Like vaccines, COVID tests have not been available in many countries throughout the pandemic. With new COVID treatments coming online, test and treat strategies will make access to tests even more important. This week, members of civil society, clinicians, advocates, and communities affected by COVID-19 have signed an open letter urging WHO, “to rapidly recommend self-testing for COVID-19 and request your leadership in more broadly improving access to diagnostics for COVID-19. We specifically call on WHO to expedite the finalisation and release of a self-testing guideline for SARS-CoV-2 infection that includes a strong recommendation in favour of widespread access to self-testing. We understand that the Guideline Development Process is ongoing but emphasise the urgency of making an immediate statement in favour of this important tool for COVID-19 control in the interim.”
 
A new fact sheet from Duke’s COVID GAP argues, “with promising oral therapeutics entering the market, diagnostics are even more crucial as they are integral to the roll-out and effective use of the new antivirals…. Striking inequalities remain for the number of tests administered in high-income countries in comparison to low- and middle-income countries. According to FIND, low- and lower-middle income countries (LMICs) account for only 21.7 percent of COVID-19 tests administered globally (but represent about 50 percent of the world’s population).”
 

If You Are in a Hurry

 

• Read about a new study in Malawi that shows COVID may be becoming endemic there and elsewhere in Africa at NPR.
• Then read two epidemiologists on what endemicity means for COVID in The Conversation.
• Read one doctor’s hopes that the Novavax vaccine could provide a new opportunity for some who are vaccine hesitant to get vaccinated on MedPage Today.
• Read about the protective effect for children when their parents are up to date on their vaccines in Medscape.
• Read New York Magazine on high rates of vaccination in Brazil, despite the country’s notoriously anti-vax president. 
• Read Vox on the search for the cause of long COVID.
• Read Science and The Atlantic on what might come after Omicron.
• Read a BMJ editorial on tackling the twin pandemics of HIV and COVID in South Africa.

 

Endemicity

 
Is COVID becoming endemic? A new study from Malawi provides some hope for that country, and perhaps others, that it could be. NPR (US) reports on a study from immunologist Kondwani Jambo: “his study revealed that the scale of spread was beyond anything he had anticipated—with a huge majority of Malawians infected long before the omicron variant emerged…. Most important, he says, the finding suggests that it has now been months since Malawi entered something akin to what many countries still struggling with massive omicron waves consider the holy grail: the endemic stage of the pandemic, in which the coronavirus becomes a more predictable seasonal bug like the flu or common cold.”
 
Two epidemiologists writing in The Conversation (US) break down what endemic means. “Instead of explosive and unpredictable disease spread, we reach a point where the presence of circulating disease represents a lower threat to the community than it did at the beginning of an epidemic. Transmission becomes more predictable, but not necessarily constant—we may still see some waves, especially seasonally. But these are expected and manageable. In short, we start to live alongside the virus…. Importantly, a disease being considered endemic doesn’t mean we consider it mild. It just means it remains a part of our lives, and therefore we still protect the vulnerable from severe illness, as we do with other diseases.”
 

Could COVID Become Seasonal?

 
The Washington Post (US) reports, “COVID-19 transmission may have seasonal spikes tied to temperature and humidity, increasing at different times of the year for different locations, a new study in the American Journal of Tropical Medicine and Hygiene suggests…. ‘We need to basically design the intervention or mitigation strategies based on the environment in which we live,’ [study author Antar] Jutla said. ‘Regions like Florida, India, Africa—they are warm regions. … They basically get hit by these waves, but at different times than what happens in the northern parts, the colder regions.’”
 

Omicron’s Cousin

 
Reuters (UK) reports, “Scientists are now tracking a rise in cases caused by a close cousin known as BA.2, which is starting to outcompete BA.1 in parts of Europe and Asia…. Danish health officials estimate that BA.2 may be 1.5 times more transmissible than BA.1, based on preliminary data, though it likely does not cause more severe disease.”
 
STAT (US) reports, “New data show that vaccines still protect against a spinoff of the Omicron variant, a welcome sign as the world keeps a close eye on the latest coronavirus iteration. BA.2, as the sublineage is known, is part of the broader Omicron umbrella. Scientists are paying more attention to it as it begins to eat into the dominance of the more common Omicron strain, which is technically called BA.1…. As with any emerging variant, there are more questions than answers about BA.2’s transmissibility, severity, and ability to erode the immunity built by vaccination or prior infection. As the World Health Organization put it last week, ‘drivers of transmission and other properties of BA.2 are under investigation but remain unclear to date.’”
 

Do We Need an Omicron Vaccine?

 
Pfizer and Moderna are both working to develop and test an Omicron-specific vaccine. Nature (UK) asks if such a vaccine is needed and reports: “whether rolling out these jabs is necessary, or even practical, is unclear, according to public-health authorities and infectious-disease specialists interviewed by Nature…. Such a vaccine might work against the variant that dominates after Omicron—especially if the virus continues on that genetic trajectory. But no one knows how the virus will evolve, [virologist Paul] Bieniasz says. ‘All of us should be pretty reticent about predicting what is going to be the best matched vaccine months from now,’ he says. Just a few months ago, many researchers predicted—logically, but incorrectly—that the next dominant variant to follow Delta would be a virus like Delta. Omicron, however, is completely different.”
 

What Comes After Omicron?

 
Science (US) reports on what might come next as the Omicron wave wanes in several countries, quoting WHO Europe’s Hans Kluge: “We anticipate that there will be a period of quiet before COVID-19 may come back towards the end of the year, but not necessarily the pandemic coming back.” South African vaccinologist Shabir Mahdi is “optimistic about the future. A serosurvey he led in Gauteng province, home to one-quarter of South Africa’s population, showed close to 70 percent of unvaccinated people carried SARS-CoV-2 antibodies at the start of the Omicron wave. In the next survey, he expects that number to have gone up to at least 85 percent, a level that should prepare South Africa for a post-Omicron future.” However, Science warns, “One scenario in particular could put an end to the newfound optimism: the emergence of a variant able to evade not just human antibodies, but also the T cell response, which protects from severe disease and death.”
 
Sarah Zhang writes in The Atlantic (US), “The next variant may surprise us again. It could, by chance, become more virulent. It could become more transmissible. It will definitely alight upon new ways to escape the antibodies we’ve built up. The virus will keep finding those fitness peaks…. ‘The next variant is more likely to be not Omicron, or something as antigenically distinct from Omicron as possible,’ says Aris Katzourakis, a virologist at the University of Oxford. But exactly what that looks like? Perhaps we know enough now to know we shouldn’t try to predict that.”
 

COVID Treatment

 
Reuters (UK) reports, “Britain will start rolling out Pfizer's COVID-19 pill to vulnerable people next month, the health ministry said on Friday, targeting the treatment at people with compromised immune systems for whom the vaccine can be less effective.”
 
AP (US) reports, “COVID-19 antibody drugs from Regeneron and Eli Lilly should no longer be used because they don’t work against the omicron variant that now accounts for nearly all US infections, US health regulators said Monday. The Food and Drug Administration said it was revoking emergency authorization for both drugs, which were purchased by the federal government and have been administered to millions of Americans with COVID-19. If the drugs prove effective against future variants, the FDA said it could reauthorize their use.”
 

COVID and HIV

 
A BMJ (UK) editorial looks at how to confront the twin pandemic of HIV and COVID in South Africa. “How should we tackle these synergistic pandemics? The UN’s human rights approach has been critical to the effectiveness of responses to HIV and could be constructively applied to COVID-19. This involves improving equitable access to all aspects of healthcare, with service users participating in decision making and providers held accountable for high quality care, while simultaneously addressing the social determinants of health, including discrimination and stigma. These concepts could be applied to COVID-19 by channelling public health measures (including vaccination and contact tracing) through existing civil society structures and meaningfully involving citizens—especially marginalised groups such as people with HIV—in the process.”
 
Angeli Achrekar and Peter Sands write in The Hill (US), “With PEPFAR and Global Fund support, partner countries have increased the reach and resilience of their health systems, with the capacity to adapt, innovate and respond rapidly to significant shocks…. This progress did more than save lives; it built the public health foundations that many countries now use to confront the COVID-19 pandemic…. PEPFAR and the Global Fund have helped countries build firm foundations for combating infectious disease as well as broader pandemic preparedness and response. We are poised to continue supporting them to meet these evolving challenges well into the future.”
 
In a new UNAIDS report, “Holding the line: communities as first responders to COVID-19 and emerging health threats, organizations led by and for people living with HIV and key populations detail their efforts to respond to the colliding pandemics of COVID-19 and HIV. Drawing on qualitative survey data spanning 225 community-led organizations across 72 countries, the report provides a snapshot of the organizations’ work during early 2020 to sustain the HIV response while supporting their communities through the COVID-19 pandemic.”
 

COVAX Needs More Funds

 
More doses of COVID vaccines are beginning to be available to lower income countries. But without syringes, safety boxes, transport costs and other accessories needed to deliver vaccines, those doses may not be able to make into the arms of people waiting for them. FT (UK) reports COVAX, “last week said it needed a fresh cash injection of $5.2bn to support its global vaccine rollout this year.” FT quotes GAVI’s Seth Berkley: “We are in a position where we will not be able to accept more dose donations [that come without syringes or other accessory elements] unless we get more cash.”
 

Brazil’s Vaccine Success

 
New York Magazine (US) reports that despite Brazilian president Bolsonaro’s anti-vax stance, “the vast majority of Brazilians…are taking the shots as soon as they can get them…. National surveys point to a vanishingly small anti-vaccine population. In July, only 5 percent of respondents told the pollster Datafolha they did not plan to get the vaccine, and the number may have gone down since then.”
 

Changing Policies

 
Many countries are changing policies on testing, isolation periods and other restrictions. This week The Daily Maverick (South Africa) reports, “South Africa no longer requires those who test positive for COVID-19 without symptoms to isolate and has also reduced the isolation period for those with symptoms by three days, as the country exits its fourth wave of the coronavirus, a government statement said on Monday.”
 
Bloomberg (US) reports, “Denmark will end virus restrictions next week and reclassify COVID-19 as a disease that no longer poses a threat to society, even as infections hit a record high. The Nordic country, one of the most vaccinated in the world, won’t extend the pandemic measures beyond Jan. 31…Denmark’s decision on reclassifying the virus dramatically pushes forward an idea that’s emerged recently in Europe—that it’s time to start thinking about COVID as endemic rather than a pandemic. However, World Health Organization experts have warned against complacency.”
 

COVID and Women

 
News24 (South Africa) reports, The Commission for Gender Equality (CGE) has withdrawn its statement that COVID-19 vaccines have an impact on women's reproductive health. In a statement on Thursday night, the commission said it ‘erroneously quoted an article published in a medical journal which alleges possible negative consequences of vaccination on women's sexual and reproductive health’…. To rectify the recent misinformation, the CGE said it would coordinate various education drives, in collaboration with health and medical experts.”
 

COVID and the Olympics

 
China is one of the last countries in the world still pursuing a zero COVID strategy. POLITICO (US) reports ahead of the Winter Olympics, “Beijing officials said Sunday they sealed off several residential communities in the city’s northern district after two cases of COVID-19 were found…. While the cases are low compared to other countries in the region, China has double down on its ‘zero-tolerance’ policy, which includes breaking the chain of transmission as soon as it is found.”
 

Novavax

 
Dr. Jesse Pelletier writes in MedPage Today (US) that the platform used in the Novavax vaccine, “has a significant history of use for diseases like pertussis, hepatitis B, and pneumococcus. In trials, the vaccine showed similar protection to currently available vaccines, and none of the participants experienced severe clotting, anaphylaxis, or myocarditis…. Adding a protein subunit construct to the melee finally gives us the much needed, traditional option available for both the immunologically naïve and those hesitant to get boosted. It may provide a path forward for some who are pro-vaccine, but who drew the line at novel mRNA products. This is especially important given the disconnect that can exist between COVID-19 advocacy, science, and the manner in which this plays out in the realm of public policy.”
 

COVID and Children

 
Medscape (US) reports, “Parents who keep up to date with their COVID-19 vaccines may help protect their unvaccinated children from the disease in the process, new research shows. Having one fully vaccinated parent reduced the risk for infection with the original strain of SARS-CoV-2 in children by 26 percent, while having two fully vaccinated parents cut the risk by nearly 72 percent, according to the researchers.”
 
The Washington Post (US) reports that in the US, “Coronavirus vaccines for children younger than 5 could be available far sooner than expected—perhaps by the end of February—under a plan that would lead to the potential authorization of a two-shot regimen in the coming weeks, people briefed on the situation said Monday…. Pfizer and its partner, BioNTech, the manufacturers of the vaccine, are expected to submit to the Food and Drug Administration as early as Tuesday a request for emergency-use authorization for the vaccine for children 6 months to 5 years old, which would make it the first vaccine available for that age group.”
 

In US Omicron Deaths Surpass Delta Deaths

 
Medscape (US) reports, “With the Omicron variant accounting for 99.9 percent of all COVID-19 cases in the United States, it’s proving even deadlier than the Delta variant. This week the nation recorded a seven-day average of 2,200 daily coronavirus-related deaths, higher than the daily death count recorded two months ago during the Delta variant surge…. Health experts say that Omicron generally causes milder symptom than previous variants. But the death count is high because Omicron spreads quickly and is infecting a large number of people.”
 

Long COVID

 
Vox (US) looks at the work to find what is causing long COVID: “Scientists have proposed numerous hypotheses to explain long COVID’s myriad symptoms since research began in earnest after the first wave of cases in 2020…. There are no firm answers yet, but there’s now greater consensus among researchers about the two leading theories and the ways they may be connected. Scientists also have a better understanding of the people who are susceptible to long COVID. While many used to think that the condition only affected people with severe illness, patients now range from teens to older adults, some of whom had only mild or even asymptomatic illness…. Early research is pointing to factors that may raise a person’s risk of long COVID, such as low levels of certain antibodies, reactivated viruses in the bloodstream, and existing conditions such as diabetes or asthma.”
 

Disseminating Science Quickly and Accurately

 
An opinion piece in The New York Times (US) examines the issues around preprints vs. peer reviewed science. “Peer review is both the greatest strength and the greatest weakness of the scientific research system. It filters out bad work and makes good work better. But it can also slow down the dispersal of new ideas, which is a big problem when it comes to tackling fast-changing challenges like the COVID-19 pandemic.” Been around for decades, but “it was the COVID-19 pandemic that brought preprints into the mainstream of medicine…. The challenge in scientific publication is to keep out all of the bad stuff while blocking none of the good stuff. It’s not easy. Fortunately, lots of smart people are tackling the problem.”