Covid-19 Updates & Info

[ponchi101]

I believe it was the soil. Caracas is also like that. Many of our boroughs are named after the plantations that were there before urbanization. My mom lives in "El Cafetal" (the coffee plantation), which is near "Los Naranjos" (the orange grove). And then other sectors are named after the forests that were there: Los Caobos (a local tree), Los Ruices (another) and so forth.
Soil and water. No cities without those conditions (specially a river with fresh water) were built before modern times (Las Vegas, Dubai, etc).

As for your example in Switzerland: you guys have the issue of snow. Not a great idea to build a city where you will be snowed in for months of the year. Or outright die of exposure. No such issue here.

[Suliso]

In the ancient past vast majority of cities were built at confluence of some kind of trade routes (sea, river, near mountain crossing etc) and trade routes in those days were mostly water based. A notable exception are some Italian cities which were founded deliberately as military veteran colonies at the crossroads of Roman roads.

[ti-amie]

I agree with Dr Wen on this. Fauci has been working trying to clarify what the new guidelines mean but I think that horse, for some people, is long gone.

[ponchi101]

In CONTAGION (the movie) the vaccines came with a band that you could strap on your wrist to verify you had the vaccine.
C'mon, it can't be that hard. The people that took the vaccine certainly won't mind, the antivaxxers are out on their own.

[ti-amie]

In CONTAGION (the movie) the vaccines came with a band that you could strap on your wrist to verify you had the vaccine.
C'mon, it can't be that hard. The people that took the vaccine certainly won't mind, the antivaxxers are out on their own.

I just heard a report on the local all news station that was about companies are concerned about how to guarantee a safe work environment since there is no real way - at this time - of telling who is vaccinated and who is not.

There is a Mass I've been watching on Sunday mornings during the pandemic. The Rector, in his remarks before the start said, and I'm paraphrasing, that despite what the CDC or the government says they have no way of knowing who is vaccinated and who is not. He went on to say that masking will continue to be mandatory inside the Basilica. I've been retired for awhile but why can't companies do the same thing?

[atlpam]

In CONTAGION (the movie) the vaccines came with a band that you could strap on your wrist to verify you had the vaccine.
C'mon, it can't be that hard. The people that took the vaccine certainly won't mind, the antivaxxers are out on their own.

I just heard a report on the local all news station that was about companies are concerned about how to guarantee a safe work environment since there is no real way - at this time - of telling who is vaccinated and who is not.

There is a Mass I've been watching on Sunday mornings during the pandemic. The Rector, in his remarks before the start said, and I'm paraphrasing, that despite what the CDC or the government says they have no way of knowing who is vaccinated and who is not. He went on to say that masking will continue to be mandatory inside the Basilica. I've been retired for awhile but why can't companies do the same thing?

Companies can do the same thing (at least private ones). When the governor here removed all the restrictions, it was still noted that businesses were free to continue requiring masks and/or continue with capacity restrictions as they see fit. For example, my town has outdoor concerts on a green. When restrictions were in place, they were creating distanced spaces and only taking reservations for 500 people. After guidance on low risk for outdoor activities, they are still requiring reservations but now allowing 2500 people (total capacity is 5000). Based on the state guidelines, they could go full capacity, but they are continuing to be more cautious.

[MJ2004]

The university I work for just announced that students will be required to be vaccinated, and that staff are “strongly advised” to get the vaccine.

[Suliso]

How will you verify? I hear some states are refusing to provide any documents.

[Suliso]

How can more covid-19 vaccines be made available?

The nuts and bolts of scaling up production matter more than intellectual property

Biomedicine has never seen anything like it. This time last year, no company had ever made a vaccine against sars-cov-2, the virus that causes covid 19, on an industrial scale. By the middle of this April a billion doses had been delivered. According to Airfinity, a data provider, a second billion doses are expected by June 1st. On current estimates the world’s pharmaceutical companies look set to provide 10.9bn doses over the course of 2021.

So far this effort has increased the world’s capacity for producing vaccines of all sorts by a factor of three to four. “It’s insane,” says Tim Gardner, the boss of Riffyn, a biotechnology startup focused on speeding up drug-production processes. “It’s an incredible success.”

At the same time many parts of the world have no smooth-running avenues of supply. The Covid-19 Vaccines Global Access Facility (covax), a vaccine-sharing scheme designed to provide supplies to low- and middle-income countries, has so far distributed only 59m doses. Most of the most vulnerable unvaccinated people look unlikely to be vaccinated soon. This is both inequitable and inefficient; it will increase the death toll and prolong the pandemic, increasing both economic losses and the odds of new variants of concern.

A recent report from the oecd, a club of mostly rich countries, made the case for continued government investment in vaccine-production capacity, putting the idea into the context of long-term strategies such as “co-ordinated approaches to the sharing of intellectual property and technology transfer”.

It is the sharing of intellectual property, not increased investment, which has drawn the most attention. Since last October, South Africa and India have been arguing for an arrangement whereby the World Trade Organisation no longer obliges countries to protect patents, industrial designs, copyright and trade secrets which apply to covid-19 vaccines, therapeutics and diagnostics. America, Britain, the European Union and Switzerland—home, between them, to most of the world’s big drugmakers—opposed the waiver. But on May 5th President Joe Biden broke ranks. Katherine Tai, the us trade representative, said that the administration would support proposals to waive intellectual property protections for covid-19 vaccines, winning the administration plaudits from over 100 countries which support the waiver as well as from people at home who think drug companies inherently villainous.

If such a waiver is agreed on, it will not be soon. Proponents take that in their stride: better to arrive at the end of the year with a waiver agreement close to hand and no need to use it, goes one argument, than still to be facing a global crisis of unmanageable proportions but with a diplomatic mountain to climb. That may be so. But the world’s need to create new production facilities, and ideally to work the various capabilities it has already developed even harder, will not wait. And intellectual-property rights are far from the most pressing, or most restrictive, constraint.

Billion wise, trillion foolish

The increase in capacity seen over the past year was brought about in large part because of government interventions, most notably Operation Warp Speed in America and the activities of the Vaccine Taskforce in Britain, which guaranteed payments and drove the expansion of supply chains.

These efforts splashed around a lot of money which, if none of the vaccines had worked, would have been lost. But with the benefit of hindsight it is now hard not to wish they had been more generous still. In March Science, a journal, published estimates from a group of economists of the total global economic loss that would have been avoided if enough money to produce vaccines for the entire world had been provided up front, rather than enough for most of the rich world. They calculated that if the world had put in place a vaccine-production infrastructure capable of pumping out some 1.2bn doses per month by January 2021, it would have saved the global economy almost $5trn (see chart).

Eric Budish of the Chicago Booth School of Business, one of the model’s authors, explains the situation using a plumbing metaphor: it is faster to lay down a wider-bore pipe at the start of a project than to expand a narrow one later. The rich world succeeded in producing effective vaccines remarkably quickly in quantities broadly sufficient to its needs: an extraordinary achievement. But the capacity of the system it built in order to do so created constraints that the rest of the world must now live with. That was a choice, not destiny.

[Suliso]

But if the best time to invest was last year, the second best is now. Three distinct types of vaccine—based on mrna, on dna packaged inside an adenovirus, and on inactivated sars-cov-2 particles—have been widely authorised for use, if in most cases and places only on an emergency basis. Companies that play a role in relevant supply chains are able to invest with an assuredness about what is to come that they could not have had last year. Thermo Fisher, an American firm which sells a range of scientific and pharmaceutical supplies, having seen “mrna confidence increase on the demand side”, is spending $60m on a facility in Texas that will produce more of the nucleotide building blocks from which mrna vaccines are assembled.

The mrna vaccines made by Pfizer/BioNTech and Moderna are, in general, those which Western customers are most excited about seeing scaled up. Moderna is ramping up production around the world; it recently announced that it will make 3bn doses next year. On May 10th BioNTech said it plans to create a factory with an annual capacity of several hundred million doses in Singapore. The firm is in discussion with other countries about further production sites. A joint venture with Fosun Pharma, a Chinese firm, could make up to 1bn doses a year. A number of African countries are known to be keen on bringing the technology to the continent.

Unfortunately for the vulnerable people at growing risk around the world none of this will be quick. Stéphane Bancel, the boss of Moderna, says that it takes six to nine months at a minimum to add significant capacity, which means there is no way to increase capacity this year beyond what is already planned. Even when a company has a site ready to take mrna manufacturing equipment, machines have to be ordered, built, shipped and installed, a reliable supply of raw materials has to be arranged and people have to be hired, trained and brought up to speed on the processes involved.

Pollyanna, meet Polanyi

Building up the requisite knowledge in the new teams is the hardest task. The problem, says Rob Carlson, a veteran biotechnology investor, is that that knowledge is not stored in a format that is easy to copy between facilities. Each vaccine is produced according to a “recipe” which lists the settings for all of the things in a production facility that can be changed from job to job: every dial on every machine, timings, temperatures, masses, volumes and concentrations. Such a recipe may run to hundreds of pages. And it will still typically be incomplete; tacit knowledge matters, too, and it is for the most part lodged in the minds of very busy people.

Under pandemic conditions accessing what those people know will be complicated by the fact that they may well be on the edge of burnout. Mr Bancel says his team “has been working hard for a year, seven days a week…we are not even finished doing all the tech transfer to deliver the billion for this year.” Every day he worries that he is pushing them too close to their breaking point.

The non-mrna Western firms have been working just as hard at transferring their technology. AstraZeneca made global production of its adenovirus vaccine a particular focus; the tech transfer of Oxford University vaccine taken forward by AstraZeneca to one British production site took about seven months, says Sandy Douglas, the Oxford professor who managed the transfer. Novavax has taken the better part of a year to transfer the insect-cell-based manufacturing system for its not-yet approved protein-subunit vaccine to the Serum Institute of India (sii), a huge and very experienced vaccine-maker. Stan Erck, the company’s ceo, says it is repeating the process in the Czech Republic, Korea, Japan and America.

All told, pharma firms have made 280 partnership contracts covering the production of covid-19 vaccines, says Thomas Cueni, head of the International Federation of Pharmaceutical Manufacturers and Associations, a trade group. About three-quarters of those deals involve technology transfer. He adds that the firms that are doing well in terms of meeting production targets tend to have relatively few production sites, pointing to the benefits centralisation offers attempts to scale up.

Biobags and bottlenecks

Despite all this activity, though, some companies which could be making vaccines are not. Teva Pharmaceutical Industries, an established Israeli generic-medicine maker, has failed to reach a co-production deal with any covid-19-vaccine-maker. At the end of April it said it had stopped trying. Incepta, a Bangladeshi firm with the capacity to fill and finish hundreds of millions of vaccine vials a year, has also complained that it has been unable to interest producers in its services.

Given the constraints on expansion, it is vital that the supply chains on which current production rests be kept in fine fettle. “The number one priority today must be to do everything that we can to ramp up raw materials and get them to the production centres,” says the European Federation of Pharmaceutical Industries and Associations, a trade group. Unfortunately, production has been slowed at various facilities by insufficient supplies of biobags (the containers in which vaccines are often made), tubing, filters and growth media for cells. Novavax’s lines in both Britain and India have been hit by shortages, at times coming to a halt; the company’s production plans have been set back significantly.

On April 16th the trouble with the Indian line led to a remarkable tweet. Adar Poonawalla, the head of sii, begged President Biden—“Respected @potus”—“to lift the embargo of raw material exports out of the U.S. so that vaccine production can ramp up”. At issue was America’s Defence Production Act (dpa), which grants the president broad industrial-mobilisation powers. The government is using the dpa to prioritise domestic firms’ orders for material and equipment used in vaccine production over those flooding in from other countries. Overseas producers who depend on American equipment or materials are feeling the pinch.

The sii said difficulties in getting materials from America were putting an AstraZeneca line at risk, as well as the Novavax one; between them they have a capacity of 160m-170m doses a month. On April 26th Tim Manning, the White House’s supply co-ordinator for covid-19, defended the use of the dpa, saying it is not a “de facto ban” on export and does not create supply shortages. But Biovac, a South African vaccine-maker, told Reuters that its American supplier of biobags was explicitly blaming the dpa for a 14 month backlog on biobag deliveries. Last year a number of big pharma firms started re-creating supply chains outside America to serve international customers. The sii Novavax line is still running at a fraction of its full capacity.

Disruptions to supply chains, whether down to the dpa or other factors, are a source of deep frustration. “Why on earth is production at the Serum Institute being delayed because it can’t get enough culture media?” asks Dr Douglas. “It’s madness! Is it because the company that makes culture media has a shortage of its own? If so let’s fix that.” Such problems have a worrying tendency to amplify themselves; when companies have concerns about supply chains they stockpile supplies, stressing the chains even more. The fact that some of the equipment needed for vaccine-making also plays a part in the production of considerably higher-margin products such as cancer treatments further complicates the situation, breeding suspicion.

Despite the supply difficulties, Airfinity says that current roll-out forecasts suggest that the America, Britain, Canada, the eu and Japan will have enough doses for their entire adult populations between the summer of 2021 and January 2022. But middle- and low-income countries are at risk. Donors have committed money to covax, but it has not been getting the vaccines it is meant to buy. Bruce Aylward, senior adviser to the director general at the World Health Organisation (who), says covax hopes to have the j&j adenovirus vaccine by June but “who knows, it is at risk for a million reasons so maybe June, maybe July, maybe August”. Of the 40m doses that Pfizer has promised, he says, it has delivered only 960,000. There was, though, some good news for covax on May 7th, when Sinopharm’s vaccine was given emergency-use authorisation by the who. This means that the vaccine, one of two inactivated-virus formulations being made in bulk by China, can now be distributed through covax.

Some countries have promised to donate doses to covax, but the volumes are small. Spain and New Zealand, the most generous, have pledged 1.6m and 7.5m doses respectively. The organisation has so far dealt with just 100,000 donated doses, provided by France and dispatched to Mauritania, says Dr Aylward. Rasmus Bech Hansen, boss of Airfinity, says he hears that the large purchase orders made by some governments may be resold rather than donated. The possibility of donations could be further dampened by a perceived need for booster shots as new variants spread.

Fail better

Bottlenecks in supply and hold-ups in distribution have led to calls for a fresh round of state investment. Public Citizen, an American consumer-advocacy group, says that with $25bn the Biomedical Advanced Research and Development Authority, a part of America’s Department of Health which comes up with solutions to health emergencies, could scale up vaccine production enough to cut years off the tail of the pandemic. The money would be spent on stimulating production all the way along the supply chain, on technology transfer and on the construction of new facilities around the world. All of those people that The Economist spoke to who work in the existing vaccine-supply chain agreed that this was one sure-fire way to boost vaccine output yet further. The second-best time will always be now.

https://www.economist.com/briefing/2021 ... -available

[shtexas]

My morning paper wrote the following:

"In Dallas County, there have been 506 “breakthrough” cases of COVID-19 in people who have been fully vaccinated, or about six cases for every 10,000 fully vaccinated residents. Eighty-two of those breakthrough patients were hospitalized, and seven died."

How do you throw out these numbers without telling us how many cases there were without the vaccine, what that percentage is, how many were hospitalized, and how many died?

Just saying what they wrote gives people the impression the vaccine is not working. If they gave all the numbers, I am sure the difference between the vaccinated and the unvaccinated will be significant.

[atlpam]

Just curious, in all the reports of golfer Jordan Spieth having Covid, they never mention vaccination status.
Are we only publicizing breakthrough cases for those who were vaccinated and not publicizing cases that could have been avoided through vaccination?

[dryrunguy]

Here's the latest Situation Report. Haven't read it. I have been distracted by Eurovision.

::

EPI UPDATE The WHO COVID-19 Dashboard reports 163 million cumulative cases and 3.4 million deaths worldwide as of 5:45am EDT on May 18. As India’s current COVID-19 surge peaked and began to decline, global weekly incidence decreased for the second consecutive week, down more than 12% compared to the previous week. Global weekly mortality also declined for the second consecutive week, down nearly 5% from the previous week. Notably, the global trend in mortality is not lagging incidence by 3-4 weeks, as we have observed previously during the pandemic. It is not immediately apparent why this is the case, and it warrants monitoring over the coming weeks.

India’s daily incidence continues to decrease sharply from its peak on May 8 (391,282 new cases per day). Notably, the rate of decrease since the peak appears to be even sharper than the steep increase prior to the peak. The current daily incidence is 319,497 new cases per day, representing a 18% decrease over the past 9 days. India’s test positivity is also decreasing sharply, down from a peak of 22.7% on May 8 to 18.9% on May 15*, a 17% decrease over that period. While India’s test positivity remains elevated, which suggests that the official reports continue to undercount the true daily incidence, the decreasing trend provides an indication that testing volume is beginning to catch up to the scale of community transmission.
*The most recent data available for India.

Global Vaccination
The WHO reported 1.26 billion doses of SARS-CoV-2 vaccines administered globally, including 637 million individuals with at least 1 dose, but these data have not been updated since May 12. Our World in Data reported 1.50 billion cumulative doses administered globally, an increase of 13% over the previous week. Daily doses administered continues to increase, up to a new record of 24.7 million doses per day. Our World in Data estimates there are 360 million people worldwide who are fully vaccinated, corresponding to approximately 4.6% of the global population, although reporting is less complete than for other data.

UNITED STATES
The US CDC reported 32.8 million cumulative cases and 583,074 deaths. On May 16, the US reported 17,724 new cases, the first day with fewer than 20,000 new cases since June 15, 2020, and the lowest single-day total since June 7, 2020. On May 14, the United States’ per capita daily incidence fell below 10 daily cases per 100,000 population for the first time since early in the country’s second surge. The current daily incidence (30,211 new cases per day) is the lowest since June 23, 2020. Between the first and second surges, the lowest average daily incidence was 19,817 new cases per day (June 1, 2020), the only day below 20,000 since March 2020. If the US continues on its current trajectory, it could fall below that number in the next week or so. At 545 deaths per day, the current daily mortality is at its lowest point since April 1, 2020, which was less than 1 month after the first COVID-19 death was reported in the US.

Daily incidence and mortality continue a prolonged decline, first from the largest peak in January 2021 and again following the minor surge that peaked in mid-April. Testing volume similarly decreased over that time. At the national level, test positivity peaked at nearly 15% in early January 2021, the highest point since the initial surge in early 2020, when testing capacity was extremely limited and eligibility was focused on symptomatic patients. From there, both testing volume and positivity decreased substantially through mid-March 2021, as the US recovered from its winter surge. Testing volume increased only slightly during the March-April surge, but test positivity increased over that period, from 4% to nearly 5.5%. Test positivity decreased steadily after that peak, and on May 16, the CDC reported the lowest average since it started tracking it on March 1, 2020 (3.32%).

In total, 10 states are reporting test positivity* of more than 5%. Of these states, only Montana is reporting an increasing trend, up from 3.52% on March 28 to 5.17% on May 15. Most of these states—including Florida (5.58%), Michigan (6.36%), Nebraska (5.89%), Oregon (5.02%), South Dakota (6.94%), Tennessee (5.18%), and West Virginia (5.97%)—have reported declines in test positivity since mid-to-late April, and if they continue on their respective current trajectories, they could fall below 5% in the near future. Indiana’s test positivity (5.18%) increased after its most recent surge and has hovered around 4.5-5.5% since then. Alabama (5.44%) has largely hovered around 5.25-6% since mid-March.

The majority of states are reporting steady declines in test positivity over the past several weeks, particularly since the peak of the most recent surge in mid-April. Massachusetts is reporting the lowest test positivity, at 1.03% and still decreasing. New Mexico and Utah have reported steadily increasing test positivity since late March/early April. New Mexico’s average is up from a low of 1.93% to 2.66% in its more recent report on May 5, and Utah’s average has increased from 3.73% on April 4 to 4.6%. Louisiana (3.61%) is reporting a slight increase over the past several weeks, up from 2.62% on May 1. Arizona is exhibiting a similar trend, but on a longer timeline. Arizona’s test positivity has increased slowly from a low of 3.58% on March 24 to 4.95% on May 12, before falling slightly to 4.69%. The overall decreasing trends, including a number of states that are setting or approaching new record lows, is an encouraging indication that testing volume is reaching and sustaining at a level that can accurately capture the scale of community transmission.
*Data not available for May 16; the values reported here correspond to the most recent data available for each state, most of which are from May 15.

US Vaccination
The US has distributed 345 million doses of SARS-CoV-2 vaccine and administered 274 million. Daily doses administered* continues to decrease steadily, down from a high of 3.3 million on April 11 to 1.6 million. Approximately 1.1 million people are achieving fully vaccinated status per day, down from a high of 1.8 million per day on April 12.

A total of 158 million individuals in the US have received at least 1 dose of SARS-CoV-2 vaccine, equivalent to 48% of the entire US population and 60% of all adults. Of those, 124 million are fully vaccinated, which corresponds to 37% of the total population and 47% of adults. Among adults aged 65 years and older, progress has largely stalled at 85% with at least 1 dose and 73% fully vaccinated. Among individuals aged 12-17 years—including individuals aged 16 and 17 who were previously eligible—3.3 million have received at least 1 dose, and 1.6 million are fully vaccinated. In terms of full vaccination, 64 million individuals have received the Pfizer-BioNTech vaccine, 50 million have received the Moderna vaccine, and 9.6 million have received the J&J-Janssen vaccine.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

US CDC MASK GUIDANCE Following the US CDC’s announcement of updated mask guidance on May 14, federal health officials have spent the past several days “defending” the updated guidance. Numerous accounts describe the new guidance that eliminated recommendations for mask use and physical distancing for fully vaccinated individuals in most situations as “surprising” or “startling.” Reportedly, the CDC did not brief state and local health officials on the changes prior to the announcement, which resulted in many being caught off guard by the new guidance. Numerous states and businesses removed or relaxed mask mandates in response to the change, some with little or no advance notice. The sudden change has caused confusion among the public, state and local health and elected officials, and schools and businesses, particularly regarding whether (and how) to maintain mandates for unvaccinated individuals while allowing vaccinated individuals to go maskless.

Some experts applauded the change, but others expressed concern about both the policy’s content and its rollout. While many felt guidance has evolved too slowly, the CDC is now being criticized for overcorrecting and moving too quickly. Some are concerned that the change—and subsequent end of mandates—will encourage individuals to forego COVID-19 protective measures, such as mask use, even if they are not yet vaccinated, which could increase the risk for individuals who are not yet fully protected. Some argue that the guidance is based, at least in part, on the assumption that anyone who wants to get vaccinated is already fully protected. Notably, some states only expanded eligibility to everyone aged 16 years and older in late April, adolescents aged 12-15 have only been eligible since May 12, children under the age of 12 are still not eligible at all, and millions of individuals with compromised immune systems either cannot be vaccinated or may only obtain partial protection. National Nurses United, the country’s largest nurses union, issued a statement opposing the new guidance, emphasizing concern about ongoing elevated daily incidence, increasing prevalence of variants of concern, risk to healthcare workers and patients, and the disproportionate impact on historically underserved Black, Hispanic/Latino, and Indigenous populations.

CDC Director Dr. Rochelle Walensky emphasized that the risk of infection and transmission for vaccinated individuals is very low and that the changes stem from evolving data. She also encouraged “individual assessment of...risk” and stressed unvaccinated individuals should continue practicing physical distancing and mask use. White House Chief Medical Advisor Dr. Anthony Fauci acknowledged that additional clarification on the new guidance likely would be published in the coming weeks.

US VACCINE ACCESS As vaccination progress in the US slows, health officials are increasing efforts to understand and mitigate the remaining barriers, particularly in undervaccinated populations. Much attention has been given to vaccine hesitancy, particularly in the context of historical examples of unethical medical practices in communities of color, the lasting effects of systemic racism, and political divisions. However, vaccine hesitancy may be less of an issue among some communities than barriers to accessing the vaccine.

The declining trend in daily doses administered, particularly in the context of increasing supply, could signal waning demand, but evidence shows that interest remains high. In fact, recent data from the US Census Bureau indicates that more than 40% of adult Americans who have not yet been vaccinated are interested in doing so, which is more than those who do not intend to get vaccinated (37.8%; 21.6% remain unsure). Many individuals are finding it difficult to make time to get vaccinated, particularly lower-income individuals who do not have the benefit of paid time off to get vaccinated and who may be working multiple jobs to provide for their families.

Looking ahead, there appears to be a shift away from large-scale, centralized mass vaccination sites and toward smaller efforts that disperse vaccination sites throughout communities. Vaccination availability at national and regional chain pharmacies and drug stores has increased access in many communities, but including primary care offices and mobile programs to reach people at home or other convenient locations can further increase accessibility. In addition to making vaccination more convenient, community-based efforts also can make vaccination more comfortable by involving vaccinators or advocates who have established relationships in the community.

US VACCINE DONATIONS On May 17, US President Joe Biden announced the US government will send an additional 20 million SARS-CoV-2 vaccine doses abroad. Previously, the US government announced a donation of 60 million doses of the AstraZeneca-Oxford vaccine as soon as they are reviewed by the US FDA, and Monday’s announcement adds at least 20 million doses of vaccines already authorized in the US. The government also previously committed to providing about 4 million doses of vaccine to Canada and Mexico, although in the form of a loan. According to a White House fact sheet, the government will continue to donate vaccines from its excess supply as it receives delivery of that supply. US government officials are expected to announce in the coming days how they are deciding where to send vaccines.

The US has come under increasing pressure to play a larger role in global vaccination efforts, as countries in South Asia and South America struggle with outbreaks. Additionally, US diplomats and other experts are pressing the US to move more quickly in helping to distribute vaccines to counter efforts by China and Russia, over concerns that those countries are using their homegrown vaccines as political collateral. The US government explicitly states it “will not use its vaccines to secure favors from other countries.” US diplomats in South Asia, the Middle East, and Africa say they received urgent requests from officials in their host countries for COVID-19 assistance. On Monday, President Biden committed to working with the international community, including the COVAX facility and G7 leaders, to play a significant role in helping to slow the pandemic’s global toll.

TRACKING VARIANTS GLOBALLY Researchers and health officials are tracking the emergence of several variants of concern (VOCs), including B.1.1.7, B.1.351, P.1, and the B.1.617 variant that appears to be driving the surge in India. Because emerging variants may behave differently, which can affect the effectiveness of protective measures (e.g., physical and social distancing, vaccines), it is critical to quickly identify and characterize new variants and to identify their origin.

One of the principal challenges in identifying and tracing VOCs back to their origin is genomic sequencing capacity at the global and national levels. Countries vary widely in terms of the proportion of COVID-19 cases that they can sequence, and even higher-income countries like the US have struggled to scale up this capacity in the midst of the pandemic. Health officials also are monitoring the geographic spread of VOCs, such as possible expansion of the B.1.617 from India to neighboring countries, including Sri Lanka and Nepal. The national sequencing capacity in many countries would be limited under ideal circumstances, but restricted travel during the pandemic is further stressing available resources by delaying the delivery of supplies, such as the reagents necessary for genomic sequencing. A number of organizations are supporting efforts to expand laboratory capacity to monitor emerging variants, including the Coalition for Epidemic Preparedness Innovations, which is expanding its laboratory network to provide better global surveillance coverage for emerging variants—from 8 laboratories to 10—with a focus on assessing vaccine efficacy against VOCs, part of a US$17.5 million effort.

VACCINATION TIMING When rolling out its vaccination program at the end of 2020, the UK made a bold and controversial decision to recommend a longer interval between SARS-CoV-2 vaccine doses to extend its limited supply and maximize the number of people who would at least be partially protected from hospitalization and death. Now a study (preprint) published May 17 by medRxiv shows delaying the second dose of the Pfizer-BioNTech SARS-CoV-2 vaccine to 12 weeks instead of 3 weeks produced a much stronger antibody response among older adults. Researchers from the University of Birmingham and Public Health England found that delaying the second shot of the mRNA vaccine produced peak antibody responses 3.5-fold higher among people aged 80-99 years who had no evidence of previous infection when compared with those who received the vaccine after the recommended 3-week interval. Cellular immune responses were 3.6-fold lower among those in the 12-week group but that did not impact antibody level decline over 9 weeks post-final vaccination. The researchers noted the extended interval has the potential to enhance and extend humoral immunity among older individuals, although further research is needed to assess long-term immunity and clinical protection. This data—as well as data from a predictive modeling study from US researchers published in The BMJ showing delaying mRNA vaccine second doses could reduce deaths, hospitalizations, and infections among people aged 65 and older if certain conditions are met—could inform other countries’ vaccination efforts and recommendations.

PFIZER-BIONTECH VACCINE STORAGE The European Medicines Agency Committee for Medicinal Products for Human Use (CHMP) updated its recommendation regarding the storage of the Pfizer-BioNTech SARS-CoV-2 vaccine. The new guidance extends the duration that thawed but unopened/undiluted vials of the vaccine can be stored at normal refrigerator temperatures (2-8°C; ~36-46°F) from 5 days to 31 days. This change will facilitate vaccination efforts, particularly those conducted outside of healthcare facilities, by reducing the dependence on ultra-cold freezers. The CHMP approved the change based on an assessment of “additional stability study data” submitted by BioNTech. The US FDA previously extended the storage period for frozen vials at regular freezer temperature to 2 weeks, but it has not extended storage for thawed vials. The US FDA guidance continues to limit the storage of thawed vials at refrigerator temperatures to 5 days.

INDIA India’s cumulative COVID-19 caseload passed 25 million today, as Cyclone Tauktae hit the western states of Gujarat and Maharashtra, complicating pandemic response efforts in those already hard-hit states. Although India recently reported a decline in new COVID-19 cases, the number of daily deaths remains above 4,000, and health experts estimate the true burden of COVID-19 in the country to be much higher due to poor testing availability, fear and stigma of getting tested, and limited health service capacity especially in rural areas. In Mumbai, the number of new cases has dropped precipitously, and New Delhi is beginning to see shrinking caseloads, with some experts attributing the declines to strict and tightly enforced lockdowns. Others lament the lack of adequate preparedness and government-facilitated response, especially given India’s size, population density, and social structure.

In a comment published online May 14 by The Lancet, a group of clinicians, public health professionals, and scientists working in India or with collaborators in the country endorsed the national action plan put forth by The Lancet COVID-19 Commission India Task Force and outlined 8 steps for the international community to help ameliorate the crisis in India, including expanding healthcare capacity, scaling up mass vaccination and testing, and stepping in to ensure the global supply chains of medications produced in India is not interrupted.

SINGAPORE With the number of new COVID-19 cases rising in Singapore, health officials are expressing concern over unknown chains of community transmission, and the government has tightened measures meant to control the virus’s spread. Increased restrictions on travel and in-person activities—such as restaurant dining and limitations on social gatherings—began on May 16 and will run through June 13. The number of new cases without a link to an identified case has more than doubled over the previous week. Overall, 71 new cases have been identified in the last week, up from 48 the previous week, with a cluster linked to Changi Airport. Singapore’s increase in cases and move to tighten restrictions is hindering its ability to meet criteria to open an “air travel bubble” with Hong Kong, which was expected to open on May 26. Officials plan to reevaluate the launch of the travel bubble no earlier than June 13.

UK EASING RESTRICTIONS The United Kingdom moved this week into their third of 4 phases to lift COVID-19 restrictions. In this phase, pubs and restaurants are allowed to serve customers indoors, museums and movie theaters can open, and more people from separate households can gather. Additionally, travel restrictions have been somewhat eased, with destination countries classified as “red,” “amber,” or “green” depending on each country’s situation. The different color classifications also outline various requirements for quarantine following travel. Supporting the easing of restrictions is the UK’s strong vaccination program, which has delivered a first dose to nearly 70% of its population. However, the proportion of the population fully vaccinated remains closer to 36%.

While the vaccines appear to be contributing to decreasing COVID-19 cases overall, the UK government is concerned with the spread of the B.1.617.2 variant that was first identified in India. Current evidence suggests that the B.1.617.2 variant may be even more transmissible than the B.1.1.7 variant but current evidence suggests it does not cause more severe disease. Still, the UK has pledged to speed up its vaccinations in order to remain abreast of the variant’s spread. It is hoped that the B.1.617.2 variant will not disrupt further relaxations of COVID-19 restrictions or, in a worse case, cause the country to reinstate stricter measures.

GLOBAL EXCESS MORTALITY On May 14, The Economist published statistical modeling that estimates 7-13 million people have died worldwide as a result of the COVID-19 pandemic, approximately 2-4 times the deaths reported in the official WHO data. The model is based on 121 indicators and modeled excess mortality in more than 200 countries. They used a machine learning approach to identify relationships between the various indicators and excess mortality in countries that report it and then used those relationships to project excess mortality at the national level for all of the included countries.

The model estimates 10 million excess deaths (95% CI: 7.1-12.7 million) globally. Notably, excess deaths include those directly attributable to COVID-19 as well as those due to downstream effects of the pandemic. The Economist researchers assert that the most severe impact of excess mortality is in low- and middle-income countries, where SARS-CoV-2 testing is less widespread, which could result in the underreporting of COVID-19 cases and deaths. In India, the researchers estimate that 20,000 people are dying each day, 5 times the 4,000 deaths per day reported in India’s official COVID-19 data. Some countries—including Australia, New Zealand, and Norway—actually have negative excess mortality (ie, fewer deaths than expected based on historical data). These countries have faced relatively mild COVID-19 epidemics, and the decreased mortality could be a result of COVID-19 measures (eg, physical distancing, mask use) on other causes of deaths, such as seasonal influenza.

Notably, the researchers estimate that on a per capita basis, the impact of COVID-19 has been worse in higher-income countries. They posit that this could be driven by differences in population age. Because older individuals are at elevated risk for severe COVID-19 disease and death, countries with older populations—which tend to be higher-income countries—may have elevated COVID-19 mortality, while lower-income countries with younger populations may have higher incidence but lower mortality.

COVID-19 “LONG HAULER” REGISTRIES Long-term symptoms following recovery from acute SARS-CoV-2 infection continue to be described for a nontrivial portion of the population. Commonly described symptoms of so-called “long COVID-19,” also known as Post-Acute Sequelae SARS-CoV-2 infection (PASC), include brain fog, trouble breathing, and fatigue. To gain insight into lasting COVID-19 symptoms, some US state and federal lawmakers are pushing to create COVID-19 registries to track such cases. These registries could be modeled on the registry created to track chronic illnesses among those exposed to toxins during the September 11, 2000, World Trade Center attacks. New York state lawmakers have drafted legislation for a registry based on this model. Through these voluntary registries, researchers will be able to analyze possible patterns within the data to target potential treatments. Already, some studies are underway to evaluate the effect of vaccination on improving “long COVID-19” symptoms. One survey indicated improvement of lasting symptoms in just over half of 812 people surveyed following their first vaccine dose. The data also showed mRNA vaccines appear to have a greater effect on symptom improvement compared to other types of vaccines.

“COVID HEART” According to a case-control study published in JACC: Cardiovascular Imaging, SARS-CoV-2 infection does not impact the heart more than other viral illnesses. The issue of “COVID-19 Heart” was first introduced into mainstream media early in the pandemic, when some researchers expressed concern over the potential impact of SARS-CoV-2 infection on cardiovascular health. Results from this recent study, which examined 74 seropositive healthcare workers 6 months post-infection and 75 seronegative matched control subjects, showed no differences between cardiac structure, function, tissue or biomarkers. Some experts say data from this study, along with information from several others, should be sufficient evidence to show COVID-19 does not cause cardiac problems. Though COVID-19 can result in some cardiac issues, like other viral diseases, science communication in the future must do a better job of explaining the scientific review process, methodology, and study implications, experts maintain.

https://covid19.who.int/

[ponchi101]

The Global Excess Mortality numbers go along with what we have been saying here since the beginning. There is no way that the death numbers are accurate, with so many "smaller" countries unable to report properly. I doubt the numbers from Ecuador or Venezuela can be believed, for example.
Side note. An article I read yesterday claims that at the rate Venezuela is vaccinating people, the country will reach full vaccination in 10 years.

[ti-amie]