DJ

-The WHO reported yesterday exponential growth of new cases. A.o in India, Brazil, Turkey, Iran new variants may be "out of control". I do expect we may get over the 1 million new  (reported/tested) cases per day within a week...Maybe we are already there with testing itself still be a problem in many countries. 

-Healthcare itself is in a growing crisis due to more HCW-ers not being able to provide care. Here in NL 20%-1-in-5 !!! HCW-er is now on sick leave. The duration of extreme burden on care means more and more HCW-ers get long term healthissues like PTSD, depression, burn-out-but also variants may infect more HCW-ers. Vaccination of HCW-ers does not seem to be top-priority. We may have hospital/ICU beds-but not enough staff...

-There are limited reports of newer variants (Tanzania-with 31 mutations, Brazil mix of several variants) and vaccines offering less protection against new variants. Newer variants may evade natural/vaccine immunity and there are (alarming) studies indicating that is already happening.

-Vaccination itself may "select" by protecting against "milder variants" and in that way strengthening "more agressive" variants. Countries like Israel, the UK do their best to limit the spread of new, newest variants. In the US with the UK variant as dominant-and 1/3 of the population vaccinated the P1 variant may be getting problematic...maybe even because of vaccination/variant selection.

-Due to poor communications, duration, bad info, half choices the basics for NPI in most of the population is eroding. Governments/politics can make rules but may not be longer able to enforce those rules...

-Russia and Nigeria in the last months reported bird flu variants jumping into humans. Other cases may remain unnnoticed. Also H5/H7 bird flu may jump into other species-becoming a growing indirect risk. 

-Looking at the timing, new variants showing up, wave 4 may come while wave 3 is not over yet...If you put the peak of wave 1 at april 2020

Conclusion; Allthough vaccinations offer protection against severe disease/death a lot of people in many countries do not have vaccine protection. On the short term NPI is the other way to get a grip on the pandemic-but the bases for that may be slipping away. Healthcare is sinking deeper in crisis with staff the main problem but oxygen, medication a fast growing problem on top of that there is limited influx of new HCW-ers due to low pay, major responsibility/risk. 

Governments have to increase the ways to get a grip on this pandemic otherwise we may face a global health disaster that could kill billions...

(Of course as a reminder I am NOT an expert-or "neutral"...just trying to make some sense...) 

Major global health crisis! Alert alert! Sound the alarms.... Quickly. 

The third world needs to be vaccinated. They need to be vaccinated for the good of society.  BUT they cant afford it...    

Maybe western nations can fund the vaccines. What a great idea. lets all chip in.         

In all seriousness. This was predicted. When does this bloody circus end?  Are you all just going to continue to gobble this crap? No critical thinking.

Meanwhile, I live in Oklahoma and we lifted our mask restrictions and let's everyone pretend like the pandemic is over (insert sarcasm). As did Texas, the state below us. However,  there are individual stores that still require masks. I'm still wearing mine, even though I'm fully vaccinated. The one positive thing I will say about our state is that if you want the vaccine it's been easy to get. 

[url]https://nltimes.nl/2021/04/13/rivm-96-test-positive-coronavirus-last-week-since-february[/url] or https://nltimes.nl/2021/04/13/rivm-96-test-positive-coronavirus-last-week-since-february - https://nltimes.nl/2021/04/13/rivm-96-test-positive-coronavirus-last-week-since-february ; 

The percentage of people testing positive for the SARS-CoV-2 coronavirus infection rose for the fourth straight week, with an increase from 8.9 percent to 9.6 percent last week. That was the highest rate in which people tested positive for the virus since the last week of February. At the same time, there was a slight decrease in the number of hospitalizations for Covid-19, though intensive care admissions rose.

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There were more infections per capita in all age groups from 13 through 69, the data showed. "A relative decrease was seen in the age groups 80+ (-15%) and children under 12 (-7%). A relative increase was seen in the age groups 13 to 17 years (+ 15%) and 18 to 24 year olds (+ 5%), despite the fact that no more tests were conducted," the RIVM said.

The latest model from the RIVM also showed that there were 163 thousand people contagious with the virus on March 29. On that day, the basic reproduction (R) number for the spread of the virus was 0.97. That means that 100 contagious people were likely to infect 97 others. A R-number below 1.00 was once seen as a positive sign to eventually relax lockdown restrictions. 

However, on Tuesday, the RIVM said of the R-number, "That is not enough to slow down the virus."

DJ-Not in this story is an increase of the P1 (Brazil) variant from 0,5 to 1,5% of all cases in NL since last month. Maybe the P1 variant could become the dominant form in NL this summer...

[url]https://www.dw.com/en/german-cabinet-approves-uniform-covid-measures-nationwide/a-57178073[/url] or https://www.dw.com/en/german-cabinet-approves-uniform-covid-measures-nationwide/a-57178073 - https://www.dw.com/en/german-cabinet-approves-uniform-covid-measures-nationwide/a-57178073 ; 

On Tuesday, cabinet members approved legal changes to grant the federal government more power to enforce coronavirus regulations in German states.

The  https://www.dw.com/en/covid-response-what-the-german-federal-governments-new-powers-mean/a-57151957" style="color: rgb(0, 135, 235); text-decoration: none; - changes to the German Infection Protection Act must now be passed in the parliament, the Bundestag.

If approved, the new "federal emergency brake" means that any region in any state with a high incidence of COVID-19 cases would be legally required to implement a uniform set of rules set out by the federal government.

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One of the more controversial measures is an  https://www.dw.com/en/fact-check-how-effective-are-nighttime-curfews/a-57172102" style="color: rgb(0, 135, 235); text-decoration: none; font-family: Georgia, Times, serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); - overnight curfew  to be enforced between 9 p.m. and 5 a.m. in cities and districts that cross the 100-cases threshold. Exceptions to this rule include medical emergencies and work.

DJ-The German central government taking over rules to contain this pandemic from the states is very unusual...!  (Just like the US in Germany member-states have a lot of power. It would be like the federal government taking over rules from the states in the US...) 

The Dutch-German border closed is causing some problems-most on the German side. A lot of Dutch people shop across the border (very open in normal times). Some German bordertowns see a decrease of 70/90% of spending now Dutch customers do not cross the border...

[url]https://www.france24.com/en/europe/20210413-france-suspends-all-brazil-flights-over-covid-19-variant-fears[/url] or https://www.france24.com/en/europe/20210413-france-suspends-all-brazil-flights-over-covid-19-variant-fears - https://www.france24.com/en/europe/20210413-france-suspends-all-brazil-flights-over-covid-19-variant-fears ; 

France is suspending all flights to and from Brazil to curb the spread of a new Covid-19 variant found in the South American country, Prime Minister Jean Castex said on Tuesday.

DJ-Other then UK variants are increasing...