COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS
MONKEYPOX VIRTUAL BRIEFING Johns Hopkins University will host a live virtual briefing on monkeypox on Wednesday, August 10 from 10:30 am to 11:30 am EDT. Johns Hopkins faculty experts will discuss topics ranging from prevention, transmission, treatment, vaccine distribution and availability, and ways to reduce stigma in the outbreak response. Registration is available here. To watch the live briefing on August 10, please go to: https://hub.jhu.edu/monkeypox-briefing/.
OMICRON-ADAPTED VACCINES The European Medicines Agency (EMA) announced today that it has started a rolling review of an Omicron-adapted vaccine developed by Pfizer and BioNTech. This update follows a large push from national governments for vaccine companies to develop a variant-adapted version of SARS-CoV-2 vaccines to protect individuals against more transmissible variants, including the Omicron subvariants BA.4 and BA.5. Pfizer and BioNTech expect to begin clinical trials later this month using an enhanced vaccine candidate targeting the original strain identified in Wuhan, China, in late 2019 and the Omicron BA.4 and BA.5 subvariants, which are the dominant drivers of outbreaks in Europe. The companies said they would be able to begin delivering doses as early as October. The EMA’s rolling review constitutes an ongoing process in which the agency will assess data as it becomes available. Notably, US FDA officials previously said they anticipate an updated Pfizer-BioNTech vaccine to be available as early as September, and the agency has indicated that it would approve the variant-adapted vaccine while trials are ongoing. However, both the EMA and FDA will still require clinical data from this month’s trial to guide their decisions on the companies’ candidate targeting BA.4/5. Pfizer and BioNTech also are testing vaccine candidates encoding for Omicron BA.1 and BA.2. Both the US and European Union are hoping to use updated SARS-CoV-2 vaccines for fall booster campaigns.

The Biden administration on July 29 announced an agreement to purchase 66 million doses of a version of Moderna’s Omicron-adapted vaccine booster, with intentions to distribute the shots this fall and winter. In July, Moderna announced that its bivalent Omicron (BA.1) booster (mRNA-1273.214) elicited higher neutralizing antibody responses than the currently available booster and said it is simultaneously developing a booster specific to BA.4/5 (mRNA-1273.222). The US government previously purchased 105 million doses of a Pfizer-BioNTech bivalent vaccine for use later this year, although it is unclear which version of the companies’ booster candidate is covered under the agreement. 

US EMERGENCY DECLARATION The Biden administration is deliberating whether to once again extend the COVID-19 public health emergency, which facilitates federal assistance for pandemic-related healthcare coverage and access to vaccines and treatments. The deadline to announce a decision is August 15, if the US Department of Health and Human Services is to give states 60 days’ notice before allowing the declaration to expire. If approved, the proposed extension could last into 2023, beyond the November elections and into the pandemic’s fourth year. Reportedly, debate surrounding the declaration has grown more contentious, with some officials pushing for the declaration to expire in October after the expected rollout of updated booster vaccines. The US government has repeatedly renewed the emergency declaration since first instituted in January 2020.

US PANDEMIC VIEWS According to a national survey conducted July 12-18 by the Annenberg Public Policy Center, the majority of Americans (54%) say they rarely or never wear a mask indoors around people outside their household to help prevent COVID-19, and 41% say they have returned to their normal, pre-pandemic lives. Among these individuals, the majority are aware of the risks of infection but say they have adjusted to the “new normal,” with a growing number having returned to pre-pandemic routines and activities. In another poll from Axios and Ipsos conducted July 15-18, 29% of respondents said they believe the pandemic is over. The results varied by political affiliation: 48% of Republicans said the pandemic is over, compared with only 9% of Democrats. Despite this, 4 of 5 respondents agreed with the statement, "We will never fully be rid of the coronavirus in my lifetime." Although the number of new COVID-19 cases has risen significantly with the emergence of the BA.5 Omicron subvariant, reported mask use continues to decline and these polls suggest growing numbers of US residents are returning to their pre-pandemic lives, with limited precautions.

POST-COVID SYMPTOMS IN CHILDREN Researchers led by the CDC COVID-19 Emergency Response Team published a report on post-COVID-19 symptoms and conditions in children in the August 5 Morbidity and Mortality Weekly Report (MMWR). The researchers compared the symptoms of 781,419 children with confirmed COVID-19 to 2,344,257 children without COVID-19 from March 1, 2020, to January 31, 2022. Children with confirmed COVID-19 were more likely than were those without COVID-19 to develop certain post-COVID conditions, including blood clots in the lung (adjusted hazard ratio [aHR]=2.01), heart muscle inflammation (1.99), venous blood clot (1.87), acute renal failure (1.32), type 1 diabetes (1.23), blood clotting or bleeding disorders (1.18), type 2 diabetes (1.17), and abnormal heart rhythms (1.16). Additional symptoms were associated with COVID-19, including smell and taste disorders and malaise or fatigue. Still, the incidence of these conditions remained uncommon in the post-COVID pediatric population. Notably, children who had COVID-19 reported lower rates of respiratory, mental health, muscle, and sleeping disorders than those without COVID-19. Reasons for the observation are thought to include the fact that the general population for this study was selected from patients with a healthcare encounter possibly related to COVID-19. As a result, the general population may have been less healthy than patients with COVID-19 at baseline. 

LONG COVID DIAGNOSIS & TREATMENT Post-COVID-19 symptoms and conditions, which can linger for months or years in both children and adults, are often referred to as long COVID. However, there is no test for the condition, and there is little agreement around a standard definition for the condition, which is estimated to affect 1 in 5 to 1 in 8 COVID-19 patients. Treatments typically involve symptom management, but researchers are beginning to hone in on the condition’s pathology and begin clinical trials on medicines that target the immune system, blood clots, or lasting fragments of the virus itself. Some researchers are examining the similarities between long COVID and an older condition known as ME/CFS, or myalgic encephalomyelitis/chronic fatigue syndrome. The US government recently released a set of reports that sketch out an action plan to address long COVID, including calling for the establishment of a new office at the US HHS, new funding, and additional focus on the condition from the private sector. Though the full impact of the COVID-19 pandemic is hard to predict, it is becoming increasingly clear that individuals with long COVID may face health challenges for years to come.

DISRUPTIONS TO ROUTINE HEALTHCARE During the early stages of the COVID-19 pandemic, lockdowns prevented many US residents from accessing routine, and sometimes emergency, healthcare. Among households that had a serious illness in the past year, about 1 in 5 respondents to a new poll by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health said they had trouble accessing care during the pandemic. Some experts are concerned these disruptions, which continue to occur, could have lasting impacts on people’s health as well as the nation’s healthcare system. The poll found the difficulties accessing healthcare hit some racial/ethnic minority populations harder. Among those households with a serious illness in the past year, 35% of Native American households, 24% of Black households, 18% of Latino households, 18% of White households, and 10% of Asian households had difficulty accessing care when they needed it. The survey, conducted from May 16 to June 13, 2022, also examined other problems facing racial/ethnic minorities, including issues concerning finances, housing, neighborhood conditions, and personal safety. 

COVID-19 IN ANIMALS A recent report published July 23 in Scientific Data describes a dashboard that monitors COVID-19 cases in animal populations. The online dashboard, called SARS-ANI, is an open-access curated global dataset of SARS-CoV-2 events in animals containing a wide variety of information, including total number of infection events, number of animal species described, number of countries where animal infections have been reported, clinical signs of infection categorized by animal, a SARS-CoV-2 variant breakdown by animal, and more. The majority of animal cases have occurred in mink, with cats and dogs following closely behind. Cases of COVID-19 also have been reported in wild and captive animals, such as deer, gorillas, hippos, hyenas, and marmosets. A separate online dashboard tracking COVID-19 in animals around the world reports that cases have also occurred in certain avian populations, such as swans. 

The detection of so many COVID-19 cases in animal populations raises questions about how the pandemic will look in the future. The SARS-CoV-2 virus can mutate in an animal just like it can mutate in humans, so it is entirely possible that SARS-CoV-2 could circulate widely within a population of animals before spilling back into humans to cause a completely new variant through a process known as zoonotic transmission. Additionally, an expansion of the virus into more avian populations could enhance the ability of new variants to be transported and emerge in unexpected places. One of the other concerning aspects of COVID-19 in animals is potential establishment of “viral reservoirs.” Viral reservoirs are animal populations that maintain low levels of circulating virus within their species, which could allow the virus to jump back to humans years or decades after the last human case. One of the reasons smallpox was successfully eradicated was the absence of animal or insect viral reservoirs. The presence of COVID-19 in animals means that a “One Health” approach is needed to properly address the pandemic. One Health focuses on treating the health of humans, animals, plants, insects, and the environment as a connected web. 

CHINA China’s tourism-dependent island province of Hainan on August 8 expanded lockdowns amid a growing COVID-19 outbreak during the summer school holiday. The tropical resort of Sanya began an indefinite lockdown on August 6, confining about 80,000 vacationers to their hotel rooms. Tourists who test negative 5 times over 7 days can leave, but many flights to the area have been canceled. Additionally, 4 other cities and 4 counties in Hainan—a total population of about 7 million—began lockdowns of 2 or more days on August 7 and August 8. Hainan reported 471 new COVID-19 cases on August 8, out of a total of 939 new local and imported cases nationwide. It is the province’s largest outbreak since the pandemic began. 

In related news, the Chinese autonomous region of Tibet has imposed various restrictions in its capital city Lhasa, as well as in its second-largest city, Shigatse. Residents in the 2 largest cities and other areas will undergo mass testing. Until now, the region had remained COVID-19-free for more than 900 days, the best record of enforcing China’s “zero COVID” policy. The region reported 22 new cases on August 8. The fresh lockdowns came as Hong Kong, a semi-autonomous Chinese city, announced it will reduce mandatory hotel quarantine for international travelers from 1 week to 3 days, followed by 4 days of at-home surveillance, beginning Friday.

NEW ZEALAND & AUSTRALIA According to analysis from the New Zealand Herald, COVID-19 became a leading cause of death in the country, tied with heart disease, in the week ending July 17. During that week, 836 people died nationwide, and nearly 15% of those deaths were attributed to COVID-19. Experts expressed concern that at the same time the nation is experiencing its highest COVID-19 mortality impact, public attention to the pandemic appears to be at its lowest levels. Overall, New Zealand’s cumulative death rate from COVID-19 remains low—at 316 per million population—compared with the US and UK, with 3,062 and 2,753 deaths per million population, respectively. Public health officials predict COVID-19 will continue to be a significant contributor to overall mortality for the foreseeable future—with annual COVID-19 deaths at about 5 times influenza deaths—and could have a significant impact on the country’s life expectancy. 

In Australia, modelers with the Actuaries Institute Covid-19 Mortality Working Group estimate that COVID-19 was the primary cause of 7,100 deaths in the country from the beginning of this year through the end of July, making the virus the third most common cause of death this year so far. Only ischemic heart diseases and dementia, which caused about 10,000 deaths each, beat out COVID-19, with deaths from cardiovascular disease (primarily stroke; about 5,500 deaths) and lung cancer (5,400 deaths), following behind. 

THAILAND Beginning in October, Thailand will downgrade COVID-19 from a “dangerous” communicable disease, similar to plague and smallpox, to one that “need monitoring,” a group that includes influenza and dengue. In an announcement, Thailand Health Minister Anutin Charnvirakul said the action reflects the readiness of the nation’s public health system, public acceptance of “self-protection behavior,” and the availability of treatments. Thailand’s number of newly confirmed daily COVID-19 cases has remained relatively stable since mid-July. While the number of daily deaths is elevated, officials said they expect to see a decline in both cases and deaths by mid-August.