preventing COVID-19 and reducing hospitalisations and deaths.

A direct healthcare professional communication (DHPC) will be sent to healthcare professionals involved in giving the vaccine in the EU. The DHPC will also be published.

More about the vaccine

COVID-19 Vaccine Janssen is a vaccine for preventing coronavirus disease 2019 (COVID-19) in people aged 18 years and older. COVID-19 is caused by SARS-CoV-2 virus. COVID-19 Vaccine Janssen is made up of another virus (of the adenovirus family) that has been modified to contain the gene for making a protein from SARS-CoV-2. COVID-19 Vaccine Janssen does not contain the virus itself and cannot cause COVID-19.

The most common side effects with COVID-19 Vaccine Janssen are usually mild or moderate and improve within a few days after vaccination. More information is available.

COVID-19 Vaccine Janssen was authorised in the EU on 11 March 2021; the rollout of the vaccine in the EU was temporarily delayed by the company.

More about the procedure

The review of thromboembolic events with COVID-19 Vaccine Janssen is being carried out in the context of a safety signal, under an accelerated timetable. A safety signal is information on a new or incompletely documented adverse event that is potentially caused by a medicine and that warrants further investigation. The presence of a safety signal does not necessarily mean that a medicine has caused the reported adverse event. The assessment of safety signals seeks to establish whether a causal relationship between the medicine and the adverse event is at least a reasonable possibility.

The review is being carried out by EMA's Pharmacovigilance Risk Assessment Committee (PRAC), the Committee responsible for the evaluation of safety issues for human medicines. Once the review is completed, PRAC will make further recommendations as necessary to minimise risks and protect patients' health. EMA’s human medicine committee, CHMP, will then rapidly assess any necessary changes to the product information.

EMA’s scientific assessment underpins the safe and effective use of COVID-19 vaccines. EMA’s recommendations are the foundation upon which individual EU member states will design and implement their own national vaccination campaigns. These may differ from country to country depending on their national needs and circumstances, such as infection rates, priority populations, vaccine availability and hospitalization rates.

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Greece opens to tourists, anxious to move on from crisis season

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Greece began opening to tourists on Monday (19 April) with few bookings but hopes for a better season to help make up for a 2020 devastated by the coronavirus pandemic, writes Karolina Tagaris.

On Rhodes island, where most visitors are from abroad, hoteliers are scrubbing, polishing and painting in anticipation of a make-or-break year.

"We're preparing the hotel in order to start as soon as the government gives us the green light," said George Tselios, general manager of Sun Beach Hotel, whose customers are from Scandinavia, Germany, Austria and Britain.

Greece will formally open on 14 May but starting Monday, tourists from the European Union, the United States, Britain, Serbia, Israel and the United Arab Emirates will not quarantine if they are vaccinated or test negative for COVID-19.

Tourism, which generates a fifth of Greece's GDP and one in five jobs, is vital for an economy which had climbed out of a decade-long slump only to slip back into recession last year as COVID-19 struck.

In a normal year, Rhodes would have already laid out the umbrellas for a season that runs from March through October. In mid-April, it resembled a ghost city.

Shuttered luxury resorts towered over a long, sandy, empty coastline. Beach towns normally bursting with crowds of British tourists were silent, with boarded up shops, tavernas and bars.

Many have been closed since 2020, when just 7.4 million people visited Greece, fewer than any year in its decade-long economic crisis and down from a record 31.3 million in 2019.

From hotels to restaurants and daily cruise boats, the many businesses surviving on state aid cannot afford another lost summer.

"Most of them feel the country cannot survive another crisis," Rhodes's deputy mayor for tourism, Konstantinos Taraslias, said.

Nearly 600,000 tourists visited Rhodes last year, down from 2.3 million in 2019. Just over half its 650 hotels opened, the hoteliers' association said.

Sand hills are formed in front of a hotel, in order to be spread on the beach at the beginning of the tourist season, at Ammoudes Beach, amid the coronavirus disease (COVID-19) pandemic, on the island of Rhodes, Greece, April 12, 2021.  REUTERS/Louiza Vradi
People stand on Elli Beach, amid the coronavirus disease (COVID-19) pandemic, on the island of Rhodes, Greece, April 12, 2021. REUTERS/Louiza Vradi
A man works on the restoration of a resort at Ammoudes Beach, amid the coronavirus disease (COVID-19) pandemic, on the island of Rhodes, Greece, April 12, 2021. REUTERS/Louiza Vradi

Greece says it is better placed this summer thanks to widespread testing, quarantine hotels and plans to vaccinate islanders and tourism workers.

"We've done everything within our power to have a better season," said George Hatzimarkos, governor of Greece's most popular region, the south Aegean islands, which besides Rhodes includes Mykonos and Santorini.

"We'll be absolutely ready," by mid-May, Hatzimarkos said.

But bookings are few and most for August to October, said the president of Rhodes' hoteliers, Manolis Markopoulos, forecasting a year of last-minute reservations.

"We can understand it because guests really want to be sure that they will fly," he said. "But that does not mean that we will not get bookings later."

While Greece fared better than much of Europe in containing the first wave of the pandemic, a continuous rise in infections has forced it to impose several lockdowns to protect its strained health service.

Tourists will be subject to lockdown restrictions, which include night-time curfews. Restaurants and bars have been closed since November.

Giannis Chalikias, who manages nine businesses on Rhodes, said only one is open and struggling to meet the obligations of the remaining eight.

"We're going through an unprecedented situation," he said. "We're waiting day by day for people to get vaccinated... so that we can open and have a normal season."

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Merkel says lockdowns and curfews vital to break Germany's third wave

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German Chancellor Angela Merkel urged lawmakers on Friday to approve new powers that would allow her to force coronavirus lockdowns and curfews on areas with high infection rates, saying a majority of Germans were in favour of stricter measures.

"The third wave of the pandemic has our country firmly in its grip," said Merkel, wh (16 April)ose speech in parliament was interrupted by heckling from lawmakers of the far-right Alternative for Germany party opposed to lockdowns.

"Intensive care workers are sending one distress call after the other. Who are we to ignore their pleas?" Merkel said.

Her government wants parliament to change the Infection Protection Act to enable federal authorities to enforce restrictions even if regional leaders resist them, hoping to alleviate pressure on intensive care units.

The imposition of curfews and granting the federal government powers to force them on Germany's 16 states has also drawn criticism from within Merkel's conservative bloc, which opinion polls suggest will suffer their worst ever result in a September national election.

Unlike Britain and France, Germany has been reluctant to impose drastic limits on movement in a country fiercely protective of democratic freedoms due to its Nazi and Communist past.

Opponents of the lockdown have held demonstrations across Germany, but particularly in the former east, which is more supportive of the AfD. The far-right party says restrictions have failed to halt the pandemic and that they cause more damage to both the economy and people's mental health.

Merkel acknowledged in her speech that the new powers were no bullet-proof solution to the pandemic, which she said could only be defeated with vaccinations.

AfD parliamentary leader Alice Weidel said the new measures were an unprecedented attack on basic democratic freedoms.

"The proposed amendments of the Infection Protection Act are an alarming document of an authoritarian state," said Weidel. "This relapse into the authoritarian demon is coming from the chancellery and you, Madame Chancellor."

Merkel gazed at her smartphone during most of Weidel's speech.

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