Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

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The Johns Hopkins Center for Health Security also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.
The Johns Hopkins Center for Health Security produces weekly updates on SARS-CoV-2 vaccine development, policy, and public perception in the US. This is a resource from CommuniVax, a research coalition convened by the Johns Hopkins Center for Health Security and the Texas State University Department of Anthropology, with support from the Chan Zuckerberg Initiative. You can access them here.
EPI UPDATE The WHO COVID-19 Dashboard reports 93.96 million cases and 2.03 million deaths as of 4am EST on January 15. The global cumulative mortality surpassed 2 million deaths on January 19:
1 death to 250k: 115 days
250k to 500k: 56 days
500k to 750k: 46 days
750k to 1 million: 45 days
1 to 1.25 million: 40 days
1.25 to 1.5 million: 26 days
1.5 to 1.75 million: 23 days
1.75 to 2 million: 20 days

The global weekly incidence decreased for the first time since the week of November 23*. The weekly total of 4.73 million new cases is approximately equal to the week preceding the holidays (4.65 million). Global mortality continues to increase, however, up to 93,882 new deaths, a new record high and an 8.7% increase compared to the previous week.
*Excluding the last 2 weeks of 2020, which are affected by holiday reporting delays.

Our World in Data reports that 41.39 million vaccine doses have been administered globally. 

The US CDC reported 23.65 million total cases and 394,495 deaths*. The US is averaging more than 220,000 new cases per day. At this pace, the US could surpass 25 million cumulative cases within the next week. The US could potentially surpass 400,000 cumulative deaths this afternoon—which would include deaths reported on both January 17 and 18.
*The US CDC did not update data on January 18 due to the Martin Luther King, Jr. Day holiday in the US. These figures correspond to the data published on January 17.

COVID-19 incidence in the US has declined steadily since January 11, down from 248,367 new cases per day to 221,692, a decrease of nearly 11%. In light of interrupted reporting over the recent holidays, it is difficult to accurately determine the longer-term trend in COVID-19 data. If the US daily incidence is plateauing or peaking, the exact timing of this transition is unclear. The current daily incidence is approximately equal to immediately prior to the Christmas holiday weekend. It is likely that reporting will be delayed to some degree by the Martin Luther King, Jr. Day holiday weekend, but data from this week and next will hopefully provide a better picture of the current US trend. COVID-19 mortality remains high, at 3,344 deaths per day, approximately equal to the record high of 3,357 reported on January 13.

In addition to decreasing daily incidence and initial indications that mortality could be leveling off, current COVID-19 hospitalizations in the US appear to have passed a peak. As we have covered previously, current hospitalizations tend to be more resilient to holiday-related reporting delays than incidence and mortality, so a decreasing trend can provide additional confidence that the US could be passing its third peak. In addition to current hospitalizations, the CDC reported steady decreases in the percentage of emergency department (ED) visits for COVID-19 or COVID-like illness (CLI) since early January, down from a peak of 8.5% on January 3 to 5.8% on January 14. This could be a result of decreased COVID-19 activity or increases in patients seeking care for other conditions.

Based on data published by the COVID Tracking Project, the declines in COVID-19 hospitalizations are evident in all 4 US regions. The Midwest region peaked in late November/early December, and other 3 regions have peaked since the New Year. On a per capita basis, states on the East and West Coasts and in the South are generally reporting more hospitalizations than in the Midwest, Pacific Northwest, and New England. Overall, only 1 US state, North Dakota, is reporting increased COVID-19 hospitalizations over the past 2 weeks, compared to 33 states holding steady (-10% to +10%) and 17 states reporting decreases.

The COVID Exit Strategy website lists 8 states as Severely Constrained in terms of ICU bed availability: New Mexico (96%), Alabama (90%), Georgia (90%), Nevada (89%), Oklahoma (89%), Rhode Island (88%), Mississippi (87%), and California (85%). As with the data described above, these states are generally located on the East and West Coasts and the South. With respect to total hospital beds, no states are listed as Severely Constrained, and only 1 state is listed as Constrained: Rhode Island (89%). Notably, 20 states are listed as Normal for ICU beds, and 25 are Normal for overall hospital beds.

The US CDC reported 31.16 million vaccine doses distributed and 12.28 million doses administered (39.4%), as of January 15. This includes 1.38 million administered in long-term care facilities. In total, 10.60 million people have received at least 1 dose of the vaccine, and 1.61 million have received both doses. In total, 7.15 million doses of the Pfizer/BioNTech vaccine and 5.12 million doses of the Moderna vaccine have been administered nationwide.

The Johns Hopkins CSSE dashboard reported 24.14 million US cases and 399,828 deaths as of 1:30pm EST on January 19.

EMERGING VARIANTS Several SARS-CoV-2 variants with evidence of increased transmissibility continue to raise alarms as they are identified in more countries. Viruses continually mutate, and the SARS-CoV-2 virus has evolved throughout the pandemic. The specific mutations in the recently identified variants of concern—including B.1.1.7, B.1.351, and P.1—are being investigated for increased transmissibility and potentially immune escape.

Researchers from the US CDC COVID-19 Response Team projected that the B.1.1.7 variant would contribute to a rapid growth in cases in the US early in 2021. The B.1.1.7 has been identified in 122 cases in 20 US states, including California and Florida with at least 40 reported cases each. CDC officials projected that the B.1.1.7 variant is likely to become the dominant variant in the US. In order to avoid uncontrolled spread of this variant, health experts encourage individuals to recommit to recommended control measures such as mask wearing, physical distancing, and enhanced hygiene. The CDC also indicated that rapid vaccination, at the level of 1 million doses administered per day, could dramatically decrease spread of COVID-19, including the B.1.1.7 variant. 

ETHICAL VACCINE DISTRIBUTION On Monday, WHO Director-General Dr. Tedros Adhanom Ghebreyesus addressed historical inequities in vaccine access and outlined the importance of avoiding such inequities in the context of COVID-19, warning of a “catastrophic moral failure” if SARS-CoV-2 vaccines are not allocated equitably. For example, low- and middle-income countries (LMICs) received vaccines after wealthier countries during the 2009 H1N1 influenza pandemic. And during the COVID-19 pandemic, these countries are once again in line behind high-income countries that were able to arrange the purchase of vaccines directly from manufacturers.

While approximately 39 million doses have been administered across 49 higher-income countries, one “lowest-income country” has been able to administer only 25 total doses. This stark difference underscores the need for the global community to meet its commitments to equitable and ethical distribution of vaccines to ensure the most vulnerable are protected. The WHO COVAX initiative has received numerous pledges to supply vaccine doses for global distribution, but few countries have delivered on those pledges thus far. Further, countries that have made individual agreements with vaccine manufacturers, ostensibly moving their populations higher in the distribution order, are driving up prices and making it more difficult for LMICs to afford the vaccines.

EUROPE VACCINE SUPPLY Pfizer issued a statement on January 15 indicating that it will temporarily decrease the supply of SARS-CoV-2 vaccine to countries in Europe. According to the statement, the reduced supply is part of an effort to scale up production in European facilities. For example, updates to a facility in Belgium are expected to slow production through January 25, but production capacity is expected to increase starting in mid-February. Despite the short-term delays, Pfizer expects to meet its first-quarter commitments and increase its delivery for the second quarter. Reportedly, the announcement was a surprise to some European countries, and several called on EU leadership to pressure Pfizer to meet its original delivery timeline. Reportedly, the production delay could also potentially affect deliveries to Canada, but efforts are underway to mitigate the delays.

US VACCINE DISTRIBUTION Last week, the federal government announced that it was updating its SARS-CoV-2 vaccine distribution plan to release the remaining reserve inventory—as opposed to the previous plan that maintained a stockpile to ensure availability for the second dose. The announcement was initially met with optimism that state allocations would increase as the US government released the reserved doses; however, multiple news media outlets reported that the federal government actually had relatively few doses in its inventory to distribute to states. The reports were based on statements from senior government officials, including Secretary of Health and Human Services Alex Azar, that the US government did not have any remaining stockpiled vaccines and that it had started distributing the reserved doses in late December, more than a week before the announcement.

Reportedly, some states accelerated plans to expand vaccine eligibility following the announcement, in anticipation of increased supply from the federal government. Notably, Secretary Azar’s announcement that the federal government would release the reserve doses was accompanied by guidance to expand eligibility to all adults aged 65 and older, but without an associated increase in supply, progress in vaccinating such a large portion of the population will proceed slowly.

Pfizer issued a statement indicating that it continues to ship vaccine doses as directed by the US government and that it has “millions more doses sitting in [its] warehouse” awaiting direction from federal officials.

In response to limited vaccine supply from the federal government, New York Governor Andrew Cuomo issued a letter to the Chairman and CEO of Pfizer, Dr. Albert Bourla, requesting to purchase vaccine doses directly from the company. According to the letter, Pfizer does not have any agreement with Operation Warp Speed that would prohibit it from contracting directly with purchasers outside the federal government, but a spokesperson from Pfizer reportedly indicated that it would require authorization from the Department of Health and Human Services to enter into such an agreement. According to CDC data, New York State* has received 9,686 doses per 100,000 population, putting it #15 among US states, and it is #4 in terms of the total number of distributed doses. New York has administered 757,466 of its 1.88 million doses (40%). If New York were to purchase doses directly from Pfizer, it is unclear whether the state would be able to receive any vaccine ahead of Pfizer’s existing contracts, including with the US and other countries.
*Unlike much of the CDC’s COVID-19 data, New York City is not listed separately for vaccine reporting.

IVERMECTIN Ivermectin, an antiparasitic drug with antiviral properties, has shown promise during in vitro studies by inhibiting replication of SARS-CoV-2 in very small concentrations. Observational studies, case series reports, and ecological analyses have also supported this finding. Today, EClinicalMedicine (published by The Lancet) published the first pilot clinical trial testing ivermectin as a treatment of COVID-19. The study used a double-blinded, placebo-controlled design to evaluate ivermectin’s ability to treat COVID-19 disease or mitigate transmission risk. The study included 24 patients, with half (12) receiving a single dose of 400 mcg/kg of ivermectin and the other half (12) receiving a placebo. The treatment was administered within 72 hours of developing a fever or cough. The researchers collected clinical data and nasopharyngeal swabs on Days 4, 7, 14, and 21 post-treatment to assess detectable SARS-CoV-2 RNA by PCR, viral load, symptom severity, and seroconversion. The treatment group had lower viral loads at Days 4 and 7 and lower IgG titers at day 21, but these differences were not statistically significant. Patients in the did have a statistically significant improvement in the time to recover from hyposmia/anosmia—76 patient-days in the treatment group compared to 158 patient-days in the control group.

NORWAY DEATHS Norwegian health authorities are currently investigating the deaths of 23 elderly individuals who received the Pfizer/BioNTech SARS-CoV-2 vaccine to determine if adverse reactions to vaccination could have contributed to the patients’ mortality. The Norwegian Medicines Agency (NOMA) has investigated 13 of the deaths, concluding that some of the common adverse reactions to the vaccine—including fever, nausea, and diarrhea—could have contributed to the deaths. The Paul Ehrlich Institute is investigating 10 deaths reported in individuals who recently received the SARS-CoV-2 vaccine.

Dr. Steinar Madsen, Medical Director for NOMA, told BMJ that there is no certain connection between the vaccine and the patients’ deaths, but it could be possible that common adverse events that are generally mild in younger, healthier individuals could aggravate pre-existing conditions among older, medically frail individuals. The Norwegian Adverse Drug Reaction (ADR) Registry is continually monitoring adverse events related to SARS-CoV-2 vaccination and publishes public weekly reports. The most recent report (January 14) notes that an average of 45 patients in long-term care facilities die each day, and a statement about the deaths indicates that 400 people per week die at long-term care facilities. It is not unexpected that some individuals who get vaccinated will die of unrelated health conditions, and at this point, there is no evidence pointing to a significant increase in the number of deaths following vaccination in Norway.

In response to the reported deaths, The Norwegian Institute of Public Health updated its SARS-CoV-2 vaccination guidance to ask healthcare providers to weigh the risks of potential adverse reactions against the benefits of vaccination when considering vaccination for elderly, medically frail individuals. Norway continues to prioritize long-term care facility residents for vaccination due to their elevated risk of infection and severe disease.