December 20, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Erin Fink, MS; Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; and Rachel A. Vahey, MHS

CALLS FOR PAPERS In 2023, the Johns Hopkins Center for Health Security journal, Health Security, will issue a special feature that considers threat agnostic approaches to biodefense and public health (deadline March 31, 2023), as well as a supplement focused on extending conversations begun at the 2022 Preparedness Summit to contribute to a growing body of knowledge about the COVID-19 pandemic and its impact on public health preparedness (deadline January 17, 2023). For more information, visit: https://www.centerforhealthsecurity.org/our-work/journal/

The COVID-19 Situation Report will not be published on December 29. The next report will be published on January 5, 2023. Thank you for your readership and support!

EPI UPDATE The WHO COVID-19 Dashboard reports 650 million cumulative cases and 6.65 million deaths worldwide as of December 20. Global weekly incidence remained relatively stable last week, increasing 4.8% compared to an increase of 12% the previous week. A total of 3.8 million cases were confirmed the week of December 12. Weekly incidence fell over the previous week in South-East Asia (-36%), Africa (-29%), Eastern Mediterranean (-26%), Europe (-9%). Weekly incidence increased in the Americas (+18%) and Western Pacific (+8%) regions. Global weekly mortality remained relatively stable compared with the previous week, down 5%.

UNITED STATES

The US CDC is reporting 99.7 million cumulative cases of COVID-19 and 1.08 million deaths. Incidence for the week ending December 14 remained relatively stable over the previous week, falling to 455,466 cases from 469,240 cases for the week ending December 7. Weekly mortality fell for the week ending December 14, with 2,703 reported deaths, compared to 3,115 deaths the week ending December 7.

Both new hospital admissions and current hospitalizations began falling last week, both down 10% over the previous week.*

*Due to a change in COVID-19 hospital data reporting guidance, the CDC urges caution in interpreting data immediately reported after December 15, 2022, when the transition to the CDC’s National Healthcare Safety Network (NHSN) began. Additional information on the transition can be found here.

The Omicron sublineages BQ.1.1 (38%) and BQ.1 (31%) together represent the most dominant subvariants of sequenced specimens in the US. BA.5 (10%) accounts for a dwindling proportion of cases, and a growing proportion of cases are due to XBB (7.2%). A host of other Omicron sublineages—including BF.7, BN.1, BA.5.2.6, BA.4.6, BF.11, BA.2, BA.2.75, BA.2.75.2, and others—make up the remainder of cases.

US WINTER PREPAREDNESS PLAN The Biden administration last week announced a COVID-19 Winter Preparedness Plan in an attempt to stay ahead of what many experts believe will be a continued increase in COVID-19 cases this season. The plan involves reopening COVIDTests.gov, through which US residents can order up to 4 tests per household this winter; making more free tests available at community and rural health clinics, schools, food banks, and other convenient locations; offering resources and assistance to increase vaccine uptake, including pop-up and mobile vaccination sites; pre-positioning supplies from the Strategic National Stockpile to help prepare health facilities; monitoring emerging variants and their susceptibility to existing treatments and vaccines; and expanding efforts to increase vaccination rates in long-term care facilities and nursing homes.

White House COVID-19 Response Coordinator Dr. Ashish Jha stressed that the nation is facing other respiratory viruses, including RSV and one of the worst and earliest influenza seasons, which, along with COVID-19, are stressing hospital capacity. Dr. Jha encouraged people to receive an updated bivalent vaccine booster if they are eligible and have not done so already. US CDC data show that while about 69% of the US population has completed the primary 2-dose vaccine series, only about 14% of people aged 5 and older have received the updated booster.

According to recent polling from the Kaiser Family Foundation, many people are unsure about the benefit of the updated COVID-19 vaccine. But 2 new studies published last week in the CDC’s Morbidity and Mortality Weekly Report (MMWR) show the updated shots provide substantial protection against illness and hospitalization, particularly among seniors and including among people who had received 2-4 doses of the original monovalent vaccine. The studies used data from a period during predominance of the Omicron BA.5 subvariant, which the bivalent booster partially targets. Since then, the more immune-evasive Omicron sublineages of BQ.1 and BQ.1.1 have gained traction, and it is unclear how applicable the studies’ findings are to these new subvariants. Additionally, a recent analysis from the Commonwealth Fund shows earlier vaccines’ value. The report estimates that from December 2020 to November 2022, the US COVID-19 vaccination program prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths, as well as saved more than US$1 trillion in medical costs that would otherwise have been incurred. The analysis estimates there would have been nearly 120 million more COVID-19 infections without vaccination. The US FDA announced it will hold a meeting of its vaccines advisory board next month to discuss the future of COVID-19 vaccines, including whether people who have never received a shot should get the bivalent formulation as their first dose.

With other viruses that cause influenza-like illnesses or stomach flu circulating this season, experts agree taking individual actions can help reduce the risk of serious illness. Some of these actions include:

• Getting vaccinated against COVID-19 or getting the most recent COVID-19 booster*, as well as receiving a flu vaccine
• Wearing a high-quality mask while in crowded, indoor places
• Improving ventilation when possible, including opening doors and windows, running fans on HVAC systems, or installing high-quality air filters
• Practicing proper hand hygiene, including thorough hand washing or use of hand sanitizer when appropriate, especially when preparing or sharing food
• Staying home if showing any symptoms such as runny nose, cough, fevers, chills, nausea, body aches, or sore throat
• Testing for COVID-19 before and after traveling and before gathering indoors, particularly if older adults will be present
• Drinking plenty of water, especially while traveling or if consuming alcoholic beverages.

*The US FDA recently authorized and the CDC recommended bivalent boosters for children down to 6 months of age. Eligibility among this age group can be confusing, as it depends on what vaccine series—and how much of that series—has been received so far:

• Moderna: Children 6 months through 5 years who received the original, 2-dose Moderna vaccine are eligible to receive a single booster of the updated bivalent Moderna vaccine 2 months after completing the primary series.
• Pfizer:
• Children 6 months through 4 years who completed the 3-dose primary series are not eligible at this time.
• Children 6 months through 4 years who have not started the 3-dose primary series or who have not completed the series will receive the updated Pfizer vaccine as their third dose.

LONG COVID-RELATED MORTALITY Post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, contributed to 3,544 deaths in the US from January 2020 through the end of June 2022, according to a recent report from the US CDC’s National Center for Health Statistics (NCHS). The deaths were identified using data entered on death certificates in the National Vital Statistics System, a methodology that could lead to an undercount, the report’s authors and other experts cautioned. The majority of long COVID-related deaths occurred among non-Hispanic white and older individuals.

An estimated 1 in 4 people with COVID-19 experience long COVID, which includes a complex constellation of symptoms—such as breathing problems, heart issues, fatigue, and cognitive and neurological issues—that can last for several months or longer or appear months after acute infection and can affect virtually every organ system. There is no agreed upon definition for the condition, and no diagnostic code for the condition existed until October 2021. Though knowledge about long COVID has improved over the past several years, and the US government earlier this year launched the National Research Action Plan on Long COVID, people impacted by the condition and their clinicians are urging more federal efforts and funding to support research, care, and education on the condition. Some experts warn long COVID could critically impact the nation’s economy and productive capacity in the short and long terms.

LONG-TERM CARE FACILITIES/NURSING HOMES As older adults, usually with underlying health conditions, nursing home and long-term care facility (LTCF) residents are at high risk of infection and death due to COVID-19, and the congregate nature of these facilities increases the risk of SARS-CoV-2 transmission. To examine the disproportionate impact the COVID-19 pandemic has had on LTCF/nursing home residents, the US Government Accountability Office (GAO) conducted an analysis of US CDC and Centers for Medicare & Medicaid Services (CMS) data. According to the report, released December 15, the average COVID-19 nursing home outbreak from June 2020 through December 2021 lasted 4 weeks and transmission of COVID-19 in the community surrounding a nursing home, known as community spread, had the strongest association with the duration of an outbreak. Additionally, the longest outbreaks were associated with nursing home facilities that had more than 100 beds, reported staff shortages, and were government-owned. Staff shortages and low staff morale were identified as critical challenges during interviews with officials from 6 nursing homes in 4 states, according to the report.

As of November 20, only 45% of nursing home residents and 22% of staff were up to date with their COVID-19 vaccines, according to recent analysis from the Kaiser Family Foundation. In light of this, the LCTF/nursing home industry is calling for changes to vaccination practices for residents. In a recent letter to US Health and Human Services Secretary Xavier Becerra, industry groups outlined an “all-hands-on-deck” approach to vaccinating residents, including efforts to better educate residents and their families about COVID-19, influenza, and other vaccines; reaching out to hospitals to vaccinate patients before discharging them to their facilities; mobilizing the National Guard to administer vaccines at facilities when LTCF pharmacies cannot; and reaching out to state and local public health agencies to conduct on-site vaccine clinics when needed. Hesitancy remains the primary obstacle to getting more residents and staff up to date on their vaccinations, which means completing a COVID-19 vaccine primary series and receiving the most recent booster dose recommended.

GLOBAL EXCESS MORTALITY An estimated 14.83 million excess deaths occurred during the first 2 years of the COVID-19 pandemic globally, 2.74 times more deaths than the 5.42 million reported as a result of COVID-19 for 2020 and 2021, according to a new WHO study published last week in Nature. India, Russia, Indonesia, the US, Brazil, and Mexico suffered the most estimated deaths due to COVID-19 during the 2-year period. Overall, 4 of 5 excess deaths in 2020 and 2021 occurred in either Southeast Asia—led by India—Europe, and the Americas. By comparison, heart disease was the leading worldwide cause of death in 2019, resulting in nearly 9 million deaths. The researchers said they expect COVID-19 was among the leading causes of death in 2020 and the leading cause of death in 2021. Knowing exactly how many people have died in the pandemic—including deaths from COVID-19 as well as those indirectly related to the pandemic, such as deaths related to interruptions and disruptions to healthcare—will never be possible.

GLOBAL HEALTH EMERGENCY WHO Director-General Dr. Tedros Adhanom Ghebreyesus last week said he is hopeful the COVID-19 global health emergency can end next year. The International Health Regulations (IHR) Emergency Committee for COVID-19 is expected to begin discussions in January outlining criteria for declaring an end to the COVID-19 Public Health Emergency of International Concern (PHEIC) declaration, first announced on January 30, 2020. Even if the emergency ends, COVID-19 is not going away. During an end-of-the-year press conference, Dr. Tedros noted several challenges, including the growing health burden of post-COVID conditions including long COVID, ongoing vaccine inequity and low vaccine uptake in some areas, remaining gaps and weaknesses in variant surveillance, and rising case numbers in several countries, including China. After highlighting several upbeat developments—such as a declining rate of COVID-19 deaths and falling numbers of mpox and Ebola cases—he called for more investment in pandemic preparedness so the world can be ready for the next emerging health threat. Notably, other experts said COVID-19 remains an emergency, warning the pandemic could worsen over the coming months.

CHINA In a rapid and stark reversal from its “zero COVID” policy, China has largely dropped much of its carefully crafted systems of lockdowns and mass testing. The unpopular policy most recently led to widespread protests, rarely seen in China, before being relaxed. Given the high transmissibility of the Omicron subvariants in circulation, predictions of a massive surge in cases across the country are coming true. COVID-19 is spreading rapidly through the population of 1.4 billion, many of whom are inadequately vaccinated and have little to no natural immunity.

On December 19, the Chinese government reported 2 COVID-related deaths, the first in weeks, but many within the country, as well as outside experts, say the low counts are implausible and ignore the high level of loss and grief the latest wave is causing. One of Beijing’s designated crematoria for COVID-19 patients has received a jump in requests for services, and authorities are rushing to increase the number of intensive care beds and healthcare workers, as well as increase dwindling medication supplies, signs of the human toll of abruptly loosening restrictions. Some provincial governments have suggested that people with mild COVID-19 illness continue to go to work, particularly healthcare and food delivery workers. The surge is also coming ahead of Lunar New Year in January, when millions are expected to travel to be with relatives for the holiday. Multiple models predict a winter wave of COVID-19 infections could kill up to 1 million people over the next several months.

China’s strategy has always been deeply political: President Xi Jinping staked the reputation of the Chinese Communist Party on the ability to control COVID-19 better than Western countries. But with the current COVID-19 situation appearing to spiral rapidly, President Xi is now in the position of deciding whether to accept foreign aid and from whom. European and US officials are in contact with Chinese counterparts, but public statements are being carefully worded to make clear the onus is on China to accept any offers of assistance in obtaining vaccines, treatments, or other countermeasures. China’s state media appear to be positioning the current surge as a pre-planned strategy, an “exit wave,” and promised a return to “normalcy by Spring.” Nevertheless, there remain global concerns that China’s situation will have long-term economic and social impacts and increase the risk of a new variant emerging.