March 2021 in Review: US Trends, Expanding Vaccine Eligibility, and Oxford-AstraZeneca

By Edward Chen

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Since the first US death from COVID-19 on February 29, 2020, the very last day of February 2020, the US has now recorded almost 550,000 deaths. It took 3 months to reach 100,000 deaths, another 3 months to reach 200,000 deaths, and another 3 months to reach 300,000 deaths. From there, it took only a single month to reach 400,000 deaths, and another single month to reach 500,000 deaths. Thankfully, deaths have increased by 40,000, and not a full hundred thousand, in the last 30 days. And despite starting the month with over 20% of the worldwide deaths from COVID-19, the US now accounts for around 19.6% of worldwide deaths. Still, as the US population is approximately 330 million people, the current COVID death rate is a not insignificant 165 deaths out of every 100,000 people. The Centers for Disease Control and Prevention (CDC) forecasts the US will reach 566,000 deaths by mid-April, the equivalent of nearly 172 deaths for every 100,000 people.

Cases and deaths have both plateaued in recent times, significantly down from near-record levels in January and February, though cases have been increasing again in the last week. Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, has attributed this recent rise in cases to both new SARS-CoV-2 variants, particularly the B.1.1.7 strain, and a “premature” relaxing of COVID-associated restrictions in many states. The CDC publishes information on variants circulating in the US, including on their prevalence. Before the recent uptick in new cases, the US had been reporting an average of fewer than 60,000 cases a day for the past 3 weeks. The CDC forecast predicts the COVID-19 caseload will decline to 30,000 new cases per week by mid-April, compared to 60,425 cases in the past week, though that same forecast has not been accurate for the current week. The US has now had over 30 million COVID cases.

The ongoing US vaccination effort has been continuing steadily with two-shot vaccines from Pfizer-BioNTech and Moderna, and single-dose vaccines from Johnson & Johnson. Johnson & Johnson’s Janssen COVID-19 vaccine received an EUA in the waning days of February, on February 27. Today, 93.6 million people in the US, comprising 28% of the total population, 36.2% of adults, and 72.4% of those 65 and older, have received at least a single COVID-19 vaccine dose. Of the 93.6 million people, close to 51.6 million have been fully vaccinated. This is 15.5% of the population, 20% of adults, and 48.4% of those 65 and older. These numbers reflect 143 million administered vaccine doses, out of 180 million doses distributed. Note that the Pfizer-BioNTech vaccine is approved for those 16 and older while both the Moderna and Johnson & Johnson vaccine are approved for those 18 and older.

Among more positive news on the COVID vaccines, states are increasingly expanding access to the vaccine to all adults. 46 states and Washington, D.C. plan to allow all adults to sign-up for COVID vaccinations by May 1. On March 10, Alaska was the first state to fully open their eligibility criteria, allowing adults (and individuals 16 and older) to receive COVID vaccines. 6 states have since introduced guidelines similar to Alaska’s and, before the end of March, 6 other states will follow.

Less positively, Oxford-AstraZeneca’s vaccine has shaken public confidence with concerns that their vaccine may be associated with blood clots. In mid-March, more than 20 European countries, including Germany, France, and Spain, stopped administering the Oxford-AstraZeneca vaccine. The European Medicines Agency (EMA), which is responsible for evaluating vaccines in the EU, responded on March 18 that the “benefits still outweigh the risks despite possible link to rare blood clots with low blood platelets.” Not long after, and on the same day, at least 12 countries resumed use of the Oxford-AstraZeneca vaccine. More recently, on March 25, the EMA published an update which concluded that the Oxford-AstraZeneca vaccine “is not associated with an increase in the overall risk of blood clots and that the benefits of the vaccine in combating the still widespread threat of COVID-19 continue to outweigh the risk of side effects.” The EMA will convene an expert group on March 29 to further study this potential problem.

Any problems with the Oxford-AstraZeneca vaccine will be concerning not only to Europeans, but also the world. As we covered in last month’s podcast, the AstraZeneca vaccine is heavily relied on by COVAX, a global initiative aimed at “guarantee[ing] fair and equitable access” to COVID-19 vaccines for everyone in the world. Of the 2.01 billion total vaccine doses COVAX has deals or options for, the up to 1.27 billion doses of the Oxford-AstraZeneca vaccine is equivalent to 63.2% of COVAX’s secured supply. Any hit suffered by the Oxford-AstraZeneca vaccine will imperil COVAX’s commitment to distribute vaccines to at least 20% of the population of 92 participating lower- and middle-income countries.

In the US, where the Oxford-AstraZeneca vaccine has not yet been approved, the National Institute of Allergy and Infectious Diseases (NIAID) released a statement last Tuesday, March 23, that a Data and Safety Monitoring Board was concerned with data in an AstraZeneca press release that hyped a 79% vaccine efficacy. This efficacy figure is higher than the 62.1% efficacy for two standard full-dose shots observed in clinical trials in the UK, Brazil, and South Africa. The NIAID statement did not mention vaccine safety, but contended that the 79% efficacy figure reported by AstraZeneca for their US Phase III trial was premature as 33 potential COVID-19 cases that could negatively impact vaccine efficacy had not yet been evaluated. News outlets have variously described the statement as an “extraordinary step,” “unprecedented rebuke,” and “just one of many recent embarrassments.” AstraZeneca later published a new press release on March 25 claiming a slightly revised 76% efficacy against developing symptomatic COVID019, and a 85% efficacy among those 65 and older, though the release pointed out 14 possible or probable COVID-19 cases still required evaluation. AstraZeneca reiterated that their vaccine was 100% effective for preventing severe disease and hospitalizations. AstraZeneca expects to receive an emergency use authorization from the FDA sometime after mid-April.

To conclude this summary, keep in mind that even after receiving 2 doses of the Pfizer-BioNTech or Moderna vaccine, or 1 dose of the Johnson & Johnson vaccine, it is still important to wear masks and physically distance in public. The extent to which the COVID-19 vaccines can prevent disease transmission is still unclear. And therefore, it is important to protect those around you as well by continuing to take precautions.

Results from ongoing research and the current understanding of COVID-19 are constantly evolving. This post contains information that was last updated on March 27, 2021.

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