October 20, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

PhD APPLICATIONS OPEN In a world of rapid innovation in the biological sciences, the emergence of new diseases, and changing environmental pressures, health security risks to the global community are a rising concern. The field of health security has a growing need for trained experts who can provide science-based solutions and inform global policies to shape preparedness and response efforts. Selected students, with interest in pandemics and global catastrophic biological risks (GCBRs), will receive full funding to complete their PhDs in the Health Security track within the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health and Engineering. More information and application details can be found https://www.centerforhealthsecurity.org/our-work/education/#phd. The application deadline is December 1, 2022.

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

EPI UPDATE The WHO COVID-19 Dashboard reports 623 million cumulative cases and 6.55 million deaths worldwide as of October 19. Global weekly incidence again remained steady at slightly more than 3 million cases for the sixth consecutive week, decreasing only 0.87% compared to the previous week. Weekly incidence in Europe remained relatively steady over the previous week, falling 3% after steady increases for the previous 4 weeks. Weekly incidence increased 11% in the Western Pacific, while all other regions reported decreasing trends. Global weekly mortality continued to decrease for the ninth consecutive week, down 15% from the previous week.

UNITED STATES

The US CDC is reporting 96.8 million cumulative cases of COVID-19 and 1.06 million deaths. Daily incidence continues to decline, down to 37,052 new cases per day, the lowest average since mid-April. Average daily mortality also continues to decline, down to 323 deaths per day on October 18.**

**Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.

Both new hospital admissions and current hospitalizations continue to exhibit downward trends, with decreases of 1.8% and 3.3%, respectively, over the past week. Both trends peaked around the end of July, although the decreasing trend appears to be leveling.

The BA.5 sublineage continues to be the dominant strain in the US, accounting for 67.9% of sequenced specimens; however, its estimated prevalence has decreased for 8 consecutive weeks. Notably, the BA.4.6 sublineage (12.2%) appears to be losing its growth advantage to others, including BQ.1 (5.7%), BQ.1.1 (5.7%), and BF.7 (5.3%). BA.2.75.2 (1.4%) and BA.2.75 (1.3%) also show relative growth advantage over BA.5.

IMMUNE EVASIVE OMICRON SUBVARIANTS ​​While past surges in COVID-19 cases have been driven largely by single SARS-CoV-2 variants, experts are eyeing a collection of Omicron subvariants that could drive an anticipated wave of infections this fall and winter. In the US, BA.4.6 appeared to be gaining momentum, although BF.7, BQ.1, and BQ.1.1 are showing recent potential growth advantage. The same sublineages are also showing evidence of growth advantage over BA.5 in the United Kingdom. Additional variants, including the recombinant variant XBB, are fueling increases in cases in Southeast Asia and Europe. The US has yet to see a large surge due to these subvariants, with the number of new cases continuing to drop. But public health experts warn data on new cases is unreliable—many are turning to wastewater surveillance to help predict where and when surges may occur—and most expect the downward trend to reverse over the next few weeks. The collection of variants, sometimes referred to as “scrabble variants” or “subvariant soup,” accounts for nearly 1 in 3 new infections reported in the US last week. Globally, detecting these variants and developing accurate assessments of the risk they pose to public health is challenging, as many countries have rolled back their surveillance efforts.

While available vaccines remain effective in preventing severe illness and death from COVID-19, there are concerns the emerging subvariants will be more immune evasive than previous variants, particularly due to mutations in the receptor binding domain that would prevent antibodies from docking and attacking the virus. AstraZeneca’s EvuSheld, the only monoclonal antibody authorized to prevent SARS-CoV-2 infection, is ineffective against BA.4.6. Other monoclonal antibodies in development already demonstrate vulnerabilities to newly emerging Omicron subvariants. With this new information, the Biden administration is searching for other potential candidates for use among immunocompromised persons.

US RESPONSE With public vigilance waning and the hopes of new pandemic funding from the US Congress fading, the COVID-19 response in the US is entering a new and uncertain phase. Omicron subvariants remain the predominant circulating lineages, many with high levels of transmissibility and immune evasion. Most places have completely dropped public health measures meant to mitigate transmission, and fewer and fewer Americans are wearing masks indoors or in crowded public spaces. With lower vaccine demand and less federal funding, vaccine manufacturers must soon decide whether and how high to price vaccines and boosters moving forward. While people with health insurance likely will continue to be able to access free or low-cost COVID-19 vaccines and therapies, those who are uninsured or underinsured potentially could lose no-cost access, a factor that would exacerbate underlying inequities. One factor influencing when COVID-19 tools will be commercialized is when the public health emergency declaration ends; however, the Biden administration last week extended the public health emergency for another 90 days, into January 2023, ahead of an expected potential winter surge. This decision aligns with a recent statement from the WHO reinforcing that COVID-19 very much remains a global emergency and calling for nations to sustain efforts to fight against its spread. Still, the US likely will end its public health emergency in 2023, when it will significantly cut back on certain components of its COVID-19 response.

Notably, efforts are underway to prevent such a situation from happening again in the future. On October 18, US President Joe Biden signed a National Security Memorandum to launch the administration’s “National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security.” The strategy calls for US$88 billion in funding over the next 5 years to strengthen key areas of pandemic preparedness and biodefense. The strategy will also bring together key government sectors to support its implementation, including the White House, the Intelligence Community, the US Department of State, and the US HHS.

GAIN-OF-FUNCTION STUDY A laboratory at Boston University has come under criticism for its recent gain-of-function experiments on the SARS-CoV-2 virus. Gain-of-function (GOF) refers to laboratory experiments that strategically and specifically enhance the function of one or more genes to study the outcome. They can range from something as simple as overactivating an important enzyme to enhancing the pathogenicity of a virus. In the Boston University (BU) experiments, performed at the BSL-3 level, the original strain of SARS-CoV-2 was modified to contain Omicron variant spike proteins with the aim of studying why some strains of SARS-CoV-2 are more pathogenic and transmissible than others. This work was reviewed internally by the BU institutional review board (IRB) and externally by the Boston Public Health Commission but not by the US NIH or NIAID, which were partial funders. NIH is currently launching a probe to evaluate whether this experiment should have been subject to federal oversight and review before moving forward. BU maintains that the research was not directly funded by the NIH and therefore there was no wrongdoing in not alerting them before beginning the experiment. The federal government takes GOF research very seriously, especially for those manipulating pathogens with potential pandemic potential, as SARS-CoV-2 certainly is. Even before the lab-leak hypothesis of SARS-CoV-2 origins, there was a large amount of controversy surrounding how and when to allow GOF research to move forward.

However, BU refutes that this experiment even should be considered as gain-of-function and maintain that they actually made a less dangerous version of the virus. The school criticized the initial media reports of the experiment, saying they were highly sensationalized; several outlets stressed the study’s finding that the altered strain caused 80% mortality in mice with severe disease, but that proportion is in line with experiments using unaltered SARS-CoV-2. Still, the finding that the resulting strain was less pathogenic does not alter the fact that the methods used fall within the definition of GOF research. Many biosecurity experts have come forward to disagree with BU’s characterization of their research and reiterate that this was in fact GOF research. The NIH inquiry and the renewed conversation among the scientific community will hopefully spur greater understanding and consensus around the risks and benefits of GOF research, in addition to institutionalizing the use of greater safeguards when conducting research with pathogens of pandemic potential.

LIFE EXPECTANCY & PREGNANCY-RELATED MORTALITY The COVID-19 pandemic interrupted decades worth of gains in global life expectancy. According to a study published October 17 in Nature Human Behaviour examining life expectancy losses during the pandemic, those countries that had higher proportions of their populations vaccinated by October 2021 experienced smaller life expectancy deficits in winter 2021. Of the 29 countries included in the analysis, most countries in Western Europe bounced back relatively well from life expectancy losses while most countries in Eastern Europe, the United States, and Chile experienced continuing declines in their pre-pandemic life expectancy. All nations had lower life expectancy than would be expected if pre-pandemic trends had continued. According to data from the US CDC, US life expectancy fell by a total of 2.6 years between 2019 and 2021 to 76.1 years, the lowest level since 1996.

In the US, COVID-19 contributed to about 25% of the more than 2,000 maternal deaths in 2020 and 2021, according to a report published by the US Government Accountability Office. Pregnant people are more vulnerable to severe COVID-19 outcomes, the US CDC has warned. Since 2018, maternal deaths have increased nearly 80%, with COVID-19 associated with 401 of the 1,178 pregnancy-related deaths last year. Additionally, racial and ethnic disparities widened; pregnancy-related deaths among Black people climbed from 44 per 100,000 in 2019 to 68.9 per 100,000 in 2021, rose from 12.6 per 100,000 in 2019 to 27.5 last year for Hispanic individuals, and increased from 17.9 in 2019 to 26.1 in 2021 for White people. Many factors contributed to the increase in maternal deaths, including the emergence of the Delta variant, mental health, lack of access to medical care, and low vaccination rates among pregnant people, among others. Experts note that many of these deaths were preventable, highlighting the urgent need to find solutions.

US CDC VACCINES FOR CHILDREN PROGRAM The US CDC Advisory Committee on Immunization Practices (ACIP) on October 19 recommended that vaccines against COVID-19 be included in the CDC Vaccines for Children program, which provides no-cost vaccines for a variety of diseases to children and adolescents aged 18 and younger whose families cannot afford them. Children are eligible for the program if they qualify for Medicaid, or are uninsured, underinsured, or Native American. The panel of independent advisors voted unanimously to include COVID-19 vaccines in the program to ensure these children can receive the shots for free after the federal government shifts the vaccination program to the commercial market. When the Biden administration decides to end the COVID-19 public health emergency—which it extended again last week—more than 5 million children are expected to lose health insurance under federal programs.

During the meeting, the panel emphasized they were not voting on adding COVID-19 vaccines to the CDC annual vaccination schedule, although a meeting to consider doing is taking place today. While the CDC decides a recommended vaccination schedule for children based on age, US states decide which vaccines are mandatory for entry into schools. Nonetheless, the CDC had to push back on a Fox News contributor who amplified a false claim that the CDC was set to mandate COVID-19 vaccines for schoolchildren. Public health experts agree there is legitimate debate over whether school-aged children should be required to receive the vaccines but warned the erroneous claim represents another example of how quickly misinformation can spread and potentially harm children, erode trust in federal health institutions, or endanger health officials. Experts also agree more states and localities will require children be vaccinated to attend the upcoming 2023 school year.

NOVAVAX BOOSTER On October 19, the US FDA authorized Novavax’s monovalent, protein-based COVID-19 vaccine as a booster for adults. The Novavax booster targets only the original coronavirus strain, although the company is concurrently studying an Omicron-targeting vaccine, in addition to a bivalent booster. The US CDC recommended the monovalent product for use among adults aged 18 years and older who have not yet received any COVID-19 booster but who have completed a primary series vaccination with any authorized or approved vaccine at least 6 months prior. The authorization offers another option for individuals who cannot or are reluctant to receive one of the bivalent mRNA vaccine boosters, or for those who would otherwise not receive a booster.

MODERNA OMICRON BOOSTERS Moderna’s bivalent Omicron-containing booster (mRNA-1273.214), administered as a fourth vaccine dose, produced a stronger immune response to Omicron BA.1 compared to its original booster dose at 90 days, according to the company. Additionally, the updated booster elicited a significantly higher neutralizing antibody response against Omicron BA.4/BA.5 compared to the original version at 28 days, suggesting the booster can produce broad cross-neutralization against Omicron subvariants. Moderna’s BA.1 bivalent booster is central to fall and winter vaccination campaigns in the UK. The company expects to announce interim immunogenicity results of its Omicron BA.4/BA.5-targeting bivalent vaccine (mRNA-1273.222), which is authorized for use in the United States, later this year. It is unclear how well either booster will work against newly emerging Omicron sublineages—including BQ.1.1, XBB, BF.7, and BA.2.75.2—which are expected to be more immune evasive than their older relatives and expected to cause COVID-19 surges in several nations through the end of this year and into the next.

Moderna also announced this week it will work with Gavi, the Vaccine Alliance, to supply more than 100 million doses of its Omicron-adapted bivalent vaccines for purchase at its lowest-tier pricing in 2023 to the COVAX Advance Market Commitment (AMC). Under the new framework, pending orders for Moderna’s original SARS-CoV-2 vaccine will be canceled, and COVAX will instead offer the newer vaccines to low- and middle-income countries (LMICs), which can use them as they see fit. COVAX has delivered nearly 1.8 billion doses of vaccines for COVID-19 to 146 countries, overcoming a rough start to obtain vaccine doses due to hoarding by wealthier nations. Dr. Mike Ryan, executive director of the WHO Health Emergencies Programme, this week at the World Health Summit harshly criticized wealthy nations and pharmaceutical companies for failing to adequately share vaccine doses through COVAX.

Glenn Kirschner: A jury will convict Trump

Salon

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"They are going to convict very quickly": Glenn Kirschner on the trial of Donald J. Trump

Chauncey DeVega - 14h ago

Donald Trump© Provided by Salon

Former President Donald Trump stands at a ‘Save America’ rally on July 22, 2022 in Prescott Valley, Arizona. Mario Tama/Getty Images

Over the course of nine public hearings the House Jan. 6 committee has conclusively shown that Donald Trump tried to end American democracy by nullifying the results of the 2020 election. In an exclamation mark to that conclusion, the House committee has now subpoenaed Trump. It's unlikely, of course, that Trump will supply the evidence the committee demands or appear to testify.

Trump's coup plot was complex and multifaceted. Its tentacles included numerous Republican officials, right-wing paramilitaries, media propagandists, private funders, interest groups, think tanks, and other agents. As was confirmed during last Thursday's committee hearing (presumably its last), the FBI, the Department of Homeland Security, the Secret Service and other law enforcement and national security agencies were aware that some of Trump's followers were armed and were coming to Washington with violent intentions on Jan. 6. Even worse, the evidence suggests that some individuals at the highest levels of the federal government either actively aided Trump's coup attempt or did nothing to prevent it.

Jan. 6 was not the climax of Trump and the Republican fascists' campaign to subvert the Constitution, demolish the rule of law and overthrow democracy. That day was just one more chapter in Trump's lawlessness and contempt for democracy. Trump's presidency was itself an extension of a much larger pattern: Throughout his decades of public life, he has behaved like a crime boss with no respect for anything or anyone beyond his own narrow self-interest and his bottomless hunger for power and wealth.

Ultimately, the Jan. 6 insurrection was just the beginning. Donald Trump and the Republicans' assault on democracy is only escalating as the midterms approach and the future of the country hangs on the precipice. What happens next? What are Attorney General Merrick Garland and the Department of Justice waiting for? What does justice look like? Will Donald Trump and the other coup plotters ever be prosecuted and punished?

Glenn Kirschner is a legal analyst for NBC News and MSNBC who teaches criminal law at George Washington University. For most of his 30-year career in law enforcement, Kirschner was an assistant U.S. attorney in Washington, D.C., often prosecuting serious crimes in federal court, and before that was a prosecutor and appellate attorney in the U.S. Army.

In this conversation, Kirschner describes Donald Trump as a "ruling-class criminal" who serves as living proof of how the rich and the powerful often evade justice in America. Trump's contempt for the rule of law is understandable, since he has never been held properly accountable for his lawbreaking. This time, Kirschner says, Trump may finally gone too far. 

The House Jan. 6 committee hearings, Kirschner suggests, have provided a roadmap for prosecuting Donald Trump for such serious crimes as seditious conspiracy and attempting to defraud the United States. Kirschner believes the evidence is overwhelming and clear, and that it will not be difficult to convince a jury to convict Donald Trump. That does not mean, Kirschner cautions, that Trump is likely to serve time in prison.

The Department of Justice may approach Trump's prosecution, Kirschner says, as a series of overlapping conspiracies rather than as the kind of comprehensive RICO case used against organized crime and other complex criminal organizations.

Toward the end of this conversation, Kirschner warns that it's likely Trump's followers will follow through on his commands to commit acts of violence if he is prosecuted or convicted — but says that most of Trump's MAGA followers are cowards and that any potential violence will be limited in scope.

How are you feeling? As a human being, how are you managing this democracy crisis and the troubled state of our country?

I feel schizophrenic, because one moment I am extremely frustrated and then the next moment I find some reason for hope and optimism. But as a whole I have been trying to balance the need for patience in any large-scale criminal investigation with the frustration that I feel.

Part of my daily work when I was a prosecutor involved assessing whether there was probable cause to support the application for an arrest warrant or an indictment. We had many long-term investigations that started out covert, they were proactive. By comparison, a reactive investigation is when an arrest is made, and we begin presenting evidence and information and seek an indictment. That is the stock in trade of state, local and county prosecutors as opposed to federal prosecutors.

Federal prosecutors mostly do proactive investigations where there is adequate predication and then we start in a very leisurely way. We want the case to be perfect. That's always the goal of the federal prosecutor. When federal prosecutors decide to return an indictment, they have likely already negotiated a pre-indictment plea, so it's already wrapped up in a pretty little bow and dropped on the court docket such that the Department of Justice is never operating under deadlines. We didn't have a sense of urgency. I often found that problematic. Every day, particularly when I was chief of homicide, we were investigating murders, conspiracies and obstruction cases.

Once we had probable cause to make an arrest, to indict somebody, I had to assess whether the right thing to do was to continue to investigate proactively, meaning covertly, without making an arrest, or to move forward to an arrest, a takedown and an indictment. The biggest factor in that decision was public safety.

The fact that Donald Trump is not being held accountable doesn't make sense. But it can be explained by the phenomenon of the ruling-class criminal. America has never been willing to hold them accountable.

How does that translate to the investigation of a former president? They're very different investigations in very different circumstances, of course. But I maintain that public safety writ large — for example, the viability of our democracy — should be an enormous factor in when the Department of Justice chooses to move toward an indictment of Donald Trump. Public safety is at risk. Our democracy hangs in the balance.

We are prosecuting Donald Trump's foot soldiers who he unleashed upon the Capitol on Jan. 6 to stop the certification. They are going to trial; they're going to prison. The man who gave the criminal order to attack is playing golf, holding rallies and attending dinner parties. That is a deep injustice at play in America every minute of every day, until Donald Trump is held accountable.

As a working-class black man in America, I know that if I did one-millionth of what Trump is alleged to have done, never mind what is obvious, I would be in prison long ago. The fact that Trump is not in jail facilitates and nurtures this democracy crisis, and feeds the anger that there is one set of rules for the rich and powerful and another one for everybody else. What are Merrick Garland and the Department of Justice and the others investigating Trump waiting for?

Don't ask me to explain the inexplicable, because I can't. Every single jury I spoke with, I warned them that they should not try to make sense of murder or other crimes. Because if you're waiting for it to make sense, or you require it to make sense in order to vote guilty, nobody would ever be convicted. The fact that Donald Trump is not being held accountable doesn't make sense. But it can be explained by the phenomenon of the ruling-class criminal. America has never been willing to hold the ruling-class criminals accountable, whether they are in politics, business, entertainment, the tech business or what have you.

Donald Trump is publicly admitting, for all intents and purposes, that he violated the Espionage Act and committed other high crimes. He is trying to extort the DOJ and Garland with threats of violence. He brags about financially supporting his followers who attacked the Capitol. He shows no fear of being prosecuted or being punished in any way for his obvious crimes. Does he want to go to jail? Or does he simply believe that he is above the law?

Donald Trump believes that he is above the law. And he holds that belief for good reason. It appears that Trump has lived a life of crime and has never been held accountable. That is a dramatic failing of our criminal justice system, our law enforcement agencies and most certainly our nation's prosecutors. Trump, in my opinion, has also come to believe, with good reason, that if he admits his crimes out loud people will take a step back and scratch their heads and say, "Geez, I thought it was criminal what he did, but he is saying he did it. So I'm uncomfortable, because that's not the way we go about investigating and prosecuting crimes in America. Something is wrong here. I don't know what it is, but we have to figure it out." In reality, what we as a society need to do is to focus on why Trump and other such people are not being prosecuted.

I would take that 14-page statement that he issued last week in response to the House Jan. 6 committee subpoena and slap a government exhibit sticker on it. I would then hand it to the jury as sharply self-incriminating evidence of Donald Trump's admission of guilt. This is what has me so unbelievably frustrated and angry. The prosecutors, on both the state and federal level, have all been reluctant, hesitant and maybe even afraid to be the first to charge Donald Trump with committing crimes. No prosecutor wants to be the first to charge a former president who committed crimes. However, everybody will want to be the second to do so. Once that barrier is broken, and the white-hot glare of world media attention is focused on the first prosecutor and his or her office, then everybody's going to want to get into the prosecuting Donald Trump business.

I believe I've seen proof beyond a reasonable doubt in the public reporting, assuming it to be accurate. Moreover, I am 100% confident that the evidence of criminal conduct that we've seen publicly reported or shared with us in the Jan. 6 committee public hearings is about one-tenth of what the Department of Justice has by way of incriminating information.

Certainly, I see a conspiracy to commit offenses against or to defraud the United States. Judge David Carter in California ruled that there was a preponderance of evidence to conclude that Donald Trump committed that crime in a conspiracy with John Eastman. He also concluded that Donald Trump committed a second federal felony, obstructing an official proceeding.

No prosecutor wants to be the first to charge a former president who committed crimes. However, once that barrier is broken, everybody will want to be the second to do so.

I also see evidence of inciting an insurrection or rebellion. Trump gathered together his angry supporters, he promised them a wild time and told them that their vote had been stolen. In total, that is compelling evidence of Donald Trump's criminal intent. Now, what sealed the deal for me was when we learned that Donald Trump told his own DOJ officials that he didn't care if there was no voting fraud and that they should just say that there was and then "leave the rest up to me and the Republican members of Congress."

To my eyes that is conclusive evidence of criminal intent, corrupt intent, guilty mens rea [knowledge of wrongdoing]. We can prove that in our sleep, in my estimation. Trump lied to people with the goal of inspiring them to anger. Then you tell them, "If you don't fight like hell, you're not going to have a country anymore. Go to the Capitol and stop the steal." That is more evidence of Trump's corrupt intent, because he continued to lie to them right up to the moment before they marched on the Capitol. Trump told them directly to go down there and stop the lawful functions of government — and Trump's followers did it. That is inciting an insurrection or rebellion. If we can ever get a prosecutor to plant his or her feet in the well of a court and present this to 12 jurors, they are going to convict Trump very quickly. This is a stronger case than the vast majority of cases I tried in 30 years.

Trump's response to the subpoena, which was a 14-page missive, was really a non-response. He didn't mention the subpoena. He didn't acknowledge it. Trump did not say he would or would not comply, or that he would defy it and file suit. He said nothing about it. Trump began by saying that the election was fraudulent and stolen. That's an admission of guilt. Why? Because his own DOJ officials, his own DHS officials, his own attorney general, all said there was no fraud undermining the election result. In fact, they said it was the safest, most secure election ever. His own staff said that too.

Trump continues to lie. That is evidence of an ongoing 371 conspiracy to defraud the United States. Of course, Trump will defy the subpoena. He will probably file suit and try to run out the clock and he will probably succeed, given how little time the select committee has left. In the end, the subpoena will get stuck in the courts and it will die.

I am concerned that Trump's influence is so great that it will be very difficult to find a fair and impartial jury. Even worse, Trump's followers will try to get on the jury to sabotage the result so that he can escape accountability. If Trump is tried and not convicted, for whatever reason, he may end up becoming even more powerful and dangerous.

Of course those are reasonable concerns. But none of that is a reason not to indict and try somebody for the crimes they committed.

A politician who contemplates offenses against the United States will know that Donald Trump was indicted, he went to trial and it took up two or three years of his life, burning through every penny he might have.

I spent decades trying cases before D.C. juries, and they're not monolithic, but there are certain similarities that I saw. They like their proof beyond a reasonable doubt. But once you give it to them, they're not easily distracted or confused by chaff that may be thrown into the mix by defense attorneys. Also, in my experience D.C. juries tend to take their oath of jury service seriously and decide the case based solely on the evidence, not on politics, ideology, preconceived notions or media accounts that they may have been exposed to before becoming jurors. I have complete confidence, actually, that if you give 12 citizens of the District of Columbia enough evidence to convict, they're going to convict based on the evidence.

Again, I believe the evidence is overwhelming of Donald Trump's guilt. Indicting and trying somebody for serious criminal offenses in and of itself has a powerful deterrent effect, whatever the outcome may be. A politician who is contemplating committing offenses against the United States will know that Donald Trump was indicted, he went to trial and it took up two or three years of his life to burn through every penny he might still have. Even if the jury could not come to a unanimous decision — he's not going to be acquitted, I am almost certain of that — guess what? The benefit of a hung jury is that Donald Trump can be put on trial again. It has to be done. The results are almost secondary. I always told my homicide prosecutors that it is far more important to try cases than to win cases.

I have consistently described Trump as a political crime boss. Would you apply that framework for prosecuting Trump as the leader of a criminal conspiracy under the RICO laws?

First of all, I never want to bring a case that I make more difficult for myself than it has to be. You can bring a conspiracy case. That is a much easier prosecution for what Donald Trump did, in connection with the insurrection, than trying to build a RICO conspiracy. For the latter, you would have to prove there's an organization or an enterprise. You have to prove there's a pattern of racketeering activity. You have to generally show that there were people who fulfill the established roles in the hierarchy of the organization. That having been said, do I see a RICO case in Donald Trump? Yes. I think the Trump Organization was run as a criminal enterprise. That's a RICO organization. One can see Donald Trump's administration as a potential RICO case.

To that point, I see his Cabinet secretaries as having been involved in questionable conduct. Trump's cabinet was literally structured with the kind of hierarchy we would see in a RICO organization. With respect to the insurrection and everything that led up to it and has come after it, I see that much more as a hub-and-spoke conspiracy. Donald Trump is the hub and there are these spokes, the people radiating out from the center. They do not necessarily intersect with each other, but they are all connected to the central person, the mob boss, the kingpin, the one for whose benefit they're committing these crimes — in this example, to try to keep Trump in office unlawfully and unconstitutionally.

There are all these people, every single day on social media and elsewhere, who proclaim, "Donald Trump is going to jail! He will do a perp walk!" To my eyes that borders on the ridiculous. What do you think is going to happen? Is Trump going to jail?

I believe that Donald Trump will be indicted and arrested. It will probably be a negotiated turn in which means that we will not see a perp walk. Trump will go to trial. He is a deeply damaged human being who does not have the capacity to admit guilt. Therefore, Trump goes to trial and gets convicted of his alleged crimes. I believe that the charges will be for a series of different conspiracies. There may be one for the Espionage Act and the document cases involving Mar-a-Lago. There may be another charge for the insurrection. Trump will be convicted. I am almost certain of that outcome.

Will Donald Trump go to prison? My instincts tell me no, because I don't think we have the courage in this country to put a former president in prison. If Trump does not go to prison and is instead sentenced to home confinement, that will be an enormous failing of our government. My position on home confinement has always been that is sentencing somebody to watch movies and TV and order food. That's no kind of punishment. Donald Trump needs to be put in prison, not only to punish him for crimes against the United States, but to deter the next aspiring political criminal or dictator or other killer of our democracy.

Does this all end with a whimper or a bang? Will Donald Trump unleash violence across the country by his followers if he is indicted or convicted?

I don't think we have the courage to put a former president in prison. If Trump does not go to prison and is instead sentenced to home confinement, that will be an enormous failing of our government.

Trump goes out with what he hopes is a bang, but in the end it will be a whimper. His supporters are not strong people. Many of them are not critical thinkers. Many of them only feel strong when they have guns, big automatic weapons, across their bellies and prance around with them. That is not a strong person. That's not the kind of person who's going to take up arms because Donald Trump has been indicted. Instead, that's the kind of person who is going to look for the next false God to worship, such as Ron DeSantis or whoever else it might be.

Trump is going to call for violence, but it will fizzle out because his followers will not rise up. There might be small pockets of violence, but the reality is that we have small pockets of violence across the country in major cities every day. In the end, I don't think there will be any more violence inspired by Donald Trump's arrest than, unfortunately, we suffer in every city and every county in every town across America every damn day.

If you had Merrick Garland's ear right now, what would you tell him?

He is a good, honorable, honest and ethical man. If I could be so bold as to offer him any thoughts, I would say the nation is suffering. The American people are desperate, anxious, depressed, angry and upset. They don't understand why somebody who has committed crimes in the harsh light of day, and then not only admitted to them but bragged about them, is free to play golf every day. That is such a deep injustice. It is doing enormous damage to the legitimacy of the Department of Justice, an institution I respect and love.

On the one hand, you want to say better late than never if you're going to bring charges against Donald Trump. But it's already so late. People have lost so much confidence. You came in as somebody who was determined to rebuild the institution, the prestige and the legitimacy of the Department of Justice. But I think the way this investigation is lingering is doing the exact opposite. I hope he can make decisions quickly that will remedy all of that.

Above is from:  https://www.salon.com/2022/10/17/they-are-going-to-convict-very-quickly-glenn-kirschner-on-the-trial-of-donald-j/

October 13: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

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

CALL FOR APPLICATIONS Applications are now open for the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity (ELBI) Fellowship Class of 2023. ELBI inspires and connects the next generation of biosecurity leaders and innovators. This highly competitive, part-time program is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events. Applications can be submitted through 11:59pm (ET) November 11, 2022. Learn more about eligibility requirements and application materials here: https://www.centerforhealthsecurity.org/our-work/emergingbioleaders/apply.html

EPI UPDATE The WHO COVID-19 Dashboard reports 619.8 million cumulative cases and 6.54 million deaths worldwide as of October 12. Global weekly incidence remained relatively steady at slightly more than 3 million cases for the fifth consecutive week, decreasing 6% compared to the previous week. Weekly incidence in Europe increased for the fourth consecutive week, up 5% over the previous week. All other regions reported decreasing trends. Global weekly mortality continued to decrease for the eighth consecutive week, although it appears to be leveling off, down 5% from the previous week.*

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

UNITED STATES

The US CDC is reporting 96.6 million cumulative cases of COVID-19 and 1.06 million deaths. Daily incidence continues to decline, down to 39,893 new cases per day, the lowest average since mid-April. Average daily mortality is down from a recent high of 505 deaths per day on August 12 to 338 on October 11, but the steadily decreasing trend appears to be leveling off.**

**Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.

Both new hospital admissions and current hospitalizations continue to exhibit downward trends, with decreases of 2.8% and 5.2%, respectively, over the past week. Both trends peaked around the end of July, approximately 1 week after the peak in daily incidence.

The BA.5 sublineage continues to be the dominant strain in the US, accounting for 79.2% of sequenced specimens; however, its estimated prevalence has decreased for 7 consecutive weeks. Several other Omicron sublineages continue to exhibit increasing trends. Notably, the BA.4.6 sublineage is up to 13.6%, BF.7 is up to 4.6%, and BA.2.75 is up to 1.8%. The increasing trends suggest that these subvariants may have some growth advantage over BA.5.

UPDATED BOOSTERS FOR CHILDREN US health regulators on October 12 authorized the updated SARS-CoV-2 bivalent vaccine boosters for children as young as 5 years old. Specifically, the booster from Pfizer-BioNTech is now available for children aged 5-11 and the shot from Moderna is authorized for children and adolescents aged 6-17. The booster shots—which target the original virus and the currently predominant Omicron BA.5 and BA.4 sublineages—are available to anyone age 5 or older who completed their 2-dose primary series at least 2 months prior. US CDC Director Dr. Rochelle Walensky signed off on the updated bivalent COVID boosters for children shortly after the US FDA issued its authorization. The new formulations will help bolster antibodies that have waned since prior vaccination or infection while targeting newer variants that are more transmissible and immune evasive, particularly important as children are back to in-person schooling and as the US heads into a busy holiday season.

Experts hope the new booster formulation will renew interest in getting children vaccinated before an expected fall and winter surge in cases. As of September 28, only 15.2% of children aged 5-12 years had received a first booster dose, according to CDC data. According to US regulators, there are no safety concerns for the bivalent vaccines, and they stress that vaccination is one of the best ways to keep children healthy and in school. Currently, no bivalent vaccines are approved for children under 5; however, Moderna and Pfizer-BioNTech are expected to have data available later this year. Vaccination continues to be the best way to protect against severe disease and hospitalization, and all eligible individuals are recommended to receive a bivalent booster dose as soon as possible.

LONG & 'MEDIUM' COVID Increasing evidence shows that a significant proportion of people infected with SARS-CoV-2 do not fully recover from acute infection even months later, experiencing a host of post-acute sequelae of SARS-CoV-2 (PASC), more commonly known as long COVID. Research to better understand the condition will help inform the development of care, treatment, and social support systems for people experiencing the condition. A new modeling study, published online this week in JAMA and based on information from a database of more than 1.2 million COVID-19 patients in 22 countries, estimates that 6.2% of people had long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection. The model estimates the proportion of those who had at least 1 of 3 self-reported long COVID symptom clusters: persistent fatigue with bodily pain or mood swings (3.2%), cognitive problems (2.2%), or ongoing respiratory problems (3.7%). Estimated symptom duration for hospitalized COVID-19 patients was 9 months, and 4 months for those who were not hospitalized. Even after one year, 15.1% of those with long COVID continued to experience symptoms. 

Another study, published in Nature Communications and performed in Scotland, utilized a matched pair design to evaluate long COVID outcomes in people with and without a previous COVID-19 diagnosis. The cohort of more than 33,000 laboratory-confirmed SARS-CoV-2 infections and nearly 63,000 individuals who had not been infected were evaluated at several time points during the study, including 6, 12, and 18 months. Among those who had symptomatic infection, 6% reported they had not recovered at all, and 42% said they had only partially recovered. No recovery was associated with hospitalization, age, female sex, deprivation, respiratory disease, depression, and multimorbidity. While asymptomatic infection was not associated with adverse outcomes, previous symptomatic infection was associated with poorer quality of life and persistent symptoms—including breathlessness, palpitations, chest pain, and confusion—that impact daily life. Vaccination was associated with a reduced risk of 7 of the 26 symptoms listed in the questionnaire. Further research is ongoing through the COVID in Scotland Study.

Many studies are focusing on the implications of long COVID, but concerns are being raised over “medium COVID”: the middle phase of recovery that stretches to about 12 weeks after infection. Lumping lasting symptoms into the long COVID category and varying definitions of post-COVID conditions have led to little clarity on what classifies as medium COVID. Notably, a few studies indicate that the most severe post-COVID complications may arise in this middle phase of recovery, rather than many months after infection or in the midst of active, symptomatic infection. While time-limited, medium COVID can still cause months of distress and life-altering symptoms. A Swedish study suggests that the risk of developing pulmonary embolism was 32 times higher in the first month after testing positive, twice as likely at 60 days, and indistinguishable from baseline by 3-4 months after infection. Similar risks and trends were found for heart attack and stroke. The findings are supported by similar data from a UK study published over the summer, in which researchers found that new-onset cardiovascular disease was increased early after COVID-19—primarily due to pulmonary embolism, atrial arrhythmias, and venous thrombosis—and new-onset diabetes mellitus incidence remained elevated for at least 12 weeks following COVID-19 before declining. All of these studies have incredible public health implications and show that even if the emergency phase of the pandemic is winding down in many regions, its long-lasting impacts are only beginning to be understood.

THERAPEUTICS Scientists expect numerous countries will experience sizable COVID-19 surges from this month through January, driven by various SARS-CoV-2 Omicron sublineages that will likely be the most transmissible and immune evasive yet. Several nations in Europe—including Germany, France, and Italy—are in the early stages of another wave, and the US typically follows this trend by about 4-6 weeks. Additionally, the new, highly immune-evasive variant XBB—a combination of two different Omicron subvariants—is driving a surge of cases in Singapore. Researchers are concerned over the new strains’ abilities to dodge vaccine-induced or natural immunity, as well as other authorized treatments.

There is evidence that Evusheld, a monoclonal antibody treatment used to bolster protection among immunocompromised individuals, may not be effective against the BA.4.6 Omicron sublineage, which now accounts for about 14% of cases in the US. If BA.4.6 can evade Evusheld, bebtelovimab could be the only monoclonal antibody treatment available to treat circulating strains of the virus. Additionally, Merck and Ridgeback Biotherapeutics released preliminary data last week showing their antiviral molnupiravir (Lagevrio) failed to reduce hospitalizations or deaths compared to placebo among multiply-vaccinated adults mostly under age 65 who were at higher risk of severe disease. The therapy did reduce the time to recovery by 6 days, and use of the drug was associated with earlier recovery across a variety of other symptom measures.

Another antiviral, Paxlovid, is being underused among patients at highest risk of severe disease in the US, experts warn. Some physicians might be reluctant to prescribe the drug due to its known interactions with several types of medications, including some used for cardiovascular disease. Notably, however, several studies show the therapy can reduce hospitalization, death, and time to recovery among older adults and those with at least one high-risk comorbidity, even those who are vaccinated. The US NIH released results from a small study last week showing that a return of COVID-19 symptoms and/or a positive test after completing an initial 5-day course of Paxlovid—commonly called COVID-19 rebound—is likely not caused by impaired immune responses. Instead, the rebound in symptoms could be partially driven by robust cellular immune responses to residual viral RNA in the respiratory tract. Infectious virus was detected in only 1 of 8 rebound participants. The study authors note that larger studies are needed to more fully understand the clinical significance and epidemiological consequences of COVID-19 rebound, but added that the findings do not support the hypothesis that a 5-day course of Paxlovid is too short for the body to mount a robust immune response. Nevertheless, Pfizer, which makes the treatment, plans to study a repeat 5-day course of Paxlovid among people who experience rebound. The US FDA requested such a clinical trial in August, ordering Pfizer to complete such a test by September 30, 2023.

US PUBLIC HEALTH MEASURES The US government, states, and localities implemented various types of public health measures—including mask use requirements, physical distancing recommendations, vaccination mandates, and quarantine rules—during the COVID-19 pandemic to help mitigate transmission of SARS-CoV-2 and protect communities. The results of a new survey, published October 10 in JAMA Network Open, show that nearly 42% of the 1,733 adult respondents reported misrepresenting and/or nonadherence to at least 1 of 9 public health measures. The survey—conducted by researchers from Middlesex Community College in Connecticut and the University of Utah between December 8-23, 2021—showed that 24.3% of respondents told someone they were with or about to be with that they were taking more COVID-19 precautions than they were; 22.5% disobeyed quarantine rules; 21.5% avoided testing when they thought they might be infected; and 20.4% did not divulge that they had a suspected or confirmed infection when entering a doctor's office.

The most common reasons for the diversions were wanting life to feel normal or desiring to exercise personal freedoms, although some people said they felt the pandemic was a hoax or not serious, were following the advice of a celebrity or other public figure, or did not want to miss work. Certain public health measures can be burdensome and highly disruptive, but they are effective, the researchers noted, and nonadherence or dishonesty can have significant consequences, including prolonging the pandemic by leading to more infections, hospitalizations, or deaths. Notably, misrepresentation and nonadherence was more common among those with a greater distrust for science, although the researchers found no association between misrepresentation/nonadherence and political belief, political party affiliation, or religion. Understanding the public’s concerns regarding public health measures could help improve willingness to follow them in the future.

WORSENING INEQUALITY Oxfam and Development Finance International (DFI) published a research report on October 11 that ranks countries on their commitment to reducing inequality between 2020-2022. The report, titled “The Commitment to Reducing Inequality Index 2022,” reviews the spending, tax, and labor policies of 161 governments and finds that both high-income countries (HICs) and low- and middle-income countries (LMICs) pursued policies that worsen inequality since the start of the COVID-19 pandemic. According to the report, 70% of LMICs made cuts to their education budgets, 50% of LMICs cut their health budgets, and nearly 50% of LMICs reduced social protection program spending. In 2021, lower-income countries reportedly spent 27.5% of their budgets to repay debts, about four times the amount those countries spent on health. Additionally, nearly 90% of assessed countries froze tax rates for the rich while poverty levels increased, and many countries failed to raise minimum wages.

The report highlights Norway and Germany as top performers in actions taken to reduce inequality. Other well-performing nations include Australia, Belgium, and Canada. However, the report claims that HICs played a role in exacerbating inequality in LMICs by overseeing lender repayment demands despite the economic hardships imposed by the COVID-19 pandemic. Oxfam accused the International Monetary Fund (IMF) of worsening inequality by demanding new austerity measures to reduce budget deficits. One of the important lessons learned during the COVID-19 pandemic is that health inequality leaves the door open for new and more dangerous viral variants to develop and has the potential to mask the emergence of novel pathogens with pandemic potential. The world must address rapidly deteriorating equality levels to help prepare for and prevent the next pandemic. 

SARS-COV-2 ORIGIN A panel of experts examining the origins of SARS-CoV-2—many of whom were originally convened as part of a task force for The Lancet COVID-19 Commission—this week reported their findings in the Proceedings of the National Academy of Sciences (PNAS). Like the Commission’s report, the PNAS analysis stresses the need to apply a One Health lens to help decrease the risk of disease spillover events and to make improvements in the safety of laboratory and field research. While the Commission’s report gave equal weight to theories supporting the virus naturally spilling over to humans and accidentally being leaked from a lab, the PNAS report concludes that increasing scientific evidence is most consistent with the theory that the COVID-19 pandemic began due to zoonosis from wildlife to humans via the wildlife trade or farming. To reach that conclusion, the researchers conducted a literature review, interviewed other experts, and examined major RNA virus outbreaks since 1967 to identify common features as well as opportunities to prevent novel disease emergence. Though the origin of SARS-CoV-2 has not yet been conclusively determined—and may never be—the authors of the PNAS paper say it is time to look beyond trying to answer that question and use lessons learned from the COVID-19 pandemic to improve upon future prevention and preparedness.

BIOSAFETY The COVID-19 pandemic has spurred plans to build more than 40 high-level biosafety laboratories in several nations, prompting concerns from researchers about how these new facilities—which many agree are needed—will obtain sustainable funding to handle dangerous pathogens safely and securely. India, Kazakhstan, Singapore, Philippines, Russia, and the United States plan to establish high-containment facilities. While some researchers question the need for so many new labs and their high operating costs, others maintain that new biosafety centers could lead to improved safety practices, allowing scientists to work more safely than they could without them