EPI UPDATE The WHO COVID-19 Dashboard reports 639.5 million cumulative cases and 6.62 million deaths worldwide as of December 1. Global weekly incidence increased for the third week in a row last week, rising 8.9% compared to an increase of 2.36% the previous week. A total of 2.87 million cases were confirmed the week of November 21. Weekly incidence fell over the previous week in Africa (-40%), the Eastern Mediterranean (-17%), South-East Asia (-8%), and Europe (-4%). The Americas (+19%) and Western Pacific (+16%) regions experienced increasing weekly incidence. Global weekly mortality remained relatively steady from the previous week, down 3%.*
*The WHO dashboard notes that data from the Africa region are incomplete.
The US CDC is reporting 98.5 million cumulative cases of COVID-19 and 1.07 million deaths. Incidence for the week ending November 23 rose slightly over the previous week, increasing to 305,082 cases from 281,691 cases for the week ending November 16. Weekly mortality increased for the week ending November 23, with 2,644 reported deaths compared to 2,266 deaths the week ending November 16.**
**The US CDC updates weekly COVID-19 data on cases and deaths on Thursdays by 8pm ET.
Both new hospital admissions and current hospitalizations increased last week, up by 18% and 11%, respectively, over the previous week.
The BA.5 sublineage rapidly lost dominance over the past 2 weeks, now accounting for only 19.4% of sequenced specimens. The Omicron sublineages BQ.1.1 (29.4%) and BQ.1 (27.9%) together represent the two most dominant subvariants. A host of other Omicron sublineages—including BF.7, BA.4.6, XBB, BN.1, BA.2.75, BA.5.2.6, BF.11, BA.2, BA.2.75.2, and others—make up the remainder of cases.
US PANDEMIC MORTALITY On average, more than 300 people in the US die each day from COVID-19. While the death toll is significantly lower than during the peak of the Delta wave, the number is 2 to 3 times higher than the average number of deaths from flu. Increasingly, COVID-19 is becoming a disease of the elderly. In summer 2021, about 58% of COVID-19 deaths occurred among adults aged 65 or older. Today, that proportion is 9 of 10 COVID-related deaths, according to US CDC data. This upward trend is expected to continue, and despite the nation’s pursuit of normalcy, is set to cause significant disruptions to the health system.
Mortality trends have shifted throughout the pandemic. A study published this week in the Annals of Internal Medicine by investigators at Brigham and Women’s Hospital in Boston, Massachusetts (US), found that the proportion of younger people who died from COVID-19 in 2021 surpassed that of 2020, with the median age of COVID-related deaths falling from 78 years old in 2020 to 69 years old in 2021. Researchers calculated years of life lost (YLL) and compared timeframes in 2020 and 2021. Using this calculation, the team was able to assess premature deaths based on the number of years an individual would have lived. In 2021, there were about 21% fewer deaths compared to 2020. However, YLL per COVID-19 death increased by 36%. Better understanding age shifts in COVID-19 mortality can help inform prevention and treatment approaches, public policy, and community measures to minimize the impacts of this increasingly preventable disease.
US PUBLIC HEALTH WORKFORCE The US CDC this week announced it will award more than US$3 billion in grants to strengthen the nation’s public health workforce and infrastructure. The funding is the first of its kind, as all US citizens live in a jurisdiction that will receive funds. Notably, the new funding is intended for government-run public health agencies, leaving community health organizations concerned they will be left out. States relied heavily on community and grassroots organizations for vaccine rollout, testing, and other services throughout the COVID-19 pandemic. While it is crucial that government health departments in communities that are economically and socially marginalized or rural, or in communities with people from racial and ethnic minority groups, receive this support, particularly with a growing shortage of healthcare workers, community leaders in these settings feel additional funding is needed to sustain and grow health promotion efforts begun during the pandemic. The CommuniHealth Coalition, led by the Johns Hopkins Center for Health Security and the Department of Anthropology at Texas State University, recently released reports examining the role of community health workers in the COVID-19 pandemic response and recovery and providing guidance for how to build and grow the community health sector.
MONOCLONAL ANTIBODY BEBTELOVIMAB The US FDA on November 30 ended its emergency use authorization (EUA) for Eli Lilly’s monoclonal antibody bebtelovimab because it is not expected to neutralize the two most widely circulating SARS-CoV-2 Omicron subvariants, BQ.1 and BQ.1.1. Known together as the “BQs,” those subvariants account for 57% of cases nationwide, according to US CDC estimates. Bebtelovimab was the only remaining authorized COVID-19 antibody therapy. Several companies are working on updated antibodies, although none appear to be close to authorization. The FDA recommended health providers choose other appropriate approved or authorized treatments, including the antivirals Paxlovid, Veklury, or Lagevrio, or convalescent plasma with high titers of SARS-CoV-2 antibodies. A recent preprint literature review posted to bioRxiv concluded that convalescent plasma from recently vaccine-boosted people who had confirmed COVID-19 neutralized more than 95% of the SARS-CoV-2 Omicron subvariants BQ.1.1, BF.7, and XBB and could be a viable substitute for monoclonal antibodies as passive immunotherapy for both COVID-19 prophylaxis and therapy among immunocompromised patients.
LONG COVID Nearly a third of people in the US with COVID-19 will develop long-term symptoms, according to a recent report from the US Department of Health and Human Services (HHS). Health experts are warning that this collection of post-acute symptoms, commonly known as long COVID, could be the next public health crisis—so far impacting as many as 23 million people, a number expected to grow as COVID-19 continues to circulate. In addition to increased medical expenses, individuals and families dealing with long COVID could face a reduced quality of life, reduced income, higher household debt, and lower retirement savings, further widening existing inequalities and costing the US economy US$3.7 trillion, according to one estimate. A Swiss study published in Nature Communications examined the prevalence of post-COVID conditions among children, with the findings suggesting that risk factors for lingering symptoms included older age, lower socioeconomic status, and having an existing chronic health condition, particularly asthma.
With little known about the underlying causes of lasting symptoms and a lack of a clear definition, healthcare professionals are stuck between wanting more evidence for effective therapies and trying to treat vulnerable and suffering patients. Some people with long COVID are turning to expensive and untested therapies, from vitamin supplements to stem cell treatments. The US NIH created the RECOVER Initiative to learn more about the long-term effects of COVID-19 and recently announced a clinical trial to investigate the antiviral Paxlovid for treatment of long COVID, with results expected in 2024. But many experts argue a more agile research model is needed to more quickly address the growing problem.
FUTURE OF VACCINES Global efforts are underway to prepare vaccine research, development, and production facilities for the next pandemic. This week, the Coalition for Epidemic Preparedness Innovations (CEPI) launched its 100 Days Mission, a US$3.5 billion plan to invest in vaccine research and development and achieve equitable access to vaccines for emerging viruses with pandemic potential, with the goal of producing a safe and effective vaccine within 100 days. This effort, if successful, would significantly shorten the time it took scientists to develop shots for COVID-19, a record 326 days. In Africa, Afrigen Biologics & Vaccines, the Biovac Institute, and a variety of partners are working to bring mRNA vaccines—for COVID-19 and other diseases—to the continent and adapt them for the setting, such as doing away with the need for deep freezing and making them more stable at room or refrigerated temperatures. Those involved in the effort hope more African national governments will prioritize vaccine development and manufacturing, ultimately allowing them to own the intellectual property on domestically produced vaccines that can help protect their own populations.
CHINA At a meeting on November 30, Vice Premier Sun Chunlan, the senior official in charge of China’s COVID-19 response, said that “with the decreasing toxicity of the Omicron variant, the increasing vaccination rate, and the accumulating experience of outbreak control and prevention, China’s pandemic containment faces new stage and mission.” These remarks, as well as state media downplaying the severity of the Omicron variant and a few cities lifting lockdown restrictions, signal a potential shift in China’s pandemic response strategy, though no explicit policy changes have been made yet.
To date, China has relied on its “zero-COVID” policy—comprising isolation for all known cases, quarantining anyone who may have come into contact with COVID-19, strict lockdowns, school and business closures, mandatory testing, and home confinement, sometimes without access to supplies—which has led to entire cities shutting down for weeks or months. Recently, public anger over the human costs of China’s zero-COVID policy sparked public unrest and numerous protests that brought together a diverse group, including workers, students, rural residents, and middle-class people. The events are notable because public protest is rare in China, where the central government strictly cracks down on dissent and has established a high-tech surveillance state.
This week, 2 of China's largest cities, Guangzhou and Chongqing, announced they were easing COVID-19 restrictions. In Chongqing, close contacts of positive COVID-19 cases will be allowed to quarantine at home instead of at centralized, government-run centers. Guangzhou is lifting lockdowns in 4 districts (though lockdowns remain in high-risk areas), allowing close contacts of COVID-19 cases to quarantine at home instead of central facilities, and is no longer launching district-wide mass COVID-19 testing.
Some experts believe the government’s zero-COVID strategy is likely to stay in place until vaccination rates increase, especially among older adults, and a long-term strategy for living with COVID-19 can be established. China’s National Health Commission is launching a national campaign to encourage people who are over 60 years old to be vaccinated and boosted. The campaign will bring vaccines to people in nursing homes, go door-to-door, use mobile vaccination stations for older adults who cannot leave their homes, and press those who are reluctant to give a reason for not being vaccinated. With changes on the horizon, China’s leadership must reckon with the large economic and social toll their blanket approach to controlling COVID-19 is taking while also accounting for the burden that soaring numbers of new infections will place on the country’s health care system.
WORLD AIDS DAY World AIDS Day is commemorated annually on December 1, to show support for people living with and affected by HIV and to remember the approximately 40 million people who have died of AIDS-related illnesses. This year’s theme is “Equalize,” a call to action to address inequalities and continue to work toward ending the AIDS pandemic. Data from UNAIDS, however, show the COVID-19 pandemic and other global crises have impacted progress against HIV/AIDS, shrinking available resources and interrupting access to vital treatment and prevention services. In South Africa, which has the largest population of people living with HIV, some girls and women turned to transactional sex during COVID-19 lockdowns to support their families, increasing their risk of becoming infected. In a joint report, WHO and the European Centre for Disease Prevention and Control (ECDC) said the number of people in Europe living with undiagnosed HIV rose in 2021, when one quarter fewer HIV diagnoses were recorded compared with pre-pandemic levels in the WHO European region. UK Health Security Agency (UKHSA) data show that while new HIV diagnoses fell in England by nearly one-third between 2019 and 2021, progress toward ending HIV transmission has slowed, particularly among heterosexual people. In the US, President Joe Biden outlined steps his administration has taken against the AIDS pandemic, highlighting the ongoing need to better address racial, gender, and other inequities in health systems, through domestic and international programs. The many lessons learned from decades of action against AIDS can serve as a model for how policymakers, public health practitioners, and civil society deal with health threats, including COVID-19, monkeypox/mpox, and other infectious diseases. Importantly, the biomedical, social, and structural actions needed to end AIDS will better prepare the world to address future pandemics.
TWITTER MISINFORMATION POLICY Public health experts, healthcare professionals, and social media researchers are expressing concern after Twitter quietly ended its enforcement of its policy against COVID-19 misinformation on November 23. Twitter implemented the policy in 2020, during the early days of the pandemic, and since then had suspended more than 11,000 accounts and removed more than 100,000 posts for violating the policy. Though many agree the policy was imperfect, the lack of enforcement likely will lead to more false claims about COVID-19, including about the origin of the virus or the safety and effectiveness of vaccines. The move is the latest in a series of rollbacks at Twitter, implemented since the company was purchased by Elon Musk, who himself has spread COVID-19 misinformation.