The US winter COVID-19 surge appears to be ending, with the increase in reported cases not as bad as initially expected. There was concern in early winter that a combination of COVID-19, RSV, and seasonal influenza would overwhelm hospitals and cause a large surge in deaths. Speculation around why the winter surge was not as bad as expected has centered on people possibly avoiding crowds over the holidays, viral interference among various circulating diseases, and more immunity in the US population due to prior infection and/or vaccination. COVID-19 remains a significant public health threat and a leading cause of death in the US, but there appears to be hope on the horizon. As such, the Biden administration is expected to soon release a roadmap to transition out of the COVID-19 public health emergency, which is set to end on May 11. The end of the public health emergency will also terminate the Trump-era Title 42 orders that US-Mexico border patrol agents have used to return undocumented migrants across the border in the name of COVID-19 prevention. Title 42 has been heavily criticized by public health experts and immigrant advocates, but Republican-led states have sought to keep the orders in place. 

Additionally, the Republican-led US House of Representatives is stepping up efforts to investigate the pandemic response. The House Energy and Commerce Committee held a hearing on “The Federal Response to COVID-19” this week. Republicans on the committee used the opportunity to ask leading health officials and scientists about vaccine mandates, mask requirements for children, origin theories of SARS-CoV-2, and the public’s broken trust in health agencies. Additional hearings on similar topics are expected. In a mostly symbolic move, the House on February 8 passed a bill mostly along party lines that would end US CDC-imposed COVID-19 vaccination requirements for foreign travelers entering the US. The White House said it opposes rescinding the order without scientific review, but the travel industry has lobbied for the removal of the requirement, claiming it is an unnecessary barrier to travelers. 

In the last week, two major global efforts to combat future outbreak emergencies and strengthen global health security have reached important milestones in their continuing efforts. Last week, the WHO released a zero draft of a global pandemic treaty, focused on international prevention, preparedness, and response. This would be the first legally binding treaty helping to ensure a more equitable distribution of pandemic-related vaccines, drugs, and diagnostics. WHO member states will now deliberate to negotiate treaty terms and make progress to ensure stronger international collaboration and equity throughout future biological events.

This week, US Secretary of State Anthony Blinken hosted a fourth and final Ministerial of the COVID-19 Global Action Plan (GAP). The GAP has been working for the past year to continue addressing acute pandemic response needs and identifying remaining barriers to fighting the COVID-19 pandemic, as well as planning collaborative prevention, detection, and response methods among many countries and global organizations ahead of the next global health threat. During the meeting, Japan Foreign Minister Yoshimasa Hayashi said that Japan has chosen global health as a priority issue when the nation hosts a Group of Seven summit in May, partly because of the continuing challenge of equitable vaccine access.

Cochrane Library review examines effectiveness of various nonpharmaceutical interventions; most experts agree future pandemics will require more nuanced responses 

More than 3 years into the COVID-19 pandemic, experts continue to discuss whether masking definitively slows transmission of respiratory viruses, and by how much. Throughout the pandemic, numerous studies have been published with conflicting results and conclusions, culminating in a recent review published by the Cochrane Library. The review found that masking, either with surgical masks or N95 respirators, made little to no difference in the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks; however, the review emphasized that the findings could be due in part to multiple factors such as poor study design, low adherence to mask rules, quality of masks used, and incorrect mask usage. Notably, several individual studies have shown an association between community mask use and a reduction in COVID-19 cases. The review also found that hand hygiene programs may help slow the spread of respiratory diseases. Results of the review have split infectious disease experts, leading some to critique its methodologies and emphasize the importance of public messaging on nonpharmaceutical interventions (NPIs) to prevent disease transmission. More research is needed into various NPIs and public health interventions and their use in future disease outbreaks likely will need to be more nuanced.

Monoclonal antibodies have been an important tool in treating COVID-19 and as pre-exposure prophylaxis for those at high risk of severe disease, especially individuals with compromised immune systems. Following the US FDA’s suspension of emergency use authorization (EUA) for Evusheld last month, however, no monoclonal antibodies are authorized for use in the US because of inactivity against currently circulating variants of SARS-CoV-2. Other treatments exist, including the antivirals Paxlovid and molnupiravir, but each comes with its own concerns, including worry over viral rebound, drug interactions, or viral mutations. 

Newer medicines that remain active against various SARS-CoV-2 lineages are needed to help shore up the nation’s therapeutic toolbox, and potentially help protect people who are immunocompromised. The results of a clinical trial involving nearly 2,000 patients published this week in the New England Journal of Medicine show that people with early COVID-19 who had a single injection of a treatment called pegylated interferon lambda (PEG-lambda) were 51% less likely to be hospitalized or to go to an emergency room, compared with those who received a placebo shot. Most of the study participants were vaccinated—an already low-risk group—but the treatment was even more effective in unvaccinated participants. 

Interferons are a part of the body’s natural immune response, and PEG-lambda is a synthetic version of a naturally produced interferon. Even with promising results, the treatment faces hurdles to regulatory approval by the FDA, which has signaled it needs data from a larger trial with sites located in the US, an expensive and multi-year process. Some experts worry the barriers are indicative of problems threatening the future development of next-generation COVID-19 medical countermeasures, some of which might help prepare for the next pandemic. 

Though the medical community is learning more about long COVID, also called post-COVID condition or post-acute sequelae of COVID-19, much remains unknown about how many people have the condition, why and what their prospects for recovery are, or the long-term impacts on society. In the US Black community, already disproportionately impacted by the pandemic, many with symptoms lingering a month or longer after recovering from acute COVID-19 are struggling to find the care they need. According to the latest data from the US Census Bureau Household Pulse Survey, nearly 30% of Black respondents said they currently have or have had long COVID and about 35% of those with long COVID reported severe limitations on their ability to perform day-to-day activities. Additionally, caregivers of people with long COVID, many of whom suffer from the same or other health conditions, need to establish their own support systems, sometimes in the form of support groups such as those with Survivor Corps or Body Politic. Online support groups and other forms of telerehabilitation are useful for both people with long COVID and their caregivers, some face barriers to access because of internet and digital literacy considerations.

SARS-COV-2 VARIANTS No new variants of SARS-CoV-2 were detected in China between November 14 and December 20, 2022, during a time when the nation began experiencing a surge of COVID-19 cases, according to a study published February 8 in The Lancet. A majority of the sequenced samples were the already circulating Omicron subvariants BF.7 and BA5.2. Notably, the study only looked at samples from Beijing and only covered a few weeks after the government lifted its strict “zero COVID” policies, which some experts warn would be too early to detect new lineages. Scientists have their eye on another variant—CH.1.1—that emerged in November 2022 in Southeast Asia and now accounts for about 25% of cases in the UK and New Zealand, and about 12% of overall cases in Europe. According to a preprint report posted on bioXriv, the lineage contains the mutation L452R seen in Delta, but not Omicron, and has “a consistently stronger neutralization resistance available than XBB, XBB.1, and XBB.1.5,” which is worthy of monitoring. 

EXCESS MORTALITY Between March 2020 to December 2021, 622 more physicians died in the US than expected, according to a study published in JAMA Internal Medicine this week. Excess mortality among physicians was substantially lower than for the general population during this time, and there were no excess deaths among physicians after April 2021, concurrent with the availability of COVID-19 vaccines. In related news, the New York Times examined the obituaries of China’s top academics to gain some insight into the nation’s true death toll since it dropped its “zero COVID” strategy, finding significantly higher numbers of published obituaries in December 2022 and January 2023 than in preceding months. 

HONORING THOSE LOST More than 1.1 million people in the US have died of COVID-19 since the beginning of the pandemic, and about 3,500 people continue to die each week of the disease. Colorado Public Radio/NPR reports on the desire—some say need—to memorialize individuals who died of COVID-19, to recognize and remember their lives but also to help those left behind heal from the trauma of losing loved ones. In October 2022, the Johns Hopkins Center for Health Security, in collaboration with the Center for Health and Economic Resilience Research at Texas State University, held a 2-day virtual symposium, titled Post-Pandemic Recovery: From What, For Whom, and How?, to consider how to operationalize the process of holistic recovery from the COVID-19 pandemic, including a focus on trauma recovery centered on safety, memorialization, and social connection.

LEARNING LOSSES & MISSING STUDENTS Half of US students began this academic year below their grade level in at least one subject, according to new federal survey data based on reports from schools nationwide. Nearly all schools said some students were behind in reading and math, 80% reported students behind in science, and 70% reported lags in social studies. The results, along with other research, show students and educators have a long road ahead to reverse pandemic impacts. Worse, an analysis by the Associated Press, Stanford University’s Big Local News project, and Stanford professor Thomas Dee found an estimated 240,000 students in 21 states who disappeared from public schools during the pandemic and whose absences cannot be accounted for. Some students who left public schools moved out of state or switched to private schools or home-schooling, but nearly a quarter million remain “missing” and the true number is likely much higher.

ANTIMICROBIAL RESISTANCE According to a study published recently in The Lancet Microbe, antimicrobial resistance (AMR) is highly prevalent in patients with laboratory-confirmed COVID-19 and bacterial infections. In another recent analysis published in eClinical Medicine, researchers found that increases in antibiotic sales were associated with increases in COVID-19 cases, according to data collected during the first 2 years of the pandemic in 71 countries. Despite less than 10% of COVID-19 patients having a bacterial coinfection, an estimated 75% of COVID-19 patients are prescribed antibiotics, underlining the need for greater antibiotic stewardship in the context of COVID-19. In related news, the United Nations Environment Programme (UNEP) published a report this week warning that up to 10 million people could die annually by 2050 due to AMR, making it one of the top 10 global threats to health requiring a multisectoral response that recognizes the intertwined health of people, animals, plants, and the environment, referred to as One Health.

As of February 9, the WHO COVID-19 Dashboard reports: 

The US CDC is reporting: 

The Omicron sublineages XBB.1.5 (66%), BQ.1.1 (20%), and BQ.1 (7%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases. 

Johns Hopkins University Daily COVID-19 Data in Motion (daily video showing global and US trends)

New York Times Coronavirus in the US: Latest Map and Case Count (US data portrayed in tables, maps, and graphs)

US CDC COVID-19 Integrated County View (click on pulldown menu to view either COVID-19 Community Levels or Community Transmission, as well as other indicators specific to the US)

Editor: Alyson Browett, MPH

Contributors: Erin Fink, MS; Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; and Rachel A. Vahey, MHS