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 380 million cumulative cases and 5.68 million deaths worldwide as of February 2. The global weekly incidence increased for the 15th consecutive week, up to 23.2 million new cases (+1.4% compared to the previous week)—once again, setting a new record. The trend appears to be tapering off, which could indicate that the Omicron surge is peaking on the global level. The Eastern Mediterranean, European, and Western Pacific regions continue to report record high weekly totals, but the other regions appear to be past their respective Omicron peaks. Notably, South-East Asia’s peak appears to be only its second highest since the onset of the pandemic, while all of the other regions recently set new weekly incidence records. Global weekly mortality increased for the fourth consecutive week, up 13.9% from the previous week. The weekly total of 63,298 deaths is the highest since the week of August 30, 2021. Based on trends observed over the course of the COVID-19 pandemic, we expect the weekly mortality to continue increasing over the next several weeks before it peaks.

Global Vaccination
The cumulative global SARS-CoV-2 vaccine doses administered surpassed 10 billion. The WHO reported 10.04 billion cumulative doses administered globally as of February 2. A total of 4.79 billion individuals have received at least 1 dose, and 4.13 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 38 million doses per day in early January 2022 to 20.7 million.* Our World in Data estimates that there are 4.82 billion vaccinated individuals worldwide (1+ dose; 61.2% of the global population) and 4.18 billion who are fully vaccinated (53.1% of the global population).
*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 US CDC is currently reporting 75.3 million cumulative cases of COVID-19 and 888,784 deaths. The US is averaging 415,552 new cases and 2,369 deaths per day.* Sufficient time has elapsed since the Martin Luther King Jr. Day holiday to assess the longer-term US trends, and it appears that the US has passed the peak of its Omicron surge at the national level—although this varies at regional and state levels. The surge began in earnest in mid-December 2021, and daily incidence peaked at a record high of 805,904 new cases per day on January 15, 2022. The trend has decreased rapidly since then, falling by nearly half over the second half of January. Daily mortality continues to increase, surpassing the spring 2020 peak—2,297 on April 21, 2020—which makes the Omicron surge the second highest peak daily mortality to date. Based on trends observed over the course of the pandemic, we expect daily mortality to peak sometime in the next week or so, lagging the trend in daily incidence by 3-4 weeks.
*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 surpassed 250 million individuals who have received at least 1 vaccine dose, which corresponds to more than 75% of the entire US population. The US has administered 668 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 644,000 on January 28.* Among adults, 87.0% have received at least 1 dose, as well as 25.6 million children under the age of 18. A total of 212 million individuals are fully vaccinated**, which corresponds to 63.9% of the total population. Approximately 74.2% of adults are fully vaccinated, as well as 20.5 million children under the age of 18. Since August 13, 88.6 million individuals have received an additional or booster dose. This corresponds to 41.8% of fully vaccinated individuals, including 64.5% 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.

VACCINE FOR <5 CHILDREN At the request of the US FDA over concerns about an increase in COVID-19 cases and hospitalizations among children, Pfizer and BioNTech announced they have initiated a “rolling submission” that seeks an amendment to the Emergency Use Authorization (EUA) for the companies’ SARS-CoV-2 vaccine that would expand eligibility to children as young as 6 months. The companies expect to complete the application in “the coming days,” and it will cover the first 2 doses of an expected 3-dose primary series using a 3 µg dosage for this age group. Data on the third dose, which is administered at least 8 weeks after the second dose, is expected to be available in the coming months, and a subsequent determination on further expanding the EUA to a full 3-dose series would need to be addressed at that time. Pfizer Chairman and CEO Albert Bourla indicated that Pfizer expects 3 doses to be necessary to provide adequate protection, but the initial EUA for 2 doses will enable children to begin that series while awaiting the final determination on the third dose. Review by the FDA and US CDC could potentially be completed this month. The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) will discuss the issue at its meeting scheduled for February 15.

The unusual and aggressive plan is raising concerns among some vaccine experts who argue that the FDA’s willingness to consider an EUA for a vaccine that has yet to demonstrate efficacy could risk increasing vaccine hesitancy and anti-vaccine sentiment and negatively affect vaccine uptake among young children. There are 2 principal concerns. First, the FDA is evaluating data from only 2 doses of a possible 3-dose series, without any data available yet for that third dose. And second, the small-scale trials may not be sufficient to capture adverse events that would emerge in larger trials.

Early clinical trial data published in December 2021 showed that a 2-dose series failed to elicit sufficient antibody responses in children aged 2-4 years, although children aged 6-23 months produced antibodies similar to older individuals. Notably, the Phase 2b/3 clinical trials were designed only to determine if the vaccine stimulated an immune response similar to older individuals—since previous trials demonstrated efficacy corresponding to that degree of antibody response—so traditional efficacy estimates are not available for young children. The early clinical trial data showed minimal adverse events, but there is concern that additional adverse events could be missed without larger trials. To date, only about 20% of children aged 5-11 years are fully vaccinated. A recent poll found that only 31% of parents of children under 5 years plan to vaccinate their child as soon as a vaccine is available, and some experts argue that speeding the EUA process is unlikely to make a substantial impact on vaccination coverage.

BOOSTER EFFECTIVENESS An early release published in the US CDC’s Morbidity and Mortality Weekly Report examining infection and hospitalization rates in Los Angeles County, California, depicts stark differences among vaccinated and unvaccinated individuals from November 7 to January 8, a period spanning the end of Delta variant predominance and the beginning of Omicron’s predominance. Data were further stratified among vaccinated individuals to include those with and without a booster to show booster effectiveness. For the 14-day period ending December 11, also the last week of Delta predominance, incidence and hospitalization rates among unvaccinated individuals were 12.3 and 83.0 times, respectively, those of boosted fully vaccinated individuals, and 3.8 and 12.9 times, respectively, those of fully vaccinated individuals without a booster. During the period ending January 8, when Omicron gained predominance, the rate ratios dropped, but vaccinated persons remained better protected. Unvaccinated individuals had infection and hospitalization rates 3.6 and 23.0 times, respectively, those of fully vaccinated persons with a booster and 2.0 and 5.3 times, respectively, those of fully vaccinated persons without a booster. According to Los Angeles County Department of Public Health data, 71% of county residents were fully vaccinated as of January 8. 

During a White House briefing on February 2, US CDC Director Dr. Rochelle Walensky shared data from 25 US jurisdictions showing unvaccinated individuals were 14 times more likely to die of COVID-19 than fully vaccinated individuals and unvaccinated individuals were 97 times more likely to die than people who were fully vaccinated and boosted. According to an analysis of Omicron’s impact conducted by the Financial Times, nearly half of US COVID-19-related hospitalizations this winter could have been prevented if the nation had vaccination coverage similar to leading European countries. About 64% of the total US population is fully vaccinated, and only 42% of eligible individuals have received a booster dose. 

PANDEMIC PREPAREDNESS An analysis of pandemic preparedness across 177 countries and territories published this week in The Lancet suggests that trust—both in the government and among people—could be a driving factor behind why COVID-19 hit some countries harder than others. Trust in government and fellow citizens was strongly associated with higher vaccination rates and decreased mobility, an indicator of social distancing. Notably, no associations were found between COVID-19 outcomes and democracy, populism, government effectiveness, universal healthcare, pandemic preparedness metrics, economic inequality, or trust in science. The researchers estimated that if every country had the same level of government or interpersonal trust as Denmark, which ranks in the 75th percentile for these indicators, global infections between January 1, 2020, and September 30, 2021, might have been reduced by 12.9% for government trust and 40.3% for interpersonal trust. Other factors that explained the most variation in COVID-19 infection-fatality rate (IFR) included a country’s age profile, GDP per capita, and national mean body mass index (BMI). The researchers suggest that countries prepare for the next pandemic by investing in risk communication and community engagement to improve trust in public health guidance, as well as improving health promotion to reduce risks, such as BMI, associated with fatality. 

Meanwhile in the US, a bipartisan duo of US Senate lawmakers is expected to introduce a new bill aimed at strengthening the government’s response to a future pandemic. The draft bill includes measures that would establish a 9/11-style bipartisan commission to formally investigate the US pandemic response and require Senate confirmation for the director of the US CDC. The effort—being led by Senators Patty Murray, a Democrat from Washington, and Richard Burr, a Republican from North Carolina—includes several other proposals outlining CDC oversight and tasks, better defining the role of the Assistant Secretary for Preparedness and Response (ASPR), requiring collaboration between the US NIH and other agencies, and ensuring manufacturing capabilities for pandemic tools such as vaccines and therapeutics. Additionally, senior administration officials, public health experts, and US lawmakers are taking stock of the US global COVID-19 strategy, urging more investment in global vaccination coverage and warning that leaving unfilled gaps risks the emergence of new variants. A group of Democrats in the US House is calling for an additional US$17 billion in federal funding for global vaccination delivery and infrastructure. Others are expressing concern over US President Joe Biden’s structuring of authority overseeing the US global COVID-19 strategy. The White House recently published a fact sheet on the Biden administration’s commitment to global health, and NIH issued a press release outlining the National Institute of Allergy and Infectious Diseases’ (NIAID) Pandemic Preparedness Plan.

COVID-19 IN US PRISONS Deaths among incarcerated populations in the US increased 46% from 2019 to 2020, as well as increased 32% among people on parole and 6% among people on probation, according to new data from the Bureau of Justice Statistics (BJS) analyzed by the Prison Policy Initiative. While researchers cannot yet say specifically that the increase is due to COVID-19, they do attribute many of the deaths to the pandemic in some way: directly from infections, a lack of access to regular health care, increases in overdoses and suicides, or a general burden on the correctional system. Since the start of the pandemic, nearly 3,000 incarcerated people have died of COVID-19, including about 300 in federal custody. Notably, imprisoned people are about 3 times more likely to die of COVID-19 than the general population, when data are adjusted for the population’s younger age. Since the emergence of Omicron, prisons across the US are witnessing an alarming increase in COVID-19 cases. In mid- to late-January, at least 7 federal prisons had triple-digit increases in new COVID-19 cases.

US President Joe Biden’s National Strategy for the COVID-19 Response, released in January 2021, included 2 pledges specifically addressing COVID-19 in prisons. One called for the distribution of SARS-CoV-2 vaccines to facility staff and incarcerated individuals in jails, prisons, and detention centers. Today, nearly 70% of the federal prison population is fully vaccinated, but the US Bureau of Prisons (BOP) has not conducted the educational efforts needed to address people with questions regarding medical concerns or distrust of the system, according to advocates. A second pledge promised an executive order to require the BOP and the US Immigration and Customs Enforcement (ICE) to evaluate their COVID-19 protocols, release data on cases, and use federal grant funding for state and local facilities to also follow public health guidance, but the order never came. Advocates say there has been some progress, including on accessibility to SARS-CoV-2 PCR testing and allowing people who were released to home confinement to remain so instead of returning to prison. However, the deteriorating situation in several prison systems since the emergence of the Omicron variant suggests that the response inside of federal, state, local, and private prisons remains inadequate 2 years into the pandemic. 

HUMAN CHALLENGE TRIAL The first COVID-19 human challenge clinical trial was found to be safe in healthy young adults, according to the latest not-yet-peer-reviewed data. The Human Challenge Programme—run by Open Orphan, Imperial College London, and other partners—exposed 36 healthy adult volunteers aged 18 to 29 with no immunity to SARS-CoV-2 to the original strain of the virus and monitored them in a quarantine setting, where no serious adverse events occurred. The trial produced several clinical outcomes that could inform public health policy, including that symptoms in infected persons began to develop an average of 2 days following exposure—earlier than the widely accepted 5 days—and that infectious virus peaks around 5 days, when the virus is more concentrated in the nose versus the throat. The researchers plan to monitor participants for 12 months following discharge. Imperial College said it plans to use the trial model with the Delta variant and share the framework to allow similar research around the world, aiming to provide an accelerated route for testing new vaccines, antivirals, and diagnostics.

HEALTHCARE WASTE The COVID-19 pandemic response has generated tens of thousands of metric tons of extra medical waste, straining healthcare waste management systems, threatening human health and the environment, and highlighting an urgent need to improve waste management protocols, according to a WHO report released this week. The analysis only takes into account the amount of potential waste generated through shipments from a joint UN emergency initiative and does not account for COVID-19-related commodities procured outside of the initiative or waste generated by the public. The report estimates that 87,000 metric tons of personal protective equipment (PPE); 2,600 metric tons of non-infectious mainly plastic waste, such as test kits; 144,000 metric tons of vaccine-related waste including syringes, needles, and safety boxes; and 731,000 liters of chemical waste were produced solely through the UN initiative. Overall, the WHO estimates the pandemic has increased healthcare waste loads up to 10 times, potentially exposing workers to needle-stick injuries, burns, and infections, and local communities to poorly managed landfills and carcinogens from improperly incinerated waste. The report encourages countries to see this as an opportunity to revamp waste streams, recommending healthcare facilities and the public responsibly use and dispose of waste and calling for investment into innovative waste treatment technologies and the use of more reusable, recyclable, or biodegradable materials. 

TONGA The South Pacific archipelago nation of Tonga went into lockdown on February 2 after at least 5 people were diagnosed with COVID-19. Two port workers in the capital city Nuku’alofa contracted the virus and then transmitted it to 3 family members, marking the first time the country has recorded community transmission. Concerns were high that an influx of international ships and planes delivering needed food, water, and supplies following a devastating volcanic eruption and tsunami would bring SARS-CoV-2 to Tonga, which previously had only 1 recorded COVID-19 case in a visitor. It is unclear how the workers contracted the virus. All foreign aid deliveries have been conveyed using contactless protocols, but the workers dealt with commercial ships at a different wharf. Under the lockdown, domestic flights are grounded, boats are disallowed from traveling between islands, schools are closed, most people are required to remain at home, and masking is encouraged in all public spaces. The lockdown will be reviewed every 48 hours, according to officials.