COVID-19 Data Dispatch

Author: Betsy Ladyzhets

  • How is the CDC tracking the latest round of COVID-19 vaccines?

    How is the CDC tracking the latest round of COVID-19 vaccines?

    The CDC’s vaccination data pages all stopped updating in May 2023. How is the agency tracking our current round of shots?

    It’s now been a couple of weeks since updated COVID-19 vaccines became available in the U.S. At this point in prior COVID-19 vaccine rollouts, we would know a lot about who had received those vaccines: data would be available by state, for different age groups, and other demographic categories.

    This time, though, the data are missing on a national scale. Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards.

    But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations. In fact, last week, the federal Department of Health and Human Services (HHS) told reporters that more than seven million Americans have received updated COVID-19 vaccines so far this fall.

    HHS also said that about 14 million doses have been shipped to vaccination sites, primarily pharmacies. In addition, 710,000 vaccines for children have been ordered through a federal program that provides these shots.

    Vaccine distribution numbers are slightly easier for the CDC and HHS to collect, as they can work directly with vaccine manufacturers. To understand how many people are getting the shots, though, is more challenging—requiring a mix of data from state and local agencies, surveys, and other surveillance mechanisms.

    What changed with the PHE’s end:

    Early in the pandemic, the CDC established data-sharing agreements with the health agencies that keep immunization records. This includes all states, territories, and a few large cities (such as New York City and Philadelphia) that have separate records systems from their states; you can see a full list of records systems here.

    Through those agreements, the CDC collected vaccine administration numbers, standardized the data (as much as possible), and reported them on public dashboards. The CDC wasn’t able to collect as detailed demographic information as many health experts would’ve liked—for example, they never reported vaccinations by race and ethnicity below the national level. But the data were still useful for tracking who got vaccinated across the U.S.

    These data-sharing agreements concluded with the end of the public health emergency (PHE) in May 2023. According to a CDC report published at that time, the CDC was able to extend agreements with some jurisdictions past the PHE’s end. Still, the report’s authors acknowledged that “future data might not be as complete” as during the emergency period. Even if 40 out of 50 states keep reporting, the remaining 10 represent data gaps.

    Notably, the May report also claims that the CDC would continue to provide data on COVID-19 vaccination coverage on the CDC’s COVID-19 dashboard and a separate vaccination dashboard. But neither of those dashboards has been updated with any information from this fall’s vaccine campaign, as of this publication.

    In addition to compiling data from state and local systems, the CDC has other mechanisms for tracking vaccinations. According to CBS News reporter Alexander Tin, CDC officials highlighted a couple during a briefing on October 4:

    • The National Immunization Survey, a phone survey conducted by CDC officials to estimate national vaccination coverage based on a representative sample of Americans. This survey is currently the CDC’s method for tracking flu vaccinations.
    • CDC’s Bridge Access and Vaccines for Children (VFC) programs, both of which buy vaccines to distribute to Americans who may not have health insurance or face other financial barriers to vaccination. The Bridge Access program was specifically set up for COVID-19 vaccines, while the VFC program covers other childhood vaccines.
    • Contact with vaccine manufacturers and distributors, i.e. the pharmaceutical companies that make the vaccines and the pharmacies and healthcare organizations that give them out. These companies share data with the CDC, offering insights into how many vaccines have been distributed to different locations; though the data may not be comprehensive if not all distributors are included (i.e. just big pharmacy chains, not smaller, independent stores).

    Other places to look for vaccination data:

    Outside of the CDC, there are a few other places where you can look for vaccination data. Here are a couple that I’m monitoring:

    • State and local public health agencies: Some agencies that track immunizations have their own dashboards, reporting on vaccinations in a specific state or locality. For example, New York City’s health department tracks COVID-19 vaccinations among city residents, although the agency hasn’t yet published data for this fall’s vaccines. I have a list of state vaccination dashboards here; this doesn’t currently represent data on the fall 2023 vaccines, but I aim to do that update in the coming weeks.
    • Outside surveys, such as KFF’s COVID-19 Vaccine Monitor: Like the CDC’s National Immunization Survey, other health organizations conduct surveys to track vaccinations. The Kaiser Family Foundation’s COVID-19 Vaccine Monitor is one well-known project, which has been doing regular surveys on COVID-19 vaccine uptake since December 2020.
    • Scientific reports answering specific vaccination questions: Public health researchers may use surveys, immunization records, or other data systems to study specific questions about vaccination, such as the impact that vaccination has on lowering a patient’s risk of severe disease. These studies are often published in the CDC’s Morbidity and Mortality Weekly Report and other journals.

    If you have other questions about vaccination data—or want to share a data source I didn’t mention here—please reach out: email me or leave a comment below.

    more vaccine coverage
  • National numbers, October 15

    National numbers, October 15

    Coronavirus levels are high in the Northeast and medium in other regions, according to WastewaterSCAN.

    During the most recent week of data available (October 1-7), the U.S. reported about 16,800 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 2,400 new admissions each day
    • 5.1 total admissions for every 100,000 Americans
    • 8% fewer new admissions than the prior week (September 24-30)

    Additionally, the U.S. reported:

    • 10.1% of tests in the CDC’s surveillance network came back positive
    • 24% of new cases are caused by Omicron EG.5, 20% by XBB.1.6, 20% by HV.1, 14% by FL.1.5.1 (as of October 14)

    COVID-19 data signals point to a continued lull in transmission across the U.S., ahead of likely increases as the weather gets colder. The Northeast is still reporting higher COVID-19 levels than other regions, according to wastewater and test positivity data.

    National wastewater surveillance patterns suggest that coronavirus spread is trending slightly downward, according to WastewaterSCAN’s dashboard. Viral levels are high in the Northeast and medium in the other major regions, per WastewaterSCAN’s metrics, with sites in Massachusetts, New York, Vermont, New Hampshire, and Maine reporting upticks.

    Wastewater data from Boston and New York City similarly show recent coronavirus increases. As I noted last week, these Northeast cities are frequently the first sites of late fall/winter surges, as colder temperatures contribute to more indoor gatherings.

    Biobot Analytics, typically one of my main sources of wastewater data, hasn’t updated its COVID-19 dashboard since October 2. The company is currently “making some improvements to [its] data infrastructure,” leading to less frequent updates at this time, a representative from Biobot wrote on Twitter last week. Data updates are planned on October 20 and November 3.

    Biobot’s data infrastructure updates might be related to the CDC contract change (which I covered last week), though the Twitter post didn’t mention this specifically. The CDC’s wastewater dashboard, while missing updates from a couple hundred sites as they switch contractors, also shows higher COVID-19 spread in the Northeast.

    The CDC’s test positivity data similarly report a continued lull at the national level: about 10% of tests in the agency’s lab testing network reported positive results in the week ending October 7, compared to a high of 15% in late August. Test positivity, like wastewater data, suggests higher spread in New England states and New York/New Jersey, as well as in some Midwest states, compared to other regions.

    Variant surveillance by the CDC suggests that most cases in the U.S. are still caused by a variety of XBB.1.5 relatives: EG.5, HV.1, XBB.1.6, etc. This is a good time to get one of the updated COVID-19 vaccines, which are designed to target XBB.1.5, if you haven’t already. BA.2.86, a variant of interest that emerged a few weeks ago, hasn’t shown up in major numbers yet, but is beginning to appear in the CDC’s data and may drive more spread later in the fall.

    Flu season has officially started, as of this week. Influenza-like illness (i.e. numbers of patients who go to their doctors’ offices with respiratory symptoms) is currently at lower levels than it was at this time last year, but is starting to “creep up,” Dr. Katelyn Jetelina wrote in a recent newsletter. Last year’s respiratory virus season “hit early and hard,” she said; we’ll see what happens this year.

    more national numbers

  • Sources and updates, October 8

    • Vaccination disparities in long-term care facilities: A new study in the CDC’s Morbidity and Mortality Weekly Report shares vaccination patterns from about 1,800 nursing homes, assisted living facilities, and other long-term care facilities across the U.S., focusing on the bivalent booster (or, last fall’s vaccine). The CDC researchers found significant disparities in these vaccinations: vaccine coverage was lowest among Black and Hispanic residents compared to other demographics, and was lowest in the South and Southeast compared to other regions. Future vaccination campaigns need to make it easy for these groups to get their shots, the authors suggest; but based on how the 2023 rollout has gone so far, this trend seems likely to continue.
    • Reasons for poor bivalent booster uptake: Speaking of last fall’s boosters, a study from researchers at the University of Arizona suggests reasons why people didn’t get the shots last year. Researchers surveyed about 2,200 Arizona residents who had received at least one COVID-19 vaccine dose. Among the survey respondents who didn’t get last year’s booster, the most common reason for not doing so was a belief that a prior infection made the shot unnecessary (40%), concerns about vaccine side effects (32%), believing the booster wouldn’t provide additional protection over prior shots (29%), and safety concerns (23%). As with the study above, this paper shows weaknesses in the U.S.’s recent vaccine promotion strategies.
    • At-home tests are useful but far from perfect: Researchers at Nagoya University and the University of Oxford used mathematical models to study how different safety measures impact chances of COVID-19 outbreaks. The researchers developed models based on contact tracing data reflecting how Omicron spreads through groups. Rapid, at-home, antigen tests are a useful but imperfect method for reducing outbreak risk, the study found, with daily testing reducing the risk of a school or workplace outbreak by 45% compared to a scenario in which new cases are identified by symptoms only. “In high-contact settings, or when a new variant emerges, mitigations other than antigen tests will be necessary,” one of the scientists said in a statement.
    • Long-term symptoms from non-COVID infections: The prevalence of Long COVID has led many scientists to develop new interest in chronic conditions that may arise after other common infections, such as the flu and other respiratory viruses. One recent study from Queen Mary University of London identifies a potential pattern, using data from COVIDENCE UK, a long-term study tracking about 20,000 people through monthly surveys. Researchers compared symptoms between people who had a COVID-19 diagnosis and those with other respiratory infections, looking at the month following infection. They found similar risks of health issues in the one-month timeframe for both groups, though specific symptoms (loss of taste and smell, dizziness) were more specific to Long COVID. Of course, some people in the “non-COVID” group could have had COVID-19 without a positive test; still, the data indicate more, longer-term research is needed.
    • Autoimmune disorders following COVID-19: In another Long COVID-related paper, researchers at Yonsei University and St. Vincent’s Hospital in South Korea found that patients had increased risks of autoimmune and autoinflammatory disorders following COVID-19 cases. The study used patient records from South Korea’s national public health system, comparing about 354,000 people who had COVID-19 diagnoses to 6.1 million controls. COVID-19 patients had a significant risk of new autoimmune issues within several months after infection; new diagnoses included alopecia (or hair loss), Crohn’s disease (inflammatory bowel issues), sarcoidosis (overactive immune system), and more. These conditions should be considered by doctors evaluating potential Long COVID patients, the researchers wrote in their paper.
    • New climate vulnerability index: This last item isn’t directly COVID-19 related, but may be useful in evaluating community risks for public health threats. The Environmental Defense Fund, Texas A&M University, and other partners have launched the U.S. Climate Vulnerability Index, a database providing Census tract-level information about how our changing climate will impact different communities. Communities are ranked from low to high climate vulnerability, with detailed data available on sociodemographic characteristics as well as potential extreme weather events and health trends.

  • COVID source shout-out: Novavax’s booster is now available

    This week, the FDA authorized Novavax’s updated COVID-19 vaccine. The CDC’s fall vaccine recommendations were already set up to include Novavax once it was authorized, so pharmacies and health providers can start administering it without any additional hurdles at the federal level.

    Novavax’s new vaccine, like the options from Pfizer and Moderna for this fall, is designed to protect against XBB.1.5, a recently circulating variant that is closely related to most of the strains causing disease in the U.S. right now. But unlike the Pfizer and Moderna vaccines (which use mRNA technology), Novavax’s uses a piece of viral spike protein to teach recipients’ immune systems how to recognize the coronavirus.

    Some scientists and health advocates I follow have been particularly looking forward to the Novavax authorization, hoping to get their shot rather than one of the mRNA options. There are two main reasons for this choice, based on my reading:

    • The Novavax vaccine may have fewer or easier side effects than the mRNA vaccines. This is particularly appealing for some people who had poor reactions to earlier mRNA vaccine doses (including, in some cases, long-term issues similar to Long COVID), and some people with chronic conditions.
    • Some experts say that “mixing and matching” different types of vaccines might lead to a more robust, long-term immune response against the coronavirus, compared to sticking with one vaccine type. 

    A recent article in Science goes into more detail about these considerations. Writer Jennifer Couzin-Frankel walks through scientific studies that look at Novavax compared to the other vaccine options, and explains some of the questions that we don’t have sufficient data to answer yet. For example, as fewer people have received Novavax vaccines compared to the mRNA options, it’s harder to see signals for potential rare adverse reactions. More studies are coming in that will help address these questions, but for now, many people are making personal choices about which vaccine to get this fall.

    more vaccine coverage
  • The CDC has a new wastewater surveillance contract; here’s what this means for public data sources

    The CDC has a new wastewater surveillance contract; here’s what this means for public data sources

    The number of wastewater testing sites that recently reported to the CDC’s national surveillance system has dropped in recent weeks, likely in time with a contract switch.

    Editor’s note, October 15: This article has been updated with comments from Verily.

    This week, the CDC and life sciences company Verily announced that the agency awarded a five-year wastewater surveillance contract to Verily. The announcement marks a shift in the U.S. sewage monitoring landscape and will impact our public COVID-19 data, with short-term gaps and changing coverage in a couple of sources—but ultimate improvements in the long term.

    First, some background:

    In fall 2020, the CDC launched the National Wastewater Surveillance System (NWSS), a network of sewage testing sites around the country all reporting data to a central location. While some state and local health agencies quickly developed in-house systems for testing wastewater and reporting their data to NWSS, others lacked the resources (staff, lab capacity, data infrastructure, etc.) to start doing this new type of health surveillance.

    As a result, the CDC began working with private testing companies to fill gaps in the NWSS network and expand surveillance more quickly across the country. The first contactor was a diagnostic company headquartered in Canada called LuminUltra. Then, last spring, the CDC awarded a contract to Biobot Analytics, a startup focused on wastewater surveillance. Biobot did a lot of work to extend the NWSS, helping bring the total CDC network up to nearly 1,400 sites; but the contractor switch initially led to a few weeks of missing data for about 150 sites covered by the CDC contract, as they transitioned from one set of testing protocols to another. (See my coverage at the time for more details.)

    One advantage of Biobot working with the NWSS, if you’re someone who cares about public wastewater data, is that the company added data from many CDC contract sites to its COVID-19 wastewater dashboard, making that dashboard more comprehensive in its view of national COVID-19 patterns. You couldn’t view the CDC sites in Biobot’s county-level visualizations; those present data from other sites that have individual contracts with the company or are participating in the free Biobot Network program. But Biobot added CDC sites that opted into data-sharing to its national and regional visualizations, a company spokesperson told me last year.

    What’s changing with the new contract:

    Biobot’s contract with the CDC ended last month. The CDC’s new contract with Verily replaces it. Verily’s contract covers five years (as opposed to shorter periods for prior CDC wastewater testing contracts), and includes additions of more pathogens that may be tested through NWSS, in addition to SARS-CoV-2. These are both great improvements, adding to the surveillance system’s longevity and expanding its capacity beyond COVID-19—though additional federal funds will likely be needed past this contract.

    However, in the short term, we will see data gaps on NWSS as contracted sites change over to Verily from Biobot. These testing sites may have to adjust how they collect samples, how they package and ship samples, and other logistical changes. The CDC NWSS dashboard already indicates a reporting dip in the last couple of weeks, coinciding with the contract change.

    Meanwhile, Biobot will no longer have the same direct access to the CDC contract testing sites. While all the sites’ data will still be published publicly by the CDC, the Biobot-Verily switch will likely lead to changes in sample processing and analysis that make data from those sites no longer directly comparable with the hundreds of other sites covered by Biobot. My guess here is that Biobot may no longer be able to include the CDC contract sites in its national and regional visualizations.

    I reached out to Biobot for comment about this shift, and haven’t heard back from them yet. I’ve also reached out to Verily asking about the contract changeover and any data-sharing plans they may have, and haven’t heard back there yet either. I will update this post with more details from the companies as I receive them.

    How this new contract may impact major data sources:

    • CDC NWSS: Data from all sites participating in NWSS will continue to be available on the CDC’s dashboard, though the sites covered by the CDC’s national testing contract (previously with Biobot, now with Verily) may have missing data for a couple of weeks. NWSS continues to be the most comprehensive place to find wastewater data in the U.S., but unfortunately doesn’t share national or regional trends because it is compiling from many different testing programs with different methodologies.
    • Biobot Analytics: County-level data won’t change. National and regional data will still be available, but are likely to be less comprehensive pictures of wastewater trends across the U.S., if I’m right about Biobot no longer including CDC contract sites in those visualizations. Also worth noting, Biobot shifted its update schedule recently to once a week on Mondays (with a longer delay in data, but likely less retroactive updating).
    • WastewaterSCAN: No changes due to this contract switch, though WastewaterSCAN has been working with Verily for a while to test sewage samples from its network. This project also recently announced that it’s adding six more disease targets to its program: parainfluenza, rotavirus, adenovirus group F, enterovirus D68, Candida auris, and hepatitis A. See the statement from WastewaterSCAN below for more details.
    • In the long-term: The CDC’s new five-year contract will enable continued expansion of the NWSS, potentially with both more sites and more disease targets. I also expect public data offerings will continue to improve as scientists and public health officials learn more about how to interpret wastewater surveillance data.

    Statement from WastewaterSCAN about the new contract

    WastewaterSCAN was pleased to learn that the CDC selected Verily to support the National Wastewater Surveillance System (NWSS). As our lab partner, Verily has an important role managing sample collection logistics from wastewater treatment plants participating in the WastewaterSCAN network, processing samples, and supporting our research to advance the science of wastewater-based epidemiology.

    WastewaterSCAN continues to demonstrate that wastewater monitoring can provide comprehensive, efficient, community-wide tracking of seasonal and emerging diseases. We recently added six disease targets to our program and are helping many communities prepare for the respiratory virus season with a public data dashboard to communicate what wastewater is telling us about the diseases circulating in our communities.

    At this time, only data from our program will appear on WastewaterSCAN’s data dashboard. WastewaterSCAN will continue to make our methods public and to collaborate and share data with NWSS and contribute to its important, mission-critical work.

    Statement from Verily, responding to COVID-19 Data Dispatch questions

    CDD: Will the WastewaterSCAN dashboard start including data from wastewater testing sites included in the CDC contract, as they come online? Or is Verily planning to launch its own dashboard that will share data from those sites (perhaps in aggregate, national trends, similar to the current Biobot dashboard)?

    Verily: WastewaterSCAN representatives have responded.
    On the question of sharing aggregated, national trends data from these sites: This is a CDC decision for the NWSS testing program.

    CDD: Besides public dashboards, will there be alignment between WastewaterSCAN and Verily in how wastewater data are processed, analyzed, and interpreted?

    Verily: There are many methods for analyzing the concentration of pathogens in wastewater. Verily offers several methods for wastewater analysis to its customers and ones chosen by the CDC NWSS and WastewaterSCAN programs differ primarily in what part of the wastewater is analyzed and how the pathogens are concentrated and extracted before measurement of pathogen concentrations. Beyond these initial steps, Verily’s lab processes all samples similarly.

    The liquid fraction (of influent samples) will be concentrated and tested for the CDC NWSS program, similar to the approach previously used for NWSS contract testing.

    The solid fraction of samples (from the primary clarifier or influent) has been shown to concentrate many pathogens and is tested for the WastewaterSCAN program.

    Results from methods have shown agreement with case data in the literature. However, differences between the methods make them complementary to each other.

    CDD: When the CDC previously switched contractors in spring 2022, some testing sites covered by the contract didn’t report to NWSS for several weeks while they transferred to a new process. What is Verily doing to help transition sites during the current switch?

    Verily: Verily has an established system and team dedicated to onboarding new sites with the ability to rapidly initiate testing. This is informed by our previous experience providing logistics and lab services to over 200 sites in wastewater monitoring programs.

    As we receive information from the CDC NWSS program about which sites will transition, we will get sites up and running as soon as possible. Our goal is to have up to 200 sites testing within the first four weeks of the contract.

    More on wastewater surveillance
  • National numbers, October 8

    National numbers, October 8

    Data from WastewaterSCAN’s network of testing sites suggest a recent increase in coronavirus in Northeast states’ wastewater.

    During the most recent week of data available (September 24-30), the U.S. reported about 18,100 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 2,600 new admissions each day
    • 5.5 total admissions for every 100,000 Americans
    • 6% fewer new admissions than the prior week (September 17-23)

    Additionally, the U.S. reported:

    • 10.9% of tests in the CDC’s surveillance network came back positive
    • A 1% higher concentration of SARS-CoV-2 in wastewater than the prior week (as of September 27, per Biobot’s dashboard)
    • 29% of new cases are caused by Omicron EG.5, 23% by XBB.1.6, 14% by FL.1.5.1 (as of September 30)

    After a couple of weeks’ decline, COVID-19 spread in the U.S. may be leveling off ahead of more increases in late fall and winter. We’re seeing plateaus in wastewater data, paired with slight declines in test positivity and hospital indicators.

    Biobot’s COVID-19 wastewater dashboard suggests that national COVID-19 spread reached a plateau last week, increasing very slightly from September 20 to September 27. The company’s regional data suggest that this plateau is consistent in all four regions, but the Northeast has significantly higher (and potentially rising) viral levels. It’s worth noting Biobot’s data may have become less comprehensive recently; see below for more details.

    The WastewaterSCAN project similarly shows that COVID-19 spread hasn’t changed much at the national level in recent weeks: it is high with no significant trend up or down, according to the project’s assessment. Per WastewaterSCAN, the Northeast and Midwest continue to have more coronavirus transmission than the West and South.

    Some Northeast cities are reporting significant upticks in the last week, including South Boston, Portland, Maine, and Montpelier, Vermont (the latter two report to WastewaterSCAN). In past years, late fall/winter surges have started in the Northeast and Midwest, as these regions see colder weather earlier, sometimes paired with the introduction of new variants. It seems likely that a similar trend will occur this year.

    In non-wastewater indicators: test positivity from the CDC’s laboratory network continues to trend slightly down, reported at 10.9% for the week ending September 30. Hospitalizations have also dipped slightly, though more than 2,500 people have still been hospitalized daily with COVID-19 in recent weeks.

    I wish I could update you about the fall vaccine rollout, but we literally don’t have national data on it, thanks to the end of CDC vaccination reporting requirements tied to the federal public health emergency. The CDC’s last vaccination data update occurred on May 11.

    Respiratory virus season is about to start, meaning that other common viruses (flu, RSV, etc.) will join COVID-19 in causing easily preventable illnesses. Remember that masks, ventilation, and shifting activities outdoors help reduce risks of all these viruses, not just SARS-CoV-2.

    more national numbers

  • COVID source shout-out: Moving closer to Long COVID biomarkers

    Scientists are moving closer to biomarkers, or clear biological indicators, of Long COVID. A new study—posted this week in Nature ahead of full publication—identifies clear differences between blood samples of people who have the condition and those who don’t.

    The study was a collaborative effort between researchers at Mount Sinai (David Putrino and his team) and Yale University (Akiko Iwasaki and her team). Both of these research groups have been leaders in studying Long COVID: Mount Sinai was one of the first health institutions to start caring for people with Long COVID back in spring 2020, while the Yale group has analyzed patients’ immune systems in ways that go far beyond typical medical testing.

    The differences identified by this study fall into “three big areas,” Putrino wrote in a Twitter thread describing the findings. These are hormonal differences (particularly low cortisol levels in the Long COVID group during morning hours), immune differences (particularly differences in T cell and B cells for people with Long COVID), and evidence of a coronavirus infection re-activating other viruses that might have already been present in people with Long COVID.

    While other research has pointed at these Long COVID markers before, the new study goes further in connecting a Long COVID diagnosis to specific medical tests. If backed up by further research, those tests could be used as biomarkers, informing clinical trials of Long COVID treatments. Notably, as Iwasaki pointed out in a statement, the tests done in this study would not be included in a patient’s “routine lab work,” signifying the higher level of inquiry needed to understand this condition.

    Long COVID is incredibly complex and may have different causes from one person to another. So, any biomarkers (from this study or another one) likely would not be universal points of success for all patients. This study also isn’t “proof that Long COVID is real,” as you might have seen some headlines suggest; we’ve had plenty of proof for years now, from prior research and patient experiences. Still, the study is a major step forward in identifying key tests that may be used for diagnosis and treatment.

    more source spotlights

  • Sources and updates, October 1

    • CDC publishes Long COVID data from national survey: Every year, the CDC conducts the National Health Interview Survey, a detailed look at population health in the U.S. through interviews of about 30,000 adults and 9,000 children. In 2022, the survey included questions about Long COVID, defining the condition as symptoms for at least three months after an initial COVID-19 case. This week, the CDC published data from the 2022 survey. Among the findings: about 6.9% of adults had ever experienced Long COVID, and 3.4% had it at the time of their interview. These figures were 1.3% and 0.5% for children, respectively. Women were more likely to experience it than men, and the survey identified other demographic differences (race, income, etc.). While many of the findings align with other Long COVID data, this CDC survey is unique in providing data on Long COVID in kids—which can be devastating for the small (yet significant) number of people impacted.
    • Molnupiravir could lead to new coronavirus mutations: A new study, posted in Nature this week ahead of its final publication, identifies potential dangers of using the antiviral molnupiravir. (Molnupiravir, made by Merck, is a similar drug to Paxlovid but tends to be less effective, so it’s not used as widely.) For this study, researchers at the University of Cambridge, Imperial College London, and colleagues examined coronavirus sequence data and found that certain mutations were likely to increase after molnupiravir use. Researchers have already known that this antiviral could lead to more viral evolution, but the paper provides more details on specific mutation risks; further research may examine the drug’s implications for immunocompromised patients.
    • Accessibility issues for COVID-19 websites: Many state and territorial COVID-19 websites don’t meet accessibility guidelines, making their key health information difficult for people who are blind or visually impaired to access, according to researchers at North Carolina State University. The researchers recently replicated a study that they’d first done in 2021, running checks on state sites against standard web accessibility guidance. “In 2021, none of these public-facing COVID-19 sites met all the checked WCAG guidelines, and things did not get any better in 2023,” study author Dylan Hewitt said in a statement. Issues include incompatibility with screen readers, limited color contrast, and no alt text for images.
    • Polling data indicate higher interest in flu shots than COVID-19 shots: The Kaiser Family Foundation (KFF) has published a new round of polling data from its COVID-19 Vaccine Monitor, focusing on vaccinations this fall. About 58% of adults in the poll said they would get a flu shot this year, compared to 47% who said they would get an updated COVID-19 shot. Vaccine interest continues to be partisan, the poll suggested, with Democrats much more likely to express confidence in the updated COVID-19 vaccines’ safety than Republicans. Democrats were also more likely to respond to increased COVID-19 spread, with 58% of those polled saying they recently took more precautions in response to the surge this summer.
    • New behavioral health survey data from the CDC: One more CDC update from this week: the agency has just published 2022 data from its Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS involves interviews of more than 400,000 adults each year, including questions about alcohol use, tobacco use, immunizations, cancer screenings, mental health, and more. While the data aren’t directly related to COVID-19, this surveillance system may be a valuable source for reporters or researchers seeking contextual data about health behaviors in a particular state, city, or county.

  • COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.

    COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.

    Last year, just 17% of the U.S. population received a bivalent booster. Will this year’s uptake be better?

    Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.

    I’ve published the full responses in the table below. Here are a few common themes that I saw in these stories:

    • Pharmacies aren’t receiving enough vaccines. Several readers shared that their pharmacies had inadequate vaccine supply to accommodate all the people who made vaccination appointments, or who wanted appointments. Vaccine supply may also be unpredictable—a pharmacy may think they’re getting more shots, but in fact not receive them—leading to appointment cancellations.
    • Insurance providers weren’t prepared for this vaccine rollout. Despite months of advance notice that a fall COVID-19 vaccine was coming, many insurance companies apparently failed to prepare billing codes or other system updates that would allow them to cover the shots. A couple of people who shared insurance issue stories are on Medicare—representing a population (i.e. seniors) who should be at the front of the vaccine line.
    • Very limited, confusing vaccine availability for young kids. Several readers shared that they were able to get vaccinated, but their children under 12 have not received a vaccine yet. While the FDA and CDC have authorized this fall’s COVID-19 vaccines for all Americans ages six months and older, younger children require a different vaccine formulation from adults. And this formulation appears either entirely unavailable or very difficult to access, depending on where you live.
    • People living in less dense areas may need to travel. A few readers shared that, as they searched for vaccine appointments in their areas, the closest pharmacies with doses available were miles away—over 10 miles, in one case. This is a significant barrier for people fitting vaccine appointments into their work schedules.
    • Information may be inconsistent. Vaccine availability listed in one place (such as a pharmacy chain’s website or the federal vaccines.gov website) may be inaccurate in another. Some readers shared that they spent extra time on the phone with pharmacies or health providers to get accurate information—another barrier.
    • Pharmacies don’t have enough staff for this. Even readers who were able to receive COVID-19 vaccines often had to wait a long time at their pharmacies. Several shared that their pharmacies appeared to be understaffed, dealing with the COVID-19 shots along with routine prescriptions and other duties. The days of mass vaccination sites, efficiently run by public health departments, are long over.
    • Kaiser Permanente members face delays. One company that appears to be causing outsized problems is Kaiser Permanente, one of the biggest insurers and health providers on the West Coast. Several readers shared that Kaiser was not providing new COVID-19 vaccines until early October, and would not cover the shots if their members went to another location. That’s a big delay, and it may be further impacted by a coming strike at the company.
    • These vaccines are expensive. If you decide to pay for a COVID-19 shot out-of-pocket (as some readers did), it costs almost $200. Even the federal government is paying about triple the cost of last year’s COVID-19 vaccines per shot, for the doses it is covering, STAT News reports. The U.S. may have received a “bad deal” here, STAT suggests, considering all of the federal funding that’s supported vaccine research and development.

    As I wrote last week, some news outlets have covered these challenges, but this issue really deserves more attention. The updated COVID-19 vaccines are basically the U.S. government’s only strategy to curb a surge this winter, and they should be easily, universally accessible. Instead, many people eager to get vaccinated are going through multiple rounds of appointments, phone calls, pharmacy lines, and more.

    For every one of these readers who has persisted in getting their shot, there are likely many other people who tried once and then gave up. And those people who don’t receive the vaccine will be at higher risk of severe illness, death, and long-term symptoms from COVID-19 this fall and winter. This is a public health failure, plain and simple.

    And it’s important to emphasize that this failure is not surprising. Many health commentators predicted that these challenges would arise as the federal public health emergency ended and COVID-19 tools transitioned from government-funded to covered-by-insurance. For more context on why this is happening, I recommend the Death Panel podcast’s latest episode, “Scenes from the Class Struggle at CVS.”

    If you’re a reporter who would like to connect with one of the COVID-19 Data Dispatch readers who shared a story, please email me at betsy@coviddatadispatch.com. Most of the people in the database below shared an email or other contact info.

    [table id=10 responsive=collapse responsive_breakpoint=all /]

    more vaccine coverage
  • National numbers, October 1

    National numbers, October 1

    Test positivity for COVID-19 is declining while hospitalizations are starting to plateau, according to the CDC’s data.

    During the most recent week of data available (September 17-23), the U.S. reported about 19,100 new COVID-19 patients admitted to hospitals, according to the CDC. This amounts to:

    • An average of 2,700 new admissions each day
    • 5.8 total admissions for every 100,000 Americans
    • 3% fewer new admissions than the prior week (September 10-16)

    Additionally, the U.S. reported:

    • 11.6% of tests in the CDC’s surveillance network came back positive
    • A 13% lower concentration of SARS-CoV-2 in wastewater than the prior week (as of September 20, per Biobot’s dashboard)
    • 29% of new cases are caused by Omicron EG.5, 23% by XBB.1.6, 14% by FL.1.5.1 (as of September 30)

    COVID-19 spread is on the decline nationally, following a trend from the last couple of weeks. But levels are still very high, and it’s unclear how long this decline will continue before colder weather and indoor gatherings push transmission up again.

    Wastewater surveillance (from Biobot, WastewaterSCAN, and the CDC’s network) reports national COVID-19 declines for the last two to three weeks. Patterns differ at the regional level, though, likely due to different behavioral patterns and variants.

    Biobot Analytics’ dashboard shows that national coronavirus levels in wastewater have dropped by about 20% from August 30 to September 20. While all four regions report declines, the Northeast is experiencing more of a plateau compared to starker drops in the South, West, and Midwest.

    Biobot announced this week that they will be updating COVID-19 data weekly on Mondays, a change from their prior biweekly reports on Tuesdays and Thursdays. This shift will lead to a greater delay in Biobot’s data; the most recent data on their dashboard are now as of September 20, over a week ago. But, as a tradeoff, the data may now be more accurate in incorporating samples from Biobot’s entire network, reducing retrospective updates.

    WastewaterSCAN’s dashboard shows a similar picture to Biobot’s: a slow decline in SARS-CoV-2 levels nationally, with more coronavirus spreading in the Northeast and Midwest than West and South. The WastewaterSCAN team recently updated their dashboard to more easily show national and regional trends—I’m a fan of the change.

    Aligning with wastewater data, test positivity from the CDC’s lab testing network has declined by about 20% in the last month. This metric also differs by region; test positivity is higher in Health Region 2 (including New York and New Jersey) as well as 5 and 7 (including some Midwestern states) than in other parts of the country.

    Hospitalizations (a more delayed indicator) are starting to plateau, according to the CDC. But it’s important to recognize that our limited wastewater and testing data suggest, while COVID-19 levels may be declining, they are still quite high compared to past lulls in transmission. Biobot’s data, for example, suggest that current spread is comparable to this time in early fall 2021, during the Delta wave.

    There hasn’t been much change in the variant picture during recent weeks: XBB.1.5-related variants EG.5 and XBB.1.6 caused the majority of cases in September, according to the CDC’s latest estimates. (EG.5 is an offshoot of XBB.1.9.) BA.2.86 has yet to show up in significant numbers, suggesting it might not be as competitive as some experts initially expected; though it could still accumulate and cause problems later this fall.

    The CDC is now updating its COVID-19 data weekly on Fridays, timed with its updates to other respiratory virus data pages. This suggests—as I noted last week—that the agency is now incorporating COVID-19 into its regular fall/winter virus surveillance systems.

    more national numbers