New Coronavirus News from 21 Jan 2022

These Are the Latest COVID Treatments [Scientific American, 21 Jan 2022]

By Esther Landhuis

But shortages mean that new antivirals and other drugs may be hard to come by
Two years into the COVID pandemic, as the highly contagious Omicron variant pushes infections to record highs, U.S. physicians have a growing arsenal of therapies to keep mild disease from worsening. At the same time, limited availability and challenging logistics are complicating decisions about which patients receive them. Here is a rundown of what is on hand for hospitalized patients, as well as for people who are primarily recovering at home.

TREATMENTS FOR NONHOSPITALIZED PATIENTS
Monoclonal antibodies: For newly diagnosed patients at high risk for severe COVID-19, the recommended therapy has generally been monoclonal antibodies—lab-made proteins that bind to SARS-CoV-2, the virus that causes COVID, and keep it from grabbing onto and infecting cells. If administered within 10 days of diagnosis, either intravenously or as a series of shots under the skin, monoclonal antibodies can cut hospitalizations and deaths by more than 80 percent.

Several companies make these antibody treatments, which started to receive emergency-use authorization from the U.S. Food and Drug Administration in late 2020. Yet with most COVID cases in the U.S. currently caused by fast-spreading Omicron, a new coronavirus variant with mutations in the part of SARS-CoV-2 targeted by monoclonals, “there’s only one [antibody] that actually works,” says Michelle Barron, a professor of medicine at the University of Colorado School of Medicine and senior medical director of infection prevention and control at the nonprofit health system UCHealth.

That treatment—a monoclonal antibody called sotrovimab that is made by GlaxoSmithKline and Vir Biotechnology—can only be administered intravenously. “So from a logistics standpoint, that’s a little different than giving you shots in your leg or arm,” Barron says. “You have to be there at least an hour for the infusion, and you have to be able to get to the location.” And on the provider end, she adds, “you have to figure out where to do it, because you obviously don’t want these individuals who have COVID walking through a very populated waiting room.”

Antiviral pills: Last month the FDA authorized emergency use of two antiviral treatments that can be taken at home as pills: Pfizer’s Paxlovid and Merck and Ridgeback Biotherapeutics’ molnupiravir. In studies of high-risk adults who started these treatments within their first five days of COVID symptoms, Paxlovid cut the risk of hospitalization or death by 89 percent, and molnupiravir cut these sufferings by 30 percent, compared with placebo pills.

One issue with Paxlovid is that it consists of the antiviral nirmatrelvir given in combination with ritonavir, “an old HIV drug that’s known to interact with everything,” Barron says. “A lot of our highest-risk patients will potentially have a medication that will interact.” A pharmacist has to review all of a patient’s other medications before writing a prescription.

Access: But the biggest challenge with most of these outpatient treatments is short supply. Last fall the monoclonal antibody sotrovimab was available directly through a wholesaler, making them easier for physicians and medical facilities to procure. But as monoclonal antibody use surged because of a rise in COVID cases caused by the Omicron variant, the U.S. Department of Health and Human Services began overseeing distribution to states and territories. Each state receives a limited allocation in accordance with COVID rates and hospitalizations, and federal guidelines now expect states to prioritize giving antibodies to immunosuppressed or elderly individuals at highest risk for severe disease. And because sotrovimab is the only monoclonal found to work well against Omicron, it is particularly in demand.

Antiviral pills are also scarce and similarly prioritized for highest-risk outpatients. “Yesterday our health system just prescribed our first Paxlovid dose—for one person,” said David Boulware, an infectious disease physician-scientist at the University of Minnesota Medical School, when he was interviewed for Scientific American on January 7.

As of January 10 Zuckerberg San Francisco General Hospital and Trauma Center, which serves 100,000 patients each year and provides 20 percent of the city’s inpatient care, had received 20 courses of Paxlovid, says Monica Gandhi, an HIV and infectious disease physician at the University of California, San Francisco.

New York City, with a population of more than eight million and more than 30,000 infections per day in early January, had received about 1,600 doses of Paxlovid as of the first full week of January, says Celine Gounder, a physician and infectious disease expert at the New York University Grossman School of Medicine. The U.S. Department of Health and Human Services is allocating the pills per capita rather than based on infection rates, she says.

For every patient who manages to receive antiviral pills, many other immunocompromised, high-risk patients cannot get them, Boulware says. “‘Okay, they don’t have this; they don’t have that. What do you recommend?’ I’ve been called about that,” he adds. Plus, Paxlovid and sotrovimab are not authorized for children under 12 years of age, and the FDA limits molnupiravir to adults age 18 and up.

In these situations, Boulware suggests considering fluvoxamine or budesonide—widely available, low-cost drugs for other conditions that have published data suggesting benefits in nonhospitalized COVID patients.

Repurposed drugs: Fluvoxamine, an antidepressant pill that is approved in the U.S. for obsessive-compulsive disorder, can tame inflammatory responses, which typically arise in severe COVID-19. In a randomized trial of 1,497 high-risk COVID outpatients in Brazil, those who tolerated a 10-day course of fluvoxamine suffered about 90 percent fewer deaths, and their need for emergency care fell by 65 percent, compared with patients who were randomly assigned placebo pills.

Budesonide, an inhaled steroid that is used to prevent asthma symptoms, showed modest benefits in a large, open-label study in the U. K. that enrolled older, nonhospitalized patients with comorbidities such as high blood pressure and diabetes. Those who started to use the inhaler within two weeks of developing COVID symptoms saw an approximately three-day reduction in symptom duration. “So there’s a mild benefit, particularly during the second week of illness,” Boulware says.

TREATMENTS FOR HOSPITALIZED PATIENTS
For hospitalized COVID patients whose blood oxygen has dropped low enough to require monitoring, the National Institutes of Health recommends the widely available and relatively inexpensive steroid dexamethasone, which can be taken as oral tablets or intravenously.

Remdesivir, an intravenous antiviral, is also offered, often concurrently, to hospitalized patients who are in the severe inflammatory stage of COVID-19. “It’s better when given earlier,” Boulware says. “By the time you get in the ICU on a ventilator, there’s less benefit.”

To keep COVID from worsening to that stage, NIH guidelines updated this month are also recommending high doses of intravenous heparin, a drug used to prevent blood clots, in some patients. “What’s new is that therapeutic-dose heparin is now recommended for patients before they get to the ICU,” says Farid Jalali, a gastroenterologist in Laguna Hills, Calif., whose theories about COVID lung injury have been featured in the emergency medicine blog REBEL EM.

Several arthritis drugs, such as baricitinib or tocilizumab, can be given to dampen inflammation as disease progresses in hospitalized COVID patients two years of age or older. Baricitinib is a tablet taken by mouth, and tocilizumab is given through the vein as a drip infusion.
NEW HOPE FOR “OLD” COVID DRUGS
New research suggests remdesivir could also be helpful in COVID outpatients. In a randomized trial published in December in the New England Journal of Medicine, COVID-related hospitalizations and deaths were 87 percent lower in 279 symptomatic, nonhospitalized patients who received remdesivir, compared with 283 in the placebo group. “It looked really good, and supplies are not an issue,” Barron says. She notes, however, that “logistics are a little challenging because it’s three days of infusions.”

Similar logistical hurdles, as well as unclear findings from past research, have raised questions about the utility of the once eagerly studied convalescent plasma—collected from the blood of donors who have recovered from COVID-19. “It’s kind of falling out of favor right now,” Barron says.

Yet new research could be reviving interest in this treatment, especially given the limited supplies of outpatient therapies. The findings, posted on December 21 as a not-yet-peer reviewed preprint paper, revealed that, in a study of 1,181 patients, convalescent plasma cut hospitalizations by 54 percent when administered within the first 8 days of COVID symptoms.

“The one thing we’ve all learned is to be flexible,” Barron says. “What we do today may not be what we do tomorrow, and you just gotta be okay with that.”

Heterologous versus homologous COVID-19 booster vaccination in previous recipients of two doses of CoronaVac COVID-19 vaccine in Brazil (RHH-001): a phase 4, non-inferiority, single blind, randomised study [The Lancet, 21 Jan 2022]

Authored by Sue Ann Costa Clemens, Lily Weckx, Ralf Clemens, Ana Verena Almeida Mendes, Alessandra Ramos Souza, Mariana B V Silveira, Suzete Nascimento Farias da Guarda,
Maristela Miyamoto de Nobrega, Maria Isabel de Moraes Pinto, Isabela G S Gonzalez, Natalia Salvador, Marilia Miranda Franco, Renata Navis de Avila Mendonça, Isabelle Silva Queiroz Oliveira, Bruno Solano de Freitas Souza, Mayara Fraga, Parvinder Aley, Sagida Bibi, Liberty Cantrell, Wanwisa Dejnirattisai, Xinxue Liu, Juthathip Mongkolsapaya, Piyada Supasa, Gavin R Screaton, Teresa Lambe, Merryn Voysey, Andrew J Pollard, FMedSci and the RHH-001 study team

Summary

Introduction
The inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac, Sinovac) has been widely used in a two-dose schedule. We assessed whether a third dose of the homologous or a different vaccine could boost immune responses.

Methods
RHH-001 is a phase 4, participant masked, two centre, safety and immunogenicity study of Brazilian adults (18 years and older) in São Paulo or Salvador who had received two doses of CoronaVac 6 months previously. The third heterologous dose was of either a recombinant adenoviral vectored vaccine (Ad26.COV2-S, Janssen), an mRNA vaccine (BNT162b2, Pfizer–BioNTech), or a recombinant adenoviral-vectored ChAdOx1 nCoV-19 vaccine (AZD1222, AstraZeneca), compared with a third homologous dose of CoronaVac. Participants were randomly assigned (5:6:5:5) by a RedCAP computer randomisation system stratified by site, age group (18–60 years or 61 years and over), and day of randomisation, with a block size of 42. The primary outcome was non-inferiority of anti-spike IgG antibodies 28 days after the booster dose in the heterologous boost groups compared with homologous regimen, using a non-inferiority margin for the geometric mean ratio (heterologous vs homologous) of 0·67.
Secondary outcomes included neutralising antibody titres at day 28, local and systemic reactogenicity profiles, adverse events, and serious adverse events. This study was registered with Registro Brasileiro de Ensaios Clínicos, number RBR–9nn3scw.

Findings
Between Aug 16, and Sept 1, 2021, 1240 participants were randomly assigned to one of the four groups, of whom 1239 were vaccinated and 1205 were eligible for inclusion in the primary analysis. Antibody concentrations were low before administration of a booster dose with detectable neutralising antibodies of 20·4% (95% CI 12·8–30·1) in adults aged 18–60 years and 8·9% (4·2–16·2) in adults 61 years or older. From baseline to day 28 after the booster vaccine, all groups had a substantial rise in IgG antibody concentrations: the geometric fold-rise was 77 (95% CI 67–88) for Ad26.COV2-S, 152 (134–173) for BNT162b2, 90 (77–104) for ChAdOx1 nCoV-19, and 12 (11–14) for CoronaVac. All heterologous regimens had anti-spike IgG responses at day 28 that were superior to homologous booster responses: geometric mean ratios (heterologous vs homologous) were 6·7 (95% CI 5·8–7·7) for Ad26.COV2-S, 13·4 (11·6–15·3) for BNT162b2, and 7·0 (6·1–8·1) for ChAdOx1 nCoV-19. All heterologous boost regimens induced high concentrations of pseudovirus neutralising antibodies. At day 28, all groups except for the homologous boost in the older adults reached 100% seropositivity: geometric mean ratios (heterologous vs homologous) were 8·7 (95% CI 5·9–12·9) for Ad26.COV2-S vaccine, 21·5 (14·5–31·9) for BNT162b2, and 10·6 (7·2–15·6) for ChAdOx1 nCoV-19. Live virus neutralising antibodies were also boosted against delta (B.1.617.2) and omicron variants (B.1.1.529). There were five serious adverse events. Three of which were considered possibly related to the vaccine received: one in the BNT162b2 group and two in the Ad26.COV2-S group. All participants recovered and were discharged home.

Interpretation
Antibody concentrations were low at 6 months after previous immunisation with two doses of CoronaVac. However, all four vaccines administered as a third dose induced a significant increase in binding and neutralising antibodies, which could improve protection against infection. Heterologous boosting resulted in more robust immune responses than homologous boosting and might enhance protection.

Funding
Research in context
Evidence before this study
By Jan 17, 2022, 9·7 billion doses of COVID-19 vaccines had been deployed worldwide to reduce severe disease and death caused by the SARS-CoV-2. The most widely used vaccines were mRNA, viral vector, and inactivated vaccines, with widespread two-dose priming undertaken in low-income and middle-income countries with the inactivated vaccines from Sinovac and Sinopharm. As a result of waning immunity after two doses of COVID-19 vaccines and some evidence of reduced effectiveness, many countries are now considering offering third or booster doses. We searched PubMed for studies in English from Jan 1 to Dec 31, 2021 on booster doses of vaccines for individuals who had received two priming doses of the inactivated vaccine, CoronaVac. We found that heterologous boosting of CoronaVac with recombinant adenovirus type-5 COVID-19 vaccine produced greater neutralising antibody titres than did homologous boosting in a randomised trial in China. Similar findings are included in a preprint from Thailand comparing heterologous boosting with ChAdOx1 nCoV-19 (AstraZeneca), BNT162b2 (Pfizer–BioNTech), or BBIBP-CorV (Sinopharm), 3–4 months after CoronaVac.

Added value of this study
We report a comprehensive analysis of the immunogenicity and safety of homologous and heterologous boosting of the inactivated vaccine CoronaVac. We show that there are low concentrations of antibody present at 6 months after two doses of CoronaVac and largely undetectable neutralising antibodies. A third dose of CoronaVac boosts these responses and boosts are stronger with two different viral vector vaccines tested; the highest antibody concentrations are observed after an mRNA boost. We also show that heterologous boosting increases live virus neutralisation titres against both delta and omicron variants.

Implications of all the available evidence
Heterologous boosting of the inactivated vaccine, CoronaVac, results in more robust immune responses than homologous boosting and could enhance protection.

COVID lockdowns, record heat won't stop German retiree Kuno Penner walking around the world [ABC News, 21 Jan 2022]

by Kelly Gudgeon and Amelia Searson

Jakob Penner, or Kuno as he is better known, has become a bit of a social media star.
Key points:
• Jakob Penner, better known as Kuno, has walked 41,000km across 25 different countries in five years
• The German retiree is spending time in WA's Pilbara, where he experienced last week's record-breaking temperatures
• Mr Penner says he has no plans to stop and expects to travel to New Zealand after walking around Australia

The German retiree left his home five years ago, armed with only a small cart of supplies and a goal to walk around the world.

"I think everybody would like to see the world and I just do it," he said.

"Most people when they are retired, and they think they are old and weak and cannot move and they are sitting at home, watching TV — I don't like it, I would like to see the world."
Mr Penner has crossed 25 countries covering 41,000 kilometres from Germany through much of Europe, the Middle East, India, and South-East Asia.

In February 2020, just before the world closed down due to the pandemic, Mr Penner planned to spend three months walking from Cairns to Sydney.

He found himself locked down in a friend's house in Brisbane, where he applied for an extension to his visa.

His next plan to walk to Melbourne and then fly to New Zealand was again impacted by lockdowns.

With another visa extension, he has walked all around the east coast, down to Tasmania and then across the Nullarbor into Western Australia.

Last week, Mr Penner found himself in the middle of the Pilbara's record-breaking heat.
"Never I have seen 50 degrees. I was on the road, just north of Carnarvon, near the Minilya Roadhouse," he said.

The sleepy beachside town of Onslow reached 50.7 degrees Celsius last week, while many other Pilbara towns sweltered through their own record-breaking temperatures.

Mr Penner said when it was hot, he had to take extra precautions.

"I have a long rest in the hottest hours of the day, between two and five o'clock was the hottest. I have a piece of plastic to make a shadow and I rest," he said.

Mr Penner said the people he had met during his travels around Australia had stood out to him the most.

"It is the kindness of the people, they ask me 'Do you need anything, can we help?'" he said.

"If I would see an old man with a grey beard going across maybe the Nullarbor, I would ask him if he's crazy, does he know what he's doing, if he has enough water, if he has enough food.

"If not, it can be very dangerous. I think we have a responsibility about other people."

Mr Penner is taking a short break in the Pilbara to get repairs done to his cart before he completes the journey across the top end of Australia, weather permitting.
He has six months to be back in Cairns before he finally makes it across to New Zealand.

COVID-19: Russia hits all-time high infections, blames omicron variant [Fox News, 21 Jan 2022]

Russia's Deputy Prime Minister Tatyana Golikova urged those who are vaccinated to get boosters

Daily new coronavirus infections in Russia reached an all-time high Friday and authorities blamed the highly contagious omicron variant, which they expect to soon dominate the country's outbreak.

Deputy Prime Minister Tatyana Golikova on Friday noted "intensive spread of the omicron variant" and said the authorities "expect it to become the dominating" variant driving the outbreak. The state coronavirus task force Golikova heads reported 49,513 new infections on Friday — the highest yet in the pandemic.

Record numbers of 15,987 new cases and 5,922 cases were reported respectively in Moscow and St. Petersburg, Russia's second-largest city. In light of the surge, health officials in St. Petersburg on Friday limited elective outpatient care.

Golikova on Friday urged Russians who received their vaccinations or recovered from the virus more than six months ago to "head to a vaccination point again in order to protect yourself from the virus" with a booster.

Also Friday, Prime Minister Mikhail Mishustin ordered cabinet members to hold meetings online and have their staff work remotely "where possible."

Just about half of Russia's 146 million people have been fully vaccinated despite the fact that Russia was among the first in the world to approve and roll out a COVID-19 vaccine. In Russia, everyone who received their primary vaccination more than six months ago has been eligible for a booster shot since July.

Gogov.ru, an independent website that tracks vaccinations, estimates that 8.8 million people have also received a booster shot, out of approximately 21.8 million who qualify.

Daily new infections in Russia have been steadily climbing since Jan. 10, when just over 15,000 new cases were registered — a number that tripled on Friday, surpassing 49,000 in less than two weeks. Friday's daily tally was more than 10,000 higher than the previous day.

Russia’s state coronavirus task force has registered 324,752 deaths since the start of the pandemic — by far Europe’s worst death toll. Russia’s state statistics agency, which uses broader counting criteria, puts the pandemic death toll even higher, saying the overall number of virus-linked deaths between April 2020 and October 2021 was over 625,000.

Russia’s authorities admit that current surge could end up as the country’s biggest yet but so far haven’t announced any major restrictions to stem it.

A nationwide lockdown wasn't being discussed, officials said, and last week the government decided to indefinitely postpone introducing restrictions for unvaccinated people, which would have been extremely unpopular among vaccine-hesitant Russians.

Golikova earlier this week also announced a decision to cut the required isolation period for people infected with COVID-19 from 14 to seven days, although it still remained unclear when that will take effect.

The authorities say the soaring infections so far haven’t led to a spike in hospitalizations. Moscow Mayor Sergei Sobyanin said the current surge is putting more strain on outpatient facilities than on hospitals in the city of nearly 13 million. City officials have increased the number of physicians on duty in outpatient clinics.

2 years after COVID first hit the US, hundreds of thousands of Americans are still falling ill [ABC News, 21 Jan 2022]

By Arielle Mitropoulos

Two years ago, the C.D.C. confirmed the first domestic case of coronavirus.

At the beginning of 2020, as the nation celebrated the start of a new year, many Americans were still unaware of the "mysterious pneumonia" that had sickened dozens of workers at a live animal market in Wuhan, China.

The illness, later identified as the "novel coronavirus", began spreading rapidly across the globe. Several studies have suggested that the virus had already been spreading in the United States, potentially as early as December 2019.

However, it was not until mid-January of 2020, when the virus would officially be recognized as present on U.S. soil.

Two years ago, on Jan. 21, 2020, the Centers for Disease Control and Prevention (CDC) confirmed the first domestic case of coronavirus. The positive patient was a 35-year-old man from Washington state, who had recently returned from Wuhan, China.

Now, two years later, the U.S. has confirmed more than 69 million COVID-19 cases, and 859,000 deaths, the highest in the total for any country, according to data from Johns Hopkins University. And the nation, despite the wide availability of highly effective vaccines and novel treatments, is experiencing its most significant surge on record due to the highly transmissible omicron variant and tens of millions of eligible Americans remaining unvaccinated.

“These last two years have brought transformational advancements spanning vaccines, treatments and testing. Though these tools are having a clear impact on reducing poor outcomes, we are still seeing one of the worst surges to date,” said John Brownstein, Ph.D., an epidemiologist at Boston Children's Hospital and an ABC News contributor.

'Low' risk morphs into pandemic
Just days before the first case was confirmed two years ago, the CDC had implemented public health entry screening at several major airports including San Francisco International Airport, New York’s John F. Kennedy International Airport and Los Angeles International Airport.
At the time, the CDC reported that while the virus was originally thought to be spreading from animal-to-person, there were "growing indications" that "limited person-to-person spread" was taking place.

"This is certainly not a moment for panic or high anxiety. It is a moment for vigilance," Washington state Gov. Jay Inslee said during a news conference that same day. "The risk is low to residents in Washington."

Less than a week after the first domestic case was confirmed, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, which is a division of the CDC, stressed that the “virus is not spreading in the community… For that reason, we continue to believe that the immediate health risk from the new virus to the general public is low at this time.”

In late February, Messonnier said she ultimately expected to see community spread in the U.S. At the time, health officials noted that the virus may not be able to be contained at the border and that Americans should prepare for a "significant disruption" in their lives.

In the months to come, Life Care Center of Kirkland, a skilled nursing and rehabilitation facility in Seattle suburbs, would become the first epicenter of the virus' deadly journey across the country. The epicenter quickly then became New York City, which experienced hundreds of deaths a day at the peak of April 2020.

It would be another seven weeks until the World Health Organization would declare the global coronavirus a pandemic, subsequently forcing borders to close, and Americans to retreat to their homes for what some thought would be just a few weeks of "social distancing" and "stay-at-home" orders.

In the first months of pandemic, through April 2020, more than 1 million Americans were sickened and 65,000 died, when the virus was still largely mysterious, treatments and supplies were scarce and hospitals were overwhelmed in large urban areas like New York. Subsequent waves of the virus each had their own characteristics from the deadly winter surge of 2020 to 2021 and the delta variant surge, which upended the optimism that the pandemic would finally come to an end after mass vaccination.

In fact, in the last year alone, more than 450,000 Americans have been lost to the virus.

17 million cases in a month
Two years into the pandemic, federal data shows that hundreds of thousands of Americans are still testing positive for the virus every day, and more than 1,600 others are dying from COVID-19.

In the last month alone, there have been more than 17.1 million confirmed COVID-19 cases, and 44,700 reported virus-related deaths. In addition, more than a year into the U.S. domestic vaccine rollout, 62 million eligible Americans who are over the age of 5, about 20% of that group, remain completely unvaccinated.

“After 24 months and unprecedented medical innovation, the last month has brought millions of cases and tens of thousands of deaths. While many might declare victory on the pandemic, we are clearly very far from where want we want to be right now, especially with billions of people yet to be vaccinated,” Brownstein said, referring to the continued global crisis.

The U.S. is still averaging more than 750,000 new cases a day, about three times the surge from last winter in 2021. However, there is growing evidence to suggest that the latest omicron case surge may be beginning to recede in the parts of the country that were first struck by the variant.

Although preliminary global studies indicate that the omicron variant may cause less severe illness than prior variants, health officials say that the sheer numbers of infections caused by the new variant could still overwhelm the health care system.

Glimmers of hope
In New York, daily cases have dropped by 33% in the last week, and in New Jersey, new cases are down by 43.7%. In Massachusetts, wastewater samples indicate the state’s omicron surge is falling rapidly.

In the Southeast, daily cases in Florida are falling too – down by 30% in the last week, though the state is still averaging more than 45,000 new cases a day.

However, health officials caution that overall, the latest COVID-19 surge across much of the country has yet to peak, and hospitals could still be faced with difficult weeks ahead.

Surgeon General Dr. Vivek Murthy told CNN’s “State of the Union” on Sunday that the omicron surge has not yet peaked nationally.

"This is a very difficult time during this surge. We are seeing high case numbers and hospitalization rates... we're also seeing strain in many of our hospitals around the country," Murthy said. "The next few weeks will be tough."

More than 160,000 virus-positive Americans are currently hospitalized across the country, a pandemic high. It was just over two weeks ago that we hit 100,000 COVID-19 positive Americans hospitalized.

MORE: One year of COVID-19 vaccines: Millions inoculated, but hundreds of thousands still lost
Half the country – 25 states and Puerto Rico – has seen their COVID-19 related hospital admission rates jump by at least 10% in the last week, and nationwide, an average of more than 21,000 virus-positive Americans are seeking care every day.

And nationally, 99% of U.S. counties are still reporting high transmission. Out of the 3,220 U.S. counties, just 16 counties are not reporting high transmission.

Earlier this week, Dr. Anthony Fauci, chief medical adviser to the White House, said at the Davos Agenda, a virtual event held by the World Economic Forum, that it is an “open question” as to whether the omicron variant will lead the globe into a new phase of the pandemic.

“It's not going to be that you're going to eliminate this disease completely. We're not going to do that. But hopefully it will be at such a low level that it doesn't disrupt our normal, social, economic and other interactions with each other," Fauci said. “To me, that's what the new normal is. I hope the new normal also includes a real strong corporate memory of what pandemics can do.”

Two years since Covid was first confirmed in U.S., the pandemic is worse than anyone imagined [CNBC, 21 Jan 2022]

BY Spencer Kimball & Nate Rattner

A 35-year-old man returned to the U.S. from Wuhan, China on Jan. 15, 2020 and fell ill with a cough and fever.

He had read an alert from the Centers for Disease Control and Prevention about an outbreak of a novel coronavirus in Wuhan and sought treatment at an urgent care clinic in Snohomish County, Washington four days later.

On Jan. 21, the CDC publicly confirmed he had the first known case of coronavirus in the U.S., although the agency would later find the virus had arrived on the West Coast as early as December after testing blood samples for antibodies.

The man said he had not spent time at the Huanan seafood market in Wuhan, where a cluster of early cases were identified in December. He was admitted to isolation unit at Providence Regional Medical Center in Everett, Wash. for observation.

After confirming the Washington state case, the CDC told the public it believed the risk "remains low at this time." There was growing evidence of person-to-person transmission of the virus, the CDC said, but "it's unclear how easily this virus is spreading between people."

Then President Donald Trump told CNBC the U.S. had it "totally under control."

"It's one person coming in from China. We have it under control. It's going to be just fine," Trump told "Squawk Box" co-host Joe Kernen in an interview from the World Economic Forum in Davos, Switzerland.

However, Dr. Anthony Fauci would confirm the public's worst fears on Jan. 31: People could carry and spread the virus without showing any symptoms. Dr. Helen Chu's research team at the Seattle Flu Study started examining genomic data from Wuhan. It became clear early on that person-to-person transmission was happening, Chu said. By using the flu study's databank of nasal swab samples, the team was able to identify another Covid case in a 15-year-old who hadn't recently traveled, indicating it was spreading throughout the community.

In late February, a senior CDC official, Dr. Nancy Messonnier, warned that containing the virus at the nation's borders was no longer feasible. Community spread would happen in the U.S., she said, and the central was question was "how many people in this country will have severe illness."
In the two years since that first confirmed case, the virus has torn through the U.S. with a ferocity and duration few anticipated. The human toll is staggering, with more than 860,000 people dead and more than 69 million total infections. Hospitals around the nation have been pushed to the breaking point with more than 4 million admissions of confirmed Covid patients since August 2020, when the CDC started tracking hospitalizations. The hospital admissions are an undercount because they do not include the wave of cases that first hit the U.S. in the spring 2020 when hospitals were caught flat footed and testing was inadequate.

Though the U.S. now has effective vaccines and therapeutics to fight Covid, the future course of the pandemic remains uncertain as the virus mutates into new variants that are more transmissible and can evade vaccine protection. The highly contagious omicron variant has pushed infections and hospitalizations to record highs across the globe this month, a shock to a weary public that wants a return to normal life after two years of lockdowns, event cancellations, working from home and mask and vaccine mandates.

The rapid evolution of the virus and the dramatic waves of infection that would follow, from alpha to delta and omicron, came as a surprise to many elected leaders, public health officials and scientists. Dr. Michael Osterholm, a top epidemiologist, said the Covid mutations are the big unknown that will determine the future course of the pandemic.

"We don't yet understand how these variants emerge and what they are capable of doing," Osterholm, director of the Center for Infectious Disease Research and Policy in Minnesota, told CNBC. "Look at how omicron caught us as a global community surprised by the rapid transmission, the immune evasion. Look at delta and all the impact it had on disease severity," he said.

As new infections started to decline in the spring of 2021 and the vaccines became widely available, the U.S. began to let its guard down. The CDC said the fully vaccinated no longer need to wear masks indoors. President Joe Biden proclaimed on July 4th the U.S. was closer than ever to declaring independence from the virus.

However, the delta variant was taking hold in the U.S. at the time and would soon cause a new wave of infection, hospitalization and death as vaccination rates slowed. Public health leaders have struggled for months to convince skeptics to get the shots.

More than a year after the first vaccine was administered in the U.S., about 67% of Americans older than 5 are fully vaccinated, according to CDC data. Tens of millions of Americans still have not gotten their shots, despite the fact that data has proven them to be safe and effective at preventing severe illness and death.

"We had no sense in January of 2020, the divisive politics and community reaction to this that were going to occur," Osterholm said. "Who would have imagined the kind of vaccine hesitancy and hostility that's occurred."

Delta was more than twice as transmissible as previous variants and research indicated it caused more severe disease in unvaccinated people. The CDC would reverse its loosened mask guidance and encourage everyone, regardless of vaccination status, to wear masks indoors in public in areas of substantial transmission as delta spread.

The vaccines took a hit when omicron emerged in November. Though they still protect against severe illness and death, they are less effective at preventing infection from omicron. Chu said the U.S. relied primarily on vaccines to prevent transmission of the virus without equally emphasizing widespread masking and testing, which are crucial to controlling a variant like omicron that can evade immunity.

"We now know that, proportionately, you can be repeatedly infected, you can have vaccine breakthroughs, and that this virus will just continue to mutate and continue to evade us for a long time," Chu said.

Katriona Shea co-leads a team of researchers who bring together models to forecast the trajectory of the pandemic. In their latest update, the omicron wave of cases and hospitalizations will likely peak before the end of the month. However, their most optimistic projection shows anywhere from 16,000 to up to 98,000 additional deaths from the omicron wave by April 2.

Currently, the U.S. is reporting an average of more than 736,000 new infections per day, according to a seven-day average of Johns Hopkins data analyzed by CNBC. While that is still far higher than previous waves, average daily infections are down 8% from the previous week. The U.S. is reporting more than 1,800 deaths per day as a seven-day average.

"It's really, really frustrating and tragic to see people dying from a vaccine preventable disease," Chu said.

The implications of omicron for the future course of the pandemic are unclear. In in the classic view, viruses evolve to become more transmissible and less severe, making it easier to find new hosts.

"There are lots of reasons to believe that might not be true because the jump to omicron was so massive, it suggests that there's lots of space for it to change quite dramatically," said Shea, a professor of biology at Pennsylvania State University. Omicron has more than 30 mutations on the spike protein that binds to human cells. The shots target the spike protein, and the mutations make it more difficult for vaccine-induced antibodies to block infection.

Doctors and infectious disease experts in South Africa, where omicron was first identified, said the variant peaked and started to declined rapidly, demonstrating a significantly different trajectory than past strains. The researchers also said ICU admissions and deaths were lower at Steve Biko Academic Hospital, indicating decreased severity.

"If this pattern continues and is repeated globally, we are likely to see a complete decoupling of case and death rates, suggesting that Omicron may be a harbinger of the end of the epidemic phase of the Covid pandemic, ushering in its endemic phase," the researchers wrote.

Over time, the virus could become less disruptive to society as mutations slow and it becomes mild as greater immunity in the population limits severe disease, according to Jennie Lavine, a computational investigational biologist at the biotech company Karius.

However, the head of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, cautioned earlier this week that the pandemic is "nowhere near over," warning that new variants are likely to emerge as omicron rapidly spread across the world.

"Everybody wants to get to this thing called endemic. I still don't know what the hell that means," Osterholm said, noting that he has 46 years of experience as an epidemiologist. "With variants, we can go for a period of time with relatively low activity, like we've seen in many places in the world, and then a new variant could change all that overnight. We don't really understand our future yet."

Japan's post-Covid regional dilemma [Bangkok Post, 21 Jan 2022]

By THITINAN PONGSUDHIRAK

Among the major powers that are moving forward with an eye on the post-pandemic era, when Covid-19 will eventually become an endemic with flu-like manageability, Japan is second to none. The visit last week by its minister of economy, trade, and industry (METI), Koichi Hagiuda, made front-page news in Bangkok, following similarly notable media coverage in Jakarta and Singapore. But while it has played a critical role in Asean's economic development and regional security, Japan's Indo-Pacific geostrategic environment has become adverse with more downside risks.

Addressing these risks will require strategic planners in Tokyo to bite the bullet and emerge fully into the 21st century by coming to terms with what kind of great power they want Japan to be.

Japan offers more geostrategic weight than, say, Australia, which carries itself as a self-respecting, solid and straightforward middle power that is willing to put up an ongoing fight on tariffs and trade against China in order not to be bullied. This means Australia has been spending more on defence, bolstering its military hardware and capabilities, and aligning itself closer with the United States based on their bilateral alliance.

South Korea is another emerging middle power, less muscular than Australia but no less ambitious in projecting its soft power and positioning itself as a force to be reckoned with in the region, spearheading a "new southern policy" to leverage economic ties with Southeast Asia vis-à-vis structural security risks on the Korean Peninsula. Given North Korea's nuclear threat, Seoul has no choice but to rely on the US treaty alliance and nuclear umbrella for deterrence and security.

Further afield, India is an upper middle power with nuclear weapons. It does not have the kind of resources and largesse to project soft power compared with Japan and South Korea, but its military reach and hardware are not to be trifled with. Indonesia, on the other hand, is an aspiring middle power that bases its status on its moral authority and power of persuasion. With a history deeply rooted in non-alignment, Indonesia is the largest Muslim country, the third-largest democracy in the world, and the lynchpin of Asean, practising moderate Islam within a secular state.

Thailand does not fit any of these moulds of middle powers, as its international reputation has been undermined by repeated military coups, dismal governance, and meagre growth prospects. But at its peak, perhaps in the late 1980s and early 2000s, there was the potential for Thailand to be a middle power of sorts, leveraging its unique geography and history combined with ambitious growth strategies and regional centrality. Now Thailand ranks more as an also-ran.

Japan ranks among none of these categories. It is more than a middle power but nowhere near being a superpower like the United States or China. If economic size and power were the only benchmarks, Japan would outrank and outstrip most other major powers, as it harbours the third-largest economy in the world. But the key measurement is the calculation of global power and its distribution of military might. This is a category that has hobbled Japan's global standing since 1945.

That being said, Japan is gradually catching up. Its "defence agency" was upgraded into a fully fledged ministry of defence in 2006, although its armed forces are still referred to as "self-defence forces". While its defence budget has been on the rise, Japan over the past few years has converted two helicopter destroyers into aircraft carriers capable of launching jump jets with vertical take-off capability. But while its strategic planners may have interpreted Article 9 of Japan's constitution more loosely, the country's renunciation of war as a sovereign right remains in place after 77 years.

Unlike other countries, Japan is constitutionally unable to settle international disputes by the threat or use of force. This means it has to rely on the US treaty alliance and nuclear protection much like South Korea but with a different set of geostrategic challenges. Japan, for example, has had to confront China's aggressiveness in the East China Sea, while America's reliability was called into question under the administration of former president Donald Trump.
Tokyo has addressed these dilemmas related to its power status by bolstering joint efforts with like-minded allies and partners, such as Australia. It has also taken part in the Quad, which originated from former Japanese prime minister Shinzo Abe's vision and 2007 speech of the "confluence" of the Pacific and India oceans, with Australia, India, and the United States. There is even talk of Japan's ability to go "nuclear" at short notice if push comes to shove, and without any viable alternatives.

But Japan's secret weapon thus far is not its military. Its geoeconomic heft underpins what Japan does geopolitically. METI Minister Hagiuda's choice of Asean countries on his regional tour -- Indonesia, Singapore, and Thailand -- was telling. These are places -- Southeast Asia's maritime fulcrum, mainland hub, and island vortex of commerce and finance -- where Japan has staked its economic future and plotted its trajectory with Asean for the next decades.
As China is unable and unwilling to reopen its borders while the United States and major European countries are increasingly able to live with the pandemic, the geostrategic environment will likely heat up. China may be forced to rely on its huge internal market, stoking nationalist sentiment at home and possibly lashing out at others outside. The United States may react in kind given its own domestic stress and strain.

While it has Asean as a ready bunch of allies and partners to maintain peace and stability in the region, Japan may soon have no choice but to chart its own geostrategic path. In the post-pandemic "new normal", Tokyo's desperate need to normalise the way it defends its national interests and security maintenance will become imperative.