COVID-19 Situation Report
Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.
In this issue
> COVID-19 pandemic continues despite end of WHO, US emergency declarations; world must take actions on lessons learned to prepare for next disease emergency
> US CDC building ventilation guidance, ASHRAE draft standard for control of infectious aerosols represent important public health achievements, experts say
> Debate over masking in healthcare settings continues, with more evidence provided by new review in Annals of Internal Medicine
> What we're reading
> Epi update
COVID-19 pandemic continues despite end of WHO, US emergency declarations; world must take actions on lessons learned to prepare for next disease emergency
On May 5, WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared that the COVID-19 pandemic no longer constitutes a public health emergency of international concern (PHEIC) as defined under the International Health Regulations (IHR). In its 15th meeting, the IHR Emergency Committee for COVID-19 agreed that the pandemic no longer represents an “extraordinary event,” as all nations are now used to dealing with the virus, though not all are equally equipped to do so. With this change in designation, the WHO now recommends that all nations shift into long-term management of the pandemic. Additionally, the US public health emergency (PHE) for COVID-19 expired on May 11, 3 years and 100 days after the Trump administration first made the declaration.
It is easy to misinterpret WHO’s removal of the PHEIC designation and the end of the US PHE as an end to the pandemic, accompanied by a return to normalcy. However, SARS-CoV-2 continues to circulate and cause thousands of cases of COVID-19 per day. According to the US CDC, more than 1,000 people die each from COVID-19–related complications. While the overt signs of daily life disruptions and mitigation measures have ended, such as lockdowns and mask mandates, many still find their lives uprooted due to the loss of loved ones, struggles with long COVID, or continuous efforts to protect themselves or their friends and family who are at higher risk of severe disease from infection. Those in the US who were most vulnerable at the beginning of the pandemic remain so but now have access to fewer resources and programs for assistance, as federal pandemic funding runs out. Policymakers and public health officials must remain cognizant to not leave behind those most vulnerable and to better prepare for future SARS-CoV-2 variants or a new pandemic.
Additionally, global economies continue to experience the fallout from the pandemic, though some are recovering faster than others. The UN Department of Economic and Social Affairs projects that the global economy will grow by 2.3% in 2023 and 2.5% in 2024, well below the average growth rate of 3.1% in the 2 decades prior to COVID-19. In particular, the Africa region and the Latin America and Caribbean region are experiencing the least economic growth, falling well below growth targets set in the 2030 Agenda for Sustainable Development. In addition to dealing with supply chain issues, recent estimates suggest that about 10% of people infected with SARS-CoV-2 go on to develop long COVID, decreasing workforce functionality. As the world settles into this new global context, it is the responsibility of governments to maintain vigilance against the ongoing pandemic and to invest in preparedness to help avoid catastrophic outcomes in future disease outbreaks. Work is underway—and must continue—to evaluate response efforts and act on lessons learned so governments, institutions, and international organizations can prevent the cycle of neglect the world has experienced in past interpandemic periods.
US CDC building ventilation guidance, ASHRAE draft standard for control of infectious aerosols represent important public health achievements, experts say
The US CDC last week published updated guidance for building ventilation to help prevent indoor transmission of airborne viral particles, including recommendations for a goal of 5 air changes per hour and upgrading to MERV-13 air filters. The document represents the first time a federal agency has included a target for how much rooms and buildings should be ventilated to help reduce the risk of disease transmission. The recommendations also include suggestions to keep fans in the “on” versus “auto” position, adding fresh air when possible, using appropriately sized air cleaners, installing ultraviolet air treatment systems, and using carbon dioxide monitoring systems.
Additionally, ASHRAE—a professional society of building mechanical engineers that sets building energy and ventilation standards, among other standards and guidelines—this week released a first draft of its standard for maintaining healthy indoor air quality (IAQ), ASHRAE Standard 241P, Control of Infectious Aerosols. The standard provides minimum requirements for HVAC-related measures to reduce the risk of transmission of SARS-CoV-2, influenza, and other airborne viruses in homes, offices, schools, hospitals, and other buildings during periods of high risk. A public comment period runs through May 26, with publication expected in July.
IAQ experts lauded the release of both the CDC guidance and the ASHRAE standard, with some saying the developments could represent the beginning of an IAQ “revolution” and are among the most important public health achievements of the 21st century. Because most buildings in the US were constructed to meet minimal air quality standards, before much was known about how to mitigate indoor respiratory disease transmission, the recommended improvements will go a long way toward not only reducing disease spread but also help reduce asthma exacerbations and allergy symptoms and improve cognitive functioning for people working and studying in buildings that follow the new standards.
Debate over masking in healthcare settings continues, with more evidence provided by new review in Annals of Internal Medicine
Mask use in healthcare settingsremains a highly politicized and divisive topic. Continuing mask use in healthcare settings such as hospitals could help tocurb transmission of respiratory viral diseases between patients and staff. Not only could it reduce occupational exposure to COVID-19 for healthcare personnel, but it also could protect patients—particularly those who are immunocompromised—in cases where healthcare personnel with respiratory infections feel pressured to come to work when sick. Masking remains one ofthe last lines of protection against COVID-19 for medically vulnerable patients.
However, substantial gaps remain about whether masks work to prevent SARS-CoV-2 infections in healthcare settings and under what conditions.A recent review published in the Annals of Internal Medicine adds to the evidence base around whether masks are protective against SARS-CoV-2 infection in healthcare and community settings, an approach that differs from a recently published Cochrane review that examined studies of various physical interventions, including masks, to reduce viral respiratory illness in general. The Annals study found that mask use may be associated with a small reduction in risk of SARS-CoV-2 infection in community settings and that surgical masks and N95 respirators may be associated with similar infection risk in routine patient care settings, though the researchers did not rule out the beneficial effects of N95 respirators.
The authors ofan accompanying commentary recommend that despite the lack of gold-standard evidence about whether masks are protective in healthcare settings, mask use for patient and healthcare personnel interactions should be considered a safety measure, as with the widely accepted practice of hand hygiene.In an editorial, Annals of Internal Medicine editors note that studying the effectiveness of masks to prevent passage of a virus or to prevent SARS-CoV-2 infection is different from studying the effectiveness of masks themselves or of masking recommendations or policies. Whether policies move forward with mask-optional or mask-required approaches, experts agree that mask use should be only one element of a multicomponent strategy to reduce respiratory disease transmission in healthcare or other settings.
What we’re reading
US GAO REPORT A US Government Accountability Office (GAO) report released last week highlights persistent deficiencies of the US Department of Health and Human Services (HHS) in its ability to lead preparedness and response efforts for public health emergencies. The 13-page report calls out 5 areas where HHS has consistently fallen short, including developing clear roles and responsibilities; establishing a network to collect and analyze complete and consistent data; providing clear and consistent communication; establishing transparency and accountability; and working to understand key partners’ capabilities and limitations. The report notes that 91 of 155 GAO recommendations to HHS since 2007 remain outstanding as of April 2023 and calls on the executive branch and US Congress to urgently provide leadership and attention to ensure the nation is prepared to manage multiple simultaneous threats, mitigate their economic impact, and aid in recovery.
US SENATE COVID-19 ORIGIN REPORT US Senator Marco Rubio (R-FL), vice chair of the Senate Intelligence Committee, this week published a report based on a nearly 2-year investigation into the origins of the COVID-19 pandemic that presents circumstantial evidence his office says supports the theory that the novel coronavirus likely escaped from a lab in Wuhan, China. The report acknowledges that the probe did not find a “smoking gun” to prove the virus emerged from a lab incident rather than arose naturally, although the report suggests there was some sort of serious biocontainment failure or accident at the Wuhan Institute of Virology during the latter half of 2019. Various intelligence agencies remain split on the virus’s origin. Under the COVID-19 Origin Act of 2023, which US President Joe Biden signed on March 20, the director of national intelligence has until June 18—90 days—to declassify information about the Wuhan lab’s research and activities related to the pandemic, including details about any researchers who fell ill in the fall of 2019.
INFECTIOUS DISEASE EXPERTS' CONTRIBUTIONS In an interview with Healio, Dr. Amesh Adalja, senior scholar with the Johns Hopkins Center for Health Security, discusses a recent research article published in the journal Clinical Infectious Diseases, in which he and colleagues wrote about the contributions of infectious disease specialists in helping to mitigate the impacts of COVID-19, from treating patients to improving understanding of the new disease. The paper is based on a larger report published in August 2022. The authors noted that infectious disease experts made “diverse and unique contributions that went well beyond their usual responsibilities”—often without additional compensation—such as helping to reopen schools, workplaces, and entertainment venues. In the interview, Dr. Adalja notes those efforts were core to the resiliency and recovery of many communities and organizations and says policy changes, such as medical school debt relief and increased compensation, could help to fortify the infectious disease workforce for future pandemics.
J&J-JANSSEN VACCINE The J&J-Janssen COVID-19 vaccine is no longer available in the United States, according to an announcement from the US CDC. The last remaining stockpiles of the vaccine expired on May 7, and the agency said any remaining shots should be disposed of in accordance with local, state, and federal regulations. More than 31.5 million doses of the vaccine were delivered to states and territories, but only about 19 million people received the vaccine, representing about 7% of vaccinated US residents.
ACCESS TO MEDICAL OXYGEN The COVID-19 pandemic highlighted the longstanding problem of unequal access to medical oxygen in low- and middle-income countries (LMICs), where demand surged but supply fell short, Devex reports. Advocates are now urging the gas industry, especially the 6 major companies producing medical liquid oxygen (LOX), to ensure sustainable access to LMICs. Before the pandemic, the industry’s focus was more on industrial gasses and not medical products, and LOX sales were mainly to high-income countries. The industry's lack of investment in production facilities in LMICs and a lack of demand from those countries exacerbated the crisis. In a recent report, the Access to Medicine Foundation proposed 6 steps to improve access to LOX in LMICs over the next several years, including industrywide strategies, equitable pricing, expanded production capacity, and collaboration with governments and donors. The World Health Assembly also is considering a WHO resolution to address the issue.
“THE BAT LANDS” In the first of a graphically rich 5-part series, Reuters examines areas of the world where bat habitat is being threatened by agriculture, extractive industries, infrastructure, and other development, creating “jump zones” where there is an increased risk of a bat-borne pathogen spilling over to the human population. According to the analysis, these areas cover 6% of Earth’s land mass, and more than 1 of every 5 people on the planet lives in an area at highest risk of bat disease zoonosis. The other 4 parts examine the spread of the Nipah virus, how China’s efforts to expand its economic reach are driving deforestation and increasing the risk of bat zoonotic diseases, research into bats and their habitats in the vast Amazon rainforest, and efforts to manage bat-human interactions and invest in more monitoring and preparedness.
Epi update
As of May 17, the WHO COVID-19 Dashboard reports:
- 766.4 million cumulative COVID-19 cases
- 6.9 million deaths
- 546,435 million cases reported week of May 8
- 11% decrease in global weekly incidence
- 4,266 deaths reported week of May 8
- 9% increase in global weekly mortality
Over the previous week, case incidence declined or remained relatively stable in all WHO regions. The increase in deaths is attributable primarily to a 49% weekly increase in the Americas, which could be the result of a reporting backlog.
UNITED STATES
When the US public health emergency for SARS-CoV-2 expired on May 11, so too did the US CDC’s authorizations to collect certain public health data. Though COVID-19 remains a public health priority, the CDC will use COVID-19–associated hospital admission levels and the percentage of all COVID-19–associated deaths as the primary surveillance indicators. As such, the CDC COVID Data Tracker has been redesigned and most remaining data will be updated on a weekly basis.
The US CDC is reporting:
- 1.13 million deaths (decrease of 5.3% in past week)
- 9,456 weekly COVID-19 hospital admissions as of May 6 (decrease of 6.5%)
The Omicron sublineages XBB.1.5 (64%), XBB.1.16 (14%), XBB.1.9.1 (9%), XBB.1.9.2 (4%), XBB.2.3 (3.5%), XBB.1.5.1 (2.4%), and FD.2 (1.8%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.
Editor: Alyson Browett, MPH
Contributors: Erin Fink, MS; Clint Haines, MS; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; and Rachel A. Vahey, MHS
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