June 30, 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.

CALL FOR PAPERS In 2023, Health Security will devote a supplement to Global Catastrophic Biological Risks (GCBRs). We encourage submissions of original research articles, case studies, and commentaries that discuss lessons learned from the COVID-19 pandemic response and/or key policy and technology advances that could prevent or better prepare for a future, potentially more severe, globally catastrophic infectious disease pandemic. The deadline is October 3, 2022. Click here more information.

NOTICE The COVID-19 Situation Report will not be published on July 5 or July 7. The report will resume publication the following week on July 12.

EPI UPDATE The WHO COVID-19 Dashboard reports 543 million cumulative cases and 6.33 million deaths worldwide as of June 29. The global weekly incidence increased 21.32% from the previous week. Global weekly mortality increased as well, up 7.43% from the previous week. At the regional level, Europe (+40%), the Americas (+15%), Southeast Asia (+32%), and the Eastern Mediterranean (+47%) experienced increases, while the Western Pacific (-3%) and Africa (-34%) had decreasing trends. The number of new weekly deaths increased in the Eastern Mediterranean (+22%), Southeast Asia (+15%), and the Americas (+11%) and decreased in the Western Pacific (-6%), Europe (-5%) and Africa (-1%).

UNITED STATES

The US CDC is reporting 87.2 million cumulative cases of COVID-19 and 1,012,166 deaths. The average daily incidence has plateaued over the past several weeks, holding relatively steady at approximately 100-110,000 new cases per day. The current 7-day average is 108,505 new cases per day. The average daily mortality has held relatively steady at approximately 250-300 deaths per day since late May* However, the 7-day average appears to be rising and currently is 321 deaths per day.

*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.

Both new hospital admissions (+13% over the past week) and current hospitalizations (+5%) continue to increase. Considering the plateau in daily incidence, it is possible that hospitalizations could also remain elevated, rather than peaking and then declining.

Community transmission in the US is now being driven by the Omicron BA.5 (36.6%) and BA.4 (15.7%) sublineages, which together are now more prevalent than the BA.2.12.1 sublineage (42%). Along with BA.2 (5.7%), these 4 sublineages of the Omicron variant represent all new SARS-CoV-2 infections in the US.

OMICRON BA.4/BA.5 SARS-CoV-2 Omicron subvariants BA.4 and BA.5 have overtaken BA.2.12.1 as the dominant strains in the US. While BA.2.12.1 still makes up approximately 42% of new cases as of June 25, BA.4 accounts for 15.7% and BA.5 accounts for 36.6%, for a combined total of 52.3%. BA.4 and BA.5 were first detected in South Africa in November 2021, and they are now fueling a worldwide increase in cases. Additionally, hospitalizations are on the rise in Israel, Portugal, South Africa, the UK, and the US. The increases in case and hospitalization numbers are likely due to the fact that BA.4 and BA.5 contain mutations that are believed to aid in immune evasion. This means that prior infection with an earlier Omicron strain, such as BA.1 from winter 2022, might not be enough to protect against disease. BA.4 and BA.5 also are capable of escaping some immunity from vaccines, but vaccinated individuals still tend to fare better than those relying on natural immunity alone. It is increasingly likely that more individuals will start experiencing reinfections. There are concerns that multiple reinfections could put individuals at a higher risk for health problems, but research on the matter is ongoing.

In a June 29 briefing, WHO Director-General Dr. Tedros Adhanom Ghebreyesus noted that BA.4 and BA.5 are responsible for an approximately 20% increase in the number of COVID-19 cases worldwide. COVID-19 cases are on the rise in 110 countries and deaths are increasing in half of the 6 regions monitored by the WHO. Dr. Tedros also spoke out against complacency in the face of the pandemic, stressing that the pandemic is changing and not yet over. He urged the international community to quickly work toward achieving 100% vaccination rates for healthcare workers and individuals over age 60 years. Dr. Tedros also re-emphasized the need for a pan-coronavirus vaccine that can stand up to the rapid evolutionary rate of SARS-CoV-2. Notably, BioNTech announced this week that the company and its partner Pfizer will begin human trials of a pan-coronavirus vaccine in the second half of the year.

VACCINE UPDATES FOR OMICRON The US FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) on June 28 voted 19-2 to recommend the agency take steps to authorize updated COVID-19 booster shots targeting some form of the SARS-CoV-2 Omicron variant that has been dominant since the beginning of this year. A confluence of factors makes the US population more susceptible to a winter COVID-19 surge, including waning immunity, the possible emergence of a new variant, and colder weather that pushes more people indoors. Current vaccines and boosters are based on the spike protein structure and characteristics of only the original SARS-CoV-2 virus, so introducing individuals to an Omicron spike protein should broaden the body’s immune response against additional versions of the virus, whether currently circulating or a future but similar variant. Many committee members expressed dismay over the limited amount of data on updated vaccine formulations—including if or how well they might provide additional protection—and unknowns about which variants will be circulating this fall.

In an announcement released today, the FDA said that based on the committee’s discussions, it has advised manufacturers seeking to update their COVID-19 vaccines to develop modified versions that add spike protein components of the Omicron BA.4/BA.4 subvariants to current vaccine formulations to create a 2-component, or bivalent, booster vaccine. The decision paves the way for vaccine companies to start manufacturing Omicron-containing doses to potentially be ready for use beginning in early to mid-fall. The FDA did not recommend a change to the primary vaccination formulations.

Introducing another booster this year may come with its own suite of challenges in terms of communication, including possibly moving away from the term booster to something like “another annual shot.” A significant proportion of individuals in the US who are eligible to receive third or fourth shots have yet to do so, leaving them more vulnerable as BA.4 and BA.5 become predominant and highlighting the need for a comprehensive communication strategy about who should get additional shots, when, and why. The administration of US President Joe Biden on June 29 announced an agreement to purchase 105 million doses of the Pfizer-BioNTech COVID-19 vaccine for US$3.2 billion for a fall vaccination campaign, with options for an additional 195 million doses. Pfizer-BioNTech will provide its new formulation based on FDA recommendations. Both Pfizer-BioNTech and Moderna are working on vaccine booster reformulations.

US MATERNAL MORTALITY A new study examining maternal mortality rates in the US before and during the COVID-19 pandemic was published June 28 in the peer-reviewed journal JAMA Network Open. The study compared pre-pandemic and pandemic maternal mortality using de-identified records from the National Center for Health Statistics. Deaths occurring in 2018, 2019, or January-March 2020 were classified as pre-pandemic. Deaths occurring from April-December 2020 were classified as during the pandemic. The study found that maternal mortality rose from 18.8 per 100,000 live births to 25.1 per 100,000 live births. This represents an increase of 33%, higher than the 22% increase in mortality expected as a result of the pandemic. Late maternal mortality increased 41%.

The largest increases in maternal mortality were seen in Hispanic populations, at 74.2%, and non-Hispanic Black populations, at 40.2%, compared to an increase of 17.2% in non-Hispanic White populations. The largest increases in maternal mortality were seen for underlying cause-of-death codes related to indirect causes of death such as other viral diseases (2,374.7%), diseases of the respiratory system (117.7%), and diseases of the circulatory system (72.1%). Maternal mortality increases associated with direct causes of death were largely due to diabetes (95.9%), hypertension disorders (39%), and other pregnancy-related conditions (48%). The authors call for future studies that examine ethnic and racial disparities along with specific causes of COVID-19-related maternal mortality. They also expressed hope that improvements due to the rollout of vaccines could be realized in future analyses.

The new study further confirms a trend seen before the pandemic, when maternal mortality rates were twice as high in the US as in many other high-income countries. More resources are needed to protect pregnant populations from the dangers associated with COVID-19, but pre-existing issues that lead to high maternal mortality must also be addressed to protect this often overlooked high-risk population in the US.

MONOCLONAL ANTIBODY THERAPIES The US government is expected to use up its supplies of Eli Lilly’s monoclonal antibody therapy for COVID-19 in late August because its pandemic funding is running out. Lilly said it agreed to supply the US with an additional 150,000 doses of bebtelovimab for about US$275 million in order to meet demand through the end of August. The agreement includes an option for an additional 350,000 doses that must be applied no later than September 14. Currently, the federal government is distributing about 30,000 doses per week. The antibody received US FDA emergency use authorization earlier this year for use among non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk of disease progression, and the drug has shown effectiveness against the Omicron variant. If the federal government is unable to procure more doses than currently agreed upon, Lilly will need to sell the treatment directly to hospitals and states, a move that would represent a first test of shifting a COVID-19-related drug to the commercial market.

The US FDA and the Assistant Secretary for Preparedness and Response (ASPR) authorized a shelf-life extension for another monoclonal antibody therapy, Evusheld (tixagevimab co-packaged with cilgavimab) made by AstraZeneca. The shelf life of certain lots of the refrigerated treatment can be extended from 18 months to 24 months. Evusheld is authorized for pre-exposure prophylaxis of COVID-19 in certain adults and pediatric individuals. Several experts are hoping for more funding and research into antibody treatments for COVID-19 and other ailments, with some noting that antibodies can have more long-lasting impacts than vaccines, especially among people with immunodeficiencies, and could serve as a key solution during the next pandemic.

DIGITAL SOLUTIONS FOR INFODEMIC During the COVID-19 pandemic, the public has been faced with an overabundance of information, including false or misleading content, in both online and offline environments. To address the online information epidemic, the WHO Regional Office for Europe published a policy brief on how digital solutions can be used to address this so-called “infodemic” to help improve the public health response to COVID-19 and future health emergencies. The brief outlines what WHO is doing to address the infodemic in Europe and globally and highlights 6 specific policy considerations for policymakers and other key stakeholders to help improve infodemic management, including reinforcing multistakeholder networks for infodemic management; strengthening overall risk communication and community engagement; implementing continuous monitoring of harmful and false online content; improving digital literacy approaches and organizing infodemic management trainings; advocating for infodemic management through communication campaigns; and ensuring safe online platforms, which protect people from harmful content.

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

From Emerging Infectious Diseases, a case report from Thailand of a veterinarian who was diagnosed with COVID-19 after treating and being sneezed on by a domestic cat owned by a person infected with SARS-CoV-2 at the time. Genetic analysis supports the hypothesis that viral transmission occurred from the owner to the cat and then from the cat to the veterinarian. Notably, the veterinarian was wearing an N95 during the cat’s examination, leading the researchers to postulate her eyes were left vulnerable to infection when the cat sneezed in her face, highlighting the importance of face shields or goggles, in addition to masks, to prevent transmission.

From JAMA Internal Medicine, a study suggesting that patients of African ancestry with sickle cell trait (SCT) and associated history of one of several kidney conditions were at increased risk of mortality and acute kidney failure following COVID-19. The results strongly support advising that patients with SCT be regarded as at high-risk of COVID-19.

From The Journal of Infectious Diseases, a cohort study evaluating the risk of SARS-CoV-2 infection and severe COVID-19 disease in persons with Down syndrome (DS) and matched controls prior to available vaccination. Though the risk of infection among individuals with DS was 32% lower than their matched counterparts (aHR 0.68, 95% CI: 0.56-0.83), the rate of severe COVID-19 disease was 6-fold higher (aHR 6.14, 95% CI: 1.87-20.16). The results support better infection monitoring, early treatment, and vaccination for individuals with DS.

From the New England Journal of Medicine, a cohort study of US children aged 5-11 who were vaccinated on or after November 23, 2021, compared with matched controls who were unvaccinated to estimate the effectiveness of the Pfizer-BioNTech vaccine at the start of the Omicron surge. The estimated vaccine effectiveness against symptomatic COVID-19 was 18% (95% CI: -2 to 34) at 14 to 27 days after the first dose and 48% (95% CI: 29 to 63) at 7 to 21 days after the second dose, showing moderate protection as Omicron was becoming dominant.

From Pediatrics, a multicenter prospective observational cohort study conducted in 25 US pediatric hospitals that followed COVID-19 patients under age 21 who were hospitalized between May 2020 and May 2021 for COVID-19 or multisystem inflammatory syndrome in children (MIS-C) for 2-4 months after admission. The researchers found that more than 1 in 4 children with COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Those patients with MIS-C who have respiratory problems or obesity had a higher risk of prolonged recovery.

From Scientific Reports, a mathematical modeling study examining how human movement—from home to other locations such as school, work, and elsewhere—social distancing behavior, and other restrictive measures such as quarantine affect COVID-19 dynamics within a population. The study’s model showed that SARS-CoV-2 transmission is most attributable to the home location, including gatherings of relatives and close friends. Therefore, limiting encounters or travel to other locations is only effective if the same social distancing measures are also effectively implemented in the home setting.

Monkeypox is an “evolving health threat”

Outbreak Alerts

Monkeypox

Editor: Alyson Browett, MPH

Contributors: Christina Potter, MSPH, Eric Toner, MD, Rachel Vahey, MHS, and Lane Warmbrod, MS, MPH

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Additional Monkeypox Resources

Recent Outbreak Update as of June 29, 2022 at 2pm EDT

As of 5pm EDT on June 28, there were 4,769 cumulative confirmed cases of monkeypox in 49 countries, territories, and areas where the virus is not endemic, according to the US CDC. As of 2pm EDT today, the Global.health database reports 4,780 confirmed cases and an additional 44 suspected cases. A majority of the cases are being reported in European countries. Notably, the trackers do not include year-to-date cases in endemic countries. No deaths have been reported in non-endemic countries.

WHO DECLINES PHEIC DESIGNATION On June 25, World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus announced the multi-country outbreak of monkeypox constitutes an “evolving health threat” but stopped short of declaring a Public Health Emergency of International Concern (PHEIC), based on 2 days of deliberation by the Emergency Committee.

The PHEIC designation is the WHO’s highest level of alert, showing an event constitutes an extraordinary public health risk to other countries through international spread and requires a coordinated international response. Though the Committee agreed that the outbreak requires coordinated action to stop the spread of the virus—including greater surveillance, improved diagnostics, community engagement and risk communication, and the appropriate use of therapeutics, vaccines, and public health measures such as contact tracing and isolation—there was disagreement among members about whether the event constitutes a PHEIC.

The WHO said it will continue to monitor the outbreak and reconvene the Emergency Committee in the coming days or weeks if it grows in severity or reach, particularly if affecting new countries or new populations. A vast majority of confirmed cases so far have been among men who have sex with men (MSM), signaling the virus is being spread within close-knit communities. Additionally, the Committee said if there is evidence monkeypox has established itself within animal reservoirs outside of Africa, it will reconsider its recommendation regarding a PHEIC declaration to the Director-General.

Many public health experts were surprised that the WHO did not classify the monkeypox outbreak as a PHEIC since it appeared the Emergency Committee concluded the outbreak met all 3 criteria of being extraordinary, at risk of international spread, and in need of a coordinated response. The reasons for not declaring a PHEIC likely vary. Notably, monkeypox has been circulating in several African nations for decades with little international concern. In fact, Nigeria, where monkeypox is endemic, warned this week that the country’s number of confirmed cases could reach its highest level in 5 years if current infection trends persist.

GLOBAL ASSESSMENT In a June 27 situation update, the WHO assessed the overall risk at the global level as moderate, noting this is the first time that cases and clusters are being reported simultaneously in 5 WHO Regions. The agency assessed the risk in the European Region as high due to the geographically widespread outbreak in the region involving newly affected countries. The WHO this week also published guidance for host governments, public health authorities, organizers, and other decision-makers involved in the planning and delivery of small or large gatherings during the current monkeypox outbreak. While the agency calls for organizers to take a risk-based approach to managing close interactions—noting that it remains unclear whether monkeypox can be transmitted by asymptomatic individuals—it did not call for the postponement or cancellation of events.

EUROPEAN REGION RESPONSE In a joint surveillance bulletin released today, the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe report that 4,178 cases of monkeypox have been identified in 31 European countries and areas as of June 28, with 3,082 of those being laboratory-confirmed. The report also contains epidemiological information, demographics and clinical descriptions of cases, and phylogenetic analysis.

The European Commission announced on June 28 that it has delivered an initial 5,300 doses of Bavarian-Nordic’s (BN) smallpox vaccine to Spain, out of a total 109,090 doses procured. The BN vaccine, marketed as Imvanex in Europe and Jynneos in the US, is known to be effective against monkeypox. The vaccine is US FDA-approved for monkeypox, and the European Medicines Agency (EMA) this week began a review of the vaccine to extend its authorization to cover monkeypox in addition to smallpox.

US RESPONSE The US CDC activated its Emergency Operations Center (EOC) this week to respond to the US monkeypox outbreak. In a press release, the CDC said the action will allow the agency “to further increase operational support for the response to meet the outbreak’s evolving challenges.” As part of its overall monkeypox outbreak response, which includes ramping up testing capabilities nationwide, the White House announced a national monkeypox vaccine strategy to significantly expand the availability of the 2-dose Jynneos monkeypox vaccines and broaden eligibility, with the goal of slowing the spread of the virus. In addition to offering the vaccine to people who have had a known exposure to the virus, the vaccine will be available to MSM who have had multiple recent partners in gatherings where monkeypox virus is known to have been spreading or in geographic areas where monkeypox transmission is occurring.

To date, the US Department of Health and Human Services (HHS) has distributed 9,000 doses of Jynneos vaccine to 32 states and jurisdictions, as well as 300 courses of antiviral treatments. HHS plans to allocate an additional 56,000 doses immediately and another 240,000 over the coming weeks. Notably, a combined 1.6 million doses is expected to become available over the coming months. Under a 4-tier distribution plan, areas with the highest monkeypox case rates will be prioritized. Due to a limited supply of the Jynneos vaccine, officials are considering whether to use another, older smallpox vaccine, ACAM2000, that is effective against monkeypox. However, that vaccine comes with risks because it is an attenuated live-virus vaccine, which is presumed to not be safe for use among certain populations, including pregnant people, older adults, and  immunocompromised people, such as those living with HIV.

Many public health experts fear time is running out to effectively stop the transmission of monkeypox before the disease becomes endemic in the US and Europe. Cases with no known link to chains of transmission indicate community spread is occurring, with people possibly spreading the virus without knowledge that they are infected and testing still difficult to obtain. Therefore, the official case count, in the US and globally, likely is an undercount.

June 28, 2020: 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 updates on the monkeypox outbreaks on our 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.

US FDA CONSIDERS VACCINE UPDATES Today, the US FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) is meeting to discuss if and how the strain compositions of COVID-19 vaccines should be modified going forward. The meeting will be livestreamed on the FDA website here with presentation materials also available for download. Presentations and discussion points expected to be covered include: evolution of SARS-CoV-2 variants thus far, as well as models predicting future evolution; current effectiveness of COVID-19 vaccines; related recommendations from the WHO on the subject; clinical trial data evaluating COVID-19 vaccines with varying strain composition; and the FDA perspective on the issue, including considerations for and data required to support authorization of any modified vaccines. The committee will then vote regarding recommendations for a COVID-19 vaccine strain composition, weighing the potential expected increases in immunity against the expense and complexity of a change in composition. Experts are hopeful that an updated strain composition could help provide increased protection from a potential fall surge, although there is concern that the speed of SARS-CoV-2 mutations and slowness of updates to formulations could reduce efficacy of boosters, as vaccine protection wanes and composition becomes outdated compared with circulating variants.

PFIZER-BIONTECH OMICRON-ADAPTED VACCINES Pfizer-BioNTech shared new data over the weekend of 2 Omicron-adapted vaccine candidates, both exhibiting positive safety, tolerability, and immunogenicity, and even outperforming the companies’ current vaccine. Given at 30 microgram and 60 microgram doses as a fourth booster dose, the monovalent candidate elicited a 13.5- and 19.6-fold increase in neutralizing geometric titers against Omicron BA.1, respectively, compared to pre-booster levels. The bivalent candidate, which contains antigens to both Omicron and the original strain, exhibited a 9.1- and 10.9-fold increase at the same dosages against BA.1. Both candidates were well-tolerated among participants of the phase 2/3 trial of adults over age 56. Preliminary lab studies show both candidates neutralize BA.4 and BA.5, but to a lesser extent than BA.1. The companies have shared the data with the US FDA ahead of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting today, alongside data from ongoing COVID-19 booster studies. The companies also shared the data with the European Medicines Agency (EMA) ahead of the June 30 meeting of the International Coalition of Medicines Regulatory Authorities (ICMRA).

MODERNA VACCINE FOR OLDER CHILDREN Children and adolescents aged 6 through 17 years can now receive the Moderna COVID-19 vaccine in the US, following publication of the US CDC Advisory Committee on Immunization Practices’ (ACIP) recommendations and CDC Director Dr. Rochelle Wallensky’s endorsement. The US FDA authorized the vaccine for that age group last week. Adolescents and teens ages 12-17 receive the same dosage as adults, while younger children ages 6-11 receive half of that dose, administered in 2 shots separated by 4-8 weeks. The Pfizer-BioNTech vaccine is already available for adolescents and older children.

A decision on the Moderna vaccine for this age group was delayed due to FDA review of data on the risk of heart problems, including myocarditis and pericarditis, among adolescent boys. However, the FDA said the vaccine’s benefits outweigh the risks, which are very small and also observed with the Pfizer-BioNTech vaccine. COVID-19 carries a much greater risk of heart problems than either vaccine, which are both safe overall. To minimize the risk of transient heart problems related to the vaccines, the CDC recommends that boys and men aged 12 through 39 years space their doses by 8 weeks. That recommendation, particularly for young adult men, is supported by findings from a recent study from Canada published in JAMA Network Open.

LONG COVID/PASC Researchers worldwide are investigating the potential causes of post-acute sequelae of SARS-CoV-2 infection (PASC), commonly known as long COVID. Blood clots, persistent virus, and immune system abnormalities—or a combination of those or other underlying mechanisms—are leading theories about what could be causing long-term symptoms following recovery from acute infection. To date, there is no agreement on how to define and diagnose long COVID, and estimates of its prevalence range from 5% to 50% of recovered patients. Recent data published by the US CDC, collected between June 1 and June 13, 2022, show that nearly 1 in 5 US adults who previously had COVID-19 continue to experience symptoms of long COVID, such as fatigue, rapid heartbeat, shortness of breath, muscle weakness, chronic pain, or cognitive difficulties. Overall, about 1 in 13 US adults, or 7.5% of the population, have symptoms lasting 3 or more months after COVID-19 recovery that were not experienced prior to infection. Women were more likely than men to currently have long COVID (9.4% vs. 5.5%), according to the data, findings that are supported by a review published June 20 in Current Medical Research and Opinion.

The CDC data show that older adults are less likely to have long COVID than younger adults, but the symptoms are often overlooked in older individuals and some research suggests seniors are more likely to develop long-term symptoms. A study from Denmark published June 22 in The Lancet Child & Adolescent Health found that among children ranging in age from 0 through 14 years, those who previously tested positive for SARS-CoV-2 were more likely to experience at least 1 symptom for 2 months or more than children who never tested positive. Additionally, one-third of children who previously tested positive experienced at least 1 long-term symptom they did not have prior to infection, including mood swings, rashes, and stomach aches, memory and concentration problems, and fatigue. While any person of any age can experience long COVID, the question of why remains a mystery. But most scientists and public health officials agree that unraveling that mystery, including standardizing the condition’s definition and diagnosis and finding treatments, represents an urgent global emergency to prevent mass suffering.

ESTIMATES OF DEATHS AVERTED Last week, a study published in The Lancet Infectious Diseases reported results from transmission modeling efforts estimating that COVID-19 vaccination programs may have prevented 19.8 million deaths (95% CI: 19.1-20.4 million) worldwide during their first year of rollout, even though global vaccination targets were not reached. The figure is based on using excess deaths to determine the true mortality burden of COVID-19, although modelers also found that using COVID-19 mortality alone and not excess deaths yielded a finding of 14.4 million deaths prevented (95% CI: 13.7-15.9 million), including 7.4 million (95% CI: 6.8-7.7 million) deaths prevented in countries provided vaccine by the COVID-19 Vaccines Global Access (COVAX) Advance Market Commitment. However, if vaccination coverage targets of 20% or 40% had been met in low-income countries, further reductions in mortality in those nations of 45% (95% CI: 42-49%) and 111% (95% CI: 105-118%), respectively, could have been reached. Experts noted that the study highlighted not only the importance of vaccination but also equitable access, with the majority of predicted prevented deaths occurring among high-income and upper-middle-income nations. Notably, China was not included in the analysis due to its status as the origin of the outbreak and its large influence on estimates due to its population size.

CHINA The National Health Commission of China today announced a reduction of the country’s quarantine policy for overseas travelers to 7 days in a centralized facility and an additional 3 days at home. Previously, travelers were required to stay 14-21 days in centralized quarantine depending on the city of entry and destination. The announcement also includes similar guidelines for close contacts of confirmed COVID-19 cases, requiring 7 days in centralized quarantine and 3 days of health monitoring at home, compared to the prior minimum 14-day requirement. China remains an outlier, as most nations have dropped their vaccination and quarantine requirements for international travelers.

Over the weekend, Beijing said it would allow primary and secondary schools to reopen for in-person instruction, with youth sports soon to follow at non-school locations. Shanghai officials also declared that the city reported no new local cases in 2 months, following a 2-month citywide lockdown that ended June 1. The lockdown effort was in line with China’s zero-COVID policy to stop all outbreaks. The policy is being discussed with renewed interest after authorities in Beijing mentioned that the strict policy could be in place for 5 years. The notice was published Monday on the official Communist Party newspaper of the capital, Beijing Daily, and republished by other media outlets, but officials quickly removed the reference to “5 years” from most online publications, as well as a hashtag on the microblogging site Weibo.

COVID-19 RECOVERY As world leaders drop the COVID-19 pandemic from their agendas, and US federal, state, tribal, and local governments roll back pandemic-related funding and mitigation efforts—such as mask mandates—local officials, grassroots organizations, and frontline community health workers continue to push for and implement piecemeal strategies to help increase vaccination rates, draw attention to the need for research into long COVID, and improve trust in and funding for public health systems. There is a need for the US to create “a sustainable infrastructure that can keep more people from getting COVID, regardless of their social circumstances,” writes Ed Yong in The Atlantic. Indeed, the US Government Accountability Office (GAO) last week released a report recommending that the US Department of Health and Human Services (HHS) prioritize the development of a real-time, public health situational awareness network to help raise public awareness to facilitate the early detection of and rapid response to future and potentially catastrophic disease outbreaks, such as COVID-19.

Trump can teach Democrats a lot about working people

There Is a Major Rift Dividing the White Working Class — And Democrats Are Clueless

Lisa R. Pruitt

Fri, June 24, 2022, 3:30 AM·17 min read

Ever since J.D. Vance became the Republican Senate nominee in Ohio, journalists and pundits have been preoccupied with how Vance’s politics have shifted since the 2016 publication of his memoir, Hillbilly Elegy. The book brought Vance fame and a platform that he used, among other things, to criticize Donald Trump. Since then, Vance’s positions on polarizing issues like immigration have lurched to the right and he sought — and won — Trump’s endorsement. Vance now also dabbles in conspiracy theories and has taken on a belligerent, Trump-like tone.

What the pundit class isn’t talking about, however, is an important consistency between 2016 author Vance and 2022 politician Vance. In his memoir, Vance pitted two groups of low-status whites against each other—those who work versus those who don’t. In academic circles, these two groups are sometimes labeled the “settled” working class versus the “hard living.” A broad and fuzzy line divides these two groups, but generally speaking, settled folks work consistently while the hard living do not. The latter are thus more likely to fall into destructive habits like substance abuse that lead to further destabilization and, importantly, to reliance on government benefits.

Vance has not renounced that divisive message. He no doubt hopes to garner the support of the slightly more upmarket of the two factions—which, probably not coincidentally, is also the group more likely to go to the polls. While elite progressives tend to see the white working class as monolithic, Vance’s competitiveness in the Ohio Senate race can be explained in no small part by his ability to politically exploit this cleavage.

As a scholar studying working-class and rural whites, I have written about this subtle but consequential divide. I have also lived it. I grew up working-class white, and I watched my truck driver father and teacher’s aide mother struggle mightily to stay on the “settled” side of the ledger. They worked to pay the bills, yes, but also because work set them apart from those in their community who were willing to accept public benefits. Work represented the moral high ground. Work was their religion.

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We lived in an all-white corner of the Arkansas Ozarks, so my parents weren’t fretting about the Black folks Ronald Reagan would later denigrate with the "welfare queen" stereotype. They were talking about their lazy neighbors. They called these folks “white trash,” the worst slur they knew.

Though Vance described this divide in Hillbilly Elegy, readers unfamiliar with the white working class may not have picked up on it. Vance’s beloved grandparents, Mamaw and Papaw, represented hard work. Papaw had a steady job at the Armco steel mill—one good enough to draw him and hundreds like him out of the Appalachian Kentucky hills to Middletown, Ohio. Indeed, it was such a good job that Mamaw could stay home and take care of the kids. Though they were crass and unconventional by polite, mainstream standards, Papaw and Mamaw’s work ethic positioned them in the settled working class.

From that perch, Vance’s grandparents harshly judged neighbors who didn’t work. They even judged their daughter, Vance’s mother, Bev. Though she’d trained for a good job, as a nurse, Bev’s drug use and frequent churn of male partners led to the instability associated with the “hard living.” Indeed, at one point Vance uses that very term to refer to his mother: “Mom’s behavior grew increasingly erratic,” Vance writes. “She was more roommate than parent, and of the three of us — Mom, [my sister], and me — Mom was the roommate most prone to hard living” as she partied and stayed out ‘til the wee hours of the morning.

Given the childhood trauma associated with his mother’s behavior, it’s perhaps not surprising that Vance came to emulate his grandparents’ judgmental stance toward the hard living. This is illustrated by his condemnation of shirking co-workers at a warehouse job and those who used food stamps (SNAP) to pay for the groceries he bagged as a teenager. (It seems that Vance also inherited his family’s pugilistic tendencies, which have come in handy with his conversion to Trumpism; words like “scumbag” and “idiot,” which readers of Hillbilly Elegy can easily imagine coming out of Mamaw’s mouth, have become staples of Vance’s campaign vocabulary).

Ultimately, of course, Vance traveled far from his modest roots to graduate from Yale Law School and become a venture capitalist. For this success, he credited the hard work and boot-strapping mentality he learned from his grandparents. What Vance didn’t credit — not explicitly, anyway — were the structural forces that benefitted him and his grandparents. For Vance, these included an undergraduate degree from an excellent public university (Ohio State) and opportunities in the military. For his grandparents, these included that good union job at Armco Steel—even as Papaw complained about the union. (A significant faction of workers believe that hard-working people like themselves don’t need unions, that unions simply protect slackers from hard work. My own father’s pet peeve was unionized loading dock employees whose generous breaks delayed getting his truck loaded or unloaded and thus back on the road earning money. The naming of “right-to-work” laws plays to this mindset.)

Like Vance, settled white workers tend to see themselves living a version of the American dream grounded primarily — if not entirely — in their own agency. They believe they can survive, even thrive, if they just work hard enough. And some of them are doing just that. Because they lean into the grit of the individual, they tend to downplay structural obstacles to their quest to make a living, e.g., poor schools and even crummy job markets, just as they downplay structural benefits. They also discount “white privilege” because giving skin color credit for what they have achieved devalues the significance of their work. This mindset is also the reason that when Obama said in 2012, “if you’ve got a business, you didn’t build that,” the remark landed so badly among the settled working class. They’re not accustomed to sharing credit for what they have — perhaps especially when they don’t have much.

Vance and my parents are mere anecdotes, yes, but scholars have documented the phenomenon they represent. Kathryn Edin of Princeton University, Jennifer Sherman of Washington State University and Monica Prasad of Northwestern University have studied folks like them in both urban and rural locales. What “settled” and “hard living” express as cultural phenomena, Edin and colleagues express quantitatively as the second-lowest income quintile dissociating from the bottom quintile — the very place from whence many had climbed. Edin described that disassociation as a “virulent social distancing” — “suddenly, you’re a worker and anyone who is not a worker is a bad person.”

Journalists have also brought us illustrations of the settled working class. Alec MacGillis did so in a 2015 New York Times essay, introducing us to Pamela Dougherty of Marshalltown, Iowa, a staunch opponent of safety net programs. As a teenaged mother who divorced young, Pamela’s own journey had been rocky, and she had benefitted from taxpayer-funded tuition breaks at community college to become a nurse. But at the dialysis center where Pamela worked and where Medicare covered everyone’s treatment regardless of age, she noticed that very few patients had regular jobs. Pamela resented this. She thought the patients should have “hoops to jump through” to get the treatment, just as she’d had to keep up her grades when she was getting assistance with college. She thought they should have some skin in the game.

Atul Gawande brought us a similar tale in a 2017 New Yorker article about whether health care should be a right. He introduced us to Monna, a librarian earning $16.50 an hour in Athens, Ohio. After taxes and health insurance premiums were deducted, Monna was taking home less than $1,000 a month, and her health insurance annual deductible was a whopping $3,000. It was her retired husband’s pension, military benefits, and Medicare — all benefits considered earned, not handouts — that kept them afloat. In spite of this struggle, Monna didn’t support health care as a right because it was “another way of undermining responsibility.” Noting that she could quit her job and get Medicaid for free like some of her neighbors were doing, Monna explained that she was “old school” and “not really good at accepting anything I don’t work for.”

Exit polls from 2016 also reflect this division, with the lowest-income voters supporting Clinton—and therefore safety-net programs associated with Democrats—by the greatest margin, 53 percent to 41 percent over Trump. It was folks earning $50,000 to $99,000, those who depending on region and family size might be considered settled working class, who preferred Trump by the greatest margin of all income brackets — 50 percent to 46 percent.

This dynamic shifted a bit by 2020, when exit polls showed Trump garnering the greatest level of support from those earning between $100,000 and $199,000. This may suggest an improvement in the circumstances of the settled working class, or that the lack of empathy for those who don’t work is creeping up the income ladder. By 2020, those in the $50,000 to $99,000 bracket may also have begun feeling the vulnerability associated with those a rung beneath them, particularly during the pandemic, causing them to lean Democratic. Meanwhile, folks in the higher income group may have become increasingly judgmental — and more beholden to Trump as they saw their 401K accounts gain value during his administration.

As important as this divide is to understanding working-class whites — and in spite of national publicity by big-name scholars and journalists — coastal and urban progressives often seem oblivious to it. This may be because few have any meaningful interaction with either faction of the white working class. Outsiders struggle to grasp the significance of this class war that rages within our nation’s broader class war.

But this war within a war animates a lot of voters. It also drives a lot of policy decisions, including work requirements for Medicaid and food stamps (SNAP) imposed by red state governors and legislatures, just as the Clinton administration did for welfare (TANF) a quarter century ago.

Whenever I talk about this settled working class mindset to folks in my coastal progressive world, I get two responses. The first is an assumption that these folks are simply racists whose sole motivation is to deny benefits to people of color. The second response is that they are irrational, even delusional, not to see that they are vulnerable — that they might someday need public benefits, too, given the way precarity has not only crept up the socioeconomic ladder, but also outward and into a growing number of communities left behind by the knowledge economy.

Indeed, it’s true that many in the settled working class would benefit from big structural government interventions like single-payer health care, universal pre-K and other childcare supports, greater investments in education and broadband. They would also benefit if higher taxes on the wealthy paid for these interventions. That many white workers don’t see it this way leads to the oft-heard assertion that working-class whites vote against their own interests.

But both of these progressive responses further alienate folks with strong identities as workers, those hanging on to a version of the American dream that places the individual squarely in the driver’s seat.

First, going straight to allegations of racism is incendiary and infuriating to the folks being labeled “racist.” They tend to define that term narrowly, referring to people who say the n-word or explicitly endorse white nationalism. (Academics label this cohort “old-fashioned racists” to differentiate from the many broader definitions that now dominate public discourse.) Many of these folks know they don’t use overtly racist terms or believe in white supremacy. But just as those oriented to work tend to discount the significance of beneficial structures in their own lives, they also tend to discount the force of structural racism in others’ lives.

Plus, an assumption that these white workers are thinking only in terms of the “welfare queen” stereotype fails to consider that most of the non-workers who people like Pamela and Monna know are almost certainly white folks. After all, they live in Marshalltown, Iowa and Athens, Ohio — virtually all-white burgs. Ditto my folks in the Arkansas Ozarks.

I’m not saying that no one in the settled working class has racist impulses; some do. I am pointing out their tendency to harbor class-based animus toward anyone who doesn’t work, regardless of skin color. Bias based on race and bias based on class are not mutually exclusive, and it can be easier to assume that racial animus is at work when in fact, it’s classist or cultural animus directed at those on a lower economic or social rung. As the late cultural critic Joe Bageant expressed it, “what middle America loathes … are poor and poorish people, especially the kind who look and sound like they just might live in a house trailer.”

Depending on your politics, this is not a flattering image of the settled working class. But it is the reality political candidates are facing when they seek their votes—and J.D. Vance knows that. So does his Democratic opponent Tim Ryan, also a product of white working-class Ohio.

In July 2016, Senator Chuck Schumer suggested Democrats could ignore this constituency. “For every blue-collar Democrat we lose in western Pennsylvania,” he said, “we will pick up two moderate Republicans in the suburbs in Philadelphia, and you can repeat that in Ohio and Illinois and Wisconsin.”

Schumer’s strategy proved a notorious disaster for Democrats, and it’s not a gamble the party can afford to repeat in 2022 or 2024. If anything, white workers look more critical than ever to a winning Democratic coalition, as more Latinos drift into the Republican column.

It thus behooves Ryan and other Democrats to consider carefully how to communicate with a voting bloc they once took for granted.

President Biden talks more about jobs and the working class than President Obama did, but generic job talk may no longer be getting through to workers given the shifting image (and reality) of Democrats as the party of elites and intellectuals. The sad truth is that coastal progressive condescension toward workers has become second nature to many Democrats, so much so that they don’t realize they’re doing it.

Take the issue of higher education. Wider, more affordable access to college is absolutely critical to our country’s future, and I’m a grateful poster child for how it can propel working-class kids up the socioeconomic class ladder. But elite preoccupation with higher education (never mind elitism within that sector) sends a signal that getting a college degree is the only way people succeed and make contributions to our nation. By implication, everyone else is a loser. What the credentialed class often conveys—whether or not they intend to—is that if workers were smart and ambitious enough, they’d have degrees and careers like ours. But many in the settled working class never aspired to go to college. They nevertheless look to their work as a source of dignity, identity, and pride.

Ryan, Vance’s Democratic opponent, gets this. He recently tweeted “Say it with me:  you shouldn’t need a college degree to get a good job and live a good life.”

When Trump said he “love[d] the poorly educated,” the credentialed class cringed. They assumed no one would want to be labeled as such and, indeed, that no one would want to be poorly educated (read to mean having little formal education). But folks without college degrees — even folks without high school diplomas — heard Trump’s comment as affirmation. He was happy to be associated with them, and Trump’s warm embrace was a salve on a deep, festering wound. Trump’s comment was also a rare one that did double duty in speaking to both settled and hard-living factions of the white working class.

But Trump also found a way to speak specifically to the settled working class, those with strong identities as workers. The “again” part of “Make America Great Again” brings to mind a time when their jobs provided greater economic security—as Papaw Vance’s steel mill job had—and also a time when blue-collar workers felt broadly respected. For workers displaced or fearing displacement, Trump named various external culprits (aka structural challenges)—unfair foreign imports, immigrants, regulation. He also offered solutions, e.g., tariffs, a border wall, less red tape, though he didn’t deliver on all of his promises. Trump didn’t save coal jobs, but the American steel industry did benefit from his tariffs.

Democratic solutions to worker travails will mostly differ from those proposed by Republicans, of course, but Democrats can fruitfully borrow a page from how Trump communicated with workers. First and foremost, tell workers that they and their labor are seen and appreciated. A key theme of 2016 election coverage was that many working-class white and rural voters felt overlooked. Tracie St. Martin, a union member and heavy construction worker who supported Trump, summed up the disgruntlement, “I wanted people like me to be cared about. People don’t realize there’s nothing without a blue-collar worker.” (St. Martin, of Miamisburg, Ohio, was quoted in a ProPublica story reported by MacGillis aptly titled “Revenge of the Forgotten Class.”)

The more specific Democrats’ affirming messages, the better. Democrats should go beyond broad “jobs” platitudes and say workers’ names—that is, the names of their vocations: steelworkers, yes, but also stylists, caregivers, police officers, machinists, and food service workers.

Our nation got better at seeing workers—especially certain categories of workers—in the early days of the pandemic. As we collectively waxed poetic about shelf-stockers and truck drivers, I recalled the pride my whole family felt in the mid-1970s when the trucker song “Convoy” topped both pop and country charts and the movie “Smokey and the Bandit” glamorized the work that truckers do. Of course, that was long before we started thinking in terms of two Americas, one blue, the other red, before we started putting down one group to build up the other. To many of us—white folks anyway—America felt more like a commonwealth back then.

Needless to say, I’m not suggesting that it’s within the Democratic Party’s power to deliver another 1970s-style love fest for truckers or any other blue-collar constituency. But the broad, mainstream dignity associated with workers in that earlier era is something for Democrats to aspire to in their messaging.

The ongoing labor shortage is all the more reason Democrats should keep telling blue-collar workers of all races that they are valued—and all the more reason to mean it. Our nation badly needs carpenters, electricians, plumbers and the full array of blue-collar workers who are going to help us overcome our national housing shortage and actually reconstruct our infrastructure. Politicians like Sen. Amy Klobuchar (D-Minn.) speak more often than most about job training for workers like these, as with her Skills Investment and Skills Renewal Acts (co-sponsored by Ben Sasse); others should follow her lead.

There’s other low-hanging fruit. When Democrats talk about investments in childcare, they should talk about it as not only good for the children, but good for the parents—a way to keep them in the workforce and off public benefits.

Finally, Democrats need to channel the can-do spirit of workers themselves and lead with solutions. When politicians belabor the structural challenges to which solutions are supposed to respond, some in the white working class hear government making excuses. When work is your religion, too much emphasis on what’s keeping you from making a living sounds like apostasy.

For them, the most important thing is simply to get to work. A close second is living in a country that values their work—along with a paycheck that reflects both that value and their dignity as workers.

Above is from:  https://www.yahoo.com/news/major-rift-dividing-white-working-083000790.html