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.
The Situation Report will not publish on Tuesday, January 18, in recognition of Martin Luther King Jr. Day (US holiday) on January 17. We will resume publication on Thursday, January 20.
EPI UPDATE The WHO COVID-19 Dashboard reports 312 million cumulative cases and 5.5 million deaths worldwide as of January 12. Global weekly incidence again increased substantially last week, up 59% over the previous week. This is the 12th consecutive week of increasing weekly incidence, setting another new record with 15.58 million new cases. The increase continues to largely be due to surges in the Americas (+78.8%) and Europe (+37%), but nearly all WHO regions reported increases last week. Notably, the WHO reported a decrease in the Africa region (-11%), potentially signaling the Omicron surge there has peaked. The Omicron surge in the UK also appears to have peaked, with government data showing the weekly average number of cases down 19% over the previous week. However, weekly average mortality within 28 days of a positive SARS-CoV-2 test is up 44.3%. Global weekly mortality increased for the first time in 5 weeks, up 2.7% from the previous week with 43,522 total deaths. 

Global Vaccination
The WHO reported 9.2 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of January 11. A total of 4.59 billion individuals have received at least 1 dose, and 3.89 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations increased from mid-October (21.7 million doses per day) through mid-December (39.1 million). Daily vaccinations have decreased since December 20, down to 35 million.* Our World in Data estimates that there are 4.69 billion vaccinated individuals worldwide (1+ dose; 59.53% of the global population) and 3.98 billion who are fully vaccinated (50.5% 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 62.5 million cumulative cases of COVID-19 and 840,286 deaths. The US is averaging 761,535 new cases and 1,656 deaths per day.* Notably, the US reported 1.35 million new COVID-19 cases on January 10. This exceeds the previous single-day record, set on January 3, by 397,521 cases. 
*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.

COVID-19 hospitalizations in the US set a record high this week, passing the previous record of 16,497 new hospitalizations per day (January 8, 2021). The 7-day average as of January 10 is 20,269. The CDC is also reporting a surge in the number of current hospitalizations, up from an average of 91,030 hospitalized COVID-19 patients on January 3 to 124,163 on January 10, an increase of 36.4% over that period. The current average is slightly above the previous record high—124,031 on January 11, 2021. Daily mortality is increasing, and the surge in hospitalizations is placing severe strain on health systems nationwide, which could contribute to increased mortality for COVID-19 patients as well as those seeking care for other conditions.

US Vaccination
The US has administered 522.5 million cumulative doses of SARS-CoV-2 vaccines. The trend in daily vaccinations continues to decline, down from a recent high of 1.74 million doses per day on December 6 to 1 million on January 7.* 

A total of 247.7 million individuals have received at least 1 vaccine dose, equivalent to 74.6% of the entire US population. Among adults, 86.6% have received at least 1 dose, as well as 24 million children under the age of 18. A total of 208 million individuals are fully vaccinated**, which corresponds to 62.7% of the total population. Approximately 73.4% of adults are fully vaccinated, as well as 18.7 million children under the age of 18. Since August 13, 77.1 million fully vaccinated individuals have received an additional or booster dose. An estimated 37% of fully vaccinated individuals have received a booster, including 60.8% 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.

WHO ON SARS-COV-2 VACCINES A WHO panel of vaccine subject matter experts known as the Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) released an interim statement on January 11 regarding vaccination strategies to combat the ongoing pandemic. The TAG-CO-VAC advised increasing access to primary and booster doses of current vaccines in low- and middle-income countries (LMICs) to prevent the emergence of new SARS-CoV-2 variants and updating vaccine composition to cover currently circulating variants. Vaccine inequity is an issue often discussed by the WHO, and it is believed to be a large driver for the emergence of new variants that have the potential to escape vaccine-induced immunity, such as Omicron. Increasing efforts to provide initial vaccination doses to under-immunized nations has the potential to slow the emergence of new variants and take pressure off health systems that are buckling under the weight of new cases. TAG-CO-VAC also stated that promoting a vaccination strategy that relies on multiple booster doses of the original vaccine design is unlikely to be effective. TAG-CO-VAC called for an updated vaccine design that protects against infection and severe disease, is based on currently circulating variants, and elicits a robust immune response. The best options for new vaccine design include multivalent vaccines that protect against many circulating variants or pan-SARS vaccines that provide protection from current and future variants. 

OMICRON SEVERITY Real-world evidence is supporting the theory that the highly infectious SARS-CoV-2 Omicron variant of concern (VOC) causes less severe disease than the Delta VOC, but officials are warning that Omicron cannot be described as “mild” and unvaccinated individuals remain at risk for severe outcomes. A study posted January 11 to the preprint server medRxiv examined the outcomes of nearly 70,000 COVID-19 patients in California and suggests Omicron causes less severe disease than previous variants. The findings, which are not yet peer-reviewed, align with similar data from research conducted in South Africa, the UK, and Denmark. Additionally, laboratory studies show Omicron’s lower virulence might be due to its tendency to replicate more in cells of the upper respiratory tract instead of the lungs, where the virus can lead to more serious breathing problems. While more is being learned about how well vaccine-induced or natural immunity helps to protect against severe outcomes in Omicron cases, early reports indicate infections are less severe in people with some prior immunity. Additionally, it is too soon to conclude whether Omicron is less lethal than previous variants. While real-world anecdotes suggest people infected with Omicron are less likely to need intensive care including breathing support, COVID-19 hospitalizations set a new record this week in the US. Hospitals nationwide already are overwhelmed with an enormous number of people with COVID-19—as well as with other health conditions—all while facing staffing shortages exacerbated by workers themselves becoming ill. Most agree that this surge of Omicron will help push the world further toward COVID-19 endemicity, but the short- and long-term costs remain to be realized.

SARS-COV-2 IMMUNITY Emergence of the SARS-CoV-2 Omicron variant, which has a highly mutated spike protein when compared with the Beta or Delta variants, has increased international attention on how mutations impact immunity and neutralizing antibody production. A preprint study from Japan provides evidence that fully vaccinated individuals who have also had breakthrough infections—known as hybrid immunity—may be better protected against infection with Omicron. According to the study, which is not yet peer-reviewed, the greater the span of time between the last vaccination and a breakthrough infection directly correlates with the quality of protection. The results of this study imply that countries that were hit harder by the Delta wave could be in a better position to withstand the current Omicron wave, but the authors urged a cautious approach when trying to understand how population immunity interacts with new and future variants. 

An additional preprint study from India suggests that Omicron’s rapid global spread may be due to decreased efficacy of neutralizing antibodies in both vaccine-only and hybrid immunity populations. According to the study, which also is not yet peer-reviewed, neutralizing antibodies were extremely effective against the original strain of the virus but efficacy was much lower against the Omicron variant. Despite the lower efficacy, the study also provided further confirmation that hybrid immunity provides better protection than vaccine-only immunity. 

Discussions about the impact of spike protein mutations on immunity typically focus on neutralizing antibodies, but a subset of immunologists are highlighting the importance of T-cells. Current evidence shows that new SARS-CoV-2 variants, such as Omicron, remain susceptible to T-cell mediated immunity. Susceptibility of Omicron to T-cell immunity means that vaccinated populations are likely to be protected from severe disease, hospitalization, and death despite a drop in neutralizing antibody titers. Vaccination remains the best tool to defend against severe outcomes, and it is becoming increasingly clear that natural immunity from prior infection alone is not sufficient for protection. Unvaccinated populations in the US are 20 times more likely to die from COVID-19 than fully vaccinated populations. 

GLOBAL ECONOMIC GROWTH SLOWDOWN The quick rise of the SARS-CoV-2 Omicron variant of concern (VOC), as well as the threat of other potential variants, is helping to fuel a global economic slowdown, endangering economic recovery in emerging and developing economies, scaling back progress on reducing poverty, and disrupting social cohesion and global cooperation, according to 2 reports released this week. The World Bank’s latest Global Economic Prospects report predicts the pandemic will continue to disrupt economic activity in the near term, causing a deceleration in global growth from 5.5% in 2021 to 4.1% in 2022 and 3.2% in 2023. Notably, growth in emerging and developing countries is expected to drop from 6.3% in 2021 to 4.4% in 2023, at an output level 4% below the pre-pandemic trend. President of the World Bank Group David Malpass said more international action and national-level policy responses are needed to address the pandemic, inflation, inequality, security challenges, and general uncertainty. The report highlights prioritizing vaccine equity and alleviating vaccine deployment bottlenecks in low- and middle-income countries as one way to bring the pandemic under control. 

The World Economic Forum’s (WEF) Global Risks Report 2021 also warns that the pandemic and vaccine inequality are causing lost opportunities for large parts of the global population—including job losses, a widening digital divide, and shifts in markets—that will result in social unrest, political fragmentation, and geopolitical tensions impacting how the global community responds to other key economic threats such as cyberattacks, space exploitation, weapons of mass destruction, and, “most notably,” climate change. Of about 1,000 global experts and leaders from academia, business, civil society, government and other organizations surveyed in the WEF’s Global Risks Perception Survey (GRPS), more than 84% are worried or concerned about the global outlook. Vaccine inequality is driving growing gaps in economic recovery—a “global divergence”—which threatens to compound pre-existing social cleavages and geopolitical tensions. The WEF said policymakers must prepare for the next pandemic now and outlined 4 governance opportunities to improve overall resilience, including taking a holistic and systems-based approach to risk impacts; investing in “risk champions” to encourage national and international action; improving risk communications and combating misinformation; and exploring new forms of public-private partnership. 

SCHOOL IMPACTS As many schools worldwide reopen to in-person learning, some scientists, public health experts, and teachers are wondering why more mitigation measures—including vaccination, masking, regular testing, contact tracing, improved ventilation, desk-spacing, outdoor area use, and handwashing—are not in place. In the US, COVID-19 cases among school-aged children are increasing exponentially, according to the American Academy of Pediatrics. Pediatric hospitalizations are at the highest rate in the pandemic; the vaccination rate among 5- to 11-year-olds remains low, just over 17%; and children under age 5 remain ineligible for any SARS-CoV-2 vaccine and likely will remain so for at least a few more months. With teachers’ unions and local governments at odds over returning to in-person instruction in some districts, including Chicago, students are organizing to have their voices heard. In Massachusetts, an online petition has gained nearly 6,000 signatures in favor of a remote learning option, and students in New York and Michigan walked out of classrooms in protest over their schools’ COVID-19 policies. The Biden administration on January 12 announced it will increase the number of SARS-CoV-2 tests available to schools by 10 million per month*, in addition to other testing capacities, which they hope will help schools operate safely.   

In France today, members of 11 educator unions took part in a walkout in protest over pandemic work conditions, forcing the closure of schools and classrooms nationwide. France is in the midst of a record-breaking surge in Omicron cases, and government changes to school rules have caused a “mess,” teachers say. In Uganda, students this week celebrated the reopening of schools after being closed nearly 2 years because of COVID-19. However, not all students celebrated. Officials warned at least 30% and as much as 50% of students may never return, with those from low-income and rural families impacted the most. Some students instead began working, while others became pregnant or married early. Many cannot afford tuition fees for high school. Some educational experts feel an entire generation of learners may have been lost during the pandemic, though others disagree. Additionally, some teachers could not go without pay and found other employment, and thousands of schools, both public and private, are likely to remain closed permanently. COVID-19 school closures and other indirect damage in several African nations have hit young women harder than men, and the extent is difficult to measure. But the pandemic likely has set girls’ progress back, leaving questions about whether recovery is possible.
*The administration intends to send 5 million rapid tests and 5 million lab-based PCR tests to schools per month at no cost. 

US LAW ENFORCEMENT For the second year in a row, COVID-19 was the leading cause of death among US law enforcement officers. According to preliminary data from the National Law Enforcement Officers Memorial Fund, 458 local, state, tribal, and federal officers died in the line of duty in 2021, a 55% increase over 2020 and the highest total since 1930. Of those deaths, 301 were related to COVID-19, with the virus reportedly contracted in the line of duty. Some law enforcement and police unions have pushed back against local government regulations requiring vaccines for workers, threatening resignations and legal action. A federal judge this week dismissed a lawsuit brought by Los Angeles police officers challenging the city’s SARS-CoV-2 vaccination and testing mandate, saying the rule did not violate their constitutional rights.