Confirmed global COVID cases passed 200 million this week. The actual toll of the disease is likely much, much higher. Surges in new cases around the word are largely driven by the more contagious Delta variant. The New York Times (US) reports, “The global [death] toll as of Wednesday was about 4.25 million — a serious underestimate, experts say, given the discrepancies in the way nations record Covid deaths.”

Globally just over 15 percent of people are fully vaccinated, even as rich countries contemplate booster shots for the fully vaccinated. 

If You're in a Hurry

Read Nature on why so many global health experts say booster shots in rich countries could set the pandemic back even more.
 
Read Vox on why breakthrough cases in the US are not driving (or substantially contributing to) the surge in cases.
 
Listen to an NPR story about a citizen scientist statistician who helped document and get data about the Provincetown outbreak to the CDC.
 
Read Ugandan researcher Henry Zakumumpa on HIV service delivery during lockdowns and implications beyond COVID in The Conversation.
 
Barbie has been many things over the decades. Now she’s a vaccine developer. Read about a new series of COVID hero Barbie dolls on Washington Post.
 
Read AP on how Novavax is looking to lower-income countries for earlier approval of its vaccine.
 
Read AIDSMAP on new data about mRNA vaccines and PLWHIV.
 
Read i-base on a new preprint study of PLWHIV and COVID.
 
Read Medscape on a NEJM study of monoclonal antibodies for prevention of COVID.

WHO Calls for Moratorium on Booster Shots

A few countries have already begin giving booster shots and others are developing plans to give at least some populations boosters, but the WHO and others have called for more equitable global vaccine distribution before rich countries boost already vaccinated people.
 
STAT (US) reports, “The World Health Organization called Wednesday for a temporary moratorium on the use of Covid-19 vaccine booster shots by wealthy countries, saying the global priority should be on increasing supplies of first doses to countries that are still struggling to protect health workers and older adults. Director-General Tedros Adhanom Ghebreyesus said that countries should hold off on starting to give booster doses until at least the end of September — though it was quickly clear that the global health agency might extend the call if vaccine doses available to lower-income countries do not increase to adequate levels.
 
Researcher Carlos del Rio tweeted, “@WHO DG @DrTedros asks for a moratorium in booster shots until more globally can get a first shot. “First shots before third shots” should become a call for global vaccine equity.”
 
Nature (UK) reports, “Israel has announced plans to begin giving booster shots to older adults next week, in the hope of increasing their protection against COVID-19 — and a number of other wealthy countries are considering the same. But global-health researchers warn that this strategy could set back efforts to end the pandemic. Each booster, they say, represents a vaccine dose that could instead go to low- and middle-income countries, where most citizens have no protection at all, and where dangerous coronavirus variants could emerge as cases surge. Data do not yet show that extra doses are needed to save lives, researchers say, except perhaps for people with compromised immune systems, who might fail to generate much of an antibody response to the initial COVID-19 shots… For Leena Menghaney, the South Asia regional head of the Access Campaign at MSF, this debate is personal. She was caught in a stampede for a limited supply of vaccines offered earlier this month in Uttar Pradesh, India’s most densely populated state, where the desperation was palpable. ‘We have always known that we were second-class citizens,’ she says, ‘but you really feel it in that moment.’”
 
EFE News (Spain) reports, “Health authorities in Africa endorsed Thursday the call from the World Health Organization (WHO) for a global moratorium on booster doses of the Covid-19 vaccine until the end of September. Only 1.58 percent of the continent’s 1.2 billion residents have received the full course of the Covid-19 vaccine and fewer than 4 percent have had at least one dose. ‘Our position is clear. We need to vaccinate as many people as possible with the available vaccines before looking at booster doses,’ John Nkengasong, director of the African Union’s Africa Centers for Disease Control and Prevention, told a press conference.”
 
WSJ (US) reports the US FDA “expects to have a strategy on Covid-19 vaccine boosters by early September that would lay out when and which vaccinated individuals should get the follow-up shots, according to people familiar with discussions within the agency… Any booster strategy from the U.S. government will need to address declining protection for certain people at a time when vaccines remain in short supply in the developing world.”
 
San Francisco Chronicle (US) reports, “San Francisco residents who received Johnson & Johnson’s single-dose vaccine against the coronavirus are now able to get a supplemental mRNA dose at city-run clinics. Dr. Grant Colfax, the city’s health director, confirmed Tuesday that the additional shot would be an option for those who have consulted with a physician. He stressed that San Francisco’s health department does not currently recommend that people who received Johnson and Johnson’s COVID-19 vaccine get an mRNA booster — a stance in line with guidelines from the U.S. Centers for Disease Control and Prevention.”
 
In a Twitter thread epidemiologist Céline Gounder lays out the evidence (or lack of evidence) for booster shots, writing that “We may need extra doses EVENTUALLY. But right now, the data only supports extra doses for - HIGHLY immunosuppressed people - people over 80 - nursing home residents.”
 
CNBC (US) reports Fauci told a press briefing: “Immunocompromised individuals are vulnerable. It is extremely important for us to move to get those individuals their boosters, and we are now working on that and we will make that be implemented as quickly as possible. ... It is a very high priority.”

Novavax Aiming for Approvals in Lower-income Countries

AP (US) reports, “Vaccine maker Novavax announced Thursday it has asked regulators in India, Indonesia and the Philippines to allow emergency use of its COVID-19 vaccine -- offering its shot to some low-income countries before rich ones with ample supplies. U.S.-based Novavax partnered with the Serum Institute of India to apply in the three countries, and plans later this month to also seek the World Health Organization review needed to be part of the COVAX global vaccine program.”

COVID and HIV

AIDSMAP (UK) reports, “The Pfizer and Moderna vaccines against SARS-CoV-2 produce strong antibody responses in people with HIV and similar antibody and cellular immune responses in people with and without HIV, two studies published in the journals AIDS and Clinical Infectious Diseases show. Although people with HIV have been prioritised for SARS-CoV-2 vaccination in some countries, it has been unclear whether immunosuppression caused by HIV could lead to weaker vaccine responses.
 
Spotlight (South Africa) reports on the implications of the WHO data on COVID and HIV presented at the IAS conference last month. “In addition to informing vaccination strategies, the report adds to local data in highlighting the need for sustained HIV service delivery and framing research questions for how to protect those living with HIV.”
 
i-base (UK) reports, “The largest national US cohort study so far, reports that people living with HIV have significantly higher risks of more severe COVID-19 and that these risks increase further with lower CD4 counts and higher viral load. The analysis included almost 1.5 million people diagnosed with COVID-19 from January 2020 to May 2021. It looked at outcomes in more than 8,200 people living with HIV and more than 11,300 who had a solid organ transplant (SOT) (and 267 with both) and used multivariate analyses that also adjusted for demographics, medical and social factors.” The paper has not yet been peer reviewed.
 
In a piece in The Conversation (US) Uganda researcher Henry Zakumumpa looks at how healthcare teams provided care for PLWHIV in Uganda during lockdowns. “My colleagues and I conducted a study soon after the first lockdown in Uganda last year in eight districts from Eastern and Western Uganda. We found that HIV care providers used alternative ways to reach patients stuck in their homes by delivering HIV medications to their doorsteps. The identified innovations include decentralisation of ART distribution to community platforms, and six-monthly refills. These will be applicable beyond COVID-19.

Solidarity Treatment Trial Restarting

Science (US) reports, “Solidarity, a global study led by the World Health Organization (WHO), will test three new drugs in hospitalized COVID-19 patients: the cancer drug imatinib, an antibody named infliximab that is used to treat autoimmune diseases, and artesunate, an antimalarial.” The trial is starting first in Finland, with more than 40 other countries in various stages of approvals.

Prevention with Monoclonal Antibodies

Medscape (US) reports, “A combination of two monoclonal antibodies given as a subcutaneous injection prevented COVID-19 in patients at a high risk of infection due to household exposure, according to results of a randomized, double-blind, placebo-controlled clinical trial published online August 4 in the New England Journal of Medicine… The trial was done before there was widespread vaccination, so it's unclear what the results mean for people who have been vaccinated. Cohen and Wohl said there are ongoing conversations about whether monoclonal antibodies could be complementary to vaccination and if there's potential for continued monthly use of these therapies.”

Delta Plus and Lambda

Washington Post (US) looks at “what we know” about Delta Plus, “yet another new variant causing alarm among governments and health officials? First identified in Europe in March, the variant is also known as B. 1.617.2.1 or AY.1. It has been detected in several countries, including the United Kingdom, the United States and India…. The “plus” of the variant’s name refers to its K417N spike protein mutation… ’To date, there is no clear evidence that it conveys enough of a benefit to the virus to allow it to dominate the original delta variant,’ [modeler Colin Angus] said…. Angus also noted that delta-plus cases have primarily been in younger people but that preliminary data has shown that antibodies from vaccinated people are still effective against the variant.”
 
Reuters (UK) reports, “The Lambda variant of the coronavirus, first identified in Peru and now spreading in South America, is highly infectious and more resistant to vaccines than the original version of the virus… In laboratory experiments, they found that three mutations in Lambda's spike protein, known as RSYLTPGD246-253N, 260 L452Q and F490S, help it resist neutralization by vaccine-induced antibodies.” The study has not been peer reviewed.

Vaccines in Africa

Punch (Nigeria) reports, “Africa Union has announced the commencement of monthly shipments of the 400m doses of Johnson & Johnson COVID-19 vaccine acquired by it through the African Vaccine Acquisition Trust to its member-states, beginning from Thursday…. The Johnson & Johnson vaccine, according to AU, was selected for this first pooled procurement for some reasons: first of all, as a single-shot vaccine, it is easier and cheaper to administer; second, the vaccine has a long shelf-life and favourable storage conditions.”
 
Bloomberg (US) reports, “A record number of people died from the coronavirus this week in Africa, where the authorities began the rollout of 400 million vaccines to contain the spread of the disease. More than 6,400 people succumbed to Covid-19, while new infections rose by almost a fifth, Phionah Atuhebwe, the World Health Organization’s new vaccines introductory officer, said in an online briefing Thursday. The number of vaccines delivered to African nations jumped 12-fold in the last two weeks of July, compared with the previous fortnight, bringing the total number of shots delivered to 91 million, she said.”
 
VOA (US) quotes Atuhebwe: “We need to be clear though: In a continent of over 1.3 billion people, this is just a tiny drop in a very large ocean, and in the face of a surging third wave and more contagious variants, vaccine shortages leave Africa dangerously exposed. We have a very long way to go. With less than two percent of Africans fully vaccinated, we cannot get vaccines fast enough into the arms of the people.” 
 
NY Daily News (US) reports, “The vaccinated head of Africa’s disease control body is promoting the shot amid his own ‘unbearable’ case of coronavirus. John Nkengasong contracted COVID-19 last week and told reporters that ‘the severity of the attack is unbearable,’ but it could be far more dire…Nkengasong, in an effort to challenge vaccine hesitancy, admitted that he ‘would not be here by now’ had he not previously received the jab.”

Making Sense of the Provincetown Data

Slate (US) reporter Joel Rozen writes about being a part of the Provincetown outbreak: “More than a few of my friends surprised me with gallows humor about the AIDS crisis and the outbreak, theorizing that it’d been too much sex, too many drugs—too much “fun”? —that we might blame for our predicament. Suddenly, my illness was being casually equated with promiscuity, as if personal behavior, and not poor public health guidance and quickly shifting science, was the culprit. Still, if being at the center of this latest chapter of the COVID story had chipped away at my trust in the CDC’s ever-evolving guidelines, it had also offered us gay men a glimpse of an important facet of our history, exemplified most powerfully in the legendary self-advocacy of ACT UP: playing armchair scientist when institutional and social knowledge isn’t there for us, when it breaks down.”
 
NPR (US) reports, “A statistician compiled data to share with the CDC after friends kept testing positive after a week in Provincetown, Mass. It spurred an investigation that changed how officials saw the delta variant.” This citizen scientist, a statistician who was in Provincetown and kept hearing from friends who were infected, reached out to a contact at CDC with a spreadsheet documenting the infections he knew about. Michael Donnelly is a cofounder of the COVID data site COVID Outlook.

"A Long War"

STAT (US) reports, “The prospect of contending with a prolonged outbreak phase — and adjusting again to a constantly evolving roster of restrictions — has brought back another feature of pandemic living in America: anger…. For those who’ve made a living studying pandemics, they see another lesson in the current outpouring of outrage — the danger of setting unrealistic expectations. ‘One of the big mistakes of the U.S. Covid response, among many, was at the beginning to not make it clear that this was going to be a long war,’ said historian John Barry, who wrote the definitive account of the 1918 Spanish Flu pandemic, ‘The Great Influenza.’”

COVID Deaths and Hospitalizations Low Among Vaccinated in US

Vox (US) reports, “As cases increase nationwide, it’s understandable to think that breakthrough cases (infections in vaccinated people) are now a main driver of the ongoing Covid-19 surge. But the evidence is clear: The problem is the unvaccinated population. If more people got the vaccines, the current surge wouldn’t be as big; it certainly wouldn’t lead to the levels of hospitalization and death now seen across the US. This was true months ago, and remains true today.”
 

MedPage Today (US) reports on a CSIS interview with Dr. Fauci in which he “described his vision of an antiviral that would fight COVID-19. ‘I want a pill that blocks a specific viral function,’ Fauci said. ‘I want to give it once a day, if possible, I want it to be low in toxicity, and I want it to have very minimal drug-drug interactions. Give me that, and I'll be really happy…When you have variants, you've got to be ready,’ he said, noting that it's unlikely it will be as simple as ‘one pathogen and one drug that's the knock-out home-run drug. You always have to be ready to continue to develop alternatives that could keep up with the variants.’"

Vaccine Safety Among Adolescents

A study in MMWR (US) looks at safety of the Pfizer-BioNTech vaccine among those ages 12-17. “Mild local and systemic reactions are common among adolescents following Pfizer-BioNTech vaccine, and serious adverse events are rare. The Advisory Committee on Immunization Practices conducted a risk-benefit assessment and continues to recommend the Pfizer-BioNTech COVID-19 vaccine for all persons aged ≥12 years.”

The Council for the Advancement of Science Writing (US) announced an award for two journalists who have helped shape our understanding of the science of COVID. “Journalists Helen Branswell (@HelenBranswell) of STAT and Amy Maxmen (@amymaxmen) of Nature have been chosen to receive the 2021 Victor Cohn Prize for Excellence in Medical Science Reporting. Given the remarkable quality and impact of Branswell and Maxmen’s reporting on infectious disease in a year of outstanding and critically important science journalism, the judges elected to split the prize for the third time in the history of the award. They cited Branswell for her extraordinary depth of knowledge and her prescient, sharp, high-impact coverage of the COVID-19 pandemic. Maxmen was cited for intrepid, rigorous, humane reporting that revealed the unequal toll of the pandemic by centering the voices and experiences of underserved communities.” Their writing has featured in this roundup week after week as we tried to provide an overview of the evolving pandemic.