Since the end of July, the number of coronavirus cases in Kazakhstan was increasing exponentially. In early August, health officers registered three thousand coronavirus cases every day. Although now the number of cases has decreased, health officers still expect excess incidence in August. The new wave of Covid-19 will decline in September only.
How the new wave develops
Kazakhstan has faced the third summer of pandemic by the traditionally increased number of Covid-19 cases. In the first decade of June, the number of new cases was very low, only 14, but at the end of July the daily number of cases across the country increased up to 3.1 thousand people. That is more than a 100-fold increase. This conclusion arises from analysis of daily publications about the epidemiologic situation published on the official website of the Ministry of Health of Kazakhstan.
The peak incidence was on July 30, when Kazakhstan reported 3,107 new cases of Covid-19 and 27 cases with negative PCR test results. By this date, the total number of sick and treated patients was 25.4 thousand people.
The incidence curve went up in the second decade of July and reached its peak on August 4, when the number of Covid-19 cases was 34.5 thousand Kazakhstanis. As Azhar Giniyat, minister of health, said at the briefing in the Central Communications Service of the President of Kazakhstan, the new wave of Covid-19 incidence in Kazakhstan is characterised by the milder course of the disease. 94 per cent of all patients undergo outpatient treatment, the occupancy rate in infectious hospitals is 28 per cent (1.4 thousand), and the occupancy rate in intensive care is 7 per cent (43 patients). Most of those 43 seriously ill patients have concurrent conditions – arterial hypertension, chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus.
Overall, according to the Interdepartmental Commission on Preventing the Spread of Coronavirus Infection, 1 million 376 thousand people have already had coronavirus in Kazakhstan. Among them, 1 million 340 thousand citizens have recovered. The map shows the regional distribution of the infection. The majority of Covid patients was reported in the capital of the state (261.4 thousand). Due to this top position, Nur-Sultan became the only city in the country that was a yellow zone. All other regions are considered green zones.
It is important that in 2022 the ministry of health of Kazakhstan changed the method of epidemiologic situation assessment matrix generation. Previously, the regions were distinguished by colour depending on the number of newly confirmed cases daily per 100 thousand people, but now health officers paint the map of Kazakhstan based on a different principle. The basis is the bed occupancy. This indicator – hospitalisation per 100 thousand people – will now affect the strictness of restrictions in Kazakhstan.
As to the virus strains that are now actively migrating in the country, medical workers call Omicron (and its subtypes BA1, BA2, BA3, BA4) the most widespread strain. This information was told by Bakyt Kosherova, doctor of medicine, professor, first category infectious disease physician of Kazakhstan, at the press conference in Nur-Sultan.
“The new virus variants differ from the first strain by the degree of disease severity. Previously, we used to focus on the signs of respiratory insufficiency caused by pneumonia as the determining criteria of severity, but now the severity of condition may be caused by intoxication symptoms, multiple organ failure, severity of comorbidity and concurrent conditions in our patients. The moderate and severe course of the disease may develop without lung damage because of the intoxication syndrome, vascular abnormalities and other disorders. It’s only the physician who can determine the severity of the disease,” the speaker said.
The distinctive peculiarity of Omicron strain is the reduction of the incubation period upon infection. It lasts 2-4 days only. The main symptoms of the disease are close to common cold: fever (or no fever), general weakness, sweating, throat irritation, nasal congestion. The infectious disease physician pays attention to the fact that the migrating virus strain gives an atypical picture of the disease in elderly patients. Despite the fact that at first sight the symptoms in the elderly may seem as a slight cold, this picture in fact does not correspond to the severity of Covid and the seriousness of the diagnosis. Coupled with the concurrent conditions, it poses more risk to the patients aged 60+.
According to preliminary forecast of the Ministry of Health of Kazakhstan, in August doctors are still expecting the increase in the incidence rate. The Covid wave will decline in September only.
How vaccination is going
According to the Ministry of Health of Kazakhstan, 80.6 per cent of adult population, or 56 per cent of total population, have been vaccinated during the pandemic in Kazakhstan. The first vaccine component has been administered to 10.8 million people (out of 19.2 million), the second one to 10.5 million. Only half of this number have been revaccinated – 5.1 million Kazakhstanis.
Compared to the global figures, the vaccination level in Kazakhstan is below the average. According to the Ourworldindata.org, which is highly ranked by the leading global media, the average Covid immunisation indicator in the world as of August 13 was 67 per cent. Moreover, in developed countries the proportion of those vaccinated is much higher than this figure. For example, 86 per cent of population of Canada have been vaccinated, 83 per cent in Japan, and 80 per cent in Great Britain.
According to the sources in the Ministry of Health of Kazakhstan, currently three kinds of vaccine are available for people – Kazakhstan-made QazVac, Chinese Sinofarm, and American Pfizer. Over 1.2 million doses are available, with small number of Pfizer (only 29 thousand). Before the end of the year, the ministry is planning to buy extra 500 thousand doses of QazVac and 300 thousand doses of Pfizer. The latter is administered mainly to vulnerable groups of people.
According to Aizhan Yesmagambetova, chief state medical officer of Kazakhstan, Kazakhstan is not going to buy foreign vaccines anymore (except for the said volume of Pfizer intended for adolescents, pregnant and breastfeeding women).
“The capacity of the Kazakhstan-based pharmaceutical factory allows to produce up to 500 thousand doses of QazVac every month. This volume is quite enough to meet the needs of our country regarding the coronavirus infection (until the end of the year – author’s note). The next batch will be manufactured and available to us in September,” Yesmagambetova said.
Moreover, the medical officer said that Kazakhstanis will have no opportunity to get a foreign vaccine for a charge soon. The point is that manufacturers of foreign vaccines keep to a strategy to provide such vaccines only to the states for further free of charge distribution. As long as there is the pandemic in the world, manufacturers will not produce vaccines for commercial sale.
Expert opinion
How contagious new subtypes of Omicron, what damage they can cause to the immunity of Kazakhstanis, and can we speak about the ‘attenuation’ of the pandemic based on the milder course of the disease. These are the questions we have asked Asel Musabekova, virologist, PhD in molecular biology and virology (Kazakhstan).
- Since the end of June, Kazakhstan again reports the increase in the coronavirus incidence rate. Do you think it is related to the global trend or is it due to the regional specificity of Kazakhstan?
- It is definitely the global trend, and the increase in the incidence rate in the world is linked to a few factors. The first and foremost is that the new wave is mainly related to two subtypes of Omicron – BA4 and BA5. Both are very contagious. During adaptation, the virus changes, develops subtypes, which are different because of their advantage. The virus seems to get away and hide from detection by antibodies. Thus, it turns out that even a person who has had the disease and has been vaccinated can catch Omicron, namely BA4 or BA5.
This adaptation comes expensive to the virus because it becomes less dangerous in terms of mortality and severe consequences for a person. Omicron is different because it does not multiply readily in the lower respiratory tract, which causes fewer cases of shortness of breath and pneumonia. Therefore, the new types of Omicron cause a milder course of the disease.
These changes have caused the new wave. If we look at the world statistics, we can see the decline in the mortality rate this summer. However, we understand that the mortality rate depends not only on the virus, but also on a host. Since most of the people have already developed immunity to some extent (or recovered, or vaccinated), it is not correct to compare the mortality rate among the newly confirmed Covid cases with that among the Omicron cases. Because now the virus exists in different conditions.
If we compare the data of the Kazakhstan Interdepartmental Commission on Preventing the Spread of Coronavirus Infection as of August 1, 2021 and 2022, we will see that one year ago there were 7.8 thousand new cases of infection, and 1.6 thousand patients were in grave condition. And we compare with today’s data, 1.6 thousand new cases daily and 33 patients are in grave condition. Therefore, we can arrive at a conclusion how the Covid wave is developing in Kazakhstan.
- In other words, can we say that the current situation is not related to the ease of restrictions?
- In our country, restrictions do not play a big role because people have not always followed these restrictions, and there has been high pressure on business. We know that our cultural, social, economic peculiarities did not allow our citizens follow the restrictions strictly.
Consider masks, for example. People failed to observe simple rules, they wore them on their chin, did not change them, there was no access to free masks in the country unlike in other countries. In my opinion, there was no isolation in Kazakhstan compared to other states, where restrictions were obviously followed.
- What is your forecast of the pandemic development in Kazakhstan until the end of the year? Should we expect any bursts or will the new epidemiologic season be more quiet than the autumn of 2020 and the autumn of 2021?
- Despite the fact that the new subtypes of Omicron have lower lethality rate, the virus is still contagious, people will get into intensive care, and there will be deaths from it anyway. The point is that there will be fewer deaths.
In general, compared to the autumn of 2020 and 2021, the last quarter of this year will be easier in terms of the burden on the healthcare system. At least, we hope so. However, there are various factors that can change the situation: children get back to schools, co-infections cannot be excluded. No one excludes acute respiratory viral infection, influenza. Covid-19 has a strong impact on the immune system. Very often, after a person recovers from Covid, he/she catches various diseases. Generally, such cases can be not PCR positive cases of Covid-19, but grave course of cold-related diseases.
The pandemic course in Kazakhstan is peculiar for the relatively low coverage of vaccination. The problem is that the least vaccinated groups of adult people are the elderly people aged 60+. Over a half of our old people are unvaccinated. It happens mostly because we have a high rate of false medical exemptions, i.e. when a doctor specifies contraindications, which are not so in fact. For example, diabetes mellitus per se is not a contraindication for vaccination, but vice versa should be a direct indication for immunisation. The same is with blood vessel diseases.
I have participated in the creation of the brochure about medical exemptions, which fully describes when a person with any diseases may be vaccinated, and when not. If your close ones are not vaccinated because they have medical exemption, update your information in this regard and recommend them to vaccinate. It will give an opportunity to reduce the risks of dangerous consequences, even given the new types of Omicron.
- Kazakhstan has decided to refuse foreign vaccines, and leave only Pfizer for certain categories of people. Please, give your comment on this decision.
- A few types of vaccines, including foreign ones, have been available in Kazakhstan for a long time. Those who were waiting for them could get them freely. Therefore, now I wonder when I hear criticism about the decision to stop supplies of some types of foreign vaccines into the country. The QazVac vaccine is a local vaccine and will be mainly administered to our people. So, no wonder that the country will prefer it to others.
- Should we expect new records in incidence rates and new restrictions?
- We know that viruses do not disappear; they take their niche. For example, now Omicron wants to take its niche and hide from the immune system, and focus on mild symptoms of cold. The virus is more likely to turn into a seasonal virus, adapt, and we’ll see new variants of it. Therefore, there will never be the end of the coronavirus story.
The end of the pandemic as the threat to the humanity will occur only when we develop mechanisms of regular protection from this virus group. These could be seasonal vaccines that will adapt to the current strain. Or we can come to the point when Covid becomes a regular cold. It may happen that vaccines will be recommended to particularly vulnerable groups, and will not be mandatory for the others. It all will depend on how the virus will change and how much interested we will be in the vaccine production, whether it will be reasonable at all.