January 5, 2023 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

EPI UPDATE* As of January 5, the WHO COVID-19 Dashboard reports:

• 657 million cumulative COVID-19 cases
• 6.67 million deaths
• 3 million cases reported week of December 26
• 22% decline in global weekly incidence as of December 26
• 10,794 deaths reported week of December 26
• 12% decline in global weekly mortality as of December 26

Over the previous week, incidence declined 73% in Africa; 42% in Europe; 26% in South-East Asia; 20% in the Americas; 16% in the Eastern Mediterranean; and 12% in the Western Pacific.

UNITED STATES

The US CDC is reporting:

• 100.6 million cumulative cases
• 1.09 million deaths
• 402,525 cases reported week of December 28
• 17% decline in weekly incidence as of December 28
• 2,530 deaths reported week of December 28
• 14% decline in weekly mortality as of December 28
• 17% increase in new hospital admissions
• 8.6% increase in current hospitalizations

*Recent holidays might delay data reporting for the WHO and US.

The Omicron sublineage XBB.1.5 experienced rapid growth over the past 2 weeks, accounting for an estimated 40.5% of all new sequenced specimens. BQ.1.1 (27%) and BQ.1 (18%) fall in line next, with various other Omicron subvariants accounting for the remainder of cases.

THE FOURTH YEAR As the COVID-19 pandemic enters its fourth year, many nations are better positioned to manage the disease due to clinical care management, vaccines, and therapies, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said during a January 4 briefing. Nevertheless, inequities in access to testing, treatment, and vaccination remain, threatening individuals’ health, the global economy, and societies overall, he said, noting that approximately 10,000 people die of COVID-19 worldwide each week. On December 25, the WHO announced it prequalified the first generic version of Paxlovid for production by an Indian manufacturer and said its scientists are closely monitoring and evaluating the emergence of Omicron XBB.1.5, which is quickly spreading in the United States and has been detected in nearly 30 countries. WHO officials also expressed concern over the situation in China, urging health authorities there to regularly share reliable epidemiologic data.

OMICRON XBB.1.5 A new Omicron subvariant, XBB.1.5, has quickly become predominant in the United States, accounting for about 40% of all US cases—and 75% in the Northeast region—this week compared to around 4% of cases during the first week of December. XBB.1.5 is a recombinant Omicron sublineage, a fusion of 2 different BA.2 variants—BJ.1 (BA.2.10.1.1) and BA.2.75 (BA.2.75.3.1.1.1)—making it more closely related to the BA.2 subvariants that were predominant in the earlier part of 2022 than to the BA.5 subvariants that were responsible for most cases in the second half of 2022. Its rapid growth has concerned public health officials and healthcare practitioners alike, with WHO officials calling it the most transmissible subvariant detected yet. Though there is not yet much data on the severity of XBB.1.5, so far there is no indication it makes people more sick than previous subvariants. Hospitals in the US are already under significant stress, however, due to an early flu season as well as widespread incidence of other respiratory viruses such as RSV.

Some experts are concerned about XBB.1.5’s potential to evade prior immunity, with research on the related XBB subvariants showing the potential to escape the protections of antibodies resulting from vaccination, prior infection, or treatments, including Evusheld. In addition to being immune evasive, XBB.1.5 contains a mutation at genomic site 486 that is associated with enhanced viral binding to human ACE2 receptors, which could be boosting its transmissibility and causing it to surge. Notably, many experts highlight that vaccination and quick treatment with Paxlovid remains highly effective at preventing severe illness. It is unclear just how large of a surge may be driven by XBB.1.5, but the nation—and the world—is much better positioned at this point in the pandemic with vaccines, treatments, and nonpharmaceutical interventions such as masking helping to prevent infection, severe illness, and death.

US WINTER SURGE Much of the United States is experiencing a winter surge in COVID-19 cases, driven by waning immunity, holiday gatherings, and the emergence of the highly transmissible Omicron XBB.1.5 recombinant subvariant. Around the time of this report’s last publication on December 20, the nation surpassed 100 million cumulative reported COVID-19 cases, according to the US CDC. Federal data also show the number of hospitalized patients with COVID-19 is set to surpass the number reached during the summer 2022 surge, with new hospital admissions particularly high among individuals aged 70 and older who are most vulnerable to severe disease. Hospitals and clinics are feeling pressure from an influx of people with various respiratory illnesses in addition to COVID-19, including other coronaviruses that cause colds, influenza, and respiratory syncytial virus. Despite this, only 15% of people over age 5—and only 37.5% of those aged 65 and older—have received an updated bivalent vaccine booster dose. While recent data might not provide a clear picture of where the nation stands—due to reporting delays from recent holidays or severe weather as well as a lack of reporting from people using home tests—levels of SARS-CoV-2 detected in wastewater samples are rising in several regions, particularly in the Northeast, where the XBB.1.5 variant accounts for about 75% of new cases. Though health experts and some government officials, including those in New York City and Los Angeles, are urging people to begin wearing masks again and receive the latest booster, much of the country appears to have moved beyond the pandemic.

CHINA Following a reversal of its “zero COVID” containment strategy in early December after widespread protests, China is experiencing an unprecedented surge in cases. The outbreak appears to have spread first in urban areas, overwhelming healthcare facilities and morgues, and officials are concerned that weaker health systems in more rural areas will not fare well. The true impact of the current surge in cases and the number of resulting deaths is not fully understood due to unreliable data. The WHO has urged China to share more geographically based data on COVID-19 hospital admissions, intensive care unit (ICU) patients, and related deaths. Today, the organization said China supplied data on new COVID-19 hospitalizations showing a nearly 50% increase, from 15,161 new hospitalizations for mainland China during the week ending December 25 to 22,416 for the week ending January 1. China continues to report daily COVID deaths in single figures. The numbers likely are undercounts, based on officials’ use of a narrow definition of COVID-19 deaths, anecdotal evidence from individuals, and reports of deaths among prominent public figures.

In addition to the WHO, health and government officials worldwide are struggling to get a true sense of the situation in China and how to respond. Several countries have introduced—and the European Union recommended—pre-departure COVID-19 tests for travelers arriving from China, moves that the Chinese government and others have criticized as useless or even harmful. Some officials are concerned the large outbreak could provide an opportunity for a new SARS-CoV-2 variant to emerge. According to data from China’s CDC, the Omicron variant—specifically sublineages BA.5.2 and BF.7—is the most dominant based on recent genomic sequencing. The data allay concerns, for now, about the potential for a new variant of concern emerging from the outbreak, but some experts say the situation highlights the need to develop an early warning surveillance system using viral genomic data.

THERAPEUTICS Over the past several years, monoclonal antibodies were critical therapies for millions of people who were at high risk of getting sick from COVID-19 but who did not respond to or could not receive SARS-CoV-2 vaccines. However, new immune-evasive Omicron subvariants have rendered them largely ineffective as treatments for currently circulating SARS-CoV-2 variants, and even prophylactic antibody therapies like Evusheld show diminished efficacy. In 2022, the US FDA rescinded emergency use authorizations for major monoclonal antibody treatments including bamlanivimab, etesevimab, sotrovimab, casirivimab, imdevimab, and bebtelovimab, leaving immunocompromised individuals without many treatment options.

Other therapies have mixed benefits for immunocompromised individuals. Although antivirals are available,they have seen lackluster uptake and are not accessible to everyone; Pfizer’s Paxlovid interacts with other widely prescribed drugs, Merck’s Lagevrio shows lower efficacy, and Gilead’s intravenous remdesivir requires infusions over 3 days in hospital or outpatient settings. Although the US government has strongly promoted antivirals like Paxlovid,misinformation and misconceptions about the drug, as well as worries about side effects and viral rebounding after finishing a regimen, have hampered its uptake. Even convalescent plasma, which can be adapted to different strains,is inconsistently available and difficult to administer.

An FDA spokesperson said the agency will work with pharmaceutical companies on expediting the development of preventive therapies for immunocompromised patients, though it is unknown if the agency will accept fact-tracked data gathered from laboratory studies instead of large-scale clinical trials. Additionally, without the support of federal funding that drove drug development during earlier stages of the pandemic,pharmaceutical companies have little incentive to work on new and more effective antibody treatments. The lack of effective, specialized, and widely used therapies leaves many immunocompromised people with limited options if they become sick with COVID-19.

UNFOUNDED VACCINE RUMORS During a primetime US National Football League (NFL) game on January 2, Buffalo Bills player Damar Hamlin collapsed shortly after suffering a blow to his chest and subsequent cardiac arrest. Hamlin was resuscitated on the field and remains in critical condition in a Cincinnati hospital. Although little is known about the true cause of Hamlin’s collapse, cardiologistssuspect that the blow to his chest may have disrupted his heart’s rhythm and hindered blood flow to his brain; they note there is no indication Hamlin’s COVID-19 vaccine status played a role. Shortly after the incident, however, unfounded rumors began circulating on social media linking Hamlin’s injury to COVID-19 vaccines, revealing the pervasiveness of false and misleading information 3 years into the pandemic. The November 2022 rollback of Twitter’s ban on COVID-19 misinformation likely helped the rumors spread quickly and widely.

Although certain viral infections and vaccinescan lead to myocarditis in some instances, the risk ofvaccine-induced cardiac arrest associated with COVID-19 vaccines is inflated. A September 2022 study in the journalCirculation found that the risk of developing myocarditis following a booster dose of the Pfizer-BioNTech vaccine is low, and an August 2022 study published in Frontiers in Cardiovascular Medicine found that the risk of myocarditis is more than 7-fold higher in persons who were infected with SARS-CoV-2 than in those who were vaccinated. Additionally, a July 2020 study in theClinical Journal of Sport Medicine found that structural abnormalities of the heart muscle or arteries and faulty electric rhythms were the most common causes of sudden cardiac events among competitive professional athletes in the US.

With skepticism surrounding COVID-19 vaccines now threatening other public health priorities, including childhood vaccinations, health officials are struggling to combat misinformation and improve communities’ trust in public health. Experts are concerned that this new wave of misleading information surrounding COVID-19 vaccines threatens the rollout of updated booster doses and ongoing efforts to stop the spread of COVID-19 and other diseases such as measles.

Immigration might solve labor shortage

Lack of immigration is a contributing ‘cause of the labor market shortage’: Economist

There are now 3 million more job openings since pre-pandemic times and according to one economist, a slowdown in immigration is a contributing factor.

Tanya Kaushal

·Writer

Thu, December 22, 2022 at 1:12 PM CST

With too many jobs to fill and not enough workers, America is heading into the new year with a labor shortage.

There are now 3 million more job openings since pre-pandemic times and according to one economist, a slowdown in immigration is a contributing factor.

"It's really important to contrast two ideas," Adam Ozimek, chief economist at the Economic Innovation Group (EIG), told Yahoo Finance Live (video above). "One is that lack of immigration is a cause of the labor market shortage, and the other is that more immigration could help alleviate some of the shortages."

Data from the Department of Homeland Security (DHS) shows that authorized immigration in 2021 rose by 5% year over year — with 740,002 individuals being granted legal permanent resident (LPR) status — but still 28% lower than the 2011-2020 average, and the second-lowest amount since 2003.

During a November speech at the Brookings Institution, Federal Reserve Chair Jerome Powell spoke about the ongoing labor shortage, citing a lack of immigration as one of the causes.

“The combination of a plunge in net immigration and a surge in deaths during the pandemic probably accounts for about 1.5 million missing workers," he said.

The economic benefits to immigration

Economists and lawyers have often referred to the American immigrant population as the “backbone of our communities” as they tend to a higher labor force participation rate.

The reason why that's important, Ozimek argued, is because immigrants not only bring major labor supply but also create more demand.

"That means they spend money on houses and cars and furniture and all the stuff that's in shortage right now," he said.

According to a 2021 report from FWD.us, if immigration levels were doubled to more than 2 million new permanent and temporary immigrants each year, U.S. GDP could double and grow as large as $47 trillion in 2050.

A woman poses in front of a replica of the Statue of Liberty after participating in a USCIS naturalization ceremony on August 17, 2018 in Miami. (Photo by Joe Raedle/Getty Images)

"Per capita, this would lead to a 3% increase in average income by 2050 for all Americans compared with keeping immigration at recent levels, and a 7% increase compared with a zero immigration scenario," the report stated. "Compared with recent immigration levels of around 1.2 million immigrants per year, doubling of immigration now would greatly expand the economic future of the country."

While certain industries are dominated by foreign-born workers — like agriculture and manufacturing — immigrants also create more jobs as they are twice more likely to be entrepreneurial than Americans, according to a study by Northwestern University.

“The predominance of the imbalance between supply and demand is on the lower-skilled side, but there are areas across the skill spectrum where we can use more immigrants,” said Ozimek.

However, Ozimek stressed that increasing immigration isn't the only way to improve America's workforce.

"It's not as simple as saying that if all the people who planned on coming here would have otherwise come here [if] we wouldn't have labor market shortages, but it is the case that because immigrants are so flexible, because they've so geographically mobile and they move towards opportunity, they could help alleviate the acute labor market shortages we have today," he said.

A U.S. Marine veteran prays near the border wall between the U.S. and Mexico in Sunland Park, New Mexico, July 21, 2021. REUTERS/Jose Luis Gonzalez

The Trump effect

The slowdown in immigration is tied not only to the effects of the coronavirus pandemic, but also the fallout of Trump-era policies.

Pandemic lockdowns combined with a lack of federal funding caused a backlog of nearly 1.5 million work permit applications with the U.S. Citizenship and Immigration Services (USCIS), whereas Trump’s policies discouraged immigrants from entering the U.S.

The Trump administration "did a variety of things to reduce immigration," Ozimek said. "Some of them, like banning immigrants from certain countries, was very big and transparent and obviously made the U.S. look like not as great of a destination from that perspective."

Other actions they took, he continued, "were more technocratic, like trying to make it harder for skilled workers' spouses to get jobs. Other things are very administratively detailed. So it's a lot of stuff they did that's taking some time to unwind."

During the Trump administration, new H1B (high-skilled worker) visas and temporary worker visas were halted, which kept out nearly 525,000 workers.

Each worker visa is unique with its own limitations and requirements. There are four broad categories: temporary non-immigrant, permanent immigrant, work-study program, and international entrepreneur.

The H1B visa is a lottery system in which employers must file a petition to the government to state their interest in hiring a particular candidate through what's known as a Labor Condition Application. The annual cap for granting H1B visas is 65,000 and another 20,000 only for workers with a master's or doctorate degree obtained in the U.S.

Among the top 10 companies that have filed for the most Labor Condition Applications are Amazon (AMZN), Google (GOOG, GOOGL), Microsoft (MSFT), Meta (META), and Apple (AAPL), according to MyVisaJobs.

Granting workers these visas isn't the only challenge, Ozimek said. There's also an issue of "flexibility." Under both H-2A and H1B visas, if a worker wishes to switch jobs, they must find another employer who can file another petition for them.

“Letting workers go where the opportunity is, where the shortages are, not tying them to one employer, increasing flexibility could be very helpful in addressing some of these acute shortages that we see," Ozimek said. "And also providing faster, more certain paths to green cards. So it's not just about getting workers here — it's about getting them the ability to take whatever job has the highest and best return and where we're seeing the most shortages."

—

Tanya is a data reporter at Yahoo Finance. You can follow her on Twitter @tanyakaushal00.

Above is from:  https://www.yahoo.com/news/lack-immigration-labor-market-shortage-economist-191213573.html

NY Times: Belvidere imperiled?

Jeep Plant Shutdown Imperils Illinois Town and 1,350 Workers

Jeep Plant Shutdown Imperils Illinois Town and 1,350 Workers

Neal E. Boudette and Robert Chiarito

Fri, December 23, 2022 at 1:10 PM CST

BELVIDERE, Ill. — The Jeep Cherokee was a strong seller just a few years ago. In 2019, a plant in Belvidere produced about 190,000 of the sport utility vehicles, employing close to 5,000 people and operating three shifts a day.

Since then, sales have fallen. The factory laid off the third shift, and then the second. This year it is on track to make fewer than 20,000 vehicles.

Even so, it was a shock when the manufacturer, Stellantis, announced this month that the 57-year-old plant would shut down indefinitely at the end of February, putting 1,350 people out of work. And there is fear across the area, an hour’s drive west of Chicago, that “indefinitely” could mean forever.

Shane Mathison, a line operator who has worked at the Belvidere plant since 2006, said the news hit hard at home, especially for his wife. “She’s freaking out,” he said. “She’s scared to death. But I told her, we’ll make ends meet. If I have to wash dishes at two different places, I will. I have to do what I have to do for the family.”

The prospective shutdown is a fresh sign of upheaval in the American auto industry. Beyond threatening economic pain locally, it adds a contentious element to looming labor negotiations with the company and a hard-fought leadership race in the United Auto Workers union.

Sales of the Jeep Cherokee, a midsize sport utility vehicle, have been slowed by the shortage of computer chips that has hindered auto production around the world for the last two years. Several times Stellantis has halted Cherokee production to divert the chips it had to larger, more profitable vehicles such as the Grand Cherokee and trucks like the Ram pickup.

The Cherokee is also in a crowded, highly competitive segment, and is an aging model. It had its last major redesign in 2014. By contrast, new versions of the Chevrolet Equinox, Ford Escape and Toyota RAV4 have all been introduced in the last four years. An updated Honda CR-V arrived this summer.

At the same time, the auto industry is investing billions of dollars to transition to electric vehicles, one of the most fundamental shifts in the industry in more than 100 years. A half dozen automakers are building battery plants in Georgia, North Carolina, Michigan, Tennessee and Kentucky. Computer chip producers, moving in part to meet the automotive demand, plan new plants in Ohio, Michigan, New York and Arizona, with the help of subsidies under the CHIPS and Science Act, passed by Congress in July.

For now, the northwestern corner of Illinois is bracing for the effects of the idling of the plant, the largest employer in Belvidere, which has a population of 25,000. At Buchanan Street Pub, Jim Edwards, the bar manager, fretted at the notion.

“It’s been affecting us,” he said. “You don’t have that second and third shift coming by anymore. Most of the workers live here in Belvidere. It’s going to be a ghost town.”

The factory is also an important economic engine for a wider area. “There’s always a big hole left when a plant closes,” said Tom McNamara, mayor of Rockford, a city of 147,000 just west of Belvidere. “Auto assembly is a big jobs multiplier. When the plant closes, there are a lot of suppliers and other businesses that will be affected.”

Stellantis, formed two years ago through the merger of Fiat Chrysler and France’s Peugeot, is solidly profitable, having reported 8 billion euros ($8.5 billion) in net income for the first half of the year. But it is also spending heavily to catch up to Tesla, General Motors and Ford Motor in EVs. The company said this year it would invest $2.5 billion to build a battery plant of its own in Indiana.

“Our industry has been adversely affected by a multitude of factors like the ongoing COVID-19 pandemic and the global microchip shortage, but the most impactful challenge is the increasing cost related to the electrification of the automotive market,” Stellantis said in a statement.

Kristin Dziczek, a policy adviser at the Federal Reserve Bank of Chicago who focuses on the auto industry, said Stellantis was encountering a challenge other automakers will face as they ramp up production of EVs and sales of conventional models decline.

“It’s tough,” she said. Keeping plants operating at full capacity “has been hard while companies have to put out a lot of money for the shift to EVs.”

Earlier this year, it seemed the Belvidere plant might become a key part of the company’s strategy. It was in the running to produce battery-powered cars, but Stellantis chose to retool a plant in Brampton, Ontario, instead.

Stellantis said it planned to try to transfer Belvidere workers into positions at other plants that have openings.

Matt Frantzen, 48, a father of five who has worked at the plant since 1994, said he would most likely have to take a transfer to another Stellantis location because he needed to work about another year before he could retire with full benefits.

“It may be Ohio,” he said. “It may be Michigan. But wherever it is, I’m so far invested, I have to go. I’ll leave my family in Belvidere, and I’ll go do my job until retirement. Then I’ll come home and look for new work.”

Eric Fulton, a 25-year employee who works in the plant’s paint reprocess department, said many Belvidere workers had been through downsizing in the past.

“A large portion of employees are transfers already, so we are numb to having to do it again,” he said. “It is very sad, but again, this is the norm that most of us are used to.”

The UAW, which is heading into contract negotiations with Stellantis next year, will push the company to keep Belvidere open and assign new models to the plant.

“A plant can’t be permanently shuttered without the buy-in from the UAW,” Dziczek said. “So this is a really significant round of talks coming up.”

The Detroit automakers have idled plants before past contract negotiations, only to reopen them after bargaining with the union. In 2019, GM was winding down production at its Hamtramck plant in Detroit as contract talks began, and ended up agreeing to produce the first of its new generation of electric vehicles there.

In those same talks, however, GM closed its plant in Lordstown, Ohio, and resisted the union’s efforts to reopen it. While the Lordstown plant was sold, GM built a new battery plant a mile away. Workers at the battery plant this month voted overwhelmingly in favor of UAW representation.

The president of the UAW, Ray Curry, said in an interview that he had been having discussions since August with Stellantis’ chief executive, Carlos Tavares, as well as officials of the Biden administration and the Illinois governor’s office in a push to keep the Belvidere plant alive.

“The corporation is looking at scenarios for putting product in Belvidere,” he said, “and I can tell you the governor has not given up, I have not given up, and we are all advocating for the survival of that plant.”

The plant is certain to become a key topic next year when the UAW membership chooses a president. Curry finished slightly ahead of a reform candidate, Shawn Fain, in a field of five presidential candidates in a November election. Curry and Fain will face each other in a runoff early next year.

Fain said he would push Stellantis hard to assign new models to be built in Belvidere and preserve jobs. In the past, he said, UAW leaders have been too willing to accept wage, benefit and job concessions sought by Ford, GM and Stellantis.

“These companies have had near-record profits for 10 years now,” he said in an interview. “You have workers who’ve worked their butts off and have done their part.”

Even if the UAW is able to negotiate a future for the Belvidere plant, it will probably remain idle long enough to force some workers to retire, transfer or move on to new jobs.

Mathison, the union line operator at Belvidere, may be one of them. He said he planned to look into going back to school to become a certified nursing assistant because a transfer to another state would be difficult.

“I have three kids,” he said. “Both my mom and dad are up there in age. I can’t move. I’m basically going to have to start over at 47.”

Above is from:  https://www.yahoo.com/news/jeep-plant-shutdown-imperils-illinois-191012171.html

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.