Multiple countries like the United States and UK have stopped their broad PCR testing programs and both nations and many states are not tracking positive rapid antigen tests for SARS-CoV-2. In addition, many countries and many states are not reporting the positive tests and deaths in a timely manner. These things make it difficult to assess the actual numbers of infections and deaths in any country with the exception of probably France, Germany, Japan, and South Korea. For these reasons, we have decided to reduce the frequency of our updates to once a month in order to attempt to capture more data for analysis. Our next update will be June 2.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 5/06/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 66.9% of infections, XBB.1.16 at 12.5% of infections, XBB.1.9.1 at 9.4% of infections, XBB.1.9.2 at 3.7% of infections, XBB .1.5.1 at 2.4% of infections and isolate FD.2 at 1.6% of isolates rounding out the top six SARS-CoV-2 variants. Variant XBB.1.9.1, unlike all other variants tested in March 10th UK Technical Bulletin 51, had a 15% growth advantage over XBB.1.5. XBB.1.16 was not tested at that time but based on rapid spread worldwide appears to also have a significant growth advantage. In the UK Technical Bulletin 52 from April 21, XBB.1.9.2 and XBB.1.16 have a growth advantage over XBB.1.5.
What happens next? History shows us that the variants with the most significant growth rate advantage will be the next dominant variant. Our current guess is as always a moving target with the current leading candidates being XBB.1.9.1, XBB.1.9.2, XBB.1.16 and XBB.1.5 variants. Due to increased air travel between countries with no masking required in airports other isolates from China or India might become predominant in the next three months.
The following is a quote from a recent paper by Madison Stoddard et al.: “At its heart, the problem is one of risk management-plausible risks do not need to be inevitable in order to warrant mitigation. In his book “The Black Swan”, a classic in the risk-management community, author Nassim Nicholas Talib describes a type of event known as a Grey Swan – a rare and highly consequential event that, unlike absolutely unforeseen Black Swan events, can be expected. Our work here shows that ahistorical and potentially destabilizing mortality events as a result of the COVID-19 pandemic are Grey Swans, very much within the realm of the possible. In this paper, we describe one mechanism by which this can occur-antigenic shift (a sudden jump in immune evasion) leading to a reversion to a higher death rate. Such an event, if it were to happen, would not only have been predictable, but can occur repeatedly in the absence of further corrective measures.”
We’re asking people to take those corrective measures; be respiratorily safe by wearing an N95 mask, avoiding in-person gatherings, and improving ventilation. This is the only way to prevent a possible Gray Swan event.
U.S. COVID Data
Here are our 14-day moving average determinations for SARS-CoV-2 for the United States. We use the WORLDOMETERS aggregators data set to make any projections since it includes data from the Department of Veterans Affairs, the U.S. Military, federal prisons and the Navajo Nation.
On 5/05/23, the United States had 2,559 documented new infections. There were also 8 deaths. Forty-three states and the District of Columbia did not report their infections, and 47 states and the District of Columbia didn’t report their deaths.
In the United States on 4/20/23 the number of hospitalized patients (4,778) had decreased (-13% compared to the previous 14 days). On 4/21/23 1,473 patients were seriously or critically ill. Patients are still dying each day (average 244/day, the last 14 days).
As of 5/05/23, we have had 1,162,420 deaths and 106,765,870 SARS-CoV-2 infections in the United States. We have had at least 215,030 new infections in the last 14 days. We are adding an average of 107,515 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.85 infections or over 10,888 deaths for each one million infections. As of 5/05/23, thirty-nine states have had greater than 500,000 total infections, and 39 states and Puerto Rico have had greater than 5,000 total deaths. Forty-seven states and Puerto Rico have had greater than 2,000 deaths. Only Vermont has had less than a thousand deaths (929 deaths). As of 5/05/23, 14 states have over 4,000 deaths per million population: Arizona (4,591, Mississippi (4,518), West Virginia (4,525), New Mexico (4,405), Arkansas (4,346), Alabama (4,311), Tennessee (4,294, unchanged in 4 weeks), Michigan (4,287), Kentucky (4,152), New Jersey (4,066), Florida (4,107), Louisiana (4,078), Georgia (4,028) and Oklahoma (4,083). Eighteen states (Alabama, Virginia, Missouri, North Carolina, Indiana, Tennessee, Massachusetts, Ohio, Michigan, Georgia, Illinois, New Jersey, Pennsylvania, Florida, Texas, New York, Arizona and California) have had greater than 20,000 deaths. Nine states have had greater than 40,000 deaths: Florida (88,219 deaths), Texas (94,386 deaths), New York (77,535 deaths), Pennsylvania (51,042 deaths), Georgia (42,766 deaths), Ohio (42,213 deaths), Illinois (41,866 deaths), Michigan (42,811), and California (102,496 deaths, 19th most deaths in the world).
On 11/20/20, there were 260,331 (cumulative) deaths in the US from SARS-CoV-2. Since 11/20/20 (29 months), there were 895,309 new deaths from SARS-CoV-2. For 25 of those months, vaccines have been available to all adults. During these 25 months, 590,221 people have died of SARS-CoV-2 infections. Clearly, a vaccine-only approach is not working anywhere, especially not in the United States. In addition to getting more people vaccinated, most of the hospitalizations and deaths could have been prevented by proper masking (N95 or better), social distancing, and treatment with oral antiviral agents like Paxlovid. We recommend all of these precautions and treatments to every patient in our clinic, and we have only lost one patient to COVID-19 in 3 years.
As of 5/05/23, California was ranked 31st in the USA in infection percentage at 30.96%. In California, 26.99% of the people were infected in the last 24 months. As of 4/21/23, 33 states have had greater than 30% of their population infected. Fifty states, the District of Columbia and Puerto Rico have greater than 20% of their population infected.
Watching World Data
Over the next few months, we’ll be paying close attention to correlations between the SARS-CoV-2 data, the number of isolates identified in various countries and states, and the non-pharmaceutical interventions (like mask mandates and lockdowns) put in place by state and national governments. Data on infections, deaths, and percent of population infected was compiled from Worldometers. Data for this table for SARS-CoV-2 Isolates Currently Known in Location was compiled from GISAID and the CDC. It’s worth noting that GISAID provided more data than the CDC.
|Location||Total Infections as of 5/05/23||New Infections on 5/05/23||Total Deaths||New Deaths on 5/05/23||% of Pop.Infected||Deaths per million population|
|World||687,690,026(1,337,015new infections in the last 14 days with an average of 95,501 infections per day).||56,172||6,870,703(11,473 new deaths in the last 14 days with an average of 820 deaths per day.)||397||8.82%||881.5|
|USA||106,765,870(ranked #1) 215,030 new infections in the last 14 days with an average of 15,359 infections/day||2,559(ranked #7)|
43 states and D.C. failed to report infections on 5/05/23.
|1,162,420(ranked #1) 3,417 new deaths reported in the last 14 days or an average of 244 deaths/ day.||8|
47 states and D.C.failed to report deaths on 5/05/23.
|Brazil||37,487,971(ranked #5) 80,739 new infections in the last 14 days.||–||701,833(ranked #2; 618 new deaths in the last 14 days)||–||17.40%||3,259|
|India||44,964,289(ranked #2)94,605 new infections in the last 14 days.||–||531,642(ranked #3) 384 new deaths in the last 14 days)||–||3.20%||378|
|United Kingdom||24,569,895(ranked #9) 14,265 new infections reported in the last 14 days.||–||223,396 (ranked #6) 1,453 new deaths reported in the last 14 days.||–||35.87%||3,261|
|California, USA||12,234,136(ranked #13 in the world; 47,915 new infections in the last 14 days).||–||102,496 (ranked #19in world; 400 new deaths in the last 14 days||–||30.96%||2,594|
|Mexico||7,587,643(ranked #19) 14,938 new infections in 14 days).||–||333,913(ranked #5) 181 new deaths in the last 14 days)||–||5.77%||2,538|
|South Africa||4,076,463(ranked #38; No new infections reported in the last 14 days).||–||102,595 (ranked #18) no new deaths reported in the last 98 days).||–||6.70%||1,689|
|Canada||4,641,301(ranked #33) No new infections reported in 14 days).||–||52,247(ranked #24) No new reported deaths in the last 14 days.||–||12.09%||1,361|
|Russia||22,870,557(ranked #10), 73,712 new infections in 14 days).||4,215 (ranked #5)||398,463(ranked #4)456 new deaths in 14 days||32||15.69%0.06% increase in 14 days.||2,733|
|Peru||4,503,222(ranked #35, 3,867 new infections in 14 days)..||–||220,196(ranked #7) 123 new deaths in the last 14 days.||–||13.37%||6,537|
|Spain||13,845,825(ranked #12; 20,773 new infections in 14 days).||1,481 (ranked#10)||120,964 (ranked #15) 249 new deaths in 14 days.||15||29.64%||2,589|
|France||40,012,786 (ranked #3) 74,343 new infections in 14 days).||5,505 (ranked #3)||166,811` (ranked #10) 522 new deaths in 14 days.||166||61.01% a 0.12% increase in 14 days.||2,543|
|Germany||38,411,062(ranked #4; 17,080 new infections in 14 days.)||1,442 (ranked #11)||173,375 (ranked #9)839 new deaths in 14 days.||68||45.79%0.02% increase in 14 days||2,067|
|South Korea||31,251,203 (ranked #7; 97,744 new infections in 14 days).||18,459(ranked #1)||34,518 (ranked #32) 110 new deaths in 14 days.||6||60.88%0.39% increase in 14 days||672|
|Japan||33,772,764(ranked #6)144,219 new infections in the last 14 days||5,807(ranked #2)||74,633(ranked #20)245 new deaths in the last 14 days for an average of 18 deaths per day.||19||26.89%0.12% of the population infected in the last 14 days.||594|
|Hong Kong||2,892,926(ranked# 41) 5,172 new infections in the last 14 days.||476 (rank #13)||13,575 (ranked #60)75 new deaths in the last 14 days.||12||38.04%0.07% increase in the last 14 days.`||1,785|
What Our Team Is Reading This Week
- High risk of autoimmune diseases after COVID-19 https://doi.org/10.1038/s41584-023-00964-y
- Virological characteristics of the SARS-CoV-2 Omicron XBB.1.16 variant (preprint) https://doi.org/10.1101/2023.04.06.535883
- SARS-CoV-2 Spike Protein Accumulation in the Skull-Meninges-Brain Axis: Potential Implications for Long-Term Neurological Complications in post-COVID-19 (preprint) https://doi.org/10.1101/2023.04.04.535604
- Live-attenuated vaccine sCPD9 elicits superior mucosal and systemic immunity to SARS-CoV-2 variants in hamsters https://www.nature.com/articles/s41564-023-01352-8
- SARS-CoV-2 variants resistant to monoclonal antibodies in immunocompromised patients constitute a public health concern https://doi.org/10.1172/JCI168603
- “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina https://www.nejm.org/doi/full/10.1056/NEJMoa2009040
- The gray swan: model-based assessment of the risk of sudden failure of hybrid immunity to SARS-CoV-2 https://doi.org/10.1101/2023.02.26.23286471
- The Black Swan by Nassim Nicholas Talib https://bookshop.org/p/books/the-black-swan-second-edition-the-impact-of-the-highly-improbable-with-a-new-section-on-robustness-and-fragility-nassim-nicholas-taleb/7841914?ean=9780812973815
- SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing 51, 10 March 2023 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1141754/variant-technical-briefing-51-10-march-2023.pdf
- SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing 50, 10 February 2023 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1135877/variant-technical-briefing-50-10-february-2023.pdf
- Identification of a molnupiravir-associated mutational signature in SARS-CoV-2 sequencing databases (Preprint) https://doi.org/10.1101/2023.01.26.23284998
- COVID drug drives viral mutations — and now some want to halt its use https://www.nature.com/articles/d41586-023-00347-z#ref-CR1
- SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing 49, 11 January 2023 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1128554/variant-technical-briefing-49-11-january-2023.pdf
- Long COVID: major findings, mechanisms and recommendations (Nature) https://www.nature.com/articles/s41579-022-00846-2
- Enhanced fusogenicity and pathogenicity of SARS-CoV-2 Delta P681R mutation (Nature) https://doi.org/10.1038/s41586-021-04266-9
- Virological characteristics of the SARS-CoV-2 XBB variant derived from recombination of two Omicron subvariants (Preprint) https://doi.org/10.1101/2022.12.27.521986
- SARS-CoV-2 infection and persistence in the human body and brain at autopsy (Nature) https://doi.org/10.1038/s41586-022-05542-y
- Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff (NEJM) https://www.nejm.org/doi/full/10.1056/NEJMoa2211029
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