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

CALL FOR PAPERS Early detection of biological threats, whether naturally occurring or manmade, is critical. Threat agnostic approaches, which do not rely on determining the identity of the agent or pathogen, show early promise. In 2023, the Johns Hopkins Center for Health Security journal, Health Security, will issue a special feature that considers threat agnostic approaches to biodefense and public health. We encourage submissions of original research articles, case studies, and commentaries that explore policy gaps, data and data analysis, and implementation, among potential topics. The deadline is March 31, 2023. For more information, visit:
In this issue

> New analysis appears to link SARS-CoV-2 origin to raccoon dogs in Wuhan market, raises questions about completeness of data shared by China; US law requires declassification of intelligence information

> End of US public health emergency to impact various healthcare programs, rules; US House Republicans eye canceling unspent COVID-19 aid to help rein in federal spending

> US Senate HELP Committee hears testimony from Moderna CEO about expected commercial market price increase for vaccine

> US FDA expected to soon decide on authorization of additional bivalent booster dose; Canada, UK move forward with shots for some individuals

> What we're reading

> Epi update
New analysis appears to link SARS-CoV-2 origin to raccoon dogs in Wuhan market, raises questions about completeness of data shared by China; US law requires declassification of intelligence information 

More than 3 years into the COVID-19 pandemic, the origin of the SARS-CoV-2 virus remains a hotly contested topic. In the absence of a “smoking gun,” it is unclear exactly how the virus first infected humans, and it may never be definitively determined whether the virus evolved naturally among animals or escaped a laboratory setting. Investigations into the emergence of SARS-CoV-2 have been hindered by insufficient access to facilities, personnel, specimens, and data in China, and intense political divisions—in the US and elsewhere—have made public debate over the available evidence difficult.

Recent revelations regarding early genetic data from specimens collected at the Huanan Seafood Wholesale Market in Wuhan, China, in early 2020 provide additional support for theories that the pandemic emerged as a result of natural zoonotic transmission. Dr. Florence Débarre, a researcher from France, recently identified a previously undisclosed trove of genetic data published on the GISAID platform. Among the viral genetic data, she 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. Notably, the Chinese government previously asserted that these types of animals were not present at the market. Reportedly, after Dr. Débarre reached out to Dr. George Gao, former Director of the China CDC, to collaborate on further research, the data were removed from GISAID “at the request of the submitter.” Following a briefing by Dr. Débarre’s team last week, WHO Director-General Dr. Tedros Adhanom Ghebreyesus chastised China for withholding the data and called on the Chinese government to share all of the available data immediately. The researchers published their findings (preprint) on March 20. While the new data still do not provide definitive proof, they demonstrate that the Chinese government has more data available than what it has shared.

Following unanimous approvals in both houses of the US Congress, President Joe Biden signed a bill requiring US intelligence agencies to declassify all information related to investigations on the origin of SARS-CoV-2 and the Wuhan Institute of Virology in China. To date, various public reports from the US intelligence community indicate that agencies have reached different conclusions regarding the likely origin of the pandemic. Following the release of its report that concluded—albeit with “low confidence”—that a laboratory incident was the most likely origin, the US Department of Energy briefed the Senate Energy and Natural Resources Committee on March 16 about classified information underpinning that analysis.
End of US public health emergency to impact various healthcare programs, rules; US House Republicans eye canceling unspent COVID-19 aid to help rein in federal spending

The WHO said this week that its experts are confident that the public health emergency of international concern (PHEIC) declaration for COVID-19 will be able to be declared over by the end of this year. Similarly, the Biden administration previously announced an end to the US public health emergency for COVID-19 in May, and this week said it will disband its White House COVID-19 Response Team at the same time. The end of the public health emergency will bring with it changes to healthcare access and benefits for many residents nationwide. Millions will lose healthcare coverage with the end of continuous Medicaid enrollment, a change likely to disproportionately impact Black and Hispanic adults, according to a recent Commonwealth Fund report. Additionally, training rules for nursing home staff will become stricter; rollbacks of broader access to certain controlled substances threaten treatment for people recovering from addiction; hospitals and other care facilities will have to comply with stricter capacity and staffing rules; and federal COVID-19 surveillance reporting requirements for states will end. 

Additionally, Republicans in the US House are targeting unspent COVID-19 relief money in a plan to cut federal spending. Though a small amount—less than US$80 billion unspent as of January out of the total US$5.2 trillion relief aid allocated—canceling the funds would have huge repercussions for union pension funds, healthcare for veterans, COVID-19 research efforts, and aid for small businesses and transportation systems.
US Senate HELP Committee hears testimony from Moderna CEO about expected commercial market price increase for vaccine 

In early 2023, reports emerged publicly that Moderna planned to increase the price of its SARS-CoV-2 vaccine, quadrupling it from between US$15–$26.36 to US$110–$130 per dose, when it shifts its sales to the commercial market later this year. The end of the COVID-19 public health emergency in May will shift the burden of purchasing vaccines to the private sector. Moderna earned about US$40 billion from sales of its COVID-19 vaccines alone over the past 2 years. On March 22, Moderna CEO Stéphane Bancel testified regarding those plans before the US Senate Committee on Health, Education, Labor and Pensions (HELP Committee). Mr. Bancel argued that, while Moderna received considerable funding from the federal government—on the order of US$12 billion for research, development, and procurement—the company will need to implement new production and logistics as the pandemic enters an endemic phase. The combination of new manufacturing processes, storage, wastage, and significantly lower demand necessitates higher costs per dose, he said. Some Senators on the committee argued in favor of Moderna, noting that the success of Moderna’s vaccine illustrates the benefits of capitalism. While the purchase cost of the vaccine is expected to increase, Moderna has committed to ensuring the vaccines remain fully covered by health insurance. Patient assistance programs also will help uninsured or underinsured individuals access the vaccines, but some Senators noted that the paperwork for these programs can be difficult to navigate. Pfizer and BioNTech also plan to increase the cost of their SARS-CoV-2 vaccine to US$110–$130 per dose, but the companies did not use US government funding in developing the shot.
US FDA expected to soon decide on authorization of additional bivalent booster dose; Canada, UK move forward with shots for some individuals

The US FDA is discussing the possibility of authorizing a second round of vaccine boosters targeting the Omicron variant for certain people at high risk of severe COVID-19 illness. The agency is expected to decide within a few weeks, according to people familiar with the deliberations. The bivalent booster is currently recommended for anyone aged 6 months and older after completion of any FDA-approved or FDA-authorized primary series or previously received monovalent booster dose(s), with an exception for the youngest children who received the bivalent vaccine as the last dose in their 3-dose primary series. 

While only 16.4% of the total US population has received the updated booster, a small percentage of people are anxiously wondering when they can get another shot. People aged 65 and older are contributing a larger proportion of COVID-19-related deaths over time, particularly those who have underlying health conditions. Additionally, though people who are immunocompromised make up about 3% of the US population, they account for 25% of people hospitalized with COVID-19. For both of these populations, vaccine effectiveness against hospitalization and symptomatic infection begins to drop significantly 2–4 months following their last booster. Canada and the United Kingdom are offering the bivalent booster to older adults, residents of care homes and other senior living settings, and certain people who are immunocompromised. We should know soon whether the US will authorize boosters for similar groups.
What we’re reading

CHILDREN & FAMILIES The COVID-19 pandemic had an unprecedented impact on the lives of children and their families in the United States, and greater focus and investment are needed to address the critical social, emotional, behavioral, educational, mental, physical, and economic health and well-being challenges that the pandemic caused or exacerbated, especially among families identifying as Black, Latino, and Native American, and those with low incomes, that have disproportionately borne the stress of these negative effects, according to a report published March 16 by the National Academies of Sciences, Engineering and Medicine. The report makes several recommendations for federal- and state-level legislatures and agencies to address the short- and long-term effects on children and families and to prepare for the next pandemic.  

PAXLOVID A panel of expert advisors to the US FDA voted 16-1 last week to endorse the antiviral Paxlovid (nirmatrelvir-ritonavir) as a treatment for adults with COVID-19 who are at high risk for progression to severe illness. Notably, the committee highlighted potentially harmful drug interactions. Experts later said there is not enough data to determine exactly who would benefit most from the drug and a poor understanding of the treatment among the medical community, hindering its prescription. According to a recently released analysis, Paxlovid use could “lead to 1,500 lives saved and 13,000 hospitalizations averted each week in the United States,” based on COVID-19 data from January 2023. Another study, published March 17 in JAMA Health Forum, modeled population-level impacts of a Paxlovid rollout during a surge like the 2022 winter Omicron wave. The panel’s endorsement likely will lead to full approval of the drug by FDA, although the agency is not required to follow the advice of its advisory committees. A final decision is expected in May. In related news, a study by the Yale School of Medicine is testing whether a 15-day course of Paxlovid can improve the health of people with long COVID.

PANDEMIC-RELATED STATE LAWS, LEGISLATION & REGULATIONS On March 17, KHN published 2 articles examining various state-level legislative actions or laws with pandemic-related roots. One article discusses legislation and proposed regulations in more than a dozen states aimed at controlling healthcare staffing agency wage rates for temporary workers during health emergencies, as well as steps hospitals and health facilities are taking to retain their workers with the acute challenges of the pandemic now in the past. Another article examines how California’s COVID-19 misinformation law, which is meant to discipline doctors who provide false information about COVID-19 patients, is mired in legal limbo after 2 federal judges issued conflicting rulings in recent lawsuits.

CHINA China this week authorized a domestically produced mRNA vaccine against COVID-19, after showing reluctance to use similar vaccines produced in the US and European nations. According to CSPC Pharmaceutical Group Ltd., which makes the vaccine, known as SYS6006, a large clinical trial showed the vaccine is safe and effective against several Omicron subvariants. The WHO urged CSPC to share its full data so the health agency can assess the vaccine for use on the international market. China’s other homegrown vaccines, which use more traditional platforms, proved less effective against newer Omicron variants. According to a report from the Associated Press, China’s sudden scrapping of its strict “zero COVID” policy in late 2022 went against the advice of experts and led to hundreds of thousands of COVID-19-related deaths, some of which could have been avoided with better vaccination coverage and more prepared healthcare facilities. 

EQUITABLE VACCINE DISTRIBUTION Equitable worldwide distribution of COVID-19 vaccines would increase global economic benefits by about US$950 billion per year by improving health gains, helping to ease lockdowns, and supporting supply chain recovery, when compared with a scenario focused on vaccinating the entire populations of vaccine-producing countries first then distributing vaccines to other nations, according to an analysis published this week in Nature Communications. The researchers propose a benefit-sharing mechanism that allows all stakeholders to benefit and provides a model to analyze distribution strategies in different infectious and socioeconomic contexts. They note that the need for equitable vaccine distribution is one of the most important lessons to be learned from COVID-19, though global collaboration continues to present a challenge. Notably, wealthy nations already appear to be repeating their COVID-19-era vaccine hoarding tendencies with avian influenza vaccines

UN CLIMATE REPORT A report released this week by the UN Intergovernmental Panel on Climate Change (IPCC) warned that the world is likely to fail at meeting its most ambitious climate target—limiting warming to 1.5 degree Celsius (2.7 degrees Fahrenheit) above preindustrial temperatures—by the early 2030s. This change could bring about catastrophic damage to the Earth, causing climate disasters and other impacts—such as heat waves, famines, and infectious disease outbreaks—so extreme that humans will have difficulty adapting. The authors said humanity has reached a “critical moment in history” and needs to accelerate actions to achieve its climate goals.
Epi update

As of March 21, the WHO COVID-19 Dashboard reports: 
  • 761 million cumulative COVID-19 cases 
  • 6.88 million deaths
  • 734,302 million cases reported week of March 13 
  • 18% decrease in global weekly incidence
  • 4,897 deaths reported week of March 13 
  • 22% decrease in global weekly mortality 

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+57%) and Eastern Mediterranean (+47%) regions. 

The US CDC is reporting: 
  • 103.8 million cumulative cases
  • 1.12 million deaths
  • 149,955 cases week of March 15 (down from previous week)
  • 1,706 deaths week of March 15 (down from previous week)
  • This is the lowest weekly mortality since March 2020
  • 7.8% weekly decrease in new hospital admissions 
  • 12.1% weekly decrease in current hospitalizations 

The Omicron sublineages XBB.1.5 (90.2%), BQ.1.1 (3.5%), XBB (2.5%), and XBB.1.5.1 (2.2%) currently account for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases. 

Please note, this is the last week we will include this section; bookmark pages for easy future reference.

The New York Times this week ended its COVID-19 data collection and switched to using official data from the US CDC, which is updated weekly. The dashboard shows information about hospital patients with COVID-19; reported cases and tests; the number of COVID-19 deaths; vaccination coverage and comparisons between vaccinated and unvaccinated populations; and a new interactive county map, including COVID-19 community levels that take into account case and hospitalization data.

Community transmission data, which takes into account case and test positivity data, is available on the US CDC COVID-19 Integrated County View (click on pulldown menu to view COVID-19 Community Transmission, as well as other indicators specific to the US).
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