May 25: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

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

Editor’s Note: Our COVID-19 Situation Report team is taking a break next week. We will be back on Tuesday, June 8, with our curated analysis of the latest COVID-19 news and research.

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

EPI UPDATE The WHO COVID-19 Dashboard reports 167 million cumulative cases and 3.5 million deaths worldwide as of 4:45am EDT on May 25. Global weekly incidence and mortality continue to decline, both for the third consecutive week. The weekly incidence decreased 14% from the previous week, and weekly mortality decreased by 2%.

Global Vaccination

The WHO reported 1.49 billion doses of SARS-CoV-2 vaccines administered globally as of May 24, and 700 million individuals have received at least 1 dose. Our World in Data reported 1.70 billion cumulative doses administered globally. The global cumulative total continues to increase at approximately 13% per week. Daily doses administered continue to increase, up to a new record of 28.4 million doses per day on May 22 before falling slightly to 28.1 million. The global increase is largely driven by Asia, which, in turn, is largely driven by China. Our World in Data estimates there are 395 million people worldwide who are fully vaccinated, corresponding to approximately 5.1% of the global population, although reporting is less complete than for other data.

UNITED STATES

The US CDC reported 32.9 million cumulative cases and 587,342 deaths. Daily incidence continues to decline, to the lowest levels since early in the pandemic. The current average daily incidence—22,877 new cases per day—is the lowest since June 14, 2020. The lowest daily incidence between the United States’ first and second surge was 20,733 on June 1, 2020, and the US could fall below that average in the coming days, if it continues on this trajectory. After falling below 500 deaths per day on May 20, daily mortality increased slightly, up to 508 on May 22 before falling back to 500.

US Vaccination

The US has distributed 357 million doses of SARS-CoV-2 vaccines and administered 287 million. After more than a month of decline, the daily doses administered* has increased for 5 consecutive days, back up to 1.7 million doses per day. The increase over the past several days is due to an increase in the number of first doses administered—up from 554,890 individuals per day on May 12 to 882,463 on May 19, an increase of nearly 60% over that period. Approximately 953,000 people are achieving fully vaccinated status per day, down from a high of 1.8 million per day on April 12. If this level of interest is sustained from the first to the second dose, we could expect to see an increase in the number of fully vaccinated individuals each day starting in the next 2-3 weeks, once second doses are administered.

A total of 164 million individuals in the US have received at least 1 dose of SARS-CoV-2 vaccine, equivalent to 49% of the entire US population. Among adults, 62% have received at least 1 dose, and 5.2 million adolescents aged 12-17 years have received at least 1 dose. A total of 131 million people are fully vaccinated, which corresponds to 39% of the total population. Among adults, 50% are fully vaccinated, and 2.0 million adolescents aged 12-17 years are fully vaccinated. Progress has largely stalled among adults aged 65 years and older: 85% with at least 1 dose and 74% fully vaccinated. In terms of full vaccination, 67 million individuals have received the Pfizer-BioNTech vaccine, 53 million have received the Moderna vaccine, and 10.2 million have received the J&J-Janssen vaccine.

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

Following updated guidance from the US CDC regarding recommendations for fully vaccinated individuals, US states are moving forward with efforts to relax or remove COVID-19 restrictions. However, US states vary widely in terms of vaccination coverage, and increased social interaction among unvaccinated individuals could increase risk of community transmission. The full vaccination coverage in states at the top of the rankings is nearly double the coverage in states at the bottom, ranging from 26.5% to 52.7%. There are 4 states currently reporting full coverage greater than 50%—Vermont (52.7%), Connecticut (51.6%), Maine (51.9%), and Massachusetts (50.5%)—and Rhode Island is nearly there with 49.9%. At the other end of the spectrum, there are 6 states reporting 31% or lower, including 2 with less than 30%—Mississippi (26.5%) and Alabama (28.7%). The median full vaccination coverage is 39%, and most states fall between approximately 34-44%.

There are some notable regional disparities as well. The top 6 states in terms of full vaccination coverage are all in the Northeast region. Conversely, the South represents the bottom 6 states and 9 of the bottom 12. Maryland (#9) is the highest-ranking state from the South, although it is among the northernmost states in the region, bordering the Northeast region. New Hampshire is the lowest-ranking state from the Northeast region, although at #22, it is still among the top half of all states. It is also #4 in terms of partial vaccination coverage. The states from the West and Midwest regions are largely scattered throughout the middle of the rankings. While the West represents 3 of the bottom 10 states—Idaho (#42), Utah (#43), and Wyoming (#44)—it also accounts for 2 of the top 10—Hawai’i (#7) and New Mexico (#8).

G20 BACKS VACCINE VOLUNTARY LICENSING On May 21, G20 leaders adopted a declaration pledging to bridge gaps in responses to the COVID-19 pandemic and to support voluntary licensing and technology transfers in order to boost vaccine production. Some view the Rome Declaration, adopted at the conclusion of a special summit on the COVID-19 pandemic hosted by Italy and the European Union's Executive Commission, as a snub to recent international discussions about waiving intellectual property rights for certain COVID-19 vaccines. Instead, G20 leaders reaffirmed their support for patent pooling through the WHO’s ACT-Accelerator, allowing pharmaceutical companies more flexibility in deciding what information to share. While the leaders supported technology pooling, they did not commit to additional financial resources for the scheme, which remains $19 billion short of its goal. Additionally, there are no commitments in the declaration to share vaccine stockpiles with low- and middle-income countries, although it does mention the COVAX facility as a means to do so. The Rome Declaration also lists 16 guiding principles for responding to the current pandemic and preparing for the next.

WORLD HEALTH ASSEMBLY The 74th World Health Assembly opened on May 24 with a focus on ending the COVID-19 pandemic and preparing for the next one. The meeting of the WHO’s decision-making body, this year held virtually, will run through June 1. In his opening remarks, WHO Director-General Dr. Tedros Adhanom Ghebreyesus paid tribute to the more than 100,000 healthcare workers who lost their lives fighting the COVID-19 pandemic on the front lines and called on member states to urgently invest in their health and care workers. Dr. Tedros also warned that no country is “out of the woods” in the pandemic, despite their vaccination rates, saying the pandemic will not end until transmission is controlled in every nation. He urged wealthier countries to help reach a goal of vaccinating at least 10% of the population of every country by September, and a “drive to December” to reach at least 30% by the end of the year.

In a video message, UN Secretary-General António Guterres laid out a 3-part plan to end the pandemic, calling on nations to more equitably distribute vaccines, diagnostics, and treatments; boost domestic primary health care and universal health coverage; and commit to transforming existing pandemic warning systems, with the WHO at the center of any global preparedness strategy. Member states are expected to receive 3 pandemic-related reports during the meeting, including one from the Independent Panel for Pandemic Preparedness and Response, an independent review of the WHO's Health Emergencies Programme, and a review of how the International Health Regulations have performed during the pandemic.

NOVAVAX VACCINE PHASE 3 TRIAL RESULTS Last week, US pharmaceutical company Novavax posted complete results from a Phase 3 clinical trial testing its 2-dose recombinant protein SARS-CoV-2 vaccine candidate to the preprint server medRxiv, after releasing initial results in March. According to the results of the randomized, double-blind, placebo-controlled study conducted in the United Kingdom, the vaccine, NVX-CoV2373, was 89.7% (95% CI, 80.2-94.6) effective in preventing COVID-19, with no hospitalizations or deaths reported, with post hoc analysis showing efficacies of 96.4% (73.8-99.5) and 86.3% (71.3-93.5) against the original strain and B.1.1.7 variant, respectively. According to some reports, Novavax is expected to apply for emergency authorization in the US in the coming weeks. Notably, the company has never brought a product to market. If it receives authorization, the company has pledged to provide 100 million doses to the US later this year and has promised 1.1 billion doses to COVAX for distribution in low- and middle-income countries. Indian vaccine maker Serum Institute is contracted to make most of the 1.1 billion doses, but backlogs there have Novavax seeking other options. Novavax recently reaffirmed its relationship with the South Korea Ministry of Health and Welfare and SK Bioscience Co. Ltd. to manufacture NVX-CoV2373 and explore expansion of the partnership, having previously entered into a licensing agreement with SK Bioscience to produce 40 million doses of its vaccine candidate.

Additionally, Novavax announced its participation in a mix-and-match clinical trial testing the potential of 7 SARS-CoV-2 vaccines as booster doses for vaccines from different manufacturers among people who are already fully vaccinated. The company also noted the UK National Health Service, Vaccines Task Force, and National Institute for Health Research are working to ensure participants in the Phase 3 clinical trial who received NVX-CoV2373 are entered into the NHS App, which helps vaccinees prove their vaccination status when traveling.

MODERNA VACCINE ADOLESCENT CLINICAL TRIAL Moderna announced this week that their SARS-CoV-2 vaccine trial in adolescents, TeenCOVE, has reached its primary endpoint. More than 3,700 adolescents aged 12 to less than 18 years old were enrolled in the trial. No cases of COVID-19 were recorded in vaccine recipients following two doses of the Moderna vaccine. With these results indicating an efficacy of 100% 14 days after both doses, Moderna also found approximately 93% efficacy following one dose of the vaccine. The company plans to send the trial data to regulators in early June. Moderna would be the second SARS-CoV-2 vaccine to be authorized for use in adolescents in the US, following Pfizer-BioNTech’s authorization earlier in May. Both Moderna and Pfizer-BioNTech are investigating vaccine safety and efficacy in children aged 6 months to 11 years, but those results are not expected for some time due to the need to adjust dosing amounts.

AFRICA COVID-19 MORTALITY People in Africa who become critically ill with COVID-19 are more likely to die than people in other parts of the world, according to a study based on data from 64 hospitals in 10 countries collected between May and December 2020 and published in The Lancet. Among 3,077 critically ill patients admitted to the hospitals—located in Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger, Nigeria, and South Africa—48.2% died within 30 days, compared with a global average of 31.5%, according to the study. The majority of patients were men (61%), and the overall cohort had an average age of 56 and few underlying conditions. People with pre-existing conditions had the highest risk of poor outcomes. Having chronic kidney disease or HIV/AIDS nearly doubled the risk of death, chronic liver disease more than tripled the risk of death, and diabetes also was associated with poor survival.

Notably, being male was not associated with increased mortality, an unexpected result, according to the African COVID-19 Critical Care Outcomes Study researchers. They noted this could be due to women having less access to care or biases in care when critically ill. Overall, the researchers posited scarce critical care resources and under-resourced facilities could have played a role in the deaths, as well as an apparent failure to use available resources and medical interventions. The researchers highlighted limitations to their study, including that the observations occurred primarily at university-affiliated, government-funded, and tertiary hospitals, so outcomes could be worse in lower-level, less-resourced hospitals across the continent. Another analysis published in The Lancet found that Africa’s second COVID-19 wave was more severe than the first. Taken together, these studies underscore the importance of improved epidemiological surveillance on the continent.

RESPIRATORY STATUS & MORTALITY RISK Researchers from the University of Washington and Rush University Medical Center (Illinois; US) found that respiratory symptoms may not be an accurate predictor of COVID-19 mortality risk. The presence of respiratory symptoms—such as coughing, wheezing, or difficulty breathing—may not necessarily correlate with respiratory compromise. Clinical measurements such as blood oxygen saturation and respiratory rate can provide a more objective assessment of respiratory compromise. The researchers evaluated data from more than 1,000 hospitalized COVID-19 patients and assessed COVID-19 mortality risk associated with both respiratory symptoms as well as oxygen saturation and respiratory rate.

The researchers found that blood oxygen saturation of 91% or lower was significantly associated with increased risk of COVID-19 mortality (compared to 92% or higher), ranging from 1.8 times the risk for 89-91% to 4.0 for less than 80%. Increased respiratory rate was also significantly associated with increased mortality. The risk of death was 1.9 times higher among individuals with respiratory rates of 23-24 breaths per minute (compared to 20 or fewer). Individuals with more than 32 breaths per minute were 3.2 times as likely to die. In contrast, the presence of respiratory symptoms or fever were not significantly associated with increased COVID-19 mortality.

LONG-TERM EFFECTS IN CHILDREN Most children with COVID-19 who develop a rare but potentially severe condition known as multisystem inflammatory syndrome in children (MIS-C) experience symptom alleviation within 6 months, according to a small study published May 24 in The Lancet Child & Adolescent Health. Researchers followed 46 children initially admitted with COVID-19-related MIS-C—also known as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2—to Great Ormond Street Hospital (London; UK) between April 4 and September 1, 2020. Six months after discharge from the hospital, only 1 child still had systemic inflammation, 2 had heart abnormalities, and 6 had gastrointestinal symptoms. Eighteen of the children continued to have diminished exercise tolerance and 15 were experiencing emotional difficulties. The researchers emphasized that longer-term follow-up studies are needed to better characterize the natural history of MIS-C among children with COVID-19.

US COVID-19 EPIDEMIC IN UNVACCINATED INDIVIDUALS A report from The Washington Post breaks down national and state populations into vaccinated and unvaccinated individuals by assuming that all vaccinated individuals are fully immune and removes them from the population. While this is not necessarily the case, we expect this to be a reasonable approximation due to the low risk of breakthrough infection—and even lower risk for severe disease and death. With just the unvaccinated portion of the population remaining, the report estimates the per capita COVID-19 daily incidence, hospitalization, and mortality among unvaccinated individuals.

While the overall daily incidence is declining across the country, the Washington Post analysis says that COVID-19 “is spreading as fast among the unvaccinated as it did during the winter surge.” There are just fewer susceptible individuals due to vaccination. Similar trends are apparent for both hospitalizations and mortality. While nearly half of the US population has received at least 1 dose and nearly 40% are fully vaccinated, unvaccinated individuals remain at risk, and vaccination coverage is not yet sufficient to provide protection to the unvaccinated portion of the population. Vaccination coverage varies widely by state, and states with lower coverage still have substantial populations remaining to facilitate community transmission if effective protective measures are not in place.

CLINICAL TRIAL LANDSCAPE Since the beginning of the pandemic, many studies testing potential COVID-19 therapies have been too small to gather meaningful data or did not include a control arm. Researchers in Europe and the US are working to launch large-scale, randomized clinical trials of multiple drugs to evaluate whether they work to help people with COVID-19 are more likely to survivor or recover more quickly. The WHO is relaunching its multi-arm Solidarity trial to look at repurposed drugs meant to prevent immune system overreaction in COVID-19 patients, and the REMAP-CAP study is ongoing in Europe. In the US, the NIH-sponsored Accelerating COVID-19 Therapies and Vaccines (ACTIV) program is set to begin enrolling patients in ACTIV-6, a master protocol that will evaluate at least 4 different oral medications already approved to treat other diseases among people with mild to moderate COVID-19 who are not hospitalized. These trials are all designed to examine several treatment options simultaneously and efficiently, with built-in flexibilities and pooled control groups. The FDA recently released new guidance for these types of master protocols. One potential obstacle for these larger studies is enrolling sufficient numbers of patients, as some places are experiencing sustained declines in new COVID-19 cases.

SARS-COV-2 ORIGINS Many questions remain regarding the origin of the SARS-CoV-2 virus. An article in the The Wall Street Journal (WSJ) says that 3 illnesses among personnel who worked at the Wuhan Institute of Virology (WIV; China) in November 2019 are linked to the COVID-19 pandemic. Reportedly, the individuals’ symptoms were consistent with COVID-19; however, COVID-19 shares many common symptoms with other diseases, including seasonal influenza. The illnesses were previously listed in a fact sheet issued by the US Department of State, but the WSJ article indicates that additional details—including the number of cases and the timing of the illnesses—are contained in an “undisclosed U.S. intelligence report.” The WSJ article acknowledges that some government officials familiar with the intelligence report question the “supporting evidence for the assessment,” and to our knowledge, the report’s contents have not been released publicly. In a separate article, WSJ also investigated a potential link between illnesses at a Chinese mine in 2012 and the emergence of SARS-CoV-2 in 2019.

As we have covered previously, it will be difficult to definitively determine the original source of SARS-CoV-2, whether from a natural spillover event, laboratory accident, or other events. Continued discussions about the possibility of a laboratory release has fueled calls for further investigations into activities at WIV. A previous investigation led by the WHO determined that the likelihood of the pandemic originating from a laboratory release to be “extremely low,” but in the absence of definitive evidence of another source, it is nearly impossible to rule it out. Rigorous, transparent, and independent investigations are an important step to understanding the origins of the pandemic, but myriad technical, practical, and political barriers remain that could impede these efforts.

OLYMPICS With the 2020 Summer Olympic Games scheduled to begin in July, Japan continues to combat one of its largest COVID-19 surges. Officials from hospitals in Osaka, Japan’s second largest city, are warning that the medical system could be on the verge of collapse. Some experts and health officials worry that the influx of tens of thousands of Olympic participants will further strain the already overburdened health system and potentially introduce new variants of concern into the population. The Japanese government recently opened 2 mass vaccination centers following Prime Minister Yoshihide Suga’s pledge to vaccinate the country’s entire elderly population of 36 million citizens by the end of July. Still, vaccination levels remain extremely low, with only around 2% of the population fully vaccinated.

In response to Japan’s ongoing surge, the US Department of State recently upgraded its travel advisory from a Level 3 (Reconsider Travel) to Level 4 (Do Not Travel). The US CDC also stated that even vaccinated travelers could be at risk of contracting and spreading SARS-CoV-2 due to the circulation of variants of concern. Notably, international spectators will not be permitted to attend the Olympics, but it is unclear if or how the Level 4 travel advisory could impact athletes’ travel from the US or other nations that consider US guidance.

'The final straw': Pandemic pushes restaurant workers over the edge

'The final straw': Pandemic pushes restaurant workers over the edge

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'The final straw': Pandemic pushes restaurant workers over the edge

Eli Rosenberg

Mon, May 24, 2021, 3:03 PM CDT

Jim Conway started working in restaurants in 1982, making $2.13 an hour, plus tips.

And though the world has changed significantly in the nearly 40 years since then, his hourly wage has not. At the Olive Garden outside of Pittsburgh where he worked when the pandemic hit last year, he was making $2.83 an hour, the minimum wage for tipped workers in Pennsylvania, plus tips.

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So after being furloughed for months last spring, Conway, 64, decided to retire.

Being paid the rough equivalent of a chocolate bar an hour from the chain was little incentive for him to stick it out longer in the industry after so many years, especially with tips no longer a reliable source of income and lingering health concerns about covid-19.

"The main issue for me was safety," Conway said. "There are lots of people who don't want to participate in the old ways."

Conway is one of the millions of workers who left the restaurant industry during the pandemic and haven't come back. The industry has 1.7 million fewer jobs filled than before the pandemic, despite posting almost a million job openings in March, along with hotels, and raising pay 3.6%, an average of 58 cents an hour, in the first three months of 2021.

Restaurant chains and industry groups say a shortage of workers like Conway is slowing their recovery, as the sector tries to get back on its feet amid sinking covid cases, falling restrictions and resurgent demand in many areas around the country.

The issue has quickly become political, with Republicans blaming the labor crunch on the Biden administration's move to boost federal unemployment insurance supplement, which has been a central part of the government's response to the pandemic for most of the past year. GOP leaders and business groups such as the U.S. Chamber of Commerce say the extra unemployment insurance is a disincentive for some workers to return to work.

In interviews with The Washington Post, 10 current and former workers expressed a wide range of reasons they are or were reluctant to return to work. Some, like Conway, have left the industry or changed careers, saying they felt as if the industry was no longer worth the stress and volatility.

Others said jobs that didn't pay enough for them to make ends meet no longer felt appropriate to them. Others left after disputes with managers over issues around safety and pay and other flash points that have emerged in the past year.

All described the pandemic as an awakening, realizing that long-held concerns about the industry were valid, and compounded by the new health concerns. Forced to stop working or look for other jobs early on in the pandemic, many realized they had other options.

"The staffing issue has actually a lot more to do with the conditions that the industry was in before covid and people not wanting to go back to that, knowing what they would be facing with a pandemic on top of it," said Crystal Maher, 36, a restaurant worker in Austin who's become more active on the industry's labor issues in the past year. "People are forgetting that restaurant workers have actually experienced decades of abuse and trauma. The pandemic is just the final straw."

Tonya Breslow, the owner of Mis en Place, a restaurant staffing firm, said a huge number of restaurants she works with are dealing with shortages.

The firm recently surveyed 2,000 line cooks and back-of-the-house restaurant workers nationally and found just over a quarter, 26%, reported leaving the industry, while 41% of workers said they were still employed in the industry. That left about a third of respondents who had not gone back to work.

Of that group, most workers said they were not yet back, because they were either looking for the right opportunity, they had concerns about safety during the pandemic, or they did not plan to return to the industry.

The restaurant industry is famously volatile, home to strong personalities, tense workplaces, grinding hours and unpredictable scheduling. Issues like tip and wage theft, sexual harassment, and drug and alcohol abuse can be widespread, and there is often little in the way of formal job benefits such as health care, vacation time, sick pay or a livable minimum wage, though many workers do well in tips during flush times.

Turnover is a way of life; the average job tenure for hourly food service workers is less than two months, according to data compiled by Mis en Place.

This constant churn was affecting Jazz Salm's life even before the pandemic.

The 37-year-old had worked for Carrabba's Italian Grill, a Florida-headquartered chain, at different locations for more than 15 years, but said she had to find another job after one of the restaurants' outposts, near Miami, burned down.

She got a job at a Chili's in that area in early March of last year, but was furloughed when the pandemic shuttered the business after her first week.

It took her months to get approved for unemployment insurance in Florida, as the state's system struggled to process the flood of applications in the early months of the crisis.

By the end of summer, Salm found a job at a Walmart, after moving back in with her mother in Sarasota. But shortly after starting work there, she registered a fever during the screening the store administered to workers before they clocked in, and was sent home to quarantine. The company required a two-week, quarantine, she said, even though she had tested negative days a few days before developing the fever.

Walmart pays employees if they're sent home for failing a health screening, but Salm said she was unaware of the benefit, and thought she'd have to go two weeks without a paycheck.

She decided to quit the job and drive up the coast to go stay with a friend who had invited her to come live at her house in Upstate New York. She slept in her car along the way.

She said she tried to find a job at a restaurant but couldn't. So she started taking care of her friend's 81-year-old father-in-law, who had just returned from the hospital after receiving chemotherapy for throat cancer. The money takes care of her rent, groceries and some spending money.

She said she may return eventually to the food service industry in Florida, where restaurant owners have complained vociferously about the worker shortage, but it will take her time. She won't be fully vaccinated until mid-June, for starters. And she wonders about getting trained and going into medical caregiving full time.

"I'm trying to trust the process and hope that this all works out and there's not another spike or anything else," she said. "The restaurant industry really doesn't guarantee the money that I used to make, with this pandemic. Because if it flares up again, or God forbid something happens in the restaurant, you have to close it down, you're out of work for weeks and there's nothing you can do to make money. Other than find another job."

Allan Creasy, 39, had worked in restaurants and bars for more than two decades, most recently as a bartender at Celtic Crossing, an Irish bar in Memphis, where he was voted the city's best bartender three times over the years by readers of the city's alt-weekly newspaper, the Memphis Flyer.

Like others, Creasy said the pandemic proved to be the tipping point for him, exacerbating long-standing labor issues in the industry and drawing attention to how low his wages were: $2.13 an hour before tips - the minimum wage for tipped positions in Tennessee and at the federal level.

After three months back at the bar after the initial lockdown, Creasy decided to quit and pursue a career change.

"I didn't come back to the same job I left previously," he said. "It was very difficult to constantly have to police people about mask-wearing. It was very difficult to try to bartend and run out to the back parking lot to deliver to-go food, and to deal with Uber Eats drivers and the like, while making significantly less money than I'd been making previously."

And the pay had gotten worse - with his income dropping from about $60,000 a year around 2011 to less than $40,000 before the pandemic, he said.

"I've seen the number of people who are passionate about the restaurant industry slowly ebb away over the last 20 years," he said. "In my opinion, it's because the server's minimum wage hasn't changed. There is this belief that servers and bartenders are interchangeable."

Creasy, who has a bachelor's degree in history, has been doing fundraising and social media work for a local political action committee since. He's making about the same amount of money he did at the bar but doing something that feels closer to his heart with less risk.

"You had so many folks working in the industry because they loved it, but now so many folks found a job in a warehouse making $15 an hour, or making as much money driving for Uber Eats, all these different businesses," he said. "It's not that we're on unemployment. We did our unemployment stint, and we found something else."

Nathaniel Santiago, 20, who works at a McDonald's in the Fort Lauderdale area in Florida, said he believes the industry's low wages are playing a role.

He had to move back in with his parents last year after losing his job at a manufacturing facility, before finding work at the fast-food chain, where he said he's making $11 an hour - just $1,760 per month for full-time work, with no health care. That's about $4 an hour below what is estimated to be a living wage for a single person with no children in that area - the minimum amount calculated for a person to be able to meet basic standards of living.

He also believes unemployment insurance is playing a role in the shortage, saying he's heard from some friends and family members who say they are happy getting by with support from the government in the meantime.

"We need to pay workers $15 an hour at the moment," he said. "People want to talk about inflation or that if you pay everybody $15 an hour, everything is going to get more expensive, but it already is. Food, clothing, gasoline, rent - you name it."

Peter DeQuattro, 36, a line cook in Memphis who recently left a job because it paid less than $15 an hour, said he thinks the pandemic has changed the paradigm for low-wage workers - giving people more confidence to demand better wages.

"There is a growing movement of people, including myself, that just flat out refuse to work for somebody that isn't willing to pay a living wage," he said.

There are signs that businesses are reacting to the shortage.

Companies that pay less than $15 an hour - the amount many liberal economists and labor advocates say should be a baseline to provide people with something closer to a living wage in many areas of the country - are increasingly dangling incentives, bonuses and pay raises in front of workers in the hopes of staffing up. Pay is increasing in the industry as well: The median wage for nonmanagement restaurant and bar workers rose 70 cents an hour, to $14.50, in the past three months - a significant 5.1% jump.

Costco, Chipotle and McDonald's are among the publicly traded companies that have announced wage increases in recent weeks, and others, like Target, raised their wages in 2020 as the pandemic drew more attention to the plight of workers.

Local media outlets have been flooded with tales of the worker shortage, written mostly from the perspective of businesses, from Santa Fe to Connecticut. A brewery in Albuquerque is offering workers a free 64-ounce growler of beer after every shift; Applebees is offering free appetizers to people who apply to jobs, as it seeks to hire thousands of workers across the country.

Breslow, the owner of the staffing firm Mis en Place, knows restaurant owners who are offering bonuses as high as $3,000 to new hires, and others who are adding health insurance and 401(k) benefits to employee incentive packages.

"The country is scrambling to get that 33 percent," Breslow said, referring to those workers who have not returned to the industry. "The leverage is unreal."

Above is from:  https://www.yahoo.com/news/final-straw-pandemic-pushes-restaurant-200323148.html

May 21: 1573 New COVID 19 Cases in Illinois

May 21: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

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

EPI UPDATE The WHO COVID-19 Dashboard reports 165 million cumulative cases and 3.4 million deaths worldwide as of 4:45am EDT on May 21.

Following a brief decrease, India’s daily mortality is once again increasing, setting new global records. On May 18, India reported 4,529 deaths, surpassing the previous record for single-day mortality (US: 4,475 deaths on January 12, 2021). With 4,150 deaths per day on May 18, India also holds the global record for average daily mortality. India is the only country to report an average of more than 4,000 deaths per day, and it has hovered around 4,100 deaths per day for the past several days.

On Tuesday, we looked at state-level test positivity in the US, and in light of numerous ongoing surges in countries around the world, we will take a similar look at some national trends in test positivity. Of the top 20 countries* globally, 10 are in Central and South America (including 5 of the top 7), plus Trinidad and Tobago and the Dominican Republic in the Caribbean; 4 are in Africa; and 3 are in Asia. Ukraine is the only country in Europe. Notably, 13 of these countries are reporting test positivity of more than 20%, including 5 with more than 30%: Nepal (44.2%), Paraguay (36.9%), Maldives (31.3%), Argentina (30.6%), and Ecuador (30.6%).

*Oman would be in the top 20, based on its most recent report, but it has not updated its test positivity data since July 2020.

Fortunately, fewer than half of these countries are reporting increasing trends in daily incidence. In terms of the relative biweekly change, 9 are reporting positive values, 7 of which are greater than +10% and 4 of which are greater than +50%. Maldives is reporting the largest biweekly increase, with +177%, followed by Trinidad and Tobago (+94%), the Dominican Republic (+89%), and Nepal (+57%). The high test positivity in these countries could result in substantial underreporting of COVID-19 incidence, which is particularly concerning in light of their increasing trends. Maldives may be the most concerning country on this list. In addition to having the largest biweekly increase, it is also reporting the world’s highest per capita daily incidence. At more than 2,500 daily cases per million population, Maldives is reporting more than 2.5 times the per capita incidence of the next closest country in this group (Uruguay; 906). Notably, while Nepal’s overall biweekly trend is positive, it does appear to have passed a peak and is now declining.

While their relative biweekly increases do not necessarily reflect it, several other countries also are reporting concerning increases in daily incidence. Following approximately 2 weeks of decreasing trends, both Uruguay and Argentina are reporting increasing daily incidence. In fact, Argentina has already surpassed its previous peak, and Uruguay could soon do so as well, if it continues on its current trajectory. Additionally, Bolivia’s daily incidence has increased steadily since late March, briefly surpassing its previous record on May 17. Paraguay’s epidemic has exhibited a protracted but slow increase since early February, and it is currently reporting near its record high, set on April 23.

Notably, most of the countries with high test positivity are reporting decreasing daily incidence, including 4 that have decreased by more than one-third over the past 2 weeks: Madagascar (-49%), Tunisia (-36%), the Democratic Republic of Congo (-35%), and Ecuador (-33%).

Several countries with biweekly increases in daily incidence also are reporting increasing test positivity, which signals that testing capacity is falling further behind as the surges worsen. The Dominican Republic reported a steady decline in test positivity in early 2021; however, it recently reported a considerable increase, from 11.4% on May 10 to 15.3% on May 15 (its most recent report), an increase of more than one-third over only a few days. After a prolonged decline from late January to April, Bolivia’s test positivity has increased from a low of 9.5% on April 17 to nearly 25% on May 17 before falling slightly to 22.3%. Trinidad and Tobago’s test positivity accelerated consistently from 1% in late February to a high of 38.2% on May 10 before falling sharply to 20.2% on May 11 (its most recent report). Maldives also reported a concerning accelerating trend, up from 3.2% on April 16 to 30.9% on May 19, slightly more than a month later. While Nepal’s test positivity increased from less than 2% in early March to a peak of more than 45% on May 13, it has declined steadily in the few days since then. In contrast to other countries discussed here, this is an encouraging indication that its testing capacity is beginning to move in the right direction during its ongoing surge, even though test positivity remains elevated.

Global Vaccination

The WHO reported 1.42 billion doses of SARS-CoV-2 vaccines administered globally as of May 20, including 666 million individuals with at least 1 dose. Our World in Data reported 1.59 billion cumulative doses administered globally. The global cumulative total continues to increase at approximately 13% per week. Daily doses administered continue to increase, up to a new record of 26.0 million doses per day. Our World in Data estimates there are 376 million people worldwide who are fully vaccinated, corresponding to approximately 4.8% of the global population, although reporting is less complete than for other data.

UNITED STATES

The US CDC reported 32.9 million cumulative cases and 584,975 deaths. The current average daily incidence—27,788 new cases per day—is the lowest since June 18, 2020. The average daily COVID-19 mortality fell below 500 deaths per day for the first time since March 31, 2020.

US Vaccination

The US has distributed 352 million doses of SARS-CoV-2 vaccines and administered 279 million. After more than a month of decline, the daily doses administered* increased slightly on May 15 to 1.6 million doses per day. Approximately 1.0 million people are achieving fully vaccinated status per day, down from a high of 1.8 million per day on April 12.

A total of 160 million individuals in the US have received at least 1 dose of SARS-CoV-2 vaccine, equivalent to 48% of the entire US population. Among adults, 61% have received at least 1 dose, and 4.1 million adolescents aged 12-17 years have received at least 1 dose. A total of 127 million people are fully vaccinated, which corresponds to 38% of the total population. Among adults, 48% are fully vaccinated, and 1.8 million adolescents aged 12-17 years are fully vaccinated. Progress has largely stalled among adults aged 65 years and older: 85% with at least 1 dose and 73% fully vaccinated. In terms of full vaccination, 65 million individuals have received the Pfizer-BioNTech vaccine, 51 million have received the Moderna vaccine, and 9.8 million have received the J&J-Janssen vaccine.

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

The Johns Hopkins Coronavirus Resource Center is reporting 33.1 million cumulative cases and 588,559 deaths in the US as of 10:15am EDT on May 21.

BRAZIL PEDIATRIC MORTALITY Since early in the pandemic, it was clear that older adults were at elevated risk for severe COVID-19 disease and death. In contrast, Brazil’s epidemic is exhibiting elevated mortality among children and infants. A report by The New York Times describes some of the factors that could be contributing to increased pediatric mortality. Since the onset of the pandemic, Brazil has reported at least 832 deaths among children aged 5 years and younger, which likely is a “substantial undercount.” In fact, researchers at the University of São Paulo estimate that the actual total is closer to 2,200, including more than 1,600 infants younger than 1 year. For comparison, the US has reported only 139 deaths among children aged 4 years and younger. While the age range is slightly smaller than in Brazil’s tally, the US has a population approximately 50% larger than Brazil’s.

Myriad factors could be contributing to Brazil’s high pediatric mortality. The P.1 variant that is circulating widely in Brazil has been linked to increased disease severity and mortality among pregnant women as well as elevated risks of stillbirth or premature delivery. A lack of testing leads to untimely or inadequate access to health care for children with COVID-19, and poor and overwhelmed health systems also could result in increased mortality among this population. Underlying health conditions—some related to poverty and food insecurity—can exacerbate the risk of severe disease in children, but Brazil’s pediatric COVID-19 mortality also is elevated in otherwise healthy children. Further study is needed to better characterize the factors influencing elevated mortality among children and infants in Brazil.

COVAX MANUFACTURING TASK FORCE The COVAX facility is struggling to reach its goal of providing 2 billion doses of SARS-CoV-2 vaccines to low- and middle-income countries (LMICs) by the end of this year. So far, COVAX has delivered just over 68 million doses, or 3.4% of its goal. Experts maintain the 3 primary obstacles preventing COVAX from reaching its goal include a lack of funding, vaccine supply constraints, and a lack of willingness from some countries to share vaccine doses. But they also argue all of these problems are solvable. WHO Regional Director for Africa Dr. Matshidiso Moeti on Thursday appealed to rich nations to share their surplus vaccine doses, commending France for shipping jabs to Mauritania and the US for pledging to donate 80 million of its excess doses. Yet more needs to be done, as the world continues to stumble in ramping up manufacturing of vaccines that were developed with record speed.

In an effort to address bottlenecks in the supply of vaccine raw materials and trade barriers impacting the supply chain, the co-leads of COVAX—the Coalition for Epidemic Preparedness Innovations (CEPI), WHO, Gavi, and UNICEF, working in partnership with the Bill & Melinda Gates Foundation, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), Developing Countries Vaccine Manufacturers Network (DCVMN), and Biotechnology Innovation Organization (BIO)—announced the launch of the “COVAX Manufacturing Task Force.” The Task Force plans to engage additional partners within the clinical development, manufacturing, and regulatory sectors, as well as governments, regional entities, and other institutions, to address short-, medium-, and long-term objectives that aim to alleviate shortages of raw and single-use materials, speed delivery of such materials, and encourage cooperation among manufacturers.

EMERGENT VACCINE PRODUCTION FACILITY On May 19, the US House of Representatives Select Subcommittee on the Coronavirus Crisis held a hearing as part of an investigation into Emergent BioSolutions’ failures to address manufacturing problems at its Baltimore, MD, (US) plant that led to the contamination and subsequent destruction of 15 million doses of the J&J-Janssen SARS-CoV-2 vaccine made at the facility. The hearing comes 1 month after the US government put J&J in charge of the plant following revelations that Emergent, under federal contract to make key materials for J&J-Janssen and AstraZeneca-Oxford vaccines, cross-contaminated ingredients for the different jabs.

At the hearing, Emergent executives testified for more than 3 hours about manufacturing deficiencies and disclosed for the first time that more than 100 million doses of the J&J-Janssen vaccine are on hold and under review by the US FDA, 30 million more than previously recognized. Emergent CEO Robert G. Kramer acknowledged that it was J&J, not Emergent, that first discovered the contaminated doses. The subcommittee also released a preliminary report outlining details about unaddressed issues at the Emergent plant, including unsanitary conditions, mold, poor employee training, and insufficient attention paid to operating protocols. In 2020, the federal government awarded Emergent a $628 million contract to produce SARS-CoV-2 vaccines, and so far has paid $271 million. However, the FDA has yet to clear for use a single dose of vaccine produced at the plant. The FDA published a report in April stating the Baltimore facility was unsuitable to produce vaccine doses, and Emergent agreed to pause production of materials until issues identified in the report are resolved.

EU TRAVEL The European Council on May 20 adopted updated recommendations for non-essential travel into the region, a move that could increase the number of foreign travelers able to enter the EU. The bloc has had many restrictions on the movement of travelers during the COVID-19 pandemic, with this new policy marking a turning point for pandemic policies. The plan would grant anyone vaccinated with an EU-approved COVID-19 vaccine permission to travel, greatly increasing the potential for tourism. This rule could open up travel to an increasing number of foreign individuals but would restrict those who received Russian- or Chinese-made vaccines, none of which are authorized in the EU. Bloc leadership has shared that countries may still implement more restrictive guidance if they choose, but they are urging member states to move toward more open borders as larger percentages of adults receive SARS-CoV-2 vaccines. The recommendations allow for an “emergency brake mechanism,” under which member countries can adopt urgent, temporary travel restrictions if a variant of concern or interest is detected.

MODERNA VACCINE PRODUCTION In an effort to further scale up SARS-CoV-2 vaccine production capacity, the Swiss government is supporting efforts to hire temporary personnel to staff a facility operated by the Lonza Group. The Lonza facility in Visp, Switzerland, manufactures ingredients that are needed to produce Moderna’s SARS-CoV-2 vaccines, and Lonza recently added 3 new production lines to meet the ongoing demand. Reportedly, Lonza was struggling to find qualified personnel to operate the production lines, but the Swiss government was able to identify 75 personnel with the required expertise from within government agencies as well as academic institutions. Lonza anticipates further efforts to increase production capacity, up to 600 million doses per year. Lonza will require additional personnel in the future, as the current temporary employees are not a long-term solution.

INDIA VACCINATIONS At the beginning of May, India expanded eligibility for SARS-CoV-2 vaccinations to its entire adult population. The country has faced an incredibly challenging surge in new COVID-19 cases, increasing the urgency to vaccinate its population. However, access to vaccines is being hindered by the current outbreak, lockdowns, cost, and production backlogs. The government recently estimated it would be able to produce 1.46 billion doses of the authorized AstraZeneca-Oxford, Sputnik V, and Covaxin vaccines between the months of August and December, but lower-than-expected production estimates reported to Reuters fall short of the government’s goal. In a further setback, the Indian government and Pfizer have reached an impasse over the company’s demand for indemnity against any claims related to its vaccine. In addition to questions over vaccine supply, the influence of mis- and disinformation surrounding COVID-19 and vaccines is hampering willingness among some to be vaccinated, particularly those in rural areas. It is reasonable to expect that the severity of the ongoing outbreak, and other events like Cyclone Tauktae, have negatively impacted the country’s vaccination efforts, but it will be troublesome if a high prevalence of vaccine hesitancy impedes vaccination rates as more doses become available.

CHINA VACCINE DONATIONS China on May 20 said it has donated or sold at “favorable prices” its homegrown vaccines to nearly 40 African countries, describing its actions as purely altruistic. The announcement is the latest example of how geopolitics is intensifying global moves on what is being called vaccine diplomacy. A day before, the 15-member UN Security Council unanimously approved a presidential statement calling for the accelerated availability of SARS-CoV-2 vaccines for Africa and expressing concern that the continent has received only about 2% of all doses administered worldwide. Also at the Security Council meeting, organized by China, which holds the body’s rotating presidency for May, member states heard from Africa Union Commission Chair Moussa Faki Mahamat, who said vaccine access is the biggest challenge Africa faces, amid increasing numbers of COVID-19 cases and related deaths. The same day, the US government said it will prioritize sending excess vaccine doses to Latin America over concerns that China is using vaccine donations to the region to influence nations there to drop diplomatic recognition of Taiwan. Both Paraguay and Honduras have signaled they might switch ties from the US to China, which claims Taiwan as its territory, in order to gain access to Chinese vaccine supplies. Chinese and Taiwanese officials have accused one another of politicizing pandemic responses, accusations both sides deny.

AFRICA R&D FUNDING Global health experts affiliated with academic, medical, and nonprofit institutions in Africa, the UK, and the US published an open letter to African political and research leaders, calling on them to expand funding and support for research and development capacity on the continent. In 2006, African Union member countries pledged to allocate at least 1% of their GDP to research and development; however, by 2019, the average across the continent remained below 0.5% of GDP—compared with 1.7% globally. The authors emphasized that the COVID-19 pandemic should serve as a wake-up call and inspire investments to avert future health emergencies. They argue that a “glaring lack of leadership” at the national level is driving “the chronic lack of government investment—and regard—for science,” both for COVID-19 and the broader scope of infectious diseases. The absence of political priority has driven an “overreliance on international funding” across Africa, and as COVID-19 forced countries to focus inward, international funding support dwindled. The group previously penned a letter published in Nature Medicine that called on international funders of science and development in Africa to recognize power imbalances, include more Africa-based programs in their investments, and more equitably distribute funding. 

PFIZER-BIONTECH VACCINE STORAGE The US FDA extended the storage period at refrigeration temperatures for the Pfizer-BioNTech SARS-CoV-2 vaccine. The FDA now permits the vaccine to be stored at refrigerator temperatures—2-8°C (35-46°F)—for as long as 1 month. The change applies only to thawed but undiluted vials. Previously, FDA guidance limited refrigerator storage to only 5 days. Earlier this week, the European Medicines Agency (EMA) announced a similar change. Increasing the time that the vaccine can be stored outside of ultra-cold temperatures will ease logistical and operational burdens for this vaccine and can increase the radius of vaccination efforts from centralized ultra-cold freezers.

IMMUNE RESPONSE The human immune system’s production of antibodies is important to fend off infection with SARS-CoV-2, but more evidence is emerging that the production of autoantibodies—which can target a person’s tissues and organs and interfere with other immune system proteins meant to fight infections—can cause more severe or longer-lasting disease in some COVID-19 patients. In a study published in Nature, Yale University researchers detail how these so-called “rogue autoantibodies” interact with nearly 3,000 human proteins using a novel technology called Rapid Extracellular Antigen Profiling (REAP). The researchers underscored the importance of SARS-CoV-2 vaccination to lower the risk of infection, as autoantibody production was seen in even mild COVID-19 cases, having the potential to cause long-term health consequences. The team’s findings could lead to treatment or prevention strategies for SARS-CoV-2, and the new REAP technology already is being used to identify specific antibody responses for other conditions, including autoimmune diseases, cancer, and neurological illnesses.

VACCINE LOTTERIES In an effort to promote vaccinations, some US states are turning to lotteries to increase interest. In contrast to lotteries to allocate scarce vaccines—such as those proposed and opposed during the pandemic response—these vaccine lotteries are offering the chance for cash payments and other prizes, and eligibility is limited to vaccinated individuals. Under Ohio’s Vax-A-Million lottery, the state government is awarding US$1 million to 1 lucky adult vaccinee each week for 5 weeks. Additionally, the state will award a full 4-year scholarship to 5 vaccinated adolescents aged 12-17 years. Notably, Ohio reported increasing vaccination rates following the program’s announcement—a weekly increase of more than 50%—a potential indication that the program is increasing interest in vaccination. In a similar program, New York state will distribute “scratch-off” lottery tickets to individuals who get vaccinated at some state-run clinics. New York’s “Vax and Scratch” tickets offer a 1-in-9 chance of a prize, ranging from US$20 to US$5 million. Maryland also announced its own vaccine lottery, VaxCash, which will award a total of US$2 million through 40 daily drawings for US$40,000 each and a final grand prize drawing on July 4 worth US$400,000.

OLYMPICS As the 2020 Summer Olympic and Paralympic Games in Tokyo, Japan, rapidly approach, many questions remain regarding the status of the games. According to multiple news media reports, there is growing opposition to the Tokyo Olympics—including among the public, Japan’s health system, and other experts—in light of ongoing struggles to contain the country’s COVID-19 epidemic. Earlier this month, an online petition to cancel the Tokyo Olympics reportedly received approximately 50,000 signatures within the first 24 hours. Recent polling data estimate that 60-80% of the Japanese public oppose hosting the Olympics this summer. The Tokyo Medical Practitioners’ Association recently called on senior Tokyo and Japanese elected officials—including Prime Minister Yoshihide Suga, Tokyo Governor Yuriko Koike, and Olympic Minister Tamayo Marukawa—to cancel the games. Some high-profile athletes also are questioning the safety of holding the Olympics this year.

On May 19, the International Olympic Committee (IOC) provided an update on the situation, emphasizing that it intends to move forward as planned. The IOC statement indicated that the 2020 Summer Olympics have now moved into the final “operational delivery” phase of preparations and that the IOC and Japanese government will “move forward at full speed” to ensure that the Olympics can be hosted in a safe manner, both for the athletes and the Tokyo community. Additionally, the IOC committed to providing additional support for the medical community, including at the Olympic Village and event venues, but it is unclear exactly what that will entail.

May 18: 1495 New COVID 10 Cases in Illinois