COVID Pandemic Updates - July 19, 2022 - AHMC COVID Team
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
COVID Pandemic Updates
July 19, 2022
AHMC COVID Team
Outline 7/18/2022 1. Topic of Interest: BA.5 & Reinfection P. 3 2. Rapid Increase of LA and AHMC Cases P. 16 3. Cases and Deaths P. 22 4. Vaccines and Variants P. 37 5. Monkeypox Updates P. 47 2
1. Topic of Interest: BA.5 & Reinfection
Source 3
COVID-19 Variant Proportions in the US
- BA.5 increased to 65% in ~2 weeks
- BA.5/BA.4 account for 81.3%
(CDC, 7/15/2022)
6/19/2022 – 6/25/2022 7/3/2022 – 7/9/2022
BA.5:
BA.5: 65%
36.6% BA.4:
BA.4: 16.3%
15.7%
81.3%
52.3%
Source: CDC 4
BA.5 Now Second Highest in Confirmed Cases
- The real number may be substantially higher due to case undercounts
(Our World in Data, 7/16/2022)
Global Confirmed Cases Omicron
BA.1
Omicron
BA.5
Source: Our World In Data 5
Omicron BA.5 Reinfection Risks (1/2)
- BA.5 is driving a wave of infections in vaccinated / unvaccinated
(Johns Hopkins, 7/2/2022)
● The Omicron BA.5 subvariant has quickly become the most
predominant variant in the US due to its ability to evade
immunity from either previous infection or vaccination.
● The subvariant is more likely to cause reinfections and is
driving a wave of new infections across the country, with
official US CDC data showing a daily average of around
100,000 new cases.
● However, experts warn this represents a severe undercount
of new cases.
Source: Johns Hopkins 6
Omicron BA.5 Reinfection Risks (2/2)
- Reinfections can increase risk of long-term morbidities
(Johns Hopkins, 7/2/2022)
● Prior to Omicron, reinfections were rare; but now in
countries such as the UK, about 25% of new cases are
reinfections.
● Though many believe BA.5 does not cause more severe
disease than other variants, hospitalizations in many
countries are rising and evidence suggests that multiple
infections can increase the risk of long COVID.
● New York City and Los Angeles have reinstated or may
soon reinstate mask mandates for indoor spaces.
Source: Johns Hopkins 7
New Moderna and Pfizer Omicron Booster
Candidates Not as Effective Against BA.4 and BA.5
- Neutralizing titers against BA.4 and BA.5 were approximately
3-fold lower for both boosters compared to BA.1
(Moderna/Pfizer, 6/25/2022)
● Upcoming Omicron bivalent booster candidates from Moderna
and Pfizer currently target both ancestral strain and BA.1.
● For Moderna Booster:
○ Neutralizing titers against BA.5/BA.4 were approximately 3-
fold lower than neutralizing titers against BA.1.
● For Pfizer Booster:
○ Sera from participants neutralized BA.5/BA.4 with titers
approximately 3-fold lower than BA.1. 8
Source: Moderna, Pfizer
BA.5 and BA.4 Escape Antibodies
- Immune evasiveness raises concerns of
effectiveness of BA.1-specific boosters
(Nature, 6/17/2022)
● Most cross-reactive neutralizing antibodies from BA.1 are heavily
escaped by certain mutations (L452Q, L452R, and F486V).
● While BA.1 infection can induce new clones of BA.1 antibodies,
these neutralizing antibodies are largely escaped by BA.5/BA.4.
● Other mutations (S371F, D405N, and R408S) undermine most
broad sarbecovirus neutralizing antibodies.
● Results indicate that Omicron may evolve mutations to evade the
humoral immunity elicited by BA.1 infection, suggesting that BA.1
boosters may not achieve broad-spectrum protection against new
Omicron variants.
Source: Nature 9
FDA Recommends Inclusion of Omicron BA.5
and BA.4 for Upcoming Vaccine Boosters
- New booster candidates may include BA.5/4
(FDA, 6/30/2022)
● BA.5 and BA.4 made up about 81.3% of all new COVID cases in the
United States (as of 7/18).
● Pfizer and Moderna developed new boosters targeting both the original
strain and BA.1. While those vaccines upped the immune response to
all Omicron, they provided less protection against BA.5 and BA.4.
● FDA is urging development of safe and effective boosters that provide
protection against circulating and emerging variants (such as BA.5/4).
● Both Pfizer and Moderna have said they are prepared to update their
current candidates to include BA.5 and BA.4.
Source: FDA, Pfizer 10New Omicron Boosters Won’t Need New
Clinical Trials for Clearance
- FDA is fast tracking new booster development
(FDA, 7/1/2022)
● Vaccine manufacturers won’t need to conduct new clinical trials as
they develop booster shots targeting BA.5/BA.4.
● FDA will use data from earlier clinical trials to evaluate the shots.
● FDA said that the next set of booster shots should be against the
newest variants of the virus instead of just BA.1.
● Relying on existing data will let the FDA and vaccine makers move
more quickly to make booster shots available, though some worry it
may not be ready in time to stave off the current BA.5 wave.
Source: FDA 11White House Outlines Strategy to Combat BA.5
- 2nd booster eligibility for all adults may help against BA.5 wave
(BHR, 7/12/2022)
● White House wants to make 2nd boosters available to all adults to
help against rising cases and hospitalizations driven by BA.5.
● Approval from the FDA and CDC is still needed.
● Health officials are urging people to get their 1st booster if they
haven't, while those aged 50+ should get their 2nd booster.
● Data shows that those vaccinated with a 3 doses had 4x the risk of
dying from COVID compared to those who had 4 doses. CDC
data shows only 28% of people 50+ have gotten their 2nd booster.
Source: BHR 12We Can Do More to Stop New Variants Like BA.5
- New infection waves can be minimized with more mitigation
- Nasal and variant-proof vaccines should be a priority
(LA Times, 7/13/2022)
● BA.5's growth potential and immune evasiveness were predicted long
before it predominated in the U.S.
● While vaccines and prior infections offer some limited cross-immunity,
there are proven mitigation measures that can help reduce our
vulnerability to new or repeat infections, such as mask mandates, physical
distancing, indoor air treatment, and booster eligibility expansion.
● The tools and technology exist for nasal spray and variant-proof vaccines,
but more funding and OWS*-like government fast-tracking is necessary.
● Nasal spray vaccines will help achieve mucosal immunity, which will offer
more durable protection than current intramuscular vaccines. They may
also be better suited as a first line of defense against new variants.
*OWS: Operation Warp Speed Source: LA Times 13Q&A: BA.5 & Reinfection (1/2)
(NYT, The Lancet, Johns Hopkins, Research Square; June-July 2022)
● Q1: Are there any symptomatic differences for BA.5 infection?
○ Cough, runny rose, sore throat, fatigue, headache, and muscle pain
are commonly reported. However, there is less likelihood of loss of
smell, taste, and shortness of breath. Painful sinus congestion and
severe sore throat were also reported in some studies.
● Q2: Is reinfection more common with BA.5?
○ BA.5 is more adept at evading immune protection, thus the reinfection
risk is relatively higher. Currently in the UK, about 25% of new cases
are reinfections.
Source: NYT, The Lancet, Johns Hopkins, Research Square 14Q&A: BA.5 & Reinfection (2/2)
(NYT, NEJM, Lancet, Johns Hopkins, Research Square; June-July 2022)
● Q3: How often does reinfection occur?
○ Reinfections were rare before Omicron. After Omicron, prior infections
only provided 50% protection against reinfection, and they could occur as
early as 20 days (Denmark study) or 3 months (Lancet).
● Q4: Will subsequent infections be more or less severe?
○ Still unclear. While many believe that BA.5 reinfection is generally mild,
multiple reinfections may be concerning. A recent Nature preprint
concluded that two or more reinfections doubles the risk for death, blood
clots, and lung damage (among other negative health outcomes).
Source: NYT, The Lancet, Johns Hopkins, Research Square 152. Rapid Increase of LA and AHMC Cases
Source 16L.A. County COVID Deaths and
Hospitalizations Rising
- Deaths, ICU, and ED visits all increased over last month
(LA Times, 7/13/2022)
● Weekly LA deaths have rapidly increased over the last month.
● Roughly 100 deaths were reported last week. A month ago, the
county was reporting about 50 deaths per week.
● This sudden rise underscores growing concerns regarding
BA.5's infectiousness.
● Likewise, COVID hospitalizations have increased in the last
month to nearly 1,200, the highest since February. ICU cases
increased by 64%, while ED have increased from 5% to 10%.
Source: LA Times 17L.A. County COVID Deaths and
Hospitalizations Rising
- Weekly deaths rapidly increased over last month
(LA Times, 7/13/2022)
Weekly deaths rising fast
Source: LA Times 18Los Angeles May Soon Require Masks as
COVID Surges
- New mask mandate may be on July 29, 2022
(NYT, 7/14/2022)
● LA County could become the first major population
center to reinstate indoor mask rules due to another
spike in COVID cases.
● As the nation’s most populous county of 10 million
residents, a return to a broad indoor mask mandate on
July 29 will happen if current trends in hospital
admissions continue.
19
Source: NYTRapid Increase of New AHMC COVID Cases
- 118% increased during 7/4-7/10; 9.8% increased during 7/11-
7/17
● Currently, COVID-19 cases have been rising in
our hospitals. Last week (7/4-7/10), there was a
118% increase in cases compared to the
previous week (6/27-7/3).
● It is estimated that there will be an additional
9.8% increase this week (7/11-7/17).
● Please continue to enforce COVID-19 control
and prevention strategies.
20AHMC Weekly Cases
(Data as of 7/15/2022)
AHMC Weekly Cases
+9.8%
392
357
213. Cases and Deaths (14 Day Change)
Source
22Global New Cases and Deaths 14 Days Changes
-Over 12 billion vaccine doses have been administered worldwide,
including more than two billion booster or additional doses.
(NYT, 7/18/2022)
Cases Deaths
+23% +27%
Full Vaccination Case Fatality Rate (CFR)
Rate
61.27%
(Booster:
27.54%)
0.24%
23Global COVID-19 Hotspots
(NYT, 7/18/2022)
Source: NYT 24Current Trends in France
● Case Fatality Rate: 0.08%
● Fully Vaccinated: 78.54%
● Vaccine Booster Doses: 60.64%
New Cases (per 1M) New Tests (per 1M)
Positive Test Rate (%) Reproduction Rate (Ro) (%)
Source: Our World in Data, NYT 25
(Our World in Data, 7/18/2022)Current Trends in Germany
● Case Fatality Rate: 0.11%
● Fully Vaccinated: 75.98%
● Vaccine Booster Doses: 69.08%
New Cases (per 1M) New Tests (per 1M)
Positive Test Rate (%) Reproduction Rate (Ro) (%)
Source: Our World in Data, NYT 26
(Our World in Data, 7/18/2022)Current Trends in Italy
● Case Fatality Rate: 0.13%
● Fully Vaccinated: 80.95%
● Vaccine Booster Doses: 70.12%
New Cases (per 1M) New Tests (per 1M)
Positive Test Rate (%) Reproduction Rate (Ro) (%)
Source: Our World in Data, NYT 27
(Our World in Data, 7/18/2022)Current Trends in Brazil
● Case Fatality Rate: 0.43%
● Fully Vaccinated: 79.17%
● Vaccine Booster Doses: 52.37%
New Cases (per 1M) New Tests (per 1M)
Reproduction Rate (Ro) (%)
Source: Our World in Data, NYT 28
(Our World in Data, 7/18/2022)Current Trends in Japan
● Case Fatality Rate: 0.08%
● Fully Vaccinated: 82.20%
● Vaccine Booster Doses: 66.32%
New Cases (per 1M) New Tests (per 1M)
Positive Test Rate (%) Reproduction Rate (Ro) (%)
Source: Our World in Data, NYT 29
(Our World in Data, 7/18/2022)US Trend and 14-Day Change
- Cases and hospitalizations are rising in the U.S.
- This pattern is similar to hospitalization surges seen earlier this
summer in countries where BA.5 first began to circulate.
(NYT, 7/18/2022)
Cases
+15%
Tests Positivity Rate Hospitalizations +20% Deaths +10%
Source: NYTTop 10 US States with Highest Daily New Cases
(NYT, 7/18/2022)
# States Daily New Cases Test Positivity Fully Vaccinated 14 Days Change
1 California 22,118 17% 73% 18%
2 Texas 12,493 30% 62% 16%
3 Florida 11,173 25% 68% 5%
4 New York 7,597 13% 78% 27%
5 Illinois 4,754 12% 69% 33%
North
6 3,771 23% 63% 26%
Carolina
7 Georgia 3,652 25% 56% 28%
8 New Jersey 3,603 13% 77% 15%
9 Ohio 3,495 18% 59% 42%
10 Virginia 3,035 23% 74% 8%
31Hospital Utilizations in the US
(HHS, 7/15/2022)
ICU Bed Use HHS ICU Bed Dashboard
● 70.67% ICU beds in use
(6,100 Hospitals Reporting)
● 6.02% ICU beds in use for
COVID-19 (14 days ago 4.91%)
(5,975 Hospitals Reporting)
Inpatient Bed Use
● 75.36% inpatient beds in use
(6,102 Hospitals Reporting)
● 5.49% Inpatient beds in use
for COVID-19 (14 days ago
4.51%)
(5,977 Hospitals Reporting)
Source: HHS 32California New Cases Trend
- Increase in cases (5%) and in deaths (11%) in the past 14 days
(NYT, 7/18/2022)
+18%
+26% -7 %
Source: NYT 3390-Day County Trends in AHMC Service Area
(NYT, 7/15/2022)
Los Angeles County Riverside County
+25%
(14-day) +29%
(14-day)
Orange County San Mateo County
+1% -13%
(14-day) (14-day)
Source: NYT 34Current State of the Virus
- Cases, hospitalizations, and deaths rising as BA.5 grows
(NYT, 7/18/2022)
● New daily cases are rising. The daily case average grew to
more than 129,000/day, and cases are rising in more than 40
states. Due to case undercount, it is likely that the true number
of cases is far higher.
● Hospitalizations are also rising in the U.S. due to BA.5. More
than 40,000 people are in American hospitals with COVID on
an average day, an increase of 20% over the last two weeks.
● Currently, about 425 deaths per day are being reported
nationwide, with most increases happening in metro areas.
Source: BHR 35Novavax’ Statement on Reported Allergic Reactions
- Novavax will update its vaccine label
- Based on 2 confirmed cases of anaphylaxis
(Novavax, 7/14/2022)
● The EMA updated the label for Novavax to include the risk of
severe allergic reactions (anaphylaxis).
● Novavax’ clinical development program reported no severe allergic
reactions, hence this risk was not listed in the initial product label.
● With broader deployment of doses, 2 reported cases of anaphylaxis
met a probable/definite case definition.
● Novavax and the EMA agreed to update the label accordingly and
will continue to monitor all adverse events, including allergic
reactions.
Source: Novavax 364. Vaccines and Variants
Source 37Approved/EUA COVID-19 Vaccines
- Novavax received EUA on July 13, 2022
(CDC, 7/14/2022)
Pfizer Moderna Janssen Novavax
(Stabilized form of spike
(mRNA) (mRNA) (Modified cold virus)
protein)
First Approved Aug 23, 2021 Dec 18, 2021 Feb 27, 2021 Jul 13, 2022
6 mos-4 yrs (Pfizer)
6 mos-5 yrs (Moderna)
YES YES No No
5-11 years (Pfizer)
YES YES No No
6-11 years (Moderna)
12-17 years YES YES No No
18+ years YES YES YES YES
1 Booster ● Everyone age 5 years and older No No
● Adults ages 50 years and older
● People ages 12 years and older
2 Boosters who are moderately or severely
No No
38
immunocompromised CDC; WebMDCOVID-19 Vaccinations in the US
Pfizer, Moderna, and J&J
- Booster uptake is 48.1% for all and 70.4% in 65+ y/o
- Second booster uptake is 35.2% in 65+ y/o
(CDC, 7/15/2022)
Source: CDC 39Rates of Case, Death, and Hospitalization by Vaccination Status
(CDC, 7/15/2022)
Cases Deaths
Unvaccinated Unvaccinated
2.0X 6X
Vaccinated
Vaccinated
Hospitalizations
Unvaccinated
Vaccinated
Source: CDC 40COVID-19 Variant Proportions in the US
- BA.5/4 are now dominant (81.3%)
(CDC, 7/15/2022)
Predominant
Variant
BA.2.12.1:
17.3%
BA.2:
1.4%
BA.5:
65%
BA.4:
16.3%
81.3%
Source: CDC 41FDA Authorizes Emergency Use of Novavax
- Novavax will be the 4th authorized vaccine for use in the U.S.
(FDA, 7/13/2022)
● The FDA authorized the Novavax for people 18 and older.
● Unlike mRNA vaccines, Novavax is a protein-based vaccine that
delivers pieces of the virus spike protein directly to the body.
● Clinical trials found that the shot was 90% effective at preventing
COVID. However, the trials were conducted in early 2021 before
the Delta and Omicron variants of the virus predominated, so those
numbers are likely lower now.
● FDA leadership hopes that having an alternative to the mRNA
vaccines could be a way to encourage people who are still
unvaccinated to get a shot.
Source: FDA 42EMA Plans Allergic Reactions Label for Novavax
- A few cases of anaphylaxis have been reported so far
(ContagionLive, 7/15/2022)
● The EMA is adding a warning label on the Novavax vaccine for
anaphylaxis, paraesthesia, and hypoaesthesia.
● A few cases of anaphylaxis have been reported spontaneously with
use of Novavax.
● A total of 1094 cases of spontaneous side effects were reported from
EU/EEA countries with zero fatalities. These side effects are not
necessarily related to or caused by the vaccine
● According to the EMA, about 216,000 doses of Novavax vaccines
had been administered in adults in the EU since June 26, 2022.
Source: ContagionLive 43Effectiveness of 2, 3, or 4 Vaccine Doses Among
Immunocompetent Adults
- COVID vaccine efficacy waned as Omicron mutated
(CDC MMWR, 7/15/2022)
mRNA Time Dominant Vaccine
Vaccine Effectiveness
December 2021 - March 2022 BA.1 61%
1st or 2nd
Doses March 2022 - June 2022 24%
BA.2 / BA.2.12.1
- BA.1 92%
3rd Dose
- BA.2.12.1 69%
4th doses Late March 2022 BA.2 / BA.2.12.1 80%
Source: CDC 44Effectiveness of 2, 3, or 4 Vaccine Doses Among
Immunocompetent Adults
- COVID vaccine efficacy waned as Omicron mutated
(CDC MMWR, 7/15/2022)
● Vaccine effectiveness during the BA.2/BA.2.12.2 period was lower
than during the BA.1 period in immunocompetent adults.
● 3rd dose provided additional protection against moderate and
severe COVID illness in all groups.
● 4th dose provided additional protection in adults aged ≥ 50 years
● Immunocompetent persons should receive recommended booster
doses to prevent moderate to severe COVID, including a 1st
booster for all eligible persons and 2nd booster for adults aged ≥
50 years at least 4 months after an initial booster dose.
Source: CDC 45Duration of Shedding of Culturable Virus in
Omicron Infections
- Omicron-infected persons may shed culturable virus >5 days
- No major difference in duration for vaccinated vs. unvaccinated
(NEJM, 6/29/2022)
● Median time from the initial positive PCR assay to culture conversion 5 days
(IQR, 3 to 9) for Omicron.
● Median time from symptom onset or the initial positive PCR assay, whichever
was earlier, to culture conversion was 8 days (IQR, 5 to 10) for Omicron.
● Despite detection of culturable virus being greater than 5 days for Omicron in
many cases, CDC guidelines only suggest 5 days quarantine after symptom
onset or positive PCR test.
● While vaccination has been shown to reduce infection risk and severity,
there was no major difference in the median duration of viral shedding among
all participants (unvaccinated, vaccinated, or vaccinated + boosted).
Source: NEJM 465. Monkeypox Updates
Source 47Monkeypox Information for Clinicians
- Global case distribution
(CDC, 7/18/2022)
○ 13,340 cases in 69 countries (7/18/22)
○ 43 US states with 1971 confirmed cases (7/18/22)
48
Source: CDCKey Characteristics of Monkeypox Rash
(CDC, 6/24/2022)
Stage Stage
Duration
Enanthem
Onset
Macules
1−2 days
Papules
1−2 days
Vesicles
1−2 days
Pustules
5−7 days
Scabs
7−14 days
49
Source: CDCBiden Administration’s Monkeypox Outbreak Response
(White House, 6/28/2022)
● The first phase of the strategy aims to rapidly deploy vaccines in the
most affected communities and mitigate the spread of the disease.
○ Scaling and Delivering Vaccines to Mitigate New Infections :
allocating 296,000 doses over the coming weeks
○ Making Testing Easier : The CDC has since scaled testing capacity
to 78 sites in 48 states, primarily at state public health labs, with
spare capacity to conduct 10,000 testes per week.
○ Activating Community Leaders and Stakeholders : share
information on what the virus is, how to treat it, and which
communities are most at risk.
Source: WhiteHouse 50WHO May Declare Monkeypox a Global Health Emergency
(Dailymail, 7/16/2022)
● WHO meeting will decide on if monkeypox cases constitutes a
Public Health Emergency of International Concern (PHEIC*)
○ The last committee meeting found that the situation had
not yet met the threshold despite case numbers rising
● A PHEIC is the highest formal declaration alarm the WHO
can raise for the spread of a disease like monkeypox
＊PHEIC definition:
● Serious, sudden, unusual or unexpected
● Carries implications for public health beyond the affected State’s
national border
● May require immediate international action
51
Source: Dailymail, WHOMonkeypox Vaccination
(Health.ny.gov, 7/2022)
● JYNNEOS is a vaccine licensed by the U.S. FDA as a two-dose
series for the prevention of monkeypox among adults ages 18+
● Administer two doses (0.5 mL each) vaccine 28 days apart
● There is currently a limited supply of
JYNNEOS vaccine, but more is
expected in the weeks and months
ahead.
52
Health.ny.govDemand for Monkeypox Vaccine Exceeds Supply
- As Monkeypox outbreak grows in US, demand for the vaccine is
outstripping the nation’s supply.
(NYT, 7/18/2022)
● The U.S. has purchased nearly 7 million doses in total, but has
received just 372,000 of them. So far, 156,000 doses have been
distributed nationally.
● When the supply crunch will ease is still unknown. The federal
government made another 131,000 doses available to states and
other jurisdictions on 7/22.
● The CDC has teamed up with five commercial testing
companies to expand the nation’s testing capacity, which now
stands at 70,000 samples per week, up from 6,000 at the
beginning of the outbreak.
53
Source: NYTMonkeypox Q&A (1/2)
(WHO, 7/12/2022)
● Can people get seriously ill or die from monkeypox?
Symptoms of monkeypox typically resolve on their own within a few weeks.
However, newborn babies, children, and people with underlying immune
deficiencies may be at risk of more serious symptoms and death from
monkeypox (1% to 10% of people with monkeypox have died).
● Is there a vaccine against monkeypox?
Yes. A vaccine was recently approved for preventing monkeypox. Smallpox
vaccine may also be useful for monkeypox.
● What is the treatment for people with monkeypox?
Symptoms normally resolve on their own without the need for treatment. If
needed, medication for pain (analgesics) and fever (antipyretics) can be
used to relieve some symptoms.
54
Source: WHOMonkeypox Q&A (2/2)
(WHO, 7/12/2022; CDC, 6/24/2022)
● How does monkeypox spread from person to person?
Monkeypox spreads from person to person through close contact,
including face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin or
sexual contact
● How long is the incubation period of monkeypox?
The incubation period is roughly 1-2 weeks. The development of initial
symptoms (e.g., fever, malaise, headache, weakness, etc.) marks the
beginning of the prodromal period
● How long do the symptoms last?
The illness typically lasts 2-4 weeks. The severity of illness can depend
upon the initial health of the individual, the route of exposure, and the
strain of the infecting virus 55
Source: WHO, CDCThank You!
Source 56You can also read
