Over the past month, global COVID-19 cases rose slightly, with a steady drop in deaths from the virus, the World Health Organization (WHO) said in its latest monthly update.
However, the group cautioned about interpreting the data, given that less than half of countries reported their COVID metrics during the latest reporting period, which covers December 11, 2023, to January 7.
"According to estimates obtained from wastewater surveillance, clinical detection of cases underestimates the real burden from 2 to 19-fold," the WHO said.
In the final week of 2023, the JN.1 variant made up 65.5% of sequences, up sharply from 24.8% the month before.
A few hot spots in Asia
In its analysis of regional trends, the WHO said cases rose in two regions. Numbers were up sharply in the South East Asia region, with a more modest increase in the Western Pacific region. In South East Asia, countries reporting some of the highest increases were India and Indonesia. JN.1, part of the BA.2.86 family, became dominant in India in the first week of January.
Meanwhile, in the Western Pacific region, Malaysia and Singapore reported the biggest case rises. Information on Malaysia's health ministry website show that cases in the current wave peaked just before Christmas and are declining steadily. Singapore's health ministry data show a similar pattern.
Deaths declined or remained stable across five of WHO's regions, with only South East Asia reporting a rise, which was sharp. The region's highest numbers were from India, Indonesia, and Thailand.
Hospital and ICU trends
The WHO closely monitors hospitalizations and intensive care unit (ICU) indicators to look for any changes in illness severity. Very few countries regularly report their hospitalizations and ICU admissions for COVID. Of 22 countries that do, 36% saw a 20% or more rise in hospitalizations over the past month, which included Indonesia, Malta, Brunei Darussalam, Malaysia, Greece, Singapore, the United States, and Ireland.
And of 18 countries regularly reporting ICU data, 44% reflected a rise of 20% or more in admissions for COVID. They include Indonesia, Malaysia, Singapore, Estonia, Ireland, the Netherlands, Greece, and the Czech Republic.
Encouraging severity trends
As part of severity monitoring, the group also tracks ICU-to-hospitalization and death-to-hospitalization ratios, which it said are still subject to the same incomplete reporting constraints. The WHO said ICU-to-hospitalization ratios have been decreasing since the peak in July 2021, with a stable trend in recent weeks.
The death-to-hospitalization ratio has also been declining since July 2021, and since January 2023 has remained under 0.15. "This is an encouraging trend indicating a lower mortality risk among hospitalized individuals," the WHO said. It said multiple factors may be responsible, including infection- or vaccine-derived immunity, earlier diagnosis and treatment, and reduced strain on health systems.
Also, the WHO included a caveat that it's not possible to say—based on ratio tracking—-if the newer SARS-CoV-2 variants are less virulent.
