February 1, 2022: Johns Hopkins COVID Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Natasha Kaushal, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.

PANDEMIC VS ENDEMIC Even as the number of COVID-19 cases continue to reach record levels in some regions, those in the general public, members of the scientific community, and politicians are debating when the world can move on from the pandemic, arguments summarized as “pandemic vs endemic.” Some health officials from the US and Europe have recently expressed cautious optimism that their regions could be moving out of a pandemic state and into a period of endemic disease control, citing a different immunological landscape due to vaccination and previous infections, continued mitigation measures such as mask-wearing and testing, and newly available antiviral treatments. Other experts warn it is too soon to declare a pandemic endgame, saying global vaccination gaps and the threat of new, possibly more dangerous variants make predicting the pandemic’s path impossible. Still others are warning that endemicity does not mean COVID-19 becomes harmless, as other endemic diseases continue to cause substantial suffering and death. For example, HIV, malaria, and tuberculosis—all considered to be endemic in certain regions—continue to kill millions of people each year and, although relatively controlled in wealthy nations, linger in poorer, more vulnerable countries.

The surge of COVID-19 cases caused by the Omicron variant is beginning to recede in regions of the US hit first, but other areas of the nation continue to experience record numbers of hospitalizations and deaths, creating various pandemic scenarios nationwide. In Europe, Denmark lifted all of its remaining COVID-19 restrictions last week, the first country on the continent to do so, while other nations, such as the UK and Austria, also are relaxing their rules. Thailand on January 27 adopted guidelines outlining how COVID-19 could become an endemic disease, but officials said it likely will still be between 6 months to a year before the country reaches that point. Research from Malawi, supported by evidence from other countries, suggests that a very high prevalence of the population in several African nations have already been infected with SARS-CoV-2, providing high levels of natural immunity and possibly signaling endemicity. While it remains unclear how the pandemic will reach an end, scientists agree that there is a light at the end of the tunnel.

OMICRON BA.2 Only about 2 months from first being detected, the highly transmissible Omicron variant of the SARS-CoV-2 virus—the most common form of which is called BA.1—has become the predominant variant worldwide, accounting for nearly 99% of all sequenced cases as of the end of January. Scientists are now tracking a sublineage of the original Omicron variant known as BA.2, or “stealth Omicron,” as well as 2 other subvariants, BA.1.1529 and BA.3. A growing number of cases are being attributed to BA.2, including 82% of new cases in Denmark,* 9% in the UK, and 8% in the US. Though BA.2 appears to be even more transmissible than its cousin, according to a Danish study, vaccines remain effective—perhaps more so—against it than BA.1. The WHO has urged health agencies worldwide to begin investigating BA.2, and the US CDC last week said that while the subvariant is circulating at low levels in the country, there is no evidence it causes more severe disease than the BA.1 lineage.

In a study posted online last week on the preprint server bioRxiv, researchers describe unusual genetic mutations in Omicron’s BA.1 lineage and postulate that it likely evolved under unusual conditions, such as within the body of a person with a compromised immune system. The research—which suggests that Omicron developed over time and not in a stepwise fashion from the last variant, Delta—makes it clear that scientists are unable to predict how and where the next variant will evolve, nor whether it will be more transmissible or virulent.

*This high percentage could be attributable to Denmark’s robust sequencing program.

MODERNA VACCINE APPROVAL The US FDA on January 31 granted full approval to Moderna’s SARS-CoV-2 vaccine for the prevention of COVID-19 in adults aged 18 and older, the second such vaccine to receive approval in the US. The vaccine, to be marketed under the brand name Spikevax, is administered as 2 shots given 28 days apart and is the same formulation that has been available under emergency use authorization (EUA) since December 2020. The mRNA vaccine remains available under EUA as a third primary series dose for adults with certain types of immunocompromise and as a single booster dose for adults who originally received the same or different SARS-CoV-2 vaccine. Moderna’s vaccine—which is already licensed in several other countries and regions, including Canada, Japan, Israel, UK, and the EU—is the company’s first FDA-approved product. The FDA is currently reviewing Moderna’s EUA application for authorization among teenagers ages 12 to 17.

Also on January 31, Novavax filed for authorization of its SARS-CoV-2 vaccine, NVX-CoV2373, which uses nanoparticles of the viral spike protein to elicit an immune response. According to the Associated Press, US regulators have urged Pfizer-BioNTech to apply for emergency authorization for a 2-dose regimen of their SARS-CoV-2 vaccine for children ages 6 months to 5 years while awaiting data on a 3-dose course. The companies’ vaccine, marketed as Comirnaty, was the first vaccine to receive FDA approval for people aged 16 years and older, and it is authorized for use among children aged 5 to 15 years.

PAXLOVID The European Medicines Agency (EMA) last week recommended Pfizer’s antiviral COVID-19 treatment Paxlovid for conditional marketing authorization. The European Commission will fast-track review the recommendation, and if approved, EU member states would be able to use the oral antiviral to treat adults with COVID-19 who are at risk of severe illness while they recover at home. Italy, Germany, and Belgium are among several European countries that have already purchased the drug.

VACCINE EFFECTIVENESS New findings from the UK Health Security Agency provide further evidence that booster doses of SARS-CoV-2 vaccines are critical for protection against the Omicron variant. Two doses of a vaccine provided 60% protection from death around 6 months after the last dose in individuals 50 years and older, but a booster dose raised the protective efficacy to 95% 2 weeks after receipt of the shot. Uptake of booster doses is increasing in Europe but only approximately 50% of adults have received one as of late January. Modeling of the Omicron variant surge in Europe predicts that current levels of booster vaccinations could reduce the number of hospital admissions by 500,000-800,000, with further reductions of another 300,000-500,000 admissions if all previously vaccinated people received boosters. The assessment from the European Centre for Disease Prevention and Control (ECDC) also warns that countries with low vaccination rates are expected to face significant pressures on their hospital systems. Vaccines and booster doses remain one of the best tools for protecting individuals against death and reducing pressure on chronically overworked hospital staff.

Recent evidence indicates that current vaccine designs are still capable of providing protection against the Omicron variant sublineage BA.2. Protection against symptomatic infection 25 weeks after a second dose of vaccine is only around 13%, but the protective efficacy jumps to 70% 2 weeks after a booster dose. The jump in protective efficacy against symptomatic disease further highlights the role that booster doses can play in mitigating the severity of disease during the pandemic. The evidence that BA.2 does not escape immunity more than the original Omicron variant is welcome news after the immune escape shift seen between Delta and Omicron. However, a preprint report from Denmark suggests that the BA.2 variant may be 1.5 times more infectious than Omicron.

AT-HOME SARS-COV-2 TESTS Only 2 weeks after launching COVIDtests.gov, a website for US residents to order SARS-CoV-2 tests through the US Postal Service, about 60 million households have requested the tests so far, according to White House officials. The orders leave enough tests for about 65 million more households—about 260 million tests of the US government’s initial order of 500 million. Reportedly, the government plans to order an additional 500 million tests to increase availability. The US has been criticized for not having federal guidance on how to use testing as a COVID-19 mitigation strategy. But even when given FDA-authorized test instructions, a substantial proportion of test users misinterpret negative results of at-home self-tests by not taking into account the implications of a high-risk, pretest exposure and ignoring federal self-quarantine recommendations, according to a study published on January 31 in JAMA Internal Medicine. The researchers suggest that pilot-tested decision science-based instructions might help to increase test takers’ understanding of results and the tests’ usefulness to public health.

ADDITIONAL DOSES FOR IMMUNOCOMPROMISED Public health agencies around the world continue work to determine the effectiveness of additional or booster SARS-CoV-2 mRNA vaccine doses for various populations, including healthcare workers, older adults, and people with compromised immune systems. A report published January 28 in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) aimed to better understand the effects of a third mRNA vaccine dose in immunocompetent and immunocompromised individuals. In the study, a third dose increased vaccine effectiveness (VE) against COVID-19-associated hospitalization from 82% to 97% among individuals with healthy immune systems and from 69% to 88% among people with immunocompromise. The researchers concluded the results support recommendations for a third mRNA vaccine dose as part of a primary series for immunocompromised adults or as a booster dose among immunocompetent adults.

Third doses of both the Pfizer-BioNTech and Moderna vaccines are authorized in the US as part of a primary series for people with immunocompromise, and in October 2021, the CDC recommended certain immunocompromised individuals receive a fourth, or booster, dose 6 months after their third shot. But some immunocompromised people say pharmacies have turned them away for a fourth dose. Last week, the CDC was expected to reinforce its messaging regarding fourth doses for certain immunocompromised individuals in a conference call with pharmacies. An estimated 7 million people in the US live with compromised immune systems, such as those with HIV or those taking immunosuppressive treatments for cancer or following an organ transplant. The US NIH announced this week it plans to study antibody responses to additional vaccine doses among kidney and liver transplant recipients who have had 2 to 4 previous vaccine doses but who did not have a detectable immune response. The study also will examine whether a concurrent reduction in immunosuppressive medication impacts antibody response.

CANADIAN PROTEST Thousands of Canadian truckers and other protesters made their way to Ottawa on January 29 as part of a so-called “Freedom Convoy” to protest vaccine mandates and other public health measures implemented during the COVID-19 pandemic. The rally originated in British Columbia the week prior and consisted of trucks and their supporters driving across the country to the nation’s capital. The original goal of the rally was to protest a mandate put in place on January 15 that required all unvaccinated cross-border truckers to quarantine upon returning home, but the message has since shifted to a general condemnation of all public health interventions. Media reported that people and vehicles clogged the streets of Ottawa making noise and bringing the city to a standstill, but the rally was largely peaceful.

The “Freedom Convoy” rally has been shrouded in controversy since before the event. The Canadian Trucking Alliance (CTA) directly opposed the rally and urged the public to be aware that many of the individuals who are speaking out have no direct connection to the trucking industry. Canadian government officials and the CTA also claim that approximately 90% of the nation’s truckers are already vaccinated and that the individuals participating in the rally represent a fringe minority group. The controversy began heating up when a GoFundMe for the rally raised C$5.5 million (US$4.3 million) in a short time. GoFundMe froze the account for discussions with the organizers, and a former intelligence analyst stated that the speed and anonymity of the donations raised red flags. The analyst also said there is clear activity from foreign countries on the GoFundMe page. Additionally, there are reports that some protestors espouse anti-Semitic and racist views and waved Nazi flags during the rally, defecated in the streets, harassed staff at a local homeless shelter, and at least one protester danced on Canada’s Tomb of the Unknown Soldier. Some protestors called for an attack on the Canadian Parliament similar to the attack on the US Capitol on January 6, 2021. By midday on January 31, many of the protestors had left the area. Prime Minister Justin Trudeau—who is isolating at an undisclosed location after announcing this week he tested positive for COVID-19—said he would not be intimidated by the protestors. The rally notably garnered support from a former US president’s son, Donald Trump Jr., and a tech billionaire, Elon Musk.

COVID-19 MISINFORMATION The music streaming platform Spotify was in the spotlight over the weekend after Canadian music icon Neil Young criticized the service for hosting a podcast by comedian Joe Rogan, who has come under fire for spreading COVID-19 misinformation. Late last week, Young called for his music to be removed from Spotify in protest, and he was later joined by other legendary artists Joni Mitchell and Nils Lofgren. Other popular podcast hosts on Spotify, including Brene Brown and Prince Harry and Meghan Markle, expressed concerns over the platform’s handling of pandemic misinformation. The hashtags #CancelSpotify, #DeleteSpotify, and #ByeSpotify were trending on social media. Spotify removed Young’s music over the weekend, and Spotify Chief Executive Daniel Ek on January 30 published transparency rules, saying the streaming service would add advisories before any content that discusses the virus and link to Spotify’s COVID-19 hub. Rogan responded in a video posted to Instagram, saying he would interview doctors with different opinions right after he talks to “the controversial ones.” WHO Director-General Tedros Adhanom Ghebreyesus thanked Young on Twitter “for standing up against misinformation and inaccuracies around #COVID19 vaccination.”

Meanwhile, in an address to the International Catholic Media Consortium on COVID-19 Vaccines on January 28, Pope Francis said that spreading misinformation and fake news regarding COVID-19 and vaccines constitutes a violation of human rights. His comments were the second time in less than a month that he has addressed misleading information about COVID-19. Pope Francis called on journalists to help the public better understand scientific facts and address the spreading “infodemic.”

COVID Vaccines for 6 month to 5 year olds

Health

Pfizer-BioNTech coronavirus vaccine for children under 5 could be available by the end of February, people with knowledge say

People wait in line in the District for coronavirus testing in December. (Craig Hudson for The Washington Post)

By Laurie McGinley

,

Lena H. Sun

and

Carolyn Y. Johnson

Yesterday at 7:45 p.m. EST

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Coronavirus vaccines for children younger than 5 could be available far sooner than expected — perhaps by the end of February — under a plan that would lead to the potential authorization of a two-shot regimen in the coming weeks, people briefed on the situation said Monday.

Pfizer and its partner, BioNTech, the manufacturers of the vaccine, are expected to submit to the Food and Drug Administration as early as Tuesday a request for emergency-use authorization for the vaccine for children 6 months to 5 years old, which would make it the first vaccine available for that age group. Older children already can receive the shot.

The FDA urged the companies to submit the application so that regulators could begin reviewing the two-shot data, according to the knowledgeable individuals, who spoke on the condition of anonymity because they were not authorized to speak publicly.

The companies in the last few months have been testing a third dose, following disappointing results for the two-shot regimen showing that while the vaccine is safe, two doses did not provide a strong enough immune response in all age groups. But data on a third shot will not be available until at least late March. Once that information is submitted, regulators are expected to authorize a third dose of the pediatric vaccine.

“We know that two doses isn’t enough, and we get that,” said one of the people familiar with the situation. “The idea is, let’s go ahead and start the review of two doses. If the data holds up in the submission, you could start kids on their primary baseline months earlier than if you don’t do anything until the third-dose data comes in.”

Parents fear the omicron surge could mean another lost school year

Entering a third academic year disrupted by the pandemic, and in the midst of another covid-19 wave, parents, students and teachers are near a breaking point. (Jorge Ribas/The Washington Post)

A Biden administration official said there is consensus among health officials in “seeing this move forward,” referring to the plan by Pfizer-BioNTech to submit an application. Last Friday, Pfizer presented updated trial data to federal health officials about the shots, according to an administration official who spoke on the condition of anonymity to discuss a sensitive topic.

The participants in the briefing included Anthony S. Fauci, chief medical adviser for the White House coronavirus response; David Kessler, chief science officer for the response; a representative from the Centers for Disease Control and Prevention; and other officials from the Department of Health and Human Services.

The session included a “robust conversation” that three doses were likely to be much better than two shots, the administration official said. “But to get to three, you have to get two shots first. … There’s interest in seeing this move forward.”

The FDA’s outside advisers are expected to meet on the two-dose application in mid-February. The CDC’s outside experts, members of the Advisory Committee on Immunization Practices, also are expected to convene to consider the issue.

In December, Pfizer and BioNTech announced that two doses of the vaccine in 2-, 3- and 4-year-olds did not trigger an immune response comparable to what was generated in teens and adults. But the two-shot regimen did create a protective immune response in children 6 months to 2 years old. That’s when drugmakers added a third shot to the trial to try to improve the immune response, a crushing blow to many pediatricians and parents who would now have to wait several more months to protect children.

People familiar with the updated two-dose data say the vaccine has a good safety profile in young children and showed an ability to prevent a significant number of covid-19 cases.

But outside experts were eager to see any new data showing how effective the vaccine was. And some worried that any effort to speed access to the shots could backfire by increasing skepticism about vaccines.

In the trial, children between 6 months and 5 years old received two doses of 3-microgram shots, a tenth of the dose given to adults, three weeks apart.

The trial was designed to measure immune responses in younger children after immunization, to see if their responses were comparable to what was reported to be protective in teens and young adults. This approach is called “immunobridging.” It is often used to show that vaccines work and are safe in other age groups — and typically takes far less time than efficacy trials, which enroll more study subjects and wait to see if people who are vaccinated are less likely to fall sick than people who receive a placebo.

Pfizer and BioNTech are expected to provide updated data when they submit their request for authorization to the FDA. There were so many cases of covid-19 during the omicron surge, when the trial was ongoing, that the companies have some data showing how well the vaccine worked to prevent illness.

Outside experts who were not involved in the trial said they would be interested to see what new data Pfizer submitted, but they expressed skepticism that the two-dose data would be enough, if it depended on the likelihood that a third dose would raise the immune response.

“I would say it’s certainly fine to release an under-5 [year-old] covid vaccine on the basis of immunobridging data, but there has to be sufficiently robust immune response,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

Additional data will become available when the company files with the FDA for emergency-use authorization, according to people familiar with the situation.

“At this time, we have not filed a submission and we’re continuing to collect and analyze data from both two and three doses in our younger age cohort,” Pfizer spokeswoman Jerica Pitts said in an email. “As part of our ongoing commitment, we will share new updates as they become available.”

A segment of parents has been trying to push the FDA to move faster on children’s vaccines. A grass-roots group of physicians, parents and advocates called Protect Their Future has collected more than 5,700 signatures on a petition asking for the shots to become available to younger age groups. That includes off-label use of the higher-dose vaccine authorized for 5- to 11-year-olds, or authorization of the vaccine in the youngest children, in whom it triggered a protective immune response.

The American Academy of Pediatrics said parents with children under 5 are facing “an especially challenging moment in this pandemic.”

“We understand the urgent need for a safe and effective vaccine for that age group,” AAP chief executive Mark Del Monte said in a statement. “We are eager to see the data and will continue to follow the science.”

But some doctors said they worry that an effort to accelerate pediatric vaccines could hurt the push to increase uptake of boosters in adults and vaccinations in older children. Kavita Patel, a primary-care physician who worked in the Obama administration, said Monday that the government should avoid any steps that could undermine faith in the shots, considering the extensive skepticism that has dogged inoculation efforts.

While those demanding the vaccine have been vocal, vaccine uptake among children who are already eligible has been slow — and some pediatricians fear that acceptance will be lower in younger age groups. In areas where shots have been available to 5- to 11-year-olds since early November, more than 70 percent of eligible children have not gotten a single shot, according to the Kaiser Family Foundation.

Much of the conversation at the meeting involving Pfizer and the government officials Friday was about whether the manufacturers could ramp up production within the next four weeks to produce enough doses for this population, the administration official said. Pfizer said it could, the official said.

Above is from:  https://www.washingtonpost.com/health/2022/01/31/coronavirus-vaccine-children-under-5/

Omicron’s Successor is on the way?

Explainer-Scientists on alert over rising cases caused by Omicron cousin BA.2

Julie Steenhuysen

Sun, January 30, 2022, 7:06 AM

By Julie Steenhuysen

  CHICAGO (Reuters) - The highly transmissible Omicron variant of the SARS-CoV-2 virus - the most common form of which is known as BA.1 - now accounts for nearly all of the coronavirus infections globally, although dramatic surges in COVID cases have already peaked in some countries.

  Scientists are now tracking a rise in cases caused by a close cousin known as BA.2, which is starting to outcompete BA.1 in parts of Europe and Asia. The following is what we know so far about the new subvariant:

  "STEALTH" SUBVARIANT

  Globally, BA.1 accounted for 98.8% of sequenced cases submitted to the public virus tracking database GISAID as of Jan. 25. But several countries are reporting recent increases in the subvariant known as BA.2, according to the World Health Organization.

  In addition to BA.1 and BA.2, the WHO lists two other subvariants under the Omicron umbrella: BA.1.1.529 and BA.3. All are closely related genetically, but each features mutations that could alter how they behave.

  Trevor Bedford, a computational virologist at Fred Hutchinson Cancer Center who has been tracking the evolution of SARS-CoV-2, wrote on Twitter on Friday that BA.2 represents roughly 82% of cases in Denmark, 9% in the UK and 8% in the United States, based on his analysis of sequencing data from the GISAID database and case counts from the Our World in Data project at the University of Oxford.

  The BA.1 version of Omicron has been somewhat easier to track than prior variants. That is because BA.1 is missing one of three target genes used in a common PCR test. Cases showing this pattern were assumed by default to be caused by BA.1.

  BA.2, sometimes known as a "stealth" subvariant, does not have the same missing target gene. Instead, scientists are monitoring it the same way they have prior variants, including Delta, by tracking the number of virus genomes submitted to public databases such as GISAID.

  As with other variants, an infection with BA.2 can be detected by coronavirus home tests kits, though they cannot indicate which variant is responsible, experts said.

  MORE TRANSMISSIBLE?

  Some early reports indicate that BA.2 may be even more infectious than the already extremely contagious BA.1, but there is no evidence so far that it is more likely to evade vaccine protection.

  Danish health officials estimate that BA.2 may be 1.5 times more transmissible than BA.1, based on preliminary data, though it likely does not cause more severe disease.

  In England, a preliminary analysis of contact tracing from Dec. 27, 2021, through Jan. 11, 2022, by the UK Health Security Agency (HSA) suggests that household transmission is higher among contacts of people infected with BA.2 (13.4%) compared with other Omicron cases (10.3%).

  The HSA found no evidence of a difference in vaccine

, according to the Jan. 28 report.

  A critical question is whether people who were infected in the BA.1 wave will be protected from BA.2, said Dr. Egon Ozer, an infectious disease expert at Northwestern University Feinberg School of Medicine in Chicago.

  That has been a concern in Denmark, where some places that saw high case counts of BA.1 infections were reporting rising cases of BA.2, Ozer said.

  If prior BA.1 infection does not protect against BA.2, "this could be sort of a two-humped camel kind of wave," Ozer said. "It's too early to know if that will happen."

  The good news, he said, is that vaccines and boosters still "keep people out of the hospital and keep people from dying."

  (Reporting by Julie Steenhuysen; Editing by Bill Berkro

Above is from:  https://www.yahoo.com/news/explainer-scientists-alert-over-rising-130643664.html

January 27, 2022: Johns Hopkins COVID Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Natasha Kaushal, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.

From the Center: Call for Papers—Special Feature on Climate Change and Health Security: Health Security will devote a special feature to climate change and its impact upon national and global health security. We encourage submissions of original research articles, case studies, and commentaries, on topics including climate change-related public health emergencies; public health emergency management and climate change; displacement of populations and the health impact of climate change, and more. All manuscripts should be submitted for consideration by March 21, 2022. Learn more here: https://home.liebertpub.com/cfp/special-feature-on-climate-change-and-health-security/378/

EPI UPDATE The WHO COVID-19 Dashboard reports 357 million cumulative cases and 5.61 million deaths worldwide as of January 26. Global weekly incidence increased again last week, up 11.03% over the previous week. This is the 14th consecutive week of increasing weekly incidence, setting another new record with 22.77 million new cases. The Omicron variant drove the greatest percentage increases in the WHO regions of Eastern Mediterranean (+38.58%), South-East Asia (+36.05%), Europe (+19.29%), and the Western Pacific (+1.26%). Both Africa (-31.04%) and the Americas (-2.01%) experienced declines in weekly incidence.

While there is optimism among some public health experts that the rapid rise and fall of the Omicron surge in some regions could usher in an end to the pandemic, the WHO determined last week that the COVID-19 pandemic continues to constitute a Public Health Emergency of International Concern (PHEIC). Other experts warn that as long as the threat of new variants exists, calls for reaching COVID-19 endemicity are misguided.

Meanwhile, global weekly mortality increased for the third week, up 8.49% from the previous week with 53,935 total deaths. The Pan American Health Organization (PAHO) on January 26 warned that the average number of COVID-19-related deaths is up 37% in the region over the previous week.

Global Vaccination

The WHO reported 9.68 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of January 26. A total of 4.7 billion individuals have received at least 1 dose, and 4.0 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations continues to decrease, down to 25.08 million on January 26 from a recent high of 38.88 million on December 23.* Our World in Data estimates that there are 4.78 billion vaccinated individuals worldwide (1+ dose; 60.79% of the global population) and 4.12 billion who are fully vaccinated (52.3% of the global population).

*The average daily doses administered may exhibit a sharp decrease for the most recent data, particularly over the weekend, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent data.

UNITED STATES

The US CDC is currently reporting 72.3 million cumulative cases of COVID-19 and 870,195 deaths. The US is averaging 627,294 new cases—down from 726,941 on January 20—and 2,246 deaths per day—up from 1,860 one week ago and at the highest level since mid-February 2021.*

*Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.

COVID-19 hospitalizations in the US are down 7.7% this week over last, with a 7-day average of 19,640 new hospitalizations per day. The recent surge in current hospitalizations appears to have peaked around January 19, down 1.7% to an average of 142,194 for the week ending January 24. According to analysis from The New York Times, the overall downward trend in hospitalizations belies the reality in some regions, where the number of cases and hospitalizations continue to grow significantly.

US Vaccination

The US has administered 537.2 million cumulative doses of SARS-CoV-2 vaccines. The trend in daily vaccinations continues to decline, down significantly from a recent high of 1.77 million doses per day on December 6 to 760,975 on January 21.*

A total of 251.5 million individuals have received at least 1 vaccine dose, equivalent to 75.8% of the entire US population. Among adults, 87.6% have received at least 1 dose, as well as 25.3 million children under the age of 18. A total of 210.9 million individuals are fully vaccinated**, which corresponds to 63.5% of the total population. Approximately 73.9% of adults are fully vaccinated, as well as 19.9 million children under the age of 18. Since August 13, 85.2 million fully vaccinated individuals have received an additional or booster dose. An estimated 43.5% of fully vaccinated individuals have received a booster, including 63.3% of fully vaccinated adults aged 65 years or older.

*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.

**Full original course of the vaccine, not including additional or booster doses.

GLOBAL VACCINE GAP US officials announced on January 26 that the government has shipped a total of 400 million SARS-CoV-2 vaccine doses to 112 countries, part of its efforts to fulfill its pledge to donate 1.2 billion doses. At a briefing, White House COVID-19 Coordinator Jeff Zients noted that the US has donated 4 times more doses than any other country. Still, 5 billion to 6 billion doses are needed in low- and middle-income countries to help protect them against COVID-19, and vaccine access gaps in those areas create fertile grounds for the emergence of new, possibly more dangerous, SARS-CoV-2 variants, the WHO has warned. The divide is stark: about 78% of people in high- and upper-middle-income countries have received at least one dose of vaccine compared with about 10% in low-income nations. According to calculations from the International Monetary Fund (IMF), 86 of 206 countries had immunized less than 40% of their populations as of the end of 2021, far from the fund’s goal of vaccinating 70% of the world’s population in the first half of this year. Experts agree that vaccine inequities led to the emergence of the Omicron variant and warn of future variants if a concerted global effort is not undertaken to manufacture, distribute, and administer more vaccines to prevent the virus from circulating among the unvaccinated. A group of Democratic US lawmakers is calling for the government to immediately provide an additional US$17 billion for global vaccination delivery and infrastructure and to streamline federal efforts to coordinate the nation’s global COVID-19 strategy. Some experts say additional funding could be useful but drumming up international political will is more important. Others warn the next variant—if it is capable of immune evasion—could be like starting from scratch.

US HEALTHCARE UTILIZATION The Omicron variant of concern (VOC) has caused massive surges in COVID-19 cases and, subsequently, in people seeking healthcare. A recent study published in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) examined hospital-associated disease severity markers, including ICU admissions, length of stay, and death. The study found that disease severity, measured by US healthcare utilization, appeared to be lower during the Omicron VOC surge compared to both the Delta VOC surge and the previous winter season. ICU admissions during the beginning of the Omicron surge were 26% lower and 29% lower than during the Delta and winter 2020-2021 surges, respectively. Mean length of hospital stay was also comparatively lower. However, due to the massive number of positive cases, overall staffed hospital bed usage was 7% higher than during Delta and 3% higher than during winter 2020-2021.

The study was not able to directly assess the impact that vaccines had on disease severity markers or hospital stay lengths, but the authors posit that decreased admissions to the ICU and lower overall hospital stays during the Omicron surge can likely be attributed to higher vaccine coverage as well as higher levels of infection-acquired immunity. Supporting this hypothesis, high relative increases in hospital admittance were only observed in children 0- to 4-years-old who are currently not eligible for vaccination. Although people infected with Omicron appeared to require less intensive care at the hospital level, the sheer number of cases and burden on the healthcare system overall required significant resources and resulted in severe strain. The authors state that this analysis “underscores the importance of national emergency preparedness, specifically, hospital surge capacity and the ability to adequately staff local health care systems.”

HEALTHCARE WORKER BURNOUT As the world enters its third year of response to the COVID-19 pandemic, burnout in the global healthcare workforce continues to grow. In the US, a rapid increase in the number of COVID-19 cases due to the Omicron variant of concern (VOC) has led to a record surge of individuals requiring medical attention across healthcare settings. In California, hospitals have canceled operations and other elective procedures and ambulances have experienced backlogs for patient delivery. Healthcare professionals warn that the continued high intensity of care, a limited amount of life-saving countermeasures, and a large number of staff out sick are creating a continuously stressful work environment. Notably, the country has experienced a mass exodus of healthcare workers. In the Southern US, this trend has hit nonprofit safety-net hospitals particularly hard, reducing the capacity of necessary resources for many throughout the region. Earlier this year, the US Department of Health and Human Services (HHS) announced that US$103 million of funding from the American Rescue Plan will be committed to strengthening resilience and addressing burnout in the domestic healthcare workforce. However, STAT reports that another fund meant to support hospitals and clinics during the pandemic has run out of money, after the Biden administration quietly redirected nearly US$7 billion from the fund and used it to buy SARS-CoV-2 vaccines and therapeutics.

Workforce mental health issues are not exclusive to the US. Researchers in Canada analyzed anonymous data from 34,000 physicians working in Ontario. The analysis found a 27% increase in the number of doctors seeking care for burnout or substance misuse in the first year of the pandemic compared with the prior year. Burnout of nurses and other healthcare professionals is a universal issue and has led to wealthier countries recruiting healthcare workers from other less-wealthy countries. This phenomenon has intensified during the Omicron surge, raising many questions about the ethics of the practice.

US VACCINE REQUIREMENTS FOR LARGE EMPLOYERS The US Department of Labor’s Occupational Safety and Health Administration (OSHA) on January 25 withdrew its emergency temporary standard (ETS) that called for employers with 100 or more workers to require their employees to be vaccinated for COVID-19 or undergo regular testing and wear face masks while at work. The withdrawal, which took effect January 26, follows the US Supreme Court’s January 13 opinion that halted enforcement of the rule. In a 6 to 3 decision, the justices concluded that OSHA overstepped its authority in issuing the requirement covering 84 million workers and issued a stay pending a decision from the US Court of Appeals for the Sixth Circuit. Though OSHA withdrew the requirement as an enforceable emergency regulation, the agency said it is maintaining the ETS as a proposed rule. On its website, OSHA stated it is “prioritizing its resources to focus on finalizing a permanent Healthcare Standard” and that it continues to “strongly encourage” workers to be vaccinated.

ISRAEL Israel’s Ministry of Health on January 25 said its vaccine advisory panel has recommended making all adults eligible to receive a fourth dose of SARS-CoV-2 vaccine. If the ministry approves the recommendation, it would be the first country in the world to make a fourth vaccine dose available to all adults. Israel already offers fourth doses to people aged 60 and older, healthcare workers, and people with compromised immune systems. About 600,000 Israelis have already received a fourth dose. Over the weekend, the health ministry shared preliminary data from its own researchers suggesting a fourth dose provides 3 to 5 times as much protection against severe disease in older adults when compared with those in the same age group who had received a booster dose at least 4 months prior. It is not clear when the ministry’s director-general will decide on the panel’s recommendation. Israel is in the midst of a surge in new COVID-19 cases driven by the Omicron variant.

POST-ACUTE SEQUELAE Researchers continue work to learn more about the clinical presentation and duration of persistent symptoms of SARS-CoV-2 infection, known as post-acute sequelae of COVID-19 (PASC) or “long COVID.” Prevalence of the condition—which is characterized by fatigue, shortness of breath, brain fog, stress and anxiety, and other symptoms that last for weeks or years after acute infection—is unknown but estimated to be between 7% to 80% of recovered patients. A study published this week in Cell suggests an association between the development of long COVID and 4 factors, including the presence of certain autoantibodies that mistakenly turn on the body’s own tissues, reactivation of previous Epstein-Barr virus infection, viral load levels in early infection, and having Type 2 diabetes. Because 2 of the factors are virus levels in the blood, the researchers speculate that antiviral administration early in SARS-CoV-2 infection might help lower the risk of longer-lasting symptoms in some people. However, authorized antivirals in the US are in very short supply and difficult to obtain. Additionally, preliminary data from Israel and the UK suggest that people who were fully vaccinated when infected were much less likely to report long COVID symptoms than people who were unvaccinated when infected. Other studies are looking at ways to predict who might be at risk of long COVID and underlying causes of the condition.

In the US, 2 Democratic lawmakers this week sent a letter to the US CDC requesting the agency release data on the number of Americans with long COVID, including information on race, gender, and age. The lawmakers, healthcare providers, and experts nationwide say more data are needed on how many people suffer from long-term symptoms in order to better target resources and provide a more equitable recovery from the pandemic. A recent article published in Nature Medicine examined inequities in understanding and addressing neurological complications of COVID-19 among marginalized US communities, with the authors calling for more equity in COVID-19 research and “a dismantling of structural barriers that perpetuate disparities in clinical care.” Advocates and health experts are pressuring the government for more attention on long COVID, including greater financial assistance, access to disability benefits, and improved healthcare. The US National Institutes of Health (NIH) early last year launched an initiative to identify the causes and means of prevention and treatment of long COVID, but the research is expected to take years. Some say the condition could be contributing to a worker shortage in the US, with a recent analysis from the Brookings Institution estimating that long COVID could account for 15% of the nation’s 10.6 million unfilled jobs.

VACCINATION & FERTILITY New research provides evidence that SARS-CoV-2 vaccination has no negative impact on reproduction—whether conception is achieved through heterosexual intercourse or in vitro fertilization—but men who become infected with the virus appear to have a short-term decline in fertility. In a study published in the American Journal of Epidemiology, researchers from the Boston University School of Public Health found no association between vaccination of males or females with any of the vaccines available in the US—Pfizer-BioNTech, Moderna, or J&J-Janssen—and the likelihood of conception, with fertility rates among female participants with at least 1 dose of vaccine almost identical to rates among unvaccinated female participants. In the same study, researchers report that men who tested positive for SARS-CoV-2 within 60 days of a woman’s menstrual cycle had reduced fertility when compared with men who never tested positive or who tested positive at least 60 days prior to the cycle. Previous research has linked COVID-19 in men to poor sperm quality and other reproductive dysfunction. A separate study, published in Obstetrics & Gynecology, showed that IVF patients who were vaccinated had similar fertilization rates compared with unvaccinated patients after undergoing controlled ovarian hyperstimulation, single frozen-thawed embryo transfer, and other procedures such as egg or mature oocyte retrieval. Additionally, both groups had similar rates of early pregnancy loss. These studies provide further evidence that SARS-CoV-2 vaccination is safe for people who are trying to conceive. The CDC and other medical groups recommend all people trying to become pregnant to get vaccinated.

Separate studies—including one conducted in the US and another in Norway—showed that vaccination can change menstruation cycles, but the impacts are short-lived and small when compared to natural variation. All of the data should be reassuring to pregnant people and those trying to become pregnant as well as the approximately two-thirds of US parents who cite future fertility as a concern when it comes to vaccinating younger children ages 5 to 11. The vaccination rate among this latter cohort remains quite low in the US and the rates vary widely among US states. 

OMICRON-SPECIFIC VACCINES Moderna announced on January 26 it has begun a Phase 2 clinical trial testing an Omicron variant-specific booster candidate. The study will evaluate the booster in 2 cohorts of participants: individuals who received the 2-dose primary series of the company’s mRNA vaccine and individuals who received the primary series plus a 50 µg booster dose. Moderna also announced the publication of neutralizing antibody data against the Omicron variant 6 months after receipt of the authorized booster dose. The study, published in the New England Journal of Medicine (NEJM), shows that the authorized 50 µg booster dose increased Omicron neutralizing titers to 20-fold higher than peak Omicron titers post-dose 2. However, 6 months later, Omicron neutralization declined 6.3-fold from peak titers at day 29 post-boost but remained detectable in all participants. Neutralizing titers against Omicron declined faster after the booster than for the wild-type virus.