Thursday, January 26, 2023

January 26, 2023: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.

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Announcements

CENTER WELCOMES NEW SENIOR SCHOLAR We are thrilled to welcome Alexandra Phelan to the John Hopkins Center for Health Security as a Senior Scholar and to the Johns Hopkins Bloomberg School of Public Health as an Associate Professor in the Department of Environmental Health and Engineering. At the Center, Dr. Phelan will contribute to several ongoing projects, as well as spearhead a portfolio of multidisciplinary work spanning global health law, infectious disease, and climate change. She/they are an alum of the Center’s ELBI fellowship. Read our news story: https://bit.ly/3iXunJU

In this issue

> Emergency Committee on COVID-19 to discuss PHEIC designation; WHO launches US$2.5B emergency appeal

> US FDA panel considering shift to regular vaccine boosters but many questions, uncertainties remain

> Two new studies provide evidence bivalent boosters increase protection against Omicron subvariants compared to original vaccines, boosters

> Number of US cardiovascular deaths rose during pandemic’s first year prior to vaccine availability, especially among some populations

> Papers, meetings evaluate pandemic-related public health measures

> What we're reading

> Epi update

Emergency Committee on COVID-19 to discuss PHEIC designation; WHO launches US$2.5B emergency appeal

The Emergency Committee on COVID-19 is set to meet for a 14th time on January 27 to consider whether SARS-CoV-2 continues to merit designation as a Public Health Emergency of International Concern (PHEIC), 3 years after the panel first agreed the outbreak met the criteria. Under the International Health Regulations (IHR), a PHEIC can be declared if a health event meets 3 criteria:

  • it is serious, sudden, unusual, or unexpected
  • carries implications for public health beyond the affected State’s national border, and
  • may require immediate international action.

While COVID-19 has spread globally and is no longer sudden or unexpected, WHO Director-General Dr. Tedros Adhanom Ghebreyesus—who makes the final decision about whether to end the global health emergency, no matter the committee’s recommendation—this week said he is “very concerned” about a rising number of global COVID-related deaths. The US alone is averaging more than 500 deaths per day. The meeting comes as China is experiencing the largest COVID-19 outbreak in the world, raising fears that a new variant of concern could emerge, factors that could influence the committee’s recommendations and Dr. Tedros’s decision.

Notably, there are no guidelines to determine when or how a PHEIC declaration should end. To be clear, ending the PHEIC would not mean that COVID-19 no longer poses a global threat nor would it signal the end of the pandemic, as the IHR do not include mechanisms for formally declaring pandemics or their ends. Many experts say the binary nature of the PHEIC mechanism needs to be reviewed and reformed to better achieve its intended goal of helping to coordinate response and policy.

In related news, the WHO this week launched a 2023 health emergency appeal for US$2.54 billion to address an unprecedented number of intersecting health emergencies worldwide, including COVID-19.

US FDA panel considering shift to regular vaccine boosters; many questions, uncertainties remain

As the SARS-CoV-2 virus continues to mutate, researchers and policymakers are evaluating longer-term vaccination strategies to maintain individual- and community-level protection from COVID-19. In the US, the FDA’s Vaccines and Related Biological Product Advisory Committee (VRBPAC) is meeting today (webcast live) to discuss an array of potential options, including vaccines from multiple manufacturers. Following the availability of bivalent booster doses last year, regulatory officials are considering shifts toward regular boosters, administered either annually or biannually, that could include two or more strains of the virus.

These decisions, however, must also account for individuals who have not yet received their initial course of vaccination, including many infants and young children. Another major concern is the safety and effectiveness of multi-valent boosters, especially the relative benefits and risks for different age groups and other subpopulations. The timing of doses is also a major point of debate. Regulators and health officials will need to walk a fine line between maintaining a high degree of protection, providing significant added benefit from each dose, and establishing a schedule that the public can understand and is willing to follow. And the same schedule may not be appropriate for people with varying degrees of risk. Early studies have yielded mixed results across these areas of concern, and some experts question the value of annual boosters or acknowledge the considerable uncertainty that remains, and research is still ongoing to provide the necessary data.

This week, the UK government announced that it will offer another round of SARS-CoV-2 vaccine booster doses this autumn for those at higher risk of severe COVID-19, based on recommendations from its Joint Committee on Vaccination and Immunisation (JCVI). JCVI also indicated that an additional booster dose for those individuals at greatest risk, such as older adults or those with compromised immune systems, may be recommended for this spring, and plans for the spring 2023 vaccination program will be announced soon.

Two new studies provide evidence bivalent boosters increase protection against Omicron subvariants compared to original vaccines, boosters

Part of the efforts to evaluate longer-term SARS-CoV-2 vaccination strategies necessitates understanding the safety and effectiveness profiles of the recent bivalent booster doses. Two studies published this week offer additional insight into the protective value of these boosters. Both studies provide evidence that bivalent boosters provided increased protection against Omicron subvariants compared to monovalent vaccines and boosters, at least in the short term.

A study conducted by researchers in North Carolina—published as a correspondence in NEJM—evaluated bivalent mRNA vaccine boosters’ effectiveness against severe COVID-19 disease caused by several Omicron subvariants (BA.4.6, BA.5, BQ.1, and BQ.1.1). Based on data from more than 1 million individuals who received bivalent boosters, followed over a 99-day period after vaccination, they estimated the boosters’ effectiveness against hospitalization or death to be 54.0% as the first booster dose*, 64.0% as the second booster dose, and 63.1% as the third booster dose. Across all measured outcomes, the bivalent boosters consistently outperformed monovalent boosters by more than 30 percentage points (pp)**, including in older adults—+37.8pp against hospitalization and +41.2pp against hospitalization or death.

*Marginally not statistically significant (CI: -.03-78.9%).

**Mix of statistically significant and non-significant results.

A study led by the US CDC’s National Center for Immunization and Respiratory Diseases—published in the CDC’s MMWR—evaluated the effectiveness of bivalent mRNA vaccine boosters in preventing symptomatic COVID-19 disease caused by the Omicron BA.5 and XBB/XBB.1.5 sublineages, compared to full vaccination and/or boosting using only the original monovalent vaccines. The study involved data from nearly 30,000 PCR-based SARS-CoV-2 tests conducted among persons with COVID-like illness symptoms at US pharmacies from December 1, 2022, to January 13, 2023. The researchers estimated the bivalent boosters’ additional effectiveness against the BA.5 subvariant to be 52% higher among adults aged 18-49 years, 43% higher in adults aged 50-64 years, and 37% higher among adults 65 years and older. Against the XBB sublineages the bivalent boosters outperformed the monovalent vaccines by 49% among adults aged 18-49 years, 40% in adults 50-64 years, and 43% in adults aged 65 years and older, again with some evidence of waning protection by 2-3 months. Notably, these are some of the earliest data available on protection against XBB subvariants, and the study provides a near-real-time assessment of recent vaccinations.

Number of US cardiovascular deaths rose during pandemic’s first year prior to vaccine availability, especially among some populations

Deaths due to cardiovascular disease (CVD) rose substantially during 2020—the first year of the COVID-19 pandemic and prior to the availability of vaccines—representing the largest single-year increase since 2015 and surpassing the previous single-year total set in 2003, according to new data from the American Heart Association. Notably, the age-adjusted mortality rate increased for the first time in many years, by 4.6%, and the largest overall number of CVD-related deaths were seen among Asian, Black, and Hispanic populations, some of which have been disproportionately impacted by COVID-19.

The COVID-19 pandemic has had both direct and indirect impacts on cardiovascular health. Importantly, infection with SARS-CoV-2 is associated with new-onset clotting and inflammation in some people. According to a study recently published in Cardiovascular Research, COVID-19 disease—including post-COVID conditions commonly known as long COVID—is associated with increased short- and long-term risks of CVD and death from any cause. Additionally, during the beginning months of the pandemic especially, people with new or existing risk factors for CVD outcomes, such as heart disease, hypertension, or stroke symptoms, were reluctant or unable to access medical care. A recent study published in Nature Medicine estimates that the interruption of preventive care could result in more than 13,000 extra cardiovascular events in the UK. Some people are leveraging the association between CVD and COVID-19 to create and spread misinformation surrounding sudden deaths and injuries and vaccine safety, despite a lack of scientific evidence supporting their claims.

Papers, meetings evaluate pandemic-related public health measures

Gaining insight into the effectiveness and impacts of how various nations and institutions responded to the COVID-19 pandemic will provide lessons for future pandemic preparedness and public health measures. Several recent papers and meetings attempt to evaluate these measures, coordinate their use, and identify challenges for future events.

  • A paper from the OECD published January 21 draws lessons and provides a synthesis of evidence from 67 national government-level evaluations produced in OECD countries during the first 15 months of the pandemic. Overall, the report finds that pandemic preparedness was insufficient, governments should carefully consider longer-term budgetary costs of actions to mitigate economic and financial pandemic effects, and trust requires transparency and stakeholder engagement, including from the public. The report also notes there is insufficient evidence on critical sectors’ pandemic preparedness and further assessment of lockdowns and restriction measures is needed, including the impact of lockdowns on domestic violence, alcohol consumption, mental health, and youth.
  • A January 20 commentary published in PLOS Global Public Health by an international group of authors proposes a framework to unite scholarship into the institutional, political, organizational, and governance (IPOG) aspects of the COVID-19 response. Politics and governance are influenced by factors such as institutional norms and the structure and functioning of key public health organizations, they note, contending that “COVID-19 has exposed the need to expand, deepen, and sharpen the focus of investigation to explore the intersection of all of these key contextual factors and how they combine to influence outcomes.”
  • An article published January 25 in Scientific Reports aims to explain why models used to project rates of COVID-19 incidence and confirmed cases in the latter part of 2020 were not especially accurate. According to the researchers, "Frequent changes in restrictions implemented by governments, which the modeling team was not always able to predict, in part explains why the majority of model projections were inaccurate compared with actual outcomes and supports revision of projections when policies are changed as well as the importance of modeling teams collaborating with policy experts.”
  • Another article published January 25 in Scientific Reports analyzes COVID-19 community transmission risk associated with US colleges and universities. Contrary to rising public sentiment that younger and less-vulnerable populations act as primary introducers of COVID-19 to communities, the findings show that counties with high university enrollments might adhere more closely to public health and safety measures and vaccinations, potentially contributing to safer communities.

What we’re reading

CORONAVIRUS RESEARCH OVERSIGHT A 64-page report from the US Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) says the US NIH did not sufficiently and effectively monitor grant awards to EcoHealth Alliance, limiting the federal agency’s ability to fully understand the nature of the research being conducted—including research on coronaviruses that might fall under enhanced potential pandemic pathogens (ePPPs)—identify potential problem areas, and take corrective action. The report comes as the National Science Advisory Board for Biosecurity (NSABB) is set to discuss new draft recommendations for biosecurity oversight.

RAPID ANTIGEN TESTS At-home COVID-19 tests, also called rapid antigen tests, remain a useful tool in helping to interrupt transmission of SARS-CoV-2, although they are not foolproof. Both NPR and the New York Times recently published articles discussing the tests’ advantages and disadvantages and how to increase testing accuracy (hint: serial testing). To order tests for home delivery in the US, find at-home tests at retailers and pharmacies, and learn about insurance reimbursement, visit covidtests.gov.

MEDICAID CONTINUOUS ENROLLMENT Between 5 and 14 million US citizens and certain legal immigrants are expected to lose their Medicaid coverage when a pandemic-era provision known as “continuous enrollment” ends on March 31. Of those, the US HHS expects 6.8 million people will lose coverage even though they are still eligible, based on historical trends of paperwork and other administrative hurdles. A new analysis from KFF estimates that about two-thirds of those who are disenrolled likely will experience a period of uninsurance. Disruption in Medicaid or other insurance coverage can lead to delayed or missed care, less access to preventive care, and higher healthcare costs, particularly for chronic health conditions.

YOUTH MENTAL HEALTH & NUTRITION Parents are growing increasingly concerned about young people’s mental health, according to a new report from the Pew Research Center, as children and teenagers continue to struggle with depression and anxiety after returning to in-person schooling following widespread school closures and remote learning during the early months of the COVID-19 pandemic. The isolation of remote learning and other pandemic-related stressors may have strained youth mental health, and some children may have experienced adverse childhood experiences (ACEs), such as abuse, neglect, or violence. One such stressor, food insecurity, is increasing among families due to rising food prices and the winding down of pandemic-era assistance programs providing free school meals.

Epi update

As of January 25, the WHO COVID-19 Dashboard reports:

  • 665 million cumulative COVID-19 cases
  • 6.7 million deaths
  • 1.9 million cases reported week of January 16
  • 33% decline in global weekly incidence
  • 12,937 deaths reported week of January 16
  • 16% increase in global weekly mortality

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the Eastern Mediterranean, which recorded a 54% increase in reported cases.

UNITED STATES

The US CDC is reporting:

  • 101.9 million cumulative cases
  • 1.1 million deaths
  • 332,212 cases week of January 18 (down from previous week)
  • 3,953 deaths week of January 18 (down from previous week)
  • 13.7% weekly decrease in new hospital admissions
  • 15.3% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (49%), BQ.1.1 (27%), and BQ.1 (13%) account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

USEFUL EPI GRAPHICS

The following websites provide up-to-date epidemiological information, down to the US county level:

Johns Hopkins University Daily COVID-19 Data in Motion (daily video showing global and US trends)

New York Times Coronavirus in the US: Latest Map and Case Count (US data portrayed in tables, maps, and graphs)

US CDC COVID-19 Integrated County View (click on pulldown menu to view either COVID-19 Community Levels or Community Transmission, as well as other indicators specific to the US)

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