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

> US Department of Energy concludes with ‘low confidence’ COVID-19 pandemic began as result of lab incident, prompting congressional hearing; experts call for actions to improve biosafety, biosecurity

> Most US states with pandemic-related emergency declarations will allow them to expire this month

> US CDC advisory panel supports annual COVID-19 vaccine booster for high-risk populations; Pfizer-BioNTech request EUA for bivalent vaccine as booster for youngest children

> Incidence of long COVID could be declining; people with condition more likely to develop cardiac complications, suffer from orthostatic tachycardia

> US FDA authorizes first-ever at-home COVID-19, flu test kit

> What we're reading

> Epi update
US Department of Energy concludes with ‘low confidence’ COVID-19 pandemic began as result of lab incident, prompting congressional hearing; experts call for actions to improve biosafety, biosecurity 

After assessing new intelligence, the US Department of Energy (DoE) concluded with “low confidence” that the SARS-CoV-2 virus likely emerged from a potential laboratory incident in China, according to a classified intelligence report delivered recently to the White House and key members of the US Congress. The DoE joins the FBI as the only other US intelligence agency to conclude that the COVID-19 pandemic most likely began as the result of a laboratory leak. The FBI arrived at its conclusion with “moderate confidence,” according to FBI Director Christopher Wray. Four other unidentified government agencies and the National Intelligence Council maintain their positions with “low confidence” that the pandemic arose as a result of natural zoonosis. The US CIA and one other unnamed government intelligence agency have yet to arrive at conclusions about the pandemic’s origin. Despite the divide, all agencies currently agree that the virus was not released as an intentional weapon. The new intelligence that led the DoE to change its previous position from undecided remains classified. Some officials briefed on the new intelligence said it is relatively weak, likely leading to the DoE saying its decision was made with “low confidence.” Notably, DoE shared the intelligence with other agencies and none have changed their previous conclusions.  

White House National Security Advisor Jake Sullivan this week said there is “no definitive conclusion” on the pandemic’s origin. Many scientists and virologists point to data and what some say is “overwhelming evidence” of a zoonotic origin. Some of these same scientists are curious to learn more about the intelligence information that led the DoE to its conclusion. In the US Congress, reactions to the report have been mixed. Some lawmakers are calling for the declassification of information related to the pandemic’s origin, the establishment of a nonpartisan commission to investigate the virus’s beginnings, and restrictions on data-sharing with Chinese scientists. Others, however, are requesting classified intelligence briefings and warned against too much focus on the past at the expense of current threats. The US House Select Subcommittee on the Coronavirus Pandemic announced it will hold a hearing March 8 focused on investigating the origins of the COVID-19 pandemic. The chairs of the subcommittee and the Committee on Oversight and Accountability this week sent a letter to DoE Secretary Jennifer Granholm requesting the release of certain documents and information related to the pandemic’s origins. Additionally, US Senator John Barrasso, ranking member of the Senate Committee on Energy and Natural Resources (ENR), requested the DoE hold a classified briefing for all members of Congress on the new intelligence that led to its revised conclusion. 

Notably, the DoE assessment likely will create more tension for US-China relations already strained by recent events. US Ambassador to China Nicholas Burns this week called on China to be “more honest” about the origins of the pandemic and increase cooperation with the WHO. In response, Chinese Foreign Minister Mao Ning said China has been “open and transparent” in matters related to origin investigations and shared information and data with the international community, including the WHO, in “a timely manner.” Foreign Minister Mao also said the US government is politicizing origin investigations and called for a stop to efforts that she said are “disrupting social solidarity and origins cooperation.” 

Several experts say the debate over whether the pandemic arose due to a lab leak or a viral jump from animals to humans detracts from efforts that could help prevent either scenario in the future. Several experts previously have outlined specific steps governments and scientific institutions should take to address uncertainties about the origin of the COVID-19 pandemic. Dr. Caitlin Rivers, an epidemiologist and Senior Scholar at the Johns Hopkins Center for Health Security, this week wrote about the importance of taking actions to strengthen biosafety and biosecurity despite the likelihood that the world will never have a definitive answer on where COVID-19 originated. Such actions could include enhanced oversight of research with high consequence pathogens, better mechanisms for providing proper equipment to laboratories in low-resource settings, and the adoption of a code of conduct for biological scientists. Dr. Katelyn Jetelina, an epidemiologist and science communicator, echoed this sentiment, writing that accidental laboratory leaks, intentional laboratory leaks, and natural spillover events all need to be addressed for a safer future. She also called for more transparency, because without concrete evidence, people are forming narratives based on incomplete or sometimes downright false information, leading to the resurgence of conspiracy theories that have been disproven, as well as the emergence of new, unproven theories.
Most US states with pandemic-related emergency declarations will allow them to expire this month

Three years into the pandemic, the few US states that still have COVID-19 emergency declarations are allowing them to wind down, for the most part, offering symbolic endings to a period marked by pandemic-related challenges and the loss of more than 1.1 million lives to the disease. California’s emergency declaration ended on February 28, although some local emergencies remain in place. One of those localities is Los Angeles County, which is expected to end its COVID-19 emergency on March 31. 

According to the National Academy for State Health Policy, 7 other states have ongoing emergency declarations related to public health, disaster recovery, or supply chain issues, but all are set to expire in March unless renewed. The exception is Illinois, which is ending its disaster declaration on May 11 to coincide with the end of the federal emergency. Notably, in Texas, Governor Greg Abbott has continued to extend the state’s emergency declaration to prevent cities from imposing their own restrictions, including mask and vaccine requirements. Governor Abbott has indicated that the state’s emergency declaration will stay in place until the Texas legislature passes laws to prevent local governments from imposing these types of restrictions. The state’s Republican-controlled legislature is currently considering several bills to forbid what the sponsor called “restrictions on our personal liberties.”
US CDC advisory panel supports annual COVID-19 vaccine booster for high-risk populations; Pfizer-BioNTech request EUA for bivalent vaccine as booster for youngest children

There is insufficient evidence to support SARS-CoV-2 vaccine boosters more than once a year for older adults and people with compromised immune systems, the COVID-19 working group of the US CDC's Advisory Committee For Immunization Practices (ACIP) said on February 24. The working group supported an annual COVID-19 vaccine booster, likely in the fall, for high-risk populations, although ACIP advised showing flexibility in booster frequency recommendations, particularly for individuals at risk of severe COVID-19. CDC advisors did not vote on new recommendations, and both the CDC and US FDA continue to explore how best to annually update the vaccines to target circulating variants, in a way similar to annual influenza vaccines.

In February, the CDC added the COVID-19 vaccine to its child and adolescent immunization schedule. The schedule recommends that children between the ages of 6 months and 18 years receive 2 doses of a primary series 4-8 weeks apart and a booster dose at least 8 weeks after the second dose. On March 1, Pfizer-BioNTech requested emergency use authorization for their Omicron-adapted bivalent vaccine as a booster dose for children aged 6 months to 4 years. The bivalent vaccine is already authorized as a third dose of the 3-dose series for this age group, but a new EUA would allow children under age 5 to get a fourth dose using the updated vaccine, at least 2 months after completing their primary series. 
Incidence of long COVID could be declining; people with condition more likely to develop cardiac complications, suffer from orthostatic tachycardia

Several recent studies, as well as anecdotal evidence, suggest the incidence of post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, has decreased over time. Nevertheless, there are an enormous number of people who are suffering with lasting symptoms—at least 65 million people worldwide, according to one study. Notably, a recent study published in Preventive Medicine found the prevalence of SARS-CoV-2 infections and incidence of long COVID among US adults during the Omicron BA.4/BA.5 surge was higher than previous estimates that focused primarily on people who were hospitalized or sought medical care, which has key implications on the burden of long COVID.

A study published in Clinical Infectious Diseases earlier this year showed prolonged symptoms of COVID-19 were more common among participants during the beginning of the pandemic, before the Delta and Omicron variants of concern emerged. When the researchers adjusted for vaccination status, the differences were no longer significant, suggesting vaccination, or possibly immunity from prior infection, has a beneficial effect on the risk of long COVID. Two other studies published this week in BMJ Medicine, as well as another published in JAMA Network Open, also support the theory that vaccination reduces case severity and the risk of developing long COVID, although it is not known to what degree and additional studies are needed.

According to a meta-analysis to be presented next week at the American College of Cardiology (ACC)/World Congress of Cardiology Annual Scientific Session, people with long COVID are at more than double the risk of new-onset cardiovascular symptoms than people who were never infected with SARS-CoV-2. The researchers noted that clinicians need to be aware of the association between long COVID and cardiac complications, which some speculate could be caused by chronic inflammation. Another condition that impacts up to 30% of patients with long COVID is postural orthostatic tachycardia syndrome, or POTS, a disorder of the autonomic nervous system that can result in symptoms such as dizziness, fainting, fatigue, and a significant increase in heart rate upon standing or exertion. Few clinicians know how to care for POTS patients, and The BMJ recently published a Practice Pointer on orthostatic tachycardia after COVID-19 to raise awareness.
To help better understand the long-term implications of post-COVID conditions, the US CDC recently expanded its guidelines for certifying deaths to include PASC as the reason for or an underlying cause of death, even if the original SARS-CoV-2 infection occurred months or years prior.
US FDA authorizes first-ever at-home COVID-19, flu test kit

The US FDA on February 24 issued an emergency use authorization (EUA) for the first over-the-counter (OTC) at-home diagnostic test that can differentiate and detect influenza A and B, commonly known as the flu, and SARS-CoV-2, the virus that causes COVID-19. The Lucira COVID-19 & Flu Home Test, a single-use at-home test kit, uses nasal swab samples to provide results in about 30 minutes. Notably, Lucira Health, the California-based test manufacturer, filed bankruptcy on February 22, blaming the FDA’s “protracted” authorization process for its financial troubles. Questions remain about the company’s manufacturing capacity, how much the test will cost, and when such a combined test—from Lucira or other companies—will be widely available to consumers. 
What we’re reading

VACCINE RESEARCH PUBLIC INVESTMENTS According to a study published March 1 in BMJ, the US government invested at least US$31.9 billion to develop, produce, and purchase mRNA COVID-19 vaccines, including significant investments made in the 30 years prior to the pandemic. Moderna recently made a US$400 million payment for the rights to a chemical technique that its scientists said they borrowed from government-funded research to make the company’s mRNA-based SARS-CoV-2 vaccine. The payment will be shared among the US NIH and 2 US universities where the method was invented. Moderna and NIH continue to dispute who owns the rights to information that makes up the central component of the vaccine. 

PRETERM BIRTHS Across a group of mostly high-income countries—including Belgium, Canada, Chile, Denmark, Switzerland, and the United States—about 4% fewer preterm births than expected occurred in spring 2020, when most of the world was in lockdown at the onset of the COVID-19 pandemic. According to the research, published in Nature Human Behavior, this translates to nearly 50,000 premature births averted globally in the first month of lockdown alone. The finding could help researchers better understand what leads to preterm birth, which is the leading cause of infant mortality worldwide.

SURVEILLANCE TECHNOLOGIES In the beginning of the COVID-19 pandemic, the use of surveillance technologies—such as overhead infrared thermometers and wearable tracking devices—ramped up quickly. These technologies often forced essential workers to change how they worked, sometimes made workplaces less safe, and typically did not offer clear and accurate information to help workers protect their own health, according to a new report by the nonprofit Data & Society. The report assessed the impact of COVID-19 surveillance on the employees—who were mostly Black, Latino, and low-income—of several industries such as meatpacking and food processing, warehousing, grocery retail, and manufacturing. 

ASYMPTOMATIC TRANSMISSION Initially, SARS-CoV-2 was thought to spread only from symptomatic infected people, as SARS-CoV did, but was later understood to also transmit from people without symptoms. This covert transmission potential prompted public health officials to encourage widespread mask use, physical distancing, and testing to help prevent the virus’s spread. Now, enthusiasm for these protective measures is waning, partially because people have more immune protection from vaccination and/or prior infection; however, asymptomatic transmission still occurs, leaving questions about how many people experience COVID-19 without becoming symptomatic. 

PANDEMIC TREATY In a commentary published in The BMJ, Dr. Alexandra Phelan, Senior Scholar at the Johns Hopkins Center for Health Security, discusses the importance of operationalizing equity through international law surrounding infectious diseases, specifically within a draft pandemic treaty currently under negotiation among WHO member states. Dr. Phelan calls for the “effective participation of all member states, strong civil society engagement, and transparency” in the negotiation processes, as well as the incorporation of legal measures aimed at decolonization and benefit sharing, as all will help prepare the world to better respond to the next disease threat.  
Epi update

As of February 28, the WHO COVID-19 Dashboard reports: 
  • 758 million cumulative COVID-19 cases 
  • 6.86 million deaths
  • 1.02 million cases reported week of February 20 
  • 13% decrease in global weekly incidence 
  • 6,958 deaths reported week of February 20 
  • 13.5% decrease in global weekly mortality 

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+9.35%). 

The US CDC is reporting: 
  • 103 million cumulative cases
  • 1.1 million deaths
  • 236,131 cases week of February 22 (down from previous week)
  • 2,407 deaths week of February 22 (down from previous week)
  • 7.5% weekly decrease in new hospital admissions 
  • 7.3% weekly decrease in current hospitalizations 

The Omicron sublineages XBB.1.5 (85%), BQ.1.1 (9%), and BQ.1 (3%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.

The following websites provide up-to-date epidemiological information down to the US county level:

Johns Hopkins University Daily COVID-19 Data in Motion (daily video showing global and US trends)**

New York Times Coronavirus in the US: Latest Map and Case Count (US data portrayed in tables, maps, and graphs)

US CDC COVID-19 Integrated County View (click on pulldown menu to view either COVID-19 Community Levels or Community Transmission, as well as other indicators specific to the US)

**The Johns Hopkins University Coronavirus Resource Center will cease live COVID-19 data reporting on March 10.
Editor: Alyson Browett, MPH

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