April 29: 3394 New COVID 19 Cases in Illinois

April 30: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

EPI UPDATE The WHO COVID-19 Dashboard reports 150.1 million cases and 3.2 million deaths worldwide as of 8:45am EDT on April 30. From the first reported COVID-19 case, it took 90 days to reach 1 million cases and 177 days to reach 10 million cases:

1 case to 25 million- 240 days

25 to 50 million- 69 days

50 to 75 million- 41 days

75 to 100 million- 40 days

100 to 125 million- 57 days

125 to 150 million- 35 days

India surpassed 200,000 cumulative COVID-19 deaths on April 28, and Brazil surpassed 400,000 deaths on April 29. Brazil remains #2 globally, with 401,186 deaths, and India is #4 with 208,330. The US is #1 (575,194), and Mexico is #3 (216,447). At its current pace, however, India could surpass Mexico in the next several days. Additionally, India surpassed 350,000 new cases per day on April 29, the only country to surpass this milestone. With 357,040 new cases per day, India currently accounts for more than 40% of the global daily incidence and nearly 6 times the daily incidence in any other country. It does appear as though India may have passed an inflection point, as the increase in daily incidence has tapered off to some degree over the past several days.

In addition to India, several other countries in and near the WHO’s South-East Asia Region (SEARO) are exhibiting concerning COVID-19 incidence trends. Including India, 7 of the 11 SEARO countries are exhibiting biweekly increases greater than 100%. These countries’ respective epidemics are considerably smaller than India’s, which is allowing them to be overlooked; however, the proportionate increases are concerning indications that they could be facing severe impacts in the very near future. In addition to the SEARO region, nearby Afghanistan, Cambodia, and Laos also are battling substantial surges. The surges in these countries—most of which either border India or are located within approximately 1,000 miles (1,600 km)—started around the same time or shortly after India’s. If these countries continue on this trajectory, they could face similar impacts on their health systems as we have observed in India as well as associated increases in COVID-19 mortality. These countries should be monitored closely.

Nepal’s COVID-19 biweekly incidence increased by more than 600% compared to 2 weeks ago. After peaking at more than 3,800 new cases per day in October 2020, Nepal brought its COVID-19 epidemic under control, down to 71 new cases per day in mid-March 2021. Nepal’s epidemic began a sharp surge in early April, and it is already back up to more than 3,600 new cases per day and still increasing rapidly. The current surges in Thailand and Bhutan began in late March/early April as well, but their increases have not been quite as sharp as Nepal’s. Thailand is currently reporting more than 2,200 new cases per day, more than double its previous peak, and still increasing rapidly. Bhutan is only reporting 10-12 new cases per day, but this is at least a 20-fold increase since late March.

The surges in Sri Lanka and Maldives started several weeks later, in mid-to-late April. In Sri Lanka, the daily incidence increased from a recent low of 215 new cases per day on April 17 to more than 1,100. Sri Lanka is currently reporting nearly 25% more daily cases than its previous highest peak, and its epidemic continues to accelerate rapidly. Maldives is also setting new national records. Its current daily incidence climbed from 84 new cases per day to 327, 75% higher than its previous highest peak and still increasing rapidly.

Timor-Leste is the most remote SEARO country relative to India, and its surge started in early March, around the same time as India’s. Timor’s daily incidence increased from fewer than 0.5 new cases per day to nearly 90. The daily incidence fell sharply from 88 to 76 new cases per day on April 29, but it is too early to determine if this is the start of a longer-term trend.

Outside the SEARO region, nearby Afghanistan, Cambodia, and Laos also are facing surges that raise concern. Cambodia and Laos are in the WHO’s Western Pacific Region, but they border Thailand and are located approximately 1,000 miles (1,600 km) or less from India. Laos is the #1 country globally in terms of the relative increase in biweekly incidence, up more than 15,000% compared to 2 weeks ago. From the onset of the pandemic through April 20, Laos reported more than 5 cases in a single day only once and only 60 cumulative cases; however, it has reported more than 600 new cases since then. Laos currently is averaging more than 80 new cases per day and increasing rapidly. In the context of larger countries and epidemics, Laos’ epidemic is small, but its rapid acceleration is particularly concerning. Cambodia reported fewer than 1 new case per day as recently as mid-February, before a smaller surge. Since early April, however, its daily incidence has surged sharply, up from 53 new cases per day to more than 650—a 12-fold increase in less than a month. Afghanistan is in the WHO’s Eastern Mediterranean Region, but it is located approximately 125-250 miles (200-400 km) from India. Afghanistan’s current surge began in mid-to-late March, and its daily incidence has increased from fewer than 20 new cases per day to 181, and still increasing. The current daily incidence is approaching Afghanistan’s previous peak (217 on November 24, 2020), but it is still well below its highest peak (759 on June 5, 2020). Afghanistan’s epidemic is accelerating at a much slower rate than many of the other countries discussed here.

Global Vaccination

The WHO reported 1.0 billion vaccine doses administered globally, including 546 million individuals with at least 1 dose. The WHO dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

Our World in Data reported 1.1 billion cumulative doses administered globally. The global total continues to increase at 13% per week. After a brief decline, the daily doses administered rebounded to the previous record high of 18.7 million doses per day. Our World in Data estimates that there are 262 million people worldwide who are fully vaccinated, although reporting is less complete than for other data.

UNITED STATES

The US CDC reported 32.0 million cumulative cases and 571,297 deaths. Both daily incidence and mortality continue to decrease. Daily incidence is down to 52,528 new cases per day, the lowest average since October 12, 2020. The CDC reported an average of 626 and 628 deaths per day, respectively, over the past 2 days, which are the lowest daily mortality averages since June 27, 2020*. Notably, national test positivity is decreasing as well, down from 5.43% on April 12 to 4.47% on April 27**, which is an encouraging sign.

*Excepting the reports immediately following the 2020 Independence Day holiday.

**Test positivity data not published for April 28.

US Vaccination

The US has distributed more than 300 million doses of SARS-CoV-2 vaccine and administered 237 million doses. Daily doses administered* continues to decrease, down from a high of 3.2 million (April 11) to 2.5 million. Approximately 1.4 million people are achieving fully vaccinated status per day.

A total of 144 million individuals have received at least 1 dose of the vaccine, equivalent to 43% of the entire US population and 55% of all adults. Of those, nearly 100 million (99.7 million) are fully vaccinated, which corresponds to 30% of the total population and 38% of adults. Among adults aged 65 years and older, progress has largely stalled at 82% with at least 1 dose and 68% fully vaccinated. In terms of full vaccination, 50 million individuals have received the Pfizer-BioNTech vaccine, 41 million have received the Moderna vaccine, and 8.1 million have received the J&J-Janssen vaccine.

The Johns Hopkins Coronavirus Resource Center is reporting 32.3 million cumulative cases and 575,213 deaths in the U.S. as of 10:15am EDT on April 30.

UPDATED US CDC GUIDANCE On April 27, the US CDC issued updated guidance on COVID-19 protective measures, with the changes focusing largely on vaccinated individuals and outdoor activities. The new guidance accounts for a variety of factors, including increasing vaccination coverage, declining community transmission, and evolving evidence regarding transmission risk factors. The CDC’s overhauled webpage on “Choosing Safer Activities” provides a consolidated overview of the changes, including differences between vaccinated and unvaccinated individuals across a broad scope of activities. Notably, the new guidance indicates that fully vaccinated individuals can participate in a number of outdoor activities without wearing a mask, including exercise, small gatherings with vaccinated and unvaccinated individuals, and dining at restaurants. Mask use is still recommended for vaccinated individuals, however, for large outdoor gatherings (eg, concerts, sporting events) and indoor settings, including restaurants and bars, movie theaters, gyms and fitness centers, and places of worship.

Recognizing the relatively low risk of transmission in most outdoor settings, the CDC no longer recommends mask use for unvaccinated individuals in general outdoor settings (eg, walking or exercising) or for small gatherings with vaccinated individuals. Unvaccinated individuals are encouraged to wear masks in small gatherings with other unvaccinated individuals and in higher-risk settings, including indoor and outdoor dining at restaurants and bars, large indoor and outdoor gatherings, and other indoor settings. The CDC guidance emphasizes that many of these higher-risk settings are “less safe” or “least safe” for unvaccinated individuals, even with mask use.

The CDC also issued updated guidance this week for international travelers, including removing the requirements for a negative SARS-CoV-2 test before departing the US* and mandatory quarantine upon arrival in the US for fully vaccinated individuals**. Testing remains mandatory for all air travelers before departing on a flight to the US. Last week, the CDC issued new COVID-19 guidance for youth and summer camps, including updates regarding vaccination, physical distancing, screening and testing, and ventilation.

*Unless required by the destination country.

**Notably, the guidance explicitly specifies vaccines authorized for use by the US FDA or WHO.

EUROPEAN TRAVEL After restrictions on nonessential travel over the past year, fully vaccinated Americans will be allowed to travel to the EU this summer. European Commission President Ursula von der Leyen said in an interview Sunday with the New York Times that as long as visitors have been vaccinated with a product authorized by the European Medicines Agency (EMA), they will be permitted to enter all 27 member countries. The 3 vaccines authorized by the US FDA also are authorized by the EMA: Moderna, Pfizer-BioNTech, and J&J-Janssen. A specific date has not been announced to lift restrictions, but President von der Leyen noted that policies are in flux based on vaccination rates, the “epidemiological situation,” and vaccination certificates. Individual EU countries will be allowed to enact stricter regulations than the EU as a whole when travel resumes to the region.  

INDIA VACCINE SUPPLIES India’s record-breaking COVID-19 surge is impacting the country’s ability to supply SARS-CoV-2 vaccine doses domestically and abroad. India is the world’s leading producer of vaccines, but it is struggling to produce and distribute enough vaccines for its population of 1.4 billion. As a result, India Prime Minister Narendra Modi recently suspended exports of nearly all 2.4 million doses of the AstraZeneca-Oxford vaccine produced daily by the Serum Institute of India, in effect stopping supply of the vaccine to the COVAX facility. This has raised alarms in Africa, which relies on COVAX for its vaccine doses. Africa CDC officials called the anticipated delay in supplies “devastating” and urged other nations to step in to fill the gaps. In an unexpected move, the Democratic Republic of Congo is returning 1.3 million vaccine doses to COVAX, saying it will be unable to administer them before they expire due to difficulties in distribution and vaccine refusal. The vaccines will now go to nations who can use them more quickly.

Additionally, many global health experts and others worldwide are insisting the US and other nations support a proposal at the World Trade Organization (WTO) by India and South Africa to temporarily waive some trade and intellectual property rules to help low- and middle-income countries (LMICs) fill the gaps. Even if the temporary waiver goes through at the WTO, which is set to hold its next General Council meeting on May 5, production and distribution challenges will remain. But experts contend these constraints could be overcome with more global cooperation and funding. In an April 28 address to the US Congress, US President Joe Biden focused his comments on the COVID-19 pandemic’s impacts on the US population and economy and did not mention global cooperation on vaccines. However, US government officials insist several proposals are being considered to pressure companies to share information on vaccines or boost US vaccine production for export. The White House also on April 28 published a fact sheet outlining its plans to help India with emergency assistance.

US-MADE VACCINE SHIPPED TO MEXICO This week Pfizer shipped US-made doses of its SARS-CoV-2 vaccine produced with BioNTech to Mexico, marking the first time the pharmaceutical company has delivered abroad from US facilities following the expiration of US government restrictions on vaccine exports. Pfizer is Mexico’s largest supplier of SARS-CoV-2 vaccines, having shipped more than 10 million doses so far. Pfizer expects to be making up to 25 million vaccine doses each week in the US by mid-year, more than it needs to meet US commitments. With agreements to supply more than 1 billion doses to countries worldwide, the company plans to continue shipping extra US-made vaccine doses abroad, as well as from production facilities in Belgium.

VACCINE EFFECTIVENESS An early release article published April 28 in the US CDC’s Morbidity and Mortality Weekly Report details the effectiveness of the Pfizer-BioNTech and Moderna vaccines in preventing COVID-19-related hospitalizations among a population at higher risk of the disease. Data from 24 hospitals in 14 states were collected from January to March 2021 for adults ages 65 years and older who were hospitalized for COVID-19-like illnesses to gauge the effectiveness of the two vaccines via partial or full vaccination. The adjusted vaccine effectiveness for full vaccination against COVID-19-associated hospitalization was estimated to be 94% (95% CI: 49-99%), and 64% (95% CI: 28-82%) for partial vaccination. The real-world findings confirm those from clinical trials, highlighting the importance of vaccinating older populations to reduce the risk of COVID-19-associated hospitalizations and potentially leading to reductions in post-COVID conditions and deaths.

SECOND DOSES The US government has directed pharmacies to expand access for second-dose vaccinations to include those who may have received their first dose elsewhere. The move follows reports that millions are skipping their second dose, sometimes due to supply challenges or access issues. The directive is aimed largely at college students, many of whom received their first dose on or near their campuses but will be returning home before becoming eligible for their second dose. Pharmacies participating in the federal vaccine distribution program will waive any residency requirements to allow people easier access to receive a second dose.

VACCINATION & RACIAL/ETHNIC DISPARITIES Preventing disparities in vaccine uptake among racial and ethnic groups in the US will be critical to mitigating disproportionate impacts of COVID-19 among people of color. According to US CDC data as of April 29, race/ethnicity data were available for 55% of people with at least one dose of vaccine and 58% of those fully vaccinated, with 64% and 67% of those, respectively, identifying as white. The Kaiser Family Foundation (KFF) also monitors this data, comparing it to localized health outcomes of race/ethnicity groups during the pandemic. According to KFF, Black and Hispanic populations have received smaller shares of vaccine doses compared to their shares of COVID-19 burden (cases and deaths) and their shares of total population in most states. According to experts, a complex set of reasons has led to these disparities in vaccine coverage, but access remains a leading issue. Across the US, vaccination sites’ locations, registration processes, time requirements to register and receive a vaccine, and transportation play predominant roles in vaccination coverage. Public health officials are encouraging the establishment of vaccination sites in communities with the lowest vaccination rates and with easier appointment scheduling, including walk-in clinics.

VACCINATION INCENTIVES With the number of daily SARS-CoV-2 vaccines administered in the US declining, public health entities and companies are getting creative, implementing various incentives to encourage more people to be vaccinated. Examples include offers of free donuts, beer, and even marijuana in states where it is legal; chances to win vehicles, airline tickets, or other large items; time off from work; or cash for people who give others rides to vaccination sites. Officials say the incentives are necessary to reach people who have yet to be vaccinated due to hesitancy, difficulties making appointments, or obstacles to accessing sites. According to one survey, more than two-thirds of respondents would get vaccinated in exchange for a financial incentive. However, some critics say the incentives could perpetuate individual unhealthy behaviors while promoting public health efforts. And some experts are calling for more strict interventions, urging some employers—including health systems and academic institutions—to make vaccination mandatory for employees.

TURKEY Earlier this week, Turkish President Tayyip Erdoğan announced a nearly 3-week lockdown in response to a sharp rise in COVID-19 cases and deaths across the country. The measure, which is being described as a “full lockdown,” went into effect on the evening of April 29 and will remain active until the early morning of May 17. The lockdown order requires residents to stay at home, with exceptions for essential functions such as grocery shopping, and mandates individuals receive permission before conducting inter-city travel. Notably, some businesses and industries are exempt from the shutdown, and lawmakers, healthcare workers, law enforcement officers, and tourists also are exempt from the stay-at-home order. The lockdown will encompass the final weeks of Ramadan, including Eid al-Fitr, a holiday traditionally marked by social gatherings across the country. Some families departed city centers for coastal vacation homes before the lockdown’s initiation, causing crowding in bus terminals and airports and along the nation’s highways.

ROUTINE TESTING STRATEGIES Researchers from the UK developed a model to evaluate the ability of routine asymptomatic PCR-based testing to detect SARS-CoV-2 infection. The study, published in BMC Medicine, utilized data from a study of repeated, self-administered testing of healthcare workers to estimate probability that twice-weekly testing would identify infected, asymptomatic individuals. Notably, individuals who were infected within several days of testing may not have sufficient virus present to result in a positive test. The researchers evaluated both the probability that a symptomatic case would be detected before the onset of symptoms and the probability that an asymptomatic infection would be detected within 7 days of infection, including test turnaround time, for various testing frequencies.

Assuming a 1-day test turnaround time, the researchers estimate that testing every 4 days would have a 76% probability of detecting an asymptomatic infection within 7 days, but increasing the frequency to every 2 days would increase that probability to 95%. Not surprisingly, increased test turnaround time decreased the probability of timely detection for both symptomatic and asymptomatic infections. The researchers note that as the frequency of testing increases, burden on laboratories increases, which can slow the turnaround time. It may be necessary to balance increased testing frequency against the associated increase in testing volume and slower turnaround times. As organizations—including health systems, businesses, and schools—consider routine testing programs, this study can provide insight into the appropriate frequency to mitigate transmission risk.

Illinois will lose one Congressional Seat but actual population is basically stable.

The “Illinois Exodus” numbers were all spectacularly wrong

Tuesday, Apr 27, 2021

* The Chicago Tribune and the “Illinois Exodus”…

* 2021 John Kass column: Illinois has lost close to a quarter-million taxpayers in the past 10 years in the great Illinois Exodus.

* 2020 Tribune editorial: In 2019, the U.S. Census Bureau calculates, our population fell by about 51,250 people. That’s the equivalent of everyone in Hoffman Estates packing up and heading out.

* 2020 Tribune editorial: Several recent Chicago Tribune stories on tax hikes and population losses may have caught your eye. Against the backdrop of rising taxes in Chicago for 2020, U.S. Census Bureau numbers released Dec. 30 showed Illinois losing population for a sixth straight year.

* 2020 Kristen McQueary column: You’ve seen the numbers. U.S. census data released in December showed Illinois’ net population since 2013 has dropped by more than 223,000 residents, roughly the equivalent of Naperville and Bolingbrook wiped off the map. That number includes births, deaths, domestic and international migration.

* 2019 Kristen McQueary column: Reality check: The number of residents fleeing Illinois for other states jumped to 93,704 in 2014 from 68,204 the previous year. It increased in 2015 to 106,544, and in 2016 to 109,941. More exodus in 2017 of 114,779 and last year, another 114,154.

* 2019 Tribune editorial: Who wants to be the last ones at the party? It only means you’ll have to clean up the mess. That’s what we mean by the Illinois Exodus.

* 2019 Tribune editorial: If [Mayor Lightfoot] keeps talking truth around her fellow Illinois Democrats, Chicago’s next mayor will make them squirm. She must be ignoring the memos instructing her to “Shush up about the ‘Illinois Exodus.’ Bad for our brand.” Lightfoot offered her comment to the Tribune’s Lisa Donovan about U.S. census data showing that the Chicago metro area lost another 22,000 residents from 2017 to 2018.

* 2019 Tribune editorial: Last year’s estimated net reduction of residents hit 45,116, the worst of five straight years of population decline.

* 2019 Tribune editorial: The early numbers show Illinois’ net population dropped from July 2018 to July 2019 by 51,250, down slightly from last year’s net loss of 55,757 residents, an updated number. The figures continue to confirm a sorry trend.

* 2018 Tribune Editorial: People are fleeing. Last year’s net loss: 33,703.

* 2018 Tribune editorial: By the tens of thousands each year, Illinoisans are fleeing this state’s rising taxes and mediocre jobs climate.

* 2018 Tribune editorial: In the big picture, Illinois is shrinking. It lost a net 33,703 people in 2017, and was 1 of 8 states to see a decline. This was Illinois’ fourth year in a row of population decline.

* 2018 Tribune editorial: The release on Wednesday of new census data about Illinois was alarming: Not only has the flight of citizens continued for a fifth straight year, but the population loss is intensifying. This year’s estimated net reduction of 45,116 residents is the worst of these five losing years.

* 2017 Tribune editorial: People are fleeing Illinois in record numbers. For four years running, this state has bled population. In 2017, Illinois lost a net 33,703 residents

* Actual net Illinois population loss according to the official US Census: 18,124. [And subtract 10,289 from that to account for Illinois residents living overseas and it’s a net decline of 7,835.]

It’s not that the Tribune was wrong. The census estimates were way off. But the Tribune did everything it could to hype those numbers and propose solutions to a problem that, while still quite real, was never as bad as was claimed. I’m not sure I’d hold your breath waiting for a clarification.

- Posted by Rich Miller

Above story is from:  https://capitolfax.com/2021/04/27/the-illinois-exodus-numbers-were-all-spectacularly-wrong/?utm_source=dlvr.it&utm_medium=twitter

April 27: 2556 New COVID 19 Cases in Illinois

April 27: Johns Hopkins COVID 19 Report

COVID-19

The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

EPI UPDATE The WHO COVID-19 Dashboard reports 147.5 million cases and 3.1 million deaths worldwide as of 10:00am EDT on April 27. The WHO reported a new record high last week in terms of weekly incidence, with nearly 5.7 million new cases. Weekly incidence increased for the ninth consecutive week. Global weekly mortality increased for the sixth consecutive week, up to 87,733 deaths—the highest weekly total since the first week of February.

India continues to set new global records in terms of daily incidence. On April 24, India became the first country to surpass 300,000 new cases per day, and its daily incidence continues to increase rapidly. India is currently reporting more than 330,000 new cases per day, and if it continues on this trajectory, it could surpass 350,000 new cases per day in the next 2-3 days. The rate of increase appears to have slowed slightly over the past several days, but it is not yet clear whether this is an early sign of a longer-term trend. India also became the first country to report more than 350,000 new cases in a single day on April 25.

Turkey’s daily incidence peaked on April 20, with 60,266 new cases per day. Turkey approached Brazil (#3) and the US (#2)—both of which continue to report decreasing daily incidence—but it did not surpass either country before declining for 6 consecutive days. The epidemics in Argentina, Colombia, Germany, and Iran also appeared to level off over the past several days. France’s and Italy’s epidemics are declining as well.

Global Vaccination

The WHO reported 961 million vaccine doses administered globally, including more than 500 million individuals with at least 1 dose. The WHO dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

According to Our World in Data, the global cumulative total doses administered surpassed 1 billion doses. This is 13% more than this time last week, slightly lower than the previous growth rate of approximately 18% per week. After 6 days of declining averages, the daily doses administered rebounded slightly over the past 6 days, back up to 16.6 million.

UNITED STATES

The US CDC reported 31.9 million cumulative cases and 569,272 deaths. Both daily incidence and mortality are decreasing in the US. Daily incidence is down to 54,405 new cases per day, a 22% decrease from the most recent peak on April 13 (69,878). Daily mortality fell to 661 deaths per day, which is still essentially equal to the low that preceded the autumn/winter 2020 surge (662).

US Vaccination

The US has distributed 291 million doses of SARS-CoV-2 vaccine and administered 231 million doses. Daily doses administered* continue to decrease, down from a high of 3.2 million (April 11) to 2.6 million. Approximately 1.4 million people are achieving fully vaccinated status per day.

A total of 141 million individuals have received at least 1 dose of the vaccine, equivalent to 43% of the entire US population and 54% of all adults. Of those, 96 million (29% of the total population; 37% of adults) are fully vaccinated. Among adults aged 65 years and older, progress has largely stalled at 82% with at least 1 dose and 68% fully vaccinated. In terms of full vaccination, 48 million individuals have received the Pfizer-BioNTech vaccine, 40 million have received the Moderna vaccine, and 8.0 million have received the J&J-Janssen vaccine.

As of April 19, all US states expanded vaccination eligibility to all individuals aged 16 years and older, but the pace of vaccinations is beginning to taper off. Since the national high of 3.2 million doses per day on April 11, the daily average has steadily decreased by more than 20%, down to 2.4 million*. Even with everyone aged 16 years and older now eligible and with sufficient supply, progress toward herd immunity will slow considerably over the coming weeks for a variety of reasons. Some reasons include vaccine opposition and hesitancy, barriers to accessing the vaccine, and dwindling unvaccinated population. In light of the slowing pace, we will look at state-level trends in daily vaccine administration.

*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The majority of states reported their peak doses administered around the time they expanded eligibility to everyone aged 16 years and older or shortly thereafter. More than half of US states (27) reported peaks between 3 days before and 11 days after they expanded to full eligibility. Three states—New Mexico (44 days before), Oklahoma (32 before), and South Dakota (39 before)—reported peaks more than 4 weeks before they expanded eligibility to all individuals aged 16 years and older. If you remove short, temporary reporting spikes for these states, however, their peaks would be in early April, near or shortly after they expanded eligibility. Three (3) states reported peaks at least 3 weeks after they expanded eligibility: Alaska (+35 days), Florida (+25), and Utah (+26). All 3 states reported peaks in early-to-mid April, similar to many other states, but they expanded eligibility much earlier than most states. Alaska was the first state to expand eligibility to everyone aged 16 years and older (March 9), and Florida (March 25) and Utah (March 24) were among the first 6 states to do so.

In total, 9 states reported their peak daily doses administered by the end of March; however, none of these states appear to have exhibited a definitive early peak. Notably, reporting aberrations could account for nearly half of these states. As noted above, the peaks in New Mexico (February 25), Oklahoma (February 25), and South Dakota (February 25) appear to be due to reporting fluctuations, and Louisiana (March 13) exhibited a similar brief spike. The true peaks for these states were actually in early April. Additionally, Arizona’s peak was on March 31, just before April, and Idaho’s average held relatively steady between March 24 and April 13. Iowa (March 13), Mississippi (March 4), and North Carolina (March 18) all reported early peaks, followed by a slight decrease and then a second peak in April that was nearly as high, before finally beginning to decline steadily.

Only 3 states reported their record high in the past week: California (April 20), Hawai’i (April 26), and Maryland (April 24). California and Hawai’i were among the last states to expand to full eligibility (April 15 and 19, respectively). The peak in Hawai’i could be a function of a spike in reported doses on April 20, but the trend does appear to still be increasing overall. More than half of all states (28) reported their peak daily doses administered within the past 2 weeks.

A total of 6 states are currently reporting increasing daily doses administered over the past week**. Pennsylvania reported its highest peak on April 16, but its overall trend appears to still be increasing. As noted above, Hawai’i reported a sharp spike in doses administered on April 20, which puts its weekly average far above the previous week; however, it still appears to be exhibiting an increasing trend since that jump. While Idaho and Wyoming are reporting increases compared to last week, they both appear to be exhibiting an overall decline in daily doses administered—although it is a little difficult to be certain due to fluctuations in the weekly average. Rhode Island and Minnesota appear to be near their respective peaks, but they have not begun to exhibit a clear decline. Massachusetts also could still be approaching its peak, but it is difficult to determine the longer-term trend. The remaining states generally appear to be past their peak and either holding relatively steady or declining. Nine (9) states are holding steady (including Massachusetts), and 35 are reporting decreasing trends**.

**Increasing means at least a 5% increase compared to this time last week, holding steady is less than a 5% increase or decrease, and decreasing means 5% or greater decrease.

The Johns Hopkins Coronavirus Resource Center is reporting 32.1 million cumulative cases and 572,794 deaths as of 11:15am EDT on April 27.

INDIA India is experiencing the world’s largest COVID-19 surge, with more than 350,000 new cases per day. Experts fear the true number of cases could be substantially higher, with cases underreported for reasons including a variety in case-reporting infrastructures and lack of testing. Under the already strained health care system, hospitals are unable to take new patients and many grieving families have been forced to forgo regular funeral ceremonies formass cremations, painting a devastating picture of the reality on the ground. India’s government has left decisions about non-pharmaceutical interventions such as physical distancing or mask wearing up to individual states, with many citizens lamenting a lack of proper government direction and dearth of resources, including diagnostics, hospital bed space, and oxygen. While some volunteers, dubbed “COVID Warriors,” are developing databases to connect people to resources, hospitals, and supplies, others are turning to the black market in a last-ditch effort to save their loved ones. In response tointernational pressure and rising calls for action, the US government on April 25announced intentions to provide supplies and support to India, and lifted previous bans on the export of raw materials, diagnostic kits, and equipment. Additionally, USAID and the US CDC are deploying a “strike team” of staffers to India to work with local governments and organizations to address the surge in cases.

US DONATING ASTRAZENECA-OXFORD VACCINE The US government announced on April 26 it intends to share up to 60 million doses of the AstraZeneca-Oxford SARS-CoV-2 vaccine with other nations, greatly expanding its previous announcement to share about 4 million doses of the vaccine with Mexico and Canada. The US FDA has not yet authorized the AstraZeneca-Oxford for emergency use, although it is widely available in other countries. White House Coronavirus Response Coordinator Jeffrey Zients said about 10 million doses of the vaccine are undergoing a safety and quality review, which is expected to be complete in the next several weeks. An additional 50 million doses are in various production stages and could be available to ship in May and June after FDA review. White House officials said they are in the planning phase and do not yet know which countries will receive the donated doses. The announcement followed a conversation between US President Joe Biden and India Prime Minister Narendra Modi, whose country currently is facing the world’s largest surge in COVID-19 cases. The US government has come under increasing pressure to do more to address the pandemic abroad, and the announcement marks a shift in the government’s willingness to commit to vaccine donations.

VACCINE INTELLECTUAL PROPERTY US Trade Representative Katherine Tai on April 26 met virtually with executives of Pfizer and AstraZeneca to discuss increasing access to and production of SARS-CoV-2 vaccines during the COVID-19 pandemic. The meetings follow delivery to the White House of a petition signed by more than 2 million people urging the US government to support a proposal at the World Trade Organization to temporarily waive the intellectual property (IP) rights of pharmaceutical companies to allow low- and middle-income countries (LMICs) to more easily produce SARS-CoV-2 vaccines. India and South Africa, with support from more than 100 LMICs, repeatedly have proposed the waiver to the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), but their efforts have failed amid pushback from the pharmaceutical industry and several wealthy nations, including the US. Industry lobbyists have increased their efforts to oppose a waiver, with some warning a loosening of patents could expose new technologies to exploitation by China and Russia. However, US trade officials have acknowledged steps need to be taken to increase global vaccine production, as gaps in access could undermine US progress toward ending the COVID-19 pandemic. Tai’s meetings with the pharmaceutical executives reflect the USTR’s engagement in efforts to increase access to vaccines and support her statements at a recent WTO meeting that the divide in access is “completely unacceptable.”

J&J-JANSSEN VACCINE & BLOOD CLOTS The US CDC and US FDA on April 23 recommended resuming use of the J&J-Janssen SARS-CoV-2 vaccine following a temporary pause. The agencies issued a pause on April 13 due to reports of rare but potentially serious blood-clotting events among 6 vaccine recipients, out of nearly 7 million recipients at the time. The FDA has amended the vaccine’s Emergency Use Authorization to mention the potential for clotting issues and will add warnings on fact sheets for providers and vaccinees specifically mentioning blood clots occurring with low platelets. The CDC’s Advisory Committee on Immunization Practices (ACIP) also recommended the continued use of the vaccine after a meeting on Friday, saying their review of data shows that the J&J-Janssen vaccine’s “known and potential benefits outweigh its known and potential risks.” The committee emphasized that nearly all reported cases of the adverse event occurred among women younger than age 50, that those women should be aware of the rare but increased risk, and that there are other SARS-CoV-2 vaccine options. Some experts are warning the pause might have caused more harm than good, with more than 10 million doses of the single-shot vaccine now waiting to be administered. According to a Washington Post-ABC poll, only 22% of respondents who are not yet vaccinated said they are willing to receive the J&J-Janssen vaccine. This unwillingness of the public to use the vaccine could negatively impact US vaccination efforts, especially in rural areas, prisons, and among homebound or transient populations, where the single-dose shot provided convenience.

On April 20, the European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) issued a statement recommending a warning about unusual blood clots with low blood platelets be added to the label of the J&J-Janssen vaccine but maintained these events should be listed as very rare. Like the US agencies, the European regulator emphasized that the vaccine’s benefits in preventing COVID-19 outweigh the risks of adverse events. On April 23, the EMA Committee for Medicinal Products for Human Use (CHMP) addressed concerns over blood-clotting events associated with the AstraZeneca-Oxford SARS-CoV-2 vaccine, saying people who have received a first dose should move forward to receive a second dose between 4 and 12 weeks after their initial shot. As we previously reported, the same rare type of blood clots with low platelet counts have been identified among some people who received that vaccine, which uses a viral vector platform similar to the J&J-Janssen vaccine.

US CDC RECOMMENDS VACCINATION FOR PREGNANT WOMEN Following the publication of preliminaryfindings detailing the effectiveness of SARS-CoV-2 mRNA vaccines in pregnant persons in the April 21 New England Journal of Medicine, US CDC Director Dr. Rochelle Walensky said during a briefing on April 23 that the agency recommends all pregnant persons receive a vaccine. Dr. Walensky noted that no safety concerns arose for pregnant persons vaccinated during their third trimester nor for their infants, although the study did not include the J&J-Janssen vaccine. Experts have taken special interest in the effect of vaccinations in pregnant persons, and a study published on April 22 in JAMA Pediatrics shows they are at ahigher risk for complications due to COVID-19. The research, which described the experiences of 2,130 pregnant persons in 18 countries, concluded that the risks of COVID-19-related morbidity and mortality among pregnant people and their infants are greater than previously thought, underscoring the importance of vaccination for pregnant people. 

BRAZIL REJECTS RUSSIAN VACCINE Brazil’s national health surveillance agency Anvisa has rejected importation of Russia’s Sputnik V vaccine, citing a lack of consistency in the vaccine’s efficacy and safety data. The decision was made following a unanimous vote from Anvisa’s 5 board directors, each of whom expressed doubts about the vaccine candidate’s benefits and concerns over the potential risk of harmful adverse events. Ana Carolina Moreira Marino Araújo, advisor for the Directorate of Authorization and Registration at Anvisa, stated the agency’s inspectors were denied access to key manufacturing facilities in Russia and found faults in areas they were able to inspect. Russian officials pushed back against the decision, alleging it was politically rather than scientifically motivated. The Gamaleya National Research Center of Epidemiology and Microbiology, which developed the Sputnik V vaccine, maintains the vaccine’s efficacy to be 97.6% in preventing symptomatic COVID-19 disease. Several of Brazil’s state governments have contracts to receive millions of Sputnik V doses once it is cleared for importation. Despite pushback, Anvisa has stood behind its decision, even amid circulation of the P.1 SARS-COV-2 variant, saying other SARS-CoV-2 vaccines are approved for use in Brazil.

SECOND DOSES According to new US CDC data reported by multiple news media outlets, nearly 8% of people who received their first dose of the Pfizer-BioNTech or Moderna SARS-CoV-2 vaccines have not received their second dose. That is more than double the rate seen in the early part of vaccination campaigns, from December 2020 to February 2021. The CDC’s new data cover missed doses through April 9, including those who received a first Moderna dose by March 7 or a first Pfizer-BioNTech dose by March 14. Reasons for the lapses in dosing vary, ranging from a lack of supply, fears of side effects, or feelings among vaccine recipients that one dose provides sufficient protection, especially as vaccine administration becomes more widespread. But the increasing number of people missing or foregoing a second dose is fueling concern among state public health officials, some of whom are implementing reminder services and allocating doses to be used specifically for people who are overdue for their second shot. Data from clinical trials and real-world follow-up studies show that a single dose triggers a weaker immune response than two doses, potentially leaving those one-dose recipients more susceptible to infection.

Brazil is facing similar concerns, with 1.5 million people missing appointments for their second dose, according to the Ministry of Health. In a technical note issued April 26, the agency urged people to receive their second dose even if the recommended timing target had passed. Some experts cited concerns over real-world data from Chile, showing the Sinovac SARS-CoV-2 vaccine, which accounts for about 80% of Brazil's vaccination program, is only 16% effective after one shot. The Ministry of Health said it is planning a national media campaign to improve communication surrounding the importance of getting the second dose.

EU LAWSUIT AGAINST ASTRAZENECA The European Commission (EC), the EU’s executive branch, announced a lawsuit against AstraZeneca alleging the company has failed to meet its contractual agreements for vaccine delivery. The lawsuit claims AstraZeneca has failed to deliver hundreds of millions of vaccine doses in a timely manner, according to an advanced purchase agreement. AstraZeneca previously stated it would only be able to provide about 100 million out of 300 million promised vaccine doses by the end of June. EC representatives also allege AstraZeneca has not developed an adequate strategy to combat delivery delays. In response to the lawsuit, AstraZeneca said in a statement that it is on course to fulfill its commitments to the EU for the end of this month and noted that its vaccine made up 97% of the vaccine doses provided through the COVAX facility. The lawsuit follows a dispute resolution mechanism launched by the EC in March that was intended to internally settle existing disputes between the two entities. Regardless of the outcome, the fact remains that the EU has fewer than anticipated doses of SARS-CoV-2 vaccines to distribute among its Member States. To fill in some of these gaps, EC President Ursula von der Leyen announced a new contract with Pfizer-BioNTech last week for 1.8 billion doses of its vaccine over the 2021-2023 period.

LONG-TERM EFFECTS Research continues to better characterize the long-term health effects of SARS-CoV-2 infection, formally referred to as post-acute sequelae of SARS-CoV-2 infection (PASC) and commonly referred to as “long COVID.” Researchers from St. Louis, Missouri (US), published an analysis of morbidity and mortality risk in the 6 months following infection. The study, published in Nature, included data from more than 73,000 COVID-19 patients treated in the US Department of Veterans Affairs health system and compared them with nearly 5 million non-COVID-19 patients within the system. The researchers found that mortality risk among COVID-19 patients beyond the first 30 days of illness was nearly 60% higher, corresponding to 8.39 excess deaths per 1,000 individuals at the 6-month point. The excess deaths among hospitalized COVID-19 patients was even higher (28.79).

The researchers also observed a statistically significant increase in outpatient care and use of certain treatment drugs, including opioid and non-opioid pain medications, among COVID-19 patients. The use of beta blockers and opioid analgesics was nearly 10 times higher among COVID-19 patients when compared with non-COVID-19 patients. The study presents detailed results for more than 75 conditions and medications associated with COVID-19. Notably, many of the statistically significant results remained when compared against seasonal influenza patients. This appears to be the largest study of its kind to evaluate the long-term health effects of SARS-CoV-2 infection.

HOMELESSNESS & VACCINATION As the US moves toward increased SARS-CoV-2 vaccine coverage among a majority of adults, current vaccination efforts aim to address at-risk and vulnerable populations, such aspersons experiencing homelessness. Public health officials are facing vaccine refusal and hesitancy among the entire US population, but they face additional policy and logistical challenges—such as the added complexity of a multi-dose regimen—when creating outreach plans for persons experiencing homelessness. Reaching adequate coverage among this population will require joint task forces, community-level outreach, information and education campaigns geared at addressing vaccine willingness, and establishing mobile vaccination teams to meet residents where they are. For example, theCity of San Francisco implemented mobile teams to serve homebound adults and people living in congregate facilities. Community members and non-profit organizations are collaborating to provide food and other incentives at vaccination events to increase accessibility and awareness of the SARS-CoV-2 vaccine.