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 produces US Travel Industry and Retail Supply Chain Updates. 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 99.36 million cases and 2.14 million deaths as of 11am EST on January 26. The WHO reported decreasing global incidence for the second consecutive week, down to 4.10 million new cases last week, a 15.2% decrease from the previous week. But even with the recent decline, the average global daily incidence exceeds 575,000 new cases per day. At this pace, we expect the global cumulative incidence to surpass 100 million cases in the next 2 days. While daily incidence is decreasing, mortality continues to increase. The WHO reported 95,991 deaths last week, a new record and an increase of slightly more than 1% compared to the previous week.

Our World in Data reports that 55.58 million vaccine doses have been administered globally. 

The US CDC reported 25.02 million total cases and 417,936 deaths. The US surpassed 25 million cumulative cases in yesterday’s update.
1 case to 5 million cases- 200 days
5 million to 10 million- 92 days
10 million to 15 million- 29 days
15 million to 20 million- 24 days
20 million to 25 million- 23 days

It is becoming more clear that the US has passed a peak in terms of daily incidence, and the current average is less than what it was prior to the Thanksgiving holiday weekend. In light of fluctuations in reporting over the winter holidays, it is difficult to determine when the daily incidence actually peaked; however, the peak in terms of reported incidence was 248,706 new cases per day on January 8. In addition to daily incidence, we are beginning to observe an associated decrease in hospitalizations at the national level.

This trend is evident at the regional and state levels as well. All 4 regions have reported decreasing daily incidence since approximately January 8-10, including a further decrease in the Midwest, which has reported a steady decline in daily incidence since mid-to-late November. According to data from the COVID Exit Strategy website, 28 states are reporting decreasing daily incidence over the past 2 weeks, including nearly every state stretching from the Midwest to the Pacific Northwest as well as several states in the South, Mid-Atlantic, and Northeast. According to data from The COVID Tracking Project, 45 states (plus Washington, DC) are reporting decreasing daily incidence over the past week, and 5 are holding steady (-10% to +10%). In fact, only Tennessee is reporting increased incidence over the past week, but at +7%, it still falls under the category of “Staying the Same.” Similarly, hospitalizations are decreasing in all 4 regions. Additionally, 33 states are reporting decreasing hospitalizations over the past week, and 15 (plus Washington, DC) are reporting steady hospitalizations (-10% to +10%)—compared to only 2 states reporting increases.

Looking at mortality at the regional level, COVID-19 deaths continue to decrease steadily in the Midwest, and the Northeast region appears to have recently passed a peak. The South and West regions may be at or approaching their own peaks, but holiday-related delays in reporting make it difficult to determine the longer-term trend in these regions. At the state level, 21 states (plus Washington, DC) are reporting decreasing daily mortality over the past week, compared to 11 with increasing mortality and 18 holding relatively steady (-10% to +10%).

The US has now administered more than half of the distributed vaccine doses. The US CDC reported 41.42 million vaccine doses distributed and 22.73 million doses administered (54.9%%), including 2.71 million administered in long-term care facilities (LTCFs). In total, 19.25 million people have received at least 1 dose of the vaccine, and 3.35 million have received both doses. The US is now averaging 1.13 million doses administered per day, an increase of 35% compared to this time last week. The breakdown of doses by manufacturer remains relatively even, with slightly more Pfizer/BioNTech doses administered (12.55 million; 55%) than Moderna (10.08 million; 45%).

The Johns Hopkins CSSE dashboard reported 25.34 million US cases and 422,583 deaths as of 1:30pm EST on January 26.

EMERGING VARIANTS & MORTALITY New evidence indicates the B.1.1.7 variant of concern (VOC) may be associated with increased mortality compared to other strains of SARS-CoV-2. At a press conference this week, Sir Patrick Vallance, the UK’s Government Chief Scientific Advisor, said that infection with the new variant may be associated with an increased risk of death, in addition to its increased transmissibility. He noted that the mortality risk could be on the order of 30-40% higher for some individuals, but he also said that further analysis is needed to better characterize this relationship. Analysis published by the UK’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) found that that mortality risk was significantly higher in individuals infected with the B.1.1.7 variant across multiple age groups, with increases ranging from 29% to 91% in multiple studies.

In response to the potential for increased mortality, UK Prime Minister Boris Johnson called for redoubled vigilance and adherence to COVID-19 prevention measures in order to protect the capacity of national healthcare system. Fortunately, current vaccine candidates still appear to be effective against the variant. The UK government will continue to drive toward its goal of vaccinating 15 million people by mid-February in order to protect the most vulnerable against infection by any variant of SARS-CoV-2. 

In the US, Dr. Anthony Fauci acknowledged the NERVTAG results as highly concerning and in need of further study in the coming weeks. He emphasized that current vaccines still appear to be effective against existing VOCs, but adjustments can and will be made as needed. Dr. Fauci did note that monoclonal antibody treatments did appear to be significantly less effective against some VOCs compared to reference strains.

VACCINE DEVELOPMENT & EFFICACY On January 25, Merck announced that it “is discontinuing development of its SARS-CoV-2/COVID-19 vaccine candidates” as a result of poor performance during Phase 1 clinical trials. While Merck’s 2 candidates were well tolerated from a safety perspective, the immune response generated in the study participants was “inferior to those seen following natural infection and...for other SARS-CoV-2/COVID-19 vaccines.” The Merck vaccines were highly anticipated, as they used viral platforms that could replicate in the human body, which had the potential to confer longer-lasting immunity with a single dose.

Despite having already received authorization for the use of its SARS-CoV-2 vaccine in multiple countries, Moderna is already developing a booster to better protect against emerging variants. On January 25, Moderna announced preliminary results from a study assessing the current vaccine’s efficacy against emerging variants, including B.1.1.7 and B.1.351. Compared to reference strains, the vaccine did not exhibit any decrease in neutralizing antibody titers against the B.1.1.7 variant. Conversely, the vaccine exhibited a 6-fold reduction in neutralizing antibodies effective against the B.1.351 variant, which could indicate a lesser degree of protection or faster waning of immunity. A press release from the company indicated that while the immune response was lower, the vaccine did offer some protection. Considering that the immune response from the vaccine appears to be stronger than from natural infection, a moderate decrease in efficacy could still provide a meaningful degree of protection. In response to the concerning results, Moderna announced that it is in the process of developing a new booster that is tailored to provide increased protection against the B.1.351 variant. Additionally, Moderna is testing the effect of a second booster dose of the existing vaccine to determine any additional benefit in terms of protection against the B.1.351 variant. Considering that Moderna’s existing vaccine is already authorized for use in multiple countries, it is unclear what the regulatory review process would look like for a new booster or an additional booster dose.

AUSTRALIA VACCINE AUTHORIZATION On January 25, the Australian Therapeutic Goods Administration granted provisional authorization for the use of the Pfizer/BioNTech vaccine candidate. The provisional approval applies for use in individuals aged 16 years and older, and vaccinations are expected to begin in February. Australian Prime Minister Scott Morrison emphasized that the provisional approval is different from an emergency authorization and requires a more comprehensive review of the vaccine’s safety and efficacy, among the first such effort globally. The vaccine will be provided for free to all Australian citizens. According to the National Rollout Strategy, as many as 1.4 million doses will be distributed to “1a” priority groups, which include healthcare workers, long-term care facility staff and residents, and border and quarantine workers. The vaccine will initially be delivered to 50 priority vaccination sites during Phase 1a and then expanded to more than 1,000 sites nationwide. The initial vaccine hubs are concentrated in coastal areas, where the majority of the population resides. Few of the initial sites are located in Australia’s interior where many aboriginal communities reside. Australian authorities must set up cold storage facilities and train vaccinators in advance of beginning Phase 1a, and each batch will be tested before doses are administered.

VACCINE DONATIONS India has pledged to donate more than 4.5 million doses of the AstraZeneca vaccine, manufactured in India by the Serum Institute, to several neighboring countries. Deliveries have reportedly already arrived in Bangladesh, Bhutan, Maldives, Mauritius, Nepal, and Seychelles, and additional donations are expected for Afghanistan and Sri Lanka. India has already stockpiled 80 million doses of the AstraZeneca vaccine, and it is expected to manufacture an additional 50 million doses per month. In addition to India, China has donated vaccine to numerous countries, including Myanmar, Cambodia, Philippines, and Pakistan. Commentators have noted that these donations may be a strategic form of diplomacy that aims, in part, to increase political influence in the region and improve bilateral relations. In addition to donations, both India and China have also sold doses of vaccine to global partners. 

US TRAVEL RESTRICTIONS Yesterday, US President Joe Biden issued travel restrictions for several countries that are currently experiencing increased COVID-19 incidence, including several emerging variants of SARS-CoV-2. The restrictions apply to individuals who traveled to Brazil, Ireland, South Africa, the UK, or any country in the EU (Schengen Area) in the 14 days prior to their arrival in the US. The restrictions existed previously for Brazil, Ireland, the UK, and the EU, but South Africa is new to the list. The presidential proclamation took effect today. Dr. Anthony Fauci described the restrictions as “very prudent,” particularly as new evidence indicates that these emerging variants may be associated with increased mortality risk. Exceptions to the new policy include US citizens, permanent residents, noncitizen nationals, certain immediate family members of permanent residents or citizens, individuals who fall under exceptions related to US national interests and individuals seeking asylum.

MEXICAN PRESIDENT On Sunday, Mexican President Andrés Manuel López Obrador announced that he tested positive for SARS-CoV-2. President Obrador described his symptoms as “mild,” but he is currently undergoing medical treatment. President Obrador will continue to isolate at home, and he has handed off responsibility for daily news conferences to Mexico’s Secretary of the Interior, Olga Sánchez Cordero. President Obrador had not yet been vaccinated against SARS-CoV-2.

RESTRICTIONS & PROTESTS For the past several days in the Netherlands, protests against stronger COVID-19 restrictions have turned violent. The Dutch government implemented new ”lockdown measures” on January 23, including a nighttime curfew from 8:30pm-4:30am, a travel advisory discouraging any travel out of the country, and a limit of 1 visitor per household per day. The curfew, in particular, drew opposition from the public. As we covered previously, the last time that the Netherlands implemented a nationwide curfew was during World War II. The large public protests turned violent on Sunday the 24, reportedly including a fire at a SARS-CoV-2 testing center. Since then, hundreds of protestors have been arrested, and several cities have imposed ordinances against entering the city center in order to suppress further riots. Prime Minister Mark Rutte condemned the riots, describing the events as instances of criminal violence rather than protests. The curfew and other new measures are scheduled to remain in place through February 9. 

ECONOMIC IMPACT & RECOVERY A report published this week by Oxfam International illustrates significant disparities in terms of the financial impact of the COVID-19 pandemic. The report—released to coincide with the annual World Economic Forum summit typically held in Davos, Switzerland—indicates that the “mega-rich” have already recovered financially from the pandemic, whereas the world’s poorest could take years or longer. Notably, the research suggests that COVID-19 could exacerbate economic inequalities in nearly every country on Earth. The 1,000 wealthiest people in the world, “mostly White male[s],” took approximately 9 months to recuperate financial losses, but those living in poverty are expected to take more than a decade to recover. The analysis also estimates that “the increase in the 10 richest billionaires’ wealth since the crisis began [more than US$500 billion] is more than enough to prevent anyone on Earth from falling into poverty because of the virus, and to pay for a COVID-19 vaccine for everyone.” Notably, women and racial and ethnic minorities are disproportionately affected by the global economic crisis. In addition to shorter-term and immediate financial struggles, many people around the world will face prolonged financial hardship stemming from the pandemic, compounding economic inequalities around the world.