March 30: 2404 New COVID 19 Cases in Illinois

March 29: 1761 New COVID 19 Cases in Illinois

Empower Boone Food Pantry to hold drive-thru market

BELVIDERE — The Empower Boone Food Pantry will hold a drive-thru pop-up market from 8 to 10 a.m. April 3 in the municipal lot on Whitney Boulevard. The market will have fresh produce and dairy items. People are asked to have their trunks empty. Food will be distributed on a first come, first served basis. All are welcome.

March 26: Johns Hopkins COVID 19 Report

COVID-19

The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

Editor’s Note: Our COVID-19 Situation Report team is taking a short break next week; we will not send updates on Tuesday, March 30 nor Friday, April 2. We’ll be back on Tuesday, April 6 with our curated analysis of the latest COVID-19 news and research.

Thanks to our wonderful team who pulls these together: Alyson Browett, Amanda Kobokovich, Margaret Miller, Christina Potter, Caitlin Rivers, Matthew Shearer, Marc Trotochaud, and Rachel Vahey.

EPI UPDATE The WHO COVID-19 Dashboard reports 124.9 million cases and 2.7 million deaths as of 12:00am EDT on March 26.

As global-level epidemiological trends indicate another COVID-19 surge, the epidemics in Brazil and India are driving a major portion of the global increase in daily incidence and mortality. Brazil’s current surge began in mid-November 2020, and its incidence has increased relatively steadily since then. It experienced brief decreases in daily incidence in early January and early-to-mid February 2021, but not enough to affect the overall trajectory. Conversely, India’s current surge began in late February 2021, but it is accelerating more rapidly. Brazil is currently #1 globally in terms of daily incidence, with more than 77,000 new cases per day. With more than 47,000 new cases per day, India is currently #3 globally; however, it could surpass the US (~59,000) as #2 in the coming days if it continues on its current trajectory. The global daily incidence was at a relative low on February 20, with 358,550 new cases per day, and since that time, daily incidence has increased by nearly 50% to 528,854—a difference of 170,304 cases. Notably, Brazil and India account for 38% of the global increase over that time (65,081 combined cases).

Brazil has reported more than 500,000 new cases each of the past 2 weeks, its 2 highest weekly totals to date. Brazil reported its highest single-day total on March 25, surpassing 100,000 new cases for the first time since the onset of the pandemic. Brazil’s daily incidence has increased 11% over the past 2 weeks and 50% over the past 4 weeks. On March 9, Brazil surpassed the US as #1 globally in terms of daily mortality, and its trend continues to increase sharply. With more than 2,300 deaths per day, Brazil is currently reporting more than a quarter of the global daily COVID-19 mortality. Last week, Brazil reported 15,650 deaths, its highest weekly total to date and 22% more than its previous record the week before. On March 23, Brazil reported 3,251 deaths, its highest single-day total. Brazil’s daily COVID-19 mortality has increased 34% over the past 2 weeks and doubled over the past 4 weeks.

While India’s current surge started much more recently, it is exhibiting a much sharper increase in daily incidence. India’s daily incidence has increased 146% over the past 2 weeks, and it has more than tripled since the beginning of March. On this trajectory, it will surpass the US as #2 globally in the next several days. India’s national records in terms of daily incidence remain from its peak in mid-September 2020 (93,198 new cases per day), but its epidemic currently is accelerating proportionately faster than at any time since May 2020, when the daily incidence was still fewer than 4,000 new cases per day. From its low on February 11, India is already 44% of the way back to its previous peak. India’s daily mortality is beginning to increase as well. Notably, the increase in mortality started on March 9, approximately 3 weeks after the daily incidence began to increase (February 16), consistent with the pattern exhibited throughout the pandemic. Since March 9, India’s daily mortality has more than doubled, from 102 deaths per day to 225—and is still accelerating. In fact, the current relative increase in mortality is India’s highest since June 2020.

India and Brazil are both in the top 5 globally in terms of total vaccine doses administered per day. Brazil is currently administering more than 500,000 doses per day, #5 globally, and India is #2 with 2.3 million. Both countries also are in the top 5 in terms of total cumulative doses administered—India at #3 (55.5 million doses) and Brazil at #5 (16.6 million). Both countries have very large populations, however, and they rank much lower in terms of the per capita daily and cumulative doses administered. With such large populations, even the large number of doses administered does not necessarily translate to high vaccination coverage. Brazil reports that 6.0% of its population has received at least 1 dose and 1.8% is fully vaccinated. In India, 3.4% of the population has received at least 1 dose and 0.6% is fully vaccinated. Both countries are far behind some other countries in terms of vaccination coverage, including Israel, the US, and the UK. For reference, the global average is 3.7% with at least 1 dose and 1.4% fully vaccinated, and many countries have not yet started vaccination efforts or have only recently started.

Global Vaccination

The WHO reported 456.8 million vaccine doses administered globally as of March 24, including 256.1 million individuals with at least 1 dose. The dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

Our World in Data reports that more than half a billion doses have been administered globally (508.2 million), a 23% increase compared to this time last week. The global cumulative total continues to increase at a rate of approximately 20% per week. The daily average continues to increase, up to 13.7 million doses per day (+29% compared to the previous week). At least 145 countries and territories are reporting vaccination data.

UNITED STATES

The US CDC reported 29.8 million cumulative cases and 542,584 deaths. Daily incidence has increased slightly over the past 5 days, up from 53,501 new cases per day to 57,249 (+7%). It is too early to determine if this is the beginning of a longer-term trend, but this is the highest daily incidence since March 7. Daily mortality continues to level off, hovering at slightly more than 1,000 deaths per day for more than a week.

US Vaccination

The US CDC reported 173.5 million SARS-CoV-2 vaccine doses distributed and 133.3 million doses administered. With 87.3 million individuals receiving at least 1 dose of the vaccine, more than a quarter of the entire US population (26.3%) and a third of all adults (33.7%) have been at least partially vaccinated. Of those, 47.4 million (14.3% of the total population; 18.3% of adults) are fully vaccinated. Among adults aged 65 years and older, 71.0% have received at least 1 dose and 44.8% are fully vaccinated.

The average daily doses administered* decreased slightly to 2.2 million doses per day, including 823,570 individuals fully vaccinated (ie, second dose of a 2-dose vaccine or a single dose of a 1-dose vaccine). In terms of full vaccination, 23.6 million individuals have received the Pfizer-BioNTech vaccine, 21.1 million have received the Moderna vaccine, and 2.7 million have received the J&J-Janssen vaccine.

*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The Johns Hopkins Coronavirus Resource Center is reporting 30.1 million cumulative cases and 546,915 deaths as of 12:15am EDT on March 26.

ASTRAZENECA-OXFORD VACCINE PHASE 3 RESULTS Following questions about reported Phase 3 clinical trial efficacy data, AstraZeneca issued a press release containing updated results for its SARS-CoV-2 vaccine, developed in collaboration with the University of Oxford. The updated analysis estimates an overall efficacy of 76% against any symptomatic COVID-19 disease, slightly less that the 79% announced in the original press release. The updated analysis included an additional 49 symptomatic cases, bringing the total to 190 out of more than 32,000 participants, and an additional 14 possible or probable cases were identified, though they have not yet been adjudicated. Additionally, AstraZeneca reported 85% efficacy in adults aged 65 years and older and 100% efficacy against hospitalization and death. Notably, the new press release indicates there were 8 cases of severe COVID-19 disease among the placebo group. AstraZeneca noted that these figures “will be the basis for a regulatory submission [to the US FDA] in the coming weeks.” The clinical trial data have not yet been published publicly nor subjected to peer review.

EU VACCINE EXPORTS The European Union continues to weigh options that will limit the export of regionally produced COVID-19 vaccinations. The governing body this week proposed emergency legislation that would curb the number of vaccine exports over the next six weeks. AstraZeneca is in line to be most heavily impacted by these new rules. The company has been in conflict with the EU since the manufacturer reduced the number of COVID-19 vaccines they planned to deliver earlier this year. The EU’s original contract with AstraZeneca aimed to deliver 300 million vaccine doses by the end of June, but the company has since cut this target by two-thirds. While some EU leaders acknowledge the negative implications that curbing vaccine distribution will have on global vaccination targets, others are steadfast in their opinion that vaccine production companies work to meet earlier agreements. The EU has stressed that this new legislation will not be a blanket ban on regional exports and that there will be measures put in place to allow for flexibility of vaccine exports internationally.

PFIZER-BIONTECH VACCINE TRIALS IN CHILDREN Pfizer and BioNTech announced they are beginning a Phase 1/2/3 clinical trial evaluating their SARS-CoV-2 vaccine in children under the age of 12. Results from the trial are expected later this year, and depending on data, will support an application to the US FDA for emergency use authorization (EUA) this autumn, a company spokesperson noted. The companies finished enrolling a study of the vaccine among children ages 12-15 in January. The FDA already granted an EUA for use of the Pfizer-BioNTech vaccine among people ages 16 and older. The new trial intends to enroll 144 children in the first phase, which is aimed at identifying the preferred dosing level for 3 age groups—participants ≥5 to <12 years, ≥2 to <5 years, and ≥6 months to <2 years of age. Phase 2/3 will evaluate the safety, tolerability, and immunogenicity in each age group at the selected dose level from Phase 1, when compared with patients in a placebo arm. After 6 months, the trial will be unblinded and offer the vaccine to all participants. The trial is expected to enroll a total of 4,500 children in the US and UK. 

The news follows announcements last week from Moderna that it began enrolling for a Phase 2/3 trial testing its SARS-CoV-2 vaccine, which is authorized for adults ages 18 and older, among children ages 6 months to less than 12 years. AstraZeneca last month began testing its vaccine in children 6 months and older, and Johnson & Johnson-Janssen has plans to extend its trials of its vaccine among younger children. Though children appear to be at lower risk of contracting SARS-CoV-2 compared with adults, the American Academy of Pediatrics estimates they account for 13% of US COVID-19 cases. Children comprise 23% of the US population, so vaccinating the younger population is critical to achieving herd immunity, according to experts. Vaccinating children also will help lower their and teachers’ risk of disease as they return to school buildings.

EMERGING VARIANTS & VACCINES In a letter published in the New England Journal of Medicine, infectious disease experts from South Africa provide an overview of emerging COVID-19 variants, including those that have become the dominant strain in several countries, and evaluate the implications for vaccine efficacy, transmissibility, and disease severity. The authors highlight the B.1.1.7 strain, first identified in the UK; B.1.351 (501Y.V2), first identified in South Africa; and P.1 (B.1.1.28.1), first reported in Brazil, and note the need for continued genomic surveillance to manage variants.

A group led by researchers from the London School of Hygiene and Tropical Health report on case fatality risk of the B.1.1.7 variant in an Eurosurveillance article. Noting the strain is now dominant in the UK and increasing in prevalence across Europe, the authors evaluated the case fatality risk of the variant in England from November 2020-January 2021. Infection with the variant of concern (VOC) was consistently associated with an increased hazard of death, and once adjusted for comorbidities and demographics, the researchers found a two-thirds higher hazard ratio in the VOC group (1.67 HR, 95% CI: 1.34-2.09).

The B.1.351 (501Y.V2) variant, now the dominant strain in South Africa, elicits cross-reactive neutralizing antibodies that may provoke an immune response capable of fending off multiple variants. In a preprint study published in bioRxiv, South African researchers describe how sera from B.1.351-infected patients showed robust binding and neutralizing activity against variants from the first wave of infections in South Africa as well as against the P.1 variant. The cross-reactive responses of sera from B.1.351-infected patients suggests the broad specificity potential of a vaccine designed with the that variant’s sequence. Moderna is conducting a Phase I clinical trial of its mRNA-1273.351 vaccine, which encodes for a protein specific to the B.1.351 variant. Other developers are expected to follow suit.

The B.1.1.7 variant has been identified for the first time in household pets. In a preprint study published in bioRxiv, veterinarians from a specialty veterinary clinic located in the southeast of England describe the first cases of B.1.1.7 infection among 8 cats and 3 dogs, all of which required veterinary visits due to new-onset symptoms, including lethargy, loss of appetite, rapid breathing, and severe cardiac abnormalities. All of the owners had tested positive for SARS-CoV-2 prior to their pets developing symptoms. In another report, researchers from Texas A&M University, as part of an ongoing research project funded by the US CDC, describe a cat and dog from the same household infected with the B.1.1.7 variant but showing no symptoms at the time of initial testing. Their owner was diagnosed with the B.1.1.7 variant only two days prior to the pets’ tests. The report notes both pets later developed symptoms, including sneezing, that resolved after one month. The researchers say these cases raise questions regarding the risk companion animals may play in the COVID-19 pandemic, particularly given the enhanced infectivity and transmissibility of the B.1.1.7 variant, and encourage additional research. 

GERMANY EASTER SHUTDOWN On March 22, Germany announced highly restrictive COVID-19 “emergency brake” measures that were scheduled to be in effect through April 18, including additional restrictions over the Easter holiday weekend. However, German Chancellor Angela Merkel reversed that decision on March 24. Chancellor Merkel noted that the plan was finalized too close to the start date and that too many questions remained regarding how to implement the restrictions. The original plan included “quiet days” on April 1 and April 3, the Thursday before and Saturday of Easter weekend, during which non-essential businesses would be closed and gatherings would be limited to individual households plus one additional individual, up to 5 total individuals. Additionally, the restrictions would have limited gatherings in churches and other religious services. Combined with the existing national holiday dates on Friday and Monday, the restrictions would have resulted in a 5-day national shutdown over Easter weekend. Germany’s daily incidence has more than doubled since its low on February 14, including a 69% increase over the past 2 weeks.

On March 25, Germany announced a reinstatement of vaccination efforts using the AstraZeneca-Oxford vaccine. Germany resumed use of the vaccine following safety analysis by the European Medicines Agency (EMA) and Germany’s Paul Ehrlich Institute (PEI). Vaccination with this vaccine was paused on March 15 over concerns regarding the possible associated risk of blood clots (thromboembolic events) following vaccination.

US EVICTION MORATORIUM The US government is weighing an extension of a federal policy prohibiting landlords from evicting tenants who have fallen behind on paying rent during the COVID-19 pandemic. The extension, which would impact an estimated 10 million families, could run through at least July. Without an extension, the ban is set to expire at the end of this month. The recently passed stimulus bill, known as the American Rescue Plan, included more than $40 billion to help homeowners and renters behind on their mortgage and rent payments. However, due to implementation delays, many people have not yet received the assistance, putting pressure on the government to extend the ban. According to a survey by the Census Bureau released last week, nearly 1 in 5 renters say they are behind on payments, with people of color bearing a majority of the hardship. According to the Washington Post, some officials at the US CDC, which implements the policy, have expressed concern over the agency overseeing the ban, saying it was implemented in a way no one thought possible. Biden administration officials largely have been silent on the extension and have not named another agency that could steward the policy.

COVID-19 WAVES IN AFRICA In a report published online in The Lancet, researchers led by the Africa CDC detail the first and second waves of SARS-CoV-2 infections across the African continent from February 2020 to December 2020. Using epidemiological, testing, and mitigation strategy data reported by African Union (AU) member states, the group conducted descriptive analyses for cumulative and weekly incidence rates, case fatality ratios (CFRs), tests per case ratios, growth rates, and public health and social measures in place. Their analysis showed the continent experienced a more aggressive second wave of infections compared to the first. In July 2020, at the peak of the first wave, the continent’s mean daily number of new cases was 18,273, with that number rising to a mean of 23,790 daily new cases by the end of December 2020, representing a 30% increase. Nine of 55 AU member states accounted for 82.6% of reported cases as of December 2020, and eighteen countries reported CFRs greater than the global CFR of 2.2%. By April 15, 2020, 96% of 50 AU countries had five or more stringent public health and social measures in place, but that number decreased to 36 (72%) countries as of December 31, 2020, despite an increasing number of cases. 

Dr. John Nkengasong, Director of the Africa CDC and one of the study’s authors, said the increase in cases likely was due to several factors, including lower adherence to public health mitigation strategies like mask wearing and physical distancing as well as a growing prevalence of more infectious SARS-CoV-2 variants. In a statement to CNN, he called on countries to improve testing capacity, strengthen their public health campaigns, and recognize the importance of balancing mitigation strategies with economic needs. Dr. Nkengasong also called for a scale-up of vaccine distribution throughout the continent, warning some countries are beginning to see the start of a third wave.

CUBAN VACCINES Cuba announced that one of its five SARS-CoV-2 vaccine candidates, Soberana 2, has had promising preliminary results and is entering a Phase 3 trial involving 44,000 people. This is the first SARS-CoV-2 vaccine developed in Latin America to enter the final phase of testing. A second Cuban vaccine candidate, named Abdala, has entered Phase 3 testing. Several Cuban experts shared that the country could produce enough vaccinations for its entire population by the end of the summer, assuming the vaccine candidate proves successful in the last phase of clinical trials. This is a major development for Cuba, which has not yet purchased foreign-produced vaccines nor attempted to acquire vaccines through the COVAX initiative. By May, Cuba plans to administer one of its experimental vaccines to 1.7 million people, nearly the entire population of the capital, Havana. The country already has begun vaccinating the city’s frontline workers. Havana is experiencing its worst outbreak since the beginning of the pandemic, according to local authorities.

US GOVERNMENT PATENT A group of public health advocates and academics is urging the US NIH to negotiate with Moderna to create patent licensing terms that would help speed the production and reduce the price of its SARS-CoV-2 vaccine for use in low- and middle-income countries (LMICs). At issue is a key patent owned by the US government that applies to the spike protein molecule necessary for Moderna’s vaccine to elicit a human immune response against the virus. The group, led by PrEP4All, claims the patent is being used by 5 different vaccine manufacturers, although only one, BioNTech, has paid to obtain a license. Historically, the US government has been reluctant to exert its patent rights over private sector partners. However, the US government filed a lawsuit in 2019 against the pharmaceutical company Gilead over a patent used in the HIV treatment and prevention medications Truvada and Descovy. That lawsuit is pending. Some patent lawyers and public health experts say similar lawsuits over the SARS-CoV-2 patent are possible unless other companies negotiate licensing agreements with the government.

SINOPHARM VACCINE Reports are emerging from the United Arab Emirates (UAE) that some individuals vaccinated with the Sinopharm vaccine from China may require a third dose. Some individuals have not developed sufficient immune response following their second dose, and they may benefit from a third dose to stimulate the appropriate antibody response. The UAE reportedly has implemented a program to reach out to individuals with low antibody response and offer them an additional booster. It is unclear what proportion of vaccinees are affected or the degree to which they benefit from a third dose, but it is not necessarily rare for individuals to not respond to vaccines against other pathogens. China has distributed its vaccines, including the Sinopharm vaccine, to numerous other countries; however, Phase 3 clinical trial data for these vaccines have not yet been published publicly. Sinopharm has reported efficacy of 79%. The UAE issued an emergency authorization for the Sinopharm vaccine in September 2020, prior to the completion of a Phase 3 clinical trial conducted there.

COMBATING MISINFORMATION The COVID-19 pandemic has illustrated that health-related misinformation and disinformation can dangerously undermine responses to public health crises. To address this issue, the Johns Hopkins Center for Health Security published the National Priorities to Combat Misinformation and Disinformation for COVID-19 and Future Public Health Threats. The report provides an overview of mis- and disinformation challenges during the pandemic—including contradictory messaging and active subversion, increased mistrust in science, and the politicization of public health measures—and ongoing efforts to counter them. The report also presents a series of recommendations targeted at a broad range of stakeholders, including media companies, government officials, and the public. The report also calls for a national strategy, under the purview of the National Security Council (NSC), to coordinate government activities and policies to counter mis- and disinformation and to develop evidence-based guidelines and recommendations for nonpartisan oversight of these challenges.

PANDEMIC PREPAREDNESS On Tuesday, March 30 at 11am EDT, Anita Cicero, JD, Deputy Director of the Johns Hopkins Center for Health Security, will moderate a webinar for the Capitol Hill Steering Committee on Pandemic Preparedness and Health Security, titled “Strengthening the Supply Chain for US Pandemic Response: Strategies for Stockpiling, Surge Capacity, and Distribution.” The webinar will examine supply challenges in the ongoing COVID-19 pandemic, vulnerabilities exposed by the pandemic, and emerging lessons from both the private and public sectors that can inform new policies and practices that enhance US preparedness for future pandemics. The non-partisan Steering Committee is sponsored and managed by the Johns Hopkins Center for Health Security. Register for the webinar here.

March 25: 2190 New COVID 19 Cases in Illinois

Boone County Health Department

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As of this week, higher education staff, government workers, and media are now eligible for vaccination. Also, beginning Monday, March 29, food and beverage workers, construction trade workers, and religious leaders will be eligible for the COVID-19 vaccine. Boone County has clinic spots available on April 8, 15 and 22nd that include these expanded essential workers . These appointments are only for Boone County residents or those who work in Boone County. Use this link to make an appointment: https://events.juvare.com/.../e025ae11-5fdd-43ed-bcd7.../

Clayton Stevens supports Clint Morris for Mayor

Ex-Sheriff Wirth supports Morris for Mayor

March 24: 2793 New COVID 19 Cases in Illinois

March 23: 1823 New COVID 19 Cases in Illinois

March 23: Johns Hopkins COVID 19 Report

COVID-19

The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

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EPI UPDATE The WHO COVID-19 Dashboard reports 123.4 million cases and 2.7 million deaths as of 11am EDT on March 23. The global weekly incidence increased for the fourth consecutive week, up to 3.3 million new cases (7.9% more than the previous week). After 6 consecutive weeks of decreases, the global mortality increased last week as well, up to 60,414 global deaths (2.5% more than the previous week). If this is the beginning of a longer-term trend, it would correspond to a 4-week lag behind the global weekly incidence, consistent with the pattern exhibited throughout the pandemic.

Global Vaccination

The WHO reported 398.0 million vaccine doses administered globally, including 226.0 million individuals with at least 1 dose. The dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

Our World in Data reports that 458.1 million cumulative vaccine doses have been administered globally, a 19% increase compared to this time last week. The daily average continues to increase, up to 10.6 million doses per day (+6% compared to the previous week). At least 146 countries and territories are reporting national vaccination data.

UNITED STATES

The US CDC reported 29.7 million cumulative cases and 539,517 deaths. Daily incidence continues to level off at approximately 53-54,000 new cases per day. While this is an 80% decrease from the peak in January 2021, it is only 20% less than the peak during the summer 2020 surge. Daily mortality is beginning to taper off as well. The CDC has reported an average of approximately 1,000-1,050 deaths per day over the past 5 days.

On March 19, the CDC reassigned more than 80,000 previously unreported cases in Missouri (reported on March 8) to the correct dates. The correction caused the average daily incidence for January 11, 2021, to exceed 250,000 new cases per day, making the US the only country to surpass that benchmark to date. The US was also the first, and remains the only, country to surpass 100k, 150k, and 200k new cases per day.

While the national-level trends are leveling off, a number of states are reporting increasing daily incidence*. These states are mostly distributed across the Midwest and Northeast regions, but case counts in Idaho, Maryland, and West Virginia are also increasing. Perhaps the largest resurgence is in Michigan, which has reported increasing trends since February 22. After peaking in early December 2020, Michigan’s daily incidence decreased by 90% before rebounding. Michigan’s daily incidence has nearly tripled since February 22—currently 2,997 new cases per day—and it appears to still be accelerating.

*In an effort to be consistent with respect to the timing of the most recent data, we are using official data reported to the CDC. The data published on the state COVID-19 websites referenced in this section may vary.

New Jersey’s autumn/winter surge peaked in early January and then leveled off briefly from February 19-February 26 before increasing again. Unlike many states, New Jersey’s daily incidence only declined 50%—from approximately 6,000 new cases per day** to 3,000—before rebounding. New Jersey is now reporting 3,980 new cases per day, higher than its first peak in April 2020, and increasing steadily. Maine’s epidemic also rebounded almost immediately after its autumn/winter surge, falling 80% from January 14 to February 22—624 to 131 new cases per day—before increasing immediately back up to 206, a 50% rebound.

**With the exception of the week following January 7 and 8, when New Jersey reported 23,925 and zero new cases, respectively, which resulted in aberrations in the average values.

The current surge in several states started more recently. After coming down from the peak of its autumn/winter 2020 surge, Maryland’s daily incidence began to increase again relatively quickly. Maryland’s lull lasted from approximately February 20-March 7, and its average daily incidence has increased nearly 25% since then, up to 949 new cases per day. Idaho (312), Massachusetts (1,566), and West Virginia (336) followed similar trajectories, with small bumps following their autumn/winter surges—approximately February 22-March 8***—and then a steady increase in daily incidence of approximately 25% or more. In Minnesota, the daily incidence held relatively steady for most of February at approximately 775-800 new cases per day, but it also started to surge on March 8. Minnesota is currently reporting 1,118 new cases per day, approximately 40% higher than in February. In New Hampshire, the decline in daily incidence leveled off at 200-220 new cases per day from March 5-10 before climbing back up to 275, a 25-35% increase and still rising. Pennsylvania is just beginning to exhibit increasing daily incidence, up from 2,473 new cases per day on March 13 to 2,949 on March 21 (+19%).

***The President’s Day holiday was February 15, so weekly averages in the following week were artificially depressed due to reporting delays and interruptions.

Following the decline in daily incidence in the wake of the autumn/winter 2020 surge and expanding vaccination efforts, many states are relaxing or eliminating COVID-19 restrictions. Most of the country has not yet been vaccinated, however, and there is evidence of increasing prevalence of emerging variants, both of which could increase COVID-19 risk. It will be critical to monitor the epidemiological trends in these and other states over the next several weeks in order to mitigate the risk of another surge.

US Vaccination

The US CDC reported 156.7 million SARS-CoV-2 vaccine doses distributed and 126.5 million doses administered. This includes 82.8 million people (24.9% of the entire US population; 32.0% of the adult population) who have received at least 1 dose of the vaccine and 44.9 million (13.5%; 17.4%) who are fully vaccinated. Among adults aged 65 years and older, 69.2% have received at least 1 dose and 42.5% are fully vaccinated.

The average doses administered* continues to level off at approximately 2.3 million doses per day, including 901,311 individuals fully vaccinated (i.e., second dose of a 2-dose vaccine or a single dose of a 1-dose vaccine). In terms of full vaccination, 22.2 million individuals have received the Pfizer-BioNTech vaccine, 20.3 million have received the Moderna vaccine, and 2.4 million have received the J&J-Janssen vaccine.

*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The Johns Hopkins Coronavirus Resource Center is reporting 29.9 million cumulative cases and 543,057 deaths as of 11:30am EDT on March 23.

ASTRAZENECA-OXFORD VACCINE PHASE 3 TRIAL AstraZeneca announced preliminary results from a Phase 3 clinical trial for its SARS-CoV-2 vaccine, developed in collaboration with the University of Oxford. The trial included more than 32,000 participants in Chile, Peru, and the US, including 21,583 who received at least one dose of the vaccine. The press release reports an overall efficacy of 79% against any COVID-19 disease among all age groups and 80% efficacy for adults aged 65 years and older. Additionally, the press release describes 100% efficacy against severe disease and hospitalization. AstraZeneca explicitly noted that an independent review of the safety data “found no increased risk of thrombosis or events characterised by thrombosis” associated with the vaccine. Previous analysis of data from trials in Brazil, South Africa, and the UK estimated the overall efficacy to be 60%.

AstraZeneca has not yet published the full clinical trial data—including the number of severe cases and hospitalizations among the placebo group nor data pertaining to emerging variants—and the results have not yet been subjected to peer review. The press release indicates AstraZeneca is continuing to analyze the trial data to prepare a final analysis for submission to the US FDA. The AstraZeneca-Oxford vaccine has received a conditional marketing authorization in the EU and similar emergency use authorizations in a number of other countries as well as an emergency use listing from the WHO, but it has not been granted an Emergency Use Authorization from the US FDA. Similar to the J&J-Janssen vaccine, the AstraZeneca-Oxford vaccine does not require freezer (or ultra-cold freezer) temperatures for storage and transportation, which reduces logistical and operational barriers to mass vaccination efforts.

Today, the US National Institute of Allergy and Infectious Diseases (NIAID) issued a statement that called into question the vaccine’s efficacy estimate. The statement indicated the Data Safety Monitoring Board (DSMB) that oversaw the clinical trials had concerns regarding the efficacy reported in the press release. In particular, the DSMB expressed concern that “outdated information” was included in the calculation, “which may have provided an incomplete view of the efficacy data.” No further details were provided, but the NIAID called on AstraZeneca to work with the DSMB to identify and correct any issues. In response, AstraZeneca stated the preliminary results were based on a “pre-specified interim analysis” of a subset of data collected through February 17. AstraZeneca indicated that it is validating its statistical analysis and engaging with the DSMB, with the goal of publishing the primary results in the next 48 hours.

ASTRAZENECA-OXFORD VACCINE HESITANCY AstraZeneca’s announcement of results from Phase 3 clinical trials, combined with statements last week from the European Medicines Agency (EMA) and WHO supporting the AstraZeneca-Oxford vaccine’s safety, appeared poised to provide a boost in confidence in the vaccine, but questions regarding the accuracy of the trial’s efficacy analysis threaten to further erode public trust and interest. While the most recent issues may be more of an issue with AstraZeneca’s communications than the vaccine itself, the misstep could taint the public’s impression of the vaccine. In fact, Chief Medical Advisor to the President Dr. Anthony Fauci described the issue as an “unforced error” by AstraZeneca that could have an unfortunate negative effect on the public’s perception of what is “very likely a very good vaccine.”

Recent surveys conducted in several European countries found a substantial portion of the population still believes the vaccine is unsafe. Notably, 61% of French respondents indicated that they felt the vaccine is unsafe, up 18% compared to results from February. Similarly, 55%, 52%, and 43% of German, Spanish, and Italian respondents, respectively, expressed concern about the vaccine’s safety. In Spain and Italy, the new totals are 27 percentage points higher than in February. The UK—where the vaccine was originally developed—was the only country to express confidence in the vaccine, with nearly 75% believing the vaccine is safe.

In addition to challenges of public perception, the AstraZeneca-Oxford vaccine finds itself in the middle of a battle between the EU and the UK regarding access. Reportedly, the European Commission continues to evaluate a “ban” on exporting doses of the vaccine manufactured in the EU in order to direct those doses to meet contractual commitments to EU countries before allowing them to be delivered outside the bloc, including to the UK. Reportedly, the EU has received only one-third of its doses of the AstraZeneca-Oxford vaccine, and the UK has been able to vaccinate approximately 40% of its population, compared to less than 12% across the EU. Officials from AstraZeneca noted that the UK contracts were signed before the EU contracts, which likely factors into the company’s allocations.

PASC/LONG COVID Researchers from the COMEBAC Study Group published data in JAMA from a cohort study describing 4-month outcomes for patients who were hospitalized with COVID-19 in Paris. Among 478 participants contacted by telephone, 244 patients (51%) reported they were experiencing at least 1 new symptom 4 months post-hospitalization. The most common complaints were fatigue (31%), cognitive impairment (21%), and dyspnea (ie, difficulty breathing; 16%). In addition, 63% of 171 patients assessed at follow-up ambulatory visits had abnormal lung CT scans, although the researchers note that lasting severe pulmonary impacts are not uncommon among COVID-19 survivors. The researchers emphasize their data is limited by the lack of a control group and pre-COVID baseline data.

Another study published in The Annals of Clinical and Translational Neurology by researchers from Northwestern University describes the experiences of patients treated at the university’s specialized clinic for patients experiencing COVID-19-related neurological symptoms. The study included 100 patients from 21 states (50 testing positive for SARS-CoV-2 but non-hospitalized, and 50 testing negative for SARS-CoV-2; average age of 43) who were treated between May and November 2020. The most frequently reported neurologic manifestations included “brain fog” (81%), headache (68%), numbness/tingling (60%), dysgeusia (altered taste; 59%), anosmia (loss of smell; 55%), and myalgias (55%). The researchers note that only anosmia was significantly more frequent in patients who tested positive than those who tested negative (74% vs 36%) and that positive patients performed worse in attention and working memory cognitive tasks when compared to a demographic‐matched US population.

Several experts are calling for media outlets to be cautious in their reporting of so-called “long COVID,” collectively referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC). They note some patients who describe long-lasting symptoms of COVID-19—including gastrointestinal symptoms, “brain fog,” severe fatigue, hair loss, and headaches—never tested positive for SARS-CoV-2. They also emphasize these symptoms are associated with many conditions and are common in the general population, especially among individuals experiencing social and emotional distress. But the experts also call for more study on the potential long-term impacts of SARS-CoV-2 infection, but they caution against “getting ahead of the evidence.” As we reported previously, the US National Institutes of Health in February launched a US$1.15 million initiative to study the potential long-term health impacts of COVID-19.

SPRING BREAK US colleges and university students typically visit popular warm-weather destinations for spring break for a vacation from classes. This year, the combination of the timing of spring break, unusually discounted prices on accommodations and travel, and efforts to ease COVID-19 restrictions in Florida have made officials concerned that mass gatherings could lead to local and national spikes in transmission. On Saturday, tens of thousands of spring breakers converged on Miami Beach, leading city officials to declare a state of emergency for 3 days, including a curfew imposed from 8pm-6am for all non-essential travel and operations. Traffic also was shut down in certain areas, and indoor and outdoor dining establishments in high-traffic areas were ordered to cease operations starting at 7pm through the duration of curfew.

Local law enforcement have made more than 160 arrests in the past week related to gatherings—often citing lack of proper mask use, overcrowding, violence, or damage to local property. Law enforcement officials fired pepper spray-filled balls to break up crowds, among other measures. On March 21, city officials extended some emergency measures for an additional 3 weeks, including traffic restrictions and curfews, although city residents, hotel guests, and local employees are exempt. 

NEW ZEALAND CONSIDERS “TRAVEL BUBBLE” New Zealand’s COVID-19 control strategy has received praise as one of the most effective in the world. Neighboring Australia has shown similar effectiveness in controlling COVID-19, prompting the two countries to consider creating a COVID-19 bubble for air travel. The so-called “trans-Tasman travel bubble” would allow travelers to skip 14-day quarantine measures. Ideally, the travel bubble would consist of shared protocols, detailed plans for isolation facilities, and contact tracing; however, plans for the travel network have not been finalized.New Zealand Prime Minister Jacinda Ardern postponed an announcement for a definitive launch date until April 6.

A study by New Zealand public health officials, published in the US CDC’s Emerging Infectious Diseases (EID) journal, outlines an outbreak investigation in September 2020 originating from an international flight from India to New Zealand. At least 6 passengers tested positive in the managed quarantine and isolation facility or following the completion of their 14-day quarantine. Using genomic analysis and standard contact tracing, the authors hypothesized that transmission occurred during the quarantine period, including between individuals with no direct contact. The case investigators demonstrated that SARS-CoV-2 transmission on international flights can be successfully traced and managed, which will be critical if travelers in the bubble can forgo the quarantine period.

GLOBAL VACCINE COORDINATION Earlier this month, COVAX shipped some of their first COVID-19 vaccine doses to almost 30 different countries. An editorial in The Lancet and a letter in The BMJ raised the idea of appointing a Global Vaccine Coordinator, who would lead an international effort for the equitable distribution of vaccines. The authors argue that clear leadership and oversight are needed to organize what has become largely a piecemeal vaccination effort, with nations, NGOs, and the private sector working independently or bilaterally. While a centralized global champion or body could provide high-level coordination for global vaccine allocation and distribution, it would be a major challenge to ensure they have the authority necessary to compel national governments and private sector companies to participate.

MATERNAL AND NEWBORN IMMUNITY Previously published research has already provided evidence that seropositive pregnant mothers can transfer SARS-CoV-2 antibodies to their fetus via the placenta, based on IgG antibodies detected in umbilical cord blood. Now, pre-prints and new publications are supporting the notion that this phenomenon also may be true in vaccinated pregnant women, with SARS-CoV-2-specific antibodies present in both breast milk and cord blood.

A prospective cohort study (preprint) investigated the effects of COVID-19 mRNA vaccination on pregnant and lactating women, including immunogenicity, reactogenicity, and presence of vaccine-generated antibodies in umbilical cord blood and breast milk samples. The researchers found that vaccine-generated antibodies were present across all samples of umbilical cord sera and breast milk, when compared with baseline samples. The effect was also dose dependent, with detectable SARS-CoV-2-specific IgG increasing in cord blood and breast milk after administration of the second dose. Researchers from Florida Atlantic University (US) published a case report in BMC: Pediatrics documenting the first known presence of vaccine-induced SARS-CoV-2 IgG antibodies in cord blood. The antibodies were detected in the cord blood for an infant born to a mother who received the first dose of the Moderna vaccine 3 weeks before delivery.

SEROPREVALENCE AND IMMUNITY IN WUHAN In a study published in The Lancet, Chinese researchers estimate the burden of SARS-CoV-2 infection during the initial COVID-19 outbreak in Wuhan, China. They performed a cross-sectional analysis of seropositivity for SARS-CoV-2 antibodies in 9,702 individuals who reported living in Wuhan during December 2019. Initial blood specimens were collected in April 2020, and subsequent specimens were collected in June and October 2020. The researchers estimate a seroprevalence of 6.92% in their study population. Notably, 82% who were seropositive were asymptomatic during the study period.

In an associated commentary, experts from the University of Melbourne (Australia) point out that this seroprevalence estimate would equate to more than 622,000 COVID-19 cases during the initial outbreak if applied to the entire Wuhan population, far more cases than were reported in April 2020 (50,333 as of April 17). The commentary authors hypothesize that the discrepancy could be due to high levels of asymptomatic infection and transmission or potentially underreporting, which could also be impacted by high proportions of asymptomatic infections. Of the 6.92% of seropositive participants, approximately 39.8% were positive for neutralizing antibodies at the baseline visit in April 2020, and this value persisted throughout the study period, which provides evidence of protective immunity conferred through natural infection. With less than half of this population showing protective immunity, the authors underscore the importance of mass vaccination campaigns to prevent future infections and reinfections.  

REINFECTION RISK Researchers in Denmark found that natural infection confers lasting immunity against SARS-CoV-2, but to a lesser degree in older adults. The study, published in The Lancet, included data from more than 500,000 individuals during Denmark’s first surge, including 11,068 who tested positive. Among those who tested positive, 72 tested positive again at least 90 days later, compared to 16,819 who tested negative. This corresponds to 80.5% protection against reinfection. A secondary cohort analysis of more than 2.4 million individuals found similar overall results (78.8% protection), but lower protection (47.1%) in adults aged 65 years and older.

A study by researchers at the Cleveland Clinic (Ohio, US), published in Clinical Infectious Diseases, found similar levels of protection. The study included test data from more than 150,000 patients tested prior to August 30, 2020, including 8,845 who tested positive. Among the positive patients, 1,278 were retested at least 90 days later, and the researchers identified 63 possible reinfections (31 symptomatic). The researchers estimate 81.8% protection against reinfection.

Both studies acknowledge that PCR tests can be positive for prolonged periods of time following the resolution of acute infection, due to persistent fragments of SARS-CoV-2 RNA, but these studies provide further evidence regarding the degree of protection conferred by natural infection and help characterize the risk of reinfection.

COVID-19 TESTING TOOLKIT WEBINAR The Johns Hopkins Center for Health Security is launching a new informational webinar series on SARS-CoV-2 testing strategies and best practices from selected organizational leaders. This webinar series will be hosted as part of the Center’s new COVID-19 Testing Toolkit, which aims to provide essential information for all organizations seeking to engage in SARS-CoV-2 testing.

This first webinar, held on March 24 at 11am EDT, will feature a conversation with Ginkgo Bioworks on how they launched their innovative SARS-CoV-2 testing service, Concentric by Ginkgo, and their efforts to pilot the program in schools. The panelists will discuss the importance of testing to mitigate COVID-19 risk as schools resume in-person classes as well as the role of biotechnology in countering future outbreaks and pandemics. Register for the webinar here.