Covid-19 Updates & Info

[JazzNU]

You're welcome, ponchi. Tomorrow morning, I'll have a few hours to kill while dolphins is having a nerve kill done, so I'll use part of that time to swing by the pharmacy where I received both of my shots (once it opens) to ask them what they have been told and what they recommend regarding those of who started with J&J, then went Moderna, but don't fall into "waiting for fourth dose" territory. No one ever talks about our situation.

I think that's a good idea.

Here's additional guidance from the CDC for immunocompromised who got J&J and then a MRNA booster. They say to get 2nd MRNA booster for a total of 3 doses.

https://www.cdc.gov/coronavirus/2019-nc ... mmuno.html

[dryrunguy]

You're welcome, ponchi. Tomorrow morning, I'll have a few hours to kill while dolphins is having a nerve kill done, so I'll use part of that time to swing by the pharmacy where I received both of my shots (once it opens) to ask them what they have been told and what they recommend regarding those of who started with J&J, then went Moderna, but don't fall into "waiting for fourth dose" territory. No one ever talks about our situation.

I think that's a good idea.

Here's additional guidance from the CDC for immunocompromised who got J&J and then a MRNA booster. They say to get 2nd MRNA booster for a total of 3 doses.

https://www.cdc.gov/coronavirus/2019-nc ... mmuno.html

Thanks, Jazz. So that's different than anything I've read to this point. According to that, what does "at least 2 months after" of the second done of Moderna mean? Right now, I'm at the 2 month threshold after my second dose and my first dose of Moderna. Is there a reason to believe it would preferable to wait another month or two to get the third jab? And to what degree does the fact that 6 months lapsed between my initial J&J dose and my first Moderna dose mean? (Because that was the guidance at the time. I got my second dose as soon as I read that existing evidence (again, at that time) indicated that the J&J vaccine MIGHT only be good for 4 months.

And I am not immunocompromised (as far as I know).

It's all so confusing.

[JazzNU]

Thanks, Jazz. So that's different than anything I've read to this point. According to that, what does "at least 2 months after" of the second done of Moderna mean? Right now, I'm at the 2 month threshold after my second dose and my first dose of Moderna. Is there a reason to believe it would preferable to wait another month or two to get the third jab? And to what degree does the fact that 6 months lapsed between my initial J&J dose and my first Moderna dose mean? (Because that was the guidance at the time. I got my second dose as soon as I read that existing evidence (again, at that time) indicated that the J&J vaccine MIGHT only be good for 4 months.

And I am not immunocompromised (as far as I know).

It's all so confusing.

To my knowledge, the CDC hasn't advised those who are not immunocompromised to get an additional booster shot yet. I've seen the same echoed by other public health professionals, that if you're not immunocompromised and also not working in healthcare, then you're fine with the original course plus the booster. But that's a good question to ask the pharmacist, maybe they are moving in a new direction soon and they have different advice.

Personally, the uncertainty you have about when to get a shot and if it's needed, is part of why I got an antibodies test last fall. I wanted some idea of where I was and thought it might be a good measuring stick if I'm not exactly sure about when in the future. But also, I believe I'm higher risk than you are, so I'm a bit paranoid about trying to stay ahead of the curve knowing I don't have the best outcome if I get it. But I think it's really hard to know now matter what series of shots you got, though I understand that J&J is talked about by far the least.


Also, meant to say this in my last post. I hope Dolphins is doing okay and please tell him I said hi.

[dryrunguy]

Thanks, Jazz. Dolphins is fine. They'll do the same nerve kill tomorrow--but on his right shoulder.

[dryrunguy]

So, I did talk to the woman who oversees vaccinations at the pharmacy where I got my jabs. She admitted the guidance is constantly changing based on emerging evidence. But at this point in time, I am actually NOT eligible for a booster (she referred to it as the fourth dose, even though I've only had two doses so far... they are still counting the initial J&J vaccine as two doses), and there is currently no timeline for when "normal" people like me should seek the fourth those. Currently, fourth doses are only available to people who are immunocompromised.

It was nice to at least get some clarity.... Clarity that will probably change again next week.

[dryrunguy]

Meanwhile, here's the latest Situation Report. Haven't read it yet.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 426.6 million cumulative cases and 5.9 million deaths worldwide as of February 23. The global weekly incidence continues to decline, down 21.1% from the previous week. Notably, all WHO regions with the exception of the Western Pacific region (+28.8%) reported decreasing weekly incidence last week. Global weekly mortality fell 10.85% from the previous week. We expect the cumulative number of deaths to pass 6 million within the next 2 weeks.

Global Vaccination
The WHO reported 10.4 billion cumulative doses administered globally as of February 21. A total of 4.87 billion individuals have received at least 1 dose, and 4.29 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations continues to increase, closely following the trend in Asia. The trend is up from the most recent low of 18.34 million doses per day on February 7 to 24.8 million per day on February 22.* The global weekly average jumped to 33.4 million doses per day on February 23, corresponding to a large increase reported in Asia and may be a reporting error.** Our World in Data estimates that there are 4.93 billion vaccinated individuals worldwide (1+ dose; 62.6% of the global population) and 4.36 billion who are fully vaccinated (55.4% of the global population). A total of 1.27 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.
**The OWID data show 17.65 million doses reported in Asia on February 22 and 26.75 million on February 23 (+9.1 million), but it is not immediately clear what country or countries accounted for that increase.

UNITED STATES
The US CDC is currently reporting 78.52 million cumulative cases of COVID-19 and 936,162 deaths. Daily incidence continues its sharp decline, down from a record high of 807,285 new cases per day on January 15 to 79,539 on February 22, a 90% decrease. Daily mortality appears to have peaked on February 2 at 2,597 deaths per day, down to 1,602 on February 22.*
*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 687.7 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.78 million doses per day on December 7 to 337,874 on February 18.* A total of 253.2 million individuals have received at least 1 vaccine dose, which corresponds to 76.3% of the entire US population. Among adults, 87.8% have received at least 1 dose, as well as 26.5 million children under the age of 18. A total of 215.1 million individuals are fully vaccinated**, which corresponds to 64.8% of the total population. Approximately 74.9% of adults are fully vaccinated, as well as 21.8 million children under the age of 18. Since August 2021, 93.4 million individuals have received an additional or booster dose. This corresponds to 43.4% of fully vaccinated individuals, including 66% 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 5 days. The most current average provided here corresponds to 5 days ago.
**Full original course of the vaccine, not including additional or booster doses.

RUSSIAN INVASION OF UKRAINE Russia began a military invasion of neighboring Ukraine this morning, destroying more than 70 military targets through land, sea, and air assaults. The invasion represents the largest attack by one state against another in Europe since World War II. Although the COVID-19 pandemic has played no role in the Russian invasion of Ukraine, the incursion likely will impact virus transmission, testing, surveillance, and treatment for the foreseeable future. The current surge of COVID-19 cases due to the Omicron variant appears to have peaked in both Ukraine and Russia, but the numbers of new cases in both countries remain at record-high levels, and Ukrainian authorities have warned that, despite a 99% vaccination rate among its army, transmission is occurring on the Russian battlefront. The fighting is forcing people to travel west, crowding trains and roads in an effort to reach smaller towns and villages on the European Union border or cross the border into neighboring countries. Poland, Hungary, Slovakia, and Romania are preparing for an influx of refugees. Amid the pandemic, the Ukraine crisis indicates that balance-of-power politics have returned, confirms that pandemics can threaten military power, and reminds us that war has innumerable impacts on human health.

VACCINATION INTERVALS To increase the safety profile of mRNA vaccines, the US CDC is now recommending that certain groups wait longer between their first and second doses. The standard timeline between doses for the Pfizer-BioNTech and Moderna vaccines is 3 and 4 weeks, respectively. Some groups, including men between the ages of 12-39 years old, are now recommended to wait 8 weeks between doses in order to further decrease the risk of myocarditis. Men in this age group appeared to be at a higher relative risk of developing myocarditis following vaccination with an mRNA vaccine, which has prompted further research on ways to mitigate this outcome. Myocarditis associated with vaccination has a low relative risk, around 3.24, compared to the relative risk of COVID-associated myocarditis, around 18.28. Still, new evidence indicates that an 8-week interval between doses can further decrease the risk, which prompted CDC’s change in advice. People not in this group, such as the elderly and immunocompromised, are still recommended to receive their doses on the original 3- and 4-week schedules to prevent severe illness from COVID-19 should they be infected. However, more studies are continuing to evaluate whether a slightly longer period between doses, such as 6 weeks, might result in greater protection for all vaccine-eligible groups.

SANOFI-GSK VACCINE Sanofi and GSK are planning to request US FDA and European Medical Agency (EMA) authorization for their SARS-CoV-2 vaccine candidate—as a primary series and booster dose—following promising results in phase 3 clinical trials. The Sanofi-GSK candidate is an adjuvanted recombinant protein-based vaccine, which is a more traditional vaccine platform compared to the relatively new mRNA vaccines. These vaccines tend to have a good safety profile and have less complicated storage requirements, but mediocre results from a previous iteration kept Sanofi and GSK from applying for authorization last year. This modified candidate has now shown strong efficacy and safety in trials, with 100% efficacy against severe COVID-19 disease and hospitalization. While efficacy against symptomatic infection was around 58%, the vaccine creators assert that these numbers are in line with expected efficacy in the current variant-dominant environment and point to its strong performance against severe and moderate disease outcomes. Novavax, another manufacturer with a protein-based vaccine candidate, is awaiting US FDA review of its request for authorization. Canada and Singapore recently cleared the Novavax vaccine, known as Nuvaxovid, for use among adults.

TESTING & SURVEILLANCE A WHO official recently expressed concern that reduced SARS-CoV-2 testing and surveillance could be contributing to a decline in global COVID-19 cases, saying the falling number of cases and deaths “may not be real.” WHO COVID Technical Lead Dr. Maria Van Kerkhove urged countries to continue their surveillance systems, especially as the number of cases caused by the more transmissible Omicron variant of concern (VOC) BA.2 sublineage begins to climb worldwide. In addition to tracking cases among humans, some experts are encouraging more attention be paid to the hundreds of animal species that are potentially able to be infected with SARS-CoV-2. Cats, dogs, mice, tigers, red fox, deer, and other mammals can be infected by the virus, which could establish itself, mutate, and spread to other species, including back into the human population. Scientists worldwide are collecting genomic surveillance data on various animals, and the World Organisation for Animal Health (OIE) publishes monthly situation reports on SARS-CoV-2 animal investigations. A preprint study posted to medRxiv shows the detection of both the Alpha and Delta variants in Pennsylvania (US) white-tailed deer, the first time those variants have been found in deer. The data for the study, which is not yet peer-reviewed, was collected prior to the emergence of the Omicron variant. Additional long-term funding is needed for research to better understand how animal health is linked to human health, and vice versa.

POST-VACCINATION MIS-C The risk of developing multisystem inflammatory syndrome in children (MIS-C) is very low among young people who were vaccinated against COVID-19, according to a study published in The Lancet Child & Adolescent Health. Using surveillance data from the nationwide Vaccine Adverse Event Reporting System (VAERS), researchers identified 21 young individuals who experienced MIS-C following vaccination between December 14, 2020, and August 31, 2021. All 21 individuals were hospitalized but all were discharged home. As of August 31, 2021, 21.3 million individuals aged 12 to 20 years had received 1 or more doses of SARS-CoV-2 vaccine, making the overall reporting rate of MIS-C following vaccination 1 case per million. Among those individuals who had no evidence of previous or current SARS-CoV-2 infection, the reporting rate was 0.3 cases per million vaccinated individuals.

The rare condition—which can cause dangerous inflammation in major organs as well as vomiting, diarrhea, and low blood pressure—can also follow SARS-CoV-2 infection, showing up sometimes weeks after acute infection. The US CDC updates its data on MIS-C cases monthly. As of January 31, there have been 6,851 cases with 59 associated deaths reported by state and local jurisdictional health departments. Those cases represent a very small portion of the more than 12.5 million COVID-19 cases that have been reported in children since the beginning of the pandemic. Some experts worried that the number of MIS-C cases would spike during the recent wave of cases caused by the Omicron variant, but fortunately that concern has not yet become reality. The CDC and others are working to learn more about why and how MIS-C occurs, and several studies investigating the long-term consequences of MIS-C, its presentation in children, and pathways for treatment and recovery are underway.

FRACTIONAL VACCINE DOSES Administering fractional, or reduced, SARS-CoV-2 vaccines doses could increase global supply, produce fewer side effects, and hasten vaccination uptake. While additional data must be collected, evidence suggests that half or quarter doses of some SARS-CoV-2 vaccines—used as part of a primary series or as booster shots—could be nearly as or even more efficacious than currently used doses of the same or similar vaccines. The Coalition for Epidemic Preparedness Innovations (CEPI) and Australia’s Murdoch Children’s Research Institute (MCRI) announced the launch of a global clinical trial to investigate the efficacy and acceptability of fractional booster doses. Up to 3,300 healthy adults who have received a primary vaccination series with either Pfizer-BioNTech, Oxford-AstraZeneca, Sinovac, or Sinopharm vaccines will receive either a full or fractional booster dose of either the Pfizer-BioNTech, Moderna, or Oxford-AstraZeneca vaccine. The trial, supported with up to US$8.7 million from CEPI, is part of the organization’s Call for Proposals to evaluate the impact of reduced SARS-CoV-2 vaccines in an effort to stretch global supplies and improve vaccine equity.

VACCINE SUPPLY & DEMAND Only about 12% of people in low-income countries are fully or partially vaccinated against COVID-19, but for the first time since the beginning of the pandemic, global vaccine supply is outpacing demand. The COVAX initiative is working to place more than 300 million vaccine doses in countries that need them, but those nations now face other challenges such as gaps in cold-chain storage, lack of funding for distribution networks and administration supplies such as syringes, and stalled vaccination uptake. Additionally, the Africa Centres for Disease Control (Africa CDC) plans to ask all vaccine donations be paused until later this year so countries can avoid wasting the shots if they expire and focus instead on bolstering vaccination logistics and last-mile strategies.

In countries with sufficient supplies, efforts are being made to get more people vaccinated. In South Africa, the government is shortening the required intervals between the first and second doses of a primary series and between the second dose and a booster shot, as well as offering heterologous booster dosing. In Uganda, which has a history of passing controversial public health-related laws, the parliament is considering adopting a vaccination mandate that would result in harsh penalties for people who refuse to comply, including steep fines of about US$1,137 or imprisonment for 6 months. Rights groups criticize the proposal and have called for officials to institute a more organized and inclusive vaccine rollout. Although governments hold much of the power to make vaccines accessible and acceptable, it will take coordinated efforts involving multiple stakeholders to improve vaccine uptake in many low- and middle-income countries.

US TRUCK CONVOYS After police in Ottawa, Canada, earlier this week cleared demonstrators who occupied the capital city for more than 3 weeks in protest against SARS-CoV-2 vaccine mandates and other pandemic restrictions, spin-offs of the so-called “Freedom Convoy” are taking shape across the US. Convoys of trucks are threatening to inundate the Washington, DC, metropolitan area as soon as this week, arriving from as near as Pennsylvania and as far as California, as well as hold a rally near the Washington Monument on March 1, the day US President Joe Biden is scheduled to deliver the annual State of the Union address. In anticipation of the protests, the US Department of Defense approved the deployment of 700 unarmed National Guard troops, at the request of the DC government and the US Capitol Police, to assist with traffic and mitigate possible disruptions. The California convoy—dubbed the “People’s Convoy”—departed Adelanto, California, on February 23 amid much fanfare and is expected to arrive in the DC area on March 5. The convoy is demanding an end to the national emergency first declared by former US President Donald Trump and recently extended by President Biden; a congressional investigation into the origin of SARS-CoV-2; and an end to government-issued public health measures including mask mandates and vaccination requirements. Unlike the Canadian truck convoy demonstrators, American truckers have no vaccination requirement to cross the US-Canada border, and most states have eased masking and vaccination requirements as the number of new COVID-19 cases fall.

The Freedom Convoy protests also have inspired similar demonstrations against pandemic mitigation measures in other countries. Authorities in Austria, Belgium, and France earlier this month banned motor protests in their capital cities. In New Zealand, people protesting the nation’s vaccination mandate have occupied Parliament grounds for at least 17 days, with what began as a peaceful demonstration turning violent this week. Today, protestors chased Prime Minister Jacinda Ardern’s vehicle down a driveway as she visited a Christchurch primary school. Earlier this week, Prime Minister Ardern expressed concern for police safety after several officers were hospitalized after protestors threw an unidentified liquid in their faces. She has resisted calls to use emergency powers or defense forces to dispel protesters. The convoys and occupations represent a show of frustration at the years-long pandemic and associated efforts to control transmission of the virus and expose ideological rifts that can be exacerbated by misinformation, disinformation, and conspiracy theories.

https://covid19.who.int/

[JazzNU]

So, I did talk to the woman who oversees vaccinations at the pharmacy where I got my jabs. She admitted the guidance is constantly changing based on emerging evidence. But at this point in time, I am actually NOT eligible for a booster (she referred to it as the fourth dose, even though I've only had two doses so far... they are still counting the initial J&J vaccine as two doses), and there is currently no timeline for when "normal" people like me should seek the fourth those. Currently, fourth doses are only available to people who are immunocompromised.

Yeah, so if people on here don't personally know anyone who is immunocompromised and understand why they have different guidance than others, this will helpfully give you some idea.

My mom is immunocompromised. She's on a medication that suppresses her immune system and it is vital that she stays on the medication for her to remain in good health.

My mom and I both got vaccinated with Pfizer and it was only days apart. In the fall when I got my antibodies test, right before she went to get her booster shot, she decided why not also get an antibody test as well. Glad we did that. It was 6 months after our initial series. It's not a definitive showing of your antibody levels, only measures the one thing, but still, it was good to know something. My antibody levels were almost 3x that of hers. And I do not have a great immune system, I can get sick at the drop of a dime and have a chronic illness that has affected it as well. So for those to be the differences, are the reason for the different guidelines.

Their antibody levels dip much quicker than others and they are much more prone to a negative outcome. There are a ton of stories about what levels come back for the immunocompromised, some have trouble showing almost any antibodies shortly after getting the vaccine, others do okay to start, but drop off much quicker than the norm. My mom, though more vulnerable than the norm, is one of the lucky ones, in that she kept at least some antibodies 6 months after the fact. It's part of why there's hope for one of the pills in late development, it's shown to to boost antibody levels in the immunocompromised that have struggled to keep their levels up thru the vaccine.

[JazzNU]

[JazzNU]

^^ This is of course on top of a host of cities and states that have previously announced expiring or expired mask mandates as Omicron wanes.

[ti-amie]

Let's talk to Denmark about this...

Also, keeping my mask on.

[dryrunguy]

Here's the latest Situation Report.

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US CDC MASK GUIDANCE The US CDC issued new guidance on February 25 on when US residents should consider wearing masks to lower the risk of SARS-CoV-2 transmission. The strategy moves beyond using the number of new COVID-19 cases and percentage of positive test results over the previous week as benchmarks and instead considers 3 different metrics—new COVID-19 admissions per 100,000 population in the past 7 days, the percent of staffed inpatient beds occupied by COVID-19 patients*, and total new COVID-19 cases per 100,000 population in the past 7 days—to determine US counties’ COVID-19 community level. Using that data, community level is classified as low (green), medium (yellow), or high (orange), and the CDC released an interactive map allowing people to search visually or by county name to determine counties’ COVID-19 community level. The agency advises universal indoor masking, including in schools, only in counties with a “high” COVID-19 community level. In medium-risk communities, the agency recommends those who are at an increased risk of severe disease ask their doctor about wearing a mask. Others in medium- and low-risk communities may choose whether or not to wear a mask, regardless of vaccination status. However, the agency continues to recommend vaccination and boosters for all eligible people, and anyone with symptoms, a positive SARS-CoV-2 test, or exposure to someone with COVID-19 should wear a mask in public. The new strategy does not apply to travelers on airplanes, trains, and buses and at airports and train stations. The CDC plans to soon revisit those requirements, which are set to expire on March 18.

Many public health experts agreed the changes make sense, with some saying masks should become a normalized courtesy, where people wear them out of respect if they have symptoms. Others, including individuals made vulnerable to severe COVID-19 because of compromised immune systems or other conditions, feel left behind under the new guidance. The administration of US President Joe Biden announced last week it is taking steps to make masks and tests more accessible to people with certain disabilities, but some advocates say the efforts have been slow to materialize and viewed as an afterthought. The new CDC mask recommendations, as well as the waning number of new COVID-19 cases nationwide, also led some experts to warn that, while hopeful, these conditions do not signal the end of the pandemic. According to a recent poll from the Kaiser Family Foundation, most adults disagree about what a return to normal means and when it should occur. And while most agree that the worst of the pandemic is over, there remains uncertainty about the future, with 17% of adults saying the worst is yet to come. With mask mandates and other pandemic-related restrictions being dropped across the country, President Biden is expected to address the state of the pandemic in his first State of the Union address this evening but stop short of declaring victory.
*Hospitalizations are counted as all patients with COVID-19, regardless of reason for admission.

VACCINE EFFECTIVENESS Data compiled by the New York State Department of Health indicates that the smaller Pfizer-BioNTech SARS-CoV-2 vaccine is less effective at preventing infection and COVID-19-related hospitalization in children ages 5 to 11 years compared with older children ages 12 to 17. The findings, which are not yet peer-reviewed, showed quicker declines in vaccine effectiveness (VE) in the younger cohort. VE against cases declined from 66% to 12% in the 5- to 11-year-old cohort, while VE in the 12- to 17-year-old group declined from 66% to 51% between December 13, 2021, and January 30, 2022. A similar trend was shown in VE against hospitalizations over the study period: 100% down to 48% among the youngest cohort and 85% to 73% in the young adolescent group. The authors note that dosing could be a factor in the VE decline, as children ages 5 to 11 receive smaller doses of vaccine. The adult dose, also given to those aged 12 to 17 years, is a 2-dose regimen of 30 µg, while those aged 5 to 11 receive 2 10μg doses in the trial. In clinical trials, children ages 6 months to <5 years are receiving even lower doses of the Pfizer-BioNTech vaccine, 2 or 3 shots of 3μg. The US FDA and the companies recently delayed review of an application for authorization among this group to await trial results of a 3-dose regimen, expected in April, after 2 doses did not produce antibody levels in 2- to 4-year-olds on par with people aged 16 to 25. The Pfizer-BioNTech vaccine is currently the only one authorized in the US for use among children ages 5 to 11.

Results of a test-negative case-control study evaluating Moderna’s vaccine effectiveness against the Delta and Omicron variants found the vaccine to be more effective against infection with the Delta variant but highly protective against hospitalizations for both variants. Three-dose (2-dose primary series plus a booster dose) VE against hospitalization with Delta and Omicron was >99% across the entire study population. Evaluated at 14-60 days and >60 days, 3-dose VE against infection showed high, durable immunity against Delta, with VE declining slightly from 93.7% to 86.0%, but lower effectiveness against Omicron, with VE falling from 71.6% to 47.4%. In immunocompromised individuals, the 3-dose VE was 29.4% against Omicron.

The study aligns with US CDC findings that vaccine protection against Omicron was weaker compared to other variants, but vaccination continued to provide protection against hospitalization during the Omicron surge. The likelihood of unvaccinated people being hospitalized was 15 times greater than that of fully vaccinated people during earlier variants and fell to about 7 times the risk with the Omicron variant. Despite waning effectiveness, vaccines continue to protect against death amid the Omicron surge. At the end of December 2021, unvaccinated people were 10 times more likely to die of COVID-19 than fully vaccinated individuals.

ASIA The number of new COVID-19 cases continues to drop globally except in Asia, where the number of confirmed cases increased nearly 32% the week ending February 21. In Hong Kong, an Omicron variant-fueled surge has overwhelmed the city’s “dynamic zero” strategy—the same as mainland China’s—raising panic and fear among residents who emptied grocery store shelves over the weekend. The COVID-19 fatality rate in Hong Kong is now the highest in the developed world, leaving the healthcare system overloaded with patients and mortuaries at capacity. Older residents, who are most at risk, remain the least vaccinated. Leaders have implemented vaccine passports, mask mandates, and mandatory mass SARS-CoV-2 testing—3 tests for each resident over a 9-day period—and many are concerned lockdowns could soon follow. Some expatriate residents are leaving the city in order to avoid testing and potential lockdowns and keep their children in school, after the city announced school closures this month.

The number of new COVID-19 cases and related deaths also are soaring in South Korea, with the nation setting a single-day mortality record on February 28 with 114 deaths. Notably, the nation dropped its “anti-epidemic pass” mandate today, which required people to show proof of vaccination or negative test to enter any indoor area, in order to allow more healthcare workers to move freely to care for the nearly 800,000 patients with mild-to-moderate COVID-19 who are isolating at home to preserve hospital beds. Some say the new strategy to monitor patients at home felt like “home abandonment,” with government-sponsored shipments of medical supplies—such as thermometers, pulse oximeters, and other supplies—failing to arrive on time.

Across the border in North Korea, the government continues to claim it has recorded no COVID-19 cases since the beginning of the pandemic. Last week, an independent UN human rights investigator called on the international community to provide North Korea with at least 60 million doses of SARS-CoV-2 vaccines in order to ward off a humanitarian crisis and persuade the country to ease lockdowns that have left much of its population at risk of starvation. Notably, the COVAX initiative recently scaled back the number of vaccine doses allocated to the country since the government has failed to arrange for any deliveries and previously rejected planned shipments.

CARIBBEAN While the number of new COVID-19 cases are declining across the Americas, the Caribbean is falling behind, the Pan American Health Organization (PAHO) warned last week. In the region, 10 out of the 13 countries and territories that have yet to reach the WHO goal of vaccinating 40% of their populations are in the Caribbean. Experts caution against interpreting declines in case numbers as evidence that the virus is disappearing, as some locations continue to experience outbreaks. Although barriers to vaccination persist in the Caribbean—including vaccine hesitancy, lack of rural vaccination centers, insufficient staff, and limited cold-chain infrastructure—PAHO called on governments and healthcare workers to use available tools to “to turn the tide on vaccinations” by providing communities with more information, education, and accessible vaccination opportunities.

CHILDREN WHO LOST CAREGIVERS Globally, more than 5.2 million children lost a parent or caregiver during the first 19 months of the COVID-19 pandemic, according to a study published in The Lancet Child & Adolescent Health. A collective of international researchers and experts from various health organizations and universities collected data from more than 20 countries. The research estimates the number of children experiencing COVID-19-associated orphanhood or caregiver death increased 90% from April 30 to October 31, 2021, from 2,737,300 to 5,200,300. Paternal orphans represented 76.5% of the orphaned children, compared to 23.5% who lost their mother. Beyond the tragic numbers, the study warns that children who lose a parent are at greater risk of poverty, sexual abuse, mental challenges, and severe stress.

PLANT-BASED VACCINE After authorizing Novavax’s protein-based SARS-CoV-2 vaccine Nuvaxovid for adults aged 18 and older on February 17, Canada’s drug regulator last week cleared a second non-mRNA vaccine against COVID-19, authorizing Medicago’s Covifenz vaccine for adults ages 18 to 64. The 2-dose vaccine uses plant-based, non-infectious virus-like particles (VLP) of spike protein from the original SARS-CoV-2 strain, as well as an adjuvant from GlaxoSmithKline to boost immune response. Quebec-based Medicago has agreed to supply up to 76 million vaccine doses to the Canadian government, the first shipments of which are expected in May. In a study of 24,000 adults, the overall vaccine efficacy rate was 71% against all SARS-CoV-2 variants, although the clinical trial was performed prior to the emergence of the Omicron variant of concern. The authorization represents the first of a vaccine manufactured using plant-based technologies, and public health officials are hopeful Covifenz and Nuvaxovid will provide options to people who are not willing to receive an mRNA-based vaccine. However, since 81% of the total Canadian population is fully vaccinated, many of the vaccine doses likely will be shipped overseas. Health Canada has authorized the use of 6 SARS-CoV-2 vaccines.

SARS-COV-2 ORIGIN In 3 preprint studies posted online last week, scientists provide additional evidence that the COVID-19 pandemic originated in a Wuhan, China, market due to a zoonotic viral spillover event. The studies, posted on February 25 and 26, have not yet been peer-reviewed or published in a professional journal. The first study presents analyses of 1,380 samples collected in early 2020 from the Huanan Seafood Market (HSM), the surrounding environment, and animals within the market. Researchers detected SARS-CoV-2 in the stalls of the HSM western zone and other environmental samples, but they did not detect the virus in samples taken from 18 animal species present at the market, including some stray animals. A second study uses geospatial analyses to show that the earliest COVID-19 cases diagnosed in December 2019 were located close to and centered on the market and that environmental samples positive for SARS-CoV-2 were strongly associated with vendors selling live animals. A third study suggests that SARS-CoV-2 arose in humans after at least 2 separate cross-species transmission events in late 2019, possibly from live animals sold at the HSM.

Many scientists agree that the preponderance of evidence, included in these studies and others, supports a zoonotic origin story of SARS-CoV-2 instead of an accidental laboratory leak. However, none of the studies provide definitive evidence about what animal species might have hosted the virus prior to it jumping to humans. Nor do the studies rule out that the HSM could have simply served as the location of a large amplifying event in which an infected person transmitted the virus to many others. Researchers around the world continue to analyze available evidence, but without additional samples from early human cases and animals, the world may never know the true origin of the novel coronavirus that has so far killed at least 6 million people worldwide in just over 2 years.

[dryrunguy]

Here's the latest Situation Report. You can imagine what the section on Ukraine is about. The section on increases in maternal mortality in the first year of the pandemic in the U.S., particularly among Black women, is quite sad as well.

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EPI UPDATE The WHO COVID-19 Dashboard reports 437.3 million cumulative cases and 5.96 million deaths worldwide as of March 2. The global weekly incidence continues to decline, down 15.5% from the previous week. Notably, the Western Pacific region continues to report increasing weekly incidence (+31.7%), while all other regions reported decreasing weekly incidence last week. Global weekly mortality fell 14.4% from the previous week. We expect the cumulative number of deaths to pass 6 million this week.

Global Vaccination
The WHO reported 10.58 billion cumulative doses administered globally as of February 27. A total of 4.9 billion individuals have received at least 1 dose, and 4.32 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations appears to have stabilized over the past 2 weeks. As of March 2, 23.5 million doses per day were recorded, a relatively small decline compared to the 25.5 million doses per day on February 17.* The trend continues to closely follow that of Asia. Our World in Data estimates that there are 4.97 billion vaccinated individuals worldwide (1+ dose; 63.13% of the global population) and 4.39 billion who are fully vaccinated (55.7% of the global population). A total of 1.41 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.

UNITED STATES
The US CDC is currently reporting 78.9 million cumulative cases of COVID-19 and 950,112 deaths. Daily incidence continues its sharp decline, down from a record high of 807,843 new cases per day on January 15 to 56,253 on March 1. Daily mortality appears to have peaked on February 2 at 2,627 deaths per day, down to 1,674 on March 1.*

According to CDC COVID-19 Seroprevalence Estimates released this week, more than 140 million US residents have been infected with SARS-CoV-2, about 43% of the total population. The data are based on 72,000 blood samples taken through the end of January 2022 and only include people who have antibodies from natural symptomatic or asymptomatic infection, not vaccination.
*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 691 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 7 to 284,281 on February 25.* The number of daily vaccinations is at its lowest level since late December 2020, right after the vaccines were authorized. A total of 253.7 million individuals have received at least 1 vaccine dose, which corresponds to 76.4% of the entire US population. Among adults, 87.9% have received at least 1 dose, as well as 26.7 million children under the age of 18. A total of 215.8 million individuals are fully vaccinated**, which corresponds to 65% of the total population. Approximately 75% of adults are fully vaccinated, as well as 22.1 million children under the age of 18. Since August 2021, 93.6 million individuals have received an additional or booster dose. This corresponds to 43.8% of fully vaccinated individuals, including 66.3% 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 5 days. The most current average provided here corresponds to 5 days ago.
**Full original course of the vaccine, not including additional or booster doses.

US NATIONAL COVID-19 PREPAREDNESS PLAN Moving the US from a state of pandemic crisis to a time when COVID-19 does not disrupt daily life will require focus on 4 primary goals: protecting people from infection and treating COVID-19; preparing for the emergence of new variants; keeping businesses and schools open and operating; and leading global vaccination efforts, according to a new roadmap released on March 2 by the administration of US President Joe Biden. To achieve its objectives, the 96-page National Covid-19 Preparedness Plan depends on the US Congress approving billions of dollars in new funding. The Biden administration has informally indicated it will request US$30 billion for domestic needs and US$5 billion for global vaccination efforts. Some US lawmakers and advocates have said at least triple that amount will be needed for international efforts. A formal budget request is expected soon.

The plan’s release follows President Biden’s first State of the Union address delivered the night before, during which he touched on several aspects of the plan. President Biden emphasized that “COVID need not control our lives,” touting new US CDC guidance that allows much of the country’s population to remove masks, but he simultaneously expressed caution that the nation must remain “on guard.” He announced that people soon will be able to order additional rapid antigen tests through the COVIDtests.gov website. Nearly half of the 500 million free SARS-CoV-2 tests remain unclaimed, with 40% of the already-mailed tests having gone to households in low-income areas, according to the White House. President Biden also announced a “Test to Treat” initiative set to launch later this month that will allow people to receive immediate COVID-19 therapy—likely Pfizer’s Paxlovid antiviral—if they test positive at a participating pharmacy. Noting that variants remain a threat, President Biden restated his administration’s commitment to being able to quickly develop and ship variant-specific vaccines as well as accelerating efforts to detect, prevent, and treat long COVID.

White House and US Health and Human Services (HHS) public health officials further expanded on details of the new National COVID-19 Preparedness Plan during a March 2 briefing. They noted a priority to keep businesses and schools open, including efforts to improve ventilation and air filtration as well as calls for Congress to reinstate tax credits for small- and mid-size businesses to provide sick or family leave for people affected by COVID-19. High-quality masks will continue to be made available at participating locations including grocery stores, pharmacies, and community health centers, and the administration plans to launch a new website to help people locate vaccines and masks in their communities. COVID-19-specific testing, treatment, and prevention tools such as masks, including those for children, will be added for the first time to the nation’s Strategic National Stockpile, and federal plans to develop a pan-SARS-CoV-2 vaccine—and later a universal coronavirus vaccine—are moving forward. Additionally, the roadmap includes strategies for rolling out a vaccine for children under age 5 when and if one is authorized and recommended by health authorities.

Notably, some public health experts criticized the plan and the US CDC’s recent shift in masking guidance, saying a move toward a medical framework focused primarily on testing and treatment places too much onus on individual responsibility versus community-level intervention. This shift adds burdens on vulnerable individuals and populations, including the immunocompromised, rural and low-income communities, those who live or work in high-exposure environments, and young children who remain ineligible for vaccination.

UKRAINE Ukraine already has experienced immediate downstream impacts of the Russian invasion. One of these far-reaching impacts is the damage that the invasion has played on Ukraine’s ability to control the COVID-19 pandemic. Dr. Bruce Aylward, a senior advisor at the WHO, said in a statement earlier this week that “infectious diseases ruthlessly exploit the conditions created by war,” while WHO Director-General Dr. Tedros Adhanom Ghebreyesus called for increased humanitarian channels to provide lifesaving medical supplies to those remaining in the country. Notably, the WHO avoided naming Russia as an aggressor during their press conference, instead focusing on calls to stop attacks on civilians and medical institutions. Healthcare systems already face supply chain challenges. The WHO warned on February 27 the country has dangerously low supplies of medical oxygen, a key tool in treating people hospitalized with COVID-19 and other diseases. The agency announced its first shipment of medical aid for Ukraine will arrive in Poland today, but details about last-mile delivery to Ukrainians in need remain unclear.

Experts warn that the conflict also threatens to disrupt efforts to control the pandemic, as well as other vaccine-preventable diseases, in neighboring countries. At least 1 million refugees already have fled across the borders since the start of the invasion. Prior to the conflict in the country, COVAX had delivered more than 8 million vaccine doses to Ukraine, but this disruption may offset hard fought gains in vaccination. Prior to last week’s events, only 35% of Ukraine’s population was fully vaccinated, creating an atmosphere for increased SARS-CoV-2 transmission and the potential for a greater number of severe health outcomes. The country’s low vaccination coverage is not sufficient to prevent the virus from spreading among large populations living in crowded shelter situations and increases the potential for new variants to emerge. COVAX indicated it will continue to support Ukraine’s vaccination efforts and has a “Humanitarian Buffer” mechanism for delivering vaccines in humanitarian crises, but the coordination and cooperation needed to establish such services will take time.

US MATERNAL MORTALITY Pregnant people or those recently pregnant are at an increased risk for severe illness from COVID-19 when compared to people who are not pregnant. As of February 19, about 68% of pregnant people were vaccinated before or during pregnancy, a sharp increase from the beginning of the summer when the proportion was around 40%. Some pregnant people say they feel they were left behind in rushed efforts to vaccinate the population, having been excluded from vaccine clinical trials for safety reasons and receiving mixed guidance when vaccines first became available. While the full scope of impacts from maternal SARS-CoV-2 infection remain unclear, some evidence suggest even mild or moderate infection can increase the risk of premature birth or stillbirth.

Additionally, a new report from the US CDC National Center for Health Statistics shows that the number of women in the US who died during pregnancy or shortly after giving birth rose sharply during the first year of the pandemic. The data show that 861 women died of maternal causes in the US during 2020, an increase of 14% over the prior year. The maternal mortality rate increased to 23.8 deaths per 100,000 live births, up from 20.1 per 100,000 in 2019. Notably, the rate for non-Hispanic Black women was 2.9 times higher than the rate for non-Hispanic white women, a gap that increased between 2019 and 2020. Although the report does not provide details on potential causes for the increases, experts said some of the deaths likely were directly or indirectly related to the COVID-19 pandemic. As in other aspects of healthcare, the pandemic helped to magnify disparities in access to quality maternal care. There has been a push to address this critical issue at the federal level, including language in the American Rescue Plan that gave states the opportunity to extend Medicaid coverage for new mothers from 60 days to up to a year postpartum. The CDC supports multiple efforts to better understand the impact of COVID-19 on pregnant people and infants and encourages those who are pregnant or considering pregnancy to get vaccinated, citing the growing amount of data that show the protective measures that SARS-CoV-2 vaccines offer this vulnerable group.

COVID-19 THERAPIES During the State of the Union address, US President Joe Biden announced his administration is launching a new “Test to Treat” initiative that will provide free antiviral treatment to qualified individuals who test positive for SARS-CoV-2 at pharmacies or community health centers. The US has ordered more authorized COVID-19 treatments than any other country, with Pfizer expected to increase its supply of Paxlovid—which reduced the risk of COVID-related hospitalization by about 90% in clinical trials—to more than 2 million pills in April. But questions remain about the initiative’s details. The program is not set up yet, although CVS, Walgreens, and Walmart have indicated they will participate. Still, people will need to find and access participating locations and obtain a prescription for treatment from either an on-site doctor or their primary care provider, if they have one. Alternatively, pharmacists may be permitted under federal guidance to assess patients and order the oral therapies. Notably, some pharmacies are complaining that the costs of filling the prescriptions are not adequately covered by commercial and government health plans, which could cause some to drop out of supplying the antivirals at all.

Following the December 2021 authorization of the antiviral therapies Paxlovid and Merck’s molnupiravir—which has limited use and is much less effective than Paxlovid—nationwide supplies are increasing, making the treatments more easily accessible. Since December, the federal government has sent more than 500,000 courses of Paxlovid and about 1.85 million courses of molnupiravir to the states. Additionally, more than 100 vaccines, antivirals, and other treatments, such as monoclonal antibodies and repurposed medicines, are currently being tested in late stage clinical trials globally. New SARS-CoV-2 variants continue to be a wildcard for existing therapies and those under investigation. The US has paused or limited the use of certain monoclonal antibodies because the Omicron variant of concern is not susceptible to the drugs.

VACCINE EFFECTIVENESS AMONG CHILDREN According to new data published this week in the US CDC’s Morbidity and Mortality Weekly Report (MMWR), 2 doses of the Pfizer-BioNTech SARS-CoV-2 vaccine provided strong initial protection against urgent care and emergency department visits and hospitalization for children aged 5 to 17 years (overall vaccine effectiveness [VE] against hospitalization was 73%-94%). As seen in other age groups, VE weakened over time and was lower during Omicron predominance. However, the data show that a booster dose was able to restore vaccine effectiveness to 81% among individuals aged 16-17 years. The new MMWR findings supplement earlier data from New York state, discussed in our March 1 briefing. The New York data, which is not yet peer-reviewed, asserted that the Pfizer-BioNTech vaccine’s protection against infection and hospitalization for children aged 5 to 11 years waned quickly compared to children aged 12 to 17. Scientists from the CDC and other institutions warn that the New York study might be too small to draw solid conclusions and might not take into account children who were tested at home instead of a clinic. They assert that some drop in protection was the result of the Omicron variant, which affected all age groups. The CDC currently recommends that all eligible children and adolescents remain up-to-date on their vaccinations, including receipt of a booster dose for individuals aged 12 and older. A separate MMWR study examined the safety of booster doses for children aged 12 to 17 years, showing that local and systemic reactions are expected but that serious adverse events are rare.

US MILITARY VACCINE MANDATE The 5th US Circuit Court of Appeals this week upheld a lower court’s injunction barring the US Navy from considering the vaccination status of 35 special forces personnel in making deployment decisions. The US Department of Defense requires all service members to receive SARS-CoV-2 vaccination, and although the rule allows for religious exemptions, only 15 of about 16,000 requests have been approved so far. The US Justice Department argued that the courts did not have jurisdiction to rule on military deployment decisions, but the appeals panel in its decision said the judiciary does have the power to consider the plaintiffs’ objections on religious grounds. The case represents another setback for government-imposed broad-reaching vaccination requirements. The 5th Circuit previously ruled against the Occupational Safety and Health Administration’s (OSHA) emergency temporary standard (ETS) that required businesses with 100 or more staff to ensure their employees were either vaccinated or tested weekly and wore masks. OSHA withdrew that rule after the US Supreme Court ruled against the requirement.

Separately, the US Senate on March 2 voted 49-44 to strike down the Centers for Medicare and Medicaid Services' (CMS) vaccine mandate for healthcare workers. The measure, allowed under the Congressional Review Act, passed in the evenly divided Senate due to the absence of 6 Democratic members.

WHITE-TAILED DEER As previously discussed in this report, animal reservoirs of SARS-CoV-2 present a risk of viral mutation and spillback into humans. The virus is known to infect several non-human mammalian species, including mink, hamsters, mice, and white-tailed deer. Researchers examining coronavirus in Canadian white-tailed deer populations have identified a new, highly divergent lineage of SARS-CoV-2 in deer. Additionally, they report the identification of a very similar viral sequence in a single person in the same geographical region who had close contact with deer. No other human-derived genetic sequences were similar, leading the researchers to speculate it likely was an isolated case with no evidence of recurrent deer-to-human or sustained human-to-human transmission. The preprint report, posted in bioRxiv and not yet peer-reviewed, is the first evidence of possible deer-to-human transmission of SARS-CoV-2. The researchers noted that SARS-CoV-2 circulating among wild deer populations posed more of a containment challenge than farmed or domestic animals and stressed the need for a broader, interdisciplinary One Health approach to SARS-CoV-2 surveillance.

https://covid19.who.int/

[ti-amie]

[ponchi101]

Now the question will be: do you suffer these symptoms to the same degree if you are vaccinated? Since we know that vaccination does not stop you from getting infected, is the vaccinated/controlled infection as serious a non-vaccinated infection?
And, of course:
The people that are not vaccinated will have their brains shrink even more. Where does the joke end?

[Suliso]

In the grand scheme of things covid seems so unimportant now...