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 dayswith 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.
31.89%
3,472
Brazil
37,487,971(ranked #5) 80,739new 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.
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
SARS-CoV-2 variants resistant to monoclonal antibodies in immunocompromised patients constitute a public health concern https://doi.org/10.1172/JCI168603
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
In 2023 our Covid-19 infection problems are being caused by XBB recombinant variants. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. Since then the XBB variant XBB.1.5, has rapidly spread across the country and the world. XBB variants are rapidly increasing with XBB.1.9.1, XBB.1.9.2, and XBB.1.16 of particular concern.
On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 4/21/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 73.6% of infections, XBB.1.16 at 9.6% of infections, XBB.1.9.1 at 7.9% of infections, XBB.1.9.2 at 2.9% of infections, XBB .1.5.1 at 2.2% of infections and new 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.
This paper is also notable because it challenges the widely-held belief that “hybrid immunity” to SARS-CoV-2 is advantageous.
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 4/21/23, the United States had 4,172 documented new infections. There were also 35 deaths. Forty-one states and the District of Columbia did not report their infections, and 43 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 152/day, the last 14 days).
As of 4/21/23, we have had 1,159,003 deaths and 106,540,840 SARS-CoV-2 infections in the United States. We have had at least 177,414 new infections in the last 14 days. We are adding an average of 88,707 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.92 infections or over 10,878 deaths for each one million infections. As of 4/21/23, 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 4/21/23, 14 states have over 4,000 deaths per million population: Arizona (4,585, Mississippi (4,512), West Virginia (4,488, unchanged in 2 weeks), New Mexico (4,376), Arkansas (4,328, unchanged in 4 weeks), Alabama (4,310, unchanged in 2 weeks), Tennessee (4,294, unchanged in 2 weeks), Michigan (4,272), Kentucky (4,131), New Jersey (4,065), Florida (4,057, unchanged in 4 weeks), Louisiana (4,064), Georgia (4,023) and Oklahoma (4,052). 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 (87,141 deaths, unchanged in 4 weeks), Texas (94,260 deaths), New York (77,513 deaths), Pennsylvania (50,860 deaths), Georgia (42,717 deaths), Ohio (42,126 deaths), Illinois (41,866 deaths), Michigan (42,667), and California (102,096 deaths, 20th 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 891,892 new deaths from SARS-CoV-2. For 25 of those months, vaccines have been available to all adults. During these 25 months, 586,804 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 4/21/23, California was ranked 31st in the USA in infection percentage at 30.84%. In California, 26.87% 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 4/21/23
New Infections on 4/21/23
Total Deaths
New Deaths on 4/21/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
686,333,011(1,457,824 new infections in the last 14 days with an average of 104,130 infections per day).
60,230
6,859,230(21,719 new deaths in the last 14 days with an average of 1,551 deaths per day.)
413
8.80%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1XBB.1.9.1XBB.1.5.1XBB.1.16FD.2
No
No
USA
106,540,840(ranked #1) 177,414 new infections in the last 14 dayswith an average of 12,672 infections/day
4,172(ranked #6) 41 states and D.C. failed to report infections on 4/21/23.
1,159,003(ranked #1) 2,107 new deaths reported in the last 14 days or an average of 151 deaths/ day.
35 43 states and D.C.failed to report deaths on 4/21/23.
31.82%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1XBBB.1.9.2XBB.1.16FD.2
No
No
Brazil
37,407,232(ranked #5) 87,978new infections in the last 14 days.
–
701,215(ranked #2; 659 new deaths in the last 14 days)
–
17.37%
No
No
India
44,869,684(ranked #2)124,580 new infections in the last 14 days.
–
531,258(ranked #3) 324 new deaths in the last 14 days)
–
319%
No
No
United Kingdom
24,555,629(ranked #9) 106,900 new infections reported in the last 42 days.
–
221,943 (ranked #6) 12,547 new deaths reported in the last 42 days.
–
35.85%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)XBBXBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1
No
No
California, USA
12,186,221(ranked #13 in the world; 2,709 new infections in the last 14 days).
–
102,096 (ranked #20 in world; 53 new deaths in the last 14 days
–
30.84%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/ B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1XBB.1. 5.1XBB.1.9.1XBB.1.9.2XBB.1.16
No
No
Mexico
7,572,705(ranked #19) 19,979 new infections in 14 days).
1,949(rank #8)
333,732,(ranked #5) 143 new deaths in the last 14 days)
14
5.75%
No
No
South Africa
4,076,463(ranked #38; 1,362 new infections in the last 14 days).
–
102,595 (ranked #18) no new deaths reported in the last 84 days).
–
6.70%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,641,301(ranked #33) 7,624 new infections in 14 days).
–
52,247(ranked #24) 126 new deaths in the last 14 days.
–
12.09%
No
No
Russia
22,796,845(ranked #10), 98,820 new infections in 14 days).
7,116 (ranked #4)
398,007(ranked #4)510 new deaths in 14 days
33
15.63%0.07% increase in 14 days.
No
No
Peru
4,499,355(ranked #35, 4,984 new infections in 14 days)..
–
220,073(ranked #7) 124 new deaths in the last 14 days.
–
13.35%
No
No
Spain
13,825,052(ranked #12; 26,305 new infections in 14 days).
1,604 (ranked#10)
120,715 (ranked #15) 289 new deaths in 14 days.
13
29.59%
No
No
France
39,938,443 (ranked #3) 102,626 new infections in 14 days).
7,400 (ranked #3)
166,289 (ranked #10) 432 new deaths in 14 days.
125
60.89% a 0.15% increase in 14 days.
No
No
Germany
38,393,992(ranked #4; 25,101 new infections in 14 days.)
1,626 (ranked #9)
172,536 (ranked #9)1,125 new deaths in 14 days.
108
45.77%0.07% increase in 14 days
No
No
South Korea
31,053,459 (ranked #7; 158,800 new infections in 14 days).
13,596(ranked #1)
34,408 (ranked #32) 90 new deaths in 14 days.
7
60.49%0.30%increase in 14 days
No
No
Japan
33,628,545(ranked #6)120,165 new infections in the last 14 days
10,074(ranked #2)
74,388(ranked #20)278 new deaths in the last 14 days for an average of 27 deaths per day.
24
26.77%0.09% of the population infected in the last 14 days.
No
No
Hong Kong
2,887,756(ranked# 41) 2,330 new infections in the last 14 days.
234
13,500 (ranked #60)17 new deaths in the last 14 days.
SARS-CoV-2 variants resistant to monoclonal antibodies in immunocompromised patients constitute a public health concern https://doi.org/10.1172/JCI168603
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
In 2023 our Covid-19 infection problems are being caused by XBB recombinant variants and still some BA.5 sub-variants BQ.1 and BQ.1.1. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. Since then the XBB variant XBB.1.5, has rapidly spread across the country and the world. Another variant, CH.1.1 (BA.2.75.3.4.1.1.1.1) caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom. CH.1.1 has not become a predominant isolate in the USA. We follow all UK Technical bulletins and the 51st was released March 10, 2023.
In UK testing XBB.1.5 has a significant growth advantage over BQ and CH.1.1 isolates and has dominated infections in the USA. The new variant XBB.1.9.1 has a 15% growth advantage over XBB.1.5 (see Table 8 from UK Technical Bulletin 51 below). Whether an XBB.1.5 infection will provide any protection against other variants like XBB.1.9.1 is currently unknown. On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 4/07/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 88.3% of infections, XBB.1.9.1 at 5.1% of infections, BQ.1.1 1.4% of infections, XBB.1.5.1 2.4% of infections, XBB at 1.9% of infections, followed by BQ.1 at 0.2%,, CH.1.1 at 0.4% and BA.2 at 0.1%. Variant XBB.1.9.1, unlike all other variants tested (UK Technical Bulletin 51), has a 15% growth advantage over XBB.1.5.
What happens next? History shows us that the variant with the most significant growth rate advantage will be the next dominant variant. Our bet is still on XBB.1.9.1.
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 4/07/23, the United States had 3,301 documented new infections. There were also 46 deaths. Forty-three states and the District of Columbia did not report their infections, and 44 states and the District of Columbia and Puerto Rico didn’t report their deaths.
In the United States on 4/3/23 the number of hospitalized patients (5,673) had decreased (-6% compared to the previous 14 days). On 4/3/23 there were 2,678 patients who were seriously or critically ill. Patients are still dying each day (average 237/day, the last 14 days).
As of 4/07/23, we have had 1,156,896 deaths and 106,363,426 SARS-CoV-2 infections in the United States. We have had at least 275,591 new infections in the last 14 days. We are adding an average of 137,795 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.94 infections or over 10,876 deaths for each one million infections. As of 4/7/23, 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 (910 deaths). As of 4/7/23, 14 states have over 4,000 deaths per million population: Arizona (4,569, Mississippi (4,509), West Virginia (4,488), New Mexico (4,362), Arkansas (4,328, unchanged in 2 weeks), Alabama (4,310), Tennessee (4,294), Michigan (4,258), Kentucky (4,107), New Jersey (4,063), Florida (4,057, unchanged in 2 weeks), Louisiana (4,060), Georgia (4,013) and Oklahoma (4,041). 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 (87,141 deaths, unchanged in 2 weeks), Texas (94,126 deaths), New York (77,460 deaths), Pennsylvania (50,623 deaths, unchanged in 2 weeks), Georgia (42,608 deaths), Ohio (41,973 deaths), Illinois (41,758 deaths), Michigan (42,523), and California (102,043 deaths, 18th 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 (28 months), there were 889,785 new deaths from SARS-CoV-2. For twenty-four of those months, vaccines have been available to all adults. During these twenty-four months, 584,697 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 4/07/23, California was ranked 31st in the USA in infection percentage at 30.83%. In California, 26.86% of the people were infected in the last 23 months. As of 4/07/23, 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 4/07/23
New Infections on 4/07/23
Total Deaths
New Deaths on 4/07/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
684,875,187(1,678,217 new infections in the last 14 days with an average of 119,878 infections per day).
53,552
6,837,511(11,210 new deaths in the last 14 days with an average of 801 deaths per day.)
220
8.79%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1XBB.1.9.1XBB.1.5.1
No
No
USA
106,363,426(ranked #1) 275,591 new infections in the last 14 dayswith an average of 19,685 infections/day
3,331(ranked #6) 43 states and D.C. failed to report infections on 4/07/23.
1,156,896(ranked #1) 3,316 new deaths reported in the last 14 days or an average of 237 deaths/ day.
46 44 states and D.C.and Puerto Rico failed to report deaths on 4/07/23.
31.77%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1
No
No
Brazil
37,319,254(ranked #5) 114,577new infections in the last 14 days.
–
700,556(ranked #2; 639 new deaths in the last 14 days)
–
17.33%
No
No
India
44,745,104(ranked #2)42,847 new infections in the last 14 days..
–
530,934(ranked #3) 110 new deaths in the last 14 days)
6
3.18%
No
No
United Kingdom
24,448,729(ranked #9) Unchanged in 4 weeks
–
209,396 (ranked #7) Unchanged in 4 weeks
–
35.69% Unchanged in 4 weeks
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)XBBXBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1
No
No
California, USA
12,183,512(ranked #13 in the world; 27,687 new infections in the last 14 days).
–
102,043 (ranked #20 in world; 245 new deaths in the last 14 days
–
30.83%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/ B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1XBB.1. 5.1XBB.1.9.1
No
No
Mexico
7,552,726(ranked #19) 36,680 new infections in 14 days).
2,178(rank #8)
333,589(ranked #5) 227 new deaths in the last 14 days)
19
5.74%
No
No
South Africa
4,075,101(ranked #38; 3,103 new infections in the last 14 days).
–
102,595 (ranked #18) no new deaths reported in the last 70 days).
–
6.70%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,634,277(ranked #34) 16,218 new infections in 14 days).
–
52,121(ranked #24) 321 new deaths in the last 14 days.
–
12.07%
No
No
Russia
22,698,025(ranked #10), 135,137 new infections in 14 days).
8,915 (ranked #2)
397,497(ranked #4)488 new deaths in 14 days
38
15.56%0.09% increase in 14 days.
No
No
Peru
4,494,371(ranked #35, 3,880 new infections in 14 days)..
–
219,849(ranked #6) 155 new deaths in the last 14 days.
–
13.34%
No
No
Spain
13,798,747(ranked #12; 8,167 new infections in 14 days).
–
120,426 (ranked #15) 256 new deaths in 14 days.
–
29.54%
No
No
France
39,835,817 (ranked #3) 91,699 new infections in 14 days).
8,786 (ranked #3)
165,857 (ranked #10) 388 new deaths in 14 days.
28
60.74% a 0.14% increase in 14 days.
No
No
Germany
38,368,891(ranked #4; 37,951 new infections in 14 days.)
–
171,411 (ranked #9)1,090 new deaths in 14 days.
100
45.70%0.10% increase in 14 days
No
No
South Korea
30,894,559 (ranked #7; 144,819 new infections in 14 days).
10,735(ranked #1)
34,318 (ranked #32) 107 new deaths in 14 days.
9
60.19%0.28%increase in 14 days
No
No
Netherlands
8,610,372 (ranked #17; 2,249 new infections in 14 days).
–
22,992 (ranked #42) Unchanged in 10 weeks
–
50.02%
No
No
Taiwan
10,239.998(ranked #15);
–
19,005
–
42.87%
No
No
Japan
33,508,380(ranked #6)101,205 new infections in the last 14 days
8,338(ranked #4)
74,060(ranked #20)379 new deaths in the last 14 days for an average of 27 deaths per day.
31
26.68%0.08% of the population infected in the last 14 days.
No
No
Hong Kong
2,885,426(ranked# 41) 979 new infections in the last 14 days.
98
13,483 (ranked #60)9 new deaths in the last 14 days.
SARS-CoV-2 variants resistant to monoclonal antibodies in immunocompromised patients constitute a public health concern https://doi.org/10.1172/JCI168603
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
In 2023 our Covid-19 infection problems are being caused by XBB recombinant variants and still some BA.5 sub-variants BQ.1 and BQ.1.1. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. Since then the XBB variant XBB.1.5, has rapidly spread across the country and the world. Another variant, CH.1.1 (BA.2.75.3.4.1.1.1.1) caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom. CH.1.1 has not become a predominant isolate in the USA. We follow all UK Technical bulletins and the 51st was released March 10, 2023.
In UK testing XBB.1.5 has a significant growth advantage over BQ and CH.1.1 isolates and has dominated infections in the USA. The new variant XBB.1.9.1 has a 15% growth advantage over XBB.1.5 (see Table 8 from UK Technical Bulletin 51 below). Whether an XBB.1.5 infection will provide any protection against other variants like XBB.1.9.1 is currently unknown. On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 3/25/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 90.2% of infections, XBB.1.9.1 2.5% 0f infections, BQ.1.1 2.5% of infections, XBB.1.5.1 2.4% of infections, XBB at 1.2% of infections, followed by BQ.1 at 0.4%,, CH.1.1 at 0.4%, BA.2 at 0.2% and BN.1 at 0.1%. .
BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5 has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA. As of 3/25/23, XBB.1.5 has a growth advantage over all other variants except XBB.1.9.1. XBB.1.5 now causes over 90.2% of infections in the United States. Variant XBB.1.9.1, unlike all other variants tested (UK Technical Bulletin 51), has a 15% growth advantage over XBB.1.5.
What happens next? History shows us that the variant with the most significant growth rate advantage will be the next dominant variant. Our bet is on XBB.1.9.1.
We are setting ourselves up for what has been described by Nassim Nicholas Talib as a gray swan event. The uncontrolled spread of SARS-CoV-2 in human populations could result in isolates that have enhanced lethality, just like acquisition of ITAM sequences did in the outbreak of Andes virus (ANDV) hantavirus pulmonary syndrome in Argentina in 2018-2019, which resulted in a 32% fatality rate. Our current death rates for SARS-CoV-2 are already catastrophic; a 32% death rate would be apocalyptic.
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.
This paper is also notable because it challenges the widely-held belief that “hybrid immunity” to SARS-CoV-2 is advantageous.
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 3/24/23, the United States had 5,076 documented new infections. There were also 54 deaths. Forty-one states and the District of Columbia did not report their infections, and 44 states and the District of Columbia didn’t report their deaths. In the United States on 3/23/23 the number of hospitalized patients (22,522) has decreased (-4.95% compared to the previous 14 days) and was 23,697 on March 13th. On 2/23/23 there were 3,013 patients who were seriously or critically ill (a 4.28% decrease); that number was 3,148 two weeks ago. The number of critically ill patients has decreased by 135 in the last 14 days, while at least 4,815 new deaths occurred. Patients are still dying each day (average 344/day, the last 14 days).
As of 3/24/23, we have had 1,153,580 deaths and 106,087,835 SARS-CoV-2 infections in the United States. We have had 528,770 new infections in the last 14 days. We are adding an average of 264,385 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.96 infections or over 10,874 deaths for each one million infections. As of 3/10/23, thirty-nine states have had greater than 500,000 total infections, and 38 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 (910 deaths). As of 3/24/23, 14 states have over 4,000 deaths per million population: Arizona (4,560, Mississippi (4,503), West Virginia (4,470), New Mexico (4,336), Arkansas (4,328), Alabama (4,306), Tennessee (4,290), Michigan (4,233), Kentucky (4,083), New Jersey (4,060), Florida (4,057) Louisiana (4,052), Georgia (4,010) and Oklahoma (4,004). 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 (87,141 deaths), Texas (93,964 deaths), New York (77,331 deaths), Pennsylvania (50,623 deaths), Georgia (42,571 deaths), Ohio (41,924 deaths), Illinois (41,618 deaths), Michigan (42,278), and California (101,798 deaths, 18th 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 (28 months), there were 886,479 new deaths from SARS-CoV-2. For twenty-four of those months, vaccines have been available to all adults. During these twenty-four months, 581,381 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 3/24/23, California was ranked 30th in the USA in infection percentage at 30.76%. In California, 26.79% of the people were infected in the last 23 months. As of 3/24/23, 33 states have had greater than 30% of their population infected. Fifty states, the District of Columbia and Puerto Rico have greater than 25% 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 3/24/23
New Infections on 3/24/23
Total Deaths
New Deaths on 3/24/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
683,196,970(1,785,969 new infections in the last 14 days with an average of 127,569 infections per day).
71,260
6,826,301(15,937 new deaths in the last 14 days with an average of 1,138 deaths per day.)
435
8.76%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1XBB.1.9.1XBB.1.5.1
No
No
USA
106,087,835(ranked #1) 528,770 new infections in the last 14 dayswith an average of 37,769 infections/day
5,076(ranked #5) 41 states and D.C. failed to report infections on 3/24/23.
1,153,580(ranked #1) 4,815 new deaths reported in the last 14 days or an average of 344 deaths/ day.
54 44 states and D.C. failed to report deaths on 3/24/23.
31.68%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1
No
No
Brazil
37,204,677(ranked #5) 119,157new infections in the last 14 days.
–
699,917(ranked #2; 607 new deaths in the last 14 days)
–
17.27%
No
No
India
44,702,257(ranked #2)12,289 new infections in the last 14 days..
–
530,824(ranked #3) 44 new deaths in the last 14 days)
6
3.17% Unchanged in 14 weeks
No
No
United Kingdom
24,448,729(ranked #9) 52,195new infections in the last 2 weeks.
–
209,396 (ranked #7) 1,701 new deaths in the last 2 weeks
–
35.69%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)XBBXBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1
No
No
California, USA
12,155,825(ranked #13 in the world; 59,316 new infections in the last 14 days).
908
101,798 (ranked #18 in world; 516 new deaths in the last 14 days
10
30.76%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/ B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1XBB.1. 5.1XBB.1.9.1
No
No
Mexico
7,516,046(ranked #19) 32,602 new infections in 14 days).
–(
333,362(ranked #5) 174 new deaths in the last 14 days)
–
5.71%
No
No
South Africa
4,071,998(ranked #38; 4,545 new infections in the last 14 days).
359
102,595 (ranked #18) no new deaths reported in the last 56 days).
–
6.70%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,618,059(ranked #34) 17.444 new infections in 14 days).
–
51,800(ranked #24) 353 new deaths in the last 14 days.
–
12.03%
No
No
Russia
22,562,888(ranked #10), 164,021 new infections in 14 days).
12,493 (ranked #1)
397,009(ranked #4)502 new deaths in 14 days
-5
15.47%0.11% increase in 14 days.
No
No
Peru
4,490,491(ranked #35, 2,721 new infections in 14 days)..
–
219,694(ranked #6) 146 new deaths in the last 14 days.
–
13.33%
No
No
Spain
13,790,580(ranked #12; 12,113 new infections in 14 days).
1,057 (ranked #12)
120,170 (ranked #15) 552 new deaths in 14 days.
40
29.51%
No
No
France
39,744,118 (ranked #3) 78,188 new infections in 14 days).
8,839 (ranked #3)
165,469 (ranked #10) 306 new deaths in 14 days.
15
60.60% a 0.14% increase in 14 days.
No
No
Germany
38,330,941(ranked #4; 74,938 new infections in 14 days.)
4,325 (ranked #6)
170,331 (ranked #9)1,274 new deaths in 14 days.
100
45.70%0.10% increase in 14 days
No
No
South Korea
30,749,740 (ranked #7; 134,218 new infections in 14 days).
10,283(ranked #2)
34,211 (ranked #32) 118 new deaths in 14 days.
10
59.91%0.27%increase in 14 days
No
No
Netherlands
8,608,123(ranked #17; 5,857 new infections in 14 days).
318 (ranked #20)
22,992 (ranked #42) Unchanged in 8 weeks
–
50.01%
No
No
Taiwan
10,239,980(ranked #15); 87,102 new infections in 14 days
25)
18,931 (ranked #50; 506 new deaths in the last 14 days)
39
42.87% 0.37% of population has been infected in the last 14 days
No
No
Japan
33,407,175(ranked #6)99,766 new infections in the last 14 days
8,639(ranked #4)
73,681(ranked #20)643 new deaths in the last 14 days for an average of 46 deaths per day.
49
26.60%0.08% of the population infected in the last 14 days.
No
No
Hong Kong
2,884,447(ranked# 41) 560 new infections in the last 14 days.
25
13,474 (ranked#60)7 new deaths in the last 14 days.
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
In 2022, multiple new Omicron variants BA.1, BA.2, BA.4, and BA.5 assaulted the world’s population of humans and other animals. By the time multiple companies made and tested Omicron BA.1 vaccines, BA.1 was no longer the dominant variant; in fact, it was no longer present. On August 31, 2022, the FDA allowed rapid introduction of an Omicron BA.5 bivalent vaccine. In 2023 our problems are being caused by XBB recombinant variants and BA.5 sub-variants BQ.1 and BQ.1.1. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. The XBB variant XBB.1.5, has rapidly spread across the country and the world. Another new variant, CH.1.1 (BA.2.75.3.4.1.1.1.1) caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom.
On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission. 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.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 2/24/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 85% of infections, followed by BQ.1.1 at 9.4%, BQ.1 at 2.6%, XBB at 1.2%, CH.1.1 at 0.9%, BN.1 at 0.4%, BA.5 at 0.1%, and BF.7 at 0.1%.
CDC
BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5 has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA. As of 2/24/23, XBB.1.5 now causes over 85% of infections in the United States.
CDC
XBB.1.5 Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
1/21/23
1/28/23
2/04/23
2/11/23
2/18/23
2/25/23
2.3%
4.4%
7.4%
11.8%
20.1%
30.4%
43.0%
49.1%
61.3%
65.9%
74.7%
80.2%
85.0%
BQ. 1 and BQ.1.1 Totaled Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
1/21/23
1/28/23
2/04/23
2/11/23
2/18/23
2/25/23
53.5%
57.4%
58.6%
60.3%
59.2%
53.2%
44.7%
40.2%
31.1%
27.4%
21.4%
15.8%
12.0%
Percent of isolates identified as XBB.1.5 by Region
Region
Week ending in
1
2
3
4
5
6
7
8
9
10
12/31/22
75.3%
72.2%
32.7%
19.0%
6.0%
21.5%
8.1%
2.1%
9.2%
2.5%
1/14/23
81.7%
82.7%
49.0%
31.1%
14%
24.9%
8.8%
15%
15.8%
8.1%
1/28/23
89.3%
91.1%
72.5%
52.1%
36.5%
42.8%
24.4%
32.5%
35.1%
20.3%
2/11/23
93.8%
95.2%
85.8%
72.4%
60.4%
63.4%
53.1%
60.9%
56.9%
37.4%
2/25/23
97.3%
97.9%
93.7%
86.5%
81.2%
81.7%
79.4%
83.4%
79.0%
65.6%
SARS-CoV-2 infections per day in the United States have decreased for the first time in 4 weeks. There is still widespread underreporting by states, a failure to capture all positive home tests, and a decreased PCR screening program in most states. Deaths per day in the United States have decreased by 234 deaths per day. Many states are not reporting deaths or infections in a timely manner. The number of infections per day is expected to increase in the next four weeks due to a lack of mask use in schools, businesses, and airports; a failure of adequate building ventilation; lack of social distancing; and low rates of bivalent booster uptake. XBB, an Omicron recombinant variant first identified in India, caused a major outbreak in Singapore. XBB is the first recombinant variant combining spike protein sequences from two other Omicron BA.2 variants, that has spread aggressively around the world. New mutations of XBB, specifically XBB.1.5 have rapidly crowded out other variants in the USA.Current vaccines, monoclonal antibodies and prior infections will not protect you from getting an XBB.1.5 infection. A more detailed description of XBB variant mutations and epidemiology can be found on page 17 of the UK Health Security Agency Technical Briefing from November 25.
For a more detailed picture of COVID variant evolution in the United States, we recommend checking out the dashboard put together by Raj Rajnarayanan, Assistant Dean of Research and Associate Professor at NYITCOM at Arkansas State University.
To understand the true impact of these variants, it’s helpful to examine their evolution. Two virologists collaborated on Twitter to create the figure below, which Professor Johnson titled “Convergent Evolution on Steroids.” It shows the key mutations present in many of the currently-circulating Omicron subvariants and demonstrates that mutation at site 346 is becoming more and more common.
From Daniele Focosi, M.D., Ph.D. @dfocosi on Twitter, February 3, 2023
Past infections with a BA.1, BA.2 or BA.5 variants will not prevent infections with any of the newer variants. Monoclonal antibodies are no longer effective against newer BQ variants, XBB variants and other spike protein mutated variants. The last remaining monoclonal antibody, bebtelovimab, was removed from use by the FDA on 12/2/22. Paxlovid was only 89% effective in the original clinical trials against SARS-CoV-2. If resistance develops this winter to oral Paxlovid, we will have more Paxlovid failures and increased hospitalizations and deaths.
A Deeper Dive into U.S. COVID Data
On 2/24/23, the United States had 8,922 documented new infections. There were also 73 deaths. Thirty-nine states did not report their infections, and 38 states and the District of Columbia didn’t report their deaths. In the United States on 2/23/23 the number of hospitalized patients (27,966) has decreased (-4.76% compared to the previous 14 days) and was 29,299 on February 9th. On 2/23/23 there were 3,610 patients who were seriously or critically ill (a 0.06% increase); that number was 3,608 two weeks ago. The number of critically ill patients has increased by 2 in the last 14 days, while at least 4,462 new deaths occurred. Patients are still dying each day (average 319/day).
As of 2/24/23, we have had 1,144,441 deaths and 105,169,945 SARS-CoV-2 infections in the United States. We have had 409,500 new infections in the last 14 days. We are adding an average of 204,750 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.90 infections or over 10,882 deaths for each one million infections. As of 2/24/23, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-six states have had greater than 2,000 deaths. Only Vermont has had less than a thousand deaths (910 deaths). Now 12 states have over 4,000 deaths per million population: Mississippi (4,476), Arizona (4,534), Alabama (4,261), West Virginia (4,428), New Mexico (4,302), Tennessee (4,263), Arkansas (4,295), Michigan (4,201), New Jersey (4,047), Kentucky (4,041), Louisiana (4,024) and the new addition, Florida (4,005). 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 (86,012 deaths), Texas (93,604 deaths), New York (77,086 deaths), Pennsylvania (50,160 deaths), Georgia (42,332 deaths), Ohio (41,686 deaths), Illinois (41,338 deaths), Michigan (41,957), and California (100,562 deaths, 20th 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 (27 months), there were 877,340 new deaths from SARS-CoV-2. For twenty-three of those months, vaccines have been available to all adults. During these twenty-three months, 572,242 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 in 3 years.
As of 2/24/23, California was ranked 32nd in the USA in infection percentage at 30.43%. In California, 26.46% of the people were infected in the last 22 months. As of 2/24/23, 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.
FDA-Approved Oral Drug Treatments for SARS-CoV-2
Pfizer has developed PAXLOVID™, an oral reversible inhibitor of C3-like protease of SARS-CoV-2. The drug inhibits this key enzyme that is crucial for virus production. The compound, also called Compound 6 (PF-07321332), is part of the drug combination PAXLOVID™ (PF-07321332; ritonavir), which successfully completed a Phase 2-3 trial in humans in multiple countries. The preliminary results were announced on 11/5/21 by Pfizer. The results showed that 89% of the hospitalizations and deaths were prevented in the drug treatment arm. The drug was administered twice a day for five days. No deaths occurred in the treatment group, and ten deaths occurred in the placebo group. The study was stopped by an independent data safety monitoring board, and the FDA concurred with this decision. Pfizer applied for an Emergency Use Authorization for this drug on 11/15/21. This drug was approved on 12/23/21. PAXLOVID™ one year later is widely available at major pharmaceutical chains and smaller independent drug stores throughout the USA. We have been able to obtain PAXLOVID™ for any patient desiring treatment. We have only had one drug failure and death from SARS-CoV-2 during 2022. That death occurred in an octogenarian male in the fourth quarter of 2022.
28, p740–746 (2021)with four 200 mg capsules orally twice a day for five dayfour 200 mg capsules orally twice a day for five daysIntravenous Drug Treatment for non-hospitalized SARS-CoV-2 Infected Patient
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 2/24/23
New Infections on 2/24/23
Total Deaths
New Deaths on 2/24/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
679,493,562(2,199,451 new infections in the last 14 days with an average of 157,111 infections per day).
117,709
6,797,242(16,487 new deaths in the last 14 days with an average of 1,178 deaths per day.)
677
8.71%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1
No
No
USA
105,169,945(ranked #1) 409,500 new infections in the last 14 dayswith an average of 29,250 infections/day
8,922(ranked #6) 39 states failed to report infections on 2/24/23.
1,144,441(ranked #1) 4,462 new deaths reported in the last 14 days or an average of 319 deaths/ day.
73 38 states failed to report deaths on 2/24/23.
31.43%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5CH.1.1
No
No
Brazil
37,020,531(ranked #5) 90,192new infections in the last 14 days.
11,587 (ranked#4)
698.928(ranked #2; 1,266 new deaths in the last 14 days)
94
17.19%
No
No
India
44,685,530(ranked #2).
–
530,764(ranked #3)
–
3.17% Unchanged in 10 weeks
No
No
United Kingdom
24,341,615(ranked #9) 47,863new infections in the last 2 weeks.
–
206,246 (ranked #7) 1,348 new deaths in the last 2 weeks
–
35.53%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)
No
No
California, USA
12,025,682(ranked #13 in the world; 14,161 new infections in the last 14 days).
1,459
100,562 (ranked #20 in world; 217 new deaths in the last 14 days
11
30.43%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1
No
No
Mexico
7,443,151(ranked #19) 42,303 new infections in 14 days).
3,870 (ranked #10)
332,938(ranked #5) 78 new deaths in the last 14 days)
25
5.65%
No
No
South Africa
4,061,383(ranked #38; 4,172 new infections in the last 14 days).
298
102,595 (ranked #18) no new deaths reported in the last 28 days).
–
6.68%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,581,763(ranked #34) 20,801 new infections in 14 days).
–
51,061(ranked #24) 432 new deaths in the last 14 days.
–
11.93%
No
No
Russia
22,232,492 (ranked #10), 184,967 new infections in 14 days).
13,829 (ranked #2)
395,970(ranked #4)486 new deaths in 14 days
32
15.24%
No
No
Peru
4,485,033(ranked #35, 1,797 new infections in 14 days).
100
219,378(ranked #6) 149 new deaths in the last 14 days.
13
13.31%
No
No
Spain
13,762,280(ranked #12; 13,362 new infections in 14 days).
1,054 (ranked #17)
119,354 (ranked #15) 478 new deaths in 14 days.
28
29.45%
No
No
France
39,605,037 (ranked #3) 45,910 new infections in 14 days).
4,489 (ranked #10)
164,848 (ranked #10) 311 new deaths in 14 days.
44
60.39% a 0.08% increase in 14 days.
No
No
Germany
38,090,089(ranked #4; 350,619 new infections in 14 days.)
21,177 (ranked #1)
167,723 (ranked #9)960 new deaths in 14 days.
119
45.41%0.22% increase in 14 days
No
No
South Korea
30,469,702 (ranked #7; 144,219 new infections in 14 days).
10,845(ranked #7)
33,909 (ranked #32) 212 new deaths in 14 days.
22
59.36%0.29%increase in 14 days
No
No
Netherlands
8,591,721 (ranked #17; 5,349 new infections in 14 days).
–
22,992 (ranked #41) Unchanged in 4 weeks
–
49.92%
No
No
Taiwan
9,985,320(ranked #16); 211,693 new infections in 14 days
14,387 (ranked #4)
17,709 (ranked #56; 745 new deaths in the last 14 days)
37
41.79% 0.87% of population has been infected in the last 14 days
No
No
Japan
33,151,209(ranked #6)242,969 new infections in the last 14 days
15,193(ranked #2)
72,051(ranked #20) 1,674 new deaths in the last 14 days for an average of 120 deaths per day.
128
26.40% 0.20% of the population infected in the last 14 days.
No
No
Australia
11,363,400(ranked #14) 33,058 new infections in 14 days.
2,961 (ranked #12)
19,357(ranked #49) 287 new deaths in 14 days.
17
43.59% 0.13% of the population infected in last 14 days.
No
No
Hong Kong
2,882,823(ranked# 41) 2,305 new infections in the last 14 days.
140
13,445 (ranked#60)33 new deaths in the last 14 days.
–
37.91% 0.03% of the population infected in the last 14 days.
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
Single-cell multiomics revealed the dynamics of antigen presentation, immune response and T cell activation in the COVID-19 positive and recovered individuals https://doi.org/10.3389/fimmu.2022.1034159
Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection (Experimental Hematology & Oncology) https://ehoonline.biomedcentral.com/articles/10.1186/s40164-022-00307-9
Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies (Acta Pharmacologica Sinica) https://doi.org/10.1038/s41401-022-00998-0
Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (European Journal of Nuclear Medicine and Molecular Imaging) https://doi.org/10.1007/s00259-022-06013-2
Successful treatment of prolonged, severe COVID-19 lower respiratory tract disease in a B-cell ALL patient with an extended course of remdesivir and nirmatrelvir/ritonavir (Clinical Infectious Diseases) https://doi.org/10.1093/cid/ciac868
In 2022, multiple new Omicron variants BA.1, BA.2, BA.4, and BA.5 assaulted the world’s population of humans and other animals. By the time multiple companies made and tested Omicron BA.1 vaccines, BA.1 was no longer the dominant variant; in fact, it was no longer present. On August 31, 2022, the FDA allowed rapid introduction of an Omicron BA.5 bivalent vaccine. In 2023 our problems are being caused by XBB recombinant variants and BA.5 sub-variants BQ.1 and BQ.1.1. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. The XBB variant XBB.1.5, has rapidly spread across the country and the world. Another new variant, CH.1.1 (BA.2.75.3.4.1.1.1.1) caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom.
On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission.
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.
XBB.1.5 Variant Continues to Dominate in the United States
During the week ending in 2/11/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 74.7% of infections, followed by BQ.1.1 at 16.3%, BQ.1 at 5.1%, XBB at 1.9%, CH.1.1 at 1.3%, BN.1 at 0.8%, BA.5 at 0.3%, and BF.7 at 0.3%.
CDC
BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5 has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA. As of 1/14/23, XBB.1.5 now causes over 80% of infections in Regions 1 and 2.
The “Omicron family feud” is a phrase coined by Dr. Raj Rajnarayanan to describe what’s going on between the Omicron BQ variants, BQ.1, BQ,1.1 (and other BQ variants) and XBB.1.5 (and other XBB variants). In the USA in regions 1 and 2, XBB.1.5 has won the feud. A new variant of BA2.75, CH.1.1, is now 4.9% of SARS-CoV-2 isolates in the world. It has the Delta mutation, P681R, which should raise a red flag. According to Saito et al, the P681R mutation, “facilitates cleavage of the spike protein and enhances viral fusogenicity [the ability of the virus to fuse to human cell membranes]….and pathogenicity [lethality].”
XBB.1.5 Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
1/21/23
1/28/23
2/04/23
2/11/23
2.3%
4.4%
7.4%
11.8%
20.1%
30.4%
43.0%
49.1%
61.3%
65.9%
74.7%
BQ. 1 and BQ.1.1 Totaled Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
1/21/23
1/28/23
2/04/23
2/11/23
53.5%
57.4%
58.6%
60.3%
59.2%
53.2%
44.7%
40.2%
31.1%
27.4%
21.4%
Percent of isolates identified as XBB.1.5 by Region
Region
Week ending in
1
2
3
4
5
6
7
8
9
10
12/31/22
75.3%
72.2%
32.7%
19.0%
6.0%
21.5%
8.1%
2.1%
9.2%
2.5%
1/14/23
81.7%
82.7%
49.0%
31.1%
14%
24.9%
8.8%
15%
15.8%
8.1%
1/28/23
89.3%
91.1%
72.5%
52.1%
36.5%
42.8%
24.4%
32.5%
35.1%
20.3%
2/11/23
93.8%
95.2%
85.8%
72.4%
60.4%
63.4%
53.1%
60.9%
56.9%
37.4%
CDC
SARS-CoV-2 infections per day in the United States have increased for the second time in 6 weeks. There is still widespread underreporting by states, a failure to capture all positive home tests, and a decreased PCR screening program in most states. Deaths per day in the United States have increased by 147 deaths per day. Many states are not reporting deaths or infections in a timely manner. The number of infections per day is expected to increase in the next four weeks due to a lack of mask use in schools, businesses, and airports; a failure of adequate building ventilation; lack of social distancing; and low rates of bivalent booster uptake. XBB, an Omicron recombinant variant first identified in India, caused a major outbreak in Singapore. XBB is the first recombinant variant combining spike protein sequences from two other Omicron BA.2 variants, that has spread aggressively around the world. New mutations of XBB, specifically XBB.1.5 have rapidly crowded out other variants in the USA.Current vaccines, monoclonal antibodies and prior infections will not protect you from getting an XBB.1.5 infection. A more detailed description of XBB variant mutations and epidemiology can be found on page 17 of the UK Health Security Agency Technical Briefing from November 25.
Troubling Variant News from the UK
The latest UK Health Security Agency Technical Briefing, published February 10, reports that variants XBB.1.5 and CH.1.1, along with their sublineages, have a growth advantage over previously dominant variants, are likely responsible for the current increase in cases in the UK, and “will continue to increase overall transmission as they become more prevalent.” In addition, they state that, based on their data, vaccine effectiveness against CH.1.1 and XBB.1.5 may be reduced compared to BQ.1. From this, we can conclude, as we have previously, that vaccination alone is not enough to protect people from being infected with these newer SARS-CoV-2 variants.
Another new variant, XBF, which is a recombinant of BA.5 and CJ.1 (which is a descendant of BA.2.75) has also shown up in low proportions in the UKHSA’s signal monitoring. More troubling is that, per GISAID, XBF currently accounts for more than 15% of sequences in Australia. We’ll be watching carefully to see which isolate will eventually supplant XBB.1.5. At this stage, it’s unclear whether it will be a mutation of XBB.1.5, another recombinant like XBF, or something else.
Yet another piece of bad news from UKHSA concerns molnupiravir, one of two oral antiviral medications approved in the U.S. for the treatment of COVID-19. This drug works by causing a large number of random mutations in the virus, which hinder its replication. That also means that molnupiravir leaves a particular “signature” of mutations that can be observed through viral sequencing. The Technical Briefing references a new preprint out of the London-based Francis Crick Institute which contains analysis of more than 13 million SARS-CoV-2 sequences in global databases. The researchers observed “a set of long phylogenetic branches that exhibit a high number of transition mutations.” In other words, on the SARS-CoV-2 family tree, there are some variants that are very different from their parents. They also observed that the number of these long branches (with more mutations between variant and sub-variant) increased in 2022, after the introduction of molnupiravir, and that the variants on those branches were more common in countries where molnupiravir was in use. In addition, they noted that the patterns of mutations among these variants were “highly similar to that in patients known to be treated with molnupiravir.” They conclude that there have been some cases in which “viruses with a large number of molnupiravir-induced substitutions have been transmitted to other individuals.” This analysis was compelling enough that the UKHSA’s Variant Technical Group is recommending further investigation into the impact of molnupiravir treatment on the evolution of the virus, especially in the case of chronic infections and infections in immunocompromised people.
In our clinic, we only treat patients with Paxlovid because of our concerns about the potential of developing new resistant variants on molnupiravir therapy, particularly in our immunocompromised patients. If additional information develops about the mutation problem with molnupiravir, then the drug may need to be pulled off the market.
UK Health Security AgencyUK Health Security Agency
For a more detailed picture of COVID variant evolution in the United States, we recommend checking out the dashboard put together by Raj Rajnarayanan, Assistant Dean of Research and Associate Professor at NYITCOM at Arkansas State University.
To understand the true impact of these variants, it’s helpful to examine their evolution. Two virologists collaborated on Twitter to create the figure below, which Professor Johnson titled “Convergent Evolution on Steroids.” It shows the key mutations present in many of the currently-circulating Omicron subvariants and demonstrates that mutation at site 346 is becoming more and more common.
From Daniele Focosi, M.D., Ph.D. @dfocosi on Twitter, February 3, 2023
Past infections with a BA.1, BA.2 or BA.5 variants will not prevent infections with any of the newer variants. Monoclonal antibodies are no longer effective against newer BQ variants, XBB variants and other spike protein mutated variants. The last remaining monoclonal antibody, bebtelovimab, was removed from use by the FDA on 12/2/22. Paxlovid was only 89% effective in the original clinical trials against SARS-CoV-2. If resistance develops this winter to oral Paxlovid, we will have more Paxlovid failures and increased hospitalizations and deaths.
A Deeper Dive into U.S. COVID Data
On 1/27/23, the United States had 12,107 documented new infections. There were also 159 deaths. Thirty-nine states did not report their infections, and 38 states and the District of Columbia didn’t report their deaths. In the United States on 2/09/23 the number of hospitalized patients (29,299) has decreased (-13.83% compared to the previous 14 days) and was 34,015 on January 27. On 1/27/23 there were 3,608 patients who were seriously or critically ill (a 17.03% decrease); that number was 4,349 two weeks ago. The number of critically ill patients has decreased by 741 in the last 14 days, while at least 7,743 new deaths occurred. Patients are still dying each day (average 553/day).
As of 2/10/23, we have had 1,139,979 deaths and 104,760,445 SARS-CoV-2 infections in the United States. We have had 653,533 new infections in the last 14 days. We are adding an average of 326,767 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.89 infections or over 10,882 deaths for each one million infections. As of 2//23, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-six states have had greater than 2,000 deaths. Only Vermont has had less than a thousand deaths (901 deaths). Now 11 states have over 4,000 deaths per million population: Mississippi (4,444), Arizona (4,525), Alabama (4,261), West Virginia (4,410), New Mexico (4,293), Tennessee (4,234), Arkansas (4,281), Michigan (4,186), New Jersey (4,038), Kentucky (4,015) and Louisiana (4,006). 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 (85,710 deaths), Texas (93,364 deaths), New York (76,800 deaths), Pennsylvania (49,921 deaths), Georgia (42,161 deaths), Ohio (41,535 deaths), Illinois (41,263 deaths), Michigan (41,809), and California (100,345 deaths, 20th 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 (27 months), there were 872,878 new deaths from SARS-CoV-2. For twenty-three of those months, vaccines have been available to all adults. During these twenty-three months, 567,780 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 in 3 years.
As of 2/10/23, California was ranked 31st in the USA in infection percentage at 30.39%. In California, 26.42% of the people were infected in the last 22 months. As of 2/10/23, 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.
Don’t want to miss an update?
Get the latest COVID updates from Dr. Wright delivered to your inbox as soon as they’re published!
FDA-Approved Oral Drug Treatments for SARS-CoV-2
Pfizer has developed PAXLOVID™, an oral reversible inhibitor of C3-like protease of SARS-CoV-2. The drug inhibits this key enzyme that is crucial for virus production. The compound, also called Compound 6 (PF-07321332), is part of the drug combination PAXLOVID™ (PF-07321332; ritonavir), which successfully completed a Phase 2-3 trial in humans in multiple countries. The preliminary results were announced on 11/5/21 by Pfizer. The results showed that 89% of the hospitalizations and deaths were prevented in the drug treatment arm. The drug was administered twice a day for five days. No deaths occurred in the treatment group, and ten deaths occurred in the placebo group. The study was stopped by an independent data safety monitoring board, and the FDA concurred with this decision. Pfizer applied for an Emergency Use Authorization for this drug on 11/15/21. This drug was approved on 12/23/21. PAXLOVID™ one year later is widely available at major pharmaceutical chains and smaller independent drug stores throughout the USA. We have been able to obtain PAXLOVID™ for any patient desiring treatment. We have only had one drug failure and death from SARS-CoV-2 during 2022. That death occurred in an octogenarian male in the fourth quarter of 2022.
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 2/10/23
New Infections on 2/10/23
Total Deaths
New Deaths on 2/10/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
677,294,111(2,779,648 new infections in the last 14 days with an average of 198,546 infections per day).
135,509
6,780755(52,474 new deaths in the last 14 days with an average of 3,748 deaths per day.)
888
8.68%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1
No
No
USA
104,760,445(ranked #1) 653,533 new infections in the last 14 dayswith an average of 46,681 infections/day
12,107(ranked #7) 39 states failed to report infections on 2/10/23.
1,139,979(ranked #1) 7,743 new deaths reported in the last 14 days or an average of 553 deaths/ day.
159 38 states failed to report deaths on 2/10/23.
31.29%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5CH.1.1
No
No
Brazil
36,930,339(ranked #5) 124,372new infections in the last 14 days.
12,716 (ranked#5)
697,662(ranked #2; 1,777 new deaths in the last 14 days)
42
17.14%
No
No
India
44,682,530(ranked #2).
–
530,739(ranked #3)
–
3.17% Unchanged in 8 weeks
No
No
United Kingdom
24,293,752(ranked #9) 34,506 new infections in the last 2 weeks.
–
204,898 (ranked #7) 1,669 new deaths in the last 2 weeks
–
35.46%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)
No
No
California, USA
12,011,521(ranked #12 in the world; 50,447 new infections in the last 14 days).
1,459
100,345 (ranked #20 in world; 452 new deaths in the last 14 days
22
30.39%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1
No
No
Mexico
7,400,848(ranked #19) 47,218 new infections in 14 days).
–
332,850(ranked #5) 834 new deaths in the last 14 days)
–
5.62%
No
No
South Africa
4,057,211(ranked #38; 1,927 new infections in the last 14 days).
–
102,595 (ranked #18) no new deaths in the last 14 days).
–
6.67%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,560,962(ranked #34) 21,733 new infections in 14 days).
–
50,629(ranked #24) 494 new deaths in the last 14 days.
–
11.88%
No
No
Russia
22,047,525 (ranked #10), 77,539 new infections in 14 days).
12,392 (ranked #6)
395,484(ranked #4)582 new deaths in 14 days
37
15.12%
No
No
Peru
4,483,236(ranked #35, 2,408 new infections in 14 days).
200
219,229(ranked #6) 500 new deaths in the last 14 days.
1
13.31%
No
No
Spain
13,748,918(ranked #12; 37,667 new infections in 14 days).
1,119 (ranked #13)
118,876 (ranked #16) 542 new deaths in 14 days.
36
29.42%
No
No
France
39,,559,127 (ranked #3)
3,336 (ranked #9)
164,537 (ranked #10) 457 new deaths in 14 days.
44
60.31% a 0.07% increase in 14 days.
No
No
Germany
37,739,472(ranked #4; 167,840 new infections in 14 days.)
13,420 (ranked #4)
166,763 (ranked #9)1,322 new deaths in 14 days.
103
45.19%0.20% increase in 14 days
No
No
South Korea
30,325,483 (ranked #7; 218,129 new infections in 14 days).
13,504(ranked #3)
33,697 (ranked #34) 365 new deaths in 14 days.
17
59.07%0.42%increase in 14 days
No
No
Netherlands
8,586,372 (ranked #17; 4,951 new infections in 14 days).
396
22,992 (ranked #41)
–
49.88%
No
No
Taiwan
9,773,627(ranked #16); 345,147 new infections in 14 days
16,964 (ranked #2)
16,964 (ranked #56; 760 new deaths in the last 14 days)
70
40.91% 1.45% of population has been infected in the last 14 days
No
No
Japan
32,908,240(ranked #6)543,390 new infections in the last 14 days
28,615(ranked #1)
70,377(ranked #20) 3,327 new deaths in the last 14 days for an average of 238 deaths per day.
192
26.20% 0.43-% of the population infected in the last 14 days.
No
No
Australia
11,330,342(ranked #14) 34,876 new infections in 14 days.
2,491 (ranked #10)
19,070(ranked #49) 455 new deaths in 14 days.
35
43.46% 0.14-% of the population infected in last 14 days.
No
No
Hong Kong
2,880,518(ranked# 41) 62,811 new infections in the last 14 days.
250
13,412 (ranked#60)132 new deaths in the last 14 days.
5
37.88% 0.15% of the population infected in the last 14 days.
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
Single-cell multiomics revealed the dynamics of antigen presentation, immune response and T cell activation in the COVID-19 positive and recovered individuals https://doi.org/10.3389/fimmu.2022.1034159
Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection (Experimental Hematology & Oncology) https://ehoonline.biomedcentral.com/articles/10.1186/s40164-022-00307-9
Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies (Acta Pharmacologica Sinica) https://doi.org/10.1038/s41401-022-00998-0
Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (European Journal of Nuclear Medicine and Molecular Imaging) https://doi.org/10.1007/s00259-022-06013-2
Successful treatment of prolonged, severe COVID-19 lower respiratory tract disease in a B-cell ALL patient with an extended course of remdesivir and nirmatrelvir/ritonavir (Clinical Infectious Diseases) https://doi.org/10.1093/cid/ciac868
Effectiveness of Monovalent mRNA Vaccines Against COVID-19–Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States — IVY Network, 18 States, December 26, 2021–August 31, 2022 (MMWR) https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a3.htm
“Three-dose monovalent mRNA VE estimates against COVID-19–associated hospitalization decreased with time since vaccination. Three-dose VE during the BA.1/BA.2 and BA.4/BA.5 periods was 79% and 60%, respectively, during the initial 120 days after the third dose and decreased to 41% and 29%, respectively, after 120 days from vaccination.”
Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome (Frontiers in Immunology) https://doi.org/10.3389/fimmu.2022.949787
In 2022, multiple new Omicron variants BA.1, BA.2, BA.4, and BA.5 assaulted the world’s population of humans and other animals. By the time multiple companies made and tested Omicron BA.1 vaccines, BA.1 was no longer the dominant variant; in fact, it was no longer present. On August 31, 2022, the FDA allowed rapid introduction of an Omicron BA.5 bivalent vaccine. However, this has had no effect on new immune evading BQ variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. An additional variant, XBB.1.5, is now rapidly spreading across the country and the world causing increased numbers of hospitalizations and critically ill patients in the USA. A new variant, CH.1.1 (BA.2.75.3.4.1.1.1.1) caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom.
On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission. 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.
XBB.1.5 Variant Continues to Dominate
During the week ending in 1/14/22, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 43% of infections, followed by BQ.1.1 at 28.8%, BQ.1 at 15.9%, XBB at 3.9%, BA.5 at 2.6%, BN.1 at 2.1%, BF.7 at 1.4%, and BA.2.75 at 1.3%. The remaining variants made up less than 1% each: BA.5.2.6 (0.5%), BA.2 (0.2%), BF.11 (0.2%), BA.4.6 (0.1%), and BA.2.75.2 (0.1%). We are keeping our eye on BA.2.75, as the CDC is likely lumping in its descendant, CH.1, and its subvariants under this label.
CDC
BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5 has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA. As of 1/14/23, XBB.1.5 now causes over 80% of infections in Regions 1 and 2.
The “Omicron family feud” is a phrase coined by Dr. Raj Rajnarayanan to describe what’s going on between the Omicron BQ variants, BQ.1, BQ,1.1 (and other BQ variants) and XBB.1.5 (and other XBB variants). In the USA in regions 1 and 2, XBB.1.5 has won the feud. A new variant of BA2.75, CH.1.1, is now 4.9% of SARS-CoV-2 isolates in the world. It has the Delta mutation, P681R, which should raise a red flag. According to Saito et al, the P681R mutation, “facilitates cleavage of the spike protein and enhances viral fusogenicity [the ability of the virus to fuse to human cell membranes]….and pathogenicity [lethality].”
XBB.1.5 Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
2.3%
4.4%
7.4%
11.8%
20.1%
30.4%
43.0%
BQ. 1 and BQ.1.1 Totaled Proportion of Sequenced Isolates in the USA
12/3/22
12/10/22
12/17/22
12/24/22
12/31/22
1/7/23
1/14/23
53.5%
57.4%
58.6%
60.3%
59.2%
53.2%
44.7%
Percent of isolates identified as XBB.1.5 by Region
Region
Week ending in
1
2
3
4
5
6
7
8
9
10
12/31/22
75.3%
72.2%
32.7%
19.0%
6.0%
21.5%
8.1%
2.1%
9.2%
2.5%
1/14/23
81.7%
82.7%
49.0%
31.1%
14%
24.9%
8.8%
15%
15.8%
8.1%
CDC
SARS-CoV-2 infections per day in the United States have increased for the second time in 6 weeks. There is still widespread underreporting by states, a failure to capture all positive home tests, and a decreased PCR screening program in most states. Deaths per day in the United States have increased by 147 deaths per day. Many states are not reporting deaths or infections in a timely manner. The number of infections per day is expected to increase in the next four weeks due to a lack of mask use in schools, businesses, and airports; a failure of adequate building ventilation; lack of social distancing; and low rates of bivalent booster uptake. XBB, an Omicron recombinant variant first identified in India, caused a major outbreak in Singapore. XBB is the first recombinant variant combining spike protein sequences from two other Omicron BA.2 variants, that has spread aggressively around the world. New mutations of XBB, specifically XBB.1.5 are rapidly crowding out other variants in the USA.Current vaccines, monoclonal antibodies and prior infections will not protect you from getting an XBB.1.5 infection. A more detailed description of XBB variant mutations and epidemiology can be found on page 17 of the UK Health Security Agency Technical Briefing from November 25.
For a more detailed picture of COVID variant evolution in the United States, we recommend checking out the dashboard put together by Raj Rajnarayanan, Assistant Dean of Research and Associate Professor at NYITCOM at Arkansas State University.
To understand the true impact of these variants, it’s helpful to examine their evolution. Two virologists collaborated on Twitter to create the figure below, which Professor Johnson titled “Convergent Evolution on Steroids.” It shows the key mutations present in many of the currently-circulating Omicron subvariants and demonstrates that mutation at site 346 is becoming more and more common.
From Daniele Focosi, M.D., Ph.D. @dfocosi on Twitter, January 9, 2023
Past infections with a BA.1, BA.2 or BA.5 variants will not prevent infections with any of the newer variants. Monoclonal antibodies are no longer effective against newer BQ variants, XBB variants and other spike protein mutated variants. The last remaining monoclonal antibody, bebtelovimab, was removed from use by the FDA on 12/2/22. Paxlovid was only 89% effective in the original clinical trials against SARS-CoV-2. If resistance develops this winter to oral Paxlovid, we will have more Paxlovid failures and increased hospitalizations and deaths.
A Deeper Dive into U.S. COVID Data
On 1/13/23, the United States had 19,397 documented new infections. There were also 193 deaths. Thirty-seven states did not report their infections, and 37 states didn’t report their deaths. In the United States on 1/13/23 the number of hospitalized patients (44,806) has increased (+10.98% compared to the previous 14 days) and was 40,374 on December 30. On 1/13/22 there were 5,449 patients who were seriously or critically ill (a 6.1% increase); that number was 5,135 two weeks ago. The number of critically ill patients has increased by 315 in the last 14 days, while at least 7,064 new deaths occurred. The number of critically ill patients has increased for the 11th time in thirty-five 14-day periods. Patients are still dying each day (average 505/day).
As of 1/13/23, we have had 1,125,020 deaths and 103,482,187 SARS-CoV-2 infections in the United States. We have had 971,709 new infections in the last 14 days. We are adding an average of 485,855 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.98 infections or over 10,872 deaths for each one million infections. As of 1/13/22, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-six states have had greater than 2,000 deaths, and 33 states have greater than 3,000 deaths per million population. Nine states have over 4,000 deaths per million population: Mississippi (4,406), Arizona (4,465), Alabama (4,246), West Virginia (4,340), New Mexico (4,240), Tennessee (4,186), Arkansas (4,225), Michigan (4,105) and New Jersey (4,016). 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 (84,170 deaths), Texas (92,600 deaths), New York (75,909 deaths), Pennsylvania (49,263 deaths), Georgia (41,648 deaths), Ohio (41,001 deaths) , Illinois (40,678 deaths), Michigan (41,001), and California (98,954 deaths, 20th 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 (26 months), there were 857,919 new deaths from SARS-CoV-2. For twenty-two of those months, vaccines have been available to all adults. During these twenty-two months, 552,821 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 in 2.5 years.
As of 1/13/23, California was ranked 32nd in the USA in infection percentage at 29.99%. In California, 26.02% of the people were infected in the last 22 months. As of 1/13/23, 31 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.
FDA-Approved Oral Drug Treatments for SARS-CoV-2
Pfizer has developed PAXLOVID™, an oral reversible inhibitor of C3-like protease of SARS-CoV-2. The drug inhibits this key enzyme that is crucial for virus production. The compound, also called Compound 6 (PF-07321332), is part of the drug combination PAXLOVID™ (PF-07321332; ritonavir), which successfully completed a Phase 2-3 trial in humans in multiple countries. The preliminary results were announced on 11/5/21 by Pfizer. The results showed that 89% of the hospitalizations and deaths were prevented in the drug treatment arm. The drug was administered twice a day for five days. No deaths occurred in the treatment group, and ten deaths occurred in the placebo group. The study was stopped by an independent data safety monitoring board, and the FDA concurred with this decision. Pfizer applied for an Emergency Use Authorization for this drug on 11/15/21. This drug was approved on 12/23/21. PAXLOVID™ one year later is widely available at major pharmaceutical chains and smaller independent drug stores throughout the USA. We have been able to obtain PAXLOVID™ for any patient desiring treatment. We have only had one drug failure and death from SARS-CoV-2 during 2022. That death occurred in an octogenarian male in the fourth quarter of 2022.
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 1/13/23
New Infections on 1/13/23
Total Deaths
New Deaths on 1/13/23
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
670,816,950
319,987
6,728,270
1,607
8.60%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBBBQ.1BQ.1.1BS.1BN.1
No
No
USA
103,482,187 (ranked #1)
19,397 (ranked #5) 37 states and D,C. failed to report infections on 12/2/22.
1,125,020 (ranked #1)
193 37 states and D.C. failed to report deaths on 1/13/23.
30.90%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BQ.1BQ.1.1BN.1
No
No
Brazil
36,623,217(ranked #5)
20,548 (ranked#4)
695,334 (ranked #2)
79
17.00%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
India
44,681,884 (ranked #2)
–
530,726(ranked #3)
–
3.17% Unchanged in 4 weeks
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)APTK India VOI 32421Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India)Iota/B.1.526 (USA-NYC) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India)
No
No
United Kingdom
24,243,576 (ranked #9)
–
202,157 (ranked #7) 470 new deaths in 2 weeks
–
35.39%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)
No
No
California, USA
11,852,546 (ranked #13 in the world)
1,516
98,954 (ranked #20 in world)
25
29.99%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1
No
No
Mexico
7,303,600 (ranked #19)
5,686 (ranked #11)
331,452(ranked #5)
45
5.55%
No
No
South Africa
4,051,243 (ranked #37; 4,347 new infections in 14 days).
183
102,568 (ranked #18) 0 new deaths in 14 days) Unchanged in 4 weeks
–
6.66%
Unchanged in 4 weeks
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,508275 (ranked #34)
–
49,566 (ranked #24 )
–
11.74%
No
No
Poland
6,732,901 (ranked #21)
324
118,640 (ranked #15) 87 new deaths in the last 14 days
7
16.88%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 + (South Africa November 2021),Omicron/B.1.1.529 +BA.3
No
No
Russia
21,846,722 (ranked #10)
5,978 (ranked #12)
394,209(ranked #4)
47
14.98%
No
No
Peru
4,473,821(ranked #35)
627
218,490(ranked #6)
13
13.28%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Gamma/P.1 (Brazil)Iota/B.1.526 (USA-NYC)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Iran
7,562,446 (ranked #18)
75
144,723 (ranked #12)
1
8.78% Unchanged in 4 weeks
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Spain
13,711,251 (ranked #12)
9,871 (ranked #7)
117,759 (ranked #16) new deaths in 14 days
76
29.34%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Kappa/B.1.617.1 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)
No
No
France
39,442,176 (ranked #3)
6,238 (ranked #9)
163,347 (ranked #10)
101
60.13%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
Germany
37,605,135 (ranked #4)
10,609 (ranked #6)
163,775 (ranked #9)
150
44.83%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
South Korea
29,737,769 (ranked #7)
39,726 (ranked #2)
32,867 (ranked #34)
66
57.93%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Vietnam
11,526,089 (ranked #13)
55
43,186(ranked #26)
–
11.64% Unchanged in 4 weeks
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
,
No
Netherlands
8,576,523 (ranked #17)
–
22,989 (ranked #41)
–
49.83%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Denmark
3,171,515 (ranked #40)
190
7,982 (ranked #76)
11
54.35%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Taiwan
9,167,795 (ranked #16)
21,721 (ranked #3)
15,755 (ranked #56)
53
38.37%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Japan
31,176,281(ranked #6)
144,077 (ranked #1)
61,761(ranked #23)
480
24.82% 14 days.
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)BA.2*BA.5*
No
No
Argentina
10,004,679 (ranked #15)
–
130,249(ranked #14)
–
21.74%
No
No
Italy
25,363,742 (ranked #8)
–
185,993(ranked #8)
–
42.08%
No
No
Chile
5,081,862 (ranked #27)
3,289 (ranked#14)
63,466(ranked #22)
29
26.39%
No
No
Colombia
6,349,971 (ranked #22)
–
142,259(ranked #13)
–
12.32%
No
No
Australia
11,247,412 (ranked #14)
5,985 (ranked #10)
17,712(ranked #50)
59
43.14%
No
No
Turkey
17,042,722 (ranked #11)
–
101,492 (ranked #19)
–
19.91% Unchanged in 4 weeks
No
No
Indonesia
6,725,458 (ranked #20)
363
160,719 (ranked #11) 478 new deaths in the last 14 days.
8
24.09%
No
No
Malaysia
5,032,146 (ranked #28)
320
36,908 (ranked #29)
3
15.16%
No
No
Hong Kong
2,817,707(ranked#41)
8,260 (ranked #8)
12,693 (ranked#60) 345 new deaths in the last 14 days.
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
Single-cell multiomics revealed the dynamics of antigen presentation, immune response and T cell activation in the COVID-19 positive and recovered individuals https://doi.org/10.3389/fimmu.2022.1034159
Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection (Experimental Hematology & Oncology) https://ehoonline.biomedcentral.com/articles/10.1186/s40164-022-00307-9
Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies (Acta Pharmacologica Sinica) https://doi.org/10.1038/s41401-022-00998-0
Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (European Journal of Nuclear Medicine and Molecular Imaging) https://doi.org/10.1007/s00259-022-06013-2
Successful treatment of prolonged, severe COVID-19 lower respiratory tract disease in a B-cell ALL patient with an extended course of remdesivir and nirmatrelvir/ritonavir (Clinical Infectious Diseases) https://doi.org/10.1093/cid/ciac868
Effectiveness of Monovalent mRNA Vaccines Against COVID-19–Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States — IVY Network, 18 States, December 26, 2021–August 31, 2022 (MMWR) https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a3.htm
“Three-dose monovalent mRNA VE estimates against COVID-19–associated hospitalization decreased with time since vaccination. Three-dose VE during the BA.1/BA.2 and BA.4/BA.5 periods was 79% and 60%, respectively, during the initial 120 days after the third dose and decreased to 41% and 29%, respectively, after 120 days from vaccination.”
Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome (Frontiers in Immunology) https://doi.org/10.3389/fimmu.2022.949787
When my daughter, Emily, and I started writing this blog in the spring of 2020, we did not anticipate that almost three years later, there would still be no end in sight for this pandemic. As we begin a new year, we wish we had better news, but the data continues to tell a grim story, and, as our long-time readers know, we always ground our outlook in the numbers.
In the United States, from March 2020 to December 31, 2021, we had 55,696,500 SARS CoV-2 infections and 846,905 deaths (66 infections per death). In the last 12 months we have had an additional 46,813,072 new infections and an additional 271,051 deaths (173 infections per death). That’s an average of 742 deaths per day. The majority of these deaths were in people over the age of 65, and all of them were preventable. In November 2022, KFF reported that COVID-19 was still the number 3 cause of death in the United States. It’s also worth noting that the number one cause of death, cardiovascular disease, is a known complication of COVID.
In late December 2021 the FDA approved both oral Paxlovid and oral Molnupiravir for outpatient treatment of SARS-CoV-2 with distribution beginning in January 2022. Unfortunately, all of the mask mandates were removed by individual states in 2022, and despite President Biden’s vow to institute a federal mask mandate during his 2020 campaign, the President and his administration adopted a decidedly anti-mask policy this year. CDC Director Rochelle Walensky even went so far as to describe masks as “the scarlet letter of this pandemic.” This irresponsible public health messaging has led to thousands of infections and deaths that could have been otherwise prevented by responsible mask wearing. We continue to urge our patients to protect themselves and others by wearing an N95 (or better) mask in public.
This year, multiple new Omicron variants BA.1, BA.2, BA.4, and BA.5 assaulted the world’s population of humans and other animals. By the time multiple companies made and tested Omicron BA.1 vaccines, BA.1 was no longer the dominant variant; in fact, it was no longer present. On August 31, 2022, the FDA allowed rapid introduction of an Omicron BA.5 bivalent vaccine. However, this has had no effect on new immune evading BQ variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. An additional variant, XBB.1.5, is now rapidly spreading across the country and the world causing increased numbers of hospitalizations and critically ill patients in the USA.
At the same time, we have had outbreaks and deaths from Influenza A H3N2 and RSV. Travel and lack of masking and social distancing have exacerbated the spread of these viruses. In addition, Mpox virus outbreaks occurred nationwide, a measles outbreak began in Ohio in unvaccinated children, and several cases of polio in New York were reported.
Part of why the United States’ vaccine-only approach to COVID-19 is so dangerous is that SARS-CoV-2 mutates, evading immune protection, and spreads more quickly than anyone can make, get approved, and distribute new vaccines. The Omicron BQ.1.1 variant is now being rapidly replaced by XBB.1.5. As an example, at D4 Labs, we designed, manufactured and packaged a new vaccine for Omicron BQ.1.1 in 6 weeks. Minimal animal testing, IRB approval, human testing, and expedited FDA approval under an EUA would probably require at least another 6 months. Even if we skipped or delayed animal testing, obtained IRB approval, and internally did a standard two-dose immunogenicity study in 20 humans using IgG antibody to the RBD of SARS-CoV-2 as the surrogate marker for protection, it would still take three months in our in-house human testing and assay facility to complete the study. This approach would probably not be acceptable to the FDA for even EUA approval but might be attempted in individual states. The timely production and distribution of any new vaccine against any new SARS-CoV-2 mutant will be difficult to accomplish by any company using the current regulatory framework for approval of vaccines in the United States. Using XBB.1.5 as an example, it is responsible for over 40% of the infections in the United States in the last 28 days. Vaccines would have to be designed, manufactured, and distributed in less than four weeks to stop an outbreak of a virulent, highly-infectious respiratory pathogen. Considerable thought needs to be entertained on how to accomplish this task rapidly.
Sadly, we do not see things improving in 2023 for respiratory virus control in the United States unless people wear high quality masks (N95 or better) and practice social distancing again. Continued infection and death increases are expected in the next eight weeks with 113 million people expected to travel during the holiday season, schools reopening on January 2, and people returning to work in poorly ventilated spaces.
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.
After Delays, CDC Discloses XBB.1.5 Variant Data
On 12/31/22 the CDC estimates that BA.5 accounted for 3.7% of infections (a 49.6% point drop from its peak), BQ.1 accounted for 18.3% (a 12.4% point drop decrease from its peak on 12/17/22), BQ.1.1 accounted for 26.9% (a 11.5% point drop from its peak on 12/17/22), BA.4.6 accounted for 0.3%, BF.7 accounted for 2.1% of infections, BN.1 accounted for 2.4% of isolates,andBA.2.75.2 accounted for 0.1%. XBB is 3.6% of isolates, XBB.1.5 is 40.5% of isolates, BA.5.2.6 is 0.6% of isolates, and BF.11 0.3% of isolates. In the week ending December 31, 2022, BQ isolates accounted for 45.2% of isolates (a 23.9% point decrease in infections caused by these BQ variants since 12/17/22).
CDC
BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5 has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA and it now causes over 70% of infections in Regions 1 and 2.
XBB.1.5 Proportion of Sequenced Isolates in the USA
In the United States, daily COVID deaths and infections increased over the last two weeks, with an average loss of 453 lives per day.
The US government is mailing free COVID test kits again, and US residents can anonymously report the results of at-home tests to NIH.
Immune-escaping BQ variants continue to dominate in the US, though recombinant XBB lineages, which have been demonstrated to evade neutralizing antibodies in vaccinated people, are on the rise.
Bivalent booster uptake is still insufficient to protect the US population this winter, with only 14.1% of the population up to date on COVID vaccines.
In Monterey County, just over half of the population has received three vaccine doses, and only 16.1% have received the bivalent booster.
Dr. Wright continues to recommend that everyone wear N95 or P100 masks when gathering indoors. This will help protect not only against COVID-19, but also against other respiratory viruses that are on the rise around the country, including RSV, flu, and measles. Anyone who is not up to date on flu and measles vaccines should get vaccinated as soon as possible.
Don’t want to miss an update?
Get the latest COVID updates from Dr. Wright delivered to your inbox as soon as they’re published!
It’s time for our next 14-day moving average determinations for SARS-CoV-2 for the United States and my thoughts on vaccines, SARS-CoV-2 therapeutic agents and mutant viruses. 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.
SARS-CoV-2 infections per day in the United States have increased for the fourth time in 8 weeks.There is still widespread underreporting by states, a failure to capture all positive home tests, and a decreased PCR screening program in most states. Deaths per day in the United States have increased by 157 deaths per day. Many states are not reporting deaths or infections in a timely manner. The number of infections per day has increased by 23,190 due to the lack of mask use in schools, businesses, and airports; a failure of adequate building ventilation; lack of social distancing; and low rates of bivalent booster uptake. Continued infection and death increases are expected in the next four weeks with 113 million people expected to travel during the holiday season.In late November of this year, the National Institutes of Health launched MakeMyTestCount.org, a website that allows users to anonymously report the results of at-home COVID tests. Unfortunately, it has thus far not been widely publicized. The US government has begun mailing free test kits again. Go to the following website to obtain free test kits: https://special.usps.com/testkits
Drug-Evading Mutants Continue to Dominate the Variant Soup
On 12/17/22 the CDC estimates that BA.5 accounted for 10% of infections (a 42.4% drop from 10/21/22), BQ.1 accounted for 30.7% (a 21.3% increase since 10/21/22), BQ.1.1 accounted for 38.4% (a 31.2% increase since 10/21/22), BA.4.6 accounted for 1.1% (a 8.4% decrease from 10/21/22), BF.7 accounted for 4.9% (a 4.1% decrease from 10/21/22), BN.1 accounted for 4.1% of isolates (a 1% decrease since 1/19/22),andBA.2.75.2 accounted for 0.3%. In the last four weeks, three isolates were added to the CDC’s reporting: XBB (7.2% an increase of 1.7% since 12/2/22), BA.5.2.6 (1.6% a decrease of 0.2% since 12/2/22), and BF.11 (0.7% decrease of 0.2% since 12/2/22). In the week ending December 17, 2022, BQ isolates accounted for 69.1% of infections (a 33.8% increase in infections caused by these BQ variants since 10/21/22). BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine.
CDCCDC
The total percentage of BQ variant infections in the region that includes New York and New Jersey was 72.4% two weeks ago and is now 70.2%. BA.5 accounts for 9.6% of infections, BF.7 accounts for 2.7%, BN.1 accounts for 2.0%, BA.5.2.6 accounts for 1%, and BA.2.75 lineages account for 0.7% of infections. XBB isolates (STILL not shown in above chart) are 12.5% of isolates in Region 2 (see below).
CDCCDC
The total percentage of BQ variant infections in the region that includes California, Nevada, Arizona, and Hawaii was 62.6% on 12/3/22 and is now 69.4%. BA.5 accounts for 9.5% of isolates, and BA.5.2.6 accounts for 1.4%. The BA.2.75 lineages account for 1.2%. BF.7 accounts for 3.9%, BN.1 accounts for 4.5%, and BA.2 isolates account for 1.2%. Again, CDC is not reporting XBB in the Region 9 chart above. XBB isolates are 8.2% of isolates in region 9.
CDC
Data on the rapid spread of a dangerous variant category, the BQ variants, was withheld by the CDC in their weekly reports until seven weeks ago. This data on BQ.1 and BQ.1.1 should have been disclosed earlier.
For a more detailed picture of COVID variant evolution in the United States, we recommend checking out the dashboard put together by Raj Rajnarayanan, Assistant Dean of Research and Associate Professor at NYITCOM at Arkansas State University. We can see that XBB already has a few subvariants that are gaining prevalence in New York.
To understand the true impact of these variants, it’s helpful to examine their evolution. Two virologists collaborated on Twitter to create the figure below, which Professor Johnson titled “Convergent Evolution on Steroids.” It shows the key mutations present in many of the currently-circulating Omicron subvariants and demonstrates that mutation at site 346 is becoming more and more common.
From Daniele Focosi, M.D., Ph.D. @dfocosi on Twitter, November 4, 2022
Past infections with a BA.1, BA.2 or BA.5 variants will not prevent infections with any of the newer variants. Monoclonal antibodies are no longer effective against newer BQ variants and other spike protein mutated variants. The last remaining monoclonal antibody, bebtelovimab, was removed from use by the FDA on 12/2/22. Paxlovid was only 89% effective in the original clinical trials against SARS-CoV-2. If resistance develops this winter to oral Paxlovid, we will have more Paxlovid failures and increased hospitalizations and deaths.
The November 25 UK Health Security Agency Technical Briefing identifies lineages BA.5, BA.5.2.35, BA.5.7, BQ.1, BQ.1.1, XBB, and BN1 (BA.2.75.5.1) as isolates of concern.
Variant
Sublineage of
Mutations
Global Sequences outside UK
UK Sequences
BQ.1
BA.5
L452RN460KK444T
33,206 (81 countries)
9,285 (> 40% of all sequenced samples)
BQ.1.1
BA.5
N460KK444TR346T
17,621(70 countries)
4,715
BA.5.2.35
BA.5.2
R346T, 2 synonymous single nucleotide polymorphisms (SNPs) G28423C and C7006T
447
848
BN.1
BA.2.75.5
R346T F490S
1,127
190
XBB
Recombinant of BJ.1 and BM.1.1.1 (both descended from BA.2), approximate break point between spike mutations G446S and N460K
E: T11A, Spike: V83A, H146Q, Q183E, F486S, F490S.Spike mutations inherited from BJ.1 are G339H, R346T, V445P, G446S and from BM.1.1.1 areN460K, F486V, F490S, and R493Q
4,831 (51 countries)
345
Disappointing Vaccine Uptake, Especially Among Children
Our monoclonal antibody therapies do not work for these isolates, but these emerging BQ variants are descendants of BA.5, so the new BA.5 bivalent vaccine should offer some protection, when combined with an N95 mask. It’s troubling that, despite the availability of this vaccine, few people are getting vaccinated. As of December 14, 2022, the CDC reports that 44,154,294 people in the United States (5 years and up) have received the bivalent vaccine. That’s only 19.4% of people (5 and up) who received the primary series and 14.1% of the overall population.
Children under the age of 5 have not been approved to receive either Omicron BA.5 mRNA booster. Sadly, in children between 0 and 5 years of age only 1.61 million have received at least one dose of any SARS-CoV-2 mRNA vaccine based on the original Wuhan isolate. In the United States, at least 1,390 children have died of COVID-19, and another 74 have died of multisystem inflammatory syndrome (MIS-C). Worldwide, according to UNICEF, over 16,100 children and young adults aged 0-20 have died of COVID-19.
The Monterey County Health Department reports that, as of 12/19/22, 3.7% of 0-4 year-olds and 40.2% of 5-11 year-olds have received the first two doses of vaccine, while 73.4% of 12-17 year-olds have received two doses. Only 55.5% of Monterey County residents have received a third dose of the vaccine. The Monterey County Health Department does not publish data on how many residents have received the new BA.5 bivalent booster vaccine, but the Monterey Weekly reported on December 8 that only 16.1% of county residents had received it. On June 17, The FDA authorized both the Pfizer and Moderna vaccines for use in children ages 6 months to four years. We believe children under 5 should be vaccinated as soon as possible. All Monterey County residents should get up to date on COVID-19 vaccinations, including the bivalent BA.5 booster, as soon as possible.
Source: Monterey County Health Department
Mask Up to Protect Against Additional Viral Threats This Winter
In a new preprint on respiratory syncytial virus (RSV) in young children, researchers from Case Western University write, “Among RSV-infected children in 2022, 19.2% had prior documented COVID-19 infection, significantly higher than the 9.7% among uninfected children, suggesting that prior COVID-19 could be a risk factor for RSV infection or that there are common risk factors for both viral infections.” Wearing a well-fitting, high-filtration mask not only protects against COVID but also protects against other viruses like RSV, influenza, and measles. The recent surge in respiratory infections among children that has overwhelmed hospitals around the country is most certainly a result of the removal of mask mandates throughout the United States. A new study of COVID infection data in Massachusetts public schools from February to June 2022, after many districts rescinded mask mandates, shows that “the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff,” compared to in schools where mask requirements were upheld. The authors explain that the districts which kept mask requirements in place were ones that tended to have less updated buildings and whose student populations had a greater percentage of low-income families, students with disabilities, English learners, and Black and Latinx students. As such, they conclude, “we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.” This is something that we’ve been saying since the beginning of the pandemic; removing nonpharmaceutical interventions always disproportionately harms the most vulnerable members of our society.
Two weeks ago, we mentioned an Arstechnica report that the state of Ohio had had 54 cases of measles this year, 50 of which were in the Columbus area, 20 of which required hospitalization, and all of which were in unvaccinated people. As of December 20, the number of measles cases in Central Ohio has risen to 81, and 29 of these have been hospitalized.
As of December 15, the CDC has reported 106 cases of measles in the United States in five (undisclosed) jurisdictions. We’re certain that with no airborne disease mitigations for holiday travel, measles cases will increase over the next month.
A Deeper Dive into U.S. COVID Data
On 12/16/22, the United States had 28,877 documented new infections. There were also 147 deaths. Thirty-five states did not report their infections, and 36 states didn’t report their deaths. In the United States on 12/17/22 the number of hospitalized patients (40,374) has increased (+16.5% compared to the previous 14 days) and was 34,646 on December 2. On 12/17/22 there were 4,627 patients who were seriously or critically ill (a 15.5% increase); that number was 4,005 two weeks ago. The number of critically ill patients has increased by 643 in the last 14 days, while at least 4,168 new deaths occurred. The number of critically ill patients has increased for the eighth time in thirty-two 14-day periods. Patients are still dying each day (average 298/day).
As of 12/16/22, we have had 1,112,944 deaths and 101,743,845 SARS-CoV-2 infections in the United States. We have had 956,066 new infections in the last 14 days. We are adding an average of 478,033 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.41 infections or over 10,939 deaths for each one million infections. As of 12/16/22, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-six states have had greater than 2,000 deaths, and 33 states have greater than 3,000 deaths per million population. Eight states have over 4,000 deaths per million population: Mississippi (4,389), Arizona (4,387), Alabama (4,223), West Virginia (4,275), New Mexico (4,179), Tennessee (4,160), Arkansas (4,194) and Michigan (4,056). 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. Eight states have had greater than 40,000 deaths: Florida (83,380 deaths), Texas (92,108 deaths), New York (74,759 deaths), Pennsylvania (48,662 deaths), Georgia (41,244 deaths), Ohio (40,747 deaths) , Illinois (40,502 deaths), Michigan (40,508), and California (98,034 deaths, 20th 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 (25 months), there were 845,843 new deaths from SARS-CoV-2. For twenty-one of those months, vaccines have been available to all adults. During these twenty-one months, 540,845 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 in 2.5 years.
As of 12/16/22, California was ranked 33rd in the USA in infection percentage at 29.45%. In California, 25.48% of the people were infected in the last 21 months. As of 12/16/22, 29 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.
Worldwide, average deaths per day are 1,760 for the last 14 days. The United States accounts for 25.73% (453 per day) of all deaths per day in the world over the last two weeks. Worldwide infections per day were 546,064 the last two weeks. The United States accounts for 12.50% of those infections (or 68,294 infections per day).
FDA-Approved Oral Drug Treatments for SARS-CoV-2
Pfizer has developed PAXLOVID™, an oral reversible inhibitor of C3-like protease of SARS-CoV-2. The drug inhibits this key enzyme that is crucial for virus production. The compound, also called Compound 6 (PF-07321332), is part of the drug combination PAXLOVID™ (PF-07321332; ritonavir), which just successfully completed a Phase 2-3 trial in humans in multiple countries. The preliminary results were announced on 11/5/21 by Pfizer. The results show that 89% of the hospitalizations and deaths were prevented in the drug treatment arm. The drug was administered twice a day for five days. No deaths occurred in the treatment group, and ten deaths occurred in the placebo group. The study was stopped by an independent data safety monitoring board, and the FDA concurred with this decision. Pfizer applied for an Emergency Use Authorization for this drug on 11/15/21. This drug was approved on 12/23/21. We have only been able to obtain PAXLOVID™ for two patients who we successfully treated with this drug obtained from CVS in Salinas (East Alisal Street; phone number 831-424-0026). They were expecting another shipment on 1/28/22. In my opinion, this agent, if more widely available, could markedly alter the course of every coronavirus infection throughout the world.
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 12/16/22
New Infections on 12/16/22
Total Deaths
New Deaths on 12/16/22
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
656,953,845(7,644,889 new infections in 14 days).
473,615
6,669,730(24,636 new deaths in last 14 days)
1,104
8.42%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBBBQ.1BQ.1.1BS.1BN.1
No
No
USA
101,743,845(ranked #1) 956,066 new infections in the last 14 daysor 68,294/day.
28,877(ranked #5) 35 states and D,C. failed to report infections on 12/2/22.
1,112,944(ranked #1) 6,337 new deaths reported in the last 14 days or 388/day.
147 33 states and D.C. failed to report deaths on 12/2/22.
30.38%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BQ.1BQ.1.1BN.1
No
No
Brazil
35,874,528(ranked #5) 498,995 new infections in the last 14 days.
64,696 (ranked#3)
691,776(ranked #2; 1,647 new deaths in 14 days)
124
16.65%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
India
44,676,911(ranked #2); 2,716 new infections in 2 weeks.
220
530,663(ranked #3) 36 new deaths in 2 weeks.
–
3.17%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)APTK India VOI 32421Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India)Iota/B.1.526 (USA-NYC) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India)
No
No
United Kingdom
24,053,576(ranked #9) 28,830 new infections in 2 weeks.
–
197,723 (ranked #7) 470 new deaths in 2 weeks
–
35.11%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)
No
No
California, USA
11,639,487(ranked #13 in the world; 155,919 new infections in the last 14 days).
3,235
98,034 (ranked #20 in world) 176 new deaths in the last 14 days
20
29.45%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1
No
No
Mexico
7,174,464(ranked #19) 41,672 new infections in 14 days).
–
330,743(ranked #5)218 new deaths in 14 days)
–
5.45%
No
No
South Africa
4,046,568(ranked #37; 4,347 new infections in 14 days).
418
102,568 (ranked #18) 104 new deaths in 14 days)
–
6.66%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,440,839(ranked #34) 32,563 new infections in 14 days).
–
48,353(ranked #25 ) 572 new deaths in the last 14 days
–
11.56%
No
No
Poland
6,360,843 (ranked #21;6,993 new infections in 14 days).
604
118,419 (ranked #15)87 new deaths in the last 14 days
7
16.85%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 + (South Africa November 2021),Omicron/B.1.1.529 +BA.3
No
No
Russia
21,701,321 (ranked #10), 103,708 new infections in 14 days).
8,451 (ranked #10)
392,891(ranked #4)831 new deaths in 14 days
59
14.88%
No
No
Peru
4,405,843(ranked #35, 139,592 new infections in 14 days).
6,770 (ranked #11)
217,821(ranked #6) 393 new deaths in the last 14 days
39
13.07%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Gamma/P.1 (Brazil)Iota/B.1.526 (USA-NYC)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Iran
7,560,372(ranked #18; 635 new infections in last 14 days)
49
144,659(ranked #12) 25 new deaths in the last 14 days
–
8.78%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Spain
13,651,239(ranked #12; 39,187 new infections in 14 days).
2,656 (ranked #15)
116,658 (ranked #16)577 new deaths in 14 days
32
29.21%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Kappa/B.1.617.1 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)
No
No
France
38,801,884 (ranked #3; 885,832 new infections in the last 14 days).
56,361 (ranked #4)
160,359 (ranked #10)1,333 new deaths in 14 days.
131
59.16% a 1.35% increase in 14 days.
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
Germany
36,980,882(ranked #4; 450,862 new infections in 14 days.)
34,308 (ranked #5)
159,889 (ranked #11)1,776 new deaths in 14 days
147
44.08% 0.54% increase in 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
South Korea
28,062,679 (ranked #6 906,866 new infections in 14 days).
66,953(ranked #2)
31,298 (ranked #35) 730 new deaths in 14 days
66
54.67%1.77%increase in 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Vietnam
11,522,431 (ranked #13; 5,942 new infections in 14 days).
333
43,179(ranked #26)
–
11.64%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Netherlands
8,556,131 (ranked #16; 12,293 new infections in 14 days).
868
22,943 (ranked #41)
–
49.71%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Denmark
3,157,132 (ranked #40) 8,922 new infections in 14 days.
569
7,635(ranked #77 98 new deaths in the last 14 days)
9
54.10%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Taiwan
8,547,306(ranked #17)218,306 new infections in 14 days
15,407 (153,602ranked #9)
14,820 (ranked #58 433 new deaths in the last 14 days)
24
35.77% 0.41% of population has been infected in the last 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Japan
26,821,853(ranked #7)1,910,466 new infections in the last 14 days
156,602(ranked #1)
52,823(ranked #23) 2,997 new deaths in the last 14 days
182
21.35% 1.52% of the population infected in the last 14 days.
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)BA.2*BA.5*
No
No
Argentina
9,766,975, (ranked #15)39,728 new infections in the last 14 days.
–
130,041(ranked #14)
–
21.22%
No
No
Italy
24,884,034 (ranked #8)556,370 new infections in the last 14 days.
–
183,138(ranked #8) 1,405 new deaths in the last 14 days
–
41.29% 0.93% of population infected in last 14 days.
No
No
Chile
4,975,862(ranked #28) 50,811 new infections in14 days..
4,009 (ranked#13)
62,822(ranked #22) 338 new deaths in the last 14 days.
27
25.84% 0.56% of population infected in the last 14 days.
No
No
Colombia
6,330,843(ranked #22) 12,822 new infections in the last 14 days.
–
141,996(ranked #13)
–
12.28%
No
No
Australia
10,966,207(ranked #14) 240,968 new infections in 14 days.
20,033 (ranked #7)
16,673(ranked #55) 486 new deaths in 14 days.
42
42.06% 0.82% of population infected in last 14 days.
No
No
Turkey
17,042,722(ranked #11)37,185 new infections in 14 days.
–
101,492(ranked #19) 92 new deaths in 14 days..
–
19.91%
No
No
Indonesia
6,707,504 (ranked #20) 37,683 new infections in last 14 days.
1,451
160,362 (ranked #9) 478 new deaths in the last 14 days.
27
24.03%
No
No
Malaysia
5,016,023 (ranked #27) 21,480 new infections in the last 14 days.
1,138
36,795 (ranked #29) 107 new deaths in the last 14 days.
8
15.05%
No
No
Hong Kong
2,323,123(ranked#44) 194,741 new infections in the last 14 days.
15,726 (ranked #8)
11,107 (ranked#64)345 new deaths in the last 14 days.
32
30.55% 2.57% of population infected in the last 14 days.
No
No
China
374,075 (ranked #98)50,389 new infections in 14 days
Single-cell multiomics revealed the dynamics of antigen presentation, immune response and T cell activation in the COVID-19 positive and recovered individuals https://doi.org/10.3389/fimmu.2022.1034159
Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection (Experimental Hematology & Oncology) https://ehoonline.biomedcentral.com/articles/10.1186/s40164-022-00307-9
Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies (Acta Pharmacologica Sinica) https://doi.org/10.1038/s41401-022-00998-0
Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (European Journal of Nuclear Medicine and Molecular Imaging) https://doi.org/10.1007/s00259-022-06013-2
Successful treatment of prolonged, severe COVID-19 lower respiratory tract disease in a B-cell ALL patient with an extended course of remdesivir and nirmatrelvir/ritonavir (Clinical Infectious Diseases) https://doi.org/10.1093/cid/ciac868
Effectiveness of Monovalent mRNA Vaccines Against COVID-19–Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States — IVY Network, 18 States, December 26, 2021–August 31, 2022 (MMWR) https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a3.htm
“Three-dose monovalent mRNA VE estimates against COVID-19–associated hospitalization decreased with time since vaccination. Three-dose VE during the BA.1/BA.2 and BA.4/BA.5 periods was 79% and 60%, respectively, during the initial 120 days after the third dose and decreased to 41% and 29%, respectively, after 120 days from vaccination.”
Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome (Frontiers in Immunology) https://doi.org/10.3389/fimmu.2022.949787
Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study (The Lancet) https://doi.org/10.1016/S0140-6736(22)01586-0
Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients (Ear, Nose, and Throat Journal) https://doi.org/10.1177/01455613221123737
Note: This is a frightening paper and if the conclusions are accurate humans in general are in trouble. From other papers the facts that HERV-M and EBV are activated by SARS-CoV-2 infection does not bode well for humans moving forward.
SARS-CoV-2 Spike protein promotes vWF secretion and thrombosis via endothelial cytoskeleton-associated protein 4 (CKAP4) (Signal Transduction and Targeted Therapy) https://www.nature.com/articles/s41392-022-01183-9
It’s time for our next 14-day moving average determinations for SARS-CoV-2 for the United States, and my thoughts on vaccines, SARS-CoV-2 therapeutic agents and mutant viruses. 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.
Don’t want to miss an update?
Get the latest COVID updates from Dr. Wright delivered to your inbox as soon as they’re published!
SARS-CoV-2 infections per day in the United States have increased for the second time in 16 weeks.There is still widespread underreporting by states, a failure to capture positive home tests, and a decreased PCR screening program in most states. Deaths per day in the United States have decreased by 54 deaths per day. Many states are not reporting deaths or infections in a timely manner. The number of infections per day has increased by 494.In late November of this year, the National Institutes of Health launched MakeMyTestCount.org, a website that allows users to anonymously report the results of at-home COVID tests. Unfortunately, it has thus far not been widely publicized.
Drug-Evading Mutants Continue to Dominate the Variant Soup
On 12/3/22 the CDC estimates that BA.5 accounted for 13.8% of infections (a 38.6% drop from 10/21/22), BQ.1 accounted for 30.9% (a 21.5% increase since 10/21/22), BQ.1.1 accounted for 31.9% (a 24.77% increase since 10/21/22), BA.4.6 accounted for 2.3% (a 7.2% decrease from 10/21/22), BF.7 accounted for 6.3% (a 2.7% decrease from 10/21/22), BN.1 accounted for 4.6% of isolates (a 0.5% decrease since 1/19/22),andBA.2.75.2 accounted for 0.5%. In the last two weeks, three isolates were added to the CDC’s reporting: XBB (5.5% of isolates), BA.5.2.6 (1.8%), and BF.11 (0.9%). In the week ending December 3, 2022, BQ isolates accounted for 62.8% of infections (a 27.5% increase in infections caused by these BQ variants since 10/21/22). BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine.
CDC
CDC
The total percentage of BQ variant infections in the region that includes New York and New Jersey was 64.8% two weeks ago and is now 72.4%. BA.5 accounts for 6.9% of infections, BF.7 accounts for 4.2%, BN.1 accounts for 2.4%, BA.5.2.6 accounts for 1.5%, and BA.2.75 lineages account for 1.3% of infections. Curiously, no XBB isolates are currently being reported in Region 2.
CDC
The total percentage of BQ variant infections in the region that includes California, Nevada, Arizona, and Hawaii was 36.9% two weeks ago and is now 62.6%. BA.5.2.6 isolates now account for 1.6% of cases. The BA.2.75 lineages account for 1.3%. BF.7 accounts for 5.5%, BN.1 accounts for 6.0%, and BA.2 isolates account for 1.9%. Again, CDC is not reporting XBB in Region 9.
Data on the rapid spread of a dangerous variant category, the BQ variants, was withheld by the CDC in their weekly reports until five weeks ago. The data on BQ.1 and BQ.1.1, the last being a variant with five significant spike protein mutations leading to escape from immunity from prior infections or vaccination. Similarly, the XBB variant wasn’t present in the CDC’s variant proportions reporting two weeks ago, but the December 3 iteration adds XBB going back at least three weeks.
Two virologists collaborated on Twitter to create the figure below, which Professor Johnson titled “Convergent Evolution on Steroids.” It shows the key mutations present in many of the currently-circulating Omicron subvariants and demonstrates that mutation at site 346 is becoming more and more common.
From Daniele Focosi, M.D., Ph.D. @dfocosi on Twitter, November 4, 2022
Past infections with a BA.1, BA.2 or BA.5 variants will not prevent infections with any of the newer variants. Monoclonal antibodies are no longer effective against newer BQ variants and other spike protein mutated variants. The last remaining monoclonal antibody, bebtelovimab, was removed from use by the FDA on 12/2/22. Paxlovid was only 89% effective in the original clinical trials against SARS-CoV-2. If resistance develops this winter to oral Paxlovid, we will have more Paxlovid failures and increased hospitalizations and deaths.
The November 25 UK Health Security Agency Technical Briefing identifies lineages BA.5, BA.5.2.35, BA.5.7, BQ.1, BQ.1.1, XBB, and BN1 (BA.2.75.5.1) as isolates of concern.
Variant
Sublineage of
Mutations
Global Sequences outside UK
UK Sequences
BQ.1
BA.5
L452R, N460K, K444T
33,206 (81 countries)
9,285 (> 40% of all sequenced samples)
BQ.1.1
BA.5
N460K, K444T, R346T
17,621 (70 countries)
4,715
BA.5.2.35
BA.5.2
R346T, 2 synonymous single nucleotide polymorphisms (SNPs) G28423C and C7006T
447
848
BN.1
BA.2.75.5
R346T, F490S
1,127
190
XBB
Recombinant of BJ.1 and BM.1.1.1 (both descended from BA.2), approximate break point between spike mutations G446S and N460K
E: T11A, Spike: V83A, H146Q, Q183E, F486S, F490S. Spike mutations inherited from BJ.1 are G339H, R346T, V445P, G446S and from BM.1.1.1 are N460K, F486V, F490S, and R493Q
4,831 (51 countries)
345
Disappointing Vaccine Uptake, Especially Among Children
Our monoclonal antibody therapies do not work for these isolates, but these emerging BQ variants are descendants of BA.5, so the new BA.5 bivalent vaccine should offer some protection, when combined with an N95 mask. It’s troubling that, despite the availability of this vaccine, few people are getting vaccinated. As of November 30, 2022, the CDC reports that 39,719,443 people in the United States (5 years and up) have received the bivalent vaccine. That’s only 17.4% of people who received the primary series and 12% of the overall population.
Children under the age of 5 have not been approved to receive either Omicron BA.5 mRNA booster. Sadly, in children between 0 and 5 years of age only 1.61 million have received at least one dose of any SARS-CoV-2 mRNA vaccine based on the original Wuhan isolate. In the United States, at least 1,372 children have died of COVID-19, and another 74 have died of multisystem inflammatory syndrome (MIS-C). Worldwide, according to UNICEF, over 16,100 children and young adults aged 0-20 have died of COVID-19.
In Monterey County, during the pandemic we have had 96,851 reported SARS-CoV-2 infections, 3,022 hospitalizations and 797 reported deaths as of 12/3/22. The Monterey County Health Department reports that, as of 12/3/22, 3.3% of 0-4 year-olds and 40.1% of 5-11 year-olds have received the first two doses of vaccine, while 73.3% of 12-17 year-olds have received two doses. Only 55.1% of Monterey County residents have received a third dose of the vaccine. The Monterey County Health Department does not publish data on how many residents have received the new BA.5 bivalent booster vaccine. On June 17, The FDA authorized both the Pfizer and Moderna vaccines for use in children ages 6 months to four years. We believe children under 5 should be vaccinated as soon as possible. All Monterey County residents should get up to date on COVID-19 vaccinations, including the bivalent BA.5 booster, as soon as possible.
Monterey County Health Department
Mask Up to Protect Against Additional Viral Threats This Winter
In a new preprint on respiratory syncytial virus (RSV) in young children, researchers from Case Western University write, “Among RSV-infected children in 2022, 19.2% had prior documented COVID-19 infection, significantly higher than the 9.7% among uninfected children, suggesting that prior COVID-19 could be a risk factor for RSV infection or that there are common risk factors for both viral infections.” Wearing a well-fitting, high-filtration mask not only protects against COVID but also protects against other viruses like RSV, influenza, and measles. The recent surge in respiratory infections among children that has overwhelmed hospitals around the country is most certainly a result of the removal of mask mandates throughout the United States. A new study of COVID infection data in Massachusetts public schools from February to June 2022, after many districts rescinded mask mandates, shows that “the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff,” compared to in schools where mask requirements were upheld. The authors explain that the districts which kept mask requirements in place were ones that tended to have less updated buildings and whose student populations had a greater percentage of low-income families, students with disabilities, English learners, and Black and Latinx students. As such, they conclude, “we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.” This is something that we’ve been saying since the beginning of the pandemic; removing nonpharmaceutical interventions always disproportionately harms the most vulnerable members of our society.
The state of Ohio has had 54 cases of measles this year, 50 of which were in the Columbus area, and 20 of which have required hospitalization. All of the infected were unvaccinated. Arstechnica reports, “Nine of the cases are in babies under the age of 1 year, who are typically not yet eligible for vaccination. Twenty-six cases are in infants ages 1 to 2 years—who are eligible for their first dose. Ten cases are in toddlers ages 3 to 5—some of whom would have been eligible for their second dose—and there are five cases in children between the ages of 6 and 17.”
As of December 1, the CDC has reported 76 cases of measles in the United States in five (undisclosed) jurisdictions. We’re certain that with no COVID mitigations for holiday travel, the measles will not remain in Ohio.
A Deeper Dive into U.S. COVID Data
On 12/2/22, the United States had 32,724 documented new infections. There were also 149 deaths. Thirty-four states did not report their infections, and 38 states didn’t report their deaths. In the United States on 12/2/22 the number of hospitalized patients (34,646) has increased (+24% compared to the previous 14 days) and was 27,868 on November 18. On 12/2/22 there were 4,005 patients who were seriously or critically ill (a 20% increase); that number was 3,362 two weeks ago. The number of critically ill patients has increased by 643 in the last 14 days, while at least 4,168 new deaths occurred. The number of critically ill patients has increased for the eighth time in thirty-two 14-day periods. Patients are still dying each day (average 298/day).
As of 11/18/22, we have had 1,106,607 deaths and 100,787,799 SARS-CoV-2 infections in the United States. We have had 631,454 new infections in the last 14 days. We are adding an average of 315,727 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.08 infections or over 10,980 deaths for each one million infections. As of 12/02/22, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-six states have had greater than 2,000 deaths, and 33 states have greater than 3,000 deaths per million population. Eight states have over 4,000 deaths per million population: Mississippi (4,380), Arizona (4,362), Alabama (4,212), West Virginia (4,256), New Mexico (4,150), Tennessee (4,145), Arkansas (4,168) and Michigan (4,014). 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. Eight states have had greater than 40,000 deaths: Florida (82,875 deaths), Texas (91,934 deaths), New York (74,288 deaths), Pennsylvania (48,387 deaths), Georgia (41,070 deaths), Ohio (40,558 deaths) , Illinois (40,339 deaths), Michigan (40,085), and California (97,515 deaths, 20th 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 (24 months), there were 839,506 new deaths from SARS-CoV-2. For twenty of those months, vaccines have been available to all adults. During these twenty months, 534,508 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 in 2.5 years.
As of 12/02/22, California was ranked 33rd in the USA in infection percentage at 29.06%. In California, 25.09% of the people were infected in the last 21 months. As of 12/2/22, 28 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.
Worldwide, average deaths per day are 1,444 for the last 14 days. The United States accounts for 20.63% (298 per day) of all deaths per day in the world over the last two weeks. Worldwide infections per day were 482,580 the last two weeks. The United States accounts for 9.34% of those infections (or 45,104 infections per day).
FDA-Approved Oral Drug Treatments for SARS-CoV-2
Pfizer has developed PAXLOVID™, an oral reversible inhibitor of C3-like protease of SARS-CoV-2. The drug inhibits this key enzyme that is crucial for virus production. The compound, also called Compound 6 (PF-07321332), is part of the drug combination PAXLOVID™ (PF-07321332; ritonavir), which just successfully completed a Phase 2-3 trial in humans in multiple countries. The preliminary results were announced on 11/5/21 by Pfizer. The results show that 89% of the hospitalizations and deaths were prevented in the drug treatment arm. The drug was administered twice a day for five days. No deaths occurred in the treatment group, and ten deaths occurred in the placebo group. The study was stopped by an independent data safety monitoring board, and the FDA concurred with this decision. Pfizer applied for an Emergency Use Authorization for this drug on 11/15/21. This drug was approved on 12/23/21. We have only been able to obtain PAXLOVID™ for two patients who we successfully treated with this drug obtained from CVS in Salinas (East Alisal Street; phone number 831-424-0026). They were expecting another shipment on 1/28/22. In my opinion, this agent, if more widely available, could markedly alter the course of every coronavirus infection throughout the world.
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 12/2/22
New Infections on 12/2/22
Total Deaths
New Deaths on 12/2/22
% of Pop.Infected
SARS-CoV-2 Isolates Currently Known in Location
National/ State Mask Mandate
Currently in Lockdown
World
649,308,956(6,756,121 new infections in 14 days).
429,743
6,645,094(20,221 new deaths in last 14 days)
1,029
8.33%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBBBQ.1BQ.1.1BS.1BN.1
No
No
USA
100,787,779(ranked #1) 631,454 new infections in the last 14 daysor 45,104/day.
32,724(ranked #5) 34 states and D,C. failed to report infections on 12/2/22.
1,106,607(ranked #1) 4,168 new deaths reported in the last 14 days or 388/day.
149 38 states and D.C. failed to report deaths on 12/2/22.
30.10%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan) Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BQ.1BQ.1.1BN.1
No
No
Brazil
35,375,733(ranked #5) 336,119 new infections in the last 14 days.
399251 (ranked#4)
690,129(ranked #2; 1,171 new deaths in 14 days)
131
16.42%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
India
44,674,195(ranked #2); 4,668 new infections in 2 weeks.
211
530,627(ranked #3) 94 new deaths in 2 weeks.
3
3.17%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)APTK India VOI 32421Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India)Iota/B.1.526 (USA-NYC) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India)
No
No
United Kingdom
24,024,746(ranked #6) 47,109 new infections in 2 weeks.
–
197253 (ranked #7) 1,102 new deaths in 2 weeks
–
35.07%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)
No
No
California, USA
11,483,568(ranked #14 in the world; 78,380 new infections in the last 14 days).
4,819
97,515 (ranked #20 in world) 176 new deaths in the last 14 days
14
29.06%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1
No
No
Mexico
7,132,792(ranked #19) 13,859 new infections in 14 days).
–
330,525(ranked #5)81 new deaths in 14 days)
–
5.42%
No
No
South Africa
4,042,221(ranked #37; 5,299 new infections in 14 days).
312
102,464 (ranked #18) 93 new deaths in 14 days)
–
6.65%
B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India) C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)
No
No
Canada
4,408,276(ranked #34) 31,206 new infections in 14 days).
–
47,781(ranked #25 ) 663 new deaths in the last 14 days
–
11.48%
No
No
Poland
6,353,850 (ranked #21;5,470 new infections in 14 days).
542
118,332 (ranked #15)65 new deaths in the last 14 days
4
16.83%
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 + (South Africa November 2021),Omicron/B.1.1.529 +BA.3
No
No
Russia
21,597,613 (ranked #10), 72,046 new infections in 14 days).
6,785 (ranked #11)
392,060(ranked #4)727 new deaths in 14 days
58
14.81%
No
No
Peru
4,266,251(ranked #36, 107,119 new infections in 14 days).
13,868 (ranked#9)
217,428(ranked #6) 199 new deaths in the last 14 days
14
12.66%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Gamma/P.1 (Brazil)Iota/B.1.526 (USA-NYC)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Iran
7,559,737(ranked #18; 526 new infections in last 14 days)
31
144,634(ranked #12) 14 new deaths in the last 14 days
1
8.78%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)
No
No
Spain
13,612,052(ranked #12; 38,331 new infections in 14 days).
2,758
116,081 (ranked #16)440 new deaths in 14 days
30
29.13%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Kappa/B.1.617.1 (India)Mu/B.1.621 (Colombia)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)
No
No
France
37,916,052 (ranked #3; 628,505 new infections in the last 14 days).
69,253 (ranked #2)
159,026 (ranked #10)863 new deaths in 14 days.
76
57.81% a 1.52% increase in 14 days.
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
Germany
36,530,020(ranked #4; 324,615 new infections in 14 days.)
30,420 (ranked #6)
158,108 (ranked #11)1,486 new deaths in 14 days
166
43.54% 0.38% increase in 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinantBQ.1.1
No
No
South Korea
27,155,813 (ranked #6 693,494 new infections in 14 days).
57,079(ranked #3)
30,568 (ranked #35) 643 new deaths in 14 days
62
52.90%1.35%increase in 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Vietnam
11,516,489 (ranked #13; 5,570new infections in 14 days).
581
43,176(ranked #26)
1
11.63%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Netherlands
8,543,838 (ranked #16; 9,694 new infections in 14 days).
959
22,916 (ranked #41)
3
49.64%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Denmark
3,148,210 (ranked #40) 4,949 new infections in 14 days.
610
7,537(ranked #78 67 new deaths in the last 14 days)
5
53.95%
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)GKA (AY.4/BA.1) recombinant
No
No
Taiwan
8,329,000(ranked #17)198,781 new infections in 14 days
15,643 (ranked #7)
14,387 (ranked #58 539 new deaths in the last 14 days)
53
34.86% 0.83% of population has been infected in the last 14 days
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)
No
No
Japan
24,911,367(ranked #7)1,307,161 new infections in the last 14 days
118,201(ranked #1)
49,826(ranked #23) 1,768 new deaths in the last 14 days
182
19.83% 1.04% of the population infected in the last 14 days.
B2 lineageAlpha/B.1.1.7 (UK)Delta/B.1.617.2 (India) Delta/B.1.617.2 (India) Omicron/B.1.1.529 South Africa November 2021)BA.2*BA.5*
No
No
Argentina
9,727,247 (ranked #15)5,529 new infections in the last 14 days.
–
130,025(ranked #14)
–
21.14%
No
No
Italy
24,327,664 (ranked #8)96,126 new infections in the last 14 days.
–
181,733(ranked #8) 1,152 new deaths in the last 14 days
–
40.36% 0.49% of population infected in last 14 days.
No
No
Chile
4,925,051(ranked #28) 59,393 new infections in14 days..
5,041 (ranked#13)
62,484(ranked #22) 354 new deaths in the last 14 days.
26
25.28% 0.31% of population infected in the last 14 days.
No
No
Colombia
6,318,021(ranked #22) 5,364 new infections in the last 14 days.
3,252
141,811(ranked #13)
16
12.26%
No
No
Australia
10,725,239(ranked #14) 172,561 new infections in 14 days.
14,741 (ranked #8)
16,187(ranked #55) 220 new deaths in 14 days.
16
41.14% 0.66% of population infected in last 14 days.
No
No
Turkey
17,005,537(ranked #11)28,808 new infections in 14 days.
–
101,400(ranked #19) 73 new deaths in 14 days..
–
19.87%
No
No
Indonesia
6,669,821 (ranked #20) 73,009 new infections in last 14 days.
4,977 (ranked #14)
159,884 (ranked #9) 561 new deaths in the last 14 days.
54
23.89%
No
No
Malaysia
4,994,543 (ranked #27) 31,327 new infections in the last 14 days.
2,375
36,695 (ranked #29) 107 new deaths in the last 14 days.
11
15.05%
No
No
Hong Kong
2,128,382(ranked#46) 107,497 new infections in the last 14 days.
10,137 (ranked #10)
10,762 (ranked#64)185 new deaths in the last 14 days.
15
27.98% 1.41% of population infected in the last 14 days.
No
No
China
323,686 (ranked #103)44,255 new infections in 14 days
Single-cell multiomics revealed the dynamics of antigen presentation, immune response and T cell activation in the COVID-19 positive and recovered individuals https://doi.org/10.3389/fimmu.2022.1034159
Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection (Experimental Hematology & Oncology) https://ehoonline.biomedcentral.com/articles/10.1186/s40164-022-00307-9
Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies (Acta Pharmacologica Sinica) https://doi.org/10.1038/s41401-022-00998-0
Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics (European Journal of Nuclear Medicine and Molecular Imaging) https://doi.org/10.1007/s00259-022-06013-2
Successful treatment of prolonged, severe COVID-19 lower respiratory tract disease in a B-cell ALL patient with an extended course of remdesivir and nirmatrelvir/ritonavir (Clinical Infectious Diseases) https://doi.org/10.1093/cid/ciac868
Effectiveness of Monovalent mRNA Vaccines Against COVID-19–Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States — IVY Network, 18 States, December 26, 2021–August 31, 2022 (MMWR) https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a3.htm
“Three-dose monovalent mRNA VE estimates against COVID-19–associated hospitalization decreased with time since vaccination. Three-dose VE during the BA.1/BA.2 and BA.4/BA.5 periods was 79% and 60%, respectively, during the initial 120 days after the third dose and decreased to 41% and 29%, respectively, after 120 days from vaccination.”
Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome (Frontiers in Immunology) https://doi.org/10.3389/fimmu.2022.949787
David C. Wright, M.D. 
You must be logged in to post a comment.