COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Natasha Kaushal, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.
NEW OMICRON SUBVARIANTS The WHO is tracking cases of 2 new sublineages of the Omicron variant, adding BA.4 and BA.5 to the monitoring list alongside BA.1, BA1.1, BA.3, and the globally dominant BA.2. Dr. Tulio de Oliveira, Director of the Centre for Epidemic Response & Innovation (CERI) in South Africa, tweeted about the presence of BA.4 and BA.5 in South Africa, one of the first countries to identify the original Omicron variant in November 2021. The series of tweets said the sublineages have been found in samples from Botswana, Belgium, Germany, and the UK but not yet caused a rise in cases in South Africa. BA.4 and BA.5 have mutations on their spike proteins similar to BA.2, in addition to several other mutations. De Oliveira said that where the subvariants differ from each other is in amino acid mutations outside of the spike protein and work is underway to further characterize the 2 Omicron sublineages. 

COVID-19 OUTBREAKS IN US Since the middle of March, the US has averaged between 25,000 and 30,000 new daily COVID-19 cases. But some health experts believe the country may be experiencing a new surge of cases, fueled by the Omicron BA.2 subvariant and masked by incomplete data from unreported at-home testing, a lack of testing among milder cases, and reduced access to testing centers. Numbers of new cases are beginning to rise in the northeast region of the country; of the 10 states with the highest 7-day case rates per 100,000 people, 7 are in the northeast. Average daily COVID-19 case numbers have increased approximately 53% in Rhode Island and 64% in both New Jersey and New York over the last 2 weeks. Other northeastern states experiencing increases in COVID-19 case loads include Connecticut, Maine, and Vermont. COVID-19 levels in wastewater have increased nationwide over the last 3 weeks, with the northeast showing the highest levels, according to Biobot Analytics. The Philadelphia Department of Public Health announced April 11 it will reinstate a citywide indoor mask mandate beginning April 18, including all public spaces such as schools, restaurants, government buildings, and other settings. The city’s number of new COVID-19 cases has increased 50% over the last 10 days, according to the department. Additionally, the federal government may extend the mask mandate for public transportation, which is set to expire April 18, according to White House Coronavirus Response Coordinator Dr. Ashish Jha.

Several recent outbreaks among high-profile politicians and celebrities could represent the tip of the iceberg in understanding ongoing SARS-CoV-2 transmission in the US. Health officials note that politicians and celebrities are tested more frequently than the average individual, and increases in cases among their ranks might signal that more people are becoming infected but experiencing mild or no symptoms. More than 70 high-profile people tested positive after an event known as the Gridiron Dinner in Washington, DC, including New York City Mayor Eric Adams, US Agriculture Secretary Tom Vilsak, US Attorney General Merrick Garland, US Commerce Secretary Gina Raimondo, several US lawmakers, and many others. Some of those who were infected are reportedly up-to-date on their vaccinations. Meanwhile, less than 10% of the US population feels that COVID-19 represents a serious crisis in the country, 17% say it is not a crisis at all, and 73% feel the pandemic is a manageable problem, according to an Axios-Ipsos poll. Notably, an average of 500 people in the US die daily from COVID-19. 

VACCINATION IMPACTS In an update to a December 2021 report, the Commonwealth Fund released new estimates on the impact of US SARS-CoV-2 vaccination efforts to include the winter Omicron surge. The report estimates that 2.27 million COVID-19-related deaths were averted in the US between mid-December 2020, when vaccines first became available, and March 31, 2022, when the Omicron surge was over. Additionally, the report estimates that vaccinations prevented 17 million COVID-19-related hospitalizations, about 66 million infections, and saved approximately $900 billion in healthcare costs. The report highlights the ongoing impact of US vaccination efforts and encourages efforts to increase vaccine uptake, while recognizing that nearly 1 million people have died of COVID-19 in the US since the start of the pandemic. In a statement, the White House said the report underscores the success of the nation’s historic vaccination effort and called on the US Congress to urgently authorize additional funding for the COVID-19 response. Lawmakers last week negotiated a US$10 billion COVID-19 spending deal, with no additional money for global vaccination efforts. However, debate over immigration policies delayed a vote on the legislation until after the US Senate returns from its spring recess at the end of the month.

US STATE DEPARTMENT CHINA TRAVEL ADVISORY The US Department of State on April 11 ordered all non-essential personnel and their family members in Shanghai, China, to leave and issued an advisory for US citizens to reconsider travel to China due to surges in COVID-19 cases. The State Department also cited the “arbitrary enforcement of local laws and COVID-19-related restrictions,” including the separation of children from parents, as reasons for the order and advisory. Many of Shanghai’s 26 million residents have been under strict lockdown, some for up to 3 weeks, as the nation continues to enforce its “zero COVID” strategy amid its worst COVID-19 outbreak since the beginning of the pandemic. Some residents have described being unable to obtain sufficient food, water, and other essentials while confined to their homes. Mass isolation facilities are reportedly overcrowded and unsanitary. In a shocking incident, a health worker beat a pet dog to death in the street as it was chasing a bus carrying its owner to an isolation facility. 

The State Department’s orders elevated diplomatic tensions, with the Chinese government expressing “strong dissatisfaction and firm opposition to the US side's groundless accusations about China's epidemic control policy” in a Foreign Ministry statement. Additionally, the situation in Shanghai is raising fears nationwide that similar stringent measures will be imposed in other regions as COVID-19 cases rise. The WHO said it is closely monitoring the situation in China, which reported a record 27,595 new COVID-19 cases in 31 provincial-level regions on April 10. 

US FEDERAL EMPLOYEE VACCINE MANDATE A panel of the US Court of Appeals for the 5th Circuit last week lifted a nationwide injunction of US President Joe Biden’s requirement that all federal government employees be vaccinated against COVID-19. In the 2-1 ruling, Judges Carl Stewart and James Dennis said the US District Court judge who originally issued the injunction did not have jurisdiction in the case, noting the plaintiffs should have raised their grievance through the Civil Service Reform Act (CSRA), not in the court system. On April 11, the US Department of Justice formally asked the appeals court to immediately issue its order to allow the ruling to take effect and enable federal agencies to once again enforce the executive order. Notably, in its last accounting, the White House said 96.5% of federal employees had at least 1 dose of vaccine or are seeking religious or medical exemption from the requirement.

US LIFE EXPECTANCY The estimated US life expectancy dropped for a second year in a row in 2021, falling by just under a half a year to 76.6 years, the lowest in at least 25 years, according to a new analysis. The report, posted to medRxiv and not yet peer-reviewed, shows that US life expectancy decreased from 78.86 years in 2019 to 76.99 years in 2020, falling another 0.4 years in 2021. In the 10 years prior to the pandemic, life expectancy changed by an average of less than 0.1 year annually, according to US CDC data. The findings reflect the toll of the COVID-19 pandemic, with the disease causing more US deaths in 2021 than in 2020. As more people became vaccinated in 2021, many other high-income countries began to see life expectancies rebound, and the researchers expected to find a similar trend in the US. However, that was not the case. For comparison, they examined data from 19 peer countries, which averaged a life expectancy decrease of 0.4 years between 2019 and 2020 and an increase of 0.28 years between 2020 and 2021, with a net loss of only 0.3 years—versus 2.26 years in the US—over the 2-year period. 

US Black and Hispanic populations experienced the largest declines in life expectancy between 2019 and 2021, with the researchers blaming the country’s history of structural racism in healthcare and other inadequacies in how the country handled the pandemic for the discrepancies. Notably, the drop in US life expectancy in 2021 was driven primarily by an increase in deaths among the white population, according to the analysis, which said multiple factors—including slow vaccine uptake and the Delta variant surge—helped to fuel an increase in mortality. As more people gain some immunity to SARS-CoV-2, either through vaccination or natural infection, US life expectancy should rise again in the coming years, unless a more virulent variant emerges or another pandemic disease arises. However, a recent report from the Peterson-KFF Health System Tracker shows an ominous start to the current year. In January, COVID-19 was the leading cause of death for people between the ages of 45 and 84, and in February, COVID-19 killed as many people as the typical number of deaths from heart disease, according to the report.  

EARLY REINFECTION A report published April 8 in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) describes 10 individuals who were reinfected with the Omicron variant of SARS-CoV-2 within 90 days of initial infection with the Delta variant. The report represents a significant finding, as reinfection within 90 days of infection is not well understood. Early reports of reinfection were difficult to verify because a positive reading on a nucleic acid amplification test (NAAT) could signal prolonged viral shedding from the initial infection rather than a new infection if taken within 3 months of acute infection. For the report, researchers conducted whole genome sequencing on 10 individuals—8 children and 2 adults—to determine which variant caused the initial and subsequent infections. Only 1 of the patients had received a 2-dose primary vaccine regimen, 2 had received 1 dose, and 7 were unvaccinated. Of 8 patients with available data on symptoms, 6 experienced symptoms during both infections. The authors noted that the patients may have been at increased risk for infection due to lack of vaccination and the high likelihood of exposure to SARS-CoV-2 in schools and the work and living settings of the adults. 

The CDC’s report comes at a time when health officials in Canada are warning residents about the possibility of reinfection with Omicron. Experts say global data continue to support evidence that reinfection is becoming more common but symptoms during reinfection often are not worse than the initial infection. The Omicron variant has proven adept at evading immunity from natural infection and infecting individuals with 2-3 doses of mRNA-based vaccines, dashing any last hopes of herd immunity. However, vaccination remains highly protective against severe consequences of COVID-19, including hospitalization and death, and being up-to-date on vaccinations remains the best way to protect against severe COVID-19 outcomes. 

COVID-19 ESTIMATES IN AFRICA A new meta-analysis of standardized seroprevalence studies indicates that the true number of SARS-CoV-2 infections across Africa may be 97 times higher than the number of reported confirmed cases. The study—led by the WHO Solidarity Response Fund and the German Federal Ministry of Health COVID-19 Research and Development and posted to the preprint server medRxiv—evaluated more than 150 seroprevalence studies from January 2020 to December 2021 and suggests that more than two-thirds of the African population have been infected with SARS-CoV-2. From Q2 2020 to Q3 2021, seroprevalence increased markedly from 3% to 61.5%. According to the study, which is undergoing peer review, rather than the reported 8.2 million cumulative cases in September 2021, there were actually more than 800 million infections. The study also determined that seroprevalence was higher in urban areas than rural areas, with varied seroprevalence among African sub-regions, where Middle, Western, and Eastern Africa exhibited higher seroprevalence. 

WHO Regional Director for Africa Dr. Matshidiso Moeti noted in the press conference that testing strategy and capacity is a significant factor in the discrepancy between reported cases and the estimated true number of infections. Testing across the continent has largely focused on symptomatic people, particularly where there were supply constraints, resulting in an undercount of exposures and infections. Dr. Moeti highlighted the need for sustained routine testing and surveillance capacity on the continent in order to identify cases among the estimated 67% of people with COVID-19 in Africa who are asymptomatic and monitor for emerging variants. 

BREAK COVID NOW SUMMIT An international donor conference last week secured US$4.8 billion in pledges for the Gavi COVAX Advance Market Commitment (AMC), the mechanism supporting the global vaccine-sharing initiative that delivers doses to lower-income countries. While reaffirming the international community’s support for COVAX, the 2022 Break COVID Now Summit—hosted by Gavi, the Vaccine Alliance in partnership with the governments of Germany, Ghana, Indonesia, and Senegal—fell short of its previously stated need of US$5.2 billion. Of the total commitments, innovative financing mechanisms, including the European Investment Bank (EIB) and the US Development Finance Corporation (DFC), pledged US$2.1 billion; individual nations committed US$1.7 billion; and 3 multinational development banks, including the World Bank, Asian Development Bank (ADB), and EIB, promised US$1 billion. The funds will allow COVAX to continue shipping and supporting the delivery and administration of SARS-CoV-2 vaccines in lower-income countries, as well as launch the new Pandemic Vaccine Pool to help ensure equitable access to updated SARS-CoV-2 vaccines in the future. In opening remarks, UN Secretary-General António Guterres excoriated the unequal distribution of vaccines, saying one-third of the global population has yet to receive a single dose creating ideal conditions for the emergence of new variants, more deaths, and further social and economic impacts.