COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Natasha Kaushal, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.
MONKEYPOX OUTBREAKS UPDATE Read our latest update from June 1 on the monkeypox outbreaks and visit our monkeypox resource page. We will continue to analyze the situation and provide updates, as needed. If you would like to receive these updates, please sign up here.
EPI UPDATE The WHO COVID-19 Dashboard reports 531 million cumulative cases and 6.30 million deaths worldwide as of June 8*. The global weekly incidence decreased for the third consecutive week, down 8.4% from the previous week. All WHO regions reported decreasing weekly trends, except the Eastern Mediterranean (+19.5%) and South-East Asia (+1.2%) regions. Notably, the Eastern Mediterranean region is reporting the lowest total weekly incidence—21,116 new cases—so even small changes are proportionately larger than in other regions. Weekly incidence decreased in the Americas for the first time since early April, down 1.5% from the previous week. Global weekly mortality decreased for the 16th consecutive week**, down 17.9% from the previous week and nearly 90% from the most recent high in early February. The weekly total (8,153 deaths) is the lowest since the week of March 9, 2020, very early in the pandemic.
*The WHO COVID-19 dashboard indicates that there is a delay in reporting for the African Region, so the current totals may not be complete.
**With the exception of a 1-week spike the week of March 21, which appears to be the result of a reporting anomaly in the Americas and South-East Asia.

The Omicron variant of concern (VOC) continues to account for essentially all analyzed SARS-CoV-2 samples worldwide. Together, the BA.2 sublineages represent 86.2% of all sequenced specimens last week***. Both the BA.4 (4.1%) and BA.5 (8.8%) sublineages are increasing in prevalence, and collectively, the BA.1 sublineage represents less than 0.2% of sequenced specimens last week. The WHO now categorizes the Delta VOC as “previously circulating,” joining the Alpha, Beta, and Gamma variants.
***Reported in GISAID.

UNITED STATES
The US CDC is reporting 84.9 million cumulative cases of COVID-19 and 1,004,732 deaths. The average daily incidence appears to be peaking, down slightly from the most recent high of 110,433 on May 26 to 104,511 on June 7. The average fell briefly following the US Memorial Day holiday weekend in late May; however, reporting has largely recovered, and the overall trend now shows early signs of a longer-term decline. Despite the current surge in daily incidence, daily mortality continues to remain relatively steady at approximately 290 deaths per day*—with the exception of the week following the Memorial Day holiday weekend. Looking at regional trends, this appears to be the result of daily mortality from the first Omicron surge continuing to decline in some parts of the country (eg, Regions 6, 7, 8, 9, and 10), while it increased slightly in regions that were affected earliest in the current surge (eg, Regions 1, 2, and 3).
*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.

Both new hospital admissions (+6.3% over the past week) and current hospitalizations (+8.4%) continue to increase; however, both trends appear to be tapering off. Community transmission in the US continues to be driven by the BA.2.12.1 sublineage of Omicron (62.2%), followed by BA.2 (24.8%), BA.5 (7.6%), and BA.4 (5.4%). These variants represent essentially all new SARS-CoV-2 infections in the US. Analysis from Our World In Data—based on data from the US Department of Health and Human Services—indicates that US test positivity continues to increase, up to 13.8% on June 3. The current average is 30% higher than the peak of the Delta surge (10.6%), but still considerably lower than the first Omicron surge (29.2%).

NOVAVAX SARS-COV-2 VACCINE EUA The US FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on June 7 to discuss the Emergency Use Authorization (EUA) application for Novavax’s 2-dose SARS-CoV-2 vaccine for use in adults aged 18 years and older. At that meeting, the VRBPAC members voted nearly unanimously—21-0, with 1 abstention—in support of issuing the EUA. The FDA is not obligated to follow the committee’s recommendations, but it usually does. In clinical trials, the vaccine demonstrated an overall efficacy of 90% against symptomatic COVID-19 disease and 100% efficacy against moderate or severe disease. The FDA briefing document released ahead of the meeting showed that adverse events associated with the vaccine were generally mild and short-lived. Only 6 of the vaccinated trial participants, of nearly 30,000 total, experienced the heart inflammation conditions of myocarditis or pericarditis, which was similar to the placebo arm. 

If the FDA issues an EUA for the Novavax vaccine, it would be the fourth SARS-CoV-2 vaccine authorized in the US, but the first to use a protein-based technology. There is hope that the vaccine’s more traditional platform will help entice those skeptical of mRNA vaccines to get vaccinated. If authorized, the Serum Institute of India (SII) will manufacture the Novavax vaccine for the US. Novavax faced manufacturing quality issues in early 2021, which delayed clinical trials. Novavax also has manufacturing facilities in the Czech Republic, Australia, and Canada.

MODERNA OMICRON-SPECIFIC BOOSTER Moderna announced Phase 2/3 clinical data for its Omicron-specific candidate booster dose. The bivalent booster contains Moderna’s original Spikevax vaccine and a candidate vaccine that specifically targets the Omicron variant. In a clinical trial of more than 400 participants, it demonstrated superior antibody response against Omicron 1 month after administration, compared to the original Spikevax vaccine alone. Against the Omicron variant, the candidate booster stimulated a neutralizing antibody response that was 1.75 times that of the monovalent Spikevax booster. Binding antibody titers against all other variants of concern (Alpha, Beta, Gamma, Delta) were also significantly higher than those stimulated by the original vaccine. Moderna indicated that it will seek authorization for the new candidate to be available in late 2022. The Moderna press release did not report any data regarding the booster’s performance specifically against the BA.4 or BA.5 Omicron subvariants that now represent 13% of new cases in the US.

US COVID-19 FUNDING The Biden Administration announced that the federal government will reallocate US$10 billion in COVID-19 funding due to failure of the US Congress to authorize additional emergency funding. Specifically, the reallocation will move funding originally allotted for domestic testing and the procurement of personal protective equipment (PPE) to enable future purchases of new or updated vaccines and expand the availability of Paxlovid and other therapeutics. The Biden Administration stressed that these tradeoffs leave the US more susceptible to a prolonged COVID-19 response and urged the Congress to make progress on stalled supplemental funding. 

US STATE-LEVEL COVID-19 POLICY DATABASE In spring 2020, shortly after the onset of the COVID-19 pandemic, researchers at Boston University established the COVID-19 US State Policies (CUSP) database to track rapidly changing state-level COVID-19 response policies and strategies. This tool not only updated information as states implemented and removed various protective measures, restrictions, and other mitigation and response strategies during the pandemic, it also provides a valuable resource for those researching the evolution of response efforts over the course of the pandemic. CUSP also enables visualizations of state policies and COVID-19 epidemiological data to support efforts to analyze the effects of various policies and response activities.

Researchers from Boston University, along with colleagues from the Johns Hopkins and Wake Forest Universities, recently published a detailed overview of the database and its capabilities. In addition to a description of the breadth of sources and documents reviewed to compile the state-level policies and the processes implemented to maintain the updated database, the article—published in BMC Public Health—highlights CUSP’s utility to support research efforts. The authors identify a number of recent studies on mitigation strategies, economic policies, vaccine allocation, and other aspects of the COVID-19 response that have already leveraged CUSP data to provide valuable insight to support ongoing COVID-19 response decision-making. The authors also note that similar databases have facilitated longer-term research following previous emergencies, including the 2008 financial crisis. This database will provide valuable historical data as researchers investigate various aspects of the US COVID-19 response and their associated impacts—including on physical and mental health, the economy, and social dynamics—for years to come.

JAPAN Following the peak of its current COVID-19 surge, the Japanese government announced that it will begin lifting travel restrictions and, starting June 10, allow international tourists to enter the country for the first time since early in the pandemic. The new policies still include a number of restrictions and protective measures for international travelers, including mandatory mask use. Additionally, international tourists will be required to coordinate their travel with local travel agencies and remain with their chaperones/tour guides, who will monitor compliance with mask use and other restrictions, throughout their visit. Additionally, tour guides have been instructed to select itineraries that avoid densely populated areas and to select hotels that have COVID-19 mitigation measures in place. The Japanese government will also require each visitor to have health insurance coverage that would cover the cost of COVID-19 treatment, in the event they become ill during their trip. Individuals who fail to comply with the restrictions may be deported.

MENTAL HEALTH Researchers from Denmark published findings from a study on changes in mental health in Europe during the COVID-19 pandemic. The study, published in Annals of Epidemiology, analyzed data from more than 36,000 adults aged 50 years and older (mean: 70.1 years) across 27 countries, collected as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) and the SHARE Corona Survey. They compared data from surveys collected before the pandemic to those collected since it began.

Compared to before the pandemic, the participants exhibited a decreased risk of feeling “sad or depressed” (-14.4%) or having trouble sleeping (-9.9%), but a slightly higher risk of experiencing feelings of loneliness (+1.2%). Women exhibited a significantly larger increase in the risk of feelings of loneliness (+2.3%) compared to men, who actually exhibited decreased risk of loneliness (-0.42%, although not a statistically significant decrease compared to pre-pandemic). Additionally, individuals in countries with greater degrees of COVID-19 restrictions experienced smaller decreases in the risk of sadness or depression and larger increases in the risk of loneliness, compared to those in countries with fewer restrictions. Individuals with larger close social networks (2 or more people) before the pandemic exhibited larger decreases in the risk of sadness/depression and sleep problems than those with smaller close social networks (0 or 1 person). Interestingly, though, individuals with larger social networks were at higher risk for loneliness during the pandemic (+2.3%), whereas those with smaller social networks actually exhibited a significant decrease in the risk of loneliness (-1.9%). And individuals who had COVID-19 exhibited higher risk of loneliness (+3.1%) compared to those who did not (+1.0%). The authors emphasized the need to study the longer-term effects of the COVID-19 pandemic on mental health, particularly those stemming from restrictive public health measures, such as “lockdowns.”