This week—like so many weeks before in this pandemic—brought good news and bad news about the virus and our response to it.
 
In sobering news, the world passed 2 million deaths and the US passed 400,000 deaths. Public health experts warned the worst is yet to come in the US and globally. As cases spiked again in South Africa the country mourned the death from COVID of a prominent minister.
 
The good news came largely on the policy front. The US’s Biden Harris administration hit the ground running with a focus on responding to the pandemic at home and rejoining the global response. And Anthony Fauci is very happy to be working for a President who believes in science and truth.
 

If You Are in a Hurry

 

• See the impact of the second wave on South African healthcare workers in a Bhekisisa photo essay.
• Read a Medscape FAQ to help answer common questions about COVID vaccines.
• Read an NPR report on China’s Sinovac vaccine, which is being rolled out in many countries despite unclear efficacy data. The piece includes a nice discussion of how efficacy is determined.
• Watch a JAMA video interview with new CDC director Rochelle Walensky on freeing the voices of the CDC employees she now directs.
• Read Dr. Anthony Fauci’s remarks to the WHO.
• Then read “Fauci Unchained” in The Washington Post. 
• Read The New York Times on two small preprint studies that raise concerns about the new variants and vaccines. 
• Read AP on preliminary data from a study that shows potential prevention effects of antibodies.

 

Science is Back in the White House

 
The Biden Harris administration came to office on Wednesday armed with a pandemic plan and a rash of key executive orders aimed at getting the pandemic under control in the US and responding globally.
 
The New York Times reports on the “string of executive orders and presidential directives on Thursday aimed at creating the kind of centralized authority that the Trump administration had shied away from…. The orders included new requirements for masks on interstate planes, trains and buses, the creation of a national testing board and mandatory quarantines for international travelers arriving in the United States.” It also lays out critical plans for supporting and ramping up vaccination programs. “But the plan is in some respects overly optimistic and in others not ambitious enough, some experts say. It is not clear how Mr. Biden will enforce the new quarantine requirement for foreign travelers. The president has also promised to inject 100 million vaccines in his first 100 days. But that is actually aiming low. Over that period, the number of available doses should be enough for 200 million injections.”
 
MedPage Today report, “At a White House signing ceremony on Thursday, Biden repeated earlier sentiments about his administration following the science on COVID-19. ‘We will make sure that scientists and public health experts will speak directly to you—not the president, but real, genuine experts and scientists. We'll make sure they work free from political interference and make decisions strictly based on science and health alone, not what the political consequences are.’ He added that ‘we will level with you when we make a mistake. We'll straight up say what happened.’”
 
AP reports the Biden administration moved quickly to rejoin the WHO, quoting Fauci: “’I am honored to announce that the United States will remain a member of the World Health Organization,’ Fauci told a virtual meeting of the WHO from the United States, where it was 4:10 am in Washington. It was the first public statement by a member of Biden’s administration to an international audience—and a sign of the priority that the new president has made of fighting COVID-19 both at home and with world partners…. Fauci said the Biden administration will resume ‘regular engagement’ with WHO and will ‘fulfill its financial obligations to the organization.’” Fauci also said the US would “join the COVAX Facility, a project to deploy COVID-19 vaccines to people in need around the world—whether in rich or poor countries. Under Trump, the US had been the highest-profile—and most deep-pocketed—holdout from the COVAX Facility, which has struggled to meet its goals of distributing millions of vaccines both because of financial and logistic difficulties.” Read Fauci’s full remarks to the WHO.
 
Reuters reports, “The United States will back a global plan to combat COVID-19 and get vaccines to poorer countries as part of a national strategy unveiled by President Joe Biden on Thursday, which includes pushing Congress for more funding for international efforts. Global re-engagement has been among Biden’s priorities since taking office on Wednesday…. Under the US COVID-19 strategy, Biden will direct his secretary of state and secretary of health and human services to notify the WHO and the GAVI vaccine alliance of Washington’s intent to support the Access to COVID-19 Tools (ACT) Accelerator and join its COVAX facility….’ The Biden-Harris Administration will seek funding from Congress to strengthen and sustain these efforts, as well as other existing multilateral initiatives involved in fighting COVID-19,’ according to the strategy, which also calls for Washington to work on a way to donate any future US vaccine surplus.”
 
In a JAMA video interview with Rochelle Walensky, the new CDC director says of the CDC employees she now leads, “I think they have been diminished. I think they have been muzzled. Science hasn’t been heard. I have to fix that…and make sure those voices get heard again…. The right information hasn’t been getting out there… I want to make sure the science is heard.” In a Twitter thread, Walensky says, “Better, healthier days lie ahead. But to get there, #COVID19 testing, surveillance, and vaccination must accelerate rapidly. We must also confront the longstanding public health challenges of social and racial injustice and inequity that have demanded action for far too long.”
 
In a piece headlined “Fauci Unchained,” The Washington Post reports, “As of noon Wednesday, there is a new White House. And Fauci, speaking to reporters on Thursday afternoon, was clearly enjoying being unshackled….’ One of the things that we’re going to do is to be completely transparent, open and honest,’ he said of the government’s approach to the pandemic. ‘If things go wrong, not point fingers but to correct them and to make everything we do be based on science and evidence. I mean, that was literally a conversation I had 15 minutes ago with the president, and he has said that multiple times.’”
 

Second Wave Swamps SA Healthcare Workers

 
A Bhekisisa photo essay looks at the impact of the second wave of COVID in South Africa through photos and interviews with healthcare workers.
 

Africa’s Case Fatality Rate Rises

 
Reuters reports “Africa’s coronavirus case fatality rate has risen alarmingly to 2.5 percent, higher than the global level of 2.2 percent.... Earlier in the pandemic, Africa’s rate had been below the global average, the Africa Centres for Disease Control and Prevention (CDC) head John Nkengasong told reporters. ‘The case fatality rate is beginning to be very worrying and concerning for all of us,’ he said, without giving a reason for the increase. The number of African nations with a rate of deaths-per-cases higher than the global average is growing, he added. There are 21 countries on the continent with a rate above 3 percent, including Egypt, the Democratic Republic of Congo, and Sudan.”
 

The Variants

 
More information is emerging about the currently identified variants and more variants appear to be emerging.
 
Bhekisisa answers six key questions about the south Africa variant, including, “Is this new variant more severe?” The answer: Plainly put, no…. As Davies brings home: “What we see is that the risk of death when we take into account age and comorbidities, and the number of admissions that hospitals are experiencing, is no different between the upsurge of wave one and the upsurge of wave two, which would suggest that this new variant is not causing more severe disease.”
 
The Washington Post reports, “A coronavirus variant first identified in Denmark has ripped through Northern California—including outbreaks at nursing homes, jails and a hospital in the San Jose area—prompting state and local officials to investigate whether it may be more transmissible. California officials disclosed the rise of the variant Sunday night after genetic monitoring linked it to a fast-growing share of new cases….”
 
Politico reports, “New variants of the coronavirus may make vaccines less effective against the disease, making it even more urgent to quickly inoculate the country and beat back the pandemic, Anthony Fauci said Thursday…. [He] warned that strains first identified in South Africa and Brazil could reduce the potency of the two vaccines now in use. Fauci cited studies published online this week that have not yet been peer-reviewed, and said it would be important to monitor the mutations going forward.”
 
Reporting on the studies Fauci referenced The New York Times writes “two small new studies, posted online Tuesday night, suggest that some variants may pose unexpected challenges to the immune system, even in those who have been vaccinated—a development that most scientists had not anticipated seeing for months, even years. The findings result from laboratory experiments with blood samples from groups of patients, not observations of the virus spreading in the real world. The studies have not yet been peer-reviewed.”
 
VOA reports, “Kenyan scientists have raised an alarm on a coronavirus variant they say differs from the one spreading in South Africa and Britain…. Charles Agoti, a principal investigator and researcher, says that the variant unique to Kenya was detected in a batch of samples taken from Taita Taveta county, located in the southeastern part of the country.”
 
The Lancet reports in South Africa, “The spread of the new variant puts more pressure on the health system because the number of cases increases so rapidly and the hospitals get full more quickly, but the transmission of the new variant can be prevented using exactly the same measures that we have been using for protection against the virus all along, said Ramaphosa….” “’[The situation is] terrible, how more transmission [ends] up with much more deaths, even if the variant is not more pathogenic’, said Tulio de Oliveira, director of the KwaZulu-Natal Research Innovation and Sequencing Platform and principal investigator of the Network for Genomic Surveillance in South Africa in a post on Twitter. ‘People need to realise that when hospitals get overwhelmed, deaths increase very fast’, he added.”
 
The Atlantic reports “recently, three distinct versions of the virus seem to have independently converged on some of the same mutations, despite being thousands of miles apart in the United Kingdom, South Africa, and Brazil…. The fact that these mutations have popped up not one, not two, but now three times—that we know of—in variants with unusual behavior suggests that they confer an evolutionary advantage to the virus. All three variants seem to be becoming more common. And all three are potentially more transmissible.”
 

South Africa Loses Minister to COVID

 
Africa Times reports, “South Africa is the latest nation to bid farewell to one of its high-level ministers because of COVID, as President Cyril Ramaphosa announced Thursday the death of longtime African National Congress member Jackson Mthembu. The 62-year-old Mthembu, above, an ANC national executive committee member with a legacy of anti-apartheid and labor activism, publicly acknowledged his positive coronavirus test on January 11 after seeking treatment at a hospital in Tshwane. He died of COVID complications early Thursday morning.”
 

Failed Global Solidarity

 
Forbes reports on a progress report from the “Independent Panel for Pandemic Preparedness and Response, co-chaired by the Right Honourable Helen Clark and Her Excellency Ellen Johnson Sirleaf…. The report notes that ‘despite the myriad shining examples on every continent of human ingenuity in response to the virus, we have failed in our collective capacity to come together in solidarity to create a protective web of human security.’” Panel member Joanne Liu, is quoted: “Collectively, in fighting COVID-19, we failed the solidarity test is the sad takeaway. The race for resources to fight COVID-19 is an unfair predatory race. It’s shameful to see high income nations hijacking the bulk of vaccines available with a vaccination strategy to cover everybody while low- and middle-income countries need to do by covering only 20 percent of their population.”
 
A WHO press release notes that in Africa, “As of early this week 40 million COVID-19 vaccine doses have been administered in 50 mostly high-income countries. However, in Africa, Guinea is the sole low-income nation to provide vaccines and to date these have only been administered to 25 people. Seychelles, which is a high-income country, is the only one on the continent to start a national vaccination campaign.”
 
BBC reports, “Africa will have to wait ‘weeks if not months’ before receiving COVID-19 vaccines approved by the World Health Organization, according to various officials working towards getting doses for the continent. Close to 900 million doses have been secured so far through various initiatives, enough to inoculate about 30 percent of the continent's 1.3 billion people this year. Hoarding by wealthy nations, funding shortfalls, regulations and cold chain requirements have slowed the process of rolling out the vaccines. ‘The world is on the brink of a catastrophic moral failure and the price will be paid with lives and livelihoods in the poorest countries,’ warned WHO head Dr. Tedros Ghebreyesus.”
 
Reuters reports, “African countries will pay between $3 and $10 per vaccine dose to access 270 million COVID-19 shots secured this month by the African Union (AU), according to a draft briefing on the plan prepared by the African Export-Import Bank….” This is the first information about pricing for vaccines in African countries outside of the COVAX facility. “Although the prices are heavily discounted compared to what wealthier nations are paying, some experts worry about countries already struggling to manage the economic fallout of the pandemic having to borrow more money to protect their people.”
 

New Mask Regulations in Europe

 
The Washington Post reports “Faced with new, more contagious, strains of the coronavirus and a winter surge in cases, European nations have begun to tighten mask regulations in the hope that they can slow the spread of the virus. Germany…made it mandatory for people riding on public transport or in supermarkets to wear medical style masks: either N95s, the Chinese or European equivalent KN95 or FFP2s, or a surgical mask…. Meanwhile in France, the country’s health advisory council on Monday discouraged the wearing of inefficient cloth and homemade masks, also arguing they may not offer sufficient protection against the more highly transmissible coronavirus variants.”
 

Antibodies Show Prevention Possibilities

 
AP reports “Drugmaker Eli Lilly said Thursday its antibody drug can prevent COVID-19 illness in residents and staff of nursing homes and other long-term care locations. It’s the first major study to show such a treatment may prevent illness in a group that has been devastated by the pandemic.” Data from the NIH-conduced study was released via press release, with additional data to come.
 

Deaths Among Elderly

 
Medscape reports “A small number of deaths in elderly patients across Europe who had received a COVID-19 vaccine is no cause for concern, says the French Agency for the Safety of Health Products (ANSM).” Concerns arose after reports of 23 deaths among the elderly in Norway potentially linked to the Pfizer vaccine. “As of January 19, there were ‘71 observed deaths linked to the Pfizer COVID-19 vaccine’ across Europe…the French Health Minister told Medscape French Edition. However, the French agency believes that, taking into account the available evidence, there is ‘nothing to suggest that the reported deaths were linked to the vaccination.’"
 
EuroNews reports, “Norway's Public Health Authority has stated that there was no link established between the Pfizer/BioNTech vaccine and the deaths of elderly people who had been vaccinated.” In a report they also recommended a medical evaluation before vaccinating the elderly and very fragile.
 

Vaccine Hesitancy

 
Medscape provides an FAQ to help answer common questions about COVID vaccines and address hesitancy. “Although vaccine enthusiasm is evident in some areas, especially with the current shortages of vaccine, there remain pockets of vaccine hesitancy that need to be addressed.” Questions about side effects, safety, efficacy and whether or not an mRNA vaccine can “alter my genes” are addressed.
 
The Guardian reports “India’s COVID-19 vaccine drive has been hampered by turnout as low as 22 percent in some states, as fears over the safety of the vaccine and the spread of misinformation has fueled widespread hesitancy…. he low turnout was attributed to a nervousness about safety among the healthcare workers who were first in line to receive the vaccine, as well as technical difficulties with the app designed to alert people to their vaccine appointments.”
 

Challenges for Vaccine Study Recruitment/Retention

 
The Washington Post reports “[US] States have responded to the slow rollout of coronavirus vaccine by expanding eligibility to people over 65. But that is making it more difficult to recruit subjects for clinical trials of other vaccines that have yet to win approval…. The most immediately impacted vaccine trial in the United States involves Novavax, which on Dec. 28 set out to recruit 30,000 people for a major domestic trial, including 25 percent in the crucial over-65 category who are at the greatest risk for serious COVID-19 disease.”
 

More Countries Begin Vaccine Campaigns

 
The New York Times reports, “Brazil on Monday kicked off its nationwide coronavirus vaccination campaign, providing a glimmer of hope in a nation where political infighting, a strained health care system and lax precautions have given the virus free rein. But the rollout is expected to be painfully slow, even as Brazil battles two worrisome new variants of the virus, at least one of which is more contagious and could be contributing to the country’s recent surge of cases…. The government is scrambling to buy more vaccine after months of taking a lackadaisical approach…. The country now has just six million doses of vaccine on hand for a nation of 213 million people.
 
NPR reports “Many countries are betting on a vaccine from China to help them stop the coronavirus — although questions are surfacing about whether it's a smart bet. The vaccine is made by the Chinese pharmaceutical company Sinovac. This week, Brazil began rolling out its national immunization program after granting emergency use authorization for the vaccine over the weekend. Indonesia and Turkey started their mass vaccinations with Sinovac's vaccine, called CoronaVac, last week. But there are conflicting reports about just how well the vaccine works…. Rich countries have secured the lion's share of vaccine doses, and global demand is expected to outstrip the supply of vaccines from Moderna and Pfizer for months to come. For countries like Indonesia, where COVID cases are surging, the calculus may well be to bet on the vaccine they can access right now, says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. ‘The China-made vaccine is the one that is readily available and that appears to be effective. So why not?’"
 
The Wall Street Journal reports, “France’s mass vaccination campaign is off to a glacial start, with only around 422,000 people receiving the vaccine in more than three weeks since European regulators authorized the drug, far behind most other developed nations. A big reason: French officials are running up against deeply ingrained opposition that has made France among the world’s top vaccine skeptics…. An Ipsos poll conducted in December found that France ranked at the bottom of 15 countries on willingness to take a COVID-19 vaccine, with only 40 percent of the public saying they wanted the shot.”
 
The Washington Post reports, “India started vaccinating its own population against the coronavirus only a few days ago, but it is already using its manufacturing heft to generate goodwill with its neighbors. India’s government has made the calculation that it has enough vaccine doses to share. The result is a form of vaccine diplomacy that appears to be unlike any other in the world. Since Wednesday, the Indian government has sent free doses to Bangladesh, Nepal, Bhutan and Maldives—more than 3.2 million in total. Donations to Mauritius, Myanmar and Seychelles are set to follow. Sri Lanka and Afghanistan are next on the list. The shipments reflect one of India’s unique strengths: It is home to a robust vaccine industry, including Serum Institute of India, one of the world’s largest vaccine makers."
 

Black Market Vaccines

 
The Washington Post reports on a thriving COVID vaccine black market in the Philippines. “No coronavirus vaccine has been approved for general use in the Philippines, nor is one expected to arrive, officially, until at least February. It is illegal to import unauthorized pharmaceuticals. But soaring demand among Chinese workers, many of them employed in the Philippines’ lucrative online casinos catering to gamblers in China, is driving a black market in which vaccine doses are sold for many times the standard $30 price in China."
 

Disgraced Studies Still Cited

 
Science reports, “In June 2020, in the biggest research scandal of the pandemic so far, two of the most important medical journals each retracted a high-profile study of COVID-19 patients. Thousands of news articles, tweets, and scholarly commentaries highlighted the scandal, yet many researchers apparently failed to notice. In an examination of the most recent 200 academic articles published in 2020 that cite those papers, Science found that more than half—including many in leading journals—used the disgraced papers to support scientific findings and failed to note the retractions.”
 

The Guy You Know

 
An anthropologist who has been studying people’s “stories” about the virus and the pandemic writes in an opinion piece in STAT, “We have seen a dangerous theme emerge: the belief that dangers of the virus come from strangers and that friendship and family ties can cancel contagion. Though logical, these interpretations of biology are wrong — sometimes dead wrong…. The stories people hold of the origin and intent of unknown particles can and do lead to sometimes illogical conclusions about other people. That’s not unexpected. Throughout history there have been examples of epidemics and blame…. What we are seeing in our data from this project has a twist on the idea of ‘other.’ People are telling themselves stories about the safety of people they know. This means that many people report that they’re doing everything possible to stay safe and, in the next breath, tell us about a party they attended for the holidays with friends and family. ‘It’s OK,’ they say, ‘we knew everyone there.’”
 

COVID Stigma

 
The Atlantic reports on people who hide the fact that they’ve had COVID. The author says there are many reasons people hide a diagnosis. “But secrecy can also be motivated by one of the deepest-rooted myths around: that health is a sign of virtue, and infection a sign of sin. A particularly cruel dynamic of the coronavirus is that although everyone runs the risk of contracting it, those unlucky enough to fall ill can still feel the wrath of shame from those lucky enough not to. ‘It’s not surprising that people are scared of judgment when we’ve been telling them for months on end that if they take any risks, they are selfish, reckless, and irresponsible,’ Julia Marcus, a Harvard epidemiologist…told me. ‘So of course, when people test positive, their first reaction is What did I do wrong?’…John Pachankis, a public-health professor who runs Yale’s LGBTQ Mental Health Initiative…told me, COVID camouflaging reminds him of an entirely different phenomenon: staying in the closet. People don’t conceal who they are because of some spur-of-the-moment brain fritz, he said. They do so after endlessly running the cost-benefit analysis in their head and deciding that telling the truth is just not worth it.”
 

COVID Sea Shanty

 
A TikTok video from the handle Acapella Science tells the story of how COVID vaccines work via with a sea shanty tune. Lyrics include “RNA transcribed to spike of spore, by macrophage displayed in a form that the T-cell soon will know.”