August 28, 2023

COVID-19 indicators increase in 3 of 6 WHO regions, US; updated boosters expected in mid-September

COVID-19 indicators increased in 3 of the 6 WHO regions, and US CDC data show a continued slow but steady rise in COVID-19 activity in the most recent week, with hospitalizations up nearly 22% and deaths from the disease up a little more than 21%. Though the US is in a good position to face this late-summer increase in COVID-19 cases—as well as other respiratory viruses responsible for the majority of fall and winter hospitalizations—the uptick serves as a reminder that the novel coronavirus is here to stay.

Experts are closely watching the new BA.2.86 variant, which has been detected in 13 cases in 6 different countries and in wastewater in several additional nations. The new variant has a high number of mutations that likely enable it to evade antibodies developed in response to previous SARS-CoV-2 infections or vaccination. While BA.2.86 does not appear to cause more severe disease than other variants, and existing treatments likely will work against the variant, more data are needed to know how well the forthcoming, updated vaccines will protect against severe disease and hospitalization. US President Joe Biden last week said he is planning to request additional funding from the US Congress to develop another new COVID-19 vaccine, as the virus continues to mutate.

The updated vaccines likely will be available in mid-September, earlier than previously expected, following a meeting of the US CDC's Advisory Committee on Immunization Practices (ACIP) on September 12. People who are aged 65 or older or immunocompromised should talk with their health care provider about whether to get an additional dose of the currently available bivalent booster or wait for the updated monovalent shot. Those who are behind on their recommended vaccinations or unvaccinated might consider completing their vaccine series now. Most others who are not at high risk of severe COVID-19 can wait for the updated vaccine, or even skip this next dose, according to some experts. In the meantime, those at high risk should consider wearing high-quality masks in indoor settings to lower their risk of infection. Several US hospital systems, schools, and businesses have reinstituted mask mandates, though another federal mandate is highly unlikely.

COVID-19 continues to interrupt in-person learning in US public schools; experts urge improvements to indoor air quality to avoid closures

The uptick in COVID-19 cases is impacting the start of the new school year in several areas around the US. At least 3 school districts suspended in-person learning due to significant drops in student and teacher attendance attributed to COVID-19 and other illnesses. Notably, US CDC data show greater increases over the previous week in the percentage of emergency department visits diagnosed with COVID-19 among children and adolescents compared with older age groups.

In-person schooling interruptions due to COVID-19 and other illnesses have led to significant learning losses among the nation's children despite K-12 schools receiving unprecedented amounts of federal aid to help them address pandemic-related challenges. Some of that funding, appropriated in 2020, was meant to help schools improve their HVAC systems; however, an estimated 36,000 public schools still lack adequate air conditioning. Record high temperatures across much of the country this summer drove up classroom temperatures, which inhibits focus and learning. Additionally, poorly ventilated spaces offer ideal conditions for the transmission of airborne diseases, including the virus that causes COVID-19. Improvements to indoor air quality could help keep more students and teachers in the classroom and help avoid closures due to disease outbreaks.

US health officials outline plan for approaching respiratory virus season, release updated flu vaccine guidance

US health officials last week detailed the various medical countermeasures available to combat the viruses that cause respiratory illness ahead of the fall and winter, when increases in disease incidence typically occurs. Updated vaccines for COVID-19 and influenza are expected in September and October, and new vaccines against RSV are now available for adults aged 60 years and older and available soon for pregnant people in their third trimester. Additionally, a new monoclonal antibody shot against RSV will be available this fall for infants under 8 months and young children at increased risk of severe disease.

For those eligible, experts agree it is safe to get a COVID-19 booster and flu shot at the same time. The new mRNA-based COVID-19 vaccines from Pfizer-BioNTech and Moderna are expected to be fully licensed vaccines for individuals aged 12 and older and available under an emergency use authorization (EUA) for children ages 11 and younger. The protein-based COVID-19 vaccine from Novavax is also expected be available under an EUA. The US CDC published new guidelines for flu vaccinations last week, outlining the composition of the 2023-2024 seasonal vaccines and updating recommendations regarding flu vaccination for people with egg allergy. The agency's experts now say that all people aged 6 months or older with egg allergy should receive a flu vaccine, whether it is egg-based or non-egg-based, and no additional safety measures are needed for vaccination.

As for RSV immunizations, the US FDA has approved 2 vaccines for older adults, approved one of those vaccines for use in pregnant people to pass immunity on their newborns, and approved a preventive monoclonal antibody for infants and vulnerable toddlers. The monoclonal antibody is now included in the federal Vaccines for Children program, meaning it will be available at no cost to children who are uninsured, Medicaid eligible, Native American or Alaska Native, or underinsured in a plan that does not cover vaccines. For adults, the RSV vaccines are covered under Medicare Part D, which pays for prescription drugs, but those without a Part D plan may have to pay for an RSV vaccine out of pocket, depending on their non-Medicaid prescription drug coverage.  

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CIDRAP: COVID Omicron carries 4 times the risk of death as flu, new data show

Epidemiology & Infection: Mortality associated with Omicron and influenza infections in France before and during the COVID-19 pandemic

US hospital patients' perceived quality of care worsened during COVID-19 pandemic, possibly due to staffing shortages, absenteeism

CIDRAP: US hospital patient survey reveals worse perceived care amid COVID-19

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In-person, online mental health care visits increased substantially during pandemic, research shows; telehealth made visits more accessible but questions remain about future insurance coverage

New York Times: Mental Health Spending Surged During the Pandemic

The Hill: Mental health spending up 50 percent since beginning of COVID-19 pandemic: study

Axios: Americans invested in their mental health during the pandemic

Pulse oximeters' overestimation of blood oxygen saturation led to COVID-19 treatment delays, especially among darker skinned patients

New York Times: Faulty Oxygen Readings Delayed Care to Black and Hispanic Covid Patients, Study Finds

CIDRAP: Study: Oximeters often overestimate COVID patients' oxygen levels, delaying care

China had estimated 1.87 million excess deaths after lifting of zero COVID policy, US study suggests

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Medical Xpress: American study estimates 1.87 million excess deaths occurred in China two months after its zero COVID policy ended

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CNN: This country is finally reopening after Covid. But it still requires a one-week quarantine

AP: China won't require COVID-19 tests for incoming travelers in a milestone in its reopening

See also: Reuters: Pandemic, inflation push 68 million more in Asia into extreme poverty, Asian Development Bank says

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Guardian: Families sue UK government over relatives' deaths during Covid crisis

Link between climate change, infectious disease outbreaks should prompt scientists, policymakers to evaluate risks, opportunities for mitigation, adaptation, experts say

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See also: AP: Norway to spend $6 million a year stock-piling grain, citing pandemic, war and climate change

Asthma-related hospital visits increased in US on days with significant wildfire smoke

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See also: Wired: It's Easy to Check the Air Quality. Meet the People Collecting That Data for You

US CDC calls on nation's hospitals to implement sepsis programs, improve sepsis care; nurses, patients, professional groups call for more rigorous CDC isolation precaution guidelines

CNN: CDC launches effort to bolster hospital sepsis programs

MedPage Today: CDC Advisory Group Under Fire for Proposed Infection Control Guidelines

'Silent pandemic' of antimicrobial resistance worsening; experts warn lack of urgency on part of governments, pharma companies to address issue risks future disaster

Financial Times: Superbugs: why it's so hard to stop the 'silent pandemic'

Al-Monitor: Iraq's war-battered cities grapple with rising resistance to antibiotics

See also: Wired: The Battle Against the Fungal Apocalypse Is Just Beginning

And: CIDRAP: Study shows artemisinin-resistant malaria is spreading in Uganda

West Nile virus leading cause of insect-borne viral disease in US; surveillance shows outbreaks of other mosquito-, tick-borne diseases

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CIDRAP: Pandemic altered teen vaccine uptake, with major lags seen in HPV

MMWR: Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey–Teen, United States, 2022

Polish authorities investigating whether water tampering caused Legionnaires' outbreak that killed 7 people in Ukrainian border city

AP: Legionnaires' disease kills 7 people in a strategic Polish city on the Ukrainian border

Reuters: Polish authorities probe whether deadly Legionnaires' outbreak was result of water tampering

Editors: Alyson Browett, MPH and Rachel A. Vahey, MHS

Contributors: Erin Fink, MS; Vanessa Gregoire, MSc; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Prarthana Vasudevan, MS, MSPH, DrPH (c); and Alex Zhu, MSPH