LONG COVID
Box O.1. Vaccines, mortality, and availability The experience of high vaccination countries suggests that it may be possible for countries to transition from the more malignant phase of the disease to a relatively benign phase of “managed endemicity.” Like most other countries, the UK initially suffered recurrent waves of the pandemic that were associated with high levels of infection and significant mortality. As vaccination rates surpassed 60 percent, UK relaxed social restrictions allowing for a resumption of economic activity (figure O.B1.1). The expectation was that a certain threshold level of immunity, due to a combination of vaccination and infection, would usher in a phase where we still see waves of infection but less severe illness and mortality. The reason is that vaccines do not offer sterilizing immunity, critical for preventing transmission, and different types differ in their efficacy as far as infection and mild illness is concerned, but most offer high levels of protection against hospitalization and death and differ much less in this respect. The current situation is in line with expectations, except that high levels of transmission have led to significant deaths even though case fatality is low—mortality in the UK is higher than 2020 when nobody was vaccinated but less infectious variants prevailed. The country has found the sustainability of this benign phase is conditional on vaccination staying a step ahead of the disease, in terms of immunity offered across people and over time against old and new variants. The recent upturn in mortality in the UK suggests (1) immunity wanes after a certain period and may require booster shots to sustain it; and (2) absent other measures to suppress transmission, new variants can lead to increased levels of infection and hence mortality, putting pressure on health systems even though case fatality rates are low. Figure BO.1.1. Increases in the vaccination rate reduce mortality but not necessarily infections, and vaccination above certain thresholds is associated with increased mobility and economic activity B. Germany
20 40
1000
0 20
–100 0
0–20
–100
–20
Percent, index index Percent,
100 200
Sep-21Sep-21
Jun-21Jun-21
Dec-20Dec-20
Mar-21Mar-21
Deaths per 100,000 80 60 80 40 60
100 200 1000
20 40 0 20
–100 0
0–20
–100
–20 Sep-21Sep-21
Cases per 1 million Vaccination rate (rhs) Manufacturing PMI (rhs) Cases per 1 million Vaccination rate (rhs) Manufacturing PMI (rhs)
Percent, index index Percent,
300 400 200 300
Jun-21Jun-21
Deaths per 100,000 Mobility reduction (rhs) Servicesper PMI (rhs) Deaths 100,000 Mobility reduction (rhs) Services PMI (rhs)
Deaths per 100,000
Mar-21Mar-21
Sep-21Sep-21
Jun-21Jun-21
Mar-21Mar-21
Dec-20Dec-20
Cases,Cases, deathsdeaths
Cases per 1 million Vaccination rate (rhs) Manufacturing PMI (rhs) Cases per 1 million Vaccination rate (rhs) Manufacturing PMI (rhs)
D. Germany
Cases per 1 million Vaccination rate (rhs) Cases per 1 million Vaccination rate (rhs)
Dec-20Dec-20
–20
400
Mar-20Mar-20
–200
Percent, index index Percent,
80 100 60 80 40 60 20 40 0 20 –20 0 Sep-20Sep-20
40 60
Cases,Cases, deathsdeaths
100
800 1,000 600 800 400 600 200 400 0 200 –200 0
Jun-20Jun-20
200 300
Deaths per 100,000
C. United Kingdom
Mar-20Mar-20
60 80
Sep-20Sep-20
Deaths per 100,000
Sep-21Sep-21
Jun-21Jun-21
Mar-21Mar-21
Dec-20Dec-20
Sep-20Sep-20
Jun-20Jun-20
Mar-20Mar-20
Cases,Cases, deathsdeaths
1,000
Cases per 1 million Vaccination rate (rhs) Cases per 1 million Vaccination rate (rhs)
300 400
Sep-20Sep-20
–20
80
Jun-20Jun-20
–200
400
Jun-20Jun-20
80 100 60 80 40 60 20 40 0 20 –20 0
Mar-20Mar-20
100
800 1,000 600 800 400 600 200 400 0 200 –200 0
Percent, index index Percent,
1,000
Cases,Cases, deathsdeaths
A. United Kingdom
Deaths per 100,000 Mobility reduction (rhs) Servicesper PMI (rhs) Deaths 100,000 Mobility reduction (rhs) Services PMI (rhs)
Source: Haver Analytics; Oxford Covid-19 Government Response Tracker (OxCGRT). Note: Latest available data as of September 15, 2021.
(continued)
Long COVID
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