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The Newsletter | Dec 15, 2020

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In terms of mortality, the US is averaging 2,430 deaths per day, which corresponds to 1 US death every 36 seconds.

Johns Hopkins Center for Health Security Tweet

The COVID-19 Brief

The WHO reports 71.35 million cases and 1.61 million deaths as of December 15. The world reached 70 million cases on December 13. 
From the first reported COVID-19 case, it took 90 days to reach 1 million cases.

  • 1 case to 1 million- 90 days
  • 1 case to 10 million- 177 days
  • 10 to 20 million- 44 days
  • 20 to 30 million- 37 days
  • 30 to 40 million- 31 days
  • 40 to 50 million- 21 days
  • 50 to 60 million- 17 days
  • 60 to 70 million- 17 days
 
Mortality, which is the proportion of people dying and not the number of deaths overall, increased for the eighth consecutive week. 

 

UNITED STATES

The US CDC reported 16.11 million total cases and 298,266 deaths.
The US reported a new single-day record for daily incidence on December 11, with over 244,000 new cases.
It continues to appear as though US daily incidence is beginning to taper off toward a peak or plateau; however, we have likely still not yet seen the effects of Thanksgiving travel and gatherings.
If the Thanksgiving holiday had a major impact on the US epidemic, we expect to see the early evidence over the next week or two.

In terms of mortality, the US is averaging 2,430 deaths per day, which corresponds to 1 US death every 36 seconds.

To date, the US has only exceeded this rate for a 3-day period from April 19-21, at the very peak of the initial US surge and just days after New York City reported 3,700 previously unreported probable COVID-19 deaths from the onset of its epidemic.

We expect the US to surpass 300,000 cumulative deaths in this afternoon’s CDC update. From the first US death reported on February 29, it took 46 days to reach 25,000 deaths. From there:

 

  • 25k to 50k- 9 days
  • 50k to 75k- 13 days
  • 75k to 100k- 20 days
  • 100k to 125k- 31 days
  • 125k to 150k- 32 days
  • 150k to 175k- 24 days
  • 175k to 200k- 31 days
  • 200k to 225k- 34 days
  • 225k to 250k- 24 days
  • 250k to 275k- 14 days
  • 275k to 300k- 11 days

According to an analysis by the COVID Tracking Project, all but 3 states have reported record high daily incidence since the beginning of November, including 17 since last week.
The Midwest region is the only one to have passed a peak in daily incidence or hospitalizations, although mortality continues to increase across all 4 regions. The Midwest and South regions appear as though they may be at or approaching a peak in daily mortality, but we need more data to better characterize the longer-term trends. 
While the regional mortality may turn in the Midwest, Iowa and North and South Dakota continue to report per capita daily mortality substantially higher than the rest of the country, on the order of 50% or higher than any other states.

Ranking of COVID-19 among the leading causes of death for the year

Deaths from COVID-19 are projections of cumulative deaths on Jan 1, 2021, from the reference scenario. Deaths from other causes are from the Global Burden of Disease study 2019 (rounded to the nearest 100).

Cause of Death RankingsDeathsRanking
Ischemic heart disease5500001
COVID-193483112
Tracheal, bronchus, and lung cancer2062003
Chronic obstructive pulmonary disease1958004
Stroke1895005
Alzheimer’s disease and other dementias1439006
Chronic kidney disease1070007
Colon and rectum cancer840008
Lower respiratory infection8190009
Diabetes mellitus7770010
Ranking of COVID-19 among the leading causes of mortality in the full year 2020. Deaths from COVID-19 are projections of cumulative deaths on Jan 1, 2021 from the reference scenario. Deaths from
other causes are from the Global Burden of Disease study 2019 (rounded to the nearest 100).
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Science & Society News

 US FDA AUTHORIZES PFIZER VACCINE

On December 11, the US FDA issued an Emergency Use Authorization (EUA) for the Pfizer/BioNTech vaccine, which allowed Pfizer to begin distributing the first allotments of the vaccine nationwide. The FDA also published guidance for vaccinators—including storage, thawing, dilution, and dosing information—and recipients. The EUA specifically authorizes the vaccine for use in individuals aged 16 years and older, but as we covered previously, not everyone in this population will be immediately eligible for vaccination. Eligibility will be expanded slowly, starting with priority populations such as high-risk individuals and essential workers. The only contraindication listed in the vaccine information is a history of allergies to vaccine ingredients, although safety monitoring and reporting will be ongoing as the vaccination program unfolds in order to identify any additional conditions associated that could be associated with adverse events following vaccination. 

 

US VACCINE DISTRIBUTION & ADMINISTRATION

On December 11-12, the US Advisory Committee on Immunization Practices (ACIP) met to approve its interim recommendations for use of the Pfizer/BioNTech SARS-CoV-2 vaccine, following the FDA’s issuance of an EUA. The content of the recommendations, published in the US CDC’s MMWR, provide an update to the initial interim guidance published on December 3. ACIP also updated the underlying evidence considered in developing the recommendations. ACIP recommended that the vaccine could be administered to those aged 16 years or older in the US, and that two doses should be administered 21 days apart. ACIP previously also stated that initial doses should be prioritized for healthcare personnel and long-term care facility residents in the first tier of recipients. Notably, the EUA included a provision for pregnant women to potentially be immunized.

The first shipments of the Pfizer/BioNTech vaccine have already been sent out from Pfizer’s facility in Kalamazoo, Michigan, as well as a distribution center in Wisconsin, and vaccination efforts began across the country. Most of the initial reports indicated that healthcare workers were among the first to be vaccinated, as major hospitals are better equipped than many locations to maintain the resource-intensive storage requirements, including that the vaccine be maintained at -112°F (-80°C). Many hospitals will serve as hubs to distribute vaccines locally for long-term care facilities (LCTFs), and there are reports that vaccinations have already commenced at some LCTFs as well.

 

VACCINE COMBINATIONS 

As initial doses of first generation SARS-CoV-2 vaccines are being distributed in some countries, discussions are already underway to optimize second generation vaccine formulations and dosing schedules. Last week, AstraZeneca announced that it is collaborating with the developers of Russia’s Sputnik V vaccine to determine whether administering a combination of the two vaccines could improve efficacy. Reportedly, the initial clinical trials of the combination vaccine would be held in Russia to assess this will begin in Russian adults. According to the press release issued by AstraZeneca, the UK government has already announced upcoming clinical trials to evaluate combinations of adenovirus-based vaccines, like those produced by AstraZeneca/Oxford University and Russia’s Gamaleya Research Institute, and mRNA vaccines, like those from Pfizer/BioNTech and Moderna; however, the AstraZeneca and Gamaleya Institute collaboration will evaluate a combination of two adenovirus-based vaccines.

Utilizing a combination of different vaccines for the same pathogen is called “heterologous boosting,” and it aims to improve both efficacy and accessibility. AstraZeneca indicated that the heterologous boosting approach could speed the process of completing the 2-dose regimen, particularly if the availability of some vaccines is limited; however, UK government health officials stated that the focus is on improving the immune response and not a response to limited supply.

 

European Covid Restrictions

GERMANY 

Despite implementing “partial lockdown” measures in early November, Germany is strengthening restrictions ahead of the winter holidays. Germany’s daily incidence has increased tenfold since the beginning of October, and its cumulative incidence increased quadrupled over that time. The magnitude of this “second wave” spurred the German government to take further actions. In the previous partial lockdown, bars and restaurants were closed, while stores and schools remained open.

In this new “reinforced” lockdown, currently scheduled from December 16 to January 10, schools, retail stores other than grocery stores and supermarkets, and other non-essential businesses will be closed, besides bars and restaurants. Businesses that are mandated to close will receive financial support from the government, up to €500,000 (US$600,000) per month.

Germany is also implementing household visiting restrictions, with some minor exceptions for Christmas. Gatherings will be limited to a maximum of 5 total individuals from 2 households. Over Christmas, including Christmas Eve, households may invite 4 additional people “from the closest family circle.” These celebratory exceptions do not apply to New Year’s Eve. Scheduled New Year’s events are being canceled, and Germany banned the sale of fireworks. By entering this period of reinforced lockdown, German authorities are hoping to stave off another potential wave that could overwhelm its healthcare system and provide enough time for the European Medicines Agency to authorize a vaccine and vaccination efforts to commence.

 

UNITED KINGDOM

Many areas of the UK are entering the highest tier of COVID-19 restrictions. All boroughs of London as well as areas of Essex and Hertfordshire in England will enter Tier 3 restrictions, which include limitations on indoor and outdoor gatherings and closures for non-essential businesses. A majority of England’s population, 34 million people, will be affected. Individuals not living in Tier 3 areas are advised not to travel to and from those areas. Several restrictions, including indoor gatherings, will be relaxed for Christmas celebrations. The UK will permit individuals and families to form a “Christmas bubble”, which will allow individuals from up to 3 households to visit each other indoors and stay overnight. Travel restrictions will also be lifted to allow individuals to visit family members anywhere in the UK.

 

NETHERLANDS 

Like its neighbor Germany, the Netherlands is also strengthening “lockdown” restrictions ahead of the holiday season. The Dutch government decided to order renewed measures against COVID-19 following a sharp rise in cases over the last 2 weeks. Following a 50% decrease in daily incidence from its second peak, the Netherlands jumped back up 70% since December 1. Under the updated restrictions, non-essential businesses must close, schools must switch to remote learning, and gatherings are limited to 2 people, even outdoors. Notably, households will be permitted to have 3 guests indoors from December 24-26, not including children aged 12 years and younger. The Dutch government also outlined “crucial professions” that are permitted to continue in-person operations and noted that children of crucial workers may still attend primary school or after-care programs.

 

FRANCE 

In contrast to some other European countries, France is taking steps to ease COVID-19 restrictions. After passing its second peak, France ended its “lockdown” today and relaxed some social distancing measures. Rather than a formal lockdown period, France is instituting an 8 pm curfew that aims to limit transmission at gatherings at times when people may be less vigilant about implementing appropriate protections, such as physical distancing and mask use. After 8 pm, most businesses will be directed to close, and individuals will need to carry official exemption certificates in order to be out in public. Violators could face fines of €135, and up to € 3,750 for repeat offenders. Bars, restaurants, and nightclubs are scheduled to remain closed until January 20. The French government will permit individuals and families to travel on December 24, but they will prohibit public gatherings. While the restrictions will be eased slightly for Christmas Eve, France intends to enforce the curfew on January 31, New Year’s Eve.

 

EUROPEAN MEDICINES AGENCY VACCINE AUTHORIZATION

Following regulatory agencies in Canada, the UK, and the US authorizing the use of Pfizer and BioNTech’s SARS-CoV-2 vaccine, the European Medicines Agency (EMA) is set to complete its assessment by next week. The EMA’s human medicines committee (CHMP) received additional data yesterday and scheduled a meeting for December 21 to discuss its recommendations regarding a conditional authorization. Like in other countries, the official determination will be made by the EMA with strong consideration of the CHMP’s recommendations. The meeting was moved forward from December 29, but the CHMP is keeping the originally scheduled meeting on the calendar in the event it is needed. The timing of the CHMP meeting has been criticized as delayed, particularly in light of the authorizations already issued in Canada, the UK, and the US; however, EMA’s Executive Director, Emer Cooke, suggested that the other countries received the clinical trial data earlier than the EMA.

Reports emerged yesterday that documents related to Moderna’s application for conditional authorization for its candidate SARS-CoV-2 vaccine was accessed via a cyberattack on the EMA. The EMA was also attacked earlier in December, during which hackers gained access to documents related to the Pfizer/BioNTech vaccine as well. Reportedly, the Moderna documents did not include personally identifiable information for study participants.

 

REMDESIVIR & BARICITINIB

Researchers conducting clinical trials under the Adaptive COVID-19 Treatment Trial 2 (ACCT-2) program published findings from a randomized, placebo-controlled clinical trial evaluating the effect of remdesivir and baricitinib combination therapy for COVID-19. The study, published in NEJM, included more than 1,000 participants divided approximately equally between patients treated with remdesivir and baricitinib and patients treated with just remdesivir (in combination with a placebo).

The primary analysis focused on time to recovery, and the researchers identified a slight but significant improvement among the treatment group. Patients who received the combination therapy recovered in an average of 7 days, compared to 8 days among the control group. Perhaps most notably, however, the researchers identified an improvement in recovery time from 18 days to 10 days among the 216 patients who received high-flow oxygen therapy or non-invasive ventilation. The researchers indicate that the faster recovery time among these patients with severe disease could be a result of reduced risk of hospital-acquired infections and thrombosis.

 

GUILLAIN-BARRÉ SYNDROME

Researchers in the UK published findings from a study on Guillain-Barré syndrome (GBS) and COVID-19. GBS is a relatively rare neurological condition that can develop following various kinds of infections, including viral, and some have speculated that COVID-19 could be driving an increase in GBS. GBS can cause pain and numbness and even muscle weakness or paralysis in severe cases. If the weakness or paralysis affects the muscles responsible for breathing, it could be fatal, and patients could require mechanical ventilation.

The GBS study, published in Brain, found no causative association between GBS and COVID-19. The researchers compared GBS data during the UK’s first COVID-19 wave (March-May 2020) against GBS data from 2016 to 19. Like many other health conditions, reports of GBS decreased during the first wave, falling from 113 to 132 cases in March-May in 2016-19 to 56-93 cases in 2020.

This could result from individuals delaying medical care during the UK’s “lockdown” or a reduction in transmission of other infections that could lead to GBS. The researchers also included seroprevalence data for SARS-CoV-2 infection among blood donors, and they estimate the risk of GBS to be approximately 0.016 cases of GBS per 1,000 cases of COVID-19. The researchers also evaluated patient-level data from 47 GBS cases reported in the UK, including 13 confirmed and 12 probable COVID-19 cases and 22 non-COVID-19 patients. They identified an increase in using intubation among GBS patients with COVID-19, which the researchers believe is “likely” because of the pulmonary effects of COVID-19 rather than increased severity of GBS presentation.

We have previously identified GBS following vaccination, with frequency estimates ranging from occasional to rare. Following influenza vaccination efforts in the US in 1976-77, reports of GBS in recently vaccinated individuals ultimately resulted in the suspension of vaccination activities, and this historical example has contributed to concerns about links between vaccination and GBS. Considering the UK and other countries commencing SARS-CoV-2 vaccination efforts, they published the research study alongside a commentary regarding the risk of GBS associated with SARS-CoV-2 vaccination.

The commentary—authored by researchers from the Netherlands, Spain, the UK, and the US—called on health and elected officials to resist the urge to link GBS cases after vaccination to the vaccine. The researchers outline approximations for the expected incidence of GBS under normal conditions, and they conclude that normal GBS incidence would result in over 13,000 cases globally in the 10 weeks following a SARS-CoV-2 vaccination, with no effect at all from the vaccine.

They use this analysis to highlight that many individuals will inevitably develop GBS, whether they are vaccinated or not, and a substantial portion of these cases will, by pure coincidence, develop in the period after vaccination. It is critically important to closely monitor for adverse events, but it is just as important to ensure that we do not unnecessarily suspend vaccination activities because of preconceived notions regarding the risk of GBS or other conditions.

 
 

 

Headlines That Meet the Moment

Debunking the False Claim That COVID Deaths Are Inflated 

President Trump and other conspiracy fantasists touted the fake claim that COVID death counts are exaggerated. But three kinds of evidence point to more than 250,000 deaths.

>>>Read More


Eight Persistent COVID-19 Myths and Why People Believe Them

From a human-made virus to vaccine conspiracy theories, we rounded up the most insidious false claims about the pandemic. >>> Read More

Information Overload Helps Fake News Spread, and Social Media Knows It

Understanding how algorithm manipulators exploit our cognitive vulnerabilities empowers us to fight back. >>>Read More

UK Scientists Investigate Spike Protein Mutation 

Could a novel strain of SARS-CoV-2 identified this month be linked to an accelerating spread in the country’s southeast? Public Health England is investigating.

British scientists emphasized there is currently no evidence the new strain causes more severe illness or has any impact on antibody response or vaccine efficacy.

It would be “pretty surprising” if the virus would have already evolved to evade such a new vaccine, chief medical officer Professor Chris Whitty said in a press conference, BBC Science Focus reports.

The new strain includes a mutation in the spike protein, which in theory could help the virus become more infectious and spread more easily.

Some Perspective: SARS-CoV-2 has already mutated many times—including around 4,000 mutations in the spike protein gene alone.

The WHO is aware of the new variant, emergencies chief Mike Ryan said, stressing that there is no evidence the strain behaves differently, Reuters reports.

 

Other Stories

  • People hospitalized with COVID-19 may face a heightened risk of clinical deterioration in the first 10 days after being discharged; a study of VA patients found that during this period, their rates of readmission or death were higher than for patients with pneumonia or heart failure. JAMA
     
  • Even if in mild or asymptomatic cases, kids’ blood vessels may be damaged by SARS-CoV-2 in ways that could manifest decades after the infection clears—but existing treatments may reduce the risk, according to preliminary findings published in Blood Advances. MedScape
     
  • Once known for its robust vaccination and pharmaceutical capacity, Brazil has suffered the world’s second-largest COVID-19 death toll amid “political infighting, haphazard planning and a nascent anti-vaccine movement.” The New York Times
  • “Only with the Vaccination of Younger People Will the Number of Cases Decrease” – Der Spiegel
 
  • Annette Rid, Marc Lipsitch, and Franklin G. Miller: The Ethics of Continuing Placebo in SARS-CoV-2 Vaccine Trials – JAMA (commentary)
 
 
  • COVID-19 Vaccine Trials to Begin on Pregnant Women, Young Kids in January – NBC 7 San Diego
 
 
  • China plans set up of new disease control agency in COVID-19 aftermath -Caixin – Reuters
 
  • In their own words: Public health officials on the frontline – AP
 
 
  • WHO releases physical activity guidelines for keeping fit during quarantine, lockdowns – Firstpost
 
  • How influencers are being recruited to promote the Covid-19 vaccine – Vox
 
  • The polio vaccine had Elvis. Can celebrities similarly spur acceptance of the Covid-19 vaccine? – STAT
 

Americans mostly approve of their news sources’ election coverage, but Republicans less so than Democrats

Americans split on whether media’s election coverage protects or hurts democracy>>>Read More

Most Republicans Approve of Trump’s Post-election Messaging, but About a Third Say It Has Been Wrong

Partisans differ on whether social media companies’ decisions had a major impact on the election.

Partisans largely approve of their party’s candidate’s message after the election, although about one-third of Republicans say Trump’s has been wrong

Democrats much more likely to recognize that all losing presidential candidates in modern U.S. history have publicly conceded

Partisans largely approve of their party’s candidate’s message after the election, although about one-third of Republicans say Trump’s has been wrong

 

Over the weekend Novel Science created a data visualization that expressed the dramatic loss in the US. Humans can adjust to anything, but the preventable loss of life is a failing to which we ought never grow accustomed

It's important to remember these are lives and that each of us has the power to save others.

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