December 20, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

CALLS FOR PAPERS In 2023, the Johns Hopkins Center for Health Security journal, Health Security, will issue a special feature that considers threat agnostic approaches to biodefense and public health (deadline March 31, 2023), as well as a supplement focused on extending conversations begun at the 2022 Preparedness Summit to contribute to a growing body of knowledge about the COVID-19 pandemic and its impact on public health preparedness (deadline January 17, 2023). For more information, visit: https://www.centerforhealthsecurity.org/our-work/journal/

The COVID-19 Situation Report will not be published on December 29. The next report will be published on January 5, 2023. Thank you for your readership and support!

EPI UPDATE The WHO COVID-19 Dashboard reports 650 million cumulative cases and 6.65 million deaths worldwide as of December 20. Global weekly incidence remained relatively stable last week, increasing 4.8% compared to an increase of 12% the previous week. A total of 3.8 million cases were confirmed the week of December 12. Weekly incidence fell over the previous week in South-East Asia (-36%), Africa (-29%), Eastern Mediterranean (-26%), Europe (-9%). Weekly incidence increased in the Americas (+18%) and Western Pacific (+8%) regions. Global weekly mortality remained relatively stable compared with the previous week, down 5%.

UNITED STATES

The US CDC is reporting 99.7 million cumulative cases of COVID-19 and 1.08 million deaths. Incidence for the week ending December 14 remained relatively stable over the previous week, falling to 455,466 cases from 469,240 cases for the week ending December 7. Weekly mortality fell for the week ending December 14, with 2,703 reported deaths, compared to 3,115 deaths the week ending December 7.

Both new hospital admissions and current hospitalizations began falling last week, both down 10% over the previous week.*

*Due to a change in COVID-19 hospital data reporting guidance, the CDC urges caution in interpreting data immediately reported after December 15, 2022, when the transition to the CDC’s National Healthcare Safety Network (NHSN) began. Additional information on the transition can be found here.

The Omicron sublineages BQ.1.1 (38%) and BQ.1 (31%) together represent the most dominant subvariants of sequenced specimens in the US. BA.5 (10%) accounts for a dwindling proportion of cases, and a growing proportion of cases are due to XBB (7.2%). A host of other Omicron sublineages—including BF.7, BN.1, BA.5.2.6, BA.4.6, BF.11, BA.2, BA.2.75, BA.2.75.2, and others—make up the remainder of cases.

US WINTER PREPAREDNESS PLAN The Biden administration last week announced a COVID-19 Winter Preparedness Plan in an attempt to stay ahead of what many experts believe will be a continued increase in COVID-19 cases this season. The plan involves reopening COVIDTests.gov, through which US residents can order up to 4 tests per household this winter; making more free tests available at community and rural health clinics, schools, food banks, and other convenient locations; offering resources and assistance to increase vaccine uptake, including pop-up and mobile vaccination sites; pre-positioning supplies from the Strategic National Stockpile to help prepare health facilities; monitoring emerging variants and their susceptibility to existing treatments and vaccines; and expanding efforts to increase vaccination rates in long-term care facilities and nursing homes.

White House COVID-19 Response Coordinator Dr. Ashish Jha stressed that the nation is facing other respiratory viruses, including RSV and one of the worst and earliest influenza seasons, which, along with COVID-19, are stressing hospital capacity. Dr. Jha encouraged people to receive an updated bivalent vaccine booster if they are eligible and have not done so already. US CDC data show that while about 69% of the US population has completed the primary 2-dose vaccine series, only about 14% of people aged 5 and older have received the updated booster.

According to recent polling from the Kaiser Family Foundation, many people are unsure about the benefit of the updated COVID-19 vaccine. But 2 new studies published last week in the CDC’s Morbidity and Mortality Weekly Report (MMWR) show the updated shots provide substantial protection against illness and hospitalization, particularly among seniors and including among people who had received 2-4 doses of the original monovalent vaccine. The studies used data from a period during predominance of the Omicron BA.5 subvariant, which the bivalent booster partially targets. Since then, the more immune-evasive Omicron sublineages of BQ.1 and BQ.1.1 have gained traction, and it is unclear how applicable the studies’ findings are to these new subvariants. Additionally, a recent analysis from the Commonwealth Fund shows earlier vaccines’ value. The report estimates that from December 2020 to November 2022, the US COVID-19 vaccination program prevented more than 18.5 million additional hospitalizations and 3.2 million additional deaths, as well as saved more than US$1 trillion in medical costs that would otherwise have been incurred. The analysis estimates there would have been nearly 120 million more COVID-19 infections without vaccination. The US FDA announced it will hold a meeting of its vaccines advisory board next month to discuss the future of COVID-19 vaccines, including whether people who have never received a shot should get the bivalent formulation as their first dose.

With other viruses that cause influenza-like illnesses or stomach flu circulating this season, experts agree taking individual actions can help reduce the risk of serious illness. Some of these actions include:

• Getting vaccinated against COVID-19 or getting the most recent COVID-19 booster*, as well as receiving a flu vaccine
• Wearing a high-quality mask while in crowded, indoor places
• Improving ventilation when possible, including opening doors and windows, running fans on HVAC systems, or installing high-quality air filters
• Practicing proper hand hygiene, including thorough hand washing or use of hand sanitizer when appropriate, especially when preparing or sharing food
• Staying home if showing any symptoms such as runny nose, cough, fevers, chills, nausea, body aches, or sore throat
• Testing for COVID-19 before and after traveling and before gathering indoors, particularly if older adults will be present
• Drinking plenty of water, especially while traveling or if consuming alcoholic beverages.

*The US FDA recently authorized and the CDC recommended bivalent boosters for children down to 6 months of age. Eligibility among this age group can be confusing, as it depends on what vaccine series—and how much of that series—has been received so far:

• Moderna: Children 6 months through 5 years who received the original, 2-dose Moderna vaccine are eligible to receive a single booster of the updated bivalent Moderna vaccine 2 months after completing the primary series.
• Pfizer:
• Children 6 months through 4 years who completed the 3-dose primary series are not eligible at this time.
• Children 6 months through 4 years who have not started the 3-dose primary series or who have not completed the series will receive the updated Pfizer vaccine as their third dose.

LONG COVID-RELATED MORTALITY Post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, contributed to 3,544 deaths in the US from January 2020 through the end of June 2022, according to a recent report from the US CDC’s National Center for Health Statistics (NCHS). The deaths were identified using data entered on death certificates in the National Vital Statistics System, a methodology that could lead to an undercount, the report’s authors and other experts cautioned. The majority of long COVID-related deaths occurred among non-Hispanic white and older individuals.

An estimated 1 in 4 people with COVID-19 experience long COVID, which includes a complex constellation of symptoms—such as breathing problems, heart issues, fatigue, and cognitive and neurological issues—that can last for several months or longer or appear months after acute infection and can affect virtually every organ system. There is no agreed upon definition for the condition, and no diagnostic code for the condition existed until October 2021. Though knowledge about long COVID has improved over the past several years, and the US government earlier this year launched the National Research Action Plan on Long COVID, people impacted by the condition and their clinicians are urging more federal efforts and funding to support research, care, and education on the condition. Some experts warn long COVID could critically impact the nation’s economy and productive capacity in the short and long terms.

LONG-TERM CARE FACILITIES/NURSING HOMES As older adults, usually with underlying health conditions, nursing home and long-term care facility (LTCF) residents are at high risk of infection and death due to COVID-19, and the congregate nature of these facilities increases the risk of SARS-CoV-2 transmission. To examine the disproportionate impact the COVID-19 pandemic has had on LTCF/nursing home residents, the US Government Accountability Office (GAO) conducted an analysis of US CDC and Centers for Medicare & Medicaid Services (CMS) data. According to the report, released December 15, the average COVID-19 nursing home outbreak from June 2020 through December 2021 lasted 4 weeks and transmission of COVID-19 in the community surrounding a nursing home, known as community spread, had the strongest association with the duration of an outbreak. Additionally, the longest outbreaks were associated with nursing home facilities that had more than 100 beds, reported staff shortages, and were government-owned. Staff shortages and low staff morale were identified as critical challenges during interviews with officials from 6 nursing homes in 4 states, according to the report.

As of November 20, only 45% of nursing home residents and 22% of staff were up to date with their COVID-19 vaccines, according to recent analysis from the Kaiser Family Foundation. In light of this, the LCTF/nursing home industry is calling for changes to vaccination practices for residents. In a recent letter to US Health and Human Services Secretary Xavier Becerra, industry groups outlined an “all-hands-on-deck” approach to vaccinating residents, including efforts to better educate residents and their families about COVID-19, influenza, and other vaccines; reaching out to hospitals to vaccinate patients before discharging them to their facilities; mobilizing the National Guard to administer vaccines at facilities when LTCF pharmacies cannot; and reaching out to state and local public health agencies to conduct on-site vaccine clinics when needed. Hesitancy remains the primary obstacle to getting more residents and staff up to date on their vaccinations, which means completing a COVID-19 vaccine primary series and receiving the most recent booster dose recommended.

GLOBAL EXCESS MORTALITY An estimated 14.83 million excess deaths occurred during the first 2 years of the COVID-19 pandemic globally, 2.74 times more deaths than the 5.42 million reported as a result of COVID-19 for 2020 and 2021, according to a new WHO study published last week in Nature. India, Russia, Indonesia, the US, Brazil, and Mexico suffered the most estimated deaths due to COVID-19 during the 2-year period. Overall, 4 of 5 excess deaths in 2020 and 2021 occurred in either Southeast Asia—led by India—Europe, and the Americas. By comparison, heart disease was the leading worldwide cause of death in 2019, resulting in nearly 9 million deaths. The researchers said they expect COVID-19 was among the leading causes of death in 2020 and the leading cause of death in 2021. Knowing exactly how many people have died in the pandemic—including deaths from COVID-19 as well as those indirectly related to the pandemic, such as deaths related to interruptions and disruptions to healthcare—will never be possible.

GLOBAL HEALTH EMERGENCY WHO Director-General Dr. Tedros Adhanom Ghebreyesus last week said he is hopeful the COVID-19 global health emergency can end next year. The International Health Regulations (IHR) Emergency Committee for COVID-19 is expected to begin discussions in January outlining criteria for declaring an end to the COVID-19 Public Health Emergency of International Concern (PHEIC) declaration, first announced on January 30, 2020. Even if the emergency ends, COVID-19 is not going away. During an end-of-the-year press conference, Dr. Tedros noted several challenges, including the growing health burden of post-COVID conditions including long COVID, ongoing vaccine inequity and low vaccine uptake in some areas, remaining gaps and weaknesses in variant surveillance, and rising case numbers in several countries, including China. After highlighting several upbeat developments—such as a declining rate of COVID-19 deaths and falling numbers of mpox and Ebola cases—he called for more investment in pandemic preparedness so the world can be ready for the next emerging health threat. Notably, other experts said COVID-19 remains an emergency, warning the pandemic could worsen over the coming months.

CHINA In a rapid and stark reversal from its “zero COVID” policy, China has largely dropped much of its carefully crafted systems of lockdowns and mass testing. The unpopular policy most recently led to widespread protests, rarely seen in China, before being relaxed. Given the high transmissibility of the Omicron subvariants in circulation, predictions of a massive surge in cases across the country are coming true. COVID-19 is spreading rapidly through the population of 1.4 billion, many of whom are inadequately vaccinated and have little to no natural immunity.

On December 19, the Chinese government reported 2 COVID-related deaths, the first in weeks, but many within the country, as well as outside experts, say the low counts are implausible and ignore the high level of loss and grief the latest wave is causing. One of Beijing’s designated crematoria for COVID-19 patients has received a jump in requests for services, and authorities are rushing to increase the number of intensive care beds and healthcare workers, as well as increase dwindling medication supplies, signs of the human toll of abruptly loosening restrictions. Some provincial governments have suggested that people with mild COVID-19 illness continue to go to work, particularly healthcare and food delivery workers. The surge is also coming ahead of Lunar New Year in January, when millions are expected to travel to be with relatives for the holiday. Multiple models predict a winter wave of COVID-19 infections could kill up to 1 million people over the next several months.

China’s strategy has always been deeply political: President Xi Jinping staked the reputation of the Chinese Communist Party on the ability to control COVID-19 better than Western countries. But with the current COVID-19 situation appearing to spiral rapidly, President Xi is now in the position of deciding whether to accept foreign aid and from whom. European and US officials are in contact with Chinese counterparts, but public statements are being carefully worded to make clear the onus is on China to accept any offers of assistance in obtaining vaccines, treatments, or other countermeasures. China’s state media appear to be positioning the current surge as a pre-planned strategy, an “exit wave,” and promised a return to “normalcy by Spring.” Nevertheless, there remain global concerns that China’s situation will have long-term economic and social impacts and increase the risk of a new variant emerging.

Is February 28 the end of Belvidere Assembly Plant?

Rockford Register Star

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Frustrated Rockford area officials vow to keep fighting for Belvidere Assembly Plant

Story by Jeff Kolkey, Rockford Register Star • 7h ago

Despite a surprise announcement on Friday that the Belvidere Assembly Plant would go dark indefinitely starting Feb. 28, Belvidere Mayor Clint Morris said the book has not closed on the facility.

There are 1,350 people still working at the plant. The announcement which appeared to leave a door open for repurposing the plant, was a gut punch coming months before the holidays. And it comes after Gov. JB Pritzker had signed a package of tax incentives for investment in the electric vehicle industry and the General Assembly recently amended the bill to expand and enhance it.

"I was surprised," Morris said. "I know the governor's office had been working with our state representatives and local officials. It caught me off-guard. I didn't expect that."

But Morris said he does not think the final chapter has been written on the Belvidere plant where generations have built vehicles since it opened in 1965. Morris said he remains hopeful that if the Jeep Cherokee is not viable in Belvidere, another option will be chosen.

Stellantis — the automaker formed from the 2021 merger of Fiat Chrysler Automobiles NV and French automaker Groupe PSA — owns 14 car brands including Chrysler and Jeep. The company has steadily reduced its workforce in Belvidere since the pandemic citing a microchip shortage and other issues. Now, it has announced plans to "idle" the plant in February.

More:Will major incentive package save Belvidere Assembly Plant from closing for good?

Morris said it was good that Stellantis' announcement did not definitively say the more than 5 million-square-foot plant would be closing for good. It instead left a door open for it to be retooled. The company in part said while the plant is closed it would be "working to identify other opportunities to repurpose the Belvidere facility."

The announcement angered officials with the United Auto Workers, the union that represents workers at the Belvidere facility through Locals 1268 and 1761.

“We are all deeply angered by Stellantis’ s decision to idle the Belvidere Assembly plant without a plan for future product,” said Cindy Estrada, UAW vice president for Stellantis in a statement.  “There are many vehicle platforms imported from other countries that could be built in Belvidere with skill and quality by UAW members at Belvidere.  The transition to electrification also creates opportunities for new product.  Companies like Stellantis receive billions in government incentives to transition to clean energy.  It is an insult to all taxpayers that they are not investing that money back into our communities.”

UAW President Ray Curry vowed in a statement to fight back and said the announcement coming just before the holidays showed "cruel disregard" for Stellantis' workers.

“We believe Stellantis is grossly misguided in idling this plant which has produced profits for the company since 1965,” adds UAW President Ray Curry. “Not allocating new product to plants like Belvidere is unacceptable."

State Sen. Dave Syverson, R-Cherry Valley, said he was afraid that Friday's announcement would come at some point, but it remained disappointing.

“While we know Illinois’ jobs climate is not as competitive as it is in other states, this plant is known for the strong productivity of its employees,” Syverson said in a statement. “The skilled workers at this plant have always scored higher than counterparts in other states when it came to productivity. That’s something Stellantis needs to keep in mind.”

State Sen. Steve Stadelman, D-Loves Park, in a phone interview said Stellantis has signaled a willingness to continue conversations about the future of the plant and whether it can be repurposed and retooled.

"You have to take that as a positive sign and keep working," Stadelman said. "We have no other choice. We need to continue to work to make sure there is investment in that plant. But it's frustrating, we passed several bills including one two weeks ago, a second round of incentives, and the most recent round was geared toward existing plants."

Jeff Kolkey can be reached at  (815) 987-1374, via email at jkolkey@rrstar.com and on Twitter @jeffkolkey.

This article originally appeared on Rockford Register Star: Frustrated Rockford area officials vow to keep fighting for Belvidere Assembly Plant

The Associated Press

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Stellantis to close Illinois assembly plant, lay off workers

‎

BELVIDERE, Ill. (AP) — Hundreds of workers are expected to be laid off when automaker Stellantis closes an assembly plant in northern Illinois early next year, citing the challenge of rising costs related to the electric vehicle market and other factors.

Stellantis said Friday that its Belvidere Assembly Plant will be idled effective Feb. 28 as the company “considers other avenues to optimize operations.”

“This difficult but necessary action will result in indefinite layoffs, which are expected to exceed six months,” Stellantis said in a statement, adding that notices have been sent to hourly and salaried workers.

About 1,350 people are employed at the plant, which produces the Jeep Cherokee. Belvidere is about 70 miles (112 kilometers) northwest of Chicago.

“The company will make every effort to place indefinitely laid off employees in open full-time positions as they become available,” it said.

Stellantis was formed last year with the merger of Fiat Chrysler and France’s PSA Peugeot.

Gov. J.B. Pritzker's administration has assembled a response team from the Department of Commerce and Economic Opportunity to help displaced workers find new employment, said Pritzker spokesperson Jordan Abudeyyeh.

She said the administration will work with local elected officials, community colleges and others to ensure appropriate retraining programs are available, and with Stellantis to find new uses for the Belvidere plant.

In 2016, then-Fiat Chrysler announced it would invest $350 million in the plant to produce the Jeep Cherokee. Production on the Cherokee began there in 2017.

Stellantis said Friday that the automaker is not commenting on the future of the “Cherokee nameplate.”

“This is an important vehicle in the lineup, and we remain committed long term to this mid-size SUV segment,” company spokesperson Jodi Tinson said in an email.

Stellantis, which also pointed to the coronavirus pandemic and global microchip shortage as challenges to the auto industry, said it is working to identify opportunities to repurpose the Belvidere facility.

Above is from:  Stellantis to close Illinois assembly plant, lay off workers (msn.com)

December 8, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

CALL FOR PAPERS Early detection of biological threats, whether naturally occurring or manmade, is critical. Threat agnostic approaches, which do not rely on determining the identity of the agent or pathogen, show early promise. In 2023, the Johns Hopkins Center for Health Security journal, Health Security, will issue a special feature that considers threat agnostic approaches to biodefense and public health. We encourage submissions of original research articles, case studies, and commentaries that explore policy gaps, data and data analysis, and implementation, among potential topics.   The deadline is March 31, 2023. For more information, visit: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/call-for-papers.html

NOTICE The COVID-19 Situation Report will not be published on December 15 to allow our staff to engage in a team-building event. We will publish once more in 2022, on December 22.

EPI UPDATE The WHO COVID-19 Dashboard reports 643 million cumulative cases and 6.62 million deaths worldwide as of December 8. Global weekly incidence remained relatively stable last week, decreasing 1.3% compared to an increase of 16.8% the previous week. A total of 3.04 million cases were confirmed the week of November 28. Weekly incidence fell over the previous week in Africa (-64%)*, South-East Asia (-27%), Western Pacific (-10%), and the Eastern Mediterranean (-4%). The Americas (+14%) and Europe (+4.5%) regions experienced increasing weekly incidence. Global weekly mortality decreased from the previous week, down 17%.

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

UNITED STATES

The US CDC is reporting 98.8 million cumulative cases of COVID-19 and 1.08 million deaths. Incidence for the week ending November 30 remained relatively stable over the previous week, falling to 303,101 cases from 306,856 cases for the week ending November 23. Weekly mortality fell significantly for the week ending November 30, with 1,780 reported deaths compared to 2,634 deaths the week ending November 23. The decline could be a result of delayed reporting due to the US Thanksgiving holiday.**

**The US CDC updates weekly COVID-19 data on cases and deaths on Thursdays by 8pm ET.

Both new hospital admissions and current hospitalizations continue to rise, increasing last week by 20% and 18%, respectively, over the previous week.

The Omicron sublineages BQ.1.1 (32%) and BQ.1 (31%) together represent the most dominant subvariants of sequenced specimens. A host of other Omicron sublineages—including BA.5 (14%), BF.7, XBB, BN.1, BA.4.6, BA.5.2.6, BF.11, BA.2, BA.2.75, BA.2.75.2, and others—make up the remainder of cases.

US SENATE COMMITTEE REPORT Initial efforts to curb the novel SARS-CoV-2 outbreak in early 2020 was “one of the worst public health responses in US history,” according to a 242-page report released today by Democrats on the US Senate Homeland Security and Governmental Affairs Committee. The latest of several federal efforts to evaluate the nation’s pandemic response, the report focuses only on the first few months of the pandemic, saying the federal government “failed to heed critical public warnings” and has many longstanding and ongoing “systemic problems” that hamper US government preparedness and response capacities. Those problems include weaknesses in data collection and analysis, insufficient testing capacity, supply chain vulnerabilities, overlapping government roles, and, critically, “insufficient funding across multiple administrations.”

Some of the report’s recommendations will require new legislation and funding, according to the authors, although they did not offer an amount. US CDC Director Dr. Rochelle Walensky in an interview with Roll Call this week said the agency is running out of funding to help stave off a winter COVID-19 surge and for other near-term activities. In addition to calling for more funding, she urged the US Congress to improve CDC’s authority to collect data. The White House last month requested nearly US$10 billion more for short-term pandemic response needs, but lawmakers so far have refused to include additional COVID-19 spending in a year-end funding bill.

MASK USE The US CDC is once again encouraging people to wear masks to help reduce the spread of respiratory illnesses, as hospitalizations rise due to the so-called “tripledemic” of COVID-19, RSV, and flu. The nation appears to be at the start of another COVID-19 wave, with hospitalizations reaching a 3-month high last week. Hospitals are already feeling strain from earlier-than-normal increases in RSV and flu cases and hospitalizations. The US is experiencing the highest levels of hospitalization from flu that it has seen in a decade this early in the season. Experts warn that holiday gatherings present a prime opportunity for respiratory viruses to spread and urge people to take precautions, including mask use, physical distancing, testing, and increased air ventilation. While it is unlikely that widespread mask mandates will return, masking in crowded areas can lower the risk of infection and help decrease the burden on overwhelmed hospitals.

One more reason to don a mask during the colder months could be to help keep your nose warm. A study published this week in the Journal of Allergy and Clinical Immunology suggests that exposure to cold temperatures hinder immune responses in the upper respiratory tract by killing nearly half of the virus and bacteria-fighting cells in the nostrils, allowing viruses or bacteria to evade this initial immune response.

INDOOR AIR QUALITY The Lancet COVID-19 Commission Task Force on Safe Work, Safe Schools, and Safe Travel recently published a report on air delivery rates capable of reducing the spread of airborne diseases indoors. The report states that air filtration and ventilation targets in current building standards were not designed to prevent the spread of airborne diseases, including SARS-CoV-2, and the authors recommend a set of new non-infectious air delivery rate (NADR) targets that could improve overall occupant health and prevent the spread of respiratory illnesses. The NADR targets include a gradient from good to best of 4 air changes per hour, 6 air changes per hour, and greater than 6 air changes per hour. Some research indicates that 5 air changes per hour can reduce the risk of SARS-CoV-2 transmission by approximately 50%.

Additionally, the Board of Directors of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) this week announced intentions to develop an indoor air quality standard for pathogen mitigation within the next 6 months. ASHRAE’s 2022-2023 President, Farooq Mehboob, further affirmed commitment to the idea that the health and wellbeing of building occupants should be a crucial aspect of building design and operation. The standard is expected to contain aspects related to building design and operation, alternative pathways for clean air, and testing and verification.

The Lancet COVID-19 Commission Task Force report and ASHRAE announcement come at a time when more governments and professional organizations are examining indoor air quality as a means to reduce disease transmission. Mechanical interventions to disease transmission, such as air filtration and ventilation, can be applied throughout an entire building and are not reliant on the individuals' actions to work effectively. The recent increase in attention to indoor air quality has largely been driven by the COVID-19 pandemic, but long-term improvements will continue to reduce the risk of other respiratory diseases such as influenza, measles, RSV, and others.

COST OF TREATMENTS & VACCINES As federal funding to support COVID-19 healthcare runs out, US residents without insurance are finding it increasingly difficult to receive the necessary care that was universally accessible only months ago. The Biden administration’s requests to the US Congress for additional funding for the COVID-19 response so far have been unsuccessful, despite the potential for new variants and a winter surge in cases. The federal government expects to allow manufacturers of COVID-19 vaccines and treatments to move their products to the commercial market by summer 2023, which could further limit access to people without insurance and others who do not have the means to pay.

As a result, public health experts predict that fewer people will seek lifesaving COVID-19 treatments, such as Paxlovid. Paxlovid has been administered at no cost to nearly 6 million US residents, as a result of federal funding; however, with dwindling funding and restrictions preventing Medicare coverage of the treatment, drug pricing is certain to become a substantial barrier for those seeking the therapy. The federal government has been able to purchase Paxlovid for $530 per course—a significantly discounted rate, according to Pfizer, the drug’s manufacturer. Likewise, the Biden administration has announced it no longer has funding to purchase additional COVID-19 vaccines, without action from Congress, and provide them at no cost to consumers. An analysis from KFF shows the cost of the Pfizer-BioNTech and Moderna COVID-19 vaccines is expected to increase at least 3-fold from the pre-purchased federal price when the products reach the commercial market, to approximately US$96 to US$130 per dose.

BIVALENT VACCINES The US CDC last week published its first “real-world” effectiveness data on updated bivalent SARS-CoV-2 mRNA boosters, showing the shots provided significant additional protection against symptomatic SARS-CoV-2 infection among people who previously received 2, 3, or 4 monovalent vaccine doses. Notably, the benefit of the bivalent booster increased with time since receipt of the most recent monovalent vaccine dose. The data were collected from pharmacy-based testing conducted between September 14 and November 11, 2022. Another study, published December 6 in Nature Medicine by researchers from the University of Texas Medical Branch, showed the bivalent boosters elicited a robust antibody response against the Omicron BA.4/BA.5 subvariants but not against the more recent BA.2.75.2, BQ.1.1, or XBB.1 Omicron subvariants, possibly because of their additional mutations in the spike protein. The researchers noted the adaptability of the mRNA platform and suggested future boosters be altered to match newly emerged variants.

In related news, the European Medicines Agency (EMA) this week backed the use of bivalent mRNA vaccines targeting both the original SARS-CoV-2 strain and the Omicron BA.4/BA.5 subvariants as a primary series in previously unvaccinated adults and children. The agency said the decision was based on data suggesting the bivalent vaccines should produce a robust immune response in previously unvaccinated and unexposed individuals and have a similar safety profile to the original mRNA vaccines. This recommendation paves the way for national authorities in Europe to use the bivalent mRNA technology in future vaccine campaigns.

In the United States, Pfizer-BioNTech has asked the US FDA to authorize their bivalent mRNA vaccine for use in children under age 5 as part of the initial vaccine series. Currently, children under 5 receive 3 small doses of the monovalent vaccine formula targeting the original SARS-CoV-2 strain. The series that Pfizer-BioNTech is asking regulators to authorize would replace the 3rd shot in the primary series with a dose of the bivalent vaccine. Pfizer and BioNTech say the new series could help prevent severe illness and hospitalization among children at a time when other respiratory diseases, such as influenza and RSV, are straining hospital systems.

US MILITARY VACCINE MANDATE US House and Senate lawmakers this week released a compromise US$858 billion defense authorization bill that would increase military spending by 8% over fiscal year 2022 levels and rescind the military’s COVID-19 vaccine mandate for service members. The mandate—which required troops to be separated if they refused the vaccine and did not receive a waiver—became a point of contention in recent days’ talks, after conservatives threatened to hold up the bill if the measure was not removed from the final version of the National Defense Authorization Act (NDAA). Both the White House and US Secretary of Defense Lloyd Austin want to keep the vaccine mandate in place to protect the health of military members and national readiness. The White House declined to explicitly state whether US President Joe Biden will sign the annual defense bill if it includes the provision to rescind the mandate. Both the House and Senate need to pass the bill before it heads to President Biden.

CHINA On December 7, China announced significant easing of its strict “zero COVID” policy, including relaxation of frequent mass PCR testing and digital health codes that were required for people to go about their daily life or travel within the country. The changes, released by the State Council in a 10-point plan, also allows those with less severe coronavirus infections to quarantine at home rather than in centralized facilities. The changes, an extension of a November 20-step “optimization” plan aimed at reducing the economic and social costs of restrictions, came after unprecedented protests in more than a dozen cities nationwide over recent weeks. Many residents expressed relief over the policy’s relaxation but some, including health experts, voiced unease over the rapidity of the changes, leaving many concerned that the population is unprepared for what could be an impending surge in cases. Most people in China have not been exposed to the virus, which would have given residents some natural immunity; vaccination and booster rates are lagging, especially among older adults; and the country’s domestically developed vaccines offer suboptimal protection compared to mRNA vaccines. Additionally, some experts say China has not effectively communicated how to move from "dynamic" suppression to mitigation, leaving some people believing they can simply return to pre-pandemic life.

Some are worried a spike in infections will overwhelm the healthcare system and bring a high death toll—as many as 1 million people, according to some models. Already, hospitals are reporting an influx of COVID-19 patients and rationing fever medicines such as ibuprofen and paracetamol because of shortages. The Chinese government appears to be placing some faith in what they say is a “less pathogenic” Omicron variant, but experts warn that all of Omicron’s sublineages remain capable of causing severe disease and post-acute COVID-19 symptoms, particularly in a population with little to no natural immunity. To some experts, it appears China is moving out of its “zero COVID” restrictions without a solid plan—such as strategies implemented by Australia, New Zealand, and Singapore, all of which followed some type of zero COVID approach—and at a time when the dominant viral strains are more transmissible. For now, China—and the world—will have to wait and see how the nation fares. 

GLOBAL ACCESS TO MEDICAL COUNTERMEASURES Global demand for COVID-19 vaccines is falling rapidly worldwide. The Board of Directors of Gavi, the Vaccine Alliance, the nonprofit organization that led the COVAX initiative, is set to vote this week on a proposal to allow the vaccine delivery mechanism to lapse sometime in 2023. If approved, no-cost COVID-19 vaccines would be included in Gavi’s standard immunization programming for the 54 low-income nations that traditionally receive the organization’s support, and 37 other middle-income nations would receive a one-time payout to help them establish their own COVID-19 vaccination programs. The Board is also considering other issues, including efforts to bolster or begin routine immunization programs that were delayed during the pandemic and a proposal from the Gavi secretariat to keep a “pandemic preparedness pool” of US$1.8 billion to allow the acquisition of future COVID-19 vaccine doses. Some Board members expressed concern over the latter proposal, saying such a fund could unintentionally broaden Gavi’s mandate and that the organization does not have governance in place to manage those funds.

In related news, the US government has expressed support for extending a December 17 deadline to decide whether the World Trade Organization’s Ministerial Decision on waiving intellectual property protections for COVID-19 vaccines should encompass diagnostics and treatments. US Trade Representative Ambassador Katherine Tai said her agency will ask the US International Trade Commission to investigate certain market dynamics such as pricing, production, access, and supply and demand, a process that usually takes 9-12 months. The move will delay the prospects of a World Trade Organization agreement meant to improve global access to COVID-related medical countermeasures.

Illinois Gas Taxes increase 45 cents on January 1

To see the details go to: 

Two gas tax increases coming to Illinois next year (msn.com)

December 1, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

CALL FOR PAPERS Together with the 2022 Preparedness Summit Planning Committee, the Johns Hopkins Center for Health Security journal, Health Security, will publish a new supplement in 2023. The aim of this supplement is to extend conversations begun at the 2022 Preparedness Summit to contribute to a growing body of knowledge about the COVID-19 pandemic and its impact on public health preparedness. Potential authors are encouraged to submit manuscripts that consider how the COVID-19 pandemic is transforming public health preparedness policy and practice and discuss the future of the field. The deadline for submissions is January 17, 2023. More information is available here: https://www.centerforhealthsecurity.org/our-work/journal/call-for-papers/index.html

EPI UPDATE The WHO COVID-19 Dashboard reports 639.5 million cumulative cases and 6.62 million deaths worldwide as of December 1. Global weekly incidence increased for the third week in a row last week, rising 8.9% compared to an increase of 2.36% the previous week. A total of 2.87 million cases were confirmed the week of November 21. Weekly incidence fell over the previous week in Africa (-40%), the Eastern Mediterranean (-17%), South-East Asia (-8%), and Europe (-4%). The Americas (+19%) and Western Pacific (+16%) regions experienced increasing weekly incidence. Global weekly mortality remained relatively steady from the previous week, down 3%.*

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

UNITED STATES

The US CDC is reporting 98.5 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending November 23 rose slightly over the previous week, increasing to 305,082 cases from 281,691 cases for the week ending November 16. Weekly mortality increased for the week ending November 23, with 2,644 reported deaths compared to 2,266 deaths the week ending November 16.**

**The US CDC updates weekly COVID-19 data on cases and deaths on Thursdays by 8pm ET.

Both new hospital admissions and current hospitalizations increased last week, up by 18% and 11%, respectively, over the previous week.

The BA.5 sublineage rapidly lost dominance over the past 2 weeks, now accounting for only 19.4% of sequenced specimens. The Omicron sublineages BQ.1.1 (29.4%) and BQ.1 (27.9%) together represent the two most dominant subvariants. A host of other Omicron sublineages—including BF.7, BA.4.6, XBB, BN.1, BA.2.75, BA.5.2.6, BF.11, BA.2, BA.2.75.2, and others—make up the remainder of cases. 

US PANDEMIC MORTALITY On average, more than 300 people in the US die each day from COVID-19. While the death toll is significantly lower than during the peak of the Delta wave, the number is 2 to 3 times higher than the average number of deaths from flu. Increasingly, COVID-19 is becoming a disease of the elderly. In summer 2021, about 58% of COVID-19 deaths occurred among adults aged 65 or older. Today, that proportion is 9 of 10 COVID-related deaths, according to US CDC data. This upward trend is expected to continue, and despite the nation’s pursuit of normalcy, is set to cause significant disruptions to the health system.

Mortality trends have shifted throughout the pandemic. A study published this week in the Annals of Internal Medicine by investigators at Brigham and Women’s Hospital in Boston, Massachusetts (US), found that the proportion of younger people who died from COVID-19 in 2021 surpassed that of 2020, with the median age of COVID-related deaths falling from 78 years old in 2020 to 69 years old in 2021. Researchers calculated years of life lost (YLL) and compared timeframes in 2020 and 2021. Using this calculation, the team was able to assess premature deaths based on the number of years an individual would have lived. In 2021, there were about 21% fewer deaths compared to 2020. However, YLL per COVID-19 death increased by 36%. Better understanding age shifts in COVID-19 mortality can help inform prevention and treatment approaches, public policy, and community measures to minimize the impacts of this increasingly preventable disease.

US PUBLIC HEALTH WORKFORCE The US CDC this week announced it will award more than US$3 billion in grants to strengthen the nation’s public health workforce and infrastructure. The funding is the first of its kind, as all US citizens live in a jurisdiction that will receive funds. Notably, the new funding is intended for government-run public health agencies, leaving community health organizations concerned they will be left out. States relied heavily on community and grassroots organizations for vaccine rollout, testing, and other services throughout the COVID-19 pandemic. While it is crucial that government health departments in communities that are economically and socially marginalized or rural, or in communities with people from racial and ethnic minority groups, receive this support, particularly with a growing shortage of healthcare workers, community leaders in these settings feel additional funding is needed to sustain and grow health promotion efforts begun during the pandemic. The CommuniHealth Coalition, led by the Johns Hopkins Center for Health Security and the Department of Anthropology at Texas State University, recently released reports examining the role of community health workers in the COVID-19 pandemic response and recovery and providing guidance for how to build and grow the community health sector.

MONOCLONAL ANTIBODY BEBTELOVIMAB The US FDA on November 30 ended its emergency use authorization (EUA) for Eli Lilly’s monoclonal antibody bebtelovimab because it is not expected to neutralize the two most widely circulating SARS-CoV-2 Omicron subvariants, BQ.1 and BQ.1.1. Known together as the “BQs,” those subvariants account for 57% of cases nationwide, according to US CDC estimates. Bebtelovimab was the only remaining authorized COVID-19 antibody therapy. Several companies are working on updated antibodies, although none appear to be close to authorization. The FDA recommended health providers choose other appropriate approved or authorized treatments, including the antivirals Paxlovid, Veklury, or Lagevrio, or convalescent plasma with high titers of SARS-CoV-2 antibodies. A recent preprint literature review posted to bioRxiv concluded that convalescent plasma from recently vaccine-boosted people who had confirmed COVID-19 neutralized more than 95% of the SARS-CoV-2 Omicron subvariants BQ.1.1, BF.7, and XBB and could be a viable substitute for monoclonal antibodies as passive immunotherapy for both COVID-19 prophylaxis and therapy among immunocompromised patients.

LONG COVID Nearly a third of people in the US with COVID-19 will develop long-term symptoms, according to a recent report from the US Department of Health and Human Services (HHS). Health experts are warning that this collection of post-acute symptoms, commonly known as long COVID, could be the next public health crisis—so far impacting as many as 23 million people, a number expected to grow as COVID-19 continues to circulate. In addition to increased medical expenses, individuals and families dealing with long COVID could face a reduced quality of life, reduced income, higher household debt, and lower retirement savings, further widening existing inequalities and costing the US economy US$3.7 trillion, according to one estimate. A Swiss study published in Nature Communications examined the prevalence of post-COVID conditions among children, with the findings suggesting that risk factors for lingering symptoms included older age, lower socioeconomic status, and having an existing chronic health condition, particularly asthma.

With little known about the underlying causes of lasting symptoms and a lack of a clear definition, healthcare professionals are stuck between wanting more evidence for effective therapies and trying to treat vulnerable and suffering patients. Some people with long COVID are turning to expensive and untested therapies, from vitamin supplements to stem cell treatments. The US NIH created the RECOVER Initiative to learn more about the long-term effects of COVID-19 and recently announced a clinical trial to investigate the antiviral Paxlovid for treatment of long COVID, with results expected in 2024. But many experts argue a more agile research model is needed to more quickly address the growing problem.

FUTURE OF VACCINES Global efforts are underway to prepare vaccine research, development, and production facilities for the next pandemic. This week, the Coalition for Epidemic Preparedness Innovations (CEPI) launched its 100 Days Mission, a US$3.5 billion plan to invest in vaccine research and development and achieve equitable access to vaccines for emerging viruses with pandemic potential, with the goal of producing a safe and effective vaccine within 100 days. This effort, if successful, would significantly shorten the time it took scientists to develop shots for COVID-19, a record 326 days. In Africa, Afrigen Biologics & Vaccines, the Biovac Institute, and a variety of partners are working to bring mRNA vaccines—for COVID-19 and other diseases—to the continent and adapt them for the setting, such as doing away with the need for deep freezing and making them more stable at room or refrigerated temperatures. Those involved in the effort hope more African national governments will prioritize vaccine development and manufacturing, ultimately allowing them to own the intellectual property on domestically produced vaccines that can help protect their own populations.

CHINA At a meeting on November 30, Vice Premier Sun Chunlan, the senior official in charge of China’s COVID-19 response, said that “with the decreasing toxicity of the Omicron variant, the increasing vaccination rate, and the accumulating experience of outbreak control and prevention,China’s pandemic containment faces new stage and mission.” These remarks, as well as state media downplaying the severity of the Omicron variant and a few cities lifting lockdown restrictions,signal a potential shift in China’s pandemic response strategy, though no explicit policy changes have been made yet.

To date, China hasrelied on its “zero-COVID” policy—comprising isolation for all known cases, quarantining anyone who may have come into contact with COVID-19, strict lockdowns, school and business closures, mandatory testing, and home confinement, sometimes without access to supplies—which has led to entire cities shutting down for weeks or months. Recently, public anger over the human costs of China’s zero-COVID policysparked public unrest and numerous protests that brought together a diverse group, including workers, students, rural residents, and middle-class people. The events are notable because public protest is rare in China, where the central government strictly cracks down on dissent and has established a high-tech surveillance state.

This week, 2 of China's largest cities, Guangzhou and Chongqing,announced they were easing COVID-19 restrictions. In Chongqing, close contacts of positive COVID-19 cases will be allowed to quarantine at home instead of at centralized, government-run centers. Guangzhou islifting lockdowns in 4 districts (though lockdowns remain in high-risk areas), allowing close contacts of COVID-19 cases to quarantine at home instead of central facilities, and is no longer launching district-wide mass COVID-19 testing.

Some experts believe the government’s zero-COVID strategy islikely to stay in place until vaccination rates increase, especially among older adults, and a long-term strategy for living with COVID-19 can be established. China’s National Health Commission islaunching a national campaign to encourage people who are over 60 years old to be vaccinated and boosted. The campaign willbring vaccines to people in nursing homes, go door-to-door, use mobile vaccination stations for older adults who cannot leave their homes, and press those who are reluctant to give a reason for not being vaccinated. With changes on the horizon,China’s leadership must reckon with the large economic and social toll their blanket approach to controlling COVID-19 is taking while also accounting for the burden that soaring numbers of new infections will place on the country’s health care system.

WORLD AIDS DAY World AIDS Day is commemorated annually on December 1, to show support for people living with and affected by HIV and to remember the approximately 40 million people who have died of AIDS-related illnesses. This year’s theme is “Equalize,” a call to action to address inequalities and continue to work toward ending the AIDS pandemic. Data from UNAIDS, however, show the COVID-19 pandemic and other global crises have impacted progress against HIV/AIDS, shrinking available resources and interrupting access to vital treatment and prevention services. In South Africa, which has the largest population of people living with HIV, some girls and women turned to transactional sex during COVID-19 lockdowns to support their families, increasing their risk of becoming infected. In a joint report, WHO and the European Centre for Disease Prevention and Control (ECDC) said the number of people in Europe living with undiagnosed HIV rose in 2021, when one quarter fewer HIV diagnoses were recorded compared with pre-pandemic levels in the WHO European region. UK Health Security Agency (UKHSA) data show that while new HIV diagnoses fell in England by nearly one-third between 2019 and 2021, progress toward ending HIV transmission has slowed, particularly among heterosexual people. In the US, President Joe Biden outlined steps his administration has taken against the AIDS pandemic, highlighting the ongoing need to better address racial, gender, and other inequities in health systems, through domestic and international programs. The many lessons learned from decades of action against AIDS can serve as a model for how policymakers, public health practitioners, and civil society deal with health threats, including COVID-19, monkeypox/mpox, and other infectious diseases. Importantly, the biomedical, social, and structural actions needed to end AIDS will better prepare the world to address future pandemics.

TWITTER MISINFORMATION POLICY Public health experts, healthcare professionals, and social media researchers are expressing concern after Twitter quietly ended its enforcement of its policy against COVID-19 misinformation on November 23. Twitter implemented the policy in 2020, during the early days of the pandemic, and since then had suspended more than 11,000 accounts and removed more than 100,000 posts for violating the policy. Though many agree the policy was imperfect, the lack of enforcement likely will lead to more false claims about COVID-19, including about the origin of the virus or the safety and effectiveness of vaccines. The move is the latest in a series of rollbacks at Twitter, implemented since the company was purchased by Elon Musk, who himself has spread COVID-19 misinformation.

Illinois’ richest citizen

Here’s The Richest Billionaire In Every U.S. State 2021

Lisette Voytko Forbes Staff BUSINESS

Michael Kovac/Getty Images

17. Illinois | Ken Griffin

City: Chicago
Net Worth: $16 Billion
Rank: 119
Source Of Wealth: Hedge Funds

Despite shelling out $800 million in recent years for homes in London, New York and Palm Beach, Chicago continues to be Griffin’s home base. It’s there that he runs Citadel, a hedge fund he founded with about $34 billion in assets.

John Menard—Wisconsin’s richest man

Here’s The Richest Billionaire In Every U.S. State 2021

Lisette Voytko Forbes Staff BUSINESS

MICHAEL ALLIO/ICON SPORTSWIRE VIA GETTY IMAGES

20. Wisconsin | John Menard Jr.

City: Eau Claire
Net Worth: $14.2 Billion
Rank: 145
Source Of Wealth: Home Improvement Stores

Menard’s 300 home-improvement stores generate an estimated $10.7 billion in revenue. He started his first construction business in 1958—a full two decades before the first Home Depot opened.