June 7, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

NOVAVAX VACCINE The US FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) is meeting today to discuss and vote on the question of whether the benefits of Novavax’s 2-dose SARS-CoV-2 vaccine outweigh the risks of use among adults. The Novavax vaccine uses decades-old technology, and a vaccine using more traditional technology could help fill gaps in vaccination coverage among those who are hesitant to be vaccinated with shots using newer mRNA technology. In clinical trials, the vaccine demonstrated 90.4% efficacy in preventing mild, moderate, or severe infections with older variants, and 100% efficacy in preventing moderate or severe infection. However, it is unclear how effective the vaccine is against currently circulating Omicron subvariants. There also are concerns over the risk of the heart conditions myocarditis and pericarditis associated with the vaccine, particularly among young men, outlined in a briefing document for the meeting. These rare occurrences of heart inflammation also are associated with the Pfizer-BioNTech and Moderna mRNA vaccines. Notably, there is not enough data to evaluate the Novavax vaccine for use among pregnant women, children, or immunocompromised individuals.

If VRBPAC recommends the vaccine and the FDA grants emergency use authorization, after also evaluating information about the company’s manufacturing processes, the vaccine will be the fourth authorized for use in the US and could be available later this summer. The Novavax vaccine, one of 6 candidates supported by Operation Warp Speed, is authorized for use among adults in dozens of countries, as well as by the WHO and European Union.

BOOSTER EFFECTIVENESS DURING OMICRON Researchers continue to examine the effectiveness of SARS-CoV-2 vaccines booster doses in preventing infection during Omicron predominance. A research letter published on June 2 in JAMA examines the association between booster doses and Omicron infections among US National Basketball Association (NBA) players and staff between December 1, 2021, and January 15, 2022. A full vaccine regimen and a booster dose was required for staff members, but vaccination was optional for players. During the study period, the proportion of participants who were fully vaccinated but not boosted dropped from 26% to 8%, while the proportion of participants who received a booster rose from 49% to 85%. There were 608 SARS-CoV-2 infections among the boosted population and 127 infections among the unboosted population. While it appears that more cases occurred among vaccinated individuals, it is important to remember that the total size of the 2 populations varied widely. As a result, the whole number must be standardized to accurately reflect booster effectiveness. Overall, the study found that boosted participants were significantly less likely to develop SARS-CoV-2 infection or symptoms of COVID-19.

Another study published in The Lancet Infectious Diseases examined the connection between booster doses and Omicron infection in Spain. The study utilized data from 3 national registries, matching individuals who had completed their primary vaccination series at least 3 months earlier with those who had not, and who were aged 40 years or older and had not previously tested positive for SARS-CoV-2. Between January 3 and February 6, 2022, the researchers looked for laboratory-confirmed infections among the study population, finding the average estimated effectiveness for boosters protecting against Omicron infection for 1 month after administration was 51%. Notably, booster effectiveness was higher when a longer time passed between the initial primary vaccine regimen and the booster dose. Effectiveness also varied slightly depending on which vaccine was used for the booster. Overall, both studies indicate that booster doses of SARS-CoV-2 vaccines remain an effective means of protection, even if only for a short period of time following vaccination.

NEXT-GENERATION VACCINE DEVELOPMENT Health experts in the US are discussing the next generation of SARS-CoV-2 vaccines. While individuals who are fully vaccinated and boosted have a lower overall risk of COVID-19-associated hospitalization and death than people who are not up-to-date on their vaccinations, even boosted populations can acquire and transmit SARS-CoV-2 due to waning immunity and the ability of newer Omicron subvariants to evade both natural and vaccine-induced immunity. As a result, the US FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) is scheduled to meet on June 28 to discuss whether and how the SARS-CoV-2 strain composition of vaccines should be modified. Pfizer-BioNTech and Moderna are conducting clinical trials of modified versions of their vaccines that target multiple variants, including more recent Omicron subvariants, and 2 additional novel SARS-CoV-2 vaccine designs are in clinical trials, including a plant-based vaccine and a receptor binding domain (RBD)-dimer-based vaccine. Additionally, different delivery methods, such as inhaled nasal administration, could produce better mucosal immunity and potentially reduce breakthrough infections.

As the next generation of SARS-CoV-2 vaccines are being developed, health officials are speculating about whether booster doses will be needed annually, similar to a flu shot. The aspiration is a pancoronavirus that protects against all variants and sublineages, including possibly yet-to-emerge versions. While some experts believe the science is available to develop a pancoronavirus vaccine, the sense of urgency and the funding for such an effort are not. The US Congress remains deadlocked over negotiations for additional COVID-19 funding that would help progress research on future SARS-CoV-2 vaccines.

US VACCINE WASTE According to data from the US CDC, more than 82 million doses (11%) of distributed SARS-CoV-2 vaccines in the US were wasted between December 2020 and May 2022. This demonstrates an upward trend, as roughly 65 million doses were estimated to be wasted as of February 2022, when the figures were last reported. Over a quarter of doses thrown away were distributed by CVS (11.8 million doses) and Walgreens (8.3 million doses), the 2 largest US retail pharmacy chains. Other pharmacies and health centers, including Rite Aid, Costco, and DaVita, wasted fewer overall doses but a higher share of their received doses than CVS and Walgreens. Demand for the vaccines has plateaued, and in some parts of the country demand has dropped. Less than half of fully vaccinated US residents have received a booster shot (47%) as of June 6.

Packaging is a large contributing factor to vaccine wastage. The SARS-CoV-2 vaccines are packaged in multidose vials, and if a vial is not quickly used after opening, it has to be discarded due to their short shelf life under emergency authorizations. Concerns around vaccine wastage due to packaging are not unique to the US. Prior to the COVID-19 pandemic, the WHO cautioned that large vaccination campaigns using multidose vials will experience significant rates of vaccine wastage. The CDC is working with vaccine manufacturers to produce single-dose vials to help reduce waste. Additionally, Pfizer is making adjustments to extend shelf-life, improve handling and storage requirements, and minimize waste.

OMICRON SUBVARIANT IMPACTS Sublineages of the Omicron variant of concern continue to edge out previously dominant variants. Prevalence of the latest subvariant, BA.2.12.1, nearly tripled in the US between mid-April and late-May, and it appears the newer BA.4 and BA.5 sublineages are gaining ground among the nation’s population. However, the US CDC is aggregating genomic data with B.1.1.529, making it difficult to parse out exactly what proportion of cases are due to these newest subvariants. While much of the population has some immunity from either previous infection or vaccination, with or without 1 or 2 booster doses, reinfection remains a real risk as immunity fades over time or newer, potentially more transmissible or virulent, variants emerge. BA.4/5 appear to cause little severe disease but are highly transmissible and capable of immune escape, so we likely can expect another wave of infection due to these subvariants. Notably, BA.4/5 appear to be responsive to boosters, albeit with waning protection, as well as monoclonal antibodies and antivirals. However, unvaccinated individuals, even those with some immunity from infection with previous strains, are most at risk of severe COVID-19 outcomes.

A new report, which is not yet peer-reviewed, estimates the US death toll of each variant. According to the researchers from Yale University and Public Citizen, nearly half of COVID-19 deaths (46%) have occurred after the ancestral strain of SARS-CoV-2 was replaced by variants. The research dispels the myth that Omicron causes less severe disease than previous variants. This year, more deaths have been among older adults, especially those in long-term care facilities. The research highlights the importance of continuing vaccination and other public health strategies as long as the virus is circulating and underlines the need for additional surveillance to detect the emergence of new variants. A partnership among the US CDC, Ginkgo Bioworks Inc., and the airport-based massage and nail salon XpresSpa is hoping to fill some surveillance gaps, launching a testing service for international travelers that already has found both positive cases and new SARS-CoV-2 mutations. This type of partnership, if continued and expanded, could help to monitor for other biological threats into the future.

PAXLOVID EFFECTIVENESS The US FDA authorized the COVID-19 antiviral treatment Paxlovid in December 2021 for early COVID-19 treatment among anyone aged 12 and older who are at high risk for progression to severe COVID-19 based on data collected from its use among unvaccinated individuals during the Delta variant surge of 2021. An accepted manuscript by researchers in Israel published last week in Clinical Infectious Diseases evaluates the effectiveness of Paxlovid in a real-world setting among vaccinated and unvaccinated adults during Omicron variant predominance. According to the study, treatment with Paxlovid reduced the risk of severe COVID-19 or death by about half (46%) regardless of vaccination status, while up-to-date vaccination reduced the risk 80%. Notably, Paxlovid was more effective in older patients, immunocompromised patients, and those with underlying neurological or cardiovascular disease, and no interaction was observed between Paxlovid therapy and vaccination status.

Another preprint study posted to Research Square, also conducted by Israeli researchers, suggests Paxlovid is most effective among older adults (>=65 years), reducing the risk of COVID-19 hospitalization by 67% and COVID-19 mortality by 81%. However, patients aged 40-64 years, regardless of prior immunity, saw no significant benefit from Paxlovid treatment in reducing the risk of severe COVID-19 outcomes. Some people are experiencing what is being called “Paxlovid rebound” or “COVID rebound”—a resurgence in viral load and symptoms days after finishing the 5-day course of medicine—although data on how many patients experience the rebound or their demographics are not available at this time. Pfizer, which makes the treatment, said it plans to spend US$120 million to boost its production to make 120 million courses this year.

The White House continues to expand its test-to-treat initiative, doubling the number of sites where Paxlovid is available nationally over the past 2 months. Additionally, the number of US prescriptions filled each week has increased nearly 7-fold over the past 2 months, according to a White House fact sheet published 2 weeks ago. Importantly, both studies from Israel, which showed the greatest benefit among older patients, call into question the widespread use of Paxlovid in the US. More than 1 million courses of the drug have been administered in the US, but it remains unclear who is taking it.

VACCINE MISINFORMATION DURING PREGNANCY Pregnancy-related misinformation about SARS-CoV-2 vaccines is common and persistent, leading about 1 in 5 US adults (18%) and about 3 in 10 women who are pregnant or planning to become pregnant (29%) to believe in at least 1 of 3 false statements about vaccines and pregnancy, according to the latest findings of the Kaiser Family Foundation’s COVID-19 Vaccine Monitor. Larger proportions of those surveyed said they believe or are unsure of at least 1 of 3 false statements about pregnancy and SARS-CoV-2 vaccines, including segments of the population that generally believe the vaccines are safe for adults. The survey, conducted in May, included responses from more than 1,500 US adults, including 900 women, who evaluated 3 false statements on vaccines and pregnancy, breastfeeding, and infertility. About 1 in 7 adults (14%) and almost 1 in 4 women who are pregnant or planning to become pregnant (24%) incorrectly believe pregnant women should not be vaccinated against COVID-19, according to the survey.

Pregnant people are at an increased risk of severe COVID-19 outcomes, including death, and health experts recommend that pregnant people and those looking to become pregnant remain up to date on their vaccinations. Notably, vaccination of pregnant people likely has benefits to newborns, as well. Research out of Norway, published in JAMA Internal Medicine, suggests that infants born to women who had received a second or third vaccine dose during pregnancy were 33% less likely to test positive for SARS-CoV-2 infection at age 4 months than infants born to unvaccinated women. The difference between infants born to vaccinated versus unvaccinated women was more pronounced during Delta predominance, with those born to vaccinated women 71% less likely to test positive in the 4 months following birth. About 30% of pregnant people in the US remain unvaccinated.

COVID-19 DEATHS In discussions regarding how to best articulate the end of the COVID-19 pandemic emergency phase, officials in the administration of US President Joe Biden considered using a specific threshold of daily COVID-19 deaths but decided not to use that number as a formal metric. The exercise was meant more as a thought experiment, with the continuing goal to bring down the number of new infections and deaths. An average of 247 people are dying of COVID-19 each day as of June 5. At no point since the beginning of the pandemic have fewer than 200 people died of COVID-19 per day in the US for a sustained time period.

Iowa farmland sells for $25,000 per acre?

100-acre Plymouth County farm sells for $2.6M at auction

• Mason Dockter
• May 29, 2022
• <?XML:NAMESPACE PREFIX = "[default] https://www.w3.org/2000/svg" NS = "https://www.w3.org/2000/svg" /> 0

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This 96.3-acre farm and 3.5-acre farm place, southeast of Le Mars, sold for more than $2.6 million at auction. The price per acre was significantly higher than average farmland in Plymouth County.

• Brock Auction Company

This 96.3-acre farm and 3.5-acre farm place, southeast of Le Mars, sold for more than $2.6 million at auction. The price per acre was significantly higher than average farmland in Plymouth County.

• Brock Auction Company

This 96.3-acre farm and 3.5-acre farm place, southeast of Le Mars, sold for more than $2.6 million at auction. The price per acre was significantly higher than average farmland in Plymouth County.

• Brock Auction Company

This 96.3-acre farm and 3.5-acre farm place, southeast of Le Mars, sold for more than $2.6 million at auction. The price per acre was significantly higher than average farmland in Plymouth County.

• 
  
• Mason Dockter
• 
  

LE MARS, Iowa -- A farm in Plymouth County sold for $25,000 an acre on Friday, a price more than twice as high as the average in the county.

Bruce R. Brock, whose Brock Auction Company conducted the sale, said the land -- about 96.33 acres of farmland and a 3.67-acre farm place at 38625 200th St., a gravel road about 5 miles southeast of Le Mars -- sold for a total of more than $2.6 million.

The buyers are neighbors to the north of the farm, who Brock described as "a great farm family."

The land, which Brock described as top quality, was put up for sale following the death of Eilene L. Rolling, the owner of the farm. Rolling's husband had died several years earlier. The family had owned the land for decades.

"I think it was a very good farm, no question about it," Brock said in a phone call Sunday. "It had a lot going for it, it didn't take on any water from anybody else, there was just a teeny little bit of slope to it, so that the water drained well off it. It was top-quality soil, in a good, high state of productivity."

(As a description of the farm on Brock's auction website put it, "What more could you want.")

The auction was attended by more than 100 people, Brock said.

The price was well above average farmland values in Plymouth County or anywhere else in the state. As of 2021, an average acre of farmland in Plymouth County was valued at around $12,416 -- a 31.4 percent increase from the year prior, according to Iowa State University data. That figure was the fourth-highest in the state, behind only Sioux, O'Brien and Lyon counties.

Farmland in Northwest Iowa is generally the richest and most valuable in the state. 

Statewide, farmland values were up an average of 29 percent last year, according to ISU data. Prices are likely to increase further this year, as the war in Ukraine constricts global grain supplies, driving up farm revenues and the value of land.

"Last year, and the last couple months in 2020, we sold $78 million worth of land, and it just steadily went up and up and up and up and up," said Brock, who predicted that farm prices are likely to continue on their "up" path, with a possible "retracement or two for a short period of time."

"Then the land will come back strong. It's a good investment, there's no question about it," he added. "There's a lot of interest, we get several calls a week from people looking for farmland, of all types."

Above is from:  https://siouxcityjournal.com/news/local/100-acre-plymouth-county-farm-sells-for-2-6m-at-auction/article_bd983103-4dd2-5ec6-ba2a-cba1cca1ab35.html

June 2, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

MONKEYPOX OUTBREAKS UPDATE Read our latest update from June 1 on the monkeypox outbreaks and visit our monkeypox resource page. We will continue to analyze the situation and provide updates, as needed. If you would like to receive these updates, please sign up here.

EPI UPDATE The WHO COVID-19 Dashboard reports 527.6 million cumulative cases and 6.29 million deaths worldwide as of June 1. The global weekly incidence decreased (-11.4%) over the previous week. The weekly trend increased in the Americas (+9.2%) and Eastern Mediterranean (+1.4%), while decreasing trends were observed in the remaining 4 regions. The trend in reported global weekly mortality decreased for an eighth consecutive week, but appears to be slowing, down 2.2% from the previous week. The number of new weekly deaths increased in the Americas (+13.2%), Western Pacific (+18.3%), and Africa (+15.2%). The number of new weekly deaths decreased in the other 3 regions.

The Omicron variant of concern (VOC) accounts for nearly all analyzed samples, with BA.2 responsible for 75% of these. Other Omicron sublineages are responsible for nearly all other cases, with BA.1 accounting for 4%, BA.2.12.1 for 16%, BA.4 for 3%, and BA.5 for 2%.

UNITED STATES

The US CDC is reporting 84.2 million cumulative cases of COVID-19 and 1,002,422 deaths. The current average daily incidence appears to have peaked, falling to a 7-day moving average of 103,686 on May 31, down from a high of 110,350 on May 26. However, the decline could be due to delayed reporting attributable to the Memorial Day holiday. The average daily incidence on Memorial Day (May 30) this year is 5 times higher than the average reported on last year’s Memorial Day (May 31, 2021). Prior to the holiday weekend, Our World In Data reported 7-day average US test positivity of 12%. The daily mortality dropped slightly to an average of 264 deaths per day*, and we have not yet observed an increase corresponding to the surge in daily incidence. Hospital admissions of people with COVID-19 continue to trend upwards, although more slowly, with an increase of 6% over the past week. New cases continue to be driven by the the BA.2.12.1 sublineage of Omicron (59%), followed by the BA.2 subvariant (35%) and B.1.1.529 (6%).

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

WHO ESTIMATED GLOBAL EXCESS DEATHS Scientists working with the WHO have admitted to errors in the estimated global excess deaths associated with COVID-19, data first reported in the beginning of May. In a preprint revision, the researchers lowered Germany’s estimated COVID-related deaths by 37% and increased estimates for Sweden by 19%. The numbers are not yet corrected in the project website, a living model that researchers will continuously update. WHO experts said they are working to correct the inaccuracies and communicate the changes.

PFIZER-BIONTECH EUA APPLICATION FOR UNDER-5 VACCINE On June 1, Pfizer-BioNTech completed their request to the US FDA for Emergency Use Authorization (EUA) of their SARS-CoV-2 vaccine for children ages 6 months through 4 years. A SARS-CoV-2 vaccine for this age group is greatly anticipated, as children have been more affected during the Omicron variant surges compared to past surges caused by other variants. The US FDA acknowledged receipt of Pfizer-BioNTech’s application and said its experts will be evaluating the data. The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) is scheduled to review EUA requests for both the Pfizer-BioNTech 3-dose vaccine regimen for children under age 5 and the Moderna 2-dose vaccine regimen for children under age 6 on June 15.

The under-5 age group is the only in the US that remains ineligible for SARS-CoV-2 vaccination. However, parents remain divided on whether to jump at the opportunity to vaccinate their children once the option becomes available or wait. A Kaiser Family Foundation survey conducted in April found that 18% of parents would vaccinate their under-5 children as soon as the series becomes available, 11% would do so only if required, 38% would “wait and see,” and 27% indicated they would “definitely not” vaccinate their young children.

US TRAVEL MASK MANDATE The US Department of Justice on May 31 asked the 11th US Circuit Court of Appeals to overturn an April decision by a federal judge that struck down the mandate requiring masks on public transportation and in transit stations. In that April decision, US District Judge Kathryn Kimball Mizelle argued that the mandate violates the Administrative Procedure Act and exceeds the US CDC’s statutory authority. However, the Justice Department argues in a 48-page brief that a mask mandate falls squarely within the CDC’s authority to protect public health and argues the District Court did not show the agency acted outside the “zone of reasonableness.”

In related travel news, White House officials met this week with travel industry officials who are pushing for the Biden administration to end a requirement that vaccinated international travelers test for SARS-CoV-2 prior to flying to the US. Industry officials argue that the pre-departure test requirement is not in line with the current threat from COVID-19 and that it is harming the US economy, as travelers are visiting other nations that have dropped their testing mandates. Some medical and public health experts also question the usefulness of pre-departure testing, arguing the disease is already circulating in the US.

HEALTH SYSTEMS STRENGTHENING Since the beginning of the COVID-19 pandemic, international organizations and national governments have focused on the public health emergency and set aside little funding aimed at strengthening healthcare systems, particularly in relation to pandemic preparedness. A proposed Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness and Response, to be hosted by the World Bank, has received US$962 million in pledges, but it remains unclear how much of those or future commitments will go directly to national governments to fortify their public health infrastructure versus directly funding medical countermeasures. The comment period on a World Bank white paper on the proposed FIF closed yesterday, and feedback will be valuable in clarifying priorities for the fund. Without additional and sustained assistance from international and national sources, low- and middle-income countries likely will continue to struggle to purchase sufficient equipment and medicines, and pay for qualified staffing, in order to take care of patients today and prepare for the next pandemic.

CHINA Following a surge in cases during March and April due to the Omicron variant of concern (VOC), the number of new COVID-19 cases in China has dropped significantly under the country’s stringent “zero COVID” strategy that employs widespread lockdowns, mass testing, and other mobility controls. In Shanghai, authorities are moving toward lifting strict lockdowns that have been in place for 2 months, heavily impacting the economy and, arguably, residents’ mental health. Though most residents are allowed to freely move about the city and return to work and school, COVID-19 restrictions continue to impact everyday life in the city, with residents needing to show negative PCR test results taken within the previous 72 hours to enter public spaces or access public transit. Officials hope that Shanghai’s reopening will quickly mobilize its manufacturing and export-heavy economy and help to correct a sharp economic slowdown. Beijing officials also announced restrictions in that city will be partially lifted, allowing people to return to work and resume shopping. While officials and state media laud the nation’s zero COVID policy, including a front-page feature in the People’s Daily declaring Shanghai’s victory over COVID-19, others cite mounting mental, social, and economic impacts on residents and question the policy’s endgame, with the looming threat of future lockdowns amid further outbreaks.

NORTH KOREA Last week, North Korean leader Kim Jong Un and other top officials discussed loosening tight COVID-19-related restrictions, maintaining that the nation’s first pandemic outbreak is receding. However, those claims are widely disputed, with the WHO stating that the situation likely is getting worse, not improving. The daily number of people reported as having fever has dropped from about 390,000 2 weeks ago to 96,000 today. The WHO has offered technical support and medical resources, including vaccines, on 3 separate occasions, but officials have declined those offers. Additionally, WHO officials have requested access to details about symptoms, transmission, and severity to better understand the nation’s situation, but have not yet received that information. North Korea’s claim to have controlled COVID-19 without vaccinations, lockdowns, or drugs raises many questions and concerns among experts, particularly because the outbreak there could have global implications.

PAXLOVID Some healthcare providers are reconsidering prescribing Paxlovid to very low-risk individuals infected with SARS-CoV-2. The rationale is based on the potential for viral rebound, previously reported by the CDC, and that individuals who experience a rebound after completing isolation are more likely to transmit the virus to others before they are actually recovered. Therefore, some providers are choosing not to prescribe Paxlovid to individuals not meeting criteria for high-risk categories, instead hoping mild infections will run their course. Pfizer is currently reporting a rebound rate of about 2%. Still, the proportion could possibly be an underestimate, as there is low visibility on the true number of Paxlovid courses being prescribed and taken, and by which populations. Additionally, there is no central mechanism for people taking Paxlovid to report instances of adverse events or viral rebound. The US HHS Office of the Assistant Secretary for Preparedness & Response (ASPR) maintains a website tracking ordered and dispensed COVID-19 therapeutics among US states and territories, but there is no demographic data associated with the numbers. Prescribers appear amenable to continuing to prescribe Paxlovid to high-risk individuals, as the drug reduced the risk of hospitalization and death by about 90% in clinical trials. Notably, those data are based on the use of Paxlovid among only unvaccinated people who were never previously diagnosed with COVID-19, highlighting the need for data on the drug’s use among other populations, including those who were previously vaccinated, previously infected, or are at low-risk of disease progression.

TESTING & ISOLATION The US CDC recommends that people who test positive for COVID-19 isolate for a minimum of 5 days and follow that with 5 days of wearing a mask if they are asymptomatic or symptoms are resolving. However, some people continue to test positive on at-home rapid antigen tests 5, 10, even 13 days after their initial diagnosis, raising concerns they might remain infectious longer than the recommended isolation period. Experts are divided as to whether rapid tests should be used as a bellwether of infectiousness but agree that the tests are a useful tool in helping people recovering from COVID-19 assess whether they should engage in certain activities after day 10, such as attending large indoor gatherings or visiting with elderly or immunocompromised people. Overall, people with COVID-19 in the US should continue to follow CDC guidance to help prevent further transmission of the virus.

NIH TREATMENT GUIDELINES The US NIH updated its Coronavirus Disease 2019 (COVID-19) Treatment Guidelines on May 31. The updates include 4 new sections discussing the care of children critically ill with COVID-19 or multisystem inflammatory syndrome in children (MIS-C); new information informing treatments to prevent blood clots among patients with COVID-19; additional rationale in sections discussing critical care for adults with COVID-19; new information about the use of Evusheld (tixagevimab/cilgavimab) for pre-exposure prophylaxis among immunocompromised individuals; and other information.

RESEARCH ROUNDUP The research roundup provides quick synopses of COVID-19-related research.

From BMJ, a living systematic review and network meta-analysis evaluating the effectiveness of heterologous and homologous SARS-CoV-2 vaccine regimens with and without boosters in preventing infection, hospitalization, and death. The researchers found that 3-dose mRNA vaccine regimens, regardless of being heterologous or homologous, are the most effective against asymptomatic and symptomatic infections with SARS-CoV-2 variants including Alpha, Delta, and Omicron. The effectiveness of 3-dose regimens against COVID-19-related mortality could not be determined.

From the European Heart Journal, a systematic review and meta-analysis of 158 observational studies from 49 countries on 6 continents looking at the effect of the COVID-19 pandemic on the care for and outcomes of cardiovascular (CV) diseases unrelated to SARS-CoV-2 infection. Overall, the pandemic severely disrupted CV-related care, with disparity in severity by country income classification. According to the researchers, the disruptions likely will have impacts well into the future, as the longer people wait for CV-related care, the more damage to the heart muscle, increasing the risk of adverse outcomes.

From JAMA Internal Medicine, a retrospective cohort study showing that pulse oximeters overestimate blood oxygen levels among darker-skinned COVID-19 patients—including those who are Asian, Black, and Hispanic—compared with White COVID-19 patients, possibly leading to delays in treatment. The findings point to one possible reason COVID-19 mortality rates have been higher in US communities of color.

From The Lancet Global Health, a modeling study estimating the transmission dynamics of SARS-CoV-2 in the African region from the beginning of the pandemic through 2022. According to the model, only 1.4% of the region’s estimated 505.6 million SARS-CoV-2 infections were reported, and 35.3% of the region’s estimated 439,000 deaths were reported as COVID-19-related. While the number of estimated infections were similar in 2020 and 2021, 81% of the deaths were in 2021. The researchers estimate that SARS-CoV-2 infections will remain high throughout this year but deaths will be substantially reduced due to an estimated 52.3% of the region’s population having some SARS-CoV-2 immunity, mostly from previous infection.

From medRxiv, a preprint study examining the protection conferred by prior SARS-CoV-2 infection and vaccination during the Omicron wave within resident and staff populations. Even among individuals infected prior to or during the period of Delta predominance, a third dose of mRNA vaccine provided significantly more protection from infection with Omicron than the primary 2-dose series, suggesting booster doses should remain a priority even among populations with previous infection.

From medRxiv, a preprint study examining the effectiveness of the combination monoclonal antibody treatment Evusheld (tixagevimab/cilgavimab) as pre-exposure prophylaxis among adults who were immunocompromised or otherwise at high-risk of COVID-19 infection or severe disease. Compared with controls, treated individuals had lower incidences of COVID-19 infection, hospitalization, and all-cause mortality.

From medRxiv, a preprint study estimating the prevalence of SARS-CoV-2 infection during the Omicron BA.2/BA.2.12.1 surge in relation to official case counts and assessing the uptake of SARS-CoV-2 antivirals in New York City adult residents. According to the researchers, official surveillance data vastly underestimated the true magnitude of the recent BA.2/BA.2.12.1 surge, by about 30-fold, and among those residents with COVID-19, 56% were unaware of the availability of the antiviral Paxlovid.

From Nature Communications, a study evaluating the virus-neutralizing capacity against SARS-CoV-2 variants Alpha, Beta, Gamma, Delta, and Omicron among 62 pediatric patients who were hospitalized with severe COVID-19 or acute multisystem inflammatory syndrome (MIS-C) and 65 pediatric outpatients who had recovered from mild COVID-19 prior to the emergence of Omicron. The researchers found that children who were previously infected with SARS-CoV-2 or had MIS-C are not protected against Omicron, but children who had received a 2-dose vaccine regimen demonstrated high cross-neutralization against all variants, including Omicron. The findings support the need for vaccination of children.

From PLOS Medicine, the latest update to a living systematic review and meta-analysis of studies published through July 2021 showing that most SARS-CoV-2 infections are not persistently asymptomatic and those infections that were asymptomatic were less infectious than symptomatic infections. The researchers note that the true proportion of asymptomatic COVID-19 cases remains unknown.

From PLOS ONE, a prospective cohort study conducted in 2 community COVID-19 screening centers to evaluate the diagnostic accuracy of non-invasive detection of SARS-CoV-2 infection by trained dogs compared with nasopharyngeal RT-PCR, saliva RT-PCR, and nasopharyngeal antigen testing. The overall sensitivity of canine olfactory detection was 97% and reached 100% in asymptomatic individuals compared to RT-PCR, while the specificity was 91% and 94% in asymptomatic individuals. For nasopharyngeal antigen testing, dog detection had higher sensitivity (97% vs 84%) but lower specificity (90% vs 97%). The study supports the use of dogs to quickly obtain results and could be used in the context of mass screening.

From PNAS, a large study drawing information from several datasets covering 92 regions on 6 continents to estimate the effect of mask wearing on SARS-CoV-2 transmission, adjusting for mobility and nonpharmaceutical interventions (NPIs). The researchers found that the mean observed level of mask wearing corresponds to a 19% decrease in the reproduction number R, showing mask wearing in community settings is associated with a notable reduction in transm

May 26, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

NOTICE The COVID-19 Situation Report will not publish on Tuesday, May 31, 2022. The next Report will be published on Thursday, June 2, 2022.

UPCOMING WEBINAR With summer approaching, engaging in sporting events can seem daunting for athletes and spectators alike, especially as the world continues to respond to the pandemic. This webinar will focus on COVID-19 testing strategies and best practices for large sporting events. The panelists, Dr. Brian McCloskey and Ms. Lucia Mullen, served on WHO’s COVID-19 Mass Gatherings Expert Group. They advised Olympic organizers on COVID-19 countermeasures for the Tokyo 2020 Summer and the Beijing 2022 Winter Games. They will discuss developing and implementing masking, testing, and vaccination strategies for the world’s largest international sporting celebrations. Please join us on June 1 at 10:00am ET. Registration is available here.

MONKEYPOX OUTBREAKS UPDATE Read our latest update from May 25 on the monkeypox outbreaks. A newfact sheet also is available. We will continue to analyze the situation and provide updates, as needed. If you would like to receive these updates, please sign up here.

EPI UPDATE The WHO COVID-19 Dashboard reports 524.3 million cumulative cases and 6.28 million deaths worldwide as of May 25. The global weekly incidence decreased slightly (-0.8%) over the previous week. The weekly trends are increasing in the Americas (+13.2%) and Western Pacific (+5.7%) regions, while decreasing trends were observed in the remaining 4 regions. The trend in reported global weekly mortality decreased for a seventh consecutive week, down 6% from the previous week. The number of new weekly deaths increased in the Eastern Mediterranean region (+30%) after the region reported major increases in daily incidence over the past couple weeks. The number of new weekly deaths remained stable in the Western Pacific and the Americas regions (both <1%), and decreased in the other 3 regions.

UNITED STATES

The US CDC is reporting 83.4 million cumulative cases of COVID-19 and 1,000,254 deaths. As expected, the cumulative number of COVID-19 deaths surpassed 1 million on May 24. The current average daily incidence continues to increase, up to 104,399 on May 24 from 99,215 new cases per day on May 17. The daily mortality is fairly steady at an average of 288 deaths per day*, and we have not yet observed an increase corresponding to the surge in daily incidence. New COVID-19 hospital admissions continue to trend upwards, with an increase of 14% over the past week. New cases are now being driven by the the BA.2.12.1 sublineage of Omicron (58%), which this week became the predominant variant over the BA.2 subvariant (39%).

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

OMICRON SUBVARIANTS The US recently began averaging more than 100,000 new daily COVID-19 cases for the first time since February. As of the end of last week, 58% of new US cases are caused by the Omicron subvariant known as BA.2.12.1. There is no indication the variant causes more severe disease than previous Omicron variants, but new hospitalizations also are increasing. However, BA.2.12.1—as well as the other Omicron sublineages BA.4 and BA.5, which the European Centre for Disease Control and Prevention (ECDC) have deemed variants of concern and are currently circulating at low levels in the US—are even more transmissible than the BA.1 version of Omicron that caused high caseloads in early 2022. The 3 sublineages also likely are capable of escaping some of the immunity produced by infection with BA.1 and BA.2. The consistent resurgence of viral variants creates challenges to maintaining long-lasting defense against COVID-19, but the best defense against severe disease and death remains staying up-to-date on vaccinations.

US CDC PAXLOVID ADVISORY ​The US CDC on May 24 issued a Health Alert Network (HAN) Health Advisory to inform healthcare providers and the public about the possible recurrence of COVID-19 following Paxlovid treatment, commonly referred to as “COVID-19 rebound” or “Paxlovid rebound.” Paxlovid, an oral antiviral drug for early-stage treatment of mild-to-moderate COVID-19, was authorized for emergency use in December 2021 for persons aged 12 years and older who are at high risk for progression to severe illness. The drug has shown to reduce the risk of hospitalization and death due to COVID-19. In the advisory, the CDC emphasized that brief recurrence of COVID-19 symptoms could be part of the natural history of infection, regardless of treatment and vaccination status. However, individuals with recurrent symptoms or a new positive viral test are advised to follow current CDC recommendations for isolation by re-isolating for at least 5 days and when fever has resolved for 24 hours. 

Today, the administration of US President Joe Biden announced plans to make Paxlovid even more accessible as the nation experiences another surge in new COVID-19 cases. The nation’s first federally supported test-to-treat site opened today in Rhode Island to provide Paxlovid to individuals who test positive. Other test-to-treat sites are expected to open soon in Massachusetts and New York City, and established testing sites across the country will soon be equipped to transition to test-to-treat locations, according to the administration.

LONG COVID/PASC In the third year of the COVID-19 pandemic, researchers are beginning to learn more about post-acute sequelae of SARS-CoV-2 (PASC), commonly known as long COVID. The condition—characterized by a broad range of symptoms lasting anywhere from 4 weeks to 2 years or longer—could prove one of the biggest hurdles to pandemic recovery. Estimates of the proportion of people who have had COVID-19 and continue to experience symptoms range from 5% to 80%, although the WHO puts the range at 10% to 20%. Results from a large study published this week in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) estimates that 1 in 5 COVID-19 survivors aged 18-64 and 1 in 4 survivors aged 65 or older experienced at least 1 of 26 conditions often attributable to long COVID at 30 days and up to 1 year following diagnosis. Both age groups had twice the risk of uninfected people of developing respiratory symptoms or other lung problems, including pulmonary embolism. The older cohort was at greater risk than the younger group to develop kidney failure, neurological conditions, and mental health conditions. The authors of the study, members of the CDC COVID-19 Emergency Response Team, encouraged people who survive COVID-19 to undergo routine assessment for post-COVID conditions.

Another study, published in Nature Medicine on May 23, found that 1 in 8 adults who were hospitalized with COVID-19 developed myocarditis 28 to 60 days post-discharge, and many COVID-19 survivors experienced reduced exercise capacity, lower quality of life, and persistent abnormalities in heart, lung, and kidney exams. The researchers said study participants’ post-COVID conditions were more closely correlated with the severity of their COVID-19 infection, not their underlying health condition prior to infection, and they cautioned these persistent health problems could place a substantial demand on healthcare services in the future, as more people survive COVID-19.

US NIH researchers conducting an ongoing study comparing 189 COVID-19 patients to 120 similar patients who did not have COVID-19 found no indications of underlying cause for the COVID-19 group to have more persistent symptoms. The study, published in the Annals of Internal Medicine, showed no evidence of persistent viral infection, autoimmunity, or abnormal immune activation among long COVID patients. They did note that women and those with a history of anxiety disorder were at increased risk of PASC/long COVID, but they also stressed the findings do not mean the condition is psychological. A third study, published in the Annals of Clinical and Translational Neurology, found that neurological symptoms—including brain fog, numbness/tingling, headache, dizziness, blurred vision, tinnitus, and fatigue—among many of the 52 non-hospitalized COVID-19 patients in the study persisted for nearly 15 months after initial diagnosis. Some symptoms, including variations in heart rate and blood pressure and gastrointestinal problems, increased over time, but loss of taste and smell generally improved. Among the participants, 77% were vaccinated against COVID-19, but vaccination did not have a positive or negative impact on cognitive function or fatigue.

Notably, a large study conducted by the US Department of Veterans Affairs (VA) and published in Nature Medicine showed that SARS-CoV-2 vaccination appears to reduce the risk of lung and blood clot disorders among COVID-19 survivors, but vaccination does little to protect against long-term symptoms among those who had breakthrough infections, about 1% of the study participants. Overall, vaccinated people who had breakthrough infections had lower risks of death (HR=0.66, 95% CI: 0.58, 0.74) and long-term symptoms (HR=0.85, 95% CI: 0.82, 0.89). The data confirm that vaccination strongly protects against serious disease and death but suggest that vaccination prior to infection confers only partial protection against PASC and should not be relied upon as a sole mitigation strategy, the researchers noted. The VA study was conducted prior to the emergence of the Omicron variant, and a preprint study conducted in Japan and posted this week to medRxiv suggests the prevalence of long-term symptoms following infection with Omicron might be less than with other variants.

PFIZER PRICING DEAL During the World Economic Forum annual meeting in Davos, Switzerland, this week, Pfizer pledged to provide 23 of its patented medicines and vaccines to treat infectious diseases, certain cancers, and rare and inflammatory diseases—including those for COVID-19—at not-for-profit pricing to 45 lower-income countries. The company’s “An Accord for a Healthier World” also includes future products and is expected to benefit 1.2 billion people. Rwanda, Ghana, Malawi, Senegal, and Uganda are the first nations included in the deal. Haiti, Bangladesh, and Tajikistan also are on the list. Pfizer CEO Albert Bourla said the plan also includes strategies aimed at improving access to diagnostics, technical assistance, and training of healthcare workers. Some advocates welcomed the announcement, while others criticized the effort as being too little, too late.

Also at the meeting, the Serum Institute of India (SII), the world's largest vaccine manufacturer, announced it is looking into establishing a manufacturing plant in Africa. SII CEO Adar Poonawalla said he is working to distribute a draft global treaty to help ensure more equitable access to vaccines and other healthcare during this pandemic and future outbreak emergencies.

PANDEMIC PREPAREDNESS The World Health Assembly (WHA) is meeting this week in Geneva, the first time the WHO decision-making body has met in person since the beginning of the COVID-19 pandemic. On May 24, the WHA approved a report from the Working Group on Preparedness and Response to Health Emergencies that includes a roadmap for the creation of a new instrument for pandemic preparedness and response. The report proposes actions to address critical gaps in prevention, preparedness and response to health emergencies, including pandemics; categorizes 131 recommendations by priority, feasibility, and implementation pathway; and highlights which steps are currently underway. High priority recommendations include recommitment to the binding obligations of the International Health Regulations (IHR). Other priorities include building capacity for local manufacturing with the support of technology transfer and research hubs, international coordination to quickly identify and sound alerts to emerging zoonotic diseases, and expanding regional capacities for genomic sequencing. In June, the Intergovernmental Negotiating Body will meet to discuss the roadmap and recommendations.

​​The WHA has faced online conspiracy theories regarding the discussion of a pandemic treaty, with misinformation accusing the WHO of attempting to impede national sovereignty. While Member States agreed that a new agreement is needed, negotiations for such an agreement will take years to produce a final draft. The false ideas of the treaty being used to take power from national governments have been popularized by various internet figures and boosted by mainstream politicians. Despite these statements, the WHA remains focused on navigating the end of the COVID-19 pandemic and preparing for the next health emergency.

CHILDHOOD LEARNING LOSS The COVID-19 pandemic caused the greatest disruption to education in history, causing students worldwide to miss an average of 4.5 months of schooling or up to 22 weeks of learning. Many students fell behind in standards of learning, and some developed behavioral or psychological problems. Those students in the poorest countries have been hit hardest, as have disadvantaged and vulnerable children in wealthier nations, exacerbating existing inequities. As school systems and teachers try to get students back on track, some nations are looking to decades of research to inform their COVID-19 responses, with a focus on tutoring, voluntary summer school, and other evidence-based education recovery strategies. Proponents of evidence-informed education encourage more quality research be conducted and urge educators and policymakers to seriously consider the results and implement reforms specific to their settings in order to strengthen education systems. Additionally, they encourage the coupling of education research and continuing education for teachers, making teachers researchers and vice versa. But advocates warn that national, state, and local leaders must act quickly to fill the educational gaps created by school closures during the pandemic.

CHINA Full economic recovery from the COVID-19 pandemic is expected to be a gradual process for China. But the country is taking the matter seriously, with China’s cabinet holding an emergency meeting of more than 100,000 provincial, city, and council leaders to discuss new measures to stabilize the economy. Shanghai, the nation’s financial hub, looks to be making steps toward normalization after dealing with months of severe pandemic prevention restrictions. China continues to pursue a “zero COVID” policy, but increasingly strict control measures are causing tension in some metropolitan areas. The government has used extreme measures, including locking residents in their buildings, relocating thousands of residents to other cities for quarantine, and invading private residences to spray disinfectants. Now, some cities and provinces are instituting regular mass SARS-CoV-2 testing to try to keep the virus at bay. The 99 million residents of Henan Province will be required to take PCR tests every other day as of June, and people in Beijing must test in order to ride the subway or enter any public space. The intense restrictions on personal life and freedom have been a major cause of discontent among younger populations, and many are now seeking to leave China or are protesting the restrictions by refusing to have children. The discontented populations claim they do not want to have children because they feel they could never protect them from an authoritarian regime that has little regard for personal liberties.

RESEARCH ROUNDUP The research roundup provides quick synopses of COVID-19-related research.

From JAMA Network Open, a small cohort study of 50 healthy young and middle-aged individuals examining factors associated with blood levels of anti-SARS-CoV-2 antibodies at 6 months following vaccination. The study found that anti-SARS-CoV-2-specific antibody levels were inversely correlated with bodyweight, body mass index, body fat amount, and body weight to height ratio, sustained up to 6 months post-vaccination. The researchers concluded that young and middle-aged healthy persons with low body weight could wait at least 6 months after finishing a primary 2-dose vaccination series to receive a booster dose.

From The Lancet Respiratory Medicine, a randomized, open-label, controlled clinical trial evaluating the safety and immune response of a heterologous high- or low-dose booster of an adenovirus vector-based SARS-CoV-2 vaccine (CanSino Biologic’s Convidecia) administered via oral aerosolization or a homologous intramuscular vaccination with CoronaVac among Chinese adults who previously received 2 doses of CoronaVac. The researchers found that participants in both the high- and low-dose heterologous booster groups had fewer side effects and higher neutralizing antibody responses compared with the CoronaVac group. The interim analysis serves as a proof of concept for an inhaled aerosolized vaccination, and an additional trial to evaluate the vaccine as a booster is planned.

From eClinicalMedicine, a systematic review of 156 studies published through March 13, 2022, analyzing social media use and attitudes toward and behaviors related to SARS-CoV-2 vaccination. The researchers—from Italy, Serbia, and the US—conclude that public health interventions could effectively use social media platforms to promote vaccine uptake.

From JAMA, a research letter describing a prospective study examining the outcomes of children with multisystem inflammatory syndrome (MIS-C) as a complication of SARS-CoV-2 infection who were evaluated at 12 Israeli hospitals over 16-week periods in each of the Alpha, Delta, and Omicron variant waves. The researchers found that cardiac outcomes were more favorable, fewer children were admitted to intensive care units (ICUs), and median hospital length of stay was shorter during the Omicron wave compared with the Alpha and Delta waves. None of the patients needed mechanical ventilation during the Omicron wave, compared with 8.5% during Alpha and 8.9% during Delta. The results suggest that MIS-C was less severe during the Omicron wave compared with other COVID-19 pandemic waves, a finding that is consistent with other studies.

From BMJ, a retrospective, test-negative, case-control study examining the relative vaccine effectiveness (VE) of a fourth dose of the Pfizer-BioNTech mRNA SARS-CoV-2 vaccine compared with 3 doses over a 10-week span. The study included nearly 97,500 individuals aged 60 and older in Israel. The researchers concluded that a fourth vaccine dose appears to provide additional protection from COVID-19-related severe disease and death but the relative VE of the fourth dose against infection wanes sooner than that of a third dose, peaking at 65% 3 weeks following the booster and falling to 22% at the end of week 10. However, relative VE against severe disease remained high (72%) through the 10-week follow-up, although severe disease was rare among participants who had received 3 or 4 doses.

From The Lancet Oncology, a population-based, test-negative, case-control study examining overall SARS-CoV-2 vaccine effectiveness (VE) against breakthrough infections at 3-6 months after the second dose among people with cancer and a control population in the UK. The researchers found that although SARS-CoV-2 vaccination is effective in most individuals with active or recent cancer, vaccination provides lower levels of protection against infection, hospitalization, and death than in the general population. Additionally, VE wanes more quickly among cancer patients than the general population and is lowest and wanes most quickly in those with lymphoma and leukemia. The researchers encouraged those with active or recent cancer, and especially those with blood cancers, to stay up-to-date on their vaccine doses, in some cases meaning 5 doses.

From Scientific Reports, a longitudinal study evaluating COVID-19 containment strategies across 50 different countries and territories, differentiating between pre-vaccine and vaccinating phases. The ranking shows that countries in Oceania and Asia outperformed countries in other regions on pandemic containment during the pre-vaccine phase, with success related to nonpharmaceutical interventions (NPIs), early action, and policy adjustment when necessary. In the vaccinating phase, the researchers found that maintaining NPIs was the best way to protect populations, providing insight into the effectiveness of various infectious disease containment policies in different regions.