The case rate continues to decline in Easthampton, although the decline has slowed. The confirmed case rate is hovering around 30 new cases per day per 100k population - far lower than we've seen in the past two surges, but a rate that we would have considered worrisome a year ago. The percent positivity seems to have settled at around 5% as a result of decreased testing.
There were only seven (!!) new confirmed cases this week, which means that next week's case rate will be substantially lower than this weeks. Wastewater surveillance data, however, is indicating that we might have an increase in cases coming our way in the next few weeks. Cases lag behind wastewater surveillance, so it makes sense that we don't see that reversal in cases yet.
Hampshire County is back in the CDC's low category of county transmission according to case rate and hospitalization data. All of MA is back in the green, as well as much as New England. This is great news as we approach a time of summer travel! However - I think the CDC county categorizations give an overly optimistic view of what's going on with the virus out there. I've included a side-by-side comparison of the map of the CDC's county transmission level and a map of case rate / transmission produced by the CDC. They are visual representations of two different ways of thinking about the data from the exact same date - June 23, 2022. They are wildly different perspectives! Transmission throughout the US, including MA, is incredibly high! Almost the entire map of the US is lit up red (high transmission). Folks who are high risk or who live with someone who is high risk (including unvaccinated folks of any age) should keep that in mind and layer other mitigation measures accordingly.
BA.4 and BA.5 are continuing to gain dominance throughout the US. More than half of new cases in the US are a result of the BA.4 and BA.5 variants. The proportion remains slightly lower in the Northeast. When paired with the wastewater data, it may be an indication that we're about to experience a BA.4 / BA.5 surge. It brings me no joy at all to write that sentence. I would love to be wrong. Perhaps countries where BA.4 and BA.5 are already dominant can provide an idea of what's coming. Countries like the UK, France, Germany, and Italy are experiencing an increase in cases again. However, the US is no longer having the same experience as these countries, just a few months or weeks behind. So perhaps those countries are not a good indicator of what might occur here. I suppose the most accurate statement right now is that a BA.4 / BA.5 surge is certainly a possibility, based on all the data we've reviewed thus far.
- Researchers from the Imperial College of London estimate that vaccines have prevented about 20 million deaths from COVID-19 in the first 365 days of vaccine use. The scope of that number is... beyond comprehension. Getting an exact number is hard - it's an estimate. The truth is probably a few million more or less than that. It's also, as we have discussed before, a smaller number than the number of deaths that could have been prevented, if more folks had been fully vaccinated sooner, both in regards to personal choice but also in regards to global equity in access to vaccines. Oh, and a small side note from the authors (that's actually an enormous side note) - their estimate does not include data from China, because case and death data from that country is just not clear enough yet. We can assume, however, that the number of deaths prevented or that could have been prevented is far greater than these estimates.
- We also saw data this week from the CDC with updated mortality rates by vaccination status. Those who remain unvaccinated have 42x greater risk of death than those with the prime series and 2 booster doses. The 2nd booster is already making a difference, too - those with 1 booster have 4x greater risk of death than those with the prime series and 2 booster doses. Get yourself boosted!
- Everyone over 6 months of age can now be vaccinated. My four year old was vaccinated this weekend. YAY! It was a really emotional moment as an epidemiologist parent. Thank you, science and scientists! Elmo was also vaccinated this week (Elmo is, apparently, three years old). This age group hasn't been added to the MA COVID-19 vaccination data yet, but I hope to see it there next week - and I hope to see those numbers climb quickly!
- The FDA's Vaccines and Related Biological Products Advisory Committee met to discuss a fall booster dose. Here's a run-down of key information discussed at the meeting:
a) We've been using the same vaccine formula throughout the pandemic, developed for the original SARS-CoV-2 identified first in Wuhan.
b) Pfizer and Moderna are developing and testing an omicron-specific booster in two ways: a "monovalent" vaccine (which includes only the omicron-specific formula), and a "bivalent" vaccine (which includes the omicron-specific formula and the original formula). Both worked "well," meaning that they had good antibody response in the lab and in humans.
c) The "omicron-specific" formula is really a BA.1-specific formula. It's already outdated by BA.4 and BA.5. Antibody production was less robust against the newer variants. d) Pfizer has already developed a BA.4/BA.5-specific booster formula. It works well in animal studies.
The FDA is responsible for deciding if there will be a fall booster, and if so, what formula will be included. The possibilities are the original formula, the BA.1-specific formula, and the BA.4/BA.5-specific formula. It might sound strange that the FDA would consider a formula that has only been through mice trials so far, but this is actually very normal. This is how the flu shot is created every year - we have a formula that we know is safe and effective, and there are minor adjustments made each year based on the flu strains predicted to be dominated by the World Health Organization. The fact of the matter is that we'll have to move to a model like the flu vaccine soon where we approve new formulations faster. Otherwise, we'll be chasing variant surges indefinitely.
So what has been decided? The VRBPAC voted in favor of a fall booster, by a vote of 19-2. The formula has not been selected yet. The timing has not been selected yet. The age groups and populations eligible have not been selected yet. But there will be a booster available this fall.
- We also learned this week that Pfizer is working on a universal COVID-19 vaccine and that clinical trials would likely begin later this year. The universal vaccine will additionally target T-cells in the immune system, which will prevent severe disease regardless of mutations that make the virus more severe. It would also provide broader coverage against coronaviruses in general, which will provide more general COVID-19 coverage as the virus mutates. This news makes me feel... wait, what is that feeling? Hope? Hope. There it is. The vaccine technology and clinical trial process has progressed rapidly and has become well understood as a result of the COVID-19 pandemic. Scientists are now turning their attention to universal vaccines for COVID-19, but also for things like the flu, and HIV. The possibilities are really promising, and yep, there's that feeling again (hope).
Stay well, and thanks for continuing to engage and ask questions. I know it's exhausting. I hope these updates bring you a little sliver of that hope, too.
Megan W. Harvey, PhD (she/her)