Friday, February 18, 2022

Ukraine would not be on the brink of invasion were it not for Paul Manafort and Donald Trump

Ukraine would not be on the brink of invasion were it not for Paul Manafort and Donald Trump

Mark Sumner

Daily Kos Staff

Tuesday January 25, 2022 · 11:05 AM CST

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Employees unload a plane with a new US security assistance provided to Ukraine, at Kyiv's airport Boryspil on January 25, 2022. - The US has stepped up security assistance to Ukraine, amid fear of Russian invasion with Russia's build-up of tens of thousands of troops on Ukraine's border. (Photo by Sergei Supinsky / AFP) (Photo by SERGEI SUPINSKY/AFP via Getty Images)

US military supplies arriving in Kyiv on January 25, 2022

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In 1995, a collapse of Soviet-era infrastructure created a massive public health disaster in Ukraine’s second-largest city. Over 1.6 million people were left without drinking water, and sewage was polluting local wells and rivers. A deadly cholera outbreak was considered likely and hundreds of thousands of people were forced from their homes. Then tanker trucks rolled into the city carrying fresh water and engineers arrived to help plan and execute an overhaul of the failed systems. That assistance came from NATO.

On Tuesday, as NATO continues to position troops in anticipation of an expansion of Russia’s ongoing invasion of Ukraine, it’s worth remembering that cooperation between Ukraine and NATO is far from new. It’s not an idea that’s been pushed on the country by the United States. It’s not some kind of one-sided deal to place pressure on Russia. NATO assistance and closer ties to the West—including NATO membership—have been regularly sought by Ukraine because its government recognized that those bonds offered not just military protection, but economic stability that could not be found in the criminal oligarchy of Russia and other kleptocratic former Soviet republics.

However, in addition to facing a string of economic, political, and structural disasters left behind by the crumbling Soviet empire, Ukraine soon found that it was also subject to an enormous rising threat: The vaunting ambitions of Vladimir Putin to create a new Russian empire to fill that Soviet-shaped hole.

To support that ambition, Putin sought out allies who would help him break Ukraine by breaking its connection to the West. He needed propagandists. He needed specialists in subverting elections, raising public ire, and spreading lies about the actual threats. And Putin found that assistance—from Republicans.

MANAFORT

To fold Ukraine back into his Greater Russia, Putin first had to break its emerging ties with the West. To do so, he engaged former Trump campaign chair Paul Manafort.

Manafort, along with Roger Stone, was one of the founders of Black, Manafort & Stone, a lobbying firm that helped shape Ronald Reagan’s profile for his 1980 victory. That firm also gained another name around the world, where it became known as “The Torturer’s Lobby” for its starring role in helping to promote such figures as Philippine authoritarian Ferdinand Marcos, Angolan mass murderer Jonas Savimbi, and Zairian military dictator Mobutu Sese Seko.

As Spy magazine put it back in 1992, “The well-compensated flacks at Black, Manafort stand at the pinnacle of organizational apologism. Name a corrupt despot, and Black, Manafort will name [a price].”

That price was often quite high. Mobutu signed a million-dollar per year deal in 1989, but from all accounts, he got his money’s worth, because as The Washington Post said at the time, “Black Manafort counts some of the heaviest hitters in politics among its clientele, including President Bush and HUD Secretary Jack Kemp. … Paul Manafort, a partner in the firm, admitted to ‘influence peddling’ to win HUD contracts for his clients, including a housing project in New Jersey that local officials called a horrible waste of taxpayers money.”

What did Manafort’s influence-peddling get for Mobutu? Quite a lot. “[Mobutu] keeps coming back to Washington with his hand out, and Congress keeps filling that hand, in spite of the human rights abuses in Zaire and the inexplicable lack of progress by the country under his reign.”

In 2004, it was Ukraine’s turn.

In the decade following the Kharkiv water disaster, Ukraine had seen ample evidence that stronger ties to the West offered the nation’s best chance for progress. The nation was negotiating potential affiliations with both NATO and the European Union. Meanwhile, Putin was directly fueling corruption and instability in the country, as well as providing both literal and philosophical ammunition to those who wanted to see Ukraine hustle back under Russia’s wing.

The pro-Russian Party of Regions party had both an unsavory reputation as a group of oligarchs and crime bosses supported by Russia. In fact, the party had been created with Russian support as a means of pushing a pro-Russian viewpoint within Ukraine. While they had been successful at getting a lot of publicity, they had little success in placing their candidates in parliament. But in 2004, the Party of Regions officially shifted their positions to become more popular, embracing both many of the promises of the Communist Party and at the same time agreeing that Ukraine needed stronger ties to Europe. The party also brought in a group of high-priced political consultants—from Russia—to assist in planting propaganda about their opponents. Coincidentally, the leading candidate of the most popular party was disfigured by an unknown poison a month before election day.

The previously unsuccessful Party of Regions appeared to squeak out a surprise marginal victory, making candidate Viktor Yanukovych the new president. That lasted only long enough for the second round of voting, in which Yanukovych lost decisively. The period of instability between and around those elections, including the “Orange Revolution” calling for Yanukovych’s removal, eroded Ukraine’s progress toward becoming a stable democratic state.

Following this period of disruption, Yanukovych and the Party of Regions decided that they needed to bring in a real expert — Paul Manafort.

Two years later, as part of growing ties between Ukraine and NATO, U.S. Marines were visiting the Ukrainian city of Feodosia. The Marines were supposed to be part of a military exercise that would see NATO troops and Ukrainian military working together—a precursor to bringing Ukraine into NATO.  Except the Marines fell under attack from “angry locals.”

“We had rocks thrown at us,” reported one Maine. “Rocks hit Marines. Buses were rocked back and forth. We were just trying to get to our base.”

The violence was bad enough that Marines were unable to reach either their base or their supply ship. Eventually, the situation was described as an anti-NATO “riot.” The joint exercise was canceled. However, later analysis of that “riot” showed it to be anything but a spontaneous outbreak of anti-Western sentiment.

American diplomatic cables and Ukrainian prosecutors say the anti-US, anti-NATO protests that threatened these Marines were largely partisan plants, organized by politicians who consulted with Paul Manafort, now the prominent campaign aide to presidential candidate Donald Trump.

Manafort’s staged riot did more than cancel a single exercise. It became the “evidence” that Ukrainians didn’t really want ties with NATO. Nine years later, Vladimir Putin directly cited this event to support his claim that Ukrainians supported the Russian invasion of Ukraine that resulted in the occupation of Crimea.

By the time a spiraling list of charges against Manafort caused him to step back as the official head of Trump’s campaign. Manafort had been paid over $12.7 million by pro-Russian forces inside Ukraine. Over a 15-year relationship, one that continued even as he was working for Trump, Manafort helped to spread propaganda, protect corruption, and conduct illegal lobbying in the U.S. all in support of increasing Russia’s claim on Ukraine.

And it wasn’t all filtered through the Party of Regions. In 2005, in between his being hired to help Yanukovych and the attack on those U.S. Marines, Manafort went to Russian officials directly. At that meeting, Manafort “offered to help Vladimir Putin advance Moscow’s interests.”  In a memo obtained by the Associated Press, Manafort wrote to oligarch Oleg Deripaska to ensure the Putin ally that he could provide: “a great service that can re-focus, both internally and externally, the policies of the Putin government.”  Deripaska would then sign Manafort up for a $10 million contract.

As the Republican-led Senate report on Trump’s connections with Russia in 2016 found:

“Paul Manafort's connections to Russia and Ukraine began in approximately late 2004 with the start of his work for Oleg Deripaska and other Russia-aligned  oligarchs in Ukraine. … The Russian government coordinates with and directs Deripaska on many of his influence operations.”

Something else that Manafort did in 2005 — he hired Russian spy Konstantin Kilimnik as an employee of his consulting firm. Kilimnik would go on to become Manafort’s primary operative in Ukraine, as well as his intermediary in dealings with Vladimir Putin.

With Manafort’s help, and the injection of untold millions from Russia, the Part of Regions gradually absorbed other Ukrainian parties, inked a supposed commitment to the European parliament, and pushed for prosecutions of officials in the ruling party. By 2010, Yanukovych was president for a second time. However, despite having campaigned on support for an already initialed agreement that would make Ukraine an affiliate of the European Union, Yanukovych refused to sign the agreement. Instead, he signed onto a deal that strengthened Ukraine’s connection with, and dependence on, Russia. The result was two years of protests eventually leading to Yanukovych’s ouster (again) in 2014.

It was only in the wake of this second collapse that ledgers and records began to reveal the extent of Manafort’s role in keeping Ukraine broken and unable to stand up to Putin.

TRUMP

The handoff from Manafort to Trump, when it comes to the ongoing injury to Ukraine, was a smooth one. As the Senate report described in 2020: 

“Manafort hired and worked increasingly closely with a Russian national, Konstantin Kilimnik. Kilimnik is a Russian intelligence officer. Kilimnik became an integral part of Manafort's operations in Ukraine and Russia, serving as Manafort's primary liaison to Deripaska and eventually managing Manafort's office in Kyiv.”

And when it came to the Trump campaign:

“Prior to joining the Trump Campaign in March 2016 and continuing throughout his time on the Campaign, Manafort directly and indirectly communicated with  Kilimnik, Deripaska, and the pro-Russian oligarchs in Ukraine.”

That included injecting into the Trump campaign a “peace plan for eastern Ukraine that benefited the Kremlin.”

Trump’s association with pro-Russian oligarchs and the remnants of Yanukovych’s failed regime would then become the basis of the second act for Ukraine and Trump — the one in which Trump tried to leverage Ukraine into a weapon he could use against Joe Biden.

With Rudy Giuliani acting as his agent on the ground, Trump established ties with disgraced prosecutors, exiled oligarchs, and a series of corrupt officials. All of them were willing to give Trump what he wanted: False claims against Biden and his son, Hunter. What they wanted was never in doubt — support for Russia’s goals inside of Ukraine.

To clear the way for this activity, Trump dismissed a well-respected and experienced ambassador so that Giuliani could operate more freely. This came shortly after the New York Times began running a series of false claims by Giuliani that undercut Ukraine’s sitting government and applied a broad brush of corruption to the people and agencies tasked with ending the corruption being sponsored by Putin through Deripaska, Kilimnik, and others.

Ultimately, Trump would attempt to blackmail the president of Ukraine by putting him into an impossible position. In exchange for vital support, Trump would require the Ukrainian government to not only lie about Biden, but to prove that it was just as corrupt as the opposition claimed. To give Trump what he wanted, president Volodymyr Zelensky wouldn’t have been just lying about Joe Biden, he would have been undercutting the foundation of his own government. There was no right solution to the dilemma Trump posed—just a choice of roads to destruction.

When Trump and Putin met in 2018, Putin said that Trump agreed that Crimea belonged to Russia, and that he would “help resolve the conflict” by following the plan Manafort and Kilimnik created, essentially dividing Ukraine down the middle and handing one half to Russia.

But of course, Trump didn’t stop with battering Ukraine. He also helped Putin from the other end. Throughout his time in the White House, Trump constantly attacked NATO, dangled the possibility of the U.S. dropping out of the alliance, and suggested simply destroying the organization. Trump’s actions not only led to an extreme distrust of the U.S. as an ally—especially after the sacrifices NATO nations made in Afghanistan—it left divisions in the organization that are still affecting the ability to mount an effective opposition to Putin’s threats.

RIGHT-WING MEDIA

The thread that runs from Putin to Manafort to Trump is far from the only infiltration that the Russian leader has made into the Republican Party. Americans have seen such spectacles as Republican senators choosing to spend their 4th of July holiday visiting with Putin. Republicans like Sen. Ron Johnson have become reliable mouthpieces for Russian disinformation, and Republican admiration for the authoritarian leader of the Kremlin has been boundless.

Republican actions demonstrating love for Putin is too widespread to be contained in this or any article. So is Russian expertise in using social media to widen social and political divides in the United States. Even definitive proof that Russia engaged in campaign interference that included sending Russian agents to put “boots on the ground” in the U.S. in order to create fake “grassroots” protests, did nothing but deepen the Republican bonds to the Russian dictator. That Russian state media now has an entire network devoted to strengthening the bonds between Putin and wannabe authoritarians around the world doesn’t hurt.

But over the last few weeks, Fox News has conducted a spectacular display of how willing they are to join in with Russia to invade and dismember a U.S. ally, and how eager they are to consider protecting democracy a “threat” that deserves attack.

While this theme has pervaded Fox’s broadcasts, nowhere has it been so jaw-droppingly straightforward as in the weeks Tucker Carlson has spent forwarding the Kremlin’s agenda. That’s included praising Putin’s “strength,” talking up Russia for its “energy resources,” and dismissing the whole idea that there is anything admirable about supporting a long-time ally.

As the situation on Ukraine’s borders gets worse, so does Carlson.

If this looks like a fifth-column effort to forward Russia’s agenda in the United States, that’s only because that’s exactly what it is. Not only that, it’s an effective fifth-column effort.

UKRAINE

Paul Manafort was instrumental in making possible Putin’s first (and still ongoing) invasion of Ukraine. Now the legacy of Donald Trump, paired with ongoing efforts from pro-Russian Republicans and Fox News, are key to utterly destroying a longtime U.S. ally. Currently, more than 100,000 Russian forces now located just outside that nation. There is little doubt that, should Putin decide to attack, he can overwhelm the nation’s defenses in a matter of days and install pro-Russian puppets in Kyiv.

Meanwhile, Fox News continues to undermine support for defending Ukraine with a pro-Russian position that the station has been pushing for months.

With the possibility of conflict not just on the horizon, but facing both the U.S. and Ukraine hour by hour, it’s worth noting that the answer to Tucker Carlson’s question of “Why is it disloyal to side with Russia but loyal to side with Ukraine?” is a simple one: Because Ukraine has been a U.S. ally for decades, to whom we’ve made both diplomatic and military promises. On the other hand, Russia is a longtime antagonist—if not an outright enemy—which has worked tirelessly to undermine the U.S. position at home and abroad, including direct interference in U.S. elections and engaging in extensive propaganda efforts designed to weaken America through raising racial tensions.

There is no world in which Ukraine represents a threat to Russia. It does, however, represent a challenge to Vladimir Putin’s vaunting ambitions to stitch together a Russian empire in the shape of the expired Soviet Union. Russia invaded Ukraine in 2014 and has occupied Crimea since that time. It has also funded rebels in eastern Ukraine—some of whom are certainly Russian military forces—creating a constant crisis that drains Ukraine’s resources and resolve.

Support for Ukraine by NATO—and support of NATO within Ukraine—is far from a new thing, and far from something pushed only by the United States. The same thing goes for other connections between Ukraine and the West. This is a former Soviet republic that has desperately sought to escape from the criminal organization that is Putin’s Russia, but has failed to make that escape, in large part because Republicans in the U.S. have been complicit in shoving them back toward Moscow.

What happens now is still up in the air, but any situation that doesn’t end with Ukraine being strong, whole, and more closely supported by the West, is a win for Putin and his minions: Tucker Carlson, Paul Manafort, and Donald Trump.

Above is from:  https://www.dailykos.com/stories/2022/1/25/2076638/-Ukraine-would-not-be-on-the-brink-of-invasion-were-it-not-for-Paul-Manafort-and-Donald-Trump

Thursday, February 17, 2022

February 17, 2022: Johns Hopkins COVID 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 414.5 million cumulative cases and 5.83 million deaths worldwide as of February 16. The global cumulative incidence passed 400 million cases on February 9, only 33 days after reaching 300 million. The global weekly incidence continues to decline, down 18.2% from the previous week. Notably, all WHO regions with the exception of the Western Pacific region (+18.7%) reported decreasing weekly incidence last week.

Global weekly mortality remained relatively steady, up 0.5% from the previous week. The weekly total of 73,145 deaths is the highest since the week of August 23, 2021—the peak of the previous wave.

Global Vaccination

The WHO reported 10.2 billion cumulative doses administered globally as of February 14. A total of 4.84 billion individuals have received at least 1 dose, and 4.21 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations began to increase last week, closely following the trend in Asia. The trend is up from the most recent low of 18.32 million doses per day on February 7 to 22.1 million per day on February 15.* The global weekly average jumped to 29.5 million doses per day on February 16, corresponding to a large increase reported in Asia and may be a reporting error.** Our World in Data estimates that there are 4.88 billion vaccinated individuals worldwide (1+ dose; 62% of the global population) and 4.28 billion who are fully vaccinated (54.4% of the global population). A total of 1.23 billion booster doses have been administered globally.

*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.

**The OWID data show 16.3 million doses reported in Asia on February 15 and 24.1 million on February 16 (+7.8 million), but it is not immediately clear what country or countries accounted for that increase.

UNITED STATES

The US CDC is currently reporting 77.95 million cumulative cases of COVID-19 and 923,067 deaths. Daily incidence continues its sharp decline, down from a record high of 807,120 new cases per day on January 15 to 134,468 on February 15, an 83% decrease over 4 weeks. Average daily incidence is now below the peak of the previous wave. Daily mortality appears to have peaked on February 1 at 2,516 deaths per day, down to 2,100 on February 15.*

*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.

US Vaccination

The US has administered 677.8 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.78 million doses per day on December 6 to 429,530 on February 11.* A total of 252.4 million individuals have received at least 1 vaccine dose, which corresponds to 76% of the entire US population. Among adults, 87.6% have received at least 1 dose, as well as 26.3 million children under the age of 18. A total of 214 million individuals are fully vaccinated**, which corresponds to 64.5% of the total population. Approximately 74.6% of adults are fully vaccinated, as well as 21.5 million children under the age of 18. Since August 2021, 92.2 million individuals have received an additional or booster dose. This corresponds to 46.3% of fully vaccinated individuals, including 65.7% 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.

**Full original course of the vaccine, not including additional or booster doses.

US RESPONSE Daily COVID-19 incidence has dropped sharply over the past month in the US, and many states are rolling back mitigation measures, including masking requirements for public spaces and schools. Additionally, some Republicans in the US Congress are urging US President Biden to end the designation of COVID-19 as a public health emergency. Based on comments from the White House COVID-19 Response Team on February 16, it appears the Biden administration is working on a plan for the next phase of the pandemic. White House Coronavirus Response Coordinator Jeff Zients said the country has made “tremendous progress” and the Biden administration is actively planning for a future “when COVID isn’t a crisis.” US CDC Director Dr. Rochelle Walensky said the agency wants to “give people a break” from mask wearing and expects to update its indoor masking guidelines as early as next week. The CDC reportedly is shifting its focus to COVID-19 hospitalizations as a key benchmark for determining when mitigation measures can be lifted or tightened. The Biden administration this week requested US$30 billion in additional funding for the domestic pandemic response. According to an anonymous source, the majority of the money would go toward vaccines and therapeutics (US$17.9 billion), with the remainder split among testing, care for uninsured individuals, and future variants. There is bipartisan skepticism surrounding the need for additional pandemic funding, with several members of Congress saying the American Rescue Plan provided plenty of support.

Notably, the funding request does not contain additional money for global vaccination efforts in low- and middle-income countries (LMICs), efforts that are running low on funds. A group of Democratic lawmakers is pushing for an additional US$17 billion for the global COVID-19 response, and USAID has said it needs an additional US$19 billion in 2022 to complete its COVID-related work. According to reporting from Politico, the White House’s proposed global COVID-19 supplemental funding request is US$10.95 billion, although it is unclear whether the Biden administration will officially request that money. In a virtual meeting with other countries earlier this week, US Secretary of State Antony Blinken acknowledged the world is not on pace to reach the goal of vaccinating 70% of the world’s population by later this year. Secretary Blinken announced a “Global Action Plan,” with a focus on overcoming last-mile challenges to deliver and administer vaccines in LMICs. President Biden is expected to hold another international vaccine summit next month, although details on the meeting are not yet available.

US EXCESS DEATHS The US CDC’s National Center for Health Statistics (NCHS) has been tracking excess deaths associated with the COVID-19 pandemic in the United States, crossing the threshold of 1 million excess deaths last week. Excess deaths are defined as the number of unexpected observed deaths to occur during a specific time period. This statistic can aid in further elucidating the burden of COVID-19, documenting both mortality directly caused by the virus as well as deaths indirectly caused by the pandemic’s impact. The NCHS’s excess death dashboard associated with COVID-19 breaks down deaths by direct cause, time, age and race/ethnicity. Dr. Robert Anderson, Chief of Mortality Statistics at NCHS, noted to The Washington Post that 91% of the excess deaths associated with COVID-19 were directly attributed to the disease, while the other 9% of excess deaths had COVID-19 listed as a contributing factor. These non-COVID-19 deaths were attributed to 13 other conditions, with Alzheimer’s disease and dementia, hypertensive diseases, and diabetes showing the greatest increases. Excess deaths not directly attributable to COVID-19 could be due to undiagnosed COVID-19 or conditions exacerbated by the pandemic’s impacts on society, including poorer healthcare due to health system strain or patients reluctant to seek care for other conditions while trying to avoid COVID-19. Timing of excess deaths appears to coincide with surges in SARS-CoV-2 transmission during the pandemic beginning in late March 2020.

US CDC TRAVEL GUIDANCE The US CDC is warning travelers to avoid at least 135 destinations, this week moving several countries—including South Korea, Azerbaijan, and Belarus—to its level 4 COVID-19 risk category due to “very high” transmission levels. The agency warned that people who must travel to these areas be fully vaccinated before going. Several nations moved into the “high” level 3 category, with Eswatini and Mauritius dropping a level and El Salvador and Indonesia moving up from lower levels. Notably, the CDC lowered the cruise travel warning from “very high” to “high,” recommending that travelers be “up to date” on vaccinations—meaning completing a primary series and a booster dose—before vacationing on a cruise ship. The agency recommended prospective cruise ship passengers get tested prior to departures, check to see if the ship has reported COVID-19 cases, and see if the majority of crew and passengers will be vaccinated. CDC’s Conditional Sailing Order, which outlined mandatory rules cruise companies had to follow to operate in US waters, expired on January 15, allowing operators to implement voluntary mitigation measures and choose whether to participate in the agency’s COVID-19 Program for Cruise Ships. According to the agency, 14,803 COVID-19 cases were reported on cruise ships between December 30, 2021, and January 12, 95 times the number reported during the first 2 weeks of December 2021.

VACCINATION DURING PREGNANCY As reported here previously, evidence shows people who receive SARS-CoV-2 vaccinations during pregnancy pass along more durable antibodies to their newborns than do unvaccinated individuals who had COVID-19 during pregnancy. Now, a study published in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) suggests that completion of a 2-dose primary mRNA vaccination series during pregnancy is associated with a reduced risk for COVID-19 hospitalization among infants aged <6 months. For women who completed the series at any time during pregnancy, vaccine effectiveness against COVID-19-associated hospitalization in infants aged <6 months was 61% (95% CI: 31% to 78%). Vaccine effectiveness against infant hospitalization was 32% (95% CI: –43% to 68%) for women who completed vaccination during the first 20 weeks of pregnancy and 80% (95% CI: 55% to 91%) for women who completed vaccination late in pregnancy, at 21 weeks’ gestation through 14 days before delivery. The case-control study recruited participants from 20 pediatric hospitals in 17 states from July 2021 to January 2022, with 176 hospitalized infants with COVID-19 and 203 hospitalized infants without COVID-19. This news could bring some comfort to prospective parents concerned by the recent increase in hospitalization among children under the age of 5 who are not yet eligible for vaccination against COVID-19. Further research results on the effects of COVID-19 variants and vaccination among pregnant women and newborns is expected in May 2022 with the University of Oxford launching a global study this week involving 40 medical institutions and 4,500 pregnant women.

ESTROGEN LEVELS Higher estrogen levels may be associated with a decreased risk of dying from COVID-19 among older women who take supplements of the hormone, according to a study published in the February issue of BMJ Open. All of the 14,685 postmenopausal Swedish women, aged 50 to 80 years, included in the study had COVID-19 between February 1 and September 14, 2020. They were grouped based on estrogen levels, with women receiving endocrine therapy because of breast cancer representing lower estrogen levels, women on hormone replacement therapy representing higher levels, and a control group of women who had received neither therapy. The adjusted odds ratio (OR) for death following COVID-19 remained statistically significant for only the higher estrogen group with OR 0.47 (0.34 to 0.63), a risk reduction of more than half. Absolute risk of death was 4.6% for the control group versus 10.1% and 2.1%, for the decreased and increased estrogen groups, respectively. The researchers noted that the risk of death from COVID-19 was significantly associated with age, annual income, and education, and they recommended further clinical trials testing the use of estrogen supplementation as a COVID-19 therapy among postmenopausal women.

LONG COVID/PASC Researchers continue to examine potential causes for post-acute sequelae of SARS-CoV-2 infection (PASC), otherwise known as post-COVID condition or long COVID, with recent findings pointing to vagus nerve dysfunction (VND), microclots, or inflammation as possible underlying factors or opportunities for treatment. The range of symptoms that people with long COVID experience—including fatigue, shortness of breath, joint and muscle pain, cognitive problems, depression, headache, and rapid heartbeat—call for a multidisciplinary approach to treatment, according to researchers who are developing a consensus statement (preprint) on core outcomes of long COVID in adults.

Studies differ on how many people experience long COVID symptoms, with one US CDC study estimating 1 in 10 will develop symptoms more than a month after acute infection and another from Oxford University estimating 1 in 3 individuals. While some see their symptoms resolve within weeks or months, others are experiencing nagging symptoms that have lasted a year or more. Additionally, evidence is emerging that people who have had COVID-19—including those with mild cases and who do not have typical long COVID symptoms—have an increased risk of cardiovascular disease and mental health conditions when compared with individuals who have never had the disease. Therefore, millions of people worldwide could experience long COVID or future health implications, with lasting societal and economic impacts. In a survey of 804 organizations representing more than 4.3 million employees in the UK, the Chartered Institute of Personnel and Development (CIPD) found that 46% of the organizations had employees who experienced long COVID and 26% of those employers now include long COVID as a primary cause of long-term sickness absence. In the UK, 1.3 million people—2% of the population—reported experiencing long COVID symptoms for more than 4 weeks after their initial infection.

This week the UK Health Security Agency released a rapid review examining available evidence from 15 studies conducted around the world prior to January 12, 2022, to determine the effectiveness of SARS-CoV-2 vaccination against long COVID. The analysis suggests that individuals who are fully vaccinated against COVID-19 have a significantly reduced risk of developing long COVID symptoms compared to partially vaccinated or unvaccinated individuals, and those currently suffering long COVID who are unvaccinated may experience some improvement if they get the shots. The review underscores the importance of vaccination in lowering the risk of infection in the first place and the potential to lower the risk of long-term symptoms if a breakthrough infection occurs.

IMMUNOCOMPROMISED INDIVIDUALS US states’ rollbacks of certain COVID-19 restrictions and mask mandates signal a bit more freedom is on the horizon for some. But for immunocompromised people, who are at high risk of infections including SARS-CoV-2, the relaxation of public health measures places them in a sort of limbo, unsure about their safety in a world where the coronavirus continues to circulate and people are returning to pre-pandemic activities. At least 7 million people in the US take immunosuppressive drugs, and millions more have conditions that inhibit immune responses, including HIV and genetic disorders. They are less likely to mount a significant immune response to SARS-CoV-2 vaccinations, even after 3, sometimes 4, doses. Many immunocompromised people feel vulnerable, left behind by a nation that is increasingly loosening precautions such as masking and working from home without any consideration of how to keep them safe. Vaccinating more of the US population, improving ventilation systems, and taking other steps to limit the amount of circulating virus would help. Additionally, making prophylactic antibody treatments such as Evusheld more widely available to immunocompromised people—as Israel did this week—and improving access to other COVID-19 treatments for the highest-risk patients could help some return to more of a sense of normalcy. The US government has announced it plans to convene a working group of advocates for people with vulnerabilities, but in the meantime, immunocompromised people continue to feel abandoned, isolated, frustrated, and fearful.

Wednesday, February 16, 2022

Tuesday, February 15, 2022

February 15, 2021: 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.

VACCINE FOR <5 CHILDREN The US FDA on February 11 postponed an advisory committee meeting set for today to discuss data on the Pfizer-BioNTech SARS-CoV-2 vaccine for young children ages 6 months through 4 years. According to an FDA statement, Pfizer notified the agency of new data from an ongoing clinical trial, and the postponement will allow the FDA time to consider that data. As previously reported here, the companies originally tested the vaccine as a 2-dose regimen, with each dose containing 3 μg, one-tenth of the dose given to those ages 12 and older. However, the companies announced late last year that among children aged 2 to 4 years old, 2 doses generated only 60% of the antibody levels seen in individuals aged 16 to 25 years who received 2 doses. Notably, 2 doses did appear to elicit antibody levels among the youngest children aged 6 months to 23 months similar to those in the older individuals.

The FDA originally pushed Pfizer and BioNTech to request authorization for an initial 2-dose regimen while collecting data on a third dose, but Dr. Peter Marks, Director of the FDA Center for Biologics Evaluation and Research, implied the new data showed that 2 doses were not sufficient in protecting against symptomatic infection, particularly during the latest Omicron surge. Former FDA Administrator and current Pfizer Board Member Dr. Scott Gottlieb said the delay was due to a “low number of cases” in the trial, perhaps insufficient for data analysis. The companies expect data on the 3-dose regimen to be available in early April.

Efforts last week by the US CDC to open preordering of the vaccine indicated the decision to authorize a 2-dose regimen while waiting on further data on 3 doses was nearly a done deal, with the agency predicting shipments of the lower-dose version could begin the week of February 21. While some experts breathed a sigh of relief that the FDA is taking extra time to review the scientific evidence, some parents expressed dismay and frustration over what they say feels like a string of setbacks. Still, not all parents are eager to vaccinate their younger children. The Pfizer-BioNTech vaccine has been available for children aged 5 to 11 since early November 2021, yet only about one third of the 28 million children in that age group have received at least 1 dose so far. A recent survey from the Kaiser Family Foundation showed about 30% of parents of children younger than age 5 intend to get them vaccinated as soon as shots become available. Approximately 400 children under age 5 have died of COVID-19 since the beginning of the pandemic.

BOOSTER DOSE EFFECTIVENESS Booster doses of SARS-CoV-2 mRNA vaccines are strongly recommended by public health and medical professionals—even more so during the recent surge in cases caused by the Omicron variant of concern—to lower the risk of symptomatic COVID-19 and more severe cases requiring hospitalization. Emerging data continue to support booster doses as both safe and effective for these purposes. A recent study published in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) found that vaccine effectiveness at preventing severe COVID-19 was higher after a booster dose than after the second dose of mRNA vaccine. The effectiveness of boosters wanes after about 4 months but remains highly protective against severe disease. These findings were consistent across both the Delta-dominant and Omicron-dominant periods. The findings support further consideration of additional booster doses that could be valuable against future outbreaks or variants.

Despite booster doses being highly effective in preventing emergency department visits and hospitalizations due to COVID-19, public uptake of booster doses has slowed in recent months in the US. A survey from the Kaiser Family Foundation found that 60% of vaccinated but not boosted respondents stated that the Omicron wave did not greatly impact their decision whether or not to get a booster. Only around 29% of respondents reported that the Omicron wave made them more likely to get a booster shot. Additional data from the CDC on hospitalizations and deaths show that booster doses are most beneficial to older adults. The argument for booster doses is strongest in those aged 65 years and older, for whom booster doses reduced the death rate per 100,000 cases by around 90 times. More work still needs to be done to better understand the durability of immunity following booster doses as well as to encourage more people, particularly those in higher-risk populations, to receive their booster doses.

COVID-19 THERAPEUTICS Late last week, the US FDA authorized a new monoclonal antibody (mAb) treatment that reportedly retains activity against the SARS-CoV-2 Omicron variant in laboratory experiments. The treatment—known as bebtelovimab and made by Eli Lilly—received Emergency Use Authorization (EUA) for adults and certain pediatric patients who are at high risk of severe COVID-19 outcomes but was not authorized for hospitalized COVID-19 patients or those requiring supplemental oxygen. Eli Lilly has signed a contract with the US government to supply up to 600,000 doses of the treatment by March 31, with the option for an additional 500,000 doses to be delivered later this year, at a cost of at least US$720 million. The company said it will immediately begin shipments to fulfill the agreement. Many providers expressed gratitude for the authorization, after the US government halted the use of 2 of the most common monoclonal antibody treatments due to a loss of effectiveness against Omicron.

Also late last week, the WHO prequalified a different mAb treatment, tocilizumab, that inhibits the interleukin-6 (IL-6) receptor. The prequalification includes 3 different presentations of the treatment and represents the first mAb to receive the designation. Tocilizumab—which is used primarily to manage arthritis and has been the subject of many COVID-19 clinical trials, including the large RECOVERY trial—is prequalified only for patients diagnosed with severe or critical COVID-19. The RECOVERY trial continues its work to establish an empirical baseline of effectiveness for other therapeutics. In a study published February 12 in The Lancet, the RECOVERY Collaborative Group summarized the results of evaluation of the monoclonal antibodies casirivimab and imdevimab used in combination. Between September 2020 and May 2021, the combination treatment reduced 28-day mortality in patients who were seronegative at baseline—meaning they had not mounted their own immune response—but not among individuals who were seropositive at baseline. However, when all patients were considered together, the treatments had no significant difference in outcomes. The results support the use of the combination therapy only among hospitalized individuals who are seronegative.

Questions remain over how well mAb treatments work against Omicron, as well as its BA.2 sublineage. Vir, the producer of the mAb sotrovimab, published a press release last week stating that its treatment retains neutralizing activity against the BA.2 sublineage of Omicron. The laboratory data, which are expected to be posted to a preprint server this week, are not yet peer-reviewed. Conversely, a separate study posted to bioRxiv (also not yet peer-reviewed) found BA.2 exhibited resistance to sotrovimab. Other therapies, including the antivirals Paxlovid and remdesivir, remain effective at reducing the risk of COVID-19-associated hospitalization or severe disease, but supply constraints and administration challenges are limiting access to only the highest-risk patients.

US VACCINE MANDATES New York City last week fired 1,430 municipal employees—less than 1% of the city’s workforce—for not complying with the city’s SARS-CoV-2 vaccination mandate. About 95% of the city’s 370,000 workers have received at least 1 dose of vaccine. Approximately 9,000 workers remain unvaccinated and are seeking exemptions but still could face termination. A majority of the fired employees, about 900, worked at the Department of Education. On February 11, the US Supreme Court denied a request from a group of New York City public school teachers, administrators, and staff seeking to block the mandate for employees who were not granted religious exemption. Those involved in the lawsuit were told they would be fired if they did not get vaccinated by February 14.

In compliance with the US Department of Defense vaccine mandate for military personnel, the US Navy and US Army announced they have begun discharging unvaccinated soldiers. The US Air Force last week said it has granted 9 religious exemptions and continues to process 2,556 pending requests and 732 pending appeals. Overall, the Air Force has turned down more than 3,200 requests for exemptions and approximately 440 appeals. The US Navy has not yet granted any religious exemptions.

CANADIAN PROTESTS After being closed for nearly a week because of demonstrations against COVID-19 vaccine mandates and restrictions, the Ambassador Bridge—the busiest US-Canada border crossing—reopened late February 13 after police made more than 2 dozen arrests, towed 7 vehicles, and seized 5 others. The bridge, which links Ontario to Detroit, is a major artery for the transport of vehicle parts from Canada to automotive plants in the US. Protests continue to block border crossings between Emerson, Manitoba, and Pembina, North Dakota, and Coutts, Alberta, and Sweet Grass, Montana. Additionally, demonstrations that began January 29 continue in the Canadian capital of Ottawa, disrupting transportation and daily activity. On February 14, Canada Prime Minister Justin Trudeau announced he is invoking the Emergencies Act, allowing the government the authority to “restore order.” The unusual move is meant to counter acts of lawlessness seen during the protests, according to Canada Public Safety Minister Marco Mendicino, who called the move “very careful and deliberate.” 

Earlier on February 14, TD Bank—short for Toronto-Dominion Bank—froze approximately US$1.1 million that was intended to go to groups supporting the “Freedom Convoy” leading the Ottawa demonstrations, most of which came from a GoFundMe account that was shut down. TD Bank has said it wants the courts to decide where the money should go. After the GoFundMe account was shuttered, a crowdsourcing site on GiveSendGo began to raise money. Late last week, an Ontario Superior Court decision to grant the Canadian government authority to freeze access to any money raised to back the blockade. Meanwhile, GiveSendGo said it could continue to deliver money to protestors, but the site was hacked late on February 13, with hackers releasing the names of donors. Also on February 14, Ontario Premier Doug Ford announced the province will no longer require proof of vaccination to enter indoor spaces as of March 1 due to a decreasing number of COVID-19 cases and hospitalizations. He clarified that the restrictions were not being lifted in response to the demonstrations.

ASIA Several nations and regions in Asia have experienced increases in new COVID-19 cases following Lunar New Year celebrations held early this month, with governments grappling with how to respond to the Omicron variant that has found its way through strict border controls. Hong Kong is experiencing a record surge in cases, reporting more than 2,000 new cases on February 14. The outbreak is overwhelming hospitals, forcing schools to remain closed, and necessitating help from China to address what Hong Kong Chief Executive Carrie Lam called an “aggravating situation.” Hong Kong has been following the mainland’s zero-COVID strategy by isolating all patients in hospitals to suppress transmission, but this outbreak is testing the limits of that policy. For now, there are no plans for a strict lockdown in Hong Kong, although a more-intrusive contact-tracing app is being used to restrict the movements of unvaccinated individuals.

China is continuing to enforce its zero-COVID policy, shutting down entire cities and holding the Beijing Winter Olympics in a strict “closed-loop” bubble that some have criticized as excessive. A paper published last week in the weekly bulletin of the China Center for Disease Control and Prevention (CCDC) estimated that if the global vaccination rate was 95% and population mobility returned to 2019 levels, zero-COVID regions would see more than 234 million new cases in 1 year, including 2 million deaths. Without the development of more effective and durable vaccines, a constellation of public health mitigation measures will need to be continued to stave off further crises, although most experts agree that China’s widespread lockdowns are extreme.