COVID-19 Situation Report |
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Editor: Alyson Browett, MPH
Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.
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EPI UPDATE The WHO COVID-19 Dashboard reports 562.7 million cumulative cases and 6.37 million deaths worldwide as of July 20. The global weekly incidence remained relatively stable after an increasing trend for the past 5 weeks, up 1.54% from the previous week. Global weekly mortality also remained stable, rising 0.5% over the previous week with 11,257 total reported deaths.
At the regional level, the Western Pacific (+37.83%), Americas (+9.53%), and Southeast Asia (+5.25%) experienced increases in new cases, while Europe (-13.88%), the Eastern Mediterranean (-3.88%), and Africa (-21.91%) regions had decreasing trends. The number of new weekly deaths increased in the Southeast Asia (+20%), Eastern Mediterranean (+15%), and Americas (+7%) regions, decreased in the Africa (-39%) and Europe (-14%) regions, and remained stable in the Western Pacific region.
UNITED STATES
The US CDC is reporting 89.7 million cumulative cases of COVID-19 and 1,020,355 deaths. After plateauing over the past several weeks around 100-110,000 new cases per day, the weekly average increased to 126,018 on July 19. The average daily mortality has held relatively steady at approximately 275-350 deaths per day since late April.*
*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.
Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is projected to have accounted for more than half of sequenced specimens starting the week of July 2, and the estimate reached 77.9% for the week of July 16. The BA.4 sublineage accounts for a smaller proportion of cases and appears to be decreasing in prevalence. The BA.4 sublineage fell from an estimated 16% over the past 2 weeks to 12.8% the week of July 16, and is now outpacing BA.2.12.1 as the second most prevalent sublineage. Together, Omicron variants represent essentially all new cases in the US.
NOVAVAX VACCINE The CDC Advisory Committee on Immunization Practices (ACIP) on July 19 voted 12-0 to recommend the use of the Novavax recombinant protein COVID-19 vaccine as a 2-dose primary series for adults aged 18 years and older. Within hours of the vote, CDC Director Dr. Rochelle Walensky endorsed the recommendation, prompting a rollout over the coming weeks of 3.2 million doses the US has secured. As the fourth COVID-19 vaccine to be authorized in the US, the Novavax vaccine offers a more traditional vaccine technology, which some hope will prompt US vaccination holdouts wary of the newer mRNA technology to get vaccinated. The approach is similar to that of vaccines for influenza and HPV—protein-based vaccines that make the immune system recognize modified pieces of the target virus. In a statement, US President Joe Biden, who today tested positive for COVID-19, applauded the news and noted vaccines continue to protect people from serious COVID-19-related illness, hospitalizations, and death. President Biden, who is up to date on his vaccinations, also encouraged US residents to vaccinate their children and get a booster dose if they are eligible.
VACCINE-INDUCED IMMUNITY Virologists and health officials are trying to stay one step ahead of the constantly mutating SARS-CoV-2 virus in order to develop future vaccines, treatments, and other interventions. However, those predictions are complicated, with experts depending on modeling based on what we already understand about the virus. Several recently published studies examine how well current vaccines elicit immunity against Omicron variants.
Published July 19 in Science, a study of spike protein function and neutralizing capability of 7 different SARS-CoV-2 vaccines against Omicron sublineages shows that a large number of the sublineage mutations lead to enhanced ACE2 binding and reduced plasma neutralizing activity. However, homologous or heterologous boosters markedly increased neutralizing antibody titers against BA.1, BA.2, BA.2.12.2, and BA.4/5 across all vaccines evaluated to provide sufficient protection against Omicron-induced severe disease. The vaccines evaluated included mRNA vaccines from Moderna and Pfizer-BioNTech, viral-vectored vaccines from J&J-Janssen, AstraZeneca-Oxford, and Sputnik V, as well as the Novavax and Sinopharm vaccines that use different platforms.
Another study, published in Cell Reports Medicine and led by researchers at NIAID, examined a “mix and match” booster strategy. The findings suggest that nearly all vaccine combinations elicited high levels of neutralizing antibodies against the BA.1 sublineage, but antibody levels remained low in the group that received the J&J-Janssen vaccine for both primary series and booster dose. Notably, the neutralizing antibody levels of all groups decreased substantially (2.4-5.3 fold) by the third month following the booster dose, which is consistent with real-world reports of waning immunity over time.
Another preprint study posted to medRxiv evaluated a 3- or 4-dose regime of the Pfizer-BioNTech vaccine, showing that the fourth dose elicited “significant rise in antibody binding and neutralizing titers against multiple variants” and reduced the risk of symptomatic infection. In the 3-dose group, 45% of participants developed infection during the 90-day follow up period compared to 30% in the 4-dose group. The study notes that several IgG and IgA markers and their combinations were correlates of protection (COP). The paper also recommends further study of a subpopulation identified with low-baseline antibody levels after 3 doses who were at increased risk of infection despite receiving a fourth dose.
COVID-19 TREATMENTS Researchers continue efforts to develop COVID-19 treatments for people with mild disease or those who are not at high risk of progressing to severe illness. Several treatments, including monoclonal antibodies and antivirals, are authorized for people at high risk of severe disease, but those medicines might not benefit people who fall into lower risk categories. Pfizer recently announced it is ceasing enrollment into its clinical trial evaluating whether the antiviral Paxlovid would help standard-risk patients, saying they could not obtain sufficient data on whether the drug prevented hospitalization or death in this population. Some COVID-19 patients are turning to unproven or alternative treatments, whether they qualify for authorized medicines or not. Additionally, some individuals with long COVID are seeking out experimental therapies, such as “blood washing,” due to a lack of treatments for lasting COVID-19 symptoms. For some, distrust—in the healthcare system, research methods, or doctors—is the reason they seek out often expensive and potentially useless or even harmful therapies. But others feel desperate for help when they test positive, as there are no COVID-19-specific treatments currently recommended for people who do not fall into a high-risk category.
US PANDEMIC PREPAREDNESS The administration of US President Joe Biden is reorganizing the US Department of Health and Human Services to elevate the Office of the Assistant Secretary for Preparedness and Response (ASPR) from a staff division into an independent operating division—similar to the US CDC, FDA, and NIH—responsible for leading the nation’s responses to future pandemics and health emergencies. Under the reorganization, ASPR will now be known as the Administration for Strategic Preparedness and Response, and efforts to stand up the new division will be phased in over the next 2 years. ASPR oversees the Strategic National Stockpile, the national Medical Reserve Corps, and contracts for and distribution of vaccines and certain medicines in health emergencies. Though many current and former HHS officials welcomed the move, other experts say that shifting some health emergency coordination responsibilities to ASPR could undercut response efficacy, create confusion and tension, and does not address ongoing challenges at CDC, which has much closer relationships with states.
US GLOBAL RESPONSE Funding for the US Agency for International Development’s (USAID) global COVID-19 response efforts will soon run dry if the US Congress does not authorize additional financing, USAID Assistant Administrator for Global Health Dr. Atul Gawande warned at a healthcare summit this week. USAID is responsible for coordinating US global COVID-19 response efforts, helping more than 120 countries address the pandemic over the past 2.5 years, delivering nearly 566 million vaccine doses of the 1.1 billion the US has pledged to donate, as well as providing diagnostics, treatments, and other tools. But funding for the agency’s COVID-19 task force ran out last month, and Congress has not moved to reauthorize financing for the program, which needs a minimum of US$5 billion to continue operations.
Also this week, US Secretary of State Antony Blinken and Minister of Foreign Affairs of Japan Hayashi Yoshimasa co-hosted a virtual COVID-19 Global Action Plan (GAP) Foreign Ministerial Meeting with representatives of more than 25 countries, the African Union, WHO, and World Bank. The meeting was a follow-up to the June 15 COVID-19 Senior Officials Meeting, and came in the same week Japan set a record for new daily COVID-19 cases, exceeding 180,000 cases today. Participants discussed the ongoing need for equitable and sustainable access to vaccines, diagnostics, and treatments, as well as ways to close gaps in vaccine confidence, distribution, uptake, and funding, for both the current pandemic and future health emergencies. In remarks, WHO Director-General Dr. Tedros Adhanom Ghebreyesus cautioned that the number of global COVID-19 cases is elevated again, lauded the establishment of a new Financial Intermediary Fund (FIF) at the World Bank, and called on nations to work toward ending the acute phase of the pandemic by focusing on vaccinating at-risk populations and reaching the WHO goal of 70% vaccination coverage in all nations.
BERLIN DECLARATION Many nations remain significantly behind in their efforts to reach a WHO goal of vaccinating 70% of the global population against COVID-19. The latest data from Our World in Data show that only 1 in 7 people in low-income countries are fully vaccinated compared with 3 in 4 people in high-income countries. Activists across the world are calling for a renewed push to close this gap, particularly as circulating and emerging variants threaten to put additional strain on healthcare systems and avert available response tools. As new COVID-19 cases rise once again in several regions, many organizations are focused both on COVID-19 and future pandemic responses, including bolstering healthcare system infrastructure.
On July 19, the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) published the Berlin Declaration, a set of recommendations for strengthening equitable vaccine access for future health crises. IFPMA represents many biopharmaceutical players, including many of the companies involved in COVID-19 product development, like Pfizer, Moderna, AstraZeneca, GSK, and Merck. The Berlin Declaration lays out lessons learned in the global response to COVID-19 and proposes using several approaches—including donations, not-for-profit supply, voluntary licenses, and tiered-pricing systems—to help ensure pandemic interventions are available to countries of all income levels. However, the declaration says the first step is for lower-income countries to develop infrastructure to receive and deliver vaccines and other medical countermeasures and calls on the G7, G20, and other global stakeholders to take steps to accelerate resource and financial capacity for countries to strengthen product delivery infrastructure. In reaction to the Berlin Declaration, which is not legally binding, some advocates accused the pharmaceutical industry of shifting blame and onus onto lower-income nations and shirking public responsibility to equitably supply health interventions, some of which were developed using public funding.
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