Covid-19 Updates & Info

[ti-amie]

I was asking myself, after seeing the tweet about how stupid you have to be to let people who have been vaccinated tell you not to be and you believe them, if a lot of this is performative? There are lots of out of work actors, there always are, and how many, for a grand, will stand on a corner or attend a presser and scream a bunch of crap they don't mean at all? It was recently confirmed that a lot of the folks cheering tfg when he announced his candidacy were actors. That makes this even more vile if it's true. Too bad we don't have real reporters like there were back in the day.

If only it was so simple... Unfortunately I also have a couple of antivaxxers among my relatives/acquaintances. Not maybe the complete flat earthers, but still.

Do you think if it was proved that the folks saying this are being paid it would make a difference to them?

[Suliso]

You'd be unable to convince them of that being the case. They'll just say it's all lies, big government, big pharma blah, blah, blah...

[ti-amie]

You'd be unable to convince them of that being the case. They'll just say it's all lies, big government, big pharma blah, blah, blah...

[ti-amie]

Irony is dead.

[ti-amie]

[patrick]

Leon (Tallahassee) and Alachua (Gainesville) counties are defying DeSantis no mask mandate. Think Miami is doing the same. Hillsborough County (Tampa) says masks are required but parents can opt out. Haven't heard a peep from DeSantis since this.

[dryrunguy]

Here's the latest Situation Report. DeSantis is a jackass.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 202.6 million cumulative cases and 4.29 million deaths worldwide as of 1:00pm EDT on August 9. The global weekly incidence increased for the seventh consecutive week. Last week’s total is 3.3% higher than the previous week, but it appears as though case counts may have passed an inflection point and could be approaching a peak or plateau. Global weekly mortality increased again as well, up 1.3% compared to the previous week. Overall, the trend has increased steadily for 5 consecutive weeks, with the exception of a spike during the week of July 19, which was the result of 8,786 deaths reported by Ecuador on July 21.

Global Vaccination
The WHO reported 4.03 billion doses of SARS-CoV-2 vaccines administered globally as of August 9. The WHO reports that a total of 1.59 billion individuals have received at least 1 dose, and 798 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered has leveled off at approximately 41 million doses per day*. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.35 billion vaccinated individuals worldwide (1+ dose; 30.2% of the global population) and 1.22 billion who are fully vaccinated (15.6% of the global population).
*Average doses administered is exhibiting a sharp decrease for the most recent several days, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent data.

UNITED STATES
The US CDC reported 35.8 million cumulative COVID-19 cases and 614,856 deaths. On August 5, the US surpassed 100,000 new cases per day for the first time since February 10. The current average of 102,413 is nearly 9 times the most recent low—11,486 on June 19—and still increasing rapidly. Daily mortality appears to continue its exponential increase up to 457 deaths per day. This is the highest average since May 27, and it is an increase of 46% over the past week and 79% over the past 2 weeks*
*Changes in the frequency of state-level reporting may affect the accuracy of recently reported data, particularly over the weekend. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent dates.

Florida in #1 nationally in terms of both total weekly incidence and mortality, representing 22% and 25% of the national total, respectively. Florida is also #1 nationally in terms of per capita weekly incidence with 733 new cases per 100,000 population, 3.5 times the national average (205). Arkansas is #1 in terms of per capita weekly mortality with 4.8 deaths per 100,000 population, nearly 5 times the national average (1.0).

US Vaccination
On August 4, the US surpassed 350 million cumulative doses of SARS-CoV-2 vaccines administered. The current cumulative total is 351.9 million. Daily vaccinations continue to increase slowly, now up to 608,654 doses per day*. The US also surpassed 50% of the total population fully vaccinated. A total of 195.2 million individuals in the US have received at least 1 dose, equivalent to 58.8% of the entire US population. Among adults, 71.1% have received at least 1 dose, as well as 11.7 million adolescents aged 12-17 years. A total of 166.7 million individuals are fully vaccinated, which corresponds to 50.2% of the total population. Approximately 61.1% of adults are fully vaccinated, as well as 8.8 million adolescents aged 12-17 years.
*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.

US SURGE The US continues to face a COVID-19 surge, with the most severe burden faced by states in the South and Southeast regions of the country. The national biweekly relative change peaked at more than +160% in late July—the largest relative increase since the initial surge in March/April 2020—but a slight decrease to +119% indicates that the increase is beginning to taper off.

While full vaccination coverage has surpassed 50% nationally, major disparities remain at the state level. Analysis by The Wall Street Journal found that all 12 states that are reporting per capita hospitalizations greater than the national average have full vaccination coverage below the national average. Additionally, all 20 states with full vaccination coverage higher than the national average are reporting per capita hospitalizations below the national average. At the local level, counties with the lowest vaccination coverage also are experiencing much larger surges in mortality, compared to counties with higher vaccination coverage. These statistics illustrate that low vaccination coverage is a driver of the ongoing surge in severely affected states and that the vaccines are providing protection against severe disease, hospitalization, and death.

In severely affected cities and states, the surge is placing a major burden on health systems. In some instances, the current surge is as severe or worse than the United States’ largest surge in January 2021. Hospitals in Houston, Texas, and Orange County, California, are reporting increased wait times for ambulances to drop off patients at emergency departments (ED). Hospitals in some parts of the country faced similar challenges during the January 2021 surge. Texas Governor Greg Abbott issued a statement to the Texas Hospital Association encouraging hospitals to “voluntarily postpone [some] medical procedures” in order to ensure sufficient capacity is available to treat COVID-19 patients, but at least 1 hospital in Houston is already preparing an emergency tent to handle overflow COVID-19 patients.

As schools resume classes, some school districts in states that have banned mask mandates are pushing back against state-level legislation and policies. In Texas, the Dallas Independent School District (ISD), the second-largest in the state, announced it will temporarily require masks for students, employees, and visitors during the surge, defying Governor Abbott’s statewide ban. Reportedly, the Houston ISD is expected to vote on a similar mandate this week. In Florida, Governor Ron Desantis threatened to withhold pay for school administrators that institute mask mandates during the state’s most severe surge to date, including a record high for pediatric hospital admissions.

US MILITARY VACCINE MANDATE SARS-CoV-2 vaccination will be mandatory for all 1.3 million members of the US Armed Forces no later than mid-September, or as soon as the US FDA fully licenses a vaccine, “whichever comes first,” US Secretary of Defense Lloyd J. Austin III said in an August 9 message to all troops. Secretary Austin implored all US Department of Defense (DOD) military, civilian, and contractor personnel to get vaccinated, regardless of a mandate. US President Joe Biden strongly supports the plan and is prepared to issue a waiver to make the shots mandatory if the FDA’s expected timeline for approval of the Pfizer-BioNTech moves past early-September. In a statement, President Biden said vaccinations “will enable our service members to stay healthy, to better protect their families, and to ensure that our force is ready to operate anywhere in the world,” calling out the Delta variant as a threat to unvaccinated populations. In a related memo, Chairman of the Joint Chiefs General Mark Milley called COVID-19 “a threat to force protection and readiness” and reminded troops that vaccine mandates in the military are common. About 73% of active-duty US service members have received at least one SARS-CoV-2 vaccine dose, according to the Pentagon. But without more members fully vaccinated, the military faces challenges in deploying unvaccinated troops to countries that have strict local rules, and an increase in cases among its ranks could harm military readiness. Secretary Austin added that if COVID-19 incidence increases among military personnel, he could act sooner or recommend a different course of action to President Biden. Earlier this month, the DOD recommended an immediate waiver to institute a mandate before FDA approval, but White House officials urged caution and settled on the current plan.

J&J-JANSSEN VACCINE EFFECTIVENESS Researchers leading the Sisonke clinical trial in South Africa on August 6 presented data showing the J&J-Janssen SARS-CoV-2 single-shot vaccine is highly effective in preventing severe disease and death from COVID-19 among healthcare workers. The Phase 3b study enrolled 477,234 healthcare workers at 122 sites throughout South Africa, administering the J&J-Janssen vaccine between February and May 2021. Data collection ran through July 17, and researchers will continue to monitor participants for another 2 years. Overall, the J&J-Janssen vaccine provided 91-96.2% protection against death from both the Beta and Delta SARS-CoV-2 variants. When the Beta variant was dominant, the vaccine offered 67% protection from hospitalization, and 71% protection against hospitalization when the Delta variant became dominant. When breakthrough cases occurred, healthcare workers experienced mild symptoms and less than 0.05% of those cases resulted in severe disease or death. Two cases of rare blood clots occurred among participants, but both fully recovered.

The data have not yet been peer reviewed nor published in a scientific journal, but they should alleviate some concerns over the J&J-Janssen vaccine’s effectiveness. Some previous studies suggest the vaccine might not be as effective against the Delta variant, leading some people to seek out an additional vaccine dose; however, the researchers concluded additional doses are not warranted at this time based on the data. J&J-Janssen is expected to release results of a trial evaluating a 2-dose regimen in the coming weeks. South Africa granted conditional approval to the J&J-Janssen vaccine in April, and so far has administered more than 1.85 million doses. The country also uses the Pfizer-BioNTech vaccine and has administered more than 6.77 million doses of that vaccine.

REINFECTION AFTER VACCINATION Among people previously infected with SARS-CoV-2, full vaccination provides additional protection from reinfection, according to an early release study published last week in the US CDC’s MMWR. The findings from the retrospective, case-control study underscore the CDC’s recommendation that all eligible individuals receive a SARS-CoV-2 vaccine. Using several databases, researchers identified 246 case-patients, all adult and Kentucky (US) residents with laboratory-confirmed SARS-CoV-2 infection in 2020 and a subsequent positive nucleic acid amplification test or antigen test result between May 1 and June 30, 2021. They also identified 492 control participants, who were adult Kentucky residents matched on a 1:2 ratio based on sex, age, and date of initial positive SARS-CoV-2 test but who did not have evidence of reinfection during those 2 months in 2021. Notably, the data were collected prior to the Delta variant becoming dominant in the US. Among the case-patients, 20.3% were fully vaccinated, compared with 34.3% of the control participants. Unvaccinated Kentucky residents who were previously infected with SARS-CoV-2 had 2.34 times the odds of reinfection (95% confidence interval [CI]=1.58-3.47) when compared with those who were previously infected but also fully vaccinated. Partial vaccination was not significantly associated with reinfection (odds ratio=1.56; 95% CI=0.81-3.01), according to the researchers. They warned that little is known about the durability of natural immunity after initial infection and noted the study suggests that vaccination offers better protection than the natural immunity developed post-acute infection for people who have recovered from SARS-CoV-2 infection.

COUNTERFEIT VACCINATION CARDS As more employers, universities, and venues in the US and Europe implement vaccine mandates, officials are warning of a rise in fake SARS-CoV-2 vaccination certificates. According to investigators and cybersecurity experts, the past few weeks have seen a number of ways to purchase counterfeit vaccine cards on social media, messaging apps, and the dark web. While the European Union has a digital vaccine passport system that assigns a unique QR code to each individual, the US relies on paper cards distributed by the US CDC, which are easy to forge and were never intended to be used as proof of vaccination. Some US states are working to implement digital verification systems, but other states have outlawed the use of such systems or implemented punishments for businesses and other entities that ask for proof of vaccination.

The ease with which US vaccination cards can be forged is alarming both faculty and students at universities and colleges heading back to in-person learning this fall. According to an estimate from the Chronicle of Higher Education, at least 675 colleges and universities now require proof of SARS-CoV-2 vaccination. Many university administrators face challenges in identifying fake vaccination cards digitally uploaded to students’ online portals. The proliferation of counterfeit vaccination cards prompted the US Federal Bureau of Investigation and the US Department of Health and Human Services Office of the Inspector General to issue a statement earlier this year warning the public that buying, creating, or selling fabricated cards is a federal offense. For people in the US with a valid vaccination certificate, there are several options to store the oddly sized CDC card digitally on a smartphone.

UNAUTHORIZED THIRD VACCINE DOSES In the US, the federal government is expected to release a plan for third SARS-CoV-2 vaccine doses in the coming weeks. In the meantime, there seems to be a growing divide between near-stagnant vaccine hesitancy and people seeking unauthorized additional shots, the latter underlining a heightened anxiety over the Delta variant’s spread. According to reports, some people who received the J&J-Janssen vaccine have received additional doses of another authorized vaccine over fears the single-shot dose might not be as effective as others. And it appears some are going to great lengths to obtain extra doses by falsifying vaccine certificates, lying about their name or health insurance status, or traveling to other cities or states. Most experts stress that further research is warranted to determine the safety and efficacy of second or third doses and whether combining doses of various vaccines will provide substantial protection.

But as the Delta variant continues to drive up the number of new COVID-19 cases worldwide, calls for so-called “booster” doses are highlighting global inequities in vaccine access, as wealthier nations with ample vaccine supplies begin to recommend additional doses for some populations while low- and middle-income countries (LMICs) struggle to obtain sufficient supplies to vaccinate even small proportions of their populations. Worldwide, public health experts, international organizations, and ethicists caution countries against offering booster doses until more data become available and to shore up supplies in LMICs. The WHO last week called for a moratorium on offering additional doses for most people, but it appears several nations—including Israel, Germany, France, the UK, and Russia—will move ahead with plans to offer booster shots to some populations.

HEART INFLAMMATION FOLLOWING VACCINATION In a research letter published in the peer-reviewed journal JAMA, researchers examined the clinical records of more than 2 million patients who received at least 1 dose of SARS-CoV-2 vaccination within the Providence Health Care System or recorded through state registries in Washington, Oregon, Montana, and Los Angeles County, California (US) in order to identify post-vaccination cases of myocarditis (heart muscle inflammation) and pericarditis (heart membrane inflammation). Of these individuals, 76.5% received more than 1 vaccine dose, 52.6% received the Pfizer-BioNTech vaccine, 44.1% received Moderna, and 3.1% received J&J-Janssen. Overall, 20 individuals had vaccine-related myocarditis (1.0 [95% confidence interval (CI), 0.61-1.54] per 100,000) and 37 had pericarditis (1.8 [95% CI, 1.30-2.55] per 100,000). Of the cases of myocarditis, 75% occurred in males with a median age of 36, happened on average 3.5 days after vaccination, and resulted in hospitalization in 19 of 20 cases. No mortality was reported, and most patients were discharged after approximately 2 days. Of the pericarditis cases, 73% occurred in males with a median age of 59, happened on average 20 days after vaccination, and resulted in hospitalization in 13 of 37 cases. No mortality was reported, and most patients were discharged after approximately 1 day. Notably, the incidence of myocarditis following SARS-CoV-2 vaccination described in the study—10 per million—is higher than the US CDC’s estimate of 4.8 cases per million, suggesting an underreporting of cases to federal databases. The researchers stressed that the hospitalizations resulting from heart inflammation in the study were unremarkable and cautioned that COVID-19-related heart inflammation is much more common. Overall, vaccination remains the most important tool for protecting individuals from severe symptoms of COVID-19.

COVID-19 TREATMENT RESEARCH Research efforts to find treatments for people with mild-to-severe COVID-19 are underway worldwide. The WHO last week announced it is restarting the Solidarity clinical trial—now dubbed SolidarityPlus—to test 3 repurposed drugs in hospitalized COVID-19 patients: the cancer chemotherapy drug imatinib, a chimeric monoclonal antibody called infliximab that is used to treat several autoimmune diseases, and the antimalarial drug artesunate. The first patients are expected to be enrolled soon in Finland, and 40 other countries are in the process of gaining regulatory and institutional review board approvals. The original Solidarity trial began in March 2020, but in October 2020 researchers published interim results showing no benefit for 4 repurposed drugs—remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a—in hospitalized COVID-19 patients. An independent expert committee chose the 3 new medications at the beginning of this year, but delays due to negotiations with drug manufacturers, as well as regulatory and ethical approval processes, held up the trial’s restart until now.

In the US, the Duke Clinical Research Institute announced the expansion of a clinical trial testing repurposed medications among people with mild-to-moderate COVID-19 who are recovering at home. Part of the National Institutes of Health (NIH)-funded Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) initiative, the ACTIV-6 study is now testing 3 drugs that are FDA-approved for other conditions—the antiparasitic ivermectin, the inhaled steroid fluticasone, and the selective serotonin reuptake inhibitor fluvoxamine—and expects to add other medications over time. The study is recruiting participants ages 30 and older who recently tested positive for SARS-CoV-2 and are experiencing at least 2 COVID-19 symptoms. Notably, the study is completely remote, meaning people recovering from COVID-19 at home can participate from anywhere in the US and do not need to leave their homes while isolating to obtain medication or visit clinics. With only a handful of medications approved or authorized to treat COVID-19, researchers are hopeful these trials can help broaden the tools available to lower the risk of complications, shorten the time of symptoms, or prevent progression to more severe disease.

US/CANADA TRAVEL RESTRICTIONS On August 9, Canada lifted some travel restrictions for fully vaccinated US citizens and permanent residents. However, prospective travelers must adhere to certain pandemic safety standards before being allowed to cross the border. In order to enter Canada, Americans must show proof of a full SARS-CoV-2 vaccine regimen completed at least 14 days prior, a negative molecular SARS-CoV-2 test taken within 3 days of travel regardless of individual vaccine status, and an in-country, 14-day quarantine plan in case symptoms develop. They must also fill out a detailed application on the country’s arriveCAN app before crossing the border. Canadian authorities have issued warnings to prospective travelers that longer wait times can be expected at border crossings. Canada plans to open its borders to visitors from other countries beginning next month, depending on conditions. The US government recently announced plans to extend its border closures with Canada and Mexico for all nonessential travel until at least August 21, but a plan for a phased reopening of the borders is being formulated, according to officials.

CRUISE LINES & VACCINATION Norwegian Cruise Lines can require passengers to show proof of SARS-CoV-2 vaccination before boarding any of its ships based in Florida, despite that state’s law banning so-called “vaccine passports,” a US District Court judge has ruled. The law, signed by Florida Governor Ron DeSantis in May, fines businesses $5,000 per violation for asking customers to prove they have been vaccinated against SARS-CoV-2. But in an August 8 preliminary ruling, US District Court Judge Kathleen M. Williams of the Southern District of Florida said Norwegian likely will prevail in arguing that the law risks public health and qualifies as an unconstitutional infringement on the company’s First Amendment rights. While Norwegian “has demonstrated that public health will be jeopardized if it is required to suspend its vaccination requirement,” Judge Williams wrote, the “defendant fails to articulate or provide any evidence of harms that the state would suffer if an injunction was entered.” The injunction blocks the state government from enforcing the law against Norwegian, which is scheduled to resume port activity on August 15. In a statement, Norwegian said the order will allow it “to operate in the safest way possible with 100% vaccination* of all guests and crew when sailing from Florida ports.” On August 9, Governor DeSantis said Florida will appeal the ruling to the Eleventh Circuit Court of Appeals.

Cruise ship operators are working to keep up with rapidly changing guidelines as the highly transmissible Delta variant drives an increase in COVID-19 case numbers nationwide, particularly in Florida, where many ships embark. While most cruise lines are requiring passengers to show proof of vaccination, some are adding requirements including proof of a negative SARS-CoV-2 test before boarding and masking in crowded indoor spaces. For all cruise ships operating in US waters, or seeking to operate in US waters, the US CDC has devised a Framework for Conditional Sailing Order (CSO) and Technical Instructions that ships are recommended to follow even when located outside of US waters, as well as a color-coded system for ships. Of the 65 cruise ships listed, 25 are categorized as orange or yellow as of August 9, indicating that those ships have reported COVID-19 cases and the CDC is either monitoring the situation, actively investigating an outbreak, or has concluded its investigation and continues to monitor. The remainder of the listed ships are operating under a green status, meaning they have not reported any COVID-19 cases or COVID-19-like illnesses. If a ship reaches red status, it has been determined through investigation to be “at or above” the threshold for passenger and crew cases and must return immediately to port or delay its next voyage. Notably, cruise lines must report all information on COVID-19 cases aboard ships to the CDC. If a cruise operator chooses not to follow the CSO—which became voluntary under a court order issued in June—the ships are marked as gray but are still required to report cases of illnesses or death due to other causes.
*In a footnote on its release, Norwegian indicated “limited exceptions” for vaccination requirements may be made due to “valid medical or religious exemptions.” Under the CDC’s CSO, 95% of crew and guests must be vaccinated.

https://covid19.who.int/

[ti-amie]

[ponchi101]

You don't need to "find them". When you get the virus and you end up in the ICU, THEY will find you. If you are lucky.

[ti-amie]

Isn't Mississippi one of the states screaming about secession? I think Biden is being smart here. You can't let people die due to lack of Federal assistance (unless you're in the GQP) and a not so subtle message is being sent about who is helping.

[ti-amie]

It's always about the money with these people.

[Jeff from TX]

Simply, WOW! So many a******s in the world with anger issues. Scary.

[ti-amie]

[dryrunguy]

Here's the latest Situation Report. It's packed. The section focused on Senegal was... tough to read.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 204.6 million cumulative cases and 4.32 million deaths worldwide as of 12:15pm EDT on August 12.

Global Vaccination
The WHO reported 4.43 billion doses of SARS-CoV-2 vaccines administered globally as of August 12. The WHO reports that a total of 1.70 billion individuals have received at least 1 dose, and 866 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered has declined steadily from its second-highest peak—43.3 million doses per day—down to 35.9 million*. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.40 billion vaccinated individuals worldwide (1+ dose; 30.8% of the global population) and 1.26 billion who are fully vaccinated (16.1% of the global population).
*Average doses administered is exhibiting a sharp decrease for the most recent several days, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent data.

As national SARS-CoV-2 vaccination campaigns continue, some new countries are emerging as successes, while some that were among the top countries earlier in the year have tapered off. This week, we will compare trends among the top countries in terms of full vaccination over the past several months**.

Top 10 as of August 12
1. Malta- 91%
2. Iceland- 75%
3. UAE- 73%
4. San Marino- 70%
5. Seychelles- 70%
6. Uruguay- 68%
7. Singapore- 68%
8. Chile- 67%
9. Nauru- 67%
10. Belgium- 65%

Among these countries, only 4 have remained in the top 10 since May: Chile, Malta, San Marino, and Seychelles. The UAE was only outside the top 10 in June, but this was likely a result of no updated data between April 20 and July 5. While Malta has remained among the top countries over this period, it climbed steadily through the rankings, up from #9 in May to #1 in August. Iceland also quickly rose through the rankings, from nearly 10 percentage points (pp) outside the top 10 in May to #2 globally in August. Seychelles’ vaccination coverage increased rapidly through the end of April, but progress has slowed considerably since then, causing it to fall from #1 to #5 since May. Interestingly, Qatar was not in the top 10 at any of the dates included in this analysis, but it was consistently close, ranking #12 in May and #11 from June through August.

In May, there was a gap of approximately 20pp between Seychelles and Israel and the rest of the top 10 countries—from #3 UAE at 39% to #2 Israel at 59%—but that gap closed over the past several months. Israel was #1 globally through late April, but after reaching 58% by the end of that month, its coverage increased by fewer than 5pp since then, with most of that occurring since mid-July. By virtue of initiating vaccination earlier than most countries, the US was among the top 3 globally through early March, but as progress slowed, it fell to #7 in May and #10 in June before falling outside the top 10 in July. Similar to the US, slowing progress in the UK following steady progress earlier in the year caused it to fall out of the top 10 between June and July. Bahrain and Hungary have exhibited similar trends.

In July, Singapore was 15pp outside the top 10, but rapid progress resulted in an increase in coverage of nearly 30pp in just a month—from 40% to 68%—propelling Singapore to #7 in August. Similarly, Nauru reported a rapid increase between July and August, climbing from just 17% coverage on June 29 (its earliest available data) to 67% on July 27 (its most recent data), good enough for #9 globally in August. After a relatively slow start, Belgium’s vaccination coverage increased rapidly starting in early May, outpacing the European average and moving the country up to #10 globally. Among the countries currently in the top 10, Uruguay and Mongolia initiated vaccination efforts later than most others, with less than 1% coverage reported on March 30 and April 22, respectively. Both countries exhibited rapid progress, however, and have been among the global top 10 since June.
**Data and rankings correspond to the 12th of each month, unless noted otherwise.

UNITED STATES
The US CDC reported 36.3 million cumulative COVID-19 cases and 617,096 deaths. The current average of 114,190 new cases per day is the highest since February 6 and nearly 10 times the most recent low—11,606 on June 19. It appears as though the US may be passing an inflection point, but it is difficult to determine whether this is an artifact of reporting frequency or an early indication of a longer-term trend. Daily mortality appears to continue its exponential increase up to 492 deaths per day, the highest average since May 22*.
*Changes in the frequency of state-level reporting may affect the accuracy of recently reported data, particularly over the weekend. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent dates.

US Vaccination
The US has administered 353.9 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to increase steadily, up to 640,617 doses per day*. A total of 196.5 million individuals in the US have received at least 1 dose, equivalent to 59.2% of the entire US population. Among adults, 71.5% have received at least 1 dose, as well as 11.9 million adolescents aged 12-17 years. A total of 167.4 million individuals are fully vaccinated, which corresponds to 50.4% of the total population. Approximately 61.3% of adults are fully vaccinated, as well as 8.9 million adolescents aged 12-17 years.
*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.

THIRD DOSE AMONG IMMUNOCOMPROMISED The US FDA on August 12 authorized the administration of an additional dose of SARS-CoV-2 mRNA vaccines for certain people with compromised immune systems, “specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” The FDA amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech and Moderna vaccines to allow for a third dose for this population, which is estimated to be about 2.7% of the US adult population. Several studies, including one published this week in the New England Journal of Medicine, show that immunocompromised people experience a significant increase in their immune response after a third dose of vaccine. The agency noted that other fully vaccinated people do not need an additional dose at this time, but several US health officials believe extra doses might be needed in the future. According to the FDA, the EUA for the J&J-Janssen vaccine was not updated because there is not yet sufficient evidence to support additional doses in any population.

The US CDC’s Advisory Committee on Immunization Practices (ACIP) is meeting today to further discuss and vote on clinical recommendations regarding who will be eligible for extra shots and how they will be administered, with CDC Director Dr. Rochelle Walensky expected to sign off on any decisions later in the day. The ACIP also is expected to discuss what type of evidence is needed to inform a decision about whether additional vaccine doses are needed for a larger portion of the population and, if so, which populations should get them first.

US SURGE The US COVID-19 surge continues, its second largest to date, and concerns are growing regarding the impact on health systems and schools. Analysis from The Washington Post illustrates a close correlation between low vaccination coverage and elevated SARS-CoV-2 transmission, with the vast majority of hotspot areas located in counties with full vaccination coverage less than 40%, including much of the South and Southeast regions, and relatively few in counties with moderate or high coverage. Even as the surge grows, some state lawmakers are continuing efforts to curb the authority of local governments and health officials. In Tennessee, all 73 Republican members of the state House of Representatives called for a special legislative session in order to pass measures that would limit local officials’ ability to implement COVID-19 protective measures such as mask mandates.

In severely affected areas, hospitals are being forced to implement emergency plans to manage the influx of COVID-19 patients. In Florida, which represents 22% of the national daily incidence, state health officials requested 200 ventilators and 100 high-flow nasal cannula kits from the federal Strategic National Stockpile (SNS). The state is not yet experiencing a shortage of this equipment, but statewide hospitalizations continue to set new records. Reportedly, officials in Brevard County, Florida, are emphasizing that the 9-1-1 telephone number should be used only for emergencies and encouraging residents to seek care through other means for less urgent conditions in order to reduce the burden on ambulance services and emergency departments. Despite having the country’s largest surge, Florida Governor Ron DeSantis continues to resist protective measures, including mask mandates, to slow transmission. Rather, he touted a state plan to expand infusion centers for monoclonal antibody treatments to mitigate the impact on hospitals. Notably, these treatments require a prescription and could cost thousands of dollars, whereas mask use is relatively inexpensive and vaccination is provided free of charge.

Daily incidence among children continues to increase, setting new records nationally and in severely affected states. In Mississippi, one school district—notably, with no mask mandate—is transitioning to virtual learning only 1 week into the school year, after 40% of students at one high school were required to quarantine. As of August 12, at least 10 cohorts of students at the high school are under quarantine, but the school elected to resume in-person classes and continue quarantining students following exposures prior to the district order to go virtual beginning August 16.

VACCINE MANDATES FOR PUBLIC SCHOOL STAFF California (US) Governor Gavin Newsom on August 11 announced the state will require all teachers and school staff to show proof of SARS-CoV-2 vaccination or undergo weekly testing. The move—which applies to more than 800,000 employees, including about 320,000 public school teachers and many other support and administrative staff—comes after several large state school districts (San Jose Unified, San Francisco Unified, Sacramento City Unified, and Long Beach Unified) announced similar requirements for their employees. The state’s 2 major teachers unions—the California Teachers Association and the California Federation of Teachers—among other unions, support the plan, citing state and national data showing that nearly 90% of educators have been vaccinated. There is debate over whether California is the first state with such a requirement for public school employees, as Hawai’i Governor David Ige last week announced his intention to require vaccinations for all public sector workers, including school staff. However, several public workers unions, including those representing teachers, pushed back on the announcement, saying they were not consulted and arguing there is no detailed plan on implementation.

Over the weekend, Randi Weingarten, President of the American Federation of Teachers, announced support for vaccine mandates for educators as the first line of prevention for unvaccinated, younger students as they return to in-person learning, saying mask wearing is the second most important factor for keeping kids in school. Weingarten cited an increasing number of new COVID-19 cases among children over the past few weeks, as compiled by the American Academy of Pediatrics (AAP). Last week, Becky Pringle, President of the National Education Association, the largest teachers union in the US, said vaccine and mask mandates should be decided on local levels. In an interview on August 10, Dr. Anthony Fauci, Chief Medical Adviser to the President, voiced support for vaccination mandates for public school employees, saying vaccination of all eligible adults would help children more safely return to classrooms this fall. In most states, there are laws dictating vaccination requirements for school children but, to our knowledge, none requiring teachers and school staff workers to undergo immunizations. Some states provide public school employees a list of recommended vaccines—such as those for diphtheria, tetanus and pertussis (DTaP); influenza; and measles, mumps and rubella (MMR)—but there is no requirement or follow-up.

Much of the urgency over vaccinating public school employees centers on the fact that children under the age of 12 remain ineligible for vaccination in the US. In a letter sent last week to the US FDA, AAP President Lee Savio Beers urged the agency to fast-track vaccine authorization for this age group, saying the Delta variant “changes the risk-benefit analysis.” In May, the FDA authorized the emergency use of the Pfizer-BioNTech vaccine for young people aged 12 to 15 years, but the companies have not yet applied for authorization among children aged 5 to 11 years. A Pfizer spokesperson said the company plans to submit an emergency use authorization (EUA) application for that age group by the end of September. For now, the timeline for a vaccine EUA for school-aged children is amorphous, but experts remain hopeful that authorization and recommendations could still come before the end of the year.

COVID-19 AMONG CHILDREN Public health experts, state officials, and healthcare providers are warning about a surge in COVID-19-related hospitalizations among children and cautioning that the Delta variant could be more dangerous for younger individuals. As of August 10, US hospitals admitted an average of 246 children with COVID-19 every day over the previous week, representing a 27.3% increase over the week ending August 3, according to CDC data. While children ages 12 and older are eligible to receive the Pfizer-BioNTech SARS-CoV-2 vaccine, rates of vaccination in that age group remain below the national average, around 31% fully vaccinated.

States experiencing the largest increases in overall COVID-19 cases, such as Louisiana and Florida, also are seeing the greatest increases in hospitalizations among children. Dr. Mark Kline of Children’s Hospital in New Orleans said children with COVID-19 account for about 20% of the facility’s hospitalized patients, with most of them under age 10 and too young to be vaccinated. In Texas, more children are being treated in hospitals for COVID-19 than ever before, and many also are infected with respiratory syncytial virus (RSV). One physician, warning of dwindling hospital capacity, said the 2 viruses are “spreading like wildfire” among younger children, particularly those under age 2. According to the American Academy of Pediatrics, nearly 94,000 cases among children were recorded in the week ending August 5, continuing a “substantial increase” in the number of new cases since the beginning of July.

Although children continue to account for a small percentage of total COVID-19 hospitalizations—between 1.5% and 3.5%—the disease impacts kids of different ages differently, and even those who have asymptomatic or mild infections could experience so-called “long COVID,” or post-acute sequelae of COVID-19 (PASC). Experts are still learning about the condition, which is characterized by a variety of symptoms including memory or concentration difficulties (ie, “brain fog”), trouble sleeping, fatigue, dizziness, headaches, gastrointestinal problems, or changes to smell or taste. The impacts of these long-lasting symptoms could be “huge,” according to some pediatric experts, with the symptoms disrupting school and extracurricular activities especially among those in their formative teen years. Concern over the rising number of COVID-19 cases and hospitalizations among younger populations, and the potential for long-term impacts, is amplified by anecdotal evidence the Delta variant might cause more severe disease among children and that many are returning to in-person learning. These factors, and the fact that about 50 million children remain ineligible for vaccination, places even more importance on utilizing other risk reduction methods, including vaccination among those who are eligible, mask wearing, and physical distancing.

US CDC VACCINATION GUIDANCE FOR PREGNANT WOMEN The US CDC on August 11 recommended that all people who are pregnant, breastfeeding, trying to get pregnant, or might become pregnant in the future be vaccinated for SARS-CoV-2. The agency cited a growing body of evidence showing vaccination during pregnancy is safe, noting new data that found no increased risk of miscarriage among pregnant people who received a SARS-CoV-2 mRNA vaccine during the first 20 weeks of gestation. Previously, the CDC said the vaccine could be offered during pregnancy, but the new recommendation urges all pregnant people to be vaccinated. According to CDC data, only about 23% of pregnant people have received at least one dose of a vaccine. The new recommendation comes amid a surge of new COVID-19 cases, hospitalizations, and deaths in the US, driven by the highly transmissible Delta variant. The CDC’s updated recommendation came 2 days after the release of a joint statement by the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and 20 other health organizations “strongly” urging pregnant and recently pregnant individuals, as well as those planning to become pregnant, to be vaccinated. The groups noted that pregnant individuals are at an increased risk of severe COVID-19 disease, including death, and the best way to protect themselves is through vaccination.

US GOVERNMENT VACCINE MANDATES The US Department of Health and Human Services (HHS) became the latest federal agency to announce a vaccine mandate for some of its employees, requiring more than 25,000 members of its health care workforce to be vaccinated against SARS-CoV-2. Staff of the Indian Health Services (IHS) and National Institutes of Health (NIH) who work in health and clinical research facilities or who have direct contact with patients and members of the US Public Health Service Commissioned Corps who respond to public health crises nationwide are included in the mandate. The HHS mandate also applies to contractors, trainees, and volunteers who might have patient contact at federal clinical research or medical facilities. IHS, NIH, and Commissioned Corps staff already are required to receive seasonal influenza and other routine vaccinations, with allowances for certain medical and religious exemptions.

The US Department of Veterans Affairs (VA) announced a similar vaccine mandate at the end of July, and on August 12 expanded the requirement to apply to most Veterans Health Administration (VHA) employees, volunteers, and contractors who work in VHA facilities, visit such facilities, or otherwise come into contact with VA patients and healthcare workers as part of their jobs. The US Department of Defense earlier this week announced a plan to require all military members to be vaccinated by mid-September or earlier. All other US government employees are required to show proof of vaccination or be subject to other precautions, including regular testing, mask wearing, and travel restrictions.

VACCINE EFFECTIVENESS & VOCs New information continues to emerge regarding the effectiveness of different SARS-CoV-2 vaccines, particularly with respect to variants of concern (VOCs). This week, several articles were published in academic journals and on preprint servers. In one study, published in The New England Journal of Medicine, UK researchers examined vaccine effectiveness against symptomatic disease for both the Alpha and Delta SARS-CoV-2 variants. They included data on participants who received either the Pfizer-BioNTech or AstraZeneca-Oxford vaccines and stratified the sample for those who had received partial or full doses. The research team found that both vaccines were less effective against the Delta variant than the Alpha variant when the individual only had one dose (30.7% vs 48.7%), and also saw reduced effectiveness against Delta for fully vaccinated individuals when compared to Alpha. The Pfizer-BioNTech vaccine was 93.7% effective in preventing symptomatic disease against Alpha and 88% against Delta among fully vaccinated individuals, while the AstraZeneca-Oxford vaccine was 74.5% and 64% effective, respectively.

Another study, conducted in Utah (US) and posted on the preprint server medRxiv, suggested similar findings. The researchers found a modest reduction in overall vaccine effectiveness for all US FDA-authorized vaccines corresponding to the expansion of the Delta variant in the state, saying the reduction in effectiveness due to the VOC, and not waning immunity, is “highly concerning.” A third study, conducted in Qatar and also posted to medRxiv, examined the effectiveness of the Pfizer-BioNTech and Moderna vaccines against the Delta variant. The research team estimated the effectiveness against symptomatic COVID-19 to be 79.0% for the Pfizer-BioNTech vaccine and 84.8% for the Moderna vaccine. The Pfizer-BioNTech vaccine exhibited 89.7% effectiveness against severe, critical, or fatal COVID-19 disease due to Delta, and the Moderna exhibited 100% effectiveness, although this analysis had a very small sample size.

A fourth preprint study, posted to medRxiv and based on data collected by the Mayo Clinic, retrospectively examined SARS-CoV-2 PCR test data collected between January and July 2021 from 645,109 individuals vaccinated with either the Pfizer-BioNTech or Moderna vaccines. Both vaccines were highly effective during the study period for preventing infection, with Moderna exhibiting 86% effectiveness and Pfizer-BioNTech 76% effectiveness. Additionally, the vaccines worked well to prevent COVID-19 hospitalizations, with an estimated effectiveness of 91.6% for the Moderna vaccine and 85% for the Pfizer-BioNTech vaccine. However, effectiveness against infection dropped in July with the rise of the Delta variant, with Moderna at 76% and Pfizer-BioNtech at 42%. All of these papers reinforce that current SARS-CoV-2 vaccines are effective at preventing COVID-19 disease—particularly severe disease, hospitalization, and death—even in the face of increasing prevalence of VOCs, including the Delta variant.

SARS-COV-2 RAPID ANTIGEN TESTS Researchers from Germany published (preprint) findings from a study on the accuracy of 2 commercially available SARS-CoV-2 antigen rapid diagnostic tests (RDTs), comparing them to the "gold standard" real-time reverse transcription-polymerase chain reaction (rRT-PCR)-based tests. The SD Biosensor SARS-CoV-2 Rapid Antigen Test by Roche Diagnostics and Panbio COVID-19 Ag Rapid Test by Abbott Diagnostics were compared in a German diagnostic center between February 1 and March 31, 2021. Of 2,215 tests conducted, 338 (15%) were rRT-PCR positive for SARS-CoV-2. The Roche RDT exhibited 60.4% sensitivity and 99.7% specificity, and the Abbott RDT exhibited 56.8% sensitivity and 99.8% specificity. The sensitivities of the RDTs were higher among individuals referred by physicians and health departments compared to the total study population, where the Roche RDT performed at 79.5% and the Abbott RDT at 78.7%. The RDTs had substantially lower sensitivities in individuals with at least one comorbidity (Roche 38.2%, Abbott 34.4%) compared to those without comorbidities (Roche 74.4%, Abbott 71.0%). Higher unadjusted sensitivities in RDTs were also observed in symptomatic individuals (Roche 75.2%, Abbott 74.3%) compared to asymptomatic individuals (Roche 23.8%, Abbott 31.9%).

To put these results in context, if 10,000 symptomatic individuals were tested, of which 500 were truly positive, these RDTs would yield 38 false-positive and 124 false-negative results. If 10,000 asymptomatic individuals were tested, of which 50 are true positives, the RDTs would yield 18 false-positive and 34 false-negative results. Based on the study, the authors call into question whether the widespread use of RDTs for screening purposes is beneficial. Since screening often is recommended for asymptomatic individuals, the results of the study are of crucial importance in assessing tests best suited for this use.

CANADA VACCINE MANUFACTURING FACILITY Pharmaceutical company Moderna and the Government of Canada on August 10 announced a memorandum of understanding to build a “state-of-the-art” manufacturing facility in Canada to make the company’s SARS-CoV-2 vaccine and possibly other respiratory virus vaccines that use the mRNA platform. Moderna said the facility will help provide Canada with supplies of its SARS-CoV-2 vaccine, “direct access” to pandemic response capabilities in the future, and access to any vaccines currently in development that might receive approval. About 30% of the SARS-CoV-2 vaccine doses distributed in Canada are from Moderna, and that proportion could go up depending on regulatory approval of additional doses. Though the location of the manufacturing plant has not yet been decided, it will likely be similar to Moderna’s main facility in Norwood, Massachusetts (US), and will employ a couple hundred people. Moderna CEO Stéphane Bancel said the company is in talks to build similar manufacturing facilities in other nations in Europe and Asia, although he did not specify which ones, adding they expect to build 5 to 10 such plants worldwide over the coming years. Earlier this year, Canada announced an agreement with Novavax, which is working on its own SARS-CoV-2 vaccine, to produce its doses at a government-owned facility in Montreal either late this year or early next year. Notably, Novavax has delayed its submission for authorization to the US FDA 3 times, most recently citing efforts to validate production consistency.

SENEGAL The Senegalese health system continues to struggle under a third wave of SARS-CoV-2 infections, where cases have skyrocketed. More than 15,000 cases and 139 deaths were reported in July, according to the Ministry of Health. Prior to July, Senegal reported fewer than 44,000 cases and 1,166 deaths. Ambulance services in Dakar, the current epicenter of the outbreak, also are feeling the strain. Since the beginning of the third wave, more than 90% of calls to the Mobile Emergency Care Service (SAMU) have been for respiratory distress. With the influx of emergency calls, hospitals are low on bed space with supplemental oxygen to care for patients, and delivery workers have been working through the night to keep up with the oxygen demand. Cemetery workers also are among personnel working around the clock to keep up with demand. A cemetery manager close to the Dakar hospital reports an average of 30 burials per day during this wave of infections. During the last surge, the average was 20 burials a day, and prior to the pandemic, 10 each day.

Last month, the government announced construction of a vaccine manufacturing plant in the capital, which is expected to produce 25 million doses per month by the end of 2022. The Institut Pasteur in Dakar will run the plant to reduce outside dependence on vaccine supply. As of August 9, just under 2% of the Senegalese population was fully vaccinated against SARS-CoV-2.

GLOBAL VACCINE ACCESS The WHO is continuing to press wealthier nations and SARS-CoV-2 vaccine manufacturers to reverse the “disgraceful” inequity in global access to vaccines to help low- and middle-income countries (LMICs) vaccinate at least 10% of their populations by the end of September. Speaking during an online Q&A session with WHO officials, Dr. Bruce Aylward, Senior Adviser to the WHO Director-General and head of the Access to COVID-19 Tools (ACT) Accelerator initiative, criticized wealthier nations, saying they should be “disgusted” by the imbalance in the available tools to address the pandemic and calling for US$.7.7 billion to help the WHO supply vaccines, oxygen, and other medical supplies to LMICs. Dr. Aylward’s comments come a week after WHO Director-General Dr. Tedros Adhanom Ghebreyesus called for a moratorium on providing additional, or booster, doses to most people in order to improve global access. Researchers with the Council on Foreign Relations identified 37 high- and middle-income countries that are considering or already administering booster shots as of August 12. They warn—as does the WHO in a recently released interim statement on booster doses—that offering third doses to large swaths of populations, beyond vulnerable groups such as the immunocompromised or people over the age of 80, threatens to further widen the gap between “vaccine-haves and vaccine-have-nots.”

The Pan American Health Organization (PAHO) this week announced a plan to increase SARS-CoV-2 vaccine availability for its member countries. The new COVID-19 initiative, which will be operated through the organization’s well-established Revolving Fund, will purchase “tens of millions” of vaccine doses, syringes, and related supplies and begin delivering them in October to the more than 20 countries in the region that have expressed interest in joining. In making the announcement, PAHO recognized it is not clear whether the COVAX facility will succeed in providing the necessary vaccine doses to its member nations.

On August 10, more than 175 public health experts, scientists, and civil society leaders as well as more than 50 organizations sent a letter to officials in the administration of US President Joe Biden, calling on them to immediately ramp up a global vaccine manufacturing program to help vaccinate the rest of the world and reduce the likelihood of newer, possibly more dangerous variants emerging. In a separate letter addressed to President Biden, they urge him to release millions of stockpiled doses each week to countries in need, noting the US has more than 55 million doses of mRNA vaccines stockpiled but is administering fewer than 900,000 per day. While many experts are focused on the threat of emerging new variants, the UN Development Programme (UNDP) warns vaccine inequities will have long-term economic and social impacts in LMICs, including a widening poverty gap, increased divides in health care spending, and swollen public debt.

HERD IMMUNITY IMPOSSIBLE Consensus is forming among public health experts and scientists worldwide: the highly transmissible Delta variant of SARS-CoV-2 changed the COVID-19 pandemic, dashing hopes of widespread vaccination creating herd immunity that could protect people from infection and guaranteeing the novel coronavirus will become endemic. While the vaccines are highly effective at preventing serious illness or death, they do not fully protect the vaccinated from infection. Additionally, people who had previous SARS-CoV-2 infections are not necessarily protected from infection from future variants. And because infected people can in turn infect others, whether vaccinated or not, the concept of herd or population immunity with COVID-19 “is not a possibility,” according to experts who recently spoke to the UK’s All-Party Parliamentary Group. However, the vaccines still work, and work well, protecting those fully vaccinated from death and keeping them out of the hospital, and vaccine doses should be urgently distributed to "where they can have the greatest impact," especially to countries in need, Professor Sir Andrew John Pollard, Director of the Oxford Vaccine Group, urged. In the meantime, “the world needs to stay alert,” Ed Yong writes in The Atlantic, and make use of all available protective measures that could help stave off the emergence of new, potentially more dangerous variants.

https://covid19.who.int/

[ponchi101]

The paragraph about herd immunity stands out to me. By definition, and with a virus multiplying by the billions/trillions in anybody, some more mutations will happen. And then maybe one of them will be immune against the vaccine, and there we will go again.
Of course, the Delta variant will perhaps remain with everybody, and pretty soon non-vaccinated people will be surrounded, by their unvaccinated peers or by vaccinated people that will still be able to transmit the virus.