The Coronavirus Is Here Forever. This Is How We Live With It.

The Coronavirus Is Here Forever. This Is How We Live With It.

We can’t avoid the virus for the rest of our lives, but we can minimize its impact.

By Sarah Zhang

Getty ; The Atlantic

AUGUST 17, 2021

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In the 1980s, doctors at an English hospital deliberately tried to infect 15 volunteers with a coronavirus. COVID-19 did not yet exist—what interested those doctors was a coronavirus in the same family called 229E, which causes the common cold. 229E is both ubiquitous and obscure. Most of us have had it, probably first as children, but the resulting colds were so mild as to be unremarkable. And indeed, of the 15 adult volunteers who got 229E misted up their nose, only 10 became infected, and of those, only eight actually developed cold symptoms.

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The following year, the doctors repeated their experiment. They tracked down all but one of the original volunteers and sprayed 229E up their nose again. Six of the previously infected became reinfected, but the second time, none developed symptoms. From this, the doctors surmised that immunity against coronavirus infection wanes quickly and reinfections are common. But subsequent infections are milder—even asymptomatic. Not only have most of us likely been infected with 229E before, but we’ve probably been infected more than once.

This tiny study made little impression at the time. In the ’80s and ’90s, coronaviruses still belonged to the backwater of viral research, because the colds they caused seemed trivial in the grand scheme of human health. Then, in the spring of 2020, scientists urgently searching for clues to immunity against a novel coronavirus rediscovered this decades-old research. Before the emergence of SARS-CoV-2, which causes COVID-19, only four known coronaviruses were circulating among humans, including 229E. All four of these coronaviruses cause common colds, and in the most optimistic scenario, experts have told me, our newest coronavirus will end up as the fifth. In that case, COVID-19 might look a lot like a cold from 229E—recurrent but largely unremarkable.

That future may be hard to imagine with intensive-care units filling up yet again during this Delta surge. But the pandemic will end. One way or another, it will end. The current spikes in cases and deaths are the result of a novel coronavirus meeting naive immune systems. When enough people have gained some immunity through either vaccination or infection—preferably vaccination—the coronavirus will transition to what epidemiologists call “endemic.” It won’t be eliminated, but it won’t upend our lives anymore.

With that blanket of initial immunity laid down, there will be fewer hospitalizations and fewer deaths from COVID-19. Boosters can periodically re-up immunity too. Cases may continue to rise and fall in this scenario, perhaps seasonally, but the worst outcomes will be avoided.

We don’t know exactly how the four common-cold coronaviruses first came to infect humans, but some have speculated that at least one also began with a pandemic. If immunity to the new coronavirus wanes like it does with these others, then it will keep causing reinfections and breakthrough infections, more and more of them over time, but still mild enough. We’ll have to adjust our thinking about COVID-19 too. The coronavirus is not something we can avoid forever; we have to prepare for the possibility that we will all get exposed one way or another. “This is something we’re going to have to live with,” says Richard Webby, an infectious-disease researcher at St. Jude. “And so long as it’s not impacting health care as a whole, then I think we can.” The coronavirus will no longer be novel—to our immune systems or our society.

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Endemicity as the COVID-19 endgame seems quite clear, but how we get there is less so. In part, that is because the path depends on us. As my colleague Ed Yong has written, the eventuality of endemic COVID-19 does not mean we should drop all precautions. The more we can flatten the curve now, the less hospitals will become overwhelmed and the more time we buy to vaccinate the unvaccinated, including children. Letting the virus rip through unvaccinated people may get us to endemicity quickest, but it will also kill the most people along the way.

The path to endemic COVID-19 will also depend on how much the virus itself continues to mutate. Delta has already derailed summer reopening plans in the U.S. And with so much of the world still vulnerable to infection, the virus has many, many opportunities to luck into new variants that may yet enhance its ability to spread and reinfect. The good news is this virus is unlikely to evolve so much that it sets our immunity back to zero. “Our immune responses are so complex, it’s basically impossible for a virus to escape them all,” says Sarah Cobey, an evolutionary biologist at the University of Chicago. For example, levels of antibodies that quickly neutralize SARS-CoV-2 do indeed drop over time, as happens against most pathogens, but reserves of B cells and T cells that also recognize the virus lie in wait. This means that immunity against infection may wane first, but the protection against severe illness and death are much more durable.

Read: Your vaccinated immune system is ready for breakthroughs

Protection against severe illness and death was, in fact, the original goal of vaccines. When I spoke with vaccine experts as the trials were under way last summer, they universally told me to temper expectations. Vaccines against respiratory viruses rarely protect against full infection because they are better at inducing immunity in the lungs than in the nose, where respiratory viruses gain their first foothold. (Consider: The flu shot is 10 to 60 percent effective depending on the year.) But “the extraordinary efficacy” from the initial clinical trials raised expectations, Ruth Karron, the director of the Center for Immunization Research at Johns Hopkins University, told me. With the Pfizer and Moderna vaccines 95 percent effective against symptomatic infection, eliminating COVID-19 locally, like measles or mumps in the U.S., suddenly seemed possible.

Then came the less pleasant surprise: new variants, like Beta, Gamma, and now Delta, that erode some protection from vaccines. “We now are where we thought we would be a year ago,” Karron said. The vaccines still protect against serious illness very well, as expected, but herd immunity again seems out of reach. The virus will continue to circulate, but fewer people will get sick enough to be hospitalized or die. Highly publicized outbreaks among vaccinated people, such as in Provincetown, Massachusetts, already show this pattern playing out. And entire countries with high vaccination rates, such as the U.K., Iceland, and Israel, are also seeing spikes with only a fraction of their pre-vaccine deaths.

The timing and severity of reinfections and breakthrough infections once COVID-19 becomes endemic depend on how quickly the protective effects of immunity against the virus wanes. And that, in turn, depends on a combination of two factors: first, how quickly our immune systems get rusty against SARS-CoV-2, and second, how quickly this coronavirus evolves to disguise itself. The immunological machinery is simply harder to rouse against an old enemy. But a reinfection or breakthrough infection does reinvigorate the immune response. A breakthrough case acts “like a booster for the vaccine,” as Laura Su, an immunologist at the University of Pennsylvania, told my colleague Katherine J. Wu. In the 229E study, the doctors also found that the volunteers who did not get infected the first time were more likely to be infected when exposed a year later, compared with volunteers who got sick the first time—suggesting that more recent illness is more protective.

The virus itself will also change with time. As more people gain immunity via either infection or vaccination, the coronavirus will try to find ways to evade that immunity too. This is a natural consequence of living with a circulating virus; the flu also mutates every year in response to existing immunity. But in the endemic scenario, where many people have some immunity, the coronavirus will not be able to infect as many people nor replicate as many times in each person it infects. “I’m very confident that the rate of adaptation is going to be set by the prevalence of SARS-CoV-2 in the world,” Cobey says. You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down.

Reinfections with the four common coronaviruses are likely driven by a combination of our immunity fading and the viruses themselves evolving. Putting together everything we do know, a pattern starts to emerge: We are likely first exposed to these common coronaviruses as children, when the resulting disease tends to be mild; our immune systems get rusty; the virus changes; we get reinfected; the immune response is updated; the immune system gets rusty again; the virus changes again; we get infected. And so on.

In the best case, COVID-19 will follow the same pattern, with subsequent infections being mild, says Stephen Morse, an epidemiologist at Columbia University. “If the burden of disease is not high, we take [the virus] very much for granted,” he says. Still, these colds are not completely benign; one of the common-cold coronaviruses has caused deadly outbreaks in nursing homes before. In a less good scenario, COVID-19 looks like the flu, which kills 12,000 to 61,000 Americans a year, depending on the season’s severity. But deaths alone do not capture the full impact of COVID-19. “A big question mark there is long COVID,” says Yonatan Grad, an immunologist and infectious-disease researcher at Harvard. There are still no data to prove how well the vaccines prevent long COVID, but experts generally agree that a vaccinated immune system is better prepared to fight off the virus without doing collateral damage.

The transition to endemic COVID-19 is also a psychological one. When everyone has some immunity, a COVID-19 diagnosis becomes as routine as diagnosis of strep or flu—not good news, but not a reason for particular fear or worry or embarrassment either. That means unlearning a year of messaging that said COVID-19 was not just a flu. If the confusion around the CDC dropping mask recommendations for the vaccinated earlier this summer is any indication, this transition to endemicity might be psychologically rocky. Reopening felt too fast for some, too slow for others. “People are having a hard time understanding one another’s risk tolerance,” says Julie Downs, a psychologist who studies health decisions at Carnegie Mellon University.

The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.

Above is from:  https://www.theatlantic.com/science/archive/2021/08/how-we-live-coronavirus-forever/619783/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-weekly-newsletter&utm_content=20210822&silverid=%25%25RECIPIENT_ID%25%25&utm_term=This%20Week%20on%20TheAtlanticcom

August 20: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

EPI UPDATE The WHO COVID-19 Dashboard reports 209.2 million cumulative cases and 4.39 million deaths worldwide as of August 20.

As we previously covered, COVID-19 data from August 15 was delayed for multiple countries in the African Region, which gave the appearance of decreasing trends in last week’s data. It appears that reporting for last week is now complete, which corrected the weekly trends. Weekly incidence increased for the eighth consecutive week—an increase of 3.2% over the previous week—although the trend is tapering off toward a peak or plateau. Weekly mortality increased for the sixth consecutive week*, 0.7% higher than the previous week.

*With the exception of the week of July 19, when Ecuador reported 8,786 deaths.

Global Vaccination

More than 1 billion individuals worldwide are fully vaccinated. The WHO reported 4.56 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of August 20. The WHO reports that a total of 1.78 billion individuals have received at least 1 dose, and 1.03 billion are fully vaccinated. Analysis from Our World in Data indicates that the global daily doses administered continues to hold relatively steady at approximately 35-40 million doses per day*. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.51 billion vaccinated individuals worldwide (1+ dose; 32.2% of the global population) and 1.88 billion who are fully vaccinated (24.2% of the global population). We expect the global total to surpass one-third of the population with 1+ dose and one-quarter with full vaccination in the coming days.

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

UNITED STATES

The US CDC reported 37.3 million cumulative COVID-19 cases and 623,244 deaths. Daily incidence is up to 133,055 new cases per day, the highest since February 2. Daily incidence continues to increase rapidly, but it appears that the US has passed an inflection point and is now tapering off. Based on the timeline from the previous peak, this could indicate that the current surge could peak in the next several weeks. While some severely affected states are beginning to peak—including Arkansas, Florida, and Louisiana—many others are still exhibiting increasing trends as the surge spreads to other parts of the country, with some states still early in their respective surges. Daily mortality continues to increase as well, although it is difficult to determine whether the current trend is a linear or exponential increase. The current average of 640 deaths per day is the highest since April 24. On August 18, the US reported more than 1,000 deaths in a single day for the first time since March 19*.

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

As the US continues to combat its ongoing surge hospitalizations are setting new records at the national and state level, particularly for individuals under the age of 50. At the national level, new daily hospitalizations are at record highs for all age groups aged 49 years and younger, and the 50-59 years age group is at 91% of its record high. Notably, the 0-17 years age group—most of whom are still not eligible for vaccination—is currently 40% higher than its previous peak and still increasing rapidly, just as schools are resuming classes across the country. In terms of the percent of emergency department (ED) visits for COVID-19, most age groups appear to be peaking at the national level. Similar to new hospitalizations, all age groups aged 49 years and younger are setting new records, ranging from 3.2% for 0-11 years to 8.1% for 40-49 years. The CDC’s COVID-19 dashboard does not provide data for current hospitalizations broken down by age group, but the current average across all age groups (76,077 hospitalized patients) is within 40% of the previous peak and still increasing.

Similar trends are evident across the whole of HHS Region 4 (Southeast), where the current surge is most severe. Current hospitalizations in the region set a new record high last week, and the current average is just shy of 30,000 patients and still increasing. We have paid considerable attention to Region 4, but Region 10 (Northwest) is also exhibiting concerning trends. While Region 10 is not setting records for new daily hospitalizations in the 0-11 years age group—suggesting lower transmission among children—all other age groups 59 years and younger are surpassing their previous records and still increasing sharply. Region 10 is also setting new records in terms of the percent of ED visits for COVID-19, both averaged across all ages and individually for all age groups 64 years and younger. Regions 4 and 10 also are both reporting record high current hospitalizations, and Region 6 (South) is 11% below its highest peak and still increasing steadily. While these 3 regions are exhibiting similar trends, the magnitude of the epidemics are quite different, with Region 10 reporting 2,000 hospitalizations compared to 30,000 and 17,000 in Regions 4 and 6, respectively. On a per capita basis**, COVID-19 hospitalizations in Regions 4 and 6 are 2.3 and 1.9 times higher than in Region 10, respectively.

**Based on 2020 census data.

At the state level, Arkansas, Florida, Hawai’i, Louisiana, Mississippi, Oregon, and Washington are all setting new records in terms of current hospitalizations. A total of 5 other states—3 from Region 4 and 2 others that border it—are within 20% of their records and still increasing. Among the states setting new records for current hospitalizations, all are setting new records in terms of new daily hospitalizations among most age groups 59 years and younger. Notably, all of these states, with the exception of Oregon and Washington, are setting new records for the 0-11 years age group. As with the regional trends, the magnitude of these epidemics varies widely at the state level. Hawai’i, Oregon, and Washington are reporting between 1.7 and 3.5 new daily hospitalizations per 100,000 population, whereas Arkansas, Florida, Louisiana, and Mississippi range from 6 to more than 10. In Florida, all age groups—with the exception of 0-11 years—have equaled or surpassed the record peak for percent of ED visits for COVID-19 set by the 65-74 years and 75+ years age groups in the previous surge—ie, higher than the highest peak for the most vulnerable age groups. Notably, the 40-49 years and 50-64 years age groups are more than 60% higher than that previous record. A similar trend is evident in Louisiana, with all age groups except 0-11 years and 75+ years equaling or surpassing the previous record.

US Vaccination

The US has administered 359.6 million cumulative doses of SARS-CoV-2 vaccines. After approximately 5 weeks of steady increase, the daily vaccinations leveled off over the past several days, holding relatively steady at approximately 670,000 doses per day*. A total of 199.9 million individuals in the US have received at least 1 dose, equivalent to 60.2% of the entire US population. Among adults, 72.5% have received at least 1 dose, as well as 12.6 million adolescents aged 12-17 years. A total of 169.6 million individuals are fully vaccinated, which corresponds to 51.1% of the total population. Approximately 62.0% of adults are fully vaccinated, as well as 9.4 million adolescents aged 12-17 years.

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

US PLANS FOR THIRD DOSES US health officials on August 18 announced plans to make third doses of SARS-CoV-2 mRNA vaccines available to all US residents as soon as the week of September 20. The third dose is meant to bolster individuals’ immune responses at least 8 months from their second dose of either the Pfizer-BioNTech or Moderna vaccines. People who received the J&J-Janssen vaccine likely will need an additional dose, but officials are waiting on results from a clinical trial expected to be available later this month. US officials based their decision to offer booster doses on published and unpublished data showing vaccine effectiveness across age groups appears to wane over time and particularly amid the spread of the highly transmissible Delta variant. While they stressed the vaccines remain highly effective at preventing severe disease, hospitalizations, and death, they said the vaccines’ ability to prevent infection or symptomatic disease has declined since the spring. Some of the breakthrough infections seen among vaccinated individuals could be due to weakening immunity, lapses in protective measures such as mask wearing, or the now widespread Delta variant, or a combination of such factors, experts noted, contending that no vaccine was meant to be 100% effective in preventing infection.

At a White House COVID-19 Task Force briefing, US CDC Director Dr. Rochelle Walensky presented data from 3 early release Morbidity and Mortality Weekly Report (MMWR) studies, 1 not-yet-peer-reviewed study published on medRxiv, and unpublished CDC data. One of the MMWR studies included data from New York collected between May 3 and July 25, 2021, showing vaccine effectiveness (VE) against infection declined from 91.7% to 79.8%. A second MMWR study showed the mRNA vaccines’ protection against infection among nursing home residents declined from 75% between March 1 and May 9, 2021, before Delta became the dominant strain, to 53% between June 21 and August 1, when Delta accounted for at least half of new COVID-19 cases. In positive news, a third MMWR publication showed no significant decline in the vaccines’ effectiveness against COVID-19 hospitalization over a 24-week period, ranging from 85% 2-12 weeks post-vaccination and 84% at 13-24 weeks. However, data from a Mayo Clinic preprint in medRxiv showed Moderna VE fell from 86% in January 2021 to 76% in July, while Pfizer-BioNTech VE dropped from 76% to 42% during the same time. According to a joint statement from US Department of Health and Human Services (HHS) experts, data from these sources make the argument for booster doses “very clear” that protection against SARS-CoV-2 infection wanes over time. However, some experts argued the case for third doses remains unclear, saying officials presented no data regarding how much third doses boost immune responses or how long any benefits might last. US officials previously said the logistics of rolling out a booster dose program are too complex to wait for scientific certainty that the extra doses are actually necessary.

Third doses initially will be available for about 5 million people who were first to receive vaccines over the 2020-2021 winter, including healthcare workers, nursing home residents, and older adults. Last week, regulators authorized third doses for people with compromised immune systems, such as cancer patients and organ transplant recipients, who represent less than 3% of the US population. The plan to provide booster doses is contingent upon the US FDA authorizing a third dose of either mRNA vaccine and the CDC’s Advisory Committee on Immunization Practices (ACIP) making subsequent recommendations. Only earlier this week did Pfizer-BioNTech submit initial data to the FDA supporting the evaluation of a booster dose of its vaccine. Moderna has yet to submit data. Some experts speculate that a third dose given 8 months from the second dose could provide a more robust and long-lasting immune response, potentially requiring few or no future boosters, although US Surgeon General Vivek Murthy said “there’s nothing magical” about the 8-month timeframe. Some of the same experts, as well as others, expressed additional concerns over the plan for multiple reasons, including that all US residents might not immediately need boosters, that a timeframe for providing extra doses apparently has been decided prior to regulatory decisions, and that more focus should be placed on vaccinating more people in the US and globally.

THIRD DOSE CONCERNS The announcement reignited criticism about global vaccine inequity, with some experts expressing fear, frustration, and even anger over wealthier nations’ continuing disregard for a WHO call for a moratorium on booster doses. WHO officials and other experts continue to argue that booster programs—also implemented in Israel, France, Germany, and other nations—will further deplete scarce vaccine resources and deprive low- and middle-income countries (LMICs) of needed doses. The WHO estimates 11 billion vaccine doses are needed to help control the pandemic. WHO Regional Director for Africa Dr. Matshidiso Moeti chastised wealthier nations, saying “they make a mockery of vaccine equity” by stockpiling vaccine doses while the situation in Africa remains “very fragile.” WHO chief scientist Dr. Soumya Swaminathan and other researchers warned that a focus on booster programs in wealthy nations could lead to the development of more viral variants and “an even more dire situation” globally, because the virus continues to spread unabated in unvaccinated—not vaccinated—populations. Other experts said there was still not enough conclusive evidence supporting third doses to recommend them to everyone.

But US officials pushed back at the disapproval. White House Press Secretary Jen Psaki said the notion the US would not be able to provide boosters and simultaneously donate doses to countries in need represented a “false choice.” US CDC Director Dr. Rochelle Walensky agreed, saying, “We're going to do both and we have been doing both," noting the country plans to distribute 200 million doses worldwide and administer 100 million booster doses by the end of the year. Global health advocates continue to call on the US to be more of a leader in efforts to bolster global vaccine supplies, including by pressuring pharmaceutical companies to share technologies with LMICs and help scale up manufacturing in those countries.

US CDC DISEASE FORECASTING CENTER On August 18, the US CDC officially announced its new Center for Forecasting and Outbreak Analytics. The center will leverage advanced data and modeling capacities to provide health officials with projections and other analysis during outbreaks and epidemics, aiming to “accelerate access to and use of data for public health decision-makers.” The center also will provide forecasting capacity for emerging infectious disease threats, as the pandemic response highlighted the need to streamline and modernize data collection reporting at the state and local levels. Prior to establishing this center, the US government had relatively little internal capacity for infectious disease modeling, genomic surveillance, and other real-time analytics, requiring it to draw on external support from academic institutions, think tanks, and other organizations, which often volunteered their time and effort. The new center will continue to draw on these external resources, but it establishes a central point within the CDC to provide coordination and support. Initial funding for the program comes from the American Rescue Plan, part of a series of emergency funding packages approved during the COVID-19 pandemic. The center will be led by Dr. Marc Lipsitch, Dr. Dylan George, Dr. Rebecca Kahn, and the Johns Hopkins Center for Health Security’s own Dr. Caitlin Rivers.

US NURSING HOME FUNDING US President Joe Biden announced on August 18 that nursing home staff must be vaccinated against SARS-CoV-2 or their facilities risk losing federal funding that many facilities rely on to maintain operations. The vaccine requirement would affect more than 15,000 facilities and 1.3 million employees nationwide. According to the Centers for Medicare and Medicaid Services (CMS), nursing home residents have a higher rate of vaccination compared to staff, with nearly 83% of residents vaccinated per facility compared to 60% of staff per facility. But that represents the national average; vaccination rates vary by state since many nursing homes have not implemented vaccine requirements. Florida has the lowest percentage of staff with completed vaccinations per facility at 40%. At the other end of the spectrum, Hawai'i boasts the highest percentage, with nearly 87% of staff vaccinated per facility. The new mandate is expected to be formalized by CMS regulation. An official deadline for the requirement has not been set, although it could take effect as soon as next month. 

MASKS IN SCHOOLS US President Joe Biden this week ordered Secretary of Education Miguel Cardona to use all available tools to ensure that governors and other state officials are taking appropriate actions to safeguard students' return to in-person schooling, including possibly taking legal action against governors who ban universal masking in schools. Secretary Cardona said he will use the department’s civil rights enforcement capacity to investigate states that ban masking. The Biden administration plans to send letters to the governors of Arizona, Iowa, Oklahoma, South Carolina, Tennessee, and Utah—in addition to those Secretary Cardona already sent to Florida and Texas—reprimanding their efforts to block universal masking in schools and expressing support for local officials who defy mask bans. Secretary Cardona also noted that the department would pay the full salaries of educators if their “states move to withhold pay or levy financial penalties on their schools.” Earlier this year, the department’s Office of Civil Rights published a report outlining the impacts of the COVID-19 pandemic on US students, warning that existing educational gaps are widening during the pandemic, falling disproportionately on those students with the greatest educational needs and fewest opportunities, many from historically marginalized and underserved populations.

In Miami-Dade County, the largest county in Florida, the school board on August 18 voted to require masks for students when in-person learning resumes next week, defying an order from Governor Ron DeSantis that effectively bans mask mandates. Miami-Dade joins Alachua, Broward, and Hillsborough as Florida counties requiring masks for students, employees, and visitors, with only medical exemptions accepted. The school districts cited updated CDC guidance and the rise in pediatric infections, including record high hospitalizations, as the basis for requiring face coverings.

In Texas, the State Supreme Court on August 19 denied Governor Greg Abbott’s request to block temporary restraining orders on his ban on mask mandates issued by Travis County Judge Jan Soifer. As a result, the lower court’s ruling stands, for now, allowing school districts to continue their requirements. The governor now must appeal to the Texas Court of Appeals. On the same day, the Texas Education Agency suspended enforcement of Governor Abbott’s ban in the state’s public school system. The State Supreme Court’s order comes only days after it sided with Governor Abbott, granting a temporary emergency stay of an appellate court ruling and allowing his ban on mask mandates, including those in public schools. Following that order, the Dallas and San Antonio school districts, 2 of the largest in the state, said they would continue to require masks until a final ruling is made. Since then, several other districts have implemented universal masking requirements. The legal battles over masking in schools undoubtedly will continue to work their way through the courts.

SCHOOL VACCINE MANDATES As states around the country return or prepare to return to school in the coming weeks, some state legislatures are taking final steps to increase the proportion of vaccinated public school employees. In Washington state, Governor Jay Inslee announced a vaccination requirement for all employees in K-12 schools at the private, public, and charter levels and those working in childcare settings and higher education institutions. Employees must show proof of full vaccination prior to October 18 or possibly face dismissal. The policy has limited medical and religious exemptions, and there is no test out option, possibly representing the most widespread and strict requirements implemented by a state yet. Governor Inslee also expanded a statewide mask mandate, applicable to all individuals regardless of vaccination status. Other states with vaccine requirements for school staff, such as California and Connecticut, have allowed employees the option of choosing between mandatory vaccination or routine testing for those who wish not to comply. Several major cities across the country, including Los Angeles and Chicago, also are requiring public school employees to get vaccinated. Other states likely will implement vaccine requirements for school staff as students return to in-person learning, with rumors that New Jersey could be next.

MODERNA VACCINE FOR UK ADOLESCENTS The UK Medicines and Healthcare products Regulatory Agency (MHRA) granted Conditional Marketing Authorization (CMA) for the use of the Moderna SARS-CoV-2 vaccine in children aged 12-17 years. The CMA was granted through the European Commission (EC) Decision Reliance Route, which allows for new Marketing Authorizations based on previous authorizations through the centralized EC process, but it means that the CMA only applies to Great Britain. Northern Ireland issued a CMA for 12- to 17-year-olds via the same process on July 23. The approval in Great Britain comes a week after the England Department of Health announced 16- and 17-year-olds will be offered a first dose of SARS-CoV-2 vaccine by August 23, before schools resume classes in September. MHRA Chief Executive Dr. June Raine said “the vaccine is safe and effective in this age group” and that it will be up to the Joint Committee on Vaccination and Immunization (JCVI) to advise on whether adolescents aged 12 and older should receive the Moderna vaccine as part of the deployment program. The Moderna vaccine has not yet been authorized for use in individuals aged 12 to 17 years in the US, but the European Medicines Agency (EMA) recommended its use in this age group on July 23.

ISRAEL Throughout the COVID-19 pandemic, Israel has been one of the countries on the forefront of disease control. Following an early and successful SARS-CoV-2 vaccination campaign, Israel saw a drop in the incidence of new COVID-19 cases. Unfortunately, the region has now seen a drastic increase in cases, despite a large proportion of its adult population having received a SARS-CoV-2 vaccine. With worries that waning vaccine effectiveness contributed to the new surge, Israel announced a campaign of so-called booster doses for senior residents that started at the end of July. However, there is minimal evidence to support the application of booster doses, leading some experts to question the decision. So far, 37 individuals have tested positive for COVID-19 following their third dose. These recent developments have increased concerns over the longevity of vaccine efficacy, especially against more transmissible SARS-CoV-2 variants of concern.

POPE ENCOURAGES VACCINATION In a new public service campaign made in coordination with the Ad Council and directed specifically at the Americas, Pope Francis encourages people to get vaccinated, saying it is “an act of love.” The video features Pope Francis speaking Spanish with English subtitles in the Ad Council’s first campaign outside of the United States. The Pope is joined by church officials from Brazil, Mexico, the United States, and other countries who describe getting vaccinated as a “moral responsibility.” Vaccine hesitancy among religious groups has been a barrier to vaccination during the pandemic, but a survey by the Public Religion Research Institute and Interfaith Youth Core nonprofit groups conducted in June suggests acceptance may be on the rise. Of more than 5,000 people surveyed in the US, acceptance rose from 56% in March to 80% in June among Hispanic Catholics, and from 68% to 79% among White Catholics. Vaccine-hesitant participants also told researchers that faith-based arguments may convince them to get vaccinated, underlining the importance of the Pope’s message. The ad will be run on Telemundo, Universo, and WarnerMedia platforms, and media outlets in various Spanish-speaking countries.

FAKE VACCINATIONS/CARDS As more SARS-CoV-2 vaccine requirements are enacted for everything from employment, to travel, to restaurant dining, the black market for vaccine cards is growing. US Customs and Border Protection (CBP) agents in Memphis, Tennessee (US), recently announced they have seized more than 3,000 fake vaccination cards shipped from China and destined for various US cities since the end of June. Additionally, a Chicago pharmacist was charged with 12 counts of theft of government property after allegedly stealing and selling official US CDC vaccination cards on eBay. The FBI has warned that buying, selling, or using counterfeit vaccination cards is a crime, punishable by a fine and up to 5 years in prison. In France, fake vaccine passes are being sold through social media platforms such as Snapchat and Facebook for up to €400 (US$467). If caught, those who distribute counterfeit passes face up to 5 years in prison and fines up to €150,000 (US$175,000), and users could spend 3 years in prison. Officials in the US and France reminded the public that SARS-CoV-2 vaccines are available at no cost.

In more disturbing developments, the WHO identified counterfeit versions of Covishield—the Indian-made version of the AstraZeneca-Oxford SARS-CoV-2 vaccine—in India and Africa in recent months. The Indian government said it has launched an investigation into the allegations. Last month, around 4,000 people in India paid to receive a SARS-CoV-2 vaccine at a “vaccination camp” but instead got shots of saline solution. Authorities arrested 14 people in connection with the scheme. In Germany, a Red Cross nurse is believed to have injected more than 8,000 residents with shots of saline rather than a SARS-CoV-2 vaccine, authorities there say, although it is unclear whether any arrests have been made or charges filed. Officials continue their work to stop the counterfeiting of vaccine cards and shots worldwide.

NFL VACCINATION This week the Atlanta Falcons became the first and reportedly only US National Football League (NFL) team to achieve 100% SARS-CoV-2 vaccination of its roster. Now, all players are able to work out and eat together and are exempt from daily testing, mask use in team facilities, and quarantine following close contact with someone who tests positive, the team confirmed in a statement. As we previously reported, the NFL implemented strict consequences for teams with unvaccinated players, potentially including forfeiting games that are canceled because of outbreaks. Additionally, unvaccinated players could lose pay for games missed due to testing positive. On August 18, Tampa Bay Buccaneers Head Coach Bruce Arians said his team likely would reach 100% vaccination before the start of the regular season on September 9. The NFL Network on August 11 reported that 92% of NFL players have at least 1 dose of vaccine, well above the national average of 60%. NFL teams could provide insight into vaccine effectiveness in close-contact settings where every individual is vaccinated.

August 17: Johns Hopkins COVID-19 Report

COVID-19 Situation Report

EPI UPDATE The WHO COVID-19 Dashboard reports 207.2 million cumulative cases and 4.36 million deaths worldwide as of 12:45pm EDT on August 16. Global weekly incidence continues to increase, but it appears to be approaching a peak or plateau, however this could be a function of reporting delays. Last week, the weekly total increased less than 2% compared to the previous week. Global weekly mortality held relatively steady last week, decreasing less than 0.5% compared to the previous week. The dashboard indicates that there are delayed reports from multiple countries in the African Region for August 15, which are likely impacting the global trends. Notably, the weekly incidence for the African Region was nearly 23% lower than the previous week—a difference of more than 40,000 new cases—and weekly mortality was nearly 18% lower—a difference of 834 deaths. The global trends could shift upward once reporting is complete for Africa for last week.

Global Vaccination

The WHO reported 4.46 billion doses of SARS-CoV-2 vaccines administered globally as of August 16. The WHO reports that a total of 1.70 billion individuals have received at least 1 dose, and 880 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered has leveled off after a week of decline, holding relatively steady at approximately 37 million doses per day*. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.47 billion vaccinated individuals worldwide (1+ dose; 31.7% of the global population) and 1.85 billion who are fully vaccinated (23.7% of the global population). Notably, the global total jumped from 1.25 million fully vaccinated individuals on August 11 to 1.81 million on August 12 due to newly reported data from China**.

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

**The previous report from China’s National Health Commission was on June 10. China has not updated data regarding its partially vaccinated population (1+ dose) since June 10.

UNITED STATES

The US CDC reported 36.7 million cumulative COVID-19 cases and 619,564 deaths. The daily average is up to 121,873 new cases per day, the highest since February 4. Daily incidence continues to increase rapidly, but it appears as though the US may be passing an inflection point. It is difficult to determine, however, whether this is an artifact of reporting frequency—particularly over the weekend—or an early indication of a longer-term trend. Daily mortality continues to increase as well, although it is difficult to determine whether the current trend is a linear or exponential increase. The current average of 548 deaths per day is the highest since May 13*.

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

US Vaccination

The US has administered 357.3 million cumulative doses of SARS-CoV-2 vaccines. After approximately 5 weeks of steady increase, the daily vaccinations leveled off over the past several days, holding relatively steady at approximately 650-660,000 doses per day*. A total of 198.6 million individuals in the US have received at least 1 dose, equivalent to 59.8% of the entire US population. Among adults, 72.1% have received at least 1 dose, as well as 12.4 million adolescents aged 12-17 years. A total of 168.7 million individuals are fully vaccinated, which corresponds to 50.8% of the total population. Approximately 61.8% of adults are fully vaccinated, as well as 9.2 million adolescents aged 12-17 years.

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

THIRD DOSE FOR IMMUNOCOMPROMISED INDIVIDUALS The US CDC approved a recommendation to provide a third dose of mRNA-based SARS-CoV-2 vaccines to individuals with moderate-to-severe compromised immune systems on August 13. CDC Director Dr. Rochelle Walensky’s approval of the recommendation followed a unanimous vote by the agency’s Advisory Committee on Immunization Practices (ACIP) and an emergency use authorization by the US FDA. The Pfizer-BioNTech vaccine is authorized for use among individuals aged 12 and older, and the Moderna vaccine is authorized for individuals aged 18 and older. The FDA did not extend the authorization for a third dose to the J&J-Janssen vaccine due to a lack of efficacy data, but officials have stated they are working to develop a recommendation.

A third dose of the mRNA-based SARS-CoV-2 vaccines is recommended for moderately to severely immunocompromised individuals, including those receiving cancer treatment, recent recipients of an organ or stem cell transplant, those with advanced or untreated HIV infection, individuals taking a high dose of corticosteroid, and people who are anticipating treatment that may weaken their immune system. However, a third dose of vaccine is not recommended for adults with chronic conditions that may cause mild immunosuppression, such as people with diabetes and heart disease or residents in long-term care facilities. According to the guidance, the third dose should be given at least 28 days after the second dose for the best results. The CDC urges eligible individuals to try to get the same vaccine for their third dose, but receiving a different vaccine for the third dose is acceptable if the original is unavailable. Notably, immunocompromised people will not need a prescription or doctor’s note to get a third dose but will need to attest to their eligibility, raising questions about the potential for people to lie about their immune status in order to receive a third vaccine dose.

PFIZER-BIONTECH THIRD DOSE Pfizer-BioNTech submitted early-stage clinical trial data to the US FDA on August 16 to seek emergency use authorization for a third SARS-CoV-2 vaccine dose for all people aged 16 years and older. The companies claim the trial data show a third dose administered 6 to 12 months after the second dose generates higher levels of neutralizing antibodies against the Alpha, Beta, and Delta variants of SARS-CoV-2. The companies state that late-stage trial data will be submitted to the FDA and additional worldwide regulatory authorities once available.

The US government is not yet officially recommending third doses of mRNA-based vaccines for the general public despite the recent guidance for booster vaccinations for people with moderate-to-severely compromised immune systems. However, officials are reportedly developing plans to start offering third doses of vaccines to more of the general public as early as the fall. Initial doses given under the plan likely would be reserved for healthcare workers and long-term care facility residents who are at increased risk of severe disease. The FDA must first review the data submitted by Pfizer-BioNTech before an emergency use authorization can be approved and before the US CDC can make an official recommendation.

US EVICTION MORATORIUM The new version of a US CDC eviction moratorium faced its first legal challenge last week, with US District Judge Dabney Friedrich in Washington, DC, allowing the order to stay in place because she is bound by a ruling from the US Court of Appeals for the District of Columbia (DC) Circuit that allowed the previous version of the moratorium to continue. In May, Judge Friedrich ruled the previous nationwide moratorium exceeded the CDC’s authority but she stayed the judgment pending appeal, which allowed the moratorium to remain in force. The plaintiffs then asked the US Court of Appeals to vacate the stay, but the court declined, again allowing the moratorium to continue. In doing so, the court said the moratorium falls within a 1944 public health emergencies law and that the US government “made a strong showing that it is likely to succeed on the merits.” At this point, the plaintiffs asked US Supreme Court Chief Justice John Roberts to vacate Judge Friedrich’s stay, but Chief Justice Roberts denied relief on June 29. Notably, 5 justices indicated they would grant the application to vacate the stay.

When a group of property managers and realtors asked Judge Friedrich to put a hold on the new eviction ban—which is set to expire October 3 and applies only to places in the country experiencing significant SARS-CoV-2 transmission, instead of the entire nation—she wrote that “the minor differences between the current and previous moratoria do not exempt the former from this Court’s order.” Judge Friedrich indicated she would vacate the stay but that she does not have the authority to act on a higher court’s decision. The plaintiffs are expected to ask the US Court of Appeals to reconsider its ruling and likely will go to the US Supreme Court if they don’t get their desired outcome. In a statement, White House Press Secretary Jen Psaki said the administration of US President Joe Biden “believes that CDC’s new moratorium is a proper use of its lawful authority to protect the public health. We are pleased that the district court left the moratorium in place, though we are aware that further proceedings in this case are likely.” She said President Biden is calling on all officials to urgently distribute US$46.5 billion in emergency rental assistance funds made available through Congressional action on COVID relief.

US SUPREME COURT VACCINE MANDATE CHALLENGE The US Supreme Court last week refused to block Indiana University’s requirement that all students, faculty, and staff have a SARS-CoV-2 vaccination, unless they qualify for one of several exemptions. The decision to turn down a group of students’ request for emergency relief was issued independently by Justice Amy Coney Barrett, who handles emergency requests from Indiana, without explanation, without dissents from other justices, and without asking the university for a response. All of these moves could signal the request does not stand on solid legal ground. Both a federal district judge and an unanimous panel of the US Court of Appeals for the 7th Circuit previously rejected requests for emergency relief while the issue moved through the courts. This was the first case involving mandatory SARS-CoV-2 vaccinations to reach the Supreme Court.

FUNDING FOR US RURAL HEALTHCARE The Administration of US President Joe Biden on August 13 announced the US Department of Health and Human Services (HHS) will provide US$8.5 billion in American Rescue Plan (ARP) spending to help aid healthcare providers who serve rural Medicare, Medicaid, and Children’s Health Insurance Plan (CHIP) patients for lost revenue and increased expenses associated with COVID-19. Additionally, the US Department of Agriculture (USDA) will use US$500 million in ARP funding to establish the Emergency Rural Health Care Grant Program to help rural healthcare facilities increase access to SARS-CoV-2 vaccines and testing, medical supplies, telehealth, and food assistance; support construction or renovation; compensate for lost revenue or staffing expenses due to the pandemic; and plan and implement models to improve long-term viability. The announcement also included funding to train new rural healthcare providers and expand telehealth services. In a fact sheet, the White House said the funding “builds on efforts the Administration has already taken to help rural communities tackle the COVID-19 crisis and improve access to health care,” including a previous announcement of US$100 in funding to assist rural health facilities conduct vaccine outreach.

VACCINE INCENTIVES Mercer, an employee benefit consultant company, recently stated that at least 20 companies have approached them to ask about implementing health insurance coverage surcharges of US$20-50 per month for employees who refuse to get a SARS-CoV-2 vaccine. Employers have offered benefits and incentives such as cash payments and paid time off to encourage vaccination among their ranks, but stalling vaccination rates have some companies reconsidering their approach. Health coverage surcharges already are a tool used when insured individuals act against common medical advice, such as continuing to smoke cigarettes. For example, the Affordable Care Act allows insurers to charge smokers up to 50% more than non-smokers for health coverage. The likelihood of health coverage surcharges for not receiving a SARS-CoV-2 vaccine remains unclear, but employers or insurers may decide to implement these measures if the cost of hospitalization for unvaccinated insurance recipients gets too high.

FLORIDA SCHOOL DISTRICT The Hillsborough County School District, which includes Tampa, Florida (US), is expected to hold an emergency school board meeting on August 18 to discuss COVID-19 protective measures only 1 week after resuming in-person classes for the fall semester. Since the start of classes, nearly 6,000 students and employees have been asked to isolate or quarantine due to SARS-CoV-2 infection or exposure. COVID-19 data from the school district indicate that nearly 1,300 new cases have been reported among students and staff since August 2, including 399 students and 88 staff reported on August 16 alone. The school district reported 8,771 cumulative cases from March 2020 to August 1, 2021. Notably, the cases are distributed relatively evenly across the county’s 250 schools, with only one school exceeding 50 cases. The district announced on August 7 that it was implementing a mask requirement through September 3, but parents would be able to opt their children out of the requirement. So far, the district—the 7th largest in the nation with 208,000 students—has received 27,915 opt-out submissions. Florida Governor Ron DeSantis’s office has said the state Board of Education could withhold the salaries of district superintendents or school board members who disregard the governor’s executive order that effectively prohibits school districts from implementing mask mandates. Statewide, Florida’s epidemic continues to surge to record levels.

GLOBAL VACCINE DISTRIBUTION Australia has purchased and received 500,000 doses of SARS-CoV-2 vaccine from the COVAX facility, raising questions about how many of the vaccine-sharing mechanism’s doses should go to low- and middle-income countries (LMICs). Australia received the doses in COVAX’s third round of vaccine distributions. Also in that round, the UK received nearly 540,000 doses and New Zealand received nearly 101,000 doses. Australia is domestically producing the AstraZeneca-Oxford vaccine and has plentiful supplies but has been trying to obtain more doses of the Pfizer-BioNTech vaccine due to medical advice that the vaccine is preferred for people under age 59 and hesitancy among some to receive the AstraZeneca-Oxford vaccine. According to a report in The New York Times, Pfizer-BioNTech expressed its desire for a COVAX shipment of its vaccine to go only to LMICs, but the facility allegedly insisted it first fulfill orders from higher-income nations that paid more for the doses. Concerns remain whether COVAX can move beyond pressures from wealthy countries and pharmaceutical companies, manufacturing delays, and bureaucratic infighting to help reach its goal of supplying 2 billion vaccine doses by the end of 2021.

In the meantime, millions of J&J-Janssen vaccine doses being “filled and finished” by South African-based Aspen Pharmacare are being shipped to Europe for distribution because of “an unusual stipulation” in the contract between the country’s government and the vaccine company. Reportedly, the contract required South Africa to waive its right to impose export restrictions on vaccine doses finished in-country. A South African health ministry official said the government was not pleased with the contract’s stipulation but did not have the leverage to change it. J&J-Janssen has shipped 32 million doses to Europe in recent months, according to an investigation by The New York Times. The company had agreed to sell enough of its vaccine to African countries to eventually vaccinate about one-third of the continent’s residents. However, Africa continues to struggle to obtain enough supplies, and only about 2% of Africans are fully vaccinated. According to a J&J official, the Aspen plant will begin exclusively supplying doses to African countries later this year. In a Guardian opinion piece, former UK Prime Minister Gordon Brown criticized Europe for taking a “neocolonial approach” to global health, saying the shipments of J&J-Janssen vaccine from South Africa to Europe represent a “shocking symbol of the west’s failure to honor its promise of equitable vaccine distribution.”

GERMANY PEDIATRIC VACCINATION Germany’s vaccine advisory committee, known as STIKO, on August 16 updated its guidance to recommend that all individuals aged 12 to 17 years receive a SARS-CoV-2 vaccine. The recommendation expands on the committee’s previous guidance for that age group, which advised only those children and young adults who had an increased risk of severe COVID-19 disease, including those with compromised immune systems or those who might have professional exposure to the virus, be vaccinated. STIKO said its decision was based on surveillance data from the US showing the benefits of vaccination outweigh the risk of very rare side effects, including heart inflammation, and modeling data showing children and adolescents have a higher risk of infection from the Delta variant. Germany’s 16 state health ministers decided on August 2 that all children and teenagers ages 12 and older should be eligible for vaccination, but the STIKO held off on recommending the same until now. The European Medicines Agency (EMA) has authorized both the Pfizer-BioNTech and Moderna vaccines for that age group.

IRAN The spread of the highly transmissible SARS-CoV-2 Delta variant in Iran has led to record numbers of COVID-19 cases and deaths, forcing the country’s health system to the edge of collapse. On August 16, Iran’s Ministry of Health reported a daily record of 655 deaths, although some, including Iran’s state television, estimate the daily totals to be higher, between 720 and 1,000. A 6-day nationwide lockdown began August 16, including the closure of offices, banks, bazaars, and non-essential businesses such as theaters, gyms, and restaurants in all Iranian cities, and a separate 6-day ban on intra-city travel began on August 15.

According to the Ministry of Health, nearly 15.5 million Iranians have received at least one dose of a SARS-CoV-2 vaccine, with 4.4 million having received 2 doses, less than 5% of the total population. Supreme Leader Ayatollah Ali Khamenei earlier this year banned vaccines made in the US and Britain, saying the shots were designed to “contaminate other nations.” Last week, Khamenei appeared to backpedal slightly, calling the pandemic the country’s top priority and saying “efforts must be redoubled so vaccines can be provided for the people through any means necessary.” Following his comments, a health official said vaccines developed by Western countries would be allowed if they are manufactured in other nations. So far, Iran has accepted more than 21 million doses of various vaccines from China, Russia, India, Cuba, Japan, and the COVAX initiative. The country also is using its domestically developed COVIran Barekat vaccine, which the government has said is 85% effective at preventing COVID-19 but has not released any clinical data. In the absence of sufficient vaccine and medication supplies, private dealers and black markets are filling the gaps, affordable only to more wealthy Iranians, with each vaccine dose costing up to US$1,200.

More Iranians are trying to raise awareness about the country’s plight, using the hashtag #SOSIran on social media and speaking anonymously to media outlets. Iranian security forces arrested 5 lawyers and a civil rights advocate over the weekend, allegedly for planning to take legal action against Iranian authorities for mismanagement of the pandemic and a slow vaccination campaign rollout. Critics blame both Khamenei and newly elected President Ebrahim Raisi for the current crisis, while some officials recently shifted blame to the previous government of President Hassan Rouhani.

AFGHANISTAN The WHO today expressed concern over the Taliban’s rapid advance and seizure of power in Afghanistan, as the security situation deteriorates and humanitarian needs increase. At a UN briefing, a WHO spokesperson said the agency is “extremely concerned over the unfolding safety and humanitarian needs in the country, including risk of disease outbreaks and rise in COVID-19 transmission." He indicated WHO mobile teams are on hold in the capital, but the agency remains committed to staying in the country. The Taliban reportedly has banned SARS-CoV-2 vaccines in Paktia province, one of the nation's 34 provinces located in the country’s eastern region. In recent weeks and since the withdrawal of US troops from Afghanistan, the Taliban have captured much of the northern, western, and southern regions of the country.

NEW ZEALAND LOCKDOWN Following its first domestic case of COVID-19 in 6 months, New Zealand is entering a nationwide lockdown. Prime Minister Jacinda Ardern announced the Alert Level 4 restrictions earlier today, which will apply to the entire country for a period of 3 days. The restrictions are scheduled to last for 7 days in Auckland and the Coromandel Peninsula where the case was identified and traveled in the days prior to testing positive. The individual was unvaccinated but was in the process of scheduling an appointment when he tested positive. His wife, who is vaccinated, has tested negative. Prime Minister Ardern noted that it is not yet known if the case was a result of the Delta variant, but she emphasized that all recent infections identified among quarantined travelers have been a result of the Delta variant.

AIR POLLUTION & COVID Wildfires continue to rage across several western US states, and exposure to smoke and soot from the blazes could be associated with an increased risk of COVID-19 disease, including severe disease and death. Like smoking tobacco, exposure to smoke from wildfires can impair lung function, especially due to tiny airborne particles that can penetrate deep into lung tissue. Smoke from wildfires can contain high concentrations of this fine particulate matter, known as PM 2.5 (ie, particulate matter with a diameter of 2.5 microns or less), and exposure to high concentrations of PM 2.5 can impede the exchange of oxygen in the lungs.

The study, published on August 13 in Science Advances, evaluated COVID-19 data and PM 2.5 concentration data from 92 counties in California, Oregon, and Washington from March-December 2020. The researchers from Harvard University estimated air pollution levels based on satellite imagery from the US National Oceanic and Atmospheric Administration (NOAA), and they defined “wildfire days” as heavy PM 2.5 concentration (21-32 μg/m3). Based on the smoke exposure data, the researchers developed a model to estimate the effect of higher-than-expected PM 2.5 concentration on COVID-19 incidence and mortality. The researchers observed increased daily COVID-19 incidence and mortality for up to 4 weeks following exposure to high concentrations of PM 2.5 particles, although they noted several differences across counties. They estimated that even relatively short-term exposure to smoke from wildfires (typically on the order of days or weeks) was associated with nearly 20,000 extra COVID-19 cases and 750 deaths. Numerous complex environmental, social, and epidemiological factors drive COVID-19 incidence and mortality, but the study provides evidence that short-term exposure to elevated concentrations of air pollution, including from wildfire smoke, potentially can increase the risk of COVID-19 disease and death.