COVID-19 Situation Report
Weekly updates on COVID-19 epidemiology, science, policy, and other news you can use.

UPCOMING WORKSHOP The COVID-19 pandemic incited an unprecedented infodemic and has highlighted the impact of information disseminated with malintent toward public health action. Join the National Academies of Sciences, Engineering, and Medicine for a 2-day public workshop, April 10–11, to examine public health infodemics, the COVID-19 infodemic, the impact of infodemics on trust in the public health enterprise and broader national health security, and tools and practices used to address infodemics. Register here.
In this issue

> White House disbanding COVID-19 Response Team as end of pandemic emergency nears; No movement seen on establishing new preparedness and response office

> US FDA expected to announce authorization of second bivalent booster for certain people; UK, Canada move forward with spring shots for high-risk populations

> WHO monitoring XBB.1.16 Omicron subvariant driving surge of cases in India

> Nature publishes first peer-reviewed data on SARS-CoV-2 origin from Chinese scientists 

> Researchers, patient advocates call on US government to more effectively respond to long COVID, urge global consensus on definition of condition

> What we're reading

> Epi update
White House disbanding COVID-19 Response Team as end of pandemic emergency nears; No movement seen on establishing new preparedness and response office

The White House is disbanding the COVID-19 Response Team that led the federal response to the pandemic since February 2020. The move makes sense, according to officials, as the nation prepares to wind down the COVID-19 national emergency and public health emergency on May 11. The end to those declarations could come even sooner, however, as the US Senate last week voted to end the national emergency order that was first implemented during the Trump administration. The US House of Representatives passed the measure in February, and US President Joe Biden said he will sign it despite his opposition. Meanwhile, the US Congress in December 2022 asked the White House to stand up a new, permanent office to coordinate the government’s preparedness activities before the next pandemic threat, but there has been little movement to do so. With only a month, or less, remaining before the pandemic emergency ends—which has implications for millions of US residents—it appears the political will to create a new pandemic preparedness and response office already is dwindling, perpetuating the cycle of “panic and neglect” so often experienced in health emergencies.
US FDA expected to announce authorization of second bivalent booster for certain people; UK, Canada move forward with spring shots for high-risk populations
The US FDA is expected to announce authorization of a second bivalent booster for certain high-risk groups within the next few weeks. The second Omicron-specific booster—with the same formulation as the first—likely will be authorized for individuals aged 65 years and older or with those with weakened immune systems, to be given at least 4 months or 2 months, respectively, after the first bivalent booster. According to officials familiar with the plan, the new policy will be “permissive,” allowing people to choose to get the shot rather than standing as a formal recommendation. About 42% of people aged 65 and older have received the bivalent booster shot, according to the US CDC. 

Once the FDA makes a final decision, the CDC will have to recommend use of the second booster, but it is unclear whether the agency will convene a meeting of its vaccine advisory committee. A reformulated booster is anticipated for summer or early fall rollout to align with a proposed plan made in January by the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) to switch to annual COVID-19 boosters for the majority of people. Data from CDC’s vaccine advisory committee February meeting confirms earlier real-world reports that bivalent vaccines provide better protection against serious illness in adults than monovalent boosters. While data collection is ongoing, studies show that an additional booster may be particularly beneficial to older adults, but experts note that boosters likely will need to be updated to keep up with emerging variants, to maintain immunity levels as the virus evolves. 

Last month, health officials in the UK and Canada recommended additional boosters this spring for the elderly, residents of nursing homes, or immunocompromised people. Today, the UK Joint Committee on Vaccination and Immunisation (JCVI) said children between the ages of 6 months to 4 years with underlying medical conditions be offered 2 doses of the Pfizer-BioNTech vaccine, with an interval of 8 to 12 weeks between the first and second doses. UK health regulators authorized the vaccine for children in that age group in December 2022, but the JCVI did not advise vaccination of children of that age who are not in a clinical risk group. On April 5, the European Centre for Disease Prevention and Control (ECDC) released guidance calling on countries in the region to plan for continued rollout of COVID-19 vaccines in 2023, with efforts focused on protecting older adults and other vulnerable groups, such as those with underlying comorbidities and the immunocompromised, irrespective of age.
WHO monitoring XBB.1.16 Omicron subvariant driving surge of cases in India

The WHO is monitoring a new SARS-CoV-2 Omicron subvariant called XBB.1.16, which is driving a surge of cases in India. Dr. Maria Van Kerkhove, WHO's COVID-19 technical lead, said the subvariant has replaced other variants in India and noted it is “one to watch.” The WHO added XBB.1.16 to its list of monitored variants on March 22. XBB.1.16—which is a recombinant variant from BA.2.10.1 and BA.2.75—is similar to the XBB.1.5 variant that is currently dominant in the US and accounts for 45% of global cases, but additional mutations in the spike protein may give it some growth advantages over the older subvariant. The mutations have the potential for increased infectivity and potential increased pathogenicity, although reports do not indicate a rise in hospitalizations, ICU admissions, or deaths due to XBB.1.16, the WHO noted. 

So far, there are about 800 sequences of XBB.1.16 from 22 countries, primarily India, which is reporting its highest number of COVID-19 cases in 6 months. In its weekly situation report, the WHO noted that while overall COVID-19 cases and deaths continue to decline, several other countries in the Eastern Mediterranean and South-East Asia regions—which comprises India—are reporting significant increases in cases, including Iran, Kuwait, Libya, United Arab Emirates, and Qatar. In the US, the 7-day average for new daily cases continues to decline to around 20,000, down 9.2% compared to the previous 7-day average. XBB.1.5 has reached saturation, accounting for 87.9% of samples, while 3 other Omicron subvariants show positive growth: XBB.1.9.1, XBB, and XBB.1.5.1. The XBB.1.16 subvariant has been detected in at least 18 US states, and a descendant of the new subvariant that is raising concern among experts, XBB.1.16.1, has been found in 15 states. 

Though many people are weary of the pandemic, health experts note it is important to remain vigilant, as past experience with variants shows that things can change quickly. In the US, XBB.1.5 accounted for less than a quarter of COVID-19 cases in late December 2022, but it became the dominant variant over the ensuing week. In the US, XBB.1.16 has shown a 188% growth advantage over XBB.1.5 in the past 3 months, and a 64% growth advantage in India. While the WHO is closely monitoring this new subvariant, as well as several others, it said maintaining and developing surveillance systems to track known variants and detect emerging strains is critical to healthcare system and response agility. Additionally, the WHO urged people to continue taking precautions against COVID-19, including vaccination, social distancing, and wearing masks.
Nature publishes first peer-reviewed data on SARS-CoV-2 origin from Chinese scientists 

The journal Nature this week posted a peer-reviewed but unedited study from Chinese scientists examining the results of surveillance samples taken from the Huanan Seafood Market in Wuhan, China, in January 2020, once again reigniting the debate surrounding the origin of SARS-CoV-2. The study examined 923 environmental swabs taken from locations around the market and 457 swabs collected from 18 animal species. The animal swabs were taken from fish tanks, stray animals, and unsold refrigerator and freezer contents. Sample analysis through RT-PCR detected SARS-CoV-2 in 73 environmental samples, but no evidence of SARS-CoV-2 was detected in the animal samples. Three live viruses were isolated from the SARS-CoV-2-positive samples, and the viruses shared a 99.99-100% nucleotide identity with the wild-type virus isolated from humans. 

The first version of the article was originally posted to a preprint server in February 2022 and downplayed the possibility of animal infections at the market. But recently, Dr. Florence DĂ©barre, a researcher from France, identified a previously undisclosed trove of genetic data published on the GISAID platform. A group of international researchers led by Dr. DĂ©barre released their own analysis of the data on the preprint server Zenodo, which identified DNA from multiple mammal species, including raccoon dogs, which are known to be susceptible to coronaviruses. The presence of raccoon dog DNA among the viral sequences indicates that these animals were present at the market and may have been infected with the SARS-CoV-2 virus, but the preprint did not provide definitive data to support their infection. Notably, the Chinese government previously asserted that these types of animals were not present at the market. However, in the recently published Nature article, the Chinese scientists confirm the presence of raccoon dogs in the Huanan Market, but the authors stress the remaining uncertainty surrounding the virus’s origins. The authors state that the virus could have been transmitted from humans to raccoon dogs in the Huanan Market or that the virus could have been imported on cold-chain products such as frozen foods. 

The release of the Nature publication and the Zenodo preprint analysis has led to varied reactions from the international community. Dr. Alice Hughes, a conservation biologist with the University of Hong Kong, questioned whether the Nature data could have been improperly processed or contaminated, particularly because the Chinese research team found genetic traces from animals such as pandas and chimpanzees, which would not have been in the market. Similarly, Dr. Angela Rasmussen of the University of Saskatchewan said the Nature study is “deeply flawed” because the Chinese researchers used a reference database that excluded the genome of the raccoon dog for sequencing. Meanwhile, authorities in China continue to promote the cold-chain import theory. The WHO has called on China to immediately share all relevant data with the international scientific community.

While the origin of SARS-CoV-2 is unlikely to be definitively proven at this point, scientific evidence points to a natural origin. Full transparency within the scientific community is necessary for the mystery surrounding the virus’s origin to be resolved. Nonetheless, work can begin now to put measures in place to help lower the likelihood of future viral events, including improving standards and guidance for animal markets to lower the risk of disease transmission between humans and animals and enhancing international biosafety and biosecurity standards at laboratories globally.
Researchers, patient advocates call on US government to more effectively respond to long COVID, urge global consensus on definition of condition

Long COVID, also called post-COVID condition (PCC) or post-acute sequelae of SARS-COV-2/COVID (PASC), is a multifaceted and often disabling condition that can affect the neurologic, cardiovascular, pulmonary, hematologic, and endocrine systems of people of all ages, including children. As many as 23 million US adults and 65 million people worldwide have developed long COVID, which involves a variety of symptoms lasting more than 3 months after initial COVID-19 infection. This week, the US Department of Health and Human Services (HHS) marked 1 year of its whole-of-government response to long COVID with a press release outlining its progress and actions moving forward. As part of the initial federal response to long COVID, the US NIH is working with Palantir Technologies Inc. to build an enormous, collaborative database of deidentified data collected from people with COVID-19 or related conditions and launched the Researching COVID-19 to Enhance Recovery (RECOVER) Initiative, which selected a network of enrollment sites or hubs across 24 states, Puerto Rico, and the District of Columbia, with each site collecting clinical and biobank data from about 1,000 participants. 

Over months of collaboration, the RECOVER principal investigators (PIs) say they have identified gaps in the response to care for patients with long COVID and developed strategies to address those gaps, and this week they called on the federal government to evolve its response. To do so, the PIs are urging the US Congress to include US$37.5 million in Fiscal Year 2024 funding for the Department of Health and Human Services (HHS) to competitively select Long COVID Centers of Excellence that could gather, develop, and disseminate data regarding evidence-based treatment; educate and train providers on best practices; conduct outreach to affected populations and community organizations; and coordinate access to care, with the aim of coordinating long COVID care, reducing healthcare disparities, and improving psychosocial and medical outcomes. Other experts are calling for the federal government to support an “Operation Warp Speed” for long COVID like it did to develop vaccines, therapeutics, and diagnostics for COVID-19. Such a program could help define, diagnose, treat, and classify the condition, as well as help improve the understanding of risk factors or the protective effect of vaccines or other therapies.

Additionally, advocates for and patients with long COVID are calling on the US NIH to reconsider plans to include exercise trials in its RECOVER initiative to find treatments for the condition. A large proportion of people with long COVID report experiencing post-exertional malaise (PEM), which can cause a worsening of symptoms such as fatigue, poor body temperature regulation, and cognitive dysfunction after even light exercise. Advocates fear that some trial participants could be harmed if they are not properly informed of the risks or the trials do not include adequate screening or post-exercise monitoring. Through a petition and letters, they also are asking researchers to share their rationale and trial protocols so potential risks can be assessed. Trial protocols for the RECOVER initiative are still under development, and a statement sent to Nature on behalf of NIH said patient representatives are included in that process.

Separately, in a commentary published in JAMA Network Open on April 5, experts argue that if the condition is universally defined, more effective treatments for it can then be developed. They say working toward this consistency can be accomplished in 3 parts: agreeing on a universal definition of this condition, with 1 name that can be adopted by all studies in the future; characterizing those who may be experiencing PCC unknowingly in studies, particularly among those who are at highest risk of exposure and severe disease; and conducting longitudinal research to collect data on symptoms and different outcomes over time. In an accompanying JAMA Network Open research letter, researchers aimed to describe how post-COVID-19 condition has been defined to date in studies on this topic.
What we’re reading

GLOBAL HEALTH WORKFORCE On the occasion of its 75th anniversary this week, the WHO called for global action to address health inequities and protect the health workforce, many of whom are facing burnout from the COVID-19 pandemic. Millions of health and other care workers were infected during the pandemic, thousands died, and many suffer from anxiety, depression, and other declines in mental health wellbeing. The agency urged governments to invest in education, skills-building, and decent jobs to meet the rapidly growing demand for healthcare and avert a projected shortage of 10 million health workers by 2030, particularly in low- and middle-income countries. The agency stressed the importance of upholding labor rights; investing in decent working conditions, fair pay, training, and leadership; and addressing gender inequalities in the health sector. Additionally, the WHO, in conjunction with the World Health Professions Alliance, recently published a report comparing the experiences of dentists, nurses, pharmacists, physicians, and physiotherapists during the COVID-19 pandemic and summarizing those 5 professions were impacted in common and different ways.  

US PUBLIC SCHOOLS The COVID-19 pandemic affected all US schools in profound ways, but in a system where inequities existed prior to the national health emergency, those that were already the most vulnerable suffered the deepest and most lasting impacts. The Washington Post examines the experiences of 2 Alabama school districts that diverge on socioeconomic status, and the New York Times Magazine highlights the experiences of teachers, parents, and students in one Los Angeles County public school in a neighborhood that suffered immense stress and grief. In one fifth grade class alone, 17 of the students had a loved one die during the first year of the pandemic. 

VILOBELIMAB EUA The US FDA issued an emergency use authorization (EUA) for vilobelimab, also known as Gohibic, to treat COVID-19 in hospitalized adults when initiated within 48 hours of receiving invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). The drug is a monoclonal anti-human complement factor C5a antibody, which works to control a part of the immune system that is thought to lead to inflammation and COVID-19 disease progression. The clinical trial supporting the authorization showed that patients treated with Gohibic had a lower risk of death by day 28 and day 60 of treatment compared to those who received a placebo. InflaRx, the treatment’s manufacturer, said it currently has a supply of the drug available and is working to increase production at a contractor facility. The EUA is expected to offer another potentially life-saving treatment option for the most critically ill COVID-19 patients.

MONOCLONAL ANTIBODIES Monoclonal antibodies (mAbs) administered to high-risk COVID-19 patients within 2 days of diagnosis reduced their risk of hospitalization or death by 39%, according to a hypothetical randomized study using observational data published this week in the Annals of Internal Medicine. Researchers at the University of Pittsburgh Medical Center assigned 7,706 high-risk COVID-19 patients aged 12 years or older to receive either mAbs (bamlanivimab, bamlanivimab-etesevimab, sotrovimab, bebtelovimab, or casirivimab-imdevimab) or no treatment between December 8, 2020, and August 31, 2022. The risk of hospitalization or death by 28 days was 4.6% among mAb recipients, compared with 7.6% among control patients. Notably, the US FDA revoked or suspended emergency authorization for all 5 mAbs during the study period after in vitro studies showed little to no benefit against newer SARS-CoV-2 variants. In the study, the benefit was greatest amid the Alpha and Delta variants, potentially reflecting the more virulent earlier strains and lower levels of immunity early in the pandemic. Using one of the largest US databases of patients treated with mAbs, the study confirms that the therapies saved lives and prevented hospitalizations.

NASAL VACCINE CANDIDATE In a study published April 3 in Nature Microbiology, researchers from Germany describe the results of a nasal vaccine candidate made with a live-attenuated form of COVID-19 that they claim can block SARS-CoV-2 from copying itself in the upper airways, where the virus generally gains a foothold. The team used a technique called codon pair deoptimization to manipulate the virus’s genetic material and weaken it so it can be shown to the immune system without making the body sick. In experiments conducted on hamsters, 2 doses of the nasal vaccine candidate, sCPD9, elicited the most robust immunity when compared with homogeneous and heterologous vaccination regimens using the Pfizer-BioNTech mRNA vaccine and Ad2-Spike, an adenovirus-vectored spike protein vaccine candidate. Notably, it remains unclear how effective nasal vaccines may be in humans. As of July 2022, there were at least 12 nasal vaccines under development worldwide. China, India, Iran, and Russia have authorized nasal vaccines, but little is known about their effectiveness.

LATIN AMERICA & CARIBBEAN The Lancet Regional Health Americas discusses the challenges faced by Latin America and the Caribbean (LAC) in rebuilding after the COVID-19 pandemic. In January, representatives from the World Bank, PAHO, and UNICEF met with health ministers and decision-makers from the region to discuss the extensive and enduring effects of the pandemic, which include high mortality rates, economic contraction, increased unemployment, and poverty. The pandemic also revealed vulnerabilities in the region’s healthcare systems with knock-on effects on primary health care, noncommunicable diseases, and education. Additionally, the pandemic disproportionately impacted the mental health of people in the region, with a 35% increase in depression and a 32% increase in anxiety, and mental health care services were disrupted. Representatives at the meeting emphasized the urgent need to address mental health, strengthen essential public health services, provide timely primary care, increase healthcare coverage, and include climate change in rebuilding efforts.
Epi update

As of April 6, the WHO COVID-19 Dashboard reports: 
  • 762 million cumulative COVID-19 cases 
  • 6.89 million deaths
  • 711,352 million cases reported week of March 27 
  • 12% decrease in global weekly incidence
  • 4,745 deaths reported week of March 27 
  • 25% decrease in global weekly mortality 

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+90%) region. 

The US CDC is reporting: 
  • 104.1 million cumulative cases
  • 1.12 million deaths
  • 139,991 cases week of March 29 (down from previous week)
  • 1,596 deaths week of March 29 (down from previous week)
  • 10.2% weekly decrease in new hospital admissions 
  • 11.4% weekly decrease in current hospitalizations 

The Omicron sublineages XBB.1.5 (87.9%), XBB.1.9.1 (4.6%), XBB (2.5%), and XBB.1.5.1 (2.1%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases. 

The New York Times this week launched a “build-your-own-dashboard” to track COVID-19 in US locations. 
Editor: Alyson Browett, MPH

Contributors: Erin Fink, MS; Clint Haines, MS; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; and Rachel A. Vahey, MHS