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 437.3 million cumulative cases and 5.96 million deaths worldwide as of March 2. The global weekly incidence continues to decline, down 15.5% from the previous week. Notably, the Western Pacific region continues to report increasing weekly incidence (+31.7%), while all other regions reported decreasing weekly incidence last week. Global weekly mortality fell 14.4% from the previous week. We expect the cumulative number of deaths to pass 6 million this week. 

Global Vaccination
The WHO reported 10.58 billion cumulative doses administered globally as of February 27. A total of 4.9 billion individuals have received at least 1 dose, and 4.32 billion are fully vaccinated. Analysis from Our World in Data indicates that the overall trend in global daily vaccinations appears to have stabilized over the past 2 weeks. As of March 2, 23.5 million doses per day were recorded, a relatively small decline compared to the 25.5 million doses per day on February 17.* The trend continues to closely follow that of Asia. Our World in Data estimates that there are 4.97 billion vaccinated individuals worldwide (1+ dose; 63.13% of the global population) and 4.39 billion who are fully vaccinated (55.7% of the global population). A total of 1.41 billion booster doses have been administered globally.
*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 78.9 million cumulative cases of COVID-19 and 950,112 deaths. Daily incidence continues its sharp decline, down from a record high of 807,843 new cases per day on January 15 to 56,253 on March 1. Daily mortality appears to have peaked on February 2 at 2,627 deaths per day, down to 1,674 on March 1.* 

According to CDC COVID-19 Seroprevalence Estimates released this week, more than 140 million US residents have been infected with SARS-CoV-2, about 43% of the total population. The data are based on 72,000 blood samples taken through the end of January 2022 and only include people who have antibodies from natural symptomatic or asymptomatic infection, not vaccination.
*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 has administered 691 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to decline, down from the most recent peak of 1.79 million doses per day on December 7 to 284,281 on February 25.* The number of daily vaccinations is at its lowest level since late December 2020, right after the vaccines were authorized. A total of 253.7 million individuals have received at least 1 vaccine dose, which corresponds to 76.4% of the entire US population. Among adults, 87.9% have received at least 1 dose, as well as 26.7 million children under the age of 18. A total of 215.8 million individuals are fully vaccinated**, which corresponds to 65% of the total population. Approximately 75% of adults are fully vaccinated, as well as 22.1 million children under the age of 18. Since August 2021, 93.6 million individuals have received an additional or booster dose. This corresponds to 43.8% of fully vaccinated individuals, including 66.3% 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.

US NATIONAL COVID-19 PREPAREDNESS PLAN Moving the US from a state of pandemic crisis to a time when COVID-19 does not disrupt daily life will require focus on 4 primary goals: protecting people from infection and treating COVID-19; preparing for the emergence of new variants; keeping businesses and schools open and operating; and leading global vaccination efforts, according to a new roadmap released on March 2 by the administration of US President Joe Biden. To achieve its objectives, the 96-page National Covid-19 Preparedness Plan depends on the US Congress approving billions of dollars in new funding. The Biden administration has informally indicated it will request US$30 billion for domestic needs and US$5 billion for global vaccination efforts. Some US lawmakers and advocates have said at least triple that amount will be needed for international efforts. A formal budget request is expected soon.

The plan’s release follows President Biden’s first State of the Union address delivered the night before, during which he touched on several aspects of the plan. President Biden emphasized that “COVID need not control our lives,” touting new US CDC guidance that allows much of the country’s population to remove masks, but he simultaneously expressed caution that the nation must remain “on guard.” He announced that people soon will be able to order additional rapid antigen tests through the website. Nearly half of the 500 million free SARS-CoV-2 tests remain unclaimed, with 40% of the already-mailed tests having gone to households in low-income areas, according to the White House. President Biden also announced a “Test to Treat” initiative set to launch later this month that will allow people to receive immediate COVID-19 therapy—likely Pfizer’s Paxlovid antiviral—if they test positive at a participating pharmacy. Noting that variants remain a threat, President Biden restated his administration’s commitment to being able to quickly develop and ship variant-specific vaccines as well as accelerating efforts to detect, prevent, and treat long COVID.

White House and US Health and Human Services (HHS) public health officials further expanded on details of the new National COVID-19 Preparedness Plan during a March 2 briefing. They noted a priority to keep businesses and schools open, including efforts to improve ventilation and air filtration as well as calls for Congress to reinstate tax credits for small- and mid-size businesses to provide sick or family leave for people affected by COVID-19. High-quality masks will continue to be made available at participating locations including grocery stores, pharmacies, and community health centers, and the administration plans to launch a new website to help people locate vaccines and masks in their communities. COVID-19-specific testing, treatment, and prevention tools such as masks, including those for children, will be added for the first time to the nation’s Strategic National Stockpile, and federal plans to develop a pan-SARS-CoV-2 vaccine—and later a universal coronavirus vaccine—are moving forward. Additionally, the roadmap includes strategies for rolling out a vaccine for children under age 5 when and if one is authorized and recommended by health authorities. 

Notably, some public health experts criticized the plan and the US CDC’s recent shift in masking guidance, saying a move toward a medical framework focused primarily on testing and treatment places too much onus on individual responsibility versus community-level intervention. This shift adds burdens on vulnerable individuals and populations, including the immunocompromised, rural and low-income communities, those who live or work in high-exposure environments, and young children who remain ineligible for vaccination. 

UKRAINE Ukraine already has experienced immediate downstream impacts of the Russian invasion. One of these far-reaching impacts is the damage that the invasion has played on Ukraine’s ability to control the COVID-19 pandemic. Dr. Bruce Aylward, a senior advisor at the WHO, said in a statement earlier this week that “infectious diseases ruthlessly exploit the conditions created by war,” while WHO Director-General Dr. Tedros Adhanom Ghebreyesus called for increased humanitarian channels to provide lifesaving medical supplies to those remaining in the country. Notably, the WHO avoided naming Russia as an aggressor during their press conference, instead focusing on calls to stop attacks on civilians and medical institutions. Healthcare systems already face supply chain challenges. The WHO warned on February 27 the country has dangerously low supplies of medical oxygen, a key tool in treating people hospitalized with COVID-19 and other diseases. The agency announced its first shipment of medical aid for Ukraine will arrive in Poland today, but details about last-mile delivery to Ukrainians in need remain unclear.

Experts warn that the conflict also threatens to disrupt efforts to control the pandemic, as well as other vaccine-preventable diseases, in neighboring countries. At least 1 million refugees already have fled across the borders since the start of the invasion. Prior to the conflict in the country, COVAX had delivered more than 8 million vaccine doses to Ukraine, but this disruption may offset hard fought gains in vaccination. Prior to last week’s events, only 35% of Ukraine’s population was fully vaccinated, creating an atmosphere for increased SARS-CoV-2 transmission and the potential for a greater number of severe health outcomes. The country’s low vaccination coverage is not sufficient to prevent the virus from spreading among large populations living in crowded shelter situations and increases the potential for new variants to emerge. COVAX indicated it will continue to support Ukraine’s vaccination efforts and has a “Humanitarian Buffer” mechanism for delivering vaccines in humanitarian crises, but the coordination and cooperation needed to establish such services will take time.

US MATERNAL MORTALITY Pregnant people or those recently pregnant are at an increased risk for severe illness from COVID-19 when compared to people who are not pregnant. As of February 19, about 68% of pregnant people were vaccinated before or during pregnancy, a sharp increase from the beginning of the summer when the proportion was around 40%. Some pregnant people say they feel they were left behind in rushed efforts to vaccinate the population, having been excluded from vaccine clinical trials for safety reasons and receiving mixed guidance when vaccines first became available. While the full scope of impacts from maternal SARS-CoV-2 infection remain unclear, some evidence suggest even mild or moderate infection can increase the risk of premature birth or stillbirth

Additionally, a new report from the US CDC National Center for Health Statistics shows that the number of women in the US who died during pregnancy or shortly after giving birth rose sharply during the first year of the pandemic. The data show that 861 women died of maternal causes in the US during 2020, an increase of 14% over the prior year. The maternal mortality rate increased to 23.8 deaths per 100,000 live births, up from 20.1 per 100,000 in 2019. Notably, the rate for non-Hispanic Black women was 2.9 times higher than the rate for non-Hispanic white women, a gap that increased between 2019 and 2020. Although the report does not provide details on potential causes for the increases, experts said some of the deaths likely were directly or indirectly related to the COVID-19 pandemic. As in other aspects of healthcare, the pandemic helped to magnify disparities in access to quality maternal care. There has been a push to address this critical issue at the federal level, including language in the American Rescue Plan that gave states the opportunity to extend Medicaid coverage for new mothers from 60 days to up to a year postpartum. The CDC supports multiple efforts to better understand the impact of COVID-19 on pregnant people and infants and encourages those who are pregnant or considering pregnancy to get vaccinated, citing the growing amount of data that show the protective measures that SARS-CoV-2 vaccines offer this vulnerable group. 

COVID-19 THERAPIES During the State of the Union address, US President Joe Biden announced his administration is launching a new “Test to Treat” initiative that will provide free antiviral treatment to qualified individuals who test positive for SARS-CoV-2 at pharmacies or community health centers. The US has ordered more authorized COVID-19 treatments than any other country, with Pfizer expected to increase its supply of Paxlovid—which reduced the risk of COVID-related hospitalization by about 90% in clinical trials—to more than 2 million pills in April. But questions remain about the initiative’s details. The program is not set up yet, although CVS, Walgreens, and Walmart have indicated they will participate. Still, people will need to find and access participating locations and obtain a prescription for treatment from either an on-site doctor or their primary care provider, if they have one. Alternatively, pharmacists may be permitted under federal guidance to assess patients and order the oral therapies. Notably, some pharmacies are complaining that the costs of filling the prescriptions are not adequately covered by commercial and government health plans, which could cause some to drop out of supplying the antivirals at all. 

Following the December 2021 authorization of the antiviral therapies Paxlovid and Merck’s molnupiravir—which has limited use and is much less effective than Paxlovid—nationwide supplies are increasing, making the treatments more easily accessible. Since December, the federal government has sent more than 500,000 courses of Paxlovid and about 1.85 million courses of molnupiravir to the states. Additionally, more than 100 vaccines, antivirals, and other treatments, such as monoclonal antibodies and repurposed medicines, are currently being tested in late stage clinical trials globally. New SARS-CoV-2 variants continue to be a wildcard for existing therapies and those under investigation. The US has paused or limited the use of certain monoclonal antibodies because the Omicron variant of concern is not susceptible to the drugs. 

VACCINE EFFECTIVENESS AMONG CHILDREN According to new data published this week in the US CDC’s Morbidity and Mortality Weekly Report (MMWR), 2 doses of the Pfizer-BioNTech SARS-CoV-2 vaccine provided strong initial protection against urgent care and emergency department visits and hospitalization for children aged 5 to 17 years (overall vaccine effectiveness [VE] against hospitalization was 73%-94%). As seen in other age groups, VE weakened over time and was lower during Omicron predominance. However, the data show that a booster dose was able to restore vaccine effectiveness to 81% among individuals aged 16-17 years. The new MMWR findings supplement earlier data from New York state, discussed in our March 1 briefing. The New York data, which is not yet peer-reviewed, asserted that the Pfizer-BioNTech vaccine’s protection against infection and hospitalization for children aged 5 to 11 years waned quickly compared to children aged 12 to 17. Scientists from the CDC and other institutions warn that the New York study might be too small to draw solid conclusions and might not take into account children who were tested at home instead of a clinic. They assert that some drop in protection was the result of the Omicron variant, which affected all age groups. The CDC currently recommends that all eligible children and adolescents remain up-to-date on their vaccinations, including receipt of a booster dose for individuals aged 12 and older. A separate MMWR study examined the safety of booster doses for children aged 12 to 17 years, showing that local and systemic reactions are expected but that serious adverse events are rare.

US MILITARY VACCINE MANDATE ​​The 5th US Circuit Court of Appeals this week upheld a lower court’s injunction barring the US Navy from considering the vaccination status of 35 special forces personnel in making deployment decisions. The US Department of Defense requires all service members to receive SARS-CoV-2 vaccination, and although the rule allows for religious exemptions, only 15 of about 16,000 requests have been approved so far. The US Justice Department argued that the courts did not have jurisdiction to rule on military deployment decisions, but the appeals panel in its decision said the judiciary does have the power to consider the plaintiffs’ objections on religious grounds. The case represents another setback for government-imposed broad-reaching vaccination requirements. The 5th Circuit previously ruled against the Occupational Safety and Health Administration’s (OSHA) emergency temporary standard (ETS) that required businesses with 100 or more staff to ensure their employees were either vaccinated or tested weekly and wore masks. OSHA withdrew that rule after the US Supreme Court ruled against the requirement.

Separately, the US Senate on March 2 voted 49-44 to strike down the Centers for Medicare and Medicaid Services' (CMS) vaccine mandate for healthcare workers. The measure, allowed under the Congressional Review Act, passed in the evenly divided Senate due to the absence of 6 Democratic members.

WHITE-TAILED DEER As previously discussed in this report, animal reservoirs of SARS-CoV-2 present a risk of viral mutation and spillback into humans. The virus is known to infect several non-human mammalian species, including mink, hamsters, mice, and white-tailed deer. Researchers examining coronavirus in Canadian white-tailed deer populations have identified a new, highly divergent lineage of SARS-CoV-2 in deer. Additionally, they report the identification of a very similar viral sequence in a single person in the same geographical region who had close contact with deer. No other human-derived genetic sequences were similar, leading the researchers to speculate it likely was an isolated case with no evidence of recurrent deer-to-human or sustained human-to-human transmission. The preprint report, posted in bioRxiv and not yet peer-reviewed, is the first evidence of possible deer-to-human transmission of SARS-CoV-2. The researchers noted that SARS-CoV-2 circulating among wild deer populations posed more of a containment challenge than farmed or domestic animals and stressed the need for a broader, interdisciplinary One Health approach to SARS-CoV-2 surveillance.