Key Points:

• In today’s Recommendations for Industry, we discuss the flattening of global COVID cases. Read more below.
• Asian COVID hot spots show signs of improvement. The pace of COVID-19 spread appears to be slowing in some of Asia’s recent hot spots, including Hong Kong, where the number of daily cases has been declining since about the second week of March, with cases now at their lowest level in a month. In Vietnam, cases are showing signs of decline, with the 7-day average for daily cases down 27% compared to the week before. South Korea’s daily cases today dropped below 400,000 for the second day in a row. 
• The WHO says the BA.2 subvariant of Omicron is driving most cases around the world. The World Health Organization reported that the Omicron subvariant, BA.2 is now the dominant version of Omicron around the world. Globally, BA.2 made up about 86% of cases reported to the WHO between Feb. 16 and March 17. The previously dominant subvariants, BA.1 and BA.1.1, together represented about 13 percent of the cases.
• Shanghai’s lockdown. China’s largest outbreak since the beginning of the pandemic is now gripping Shanghai, its largest city and a global financial center. The city of 26 million reported more than 2,600 COVID infections yesterday, from just a handful in early March, with hospitals and medical staff already stretched thin. The government is introducing a two-stage lockdown and plans to test all 26 million residents in the coming weeks.
• Africa’s Low Vaccination Rates Should Concern Everyone/S. Africa easing COVID restrictions. Only about 15 percent of the population in Africa has been fully vaccinated. Because of this, the trajectory of the pandemic on the continent remains unpredictable and uncertain. With low vaccination rates, we run the risk of being hit by new variants that may severely impact the effectiveness of vaccines globally and limit people’s lives once again. On the other hand, South Africa, the country in Africa worst affected by coronavirus, has eased COVID restrictions for vaccinated travellers, dropping mandatory negative results for inbound fully vaccinated travellers, a move expected to boost tourism.
• The Pandemic Revolutionized Disease Surveillance. Now What? As the pandemic enters its third year, funding for COVID data collection is drying up. The article discusses a number of UK-funded COVID surveys will be greatly reduced or discontinued. Researchers warn that relaxing restrictions and surveillance at the same time could be unwise since these surveys act as early warning systems for new variants or mysterious bumps in cases. With stripped-back restrictions, data is all we’ve got. There also remains a threat of future waves because there’s the threat of new variants.
• Cruise ship with fully vaccinated passengers/crew has COVID outbreak. The Ruby Princess returned to San Francisco from a 15-day Panama Canal cruise with some passengers and crew members infected with COVID-19. All guests and crew on the ship were fully vaccinated, and those infected were either asymptomatic or showed mild symptoms. The total number of infections resulting from the cruise was not released. The ship’s medical team ordered everyone who tested positive to isolate.

Influenza, Infectious Disease, and Food Safety:

• There are continuing reports of rising flu cases in parts of the world, attributed to relaxation of COVID precautions.
• Tuberculosis
  • March 24 was world tuberculosis day, so it is a good time to remind all of the need to focus on recognizing and following latent TB cases and those among pregnant women and children to ensure treatment is effective.
  • In India – As the home to a quarter of the world’s TB infections, an estimated half-million people died of TB in 2020 – one-third of the global toll.
    • It now faces an uphill battle to meet its goal of ending the spread of TB by 2025, after the pandemic reversed years of progress
    • Increased mask-wearing was one silver lining, but more funding is now needed for TB vaccines and support to combat malnutrition, a major trigger for the disease
  • In the U.S. Reported tuberculosis (TB) diagnoses in the United States fell 20% in 2020 and remained 13% lower in 2021 than TB diagnoses made prior to the COVID-19 pandemic
    • Mask use and distancing measures—aimed at preventing COVID spread—likely limited TB transmission, and TB infections were likely missed as healthcare visits dropped during the first months of the pandemic.
• Three states report more avian flu outbreaks in poultry. Iowa, New York, and South Dakota reported more highly pathogenic avian influenza (HPAI) outbreaks in poultry, most of them involving commercial flocks. The spread of the Eurasian H5N1 strain has affected poultry in 17 states and led to the loss of at least 13.6 million birds, and the Philippines has reported its first outbreak in poultry involving the highly pathogenic H5N8 strain.

Recommendations for Industry

Global COVID Flattening, Showing No Rise in U.S.

As the most recent CDC map (above left) of Community levels shows, COVID is continuing to decline in much of the U.S. as compared with previous weeks (last week’s data shown above right). While we may still expect a nudge of increase from the BA.2 subvariant of Omicron, as took place in Europe, we are not yet seeing a general increase or any indication of any immediate threat of anything significant occurring in the U.S.

On the global front, the BA.2 surge seems to have peaked out in Europe, with the rate of increase generally plateauing or declining in the UK and other countries.

Additionally, we are seeing daily cases dropping around the world according to Worldometer data.

For us in the United States, Western Europe and the UK have presaged the trajectory of COVID in the US so the current situation in Europe is encouraging for them (and us). We would expect a small increase in cases driven by BA.2 over the coming weeks in the US, but nothing like what we saw in January or February. As case rates rise, stay tuned for TAG’s recommendations regarding the strategic implementation of mitigation measures.

In Case You Missed It:

• In last Thursday’s Recommendations for Industry, we discussed TAG’s interpretation of COVID trends being seen in TAG’s matrix and other news indicating a “nudge” – not a surge – in the US. Read more here.
• Weekly WHO Update: Global COVID-19 cases climb for second week in a row. Led mainly by surges in Asian hot spots, COVID-19 cases last week increased for the second straight week, though deaths continued to fall. Cases are up 7% compared to the week before, with cases up 21% in the Western Pacific region. Deaths overall declined 23% compared to the week before, though they were up 5% in the Western Pacific region.
• In the U.S., new COVID-19 cases are holding steady or increasing in about 19 states, according to data from Johns Hopkins University. Although health officials have warned that overall COVID-19 infections could rise across the US in a few weeks, parallel to trends in the UK and Europe, leading public health officials are not expecting another dramatic surge in new cases, largely due to the level of immunity the population has from vaccination and the fierce outbreak during the winter Omicron wave.
• FDA announced that the Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet on Apr 6 to discuss the future role of booster shots, following emergency use authorization (EUA) submissions from both Pfizer and Moderna for fourth doses. Moderna is seeking emergency use authorization for a two-dose primary series of its COVID-19 vaccine for children ages 6 months to 6 years and plans to ask for regulatory authorization in Europe and is seeking to have larger-dose shots cleared for older children and teens in the U.S.
• Millions of Americans are wondering about their protection after a winter of booster shots and Omicron infections. As mask mandates are lifted and restrictions removed in a step toward normalcy, a test to measure immunity would be a powerful tool to measure individual risk.  With FDA recommending against checking antibody levels because there’s no agreed-upon way to calculate how any given antibody level protects you from infection or severe disease, scientists are trying to fill the knowledge gap, but it’s not a straightforward concept due to factors such as not all antibodies can prevent infection, levels can vary person to person, natural and vaccine-acquired immunity varies, and antibody levels are just one factor of immunity.
• COVID-19 patients can safely use inexpensive pulse oximeters at home to watch for a drop in blood oxygen that signals the need to seek advanced care, according to a systematic review published in The Lancet Digital Health. The review showed that pulse oximetry enabled early identification of decreasing oxygen levels and helped triage patients with guided care escalation and has led to recommendations for creating a remote patient monitoring (RPM) program with pulse oximetry including a cutoff point in blood oxygen saturation of 92% and a decrease of more than 3% after exertion.
• In a press release, AstraZeneca said its antibody preventive treatment Evusheld retains neutralizing antibody activity against Omicron and its BA.2 subvariant. New preclinical authentic ‘live’ virus data from Washington University School of Medicine demonstrated that Evusheld (tixagevimab co-packaged with cilgavimab) retains potent neutralizing activity against Omicron BA.1, BA.2, and BA.1.1.1., significantly reducing the viral burden and limited inflammation in the lungs for all three subvariants.