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.
From the Center: Call for Papers—Special Feature on Climate Change and Health Security: Health Security will devote a special feature to climate change and its impact upon national and global health security. We encourage submissions of original research articles, case studies, and commentaries, on topics including climate change-related public health emergencies; public health emergency management and climate change; displacement of populations and the health impact of climate change, and more. All manuscripts should be submitted for consideration by March 21, 2022. Learn more here:
EPI UPDATE The WHO COVID-19 Dashboard reports 357 million cumulative cases and 5.61 million deaths worldwide as of January 26. Global weekly incidence increased again last week, up 11.03% over the previous week. This is the 14th consecutive week of increasing weekly incidence, setting another new record with 22.77 million new cases. The Omicron variant drove the greatest percentage increases in the WHO regions of Eastern Mediterranean (+38.58%), South-East Asia (+36.05%), Europe (+19.29%), and the Western Pacific (+1.26%). Both Africa (-31.04%) and the Americas (-2.01%) experienced declines in weekly incidence. 

While there is optimism among some public health experts that the rapid rise and fall of the Omicron surge in some regions could usher in an end to the pandemic, the WHO determined last week that the COVID-19 pandemic continues to constitute a Public Health Emergency of International Concern (PHEIC). Other experts warn that as long as the threat of new variants exists, calls for reaching COVID-19 endemicity are misguided.

Meanwhile, global weekly mortality increased for the third week, up 8.49% from the previous week with 53,935 total deaths. The Pan American Health Organization (PAHO) on January 26 warned that the average number of COVID-19-related deaths is up 37% in the region over the previous week.

Global Vaccination
The WHO reported 9.68 billion cumulative doses of SARS-CoV-2 vaccines administered globally as of January 26. A total of 4.7 billion individuals have received at least 1 dose, and 4.0 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations continues to decrease, down to 25.08 million on January 26 from a recent high of 38.88 million on December 23.* Our World in Data estimates that there are 4.78 billion vaccinated individuals worldwide (1+ dose; 60.79% of the global population) and 4.12 billion who are fully vaccinated (52.3% 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 72.3 million cumulative cases of COVID-19 and 870,195 deaths. The US is averaging 627,294 new cases—down from 726,941 on January 20—and 2,246 deaths per day—up from 1,860 one week ago and at the highest level since mid-February 2021.* 
*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 are down 7.7% this week over last, with a 7-day average of 19,640 new hospitalizations per day. The recent surge in current hospitalizations appears to have peaked around January 19, down 1.7% to an average of 142,194 for the week ending January 24. According to analysis from The New York Times, the overall downward trend in hospitalizations belies the reality in some regions, where the number of cases and hospitalizations continue to grow significantly. 

US Vaccination
The US has administered 537.2 million cumulative doses of SARS-CoV-2 vaccines. The trend in daily vaccinations continues to decline, down significantly from a recent high of 1.77 million doses per day on December 6 to 760,975 on January 21.* 

A total of 251.5 million individuals have received at least 1 vaccine dose, equivalent to 75.8% of the entire US population. Among adults, 87.6% have received at least 1 dose, as well as 25.3 million children under the age of 18. A total of 210.9 million individuals are fully vaccinated**, which corresponds to 63.5% of the total population. Approximately 73.9% of adults are fully vaccinated, as well as 19.9 million children under the age of 18. Since August 13, 85.2 million fully vaccinated individuals have received an additional or booster dose. An estimated 43.5% of fully vaccinated individuals have received a booster, including 63.3% 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 VACCINE GAP US officials announced on January 26 that the government has shipped a total of 400 million SARS-CoV-2 vaccine doses to 112 countries, part of its efforts to fulfill its pledge to donate 1.2 billion doses. At a briefing, White House COVID-19 Coordinator Jeff Zients noted that the US has donated 4 times more doses than any other country. Still, 5 billion to 6 billion doses are needed in low- and middle-income countries to help protect them against COVID-19, and vaccine access gaps in those areas create fertile grounds for the emergence of new, possibly more dangerous, SARS-CoV-2 variants, the WHO has warned. The divide is stark: about 78% of people in high- and upper-middle-income countries have received at least one dose of vaccine compared with about 10% in low-income nations. According to calculations from the International Monetary Fund (IMF), 86 of 206 countries had immunized less than 40% of their populations as of the end of 2021, far from the fund’s goal of vaccinating 70% of the world’s population in the first half of this year. Experts agree that vaccine inequities led to the emergence of the Omicron variant and warn of future variants if a concerted global effort is not undertaken to manufacture, distribute, and administer more vaccines to prevent the virus from circulating among the unvaccinated. A group of Democratic US lawmakers is calling for the government to immediately provide an additional US$17 billion for global vaccination delivery and infrastructure and to streamline federal efforts to coordinate the nation’s global COVID-19 strategy. Some experts say additional funding could be useful but drumming up international political will is more important. Others warn the next variant—if it is capable of immune evasion—could be like starting from scratch.

US HEALTHCARE UTILIZATION The Omicron variant of concern (VOC) has caused massive surges in COVID-19 cases and, subsequently, in people seeking healthcare. A recent study published in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) examined hospital-associated disease severity markers, including ICU admissions, length of stay, and death. The study found that disease severity, measured by US healthcare utilization, appeared to be lower during the Omicron VOC surge compared to both the Delta VOC surge and the previous winter season. ICU admissions during the beginning of the Omicron surge were 26% lower and 29% lower than during the Delta and winter 2020-2021 surges, respectively. Mean length of hospital stay was also comparatively lower. However, due to the massive number of positive cases, overall staffed hospital bed usage was 7% higher than during Delta and 3% higher than during winter 2020-2021.

The study was not able to directly assess the impact that vaccines had on disease severity markers or hospital stay lengths, but the authors posit that decreased admissions to the ICU and lower overall hospital stays during the Omicron surge can likely be attributed to higher vaccine coverage as well as higher levels of infection-acquired immunity. Supporting this hypothesis, high relative increases in hospital admittance were only observed in children 0- to 4-years-old who are currently not eligible for vaccination. Although people infected with Omicron appeared to require less intensive care at the hospital level, the sheer number of cases and burden on the healthcare system overall required significant resources and resulted in severe strain. The authors state that this analysis “underscores the importance of national emergency preparedness, specifically, hospital surge capacity and the ability to adequately staff local health care systems.”

HEALTHCARE WORKER BURNOUT As the world enters its third year of response to the COVID-19 pandemic, burnout in the global healthcare workforce continues to grow. In the US, a rapid increase in the number of COVID-19 cases due to the Omicron variant of concern (VOC) has led to a record surge of individuals requiring medical attention across healthcare settings. In California, hospitals have canceled operations and other elective procedures and ambulances have experienced backlogs for patient delivery. Healthcare professionals warn that the continued high intensity of care, a limited amount of life-saving countermeasures, and a large number of staff out sick are creating a continuously stressful work environment. Notably, the country has experienced a mass exodus of healthcare workers. In the Southern US, this trend has hit nonprofit safety-net hospitals particularly hard, reducing the capacity of necessary resources for many throughout the region. Earlier this year, the US Department of Health and Human Services (HHS) announced that US$103 million of funding from the American Rescue Plan will be committed to strengthening resilience and addressing burnout in the domestic healthcare workforce. However, STAT reports that another fund meant to support hospitals and clinics during the pandemic has run out of money, after the Biden administration quietly redirected nearly US$7 billion from the fund and used it to buy SARS-CoV-2 vaccines and therapeutics.

Workforce mental health issues are not exclusive to the US. Researchers in Canada analyzed anonymous data from 34,000 physicians working in Ontario. The analysis found a 27% increase in the number of doctors seeking care for burnout or substance misuse in the first year of the pandemic compared with the prior year. Burnout of nurses and other healthcare professionals is a universal issue and has led to wealthier countries recruiting healthcare workers from other less-wealthy countries. This phenomenon has intensified during the Omicron surge, raising many questions about the ethics of the practice. 

US VACCINE REQUIREMENTS FOR LARGE EMPLOYERS The US Department of Labor’s Occupational Safety and Health Administration (OSHA) on January 25 withdrew its emergency temporary standard (ETS) that called for employers with 100 or more workers to require their employees to be vaccinated for COVID-19 or undergo regular testing and wear face masks while at work. The withdrawal, which took effect January 26, follows the US Supreme Court’s January 13 opinion that halted enforcement of the rule. In a 6 to 3 decision, the justices concluded that OSHA overstepped its authority in issuing the requirement covering 84 million workers and issued a stay pending a decision from the US Court of Appeals for the Sixth Circuit. Though OSHA withdrew the requirement as an enforceable emergency regulation, the agency said it is maintaining the ETS as a proposed rule. On its website, OSHA stated it is “prioritizing its resources to focus on finalizing a permanent Healthcare Standard” and that it continues to “strongly encourage” workers to be vaccinated.

ISRAEL Israel’s Ministry of Health on January 25 said its vaccine advisory panel has recommended making all adults eligible to receive a fourth dose of SARS-CoV-2 vaccine. If the ministry approves the recommendation, it would be the first country in the world to make a fourth vaccine dose available to all adults. Israel already offers fourth doses to people aged 60 and older, healthcare workers, and people with compromised immune systems. About 600,000 Israelis have already received a fourth dose. Over the weekend, the health ministry shared preliminary data from its own researchers suggesting a fourth dose provides 3 to 5 times as much protection against severe disease in older adults when compared with those in the same age group who had received a booster dose at least 4 months prior. It is not clear when the ministry’s director-general will decide on the panel’s recommendation. Israel is in the midst of a surge in new COVID-19 cases driven by the Omicron variant.

POST-ACUTE SEQUELAE Researchers continue work to learn more about the clinical presentation and duration of persistent symptoms of SARS-CoV-2 infection, known as post-acute sequelae of COVID-19 (PASC) or “long COVID.” Prevalence of the condition—which is characterized by fatigue, shortness of breath, brain fog, stress and anxiety, and other symptoms that last for weeks or years after acute infection—is unknown but estimated to be between 7% to 80% of recovered patients. A study published this week in Cell suggests an association between the development of long COVID and 4 factors, including the presence of certain autoantibodies that mistakenly turn on the body’s own tissues, reactivation of previous Epstein-Barr virus infection, viral load levels in early infection, and having Type 2 diabetes. Because 2 of the factors are virus levels in the blood, the researchers speculate that antiviral administration early in SARS-CoV-2 infection might help lower the risk of longer-lasting symptoms in some people. However, authorized antivirals in the US are in very short supply and difficult to obtain. Additionally, preliminary data from Israel and the UK suggest that people who were fully vaccinated when infected were much less likely to report long COVID symptoms than people who were unvaccinated when infected. Other studies are looking at ways to predict who might be at risk of long COVID and underlying causes of the condition

In the US, 2 Democratic lawmakers this week sent a letter to the US CDC requesting the agency release data on the number of Americans with long COVID, including information on race, gender, and age. The lawmakers, healthcare providers, and experts nationwide say more data are needed on how many people suffer from long-term symptoms in order to better target resources and provide a more equitable recovery from the pandemic. A recent article published in Nature Medicine examined inequities in understanding and addressing neurological complications of COVID-19 among marginalized US communities, with the authors calling for more equity in COVID-19 research and “a dismantling of structural barriers that perpetuate disparities in clinical care.” Advocates and health experts are pressuring the government for more attention on long COVID, including greater financial assistance, access to disability benefits, and improved healthcare. The US National Institutes of Health (NIH) early last year launched an initiative to identify the causes and means of prevention and treatment of long COVID, but the research is expected to take years. Some say the condition could be contributing to a worker shortage in the US, with a recent analysis from the Brookings Institution estimating that long COVID could account for 15% of the nation’s 10.6 million unfilled jobs.

VACCINATION & FERTILITY New research provides evidence that SARS-CoV-2 vaccination has no negative impact on reproduction—whether conception is achieved through heterosexual intercourse or in vitro fertilization—but men who become infected with the virus appear to have a short-term decline in fertility. In a study published in the American Journal of Epidemiology, researchers from the Boston University School of Public Health found no association between vaccination of males or females with any of the vaccines available in the US—Pfizer-BioNTech, Moderna, or J&J-Janssen—and the likelihood of conception, with fertility rates among female participants with at least 1 dose of vaccine almost identical to rates among unvaccinated female participants. In the same study, researchers report that men who tested positive for SARS-CoV-2 within 60 days of a woman’s menstrual cycle had reduced fertility when compared with men who never tested positive or who tested positive at least 60 days prior to the cycle. Previous research has linked COVID-19 in men to poor sperm quality and other reproductive dysfunction. A separate study, published in Obstetrics & Gynecology, showed that IVF patients who were vaccinated had similar fertilization rates compared with unvaccinated patients after undergoing controlled ovarian hyperstimulation, single frozen-thawed embryo transfer, and other procedures such as egg or mature oocyte retrieval. Additionally, both groups had similar rates of early pregnancy loss. These studies provide further evidence that SARS-CoV-2 vaccination is safe for people who are trying to conceive. The CDC and other medical groups recommend all people trying to become pregnant to get vaccinated.

Separate studies—including one conducted in the US and another in Norway—showed that vaccination can change menstruation cycles, but the impacts are short-lived and small when compared to natural variation. All of the data should be reassuring to pregnant people and those trying to become pregnant as well as the approximately two-thirds of US parents who cite future fertility as a concern when it comes to vaccinating younger children ages 5 to 11. The vaccination rate among this latter cohort remains quite low in the US and the rates vary widely among US states.  

OMICRON-SPECIFIC VACCINES Moderna announced on January 26 it has begun a Phase 2 clinical trial testing an Omicron variant-specific booster candidate. The study will evaluate the booster in 2 cohorts of participants: individuals who received the 2-dose primary series of the company’s mRNA vaccine and individuals who received the primary series plus a 50 µg booster dose. Moderna also announced the publication of neutralizing antibody data against the Omicron variant 6 months after receipt of the authorized booster dose. The study, published in the New England Journal of Medicine (NEJM), shows that the authorized 50 µg booster dose increased Omicron neutralizing titers to 20-fold higher than peak Omicron titers post-dose 2. However, 6 months later, Omicron neutralization declined 6.3-fold from peak titers at day 29 post-boost but remained detectable in all participants. Neutralizing titers against Omicron declined faster after the booster than for the wild-type virus.