Covid-19 Updates & Info

[Deuce]

The PBS 'American Masters' series this week focussed on Dr. Anthony Fauci.
I found it to be extremely interesting.
About 80% of it deals with his work on COVID-19, and the other 20% is about his work with AIDS beginning in the 1980s.

Here is the link to watch it. I don't know if it's available to watch online yet - if not, it very likely will be soon.
You can also check your local PBS TV listings for it this week. It really is worth the watch...

PBS American Masters - Dr. Fauci...

Here is the 'trailer'...



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[dryrunguy]

Here's the latest Situation Report.

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New analysis appears to link SARS-CoV-2 origin to raccoon dogs in Wuhan market, raises questions about completeness of data shared by China; US law requires declassification of intelligence information

More than 3 years into the COVID-19 pandemic, the origin of the SARS-CoV-2 virus remains a hotly contested topic. In the absence of a “smoking gun,” it is unclear exactly how the virus first infected humans, and it may never be definitively determined whether the virus evolved naturally among animals or escaped a laboratory setting. Investigations into the emergence of SARS-CoV-2 have been hindered by insufficient access to facilities, personnel, specimens, and data in China, and intense political divisions—in the US and elsewhere—have made public debate over the available evidence difficult.

Recent revelations regarding early genetic data from specimens collected at the Huanan Seafood Wholesale Market in Wuhan, China, in early 2020 provide additional support for theories that the pandemic emerged as a result of natural zoonotic transmission. Dr. Florence Débarre, a researcher from France, recently identified a previously undisclosed trove of genetic data published on the GISAID platform. Among the viral genetic data, she identified DNA from multiple mammal species, including raccoon dogs, which are known to be susceptible to coronaviruses. The presence of raccoon dog DNA among the viral sequences indicates that these animals were present at the market and may have been infected with the SARS-CoV-2 virus. Notably, the Chinese government previously asserted that these types of animals were not present at the market. Reportedly, after Dr. Débarre reached out to Dr. George Gao, former Director of the China CDC, to collaborate on further research, the data were removed from GISAID “at the request of the submitter.” Following a briefing by Dr. Débarre’s team last week, WHO Director-General Dr. Tedros Adhanom Ghebreyesus chastised China for withholding the data and called on the Chinese government to share all of the available data immediately. The researchers published their findings (preprint) on March 20. While the new data still do not provide definitive proof, they demonstrate that the Chinese government has more data available than what it has shared.

Following unanimous approvals in both houses of the US Congress, President Joe Biden signed a bill requiring US intelligence agencies to declassify all information related to investigations on the origin of SARS-CoV-2 and the Wuhan Institute of Virology in China. To date, various public reports from the US intelligence community indicate that agencies have reached different conclusions regarding the likely origin of the pandemic. Following the release of its report that concluded—albeit with “low confidence”—that a laboratory incident was the most likely origin, the US Department of Energy briefed the Senate Energy and Natural Resources Committee on March 16 about classified information underpinning that analysis.

End of US public health emergency to impact various healthcare programs, rules; US House Republicans eye canceling unspent COVID-19 aid to help rein in federal spending

The WHO said this week that its experts are confident that the public health emergency of international concern (PHEIC) declaration for COVID-19 will be able to be declared over by the end of this year. Similarly, the Biden administration previously announced an end to the US public health emergency for COVID-19 in May, and this week said it will disband its White House COVID-19 Response Team at the same time. The end of the public health emergency will bring with it changes to healthcare access and benefits for many residents nationwide. Millions will lose healthcare coverage with the end of continuous Medicaid enrollment, a change likely to disproportionately impact Black and Hispanic adults, according to a recent Commonwealth Fund report. Additionally, training rules for nursing home staff will become stricter; rollbacks of broader access to certain controlled substances threaten treatment for people recovering from addiction; hospitals and other care facilities will have to comply with stricter capacity and staffing rules; and federal COVID-19 surveillance reporting requirements for states will end.

Additionally, Republicans in the US House are targeting unspent COVID-19 relief money in a plan to cut federal spending. Though a small amount—less than US$80 billion unspent as of January out of the total US$5.2 trillion relief aid allocated—canceling the funds would have huge repercussions for union pension funds, healthcare for veterans, COVID-19 research efforts, and aid for small businesses and transportation systems.

US Senate HELP Committee hears testimony from Moderna CEO about expected commercial market price increase for vaccine

In early 2023, reports emerged publicly that Moderna planned to increase the price of its SARS-CoV-2 vaccine, quadrupling it from between US$15–$26.36 to US$110–$130 per dose, when it shifts its sales to the commercial market later this year. The end of the COVID-19 public health emergency in May will shift the burden of purchasing vaccines to the private sector. Moderna earned about US$40 billion from sales of its COVID-19 vaccines alone over the past 2 years. On March 22, Moderna CEO Stéphane Bancel testified regarding those plans before the US Senate Committee on Health, Education, Labor and Pensions (HELP Committee). Mr. Bancel argued that, while Moderna received considerable funding from the federal government—on the order of US$12 billion for research, development, and procurement—the company will need to implement new production and logistics as the pandemic enters an endemic phase. The combination of new manufacturing processes, storage, wastage, and significantly lower demand necessitates higher costs per dose, he said. Some Senators on the committee argued in favor of Moderna, noting that the success of Moderna’s vaccine illustrates the benefits of capitalism. While the purchase cost of the vaccine is expected to increase, Moderna has committed to ensuring the vaccines remain fully covered by health insurance. Patient assistance programs also will help uninsured or underinsured individuals access the vaccines, but some Senators noted that the paperwork for these programs can be difficult to navigate. Pfizer and BioNTech also plan to increase the cost of their SARS-CoV-2 vaccine to US$110–$130 per dose, but the companies did not use US government funding in developing the shot.

US FDA expected to soon decide on authorization of additional bivalent booster dose; Canada, UK move forward with shots for some individuals

The US FDA is discussing the possibility of authorizing a second round of vaccine boosters targeting the Omicron variant for certain people at high risk of severe COVID-19 illness. The agency is expected to decide within a few weeks, according to people familiar with the deliberations. The bivalent booster is currently recommended for anyone aged 6 months and older after completion of any FDA-approved or FDA-authorized primary series or previously received monovalent booster dose(s), with an exception for the youngest children who received the bivalent vaccine as the last dose in their 3-dose primary series.

While only 16.4% of the total US population has received the updated booster, a small percentage of people are anxiously wondering when they can get another shot. People aged 65 and older are contributing a larger proportion of COVID-19-related deaths over time, particularly those who have underlying health conditions. Additionally, though people who are immunocompromised make up about 3% of the US population, they account for 25% of people hospitalized with COVID-19. For both of these populations, vaccine effectiveness against hospitalization and symptomatic infection begins to drop significantly 2–4 months following their last booster. Canada and the United Kingdom are offering the bivalent booster to older adults, residents of care homes and other senior living settings, and certain people who are immunocompromised. We should know soon whether the US will authorize boosters for similar groups.

What we’re reading

CHILDREN & FAMILIES The COVID-19 pandemic had an unprecedented impact on the lives of children and their families in the United States, and greater focus and investment are needed to address the critical social, emotional, behavioral, educational, mental, physical, and economic health and well-being challenges that the pandemic caused or exacerbated, especially among families identifying as Black, Latino, and Native American, and those with low incomes, that have disproportionately borne the stress of these negative effects, according to a report published March 16 by the National Academies of Sciences, Engineering and Medicine. The report makes several recommendations for federal- and state-level legislatures and agencies to address the short- and long-term effects on children and families and to prepare for the next pandemic.

PAXLOVID A panel of expert advisors to the US FDA voted 16-1 last week to endorse the antiviral Paxlovid (nirmatrelvir-ritonavir) as a treatment for adults with COVID-19 who are at high risk for progression to severe illness. Notably, the committee highlighted potentially harmful drug interactions. Experts later said there is not enough data to determine exactly who would benefit most from the drug and a poor understanding of the treatment among the medical community, hindering its prescription. According to a recently released analysis, Paxlovid use could “lead to 1,500 lives saved and 13,000 hospitalizations averted each week in the United States,” based on COVID-19 data from January 2023. Another study, published March 17 in JAMA Health Forum, modeled population-level impacts of a Paxlovid rollout during a surge like the 2022 winter Omicron wave. The panel’s endorsement likely will lead to full approval of the drug by FDA, although the agency is not required to follow the advice of its advisory committees. A final decision is expected in May. In related news, a study by the Yale School of Medicine is testing whether a 15-day course of Paxlovid can improve the health of people with long COVID.

PANDEMIC-RELATED STATE LAWS, LEGISLATION & REGULATIONS On March 17, KHN published 2 articles examining various state-level legislative actions or laws with pandemic-related roots. One article discusses legislation and proposed regulations in more than a dozen states aimed at controlling healthcare staffing agency wage rates for temporary workers during health emergencies, as well as steps hospitals and health facilities are taking to retain their workers with the acute challenges of the pandemic now in the past. Another article examines how California’s COVID-19 misinformation law, which is meant to discipline doctors who provide false information about COVID-19 patients, is mired in legal limbo after 2 federal judges issued conflicting rulings in recent lawsuits.

CHINA China this week authorized a domestically produced mRNA vaccine against COVID-19, after showing reluctance to use similar vaccines produced in the US and European nations. According to CSPC Pharmaceutical Group Ltd., which makes the vaccine, known as SYS6006, a large clinical trial showed the vaccine is safe and effective against several Omicron subvariants. The WHO urged CSPC to share its full data so the health agency can assess the vaccine for use on the international market. China’s other homegrown vaccines, which use more traditional platforms, proved less effective against newer Omicron variants. According to a report from the Associated Press, China’s sudden scrapping of its strict “zero COVID” policy in late 2022 went against the advice of experts and led to hundreds of thousands of COVID-19-related deaths, some of which could have been avoided with better vaccination coverage and more prepared healthcare facilities.

EQUITABLE VACCINE DISTRIBUTION Equitable worldwide distribution of COVID-19 vaccines would increase global economic benefits by about US$950 billion per year by improving health gains, helping to ease lockdowns, and supporting supply chain recovery, when compared with a scenario focused on vaccinating the entire populations of vaccine-producing countries first then distributing vaccines to other nations, according to an analysis published this week in Nature Communications. The researchers propose a benefit-sharing mechanism that allows all stakeholders to benefit and provides a model to analyze distribution strategies in different infectious and socioeconomic contexts. They note that the need for equitable vaccine distribution is one of the most important lessons to be learned from COVID-19, though global collaboration continues to present a challenge. Notably, wealthy nations already appear to be repeating their COVID-19-era vaccine hoarding tendencies with avian influenza vaccines.

UN CLIMATE REPORT A report released this week by the UN Intergovernmental Panel on Climate Change (IPCC) warned that the world is likely to fail at meeting its most ambitious climate target—limiting warming to 1.5 degree Celsius (2.7 degrees Fahrenheit) above preindustrial temperatures—by the early 2030s. This change could bring about catastrophic damage to the Earth, causing climate disasters and other impacts—such as heat waves, famines, and infectious disease outbreaks—so extreme that humans will have difficulty adapting. The authors said humanity has reached a “critical moment in history” and needs to accelerate actions to achieve its climate goals.

Epi update

As of March 21, the WHO COVID-19 Dashboard reports:
• 761 million cumulative COVID-19 cases
• 6.88 million deaths
• 734,302 million cases reported week of March 13
• 18% decrease in global weekly incidence
• 4,897 deaths reported week of March 13
• 22% decrease in global weekly mortality

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+57%) and Eastern Mediterranean (+47%) regions.

UNITED STATES
The US CDC is reporting:
• 103.8 million cumulative cases
• 1.12 million deaths
• 149,955 cases week of March 15 (down from previous week)
• 1,706 deaths week of March 15 (down from previous week)
• This is the lowest weekly mortality since March 2020
• 7.8% weekly decrease in new hospital admissions
• 12.1% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (90.2%), BQ.1.1 (3.5%), XBB (2.5%), and XBB.1.5.1 (2.2%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

[ponchi101]

UN CLIMATE REPORT A report released this week by the UN Intergovernmental Panel on Climate Change (IPCC) warned that the world is likely to fail at meeting its most ambitious climate target—limiting warming to 1.5 degree Celsius (2.7 degrees Fahrenheit) above preindustrial temperatures—by the early 2030s. This change could bring about catastrophic damage to the Earth, causing climate disasters and other impacts—such as heat waves, famines, and infectious disease outbreaks—so extreme that humans will have difficulty adapting. The authors said humanity has reached a “critical moment in history” and needs to accelerate actions to achieve its climate goals.

Meanwhile, in Colombia.
NO new exploration permits will be issued to any new oil and gas projects. But.
No plan to encourage solar or wind has been seen.
No plan to construct or invest in an electric train system, for transport of goods, is in place.
No plan to build or assemble electric vehicle in the country is in place.
All O&G needs for the country must therefore be imported (Colombia is not O&G self sufficient) meaning that transport of such needs is an energy expenditure, leading to more CC gases being released.

One thing is to be oblivious to CC. Another is to be stupid. Here I live.

[dryrunguy]

Here's the latest Situation Report.

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White House disbanding COVID-19 Response Team as end of pandemic emergency nears; No movement seen on establishing new preparedness and response office

The White House is disbanding the COVID-19 Response Team that led the federal response to the pandemic since February 2020. The move makes sense, according to officials, as the nation prepares to wind down the COVID-19 national emergency and public health emergency on May 11. The end to those declarations could come even sooner, however, as the US Senate last week voted to end the national emergency order that was first implemented during the Trump administration. The US House of Representatives passed the measure in February, and US President Joe Biden said he will sign it despite his opposition. Meanwhile, the US Congress in December 2022 asked the White House to stand up a new, permanent office to coordinate the government’s preparedness activities before the next pandemic threat, but there has been little movement to do so. With only a month, or less, remaining before the pandemic emergency ends—which has implications for millions of US residents—it appears the political will to create a new pandemic preparedness and response office already is dwindling, perpetuating the cycle of “panic and neglect” so often experienced in health emergencies.

US FDA expected to announce authorization of second bivalent booster for certain people; UK, Canada move forward with spring shots for high-risk populations

The US FDA is expected to announce authorization of a second bivalent booster for certain high-risk groups within the next few weeks. The second Omicron-specific booster—with the same formulation as the first—likely will be authorized for individuals aged 65 years and older or with those with weakened immune systems, to be given at least 4 months or 2 months, respectively, after the first bivalent booster. According to officials familiar with the plan, the new policy will be “permissive,” allowing people to choose to get the shot rather than standing as a formal recommendation. About 42% of people aged 65 and older have received the bivalent booster shot, according to the US CDC.

Once the FDA makes a final decision, the CDC will have to recommend use of the second booster, but it is unclear whether the agency will convene a meeting of its vaccine advisory committee. A reformulated booster is anticipated for summer or early fall rollout to align with a proposed plan made in January by the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) to switch to annual COVID-19 boosters for the majority of people. Data from CDC’s vaccine advisory committee February meeting confirms earlier real-world reports that bivalent vaccines provide better protection against serious illness in adults than monovalent boosters. While data collection is ongoing, studies show that an additional booster may be particularly beneficial to older adults, but experts note that boosters likely will need to be updated to keep up with emerging variants, to maintain immunity levels as the virus evolves.

Last month, health officials in the UK and Canada recommended additional boosters this spring for the elderly, residents of nursing homes, or immunocompromised people. Today, the UK Joint Committee on Vaccination and Immunisation (JCVI) said children between the ages of 6 months to 4 years with underlying medical conditions be offered 2 doses of the Pfizer-BioNTech vaccine, with an interval of 8 to 12 weeks between the first and second doses. UK health regulators authorized the vaccine for children in that age group in December 2022, but the JCVI did not advise vaccination of children of that age who are not in a clinical risk group. On April 5, the European Centre for Disease Prevention and Control (ECDC) released guidance calling on countries in the region to plan for continued rollout of COVID-19 vaccines in 2023, with efforts focused on protecting older adults and other vulnerable groups, such as those with underlying comorbidities and the immunocompromised, irrespective of age.

WHO monitoring XBB.1.16 Omicron subvariant driving surge of cases in India

The WHO is monitoring a new SARS-CoV-2 Omicron subvariant called XBB.1.16, which is driving a surge of cases in India. Dr. Maria Van Kerkhove, WHO's COVID-19 technical lead, said the subvariant has replaced other variants in India and noted it is “one to watch.” The WHO added XBB.1.16 to its list of monitored variants on March 22. XBB.1.16—which is a recombinant variant from BA.2.10.1 and BA.2.75—is similar to the XBB.1.5 variant that is currently dominant in the US and accounts for 45% of global cases, but additional mutations in the spike protein may give it some growth advantages over the older subvariant. The mutations have the potential for increased infectivity and potential increased pathogenicity, although reports do not indicate a rise in hospitalizations, ICU admissions, or deaths due to XBB.1.16, the WHO noted.

So far, there are about 800 sequences of XBB.1.16 from 22 countries, primarily India, which is reporting its highest number of COVID-19 cases in 6 months. In its weekly situation report, the WHO noted that while overall COVID-19 cases and deaths continue to decline, several other countries in the Eastern Mediterranean and South-East Asia regions—which comprises India—are reporting significant increases in cases, including Iran, Kuwait, Libya, United Arab Emirates, and Qatar. In the US, the 7-day average for new daily cases continues to decline to around 20,000, down 9.2% compared to the previous 7-day average. XBB.1.5 has reached saturation, accounting for 87.9% of samples, while 3 other Omicron subvariants show positive growth: XBB.1.9.1, XBB, and XBB.1.5.1. The XBB.1.16 subvariant has been detected in at least 18 US states, and a descendant of the new subvariant that is raising concern among experts, XBB.1.16.1, has been found in 15 states.

Though many people are weary of the pandemic, health experts note it is important to remain vigilant, as past experience with variants shows that things can change quickly. In the US, XBB.1.5 accounted for less than a quarter of COVID-19 cases in late December 2022, but it became the dominant variant over the ensuing week. In the US, XBB.1.16 has shown a 188% growth advantage over XBB.1.5 in the past 3 months, and a 64% growth advantage in India. While the WHO is closely monitoring this new subvariant, as well as several others, it said maintaining and developing surveillance systems to track known variants and detect emerging strains is critical to healthcare system and response agility. Additionally, the WHO urged people to continue taking precautions against COVID-19, including vaccination, social distancing, and wearing masks.

Nature publishes first peer-reviewed data on SARS-CoV-2 origin from Chinese scientists

The journal Nature this week posted a peer-reviewed but unedited study from Chinese scientists examining the results of surveillance samples taken from the Huanan Seafood Market in Wuhan, China, in January 2020, once again reigniting the debate surrounding the origin of SARS-CoV-2. The study examined 923 environmental swabs taken from locations around the market and 457 swabs collected from 18 animal species. The animal swabs were taken from fish tanks, stray animals, and unsold refrigerator and freezer contents. Sample analysis through RT-PCR detected SARS-CoV-2 in 73 environmental samples, but no evidence of SARS-CoV-2 was detected in the animal samples. Three live viruses were isolated from the SARS-CoV-2-positive samples, and the viruses shared a 99.99-100% nucleotide identity with the wild-type virus isolated from humans.

The first version of the article was originally posted to a preprint server in February 2022 and downplayed the possibility of animal infections at the market. But recently, Dr. Florence Débarre, a researcher from France, identified a previously undisclosed trove of genetic data published on the GISAID platform. A group of international researchers led by Dr. Débarre released their own analysis of the data on the preprint server Zenodo, which identified DNA from multiple mammal species, including raccoon dogs, which are known to be susceptible to coronaviruses. The presence of raccoon dog DNA among the viral sequences indicates that these animals were present at the market and may have been infected with the SARS-CoV-2 virus, but the preprint did not provide definitive data to support their infection. Notably, the Chinese government previously asserted that these types of animals were not present at the market. However, in the recently published Nature article, the Chinese scientists confirm the presence of raccoon dogs in the Huanan Market, but the authors stress the remaining uncertainty surrounding the virus’s origins. The authors state that the virus could have been transmitted from humans to raccoon dogs in the Huanan Market or that the virus could have been imported on cold-chain products such as frozen foods.

The release of the Nature publication and the Zenodo preprint analysis has led to varied reactions from the international community. Dr. Alice Hughes, a conservation biologist with the University of Hong Kong, questioned whether the Nature data could have been improperly processed or contaminated, particularly because the Chinese research team found genetic traces from animals such as pandas and chimpanzees, which would not have been in the market. Similarly, Dr. Angela Rasmussen of the University of Saskatchewan said the Nature study is “deeply flawed” because the Chinese researchers used a reference database that excluded the genome of the raccoon dog for sequencing. Meanwhile, authorities in China continue to promote the cold-chain import theory. The WHO has called on China to immediately share all relevant data with the international scientific community.

While the origin of SARS-CoV-2 is unlikely to be definitively proven at this point, scientific evidence points to a natural origin. Full transparency within the scientific community is necessary for the mystery surrounding the virus’s origin to be resolved. Nonetheless, work can begin now to put measures in place to help lower the likelihood of future viral events, including improving standards and guidance for animal markets to lower the risk of disease transmission between humans and animals and enhancing international biosafety and biosecurity standards at laboratories globally.

Researchers, patient advocates call on US government to more effectively respond to long COVID, urge global consensus on definition of condition

Long COVID, also called post-COVID condition (PCC) or post-acute sequelae of SARS-COV-2/COVID (PASC), is a multifaceted and often disabling condition that can affect the neurologic, cardiovascular, pulmonary, hematologic, and endocrine systems of people of all ages, including children. As many as 23 million US adults and 65 million people worldwide have developed long COVID, which involves a variety of symptoms lasting more than 3 months after initial COVID-19 infection. This week, the US Department of Health and Human Services (HHS) marked 1 year of its whole-of-government response to long COVID with a press release outlining its progress and actions moving forward. As part of the initial federal response to long COVID, the US NIH is working with Palantir Technologies Inc. to build an enormous, collaborative database of deidentified data collected from people with COVID-19 or related conditions and launched the Researching COVID-19 to Enhance Recovery (RECOVER) Initiative, which selected a network of enrollment sites or hubs across 24 states, Puerto Rico, and the District of Columbia, with each site collecting clinical and biobank data from about 1,000 participants.

Over months of collaboration, the RECOVER principal investigators (PIs) say they have identified gaps in the response to care for patients with long COVID and developed strategies to address those gaps, and this week they called on the federal government to evolve its response. To do so, the PIs are urging the US Congress to include US$37.5 million in Fiscal Year 2024 funding for the Department of Health and Human Services (HHS) to competitively select Long COVID Centers of Excellence that could gather, develop, and disseminate data regarding evidence-based treatment; educate and train providers on best practices; conduct outreach to affected populations and community organizations; and coordinate access to care, with the aim of coordinating long COVID care, reducing healthcare disparities, and improving psychosocial and medical outcomes. Other experts are calling for the federal government to support an “Operation Warp Speed” for long COVID like it did to develop vaccines, therapeutics, and diagnostics for COVID-19. Such a program could help define, diagnose, treat, and classify the condition, as well as help improve the understanding of risk factors or the protective effect of vaccines or other therapies.

Additionally, advocates for and patients with long COVID are calling on the US NIH to reconsider plans to include exercise trials in its RECOVER initiative to find treatments for the condition. A large proportion of people with long COVID report experiencing post-exertional malaise (PEM), which can cause a worsening of symptoms such as fatigue, poor body temperature regulation, and cognitive dysfunction after even light exercise. Advocates fear that some trial participants could be harmed if they are not properly informed of the risks or the trials do not include adequate screening or post-exercise monitoring. Through a petition and letters, they also are asking researchers to share their rationale and trial protocols so potential risks can be assessed. Trial protocols for the RECOVER initiative are still under development, and a statement sent to Nature on behalf of NIH said patient representatives are included in that process.

Separately, in a commentary published in JAMA Network Open on April 5, experts argue that if the condition is universally defined, more effective treatments for it can then be developed. They say working toward this consistency can be accomplished in 3 parts: agreeing on a universal definition of this condition, with 1 name that can be adopted by all studies in the future; characterizing those who may be experiencing PCC unknowingly in studies, particularly among those who are at highest risk of exposure and severe disease; and conducting longitudinal research to collect data on symptoms and different outcomes over time. In an accompanying JAMA Network Open research letter, researchers aimed to describe how post-COVID-19 condition has been defined to date in studies on this topic.

What we’re reading

GLOBAL HEALTH WORKFORCE On the occasion of its 75th anniversary this week, the WHO called for global action to address health inequities and protect the health workforce, many of whom are facing burnout from the COVID-19 pandemic. Millions of health and other care workers were infected during the pandemic, thousands died, and many suffer from anxiety, depression, and other declines in mental health wellbeing. The agency urged governments to invest in education, skills-building, and decent jobs to meet the rapidly growing demand for healthcare and avert a projected shortage of 10 million health workers by 2030, particularly in low- and middle-income countries. The agency stressed the importance of upholding labor rights; investing in decent working conditions, fair pay, training, and leadership; and addressing gender inequalities in the health sector. Additionally, the WHO, in conjunction with the World Health Professions Alliance, recently published a report comparing the experiences of dentists, nurses, pharmacists, physicians, and physiotherapists during the COVID-19 pandemic and summarizing those 5 professions were impacted in common and different ways.

US PUBLIC SCHOOLS The COVID-19 pandemic affected all US schools in profound ways, but in a system where inequities existed prior to the national health emergency, those that were already the most vulnerable suffered the deepest and most lasting impacts. The Washington Post examines the experiences of 2 Alabama school districts that diverge on socioeconomic status, and the New York Times Magazine highlights the experiences of teachers, parents, and students in one Los Angeles County public school in a neighborhood that suffered immense stress and grief. In one fifth grade class alone, 17 of the students had a loved one die during the first year of the pandemic.

VILOBELIMAB EUA The US FDA issued an emergency use authorization (EUA) for vilobelimab, also known as Gohibic, to treat COVID-19 in hospitalized adults when initiated within 48 hours of receiving invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). The drug is a monoclonal anti-human complement factor C5a antibody, which works to control a part of the immune system that is thought to lead to inflammation and COVID-19 disease progression. The clinical trial supporting the authorization showed that patients treated with Gohibic had a lower risk of death by day 28 and day 60 of treatment compared to those who received a placebo. InflaRx, the treatment’s manufacturer, said it currently has a supply of the drug available and is working to increase production at a contractor facility. The EUA is expected to offer another potentially life-saving treatment option for the most critically ill COVID-19 patients.

MONOCLONAL ANTIBODIES Monoclonal antibodies (mAbs) administered to high-risk COVID-19 patients within 2 days of diagnosis reduced their risk of hospitalization or death by 39%, according to a hypothetical randomized study using observational data published this week in the Annals of Internal Medicine. Researchers at the University of Pittsburgh Medical Center assigned 7,706 high-risk COVID-19 patients aged 12 years or older to receive either mAbs (bamlanivimab, bamlanivimab-etesevimab, sotrovimab, bebtelovimab, or casirivimab-imdevimab) or no treatment between December 8, 2020, and August 31, 2022. The risk of hospitalization or death by 28 days was 4.6% among mAb recipients, compared with 7.6% among control patients. Notably, the US FDA revoked or suspended emergency authorization for all 5 mAbs during the study period after in vitro studies showed little to no benefit against newer SARS-CoV-2 variants. In the study, the benefit was greatest amid the Alpha and Delta variants, potentially reflecting the more virulent earlier strains and lower levels of immunity early in the pandemic. Using one of the largest US databases of patients treated with mAbs, the study confirms that the therapies saved lives and prevented hospitalizations.

NASAL VACCINE CANDIDATE In a study published April 3 in Nature Microbiology, researchers from Germany describe the results of a nasal vaccine candidate made with a live-attenuated form of COVID-19 that they claim can block SARS-CoV-2 from copying itself in the upper airways, where the virus generally gains a foothold. The team used a technique called codon pair deoptimization to manipulate the virus’s genetic material and weaken it so it can be shown to the immune system without making the body sick. In experiments conducted on hamsters, 2 doses of the nasal vaccine candidate, sCPD9, elicited the most robust immunity when compared with homogeneous and heterologous vaccination regimens using the Pfizer-BioNTech mRNA vaccine and Ad2-Spike, an adenovirus-vectored spike protein vaccine candidate. Notably, it remains unclear how effective nasal vaccines may be in humans. As of July 2022, there were at least 12 nasal vaccines under development worldwide. China, India, Iran, and Russia have authorized nasal vaccines, but little is known about their effectiveness.

LATIN AMERICA & CARIBBEAN The Lancet Regional Health Americas discusses the challenges faced by Latin America and the Caribbean (LAC) in rebuilding after the COVID-19 pandemic. In January, representatives from the World Bank, PAHO, and UNICEF met with health ministers and decision-makers from the region to discuss the extensive and enduring effects of the pandemic, which include high mortality rates, economic contraction, increased unemployment, and poverty. The pandemic also revealed vulnerabilities in the region’s healthcare systems with knock-on effects on primary health care, noncommunicable diseases, and education. Additionally, the pandemic disproportionately impacted the mental health of people in the region, with a 35% increase in depression and a 32% increase in anxiety, and mental health care services were disrupted. Representatives at the meeting emphasized the urgent need to address mental health, strengthen essential public health services, provide timely primary care, increase healthcare coverage, and include climate change in rebuilding efforts.

Epi update

As of April 6, the WHO COVID-19 Dashboard reports:
• 762 million cumulative COVID-19 cases
• 6.89 million deaths
• 711,352 million cases reported week of March 27
• 12% decrease in global weekly incidence
• 4,745 deaths reported week of March 27
• 25% decrease in global weekly mortality

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+90%) region.

UNITED STATES
The US CDC is reporting:
• 104.1 million cumulative cases
• 1.12 million deaths
• 139,991 cases week of March 29 (down from previous week)
• 1,596 deaths week of March 29 (down from previous week)
• 10.2% weekly decrease in new hospital admissions
• 11.4% weekly decrease in current hospitalizations

The Omicron sublineages XBB.1.5 (87.9%), XBB.1.9.1 (4.6%), XBB (2.5%), and XBB.1.5.1 (2.1%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

The New York Times this week launched a “build-your-own-dashboard” to track COVID-19 in US locations.

[ti-amie]

Yesterday I heard a horror story at the hair salon. One of the young hairdressers four year old son woke up unable to walk and very sick. At the hospital they said he'd been hit by both Covid and the flu, and an MRI was scheduled to be done yesterday. This particular woman, not out of her 20's, and the daughter of a correction officer, wore a mask but it seems she herself was never vaccinated judging by comments she'd made.

This pandemic is not over and while everyone wants to live in the fantasy that it is I'm not part of that collective delusion. I continue to mask in public and will get recommended boosters when available. I'm really worried about this baby and hope he makes a full recovery.

[Deuce]

Drugs somehow couldn't kill David Crosby - but COVID-19 could...

"He Had COVID, and He Went to Take a Nap and Never Woke Up"...

.

[ti-amie]

Drugs somehow couldn't kill David Crosby - but COVID-19 could...

"He Had COVID, and He Went to Take a Nap and Never Woke Up"...

.

Wow.

[atlpam]

Drugs somehow couldn't kill David Crosby - but COVID-19 could...

"He Had COVID, and He Went to Take a Nap and Never Woke Up"...

.

so not his first bout with Covid - he was certainly in a high risk category and no mention of whether he was ever vaccinated.

[Deuce]

Drugs somehow couldn't kill David Crosby - but COVID-19 could...

"He Had COVID, and He Went to Take a Nap and Never Woke Up"...

.

so not his first bout with Covid - he was certainly in a high risk category and no mention of whether he was ever vaccinated.

I read that he did get the two original COVID-19 vaccines (the 2 which came as a pair, a few weeks apart). I don't know if he received any of the boosters, or how many.
I know that he was in favour of the vaccines, objected to vaccine misinformation, and argued with people who were anti-vaccine.

And, yes, I suppose he was in a higher risk category, based on his age and the myriad stupid abuses he subjected his body to over the years.

[dryrunguy]

Here's the latest Situation Report. I think they're only coming out once a week now. Because, you know, COVID is in our past. Except it's not.

::

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.

[ponchi101]

I don't think that it is because it is in the past. It is that there is very little else to do. When they come with new vaccines for specific variants, we will get them (those, I assume, that got the original ones). But for most people, it is just that we cannot go back to any sort of shot down or isolation.
Some industries never recovered. For example. My friends/colleagues and I used to keep a list of countries we would not go to work: Ethiopia, Pakistan, Southern Colombia, Yemen. The list has been reduced to one single location: East Ukraine. That's how hard we were hit, and we simply can't accept the world shutting down again.

[ti-amie]

[ponchi101]

If they got tired of masks and such....
I said it in 2020, when this started. This virus would defeat us. It is here to stay. Fortunately, it has mutated towards the "benign".

[dryrunguy]

Here's the latest Situation Report. The bit about the ivermectin lawsuit was interesting.

There won't be a Situation Report next week. It's safe to say this is winding down.

::

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.

[ti-amie]

My doctor recommended that I get the latest booster but specified Pfizer. I'm going one day next week.