You probably won't be surprised, given the trend from the past few weeks, that the case rate and percent positivity is up in Easthampton again this week (see case rate visual). Wastewater surveillance data confirms that the increase in the case rate reflects a true increase in community transmission (see wastewater visual).
There are two things that I find concerning this week:
1) The percent positivity is up past 4%. This is an indication that testing capacity is struggling to keep up with demand. If percent positivity goes over 5%, we're back in that old "red" category of transmission. I'm not surprised to see this, given that community transmission is increasing and testing sites have shut down or scaled back. Keep in mind that this is only reflective of PCR testing. We have to rely on wastewater surveillance to have an idea of what's going on with at home rapid testing.
2) Hospitalizations are increasing slightly (see the hospitalizations visual). This is the point we discussed last week - a rise in cases is tolerable, to the point where it overwhelms the healthcare system. I'm not suggesting the system is overwhelmed yet, and I have no idea if it will be. I hope not! But it is concerning to see a rise in hospitalizations so soon after the increasing trend in cases. I had hoped that cases and severe disease would have diverged more since our last omicron surge. There's nothing to do here but watch and wait. And, of course, get vaccinated and/or boosted if you want to increase your chances of not getting severe disease.
Notably, Hampshire County has been updated this week from a county with low transmission to medium transmission, according to the updated CDC guidelines. You can see the updated CDC categories for counties in the Northeast in the middle of this week's dashboard. I'm also including some visuals from the 2/24/22 dashboard to remind you how those categories are determined and recommendations for a county in each level of transmission. There actually aren't really any additional recommendations for folks living in a county in the medium category, except that folks who are high risk should talk to their health care provider about whether they should mask in public. If hospitalizations continue to increase, the county may move into the CDC's high category, which would come with the recommendation for universal indoor masking.
A) The FDA expanded approval of remdesiver, the COVID-19 treatment, to include children 28 days and older weight 3 kg or more. This is the first approved COVID-19 treatment for children under 12. Dr. Cavazzoni, the director of the FDA's Center for Drug Evaluation and Research, said of the decision: “As COVID-19 can cause severe illness in children, some of whom do not currently have a vaccination option, there continues to be a need for safe and effective COVID-19 treatment options for this population. Today’s approval of the first COVID-19 therapeutic for this population demonstrates the agency’s commitment to that need.”
B) While treatments for COVID-19 are available and very effective, they can sometimes be difficult to get. Part of the issue is access and part of the issue is patient and healthcare provider knowledge of treatment options. We've covered general treatment categories and options in the 2/17/22 dashboard. I'm including that visual again here for reference. An expert on COVID-19, Dr. Mostashari, recently personally navigated the system to secure treatment for his elderly parents, and created a record of the step. The New Yorker covers the story here (https://www.newyorker.com/news/daily-comment/after-a-covid-expert-struggled-to-obtain-new-treatments-for-his-parents-he-tweeted-a-road-map). A fellow COVID-19 expert, Dr. Salehizadeh, summarized the process in a publicly available google document. You can access that by following this link to twitter (https://twitter.com/bijans/status/1515335811994206221). The overarching lesson I take from this story, and the reason I share it here, is that patients and their families really must advocate for treatment options quickly after diagnosis. The New York Times also published a thorough summary of the available antiviral treatment options and their effectiveness ( https://www.nytimes.com/explain/2022/03/21/well/covid-antiviral-pills)
C) Reports have come out in the last week indicating that the data to approve the Moderna vaccine for children ages 6 months to 4 years is ready to submit and would be approved. An unnamed insider said, however, that the administration and FDA are "leaning toward postponing any action until the early summer, arguing that it would be simpler and less confusing to simultaneously authorize and promote two vaccines to the public.” This does seem to hold some weight. CNN asked Dr Fauci "If Moderna is ready to apply for that EUA and we can have it in May, why can't we have it in May?” Dr. Fauci's response was "I don’t have an answer to that. I’m sorry."
This information has not been well received by many pediatricians and parents of children under 5. There are two petitions to the FDA to approve the Moderna vaccine now, without waiting for the Pfizer vaccine for this age group, circulating. The petitions come from Protect Their Future (protecttheirfuture.org
) - one is being signed by doctors (MDs and DOs) and one is being signed by parents. There have been a number of petitions for and against various vaccine efforts for the past 2 years, so why am I reporting on these two? These particular petitions are picking up speed and seem to have already influenced leaders in DC.
The Chairman of the Select Subcommittee on the Coronavirus Crisis, sent a letter to the FDA Commissioner yesterday (4/25) requesting a briefing on the status of the Moderna vaccine approval for children under 5, to be submitted to the Subcommittee by May 9th. Specifically, the Chairman requests information on if recent reports of a potential delay of FDA’s decision are accurate and the scientific basis or other rationale for any such delay.
D) Moderna released information this week about progress towards a booster dose that targets multiple known mutations of the SARS-CoV-2 virus. The booster has been created and is undergoing testing, but the data is not yet publicly available. Early data indicates that the approach may provide a higher level of protection against all known variants and would be a big step forward - we would proactively have more protection, rather than attempting to reactively make boosters to specific variants. More data is expected at the end of June.
E) The Peterson Center on Healthcare and KFF recently updated their analysis of the number of vaccine-preventable COVID-19 deaths in the United States. Since vaccines became widely available in summer of 2021, a total of at least 389,000 adults (18+ years old) have died in the US of COVID-19. About 60% of those deaths would have been prevented if the infected person was vaccinated - that's a total of at least 234,000 vaccine-preventable deaths. See the visual for the monthly breakdown of preventable deaths. The US is about to reach the horrible milestone of surpassing at least 1 million COVID-19 deaths.
F) The Biden administration, under advice of the CDC, is going to appeal the recent ruling striking down the mask mandate on public transportation. Leaders in this area agree that this appeal is standing on the principle of a strong CDC now and in the future, rather than an overwhelming belief that a few week extension on the mask mandate is of vital importance. The appeal is meant to protect the CDC's ability to protect public health. If the ruling goes unchallenged, there is an unsettling reduction in the ability of the CDC to recommend and enforce necessary public health measures.
The CDC has the ability to protect public health under the Public Health Service Act (42 USC § 264), which authorizes the HHS Secretary "to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states." That broad power includes "inspection, fumigation, disinfection, sanitation, pest extermination, ... and other measures, as in his judgment may be necessary." In theory, the appeal should go through. The issue is that the recent judgement blocking the mask mandate interpreted this statute very narrowly - so narrowly that it limits the CDC to sanitation measures only. Which are clearly of no use for an airborne respiratory virus (like COVID-19, but importantly - in the future, against now unknown pathogens).
Dr. Gostin, an expert in public health law, advised the administration to appeal, saying that the ruling "sets up a clash between public health and a conservative judiciary, and what’s riding on it is the future ability of our nation’s public health agencies to protect the American public." The case will probably reach the US Supreme Court.
That should do it for this week. Stay well.
Megan W. Harvey, PhD (she/her)