COVID Declining; Continuing to Impart Lessons for Infectious Disease Control

Key Points:

• In today’s Recommendations for Industry, we discuss the continued decline of COVID and the lessons it continues to impart for infectious disease (and “next pandemic”) control. Read more below.
• The future of the pandemic is looking clearer as we learn more about infection (NPR). New studies are providing an optimistic picture about immunity for those who have had COVID-19, finding that a symptomatic infection triggers an immune response in the general population, likely offering protection against severe disease and death for a few years. Those under age 50 and healthy who had COVID-19 have been shown to be well protected against severe disease if reinfected again in a future surge, says epidemiologist Laith Abu-Raddad, at Weill-Cornell Medical-Qatar. That’s important because eventually everyone will be infected, but if reinfections are milder, we will be able to better live with COVID. The study, published in the New England Journal of Medicine in December, tracked 1,300 reinfections among more than 350,000 people in Qatar finding that a prior infection reduced the risk of hospitalization upon reinfection by about 90% compared with in people having their first infection. The findings are consistent with data released by CDC last month in which a prior infection was shown to reduce the risk of hospitalization during the Delta surge by more than 50 times compared with in people who hadn’t had a prior infection and were not vaccinated. People who had both a prior infection and were vaccinated had the most protection. In particular, antibodies against SARS-CoV-2 persist in the blood for months, possibly years after an infection, scientists at the Fred Hutchinson Cancer Research Center and Emory University have reported. About six months after a SARS-CoV-2 infection, right around the time when the antibody level starts to stabilize, the immune system generates long-lived plasma cells that can make potent antibodies against SAR-CoV-2 for decades, possibly even a lifetime.
• Study reveals risk factors for severe COVID-19, related syndrome in kids (CIDRAP). A prospective cohort study of US children with COVID-19 reveals that certain demographic characteristics, preexisting chronic diseases, and initial vital sign and lab values may portend disease severity. Severe disease was associated with males (odds ratio [OR], 1.37), obesity (OR, 1.19) and some pediatric complex chronic condition (PCCC) subcategories. Vital signs and many lab test values from the day of admission were predictive of peak disease severity.
• CDC head says COVID-19 mask guidance stands, for now (CIDRAP). CDC is working on updating and evaluating its mask guidance, but with COVID-19 transmission and hospitalization rates still high throughout the country, the recommendation of indoor masking regardless of vaccination status remains in place.While encouraged by current trends, Director Rochelle Walensky said, “we are not there yet.” Meanwhile, Massachusetts will  let the state’s school mask requirement expire on Feb 28 while New York is dropping mandates on both masks and vaccine requirements in businesses effective Friday. “Numbers are coming down, and it is time to adapt,” Governor Kathy Hochul said.
• Global COVID cases top 400 million as levels decline again (CIDRAP). Global cases declined 17% last week compared with the week before, though the world added 19 million new cases. The only part of the world where cases are still rising is the WHO’s Eastern Mediterranean region, where the biggest jumps were reported by Iran, Jordan, and the Palestinian Territory.
• Serious illness, death more common in pregnant women with COVID-19 (CIDRAP). Pregnant COVID-19 patients are about 40% more likely to develop serious complications or die than their uninfected peers, suggests a study led by University of Utah Health researchers published yesterday in JAMA.Relative to uninfected patients, those diagnosed as having COVID-19 were significantly more likely to die or become seriously ill because of high blood pressure-related pregnancy disorders, postpartum hemorrhage, or other respiratory infection (13.4% vs 9.2%; adjusted relative risk [aRR], 1.41). All five maternal deaths occurred in COVID-positive women.The retrospective cohort study examined the outcomes of 41,104 women who delivered at 17 US hospitals from Mar 1 to Dec 31, 2020, following them up to Feb 11, 2021. Among the patients, 2,352 had COVID-19 and 11,752 did not. A total of 14,471 newborns were included in the analysis; 2,297 were delivered by women who had COVID-19 while pregnant, and 12,017 were born to uninfected women. SARS-CoV-2 exposure was significantly linked to preterm birth at less than 37 weeks’ gestation (17.7% vs 14.1%; aRR, 1.15) and to admission to a neonatal ICU (22.0% vs 17.8%; aRR, 1.15).
• Johnson & Johnson halts production of single-dose COVID-19 vaccine (CBS News). Johnson & Johnson last year quietly shut down production at a plant in Leiden, Netherlands, which was the only facility where usable doses of the vaccine were manufactured, catching some of its customers off guard, including developing nations that prefer the single-dose drug. Johnson & Johnson has been using the plant to work on an experimental and potentially more profitable drug that could protect against an unrelated respiratory virus.
• Meet the scientist at the center of the COVID lab leak controversy (Technology Review) Shi Zhengli has spent years at the Wuhan Institute of Virology researching coronaviruses that live in bats. Her work, which has earned her the nickname China’s bat woman, has been at the center of controversy. Some have suggested that her bat samples could be the source of the COVID-19 virus, claiming that the virus could have hitched a ride to Wuhan by infecting one of her team members in their fieldwork collecting samples from bats. Or, some speculate, the live viruses her team cultured in the lab, including those created by genetic tinkering, could be the source of the pandemic.
• COVID-19 truck blockade in Canada shuts down Ford plant (AP News). A blockade of the bridge between Canada and Detroit by protesters demanding an end to Canada’s COVID-19 restrictions forced the shutdown Wednesday of a Ford plant and began to have broader implications for the North American auto industry. The bridge carries 25% of all trade between the two countries, and Canadian authorities expressed increasing worry about the economic effects.Prime Minister Justin Trudeau stood firm against an easing of Canada’s COVID-19 restrictions in the face of the mounting pressure by protests against the restrictions and against Trudeau himself.

Public Health / Food Safety:

• First avian flu case of 2022 strikes Indiana’s commercial turkeys again (FSN). Bird flu can strike twice. A commercial turkey flock in Dubois County, Indiana, last struck by highly pathogenic avian influenza (HPAI) in 2016, is again infected as the disease returns to America.The USDA’s Animal and Plant Health Inspection Service (APHIS) confirms the presence of highly pathogenic avian influenza (HPAI) in the flock, it is the first confirmed case of HPAI in commercial poultry in the US since 2020. Avian influenza rarely results in human illnesses, and no human cases have been detected in the US, but USDA reminds the public that proper handling and cooking of poultry and eggs to an internal temperature of 165˚F kills bacteria and viruses.
• Global flu slows from late December peak (CIDRAP). Global flu activity shows more signs of decline after peaking at the end of 2021, the World Health Organization (WHO) said in its latest global flu update, which covers roughly the middle 2 weeks of January.Globally, of positive flu samples at national labs in the middle of January, 64.6% were influenza A and 35.4% were influenza B. Of the subtyped influenza A samples, 96.8% were H3N2. Of the characterized influenza B samples, all belonged to the Victoria lineage.
• Groups urge McDonald’s to honor antibiotics commitment (CIDRAP). A coalition of food safety, animal welfare, and environmental health groups is pushing McDonald’s to honor its commitment to reducing the amount of antibiotics used in its beef.Yesterday, the groups sent a petition with more than 25,000 signatures to McDonald’s CEO Chris Kempczinski urging the company to fulfill its December 2018 pledge to measure medically important antibiotic use and establish reduction targets for beef suppliers in the countries that make up 85% of its beef supply chain by the end of 2020.The company has yet to set those reduction targets.

Recommendations for Industry

COVID Declining; Continuing to Impart Lessons for Infectious Disease Control

TAG’s weekly COVID matrix is continuing to show signs for optimism, as case and transmission rates continue to decline in nearly all states. Some are further along the down slope, but all are trending in that direction, continuing to follow the projections TAG has made.

For masking, TAG continues to recommend businesses follow the CDC community transmission guidelines (as discussed in TAG’s Tuesday newsletter), but if risk is significantly lowered in your community and you would like to revise your masking requirements, we don’t expect you would have any significant effects.

As businesses continue to think through their employees programs to be better prepared for a “next pandemic” or infectious disease in general, TAG recommends you consider the findings of a new study published in The Lancet. With U.S. rates of COVID-19 infection and fatality varying dramatically since the onset of the pandemic, the researchers undertook a study to understand why and what conditions would be most essential to guiding investment in more effective preparedness and response for future pandemics.

The study found the only statistically significant variables that resulted in reduced infection rates were trust in government and interpersonal trust in the population, showing that mitigation measures are dependent on people in a society actually being willing to participate.

The results suggest that an increase in risk communication, community engagement strategies to boost individual’s confidence in public health guidance, and health promotion for key modifiable risks would have a positive effect on reducing infection rates, including reduced fatalities.

Risk Matrix:

In case you missed it

• In Tuesday’s Recommendations for Industry, we discussed the current “transition” status of COVID-19, mask mandates, and recommendations. Read more here.
• Is the Coronavirus in Your Backyard?. A study of white-tailed deer killed by hunters or car crashes found more than 60 percent to be infected with COVID-19, showing that deer could become a reservoir for the virus. The virus is likely to continue circulating in deer, many experts predicted. But crucial questions remain unanswered: How are deer catching the virus? How might the pathogen mutate inside its cervid hosts? And could the animals pass it back to us?
• An Omicron subvariant gains in Europe, but is unlikely to alter the picture very much, experts say. A subvariant that scientists believe is even more contagious than the most common form of Omicron is spreading rapidly in parts of Asia and Europe and is now dominant in Denmark, where nearly all COVID restrictions were lifted last week. For now, scientists are not expecting the subvariant, known as BA.2, to do significantly more damage than the version of Omicron that remains dominant in the rest of the world, BA.1. But they are concerned that BA.2 could extend the global Omicron surge.
• Do Not Use E25Bio COVID-19 Tests: FDA Safety Communication. FDA is warning people not to use the E25Bio COVID-19 Direct Antigen Rapid Test, as it has not been authorized, cleared, or approved by the FDA, but may include false labeling representing that the test is authorized by the FDA. The E25Bio COVID-19 Direct Antigen Rapid Test may also be sold under the trade name E25Bio SARS-CoV-2 Antigen Test Kit.
• Global COVID
  • Australia will reopen its borders to all vaccinated visitors starting Feb. 21.
  • China locks down southern city as Omicron variant surges. China has ordered inhabitants of the southern city of Baise to stay home and suspended transportation links amid a surge in COVID-19 cases at least partly linked to the Omicron variant.
  • Austria’s sweeping COVID vaccine mandate is becoming law. Austria is the first Western democracy to mandate COVID vaccinations for nearly its entire adult population, a once-unthinkable move that is being seen as a test case for other countries grappling with pockets of vaccine resistance.
  • COVID-19 cases climb higher in parts of Asia. Some locations in Asia affected later by the Omicron variant are reporting more daily record highs, even in places like Hong Kong that have taken a more aggressive “zero COVID” approach to battling the virus.
  • Governors of four states of the U.S. (Connecticut, Delaware, New Jersey and Oregon) announced plans Monday to lift statewide mask requirements in schools by the end of February or March.
• Medicare will provide free at-home virus tests for pickup. The policy would “allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without needing to be reimbursed,” the Centers for Medicare and Medicaid Services said Thursday, adding that it would be the first time Medicare covered the whole cost of an over-the-counter test.
• Wastewater Monitoring for Public Health. Since September 2020, University of California, Davis, researchers have been monitoring wastewater on the UC Davis campus and in the city of Davis for COVID-19 through the Healthy Davis Together program. A new article published Feb. 8 in Proceedings of the National Academy of Sciences reviews their experiences and the advantages and limitations of wastewater testing as a public health tool in the COVID-19 pandemic.

Flu:

• Flu cases continue in many parts of the world, but generally COVID is reported more commonly among those with respiratory symptoms.
• US:
  • Influenza activity has decreased in recent weeks, but sporadic activity continues across the country. The majority of influenza viruses detected are A(H3N2), most of which are genetically closely related to the vaccine virus.
  • Globally, influenza activity remained low and decreased this period after a peak at the end of 2021. With the increasing detections of influenza during the COVID-19 pandemic, countries are recommended to prepare for co-circulation of influenza and SARS-CoV-2, and test and treat according to national guidance.