Epidemiology Update – New SARS-CoV-2 variants

• VOC 202012/01 or B.1.1.7 (UK variant) detected in ten additional countries. As of 2 February, a total of 80 countries have reported either imported cases or community transmission of this variant.
• Vietnam confirms latest virus outbreak is more contagious B.1.1.7 variant.

• Variant 501Y.V2 or B.1.351 (South Africa variant) reported in ten new countries – totaling 41 countries.
• The US detected its first case of B.1.351 or South African variant in South Carolina. Case detected in Baltimore as well.
• Both J&J and Novavax vaccines less effective against the B 1.351 variant.
• How to redesign COVID vaccines so they protect against variants?

• Variant P.1 or B.1.1.28 (Brazil variant) reported in two additional countries. To date, this variant is reported in ten countries worldwide.
• A study published in The Lancet analyzed the increased SARS-CoV-2 transmission in Manaus, Brazil, a region that had previously shown high levels of seroprevalence among its community members. Despite the high seroprevalence, Manaus exhibited a large surge in COVID-19 cases and hospitalizations in January 2021. The researchers present 4 possible explanations for the surprising surge in cases: (1) prior overestimation of seroprevalence; (2) waning of immunity; (3) new variant, including the P.1 variant, less susceptible to antibodies from prior infections;(4) much higher transmissibility, allowing for community transmission even in areas with high existing seroprevalence.
• Scientific American guide to the most-concerning mutations seen in five SARS-CoV-2 variants first identified in Spain, the UK, and South Africa, as well as two in Brazil.

Other Headlines

• The pace of the Covid pandemic has slowed in every region of the world for the third week in a row, with a 13% decline as compared to the previous week.
• Saturday 30 January 2021 marked one year since WHO declared COVID-19 a Public Health Emergency of International Concern (PHEIC). At that time, there were 9826 cases in 20 countries, and 213 deaths in one country (all in China).
• US Centers for Disease Control and Prevention (CDC) requires masks to be worn by all people traveling on public transportation, including airplanes, ships, ferries, trains, subways, buses, taxis, and ride-shares.
• Number of French coronavirus patients highest since end November.
• Nigeria battles oxygen shortages amid COVID-19 surge.
• Mexico's COVID-19 death toll surpasses India, becomes world's third highest.
• More than half of New Delhi’s 20 million inhabitants possibly infected with the coronavirus, according to a new serological survey.
• Three takeaways from India's 'pandemic budget'.
• COVID-19 cases - potential link to new diabetes cases.
• Double masking may provide additional layers of filtration for inhaled and exhaled air with the ultimate goal of further decreasing SARS-CoV-2 transmission risk.

UPDATE ON KEY TOOLS

Vaccine Development and WHO approval

·        A single dose of the Oxford/AstraZeneca vaccine provides sustained protection against Covid-19 for at least three months and reduced transmission of the disease by 67%.

·        Sputnik V vaccine results from 20,000 trial participants published in The Lancet, suggesting an efficacy of 91.6% against COVID-19. There was good efficacy in older adults, who are at highest risk for death, but little diversity, since most participants were white males.

·        EU Commission gives final approval to AstraZeneca vaccine.

·        Johnson & Johnson (J&J) vaccine demonstrated 66% efficacy in preventing moderate-to-severe COVID-19 disease across several Phase 3 trial locations: the US (72%), Latin America (66%), and South Africa (57%). The lower efficacy in Latin America and South Africa prompted concern about the vaccine’s protection against emerging variants, including B.1.351 which is circulating widely in South Africa. Nearly all trial included cases of COVID-19 (95%) [in South Africa] were due to infection with the B.1.351 lineage. The vaccine demonstrated 85% efficacy in terms of preventing severe disease across all locations, regardless of the variant.

·        Novavax says COVID-19 vaccine 89% effective in UK trial but only less effective against the South African variant.

·        The WHO updated its guidance on the Moderna SARS-CoV-2 vaccine to include pregnant women.

How do vaccine front-runners compare?

(Updated as of February 1, 2021; source: New York Times, Reuters, Bloomberg)

Vaccine  Access, Delivery, and Rollout

·        German authorities have blocked the use of the Oxford/AstraZeneca vaccine on people aged over 65, the Financial Times has reported.

·        WHO director-general says COVID-19 vaccine nationalism harmful for all.

Africa (AFE and AFW)

·        First vaccine doses arrive in hard-hit South Africa.

·        Tanzania has “no plans” to accept COVID-19 vaccines.

·        The Democratic Republic of the Congo (DRC) announced a partnership between VillageReach, Swoop Aero, and the Ministry of Health—“Drones for Health”— to promote equitable access to healthcare for half a million people in remote communities of the Equateur province. In addition to standard medical supplies, the new program is expected to support SARS-CoV-2 vaccination efforts in the country. These drones will be used to deliver medicine and other supplies to 75 health facilities in the province.

·        The Africa CDC secured another 400 million doses of the AstraZeneca/Oxford vaccine, manufactured by India’s Serum Institute. This adds to the 270 million doses previously secured from Pfizer, AstraZeneca, and Johnson & Johnson (J&J).

Europe

·        France to offer vaccine for all French people by summer-end.

·        Hungary’s drug regulator granted emergency use approval to Chinese Sinopharm’s vaccine, in addition to Sputnik V ( last month) rather than waiting for the bloc’s European Medicines Agency (EMA) approval.

·        Both France and Germany have threatened legal action against AstraZeneca in the row over a shortage of coronavirus vaccine in the EU.

·        The EU’s medicines regulator has authorized AstraZeneca’s Covid vaccine for use in adults throughout the bloc.

·        Armenia approves Russia's Sputnik V coronavirus vaccine.

East Asia and Pacific

·        Malaysia to receive first batch of Pfizer vaccines on Feb. 26.

·        China cracks fake COVID-19 vaccine ring, confiscates 3,000 doses.

Latin America and the Caribbean

·        Rio de Janeiro will be able to use hundreds of Sinovac vaccines the city initially feared spoiled after a power outage left them stored at an inappropriate temperature.

·        Peru regulators approve Pfizer vaccine against COVID-19.

·        Mexico nears approval of Russia vaccine.

·        Mexico to import AstraZeneca vaccine from India.

Middle-East and North Africa

·        The Palestinian Authority began vaccinating its health workers in the occupied West Bank against Covid-19 after receiving doses from Israel.

South Asia Region

·         Pakistan military airlifts first COVID-19 vaccine consignment from China.

·        Sputnik V Covid vaccine production starts in India.

·        Bangladesh starts COVID vaccination drive from February 7^th but misinformation may lead to vaccine skepticism.

Treatment

·        The evolving clinical treatment standards for COVID-19 patients are driving a shortage of oxygen, in the US and countries around the world. The use of high-flow oxygen, as opposed to mechanical ventilation, is placing strain on oxygen production and use capacity, which has resulted in efforts to mitigate the increase in use and identify solutions to bolster capacity.

·        Monoclonal bodies ineffective against new COVID-19 variants.

Diagnostics

·        S. Korea's Seegene develops first COVID-19 test kit that can detect multiple variants.

Epidemiology Update – New SARS-CoV-2 variants

• The South African COVID variant 501Y.V2 may be more contagious , and can elude immune responses –with several mutations in its spike protein blunt effects of neutralizing antibodies and may compromise immunity and vaccine effectiveness.
• The UK B.1.1.7 variant of concern (VOC) may be associated with increased mortality compared to other strains of SARS-CoV-2, in addition to higher transmissibility. Mortality risks were higher in multiple age groups ranging from 29% to 91% in multiple studies.

HOW DO SARS-CoV-2 VARIANTS COMPARE?

Source: New Scientist-  A guide to SARS-CoV-2 variants (Jan 25, 2021)

     Are vaccines effective against variants?

• Moderna and Pfizer-BioNTech both say their vaccines are effective against new variants of the coronavirus discovered in Britain and South Africa. Both are slightly less effective against the South Africa variant. Moderna said, although there was a six-fold reduction in vaccine’s neutralizing power to the South African vaccine in vitro, it is still protective. No data is available for Brazil variant.
• Booster Shots – Both Pfizer and Moderna are developing a booster shot to protect against COVID-19 variants.
• What to keep in mind with regards to booster shots? Booster shots will have cost implications for countries and could require further regulatory review process for a new booster or an additional booster dose.
• Minnesota confirms US’s first COVID-19 case associated with Brazil P.1 variant.

Countries reporting Coronavirus variants

Map is for illustrative purposes only and is not an official map. As a result, the map may not represent boundaries and borders accurately. 

Source: https://cov-lineages.org/global_report.html

Other Headlines

• Patients battle covid 'enemy' in Nigeria second wave.
• Countries in Europe grappled with more fallout from their surges, including riots in Netherlands over COVID-19 measures; Germany, where a Berlin hospital is on lockdown following an B117 variant outbreak, and France, where officials are considering a third lockdown amid rising cases and hospitalizations. UK crosses 100,000 deaths.
• Lebanon is facing a COVID-19 surge, with hospitals running out of room for more patients, Oxygen tanks, ventilators, and medical staff in extremely short supply.
• Mexican President tested positive for SARS-CoV-2.
• COVID-19 lessons from Bolivia – In Bolivia, non-pharmaceutical interventions were combined with income supports targeted at workers at risk of impoverishment. Further, policy making at the subnational level was a crucial aspect of the response.
• Nearly 8.8% of global working hours were lost in 2020  according to the International Labor Organization (ILO).
• New Zealand’s first case of community transmission in 2 months in form of South Africa COVID-19 variant.
• U.S. Tops 25 Million Confirmed Coronavirus Cases.
• Health worker strikes in Africa - In Eswatini, health care workers announced a national strike on 18 January. Although nurses in Bungoma, Kenya suspended their strike on 21 January, nurses continue to strike in Kenya, which may effect the number of tests performed and overall health system delivery.

UPDATE ON KEY TOOLS

Vaccine Development and WHO approval

• Status of COVID-19 Vaccines within WHO EUL/PQ evaluation process (20 January)
• Merck discontinues development of COVID-19 Viral Vector Vaccine Candidates due to inferior immune responses.
• Johnson & Johnson expected to share results from COVID-19 vaccine trial next week.
• The World Health Organization (WHO) issued recommendations on Tuesday on the use of the Moderna COVID-19 vaccine and WHO emergency use listing is now imminent.
• WHO expected to review AstraZeneca COVID-19 vaccine on February 8.
• Gamaleya begins testing a single-dose version called “Sputnik Light.”
• In India, Bharat Biotech‘s inactivated vaccine Covaxin has been given emergency approval, while it’s still finishing up Phase III trials. The Phase I data is now published.

Vaccine  Access, Delivery, and Rollout

• International Chamber of Commerce (ICC) – global economy could lose as much as $9.2 trillion if governments don't ensure that developing countries have access to COVID-19 vaccines.
• Pfizer/BioNTech sign a 40 million supply deal with COVAX.
• BioNTech to supply 50m specialty needles to countries struggling to extract a sixth dose from vials of its Covid-19 vaccine as Europe’s immunization drive is held back by a temporary supply shortfall.
• AstraZeneca vaccine may be in shorter supply due to manufacturing problems. AstraZeneca to supply 31 million COVID-19 shots to EU in first quarter, a 60% cut.
• The US Centers for Disease Control and Prevention (CDC) updated its guidance regarding use of the mRNA COVID-19 vaccines. The US Food and Drug Administration (FDA) has approved an updated label allowing a potential extra dose of the Pfizer and BioNtech COVID-19 vaccine to be extracted using low dead-volume syringes.

Map is for illustrative purposes only and is not an official map. As a result, the map may not represent boundaries and borders accurately.

Africa (AFE and AFW)

• Zimbabwe launches wide vaccine effort and plans to buy sufficient coronavirus vaccines to inoculate about two-thirds of its population, amid a surge in infections and deaths.
• Nigeria expects to get 1st COVID-19 vaccine in February.
• Mali secures AstraZeneca COVID-19 vaccine for 4.2 million people, expected to start vaccination in April.
• South Africa’s ambitious vaccine roll out plan.

Europe

• Hungary has licensed Russia’s coronavirus vaccine, breaking ranks with other EU countries and ignoring calls to stick to a common European vaccine policy.
• Turkey receives 6.5 million doses of China's Sinovac vaccine.
• Denmark will include homeless people among those given priority for Covid-19 vaccines.

East Asia and Pacific

• Australia grants provisional authorization for the use of the Pfizer/BioNTech vaccine.
• Malaysia secures 18.4 million doses of Russian, Chinese COVID-19 vaccines.
• Thailand to start its coronavirus inoculation programme next month by administering the AstraZeneca vaccine.

Latin America and the Caribbean

• Mexico is very close to signing a contract for Russia's Sputnik V coronavirus vaccine and the first shipment of around 200,000 doses could arrive next week.
• Ecuador has approved the use of AstraZeneca’s Covid-19 vaccine.
• Brazil approves use of CoronaVac doses partly manufactured locally.

Middle-East and North Africa

• Bahrain approves Oxford-AstraZeneca COVID vaccine for emergency use.
• Morocco received 2m doses of AstraZeneca’s Covid-19 vaccine, as it prepares to become the first African state to roll out a mass immunization program this week. Morocco also approved emergency use authorization for China’s Sinopharm vaccine. First batch to arrive by Wednesday.
• Iran approved Russian coronavirus vaccine Sputnik V.
• Lessons from frontrunners - Israel and UAE are world front runners in vaccine roll out with 47 and 27 vaccines administered per 100 people respectively.  Preliminary analysis of 200,000 vaccinated 60+ citizens in Israel (where more than 75% of older people have gotten a COVID-19 shot) shows that they were 33% less likely to test positive 2 weeks after their first dose, compared to 200,000 unvaccinated people. Israel also reported a 60% drop in hospitalizations for people aged 60+ just 3 weeks after they got their first Pfizer COVID vaccine dose. Reductions in hospitalizations, then deaths, are believed to be the first signs the vaccines are working. On the other hand, despite a world-leading vaccine programme, the UAE is struggling to contain surging coronavirus infections, driven in part by reluctance to shut down its vital tourism sector. Israel is using Pfizer and Moderna. UAE is using Sinopharm and Pfizer, and as of this week, approved Sputnik V.  UAE’s experience warns against complacency in public health measures during roll out of vaccines.
• What worked in Israel and why? Lessons from Israel’s vaccine roll out success highlight the importance of: (1) political stewardship; (2) outreach to minority groups; (3) dedicated vaccination sites; (4) high level of preparedness and community mobilization during crises; (5) linking prioritization for different groups to different delivery systems; (6) using traditional forms of interaction in addition to digital communication; (7) strong health workforce; and (8) system to monitor uptake and post-vaccine surveillance.

South Asia Region

• Pfizer will pursue its request for India to approve its COVID-19 vaccine if the government commits to buying shots.
• India will administer homegrown coronavirus vaccine ‘Covaxin’ in seven more states from Monday as it seeks to inoculate 30 million healthcare workers across the country.
• Indian hesitancy sets back world’s biggest Covid vaccination drive. India’s Covid-19 vaccine drive has been hampered by turnout as low as 22% in some states, as fears over the safety of the vaccine and the spread of misinformation has fueled widespread hesitancy. Many doctors have expressed concern over the incomplete data underpinning India’s Bharat Biotech  Covaxin shot.
• Taliban backs Afghan vaccine drive after COVAX pledges $112 million.
• Pakistan is all set to approve the Russian Sputnik vaccine for emergency use.
• Bangladesh receives first Covid vaccine consignment of 5 million doses from India. Bangladesh has so far purchased 30 million doses of Covishield vaccine from the Serum Institute of India. India and vaccine diplomacy.

Treatment

• Higher blood thinner dose keeps patients off ventilators : A large clinical trial found that full dose blood thinners helped reduce mortality among hospitalized COVID-19 patients.
• A new study suggests that those who recover from COVID-19 are protected against the virus for at least six months.
• Spanish pharmaceutical company PharmaMar publishes paper that shows, its drug Plitidepsin has a "potent preclinical efficacy" against COVID-19.
• WHO issues new clinical advice on treating COVID-19 patients.

Mobility

• United States extends travel bans on Brazil, South Africa, and much of Europe.
• The UK will announce on Tuesday enforced quarantine for travelers arriving in the country from abroad. Germany is extending its national lockdown until 14 February.
• Iceland to start issuing vaccine certificates.
• Olympic Games will go ahead in July despite a state of emergency being declared in Tokyo because of increasing Covid-19 cases.