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EPI UPDATE The WHO COVID-19 Dashboard reports nearly 600 million cumulative cases and 6.47 million deaths worldwide as of August 31. Global weekly incidence decreased for the third consecutive week, down 15% from the previous week. Global weekly mortality decreased for the second consecutive week, down 13% from the previous week.
Regional trends in weekly incidence and mortality also are declining. All regions reported decreases in weekly incidence, ranging from -13% to -36.5% from the previous week. Notably, incidence in the Western Pacific appears to have peaked, with weekly incidence down 15% after a slight increase (+1.6%) the week of August 15. Weekly mortality is declining in all regions except the Western Pacific (+3.5%) and South-East Asia (+15.5%). The Eastern Mediterranean region appears to have peaked, with weekly mortality down 35% over the previous week.
UNITED STATES
The US CDC is reporting 94.3 million cumulative cases of COVID-19 and 1,040,314 deaths. Average daily incidence continues to decline, down from the most recent high of 129,363 new cases per day on July 21 to 88,286 on August 30—the lowest average since May 12. Average daily mortality continues to decline, down to 383 on August 30 from a recent high of 486 on August 12.**
**Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.
Both new hospital admissions and current hospitalizations continue to decline, down 2.9% and 6.3%, respectively, over the past week. Both trends peaked around the last week of July, similar to trends in daily incidence.
The BA.5 sublineage is projected to account for 88.7% of sequenced specimens in the US. While BA.5 remains the overwhelmingly dominant Omicron subvariant, its growth has reversed as the prevalence of the BA.4.6 sublineage is increasing. BA.4.6 remains the #2 subvariant nationwide, now accounting for 7.5% of sequenced cases, while BA.4 now accounts for 3.6% of cases. It remains unclear whether BA.4.6 is capable of usurping BA.5 nationwide, but it appears to be outpacing BA.5 in certain areas, particularly HHS Region 7 (Iowa, Kansas, Missouri, Nebraska), where it accounts for 17.2% of sequenced cases. Collectively, the remaining variants account for only 0.2% of cases nationally. All variants reported here are sublineages of the Omicron variant of concern (VOC).
PANDEMIC VIGILANCE Senior WHO officials are warning that although the overall numbers of COVID-19 cases and deaths are decreasing globally, those numbers could rise as northern nations head into colder months. WHO Director-General Dr. Tedros Adhanom Ghebreyesus on August 31 urged more people—particularly healthcare workers and older adults—to get vaccinated and stay up to date on vaccinations by getting booster doses, where available; wear masks in crowded indoor spaces; and maximize air flow when possible. Dr. Tedros warned that people must remain vigilant against the virus, even if already vaccinated, saying that pretending the pandemic is over is "a huge risk."
In an interview with STAT News, Dr. Maria Van Kerkhove, the WHO’s Technical Lead for COVID-19, echoed these sentiments. She recognized the world is facing many threats—including flooding, war, famine, and several significant disease outbreaks—and acknowledged a global desire for the COVID-19 pandemic to be over. But, instead of forgetting about the deadly disease, Dr. Van Kerkhove said the international community must optimize its response at this point in the pandemic, when we have the tools, knowledge, and, to some degree, immunity to be in a better position against circulating Omicron subvariants and prepare for those that might come next. She too warned that governments and individuals must remain laser-focused on sustaining the actions, systems, and workforce put in place to address the COVID-19 emergency, as those same systems can be used for other disease threats, which appear to be becoming more common as the climate warms.
US BOOSTER CAMPAIGN The US FDA on August 31 granted emergency use authorization (EUA) for 2 Omicron-specific vaccine boosters, one from Pfizer-BioNTech and one from Moderna. Pfizer-BioNTech’s booster is authorized for people aged 12 years and older, and Moderna’s booster is authorized for adults only. The US CDC's Advisory Committee for Immunization Practices (ACIP) is expected to vote today on recommendations for the boosters, and once CDC Director Dr. Rochelle Walensky gives the final approval, the doses can start to be rolled out to states, likely after the Labor Day holiday. The new bivalent boosters target both the original virus strain and the BA.4/BA.5 subvariants, with the hopes that the shots can provide at least some additional protection against currently dominant subvariants as the nation enters colder months. Notably, under the new EUA, the monovalent mRNA COVID-19 vaccines are not authorized as booster doses for individuals 12 years of age and older. The older boosters will be phased out as the updated boosters become more readily available.
However, public health officials face challenges in rolling out the new boosters, including general pandemic fatigue and low uptake of the current boosters. There is also confusion about who should get these newer boosters, particularly among those who were recently boosted for the first or second time with original vaccine formulations. On this question, experts recommend people wait 3 to 6 months after their last immunization or most recent infection to receive the maximum benefit from the new boosters. Otherwise, recently activated immune systems may neutralize the booster components too quickly for the body to develop immune memory for later protection.
Although some people have expressed concern over the rapid timeline with which the new boosters were developed and authorized, public health officials note that annual flu vaccines are updated in much the same manner. Neither shot completed human trials, but experts maintain that safe, effective vaccine formulations with updated antigen profiles are routinely produced using a fast-track model. Therefore, while the targeted strains of SARS-CoV-2 are different, the manufacturing and safety profiles behind these updated boosters remain the same. Additionally, Dr. Walensky said last week that waiting to conduct those trials could potentially risk authorizing an outdated vaccine and that Omicron-adapted vaccines are necessary to help prevent an expected fall and winter surge. Still, data on the boosters’ ability to prevent hospitalizations and deaths will be collected. Now, public health officials must thoughtfully advocate that individuals, especially those at greatest risk of adverse outcomes, choose to receive the updated boosters, just as many in the US and around the world are growing indifferent to COVID-19 in their communities.
US LIFE EXPECTANCY Life expectancy in the US fell for the second year in a row in 2021, representing the first time life expectancy dropped 2 years in a row in 100 years. The Vital Statistics Rapid Release published by the US CDC provides life expectancy estimates calculated using complete period life tables based on provisional death counts for 2021. Someone born in the US in 2019 had a life expectancy of 79 years. But in 2020, life expectancy fell to 77 years, falling further in 2021 to 76.1 years. Notably, there is a 5.9 year gap in life expectancy between males and females. Life expectancy for males born in 2021 was 73.2 years and 79.1 years for females.
The analysis also provides life expectancies by Hispanic origin and race, where the greatest decline between 2020 and 2021 was for non-Hispanic American Indian and Alaska Native (AIAN) males, whose life expectancy declined from 63.8 to 61.5 years, followed by non-Hispanic AIAN females at 70.7 to 69.2 years. Dr. Robert Anderson, Chief of Mortality Statistics at CDC's National Center for Health Statistics, said the type of loss experienced since 2019 is similar to the decline in US life expectancy after the 1918 influenza pandemic. Asian Americans saw the smallest decline in life expectancy from 2020 at 83.1 years, a decline of 0.1 years, and Black Americans lost 0.7 years. COVID-19 accounts for about half of the decline in life expectancy, while accidents and unintentional injuries, including drug overdoses, account for another 16%. COVID-19’s impact on mortality and morbidity, as well as healthcare systems, likely will continue long after the emergency phase of the pandemic ends, as researchers become more aware of the virus’s lasting health implications.
COMMERCIALIZATION PLANNING On August 30, US health officials announced plans to begin shifting COVID-19 vaccine coverage to the commercial market as soon as January 2023. A blog post by US HHS Assistant Secretary for Preparedness and Response Dawn O’Connell noted that while the US government has supported no-cost access to vaccines and therapeutics since the beginning of the pandemic, the ability to do so always had a limited timeframe. However, the timeline to transition to the private market has been accelerated, as the US Congress has shown continued reluctance to authorize additional funds to purchase more medical countermeasures. Assistant Secretary O’Connell advocated for additional funding in order to support an “orderly wind down” of the federal programs, as well as to ensure equitable distribution and coverage for the under- and uninsured.
After the administration recently announced a pause to a program providing free, at-home testing kits, public health experts expressed concern over reduced coronavirus test accessibility for the uninsured or those who live in more remote areas, and others have highlighted the potential impacts that commercialization will have on global equity. HHS recently convened a group of more than 100 representatives from state and local governments, health care providers and insurers, pharmaceutical companies and vaccine manufacturers, patient advocates, and others to discuss first steps in how to move forward with the commercialization process, and the agency plans to continue partner engagement to better implement and communicate a plan.
VACCINATION AMONG US CHILDREN COVID-19-related hospitalizations among US children reached their second highest peak of the pandemic this summer, lower only than the initial Omicron surge earlier this year. Relaxed restrictions allowing for more socialization played a role, as did the more transmissible BA.5 Omicron subvariant, but experts say low vaccination rates also contributed. About 60% of children aged 12-17 are fully vaccinated, but only 30% of younger children, ages 5-11, have received 2 doses. Notably, the COVID-19 vaccination campaign for the youngest children, ages 6 months to 5 years, is off to a very slow start 10 months after the US FDA authorized the vaccines for use among this age group. As of August 16, only 3.4% of children under age 2 had received their first dose, and 5.7% of those aged 2-4 years had gotten their first shot, a significantly slower pace than among older kids and teens, according to US CDC data. Only about 1% of the these children are fully vaccinated.
Several factors are slowing the rate, including parental hesitation and more limited opportunities for vaccine administration. While the slow pace presents a much longer-term challenge to get this age group vaccinated, some of this trend was by design, with most vaccine doses going to pediatricians and community health centers, with the expectation that parents would look to get their children vaccinated by their healthcare providers in familiar, trusted settings. Federal officials said they hope childhood COVID-19 vaccination rates will rise as more children visit their doctors heading into the fall and winter seasons.
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