February 12, 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

CALL FOR PAPERS Early detection of biological threats, whether naturally occurring or manmade, is critical. Threat agnostic approaches, which do not rely on determining the identity of the agent or pathogen, show early promise. 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. We encourage submissions of original research articles, case studies, and commentaries that explore policy gaps, data and data analysis, and implementation, among potential topics. The deadline is March 31, 2023. For more information, visit: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/call-for-papers.html

In this issue

> US House committees begin investigations into SARS-CoV-2 origins, reviews of federal pandemic response; WHO pandemic origin inquiry to continue under SAGO panel

> Multiple studies examine aspects of long COVID, including neurological symptoms, organ damage, racial/ethnic disparities; WHO releases clinical case definition for children, adolescents

> Emergency US SNAP benefits ending March 1; older adults, rural populations, communities of color most likely impacted by increased food insecurity, hunger

> Popular figures influenced public opinion, discourse on COVID-19 through social media networks; US FDA working to dispel medical myths

> What we're reading

> Epi update

US House committees begin investigations into SARS-CoV-2 origins, reviews of federal pandemic response; WHO pandemic origin inquiry to continue under SAGO panel

As the Biden administration prepares to wind down the federal Public Health Emergency (PHE) for COVID-19 on May 11—releasing a transition roadmap on February 9—the Republican-controlled US House of Representatives is ramping up its efforts to investigate the origins of SARS-CoV-2 and examine how the federal government responded to the pandemic. At least 2 House committees are investigating the pandemic’s origins, setting the stage for overlap and possible tension over priorities. The House Energy and Commerce Oversight and Investigations Subcommittee held hearings early this month delving into biological event origin investigations and the federal pandemic response. The House Select Subcommittee on the Coronavirus Pandemic of the Committee on Oversight and Accountability recently received 900 pages of records from the US Department of Health and Human Services (HHS) it requested to begin its review of similar topics. It remains unclear how the committees will differentiate their investigations. Some outside of government are calling for the establishment of a COVID commission to conduct a broad inquiry into the federal response.

Little is known of how SARS-CoV-2 originated—though most experts agree the pandemic began in China—and definitive answers about whether the virus began spreading among humans in a market or as the result of a laboratory accident may never be known, as much of the world moves beyond the pandemic. WHO officials have expressed frustration with efforts to investigate the pandemic’s origins, with politics hampering collaboration and damaging trust among Chinese counterparts. Additionally, the amount of time elapsed since the first recorded cases in China has made investigations into the pandemic’s origin increasingly difficult. The WHO last week said there will not be a “phase 2” of its original coronavirus investigation but another WHO panel—the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO)—will continue looking for answers.

Multiple studies examine aspects of long COVID, including neurological symptoms, organ damage, racial/ethnic disparities; WHO releases clinical case definition for children, adolescents

Researchers continue their work to learn more about post-COVID-19 condition (PCC), also known as post-acute sequelae of COVID-19 (PASC) and most commonly as long COVID.

• A study published February 14 in the Journal of the Royal Society of Medicine examined the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms. Symptoms such as extreme breathlessness, cognitive dysfunction, and poor health-related quality of life were common at 6 and 12 months and associated with female gender, younger age, and single-organ impairment. Overall, 59% of 331 patients followed for 1 year experienced single organ impairment and 29% had multi-organ impairment with implications for persistent symptoms and reduced function. Researchers observed mild damage in patients’ hearts, lungs, kidneys, livers, spleens, and pancreas.
• Some of the most common symptoms among people living with long COVID are neurological, and a few experts are beginning to focus on these persistent brain and nervous system issues of their patients. A study published February 23 in The Lancet Regional Health Europe found that among 165 people with PCC in Sweden, cognitive, sensorimotor, and fatigue symptoms were the most common symptoms persisting at 24 months. Some studies suggest SARS-CoV-2 might trigger an immune response leading to ongoing inflammation in the brain, and understanding these inflammatory processes might point to potential treatment options. Still, more research is necessary to understand the mechanisms behind the possible neurological impacts of COVID-19 and differentiating those symptoms from functional neurological disorder (FND), according to a recent study published in the European Journal of Neurology.
• A preprint posted January 26 to medRxiv found SARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after acute infection, with the highest incidence rate ratio (IRR) observed for the rather uncommon autoimmune diseases of the vasculitis group, such as small vessel inflammatory processes. The large matched cohort study, which is not yet peer-reviewed, included 641,704 patients with COVID-19.
• New evidence from US NIH-supported studies shows that long COVID symptoms and diagnostic experiences vary among different racial and ethnic groups. Two studies show that Black and Hispanic Americans seem to experience more symptoms and health problems related to long COVID than White Americans; however, they are less likely to receive a long COVID diagnosis. This is even more concerning given findings from other studies showing that patients with long COVID report higher rates of unemployment, underemployment, new-onset symptoms, disabilities, and financial problems 6 months after hospitalization.
• Efforts are being made to better define long COVID but there is no consensus on its prevalence, what symptoms it comprises, or standard diagnosis protocol. Some experts question the need for a standard diagnosis, arguing that treating symptoms of the condition is sufficient, though others disagree. The WHO previously released a clinical case definition for PCC and last week published a clinical case definition for PCC in children and adolescents. Both definitions were developed using robust protocol-based methodologies and engaged diverse groups of representative patients, caregivers, and other stakeholders.

Emergency US SNAP benefits ending March 1; older adults, rural populations, communities of color most likely impacted by increased food insecurity, hunger

During the pandemic, numerous families have received additional assistance through the US Supplemental Nutrition Assistance Program (SNAP); however, these emergency allotments will end on March 1 in 32 states as well as Washington, DC; Guam; and the US Virgin Islands. With more than 41 million US residents relying on SNAP benefits, this upcoming change—dubbed by some experts as a “hunger cliff”—is expected to strain family finances, with the average recipient losing an estimated $82–$90 per month in benefits, shifting aid burdens to food banks and other similar local programs that most likely will not be able to make up the difference in assistance. Coupled with food price inflation since 2020, the end of emergency allotments is expected to hit older individuals, rural populations, and communities of color the hardest with increased food insecurity and poverty-related hunger. If you are or know someone in need of food security assistance who may be impacted by this upcoming change, contact your local SNAP office and/or call the US Department of Agriculture’s (USDA) Hunger Hotline: 1-866-3-HUNGRY (1-866-348-6479) or 1-877-8-HAMBRE (for Spanish), Monday through Friday, 7 am to 10 pm ET.

Popular figures influenced public opinion, discourse on COVID-19 through social media networks; US FDA working to dispel medical myths

Through the use of online social networks, people in the public eye (PIPE)—including news anchors, politicians, athletes, entertainers, and others—helped shape public opinion and discourse on the COVID-19 pandemic and related public health efforts, according to an analysis of 45,255 tweets posted between January 2020 and March 2022 published in BMJ Health & Care Informatics. Overall, the related sentiments shared by subgroups of public figures were found to be more negative than positive, and posts shared by politicians and news anchors appeared to be the most influential. The researchers note the analysis underscores the importance of cooperation among health professionals, public health organizations, and community groups to proactively and efficiently share clear, correct, and population-relevant health messaging to inform and educate the public about mis- and disinformation in response to future disease outbreaks.

According to US FDA Commissioner Dr. Robert Califf, some people are dying of COVID-19 because they are “misinformed” and influenced by “distortions and half-truths.” To counter misinformation, the FDA is stepping up its presence on social media outlets to debunk medical myths. But some experts are concerned the agency’s reputation as a trusted messenger might have been damaged by contentious drug approvals and other controversies. Experts also warn that the agency’s messaging is reaching a small audience and that its language, particularly surrounding decisions on COVID-19 vaccine boosters, needs to be simplified.

The Johns Hopkins Center for Health Security is engaged with several projects working to combat health-related misinformation and disinformation through conducting research, identifying best practices, educating public health professionals and policymakers, and furthering policy solutions to the problem. Read more here.

What we’re reading

MASK USE EFFECTIVENESS The January 30 publication of a Cochrane review that found masking, either with surgical masks or N95 respirators, made little to no difference in the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks has reignited the debate over mask use. As we mentioned in our February 9 coverage of the meta-analysis, the review emphasized that the finding could be due in part to multiple factors such as poor study design, low adherence to mask rules, quality of masks used, and incorrect mask usage. Several sources have since reviewed the publication, including The Atlantic, Vox, and Your Local Epidemiologist, outlining the Cochrane review’s potential shortcomings and highlighting evidence showing that masking works to reduce the risk of respiratory disease transmission. Additionally, the WHO reiterated its firm recommendation that wearing masks is an effective method to prevent the spread of COVID-19, along with vaccination and physical distancing when possible.

LIFE EXPECTANCY & ECONOMIC IMPACTS An article published in Scientific Reports assessed the impact of 1 million COVID-19 deaths in the US between February 2020 and May 2022, focusing on economic and life expectancy losses. The researchers estimated that COVID-19 deaths contributed to a drop in US life expectancy at birth by 3.08 years, effectively reversing all gains made in the last 40 years. Economic welfare losses estimated in terms of national income growth supplemented by the value of lives lost were around US$3.57 trillion. Hispanic and Black populations were disproportionately impacted. The results of the analysis underscore the need for additional investments in pandemic preparedness to prevent economic shocks from future disease outbreaks.

DEATHS IN US PRISONS The New York Times examined data on deaths in US state and federal prisons during the beginning of the COVID-19 pandemic, reporting that prisoner deaths rose nearly 50% during 2020, more than twice the increase in the US overall and exceeding the estimate of the percentage increase in nursing homes. In several states—particularly those with histories of elevated prison deaths including Alabama, Arkansas, South Carolina, and West Virginia—deaths more than doubled, and many states had high death rates continue into 2021. Though COVID-19 drove the higher death rates, inmates also died of other illnesses, suicide, and violence, according to the data collected by researchers at UCLA Law. The higher death rates were due to a variety of factors, including older inmate populations, many with other known or undiagnosed health problems; crowded and often harsh conditions; inadequate or delayed access to testing and care, for COVID-19 and other conditions; and prison worker understaffing.

CORONAVIRUS VACCINE ROADMAP The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota this week released the Coronavirus Vaccines Research and Development (R&D) Roadmap (CVR), a strategy to develop broadly protective vaccines that are suitable for use in all world regions. With US$1 million in funding from the Rockefeller Foundation and the Bill & Melinda Gates Foundation, CIDRAP convened 50 international scientists who mapped out a strategy to develop new vaccines. The roadmap—a summary of which was published in the journal Vaccine—covers a 6-year timeframe, is organized into 5 topic areas—virology, immunology, vaccinology, animal and human infection models, and policy and finance—and includes 20 goals and 86 R&D milestones, 22 of which are ranked as high priority. In a separate effort reported on by NPR, the Coalition for Epidemic Preparedness Innovations (CEPI) is funding an initiative to develop a better way of coding mRNA that makes it more stable and does not require the use of ultra-low temperature freezers for storage and transport.

Epi update

As of February 21, the WHO COVID-19 Dashboard reports*:

• 757 million cumulative COVID-19 cases
• 6.85 million deaths
• 1.08 million cases reported week of February 13
• 13% decrease in global weekly incidence
• 8,013 deaths reported week of February 13
• 22% decrease in global weekly mortality

Over the previous week, incidence declined in all WHO regions except the Eastern Mediterranean region (+25%) and Europe (+3.5%).

*Starting this week, the WHO will update the dashboard once per week on Wednesdays.

UNITED STATES

The US CDC is reporting:

• 103 million cumulative cases
• 1.1 million deaths
• 259,339 cases week of February 15 (down from previous week)
• 2,838 deaths week of February 15 (down from previous week)
• 5.7% weekly decrease in new hospital admissions
• 6.7% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (80%), BQ.1.1 (12%), and BQ.1 (4%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

USEFUL 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)

**The Johns Hopkins University Coronavirus Resource Center will cease live COVID-19 data reporting on March 10.

Democrats forced to play defense on education

Good analysis of education becoming a partisan issue

CAMPAIGN

BY LEXI LONAS - 02/22/23 6:00 AM ET

Associated Press/Gregory Bull

Math teacher Doug Walters sits among empty desks as he takes part in a video conference with other teachers to prepare for at-home learning at Twentynine Palms Junior High School in Twentynine Palms, Calif.

The Democratic Party is increasingly being forced to play defense on education, a dangerous position heading into the 2024 election cycle as Republicans ramp up their rhetoric on the issue.

Democrats have long been vocal advocates of the public education system, defending school budgets and counting on reliable support from teachers’ unions.

But since the beginning of the pandemic, Republicans have sought to brand Democrats as the party that doesn’t care about parental involvement in education, using mask mandates and school closures as a wedge while also leaning into topics such how LGBTQ identity and Black history are taught.

Glenn Youngkin flipped the Virginia governor’s mansion from blue to red in 2021 with a campaign that made school choice and parental rights its signature issue. Since then, both declared and potential GOP White House hopefuls have regularly gone on the attack on the subject.

Giving the official Republican response to President Biden’s State of the Union address this month, Arkansas Gov. Sarah Huckabee Sanders said that, under Democrats, “our children are taught to hate one another on account of their race, but not to love one another or our great country.”

“Here in Arkansas and across America, Republicans are working to end the policy of trapping kids in failing schools and sentencing them to a lifetime of poverty,” Sanders said. “We will educate, not indoctrinate, our kids and put students on a path to success.”

Democrats say their platform on education is strong and still reaches voters, but they need to work on messaging to ensure Republican “misinformation” doesn’t define their platform.

“I think that’s the wedge where Republicans have done a better job. They created this narrative that parents no longer have any say in their children’s education, which is not true. But there hasn’t really been anything to counter that,” said Rodell Mollineau, a Democratic strategist.

“I think this is more about Democrats being firm about what they stand for and defending their positions. I think it’s about shouting down and correcting misinformation that the Republicans are putting out regarding our stances on education,” Mollineau added.

The overarching accusation Republicans have made against Democrats on education since the pandemic began is that they don’t respect parents’ rights.

The idea became so popular that Speaker Kevin McCarthy (R-Calif.) introduced a parental bill of rights in the House when he was minority leader in 2021.

Florida Gov. Ron DeSantis (R), who has aggressively leaned into education issues ahead of a potential presidential bid, was able to pass a statewide parental rights in education bill, known by opponents as “Don’t Say Gay,” last year.

During the first House Education and Workforce Committee hearing this year, multiple Democrats sought to counter the narrative by directly addressing parental involvement in education.

Rep. Ilhan Omar (D-Minn.) spent most of her time during the hearing highlighting that there are no laws demanding — or anyone advocating for — parents not to be involved in their children’s education.

“I just hope that we put this argument that is not based on the actual facts taking place in our communities to rest,” Omar said.

But Republicans, sensing an advantage, are already trumpeting their education policies ahead of 2024.

Former President Trump, who in November became the first major declared White House candidate in either party, has already put out a video for his education platform almost a year out from the primaries.

In an indication of what could be a race to the right on schools, Trump is making the unusual move of calling for parents to even elect school principals.

“More than anyone else, parents know what their children need,” Trump said in a campaign video late last month. “If any principal is not getting the job done, the parents should be able to vote to fire them and select someone who will. This will be the ultimate form of local control.”

Former U.S. Ambassador to the United Nations Nikki Haley, who joined Trump in the GOP race last week, dinged DeSantis, saying the already highly controversial “Don’t Say Gay” bill in fact doesn’t go far enough.

“I think Ron’s been a good governor. I just think that third grade’s too young,” Haley said after a New Hampshire event on Thursday. “We should not be talking to kids in elementary school about gender, period.”

“And if you are going to talk to kids about it, you need to get the parents’ permission to do that,” she continued. “That is something between a parent and a child. That is not something that schools need to be teaching.”

Should they also enter the race, DeSantis and Youngkin would no doubt put their education moves front-and-center, but some Democrats say their policies have not improved schools and could be easy to combat.

Liam Watson, the spokesperson for the Democratic Party of Virginia, said there are no recent substantial advances Youngkin has made that he can tout.

“I would challenge anyone to point me towards even a single policy that Republicans have implemented that have actually improved learning outcomes in K-12 schools, where they have improved the experience of teachers and students in public schools. I would challenge anyone to come up with even a single solitary example of a time that’s happened,” Watson said.

“Democrats have shown for decades now that we are the party of parents and students and teachers,” he added. “When it comes time to fund schools, it is Democrats that are out front doing that work. When it comes time to ensure that teachers have what they need in their classrooms, to make sure that student learning outcomes are protected, it’s Democrats that are doing that work.”

At least some voters appear to agree. A poll released earlier this month by the National Parents Union reported that 46 percent of parents say they trust Democrats with primary education policy, compared to 38 percent who favored Republicans.

“The average American family is getting squeezed, we’re watching a mental health crisis unfold before our eyes, and significant barriers to a high-quality education, especially for underserved communities, remain in place. Parent voters have run out of patience for politicians that allow poisonous politics to interfere with delivering on their promise of solutions,” National Parents Union President Keri Rodrigues said of the survey.

The recent Republican energy toward education has particularly gained momentum at the local level, where they have increasingly made school board elections into partisan fights. Last year, DeSantis got directly involved and endorsed numerous school board candidates in his state.

“I’m proud to release my full slate of pro-parent, student-first school board candidate endorsements. Our school board members are on the frontlines of defending our students and standing up for parental rights,” DeSantis said in a statement when he announced his school board endorsements. “These 29 candidates are committed to advancing a bold education agenda in Florida. Parents can rest easy knowing that these candidates will fully support their right as parents to ensure their children reach their full potential in Florida’s K-12 education system.”

In order to push back against some of the Republican education gains, Democrats will also have to look toward local mobilization.

“That’s where the opportunities for Democrats are. That’s why Democrats need to seize on the opportunity and make sure that they are hyper-local. I don’t know that they need to address the issue through specific education and curriculum alternatives. They need to be able to effectively push back on what is being promoted at the local level,” said Basil Smikle, a Democratic strategist.

While some Democratic strategists acknowledge that pandemic frustration was a boost to Republicans in education, many believe culture war issues conservatives have clung to such as critical race theory (CRT) in the classrooms could be their downfall now.

DeSantis has become the prime example of the Republican culture wars in schools as his administration has banned CRT, as well as certain books and the teaching of LGBTQ issues for younger children.

Although these actions are highly popular among Republicans, it remains to be seen if they will be on a national level.

“What Democrats believe is parents should have a voice in the classroom and have a role in their children’s education, which we’ve always believed in, but it’s the idea that it’s going to be the likes of politicians who are going to decide what is acceptable and what’s not acceptable for children to learn. I think there will be a significant backlash to that with independent voters as we move forward into a Republican primary and the general election in 2024,” one Democratic strategist told The Hill.

Above is from:  https://thehill.com/homenews/campaign/3866784-democrats-caught-playing-defense-on-education/?email=47c18a370a6a122eb49503aabc2708b3790b0eab&emaila=8a776225d84f290294e4274317e366a5&emailb=982db1251d051374650c5b955ad9021ff10338eb5df4b61b37a899251cd30a75&utm_source=Sailthru&utm_medium=email&utm_campaign=02.22.23%20GR%201:30%20p.m.%20Dems%20Education

District 100 School Board Election—the other half of the story

The February 18 blog posting (below or click on following Boone County Watchdog: District 100 School Board Election) speaks of United For Student Excellence, PAC and the large union support for District 100 candidates:  Sarah Brenner, Jorge Herrera and Holly Houk.

Well there is another PAC, Prioritizing Student Success, PAC which is backing District 100 candidates:  Allison Reid-Niemiec, Tosca Degennaro and Misty Coryell .  Chairman of this PAC is Republican State Senator (35th District) Dave Syverson.

Contributions currently reported are $1,000 from Tom Bucher (a current District 100 board member whose term ends in 2025),$1,000 from Bob Walberg (former County Board Chairman) and $1,000 from the Syverson Campaign Committee. SEE:  https://www.elections.il.gov/CampaignDisclosure/CommitteeDetail.aspx?ID=FsHmsZqr9GJ3QmUPdEyd1g%3d%3d 

It certainly looks like District 100 Board election is becoming a very “partisan” event.

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Questions and Answers from Google

How are school board members elected in Illinois?

School board members are elected by their local communities during a non-partisan, consolidated election and serve four-year terms.

Do school board members get paid in Illinois?

School board members in Illinois serve without pay and are prohibited by law from having a significant financial interest in any business transacted by the school district. The term of office for most school board members is four years. Research shows that most board members are elected for two or more terms.

Does a school board have authority?

More than just legislative bodies, like city councils or police, school boards have full financial and governing authority and set the academic goals and expectations for the district.

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Here are the opposing fund raisers.

District 100 School Board Election

Don't know what is happening but there is a very expensive school board election. Three candidates are campaigning together and sent a professional printed post card to our house. I assume it went to many voters.  Both they and their three opponents have very large signs across the county.  Have never seen anything like this.  The election is April 4 with early voting beginning March 10, 2023

Here is the website from the post card people:  Belvidere School District Candidates | United For Student Excellence D100

If you know what is going on or what is the issue let me know. bill.pysson@gmail.com

Who is footing their bill?

Below is from:  https://www.elections.il.gov/campaigndisclosure/A1List.aspx?FiledDocID=188GR5IAHOGyaZjVbalnnw%3d%3d&ContributionType=wOGh3QTPfKqV2YWjeRmjTeStk426RfVK&Archived=Gl5sibpnFrQ%3d

MTC Morenos Inc
2804 Foliage Ln
Rockford, IL 61109
$1,500.00
2/2/2023
Individual Contribution
United For Student Excellence

Northwestern IL Building and Construction Trades Council PAC
5640 Sockness Dr.
Rockford, IL 61109
$2,000.00
2/1/2023
Transfer In
United For Student Excellence

Plumbers & Pipefitters UA Local 23 PAC
4525 Boeing Dr.
Rockford, IL 61109
$2,000.00
2/1/2023
Transfer In
United For Student Excellence

Sheet Metal Workers Local 219 PAC Fund
3316 Publishers Dr.
Rockford, IL 61109
$2,000.00
2/2/2023
Transfer In
United For Student Excellence

February 9, 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.

Click to Subscribe

Announcements

CENTER WELCOMES NEW SENIOR SCHOLAR We are thrilled to welcome Erin Sorrell 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. Sorrell will contribute to several ongoing projects, as well as spearhead a portfolio of multidisciplinary work spanning the disciplines of basic science, biosafety, and health systems strengthening to address infectious disease threats whether they be novel, emerging, or re-emerging. She is an alumna of the Center’s ELBI fellowship. Read our news story: http://bit.ly/3I1f24L

NON-PUBLISHING NOTICE The COVID-19 Situation Report will not be published on February 16. The next report will be published on February 23.

In this issue

> White House expected to release roadmap to transition out of public health emergency; US House committee holds hearing on pandemic response

> WHO releases zero draft of global pandemic treaty; US chairs fourth and final Ministerial of the COVID-19 Global Action Plan

> Cochrane Library review examines effectiveness of various nonpharmaceutical interventions; most experts agree future pandemics will require more nuanced responses

> Clinical trial shows promise for interferon therapy but regulatory hurdles exist; experts say additional treatment options desperately needed

> Black Americans, others face barriers to long COVID treatment, care; caregivers need support too

> What we're reading

> Epi update

White House expected to release roadmap to transition out of public health emergency; US House committee holds hearing on pandemic response

The US winter COVID-19 surge appears to be ending, with the increase in reported cases not as bad as initially expected. There was concern in early winter that a combination of COVID-19, RSV, and seasonal influenza would overwhelm hospitals and cause a large surge in deaths. Speculation around why the winter surge was not as bad as expected has centered on people possibly avoiding crowds over the holidays, viral interference among various circulating diseases, and more immunity in the US population due to prior infection and/or vaccination. COVID-19 remains a significant public health threat and a leading cause of death in the US, but there appears to be hope on the horizon. As such, the Biden administration is expected to soon release a roadmap to transition out of the COVID-19 public health emergency, which is set to end on May 11. The end of the public health emergency will also terminate the Trump-era Title 42 orders that US-Mexico border patrol agents have used to return undocumented migrants across the border in the name of COVID-19 prevention. Title 42 has been heavily criticized by public health experts and immigrant advocates, but Republican-led states have sought to keep the orders in place.

Additionally, the Republican-led US House of Representatives is stepping up efforts to investigate the pandemic response. The House Energy and Commerce Committee held a hearing on “The Federal Response to COVID-19” this week. Republicans on the committee used the opportunity to ask leading health officials and scientists about vaccine mandates, mask requirements for children, origin theories of SARS-CoV-2, and the public’s broken trust in health agencies. Additional hearings on similar topics are expected. In a mostly symbolic move, the House on February 8 passed a bill mostly along party lines that would end US CDC-imposed COVID-19 vaccination requirements for foreign travelers entering the US. The White House said it opposes rescinding the order without scientific review, but the travel industry has lobbied for the removal of the requirement, claiming it is an unnecessary barrier to travelers.

WHO releases zero draft of global pandemic treaty; US chairs fourth and final Ministerial of the COVID-19 Global Action Plan

In the last week, two major global efforts to combat future outbreak emergencies and strengthen global health security have reached important milestones in their continuing efforts. Last week, the WHO released a zero draft of a global pandemic treaty, focused on international prevention, preparedness, and response. This would be the first legally binding treaty helping to ensure a more equitable distribution of pandemic-related vaccines, drugs, and diagnostics. WHO member states will now deliberate to negotiate treaty terms and make progress to ensure stronger international collaboration and equity throughout future biological events.

This week, US Secretary of State Anthony Blinken hosted a fourth and final Ministerial of the COVID-19 Global Action Plan (GAP).The GAP has been working for the past year to continue addressing acute pandemic response needs and identifying remaining barriers to fighting the COVID-19 pandemic, as well as planning collaborative prevention, detection, and response methods among many countries and global organizations ahead of the next global health threat. During the meeting, Japan Foreign Minister Yoshimasa Hayashi said that Japan has chosen global health as a priority issue when the nation hosts a Group of Seven summit in May, partly because of the continuing challenge of equitable vaccine access.

Cochrane Library review examines effectiveness of various nonpharmaceutical interventions; most experts agree future pandemics will require more nuanced responses

More than 3 years into the COVID-19 pandemic, experts continue to discuss whether masking definitively slows transmission of respiratory viruses, and by how much. Throughout the pandemic, numerous studies have been published with conflicting results and conclusions, culminating ina recent review published by the Cochrane Library. The review found that masking, either with surgical masks or N95 respirators, made little to no difference in the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks; however, the review emphasized that the findings could be due in part to multiple factors such as poor study design, low adherence to mask rules, quality of masks used, and incorrect mask usage. Notably, several individual studies have shown an association between community mask use and a reduction in COVID-19 cases. The review also found that hand hygiene programs may help slow the spread of respiratory diseases. Results of the review have split infectious disease experts, leading some tocritique its methodologies and emphasize the importance of public messaging on nonpharmaceutical interventions (NPIs) to prevent disease transmission. More research is needed into various NPIs and public health interventions and their use in future disease outbreaks likely will need to be more nuanced.

Clinical trial shows promise for interferon therapy but regulatory hurdles exist; experts say additional treatment options desperately needed

Monoclonal antibodies have been an important tool in treating COVID-19 and as pre-exposure prophylaxis for those at high risk of severe disease, especially individuals with compromised immune systems. Following the US FDA’s suspension of emergency use authorization (EUA) for Evusheld last month, however, no monoclonal antibodies are authorized for use in the US because of inactivity against currently circulating variants of SARS-CoV-2. Other treatments exist, including the antivirals Paxlovid and molnupiravir, but each comes with its own concerns, including worry over viral rebound, drug interactions, or viral mutations.

Newer medicines that remain active against various SARS-CoV-2 lineages are needed to help shore up the nation’s therapeutic toolbox, and potentially help protect people who are immunocompromised. The results of a clinical trial involving nearly 2,000 patients published this week in the New England Journal of Medicine show that people with early COVID-19 who had a single injection of a treatment called pegylated interferon lambda (PEG-lambda) were 51% less likely to be hospitalized or to go to an emergency room, compared with those who received a placebo shot. Most of the study participants were vaccinated—an already low-risk group—but the treatment was even more effective in unvaccinated participants.

Interferons are a part of the body’s natural immune response, and PEG-lambda is a synthetic version of a naturally produced interferon. Even with promising results, the treatment faces hurdles to regulatory approval by the FDA, which has signaled it needs data from a larger trial with sites located in the US, an expensive and multi-year process. Some experts worry the barriers are indicative of problems threatening the future development of next-generation COVID-19 medical countermeasures, some of which might help prepare for the next pandemic.

Black Americans, others face barriers to long COVID treatment, care; caregivers need support too

Though the medical community is learning more about long COVID, also called post-COVID condition or post-acute sequelae of COVID-19, much remains unknown about how many people have the condition, why and what their prospects for recovery are, or the long-term impacts on society. In the US Black community, already disproportionately impacted by the pandemic, many with symptoms lingering a month or longer after recovering from acute COVID-19 are struggling to find the care they need. According to the latest data from the US Census Bureau Household Pulse Survey, nearly 30% of Black respondents said they currently have or have had long COVID and about 35% of those with long COVID reported severe limitations on their ability to perform day-to-day activities. Additionally, caregivers of people with long COVID, many of whom suffer from the same or other health conditions, need to establish their own support systems, sometimes in the form of support groups such as those with Survivor Corps or Body Politic. Online support groups and other forms of telerehabilitation are useful for both people with long COVID and their caregivers, some face barriers to access because of internet and digital literacy considerations.

What we’re reading

SARS-COV-2 VARIANTS No new variants of SARS-CoV-2 were detected in China between November 14 and December 20, 2022, during a time when the nation began experiencing a surge of COVID-19 cases, according to a study published February 8 in The Lancet. A majority of the sequenced samples were the already circulating Omicron subvariants BF.7 and BA5.2. Notably, the study only looked at samples from Beijing and only covered a few weeks after the government lifted its strict “zero COVID” policies, which some experts warn would be too early to detect new lineages. Scientists have their eye on another variant—CH.1.1—that emerged in November 2022 in Southeast Asia and now accounts for about 25% of cases in the UK and New Zealand, and about 12% of overall cases in Europe. According to a preprint report posted on bioXriv, the lineage contains the mutation L452R seen in Delta, but not Omicron, and has “a consistently stronger neutralization resistance available than XBB, XBB.1, and XBB.1.5,” which is worthy of monitoring.

EXCESS MORTALITY Between March 2020 to December 2021, 622 more physicians died in the US than expected, according to a study published in JAMA Internal Medicine this week. Excess mortality among physicians was substantially lower than for the general population during this time, and there were no excess deaths among physicians after April 2021, concurrent with the availability of COVID-19 vaccines. In related news, the New York Times examined the obituaries of China’s top academics to gain some insight into the nation’s true death toll since it dropped its “zero COVID” strategy, finding significantly higher numbers of published obituaries in December 2022 and January 2023 than in preceding months.

HONORING THOSE LOST More than 1.1 million people in the US have died of COVID-19 since the beginning of the pandemic, and about 3,500 people continue to die each week of the disease. Colorado Public Radio/NPR reports on the desire—some say need—to memorialize individuals who died of COVID-19, to recognize and remember their lives but also to help those left behind heal from the trauma of losing loved ones. In October 2022, the Johns Hopkins Center for Health Security, in collaboration with the Center for Health and Economic Resilience Research at Texas State University, held a 2-day virtual symposium, titled Post-Pandemic Recovery: From What, For Whom, and How?, to consider how to operationalize the process of holistic recovery from the COVID-19 pandemic, including a focus on trauma recovery centered on safety, memorialization, and social connection.

LEARNING LOSSES & MISSING STUDENTS Half of US students began this academic year below their grade level in at least one subject, according to new federal survey data based on reports from schools nationwide. Nearly all schools said some students were behind in reading and math, 80% reported students behind in science, and 70% reported lags in social studies. The results, along with other research, show students and educators have a long road ahead to reverse pandemic impacts. Worse, an analysis by the Associated Press, Stanford University’s Big Local News project, and Stanford professor Thomas Dee found an estimated 240,000 students in 21 states who disappeared from public schools during the pandemic and whose absences cannot be accounted for. Some students who left public schools moved out of state or switched to private schools or home-schooling, but nearly a quarter million remain “missing” and the true number is likely much higher.

ANTIMICROBIAL RESISTANCE According to a study published recently in The Lancet Microbe, antimicrobial resistance (AMR) is highly prevalent in patients with laboratory-confirmed COVID-19 and bacterial infections. In another recent analysis published in eClinical Medicine, researchers found that increases in antibiotic sales were associated with increases in COVID-19 cases, according to data collected during the first 2 years of the pandemic in 71 countries. Despite less than 10% of COVID-19 patients having a bacterial coinfection, an estimated 75% of COVID-19 patients are prescribed antibiotics, underlining the need for greater antibiotic stewardship in the context of COVID-19. In related news, the United Nations Environment Programme (UNEP) published a report this week warning that up to 10 million people could die annually by 2050 due to AMR, making it one of the top 10 global threats to health requiring a multisectoral response that recognizes the intertwined health of people, animals, plants, and the environment, referred to as One Health.

Epi update

As of February 9, the WHO COVID-19 Dashboard reports:

• 755 million cumulative COVID-19 cases
• 6.8 million deaths
• 1.35 million cases reported week of January 30
• 13.5% decline in global weekly incidence
• 13,440 deaths reported week of January 30
• 16% decrease in global weekly mortality

Over the previous week, incidence declined or remained stable in all WHO regions. The WHO notes that the case and death data for the Eastern Mediterranean region are incomplete and will be updated as soon as possible.

UNITED STATES

The US CDC is reporting:

• 102.4 million cumulative cases
• 1.1 million deaths
• 280,911 cases week of February 1 (down from previous week)
• 3,452 deaths week of February 1 (down from previous week)
• 6.2% weekly decrease in new hospital admissions
• 11.3% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (66%), BQ.1.1 (20%), and BQ.1 (7%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

USEFUL 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)

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