Belgium is considering how to combat the wave of the BA.5 variant of Covid-19, but several elements of uncertainty are clouding the cards.
The new epidemiological figures came out on Tuesday, and apart from one indicator, that of deaths, they are all in the red. Of course, this recent influx of patients, primarily caused by the emergence of the BA.5 variant, remains modest compared to previous waves. There are nearly 3,850 daily cases on a weekly average. At the worst of the wave last January, we exceeded 50,000.
For hospital admissions, the figure is currently 101 per day on average, while they were close to 750 at the worst of the second wave in 2020. But the fact remains that the epidemic is gaining ground. New from the field. Whether at the level of the authorities or the hospitals, we are slowly getting back into battle order. However, the context is quite different for this summer of 2022.
Cautious hospitals, without excessive fear, but in uncertainty
Currently, contaminations continue to climb by 38% and hospital admissions by 32%. Something new this week: even intensive care bed occupancy is up, around 26%, as for the total number of occupied hospital beds. Do not panic, however, as at the Saint-Luc university hospital in the Brussels region.
“There are no particular concerns expressed for the moment,” confirms the head of the clinic in intensive care at the hospital, Xavier Wittebole. “We mainly take care of general patients, and I would even say that it is a good thing for caregivers. The fact that it is more varied and not just the treatment of a single pathology with repetitive gestures, that counts for morale. “.
But what will happen next week, or in 15 days? He admits to us that he is still in the dark. Currently, 4% of intensive care beds are occupied by Covid cases in Belgium. In Saint-Luc, this rises to around 10%, but this remains low compared to what the hospital has experienced in the past two years.
The rest will depend on the virus’s spread, the infection’s severity with BA.5, and the need for this or that service. So there is some caution without excessive fear. “We cannot at all imagine a saturation of intensive care, for example. Now, things can change in 2-3 weeks“.
What worries Xavier Wittebole above all is the shortage of nurses, especially in summer when the capacity of hospitals is lower. “The problem is that we can make predictions, but the models are biased because of that anyway,” he explains. “We already have a certain degree of absenteeism for sickness and to a lesser extent for long-term absences, and we do not know who will also fall ill later and who will really be able to provide the services.”
An element of uncertainty, combined with the difficulty of predicting what the summer wave will ultimately look like, explains that hospitals have not yet clearly defined their organization to counter the Covid, “at least in Saint-Luc “he confides. “Committees may have been set up but to my knowledge, we were not asked for our opinion in intensive care. “
The benefit of vaccination
That’s for the hospitals, but there’s also the whole part that is directly the responsibility of the authorities, including vaccination. Health Minister Frank Vandenbroucke is already asking that those who have not yet had their third dose get it. People at risk are invited to have their fourth dose. The regions are organizing themselves in this way to give new impetus to their vaccination campaigns.
In Wallonia, the Minister of Health Christie Morreale told the DH that it is planned to “deploy around twenty vaccination centers at the start of the school year. “In the meantime, awareness is in order.
Virologist Steven Van Gucht confirms: that the vaccine remains essential. “Its effectiveness is around 72% against hospitalizations for people over 80 ,” he says. Admittedly, in intensive care, “many patients are vaccinated,” but that does not mean that the vaccine is ineffective.
It should be remembered that the average age of these patients is 79 years, and nearly 70% of them have one or more comorbidities (cardiovascular disorders, diabetes, etc.). Factors that make them vulnerable to Covid-19. Then to date, 91.2% of Belgians over 65 have received their booster dose. “Since they often have quite fragile health, this is not always enough to protect them against complications.“. But he insists: that vaccination is essential protection.
Wait to get revaccinated?
The problem is that Belgium is again facing a new variant, BA.5. What to question the effectiveness of vaccines? Steven Van Gucht does not believe it. “In this case, there are two more mutations in the Spike protein that make it less recognized by the antibodies that we have developed in the past. But these changes are not huge and should be insufficient to bring real novelties.
Our immune system always recognizes BA.5 “. Nor does he predict significantly greater virulence with BA.5. “Laboratory studies on rodents note that these differences exist but I believe that these results must be taken with a grain of salt. The type of pathology caused by BA.5 should not be so different from what has been seen with other variants. There may be small nuances but not beyond “.
Still, some people prefer to wait until the fall to get vaccinated, that is to say, when the new version of the vaccine adapted to Omicron should arrive. A good idea? Not for Steven Van Gucht, who reminds us that this update will be adjusted to BA.1, the first of the Omicron generation, not BA.5. Then, by the fall, there may be a BA.6, a BA.7, or another variant. It’s the same problem as with the flu: vaccine manufacturers chase after mutations without being able to catch up with them.
By adopting the logic of waiting, the risk would remain forever in the hope of finally having a vaccine adapted to the dominant variant, which could never happen. The risk-benefit balance, therefore, leans towards “on time “vaccination. “These mutations that allow the virus to evade antibodies are normal and part of a continuous cycle. In the case of the Omicron family, this is called antigenic shifting, which is different from a type shift from Delta to Omicron, with 50 different mutations ,” he explains.
Targeted, not collective measures
In addition to vaccination, the challenge now is to imagine managing the epidemic in a setting where there are no longer any social restrictions. Social contacts have increased sharply in recent months, including in June, which is not unrelated to the emergence of the new wave.
“Our greatest concern is to see how we can protect the most fragile people,” other than collective measures, confides the virologist. Here, the healthcare system’s capacity is a priori no longer in danger, even if some disturbances remain possible. “In this case, it is better to take targeted measures to protect the most vulnerable, not necessarily to slow the circulation of the virus in the general population but to prevent the contamination of fragile people.”
The expert cites the example of a young person who attends festivals and who must be aware that there is a high probability that he will be exposed to the virus and that this is not the right time to visit grandparents, except by wearing a mask outside. Risk groups should also remember their booster doses to avoid hospitalizations and severe complications. This message is even more significant in Brussels and Wallonia, where the vaccination figures are lower than in Flanders.
Predictions difficult to establish
If these rules are respected, even if they are not imposed, the extent of the wave could well be limited. If the experts are so optimistic, it is mainly because Portugal has already experienced a BA.5 wave at the end of May and the beginning of June. It turned out to be limited, and the numbers have been dropping.
But the Portuguese are among the most vaccinated in the world, and there are currently no other countries that can boast of having passed the course. In France and Germany, for example, the trend is still on the rise, as in Belgium, and if the level of vaccination remains significant, it is not as strong. Summer travel is also expected to boost the circulation of the virus across Europe.
For now, Belgian biostatisticians are still working on updating their projections, says Steven Van Gucht. This will allow you to know how high the summer wave will be, when the peak arrives, etc. Additional obstacle: the number of contaminations is underestimated, he believes, since the number of tests is lower than other waves.
“The wastewater analysis confirms this to us. According to this, we would be approximately halfway through the second Omicron wave (due to BA.2 in early spring 2022) and a third of the first wave. Omicron (due to BA.1 last January) “We will therefore have to be careful in establishing forecasts for the weeks and months to come. We will also have to be patient to have the predictive models for the coming autumn and winter.” For the moment, it is still too vague “.