COVID is worse in red (or blue) states?

COVID Gets Even Redder

The gap in COVID’s death toll between red and blue America has grown faster over the past month than at any previous point. (Getty Images)

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David Leonhardt

Mon, November 8, 2021, 1:13 PM

As 2020 wound down, there were good reasons to believe that the death toll during the pandemic’s first year might have been worse in red America. There were also good reasons to think it might have been worse in blue America.

Conservative areas tend to be older, less prosperous and more hostile to mask wearing, all of which can exacerbate the spread or severity of COVID-19. Liberal areas, for their part, are home both to more busy international airports and more Americans who suffer the health consequences of racial discrimination.

But it turned out that these differences largely offset each other in 2020 — or maybe they didn’t matter as much as some people assumed. Either way, the per capita death toll in blue America and red America was similar by the final weeks of 2020.

It was only a few percentage points higher in counties where Donald Trump had won at least 60% of the vote than in counties where Joe Biden crossed that threshold. In counties where neither candidate won 60%, the death toll was higher than in either Trump or Biden counties. There simply was not a strong partisan pattern to COVID during the first year that it was circulating in the United States.

Then the vaccines arrived.

They proved so powerful, and the partisan attitudes toward them so different, that a gap in COVID’s death toll quickly emerged.

The gap in COVID’s death toll between red and blue America has grown faster over the past month than at any previous point.

In October, 25 out of every 100,000 residents of heavily Trump counties died from COVID, more than three times higher than the rate in heavily Biden counties (7.8 per 100,000). October was the fifth consecutive month that the percentage gap between the death rates in Trump counties and Biden counties widened.

Some conservative writers have tried to claim that the gap may stem from regional differences in weather or age, but those arguments fall apart under scrutiny. (If weather or age were a major reason, the pattern would have begun to appear last year.) The true explanation is straightforward: The vaccines are remarkably effective at preventing severe COVID, and almost 40% of Republican adults remain unvaccinated, compared with about 10% of Democratic adults.

Charles Gaba, a Democratic health care analyst, has pointed out that the gap is also evident at finer gradations of political analysis: Counties where Trump received at least 70% of the vote have an even higher average COVID death toll than counties where Trump won at least 60%.

As a result, COVID deaths have been concentrated in counties outside of major metropolitan areas. Many of these are in red states, while others are in red parts of blue or purple states, like Arizona, Michigan, Nevada, New Mexico, Pennsylvania, Oregon, Virginia and even California.

This situation is a tragedy, in which irrational fears about vaccine side effects have overwhelmed rational fears about a deadly virus. It stems from disinformation — promoted by right-wing media, like Rupert Murdoch’s Fox News, the Sinclair Broadcast Group and online sources — that preys on the distrust that results from stagnant living standards.

A peak?

The future of COVID is uncertain, but I do think it’s possible that the partisan gap in COVID deaths reached its peak last month. There are two main reasons to expect the gap may soon shrink.

One, the new antiviral treatments from Pfizer and Merck seem likely to reduce COVID deaths everywhere, and especially in the places where they are most common. These treatments, along with the vaccines, may eventually turn this coronavirus into just another manageable virus.

Two, red America has probably built up more natural immunity to COVID — from prior infections — than blue America, because the hostility to vaccination and social distancing has caused the virus to spread more widely. A buildup in natural immunity may be one reason that the partisan gap in new COVID cases has shrunk recently.

Death trends tend to lag case trends by a few weeks, which suggests the gap in deaths will shrink in November.

Still, nobody knows what will happen next. Much of the recent decline in caseloads is mysterious, which means it may not last. And the immunity from vaccination appears to be much stronger than the immunity from infection, which means that conservative Americans will probably continue to suffer an outsized amount of unnecessary illness and death.

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Above is from:  https://www.yahoo.com/news/covid-gets-even-redder-191319465.html

November 4: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

EPI UPDATE The WHO COVID-19 Dashboard reports 247.5 million cumulative cases and 5.01 million deaths worldwide as of November 3. Global weekly incidence and mortality both increased for the second consecutive week. Weekly incidence increased by 4.1% compared to the previous week, and mortality increased by 7.9%. At the current rate, we expect the global cumulative incidence to surpass 250 million cases within the next week.

The global cumulative mortality surpassed 5 million deaths on November 2:

1 death to 1 million- 246 days

1 to 2 million- 116 days

2 to 3 million- 90 days

3 to 4 million- 90 days

4 to 5 million- 115 days

Global Vaccination

The WHO reported 7.0 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of November 5.* A total of 3.9 billion individuals have received at least 1 dose, and 3.0 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations has increased over the past week, up from 25.4 million doses per day on October 27 to 29.0 million on November 1.** The global trend continues to closely follow Asia. Since mid-October, daily vaccinations have increased in Europe and Asia and declined in Oceania. Africa is holding relatively steady near its highest rate, but it is still well below the other continents on a per capita basis. The overall trend in South America is unclear due to large fluctuations over the past several weeks. North America exhibited a spike in daily vaccinations on October 30, as a result of reporting from Mexico.

Our World in Data estimates that there are 3.93 billion vaccinated individuals worldwide (1+ dose; 49.9% of the global population) and 3.08 billion who are fully vaccinated (39.1% of the global population).

*This date might be an error but appears as such on the WHO page.

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

UNITED STATES

The US CDC reports 46.1 million cumulative COVID-19 cases and 746,705 deaths. The current daily incidence average is approximately 68,151 new cases per day and appears to be increasing. The decline in daily incidence has tapered off, and the average has held relatively steady at approximately 71,000 new cases per day since October 26. While this is considerably lower than the January 2021 and September 2021 peaks, it is still higher than the peaks from all other surges. The decline in daily mortality appears to have passed an inflection point and is beginning to taper off as well. The US is currently averaging 1,190 deaths per day, more than the summer 2020 peak, despite the widespread availability of SARS-CoV-2 vaccines.*

*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.

If the US continues at this rate, we expect it to surpass 750,000 cumulative deaths within the next 2-3 days. If the US surpasses this benchmark on November 5:

1 death to 250k- 258 days

250k to 500k- 95 days

500k to 750k- 264 days

US Vaccination

The US has administered 425 million cumulative doses of SARS-CoV-2 vaccines. The daily vaccination trend has increased sharply since October 21, up from 684,000 doses per day to 1.2 million on October 29, the first time above 1 million doses per day since June 13.* Notably, this corresponds to the date on which CDC Director Dr. Rochelle Walensky endorsed the recommendation by the CDC’s Advisory Committee on Immunization Practices (ACIP) to expand eligibility for booster doses. We expect to see some associated increase in daily vaccinations as a result of the recent decision to authorize use of the Pfizer-BioNTech vaccine in children aged 5-11 years.

There are 222 million individuals who have received at least 1 vaccine dose, equivalent to 66.9% of the entire US population. Among adults, 80.2% have received at least 1 dose, as well as 15.2 million children under the age of 18. A total of 193 million individuals are fully vaccinated, which corresponds to 58.1% of the total population. Approximately 69.8% of adults are fully vaccinated, as well as 12.8 million children under the age of 18. Since August 13, 20.6 million fully vaccinated individuals have received an additional or booster dose, including 26.6% of fully vaccinated adults aged 65 years or older.

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

MOLNUPIRAVIR The UK Medicines and Healthcare products Regulatory Agency (MHRA) today authorized the use of the oral antiviral molnupiravir for the treatment of mild-to-moderate COVID-19 in adults with diagnostic-confirmed SARS-CoV-2 infection and who have at least one risk factor for developing severe illness, making it the first country to authorize a COVID-19 treatment that can be administered at home. Molnupiravir, which is branded as Lagevrio in the UK, was developed by Merck and Ridgeback Biotherapeutics. An interim analysis of a Phase 3 clinical trial released last month showed the antiviral reduced the risk of hospitalization or death among COVID-19 patients recovering at home by approximately 50% when given early in their infection. A US FDA advisory committee is scheduled to meet later this month to discuss Merck and Ridgeback’s request for emergency use authorization (EUA) for the drug. In a statement, UK Health and Social Care Secretary Sajid Javid called molnupiravir a “gamechanger for the most vulnerable and the immunosuppressed.” Merck is making efforts to accelerate access to the drug, including entering into advance purchase agreements with individual nations, implementing tiered pricing, and granting voluntary licenses to generic manufacturers and the Medicines Patent Pool. The company expects to produce 10 million treatment courses by the end of this year.

COVAXIN The WHO on November 3 issued an emergency use listing (EUL) for Covaxin, a SARS-CoV-2 vaccine developed by Indian drugmaker Bharat Biotech. The EUL adds an eighth vaccine to a growing list of shots validated by WHO for the prevention of COVID-19 and facilitates Covaxin’s use in many countries that depend on WHO guidance for their regulatory decisions. A WHO-convened Technical Advisory Group (TAG) determined Covaxin meets quality, safety, efficacy, and production standards, and that the benefits of the vaccine far outweigh the risks. Notably, the WHO said current data are insufficient to assess vaccine safety or efficacy in pregnancy. The panel’s decision had been delayed after it sought additional information from Bharat Biotech to assess the vaccine’s risks and benefits for global use. The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) in early October recommended Covaxin be administered in a 2-dose regimen, 4 weeks apart, for adults aged 18 years and older. The vaccine—which has 78% efficacy after 2 doses—is easily stored, making it very suitable for use in low- and middle-income countries (LMICs) that might lack adequate cold chain storage and distribution capabilities. The listing also paves the way for COVAX to acquire and distribute the vaccine. Covaxin is the first vaccine fully developed and manufactured in India to receive an EUL, and the decision will help millions of Indians who have received the vaccine travel outside the country.

US AUTHORIZES PEDIATRIC VACCINE As expected, US CDC Director Dr. Rochelle Walensky on November 2 endorsed a unanimous recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP) that children aged 5 to 11 years receive a pediatric formulation of the Pfizer-BioNTech SARS-CoV-2 vaccine. The vaccine is the first to be authorized for that age group in the US, making about 28 million children immediately eligible to be vaccinated. The pediatric vaccine—a 2-dose regimen of 10μg administered 21 days apart, one-third of the dose recommended for individuals aged 12 and older—represents “a turning point” in the nation’s efforts against COVID-19, US President Joe Biden said. According to the CDC, every 1 million doses given to children aged 5 to 11 should prevent about 58,000 COVID-19 cases and 226 hospitalizations in that age group, and could prevent about 600,000 new cases in all age groups through March 2022. Widespread use of the vaccine among children will help slow the spread of the virus, make returning to in-person schooling safer, lower the risk of transmission during upcoming family holiday gatherings, possibly spur recovery in the travel industry, and generally “bring us closer to returning to a sense of normalcy,” acting US FDA Commissioner Dr. Janet Woodcock said in a statement.

Concerns remain over whether children in this age group will be at risk of myocarditis and pericarditis—inflammation of the heart muscle or tissue surrounding the heart, respectively—rare but potentially serious adverse events associated with the Pfizer-BioNTech and Moderna mRNA vaccines. The risk is highest among adolescent and young adult males aged 12 to 29 years, and experts agree the risk in younger children likely will be lower. They also concur that the benefits of vaccination in preventing COVID-19 outweigh any risks in young kids, as COVID-19 itself can lead to heart damage and other complications, including multisystem inflammatory syndrome in children, or MIS-C, and long COVID. Already, about 15 million pediatric doses are in place and ready to be administered nationwide. Those parents who are eager to get their children vaccinated—about 27%, according to the KFF COVID-19 Vaccine Monitor—can contact their pediatrician, local pharmacy, or health department to make an appointment. The children’s vaccination program is expected to be fully operational next week, and Vaccines.gov will soon be updated with available locations.

US VACCINE MANDATES The administration of US President Joe Biden today announced the details of 2 policies covering more than 100 million workers in an effort to get more people in the US vaccinated against COVID-19. The first rule, issued by the US Department of Labor’s Occupational Safety and Health Administration (OSHA), applies to employers with 100 or more employees and requires them to ensure their workers are either fully vaccinated or undergo weekly testing for SARS-CoV-2, for which employers are not required to pay. The rule also requires employers to provide paid-time off for employees to get vaccinated and compel unvaccinated workers to wear a face mask while at work. Employers who willfully do not comply with the mandate could face fines of up to $14,000 per violation, with the possibility of multiple citations per business. The second rule, issued by the Centers for Medicare & Medicaid Services (CMS) at the US Department of Health and Human Services (HHS), requires all healthcare workers employed at facilities that participate in Medicaid and Medicare—approximately 76,000 facilities nationwide—be fully vaccinated, with no option for testing but allowances for medical and religious exemptions.

Notably, under the new guidelines, all employees who fall under the OSHA, CMS, or previously announced federal contractor rules are now required to be fully vaccinated by January 4, 2022. The new deadline satisfies requests from businesses to wait until after the holiday season to implement vaccine mandates, expressing concerns over workforce shortages and soaring demand for services. Additionally, OSHA and CMS clarified that the agencies’ new rules preempt any inconsistent state or local laws, such as those banning or limiting employers’ authority to require vaccination, testing, or masking. In rolling out the new policies, the Biden administration clarified its legal authority in implementing the rules, citing OSHA’s responsibility in keeping workers safe and in healthy environments. Nonetheless, legal challenges to the rules are expected in the coming days.

Last week, 10 US states with Republican leaders filed a joint lawsuit challenging the vaccine mandate for federal contractors, saying the rule is unconstitutional. According to new vaccination mandate protocols published earlier this week, federal contractors will have more flexibility in how they enforce vaccination and testing mandates for workers who remain unvaccinated and who do not seek or receive a valid exemption. Federal contractors who do not comply with the new policies could face losing contracts. Some large federal contractors, including airlines Southwest and American and aerospace engineering company Boeing, have said their employees must abide by the original December 8 deadline to be fully vaccinated or apply for an exemption, although that deadline could be pushed back under the new guidance. According to results from the KFF COVID-19 Vaccine Monitor released last week, 5% of unvaccinated workers say they have left a job because of a vaccine requirement.

J&J-JANSSEN VACCINE A retrospective comparative-effectiveness study published in JAMA Open Network shows a single dose of the J&J-Janssen SARS-CoV-2 vaccine is 74% effective in preventing SARS-CoV-2 infection. The study—conducted by researchers from nference, a US-based software company affiliated with Janssen—examined the electronic health records (EHRs) of Mayo Clinic patients in several US states from February 27 to July 22, 2021, including 8,889 vaccinated and 88,898 matched unvaccinated adults. Both the Alpha and Delta variants were circulating at the time, although the Delta variant emerged toward the end of the study period. Overall, 0.7% of those vaccinated with the J&J-Janssen vaccine contracted SARS-CoV-2 compared with 2.5% of unvaccinated patients, corresponding to an overall vaccine effectiveness of 73.6% and 74.2% beginning 14 days post-vaccination. Vaccine recipients also had a lower risk of hospitalization and ICU admissions, although the groups had no difference in mortality due to a low number of deaths.

In a research letter published in JAMA Internal Medicine, researchers from the Mayo Clinic compared the age- and sex-specific rates of cerebral venous sinus thrombosis (CVST), a type of blood clot, after vaccination with the J&J-Janssen vaccine with pre-pandemic CVST rates in the general population in Olmsted County, Minnesota (US). CVST remained a rare occurrence following vaccination, with the overall age- and sex-adjusted incidence at 2.34 per 100k person-years between 2001 and 2015, compared with a peak incidence of 8.65 per 100k person-years 15 days post-vaccination, calculated using data from the US CDC’s Vaccine Adverse Event Reporting System (VAERS) collected between February 28 and May 7, 2021. The post-vaccination CVST rate among women was 5.1 times higher compared with the pre-pandemic rate, and the risk was highest among women aged 40 to 49 years, followed by women aged 30 to 39 years. The researchers note that the absolute CVST risk remained low for women in these age groups and the reasons for the higher incidence is unclear.

IMPACT ON LIFE EXPECTANCY & PREMATURE MORTALITY A study conducted by an international collaboration of researchers estimated that the COVID-19 pandemic has contributed to an excess loss of life of more than 28 million years in 2020. The study, published in The BMJ, collected all-cause mortality data for 37 upper-middle- and high-income countries and regions and compared data from 2020 to data from 2005-19. The researchers estimated the decrease in life expectancy and excess years lost—which is similar to “excess deaths,” but accounts for the age at death compared to the life expectancy.

Only Denmark, Iceland, New Zealand, Norway, South Korea, and Taiwan reported lower mortality than expected in 2020, and only New Zealand, Norway, and Taiwan reported an increase in life expectancy. The remaining countries accounted for more than 28 million years of life lost above the expected value, based on the WHO’s standard life table. Notably, the decrease in life expectancy was significantly greater among men than women, with an estimated 17.3 million years lost globally for men and 10.8 million for women. On a per capita basis, the largest excess years lost were observed in Bulgaria (7,260 years/100k population in men; 3,730 in women), Russia (7,020; 4,760), and Lithuania (5,430; 2,640). The researchers estimate 4,350 years lost per 100k population for men and 2,430 for women in the US. The largest decreases in life expectancy were observed in Russia (-2.33 years in men; -2.14 years in women), the US (-2.27; -1.61), and Bulgaria (-1.96; -1.37). This study includes only a small fraction of the global population and omits the vast majority of Asia and South America—including China and India and the entire continent of Africa—so it is highly likely that the actual excess loss of life is much greater than this estimate. Additionally, more deaths have been reported in 2021 than in the first year of the pandemic, so the total impact of the pandemic is likely far greater than 28 million excess years lost.

INDIGENOUS COMMUNITIES The Navajo Nation—the largest indigenous US tribe, with nearly 400,000 members—is experiencing an increase in COVID-19 cases despite a relatively high vaccination rate of about 70%, according to tribal data. Other tribes with high vaccination rates also are seeing a surge in cases, leaving experts and tribal leaders to wonder what is driving the increases. There remain pockets of unvaccinated tribal members, with most in the 17- to 45-year-old range, leading some to conclude that those of working age, many of whom travel off of reservations for employment, could be driving the increase in cases on reservations, where many live in multigenerational housing that can facilitate virus transmission among age groups.

View the impact of COVID-19 on Tribal Nations (New on JHU Coronavirus Resource Center).

Around the globe, indigenous leaders in Australia and New Zealand are concerned that as those countries reopen their borders, COVID-19 incidence will rise in their communities, many of which are remote and have limited access to medical services. And in one isolated area of Peru’s Amazon rainforest, members of the Urarina indigenous community only learned of the pandemic last month, when healthcare workers arrived to vaccinate residents. The trip to vaccinate members of the community took 3 days by boat, highlighting the challenges of vaccinating villagers in remote areas where access to healthcare is sorely lacking.

November 2: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

New Report: Together with our partner The Council on Foreign Relations, we released a new report urging governments, multilateral and international institutions, and private actors to act immediately to strengthen planning for future pandemic vaccines by incorporating lessons learned from successes and failures of the current global rollout of COVID-19 vaccines. The new report, Navigating the World that COVID-19 Made: A Strategy for Revamping the Pandemic Research and Development Preparedness and Response Ecosystem, identifies how the COVID-19 pandemic has exposed and redefined the realities of the global vaccine research, development, production and delivery ecosystem, one which has so far failed in rapid, equitable allocation and distribution of vaccines globally. You can read the full report here.

PEDIATRIC VACCINES The US FDA on October 29 authorized the emergency use of the Pfizer-BioNTech SARS-CoV-2 vaccine for children ages 5 to 11 years, making the vaccine the first to be authorized in the US for about 28 million US school-age children. The 2-dose regimen for this younger age group is one-third the dosage given to individuals aged 12 and older (10μg versus 30μg), administered 3 weeks apart. The US CDC’s Advisory Committee on Immunization Practices (ACIP) is meeting today and will vote around 4:15 pm EDT on whether to recommend the vaccine. If the panel votes that the CDC should recommend the Pfizer-BioNTech vaccine for 5- to 11-year-olds, which is likely, CDC Director Dr. Rochelle Walensky is expected to sign off on the recommendation, possibly within a few hours. While that scenario will make the vaccine available for some by the end of this week, a White House official on November 1 said the pediatric vaccination program will be “hitting full strength” the week of November 8, after vaccine doses are shipped to pediatrician offices, pharmacies, and other vaccine administrators.

Moderna recently provided an update on the FDA’s review of its SARS-CoV-2 vaccine for adolescents aged 12 to 17, saying the regulatory agency needs additional time to evaluate data on the risk of myocarditis after vaccination—inflammation of the heart muscle characterized by a rapid or irregular heartbeat. The FDA informed Moderna that regulators expect the assessment will not be completed by January 2022. Both the Moderna and Pfizer-BioNTech vaccines have been associated with rare instances of myocarditis, but COVID-19 disease is more likely to lead to the condition, and possibly cause lasting damage. The absolute risk of vaccine-associated myocarditis remains very small, and most cases are mild and recover fully quickly. So far, data suggest that the risk is highest after the second dose of an mRNA vaccine among males ages 16 to 29. Some researchers have seen a possible association between puberty hormones and myocarditis—which typically develops annually in about 10-20 people out of every 100,000 after a viral or bacterial infection—and that could explain why the condition seems to be less common among younger children. Moderna said it will wait to request authorization for its vaccine in younger children ages 6 to 11 until after an FDA decision on adolescent use.

NOVAVAX The National Agency of Drug and Food Control of the Republic of Indonesia, or Badan Pengawas Obat dan Makanan (Badan POM), on November 1 authorized the use of a SARS-CoV-2 vaccine developed by Novavax and manufactured by the Serum Institute of India (SII), marking the first authorization for the company’s recombinant nanoparticle protein-based vaccine. The company said shipments to Indonesia are expected to begin soon, with the country set to receive 20 million doses this year. Novavax has applied for authorization in India, the Philippines, the UK, and Australia, and announced on November 1 it submitted for authorization with Health Canada and completed rolling review submissions with the European Medicines Agency (EMA). The vaccine, NVX-CoV2373, appeared to provide 100% protection from moderate-to-severe COVID-19 based on data from a large Phase 3 clinical trial conducted in the US and Mexico, with 90.4% overall efficacy. Notably, Indonesia is not on the list of countries recognized by the WHO as having strict regulatory processes, so Novavax still has to win authorization elsewhere before it can fulfill a promise to COVAX to supply 1.1 billion vaccine doses. The company expects to request authorization from the US FDA by the end of this year.

NATURAL/INDUCED IMMUNITY The scientific community’s understanding of natural and induced COVID-19 immunity continues to evolve with the increasing number of vaccinated and recovered individuals. Late last week, the US CDC published a study in its Morbidity and Mortality Weekly Review (MMWR) examining the odds of hospitalization among adults with COVID-19 whose previous infection or vaccination occurred 90-179 days earlier. The study found that the odds of hospitalization were 5.5 times higher in individuals who previously had COVID-19 compared to people fully vaccinated with an mRNA vaccine and no previous SARS-CoV-2 infection. The CDC said the study affirms their recommendation for those who have had SARS-CoV-2 infections to get vaccinated. Throughout vaccination rollouts in the US, some unvaccinated individuals cite their own natural immunity from previous SARS-CoV-2 infection as a reason to avoid vaccination. An essay published in The New York Times on October 28 suggests there should be a strong effort to promote the power of so-called “hybrid immunity,” the protection previously infected individuals get when they are vaccinated. Some research suggests that individuals who have recovered from COVID-19 have a stronger immune response to new coronavirus exposures after vaccination when compared to vaccinated people who had not been previously exposed. In theory, this should allow these groups to have a better immune response to new variants.

Overall, the general consensus is that recovered individuals have a lot to gain from SARS-CoV-2 vaccination. A new poll from Axios/Ipsos shows people in the US are confused about SARS-CoV-2 vaccines’ effectiveness. According to the poll, 40% of respondents either don't believe or don't know that unvaccinated people are at least 10 times more likely to die of COVID-19. The results show the importance of public health officials underlining that vaccination continues to be the best protection from severe COVID-19 and not equating an individual’s decision to rely on natural immunity as being “anti-vax.” Research continues to explore the benefits of both natural and vaccine-induced SARS-CoV-2 immunity to develop a better understanding of the pathways that lead to more successful antibody responses.

HOUSEHOLD TRANSMISSION A study led by researchers from Imperial College of London and the UK Health Security Agency found that individuals vaccinated against SARS-CoV-2 had a reduced but still significant risk of transmission among household contacts. Published in The Lancet Infectious Diseases, the analysis determined a secondary attack rate (SAR) in household contacts exposed to contacts with the Delta variant was 25% for fully vaccinated individuals compared with 38% in unvaccinated individuals. The SAR among household contacts exposed to fully vaccinated index cases was similar to household contacts exposed to unvaccinated index cases (25% vs 23%). Peak viral loads were similar among vaccination groups and viral variants, but vaccinated individuals had a faster rate of viral load decline, implying they might become less infectious more quickly. The time interval between vaccination and study recruitment was greater in fully vaccinated PCR-positive contacts than fully vaccinated PCR-negative contacts, which the researchers note may indicate increased susceptibility to infection consistent with waning immunity as soon as 2-3 months following vaccination. They concluded that vaccination continues to protect against serious COVID-19 disease and that booster doses are warranted.

OVERWEIGHT & OBESITY People with overweight or obesity (OWOB) who become infected with SARS-CoV-2 are at a higher risk of severe COVID-19 and long-term symptoms, according to research published recently in the journal Influenza and Other Respiratory Viruses. Notably, adolescents with OWOB had longer-lasting respiratory symptoms (7 vs 4 days) and were more likely to be symptomatic than adolescents without OWOB (67% vs 34%). Recognizing these disparities, some countries—including the UK, Mexico, and Chile—are acknowledging diet-related diseases such as obesity and diabetes as risk factors for more severe COVID-19 and taking actions to curb sales of junk food, sugary drinks, and fast food and encourage people to exercise more. Less attention is being given to the association between OWOB and more severe COVID-19 in the US, where nearly 75% of adults and about 20% of children have OWOB. Additionally, almost two-thirds of COVID-19 hospitalizations in the US are estimated to be related to obesity, diabetes, hypertension, or heart failure. With no national strategy to address OWOB in the US, some researchers worry the problem could worsen in the future, as the rate of obesity during the first year of the pandemic rose among children ages 2 to 19 from 19.3% in 2019 to 22.4% in 2020. A study published November 1 in JAMA Pediatrics estimates that screen time spent outside of virtual schooling—also known as recreational screen time—among teenagers doubled from 3.8 hours a day before the pandemic to 7.7 hours per day during the pandemic. The findings imply that teenagers are spending more time engaging in sedentary behaviors, increasing their risk of developing OWOB, and could have mental health implications.

US SCHOOL SCREENING TESTING PROGRAMS In a joint effort between the US Department of Education, the US CDC, and the Rockefeller Foundation, the Biden administration is launching a new push to accelerate school-based COVID-19 screening testing for students and staff. The effort hopes to expand the reach of federal and state partners through additional resources, including a guide on how to start a school testing program, and will establish weekly “office hours” to connect schools to national testing experts for assistance in setting up and maintaining screening testing programs beginning November 2 and running through December 22. Additional personnel will be available to assist state health departments coordinate school testing programs through the CDC Foundation and the COVID Workforce Initiative as well as assist with contact tracing and other public health activities. A new directory, launched by the CDC, also aims to simplify the search for testing providers for schools to establish their testing programs. As part of the COVID-19 Action plan announced in September, US President Joe Biden allocated $10 billion for screening testing for teachers, staff, and students in K-12 schools, but not all states have accepted or utilized their share of the funding. According to a survey by the Center on Reinventing Public Education of the nation’s 100 largest school districts, less than 15% of those schools are utilizing that funding to establish COVID-19 screening testing programs.

G20 SUPPORT FOR ACT-A The Access to COVID-19 Tools Accelerator (ACT-A) last week launched a new strategic plan and budget for the next year, calling on nations to contribute US$23.4 billion through September 2022 to help the partnership close gaps in access to COVID-19 vaccines, diagnostics, treatments, and other resources in low- and middle-income countries (LMICs). Under the new plan, ACT-A partner agencies will aim to support LMICs in vaccinating 70% of their populations, increasing testing rates to at least 1 per 1,000 people per day, and treating up to 120 million COVID-19 cases by improving access to existing and emerging therapeutics. In announcing the new plan, a WHO official said 5 billion additional vaccine doses will be needed to reach the vaccination goal, requiring more transparency from manufacturers and countries with existing vaccine contracts or those that have pledged doses to COVAX, the vaccines arm of ACT-A.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus called on the Group of 20, which met over the weekend in Rome, to use their political and financial power to fund ACT-A and create a legally binding treaty on pandemic preparedness and response. In a joint communiqué issued at the end of their meeting on October 29, G20 health and finance ministers agreed to continue to support ACT-A and take steps to reach a goal of vaccinating 70% of the world’s population by mid-2022—earlier than its previous goal—by “helping boost the supply of vaccines, medical countermeasures, and inputs in developing countries and remove relevant supply and financing constraints.” The ministers also agreed to establish a G20 Joint Finance-Health Task Force to prepare for future pandemics. Notably, the G20 ministers did not make any firm financial commitments, instead calling for further cooperation and exploration of funding mechanisms to address the current pandemic or future preparedness efforts. G20 leaders concluded their meeting on October 31, agreeing to “work together towards the recognition of COVID-19 vaccines deemed safe and efficacious by the WHO and in accordance with national legislation and circumstances, and to strengthen the organization’s ability regarding approval of vaccines.” The language apparently is in response to comments from both Russia President Vladimir Putin and China President Xi Jinping, who separately complained about lags in review time and lack of mutual recognition for the countries’ domestically produced SARS-CoV-2 vaccines.

LOCKDOWNS RISE & FALL Australia, Israel, and Thailand on November 1 significantly eased international border restrictions for the first time since the beginning of the COVID-19 pandemic, while parts of Eastern Europe and China took steps to tighten lockdowns amid rising cases. Australia opened its borders to permanent residents, citizens, and their families, allowing reunions after more than 18 months apart. Australians are now free to travel internationally without an exemption, and fully vaccinated individuals are no longer required to quarantine for 2 weeks upon arrival. All other non-resident international travelers need an exemption to enter the country, even if they are fully vaccinated. In Thailand, the government hopes the return of foreign visitors will help boost the economy, for which tourism accounts for about 20%. Israel is allowing international travelers who have received vaccine boosters, but not if more than 6 months has passed since their last dose.

In contrast to its Asia-Pacific neighbors, China is becoming more isolated, implementing new lockdowns and continuing its efforts to maintain a “zero COVID-19” policy. In an extreme example, officials kept more than 30,000 visitors to the Shanghai Disneyland in the park and forced them to undergo SARS-CoV-2 testing before being able to leave after one visitor tested positive for the virus. The South Pacific island nation of Tonga entered lockdown today, after recording the country’s first imported COVID-19 case last week. The case—a traveler from New Zealand incoming on a repatriation flight—spurred thousands of residents to get vaccinated. Meanwhile, parts of Russia have implemented their strictest lockdowns in more than a year, as the country continues to hit record numbers of daily new cases, with an average of 38,194 on November 1, more than double its recent low on September 10.

SARS-COV-2 ORIGIN The US Intelligence Community last week released a declassified report on the origins of SARS-CoV-2, the novel coronavirus that caused the COVID-19 pandemic. The nation’s intelligence agencies were unable to conclude whether the pandemic began as a result of animal-to-human viral transmission or a laboratory incident, saying that while both are both plausible, analysts could not agree on which was more likely or whether an assessment can be made at all based on current knowledge. In order to provide a more clear picture of the pandemic’s origin, the agencies would need more information from China or another breakthrough in new information, according to the report. Notably, the intelligence report does rule out allegations that the virus was developed as a bioweapon, although with low confidence. Additionally, the report clarifies that intelligence analysts agree that Chinese officials did not know about the novel coronavirus until after its detection in the general population. In response to the report, a Chinese official said the fact that a potential lab leak was included as a plausible origin was “a lie,” and he called for an investigation led by a cooperative of scientists from around the world.

In a process to name such a group, the WHO on November 1 reopened its call for applications for experts to join its newly established Scientific Advisory Group for the Origins of Novel Pathogens (SAGO). Interested individuals have until November 3 24:00 CET to submit their documents. Last week, only a day before the public comment period closed for a group of 26 previously named nominees, the investigative research group US Right to Know submitted a letter to the WHO expressing concerns over several of the nominees. It is expected that the WHO will choose additional applicants and reopen a 2-week comment period, further delaying the finalization of the group.