Covid-19 Updates & Info

[atlpam]

It seems to be very individual. A friend in Virginia (35, no health risks) got her first dose (Moderna) few weeks ago and reported virtually no side effects at all and went back to work the same day.

Most people have no effects to the first dose. The side effects are usually associated with the second dose. I went hiking after my first dose

[JazzNU]

Yeah, I don't think there's any rhyme or reason to who has side effects and who doesn't. My sister and brother-in-law are not high risk like I am and both of them were laid up and running fevers while I barely had much more than some extended arm pain and headaches (that could be completely unrelated since I have migraines).

I think staggering the vaccines are a great idea for those that can. Not everyone is able to since, for instance, they might need to take off work at the same time, or traveling the distance to get the vaccine needs to be done at once, especially since it requires two trips. But if you can, yeah, it's a great idea as is taking the next day off when possible.

[JazzNU]

[JazzNU]

Kiwis and Aussies can now travel back and forth. No testing or proof of vaccination required.

[dryrunguy]

Here's the latest Situation Report. Haven't read it yet.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 141.5 million cases and 3.0 million deaths as of 4:30am EDT on April 20. Global weekly incidence and mortality continue to increase. Last week, the WHO reported a new record high for weekly incidence, with 5.23 million new cases, a 14% increase over the previous week. Weekly incidence has increased for 8 consecutive weeks, and it appears to be accelerating. Global weekly mortality has increased for 5 consecutive weeks, up to 83,021 deaths, a 7.6% increase over the previous week and the highest weekly total since early February.

The global surge is largely driven by the epidemic in India, which continues to set new national records. On April 17, India became the second country to exceed 200,000 new cases per day, after the US. India is currently reporting 233,074 new cases per day, and its epidemic continues to accelerate. If it continues on this trajectory, India could surpass 250,000 new cases per day and set a new global record in the next 1-2 days. India set its national single-day incidence record on April 18, with 273,802 new cases before falling slightly to 259,167. India is #2 globally in terms of total daily mortality, with 1,353 deaths per day, and still accelerating rapidly. India is reporting fewer than half the daily mortality of #1 Brazil (2,866), but on this trajectory, it could close that gap quickly.

Turkey continues to exhibit a concerning surge as well. At 60,003 new cases per day, Turkey is now within 11% of the US (#2; 67,122) in terms of total daily incidence. Turkey’s COVID-19 surge appears as though it could be starting to level off, but it could potentially approach Brazil or the US in the near future.

Global Vaccination
The WHO reported 843 million vaccine doses administered globally as of April 20, including 450 million individuals with at least 1 dose. The WHO dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

Our World in Data reports 920 million doses administered globally. The global cumulative total continues to increase at a rate of approximately 18% per week. The daily average has declined for 5 consecutive days, down from 18.6 million doses per day on April 14 to 15.6 million on April 19. At least 185 countries and territories* are reporting vaccination data.
*Out of 191 reporting COVID-19 incidence data.

UNITED STATES
The US CDC reported 31.5 million cumulative cases and 564,292 deaths. Daily incidence has decreased slightly over the past several days—down from 69,953 new cases per day on April 13 to 66,747 on April 18. The daily incidence is still elevated compared to several weeks ago. Daily mortality is slightly elevated compared to last week, but it has held relatively steady at approximately 700 deaths per day since April 12, approximately equal to the low reported immediately prior to the autumn/winter 2020 surge.

Michigan appears to have passed a peak in terms of daily incidence, but some inconsistencies in its recent reporting make it difficult to determine if this is the beginning of a longer-term trend. Michigan does not typically report COVID-19 data to the CDC on Sundays (or holidays), but last week—on Sunday, April 11—it reported 4,837 new cases.

US Vaccination
The US has distributed 265 million doses of SARS-CoV-2 vaccine and administered 211 million doses. Daily doses administered* remains steady at approximately 3 million, including 1.6 million people fully vaccinated.

More than half of all adults have received at least one dose of SARS-CoV-2 vaccine, and one-third are fully vaccinated. A total of 132 million individuals have received at least 1 dose of the vaccine, equivalent to 40% of the entire US population and 51% of all adults. Of those, 85 million (26% of the total population; 33% of adults) are fully vaccinated. Among adults aged 65 years and older, 80% have received at least 1 dose, and 65% are fully vaccinated. In terms of full vaccination, 42 million individuals have received the Pfizer-BioNTech vaccine, 35 million have received the Moderna vaccine, and 7.9 million have received the J&J-Janssen vaccine.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

In light of the US surpassing 50% coverage in terms of adults with at least 1 dose of SARS-CoV-2 vaccine, we will look at the partial coverage (i.e., 1 or more doses) at the state level**. New Hampshire stands out among all states, leading in terms of partial coverage among both all adults and adults aged 65 and older. In fact, New Hampshire is reporting at least 1 dose for 99.9% of its older adults. And its 71.2% partial coverage among all adults is nearly 10 percentage points higher than #2 New Mexico (61.5%). New Hampshire’s success is likely a factor in the state’s decision to open vaccination to non-residents starting April 19, the same day that the few remaining US states expanded eligibility to everyone aged 16 years and older.

Four other states are reporting partial coverage greater than 60% among all adults: New Mexico (61.2%), Connecticut (61.2%), Maine (60.3%), and Massachusetts (60.2%). The median is slightly higher than 50%, and most states fall between approximately 46% and 54%. Alabama (38.7%) and Mississippi (38.2%) are the only states reporting less than 40% partial coverage among all adults. Impressively, the median coverage among adults aged 65 years and older is nearly 80%, with most states falling between 75-85%. In addition to New Hampshire, Vermont (93.6%) is reporting partial coverage greater than 90% among older adults. Hawai’i (69.3%) and West Virginia (69.5%) are the only 2 states reporting less than 70% coverage among older adults.

Most of the states that fall in the top and bottom 10 in both partial and full coverage. In fact, 7 states appear in the top 10 of both lists, and 8 appear in the bottom 10 of both lists. However, Hawai’i ranks #25 for partial coverage among all adults (50.1%), but it falls all the way to #50 among adults aged 65 years and older (69.3%). Kansas falls from #9 in terms of partial coverage among older adults (86.5%) to #21 among all adults (52.5%). Both New Mexico and New Jersey rank in the top 10 for all adults but fall 12 places for older adults. New Mexico ranks #2 in terms coverage among all adults (61.5%) and #14 (84.3%) among older adults, and New Jersey falls from #6 among all adults (58.8%) to #18 for older adults (82.3%).
**By state of residence, even if individuals received the vaccination in another state.

ROUTES OF TRANSMISSION Scientific evidence increasingly supports the theory that the primary mode of SARS-CoV-2 transmission is through airborne infectious aerosols passed from person-to-person, according to some researchers. In three separate pieces published last week, experts outlined reasoning and evidence supporting SARS-CoV-2 transmission from both near-field and far-field aerosols. In a commentary published April 15 in The Lancet, researchers from the UK, US, and Canada present 10 reasons backing airborne transmission. In another piece published online in JAMA on April 16, experts from Harvard University and the University of Michigan describe the rationale for improving air circulation and filtration in indoor spaces to reduce far-field transmission of SARS-CoV-2 and other respiratory infectious diseases. While noting that airborne viral particles are a significant route of SARS-CoV-2 transmission and calling for improved air ventilation in indoor spaces, experts from the UK, US, and China in an editorial published April 14 in The BMJ also underline the significance of mask quality and fit.

These pieces appeal to the public health community to take action to help improve indoor air quality, ventilation, and filtration, through policy and structural changes, particularly in healthcare, work, and educational settings. Such efforts could help reduce the number of COVID-19 cases as well as other airborne infectious diseases. The commentaries could be viewed as rebuttal to a systematic review funded by the WHO and published last month that says there is inconclusive evidence for airborne transmission. On April 19, a US CDC official said during a telephone briefing that the CDC has determined the risk of SARS-CoV-2 transmission via surfaces is low and secondary to transmission through direct contact with droplets and aerosolized particles. In light of the evidence, the CDC has updated its guidance for cleaning and disinfecting surfaces in community settings.

EMERGING VARIANT RESPONSE FUNDING The US government on April 16 announced it will invest US$1.7 billion from the American Rescue Plan to help states and local jurisdictions detect, monitor, and mitigate emerging variants of SARS-CoV-2. A White House fact sheet says that an essential component of these efforts is increasing genomic sequencing, especially in states experiencing surges of cases. According to the US CDC, the B.1.1.7 variant is now the dominant strain in the US, and several states have seen recent increases in cases due to the variant. The US government is committing US$1 billion of the total allocation to the CDC, states, and localities to bolster surveillance. Of the remaining funds, US$400 million will help create 6 new Centers of Excellence in Genomic Sequencing across the nation. These centers will work in partnership with state health departments and academic institutions to develop new concepts, methods, and technologies for genomic surveillance tools. Additionally, US$300 million will go toward developing and supporting a National Bioinformatics Infrastructure to help scientists track the spread of diseases and allow for improved decision-making. The fact sheet outlines funding distribution by state, noting the first tranche will be distributed in May with a second tranche expected to be invested over the next several years.

INDIA & BANGLADESH The city of Delhi, India initiated a weeklong lockdown on April 19 in an effort to stem a severe surge in cases. On Sunday, the city reported a record single-day case count, with 24,642 cases. As a result of the increasing number of cases, city hospitals have reported near-full ICU capacity and critical shortages of oxygen and drugs. Crematoriums also report being overburdened. During the lockdown, casual gatherings will be prohibited and non-essential businesses will be ordered to close, although essential services will be allowed to remain open. Weddings and funerals will be allowed to continue, albeit with capacity restrictions. Sporting events without spectators will be permitted to continue. Public transport will be reduced to 50% seating capacity. The city lockdown is scheduled to lift the morning of April 26. Various factors may be fueling this rise in cases in India, including recent mass gatherings, as well as a new variant of interest, B.1.617. In addition to the restrictions in Delhi, new mitigation measures have been implemented in localities in the states of Uttar Pradesh and Maharashtra.

Bangladesh enacted a similar but more restrictive lockdown on April 5, with the closure of shops and offices and the cessation of domestic transportation and international flights. Citizens have been asked not to leave their residences from 6pm-6am. Restrictions were expected to lift on April 22, but they have been extended an additional week. Several senior government officials indicated that the extended lockdown will be enforced more strictly, which could further exacerbate financial impacts on lower-income individuals. Reportedly, the government is considering easing some of the restrictions before the Eid holiday.

BREAKTHROUGH INFECTIONS With vaccination rates continuing to climb in the United States, many who are vaccinated are beginning to engage in more activities that could increase their exposure to SARS-CoV-2 infection. While the vaccines available under US FDA Emergency Use Authorizations are effective, there is still a chance that vaccinated persons can become infected with SARS-CoV-2. These “breakthrough” infections are considered rare events, with the CDC on April 19 reporting fewer than 6,000 cases out of 84 million vaccinated persons. The agency continues to monitor reports of breakthrough cases and launched a website with information for public health departments and laboratories to investigate and report such cases. The agency is monitoring the age, sex, type of vaccine, and underlying conditions from breakthrough cases, but no pattern among cases has been identified. When possible, monitoring also includes genomic sequencing to identify which virus lineage caused the infection.

US VACCINE ELIGIBILITY As of April 19, all US states have expanded COVID-19 vaccine eligibility to include all individuals aged 16 years and older, meeting the goal set by the US government to expand vaccine eligibility to all adults by April 19. Hawai’i, Massachusetts, New Jersey, Oregon, Rhode Island, and Vermont were the last states to meet the deadline yesterday.

AT-HOME TEST KITS On April 19, Abbott announced that its BinaxNOW rapid antigen at-home test kit is available for purchase in the US. The test is available without a prescription and provides results in approximately 15 minutes. Initially, the test kits will be available through national chain pharmacies, including CVS, Walgreens, and Walmart. At less than US$25 per kit—which includes 2 tests—they are likely still too expensive for routine daily testing. Over-the-counter (i.e., non-prescription) test kits provide a widely accessible at-home test that can be kept on hand or potentially obtained quickly for a variety of purposes, such as after an exposure to a known COVID-19 case or prior to travel. Abbott’s announcement indicates that it aims to produce “tens of millions” of tests per month, with the potential to increase capacity beyond that point, if necessary. The test kit received an Emergency Use Authorization from the US FDA in March 2021 for use in both symptomatic and asymptomatic individuals as young as 2 years old.

VACCINE DISINFORMATION Researchers are launching projects to catalogue and counteract misinformation and disinformation about SARS-CoV-2 vaccines on social media, as well as collect data on how that information spreads and influences vaccination uptake. One research consortium, called the Virality Project and started by experts from multiple US academic institutions, is using strategies learned during the 2020 US presidential election to help social media platforms counter vaccine mis- and disinformation. Earlier this year, Facebook and Twitter announced new policies aimed at stemming the spread of misinformation. The companies will remove offending posts and shut down accounts that perpetually post false information about vaccines. However, social media platforms increasingly are running up against “gray area misinformation,” or posts that do not contain explicitly false information but present only select facts that drive commentary meant to further misleading narratives. A researcher from the nonprofit First Draft News alleged that many of the same people who pushed misleading information via social media during the 2020 election also are peddling misinformation about vaccines and the COVID-19 pandemic.

US EXCESS DEATHS Researchers at the US CDC’s National Center for Health Statistics published a brief overview of excess deaths in the US since the start of the US COVID-19 epidemic. The study, published in the US CDC’s MMWR, analyzed mortality data from the National Vital Statistics System (NVSS), corresponding to deaths from 2013 through February 2021. Between January 26, 2020—the date of the first reported COVID-19 death in the US—through February 27, 2021, the researchers estimate 545,600-660,200 excess deaths above what would be expected during that period based on historical data. During that time, approximately 75-88% of the excess deaths were directly attributable to COVID-19, leaving 63,700-162,400 additional excess deaths. These additional deaths could potentially be directly attributable to COVID-19 (i.e., undiagnosed victims), or they could result from the downstream effects of the pandemic beyond the disease itself, including “disruptions in health care access or utilization.”

US FDA REVOKES BAMLANIVIMAB EUA On April 16, the US FDA terminated the Emergency Use Authorization for Eli Lilly’s investigational monoclonal antibody bamlanivimab as a treatment for COVID-19. Specifically, the agency terminated the EUA that authorized bamlanivimab as a treatment “when administered alone”*. Analysis of available clinical data found a “sustained increase of SARS-CoV-2 viral variants that are resistant” to the drug and “increased risk for treatment failure.” Bamlanivimab remains authorized for use in combination with etesevimab, another of Eli Lilly’s monoclonal antibodies. Notably, the FDA’s decision came at the request of Eli Lilly, but a press release from the company indicates that it does not currently intend to request the withdrawal of emergency authorization for bamlanivimab as a standalone treatment in any other country.
*Emphasis in original source.

TRIAL EXAMINING REPURPOSED DRUGS The US NIH on April 19 announced it is launching a large randomized, placebo-controlled clinical trial to test whether several existing prescription and over-the-counter medications can help resolve mild-to-moderate symptoms among people with COVID-19. The Phase 3 trial, part of the Accelerating COVID 19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership, will explore up to 7 drugs approved by the US FDA for other conditions, a strategy called drug repurposing. According to the Washington Post, which quotes anonymous sources, several of the drugs under consideration for the trial include the antiparasitic ivermectin, the antidepressant fluvoxamine, and the acid-controller famotidine, the generic name for Pepcid. At least one study published in the March 4 JAMA showed that early administration of ivermectin did not significantly shorten the time to symptom resolution among nearly 400 adults with mild COVID-19 randomized to take ivermectin or placebo. As for fluvoxamine, 2 small studies, one published in JAMA and the other in Open Forum Infectious Diseases, showed the serotonin reuptake inhibitor helped reduce disease progression among those who took the drug compared with people who took a placebo or refused the drug. At least 3 other clinical trials are currently recruiting to test fluvoxamine, according to ClinicalTrials.gov, and a recent episode of 60 Minutes highlighted the drug’s potential as a COVID-19 treatment.

SUBUNIT VACCINE On April 19, Nature published an early-version manuscript describing research into a subunit SARS-CoV-2 vaccine that researchers hope will provide protective immunity against the virus. Subunit vaccines are widely used and highly effective against several infectious diseases. Researchers from various US-based institutions and the pharmaceutical company GSK showed positive results that a SARS-CoV-2 spike receptor binding domain on a protein nanoparticle (RBD-NP) can offer protection against the virus in non-human primates. The researchers evaluated 5 different adjuvants, showing variation in efficacy against SARS-Cov-2 variants and wild-type virus. With these promising results of an adjuvanted RBD-NP vaccine candidate among primates, the authors report the vaccine will move to Phase 1/2 human trials. A successful adjuvanted subunit vaccine potentially could help fill vaccination gaps in younger and older populations, as other such vaccines historically have good safety profiles in these groups.

https://covid19.who.int/

[Deuce]

Oh, well...

After Calling Pandemic 'a Scam', Rocker Ted Nugent tests positive for COVID-19

.

[ponchi101]

Not only I never had an album of his, I really can't recall ever hearing a single song from this man.
One thing that is impressive of these people (the Tiny acolytes) is their use of the phrase, or a variation of the phrase, "nobody knows ...". This idiot says "nobody knows what is in the vaccine". Heck, a simple search will let you find out everything about the vaccine.
I can't be graceful with this guy. I hope covid takes out his vocal cords, so he won't be able to speak any more nonsense.

[MJ2004]

Many years ago when I was still on FB, I unfriended an old friend because she posted a video of this a**. Haven't heard from her since. Don't regret it.

[ti-amie]

[JazzNU]

Poor India. Was genuinely hoping no country would ever come close to passing any of the US' pitiful covid milestones. Double mutant variant is no joke.

[Suliso]

Yes, but there was also a lot of arrogance both from the government and population in general which led to this. We are special, more used to microbes and pollution etc., pandemic almost over so lets open everything and have hundreds of thousands gather for religious ceremonies. Well, not so special after all...

[Suliso]

It's very likely that Brazil will pass US fatality numbers as well without even considering all the undercounting...

[ti-amie]

[dryrunguy]

Here's the latest Situation Report.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 144.1 million cases and 3.1 million deaths worldwide as of 5:45am EDT on April 23.

On April 21, India surpassed 250,000 new cases per day and set a new global record for total daily incidence. India is currently reporting 281,683 new cases per day and still increasing rapidly. On this trajectory, India could surpass 300,000 new cases per day in the next 1-2 days. On April 21, India became only the second country to report more than 300,000 new cases in a single day, after the US. India has reported more than 300,000 new cases on 2 consecutive days, including a record high 332,921 new cases on April 22.

The global daily incidence is already setting new records, and daily mortality is on track to surpass its previous high as well. While the global trends in daily incidence are largely driven by India’s ongoing surge, this is slightly less the case for mortality. Currently, South America accounts for nearly one-third of the global daily mortality, more than any other continent; however, it appears to have leveled off over the past week or so. Asia recently surpassed Europe as #2 globally, and both are reporting essentially equal daily mortality—each accounting for more than a quarter of the global total. Asia’s daily mortality is accelerating rapidly, up by more than 400% since mid-March—driven largely by India—and it could surpass South America as #1 in the coming days. Europe’s daily mortality remains slightly elevated from its most recent low in mid-March, but it has declined over the past several days. Daily mortality in Africa and North America steadily decreased from late January through mid-April; however, both are reporting increases over the past 2 weeks. Oceania averaged fewer than 1 death per day from October 2020 through mid-March 2021, and while its daily mortality is increasing, it is still fewer than 3 deaths per day.

In terms of total daily mortality, Brazil remains #1 globally, with 2,580 deaths per day, but it has decreased steadily since April 12. Brazil’s daily mortality has fluctuated around 2,700-3,000 deaths per day since late March, but this is the largest and longest decline during that period. India is #2 globally, with 1,802 deaths per day and increasing rapidly. On this trajectory, India could surpass Brazil as #1 in the coming days. Daily mortality in the US (#3; 698) and Mexico (#5; 409) have decreased steadily from their highs in mid-to-late January, but both appear to be leveling off. Poland (#4; 506), Colombia (#6; 397), Peru (#7; 399), and Iran (#8; 365) are all reporting steadily increasing trends over the past several weeks. Ukraine (#10; 379) also reported increases over the past several weeks, but it appears to be leveling off. Russia’s daily mortality (#9; 380) has held relatively steady since December 2020.

On a per capita basis, the top countries are all in Europe and South America. In fact, among the top 20 countries in terms of per capita daily mortality, 15 are in Europe, and 5 are in South America. Hungary is #1 globally, with 21.9 daily deaths per million population. Bosnia and Herzegovina (20.1) is the only other country reporting more than 20 daily deaths per million population. At #3, Uruguay (17.9) is the highest ranked South American country. All other countries in the top 10 are reporting more than 10 daily deaths per million, more than 6 times the global average (1.6). The European countries largely exhibit a similar trend. Their daily mortality peaked in December 2020, followed by a steady decline through January/February 2020 and then another steep increase. Most of these countries appear to be at or near another peak, and as noted above, the overall European daily mortality is beginning to decline. Similarly, the South American countries are reporting similar trends. With the exception of Uruguay, the South American countries reported surges with peaks between July and September 2020—Uruguay did not exhibit a major surge in 2020. Brazil and Uruguay reported increasing trends starting in late 2020, and in January 2021 for Peru. All 4 countries began exhibiting a sharp increase in daily mortality between early and late March, and all have far surpassed their previous peaks.

Global Vaccination
The WHO reported 900 million vaccine doses administered globally, including 491 million individuals with at least 1 dose. The WHO dashboard does not yet include data for daily or weekly vaccinations or fully vaccinated individuals.

Our World in Data reports 973 million doses administered globally. This is 13% more than this time last week, slightly lower than the previous growth rate of approximately 18% per week. After 6 consecutive days of declining averages, the daily doses administered rebounded slightly over the past 2 days to 15.6 million. At least 189 countries and territories* are reporting vaccination data.
*Out of 191 reporting COVID-19 incidence data.

UNITED STATES
The US CDC reported 31.7 million cumulative cases and 566,494 deaths. Daily incidence has decreased slightly over the past several days—down from 69,878 new cases per day on April 13 to 62,595 on April 21. The daily incidence fell below the summer 2020 peak, but it is still elevated compared to several weeks ago. Daily mortality continues to hold relatively steady at approximately 700 deaths per day (since April 12), which is approximately equal to the low reported immediately prior to the autumn/winter 2020 surge.

US Vaccination
The US has distributed 282 million doses of SARS-CoV-2 vaccine and administered 219 million doses. Daily doses administered* has decreased over the past several days, down from a high of 3.2 million (April 11) to 2.8 million. The fully vaccinated population is increasing by 1.4 million people per day.

A total of 136 million individuals have received at least 1 dose of the vaccine, equivalent to 41% of the entire US population and 52% of all adults. Of those, 89 million (27% of the total population; 34% of adults) are fully vaccinated. Progress among older adults has slowed considerably. Among adults aged 65 years and older, 81% have received at least 1 dose, and 66% are fully vaccinated. In terms of full vaccination, 44 million individuals have received the Pfizer-BioNTech vaccine, 37 million have received the Moderna vaccine, and 8.0 million have received the J&J-Janssen vaccine.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The Johns Hopkins Coronavirus Resource Center is reporting 31.9 million cumulative cases and 570,357 deaths as of 9:15am EDT on April 23.

INDIA COVID-19 OXYGEN SHORTAGE As India faces the world’s most severe COVID-19 epidemic, setting new records in terms of daily incidence and mortality, India’s health system is unable to manage the patient surge, and its health system may be nearing collapse. One critical problem is a severe nationwide shortage of oxygen. As we have covered previously, high-flow oxygen therapy has become a key component of COVID-19 patient care, and hospitals in areas with ongoing surges may be unable to produce or procure sufficient supply. Reportedly, hospitals are exhausting their supply or are down to minutes or hours of oxygen on hand, which is contributing to COVID-19 patient deaths, and hospitals are competing against each other to obtain limited resources.

This week, the High Court of Delhi held an emergency hearing to address a complaint filed by one Delhi hospital system alleging that India’s national government was not doing enough to ensure adequate oxygen supply. In response, a representative of the national government indicated that relevant agencies already had made plans to provide 480 metric tons of oxygen to Delhi. Regardless, the court ordered the national government to “ensure strict compliance” with that allocation plan and threatened “criminal action” in the event of non-compliance. Following the original hearing, several additional hospitals filed similar pleas. The court also chastised the government for not prioritizing hospitals over industrial uses to ensure adequate supply. Following the hearing, India’s national government reportedly put oxygen tankers on express trains to transport it to areas of need, and India’s Supreme Court directed the national government to submit its COVID-19 response plans, including for oxygen supply and vaccination.

US TRAVEL ADVISORIES The US Department of State updated its travel advisories, resulting in nearly 80% of countries falling under the “Do Not Travel” category. Previously, the State Department issued Level 4 (Do Not Travel) guidance for only 34 countries, but the recent additions bring the total to more than 150. Among the Level 4 category countries are Austria, Brazil, France, India, Italy, Mexico, Russia, and the UK. The department said the additions were made "to better reflect CDC's science-based Travel Health Notices" as well as to consider the logistics of testing availability and other travel restrictions for US travelers. The department also noted it is continuing to monitor COVID-19 data across the globe and will regularly update destination-specific advice as conditions evolve.

US PUBLIC HEALTH FUNDING US public health officials fear that once the COVID-19 pandemic ends so will state and federal public health emergency funding, pushing them back to patching together budgets from a variety of sources to provide basic, necessary services to their communities. According to the Trust for America’s Health, funding for the Public Health Emergency Preparedness cooperative agreement—which provides critical federal funding to state, local, and territorial public health departments—dropped by about half between fiscal years 2003 and 2021. Since 2010, spending for state public health departments dropped by 16% per capita and spending for local health departments has fallen by 18%, a KHN/Associated Press (AP) analysis published in July 2020 showed. These decreases led to the loss of at least 38,000 public health jobs at the state and local levels between 2008 and 2019. Compounding the problem, at least 248 state and local public health department leaders resigned, retired, or were fired during the COVID-19 pandemic, between April 1, 2020, and March 31, 2021. Experts warn this is the largest exodus of public health leaders in US history.

Years of underfunding have not only impacted staffing as public health departments’ infrastructures are suffering too, with antiquated computer, data collection, and communication systems. Several US Senators have introduced the Public Health Infrastructure Saves Lives Act, which would eventually provide $4.5 billion annually in core public health funding. But in the meantime, some state legislatures have proposed measures to weaken or remove public health powers, according to a KHN/AP investigation from December 2020. If public health departments continue to operate under a boom-or-bust cycle, experts warn they will be forced to operate at a deficit during the current pandemic and be incapable of properly preparing for the next public health disaster.

GLOBAL VACCINE ACCESS On April 22, the New York Times published an opinion piece by WHO Director-General Dr. Tedros Adhanom Ghebreyesus, who called the inequity in global SARS-CoV-2 vaccine distribution “unacceptable.” According to Dr. Tedros, of more than 890 million vaccine doses administered globally, more than 81% have been given in high- and upper-middle-income countries, with low-income nations only receiving 0.3%. To address the problem, Dr. Tedros urged countries and companies that control the global supply of vaccines to share financial support, share extra vaccine doses with the COVAX Facility, and support the massive scale-up of vaccine production and distribution. In order to achieve the latter, he proposed companies use voluntary licensing with technology transfer; share licenses through the COVID-19 Technology Access Pool, started by the WHO last year; or waive intellectual property rights on COVID-19 products, an option that South Africa and India have proposed repeatedly at the World Trade Organization. Dr. Tedros’s commentary echoed calls to action he made last week during an UN Economic and Social Council (ECOSOC) special ministerial meeting titled “A Vaccine for All.” During his opening remarks at the meeting, Dr. Tedros said, “Vaccine equity is the challenge of our time. And we are failing.” Experts warn that the longer it takes to reach vaccine equity worldwide, the longer the pandemic will continue and the higher the risk of variants emerging to which the currently available vaccines provide diminished protection.

HEALTH WORKER STRESS According to a Washington Post-Kaiser Family Foundation poll, approximately 3 in 10 healthcare workers have considered leaving their profession during the COVID-19 pandemic, with those feelings fueled by burnout, trauma, and disillusionment. The poll of 1,327 US frontline healthcare workers, conducted between February 11 and March 7, showed more than half of respondents said they are burned out and about 6 in 10 said pandemic stress has negatively impacted their mental health. Respondents cited a lack of equipment to protect themselves or treat patients, guilt and trauma over patient deaths, or frustration with governments and some in the public for refusing to enforce or take basic risk mitigation precautions. Some noted the pandemic exposed and magnified how ill-equipped the nation’s health system is to deal with public health emergencies. Experts warn the US was facing a shortage of doctors and nurses prior to the pandemic and additional losses to staffing could further harm US health care by making it more expensive, less accessible, and lower in quality.

Healthcare workers’ responses also highlight the importance of addressing mental health to prevent post-traumatic stress, anxiety, depression, substance use, or suicide. Because many healthcare workers suffer in silence, implementing accessible mental health programs becomes even more important. Still, 76% of respondents said they feel “hopeful,” and two-thirds said they remain “optimistic” about going to work. Nearly 6 in 10 said they anticipate the COVID-19 pandemic in the US will be controlled enough by early 2022 or later so people can resume normal life, while nearly half said they hope normal life can resume by mid-fall or sooner—including 5% who believed life can safely resume now.

UK CHALLENGE TRIALS A research team at the University of Oxford (UK) have announced the start of a human challenge trial that will look at what type of immune response is necessary to prevent SARS-CoV-2 reinfection and how the immune system responds during reinfection. The study is designed to include two phases. During the first phase, researchers will determine the lowest dose of SARS-CoV-2 needed to cause active but asymptomatic or low-symptom infection in 50% of participants who have fully recovered from a previous natural infection. In the second phase, scheduled to begin this summer, researchers plan to inject all participants with the “optimal” dose determined in phase one. Notably, the study will use the original strain of the virus. In February, the UK became the first country to approve human challenge trials for SARS-CoV-2, in which volunteers are deliberately exposed to the virus. Some researchers cite the positive impact these controlled trials can have on scientific understanding, while critics question the ethical and practical nature of the method.

NURSING HOME OUTBREAKS Health officials in Kentucky and experts at the US CDC published a case study of an outbreak at a long-term care facility (LTCF) initiated by an unvaccinated employee. At the facility, 90% of the residents and 53% of the staff received 2 doses of SARS-CoV-2 vaccine. Routine testing identified the outbreak, which began in an unvaccinated and symptomatic healthcare worker. Ultimately, the outbreak involved 46 total cases, including 26 residents and 20 facility personnel. Notably, 18 of the residents and 4 personnel received their second dose of the vaccine more than 14 days before the outbreak. Three (3) residents died, including 2 who were unvaccinated.

The risk of infection among unvaccinated residents was 3 times higher than among vaccinated residents. Similarly, the risk among unvaccinated personnel was 4 times higher than among vaccinated personnel. For this outbreak, the vaccine’s effectiveness against SARS-CoV-2 infection was estimated to be 66% among residents and 76% among employees, and the effectiveness against symptomatic COVID-19 disease was 86.5% among residents and 87% among employees. This is in line with the expected effectiveness based on clinical trial efficacy data. The authors conclude that low vaccination coverage among employees at LTCFs could facilitate introduction of SARS-CoV-2, which could result in outbreaks, even among resident populations with high vaccination coverage. While the authorized SARS-CoV-2 vaccines are highly effective*, COVID-19 risk remains, particularly among individuals at elevated risk for exposure and severe disease. Even as vaccination coverage increases, it is critical to maintain COVID-19 risk mitigation measures until sufficient community protection is in place to bring the pandemic under control.
*For those vaccines with publicly available Phase 3 clinical trial data.

VACCINATION & PREGNANCY The New England Journal of Medicine on April 21 published a study of preliminary findings of mRNA SARS-CoV-2 vaccine safety among pregnant people. Researchers from the CDC’s V-safe COVID-19 Pregnancy Registry Team used data from the agency’s V-safe surveillance system, the V-safe pregnancy registry, and the Vaccine Adverse Event Reporting System (VAERS). A total of 35,691 V-safe participants aged 16 to 54 years identified as pregnant. Among those people, injection site pain was reported more frequently than among the nonpregnant population, but headache, muscle aches, chills, and fever were reported less frequently. Of 221 pregnancy-related adverse events reported to the VAERS, the most frequently reported was spontaneous abortion (46 cases). The researchers note that although not directly comparable, the proportions of adverse pregnancy and neonatal outcomes (eg, fetal loss, preterm birth, small size for gestational age, congenital anomalies, and neonatal death) among vaccinated persons who had completed pregnancy were similar to incidences reported in studies of pregnant people conducted prior to the COVID-19 pandemic. The preliminary findings did not show obvious safety signals for pregnant persons receiving mRNA SARS-CoV-2 vaccines, but the researchers noted the need for continued monitoring. The American Society for Reproductive Medicine has encouraged everyone, including pregnant persons and those seeking to become pregnant, to receive a SARS-CoV-2 vaccination.

EMERGENCY DEPARTMENT VISITS The CDC’s Morbidity and Mortality Weekly Report (MMWR) on April 16 published updated data on changes to emergency department (ED) visits during the COVID-19 pandemic. Previously, researchers with the CDC COVID-19 Response Team and colleagues published data collected from the National Syndromic Surveillance Program (NSSP) showing ED visits declined 42% between March 29-April 25, 2020, following the national emergency declaration on March 13, 2020. Although the number of ED visits increased by July 2020, they remained below pre-pandemic levels. The updated data show ED visits were 25% lower during December 2020-January 2021 when compared with the same months from a year prior. The researchers note the reasons for ED visits have changed during the pandemic period when compared to those during the pre-pandemic period, with more people seeking care for mental and behavioral health-related concerns, especially pediatric patients. The researchers emphasize that, although smaller in total number, the increased proportion of visits due to mental and behavioral health complaints in both adult and pediatric groups is a sign of concern and call for public health measures to provide health messaging and resources for managing related symptoms. The impact of COVID-19 on mental health is well noted, and the CDC provides some resources on managing stress during the pandemic.

COUNTERFEIT VACCINES & VACCINATION CARDS Pfizer announced that counterfeit vaccines were seized in Mexico and Poland. Reportedly, approximately 80 people received the counterfeit vaccine in Mexico, at a cost of US$1,000 each—but so far, none of the recipients have reported any physical harm. In Poland, the doses were seized before they could be administered, and the vials are believed to contain an “anti-wrinkle treatment.” Laboratory analysis confirmed that the products contained in the vials were not the Pfizer-BioNTech vaccine. With high demand and limited supply for the SARS-CoV-2 vaccines, these incidents highlight the risk of criminals distributing counterfeit products for profit. Some of these products are being sold online, and Pfizer emphasized that no legitimate SARS-CoV-2 vaccines are sold online. Pharmaceutical companies and law enforcement agencies around the world are collaborating to quickly identify counterfeit vaccines and intervene.

As countries, businesses, schools, and other organizations evaluate options regarding mandatory vaccination, counterfeit vaccination cards also are a growing problem. Individuals who elect not to get vaccinated are seeking counterfeit vaccination cards to serve as documentation for a vaccination that they never received. There also are reports of individuals falsifying documentation of the first dose in order to jump ahead in the queue. Some of the counterfeit cards are truly counterfeit, and others are blank versions of the official vaccination cards, such as those reportedly sold online by a pharmacist in Chicago (US). The US FBI issued a warning about the counterfeit vaccination cards, emphasizing that making or purchasing the cards or filling in a blank card with false information are all illegal. The FBI encouraged the continued use of COVID-19 risk mitigation measures (eg, mask use, physical distancing) to mitigate the risk posed by counterfeit vaccination cards. The National Association of Attorneys General issued a statement calling on social media and e-commerce companies to take immediate action to prevent the sale of fraudulent vaccination cards. Some experts have criticized the use of paper forms to document vaccination status, as opposed to digital documentation, due to the ease of counterfeiting them. Reportedly, the US CDC originally intended to use digital certificates, but technical problems and delays prevented the implementation of a nationwide system in time to begin vaccination efforts.

TOKYO OLYMPICS With only 3 months until the start of the rescheduled Summer Olympics in Japan, Prime Minister Yoshihide Suga today implemented a third state of emergency order for Tokyo and 3 western prefectures—Osaka, Kyoto, and Hyogo. The order, set to last through May 11, is intended to prevent people from traveling and gathering in public spaces during Japan’s “Golden Week” holidays that run from late April through the first week in May. Prime Minister Suga expressed concern over the spread of a SARS-CoV-2 variant, saying more stringent measures are needed to curb the number of new cases. Under the state of emergency, bars, department stores, malls, theme parks, theaters, and museums in the 4 prefectures are ordered to close. Restaurants that do not serve alcohol and public transportation are being asked to close early, and universities should return to online classes, although grade schools will remain open. International Olympic Committee President Thomas Bach is scheduled to visit Japan on May 17-18 to greet the Olympic torch relay in Hiroshima. Bach said the new state of emergency is not related to his planned visit, and an official with the Japan Olympic organizing committee said there is no discussion of cancelling the event, scheduled to begin on July 23.

RECRUITING FOR VACCINATION STUDY The Johns Hopkins COVID-19 Vaccine Risk Uptake study is recruiting in-home healthcare providers to participate in focus groups to discuss motivation, hesitancy, and situational factors that impact awareness, acceptability, and access to vaccines. Interviews will be conducted in focus groups remotely (via Zoom) and will last approximately 90 minutes. If you are interested in participating, or know someone who may be, please contact Jennifer McKneely at (571) 228-1680 or Jennifer.McKneely@jhuapl.edu. Additional information is available here.

https://covid19.who.int/

[ti-amie]

Thanks again dry. When I got my second shot Tuesday the person checking me in said to keep the card in a safe place because they're going to become very important.

Fake cards is why mitigation efforts have to continue.