Monday, February 22, 2021
Friday, February 19, 2021
February 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.
The Center 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.
EPI UPDATE The WHO COVID-19 Dashboard reports 109.59 million cases and 2.42 million deaths as of 10:00am EST on February 19.
As countries continue to scale up vaccination efforts, many are beginning to report data for both partially and fully vaccinated individuals. As we have covered previously, Israel is leading the world in terms of SARS-CoV-2 vaccination, with 48.8% of its population receiving at least 1 dose of the vaccine. Seychelles is #2, with 42.6%, followed by the UK countries—Wales (26.1%), Scotland (24.8%), England (24.6%), and Northern Ireland (22.6%). Bahrain (15.5%), the US (12.3%), and Chile (12.1%) are the only other countries reporting higher than 10% coverage with at least 1 dose. In total, 50 total countries are reporting 1-dose coverage greater than 1%. Of those countries that have commenced vaccinations, 51 are reporting the number of individuals who have been fully vaccinated, mostly in Europe and North America. Israel (33.0%) and Seychelles (19.8%) lead all countries in terms of the proportion of their populations with full coverage, and no other countries are reporting higher than 5%. The US (4.8%), Malta (4.2%), and Denmark (3.0%) round out the top 5. In total, 35 countries have reported full vaccination in more than 1% of their total population.
There are major differences in how countries are allocating their available supply to first and second doses, evident in the differences between partial and full vaccination coverage. Some countries are aggressively pursuing second doses for individuals who have already received their first dose, while others are focusing on broader coverage using the first dose. For example, Costa Rica (78.5%), Croatia (78.2%), Russia (76.8%), and Spain (70.0%) are all reporting full vaccination for 70% or more of individuals who received their first dose. In contrast, fewer than 10% of those who have received the first dose are fully vaccinated in the UK—England (3.6%), Northern Ireland (7.0%), Scotland (1.8%), and Wales (2.3%); Singapore (2.3%); and Chile (2.4%). While the UK and Chile have among the highest 1-dose coverage, they are among the lowest in terms of full vaccination coverage.
*These data address “fully vaccinated” from the perspective of the number of doses administered and not with respect to the time required after the last dose to develop the full immune response.
Our World in Data reports that 194.44 million vaccine doses have been administered globally, a 21% increase compared to this time last week. Vaccination efforts have been reported in at least 92 countries and territories.
UNITED STATES
The US CDC reports 27.67 million total cases and 489,067 deaths. Daily incidence in the US continues its steady decline, now down to 77,385 new cases per day—the lowest daily average since October 28, 2020. The daily mortality is currently 2,708 deaths per day, the lowest average since January 6, 2021; however, reporting irregularities due to previously unreported deaths and holiday delays are making it difficult to project the longer-term trajectory. While the actual 7-day average daily mortality is uncertain, we expect the US to surpass 500,000 cumulative deaths in the next several days.
US Vaccination
The US CDC reported 73.38 million vaccine doses distributed and 57.74 million doses administered nationwide (78.7%).
In total, 41.02 million people (approximately 12.4% of the entire US population) have received at least 1 dose of the vaccine, and 16.16 million (4.9%) have received both doses. The average daily doses administered continues to increase, now up to a record high of 1.54 million doses per day*, including 679,199 second doses per day*. The CDC is still reporting slightly more Pfizer-BioNTech doses administered (29.59 million; 51%) than Moderna (28.04 million; 49%), but the gap is closing.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.
A total of 6.18 million doses have been administered at long-term care facilities (LTCFs)**, including residents and staff. This covers 4.31 million individuals with at least 1 dose and 1.84 million with 2 doses. Approximately 59% of the doses have gone to residents, and 41% to staff.
**The dashboard only includes data for doses administered through the Federal Pharmacy Partnership for Long-term Care (LTC) Program. It does not report data from West Virginia, which opted out of the program.
The Johns Hopkins CSSE dashboard reported 27.91 million US cases and 493,670 deaths as of 12:30pm EST on February 19.
VACCINE CLINICAL TRIALS The UK has approved plans for the world’s first SARS-CoV-2 human challenge trial, backed by £33.6 million (US$47 million) in government funding. The UK COVID Challenge trial is expected to begin sometime in the next month, pending final ethics review. It will include up to 90 healthy volunteers, aged 18-30 years old, who will be deliberately exposed to SARS-CoV-2 and monitored under controlled conditions. The first stage of the trial will aim to characterize “the smallest amount of virus needed to cause infection,” and future efforts will include patients who are vaccinated prior to exposure to assess vaccine efficacy. The trial will be a partnership between the UK government’s Vaccine Task Force, Imperial College London, the Royal Free London NHS Trust Foundation, and hVIVO, a company with experience in human viral challenge trials.
The University of Oxford announced that it will conduct a clinical trial for the AstraZeneca-Oxford vaccine in children. The Phase 2 clinical trial will take place across 3 study sites in England and include 300 participants aged 6-17 years. The placebo-controlled trial will administer the vaccine to as many as 240 participants, and the control group will receive a meningitis vaccine in order to stimulate a similar reaction (e.g., injection site soreness). Another team of researchers is also conducting a Phase 2/3 clinical trial for the Moderna vaccine. The Moderna trial aims to enroll 3,000 participants, and it will use a saline injection as its placebo. Now that several SARS-CoV-2 vaccines have demonstrated safety and efficacy in adults, children are an important population to evaluate in these next stages of clinical trials.
Researchers are also initiating clinical trials in other special populations, such as pregnant women. On February 18, Pfizer and BioNTech announced that the first participants were vaccinated in a “global Phase 2/3" clinical trial to evaluate the safety and efficacy of their SARS-CoV-2 vaccine in pregnant women. The study aims to include 4,000 participants (aged 18 years and older), and the vaccine will be administered between 24 and 34 weeks of gestation.
US VACCINE SUPPLY Following announcements from multiple US states that demand is outpacing federal supply of SARS-CoV-2 vaccine doses, the White House announced another increase in weekly distributions. The federal government will provide 13.5 million doses to state governments per week and 2 million weekly doses directly to pharmacies, compared to previous shipments of 10 million and 2 million doses per week, respectively. This brings the total national distribution to 15.5 million doses per week, which would enable 2.2 million doses to be administered per day nationwide. This corresponds to an increase of nearly 50% over the current average of 1.5 million doses administered per day.
HONG KONG AUTHORIZES SINOVAC VACCINE On February 18, the Hong Kong Secretary for Food and Health authorized the Sinovac SARS-CoV-2 vaccine for emergency use. The announcement followed recommendations from Hong Kong’s Advisory Panel on COVID-19 Vaccines. Reportedly, the efficacy data used in Hong Kong’s regulatory review showed 62% efficacy, which is higher than some other recent clinical results for the vaccine but lower than other vaccines authorized in other countries. The data have not been published, and some scientists have called on Sinovac to publicly release the clinical trial data. While Sinovac shared data with the advisory panel, critics argue that this does not meet the rigorous standard of a public peer review. Notably, a recent study conducted by Hong Kong University found that fewer than 30% of respondents would get vaccinated using the Sinovac vaccine due, in part, to concerns about its efficacy.
Hong Kong’s current agreement would supply 1 million doses of the vaccine to later this week, and vaccination is expected to start on February 26. Hong Kong established 5 priority groups for the earliest eligibility: (1) healthcare workers and “staff involved in anti-epidemic work,” (2) adults aged 60 years and older, (3) residents and staff at long-term care facilities, (4) essential workers, and (5) border control and workers at points of entry.
GLOBAL VACCINE ALLOCATION At least 92 countries and territories around the world have commenced SARS-CoV-2 vaccination campaigns. Several sizable gaps remain in vaccine access, most notably in Africa. In total, only 5 countries in Africa have reported vaccinations to date: Algeria, Egypt, Mauritius, Morocco, and Seychelles. In total African countries have reported 2.3 million cumulative vaccinations, the vast majority of which (97%) are in Morocco. Additionally, several African countries recently announced the delivery of their first vaccine doses or the start of vaccination campaigns. South Africa previously suspended its national vaccination program for the AstraZeneca-Oxford vaccine due to concerns regarding that vaccine’s efficacy against the B.1.351 variant, which was first identified in South Africa; however, it commenced vaccinations on February 17 using the Johnson & Johnson (J&J)-Janssen vaccine. Zimbabwe also commenced vaccinations this week, using Sinopharm vaccines from China. Sinopharm has also supplied doses to Egypt and Equatorial Guinea. Rwanda commenced its vaccination efforts as well, focusing initially on high-risk populations such as frontline healthcare workers. The Rwandan Ministry of Health announced the program on February 14.
In response to global disparities in SARS-CoV-2 vaccine access, particularly with respect to countries’ wealth, Mexican Minister of Foreign Affairs Marcelo Ebrard’s statement to the UN Security Council called for the “international community to guarantee fair, equitable and timely access” to the vaccine. Minister Ebrard’s statement noted that 10 countries have received 75% of the global vaccine supply and that more than 100 countries have not yet administered a single vaccination. Mexico has reportedly purchased 230 million doses of SARS-CoV-2 vaccines, across multiple manufacturers; however, its allotments have been limited relative to wealthier countries like China, the US, the UK, and many European countries. To date, Mexico has reported only 1.32 million doses administered, although more than 500,000 of those (43%) have been reported in the past 3 days. On a per capita basis, Mexico has administered only 1 dose per 100 people, compared to 17.4 in the US, 6.35 across Europe, and 2.8 in China.
As we reported previously, the COVAX facility published its anticipated vaccine allotments, which includes more than 88 million doses for 46 African countries and nearly 6.5 million doses for Mexico. The Emergency Use Listings recently issued by the WHO for the AstraZeneca-Oxford vaccine cover more than 99% of the 320 million doses in the first COVAX allotment and move COVAX one step closer to shipping the first doses.
EU VACCINE SUPPLY As supply continues to be a bottleneck in SARS-CoV-2 vaccination efforts, Pfizer and BioNTech are reportedly behind schedule in delivering vaccine to the EU, including approximately 10 million doses that were supposed to arrive in December. The missing Pfizer doses represent one-third of the anticipated supply, exacerbating the impact of delays in delivering the AstraZeneca-Oxford and Moderna vaccines. As a result of ongoing concerns regarding the availability of the AstraZeneca-Oxford vaccine, the European Commission reportedly finalized new contracts to purchase an additional 350 additional doses of the Pfizer-BioNTech and Moderna vaccines, scheduled to be delivered through the end of 2021. Recent agreements, including the February contract with Pfizer/BioNTech, include “anti-variant” clauses that would allow the bloc not to purchase vaccines that are not effective against emerging variants, and the EC reportedly hopes to add similar clauses to existing contracts. Additionally, the EU is funding almost US$300 million for efforts to combat variants, including at least €75 million (US$91 million) for expanded genomic sequencing capacity and the development of specialized tests for emerging variants and €150 million (US$182 million) for research and data sharing.
EMERGING VARIANTS A study published (preprint) by Harvard University examines the nasopharyngeal viral concentration in individuals infected with the B.1.1.7 SARS-CoV-2 variant. The researchers performed a series of PCR-based diagnostic tests over a series of weeks to evaluate temporal dynamics of the viral concentration for this variant of concern. The study included 65 total participants, including 7 infected with the B.1.1.7 variant. The researchers found that infection with the B.1.1.7 variant lasted significantly longer than for other variants, with a mean duration of infection of 13.3 days for the B.1.1.7 variant, compared to 8.2 days for non-B.1.1.7 variants. While the duration of infection was longer for the B.1.1.7 variant, the peak viral concentration was similar between B.1.1.7 and non-B.1.1.7 variants.
Even though the peak nasopharyngeal viral concentration is similar between the B.1.1.7 and non-B.1.1.7 variants, the longer duration of infection could potentially be a factor in the variant’s increased transmissibility. If individuals infected with the B.1.1.7 variant take longer to clear the virus from their system, their infectious period could potentially be longer as well, which could result in additional exposures compared to non-B.1.1.7 variants. Further investigation is necessary to better characterize the drivers of the increased transmissibility, but this study provides insight into potential mechanisms that contribute to the variant’s ability to spread more rapidly in the community.
US MORTALITY The US CDC published findings from analysis of US mortality data from January-June 2020, which indicates that the average life expectancy in the US decreased by 1 year compared to estimates from 2019. The analysis was conducted by the CDC’s National Center for Health Statistics, and the researchers evaluated all reported deaths from the first half of 2020*. The researchers estimate the overall life expectancy in the US for the first half of 2020 to be 77.8 years, a decrease from 78.8 years in 2019 and the lowest estimate since 2006. This is the largest single-year decline since World War II. The decrease was slightly greater in males than females—1.2 years compared to 0.9 years. The analysis also evaluated changes in life expectancy by racial and ethnic groups, a major concern due to the disproportionate burden of COVID-19 on racial and ethnic minorities. Life expectancy decreased by 0.8 years for the non-Hispanic White population, 1.9 years for the Hispanic population, and 2.7 years for the non-Hispanic Black population, illustrating “a worsening of racial and ethnic mortality disparities.”
Notably, these reported deaths include the initial COVID-19 surge, but they do not cover the autumn/winter 2020-21 surge, which exhibited a higher and more sustained mortality rate—exceeding 2,000 deaths per day since early December 2020 and 3,000 deaths per day from mid-January through mid-February 2021. One of the researchers indicated that the “majority of the decline” stemmed from the pandemic.
*The report indicates that the analysis is based on preliminary data and that some reports could be delayed by months.
JAPAN VACCINATION On February 17, Japan commenced its SARS-CoV-2 vaccination campaign, focusing initially on healthcare workers and older adults. Japan faced its largest surge in December 2020 and January 2021, but it delayed the start of its vaccination campaign after requiring domestic clinical trials of the Pfizer-BioNTech vaccine. Pfizer and BioNTech applied for emergency approval in Japan in December, but reportedly, Japan waited for preliminary data from a clinical trial of 160 Japanese participants in order to better assess safety in the Japanese population. Critics argue that the small sample size likely delayed the start of vaccination efforts while providing limited benefit. Review of the application for the AstraZeneca-Oxford is ongoing, and Moderna has not yet submitted an application in Japan. Japanese officials continue to express optimism that the delayed 2020 Summer Olympic Games will be held in 2021, and the national vaccination effort is likely a key step in achieving that goal.
TAIWAN VACCINE SUPPLY Taiwan’s Minister of Health and Welfare, Chen Shih-chung, announced that an agreement to purchase 5 million doses of the Pfizer-BioNTech SARS-CoV-2 vaccine is on hold. Reportedly, Taiwan was negotiating with BioNTech to purchase the vaccine, but “the company suddenly backed out.” Minister Chen indicated that the negotiations fell through as a result of “outside forces intervening,” but he did not elaborate further. Some have speculated that influence from the Chinese government is responsible for the delay, but Chinese officials deny involvement in the decision. BioNTech has not offered an explanation regarding the underlying factors in their decision.
BioNTech was coordinating with the Shanghai Fosun Pharmaceutical Group to manufacture SARS-CoV-2 vaccines for mainland China, Hong Kong, Macau, and Taiwan; however, Taiwanese pharmaceutical company TTY Biopharm was reportedly involved in negotiations directly between the Taiwanese government and BioNTech. Representatives from BioNTech stressed that the deal with Taiwan is only delayed and not withdrawn entirely. The response to the COVID-19 pandemic has further exacerbated the tense political relationship between Taiwan and China. Taiwan announced in late December that it secured approximately 20 million doses of SARS-CoV-2 vaccine, including 10 million from AstraZeneca, nearly 5 million from COVAX, and another 5 million from an impending contract, which is believed to be the suspended agreement with BioNTech.
VACCINE CEASEFIRE The UK government called for “local ceasefires across the globe” in order to enable governments and humanitarian aid organizations to implement SARS-CoV-2 vaccination efforts in conflict zones. UK Secretary of State for Foreign, Commonwealth, and Development Affairs Dominic Raab issued a statement at a meeting of the UN Security Council emphasizing the COVID-19 risk to more than 160 million people living in areas of ongoing armed conflict—“including in Yemen, South Sudan, Somalia and Ethiopia”—and highlighting the importance of conducting vaccination efforts in those areas. These “vaccine ceasefires” would not only provide direct benefit to vaccinated individuals, but it could also mitigate the risk of viral mutation and emerging variants. The UK also called for increased financial contributions to the COVAX facility, in order to increase the vaccine supply for low- and middle-income countries.
Thursday, February 18, 2021
The truth about Texan power outage
Attribution: Getty Images
Blackout continues in Texas, as Republicans blame everything but the real problem
Feb 17, 2021 8:22am CST by Mark Sumner, Daily Kos Staff
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On Wednesday morning, millions of homes in Texas are still without power as a prolonged blackout continues. Meanwhile, the temperature in Austin, Texas, is expected to approach freezing for the first time in days … as the city is hit by a massive ice storm that’s expected to bring down trees and power lines. As a bonus, the cold weather has also broken water lines in multiple Texas towns and cities. In some areas, the prolonged outage has become genuinely life-threatening.
Fox News and Republican politicians—including Texas Gov. Greg Abbott—have been taking this “opportunity” to attack Texas’ use of wind energy, call for the burning of more fossil fuels, and to make claims that green power is “deadly.” However, the statistics provided by Texas own grid managers show that wind continues to produce more power than projected for this time of year, with the great majority of outages in exactly the gas- and coal-based plants that Fox has been touting.
Meanwhile, far from being off line, wind generators are enjoying a fat payday. Thanks to the way power prices fluctuate in Texas, Bloomberg reports that a 100Mw windfarm that could normally expect to clear $40,000 on any two days in February, instead racked up over $9.5 million on Monday and Tuesday thanks to record spikes in Texas power market.
In 2003, Australia installed a pair of wind turbines at its Mawson Research Station in Antarctica. One of those turbines failed … after 14 years of operating in extreme conditions where temperatures are regularly far below zero and winds exceed 100 mph. The other turbine is still operating, providing 300 kW to power the research post.
At the opposite end of the world, Norway installed a pair of 100Mw turbines in Svalbard, the most northerly town in the world. Further south, but still within the Arctic circle, the fishing and tourist town of Havøysund, Norway, is home to Arctic Wind. Greenland also has been moving to wind power since 2008.
And in the United States, anyone traveling along Interstate 94 through North Dakota can’t help but notice that the area is graced by more than 1,500 wind turbines generating over 3,000 Mw of energy. The temperature in Dallas might have reached 24 degrees on Tuesday, but it was -1 in Fargo. North Dakota’s wind turbines kept right on cranking.
In short—wind turbines operate reliably, year in and year out, in conditions far worse than those currently being experienced in Texas. Yes, there are some turbines currently down for maintenance in Texas, but with 10,700 turbines operating, there are always turbines down for maintenance. The current number doesn’t seem to be any higher than normal. In fact, while many sources are citing wind as accounting for 13% of the 30 gigawatts of power currently offline in Texas, that’s only true if you count the rated power of every turbine offline and ignore the fact that the operating turbines are actually producing well over their projected rate.
If the wind turbines aren’t frozen, then what is? Gas pipelines. Unlike pipelines in Alaska or the Dakotas, those connected Texas fields with storage facilities and power plants are above ground and uninsulated. Methane doesn’t actually liquify until it hits a temperature that even Antarctica can’t match, but what’s in a natural gas pipeline is far from pure methane. It usually includes fluids involved in drilling and fracking as well as a good deal of water vapor. As a result, when those pipelines get cold, they can develop a kind of methane-saturated sludge that severely restricts the flow.
At the same time the pipelines are producing less, demand is going up. Not only is natural gas used at power plants, it’s used directly in home and business heating. So everyone wants the gas, just as it’s getting more difficult to move. That definitely is happening in Texas. The result is both shortages that have either taken plants offline or reduced their rate of production, while at the same time driving the spot price for natural gas through the roof. Gas that sold for $4/MMBtu last week, hit $500 over the weekend and $1,000 on Tuesday.
Coal plants are also having difficulty. Almost all the coal burned in Texas is sub-bituminous from the Powder River Basin in Wyoming, or lignite from Texas’ own fields. Both grades of coal are high in moisture. And since coal is generally shipped in open cars and often stored outside in stockpiles, also subject to local weather. Frozen coal can be hard to remove from train cars, difficult to move down conveyor belts, and clog the crushers that are used to ready it for furnaces. In addition, coal plants and gas plants are steam plants, meaning that they require huge amounts of water. That water also moves around in pipes. When those pipes are exposed and uninsulated, they freeze.
The freezing temperatures in Texas may be a record in some locations, but they were not a surprise. Forecasters could see this wave of extreme cold coming for weeks before it arrived. Even so, there appears to have been no effort made to prepare Texas’ power grid for the surge of demand that would come when all that cold air reached all those millions of homes. It appears that way … because it was that way.
As The Washington Post makes clear, natural gas is by far the largest contributor to the current power shortfall in Texas. The reason is simple lack of preparation that has nothing to do with engineering. It’s simply the system of incentives put in place by the Electric Reliability Council of Texas (ERCOT) and how Texas created a “Wild West market design based only on short-run prices.” No one prepared because there is no money in preparing. The market is designed to capitalize on high-demand situations, and—as the mid-sized wind farm back at the outset of this article illustrates—situations that are miserable for Texas consumers can be wonderful for Texas operators.
It’s no wonder that Fox News is claiming that the “Green New Deal” is killing Texas, even though that legislation has never been passed. And it’s no secret why Abbott and others want to find a convenient scapegoat that lets them announce “investigations” that have no intention of changing a thing. Texas’ power grid is not only operating as designed, it’s a showcase of Republican plans for deregulation and “free markets.”
They can’t admit the truth, because what they want is more. Not more power. More of the same system that’s keeping Texas in the dark.bove
Wednesday, February 17, 2021
Tuesday, February 16, 2021
February 16: 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.
The Center 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.
EPI UPDATE The WHO COVID-19 Dashboard reports 108.82 million cases and 2.40 million deaths as of 10:30am EST on February 16.
Both the global weekly incidence and mortality continue to decrease steadily. Weekly mortality has decreased by nearly half since the peak reported the week of January 4, 2020. The current weekly incidence is the lowest since mid-October 2020. Weekly mortality decreased for the second consecutive week, down nearly 25% from the high reported the week of January 25, 2021. At the regional level, only the Eastern Mediterranean Region is currently reporting increasing weekly incidence—up 7.5% compared to the previous week, following 3 consecutive weeks of decreasing incidence. Weekly mortality is decreasing in all WHO regions.
Our World in Data reports that 177.94 million vaccine doses have been administered globally, a 20% increase compared to this time last week. Vaccination efforts have been reported in at least 86 countries and territories.
UNITED STATES
NOTE: The US CDC did not update COVID-19 epidemiological or vaccination data yesterday due to the President’s Day holiday. The data below correspond to the most recent update on February 14.
The US CDC reported 27.42 million total cases and 482,536 deaths. Daily incidence in the US continues its steady decline, falling below 100,000 new cases per day for the first time since November 3, 2020.
On February 12, the US reported 5,520 new deaths. This is the second highest single-day total to date; however, the 3 highest single-day totals are the result of previously unreported deaths from a single state—New York (April 15, 2020), Indiana (February 4), and Ohio (February 12). As we covered previously, Ohio announced last week that it identified more than 4,000 previously unreported deaths, and it reported 721 deaths on February 11; 2,259 on February 12; and 1,204 on February 13.
The recent spikes in reported mortality make it difficult to get an accurate picture of the longer-term national trend. The mortality reported on February 11, however, could provide some insight. February 11 was the first day after the 7-day average window following February 4, and it was also the day prior to the largest report from Ohio. The average national daily mortality of 2,784 deaths per day on February 11 did include the first elevated report from Ohio, but it provides some indication that the true daily mortality is much lower than the current average of 3,136 deaths per day. This is the lowest daily mortality since January 6, prior to the estimated peak mortality in mid-to-late January, and it provides further evidence that daily mortality continues to decrease nationally.
US Vaccination
The US CDC reported 70.06 million vaccine doses distributed and 52.88 million doses administered nationwide (75.5%).
In total, 38.29 million people (approximately 11.6% of the entire US population) have received at least 1 dose of the vaccine, and 14.08 million (4.3%) have received both doses. The average daily doses administered continues to increase, now up to a record high of 1.50 million doses per day*. The number of people receiving their second dose is increasing at nearly 600,000 per day*. The breakdown of doses by manufacturer continues to shift toward the Moderna vaccine. The CDC is still reporting slightly more Pfizer-BioNTech doses administered (27.27 million; 52%) than Moderna (25.51 million; 48%), but the gap is closing.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.
A total of 5.82 million doses have been administered at long-term care facilities (LTCFs)*, including residents and staff. This covers 4.16 million individuals with at least 1 dose and 1.64 million with 2 doses. Approximately 59% of the doses have gone to residents, and 41% to staff.
*The dashboard only includes data for doses administered through the Federal Pharmacy Partnership for Long-term Care (LTC) Program. It does not report data from West Virginia, which opted out of the program.
As the US SARS-CoV-2 vaccination effort continues, there remain substantial differences in terms of how efficiently states are administering their allotted doses. On a per capita basis, nationwide distribution remains relatively even. All by 9 states have received within 10%(+/-) of the median per capita doses distributed. Only Alaska has received more than 25% above the median, and no states have received less than 75% of the median. States vary widely, however, in terms of administration. By percent of doses administered, states range from 61.74% (Rhode Island) to 97.72% (West Virginia), with a median of 76.47%. In total, 36 states are within 10%(+/-) of the median in terms of percent of doses administered, a moderate decrease compared to the national distribution. Eight (8) states are reporting 60-70% of doses administered, 27 are reporting 70-80%, and 18 are reporting 80-90%. Three (3) states—New Mexico, North Dakota, and West Virginia—are reporting greater than 90%, which is more than 25% higher than the median. No states report less than 75% of the median.
States also vary widely in terms of how they are allocating doses between first and second vaccinations. In terms of the proportion of doses allocated for second vaccinations, states range from Delaware, with slightly more than one-fifth (21.35%), to West Virginia, the only state reporting more than one-third (35.92%). The median value is 27.33%. Approximately half of the states (26) are within 10%(+/-) of the median value. In total, 13 states are reporting 20-25%, 24 states are reporting 25-30%, and 12 states are reporting 30-35%. West Virginia is the only state reporting more than 35% and the only state reporting more than 25% higher than the median. No states are less than 75% of the median.
The Johns Hopkins Coronavirus Resource Center reported 27.71 million US cases and 486,572 deaths as of 12:30pm EST on February 16.
WHO VACCINE EMERGENCY USE LISTING The WHO issued Emergency Use Listings (EULs) for two versions of the AstraZeneca-Oxford University SARS-CoV-2 vaccine. The two versions are those produced directly by AstraZeneca-SKBio and those manufactured under the license to the Serum Institute in India. With the EUL in place, the AstraZeneca-Oxford vaccine can begin distribution through the COVAX facility, which will provide doses to low- and middle-income countries (LMICs) around the world, including nearly 340 million doses of the AstraZeneca-Oxford vaccine. The first COVAX distributions are expected later this month. Additionally, an EUL from the WHO can facilitate expedited regulatory authorization for the vaccine in many countries. This is the second EUL issued for a SARS-CoV-2 vaccine, following the Pfizer-BioNTech vaccine on December 31, 2020.
US SCHOOL GUIDANCE On February 12, the US CDC published updated guidance to support schools’ efforts to mitigate COVID-19 risk for in-person classes. The biggest update is a new “phased mitigation” strategy, which couples risk mitigation measures with the level of community transmission. The guidance emphasizes 5 key mitigation mechanisms—mask use, physical distancing, hand hygiene and respiratory etiquette, cleaning and sanitization, and surveillance and contact tracing—that are applicable across all levels of COVID-19 risk, but it also provides actionable information regarding how to implement those and other strategies at various levels of COVID-19 risk. The guidance also breaks down specific recommendations for elementary, middle, and high schools, and it includes guidance for extracurricular activities, including sports.
The updated guidance emphasizes that closing schools for in-person learning should be among the last measures taken to control local transmission. With that in mind, the guidance highlights some areas of flexibility in terms of the local community COVID-19 risk and what schools are capable of implementing. The guidance provides schools with recommendations regarding the minimum standards for conducting in-person classes for various levels of COVID-19 risk. For example, 6-foot physical distancing is recommended “to the greatest extent possible” for communities with low and moderate transmission; however, the CDC recommends mandatory 6-foot distancing for schools in substantial or high transmission areas. Schools that are unable to ensure the recommended physical distancing may need to reduce attendance and/or transition to hybrid or remote learning models, if community transmission is elevated. In addition to physical distancing, the guidance includes information on improving ventilation and implementing screening or testing programs for students and staff as well as additional risk mitigation measures if these programs cannot be implemented. Some view the guidance as a positive step toward supporting schools’ efforts to resume in-person learning, particularly the emphasis on closing schools as a last resort, whereas others argue that criteria for community transmission and testing are unrealistic and overly restrictive and that the guidance will ultimately keep schools closed longer.
Some aspects of the CDC’s previous school guidance remain in place, including the COVID-19 Mitigation Toolkit, Get Ready for In-Person Learning, Setting Up Your Classroom, and Teacher and Staff Checklists—all of which were published or updated in December 2020. The CDC also updated its Operating Schools During COVID-19 guidance on February 11, but there are no changes listed since December 31, 2020.
EMERGING VARIANTS Researchers from Switzerland and the US published (preprint) findings from a study of the emergence of new SARS-CoV-2 variants that include a specific mutation in the spike protein. Mutations at amino acid 677 affect the virus’ spike protein, which could potentially factor into the virus’ transmissibility or its susceptibility (or resistance) to antibodies, including those generated through vaccination. The researchers identified at least 7 distinct sub-lineages in the US that contain this mutation, all of which appear to have emerged in the US (ie, as opposed to imported from another country). These sub-lineages first appear in specimens sequenced at least as far back as August 2020, but it is unclear exactly when they first emerged. These sub-lineages already account for a substantial proportion of the documented SARS-CoV-2 genomes nationwide, but further research is needed to better characterize the effects of these mutations on transmissibility. Increased sequencing capacity is needed to improve surveillance for these and other emerging variants.
Researchers from the Johns Hopkins Center for Health Security—led by Dr. Caitlin Rivers and Lane Warmbrod and in collaboration with Dr. Matthew Frieman (University of Maryland) and Dr. Dylan George (In-Q-Tel)—published a report outlining recommendations to improve the United States’ ability to identify, monitor, and characterize emerging SARS-CoV-2 variants. Their principal recommendations address various aspects of containing and monitoring these variants. First, implementing policies to slow transmission can mitigate the risk of new variants emerging in the first place. In order to effectively monitor for the emergence of new variants, the US needs a national strategy for genomic surveillance, including resources necessary to implement it. At the local level, infections identified with variants of concern should be prioritized for contact tracing and other follow-up in order to effectively gather data regarding the variants’ performance compared to existing strains. And finally, coordination and resources are necessary to implement effective and efficient efforts to characterize the effects of specific mutations and the capabilities of emerging variants, including with respect to transmissibility, disease severity, and susceptibility to vaccines and therapeutics.
US TESTING CAPACITY A survey conducted by STAT News and The Harris Poll (February 5-7) indicates that SARS-CoV-2 testing capacity in the US is still not meeting demand. Among those who sought testing, 44% reported being unable to get tested*. Common complaints from the respondents who were unable to get tested included long wait times, distance to a testing site or lack of transportation, and uncertainty regarding where to get tested. Among those who had been tested at least once, the majority of testing (56%) occurred at drive-through or hospital-based testing sites, and most (69%) used nasopharyngeal swabs. The Biden Administration has acknowledged the ongoing nationwide shortage of test kits, and it is negotiating with the Congress to secure funding to purchase additional tests. Current plans include purchasing 8.5 million at-home rapid tests and scaling up production of the at-home kits to more than 60 million by this summer. At-home testing could potentially alleviate barriers due to test site location, transportation, and wait times by eliminating the need to find and travel to a testing site.
*31% sought testing and were able to be tested, 24% sought testing and could not get tested, and 45% did not seek testing.
An investigation conducted by The Wall Street Journal found that “at least 32 million of 142 million” rapid antigen tests distributed by the federal government to states remain unused. These tests were intended to support larger-scale screening efforts, including at schools and long-term care facilities, but logistical challenges for facilities implementing testing programs and reporting results has limited demand. The rapid tests were viewed by some as an important tool to ongoing screening programs that could be used to resume some activities (eg, in-person learning) and respond to outbreaks, but the low use is problematic. Many of the tests have a shelf life of 6 months, and millions of test kits delivered in autumn 2020 are approaching their expiration date.
US VACCINATION As US states continue to expand vaccination eligibility to larger portions of their populations and scale up vaccination capacity, some are limited by the available supply. As we noted in the Epi Update section above, at least half of all US states have administered more than 75% of the vaccine doses they have received from the federal government. Much of the remaining inventory at the state level is reserved for second doses. Some states have been forced to shut down various aspects of their vaccination programs, including large mass vaccination sites like Dodger Stadium in Los Angeles, California. Numerous local jurisdictions in the Atlanta, Georgia, area have also stopped scheduling new vaccination appointments due to insufficient supply. US President Joe Biden announced plans to bolster vaccine supply on February 2, but the increase to 10.5 million doses per week does not provide an increase over the current average of 1.5 million doses administered per day.
In addition to supply limitations, a massive winter storm that swept across much of the US is hindering vaccination efforts in many states. Shipments of doses to some areas have been delayed, and clinics and mass vaccination sites have closed in multiple states. In Texas, large-scale electrical outages have caused vaccine freezers to lose power, and health officials scrambling to administer doses of the vaccine before they go bad.
US TRIBAL VACCINATION Tribal nations in the US have been among the hardest hit by COVID-19 due to a variety of factors, including underlying health conditions, poverty, and limited access to healthcare services. Despite these challenges, evidence is emerging that many tribal nations are vaccinating their populations more efficiently than many other US communities. Among these success stories are the Cherokee and Navajo Nations, which are both reporting high rates of vaccination and high levels of interest in getting vaccinated. Notably, Navajo Nation reported that 47.7% of the population residing on tribal lands has received at least one dose of the vaccine. Both Nations credit culturally appropriate outreach and education efforts in the community as critical to the success of their vaccination efforts.
The ability of tribal nations to decide their own vaccination priorities also contributed to building greater confidence in the vaccine. For example, the Cherokee Nation chose to include their highly revered Cherokee language speakers and Cherokee National Treasures among its first priority groups. The decision signaled that tribal leaders were prioritizing Cherokee culture, and vaccinating respected tribal elders demonstrated to others that the vaccine is safe. The Navajo Nation is engaging in community outreach through a variety of fora, including radio broadcasts and frequent town halls, conducted both in English and the Navajo language. The apparent success of these efforts, exhibited by the high vaccine uptake and willingness to be vaccinated, underscore the importance of culturally relevant messaging and education in promoting SARS-CoV-2 vaccination.
MODERNA VACCINE DOSES The US FDA is reportedly considering allowing Moderna to increase the number of doses included in each vial of its SARS-CoV-2 vaccine. Moderna has been consulting with FDA officials to determine if it can increase the doses in each vial from 10 to 14 or 15. Moderna still needs to provide data to the FDA demonstrating that the increase in doses per vial would not compromise vaccine quality; however, increasing vial capacity by 40-50% could potentially increase the country’s overall COVID-19 vaccine supply by 20%. The associated modifications to Moderna’s production lines could be completed as early April. Filling and labeling the individual vials remains a major bottleneck in the vaccine manufacturing process, so increasing the volume of vaccine in each vial would substantially increase supply without adding time to the overall time to finish each vial. A substantial increase to the vaccine supply could have a major impact on vaccination operations, both in the US and around the world.
MASK EFFICACY A commentary published in JAMA by Dr. John T. Brooks and Dr. Jay C. Butler, two experts at the US CDC, provides an overview of the evidence supporting the use of facemasks during the COVID-19 pandemic. The researchers evaluate the existing body of evidence in support of universal masking, including results from contact tracing investigations, large surveys, and ecological studies that evaluate the effect of masking policies on COVID-19 incidence, including several that compare COVID-19 incidence before and after implementing a mask mandate. The authors draw a parallel between universal mask use and herd immunity, noting that increased mask use in a given community can increase the level of protection against SARS-CoV-2 transmission. Additionally, they argue that the specific type of mask used could be less important than the act of wearing the mask.
ISRAEL Israel continues to lead the world in terms of SARS-CoV-2 vaccination. Israeli Minister of Health Yuli Edelstein announced that 2.61 million individuals have received both doses of the vaccine, approximately 30% of Israel’s total population. With such a substantial portion of its population already vaccinated, Israel is among the first countries to begin evaluating the effect of vaccination on its COVID-19 epidemic. Israel’s largest healthcare provider—Health Maintenance Organization (HMO) Clalit, which covers more than half of Israel’s population—reported a 94% decrease in symptomatic COVID-19 cases among 600,000 individuals who received 2 doses of the Pfizer-BioNTech vaccine, compared to those who have not yet been vaccinated.
Despite its success, Israel still faces many challenges in terms of vaccine hesitancy. Like many countries, misinformation remains a major challenges during Israel’s COVID-19 epidemic, particularly with respect to SARS-CoV-2 vaccination. To combat misinformation, Israel’s Ministry of Health established a taskforce to find and remove misinformation on a wide range of social media sources, including in multiple languages. In further efforts to promote vaccination, Israel is reportedly considering measures to prohibit unvaccinated individuals from some public spaces, including museums or concerts. Israel is also implementing more creative measures to incentivize vaccination. At some mass vaccination centers, DJs play music in order to attract attention and draw in younger adults. Social media influencers have also been approached by the government to promote vaccination and disseminate information on the ongoing vaccination campaign.
NEW ZEALAND LOCKDOWN A cluster of COVID-19 cases in Auckland, New Zealand, has prompted new national “lockdown” measures. On February 14, the New Zealand Ministry of Health reported 3 cases in the same household. Case investigation efforts determined that several of the newly identified cases traveled to a nearby tourist attraction during the period when they could have been infectious, but it is not clear whether any of them were infectious at that time. All members of the household have been placed into isolation/quarantine. Genomic analysis from the cases indicates that the 3 individuals are infected with the B.1.1.7 variant of concern, but the analysis was unable to link the cases to any other known chains of transmission. To date, 109 close contacts have been identified and tested, and no additional cases have been linked to the cluster. The investigation is ongoing to identify the source of exposure.
Following the announcement, New Zealand implemented a Level 3 lockdown in Auckland and moved the rest of the country to Level 2 for a period of 72 hours to allow health officials time to investigate the cluster and assess the risk. The lockdown is currently scheduled to end at midnight on February 17. New Zealand health officials determined that several major events, including the America’s Cup (sailing) and the Big Gay Out festival could continue as scheduled, as long as event organizers implemented appropriate protective measures. The Big Gay Out festival reportedly did proceed as planned, but the America’s Cup postponed races scheduled for February 17 as a precaution.
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