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COVID-19 cases fall in the U.S. but grow worldwide

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | April 27, 2021

This week we venture beyond our usual update to review how the pandemic is affecting influenza and suicide rates.

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

The overall rate of new cases of COVID-19 in the U.S. is down about 10% over the last week, and there is good news in many of the states that have been especially hard hit. New cases in Michigan, for instance, are down 18% from the peak 10 days ago, and new cases in New York are down 27% from the peak of April 1.

The global news is not nearly so good. There were 900,000 new confirmed cases globally yesterday, the highest ever recorded. This is a substantial undercount, since testing capabilities are very limited in many countries. A surge of cases in India is especially worrying, and hospitals are reporting running out of intensive care beds and oxygen.

Vaccination rates are also down somewhat in the U.S. We haven’t had a four-million-dose day in the last week, and our average number of doses per day is now 2.9 million. The pause in administering Johnson & Johnson (J&J) vaccines is partially responsible. But the biggest issue is likely that, in many states, those most eager to be vaccinated have already received their jabs, and the key will be to get vaccinations in the arms of those who are still staying on the sidelines.

Globally, the vaccine rollout continues to be bumpy. We’re at almost a billion doses administered, and Israel (57% of population) and the U.K. (33% of population) have seen dramatic decreases in their new cases of COVID-19. But much of Europe is at just 15% or less of the population covered, and many lower income countries have vaccinated few or none of their population. Large numbers of unvaccinated people globally will mean potentially dangerous variants will continue to emerge and will cause continued constraints on global travel and trade.

Agencies lift pause on J&J vaccine distribution

The Centers for Disease Control (CDC) and the Food and Drug Administration recommended resumption of vaccinations with the J&J vaccine. A total of 15 cases of a rare blood-clotting disorder, thrombosis thrombocytopenia syndrome, were identified out of seven million who received the J&J vaccine, including the initial six cases reported earlier this month. All were in women between the ages of 18 and 59 (median age 37), and symptoms began between six and 15 days after vaccination.

The vaccine is clearly safer than not being vaccinated and will come with a warning about the rare blood-clotting problem, which was not reported with the Pfizer or Moderna vaccines. Those vaccines might be more appropriate than J&J’s for women and those who are younger. We had high hopes for the J&J vaccine for potential employer-sponsored onsite COVID-19 shots, since it requires no freezing and only a single injection. This risk, even though quite small, likely means that employer-sponsored onsite vaccination will need to rely on different vaccines.

CDC approves vaccine for pregnant women

The CDC recommended that pregnant women get the COVID-19 vaccination, after a study in the New England Journal of Medicine followed over 36,500 pregnancies and showed no safety signals.

It’s important to protect pregnant women from COVID-19; pregnant women who are infected are 22 times more likely to die in pregnancy, and pregnant women who get COVID-19 are more likely to have premature deliveries. Previous research has shown that vaccine antibodies pass the placenta and are found in breast milk, so vaccination of women in pregnancy can offer some protection to their newborns too. The U.S. follows Israel and the U.K. in recommending the vaccine to pregnant women. There is no evidence that COVID-19 decreases fertility in either men or women.

How the pandemic is affecting mental health and influenza

  1. 01

    Mental health

    The pandemic has been hard on mental health. It’s no surprise that we are more anxious, more depressed and have more trouble sleeping. The increase in mental health symptoms is not evenly distributed though, and this has important implications for employers.

    The CDC has been collaborating with the Census Department to do brief pulse surveys, often multiple times a month, since last spring. The prevalence of those with major symptoms of anxiety or depression was 38.6% last month, up from 11.3% before the pandemic in 2019. The problem is most severe among those 18 to 29 and worse than average for all those under 40.

    Current data show that 52.6% of those 18 to 29, and 43.1% of those 30 to 39 report anxiety or depression.
    Portion of population reporting anxiety or depresion

    Data reflects first full week in each survey month.
    Source: National Center for Health Statistics and Census Bureau pulse surveys

    Separately, the CDC reported that in February about 22% of the population reported getting counseling or taking medications, and about 10% reported needing counseling or therapy and not receiving it.

    Surprisingly, multiple reports confirm that in the U.S. suicide rates have been lower during the pandemic. The Journal of the American Medical Association (JAMA) reports that suicide rates were down 5.6% in preliminary calendar-year 2020. JAMA Psychiatry reports data from Maryland showing that the overall suicide rate was down from March to July, driven by a 24% decrease in suicide among white people. Although, there was a corresponding 6% increase in suicide rates among Black people in the Maryland data. The numbers are small but could reflect increasing stress associated with addressing structural racism and higher rates of health care and service work among Black people.

    We need to continue to be vigilant about suicides over the coming months and years. Suicide rates in Fukushima after the 2011 tsunami and nuclear disaster declined for two years, but then rose substantially afterward. The National Suicide Prevention Lifeline is +1 800 273 8255.

    The CDC reported that drug overdose deaths continued to climb during the pandemic. Drug overdose deaths were up 28.8% from October 2019 to September 2020 and are expected to total 90,000 when all reports are complete. The importance of access to substance-use counseling and medical care, including medication-assisted treatment, has never been greater.

    In 2015, yearly drug overdose deaths were around 50,000. - Description below

    Since then, numbers have continued to climb steadily each year and are predicted to be around 90,000 for 2021.

    Provisional counts of drug overdose deaths in the U.S.

    Drug overdose deaths continue to climb during pandemic.
    Source: CDC, April 2021

  2. 02

    Influenza

    There’s been almost no influenza this year. Masks, distancing and handwashing has kept us from having a “twindemic.” This has saved many thousands of lives – last year in the U.K., an analysis found that mortality was twice as high for those who were infected with both influenza and coronavirus.

    What does this mean for the future?

    Here’s what could make us worry. The 2021 influenza virus strains were chosen early this year based on fewer data points than usual, so they could be less effective. As a population we will go into the 2021 influenza season with less immunity since so few people had influenza this year.

    Here’s what could make influenza less of a problem in 2021 – 2022, and maybe thereafter. Now that we’ve improved ventilation and gotten better at washing our hands (and stopped shaking hands), there could be much less transmission this coming season. Many will continue to wear masks in congested public places even as COVID-19 cases wane; this will protect against influenza as well. The technologies used for COVID-19 vaccines allow for more rapid development of new vaccines – so we might be able to wait until later in the year to choose strains for future influenza vaccines, increasing their effectiveness.

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led Willis Towers Watson’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


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