Is COVID Shifting from Pandemic to Endemic Disease?

Key Points:

• In today’s Recommendations for Industry, we discuss TAG’s weekly COVID matrix and its indicators for endemic vs. pandemic and related masking requirements. Read more below.
• A new, two-dose COVID vaccine showed 100% efficacy against severe disease. Two doses of a new COVID vaccine, made by the Europe-based Sanofi and GSK, achieved 100 percent efficacy against severe disease and hospitalizations, and it could be an effective booster. The new vaccine had an efficacy of 75 percent against moderate-to-severe disease and showed 58 percent efficacy against symptomatic disease in its Phase 3 clinical trial. Used as a booster dose after one of the other available coronavirus vaccines, the Sanofi-GSK shot increased antibody levels by 18- to 30-fold. The companies intend to submit the vaccine for authorization in the US and Europe.
• Interval between COVID-19 vaccine doses can be 8 weeks for some people, CDC says. The interval between the first and second doses of the Pfizer-BioNTech and Moderna COVID-19 vaccines can be 8 weeks for certain people, the CDC said in updated interim guidance. Previous guidance stated that first and second doses should be separated by 3 weeks for the Pfizer-BioNTech vaccine and 4 weeks for the Moderna vaccine. The CDC said both vaccines remain safe and effective at those intervals, but the longer interval could reduce the risk for myocarditis.
• New studies suggest boosters may protect for months, even years. According to a flurry of new studies, COVID boosters can continue to protect most people from serious illness and death for many months, and perhaps even years.Previous studies have showed that antibodies can wane over time, but that does not necessarily mean that immunity is waning. The new research looked at other parts of the immune system that can remember and destroy the virus, including B cells and T cells. The studies found that this diverse repertoire of defenses should be able to protect people who have had three shots, or even two, for months or years.
• MIS-C risk after COVID-19 vaccination falls to one in a million, study findsThe risk for multisystem inflammatory syndrome in children, or MIS-C, is reduced to just one in a million when a person receives at least one dose of COVID-19 vaccine, researchers reported in The Lancet Child & Adolescent Health. This is “substantially lower” than the previous estimate of around 200 cases per million. The CDC defines a case of MIS-C as anyone younger than 21 years who presents with a fever, inflammation, clinically severe illness requiring hospitalization, and two or more organs involved, who has no alternative plausible diagnosis and has tested positive for current or recent SARS-CoV-2 infection, or reports exposure.
• Global COVID-19 cases fall, except in Asian hot spots. Last week global COVID-19 cases and deaths continued to decline, except for parts of Asia that are experiencing later Omicron surges, according to the WHO weekly update. Cases declined 21% last week over the previous week, continuing a 3-week decline. Deaths dropped 9%.  But both continue to rise in the Western Pacific, led by surges in South Korea, Hong Kong, New Zealand, and Brunei with South Korea, Hong Kong, and Singapore breaking daily records. Genetic sequencing suggests that 99.1% of the world’s cases involve the Omicron variant, with BA.2 now dominant in 18 countries.
• Children’s innate immune systems help fend off COVID-19 more effectively than adult’s.  Although some children fall seriously ill after coming down with COVID-19, most have mild or no symptoms. Immunologists have found that children’s immune systems have higher levels of some innate molecules and increased innate responses compared with adults, which experts think is key to helping children better fight off the virus that causes COVID-19.
• Moderna starts phase 3 study of messenger RNA-based RSV vaccine. Moderna has initiated a phase 3 study of its investigational mRNA-based vaccine for RSV. The company is also testing an mRNA vaccine against influenza with a goal to create combination vaccines that protect against several respiratory viruses, including influenza, SARS-CoV-2 and RSV. The phase 3 study, called ConquerRSV, will enroll around 34,000 adults aged 60 years or older from multiple countries.
• Vaccine-hesitancy discussion guide now available. Healio has launched a new publication, Building Confidence: A COVID-19 Vaccine Discussion Guide, with answers to common questions about the COVID-19 vaccines authorized in the U.S. The initial edition addresses the contents of COVID-19 vaccines; additional versions will address concerns related to blood clots, breakthrough infections and receiving a vaccine after a natural SARS-CoV-2 infection.
• Hong Kong will require its residents to get tested in March.Hong Kong will require its more than 7 million residents to undergo coronavirus testing in March as it struggles to contain its latest wave of infections, which has led the total number of cases in the city to surpass that of the previous two years and left hospitals overflowing. Residents will have to take three tests over a short period, starting in March. And Hong Kong will expand its testing capacity to one million tests a day from about 200,000 a day by next month. New isolation facilities are also being built to house coronavirus patients and a large-scale hospital is also being planned.

Recommendations for Industry

Is COVID Shifting from a Pandemic to an Endemic Disease?

TAG’s weekly matrix is continuing to show an optimistic outlook for the waning of COVID-19 from pandemic to endemic, with many states coming close to the 25/100,000 case rate which, previously, had indicated when high rates of community transmission were occurring. Case rates have been dropping by 50% week over week in nearly all states, with transmission rates below 1.0.

We see these as very encouraging trends, particularly the reduction in new hospitalizations which is becoming a better long-term measurement than reported case rates, as it is a true marker of community infection. Additionally, as the BA.2 subvariant becomes predominant in the US, TAG will continue watching for any geographic resurgence, as that will help to determine if it is developing an endemic pattern, such as that of the flu which increases in the fall and decreases over the summer.

Although the CDC has said it is working on new masking guidance, wanting to “give people a break from things like mask wearing when these metrics are better and then have the ability to reach for them again,” we’ve not yet seen anything new from the Center. Given the current March 18 expiration for the TSA face mask requirement on all US transportation, we would see that date as a possible breakpoint for the CDC guidance, along with the renewal or dropping of the transportation requirement.

In the meantime, TAG has developed a framework for businesses to assess their own masking requirements, based first on any federal, state, or local mandates, then focusing on community hospitalization and employee respiratory illness rates, with a higher the rate of hospitalizations and/or percentage of employees with respiratory illness signifying a greater need for masking and other measures. The full risk-mitigation framework and specific parameters on risk calibration levels and measures are available by contacting TAG.

Risk Matrix:

In case you missed it:

• In Tuesday’s Recommendations for Industry, we discussed how businesses can assess risk when considering lifting of COVID protections, including masking.  Read more here.
• US COVID cases, hospitalizations continue steady decline. Average daily COVID-19 cases and hospitalizations are continuing to fall in the U.S., an indicator that the Omicron variant’s hold is weakening across the country. Total confirmed cases reported Saturday barely exceeded 100,000, a sharp downturn from around 800,850 five weeks ago on Jan. 16, according to Johns Hopkins University data. In New York, the number of cases went down by more than 50% over the last two weeks.
• States Drop Mandates. California became the first state to formally shift to an “endemic” approach to COVID-19. On Thursday, Gov. Gavin Newsom announced a plan emphasizing prevention and quick reaction to outbreaks over mandated masking and business shutdowns. Two of the last mainland states with mandates are dropping them: New Mexico has lifted its indoor mask mandate, including for schools;  Washington State will eliminate the state’s mask mandates, including for schools, at the end of March. Hawaii is the only state that has not yet announced plans to relax mask requirements.
• In the UK – Britain’s Prime Minister Boris Johnson announced a plan for “living with COVID,” phasing out free testing for most people and removing requirements to self-isolate after testing positive.
• The CDC Isn’t Publishing Large Portions of the COVID Data It Collects. A NYT article has called out CDC for withholding critical data on boosters, hospitalizations and, until recently, wastewater analyses. The agency recently debuted a dashboard of wastewater data on its website that will be updated daily and might provide early signals of an oncoming surge of COVID cases. Some states and localities had been sharing wastewater information with the agency since the start of the pandemic, but it had never before released those findings. Wastewater surveillance across the nation would spot outbreaks and emerging variants early.
• Covid Patients May Have Increased Risk of Developing Mental Health Problems.  A large new study published Wednesday in the journal The BMJ, found that people who had COVID were 39 percent more likely to be diagnosed with depression; 35 percent more likely to be diagnosed with anxiety; 38 percent more likely to be diagnosed with stress and adjustment disorders; and 41 percent more likely to be diagnosed with sleep disorders than uninfected people. The study analyzed records of nearly 154,000 COVID patients in the Veterans Health Administration system who had no mental health diagnoses or treatment for at least two years before becoming infected, and compared their experience in the year after they recovered from their initial infection with that of a similar group of people who did not contract the virus.
• Africa may have been hit harder by COVID-19 than anyone knew. New studies have suggested that the number of COVID-19 cases may be vastly undercounted across Africa, and that the number of deaths in at least one country could be significantly undercounted. But reliable public tracking of cases is dependent on easy access to coronavirus tests and the expensive infrastructure to administer and track their results. Many African nations have neither. With 83 percent of people in Africa still not having received a single dose, it creates ideal conditions for new variants to emerge.
• Olympics called ‘one of the safest places on this planet’. The coronavirus infection rate at the Beijing Olympics was 0.01% in the four weeks since a restrictive, three-layer testing system was put in place. More than 1.8 million tests were conducted, and only 437 people tested positive, of which 98 were athletes and 87 were team officials. The other 252 were described as “stakeholders.” The three-layer testing involved athletes taking pre-departure tests in their own country and again upon arrival in Beijing. All participants also were subject to daily PCR testing in the Olympic Villages and at the Olympic venues.

Flu Update:

• CDC – Sporadic influenza activity continues across the country. In some areas, influenza activity is increasing.

Food Safety & Public Health:

• Highly Pathogenic Avian Influenza found in 11 states. Highly Pathogenic Avian Influenza (HPAI) has been detected in commercial poultry flocks from Kentucky and Indiana, a mixed species backyard flock from Virginia, and over 100 wild birds from several eastern coastal states—including South Carolina, North Carolina, Maryland, Florida, Delaware, and New Hampshire. Maine and New York have reported highly pathogenic avian flu outbreaks in poultry, both involving backyard flocks, and Indiana reported a fourth H5 outbreak at another commercial turkey farm. The Philippines also reported its first highly pathogenic H5N1 outbreaks in poultry, which struck farms in two provinces.
• OSHA Webinar: Review of OSHA Recordkeeping Requirements and Injury Tracking Application. OSHA is hosting a webinar on its recordkeeping requirements and electronically submitting workplace injury and illness data using the Injury Tracking Application on February 23 from 1:00 – 3:00 p.m. EST. Registration is free.