New Omicron BA.4 and BA.5 Sublineages May Evade Vaccines, Natural Immunity. What Experts Say

Authors: Mint Newsletters April 29, 2022

  • The BA.4 and BA.5 sublineages appear to be more infectious than the earlier BA.2 lineage
  • The sub-lineages have been detected in seven of South Africa’s nine provinces and 20 countries worldwide

New omicron sublineages, discovered by South African scientists this month, are likely able to evade vaccines and natural immunity from prior infections, the head of gene sequencing units that produced a study on the strains said, according to Bloomberg report.

It is important to note that the BA.4 and BA.5 sublineages appear to be more infectious than the earlier BA.2 lineage, which itself was more infectious than the original omicron variant, Tulio de Oliveira, the head of the institutes, said.

Omicron sublineages  mutated to evade immunity

  • As almost all South Africans either having been vaccinated against the coronavirus or having had a prior infection the current surge in cases means that the strains are more likely to be capable of evading the body’s defenses rather than simply being more transmissible, de Oliveira said.
  • There are “mutations in the lineages that allow the virus to evade immunity,” he said in a response to queries. “We expect that it can cause reinfections and it can break through some vaccines, because that’s the only way something can grow in South Africa where we estimate that more than 90% of the population has a level of immune protection.”
  • South Africa is seen as a key harbinger of how the omicron variant and its sublineages are likely to play out in the rest of the world. South African and Botswanan scientists discovered omicron in November and South Africa was the first country to experience a major surge of infections as a result of the variant.
  • The new sublineages account for about 70% of new coronavirus cases in South Africa, de Oliveira said in a series of Twitter postings. 
  • “Our main scenario for Omicron BA.4 and BA.5 is that it increases infections but that does not translate into large hospitalizations and deaths,” he said.
  • So far, the sublineages have been detected in seven of South Africa’s nine provinces and 20 countries worldwide. 

Another rare virus puzzle: They got sick, got treated, got covid again

Authors: Carolyn Y. Johnson  April 27, 2022 The Washington Post

Shortly after he served on a jury in March, Gregg Crumley developed a sore throat and congestion. The retired molecular biologist took a rapid test on a Saturday and saw a dark, thick line materialize — “wildly positive” for the coronavirus.

Crumley, 71, contacted his doctor two days later. By the afternoon, friends had dropped off a course of Paxlovid, a five-day regimen of antiviral pills that aims to keep people from becoming seriously ill.

The day he took his last dose, his symptoms were abating. He tested each of the next three days: all negative.

Then, in the middle of a community Zoom meeting, he started feeling sick again. Crumley, who is vaccinated and boosted, thought it might be residual effects of his immune response to the virus. But the chills were more prolonged and unpleasant. He tested. Positive. Again.

Crumley, like other patients who have experienced relapses after taking Paxlovid, is puzzled — and concerned. On Twitter, physicians and patients alike are engaged in a real-time group brainstorm about what might be happening, with scant evidence to work with.

It is the latest twist — and newest riddle — in the pandemic, a reminder that two years in, the world is still on a learning curve with the coronavirus.

Infectious-disease experts agree that this phenomenon of the virus rebounding after some patients take the drug appears to be real but rare. Exactly how often it occurs, why it happens and what — if anything — to do about it remain matters of debate.

What’s clear is that patients should be warned it is possible so they don’t panic — and so that they know to test again if they start feeling ill. More data is needed to understand what is going on. Paxlovid, made by the drug giant Pfizer, remains a useful drug, even though it has sparked a new mystery.Biden administration boosts access to antivirals as covid cases rise

“I’m not negative on Paxlovid,” said Crumley, who lives in Philadelphia and whose last positive test was a week after his second wave of illness began. “I don’t know whether it’s just stopping [viral] replication for that five-day period of time, and it comes back.”

One of the top worries accompanying antiviral drugs is the threat of resistance, when the virus evolves to evade the treatment. A Food and Drug Administration analysis of Pfizer’s clinical trial of the drug showed the virus rebounded in several subjects about 10 to 14 days after their initial symptoms but found no reason and no evidence that their infections were resistant to the treatment.

Michael E. Charness, chief of staff at the VA Boston Healthcare System, published a detailed case study of one 71-year-old patient who had a relapse. The man, who was vaccinated and boosted, received Paxlovid and quickly felt better. When he developed cold symptoms a week after his case of covid had resolved, researchers sequenced the virus’s genetic code and found it was the same virus surging back. That ruled out a reinfection, the emergence of a variant or the virus becoming resistant.

Charness would like to see more data and other questions answered. Should antivirals be given longer, to assure the virus is cleared? Should people be treated a second time? What are the implications for people returning to their normal lives?

“If you have a resurgence of viral load, and that happens on day 10, when CDC says you’re back to work, no mask, what are you supposed to do about isolation? Is that a moment when you’re contagious again?” Charness said. “The person we studied, we advised to isolate until their viral load was gone the second time.”

Pfizer is collecting data, in clinical trials and in real-world monitoring of the drug’s use. The company’s trial data indicates there is a late uptick in viral load in “a small number” of people who take the drug, but the rates appear to be similar among study participants given a placebo, according to company spokesman Kit Longley. The people who experienced such increases also did not develop severe disease the second time around.

Those findings suggest that Paxlovid isn’t the reason people are relapsing, because that’s happening in untreated people, too.

If that turns out to be true, it raises the concern that some people — whether they have taken the drug or not — could be infectious long after they think they are in the clear, and after guidelines suggest they can stop taking precautions.

“Although it is too early to determine the cause, this suggests the observed increase in viral load is unlikely to be related to Paxlovid,” Longley wrote in an email. “We have not seen any resistance to Paxlovid, and remain very confident in its clinical effectiveness.”

The limited evidence leaves most physicians favoring the idea that Paxlovid knocks the virus down but doesn’t knock it out completely. It’s possible that by holding the virus in check, the immune response doesn’t fully ramp up, because it doesn’t see enough virus. Once the treatment ends, the virus can start multiplying again in some people.

Philip Bretsky, a primary care doctor in Santa Monica, Calif., said he has encountered two cases among patients, both of whom were vaccinated and boosted at least once.

A double-boosted 72-year-old who had chronic medical conditions that raised his risk for severe illness started to feel unwell at the end of March. He tested positive and began a course of Paxlovid. He felt better and tested negative. Then, 12 days later, he started feeling crummy again — and tested positive.

Reinfection seemed improbable, and Bretsky thought resistance was unlikely with a five-day course of treatment.

In well-vaccinated people, being reinfected so quickly would be “like getting struck by lightning or winning the lottery,” Bretsky said. “I don’t think this is reinfection. I think this is recrudescence of the original infection.”

Experts don’t know how common this phenomenon is. Many people may not test if they get sick again after their initial infection has receded, making it hard to track.

That almost happened to Holly Teliska, 42, of San Francisco. Teliska got sick shortly after returning home from a trip to New York. She has a risk factor for severe illness and got access to Paxlovid right away. When she finished her treatment course, she took a home PCR test that was negative and felt much better, though remained fatigued.

Four days later, she came down with a runny nose and cough. She assumed she had caught her daughter’s cold and powered through. Five days later, with plans to visit an immunocompromised friend, she took a test.

Teliska almost felt silly testing herself. She had been vaccinated and boosted, then infected.

“We’ve been saying I’m her safest friend now, now that I’ve had covid, so for three months, I can go spend time with her pretty safely,” Teliska said. “That really threw that narrative out the window. … This entire experience has been a real reminder there is still so much to learn.”

Paxlovid is new. It only began to be used in December, so reports people share on social media of resurgent illness may be the tip of the iceberg — or might simply reflect the eagerness to learn more about a rare, intriguing outcome.

If such cases turn out to be exceedingly rare, then these case reports may be a sporadic curiosity — something to warn patients could happen. If more common, it could lead to tweaks in treatment regimens.

The mounting anecdotes are compelling to many physicians, but it’s also possible the virus might rarely rebound. Yonatan Grad, an associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, has studied the viral loads of NBA players and staff during the course of an infection. That data, he said, shows that viral loads can bounce around.

What’s “exceptionally uncommon,” Grad said, is for the viral load to plunge for a few days to a level that suggests they are negative and then go up again.

Paul Sax, an infectious-diseases specialist at Brigham and Women’s Hospital in Boston, recently shared the story of a patient who became infected and then relapsed after taking Paxlovid. He has heard from lots of colleagues with similar stories. But the anecdotes raise more questions than they answer.

Even if the virus has not been shown to develop resistance to the treatment during a resurgence, that’s doesn’t mean it won’t happen, he points out. Does the treatment knock the virus down so successfully that people aren’t generating a robust immune response? That could have implications for understanding whether being infected acts as a potent booster.

The phenomenon is so new that many doctors aren’t aware of it. Jennifer Charness, a 31-year-old nurse who lives in Brookline, Mass., had the benefit of knowing about her father’s work at the Boston VA.

Charness started sneezing in early April and got a blaringly positive coronavirus test. She has a history of asthma and was prescribed Paxlovid. As she took the drug, she saw her positive test line grow fainter and her symptoms resolve. She swabbed to make sure she was negative before going back to work, as a precaution. Then, two days later, she felt the symptoms come back and tested positive — again.

“I’m so frustrated,” Charness said. “I don’t think I’m going to get very sick. It’s the concern of what does this mean for my viral load, and how contagious am I? And when will I not be contagious? I’m stuck back in my home again.”

Charness’s primary concern is that she doesn’t pose a risk to anyone else. She consulted a doctor via telemedicine Friday. The practice hadn’t heard of any cases like hers and decided to treat it as a reinfection and reset the isolation clock.

“I’m Day 4,” she said. “Or am I Day 13?”

Covid Could Be Surging in the U.S. Right Now and We Might Not Even Know It

Authors: Madison Muller – April 10, 12:12 PM Bloomberg

The rise of Covid cases in some regions of the U.S., just as testing efforts wane, has raised the specter that the next major wave of the virus may be difficult to detect. In fact, the country could be in the midst of a surge right now and we might not even know it.

Testing and viral sequencing are critical to responding quickly to new outbreaks of Covid. And yet, as the country tries to move on from the pandemic, demand for lab-based testing has declined and federal funding priorities have shifted. The change has forced some testing centers to shutter while others have hiked up prices in response to the end of government-subsidized testing programs.  People are increasingly relying on at-home rapid tests if they decide to test at all. But those results are rarely reported, giving public health officials little insight into how widespread the virus truly is. 

“There’s always more spread than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University.  “That’s true even more so now than earlier in the pandemic.” 

Despite groundbreaking scientific advances like vaccines and antivirals, public health experts say the U.S.’s Covid defenses appear to be getting weaker as time goes on, not stronger.

“We’re in a worse position,” said Julia Raifman, an assistant professor of health law, policy and management at Boston University School of Public Health. “We’ve learned more about the virus and how to address it, and then we haven’t done what we need to do to address it.”

In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and ICU capacity to determine community-level risk. That was a change from relying on Covid case counts and the percentage of positive tests, which are widely considered a better snapshot of how much virus is circulating in a given community. Several states, including Arizona, Hawaii, Nevada and Ohio have now completely stopped reporting daily Covid data to the CDC, making it more difficult to gauge the progression of the pandemic in those states.

According to the CDC, the majority of the country is still considered low risk. Public health experts argue this is misleading though, given hospitalization and death generally occur days to weeks after initial infection. Without widespread testing, that could make it impossible to detect a surge until it’s too late to do anything about it. 

“CDC is understating and downplaying cases,” said Gregg Gonsalves, an infectious disease expert at Yale’s School of Public Health. “Their alarm bells won’t go off until we see a rise in hospitalizations and deaths, which are lagging indicators.”

Transmissible Variant

Though omicron tends to cause milder symptoms for healthy, vaccinated people, its transmissibility led to such a huge spike in cases that it caused hospitalization rates to break previous pandemic records. The variant was also responsible for a record number of children going to the hospital. Black people were hospitalized at twice the rate of White people during the surge in New York. Vaccines are extremely effective at preventing severe disease if not always at preventing cases, one of the reasons metrics shifted toward hospitalizations to judge the state of the virus. But failing to track cases creates a blind spot. Experts say it is critical to continue to track them in order to protect vulnerable communities and respond to new waves of the virus before the health system gets overwhelmed.

In recent weeks, cases have started to tick up in places like New York, Massachusetts and in Chicago, but conflicting public messaging has caused confusion. National leaders have largely declared victory over the virus, but some local governments are starting to again urge caution. New York City delayed lifting a mask mandate for kids under 5 years of age due to rising cases and the city’s health commissioner recommended New Yorkers return to masking indoors.

Still, even in New York things look vastly different than during the start of prior surges. Gone are the days of long testing lines and sold out antigen tests. And all over the country, pop-up testing centers, once a pandemic mainstay, are starting to disappear. Though state-run testing facilities have continued to operate in some regions, people without health insurance are facing high prices. And as of March 22, the  U.S. Health Resources and Services Administration is no longer accepting reimbursement claims from health providers for Covid testing either.

At the same time, at-home rapid testing has increased. The problem is, the CDC does not require people to report positive at-home test results so it’s rare the results of at-home tests are factored into public health data.

“We are probably underestimating the number of infections we are having now because many of the infections are either without symptoms or minimally symptomatic and you will miss people that do it at home,” Anthony Fauci, the top medical adviser to President Joe Biden, told Bloomberg TV on Wednesday. 

Daily Covid Diagnostic Test Volume | Tests sequenced by labs in the U.S. and reported to the CDC

© BloombergDaily Covid Diagnostic Test Volume | Tests sequenced by labs in the U.S. and reported to the CDC

In New Jersey, for example, Stacy Flanagan, the director of health and human services for Jersey City, said that in the last three months she’s had just two people call to report positive at-home tests. Cases are continuing apace in the city with an average of 64 new cases per day, according to health department data.  That’s almost double the number of daily cases reported a month ago. 

“We’ve heard from only a handful of conscientious people who call us and say, ‘I’ve done a home test and it’s positive,’” said Dave Henry, the health officer for more than a dozen towns in Monmouth County, New Jersey.

Public health experts are left to piece together data from a variety of sources. For Rick Bright, a virologist and CEO of the Rockefeller Foundation’s Pandemic Prevention Institute, that means using the CDC data as well as a number of other sources to understand Covid’s spread. “Unfortunately, we still have to go to a handful of sites to try to patch together what’s really happening across the country.”

Other metrics such as wastewater surveillance and even air sampling may eventually become helpful alternatives in understanding how much virus is circulating in a community. For weeks, sewer data has shown cases are increasing in some regions of the U.S. — foreshadowing the uptick in positives that places like New York and Massachusetts are now seeing.

In the nation’s capital, more than 50 people who attended the elite Gridiron Club dinner on April 2 have tested positive for the coronavirus, the Washington Post reported — at least 8 percent of those who attended. The list of the infected includes the U.S. attorney general, Commerce secretary, aides to Vice President Kamala Harris and first lady Jill Biden, and the sister of the president. 

Speaker of the House Nancy Pelosi, who didn’t attend the dinner, has also tested positive, raising concern about time she spent in proximity to President Biden prior to her diagnosis.

Home Testing

The White House maintains there’s enough data about Covid in circulation to catch the next surge. Tom Inglesby, senior policy advisor for Biden’s Covid-19 Response Team, said the CDC gets 850,000 lab-based test results every day, which he believes is sufficient to detect trends in the positivity rate and variant prevalence. 

“It is true that there is a larger shift now to switch to over-the-counter testing, that’s definitely happening,” Inglesby said during a panel discussion.  “There are various efforts underway to try to assess whether people might be willing to voluntarily report some fraction of those tests that are being performed at home.” One biotech company, Ellume, has rolled out an at-home test and app that automatically reports positive tests to the CDC through a secure, HIPAA-compliant connection. 

Meanwhile the CDC has pledged to ramp up its wastewater surveillance efforts. The agency does not yet have data from sites in every state, so even getting access to some of the sampling already underway could be useful. Environmental surveillance, like many other tools to track Covid, may be at risk without additional funding from Congress. On Tuesday, lawmakers  reached an agreement to re-allocate $10 billion to pandemic preparedness, which press secretary Jen Psaki said would fund “the most immediate needs” such as antivirals and tests.  But that bill has yet to clear the Senate.

“The information we are getting from the CDC is going to be less reliable, more spotty, and lose momentum,” Bright said. “There’s really big concerns about the lack of sustainable financing to keep the momentum going and finish the job for the surveillance we’re building for pandemic prevention.”

There could be a lesson from the 1918 flu pandemic. After cases started to go down following the first two waves of the influenza virus, public sentiment shifted and many health measures were lifted. But in 1919, at the tail end of the pandemic, a fourth wave hit New York city, causing deaths to spike higher than they had during prior waves, according to a government funded study. 

“These late waves of the pandemics are sometimes the deadliest because people have given up,” said Gonsalves from Yale. 

Counties With Highest Vaccination Rates See More COVID-19 Cases Than Least Vaccinated

Authors: Petr Svab April 4, 2022 Updated: April 5, 2022 THE EPOCH TIMES

U.S. counties with the highest rates of vaccination against COVID-19 are currently experiencing more cases than those with the lowest vaccination rates, according to data collected by the Centers for Disease Control and Prevention (CDC).

The 500 counties where 62 to 95 percent of the population has been vaccinated detected more than 75 cases per 100,000 residents on average in the past week. Meanwhile, the 500 counties where 11 to 40 percent of the population has been vaccinated averaged about 58 cases per 100,000 residents.

The data is skewed by the fact that the CDC suppresses figures for counties with very low numbers of detected cases (one to nine) for privacy purposes. The Epoch Times calculated the average case rates by assuming the counties with the suppressed numbers had five cases each on average.

The least vaccinated counties tended to be much smaller, averaging less than 20,000 in population. The most vaccinated counties had an average population of over 330,000. More populous counties, however, weren’t more likely to have higher case rates.

Even when comparing counties of similar population, the ones with the most vaccinations tended to have higher case rates than those that reported the least vaccinations.

Among counties with populations of 1 million or more, the 10 most vaccinated had a case rate more than 27 percent higher than the 10 least vaccinated. In counties with populations of 500,000 to 1 million, the 10 most vaccinated had a case rate almost 19 percent higher than the 10 least vaccinated.

In counties with populations of 200,000 to 500,000, the 10 most vaccinated had case rates around 55 percent higher than the 10 least vaccinated.

The difference was more than 200 percent for counties with populations of 100,000 to 200,000.

For counties with smaller populations, the comparison becomes increasingly difficult because so much of the data is suppressed.

Another problem is that the prevalence of testing for COVID-19 infections isn’t uniform. A county may have a low case number on paper because its residents are tested less often.

The massive spike in infections during the winter appears to have abated in recent weeks. Detected infections are down to less than 30,000 per day from a high of over 800,000 per day in mid-January, according to CDC data. The seven-day average of currently hospitalized dropped to about 11,000 on April 1, from nearly 150,000 in January.

The most recent wave of COVID-19 has been attributed to the Omicron virus variant, which is more transmissible but less virulent. The variant also seems more capable of overcoming any protection offered by the vaccines, though, according to the CDC, the vaccines still reduce the risk of severe disease.

This New COVID Variant Is the Most Unpredictable One Yet

Authors: David Axe Published Apr. 03, 2022 10:47PM ET 

After spreading across Asia and Europe, the BA.2 subvariant of the novel coronavirus is now dominant in the United States, according to the U.S. Centers for Disease Control and Prevention.

Right now, U.S. COVID cases are at a six-month low. But what happens next in the U.S. and nearby countries is hard to predict. Looking to Europe for hints isn’t enormously helpful because, on that continent, BA.2 has behaved… unpredictably. Indeed, unpredictability might be exactly what Americans—and everyone else—should expect as the pandemic enters its 28th month.

A patchwork of public health rules, varying vaccination rates, and differing amounts of natural immunity from past infections mean that no two countries are the same. But even those differences don’t fully explain BA.2’s uneven impact.

“The bottom line is that it is not predictable what BA.2 will do,” John Swartzberg, a professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley’s School of Public Health, told The Daily Beast.

Amid this confusion, at least one thing remains true, however. As volatile as BA.2 is when it comes to countries and populations, you can still protect yourself by getting vaccinated.

Usually, there’s a pattern with new COVID lineages. An uptick in positive tests from clinics, hospitals, and wastewater samples correlates with a proportional increase in symptomatic infections.

But when it comes to BA.2, “something different seems to be occurring,” Peter Hotez, an expert in vaccine development at Baylor College, told The Daily Beast. “BA.2 is going up everywhere in terms of percentage of virus isolated” in tests, Hotez explained, “yet this translates into many different scenarios in terms of rise in cases.”“I can’t say with any certainty that this can be chalked up to their vaccine policies or vaccine politics alone.”

BA.2 is a highly mutated cousin of the previously dominant BA.1 subvariant of Omicron, the latest major variant—“lineage” is the scientific term–of the SARS-CoV-2 virus. Changes to the spike protein, which helps the virus to grab onto and infect our cells, make BA.1 and BA.2 extremely transmissible.

BA.1, which first appeared last fall and quickly drove record infections across much of the world, was the most contagious respiratory virus many virologists had ever seen—until BA.2 showed up a few weeks after its older cousin. BA.2 could be as much as 80 percent more transmissible than BA.1, Swartzberg said.

That’s why BA.2 eventually has outcompeted BA.1 and become the dominant sublineage in a steadily growing number of countries. It happened first in China, which for more than two years managed to avoid major COVID outbreaks through a combination of travel restrictions, business closures, careful contact-tracing and strict quarantine rules.

BA.2 blew right through China’s so-called “zero-COVID” strategy, causing cases to spike in Hong Kong then neighboring Shenzen then Shanghai. Authorities locked down each city in turn but still failed to stop the sublineage’s march across the country.

Europe was next. Health officials in the Americas watched nervously as BA.2 became dominant in one European country after another. After all, Europe tends to catch a particular coronavirus lineage or sublineage a month or six weeks before the U.S. and its neighbors do.

But BA.2 hasn’t sent clear signals. The first confusing datapoint actually wasn’t in Europe—it was in Africa. Weirdly, BA.2 was a virtual no-show in South Africa. That country logged a big surge in BA.1 cases in December, and then… nothing. A steady decline in cases even as BA.2 was ravaging other big, rich countries.

Some European countries likewise have escaped significant harm from BA.2. Others are reeling.

The United Kingdom and France caught BA.1 big-time in December and January. Both countries reported record numbers of cases that, owing to the vaccines, fortunately didn’t lead to record hospitalizations and deaths. Austria, by contrast, muddled through BA.1 before taking a huge hit from BA.2.

The U.K. reported a weekly average of 183,000 new daily cases in early January. Three weeks later, France counted a staggering weekly average of 354,000 daily new cases. The U.K.’s worst day for BA.1 deaths was Feb. 2, when authorities reported 535 COVID fatalities. On France’s worst day of BA.1, Feb. 8, 691 people died of COVID.

Comparing the two countries is natural. Not only are they neighbors, they also have roughly the same number of people–around 67 million. Both have managed to fully vaccinate around three-quarters of their populations. Both have wound down all major domestic COVID restrictions.

It makes sense that BA.2 would affect France and the U.K. similarly. And there, at least, the sublineage made some sense. The BA.2 wave that rolled across the U.K. and France starting in February has been relatively minor compared to the BA.1 wave—in both countries.

France’s daily new BA.2 cases seem to be leveling off at a weekly average of 126,000 infections. The U.K.’s weekly average of daily new cases peaked at 125,000 on March 21. Deaths tend to lag cases by a few weeks, so it’s not clear how fatal BA.2 will be in either country, but so far the worst daily death toll is much lower than it was for BA.1.

Now consider Austria. With just 8.9 million people, it’s smaller than the U.K. and France. But it’s equally well-vaccinated—and even came close to having a nationwide vaccine mandate before canceling the planned mandate back in early March, days before it was due to take effect. Austria, like most countries in Europe, has ended domestic restrictions on businesses and travel.

But unlike the U.K. and France, Austria caught BA.2 worsethan BA.1. Daily new case rates from BA.1 swelled to a weekly average of 34,000 and stayed there for a month and a half. Then BA.2 arrived in early March and, without much respite from BA.1, added another 10,000 daily new cases on top of the existing weekly average.“I don’t see a consistent thread between countries.”

Aside from a tiny dip in mid-March, the daily death rate has been going up and up on a weekly basis since January in Austria. BA.2 is claiming 40 lives a day, day after day on average.

It’s difficult to determine which policies make the difference—assuming differences in public health strategy matter at all against a virus as contagious as BA.2. Yes, Austria almost had a vaccine mandate, but it didn’t actually take force. And it’s very hard to say what the proposed mandate’s impact was, or would have been.

“Even if no additional people got vaccinated after a mandate was introduced, this doesn’t mean it didn’t ‘work,’ as the purpose of the mandate may have been to simply ensure that the only people you encounter when out at a restaurant or concert are vaccinated,” Maxwell Smith, a bioethicist at Western University in Ontario, told The Daily Beast.

“In that case, the vaccination mandate ‘working’ would mean reducing levels of transmission of the virus in the settings to which it applied,” Smith added. “Or, in the case of preserving critical infrastructure, it would mean something like fewer cases of severe illness or hospitalizations among those to whom the mandate applied.”

There are lots of ways Austria’s vaccine mandate might have improved outcomes for millions of Austrians at risk of catching COVID. But that didn’t stop Austria as a whole from suffering worse from BA.2 than other nearby countries.

“There are many factors that may have led to the case numbers we’re seeing both in Austria and its neighboring countries, so I can’t say with any certainty that this can be chalked up to their vaccine policies or vaccine politics alone,” Smith said.

Experts are at a loss to explain what other factors might be at work. If nearby countries have vaccinated roughly the same percentage of their populations and have also reopened their borders, businesses and schools—thus allowing for a certain level of natural immunity from past infection—then they should be equally prepared for a new viral lineage.

Clearly, they’re not. “I don’t see a consistent thread between countries,” Swartzberg said.

There are serious implications for the rest of the world as it braces for BA.2. Even strong vaccine uptake and lingering natural immunity might not spare you a big bump in infections. By the same token, BA.2 might just bypass a country for reasons no one fully understands, like it did with South Africa.

But the experiences of whole countries aren’t the experiences of individuals. Yes, BA.2 might have unpredictable effects on populations. But the science is clear on how people can reduce their personal risk. Favor well-ventilated indoor spaces. Wear an N95 mask when local case rates are high.

Most importantly, get vaccinated and boosted.

Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States

Authors: S. V. Subramanian & Akhil Kumar  European Journal of Epidemiology (2021)

Vaccines currently are the primary mitigation strategy to combat COVID-19 around the world. For instance, the narrative related to the ongoing surge of new cases in the United States (US) is argued to be driven by areas with low vaccination rates [1]. A similar narrative also has been observed in countries, such as Germany and the United Kingdom [2]. At the same time, Israel that was hailed for its swift and high rates of vaccination has also seen a substantial resurgence in COVID-19 cases [3]. We investigate the relationship between the percentage of population  fully vaccinated and new COVID-19 cases across 68 countries and across 2947 counties in the US.

Methods

We used COVID-19 data provided by the Our World in Data for cross-country analysis, available as of September 3, 2021 (Supplementary Table 1) [4]. We included 68 countries that met the following criteria: had second dose vaccine data available; had COVID-19 case data available; had population data available; and the last update of data was within 3 days prior to or on September 3, 2021. For the 7 days preceding September 3, 2021 we computed the COVID-19 cases per 1 million people for each country as well as the percentage of population that is fully vaccinated.

For the county-level analysis in the US, we utilized the White House COVID-19 Team data [5], available as of September 2, 2021 (Supplementary Table 2). We excluded counties that did not report fully vaccinated population percentage data yielding 2947 counties for the analysis. We computed the number and percentages of counties that experienced an increase in COVID-19 cases by levels of the percentage of people fully vaccinated in each county. The percentage increase in COVID-19 cases was calculated based on the difference in cases from the last 7 days and the 7 days preceding them. For example, Los Angeles county in California had 18,171 cases in the last 7 days (August 26 to September 1) and 31,616 cases in the previous 7 days (August 19–25), so this county did not experience an increase of cases in our dataset. We provide a dashboard of the metrics used in this analysis that is updated automatically as new data is made available by the White House COVID-19 Team (https://tiny.cc/USDashboard).

Findings

At the country-level, there appears to be no discernable relationship between percentage of population fully vaccinated and new COVID-19 cases in the last 7 days (Fig. 1). In fact, the trend line suggests a marginally positive association such that countries with higher percentage of population fully vaccinated have higher COVID-19 cases per 1 million people. Notably, Israel with over 60% of their population fully vaccinated had the highest COVID-19 cases per 1 million people in the last 7 days. The lack of a meaningful association between percentage population fully vaccinated and new COVID-19 cases is further exemplified, for instance, by comparison of Iceland and Portugal. Both countries have over 75% of their population fully vaccinated and have more COVID-19 cases per 1 million people than countries such as Vietnam and South Africa that have around 10% of their population fully vaccinated.

figure1

Across the US counties too, the median new COVID-19 cases per 100,000 people in the last 7 days is largely similar across the categories of percent population fully vaccinated (Fig. 2). Notably there is also substantial county variation in new COVID-19 cases within categories of percentage population fully vaccinated. There also appears to be no significant signaling of COVID-19 cases decreasing with higher percentages of population fully vaccinated (Fig. 3).

Fig. 2

figure2

Median, interquartile range and variation in cases per 100,000 people in the last 7 days across percentage of population fully vaccinated as of September 2, 2021Full size image

figure3

Of the top 5 counties that have the highest percentage of population fully vaccinated (99.9–84.3%), the US Centers for Disease Control and Prevention (CDC) identifies 4 of them as “High” Transmission counties. Chattahoochee (Georgia), McKinley (New Mexico), and Arecibo (Puerto Rico) counties have above 90% of their population fully vaccinated with all three being classified as “High” transmission. Conversely, of the 57 counties that have been classified as “low” transmission counties by the CDC, 26.3% (15) have percentage of population fully vaccinated below 20%.

Since full immunity from the vaccine is believed to take about 2 weeks after the second dose, we conducted sensitivity analyses by using a 1-month lag on the percentage population fully vaccinated for countries and US counties. The above findings of no discernable association between COVID-19 cases and levels of fully vaccinated was also observed when we considered a 1-month lag on the levels of fully vaccinated (Supplementary Figure 1, Supplementary Figure 2).

We should note that the COVID-19 case data is of confirmed cases, which is a function of both supply (e.g., variation in testing capacities or reporting practices) and demand-side (e.g., variation in people’s decision on when to get tested) factors.

Interpretation

The sole reliance on vaccination as a primary strategy to mitigate COVID-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants. Other pharmacological and non-pharmacological interventions may need to be put in place alongside increasing vaccination rates. Such course correction, especially with regards to the policy narrative, becomes paramount with emerging scientific evidence on real world effectiveness of the vaccines.

For instance, in a report released from the Ministry of Health in Israel, the effectiveness of 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine against preventing COVID-19 infection was reported to be 39% [6], substantially lower than the trial efficacy of 96% [7]. It is also emerging that immunity derived from the Pfizer-BioNTech vaccine may not be as strong as immunity acquired through recovery from the COVID-19 virus [8]. A substantial decline in immunity from mRNA vaccines 6-months post immunization has also been reported [9]. Even though vaccinations offers protection to individuals against severe hospitalization and death, the CDC reported an increase from 0.01 to 9% and 0 to 15.1% (between January to May 2021) in the rates of hospitalizations and deaths, respectively, amongst the fully vaccinated [10].

In summary, even as efforts should be made to encourage populations to get vaccinated it should be done so with humility and respect. Stigmatizing populations can do more harm than good. Importantly, other non-pharmacological prevention efforts (e.g., the importance of basic public health hygiene with regards to maintaining safe distance or handwashing, promoting better frequent and cheaper forms of testing) needs to be renewed in order to strike the balance of learning to live with COVID-19 in the same manner we continue to live a 100 years later with various seasonal alterations of the 1918 Influenza virus.

References

  1. 1.Vaccinations CDC. CDC COVID data tracker. Centers for Disease Control and Prevention. 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations.
  2. 2.Nicolas E. Germany mulls restrictions for unvaccinated as cases soar. EUobserver; 2021. https://euobserver.com/coronavirus/152534.
  3. 3.Estrin D. Highly vaccinated Israel is seeing a dramatic surge in New COVID cases. Here’s why. NPR; 2021. https://www.npr.org/sections/goatsandsoda/2021/08/20/1029628471/highly-vaccinated-israel-is-seeing-a-dramatic-surge-in-new-covid-cases-heres-why.
  4. 4.Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, Giattino C, Appel C, Rodés-Guirao L, Roser M. Coronavirus pandemic (COVID-19). 2020. Published online at OurWorldInData.org. Retrieved from: https://ourworldindata.org/coronavirus.
  5. 5.White House COVID-19 Team. COVID-19 community profile report. 2020. HealthData.gov. https://healthdata.gov/Health/COVID-19-Community-Profile-Report/gqxm-d9w9.
  6. 6.Ministry of Health Israel. Two-dose vaccination data. Government of Israel; 2021. https://www.gov.il/BlobFolder/reports/vaccine-efficacy-safety-follow-up-committee/he/files_publications_corona_two-dose-vaccination-data.pdf.
  7. 7.Thomas SJ, Moreira ED, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, et al. Six Month safety and efficacy of the BNT162b2 Mrna Covid-19 vaccine. MedRxiv. 2021. https://doi.org/10.1101/2021.07.28.21261159.Article PubMed PubMed Central Google Scholar 
  8. 8.Gazit S, Shlezinger R, Perez G, Lotan R, Peretz A, Ben-Tov A, Cohen D, Muhsen K, Chodick G, Patalon T. Comparing sars-cov-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections. MedRxiv. 2021. https://doi.org/10.1101/2021.08.24.21262415.Article Google Scholar 
  9. 9.Canaday DH, Oyebanji OA, Keresztesy D, Payne M, Wilk D, Carias L, Aung H, Denis KS, Lam EC, Rowley CF, Berry SD, Cameron CM, Cameron MJ, Wilson B, Balazs AB, King CL, Gravenstein S. Significant reduction in humoral Immunity among healthcare workers and nursing home residents 6 months AFTER COVID-19 BNT162b2 mRNA vaccination. MedRxiv. 2021. https://doi.org/10.1101/2021.08.15.21262067.Article PubMed PubMed Central Google Scholar 
  10. 10.McMorrow M. (rep.). Improving communications around vaccine breakthrough and vaccine effectiveness. 2021. Retrieved from https://context-cdn.washingtonpost.com/notes/prod/default/documents/8a726408-07bd-46bd-a945-3af0ae2f3c37/note/57c98604-3b54-44f0-8b44-b148d8f75165.

New South African COVID-19 strain is the most mutated one yet: report

Authors: By Yaron SteinbuchAugust 30, 2021 10:50am

COVID-19 variant first detected in South Africa could be more infectious than other mutations — and may have the potential of being resistant to vaccines, according to a report.

The C.1.2 strain has been linked to “increased transmissibility” and is said to have mutated the most from the original virus, which first emerged in the Chinese city of Wuhan, the Mirror reported.

The strain has a mutation rate of about 41.8 mutations per year, almost double the global mutation rate seen in any other existing variant of concern, according to experts at South Africa’s National Institute for Communicable Diseases and the KwaZulu-Natal Research Innovation and Sequencing Platform.

The number of C.1.2 genomes in South Africa has risen from 0.2 percent in May to 1.6 percent in June and 2 percent in July, according to scientists, who also have found 14 mutations in nearly 50 percent of the variants that had a C.1.2 sequence.

The C.1.2 strain also has been found in the UK, China, the Democratic Republic of the Congo, Mauritius, New Zealand, Portugal and Switzerland.

The latest South African variant could be capable of evading antibodies and immune systems, researchers said, while noting that additional research is needed.

“We describe and characterize a newly identified SARS-CoV-2 lineage with several spike mutations that is likely to have emerged in a major metropolitan area in South Africa after the first wave of the epidemic, and then to have spread to multiple locations within two neighboring provinces,” the researchers wrote in the report, which was published in the journal Nature.

 “We show that this lineage has rapidly expanded and become dominant in three provinces, at the same time as there has been a rapid resurgence in infections,” they added.

B.1.351, another South African strain found in April, had the potential to “break through” the Pfizer vaccine, scientists have found.

“We found a disproportionately higher rate of the South African variant among people vaccinated with a second dose, compared to the unvaccinated group,” said professor Adi Stern of Tel Aviv University in Israel, the Mirror reported. “This means that the South African variant is able, to some extent, to break through the vaccine’s protection.”

But still, he said the variant “has not spread widely through the population” — and that the UK variant may be “blocking” the spread of the South African strain.

News about the C.1.2 strain, which was discovered in May, comes as the US grapples with a resurgence caused by the Delta variant, which has complicated efforts to return to workplaces and schools.

“We Don’t Understand What’s Really Happening” – The CDC Is Under-Counting ‘Breakthrough’ COVID Cases

Authors: BY TYLER DURDENWEDNESDAY, AUG 25, 2021 – 01:04 PM

A growing number of public health officials working at the state level are worried that the federal government isn’t collecting enough accurate data about “breakthrough” infections, yet the Biden Administration has pushed ahead with plans to dole out booster shots, as well as other COVID policies.

According to Politico, 49 states are now regularly sending CDC information on hospitalized breakthrough patients. But more than a dozen have told Politico that they do not have the capacity to match hospital admission data with patients’ immunization records, forcing states to rely on hospital administrators to report breakthrough infections.

The result is data that is often aggregated, inaccurate and missing critical details like which vaccine the consumer received . Instead, those states rely on hospital administrators to report breakthrough infections. The resulting data is often aggregated, inaccurate and omits critical details for teasing out trends, such as which vaccine a person received and whether they have been fully vaccinated, a dozen state officials said.

The fact that the CDC and public health departments across the country are still struggling to collect data on breakthrough infections is almost embarrassing, considering we’re more than 18 months into the pandemic at this point, and scientists have repeatedly warned about the necessity of being prepared for the Omega Death Variant which is right around the corner, according to Dr. Fauci’s latest fearmongering blitz.

“I think it would be really challenging [for the CDC] to interpret the results or to interpret the data when you have only some jurisdictions reporting [breakthrough infections],” said Theresa Sokol, lead epidemiologist for Louisiana’s state public health department, which is working closely with the CDC on studies of breakthrough infections. “I know that there are some jurisdictions that don’t even have access to their vaccination data. They don’t have the authority or their permission.”

Perhaps the biggest obstacle to collecting data on breakthrough infections is the balkanized nature of state health-care systems. States can’t communicate with other states. For years, states have pleaded with the federal government to upgrade these systems to no avail.

Last year, the CDC allocated a small amount of money (described by Politico as “tens of millions of dollars”) to help states upgrade their systems. But the CDC admits it will take years for the necessary upgrades to be made.

“Nothing has changed since the pandemic began,” one senior Biden health official said. “We’re still dealing with this patchwork system — and it continues to fail us.”

Of particular concern for health officials now is how rapidly the Delta variant spreads, whether it is reducing the effectiveness of vaccines and whether it causes more severe disease. Tracking breakthrough infections is a critical step toward arriving at all of these assessments.

To complement data on hospitalized cases from the 50-state reporting network, the CDC is conducting a smaller study with a subset of states to examine all of their breakthrough infections, including mild cases that don’t send people to the hospital. The states participating in this smaller study have the ability to match lab reports with immunization records, but they don’t maintain their own databases of hospitalization data. ;

“We report what we have, but we know that it’s limited because it’s based on a direct report from a provider — as opposed to taking a data set of all hospitalizations and matching that against our vaccine registry,” said Sokol, the Louisiana epidemiologist. “We’re not able to do that for hospitalization. We rely on individual reports from hospitals. And some report well, others do not. So we know that it’s not complete.”

[…]

“We don’t have a clear understanding of what the data actually says about the Delta variant, transmission and boosters,” one of those officials said.

To be sure, deliberately under-counting breakthrough infections has its advantages: for example, the Biden Administration can mask the number of breakthrough infections reported, making the vaccines appear more effective than they actually are.