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CLL Society’s COVID-19 Update for the Week of January 16, 2023

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

Weekly COVID-19 Statistics

Here is the CDC’s map of community level of spread (this map’s risk is weighted based on hospitalizations), and here is the link to the New York Times actual cases per capita map as shown below. The New York Times data was last updated January 13th.

Here is the summary graphic from the New York Times as of January 13th. This summary indicates that cases, test positivity, and hospitalizations have increased only slightly over the previous 14-day average. But the COVID-19 deaths rose dramatically by 61%. This could be in part due to holiday interruptions that caused a delay in reporting this metric.

Here is a graphic from the Wastewater Monitoring Project last updated January 12th. We are finally seeing a trend downward in the nationwide average amount of SARS-CoV-2 in wastewater. Again, the good thing about wastewater data is that it is not dependent upon people testing or health departments reporting data. Note the top dark blue line (which reflects the amount of coronavirus measured in wastewater) continues to show a stark contrast to the lower light blue line (which reflects the actual reported case numbers from health departments). This verifies that actual case numbers continue to be much lower than what is being officially reported.

The additional graphic below from the Wastewater Project shows in viral concentrations by region. All regions appear to be having a downward trend, even in the Northeast where the variant XBB.1.5 has taken a particular hold which is very encouraging.

The rate of hospitalizations, last updated on January 12th, overall indicate a slight decrease as well (gray dotted line graphic on the left). This appears for the first time this winter be occurring in all age groups, but there does continue to be a stark contrast in the number of hospitalizations for those over the age of 70 (purple solid line on the right).

The weekly average number of COVID-19 deaths according to the CDC in the US ending the week of January 11th were 4,209. This is an increase of 1,176 deaths from the week prior. As mentioned above, this sharp increase is most likely due to the delayed reporting surrounding the holidays. Note that the difference in this metric and the one reported by the New York Times (NYT) mentioned above is the CDC reports changes in death rates weekly, and the NYT metric reports changes in COVID-19 deaths on a 14-day average.

Current & Emerging Variants of Concern (VOC)

XBB.1.5 (some may have heard this variant recently referred to as the Kraken variant) continues to outcompete all others in the US. This is the variant that was “homegrown” in New York state as an offshoot of the XBB variant there. It is being called the most infectious COVID-19 we have experienced yet, mainly due to it acquiring a critical double mutation that maintains a high level of immune escape from previous infection. It also has a unique ability to bind even more tightly to receptors in the body than its predecessors.

The NIH updated their COVID-19 Treatment Guidelines with a new Panel Statement on Evusheld information last week with slightly stronger language to warn individuals that it is not likely to neutralize either XBB or XBB.1.5. They also highly suggested those who are immunocompromised keep up with their vaccinations/boosters, take additional precautions against infection, and be tested immediately if you experience signs and symptoms so you can seek prompt medical attention.

Here is the overall breakdown of variants in the US according to the CDC’s Variant Tracker as of January 14th.

And here is the BA.5 breakdown by regions within the United States. We are showing the proportion of BA.5 that remains by region, as this has been the variant with the highest proportion that is still neutralized by Evusheld.

You will notice that BA.5 now only makes up 0.8% of cases in the New York State region but still consists of 9.2% of cases in the Midwest.

As a summary, data indicate Evusheld will still provide protection against the following variants (percentages are national averages and vary by region). Note that these overall percentages of variants that continue to have neutralizing capacity against the virus are at all-time combined lows and are still trending downward each week.

  • BA.5 (2.6%)
  • BN.1 (2.1%)
  • BA.2.75 (1.3%)
  • BA.2 (0.2%)

These four variants that are neutralized by Evusheld together make up only ~6.2% of cases on average nationwide as of January 14th!

Please discuss any questions you might have surrounding Evusheld with your healthcare provider.

Data indicate that Evusheld will NOT be effective against the remainder of variants in the US that are not mentioned specifically as the above four variants. (We are no longer going to list each of the variants that are not neutralized by Evusheld, as they are too numerous).

COVID-19 in the News

  • More data continues to be published on the increased effectiveness of the bivalent mRNA vaccines, in terms of its ability to increase neutralizing antibody levels compared to the original monovalent vaccine. But there was a pre-print recently published in Lancet reporting results of a large observational cohort study out of Israel (which included more than 622,000 participants). This study reported those who received the bivalent vaccine had lower hospitalization and mortality rates compared to non-recipients when followed up to 70 days after the bivalent vaccination. This is some of the first real-world data we have seen yet on the increased effectiveness of the bivalent mRNA booster vaccine. (In academic publishing, any research published as a pre-print means it is a scientific paper that precedes formal peer review and publication in a peer-reviewed scholarly or scientific journal).  
  • The CDC recently issued a Morbidity and Mortality weekly report (MMWR) on the initial bivalent booster vaccine’s effectiveness. For those who received the bivalent that were age 65 and older, there was marked protection in preventing against hospitalization (up to 84% more than those who had been vaccinated/boosted with the previous version of the monovalent COVID-19 vaccine). The report also indicated that for those age 18-65 who received the bivalent booster, there was a 57% reduction in hospitalizations. This is a lower reduction compared to those over 65, but we have seen this consistently throughout the pandemic due to the increased risk of hospitalization for those who are in the older age brackets. It is also notable how well the CDC data for seniors lines up with the Israeli data mentioned above.

In Summary

If you missed the article that discusses the FDA’s most recent guidance on COVID-19 testing recommendations, you can read more here. Please remember, if you have known exposure to COVID-19 or are experiencing any symptoms at all, please get tested early, preferably with a PCR test, and call your healthcare provider. Paxlovid must be started orally within five days of symptom onset and Remdesivir must be started intravenously within seven days of symptom onset.

We are very lucky in the US to have a big supply of the bivalent vaccine available to us (and still at no cost), and its ability to broaden immune responses has exceeded expectations. It continues to be disappointing to see the lack of uptake, misinformation, cherry picking of data, and detractors that continue to defy the body of solid scientific evidence we have been able to accumulate. CLL Society continues to encourage everyone to obtain the COVID-19 bivalent booster if you are eligible and have not yet done so.  Especially in light of what is happening right now with the lack of available COVID-19 monoclonal antibodies previously used to both prevent and treat infection, and due to the XBB.1.5 variant being so incredibly infectious and quickly picking up speed in the US.

The FDA has another vaccine advisory committee meeting planned on January 26th to discuss future vaccination strategies for COVID-19. It is scheduled to take place all day long, but anyone can listen in as it is an open meeting broadcast on YouTube. We “may” expect additional bivalent booster guidance after this meeting takes place. Stay tuned to CLL Society’s website and social media channels, as we will put out any information we have as it becomes available. If you would like to leave a public comment for the committee, reminding them to please keep the vaccination needs of the at-risk immunocompromised community in mind, especially now that Evusheld provides extremely minimal protection and Bebtelovimab is no longer an available treatment option, you can do so on the FDA’s public comment docket for this meeting (select “Drug Industry as the category from the drop down menu to submit your comment). 

Please wear a well-fitted N95 mask (or KN95) while around others who live outside of your household. You can obtain quality N95 masks free of charge from many local pharmacies across the country.

If you missed CLL Society’s COVID-19 webinar last week, you can watch it on demand here.  

Keep learning, and please stay well.

Robyn Brumble, MSN, RN
Director of Scientific Affairs & Research
CLL Society