Beware 'last mile, first smile,' syndrome as we near the end of the COVID-19 pandemic

• Fatigue, distracted attention, and the sense a crisis will soon be over contribute to bad judgement, last-minute accidents, and preventable deaths. This 'last mile, first smile' phenomenon happens in the military, in law enforcement, and in the final stages of disasters and crisis situations. It can happen to anyone while driving the last mile home. Medical teams aren't exempt from it. The end-of-crisis is all but 'class dismissed and back to normal' but things are far more complicated than that.
• Fighting COVID-19 everyday, being exposed to the danger of infection and worrying about bringing the virus home; the psychological trauma and moral injury sustained while treating patients who died alone with healthcare workers playing the role of family members, having to prioritise care while balancing a shortage of medical gear, time, and attention - all of these can induce a heavy toll. Transitioning medical teams into the post COVID-19 era needs to be planned, supported, and done with the precision of a delicate surgical procedure

WHO expert warns pandemic ‘nowhere near finished’ as Covid surges across world

• We are not yet close to a world without COVID-19, World Health Organisation special envoy on COVID-19 David Nabarro has said at a symposium of Royal College of Physicians in Edinburgh. He stressed new variants of concern will be a regular occurence whilst COVID-19 continues to circulate at the levels it is now.
  
• 'I have to stress that I am not 100% sure the world is going to find it easy to vaccinate itself out of a pandemic because of the emergence of variants that are capable of escaping the protection of current vaccines.
• With very large amounts of virus around there will be a regular arrival of new variants that are particularly troublesome. The variant problem is going on and on as long as there is a lot of virus going around. For anyone to say they are safe because they are vaccinated is more hope than probability.
• We should expect more variants to emerge and escape vaccine protection, that is inevitable, and so globally we should anticipate that this pandemic is going to go on roaring in parts of the world where there are large numbers of people still infected.'
  
• Dr David Nabarro said world leaders need to support other countries through a global COVID-19 programme, adding 'If they don't do so I think the prospect of getting collectively ahead of this pandemic in short order are next to zero and we will go on struggling with uncertainty, not just for the coming year but for a number of years.' Whilst the vaccination programmes are indeed offering some hope, there is no guarantee they will be able to protect us from new strains of COVID-19.
  

African Union seeks to boost vaccine-making with 5 new centres

• The Coalition for Epidemic Preparedness Innovations (CEPI), which helps run the global COVAX coronavirus vaccine-sharing programme with the public-private alliance GAVI and the World Health Organization (WHO) have signed a memorandum of understanding to boost African vaccine research and development as well as manufacturing.
• The five centres will be located in the north, south, east, west and centre of Africa over the next 10-15 years, according to John Nkengasong, director of the Africa Centres for Disease Control and Prevention (CDC).
• 'Trusted partnerships will be critical in advancing the vaccine manufacturing agenda on the continent,' he said on Tuesday after a two-day virtual meeting. 'The partnership with CEPI symbolises cooperation and collaboration to help respond to infectious disease threats and ensure Africa's health security.'
• The target is to produce locally within 20 years 60% of all vaccines used on the continent, compared with one percent today. 'We are aware that it is a challenge,' said Nkengasong, but added 'If Africa does not plan to address its vaccine security needs today, then we are absolutely setting ourselves up for failure going forward.'
  

Europe won't renew AstraZeneca, Johnson & Johnson COVID-19 vaccine contracts new year - report says

• Amid delivery delays and concerns over rare but serious blood clots for the AstraZeneca and Johnson & Johnson COVID-19 shots, European officials are looking elsewhere for next year's supply.
• The European Commission has opted against renewing its vaccine contracts with AstraZeneca and J&J once they expire at the end of the year, Italian newspaper La Stampa reported Wednesday, citing an unamed source from the Italian health ministry. Reuters also picked up the story.
• Both shots have come under scrutiny over rare but serious cases of blood clots in people who had received vaccine shots, prompting several countries to pause the use of the AZ shot while the European Medicines Agency completed a follow-up safety review. Meanwhile, AstraZeneca has struggled to meet the delivery targets it originally laid out, while J&J just this week said it would delay its vaccine rollout across the EU over safety concerns.

Deaths outstrip births in ten Brazilian cities as COVID-19 cases surge

• There were more deaths than births in several Brazilian cities in March, amid the country's latest surge in COVID-19 cases. At least ten cities, including Rio de Janeiro, recorded higher death rates than birth rates during the month. According to the National Civil Register, Rio de Janeiro reported 36,437 deaths in March but only 32,060 births during the same period.
• Brazil is currently the global epicenter of the COVID-19 pandemic, with daily deaths surpassing 4,000 last week. The outbreak is pushing hospitals to breaking point with many patients dying before an Intensive Care Unit bed becomes available. ICU capacity stands at about, or above, 80% full across all of Brazil's 27 regions.
• Victims are also getting younger with over 50 percent of intensive care beds occupied by patients under 40 years old, according to a study published over the weekend by the Brazilian Association of Intensive Medicine. This new statistic is a jump of 16.5% compared to the ICU bed occupancy rate for that age between December and February.