COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS.
UPCOMING WEBINAR The country’s response to the COVID-19 pandemic led to new public-private partnerships (PPPs) that drove the development of new medical countermeasures and bolstered domestic manufacturing capacity for medical products. It is critical to sustain PPPs and build a domestic bioindustrial base beyond the current pandemic. Join us for a webinar, Strengthening Private Public Partnerships in Pandemic Preparedness for National Security and Economic Competitiveness, on Wednesday, July 20, at 12pm ET. Register here:
EPI UPDATE The WHO COVID-19 Dashboard reports 555 million cumulative cases and 6.35 million deaths worldwide as of July 13. The global weekly incidence increased for the fifth consecutive week, up 12.5% from the previous week. As the WHO’s IHR Emergency Committee noted, there appears to be a “decoupling” of cases from deaths, as we are not observing a commensurate increase in weekly mortality at the global level. Global weekly mortality remained relatively steady at slightly more than 10,000 deaths, an increase of 1.1% over the previous week.

The African region continues to report decreasing trends in weekly incidence, down to 16,404 new cases last week—a 27% decrease from the previous week and the lowest weekly total since May 2020. South-East Asia increased for the sixth consecutive week, but it appears to be reaching a peak or plateau. The Americas reported a slight decrease last week, but considering that included the US Independence Day holiday weekend, it could be a residual effect of delayed reporting. All other regions reported substantial increases last week: Eastern Mediterranean (+24.7%), Europe (+15.9%; and now its third-highest peak), and Western Pacific (+27.9%).

The US CDC is reporting 88.8 million cumulative cases of COVID-19 and 1,017,391 deaths. The average daily incidence has essentially plateaued over the past several weeks, holding relatively steady at approximately 100-110,000 new cases per day, although it may be exhibiting early signs of increasing. The weekly average jumped from 109,828 new cases per day on July 10 to 123,365 on July 12 (+12%); however, additional data are needed to determine if this is the beginning of a longer-term trend or just recovery from delayed reporting over the US Independence Day holiday weekend. The 185,786 new cases reported on July 12 is the second-highest single day total since the plateau began, and it is the highest in a non-holiday week since February.* Like we observed at the global level, there appears to be a “decoupling” of cases from deaths in the US. The average daily mortality has held relatively steady at approximately 275-350 deaths per day since late April.*
*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.

Both new hospital admissions (+12.0% over the past week) and current hospitalizations (+11.4%) continue to increase, despite the ongoing plateau in daily incidence. New hospitalizations among children aged 17 years and younger are approaching its second-highest peak (November 2021). The most rapid increases in current hospitalizations are being reported in Alabama (+22%), Arkansas (+30%), Louisiana (+21%), New Hampshire (+24%), Oklahoma (+21%), Rhode Island (+22%), South Carolina (+39%), and West Virginia (+24%).

Community transmission in the US is increasingly driven by the Omicron BA.5 sublineage. BA.5 is projected to have accounted for more than half of sequenced specimens starting the week of July 2, and the estimate reached 65% for the week of July 9. The BA.4 sublineage is also increasing in prevalence, although much more slowly than BA.5. The BA.4 sublineage increased from an estimated 16.1% to 16.3% over the past 2 weeks, and we expect it to replace BA.2.12.1 as #2 nationally in the coming weeks. Together, Omicron variants represent essentially all new cases in the US.

COVID-19 REMAINS PHEIC In a meeting on July 8, the WHO’s International Health Regulations (IHR) Emergency Committee recommended that the COVID-19 pandemic continues to constitute Public Health Emergency of International Concern (PHEIC), the committee’s twelfth such meeting since the onset of the pandemic. On July 12, WHO Director-General Dr. Tedros Adhanom Ghebreyesus issued a statement indicating that he concurred with the committee’s recommendation and presented minutes from the meeting. He also called on national governments to implement appropriate protective measures, noting that many countries have essentially lifted all COVID-19 restrictions, which is allowing transmission to spread largely unabated.

The committee members emphasized the ongoing uncertainty and unpredictability of the pandemic, particularly in the context of emerging variant characteristics and the evolution of the SARS-CoV-2 virus. Additionally, the global daily COVID-19 incidence has increased 30% over the past 2 weeks, although the committee acknowledged that recent data indicates a “decoupling” of cases from hospitalizations and mortality, due in large part to vaccination coverage and therapeutic availability. As has been the case since the onset of the pandemic, the expert committee also highlighted shortcomings in disease surveillance capacity around the world, and it specifically addressed challenges posed by rapid at-home tests and the need to incorporate those results into national surveillance data. The COVID-19 pandemic was first declared a PHEIC on January 30, 2020. 

NOVAVAX VACCINE EUA The US FDA on July 13 granted emergency use authorization (EUA) to Novavax, a small Maryland-based biotechnology company, for use of its 2-dose primary series COVID-19 vaccine among adults ages 18 years and older. The FDA authorized the vaccine based on data from the company’s Phase 3 clinical trial, PREVENT-19, which demonstrated 90.4% efficacy in preventing mild, moderate, or severe COVID-19 among about 17,200 study participants who received the vaccine. The vaccine is the first COVID-19 vaccine authorized in the US that uses a more traditional protein-based platform. FDA advisors expressed hope that the vaccine’s authorization may convince individuals skeptical of mRNA vaccines to seek vaccination. On July 12, prior to the FDA’s EUA announcement, the US government announced it secured an initial 3.2 million doses of the Novavax vaccine. The US CDC’s Advisory Committee on Immunization Practices (ACIP) is scheduled to meet next week and is expected to recommend use of the vaccine for adults.

VACCINE PLATFORM COMPARISON According to an expert review of 79 real-world studies, available 2-dose vaccines meant to prevent COVID-19 are equally protective against hospitalization (91-93%) and death (91-93%) from COVID-19 whether they use a viral vector or mRNA platform. The study, published in the journal Expert Review of Vaccines, compared data for 2 doses of Pfizer-BioNTech’s and Moderna’s mRNA vaccines, or a combination of the shots, and AstraZeneca-Oxford’s viral vector vaccine Vaxzevria. The data reflected protection against Delta and earlier SARS-CoV-2 variants, although emerging data from the UK Health Security Agency and public health agencies in Brazil indicate similar levels of protection from severe COVID-19 health outcomes due to the Omicron variant after a booster, or third, dose. New analysis from Airfinity, a London-based data firm, shows that the Pfizer-BioNTech and AstraZeneca-Oxford vaccines saved an estimated 12 million lives in their first year of use (December 2020 to December 2021), with the Pfizer-BioNTech vaccine accounting for 5.9 million and the AstraZeneca-Oxford vaccine for 6.3 million lives saved. 

VACCINE ACCESS Health officials worldwide continue to warn of the risks of increasing COVID-19 cases and hospitalizations due to the Omicron subvariant BA.5, now predominant in several regions, with many recommending fourth vaccine doses, or second booster shots, for specific populations. In the US, in an effort to stem increasing COVID-19 hospitalizations, fourth doses may soon become available to all adults, according to health officials. In Europe, the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) this week updated guidance to recommend a second vaccine booster for all individuals over age 60 as well as medically vulnerable people in Europe. Additionally, the WHO European Technical Advisory Group of Experts on Immunization (ETAGE) urged EU member states to ensure people are up-to-date on their vaccinations and encouraged expanding eligibility for second booster doses to include moderately and severely immunocompromised individuals aged 5 years and above and their close contacts, older adults, healthcare workers, and pregnant women.

Meanwhile, Africa—where only 20% of the population is fully vaccinated—continues to be left behind. Without the ability to manufacture vaccines or outcompete wealthier nations in securing purchases directly from pharmaceutical companies, the continent, as well as low- and middle-income countries (LMICs) in other regions, are relying on charity from higher-income countries, including the US. But rather than global solidarity, vaccine nationalism and hoarding during the first year of COVID-19 vaccine availability resulted in a 2-tier vaccine rollout that ultimately led to vaccine waste and low vaccination rates in LMICs. Now, health leaders in Africa and elsewhere are calling for a restructuring of the global health architecture with a focus on inclusivity, equity, and partnership to enable LMICs to establish vaccine and medicine research, development, and manufacturing capabilities. In one effort, 15 nations in the global south are working with the WHO and other groups to establish the mRNA vaccine technology transfer hub, an initiative aimed at empowering lower-income countries to develop and produce their own vaccines for COVID-19 and other diseases and ultimately lessen their dependence on higher-income countries.

ANTIMICROBIAL RESISTANCE Between 2012 and 2017, the number of deaths from antimicrobial-resistant (AMR) infections in the US declined 18% overall and nearly 30% in hospitals due in large part to prevention efforts such as improving infection prevention and control and antimicrobial stewardship. But those gains were largely reversed during the first year of the COVID-19 pandemic, as both drug-resistant hospital-acquired infections and deaths increased at least 15% in 2020, according to a new US CDC analysis. Several factors likely contributed to the setback, including a shift in public health resources from tracking and preventing antimicrobial resistance to COVID-19 efforts; the incorrect use of antibiotics to treat COVID-19 patients, which is a viral, not bacterial, disease; sicker patients needing more frequent and longer use of invasive care, such as catheters and ventilators; and overwhelmed hospitals that experienced shortages of staff, personal protective equipment, and other supplies. 

The CDC estimates that more than 2.8 million AMR infections occur annually in the US, with 35,000 people dying of those infections. But the total number of AMR-related deaths in 2020 is likely much higher, according to the report. In a forward, CDC Director Dr. Rochelle Walensky wrote that the setbacks in preventing AMR infections “can and must be temporary,” noting that the COVID-19 pandemic’s major takeaway is that “prevention is preparedness.” In related news, the WHO this week released its first-ever report on the pipeline of vaccines currently in development for AMR bacterial pathogens, including several in late-stage development that address diseases on the bacterial priority pathogens list.

PEOPLE WITH DISABILITIES Many people with disabilities in the US, including those who are immunocompromised, feel left behind as COVID-19 mitigation measures are lifted and the world attempts to find a new sense of normalcy. According to a survey conducted in April by Data for Progress, 57% of disabled people surveyed believe masks should be required on public transportation and 64% feel they should be required for air travel. People with disabilities and their advocates are calling for additional efforts to stop the spread of COVID-19, such as requirements to wear a mask in public spaces, investments in indoor air filtration improvements, and more widespread wastewater surveillance to help predict community transmission levels. They point out that as the number of people with disabilities increases—specifically those who develop post-acute sequelae of SARS-CoV-2 infection (PASC), commonly known as long COVID—more public health measures aimed at stemming disease transmission are vital to provide a sense of safety for everyone.