What Do Europe’s COVID Trends mean for Current US Decline?

Key Points:

• In today’s Recommendations for Industry, we discuss the continued decline of COVID-19 cases and hospitalizations in the US and what Europe’s trends may mean here. Read more below.
• Senate votes to overturn mask mandate on airplanes, transit. The Senate yesterday voted to end the federal masking requirement for passengers on planes and other public transportation. But the measure isn’t certain to pass in the House of Representatives, and President Biden has said he would veto it. (CIDRAP)
• Canada to end prearrival COVID-19 testing rule for all fully vaccinated travelers. Canada will end its pre-entry COVID-19 testing requirement for all fully vaccinated travelers in two weeks after facing intense pressure from business and tourism groups to ease border restrictions. A federal source said the rule will be lifted on April 1, but that on-arrival random testing will remain in effect to track new variants. People who travel internationally risk getting stuck abroad if their prearrival test is positive under the current rules. The coming change won’t help families returning home in the March break travel rush, who will still need to get tested before their arrival in Canada.
• Global COVID cases rising again. After 5 weeks of declining cases, global COVID-19 cases rose last week, fueled by increasing cases in three regions, according to the WHO weekly update. One factor suspected in current rises overseas, alongside eased restrictions and waning immunity, is increased spread of BA.2. Roughly half of last week’s cases were from the Western Pacific region, with surges in Hong Kong, South Korea, and Vietnam. Hong Kong today reported nearly 29,272 new cases and 217 deaths; China reported 3,045 new cases; South Korea reported a new record daily high of more than 400,000 cases. At a WHO media briefing , Director-General Tedros Adhanom Ghebreyesus, PhD, said the new rises are occurring despite reduced testing in some countries, “which means the cases we are seeing are just the tip of the iceberg.” Each country is facing a different situation with different challenges, but the pandemic is not over,” Tedros said.
• Despite case uptick, UK easing COVID-19 testing, monitoring . After dropping nearly all coronavirus restrictions last month, Britain is now ending some of its most widespread COVID-19 testing and monitoring programs, a move some scientists fear will complicate efforts to track the virus and detect worrisome new variants.
• In the US, BA.2 levels are also showing more signs of rise. The CDC estimates that BA.2 made up 23.1% of the nation’s circulating variants during the week ending on Mar 12, up from 13.7% the previous week. The CDC’s wastewater surveillance tracker shows that 165 U.S. sites have experienced an increase in SARS-CoV-2 levels in the last 15 days. The 165 sites make up less than half of the 419 sites currently reporting data and “may simply reflect minor increases from very low levels to still low levels,” a CDC spokeswoman said. However, as we reported Tuesday, the number of sites with rising signals of COVID-19 cases is nearly twice what it was during the Feb. 1 to Feb. 10 period, when the wave of Omicron-variant cases was fading rapidly.
• With the UK, Germany, France, and others experiencing a new wave in the past couple weeks, “The US should get ready.” At least 12 countries are experiencing new increases in cases, some quite marked, such as Austria exceeding its pandemic peak, and Finland with an 85% increase from the prior week. Many are also showing a rise in hospital admissions. Over the last two years, the UK and Europe have provided five unmistakable warnings to America that a new surge was occurring. Each time, the US experienced a new wave within weeks, some not as severe (e.g., Alpha), some worse (Delta and Omicron). It has shown that what happens in the UK and Europe doesn’t stay in the UK and Europe.
• Twice as many Black COVID patients deemed lowest priority in ICU triage system. A crisis-standards-of-care (CSOC) scoring system used to triage COVID-19 intensive care unit (ICU) patients assigned twice the proportion of Black patients as other patients to the lowest-priority group, finds a modeling study published yesterday in JAMA Network Open. Relative to other participants, Black patients were more likely to be assigned to the lowest-priority group (15.2% vs 8.1%). An exploratory simulation using the score for allocation of ventilators (with only high-priority patients receiving ventilators) showed 43.9% excess deaths among Black participants, compared with 28.6% among all other patients.

Food Safety & Public Health:

• Avian flu appears in Nebraska backyard flock. Raising the number of states to report highly pathogenic avian flu in backyard flocks or commercial poultry to 15, federal and state officials today announced the first outbreak in Nebraska. In related developments, Missouri reported another outbreak in backyard poultry, and federal officials reported more H5 detections in wild birds, including the first from Ohio and Illinois.

Recommendations for Industry

What Do Europe’s COVID Trends Mean for Current US Decline?

TAG’s weekly COVID-19 matrix is continuing to show a decline in COVID-19 case rates and hospitalizations with very few outliers (e.g., Georgia and West Virginia have high hospitalizations while Idaho and Alaska have comparatively high case rates), which is leading us to be optimistic about the trends.

As the US looks to Europe as a possible predictor of what might happen here, we are seeing some increased rates in the UK and Europe (as depicted in the above graphs) and some increases in SARS-CoV-2 levels in US wastewater. Throughout the pandemic, the US has followed Europe – and particularly the UK’s – trends with a bit of a time lag. So, we want to keep a careful eye on US rates (as we do each week in our matrix), as UK/Europe could be a predictor of some increase here.

We do, however, expect that the trends in Europe are likely being driven by the BA.2 subvariant of Omicron among those who were not previously infected with BA.1 and are susceptible to Omicron. With the two subvariants being close cousins, it is likely that anyone who is vaccinated and had Omicron BA.1 has a substantial degree of cross-reactive natural immunity to BA.2.  In the US, where some models estimate that more than 70 percent of the population has been infected with Omicron, a European-type surge may be less pronounced because of greater population immunity. 

Risk Matrix:

There are no states with a TPR>10% and a case rate >25 cases/100K people. However, two states (Alaska and Idaho) have a TPR <10% and a case rate >25 cases/100K.

In Case You Missed It:

• In Tuesday’s Recommendations for Industry, we discussed the ongoing need for symptom monitoring. Read more here.
• The CDC will extend its mask-use on public transportation order until April 18, 2022. It does not seem that the U.S. will be ending testing rules for international travelers coming into the states (The Points Guy). In Europe, the UK is ending its last COVID-19 international travel rules (SCMP). As individuals continue to travel internationally, The Washington Post put together a “how to” for using vaccine passports as rules/’passports’ vary across different places (Washington Post). 
• A recent study from South Korea found that “99.1% of close contacts of Omicron-infected patients diagnosed” by the 10^th day; in fact, the average time of exposure to diagnosis was about 3.7 days. This further supports the 10-day quarantine. (CIDRAP)
• Fauci hopes that the “the world will not forget lessons from a ‘catastrophic experience’” (CNBC). COVID-19 outbreaks continue to increase within China, South Korea, and other areas within Asia (CIDRAP).
• Pfizer’s CEO acknowledged that it’s likely that a 4^th dose of COVID-19 may be needed for whatever variant arises; he acknowledged that three doses, at this time, is “actually quite good for hospitalizations and deaths.” However, the company is currently working on an all-variant shot (CIDRAP / CNN).
• How are the COVID-19 tests that we’ve been using being validated and tested for their abilities to work? Over 200 researchers based in Atlanta, working alongside the National institutes of health and the FDA, “have worked late nights and early mornings to accelerate the development of new tests and ensure that existing products can detect an alphabet of new variants, including Omicron.” Read more about the scientists seeking to keep us safe from New York Times (NYT).

Influenza:

• Within the US, please consider getting your flu shot. Influenza activity is increasing in most of the country, with positive levels seen “in states in the central and south-central regions.”
• Within the US & globally, although flu incidence is dropping, there is worry of potential increases as mask mandates against COVID-19 are relaxed.

Food Safety & Public Health:

• COVID-19 restrictions, especially in Latin America and Southeast Asia has seemingly led to hundreds of thousands of people not getting dengue. After controlling for a variety of factors, researchers believe that “the severe disruption in the movement of people” via stay-at-home orders likely helped lower the number of infected individuals as those who did get infected stayed home and “weren’t going out where new mosquitoes could bite them and then pass the virus on to other people” (NYT).
• A new malaria treatment for children has received its first approval in Australia (NYT).
• Avian flu is sweeping across the US (and globally). In Illinois, Kansas, and Wisconsin, millions of birds have had to be culled. So far, in the U.S., we have culled 6.7 million birds (chicken and turkey), which is “the biggest U.S. outbreak of the diseases in poultry since 2015” (CIDRAP/Reuters).