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

The Center for Health Security is analyzing and providing update on  the emerging novel cor on avirus. If you would like to receive these daily  update s, please  sign up here and select COVID-19. Additi on al resources are also available  on  our  website .
April 16, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 15 reports 1,914,916 confirmed cases (70,082 new) and 123,010 deaths (5,989 new).

Pakistan reported 520 new cases on April 15, its second highest reported daily total. Overall, Pakistan’s epidemic appears to continue its acceleration. In total, Pakistan reported 6,505 cases and 124 deaths (17 new). Nearly half of Pakistan’s cases have been reported in the Punjab province (3,217 cases). India reported 12,380 confirmed cases (447 new), fewer than half of the new cases reported yesterday, and 392 deaths (22 new).

Spain has reported elevated daily COVID-19 incidence for 2 consecutive days, with 5,183 new cases reported today. Spain has had several periods with a period of decreasing incidence followed by 2-3 days of elevated reports before once again declining. If this trend continues, it can be expected that Spain will report fewer new cases in the next day or two. Spain also reported 551 new deaths, back in line with its recent trend after reporting more than 1,000 new deaths yesterday. In total, Spain reported 177,633 cases and 18,579 deaths. Italy has not published updated COVID-19 data since the totals reported yesterday —165,155 total cases and 21,645 deaths. 

Indonesia reported a total of 5,516 confirmed cases (380 new) and 496 deaths (28 new). This is the second consecutive day that the daily incidence has increased; it appears that Indonesia’s COVID-19 epidemic may be continuing to accelerate after a short period of decreased reports. Singapore reported 728 new cases of COVID-19, a considerable increase in daily incidence compared to recent days. Among these new cases, 654 (90%) were reported among residents of migrant worker dormitories. Cases among these facilities are a significant driver of Singapore’s growing epidemic. Singapore’s COVID-19 Situation Report is currently unavailable; however, the national total is expected to be 4,427 confirmed cases and 10 deaths (zero new). 

The US CDC reported 605,390 cases (26,385 new) and 24,582 deaths (2,330 new) on April 15. In total, 20 states have reported more than 5,000 cases (1 new), including 14 states with more than 10,000 (1 new). New York state reported 213,779 cases (11,571 new), including 11,586 deaths (752 new). New York City reported 111,424 cases (4,161 new), including 7,905 deaths (not updated since yesterday). Additionally, there are currently 33 states (3 new), plus Guam, reporting widespread community transmission. The Indian Health Service (IHS) has not published updated COVID-19 data since April 13—1,124 total cases, with more than half reported among the Navajo Nation (636 cases). The Johns Hopkins CSSE dashboard * is reporting 640,291 US cases and 31,015 deaths as of 11:45am on April 16.
*The Johns Hopkins CSSE also publishes US-specific data , at the county level, on a dedicated dashboard.

FIRST UN SOLIDARITY FLIGHT In yesterday’s WHO COVID-19 Situation Report , the WHO noted the departure of the first UN “Solidarity Flight,” which will deliver COVID-19 response supplies destined for all countries in Africa. The shipment consists of a variety of personal protective equipment (PPE)—including gloves, gowns, and masks—as well as other supplies and equipment, such as thermometers and mechanical ventilators. The flight, operated by the UN World Food Programme, departed Addis Ababa, Ethiopia, on April 14. The supplies were largely donated by the Ethiopian government and Jack Ma, co-founder and former CEO of Alibaba, and the African Union and Africa CDC are coordinating the distribution of the supplies across the continent. The Solidarity Flights are part of a US$350 million effort to establish “humanitarian hubs around the world” to provide material support for the COVID-19 response, but so far, the program has only received US$84 million in donations.

UPDATED WHO COVID-19 GUIDANCE The WHO published an update to its COVID-19 Strategic Preparedness and Response Plan . Among the changes is a new section that includes guidance regarding conditions and considerations that should inform decisions regarding efforts to relax existing social distancing measures. The document emphasizes that countries must eliminate or maintain low levels of community transmission in order to contain the pandemic and that community transmission necessitates “exceptional measures” to rapidly suppress it. Notably, the WHO explicitly states that the decisions regarding implementing and relaxing social distancing measures should be made at the lowest levels of government to ensure “a tailored and appropriate response depending on the situation and capacities to respond.” The guidance outlines 6 principal considerations and capacities to consider in order to maintain suppressed community transmission: (1) reducing transmission to sporadic transmission or clusters of cases; (2) establishing and maintaining sufficient public health and healthcare capacity, including testing, contact tracing, and quarantine/isolation; (3) mitigating transmission risk in vulnerable settings, such as healthcare facilities and nursing homes; (4) implementing necessary protective measures for workplaces and schools, including physical distancing, improved hygiene, and temperature/symptom screening; (5) reducing risk of imported cases, including traveler screening and monitoring; and (6) engaging and educating the public to ensure protective measures are implemented effectively as changes are made to existing policies and restrictions.

The Director of the Pan American Health Organization , Carissa F. Etienne, commented that social distancing measures are the key factor in health systems being able to effectively respond to the COVID-19 pandemic within their existing capacity. Dr. Etienne emphasized that any efforts to “transition to more flexible measures should be taken with extreme caution” and that these decisions should be made in the context of the local situation, including level of community transmission, testing and surveillance capabilities, and healthcare system capacity. Additionally, Dr. Etienne called for substantial increases in testing capacity throughout the Americas, before countries face major epidemics.

BEST PRACTICES FOR HEALTHCARE FACILITIES OUTLINED The FEMA Federal Healthcare Resilience Task Force published the “ COVID-19 Hospital Resource Package ,” which is intended to provide publicly accessible guidance and tools to better enable the healthcare response to COVID-19. The document provides guidance on surge planning for the emergency department, critical care, and mortuary services; crisis standards of care; staffing surge and resilience; workforce protection; regulatory concerns; PPE and healthcare supply chains; and telemedicine to support US health systems’ efforts to combat the growing epidemic.

CHINA TIGHTENS CONTROL OF COVID-19 PUBLICATIONS A news article published by Nature discusses emerging reports that the Chinese government is providing direct oversight of scientific publications related to COVID-19 research. The article indicates that several documents issued by China’s Ministry of Education (and obtained by the journal) describe requirements for review and approval of prospective publications by university and government bodies—including the Joint Prevention and Control Mechanism, under China’s State Council—before they can be submitted for publication. According to the article, official documentation does not appear to be posted on relevant ministry websites.

CHINA CDC COVID-19 IMPORTATION RISK The majority of China’s reported COVID-19 cases over the past several weeks have been imported from other countries, as opposed to the result of local transmission. The journal China CDC Weekly published an assessment of the country’s risk of importing COVID-19 cases from various countries and regions, based on existing public data on national and sub-national COVID-19 incidence around the world. China has reported 1,101 total imported cases of COVID-19 (through April 8), including 262 in the previous week. Among the recently imported cases, 125 (47.7%) were imported via land border crossings from Russia. China CDC also reported the proportion of imported cases by region: 77% from Asia, 8% from Europe, 6% from North America, 5% from Oceania, and 2% from Africa. The analysis notes that the imported cases from the United States and United Kingdom remained relatively steady, despite growing epidemics in both countries, while “those from Russia increased dramatically.” The analysis notes that the severity of the US COVID-19 epidemic varies by state and city, and the analysis compares the situation in some areas of the country (e.g., New York City) to what has been observed in Wuhan, China, and Lombardy, Italy. The report concludes that travel restrictions instituted by China “seemed to be effective and led to a reduction in imported cases via airports”; however, many challenges remain with respect to mitigating this risk on a national level.

CANADA PREPARING TO REUSE N95 RESPIRATORS Hospitals in Canada are reportedly beginning to stockpile used N95 respirators and other PPE, in the event they need to be sterilized and reused. As the global demand for respirators remains high (or possibly increasing), health systems around the world are looking for alternate solutions to supplement existing supply chains. Hospitals across the country are evaluating prospective options for decontaminating various types of PPE, in the event they are unable to procure supplies in the future. Several techniques have been documented for decontaminating respirators; however, they are not yet in widespread use. According to this report, Canada’s Chief Medical Officer, Theresa Tam, recommended that hospitals start retaining used PPE, including N95 respirators, in case they can be disinfected in the future. Reportedly, supply-related challenges increased after the United States restricted the export of certain supplies.

COVID-19 CLINICAL AND EPI AMONG HOSPITALIZED PATIENTS Researchers from the University of California Berkeley, Imperial College London, the London School of Tropical Medicine, and Kaiser Permanente published ( preprint ) a study describing the clinical course and epidemiology of COVID-19 patients in California and Washington state. From a prospective cohort of more than 9.5 million individuals, the study identified 1,277 hospitalized COVID-19 patients (laboratory- or clinically confirmed). The study found the COVID-19 incidence of hospitalization to be between 10.6 and 14.6 per 100,000 (depending on the location). Consistent with other studies, the frequency of hospitalization increased dramatically with age—between 37.4 and 61.0 per 100,000 among those 80 years and older. The mean length of hospitalization was 10.7 days for survivors and 13.7 days for those who did not survive their illness. Notably, the authors observed significant declines in transmission in multiple locations between cases infected in early March and those infected several weeks later, suggesting that social distancing measures may be having the desired effect.

REPURPOSING VACCINES? We reported previously that 2 clinical trials are being conducted to evaluate the potential effect of the Bacille Calmette-Guérin (BCG) vaccine on preventing SARS-CoV-2 infection. In addition to these trials, a clinical trial will be conducted in the United States to similarly evaluate the oral polio vaccine . At this time, there is no evidence that either vaccine will provide benefit in terms of protecting against SARS-CoV-2 infection, but they are being evaluated for potential benefit.

US LOCAL GOVERNMENT ECONOMIC IMPACT Even with the recent emergency federal COVID-19 funding under the CARES Act, many local governments are struggling economically as a result of the pandemic and associated social distancing measures. The funding allocated to state and local governments may not adequately address the scope of the economic impact. States and larger local governments received funding directly from the federal government; however, smaller local governments received associated funding via their respective state governments, which are experiencing their own financial challenges. Additionally, the funding is reportedly restricted to COVID-19 response activities, but local governments are also experiencing financial losses due to decreased tax revenue, including lost sales tax. The National Association of Counties , representing more than 3,000 county governments, published a letter to US President Donald Trump calling on the federal government to provide additional financial support for local governments to help mitigate these losses, particularly as it is increasingly likely that economic impacts could persist for many months.