February 24, 2022: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

FELLOWSHIP OPPORTUNITY Applications are now open for the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity (ELBI) Fellowship Class of 2022. ELBI inspires and connects the next generation of biosecurity leaders and innovators. This highly competitive, part-time program is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events. Applications can be submitted through 11:59PM (EST) March 31, 2022. Learn more about eligibility requirements and application materials.

EPI UPDATE The WHO COVID-19 Dashboard reports 426.6 million cumulative cases and 5.9 million deaths worldwide as of February 23. The global weekly incidence continues to decline, down 21.1% from the previous week. Notably, all WHO regions with the exception of the Western Pacific region (+28.8%) reported decreasing weekly incidence last week. Global weekly mortality fell 10.85% from the previous week. We expect the cumulative number of deaths to pass 6 million within the next 2 weeks.

Global Vaccination

The WHO reported 10.4 billion cumulative doses administered globally as of February 21. A total of 4.87 billion individuals have received at least 1 dose, and 4.29 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations continues to increase, closely following the trend in Asia. The trend is up from the most recent low of 18.34 million doses per day on February 7 to 24.8 million per day on February 22.* The global weekly average jumped to 33.4 million doses per day on February 23, corresponding to a large increase reported in Asia and may be a reporting error.** Our World in Data estimates that there are 4.93 billion vaccinated individuals worldwide (1+ dose; 62.6% of the global population) and 4.36 billion who are fully vaccinated (55.4% of the global population). A total of 1.27 billion booster doses have been administered globally.

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

**The OWID data show 17.65 million doses reported in Asia on February 22 and 26.75 million on February 23 (+9.1 million), but it is not immediately clear what country or countries accounted for that increase.

UNITED STATES

The US CDC is currently reporting 78.52 million cumulative cases of COVID-19 and 936,162 deaths. Daily incidence continues its sharp decline, down from a record high of 807,285 new cases per day on January 15 to 79,539 on February 22, a 90% decrease. Daily mortality appears to have peaked on February 2 at 2,597 deaths per day, down to 1,602 on February 22.*

*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.

US Vaccination

The US has administered 687.7 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.78 million doses per day on December 7 to 337,874 on February 18.* A total of 253.2 million individuals have received at least 1 vaccine dose, which corresponds to 76.3% of the entire US population. Among adults, 87.8% have received at least 1 dose, as well as 26.5 million children under the age of 18. A total of 215.1 million individuals are fully vaccinated**, which corresponds to 64.8% of the total population. Approximately 74.9% of adults are fully vaccinated, as well as 21.8 million children under the age of 18. Since August 2021, 93.4 million individuals have received an additional or booster dose. This corresponds to 43.4% of fully vaccinated individuals, including 66% of fully vaccinated adults aged 65 years or older.

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

**Full original course of the vaccine, not including additional or booster doses.

RUSSIAN INVASION OF UKRAINE Russia began a military invasion of neighboring Ukraine this morning, destroying more than 70 military targets through land, sea, and air assaults. The invasion represents the largest attack by one state against another in Europe since World War II. Although the COVID-19 pandemic has played no role in the Russian invasion of Ukraine, the incursion likely will impact virus transmission, testing, surveillance, and treatment for the foreseeable future. The current surge of COVID-19 cases due to the Omicron variant appears to have peaked in both Ukraine and Russia, but the numbers of new cases in both countries remain at record-high levels, and Ukrainian authorities have warned that, despite a 99% vaccination rate among its army, transmission is occurring on the Russian battlefront. The fighting is forcing people to travel west, crowding trains and roads in an effort to reach smaller towns and villages on the European Union border or cross the border into neighboring countries. Poland, Hungary, Slovakia, and Romania are preparing for an influx of refugees. Amid the pandemic, the Ukraine crisis indicates that balance-of-power politics have returned, confirms that pandemics can threaten military power, and reminds us that war has innumerable impacts on human health.

VACCINATION INTERVALS To increase the safety profile of mRNA vaccines, the US CDC is now recommending that certain groups wait longer between their first and second doses. The standard timeline between doses for the Pfizer-BioNTech and Moderna vaccines is 3 and 4 weeks, respectively. Some groups, including men between the ages of 12-39 years old, are now recommended to wait 8 weeks between doses in order to further decrease the risk of myocarditis. Men in this age group appeared to be at a higher relative risk of developing myocarditis following vaccination with an mRNA vaccine, which has prompted further research on ways to mitigate this outcome. Myocarditis associated with vaccination has a low relative risk, around 3.24, compared to the relative risk of COVID-associated myocarditis, around 18.28. Still, new evidence indicates that an 8-week interval between doses can further decrease the risk, which prompted CDC’s change in advice. People not in this group, such as the elderly and immunocompromised, are still recommended to receive their doses on the original 3- and 4-week schedules to prevent severe illness from COVID-19 should they be infected. However, more studies are continuing to evaluate whether a slightly longer period between doses, such as 6 weeks, might result in greater protection for all vaccine-eligible groups.

SANOFI-GSK VACCINE Sanofi and GSK are planning to request US FDA and European Medical Agency (EMA) authorization for their SARS-CoV-2 vaccine candidate—as a primary series and booster dose—following promising results in phase 3 clinical trials. The Sanofi-GSK candidate is an adjuvanted recombinant protein-based vaccine, which is a more traditional vaccine platform compared to the relatively new mRNA vaccines. These vaccines tend to have a good safety profile and have less complicated storage requirements, but mediocre results from a previous iteration kept Sanofi and GSK from applying for authorization last year. This modified candidate has now shown strong efficacy and safety in trials, with 100% efficacy against severe COVID-19 disease and hospitalization. While efficacy against symptomatic infection was around 58%, the vaccine creators assert that these numbers are in line with expected efficacy in the current variant-dominant environment and point to its strong performance against severe and moderate disease outcomes. Novavax, another manufacturer with a protein-based vaccine candidate, is awaiting US FDA review of its request for authorization. Canada and Singapore recently cleared the Novavax vaccine, known as Nuvaxovid, for use among adults.

TESTING & SURVEILLANCE A WHO official recently expressed concern that reduced SARS-CoV-2 testing and surveillance could be contributing to a decline in global COVID-19 cases, saying the falling number of cases and deaths “may not be real.” WHO COVID Technical Lead Dr. Maria Van Kerkhove urged countries to continue their surveillance systems, especially as the number of cases caused by the more transmissible Omicron variant of concern (VOC) BA.2 sublineage begins to climb worldwide. In addition to tracking cases among humans, some experts are encouraging more attention be paid to the hundreds of animal species that are potentially able to be infected with SARS-CoV-2. Cats, dogs, mice, tigers, red fox, deer, and other mammals can be infected by the virus, which could establish itself, mutate, and spread to other species, including back into the human population. Scientists worldwide are collecting genomic surveillance data on various animals, and the World Organisation for Animal Health (OIE) publishes monthly situation reports on SARS-CoV-2 animal investigations. A preprint study posted to medRxiv shows the detection of both the Alpha and Delta variants in Pennsylvania (US) white-tailed deer, the first time those variants have been found in deer. The data for the study, which is not yet peer-reviewed, was collected prior to the emergence of the Omicron variant. Additional long-term funding is needed for research to better understand how animal health is linked to human health, and vice versa.

POST-VACCINATION MIS-C The risk of developing multisystem inflammatory syndrome in children (MIS-C) is very low among young people who were vaccinated against COVID-19, according to a study published in The Lancet Child & Adolescent Health. Using surveillance data from the nationwide Vaccine Adverse Event Reporting System (VAERS), researchers identified 21 young individuals who experienced MIS-C following vaccination between December 14, 2020, and August 31, 2021. All 21 individuals were hospitalized but all were discharged home. As of August 31, 2021, 21.3 million individuals aged 12 to 20 years had received 1 or more doses of SARS-CoV-2 vaccine, making the overall reporting rate of MIS-C following vaccination 1 case per million. Among those individuals who had no evidence of previous or current SARS-CoV-2 infection, the reporting rate was 0.3 cases per million vaccinated individuals.

The rare condition—which can cause dangerous inflammation in major organs as well as vomiting, diarrhea, and low blood pressure—can also follow SARS-CoV-2 infection, showing up sometimes weeks after acute infection. The US CDC updates its data on MIS-C cases monthly. As of January 31, there have been 6,851 cases with 59 associated deaths reported by state and local jurisdictional health departments. Those cases represent a very small portion of the more than 12.5 million COVID-19 cases that have been reported in children since the beginning of the pandemic. Some experts worried that the number of MIS-C cases would spike during the recent wave of cases caused by the Omicron variant, but fortunately that concern has not yet become reality. The CDC and others are working to learn more about why and how MIS-C occurs, and several studies investigating the long-term consequences of MIS-C, its presentation in children, and pathways for treatment and recovery are underway.

FRACTIONAL VACCINE DOSES Administering fractional, or reduced, SARS-CoV-2 vaccines doses could increase global supply, produce fewer side effects, and hasten vaccination uptake. While additional data must be collected, evidence suggests that half or quarter doses of some SARS-CoV-2 vaccines—used as part of a primary series or as booster shots—could be nearly as or even more efficacious than currently used doses of the same or similar vaccines. The Coalition for Epidemic Preparedness Innovations (CEPI) and Australia’s Murdoch Children’s Research Institute (MCRI) announced the launch of a global clinical trial to investigate the efficacy and acceptability of fractional booster doses. Up to 3,300 healthy adults who have received a primary vaccination series with either Pfizer-BioNTech, Oxford-AstraZeneca, Sinovac, or Sinopharm vaccines will receive either a full or fractional booster dose of either the Pfizer-BioNTech, Moderna, or Oxford-AstraZeneca vaccine. The trial, supported with up to US$8.7 million from CEPI, is part of the organization’s Call for Proposals to evaluate the impact of reduced SARS-CoV-2 vaccines in an effort to stretch global supplies and improve vaccine equity.

VACCINE SUPPLY & DEMAND Only about 12% of people in low-income countries are fully or partially vaccinated against COVID-19, but for the first time since the beginning of the pandemic, global vaccine supply is outpacing demand. The COVAX initiative is working to place more than 300 million vaccine doses in countries that need them, but those nations now face other challenges such as gaps in cold-chain storage, lack of funding for distribution networks and administration supplies such as syringes, and stalled vaccination uptake. Additionally, the Africa Centres for Disease Control (Africa CDC) plans to ask all vaccine donations be paused until later this year so countries can avoid wasting the shots if they expire and focus instead on bolstering vaccination logistics and last-mile strategies.

In countries with sufficient supplies, efforts are being made to get more people vaccinated. In South Africa, the government is shortening the required intervals between the first and second doses of a primary series and between the second dose and a booster shot, as well as offering heterologous booster dosing. In Uganda, which has a history of passing controversial public health-related laws, the parliament is considering adopting a vaccination mandate that would result in harsh penalties for people who refuse to comply, including steep fines of about US$1,137 or imprisonment for 6 months. Rights groups criticize the proposal and have called for officials to institute a more organized and inclusive vaccine rollout. Although governments hold much of the power to make vaccines accessible and acceptable, it will take coordinated efforts involving multiple stakeholders to improve vaccine uptake in many low- and middle-income countries.

US TRUCK CONVOYS After police in Ottawa, Canada, earlier this week cleared demonstrators who occupied the capital city for more than 3 weeks in protest against SARS-CoV-2 vaccine mandates and other pandemic restrictions, spin-offs of the so-called “Freedom Convoy” are taking shape across the US. Convoys of trucks are threatening to inundate the Washington, DC, metropolitan area as soon as this week, arriving from as near as Pennsylvania and as far as California, as well as hold a rally near the Washington Monument on March 1, the day US President Joe Biden is scheduled to deliver the annual State of the Union address. In anticipation of the protests, the US Department of Defense approved the deployment of 700 unarmed National Guard troops, at the request of the DC government and the US Capitol Police, to assist with traffic and mitigate possible disruptions. The California convoy—dubbed the “People’s Convoy”—departed Adelanto, California, on February 23 amid much fanfare and is expected to arrive in the DC area on March 5. The convoy is demanding an end to the national emergency first declared by former US President Donald Trump and recently extended by President Biden; a congressional investigation into the origin of SARS-CoV-2; and an end to government-issued public health measures including mask mandates and vaccination requirements. Unlike the Canadian truck convoy demonstrators, American truckers have no vaccination requirement to cross the US-Canada border, and most states have eased masking and vaccination requirements as the number of new COVID-19 cases fall.

The Freedom Convoy protests also have inspired similar demonstrations against pandemic mitigation measures in other countries. Authorities in Austria, Belgium, and France earlier this month banned motor protests in their capital cities. In New Zealand, people protesting the nation’s vaccination mandate have occupied Parliament grounds for at least 17 days, with what began as a peaceful demonstration turning violent this week. Today, protestors chased Prime Minister Jacinda Ardern’s vehicle down a driveway as she visited a Christchurch primary school. Earlier this week, Prime Minister Ardern expressed concern for police safety after several officers were hospitalized after protestors threw an unidentified liquid in their faces. She has resisted calls to use emergency powers or defense forces to dispel protesters. The convoys and occupations represent a show of frustration at the years-long pandemic and associated efforts to control transmission of the virus and expose ideological rifts that can be exacerbated by misinformation, disinformation, and conspiracy theories.