Almost from the beginning of the waves of COVID infections in the US, racial inequities have been exposed. A new US CDC study found that “Hospitalization rates among non-Hispanic Black adults increased more than rates in other racial/ethnic groups.” The Hill (US) reports, “Black adults were hospitalized at nearly four times the rate of white adults during the peak of the omicron wave over the winter…in a period beginning on Dec. 19—when omicron became the dominant variant of the coronavirus—and ending Jan. 31, Black adults were hospitalized at a rate of 94.7 per 100,000 people compared to 24.8 per 100,000 for white adults…. African Americans have faced large disparities in terms of cases and deaths during the pandemic due to a combination of factors, including limited access to quality health care and an increased number of community members working front-line jobs, a factor that has led to higher exposure to the virus.”
 

If You Are in a Hurry

• Read the memories of several US-based experts on the early days of the pandemic and what went right and what went wrong at Healio.
• Read NPR on the struggle to understand long COVID.
• Read STAT on the contracting COVID vaccine market.
• Listen to an NPR story on the link between COVID and schizophrenia.
• Read about a possible TRIPS waver compromise in POLITICO and Devex.
• Read POLITICO for a preview of US government thoughts on preparing for the next pandemic.
• Read MedPage Today on the challenges of looking for the next variant.

 

Possible TRIPS Waiver Compromise

 
POLITICO (US) reports, “The EU, South Africa, India and the US have reached a compromise in long-running negotiations on a waiver on intellectual property rights for coronavirus products…. Under the compromise, which currently only covers vaccines, developing countries that have exported less than 10 percent of the world’s coronavirus vaccine doses in 2021 would be able to authorize the use of a patented coronavirus vaccine without the owner of the patent’s consent. The solution is purportedly much broader than compulsory licensing, an alternative proposal that would allow countries to use means such as executive orders to ramp up vaccine production.”
 
Devex (US) reports, “The potential deal has been celebrated in some corners for finally breaking through negotiations that have been gridlocked for months and delivering a Trade-Related Aspects of Intellectual Property Rights, or TRIPS, agreement that has the potential to at least ease access to vaccines for the global south. But critics said what has emerged bears little resemblance to the proposal South Africa and India tabled in front of the World Trade Organization in October 2020, which also called for IP waivers on COVID-19 therapeutics and diagnostics…. The proposal would allow eligible members to issue a single authorization to waive multiple patents, including on ingredients and processes, without fear of a challenge from the patent holders.”
 

Dose Sparing for Vaccine Access

 
A Viewpoint in Lancet Global Health (UK) argues, “Dose-sparing strategies for COVID-19 vaccines can increase vaccine availability to address the global crisis. Several clinical trials evaluating dose sparing are currently underway. However, to rapidly provide solid scientific justification for different dose-sparing strategies, joint coordinated action involving both public and private parties is needed…. We argue that the establishment of a mechanism through which dose-sparing opportunities are systematically identified, scientifically tested, and ultimately implemented will prove to be valuable beyond the current pandemic for infectious diseases product development and pandemic preparedness in the future.”
 

Preparing for Next Pandemic

 
POLITICO (US) reports, “The Biden administration wants the World Health Organization to improve global equity in the next public health emergency by pushing manufacturers to voluntarily share their products and technology, according to a document drafted by the Department of Health and Human Services and obtained by POLITICO. Biden administration officials coordinating with a WHO group focusing on preparedness in health emergencies wrote the paper, outlining ways to expand equity through a potential pandemic treaty or some other kind of global agreement.”
 

Looking Back

 
In the first of an oral history series looking back over the first two years of the pandemic, Healio (US) talked with several experts about how COVID has reshaped medicine and public health. Former US CDC director Tom Frieden says, “COVID taught us how severely underprepared and underfunded our public health systems are for health threats. Memories are short, and we are seeing early signs that policymakers just want to move on. We cannot let the cycle of panic and then neglect take hold and allow us to forget COVID’s devastating human and economic losses. We need sustained investments to strengthen public health systems that detect, respond to, and contain infectious disease outbreaks before they grow into epidemics. Unless Congress can ensure a long-term sufficient, sustainable funding mechanism to support these investments, we will find ourselves unprepared for the next pandemic. At the most fundamental level, COVID should teach us that we are all connected, and that ill health anywhere is a threat to health everywhere.”
 

What Do We Know About BA.2

 
The Omicron sub-variant BA.2 is driving an increase in COVID cases in some countries. MedPage Today (US) reports, “the rise of BA.2 hasn't been as dramatic as that of its predecessor.” One model shows that in the US, “it's unlikely that BA.2 is going to create anywhere near [the] kind of a surge [BA.1 did]…. Still, it's hard to know exactly how fast vaccine efficacy wanes for different people who caught various strains or have varying levels of vaccination…. It's also hard to predict human behavior around the virus precisely…”
 
Nature (UK) reports a preprint study “shows that mRNA vaccines offer a similar degree of protection against the two strains [of Omicron, BA.1 and BA.2]—although protection against SARS-CoV-2 infection and symptomatic disease wanes within months of a third dose…. Protection against BA.2 did not seem to wane any faster than protection against BA.1, and a booster shot brought the protection against symptomatic infection by either subvariant back to 30–60 percent. Surveillance data collected in the United Kingdom reveal a similar trend: vaccine effectiveness against symptomatic COVID-19 is less than 20 percent for both subvariants 25 weeks or more after a second dose, but rises to roughly 70 percent 2–4 weeks after a third dose.”
 

Data, Data, Data

 
MedPage Today (US) reports on efforts in the US “to keep an eye out for the next troublesome variant, even in the face of numerous challenges….” Efforts to sequence viruses, share genomes and to track viral loads in wastewater are helping track the virus trajectory in the country, but experts warn, “As the tools to monitor and track variants have evolved, their shortcomings have been revealed…. The ability to track specific variants through sequencing—and send samples and data to the CDC—still varies from one level of government to the next, and depends largely on the resources a locality or state has at their disposal.”
 
The New York Times (US) reports, “A growing number of US states have stopped giving daily updates of the number of new coronavirus cases, hospitalizations and deaths, which, combined with the rise of at-home testing whose results are often not officially registered, is creating a more uneven real-time look at the state of the pandemic…. Nationally, the declines in new cases, hospitalizations and deaths are tapering off, and some experts are concerned that the drop in reporting could create blind spots if the pandemic begins a resurgence.”
 

The Politics of COVID

 
Throughout the pandemic, across the globe, the response has often been governed by politics rather than public health. Two years into the pandemic, a decline in US government funding is imperiling the response in the US and globally. The Atlantic (US) reports, “Last week, lawmakers passed a massive spending bill without any additional funding for COVID-19 relief, despite White House pleas for more. Democrats would like to fulfill the administration’s request. But Republicans have taken the position that Congress has already done enough…. Democrats may soon try to pass COVID relief as a stand-alone bill, but the chances of getting it through the tied-up Senate are slim. The White House is now warning…the government will have to cut shipments of monoclonal-antibody treatments by a third…. By next month, it won’t be able to reimburse health-care providers for treating uninsured Americans with COVID. By the summer, it’ll have to cut funds for test manufacturers. Perhaps most crucially, it’ll scale back global vaccination efforts that would help keep new variants from emerging.”
 
The Hill (US) reports that Anthony Fauci has said more funding than the $22.5 billion requested by the White House and cut from the current spending bill. “Biden’s chief medical adviser said that officials needed adequate funding in order to study possible future variants. ‘We will not be able to do the kind of research to address the inevitable next variant if we don't get the funding that we're talking about,’ Fauci said.”
 

Crowded COVID Vaccine Field

 
STAT (US) reports, “With two new players—Novavax and a Sanofi-GSK partnership—making or about to make their way into the already crowded global COVID vaccine market, the prospects for those still struggling to prove their vaccines are protective are becoming ever slimmer…. The world can now produce more COVID vaccine than it needs or can administer—more than 12 billion doses a year. For a number of existing manufacturers, purchases have plateaued; some players are already scaling back production. A company hoping to enter the market with yet another vaccine that targets the original SARS-CoV-2 strain or that offers no advantages over existing products will be hard-pressed to find buyers, experts warned.”
 
The New York Times (US) reports, “new data suggest that the [JnJ] vaccine is now preventing infections, hospitalizations and deaths at least as well as the Pfizer-BioNTech and Moderna vaccines. The reasons aren’t clear, and not all experts are convinced that the vaccine has vindicated itself. But the accumulating data nonetheless offer considerable reassurance to recipients of the vaccine and, if confirmed, have broad implications for its deployment in parts of the world.”
 

Call for More Investment in African Healthcare and Pharmaceuticals

 
NewzPost (Uganda) reports, “The COVID-19 pandemic has highlighted Africa’s urgent need for better healthcare. Unequal access to vaccines, along with disruptions to supply chains caused by worldwide economic shutdowns have underscored the continent’s overreliance on medical and pharmaceutical imports…. Under its COVID-19 response, the Africa Investment Forum is prioritizing sectors that can drive Africa’s resilience and accelerate the continent’s economic recovery from the impacts of the pandemic. ‘The COVID-19 pandemic has opened our eyes to both the necessity and the urgency with which we must create investment on the Africa Investment Forum platform,’ says Chinelo Anohu, its Senior Director.”
 

“Medium” COVID

 
NPR (US) reporter Nina Feldman looks at what it’s like for a young healthy person to recover from a COVID infection. “Waves of fatigue. The inability to smell milk that has gone bad. A racing heartbeat. These are just a few COVID-19 symptoms that can linger after an initial coronavirus infection. Though they may not always amount to the debilitating cases of long COVID-19 that can leave people bedridden or unable to perform daily functions, it's very common to take weeks to fully recover—a condition I've been thinking of as ‘medium COVID.’" She notes that there is no agreed upon timing for when COVID’s lingering effects become long COVID. One large study that will collect data from 60,000 people and it’s PI says it “will classify symptoms lasting more than 30 days as long COVID-19. Using that benchmark, he estimates that about 25 percent to 30 percent of people with COVID infections will have persisting symptoms. But he said, the 30 days is an arbitrary cutoff point.”
 

COVID’s Impact on the Brain

 
Science News (US) reports, “As part of a large brain-scanning study, researchers found that infections of SARS-CoV-2, the virus that causes COVID-19, were linked with less gray matter, tissue that’s packed with the bodies of brain cells. The results, published March 7 in Nature, prompted headlines about COVID-19 causing brain damage and shrinkage. That coverage, in turn, prompted alarmed posts on social media, including mentions of early-onset dementia and brain rotting.” The author argues the alarm in media and social media is may not be warranted. “The answer, frustrating though it may be, is that we don’t yet know [the impact of this].” One of the study authors says, “’The concern is that these damages will last and make infected people more vulnerable to brain diseases in the future.’ But these differences may not last, Douaud says. The brain can ‘reorganize and heal itself to some extent, even in older people,’ she notes.”
 
A Bloomberg (US) opinion piece on the same study argues that alarming headlines about the study were problematic. “The media shouldn’t underplay the danger of the pandemic, but overplaying risks can degrade public trust and focus attention on the wrong things…. Public health officials, doctors and media outlets aren’t helping if they mislead people for any reason. Those who feel they can’t trust the mainstream media will migrate to fringe scientists and media figures who serve up vastly exaggerated reports of vaccine side effects, or promises of miracle cures. The sea of COVID misinformation is too vast to police—the best antidote for it is trustworthy, balanced information coming through mainstream channels.”
 

COVID Cases on the Rise in Many Places

 
Reuters (UK) reports, “Figures showing a global rise in COVID-19 cases could herald a much bigger problem as some countries also report a drop in testing rates, the WHO said…warning nations to remain vigilant against the virus…. ‘These increases are occurring despite reductions in testing in some countries, which means the cases we're seeing are just the tip of the iceberg,’ WHO's head Tedros Adhanom Ghebreyesus told reporters. Low vaccination rates in some countries, driven partly by a ‘huge amount of misinformation’ also explained the rise, WHO officials said.”
 
AFP (France) reports, “COVID-19 is again surging in Western Europe due to a ‘perfect storm’ of governments lifting restrictions, waning immunity and the more contagious BA.2 Omicron subvariant, experts said…. After more than a month of falling cases across much of the continent, countries such as Britain, France, Germany and Italy have all seen a dramatic resurgence of infections in recent days.... Jean-Francois Delfraissy, president of the French government's scientific advisory board, has already warned of potential variants. ‘We are at the mercy of a new variant which, if we ask the scientist community, could be expected in the autumn.... It could happen before then,’ he said last week. ‘Will it be a more transmissible variant? Will it be more severe? Will it escape the vaccine? Nobody knows.’"
 
Al Jazeera (Qatar) reports, “China has imposed stay-at-home orders on millions more people in the country’s northeast, as it tries to tackle its biggest coronavirus outbreak in two years. The country has largely kept the virus at bay since it brought to heel its initial outbreak in 2020 using targeted lockdowns, mass testing and travel restrictions. However, the Omicron strain of COVID-19 has taken hold in multiple cities across China. Jilin, the second-biggest city in Jilin province, will lock down about 4.5 million inhabitants for three days…”
 
The New York Times (US) reports on the brutal rise on cases and deaths in Hong Kong, a city that had been relatively spared from the worst of the pandemic until Omicron. “[S]cientists have looked to Hong Kong for clues about the threat Omicron poses in an entirely different setting: a dense city where people were not only largely untouched by previous infections, but whose oldest and most vulnerable residents were also largely unvaccinated…In the era of Omicron and its even more infectious subvariant, BA.2, vaccinating a broad swath of the population remained important, scientists said. But inoculating as many older people as possible had become far and away the top priority.”
 
AP (US) reports, “Samoa has reported scores of new COVID-19 cases each day since detecting its first case of community transmission last week…. Samoa and several neighboring Pacific island nations were among the last places in the world to avoid virus outbreaks. But the more transmissible omicron variant has changed the equation, and one by one the island nations have been succumbing to COVID-19.”
 

COVID’s Impact on HIV Diagnoses in India

 
India Express (India) reports, “Fewer new cases of HIV (Human Immunodeficiency Virus) were reported in Delhi over the last two years—3,629 cases in 2020 and around 4,500 cases in 2021—according to data from the Delhi State AIDS Control Society (DSACS) that implements the national control and prevention programme in the state. This, however, is a cause of concern for the officials. There wasn’t an actual decrease in the number of cases, they say. Rather, fewer people going to hospitals during the lockdown and surge in COVID resulted in a decline in detection of HIV cases over the last two years, according to officials from Delhi’s health department.”
 

COVID and Schizophrenia

 
NPR (US) reports, “the second biggest risk factor [for dying of COVID] is schizophrenia. The pandemic has posed grave danger to people with this serious mental illness, but it also presents a unique opportunity for researchers to increase their understanding of schizophrenia itself.” One researcher says the findings across multiple countries of a two to five times risk of death in people with schizophrenia “point to a problem with the immune system. This could be what's causing severe COVID in people with schizophrenia, and it could also be what's driving psychotic symptoms like hallucinations or delusions. This would mean schizophrenia is not just a disease of the brain, but a disease of the whole body. It's a really promising area of research, and Nemani says it's the pandemic itself that's opening doors for new discoveries.”
 

COVID and Children

 
The Washington Post (US) reports on new US CDC data: “At the peak of the omicron wave, infants and other children under 5 were hospitalized at about five times the rate documented during the delta wave, although few deaths were reported, the study said. For infants under six months, hospitalizations were about six times higher during the omicron surge.”
 

Polio

 
In many countries routine childhood immunizations have lagged through the pandemic and lockdowns. A recent report of polio in Malawi has led to concern of another regional outbreak of the disease. The New York Times (US) reports, “Five southeastern African countries are set to begin vaccination drives against polio after an outbreak was declared in Malawi last month, the World Health Organization has said, highlighting the multiple health challenges facing countries on the continent as they grapple with the coronavirus pandemic.”
 

Pandemic Endgame?

 
A commentary in Time (US) argues that to end COVID, “we have to admit we failed,” drawing on experiences from the HIV pandemic. “Rather than giving up, the failure to create a viable HIV vaccine spurred scientists to develop a whole new strategy to end the AIDS pandemic. Without vaccines available to teach human immune systems to kill the virus, scientists were forced to find other ways to keep infections at bay. And here’s where four decades of scientific failure was transformed into a radical approach to pandemic control, with direct implications for the future of the global effort to end COVID-19.” The author notes that current antivirals approved for use against SARS-CoV-2 can also work against other corona viruses. “And that’s where the failure playbook, starting with Test and Treat, becomes truly great news for our species’s long conflict with coronaviruses. Regardless of whatever pathogenic coronavirus next emerges, it will also have those same genomic regions as the ones that came before, making it just as susceptible to the antiviral treatments developed to stop SARS-CoV-2.”