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.
6 MILLION DEATHS The official global death toll from COVID-19 likely will pass 6 million today. The actual total of COVID-related deaths could be 2 to 4 times higher than the official number, based on estimates of global excess deaths. As the pandemic enters its third year, the milestone is a reminder that the crisis is not over in many countrieswith the highly transmissible Omicron variant continuing to drive a surge in cases, especially in the Western Pacific region—even as other nations move to drop public health restrictions and requirements. COVID-19 has breached the strict border controls of several Pacific island nations, which until recently held off the virus. New Zealand recorded a new record of nearly 24,000 new cases today, causing severe healthcare system strain. In China, the government is quietly moving away from its aggressive “zero COVID” policy to a “dynamic clearing” model aimed at controlling local outbreaks as soon as possible. China’s National Health Commission reported 526 cases from local transmission on March 6, the highest daily total since the initial outbreak in Wuhan. Hong Kong reported more than 43,000 new cases today after the launch of a new system that allows residents to self-report at-home test results. Over the weekend, city residents cleared supermarket shelves for a seventh consecutive day, despite authorities’ calls for calm. In Ecuador’s largest city, Guayaquil, which faced one of the world’s worst COVID-19 outbreaks, violence has replaced contagion as the population struggles to recover from the pandemic’s social, economic, and mental health impacts. Highly vaccinated—and mostly wealthy—countries appear to be moving on from the pandemic, and many global health organizations are shifting their priorities away from COVID-19 to focus on preparing for the next pandemic. Still, only about 14% of people in low-income countries have received at least 1 dose of vaccine. These countries remain vulnerable to the unpredictability of the pandemic and risk being left to languish without needed vaccine doses, treatments, and testing tools. 

US COVID-19 FUNDING On March 7, members of US President Joe Biden’s administration warned that the federal government is nearly out of funding for its COVID-19 pandemic response and urged the US Congress to quickly replenish the funds. Last week, the Biden administration formally requested US$22.5 billion in emergency spending as part of its new COVID-19 Preparedness Plan. The “urgent” request is lower than the US$30 billion originally floated and is coupled with a request for US$10 billion for humanitarian and military aid for Ukraine. The emergency funding request includes money for research into a pan-SARS-CoV-2 vaccine, testing capacity, purchase of additional antiviral treatment courses, and support for the purchase of vaccines to be distributed globally. The US continues to be a large contributor to global vaccination efforts, representing 36% of the money donated to COVAX and 41% of pledged vaccine doses, according to analysis from the Kaiser Family Foundation. In a letter sent last week, Shalanda Young, the Acting Director of the Office of Management and Budget, urged lawmakers to “act expeditiously” on the request by March 11, citing a need to increase funding for the US Department of Defense and other agencies, which are operating at levels negotiated in late 2020. 

However, it is unclear if Congress will heed the urgency, as debates over the necessity of new COVID-19 funding fall along partisan lines. At least 3 dozen Republican Senators are asking for more transparency from the Biden administration about how more than US$4 trillion in previously authorized funding has been spent before supporting additional funds. Democrats warned opposition to approving emergency pandemic funds could jeopardize the nation’s return to a sense of normalcy. This news comes alongside other signals from some federal lawmakers that they are working to move past the COVID-19 pandemic. The US Senate last week passed a Republican-sponsored bill to end the national emergency declaration for COVID-19. The measure passed narrowly, with a 48-47 vote, drawing the threat of a veto from President Biden. 

COVID ROADMAP A report written by nearly 2 dozen experts charts a course for living with COVID-19, outlining recommendations to reach a “new normal.” The report, titled Getting to and Sustaining the Next Normal: A Roadmap for Living with COVID, describes 12 core elements fundamental to the roadmap, principally shifting focus from COVID-19 to major viral respiratory illnesses like influenza and respiratory syncytial virus (RSV); creating a dashboard to serve as an infectious diseases information hub for the introduction, modification, and lifting of public health measures; issuing guidance for therapeutics and additional protective measures; and increasing surveillance, testing, and data infrastructure. The report includes 3 scenarios in which the COVID-19 pandemic will continue, dependent on vaccine- or infection-derived immunity and the characteristics of new variants. Other key recommendations of the report include developing indoor air quality standards to protect from inhalation exposure; conducting additional long COVID research; and supporting the development of new therapeutics to be distributed in an accessible, equitable test-to-treat platform. Strategies to rebuild trust and credibility among public agencies like the US CDC include building in more transparency in how guidance is set and overhauling the Vaccine Adverse Event Reporting System, which relies on self-reported data and has been exploited by anti-vaccine groups to spread misinformation. The group consulted with the White House earlier this year, and some of the recommendations are similar to those included in the National COVID-⁠19 Preparedness Plan, albeit with much more detail. The 136-page report contains more than 250 discrete recommendations that go beyond the current and proposed changes.

COVID MISINFORMATION US Surgeon General Dr. Vivek Murthy last week formally requested that major technology companies send data and analysis on the prevalence of COVID-19 misinformation on their social networks, search engines, instant messaging systems, e-commerce sites, and crowdsourced platforms, as well as information on the primary sources of that misinformation. Additionally, Dr. Murthy requested that healthcare professionals and the public submit information about how COVID-19 misinformation has impacted patients and communities. Companies have until May 2 to comply with the request, which is part of US President Biden’s new National COVID-19 Preparedness Plan. Separately, a group of physicians called No License for Disinformation is calling on state medical boards to take disciplinary action against doctors who deliberately spread misinformation regarding COVID-19 therapies, vaccines, and public health measures including masking.

VACCINES FOR CHILDREN Children under age 5 in the US remain ineligible for vaccination against COVID-19, and a series of ups and downs regarding expected authorization for this age group has left some parents feeling abandoned, frustrated, and fearful as mask mandates and other restrictions are dropped. Additional data on a 3-dose regimen of the Pfizer-BioNTech vaccine in young children is expected this spring, and Moderna is expected to request authorization for its vaccine among young children by May.

Last week, the US FDA rejected an application from pharmaceutical company Ocugen seeking Emergency Use Authorization for an India-made SARS-CoV-2 vaccine for children aged 2 to 18. Covaxin, manufactured by the Indian pharmaceutical company Bharat Biotech, is not yet authorized for any age group in the US nor has the vaccine been tested in the US. A clinical trial conducted in India among individuals between ages 2 and 18, prior to the emergence of the Omicron variant, showed 2 doses of the vaccine were safe and generated robust immune responses. Ocugen contracted with Bharat to try to bring the vaccine to the US market. Covaxin is authorized in about 20 countries and has Emergency Use Listing by the WHO. Ocugen said it will continue working with US regulators to evaluate the vaccine’s use in children.

In Florida (US), the state’s surgeon general on March 7 announced that the state will issue guidance urging parents to not vaccinate their healthy children against COVID-19. Although Florida’s decision likely will have little impact on parents’ abilities to vaccinate their children, the recommendation breaks with US CDC guidance and some experts say the move could sow confusion and distrust, potentially harming individuals and communities

MODERNA In a new Global Health Policy Strategy published March 7, Moderna announced several new and expanded commitments related to COVID-19 and mRNA technologies. The company said it will expand its global health portfolio to 15 vaccine programs targeting pathogens identified as posing the greatest threat to global health by the Coalition for Epidemic Preparedness Innovations (CEPI); launch a program that will offer the company’s mRNA technology to researchers investigating new vaccines for emerging or neglected infectious diseases; and pledge to “never enforce” patents related to its SARS-CoV-2 vaccine only in the Gavi COVAX Advanced Market Commitment (AMC) for 92 low- and middle-income countries. Previously, the company said it would not enforce its patents during the pandemic but retained the right to do so in the future. As part of the new pledge, Moderna said it will not enforce patents for its SARS-CoV-2 vaccines against South Africa-based Afrigen Biologics—which has used publicly available information to replicate Moderna’s vaccine as part of the WHO-supported mRNA vaccine technology transfer hub—even though the company holds patents in South Africa and the nation is not included in the COVAX AMC. 

Additionally, Moderna announced a preliminary agreement with the government of Kenya to establish Africa’s first mRNA manufacturing facility. Moderna plans to invest US$500 million to build the facility, which is expected to produce up to 500 million vaccine doses annually for COVID-19 and other diseases. The facility will focus on manufacturing vaccine substances but could expand to fill and finish vaccine vials as early as 2023. Moderna currently is locked in a patent dispute with the US National Institutes of Health (NIH) over portions of the technology used to make its mRNA vaccine. Last week, Arbutus Biopharma and Genevant Sciences filed a lawsuit alleging Moderna infringed on a patent held by the companies for lipid nanoparticle technology, an important element of Moderna’s mRNA vaccine. 

US FEDERAL BUREAU OF PRISONS Official statistics from the US Federal Bureau of Prisons (BOP) show that 287 inmates in the 122 federal prisons nationwide have died of COVID-19 since the beginning of the pandemic. In 2020, the death rate in BOP prisons was 50% higher than the 5 years prior to the pandemic. Despite memos from the US Attorney General sent early in the pandemic asking BOP to prioritize appropriate transfers to home confinement, BOP did not move quickly to review cases nor did it move forward with many transfers.

Some prisoners turned to the judicial system to ask for compassionate release, but the process can be long and the spread of SARS-CoV-2 in prisons outpaced the reviews. According to an analysis from NPR, nearly 13,000 compassionate release motions were filed in federal court in 2020, and federal judges denied more than 80% of the motions filed between January 2020 and June 2021. Of the federal inmates who have died of COVID-19, nearly all had a higher risk of dying from the virus due to older age or medical condition and at least 1 in 4 filed motions with the judicial system asking for compassionate release, according to the analysis. At least 3 inmates had their requests granted but died before they could be released, and many others died while awaiting decisions. While most of the US is loosening COVID-19 mitigation measures, federal prison inmates and staff continue to contract the virus and die. Notably, a review by STAT found that Pfizer’s COVID-19 antiviral treatment Paxlovid—shown in clinical trials to be highly effective at preventing progression to severe disease and possibly able to reduce the risk of transmission—is not being made available to most federal inmates who test positive for SARS-CoV-2.

Separately, the American Civil Liberties Union (ACLU) last week filed a lawsuit on behalf of 4 medically vulnerable detainees who have been denied SARS-CoV-2 vaccine booster doses while being held in federal immigration detention. The suit, which the ACLU hopes to transition into a class-action suit, names the US Immigration and Customs Enforcement (ICE) and US Department of Homeland Security and the agencies’ acting director and secretary, respectively. The lawsuit—which claims ICE does not have an updated policy regarding booster doses—is the second filed by the ACLU requesting access to boosters for people in ICE detention. 

GENETIC FACTORS Researchers have identified 16 new genes and confirmed 7 previously identified genes that they say significantly predispose people to critical COVID-19 disease, some of which could provide targets for treatments, according to a study published in Nature. The researchers compared whole genome sequences of 7,491 COVID-19 patients admitted to intensive care units (ICUs) with those of 1,630 people who experienced mild COVID-19 as well as 48,400 people who never had COVID-19 and who were part of the UK government’s 100,000 Genomes Project. In addition to helping to identify new or existing drugs to treat COVID-19, the research could be used to help predict which patients are at risk of severe disease and which might need intensive care.