November 17, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

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

NON-PUBLISHING NOTICE The Situation Report will not be published next week, Thursday, November 24, in observance of the US Thanksgiving Day holiday. We will resume publication on Thursday, December 1.

CALL FOR PAPERS Together with the 2022 Preparedness Summit Planning Committee, the Johns Hopkins Center for Health Security journal, Health Security, will publish a new supplement in 2023. The aim of this supplement is to extend conversations begun at the 2022 Preparedness Summit to contribute to a growing body of knowledge about the COVID-19 pandemic and its impact on public health preparedness. Potential authors are encouraged to submit manuscripts that consider how the COVID-19 pandemic is transforming public health preparedness policy and practice and discuss the future of the field. The deadline for submissions is January 17, 2023. More information is available here: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/index.html

EPI UPDATE The WHO COVID-19 Dashboard reports 633.3 million cumulative cases and 6.59 million deaths worldwide as of November 17. Global weekly incidence increased significantly for the first time since August, rising 5% compared to a decrease of 10% the previous week. A total of 2.4 million cases were confirmed the week of November 7. Weekly incidence fell over the previous week in Europe (-15%) and the Eastern Mediterranean (-12%) and remained steady in Africa (0.42%). The Americas (+17%), South-East Asia (+15%), and Western Pacific (+18%) regions experienced increasing weekly incidence. Global weekly mortality declined from the previous week, down 26%, reaching the lowest level since the beginning of the pandemic.*

*The WHO dashboard notes that data from the Eastern Mediterranean and Africa regions are incomplete.

UNITED STATES

The US CDC is reporting 97.9 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending November 2 rose slightly over the previous week, rising to 288,989 from 273,021 for the week ending November 2. Weekly mortality remained relatively steady for the week ending November 9, down slightly to 2,344 reported deaths from 2,489 deaths the week ending November 2.**

**The US CDC updates weekly COVID-19 data on cases and deaths on Thursdays by 8pm ET.

Both new hospital admissions and current hospitalizations remained stable, falling slightly by 0.9% and 0.8%, respectively.

The BA.5 sublineage is expected to lose dominance in the US over the next week. BA.5 now accounts for 29.7% of sequenced specimens. The Omicron sublineages BQ.1.1 (24.1%) and BQ.1 (20.1%) are exhibiting growth advantages over other sublineages, including BF.7 (7.8%) and BA.4.6 (5.5%). The CDC is now tracking the Omicron sublineage BN.1, which is now responsible for 4.3% of cases. Other Omicron sublineages appear to be declining in prevalence, including BA.5.2.6 (2.9%), BA.2.75 (1.2%), and BA.2.75.2 (0.9%).

US RESPONSE The Biden administration is expected to keep in place the public health emergency status of the COVID-19 pandemic through spring 2023 to address a potential winter surge in cases and provide more time to transition vaccines and treatments to the private market, according to 2 unnamed officials. The declaration, most recently renewed in October, was set to expire in January. The US HHS has promised to provide states 60 days’ notice before winding down the emergency, and did not do so on November 11, which marked that date. This week, the White House requested the US Congress authorize an additional US$9.25 billion in pandemic funding for this year. According to officials, about US$8.25 billion would go toward purchasing treatments and vaccines ahead of a possible winter surge, efforts to accelerate research into next-generation vaccines and treatments, and long COVID research, with an additional US$1 billion going toward global vaccination and response efforts. The Biden administration has repeatedly tried to secure additional funding with no success; observers say the best chance might be during the current lame-duck session while Democrats retain control of both congressional chambers.

Though the need remains for additional spending for COVID-19 and general pandemic preparedness and response, public and congressional interest is waning. On November 15, the US Senate voted 62-36 to end the emergency declaration, with support from 12 Democrats. In response, the Office of Management and Budget said abruptly ending the emergency would be “a reckless and costly mistake” and noted US President Joe Biden would veto the measure if passed by Congress. It is unclear whether the US House will take up the resolution.

WINTER SURGE PREDICTIONS The WHO on November 16 announced that the worldwide number of new COVID-19 cases increased last week for the first time in 4 months, warning that the true number of infections is likely higher due to declines in testing. Additionally, upticks in influenza and respiratory syncytial virus (RSV) cases also are straining hospitals, particularly some countries in the Americas.

While many in the US work to find balance between COVID-19 precautions and returning to a sense of normalcy, there are signs the coronavirus has not gone away. The number of new weekly COVID-19 cases are beginning to increase, raising concerns over a potential winter surge amid waning immunity and the emergence of new subvariants. About 330 people die of COVID-10 each day in the US, and around 21,000 are hospitalized with COVID-19 on any given day. Despite low levels of uptake of the bivalent booster vaccine—only 10% of the population aged 5 and older have received the updated shot—some US health officials, including White House COVID-19 Response Coordinator Dr. Ashish Jha, say they are not expecting a large surge in cases during the winter holiday season. Dr. Jha is confident that broad vaccine coverage and widespread previous infections will help keep a large surge at bay. Other experts are not so assured, saying the possibility remains for a substantial surge, with several factors making the US underprepared. Declining support for community vaccination campaigns, a public that is tuning out renewed government vaccination messaging, few remaining treatments effective against emerging Omicron sublineages, waning use of nonpharmaceutical interventions (NPIs) such as mask use, and diminishing surveillance place the US in uncharted territory heading into what is traditionally the height of respiratory virus season.

MODERNA BIVALENT BOOSTER On November 14, Moderna announced data showing its updated Omicron BA.4/BA.5-adapted bivalent vaccine booster offers a strong immune response against BA.5 by increasing antibodies levels, when compared to the company’s original booster. The bivalent vaccine (mRNA-1273.222) demonstrated a 15-fold increase in neutralizing antibody titers compared to pre-booster levels. The data are not yet peer-reviewed or posted to a preprint server. An exploratory analysis of data from 40 participants suggested both of the company’s bivalent boosters—with the other targeting BA.1 (mRNA-1273.214)—showed robust levels of neutralizing antibodies against the emerging Omicron subvariant BQ.1.1, which has the potential to become dominant in the US by next week. Notably, however, the demonstrated antibody responses were lower than those against BA.4 and BA.5. Since Omicron-adapted booster shots began to rollout earlier this fall, acceptance and uptake has been dismal. Only 10% of the US population aged 5 and older have received an updated booster, spurring the Biden administration to launch a new campaign urging residents to get boosted ahead of Thanksgiving.

COVID-19 REBOUND Cases of COVID-19 rebound—the return of test positivity or symptoms after clearance or resolution—following treatment with the antiviral Paxlovid appear to be more common than previously believed, a preprint study posted November 15 to medRxiv suggests. The prospective observational study, which is not yet peer-reviewed, found that viral rebound among the 127 participants who took a 5-day course of Paxlovid was 14.2%, while 9.3% of the control group of 43 people experienced viral rebound.  There were no significant differences in viral rebound by demographics, pre-existing conditions, or major symptoms experienced during the acute phase or at 1 month. Additionally, COVID-19 symptom rebound incidence was higher in the Paxlovid group (18.9%) compared with the control group (7.0%). Though the study was not able to determine whether the observed differences were due to chance or as a result of treatment, many researchers agree the results mirror their real-life experiences that rebound is more common in people who take Paxlovid.

Larger studies are being planned to better understand the issue, which hopefully will help alleviate one of the causes for underprescription of Paxlovid. High-profile cases of rebound likely are contributing to underuse of the treatment. In clinical trials, Paxlovid was nearly 90% at preventing hospitalizations and deaths of high-risk patients with COVID-19. Notably, another preprint study suggests treatment with Paxlovid is associated with a 26% reduction in the occurrence of post-acute symptoms, commonly known as long COVID.

PASC/LONG COVID Although many people with COVID-19 recover within weeks, some continue to experience a constellation of symptoms—or start experiencing new ones—that can last long after their acute infection. The US CDC has recognized that post-acute sequelae of SARS-CoV-2 infection (PASC), commonly called long COVID, includes new or ongoing symptoms such as fatigue, brain fog, shortness of breath, headaches, chest pain, loss of taste or smell, and more. Notably, however, there is no widely accepted definition of the condition, often leaving clinics wrestling with how to treat long COVID patients with varying conditions.

To understand the prevalence of post-COVID-19 symptoms, a recent cross-sectional cohort study published inJAMA Network Open compared the presence of post-COVID symptoms in 360 hospitalized and 308 nonhospitalized patients at 2 healthcare centers in Madrid, Spain, 2 years after their initial acute infection early in the pandemic. The study reported that 2 years after initial infection, 59.7% of those who were hospitalized and 67.5% of those who were not hospitalized still had at least one symptom of COVID-19, with the most prevalent symptoms being fatigue (44.7% vs. 47.7%, respectively), pain and headaches (35.8% and 29.9%, respectively), and memory loss (20% and 15.9%, respectively). Overall, the research team observed no significant differences in post–COVID symptoms between hospitalized and nonhospitalized patients, although hospitalized patients experienced slightly higher levels of anxiety.

Similarly, a recent study published inPLOS Medicine investigated post-COVID-associated morbidity in children, adolescents, and adults using comprehensive healthcare data on half of the German population. The study determined that children, adolescents, and adults have the same relative risk of experiencing post-COVID-19 symptoms 90 days after their initial acute infection. Children, adolescents, and adults experienced shared symptoms like cough, fever, headache, malaise/fatigue/exhaustion, and throat or chest pain. Adults were slightly more likely to experience disturbances of smell and taste, fever, and respiratory symptoms, while children and adolescents were slightly more likely to experience malaise, fatigue/exhaustion, cough, throat or chest pain, and adjustment disorder.

This growing evidence base around the characterization and prevalence of long COVID can help inform efforts to support people whose symptoms have a significant impact on their lives. Although the US HHS and US Department of Justice have jointly declared long COVID as a disability, some Americans with long COVID have facedbarriers to accessing disability benefits. Long COVID-related disability assistance is frequently denied due a lack of specific guidance on how to evaluate the claims and lack of standard processes for diagnosing the condition. HHS in August released a report outlining federal services and support for people with long COVID, and advocates and researchers are working to raise awareness of these resources. A recent report from the Brookings Institution estimated that long COVID could be contributing to a national labor shortage, with as many as 4 million people out of work due to the condition.

VACCINE MANDATES Vaccine mandates—for COVID-19 and other diseases—are contentious issues in the US. On several occasions, the US Supreme Court has refused to hear arguments or let lower court rulings stand, allowing COVID-19 vaccine mandates to remain in force. Now, the Blackfeet Nation ischallenging a Montana law that prohibits businesses and governments from discriminating against people who are not vaccinated against COVID-19 or other diseases, after a meeting on the Blackfeet Indian Reservation that checked attendees’ COVID-19 vaccination status came under scrutiny for potentially violating state law. The case raises the question of whether Montana can enforce its law on the Blackfeet Nation, superseding the tribe’s right to enforce its own ordinances as a sovereign nation within US borders to protect the health of its people. A 1855 treaty allows the Blackfeet tribe to regulate tribal and nontribal members alike on its land. The US CDC haslauded Blackfeet Nation for implementing effective COVID-19 risk mitigation and prevention measures. Relatedly, a separate lawsuit argues that Montana’s law is unconstitutional and prevents hospitals and physicians from protecting disabled patients and employees from exposure to COVID-19.

VACCINE APPROVAL PROCESS IN INDIA India’s national drugs regulator approved a domestically developed vaccine for COVID-19—Covaxin, produced by Bharat Biotech—despite discrepancies in the number of clinical trial participants, questionable changes to trial protocols, and efforts to speed trials along without complete data on safety and efficacy, according to a report from STAT. A lack of transparency surrounding the vaccine’s development efforts, questions over Bharat Biotech’s manufacturing facilities, as well as political and scientific pressure to move testing forward contribute to ongoing concerns over Indian government oversight of and commitment to producing quality medical products. A day after the STAT report’s publication, India’s Health Ministry said any allegations that the government made missteps or rushed Covaxin’s development and testing are “completely misleading, fallacious, and ill-informed,” and Bharat Biotech called the narrative misleading, clarifying that any pressure felt originated within the company. Bharat Biotech also reiterated that Covaxin is safe and effective, having been tested more than any other Indian vaccine and with several million doses administered worldwide.

India’s pharmaceutical industry is one of the world’s largest by volume, exporting medicines to more than 200 countries and contributing a large volume of generic drugs, especially in the US. Last month, the WHO linked an Indian-made cough syrup to the deaths of nearly 70 children in West Africa; India’s drugs regulator disputed the WHO’s findings.

Is Beloit billionaire well repaid for political contributions?

DIANE HENDRICKS 2022 Cycle Contributions: $22.6 million Net Worth: $12.5 billion

The founder of a Wisconsin- -based building-supply company, Hendricks has largely concentrated her political giving on her home state. She is the biggest donor—of almost $16 million—to a single-candidate super PAC supporting Wisconsin’s Republican senator, Ron Johnson. Hendricks and fellow Wisconsinconnected billionaires the Uihleins (see above) have provided over three-quarters of the funding for this super PAC backing Johnson, whose work on tax legislation in 2017 financially benefited her with a tax break worth $36 million in 2018 alone. For Johnson’s 2016 reelection Hendricks contributed (along with the Uihleins) a combined $20 million on the Senator’s 2016 reelection. Hendricks is also one of the largest contributors to Club for Growth Action, kicking in $4.5 million this cycle.

Above is from:  https://americansfortaxfairness.org/wp-content/uploads/BILLIONAIRE-MONEY-REPORT-11_2.pdf

November 3, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

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

CALL FOR PAPERS Together with the 2022 Preparedness Summit Planning Committee, the Johns Hopkins Center for Health Security journal, Health Security, will publish a new supplement in 2023. The aim of this supplement is to extend conversations begun at the 2022 Preparedness Summit to contribute to a growing body of knowledge about the COVID-19 pandemic and its impact on public health preparedness. Potential authors are encouraged to submit manuscripts that consider how the COVID-19 pandemic is transforming public health preparedness policy and practice and discuss the future of the field. The deadline for submissions is January 17, 2023. More information is available here: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/index.html

PhD APPLICATION OPEN In a world of rapid innovation in the biological sciences, the emergence of new diseases, and changing environmental pressures, health security risks to the global community are a rising concern. The field of health security has a growing need for trained experts who can provide science-based solutions and inform global policies to shape preparedness and response efforts. Selected students, with interest in pandemics and global catastrophic biological risks (GCBRs), will receive full funding to complete their PhDs in the Health Security track within the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health and Engineering. More information and application details can be found https://www.centerforhealthsecurity.org/our-work/education/#phd. The application deadline is December 1, 2022.

EPI UPDATE The WHO COVID-19 Dashboard reports 628 million cumulative cases and 6.57 million deaths worldwide as of November 2. Global weekly incidence dropped for a second week after remaining steady for 6 weeks, falling 14% compared with the previous week to 2.5 million new cases. Weekly incidence fell over the previous week in Africa (-40%), Europe (-29%), and the Eastern Mediterranean (-8%); remained relatively steady in South-East Asia (-2%); and increased slightly in the Americas (+5%) and Western Pacific (+5%). Global weekly mortality decreased slightly from the previous week, down 4%.

UNITED STATES

The US CDC is reporting 97.3 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending October 26 remained relatively steady over the previous week, rising to 265,839 reported cases from 261,315 cases for the week ending October 19. Weekly mortality also remained relatively steady for the week ending October 26, up slightly to 2,649 reported deaths from 2,591 deaths the week ending October 19.**

**Beginning October 20, the US CDC began reporting and publishing aggregate case and death data, and line level data where applicable, from jurisdictional and state partners on a weekly basis rather than daily. As a result, COVID-19 data on cases and deaths are updated every week on Thursdays by 8pm ET.

Both new hospital admissions and current hospitalizations appear to have leveled over the past week, rising slightly by 2.1% and 0.1%, respectively.

The BA.5 sublineage continues to be the dominant strain in the US, accounting for 49.6% of sequenced specimens, but its estimated prevalence appears to be decreasing more rapidly now. The Omicron sublineages BQ.1 (14%) and BQ.1.1 (13.1%) are exhibiting growth advantages over other sublineages, including BA.4.6 (9.6%) and BF.7 (7.5%). Several other Omicron sublineages continue to exhibit increasing or steady trends, including BA.5.2.6 (2.8%), BA.2.75 (1.8%), and BA.2.75.2 (1.2%).

LONG COVID/PASC Post-acute sequelae of SARS-CoV-2 infection (PASC), commonly referred to as long COVID, continues to pose a heavy yet poorly understood toll on an uncertain proportion of individuals previously infected with SARS-CoV-2. Healthcare providers, scientists, and long COVID patients are hunting for answers regarding the condition, which cuts across all demographic groups and COVID-19 disease severities.

A group of international researchers published a commentary in Nature Reviews Nephrology highlighting recent studies indicating that long COVID increases the risk of adverse long-term kidney events and can have negative effects on the cardiovascular, hematological, and neurological systems, as well as on mental health and glycometabolism. Given the likelihood that long COVID will lead to new noncommunicable diseases in millions of people despite vaccine-mediated protection, the authors call for governments, health systems, and researchers to further investigate prevention and treatment of long COVID, in addition to building health systems capacity for the expected future noncommunicable disease burden. Notably, the US National Institute of Health’s (NIH) RECOVER Initiative has announced a new clinical trial testing Paxlovid as a treatment for long COVID in collaboration with Duke Clinical Research Institute.

A new systematic review from the European Centre for Disease Prevention and Control (ECDC) attempted to better characterize the prevalence of long COVID, stratified by initial COVID-19 disease severity, utilizing recruitment setting as a proxy indicator. Across 74,213 patients from 61 cohort studies in 15 countries assessed at least 12 weeks after initial SARS-CoV-2 infection, at least one long COVID symptom was found in 50.6% (95% CI: 41.1% to 60.2%) of patients recruited in community settings, 66.5% (95% CI: 56.0% to 76.3%) of patients recruited in hospital settings, and 73.8% (95% CI: 62.3% to 83.9%) of patients recruited in intensive care unit (ICU) settings. Prevalence of individual long COVID symptoms (specifically fatigue, shortness of breath, depression, headache, and dizziness) were higher among hospital settings than community settings. While the study only included patients infected pre-Omicron and did not include uninfected individuals as a control, this investigation—one of the largest studies of long COVID—indicates that the burden of the condition is greater than previously estimated and suggests long COVID symptoms may be worse for patients with more severe COVID-19 disease.

Similarly, a study published October 27 in JAMA Network Open assessed the prevalence of COVID-19 symptoms lasting longer than 2 months past infection in 16,091 US survey respondents between February 5, 2021, and July 6, 2022, as well as potential associations between long COVID and sociodemographic factors, prior vaccination status, and predominant variant at the time of infection. According to the results, 14.7% of respondents reported COVID-19 symptoms at least 2 months after infection, reflecting 13.9% of the previously infected US adult population after reweighting. Notably, further analysis indicated that female gender (adjusted odds ratio: 1.91; 95% CI, 1.73-2.13) and older age per decade above 40 years (adjusted odds ratio: 1.15; 95% CI, 1.12-1.19) may be associated with long COVID development, while risk may be less among those who received primary vaccination series prior to infection (odds ratio, 0.72; 95% CI, 0.60-0.86), individuals with a graduate education vs high school or less (adjusted odds ratio, 0.67; 95% CI, 0.56-0.79), and urban vs rural residence (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86). Compared with ancestral COVID-19, infection during periods when the Epsilon variant (OR, 0.81; 95% CI, 0.69-0.95) or the Omicron variant (OR, 0.77; 95% CI, 0.64-0.92) predominated in the US was also associated with lower risk of long COVID symptoms.

VACCINE BOOSTERS With a worrisome mix of SARS-CoV-2 Omicron sublineages expected to drive another cold-weather surge of COVID-19 cases, experts in the US are encouraging people to get vaccinated and boosted using the new bivalent shots. Notably, however, only 7.3% of the US population aged 5 years and older have received the updated boosters, which target both the original SARS-CoV-2 viral strain and the BA.4 and BA.5 Omicron subvariants. Experts expect the new shots to help provide broad protection against these and newly emerging sublineages. Several recent studies posted as preprints—one each from research teams led by scientists from Columbia University Vagelos College of Physicians and Surgeons, Emory University School of Medicine, the University of Texas Medical Branch, and two led by researchers from Beth Israel Deaconess Medical Center—show that the new bivalent BA.5/4 boosters performed as well as or better than the original boosters and have the potential for BA.5 neutralization 4-fold higher than the original booster. These data, taken together with a study published in Science Immunology showing that booster doses (original) help improve neutralizing antibodies without strongly affecting cellular immune responses, further underline the necessity of booster shots to help strengthen waning immunity and protect against severe disease and death from COVID-19.   

NON-NEEDLE VACCINE ADMINISTRATION The administration of vaccines through oral or nasal delivery routes offers several probable advantages, including the potential for stimulating immune reactions that could prevent transmission or symptomatic infection. Additionally, needle-free administration could make vaccination more accessible to countries with limited health infrastructure that have struggled with traditional vaccine administration in the past. Plus, those wary of needles could be persuaded to get vaccinated. The Chinese city of Shanghai last week began the rollout of what is believed to be the world’s first inhalable SARS-CoV-2 vaccine. Administration takes less than 20 seconds: a mist containing the vaccine is inhaled slowly through the mouth, then patients hold their breath for five seconds. The CanSino Biologics vaccine was approved in September as a booster dose, but the effectiveness of the inhaled vaccine is not known.

Researchers around the world are investigating another non-needle application, nasal administration. Nasal vaccines, administered through drops or sprays, could offer fast-acting protection, aimed at targeting virus cells where they first take hold in the lining of the nose and throat. Vaccines delivered intranasally differ from traditional vaccines, however, in that they are short-lived compounds aimed at blocking the virus’s ability to enter cells rather than building long-term immunity. They would require frequent application to fully coat the surface where viral cells may enter and likely would need to be used on a regular basis. Regulators in India approved a nasal vaccine in September, but it is not yet in use and efficacy data have not been released. Notably, Oxford and AstraZeneca’s attempt at nasal vaccine administration did not yield significant protection in first-phase human clinical trials. The small trial, which included 30 previously unvaccinated individuals and 12 participants who had received a primary 2-dose vaccination, elicited mucosal membrane antibody responses in only a minority of participants.

A study published October 27 in Science tested an approach the Yale-led researchers dubbed “prime and spike.” The method capitalizes on existing systemic immunity to SARS-CoV-2 gained from primary intramuscular (IM) vaccination to boost the body’s immune response in the respiratory tract using intranasal vaccine delivery. Administered in mice, the nasal spray elicited robust mucosal responses and offered comparable systemic neutralizing antibody booster responses to IM-administered boosters months out from primary vaccination. More research and funding are needed on non-needle vaccines, a key reason why nasal vaccine research has not progressed at the rate of IM-delivered vaccines. In the US, which led the race to develop SARS-CoV-2 vaccines, a lack of funding is preventing promising candidates and methodologies—such as the one tested by Yale researchers—from progressing into human studies and closer to regulatory authorization.

TRAVEL MASK MANDATES The US Supreme Court this week let stand a lower court ruling allowing the Transportation Safety Administration (TSA) to require mask use for travelers on planes, trains, and other methods of transport. The lower court’s ruling, from the US Court of Appeals for the DC Circuit, said the TSA has the authority to maintain safety and security during national emergencies. The TSA dropped its mask mandate in April after a federal judge in a different case ruled the agency had exceeded its authority. As part of a comprehensive strategy, the use of high-quality masks can help reduce the risk of viral transmission, including SARS-CoV-2. 

GLOBAL VACCINE ACCESS If SARS-CoV-2 vaccines had been equitably shared among all nations in 2021, 295.8 million infections and 1.3 million deaths due to COVID-19 could have been prevented worldwide by the end of that year, even without any associated changes in behavior, according to a retrospective modeling study published October 27 in Nature Medicine. Additionally, if wealthier nations had kept nonpharmaceutical interventions (NPIs)—such as mask use and limitations on gathering sizes—in place for longer under this scenario, as many as 3.8 million lives could have been saved, the modeling suggests. Vaccine equity has improved globally, although disparities in access persist, according to the WHO. Overall, 68% of the world’s population has received at least one vaccine dose, but that proportion drops to 23% in low-income countries.

Though vaccine access is improving, other challenges remain, including the spread of mis- and disinformation, a lack of laboratory capacity and access, and the need for large capacity storage facilities, among others. Some experts are warning that the emergence of newer variants capable of greater immune evasion could create a critical situation in 2023, particularly in low- and middle-income countries (LMICs) whose populations are undervaccinated. But the situation also provides an opportunity for increased efforts to supply LMICs with next-generation vaccine boosters. Even as access to SARS-CoV-2 vaccines improves, the world needs to seriously look to the future and devise systems that will facilitate the equitable distribution of medical countermeasures during the next disease outbreak

October 27, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

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

CALL FOR APPLICATIONS Applications are now open for the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity (ELBI) Fellowship Class of 2023. ELBI inspires and connects the next generation of biosecurity leaders and innovators. This highly competitive, part-time program is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events. Applications can be submitted through 11:59PM (EST) November 11, 2022. Learn more about eligibility requirements and application materials here: https://www.centerforhealthsecurity.org/our-work/emergingbioleaders/apply.html

EPI UPDATE The WHO COVID-19 Dashboard reports 625.7 million cumulative cases and 6.56 million deaths worldwide as of October 26. Global weekly incidence dropped to 2.8 million new cases after remaining steady for 6 weeks, decreasing 12.5% compared to the previous week. Weekly incidence in all regions remained relatively steady or fell over the previous week. Global weekly mortality continued to decrease for the tenth consecutive week, down 11.6% from the previous week.*

*The WHO dashboard notes that data from the Africa Region are incomplete.

UNITED STATES

The US CDC is reporting 97.1 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending October 19 remained steady over the previous week, at 260,808 reported cases. Weekly mortality also remained steady for the week ending October 19, at 2,566 reported deaths.**

**Beginning October 20, the US CDC began reporting and publishing aggregate case and death data, and line level data where applicable, from jurisdictional and state partners on a weekly basis rather than daily. As a result, COVID-19 data on cases and deaths are updated every week on Thursdays by 8pm ET.

New hospital admissions remained steady last week, increasing 1.1%, while current hospitalizations continued to exhibit a downward trend, decreasing 2.9% over the past week. Both trends peaked around the end of July and both now appear to be leveling.

The BA.5 sublineage continues to be the dominant strain in the US, accounting for 62.2% of sequenced specimens; however, its estimated prevalence has decreased for 9 consecutive weeks. The second most prevalent sublineage, BA.4.6, appears to be losing its growth advantage to others, decreasing to 11.3% as of October 22. Several other Omicron sublineages continue to exhibit increasing trends, including BQ.1 (9.4%), BQ.1.1 (k7.2%), and BF.7 (6.7%). BA.2.75 (1.6%) and BA.2.75.2 (1.3%) and also show relative growth advantage over BA.5.

GLOBAL PANDEMIC PROJECTIONS The number of new daily global COVID-19 cases is projected to rise slowly over the coming months, increasing from about 17 million now to about 18.7 million by the end of January 2023, the University of Washington Institute for Health Metrics and Evaluation predicts in an analysis published this week. The increase will be impacted by the emergence of various Omicron lineage subvariants, seasonal behavioral changes, and COVID-19 policies in China, where many of the world’s most susceptible population resides. The model’s reference scenario also estimates 245,000 additional reported deaths due to COVID-19 will occur through February 1. The analysis also includes estimates using an 80% mask use scenario and an antiviral access scenario.

‘TRIPLEDEMIC’ Experts in the US are warning the nation could see a convergence of three respiratory diseases—COVID-19, influenza (flu), and respiratory syncytial virus (RSV)—this fall and winter, in what some are calling a “tripledemic.” There are signs that cases of all three infections are rising in parts of the country, likely driven by people feeling confident enough to stop wearing masks and gather more indoors. Newly emerging sublineages of the Omicron variant of concern (VOC) have mutations that potentially make them resistant to existing therapeutics and preventive treatments and possibly immune evasive enough to bypass protections provided by previous infections or vaccination. That is leading the US government to step up efforts to get more people vaccinated and boosted with newer bivalent shots that target the Omicron BA.5 and BA.4 lineages.

Cases of RSV are surging earlier than usual, especially among young children. While many kids contract the virus by age 2 through mingling with other children, there is a potential that nonpharmaceutical interventions—such as lockdowns, social distancing, masking, and increased hygiene—helped to limit the spread of other respiratory diseases, essentially creating an “immunity gap.” Therefore, some toddlers and infants have never been exposed to RSV, leaving them more susceptible to infections. Notably, there is no vaccine and no effective treatment for RSV. Most people recover within a week or two, but RSV can be serious for young children and older adults who have weaker immune systems or underlying health conditions. Already, about three-quarters of pediatric hospital beds nationwide are full and emergency rooms are experiencing long waits.

Additionally, some parts of the country, especially Southern states, are experiencing an early flu season. Flu rates are highest among young children aged 0-4, but the number of cases is increasing in every age group. The past two years saw lower-than-average numbers of cases, and though there is a flu vaccine, protection rates range from 20%-60%. And, unfortunately, flu vaccine uptake dropped during the pandemic. The Southern Hemisphere saw an early flu season with higher case numbers and higher hospitalizations, and many feel nations in the Northern Hemisphere will follow that trend as the weather cools. With hundreds of circulating SARS-CoV-2 variants and increases of other respiratory viruses, taking steps to prevent disease transmission—including getting vaccinated and/or boosted, staying home if sick, wearing masks, and washing hands—remains vital this season to help prevent further strain on the healthcare system, severe disease, and more deaths.

US BOOSTER CAMPAIGN As the US heads into its third winter of the COVID-19 pandemic, US health officials this week announced additional efforts to encourage individuals, particularly those who are older or immunocompromised, to get vaccinated or boosted against COVID-19 at no cost. US President Joe Biden publicly received his fifth shot, coinciding with the release of an updated COVID-19 plan that includes enlisting Walgreens, DoorDash, and Uber to provide free delivery of antiviral prescriptions, calling on educational institutions to hold vaccination clinics for their communities, encouraging employers to provide paid time off for employees to get vaccinated, and urging building operators to improve indoor air quality.

The US appears to be in a better position heading into this winter, with treatments and vaccine doses more widely available, but Biden administration officials are concerned another surge in cases, as well as rising cases of other respiratory diseases, could overwhelm healthcare systems and lead to more deaths. Some experts are concerned a crisis-fatigued public and mixed pandemic messaging are making booster campaign efforts more challenging; only about 19.4 million US residents have gotten the updated shot, accounting for less than 10% of those who are eligible, according to US CDC data. The Omicron subvariants BQ.1 and BQ.1.1 are gaining ground in the US, and for those already vaccinated, receiving an updated booster dose is the best protection from severe disease or death. While some might not look forward to vaccination side effects, a study published October 21 in JAMA Network Open suggests those who experience fever, chills, or muscle pain tended to have more robust antibody responses following the shots. But don’t worry: even among those who experience little to no side effects, vaccines elicit a strong immune response.

BIVALENT BOOSTER IMMUNE RESPONSE Early data on the immunogenicity of the new bivalent booster targeting the Omicron BA.4 and BA.5 Omicron sublineages show the shots appear to work about as well as earlier monovalent booster doses. The two preprint studies—one from researchers from Harvard University and the other from Columbia University—show that neutralizing antibody responses to the bivalent vaccine formulation were about the same as those to the monovalent vaccine formulation when examined 3-5 weeks post-vaccination. Researchers emphasized, however, that the boosters still offer robust and prolonged protection against severe disease or death from COVID-19, and public health officials continue to encourage people to get boosted as soon as possible. Some experts suggested that the studies were not run for a long enough time and included too small of a population to provide a full picture of bivalent vaccine booster immunogenicity.

US COVID DEATH RATES A data brief published October 25 by the National Center for Health Statistics (NCHS) analyzed COVID-19 mortality rates in 2020, illuminating demographic trends early on in the outbreak according to urbanicity, age, and sex. The report’s findings noted that overall age-adjusted COVID-19 death rates ranked highest to lowest were found in large central metropolitan urban counties, noncore rural counties, micropolitan rural counties, large fringe metropolitan urban counties, small metropolitan urban counties, and medium metropolitan urban counties. When broken down by sex, geographic trends remained largely similar, although the highest death rates for women were found in noncore rural counties and the second highest death rates found in large central metropolitan urban counties. Notably, death rates were at least 50% higher for men than women across all counties, with the greatest difference found in large central metropolitan urban counties, where rates were 78% higher for men.

Another data brief by NCHS found that this trend was further exacerbated in adults aged 65 and older, with males experiencing death rates 1.5 times higher than females. Sex differences in COVID-19 death rates in adults aged 65 and over held across all races. Death rates in older men were highest among Hispanic men, followed by non-Hispanic Black men and non-Hispanic American Indian or Alaska Native men. Death rates among older women were highest among non-Hispanic American Indian or Alaska Native women, followed by non-Hispanic Black women and Hispanic women. As has been well-established in other studies, overall COVID-19 death rates increased by age group in adults aged 65 and older. The majority (66.2%) of deaths due to COVID-19 among these older adults occurred in a healthcare setting, compared with 24.3% in a nursing home or long-term care facility, and 4.7% at home.

US WORKFORCE The COVID-19 pandemic has significantly impacted the US workforce, particularly due to the burden of post-acute sequelae of SARS-CoV-2 (PASC), more commonly known as long COVID. Some estimates posit that the economic costs of long COVIDcould be trillions of dollars. With an estimated 16 million people of working age suffering with long COVID, and as many as 4 million out of work because of their symptoms, many recognize COVID-19 as a mass disabling event. A recentstudy from the Federal Reserve Bank of New York notes there has been an increase of about 1.7 million people with disabilities since the pandemic began and close to 1 million workers with new disabilities, likely due to an increase in Americans living with long COVID.

Many people with long COVID have reduced the number of hours they work or dropped out of the labor force, but an increase in the number of workers with disabilities suggests that more people with long COVID and disabilities are continuing to work. Some experts believe that the surge of workers with disabilities could also be attributed toa tight labor market and a rise in remote work, which allows people with disabilities to enter and remain in the workplace. As more people with long COVID and disabilities enter and remain in the workplace, experts encourage employers tomake reasonable workplace accommodations to retain them. Advocates encourage employers toset a positive example by supporting their employees’ needs regardless of their status under the Americans with Disabilities Act, under which employers are expected to make “reasonable accommodations” for people with disabilities.

Similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)— which also often follows viral infection—symptoms of long COVID can include fatigue, brain fog, and muscle/joint pain. The accommodations employers have provided to workers with ME/CFS, such as telework and flexible scheduling, could be extended to workers with long COVID as well, along with other changes that allow workers to control their environment, limit physical exertion and commuting, take breaks as needed, manage symptoms, and access comprehensive health benefits. Although making workplace accommodations requires upfront costs, advocates encourage employers to consider the long-term benefits of creating flexible and inclusive policies.

Relatedly, a recent study from theNational Bureau of Economic Research illustrated the phenomenon of “long social distancing” and documented that anxiety around getting COVID-19 has kept close to 3 million people out of the workforce, consequently reducing potential economic output by nearly 1%, or US$250 billion, in the first half of 2022. Long social distancing has ramifications beyond the workforce and economy; many people who continue to protect themselves through social distancinghave reported waning social support and increased isolation. Although many in the US seem to be moving on from the pandemic, the long-term economic and social impacts of COVID-19continue to affect people who struggle to make a complete recovery.

PANDEMIC POLITICIZATION Polling and analysis in the US show Republicans are more likely than Democrats to have lower rates of vaccine uptake and areas with more Republican voters have experienced more COVID-19-related deaths. But viewing the pandemic through a political lens is not useful, Dr. Ashish Jha, the White House COVID-19 Response Coordinator, said last week, urging people to instead view COVID-19 strictly through a public health and medical lens. Nevertheless, partisan messaging surrounding the pandemic is ramping up as US political candidates campaign ahead of mid-term elections. This week, US President Joe Biden publicly received an updated COVID-19 vaccine booster vaccine and called on the country to put politics aside to focus on personal health and the health of friends and family. His public vaccination likely was an effort by the White House to increase awareness that a new booster shot is available—a recent KFF poll found that around half of adults say they have heard “a little” or “nothing at all” about the bivalent boosters—but also a political move to highlight the Biden administration’s COVID-19 efforts, which typically score higher approval ratings than other issues.

Several Republican candidates are arguing that scientific and public health institutions have gained too much power during the pandemic. A new poll from the Pew Research Center suggests that while a majority of respondents agree that government investments in scientific research are worthwhile for society, many expressed a shared concern that the US is failing to gain ground in science globally. Notably, a partisan divide became apparent when respondents were asked about their views on the role of scientists in the policy arena, with Democrats more likely than Republicans to support scientists in active policy roles. Additionally, respondents’ confidence in scientists is lower than the high point seen early in the pandemic but has remained steady over the past year, according to the poll. While other issues appear to be dominating this year’s elections and both parties’ overall spending on COVID-19 messaging has dropped since the 2020 election, the pandemic remains an important issue for voters and elected officials.

Ohio Voter Suppression Case

The New York Times

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Right-Wing Operatives Plead Guilty in Voter-Suppression Scheme

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Two right-wing political operatives have pleaded guilty in Ohio to a telecommunications fraud charge for arranging thousands of robocalls that falsely claimed that the information voters included with mail ballots could be used by law enforcement and debt collectors, prosecutors said.

Jack Burkman, center, and Jacob Wohl, left, in 2018. Prosecutors said they used robocalls to intimidate residents in minority neighborhoods to refrain from voting by mail in 2020.© Joshua Roberts/Reuters

The operatives, Jacob Wohl, 24, of Los Angeles, and Jack Burkman, 56, of Arlington, Va., entered their pleas on Monday in Cuyahoga County Common Pleas Court in Cleveland, prosecutors said.

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The men were indicted in 2020 after they were accused of using the robocalls to intimidate residents in minority neighborhoods to refrain from voting by mail at a time when many voters were reluctant to cast ballots in person because of the coronavirus pandemic. The calls also claimed that the government could use mail-in voting information to track people for mandatory vaccination programs, prosecutors said.

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“These individuals infringed upon the right to vote, which is one of the most fundamental components of our democracy,” the Cuyahoga County prosecutor, Michael C. O’Malley, said in a statement announcing the guilty pleas on Monday.

According to the indictment, Mr. Wohl and Mr. Burkman were each charged with multiple counts of bribery and telecommunications fraud. Those charges were merged into one count each of telecommunications fraud under the plea deal in Ohio, James Gutierrez, an assistant Cuyahoga County prosecutor, said in an interview on Tuesday.

“We made convicted felons out of them,” Mr. Gutierrez said. “Our goal was to make them accountable, and we did.”

Mr. Gutierrez said that the count that the two men pleaded guilty to covered the calls that were made to voters in Cuyahoga County, which includes Cleveland. They face up to a year in prison and a fine of $2,500 when they are sentenced on Nov. 29, he said.

Brian Joslyn, a lawyer for Mr. Burkman, did not respond to a call to his office requesting comment. Mark Wieczorek, a lawyer representing Mr. Wohl, declined to comment when asked about the plea deal.

When announcing the indictments in 2020, prosecutors in Ohio said Mr. Burkman and Mr. Wohl used a voice broadcasting service provider to place more than 67,000 calls across several Midwestern states. More than 8,100 of them went to telephone numbers in Cleveland and East Cleveland, and about 3,400 were answered by a person or went to voice mail.

The recorded messages “falsely warned people that if they voted by mail that their information could be used by law enforcement, collection agencies” and the Centers for Disease Control and Prevention “for the purposes of pursuing old warrants, collecting outstanding debts, and tracking people for mandatory vaccines,” Mr. O’Malley’s office said.

The Ohio attorney general, Dave Yost, whose office investigated the calls, said in a statement on Monday that Mr. Wohl and Mr. Burkman had been trying to suppress voting in minority neighborhoods.

“Voter intimidation won’t be tolerated in Ohio,” Mr. Yost said.

The allegations against the two operatives came at a time when Donald J. Trump, as president, was seeking to discredit mail-in voting, saying without offering evidence that it was rife with fraud. At the time, millions of voters were expected to vote by mail because of the pandemic.

Mr. Wohl and Mr. Burkman face similar charges in Michigan, where they were charged in 2020 with intimidating voters, conspiracy to intimidate voters, using a computer to intimidate voters and conspiracy to use a computer to intimidate voters, according to a criminal complaint.

Michigan’s attorney general, Dana Nessel, said the calls were part of a broad effort to intimidate nonwhite voters from casting mail-in ballots. The case is pending in the Michigan Supreme Court, a spokeswoman said on Tuesday.

The Federal Communications Commission last year proposed a fine of just over $5 million for Mr. Wohl, Mr. Burkman and his company, J.M. Burkman & Associates, for apparently making 1,141 unlawful robocalls to wireless phones without consent. An F.C.C. spokesman said on Tuesday that the proposed fine was still pending.

In 2020, a federal judge in New York ordered the two men to call 85,000 voters who had received robocalls and inform them that the original call “contained false information.”

Above is from:  Right-Wing Operatives Plead Guilty in Voter-Suppression Scheme (msn.com)