COVID-19 Situation Report
Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.
Announcements
POST-PANDEMIC RECOVERY On October 4 and 6, 2022, the Johns Hopkins Center for Health Security, in collaboration with the Center for Health and Economic Resilience Research at Texas State University, convened a virtual symposium on how to operationalize the process of holistic recovery from the COVID-19 pandemic. The symposium kicked off the Pandemic Recovery Metrics to Drive Equity (PanREMEDY) project, which supports leaders in assessing COVID-19 recovery efforts. A report summarizing the event is now available at https://www.centerforhealthsecurity.org/our-work/publications/post-pandemic-recovery--from-what-for-whom-and-how.

US CDC REFORM A new report from the CSIS Commission on Strengthening America‚Äôs Health Security‚ÄĒauthored by the group's co-chairs, J. Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center, and Tom Inglesby, director of the Johns Hopkins Center for Health Security‚ÄĒoutlines vital, near-term steps that can help return CDC to a pathway of high performance and bolster public support. The full report is available here: https://www.csis.org/analysis/building-cdc-country-needs
In this issue

> As White House winds down COVID-19 activities, US House Republicans turn focus to investigating pandemic response

> China reports nearly 60,000 COVID-related deaths since early December; President Xi expresses concern over fragile rural healthcare system ahead of Lunar New Year holiday

> WHO updates treatment guidelines with strong endorsement of Paxlovid; renewed urgency needed for additional therapeutics

> Studies show COVID-19 during pregnancy increases risk of severe maternal, newborn outcomes, maternal death, and vaccination can reduce risks

> Preliminary safety concern for stroke among older adults after Pfizer-BioNTech bivalent booster ‚Äėvery unlikely‚Äô to represent ‚Äėtrue clinical risk,‚Äô US CDC says

> What we're reading

> Epi update
As White House winds down COVID-19 activities, US House Republicans turn focus to investigating pandemic response

Dr. David Kessler, chief science officer on the White House COVID-19 response team, is leaving the Biden administration this month, a move widely described as the unofficial end of Operation Warp Speed, the initiative to rapidly develop and distribute COVID-19 vaccines originally started during the Trump administration. In addition to the oversight of vaccine distribution, Dr. Kessler handled the purchasing and distribution of millions of doses of COVID-19 treatments such as Paxlovid and monoclonal antibodies. There are currently no plans to replace Dr. Kessler, according to the White House. Instead, the US HHS is expected to coordinate research and development efforts with the White House and private industry. Some health officials have expressed concern that letting government-led responses slip could leave the nation vulnerable

While the White House is slowing down its COVID-19 response efforts, the new Republican majority in the US House of Representatives is expected to turn its focus to science, and scientists, creating 2 new panels‚ÄĒthe Select Subcommittee on the Coronavirus Pandemic and the Select Committee on Strategic Competition between the United States and the Chinese Communist Party‚ÄĒto investigate the nation‚Äôs response to COVID-19 and activities between the US and China, respectively. Investigations could include the federal response to the pandemic, the origins of the pandemic, and scientific collaboration with China. Additionally, more than a dozen House Republicans introduced legislation this week that, if enacted, would end the public health emergency declaration that was recently extended to mid-April. Though the Pandemic Is Over Act likely will not pass both the House and Senate, conversations surrounding the US pandemic response likely will continue throughout the 118th Congress.
China reports nearly 60,000 COVID-related deaths since early December; President Xi expresses concern over fragile rural healthcare system ahead of Lunar New Year holiday

China is open to the world after ending 3 years of ‚Äúzero COVID‚ÄĚ restrictions, Vice-Premier Liu He declared to the World Economic Forum in Davos, Switzerland, this week. Immigration officials estimate that half a million people are crossing China‚Äôs borders each day since they reopened on January 8, and that number is expected to increase to 600,000 per day as the Lunar New Year holiday formally begins this weekend. Notably, China‚Äôs President Xi Jinping expressed concern over how weaker healthcare facilities in rural areas will handle a surge in COVID-19 cases in his Lunar New Year address, but he urged persistence, saying ‚Äúthe light is ahead, persistence is victory.‚ÄĚ Even better-equipped hospitals in larger cities are struggling to cope with an enormous influx of patients. 

Over the weekend, China announced there have been nearly 60,000 COVID-related hospital deaths since early December through January 12, including 5,503 deaths due to respiratory failure caused by COVID-19 and 54,435 deaths from other conditions combined with COVID-19. China previously reported 5,272 COVID deaths since the beginning of the pandemic, and only 37 fatalities since the zero COVID strategy was scrapped on December 7. Demographic details were not included, but anecdotal information points to a majority of the deaths occurring among older adults. The number is an undercount, however, as it excludes people who died at home and because physicians are being discouraged from listing COVID-19 as the main cause of death. An estimate released this week by Airfinity puts the cumulative number of COVID-19 deaths since December 1 at 608,000, 10 times the official count. The WHO requested a more detailed breakdown of the data and encouraged the government to continue to share information.

A National Health Commission official this week said the national emergency peak has passed, based on a declining number of people visiting fever clinics, and while that could be the case, a lack of data obscures the true impact of the outbreak. Data released this week show China is facing a population decline, coupled with a rise in life expectancy, forcing the nation into a demographic crisis that is being accelerated by the pandemic and is already impacting the national and global economies.
WHO updates treatment guidelines with strong endorsement of Paxlovid; renewed urgency needed for additional therapeutics

The WHO recently updated its guidelines on COVID-19 treatment, extending its strong recommendation for the use of the antiviral Paxlovid, also known as nirmatrelvir-ritonavir, among COVID-19 patients with mild or moderate illness who are at high risk of hospitalization. The global health agency also said pregnant or breastfeeding people with non-severe COVID-19 should consult with their doctors about taking the drug, which has ‚Äúlikely benefits‚ÄĚ with a lack of adverse events. The WHO recommended against the use of the monoclonal antibodies sotrovimab and casirivimab-imdevimab, as they lack or have diminished activity against currently circulating SARS-CoV-2 variants. 

Though there are 6 proven treatment options for COVID-19 patients, all of which were developed and tested relatively quickly, many say more work must be done to develop preventive and therapeutic tools in the face of waning immunity and the threat of emerging variants. These efforts will take additional funding and a renewed sense of urgency, particularly to develop pre-exposure therapies for immunocompromised individuals and alternatives to Paxlovid for people with contraindications. Additionally, more effort must be made to educate the medical community about who should get Paxlovid, under what conditions, and how to manage potential drug interactions. Other antiviral options, including Veklury (remdesivir) and Lagevrio (molnupiravir) exist for the estimated 10% of COVID-19 patients who cannot take Paxlovid.  
Studies show COVID-19 during pregnancy increases risk of severe maternal, newborn outcomes, maternal death, and vaccination can reduce risks

SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death and severe morbidities, as well as severe newborn outcomes, according to a meta-analysis of data pulled from 12 studies from as many countries published this month in BMJ Global Health. The analysis included 13,136 pregnant women, 1,942 of whom had confirmed or probable COVID-19 during pregnancy. Women with COVID-19 during pregnancy were at a higher risk of being admitted to intensive care units, receiving mechanical ventilation, receiving critical care, being diagnosed with pneumonia, developing blood clotting disorders, and death when compared to uninfected pregnant women. Additionally, infants exposed to SARS-CoV-2 during gestation were more likely to be admitted to neonatal care units, be born premature, and have low birthweight. However, this new study did not find a link between COVID-19 during pregnancy and increased risk of stillbirth. Because the analyzed studies were performed early in the pandemic when many people were immunologically na√Įve to SARS-CoV-2, it does not directly determine the impact of vaccination on risk reduction during pregnancy.
 
Other studies, however, show that vaccination reduces the risk of maternal mortality, stillbirth, preterm birth, and severe disease, and therefore remains a priority. A multinational study published January 17 in The Lancet also found that infection with the SARS-CoV-2 Omicron variant of concern is associated with an elevated risk of severe maternal illness and death, particularly among symptomatic and unvaccinated women. Those who were fully vaccinated or boosted had reduced risk for severe symptoms, complications, and death.
Preliminary safety concern for stroke among older adults after Pfizer-BioNTech bivalent booster ‚Äėvery unlikely‚Äô to represent ‚Äėtrue clinical risk,‚Äô US CDC says

After the US CDC and US FDA last week flagged a preliminary safety signal of a possible increased risk of stroke among people aged 65 and older who have received the updated bivalent Pfizer-BioNTech COVID-19 booster vaccine, the CDC now says it is ‚Äúvery unlikely‚ÄĚ there is an increased health risk. The Vaccine Safety Datalink (VSD) system used for safety monitoring detected the concern, but no other monitoring system has detected a similar issue, according to the CDC, although an investigation is ongoing. The statement notes that monitoring systems often flag safety signals for factors other than the vaccine, and that it is ‚Äúvery unlikely that the signal in VSD represents a true clinical risk.‚ÄĚ Both the European Medicines Agency and Israel‚Äôs coronavirus task force have said they have not identified any safety signals related to the Pfizer-BioNTech booster as of this week. The preliminary safety signal has not been identified with the Moderna bivalent booster shot. 
What we're reading

PATHOGEN RESEARCH OVERSIGHT Recent laboratory research that created a ‚Äúchimeric‚ÄĚ version of SARS-CoV-2‚ÄĒcombining a spike protein from Omicron with the body of the original viral strain‚ÄĒcoupled with conjecture that the COVID-19 pandemic originated due to a lab leak, has raised concerns over certain types of pathogen research. A new US Government Accountability Office (GAO) report makes recommendations to improve the US HHS's oversight of this type of study, also called gain-of-function research, including developing and documenting a standard for ‚Äúreasonably anticipated‚ÄĚ and assessing the risk of statutory limitations.

ÔĽŅHYBRID IMMUNITY Our immune systems appear to fixate on the first version of SARS-CoV-2 we are exposed to, and a better understanding of how much‚ÄĒor little‚ÄĒthese impressions last and their influence on vaccination could help researchers determine how well people can fight off the latest, or future, variants. A new WHO-supported analysis published in The Lancet Infectious Diseases suggests that hybrid immunity‚ÄĒprotection gained from both vaccination and infection‚ÄĒoffers better and more long-lasting protection from severe disease and hospitalization than infection alone. As a result, people with hybrid immunity might be able to extend the period before booster vaccinations are needed compared to individuals who have never been infected.

LONG COVID More than 65 million people worldwide‚ÄĒincluding about 19 million in the US‚ÄĒsuffer from post-COVID conditions, or long COVID, with cases increasing daily. The estimate is based on data showing that at least 10% of severe COVID-19 cases will go on to experience sometimes debilitating symptoms, and that proportion could be higher among children. For some long COVID patients with extreme fatigue, a rehabilitation strategy called ‚Äúpacing‚ÄĚ‚ÄĒactivity management that involves limiting daily activities, reducing energy expenditure, and tracking symptoms‚ÄĒcould help manage some symptoms, according to a study published recently in the Journal of Medical Virology

TRAVELER SURVEILLANCE The Traveler Genomic Surveillance (TGS) program, run by the US CDC in partnership with Ginkgo Bioworks and XpresCheck‚ÄĒpart of the nation‚Äôs biosafety infrastructure‚ÄĒhas expanded to 7 major US airports to cover travelers arriving on hundreds of international flights per week. Travelers voluntarily test for COVID-19, providing samples that can be used to try to detect new SARS-CoV-2 variants. The CDC is also looking to work with airlines and port authorities to begin collecting samples from airplanes‚Äô wastewater. The program could serve as an early warning system for when and where new pathogens‚ÄĒwhether natural or deliberate‚ÄĒenter the country.

PHYSICAL FITNESS Regular exercise is associated with lower rates of hospitalization and death from COVID-19, even among people whose age or health conditions put them at higher risk of severe outcomes, according to a study published last month in the American Journal of Preventive Medicine. Increasing physical activity as another COVID-19 mitigation strategy has gotten more accessible: KHN reports that more older adults, particularly those in rural areas, are able to attend online physical activity classes now than before the pandemic. A great place to start is with the Physical Activity Guidelines for Americans, which recommend adults get 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening activity every week.
Epi update

As of January 18, the WHO COVID-19 Dashboard reports: 
  • 663 million cumulative COVID-19 cases 
  • 6.7 million deaths
  • 2.7 million cases reported week of January 9
  • 9.7% decline in global weekly incidence 
  • 13,463 deaths reported week of January 9 
  • 3% increase in global weekly mortality 

Over the previous week, incidence declined or remained relatively stable in all WHO regions. 

UNITED STATES
The US CDC is reporting: 
  • 101.5 million cumulative cases
  • 1.1 million deaths
  • 414,721 cases week of January 11 (down from previous week)
  • 3,907 deaths week of January 11 (up from previous week)
  • 16.4% decrease in new hospital admissions 
  • 14.9% decrease in current hospitalizations 

The Omicron sublineages XBB.1.5 (43%), BQ.1.1 (29%), and BQ.1 (16%) account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases. 

Both the WHO and the European Centre for Disease Prevention and Control (ECDC) recently released risk assessments for XBB.1.5, addressing growth advantage, antibody escape, and clinical considerations.
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