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NEWS & EVENTS

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IHME COVID-19 INSIGHTS BLOG

--------------------------------------------------------------------------------

Publication date: 
December 16, 2022

After December 16, 2022, IHME will pause its COVID-19 modeling for the
foreseeable future. Past estimates and COVID-related resources will remain
publicly available via healthdata.org/covid. 

To hear the latest on COVID-19 and other topics in global health, visit our
Global Health Insights blog.

IHME director and lead modeler Dr. Christopher J.L. Murray shares insights from
our latest COVID-19 model run. Explore the forecasts: covid19.healthdata.org. 


OUR COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * Updated estimation methods for total and excess mortality due to COVID-19
   | Read the methods
 * COVID-19 model briefings delivered to your email inbox | Sign-up for emails
 * Our COVID-19 publications | View publications 
 * Questions about our projections? | Read our FAQs or email us
   at engage@healthdata.org
 * For media inquiries, please contact media@healthdata.org

--------------------------------------------------------------------------------


OCTOBER 24, 2022



 


KEY TAKEAWAYS:

 * New Omicron subvariant XBB does not appear to have immune escape with BA.5,
   meaning individuals who were previously infected with BA.5 will maintain
   their immunity against the new subvariant. 
   * New analyses also show all subvariants of Omicron appear to be less severe
     than previous variants.
 * The surge in Germany may be due to subvariants BQ.1 or BQ.1.1, and will
   likely spread to other parts of Europe in the coming weeks. 
   * We predict winter seasonality in the Northern Hemisphere will bring more
     infections, but not a large increase in deaths.
 * New research on long COVID shows it has affected millions worldwide and is
   more common in women than men. 

This transcript has been lightly edited for clarity

In this week's analysis of COVID from the Institute for Health Metrics and
Evaluation, we have spent a lot of time in the last few weeks recalibrating our
model to reflect the differences between waves of variants for the
infection-detection rate, the infection-hospitalization rate, and the
infection-fatality rate. And when we put that together with all the new data
that we've seen in the last three or four weeks, our attention gets drawn to two
key areas.


NEW SUBVARIANT XBB

First, the XBB-related surge in hospitalizations in Singapore, and it's a pretty
rapid increase in hospitalizations over a short period of time. Very nice
analyses out of Singapore, telling us that it's more transmissible. But the good
news is that also, those analyses suggest there's no immune escape with BA.5.

In fact, people who have been infected in the last three months, presumably with
BA.5, had essentially almost no incidence of XBB. So that's really good news in
terms of its potential for global spread and impact. It still, however, means
that those individuals and communities that have had low past Omicron infection,
particularly BA.5, are at risk for the surge.

The other good news out of Singapore is that it doesn't seem to be more severe
– if anything, slightly less severe. Our recalibration exercise has confirmed
what we thought almost 10 months ago, that Omicron, including BA.5, remains more
than 10-fold less severe than previous waves of the COVID pandemic. And that has
continued for all these Omicron sub-lineages so far.


SURGE IN GERMANY AND PREDICTIONS FOR EUROPE AND THE NORTHERN HEMISPHERE

The other area of concern is the really rapid increase in hospital admissions,
as reported in Germany – higher rates of hospital admission now than at any time
previously in the COVID epidemic. The last couple of days it looks like COVID
admissions may be coming down, but of course, there's this question of lags in
reporting. So we'll wait and see if that holds true in the next three or four
days.

But the increase has already been quite large. We should expect that to spread,
probably due to BQ.1 or BQ.1.1 – not 100% sure because of lags in reporting of
the sequencing data – but it should spread to other parts of Europe, we suspect.
Again, we don't have good data at all separating out admissions due to COVID as
compared to admissions with COVID, and so we're not really sure how
consequential this big surge in Germany is and how consequential it will be for
the rest of Europe.

We do expect that the sort of smaller, slow increases in the northeast of the
US, as an example, are the beginning of people going back to school, winter
seasonality starting to kick in, so we continue to expect considerable increases
in infections through the Northern Hemisphere winter, but without major
increases in deaths due to COVID – but quite a number of deaths with COVID, and
same for hospitalizations.

So until we learn more about the German surge and whether it's associated with
more severe disease, we remain reasonably, cautiously optimistic that the winter
will have more infections, maybe not so many cases because of the great
reduction in the infection-detection rate, and we should see quite a few
hospitalizations with COVID, but not so many due to COVID.


CONTINUING ZERO-COVID STRATEGY IN CHINA

China is the last big question mark, where there have been mixed signals from
different groups in China about whether or not the zero-COVID strategy would
continue. President Xi Jinping has made it clear, at least publicly, that they
plan to continue with the zero-COVID strategy.

And so when we build that into the models, we don't see a huge surge in China.
But given the large number of susceptible individuals in China and the very low
levels of past infection, the potential for an explosive epidemic always remains
there, especially if the zero-COVID strategy was backed off even a little bit
within China. So that's the sort of main pictures that we see around the
pandemic or COVID transmission in different parts of the world.

There are some interesting, but too early to tell, signals in some countries in
sub-Saharan Africa that maybe cases are also going up there, but that could also
be related to the data challenges that we've seen throughout the pandemic in
sub-Saharan Africa.

New findings on long COVID

Now, the last thing to comment on is we published this week in JAMA, our
analysis with many collaborators of all the cohorts that were available on long
COVID, and put those together to get an overall picture about long COVID.

Read the research

And just to reiterate the key findings there, the risk of long COVID is very
much related to severity of disease, much higher if you went to hospital, even
higher if you had to go to the ICU. Long COVID is more common in women than men,
and it's quite low risk in children. And with the milder variants, we also
expect to see a lower probability of long COVID.

Despite that, we're seeing 5% or 6% of individuals having long COVID symptoms at
three months. That fortunately drops down to about 1% at 12 months. But if you
take the huge volume of COVID infections in the world, those numbers do
translate into a very large number of individuals globally who will be suffering
at three months from symptoms of long COVID and many millions suffering even at
12 months with symptoms of long COVID just because of the incredible ubiquity of
COVID infection. Even though the probabilities are not that high, individual by
individual, they add up to a big toll on society.

--------------------------------------------------------------------------------


SEPTEMBER 16, 2022



 


KEY TAKEAWAYS:

 * Long COVID is a real problem. It affected 17 million people in the European
   region in 2020 and 2021.
 * The more severe a case of COVID is, the higher risk of developing Long COVID.
   Adults are at higher risk than children.
 * About 6% of people with COVID still had symptoms after three months and 1%
   had symptoms after a year.

This transcript has been lightly edited for clarity

We are very interested in the evidence base around Long COVID and have had a
number of initiatives running for about a year and a half, trying to get the
various researchers around the world that have cohort studies on Long COVID,
getting them to work together and pool that information and figure out what the
actual risks of Long COVID are.

And there are future studies that are planned and will be coming out about that
joint work with many groups. This week we used those insights with the World
Health Organization European Regional Office and put out an analysis of what the
implication of the cohort studies were for the European region. [We found] 17
million people in 2020 and 2021 with Long COVID, where Long COVID is defined as
symptoms running three months or more and, at the heart of it, it does point out
that Long COVID is a real problem.

Read the press release from WHO

It's quite considerable numbers globally and by region. And what we do know from
the examination of the cohort studies is that it seems to be a higher risk of
Long COVID the more severe your case was, so much higher probabilities of Long
COVID if you went to the ICU or you were hospitalized, than if you had mild
symptoms.

It's also a higher risk in adults than in children. And the risk, there's some
people who have, by definition three months of symptoms. And then there are
still some people in the cohort studies that have symptoms at 12 months. So some
Long COVID can be very long indeed. 

The numbers, roughly speaking, are running about 6%, everyone coming, having had
COVID, having symptoms at three months, of Long COVID and 1% having symptoms at
the end of a year. 

Given the huge volume now of Omicron infection in the world, we don't have the
implication of the number of patients with Long COVID. It could be very large
and could be a real burden on society and on health systems, and on the
individuals who are affected. But we don't have the same cohort data available
yet specifically, or very much less, specifically about Omicron.

Given the general relationship between severity and risk of Long COVID we hope
that those probabilities I was quoting for Long COVID should be somewhat lower
for Omicron.

Regardless, it is a big issue and it is important to some of the initiatives
that we've seen in the European region of coming up with strategies to help
patients manage Long COVID symptoms and I'm sure we will see similar discussions
around Long COVID in other regions of the world as the epidemic continues.

--------------------------------------------------------------------------------


SEPTEMBER 12, 2022

 



 


KEY TAKEAWAYS:

 * New projections through January 1: infections will drop until October and
   then increase in the winter.
 * Current projections show a relatively low death toll, but a new variant could
   change that.
 * Our recommendations:
   * Maintain and improve surveillance for new variants.
   * Encourage boosters.
   * Provide access to antivirals for older and high-risk individuals.
   * Determine which social distancing mandates have the greatest impact if a
     new, more severe variant emerges that warrants their use. 

This transcript has been lightly edited for clarity


NEW CHALLENGES WITH MODELING

In this week's release on modeling the COVID-19 epidemic, we've got updated
forecasts out to January 1. The analysis proves to be quite challenging the
farther into the epidemic we go, because the balance of how many people are able
to get infected and thus likely to transmit the virus and sustain transmission
is incredibly driven by two factors: first, the pace at which immunity wanes,
whether from vaccination or recent infection. 

Two aspects of that, 1) the pace at which immunity wanes for infection, which is
faster than immunity waning for severe disease, so we get these differential
effects on waning, and then 2) the degree of cross-variant immunity between
sub-variants of Omicron. So, how much can BA.5 infect people who have been
infected previously with BA.2 or BA.1?

Those are not, especially for BA.5, well understood. There are not that many
published studies on waning immunity and cross-variant immunity, so we have to
try to infer that from neutralizing antibody studies, as well as the behavior of
BA.1 and BA.2 compared to the Delta variant. So that generates quite a lot of
uncertainty, and as we try to fit each model to the available data for each
country, it is a harder challenge. It is a more brittle analysis.


THE LATEST RESULTS: A WINTER INCREASE IN INFECTIONS BUT NOT REPORTED CASES

We've been able to do that for all locations, and what we see in those forecasts
is that for many places in the world, particularly the Northern Hemisphere,
outside of China, we expect infections to keep dropping as they have in recent
weeks in most places, and then start to go back up in October through to the end
of the year. 

The increase of infections – and this is in the absence of any new variant, so
this is really just BA.5 – the increase in infections could be quite large in
the winter. But the infection-detection rate, the fraction of infections that
get reported as a case in official data, is now down to an incredibly low level.
In some parts of the Northern Hemisphere, it's below 2%; in others it may be as
high as 5%. 

That means that this big increase in infections we are modeling for the fall and
the winter will not translate into big increases in cases, but we may see a
larger increase in hospital admissions where COVID is present. 

Because of routine testing of all hospital admissions in most countries, we see
a bigger increase in some places – Norway is a great example of this –- in
hospital admissions – this was the case with BA.5 over the summer – than in
reported cases. We expect that phenomenon to continue, given the current rules
around universal testing for hospital admissions, where hospital admissions are
essentially a measure of community transmission, as opposed to a measure of
severe disease with COVID, since there are a lot of incidental hospital
admissions, people coming in for some other cause who happen to be
COVID-positive.


CURRENT PROJECTIONS SHOW RELATIVELY LOW DEATH TOLL, BUT A NEW VARIANT COULD
CHANGE THAT

Because of the sustained low infection-fatality rate that we're seeing for BA.5
due to vaccination and past infection, and access in some jurisdictions to
antivirals like Paxlovid, we expect not so many deaths, only just over 50,000 in
the Northern Hemisphere and a larger amount in the rest of the world. We expect
that the death toll to be quite modest through to January 1.

If a new variant comes along, all bets are off as we've seen with the emergence
of Omicron this year, or even a new sub-variant where there's considerable
reduction in cross-variant immunity.


CHINA'S ZERO-COVID STRATEGY CONTINUES

The one exception to this description of generally not a high level of threat
around the world in terms of severe disease is what will continue to play out in
China, where the zero-COVID strategy continues to be pursued and we continue to
see renewed outbreaks in different provinces. If the Chinese leadership decide
to back away from the zero-COVID strategy, we would see a very large outbreak of
Omicron, and, given low vaccination in the 80+ population in many provinces, we
would see quite considerable deaths as we saw in Hong Kong earlier in the year.

But that's very much a function of what the government will do. They've
committed so far publicly to zero-COVID, so we don't expect a big toll yet. But
that could change through the fall as the economic consequences of zero-COVID
continue to unfold. 


OUR RECOMMENDATIONS FOR MANAGING THE NEXT PHASE OF THE EPIDEMIC

That's our roundup of what's happening around the world. In terms of strategies
to manage it, number one is to stay vigilant for governments and to maintain
surveillance, maybe improve it, do more what the UK has done with the Office of
National Statistics Infection Survey, so you know about true transmission. And
to take a worldwide view of surveillance, so when a new variant or sub-variant
shows up, the world is ready to act if needed.

Secondly, encourage boosters in those who are due for a booster as immunity does
wane even for severe disease. 

Thirdly, make sure those who are older or at high risk get access to antivirals
as needed. 

And then, a very cautious approach to trying to look at the evidence to date to
figure out which of the social distancing interventions had the biggest impact,
so that in a worst-case scenario, if a severe variant shows up with considerable
immune escape, we can use those social distancing mandates and measures that are
most likely to be beneficial and minimize the economic, educational, and social
disruption in the future.

--------------------------------------------------------------------------------


JULY 22, 2022




KEY TAKEAWAYS:

 * COVID-positive hospital admissions are rising in the US. However, it is
   unclear whether the hospitalizations are due to COVID, or if individuals
   tested positive after being admitted for other reasons. 
 * We remain optimistic that there will not be a large amount of severe COVID,
   due to widespread use of Paxlovid and the likelihood of many hospitalizations
   to be incidental infections.
 * Our recommendations:
   * It is not necessary to implement mask or social distancing mandates at this
     time.
   * National surveillance systems should track the underlying cause of hospital
     admissions.

This transcript has been lightly edited for clarity


RISING COVID-POSITIVE HOSPITAL ADMISSIONS IN THE US

In some jurisdictions in the US, there are rising reported hospital admissions
with COVID, and in some cases, examples of rising deaths. This has caused
considerable policy discussion about whether it is time to reinstate mandates,
such as the consideration of mask mandates in LA County.

The challenge that we have in understanding what's happening with BA.5 is that
this is a very common infection. We see lots of evidence of considerable
transmission in the community that is not translating into a big surge in
reported cases, largely because we believe there is so much rapid antigen
testing at home. 


MANY COVID HOSPITALIZATIONS ARE INCIDENTAL

We do see rising numbers of hospital admissions, and the challenge – as we've
spoken about before – is distinguishing incidental, that is people coming to the
hospital with some other problem, who happened to be COVID-positive when they
get tested, from true COVID admissions. Unfortunately, in this country we don't
have data on COVID admissions where they are positive for COVID and that's the
reason for admission. Some hospital systems are reporting this. 

There are reports from USC, for example, in LA County, that fully 90% of
hospital admissions are incidental, meaning it is quite possible that we don't
have reason to be that concerned about BA.5 transmission. 

Read more in Nature »Heart disease after COVID: what the data say


UNLIKELY TO BE MANY CASES OF SEVERE COVID

It could well be, because of high levels of immunity in the population from
vaccination and from past infection, and quite widespread use of Paxlovid, if we
look at the data in the US, that there isn't really cause for concern that
there's going to be a large amount of severe COVID. This means, perhaps, that it
is not the time, at this point, to be considering imposition of new mandates
such as mask mandates or social distancing mandates.


THE SITUATION GLOBALLY

This is a phenomenon we're seeing in other countries as well – it's not unique
to the United States. There are reports from New Zealand, for example, in the
last few days, of a marked increase in daily deaths. And again, this challenge
is there, as well as in many countries in Europe – Norway is another example –
where incidental from underlying is not being distinguished. It could well be
just that BA.5 is a very common infection.

The only way we're going to resolve this for the future is if national
surveillance systems make the effort to track hospitalizations and distinguish
them by the underlying cause of admission. 

We remain reasonably positive and optimistic about the course of BA.5 in the US
and elsewhere. We do see early signs that it may have peaked already in the US
and is starting to come down – that's not true for every state, but in general
it does seem to be following the course that we've seen in other countries
around the world.

--------------------------------------------------------------------------------


JULY 20, 2022




KEY TAKEAWAYS:

 * BA.5 is surging around the world, particularly in North America, Latin
   America, and Europe.
   * We anticipate waves to last around four to six weeks, based on other
     locations’ experiences.
 * There are several new challenges for accurately tracking the pandemic:
   * More people are using at-home tests and not reporting infections to public
     health authorities, making it difficult to gather accurate case counts.
   * Countries have different requirements for COVID testing upon hospital
     admission, leading to variation in rates of hospitalization due to COVID,
     compared to incidental cases.
 * Our policy recommendations:
   * Encourage booster shots.
   * Make antivirals available to all, particularly those in low-resource
     settings.
   * High-risk individuals should consider social distancing and masking as
     transmission increases.
   * Do not focus on getting vaccines to those who have never been vaccinated.

This transcript has been lightly edited for clarity


BA.5 SURGES AROUND THE WORLD

In this week’s COVID update from IHME, we’re looking at the surges around the
world – particularly in North America, Latin America, and most of Europe – that
are traced to the combination of mobility levels being above pre-COVID levels,
mask use globally down to 16% or less, and of course the BA.5 subvariant of
Omicron.


INTERPRETING THE DATA HAS NEW CHALLENGES

It is becoming increasingly challenging to make complete sense of the COVID-19
surges in different countries, as we see very different biases in different
countries coming into reported cases, hospital admissions, and reported deaths. 

For reported cases, we're seeing very modest to no increase in some countries in
Europe, as compared to hospitalizations. Same in the United States. And we
believe that's because of the widespread use of rapid antigen tests at home and
in most countries people not reporting that to the public health authorities.
They don't get into official case numbers.

In contrast, for hospital admissions – if you want an extreme example of this
disconnect, look at Norway, where hospital admissions have gone up dramatically
and yet cases have gone up only slightly. But for hospital admissions, most
countries have required COVID testing for all patients, at least most
high-income countries, meaning that you detect a quite substantial number of
individuals who have COVID, but have gone to hospital for some other reason. We
tend to call these "incidental" COVID admissions. 

The degree to which there will be incidental COVID admissions depends on how
much transmission there is broadly in the community. So we should expect under
Omicron, the problem of incidental hospital admissions is dramatically larger
than with a much more severe variant, such as Delta in the past, where there was
less transmission in the community, and those coming to hospital who were
COVID-positive were much more likely to be there simply because of symptoms of
COVID.

So, challenging interpretation. And if you want to have a contrast to Norway,
look at Mexico, where the increase in reported cases is dramatically higher than
the increase in hospital admissions. We don't know if that's because there isn't
the same testing requirement, of universal testing for COVID for hospital
admissions, or if there is less home use of tests. Either way, it's becoming
quite a bit harder to make sense of the available data.


SHOULD WE BE VERY CONCERNED ABOUT BA.5? 

Probably not. In the places that started earlier – South Africa, Portugal – that
had their BA.5 waves begin before other locations, we've seen from the beginning
to the peak, it lasts about four to six weeks. So in many cases where countries
are three-four weeks into these surges, we do think that we will see – and the
models tend to back up that observation – we do expect to see peaks coming in
the near future. Meaning that there isn't a reason to be particularly alarmed
about BA.5,

Our long-range models also suggest in the Northern Hemisphere that we may – in
the absence of a new variant that changes the whole story – we might expect to
see a further winter or late fall Omicron wave start up again in October, and
that would be a pattern that we saw in 2020 and 2021.

Whether that happens depends very much on this balance between waning immunity
from prior vaccination – so whether or not people get a fourth booster in places
where they have access to that, whether they want a fourth booster – versus
waning immunity from infection and the protection provided from infection with
Omicron for either other subvariants or future variants. All of that means to
say that it's possible that we have a late-fall surge again from Omicron because
of waning immunity.


GOVERNMENT POLICY RECOMMENDATIONS

The strategies available for governments right now are less on getting people
who have never been vaccinated, vaccinated. The data out there suggest very few
people anywhere in the world who want to be vaccinated have not been, even in
low-resource settings. As opposed to the available strategies, which might focus
more on getting those who are willing to be vaccinated, who have been previously
vaccinated, getting a further booster to enhance their protection against severe
disease as that also wanes over time; broader use of antivirals, particularly in
low- and middle-income countries; and then, for those individuals who are at
particularly high risk, consideration of social distancing and masking as
transmission in your community goes up.

As a backdrop to all of those strategies, the thing that we are learning, that
is, two and a half years into this pandemic, is just how important surveillance
is. Paradoxically, in many ways, the data stream that we have today is worse
than a year ago because of some of the issues that I started with in this video
about home testing, and different definitions of incidental versus underlying
COVID for both hospitalization and death. So, very challenging on the
surveillance side, but absolutely critical that we keep monitoring the pandemic
and trying to do it in as comparable a fashion as possible, and particularly
keeping track of new variants. That's our roundup of what we see in our analysis
this week in the release of our new forecasts.

--------------------------------------------------------------------------------


JUNE 24, 2022




KEY TAKEAWAYS: 

 * In the United States, COVID is currently on the decline, but BA.4 and BA.5
   could change that. Why?
   * Vaccines are less effective at preventing infection from BA.4 and BA.5.
   * Previous infection provides less immunity against BA.4 and BA.5.
   * Mobility is increasing while mask wearing declines.
 * Our recommendations for the US:
   * Individuals should get another COVID vaccine and a flu vaccine before the
     winter.
   * States should secure antivirals, especially for those at high risk.
   * Governments should continue screening for new variants.
 * On a global level, we see a rise in some European countries, including
   France, Germany, and the UK. The future is still unclear in China, but much
   of the population remains susceptible to severe infection.

This transcript has been lightly edited for clarity


BA.4 AND BA.5 IN THE UNITED STATES

In the United States, reported cases, infections, hospitalizations, and deaths
continue to decline. This is the pattern we have seen in the northeastern
states. It is spreading across the United States, and we project that this will
continue all the way until the end of September, when we are expecting another
wave.

We are concerned in the United States because of the fast spread of BA.4 and
BA.5 – they are escape variants in that it seems from the new studies we are
looking at, that the vaccines are less effective in preventing infection of BA.4
and BA.5. They are still very effective in preventing severe illness and
mortality, but we are concerned that with BA.4 and BA.5 spreading fast with the
relaxation of mandates and with the patterns we are seeing in some European
countries where there is a third wave, we are concerned that there is potential
here for another bump or increase in cases in the coming months. 

We will update our models the second week of July, and we will include all this
new information in our models. We will then predict if we see a third wave or
not, and how big it will be and how long it will last. In general, we're heading
in the right direction in the United States.


OUR RECOMMENDATIONS FOR THE US

We're expecting a surge in winter, and the focus right now in the United States
should be on vaccinating people and getting the booster, and then getting
another vaccination before the winter, especially also with flu. We expect that
flu season could be bad because we haven't seen flu in the past three years. Our
recommendation would be to take another COVID-19 vaccine before winter and a flu
vaccine.

Also, our recommendation is for every state to secure enough antivirals in order
to make sure they are provided to infected people, especially those who are at
high risk, elderly, and people with immunocompromise or with risk factors,
chronic conditions, to make sure that we reduce the burden on our hospitals and
we save lives.

And, of course, continue screening and making sure that we don't lose track of
what's circulating in our country, and if there is an increase in cases due to
another variant or pre-existing variant, we take the measures that are necessary
to stop the spread of this virus.


CASES RISING IN EUROPE

On the global level, what we are seeing right now is a rise in some European
countries. We see a third wave, driven mainly by BA.4 and BA.5, and the
relaxation of mandates, increased mobility, and low mask wearing. We see the
third wave with an increasing number of reported cases, and we see it in France,
in Germany, beginning of it in the UK, in Greece, in Israel.

That's a big concern for us because what has happened before in Europe has
happened here in the United States, and we could see here in the United States a
third wave, especially from BA.4 and BA.5, which are increasing as a percentage
of the variants that are circulating.

We know right now from several studies that previous infections from other
variants do not provide as much immunity against Omicron and BA.4 and BA.5.
Also, the vaccines are less effective in terms of preventing infection. They're
still effective against severe illness and mortality for BA.4 and BA.5.

So putting these two together, we are very much concerned that we could see
potentially in the United States another wave after the second wave due to BA.4,
BA.5, relaxation of the mandates, increased mobility, and low mask wearing.

We will update our numbers in July, most likely the second week due to the
holiday, and we will take into account all this new information about the spread
of BA.4 and BA.5 in Europe, and the new studies that are showing less effect of
the vaccine against BA.4 and BA.5.


FUTURE UNCLEAR IN CHINA

China remains a big mystery for us – we don't know what's going to happen in
China. They're successful so far in containing the virus, but this could change
as soon as they change their policy and open up the country because they have
had fewer infections because of their success before, their vaccine is not as
effective, and much of their elderly population is not vaccinated. So we could
see a rise of cases in China as well.

--------------------------------------------------------------------------------


JUNE 10, 2022




KEY TAKEAWAYS:

 * Global infections are increasing: Secondary Omicron waves are hitting parts
   of sub-Saharan Africa, Latin America, Portugal, and the United States. We
   expect a peak in June, but another surge in the northern hemisphere in
   September, leading to an additional 120,000 deaths by October.
 * Outlook still uncertain for China: Strict lockdown measures continue to be
   successful but come at an economic cost.
 * Policy insights and recommendations:
   * Mask mandates in parts of the US are unlikely to have a large effect.
   * We must maintain global surveillance to prepare for the possibility of new
     variants.
   * Ensure access to antivirals for vulnerable individuals.

This transcript has been lightly edited for clarity


GLOBAL INFECTIONS ARE INCREASING

In this week's release from IHME of our COVID forecasts, there are some key
observations of what's happening around the world and what we see coming in the
models. Globally, we're starting to see the estimated number of infections go up
again, and that's driven by secondary Omicron waves in a number of places in
sub-Saharan Africa, in a wide array of locations in Latin America, from Quintana
Roo, other states in Mexico, through to a number of states in Brazil and all the
way in between. 

There are also some small increases in states in India, and perhaps most
concerning is a quite substantial secondary wave of Omicron in Portugal, related
to the BA.5 variant with an associated meaningful increase in the death rate,
which we have not generally seen with these secondary Omicron waves in Europe
and the northeast of the US. The last place where there is some secondary
increase from Omicron is some of the Southern states in the US and some of the
states in the Midwest. 


OMICRON PEAK IS EXPECTED IN JUNE

Despite these increases, we remain reasonably sure in the modeling that they
will peak sometime in June, given what we've seen in Europe with the secondary
waves, and what we've seen in the northeast of the US, as well as what we saw
with the BA.4-5 wave in South Africa. So we expect these to be short-lived, and
to not really alter the global trajectory over the next few months. 


AN OUTBREAK IN CHINA COULD HAVE A MAJOR GLOBAL IMPACT

The big question mark remains, at the global level, what happens in China. We
are assuming that strict lockdown measures will continue through to October, and
that they will be, as they have been to date, successful. The reporting of 11
cases today in Shanghai will raise the real questions about the economic toll in
China from the strict lockdown policies, but so far there's no indication of a
change from the leadership in China.


120,000 DEATHS EXPECTED GLOBALLY BY OCTOBER 1

Putting all that together in our forecasts, we do not see large numbers of
deaths. Although when you add it up around the world, still about 120,000 deaths
are to be expected between now and October 1. 

The other insight that comes from the modeling is that we expect to see numbers
starting to go back up again in the Northern Hemisphere in early September or
late September, likely leading into increases – modest increases – in the fall. 


MASK MANDATES IN THE US UNLIKELY TO HAVE A BIG IMPACT

There is some concern in parts of the US seeing secondary Omicron waves, such as
in California, where some mandates have been put back in place, namely mask
mandates, for example in Alameda county. As far as we can tell from both the
modeling, as well as from the experience elsewhere of the secondary waves, we
don't necessarily think that will have a big effect, nor is it necessary given
the low infection-fatality rate and given the availability of antivirals,
particularly, which should mean that we won't see a substantial increase in
death.

Some of the debate about this is getting still obscured, this many months into
Omicron, because we are not getting good data that differentiates incidental
hospitalizations – people coming to hospital with COVID-19, but that's not the
reason for their hospitalization – from hospitalizations and deaths where COVID
is the true cause. And without that it's very easy for a highly contagious and
reasonably prevalent infection like Omicron to appear like the numbers are
increasing substantially. 


CONTINUING SURVEILLANCE FOR NEW VARIANTS AND ACCESS TO ANTIVIRALS WILL BE KEY

Clearly all of this optimistic view over the next few months at the global level
is predicated on the idea that there will not be a new variant that has immune
escape and is more severe than Omicron. But of course, that is a distinct
possibility and it highlights why maintaining global surveillance – so that if
such a variant emerges, the world knows about it as soon as possible – is really
crucial, as is preparing for access for the vulnerable for antivirals, because
that's likely in the future to be the strategy that will make the biggest
difference if a new variant comes along.

--------------------------------------------------------------------------------


JUNE 3, 2022




KEY TAKEAWAYS:

 * Global death toll declining: We are now seeing a daily death rate last seen
   in March 2020.
 * China: Zero-COVID strategy continues to prevent major death surges, despite
   economic consequences.
 * Europe & South Africa: BA.2 and BA.4-5 surges have peaked and are now
   declining. 
 * United States: Cases are declining at the national level, despite some
   continued surges at the state level.
 * Policy recommendation: Monitor for new variants and be prepared to respond if
   a new, more dangerous one should emerge.

This transcript has been lightly edited for clarity


DAILY DEATH TOLL DECLINING GLOBALLY

This week at IHME in our update on COVID, we do not have a new model release.
That will be coming next week, but we continue to monitor the pandemic. We are
really reaching, at the global level, an extraordinarily low level of the impact
of COVID. In fact, the death toll at the daily level has now reached the level
we last saw around March 20, 2020. We continue to see this very favorable trend
down. 


LOW OR DECLINING CASES IN CHINA, SOUTH AFRICA, EUROPE, AND THE US

At the location level, the strict lockdown policy, zero-COVID strategy in China
continues to work, although it has great economic effects. The reported cases,
as far as we can tell in China, are now down to a very low level. We do expect
in our modeling, and continue to expect, that it will be hard to sustain that,
given the considerable number of susceptible individuals that are still in
China.

Elsewhere, where there were surges related to either BA.4 or BA.5 in South
Africa, that's peaked and continues to decline. The BA.2 surges in Europe seem
to have all peaked and are pretty much declining. 

Here in the US, as we expected, at the national level it appears that case
reporting has peaked and is starting to come down, but of course that varies by
location. The decline is more in the northeast. Other states are still on the
upswing, but nationally we should start to see the numbers come down.

We do continue to expect, in the absence of the emergence of a variant with
considerable immune escape on Omicron, that we will see quite low numbers
through the next few months. 


WE MUST CONTINUE MONITORING FOR NEW VARIANTS

Of course, we've learned through the pandemic that the emergence of a new
variant can completely change the story in a very quick manner. But for now, it
does appear like those countries that are largely returning to pre-COVID levels
of interaction and very low levels of mask use will continue to see low or even
declining transmission, and certainly low or declining impacts in terms of
death, given the slow but steady scale-up of the use of antivirals. So, there
are very favorable conditions for the moment.

We do believe it's important to keep up surveillance and to be ready on a
country-by-country basis to respond with booster shots, with access to
antivirals, and if a dangerous, high-severity new variant with immune escape
emerged, to be able to reconsider other actions as well.

--------------------------------------------------------------------------------


MAY 27, 2022




KEY TAKEAWAYS:

 * South Africa & China: Cases appear to have peaked and are now declining.
 * United States: The increase in cases is slowing and expected to peak by early
   June.
 * Current recommendations: 
   
   * Offer boosters to those who want them.
   * Provide antivirals to at-risk individuals who get infected.
   * Continue surveillance for potential new variants.

This transcript has been lightly edited for clarity


EVIDENCE OF BA.4-5 CROSS-VARIANT IMMUNITY IN SOUTH AFRICA

This week from IHME, we do not have a new release of our models, but we are
continuing to track the evolution of the current pandemic. Of major areas of
interest, in South Africa, the BA.4-5 related increase in cases has peaked and
is coming down, which fits with the expectation that while there was some
reduction in cross-variant immunity from BA.4-5 compared to previous waves of
Omicron, it was not very large.


OMICRON UNDER CONTROL IN CHINA

Likewise, we're seeing that the measures put in place in China for strict
lockdown, at least according to official data, continue to be successful, with
case numbers coming down. Of course, the question will be whether or not there
are going to be – as we expect, given the large volume of susceptible
individuals – further Omicron outbreaks, and the need for other efforts at
strict lockdown in China, still pursuing a zero-COVID strategy.


CASES EXPECTED TO PEAK IN THE US WITHIN A FEW WEEKS

In the United States, the increase in cases, probably driven by behavioral
relaxation, seems to be slowing. There is a spatial heterogeneity aspect to
this, but for example, in our own hospital system at the University of
Washington, our number of hospital admissions has peaked and is starting to come
down, as an example of a place with one of these surges. 

So, as we've been expecting for many weeks, we do not think these current
increases in the US will lead to large-scale increases in death, certainly, or
hospitalization. We should see a peak about the end of May or early June at the
national level.


CURRENT RECOMMENDATIONS

Pending the emergence of new variants that are more severe than Omicron, the
current strategies of continuing to offer boosters to those who would like to
get a booster, making sure that antivirals are available for those who are at
risk who do get infected with Omicron, and continuing surveillance, are the most
important aspects of monitoring the ongoing COVID-19 pandemic. 

--------------------------------------------------------------------------------


MAY 20, 2022




KEY TAKEAWAYS:

 * Regional updates:
   * China continues zero-COVID strategy and reports no increase in cases.
   * South Africa may be reaching a peak of the BA.4/BA.5 winter surge.
   * The United States is experiencing an increase in Omicron cases – likely due
     to behavioral changes, and possibly due to re-infection with BA.2 – but not
     an increase in deaths.
 * Mandates: We do not expect mandates to be widely re-implemented, outside of
   zero-COVID policies in China.
 * Cross-variant immunity: New research suggests limited immunity against other
   variants after Omicron infection. However, immunity from vaccination and
   previous infection does provide strong protection from severe illness and
   death.

This transcript has been lightly edited for clarity


CHINA REPORTS NO INCREASE IN CASES

We do not have updated models this week, but we continue to monitor the
unfolding of the pandemic around the world. Areas of ongoing interest are the
approach to zero-COVID in China, which continues. Officially reported cases are
actually not increasing, and they're maybe coming down, but stringent mandates
are in place in many locations. From experience in other countries, we do expect
at some point that Omicron will spread widely in China, but it is very much a
question of when – and when the government decides to stop pursuing this
zero-COVID strategy.


CASES INCREASING IN SOUTH AFRICA AND UNITED STATES

Elsewhere in the world, we're seeing increases. The BA.4- and BA.5-related and
winter-related increase in South Africa continues. It is certainly not as
exponential as the original Omicron wave, but it does continue to increase. With
some indication, it may be reaching a peak. 

In the United States, Omicron continues to increase in a number of states. That
increase, again, seems to be like what we've observed in many countries in
Europe, related to behavioral relaxation and possibly BA.2 re-infection of
people who have had a prior Omicron infection – although it's perhaps easiest to
account for through behavioral change. 


MANDATES NOT EXPECTED TO BE REIMPLEMENTED 

In neither case, neither what we saw in Europe nor what we're so far seeing in
the United States, are we seeing an increase in death, which is very good news.
That's likely because there is either vaccine-derived or infection-acquired
immunity, so that people aren't fully immunologically naive, and perhaps because
of the increased use of antivirals when individuals do become sick, which should
have a marked effect on the death rate. We don't, at this point, think that
there's reason for large-scale concern and also do not expect, with few
exceptions, that there will be implementation of mandates in these
jurisdictions, outside the zero-COVID strategy in China.


NEW STUDIES SHOW LIMITED IMMUNITY FROM OMICRON INFECTION

One of the critical factors that do go into the long-range modeling, and even
the short-range, is the extent to which Omicron infection provides protection
against subsequent new variants, or even sub-variants of Omicron. There was a
paper in Nature this week, which is a lab-based paper, based on the immune
responses from serum from different types of patients, which suggests that there
may be a limited cross-variant protection from Omicron infection. 

Read more in Nature »Limited cross-variant immunity from SARS-CoV-2 Omicron
without vaccination

We'll really want to wait and see when studies are able to start reporting, from
actual infection in individuals, what sort of cross-variant immunity there is.
Both from vaccine-derived immunity and infection-acquired immunity, the
available studies suggest much lower protection against Omicron infection,
pretty good protection against severe disease and death, but greatly reduced for
infection. We'll have to wait and see whether that difference holds true for
Omicron on Omicron by sub-variant, or even future variants, namely less
protection against infection, but hopefully more protection against severe
disease and death.

That issue will have a profound effect on what the fall and winter may look
like, as we do expect waning immunity, both from vaccines and infection-acquired
immunity, plus indoor exposure and opportunities for transmission, that there
should be increased transmission potential in November, December, and January,
and the extent to which there is long-range protection from severe disease and
death will have a marked effect on outcomes.  

--------------------------------------------------------------------------------


MAY 16, 2022 - US REACHES 1 MILLION COVID DEATHS



As the United States reaches this somber milestone, IHME director Dr.
Christopher Murray reflects on the impact of COVID-19 around the world and how
we can better prepare for future health threats. 

This transcript has been lightly edited for clarity

The US has officially surpassed the awful milestone of a million reported deaths
from COVID. This is a number that I think very few of us thought would ever come
to pass when the pandemic started to break in February of 2020. In fact, back
then we thought a concerted response would mean that the number would be a tenth
of that, or even less. 

Now, the true number of deaths from COVID is even larger. We think, based on
looking at excess deaths, it's probably closer to 1.3 million deaths that have
already occurred in the US, but by either metric, it's a staggering number. 

COVID has had a terrible toll, not just here in the US but around the world,
with 6 million reported deaths and more than 18 million excess deaths; those
deaths are distributed throughout the regions of the world and not just in North
America or in Europe. 

We've entered a new phase of the pandemic, a phase where Omicron is much milder
and a large fraction of the world's population has been infected with Omicron.
The Omicron story has still to play out in China and North Korea, but in general
we're entering this phase where people are going back to pre-COVID levels of
interaction. Mask use is declining dramatically, and I think that's going to be
the new normal. 

We will see continued Omicron transmission, and Omicron will come back in the
winter if we don't see a new variant. But it's likely we will see a new variant,
and so while we might think that the era of mandates and profound changes in
behavior might be behind us, we certainly haven't seen the end of COVID-19. 

We should be thinking about how we manage COVID-19 new variants as they emerge
and the critical role of continued use of boosters, vaccinating those who are
still willing to be vaccinated but haven't been, and the new tools that we have
like Paxlovid and potential other antivirals as they come along. All those
combined mean, even if we have a new variant, we don't expect it to be as bad as
it has been, which is good news. But it should give us pause to recognize the
threat that we live with in the future, for either some remarkable new variant
that will break through our current tools entirely, or new pathogens and new
pandemics in the future. 

Hopefully, this extraordinary experience in the US will motivate the US
government and other governments to invest in greater capabilities to respond to
new threats; detect them earlier; have a more rational, thoughtful, but rapid
response to those threats as they emerge; and then to figure out who are most
vulnerable, whether it's the groups that are essential workers, or those that
have some sort of comorbidity, or those that are elderly. Whatever it may be for
a new threat, it's critical that we learn about protecting the most vulnerable
for future rounds of threats as they emerge. 

At this terrible milestone, it is an opportunity for us to reflect both on what
went wrong and how we can solve and prepare ourselves better for future rounds
of COVID and future threats.

--------------------------------------------------------------------------------


MAY 12, 2022




KEY TAKEAWAYS:

 * East Asia: As rapid transmission of Omicron unfolds in Taiwan, it seems
   inevitable that an outbreak will also occur in China. However, it is
   impossible to predict when that may occur as it depends on how long the
   government chooses to continue pursuing a zero-COVID strategy.
 * United States: Cases are increasing, particularly in the Northeast and on the
   West Coast, due to returning pre-COVID behavior patterns. 
   * Short-term: We predict a small peak in May to early June, but no major
     surge until the winter.
   * Long-term: We predict as many as 30% of the US population will get infected
     through the winter with Omicron due to declining immunity. However, we
     expect the consequences to be much, much lower because of antivirals.
 * Global: Data from South Africa do not indicate that BA.4 and BA.5 will lead
   to a major global surge. Our recommended strategy for dealing with COVID on a
   global scale is securing access to antivirals for all.

This transcript has been lightly edited for clarity


OMICRON AND THE ZERO-COVID STRATEGY IN EAST ASIA

Last week in IHME’s updated forecasts, we certainly were trying to take into
account what’s unfolding in East Asia with continued rapid expansion of the
Omicron epidemic in Taiwan, and that continues to expand. There’s this very
challenging question of how Omicron will play out in China. The government is
pursuing their zero-COVID strategy with lockdowns as needed.

We have been expecting Omicron, since February, in our modeling to eventually
break through these efforts because it has appeared that control efforts on
Omicron have been generally less successful around the world than for previous
variants. So far, these strict lockdown policies have kept Omicron numbers at a
relatively low level.

It's extremely hard to understand how the policy environment will play out in
China. If they pursue strict lockdowns, it's possible they will keep Omicron
transmission at a relatively modest level through to the fall. We do believe
that it is inevitable there will be a large Omicron outbreak at some point in
China, because maintaining a strict zero-COVID strategy is probably
unsustainable as the year progresses, but it's impossible to know when that
change in policy will occur.


INCREASING CASES IN THE UNITED STATES AND PREDICTIONS FOR THE WINTER

In the US, we're seeing increases in a number of parts of the country,
particularly the Northeast, and some of the West Coast, in cases and hospital
admissions. This is a pattern that follows what we’ve seen in Europe as people's
behavior goes back to pre-COVID levels, and there is a little bit of transition
to BA.2 and perhaps BA.4 and BA.5 as they continue to spread.

We do expect a modest increase in numbers. Our expectation is they will peak
sometime in May or early June and then go back down. We don't expect a major
surge from that. There have been reports from the White House of their efforts
to model in the long term a large surge in infections.

In our long-range models, which we do not release publicly, we do expect in the
winter a return Omicron surge. Of course if there's a new highly infectious
variant that's more severe, that would trump this pattern we expect. We expect a
surge in the winter because of declining immunity from exposure to Omicron, as
well as declining immunity from vaccination and perhaps not as high a rate of
repeat boosters as we've seen for the third dose, going into the future. The
consequences of a winter surge in the US should be much smaller because of
Paxlovid and increasing availability of antivirals and use of antivirals.

We certainly expect quite large numbers in the winter, not so much in the fall –
perhaps as many as 30% of the US population getting infected through the winter
with Omicron. But we expect the consequences to be much, much lower because of
antivirals.

We don’t expect much in the way of government mandates, given the much lower ICU
admission rate and death rate that should occur with these new strategies,
particularly antivirals.


GLOBAL STRATEGY SHOULD BE ENSURING ACCESS TO ANTIVIRALS FOR ALL

At the global level, there's been ongoing debate and concern about BA.4 and BA.5
in South Africa. There’s not an exponential surge there; there's a very slow
increase in numbers. We so far are not seeing any indication that BA.4 and BA.5
could be the driver of a major global surge in cases, but of course this
warrants monitoring on a regular basis.

Overall, in terms of general strategy globally, we've seemingly maxed out
globally on the number of people who are unvaccinated that want to be vaccinated
– as far as we can tell from the data, only about 3% of the world wants a
vaccination that hasn’t received one. A lot of that is concentrated in
sub-Saharan Africa, but still it's not a large percentage of the population.

Perhaps the main strategy to deal with future variants is making sure that
anyone who needs antivirals will get access to antivirals. There's a lot in
that, both in terms of production of Paxlovid and health system infrastructure,
and response patterns so that when somebody needs it, they can get it whether
they're in a low-resource or high-resource setting. Those are our main
observations on the epidemic as it continues to unfold.

--------------------------------------------------------------------------------


MAY 9, 2022




KEY TAKEAWAYS:

 * Global: Mortality from COVID-19 is the lowest since April 2020.
   * 3.1% of the population who wants a vaccine has still not received one, most
     in Africa.
   * We must ensure equity in distribution of antiviral medication.
   * Eid El-Fitr celebrations in Islamic countries could lead to a small
     increase in cases.
 * United States: Reported cases and hospitalizations are increasing. We predict
   an additional 29,000 deaths by September.
   * Home testing and delayed reporting of infections has made it more difficult
     to track COVID-19.
   * We recommend: continuing surveillance for new variants, securing antiviral
     medication, preparing to return to mask use and physical distancing if
     another variant arises.
 * China: The large percentage of elderly and unvaccinated people makes the
   population very susceptible to high mortality rates and overwhelmed hospitals
   if the zero-COVID policy fails.
   * The current rise in Taiwan and previous surge in Hong Kong are warning
     signs of what could happen.

This transcript has been lightly edited for clarity


PROJECTIONS AND RECOMMENDATIONS FOR THE UNITED STATES

We have increased our projections to September 1. Right now in the United States
we are projecting 1.02 million deaths by September 1. That's an additional
29,000 deaths from May 2, when we ran our programs. 

For the United States, the recommendations remain the same: 

 1. We need to continue our surveillance and make sure we are doing enough
    sequencing to know what variants are circulating in the United States, and
    if BA.4 and BA.5 are being introduced in the US and how fast they are
    spreading. 
 2. At the same time, we need to ensure that we have enough antiviral
    medications in order to distribute them. We know from their clinical trials
    that they reduce hospitalization and mortality, and they will reduce the
    pressures on our hospitals.
 3. Third, which is very important, if we are seeing a rise due to another
    variant in the United States, we should go back to wearing masks and
    physical distancing.

In the United States we are seeing an increase in reported cases and
hospitalizations. In some states, we are seeing the rate of increase in
admissions to hospital is much higher than the rate of increase of reported
cases. We believe that's due to the fact that many people are testing themselves
at home and not reporting to their counties and not using the local labs, so we
are not capturing these cases.


BA.4 AND BA.5 UNDER STUDY IN SOUTH AFRICA

We are monitoring closely what's happening in South Africa, the infections with
BA.4 and BA.5. We don't know yet if they are immune escape and they are
infecting people that have been previously infected by BA.2. It's too early to
tell, and the fact that many people in South Africa have been infected by
Omicron 4-5 months ago, it's possible that the waning immunity is resulting in
the infection from BA.4 and BA.5. 


CHINESE POPULATION REMAINS SUSCEPTIBLE, RELYING ON ZERO-COVID POLICY

At the global level, mortality from COVID-19 is the lowest since April 2020. The
global trends are mainly dominated by what's happening in China. Right now we
are seeing a rise in cases in Taiwan. China is continuing with its zero-COVID
policy and we feel that they will be able to control COVID-19 for a while.
However, the economic pressure may not allow them to continue with such a
policy. 

If what we are seeing happen right now in Taiwan, or what happened previously in
Hong Kong, will happen in China, we project a lot of mortality, unfortunately,
and the surge will overwhelm the hospitals. Many older Chinese people are not
vaccinated at the same level as other countries, and also the vaccines used in
China are less effective than the vaccines used elsewhere, mRNA vaccines. So we
would expect a major surge and a rise in mortality in China.


VACCINE AND ANTIVIRAL EQUITY: WE ARE NOT SAFE UNTIL ALL OF US ARE SAFE

Based on vaccination rates and our monitoring of people who are willing to take
the vaccine, we estimate right now that about 3.1% of people globally who want
to get the vaccine and are willing to get the vaccine, have not received it. The
majority of them are in Africa. We need to make sure that people who want to get
the vaccine are receiving them, who failed distribution, which countries should
support poor countries to get the vaccine and vaccinate their population. Again,
we're not safe until all of us are safe. 

The most important thing moving forward right now globally is to ensure that the
global distribution, like with vaccination, that global distribution for
antivirals is going forward and countries can secure what they need from
antiviral in order to provide it to people who are infected, to reduce
hospitalization and mortality.


PROJECTIONS IN ISLAMIC COUNTRIES FOLLOWING EID EL-FITR

We are not projecting a rise in cases in the Middle East and the Eastern
Mediterranean region, WHO region, but we are concerned in many Islamic countries
after Eid El-Fitr celebrations with all the mobility, and people are visiting
each other and celebrating the holidays. It's possible in some of these
countries the decline will slow down and it's possible in some countries that
we'll see a small surge in the coming weeks due to the holidays and the
celebration.


CHALLENGES WITH DATA COLLECTION

At IHME, with our projections, our major challenge in the coming months is the
delay in reporting. Many countries and many states have moved to weekly
reporting and it's very hard for us to monitor the situation. The fact in the
United States that many people are testing themselves at home and not reporting
their infections to the local health departments is making it hard for us to
follow the epi-curve. 

We are using admissions to hospitals, COVID-19 admissions, as our main indicator
and some places like the United States, where we believe many people are testing
themselves at home and not reporting those results to their local health
department, we have lowered the infection-detection rate in order to make sure
we'll be able to monitor these trends.

--------------------------------------------------------------------------------


APRIL 29, 2022




KEY TAKEAWAYS:

 * Omicron will continue to spread in China. After already reaching Beijing,
   Omicron will likely continue transmission despite the government’s indication
   that they will keep pursuing the zero-COVID strategy.
 * Cases are increasing in Delhi, India, and South Africa. The question remains:
   are the increases due to new, more transmissible sub-variants, or waning
   immunity from the previous Omicron wave?
 * A concerted policy push is needed to increase access to antivirals. IP
   waivers have been given to 22 countries by Pfizer, and now a rapid scale-up
   in production must follow.

This transcript has been lightly edited for clarity

Omicron spreading in China

This week from IHME we are not releasing a new set of projections yet. With few
exceptions, the epidemic is still continuing to track our forecasts from earlier
in the month. The key areas to pay attention to right now are, first and
foremost, what's happening in China with the Omicron wave spreading, most
importantly to Beijing. Many other cities within China apparently are also under
lockdowns or partial lockdowns.

As we have been noting for months pre-Olympics, it's really a question of time
when Omicron will spread more widely in China, given how transmissible it is,
given the comparatively lower efficacy of the vaccines used in China, and
particularly this issue that the zero-COVID strategy may not actually work. But
our understanding is that the government will pursue that strategy vigorously,
at least until the fall. So, no real change in expectations there, but it simply
will be a challenging question as to whether that strategy can hold out until
the fall.


INCREASING CASES IN INDIA

The second area of concern that people have been tracking has been the steady
uptick in cases in Delhi, India. The question is whether this is due to
declining immunity from the prior Omicron wave or the possibility of one of the
sub-variants of Omicron fueling transmission in Delhi. They have re-imposed
their mask mandate, so we’ll see if that has some effect on that one part of
India and the surrounding state of Haryana having some increased transmission.


BA.4 AND BA.5 VARIANTS IN SOUTH AFRICA

The third area of concern is the uptick in South Africa associated with the BA.4
and BA.5 sub-variants, a steady increase but not exponential. The question
remains – is that because these sub-variants are more transmissible, or is it
because they have immune escape over BA.1 and BA.2, which were there in South
Africa and had become the predominant variants, or is it because of waning
immunity, just through time. We are now, for South Africa, pretty much four
months, or even four and a half in some provinces, after the peak of the Omicron
wave.


ACCESS TO ANTIVIRALS

The other main consideration globally around managing COVID, particularly in
China and for the world, when new variants that are potentially more severe
emerge, is access to Paxlovid. We’ve started to finally see some policy
discussion around the importance of availability and access to Paxlovid. IP
waivers have been given to 22 countries by Pfizer, and the question is, will
there be more rapid scale-up in production? We strongly believe that needs a
concerted policy push, equivalent to the efforts to expand vaccination. We will
certainly expect more from IHME as we run our models in the near future to
reflect any new updates in the data as we’ve been describing.

Do you have a question about IHME's COVID-19 modeling? We’d love to know what
you’re wondering about. 

Ask a question
 

Due to the sheer volume of questions we receive and our research team’s
dedicated efforts in modeling the impact of Omicron around the world, we will
only be able to address a limited number of questions. For media inquiries,
please contact media@healthdata.org.

--------------------------------------------------------------------------------


APRIL 25, 2022




KEY TAKEAWAYS:

 * New modeling suggests antivirals will be key to save lives during future
   surges. We are investigating the potential impact if a future variant were to
   be as severe as Delta with the transmission level of Omicron, and have found
   that antivirals make a profound difference.
 * Cases are rising in the eastern United States, but deaths are not. Access to
   antivirals plays a key role in the low death rate.
 * Still unknown if lockdowns will prevent an Omicron surge in China. Low
   vaccination among the 80+ population could result in a huge death toll if an
   outbreak occurs.

This transcript has been lightly edited for clarity


LOCKDOWNS AND OMICRON IN CHINA

This week from IHME, we have not rerun our models. We have been spending time
trying to understand the epidemic province by province in China. The key thing
there as the outbreak continues to unfold in Shanghai with very broad-based
transmission, is now reports of lockdown are confirmed by mobility data in many
other cities within China. It remains to be seen whether the zero-COVID strategy
will work to keep COVID, or the Omicron variant, from spreading very widely in
China.

What we do know is that vaccine coverage in the 80+ population in many provinces
is quite low. If Omicron spreads widely, there is a real risk that what we saw
in Hong Kong could re-occur in mainland China. That's something that we are
watching very closely. Currently, our models are assuming that the success that
China's had with the zero-COVID strategy controlling Omicron in February, around
the time of the Olympics, could be replicated, but we're also hearing reports
that the economic costs of this are rising.


CASES ON THE RISE IN EASTERN UNITED STATES

For the United States, we're seeing rising case numbers in a number of eastern
states. There's some suggestion of rising case numbers in other states as well.
There has not been a precipitous rise in case numbers yet – this increase looks
to be related to continued relaxation of behavior, combined with the BA.2
sub-variant. The good news there is we're not seeing an increase in deaths. But
it does point out how critical in the US – and pretty much everywhere – access
to antivirals is going to be. 


NEW MODELING SUGGESTS ANTIVIRALS WILL BE KEY TO SAVE LIVES DURING FUTURE SURGES

While there continues to be a lot of discussion about access to vaccines in low-
and middle-income countries and even discussion around boosters, there's perhaps
not enough focus on making sure that people who need these highly effective
antivirals like Paxlovid [can get them] in the future. This is somewhat
important right now for the BA.2 sub-variant, but could be extremely important
in the future as we imagine that there will be more infectious and potentially
more severe variants that emerge during the course of this year. 

We have started to do some modeling of what would happen if a variant that was
as severe as Delta came along with the transmission potential of Omicron, and in
that setting, widespread access to an antiviral like Paxlovid really makes a
profound difference in saving lives around the world. So a very high priority,
both in the US and everywhere in the world, for thinking about health system
delivery strategies and access to the drug itself, is that those who can benefit
from an antiviral are going to get that antiviral.

Expect more from us in the coming weeks as we continue to track the pandemic and
try to model out how future scenarios unfold, both with what we know is
currently occurring, but also potentially the emergence of new variants. 


EMERGENCE OF NEW SUB-VARIANTS

The last comment is on the emergence of the BA.4 and BA.5 sub-variants in South
Africa. They are replacing BA.2 and there is some increase in case numbers, but
still modest so far, as distinct from what happened with BA.2. We're now four
months or more into the peak of Omicron transmission, so some of that increase
in BA.4 and BA.5 could be from waning immunity from what was established through
the early Omicron wave in November and December in South Africa. But it’s
clearly another facet of the epidemic that will bear close monitoring.

--------------------------------------------------------------------------------


APRIL 14, 2022 - UPDATE FROM DR. ALI MOKDAD




KEY TAKEAWAYS:

 * BA.2 surge is ending in Europe. Cases are expected to continue declining in
   the Northern Hemisphere until next winter.
 * Omicron in China: With only 2% of the population previously infected and 30%
   immune from vaccination, a large surge is expected if lockdown and strict
   control measures fail.
 * BA.2 in the US: Some states are seeing a small rise in cases, but high levels
   of immunity due to previous infection (76%) are preventing a large surge.
 * Mask wearing is below 25% – the lowest since we began tracking.
 * Sharing antivirals and vaccines with countries in need is imperative.
 * Policy recommendations:
   
   * Secure and distribute antiviral medications.
   * Maintain surveillance systems to detect new variants.
   * For those who are immunocompromised or have high risk factors: continue
     wearing a mask and avoiding large crowds, especially indoors.

This transcript has been lightly edited for clarity


CASES ARE DECLINING IN EUROPE

Globally, we are seeing a decline in reported cases in the majority of
countries, and the short surge that has happened after the Omicron surge in some
European countries is declining. So we see a decline in reported cases right now
in the UK, in Germany, in France. In the long run, we believe that the number of
cases will keep declining all the way to next winter in the Northern
Hemisphere. 


SURGE PREDICTED IN CHINA IF PRECAUTIONS FAIL: ONLY 30% OF POPULATION CURRENTLY
IMMUNE

The situation we are monitoring closely right now is what’s happening in China.
We believe the strict measures and the lockdown in China have been successful so
far in containing the spread of the virus, but with Omicron being extremely
contagious and spreading much faster than any previous variant we have
encountered, we don’t believe that China could contain the spread of Omicron for
a long time. So we’re expecting a rise of infections, reported cases,
hospitalizations, and deaths in China if these measures that are in place right
now are not successful in containing the spread of the virus.

The reason we believe that for China – if you look at measures that China put in
place, they were so effective at preventing infection. Right now in China, about
2% of the public has been infected by COVID-19 since the beginning of COVID-19,
compared to 76% of us here in the United States. So we have more immunity than
people in China, we have better vaccines with mRNA, and we have a higher
vaccination rate, especially among the elderly population. Not for the general
population, but for the elderly population in the United States we have a higher
vaccination coverage.

So when you put all of these together, in the United States we have about 73% of
the public that is immune to Omicron, compared to 32% in China. So any outbreak
in China, simply because there are about 70% of the public in China that are
susceptible to Omicron, we expect a rapid surge of cases, similar to what we are
seeing in Hong Kong and in other countries as well.


MOBILITY IS INCREASING, WHILE MASK WEARING AND TESTING DECLINE

More countries are relaxing their mandates right now – for example, New Zealand
and Australia opened their borders to each other and travel is allowed right
now. This could have an impact on reported cases as people are traveling and
feel they are free to travel right now. 

Mask wearing is the lowest since we started reporting on mask wearing and since
IHME started promoting mask wearing and providing scenarios showing how
effective masks are in preventing mortality. So we're at less than 25% right now
when it comes to mask wearing – it varies by countries, but mask wearing has
dropped a lot because many countries relaxed their mask mandates, especially in
Europe.

Testing is declining in many countries: for example, in the UK, they're not
paying anymore for testing, so we're seeing a decline in testing. That will
impact our ability to track the pandemic in many countries and many locations.
Some countries and states have decided to release data on a weekly basis, not on
a daily basis, so the quality of data, the timeliness of data has changed, and
that will impact our ability to track – not only us, but other groups who are
doing similar projections – our ability to track the pandemic moving forward.


SHARING ANTIVIRALS AND VACCINES WITH COUNTRIES IN NEED IS IMPERATIVE

Globally, there is a need to secure more antiviral medication and make sure it
is available to every country to save lives and to prevent overwhelming the
hospitals and protect the medical system. In countries where we see a surge of
cases, recommending people to wear a mask and observe physical distance will be
important. And in many countries in the world, it's very important to encourage
the public to receive the vaccines, especially those who are not yet vaccinated
and those who are immunocompromised and have health conditions.

Our data right now show that a small percentage of people globally who want to
get a vaccine or are willing to take the vaccine have not been able to receive
the vaccine. The majority are in Africa. Therefore, it's very important to share
vaccines with countries where people are willing to take the vaccine and they're
waiting to get their vaccine. This is the only way for all of us to save lives
and stop the spread of the virus, and of course we're not safe until all of us
are safe. 


IN THE UNITED STATES, THE BA.2 VARIANT IS CAUSING SMALL RISE IN CASES, BUT NO
SURGE EXPECTED

In the US, we are seeing a slight rise in reported cases in some states, but we
don't expect a surge similar to what we have seen in some European countries
here in the US, simply because in the United States we have more immunity due to
higher rates of previous infections in the country. BA.2 right now is the main
circulating variant here in the United States – about 86% of the variants that
are circulating in the US are BA.2. But because of previous infections in the US
and our immunity, we don't expect a surge similar to what we have seen in
Europe. 

The extension of the mask mandate on public transportation at the federal level
and on airplanes will help a lot, especially right now with spring break
vacations and people traveling. Many families are traveling for the first time
with their children right now since the start of the pandemic, so one would
expect, with the increased mobility and the fact that mask wearing is less than
25% in the US, that we'll see a slight increase in reported cases in the United
States.

We still believe that the pandemic phase of COVID-19 is over, simply because we
have higher infections here in the United States and hence higher immunity. We
are improving our vaccine and we soon should be able to have vaccines that are
designed for the new variants; the vaccines that we have right now are highly
effective, but we need to remember they were designed for the [ancestral]
variant. And of course we have antiviral medications that will save lives and
prevent hospitalization. If there is a surge from an escape variant, we can
always go back to physical distancing and mask mandates and ask the public to
wear a high-quality mask and avoid large gatherings.


RECOMMENDATIONS FOR CONTROLLING THE VIRUS IN THE US

The recommendations in the United States to contain the virus and the epidemic
of this virus in the country remain the same: secure antiviral medications,
distribute them, make sure patients can access them in a short time to save
lives and prevent overwhelming our hospitals; maintain our surveillance system
and also our genetic sequencing to know what variants are circulating in the US
and, if there is a rise in cases, where it's happening and among whom,
especially if they are vaccinated or not, so we can tell as soon as possible if
the new variant is an escape variant and the vaccines are not as effective
against it. 

For the public who are immunocompromised or have high risk factors, they need to
remain more vigilant and wear a mask, especially if they are in close indoor
settings with a large crowd. And all of us, if there is a surge and a new
variant that is circulating, we also need to put our masks back on and make sure
we maintain a physical and safe distance in order to reduce the chance of
getting this virus. In the short term, the coming few months in the United
States, IHME is projecting a decline after this tiny little surge, a decline of
cases all the way until next winter, short of a new variant appearing. But we
are projecting a decline in the number of cases all the way until next winter.

--------------------------------------------------------------------------------


APRIL 8, 2022



Key takeaways:

 * New prediction for China: no major Omicron surge. Provinces continue
   zero-Covid strategy, adhering to strict lockdown measures whenever there is
   an outbreak. By incorporating lower mobility into our model, we no longer see
   a massive surge in the forecasts for the coming months.
 * BA.2 is declining in Europe and is not expected to cause a major surge in the
   US. Other countries around the world may also avoid a surge due to previous
   high levels of infection from Omicron.
 * Access to antivirals should be the primary focus of global efforts, shifting
   from previous emphasis on vaccination.

This transcript has been lightly edited for clarity

BA.2 is on the decline in Europe

In this week's update from IHME on the COVID-19 pandemic, first, the main
findings that we see in the data and in our forecasts are that the BA.2
secondary surge of Omicron that has affected a number of countries in Europe
appears to have peaked and is on the decline in almost all locations in Europe.
Not all – there is some question about whether the United Kingdom has peaked and
that the decline in cases may be due to access to testing since the tests now
have to be paid for. But generally, we are seeing the peak and probably the
decline of BA.2 in Europe.

We do not expect a major BA.2 surge in the US

In the United States, we have yet to see a BA.2 surge. There are some states
where we're seeing hospitalization admissions go up slightly but not seeing the
reported cases go up. So it may be that there's a small increase coming in some
states.

Our models for both Europe and the US do not suggest – at least for the US, we
don't expect a major BA.2 surge, and in Europe we expect the surges to peak and
decline.

New prediction for China: no major Omicron surge

The biggest factor in the analysis is the change in our results for China. We
had been predicting for quite some time that Omicron would break out into the
community and that China would choose to stop using a zero-Covid strategy, or
what they call dynamic lockdown. But, given the rather stringent measures put in
place in Shanghai, we don't expect, at least until the fall, that the Chinese
government is going to step back from its zero-Covid strategy. 

We've used in the forecasts the observed reduction in mobility based on Baidu
data for Shanghai and then assumed that whenever there is an outbreak in each
province in China that there will be stringent measures put in place. So we've
put substantial brakes on transmission that way through reduction in mobility in
our modeling framework.

This means that we don't predict a massive surge. We expect that will come later
in the year. But we do see quite a number of deaths, given the quite low
vaccination rates in the 80+ population in China that have become apparent. 

We must shift global focus from vaccination access to antivirals

The expected trajectory in China does point to a very important role in the
current Omicron wave, but more importantly for future new variants as they
emerge, in access to antivirals. We see a lot of global discourse about access
to vaccination, and that's certainly an important issue in terms of equity –
everybody who wants a vaccine should be able to obtain a vaccine. But in terms
of preventing death from future new variants, we think that the scale-up of
antivirals, particularly the highly effective Paxlovid – but if other antivirals
come along that are as effective, then those as well – is going to be the
critical issue between a new variant, let's say that's more severe than Omicron,
causing considerable mortality versus causing 80-90% less mortality.

We will be producing, in the near future, antiviral scale-up scenarios to go
alongside vaccination, booster, and mask use scenarios that we routinely produce
as part of our periodic assessment of the pandemic. Those are the main
findings. 

Likelihood of BA.2 surge depends on countries’ levels of previous infection

In other parts of the world, we're not seeing any evidence of a BA.2 secondary
surge, even in places like South Africa where most of the transmission is
currently BA.2. This difference across countries may well have to do with
population-level immunity, how much prior infection, how much the first Omicron
wave infected people. In places where there was a lot of transmission, there's
probably enough immunity that we won't see much of a BA.2-related hump. Those
are the main observations as we look around the world in our assessment of the
pandemic.

Do you have a question about IHME's COVID-19 modeling? We’d love to know what
you’re wondering about. 

Ask a question
 

Due to the sheer volume of questions we receive and our research team’s
dedicated efforts in modeling the impact of omicron around the world, we will
only be able to address a limited number of questions. For media inquiries,
please contact media@healthdata.org.


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--------------------------------------------------------------------------------


APRIL 4, 2022 - UPDATE FROM DR. ALI MOKDAD



Key Takeaways:

 * The European BA.2 wave is coming to an end. The wave was driven largely by
   the spread of BA.2, changing behavior following the removal of mandates, and
   waning immunity.
 * We do not expect a BA.2 wave in the US due to high rates of previous
   infections from Omicron. A surge next winter is still anticipated, and those
   over 50 years old should get a fourth vaccine dose to protect themselves.
 * China continues to keep Omicron at bay, but we predict the surge will come by
   the end of May. To reduce mortality rates, we recommend:
   
   * Scaling up production of mRNA vaccines
   * Prioritizing vaccination of the elderly
   * Preparing hospitals by increasing supply of antivirals

 * Policy recommendation: the US should begin planning for a winter surge
   including:
   
   * Securing antiviral medication
   * Planning distribution of antivirals based on risk factors and age
   * Anticipating the potential need for another vaccine dose
 * Vaccine donations are still needed, but only if they have a long shelf life.

This transcript has been lightly edited for clarity

Cases are predicted to decline in the US

The reported cases in our estimated infections are decreasing in the United
States, and we project this trend will continue all the way to next winter. Our
long-term projections for the United States show a rise in cases next winter but
a small bump in some states, similar to what we are seeing right now in Europe.
But in general in the US, we project a decline that will continue all the way
until next winter. What we need to do in the United States is to remain
vigilant, of course. COVID-19 is not over; the pandemic phase of it is over. We
need to be very careful, especially those who have a risk factor or are
immunocompromised. 

Fourth vaccine dose recommended for those aged 50+

The FDA has approved a fourth dose for people who are above 50. It’s very
important for all of us who are above 50, including myself, to go and get number
four. It will help a lot in reducing hospitalizations and mortality, especially
if you have received your second dose or your third dose more than five months
ago. 

Why is Europe seeing a second wave, and will the same happen in the US?

As far as what’s happening in Europe, we know that the second wave in Europe
after the peak of Omicron was due to BA.2 spreading, change of behavior, and
waning immunity. In the United States, because we have higher infection compared
to Europe – for example, compared to the UK – we have lower vaccination but more
infections. With the combination of the two, we have more immunity in the United
States, especially in the Southern states, where they had more infections than
we’ve seen in the UK. 

So we will not expect a big bump in the US. There may be a very minor one in
some states, but a decline overall. 

What the US needs to do is to secure more antiviral medication and keep it and
distribute it right now to places ahead of the next surge. And make sure we have
a plan for distribution based on risk factors and the aging of the population in
each location, but also to have a plan for redistribution in case we have a wave
in one state and medication sitting in a warehouse in another state. So,
shifting resources is very important for preparedness.

We believe that before winter, because of waning immunity, another shot may be
needed as well, depending on whether people have received four or three doses.
Still, in the US, vaccination is not increasing, and unfortunately we have
leveled at about 65% at the national level.

Risk of cruises and other activities varies by personal factors

CDC has announced that it's ok to get on a cruise ship. I believe it's safe, in
my opinion, if you are vaccinated and boosted, and now if you are above 50 and
getting the fourth dose. But of course, for all of us, whatever we do from now
on has to be based on our own personal risk and the risk of people we live with
or we are around. So basically, for somebody who’s young and healthy, the risk
is very minimal to get Omicron or BA.2, but for somebody who's older in age, has
a risk factor, or is immunocompromised, the risk is much higher. Of course, we
have to behave accordingly to protect ourselves and the people we live with and
we care about. That's very important.

The BA.2 wave is coming to an end in Europe

As far as the global landscape, what we are seeing right now in Europe and many
countries, the second peak has happened, and it's starting to come down – in the
UK, for example. It’s still going up in France as of today, coming down in the
Netherlands, so in many European countries, that second peak lasted about 3-4
weeks and came down. This was driven mainly by BA.2 and the change of behavior.
In Europe, they had more mandates than we did here in the United States, and
then there was a sudden change of behavior, more so than in some states here in
the United States where we didn't have any mandates, Florida for example. So
basically, the behavioral change that has happened after the peak of Omicron is
minimal in the United States compared to what we've seen in Europe.

China continues to keep Omicron at bay

China is the country that we are keeping an eye on right now. China so far has
been able to contain the spread of Omicron in Beijing by lockdown and massive
testing. Whether they will be able to do so and maintain that control in
Shanghai and other large cities is a big question mark. BA.2 and Omicron are
more infectious, so we believe the chances of containing the spread of Omicron
in China will be very limited. Our long-term projections in China show that they
will have a major surge coming up with a peak in May, towards the end of May,
with a large number of hospitalizations and mortality, for several reasons.

China has a high vaccination rate, but their vaccine is not as effective as the
vaccines we are using here in the United States or in European countries. So
what China needs to do is – and we know they have right now received the permit
to produce mRNA vaccines from Pfizer, and they have their own mRNA vaccine being
developed right now – so producing more vaccines and vaccinating people,
especially the elderly in China, because we know there are reports that
vaccination among the elderly is very low compared to what we have seen in other
countries.

Second, is to produce more antivirals, and we know that they have right now
licenses to produce antiviral medication and distribute it in China. Preparing
their hospitals for the surge is very important right now.

Vaccine donations are still appreciated, but only if they have a long shelf life

Vaccine donations have saved a lot of lives all over the world, and countries
have been generous in providing extra doses of vaccines to others who need it.
It's very important to remember as you donate these vaccines to make sure they
have a long shelf life. They shouldn't be about to expire. Once you give a
vaccine to a country, there are a lot of logistics and distributions and
manpower that's needed to administer these vaccines. Indonesia, for example, has
asked all donors, please when you give us a vaccine let's make sure it has a
long shelf life. We need to keep that in mind and not waste vaccines. Thank you
everybody for donating the vaccine, but let's make sure the vaccine can be used
by the country that is receiving them in time before they expire.

--------------------------------------------------------------------------------


MARCH 21, 2022



Key takeaways:

 * Four zones of Covid transmission in the world
   
   * Majority of countries: transmission continues to decline
   
   * Western Europe: secondary increase in transmission from BA.2
   
   * Southeast Asia: peak Omicron wave
   
   * China: not yet experienced an Omicron wave, but we anticipate it will
     arrive in the next few months, causing up to a million deaths

 * BA.2: Countries that have already dealt with BA.2 transmission (Netherlands,
   Denmark) saw brief surges that ended reasonably quickly. That pattern may
   spread to the rest of Western Europe and North America.
   
   * Increased transmission is likely due to a combination of BA.2 and reduced
     mask use and social distancing.
 * Ukraine: there will likely be increased transmission due to the ongoing war
   and crowded conditions, but the impact may be reduced because of high levels
   of prior immunity in the population.

 * Policy recommendation: We should shift focus away from vaccination and
   towards production and distribution of anti-virals like Paxlovid. 
   
   * Can reduce death rate by 90%
   
   * More likely to maintain effectiveness against new variants that may come in
     the future

This transcript has been lightly edited for clarity

In this week’s update from IHME on the COVID-19 pandemic, the first thing to
recognize is that there are really four zones of Covid transmission right now in
the world. 

In the vast majority of countries, transmission continues to decline, as
countries come off the peaks of Omicron transmission.

Western Europe is experiencing a second wave in transmission from BA.2

As there has been quite a bit of media attention, there is a secondary increase
in transmission in some countries in Western Europe, most notably the United
Kingdom, Ireland, France, Germany, and Greece, are places where transmission is
on the increase. That increase is being attributed to the substitution of the
BA.2 variant for the BA.1 variant, combined with reduced mask use and social
distancing.

We don't think it's just BA.2, because BA.2 has actually been around for quite
some time. In fact, for example in South Africa, it appeared in December. It's
replaced BA.1 but there's been no substantial increase in community level
transmission.

We don't think –  and you see this in our forecasts –  that this combination of
BA.2 and reduced caution about transmission will lead to a prolonged secondary
surge. The reason is the surge in the Netherlands –  it went up, then came back
up, and now the secondary surge has already peaked and is on its way down. In
Denmark, the BA.1 and BA.2 parts sort of coalesced into one and that also came
to an end reasonably quickly. We think that will be the pattern that we'll see
in other countries in Western Europe, and it's possible that pattern will spread
to the United States and Canada as well.

Southeast Asia is in peak Omicron wave

The third zone are those countries still in the main upswing, or peak levels of
transmission due to a delayed Omicron wave. Those are mostly in Southeast Asia –
Vietnam and Cambodia are good examples of that. And then the biggest driver of
transmission, cases, and potentially deaths, is what's playing out in the
zero-Covid strategy countries, so New Zealand looks to have hit their peak on
Omicron, but it's coming down quite slowly.

China has not yet seen an Omicron wave

And then the big, big question is China. Because we've seen in an
immunologically naive population with not good vaccination coverage in the
elderly, quite a toll in Hong Kong. And now the question is when and if that
will spread to mainland China. There are outbreaks in multiple cities, including
Shanghai and Shenzhen and a number of other locations. The Chinese government is
still pursuing the strategy of lockdown for a short period and then multiple
rounds of mass testing to identify all cases and then quarantine them.

This worked in Beijing in February to stop transmission and they are trying to
pursue this for now, but the economic consequences are very great and there's
greater calls within the Chinese leadership for less of a stringent policy. 

We predict next wave in China could be devastating

Our model foresees that that can't go on for that long and so we have a huge
peak, with perhaps as many as a million deaths in China coming through in April,
May, and into June. The timing of that will depend critically on how the Chinese
government chooses to either relax or not their zero-Covid strategy.

The other key issue that could mitigate the huge death toll that could be coming
in China is the recent announcement of an IP waiver from Pfizer for Paxlovid for
producers in 22 countries, including five producers in China. So there's an
interesting strategic choice that will play out, which is that the balance of
the economic harm of the aggressive zero-Covid strategy and creating time to
produce anti-virals that would be sufficient to protect some of the unvaccinated
elderly within China. The timing and how that plays out is going to be up to the
policy choices in China.

The importance of anti-virals

If we step back and zoom out more globally, there's still a tremendous amount of
energy in trying to address vaccine inequality and addressing supply
constraints, particularly in sub-Saharan Africa around vaccination. That's
certainly well-justified on moral grounds –  everybody should have access to
vaccination who wants it – but may not have a huge effect on death and
hospitalization. We see in the data in sub-Saharan Africa and other low-income
countries, that cumulative infection rates are quite high – 80-90% of most
countries have already been infected, they have immunity from infection, and
also vaccine hesitancy is quite high. So even if the supply constraints are
addressed – which they should be, on moral grounds – we should not expect that
to make a huge effect on this 6-month timeframe of hospitalizations and death
rates. 

However, what we don't see is similar international energy on the crucial issue
of access to anti-virals, because anti-virals like Paxlovid can reduce the death
rate by 90% and production capacity is small. With the new IP waivers going to
India and China and some other countries, perhaps we can have a more concerted
global effort in giving access to everybody who needs it, particularly the
elderly, to anti-virals. That could really change the course of Covid over the
next 12 months. The other aspect of the anti-virals scale-up that is important
to recognize is that we don't really know if current vaccines will do much for
future variants. Vaccine effectiveness against Omicron, particularly
transmission, has been quite low with current vaccines. Whereas we suspect that
the pathway that the anti-virals use will stay preserved and so the anti-virals
will be an effective strategy irrespective of the type of variants that may
come.

So, as we step out and go into this phase where it's very unlikely that we'll
see mandates and social distancing mandates as a main strategy for control. Then
it's really down to vaccination and anti-virals. We've had lots of push on
vaccination, and now we need equal policy attention and drive on the
anti-virals.

Covid in Ukraine

Lastly, of course there is a real interest and attention on what might be the
consequences on Covid of the war in Ukraine. Very difficult to assess, because
of course the information systems have fallen apart amid the setting of the
incredible destruction and invasion that is underway. But, one aspect of it that
may mean the effect of millions of refugees crowding, lack of opportunities to
social distance, may not be as bad as it might have been, is that despite low
vaccination rates in the Ukraine, they have very high levels of prior infection,
so there is quite a substantial amount of immunity. Of course, there will be
increased transmission. We probably won't get any data about it, but hopefully
the impact will be much less than if they had been a truly immunologically naive
population.

--------------------------------------------------------------------------------


MARCH 4, 2022 - COVID-19 IMPACT ON WOMEN'S EQUALITY


PRESENTED BY DR. EMMANUELA GAKIDOU



Key takeaways:

 * The pandemic has disproportionately affected women in terms of employment &
   income loss, gender-based violence, and returning to school.

 * Policy action: Governments should incentivize girls going back to school and
   prioritize the areas of life most affected in their region.

 * Read the research article.

This transcript has been lightly edited for clarity

It's really important, as we move past the latest wave of Omicron deaths and
infections, to pay a lot of attention to the other areas of life and society
that the pandemic has had a big pull on. In our study, we measured the impacts
of the pandemic on some of these areas, particularly on employment and
education, on income loss, on foregoing utilizing other health care for one’s
needs, and particularly how those may have disproportionately affected women
compared to men around the world.

As the world moves on to the next phase, it is really important to consider all
other aspects of life that the pandemic has had a big impact on, not only the
direct effects on deaths and infections that we have been living with over the
past two years.

The pandemic has disproportionately affected women when it comes to employment
loss, to income loss, to increased perceptions of gender-based violence, and
also with regard to education and who is returning to school compared to who is
dropping out of school.

Read »COVID-19 Led to Worse Social and Economic Consequences for Women published
in Think Global Health

Even though there are a lot of areas that the pandemic has affected, our
findings only scratch the surface of what the real impact of the pandemic may
have been, as we have only been able to explore a few of these areas. But we
think that the impact of the pandemic has been broad and is going to be felt for
years to come. 

It has been widely discussed that the effect of the pandemic on schools and on
education is very profound. Sadly, we have very little data to measure what is
happening right now to the millions of learners around the world, but from what
we know, we are quite concerned that as societies and schools go back to normal,
girls will be returning to education at a lower rate compared to boys. This
happened after previous crises, and there are some indications that it is
happening again as a result of COVID school closures. It is really important
that societies and governments prioritize incentivizing girls going back to
school and returning to education now that schools are reopening again.

Our study is the first study that has taken a comprehensive lens to the impact
of the pandemic on gender disparities. While we have not answered all the
questions, we’re hoping that policymakers will look at the most important areas
of society and life that have been affected by COVID with respect to gender
disparities in their own country, and prioritize what they should be addressing
first. In some regions of the world, the most severe impact has been felt on
employment loss; in other regions of the world, education should be prioritized.
We’re hoping that our study will contribute information needed as we move to the
next phase of life and COVID-19, to prioritize the areas where the gender gaps
are most pronounced and most severe. 

--------------------------------------------------------------------------------


FEBRUARY 17, 2022



Key takeaways:

 * COVID anomalies:
   
   * Cases on the rise: Russian Federation and Belarus
   
   * Cases declining faster than expected: the Caribbean and South America
   
   * Cases increasing again after a decline: Finland, Sardinia, Canada (Manitoba
     province)

 * China: Omicron wave has not yet hit, but we expect that will change by March
   or April.

 * Functional immunity: We’re updating the model to reflect patterns in immunity
   from vaccination, previous infection from Omicron, or previous infection from
   other variants.

 * United States: About ¾ of the population is currently immune to Omicron.

 * What does the future hold? We expect there to be intensified transmission
   next winter and more variants will likely emerge.

This transcript has been lightly edited for clarity

Where cases have continued to rise

This week’s update from IHME on modeling and analyzing the COVID epidemic:
First, in terms of what’s happened around the world that is not following the
trajectory that we expected, the only major observation on that front is that
the increase in cases in the Russian Federation and perhaps Belarus has
continued to rise. 

We expected because we’ve estimated past infection levels to be very high, they
should have run out of people to infect, but they’ve kept going. So we expect
that peak should come soon, but of course the fact that it has kept going may
imply that levels of past infection have not been as high as we’ve previously
expected.

Where cases are declining faster than expected

The second observation is that the Omicron wave is going down faster in some
regions than we expected, or somewhat faster. The Caribbean stands out –
actually South America in general stands out – in declining faster than perhaps
we expected.

Where cases are increasing again after a decline

There are a handful of anomalies that we are observing around countries where
after a decline, cases have gone back up. Finland is included in that, Sardinia
would be in that group, Manitoba province in Canada. In each of these, we’re not
sure what the explanation is – could be a local phenomenon around increased
transmission or spatial spread. In the case of Finland, it may be the same thing
that happened in Denmark – the spread of the BA.2 variant. But certainly, these
are not happening in a large number of locations and seem to be specific to
those particular places.

The situation in China

Our global numbers do look different because of China, where we expected that by
now the Omicron epidemic would have taken hold more broadly in the community and
we would be seeing widespread transmission. The public health authorities in
China, through vigorous lockdowns, have been able to stop transmission in
Beijing. We are therefore pushing out later into March and April what we
continue to expect will happen – which is that there will be a widespread
Omicron wave. At the global level, that makes a difference.

How we’re factoring in functional immunity

The last thing to note is that as part of our analyses, we are going to be
including what’s in the models for quite some time: the fraction of people in
each population that have got functional immunity to Omicron. That immunity
comes from vaccination, even though vaccines are only partially effective for
blocking Omicron infection; it comes from past infection with other variants;
and it comes from infection with Omicron. In each case, we compute that
functional immunity, taking into account the pattern of waning for vaccination
and for natural infection, and the cross-variant immunity, or the breakthrough
that Omicron has against prior variant infection.

When you put all that together, in a place like for example the United States,
we see about three-fourths of the population currently are immune to Omicron. We
expect that number will continue to grow as we go through this tail-end of the
Omicron wave in the United States.

Does that mean that so many people are immune to Omicron that we will see no
further transmission or waves of COVID in the future? 

The answer is no, because we will have – if no new variant emerges – we would
expect Omicron to return next winter. There will be more waning of immunity,
more people will have gone back to being susceptible, and we’d be back into
winter intensified transmission. 

Of course, we do think variants will emerge, and so further increases or
outbreaks are likely as the new variants emerge that have immune escape and can
infect people who are currently immune to Omicron. We don’t expect those new
variants, however, to have the same consequence that the Delta variant had last
year. Because global levels of immunity are going to be much higher and there’s
the advent of access, which we hope will eventually be global, to antivirals,
which will substantially reduce the infection-fatality rate.

Those are the main insights from this week’s analysis.

--------------------------------------------------------------------------------


FEBRUARY 10, 2022 - Q&A WITH DR. MURRAY



Key takeaways:

 * Incorporating incidental COVID deaths into the model is still a work in
   progress: We are working on compiling data for all the jurisdictions we
   track.
 * Our model's performance has been quite good: We have continuously modified
   the model to take into account new factors like vaccination, variants, and
   waning immunity.
 * Removing mask mandates makes sense in places where Omicron infections are on
   the downswing. The mandates have little effect when most people have already
   been infected.
 * It will be difficult for zero-COVID countries, like China, to keep Omicron at
   bay. The new variant is so transmissible that even lockdowns will not hold it
   off for long.

This transcript has been lightly edited for clarity


HOW WILL YOUR MODEL ACCOUNT FOR INCIDENTAL COVID DEATHS?

We know from a variety of community-level studies – hospital pre-admission
screenings, some cohort studies in India, the ONS [UK Office for National
Statistics] infection survey – that Omicron comes with a very high prevalence in
the community, as high as 10% or 12% of the population shedding virus at any one
time. And that’s what’s driving the incidental hospital admissions and deaths.
The challenge as we dig into this is jurisdiction. By jurisdiction, the way
incidental admissions and deaths are being counted appears to be different. And
so, at present, we're not able to understand this difference for every
jurisdiction. We are starting to compile the data as provided, or the guidance
as provided, by each jurisdiction, but since we track nearly 400 different
jurisdictions, counting the subnational units in many countries, it's going to
be quite a task for us to fully understand this. But it's a work in progress. 


HOW HAS IHME’S APPROACH TO COVID-19 FORECASTING CHANGED?

The IHME approach to modeling the epidemic has kept progressing as the epidemic
unfolded. Our very first model in March of 2020 was really driven by the
experience observed in Wuhan and the effect of non-pharmaceutical interventions
there on transmission. We then transitioned to a transmission dynamics model
with other drivers, mask use, mobility, testing, and a bunch of contextual
factors such as smoking, air pollution, and altitude, population density, and a
variety of other factors. 

And then we had to modify the model to take into account vaccination, and then
the spread of variants with the emergence of the Alpha variant. And then
finally, the big change that's come in the last few months has been taking into
account waning of infection-acquired immunity and waning of vaccine-acquired
immunity. We're trying to keep abreast of what the virus is showing us and the
complexity of what's happening around the world. I think part of the reason that
our out-of-sample predictability or model performance has continued to be quite
good is because we are trying to essentially keep up with the virus while we
learn about it. 


WHAT WILL BE THE CONSEQUENCES OF REMOVING MASK MANDATES?

Right now, in countries where Omicron is subsiding, there's a pretty rapid move
to lift mandates. We're seeing it in some US states, Canadian provinces, many
countries in Europe, and discussion elsewhere of similar moves. I think removing
the mandates makes sense in settings where we think that most people who are
susceptible to Omicron have been infected and the numbers are coming down
because we've run out of people to infect. In those settings, the mandates
aren't really achieving much at all. And so there should be little to no risk in
removing those mandates. 

In settings, which we don't see a lot of, where there is a lot of behavioral
modification, people are avoiding contact, mobility has come way down, and mask
use has gone up, then perhaps some of the peaks in Omicron may have been before
all the people who are susceptible have been infected – and then you might get a
secondary resurgence if you take the mandates off. But there are not many places
where the other data on mobility and mask use would suggest that that's really
the driver of the peak, in which case we think removing the mandates will have
little to no impact on transmission once you're on the downswing of Omicron.


SHOULD CHINA RELAX ITS RESTRICTIONS, AND WHAT WILL HAPPEN IF IT DOES?

The big question with Omicron is what do zero-COVID countries, most importantly
China, do? And it's really quite a challenge because we worry most about people
who are unvaccinated and never infected, so essentially there's almost nobody in
China who's been infected, except a very small percentage of the population from
the original outbreak. And you have quite high vaccination rates, but the
vaccine isn't particularly effective against Omicron. It's much worse efficacy
than say Pfizer or Moderna or AstraZeneca. 

The challenge that the Chinese government has is how to manage this situation.
If there's a strategy ahead where they can deliver a more effective vaccine
booster to the over-65s and under-65s with comorbidities – the vulnerable group
– or they can gain access to intellectual property around antivirals and start
producing enough antivirals to start producing a big caseload, then that becomes
a way out. You keep up with the rolling lockdowns in each place where an Omicron
outbreak occurs until you're ready with those other strategies. But if there
isn't going to be that strategy, then continuous rolling lockdown – because we
expect Omicron will just keep reemerging because it's so infectious – probably
becomes infeasible. 

Right now, that choice on strategy is probably what the Chinese leadership is
trying to figure out. We don't think it's feasible to keep Omicron out of the
community for very long, because even the non-pharmaceutical interventions that
worked well for Delta, for previous variants, for the ancestral variant, don't
work so well for Omicron because it's so transmissible. And so it's going to be
difficult, even with lockdowns, to keep it under control.

--------------------------------------------------------------------------------


FEBRUARY 4, 2022



Key takeaways:

 * Omicron wave continues: We expect most locations to have peaked and begun to
   decline by the end of March.

 * Reported cases are lower than expected in some locations. This could be a
   result of lower testing capacity or higher numbers of unreported previously
   infected individuals who are now immune.

 * Variation in incidental Omicron deaths: There is significant variation
   between hospitals in how deaths are reported among those who were admitted
   for a different reason and then later tested positive for Omicron. This
   produces an inconsistent infection-fatality rate.

 * Impact of BA.2: There is no indication that BA.2 is more severe than BA.1,
   but this could prolong the spread of the Omicron wave or cause secondary
   surges.
    
 * Summer and early fall should be a time of low transmission in the Northern
   Hemisphere, but we must continue surveillance for new variants and prepare
   for the possibility of another surge.

This transcript has been lightly edited for clarity

The global landscape of COVID-19 currently

In this week’s update from IHME on the COVID-19 epidemic, at the global level,
our forecasts remain very similar to the past one. Basically, the huge Omicron
wave continues to sweep through the world. We’re seeing in some [locations], but
not all, rapid declines after hitting a peak, and we expect that the epidemic
will have largely swept through the world now by the end of March – a little bit
longer than previously thought because the Omicron wave in China seems to be not
yet taking off, and that is such a large population that it does affect the
global epidemic.

Within that story, however, there are some interesting patterns that are worth
noting and add to the complexity of the story. In some countries – Greece is a
good example, England is another – the epidemic has reached a peak, come down,
and then about halfway down it’s leveled out. I think the best explanation we
can find for this phenomenon is that each place is having the classic peak we
see in an island state like Malta or Hawaii or Puerto Rico, where you go
straight up and come straight down, but those up and down phenomena are spread
spatially throughout each of these countries, and so in aggregate you tend to
see this spike go up, come down, and then a flat period. So we expect eventually
those numbers will shoot down. It does mean that at the national level, we may
see somewhat more protracted epidemics than we expected.

Reported cases are lower than expected

The other phenomenon that we’re seeing in some countries is that the peak that
we’re expecting to see in reported cases is much lower than our models would
have suggested. We’re seeing this in a number of middle-income countries, some
states in India, some states in Brazil. We think this is where testing capacity
is simply being overwhelmed at the peak of the epidemic, and so we’re getting a
sort of truncated peak. We’ve just run out of the ability to detect cases or,
put in other language, the infection-detection rate as the surge comes through
is dropping even faster than we expected, because of exceeding testing capacity.

Proving that is hard, but it is probably the only way we can account for these
early peaks that are smaller than expected, given everything we know about each
country in terms of vaccination levels, past exposure to previous variants, and
the waning of immunity.

Variation in infection-fatality rates caused by incidental Omicron infections

The third phenomenon that we’re seeing in the data, which complicates things
quite a bit – we’ve talked about it before, but we’re getting clearer and
clearer evidence about it – is that countries vary considerably in how they are
reporting so-called incidental Omicron infections in hospitalized patients and
in deaths. We’ve dug into the details from some jurisdictions, and it’s clear
that in some jurisdictions the recommended rules are clearly to count what are
called suspect cases, which is anybody who is hospitalized or dies who’s tested
positive in the last 60 days. Some countries use a different period – 30 days in
other places.

And so that’s including a lot of people, given how common Omicron is, who are
admitted and die from other causes. Eventually they will go back and revise
their death numbers as death certificates come in and there is adjudication and
investigation, or at least in many places. But for now, we’re seeing in some
places – we’ve noticed this particularly strongly in some states in the United
States, we’re seeing this in Spain, we’re seeing this in some other countries in
Europe – and what it shows up as is the infection-fatality rate that we observe,
or estimate, seems unusually high in those settings, and that’s where we’ve
looked into the reporting rules.

Other places do a better job of not counting the incidental hospital admissions
and deaths – Denmark is an example of that, and we’re not seeing the same rise
in deaths that we are in places that do count the incidentals. So it is making
the analysis harder, and it’s also meaning that it’s taking more time to
calibrate these models to each jurisdiction to take into account what we can see
in these differences in how data are reported.

The impact of the BA.2 subvariant of Omicron

The last consideration that everybody’s paying attention to is the BA.2
subvariant of Omicron. That is best documented in its impact in Denmark, where
you had a BA.1 surge and then immediately on top of that a BA.2 surge. While
we’ve seen BA.2 spreading in other places, we have yet to observe the same
phenomenon of a true secondary surge, but it's certainly something that we are
watching carefully. I think it’s very interesting to see what happens in Gauteng
province in South Africa, where BA.2 is replacing BA.1. There’s been a slowdown
in the decline in cases, but we have not seen a surge yet of any appreciable
size. Likewise, we haven’t seen exponential surges like we saw for BA.1 in other
jurisdictions that are reporting more BA.2. So, to be watched carefully, but the
big issue there is whether BA.2 has more immune escape, so more people who were
previously infected who didn’t get BA.1 may now be able to get BA.2 and/or
whether you can get BA.2 after having been infected with BA.1.

Either of those could and would lead to a longer Omicron surge, which is
certainly possible, but there’s no indication that BA.2 is more severe than
BA.1. So even if there is a longer surge, we don’t expect it to substantively
change the number of deaths that we’ll observe in the coming weeks. It might
prolong pressure on hospitals.

The latest forecasts

Our forecasts remain fundamentally the same. As the Omicron wave sweeps through
the world, maybe a bit delayed in China, we will come through the Omicron wave
sometime in April with a large fraction of the world (50% or more) that have
been infected with Omicron, with the highest levels of population immunity that
we’ve observed, and, barring a new variant, we should have a period of
relatively low transmission for weeks or months. In the Northern Hemisphere,
that might well extend through the summer and into the fall.

Of course, a new variant with immune escape can come along and change those
basic dynamics, but in the absence of that, or pending that emergence of a new
variant, we do expect the Omicron wave to go into essentially a decline,
starting now and in the coming weeks, and end up with much lower levels of
hospitalization and death than we’ve been observing.

--------------------------------------------------------------------------------


FEBRUARY 1, 2022 – Q&A ON WHERE WE ARE WITH OMICRON




WHY SHOULD WE STILL WEAR MASKS?

Throughout our analyses, we have found mask-wearing reduces the risk of
transmission by about 50%, and that still holds true. At the individual level,
you have a reduced risk of both transmitting and being infected of about 50%,
and this probably varies by the type of mask that you wear. At the population
level, for the first time in our models, we’re finding that the population
effect of enhanced mask-wearing is quite small, about a 10% reduction in
cumulative infection from Omicron from now forward. It’s still there, but in the
grand scheme of things, it’s relatively small. 

The reason why these are both true statements – the 50% reduction with a mask
and 10% at a population level – is that the risk of transmission of Omicron
among so many people in a community is so great that even a 50% reduction
doesn’t really do anything at a population level. Think about it like this: on a
given day, if you’re going to be exposed to Omicron six times, you may be
exposed only three times if you’re wearing a mask, but you’re still going to get
infected. That’s sort of how the logic plays out in our modeling – it’s about
the speed and intensity of Omicron. We still strongly believe that the act of
wearing a mask reduces the risk of infection on a 1:1 basis.


WHAT WILL BE THE IMPACT OF OMICRON BA.2? 

The new BA.2 lineage that is now emerging as the dominant strain in Denmark has
coincided with sort of a secondary increase in transmission in Denmark. There
are really three explanations for this:

 1. People who have had Omicron from the BA.1 lineage can somehow get infected
    from BA.2 – this is possible but probably unlikely.

 2. The mutations in the BA.2 lineage may mean that more people are susceptible
    to it than BA.1. In other words, the immune escape that we know is there
    – about 50% for BA.1 from past infection with other variants – may be even
    greater. That could create a new pool of susceptible individuals, and the
    same could be true for protection against infection through vaccination.
    It’s interesting that in Denmark already, according to the seroprevalence
    reports, the rate of Omicron in the vaccinated is actually somewhat higher
    than in the unvaccinated. It’s not probably statistically significant, or in
    other words, they’re about the same. It may also have something to do with
    who is out getting exposed and who is going to higher-risk settings.

 3. Behavior. We’re seeing a secondary ripple in Northern Ireland and in a
    number of districts in England. In the latter case, it’s only in children
    from the ONS [Office for National Statistics] infection survey. In Denmark,
    we don’t know that, and it seems to be more broad-based. It could be
    something else going on in terms of behavior. Remember back in August when
    Delta ripped through Scotland, came down, and then had a second Delta wave?
    It was thought to be related to school openings, but this was never really
    proven. So there could be some behavioral aspect in Denmark that we don’t
    understand. 

The good news from Denmark on BA.2 is that there’s no indication that it’s more
severe. That could mean a bigger surge of Omicron than we thought, even more
than half the population getting it, but probably isn’t cause for alarm in the
sense that it doesn’t look to have enhanced severity.


WHY ARE COVID SURGE MODELS SO 'SPIKY'? 

The reason COVID in a number of countries  – but not all – goes up very quickly
and then down very quickly is because it’s very infectious, it has immune escape
(a lot of people can get it), and once you run out of people who are
susceptible, then there’s nobody left to infect and so incidence comes crashing
down. We’ve seen this happen in a number of places like South Africa, Malta, or
Cyprus.

When we see a slower decline in some countries, often those are larger places.
For example, when you see the big surge in the United States, in Connecticut,
you see it start to spread to other states. When you add those all up, you get a
slower decline in the tail. So we’re seeing a bit of a mixed pattern, but in
general, we are expecting, because of increased transmissibility and the idea
that we’re basically running out of people for Omicron to infect, that it should
basically come crashing down.


HOW SHOULD SCHOOLS BE RESPONDING NOW?

Given the high prevalence of Omicron during the surge phase, testing
asymptomatic people will just yield more and more people who test positive but
have no symptoms, and will lead to more people having to stay away from school
and contacts of those people having to stay away from school. Given the very low
risk of severe outcomes of Omicron, it seems unwise to test asymptomatic people.
And then for symptomatic people – of course, sick children should stay home and
then return to school when they’re no longer symptomatic. 

I think we need to change our expectation: we are not in a situation where we
can stop at the population level this wave of transmission. That means we
therefore have to be focused on reducing harm, protecting individuals from
severe disease or certainly from actually dying. A focus on harm reduction leads
you to make different choices than trying to control transmission.


COULD THE NEXT VARIANT BE AS DEADLY AS EARLY COVID?

The way to understand our future risk, because we do expect new variants to
come, and some of those variants could be more severe than Omicron – that’s
certainly a very real possibility – but we don’t expect, even if that occurs,
for future waves in terms of hospitalization and death to be as severe as the
Delta wave in the past. Certainly, Delta was worse at the global level than the
previous Alpha and ancestral variants.

Why?

Basically, the group in the world who are at the greatest risk of a bad outcome
are the unvaccinated and the never infected. They’re what we call
immunologically naive, meaning they’ve never seen the virus. Their immune system
has never seen the virus or any part of it, like in the sense that spike
proteins in an mRNA vaccine expose your immune system to a part of the virus. 

So the naive group are therefore the ones at greatest risk of bad outcomes from
COVID-19. Now in the future, according to our modeling, there’s less than 5% of
the world at the end of this Omicron wave who are immunologically naive. So we
don’t expect the outcomes to be the same – we expect them to be much better. Add
on to that that we have a new tool in the COVID management strategy with these
highly effective antivirals. As long as those antivirals can be scaled up and be
made available widely for those most at risk, we may still be able in a future
wave to see greatly improved outcomes than what we have today. I think it’s
because of that combination of more population-level immunity and access to
antivirals that governments will likely not be putting mandates in place in
terms of behavior going forward.


IS THE DELTA VARIANT STILL INFECTING PEOPLE?

Where we have the genomic sequencing data – the GSA [US General Services
Administration] database is what we largely use, supplemented by national
databases – Omicron in a 14-day period almost completely replaces Delta rapidly.
We don’t think Delta will be around because Omicron is so much more infectious
and the neutralizing antibodies are giving us the indication that Omicron is
providing good protection from Delta. So even if there are some Delta viruses in
pockets circulating, we don’t think it’ll come back as a Delta wave.


HOW DO YOU CALCULATE ASYMPTOMATIC CASES?

The 80–90% symptomatic or very mildly symptomatic comes from initially looking
at data in South Africa, where we had reported cases of hospitalizations and
deaths, and these represented PCR samples of women showing up at prenatal
clinics and people being enrolled in prevention trials that suggested on any
given day, 30–40% of people were COVID-positive. Nobody had symptoms. If you
calculate that back, you get the huge fraction of people who are asymptomatic
– even more than 90%. When you look at other data sources where, for example, on
routine screening for kids coming back to school in a number of school districts
in the US, they’re finding 5–6% of children with no symptoms testing positive. 

Another type of data that’s telling us about this large fraction asymptomatic is
pre-admission screening for people coming into hospitals for scheduled
procedures. These are people without any symptoms for COVID testing positive
before going into a routine procedure at a Seattle hospital. About 10% of these
people are testing positive. So lots of indications of these huge volumes of
infection in the community, and most or many of them not having any symptoms or
very mild symptoms. Another type of study that supports this idea is the
screening of professional athletes, where they’re picking up large numbers of
asymptomatic or extremely mild infections. 

Putting this all together, we have to recognize that the previous numbers for
Delta, which were about 40% symptomatic, it appears the numbers are much higher
for Omicron in the category of asymptomatic or very mildly symptomatic.

Submit your questions for Dr. Murray to address here: Ask a question

--------------------------------------------------------------------------------


JANUARY 21, 2022



This transcript has been lightly edited for clarity

We first see at the global level and by region pretty much the Omicron wave
unfolding as expected. There are a handful of places where Omicron waves have
not started, places like Indonesia, Malaysia, Vietnam, or Cambodia. 

But in general, we’re seeing the wave march across countries as expected. In
fact, when we look at the timing from the first big surge in reported cases to
the peak in reported cases, we’re seeing across countries that it runs about
20-25 days. And what’s interesting is perhaps that time from introduction to
peak in very disparate places – in Canada, in many states in the US, in some
northern states in Mexico, and in countries like Qatar, Argentina, a number of
countries in southern Europe, most of eastern and southern Africa, in some
states now in India – that the time to peak is quite consistent and seems to be
about the same, regardless of the background level of immunization and previous
infection. So our understanding of that is that Omicron is so transmissible that
it’s reaching all of those people who are still susceptible, either from waning
immunity from vaccination or from previous infection, and then reaching a peak
and coming down. That’s not something we’ve seen in previous waves because of
behavior change and because of government action – we have not seen all of the
susceptible individuals getting infected. This just speaks to the extraordinary
speed and transmissibility of the Omicron wave. 

I think we’re seeing the wave unfold as expected, but there are two countries in
particular that are worth tracking, and those are two countries with zero-COVID
strategies: China and New Zealand. 

In Zealand, there now appear to be community cases. The Prime Minister has said
they won’t go into lockdown, that a major COVID wave is coming. 

In previous releases, we’ve only focused on provinces in China with ongoing
transmission, but since we project that lockdowns will not eventually work in
China, we have modeled out a major Omicron wave which will be peaking perhaps
later in February and into March.

Another aspect in this week’s analysis is what we see coming next in terms of
the impact on hospitals and death. Post-Omicron, that’s really going to depend
both on the advent of new variants and when they will emerge, and of course the
new factor that we have not yet built into our models that will have a big
effect on future waves of transmission is antivirals. I think we’ll be paying
more attention in the future to these highly effective antivirals that are now
reaching the marketplace. Even though we don’t expect big lockdowns in the
future, we know that will make a big difference in reducing future burden as
well.

--------------------------------------------------------------------------------


JANUARY 19, 2022



In a new commentary published in The Lancet, IHME director Dr. Christopher
Murray wrote that while COVID-19 will continue, the end of the pandemic from a
policy standpoint is near. We sat down with Dr. Murray to understand why he
believes that COVID-19 will soon enter a new, post-pandemic phase.

Q.  What do you mean when you say that the end of the pandemic is near?

COVID-19 will be with us for many years to come as a recurrent disease,
intensifying seasonally during the fall and winter months. As people’s immunity
declines and new variants emerge, we’re also likely to see resurgences of
COVID-19. But the current period of extraordinary social and economic disruption
is likely coming to an end as COVID becomes a challenge that health systems
manage, rather than a crisis that consumes society as a whole. I see reasons for
hope.

Q.  How can the pandemic’s end be in sight when the Omicron variant is infecting
more people than ever?

By March, IHME models show that the Omicron wave will have passed through most
of the world, leading to a period of low transmission. In the meantime, it’s
true that Omicron is spreading with greater intensity than we have seen over the
last two years of the COVID pandemic.

In countries where Omicron is already widespread, it is likely too late for new
policy measures to meaningfully contain its spread. People should continue to
wear high-quality masks and maintain physical distance to protect vulnerable
individuals; new rounds of lockdowns or mandates will come too late to deter the
spread of Omicron in most places. Thankfully, Omicron’s severity is much less
than the Delta variant that recently was the dominant strain of the virus. This
new variant has placed a heavy burden on health systems given the large number
of infections. Omicron has infected many health care workers, placing extra
pressure on hospitals. Governments will need to ramp up their support for health
systems in the next 4 to 6 weeks.

Because Omicron is transmitted so easily, it quickly reaches its peak in
affected countries and appears to taper off rapidly. While an Omicron wave is
probably unavoidable in every country, the reason for hope is what we believe
will come in its wake: an extended period of high immunity levels and low
transmission. As we look beyond the current Omicron wave, COVID will become a
recurrent disease that can be managed by health systems, like other infectious
diseases such as flu.

Q. Why does your view on where the pandemic is headed differ from what we've
heard to date?

Our view is different because the evidence shows that the vast number of cases
from this wave are asymptomatic, perhaps as high as 80% to 90%. That’s double
what we’ve seen in previous waves when 40% of infections were asymptomatic. In
hospitals where all patients are tested for COVID-19 upon admission regardless
of why they’re being admitted, the number of COVID-19 infections is
substantially higher due to the fact that all patients who tested positive for
COVID-19 are considered to be hospitalized with COVID-19 even if they, too, are
asymptomatic. Nevertheless, infection control requirements are still needed at
these hospitals, creating an extra need for more resources.

Q.  Does this mean we can ease up on the COVID-19 response?

To prevent further death and suffering, governments around the world need to
continue to take action, investing in new versions of vaccines; increasing
access to vaccines, especially in low- and middle-income countries; monitoring
the evolution of the virus through genetic surveillance; and implementing a
coordinated global response, not hindered by nationalism. Taking measures to
protect vulnerable individuals is particularly important, providing support for
physical distancing and furnishing high-quality masks for people who can’t
afford them.

At the same time, ramping up testing is unlikely to slow transmission and will
only cause more disruption with people staying home from work or school. And
since Omicron is spreading so quickly, contact tracing is no longer likely to be
effective for controlling the virus.

On an individual level, we can get the appropriate vaccines as directed by our
governmental health organizations, taking third doses if we’re eligible. Wear a
mask – ideally a high-quality one – when directed, and when social distancing
isn’t possible.

Q.  What about future variants?

New variants will surely emerge, and some may be more severe than Omicron. When
that happens, we will have a population that has some level of immunity given
how quickly infections are spreading right now, leaving very few people on the
planet who have never been infected or vaccinated. Our hope is that immunity
increases as more people have access to vaccines even if they have already been
infected. We will also have new tools to deploy against COVID-19, namely
antivirals that are already in the works. Therefore, making vaccines and
antivirals available to all countries will be very important. We’ll also need to
improve surveillance for emerging variants to minimize the impact of future
waves. Identifying emerging variants quickly will help us prepare health
systems, implement prevention measures (e.g., high-quality mask wearing and
physical distancing), and adapt vaccines.

Q. Should countries with low vaccination rates due to ideology or poor access to
vaccines also rethink social and governmental controls?

The course of the Omicron wave is unlikely to change due to the speed of
transmission. Our latest models show that the world recorded 125 million Omicron
infections a day. That’s more than 10 times what the world saw at the height of
the Delta wave in April of last year. Our projections show that Omicron will
infect every single country in the world by this spring and that it’s just a
matter of time. Thus, as we see cases increase, hospitalizations will also
increase, and restrictive measures will put additional strain on medical
facilities that are already dealing with extra pressure from staffing shortages.

Q. Does our testing and quarantine strategy need to evolve?

We’re hearing that hospitals and urgent care centers are overwhelmed with
people, especially those who are asymptomatic, seeking COVID-19 tests. This
makes it difficult for health care workers to focus on treating patients with
immediate needs. In addition, infections among hospital workers have prompted
staffing shortages and hindered proper care. Many hospitals and urgent care
centers have already sounded the alarm, asking people to show up only if they
have true medical emergencies such as worrisome symptomatic cases of COVID.
Testing should be reserved for those who are symptomatic and take place at
physicians’ offices or at designated public health testing sites. We’re also
hearing that people are missing work and school due to strict testing and
quarantine guidelines, which also affect frontline workers. More hospitals and
clinics have already begun changing their policies due to staffing challenges,
like allowing workers who are asymptomatic to return to work. How the strategy
is modified should depend on what’s happening in that particular community or
region and the impact to the public.

Q. What does this mean for healthy individuals and the kinds of choices they
should make to reduce of risk of infection?

While the emergency phase of the pandemic is winding down, COVID-19 is not going
away. This means we’ll still have infections around the world, and the choices
people make in their everyday activities will be dependent on their risk
tolerance. Since we know that the effects of Omicron are as bad as someone with
the flu or even milder, people can think back to how they reacted to those with
the flu. Did they avoid people who were sick? Did they get the flu shot on an
annual basis? When cases started to climb, did people avoid crowded venues? On
an individual level, people can still take measures to reduce the probability of
becoming infected with Omicron. That can include waiting until the current wave
is over to gather in large crowds, wearing N95 or KN95 masks properly, and
taking advantage of vaccinations and boosters as they become available.

--------------------------------------------------------------------------------


JANUARY 14, 2022 

This transcript has been lightly edited for clarity

Key takeaways:

 * Infection increase: We’re estimating more than 120 million infections daily,
   this increase has spread to all parts of the world

 * Good news: In some of the countries with early Omicron rises are already
   peaking and coming down

 * Transmission intensity: The transmission intensity of Omicron is so great
   that it has made its way through populations so fast that it has already
   started to decline

 * Omicron and health: The health effects, and the effects on death, are muted

 * 3 parts to this reduction in severity: cases with no symptoms, half as many
   hospitalized with Omicron as it was for Delta, and those who require
   intubation or mechanical ventilation, or fraction to go on to die, is down
   80-90%.

IHME director and lead modeler Dr. Christopher J.L. Murray shares insights from
our latest COVID-19 model run. Explore the forecasts: covid19.healthdata.org.

In this week’s update from IHME on the COVID-19 pandemic, we are tracking and
observing the global Omicron wave. It is unfolding, as we saw in previous
forecasts, pretty much as expected. There has been a massive increase in global
infections – we’re estimating more than 120 million infections each day and a
great reduction in the infection-detection rate, so that reported cases are also
surging but only a tiny fraction of those infections are getting detected. 

It’s a dramatic increase that has spread to nearly all parts of the world, with
the exception of some islands in Oceania and a number of countries in Southeast
Asia; it has yet to turn the case reporting in Belarus, Ukraine, and Russia, and
then there are a few countries in North Africa that have also yet to increase.
Pretty much everywhere else in the world is now with exponential increases in
cases again. Another big exception is in Southern and East Africa and it looks
like all of those countries have peaked, and transmission is on its way down. 

The good news about the Omicron wave is that we are seeing, not only in
sub-Saharan Africa, that some of the countries with early Omicron rises are
already peaking and coming down. 

As far as countries in Europe, perhaps Malta has the most impressive decline,
but the United Kingdom is declining, as well as Cyprus, and we’re seeing what
look like declines in Denmark, Italy, and a number of other countries that are
just at the crest. 

In the United States, we are seeing peaks or what appear to be peaks in about 19
states. Another place that seems to have had quite early peaks that are on the
way down is most provinces in Canada. 

So what does this all mean? It means that, as expected, the transmission
intensity of Omicron is so great that it sweeps through populations in a very
short period of time and then starts to decline. Now the numbers of infections
and numbers of reported cases really seem alarming to most people because they
are much higher than what we’ve seen in other waves in the pandemic. But the
health effects, and the effects on death, are very muted. The reason for this is
because the severity of Omicron is quite dramatically lower than Delta. There
are three parts to this reduction in severity:

 1. The fraction of cases that have no symptoms at all. For Delta, systematic
    review suggested about 40% had no symptoms, but from Omicron, as best as we
    can make out from a variety of data sources, 80-90% have no symptoms at all.
    So of these millions of infections that are happening all over the world,
    there are a huge number with no symptoms at all. This type of observation on
    the fraction asymptomatic is being validated in a number of places, even
    with hospital pre-admission screening of individuals, for example in the US,
    coming to hospitals with no symptoms of COVID-19, but coming to a hospital
    for some other type of procedure, data suggests about 10-12% of patients
    last week were testing positive. Just an example of the prevalence of
    infection in communities is dramatically higher case numbers.

 2. Among those people who have symptoms, the number who end up in the hospital
    due to Omicron turns out to be half as much as what it was for Delta.

 3. For those who end up hospitalized due to Omicron, the number who go on to
    require intubation or mechanical ventilation, or the fraction who go on to
    die, looks like it’s down 80-90%. 

You put this all together, a big increase in asymptomatics, half reduction of
those who go to hospital among those who are symptomatic, and a five-fold or
10-fold reduction of those dying from COVID-19 while in hospital, you get the
observation that Omicron is 90-99% less severe. So that’s really good news. 

--------------------------------------------------------------------------------


JANUARY 8, 2022



This transcript has been lightly edited for clarity

Key takeaways:

 * Projection adjustments: We have made some changes to our assumptions about
   Omicron due to new data from the UK, US, and South Africa.

 * Hospitalizations: The infection-hospitalization rate is higher than we
   previously stated as so many people are getting infected with Omicron.

 * Asymptomatic: For Omicron, there is a much larger share of asymptomatic
   cases, from 40% up to 85% asymptomatic.

 * Daily cases over 5 million: At the global level, we expect that the number of
   cases reported globally will top out in the month of January at over 5
   million cases a day.

 * Routine illness, incidental cases: Increases in hospitalizations partly
   reflect incidental cases, when a patient who is having a heart attack, for
   example, also tests positive for COVID-19.

 * Low death increase: We are seeing a small increase in deaths at the global
   level because of Omicron.

 * Global infection rate: We expect that by March, Omicron will infect 60% of
   the world’s population.

 * Hospitals need support: The number of those asymptomatic and the need for
   health care workers is rising.

So those are the key findings. We're in a very different phase now for the
pandemic, with much greater transmission but far less of a consequence in terms
of serious outcomes such as death.

That increase in hospitalizations at the global level, for example in the US or
India, is actually larger than perhaps the reality of individuals needing to go
to the hospital for COVID-19 because there's so much Omicron transmission in the
community that many people who have other problems—let's say a heart attack—who
show up in a hospital will test positive. 

We're seeing this in the US with reports now from New York state, for example,
that 40-50% of hospitalizations are actually incidental. So the big increase in
hospitalizations is higher than previous peaks in the US, for example, but a
good chunk of that is going to be this incidental surge.

In this week's update of the Omicron surge from IHME, firstly, we've made some
changes to our assumptions about Omicron driven by new data from the United
Kingdom, the US, and recently published analyses from South Africa.

Based on the Office of National Statistics, PCR prevalence surveys in the UK,
and similar but smaller-scale data from South Africa, we have revised the
fraction of infections that are asymptomatic—from what we'd assumed before to be
90%—instead of to a range from 80% to 90%. 

Secondly, we have seen evidence to suggest that the infection-hospitalization
rate—the fraction of infections that get hospitalized—is somewhat higher than
what we said before; that's in part due to the fact that there are so many
people getting infected with Omicron that we get many incidental
hospitalizations, people coming in with some other disease process who happen to
test positive. So to reflect that reality, we've increased the fraction of
infections that end up hospitalized to be centered around about 12.5%. 

Finally, the infection-fatality rate is down slightly from last week because of
a series of studies that suggest that even among those who end up in the
hospital, the death rate is down about 90% compared to Delta. Putting all those
together and putting in the evidence that's emerged of rapid spread in Europe,
the US, and a number of other countries in the world, what we see is an earlier
peak than we previously estimated, so a massive surge of infections peaking in
many countries in mid-January, and then, depending on later introduction, those
peaks can spread out into February.

That peak of infections is translating country by country into record case
numbers in most places. That's a function of the fraction of infections that get
detected, and two factors that are going into that are really challenging in
some settings:

 1. What fraction of symptomatic cases are going to be detected? We expect that
    to sort of stay at the same level as for Delta. 
 2. Then what fraction of them are asymptomatic cases because there are so many
    more of them with Omicron that will get detected?

We're largely trying to look to the recent past and say those
infection-detection rates for symptomatic and asymptomatic will stay about the
same in the future. This is because, for Omicron, there is a much larger share
of asymptomatic cases, from 40% up to 85% asymptomatic.

We expect overall that the infection-detection rate is going to drop a lot.
Having said that, in many countries at testing capacity, there will be record
case numbers. For example: at the global level, we expect that the number of
cases reported globally will top out in the month of January at over 5 million
cases a day. We expect in a country like the United States that reported cases
will exceed on the moving average—not, given the fluctuation, day-by-day and
weekend reporting—but the moving average will go over a million cases a day in
the United States and there will be similar record case numbers in many other
countries. In India, for example, despite a much lower infection-detection rate,
we still think there will be 500,000 cases reported a day at the peak in
January.

Now that huge number of infections with a very rapid exponential rise that we're
seeing in so many countries is going to translate into increased numbers of
hospitalizations. That increase in hospitalizations at the global level, for
example, in the US or India, is actually larger than the reality of individuals
needing to go to the hospital for COVID-19 because there's so much Omicron
transmission in the community that many people who have other problems—let's say
a heart attack—who show up in a hospital will test positive. 

We're seeing this in the US with reports now from New York state, for example,
where 40-50% of hospitalizations are actually incidental. So the big increase in
hospitalizations is higher than previous peaks in the US, for example, but a
good chunk of that is going to be this incidental surge.

Now in terms of death, the good news is that we see a very small increase in
death at the global level in each country because Omicron—even once you get to
the hospital—is so much less severe. If you take in those three factors, a big
increase in asymptomatic cases—maybe 50% reduction among cases—that end up in
the hospital, and then an 80% to 90% reduction in the death rate in hospital,
all of those put together you have a 98% or more reduction in the
infection-fatality rate. 

What can we do about Omicron?
We include in our release an analysis of different scenarios: mask use going up
to 80%, more rapid scale-up of the third dose, a scale-up of vaccinations
reaching the hesitant. The key takeaway from those scenarios in the case of
Omicron—and it varies a little by country—but there's very little impact of any
of those policy scenarios. The reason is that by the time a country is in the
exponential rise for Omicron, transmission is so intense in the community that
there's very little that can be done fast enough to stop this Omicron wave. Now
the flip side of that is that we expect this wave to peak quickly. Where we've
seen data —in South Africa and the UK—the peak from the start takes four to five
weeks, and then it drops rapidly afterward. Now that depends on the timing of
each country—you'll see that in our data visualizations. 

We do expect that by March, the Omicron wave will infect 60% of the world's
population, and in some countries, more than that. The intense part should
probably be over in many places in the month of January. 
We don't expect a lot of deaths from Omicron, but we do expect some
hospitalization, both incidental and truly driven by COVID-19 infection. But
perhaps the thing that's going to cause the greatest challenge is disruption
because of the just sheer volume of people who are going to be positive that
will be picked up on workplace travel or school screening. This large number of
asymptomatic individuals that have been picked up by screening tests will then
be asked to quarantine for some period of time, and that will lead to
considerable disruption. We actually expect that the disruption to the health
care system to hospitals, from staff shortages due to quarantine, from testing
will be greater than the disruption from just the numbers of new cases driven by
COVID-19 itself.

What can we do about the disruptions?
It's challenging given current protocols in most countries that do require
testing and quarantine, but there's a strong case to be made that because 50-60%
of each community is going to get infected with Omicron, and there's little
prospect of infection control, that testing asymptomatic people is perhaps not
useful since we really can't see in our scenarios any way to affect transmission
in a meaningful way. I think many governments are going to need to consider
stopping testing of asymptomatic individuals and revising protocols for
essential workers as to when those who are symptomatic and test positive are
appropriate to go back to the workplace. 

Looking out further as we get many questions about the long-term consequences—of
course, it's very hard to know—but what we do know is that Omicron gives, at
least from neutralizing antibody studies, protection against Delta. We presume,
although we don't have direct evidence yet on it, Omicron protects against
Omicron. We don't expect to see another wave unless of course there's a new
variant, which is certainly very possible. But we do expect, even without a new
variant, that later in 2022 we should see a return of infections in some places,
even if it's just from Omicron due to waning immunity from an infection-acquired
immunity and from vaccination. 

So those are the key findings. We're in a very different phase now for the
pandemic, with much greater transmission but far less of a consequence on
serious outcomes such as death.

--------------------------------------------------------------------------------


DECEMBER 22, 2021



Key takeaways:

 * Infections are predicted to increase: we will see about as many infections in
   the next 2-3 months as we have in the entire pandemic thus far.
 * Fewer infections are likely to be detected: as a larger fraction of cases
   will be asymptomatic (about 90% as opposed to 40% of previous variants),
   fewer people will seek out testing and thus will not have their infections
   recorded.
 * Overall hospitalizations and deaths will be lower than previous surges: the
   infection-hospitalization and infection-fatality rates of omicron are much
   lower than other variants like delta.
 * How is omicron different? It is more transmissible, but much more likely to
   be asymptomatic and much less likely to result in hospitalization or death.
 * Changes to the IHME model: we now track each variant individually and are
   taking into account waning immunity over time.
 * Policy interventions that will help: increasing mask use and increasing the
   number of people getting a third vaccine dose six months after their second.
   Track hospital admissions rather than reported cases, as many cases will be
   mild.
 * How to protect yourself as an individual:
   * Get a third dose of the vaccine if you already have two, or get a first
     dose if you haven't yet.
   * Wear a high quality mask like a KN95 or N95.
   * If you are at high risk due to age or comorbidities, avoid indoor
     gatherings.
 * The severity of omicron is still uncertain: lags in data reporting around the
   new year mean we are unlikely to have clarity for another few weeks.

This transcript has been lightly edited for clarity

We have made a set of models for every country in the world that reflect the
omicron variant -- its dramatic spread around the world, the rapid surge in
infections and cases -- and we have modelled through to what that implies for
hospitalizations and deaths until the beginning of April.

At the global level, we expect 3 billion or more omicron infections in the next
two to three months, which will translate into a tripling of global reported
cases. Because the infection-detection rate is going to be lower, that will
translate into a global surge in hospitalizations, but fortunately smaller than
the previous delta surge and previous winter surge in the Northern hemisphere.
And even smaller will be the global impact in terms of mortality, but global
deaths will go up somewhat in the next few months.

Infection Increase

While we expect -- because of the increased transmissibility of omicron  -- the
immune escape, we are going to see a huge increase in infections globally. Over
the next three months, we expect about 3 billion or more infections. To put that
in context, that's as many infections as we've seen in the entire pandemic so
far. So a really extraordinary increase in infections and daily infections at
the global level will reach a peak over 35 million a day, sometime in
mid-January. To put that in context to the enormous previous peak of the delta
wave in India in April, that was a peak of about 12.5-13 million infections a
day, so triple what we saw before. 

It varies by country, based on how much infection recently with other variants
and the vaccination levels, but at the global level and country by country,
we're going to see a truly enormous surge in infections.

Eventually, in our spread of omicron, we believe that omicron is going to reach
all countries quite soon, given how quickly it has dispersed and how many
asymptomatics there are. We expect even countries that have had very tight
control of borders, such as New Zealand, because of the experience around delta,
and even with managed border crossings (delta getting into the general
population), and given that omicron is more able to do that, we should expect to
see omicron surges in essentially all countries, including in China we suspect
in the future.

Detected Infections vs. All Infections

We don't expect reported cases, which is essentially infections that get
diagnosed (get tested and confirmed as a case), whether they're sympotomatic or
a fraction of asymptomatics that get detected, but we don't expect detected
cases to surge as much as infections. Because there's such a larger fraction of
infections that are asymptomatic, many will not even seek out testing. Only
those that are picked up by some routine screening program, either employee or
school-based are likely to be detected, and therefore we expect to see the
infection-detection rate (the fraction of infections that do get a positive
test) will drop. We should see peaks that are smaller than the number of that
massive upswing in global infections. Probably detected infections at the global
level will be three times that previous peak that we saw for delta and in the US
we expect to top out at somewhere just over 400,000 cases a day.

Hospitalizations & Deaths

The impact on hospitalizations and deaths is what everyone is most concerned
about. That is what I think, if there is any shred of good news in what we're
seeing, that is where we can look. Because of the greatly reduced
infection-hospitalization rate, and the even more-reduced infection-fatality
rate, this massive surge of infections and cases will translate into a smaller
surge in hospitalizations than either the delta wave or the winter peak last
winter at the global level. That story will vary very much by country.

Australia and New Zealand should see a much worse epidemic than they have seen
so far, but many countries should actually see a smaller surge, and certainly a
smaller surge in deaths than their previous surges that they've lived through.

In a country like, for example, the United States, the numbers suggest that
hospitalization will be possibly higher than the delta peak that we saw in early
September, but about the same level as the winter peak last year, in terms of
hospitalization. And then in terms of death, it should be either lower than the
delta peak in September or the winter peak last year.

That story will be very different country by country. One country that is ahead
of others in terms of managing this wave of omicron is the United Kingdom. In
the UK, we expect to see a big surge in infections and cases, a surge in
hospitalization, even though it's not yet appeared, and then eventually a very
modest increase in death, much lower than the previous winter surge last year in
the UK.

How is Omicron Different?

Modeling the impact of omicron and understanding the impact of omicron, we need
to go through the key aspects of the new variant that are going to determine the
next two to three months.

1. So first, omicron we know is more transmissible. And perhaps even more
importantly, there is what we call immune escape, that is that 40-60% of people
that had been infected previously of another variant like delta or the ancestral
variants, are still going to be susceptible to getting omicron. So the
combination is what's driving this very rapid increase in cases that we're
seeing in many countries.

2. Secondly, and very importantly for understanding the impact of omicron, is
that the fraction of infections that are asymptomatic appears to be much higher.
There are a number of sources of data, perhaps the most compelling from South
Africa, but we've seen this in analyses from sports teams in the US as well, but
it's likely that we've gone from about 40% of infections being asymptomatic to
over 90% and perhaps even as high as 95% asymptomatic.

3. Third, given the data that we have available from South Africa, the United
Kingdom, Denmark, and Norway, we see that the infection-hospitalization rate,
that is the fraction of infections that end up in hospital (different from the
case-hospitalization rate, which is just hospitalizations divided by reported
cases, but since many infections go undetected we're talking about the
infection-hospitalization rate), that is probably 90-96% lower for omicron than
for delta.

4. Last, and certainly not least, is that the infection-fatality rate (the
deaths out of those who get infected) is also dramatically lower in omicron
compared to delta, likely 97-99% lower.

Changes to IHME Model

It's been a number of weeks since we've had a model release and the reason is
we've had to substantially modify our model to take into account two really
fundamental things:

1. First, to be able to model omicron, we realized we really needed to be able
to keep track of each variant on its own, infection with the ancestral variant
or with alpha or beta or gamma or delta, and now omicron and a grab bag of other
variants as well. If omicron is able to reinfect people that have had a previous
infection with let's say delta, as the science evolves we'll learn more and more
about the relationship between infection with one variant and the protection it
gives for another variant. So we've revamped the model to capture and track
different variants individually.

2. Secondly, we've taken into account waning immunity. What we've learned is
that infection-acquired immunity and vaccine-derived immunity both wane over
time. That waning is actually pretty fast for prevention of infection, maybe 50%
reduction in immunity at 30 weeks or more depending on the vaccine. And that
waning immunity for preventing hospitalization and death is fortunately slower
than that. Even amongst the vaccines and vaccine-derived immunity, there's quite
a difference with Moderna having the slowest level of waning, followed by
Pfizer, and much faster waning for Johnson & Johnson and AstraZeneca. 

The other thing we've done in the model, is we are capturing the waning of
infection-acquired immunity as well as vaccine-derived immunity. That will make
a big difference to the forecasts we have for each location, depending on how
recent the last delta wave was and where it may stand on vaccination.

Policy Interventions that Will Help

We've included new scenarios in our analysis. We have a scenario where mask use
goes up to 80% (we previously had a 95% mask use scenario, which is the level
that some countries have achieved), but there hasn't been a lot of progress in
countries over the last year in mask use, so we have made a less ambitious,
perhaps more achievable 80% target for mask use. That has a really big effect,
cuts transmission quite substantially, it cuts down on imported cases, it has a
consequential effect on hospitalizations and deaths. 

So mask use comes out in our analysis as by far and away the most effective
strategy to manage omicron right now.

More rapid or increasing third doses of vaccinations, or increasing third doses
above what we assume in the reference scenario, which is we assume that 80% of
those that have been vaccinated with two doses in the past will get a third dose
at six months. In this scenario, we increased that to 100%, so it's a modest
increment in who gets a third dose. That has some effect.

We have not modeled shortening the period of eligibility for a booster from six
months to three or four months. That'll be something coming in the future that's
likely to have a bigger effect than the one that we've modeled so far.

The other thing we've noted on the policy front is that many of the policies
around testing in schools and workplace that evolved for prior variants, with
much high infection-hospitalization rates and infection-fatality rates, and the
required period of isolation after a positive test, are going to be very
problematic during the omicron surge.

Because the numbers are so much larger for omicron, so many people will be
asymptomatic. If you follow the same protocols, you may end up with some
employers with a huge reduction in available staff. I think many organizations
will have to rethink whether or not testing of asymptomatics and isolation is
actually going to make a difference, and is worth the disruption in school or
the workplace.

Last on the policy front, we're clearly in an era where infections (most of
them) are very mild, that even reported cases, many of them are going to be
mild, it's probably time, at least on the local level, to shift our focus from
reported cases to what's happening to hospitalizations.

We believe the timely, relevant metric to track in the future during omicron, is
going to be hospital admissions. That'll help keep focus on severe outcomes and
what is happening in different communities.

How can individuals best protect themselves?

There's a lot that individuals can do to protect themselves if they see the
need.

1. First, getting the third dose if you've already had two doses of vaccination
substantially increases your protection against omicron.

2. Secondly, for the unvaccinated and never infected, they're the individuals at
greatest risk. So if you're in that category, vaccination is really tremendously
important for protecting you from hospitalization and death. And if you are even
previously infected, what we do know is that vaccination on top of previous
infection is going to boost your immune response substantially and enhance your
protection against hospitalization and death from omicron.

3. Third, wear a mask. As we've learned more and more throughout the pandemic,
high-quality masks like KN95s and N95s are better, so the higher quality mask
you can wear, the better you are going to be off in preventing transmission to
you from others of omicron. For those who are at increased risk due to age or
comorbidities, it really makes sense if you want to minimize your risk to avoid
indoor gatherings. That's your safest strategy to reduce personal risk.

Remaining Uncertainties

In modeling omicron, the big challenge and the reason it's taken us several
weeks to get to the point where we have results for every country in the world,
is the remaining uncertainties around critical aspects of omicron.

There is huge uncertainty about how severe it is. Although we put out in our
reference scenario what we think is most consistent with the available data, we
suspect that our forecasts may still be somewhat pessimistic on hospitalization
and death. 

The reason is that we're just not seeing the increase in the United Kingdom in
hospital admissions that we should be, according to our own model. That does
open the door that in future revisions of the model, we may even reduce further
the infection-hospitalization rate. We've already reduced it by a huge
percentage, but we might need to reduce that further.

To encompass the other end of the spectrum, that things may be worse than what
we're seeing, that perhaps in places where there are more people that are
unvaccinated and never infected, omicron could be much worse. We have got a more
severe omicron scenario included in the release, and you'll see in that, that
infections and cases are the same, but hospitalizations and deaths are greater
bcause we've erred on the higher side of the uncertainty intervals that are
compatible with the available data on the infection-hospitalization rate and the
infection-fatality rate.

There's a third question, or issue around uncertainty, which is unfortunately we
don't expect data in the next two weeks to help resolve any of these
uncertainties. Judging by last year, the period from December 20 until about
January 2 or 3 is a period of increasing lags in reporting of cases,
hospitalizations, and deaths, so much so that many efforts in governments a year
ago at this time were very misled by the available data. So we probably won't
get further clarity on some of these assumptions around omicron until well into
the second week of January.

In terms of what are we watching the most closely, that might be changed in
future releases of our model, it's really the fraction that are asymptomatic,
the degree of immune escape, and of course severity, where the evidence may push
us to it's less severe than we previously said or possibly more severe than what
we've said in terms of the infection-hospitalization rate and the
infection-fatality rate.

--------------------------------------------------------------------------------


DECEMBER 17, 2021



This transcript has been lightly edited for clarity

In this week's update from IHME, we are not yet ready to release our models
reflecting the spread of the Omicron variant. We expect to have that early next
week [the week of December 20] as it's taking time to make sense of the Omicron
outbreak.

Presently, we have finalized our Omicron spread model that reflects airline
traffic data, what we've learned from the spread of the Delta variant, and what
we've learned through the spread and rapid-uptake replacement of Delta by
Omicron in South Africa, the spread from Hậu Giang province to adjacent
provinces, and the rapid replacement of Delta in London and other parts of the
UK, Denmark, Norway, Quebec, and even here in Washington state.  

What this information tells us is that once Omicron is in a population, it
replaces Delta in roughly a two- to three-week period, in some places even
faster than that. Based on that spread and the fact that Omicron has gotten to
many countries already, we are expecting that Omicron will be the dominant
variant in most places in the world by January, and our preliminary assessment
of transmission potential suggests that we will have a very large global
epidemic wave from Omicron unfolding at a much faster pace than the Delta wave
spread around the world. 

We will probably reach a peak sometime in January around the Omicron wave, as
there is a very quick process of Omicron spreading rapidly globally.

The biggest issue around Omicron is not whether the main vaccines are less
effective in preventing infection and somewhat less effective in preventing
hospitalization and death; that’s pretty clear now from the evidence. We’re also
pretty clear that there is considerable immune escape, so if you’ve been
previously infected with Delta or other variants, you have a 50% or more chance
of being infected with Omicron. The evidence around those two aspects is
starting to be reasonably clear, but the one that concerns us the most is just
how severe Omicron is. 

We're seeing a number of studies coming out of South Africa suggesting that it
is substantially less severe—anywhere from 75% less severe to even 95% less
severe—that's a difference on the global scale of a huge number of deaths and
associated hospitalizations. 

We are trying to make sense of the available data: we’re looking for early
signals from the United Kingdom, particularly London, and Norway and Denmark,
who are sort of—in terms of outside of South Africa—ahead of other places in
terms of their Omicron surges. 

Where’s the Omicron model update?

We have to be careful in interpreting the evidence as it emerges, because in
previous waves there have been two sources of lags in understanding severity:
one is the lag in just reporting of hospital data. Even in a country as
sophisticated as Norway, there is a three- to five-day lag in the full reporting
of hospital admissions data, so that complicates the story. We know that
transmission, for example, in the Alpha wave and then the Delta wave, appeared
to go first to younger people with a lower infection-hospitalization rate and
then spread into the older, higher at-risk groups. Due to this, there can be a
lag in hospitalizations of two to three weeks.

The next two weeks will be absolutely critical in clarifying how severe Omicron
is, and when we do release our models early next week we will have two
scenarios: one where we take the bulk of the evidence—mostly from South
Africa—and say this is what we believe is the most likely level of severity, and
then we'll have a scenario toward the higher end of the range of uncertainty
that shows if Omicron is more severe, reflecting our inability at this moment to
be sure where the most likely value of severity is for Omicron.

How can we interpret the Omicron data?
It means, irrespective, that the world needs to be ready for a very large wave.
We expect record case numbers in most places from Omicron. The question of
whether hospitals get overwhelmed or if we see a big surge in deaths will depend
on that severity question. 

How can we protect ourselves from the Omicron variant?

 1. Despite our uncertainties about severity, what we do know is that boosters
    make a huge difference to the effectiveness of the immune response, so if
    somebody who is vaccinated gets a booster actually for Omicron, they will go
    back to having very good protection. Boosters are very important.
 2. High-quality mask wearing: because Omicron is so transmissible, one should
    err on the side of a high-quality mask that protects you as well as
    protecting others. An N95-type mask is an effective mask because we know
    that health care workers who use personal protective equipment—particularly
    N95 masks—are not at increased risk, so we know that they work in pretty
    much all circumstances.
 3. Then, of course, for those people who have not been vaccinated, getting
    vaccinated is a critical part of protecting yourself and your family.

On top of the aforementioned, the things that have worked in the past to reduce
transmission will also work for Omicron. Avoiding contact with others is a
surefire way to reduce your risk of exposure to Omicron. Until we’re sure that
it's mild, it makes a lot of sense to pursue a cautious strategy, particularly
over the coming weeks. 

So that's our insights so far; expect more from us early next week.

--------------------------------------------------------------------------------


DECEMBER 2, 2021



This transcript has been lightly edited for clarity

This week at IHME we will not be releasing new estimates for COVID because we
are revising our model to take into account the emergence of the Omicron
variant. We have been working for quite some time toward incorporating into our
model waning immunity: waning vaccine-derived immunity and waning
infection-derived immunity, and the matrix of relationships between different
variants like the ancestral variant, Alpha, Beta, Gamma, and Delta. So with our
new model framework, it is relatively straightforward for us to now incorporate
Omicron, but it does take until next week before we’ll have it ready, we
believe.

Having said that, we have some insights into the critical uncertainties which
will influence how important the emergence of Omicron is. The most important is
that we have this new variant, it has many mutations in the spike protein, and
so from a theoretical basis and a number of lab studies, as well as some
neutralizing antibody-type studies, there’s reason to believe that there will be
less protection from past infection (so more immune escape) and likely reduced
vaccine efficacy. The reduction of vaccine efficacy for preventing infection may
be quite a bit larger than the reduction of vaccine efficacy in preventing
severe disease and death. There is some preliminary data that hasn’t been
publicly released that we’ve seen from South Africa that confirms some of those
expectations. 

So how worried should we be about the Omicron variant? That’s a function of the
following factors in this Q&A:

How much more transmissible is Omicron than Delta?

We’ve seen Omicron, in a relatively short period of time, replace the Delta
variant. We think that’ll hold true elsewhere, and therefore we should expect,
eventually, for Omicron to replace the Delta variant if it gets introduced into
a population.

How severe is the disease caused by Omicron? 

There have been reports of quite mild symptoms from some of the clinicians
treating these cases in South Africa, but on the other hand, if you look at the
hospital surveillance data in South Africa, hospitalizations are already going
up. In the past when we’ve seen new variants emerge, like Alpha, it took more
time for rapid transmission from younger groups to spread into older groups at
greater risk of hospitalization. At this point, our best guess is it’s as severe
as Delta. It may turn out to be less or more severe for that matter.

How much protection does past infection (with Delta or another variant) provide
against the Omicron variant?

This is going to be very important in places with high levels of past infection
– India, for example, with the Delta variant, or parts of Latin America with
high levels from the Gamma variant – whether or not it will be as if they’re a
susceptible population that can now all be infected with Omicron. We would
expect some cross-variant protection, but given all the mutations in the spike
protein, it’s likely greatly reduced – but it’ll take quite some time until
we’ll be sure. There have already been reports out of South Africa of
population-level analyses suggesting low protection from past infection, but
certainly more evidence will need to come to light for us to be sure. 

What’s the effect of the new variant on the known vaccines?

We know vaccine protection wanes over time, particularly their protection
against infection. There’s more resilience of the immunity from vaccination for
hospitalization and death, but we expect some reduction due to the mutations in
the spike protein.

There are many uncertain factors, and we’ll try to reflect all of those
uncertainties in our reference scenario next week. I think the critical thing to
recognize in the face of uncertainty is the main strategies that are likely to
help. 

Main strategy 1: Vaccines – Even if vaccines may be somewhat less effective
against Omicron, they are still effective. So we want to encourage getting
vaccinations and getting boosters out as absolutely essential. When you take a
place where cases are going up dramatically, like Germany, and throw the Omicron
variant into that setting in the winter, we could see vary rapid increases. So
trying to boost immunity back to the levels that can happen after the second
dose of the mRNA vaccines, as an example, could be a very important strategy –
as is reaching those who haven’t been vaccinated to date.

Main strategy 2: Masks – Masks will work just as effectively for this variant,
we believe, as for all prior variants. Certainly high-quality masks will be even
more effective. We know, for example, that N95 masks have low levels of
transmission from healthcare workers: these are very very effective
interventions. This may become an even more credible strategy if there’s rapid
transmission underway in certain countries. 

Main strategy 3: Thoughtful reduction of risky mobility – The last strategy is
to try to slow the spread of Omicron through thoughtful strategies that reduce
the threat of transmission from travelers coming into countries. So screening
travelers and having mask use on planes, for example, make tremendous sense as
cautious strategies. 

So we will be releasing next week results that try to quantify all of these
dimensions. At the end of the day, we can still expect that compared to what we
were saying before, it’s likely that the advent of the Omicron variant means
that our estimates of infections, hospitalizations, and deaths for many parts of
the world will be up very substantially. 

--------------------------------------------------------------------------------


NOVEMBER 18, 2021



This transcript has been lightly edited for clarity

In this week’s update from IHME on COVID-19 around the world and our forecasts
out to March 1, 2022, there’s a number of emerging patterns that we’re seeing.
Transmission for COVID is rising quite rapidly in five groups of countries or
states. 

 1. In South America, we’re seeing increases in Bolivia, Chile, and Colombia.
    Chile is the most notable. In the rest of South America, things are coming
    down. 

 2. We’re seeing a cluster of countries in the Middle East experience increased
    transmission: Algeria, Egypt, Jordan, and Lebanon.

 3. Laos and Vietnam are experiencing significant transmission surges after
    transmission had recently come down due to lockdowns that had been imposed. 

 4. The truly dramatic increases right now that are unfolding are in select US
    states like Michigan where numbers are going up, and a number of other
    northern states. 

 5. The most dramatic increases in COVID-19 transmission are in Europe.
    Interestingly, the countries with the biggest increase are the Netherlands,
    Austria, Germany, Norway, Czechia, Poland, and Slovakia. 

So what’s happening to Europe right now? In the Northern Hemisphere, where the
increases are unfolding, we believe that this is the expected increase due to
winter, but it’s more intense in places where, paradoxically, they have done a
better job during the pandemic with vaccination campaigns and have lower levels
of natural immunity (due to previous infection). It’s hard to explain the
North-South gradient otherwise. And then in Europe, there’s a very sharp
East-West gradient where countries like Bulgaria, Romania, Belarus, the Baltic
states, the Russian Federation – here, transmission is decreasing, and yet these
are the places with the lowest vaccination rates that have dramatically high
levels of past infection. 

Trying to put all the pieces together, what we think we’re observing is the
combination of winter seasonality, the levels of past infection, and waning
vaccine-derived immunity. This may suggest that when you take all the studies on
waning vaccine-derived immunity into account, the winter surges in the rest of
the Northern Hemisphere may be larger than we currently predict and what most
people expect, because there is this cohort of people who were vaccinated more
than six months ago, particularly the most vulnerable. This is something we’ve
been watching quite closely, and there’s a real potential risk of a worse winter
than perhaps we have been expecting. 

Other things to note in terms of the forecasts is that at least in our current
version of the model, we expect the numbers to increase, but not dramatically at
the global level, into and through January, and then start to come down. Big
caveat on those, because we don’t yet include in our model explicitly the waning
of immunity from vaccination or from natural infection. But we are transitioning
to a model that will include that. We’re hoping this will go into our public
release of the model in early December. The testing around that model does imply
that waning immunity is a big issue, particularly for those places that have
historically had high infection-fatality rates and high death rates from
COVID-19. So we will need to understand the strategies different countries can
deploy to address what may be a bigger winter surge than what we expect. 

Three main strategies for countries deailing with a big COVID-19 winter surge
will be:

 1. Trying to vaccinate the hesitant.

 2. Encouraging wearing masks because we know that’s the fastest way to get a
    handle on these surges.

 3. In places that have the supply, consider a third dose of vaccination because
    that has been shown to bring immunity – at least for preventing infection –
    back up and could have an effect on preventing surges in the Northern
    Hemisphere. That’s a more complex issue at the global scale because there is
    still a shortage globally and a real concern about low vaccination rates in
    some low-income countries – so there is a tradeoff at the global scale. But
    from the perspective of controlling the winter surge where we think most
    death is going to occur in the Northern Hemisphere in the next four months,
    that third dose may turn out to be critical.

--------------------------------------------------------------------------------


NOVEMBER 4, 2021



This transcript has been lightly edited for clarity

In this week's release from IHME on the COVID pandemic and forecasts out until
March 1, we see increasing evidence in the Northern Hemisphere that the expected
winter surge has started to unfold. Reductions in cases, estimated infections,
and hospitalizations have essentially stopped in the US, and we are starting to
turn around. Many countries in Western Europe are even farther ahead of the US
in the sense that numbers are going up quite quickly in places like the
Netherlands or Denmark but also in Germany now and in a number of other
countries. 

Rising COVID-19 numbers in the Northern Hemisphere are due to:

 1. Winter seasonality

 2. Waning immunity for those vaccinated

 3. Decreased mask use and increased mobility levels

We have this general pattern of rising numbers due to the three things coming
together in the Northern Hemisphere: winter seasonality, waning immunity for
those who got vaccinated – as we now understand much better as we have more
evidence that vaccine-derived immunity for protection against infection does
wane quite considerably by six months – so we have many people who were
vaccinated early in the Northern Hemisphere who are now likely susceptible.

The third factor that's fueling these winter increases is the fact that people
are much less cautious than last winter, as mask use is much lower. Currently,
it is below 40% in the US – slightly higher than that in Europe, but much lower
than a year ago. People’s mobility levels are just below the pre-COVID baseline
as opposed to 20%-30% below the pre-COVID baseline. Putting those together, we
expect that despite progress on vaccination, we will see a winter surge. The
question really comes down to how big will that Northern Hemisphere winter surge
be. In our current models, it's a relatively modest surge, nowhere near as large
as last year but still enough to put great pressure on hospitals when they have
the combination of expected flu cases as well as COVID-19 (but much less than
last year). 

Waning immunity analysis update for COVID-19 model: 

That forecast may be optimistic because we have not yet built into the modeling
that we are releasing right now the explicit analysis around waning immunity for
vaccine-derived immunity, and we have not built in waning immunity for natural
infection or prior infection. This update will come in our release in two weeks,
and that should suggest a winter surge that is possibly larger. Although, with
the efforts to roll out boosters to counteract that tendency for a bigger
epidemic as well – at least in the US – authorization for emergency use for
vaccinating children ages 5 to 11. Roughly half of the parents of children ages
5 to 11 have indicated that they'll get their child vaccinated, so we do expect
a bump in vaccination rates in the US, around 4 percentage points in terms of
the total population. Many forces are at play that may make our modest winter
surge larger than we suggest, or it may come out to be as we see in the current
set of models.

Elsewhere in the world, we see increasing transmission, although it’s not
dramatic in many regions, in a number of countries in sub-Saharan Africa. For
the first time we're seeing either flattening trends or slight increases in
transmission in a number of countries in South America, although they're heading
into summer in the southern parts of South America. Also, we're seeing
increasing transmission in some parts of Southeast Asia. Clearly, we think those
increases are driven mostly by behavioral relaxation, as people are just not as
careful anymore and that is likely the main driver. Presently, there are no new
major variants yet on the horizon, and if anything, these are not regions that
are moving into the winter season.

Much to follow, but if you step back at the global level, clearly the declines
that the world was seeing that began in late August-early September for
infections and then by mid-September for cases and deaths have essentially
stopped, and we’re starting to see at the global level flattening and actual
reversals.

 COVID is not over as some people seem to think it is, and in fact, we expect
that we're entering a phase where we will have to pay more attention to COVID,
certainly over the Northern Hemisphere winter.


WHAT WE'RE READING THIS WEEK: 

 * Associated Press: Cheap antidepressant shows promise treating early COVID-19 
 * Nature: No causal effect of school closures in Japan on spread of COVID in
   spring 2020 
 * The Atlantic: America Has Lost the Plot on COVID 


IHME IN THE NEWS: 

 * Washington Post: How does a pandemic start winding down? You are looking at
   it
 * NBC: America's falling Covid case rate, in 3 charts  

--------------------------------------------------------------------------------


OCTOBER 20, 2021




THIS TRANSCRIPT HAS BEEN LIGHTLY EDITED FOR CLARITY

In this week’s update from the Institute for Health Metrics and Evaluation on
COVID-19 around the world and forecasts out until February 1, it’s important to
start with the recognition that – at least according to the cellphone-based
mobility data that we use to track every country in the world – we have now
reached a critical threshold that mobility globally is back to the level before
the COVID-19 pandemic began. There are still places in the world, like Southeast
Asia, that are in lockdown, and there are prospects that there may be other
lockdowns with some of the ongoing Delta surges, but it's still quite a
watershed that we're back to a level of interaction and mobility that we haven't
seen throughout the pandemic. 

There are some differences [between mobility prior and now]: we still have 57%
of the world wearing a mask – which varies by country – so mobility is not the
same and life is back to what it was, but it certainly is trending in the
direction of people having more interaction and that plays out in our
forecasts. 

While the Delta wave globally is on the downswing, there are places like Eastern
Europe, Central Europe, some states in the United States, Chile, Baja
California, Australia, and New Zealand, where transmission is still going up and
they're still in the first Delta wave. We do have to recognize that globally
we're on the downswing for Delta, and we expect that decline is going to slow
and actually reverse globally in November. This is because in the Northern
Hemisphere, winter seasonality combined with people being more mobile and fewer
people wearing a mask, we should expect transmission to go back up. We won't see
anything like what we saw last winter in the Northern Hemisphere, but there will
still be a moderate increase in surge – and combined with the fact that mask use
is down, we expect a flu epidemic this winter and, in the Northern Hemisphere, a
lot of pressure on hospitals from the combined effects of COVID-19 and flu. 

There are a number of factors that can really change the next few months: 

 1. What if a new variant shows up that's not included in our model? 
    
    1. There's a lot of discussion right now about the AY4.2 sub-lineage for
       Delta in the UK, but we may be able to explain the increasing case
       numbers in the United Kingdom, Denmark, and the Netherlands with the
       combination of seasonality and behavioral relaxation. We're not yet sure
       that the new sub-lineage is going to have global ramifications, but
       having said that, we should recognize that the narrative that is out
       there that COVID-19 is over is definitely not true and likely things may
       be worse than even what we're saying in our reference scenario because of
       waning immunity.

What we know about waning immunity: 

 1. We know vaccine-derived immunity wanes. 

 2. We know that it wanes for preventing infection rather quickly in some cases,
    but probably much more slowly for preventing hospitalization and death.

 3. Nevertheless, waning immunity means there may be much more transmission
    potential in the winter just as some of the Northern Hemisphere countries
    are in that period where we expect immunity to be down quite a bit.

The other factors that will potentially have the offsetting effects are the
advent of new therapies like the antivirals that we've heard about that can
reduce the infection-fatality rate by up to 50%, and if those are widely used
that could have an impact. Of course if efforts to increase vaccination are
successful, we expand vaccination in those places with supplies, and start
vaccinating children, that can also have a substantial effect.  

Those are the main insights from the modeling this week. We are at that sort of
critical transition now in the next few weeks where we expect perhaps more
countries to start reversing again and seeing winter reversals show up, so it
will be important to watch carefully what the transmission dynamics around the
world look like.


OCTOBER 20 MODEL AND PRODUCTION UPDATE



We have made – last week and in weeks going forward – three major changes to our
modeling approach. These are, we believe, improvements. And then there will be
further changes coming quite soon. So, let me go through the major changes that
have been implemented.

First, we’ve taken on board a huge amount of new data on excess mortality, most
importantly data from the civil registration systems in a number of states in
India, which point out that the death toll related to the Delta surge was much
larger than we previously thought.

We have also improved the way we use statistical models to predict excess
mortality in places where we don’t have the direct measurement of excess
mortality. We use many more covariates or predictors, and that has improved the
robustness of the approach. The key finding there is that excess deaths related
to the pandemic are close to 15 million in the world.

If you think about roughly 5 million reported deaths and 15 million excess
deaths, of course the question is what fraction of those excess deaths are
directly related to the virus and what are due to things related to the
pandemic, but not to the virus infecting particular individuals.

So that’s the second major change, which is an attempt to calculate that number.
The actual data to do that, that is precise and available at the individual
level, is very limited. Some countries, like the Russian Federation, actually
report all the COVID-positive deaths regardless of what it says on their death
certificate, so that gives us some insights. In a place like the Russian
Federation, about 65% of the deaths are directly related to COVID and a third or
more are related to other factors that are related to the pandemic, not directly
to the virus.

We have a few other countries where there have been data audits, like in Mexico,
on causes of death, and in Peru and then a handful of local jurisdictions in the
US and in Europe.

Putting that all together and using some statistical approaches, we have tried
to estimate the fraction of excess mortality that is directly COVID and then
build that into our analysis around COVID. So when you see total COVID deaths
now on our website or in our policy briefs – they used to be excess deaths, all
excess deaths, so the assumption was that all of those were directly related to
COVID – and now we have this more nuanced approach where we’re saying a fraction
of the 15 million deaths are directly due to COVID. That number is not 15
million, it’s closer to 10.5–11 million.

The third major change is the way we estimate past infections, which is a
critical determinant of how much transmission is going on, often called R
effective. And then we use statistical models to find out what are the
predictors of R effective, like mask use or seasonality or mobility as examples.
So it’s really important the way we estimate past infections. We triangulate, as
you may know, based on seroprevalence surveys, based on case reporting, based on
hospitalizations, and based on deaths. And the major change we’ve done is we’ve
added much more extensive analysis of uncertainty, both in each of those factors
– the seroprevalence, how fast do antibody tests wane over time, uncertainty in
the estimate of the infection-detection rate, which is what we use to go from
cases to infections, or the infection-hospitalization rate, or for that matter,
the infection-fatality rate. So, multiple sources of uncertainty are being used.

In some countries with really consistent clear data or states in the US, they
almost don’t change, but in a place where the data are less robust, we see
really quite wide uncertainty in the fraction of the population that’s been
infected already. And therefore wide uncertainty in what has been past
infections by day. And that’s all been rolled into the model release last week
and this week; there’s some description in the policy briefs for last week.

It’s a good indication that we try to keep up with a fast-moving epidemic and we
are trying to constantly adapt our modeling framework to deal with the
challenges that emerge. We are on perhaps the eighth version of our model during
the course of the pandemic if you count all the different subtleties and the
introduction of variants and then immune escape variants and various ways of
getting at past infection.

Not surprisingly, we will be moving in the next few weeks to a model that takes
into account explicitly waning immunity, and the matrix of relationships between
immunity of infection with one variant, including the ancestral variant, and any
other variant. That will allow us to better capture what we don’t capture right
now, which is that more and more people over time, if they don’t get a booster,
will become susceptible again, to at least infection even if they have some
protection against severe disease and death.

Lastly, to capture the fact that right now we’re in this phase of the pandemic
where it’s important to try to stay ahead of developments like waning immunity,
stay ahead of the complex combinations of vaccinations that different
individuals are now starting to receive, stay ahead of the potential of new
variants spreading, and take into account, for example, travel patterns and data
on travel patterns. We will move to a cadence of putting out our updates every
two weeks instead of every week, giving us more time in the intervening weeks to
focus in on these model improvements and model developments.


WHAT WE'RE READING THIS WEEK: 

 * New York Times | F.D.A. to Allow ‘Mix and Match’ Approach for Covid Booster
   Shots
 * Washington Post | Vaccination could have prevented 90,000 deaths over four
   months, study says


IHME IN THE NEWS: 

 * New York Times | ‘Lurching Between Crisis and Complacency’: Was This Our Last
   Covid Surge?
 * Washington Post | So Was Sweden a Covid Success or Failure?
 * South China Morning | Next Covid-19 test? Diagnostic blind spots stir visions
   of bleak midwinter

--------------------------------------------------------------------------------


OCTOBER 14, 2021

We do not have a video update for this week, but we have implemented three major
changes to the COVID-19 modeling strategy. First, we have very substantially
updated the data and methods used to estimate excess mortality related to the
pandemic. Second, we are now estimating the fraction of excess mortality in each
country that is directly related to COVID-19 and the fraction that is increased
mortality in individuals who were not PCR-positive at the time of death. Third,
the estimation of past infection triangulating on cases, hospitalizations,
deaths, and the infection-detection rate, infection-hospitalization rate, and
infection-fatality rate has been revised to capture multiple sources of
uncertainty.

Read »Estimation of total and excess mortality due to COVID-19 for a detailed
explanation of these changes.

For updates on the latest results globally and for individual regions, please
see our COVID-19 policy briefings.

--------------------------------------------------------------------------------


OCTOBER 7, 2021

Our projections will not be updated this week. 

--------------------------------------------------------------------------------


SEPTEMBER 30, 2021



This transcript has been lightly edited for clarity

In this week’s update from the Institute for Health Metrics and Evaluation, the
first key observation is that all the global numbers continue to improve daily
in estimated infections, reported cases, hospitalizations, and reported deaths.
That global improvement does mask the fact that some countries are still seeing
their Delta surges unfold. 

There are two blocks, northern states in the US and many of the provinces in
Canada are one block where transmission is still increasing. There is a big
block of increasing transmission in Central and Eastern Europe right through the
second Delta surge in the Russian Federation. We then have smaller blocks of
countries in other parts of the world like Syria and Egypt which are going up
quite considerably. In sub-Saharan Africa, we see Angola and Equatorial Guinea
also going up rapidly, and in Southeast Asia, Laos and Cambodia are seeing
numbers and transmission increasing. 

Generally, against this backdrop, the main global impact of Delta is now
receding. in our forecasts as we look ahead, we have this driver that is
bringing down numbers, which is the Delta surges decrease because Delta is
running out of people to infect – either because of natural infection or because
of vaccination – and those two processes continue to bring numbers down globally
through October. In November and December, due to winter seasonality in the
Northern Hemisphere, we expect that decline to stop and numbers to start going
back up again.

If you look at the numbers that we forecast in our reference scenario out to the
end of the year, the increase in the winter in the Northern Hemisphere will be
much smaller than last year. We expect nearly as many infections, and as many
reported cases or more because the infection-detection rate is higher than it
used to be. In terms of hospitalization and death rates, they are much smaller
than last winter.

Hospital systems, however, in the Northern Hemisphere may be under just as
severe stress because of the combined impact of flu – which we expect will be
considerable this year – along with moderate levels of demand for
hospitalization and ICU beds for COVID. Unfortunately, health care workers and
health care systems in the Northern Hemisphere may not see a winter that is
better than last year. 

Intervention strategies and individual behavioral choices can make a big
difference to that because, in our scenario where mask use goes back up to a
high level, you could remove most of the impact of a winter surge in the
Northern Hemisphere. 

Now one of the things that we are often asked about is what the prospect is for
a new variant. And to put it in rough numbers, we've had just over 2 billion
infections with COVID so far, and that has led to four major variants that have
had an impact at the population level – using WHO’s nomenclature, Alpha, Beta,
Gamma, and Delta – meaning very roughly, about one major new variant with
population-level impact per 500 million infections. 

The last major variant to emerge, Delta, was very likely quite a bit more than
six months ago, and in that intervening time, there have been many infections at
the global level, well over 500 million. If you want to take those very rough
numbers, you would think that during this period of time perhaps a new variant
has emerged and we just haven't seen it have a population impact yet, or there's
the prospect for new variants to come. Mutations and the emergence of variants
and the spread of them is an incredibly random stochastic event, so we have no
idea when and if a new variant will come. If one emerges with considerable
immune escape, then of course there would be billions of people who would be
available to be infected and pass on the infection, and we would expect a major
surge as we've seen for Delta around the world. That is very much going to be a
function – especially as vaccination rates keep going up and we hope will
continue going up – of whether a new variant has considerable immune escape,
that is it can infect individuals previously infected or vaccinated. So that
question about immune escape and waning immunity from natural infection and
waning immunity from vaccination will be critical to what may unfold if and when
new variants emerge.


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings delivered to your email inbox | Sign-up for weekly
   emails
 * Our COVID-19 publications | View publications 
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * Washington Post | Nearly half of the unvaccinated say they’re willing to get
   a coronavirus shot. The challenge is trying to get it to them. 
 * New York Times | Harris announces $250 million in global funding to fight
   future pandemics. 
 * New York Times | C.D.C. Chief Overrules Agency Panel and Recommends
   Pfizer-BioNTech Boosters for Workers at Risk 
 * Reuters | New York hospitals fire, suspend staff who refuse COVID vaccine 


IHME IN THE NEWS: 

 * NBC | Has the spread of Covid-19 peaked in the U.S.? What future Covid spread
   could look like
 * MSNBC | Transcript: The Rachel Maddow Show, 9/22/21 
 * Nikkei | The new population bomb  

--------------------------------------------------------------------------------


SEPTEMBER 23, 2021



This transcript has been lightly edited for clarity

In this week’s update from the Institute for Health Metrics and Evaluation, we
are seeing the trajectory that we laid out last week with global infections
continuing to decline. We’re down to about 3.6 million estimated infections in
the world, which is similar to what we saw in mid-March. We expect that decline
to continue into the middle of October, and then global infections will start
climbing again, going back up to an estimated 5 million a week by the end of the
year. 

The climb in infections after mid-October will mostly be in the Northern
Hemisphere due to seasonality and the winter season. We expect that the winter
surge will be similar to last year but will be much smaller due to vaccination
and because so many people have already been infected with COVID.

If you put those two together, the cumulative immunity that’s occurring in most
countries and at the global level is starting to be quite considerable. In fact,
at the global level, we think about half the world will have effective immunity
against Delta, either from vaccination or from actual infection.

This still leaves plenty of people to be infected, and we expect transmission to
continue well into next year, even in the absence of new variants. The view of
the bottom of transmission in mid-October and the climb to a moderate winter
surge in the Northern Hemisphere is grounded in our models as they do not take
into account immunity against infection, which does seem to wane after
vaccination and natural infection, as opposed to less clear evidence about
immunity for hospitalization and deaths, which seems to last quite a long time.
Factoring that in might mean that our assessment of what’s coming in the winter
for the Northern Hemisphere is a little bit optimistic.

On the positive front, we are seeing continued spread of first-dose vaccination
in a number of middle-income countries which are getting up to considerable
levels, and we would expect that within about 60 days we would see – depending
on the national vaccination schedule for the second dose – full vaccination
following soon. Making progress on the number vaccinated around the world is
also good news, but the key issue to watch for has been the same issue that
we’ve raised for a few weeks, which is the potential for transmission in schools
with school openings in many countries. Some countries are reporting large
numbers of children in quarantine at home, but other than the double surge seen
in Scotland, we have not yet seen another accelerated surge driven by school
openings. Many will be watching that very closely.

Other things to think about as we roll later into the year is that the Northern
Hemisphere health systems will be facing moderate COVID numbers combined with
large flu numbers. The stress on health systems will be quite considerable in
the Northern Hemisphere. There are specific countries where even though the
global story is progress against Delta, they are still very much in their Delta
surge. These include some states in the northern part of the United States, some
provinces in Canada, some places in northern South America, big set of countries
and regions in central Europe, as well as specific countries around the world
like New Guinea and Australia and a belt of countries south of the Sahel in
Africa where transmission is continuing to increase. 

As we’ve seen elsewhere, we’ll see those Delta surges peak and start to come
down. This general pattern of the Delta surge is starting to diminish, and now
the question is how big will the seasonality-driven increases be in the Northern
Hemisphere. 


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings for select locations and WHO regions delivered to
   your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * STAT | Pfizer Covid-19 vaccine generates robust antibody response in
   children, without serious safety issues, company says 
 * New York Times | An extra J. & J. shot substantially boosts protection
   against Covid, the company reports. 
 * The Washington Post | U.S. to lift covid travel ban, allowing entry for
   vaccinated Europeans and others 


IHME IN THE NEWS: 

 * The Hill | Americans who refuse vaccinations are costing US big bucks as well
   as lives 
 * El Economista | Proyecciones de Covid-19 a fin de año: ¿estará 2021 peor que
   2020 en el mundo y en México?
 * Seattle Times | Spread vaccine mandates to every county 

--------------------------------------------------------------------------------


SEPTEMBER 16, 2021



This transcript has been lightly edited for clarity

In this week’s update from the Institute for Health Metrics and Evaluation, the
good news is that we’re seeing continued drops at the global level in reported
cases and in reported deaths. In our modeling of the true number of infections,
we also see that estimated infections are dropping and getting down to levels
that we last saw in March. We expect that decline to continue for the rest of
the month.

 »Our projections have extended out by a month to January 1, 2021 in this
update.

If we look more in detail about what’s behind those global trends, the peaks in
Southeast Asia and rapid declines in a country like Indonesia continue. Vietnam
has now peaked and is coming down. It’s really only for large countries in that
part of the world – only the Philippines – that has a major Delta surge on the
way up. 

In North America, we’re seeing states in the US and Mexico peak and start to
come down. Meanwhile, Canada is still entering their Delta surges, and so that
is still to unfold. 

In Europe, its sort of a tale of two zones. In western and southwestern Europe,
Delta has peaked and is declining. But there’s a big block from the border of
France right through to the border of the Russian Federation, extending all the
way from Norway down to the border of Greece, where transmission is on the
upswing. 

Read »IHME WHO Euro Region Policy Briefing (Our COVID-19 Projections Explained)
– Sample of the briefing below 


So we also see in some countries in sub-Saharan Africa where transmission is
seemingly still increasing, but none of them have very large surges. These are
either early on, or they’re just not taking off as we’ve seen in some countries
like Zambia or Namibia in the past weeks or months. Learn more in our »IHME WHO
AFRO Region Policy Briefing

South America continues to avoid major Delta surges, and hopefully that will
continue going forward. Learn more in our »IHME WHO PAHO Region Policy Briefing 

In our models, in the Northern Hemisphere – where we would have anticipated a
big winter surge – we see two stories. It’s a function of how many people have
been infected to date, and how many people have been vaccinated. Put those
together and you get our assessment of how many people are susceptible to Delta
infection. 

In most of the United States, what we’ll see is probably declines of the current
Delta peak at the national level, leveling off, and maybe some increase – but
not profound – in December. So we should have many fewer deaths and also fewer
hospitalizations compared to last winter in North America, even if reported
cases are equal to what we saw last winter. That’s again the differential effect
of the vaccines on preventing severe hospitalization and death as opposed to
being less effective for preventing infections.

»Learn more in our COVID-19 Policy Briefing for the United States




In Europe, however, we expect that there will be a winter surge, partly because
fewer people have been infected to date, and vaccination rates are high in the
western part but low in the eastern part of Europe. Put all that together and
what you see is a steady increase into the winter period in our models for
Europe – different expected experiences based on that experience of who has been
infected naturally or through vaccination. 

If we think about the factors we’re worried about that might make our forecasts
not reflect what will happen, there are two big factors: 

 1. Variants. Are there any variants out there like Mu that might be of concern
    to date? We haven’t seen any population-based data to suggest Mu is driving
    surges, so not much concern for us about that yet. But, like Delta back in
    April, variants can completely change our sense of what’s coming.

 2. Waning immunity. Of course, there has been steady evidence emerging from
    England, Scotland, Israel, a Mayo Clinic study in the US – and many other
    studies – that suggest there is waning immunity for infection for all of the
    vaccines. Of course, there is much more of a controversy about whether
    immunity for severe hospitalization and death wanes. Data from Israel
    published in the New England Journal of Medicine this week starts to suggest
    that immunity for severe hospitalization, severe cases, and for death may
    also start to wane. There was also an analysis from Public Health England
    out earlier in the week that also suggested that, at least for those with
    comorbidities, immunity for hospitalization and death also wanes – and wanes
    faster for AstraZeneca than for Pfizer or Moderna.   

Putting all that together, we’re quite concerned about waning immunity both for
infection and severe disease and death. We will build that (we hope, in the next
few weeks) into our models. That will change the long-term trajectory into 2022,
and it’ll also allow us to explore how much we can mitigate, through the use of
boosters or seasonal mask use, what may be a bigger effect in the winter due to
waning immunity than we currently assess.


WHAT WE'RE READING THIS WEEK: 

 * Associated Press | FDA official hopeful younger kids can get shots this year 
 * New York Times | In a new review, some F.D.A. scientists and others say
   boosters aren’t needed for the general population.
 * CNN | Child Covid-19 cases increased nearly 240% since July, pediatricians'
   group says 


IHME IN THE NEWS: 

 * Los Angeles Times | Can California avoid another COVID-19 surge? Britain
   offers a sober warning
 * CNBC | Gates Foundation annual report says Covid pushed 31 million into dire
   poverty, child vaccine rates fell 
 * TIME | The Gates Foundation's 2021 Report Shows That Childhood Vaccinations
   Dropped During the Pandemic—But There's a Bright Side 

--------------------------------------------------------------------------------


SEPTEMBER 10, 2021



This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID pandemic, I think at the
high level, what we’re seeing are a number of countries that have had their
Delta surges peak, and are starting to come down more than a week ago. So many
countries in Southeast Asia have peaked, with the exceptions being Vietnam and
the Philippines. We’ve seen continued declines in all of South America, and
we’re seeing peaks in Southern states of the US, most states in Mexico, and
continued declines in southwestern Europe. 

If you put it all together at the global level, we’re seeing estimated new
infections, reported cases, reported deaths start to go down. According to our
own analysis, estimated daily infections are now at the lowest level we’ve seen
since March. That’s good news at the global scale. It is a mixture of places
where we haven’t seen the Delta surge arrive yet. There are three countries in
Europe, for example: Czechia, Hungary, and Poland, where their Delta surges have
not unfolded yet and we expect them to occur – combined with other parts of the
world where the Delta surges have peaked and then come down. 

As we look ahead, particularly in the Northern Hemisphere, to the fall and
winter, what our models suggest that is in places that are having Delta surges
now – that did worse in the last 18 months, i.e., there are more people that
have been infected, like in the US for example, we may not see a true winter
surge, we may just a shoulder season, where the current Delta surge peaks,
starts to come down, and then we see sustained transmission (maybe slight
increases throughout the season) but not the big winter surge like we saw last
year.

In contrast, in many countries in Europe that have had lower cumulative
infection so far, we may see steady increases in transmission through the winter
season. But again, the surges should not be as large as last year, and certainly
not hospitalizations and death because the vaccines are very effective at
preventing hospitalization and death. It’s because of the vaccinations that
we’ll not see anything like last winter. 

When we think about other parts of the world, the factors that could change the
trajectory of the COVID-19 pandemic are quite clear:

 * First, what will be the effect of school openings? We’ve seen the double
   Delta surge in Scotland, and many attribute that to transmission in schools,
   but we’ve not seen this happen in other parts of the world yet – so it’s a
   big question mark as to how much mitigation in schools is necessary to stop
   rampant transmission in schools. We may see a number of states in the US, for
   example, with surges coming in mid- to late September because of transmission
   in schools. We just aren’t sure.

 * The evolution of new variants. There’s a lot of discussion about the Mu
   variant, but we don’t yet see, at the population level, evidence that this
   variant is driving population-level surges anywhere. That doesn’t mean that
   they won’t occur, but in the previous four variants of concern we’ve seen
   very clear population-level signals that suggest they’re something that can
   drive transmission up substantially, and we don’t see that in Mu so far.
   However, other variants may come along and completely change our assumed
   trajectories in our models. 

 * Of particular concern for the future will be variants that demonstrate more
   immune escape. As the world progressively has more and more people that are
   immune to the Delta variant, either through natural infection or vaccination
   – even taking in to account that neither is perfect for preventing infection
   – we still think that by December 1, 2021, about half the world will be
   immune to the Delta variant. As time goes by, there are fewer and fewer
   people who are available to transmit Delta, but that changes entirely if
   there’s a new variant that can infect people who have been vaccinated or
   previously infected by Delta. 

 * The debate about waning immunity – which is not incorporated right now in our
   models. So far, there's no evidence that protection through vaccination
   against hospitalization and death wanes. All the studies show highly
   sustained protection. But there’s lots and lots of evidence that vaccination
   against infection does wane, and once you build that into the models, that
   means there will be more and more people to sustain transmission later in the
   year. 

At any rate, we expect that there are plenty of people globally on a country by
country basis to sustain transmission well into 2022. And once you factor in new
variants and waning immunity, it’s very likely that transmission will be quite
broad-based throughout the world in 2022 and beyond. 

This leads us to the debate around Zero COVID. 

In a world of waning immunity from vaccination, incomplete protection from past
infection, and the evolution of new variants, we should not expect Zero COVID
strategies are going to work in any countries in the long term. 


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * Executive COVID-19 briefings for select locations and WHO regions delivered
   to your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * New York Times | When Will the Delta Surge End? 
 * PAHO | PAHO launches new collaborative platform to produce COVID-19 vaccines
   in Latin America and the Caribbean 
 * NPR | New Studies Find Evidence Of 'Superhuman' Immunity To COVID-19 In Some
   Individuals 
 * Washington Post | Pediatric cases surge in U.S. as students head back to
   school 
 * Al Jazeera | Rich countries to have 1.2bn surplus COVID vaccine doses 


IHME IN THE NEWS: 

 * NPR | A COVID Surge Is Overwhelming U.S. Hospitals, Raising Fears Of Rationed
   Care 
 * CNN | How many people have died from Covid-19? We may never know 
 * Reuters | U.S. economy's hot vax summer ends in cool COVID fall as Delta
   rises 
 * Washington Post | U.S. covid death toll hits 1,500 a day amid delta scourge 
 * MSNBC | Transcript: The 11th Hour with Brian Williams

--------------------------------------------------------------------------------


SEPTEMBER 1, 2021



This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID pandemic, there are a
number of important aspects to our analysis. First off, we’re seeing a number of
places peaking from their Delta surges, states in the US – a number of them in
the South – a number of states in Mexico have now peaked, a number of countries
in Southeast Asia have peaked and started to come down.

We’re seeing continued increased transmission in other states in Mexico, the US,
and much of Canada. There is sort of a central band in Europe, from Sweden and
Norway right down to Greece, and then a band of countries below the Sahel in
sub-Saharan Africa. Of course, Australasia is having large Delta surges.

So with Delta surges continuing, the experience in Scotland, which is now
entering its second Delta wave, is very important. If you remember, Scotland had
started their Delta surge in July, they reached a peak – a very abrupt decline –
and in the last two to three weeks there’s been a second Delta surge. Scotland
opens its schools earlier, and the current view, given the percent of cases
under the age of 18, is that this second surge is due to transmission in schools
and schoolchildren. Similarly large numbers of schoolchildren now being reported
infected in Israel lends credence to the idea that because Delta is so much more
transmissible, as schools open this may be a real driver for accelerated
transmission. 

In the past, when we’ve seen peaks in transmission, there tended to be many
weeks or months of decline after the peak, the Delta surge in India in April and
May, for example. But now with Delta being so transmissible, combined with
school openings, we may see much more complex patterns.

In terms of our forecasts, what we’re seeing is expected: large transmission at
the global level through to December 1 – throughout that whole period
transmission will be over 5 million infections a day, and we should expect to
see, in our reference scenario, global deaths continuing to be in the range of
8,000 to 10,000 a day. 

Even though vaccination is scaling up, including in many middle-income countries
now, and there’s a cumulative natural immunity through increasing Delta
infections, we are, at the global level, not expecting to see COVID go away in
any sense. 

As we look forward to 2022, there are several things that suggest that we will
see considerable COVID transmission in 2022 as well. We will only have 35% of
the world population fully vaccinated toward the end of the year, and the
combination of natural infection and immunity or partial immunity derived from
that, and vaccine-derived immunity and its partial effect on protection against
Delta infection all combined, we expect that more than half of the world will
still be susceptible to Delta toward the end of the year. Meaning there’s huge
room – even without a new variant emerging – for continued transmission around
the world. 

I think the other critical issue that we’re seeing around the world – both
playing out currently in the policy debate and in our model – is whether
high-income countries and some middle-income countries that are having higher
vaccination rates are starting to debate whether the goal of control is stopping
infection or harm reduction, that is, reducing severe hospitalizations and death
through vaccinations and seasonal mask use for those who are at risk. And that
debate, we expect, will intensify as waning immunity becomes clearer and clearer
that it’s going to be quite challenging in all countries to control infection
fully. 

So those are the sort of main themes that emerged from this week’s analysis. As
we enter September and many countries have school openings, it may shift our
forecasts from our reference case possibly toward our worst case, which has much
larger numbers in the next two months particularly.


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings for select locations and WHO regions delivered to
   your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * NPR | J&J Says A Booster Shot For Its Vaccine May Have Big Benefits
 * NPR | Highly Vaccinated Israel Is Seeing A Dramatic Surge In New COVID Cases.
   Here's Why 
 * New York Times | The Hard Covid-19 Questions We’re Not Asking
 * The Guardian |  WHO monitoring new coronavirus variant named Mu 


IHME IN THE NEWS: 

 * Associated Press | 100,000 more COVID deaths seen unless US changes its ways 
 * Los Angeles Times: Among the unvaccinated, Delta variant more than doubles
   risk of hospitalization 
 * The World | US leads the world in COVID-19 cases, prompting new travel
   restrictions from the EU

--------------------------------------------------------------------------------


AUGUST 25, 2021



This transcript has been lightly edited for clarity

In this week’s update from IHME on the COVID epidemic, we see around the world
that with the Delta surges that have been dominating what’s happening to COVID
pretty much everywhere so far besides South America, we’ve seen a number of
epidemics peak and those peaks are occurring in quite widespread regions. 

So a number of US states – Arkansas, Missouri, Louisiana, Florida, Nevada – have
peaked. We’ve seen similar peaks in previous weeks in Europe, and we’ve seen
some new ones. We’ve seen peaks in the epidemic, unfortunately, in Southeast
Asia in Thailand, Cambodia, and Malaysia as other examples where it appears that
the surges are peaking. So that’s probably the most important observation. 

There’s a cautionary tale, however, in what’s been happening in Scotland,
because Scotland did peak, and then came down by about 60%, and now in the last
8-10 days has had another rather rapid surge. Now I think what this is telling
us is that with Delta being so transmissible, relatively small differences in
behavior can account for transmission going down or transmission increasing
rather rapidly. 

As we head into the season in many countries when children are going back to
school, there’s a particular issue around how much the Delta variant will be
fueled by children’s return to school – and what we’re seeing in Scotland might
unfold in other countries as well. So we’ll want to watch very carefully what's
happening. Other things that emerge from the data, of course, are some places
where there’s a huge population of susceptible individuals – like Australia, as
they haven’t had much in the way of transmission in the past and have not yet
been able to vaccinate a substantial fraction of the population. 

We’re seeing continued very rapid increases in transmission despite lockdown in
the two affected provinces. And I think this again is indicative just of how
much more transmissible the Delta variant is and that strategies that worked
well for the previous variants may need to be stronger if you want to actually
contain transmission through mask use and social distancing. New Zealand is
trying more stringent lockdowns than Australia as they’ve now got community
transmission, and so we have this natural experiment running as to whether those
will work in New Zealand compared to the somewhat less restrictive lockdowns in
Australia. 

Elsewhere, I think monitoring what we’re seeing on first-dose vaccination is
very indicative of where we’ll get to with full vaccination within 30 to 90
days, depending on the vaccine schedule in each country. There’s more progress
in some low- and middle-income countries (LMICs) than I think many people
appreciate – Chile, Argentina, Uruguay, the southern states of Brazil – are
coming up to levels of first-dose vaccination commensurate with many US states
or higher. We have quite high levels of first-dose vaccinations in Saudi Arabia,
the United Arab Emirates, and Mongolia, and so we’re seeing some LMICs catching
up to the high levels seen in western Europe and many parts of North America. 

Will the FDA’s full approval of Pfizer's vaccine change things?

We don’t really know what it’s going to do. The only mechanism that’s going to
have an effect is through more employers feeling like they can mandate
vaccinations, so that could be the vehicle by which we see an impact of the
Pfizer approval by the FDA – normal use approval. But whether there are that
many of the hesitant that of their own right are going to be swayed by that is
unclear. 

So the story as mentioned last week that will also have a substantial effect on
what comes in the next few weeks is – is Delta arriving in Brazil? We’re seeing
some Delta-related increases, we believe, in Rio de Janeiro and a couple of
other states in Brazil, and the sort of unknown factor for us all is what’s the
impact of having been previously infected with P.1 and how much protection the
Gamma variant gives you against the Delta variant. So that’ll be another
important factor in how bad the Delta surges will be in South America, we
believe. 

Last, just a reminder that our models, which suggest that by the end of November
– by December 1st – 35% of the world will be fully vaccinated and about half of
the world will have some effective immunity against the Delta variant through
past infection and or vaccination: these models do not take into account waning
immunity – waning immunity from natural infection and waning immunity from
vaccination. So in many regards, especially as we look farther into the future,
our models are probably optimistic. To put it another way, with 50% of the world
at least – and maybe more – susceptible to Delta on December 1st, we should
expect a lot of ongoing COVID-19 Delta transmission in 2022. And of course if a
new variant comes along, that would be even larger than the current views would
suggest. So that’s the main findings from our analysis this week. 


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings for select locations and WHO regions delivered to
   your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * Washington Post | Third Pfizer dose significantly lowers risk of infection in
   seniors, Israeli data shows 
 * ProPublica | The CDC Only Tracks a Fraction of Breakthrough COVID-19
   Infections, Even as Cases Surge 
 * NPR | They're Asking Biden To Vaccinate The World. It's Not Fair. But It's
   Not Impossible 
 * The Guardian | Ending lockdowns with 80% vaccinated could cause 25,000
   Australian deaths, new modelling suggests 
 * New York Times | F.D.A. Grants Full Approval to Pfizer-BioNTech Covid
   Vaccine 
 * New York Times | Many Older Americans Still Aren’t Vaccinated, Making the
   Delta Wave Deadlier 


IHME IN THE NEWS: 

 * MSNBC | Transcript: The Rachel Maddow Show, 8/18/21 
 * CNN | Study finds 'very concerning' 74% increase in deaths associated with
   extreme heat brought on by the climate crisis 
 * El País | Más de 356.000 muertes en 2019 estuvieron relacionadas con el
   calor 

--------------------------------------------------------------------------------


AUGUST 19, 2021



This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID-19 pandemic, we have made
some changes to the assumptions around the transmissibility of the Alpha, Beta,
and Delta variants – particularly the Delta variant. These changes in
assumptions are based on a statistical analysis on the speed of Delta invasion.
We did this analysis in June, and now we have a couple more months of data.
We’ve re-estimated the combinations of cross-variant immunity (that’s how much
protection you get from previous infection against the new variants) as well as
transmissibility compared to the ancestral or Wuhan variants. That analysis has
led us to lower cross-variant immunity for the Delta variant, down to about 50%
on average, ranging in our models from 30% to 70%, and increased
transmissibility. This has some effects on our forecasts, particularly in
countries where there are many people who are still susceptible, whether they
had previously low infection and/or low vaccination rates.

When we look around the world, we see diverse patterns for the epidemic right
now. A lot of the Delta-driven surges have actually peaked and some are coming
down. We’re seeing peaks in the United States in places like Arkansas, Missouri,
Louisiana, and northern Florida. We’re also seeing peaks in a number of
countries in Europe and Africa. At the same time, we’re seeing Delta show up and
start to trigger surges in places where it hasn’t happened yet, like in Central
Europe, the Philippines, Ethiopia, and Nigeria. 

The unusual pattern in the United Kingdom warrants attention, and it’s certainly
a challenge on the modelling front, where we saw a Delta surge go up, peaks come
down, but now transmission is going back up – albeit much more slowly than the
surge in July, but still important for us to understand what has led to that
increase. The other place that everyone is watching very closely for the
insights it gives on vaccine effectiveness and how it wanes, as well as
cross-variant immunity, is the very substantial surge we are now seeing in
Israel. 

When you put this all together in our COVID-19 forecasts, we see in the Northern
Hemisphere continued quite substantial epidemics from Delta in aggregate running
through to peaks of deaths in, for example, the United States in late September.
Peaks in US cases – probably late August or early September at the national
level – vary by state. In the national forecasts, we expect transmission in
aggregate to keep going up in Western Europe, and peaks may come later in the
year. And we’re actually seeing the phenomenon where you get a Delta surge now,
then it comes down, and then you go into the winter surge in the Northern
Hemisphere, which will be smaller because of the Delta variant infecting more
people (fewer susceptibles), but in many ways there are two waves that are
starting to combine in many countries in our forecasts.

One of the big question marks for us, and of course the countries that are
affected, is that as Delta shows up in South America after they’ve been through
a major P.1 or Gamma variant epidemic, what sort of cross-variant protection is
there from Gamma to Delta? There is essentially no data for us to anchor on for
this, and so this will be a very critical question for how severe a Delta surge
there might be in South America. 

Cases in South Asia remain low, like in India. We’re not seeing a return after
the large Delta surges. Bangladesh has peaked and started and come down.
However, we’re continuing to see – and the forecasts reflect it – big surges in
Southeast Asia. It’s a very mixed story around Delta right now, but essentially
we’re seeing the Delta variant driving the global pandemic – even in the face of
vaccination in many countries.


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings for select locations and WHO regions delivered to
   your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * The Atlantic | How The Pandemic Now Ends
 * ABC News | Younger children more likely to spread COVID-19, study finds
 * CNN | Pfizer submits data to FDA showing a booster dose works well against
   original coronavirus and variant 
 * New York Times | Some Americans will be eligible for booster shots beginning
   in late September, federal officials say. 


IHME IN THE NEWS: 

 * The Guardian | America shouldn’t be sending unvaccinated kids back to school 
 * Associated Press | Analysis: Delta variant upends politicians’ COVID
   calculus 
 * The Hill | Delta's peak is difficult to project, but could come this month 
 * CNN | Studies show White people still dominate health care spending in US,
   despite efforts to even out disparities 
 * Forbes | White Americans Receive Greater Share Of U.S. Healthcare Dollars,
   Study Finds 
 * The New York Times | Racial Inequities Persist in Health Care Despite
   Expanded Insurance 

--------------------------------------------------------------------------------


AUGUST 12, 2021

No update this week. The next model update will be ready on August 19th. In the
meantime, check out the video below to learn more about a recent change to our
model tool from Ben Hurst, a member of our Visualization Team. We now have an
interactive toggle feature to show reported COVID-19 deaths, excess COVID-19
deaths, or both. These differences can vary significantly from location to
location.



--------------------------------------------------------------------------------


AUGUST 5, 2021



This transcript has been lightly edited for clarity

So in this week’s update on our models, first there’s been an important change
in some of our assumptions about vaccination and the effectiveness of vaccines.
We periodically review both the published clinical trials and also the more
numerous post-vaccination studies that have been coming out. This week, we’ve
incorporated another round of that information, including studies in Canada,
Scotland, England and Israel, which suggests two important findings. 

 1. The vaccines are probably more effective than we had previously assumed in
    preventing hospitalization and death, even against the Delta variant. So the
    mRNA vaccines are probably 90% or higher in preventing hospitalization or
    death, and we’ve upgraded quite considerably the estimate of AstraZeneca’s
    effectiveness against the Delta variant for preventing hospitalization and
    death.
 2. In contrast, I think the evidence continues to suggest that vaccines are
    much less effective at preventing infection, and that’s included in the
    latest version of our COVID-19 model, but we’ve not yet included in our
    modeling the evidence coming out of Israel that vaccine effectiveness wanes
    considerably over time from second dose for preventing infection – not for
    preventing severe disease and death, which is the good news, but in terms of
    controlling transmission that waning immunity matters a lot and it should be
    incorporated in our model in the next two weeks or so. 

This makes our model slightly or somewhat more optimistic in countries which
have heavy use of the AstraZeneca vaccine in this week’s release.

 »OUR PROJECTIONS HAVE EXTENDED OUT BY A MONTH TO DECEMBER 1, 2021 IN THIS
UPDATE.

The other important directions that we’re seeing in our models is that we’ve
been accurately forecasting peaks in a number of the delta surges. For example,
the peak in Indonesia we had forecast has now occurred, and the case numbers are
coming down. We’ve also forecast peaks in the near future in Bangladesh and
likely in Pakistan, which are good news if the model turns out to be correct
– and so far we have been tracking it reasonably well in the countries that we
are predicting these peaks in. 

THE GRAPH BELOW IS FROM THE AUGUST 5, 2021 VERSION OF OUR MODEL AND DEPICTS
DAILY COVID-19 DEATH PROJECTIONS FOR INDONESIA. »LEARN MORE IN OUR COVID-19
POLICY BRIEFING FOR INDONESIA.



There are important changes in our forecasts in the United States where we’re
seeing the current Delta surge continuing with deaths starting to rising, and
unfortunately rising into the beginning and middle of September, with cases
perhaps reaching a peak sometime in August and then starting to come down rather
slowly. So we do expect a period of ongoing increased transmission challenges as
schools open in September during a period where transmission is either
intensifying or still very high.

Read »IHME United States Policy Briefing (Our COVID-19 Projections Explained) –
Sample of the briefing below 

 

In other parts of the world, we’re seeing the continued decline in South
America. And that’s in our forecasts as well, they’re continuing to go down in
terms of daily cases and deaths. But we’re seeing this steady surge in Mexico
continue to unfold, and because vaccination rates are quite a bit lower in
Mexico than in, for example, the United States – that is associated with
considerable death unfortunately in the next months.

Read »Time For A Smart Approach To Boosters by Ali H. Mokdad and Eric L.
Ding published in Think Global Health

In other parts of our forecasts, we are having a hard time understanding the
peaks that have occurred in the Netherlands and the United Kingdom and in some
parts of Spain, while at the same time, we’re seeing continued expanded surges
in other parts of Spain, in Italy, and France and Germany. So it’s a very mixed
picture, and these sort of unexpected peaks – at least in terms of the drivers
that we have in our model – are making us really wonder what’s the transmission
dynamics behind those abrupt reversals that we saw in those particular
countries. So we’ll want to track those very carefully in the weeks ahead. One
theory behind is that transmission was mostly in younger groups, and was very
intense, and has actually infected most people in those younger age groups and
so you run out of people to infect and older groups are more vaccinated and
therefore more careful – but that’s just a hypothesis. We’ll have to see if
evidence backs that up.

I’d say in general, one of the phenomenon that we’re seeing as we push our
forecasts out to December 1st, as well as anticipating our forecasts into the
first quarter of next year, is because there’s a lot of people that have been
infected already in many countries – particularly those places that have bad
epidemics – and there’s now a big body of people that are also vaccinated, we
start to have quite a substantial fraction of the population that are now
immune, even taking into account immune escape and partial effectiveness of the
vaccines against infection. Even taking that into account, we’re up in the
high-50s of percent of the population that are immune in some countries, and
that’ll go up to about 70-percent in December for example in the United States.
What that means is that we are now anticipating that the winter surge in the
Northern Hemisphere may be smaller than we had previously thought it would be.
One way to think about that is that the Delta surge is infection enough people
earlier so that those infections have moved earlier in time, so we’ll see less
of it concentrated in winter. That may then put less pressure on hospitals when
they experience a flu epidemic this coming winter, if the COVID surge is more
spread out over time due to the Delta variant. 

Super important but quite complicated interactions here, especially as we get
closer in many countries to a much smaller fraction of the population that can
get infected. All things we’ll want to keep tracking in the weekly modeling
updates as we look farther and farther into the winter.


IHME COVID-19 RESOURCES: 

 * Policy briefings (projections explained) for 230+ national and subnational
   locations | Explore the briefings
 * COVID-19 model briefings for select locations and WHO regions delivered to
   your email inbox | Sign-up for weekly emails
 * Our COVID-19 publications | View publications related to COVID-19
 * Question about our projections? | Read our FAQs or email us
   engage@healthdata.org


WHAT WE'RE READING THIS WEEK: 

 * NPR | Biden's COVID-19 Response Coordinator Discusses The Plan To Stop The
   Delta Variant 
 * Washington Post | ‘The war has changed’: Internal CDC document urges new
   messaging, warns delta infections likely more severe 
 * STAT | Efficacy of Pfizer/BioNTech Covid vaccine slips to 84% after six
   months, data show 
 * The Atlantic | Congress Is Slashing a $30 Billion Plan to Fight the Next
   Pandemic 
 * Reuters | Delta infections among vaccinated likely contagious; Lambda variant
   shows vaccine resistance in lab 


IHME IN THE NEWS: 

 * The Washington Post | When will the summer coronavirus surge peak? It will
   get worse before it gets better, experts predict
 * NPR | Biden Has Sent Millions Of Vaccines To Nations In Need. Millions More
   Are Needed  
 * Associated Press | Schedule of ‘planned COVID-19 variants’ is fake 

--------------------------------------------------------------------------------


JULY 29, 2021



First and most importantly, there continues to be an overwhelming need for
redistribution of COVID-19 vaccinations from high-income countries lacking
demand to other countries that are lacking supply. Top locations where we are
observing significant surges:

 * Southeast Asia
 * United States
 * Bangladesh
 * Iraq
 * Iran
 * Lebanon
 * Mexico
 * Across Sub-Saharan Africa

Fortunately, the Centers for Disease Control and Prevention has changed their
guidance by recommending that vaccinated people in the United States wear masks
in areas of high transmission, and that’s going to help pull the brakes on
continued transmission. This decision by the CDC may have some influence in
other countries. But in the places with really large surges and relatively low
vaccination, some of the stronger social distancing mandates may be needed to
keep the death toll from being really large. For most of 2020, we’ve had about 5
million infections per day at the global level. We’re now settling into about 6
million infections per day. COVID is now worse than it was in 2020 – on average
at the global level. It is certainly not over.


IHME COVID-19 RESOURCES: 

 * COVID-19 policy briefings for 200+ national and subnational locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs


WHAT WE'RE READING THIS WEEK: 

 * STAT News | Public health officials have tools to beat back Covid again. Does
   anyone want to use them? 
 * Reuters | Africa demands local production of COVID vaccines 
 * The Guardian | Covid cases in US may have been undercounted by 60%, study
   shows 
 * New York Times | The C.D.C. will recommend that some vaccinated people wear
   masks indoors again. 
 * Associated Press | Tokyo sets another virus record days after Olympics begin 
 * Al Jazeera | Bhutan fully vaccinates 90 percent of adults within a week 


IHME IN THE NEWS: 

 * NPR | Public Health Experts Call On CDC To Endorse Masking Indoors
 * FOX | Dr. Murray on the Neil Cavuto Show
 * Al Jazeera | Indonesia: Raging pandemic offers fertile ground for new
   variants
 * NBC | Biden administration to recommend the vaccinated wear masks in areas
   with low vaccination rates
 * NBC | Experts back CDC change on masks as delta variant spreads 
 * Los Angeles Times | A timeline of the CDC’s advice on face masks 

--------------------------------------------------------------------------------


JULY 22, 2021



This transcript has been lightly edited for clarity

In this week’s assessment of the pandemic and modeling from the Institute for
Health Metrics and Evaluation, I think we’re seeing the continued critical role
of the Delta variant driving transmission in many parts of the world. We’re
seeing most of North America with substantial surges. For example, surges in the
United States were faster than we predicted last week, so surges are
accelerating.

(Explore projections for the United States.)

In Europe, we’re seeing very large surges in tourist destinations – Spain,
Cyprus, Malta, Greece. Also, there are big surges in the Netherlands, and much
smaller surges in other parts of Europe. In Central Europe, it really hasn’t
started yet. 

We’re seeing a peak in transmission in Russia, we think, which is certainly good
news because of the large Delta surge there. We’re seeing Delta surges
throughout Africa. We’re also seeing Delta surges throughout Southeast Asia, in
Thailand, Indonesia, and Vietnam keep accelerating.

The theme of what we saw last week – which was the theme of Delta surges
continuing – we’re also seeing in our forecast models that at the global level,
because we’ve made a revision to how we think mobility may evolve, there is no
evidence that mobility is declining in response to these surges in most places.
We think we’ve taken that into account in this week’s model. So our forecasts
for the next four months are up at the global level. It’s particularly true in
parts of the world like Southeast Asia, but there's much less effect of those
revisions in the US or in Europe.

Our forecasts have this surge continuing. It goes up at the global level until
early September. It comes down a little bit, and then, as the Northern
Hemisphere’s late fall/winter surge starts to take off, we expect numbers to
start to creep back up again.

It’s quite a complex picture, but one that’s dominated by how the Delta variant
evolves. I think the critical question in understanding the hospitalization and
death rates that we might expect to see is really how effective are the
vaccines, first – vaccine by vaccine – at preventing infection. That’s built
into our model, and we’ve done a systematic review of trials and
post-vaccination studies. But then the part that’s less understood is the effect
of the vaccines on the Delta variant in preventing hospitalizations and deaths.
We know quite a lot about preventing symptomatic disease, and that’s built into
our modeling. But the studies that focus on hospitalization and death – many of
them had too small numbers to have narrow enough uncertainty intervals for us to
adjust our predictions on the basis of a difference between symptomatic disease
and severe disease leading to death.

That evidence is starting to accumulate in places that have a lot of
hospitalization, such as the United Kingdom, and we expect to better reflect
that in the future. 

(Explore projections for the United Kingdom.)

But to get that data on how good vaccines are against the Delta variant,
countries need to be reporting disaggregated data by age, sex, and vaccination
status. In some countries that’s happening – the United Kingdom is an example
– but it’s not happening in many countries, including the United States, where
it’s actually quite difficult to get information on breakthrough infection, and
there has actually been guidance from the CDC discouraging the testing of
asymptomatic or mildly symptomatic individuals who have been vaccinated unless
they end up in the hospital. That’s making it harder to see how much we can rely
on the vaccines against the Delta variant for that critical outcome, which is
hospitalization, and the more critical outcome which is, of course, death. We
hope there will be more reporting of that kind of data in the future. That’ll
give us more information on how well we can rely on vaccines as the main
management strategy, but also as waning immunity from vaccination and natural
infection kicks in, we should expect vaccine efficacy to also be changing. So
having good surveillance will just be critical as we manage both the current
Delta surge, likely fall/winter surges in the Northern Hemisphere, and the
strong prospect that there will be other variants that will emerge which we’ll
need to understand quickly so that we can help understand which communities will
face major surges from COVID and plan accordingly.


IHME COVID-19 RESOURCES: 

 * COVID-19 policy briefings for 200+ national and subnational locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs


WHAT WE'RE READING THIS WEEK: 

 * The Hill | Top health expert says vaccinated people are spreading delta
   variant
 * CNBC | U.S. heading for ‘dangerous fall’ with surge in delta Covid cases and
   return of indoor mask mandates 
 * NPR | Where Are The Newest COVID Hot Spots? Mostly Places With Low
   Vaccination Rates 
 * Boston Globe | The world is unprepared for new ‘age of pandemics,’ G-20 panel
   warns 
 * Washington Post | New study on delta variant reveals importance of receiving
   both vaccine shots, highlights challenges posed by mutations 

--------------------------------------------------------------------------------


JULY 15, 2021



This transcript has been lightly edited for clarity

So in this week's update from the Institute for Health Metrics and Evaluation,
we are seeing a number of developments around the world that, at the highest
level, can be summarized as outbreaks driven by the spread of the Delta variant.
Generally speaking, if we go region by region, the good news in South America is
that transmission is trending down finally. But in contrast, in Central America
– particularly Cuba and many states in Mexico – and 28 states in the United
States, transmission is increasing. We think this is largely due to the spread
of the Delta variant, although low sequencing rates in Mexico make it hard to be
absolutely sure, but the timing and geographic proximity do make it seem that
the Delta variant is fueling these increases.

(Explore projections for Cuba, Mexico, and the United States.)

And these increases in transmission are occurring in some places – some of them
with 50% of the population or even higher, in the US for example – that are
vaccinated. So they are occurring in the unvaccinated and breakthrough
transmission in the vaccinated.

(Listen to IHME Professor Ali Mokdad on Twitter share recommendations for
vaccinated individuals in the United States.)

Similarly, we are seeing a mixed pattern of Delta surges in select countries in
Europe: the Netherlands, Spain, Greece, and Cyprus are having surges that have
erupted rather abruptly due to the Delta variant, though we're not seeing yet
these same surges in Germany, Italy, or in many other parts of Eastern Europe.
We are seeing large Delta variant surges in Russia, Kazakhstan, and other parts
of Central Asia.

(Read our COVID-19 policy briefing for the WHO-EURO region.)

Elsewhere, in sub-Saharan Africa, there are many countries with surges. Albeit
there have been some that have gone up, like Uganda and Zambia, that have peaked
and have started to come down, which holds out the prospect that we'll see less
dramatic, sustained surges in other countries in Africa.

(Read our policy briefings for Uganda and Zambia.)

Of course, the other big story is the eruption after relatively good control in
Southeast Asia. Thailand, Vietnam, Indonesia, and Malaysia have had large
COVID-19 surges.

(Explore our projections for Thailand, Vietnam, Indonesia, and Malaysia.)

When we look at our models for the next four months, the timing of the Delta
surge is absolutely critical, as is the race against the Delta variant in terms
of vaccination rates. Our models for the world are certainly an increase in
forecasted cases and deaths compared to our last release two weeks ago. But in
general, our global forecast is for this current Delta surge to play out, lead
to increased numbers between now and early September, a decline globally, and
then a return to increasing numbers at the end of our forecasting window in
November. When we run the models out farther, we see a Northern Hemisphere surge
coming later in the year as well.

(Explore our global projections.)

So the main message from this week's analysis is the dominant role of the Delta
variant. that even in places with quite substantial vaccination rates like
Israel, we are seeing increased transmission rates. There's enough breakthrough
transmission that we see enough "susceptibles," or kindling so to speak, that
we're seeing transmission expand. This holds out the prospect that we could see
Delta surges even in places our model doesn't predict to have surges due to the
ingredients being present. Those ingredients are fewer people with previous
infection, lower vaccination rates, and behaviors that are going back to
pre-COVID levels of interraction, and minimal mask use. I think, moving forward,
the recommendation from many public health authorities that it's okay for
vaccinated individuals not to wear a mask will probably need to be reconsidered
in those settings where there's a major surge due to Delta since we now know
that the vaccinated play an important role at least in getting infected, and
also are very likely contributing to transmission. 


IHME COVID-19 RESOURCES: 

 * COVID-19 policy briefings for 200+ national and subnational locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


JULY 8, 2021

We will not produce COVID-19 forecasts this week as we will be implementing some
changes to our modeling framework. 


IHME COVID-19 RESOURCES: 

 * COVID-19 policy briefings for 200+ national and subnational locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


JULY 1, 2021



This transcript has been lightly edited for clarity

There’s a lot happening on the COVID front, and I think it’s largely being
driven – but not exclusively – by the Delta variant. If we start in Europe where
there has been a lot of attention, we’re continuing to see an absolutely
explosive surge in the United Kingdom. It’s farther along in Scotland, and now
case reports are at the highest levels of the whole pandemic than they’ve been
at this point in the pandemic despite moderate levels of vaccination and some
number of people who’ve been previously infected. This is spreading to England,
Wales, and Northern Ireland as well. 

(Read our COVID-19 policy briefing for the United Kingdom.)

On the eastern part of Europe, we see the Russian Federation having the other
major surge for COVID. This is happening in a population that has not got high
levels of vaccination, but 80% of the population was previously infected. This
suggests that the Delta variant is highly transmissible and has a considerable
degree of immune escape. The other thing that’s happening in Russia in the case
of natural infection is that deaths are tracking up in parallel with cases going
up. 

(Read our COVID-19 policy briefing for the Russian Federation.)

The surprise in the rest of Europe is that, in aggregate, cases are trending
down quite briskly. So even though the variant has been detected in many other
countries in Europe, only in Portugal is there is a slow increase in cases – and
in Cyprus a faster increase – but in most of the rest of the countries in
Europe, although the variant is present in many, we’re not yet seeing things
take off. It’ll be important to see how that unfolds. 

(Explore our projections for Portugal and Cyprus.)

In Southeast Asia, we’re seeing large increases in Indonesia and we’re also
seeing steady increases in Thailand and Cambodia. We expect that these are
driven by the Delta variant and we do expect them to continue, and our forecasts
therefore have a considerable increase in deaths in a number of countries in
Southeast Asia. 

In Bangladesh, the government took off the social distancing measures that
brought the surge under control. Now the surge has come back, and the government
has re-established stay at home orders. We’re not seeing this yet in India;
there are two or three states where the decline in cases has slowed or stopped.
We’ll have to wait and see if what has happened in Bangladesh will now happen in
India. It’s quite plausible that it could spread to many states in India in the
next two or three weeks.

(Read our COVID-19 policy briefings for Bangladesh and India.)

In sub-Saharan Africa, there are continued surges in a number of countries, but
not all. The glimmer of hope there is that the surge in Uganda, which is in one
of the earlier surges in what we think is a Delta-driven wave, has peaked and
come down. They have had a number of social distancing measures in place, so it
argues that those measures have been effective, and that similar measures
elsewhere can help bring surges under control.

(Explore our projections for Uganda.)

In Central America, the big news is that the increasing number of states that we
see in Mexico where cases have been going down are now going up. Some of the
surges are quite brisk. It’s somewhere near half the states in Mexico now
showing increasing case numbers. The big question in Mexico is, is this due to
the P.1 variant spreading in from South America, or is it due to the Delta
variant spreading in from England or India? We don’t know – there’s very limited
sequencing in Mexico. It of course makes a really big difference for the next
month and into the fall for Mexico if this is P.1-driven and Delta will come
after? It’s hard to know what the correct answer is. 

(Read our COVID-19 policy briefing for Mexico.)

In South America, the trends are – in aggregate – on the slow and steady
increase up, reflecting this experience we see in Ecuador and Peru of flat or
slightly increasing case numbers over a prolonged period. We’re seeing similar
patterns in some states in Brazil, too, though many countries in the southern
cone have started to experience declining cases. 

In the United States, of course concern is high that the Delta variant may lead
to something that we’re seeing in Scotland like an explosive exponential growth
in cases. We are seeing hospitalizations go up in Missouri, Arkansas, Nevada,
Mississippi, and a number of other states. In some of those states, while
hospitalizations are trending up, cases are not. We expect the disconnect
between cases and hospitalizations is because of CDC guidance to states and
health providers to not test vaccinated individuals. While we understand why
that guidance was given, to create an incentive for people to get vaccinated and
to avoid reports of cases in the vaccinated, it is making it harder to track
whether the Delta variant is leading to an increase in transmission. Our models
for the US show increases, but not dramatically, over the next two-three months.
We expect the more dramatic Delta variant increases to come later in the year as
seasonality works against us as well.

(Explore projections for the United States.)

That’s the diverse set of trends we’re seeing around the world, clearly at a
critical junction in the epidemic where we race to vaccinate as many people as
possible while the Delta variant is leading to these outbreaks in many regions
around the world. 


IHME COVID-19 RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs


WHAT WE'RE READING THIS WEEK: 

 * New York Times | Training The Next Generation of Indigenious Data Scientists

 * NPR | Bangladesh Locks Down As Daily COVID Cases Quintuple 

 * Times of Israel | Israel to reinstate indoor mask mandate next week as
   COVID-19 cases keep rising

 * Reuters | Afrigen gears up to deliver Africa's first COVID-19 mRNA vaccine 

 * ABC | US had nearly 17 million undiagnosed COVID-19 cases in early months of
   pandemic: Study 

 * Times of Israel | Israel to reinstate indoor mask mandate next week as
   COVID-19 cases keep rising 

 * New York Times | Pfizer and Moderna Vaccines Likely to Produce Lasting
   Immunity, Study Finds 

 * Associated Press | Red Cross warns Indonesia faces coronavirus catastrophe 

--------------------------------------------------------------------------------


EDITOR'S NOTE

We have made a change in our COVID-19 model visualization tool, where we were
showing estimates for reported COVID-19 deaths – which is measurements that come
through the official measurement systems. Now, you can toggle to looking at
estimates from the past and forecasts for the future of total excess mortality
related to the pandemic. We had made a change back in May to show total excess
mortality in the viz tool first, but because people are more familiar with the
numbers on reported deaths, we're reverting back to showing that as the first
view.

--------------------------------------------------------------------------------


JUNE 24, 2021




RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


JUNE 18, 2021



This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. We now project about
9.2 million deaths from COVID-19 by September 1 globally (our projections run
through October 1). Global cases and deaths continue to decline, in large part
due to the declines in India. However, there are many differences between
countries and regions when it comes to infections and mortality. 



(View policy briefings for India.)

In Europe and North America, due to the rise of vaccinations and seasonality, we
are seeing a decline in cases. However, in certain locations in Europe, such as
Scotland, we see a rise in cases due to premature relaxation of social
distancing measures – even with a high vaccination rate – due to the arrival of
new escape variants. 

(View policy briefings for the United Kingdom.)

Cases are increasing in many Caribbean countries and parts of Mexico in South
America due to the circulation of the variant P.1 (first discovered in Brazil)
and possibly by the increase in circulation of the variant B.1.617 (first
discovered in India). 

In Southeast Asia, a number of locations – Malaysia, Taiwan, and Vietnam – are
experiencing a rise in cases mainly due to the arrival of the variant B.1.617
(first discovered in India). 



(View policy briefings for the WHO SEARO region.)

In many places in the world, such as Eastern Europe and Southeast Asia, where
mask wearing is very low, mobility is very high, and confidence is very low
– even with previous high infection rates we are seeing a surge of cases. There
is a potential for a surge of cases, especially with new escape variants that
are making the vaccines less effective, and of course previous infections do not
provide as much immunity against them. In many countries, distribution of the
vaccines is still very low and their health systems are unable to contain the
surge.

The best strategies to contain the surge in the days to come are improving
social distancing measures within the country, limiting the introduction of the
virus through control at the airports and through isolations, and asking people
to change their behaviors by avoiding gatherings, wearing a mask, and getting
the vaccine as soon as possible. 

COVID-19 cases and deaths continue to decline in the United States due to
seasonality and the rising vaccination rates. We now estimate that about 170
million Americans will be fully vaccinated by September 1 (our projections run
through October 1). About 30% of Americans who are now eligible to receive the
vaccine are hesitant and report that they will not take the vaccine. Also,
children under the age of 12 are still not eligible to get the vaccine.



(View policy briefings for the United States.)

Despite the fact that about 25% of Americans have received the mRNA vaccines,
our best vaccines, many people are still susceptible to getting infected by
COVID-19 – especially with the new escape variants that are now circulating
through many states. We know, for example, that P.1 is circulating in several
states and has started replacing B.1.1.7 (first discovered in the UK), which has
been circulating in many states. We estimate that about 50% of Americans will
remain susceptible to COVID-19 and this may sustain a surge in the winter. The
best strategies to prevent such a surge in winter are to address vaccine
hesitancy, expedite the rollout of the vaccine, and ask people to wear masks as
soon as possible – especially when we start seeing cases going up at the
beginning of winter. 


RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


JUNE 10, 2021



This transcript has been lightly edited for clarity

The main findings from this week's analysis are concentrated in several areas.
First, I think we're seeing evidence in Scotland particularly, but also England,
that even in a moderately vaccinated population the COVID-19 variant B.1.617.2
(Delta variant) has enough immune escape from at least AstraZeneca that we’re
seeing rapid expansion of transmission. This is something to watch closely, and
may be a marker for other countries that have used AstraZeneca, or have used
some of the other vaccines are not as effective as the mRNA vaccines.

(See our vaccine efficacy table.) 

The second area that I think is of huge concern is the really rapid increases in
select countries. These include Uganda, Zambia, DRC, and some substantial
increases in Namibia. These definitely raise questions as to whether these are
surges driven by (the Delta variant) B.1.617.2 or – in the case of Namibia – is
it just what's happening in neighboring South Africa, where they're hitting a
peak of seasonality, and it's still a B.1.351-driven surge.

(View policy briefings for the AFRO Region.) 



Elsewhere in India, the pandemic continues to decline. We’re seeing some
suggestion that lockdown and other measures is leading to a peaking of
transmission in Taiwan, and it’s important because it suggests that the measures
we’ve been using throughout the pandemic work – including against (the Delta
variant) B.1.617.2. That control in Taiwan is something we want to watch very
closely.

(View policy briefings for India and Taiwan.)

In Latin America, in Chile, another warning that with high vaccine coverage (80%
with one dose) they’re still seeing quite steadily rising cases. That could be
quite low efficacy of the vaccine against the variant P.1, which is still what
we think to be the major variant in Chile.

(View policy briefings for Chile.)



Generally the Southern Hemisphere is starting to decline again as we would
expect. In the rest of Europe and to some extent in the US and Canada, I think
we’re seeing that seasonality is very strong. We're seeing declines in
transmission beyond what we would expect to see with just the scale-up of
vaccination, which is markedly different across Europe from east to west. 


RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


JUNE 4, 2021

No video this week. Check the resources below for details on the latest
estimates. 


RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


MAY 28, 2021



This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. We are projecting
about 9.2 million deaths globally by September 1. Global cases and deaths
continue to decline, in large part due to the declines we see in India. There
are differences in countries and regions when it comes to infections and
mortality. 

In Europe and Northern America, due to the rise in vaccination and seasonality,
we are seeing a decline in cases. However, in certain location in Europe – for
example in Scotland – we see a rise in cases due to a premature relaxation of
social distancing measures, even with high vaccination rates, especially with
the arrival of new escape variants.

Cases are increasing in many Caribbean countries and in parts of Mexico and
South America due to the circulation of the P.1 variant, first discovered in
Brazil, and possibly by the increase in circulation of B.1.617, first discovered
in India.

In Southeast Asia, a number of locations like Malaysia, Taiwan, and Vietnam are
seeing a rise in cases mainly due to the arrival of B.1.617.

In many places in the world, such as Eastern Europe and Southeast Asia, where
mask wearing is very low, mobility is very high, and confidence in vaccine is
very low – even with a previous high infection rate – we’re seeing a surge in
cases. There is a potential for a surge of cases, especially with new escape
variants that are making the vaccines less effective, and previous infections do
not provide as much protection against it. In many of these countries, vaccine
distribution is very slow, and they’re not able to contain the surge.

The best strategies to contain the surge in the days to come is improving social
distancing measures within the country to contain the spread of the virus, limit
the production of the virus through control at airports with isolation, and ask
people to change their behaviors: avoid gatherings, wear a mask, and take the
vaccine as soon as possible. 

COVID-19 cases and deaths continue to decline in the United States due to
seasonality and the rising vaccination rates. We now estimate that about 170
million Americans will be fully vaccinated by September 1. About 30% of
Americans who are eligible to take the vaccine remain hesitant and report they
will not take the vaccine. Also, children under the age of 12 are still not
eligible to get the vaccine. Combine that with the fact that about 25% of
Americans who receive the mRNA vaccines are still susceptible to getting
infected by COVID-19, especially the new escape variants that are now
circulating in the United States. For example, we know that P.1 has started
circulating in several states and started replacing B.1.1.7. We believe that
about 50% of Americans will remain susceptible to COVID-19, and this percentage
will sustain a surge in winter. The best strategy to prevent such a surge in
winter is to address vaccine hesitancy, expedite the rollout of the vaccine, and
ask people to start wearing masks as soon as possible – especially if we start
to see cases going up at the beginning of winter, as we expect. 


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19
 * World maps of COVID-19 mask use
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


MAY 21, 2021



This transcript has been lightly edited for clarity

Our results are quite similar to last week’s forecasts. There are some important
points to notice in what we’re seeing develop around the world. As expected and
as forecasted for the last 4-5 weeks, cases have peaked in India and deaths and
are now peaking as we expected. We should see by next week, we believe, deaths
going down at the national level. There is some variability across states, but
good news in a very dark story that at least currently the death toll is started
to come down. 

(View projections for India.)

Elsewhere around the world, places where there is a continued marked increase in
cases include Japan. The steady rise in cases and deaths certainly are going to
cause considerable concern and discussion around the Olympics because now we’re
at a point where the epidemic is the worst it has been in Japan in the course of
the pandemic.

(View projections for Japan.)

Another important area is the slow, steady decline in cases and deaths in the
United States as well as in most of Europe. This raises the question as we
expect continued scale-up of vaccination and the low level of seasonality in the
summer should keep transmission steadily going down. Even what we expect to be
quite a considerable drop in mask use because of the CDC guidelines in the US
haven’t really changed our US forecasts very much. I think this points out that
in a period of low seasonality and rising vaccine coverage, mask use may not be
the critical driver that it will be later in the year.

(View projections for the United States and Europe.)

So we expect that there isn’t a critical challenge in sustaining high levels of
mask use over the summer in the Northern Hemisphere. We do believe, as we look
out into the winter, when seasonality starts to kick back in and as new variants
threaten to spread that have immune escape, that mask use may come back to be a
critical part of our strategy in controlling the pandemic. 

Other good news in Brazil is that cases and deaths in aggregate are starting to
trend down, suggesting that despite seasonality intensifying in Brazil, we’re
seeing some reasonable amount of control around the P.1-driven epidemic there.

(View projections for Brazil.)

With seasonality intensifying, social distancing and maintaining mask use are
absolutely critical for the control of COVID-19 in the southern part of South
America in the face of escape variant P.1. 


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


MAY 14, 2021



This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. IHME is projecting
about 9.2 million deaths globally by September 1.

(View projections at the global level.)

Cases globally are declining but mortality is stagnant. Still, the detection
rate of COVID-19 infections is very low, about 7% globally. Based on the
seroprevalence surveys that we track at IHME, we estimate about 24% of the
public have been infected, so it means that many people are still susceptible
out there. Effective R is above 1 in 63 countries, indicating that cases will
increase in the coming weeks in these locations.

(View projections for India.)

In India, cases are coming down. Mortality peaked and is also starting to come
down. This isn't true for every state in India, but at the national level,
mortality and cases are declining.

The next phase of the pandemic will be determined by three main factors:

 1. Vaccines, and how fast countries can vaccinate their populations given the
    worldwide vaccine shortage and how well they can deal with vaccine
    hesitancy, which is still high in many countries.
 2. Seasonality is still high in the Southern Hemisphere where variants like P.1
    are circulating. Cases will likely increase in this part of the world, and
    it will be incumbent on social distancing measures to help prevent
    transmission
 3. Spread of B.1.617, a variant first identified in India. We're seeing reports
    that this new escape variant is circulating in the UK and Mexico, and the
    outcome depends on how countries are able to handle it in their own
    communities with travel restrictions.

To control the pandemic, strategies remain the same: social distancing mandates,
mask-wearing, and rolling out the vaccine as soon as possible.

In the United States, we project 947,000 cumulative deaths by September 1. This
represents an additional 35,000 deaths from May 10 – September 1. We are
expecting that daily deaths will keep declining through September 1. The
epidemic continues to decline in the US with the exception of three states where
we are seeing evidence of stagnant or slightly increasing transmission. Those
states are Alabama, Montana, and New Mexico. These declines in the United States
are due to a combination of vaccination rates and declining seasonality.

(View projections for the United States.)

B.1.1.7 remains the dominant variant circulating in the United States right now,
but there is evidence of sustained increases and the prevalence of the escape
variants B.1.351, B.1.617, and P.1. Vaccinations continue declining as the US
approaches the limit of the adults who are willing to take the vaccine,
increasing the threat of escape variants – especially later in the year due to
seasonality. Every effort should be made right now to increase vaccination. Mask
use in the vaccinated continues declining, and we expect with the new CDC
guideline on mask use indoors for vaccinated people, that mask-use will drop
more drastically in the United States than what we have assumed in our models
and we will adjust for that in our future release. Our reference scenario and
our worse scenario do suggest that infection will increase in July and August in
the US, although mortality will not increase – but we will start seeing a rise
in cases. We in the United States are not out of danger, simply because of
future seasonality in the winter and the arrival of the new variants.


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


MAY 6, 2021


LATEST MODEL RESULTS



This transcript has been lightly edited for clarity

In this week’s release from IHME, we have changed our key metric from reported
deaths to the total number of COVID-19 deaths. That means that up until present,
the number of deaths that COVID-19 has caused in the world is about 6.9 million
– so all the numbers that we are now forecasting are total COVID-19 deaths,
corrected for underreporting.

(View projections at the global level.)

COVID-19 is the number one cause of death in the world this week, and the number
of deaths that we are observing so far – up until present – is about 30,000
deaths per day from COVID-19. Now if we look around the world, the main area
driving the epidemic is in India. There also seems to be an epidemic unfurling
in Nepal, spreading perhaps into other countries in Southeast Asia, but
primarily the global epidemic is being driven by what’s happening in India. Our
model suggests that infections may be at a peak in India this week. Because
there are so few people left in many states that have not been infected, we’re
starting to observe some breaks in transmission due to the small fraction of the
population that remains susceptible. That means, unfortunately, we expect the
death toll in India to continue rising probably for the next two to three weeks,
and we expect that death toll to get much higher. So the epidemic, as it unfolds
in India, is the primary global concern.

(View projections for India.)

In Brazil, and countries around Brazil, the P1 epidemic in aggregate may have
reached its peak. There are data to suggest that in many parts of South America,
cases are actually flat or maybe even coming down, and deaths are likely to
follow suit. 

(View projections for Brazil.)

We’re seeing in Europe and in North America that while there are some countries
wherein transmission is still intensifying – in aggregate – the developments
we’ve been seeing for many weeks now, like expanded vaccination and declining
seasonality, are pushing down transmission, bringing down cases,
hospitalizations, and deaths. It does suggest that in the Northern Hemisphere,
excluding India, we can expect to reach quite low levels of transmission in the
summer. In India, we expect the peak to decline, but we still anticipate that
cases and deaths will continue for many weeks into the summer. 

In aggregate, by September 1, we are expecting at the global level to see 9.4
million cumulative deaths from COVID-19. That’s an extra nearly 2.5 million
deaths from now until September 1.


TOTAL COVID-19 MORTALITY (METHODS UPDATE EXPLANATION)



Related Resources: 

 * Press release on total COVID-19 mortality methods update
 * Explanation of the new total COVID-19 mortality methods

This transcript has been lightly edited for clarity

In this week’s release from IHME, we have made a major change in how we think
about the number of deaths that have occurred from COVID-19. We have completed
an analysis of all-cause mortality for 59 countries and 198 states and provinces
within countries. Using that data, we have looked at excess mortality, and then
we have tried to relate excess mortality as a metric to get closer to the true
number of COVID-19 deaths. There are clearly other things that go into excess
mortality. For example, people have avoided health care, so that might’ve raised
mortality for some causes. There’s an increase of depression and drug use in
some countries, and that has potentially raised deaths. We know injuries are
down, perhaps by about five percent globally, due to reductions in mobility. We
know that flu deaths and RSV deaths are down globally because of lockdowns. And
we also know that when there was an intense death rate from COVID-19 in the
months afterwards, some frail individuals who died from COVID didn’t die from
heart disease and chronic lung disease. When you put all of that together, we
conclude that the closest estimate for the true COVID-19 death is still excess
mortality.

Once we completed this analysis, our understanding of the magnitude of COVID to
date has been much worse than what we have been thinking so far. We have
estimated that 6.9 million people have died from COVID globally to date. 




ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


APRIL 30, 2021

No video this week. Explore COVID-19 model resources below:

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


APRIL 23, 2021



This transcript has been lightly edited for clarity

In this week’s IHME analysis of the pandemic, the main focus is on the
extraordinary surge in India and other parts of South Asia. The exponential rise
in cases and deaths continues in India, and our analysis of seroprevalence
surveys is telling us that the infection-detection rate is below 5% – maybe even
around 3-4%. This means that the number of cases that are being detected needs
to be multiplied by 20 or more to get the number of infections that are
occurring in India. The number of infections right now is extraordinarily large.
There are more infections happening in India than what occurred globally two
weeks ago. 

Our latest projections show that the number of infections driven by the surge in
India (and perhaps also driven by the surges in Bangladesh and Pakistan) will be
reaching 15 million a day globally. The huge epidemic is likely to continue at
least into the second week of May, but given the extraordinary volume of
infections in India, COVID-19 may run out of people to infect pretty soon. Our
models are suggesting that transmission may start to decline in India as we get
into the latter half of May. Meanwhile, the surge in India is now spreading to
Nepal. 

(View projections for Bangladesh and Pakistan.)



(View projections at the global level and for India.)

Cases elsewhere in South Asia have peaked and started to come down –
particularly in Bangladesh – but we think that might be a reporting artifact
from the Ramadan period, where fewer people may be seeking to be tested, and/or
there may be lags in the data. So we’ll watch very closely the trends in
Bangladesh and Pakistan. 

In South America, where the epidemic is really fundamentally driven by P1, we’re
seeing rising cases and deaths, but nowhere near as explosively as the South
Asian epidemic. It’s important to consider what the variant is in the South
Asian epidemic. We think it’s mostly related to B.1.617, although sequencing
data in the public domain are quite sparse for India and there is certainly
plenty of B.1.351 and also B.1.17 sequenced in India. But given the explosive
increase in South Asia compared to Latin America and given the high prevalence
of previous infection in some states like Delhi, which was already 75% infected
before this started to happen, it’s clearly an escape variant, and that makes it
most likely that it’s B.1.617. 

In Europe, aggregate cases and deaths seem to have come down slightly in the
past week, but there are certainly a number of countries, like Spain and the
Netherlands and a few others, where cases are going up but deaths are either
constant or even declining slightly. So we’re perhaps seeing continued
transmission related to behavioral relaxation but effective vaccination is
enough to keep the death rate constant or declining. 

(Read the WHO EURO region policy briefing.)

In North America, we’re seeing continued growth of the epidemic in Canada,
particularly in Ontario. Some suggestion of the B.1.1.7-fueled increase in
Michigan is reaching its peak, and thus our forecasts for the US are down. We’ve
also introduced this week an important change to our analysis of past infections
by correcting seroprevalence data that we used to get the infection-detection
rate and infection-fatality rate for waning antibody sensitivity over time (read
about this change here). This change has increased the number of people who have
been previously infected in the US to near 30%, up from previous estimates in
the low 20s, and that makes a difference to our forecasts, along with steady
progress on vaccination. 

(View projections for Canada, Ontario, Michigan, and the United States.)

Those are the main areas of development in this week’s assessment. But just to
reiterate, what’s happening in South Asia is overwhelmingly driving our
assessment of the global pandemic. 


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


APRIL 16, 2021



Dr. Ali Mokdad is in for Dr. Christopher Murray this week. 

The surge in Michigan is slowing and our results indicate a decline in United
States cases until the winter months. The US is experiencing a decline in deaths
due to increase in vaccination, reduced spread of the B.1.1.7 variant compared
to Europe, and relatively high rates of immunity due to previous infection.

(Read the COVID-19 policy briefing for the United States and Michigan.)

Vaccine hesitancy is on the rise, fueled by the pausing of the Johnson & Johnson
and AstraZeneca vaccines. Come May and June, there may be more vaccines in the
US than people willing to take them. 


PROJECTIONS AND SCENARIOS FOR THE UNITED STATES:

 * In our reference scenario, which represents what we think is most likely to
   happen, our model projects 618,000 cumulative deaths on August 1, 2021. This
   represents 58,000 additional deaths from April 12 to August 1. Daily deaths
   are expected to decline from a peak around May 1 and then decline to low
   levels by August 1. Daily infections are expected in the reference scenario
   to decline steadily over the next months. 
 * By August 1, we project that 52,600 lives will be saved by the projected
   vaccine rollout.
 * If universal mask coverage (95%) were attained in the next week, our model
   projects 13,000 fewer cumulative deaths compared to the reference scenario on
   August 1, 2021.
 * Under our worse scenario, which includes faster reductions in mask use and
   faster increases in mobility, our model projects 679,000 cumulative deaths on
   August 1, 2021, an additional 61,000 deaths compared to our reference
   scenario. In the worse scenario, daily infections remain remarkably stable
   over the next four months, declining only slightly by August 1.
 * At some point from April through August 1, 12 states will have high or
   extreme stress on hospital beds and four states will have high or extreme
   stress on ICU capacity.



Globally, we see a rise in cases and mortality. We are paying particular
attention to hotspots in Asia: Pakistan, Bangladesh, Iran, and India, where we
see the spread of a new variant, B.1.617. Social distancing mandates should be
imposed to help contain the virus in those locations, in addition to scaling up
vaccinations globally. 

(Read the COVID-19 policy briefing for Pakistan, Bangladesh, Iran, and India.)

Global Projections and Scenarios:

 * In our reference scenario, which represents what we think is most likely to
   happen, our model projects 4,677,000 cumulative deaths on August 1, 2021.
   This represents 1,275,000 additional deaths from April 12 to August 1 (Figure
   19). Daily deaths are expected to peak in early to mid-May and then decline
   to nearly 5,000 by August 1. Daily infections are expected to peak in the
   reference scenario in early May and then decline to 2 million by August 1.
 * By August 1, we project that 393,200 lives will be saved by the projected
   vaccine rollout.
 * If universal mask coverage (95%) were attained in the next week, our model
   projects 286,000 fewer cumulative deaths compared to the reference scenario
   on August 1, 2021.
 * Under our worse scenario, in which mask use declines faster and mobility
   increases faster, our model projects 5,051,000 cumulative deaths on August 1,
   2021, an additional 374,000 deaths compared to our reference scenario. Daily
   deaths will remain over 10,000 through to August 1. 
 * In the worse scenario, daily infections increase through to mid-May and the
   decline to 5 million by August 1. 
 * At some point from April through August 1, 86 countries will have high or
   extreme stress on hospital beds. At some point from April through August 1,
   96 countries will have high or extreme stress on ICU capacity.

(Read the global COVID-19 policy briefing.)


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


APRIL 8, 2021



This transcript has been lightly edited for clarity 

In this week’s COVID-19 update from IHME, we see that the global epidemic is
really not improving at all. New to our model is the expansion of estimates out
to August 1 (they previously expanded to July 1). And like last week, there’s
four key centers of ongoing transmission. 

First and foremost on the list of concerns is what’s unfolding in South Asia.
There are rapid increases in cases Bangladesh, Pakistan and India. We’re seeing
this in states such as Deli, where seroprevalence surveys suggest 65-70% have
been infected. This makes us quite convinced that the outbreak in South Asia is
driven by a so-called escape variant, which is where previous infection doesn’t
necessarily protect you from the new variants (also known as the escape
variants). And where vaccines are likely to be less effective, particularly the
AstraZeneca vaccine. So the outbreak in India continues to increase very
rapidly, and I think we can expect that to continue growing for quite some time.

(Read the COVID-19 policy briefing for Bangladesh, for India, and for Pakistan.)

The second area is the ongoing P1 epidemic in Brazil. New sequencing data was
released from São Paulo this week that suggests P1 had spread into São Paulo
much earlier than the data had previously expected, making the case that the
general outbreak in the entire country is driven by the P1 variant. For those
looking at the numbers, the seeming flattening of case numbers in the last few
days around Easter is likely a data artifact. When there’s holidays, there’s
usually lags in reporting.



Projections and Scenarios for Brazil:

 * In our reference scenario, which represents what we think is most likely to
   happen, our model projects 592,000 cumulative deaths on August 1. This
   represents 256,000 additional deaths from April 5 to August 1. Daily deaths
   will peak at 3,480 on April 24, 2021.
 * We expect that 152.65 million will be vaccinated by August 1.
 * If universal mask coverage (95%) were attained in the next week, our model
   projects 60,000 fewer cumulative deaths compared to the reference scenario on
   August 1.
 * Under our worse scenario, our model projects 654,000 cumulative deaths on
   August 1, an additional 62,000 deaths compared to our reference scenario. 
 * By August 1, we project that 99,500 lives will be saved by the projected
   vaccine rollout.

(Read the COVID-19 policy briefing for Brazil, which includes detailed
information about our projections.)

Third area of concern is in Europe, where cases are increasing slowly despite
increasing social distancing mandates. Cases are increasing more rapidly in
eastern countries where mask use is lower. The good news is that this holds out
the prospect that further increases in vaccination in Europe, as long as mask
use doesn’t drop too much, will really be the main strategy to remedy rising
cases and deaths. 

We do see in the vaccine confidence data that in Eastern Europe particularly,
vaccine confidence is really low. So there are countries where less than 30% of
people are willing to be vaccinated. So there is a prospect for B.1.17 to
continue expanding in those settings. Although, for the region overall, our
reference scenario in our model projects that daily deaths will start to go down
in May.

Projections and Scenarios for Europe: 

 * In our reference scenario, which represents what we think is most likely to
   happen, our model projects 1,566,000 cumulative deaths on August 1, 2021.
   This represents 303,000 additional deaths from April 5 to August 1.
 * Daily deaths will peak at about 5,620 in late April, and then start
   declining.
 * If universal mask coverage (95%) were attained in the next week, our model
   projects 55,000 fewer cumulative deaths compared to the reference scenario on
   August 1, 2021.
 * Under our worse scenario, in which mask use declines faster and mobility
   increases faster, our model projects 1,629,000 cumulative deaths on August 1,
   2021, an additional 63,000 deaths compared to our reference scenario. Daily
   deaths remain above 1,000 on August 1 in this scenario.
 * By August 1, we project that 103,500 lives will be saved by the projected
   vaccine rollout. This does not include lives saved through vaccinations that
   have already been delivered.
 * Daily infections in the reference scenario drop below 100,000 in mid-June but
   remain above 200,000 through to August 1 in the worse scenario. 

(Read the COVID-19 policy briefing for Europe, which includes detailed
information about our projections.)

The last area of focus or concern is in Canada and the United States. We’re
seeing the largest outbreak in Michigan, that surge is really very impressive.
Numbers are shooting up, and we’re finally seeing deaths creep up as well as
cases and hospitalizations. Cases have gone up 500% in a month, and there’s no
end in site so far. The challenging part for Michigan for us is that the
increase there is not easily explained. There’s a lot of B.1.1.7 in Michigan,
but mask use and mobility aren’t unusual in Michigan. And there’s more B.1.1.7,
at least according to the data, in Maryland  – but a much bigger surge in
Michigan. So they only way we can put all this together is to expect that the
sequencing data is sort of out of sync in Michigan, and perhaps B.1.1.7 showed
up there sooner, and there’s more transmission. If not, there’s some other
factor that’s going on in Michigan.



(Read the COVID-19 policy briefing for Michigan, which includes detailed
information about our projections.)

Across the border from Michigan, we’re seeing upticks in Ontario and Quebec as
well, and we’re starting to see bigger increases in transmission in adjacent
states like Minnesota as well. Clearly, there’s a cluster of increasing
transmission in that part of Canada and the US, and everybody is watching this
very closely. The question is, is this a marker of what may happen in other
parts of these countries?

Projections and Scenarios for the United States:

 * In our reference scenario, which represents what we think is most likely to
   happen, our model projects 619,000 cumulative deaths on August 1, 2021. This
   represents 64,000 additional deaths from April 5 to August 1. Daily deaths
   are expected to decline steadily until August 1.
 * If universal mask coverage (95%) were attained in the next week, our model
   projects 14,000 fewer cumulative deaths compared to the reference scenario on
   August 1, 2021.
 * By August 1, we project that 78,200 lives will be saved by the projected
   vaccine rollout.
 * Under our worse scenario, in which mask use declines more rapidly and
   mobility increases more quickly, our model projects 698,000 cumulative deaths
   on August 1, 2021, an additional 79,000 deaths compared to our reference
   scenario. In the worse scenario, daily deaths would increase until the
   beginning of June and then decline but remain over 750 a day on August 1.
 * At some point from April through August 1, nine states will have high or
   extreme stress on hospital beds. At some point from April through August 1,
   three states will have high or extreme stress on ICU capacity.

(Read the COVID-19 policy briefing for the United States, which includes
detailed information about our projections.)

Overall, for the United States, it’s really this balance of the scale up
vaccination, past infections, and how quickly do people re-open as to whether
the variant spread of B.1.1.7 will tip us into a surge like Michigan elsewhere,
or like what our reference scenario suggests, which is that things won’t be that
bad and numbers will start to go down in May. Now it’s very easy, and our worse
scenario demonstrates that, to see death numbers rising into June with only
slightly lower mask use and slightly increase mobility. We’re on that knife edge
of transmission where small changes can really shift us to an R-effective below
1 or R-effective over 1. This really puts enormous importance on people
remaining cautious, not taking risks in terms of transmission, trying to get
vaccinated as soon as possible and when they’re eligible, and hopefully we will
win that race in terms of this spring surge. 


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs

--------------------------------------------------------------------------------


APRIL 2, 2021



This transcript has been lightly edited for clarity 

In this week’s release of the IHME models for COVID-19, I think it’s important
to look at four different areas of the world that are driving the global
epidemic right now.

 1. First and most concerning is the P1-driven surge in Brazil and some
    neighboring states, such as Peru and Ecuador. In this week’s model, we have
    very substantially revised upwards our forecasts until July 1st, and this in
    part is due to much more in-depth analysis of what combinations of
    cross-variant immunity – between ancestral variants and P1 – and increased
    transmissibility of P1 can account for what we observed in Amazonas state in
    December and January. So when we put all that together, we find a much more
    alarming forecast for Brazil and neighboring countries.
     
 2.  The second great area of concern right now is the surge that we’re now
    seeing in South Asia, in Bangladesh, in Pakistan, and many states in India.
    We had been going through a very long period of declining cases and deaths,
    and now we are in a very rapid expansion in some places – Punjab is an
    example, and Bangladesh is having particularly sharp increases. Now when you
    look within India at a state like Delhi, where 65% of the population had
    been infected already – both from a seroprevalence survey and our own
    modeling – and now you’re seeing this big upsurge starting. It strongly
    suggests that the epidemic unfolding in South Asia is also related to one of
    the escape variants. Because sequencing is not as strong there, we’re not
    100% sure, but there have been reports, for example, of mutations that look
    like escape variants that are accounting for this transmission.
     
 3. The third area of concern globally in terms of what’s happening is the
    continued expansion of daily cases in Europe, and now daily deaths going up
    at a much slower rate, but still going up. This is happening despite
    considerable vaccination underway in Europe and a very strong set of social
    distancing mandates in place. So the B.1.1.7 variant is driving increased
    transmission despite a lot of brakes on transmission that we would expect
    would be protecting them from continued expansion. In our models, despite
    this very concerning set of trends, we do think that the B.1.1.7-driven
    epidemic in Europe will peak sometime in late April and start to come down
    because, eventually, vaccination and declining seasonality will be enough to
    overwhelm an increased transmission from B.1.1.7. As we have forecasted for
    a number of weeks, we expect many countries – and we have now seen France do
    this – put tighter restrictions in place to help in putting the brakes on
    B.1.1.7.
     
 4. The last area of concern is in the United States and Canada, where we are
    seeing some places like Ontario, Michigan, Minnesota, and New Jersey with
    increasing case numbers. Some local communities, such as King County in
    Washington as well, where cases and hospitalizations are going up, and we
    expect deaths to follow soon as well despite vaccination. That is not as
    dramatic as these other three areas of concern, but certainly given what
    we’ve seen in Europe, this is enough of a concern that we should be
    monitoring this closely.

In all of these areas that we are speaking about, the three core strategies are
still the same: 

Wherever you can, accelerate vaccination – of course that’s hard to say for
places that don’t have access to vaccination – but for those that do, continue
delivering vaccines as fast as possible. Next, maintaining mask use, even after
vaccination. Finally, maintaining social distancing mandates and strengthening
them when daily cases and hospitalizations begin to rise.


ADDITIONAL RESOURCES: 

 * COVID-19 policy briefings for over 200 world locations
 * IHME publications related to COVID-19 
 * World maps of COVID-19 mask use 
 * COVID-19 model FAQs


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