COVID-19 Data Dispatch

Category: Vaccines

  • Sources and updates, March 13

    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.
    https://twitter.com/PeacockFlu/status/1502726359096909825
    • 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.)

    All featured sources
  • Pandemic preparedness: Improving our data surveillance and communication

    Pandemic preparedness: Improving our data surveillance and communication

    Screenshot of the new Biden COVID-19 plan.

    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.

    More national data

  • As COVID-19 precautions are lifted, who remains vulnerable?

    As COVID-19 precautions are lifted, who remains vulnerable?

    Hispanic, Black, and Native Americans are less likely to have received their booster shots than white Americans, according to CDC data.

    As more states and other institutions lift COVID-19 safety measures, the shift has sparked a conversation about who remains most vulnerable to COVID-19 during this period. I wanted to highlight a few of these vulnerable groups:

    • Seniors who remain unvaccinated or unboosted: “No other basic fact of life matters as dramatically as age for COVID,” writes Sarah Zhang in The Atlantic this week. Zhang’s story argues that the U.S. has not actually pushed to vaccinate elderly Americans with the same focus that other wealthy nations have. More than 10% of Americans over age 65 are not fully vaccinated and about one-third of those seniors who are fully vaccinated have not received their booster shots, according to CDC data. These seniors face higher COVID-19 risk than younger adults who are entirely unvaccinated, Zhang writes.
    • People of color who remain unvaccinated or unboosted: Zhang’s article inspired me to also look at recent vaccination trends by race and ethnicity. Black, Hispanic, and Native Americans have been at higher risk for COVID-19 throughout the pandemic, as their minority identities often coincide with lower socioeconomic status. According to CDC data, booster shot trends are similar to the vaccination trends we saw in early 2021: while 55% of eligible white Americans have received their booster shots, that number is below 50% for Black, Hispanic, and Native Americans. It’s lowest for Hispanic or Latino Americans: only 39% of those eligible have received a booster shot, as of February 19.
    • Immunocompromised people: If you haven’t yet read Ed Yong’s latest feature, about how America’s pandemic response has left immunocompromised people behind, drop everything and read it today. About 3% of U.S. adults take immunosuppressive drugs, while others live with diseases like AIDS that impact their immune systems. “In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardized their ability to be part of the world,” Yong writes. Several other articles this week have also highlighted the challenges immunocompromised Americans face at this point in the pandemic.
    • Pregnant people: According to CDC data, about 68% of pregnant people ages 18 to 49 are fully vaccinated, as of February 12. That leaves almost one-third of pregnant Americans who are not fully vaccinated. Studies have found that pregnant people infected with the coronavirus are at higher risk for complications during their pregnancies and other severe outcomes. Plus, a new CDC study released this week found that a parent’s vaccination while pregnant greatly reduces an infant’s risk of being hospitalized for COVID-19, as antibodies produced by vaccination may be transferred from parent to child.
    • Children under age five: Of course, I have to mention the one group of Americans that is still not yet eligible for vaccination: children under age five. As parents of these kids have dealt with a confusing back-and-forth from Pfizer and the FDA on when vaccines might be available, many are facing high stress levels and remaining cautious even while schools and other institutions reduce safety measures.

    More vaccination data

  • Omicron updates: BA.2, vaccine effectiveness, and more

    Omicron updates: BA.2, vaccine effectiveness, and more

    As of February 5, the CDC is now including BA.2 in its variant prevalence estimates. Screenshot from the CDC dashboard.

    A few Omicron-related news items for this week:

    • The CDC added BA.2 to its variant prevalence estimates. As I mentioned in today’s National Numbers post, the CDC is now splitting out its estimates of Omicron prevalence in the U.S. into original Omicron, also called B.1.1.529 or BA.1, and BA.2—a sister strain that’s capable of spreading faster than original Omicron. BA.2 has become the dominant variant in some parts of Europe and Asia, but seems to be present in the U.S. in fairly low numbers so far: the CDC estimates it caused about 3.6% of new cases nationwide in the week ending February 5, with a 95% confidence interval of 1.8% to 6.8%. The remainder of new cases last week were caused by original Omicron.
    • CDC describes its expanded genomic surveillance efforts in an MMWR study released this week. Between June 2021 and January 2022, the agency has extended its ability to monitor new variants spreading in the U.S., incorporating public repositories like GISAID into CDC data collection and developing modeling techniques that can produce more timely estimates of variant prevalence. (Remember: all variant data are weeks old, so the CDC uses modeling to predict the present.) According to the MMWR study, genomic sequencing capacity in the U.S. tripled from early 2021 to the second half of the year.
    • Vaccine effectiveness from a booster shot wanes several months after vaccination. In another MMWR study released this week, the CDC reports on mRNA vaccine effectiveness after two and three doses, based on data from a hospital network including hundreds of thousands of patients in 10 states. During the U.S.’s Omicron surge, researchers found, vaccine effectiveness against COVID-19 hospitalization was 91% two months after a third dose—but declined to 78% four months afterward. It’s unclear whether this declining effectiveness is a direct result of Omicron getting past the vaccine’s defenses, or whether we’d see similar declines with other variants. Also, the CDC’s findings are not stratified by age or other factors that make people more vulnerable to severe COVID-19.
    • Updated monoclonal antibody treatment from Eli Lilly gets FDA authorization. During the Omicron surge, one challenge for healthcare providers has been that, out of three monoclonal antibody treatments authorized by the FDA, only one retained effectiveness against this variant. (Monoclonal antibody treatments provide a boost to the immune system for vulnerable patients.) This week, however, the FDA authorized an updated version of Eli Lilly’s treatment that does work against Omicron, including against the BA.2 lineage. The federal government has purchased 600,000 courses of this new treatment.
    • More data released on South Africa’s mild Omicron wave. A new paper published in JAMA this week, from researchers at a healthcare provider in South Africa, compares COVID-19 hospitalizations during the Omicron surge to past surges. Among patients who visited the 49 hospitals in this provider’s network, about 41% of those who went to an emergency department with a positive COVID-19 test were admitted to the hospital during the Omicron surge—compared to almost 70% during South Africa’s prior surges. The paper provides additional evidence that Omicron is less likely to cause severe COVID-19 than past variants, though this likelihood is tied in part to high levels of vaccination and past infection in South Africa and other countries.
    • Omicron has been identified in white-tailed deer. New York City was an early Omicron hotspot in the U.S.; and the variant has been passed onto white-tailed deer in Staten Island, according to a new preprint posted this week (and not yet peer-reviewed). Scientists have previously identified coronavirus infections in 13 states, but finding Omicron is particularly concerning for researchers. “The circulation of the virus in deer provides opportunities for it to adapt and evolve,” Vivek Kapur, a veterinary microbiologist who was involved in the Staten Island study, told the New York Times. 

    More variant reporting

  • Omicron updates: The continued importance of vaccination

    Omicron updates: The continued importance of vaccination

    COVID-19 deaths during the Omicron wave have been much higher in the U.S. than in other similarly wealthy countries, according to a New York Times analysis.

    Just a few updates for this week:

    • Scientists are still learning about BA.2, the more-transmissible Omicron offshoot. There haven’t been many major updates about BA.2 since last week, when I wrote this FAQ post; but this STAT News article by Andrew Joseph provides a helpful summary of what we know so far. The article explains that BA.2 clearly has a transmission advantage over BA.1 (and has now become the dominant variant in a few countries), but BA.1 may have spread around the world due to chance and some well-placed superspreading events. Notably, the CDC is not yet splitting out its Omicron prevalence estimates into BA.1 and BA.2, so we don’t have a great sense of how much this sub-lineage is spreading in the U.S.
    • More data indicates immune system memory remains strong against Omicron. In previous Omicron update posts, I’ve noted that, while vaccinated people are more likely to have a breakthrough case with Omicron than with past variants, vaccination is still highly protective against severe symptoms. A new study published in Nature this week further affirms this protection; researchers found that 70% to 80% of T cell response to Omicron was retained in people who were vaccinated or tested positive on antibody tests, compared to past variants. (T cells are key pieces of immune system memory response.)
    • Similarly, more data backs up the importance of vaccination to protect against severe disease during the Omicron era. The CDC released more MMWR studies this week showing that fully vaccinated and boosted Americans were less likely to require hospitalization or intensive care during the Omicron surge compared to the unvaccinated. For example, in Los Angeles County, California, hospitalization rates among unvaccinated people were 23 times higher than rates among those fully vaccinated with a booster, and five times higher than those vaccinated without a booster.

    • Omicron is too transmissible for school testing programs to keep up. I’ve previously reported on the challenges of K-12 COVID-19 testing programs, including the difficulty of setting up public health logistics, getting enough tests, and increasing polarization of testing. During the Omicron surge, these challenges have been magnified—to the point that some states, including Utah, Vermont, and Massachusetts, have suspended testing programs, POLITICO reported this week. I hope to see some of these programs resume after the surge is over.
    • The U.S.’s death toll during the Omicron surge has been far higher than in similarly wealthy nations. A new analysis from the New York Times compares the death toll in the U.S. from December 2021 through January 2022, adjusted for population, to death tolls in peer wealthy nations like Germany, Canada, Australia, and Japan. The comparison is striking: “the share of Americans who have been killed by the coronavirus is at least 63 percent higher than in any of these other large, wealthy nations,” the NYT reports. This difference is largely because the U.S. is less vaccinated than these other countries, particularly when it comes to booster shots and vaccinations among seniors.
    • Globally, cases during the Omicron surge surpassed all of 2020. “In the 10 weeks since Omicron was discovered, there have been 90 million COVID-19 cases reported — more than in all of 2020,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, at a press conference last week. In a Twitter thread reporting from the press conference, STAT’s Helen Branswell noted that the WHO is concerned about countries “opening up” and lifting COVID-19 restrictions before their case numbers are actually low enough to warrant these measures.

    More variant reporting

  • We failed to vaccinate the world in 2021; will 2022 be more successful?

    We failed to vaccinate the world in 2021; will 2022 be more successful?

    According to Bloomberg, the 52 least wealthy places in the world have 5.6% of the vaccinations. Chart from Bloomberg’s vaccine tracker, screenshot taken on December 19.

    In January, COVAX set a goal that many global health advocates considered modest: delivering 2.3 billion vaccine doses to low- and middle-income countries by the end of 2021. COVAX (or COVID-19 Vaccines Global Access) is an initiative to provide equitable access to vaccines; its leadership includes the United Nations, the World Health Organization (WHO), and other organizations.

    Despite COVAX’s broad support, the initiative has revised its vaccine delivery projections down again and again this year. Now, the initiative is saying it’ll deliver just 800 million vaccine doses by the end of 2021, according to the Washington Post, and only about 600 million had been delivered by early December.

    Considering that most COVID-19 vaccines are two-dose series—and boosters will likely be necessary to combat Omicron—those doses are just a drop in the bucket. According to Bloomberg’s vaccine tracker: “The least wealthy 52 places have 5.6% of the vaccinations, but 20.5% of the world’s population.”

    Why this access gap? Many scientists and advocates in low- and middle-income nations blame vaccine manufacturers and rich countries like the U.S., I found when I reported a story on this topic for Popular Science.

    “We basically have artificial scarcity of vaccine doses,” says Robbie Silverman, a vaccine advocate at Oxfam America. The pharmaceutical companies control “where doses are produced, where they’re sold, and at what price.” The world’s vaccine supply is thus limited by contracts signed by a small number of big companies; and many of those contracts, [Fatima Hassan, health advocate from South Africa] says, are kept secret behind non-disclosure agreements.

    While rich countries claimed to support COVAX, the Washington Post reports, “they also placed advance orders with vaccine manufacturers before COVAX could raise enough money to do so.” This practice pushed COVAX to the back of the vaccine line—and then, when rich countries decided they needed booster shots, that pushed COVAX to the back of the line again. India’s spring 2021 surge didn’t help either, as the country blocked vaccine supplies produced at the Serum Institute of India from being exported to other nations.

    According to Our World in Data, low-income nations have administered about 60 million doses total, while high-income nations have administered more than 300 million booster shots. At times this winter, there were more booster shots administered daily than first and second doses in low-income countries.

    Even taking booster shots into consideration, there should be enough vaccine supplies produced by the end of this year to vaccinate 40% of the world’s population by the end of this year, meeting WHO targets, according to STAT News’ Olivia Goldhill. The world is on track to manufacture about 11 billion vaccines in total this year, Goldhill reports, while about 850 million doses are needed to get all countries to a 40% vaccination benchmark.

    But again, rich countries pose a problem: the countries currently focused on administering booster shots have stockpiled hundreds of millions of doses, and are unwilling to send their stockpiles abroad. From STAT News:

    “That number can be redistributed from what high-income countries expect to have by the end of this year. So it’s not an overall supply challenge,” said [Krishna Udayakumar, founding director of Duke’s Global Health Innovation Center]. “It’s very much an allocation challenge, as well as getting high income countries more and more comfortable that they don’t need to hold on to hundreds of millions of doses, for contingencies.”

    The vaccine shortage for low-income countries is less than the surplus vaccines within the G7 countries and the European Union, according to separate analyses from both Duke and Airfinity, a life sciences analytics firm that is tracking vaccine distribution.

    While leaders in the U.S., the U.K., and other nations with large stockpiles maintain that they can both administer booster shots at home and send doses for primary series shots abroad, their true priorities are clear. The U.S., for example, has pledged to donate 1.2 billion doses to other countries, but about 320 million—under one-third—of those doses have been shipped out so far.

    Another challenge is the type of vaccines being used in wealthy nations, as opposed to low- and middle-income nations. Wealthy nations have been particularly eager to horde Pfizer and Moderna’s vaccines, which are more effective against Omicron and other variants of concern. On the other hand, many low-income nations have relied on Sputnik, CoronaVac, and other vaccines which are less effective.

    “We’re now entering an era of second-class vaccines for second-class people,” Peter Maybarduk, director at the DC-based nonprofit Public Citizen, told me in October, discussing these differences in vaccine effectiveness. As Omicron spreads around the world, this concern is only growing.

    The more the coronavirus spreads across the world, particularly in regions with less immunity from vaccines, the more it can mutate and create new variants. Delta and Omicron provide clear examples, demonstrating the need to vaccinate the world in 2022.

    And there are some reasons to hope that this goal may be feasible. COVAX’s global supply forecast shows major jumps in vaccine supplies in the first three months of 2022. At the same time, vaccine companies are increasing their production capacity, and donations from the U.S. and other countries are expected to kick in. In South Africa, an mRNA vaccine hub is working to train African companies to manufacture COVID-19 vaccines similar to Pfizer and Moderna’s, without violating patents.

    Still, additional variants—and the need for additional booster shots—could be a major hurdle, as vaccine companies continue to prioritize wealthy nations. These companies continue to refuse to share their intellectual property with other manufacturers, even as they make patents for COVID-19 antiviral drugs widely available. And, once vaccines are delivered, getting them from shipments into arms will be a challenge.

    More international data

  • One month into vaccinations for kids 5-11, uptake varies wildly by state

    One month into vaccinations for kids 5-11, uptake varies wildly by state

    It’s been about a month since the FDA and CDC authorized a version of Pfizer’s vaccine for children ages five to 11. Those kids whose parents immediately took them to get vaccinated are now eligible for their second doses, and will be considered fully vaccinated by Christmas.

    Despite widespread availability of the shots, vaccine uptake has varied wildly: the share of children ages five to 11 who have received at least one dose ranges from almost 50% in Vermont—to under 4% in West Virginia. In Idaho, so few children in this age range have received a vaccine dose that the CDC has yet to report a number of children vaccinated.

    As you can see from the map (which uses data as of December 9), vaccination rates for kids are falling pretty much along partisan lines, with states in the Northeast and West Coast vaccinating more than those in the South and Midwest. This is unsurprising yet troubling, as the states with lower vaccination rates among kids are also those states with more lax COVID-19 safety measures in schools—suggesting that they’re exactly the kids who could use that protection.

    A new report from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor provides context on slowing vaccination rates among children. According to KFF’s polling, three in ten American parents—both of teenagers and younger kids—say they will “definitely not” get their children vaccinated. Concerns about safety and potential long-term side effects abound, even though all data so far have suggested that the vaccines are very safe for children.

    https://twitter.com/DataDrivenMD/status/1469035785374420993

    While the overall data are troubling, we lack information in one key area: demographic data. Without breakdowns of child vaccination rates by race and ethnicity, it’s difficult to say whether the racial gap in vaccinations that we saw for adults earlier in 2021 has persisted for younger Americans. This data absence makes it difficult for policymakers and health advocates to address the potential need for vaccine messaging tailored to families of color.

    More vaccination data

  • Omicron updates: More transmissible, immune evading, but still not cause for panic

    Omicron updates: More transmissible, immune evading, but still not cause for panic

    COVID-19 cases are rising rapidly in countries where Omicron is spreading, including South Africa, the U.K., and Denmark. Chart from Our World in Data, retrieved September 12.

    We continue to learn more about this new variant as it spreads rapidly across the world, though much of the data are still preliminary. Here are a few major updates:

    • Omicron is still spreading very quickly in South Africa, as well as in the U.K. and Denmark—two other countries with great genetic surveillance. Preliminary estimates based on data from these countries suggest that the variant’s R-value is between 3 and 4, indicating that the average person infected with Omicron infects three or four others. As Sarah Zhang put it in The Atlantic: “Omicron is spreading in highly immune populations as quickly as the original virus did in populations with no immunity at all.”
    • Early vaccine studies show a drop in antibody levels against Omicron, but that doesn’t necessarily correspond to overall protection. This week, we saw the first results from early studies evaluating how well vaccines work against Omicron. Here’s a summary, drawing from Katherine Wu’s coverage of these studies in The Atlantic: vaccinated people confronted with Omicron appear to produce a lot fewer antibodies that can fight the virus, compared with older variants. Numbers range from a five-fold drop in antibodies to a 41-fold drop. But remember, antibodies are just one part of the immune system—specifically, they’re the part that’s easiest to measure. Vaccinated people also have memory immune cells that provide protection over a long time period, which isn’t captured in antibody studies. We’ll need more time and more data to actually evaluate how vaccines fare against Omicron in the real world, rather than in the lab.
    • The vaccines seem to protect against severe disease and death from Omicron. So far, the data suggest that our existing COVID-19 vaccines still work quite well at protecting people from severe symptoms—even when those severe symptoms are caused by an Omicron case. “When the shots’ protection ebbs, it tends to do so stepwise: first, against infection, then transmission and symptoms, and finally against severe disease,” Wu writes. For vaccinated people to lose protection against severe disease, the virus would have to change much more than Omicron has. At the same time, however, some experts are concerned that non-mRNA vaccines may not fare as well against Omicron as Moderna and Pfizer, conferring a disadvantage to the low- and middle-income countries that have had less access to the mRNA vaccines.
    • Booster shots increase protection against Omicron. While vaccinated people are less protected against infection with Omicron than previous variants, booster shots appear to help close that gap—even though currently-available booster shots are not designed specifically for Omicron. One U.K. study suggests that boosters can increase vaccine effectiveness against infection from 30% to 75%, for people who received the Pfizer vaccines. In other words: Omicron is a good reason to go get your booster shot, if you’re eligible and you live in a place where the shots are available.
    • Experts continue to be skeptical about Omicron being “more mild.” Reports out of South Africa continue to suggest that cases caused by Omicron are more mild than cases caused by Delta, with doctors saying that fewer patients are requiring hospitalization and those hospital stays are shorter than previous outbreaks. But many of the South Africans getting sick with Omicron may have some protection from vaccination or past infection; this means they’re more likely to have mild cases, as biostatistician Natalie Dean explains in an excellent Twitter thread. Plus, even if Omicron is more mild, it appears to be more transmissible—and a smaller share of severe cases out of a larger pool of cases overall can still lead to a pretty big number of people going to the hospital. In addition, we have zero data at this point on how Omicron may impact Long COVID cases, or how well vaccines protect against Long COVID from an Omicron infection.
    • Early U.K. data confirm Omicron’s high contagiousness and its capacity for evading protection from vaccines and prior cases. After the U.K.’s best-in-the-world genetic surveillance agency first identified Omicron in late November, I wrote that the country would likely provide invaluable data on this variant. Less than two weeks later, the U.K. Health Security Agency has released its first Omicron report. The country’s real-world data confirm that Omicron can spread quite fast: for example, “19% of Omicron cases resulted in household outbreaks vs 8.5% of Delta cases,” wrote epidemiologist Meaghan Kall in a summary of the report. The report also “paints a very consistent picture for Omicron being immune evading,” Kall said, though booster shots help a lot.
    • Anime NYC was a likely Omicron superspreader event. More and more reports have emerged of Omicron cases connected to Anime NYC, a convention held in Manhattan in mid-November. The CDC is currently investigating the convention: officials are working with the NYC health department to contact all 53,000 convention attendees for testing and contact tracing. “Data from this investigation will likely provide some of the earliest looks in this country on the transmissibility of the variant,” CDC Director Dr. Rochelle Walensky said at a press briefing on Tuesday.
    • The CDC formally named Omicron a Variant of Concern. On Friday, the CDC officially designated Omicron as a Variant of Concern and added it to the variant tracking page of the agency’s COVID-19 dashboard. As of December 4, Omicron is causing 0.0% of new COVID-19 cases in the U.S., the CDC estimates. The variant has yet to be added to the CDC’s state-by-state data. Given the continued geographic disparities of the U.S.’s genomic surveillance system, however, we may expect that the variant is already spreading in states where it has yet to be formally identified.
    • Omicron can likely compete with Delta, but we need more data to get a better sense of how well. “Omicron is picking up speed in Europe, which has often served as a preview of what was headed the U.S.’s way. It’s an early sign that the already bleak situation here may get worse,” writes Andrew Joseph in a recent STAT News story. U.K. data suggest that Omicron could cause a majority of cases there within two to four weeks, Joseph reports, and the U.S. may not be far behind. Still, more real-world data from countries and regions with clear Omicron outbreaks will give us a better idea of just how worried we need to be about a potential Omicron-fueled surge.

    In summary:

    More variant reporting

  • Cash incentives for vaccination have little impact

    Cash incentives for vaccination have little impact

    Over the past year, vaccine incentives have become a popular strategy among businesses and state and local governments. From free donuts to free Mets tickets, Americans have had opportunities to get bonus rewards along with protection from the coronavirus. And one particularly common incentive is cash, offered through small payments accompanying vaccinations and lotteries that only vaccinated people can enter.

    While politicians at all levels have praised cash incentives, research has shown that this strategy has little impact on actually convincing Americans to get vaccinated. A recent investigation I worked on (at the Documenting COVID-19 project and the Missouri Independent) provides new evidence for this trend: the state of Missouri allocated $11 million for gift cards that residents could get upon receiving their first or second vaccine dose, but the vast majority of local health departments opted not to participate in the program—and a very small number of gift cards have been distributed thus far. 

    The Missouri program’s limited success fits into a national pattern. “It’s hard to tease out a causal effect of a program that’s not introduced with the purpose of a research experiment,” Dr. Allan Walkey, an epidemiologist at Boston University who’s studied vaccine incentives, told me. Still, Walkey said, the majority of research on these programs has found that cash incentives are not driving huge numbers of people to get their shots.

    Walkey specifically studied a vaccine lottery in Ohio, the first state to set up such a program. While initial reports by state leaders suggested that a lot of people got vaccinated after the lottery was announced, Walkey found that, in fact, the new vaccinations were more likely caused by an expansion of vaccine eligibility. Two days before the lottery was announced, the Pfizer vaccine was authorized for children between the ages of 12 and 15.

    The lottery “didn’t have a large effect on vaccine uptake,” Walkey told me. Studies of vaccine lotteries in other states have found similar results.

    For this story, I also spoke to Ashley Kirzinger, a polling expert at the Kaiser Family Foundation (KFF) who helps run KFF’s Vaccine Monitor surveys. In these surveys, KFF sorts unvaccinated Americans into categories based on their vaccine attitudes: “wait and see,” “only if required,” and “definitely not.” Kirzinger told me that cash incentives, vaccine requirements for events, and other social pressures are more likely to “motivate the ‘wait and see’ or ‘only if required’” groups.

    But for those Americans who “definitely” don’t want to get vaccinated, these incentives aren’t likely to move the needle. In fact, the people in this group may be angered by incentives, because they could see such programs as unfair pressure from the health system.

    This was true in some Missouri local public health departments. For example, in Carter County—where the local agency did opt in to the state gift card program—a planned vaccination drive with the gift cards was canceled due to local opposition.

    “​​So many parents and community members were upset, we were not allowed to hold the vaccination event at the school,” said Michelle Walker, the county health center administrator.

    Overall, out of 115 local public health agencies in Missouri that were eligible to participate in the incentive program, just 20 opted to get gift cards. Most departments purchased $50 gift cards, so that residents could get $50 at their first vaccine dose and $50 at their second dose.

    Through surveying the local agencies that participated, my colleague Tessa Weinberg and I obtained data from 10. Out of 6,378 gift cards that the agencies were able to purchase with state funding, we found that just 1,712 had been distributed so far, as of late November.

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    Read the full story for more on why many departments didn’t participate in this gift card program, and how it’s going for the departments that did opt in.

    MORE STATE DATA
  • Vaccines aren’t enough: What Biden can do about Omicron

    Vaccines aren’t enough: What Biden can do about Omicron

    This past Monday, President Biden gave a speech about the Omicron variant. He told America that Omicron is “cause for concern, not a cause for panic,” and thanked the South African scientists who alerted the world to this variant. (Though a travel ban is not a great way to thank those scientists!)

    Towards the end of the speech, he said: “We’re throwing everything we can at this virus, tracking it from every angle.” Which I, personally, found laughable. As I’ve pointed out in a previous post about booster shots, the U.S.’s anti-COVID strategy basically revolves around vaccines, and has for most of 2021.

    My Tweet about Biden’s vaccine-only strategy got more attention than I’m used to receiving on the platform, so I thought it was a worthwhile topic to expand upon in the COVID-19 Data Dispatch. Why aren’t vaccines enough to address Omicron—or our current surge, for that matter—and what else could the Biden administration be doing to slow the coronavirus’ spread?

    Why aren’t vaccines enough?

    Prior to Delta’s spread, there was some talk of reaching herd immunity: perhaps if 70% or 80% of Americans got fully vaccinated, it would be sufficient to tamp down on the coronavirus. But Delta’s increased capacity to spread quickly, combined with the vaccines’ decreased capacity to protect against infection and transmission, have shown that vaccines are not enough to eradicate the virus.

    In thinking about this question, I returned to an article that Ed Yong wrote for The Atlantic back in August:

    Here, then, is the current pandemic dilemma: Vaccines remain the best way for individuals to protect themselves, but societies cannot treat vaccines as their only defense. And for now, unvaccinated pockets are still large enough to sustain Delta surges, which can overwhelm hospitals, shut down schools, and create more chances for even worse variants to emerge. To prevent those outcomes, “we need to take advantage of every single tool we have at our disposal,” [Shweta Bansal of Georgetown University] said. These should include better ventilation to reduce the spread of the virus, rapid tests to catch early infections, and forms of social support such as paid sick leave, eviction moratoriums, and free isolation sites that allow infected people to stay away from others.

    Remember that Swiss cheese model of pandemic interventions? Vaccines may be the best protection we have against the coronavirus, but they’re still just one layer of protection. All the other layers—masks, testing, ventilation, etc.—are still necessary, too. Especially when we’re dealing with a new variant that might not respond as well to our vaccines.

    What we could do: better masks

    One strategy that we could employ against Omicron, as well as against the current Delta surge, is better masks. While cloth masks certainly make it less likely for the coronavirus to spread from one person to another, their efficacy varies greatly depending on the type of material, the number of layers, and the mask’s fit.

    N95 masks do the best job at stopping the coronavirus from spreading, followed by KN95 masks. Surgical masks do a better job than cloth masks, but making sure these masks fit properly can be a challenge for some people (including yours truly, who has a very narrow face!). Layering a surgical mask and cloth mask may be a safer option to get both good fit and protection, though two layers of mask can be challenging to wear for long periods of time.

    Some experts have recommended that the U.S. mail N95 or KN95 masks to all Americans, or at least require these masks in high-risk areas, such as on flights. Germany and other European countries established similar requirements last summer.

    What we could do: more widely available testing

    In many countries—including the U.K., Germany, India, and others—rapid tests are freely available. Here in the U.S., on the other hand, the tests are quite expensive (often upwards of $10 for one test) and difficult to find, with pharmacies often limiting the number of packages that people can buy at once.

    Biden has attempted to increase rapid testing access as part of his latest COVID-19 plan: in January, private insurance companies will be required to cover the cost of rapid tests. But this doesn’t solve the supply issue, and it doesn’t really make the tests more accessible, either. The measure would still require people to buy tests out of pocket, then fill out insurance reimbursement forms to maybe get their money back. Can you imagine anyone actually doing this?

    In addition, as some experts have pointed out, the people most likely to need rapid tests—essential workers and others in high-risk environments—are also those less likely to have insurance. Biden is also distributing some rapid tests to community health centers, but that’s not enough to meet the need here.

    Ideally, the Biden administration would mail every American a pack of, like, 20 rapid tests, along with that pack of N95 or KN95 masks I mentioned above. Free of charge.

    And at the same time, of course, we need more readily available PCR testing. Even in New York City, which has a better testing infrastructure than most other parts of the country, the lines at free testing sites are getting long again as cases go up. Any American who wants to get tested should be able to easily make an appointment within a day or two, and get their results within another day after that.

    Increased testing is not only important for identifying Omicron cases (and cases of any other new variant); it’s also key for the Merck and Pfizer antiviral treatments due to be approved in the U.S. soon. Without efficient testing, patients won’t be able to start these treatments within days of their symptoms starting.

    What we could do: improve genetic surveillance

    The U.S. is doing a lot more coronavirus sequencing than we were in early 2021: we’ve gone from under 5,000 cases sequenced a week to over 80,000. The CDC worked with state and local health agencies, as well as research organizations and private companies, to increase sequencing capacity across the country.

    But that capacity is still concentrated in specific states and cities, as I noted in the previous post. In a recent STAT News story on sequencing, Megan Molteni writes: 

    Urban centers close to large academic centers tend to be well covered, while rural areas are less so. That means public health departments in large parts of the country are still flying blind, even as they are figuring out ways to prioritize Omicron-suspicious samples.

    A lack of testing compounds this problem. If someone doesn’t confirm their COVID-19 case with a PCR test, their genetic information will never make it to a testing lab, much less a sequencing lab. While rapid tests are very useful for quickly finding out if you’re infected with the coronavirus, you need a PCR test for your information to actually be entered into the public health system.

    In addition, even where the U.S. is sequencing a lot of samples, the process can take weeks. Vox’s Umair Irfan writes:

    Still, it takes the US a median time of 28 days to sequence these genomes and upload the results to international databases. Contrast that with the United Kingdom, which sequences 112 genomes per 1,000 cases, taking a median of 10 days to deposit their results. A delay of only a few days in detection can give variants time to silently spread within communities and across borders.

    Despite sequencing shortfalls in the U.S., we’re still doing much more surveillance than the majority of countries. Many nations in Africa, Asia, South America, and other parts of the world are sequencing fewer than 10 cases per 1,000, Irfan reports. As the U.S. should be doing more to get the world vaccinated, the U.S. should also do more to help other countries increase their sequencing capacity—monitoring for the variants that will inevitably follow Omicron.

    What we could do: stricter domestic travel requirements

    Starting on Monday, all international travelers coming into the U.S. by air will need to show a negative COVID-19 test, taken no more than one day before their flight. This includes all travelers regardless of nationality or vaccination status. At the same time, any non-U.S. citizens traveling into the country must provide proof of their vaccination against COVID-19.

    But travelers flying domestically don’t face any such requirements. There are mask mandates on airplanes, true, but people can wear cloth masks, often pulled down below their noses, and airports tend to have limited enforcement of any mask rules.

    Both experts and polls have supported requiring vaccination for domestic air travel, though the Biden administration seems very hesitant to put this requirement in place. Speaking for myself, I felt very unsafe the last time I flew domestically. A vaccine mandate for air travel would make me much more likely to fly again.

    What we could do: more social support

    In the U.S., a positive COVID-19 test usually means that you’re in isolation for 10 to 14 days, along with everyone else in your household. This can pull kids out of school, and pull income from families. As has been the case throughout the pandemic, support is needed for people who test positive, whether that’s a safe place to isolate for two weeks, grocery delivery, or rapid tests for the rest of the household.

    This type of support could make people actually want to get tested when they have symptoms or an exposure risk, rather than avoiding the public health system entirely.

    More variant reporting