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