October 27, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

CALL FOR APPLICATIONS Applications are now open for the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity (ELBI) Fellowship Class of 2023. ELBI inspires and connects the next generation of biosecurity leaders and innovators. This highly competitive, part-time program is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events. Applications can be submitted through 11:59PM (EST) November 11, 2022. Learn more about eligibility requirements and application materials here: https://www.centerforhealthsecurity.org/our-work/emergingbioleaders/apply.html

EPI UPDATE The WHO COVID-19 Dashboard reports 625.7 million cumulative cases and 6.56 million deaths worldwide as of October 26. Global weekly incidence dropped to 2.8 million new cases after remaining steady for 6 weeks, decreasing 12.5% compared to the previous week. Weekly incidence in all regions remained relatively steady or fell over the previous week. Global weekly mortality continued to decrease for the tenth consecutive week, down 11.6% from the previous week.*

*The WHO dashboard notes that data from the Africa Region are incomplete.

UNITED STATES

The US CDC is reporting 97.1 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending October 19 remained steady over the previous week, at 260,808 reported cases. Weekly mortality also remained steady for the week ending October 19, at 2,566 reported deaths.**

**Beginning October 20, the US CDC began reporting and publishing aggregate case and death data, and line level data where applicable, from jurisdictional and state partners on a weekly basis rather than daily. As a result, COVID-19 data on cases and deaths are updated every week on Thursdays by 8pm ET.

New hospital admissions remained steady last week, increasing 1.1%, while current hospitalizations continued to exhibit a downward trend, decreasing 2.9% over the past week. Both trends peaked around the end of July and both now appear to be leveling.

The BA.5 sublineage continues to be the dominant strain in the US, accounting for 62.2% of sequenced specimens; however, its estimated prevalence has decreased for 9 consecutive weeks. The second most prevalent sublineage, BA.4.6, appears to be losing its growth advantage to others, decreasing to 11.3% as of October 22. Several other Omicron sublineages continue to exhibit increasing trends, including BQ.1 (9.4%), BQ.1.1 (k7.2%), and BF.7 (6.7%). BA.2.75 (1.6%) and BA.2.75.2 (1.3%) and also show relative growth advantage over BA.5.

GLOBAL PANDEMIC PROJECTIONS The number of new daily global COVID-19 cases is projected to rise slowly over the coming months, increasing from about 17 million now to about 18.7 million by the end of January 2023, the University of Washington Institute for Health Metrics and Evaluation predicts in an analysis published this week. The increase will be impacted by the emergence of various Omicron lineage subvariants, seasonal behavioral changes, and COVID-19 policies in China, where many of the world’s most susceptible population resides. The model’s reference scenario also estimates 245,000 additional reported deaths due to COVID-19 will occur through February 1. The analysis also includes estimates using an 80% mask use scenario and an antiviral access scenario.

‘TRIPLEDEMIC’ Experts in the US are warning the nation could see a convergence of three respiratory diseases—COVID-19, influenza (flu), and respiratory syncytial virus (RSV)—this fall and winter, in what some are calling a “tripledemic.” There are signs that cases of all three infections are rising in parts of the country, likely driven by people feeling confident enough to stop wearing masks and gather more indoors. Newly emerging sublineages of the Omicron variant of concern (VOC) have mutations that potentially make them resistant to existing therapeutics and preventive treatments and possibly immune evasive enough to bypass protections provided by previous infections or vaccination. That is leading the US government to step up efforts to get more people vaccinated and boosted with newer bivalent shots that target the Omicron BA.5 and BA.4 lineages.

Cases of RSV are surging earlier than usual, especially among young children. While many kids contract the virus by age 2 through mingling with other children, there is a potential that nonpharmaceutical interventions—such as lockdowns, social distancing, masking, and increased hygiene—helped to limit the spread of other respiratory diseases, essentially creating an “immunity gap.” Therefore, some toddlers and infants have never been exposed to RSV, leaving them more susceptible to infections. Notably, there is no vaccine and no effective treatment for RSV. Most people recover within a week or two, but RSV can be serious for young children and older adults who have weaker immune systems or underlying health conditions. Already, about three-quarters of pediatric hospital beds nationwide are full and emergency rooms are experiencing long waits.

Additionally, some parts of the country, especially Southern states, are experiencing an early flu season. Flu rates are highest among young children aged 0-4, but the number of cases is increasing in every age group. The past two years saw lower-than-average numbers of cases, and though there is a flu vaccine, protection rates range from 20%-60%. And, unfortunately, flu vaccine uptake dropped during the pandemic. The Southern Hemisphere saw an early flu season with higher case numbers and higher hospitalizations, and many feel nations in the Northern Hemisphere will follow that trend as the weather cools. With hundreds of circulating SARS-CoV-2 variants and increases of other respiratory viruses, taking steps to prevent disease transmission—including getting vaccinated and/or boosted, staying home if sick, wearing masks, and washing hands—remains vital this season to help prevent further strain on the healthcare system, severe disease, and more deaths.

US BOOSTER CAMPAIGN As the US heads into its third winter of the COVID-19 pandemic, US health officials this week announced additional efforts to encourage individuals, particularly those who are older or immunocompromised, to get vaccinated or boosted against COVID-19 at no cost. US President Joe Biden publicly received his fifth shot, coinciding with the release of an updated COVID-19 plan that includes enlisting Walgreens, DoorDash, and Uber to provide free delivery of antiviral prescriptions, calling on educational institutions to hold vaccination clinics for their communities, encouraging employers to provide paid time off for employees to get vaccinated, and urging building operators to improve indoor air quality.

The US appears to be in a better position heading into this winter, with treatments and vaccine doses more widely available, but Biden administration officials are concerned another surge in cases, as well as rising cases of other respiratory diseases, could overwhelm healthcare systems and lead to more deaths. Some experts are concerned a crisis-fatigued public and mixed pandemic messaging are making booster campaign efforts more challenging; only about 19.4 million US residents have gotten the updated shot, accounting for less than 10% of those who are eligible, according to US CDC data. The Omicron subvariants BQ.1 and BQ.1.1 are gaining ground in the US, and for those already vaccinated, receiving an updated booster dose is the best protection from severe disease or death. While some might not look forward to vaccination side effects, a study published October 21 in JAMA Network Open suggests those who experience fever, chills, or muscle pain tended to have more robust antibody responses following the shots. But don’t worry: even among those who experience little to no side effects, vaccines elicit a strong immune response.

BIVALENT BOOSTER IMMUNE RESPONSE Early data on the immunogenicity of the new bivalent booster targeting the Omicron BA.4 and BA.5 Omicron sublineages show the shots appear to work about as well as earlier monovalent booster doses. The two preprint studies—one from researchers from Harvard University and the other from Columbia University—show that neutralizing antibody responses to the bivalent vaccine formulation were about the same as those to the monovalent vaccine formulation when examined 3-5 weeks post-vaccination. Researchers emphasized, however, that the boosters still offer robust and prolonged protection against severe disease or death from COVID-19, and public health officials continue to encourage people to get boosted as soon as possible. Some experts suggested that the studies were not run for a long enough time and included too small of a population to provide a full picture of bivalent vaccine booster immunogenicity.

US COVID DEATH RATES A data brief published October 25 by the National Center for Health Statistics (NCHS) analyzed COVID-19 mortality rates in 2020, illuminating demographic trends early on in the outbreak according to urbanicity, age, and sex. The report’s findings noted that overall age-adjusted COVID-19 death rates ranked highest to lowest were found in large central metropolitan urban counties, noncore rural counties, micropolitan rural counties, large fringe metropolitan urban counties, small metropolitan urban counties, and medium metropolitan urban counties. When broken down by sex, geographic trends remained largely similar, although the highest death rates for women were found in noncore rural counties and the second highest death rates found in large central metropolitan urban counties. Notably, death rates were at least 50% higher for men than women across all counties, with the greatest difference found in large central metropolitan urban counties, where rates were 78% higher for men.

Another data brief by NCHS found that this trend was further exacerbated in adults aged 65 and older, with males experiencing death rates 1.5 times higher than females. Sex differences in COVID-19 death rates in adults aged 65 and over held across all races. Death rates in older men were highest among Hispanic men, followed by non-Hispanic Black men and non-Hispanic American Indian or Alaska Native men. Death rates among older women were highest among non-Hispanic American Indian or Alaska Native women, followed by non-Hispanic Black women and Hispanic women. As has been well-established in other studies, overall COVID-19 death rates increased by age group in adults aged 65 and older. The majority (66.2%) of deaths due to COVID-19 among these older adults occurred in a healthcare setting, compared with 24.3% in a nursing home or long-term care facility, and 4.7% at home.

US WORKFORCE The COVID-19 pandemic has significantly impacted the US workforce, particularly due to the burden of post-acute sequelae of SARS-CoV-2 (PASC), more commonly known as long COVID. Some estimates posit that the economic costs of long COVIDcould be trillions of dollars. With an estimated 16 million people of working age suffering with long COVID, and as many as 4 million out of work because of their symptoms, many recognize COVID-19 as a mass disabling event. A recentstudy from the Federal Reserve Bank of New York notes there has been an increase of about 1.7 million people with disabilities since the pandemic began and close to 1 million workers with new disabilities, likely due to an increase in Americans living with long COVID.

Many people with long COVID have reduced the number of hours they work or dropped out of the labor force, but an increase in the number of workers with disabilities suggests that more people with long COVID and disabilities are continuing to work. Some experts believe that the surge of workers with disabilities could also be attributed toa tight labor market and a rise in remote work, which allows people with disabilities to enter and remain in the workplace. As more people with long COVID and disabilities enter and remain in the workplace, experts encourage employers tomake reasonable workplace accommodations to retain them. Advocates encourage employers toset a positive example by supporting their employees’ needs regardless of their status under the Americans with Disabilities Act, under which employers are expected to make “reasonable accommodations” for people with disabilities.

Similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)— which also often follows viral infection—symptoms of long COVID can include fatigue, brain fog, and muscle/joint pain. The accommodations employers have provided to workers with ME/CFS, such as telework and flexible scheduling, could be extended to workers with long COVID as well, along with other changes that allow workers to control their environment, limit physical exertion and commuting, take breaks as needed, manage symptoms, and access comprehensive health benefits. Although making workplace accommodations requires upfront costs, advocates encourage employers to consider the long-term benefits of creating flexible and inclusive policies.

Relatedly, a recent study from theNational Bureau of Economic Research illustrated the phenomenon of “long social distancing” and documented that anxiety around getting COVID-19 has kept close to 3 million people out of the workforce, consequently reducing potential economic output by nearly 1%, or US$250 billion, in the first half of 2022. Long social distancing has ramifications beyond the workforce and economy; many people who continue to protect themselves through social distancinghave reported waning social support and increased isolation. Although many in the US seem to be moving on from the pandemic, the long-term economic and social impacts of COVID-19continue to affect people who struggle to make a complete recovery.

PANDEMIC POLITICIZATION Polling and analysis in the US show Republicans are more likely than Democrats to have lower rates of vaccine uptake and areas with more Republican voters have experienced more COVID-19-related deaths. But viewing the pandemic through a political lens is not useful, Dr. Ashish Jha, the White House COVID-19 Response Coordinator, said last week, urging people to instead view COVID-19 strictly through a public health and medical lens. Nevertheless, partisan messaging surrounding the pandemic is ramping up as US political candidates campaign ahead of mid-term elections. This week, US President Joe Biden publicly received an updated COVID-19 vaccine booster vaccine and called on the country to put politics aside to focus on personal health and the health of friends and family. His public vaccination likely was an effort by the White House to increase awareness that a new booster shot is available—a recent KFF poll found that around half of adults say they have heard “a little” or “nothing at all” about the bivalent boosters—but also a political move to highlight the Biden administration’s COVID-19 efforts, which typically score higher approval ratings than other issues.

Several Republican candidates are arguing that scientific and public health institutions have gained too much power during the pandemic. A new poll from the Pew Research Center suggests that while a majority of respondents agree that government investments in scientific research are worthwhile for society, many expressed a shared concern that the US is failing to gain ground in science globally. Notably, a partisan divide became apparent when respondents were asked about their views on the role of scientists in the policy arena, with Democrats more likely than Republicans to support scientists in active policy roles. Additionally, respondents’ confidence in scientists is lower than the high point seen early in the pandemic but has remained steady over the past year, according to the poll. While other issues appear to be dominating this year’s elections and both parties’ overall spending on COVID-19 messaging has dropped since the 2020 election, the pandemic remains an important issue for voters and elected officials.