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In Brief: November 5, 2020

Inside This Issue: Nearly 300,000 excess deaths in U.S.; high COVID-19 death rate amongs Blacks and Hispanics/Latinos; FDA approves first COVID-19 treatment; global uptake of PrEP rises despite COVID-19; Global HIV Criminalization Database, and more.

COVID-19 in the United States

U.S. Experienced Nearly 300,000 Excess Deaths from Late January Through Early October

Approximately 299,028 excess deaths occurred in the U.S. between January 26 and October 3, and about two-thirds of that total (198,081) were attributable to COVID-19, according to a recent report from researchers at the U.S. Centers for Disease Control and Prevention (CDC). “Excess deaths are defined as the number of persons who have died from all causes, in excess of the expected number of deaths for a given place and time,” the researchers note. “Measures of excess deaths have been used to estimate the impact of public health pandemics or disasters, particularly when there are questions about underascertainment of deaths directly attributable to a given event or cause.”

For their analysis, researchers compared the weekly numbers of deaths in 2020 to the deaths reported in the corresponding weeks during the period 2015 through 2019. They also examined the percentage change in excess deaths by week, race/ethnicity, and age between January 26 and October 3. They found:

Weekly Deaths – the highest percentage increase in total U.S. deaths occurred during the weeks ending (40.4% excess deaths) and August 8 (23.5% excess deaths);
Race/Ethnicity – the percentage increase in deaths for the entire period was highest among Hispanic/Latinx persons (53.6%), followed by 36.6% among Asian Americans, 34.6% for persons of unknown race/ethnicity, 32.9% among Blacks, 28.9% among American Indians/Alaska Natives, and only 11.9% among Whites; and
Age – although the total number of excess deaths was highest among elderly persons age 75 to 84 (nearly 95,000 deaths), the percentage increase in deaths from prior years was highest among persons aged 25 to 44 years (26.5%).

CDC Examines High COVID-19 Death Rates Among Blacks and Hispanics/Latinos

A separate CDC study also confirmed earlier research indicating that the elderly, Blacks, and Hispanics/Latinos have disproportionally high COVID-19 death rates compared to younger persons and those of other races/ethnicities. In a detailed analysis of the more than 114,000 U.S. COVID-19 deaths occurring from May through August, CDC found that over three-quarters (78.2%) were among persons aged 65 years or older, and about half of the deaths (51.3%) were among non-Hispanic Whites. Although the total number of deaths were lower among other racial and ethnic groups, the rates were disproportionally high. In particular, while non-Hispanic Blacks represent 12.5% of the U.S. population, they accounted for 18.7% of total COVID-19 deaths during the period. Similarly, Hispanics/Latinos represent 18.5% of the population and accounted for 24.2% of U.S. deaths.

The CDC researchers also found significant changes in the percentage of U.S. COVID-19 deaths over time by race/ethnicity. While only about 14% of U.S. COVID-19 deaths occurred among Hispanics/Latinos during the early months of the pandemic, this increased to about 25% by August. This change is explained, in part, by the shift in most new COVID-19 cases from the Northeast to South and West – regions where Hispanics/Latinos make up a larger percentage of the population. However, “the geographic shift alone does not entirely account for the increase in percentage of Hispanic decedents nationwide,” according to CDC.

“Inequities in the social determinants of health can lead to increased risk for SARS-CoV-2 exposure among some racial and ethnic groups. For example, persons from underrepresented racial and ethnic groups might be more likely to live in multigenerational and multifamily households, reside in congregate living environments, hold jobs requiring in-person work (e.g., meatpacking, agriculture, service, and health care), have limited access to health care, or experience discrimination. Differences in the prevalence of underlying conditions (e.g., diabetes and obesity) among racial and ethnic groups might also be associated with increased susceptibility to COVID-19-associated complications and death.”

The researchers conclude, “Racial and ethnic disparities among COVID-19 decedents have persisted over the course of the pandemic and continue to increase among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups so as to minimize subsequent mortality.”

COVID-19 Treatment

Remdesivir Becomes First FDA-Approved Treatment for COVID-19

Late last month, the U.S. Food and Drug Administration (FDA) approved the antiviral drug Veklury (remdesivir) for the treatment of COVID-19 in patients requiring hospitalization. Remdesivir was approved for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds). Remdesivir should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care, according to FDA.

FDA made the decision to approve remdesivir based on its analysis of data from three randomized, controlled clinical trials that included patients hospitalized with mild-to-severe COVID-19. The trials demonstrated improved outcomes for hospitalized patients receiving remdesivir, and compared the relative benefits of 5-day and 10-day courses of remdesivir treatment.

“The FDA is committed to expediting the development and availability of COVID-19 treatments during this unprecedented public health emergency,” noted Dr. Stephen Hahn, FDA Commissioner. “Today’s approval is supported by data from multiple clinical trials that the agency has rigorously assessed and represents an important scientific milestone in the COVID-19 pandemic.” Hahn also said that FDA’s goal is to help make new medical products available to patients as soon as possible, while evaluating their effectiveness and whether their benefits outweigh their risks.

Pre-Exposure Prophylaxis

Global PrEP Uptake Rises Despite COVID-19 Pandemic

The global uptake of HIV pre-exposure prophylaxis (PrEP) has continued rising during 2020 despite the challenges posed by the COVID-19 pandemic, according to AVAC – an HIV prevention advocacy group. Third quarter data from AVAC’s Global PrEP Tracker indicate that the number of people who have started on PrEP reached 770,000 to 775,000, about a 23% increase since the beginning of 2020. Countries with a substantial increase in PrEP uptake during 2020 include Australia, Brazil, China, Kenya, South Africa, Uganda, and Zambia. The Global PrEP Tracker includes a world map summarizing PrEP uptake in 78 countries, as well as a spreadsheet listing the number of people receiving PrEP in each country. The PrEP spreadsheet also includes information about the country’s ongoing and planned PrEP programs, target populations, settings in which PrEP services are delivered, and PrEP funders, guidelines, and policy framework.

The Global HIV Epidemic

Knowledge of HIV Status Lags in Key High-Risk Populations

One of the primary goals of the U.N. General Assembly’s Political Declaration on Ending AIDS is to increase the percentage of people with HIV who know their status to 90% by the end of 2020. Although substantial progress has been made toward this goal – with an estimated 81% of all people living with HIV worldwide knowing their status by the end of 2019 – UNAIDS projects that the 90% goal for 2020 will not be met. This is likely due, in part, to the fact that knowledge of HIV status is particularly low in key populations with disproportionately high rates of HIV infection, according to a recent update from UNAIDS.

Data compiled from national surveys conducted between 2016 and 2019 indicate that, globally, about two-thirds of sex workers and gay, bisexual, and other men who have sex with men either had taken an HIV test and received the results within the past 12 months or had previously tested positive for HIV. This means that about one-third did not know their HIV status. The corresponding figures for transgender people and people who inject drugs were even lower, at about 65% and 62%, respectively. To address the barriers that prevent key populations from accessing HIV testing, prevention, and treatment, UNAIDS calls for comprehensive sexuality education and the removal of punitive laws, policies, and practices focusing on HIV transmission, same-sex sexual relations, sex work, and drug use.

UNAIDS: COVID-19’s Impact on HIV Treatment Less Severe Than Feared

In the last In Brief issue, we reported that the COVID-19 pandemic has led to a significant decline in HIV testing globally. Fortunately, in contrast, a recent data analysis indicates that – at least through July – the pandemic’s impact on HIV treatment globally has been less than originally feared.

UNAIDS, the World Health Organization, and United Nations Children’s Fund have collected and analyzed HIV treatment data to determine whether the COVID-19 pandemic caused any national, regional, or global disruptions of routine HIV services. Of the 22 countries reporting sufficient monthly data to identify trends, only five countries – the Dominican Republic, Guyana, Peru, Sierra Leone, and Zimbabwe – experienced declines in the total number of people receiving HIV treatment after April. The remaining countries showed no decline in HIV treatment through July, and of these, four – Kenya, Tajikistan, Togo, and Ukraine – actually experienced a steady increase in the number of people receiving HIV treatment.

HIV Criminalization

Resource Spotlight: Global HIV Criminalization Database

The HIV Justice Network (HJN) has launched a Global HIV Criminalization Database that brings together three databases in a single web-based tool:

Laws and Analyses – a new portal providing information about and analysis of HIV criminalization laws worldwide;
Cases – a global database of reported HIV criminalization cases, usually derived from media reports; and
Organizations – a directory of organizations around the world that are actively working against HIV criminalization and other intersectional forms of criminalization.

The laws and analyses section of the database includes the full text of known HIV criminalization laws used by countries and other jurisdictions, an overview of how laws are used, and important legal developments related to HIV criminalization. All sections of the database also feature interactive search tools and global maps that provide “a visual account of where different kinds of laws are used, where various types of cases have been reported, and where organizations operate,” according to HJN.

Educational Resources

Latest CAREAction Newsletter Looks Back on 30 Years of Ryan White Program

The most recent issue of the HRSA HIV/AIDS Bureau’s CAREAction newsletter reviews the 30-year history of the Ryan White HIV/AIDS Program (RWHAP). The Program began in 1990 and currently serves more than half a million people living with HIV in the United States. The four-page newsletter includes a brief retrospective on the early years of the U.S. HIV epidemic, the ways that the RWHAP evolved to meet the changing needs of people living with HIV, the RWHAP’s current role in the nation’s system of HIV care and services, future directions of the RWHAP, and reflections from HIV organizations and service providers about the impact of the RWHAP during the past three decades.

Other New and Updated HIV Resources from HRSA and CDC

HRSA and CDC have published several other new and revised resources during the past few weeks. These include:

RWHAP AIDS Drug Assistance Program (ADAP) Annual Client-Level Data Report, 2018 – This HRSA publication describes the demographic characteristics of clients accessing ADAP services and the ADAP-funded services used during the period from 2014 through 2018. It includes client-level data with breakdowns by location, age, race/ethnicity, federal poverty level, and health care coverage.

HIV and Hispanic/Latino Gay and Bisexual Men – This fact sheet summarizes CDC’s most recent data on new HIV diagnoses, breakdowns by age, trends in diagnoses over time, the HIV care continuum, and challenges that place some Hispanic/Latino gay and bisexual men at increased risk for HIV.

HIV and African American Gay and Bisexual Men (CDC) – This fact sheet focuses specifically on the impact of the HIV epidemic on African American gay and bisexual men – the group most affected by HIV in the U.S. It summarizes CDC’s most recent data and trends in new HIV diagnoses, breakdowns by age, the HIV care continuum, and prevention challenges among African American gay and bisexual men.

Toolkit for Providing HIV Prevention Services to Transgender Women of Color – This CDC resource describes best practices that community-based organizations and other HIV prevention service providers can use to meet the prevention needs of transgender women of color. Topics covered include conducting needs assessments, providing client-centered care and services, hiring and supporting transgender staff, doing outreach and retaining clients, and building community partnerships.

Additional COVID-19 Updates

Recent COVID-19 News from MMWR

CDC’s Morbidity and Mortality Weekly Report (MMWR) continues to provide extensive coverage of COVID-19-related research – typically publishing several new reports each week and then archiving them on a page devoted to studies on COVID-19. For your convenience, we have grouped recently published MMWR reports on COVID-19 into several subtopics below:

Case Clusters/Outbreaks

Mitigation

Health Risks, Outcomes, and Related Issues