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April 22, 2021 - Brief Issue 186

The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University.

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Top Headlines

Experts Say U.S. Could Reach Vaccine “Tipping Point” as Appointments Go Unfilled Across the Country (Health & Science)

Vaccines Are Safe For Pregnant Women, According to Early CDC Data (Health & Science)

U.K. Trial Will Reinfect Young, Healthy Volunteers With Covid-19 (Health & Science)

Covid-19 Pandemic Means Less Testing, Treatment for HIV Patients in U.S. (Health & Science)

For the Time Being, WHO Doesn’t Support Vaccine Passports (Health & Science)

Antibody Data Show Racial Discrepancies in Covid-19 Infection Rates in NYC (Health & Science)

India’s Health System Crumbling Under Strain from Covid-19 Patients (Around the World)

Argentina Covid-19 Deaths Hit 60,000 (Around the World)

Europe Prepares to Start Using J&J Shots (Around the World)

Biden Urges Employers to Provide Paid Time Off for Vaccinations (U.S. Government & Politics)

Supply Chain Issues Challenge Small Businesses (U.S. Economy)

Vermont Used Isolation to Keep Covid at Bay in Prisons; It Came at a Cost (U.S. Society)

Health & Science

There have been 31,862,987 coronavirus cases in the United States, and 569,404 people have died (Johns Hopkins). The United States has conducted 421,219,495 tests and administered 215,951,909 vaccine doses, with 40.5% of Americans having received their first vaccine dose and 26.4% fully vaccinated (U.S. CDC). Worldwide, there have been 143,955,896 confirmed cases of coronavirus, with 3,061,290 deaths. At least 82,530,220 people have recovered from the virus.

Experts Say U.S. Could Reach Vaccine “Tipping Point” as Appointments Go Unfilled Across the Country

Although the U.S. just reached a milestone of 200 million vaccine doses administered, health experts are warning that within the next few weeks, vaccine supply in the U.S. might overtake demand (CNN, Politico, MSNBC). This poses a threat to the country’s goal of reaching herd immunity, which experts define as a 70-85% vaccination rate. The Kaiser Family Foundation estimated that the U.S. will reach a “tipping point” in vaccine enthusiasm within 2 to 4 weeks, after which “efforts to encourage vaccination will become much harder.” Vaccine appointments are going unfilled in big cities and rural areas alike, due to vaccine hesitancy and access issues; some states are giving out less than three quarters of their allotted doses, according to the Centers for Disease Control and Prevention. There is also a growing urban-rural divide in vaccinations in many parts of the country, with rural areas reporting lower levels of vaccination compared to urban ones, particularly among seniors (NPR).

Vaccines Are Safe For Pregnant Women, According to Early CDC Data 

Preliminary findings from the first 11 weeks of the U.S.’ vaccine rollout suggest the Pfizer and Moderna vaccines are safe for pregnant women (NYT). This study, published in the New England Journal of Medicine and authored by CDC researchers, enrolled over 35,000 people who got vaccinated right before or during pregnancy, making it the largest study of pregnancy and coronavirus vaccines to date. Though research is ongoing, the team found that pregnant women report similar patterns of side effects compared to other vaccine recipients. The vaccine also does not appear to elevate the risk of complications like miscarriage or premature birth. “It is very reassuring that there were no reported acute events in pregnant individuals,” wrote Dr. Michal Elovitz of the University of Pennsylvania in an email to the New York Times. 

U.K. Trial Will Reinfect Young, Healthy Volunteers With Covid-19

In a forthcoming trial from the University of Oxford, volunteers who previously had Covid-19 will be reinfected with the virus as researchers study how the immune system responds to repeated infection (Oxford, BBC). This “human challenge trial” will begin in late April 2021, when up to 64 healthy participants between 18-30 years old – all fully recovered from a prior, natural infection – will be reinfected with the original strain of the virus causing Covid-19. All will be carefully supervised and quarantined for at least 17 days, and those who develop symptoms will be given Regeneron’s monoclonal antibody treatment. The goal of this first phase is to determine the lowest possible dose of the virus that starts replicating in the body without producing symptoms. In the next phase, beginning in the summer, more participants will be infected with the dose previously identified. “We will then be able to understand what kind of immune responses protect against re-infection,” said chief investigator Helen McShane of the University of Oxford. “Second, we will measure the immune response at several time points after infection so we can understand what immune response is generated by the virus.” The team hopes these findings will clarify the level of immune response that actually provides protection, possibly advancing the development of vaccines and other antiviral drugs. 

Covid-19 Pandemic Means Less Testing, Treatment for HIV Patients in U.S. 

As the Covid-19 pandemic disrupts public health measures directed toward HIV/AIDS, experts are concerned about a worsening of the HIV crisis (NPR). Many HIV rapid testing programs and in-person visits for HIV screening have ground to a halt due to the pandemic, meaning health authorities have far less information on the prevalence of HIV. Between March and September 2020, the number of HIV screening tests across the U.S. fell by 45% compared to the previous year and there were 5,000 fewer doses. Prescriptions for PrEP, which helps prevent HIV infection, also dropped. This leaves experts in the dark: "There will be damage,” said Dr. Carlos del Rio of Emory University. “The question is, how much?" Services for patients with HIV have worsened over the course of the pandemic – not only have medical resources been redirected toward Covid-19, but the switch to virtual care presents access and inclusion issues – and HIV testing equipment has been diverted to Covid-19 testing. Globally, the pandemic has disrupted the fight against many other diseases, including tuberculosis, measles, and polio (Nature). 

For the Time Being, WHO Doesn’t Support Vaccine Passports

World Health Organization spokesperson Margaret Harris said on Tuesday that, as of right now, the WHO does not support the use of vaccination passports for travel (Reuters). As Harris explained, health officials aren’t yet sure how effective vaccines are in preventing transmission; there are also equity concerns over limiting certain activities to vaccinated individuals. 

Antibody Data Show Racial Discrepancies in Covid-19 Infection Rates in NYC

A study accepted by the Journal of Infectious Diseases suggests that almost a quarter of adult New Yorkers had Covid-19 least year, with far higher rates among residents of color (NYT). Antibody test results from 45,000 New Yorkers indicated that 35% of Hispanic participants, 33.5% of Black participants, 20% of Asian-American participants, and 16% of white participants had been infected with the virus. While the study was limited by an unrepresentative number of Black participants and recruiting methods that may have drawn people who believed they’d had Covid-19, thus skewing the data, experts say it illuminates how the pandemic amplifies racial disparities. Dr. Wafaa El-Sadr of the Columbia Mailman School of Public Health said frontline workers, who are often nonwhite, “bore the brunt of the first wave of the pandemic.” Dr. Kitaw Demissie, dean of the School of Public Health at SUNY Downstate Medical Center, said household crowding, which is particularly prevalent in some majority-Latino neighborhoods that had high rates of infection early on in the pandemic, could also lead to Covid-19 disparities. New York City reports gaps in vaccination rates, too, with 44% of white adult New Yorkers, 26% of Black adults, and 31% of Latino adults at least partially vaccinated. 

Study Identifies Immune System Markers for Asymptomatic Versus Severe Covid-19

A multi-institutional study from the U.K., published in Nature, found that patients with asymptomatic and severe cases of Covid-19 mount distinct immune responses (MedicalXpress). Researchers sequenced the immune cells from the blood of 130 previous Covid-19 patients, finding that asymptomatic patients had higher levels of helper T-cells and B cells, which produce antibodies in the mucus passages to help fend off disease. Patients who suffered severe cases of Covid-19 lacked these first-line defenses, possibly explaining their symptoms. Seriously ill patients yielded more monocytes and killer T-cells – which lead to serious inflammation in the lungs – and blood cells that can cause clotting. According to the authors, these results offer more understanding of how people’s immune systems react to the virus, and may help identify specific immune cell targets for Covid-19 treatment. 

FDA Cites Multiple Violations at Emergent Plant Responsible For J&J Mixup

On Wednesday, Food and Drug Administration investigators published condemning findings from their inspection of an Emergent BioSolutions plant in Baltimore, which is currently shut down after being found responsible for ruining 15 million Johnson & Johnson vaccines (NYT, WaPo). A 12-page report detailed nine violations, including improper building design, unsanitary practices, employee training issues, and failure to comply with quality-assurance procedures for vaccine manufacturing. At the time of the J&J mixup, investigators said, workers were moving back and forth between producing ingredients for the J&J shot and the AstraZeneca shot without following proper protocol, leading to cross-contamination. The plant no longer produces AstraZeneca. The FDA is working with Emergent to make improvements; Emergent said in a statement Wednesday that, “while we are never satisfied to see shortcomings in our manufacturing facilities or process, they are correctable and we will take swift action to remedy them.” The timeline for these changes has not yet been determined. 

Bonus Reads: “‘No One Was Listening’: Long Covid Patients Struggle to Get Care for Their Symptoms,” (STAT); “A New Bird Flu Jumps to Humans. So Far, It’s Not a Problem,” (NYT).

Around the World

Asia

India’s Health System Crumbling Under Strain from Covid-19 Patients 

With Indian authorities reporting nearly 300,000 new cases of Covid-19 on Wednesday, the healthcare system is showing signs of strain as it struggles to keep up with the second wave of infections. An accident at a hospital in Maharashtra that involved a leak in the hospital’s main oxygen tank and stopped the flow of oxygen to dozens of critically ill patients resulted in 24 deaths (Reuters). Hospitals across India have been warning of an acute oxygen shortage, with some saying they were just hours away from running out (NYT). Prime Minister Narendra Modi urged citizens to be more careful and said lockdowns would be a last resort, but states and cities are implementing restrictions on their own and Modi’s government is facing criticism for mixed messages. The government allowed an enormous Hindu festival, called the Kumbh Mela, to continue despite signs it would become a superspreader event. More than 70,000 worshippers showed up on Wednesday for a holy dip in the Ganges river. According to reports by Indian news media last week, more than 1,000 worshippers tested positive at the site in just 48 hours. 

Singapore Investigates Reinfection Cases in Workers’ Dormitory 

Singapore authorities are investigating the possibility of Covid-19 reinfections among residents in a migrant workers’ dormitory after finding more positive cases in the facility (Reuters). Authorities said they conducted Covid-19 tests on all residents at the Westlite Woodlands Dormitory after one worker was found positive on April 20 as part of routine testing. The worker had received his second vaccination dose on April 13. His roommate then also tested positive. At least 10 workers who previously tested positive were found to be positive again. "These cases were immediately isolated and conveyed to the National Centre for Infectious Diseases (NCID) to investigate for possible re-infection," the manpower ministry said in a statement issued late on Wednesday.

Americas

Argentina Covid-19 Deaths Hit 60,000

Argentina’s health minister Carla Vizzotti said on Wednesday that the country is going through its “worst moment” of the pandemic as deaths from the virus hit 60,000 amid a second wave (Reuters). Vizzotti warned that the country’s healthcare system was at risk of collapsing, especially in the metropolitan area around Buenos Aires. The government has put restrictions in place in an effort to get case numbers under control. Argentina is rolling out its inoculation campaign based largely on Russia’s Sputnik V vaccine but the rate of vaccinations cannot compete with the spread of more transmissible variants.

Europe

Europe Prepares to Start Using J&J Shots

European countries prepared on Wednesday to start using Johnson & Johnson’s covid-19 vaccine and increase the speed of their vaccination campaigns after Europe’s drug regulator approved the shot. Deliveries resumed after a week-long pause (Reuters). In Germany, the health ministry said it would start deliveries to federal states for use in vaccination centres shortly and that family doctors should resume use of the vaccine. France said it will receive deliveries of the shots starting the week after next. The Netherlands will start using the shot next week. Just over 320,000 doses arrived in ten countries across the European Economic Area as of Wednesday, with Poland and the Netherlands making up the bulk of the deliveries. The J&J vaccine is the fourth one to be approved for use in Europe and governments across the bloc hope it will speed up campaigns that have been plagued by production and logistical problems. 

U.S. Government & Politics

Biden Urges Employers to Provide Paid Time Off for Vaccinations

President Biden called for employers to provide paid time off for employees to get vaccinated on Wednesday (WaPo). White House officials told the Washington Post that the government plans to help underwrite some of the costs of doing so. Biden stated, “I’m calling on every employer large and small in every state to give employees the time off they need, with pay, to get vaccinated.”

U.S. Economy

Supply Chain Issues Challenge Small Businesses

Supply chain disruptions - related in large part to the pandemic - are challenging small businesses (WSJ). The Wall Street Journal reports, “An Oklahoma restaurant is paying nearly $200 for a case of gloves that normally costs $40. A medical-device maker in Colorado is tweaking the way it manufactures its products to offset higher plastic costs. A clothing wholesaler in Michigan has hundreds of hoodies it has yet to sell because winter was over by the time they arrived from Bangladesh.” The Journal writes, “Forty-four percent of small businesses reported temporary shortages or other supply-chain problems in March, according to a survey of roughly 800 companies by Vistage Worldwide Inc., a business advisory firm. A U.S. Census Bureau survey of small businesses, completed in early April, found supply-chain disruptions in wholesale trade, manufacturing and construction, among others.”

Bonus Read: “The Job Market Is Tighter Than You Think,” (WSJ).

U.S. Society

Vermont Used Isolation to Keep Covid at Bay in Prisons; It Came at a Cost

The New York Times reports that Vermont successfully controlled Covid in its prisons, and is the only state where no prisoners have died (NYT). However, Vermont’s successful strategy relied on isolating prisoners, which has come with its own costs. The Times writes, that Vermont’s approach has “taken a heavy toll on many inmates’ mental health, and driven some to psychological despair,” noting, “There has been at least one suicide and a suicide attempt inside the isolation cells where incoming inmates in Vermont are required to quarantine for 14 days. Inmates have said that existing mental health issues have been aggravated both by isolation and by the lack of regular mental health services during much of the pandemic.” John Sugrue, who spent time in such isolation, told the Times, “I have never been so terrified for such an extended period of time in my life.” The New York Times describes it thusly: “inmates were locked in 8½-by-10-foot cells in near-total isolation. They ate meals a few feet from their toilets, had no visitors, and spent as little as 10 minutes a day outside cells.”

Bonus Read: “How The Pandemic Changed The College Admissions Selection Process This Year,” (NPR).

Analysis & Arguments

Tom Bartlett writes that data does not support the conclusion that there was a pandemic-driven suicide wave (Atlantic).

Dhruv Khullar writes about one trauma surgeon’s dark year (New Yorker).

Dave Zirin and Jules Boykoff write that the Tokyo Olympics are in trouble due to the pandemic (Nation).

 Readers can send in tips, critiques, questions, and suggestions to coronavirusbrief@newamerica.org.

The Brief is edited by David Sterman and Emily Schneider with Senior Editor Peter Bergen.

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