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.
EPI UPDATE The WHO COVID-19 Dashboard reports 399.6 million cumulative cases and 5.76 million deaths worldwide as of February 9.

We expect the global cumulative incidence to surpass 400 million cases in the WHO’s next update. If that is the case:
1 case to 100 million- 389 days
100 to 200 million- 190 days
200 to 300 million- 155 days
300 to 400 million- 34 days

The global weekly incidence decreased for the first time since mid-October 2021, down 15% from the previous week. It appears that the global trend has passed the Omicron peak. If the global trend follows what we have observed at the national level in many countries, we expect the decline to be relatively steep. Notably, all WHO regions with the exception of the Eastern Mediterranean region (+35.6%) reported decreasing weekly incidence last week. Global weekly mortality increased for the fifth consecutive week, up 9.6% from the previous week. The weekly total of 70,718 deaths is the highest since the week of August 23, 2021—the peak of the previous wave. Based on trends observed over the course of the COVID-19 pandemic, we expect the weekly mortality to peak in the next 2-4 weeks.

Global Vaccination
The WHO reported 10.1 billion cumulative doses administered globally as of February 7. A total of 4.81 billion individuals have received at least 1 dose, and 4.16 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations continues to decline steadily from the most recent high of 37 million doses per day in early January 2022 to 18.1 million on February 8.* The global weekly average jumped to 26.2 million doses per day on February 9, corresponding to a large jump reported in Asia, although this may be a reporting error.** Our World in Data estimates that there are 4.85 billion vaccinated individuals worldwide (1+ dose; 61.6% of the global population) and 4.23 billion who are fully vaccinated (53.7% of the global population). A total of 1.17 billion booster doses have been administered globally.
*The average daily doses administered may exhibit a sharp decrease for the most recent data, particularly over the weekend, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent data.
**The OWID data show 18.9 million doses reported in Asia on February 8 and 71.6 million on February 9 (+52.8 million), but it is not immediately clear what country or countries accounted for that increase. Only 20 total countries and territories reported an increase in doses administered from February 8 to February 9, and the largest increase was China with +1.01 million doses.

The US CDC is currently reporting 77.0 million cumulative cases of COVID-19 and 906,603 deaths.

The US surpassed 900,000 cumulative deaths on February 6:
1 death to 100k- 87 days
100k to 200k- 111 days
200k to 300k- 88 days
300k to 400k- 35 days
400k to 500k- 33 days
500k to 600k- 121 days
600k to 700k- 105 days
700k to 800k- 78 days
800k to 900k- 52 days

Daily incidence continues its sharp decline, down from a record high of 806,176 new cases per day on January 15 to 230,602 on February 8, a 71% decrease over only 3 weeks. Daily mortality has largely leveled, holding relatively steady at approximately 2,300-2,400 deaths per day since January 24—with a slight decline since February 1.* Daily mortality has not yet exhibited a decrease commensurate with the decline in daily incidence, but if this represents a peak, it would correspond to a lag of approximately 3 weeks behind the daily incidence trend. 
*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.

US Vaccination
The US has administered 674 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.77 million doses per day on December 6 to 479,000 on February 4.* A total of 251 million individuals have received at least 1 vaccine dose, which corresponds to 75.7% of the entire US population. Among adults, 87.3% have received at least 1 dose, as well as 26.0 million children under the age of 18. A total of 213 million individuals are fully vaccinated**, which corresponds to 64.2% of the total population. Approximately 74.4% of adults are fully vaccinated, as well as 21.0 million children under the age of 18. Since August 13, 90.5 million individuals have received an additional or booster dose. This corresponds to 42.5% of fully vaccinated individuals, including 65.2% of fully vaccinated adults aged 65 years or older.
*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.
**Full original course of the vaccine, not including additional or booster doses.

GLOBAL RESPONSE During the week ending February 6, the number of new COVID-19 cases decreased 17% globally compared to the prior week but the number of new deaths increased by 7%, according to the WHO. The situation varies widely depending upon the region, leading WHO Director-General Dr. Tedros Adhanom Ghebreyesus to warn that “COVID isn’t finished with us,” while appealing for more support from wealthy nations to bring equity to the distribution and administration of vaccines, tests, therapeutics, and personal protective equipment (PPE). To date, only 0.4% of the 4.7 billion SARS-CoV-2 tests administered globally have been used in low-income countries, and only about 11% of people in those countries have received at least one dose of vaccine. 

The WHO, along with world leaders and high-level officials, on February 9 called for higher income countries to fund their “fair share” of financial support to the Access to COVID-19 Tools (ACT) Accelerator—including the COVAX initiative—to help end the pandemic by delivering necessary tools for pandemic response to low- and middle-income countries (LMICs). The ACT-Accelerator is budgeted to need US$23.4 billion through September 2022, of which it expects wealthy countries to donate US$16.8 billion. However, those nations so far have pledged only US$814 million—about 5% of the amount—leaving a US$16 billion gap. The remaining US$6.5 billion is expected to be self-financed by middle-income countries. Separately, US$6.8 billion is necessary for in-country resource delivery, which is anticipated to come from domestic resources, multilateral development bank support, and additional international grant financing support. In January, COVAX appealed for US$5.2 billion to continue operations over the next 3 months.

A new analysis from the Center for Global Development lauds the global vaccine rollout during the COVID-19 pandemic as the fastest and most widespread in history. But the paper singles out low-income countries as the exception, noting that other vaccination efforts have provided more coverage more quickly. Both the US and the EU recently indicated they will shift their focus from increasing vaccine supplies flowing into low-income countries, particularly those in Africa, to increasing vaccination administration and uptake. A paper posted February 9 to the preprint server medRxiv presents model-based estimates of deaths averted and cost per life saved by scaling up mRNA vaccinations in low- and lower-middle-income countries. According to the paper, which is not yet peer-reviewed, if every person living in those countries received 2 doses of mRNA vaccine this year, the effort would avert 1.2 million deaths at a cost between US$7,400 and US$81,500 per life saved. Despite the broad range, the price per life saved is considerably lower than some had estimated, showing the overall cost effectiveness of vaccinating the entire world.

US STATE MASK MANDATES As the number of new COVID-19 cases continues to decline across the US, a growing number of states—including California, Connecticut, Delaware, Illinois, Massachusetts, New Jersey, New York, Oregon, and Rhode Island—have either dropped or announced plans to end certain mask mandates, including some for schools, and other COVID-19 restrictions meant to reduce transmission of the virus. The moves, made largely in states controlled by Democratic governors, have put pressure on the White House, which said it is working on plans to move into a “new normal.” US President Joe Biden’s Chief Medical Advisor Dr. Anthony Fauci cautioned that the pandemic remains unpredictable and urged leaders to take gradual steps to transition out of the current surge. US CDC Director Dr. Rochelle Walensky noted her agency is working on new guidance for states and expressed optimism that new cases are dropping. But she warned that hospitalization and death rates remain high and that the nation is not yet at a point to drop mask mandates for indoor public spaces. The CDC currently recommends wearing masks in schools and in localities where coronavirus transmission is high—with case rates higher than 50 cases per 100,000 or positive test rates exceeding 8%—which at present accounts for 99% of the country. The agency reportedly is considering changing the metrics on which it bases its masking guidance, possibly shifting from case rates to data on hospitalizations.

Some parents expressed concern over the end of mask mandates for schools, saying more students over age 5 should be vaccinated before masks come off. Currently, only about 23% of children ages 5 to 11 years old are fully vaccinated and only about 56% of older children, aged 12 to 17, are fully vaccinated. Experts remain divided over when and on what metrics school mask mandates should be removed. However, all agree that masking in schools should not last forever.

US VACCINE MANDATE FOR FEDERAL EMPLOYEES In a 2-1 vote, the 5th US Circuit Court of Appeals on February 9 declined to block a lower court injunction on US President Joe Biden’s mandate requiring federal employees be vaccinated against COVID-19. The ruling, which was unexplained, signals the court will conduct a full review of the case and potentially sets the stage for the case to head to the US Supreme Court. In a dissenting opinion, Judge Stephen A. Higginson noted that a single district judge issued an injunction after several district courts rejected requests to block the mandate, writing the Supreme Court was the “only court that can now provide timely relief.” According to the US Office of Management and Budget, 97.2% of the federal workforce is compliant with the mandate, including those who are vaccinated or have pending or approved exemptions.

In a similar case, Louisiana and 15 other states filed an amended complaint last week against the federal vaccine mandate for healthcare workers at facilities that receive funding through Medicare or Medicaid. While experts agree the changes likely will not impact the rule’s fate, the new arguments—which include that state surveyors were improperly added to covered employees and that the Omicron variant’s ability to cause breakthrough infections renders vaccination meaningless—could raise new questions. The Supreme Court upheld the mandate in a January 13 opinion.  

VACCINE UPTAKE Since the onset of mass SARS-CoV-2 vaccination in the US, and even before, the federal government has struggled to communicate effectively about vaccination recommendations, benefits, and risks, particularly in the context of engaging with vulnerable populations. In an effort to improve engagement with racial and ethnic minorities and communities with low vaccination coverage, the Health Resources and Services Administration (HRSA) is distributing more than US$66 million to community groups across the country to support vaccine outreach and education efforts. The funding aims to build confidence in SARS-CoV-2 vaccines through trusted local leaders who know better how to effectively engage with communities. The funding is part of the US$1.9 trillion American Rescue Plan that was signed into law in March 2021. 

A recent study published in Nature found significant racial and ethnic disparities in terms of SARS-CoV-2 vaccine hesitancy and uptake in the US and UK. The study included data collected via a smartphone-based COVID-19 symptom monitoring study from more than 2 million individuals between March 2020 and February 2021. Among US participants, vaccine hesitancy was significantly higher for Black, Hispanic, and multi-racial individuals, compared to White participants. Similar trends were found among individuals in the UK. In the US, Black participants reported significantly lower vaccine uptake, even among those who were willing to be vaccinated; however, this trend was not observed in any other racial or ethnic minority group in the US, nor in any group in the UK. The low uptake among Black participants who were willing to get vaccinated suggests that access was also a barrier to vaccination.

The US CDC COVID-19 Emergency Response Team published findings from a study on SARS-CoV-2 vaccine uptake among lesbian, gay, bisexual, and transgender (LGBT) communities, in the CDC’s Morbidity and Mortality Weekly Report (MMWR). The CDC notes that LGBT individuals are at elevated risk for severe COVID-19 and death as a result of higher prevalence of underlying health conditions. The CDC also was concerned about the “potential for low vaccine confidence and coverage” in LGBT communities due to long-standing mistrust of healthcare systems and numerous barriers to accessing health services. Data collected through the National Immunization Survey Adult COVID Module (NIS-ACM) between August 29 and October 30, 2021, indicate that vaccination coverage was actually higher among LGBT adults (85.4%) than heterosexual adults (76.3%). While overall coverage was higher, some racial and ethnic minority groups within the LGBT community reported lower coverage than corresponding heterosexual groups, including non-Hispanic Black women. In fact, vaccination coverage was the lowest among non-Hispanic Black LGBT individuals across all categories of sexual orientation. Notably, the study also found higher degrees of confidence in vaccine safety and protection among portions of the LGBT community than among heterosexual adults. A separate study by health officials in New York found that SARS-CoV-2 vaccination coverage among individuals diagnosed with HIV infection (63.5%) was lower than among the broader New York adult population (75.0%), including across all racial and ethnic, economic, and other demographic subgroups. The analysis was conducted by matching data from New York state’s HIV surveillance registry and immunization registries for New York state and New York City.

MATERNAL ANTIBODIES People who receive SARS-CoV-2 vaccinations during pregnancy pass along more durable antibodies to their newborns than do unvaccinated individuals who had COVID-19 during pregnancy, according to a research letter published February 7 in the Journal of the American Medical Association (JAMA). The small study examined 77 vaccinated pregnant women who completed their 2-dose mRNA vaccine series between weeks 20 and 32 of gestation and 12 women who had symptomatic SARS-CoV-2 infection during pregnancy. The infants of vaccinated mothers had significantly higher immunoglobulin G (IgG) antibodies in umbilical cord blood at delivery and in blood draws at 2 and 6 months postpartum than infants who received antibodies from their unvaccinated convalescent mothers. The researchers note that while the antibody titer necessary for protection against SARS-CoV-2 infection or severe disease is unknown in infants, the findings further support recommendations for pregnant individuals to be vaccinated and provide evidence that antibodies in newborns of vaccinated individuals could persist until the infant becomes eligible for vaccination at 6 months. The US FDA is expected to authorize the Pfizer-BioNTech vaccine for young children ages 6 months to under-5 later this month.

J&J-JANSSEN VACCINE PRODUCTION Johnson & Johnson (J&J) late last year temporary halted production of its SARS-CoV-2 vaccine at the only plant making usable batches of the shots, a facility run by J&J subsidiary Janssen in the Netherlands capable of manufacturing more than 50 million doses per month, according to a report in The New York Times. The single-dose vaccine, which does not need ultra-cold storage, is the first choice for many low- and middle-income countries (LMICs), and the move caught officials with the African Union and the COVAX initiative off guard when they learned about the production suspension from Times reporters. The facility where the vaccine was being produced is instead manufacturing an experimental vaccine against a different virus, which some noted could be a more profitable venture. A J&J representative said the company has millions of finished doses in inventory, continues to deliver vaccine to fill-and-finish facilities, and intends to deliver on its vaccine commitments to LMICs. Notably, the company failed to deliver on commitments made to COVAX last May. Last year, J&J ran into regulatory problems with Maryland-based contractor Emergent BioSolutions when it did not pass US FDA inspections. The Emergent facility continues to require FDA review of vaccine batches manufactured at the plant, and none have been cleared for distribution. J&J has plans to produce SARS-CoV-2 vaccine at 2 other plants, one in the US and another in India, but those facilities are not expected to be operational until late spring. The Dutch production plant is expected to begin producing the J&J-Janssen vaccine again next month, although those doses will not be shipped until May or June.

PFIZER-BIONTECH VACCINE Pfizer this week reported US$36.78 billion in 2021 direct sales from the SARS-CoV-2 vaccine it makes with BioNTech, making the vaccine the top-selling pharmaceutical product ever in a single year. The next highest—the drug Humira, which is used to treat rheumatoid arthritis and other autoimmune and inflammatory conditions—registered US$20.7 billion in 2021 sales. In its full-year results, Pfizer predicted it will sell US$32 billion of its vaccine, called Comirnaty, and US$22 billion of its antiviral COVID-19 treatment Paxlovid in 2022. Pfizer CEO Albert Bourla this week said he expects the US FDA to soon authorize a low-dose version of the Pfizer-BioNTech vaccine for young children aged 6 months to under-5 years under a fast-track review process. Data from clinical trials of the vaccine among this age group are expected to be published later this week in preparation for a February 15 meeting of the FDA Vaccines and Related Biological Products Advisory Committee. The US CDC has begun preparations to deliver the vaccine once it is authorized, telling state and local officials they could expect to start receiving shipments on February 21

AUSTRALIA & NEW ZEALAND Several countries with the strictest closed border policies have announced they will reopen to international travelers. Australia announced it will allow fully vaccinated citizens, permanent residents, and visa holders into the country without a travel exemption beginning February 21; unvaccinated visa holders will still require a valid travel exemption. Notably, the Australian Technical Advisory Group on Immunisation (ATAGI) announced today that Australians will need 3 vaccine doses to be considered “up to date” on their shots. If an individual has gone more than 6 months from their second dose without a booster shot, they will be considered “overdue.” The new definition will only apply to COVID-19 management within Australia and will not affect rules for “fully vaccinated” people entering the country. However, each state will continue to set its own requirements for booster doses, which could impact visitors.

Neighboring New Zealand announced a phased reopening of its borders beginning at the end of this month. The country expects to welcome all international travelers from October. Everyone entering the country will be required to self-isolate at home for 10 days. Both nations’ borders have been closed for most of the past 2 years.