January 25: 2944 New COVID 19 Cases in Illinois

Masking for the new virus strain

Two Masks Are the New Masks

Tara Parker-Pope

Mon, January 25, 2021, 1:57 PM

Many of us who watched the inauguration last week were delighted by the fashion on display — the colorful matching coat and mask ensembles worn by the first lady, Jill Biden; and the Biden granddaughters; the power purple worn by Vice President Kamala Harris, Michelle Obama and Hillary Clinton; and of course, Sen. Bernie Sanders’ delightful mittens made of recycled wool sweaters.

But the fashion trend that most excited me was the double mask! Double-masking is a sensible and easy way to lower your risk, especially if circumstances require you to spend more time around others — like in a taxi, on a train or plane, or at an inauguration. Pete Buttigieg, the former presidential candidate and now the nominee for secretary of transportation, was spotted double-masking. It appears he was wearing a high-quality medical mask underneath a black cloth mask. His husband, Chasten, was sporting a similar double-masked look but with a fashionable plaid cloth mask that coordinated with his winter scarf.

We should all be thinking about the quality of our masks right now. New variants of the coronavirus continue to emerge, and one in particular is cause for pressing concern in the United States because it’s so contagious and spreading fast. I wrote about the steps you can take to better protect yourself.

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The bottom line is that you should keep taking the same pandemic precautions you always have, but do a little better. The new variant spreading in the United States appears to latch onto our cells more efficiently. The mutation in the virus may mean it could take less virus and less time in the same room with an infected person for someone to become ill. People infected with the variant may also shed larger quantities of virus, which increases the risk to people around them.

That’s why the quality of your mask is more important than ever. You can read about the latest research urging a well-fitted two- or three-layer mask. Or you can keep the masks you’ve been using and just double-mask when you go to the store or find yourself spending time with people from outside your household.

One big advantage of double-masking that I’ve found is that it creates a better fit and closes the gaps around the edge of your mask. I like layering my masks. When I walk the dog or exercise outdoors, I wear a regular mask to comply with area mask rules. When I want more protection for short errands, I wear a better mask. When I’m in a taxi or on a train, I double-mask.

I’ve just bought a new set of masks called KF94s that I really like. They fit well, have added flaps to close gaps around the face and include a moldable band to tighten the fit around the bridge of the nose. Now I wear a KF94, a type of mask made in South Korea that can be purchased easily online, covered by a cloth mask. I recently learned about the KF94 from Dr. Ashish K. Jha, dean of the Brown University School of Public Health. Jha notes that the gold-standard N95 masks are still hard to find, and we should save them for health workers. The KF94 mask resembles an N95, with some differences. It’s made of a similar nonwoven material that blocks 94% of the hardest-to-trap viral particles. But the KF94 has ear loops, instead of elastic head bands, so it won’t fit as snugly as an N95 — although double-masking can help close any gaps.

The KF94 is also disposable — you can buy a pack of 20 for about $40 on Amazon. While you can let a KF94 mask air dry and reuse it several times, it can’t be laundered and won’t last as long as a cloth mask. One solution is to save your KF94 mask for higher-risk situations — like riding a subway, spending time in a store or going to a doctor’s appointment.

This article originally appeared in The New York Times.

© 2021 The New York Times Company

Patriot Party?

Republican split widens as Donald Trump intervenes in party elections in Arizona

David Millward

Sun, January 24, 2021, 12:19 PM

Kelli Ward - Ross D Granklin/AP

The acrimonious split within Republican ranks widened over the weekend as Donald Trump made his foray back into politics, backing the re-election of a hard-line supporter as chair of the party in Arizona.

His wholehearted support for Kelli Ward was seen by allies as the former president firing a warning shot across the bows of any Republican senators considering backing his impeachment.

Underlining Mr Trump’s grip on the Republican grassroots, the Arizona party also voted to censure John McCain’s widow, Cindy, former senator Jeff Flake and governor Doug Ducey, who refused to back the former president’s claims of election fraud.

Mr Trump’s intervention came amid reports that he is considering setting up a “Patriot Party” which would spearhead primary challenges to his opponents in the 2022 mid-term elections.

The former president has already amassed a massive war chest with his Save America political action committee declaring last month that it had raked in $207.5 million in donations.

Sam Nunberg, a former political adviser to Donald Trump, believes the “Patriot Party” would – like the Tea Party – work to get supporters nominated as Republican candidates.

“These are the people he will support in the primaries,” he told the Telegraph.

“The Arizona vote made it a fait accompli that he will not be convicted in this sham impeachment trial.

“It’s an indicator that he still controls the primaries. This shows if you are a Republican and you vote convict Donald Trump and have a primary, you might as well retire.

“It’s a show of strength. Especially with Mitch McConnell coming out and criticising President Trump, and he is one of the most powerful people in the party.”

Jeff Lord, who worked in the Reagan White House, said the vote in Arizona demonstrated the grip that Mr Trump now had on the Republican party.

“This is fairly typical, this is Trump versus the establishment, this is going to be a battle royal. He did get 75 million votes and these people will stick with him.

“I think it would backfire badly on senators who voted for impeachment. It would show the establishment is a bunch of elitists who don’t care what the people who put them there have to say.

“For those Republicans who want to be re-elected to the senate and have a career, this could be problematic.”

There has been mounting anger among Donald Trump’s most fervent supporters at “establishment” Republicans who broke with Mr Trump.

Donald Trump leaving the White House - Mandel Ngan/AFP

However, Mrs McCain dismissed the vote of censure, describing it as a “badge of honour.”

The impeachment vote will be the first indication of the extent of the division within Republican ranks.

Only one Republican, Mitt Romney, broke ranks with the party in the first impeachment trial by supporting Mr Trump’s removal from office.

More are expected to do so this time, although the view in Washington is that it is unlikely that the number of defectors will reach the 17 needed for impeachment to be passed.

According to the New York Times Mitch McConnell, the Republican leader in the Senate, has told associates that he believes Mr Trump committed impeachable offences.

Reports that Mr Trump was ready to install an acting attorney general who would back his claims of a fraudulent election will strengthen the hand of those supporting impeachment.

“There’s no question that the article of impeachment that was sent over by the House describes impeachable conduct, but we have not yet heard either from the prosecution or the defence,” Mr Romney told Fox News Sunday.

Florida senator and former presidential candidate Marco Rubio told Fox News that he opposed impeachment.

We already have a flaming fire in this country,” he said, adding that the trial would be “a bunch of gasoline”.

Christopher Galdieri, an associate professor of politics at Saint Anselm College, doubted that Mr Trump would be able to start a new party.

"Starting a new party is prohibitively difficult and expensive; Ross Perot, who was richer in the early 1990s than Trump has ever been, couldn't do it then," he said.

"So threatening a new party might be more effective and have more impact than actually starting one."

Mr Trump has moved to his golf resort at Mar-a-Lago in Florida, where reportedly members are leaving because it has become a “sad place” since the former president took up residence.

Above is from:  https://www.yahoo.com/news/republican-split-widens-donald-trump-181937931.html

January 22: Johns Hopkins COVID 19 Report

COVID-19

Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

Additional resources are available on our website.

Subscribe to our newsletter

The Johns Hopkins Center for Health Security produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

The Johns Hopkins Center for Health Security produces weekly updates on SARS-CoV-2 vaccine development, policy, and public perception in the US. This is a resource fromCommuniVax, a research coalition convened by the Johns Hopkins Center for Health Security and the Texas State University Department of Anthropology, with support from the Chan Zuckerberg Initiative. You can access them here.

EPI UPDATE The WHO COVID-19 Dashboard reports 96.01 million cases and 2.08 million deaths as of 5am EST on January 22.

In our COVID-19 updates, we typically focus on epidemiological data, daily or cumulative, in countries or areas where the COVID-19 pandemic is more severe. This week, we will take a brief look at countries and territories that have had relative success in containing SARS-CoV-2.

The global average for per capita cumulative incidence is 12,507 cases per million population, and 106 of 190 countries and territories are reporting fewer per capita cases than that. In total, 31 countries and territories are reporting fewer than 500 cumulative cases per million population, and 15 are reporting fewer than 100. Among this short list are some notable examples that have received attention over the course of the pandemic regarding their success in containing transmission. New Zealand (#30; 472.0 cases per million) managed to interrupt domestic transmission, including a period of 100 days without a documented case of local transmission. China is #13 with 68.5 cases per million, despite facing the first major epidemic, which necessitated a full “lockdown” of more than 10 million people and the rapid construction of emergency hospitals in Wuhan to handle the severe patient surge. Taiwan (#9; 36.5) reported some of the earliest imported cases, but its government quickly implemented a response that included social distancing restrictions, testing and contact tracing programs, and quarantine and isolation for exposed and infected individuals in order to bring its epidemic under control. The top 4 countries—Vanuatu (3.3), Lao PDR (5.6), Tanzania (8.5), and Micronesia (8.7)—are all reporting fewer than 10 cumulative cases per million. The majority of countries reporting fewer than 500 cases per million are located in East, Central, and West Africa; Southeast Asia; and the Western Pacific, including a number of small island nations and territories. None are in Europe or North or South America, which have been impacted by the most severe surges or waves since early in the pandemic.

In terms of per capita cumulative mortality, the global average is 268.1 deaths per million population. In total, 110 countries and territories are reporting fewer per capita deaths than the global average. Of those, 45 are reporting fewer than 20 deaths per million population, including 13 countries with fewer than 5. There is considerable overlap between the lists for incidence and mortality. In fact, 38 countries and territories are among the top 50 in both lists. Much like the geographic distribution for cumulative incidence, most of the top countries/territories in terms of mortality are located in Africa, Southeast Asia, and the Western Pacific. Notably, however, there are also several countries from other regions, including Cuba (#39; 16.2) and St. Vincent and the Grenadines (#43; 18.0) in the Caribbean; Tajikistan (#30; 9.4),and Uzbekistan (#44; 18.5) in Central Asia; and Bhutan (#8; 1.3) and Sri Lanka (#35; 12.9) in Southern Asia. Burundi (0.2), Taiwan (0.3), Tanzania (0.4), and Vietnam (0.4) are all reporting fewer than 0.5 deaths per million.

Our World in Data reports that 55.58 million vaccine doses have been administered globally.

UNITED STATES

The US CDC reported 24.32 million total cases and 404,689 deaths. The US surpassed 400,000 cumulative deaths on January 19.

1 death to 50k- 55 days

50k to 100k- 33 days

100k to 150k- 63 days

150k to 200k- 55 days

200k to 250k- 58 days

250k to 300k- 25 days

300k to 350k- 20 days

350k to 400k- 16 days

On January 19, the US daily incidence fell below 200,000 new cases per day for the first time since January 1. At this pace, the US could surpass 25 million cumulative cases in the next 3-4 days. Following several days of depressed daily mortality over the Martin Luther King, Jr. Day holiday weekend, the US reported 4,383 new deaths yesterday, the highest single-day total to date*.

*With the exception of April 15, when New York City reported more than 3,700 previously unreported probable deaths from the onset of its epidemic.

The US CDC reported 37.96 million vaccine doses distributed and 17.55 million doses administered (46.2%), including 2.09 million administered in long-term care facilities (LTCFs). In total, 15.05 million people have received at least 1 dose of the vaccine, and 2.39 million have received both doses. The breakdown of doses by manufacturer remains relatively even, with slightly more Pfizer/BioNTech doses administered (9.82 million; 56%) than Moderna (7.72 million; 44%).

The Johns Hopkins CSSE dashboard reported 24.69 million US cases and 411,781 deaths as of 1:30pm EST on January 22.

US PRESIDENTIAL TRANSITION Almost immediately upon taking office, US President Joe Biden took action in the United States’ battle against COVID-19. On January 20, shortly after the President Biden's inauguration, the White House published its national COVID-19 response plan, which highlights priorities such as “listen[ing] to science,” increasing access to testing, bolstering the supply of personal protective equipment (PPE), providing support for schools and businesses, protecting high-risk individuals, and vaccination. The announcement was accompanied by a detailed, 200-page document that outlines goals and policies for a wide range of challenges facing the COVID-19 response.

President Biden also issued several executive orders shortly after taking office, which reversed the United States’ withdrawal from the WHO, established a COVID-19 Response Coordinator position in the White House, and mandated mask use by federal employees and in federal buildings. On January 21, his first full day in office, President Biden issued additional executive orders and directives to address specific aspects of the COVID-19 response, including to bolster the supply chain for critical supplies and equipment (eg, PPE, therapeutics, test kits, vaccines), including through the Defense Production Act; increase financial and operational support for state governments, including through the National Guard; enhance public health data collection and sharing; improve clinical care and expand access to novel therapeutics for COVID-19 patients; implement COVID-19 risk mitigation measures for domestic and international travel; protect worker health and safety; increase testing capacity and build a sustainable public health workforce; support schools and childcare; and promote equity in the COVID-19 response.

The US is also expected to commit funding for the WHO’s COVAX funding program, which will supply vaccines to low- and middle-income countries. President Biden also directed the Department of Education to extend the suspension of federal student loan repayments, reportedly through September 2021. Additionally, senior officials in the Biden Administration are working to develop their SARS-CoV-2 vaccine distribution plan, with the aim of achieving President Biden’s stated goal of 100 million vaccinations in 100 days.

US VACCINATION US States are struggling to maintain sufficient inventory to support their SARS-CoV-2 vaccination efforts, including multiple major cities that anticipate exhausting their supply in the coming days. In a press conference on January 20, New York Governor Andrew Cuomo said the state’s supply of SARS-CoV-2 vaccine for first doses would run out in 2-3 days. In New York City, tens of thousands of scheduled vaccination appointments were cancelled in order to ensure that sufficient reserve is available for second doses. Both New York State and New York City have scaled up vaccination capacity, but they are currently not able to maintain that pace due to supply limitations. There were concerns that San Francisco could exhaust its inventory by Thursday of this week due to limited incoming supply from the federal government and concerns about a lot of Moderna vaccines that caused those doses to be put on hold. California ultimately lifted the hold and released several thousand doses of the Moderna vaccine, which allowed vaccination efforts to continue. Officials in both New York and California have indicated that they are receiving fewer doses than in past weeks, despite expanded capacity and eligibility.

As we covered previously, Governor Cuomo appealed to Pfizer for the opportunity to purchase doses directly from the manufacturer, circumventing the federal government’s distribution system. Since then, several other states have raised the prospect of direct purchases, but the Biden Administration reportedly opposes the idea. A spokesperson for President Biden noted that a centralized national system is needed to “ensure states aren't competing against each other like they did with PPE, ventilators, and tests.” Biden Administration officials have repeatedly emphasized their intent to increase transparency and consistency in vaccine deliveries in order to facilitate longer-term planning at the state level.

EUROPE CONTROL MEASURES Several European countries have enacted new COVID-19 measures, including enhanced “lockdown” restrictions and updated mask guidance, in response to ongoing COVID-19 surges—including new records in some countries—and concerns about the increased transmissibility of emerging variants. One of the biggest efforts across Europe is a shift from cloth masks to medical-grade masks, which offer increased protection against SARS-CoV-2 transmission. Austria and Germany, for example, now require the use of medical-grade masks—including N95 or KN95 respirators or FFP2 surgical masks—on public transportation and some other public spaces (eg, retail stores, restaurants). Reportedly, France is considering a similar measure. In light of increased transmissibility of emerging SARS-CoV-2 variants, these policies hope to mitigate transmission risk through the use of more effective face coverings.

Some European countries are extending their current lockdown measures as well, including Germany (through February 14) and Austria (February 3). The Netherlands is implementing a nationwide curfew, the first of its kind since World War II. The curfew will be in effect from 9pm-4:30am, except for essential activities, and violators could face fines of €95 (US$115). In the UK, Home Secretary Priti Patel announced that fines will be issued starting next week for anyone attending house parties of more than 15 people. Fines will start at £800 (US$1,100) and double for each offence, up to a maximum of £6,400 (US$8,750)*. Existing fines of up to £10,000 for organizers of large gatherings (ie, more than 30 people) will remain in place.

*We have not been able to determine whether the fines will apply just to England or the entire UK.

EMERGING VARIANTS Many questions remain regarding the emergence of new SARS-CoV-2 variants around the world. One of the more prominent questions is whether certain mutations could affect vaccine efficacy. Last week, Dr. Ugur Sahin, co-founder and CEO of BioNTech, stated that he expected the Pfizer/BioNTech vaccine to be protective against the new variants. On January 19, Dr. Sahin and other researchers at BioNTech and Pfizer published (preprint) findings from a study that provides insight into preliminary data on the vaccine’s efficacy against new SARS-CoV-2 variants. The researchers utilized blood sera collected from 16 participants vaccinated in the Phase 1/2 clinical trials to evaluate the neutralizing capacity against the B.1.1.7 variant. The researchers found that the vaccine exhibited “no biologically significant difference in neutralization activity” between the B.1.1.7 variant and the reference strain. Research into the efficacy of existing vaccines against emerging variants continues, which will be critical to understanding the next phase of global vaccination efforts.

New evidence suggests that the B.1.351 variant may be less susceptible to antibody treatments, which also raises concerns about the potential for reduced vaccine efficacy. Researchers in South Africa, where the variant was first identified, published (preprint) findings from a study that evaluated the neutralizing capacity of blood sera collected from 21 COVID-19 patients who recovered after being hospitalized. The B.1.351 (or 501Y.V2) variant appeared to be less susceptible to the antibodies present in the sera specimens, which is cause for concern, considering that the production of such antibodies is the goal of most SARS-CoV-2 vaccines and candidates.

Additionally, analysis from South Africa’s National Health Laboratory Service (NHLS) identified more than 4,000 potential instances of reinfection in South Africa. To date, there have been relatively few documented cases of true reinfection with SARS-CoV-2, but this information raises questions regarding whether the emerging variant could increase that risk. Neutralizing antibodies generated during acute infection tend to provide some degree of protection against future infections, at least for a short period of time; however, if the neutralizing antibodies generate for one variant are less effective against new variants, recovered individuals may be more susceptible to reinfection. Further research is needed to definitively determine whether the 4,000 cases are true reinfections and to characterize any effects from the emerging variant.

The identification of emerging SARS-CoV-2 variants has prompted calls for expanded genomic surveillance globally to monitor for the emergence of novel variants as well as the spread of known variants. Ongoing genomic surveillance programs in South Africa and the UK played key roles in detecting 2 of the most prominent new variants, B.1.1.7 and B.1.351, which are believed to be driving regional surges in transmission. Without these real-time efforts, it is likely that new variants would go unnoticed, at least until their epidemiological effects become evident. Retrospective studies have started examining the timelines associated with the emergence and spread of different SARS-CoV-2 variants, illustrating the importance of active genomic surveillance activities. For example, a study published (preprint) this week by researchers at the University of Arizona (US) suggests that the B.1.1.7 variant was circulating in the US at least as early as November 2020, potentially as a result of multiple independent introductions. Continued sequencing of SARS-CoV-2 specimens in countries around the world is critical to understanding ongoing viral evolution, which can then inform effective public health response, including the development of effective medical countermeasures such as vaccines.

BAMLANIVIMAB Eli Lilly announced that its neutralizing antibody treatment bamlanivimab can reduce the risk of developing COVID-19 disease. In a press release on January 21, the company reported preliminary results from a study conducted among residents and staff at long-term care facilities. The randomized, placebo-controlled study, part of the BLAZE-2 trial effort, involved 965 total participants (299 residents and 666 staff). The researchers found that prophylactic use of bamlanivimab was associated with an 80% decrease in the risk of developing COVID-19 disease after 8 weeks. The full data have not yet been published publicly nor peer reviewed, but the company indicated that it intends to publish the data in the near future.

Eli Lilly’s Chief Scientific Officer, Dr. Daniel Skovronsky, stated that bamlanivimab is not a replacement for vaccines, but rather, it could be an option for emergency prophylaxis following known or suspected exposure. The drug could potentially mitigate the risk of disease when there may not be enough time for a vaccine to stimulate a sufficient immune response. Bamlanivimab previously received an Emergency Use Authorization (EUA) from the US FDA as a treatment for COVID-19, but not as a preventive measure.

ICU SURGE & MORTALITY Researchers in Indiana and California (US) published findings from a study on the association between patient surge in hospital intensive care units (ICUs) and COVID-19 mortality. The study, published in JAMA: Network Open, included data from more than 8,500 patients admitted to 88 Veterans Affairs hospitals across the US (March-August 2020). The researchers found that ICU patients treated during periods of high ICU patient surge were significantly more likely to die, even after discharge. Notably, patients treated in an ICU when demand—defined as the percent of the maximum ICU patient load—was greater than 75% were nearly twice as likely to die compared to patients treated when ICU demand was 25% or less (aHR=1.94).

The statistically significant results held up when stratified by date—March-May 2020 compared June-August 2020, when the patient surge was lower. During the June-August period, no patients were treated in ICUs with more than 75% of the beds filled, but those treated when the facility was at more than 75% of its maximum ICU usage still had nearly twice the risk of death than those treated at ICU demand of 25% or less (aHR=1.90). This illustrates the critical importance of mitigating community transmission and the subsequent impact on hospitals and health systems, even during times of relatively low levels of community transmission and ICU usage.

LONG COVID The UK’s Office of National Statistics (ONS) published data regarding the prevalence of symptoms associated with “long COVID” in patients who recovered from acute SARS-CoV-2 infection. The data indicate that approximately 20% of infected individuals exhibit symptoms for 5 weeks or longer, and 10% report symptoms for 12 weeks or longer. This corresponds to an estimated 186,000 individuals in England with symptoms lasting between 5 and 12 weeks. The findings are based on responses to the UK’s COVID-19 Infection Survey, which utilizes a nationally representative sample from across the UK, and efforts are ongoing to gather additional data, including on symptoms that persist longer than 12 weeks. A more detailed look at the available data shows that prevalence of long COVID symptoms* tends to increase with age, peaking in the 35-49 years (26.8%) and 50-69 years (26.1%) age groups, compared to the 2-11 years (12.9%) and 12-16 years (14.5%) age groups. Additionally, there appears to be a statistically significant increase in prevalence among women (23.6%) compared to men (20.7%).

*Data displayed here refer to the presence of any symptom at 5 weeks, but the provided tables also include data on individual symptoms.

VACCINE CLINICAL TRIALS As more vaccines are authorized for use in countries around the world, it could pose challenges for conducting clinical trials for other vaccines. As we covered previously, there are ethical and practical challenges to keeping clinical trial participants “blinded” to knowing whether they received the candidate vaccine or the placebo, particularly once that particular product is ultimately authorized for use. Another problem is arising in trials for other candidate vaccines, as participants are starting to request that they be “unblinded” in order to determine if they want to get vaccinated with a product that is currently authorized for use. In one example, researchers conducting Phase 3 clinical trials for the Novavax vaccine are reporting that older participants are requesting to be unblinded after some US states expanded eligibility to adults aged 65 and older. Notably, the Novavax trials aim to include adults aged 65 and older as 25% of the study population, which could be a major challenge if adults in this age group are getting vaccinated using the Pfizer/BioNTech or Moderna products, and similar barriers could face any future clinical trials.

There are alternatives to randomized, blinded, placebo-controlled trials—considered to be the gold standard for clinical trials—but these, too, could be challenging for vaccine candidates. One option is a “non-inferiority” trial, which compares a new product to an existing product to determine if the new product performs on par with the existing one. Considering the high efficacy of both the Pfizer/BioNTech and Moderna vaccines, it could be difficult for new products to meet an acceptable threshold. Some of the new candidates, however, do have advantages over existing vaccines that could potentially outweigh shortcomings in terms of efficacy. The Johnson & Johnson (J&J)/Janssen vaccine, for example, would require only 1 dose, which could expand access and speed vaccination programs over 2-dose vaccines. And the Novavax vaccine is expected to be stable at normal refrigeration temperatures (eg, 2-8°C/35.6-46.4°F), as opposed to the freezing or ultra-cold temperatures required for other vaccines, which could make it easier to maintain a cold chain during distribution and longer-term storage, particularly in rural or resource-limited settings.

CHINA QUARANTINE China continues its response to an ongoing COVID-19 outbreak in Shijiazhuang, a city in the northern part of the country. Last week, the Chinese government imposed a “lockdown” on Shijiazhuang and Xingtai. The lockdown then expanded to include other cities across 11 regions in 3 provinces—including Langfang, which is located just south of Beijing. In total, the lockdowns now affect an estimated 22 million people. Additionally, the Chinese government is rapidly constructing a COVID-19 quarantine center outside Shijiazhuang that could house more than 4,000 individuals. The plan is for this facility to host close contacts of confirmed COVID-19 patients as a part of the country’s expansive COVID-19 contact tracing program. The Chinese government has expressed a sense of urgency to control the spread of the pandemic, particularly as the country prepares for increases in travel and large gatherings coinciding with the Lunar New Year in February.

PANDEMIC TREATY At a meeting of the WHO’s Executive Board this week, Director-General Dr. Tedros Adhanom Ghebreyesus expressed support for a recent proposal by the European Council to establish an “international treaty on pandemics.” The proposed treaty could address various aspects of pandemic preparedness, including risk assessment, coordinating research agendas and associated funding, information sharing and event reporting, and improving healthcare access and health system capacity. Notably, international agreements and programs already exist to address preparedness and response for health emergencies like pandemics, including the International Health Regulations (IHRs) and the Global Health Security Agenda (GHSA), and it is not immediately clear what the relationship would be between the proposed pandemic treaty and these existing efforts or how they might complement or overlap with each other. An independent panel of experts recently reported to the WHO Executive Board their findings on the effectiveness of the IHRs, including that the IHRs could be improved upon, but major changes are not necessary.

January 19: 4318 New COVID 19 Cases in Illinois

January 19: Johns Hopkins COVID-19 Report

COVID-19

Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

Additional resources are available on our website.

Subscribe to our newsletter

The Johns Hopkins Center for Health Security also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.

The Johns Hopkins Center for Health Security produces weekly updates on SARS-CoV-2 vaccine development, policy, and public perception in the US. This is a resource fromCommuniVax, a research coalition convened by the Johns Hopkins Center for Health Security and the Texas State University Department of Anthropology, with support from the Chan Zuckerberg Initiative. You can access them here.

EPI UPDATE The WHO COVID-19 Dashboard reports 93.96 million cases and 2.03 million deaths as of 4am EST on January 15. The global cumulative mortality surpassed 2 million deaths on January 19:

1 death to 250k: 115 days

250k to 500k: 56 days

500k to 750k: 46 days

750k to 1 million: 45 days

1 to 1.25 million: 40 days

1.25 to 1.5 million: 26 days

1.5 to 1.75 million: 23 days

1.75 to 2 million: 20 days

The global weekly incidence decreased for the first time since the week of November 23*. The weekly total of 4.73 million new cases is approximately equal to the week preceding the holidays (4.65 million). Global mortality continues to increase, however, up to 93,882 new deaths, a new record high and an 8.7% increase compared to the previous week.

*Excluding the last 2 weeks of 2020, which are affected by holiday reporting delays.

Our World in Data reports that 41.39 million vaccine doses have been administered globally.

UNITED STATES

The US CDC reported 23.65 million total cases and 394,495 deaths*. The US is averaging more than 220,000 new cases per day. At this pace, the US could surpass 25 million cumulative cases within the next week. The US could potentially surpass 400,000 cumulative deaths this afternoon—which would include deaths reported on both January 17 and 18.

*The US CDC did not update data on January 18 due to the Martin Luther King, Jr. Day holiday in the US. These figures correspond to the data published on January 17.

COVID-19 incidence in the US has declined steadily since January 11, down from 248,367 new cases per day to 221,692, a decrease of nearly 11%. In light of interrupted reporting over the recent holidays, it is difficult to accurately determine the longer-term trend in COVID-19 data. If the US daily incidence is plateauing or peaking, the exact timing of this transition is unclear. The current daily incidence is approximately equal to immediately prior to the Christmas holiday weekend. It is likely that reporting will be delayed to some degree by the Martin Luther King, Jr. Day holiday weekend, but data from this week and next will hopefully provide a better picture of the current US trend. COVID-19 mortality remains high, at 3,344 deaths per day, approximately equal to the record high of 3,357 reported on January 13.

In addition to decreasing daily incidence and initial indications that mortality could be leveling off, current COVID-19 hospitalizations in the US appear to have passed a peak. As we have covered previously, current hospitalizations tend to be more resilient to holiday-related reporting delays than incidence and mortality, so a decreasing trend can provide additional confidence that the US could be passing its third peak. In addition to current hospitalizations, the CDC reported steady decreases in the percentage of emergency department (ED) visits for COVID-19 or COVID-like illness (CLI) since early January, down from a peak of 8.5% on January 3 to 5.8% on January 14. This could be a result of decreased COVID-19 activity or increases in patients seeking care for other conditions.

Based on data published by the COVID Tracking Project, the declines in COVID-19 hospitalizations are evident in all 4 US regions. The Midwest region peaked in late November/early December, and other 3 regions have peaked since the New Year. On a per capita basis, states on the East and West Coasts and in the South are generally reporting more hospitalizations than in the Midwest, Pacific Northwest, and New England. Overall, only 1 US state, North Dakota, is reporting increased COVID-19 hospitalizations over the past 2 weeks, compared to 33 states holding steady (-10% to +10%) and 17 states reporting decreases.

The COVID Exit Strategy website lists 8 states as Severely Constrained in terms of ICU bed availability: New Mexico (96%), Alabama (90%), Georgia (90%), Nevada (89%), Oklahoma (89%), Rhode Island (88%), Mississippi (87%), and California (85%). As with the data described above, these states are generally located on the East and West Coasts and the South. With respect to total hospital beds, no states are listed as Severely Constrained, and only 1 state is listed as Constrained: Rhode Island (89%). Notably, 20 states are listed as Normal for ICU beds, and 25 are Normal for overall hospital beds.

The US CDC reported 31.16 million vaccine doses distributed and 12.28 million doses administered (39.4%), as of January 15. This includes 1.38 million administered in long-term care facilities. In total, 10.60 million people have received at least 1 dose of the vaccine, and 1.61 million have received both doses. In total, 7.15 million doses of the Pfizer/BioNTech vaccine and 5.12 million doses of the Moderna vaccine have been administered nationwide.

The Johns Hopkins CSSE dashboard reported 24.14 million US cases and 399,828 deaths as of 1:30pm EST on January 19.

EMERGING VARIANTS Several SARS-CoV-2 variants with evidence of increased transmissibility continue to raise alarms as they are identified in more countries. Viruses continually mutate, and the SARS-CoV-2 virus has evolved throughout the pandemic. The specific mutations in the recently identified variants of concern—including B.1.1.7, B.1.351, and P.1—are being investigated for increased transmissibility and potentially immune escape.

Researchers from the US CDC COVID-19 Response Team projected that the B.1.1.7 variant would contribute to a rapid growth in cases in the US early in 2021. The B.1.1.7 has been identified in 122 cases in 20 US states, including California and Florida with at least 40 reported cases each. CDC officials projected that the B.1.1.7 variant is likely to become the dominant variant in the US. In order to avoid uncontrolled spread of this variant, health experts encourage individuals to recommit to recommended control measures such as mask wearing, physical distancing, and enhanced hygiene. The CDC also indicated that rapid vaccination, at the level of 1 million doses administered per day, could dramatically decrease spread of COVID-19, including the B.1.1.7 variant.

ETHICAL VACCINE DISTRIBUTION On Monday, WHO Director-General Dr. Tedros Adhanom Ghebreyesus addressed historical inequities in vaccine access and outlined the importance of avoiding such inequities in the context of COVID-19, warning of a “catastrophic moral failure” if SARS-CoV-2 vaccines are not allocated equitably. For example, low- and middle-income countries (LMICs) received vaccines after wealthier countries during the 2009 H1N1 influenza pandemic. And during the COVID-19 pandemic, these countries are once again in line behind high-income countries that were able to arrange the purchase of vaccines directly from manufacturers.

While approximately 39 million doses have been administered across 49 higher-income countries, one “lowest-income country” has been able to administer only 25 total doses. This stark difference underscores the need for the global community to meet its commitments to equitable and ethical distribution of vaccines to ensure the most vulnerable are protected. The WHO COVAX initiative has received numerous pledges to supply vaccine doses for global distribution, but few countries have delivered on those pledges thus far. Further, countries that have made individual agreements with vaccine manufacturers, ostensibly moving their populations higher in the distribution order, are driving up prices and making it more difficult for LMICs to afford the vaccines.

EUROPE VACCINE SUPPLY Pfizer issued a statement on January 15 indicating that it will temporarily decrease the supply of SARS-CoV-2 vaccine to countries in Europe. According to the statement, the reduced supply is part of an effort to scale up production in European facilities. For example, updates to a facility in Belgium are expected to slow production through January 25, but production capacity is expected to increase starting in mid-February. Despite the short-term delays, Pfizer expects to meet its first-quarter commitments and increase its delivery for the second quarter. Reportedly, the announcement was a surprise to some European countries, and several called on EU leadership to pressure Pfizer to meet its original delivery timeline. Reportedly, the production delay could also potentially affect deliveries to Canada, but efforts are underway to mitigate the delays.

US VACCINE DISTRIBUTION Last week, the federal government announced that it was updating its SARS-CoV-2 vaccine distribution plan to release the remaining reserve inventory—as opposed to the previous plan that maintained a stockpile to ensure availability for the second dose. The announcement was initially met with optimism that state allocations would increase as the US government released the reserved doses; however, multiple news media outlets reported that the federal government actually had relatively few doses in its inventory to distribute to states. The reports were based on statements from senior government officials, including Secretary of Health and Human Services Alex Azar, that the US government did not have any remaining stockpiled vaccines and that it had started distributing the reserved doses in late December, more than a week before the announcement.

Reportedly, some states accelerated plans to expand vaccine eligibility following the announcement, in anticipation of increased supply from the federal government. Notably, Secretary Azar’s announcement that the federal government would release the reserve doses was accompanied by guidance to expand eligibility to all adults aged 65 and older, but without an associated increase in supply, progress in vaccinating such a large portion of the population will proceed slowly.

Pfizer issued a statement indicating that it continues to ship vaccine doses as directed by the US government and that it has “millions more doses sitting in [its] warehouse” awaiting direction from federal officials.

In response to limited vaccine supply from the federal government, New York Governor Andrew Cuomo issued a letter to the Chairman and CEO of Pfizer, Dr. Albert Bourla, requesting to purchase vaccine doses directly from the company. According to the letter, Pfizer does not have any agreement with Operation Warp Speed that would prohibit it from contracting directly with purchasers outside the federal government, but a spokesperson from Pfizer reportedly indicated that it would require authorization from the Department of Health and Human Services to enter into such an agreement. According to CDC data, New York State* has received 9,686 doses per 100,000 population, putting it #15 among US states, and it is #4 in terms of the total number of distributed doses. New York has administered 757,466 of its 1.88 million doses (40%). If New York were to purchase doses directly from Pfizer, it is unclear whether the state would be able to receive any vaccine ahead of Pfizer’s existing contracts, including with the US and other countries.

*Unlike much of the CDC’s COVID-19 data, New York City is not listed separately for vaccine reporting.

IVERMECTIN Ivermectin, an antiparasitic drug with antiviral properties, has shown promise during in vitro studies by inhibiting replication of SARS-CoV-2 in very small concentrations. Observational studies, case series reports, and ecological analyses have also supported this finding. Today, EClinicalMedicine (published by The Lancet) published the first pilot clinical trial testing ivermectin as a treatment of COVID-19. The study used a double-blinded, placebo-controlled design to evaluate ivermectin’s ability to treat COVID-19 disease or mitigate transmission risk. The study included 24 patients, with half (12) receiving a single dose of 400 mcg/kg of ivermectin and the other half (12) receiving a placebo. The treatment was administered within 72 hours of developing a fever or cough. The researchers collected clinical data and nasopharyngeal swabs on Days 4, 7, 14, and 21 post-treatment to assess detectable SARS-CoV-2 RNA by PCR, viral load, symptom severity, and seroconversion. The treatment group had lower viral loads at Days 4 and 7 and lower IgG titers at day 21, but these differences were not statistically significant. Patients in the did have a statistically significant improvement in the time to recover from hyposmia/anosmia—76 patient-days in the treatment group compared to 158 patient-days in the control group.

NORWAY DEATHS Norwegian health authorities are currently investigating the deaths of 23 elderly individuals who received the Pfizer/BioNTech SARS-CoV-2 vaccine to determine if adverse reactions to vaccination could have contributed to the patients’ mortality. The Norwegian Medicines Agency (NOMA) has investigated 13 of the deaths, concluding that some of the common adverse reactions to the vaccine—including fever, nausea, and diarrhea—could have contributed to the deaths. The Paul Ehrlich Institute is investigating 10 deaths reported in individuals who recently received the SARS-CoV-2 vaccine.

Dr. Steinar Madsen, Medical Director for NOMA, told BMJ that there is no certain connection between the vaccine and the patients’ deaths, but it could be possible that common adverse events that are generally mild in younger, healthier individuals could aggravate pre-existing conditions among older, medically frail individuals. The Norwegian Adverse Drug Reaction (ADR) Registry is continually monitoring adverse events related to SARS-CoV-2 vaccination and publishes public weekly reports. The most recent report (January 14) notes that an average of 45 patients in long-term care facilities die each day, and a statement about the deaths indicates that 400 people per week die at long-term care facilities. It is not unexpected that some individuals who get vaccinated will die of unrelated health conditions, and at this point, there is no evidence pointing to a significant increase in the number of deaths following vaccination in Norway.

In response to the reported deaths, The Norwegian Institute of Public Health updated its SARS-CoV-2 vaccination guidance to ask healthcare providers to weigh the risks of potential adverse reactions against the benefits of vaccination when considering vaccination for elderly, medically frail individuals. Norway continues to prioritize long-term care facility residents for vaccination due to their elevated risk of infection and severe disease.