Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.

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April 10, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 9 reported 1,436,198 confirmed COVID-19 cases (82,837 new) and 85,522 deaths (6,287 new).

Russia reported a total of 11,917 cases (1,786 new), continuing Russia’s recent trend of 16-18% daily increase. Pakistan reported 284 new COVID-19 cases, its highest daily incidence outside the large spike on April 5-6, bringing the national total to 4,601 cases and 66 deaths (1 new). Spain reported 4,576 new cases, fewer new cases than were reported yesterday. The daily incidence has fluctuated in recent days. In total, Spain has reported 157,022 cases and 15,843 deaths (605 new). Italy has reported increasing daily incidence the past 2 days, but it still appears as though its slow decline—which has been marked by alternating decreases and rebounds—could continue. Italy has reported a total of 143,626 confirmed cases (4,204 new), and 18,279 deaths.

Both Japan and India have reported elevated COVID-19 since late March. Excluding cases associated with the Diamond Princess cruise ship, the highest reported daily incidence in Japan before March 24 was 64. Japan jumped to 101 cases by March 25 and remained above that point since. Today , Japan reported its second consecutive day with daily incidence greater than 500 (579 new), bringing the national total to 4,768 total cases and 88 deaths (3 new). India has consistently reported daily incidence in excess of 500 cases since March 31 , more than double the highest daily total prior to that date. The official India reported 6,761 confirmed cases (349 new*), including 206 deaths (7 new).
* Correction: On April 8, we reported the number of active cases in India instead of the total cases; this correct number was 6,412.

Singapore has reported elevated COVID-19 incidence since mid-to-late March. Prior to March 16, Singapore’s daily incidence did not exceed 20 cases, and most days were fewer than 10. Since then, reports have increased steadily to exceed 100, and in its most recent update, Singapore reported 287 new cases, more than double its previous daily high. The national total is now 1,910 cases, including 6 deaths.

The US CDC reported 427,460 cases (32,449 new) and 14,696 deaths (1,942 new) on April 9. As of yesterday, 17 states reported more than 5,000 cases (1 new), and the number of states reporting widespread community transmission remained at 31 states, plus Guam. The Johns Hopkins CSSE dashboard is reporting 467,184 US cases and 16,736 deaths as of 10:30am on April 10.

In addition to states and territories, the Indian Health Service (IHS) is publishing COVID-19 data reported by tribal partners. The IHS reported 741 total cases, most of which have been reported by the Navajo Nation. Navajo Nation President Jonathan Nez reported 558 confirmed cases (70 new) and 22 deaths (2 new), and the trend appears to be accelerating.

ESTIMATES OF MEDICAL PPE DEMAND Researchers at the Johns Hopkins Center for Health Security published national estimates of the demand for personal protective equipment (PPE) intended for use in medical settings—such as hospitals, emergency medical services, and nursing homes—for a single, 100-day surge of COVID-19 cases. This preliminary analysis includes various types of PPE, including gloves (7.8 billion), isolation gowns (668 million), medical masks (360 million), and N95 respirators (136 million). The investigators note that they will update and refine the estimates over time.   

US DIAGNOSTIC TESTING BARRIERS Most diagnostic testing for COVID-19 in the United States is conducted by state and local health departments and private clinical laboratories, such as Quest and LabCorps. Some academic laboratories have shifted their operations to begin diagnostic testing of COVID-19 clinical samples, including by obtaining regulatory approval. Investigators at these institutions are trained and equipped to conduct multiplexed, high-throughput assays, and therefore could have a significant testing capacity to offer. However, an article published in Nature reports that a variety of administrative, logistical, and regulatory challenges are preventing these laboratories from operating at full capacity. Some of the barriers noted in this article include incompatible electronic health record systems or the absence of a contract between hospitals and the university.

A report by CNN, based on recently obtained federal documents and interviews with public health experts and practitioners across the United States, outlines key barriers to expanding SARS-CoV-2 testing capacity early in the US COVID-19 response. A complex series of federal priorities, policies, and regulations may have slowed the development and use of SARS-CoV-2 tests developed by private laboratories, universities, hospitals, and others at a time when CDC-developed tests were not widely available nationwide. Some health officials and experts believe that increased testing early in the US COVID-19 response could have detected community transmission earlier, which could have facilitated appropriate containment efforts.

NEW US CDC GUIDANCE FOR CRITICAL INFRASTRUCTURE PERSONNEL The US CDC published new guidance intended to enable critical infrastructure workers to remain on the job following a known or suspected exposure to SARS-CoV-2. The guidance requires that that they remain healthy and that additional precautions are implemented. The guidance, which applies to personnel in 16 sectors of the workforce deemed to be critical, calls for temperature screening and symptom checks for all workers as well as self-monitoring by employees, mask usage, social distancing measures, and enhanced cleaning and disinfection protocols to mitigate the risk of transmission at the workplace. 

WHO GLOBAL VACCINE TRIAL Following the announcement of the WHO’s first-of-its-kind clinical trial protocol for candidate antiviral agents against SARS-CoV-2, dubbed the SOLIDARITY trial, the WHO issued a plan to conduct a global trial for COVID-19 vaccine candidates . Under the proposed plan, vaccine candidates would be evaluated in parallel, across multiple study sites around the world. The study will employ a common control group, and it will be able to add and drop candidate vaccines based on their performance and availability. The plan calls for the availability of data within 3-6 months.   

SUPPLY SHORTAGES US states are identifying creative solutions to obtaining the supplies and equipment necessary to implement COVID-19 response operations, including patient care. Supply shortages, existing or impending, pose major challenges for states and health systems nationwide, but many have struggled to secure the necessary level of support from the federal government, including materiel from the Strategic National Stockpile (SNS). Some states are now reportedly forming regional coalitions and partnering with neighboring states to share resources and “create greater purchasing power.” Additionally, local companies, universities, and even correctional institutions are producing necessary equipment to support their state’s response.

WHAT COMES NEXT? An article published today by Vox reviews several forecasts of how the process of relaxing social distancing will be implemented in the United States. The analysis looks at proposals published by several US groups and identifies commonalities and differences in their approach. All of the included proposals maintained a period of intense social distancing to “flatten the curve” before slowly relaxing these measures and resuming some activities. The reports outline various approaches to implementing the surveillance necessary to relax social distancing, ranging from automated smartphone tracking systems to massive and persistent testing systems. Regardless of the plan, the result is far from a return to normal. Without a vaccine, it is likely that any effective effort to relax social distancing will be a prolonged and incremental process, paired with enhanced surveillance and testing mechanisms.

While New York City continues to battle the country’s largest COVID-19 outbreak, city officials are looking ahead in order to plan for this kind of process. New York Mayor Bill de Blasio reportedly indicated that the current testing capacity would not be sufficient to begin relaxing social distancing measures without a significant risk of resurgence. New Yorkers have been recommended to forego SARS-CoV-2 testing, unless they are seriously ill, illustrating that the city does not yet have the capacity needed to deal with the current situation, let alone an increase that would allow for enhanced surveillance. Mayor de Blasio acknowledged that some of the existing social distancing measures could remain in place for months, even after the city passes its peak and begins to ease some restrictions.