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

> US House Select Subcommittee holds hearing on origin theories of SARS-CoV-2; Democrats, Republicans agree further investigation needed 

> US Intelligence Community discusses health security in Annual Threat Assessment; lawmakers push for declassification of information related to COVID-19 origin investigations

> Health Affairs studies examine trust in public health agencies, exodus of state, local public health employees

> Systematic ethnic inequalities in COVID-19 health outcomes exist, study shows

> New studies support increased risk of cardiovascular events, symptoms following even mild SARS-CoV-2 infection

> What we're reading

> Epi update
US House Select Subcommittee holds hearing on origin theories of SARS-CoV-2; Democrats, Republicans agree further investigation needed 

The US House Select Subcommittee on the Coronavirus Pandemic held a hearing March 8 on “Investigating the Origins of COVID-19” to examine theories about the origination of SARS-CoV-2. Many say determining whether the virus emerged in Wuhan, China, because of a laboratory-related incident or natural animal-to-human transmission is important to help inform efforts that could prevent another novel disease and pandemic, while others say that crucial steps to improve the security and safety of labs and to study and track the spread of diseases in nature can be taken now, without knowing the origin of this novel coronavirus. The hearing, which included a panel of scientists, most of whom support a lab leak theory, produced no new evidence and made it clear that uncovering evidence to prove either theory will be difficult. While the hearing involved some political theater, Democrats and Republicans on the committee appeared to agree that both theories are plausible, and that further investigation is needed. How to go about doing that is in question, as several witnesses noted that China has not been forthcoming in offering cooperation in the search for answers. 

Dr. Robert Redfield, former director of the US CDC, who suspects the virus emerged due to a lab leak, said he was cut out of early discussions about where the virus came from because of his beliefs and called for a moratorium on gain-of-function research. To be clear, most experts and US officials, including US intelligence agencies, do not believe the virus was intentionally created in or released from a Chinese lab. A panel of the US NIH recently convened experts to discuss boosting oversight of research involving enhanced potential pandemic pathogens (PPPs), but so far the federal government has not moved to ban this type of research entirely. The renewed debate over the origins of COVID-19 comes after the release of assessments by several federal agencies. The House is expected to vote this week on a US Senate-passed bill calling for the declassification of information related to the origins of COVID-19 (more below).
US Intelligence Community discusses health security in Annual Threat Assessment; lawmakers push for declassification of information related to COVID-19 origin investigations

The US Office of the Director of National Intelligence this week released its 2023 Annual Threat Assessment of the US National Intelligence Community (IC), which focuses on the most direct, serious threats to the nation in the next year. In a section on health security (pages 24-25), the report discusses infectious diseases and impacts from the COVID-19 pandemic—including economic, human security, political, and national security implications that will persist over the next year and for years to come—and says the IC continues to investigate whether the novel coronavirus arose due to a laboratory-associated incident or natural exposure to an infected animal. Additionally, the assessment finds countries worldwide remain vulnerable to the emergence or introduction of a novel pathogen that could lead to a new pandemic, briefly outlining drivers for disease emergence. The report also discusses threats related to the development of biological weapons and occurrence of anomalous health incidents.  

IC leaders from across the US government appeared before the US Senate Intelligence Committee on March 8 to discuss the threat assessment’s findings. Director of National Intelligence Avril Haines outlined the IC’s various findings regarding the origin of SARS-CoV-2. Several Republican Senators this week sent a letter to Director Haines requesting the independent IC assessments on the pandemic’s origin be delivered to members of US Congress so they can be evaluated “without filters, ambiguity or interpretations of the intelligence.” Last week, the Senate passed a bill by unanimous consent to require the Director of National Intelligence to declassify information related to the origins of COVID-19. The US House is scheduled to vote on the bill on March 10.
Health Affairs studies examine trust in public health agencies, exodus of state, local public health employees 

In its March 2023 issue focused on lessons learned regarding public health during the COVID-19 pandemic, the journal Health Affairs includes a study surveying 4,208 US adults to learn their reasons for trust in federal, state, and local public health agencies’ information during the COVID-19 pandemic. Among respondents, 37% said they have a "great deal" of trust in the US CDC's health recommendations, whereas state and local health departments were highly trusted by about one-quarter of respondents. Between 37%-51% of respondents trusted these public health agencies somewhat, and <10% reported no trust at all in the health information provided by these agencies. Respondents who expressed a “great deal” of trust in public health agencies associated those beliefs with agencies’ abilities to make clear, science-based recommendations instead of abilities to control the spread of COVID-19. Scientific expertise was cited more commonly as a reason for a “great deal” of trust in the CDC, whereas state and local agencies garnered more trust due to perceptions of hard work, compassionate policies, and direct services. 

Compared with a similar survey conducted in 2021, the Health Affairs study shows the US public’s trust in the CDC has dropped. Respondents’ reduced trust was influenced by their beliefs that health recommendations were politically influenced and inconsistent, concerns about private-sector influence, and dislike of excessive restrictions. To begin to address the public’s concerns, the CDC conducted an internal review of its shortcomings during the COVID-19 pandemic and is undergoing a reorganization, with greater focus on disseminating scientific evidence more rapidly, focusing on health communication, and transitioning into becoming a more response-based agency. 

Notably, a 2022 survey found that 90% of adults think public health departments play an important role in creating a healthy community. Nonetheless, another study published in Health Affairs shows that nearly half of all employees of state and local public health agencies left their positions between 2017 and 2021. Among employees aged 35 or younger or those with shorter tenures, the proportion rose to three-quarters. Reasons for the exodus are multifaceted but include low salaries, work overload and burnout, stress, harassment, and lawsuits and legislation that have stripped the public health system of its powers and authority to address health risks. Legislators in more than half of US states have proposed—and, in some cases, successfully passed—bills to curb public health authorities’ power to implement preventive measures such as mask mandates, quarantine or isolation requirements, vaccine mandates, school closures, and more. The study notes that if the separation trend continues, more than 100,000 workers—about half of the total governmental public health workforce—could leave their posts by 2025, causing significant gaps in the nation’s vital public health-related knowledge base and a lack of a pipeline for future public health leaders.
Systematic ethnic inequalities in COVID-19 health outcomes exist, study shows

The COVID-19 pandemic exacerbated existing racial and ethnic inequalities in health. A global meta-analysis of 77 studies involving more than 200 million participants published online March 5 in eClinicalMedicine highlights the ethnic inequalities in COVID-19-related clinical health outcomes. When compared to White majority populations, an increased risk of testing positive for COVID-19 was observed for Black, South Asian, Mixed, and Other ethnic populations. Black and Hispanic ethnic groups and Indigenous populations had an increased risk of hospitalization, with an increased risk of ICU admission among the same groups as well as among South Asian, East Asian, and Mixed ethnic groups. Mortality risk was increased among Hispanic, Mixed, and Indigenous groups. Additionally, the risk for severe disease among hospitalized cases was greater for minority ethnic groups in low- and middle-income countries compared with those in higher-income countries. Prognosis following hospitalization varied among groups, with South Asian, East Asian, Black, and Mixed ethnic groups having an increased risk of ICU admission, and Mixed ethnic groups showing a greater mortality risk. Studies from the US NIH support these findings, showing that Black and Hispanic Americans are more likely than White Americans to have post-COVID conditions, also known as long COVID; experience higher rates of hospital admission; and are more likely to die from COVID-19.
New studies support increased risk of cardiovascular events, symptoms following even mild SARS-CoV-2 infection 

Several recent studies have examined cardiovascular risks associated with the COVID-19 pandemic and SARS-CoV-2 infection, which can induce inflammation and blood clotting, further predisposing people to related adverse events. In February 2022, a seminal study published in Nature Medicine showed that people with COVID-19, even mild infections, are at increased risk of incident cardiovascular disease of various types more than 30 days out from acute infection. Since then, other studies have reported similar findings. A study published March 3 in JAMA Health Forum observed that US adults with post-COVID-19 conditions and symptoms were at elevated risk for cardiovascular conditions such as ischemic stroke and blood clots in the lungs 1 year after acute SARS-CoV-2 infection. Another study, presented recently at the American College of Cardiology's Scientific Conference and not-yet peer-reviewed, found that patients who tested positive for COVID-19 had significantly higher rates of chest pain up to 1 year after infection, compared with a control group of matched patients seen for other indications. Though no other increases in cardiovascular events were observed, the study signals that even mild initial COVID-19 infections could be a sign of future cardiovascular complications.

A study in Nature Cardiovascular Research found that there were 90,160 excess cardiovascular deaths, or 4.9% more cardiovascular deaths than expected, between March 2020 to March 2022. Time periods of excess cardiovascular deaths coincided with peaks of COVID-19 deaths, suggesting at least some of the excess deaths may be attributable to disruptions in cardiovascular medical care during the pandemic and patients’ risk-mitigation-related reluctance to seek healthcare. Together, these findings show the need for improved access to healthcare services during health emergencies and greater awareness of the potential for cardiovascular risks posed by even mild SARS-CoV-2 infections.
What we’re reading

TRAVEL RESTRICTIONS US officials are expected to lift COVID-19 testing restrictions on travelers from China as soon as March 10, based on a decline in the number of new cases in the country. Australia’s testing restrictions on travelers from China, Hong Kong, and Macau will end at midnight on March 11. Other countries that imposed similar restrictions, such as Japan, have recently eased testing rules.
MENTAL HEALTH The COVID-19 pandemic has been associated with worsening mental health, for people in the United States and worldwide. The Pew Research Center examines findings from its surveys, as well as those conducted by other organizations, about US residents’ mental health during the pandemic. Noting that concerns about mental health in the US were increasing prior to COVID-19, the piece summarizes findings about mental health among US adults, high school students, younger children, and parents. Another study, published in BMJ this week, reviewed 137 studies and compared general mental health, anxiety symptoms, or depression symptoms assessed during the pandemic with similar data collected between January 2018 and December 2019. The researchers, from McGill University in Canada, found symptom changes were of minimal to small magnitudes and called for more rigorous study into the nuance of mental health.

INDOOR AIR QUALITY The COVID-19 pandemic has shed light on the importance of indoor air quality (IAQ), prompting a focus on efforts to make lasting improvements to the air we breathe, Nature reports. SARS-CoV-2, as well as myriad other viruses that cause chickenpox, measles, tuberculosis, and influenza, are primarily spread in indoor spaces. To address the issue, national governments and US state legislatures have enacted laws and rules to improve ventilation and air quality in indoor spaces. IAQ experts—including a group involving scientists from the Johns Hopkins Center for Health Security that is drafting a Model State Indoor Air Quality Law—are hoping long-term changes can be made to lower the infection risks inside buildings.  

US SCHOOL PANDEMIC RELIEF FUNDS US states and school districts have spent less than half of their allotted COVID-19 education relief funds, according to the latest data by the Education Stabilization Fund, and are now working to spend or allocate those funds to close COVID-19-related learning gaps. A January 2023 report estimates that it could take decades to recover from the drastic learning losses due to academic disruption during the pandemic. The Elementary and Secondary Schools Emergency Relief funds must be allocated or spent by September 2024, or be lost. Of educational relief funds that have been spent, federal and state auditors say some have been spent questionably. The US Department of Education’s Office of Inspector General found faulty awards, improper contracts, and double payments in a sampling of US$280 billion in federal pandemic funds. The audits cover at least 9 pandemic-related programs. Thus far, 46 districts and 3 states have been evaluated, with the rest ongoing. 

DISHONESTY AMONG PARENTS In a survey including 580 parents of children younger than 18 years living with them, 26% reported "misrepresentation of and nonadherence to COVID-19 recommendations" in at least 1 of 7 COVID-related public health measures pertaining to exposure, quarantine, vaccination and testing, according to a study published this week in JAMA Network Open. Of those who lied, 52.4% said they did so to exercise their parental autonomy, 47.6% said their child did not feel very sick, 44.4% said they did not want to miss a fun event, and 42.9% said they did not want their child to miss school. Other reasons parents listed included that they wanted their child’s life to feel normal; were following advice from a public figure, like a politician or celebrity; or could not miss work or other duties. Of the respondents, who volunteered and were not chosen randomly, 70% identified as women. The researchers said the results suggest better support mechanisms, such as paid sick leave for family illnesses, might help prevent dishonest behavior in the future.

NEANDERTHAL GENES Since the beginning of the pandemic, researchers have been working to better understand why some people appear to be more susceptible to severe COVID-19 than others. A new study from an international group of scientists has identified 4 specific gene variants of Neanderthal origin that strongly modulate the regulation of the CCR1 and CCR5 genes, which are important receptors for chemokines, small proteins within the cytokine family that play significant roles in the activation of immune responses. Cytokine storms—during which the body releases too many cytokines into the blood too quickly, leading to severe immune reactions—are characteristic of severe COVID-19. Additional study is needed into the role of these gene variants and other genetic risks in immune responses to COVID-19. 
Epi update

As of March 7, the WHO COVID-19 Dashboard reports: 
  • 759 million cumulative COVID-19 cases 
  • 6.87 million deaths
  • 999,848 million cases reported week of February 27* 
  • 7% decrease in global weekly incidence
  • 6,021 deaths reported week of February 27 
  • 24% decrease in global weekly mortality 

Over the previous week, incidence declined or remained relatively stable in all WHO regions except the South-East Asia (+28%) and Eastern Mediterranean (+36%) regions. 
*Marks first time global reported cases have dropped below 1 million since June 8, 2020

The US CDC is reporting: 
  • 103.5 million cumulative cases
  • 1.1 million deaths
  • 226,618 cases week of March 1 (down from previous week)
  • 2,290 deaths week of March 1 (down from previous week)
  • 7.9% weekly decrease in new hospital admissions 
  • 9.9% weekly decrease in current hospitalizations 

The Omicron sublineages XBB.1.5 (90%), BQ.1.1 (6.7%), and BQ.1 (2%) 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