September 27, 2o22: Johns Hopkins COVIF 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

SITUATION REPORT UPDATES The Center’s COVID-19 Situation Report will not be published on September 29 to allow our staff to engage in a team-building event. Additionally, beginning in October (next week!), we will shift to a once-a-week publication schedule. You can expect the report in your inbox around 1pm ET each Thursday. We truly appreciate your continued readership and support.

Support Our Work

UPCOMING WEBINAR The COVID-19 pandemic highlighted disparities in medical readiness between urban and rural communities. On Thursday, September 29, at 1pm ET, join the Capitol Hill Steering Committee on Pandemic Preparedness & Health Security for a webinar titled, Leaving No One Behind: How Can the Federal Government Help Meet the Unique Health Needs of Rural Communities in Pandemics. The session will dive into the unique health needs of US rural communities and how the federal government can aid these communities to be better prepared for a future pandemic. To register, visit:https://jh.zoom.us/webinar/register/WN_ldw-z_72QGik1qv1jC89GQ

CALL FOR PAPERS There is an opportunity to integrate Global Catastrophic Biological Risks (GCBRs) into pandemic preparedness policy and practice. In 2023, Health Security will devote a supplement to 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 more severe, globally catastrophic infectious disease pandemic. Deadline is October 3, 2022. Learn more: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/index.html

PANDEMIC PREDICTIONS Recent increases in COVID-19 cases in the UK could signal that the US is heading into a fall and winter COVID-19 surge. Historically, the US lags the UK in case trends by about one month, and the UK trend began rising the week of September 17. Some models predict US case trends will continue to decrease into October before beginning to rise, and while current predictions suggest a big increase in infections, the infection-detection rate likely will remain low due to declines in testing. Because the US population has some underlying immunity, and most experts agree the country has the pandemic under control, the death toll is expected to be rather modest.

But this modeling is based on the Omicron BA.5 subvariant, and the emergence of a new variant or subvariant could upend these predictions, particularly if there is a reduction in cross-variant immunity. BA.5 continues to account for the majority of new COVID-19 cases in the US (83.1%), but BA.4.6 (12%) and BF.7 (2.3%), an offspring of BA.5, are beginning to show growth advantage over BA.5. BF.7 has an additional genetic mutation in the spike protein compared with BA.5, which could reduce the efficacy of the monoclonal antibody treatment Evusheld, one of the few remaining therapies effective against BA.4 and BA.5. The mix of variants in the UK appears to be about the same as the US, although epidemiologists are watching to see whether emerging variants such as BQ.1.1 and BA.2.75 grow in proportion.

US President Joe Biden's declaration that the COVID-19 pandemic is "over" during a "60 Minutes" interview on September 18 raised eyebrows among many experts, most of whom agree that while some countries are in a better place than during the first year of the pandemic—exemplified by the fact that many in the US and elsewhere are returning to their pre-pandemic lifestyles—COVID-19 should remain an urgent priority. In the US, around 400 people die every day due to COVID-19, more than triple the average number who die from influenza.

The declaration by President Biden came shortly after WHO Director-General Dr. Tedros Adhanom Ghebreyesus stated that the end of the pandemic was "in sight." Both statements drew condemnation from WHO Senior Advisor Dr. Bruce Aylward, who called on high-income countries comfortable with the state of the pandemic within their borders to increase aid to low- and middle-income countries (LMICs) that are still struggling to get COVID-19 under control and gain access to vaccines, therapeutics, diagnostics, and other tools. Additionally, allowing the SARS-CoV-2 virus to maintain footholds in LMICs and elsewhere could lead to new variants with the ability to escape immunity. There remains much work to do, experts agree, as many health disparities between high-income nations and LMICs persist and will only get worse if aid is reduced or cut off. While some may feel COVID-19 is under control in places like the US, the pandemic is not over.

US CDC INFECTION CONTROL GUIDANCE The US CDC published changes to its guidance on infection prevention and control recommendations for healthcare personnel during the COVID-19 pandemic. One of the major alterations includes ending the overarching recommendation that everyone wear masks in nursing homes and hospitals. Previously, the guidance asked that everyone wear appropriate masks and respirators in these facilities, but the update only maintains that recommendation in communities experiencing high levels of transmission. The CDC said the change was made to reflect the high levels of immunity derived from vaccinations and prior infection, as well as the availability of effective treatments.

Nevertheless, elderly populations have been hit hard by the pandemic and remain among the most vulnerable. There are concerns that the new recommendation could make life even more difficult for elderly and immunocompromised people to safely navigate healthcare settings, potentially leading to fewer care options and increased stress and isolation among populations that already have suffered greatly. Additionally, many public health experts highlighted the importance of masking in the US as the nation heads into its fall and winter seasons and predictions of a new surge in COVID-19 cases. Appropriately worn masks and respirators serve as source controls that can prevent transmission during a season when many people are gathering indoors, but public appetite for new mask mandates is at an all-time low. The CDC’s guidance leaves the responsibility to take actions to protect vulnerable populations in individuals’ hands.

UPDATED BOOSTERS FOR YOUNGER CHILDREN Updated bivalent booster vaccine doses for younger children in the United States likely will be available before the end of this year. On September 23, Moderna announced in a tweet that the company is requesting emergency use authorization (EUA) from the US FDA for its vaccine booster bivalent vaccine that targets both the original strain of SARS-CoV-2 and the BA.4/5 subvariants of Omicron for adolescents aged 12 to 17 years and children aged 6 to 11 years. The company’s application for the youngest children, ages 6 months to under-6 years, is expected to be completed by year's end.

On September 26, Pfizer-BioNTech announced they have completed a submission to the FDA requesting EUA for the companies' Omicron-adapted bivalent booster for children aged 5 to 11 years. The companies also have begun a Phase 1/2/3 study to evaluate the safety, tolerability, and immunogenicity of different doses and dosing regimens of bivalent vaccine in children ages 6 months through 11 years of age. Additionally, they expect to file for marketing authorization of the bivalent booster for children aged 5-11 with the European Medicines Agency (EMA) in the coming days. Bivalent boosters from both Moderna and Pfizer-BioNTech are already authorized for adults and individuals aged 12 years and older, respectively, in the US. The FDA could make a decision on bivalent boosters for younger children before the next meeting of the US CDC's Advisory Committee on Immunization Practices (ACIP), scheduled for October 19-20.

GLOBAL VACCINE SUPPLY Last year, the US government committed to providing 1.1 billion doses of the Pfizer-BioNTech SARS-CoV-2 vaccine to low- and middle-income countries (LMICs). Last week, however, Pfizer and the US government agreed to lower the number of Pfizer-BioNTech SARS-CoV-2 vaccine doses going to LMICs this year, with Pfizer agreeing to reduce its delivery commitment from 1 billion doses to 600 million doses. Pfizer said while it can meet its previous 1 billion dose commitment, the revised commitment reflects reduced demand for vaccine doses in LMICs, barriers in administration, and vaccine hesitancy, and provides more time for the US and its partners to address delivery and administration challenges. The US will retain an option to purchase the additional 400 million doses for its international program after this year. Under the US contract, Pfizer previously delivered more than 400 million vaccine doses to 79 countries through the COVAX initiative.

During earlier stages of the COVID-19 pandemic, many experts criticized high-income countries for hoarding vaccines and other pandemic supplies, thereby perpetuating inequitable access to lifesaving supplies during the height of the pandemic. The COVAX program was designed to ensure equitable access to vaccines and has donatedmore than 1.7 billion COVID-19 vaccine doses to 146 countries. While the program ramped up, demand for SARS-CoV-2 vaccines outmatched the supply of approved products and vaccine manufacturers prioritized bilateral customers. Pfizer executives shared that the global effort to develop, manufacture, and distribute vaccines during the COVID-19 pandemicrevealed important lessons around how to configure supply chains and design tighter logistics strategies for the future. While some countries are declaring an end to the COVID-19 pandemic, supply chain issues persist in many parts of the world, and only 24% of people in low-income countries have received at least one dose of vaccine. The shift in attention away from the pandemic was highlighted last week during the United Nations General Assembly (UNGA) meetings, where discussions about vaccine equity remained notably absent.

Despite slowing vaccine donation efforts, the US government and Pfizer remain committed to providing other critical supplies to LMICs. On the sidelines of the UNGA at the COVID Global Action Plan Ministerial Meeting, the US government announcedplans to establish a clearinghouse of medical supplies to help other countries combat COVID-19, expand its program to distribute therapeutic drugs in 10 countries, expand access to medical oxygen, train healthcare workers in LMICs, and introduce early testing systems that can help healthcare workers identify COVID-19 patients who qualify for treatment. Additionally, Pfizer recentlyannounced its intent to supply up to 6 million treatment courses of Paxlovid, its COVID-19 oral treatment, to the Global Fund as part of its COVID-19 Response Mechanism (C19RM). Depending on local regulatory approvals, 132 Global Fund-eligible LMICs will be able to procure Paxlovid beginning this year. These commitments are a crucial component of a global response to COVID-19, which exposed and continues to worsen concerning gaps in global pandemic preparedness and response systems.

CRYPTIC LINEAGES Nature examines the work of a team of scientists using wastewater surveillance to hunt for the next SARS-CoV-2 variant. In January 2022, the team identified a lineage that shared several mutations with the predominant Omicron variant of concern (VOC) but came from a different branch of the viral family tree. They then traced the cryptic lineage back to one Wisconsin business employing fewer than 30 people. None of the employees tested by nasal swab have shown signs of the lineage, leading the researchers to suspect an individual might be harboring the virus in their gut. While it does not appear the cryptic lineage is spreading, it has gained additional mutations since first being identified. Even if they do not identify the Wisconsin individual in which the virus is evolving, the researchers hope their sleuthing will inform future efforts to identify, track, and forecast emerging SARS-CoV-2, or other virus, variants.

September 19, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

“PANDEMIC IS OVER” In an interview with “60 Minutes” at the North American International Auto Show in Detroit, Michigan,US President Joe Biden said he believes that the COVID-19“pandemic is over” while simultaneously acknowledging that the disease continues to be a “problem.” Notably, a White House team that reviewed the transcript of the interview, which aired September 18 but was taped last week, did not alert its COVID-19 response team about the declaration,leaving senior federal health officials surprised and without a coordinated response for the immediate reactions. President Biden had not originally planned to make headlines on COVID-19, nor had he discussed an end to the pandemic with his health advisors. The day after the interview aired,US HHS Secretary Xavier Becerra supported the president’s comments, saying that effective vaccines, tests, and treatments put the nation on a better path than earlier in the pandemic and noted the administration is reviewing whether it will renew the national declaration of a public health emergency.

But President Biden’s comments drewswift and sharp reactions from public health experts and appeared tofurther divide opinions over when and how the nation will move out of a pandemic state and into one ofendemicity. Some experts supported the president’s comments, noting that whileCOVID-19 should continue to qualify as a top national priority, much of the nation is settling into a new way of life. Other experts fear that President Biden’s declaration furthermuddles the messaging surrounding the pandemic and comes at aninopportune time, when the US government is rolling out new bivalent vaccine boosters and asking the US Congress for additional emergency spending. Additionally, virologists are seeing signs of viral resurgence, underlining the enormous amount of uncertainty surrounding the future.

While there areno clear markers to the end of a pandemic, some experts point to 2 ways to determine when an outbreak emergency is over: by looking at what the disease is doing physically and psychologically to a population. To be sure, President Biden’s comments reflect a general national sentiment that people want to move on from the pandemic and that the situation differs significantly from 2 years ago. Schools are open;air travel has returned to pre-pandemic levels; workers arereturning to offices at the highest rates since the start of the pandemic, although1 in 3 say they fear infection by working in offices; and COVID-19testing labs and at-home test manufacturers are downsizing, but primarily due to a lack of funding.

However,many, including White House Chief Medical Advisor Dr. Anthony Fauci, are worried thenation is not where it needs to be in order to “live with the virus.” The US continues torecord more than400 daily deaths, and the world countsmore than 1,600 deaths each day. Notably, this means the US accounts for nearly 25% of the worldwide daily COVID-19 mortality, despite representing only 4% of the global population. A significant portion of the US population remains unvaccinated or under-vaccinated, and therefore at elevated risk of severe disease and death. Nationally, 68% of the population has received a primary vaccine series but only35% of those over age 5 have gotten a first vaccine booster dose. The president’s remarks couldfurther hinder efforts to increase vaccination and booster rates ahead of what many expect will be a surge in cases over the winter. Additionally, the pandemic has had crippling health, social, and economic impacts on essential workers and vulnerable populations, such as those who are immunocompromised, and on the estimated 18-23 million US residents who are suffering the long-term physical and mental health effects oflong COVID.

President Biden’s remarks also likely will undercut his administration’s efforts to procure additional emergency spending for COVID-19. The White House has requested US$22.4 billion from the US Congress, but leading Republicans, who werealready skeptical about authorizing additional funding, said the president’s commentsessentially shut the door on negotiations as well as raise questions about other pandemic-related measures. Without additional funds for vaccine, treatment, and diagnostic supplies, or for research into next generation vaccines that could prevent SARS-CoV-2 transmission, the burden to pay for pandemic-related tools and stop chains of transmission will shift to the US public, and it remains to be seen whether federal and state policymakers will learn lessons from this pandemic in order to strengthen public health infrastructure to prepare for the next.

US VACCINATION CAMPAIGN The US Department of Health and Human Services last week released a video advertisement to encourage people to get updated SARS-CoV-2 vaccine booster shots. The ad specifically highlights those who are aged 50 and older, and shares the importance of getting the updated, bivalent vaccines, which are expected to provide additional protection against currently circulating SARS-CoV-2 Omicron subvariants. More than 200 million people are eligible for the new vaccines, however demand has dropped considerably with each new round of shots. More than half of people eligible for previous boosters never got them. Nevertheless, several pharmacies and hospitals in California, Hawaii, and Washington, DC, have reported running out of doses of the updated Moderna booster but expect additional supplies soon.

Additionally, several reports have raised concerns over the potential for vaccine administration errors, particularly among children. While there is no evidence vaccine mix-ups have caused more severe adverse events, the complexity involved in keeping straight up to 11 different vaccine brands and formulations has led the US CDC to produce visual guides for vaccine administrators. The potential for errors further undercuts parents’ already low interest in vaccinating their young children. Only about 410,000 children aged 5 and younger have been fully vaccinated since the vaccines became available for this age group in June, according to CDC data. The number of COVID-19 deaths among children is low, but scientists remain concerned about possible long-term complications of COVID-19 among children. Many physicians, and parents, have cited failures among government and local public health agencies to adequately promote the vaccine, communicate about its availability, and debunk circulating myths. Some health officials are concerned that hesitancy to vaccinate children against COVID-19, as well as other diseases, could lead to future outbreaks of other childhood infections.

Public health experts had hoped that another vaccine option—the adjuvanted protein-based SARS-CoV-2 vaccine from Novavax that uses a more traditional platform—would help win over those who were hesitant to receive the newer mRNA-based vaccines. But since it was authorized in July, uptake remains low, with only 6,278 people fully vaccinated using the Novavax vaccine. Outside of the US, the Novavax vaccine has been approved in 38 other countries, including in Japan and Australia, which each recently approved the vaccine for use as a booster.

EU EMERGENCY SUPPLY CHAIN POWERS The European Commission has shared a proposed rule that would make EU Member States prioritize the production of key goods and services to preserve supply chains in a crisis. The Single Market Emergency Instrument would create a crisis governance framework to prevent market fragmentation, drawing on lessons from the COVID-19 pandemic. Among the interventions available to the European Commission, breaking contracts to facilitate the production and stockpiling of critical products would be an option, as well as repurposing production lines and facilitating expansion to prevent bottlenecks like those experienced during the COVID-19 pandemic and the Russian invasion of Ukraine. The emergency powers of the proposal aim to reorganize supply chains as quickly as possible and support the increase and availability of crisis-relevant goods. The proposal includes fines up to 300,000 euros for companies that share incorrect or misleading information. The effort, which echoes similar efforts in the United States and Japan, will likely face pushback from businesses concerned with the expanded power the ruling is overreaching and intrusive.

VACCINE PRODUCTION IN AFRICA Amid slowing global demand for SARS-CoV-2 vaccines, the world’s largest producers of vaccines for COVID-19—Pfizer-BioNTech and Moderna—continue to face pressure to allow low- and middle-income countries (LMICs) to produce their vaccines after much of the supply was purchased by high-income countries. Under a fill and finish agreement with Pfizer-BioNTech, the South Africa-based Biovac Institute, which is partly owned by the South African government, recently produced its first batch of the companies’ vaccine. The doses, the first of Pfizer-BioNTech’s shots to be produced in Africa, will undergo regulatory review and additional batches are expected to be commercially available next year. Aspen Pharmacare, which is authorized to fill and finish vials of the J&J-Janssen SARS-CoV-2 vaccine under its Aspenovax brand for distribution in Africa, earlier this year cautioned it might have to halt its vaccine production lines because it had not received a single order. At the end of August, Aspen announced it signed a deal with the Serum Institute of India to manufacture and sell 4 Aspen-branded vaccines for Africa, effectively keeping the production lines open. Moderna reportedly is seeking a partner on the continent to produce its SARS-CoV-2 vaccine.

In related news, Moderna has allowed the use of its vaccine in clinical trials to test a shot developed by Afrigen Biologics & Vaccines, another South African biotechnology company working with the WHO as part of its mRNA Vaccine Technology Transfer Hub. Afrigen is working to develop mRNA-based SARS-CoV-2 vaccines to increase production and access for LMICs. Instead of supplying the vaccine directly, Moderna approved the Medicines Patent Pool to provide its vaccine to Afrigen for use in early-stage clinical trials; Pfizer-BioNTech refused a similar request because the companies did not see the need as urgent. Afrigen expects to begin human trials of its mRNA vaccine candidate by May 2023. Additionally, Moderna last week said it is open to supplying the Chinese government with its vaccine, although no final decision has yet to be reached. China has not authorized the use of any foreign-made SARS-CoV-2 vaccines, relying on several domestically produced shots.

TREATMENT ACCESS & UPDATES Amid heightened demand from low- and middle-income countries (LMICs) for expanded access to COVID-19 therapeutics, little progress has been made at the World Trade Organization (WTO) toward reaching an agreement to include COVID-19 therapeutics and diagnostics in a limited deal reached earlier this year to temporarily waive patents on SARS-CoV-2 vaccines. High-income countries, including the UK, Switzerland, EU Member States, and the US, as well as pharmaceutical companies, appear opposed to extending the deal to treatments and tests by the end-year deadline.

Separately, a program aimed at bringing oral COVID-19 antivirals to 10 LMICs in sub-Saharan Africa and Asia—Ghana, Kenya, Laos, Malawi, Nigeria, Rwanda, South Africa, Uganda, Zambia, and Zimbabwe—recently launched. With support from nonprofit organizations and other partners, the COVID Treatment Quick Start Consortium will provide Pfizer’s Paxlovid (nirmatrelvir-ritonavir) through pilot programs to evaluate the best ways to implement test-to-treat programs in areas with limited healthcare resources and infrastructure.

In other treatment news, the European Medicines Agency (EMA) last week extended its authorization of AstraZeneca’s preventive COVID-19 therapy Evusheld (tixagevimab co-packaged with cilgavimab) as a treatment for the disease among adults and adolescents with COVID-19 who do not need supplemental oxygen but who are at increased risk of disease progression. Last month, Japan became the first country to approve the monoclonal antibody for COVID-19 treatment. Several nations already have authorized Evusheld as a preventive therapy among people with compromised immune systems who do not respond to vaccination in several nations, including the US.

Additionally, the WHO last week strongly advised against the use of 2 different antibody therapies—sotrovimab as well as casirivimab-imdevimab—to treat patients with COVID-19 because they have limited clinical activity against currently circulating viral variants. The US FDA previously pulled or limited the use of the drugs, and some experts criticized the WHO for waiting to make the updated recommendation. The WHO expanded its conditional recommendation for the antiviral remdesivir to cover patients with severe COVID-19 and those with non-severe infections but who are at high risk of hospitalization.

Only a handful of COVID-19 therapeutics remain useful against currently circulating SARS-CoV-2 strains. While researchers quickly developed 4 effective treatments for hospitalized COVID-19 patients in the year between January 2020 and February 2021, no new therapies for hospitalized patients have been authorized since February 2021, raising concerns about whether treatment advancements have stalled.

The name “Squaw” eliminated by feds

Will Boone County ever change the name of Squaw Prairie Road?

2 Illinois sites get new names, eliminating derogatory term

4h ago

PALOS PARK, Ill. (AP) — A suburban Chicago waterway and a western Illinois island have been renamed under a new national policy to remove their previous names' use of a racist term for a Native American woman.

The water feature near Palos Park in Cook County was formerly called Laughing Squaw Sloughs, but is now known as Cherry Hill Woods Sloughs, while the former Squaw Island in Calhoun County has been renamed Calhoun Island.

The two Illinois sites were renamed on Sept. 8 and are among nearly 650 geographic features across the nation to receive a new name following an order by U.S. Interior Secretary Deb Haaland, who is the first Native American to lead a cabinet agency,

Haaland’s order, issued in November, declared the word “squaw” derogatory and created a process for reviewing and replacing geographic place names that use the term.

Dorene Wiese, a member of the White Earth Ojibwe Nation and president of the American Indian Association of Illinois, said that dating back to the 1800s, cartoon drawings depicted Indigenous women and used the term “squaw" in an offensive way.

Wiese, 73, hopes that removing references to the word in place names will be a step to ensure that the next generation won’t be subjected to its offense, or even know of the word at all.

“That’s our hope, that in the future that will be erased,” she told the Chicago Tribune.

Above is from:  2 Illinois sites get new names, eliminating derogatory term (msn.com)

**********************************************************************************************************************************************************************

U.S. Department of the Interior

Secretary Haaland Takes Action to Remove Derogatory Names from Federal Lands

Secretarial Orders declare “squaw” a derogatory term, create Reconciliation in Place Names advisory committee to identify and replace additional derogatory names

11/19/2021

Date: Friday, November 19, 2021
Contact: Interior_Press@ios.doi.gov

WASHINGTON — Secretary of the Interior Deb Haaland today formally established a process to review and replace derogatory names of the nation’s geographic features. She also declared “squaw” to be a derogatory term and ordered the Board on Geographic Names – the federal body tasked with naming geographic places – to implement procedures to remove the term from federal usage.

"Racist terms have no place in our vernacular or on our federal lands. Our nation’s lands and waters should be places to celebrate the outdoors and our shared cultural heritage – not to perpetuate the legacies of oppression,” said Secretary Haaland. “Today’s actions will accelerate an important process to reconcile derogatory place names and mark a significant step in honoring the ancestors who have stewarded our lands since time immemorial.”

Secretarial Order 3404 formally identifies the term “squaw” as derogatory and creates a federal task force to find replacement names for geographic features on federal lands bearing the term. The term has historically been used as an offensive ethnic, racial, and sexist slur, particularly for Indigenous women. There are currently more than 650 federal land units that contain the term, according to a database maintained by the Board on Geographic Names.

The newly created Derogatory Geographic Names Task Force will include representatives from federal land management agencies, as well as diversity, equity, and inclusion experts from the Department. The Order requires that the task force engage in Tribal consultation and consider public feedback on proposed name changes.

Additionally, Secretarial Order 3405 creates a Federal Advisory Committee to broadly solicit, review, and recommend changes to other derogatory geographic and federal land unit names. The Advisory Committee on Reconciliation in Place Names will include representation from Indian Tribes, Tribal and Native Hawaiian organizations, civil rights, anthropology, and history experts, and members of the general public. It will establish a process to solicit and assist with proposals to the Secretary to change derogatory names, and will include engagement with Tribes, state and local governments, and the public.

Together, the Secretarial Orders will accelerate the process by which derogatory names are identified and replaced. Currently, the Board on Geographic Names is structured, by design, to act on a case-by-case basis through a process that puts the onus on the proponents to identify the offensive name and to suggest a replacement. The process to secure review and approvals can be lengthy, often taking years to complete a name change. Currently, there are hundreds of name changes pending before the Board. The newly established Federal Advisory Committee will facilitate a proactive and systematic development and review of these proposals, in consultation with local community representatives.

The Board on Geographic Names – originally established by Executive Order in 1890 – is a federal body designed to maintain uniform geographic name usage throughout the federal government. It is comprised of representatives from federal agencies concerned with geographic information, population, ecology, and management of public lands. In 1947, the Secretary of the Interior was given joint authority with the Board on Geographic Names and has final approval or review of its actions.

Derogatory names have previously been identified by the Secretary of the Interior or the Board on Geographic Names and have been comprehensively replaced. In 1962, Secretary Stewart Udall identified the N-word as derogatory, and directed that the BGN develop a policy to eliminate its use. In 1974, the Board on Geographic Names identified a pejorative term for “Japanese” as derogatory and eliminated its use.

Several states have passed legislation prohibiting the use of the word “squaw” in place names, including Montana, Oregon, Maine, and Minnesota. There is also legislation pending in both chambers of Congress to address derogatory names on geographic features on public land units.

September 15, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

EPI UPDATE The WHO COVID-19 Dashboard reports 607 million cumulative cases and 6.50 million deaths worldwide as of September 14. Global weekly incidence continues to decline, for the fifth consecutive week—down 25% from the previous week. Global weekly mortality decreased as well, for the fourth consecutive week—down 19% from the previous week.

Weekly incidence continues to decline in all WHO regions, ranging from -5% in Europe to -36% in the Western Pacific region. Notably, the pace of the decreasing trend in Europe appears to be slowing, and the region may be approaching a local minimum or plateau.

UNITED STATES

The US CDC is reporting 95.2 million cumulative cases of COVID-19 and 1,046,195 deaths. Daily incidence continues to decline, down to 60,558 new cases per day. This is the lowest average since May 1 and a 54% decrease from the most recent peak on July 16. Daily mortality continues to decline as well, down to 350 deaths per day. This is the lowest average since July 9 and a decrease of 30% from the most recent high on August 12. The CDC reported a slight increase in both daily incidence and mortality on September 12, but this is likely due to delayed reporting over the US Labor Day holiday weekend.*

*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 and current hospitalizations continue to exhibit downward trends, with decreases of 6.5% and 5.4%, respectively, over the past week. Both trends peaked around the last week of July, similar to trends in daily incidence, and both are approximately 80% lower than the record peak in mid-January 2022.

The BA.5 sublineage continues as the dominant strain in the US, accounting for 87.5% of sequenced specimens; however, growing evidence indicates that BA.4.6 might be capable of outcompeting it. The prevalence of BA.4.6 has steadily increased since at least mid-summer 2022, but the BA.5 prevalence increased more rapidly over much of that period. This is the first week that the CDC’s Nowcast projection shows a noticeable decrease in BA.5 prevalence**, while BA.4.6 continues to account for a larger share of US cases. Since last week, the BA.4.6 prevalence increased from 8.3% to 9.2%, while the prevalence of BA.5 fell slightly from 87.9% to 87.5%. The prevalence of all other reported lineages continues to decline, and together, the Omicron sublineages account for essentially all new US cases.

**From the week of August 27 to the week of September 3, the BA.5 prevalence decreased from 88.0% to 87.9%, but we interpret this as essentially remaining constant over that period.

PANDEMIC RESPONSE EVALUATIONS As daily COVID-19 incidence and mortality continue to decline globally, attention is shifting to pandemic recovery efforts, including lessons for future pandemic preparedness and response. In a long-awaited report published September 14, The Lancet COVID-19 Commission described the tremendous pandemic death toll as “both a profound tragedy and a massive global failure at multiple levels,” underlined by an absence of international cooperation, dismissal of risks by national leaders, influence of misinformation, paucity of governmental and organizational transparency, and disregard for basic public health precautions. As a result, COVID-19 impacted countries in “highly unequal” ways, with particularly severe outcomes for the most vulnerable populations, including children, immigrants and refugees, and those in low- and middle-income countries (LMICs). Additionally, a substantial portion of COVID-19 survivors continue to experience prolonged health effects stemming from SARS-CoV-2 infection, and many people are dealing with the impact of COVID-19-related deaths among family and friends. The report cites the rapid development of vaccines as a positive example of international cooperation, but it also acknowledges substantial disparities in vaccination coverage at the national level, particularly between LMICs and higher-income countries. The report also calls attention to downstream and longer-term effects of the pandemic, including setbacks in progress toward achieving Sustainable Development Goals (SDGs) in many countries.

The report—produced by a panel of 28 experts who consulted more than 170 contributors through 12 task forces—makes several recommendations falling under 5 pillars: prevention, containment, health services, equity, and global innovation. The recommendations include improving multilateral cooperation; implementing a “vaccination-plus” strategy that combines vaccination with other medical countermeasures (MCMs) and nonpharmaceutical interventions (NPIs); improving surveillance and prevention for natural and accidental spillover events; expanding international research and development and manufacturing capacity for vaccines and other products; establishing sustainable financial support for LMICs; and strengthening the WHO and national health systems. The report also calls for intensifying efforts to identify the origins of SARS-CoV-2, noting that the task force examining the pandemic’s origins was ended because “the divisive public discussion about the source of SARS-CoV-2 damaged the trust needed for the task force to complete its work.”

The report has already met pushback from some experts and organizations, including the WHO. The WHO issued a statement in response to criticisms that it acted too cautiously and sluggishly, both to declare a public health emergency of international concern (PHEIC) and warn of the potential for airborne/aerosol transmission. The WHO emphasized that it welcomes the report’s overarching recommendations but argued that there are “several key omissions and misinterpretations,” particularly related to the speed with which the WHO responded to the initial outbreak. Additionally, several experts criticized the report for reviving debate about the virus’ origins and for omitting recent relevant evidence that the novel coronavirus likely emerged through a zoonotic event in a market in Wuhan, China. Notably, the commission’s Chair, Dr. Jeffrey Sachs, has publicly supported the “lab leak” theory as the origin of the virus, and some contest that his personal beliefs unduly influenced the commission’s findings.

Earlier on September 14, WHO Director-General Dr. Tedros Adhanom Ghebreyesus told journalists during his weekly briefing that the world has “never been in a better position to end the pandemic” but is “not there yet.” He called on the international community to “seize this opportunity” and announced the release of 6 WHO policy briefs that outline essential actions for national and subnational policymakers to help reach the goal of ending the pandemic. The briefs include guidance for testing, vaccination, clinical disease management, healthcare facility infection control, combating misinformation, and community engagement. Following those comments, Africa CDC Acting Director Dr. Ahmed Ogwell Ouma emphasized that low vaccination coverage and ongoing transmission across the continent illustrate that COVID-19 remains a major threat.

In related news, an investigation published today by POLITICO and the German newspaper WELT examines the influence of several entities in the COVID-19 pandemic response, including the Bill & Melinda Gates Foundation; the Wellcome Trust; Gavi, the Vaccine Alliance; and the Coalition for Epidemic Preparedness Innovations (CEPI). The investigation concludes that the organizations were better prepared than governments for an infectious disease outbreak; the groups’ leaders were able to routinely meet with high-level government and multilateral organization leaders; they pledged billions of dollars to help close equity gaps for vaccines and treatments but hoarding by high-income nations got in the way; and their initial lack of support for intellectual property waivers might have impeded access to vaccines and therapeutics in LMICs. Several experts have criticized the report for being shortsighted and naïve, including by undervaluing public-private partnerships in pandemic responses and misrepresenting CEPI and Gavi—both financial intermediary funds (FIFs) under the World Bank—as nongovernmental organizations.

US GLOBAL RESPONSE & RECOVERY The Biden administration today released an updated version of its US COVID-19 Global Response & Recovery Framework, meant to help guide the US commitment to a globally equitable end to the emergency phase of the pandemic by working with international partners to use available tools and expertise, integrating COVID-19 response elements into existing health structures, and improving global pandemic preparedness. The plan outlines 3 primary objectives to achieve those goals: vaccinating those who are at highest risk and the hardest-to-reach by ensuring access to vaccines and integrating vaccinations into existing health structures; integrating and scaling testing and treatment efforts into existing health structures without disrupting other health services; and preparing for future variants and pandemic threats by strengthening health security infrastructure to detect and rapidly respond to emerging threats. The updated global framework comes at a time when the US is facing domestic pandemic fatigue, dwindling amounts of federal funding, and hundreds of daily deaths due to COVID-19.

US ECONOMIC IMPACTS Recent data from the US Census Bureau is helping to illuminate impacts of the COVID-19 pandemic and response. The bureau released 1-year estimates from its American Community Survey today, showing various social and economic changes. For example, fewer people moved to a new home, more people gained internet access through expanded coverage and computer ownership, more unmarried couples moved in together, more people spent over 30% of their income on rent, preschool enrollment dropped, and public transportation use dropped by half. Another report, the 2022 Current Population Survey Annual Social and Economic Supplement (CPS ASEC), included some rare good news. Childhood poverty is at a historic low, falling from 9.7% to 5.2% between 2020-2021. Experts attribute much of this improvement to the boosted child tax credit included in the American Rescue Plan that provided families additional money to pay for food, clothes, education, and extracurricular activities. Notably, the overall poverty rate also fell to 7.8% in 2021 from 9.2% in 2020. Additionally, the report shows that insurance coverage expanded in 2021, most likely due to pandemic-related measures that mandated a continuous enrollment provision Medicaid. Many of these measures have already ended or are set to expire, and it is now up to the US Congress to decide whether these measures should be renewed or stay in place.

LONG COVID IN EUROPE An estimated 17 million people across the WHO’s Europe region experienced post-acute sequelae or long-term symptoms of COVID-19, also known as long COVID, during the pandemic’s first 2 years, according to a modeling study conducted by the Institute for Health Metrics and Evaluation (IHME) for WHO/Europe. The region comprises 53 Member States across Europe and Central Asia that are home to nearly 900 million people. The report highlights the ongoing public health challenges posed by the condition, which is characterized by cognitive and mental health problems, fatigue, shortness of breath, and other symptoms experienced 12 weeks or more following a COVID-19 diagnosis.

The report, published September 13, found the number of new long COVID cases identified between 2020 and 2021 rose threefold, driven by the rapid increase in confirmed COVID-19 cases from late 2020 through 2021; women are twice as likely than men to suffer from the condition; and the risk of long COVID increases dramatically among people with severe infections who need hospitalization. WHO officials and the report authors said that although most people fully recover from COVID-19, the findings underline the need for additional analysis and investment to determine the long-term effects of the disease, including implications for the workforce and the need for rehabilitative and support services.

SARS-COV-2 VACCINE BOOSTER DURABILITY Recently published data on SARS-CoV-2 vaccine booster durability indicate that protection wanes by approximately 10-20% each month. Researchers at Ohio State University conducted a longitudinal study of healthcare workers to assess the durability of antibody titers stimulated by booster doses and published their preliminary analysis as a commentary in the New England Journal of Medicine. The study included 46 fully vaccinated participants who received their first booster—24 with the Moderna vaccine and 22 with the Pfizer-BioNTech vaccine*—and serum specimens were collected every 3 months after the booster dose to assess neutralizing antibody titers against the multiple variants, including the Omicron variant of concern (VOC).

*Neither the commentary nor supplementary appendix explicitly indicates whether the booster doses were the monovalent or bivalent formulation, but based on the study timing and duration, we understand them to be monovalent.

Among the participants, 14 had breakthrough infections during the study period, including 9 during the US Omicron variant surges. Notably, the duration of antibody titers was more robust in individuals with prior SARS-CoV-2 infection. Overall, neutralizing antibody titers decayed at a mean rate of 17.53% per month against lineages containing the D614G mutation (ie, Omicon sublineages). More specifically, titers decayed by 19.50% against the B.1 sublineage, 18.44% against BA.2.12.1, and 19.55% against BA.4/5 each month. Among participants with previous SARS-CoV-2 infection, antibody titers decayed 17.07% against lineages containing the D614G mutation, 14.22% against BA.1, 9.97% against BA.2.12.1, and 12.12% against BA.4/5. Additionally, the decay in antibody titers following the first booster dose was slower than after receiving the second dose of the primary series of the vaccines.

Experts note that waning protection is not unexpected for vaccines, emphasizing that this should not dissuade anyone from recommended booster doses. Some experts, however, have called attention to the contrast between this analysis and federal officials’ recent comments about plans for annual boosters, much like seasonal influenza. They argue that if antibody titers wane over a period of several months, annual boosters may not be often enough to provide sufficient protection. Available evidence demonstrates that booster doses do maintain protection against severe disease; however, rapid waning of that protection may necessitate regular booster doses—potentially as frequently as 4 months—especially for those at elevated risk of severe disease and death. Others posed questions regarding barriers to accessing booster doses, particularly in the context of the generally low coverage for annual seasonal influenza vaccinations.

Another issue is the absence of clearly defined and regular seasonal trends for COVID-19. While seasonal influenza tends to peak annually in the winter months, the COVID-19 pandemic has not exhibited traditional seasonality, peaking multiple times each year, across all seasons. Additionally, the emergence of new variants of concern or associated sublineages has occurred more frequently than once per year so far in the pandemic, which White House officials acknowledged could necessitate additional booster doses. Many questions remain regarding future COVID-19 trends and how those will factor into vaccination planning and guidance.