Covid-19 Updates & Info

[ponchi101]

The only idea that comes to mind: the virus has indeed killed around 0.05% of the US population. But it killed disproportionately a large number of elderly. So, the number of elderly people alive by the end of 2020 was the cohort that was more affected by the virus. Since there are fewer elders, your life "expectancy" is now slightly less.
You mentioned this tangentially in one of your posts. In the next couple of years, the US (and maybe the whole world) will see fewer elder deaths because the deaths took place in 2020. So this life expectancy may rebound very quickly.
One idea.

Also. Reading the report tells you that these data are based on deaths for the first six months of 2020. Since most deaths took place in the second half, expect a further drop.

[shtexas]

I always said Andrew is not what he seems. For the most part he did well handling C19 in New York (he's no DeSantis) but this is no surprise.

I was wondering what will come out to bring his reputation down (not whether anything will come out). Can't do NY politics without a scandal!

His long-winded Covid updates, while appreciated at the time, seemed like someone who was full of himself.

[dryrunguy]

I guess I don't understand how exactly that number is calculated. Only ca 0.05% of US population died of covid during that time period. How can it have substracted an entire year?

I would bet much of the decrease can be attributed to large numbers of deaths among middle-aged and "younger elderly" people of color (i.e., people advanced in years yet below the previous age for life expectancy). This age group was especially hard hit by COVID early on in the epidemic. Remember the early outbreak in New York City, Philadelphia, and some other urban centers? Large-scale deaths among people of color in their 40s, 50s, or 60s would bring down national life expectancy pretty quickly.

But that's just my theory based on early demographics of the pandemic.

[skatingfan]

I guess I don't understand how exactly that number is calculated. Only ca 0.05% of US population died of covid during that time period. How can it have substracted an entire year?

It's just an average of the age of people when they die - there was a significant increase in the number of deaths in that period (something like 15%) compared to previous years. Also, there was a significant increase in drug overdose deaths in that period as well, and those people tend be much younger than the average age of death, and so have a significantly higher impact on the average life expectancy.

[dryrunguy]

I guess I don't understand how exactly that number is calculated. Only ca 0.05% of US population died of covid during that time period. How can it have substracted an entire year?

It's just an average of the age of people when they die - there was a significant increase in the number of deaths in that period (something like 15%) compared to previous years. Also, there was a significant increase in drug overdose deaths in that period as well, and those people tend be much younger than the average age of death, and so have a significantly higher impact on the average life expectancy.

Because of COVID, we have completely lost track of the opioid/prescription drug overdose epidemic. Excellent point.

[Suliso]

We in Switzerland have gone under 1,000 covid patients in hospitals for the first time since mid November (peak of ca 3,800).

[ponchi101]

Good news, Suliso. Good to hear (there are few of those).
---0---
Now that the vaccine is rolling out, and that some good news are coming (it seems the Pfizer vaccine is very good with only one dose), what are the plans for the recovery? By that I mean, when can we start behaving in more normal ways in order for the economies of the world to re-start?
Do we wear masks for at least one more year? (I don't see why not)
Do the Big Pharma companies already begin plans for future vaccines, as the original virus has mutated so much?
What will be the plans for international travel? What about that vaccine passport (I don't see a reason for not having it, in the same way that most of us travel with our yellow fever vaccination certificate)
When do the countries of the world get together to plan an early warning and detection system?
How deep must the investigation of the origins of the virus must be? Do we trust the Chinese GOVERNMENT with such a delicate issue?

How can we minimize this happening again?

[Suliso]

I think nothing big will happen before June. Here we plan to open nonessential shops and museums March 1st, restaurants outdoors and gyms from April 1st. For both if conditions don't worsen. Schools for younger children and hairdressers stayed open in Switzerland during wave two.

[dryrunguy]

The latest Situation Report.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 109.59 million cases and 2.42 million deaths as of 10:00am EST on February 19.

As countries continue to scale up vaccination efforts, many are beginning to report data for both partially and fully vaccinated individuals. As we have covered previously, Israel is leading the world in terms of SARS-CoV-2 vaccination, with 48.8% of its population receiving at least 1 dose of the vaccine. Seychelles is #2, with 42.6%, followed by the UK countries—Wales (26.1%), Scotland (24.8%), England (24.6%), and Northern Ireland (22.6%). Bahrain (15.5%), the US (12.3%), and Chile (12.1%) are the only other countries reporting higher than 10% coverage with at least 1 dose. In total, 50 total countries are reporting 1-dose coverage greater than 1%. Of those countries that have commenced vaccinations, 51 are reporting the number of individuals who have been fully vaccinated, mostly in Europe and North America. Israel (33.0%) and Seychelles (19.8%) lead all countries in terms of the proportion of their populations with full coverage, and no other countries are reporting higher than 5%. The US (4.8%), Malta (4.2%), and Denmark (3.0%) round out the top 5. In total, 35 countries have reported full vaccination in more than 1% of their total population.

There are major differences in how countries are allocating their available supply to first and second doses, evident in the differences between partial and full vaccination coverage. Some countries are aggressively pursuing second doses for individuals who have already received their first dose, while others are focusing on broader coverage using the first dose. For example, Costa Rica (78.5%), Croatia (78.2%), Russia (76.8%), and Spain (70.0%) are all reporting full vaccination for 70% or more of individuals who received their first dose. In contrast, fewer than 10% of those who have received the first dose are fully vaccinated in the UK—England (3.6%), Northern Ireland (7.0%), Scotland (1.8%), and Wales (2.3%); Singapore (2.3%); and Chile (2.4%). While the UK and Chile have among the highest 1-dose coverage, they are among the lowest in terms of full vaccination coverage.
*These data address “fully vaccinated” from the perspective of the number of doses administered and not with respect to the time required after the last dose to develop the full immune response.

Our World in Data reports that 194.44 million vaccine doses have been administered globally, a 21% increase compared to this time last week. Vaccination efforts have been reported in at least 92 countries and territories.

UNITED STATES
The US CDC reports 27.67 million total cases and 489,067 deaths. Daily incidence in the US continues its steady decline, now down to 77,385 new cases per day—the lowest daily average since October 28, 2020. The daily mortality is currently 2,708 deaths per day, the lowest average since January 6, 2021; however, reporting irregularities due to previously unreported deaths and holiday delays are making it difficult to project the longer-term trajectory. While the actual 7-day average daily mortality is uncertain, we expect the US to surpass 500,000 cumulative deaths in the next several days.

US Vaccination
The US CDC reported 73.38 million vaccine doses distributed and 57.74 million doses administered nationwide (78.7%).

In total, 41.02 million people (approximately 12.4% of the entire US population) have received at least 1 dose of the vaccine, and 16.16 million (4.9%) have received both doses. The average daily doses administered continues to increase, now up to a record high of 1.54 million doses per day*, including 679,199 second doses per day*. The CDC is still reporting slightly more Pfizer-BioNTech doses administered (29.59 million; 51%) than Moderna (28.04 million; 49%), but the gap is closing.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

A total of 6.18 million doses have been administered at long-term care facilities (LTCFs)**, including residents and staff. This covers 4.31 million individuals with at least 1 dose and 1.84 million with 2 doses. Approximately 59% of the doses have gone to residents, and 41% to staff.
**The dashboard only includes data for doses administered through the Federal Pharmacy Partnership for Long-term Care (LTC) Program. It does not report data from West Virginia, which opted out of the program.

The Johns Hopkins CSSE dashboard reported 27.91 million US cases and 493,670 deaths as of 12:30pm EST on February 19.

VACCINE CLINICAL TRIALS The UK has approved plans for the world’s first SARS-CoV-2 human challenge trial, backed by £33.6 million (US$47 million) in government funding. The UK COVID Challenge trial is expected to begin sometime in the next month, pending final ethics review. It will include up to 90 healthy volunteers, aged 18-30 years old, who will be deliberately exposed to SARS-CoV-2 and monitored under controlled conditions. The first stage of the trial will aim to characterize “the smallest amount of virus needed to cause infection,” and future efforts will include patients who are vaccinated prior to exposure to assess vaccine efficacy. The trial will be a partnership between the UK government’s Vaccine Task Force, Imperial College London, the Royal Free London NHS Trust Foundation, and hVIVO, a company with experience in human viral challenge trials.

The University of Oxford announced that it will conduct a clinical trial for the AstraZeneca-Oxford vaccine in children. The Phase 2 clinical trial will take place across 3 study sites in England and include 300 participants aged 6-17 years. The placebo-controlled trial will administer the vaccine to as many as 240 participants, and the control group will receive a meningitis vaccine in order to stimulate a similar reaction (e.g., injection site soreness). Another team of researchers is also conducting a Phase 2/3 clinical trial for the Moderna vaccine. The Moderna trial aims to enroll 3,000 participants, and it will use a saline injection as its placebo. Now that several SARS-CoV-2 vaccines have demonstrated safety and efficacy in adults, children are an important population to evaluate in these next stages of clinical trials.

Researchers are also initiating clinical trials in other special populations, such as pregnant women. On February 18, Pfizer and BioNTech announced that the first participants were vaccinated in a “global Phase 2/3" clinical trial to evaluate the safety and efficacy of their SARS-CoV-2 vaccine in pregnant women. The study aims to include 4,000 participants (aged 18 years and older), and the vaccine will be administered between 24 and 34 weeks of gestation.

US VACCINE SUPPLY Following announcements from multiple US states that demand is outpacing federal supply of SARS-CoV-2 vaccine doses, the White House announced another increase in weekly distributions. The federal government will provide 13.5 million doses to state governments per week and 2 million weekly doses directly to pharmacies, compared to previous shipments of 10 million and 2 million doses per week, respectively. This brings the total national distribution to 15.5 million doses per week, which would enable 2.2 million doses to be administered per day nationwide. This corresponds to an increase of nearly 50% over the current average of 1.5 million doses administered per day.

HONG KONG AUTHORIZES SINOVAC VACCINE On February 18, the Hong Kong Secretary for Food and Health authorized the Sinovac SARS-CoV-2 vaccine for emergency use. The announcement followed recommendations from Hong Kong’s Advisory Panel on COVID-19 Vaccines. Reportedly, the efficacy data used in Hong Kong’s regulatory review showed 62% efficacy, which is higher than some other recent clinical results for the vaccine but lower than other vaccines authorized in other countries. The data have not been published, and some scientists have called on Sinovac to publicly release the clinical trial data. While Sinovac shared data with the advisory panel, critics argue that this does not meet the rigorous standard of a public peer review. Notably, a recent study conducted by Hong Kong University found that fewer than 30% of respondents would get vaccinated using the Sinovac vaccine due, in part, to concerns about its efficacy.

Hong Kong’s current agreement would supply 1 million doses of the vaccine to later this week, and vaccination is expected to start on February 26. Hong Kong established 5 priority groups for the earliest eligibility: (1) healthcare workers and “staff involved in anti-epidemic work,” (2) adults aged 60 years and older, (3) residents and staff at long-term care facilities, (4) essential workers, and (5) border control and workers at points of entry.

GLOBAL VACCINE ALLOCATION At least 92 countries and territories around the world have commenced SARS-CoV-2 vaccination campaigns. Several sizable gaps remain in vaccine access, most notably in Africa. In total, only 5 countries in Africa have reported vaccinations to date: Algeria, Egypt, Mauritius, Morocco, and Seychelles. In total African countries have reported 2.3 million cumulative vaccinations, the vast majority of which (97%) are in Morocco. Additionally, several African countries recently announced the delivery of their first vaccine doses or the start of vaccination campaigns. South Africa previously suspended its national vaccination program for the AstraZeneca-Oxford vaccine due to concerns regarding that vaccine’s efficacy against the B.1.351 variant, which was first identified in South Africa; however, it commenced vaccinations on February 17 using the Johnson & Johnson (J&J)-Janssen vaccine. Zimbabwe also commenced vaccinations this week, using Sinopharm vaccines from China. Sinopharm has also supplied doses to Egypt and Equatorial Guinea. Rwanda commenced its vaccination efforts as well, focusing initially on high-risk populations such as frontline healthcare workers. The Rwandan Ministry of Health announced the program on February 14.

In response to global disparities in SARS-CoV-2 vaccine access, particularly with respect to countries’ wealth, Mexican Minister of Foreign Affairs Marcelo Ebrard’s statement to the UN Security Council called for the “international community to guarantee fair, equitable and timely access” to the vaccine. Minister Ebrard’s statement noted that 10 countries have received 75% of the global vaccine supply and that more than 100 countries have not yet administered a single vaccination. Mexico has reportedly purchased 230 million doses of SARS-CoV-2 vaccines, across multiple manufacturers; however, its allotments have been limited relative to wealthier countries like China, the US, the UK, and many European countries. To date, Mexico has reported only 1.32 million doses administered, although more than 500,000 of those (43%) have been reported in the past 3 days. On a per capita basis, Mexico has administered only 1 dose per 100 people, compared to 17.4 in the US, 6.35 across Europe, and 2.8 in China.

As we reported previously, the COVAX facility published its anticipated vaccine allotments, which includes more than 88 million doses for 46 African countries and nearly 6.5 million doses for Mexico. The Emergency Use Listings recently issued by the WHO for the AstraZeneca-Oxford vaccine cover more than 99% of the 320 million doses in the first COVAX allotment and move COVAX one step closer to shipping the first doses.

EU VACCINE SUPPLY As supply continues to be a bottleneck in SARS-CoV-2 vaccination efforts, Pfizer and BioNTech are reportedly behind schedule in delivering vaccine to the EU, including approximately 10 million doses that were supposed to arrive in December. The missing Pfizer doses represent one-third of the anticipated supply, exacerbating the impact of delays in delivering the AstraZeneca-Oxford and Moderna vaccines. As a result of ongoing concerns regarding the availability of the AstraZeneca-Oxford vaccine, the European Commission reportedly finalized new contracts to purchase an additional 350 additional doses of the Pfizer-BioNTech and Moderna vaccines, scheduled to be delivered through the end of 2021. Recent agreements, including the February contract with Pfizer/BioNTech, include “anti-variant” clauses that would allow the bloc not to purchase vaccines that are not effective against emerging variants, and the EC reportedly hopes to add similar clauses to existing contracts. Additionally, the EU is funding almost US$300 million for efforts to combat variants, including at least €75 million (US$91 million) for expanded genomic sequencing capacity and the development of specialized tests for emerging variants and €150 million (US$182 million) for research and data sharing.

EMERGING VARIANTS A study published (preprint) by Harvard University examines the nasopharyngeal viral concentration in individuals infected with the B.1.1.7 SARS-CoV-2 variant. The researchers performed a series of PCR-based diagnostic tests over a series of weeks to evaluate temporal dynamics of the viral concentration for this variant of concern. The study included 65 total participants, including 7 infected with the B.1.1.7 variant. The researchers found that infection with the B.1.1.7 variant lasted significantly longer than for other variants, with a mean duration of infection of 13.3 days for the B.1.1.7 variant, compared to 8.2 days for non-B.1.1.7 variants. While the duration of infection was longer for the B.1.1.7 variant, the peak viral concentration was similar between B.1.1.7 and non-B.1.1.7 variants.

Even though the peak nasopharyngeal viral concentration is similar between the B.1.1.7 and non-B.1.1.7 variants, the longer duration of infection could potentially be a factor in the variant’s increased transmissibility. If individuals infected with the B.1.1.7 variant take longer to clear the virus from their system, their infectious period could potentially be longer as well, which could result in additional exposures compared to non-B.1.1.7 variants. Further investigation is necessary to better characterize the drivers of the increased transmissibility, but this study provides insight into potential mechanisms that contribute to the variant’s ability to spread more rapidly in the community.

US MORTALITY The US CDC published findings from analysis of US mortality data from January-June 2020, which indicates that the average life expectancy in the US decreased by 1 year compared to estimates from 2019. The analysis was conducted by the CDC’s National Center for Health Statistics, and the researchers evaluated all reported deaths from the first half of 2020*. The researchers estimate the overall life expectancy in the US for the first half of 2020 to be 77.8 years, a decrease from 78.8 years in 2019 and the lowest estimate since 2006. This is the largest single-year decline since World War II. The decrease was slightly greater in males than females—1.2 years compared to 0.9 years. The analysis also evaluated changes in life expectancy by racial and ethnic groups, a major concern due to the disproportionate burden of COVID-19 on racial and ethnic minorities. Life expectancy decreased by 0.8 years for the non-Hispanic White population, 1.9 years for the Hispanic population, and 2.7 years for the non-Hispanic Black population, illustrating “a worsening of racial and ethnic mortality disparities.”

Notably, these reported deaths include the initial COVID-19 surge, but they do not cover the autumn/winter 2020-21 surge, which exhibited a higher and more sustained mortality rate—exceeding 2,000 deaths per day since early December 2020 and 3,000 deaths per day from mid-January through mid-February 2021. One of the researchers indicated that the “majority of the decline” stemmed from the pandemic.
*The report indicates that the analysis is based on preliminary data and that some reports could be delayed by months.

JAPAN VACCINATION On February 17, Japan commenced its SARS-CoV-2 vaccination campaign, focusing initially on healthcare workers and older adults. Japan faced its largest surge in December 2020 and January 2021, but it delayed the start of its vaccination campaign after requiring domestic clinical trials of the Pfizer-BioNTech vaccine. Pfizer and BioNTech applied for emergency approval in Japan in December, but reportedly, Japan waited for preliminary data from a clinical trial of 160 Japanese participants in order to better assess safety in the Japanese population. Critics argue that the small sample size likely delayed the start of vaccination efforts while providing limited benefit. Review of the application for the AstraZeneca-Oxford is ongoing, and Moderna has not yet submitted an application in Japan. Japanese officials continue to express optimism that the delayed 2020 Summer Olympic Games will be held in 2021, and the national vaccination effort is likely a key step in achieving that goal.

TAIWAN VACCINE SUPPLY Taiwan’s Minister of Health and Welfare, Chen Shih-chung, announced that an agreement to purchase 5 million doses of the Pfizer-BioNTech SARS-CoV-2 vaccine is on hold. Reportedly, Taiwan was negotiating with BioNTech to purchase the vaccine, but “the company suddenly backed out.” Minister Chen indicated that the negotiations fell through as a result of “outside forces intervening,” but he did not elaborate further. Some have speculated that influence from the Chinese government is responsible for the delay, but Chinese officials deny involvement in the decision. BioNTech has not offered an explanation regarding the underlying factors in their decision.

BioNTech was coordinating with the Shanghai Fosun Pharmaceutical Group to manufacture SARS-CoV-2 vaccines for mainland China, Hong Kong, Macau, and Taiwan; however, Taiwanese pharmaceutical company TTY Biopharm was reportedly involved in negotiations directly between the Taiwanese government and BioNTech. Representatives from BioNTech stressed that the deal with Taiwan is only delayed and not withdrawn entirely. The response to the COVID-19 pandemic has further exacerbated the tense political relationship between Taiwan and China. Taiwan announced in late December that it secured approximately 20 million doses of SARS-CoV-2 vaccine, including 10 million from AstraZeneca, nearly 5 million from COVAX, and another 5 million from an impending contract, which is believed to be the suspended agreement with BioNTech.

VACCINE CEASEFIRE The UK government called for “local ceasefires across the globe” in order to enable governments and humanitarian aid organizations to implement SARS-CoV-2 vaccination efforts in conflict zones. UK Secretary of State for Foreign, Commonwealth, and Development Affairs Dominic Raab issued a statement at a meeting of the UN Security Council emphasizing the COVID-19 risk to more than 160 million people living in areas of ongoing armed conflict—“including in Yemen, South Sudan, Somalia and Ethiopia”—and highlighting the importance of conducting vaccination efforts in those areas. These “vaccine ceasefires” would not only provide direct benefit to vaccinated individuals, but it could also mitigate the risk of viral mutation and emerging variants. The UK also called for increased financial contributions to the COVAX facility, in order to increase the vaccine supply for low- and middle-income countries.

https://covid19.who.int/

[Suliso]

Vaccination campaign in Israel is a success so far and clearly the vaccine is working very well (see here for lots of data: https://ourworldindata.org/vaccination-israel-impact). However, the social lockdown and all the other measures have been a failure with Israel still among the top 10 most infected places in the world. A serious issue is that vaccination rates are slowing down due to vaccine hesitancy among specific groups and young people. Epidemiologists say at least 70% full vaccination rates are needed, in Israel that's almost every adult because 25% are children too young to be vaccinated currently. It's very unlikely to be achieved in my opinion.


What if Countries That Excel at Vaccinations Still Don’t Achieve Herd Immunity?

TEL AVIV, Israel—In the race to herd immunity, Israel has three things that put it well ahead of other countries: a relatively small population, an ample supply of the COVID-19 vaccine, and a centralized health care system that coordinates the complicated logistics of distribution.

These advantages have put Israel at the top of the world vaccination chart, with over 30 percent of the population of 9.3 million having already received the required two doses. In the United States, by comparison, the number is about 4 percent.

But Israeli officials are finding out that the first stage of the vaccination campaign might be the easy part. They now face the daunting challenge of coaxing vaccine skeptics, younger Israelis, and members of more insular communities—chiefly ultra-Orthodox Jews and some Arab Israelis—to roll up their sleeves and get the shots. Without them, Israel is unlikely to defeat the coronavirus pandemic. The process has already been hampered by what many Israelis perceive as a politicizing of the vaccine campaign by Prime Minister Benjamin Netanyahu.

How Israel fares in this second stage will hold valuable lessons for other countries hoping to achieve herd immunity, a condition that many epidemiologists believe requires at least 70 percent of the population to have either been vaccinated or recovered from the disease. Failure to reach that number in Israel, with all its advantages, would bode ill for the rest of the world.

“Demand is for sure getting slower,” said Ido Hadari, head of vaccine promotion and government affairs at Maccabi Healthcare Services, Israel’s second-largest health care provider. “It’s like getting more than halfway to the top of the mountain: It doesn’t mean we aren’t going to have to sweat to get to the peak. And we are sweating.”

The Israeli rollout began early, driven in part by a doses-for-data agreement with Pfizer that would help the company study the impact of its own vaccine. Netanyahu received the inaugural injection in December 2020.

While the United States has struggled to get shots into arms as the public clamors for injections, Israeli health care providers conducted an orderly distribution. Within two months, the campaign helped ease the stress on hospitals by driving down the total number of patients in critical condition, and it lifted Israel out of its third lockdown. Around 90 percent of Israelis over the age of 60, the main target of the initial phase, have received at least a first dose,

But demand for the shots has dropped sharply in recent weeks. Television news programs have shown clips of empty vaccination centers. Though the vaccine is now available to all citizens over the age of 16, daily injections were down nearly 39 percent on Feb. 13 from the peak in January, according to the Israeli Health Ministry. (Israel has not included most Palestinians in the West Bank and Gaza Strip in its vaccination effort, though it is broadly recognized as the occupying power in these territories, drawing condemnation from rights groups).

“I’m scared to death,” said Etti Messika, a 58-year-old hairdresser in Tel Aviv—despite clinical data that shows very few people experience serious side effects. “I got all the vaccinations for my children, but I’m afraid there hasn’t been enough time or trials for this vaccine. I’m afraid they approved it just because of the pandemic.”

All told, Israel still needs to fully vaccinate another 2.7 million people, or 29 percent of the population. (Just under one-third of Israelis are not currently eligible to get the vaccine because they are too young.)

According to polling, many younger Israelis feel less vulnerable to COVID-19 and are taking a wait-and-see attitude. There also have been lower vaccination rates among Bedouin Arabs and ultra-Orthodox Jews, whom the government has a harder time reaching with public information campaigns. Israelis in rural blue-collar towns have responded in lower numbers as well.

Vaccine hesitancy persists even in some surprising places, including medical staff at some Israeli hospitals. As of Feb. 10, the staff vaccination rate ranged from 43 to 80 percent across major Israeli hospitals.

Channel 13 News conducted a poll this past December that found that one-quarter of Israeli adults would refuse to get vaccinated altogether or wait at least a year, according to chief international affairs correspondent Nadav Eyal, who oversaw the poll. Because Israel has a relatively young population, convincing vaccine skeptics to get the injection is critical to achieving herd immunity.

“If you calculate it, we need about … 75 to 80 percent vaccination level, but we’re not going to get it anyway because we have [a large population of] children here,” Eyal said. “It’s really important that everyone that can will get themselves vaccinated because of that.”

With the country embroiled in yet another election campaign these days—Israelis go to the polls March 23—the vaccination process has seeped into politics as well. Netanyahu has made appearances at vaccination centers and taken credit for the supply deal with Pfizer. A chatbot on Netanyahu’s Facebook page even encouraged visitors to share information about people who have not yet been vaccinated, prompting the social network to remove the post because it violated its privacy policy.

Netanyahu hopes the vaccines will help reopen Israel’s economy, boosting his reelection chances. In an interview this week on Israel’s 12 News, he said: “We are going to be the first ones to get out of this. … We are going to be the first in the world because of the millions of vaccines that we brought, and because of a fantastic health system that is distributing them.”

But the mixing of politics and the pandemic has helped fuel anti-vaccination conspiracy theories. It has also stoked some resistance to the vaccination campaign among Netanyahu’s political opponents on both the left and the right. Eli Avidar, a Knesset member from the ultranationalist Yisrael Beiteinu party and a prominent critic of the government’s pandemic policy, declared at a town hall meeting Saturday that he’s not getting vaccinated.

“It doesn’t suit me. It’s my decision. Every person has the liberty to make decisions about their body,” he said. “This isn’t North Korea.”

Nadav Davidovitch, a member of an expert team advising Israel’s government on COVID-19 and the head of Ben-Gurion University’s school of public health, said vaccines have become a vehicle to attack the government.

“It reflects the tensions within Israeli society—mistrust among minorities and political instability,” he said. “Some people think it’s a conspiracy because of the involvement of Netanyahu. I think it’s crazy, but I can understand.”

The misinformation circulates even as data based on Israeli vaccinations demonstrates broad effectiveness. A study of 1.2 million people released Sunday by Israel’s largest health care provider, Clalit Health Services, found a 94 percent decline in symptomatic COVID-19 infections and a 92 percent drop in serious illness among Israelis who had both doses of the Pfizer vaccine—a finding that corroborates the company’s clinical trials. Scientists at Israel’s Weizmann Institute found there’s been a 50 percent drop in deaths and a 48 percent drop in seriously ill patients among Israelis over age 60 since mid-January.

Some officials are offering incentives for people to get vaccinated, including a reduction in municipal taxes in one Tel Aviv suburb. In the ultra-Orthodox city Bnei Brak, local officials are distributing meals ahead of the Sabbath to people willing to get the shot. Mobile vaccination sites have been set up near popular nature reserves, in part to target young hikers.

Israel’s cabinet on Monday evening approved a “green passport” program restricting entry to gyms, cultural events, swimming pools, and hotels to people with vaccination certificates. Private companies might be allowed to restrict entry to their offices based on such certificates.

But such measures would surely face court challenges in Israel, and it’s not clear how they would hold up to scrutiny. Legal and public health officials say governments in Israel and elsewhere will have to strike a balance between individual rights and the overall national interest of defeating the pandemic.

“I’m against compulsion, but on the other hand, you can’t just give total freedom of choice,” like allowing individuals to smoke in public places, said Davidovitch of Ben-Gurion University’s school of public health.

“You can’t just look at individual freedoms and forget that someone who isn’t vaccinated is also infringing on other people’s freedom. So we have to do something that is proportionate. There is no simple answer.”

https://foreignpolicy.com/2021/02/17/wh ... -immunity/

[Suliso]

Of course a solution would still be a mixture of older people getting a vaccine and many younger just getting mildly ill. Danger is that this could promote virus mutation...

[ponchi101]

Eventually we will get to the stage of accepting this virus like something we have to live with. If people refuse to get the vaccine, there will always be a reservoir and the mutations you talk about.
Their freedoms. You know, the freedom to drive a car without brakes.

[ti-amie]

It’s essential to understand why some health care workers are putting off vaccination
Early data on why health care workers are delaying the Covid-19 vaccine could help us end the pandemic sooner.

By Katherine Harmon Courage Updated Feb 19, 2021, 2:34pm EST

3 big reasons health care workers are putting off the vaccines
In addition to preventing infections, serious illness, and even death, vaccinating health care workers first provides an opportunity to gather a wealth of information we won’t be able to get from the general public. That’s because health care systems have the data not only on how many people were offered and got the vaccine, but also on their demographics.

It’s a diverse group: People working in health systems include not just nurses and doctors, but also those who move patients, work in food service, serve in administrative roles, and keep facilities clean and operational. And the people in these many roles span ages, races and ethnicities, educational attainment, income levels, and many other categories.

“In the United States, it’s our best shot at really understanding vaccine hesitancy and the populations we need to be considering for getting the most vaccine coverage,” says Whitney Robinson, an epidemiologist at the Gillings School of Public Health at the University of North Carolina.

From early trends, some key lessons about why some health care workers are putting off the vaccine are emerging.

1) Covid-19 vaccine hesitancy may not be the same as other vaccine hesitancy

The experts we spoke with noted that most of the health care workers who are reluctant to get the Covid-19 vaccine immediately are not necessarily refusing it indefinitely. Many nurses, Buttenheim said in early January, “are in a wait-and-see mode: ‘I wouldn’t mind if a few more million people got it before I did.’” Despite robust safety and efficacy data, they want to see more real-world proof first.

That’s a very different stance from people who refuse — or refuse for their children — vaccines that have been around and proven safe for decades. This means “you can’t necessarily just apply what we know about vaccine hesitancy for childhood vaccines and other vaccines,” Robinson says.

As the Yale study found, among those 15 percent of workers who said they were less likely to get a Covid-19 vaccine now, many wanted a year — or at least six months — of follow-up data on recipients. Only about 11 percent of these reluctant people said that nothing would make them comfortable getting it; and fewer than 1 percent of them said they were “anti-vaccine” overall. Still, as Vice reported, health care workers are vulnerable to both believing and disseminating the Covid-19 vaccine misinformation circulating via social media.

“Accounts with names like The Holistic Nurse are proclaiming that they won’t get vaccinated, and strongly implying their followers should do the same,” Vice’s Shayla Love and Anna Merlan write. “It’s a uniquely risky situation, where people claiming medical expertise are working to undermine trust in a vaccine, just as it becomes clear that a majority of the population worldwide will need to get it in order to keep us all safe.”

2) Covid-19 hesitancy among health care workers tends to follow education

The new February report found that, of workers in the health care field who had not received education beyond high school, 29 percent said they would not get the Covid-19 vaccine (and 22 percent said they would wait until most people they knew had been vaccinated) — compared to 9 percent (and 10 percent, respectively) of people who hold a graduate degree.

Similarly, of the 15 percent of adults in the Kaiser survey who said they would “definitely not” get a Covid-19 vaccine, more than half of those (53 percent) had a high school degree or less. On the flip side, those who reported they would get the vaccine “as soon as possible” were most likely to have at least a college degree.

These patterns track with reports from health systems so far. For example, groups getting the vaccine at higher rates also are those most likely to have among the highest education. Brita Roy, of the Yale School of Medicine, where she is also director of population health and co-author of the Yale NEJM Catalyst study, notes that by early January, about 90 percent of medical residents had chosen to get the vaccine right away, compared with about 20 to 25 percent for those working in environmental services, food service, and transportation (who are likely to have lower overall education attainment). These latter groups have since started signing up for the vaccine in larger numbers, with 45 percent of people in environmental services choosing to get the shot and 35 percent of those in food service. But a striking gap between uptake with those in higher-credentialed jobs remains.

3) There are historical reasons for health care workers of color to be skeptical about getting an early health intervention

About 40 percent of health care workers in the US are people of color. A deep history of institutionalized medical racism means that people of color have frequently been subjects of unethical experiments in the US, often sowing justified mistrust in the medical establishment. Unfortunately, due also to centuries of systemic racism, many of these groups have also been among those hardest hit by the pandemic.

“I want these populations that have been burdened so badly with Covid-19 to be prioritized” for the vaccine, Robinson says. But, she acknowledges that even that ethos could make people suspect. “That’s so unusual with how health care usually operates in the United States, people might have pause,” she says.

And while some workers who haven’t gotten a vaccine yet might be prompted to sign up through simple reminders or other behavioral nudges, overcoming mistrust due to systemic racism, “this is not a nudgeable problem,” Buttenheim says. “That set of concerns and history isn’t going to be solved by a ‘mythbusters’ fact sheet or another study. It’s about really frank conversations about what you need to feel comfortable about this vaccine.”

Another step in addressing this, she says, would also be for health and medical institutions to clearly communicate and own up to past wrongdoings and indicate their goals for equitable medical treatment now and in the future.

How to address vaccine hesitancy
The rate at which health care workers are declining or delaying Covid-19 vaccines is, to many experts, unfortunately not a surprise. “I’m on record banging my head against the wall for several months that we need to be prepared for this, to have a vaccine acceptance strategy,” says Saad Omer, an infectious disease professor at the Yale School of Medicine and director of the Yale Institute for Global Health.

Although some were optimistic that health care workers would have a particularly high uptake of the vaccine, Robinson was also skeptical. “Everybody saw this coming who works in this field,” she says. “This is one of my frustrations: We know things that we haven’t been acting on.”

And there is a vast amount of research on the best ways to help people feel more comfortable getting a vaccine in general, which we can borrow from to some extent for the new Covid-19 vaccines.

For starters, we know what not to do when approaching people who are reluctant to get a vaccine. “‘You’re wrong’ — that doesn’t tend to work,” Robinson notes. “It’s a delicate thing.” She has found that among the most effective techniques is understanding where people are coming from and what their hesitations are. Acknowledging the vaccines’ newness will likely be important in addressing people’s concerns — both in this first priority group and likely later ones, as well.

Also, giving people incentives — financial or otherwise — can actually discourage them from getting vaccinated, especially if they already have concerns about side effects.

Many health systems are already working hard to ramp up communications strategies with workers, provide peer-to-peer discussion opportunities, and even talking to their employees outside of work.

“Health care workers are also community members, so reaching them through social media and our local media outlets, as well as internal communications, has been key,” Mike Dacey, president and chief operations officer at Riverside Health System in Virginia (where they have now had about 66 percent uptake among workers), wrote to Vox in an email. “We are encouraging team members who are eligible to receive the vaccine to do so within their designated phase to best support the safety and health of our team and community.”

In a December JAMA op-ed, Buttenheim and her co-authors also suggested five behavior-based strategies for getting more people to get the Covid-19 vaccine:

Have community and public leaders endorse the vaccine

Frame vaccination as a “public act” that benefits others; maybe even hand out stickers

Make getting the vaccine free and easy

Give people early access to the vaccine — if they sign up early

Eventually make vaccination a requirement for entry, such as to schools, workplaces, and even restaurants, gyms, or airplanes

Other experts note that being transparent about any potential side effects, small and large, will help engender trust. For example, some people balked at a January 6 report from the CDC that noted several severe allergic reactions — anaphylaxis — following Covid-19 vaccinations, at a rate of about 11 per 1 million doses or about 0.001 percent of people who get the vaccine, and haven’t caused any deaths (unlike the virus itself). But these events would have been unlikely to surface in the trials of tens of thousands of people, which is why the government keeps careful record of all vaccines after they go to market.

Lesser side effects are also important to communicate clearly to improve trust and transparency now and in the future. “Planning to survey the population on mild side effects experience and share those data with our health care workers will also be useful for the community and [larger] population,” Brita Roy wrote to Vox in an email.

“The sooner we can get more people vaccinated, the sooner we can get back to some semblance of normal,” Buttenheim says. And we have to get a whole lot of people vaccinated. Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci (after revising his public immunity estimations upward) says we’ll need 70 to 90 percent of people immune to the virus to squelch the pandemic.

For health care workers who refuse their first chance at a vaccine, getting back in line could be tricky. There’s no guarantee of when people will be able to get a vaccine if they wait past their designated phase — until more doses are available to the general public. And even more immediately, some states, including Connecticut, have been resupplying facilities based on the number of doses they were able to give the week before. So if uptake is chronically low, availability could dip, too.

That many health care workers are not refusing the vaccine outright and, instead, planning to wait and see provides some small glimmer of hope. Acceptance of the vaccine “is likely to grow as the social norm is established,” Omer says, with the result of more people getting it when they can.

For now, many advocate using the science and information we already have to meet people where they are, and help them feel comfortable getting the shot. “We just need to get ahead of it,” Robinson says. “So much of the response has been reactionary when it comes to Covid-19. I just hope we can break that cycle.”

https://www.vox.com/22214210/covid-vacc ... ce=twitter

[ti-amie]

[dryrunguy]

The latest Situation Report. I read it very quickly. Because of my work, I was particularly interested in the JAMA article on PTSD among survivors of severe COVID.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 111.42 million cases and 2.47 million deaths as of 9:00am EST on February 23. The global weekly incidence continues to decrease. The weekly total is fewer than 2.5 million cases for the first time since early October 2020 and less than half the weekly total of the peak in early January. Weekly mortality continues to decrease as well, down to 66,359 deaths last week. This is a decrease of nearly 20% compared to the previous week and an overall decrease of nearly one-third from the high in late January.

Our World in Data reports that 212.15 million vaccine doses have been administered globally, a 19% increase compared to this time last week. Vaccination efforts have been reported in at least 98 countries and territories.

UNITED STATES
The US CDC reported 27.94 million total cases and 497,415 deaths. Daily incidence continues to fall sharply in the US, now down to fewer than 65,000 new cases per day—the lowest average since October 23, 2020. This trend is evident across the country, with daily incidence decreasing rapidly in all 4 regions. Additionally, 40 states (plus Washington, DC) are reporting decreasing daily incidence over the past 2 weeks. Of the remaining states, 6 are holding relatively steady (-10% to +10% change), and only 4 are reporting increasing trends: Alaska (+108%), North Dakota (+46%), Rhode Island (+14%), and Wyoming (+117%).

As daily COVID-19 incidence and mortality continue to decrease in the US, so do hospitalizations. According to data compiled by the COVID Tracking Project, current hospitalizations nationwide are down to 55,403, a decrease of 58% from the peak on January 6. Notably, the current total is now below the previous peaks in April and July 2020. Similar to incidence and mortality, current COVID-19 hospitalizations are decreasing across all 4 regions of the country. The Midwest region peaked first, in late November/early December 2020, as it began to come down from its autumn/winter surge, and the Northeast, South, and West regions all peaked around January 6-12, 2021. Most US states are reporting fewer than 200 hospitalizations per million population, and no state is reporting more than 300. New York is reporting the most per capita hospitalizations, with 298 per million population, followed by Washington, DC, with 293. Compared to the previous week, 36 states are reporting decreasing hospitalizations, and 13 states (plus Washington, DC) are holding relatively steady (-10% to +10% change). Alaska (+11%) and Hawai’i (+35%) are the only 2 states reporting an increasing trend. Data compiled by the COVID Exit Strategy website show a different trend.

The official CDC data track the number of new hospitalizations per day (ie, as opposed to current hospitalizations). New hospitalizations peaked on January 6, with an average of 16,536 per day. Since then, new daily hospitalizations have declined steadily, down to 6,417—a decrease of more than 60% from the peak. The current average is more than 20% less than the previous week.

US Vaccination
The US CDC reported 75.21 million vaccine doses distributed and 64.18 million doses administered nationwide (85.3%).

In total, 44.14 million people (13.3% of the entire US population; 16.9% of the adult population) have received at least 1 dose of the vaccine, and 19.44 million (5.9%; 7.5%) have received both doses. The average daily doses administered decreased slightly to 1.46 million doses per day*, including 664,618 second doses per day*. These decreases could be a result of delays in vaccine distribution and administration stemming from severe winter weather affecting much of the country.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

A total of 6.58 million doses have been administered at long-term care facilities (LTCFs)**, including residents and staff. This covers 4.45 million individuals with at least 1 dose and 2.01 million with 2 doses. Approximately 59% of the doses have gone to residents, and 41% to staff.
**The dashboard only includes data for doses administered through the Federal Pharmacy Partnership for Long-term Care (LTC) Program. It does not report data from West Virginia, which opted out of the program.

The Johns Hopkins CSSE dashboard reported 28.20 million US cases and 501,117 deaths as of 12:30pm EST on February 23.

VACCINATION EFFICACY More evidence is emerging that vaccination campaigns are significantly reducing the risk of both severe COVID-19 disease and SARS-CoV-2 transmission. A study by Public Health England found that the risk COVID-19 disease among healthcare workers (HCWs) decreased by 65-72% after the first dose of the Pfizer-BioNTech vaccine, and more than 85% after the second dose. Additionally, the risk of infection decreased by 70% in HCWs who received one dose and 85% in those who received both doses. Similarly, data from Public Health Scotland indicates that hospitalization risk decreased 94% for individuals vaccinated with the AstraZeneca-Oxford vaccine and 85% for the Pfizer-BioNTech vaccine. In Israel, data from the Ministry of Health reportedly indicate that the Pfizer-BioNTech vaccine decreases the risk of infection by 89% and the risk of disease by 94%. Israel has fully vaccinated approximately 27-32% of the population using the Pfizer-BioNTech vaccine, and nearly 50% of the population has received at least one dose. This is some of the earliest evidence that demonstrates SARS-CoV-2 vaccines’ effect on transmission.

NOVAVAX CLINICAL TRIALS Novavax announced that it completed enrollment in Mexico and the US for the Phase 3 clinical trials for its candidate SARS-CoV-2 vaccine. Combined, the trials will include approximately 30,000 participants, many of whom are in “communities and demographic groups most impacted by the disease.” The researchers proactively sought a demographically diverse group of participants—including 20% Latinx, 13% African American, 6% Native American, 4% Asian American, and 13% aged 65 years and older—in order to test the vaccine in communities at elevated COVID-19 risk. Additionally, study sites were deliberately assigned to areas with elevated community transmission, with the aim of accelerating the timeline for obtaining the data needed to conduct the efficacy analysis.

Novavax is using a different vaccine technology than previously authorized SARS-CoV-2 vaccines. The Novavax vaccine is protein-based, and it contains recombinant nanoparticles constructed of synthetic SARS-CoV-2 spike proteins to generate the desired immune response. The vaccine also contains a proprietary adjuvant to boost the immune response. The Novavax vaccine requires 2 doses, administered 21 days apart.

COVAX DONATIONS In conjunction with the 2021 summit of the Group of Seven (G7) on February 19, the leaders of Canada, France, Germany, Italy, Japan, the UK, and the US issued a joint statement pledging improved international collaboration and support for the global COVID-19 response, including additional funding for the COVAX facility, which aims to provide SARS-CoV-2 vaccine for low- and middle-income countries (LMICs). Collectively, the G7 governments committed an additional US$4 billion to COVAX, bringing the total to US$7 billion from these 7 countries. The pledge includes US$2 billion from the US, with an additional US$2 billion in the future, contingent upon the other G7 countries fulfilling their commitments.

While the financial donations help to increase the doses COVAX can afford to purchase, it does not necessarily impact the current lack of accessibility for most countries eligible under COVAX. With countries like the US, the UK, and those in the European Union consuming the majority of available vaccine supply, most LMICs remain unable to access doses, even if they could afford to pay for them. WHO Director-General Dr. Tedros Adhanom Ghebreyesus called on high-income countries to make vaccine available to LMICs. He noted that “having the money doesn’t mean anything,” if there is no vaccine available to purchase. Unilateral arrangements directly with vaccine manufacturers to acquire additional doses are delaying access and reducing allocations for LMICs, including through programs like COVAX. Dr. Tedros called on high-income countries to consider the effect on COVAX before negotiating any new contracts to purchase additional doses. Notably, he emphasized that when high-income countries “undermine” the COVAX effort, they are not only increasing the risk for LMICs, they are also increasing their own risk, because areas that remain unvaccinated will allow continued transmission and mutation that could then spread internationally.

MENTAL HEALTH OF SURVIVORS Several recent articles have investigated mental health effects of the COVID-19 pandemic. One study conducted by researchers in Italy, published in JAMA: Psychiatry, evaluated post-traumatic stress disorder (PTSD) in survivors of severe COVID-19 disease. The study involved 381 patients who sought care through an emergency department. Trained psychiatrists diagnosed PTSD in these patients using a standardized Clinician-Administered PTSD Scale, based on the results of a psychiatric assessment. The researchers diagnosed PTSD in 115 (30%) of the participants as well as depressive episodes in 66 (17%) and generalized anxiety disorder in 27 (7%). The presence of persistent medical symptoms was among the factors significantly associated with PTSD diagnosis. While a relatively small sample size, this study provides evidence that severe COVID-19 disease could be associated with longer-term mental health issues in recovered patients. This illustrates the broad array of long-term health conditions that can stem from COVID-19.

US VACCINE SAFETY MONITORING Researchers from the US CDC COVID-19 Response Team and the US FDA published analysis of early SARS-CoV-2 vaccine safety monitoring from the US vaccination campaign. The study, published in the US CDC’s MMWR, reviewed safety monitoring data for the Pfizer-BioNTech and Moderna vaccines administered in the US from December 14, 2020, to January 13, 2021—accounting for approximately the first month of vaccinations for both products. During this period, 13.8 million doses of vaccine were administered, and there were 6,994 post-vaccination adverse events reported in the Vaccine Adverse Event Reporting System (VAERS). The most common symptoms were headache (22.4%), fatigue (16.5%), and dizziness (16.5%). Anaphylactic reactions were reported in approximately 4.5 out of every million vaccinations, which is similar to the rate expected for inactivated seasonal influenza vaccines. Adverse events were more likely to be reported after an individual’s second dose than their first dose.

Among the 6,994 total reports, 640 (9.2%) were considered to be serious adverse events, including 113 deaths (78 among residents of long-term care facilities). Notably, VAERS data include reports from “healthcare providers, vaccine manufacturers, and the public,” and further investigation is required in order to determine whether a reported adverse event was associated with the vaccine. Information collected from “death certificates, autopsy reports, medical records, and clinical descriptions from VAERS reports and health care providers” do not indicate that any of the deaths were caused by vaccination.

US ECONOMIC STIMULUS Yesterday, the White House announced changes to the federal Payment Protection Program (PPP), part of the United States’ COVID-19 economic relief efforts, that aim to better support small and minority-owned businesses. Starting this week, the PPP will institute a 2-week period dedicated to businesses that employ fewer than 20 employees, many of which have struggled to navigate the PPP application process, which will enable lenders to provide additional assistance to the smallest businesses. The PPP will also update how it determines financial support for independent contractors and self-employed individuals, many of whom received PPP loans as little as US$1 under previous iterations of the program. “Exclusionary restrictions” for businesses owned by individuals who committed non-fraud felonies or individuals who are delinquent in repaying federal student loans will be eliminated. Finally, the changes will correct inconsistencies to ensure eligibility for businesses owned by non-citizen legal US residents, including Green Card holders and individuals residing in the US under a visa. The PPP has distributed billions of dollars in support to small businesses, but critics have raised concerns that structural barriers have prevented funding from being allocated to those in the greatest need, including businesses owned by racial and ethnic minorities.

The US House of Representatives is expected to vote this week on the newest COVID-19 economic stimulus package. The bill—the American Rescue Plan, published on February 19—includes US$1.9 trillion in funding to support state and local COVID-19 response, including vaccination and schools; financial support for small businesses and extended unemployment benefits; and direct payments to individuals and families. Reportedly, efforts to negotiate a bipartisan funding package have largely stalled, and Democratic members of the Congress could use a budget reconciliation process to pass the bill without Republican support.

LONG COVID As more and more people recover from acute COVID-19 disease, clinicians and researchers are gathering additional information on the chronic effects of SARS-CoV-2, commonly referred to as “long COVID.” A study conducted in Israel, published in Clinical Microbiology and Infection, investigated chronic symptoms in recovered COVID-19 patients over a 6-month period. The study included 103 patients who recovered from mild COVID-19 illness, and investigators collected data on the onset and duration of a variety of symptoms. Fever was among the first symptoms to resolve, with a mean duration of 5.6 days, whereas fatigue (31.1 days), difficulty breathing (18.6), and changes to taste (18.6) and smell (23.5) tended to persist longer. Notably, nearly half of the participants reported chronic symptoms that persisted for 6 months, including 22% with ongoing fatigue, 15% with changes to taste and smell, and 8% with breathing difficulties. The onset of some of the chronic symptoms—such as fatigue, breathing difficulties, memory disorders, and hair loss—tended to be reported after the 6-week point, indicating that they were newly developed conditions in recovered patients rather than longer-term continuations of acute disease.

Increasing prevalence of long-term health effects from SARS-CoV-2 infection are raising concerns regarding how long-term care will be managed for patients with long COVID. Chronic health conditions such as fatigue, neurological disorders, and difficulty breathing can be debilitating for some patients, and advocates and elected officials have raised the possibility of classifying long COVID as a disability. Patients with severe chronic conditions following SARS-CoV-2 infection may be unable to return to work, or school or other activities, but they may not be eligible for Social Security Disability Insurance benefits. Some advocates have called on the US Social Security Administration to proactively issue guidance regarding how to handle COVID-19-related claims, in anticipation of increased need in the coming months and years for disability support for recovered patients, including financial support or accommodations or assistance in the workplace.

SCHOOL-BASED TRANSMISSION A study conducted by the University of Florida and the Florida Department of Health, published in JAMA, investigated the impact of student quarantine and testing protocols at K-12 schools in Alachua County, Florida. Data indicate that the COVID-19 incubation period in children is 6 to 7 days, shorter than the 4 to 5 days in adults. The county implemented 14-day self-quarantine for students exposed to known COVID-19 cases, and students were allowed to return to school early if they received a negative RT-PCR diagnostic test on Day 9 or later. The rationale for this program was that SARS-CoV-2 infection should be detectable by Day 9 and that students who tested negative could safely return to school the next day. Out of 799 students who received a negative test under this program, only 1 developed symptomatic disease after returning to school, and genomic data indicate that the student was actually infected through a different exposure than the one that prompted quarantine. The program to enable students to end their quarantine period early reduced the total number of missed school days by more than 30% without resulting in any additional transmission. This study provides evidence that schools can implement testing protocols to promote in-person learning while effectively mitigating transmission risk.

A study conducted by the US CDC COVID-19 Response Team and school and public health officials in Georgia, published in the CDC’s MMWR, found that half of school-associated cases initiated from teacher-to-teacher transmission and then spread from teachers to students. The researchers evaluated data from 24 days of in-person learning at elementary schools in a single school district, which included approximately 2,600 students and 700 staff. In total 9 clusters of cases were identified, involving 13 teachers, 32 students, and 18 additional instances of household transmission. Of the 31 school-associated cases, 15 were students who are believed to have been infected following transmission between teachers. Notably, all 9 of the school clusters “involved less than ideal physical distancing, and five involved inadequate mask use by students.” The “central” role of teachers in school-based transmission provides support for vaccinating teachers in order to mitigate transmission risk during in-person classes. Current US CDC guidance indicates that teachers need not be vaccinated before schools can reopen, but many teachers unions are calling for changes to existing guidance and policies that would prioritize teachers as essential workers in order to provide protection before resuming in-person learning.

TANZANIA On February 20, WHO Director-General Dr. Tedros Adhanom Ghebreyesus issued a statement urging the Tanzanian government to report COVID-19 data and implement COVID-19 control measures. He noted that numerous Tanzanians traveling to other countries have tested positive for SARS-CoV-2, which indicates that Tanzania's epidemic is not contained. Tanzanian President John Magufuli has repeatedly stated that Tanzania eliminated COVID-19 and opposed vaccination and other protective measures; however, recent reports of COVID-19 deaths, including several senior government officials, have called attention to the country’s ongoing epidemic. Tanzania has not reported COVID-19 data since May 2020, when it had 509 cumulative cases and 21 deaths. President Magufuli reportedly changed course to some degree, now encouraging Tanzanians to take appropriate precautions to protect against COVID-19, including mask use and proper hand hygiene.

INFODEMICS On February 19, the Johns Hopkins Center for Health Security, in collaboration with experts at the WHO, published a special feature on Infodemics and Health Security in the journal Health Security. As the COVID-19 pandemic unfolded, the quickly WHO recognized the critical need to combat mis- and disinformation. Following the first Global Infodemiology Conference in 2020, the WHO collaborated with partners across 5 disciplines to publish research and commentaries in 5 peer reviewed journals on topics related to misinformation and infodemic management during public health emergencies. The special feature in Health Security includes a series of articles that analyze infodemics in the midst of health emergencies and communication policies and practices to overcome a variety of misinformation challenges, particularly in the context of emerging and ongoing health emergencies. Additionally, the special feature includes commentaries that specifically address crisis and emergency risk communication during the COVID-19 pandemic.

https://covid19.who.int/