Pfizer. Evolution of COVID-19 and high-risk awareness

When someone who is vaccinated and/or has a booster dose gets infected with the virus that causes COVID-19, it is referred to as a “vaccine breakthrough infection” (as per the CDC – Centers for Disease Control and Prevention). Those who get breakthrough infections can spread the virus to other people. Hospitals magazine recently interviewed Dr Muna Almaslamani, CDC Medical Director, who talked about the Evolution of COVID-19 and high-risk awareness.

What is the current average number of cases in the country? Is there a rise in the number of cases per day?

Generally, case numbers continue to fluctuate, although the most recent Omicron subvariants have led to a rise in cases.  We experienced a spike through mid-to-end of July and are now recording some 600+ cases among community members within 24 hours*. That means we have approximately 5,000+ current active cases*. We must be mindful however that the number of confirmed cases is lower than the true number of infections due to more people now conducting at-home tests, or limited/infrequent testing.

Evolving and circulating variants are a reminder that the virus continues to evolve and remains highly unpredictable. And, as long as it remains unpredictable, it remains a risk.

What do you think are the factors that are contributing to the rise of infections?

There are several reasons that have most likely contributed to the surge in cases.

One being new variants of concern, which I touched upon earlier. Since the start of the pandemic, we have identified, monitored, or classified approximately 40 variants[1].

The virus’s ability to evolve and mutate means that the virus is taking advantage of different environments, then emerging and adapting; be it jumping to a different host or remaining within a patient for an extended time. This allows the virus spread more effectively.

Secondly, we have the issue of vaccination uptake and compliance. As of June 2022, at least 65.7 per cent of the world’s population have received at least one dose of the COVID-19 vaccine[2]. However, large portions of the population remain unvaccinated or partially

vaccinated. The challenge here is that despite immunization, and being boosted, infections can still occur due to evolving variants, which is a factor towards rising numbers.

Lastly, we’ve seen the easing of COVID-19 restrictions globally. While these are welcome by many, the freedom in movement, as well as the increase in international travel, has exacerbated the spread, particularly over the past few months. 

How do you explain the surge of infections to your patient’s post-vaccinations?

When someone who is vaccinated and/or has a booster dose gets infected with the virus that causes COVID-19, it is referred to as a “vaccine breakthrough infection” (as per the CDC – Centers for Disease Control and Prevention). Those who get breakthrough infections can spread the virus to other people.

This typically happens because of the evolving strains, which means the virus mutates to outcompete those before it (infecting people who were immune to previous strains). And, secondly, because there are patients that are more susceptible to risk. Patients with one or more risk factors are vulnerable as are those that are immunocompromised.

The important thing to note, and the reason why we stress the importance of being vaccinated is because should people who have been vaccinated get COVID-19, they are much less likely to experience severe symptoms than people who are unvaccinated. Locally, as of 7 August 2022, 95.5 per cent of the population has been fully vaccinated which helps to reduce the risk of severe infection and hospitalization.  

What type of patients are particularly at high risk of COVID-19 infections? What is your advice for them in terms of testing and management of COVID-19 symptoms?

According to the WHO and the CDC, high-risk people — typically defined as those who have existing or underlying health conditions and/or meet one of the following criteria: 60+ years old, pregnant, diabetic, hypertensive, obese, high cholesterol, smokers, cancer patients, chronic kidney, lung or liver disease, sickle cell disease, heart conditions, HIV infection, neurodevelopmental disorders, or are immunocompromised, on immunosuppressive treatment, or have medical-related technological dependance, among others[3]^,[4] —  face a greater threat of COVID-19 progressing to a serious illness. A person’s risk of severe illness from COVID-19 also increases in direct proportion to the greater number of underlying medical conditions they have.

It is estimated that at present, 40-50 percent of the global population are considered high-risk, which means that they could become seriously ill or hospitalized should they become infected with the COVID-19 virus.

For example, cancer patients are much more likely to get very sick if infected with COVID-19 — because the treatment they may be receiving (such as chemotherapy) for a particular type of cancer can weaken the immune system and therefore weaken their body’s ability to fight off the virus.

Similarly, diabetics are also more likely to suffer from COVID-19 complications as high blood sugar weakens the immune system and makes it less able to fight off infections. Viral infections can also increase inflammation, or internal swelling, in people with diabetes. This can also be a result of above-target blood sugars, which leads to inflammation that could lead to more severe complications.

As healthcare providers it is our responsibility to help protect lives and identify high-risk patients, ensuring we provide the risk guidance and advice to protect them as best as we can. We encourage patients to get tested at the earliest signs of COVID-19 symptoms. Even if symptoms may appear mild, like a runny nose or sore throat, it is important to test as it could progress to a more serious disease, particularly if the patient is within one or more risk categories.

From our end, we’re tracking all reported positive cases in the country on a daily basis and have a triage system in place that allows us to identify risk factors and the severeness of symptoms and consequently prioritize the patients’ care based on the urgency of their condition. We then decide the appropriate treatment based on protocol advised by the Hamad Medical Corporation – Communicable Disease Center — which is the principal healthcare provide in the State.

*Accurate at the time of publishing.

[1] [1] ECDC. SARS-CoV-2 variants of concern as of 21 April 2022. Available at: https://www.ecdc.europa.eu/en/covid-19/variants-concern. Accessed: April 2022

[2] Our World in Data. Coronavirus (COVID-19) Vaccinations. Available at: https://ourworldindata.org/covid-vaccinations. Accessed: June 2022

[3] World Health Organization. Available at: https://www.who.int/images/default-source/wpro/health-topic/covid-19/severity-slide5.png?sfvrsn=7fbef143_7. Accessed May 2022

[4] Centers for Disease Control and Prevention. COVID-19 Information for Specific Groups of People.

Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html. Accessed May 2022.