COVID-19 Situation Report
Please join us for a new webinar, "Lessons from the Entertainment IndustryTesting as a Mitigation Strategy to Get Back on Set," on May 17 at 2:00pm ET. Our panelists, Meredith Lavender and Marcie Ulin, the executive producers and showrunners for HBO Max’s The Flight Attendant, will discuss the importance of COVID-19 testing strategies and best practices to ensure productions can safely resume. You can register here.
The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.
EPI UPDATE The WHO COVID-19 Dashboard reports 161 million cumulative cases and 3.3 million deaths worldwide as of 6:15am EDT on May 14.

Despite concerns early in the pandemic, African countries have largely managed to contain their respective COVID-19 epidemics, and the continent as a whole has fared better than most others. In terms of total cumulative incidence, South Africa has remained #1 in Africa since March 2020, and its 1.6 million cases ranks #21 globally. Morocco (514,432) and Tunisia (324,103) are a distant #2 and #3 in Africa, respectively, with fewer than one-third the cases reported in South Africa. Only 9 African countries have reported more than 100,000 cumulative cases. In fact, more countries have reported fewer than 10,000 cases (16) than have reported more than 50,000 (14). On a per capita basis, Seychelles is #1 in Africa, with 93,390 cumulative cases per million population. Notably, even with the world’s highest vaccination coverage, Seychelles’ cumulative incidence has more than tripled since early March—from 2,688 cases on March 1 to 9,184 on May 13—its largest surge to date. Cabo Verde (48,614 cases per million population) is #2 in Africa, followed by Tunisia, South Africa, and Libya clumped together at #3-5 (~26-27,000). Botswana (20,854) is the only other African country reporting higher than the global average (20,584). The average across the continent is only 3,474 cases per million population, approximately one-sixth the global average.

As noted above, Seychelles is facing a severe surge, despite its high vaccination coverage. It is currently reporting more than 4,000 daily cases per million population. This ranks #1 globally, and it is more than 8.5 times the per capita daily incidence in Cabo Verde (478; #2 in Africa, #5 globally). Tunisia (94.4) is the only other Africa country reporting higher than the global average (93.6). Notably, the global average is 15 times higher than the continent average (6.2). In terms of total daily incidence, South Africa (2,126 new cases per day) is once again #1, surpassing Tunisia on May 6. On May 13, Egypt (1,158) surpassed Tunisia (1,116) as #2 in Africa. Ethiopia (594) is the only other country reporting more than 500 new cases per day, and all but 13 countries are reporting fewer than 100. Additionally, only 12 countries across the continent are exhibiting growth rates of more than +10% over the past 2 weeks, and all but 14 have negative growth rates over that period.

Overall, African nations have performed better than many expected in terms of limiting the spread of COVID-19. As vaccine production and distribution continue to scale up, it remains critical to ensure global access and increase vaccination coverage in order to provide protection before epidemics have an opportunity to surge, which could threaten many countries’ limited health system capacity and vulnerable infrastructure.
*We included Djibouti, Egypt, Libya, Morocco, Somalia, Sudan, and Tunisia, in Africa, even though they are in the WHO’s Eastern Mediterranean Region.

Global Vaccination
The WHO reported 1.26 billion doses of SARS-CoV-2 vaccines administered globally, including 637 million individuals with at least 1 dose. Our World in Data reported 1.40 billion cumulative doses administered globally, an increase of 13% over the previous week. After a week of declining daily doses administered, the trend increased once again, up to a new record of 22.6 million doses on May 12. Our World in Data estimates that there are 341 million people worldwide who are fully vaccinated, corresponding to approximately 4.4% of the global population, although reporting is less complete than for other data.

The US CDC reported 32.6 million cumulative cases and 580,837 deaths. The United States’ daily incidence (35,442 new cases per day) is at its lowest since mid-September 2020, during the lowest point between the second and third surges. The lowest average during that period was 34,096 new cases per day on September 13, and the US could drop below that number in the coming days. The daily mortality—586 deaths per day on May 11 and 591 on May 12—is at its lowest point since April 1, 2020, early in the country’s first surge.

US Vaccination
The US has distributed 339 million doses of SARS-CoV-2 vaccine and administered 267 million. Daily doses administered* continues to decrease, down from a high of 3.3 million on April 11 to 1.8 million. Approximately 1.3 million people are achieving fully vaccinated status per day, down from a high of 1.8 million per day on April 12.

A total of 155 million individuals in the US have received at least 1 dose of SARS-CoV-2 vaccine, equivalent to 47% of the entire US population and 59% of all adults. Of those, 119 million are fully vaccinated, which corresponds to 36% of the total population and 46% of adults. Among adults aged 65 years and older, progress has largely stalled at 84% with at least 1 dose and 72% fully vaccinated. The CDC added data for individuals aged 12 years and older to its vaccination dashboard, and in total—including individuals aged 16 and 17 who were previously eligible—2.5 million adolescents have received at least 1 dose, and 1.3 million are fully vaccinated. In terms of full vaccination, 61 million individuals have received the Pfizer-BioNTech vaccine, 48 million have received the Moderna vaccine, and 9.3 million have received the J&J-Janssen vaccine.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The Johns Hopkins Coronavirus Resource Center is reporting 32.9 million cumulative cases and 584,510 deaths in the US as of 10:15am EDT on May 14.

CDC RECOMMENDS PFIZER-BIONTECH VACCINE FOR ADOLESCENTS On May 12, the US CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss SARS-CoV-2 vaccine recommendations, following the US FDA’s decision to expand the Emergency Use Authorization (EUA) for Pfizer-BioNTech’s vaccine to include adolescents aged 12-15 years. After receiving briefings on relevant safety and efficacy data from recent clinical trials, ACIP members voted unanimously—14-0; 1 recusal by a member who conducted SARS-CoV-2 vaccine clinical trials—to recommend the vaccine’s use for 12-15-year-olds. Later that day, CDC Director Dr. Rochelle Walensky issued a statement announcing that the CDC updated its vaccination guidance to recommend the Pfizer-BioNTech vaccine for children aged 12-15 years. The CDC’s decision makes the vaccine immediately available to children in that age group at all vaccination sites nationwide that offer the Pfizer-BioNTech vaccine. While children tend to experience milder disease than adults, several committee members noted the 127 COVID-19-related deaths among adolescents from January-April 2021 would have placed COVID-19 among the top 10 causes of death for that age group in 2019.

J&J-JANSSEN VACCINE & BLOOD CLOTTING The US CDC has confirmed 28 cases of a rare blood clotting disorder among adults who received the J&J-Janssen SARS-CoV-2 vaccine, all of whom were vaccinated prior to an 11-day pause of the vaccine’s use that began on April 13. During a presentation to the agency’s Advisory Committee on Immunization Practices (ACIP) on May 12, Dr. Tom Shimabukuro, deputy director of the immunization safety office at the CDC, said current evidence “suggests a plausible causal association” between the vaccine and the extremely rare post-vaccination occurrence of thrombosis with thrombocytopenia syndrome (TTS), characterized by a blood clot in combination with low levels of blood platelets. Of the cases, 22 were female and 6 were male, with a median age of 40 (18-59). Most of the cases occurred among women ages 18-49 years old. The median time from vaccination to the onset of symptoms was 9 days (3-15 days), and 19 of the 28 cases experienced cerebral venous sinus thrombosis (CVST). Dr. Shimabukuro noted that 3 of the patients died, 4 remained in the hospital as of May 7, 2 have been moved to post-acute care facilities, and the remaining 19 have been discharged. 

The ACIP concluded the benefits of the J&J-Janssen vaccine continue to outweigh the risks, as the single-shot vaccine is useful among some populations. At least 2 committee members expressed concern with continuing the vaccine’s use without some stipulations. One suggested allowing the vaccine’s use only among people over age 60, who appear to be at less risk of TTS, while another proposed obtaining written informed consent from women under age 60 to ensure they are aware of possible risks. Although the ACIP did not adopt either suggestion, states and localities could implement their own guidance. While the blood clotting events associated with the J&J-Janssen vaccine appear to be similar to reports of rare events following administration of the AstraZeneca-Oxford vaccine in Europe, the CDC stressed that TTS does not appear to be associated with the mRNA vaccines from Pfizer-BioNTech and Moderna available in the US. The ACIP assured it would continue its enhanced monitoring of the CDC’s Vaccine Adverse Event Reporting System (VAERS) and conduct surveillance in other vaccine safety systems, as well as underlined its commitment to open and transparent communication about vaccine safety with the public. 

EMERGING VARIANTS OF CONCERN In this week’s WHO epidemiological update, the WHO designated the B.1.617 variant as a variant of concern (VOC). The WHO Virus Evolution Working Group has determined that viruses within the B.1.617 lineage, which contains three sublineages, to be VOCs because they appear to be more transmissible, less responsive to some treatments, and less susceptible to antibody neutralization. Additionally, animal models show the B.1.617 variant may cause more severe disease. As of May 11, more than 4,500 sequences were added to the GISAID database and assigned to B.1.617 from 44 countries in all six WHO regions. At least 5 additional countries have reported detection of the variant. The B.1.617 variant was first reported last year in India and is possibly contributing to the current surge of COVID-19 cases and deaths there. Additional research is needed and ongoing to confirm characteristics of the variant, which is now the dominant strain in India

INDEPENDENT PANEL ON PANDEMIC PREPAREDNESS According to a report by the WHO-sanctioned Independent Panel on Pandemic Preparedness, the COVID-19 pandemic was a “preventable disaster” and the world needs a new system of pandemic preparedness. Calling global preparedness for and response to the pandemic “inconsistent,” “under-funded,” “slow,” and “meek,” the 15-member panel examined the current pandemic but focused largely on efforts moving forward. The report recommends 7 action items to ensure COVID-19 is the last pandemic. Among the key recommendations are elevating pandemic preparedness to the highest levels of political leadership, including the adoption of a Pandemic Framework Convention; improving global surveillance and alert systems; strengthening the authority and financial-backing of the WHO; and investing in preparedness activities now to prevent future crises. The panel likened the COVID-19 pandemic to a “Chernobyl moment” for the gravity of its threat to global health and security. They urged world leaders and heads of international and regional organizations to “urgently accept their responsibility to transform the way in which the world prepares for and responds to global health threats,” asking, “If not now, then when?” 

US MASK GUIDANCE On May 13, the US CDC updated its guidance for fully vaccinated individuals, which eliminates previous recommendations regarding physical distancing and mask use, including indoors. The update closely follows comments earlier this week by White House Chief Medical Advisor Dr. Anthony Fauci, who stated that fully vaccinated individuals do not need to wear a mask, except in densely crowded environments, based on a “growing body of evidence” regarding the low risk of infection and transmission for fully vaccinated individuals. The CDC’s updated guidance for fully vaccinated individuals now indicates they no longer need to wear masks or practice physical distancing in most settings. Notable exceptions include higher-risk environments, including “planes, buses, trains, and other forms of public transportation” and “correctional facilities and homeless shelters,” as well as anywhere that masks are mandated by tribal, state, or local governments or in businesses or workplaces that have their own mandates. The guidance applies to individuals who received their final vaccine dose at least 2 weeks prior.

In response to the shift in CDC guidance, some states immediately removed their mask mandates, but others are taking a more cautious approach. CDC Director Dr. Rochelle Walensky and US President Joe Biden acknowledged that some individuals may find it difficult to remove their masks in public, after wearing them for more than a year, and emphasized that individuals should make the transition when they are comfortable. Speaker of the US House of Representatives Nancy Pelosi indicated she would maintain the mask mandate until vaccination coverage increases among House members. Some mandates may remain in place due to concerns about elevated risk of community transmission in some areas or concerns about the inability to accurately identify individuals who have been vaccinated.

TAIWAN Local governments in Taiwan’s capital city of Taipei and some northern counties have announced business closures in response to 29 new domestic COVID-19 cases reported on May 14, the highest single-day figure since the pandemic began. More than half (16) have been linked to teahouses in Taipei. Health officials have not yet identified the source of infection for 7 of the cases, raising concerns of community spread. Additionally, Taiwan CDC announced 5 imported cases in arriving travelers. The previous day, Taiwan reported 13 domestic cases and 12 imported cases.

In Taipei, officials ordered the indefinite closure of bars, internet cafes, gaming and entertainment venues, including hostess clubs and teahouses, and public sport centers starting Saturday morning. The measures go beyond national guidance set by the central government, which said Taiwan will remain, for now, in Level 2: Local Cases of Unknown Sources. Under Level 2, hospitals and long-term care facilities (LTCFs) will allow only 1 individual to accompany or visit a patient or resident, with some exceptions. Taiwan Premier Su Tseng-chang took to Facebook to emphasize the importance of the next 2 weeks in controlling the outbreak, saying the alert level will not be upgraded “for the time being.” If there are 3 community clusters reported within a week or 10 locally transmitted cases from an unknown source in 1 day, Taiwan will enter Level 3. Officials are urging people to remain home, wear masks in public, and seek testing if they have been exposed to a known case or experience symptoms. Since the beginning of the pandemic, Taiwan has recorded only 1,290 cumulative COVID-19 cases, with the majority of those detected among travelers.

EID AL-FITR RESTRICTIONS Muslims around the world this week celebrated Eid al-Fitr with subdued festivities for a second year in a row, amid conflict in some regions and restrictions due to the COVID-19 pandemic. The end of the holy month of Ramadan usually is marked by millions traveling to social gatherings to pray and spend time with loved ones. The WHO’s Eastern Mediterranean Regional Office (EMRO) published guidance for safe practices during the holiday, urging people to avoid large gatherings and practice individual behaviors like wearing masks, washing hands, and getting vaccinated, when possible. Many countries with large Muslim populations—including Pakistan, India, Malaysia, and Singapore—took their own actions to prevent large social gatherings during the holiday, implementing limits on crowd sizes and temporary closures of some mosques and shops. In Bangladesh, thousands traveled from the capital of Dhaka to join their families in rural villages despite a national lockdown and road checkpoints. Some experts fear the holiday travel will lead to an increase in COVID-19 cases in the country, which is struggling to obtain sufficient vaccine supplies and concerned over the recent detection of cases due to the B.1.617 variant from India.  

ENGLAND/WALES COVID-19 APP A manuscript published online May 12 by the journal Nature provides evidence for the epidemiological impact of a UK National Health Service (NHS) COVID-19 mobile phone app for England and Wales. From its launch in September 2020 through the end of December 2020, the app was used regularly by approximately 16.5 million people (28% of the total population) and sent approximately 1.7 million exposure notifications (4.4 per index case that consented to contact tracing). The estimated fraction of app-notified individuals subsequently showing symptoms and testing positive (the secondary attack rate, SAR) was 6.0%, comparable to the SAR for manually traced close contacts. Using a modeling approach, researchers estimated that 284,000 cases were prevented by the app (108,000 to 450,000), while statistical analysis estimated the number to be even higher at 594,000 (317,000 to 914,000). The researchers projected roughly one case was averted for each case that consented to notification of their contacts through the app. For every percentage point increase in users, the number of new cases could be reduced by 0.8% (modeling) and 2.3% (statistical analysis), according to the researchers, who recommended the continued development and deployment of similar apps, especially in populations where vaccination is ongoing.

GERMANY RELAXES TRAVEL RESTRICTIONS Germany has relaxed travel restrictions for travelers who have been vaccinated or recovered from COVID-19. Such travelers will not have to be tested for SARS-CoV-2 or quarantine when entering the country, unless they are traveling from an area where variants of concern are prevalent. Additionally, non-vaccinated people will be allowed to end their quarantine early if they test negative. Health Minister Jens Spahn said the country expects to implement a digital immunity certificate by the end of June, to aid in validating vaccination status for travelers. The country hopes the app will be compatible with the vaccination certification system in development by the European Union, which also is expected to roll out by the end of June. Notably, the European Parliament has said that the EU certificate should not be used as a vaccine passport and that countries will not be obligated to implement the certificate.

US PUBLIC HEALTH WORKFORCE The White House announced a program to invest US$7.4 billion to reinforce the public health workforce, drawing from the US$1.9 trillion American Rescue Plan that was signed into law in March. Many experts attribute the US’s struggle to combat the COVID-19 pandemic, in part, to decades of chronic underfunding for public health infrastructure. Of the new funding, US$4.4 billion will support state and local health departments in hiring personnel to address shortcomings in critical capabilities, including contact tracing and case investigations, as well as school nurses to facilitate resuming in-person classes. Additionally, some of the funds will be dedicated to expanding the CDC Epidemic Intelligence Service (EIS) and establishing a Public Health AmeriCorps program. The remainder, US$3 billion, will allow the CDC to establish a federal grant program to support state and local governments’ efforts to “expand, train, and modernize the public health workforce for the future.”

SARS-COV-2 ORIGIN A group of scientists published a letter in Science asking the international scientific community to further investigate the origins of SARS-CoV-2. The group recognized the effort organized by the World Health Assembly and the WHO that occurred in May of 2020, suggesting that there was not enough evidence presented to thoroughly investigate the theory that the origins of SARS-CoV-2 stemmed from an accidental release. The group emphasized the importance of determining the pandemic’s origins, calling for a “proper” investigation that is “transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimize the impact of conflicts of interest.” The group also noted recent anti-Asian sentiment in some countries and recognized the efforts of Chinese citizens who shared information about the emerging disease with the world, “often at great personal cost.”

CONSUMER GOODS PRICES The US Consumer Price Index rose in April, up 4.2% from a year ago, the sharpest increase since 2008. The rise in prices has some economists worried, suggesting that the rebounding of an economy depressed by the COVID-19 pandemic may sustain these higher prices on everything from fuel to groceries. US Federal Reserve Chair Jerome Powell has expressed his opinion that the price increases will be transient, representing supply chain hiccups and an increased willingness among Americans to travel after a prolonged period of COVID-19 restrictions. It will take time to see which trends last as the global economy begins to recover from the COVID-19 pandemic.