Covid-19 Updates & Info

[ti-amie]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

[Suliso]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

Interesting... Hardly anyone is masked here (maybe 10%) except in public transport where it's still mandatory till the end of the month.

[dryrunguy]

Here's yesterday's Situation Report. Sorry for the delay. I haven't read it yet. (In proposal start-up hell.)

::

6 MILLION DEATHS The official global death toll from COVID-19 likely will pass 6 million today. The actual total of COVID-related deaths could be 2 to 4 times higher than the official number, based on estimates of global excess deaths. As the pandemic enters its third year, the milestone is a reminder that the crisis is not over in many countries—with the highly transmissible Omicron variant continuing to drive a surge in cases, especially in the Western Pacific region—even as other nations move to drop public health restrictions and requirements. COVID-19 has breached the strict border controls of several Pacific island nations, which until recently held off the virus. New Zealand recorded a new record of nearly 24,000 new cases today, causing severe healthcare system strain. In China, the government is quietly moving away from its aggressive “zero COVID” policy to a “dynamic clearing” model aimed at controlling local outbreaks as soon as possible. China’s National Health Commission reported 526 cases from local transmission on March 6, the highest daily total since the initial outbreak in Wuhan. Hong Kong reported more than 43,000 new cases today after the launch of a new system that allows residents to self-report at-home test results. Over the weekend, city residents cleared supermarket shelves for a seventh consecutive day, despite authorities’ calls for calm. In Ecuador’s largest city, Guayaquil, which faced one of the world’s worst COVID-19 outbreaks, violence has replaced contagion as the population struggles to recover from the pandemic’s social, economic, and mental health impacts. Highly vaccinated—and mostly wealthy—countries appear to be moving on from the pandemic, and many global health organizations are shifting their priorities away from COVID-19 to focus on preparing for the next pandemic. Still, only about 14% of people in low-income countries have received at least 1 dose of vaccine. These countries remain vulnerable to the unpredictability of the pandemic and risk being left to languish without needed vaccine doses, treatments, and testing tools.

US COVID-19 FUNDING On March 7, members of US President Joe Biden’s administration warned that the federal government is nearly out of funding for its COVID-19 pandemic response and urged the US Congress to quickly replenish the funds. Last week, the Biden administration formally requested US$22.5 billion in emergency spending as part of its new COVID-19 Preparedness Plan. The “urgent” request is lower than the US$30 billion originally floated and is coupled with a request for US$10 billion for humanitarian and military aid for Ukraine. The emergency funding request includes money for research into a pan-SARS-CoV-2 vaccine, testing capacity, purchase of additional antiviral treatment courses, and support for the purchase of vaccines to be distributed globally. The US continues to be a large contributor to global vaccination efforts, representing 36% of the money donated to COVAX and 41% of pledged vaccine doses, according to analysis from the Kaiser Family Foundation. In a letter sent last week, Shalanda Young, the Acting Director of the Office of Management and Budget, urged lawmakers to “act expeditiously” on the request by March 11, citing a need to increase funding for the US Department of Defense and other agencies, which are operating at levels negotiated in late 2020.

However, it is unclear if Congress will heed the urgency, as debates over the necessity of new COVID-19 funding fall along partisan lines. At least 3 dozen Republican Senators are asking for more transparency from the Biden administration about how more than US$4 trillion in previously authorized funding has been spent before supporting additional funds. Democrats warned opposition to approving emergency pandemic funds could jeopardize the nation’s return to a sense of normalcy. This news comes alongside other signals from some federal lawmakers that they are working to move past the COVID-19 pandemic. The US Senate last week passed a Republican-sponsored bill to end the national emergency declaration for COVID-19. The measure passed narrowly, with a 48-47 vote, drawing the threat of a veto from President Biden.

COVID ROADMAP A report written by nearly 2 dozen experts charts a course for living with COVID-19, outlining recommendations to reach a “new normal.” The report, titled Getting to and Sustaining the Next Normal: A Roadmap for Living with COVID, describes 12 core elements fundamental to the roadmap, principally shifting focus from COVID-19 to major viral respiratory illnesses like influenza and respiratory syncytial virus (RSV); creating a dashboard to serve as an infectious diseases information hub for the introduction, modification, and lifting of public health measures; issuing guidance for therapeutics and additional protective measures; and increasing surveillance, testing, and data infrastructure. The report includes 3 scenarios in which the COVID-19 pandemic will continue, dependent on vaccine- or infection-derived immunity and the characteristics of new variants. Other key recommendations of the report include developing indoor air quality standards to protect from inhalation exposure; conducting additional long COVID research; and supporting the development of new therapeutics to be distributed in an accessible, equitable test-to-treat platform. Strategies to rebuild trust and credibility among public agencies like the US CDC include building in more transparency in how guidance is set and overhauling the Vaccine Adverse Event Reporting System, which relies on self-reported data and has been exploited by anti-vaccine groups to spread misinformation. The group consulted with the White House earlier this year, and some of the recommendations are similar to those included in the National COVID-⁠19 Preparedness Plan, albeit with much more detail. The 136-page report contains more than 250 discrete recommendations that go beyond the current and proposed changes.

COVID MISINFORMATION US Surgeon General Dr. Vivek Murthy last week formally requested that major technology companies send data and analysis on the prevalence of COVID-19 misinformation on their social networks, search engines, instant messaging systems, e-commerce sites, and crowdsourced platforms, as well as information on the primary sources of that misinformation. Additionally, Dr. Murthy requested that healthcare professionals and the public submit information about how COVID-19 misinformation has impacted patients and communities. Companies have until May 2 to comply with the request, which is part of US President Biden’s new National COVID-19 Preparedness Plan. Separately, a group of physicians called No License for Disinformation is calling on state medical boards to take disciplinary action against doctors who deliberately spread misinformation regarding COVID-19 therapies, vaccines, and public health measures including masking.

VACCINES FOR CHILDREN Children under age 5 in the US remain ineligible for vaccination against COVID-19, and a series of ups and downs regarding expected authorization for this age group has left some parents feeling abandoned, frustrated, and fearful as mask mandates and other restrictions are dropped. Additional data on a 3-dose regimen of the Pfizer-BioNTech vaccine in young children is expected this spring, and Moderna is expected to request authorization for its vaccine among young children by May.

Last week, the US FDA rejected an application from pharmaceutical company Ocugen seeking Emergency Use Authorization for an India-made SARS-CoV-2 vaccine for children aged 2 to 18. Covaxin, manufactured by the Indian pharmaceutical company Bharat Biotech, is not yet authorized for any age group in the US nor has the vaccine been tested in the US. A clinical trial conducted in India among individuals between ages 2 and 18, prior to the emergence of the Omicron variant, showed 2 doses of the vaccine were safe and generated robust immune responses. Ocugen contracted with Bharat to try to bring the vaccine to the US market. Covaxin is authorized in about 20 countries and has Emergency Use Listing by the WHO. Ocugen said it will continue working with US regulators to evaluate the vaccine’s use in children.

In Florida (US), the state’s surgeon general on March 7 announced that the state will issue guidance urging parents to not vaccinate their healthy children against COVID-19. Although Florida’s decision likely will have little impact on parents’ abilities to vaccinate their children, the recommendation breaks with US CDC guidance and some experts say the move could sow confusion and distrust, potentially harming individuals and communities.

MODERNA In a new Global Health Policy Strategy published March 7, Moderna announced several new and expanded commitments related to COVID-19 and mRNA technologies. The company said it will expand its global health portfolio to 15 vaccine programs targeting pathogens identified as posing the greatest threat to global health by the Coalition for Epidemic Preparedness Innovations (CEPI); launch a program that will offer the company’s mRNA technology to researchers investigating new vaccines for emerging or neglected infectious diseases; and pledge to “never enforce” patents related to its SARS-CoV-2 vaccine only in the Gavi COVAX Advanced Market Commitment (AMC) for 92 low- and middle-income countries. Previously, the company said it would not enforce its patents during the pandemic but retained the right to do so in the future. As part of the new pledge, Moderna said it will not enforce patents for its SARS-CoV-2 vaccines against South Africa-based Afrigen Biologics—which has used publicly available information to replicate Moderna’s vaccine as part of the WHO-supported mRNA vaccine technology transfer hub—even though the company holds patents in South Africa and the nation is not included in the COVAX AMC.

Additionally, Moderna announced a preliminary agreement with the government of Kenya to establish Africa’s first mRNA manufacturing facility. Moderna plans to invest US$500 million to build the facility, which is expected to produce up to 500 million vaccine doses annually for COVID-19 and other diseases. The facility will focus on manufacturing vaccine substances but could expand to fill and finish vaccine vials as early as 2023. Moderna currently is locked in a patent dispute with the US National Institutes of Health (NIH) over portions of the technology used to make its mRNA vaccine. Last week, Arbutus Biopharma and Genevant Sciences filed a lawsuit alleging Moderna infringed on a patent held by the companies for lipid nanoparticle technology, an important element of Moderna’s mRNA vaccine.

US FEDERAL BUREAU OF PRISONS Official statistics from the US Federal Bureau of Prisons (BOP) show that 287 inmates in the 122 federal prisons nationwide have died of COVID-19 since the beginning of the pandemic. In 2020, the death rate in BOP prisons was 50% higher than the 5 years prior to the pandemic. Despite memos from the US Attorney General sent early in the pandemic asking BOP to prioritize appropriate transfers to home confinement, BOP did not move quickly to review cases nor did it move forward with many transfers.

Some prisoners turned to the judicial system to ask for compassionate release, but the process can be long and the spread of SARS-CoV-2 in prisons outpaced the reviews. According to an analysis from NPR, nearly 13,000 compassionate release motions were filed in federal court in 2020, and federal judges denied more than 80% of the motions filed between January 2020 and June 2021. Of the federal inmates who have died of COVID-19, nearly all had a higher risk of dying from the virus due to older age or medical condition and at least 1 in 4 filed motions with the judicial system asking for compassionate release, according to the analysis. At least 3 inmates had their requests granted but died before they could be released, and many others died while awaiting decisions. While most of the US is loosening COVID-19 mitigation measures, federal prison inmates and staff continue to contract the virus and die. Notably, a review by STAT found that Pfizer’s COVID-19 antiviral treatment Paxlovid—shown in clinical trials to be highly effective at preventing progression to severe disease and possibly able to reduce the risk of transmission—is not being made available to most federal inmates who test positive for SARS-CoV-2.

Separately, the American Civil Liberties Union (ACLU) last week filed a lawsuit on behalf of 4 medically vulnerable detainees who have been denied SARS-CoV-2 vaccine booster doses while being held in federal immigration detention. The suit, which the ACLU hopes to transition into a class-action suit, names the US Immigration and Customs Enforcement (ICE) and US Department of Homeland Security and the agencies’ acting director and secretary, respectively. The lawsuit—which claims ICE does not have an updated policy regarding booster doses—is the second filed by the ACLU requesting access to boosters for people in ICE detention.

GENETIC FACTORS Researchers have identified 16 new genes and confirmed 7 previously identified genes that they say significantly predispose people to critical COVID-19 disease, some of which could provide targets for treatments, according to a study published in Nature. The researchers compared whole genome sequences of 7,491 COVID-19 patients admitted to intensive care units (ICUs) with those of 1,630 people who experienced mild COVID-19 as well as 48,400 people who never had COVID-19 and who were part of the UK government’s 100,000 Genomes Project. In addition to helping to identify new or existing drugs to treat COVID-19, the research could be used to help predict which patients are at risk of severe disease and which might need intensive care.

[Deuce]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

^ Even people outside?

[Deuce]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

Interesting... Hardly anyone is masked here (maybe 10%) except in public transport where it's still mandatory till the end of the month.

^ How long has it been now since all protective mandates have been dropped there (except for public transport)?

And how are your case, hospitalisation, ICU, and death numbers doing? Are they rising? Falling? Moderately? Significantly?

[ponchi101]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

Interesting... Hardly anyone is masked here (maybe 10%) except in public transport where it's still mandatory till the end of the month.

In Georgia. Not a mask in sight.

[Suliso]

Interesting... Hardly anyone is masked here (maybe 10%) except in public transport where it's still mandatory till the end of the month.

^ How long has it been now since all protective mandates have been dropped there (except for public transport)?

And how are your case, hospitalisation, ICU, and death numbers doing? Are they rising? Falling? Moderately? Significantly?
[/quote]

About four weeks now. Case numbers are no longer reliable (lots of self testing and not reporting). Deaths, ICU and hospital entries falling moderately. In absolute numbers still relatively high.

[atlpam]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

Interesting... Hardly anyone is masked here (maybe 10%) except in public transport where it's still mandatory till the end of the month.

In Georgia. Not a mask in sight.

It depends where you are in Georgia - I still see a good portion of people with masks when I go to the grocery store or Target. Very rare to see anyone wearing one outdoors and rarely see any in restaurants anymore. Granted, other than occasional grocery trips, my primary outings are outdoor walks or weekend hiking.

[dryrunguy]

Here's the latest Situation Report. In case you missed it, the U.S. is closing in on 1 million official COVID deaths.

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EPI UPDATE The WHO COVID-19 Dashboard reports 448.3 million cumulative cases and 6.01 million deaths worldwide as of March 9. The global weekly incidence continues to decline but more slowly, down 3.5% from the previous week. Increased weekly incidence (+46.36%) in the Western Pacific region is driving the slowing decline. All other regions reported decreasing weekly incidence last week. Global weekly mortality fell 9.0% from the previous week. As expected, the cumulative number of deaths passed 6 million on March 8, serving as a reminder that the pandemic is far from over.

Global Vaccination
The WHO reported 10.7 billion cumulative doses administered globally as of March 6. A total of 4.96 billion individuals have received at least 1 dose, and 4.37 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations appears to be declining again. As of March 9, 18.05 million doses per day were recorded, down from the 25.9 million doses per day on February 14.* The trend continues to closely follow that in Asia.** Our World in Data estimates that there are 4.99 billion vaccinated individuals worldwide (1+ dose; 63.43% of the global population) and 4.45 billion who are fully vaccinated (56.5% of the global population). A total of 1.44 billion booster doses have been administered globally.
*The average daily doses administered may exhibit a sharp decrease for the most recent data, particularly over the weekend, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent data.
**Data for China are reported at irregular intervals.

UNITED STATES
The US CDC is currently reporting 79.2 million cumulative cases of COVID-19 and 959,533 deaths. Daily incidence continues its sharp decline, down from a record high of 809,345 new cases per day on January 15 to 37,879 on March 8, a more than 95% decrease. Daily mortality appears to have peaked during this surge on February 2 at 2,642 deaths per day, down to 1,161 on March 8.*
*Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.

US Vaccination
The US has administered 556 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.79 million doses per day on December 6 to 246,106 on March 3.* The number of daily vaccinations is at its lowest level since late December 2020, right after the vaccines were authorized. A total of 254.3 million individuals have received at least 1 vaccine dose, which corresponds to 76.6% of the entire US population. Among adults, 88.1% have received at least 1 dose, as well as 26.9 million children under the age of 18. A total of 216.4 million individuals are fully vaccinated**, which corresponds to 65.2% of the total population. Approximately 75.1% of adults are fully vaccinated, as well as 22.3 million children under the age of 18. Since August 2021, 95.5 million individuals have received an additional or booster dose. This corresponds to 44.1% of fully vaccinated individuals, including 66.6% of fully vaccinated adults aged 65 years or older.
*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent several days.
**Full original course of the vaccine, not including additional or booster doses.

SIGNIFICANCE OF MASS MORTALITY As the world passed 6 million official COVID-19 deaths this week, and the US moves closer to 1 million official deaths, journalist Ed Yong poses an important question in The Atlantic: “How did this many deaths become normal?” Yong notes that when the death toll in the US hit 100,000 in May 2020, The New York Times described the loss as “incalculable.” But as the nation nears another milestone 2 years later, many are left wondering how this happened and why the death rate in the US has far surpassed that of any other large, wealthy nation. As life in the US heads back toward something resembling a pre-pandemic normal, those who lost loved ones to COVID-19 know life will never be the same. Some are working to ensure the nation does not forget the pandemic and remembers those who died. A group called Marked By COVID is lobbying to establish a national COVID memorial day as well as physical memorials in cities nationwide. Following the 1918 influenza pandemic, no effort was made to commemorate those who died or suffered substantial losses. This time must be different, advocates say, to help future generations understand the significance of public health crises.

US COVID-19 RESPONSE FUNDING In a surprising last-minute revision to a US$1.5 trillion fiscal year 2022 omnibus spending package, Democratic leaders of the US House of Representatives stripped US$15.6 billion in emergency funding for the COVID-19 pandemic response from the legislation in order to salvage the measure, which includes aid for Ukraine and money to keep the federal government running through September. The House approved the measure on March 9, and the US Senate is expected to pass the bill over the weekend. Although government funding is set to expire on March 11, the House also passed a stopgap measure to keep the government running through March 15. In a letter to colleagues, House Speaker Representative Nancy Pelosi blamed Republicans for the move, but it was also discord among Democrats that led to the cut. A proposal to offset the US$15.6 billion in additional COVID-19 spending by using unspent money sent to at least 30 states as part of last year’s US$1.9 trillion American Rescue Plan riled Democrats from affected states. Facing pressure from both sides, Speaker Pelosi cut the COVID funding from the omnibus measure. The administration of US President Joe Biden originally suggested it would ask for US$30 billion but formally requested US$22.5 billion in funding for testing, vaccines, therapeutics, and efforts to address future variants.

Administration officials have said they are quickly running out of money for COVID-19 response, and the cut leaves the future of the Biden administration’s National COVID-19 Preparedness Plan uncertain. The situation also highlighted the deep political divides over the pandemic and underlined that the pandemic is no longer a national political priority. US House Democrats later introduced a stand-alone bill that would provide US$15.6 billion in COVID-19 funding, but the measure is not expected to pass the Senate. Notably, the Biden administration estimates that monoclonal antibody treatment supplies will last through May, preventive treatments for immunocompromised individuals are expected to run out by July, and antiviral stocks will be depleted by September. Additionally, if additional spending is not authorized, the administration does not have funding to purchase more vaccines if another round of booster shots are deemed necessary, and ongoing research and pandemic preparedness efforts face funding shortfalls.

WHO ON BOOSTERS The WHO’s Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) this week said it “strongly supports urgent and broad access” to primary series and booster doses of SARS-CoV-2 vaccines, particularly for groups at high risk of severe disease. The interim statement represents a policy shift for the agency after Director-General Dr. Tedros Adhanom Ghebreyesus last year urged wealthy nations to forgo booster doses through the end of the year and instead donate the shots to countries in need of additional supplies. The TAG-CO-VAC in January said evidence increasingly supported the use of booster doses, especially for vulnerable populations, but the group did not support “broad access” then as it did this week. Numerous studies have shown that booster doses of authorized vaccines help revive waning immune responses and help protect against severe disease, hospitalization, and death from COVID-19. The TAG-CO-VAC noted that although global vaccine supplies have increased, vaccine equity remains a challenge and efforts to rectify inequities are “strongly encouraged.” The statement also notes the potential need to update vaccines to address SARS-CoV-2 variants, as the currently authorized vaccines are based on the original form of the virus.

LONG COVID Long COVID, or post-acute sequelae of COVID-19 (PASC), is an emerging disease state that is poorly understood. Long COVID is characterized by several symptoms that last from 1 month to years after an acute SARS-CoV-2 infection clears. Symptoms of long COVID can include, but are not limited to, anxiety, depression, "brain fog," chronic fatigue, fever, myalgia, shortness of breath, and sleep problems. Long COVID already has led to an increase in the number of individuals suffering from long-term illness, and this trend may worsen as the pandemic continues. The UK-based disability charity Scope recently claimed that the number of people with mental health problems and chronic chest or breathing problems has risen by 800,000 individuals and 570,000 individuals, respectively, from 2018-19 to 2020-21. Worries are growing that an increase in the number of individuals suffering from long-term disabilities in the UK could also mean an increase in the number of people suffering from poverty and a lack of resources. In the US, Democratic Senator Tim Kaine introduced a bill to improve and expand research into long COVID. Senator Kaine suffers from long COVID and has become a champion for the issue as a result. The White House also has released a plan that includes support for Americans with long COVID.

A series of studies released over the last week have begun to shine a light on the impact of SARS-CoV-2 infection on brain function and cognitive health. The first study, published in Nature on March 7, compared brain scans from 401 individuals before and after SARS-CoV-2 infection. The initial brain scans were part of the UK Biobank that was collecting data before the pandemic began. Individuals were invited back for a second scan approximately 5 months after a SARS-CoV-2 infection. The study also had 384 SARS-CoV-2-negative controls. According to the study, individuals who had a SARS-CoV-2 infection lost between 0.2-2% more gray matter—mostly in areas associated with the sense of smell—than the control group. Additionally, individuals who had been infected had lower scores on cognitive function tests. The findings are significant, but it is still possible that the changes are reversible. A second study, published March 8 in JAMA Neurology, examined cognitive health in a cohort of 1,438 COVID-19 patients who were 60 years and older and who were discharged from hospitals in Wuhan, China, during the first few months of the pandemic. The study found a 12.45% increase in cognitive impairment 12 months after discharge when compared to controls. The authors noted that 21% of individuals who experienced severe cases of COVID-19 experienced cognitive decline within 12 months. A third study, posted March 7 in Open Forum Infectious Diseases, examined new-onset dementia in patients who experienced COVID pneumonia. According to the study, 3% of individuals who experienced COVID pneumonia developed new-onset dementia within 182 days compared with 2.5% of individuals who experienced pneumonia from other causes. Risk factors for new-onset dementia included ages 55 years and older, alcohol use or abuse, Hispanic race, history of depression, and stroke during COVID-19 hospitalization.

Additional complications related to long COVID include cardiovascular issues and nerve damage. A study published February 7 in Nature Medicine compared US Department of Veterans Affairs (VA) electronic health records from 150,000 patients who were infected with SARS-CoV-2 to millions of VA patients who did not have recorded infections. The study found a 4% increase in cardiovascular health issues in the SARS-CoV-2-positive individuals. Individuals who were hospitalized for COVID-19 were twice as likely to experience a significant cardiac event within 12 months of infection when compared to individuals who had milder cases of COVID-19. Another study, published in Neurology Neuroimmunology & Neuroinflammation on March 1, examined data from patients diagnosed with long COVID who did not have a prior history of nerve dysfunction. The study found that long COVID may lead to long-lasting nerve damage and pain. The growing body of research on long COVID indicates that the world may experience a surge in chronic illness once the emergency phase of the pandemic winds down. More research and support will be needed in the coming years to develop appropriate long COVID treatments and ensure that those suffering from long-term consequences of the pandemic are not forgotten.

EVUSHELD Evusheld—a monoclonal antibody treatment that is authorized by the US FDA for pre-exposure prophylaxis of COVID-19 among certain immunocompromised individuals—is going unused. US President Joe Biden has promised to protect the more than 7 million people in the US with weakened immune systems and those who cannot be vaccinated for medical reasons, and Evusheld, which was developed by AstraZeneca with support from the federal government, is a large part of that strategy. The Biden administration has ordered 1.7 million doses, enough to treat 850,000 people. Nearly 200,000 doses will be distributed this week, bringing the total shipped to states and territories close to 850,000. However, confusion about the drug among healthcare providers and a lack of awareness about its availability has left about 80% of those doses unused, sitting in warehouses and on pharmacy shelves.

The FDA recently revised Evusheld’s Emergency Use Authorization, updating the dosing regimen to a higher dose so the treatment might be more likely to protect against infection with certain Omicron subvariants. Additionally, Evusheld is expected to have greater neutralizing activity against the BA.2 sublineage of Omicron. However, the recommendation for doubling the dose will make the treatment even more scarce and could further confuse prescribers and patients. The Biden administration has accelerated its distribution schedule, but without further communication about the therapy’s availability and more equitable distribution, it appears access to the drug will remain complicated.

US MASK MANDATES After Hawai’i lifts its mask mandate on March 25, there will be no state-wide mask mandates in effect in the US. Under new US CDC masking guidance, more than 90% of the nation’s population can choose not to wear masks. However, the agency and other experts maintain that people who want to keep wearing masks can do so and in some cases should, particularly individuals who are immunocompromised or otherwise at high risk of infection or severe disease. However, some who are continuing to mask are reporting harassment and bullying from peers, strangers, and even political leaders. Individuals and communities faced with these new changes to masking guidance may feel liberation, confusion, or anxiety based on their own masking preferences. Experts have had equally mixed reactions. Some praised the move by CDC to adapt to fatigue for COVID-19 precautions, while others criticized the guidance for echoing past mistakes of relaxing measures only to end up facing another surge in cases, and simultaneously placing undue burden on those who are immunocompromised or too young to be vaccinated.

The US Transportation Security Administration (TSA) announced today that it will extend the mask mandate for people using public transportation through April 18. The requirement was set to expire on March 18 and has been extended twice previously. TSA said it will continue to assess the duration of the requirement in consultation with the CDC.

MASKING IN US SCHOOLS As new US CDC masking guidance encourages many communities to drop mask mandates and unmask in public places, a new study published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) has left some school officials in a confused position about whether to continue requiring masking among students and staff. The study compared COVID-19 incidence across 233 school districts in Arkansas that had different masking policies—from universal and partial requirements to no rules—and made additional adjustments for vaccination rates, incidence in the surrounding communities, and socioeconomic status. The researchers found that between August and October 2021, districts with universal masking requirements had a 23% lower incidence of COVID-19 among students and staff compared to districts without masking requirements (incidence rate ratio = 0.77 [95% CI = 0.66–0.88]). While data collection occurred during Delta variant predominance rather than Omicron predominance and adjustments for differences in ventilation were not done, outside experts judge that the evidence is strong that masking requirements had a powerful effect on lowering COVID-19 incidence in schools and remain an important part of multifaceted prevention strategies.

NURSE ADVOCACY Nurses in the US have been celebrated since the start of the COVID-19 pandemic, hailed as heroes in an unprecedented time. Now, the nation’s 4 million nurses and their advocates are using that spotlight to bring attention to healthcare worker shortages and unsatisfactory working conditions. The advocacy push includes plans for a Washington, DC, National Nurses March on May 12 and lobbying efforts with federal and state lawmakers. The primary issue is increased scrutiny of travel nurses, whose wages have risen, sometimes doubling, during the pandemic. Some lawmakers argue that fees for such temporary health workers are too high and are calling for wage caps, while nurses are left wondering why no caps are placed on the pay of doctors or CEOs. Other issues under discussion include caps on patient-to-nurse ratios; antidiscrimination protections and stricter penalties for people who assault healthcare workers; loan repayment and better wages; and additional help to prevent health worker burnout, including more reasonable work hours and sufficient supplies of personal protective equipment (PPE).

https://covid19.who.int/

[ti-amie]

I was out today and with one major exception - a woman in her slippers walking to her car - everyone was masked.

^ Even people outside?

Yes.

[ti-amie]

This rise is being fueled by the new variant.

[dryrunguy]

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

::

PANDEMIC MILESTONE March 11 marked 2 years since the WHO named COVID-19 a pandemic. More than 6 million people—and possibly many more—have lost their lives to SARS-CoV-2, and more than 450 million people have been infected. Notably, the WHO first declared the novel coronavirus a public health emergency of international concern (PHEIC) on January 30, 2020—when there were no deaths outside of China—but global levels of concern did not rise until the agency characterized COVID-19 as a pandemic. At that time, there were more than 118,000 cases and 4,291 deaths in 114 countries. Now, 2 years and millions more deaths later, many wealthy nations are reopening, having benefited from high levels of vaccination coverage and access to diagnostics and treatments, while some middle- and low-income countries (LMICs) continue to endure pandemic-related restrictions with low vaccination coverage and limited-to-no access to tests and therapies. To be sure, the pandemic has laid bare—and in some cases worsened—healthcare inequities among and within nations.

As some of the world seemingly moves on from the pandemic, conditions in other areas remain ideal for new variants to emerge. In the past week, there are signs that some of the sharp declines in new COVID-19 cases due to the Omicron variant could be reversing; Europe and Africa experienced an increase in cases last week, while the Western Pacific region continues to chart record numbers. More than 130 world leaders, economists, humanitarians, scientists, celebrities, and others signed an open letter urging more action to quickly vaccinate people in LMICs and “do what is necessary” to end the pandemic. Even as countries make moves to return to a “new normal” and many SARS-CoV-2 vaccines continue to prove safe and effective at preventing severe disease and death, the pandemic is not over. The virus is impossible to predict, and a new variant could develop the ability to slip past the vaccine- or infection-induced immune protection that much of the world’s population now has. That means public health measures might need to be reinstated and additional vaccine booster doses—or new vaccine formulations that address multiple variants—could be recommended in the future to combat waning protection.

EUROPEAN UPSWING Several European countries—including Austria, Germany, Netherlands, and the UK—are experiencing upswings in COVID-19 case trends over the past week, following weeks of decline. France lifted most of its restrictions on March 14 but is already seeing an increase in cases. Some nations, including the Netherlands and the UK, also are seeing increases in COVID-related hospitalizations. Several factors could be causing the increasing trends, including behavior changes following the removal of mitigation measures or waning vaccination protection. The WHO warned on March 13 that the war in Ukraine, which has forced more than 3 million people to flee to neighboring countries, could worsen the pandemic in Europe. The agency is working to keep medical supplies moving into the region. Hungary, Romania, Slovakia, and Moldova are providing testing, treatment, and vaccines at no charge to Ukrainian refugees.

Other experts posit the Omicron variant of concern (VOC) sublineage BA.2 could be driving an increase in cases. In the UK, researchers with the REACT monitoring program estimate that as of February 21, nearly half (47.2%) of sequenced samples were the BA.2 subvariant. In their previous report from late January, less than 1% of the samples were BA.2. Analysis from the Wellcome Sanger Institute shows that in the week to March 4, BA.2 is responsible for more than 75% of new COVID-19 cases in the country, suggesting the subvariant is now predominant. Notably, the REACT surveillance program, as well as several other UK COVID studies, are losing funding and will cease operations at the end of March. Several experts criticized the moves as shortsighted, saying the recent uptick in cases could portend the beginning of a sixth wave of COVID-19 cases.

In the US, daily cases, hospitalizations, and deaths continue to decline, but some warn the nation—much of which has recently dropped public health measures—should take note. With lower rates of vaccination and booster coverage than many European countries, and the BA.2 sublineage believed to be more transmissible than BA.1, the US could face rising hospitalizations if a new surge develops. The US CDC estimates that BA.2 is now responsible for about 11.6% of new COVID-19 cases in the country as of March 5, up from about 1% at the end of January. Still other experts predict the rising percentage of cases caused by BA.2 should not be cause for alarm in the US, expressing doubt that the subvariant will cause a new surge. They cite the protective effects of vaccines and natural immunity and the effectiveness of some treatments against the Omicron subvariant.

Last week at a briefing, the WHO discussed another variant, AY.4/BA.1 recombinant, or so-called “Deltacron,” which has been detected in a small number of cases in France, Netherlands, Denmark, and the US. WHO officials noted that little is known about the recombinant variant, which combines attributes from the Delta and Omicron variants of concern, but said many studies are ongoing. Several experts outside of WHO said the variant should not be cause for concern at this time.

WASTEWATER SURVEILLANCE Wastewater disease surveillance, which can detect viral fragments shed in feces, has been used for decades to track infectious agents, from polio to norovirus, but the method has moved into the spotlight during the COVID-19 pandemic. The inexpensive method can help monitor infections, predict where outbreaks might occur, and, using the added step of genetic sequencing, provide clues about how SARS-CoV-2 is evolving. In Europe, 26 of the 27 EU Member States have established SARS-CoV-2 wastewater monitoring systems.

The US CDC last month launched a dashboard for its National Wastewater Surveillance System to track SARS-CoV-2 levels in sewage so communities can quickly adapt their public health responses. But with 400 sites in 34 states, focused mainly in areas of high population, and only a dozen states routinely reporting results, the US system has enormous gaps in what could otherwise be a robust monitoring program. Instead of working with local labs to help states stand up surveillance programs, the CDC contracted a large, private commercial lab to assist states. But privacy concerns, logistical challenges, and a lack of trust in the national company have hindered progress in expanding the system. A system with wider coverage would be able to give a more detailed picture of the current pandemic’s fluctuations and also serve as a monitoring system for future disease outbreaks. But some wastewater scientists expressed concern that without permanent and more thoughtful use of funding, wastewater surveillance may never be established in the US as a long-term tool for protecting public health.

US IMMIGRATION POLICIES Early in the COVID-19 pandemic, the US CDC issued an order under Title 42 suspending the right of certain asylum seekers to enter the US at any border crossing or port of entry in order to control the situation in congregate settings where noncitizens are processed and held. Children traveling alone were exempted from the order shortly after US President Joe Biden took office in January 2021. Over the weekend, the CDC terminated the order as it relates to unaccompanied minors after determining the “expulsion of unaccompanied noncitizen children is not warranted to protect the public health.” Testing and other preventive measures now allow these children to be released to sponsors in the US, typically close relatives. The change went into effect shortly before a court order would have forced the CDC to include, not exempt, children from Title 42. The order remains in effect for all other migrants.

However, pressure is mounting for the Biden administration to end the pandemic-related border restrictions for all noncitizen migrants. President Biden made a campaign promise to end what he called the “moral and national shame” of immigration policies put into place under former US President Donald Trump, but is now facing the reality of managing what could amount to record numbers of people seeking asylum in the coming weeks. Refugees from Ukraine are making their way to the US, and last week US Vice President Kamala Harris committed to taking in more asylum seekers from the country during an overseas trip. The same day, a Ukrainian family was barred from entering the country under Title 42. Although US immigration authorities later allowed the family to enter, the situation highlighted the order that some advocates call “absurd and untenable,” especially with the availability of COVID-19 diagnostics, vaccines, and therapies. The CDC has the authority to lift the order, which is set to expire in early April.

THIRD & FOURTH VACCINE DOSES Experts are beginning to look toward the future of preventing COVID-19 cases and hospitalizations, even as many areas of the world continue to recover from surges caused by the Omicron variant of concern. Among potential strategies under review is the need for third and fourth vaccine doses, particularly of mRNA vaccines. Studies are showing that a third dose of mRNA vaccine is needed to reach the same protective levels against Omicron compared to 2 doses for the Delta and Alpha variants. Many people in the US received their third, or booster, dose before and during the Omicron wave to demonstrated efficacy in keeping people out of the hospital; a recent CDC Morbidity and Mortality Weekly Report (MMWR) study showed that unvaccinated persons were hospitalized at a rate 23.0 times higher than boosted, vaccinated persons but at a rate only 5.3 times higher than unboosted, vaccinated persons. Notably, vaccine-derived immunity does wane over time, thus necessitating future doses in order to maintain protective levels. With this expected dip in mind, some are calling for a fourth dose of mRNA vaccines. Pfizer is already planning to submit data on fourth-dose efficacy to the US FDA. A small trial conducted in Israel found that a fourth dose restored immunity levels to where they had been with a third dose, although those levels also are expected to wane.

Nevertheless, many experts are highlighting the pitfalls in continually chasing the next dose of the same vaccine, especially in the context of future variants. For this reason, vaccine manufacturers are also looking at new formulations of vaccines to cover future variants and provide longer-lasting protection. Amidst its plans to submit for authorization of a fourth dose, Pfizer also has committed to developing a longer-lasting vaccine candidate that can cover more potential SARS-CoV-2 variants. The speed and efficacy of first generation SARS-CoV-2 vaccines was remarkable and a technological feat; now vaccine manufacturers must transition to a long-term outlook for maintaining protection against SARS-CoV-2.

CHINA China is facing its largest COVID-19 outbreak since the early days of the pandemic. On March 15, the National Health Commission reported the detection of 3,507 new cases due to community transmission, more than double the 1,337 recorded in the previous 24 hours. At least 15,000 cases have been recorded in recent outbreaks in 28 provinces, with about 80% of cases caused by the highly transmissible Omicron variant. A little more than half of those testing positive are asymptomatic, and no new deaths have been reported. Authorities attribute the large proportion of asymptomatic and less serious cases to the country’s high vaccination rate, which is estimated to be about 87%.

Although the total number of cases is low compared with some other nations, China continues to enforce its “dynamic zero-COVID” approach. In response, China has locked down tens of millions of people in several neighborhoods and cities, including Jilin, where most of the new infections have occurred, and Shenzhen, the nation’s technology hub. The shutdowns are impacting car and tech manufacturing and likely will further disrupt global supply chains. Notably, Shenzhen, in Guangdong Province, shares a border with Hong Kong, which also is experiencing an Omicron-fueled surge in cases. Additionally, Jilin province shares a long border with North Korea, which continues to claim it has recorded no COVID-19 cases. The quick surge is expected to overwhelm healthcare facilities and hospitals, particularly in rural areas, and the country has moved quickly to construct temporary facilities to house thousands of people who test positive. A forecasting model run by Lanzhou University predicted the current surge of infections will be brought under control in early April, racking up about 35,000 cases. However, if the current exponential rise in daily case numbers continues, many more cases will be recorded. The current outbreak is testing China’s costly zero tolerance approach in the face of the highly infectious Omicron variant, but there is no sign the nation will pivot to a “living with the virus” mentality anytime soon, despite deep economic disruption.

HONG KONG Hong Kong is experiencing the worst Omicron variant-fueled COVID-19 surge in the world, recording the highest daily death toll of the pandemic in recent days. As of March 14, Hong Kong reported 19,844 new daily confirmed COVID-19 cases and 285 new daily deaths. It appears the city has moved beyond its peak in cases, and the number of daily deaths might be stabilizing. Still, Hong Kong’s healthcare system is overwhelmed and morgues are over capacity. The primary factor driving the surge is a low vaccination rate among those over age 80—only about 30% have received at least 1 dose—despite the availability of the shots. Comparatively, about 80% of older adults are vaccinated in the US. Additionally, the type of vaccine could be playing a role in the city’s higher death rate. A majority of vaccinated elderly received the Chinese-made CoronaVac, which has been shown to offer little to no protection against Omicron.

About 70% of assisted-living homes are experiencing outbreaks, and thousands of older adults have died of COVID-19. Hong Kong is working to maintain its “zero COVID” strategy of mass testing, contact tracing, border closures, and quarantines that kept SARS-CoV-2 at bay for the past 2 years. Nearly 300,000 of Hong Kong’s 7.4 million residents are isolating at home, and many have left the city to avoid compulsory testing, travel bans, and quarantines. Those who test positive on a rapid test—including those with mild or no symptoms—can be prosecuted if they refuse to enter a government-run quarantine center, unless the facilities are full. The government is working to construct additional isolation centers out of shipping containers. Some experts warn the initially successful “zero COVID” policy might have bred complacency, leading some people to forgo vaccination and catching the government off guard for the arrival of Omicron. Hong Kong’s situation also highlights the importance of vaccination in helping to prevent widespread disruption and protect people from hospitalization and death.

[Deuce]

This rise is being fueled by the new variant.

But... but... but... the governments said the virus is gone, everything is ok now, and we can return to 'normal'.

They wouldn't lie to us, would they?

[dryrunguy]

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

::

US PREPAREDNESS FOR BA.2 Public health professionals are warning state and federal government officials of a potential uptick in COVID-19 cases and hospitalizations due to the increasing prevalence of the Omicron subvariant BA.2. During a briefing this week, White House Chief Medical Advisor Dr. Anthony Fauci shared that current evidence suggests BA.2 is 50%-60% more transmissible than the original Omicron variant (BA.1), with similar clinical presentations. The US CDC estimates that 35% of new cases are caused by the BA.2 subvariant, and officials predict that it likely will become the predominant variant over the coming weeks.

US health officials are watching the situation in other countries, including the UK and France, for clues about how the BA.2 subvariant might impact the US. In the UK, new COVID-19 case numbers have doubled in the past 3 weeks, and hospitalizations also are rising. Case numbers also are rising in France, where most COVID-related mitigation protocols were recently lifted. There is some hope that the increased proportion of individuals with immune protection from vaccination, natural infection, or a combination could help blunt a new wave of infections in the US, leading to a less stark surge in new cases. However, many states and jurisdictions are dropping mitigation measures, reporting COVID-19 data less frequently, and closing testing sites, leaving many experts to worry these changes will create blindspots that could lead to delayed responses. Others warn the country is letting its guard down too early. Additionally, the administration of US President Joe Biden said it is quickly running out of funding to address the pandemic. All of these developments have left many, especially vulnerable populations, worried about the weeks to come.

MODERNA VACCINE Late last week, Moderna submitted a request to the US FDA for Emergency Use Authorization (EUA) of a second booster dose of its SARS-CoV-2 vaccine for all adults. Moderna’s application extends beyond the scope of Pfizer-BioNTech’s recent EUA request for a second booster dose, as that submission was limited only to adults 65 years of age and older who have received an initial booster. In a press release, Moderna explained its rationale for including an extended population pool is to provide greater flexibility to the US CDC and other healthcare providers when determining future vaccination guidance for the people in the US. Like Pfizer-BioNTech, Moderna cited data from Israel showing increased immune resilience among populations who received a fourth dose during Omicron predominance. The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) is scheduled to meet on April 6 to discuss considerations for future vaccine booster doses, as well as the process for selecting specific strains of SARS-CoV-2 for vaccines to address current and emerging variants. However, the committee will not be discussing specific applications and no vote is planned. Moderna also announced that Canada joined Australia and the EU in authorizing its SARS-CoV-2 vaccine for children aged 6-11 years.

VACCINE EFFECTIVENESS Once SARS-CoV-2 vaccines were developed, tested, and authorized for use, focus shifted toward evaluating their effectiveness in the broader population. Two of the principal concerns are the duration of protection and effectiveness against emerging SARS-CoV-2 variants. With the US past its Omicron peak, the US CDC has a wealth of data available for these analyses. The CDC’s COVID-19 Emergency Response Team published findings comparing vaccine effectiveness (VE) against hospitalization during the Omicron surge, based on data from 14 states collected from July 2021 to January 2022. At the peak of the Omicron surge, weekly per capita hospitalizations peaked at 38.4 per 100k population, compared to 15.5 during the Delta surge, and full vaccination with a booster reduced the risk of hospitalization by a factor of 12 compared to unvaccinated adults and a factor of 4 compared to adults with full vaccination and no booster. Additionally, hospitalizations during the Omicron surge were higher than during the Delta surge among both vaccinated and unvaccinated individuals. Hospitalization risk among non-Hispanic Black adults was the highest among all racial and ethnic groups and nearly 4 times the risk among non-Hispanic White adults. The researchers noted that non-Hispanic Black adults represented a larger proportion of unvaccinated adults during the Omicron surge than during the Delta surge, which likely factored into the higher hospitalization risk.

The COVID-19 Emergency Response Team also published findings from a study on mRNA SARS-CoV-2 vaccine effectiveness against invasive mechanical ventilation (IMV) and death. The researchers conducted a case-control study across 21 US medical centers from March 2021-January 2022, spanning both the Delta and Omicron surges. The study included more than 7,500 hospitalized COVID-19 patients—1,440 hospitalized adult COVID-19 patients who received IMV or died (case) and 6,104 hospitalized adult patients who tested negative for SARS-CoV-2 infection (control). Most of the vaccinated COVID-19 patients who received IMV or died “had complex underlying conditions, commonly immunosuppression.” The researchers estimated the overall VE against IMV or death to be 90%, including 88% for 2 doses and 94% for 3 doses (eg, including a booster). Specifically during the Omicron surge, the researchers estimated the effectiveness to be 79% for 2 doses and 94% for 3 doses. The overall VE among individuals who received their second dose more than 150 days prior was 84%, compared to 92% for those who received theirs 14-150 days prior. This study provides further evidence that mRNA vaccines provide substantial protection against severe COVID-19 disease and death—particularly with booster doses—including over prolonged periods and against emerging variants.

As the BA.2 subvariant begins to overtake the original Omicron subvariant (BA.1), experts have raised concerns about the continued effectiveness of SARS-CoV-2 vaccines against yet another variant. A study (preprint) of nearly 140,000 individuals conducted by researchers in Qatar found that the Pfizer-BioNTech and Moderna vaccines exhibited high effectiveness against symptomatic COVID-19 disease caused by BA.1 or BA.2 for 4-6 months after the second dose, but protection declined sharply after that point, down to approximately 10%. Booster doses restored some efficacy against both subvariants, back up to 30-60%. These data align closely with data from the UK, which show effectiveness less than 20% at 25 weeks or longer, but a third dose can increase effectiveness to approximately 70%.

A study by researchers in the UK evaluated VE for the Pfizer-BioNTech and Moderna vaccines against symptomatic disease after 1 dose among adolescents. The study utilized a case-control design and included data from children aged 12-17 years collected starting September 13, 2021, when vaccination was authorized for children aged 12-15 years. Because the UK recommends the 2 doses be administered 8-12 weeks apart, as opposed to 3, it provides the opportunity to evaluate 1-dose efficacy in this age group. The 1-dose effectiveness against the Delta variant among the 12-15 year age group peaked at 74.5% between 14 and 20 days after vaccination, before declining to 45.9% at 70-83 days. Against the Omicron variant, the 1-dose effectiveness peaked at 49.6% and declined to 16.1%. After the second dose, effectiveness peaked at 93.2% against the Omicron variant and 83.1% against the Delta variant. Similar results were observed among the 16-17 year age group, although the 2-dose effectiveness declined rapidly for the Omicron variant at Day 34 after the second dose. The vaccines exhibited 83.4% and 76.3% effectiveness against hospitalization for the Delta variant after 1 dose among the 12-15 year and 16-17 year age groups, respectively, but follow-up was not completed for 2 doses or the Omicron variant. This study provides further insight into the protection conferred against the Omicron variant, but the timing of the doses makes it difficult to compare against the efficacy estimates from clinical trials.

TYPE 2 DIABETES People who recover from acute SARS-CoV-2 infection, whether mild or severe, could experience myriad post-acute sequelae and long-term symptoms lasting weeks or months, including fatigue, shortness of breath, anxiety, depression, and cognitive impairments. The condition is known as post-acute sequelae of COVID-19 (PASC), or long COVID. Evidence is growing that people who recovered from COVID-19 within the past year have an increased risk of cardiometabolic conditions, including new onset diabetes. A study published online in The Lancet Diabetes & Endocrinology examined the post-acute risk and burden of incident diabetes in people who recovered from COVID-19. Researchers examined US Department of Veterans Health Administration (VHA) records of a cohort of 181,280 US Veterans who survived the first 30 days of SARS-CoV-2 infection between March 2020 and September 2021 and compared them with 2 large control groups—a contemporary cohort of more than 4.1 million non-infected participants who used VHA services during the same time period and a historical cohort of another 4.28 million non-infected participants who used VHA services during 2017.

Overall, COVID-19 was significantly associated with an increased risk of incident diabetes. Individuals who survived COVID-19 were 46% more likely than those with no history of COVID-19 to develop new onset diabetes (primarily Type 2) or be prescribed medication to control their blood sugar. In another calculation, the researchers found an excess burden of 1.8 per 100 people would develop diabetes or blood sugar control issues at 12 months. People older than 65 years and those with cardiovascular disease, high blood pressure, high cholesterol, or prediabetes had higher risks and burdens than younger individuals or those without underlying conditions. Additionally, Black participants had higher risks and burdens than White participants, although the researchers note that the cohort consisted primarily of White males, possibly limiting the generalizability of the findings. Notably, the risks and burdens increased according to the severity of the acute infection. Even those patients at low risk of diabetes prior to SARS-CoV-2 infection showed an increased risk of developing the condition compared to controls. The researchers concluded that diabetes and hyperglycemia should be considered in treating people recovered from COVID-19 and included in the definition of long COVID. They also warn the association between COVID-19 and incident diabetes could have significant global implications.

Another study, published recently in Diabetologia and based on records from a nationwide primary care database in Germany, found those recovered from COVID-19 had a 28% greater risk of developing Type 2 diabetes than people who never had COVID-19. Those researchers also encouraged blood sugar monitoring for all recovered COVID-19 patients. An international group of researchers have established the global CoviDIAB Registry to track COVID-19-related diabetes and severe metabolic disturbances and to examine the conditions’ pathogenesis, management, and outcomes.

US INDOOR AIR QUALITY As part of US President Joe Biden’s National COVID-19 Preparedness Plan, the US Environmental Protection Agency (EPA) last week launched the “Clean Air in Buildings Challenge” to reduce the risk of airborne viruses, including SARS-CoV-2, and other indoor contaminants. The Challenge includes a call to action for building owners and operators, schools, colleges and universities, and other organizations to assess indoor air quality and make improvements to ventilation and air filtration. Additionally, the EPA published a best practices guide, developed collaboratively with other federal agencies, that provides recommendations grouped into 4 categories: creating clean indoor air action plans, optimizing fresh air ventilation, enhancing air filtration and cleaning, and engaging those in the building community. The plan does not provide technical guidance nor discuss the cost of implementing air quality upgrades, although the EPA noted that funds from the American Rescue Plan and Bipartisan Infrastructure Law can be used to supplement investments in improving indoor air quality in public spaces.

The EPA has worked for many years to help schools improve their air quality, and the COVID-19 pandemic has brought renewed attention to the issue. Research shows that air quality improvements in schools can greatly impact health and learning, beyond reducing the risk of SARS-CoV-2 transmission. Improvements in ventilation and filtration are associated with lower rates of influenza, asthma, and absenteeism, as well as higher reading and math test scores. Advocates hope the Challenge will spur more schools and other buildings to make short- and long-term improvements as part of a layered mitigation approach to disease prevention.

PFIZER ANTIVIRAL The United Nations-backed Medicines Patent Pool (MPP) has signed agreements with 36 generic drug manufacturers in 13 countries to produce a generic version of Pfizer’s oral COVID-19 treatment for use in 95 low- and middle-income countries (LMICs) representing more than half of the world’s population. The oral treatment, known by the brand name Paxlovid, is a combination of the antiviral medications nirmatrelvir and ritonavir. The sublicense agreements are the direct result of a November 2021 voluntary licensing agreement between MPP and Pfizer. Under the agreements, the manufacturers will not need to pay royalties as long as the WHO continues to classify the COVID-19 pandemic as a public health emergency. When that designation ends, the companies can continue to sell the medication royalty-free to low-income countries but will be required to pay 5%-10% royalties on sales to certain middle-income nations. Not all of the manufacturers will fully produce the generic medication; 6 will produce ingredients, 9 will perform fill-and-finish operations, and the remaining will conduct both services. Most of the manufacturing companies—which are located in Asia, the Middle East, North and South America, Eastern Europe, and the Caribbean—indicated it will take them months to begin production. Merck and Ridgeback Biotherapeutics, which produce the oral antiviral molnupiravir, made a similar deal with the MPP in October 2021.

In a separate agreement, Pfizer will sell the United Nations Children’s Fund (UNICEF) up to 4 million courses of Paxlovid to distribute to the same 95 LMICs. Shipments of the pills will begin next month and are intended to bridge the gap in supplies until generic production is up and running. The company is providing a tiered pricing system, with low-income countries receiving the pills at lower pricing than more wealthy nations. The exact financial terms of the agreement were not disclosed.

500 MILLION DOSES US Secretary of State Antony Blinken announced last week that the US has donated more than 500 million doses of SARS-CoV-2 vaccines to more than 110 countries worldwide, bringing it closer to US President Joe Biden’s pledge to donate at least 1.2 billion doses. Notably, the US does not have data on how many of those doses have been administered and needs the US Congress to authorize additional funding for global vaccination efforts to continue. In marking the milestone, US Agency for International Development (USAID) Administrator Samantha Power said a lack of additional funding would “devastate” the agency’s efforts to help other nations deploy vaccines, as well as COVID-related diagnostics, treatments, and other supplies. Administrator Power called on the US Congress to urgently supply additional funding. Additionally, the White House has warned it will soon run out of money to purchase COVID-19 treatments and vaccines, and to maintain testing capacity domestically. A supplemental COVID-19 funding bill currently under consideration in the US Senate could provide up to US$15.6 billion, but with Republicans reluctant to approve the plan, it appears the US is set to continue its cycle of pandemic panic and neglect.

[MJ2004]

Dry, I want to thank you for continuing to post the Situation Reports. They've been a source of invaluable information all along for those of us who are too lazy to look them up ourselves.

Especially now that Covid news stories have fallen by the side.