New science developments for 2022 today

New science developments for 2022 today

New science developments for 2022 today. And, as the world enters the third year of the COVID-19 pandemic, with some might say no end in sight, the immediate challenge is to better understand the impact of Omicron, and its impact on our subsequent immunity. This year no doubt there will be other variants, and variant-specific shots and we’ll hear about combined vaccines in development: maybe against multiple variants, flu and even RSV. Meanwhile, discussions about the origins of the virus will probably continue. The WHO has renewed its efforts to solve the riddle, by appointing a team of 26 scientists. Considering the number of mutations in Omicron, am surprised we’re not hearing lab-leak theories here with respect to engineered viruses to ‘study mutations’.

In Israel, a government minister said “The cost will be a great many infections. The numbers will have to be very high in order to reach herd immunity. This is possible but we don’t want to reach it by means of infections, we want it to happen as a result of many people vaccinating.” They’ve started a 4th dose for >60 year olds and healthcare workers today, and India has started vaccinating adolescents.

Interesting thought: the mid-term elections might be influenced by an excess of deaths in unvaccinated Republicans. When the 2022 midterm elections are appraised less than a year from now, the Washington commentariat will in all likelihood render them to have been a devastating blow to Joe Biden’s presidency. Unless lots of Republicans suffer more from COVID than Democrats in swing states due to their vaccination status (more at the end today on this). Ironies abound here – if you read my healthcare thoughts yesterday, vaccination came from Africa, but African Americans are amongst the highest anti-vaxxers, alongside Republican evangelicals. Fauci meanwhile as implored those to look at hospitalisations not case numbers. Referring to the surge in the US as a “tsunami”, he also cautioned the public not to be fooled by preliminary data suggesting the variant lacks the severity of earlier Covid-19 variants, such as Delta. “You have a virus that looks like it might be less severe, at least from data we’ve gathered from South Africa, the UK and even some from preliminary data from here in the US,” he told CNN’s State of the Union. But it is milder. As France puts unvaccinated US travellers on the red list, interesting thread comparing the severity (% ICU) of the current wave in two large French regions: in the south it's still Delta (80%) and ICU% is high, in Paris it's Omicron and ICU% is much lower:

https://mobile.twitter.com/jeuasommenulle/status/1477732839391219714?s=11

PCR testing capacity is maxing out in some areas of the UK:

And this is interesting too:

T cell responses seem very adequate with Omicron. Here’s 2 papers:

  1. A group assessed the ability of T cells to react with Omicron spike in participants who were vaccinated with Ad26.CoV2.S or BNT162b2, and in unvaccinated convalescent COVID-19 patients (n = 70). They found that 70-80% of the CD4 and CD8 T cell response to spike was maintained across study groups. Moreover, the magnitude of Omicron cross-reactive T cells was similar to that of the Beta and Delta variants, despite Omicron harbouring considerably more mutations. Additionally, in Omicron-infected hospitalized patients (n = 19), there were comparable T cell responses to ancestral spike, nucleocapsid and membrane proteins to those found in patients hospitalized in previous waves dominated by the ancestral, Beta or Delta variants (n = 49). These results demonstrate that despite Omicron’s extensive mutations and reduced susceptibility to neutralizing antibodies, the majority of T cell response, induced by vaccination or natural infection, cross-recognises the variant. Well-preserved T cell immunity to Omicron is likely to contribute to protection from severe COVID-19, supporting early clinical observations from South Africa:

https://www.medrxiv.org/content/10.1101/2021.12.26.21268380v1.full.pdf

  1. A team address whether T cell responses induced by different vaccine platforms (mRNA-1273, BNT162b2, Ad26.COV2.S, NVX-CoV2373) cross-recognize SARS-CoV-2 variants. Preservation of at least 83% and 85% for CD4+ and CD8+ T cell responses was found, respectively, regardless of vaccine platform or variants analyzed. By contrast, highly significant decreases were observed for memory B cell and neutralizing antibody recognition of variants. Bioinformatic analyses showed full conservation of 91% and 94% of class II and class I spike epitopes. For Omicron, 72% of class II and 86% of class I epitopes were fully conserved, and 84% and 85% of CD4+ and CD8+ T cell responses were preserved. In-depth epitope repertoire analysis showed a median of 11 and 10 spike epitopes recognized by CD4+ and CD8+ T cells from vaccinees. Functional preservation of the majority of the T cell responses may play an important role as a second-level defense against diverse variants:

https://www.biorxiv.org/content/10.1101/2021.12.28.474333v1

This is especially important as the Gupta lab report fatal SARS-CoV-2 escape from neutralising antibodies in an immune suppressed individual treated with convalescent plasma, generating whole genome ultradeep sequences by both short and long read technologies over 23 time points spanning 101 days. Little evolutionary change was observed in the viral population over the first 65 days despite two courses of remdesivir. However, following convalescent plasma we observed dynamic virus population shifts, with the emergence of a dominant viral strain bearing D796H in S2 and ΔH69/ΔV70 in the S1 NTD of the Spike protein. As serum neutralisation waned, viruses with the escape genotype diminished in frequency, before returning during a final, unsuccessful course of convalescent plasma. In vitro, the Spike escape variant conferred decreased sensitivity to multiple units of convalescent plasma/sera from different recovered patients, whilst maintaining infectivity similar to wild type. These data reveal strong positive selection on SARS-CoV-2 during convalescent plasma therapy and identify the combination of Spike mutations D796H and ΔH69/ΔV70 as a broad antibody resistance mechanism against commonly occurring antibody responses to SARS-CoV-2:

https://www.medrxiv.org/content/10.1101/2020.12.05.20241927v1

Now skool. As masks have been made mandatory in UK schools alongside testing before pupils return, 3 failings were identified in UK school policy: delayed vaccination of 12-15 year olds; lack of public health measures in schools such as masks and ventilation; and continued high community transmission leaving schools vulnerable. So what happened? And what needs to happen next? Right now this is the status quo:

Vaccines were finally rolled out to 12-15 year olds towards the end of September, three weeks into the start of term. Unlike the roll out in Scotland, vaccines were initially offered in school settings and progress was slow. As of 19 December, only 47% of 12-15 year olds have received one dose. Meanwhile, the US FDA approved vaccines for 5-11 year olds at the end of October and the European Medicines Agency did so a month later. The UK Medicines and Healthcare products Regulatory Agency (MHRA) and Joint Committee on Vaccination and Immunisation (JCVI) have yet to make a decision, but recent indications are that JCVI will only recommend vaccination for clinically extremely vulnerable 5-11 year olds.

Schools have navigated this term with essentially no nationally required mitigation measures except for isolation for children who test positive. Carbon dioxide (CO2) monitors were promised to all schools in September, but most had still not been delivered by November. HEPA filters and germicidal ultraviolet light to reduce airborne transmission are being trialled in schools in Bradford, but have not been not rolled out more generally. Community transmission rates have remained high all autumn.

The consequence has been very high rates of infection in children. Over one million children under 16 years have had a confirmed infection since 1 September 2021, more than the rest of the pandemic combined. Rates in 5-19 year olds have been the highest across all age groups since September. The Office of National Statistics Infection Survey has reported the highest prevalence in primary and secondary school children since the start of the pandemic (in two October weeks almost 10% of secondary school children tested positive each week). Prevalence has been consistently more than three times as high as adults. As more teenagers became vaccinated over the autumn, primary school children saw the highest infections among all age groups for the first time in the pandemic.10 Schools suffered a lot of disruption as students and teachers fell sick. Over 2,000 6-17 year olds have been admitted to hospital with covid-19 since 1 September and 10 5-14 year olds have died with covid as contributing cause, compared to 720 and two respectively over the same period in 2020. Children are reporting rising cases of long covid too, a trend only likely to get worse as data come in from the last few months of the year.

High cases in children have also spilled over into their parents’ generation, cases in 35-49 year olds have consistently been the highest among adults and have risen and fallen together with cases in school age childre.

As of 19 December, almost 40% of 16-17 year olds and over 50% of 12-15 year olds remain unvaccinated. Under 12s remain unvaccinated. As the new term starts in January therefore, children are the population at highest risk of a large new wave of infection, this time driven by omicron and not delta. Over seven million doses have been administered to 5-11 year olds in the USA. So far, there have been only eight reports of myocarditis, all mild. Many European countries have now started vaccinating primary school age children since EMA approval in November. We had given a first dose to 50% of 16 and 17 year olds by end of September 2021 and this age group did not see a large spike in the autumn term. We had given a first dose to a third of 12-15 year olds by early November and by December case rates were higher in primary school children than secondary school children for the first time in the pandemic. Vaccines are safe and they work. By reducing the chance of primary infection, vaccines reduce cases, transmission, long covid, and school disruption. They also protect children from becoming severely ill. With omicron the dominant variant for next term, we cannot rely on previous infection to prevent a new wave of infections in schools. We must offer as many teenagers as possible their second dose before term starts. The JCVI are reported to have decided that only clinically vulnerable children should be offered the vaccine. 

We can lower covid transmission using methods that work against other airborne pathogens; they are all carried on respiratory aerosol particles released into the room by breathing and talking, and disease spreading is contained by cleaning these particles from the air. There are different ways to achieve this; some are quick, inexpensive improvements to current classrooms, and some require longer term investment. As each covid variant is more transmissible than the last, clean air becomes an ever more important, and long lasting, defence.

We need more CO2 monitors. Most UK classrooms rely on natural ventilation through windows or doors. The ventilation delivered depends on the weather and is hard to guess, but teachers need to manage window opening in real time to stop too much exhaled air building up, while keeping the classroom at a reasonable temperature. Having a visible CO2 display in the room helps achieve this. We therefore recommend a CO2 monitor for every naturally ventilated classroom, rather than the current one to two shared across a school.

Further adjustments can be made to provide cleaner air. Windows bolted shut could be opened with restrictors for safety; and ventilation can be enhanced using fans placed by windows. Where ventilation is still insufficient, HEPA units can provide clean air by filtering out the infectious respiratory particles. The technology was shown to be effective against covid in hospitals, and many low-cost home “air purifiers” have the required H13 filter standard and can deliver enough clean air with several units per classroom. With guidance on sources and numbers required, schools can quickly take advantage of these, rather than being limited by the two models currently recommended by the government. In the longer term, infrastructure upgrades combining clean air with energy efficiency represent a good investment for the future.

Finally, while vaccination and clean air are the foundations of safer schools, there are many other protections we can implement, and which are increasingly important given omicron’s high transmissibility. Masks need to be worn inside and outside of classrooms wherever possible by both students and staff, preferably high quality FFP2 masks that could be provided (with funding support) by schools at the entrance. With the higher risk of transmission from the omicron variant to household members of an index case, children who have a household member with covid should isolate for 10 days and be supported to learn remotely, otherwise chains of transmission are just prolonged. We also need better surveillance testing. Lateral flow tests have been an important intervention, but they are unpleasant, easy to do badly and too many students do not do them at all. There are more efficient ways to monitor large scale settings such as schools. Pooled testing using saliva-based swabs have been found to be very effective in the United States and Germany, and has been successfully implemented, for instance in Massachusetts.

In terms of new science coming up, physics and astronomy will be centre stage, for me. The James Webb Space Telescope will hopefully give us remarkable images. At the weekend it deployed its right sunshield or mid-boom, or “arm.” Webb’s sunshield has now taken on its diamond shape in space. Also it’s started tensioning the 5 sunshield layers:

https://www.nasa.gov/mission_pages/webb/main/index.html

https://twitter.com/NASAWebb/status/1477124649465040897

After a multi-year shutdown and extensive maintenance work, the Large Hadron Collider is scheduled to restart its operations at CERN, Geneva. The LHC’s major experiments ATLAS and CMS were upgraded and expanded with additional layers of detector components. This will enable them to collect more data from the 40 million collisions of protons each of them produces every second. And after their own upgrades, the world’s four gravitational-wave detectors, one in Japan, one in Italy and two in the United States, will being a new observing run in December:

https://twitter.com/ego_virgo/status/1460273590201376773?s=20

At Michigan State University the Facility for Rare Isotope Beams is expected to start operations in shortly. This multi-stage accelerator aims to synthesize thousands of new isotopes of known elements, and it will investigate nuclear structure and the physics of neutron stars and supernova explosions:

https://frib.msu.edu/

A veritable armada of orbiters and landers from space agencies and private companies is scheduled to leave for the Moon in 2022. NASA will launch the Artemis I orbiter in the first test of the long-overdue launch system that is intended eventually to take astronauts back to the surface of the Moon. And the agency’s CAPSTONE orbiter will conduct experiments in preparation for the Gateway, the first space station to orbit the Moon.

India’s third lunar mission, Chandrayaan-3, aims to be its first to make a soft landing (one that doesn’t damage the craft) and will carry its own rover. Japan will also attempt its first soft landing on the Moon, with the SLIM mission, and Russia is aiming to revive the glory of the Soviet lunar programme with the Luna 25 lander. The Korea Pathfinder Lunar Orbiter will inaugurate South Korea’s own Moon exploration.

On the private side, Tokyo-based company ispace is launching the Hakuto-R lander, which will carry the UAE’s Rashid Moon Rover. Two US companies, Astrobotic Technology in Pittsburgh, and Intuitive Machines in Houston, are readying probes that will carry NASA instruments to the lunar surface.

Another epic space journey to watch will be the joint Russian–European ExoMars mission, which is scheduled to blast off in September and will carry the European Space Agency’s Rosalind Franklin rover to Mars, where it will search for signs of past life. The launch was originally scheduled for 2020, but was delayed partly because of issues with the parachutes needed to touch down safely.

China also plans to complete its space station, Tiangong and has lined up more than 1,000 experiments for it, ranging from astronomical and Earth observation to the effects of microgravity and cosmic radiation on bacterial growth.

Energised by the COP26 summit, delegates from around the world will converge on Sharm El-Sheikh, in November 2022 for COP27, another round of United Nations climate talks. Countries are expected to come up with climate commitments consistent with the 2015 Paris agreement goal of limiting global warming to well below 2˚C above pre-industrial temperatures. In the meantime, researchers will be monitoring greenhouse-gas emissions following pledges made at COP26, which included promises to reduce the use of coal and cut methane emissions. After a pandemic-induced dip in 2020, carbon emissions have obviously rebounded strongly in 2021.

Countries are working on a new set of targets to slow down the loss of biologic diversity. The Aichi Biodiversity Targets, established in 2010, were mostly missed by their 2020 deadline. The next meeting of parties to the UN Convention on Biological Diversity, originally planned for 2020, is scheduled to take place in Kunming, China, from 25 April to 8 May, but concern over the Omicron variant might scupper those plans yet again. Habitat loss and other factors linked to human activity have put an estimated one million plant and animal species at risk of extinction.

Genomic surveillance for COVID and pathogens will intensify. Public-health policymakers cannot move on unless and until a sustainable surveillance system is in place. The Seattle Flu Study (SFS) represents a case study in what can go right, and wrong, even when such a surveillance system exists. In 2018, the Brotman Baty Institute, University of Washington School of Medicine, Seattle Children’s Hospital and the Fred Hutchinson Cancer Research Center launched a city-wide platform for the surveillance of respiratory pathogens, as well as of pilot interventions, such as home-based testing and delivery of antivirals, to mitigate emerging pandemics. This was one year before the onset of COVID-19, so their experience reflects the collision of a prototype pandemic-surveillance system and a bona fide pandemic.

The SFS platform collected samples through several mechanisms to survey respiratory pathogens in people with various symptoms and levels of severity. They obtained remnant de-identified specimens from area hospitals to monitor respiratory illness in those seeking medical care. To collect samples from people in the community, they created kiosks in high-traffic areas, such as a shopping malls, and developed a swab-and-send procedure for home use. These people signed consent forms approved by our institutional review board. The SFS laboratory was operating in a research capacity, so they could collect and test samples for research but were not authorized to return results to participants.

On 22 January 2020, one day after the USA’s first case of SARS-CoV-2 was discovered in nearby Snohomish County, they began discussions with the CDC and state and local health agencies about testing our SFS specimens for SARS-CoV-2. After the nationwide emergency was declared on 30 January, the FDA exercised regulatory enforcement over laboratory testing that required emergency use authorization (EUA) for any test that would return results. This represented a considerable change to existing regulations, which allowed certified laboratories to develop and offer such tests after meeting validation requirements.

Two weeks later, the FDA granted an EUA for the CDC to manufacture and distribute a diagnostic test for public-health laboratories. Subsequently, laboratories discovered that the assays produced inconclusive results due to contamination in one of the controls. During the weeks needed to resolve these problems, testing for SARS-CoV-2 required that samples be sent to the CDC in Atlanta, Georgia, which caused substantial delays. Using one laboratory for the entire nation with a low-throughput test eliminated any effort to contain the emerging outbreaks in the United States.

They started testing banked samples for research on 24 February using a robust assay developed internally. Three days later, they discovered their first positive result for SARS-CoV-2: a Seattle-area teenager without any epidemiological risk factors. They had an ethical obligation to inform this person and public health authorities, but recognized that this would violate their research protocol. They and the institutional review office concluded that in a public health emergency, the potential societal implications were greater than the risk of breaching individual privacy. The following morning, they informed the hospital clinic at which the teenager had been seen; they, in turn, notified the teenager’s family.

Over the next several days, their discussions with the FDA, the CDC and local and state public-health authorities explored an accelerated pathway for approval of an EUA for our test. On 29 February, the FDA issued a policy allowing laboratories to start using validated SARS-CoV-2 diagnostic tests before full review of EUA requests. Separately, the University of Washington institutional review office determined they had an ethical obligation to test all samples. The SFS had already obtained consent from participants to test for other communicable respiratory diseases and return those results to study participants.

By 19 March, their laboratory became clinically certified through the State of Washington Department of Health, and they received an EUA from the state for our SARS-CoV-2 test. Using the foundation of the SFS and its online swab-and-send program, they launched the nation’s first community surveillance program for COVID-19. However, additional regulatory and policy hurdles continued to emerge over March and April with conflicting directives from federal and state regulators.

In May, the FDA clarified that an FDA EUA was required for home-collected swabs (not just for home tests), which put the SFS on hold yet again, despite the SFS’s meeting all analytical, safety and regulatory requirements from the state.

Their efforts to test for SARS-CoV-2 in the community were constrained by the labyrinth of conflicting and uncoordinated actions among state and federal regulators. Regulatory requirements kept changing, necessitating frequent pivots by our team. An effective pandemic response requires flexibility and innovation. They now contend that at-home sample collection, coupled with a clinically validated respiratory virus–detection test, exemplifies such flexibility and innovation. One could imagine a future with swab kits in every US home that people would use for self-testing or send to a laboratory when feeling ill. It is imperative that our nation’s regulatory systems become nimbler to enable certified laboratories to provide critical information to our communities and healthcare providers in real time.

Toward such a goal, they believe that clinical laboratories, such as our academic laboratory, should continue to be regulated by the Clinical Laboratory Improvement Amendments, whose regulators have the flexibility to implement amended regulations during public-health emergencies. Modernizing the current regulatory structure, without additional regulation by the FDA, would enable healthcare professionals to respond rapidly to emerging outbreaks, including returning individual results. It would also allow the FDA to focus its attention on the agency’s core regulatory responsibilities, including vaccines. During a pandemic, the regulatory framework should include five key principles: community surveillance and engagement, as well as ongoing relationships with public-health agencies; data collection and accurate analysis; modelling of transmission dynamics and genomic epidemiology; regulatory oversight of clinical laboratory testing under the Clinical Laboratory Improvement Amendments; and laboratory flexibility in response to new and emerging pathogens and supply-chain disruptions that may emerge.

Such a regulatory framework is vital to ensure that research studies and clinical testing are conducted in an ethical manner that does no harm, provides benefits to society and limits risks to people:

https://www.nature.com/articles/s41591-021-01587-0

Snippets:

Remdesivir (RDV) is a nucleotide analog prodrug with demonstrated clinical benefit in patients with coronavirus disease 2019 (COVID-19). In October 2020, the US FDA approved intravenous (IV) RDV as the first treatment for hospitalized COVID-19 patients. Furthermore, RDV has been approved or authorized for emergency use in more than 50 countries. To make RDV more convenient for non-hospitalized patients earlier in disease, alternative routes of administration are being evaluated. Here, researchers investigated the pharmacokinetics and efficacy of RDV administered by head dome inhalation in African green monkeys (AGM). Relative to an IV administration of RDV at 10 mg/kg, an approximately 20-fold lower dose administered by inhalation produced comparable concentrations of the pharmacologically active triphosphate in lower respiratory tract tissues. Distribution of the active triphosphate into the upper respiratory tract was also observed following inhaled RDV exposure. Inhalation RDV dosing resulted in lower systemic exposures to RDV and its metabolites as compared with IV RDV dosing. An efficacy study with repeated dosing of inhaled RDV in an AGM model of SARS-CoV-2 infection demonstrated reductions in viral replication in bronchoalveolar lavage fluid and respiratory tract tissues compared with placebo. Efficacy was observed with inhaled RDV administered once daily at a pulmonary deposited dose of 0.35 mg/kg beginning approximately 8 hours post-infection. Moreover, the efficacy of inhaled RDV was similar to that of IV RDV administered once at 10 mg/kg followed by 5 mg/kg daily in the same study. Together, these findings support further clinical development of inhalation RDV:

https://www.science.org/doi/10.1126/scitranslmed.abl8282

Some drug candidates in clinical trials act against the viral RNA-dependent RNA polymerase, but there are other viral enzymes that have been considered good targets for inhibition by drugs. A team report the discovery and characterization of a drug against the main protease involved in the cleavage of polyproteins involved in viral replication. The drug, PF-07321332, can be administered orally, has good selectivity and safety profiles, and protected against infection in a mouse model. In a phase 1 clinical trial, the drug reached concentrations expected to inhibit the virus based on in vitro studies. It also inhibited other coronaviruses, including severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome coronavirus, and could be in the armoury against future viral threats:

https://www.science.org/doi/10.1126/science.abl4784

Back to the US election thought at the beginning. Interesting thought: the mid-term elections might be influenced by an excess of deaths in unvaccinated Republicans. When the 2022 midterm elections are appraised less than a year from now, the Washington commentariat will in all likelihood render them to have been a devastating blow to Joe Biden’s presidency. Barring a historic anomaly, Democrats will have lost at least one chamber of Congress, Biden’s remaining legislative goals will be placed on life support, and the growing anguish over the party’s 2024 presidential nominee will transform into a panic. Yet even sooner than that, a slice of the most reliable voters will also deliver a tangible verdict on the staying power of another politician who hovers over the next pair of election cycles like no other: the former president, who hardly needs to be named. Donald Trump will own the midterms just as much as Joe Biden will. Voters’ verdicts on Trump will come in Idaho, Alabama, and Georgia this spring. Then in Arizona, Alaska, and Wyoming in summer. Trump has already endorsed candidates in 2022 primary contests in all of those states. He’s made picks in nearly 40 congressional races to date, most recently training his ammunition on the House Republicans who voted for the bipartisan infrastructure package. He’s made another nine endorsements in gubernatorial primaries, including one against the GOP incumbent in Idaho.

The former president’s ultimate record in these races will serve as the first barometer of his continued strength as he eyes a comeback bid for the White House in 2024. So far, his picks have lifted challengers to GOP incumbents who have crossed him and a bevy of newcomers who are eager to align with his brand.

Make no mistake: Trump is making these picks himself. “I haven’t seen a time where Trump is more in control than now,” a Republican familiar with the ex-president’s staff told me on the condition of anonymity to protect private conversations within Trump’s circle. “Susie [Wiles] ain’t making endorsement decisions. [Bill] Stepien ain’t making endorsement decisions. It’s a lot more him making these endorsement decisions than ever before.” Sure, the 45th president will remain the overwhelming front-runner in hypothetical Republican presidential polling throughout the next year. But even his own allies acknowledge that his endorsement success will factor into his decision matrix. And perhaps more importantly, it’ll be closely gauged by the fleet of Republicans lying in wait, seeking any shred of Trumpian vulnerability to justify their own 2024 runs.

Trump is the only thing that could upend what should be a historic midterm for the Republican Party, Larry Hogan, the anti-Trump term-limited governor of Maryland who is mulling his own path to the White House, argues. “It’s the only way we can blow this thing,” he told me. “The people that may try to be more Trumpy to win a primary may be the least electable in the general. That’s the biggest worry I have for the Republicans.”

Given what happened in Georgia’s runoff elections, it’s easy to envision a scenario in which Trump meddles so heavily and recklessly in a battleground state that the fallout from the divisiveness costs the party a governorship or a precious Senate seat. He’s already suggested that Stacey Abrams, who just launched her second shot at the governorship and harbors her own White House ambitions, might be a better governor than Kemp. Conversely, if Trump’s highest-profile picks run the table, he’ll look unstoppable and potentially head into 2024 as a stronger candidate than he was as an incumbent president in 2020. Trump runs no formal endorsement process. Instead, he relies on spontaneous, freewheeling phone conversations. He’s certainly not seeking anyone’s approval to make a move, according to those at the other end of the line.

Graphs:

Hospitalisation in Gauteng:

Source: National Institute for Communicable Diseases

Time series of primary series/booster vaccinations (top), new COVID cases (middle) and current hospitalisations due to COVID (bottom) in the US:

Emerging hot spots in the US. The x-axis is growth rate of new cases compared to last week, the y-axis is the new case per hundred, and z is the latitude. Each state is colour coded by vaccination rate:

Back to Work Chart and Upcoming Vaccine Catalysts:

Percentage of hospital bed utilisation by US State:

US vaccinations:

Daily vaccinations in key regions:

Vaccinations vs Deaths in various countries:

Vaccine orders by country. The number on top of each bar shows the % of the population that the orders in place can cover. Note that countries whose orders cover <25% of their population were excluded:

Google search interest of three terms regarding COVID vaccines over the past 3 months:

Daily vaccinations in the US and Google trends of keywords around vaccination:

Variant for children development timeline:

 

Justin Stebbing
Managing Director

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