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April 1, 2020
EPI UPDATE
The
WHO COVID-19 Situation Report for March 31
reported 750,890 confirmed COVID-19 cases (57,610 new) and 36,405 deaths (3,301 new) globally. No new countries reported COVID-19 cases. If the recent trend continues, the pandemic could reach 1 million cases and 50,000 deaths in the next 5 days.
The
Russian Ministry of Health
reported a total of
2,765
cases (439 new), an increase of 18% from the previous day.
Iran
reported 47,593 confirmed cases of COVID-19 (2,987 new), including 3,036 deaths (138 new).
Pakistan
reported 2,039 confirmed cases on April 1, more than doubling its national total a week ago (991 cases on
March 25
).
The
US CDC reported
163,539 cases (22,635 new) and 2,860 deaths (455 new) on March 31. As of yesterday, 7 states have reported more than 5,000 cases, and 20 states have reported widespread community transmission. The
Johns Hopkins CSSE dashboard
is reporting 190,740 US cases and 4,127 deaths as of 12:00pm on April 1. Notably,
New York state
reported 9,298 new cases yesterday, bringing the statewide total to 75,795—a daily increase of 14%. New York City has reported 43,139 of these cases, including 5,686 of the newly reported cases—a daily increase of 15.2% (
New York state March 30 report
).
The New York Times
is compiling national-level COVID-19 incidence data to track the epi curves in real time.
US COVID-19 REPATRIATION
Yesterday, US Secretary of State Mike Pompeo
urged US citizens currently overseas
that wish to return home to do so as quickly as possible
. Secretary Pompeo emphasized that the US government remains committed to repatriating US citizens during this crisis. However, the continued operation of international commercial air service remains uncertain, and the US government cannot guarantee that it will be able to coordinate charter flights in the future. The United States has
repatriated 27,572 Americans
from nearly 60 countries since the end of January.
EFFECTS OF SOCIAL DISTANCING
Data from internet-connected thermometers suggest that
social distancing measures implemented nationwide in the United States could be working
. The thermometers, manufactured by Kinsa Health, automatically upload temperatures taken to a centralized database. Data collected over the past several weeks show a decrease in the number of fevers that corresponds to expanded social distancing measures. Reportedly, the company has documented as many as 162,000 temperature readings per day since the US COVID-19 epidemic began. The company has demonstrated in the past the ability to rapidly detect elevated influenza activity using collected temperature data, and the current data provides sufficient resolution to observe trends in some regions, states and cities.
COVID-19 IN PRISONS
Yesterday, we reported on new US CDC guidance for vulnerable populations, including
pregnant women, individuals experiencing homelessness
, and
hemodialysis patients
. Health officials and advocates at the state level have recently begun to proactively address another vulnerable population, prisoners and inmates. The living conditions in
jails and prisons
, including prolonged close contact and variable hygiene and sanitation standards, place these populations at elevated risk for transmission of communicable diseases, particularly respiratory infections. Some states have already taken steps to reduce incarcerated populations, particularly those at elevated risk for severe COVID-19 disease. For example,
California
is expediting the release of individuals that will soon be eligible for parole, which could facilitate the release of 3,500 prisoners.
Connecticut
published a plan to release eligible inmates a week before it reported its first COVID-19 case in an incarcerated individual.
Nebraska
suspended visitation and implemented programs to ensure that no more than 10 people occupy any space to reduce transmission. Additionally, Nebraska’s
Cornhusker State Industries
, a work program for inmates, has begun producing hand sanitizer, gowns, and facemasks for use by the Department of Correctional Services and other government agencies.
VENTILATOR SHORTAGE
Hospitals across the United States, and around the world, face the prospect of a shortage of life-saving ventilators in the coming days or weeks, if they are not already affected. The US government recently invoked the
Defense Production Act
in an effort to speed production and delivery of ventilator units by General Motors, but a number of other companies and organizations are actively pursuing alternative sources and products to mitigate the shortfall. Elon Musk announced yesterday that his company
Tesla purchased 1,200 surplus ventilators
from China, which will be distributed free of charge to hospitals in need. Researchers at the Massachusetts Institute of Technology revived a project from several years ago to develop a
makeshift ventilator using “ambu” resuscitation bags
, widely available at hospitals around the world. The team intends to share its design instructions free of charge, which will allow others to construct their own unit, using US$400-500 in supplies. The units are not currently FDA-approved, but the team hopes to obtain approval in the future. Employees at 2 General Electric facilities in Massachusetts reportedly staged
protests to demand that they be able to manufacture ventilators
. The facilities, originally designed to produce aircraft jet engines, are currently sitting idle, and the workers want those facilities to be converted to manufacture ventilators. The protests follow an announcement by GE that it will lay off 10% of its “domestic aviation workforce” as well as “temporary” layoffs for maintenance personnel in an attempt to save the company money. Additionally,
several other companies
announced that they would begin producing a “simplified version of GE Healthcare’s” ventilators.
In addition to a shortage of ventilator units themselves, hospitals are also facing a
shortage of the medications needed to use them
. In order for a patient to be put on a ventilator, they must be sedated. According to an article published by STAT News, more than a dozen drugs are currently in short supply—including “sedatives, anesthetics, painkillers, and muscle relaxants”—due to increased demand. Like much of the healthcare supply chain, hospitals and health systems do not maintain much excess inventory of these products, so any increase in demand poses challenges. Like the traditional ventilators, however, there may be alternatives that could mitigate these shortages. For example, a small company in Texas produces
“helmet-style ventilation devices”
that do not require the invasive procedures required to insert a breathing tube. Reportedly, these helmets have shown promise in previous studies, and Italian clinicians have indicated that they provide benefit for COVID-19 patients. While the units do not function like actual ventilators, products like this could potentially be used for patients with respiratory symptoms who do not yet require mechanical ventilation.
NEW YORK CITY FIELD HOSPITAL
Mount Sinai Hospital in New York City partnered with the Samaritan’s Purse humanitarian response organization to construct and operate a
field hospital in Central Park
. The hospital will provide overflow capacity for COVID-19 patients at Mount Sinai, providing an additional 68 beds.
Construction on the hospital
, consisting of 14 tents shipped from North Carolina, reportedly began on Sunday, and the hospital is operational as of today.
DEPARTMENT OF DEFENSE COVID-19 REPORTING
The
US Department of Defense
has instructed military units, bases, and Combatant Commands to cease reporting detailed COVID-19 data due to concerns about national security. Defense officials at the Pentagon indicated that detailed data on cases for specific bases, units, or regions could signal potential vulnerabilities. The Defense Department will continue to report aggregated COVID-19 data. The announcement follows recent reports about outbreaks onboard the
USS Theordore Roosevelt
aircraft carrier and the
Marines’ training center in Parris Island
, South Carolina, as well as the reported
death of a National Guard member in New Jersey
.
RESEARCH DURING HEALTH EMERGENCIES
The University of Nebraska Medical Center (UNMC) published
lessons and recommendations for implementing research studies
in the midst of response activities for health emergencies. In an article published in
The American Journal of Tropical Medicine and Hygiene
, UNMC provided an overview of their research activities—including design, review and oversight, and implementation—early in their COVID-19 response. UNMC built on lessons and experience gained during clinical and other research activities during the West Africa Ebola epidemic in their efforts to implement research studies during the COVID-19 pandemic. They emphasize that having established systems and protocols in place in advance of a health emergency plays an important role in rapidly facilitating the development and implementation of necessary research studies. In this instance, UNMC leveraged the institutional review board mechanism established under the National Ebola Training and Education Center Special Pathogens Research Network. Conducting research in the midst of health emergencies can provide vital information to support response operations, and these lessons can support other institutions in their research efforts.
DIGITAL CONTACT TRACING
A new
article
published in
Science
describes a potential digital contact tracing tool to help mitigate the spread of COVID-19. Researchers at the University of Oxford (UK) describe the limitations of in-person contact tracing efforts and the potential impact of automated solutions. In particular, they note the highly infectious nature of COVID-19—including the possible role of asymptomatic infections, mild cases, and fomites in community transmission—and the human resources required to implement the manual method. The researchers describe a potential design for a digital application, which could automate some aspects of contact tracing and facilitate a more efficient process. New approaches to traditional public health functions, including contact tracing, could potentially have a substantial impact on epidemic control, particularly on a large scale. The article also includes an ethical overview of potential dilemmas that could arise with these types of technological solutions, including individual privacy and data security concerns.
UNDERLYING HEALTH CONDITIONS
A new study published in the US CDC’s
Morbidity and Mortality Weekly Report
describes the prevalence of certain underlying health conditions among COVID-19 patients in the United States and associations with severe disease. The US CDC COVID-19 Response Team evaluated data on 122,653 US COVID-19 patients identified between February 12 and March 28. Of the confirmed cases, only 5.8% of the patients (7,162) had data the presence or absence of underlying health conditions. Of this subset, 37.6% (2,692 cases) had at least one condition reported. Despite representing just over a third of the data set, patients with at least one underlying health condition made up 73% of all hospital admissions, including 78% of those requiring ICU admission. The most prominent conditions in hospitalized cases included diabetes, cardiovascular disease, and chronic lung disease. The study also broke the data down by age, comparing those aged 65 and over to those aged 17-64. Relatively few hospitalizations were reported in patients under the age of 19. People with underlying health conditions were at elevated risk of hospitalization (with and without ICU admission) for both age groups. This study provides a preliminary assessment of the role that underlying health conditions play in severe outcomes of COVID-19.
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