COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS
INDOOR AIR WORKSHOP The Environmental Health Matters Initiative (EHMI) of the National Academies of Sciences, Engineering, and Medicine will host its first virtual workshop in a 3-part series on Indoor Air Management of Airborne Pathogens on August 18 from 11:30 am to 3:30 pm EDT. These workshops—follow ups to the 2020 workshop on the airborne transmission of SARS-CoV-2—will explore strategies needed for airborne disease control and risk reduction in enclosed places by drawing on accumulated community and institutional knowledge, on-the-ground observations of indoor environments management during the pandemic, and novel and promising scientific discoveries. For more information and to register, visit
EPI UPDATE The WHO COVID-19 Dashboard reports 584 million cumulative cases and 6.4 million deaths worldwide as of August 10.* The global weekly incidence (August 1) increased 3.9% from the previous week. Global weekly mortality fell 7.9% over the previous week, representing the first notable decline since the end of May. 

At the regional level, the number of new weekly cases rose in the Western Pacific (+29%) region and fell or remained stable in the Africa (-46%), Americas (-22%), Eastern Mediterranean (-22%), Europe (-7%), and South-East Asia (-3%) regions. The number of new weekly deaths increased in the Eastern Mediterranean (+19%) region and decreased or remained stable in the Africa (-73%), Europe (-15%), the Americas (-10%), South-East Asia (-1%), and the Western Pacific (+4%) regions.
*The WHO notes the case and death data for the Africa region are incomplete and will be updated as soon as more information becomes available.

The US CDC is reporting 92.3 million cumulative cases of COVID-19 and 1,030,010 deaths. The current 7-day moving average of new daily cases is down over last week, dropping to 107,077 on August 9 from 121,260 on August 2. The average daily mortality remains relatively stable, at 395 on August 9. Daily mortality has risen since the beginning of June, when it was around 280 deaths per day.**

Both new hospital admissions (-0.8% over the past week) and current hospitalizations (-2.6%) remained relatively stable over the previous week, possibly reflecting the slight decrease in daily incidence. 

Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is now projected to account for 87.1% of sequenced specimens. The BA.4 sublineage accounts for about 6.6% of cases, while the BA.4.6 sublineage accounts for 4.8% of cases. Together, BA.2.12.1 and BA.2 now account for only about 2.9% of cases. According to the estimate, Omicron variants represent all new cases in the US.
**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.

IMMUNE EVASION Immune escape, or immune evasion, is driving the COVID-19 pandemic’s extended life cycle. As the virus continues to infect humans, it will mutate and likely adapt to find its way around existing levels of vaccine-induced and natural immunity. The scientific community is not surprised that SARS-CoV-2 continues to evolve to evade our ever-changing immune systems, as many other viruses do the same. But because SARS-CoV-2 is a new virus to humans, attention is focused on emerging new variants and global anxiety is heightened, wondering what variant lies around the corner. 

Currently, there are many questions about whether the Omicron subvariants BA.2.75 or BA.4.6 will cause the next wave of infections. BA.2.75, which has been circulating widely in India for more than a month and has been detected in at least 20 other countries, does not currently appear likely to outcompete BA.5, the global leader of SARS-CoV-2 variants. BA.4.6, which is growing in prevalence in the US and Europe, appears to be just as transmissible as BA.2.75, but it remains unclear whether either subvariant will become predominant. Scientists continue to worry that either one of these Omicron subvariants, or an as-yet undetected variant, could gain global, regional, or local dominance. This cycle of new variant-driven waves, each with increased immune evasion, describes the global experience with COVID-19 to date, and many assume the pattern will continue into the future. This is what allowed BA.4 and BA.5 to spread widely despite widespread recent infections with the Omicron BA.1 and BA.2 subvariants. 

In addition to increased variant surveillance, more must be done to help further prepare for future increases in COVID-19 cases. The first priority is to address current infections by reducing transmission of circulating virus, limiting its chances to adapt and evade existing levels of immunity. However, limiting transmission is increasingly challenging, as many countries roll back mitigation measures and as funding for testing and vaccination programs dwindles. Many appear to be placing hope in the next generation of SARS-CoV-2 vaccines, which are expected to protect against a wider array of viral lineages. Several studies, including one conducted in non-human primates published this week in Science Translational Medicine, suggest that these vaccines may be a possibility, and they may be able to provide protection that extends to other coronaviruses, so-called pancoronavirus vaccines. While those vaccines remain a distant goal, manufacturers continue to work on current vaccine platforms that enable the fast production of variant-specific boosters. The CEO of Moderna recently compared the future of SARS-CoV-2 vaccines to the iPhone’s constant updates, with new generations developed as more data and technologies become available. 

NOVAVAX VACCINE Last month, the US FDA granted emergency use authorization (EUA) for a protein-based COVID-19 vaccine made by US-based manufacturer Novavax. Many public health advocates hoped that the vaccine’s authorization would lead to an increase in vaccinations among unvaccinated populations, having faith that the more traditional protein-based vaccine technology would ease concerns surrounding vaccination with vaccines using newer mRNA platforms. However, in the month since the EUA was issued, only about 7,400 doses have been administered in the US, with only 2,300 people receiving a 2-dose primary series using Novavax. According to the US CDC, 332,000 doses of the vaccine have been distributed nationwide. Originally, the vaccine was available at only 385 locations, although that number has grown to 986 sites. Notably, more than 53,000 locations have been used to provide other vaccinations throughout the pandemic. The limited uptake of the Novavax vaccine has received criticism given the large investment the company received from Operation Warp Speed. While it is too early to decide the fate of the vaccine in the US, Novavax recently reset its sales expectations, halving its forecast to US$2 billion to US$2.3 billion from US$4 billion to US$5 billion. 

PEDIATRIC VACCINATIONS Efforts to vaccinate young children against COVID-19 in the US got off to a sluggish start and continue to lag. Results of a survey published August 3 in JAMA Network Open indicate that only about half of the 2,031 parents of young children aged 6 months to 4 years surveyed intend to vaccinate their children at some point, and only about one-fifth said they intend to do so within 3 months of the child’s eligibility.  The research team surveyed the parents in early February 2022, about 4 months prior to the US FDA’s decision to issue an EUA for this youngest age group. According to the survey, 45.6% of the respondents would “definitely” or “probably” vaccinate their child after eligibility, and 66% said they plan to wait 3 months or longer before deciding whether or to vaccinate their child. Just over one-third of the participants said they did not know if they would seek vaccination. Overall, only 4-5% of children in this age group have been vaccinated since the EUA, with concerns over vaccine safety driving the scarce uptake. 

Looking at older pediatric age groups, a study published August 8 in The Lancet Infectious Diseases examines the effectiveness of the 2-dose primary series of the Pfizer-BioNTech vaccine in preventing symptomatic infection and severe disease among adolescents aged 12 to 17 years living in Brazil and Scotland between August 2021 and April 2022. The test-negative, case-control study found that protection against symptomatic infection from a 2-dose series administered at least 21 days apart peaked at 14-27 days after the second dose and then began to wane. However, protection against severe COVID-19 disease remained high at 98 days or more after the second dose during the Omicron-dominant period, suggesting that booster doses for this age group should be considered. 

TRANSPORTATION MASK REQUIREMENTS A group of 23 state attorneys general filed a brief in a US federal appeals court this week claiming the CDC lacks the authority to impose a nationwide transportation mask mandate to address COVID-19. Led by Florida’s State Attorney General, the group called CDC’s actions an “overreach” and expressed their support of an April ruling by a Florida federal judge who blocked the transportation-related mask mandate requiring travelers to wear masks on planes, trains, buses, ride-share vehicles, and in transit stations. Additionally, 17 Republican US lawmakers filed a similar brief the same day. The US Department of Justice appealed the April ruling to the 11th U.S. Circuit Court of Appeals, filing a May 31 brief saying the mask requirement "falls easily within the CDC's statutory authority.” The Biden administration stopped enforcing the order following the April ruling. 

VACCINE PRODUCTION IN AFRICA According to the Africa CDC, only 20% of adults on the continent have been fully vaccinated against COVID-19, but demand for vaccination has fallen. South Africa-based Aspen Pharmacare produces the J&J-Janssen vaccine for member states in Africa, which comprises almost 30% of vaccines acquired in the region, and in March finalized a deal to produce its own Aspenovax vaccine for African markets. However, the company has not received any orders for the Aspenovax shot, this week saying it will have to shut down or convert its production lines beyond this month if it does not receive orders. However, the Africa CDC, which does not want the continent’s vaccine manufacturing capacity shuttered, last month said it is in detailed discussions with buyers to generate demand for Aspenovax.

Vaccine hoarding by high-income nations deprioritized low- and middle-income countries’ (LMICs) access to vaccines during the early stages of the COVID-19 pandemic. Subsequently, many donors from high-income countries established COVID-19 response as a top funding priority, treating it as a once-in-a-century threat to public health. Global health experts have questioned this reprioritization of funding, arguing the money would be better spent on a holistic approach to healthcare and disease, as COVID-19 is one of many public health priorities that LMICs need donor support to address. A new study, published in The Lancet Global Health, highlights the disruptions the COVID-19 pandemic had on essential health services in Kenya, including access to cervical cancer screening, testing for HIV and malaria, tuberculosis therapies, and routine immunization. Donors’ shift in focus to COVID-19, and restrictions on how that funding can be used, illustrates a missed opportunity to more effectively address pressing public health concerns on the continent.

NORTH KOREA Since May, North Korea has reported more than 4.7 million cases of patients with “fever” and 74 related deaths, widely believed to be COVID-19. After not registering any new fever cases since July 29, North Korean leader Kim Jong Un on August 10 gave a speech in which he “solemnly declared a victory” over the virus, despite the nation’s limited testing capacity. North Korea and Eritrea are the only 2 countries without a SARS-CoV-2 vaccination program, and North Korea’s hospitals are poorly equipped, lacking reliable electricity and modern medical technologies. At a meeting on COVID-19 policy attended by thousands of unmasked officials, Kim vowed “deadly retaliation” against South Korea, which he blames for causing the outbreak. North Korean defectors to South Korea and activists often send balloons carrying anti-Pyongyang leaflets, and sometimes food, medicine, and money, across the border, which leaders believe brought the virus into the country. Kim called such actions an “influx of rubbish” and threatened to “wipe out” South Korean authorities, who responded by calling the claims “groundless” and “rude and threatening.” Regional experts said the meeting announcing an end to the fever outbreak could be a signal to China that North Korea is ready to reopen trade. Also at the meeting, Kim’s sister, Kim Yo Jong said the leader was “seriously unwell” with fever as the nation faced the outbreak, but she did not specify that his fever was caused by COVID-19.