The Northeast has seen a small uptick in coronavirus levels in its wastewater in recent weeks, followed by a plateau. Chart via Biobot Analytics.
In the past week (March 19 through 25), the U.S. reported about 190,000 new COVID-19 cases, according to the CDC. This amounts to:
An average of 27,000 new cases each day
58 total new cases for every 100,000 Americans
5% fewer new cases than last week (March 12-18)
In the past week, the U.S. also reported about 13,000 new COVID-19 patients admitted to hospitals. This amounts to:
An average of 1,800 new admissions each day
3.9 total admissions for every 100,000 Americans
21% fewer new admissions than last week
Additionally, the U.S. reported:
5,200 new COVID-19 deaths (1.6 for every 100,000 people)
100% of new cases are Omicron-caused; 35% BA.2-caused (as of March 19)
An average of 100,000 vaccinations per day (per Bloomberg)
New COVID-19 case numbers for the U.S. overall are still decreasing, according to the CDC’s data. But the drop from the previous week’s cases to this week’s cases (about 5%) is lower than any week-over-week change since Omicron peaked in January, suggesting that we’re heading for a plateau—if not a new increase.
Last week, I discussed a potential new surge in the U.S. driven by the Omicron sublineage BA.2, which is more transmissible than the version of Omicron we faced a couple of months ago. BA.2 caused about 35% of new COVID-19 cases nationwide in the week ending March 19, according to CDC estimates, up from 22% in the prior week.
As BA.2 slowly outcompetes the other Omicron sublineages in the U.S., we also continue to see case upticks in some parts of the country. States that reported case increases in the last week include Arkansas, Kentucky, Maine, New York, Colorado, Massachusetts, and Vermont, according to the March 24 Community Profile Report. (Arkansas and Kentucky reported week-over-week increases above 25%, while the other states here reported increases above 10%.)
Wastewater data align somewhat with these case increases. Biobot’s tracker shows a slight uptick (followed by a plateau) in coronavirus levels in the Northeast’s wastewater, at a regional level, along with plateaus in other parts of the country. And about 40% of sites in the CDC’s national wastewater network have reported increases over the last two weeks—though the CDC’s data are difficult to interpret, as this tracker doesn’t provide context on actual wastewater levels at each site.
To be clear, it’s good news that we aren’t seeing major case increases yet, just some small upticks. At the same time, numbers of newly hospitalized COVID-19 patients and deaths are dropping to levels not seen since last summer; this week, about 750 people died of the disease each day, according to the CDC—the first time this number has been under 1,000 in several months.
The 7-day avg for new hospital admissions in the U.S. (confirmed + suspected COVID) is now also at an all-time low pic.twitter.com/99LPzBCYKw
In a recent TIME article, several experts suggested that vaccines plus lingering immunity from the Omicron wave in December and January may protect the U.S. from a major surge with BA.2. Still, with safety measures dropping across the country, in the event that we do see a major new surge (from BA.2 or otherwise), we won’t be prepared to curb virus transmission in a meaningful way.
This week, the CDC added a new feature to the vaccination section of its COVID-19 dashboard: you can now look at demographic vaccination trends at the state level, not just nationally and regionally.
But there’s a catch: the state-by-state demographic trends only include age and sex data. Vaccination trends by race and ethnicity are still only available at the national level; in fact, when you click on “Race/Ethnicity” on the booster shots section of this dashboard, the CDC directs you to “please visit the relevant health department website” for more local data.
For state-level race and ethnicity data, the CDC directs users to state public health agencies. Screenshot taken on March 20.
It is now over a year into the U.S.’s vaccine rollout, and the CDC is still failing to publicly share data on vaccinations by state and race/ethnicity. I actually wrote a callout post about this in March 2021, and nothing has changed since then!
This is a major issue because such data are needed to examine equity in the vaccine rollout. While it’s possible to compile data from the states that report vaccinations by race and ethnicity themselves, major inconsistencies in state reporting practices make these data hard to standardize. Why isn’t the CDC doing this? Or, if the CDC is doing this, why aren’t the data public?
Data sources and data-related updates for this week:
APM Research Lab relaunches Color of Coronavirus tracker: From April 2020 to March 2021, the American Public Media (APM) Research Lab compiled state-level data on COVID-19 deaths by race and ethnicity, in order to present a picture of which U.S. populations were most hard-hit by the pandemic. The project relaunched this week, now utilizing CDC mortality statistics instead of compiling data from states. One major finding from the updated data: “Indigenous Americans have the highest crude COVID-19 mortality rates nationwide—about 2.8 times as high as the rate for Asians, who have the lowest crude rates.”
CDC might take back hospital data reporting responsibilities from HHS: As longtime readers may remember, back in summer 2020, the Department of Health and Human Services (HHS) developed a new data system for hospitals to report COVID-19 patient numbers and other related metrics. At the time, the HHS was taking over responsibility for these data from the CDC; this inspired some political posturing and concerns about data quality, though the eventual HHS dataset turned out to be very comprehensive and useful. (This original data switch was the subject of my very first CDD issue, and I followed the HHS data system closely throughout 2020.) Now, Bloomberg reports, the CDC wants to take back hospital data reporting from the HHS. More political posturing and data quality concerns are, it seems, inevitable—this time tied to the CDC’s challenges in modernizing its data systems.
Hospitalizations among young children, by race/ethnicity during Omicron surge: Two MMWR studies that caught my attention this week: one examined hospitalization rates among young children, ages 0 to 4, between March 2020 and February 2022. This study found that COVID-19 hospitalization rates among children in this age range were five times higher at the peak of the Omicron surge compared to the Delta surge. The second report examined hospitalizations by race and ethnicity, finding that, during Omicron’s peak, hospitalization rates among Black adults were nearly four times higher than rates among white adults. Both reports clearly demonstrate who is still vulnerable to COVID-19 as the U.S. abandons safety measures.
Pfizer and Moderna both seeking EUAs for additional booster shots:POLITICO reported this week that first Pfizer, then Moderna have requested Emergency Use Authorization for fourth doses of their COVID-19 vaccines. Pfizer’s request is specifically for people age 65 and over, while Moderna’s is for all adults. Notably, Pfizer’s request is based on data from Israel suggesting that immunity from an initial booster wanes after several months—just as Pfizer’s initial case for boosters in the fall was also based on Israeli data.
Global COVID-related deaths may be three times higher than official records: Throughout the pandemic, researchers have used excess mortality (i.e. the deaths occurring in a given region and time period above what’s expected) to determine the true toll of COVID-19. A new study, published this week in The Lancet, took this approach for 191 countries and territories from January 2020 to December 2021. The researchers estimate that about 18 million people died worldwide due to the pandemic—including not just direct COVID-19 deaths but also others caused by COVID-related disruptions. That’s three times higher than the 6 million COVID-19 deaths that have been officially reported in this time period.
In last week’s issue, I mentioned that I am thinking more about preparedness: how the U.S. can improve our capacity to respond to public health threats, future COVID-19 surges and beyond. This mindset shift was brought on, in part, by a recent story I worked on at the Documenting COVID-19 project: examining the vulnerabilities in Idaho’s hospitals as a case study of the U.S.’s decentralized healthcare system.
Last summer and fall, Idaho was completely overrun by the Delta variant. State leaders implemented crisis standards of care, a practice allowing hospitals to conserve their limited resources when they are becoming overwhelmed. All hospitals in Idaho were in crisis standards for weeks, with the northern Panhandle region remaining in this crisis mode for over 100 days.
During this time, Idaho hospitals sent out 6,300 patient transfers in the span of four months. With Audrey Dutton, my reporting partner at the Idaho Capital Sun (a nonprofit newsroom covering Idaho state government), I analyzed data from the Idaho health department that showed where these patients were transferred, as well as how the crisis period compared to previous months.
This map shows all patient transfers out of Idaho hospitals between April and November 2021. Chart by Betsy Ladyzhets, published in the Idaho Capital Sun and MuckRock.
Here are the major findings from our story (borrowing some text from my Twitter thread, linked above):
More than one in three transfers went to hospitals in neighboring states, with the highest numbers going to eastern Washington.
Transfers went as far as Seattle, Salt Lake City, San Francisco, Billings, and even Phoenix. Many of these trips required air ambulances, due to Idaho’s mountainous geography.
These transfers strained Washington hospitals. Dr. Dave Chen, chief medical officer at MultiCare Deaconess Hospital in Spokane—one Washington hospital that took on a lot of Idaho patients—told me that smaller, rural facilities in his area are all “competing for the same beds and resources,” whether these facilities are based in Washington or Idaho.
Workers at facilities in the northern Idaho region, which remained in crisis standards for over 100 days, described doubling patients up in ambulances, traveling for hours to find free beds, and taking EMS staff away from their normal duties for long trips.
Idaho is particularly vulnerable to transfer challenges: it has a lot of small rural hospitals without many ICU beds or specialized equipment, combined with geography that often requires an air ambulance rather than driving.
This story has implications beyond Idaho, as it shows the impact of America’s fractured health system. In our system, when hospitals in one state are in crisis, they cannot easily communicate with other hospitals that might be able to help them out—whether “communicating” means calling up hospital administrators to ask about free beds or sharing data about patient numbers and resources.
This is not just a COVID-19 problem. Consider what happens when a wildfire, hurricane, or other natural disaster hits. When hospitals in one area become overwhelmed, they should be able to easily reach out to other facilities—but our system makes this incredibly difficult.
One potential solution to this issue may be centralized transfer centers, which field calls from hospitals that need to send out their patients. Washington started such a transfer center during the pandemic, to great success: Dr. Steve Mitchell, who helps run the center, told me that it facilitated more than 3,500 patient transfers, mostly between summer 2021 and early 2022.
But there’s a kicker: Washington’s transfer center is funded by the state health department, and therefore it can only answer calls from Washington hospitals. If an Idaho hospital wants to transfer a patient into Washington, it has to call various Washington hospitals directly until finding a bed for that patient—a much more time- and resource-intensive process.
Look at how siloed our current system is! This is ridiculous! Clearly, we need transfer centers with regional—or even national—reach, coordinated by a national health agency. We also need more data sharing between hospitals, and better communication between facilities and EMS providers.
BA.2 caused about one in four U.S. COVID-19 cases in the week ending March 12, according to CDC estimates.
Two years into the pandemic, we now know some basic truisms about the coronavirus. For example: outdoor events are always safer than indoor events; older age is the most significant risk factor for severe symptoms; hospitalization trends typically follow case trends by a couple of weeks; and whenever Europe has a new surge, the U.S. is likely to also see a surge in the next month or so.
That last truism is particularly relevant right now, because Europe is experiencing a new surge. Cases are increasing in the U.K., Germany, the Netherlands, and many other countries. The new surge is likely due to European leaders’ decisions to end all COVID-19 safety measures in their countries, combined with the rise of Omicron sublineage BA.2.
As BA.2 prevalence increases here in the U.S.—and our leaders also end safety measures—we seem poised to follow in Europe’s footsteps once again. But a BA.2 surge is likely to look different from the intense Omicron surge that we experienced in December and January, in part because of leftover immunity from that Omicron surge.
Let’s go over what we know about BA.2, and what might happen in the next few weeks.
What is BA.2?
It’s important to note that this isn’t a new variant, at least not compared to the original Omicron strain. As I noted in a FAQ post about this strain back in January, South African scientists who originally characterized Omicron in November 2021 identified three sub-lineages: BA.1, BA.2, and BA.3.
BA.1 spread rapidly through the world, driving the surge that we experienced here in the U.S. in December through February. But BA.2, it turns out, is actually more transmissible than BA.1—allowing it to now outcompete that strain and contribute to case increases in countries that already faced major BA.1 surges.
How does BA.2 differ from BA.1, or original Omicron?
The main difference between these two strains is that BA.2 is more contagious: scientists estimate that BA.2 is about 30% more transmissible than other Omicron strains, if not more. (Note that this is a smaller difference than Omicron’s advantage over Delta and other earlier variants.)
In a recent report, the U.K. Health Security Agency estimated that someone infected with BA.2 would infect about 13.6% of their households and 5.3% of contacts outside of their households, compared to 10.7% of households and 4.2% outside contacts for other Omicron strains. The modest difference between these rates demonstrates why BA.2 is not outcompeting other Omicron strains as quickly as Omicron outcompeted Delta a couple of months ago.
Another notable feature of BA.2 is that, unlike BA.1, it can’t be identified with a PCR test. BA.1 has a mutation called S drop-out, which causes a special signal in PCR test results, allowing the variant to be flagged without sequencing; BA.2 doesn’t have this mutation. To be clear, a PCR test will still return a positive result for someone who is infected with BA.2—it’ll just take an additional sequencing step to identify that they have this particular strain.
Finally, one major challenge during the Omicron BA.1 surge has been that two of the three monoclonal antibody treatments used in the U.S. did not work well for people infected with Omicron. BA.2 may exacerbate this challenge, as some studies have suggested that the third treatment—called sotrovimab—continued working against BA.1, but may not hold up against BA.2. Luckily though, Eli Lilly (which developed one of the treatments that failed for BA.1) has produced an updated monoclonal antibody cocktail that does work for both Omicron strains.
How is BA.2 similar to BA.1, or original Omicron?
Two major pieces of good news here: 1) our existing COVID-19 vaccines work similarly well against BA.2 as they do against BA.1, and 2) prior infection with BA.1 seems to be protective against infection with BA.2.
Essentially, studies are showing that the two strains are close enough in their genetic profiles that antibodies from a BA.1 infection will provide some immunity against a BA.2 infection. And the same thing goes for vaccination, at least when it comes to protection against severe disease. A recent CDC study showed that, even during the Omicron surge, COVID-19 patients who had received three vaccine doses were far less likely to require mechanical ventilation or die from the disease than those who weren’t vaccinated.
There’s a flip side to this, though: for both BA.1 and BA.2, prior infection with a previous variant is not very protective against an Omicron infection. CDC seroprevalence data suggest that between 40% and 45% of Americans got infected with BA.1 during the winter surge; this means the remaining 55% to 60% of the population is susceptible to BA.2. Vaccines protect against severe disease and death from BA.2, but they don’t protect against BA.2 infection to the degree that they did against past variants.
This means that in terms of protection against infection, populations with high rates of vaccination or prior infection remain essentially naive to it. Though vaccines and prior infections still protect from severe disease and death (thanks to T-cell protection). 3/ pic.twitter.com/gmwlk2l7ZV
— Prof Francois Balloux (@BallouxFrancois) March 19, 2022
BA.2 and BA.1 are also similar in their severity. Both strains are less likely to cause severe disease than Delta; BA.1 had a 59% lower risk of hospital admission and 69% lower risk of death than Delta in the U.K., according to a new paper published this week in the Lancet.
It’s important to remember, however, that Delta was actually more severe than other variants that preceded it. As a result, “Omicron is about as mild/severe as early 2020 SARSCoV2,” wrote computational biologist Francois Balloux in his Twitter thread (referring to both BA.1 and BA.2).
What are the warning signs for a BA.2 surge in the U.S.?
First of all, many U.S. experts consider case increases in Europe to be an early indicator of increases in the U.S. As I said at the top of the post, Europe is seeing a surge right now, and many of the countries reporting case increases have estimated over 50% of their cases are caused by BA.2.
In the U.S., our BA.2 levels are lower: the CDC’s most recent estimates suggested that BA.2 was causing about 23% of new cases nationwide as of March 12. If BA.2 continues growing at the same rate we’ve seen in recent weeks, we have one or two more weeks before this variant hits 50% prevalence in the U.S.
“The tipping point seems to be right around 50%,” Keri Althoff, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, told CNN. “That’s when we really start to see that variant flex its power in the population” as far as showing its severity.
At the same time, several Asian countries are also seeing major BA.2 surges at the moment. For example, Hong Kong was able to deal with early Omicron cases earlier in the winter, former COVID Tracking Project lead Erin Kissane pointed out in her Calm Covid newsletter; but now, the territory is facing a terrible BA.2 wave, driving what is now the world’s highest case fatality rate.
NEW: I’m not sure people appreciate quite how bad the Covid situation is in Hong Kong, nor what might be around the corner.
First, an astonishing chart.
After keeping Covid at bay for two years, Omicron has hit HK and New Zealand, but the outcomes could not be more different. pic.twitter.com/1Ol4HHs9kT
Here in the U.S., we’re also seeing warning signals in the form of rising coronavirus levels in wastewater. (Wastewater is considered an early indicator for surges, because coronavirus material often shows up in sewer systems before people begin to experience symptoms or get tested.) About one-third of sewershed collection sites in the CDC’s wastewater monitoring network are reporting increased virus prevalence in the two-week period ending March 15.
The CDC wastewater data must be interpreted cautiously, however, as this surveillance network is biased towards states like Missouri and Ohio, which have over 50 collection sites included in the national network. 12 states still do not have any collection sites in the network at all, while 23 states have fewer than 10. This recent Bloomberg article includes more context on interpreting wastewater data.
New York City is one place that’s reporting increased viral levels in wastewater, at the same time as the city health department reports that case numbers have plateaued—or may even be ticking up. An excellent time to loosen all mask and vaccination requirements, am I right?
What might a BA.2 surge in the U.S. look like?
Between the warning signals from Europe and the newly-lax safety measures throughout the U.S., it seems very likely that we will see a BA.2 surge in the coming weeks. The bigger question, though, is this surge’s severity: to what extent will it cause severe disease and death?
As I mentioned above, estimates suggest that about 40% to 45% of Americans have some Omicron antibodies from an infection earlier in the winter. At the same time, about 65% of the population is fully vaccinated and 45% of those fully vaccinated have received a booster shot, according to the CDC.
That’s a lot of people who are protected against severe COVID-19 symptoms, if they get infected with BA.2. But the U.S. has lower vaccination coverage than other countries, particularly when it comes to boosters. For example, in the U.K., 86% of eligible people are fully vaccinated and 67% are boosted, according to CNN. These lower vaccination rates contributed to the U.S.’s high mortality rate during the Omicron surge compared to other wealthy countries.
While the vaccines offer great protection, the U.S. appears to have given up on many other COVID-19 safety measures, like masks, social distancing, and limits on in-person gatherings. Without reinstating some of these measures, we would essentially be left without any tools to slow down the spread of BA.2; and even if some states and cities put safety measures in place, they’ll likely face more pushback now than they did in earlier surges.
To quote from Kissane’s newsletter:
In practical terms, with work and school happening in-person and without high-filtration (or any) masks or serious ventilation requirements in the US and most of Europe, governments in North America and Europe have made increased covid exposure essentially mandatory for most citizens.
I want to emphasize that for most vaccinated people, this increased risk probably won’t be a huge deal even if BA.2 causes a new case surge—they’ve either already racked up enough immunity to fight off BA.2 or they’ll be sick for a week.
One big caveat to this, though: we don’t have great data yet on how Omicron (or BA.2 specifically) might contribute to Long COVID rates; collecting data on this condition is very challenging and takes a lot of time. Studies suggest that vaccination reduces an individual’s risk of long-term symptoms if they get infected, but it does not eliminate this risk.
What can you do to prepare for this potential surge?
Here are a few things that I’m doing to prepare for a potential BA.2 surge in the coming weeks:
Promoting vaccination—particularly booster shots—to family members and friends.
Stocking up on good-quality masks (i.e. N95s and KN95s) and rapid tests. (Reminder, order a new round of free tests from covidtests.gov if you haven’t yet!)
Researching my options for COVID-19 treatments (antiviral pills and monoclonal antibodies) in the event that I get infected.
Getting tested frequently, particularly before attending indoor events (such as gathering with a few other friends, or going out to a movie theater.)
Watching wastewater and case trends in my area, and preparing to cut down on riskier behaviors if(/when) cases start rising.
I don’t know what BA.2 will mean for the US.
I do know this:
It hinges on vaccination/booster rates *now*.
So: 👆+
4th doses & Evusheld for immunocompromised ASAP, if not done.
Know where you’d get Paxlovid & Sotrovimab.
Order rapids now.
Get N95s or best possible now.
— Jeremy Faust MD MS (ER physician) (@jeremyfaust) March 16, 2022
As always, if you have any COVID-19 questions (about BA.2 or otherwise) that you’d like me to address, please reach out.
In the past week (March 12 through 18), the U.S. reported about 210,000 new COVID-19 cases, according to the CDC. This amounts to:
An average of 30,000 new cases each day
64 total new cases for every 100,000 Americans
17% fewer new cases than last week (March 5-11)
In the past week, the U.S. also reported about 16,000 new COVID-19 patients admitted to hospitals. This amounts to:
An average of 2,300 new admissions each day
4.9 total admissions for every 100,000 Americans
27% fewer new admissions than last week
Additionally, the U.S. reported:
7,400 new COVID-19 deaths (2.2 for every 100,000 people)
100% of new cases are Omicron-caused; 23% BA.2-caused (as of March 12)
An average of 100,000 vaccinations per day (per Bloomberg)
National COVID-19 case numbers are still falling, as we reach two months since the peak of the Omicron surge. The U.S. reported about 30,000 new cases each day last week, according to the CDC; that’s the lowest this number has been since last summer.
Hospitalization and death numbers are also still falling. The CDC reports that only 2,300 new COVID-19 patients were admitted to U.S. hospitals each day last week, compared to almost ten times that number at Omicron’s peak. Hospital systems in all 50 states and D.C. are currently labeled as “having capacity” on the Circuit Breaker Dashboard.
While this is all good news, it’s unclear how long this lull in cases will last. BA.2, the Omicron sister strain, is slowly outcompeting the original variant thanks to its even-more-transmissible capabilities: it’s gone from causing about 2% of new COVID-19 cases nationwide in the week ending February 12 to causing 23% of new cases in the week ending March 12, according to CDC estimates.
This strain is wreaking havoc in Asia and Europe, and U.S. experts are concerned that we may see a new surge in the coming weeks. Wastewater data may also suggest an oncoming surge, as a growing number of sewershed collection sites are reporting increases in their coronavirus levels. (More on this later in the issue.)
At the state level, a few places are beginning to see case increases: Washington, D.C., New York, Kentucky, Rhode Island, and Illinois all reported modest increases this week, according to the March 17 Community Profile Report. D.C. had the highest case increase, 20% more cases than the previous week. Some of these locations were also the first to be hit in the Omicron surge last December.
U.S. leaders should be taking advantage of this lull between surges to improve our preparedness: distribute masks and rapid tests, expand surveillance systems, and—most importantly—encourage people to get vaccinated so that they are protected when case rates rise again. Yet instead, Republicans in Congress are refusing to provide more public health funding, and the rate of Americans getting their first vaccine doses is lower than it has been since December 2020.
While updating my vaccine data annotations yesterday, I noticed that Kentucky has made some changes to its COVID-19 data reporting. Kentucky’s state health department has switched from daily to weekly updates, following a common trend in state reporting over the past few weeks.
But this state also downgraded its vaccination data: it has, as far as I can tell, stopped publishing a report of vaccinations by race, ethnicity, and other demographic categories (previously posted once a week). And Kentucky’s new COVID-19 dashboard includes a “Weekly Surveillance Data” tab with, truly, some of the lowest-quality data visualizations I have seen throughout the entire course of the pandemic.
Kentucky, what is going on with this image quality?
Like, you can’t even read these numbers! Admittedly, the dashboard links out to a PDF report with better-quality visualizations, but it’s still a far cry from interactive or downloadable data. Two years into the pandemic, states are still struggling with reporting their numbers in an accessible manner.
A couple of data sources, and a few data-related news items:
COVID-19 vaccine data annotations: Yesterday, I updated my annotations page on U.S. vaccination data sources for the first time in a few weeks. The page lists both national dashboards and vaccine data pages from all 50 state public health agencies, including notes on what each source offers. Going through the dashboards yesterday, I was struck by how many states are now offering data on booster shots (43, by my count), as well as how counts of doses distributed in a state, once a major feature of these dashboards, have become less useful now that the U.S. has ample vaccine supplies.
Order more free rapid tests from the federal government: The COVIDtests.gov site is now open for additional orders of free rapid at-home tests, as part of the federal program that launched in mid-January. Each household can now order two sets of four tests. I ordered a set of tests last Monday, and received them on Thursday—much faster than the initial round of this program!
Scientists are investigating combinations of Delta and Omicron: You might have seen some recent headlines about “Deltacron,” a portmanteau of the two variants of concern. When a very unlucky person gets infected with both Delta and Omicron at the same time, the variants can combine and form a new strain with genetic elements of both lineages. Scientists have recently identified a small number of “Deltacron” cases in France, Denmark, the Netherlands, and the U.S.; it’s not cause for major concern at this time, but is under study to determine if this combined strain might have any transmission or severity advantages. The Guardian has a good explainer on the subject.
New studies on masks, vaccines for kids: This week, the CDC MMWR published a new study on masking in K-12 schools; the researchers found that Arkansas school districts with a universal mask requirement in the fall 2021 semester had 23% lower cases than schools that did not have a requirement. The journal also published a new study on vaccinations in children ages 5 to 11; this study found that, within three months of COVID-19 vaccines becoming available for this age group, 92% of kids ages 5 to 11 lived within 5 miles of a vaccine provider. However, vaccination coverage in this age group is low, suggesting the need for more targeted communication to families with young kids.
NIH starts new trial on allergic reactions to vaccines: The National Institutes of Health (NIH) recently announced a new clinical trial to understand “rare but potentially serious systemic allergic reactions” to the COVID-19 vaccines. The trial will include up to 100 people between the ages of 16 and 69 who had allergic reactions to their first vaccine doses; the NIH will provide second doses under heavily monitored conditions and study how these patients respond.
How to better recruit for COVID-19 trials: Speaking of clinical trials, a new preprint posted this week to medRxiv outlines a potential strategy for better studying effectiveness and potential rare side effects of COVID-19 treatments. The preprint authors propose targeting recruitment to people who are high-risk for coronavirus infection, so that studies may collect data on a statistically significant number of cases more quickly.
COVID-19 at the Tokyo Olympics: Another study that caught my eye this week: researchers from Tokyo described the results of intensive surveillance testing for athletes who competed in the 2021 Tokyo Olympics and Paralympics. In total, among over one million PCR tests conducted before and during the Olympic games, just 299 returned positive results—a positivity rate of 0.03%.
COVID-19 on Capitol Hill: Reporters at The Hill analyzed data on COVID-19 test results among House and Senate lawmakers, finding that more than one-quarter have tested positive since the pandemic began. The highest case numbers occurred in January 2022 during the Omicron wave, aligning with the U.S. overall. (Though I imagine many legislators travel and socialize indoors more than the average American.)
As longtime readers know, I have done a lot of reporting on school COVID-19 testing programs. I find these efforts to routinely test K-12 students fascinating, in part because of the unique potential for collaboration between school districts, health departments, and other community institutions—and also because of the immense challenges that arise when schools are asked to become health providers in a way we never would’ve considered before the pandemic.
Utah’s program caught my eye last year when I was reporting a story for Science News on the hurdles schools faced in setting up COVID-19 testing. This state was an early pioneer of Test to Stay, a strategy in which students must test negative to attend school after a potential exposure rather than going through a (potentially unnecessary) quarantine.
In Utah’s version of Test to Stay, once 1% of students tested positive for the virus, the entire school would go through a testing event. Students who tested negative could keep attending school without interruption, while those who tested positive (or those who refused to participate) could quarantine. The Utah health department tested out this program in the 2020-2021 school year, and it was so successful that a CDC MMWR boasted it had “saved over 100,000 days of in-person instruction.”
After that successful test, Utah’s state legislature codified the program into law for the 2021-2022 school year. But Test to Stay crashed and burned this past fall, even before the Omicron variant overwhelmed Utah’s test supplies.
Last school year, Utah’s Test to Stay program drew national attention as a novel strategy to prevent COVID outbreaks. But in fall 2021, the program entirely collapsed. @erinalberty and I dug into why, for @sltrib / @19Documenting: (1/12) pic.twitter.com/coho1YgTwP
Here’s why the program failed, according to our investigation:
When putting Test to Stay into law, the Utah state legislature doubled the threshold for school cases that would trigger a testing event, from 1% to 2% of the student body. (Or from 15 to 30 students at smaller schools with under 1,500 students.) This higher threshold allowed COVID-19 to spread more widely before testing events took place, leading to higher case numbers when students were finally tested.
Utah’s lawmakers also banned schools from requiring masks in fall 2021, leading to more transmission. Experts said the original program was intended to be paired with masks and other safety measures; it was not able to stand on its own.
In the 2020-2021 school year, Test to Stay was paired with a second program called Test to Play: mandatory testing every two weeks for students on sports teams and in other extracurriculars. Without this regular testing in fall 2021, Utah schools had less capacity to identify school cases outside of voluntary and symptomatic tests—so it took longer for schools to reach the Test to Stay threshold.
The Utah health department allowed individual schools and districts to request rapid tests for additional surveillance testing. Some administrators requested thousands of tests and made them regularly available to students and staff; others were entirely uninterested and did not encourage testing at their schools.
Testing in schools has become increasingly polarized in recent months, like all other COVID-19 safety measures. One school administrator told me that he faced some vocal parents who felt “that their rights were being trampled on” by the testing program. Without high numbers of students opting in to get tested, testing programs are inherently less successful.
Even though the CDC endorsed Test to Stay as part of its official school COVID-19 guidance last December—citing Utah’s program as a key example—its future in the state is now uncertain. State lawmakers paused the program during the Omicron surge in January and have yet to revive it. At the same time, lawmakers have made it even harder for Utah schools to make their own decisions around safety measures.
What school districts and health departments should actually be doing, experts told me, is stock up on rapid tests now so that they’re ready to do mass testing in future surges. It’s unlikely that the Omicron wave will be our last, much as some Utah Republicans might want to pretend that’s the case.
As COVID-19 safety measures are lifted and agencies move to an endemic view of the virus, I’m thinking about my shifting role as a COVID-19 reporter. To me, this beat is becoming less about reporting on specific hotspots or control measures and more about preparedness: what the U.S. learned from the last two years, and what lessons we can take forward—not just for the future COVID-19 surges that are almost certainly coming, but also for future infectious disease outbreaks.
To that end, I was glad to see the Biden administration release a new COVID-19 plan focused on exactly this topic: preparedness for new surges, new variants, and new infectious diseases beyond this current pandemic.
From the plan’s executive summary:
Make no mistake, President Biden will not accept just “living with COVID” any more than we accept “living with” cancer, Alzheimer’s, or AIDS. We will continue our work to stop the spread of the virus, blunt its impact on those who get infected, and deploy new treatments to dramatically reduce the occurrence of severe COVID-19 disease and deaths.
The Biden plan was released last week, in time with the president’s State of the Union address. I read through it this morning, looking for goals and actions connected to data collection and reporting.
Here are a few items that stuck out to me, either things that the Biden administration is already doing or should be doing:
Improving surveillance to identify new variants: The U.S. significantly improved its variant sequencing capacity in 2021, multiplying the number of cases sequenced by more than tenfold from the beginning to the end of the year. But the new Biden plan promises to take these improvements further, by adding more capacity for sequencing at state and local levels—and, crucially, “strengthening data infrastructure and interoperability so that more jurisdictions can link case surveillance and hospital data to vaccine data.” In plain language, that means: making it easier to track breakthrough cases (which I have argued is a key data problem in the U.S.).
Expanding wastewater surveillance:As I’ve written before, in the current national wastewater surveillance network, some states are very well-represented with over 50 collection sites; while other states are not included in the data at all. The Biden administration is committed to bring more local health agencies and research institutions into the surveillance network, thus expanding our national capacity to get early warnings about surges.
Standardizing state and local data systems: I’ve written numerous times that the U.S. suffers from a lack of standardization among its 50 different states and hundreds of local health agencies. According to the new plan, the Biden administration plans to facilitate data sharing, aggregating, and analyzing data across state and local agencies—including wastewater monitoring and other potential methods of surveillance that would provide early warnings of new surges. This would be huge if it actually happens.
Modernize the public health data infrastructure: One thing that could help health agencies better coordinate and share data: modernizing their data systems. That means phasing out fax machines and mail-in reports (which, yes, some health departments still use) and investing in new electronic health record technologies, while hiring public health workers who can manage such systems.
Use a new variant playbook to evaluate new virus strains: Also in the realm of variant preparedness, the Biden administration has developed a new “COVID-19 Variant Playbook” that may be used to quickly determine how a new variant impacts disease severity, transmissibility, vaccine effectiveness, and other factors. The new playbook may be used to quickly update vaccines, tests, and treatments if needed, by working in partnership with health systems and research institutions.
Collecting demographic data on vaccinations and treatments: The Biden plan boasts that, “Hispanic, Black, and Asian adults are now vaccinated at the same rates as White adults.” However, CDC data shows that this trend does not hold true for booster shots: eligible white Americans are more likely to be boosted than those in other racial and ethnic groups. The administration will need to continue collecting demographic data to identify and address gaps among vaccinations and treatments; indeed, the Biden plan discusses continued efforts to improve health equity data.
Tracking health outcomes for people in high-risk settings: Along with its health equity focus, the Biden plan discusses a need to better track and report on health outcomes in nursing homes, other long-term care facilities, and other congregate settings like correctional facilities and homeless shelters. Congregate facilities continue to be major COVID-19 hotspots whenever there’s a new outbreak, so improving health standards in these settings should be a major priority.
Studying and combatting vaccine misinformation, vaccine safety: The new plan acknowledges the impact of misinformation on vaccine uptake in the U.S., and commits the Biden administration to addressing this trend. This includes a Request for Information that will be issued by the Surgeon General’s office, asking researchers to share their work on misinformation. Meanwhile, the administration will also continue monitoring vaccine safety and reporting these data to the public.
Test to Treat: One widely publicized aspect of the Biden plan is an initiative called “Test to Treat,” which would allow people to get tested for COVID-19 at pharmacies, health clinics, long-term care facilities, and other locations—then, if they test positive, immediately receive treatment in the form of antiviral pills. If this initiative is widely funded and adopted, the Biden administration should require all participating health providers to share testing and treatment data. This would allow researchers to evaluate whether this testing and treatment rollout has been equitable across different parts of the country and minority groups.
Website for community risk levels and public health guidance: The Biden plan includes the launch of a government website “that allows Americans to easily find public health guidance based on the COVID-19 risk in their local area and access tools to protect themselves.” The CDC COVID-19 dashboard was recently redesigned to highlight the agency’s new Community Level guidance, which is likely connected to this goal. Still, the CDC dashboard leaves much to be desired when it comes to comprehensive information and accessibility, compared to other trackers.
A new logistics and operational hub at HHS: In the last two years, the Department of Health and Human Services (HHS) built up an office for coordinating the development, production, and delivery of COVID-19 vaccines and treatments. The new Biden plan announced that this office will become a permanent part of the agency, and may be used for future disease outbreaks. At the same time, the Biden administration has added at-home tests, antiviral pills, and masks to America’s national stockpile for future surges; and it is supporting investments in laboratory capacity for PCR testing.
Tracking Long COVID: Biden’s plan also highlights Long COVID, promoting the need for government efforts to “detect, prevent, and treat” this prolonged condition. The plan mentions NIH’s RECOVER initiative to study Long COVID, discusses funding new care centers for patients, and proposes a new National Research Action Plan on Long COVID that will bring together the HHS, VA, Department of Defense, and other agencies. Still, the plan doesn’t discuss actual, financial support for patients who have been out of work for up to two years.
Supporting health and well-being among healthcare workers: The new Biden plan acknowledges major burnout among healthcare workers, and proposes a new grant program to fund mental health resources, support groups, and other systems of combatting this issue. Surveying healthcare workers and developing systematic solutions to the challenges they face could be a major aspect of preparing for future disease outbreaks. The Biden plan also mentions investing in recruitment and pipeline programs to support diversity, equity, and inclusion among health workers.
More international collaboration: The new Biden plan also focuses on international aid—delivering vaccine donations to low-income nations—and collaboration—improving communication with the WHO and other global organizations that conduct disease surveillance. This improved communication may be especially key for identifying and studying new variants in a global pandemic surveillance system.
This week, a group of experts—including some who have advised the Biden administration— followed up on the Biden plan with their own plan, called “A Roadmap for Living with COVID.” The Roadmap plan also emphasizes data collection and reporting, with a whole section on health data infrastructure; here, the authors emphasize establishing centralized public health data platforms, linking disparate data types, designing data infrastructure with a focus on health equity, and improving public access to data.
Both the Biden administration’s plan and the Roadmap plan give me hope that U.S. experts and leaders are thinking seriously about preparedness. However, simply releasing a plan is only the first step to making meaningful changes in the U.S. healthcare system. Many aspects of the Biden plan involve funding from Congress… and Congress is pretty unwilling to invest in COVID-19 preparedness right now. Just this week, a $15 billion funding plan collapsed in the legislature after the Biden administration already made major concessions.
Readers, I recommend calling your Congressional representatives and urging them to support COVID-19 preparedness funding. You can also look into similar measures in your state, city, or other locality. We need to improve our data in order to be prepared for future disease outbreaks, COVID-19 and beyond.
COVID-19 Data Dispatch 