May 4, 2023: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.

Click to Subscribe

Announcements

PUBLISHING NOTICE The COVID-19 Situation Report will be taking a break next week and will not be published on May 11. We will resume publishing on May 18.

In this issue

> Surveillance efforts decline as US prepares to wind down public health emergency; WHO panel meets to discuss whether to continue PHEIC

> Experts begin to assess pandemic responses, glean lessons learned to prepare for next pandemic

> Journal articles review progress made, lessons learned on COVID-19 treatment; studies into new treatments, repurposed drugs continue

> Vaccine effectiveness studies support use of bivalent formulations, show monovalent vaccines highly effective against severe disease, death but effectiveness waned quickly against Omicron

> Decreasing US racial disparities in COVID-19 deaths possibly due to more deaths among Whites, study shows

> What we're reading

> Epi update

Surveillance efforts decline as US prepares to wind down public health emergency; WHO panel meets to discuss whether to continue PHEIC

As the COVID-19 pandemic enters its fourth year, surveillance of the disease has declined dramatically, both in the US and internationally. The US public health emergency is set to expire on May 11—bringing an end to most federal COVID-19 vaccine requirements—and the US CDC plans to stop reporting its color-coded COVID-19 Community Levels, switching to tracking hospitalizations in some areas. Hospitalizations, however, are a lagging indicator, as it takes about a week to 10 days for a person to be hospitalized with a serious infection. Additionally, most states have stopped public reporting of COVID-19 cases and related deaths, or stopped surveillance efforts altogether, leaving little information to enable scientists to determine how the virus is trending. While most feel the nation, and the world, has moved beyond the days of massive case surges and overwhelmed hospitals, the new normal remains unknown but likely will entail a series of smaller “wavelets.” The virus’s evolution remains unpredictable, however, and without better surveillance, experts are unable to say whether this period of the lowest levels of reported cases and deaths since the beginning of the pandemic is the beginning of a post-pandemic stability or a temporary reprieve.

A panel of global health experts is meeting today to discuss whether COVID-19 still constitutes a public health emergency of international concern (PHEIC). Although there is no consensus on what course the panel may recommend, and whether WHO Director-General Dr. Tedros Adhanom Ghebreyesus follows that advice, several experts feel it is time to wind down the emergency declaration. Regardless of its decision, COVID-19 will remain a complex public health challenge into the future, requiring countries to transition their emergency response activities to longer-term sustained disease prevention, control, and management.

Experts begin to assess pandemic responses, glean lessons learned to prepare for next pandemic

As the COVID-19 public health emergency comes to an end in the US, health officials are working to assess the nation’s response to the COVID-19 pandemic and ensure we are prepared for future health emergencies. In one such effort, 34 experts who were gearing up for the establishment of a 9/11-style commission instead formed the COVID Crisis Group, led by Dr. Philip Zelikow. When the call to establish a National COVID Commission never came, the group pivoted to develop a nonpartisan, dispassionate review of the pandemic response, which was often marred by politicization and infighting. In a report titled, Lessons from the COVID War: An Investigative Report—published by PublicAffairs as a book—the authors outline what went right and wrong with the pandemic response, including why people made certain choices, the availability of information necessary for decision makers to make choices, and the tools that were available and those that necessitated development.

The report includes information from interviews with nearly 300 people and often compares the pandemic response to a military conflict, saying the efforts in the US unraveled like fighting a war with no army or battle plan. According to the report, a lack of human coordination due to a fragmented US public health system, rather than scientific limitations, was one of the major points of failure in the response. Another major lesson centers around communication, with the report highlighting overall emergency communications as a point of failure, during both the Trump and Biden administrations. Poor communication likely exacerbated a loss of trust in US public health institutions, according to the authors. Notably, however, efforts that reached out to local community leaders were often more successful, and future responses will need practical toolkits to aid decision makers in implementing effective communications and mitigation efforts.

The European Centre for Disease Prevention and Control (ECDC) this week published its own assessment of its pandemic response. The report, titled Lessons from the COVID-19 Pandemic, contains 4 main lesson areas: investment in the public health workforce, preparation for the next public health crisis, risk communication and community engagement, and collection and analysis of data and evidence. The collection of pandemic response lessons and recommendations is a crucial task, but political buy-in is needed to implement many of the changes recommended by these assessments that are necessary for preventing and responding to the next pandemic.

Journal articles review progress made, lessons learned on COVID-19 treatment; studies into new treatments, repurposed drugs continue

The journals Nature Reviews Drug Discovery and The BMJ recently published articles examining therapeutic strategies for COVID-19, including progress made, lessons learned, and global standard of care development. Authorized or approved therapies that reduce mortality, length of hospital stay, or time on a ventilator for patients with severe disease include systemic corticosteroids (such as dexamethasone), interleukin-6 receptor antagonists (such as tocilizumab), and Janus kinase inhibitors (such as baricitinib). Additionally, marketed antivirals, including molnupiravir (Lagevrio), nirmatrelvir/ritonavir (Paxlovid), and remdesivir (Veklury), are effective against non-severe COVID-19, particularly when given within 10 days of symptom onset. More than 400 randomized clinical trials have been conducted worldwide on treatments for COVID-19, and research into new therapies continues.

• AstraZeneca’s investigational new antibody drug AZD3152 neutralizes all known variants of SARS-CoV-2 in laboratory studies and could help protect people with compromised immune systems who do not respond well to vaccination. Studies are ongoing, but AstraZeneca is aiming to make the treatment available later this year. 

• A study published in the Annals of Internal Medicine evaluated the use of 2 repurposed drugs, the oral selective serotonin reuptake inhibitor (SSRI) fluvoxamine plus the inhaled corticosteroid budesonide, among nonhospitalized adults with early symptomatic COVID-19 and at least one risk factor for severe disease in Brazil. Though a lower proportion of patients in the treatment group than in the placebo group were seen in an emergency setting for COVID-19 for more than 6 hours or were hospitalized within 28 days, no differences were noted in secondary outcomes. 

• Another study published in the Annals of Internal Medicine assessed the safety and efficacy of the monoclonal antibodies amubarvimab plus romlusevimab among patients at high risk for poor outcomes in the US, Brazil, South Africa, Mexico, Argentina, and the Philippines during the first half of 2021. Cumulative incidence of hospitalization or death was significantly lower in the treatment group than in the placebo group, regardless of treatment timing. A subgroup analysis of patients with variant data showed the combination was equally effective against Delta and pre-Delta strains, but the researchers speculated the therapy likely would have limited efficacy against the currently predominant Omicron variant.

Vaccine effectiveness studies support use of bivalent formulations, show monovalent vaccines highly effective against severe disease, death but effectiveness waned quickly against Omicron

Advisors to the US FDA are scheduled to meet on June 15 to discuss and make recommendations on future vaccinations against COVID-19 for the general public, now that a second round of bivalent boosters is available for older adults and other people at high risk of severe disease. The FDA will make decisions after the panel meets, but officials previously indicated a desire to recommend annual shots that are possibly updated to match currently circulating variants, similar to flu vaccines. In a study published in Open Forum Infectious Diseases, researchers report that the effectiveness of both Omicron BA.1-containing and BA.4/BA.5-containing bivalent COVID-19 mRNA vaccines against symptomatic infection during the BA.5-dominant period in Japan was high compared to no vaccination (65% and 76%, respectively) and moderate compared to monovalent vaccines administered over half a year earlier (46% combined). Notably, however, the bivalent vaccines were not as effective against Omicron subvariants as the original, monovalent vaccines were against the ancestral strain (Alpha) and Delta variants.

Though the monovalent mRNA vaccines are no longer authorized for use in the US, having been replaced by the bivalent versions, several recent studies show they provided substantial, durable protection against severe COVID-19 disease and death. A study published last week in Morbidity and Mortality Weekly Report found monovalent mRNA vaccination was 76% effective in preventing COVID-19-associated invasive mechanical ventilation (IMV) and death less than 6 months after the last dose and remained 56% effective at 1–2 years. Vaccine effectiveness was higher among older adults, supporting optional, additional bivalent boosters for individuals at highest risk of severe disease. A meta-analysis published in JAMA Network Open shows that vaccine effectiveness of the monovalent vaccines waned quickly and significantly against laboratory-confirmed Omicron infection and symptomatic disease, although the type of vaccine played some role. These studies support the use of updated, bivalent mRNA vaccines and boosters moving forward, and provide some evidence for reformulating the vaccines to match future dominant variants.

Decreasing US racial disparities in COVID-19 deaths possibly due to more deaths among Whites, study shows

A study published this week in JAMA Network Open examines the factors driving changes in mortality rate disparities among racial and ethnic groups over the course of the COVID-19 pandemic. Mortality rates for Hispanic and non-Hispanic Black US residents were much higher than mortality rates for non-Hispanic White residents during the initial wave of the pandemic in 2020. However, those mortality rate disparities decreased in 2021. According to the study, 60.3% of the decrease in mortality disparities are attributable to higher mortality among non-Hispanic White adults and a shift in higher mortality rates to nonmetropolitan areas, where more non-Hispanic White adults reside. The findings highlight a continued need to prioritize racial health equity despite recent reports of decreased mortality disparities, according to the authors, who also make several policy recommendations that could address health equity, including: paid medical leave for essential workers, extended unemployment benefits, and further moratoriums on eviction and foreclosure.

The Kaiser Family Foundation recently released a brief examining the impact of the COVID-19 pandemic by race and ethnicity through the lens of premature mortality, using the measures of premature mortality rate and years of life lost among excess deaths that occurred during the pandemic. The analysis shows that for all groups of color, the pandemic was associated with a steeper increase in the premature death rate than for White people. Notably, the increase in the premature death rate for Hispanic people (33%) was more than twice that of White people (14%) from 2019 to 2022.

What we’re reading

HEALTH SYSTEM RECOVERY According to a new interim report from the WHO, health systems in many countries are beginning to show the first major signs of recovery after 3 years of the COVID-19 pandemic. By early 2023, most countries reported experiencing reduced disruptions in the delivery of routine health services but highlighted the need to apply lessons learned to build more prepared and resilient health systems for the future, according to the report. Despite signs of recovery, service disruptions persist across countries in all regions and income levels, and additional support is needed for recovery, resilience, and preparedness.

US CDC CONFERENCE OUTBREAK The US CDC is investigating several dozen COVID-19 cases linked to its own annual conference held near the agency’s headquarters in Atlanta, Georgia, last week. About 35 people have tested positive as of May 2, according to a CDC spokesperson. The 3-day 2023 Epidemic Intelligence Service conference was the first time in 4 years that EIS officers and alumni gathered in-person. Around 2,000 people attended the conference, and while attendees said many people at the conference did not wear masks or socially distance, most were likely fully vaccinated. The CDC is working with state health officials to determine transmission patterns. The outbreak serves as a reminder that while COVID-19 may not pose the serious risks it did at the beginning of the pandemic, the virus continues to circulate, maybe especially easily at large indoor gatherings.

IVERMECTIN The Wisconsin Supreme Court this week ruled that a hospital cannot be forced to administer ivermectin to a COVID-19 patient. The 6-1 ruling overturned a lower court's order that required Aurora Health Care to treat John Zingsheim, who was placed on a ventilator due to COVID-19 complications, with the anti-parasitic medication. Zingsheim's nephew, Allen Gahl, who was authorized to make medical decisions for Zingsheim, requested his uncle be treated with the drug, but Aurora determined that ivermectin did not meet the standard of care for treating Zingsheim's symptoms. Gahl then sued after doctors refused to administer a prescription for ivermectin that he received from a doctor outside Aurora. The court found that the lower court had no legal basis for its order, citing no law in either its written or oral ruling. The FDA has not approved ivermectin for the treatment of COVID-19, and its misuse can be harmful, even fatal. The lawsuit is one of dozens filed across the US seeking to force hospitals to administer ivermectin to treat COVID-19.

BRAZIL INVESTIGATION Brazil's federal police on May 3 raided the home of former President Jair Bolsonaro as part of an investigation into the alleged falsification of COVID-19 vaccine cards. Authorities seized his phone, searched more than a dozen homes in Rio de Janeiro and Brasília, and arrested 6 people, including some of Bolsonaro’s closest aides. In a statement, the police said the investigation is focused on whether officials in Bolsonaro's inner circle created false vaccination certificates so that unvaccinated travelers, including Bolsonaro, his family members, and assistants' relatives, could circumvent mandatory immunization requirements to enter the US. Bolsonaro confirmed to reporters that he is not vaccinated against COVID-19 but denied playing a role in any fraud.

Epi update

As of May 3, the WHO COVID-19 Dashboard reports:

• 765.2 million cumulative COVID-19 cases
• 6.9 million deaths
• 630,979 million cases reported week of April 24
• 15% decrease in global weekly incidence
• 3,568 deaths reported week of April 24
• 18% decrease in global weekly mortality

Over the previous week, incidence declined or remained relatively stable in all regions except Africa (+17%).

UNITED STATES

The US CDC is reporting:

• 104.5 million cumulative cases
• 1.13 million deaths
• 88,330 cases week of April 26 (down from previous week)
• 1,052 deaths week of April 26 (down from previous week)
• 13.7% weekly decrease in new hospital admissions
• 15.2% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (69%), XBB.1.16 (12%), XBB.1.9.1 (69%), XBB.1.9.2 (4%), XBB (2.4%), XBB.1.5.1 (2.2%), and FD.2 (1.3%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

Editor: Alyson Browett, MPH

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

What’s next for COVID

HEALTH ·CORONAVIRUS

COVID will eventually evade one of the few treatments for those infected and cause deaths to ‘easily double,’ former White House advisor Deborah Birx says

BYERIN PRATER

April 29, 2023 at 5:00 AM CDT

Former White House Covid advisor Deborah Birx.

WIN MCNAMEE/GETTY IMAGES

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COVID will evolve to evade popular antiviral treatment Paxlovid, a critical line of defense for the unvaccinated and those at risk of severe disease and death from the virus—of this, Deborah Birx is certain.

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During her time as White House COVID response coordinator under former President Donald Trump, from March 2020 through January 2021, Birx oversaw the development and widespread distribution of COVID tests, treatments, and vaccines. American innovation in combating COVID, however, slowed to a crawl after the initial hurried push—and it leaves her frustrated and worried about the future, as the virus continues to evolve to pick off COVID treatments and chip away at the protection that vaccines provide.

“I’ve been really upset that the federal government has not prioritized next-generation vaccines that are more durable, next-generation monoclonals, and long-acting monoclonals,” Birx told Fortune in an interview at the magazine’s Brainstorm Health conference, held earlier this week in Marina del Rey, Calif.

Omicron is mutating to bypass the initial arsenal of weapons developed for use against it. Already, Omicron’s changes have rendered every universal monoclonal antibody treatment—administered to people at high risk of hospitalization and death—useless. Eventually, it will take down Paxlovid, too, Brix says.

She added: “If we lose Paxlovid, we could easily double the number of deaths,” which currently sit at just over 1,000 per week, according to data from the U.S. Centers for Disease Control and Prevention.

‘We’ve lost ground’

As the U.S. COVID public health emergency (PHE)—slated to end May 11—draws to a close, Birx is concerned that apathy has overtaken common sense. She says she’s more worried about the lack of progress on vaccines and therapeutics than she is about the government declaring an end to the COVID crisis.

“If they were ending the PHE and I could say, ‘Okay, we now have three therapeutics, we have better monoclonals, we have a more durable vaccine’—instead, we’ve lost ground in therapies for those who are vulnerable,” she said.

Thus, the end of the PHE is not a victory, she maintains—far from it.

“Right now, we’re just accepting that 270,000 Americans died last year,” she said. “Two-hundred and seventy thousand. We’re going to easily lose over 100,000 this year. That, to me, is not success.”

Birx continued: “You don’t want to back yourself into controlling the pandemic because all the vulnerable Americans have died. That’s not how you win in public health.”

Annual summer and winter surges

As for the future of the pandemic, nothing is certain. Birx points out that wastewater levels of the virus are virtually the same as they were a year ago, and that every year so far we’ve seen summer and winter surges—signaling that the virus is now seasonal, like the flu.

When it comes to COVID, “we’ll have a summer surge, and we’ll have a winter surge,” like we have had in years past, she said, adding that surges have become less dramatic lately due to a high level of population immunity.

Birx says it remains to be seen whether COVID becomes more deadly. Omicron has become so highly transmissible that it’s virtually stuck in evolutionary stasis, with new variants incredibly similar to the previous one. To get unstuck, sometimes viruses will evolve to become less infectious but more severe—”so it’s just a matter of tracking it.”

Americans have accepted repeat infections, Birx says—and while such frequent infections have helped blunt spikes in cases, they also bring along with them a “high level of long COVID,” she said.

Brix called for wastewater monitoring at every American embassy overseas, asserting that such testing would give scientists an idea of how COVID, the flu, RSV, and adenovirus are circulating globally. Doing so would allow them to better prepare for surges to come.

New York ‘wouldn’t have happened’ with better planning

We’ve missed the mark before, and without proper surveillance, we could miss it again, Birx warns. Case in point: The nation’s pandemic preparedness plan “failed immediately”—in the first week of the pandemic, she says—when those involved didn’t realize that COVID could be transmitted among people who had no symptoms.

Early in the pandemic, the bulk of those hospitalized were 50 and older. But “there’s never been a pandemic that only infects certain age groups,” she said. Just because those under 50 generally weren’t hospitalized didn’t mean they weren’t being infected. “You had to know there was a spectrum of disease and a lot of asymptomatic spread.”

When Birx joined the White House COVID response team in early March 2020, COVID testing was only available in public health labs. She gathered private companies in a hurried push to develop and manufacture tests that could be made widely available, an effort that took six weeks.

“Imagine if we had done that in the end of December, beginning of January,” she said. “New York and all of those fatalities wouldn’t have happened, because we would have seen it at the very beginning.”

‘We’re not ready’ for the next pandemic

As for the next pandemic—whether it’s a future evolution of COVID, the bird flu, or something different entirely—Birx says the U.S. is unprepared—and is perhaps even less prepared now than it was on the eve of COVID-19. In large part, that’s due to the lack of involvement of private companies in governmental pandemic planning—and a rapid-onset amnesia of lessons learned over the past three years.

When she called on private companies shortly after assuming her position, they stepped in and saved the day, she says—and countless American lives. The companies missed out on revenue when they diverted supplies to safety net hospitals that paid less, rearranged their supply chains, “and dropped all pretense of competition and just helped,” she said.

“The group that saved Americans was the private sector. To not have the private sector at the table makes certain that we’re not going to be prepared.”

Birx called for researchers to be more cautious when conducting lab experiments with viruses like COVID and the bird flu. At the moment, bird flu doesn’t easily infect humans—a trait that prevented coronaviruses SARS and MERS from becoming larger problems in the early 2000s.

But that could change quickly and easily, if researchers modify the bird flu to easily adapt to humans—a move that, in case of a lab leak, could put humans permanently at risk, she says.

As for whether the COVID pandemic started from a lab leak in China or an animal-to-human spill-over event in the Wuhan wet market or elsewhere, Birx doubts we’ll ever have enough data to say definitively.

We can—and should—guard against both scenarios, going forward, she maintains.

“We ought to be putting systems in place to prevent lab leaks,” she said, “and we should be putting systems in place to prevent leaks from wet markets.”

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School Board Elections and Culture War

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Business Insider

Defeat for many culture war 'extremists' who tried to take control of school boards and lost to liberal, union-backed candidates

Story by bdawson@insider.com (Bethany Dawson) • 13h ago

An American Flag hangs in a classroom. Getty Images.© Provided by INSIDER

• Book-banning and "don't-say-gay" style laws are filling the headlines. 
• But many right-wing candidates lost their school board elections in Illinois and Wisconsin. 
• The Democratic Gov. of Illinois said, "Those folks were shown up and, frankly, tossed out."

Many right-wing candidates lost their runs at school board elections in Illinois and Wisconsin.

Although there is no official publication of school board election results, announcements by political groups show that anti-LGBTQ+ candidates have not fared well, even if book-banning and "don't-say-gay" style laws are filling the headlines.

For example, 70% of  Democrat-endorsed candidates in Illinois won their elections, per The Guardian. Illinois congressional makeup tilts heavily Democratic with 14 Democrats and three Republicans.

A group of conservative candidates in Barrington, a northwest suburb of Chicago, endorsed by 1776 PAC, Moms For America Action, and Awake Illinois, also lost their race for the school board, Politico reports.

JB Pritzker, the Democratic governor of Illinois, said, "Fortunately, the voters saw through the hidden extremists who were running for school board."

Pritzker added, "I'm glad that those folks were shown up and, frankly, tossed out."

Related video: More political conflict in school board races (WTMJ Milwaukee, WI)

political influence is still seeping in.

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In the Wisconsin school board elections, which took place earlier this month, Politico reports that GOP-backed candidates in the city of Wauwatosa largely lost to candidates backed by teaching unions. They also performed badly in Milwaukee but better in rural area, reports said.

Wisconsin voted for President Biden in the 2020 election by the slim majorities of 20,000 votes and is considered a key battleground state in 2024.

The 1776 Project, a political action committee bankrolled by  Richard Uihlein, a billionaire GOP donor, reported a lackluster result for the 63 candidates it supported, with only a third winning races in Illinois and Wisconsin, Politico reported.

Ryan Girdusky, founder of the conservative 1776 Project political action committee, issued advice to the conservative groups fighting to influence US children's education, when he spoke to Politico. "Don't assume that a blanket message on critical race theory or transgender issues is going to claim every district — it's very personalized," he said.

"If it's happening in that district, speak to it in volumes. But don't tell parents something is happening if it's not happening, because then it doesn't look like you're running a serious operation."

Kim Anderson, executive director of the National Education Association labor union, told Politico that, "Where culture war issues were being waged by some school board candidates, those issues fell flat with voters."

She added, "the takeaway for us is that parents and community members and voters want candidates who are focused on strengthening our public schools, not abandoning them."

Above is from:  Defeat for many culture war 'extremists' who tried to take control of school boards and lost to liberal, union-backed candidates (msn.com)

April 20, 2023: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.

Click to Subscribe

Announcements

PUBLISHING NOTICE The COVID-19 Situation Report will be taking a break next week and will not publish on April 27. We will resume publishing on May 4.

In this issue

> COVID-19 pandemic still volatile, WHO says; disease remains a leading cause of death in US

> US health agencies authorize additional bivalent vaccine booster for certain populations, simplify recommendations; Biden administration launching effort to maintain equitable access to COVID-19 vaccinations

> US Congress continues investigations into COVID-19 pandemic origin with Republican-led Senate report, House hearing

> Experts debate universal masking recommendations for healthcare settings; about half of healthcare workers go to work sick with COVID-19, study shows

> People with long COVID, advocates frustrated with lack of attention to, actionable research on condition

> Wastewater surveillance gains traction as advantageous disease monitoring system in US, South Korea, globally

> What we're reading

> Epi update

COVID-19 pandemic still volatile, WHO says; disease remains a leading cause of death in US

The WHO this week said the COVID-19 pandemic remains volatile, warning that the virus could bring further trouble before settling into a predictable pattern. The agency noted that in the past 28 days, 23,000 people have died of COVID-19 and 3 million new cases have been reported, even with much lower levels of testing. In the US, COVID-19 remains a leading cause of death, with an average of about 245 deaths per day over the past 4 weeks, primarily among older adults or those who are immunocompromised. The WHO Emergency Committee on COVID-19 is set to meet in the beginning of May to once again reconsider whether the pandemic constitutes a public health emergency of international concern (PHEIC), which it has reaffirmed at its previous meetings since first making the declaration in January 2020.

Additionally, SARS-CoV-2 continues to mutate, with the Omicron subvariant XBB.1.16—first detected in India earlier this year—now accounting for more than 7% of US cases. Another Omicron subvariant, XBC.1.6, a combination of the Delta and Omicron variants of concern first detected in Southern Australia where it caused a wave of cases and hospitalizations, could provide competition to XBB.1.16. Even if many feel the pandemic is over, the virus remains a threat, particularly to vulnerable populations.

US health agencies authorize additional bivalent vaccine booster for certain populations, simplify recommendations; Biden administration launching effort to maintain equitable access to COVID-19 vaccinations

Following US FDA regulatory action earlier this week, the US CDC on April 19 took steps to simplify COVID-19 vaccine recommendations and allow more flexibility for individuals at higher risk of severe disease who would like an additional vaccine dose. Adults aged 65 years and older and people who are immunocompromised may now receive a second dose of updated bivalent mRNA booster targeting both the original viral strain and Omicron BA.4 and BA.5 subvariants at least 4 months or 2 months after their last dose, respectively. Additionally, people who are immunocompromised will now be able to receive more doses if their healthcare provider feels the shots are necessary. About 250 people die each day of COVID-19-related causes in the US, the majority of whom are age 70 or older or have weakened immune systems.

Most US residents who have had one dose of the bivalent vaccine are not currently eligible for an additional jab, although authorization for another shot is expected for the autumn. However, the CDC recommends everyone aged 6 and older receive a bivalent vaccine, regardless of whether they have previously completed their primary series with the original monovalent vaccine. In fact, the monovalent mRNA vaccines are no longer authorized for use in the US. People who are unvaccinated will now require only a single dose of bivalent mRNA vaccine to be considered vaccinated. The guidelines for children remain complicated, with recommendations varying by age, vaccine, and which shots they previously received. The CDC is expected to post a detailed chart with recommendations for children under age 6.

In related news, the Biden administration plans to spend more than US$1 billion on a new public-private partnership to maintain broad access to COVID-19 vaccines, treatments, and tests for millions of uninsured Americans when the medical countermeasures move to the commercial market later this year. The US Department of Health and Human Services (HHS) Bridge Access Program For COVID-19 Vaccines and Treatments Program would allow officials to purchase COVID-19 vaccines for uninsured individuals after the current federal supply is exhausted and when vaccine manufacturers plan to charge as much as $130 per dose. People with private insurance or who are covered under Medicare or Medicaid will also not be expected to pay out-of-pocket expenses for vaccines once the public health emergency ends in May.

Additionally, HHS officials told state governors last week that it will maintain its authority allowing pharmacists, pharmacy technicians, and pharmacy interns to administer COVID-19 and flu vaccines after the COVID-19 public health emergency declaration ends. The extension, set to last through December 2024, is based on the Public Readiness and Emergency Preparedness (PREP) Act, which offers extra protections to companies and providers making, distributing, and administering medicines and vaccines in times of emergency. The White House “Test to Treat” initiative, which allows pharmacists to test people for COVID-19 and prescribe the antiviral Paxlovid, will also continue.

US Congress continues investigations into COVID-19 pandemic origin with Republican-led Senate report, House hearing

Republicans in both houses of the US Congress continued their efforts to investigate the origin of SARS-CoV-2. The investigations, shaped by tensions between scientific knowledge and political discourse, have broad political implications and some say are detracting from the need to take steps to prevent another disease emergency. On April 18, the US House Select Subcommittee on the Coronavirus Pandemic held a second hearing on the origins of COVID-19, with testimony from former intelligence officials discussing the intelligence community’s understanding of COVID-19 origins and the Chinese government’s lack of transparency in providing data and evidence. The hearing raised the ire of the Chinese Embassy, after Li Xiang, the embassy’s liaison to Congress, emailed a staff member of the subcommittee’s chair, Rep. Brad Wenstrup, on April 14 asking “the US side to respect science and facts,” “refrain from targeting China,” “put a stop to the intelligence-led, politics-driven origins-tracing,” and “help promote international solidarity against the pandemic.”

Earlier this week, US Senate Republicans who hold minority leadership on the health subcommittee released a 300-page report that concludes the pandemic most likely began from at least one unintentional lab-related incident—possibly resulting from failures of biosafety containment during vaccine-related research—rather than naturally, via an animal infecting a human; however, the document concedes both theories are plausible but lack key supporting evidence. The report is the result of former Sen. Richard Burr's investigation into the pandemic’s origin, began when he served as the minority leader of the Health, Education, Labor and Pensions Committee, although staffers noted Sen. Burr did not review the full report nor did it go through the vetting process that was afforded an executive summary publicly released last year.

Speaking at a London summit on pandemic preparedness last week, former China CDC Director Dr. George Gao said there is no evidence yet to show an animal host or reservoir for SARS-CoV-2. The WHO has repeatedly called on China to immediately share all available data on the virus, with Chinese officials and scientists rejecting the agency’s accusations that they are hiding information. The WHO says all origin hypotheses remain plausible, while many international scientists say evidence points to a natural origin for the pandemic.

Experts debate universal masking recommendations for healthcare settings; about half of healthcare workers go to work sick with COVID-19, study shows

Most COVID-19-related mask mandates have ended—including those for the subway system in Beijing, China—but debate over whether to mask in healthcare settings is ongoing. While most US states have phased out mask mandates for healthcare settings, many healthcare facilities maintain mask requirements for all staff and patients, but they are increasingly dropping those rules. In a recent commentary published in the Annals of Internal Medicine, a group of infectious disease experts and epidemiologists notes that while “universal masking” was critically important during the pandemic—particularly when there was no population immunity, limited testing capacity, and no medical countermeasures (eg, vaccines, therapeutics)—they argue against masking becoming a required component of Standard Precautions, as COVID-19 transitions from a pandemic to an “endemic phase.” The authors conclude that mandatory masking remains an important infection prevention and control (IPC) strategy that could be employed in the future as “part of a dynamic approach to infection prevention policy that adapts to changing circumstances.”

However, some healthcare workers and other infectious disease epidemiologists have voiced opposition to dropping universal masking, noting that other disease transmission precautions are not scrapped simply because a disease is endemic. In a commentary published in February in the journal Infection Control & Hospital Epidemiology, a separate group of infectious disease experts propose an update to Standard Precautions in healthcare settings, including permanently implementing universal masking in routine patient-care interactions. They say masking prioritizes safety for patients, healthcare providers, and visitors. Other experts fall somewhere in the middle, saying masks remain important in all patient-facing interactions or recommending them to patients who have underlying conditions that put them at higher risk of severe COVID-19.

Notably, a study published last week in the journal Infection Control & Hospital Epidemiology showed that about half of healthcare workers (HCWs) with COVID-19 worked for at least some time during a day when diagnosed but returned to work for additional days with symptoms. The study found that presenteeism rates did not vary for HCWs working directly with patients, suggesting that the potential for disease transmission to patients did not influence HCWs’ choices about whether to go to work. The researchers note that new strategies are needed to help HCWs with COVID-19 reconcile their duties to do no harm and to provide or support care. Additionally, a study presented this week at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen, Denmark, suggests requirements to wear surgical masks in a large London hospital during the first 10 months of Omicron activity (December 2021 to September 2022) made no discernible difference to reducing hospital-acquired SARS-CoV-2 infections. Another study published today in Scientific Reports uses a COVID-19 model showing that a combination of mask wearing and vaccination may be more effective and reasonable in preventing and controlling SARS-CoV-2 infection and suggests infection control departments strongly recommend the use of both strategies to protect unvaccinated individuals from becoming infected.

People with long COVID, advocates frustrated with lack of attention to, actionable research on condition

Americans suffering from post-COVID condition, commonly known as long COVID, are beginning to get frustrated—and for good reason. There is still no clear medical definition, diagnostic framework, or treatment for the condition. The US NIH has received more than US$1 billion to study the condition but it has yet to recruit patients to test potential therapeutics and has released minimal findings from observational studies conducted over the last 2 years, all with allegedly insufficient accountability or oversight. Patients are frustrated that the observational studies conducted so far seem redundant to already completed research and that there are no ongoing efforts to support private sector companies or researchers trying to study long COVID through the NIH. Additionally, one treatment option under consideration—exercise—has the real potential to worsen patients’ condition, causing advocates to raise alarm. Still, other researchers are currently exploring more promising candidates for the treatment or prevention of long COVID, such as metformin, Paxlovid, and low-dose naltrexone. In the meantime, patients continue to feel dismissed by peers, healthcare providers, and institutions, as their lives are disrupted by the condition, sometimes leading to unemployment and homelessness.

Wastewater surveillance gains traction as advantageous disease monitoring system in US, South Korea, globally

The COVID-19 pandemic has provided ample case studies on the value of conducting wastewater surveillance for infectious diseases. The process has certain advantages over hospital-based surveillance in that it can detect viral markers from people with mild cases who did not seek out healthcare or who may have been asymptomatic. Wastewater surveillance has also been instrumental in detecting new viral variants, even as fewer and fewer daily PCR tests are being performed that could provide sequencing material. The US National Wastewater Surveillance System currently has more than 1,000 sites across the country that feed into their data analysis to track SARS-CoV-2 incidence and new variant profiles.

In South Korea, the Korea Disease Control and Prevention Agency (KDCA) is looking to pursue this strategy by implementing a wastewater surveillance system in most major cities and towns. In their current system, hospitals must report all positive tests, which the KDCA director described as an expensive and laborious process. The switch to wastewater surveillance is anticipated to be more cost effective and will provide a broader perspective of the country’s COVID-19 situation. There are also proposals to create a global wastewater surveillance system using airport wastewater. While this endeavor would be useful for disease monitoring, possible disincentives to participation include fear of the imposition of travel restrictions should a disease be detected.

What we’re reading

INFLUENZA PANDEMIC PREPAREDNESS Countries and international bodies must immediately revise existing pandemic influenza preparedness and response plans to incorporate lessons learned from and the impacts of COVID-19, experts from the Johns Hopkins Center for Health Security and colleagues write in Nature Medicine. The authors note these steps are “particularly urgent given both the emergence of a number of influenza spillover threats and exhausted and depleted public health systems globally.” They make recommendations about how revisions could be achieved, concluding, “The world is in a precarious public health position that warrants weighing potential pandemic risks more seriously. The next pandemic may not be influenza, but the risk calculus for such a pandemic must be prepared now.”

VACCINE MANDATE RULING A panel of the San Francisco-based 9th US Circuit Court of Appeals ruled on April 19 that President Joe Biden had the authority under the federal Procurement Act—which enables the president to adopt rules that promote economy and efficiency in federal contracting—to mandate COVID-19 vaccination for millions of federal contractor employees in 2021. The decision reverses a previous ruling by an Arizona court that blocked the mandate last year and creates a split with 3 other appeals courts that have said President Biden likely exceeded his authority. In October 2022, the White House told agencies not to enforce the contractor mandate in light of ongoing and pending legal challenges.

US PRISON POPULATION The United States is known for having the highest incarceration rate on the planet, with significant bias by class and race. COVID-19 reduced the country’s prison population by 17%, but a new study in Nature shows that racial disparities worsened with this decrease, as the proportion of incarcerated Black and Latino people sharply increased. The authors cited changes in typical distribution of those admitted into prisons, disruptions in court proceedings, disruptions in transfers from county jails, as well as ongoing racial disparities in sentence length, pre-trial case dismissals, and pre-trial plea deals as contributors to these trends. They also noted potential structural and racial inequalities in decarceration policies. Unfortunately, these trends reverse some of the progress made in the last decade to reduce prison populations and racial disparities within them.

TYPE 2 DIABETES In a study published this week in JAMA Network Open, Canadian researchers found that people who have had COVID-19 were significantly more likely to be diagnosed with Type 2 diabetes within a year of their infection, compared with those who had not been exposed to SARS-CoV-2. Notably, men were more likely than women to develop diabetes, and people who were hospitalized or in intensive care with COVID-19 were 2 and 3 times as likely to develop the condition, respectively, when compared with individuals who were not infected. The researchers concluded that 3–5% of new diabetes diagnoses could be related to COVID-19. At least 11 other studies have shown an increased risk of developing diabetes after SARS-CoV-2 infection, with one meta-analysis showing a 66% increased risk of diabetes following COVID-19. Some evidence exists suggesting that vaccination might have a protective effect but also that multiple reinfections could raise the risk of Type 2 diabetes. Healthcare organizations and medical professionals should be mindful of the potential long-term outcomes of COVID-19, including monitoring patients for diabetes.

CHILDHOOD VACCINATIONS The COVID-19 pandemic, conflict, and a loss of confidence in vaccines due to misleading information led to 67 million children missing out on at least one routine vaccination between 2019 and 2021, according to UNICEF’s State of the World’s Children 2023 report. A trend of declining confidence in childhood vaccines of up to 44 percentage points in several countries is a “worrying warning signal” of rising vaccine hesitancy, decreasing trust in governments, and increasing politicization, UNICEF Executive Director Catherine Russell said. The report stressed that vaccine confidence can shift and the findings may not indicate a long-term trend.

GLOBAL VACCINATION KNOWLEDGE The Global Compendium of Country Knowledge on COVID-19 Vaccination is now available online from TechNet-21, the WHO announced. The Compendium, which stores more than 140 documents, provides country experiences, case studies, and country evaluations on COVID-19 vaccination and is a resource for national authorities managing or making key decisions on the deployment, implementation, and monitoring of COVID-19 vaccinations, as well as for partners who can provide technical support based on the best practices.

Epi update

As of April 19, the WHO COVID-19 Dashboard reports:

• 763.7 million cumulative COVID-19 cases
• 6.9 million deaths
• 536,422 million cases reported week of April 10
• 24% decrease in global weekly incidence
• 2,289 deaths reported week of April 10
• 48% decrease in global weekly mortality

Over the previous week, incidence declined or remained relatively stable in the Africa (+4%), Europe (-11%), Eastern Mediterranean (-26%), Western Pacific (-30%), and Americas (-55%) regions but increased in South-East Asia (+79%).

UNITED STATES

The US CDC is reporting*:

• 104.3 million cumulative cases
• 1.13 million deaths
• 101,437 cases week of April 12 (down from previous week)
• 1,327 deaths week of April 12 (down from previous week)
• 6.1% weekly decrease in new hospital admissions
• 11.4% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (78%), XBB.1.16 (7.2%), XBB.1.9.1 (6.5%), XBB.1.9.2 (2.5%), XBB.1.5.1 (2.4%), and FD.2 (1.7%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

*According to the CDC, as of April 1, 2023, the state of Iowa no longer reports aggregate COVID-19 case data to CDC. As a result, case counts from Iowa will no longer be reported at the national, regional, state, or county-levels on COVID Data Tracker or data.cdc.gov.

Harlem School Board election decided by mail in ballots

Hastings wins: Mail-in ballots reverse lead in Harlem School Board race

Story by Corina Curry, Rockford Register Star • Yesterday 8:02 PM

An overjoyed and grateful Megan Hastings took to Facebook Tuesday night to thank her supporters and proclaim victory in her April 4 race for Harlem School Board.

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Megan Hastings, second from left, poses while campaigning with her daughters and wife. According to official election results released Tuesday, April 18, 2023, Hastings won a four-way race for Harlem School Board.© PHOTO PROVIDED BY MEGAN HASTINGS

"For those of you have not heard, we did it. We did it Harlem 122," Hastings said, moments after the Winnebago County Clerk did a final update to election results posted on the clerk's website. "The results are official. I have been officially declared the winner of the two-year position, and I'm unbelievably excited."

UPDATED: Your election results here: Rockford, Freeport, Belvidere, Parks and more

Up until Tuesday evening, Hastings was in second-place in a four-way race.

Candidate Pamela Harding was in the lead with 1,301 votes. Hastings had 1,273 votes. Incumbent Sue Berogan got 656 votes, and a fourth candidate, Andrea Prentice, got 351.

Official election results that include any mail-in ballots postmarked on or before Election Day but received by the election office after Election Day put Hastings in the lead with 1,370 votes to Harding's 1,357 votes. Berogan picked up 25 more votes, ending with 681, and Prentice ended with 363 votes.

Booster for People 65 and older or those with weak immune systems

FDA okays second omicron booster for people at high risk from covid

People 65 and older or those with weak immune systems will be able to get the shots after the CDC signs off

By Laurie McGinley

and

Lena H. Sun

April 18, 2023 at 9:25 a.m. EDT

The updated booster targets omicron subvariants BA.4 and BA.5 as well as the original novel coronavirus. (Allison Shelley/For The Washington Post)

The Food and Drug Administration on Tuesday cleared the way for people who are at least 65 years old or immune-compromised to receive a second updated booster shot against the coronavirus, an option designed to bolster protection for the most vulnerable Americans even as the pandemic recedes.

The action appears likely to provide a measure of reassurance to people whose age or medical issues put them at risk of serious illness if they are infected by the coronavirus. Some got updated boosters last fall, soon after the omicron-targeting shots were authorized, but patients and physicians recognize the mRNA vaccines have a history of waning protection within months of administration.

People who are eligible for the extra boosters might be able to get them as soon as this week. Vaccine advisers to the Centers for Disease Control and Prevention are scheduled to meet Wednesday to discuss the second booster, and CDC Director Rochelle Walensky is expected to sign off quickly.

The bivalent booster, as it is known, targets omicron subvariants BA.4 and BA.5 as well as the original coronavirus. Older people will be able to get the booster once four months have passed since they received their first omicron-specific booster; for the immunocompromised, the minimum spacing is two months, assuming their doctors agree. The shots are made by Moderna and by Pfizer and its German partner, BioNTech.

Federal health officials will not formally urge that people get a second booster. Instead, the “permissive” policy says they may get a second dose if they want.

Even as some people have been clamoring for a second booster, others appear unconcerned. Only about 42 percent of people 65 and older have received the first bivalent booster, according to the CDC.

Experts have expressed differing views on the necessity of a second bivalent dose. While some say little data exists to justify it, others believe the extra shot is a good option for high-risk individuals. The United Kingdom and Canada already are offering spring booster shots for vulnerable individuals.

“It seems like a pretty easy call — given the risks of covid in the immunocompromised population and the good safety record of the vaccine,” said Eric J. Rubin, a member of the FDA’s advisory committee on vaccines and editor in chief of the New England Journal of Medicine. “It seems like a reasonable strategy.”

Jesse L. Goodman, professor of medicine and infectious diseases at Georgetown University Medical Center and former chief scientist at the FDA, agreed, saying that a second booster targeted to those at high risk “makes good sense.” But he added that more studies are needed not only to improve vaccines but also to determine how best to use them.

Federal officials concede extensive information about the booster is lacking. But they say data indicates that the booster is beneficial against serious illness, although its durability fades some months after it is given, just as with the original vaccine.

A recently published Israeli study of the bivalent booster made by Pfizer and BioNTech compared people 65 and older who got the shot with those who did not. Those who received the booster had a 72 percent lower risk of covid-related hospitalization and a 68 percent lower risk of covid-related death, according to the study published in the journal Lancet Infectious Diseases.

“Bivalent mRNA booster vaccination in adults aged 65 years or older is an effective and essential tool to reduce their risk of hospitalisation and death due to covid-19,” wrote study co-author Ronen Arbel of Clalit Health Services, a health-care organization in Israel.

A recent Finnish analysis that has not been peer reviewed also found that the updated booster reduced risk of hospitalization and death from covid-19 for people 65 and older.

In addition, unpublished data presented at the CDC’s vaccine advisory panel meeting in February confirmed earlier real-world reports that bivalent vaccines are providing protection against serious illness in adults, compared with people who received previous doses of the original vaccine and no omicron-targeting dose.

Federal officials have noted they are not advocating a second omicron booster for young people, who in rare cases can experience heart-related side effects after getting the vaccine.

The FDA on Tuesday also retired the original mRNA vaccines by Moderna and Pfizer-BioNTech in favor of the updated shots.

The FDA still plans to move to a once-a-year coronavirus vaccine shot for most Americans — a timetable announced in January that is intended to coincide with annual flu inoculations in the fall. The FDA and its advisers hope the simplified schedule will encourage more people to get coronavirus vaccine doses. Officials will select a reformulated dose in coming months based on which coronavirus strain scientists think is most likely to be circulating in fall and winter.

Under that blueprint, most people, whether vaccinated or not, would be urged to receive a single annual dose of a coronavirus shot.

For now, older adults or those with weak immune systems will be eligible for two or more bivalent doses, the FDA said. And, at this time, families with young children who have not completed their initial vaccine series should consult with their pediatricians on how many shots they should get.

The updated shot will be free of charge, regardless of insurance coverage, because the government has an ample supply.

Even after the federal supply is gone, shots will continue to be free of charge to most people with private and public health insurance. But once federally purchased doses are depleted, uninsured and underinsured adults may have to pay, and privately insured people may need to confirm that their provider is in-network, according to an analysis by the Kaiser Family Foundation, a health-policy organization.

An omicron subvariant, XBB.1.5, accounts for almost 80 percent of cases now being diagnosed in the United States, according to the CDC. Another omicron descendant, XBB.1.6, which is called Arcturus and is spreading rapidly in India, is responsible for about 7 percent of U.S. cases.

Above is from  People 65 and older or those with weak immune systems

Long Range Weather Forecast for US

The Weather Channel

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Summer Temperature Outlook: Will An El Niño Cool The East?

Story by Madeline Scheinost • 13h ago

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The Weather Channel

Summer Temperature Outlook: Will An El Niño Cool The East?

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Temperatures will be warmer than average across much of the Lower 48 this summer, but are expected to be cooler than last year, a newly released outlook predicted.

A "much different, and cooler, summer is on the way this year," according to Dr. Todd Crawford, Vice President of Meteorology at Atmospheric G2 and author of the latest outlook released Thursday from The Weather Company, an IBM Business, and AG2.

B​efore we get to that summer update, let's first take a look at how next month is shaping up.

May Outlook

Warmer-than-average temperatures are expected in May in parts of the Northeast and along the Gulf Coast into the Carolinas.

Conversely, cooler-than-average temperatures are expected across much of California into Arizona, and temperature could skew slightly cooler than usual in much of the Great Basin and Southwest.

Summer 2023 Outlook

Warmer-than-average conditions will encompass much of the northern half of the country this summer.

Temperatures will be the farthest above average for parts of Montana and North Dakota. Warmer-than-average conditions will extend from parts of the Northwest southward into Oklahoma and eastward into the Great Lakes and northern New England.

The rest of the country should see temperatures near average. Much of the Southeast and parts of California and Arizona will see temperatures that are near average or slightly cooler.

A​nd if you're wondering about rainfall, the most likely scenario is that above average rainfall amounts will occur east of the Rockies while the western states will dry out after a wet, cool winter and early spring.

J​une Outlook

Starting the summer in June, the core of the heat is anticipated to be in parts of the central U.S., while the East will generally experience temperatures near average or slightly warmer.

P​arts of California and Arizona have the highest chance for cooler-than-average temperatures, while parts of the West will be near average.

July Outlook

The hottest temperatures compared to average will likely shift northward in July and stretch from parts of the Northern Rockies into the Northern Plains.

Warmer-than-average temperatures will also extend from parts of the interior Northwest into the central Rockies, northern Great Lakes and northern New England.

Meanwhile, temperatures will be near average or could even skew slightly cooler over the Ohio Valley, mid-Atlantic and South, including Florida, as well as parts of California.

August Outlook

As summer comes to a close in August, the heat is expected to extend from parts of the West Coast into New England.

Temperatures farthest above average will extend from the Pacific Northwest into the Northern Plains, but a generally hotter-than-average August is expected from the Great Basin to much of the Plains, Midwest and Northeast.

Once again, the Southeast could trend near average or even slightly cooler.

The El Niño Factor

Many factors are used to produce seasonal forecasts.

One that is dramatically different from last summer is a transition from La Niña to El Niño. This is the periodic cooling and warming of the equatorial Pacific Ocean surface temperatures.

T​hese warmer Pacific waters could cause a consistent ridging pattern, or northward bump in the jet stream, over the western U.S., bringing warmer-than-average temperatures to that region. Meanwhile, cooler-than-average conditions would then be expected in the East.

This suggests a generally cooler and wetter than average June-through-August period for much of the contiguous U.S., especially in portions of the East.

Last year's summer was characterized by La Niña conditions bringing temperatures that were far warmer than average to much of the U.S.

The Weather Company’s primary journalistic mission is to report on breaking weather news, the environment and the importance of science to our lives. This story does not necessarily represent the position of our parent company, IBM.