COVID-19
Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.

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April 29, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 28 reports 2.95 million confirmed cases (76,026 new) and 202,597 deaths (3,932 new) worldwide. Tomorrow will be the WHO’s 100th COVID-19 situation report. The global total is expected to reach 3 million cases today.

The UK COVID-19 epidemic appears to be slowing. Last week (April 19-25) is on pace to be the second consecutive week of declining daily incidence.

Russia reported fewer cases than in previous days—5,841 new cases compared to more than 6,000 in recent updates . Russia is expected to reach 100,000 cases and 1,000 deaths soon. Belarus continues its acceleration with 973 new cases, which appears to be its highest daily total so far. 

India reported 1,813 new cases, slightly elevated compared to its recent trend of 1,500-1,700 new cases per day. India has now reported more than 1,000 deaths nationwide. Pakistan reported 806 new cases, its highest daily total. Pakistan’s epidemic doubled in size over the last 11 days, and it continues to accelerate.

Singapore reported 690 new COVID-19 cases, 660 (95.7%) of whom are residents of dormitories. Migrant workers living in these dormitory facilities continue to drive Singapore’s accelerating COVID-19 epidemic; however, community transmission outside of these facilities remains low (11 new community cases reported). Indonesia’s daily incidence returned to a level similar to what was reported on April 26 and 27 (260 new cases). Indonesia’s daily incidence has fluctuated considerably over the past week, so it is difficult to forecast longer-term trends. Bangladesh reported 641 new cases, its second consecutive day of recording a new daily high total. Today’s reported incidence is an increase of 92 new cases (16.8%) over the previous high, which was set yesterday.

New York state and New York City both reported their third consecutive day of decreasing daily incidence and their lowest daily totals since March 19 and 20, respectively. The daily incidence for both New York City and state continue to largely follow trends in the number of tests performed. We are continuing to monitor COVID-19 incidence trends in states that have started to ease social distancing measures; however, it could be several weeks before any effects become evident in reported data.

The US CDC updated its COVID-19 data website. Major changes include increasing the highest category to “25,001 cases or more” for state reporting, adding change in total cases and deaths from the previous day, removing data for probable cases and deaths, adding state- and county-level COVID-19 cases and deaths, and adding a figure that tracks daily incidence. The CDC reported 981,246 total cases (23,371 new) and 55,258 deaths (1,336 new) as of April 27. Overall, the United States’ daily incidence has remained relatively steady since early April; however, April 23-26 were elevated compared to the previous 10 days. In total, 11 states reported more than 25,000 cases, including New York with more than 200,000; New Jersey more than 100,000; and Massachusetts more than 50,000. In total, 34 states (decrease of 2), plus Guam, are reporting widespread community transmission. Based on recent daily incidence trends, the United States will likely reach 1 million cases in the update later this afternoon.

The Johns Hopkins CSSE dashboard is reporting 1.02 million US cases and 58,529 deaths as of 11:30pm on April 29.

US TESTING CAPACITY As part of the White House’s roadmap to relax social distancing measures, the US President Donald Trump unveiled a “Testing Blueprint” to further scale up testing nationwide, with the stated goal of performing 2 million tests per week by the end of May. According to the plan, state, tribal, and local governments are largely responsible for procuring tests and “overcom[ing] barriers to efficient testing”; however, the federal government will “act as a supplier of last resort” and coordinate with private sector suppliers to increase production and testing capacity. A number of private sector companies announced plans to increase testing capacity to support these efforts.

Despite the efforts thus far to increase US testing capacity, some states and health systems continue to report challenges meeting testing demand. Critical supplies—including personal protective equipment (PPE), nasal swabs , and chemical reagents —remain in short supply in some areas, which can limit testing throughput. US Vice President Mike Pence addressed this issue on April 27, noting that test kit availability does not necessarily correlate with the number of tests that can be performed. The federal government has worked with private companies to increase production of these supplies, but it will remain to be seen whether laboratories will be able to maintain sufficient inventory to allow for the dramatic increases in testing.

Health experts have provided a range of predictions and estimates regarding the number of tests that states and the country will need to perform in order to adequately monitor for SARS-CoV-2 in the community, particularly as states begin to relax social distancing measures. These estimates range from 500,000 to millions of tests per day nationwide. State governments are eager to increase testing capacity , as many view it as critical to implementing effective surveillance and contact tracing as states begin to ease social distancing measures. The need for increased testing capacity is also included in the White House’s roadmap to relax social distancing measures.

In Detroit, Michigan (US), free testing sites are now being opened to the general public. Detroit is among the US cities hit hardest by COVID-19, reporting more than 8,800 cases and nearly 1,000 deaths . Previously, Detroit testing sites had offered free services for first responders and healthcare workers, but eligibility has now expanded to the broader public, including those without a doctor’s order. Some sites offer diagnostic and serological testing, which provides the opportunity to detect both current and prior infections. Some test sites are available for those who are not exhibiting symptoms, but others remain limited to symptomatic individuals only.

OXFORD UNIVERSITY VACCINE The New York Times reported promising news regarding the Edward Jenner Institute for Vaccine Research candidate COVID-19 vaccine. The vaccine developed by the Oxford University (UK) research institute reportedly demonstrated efficacy in an animal trial that could potentially signal its ability to prevent infection in humans. The trial, conducted by the US National Institutes of Health, involved 6 vaccinated rhesus macaques, and all 6 remained healthy at least 28 days after exposure to the SARS-CoV-2 virus that caused disease in unvaccinated animals. While this result is promising, efficacy in rhesus macaques does not always translate to efficacy in humans. According to the article, millions of doses of the vaccine could be available by September 2020, if clinical trials in humans demonstrate safety and efficacy. The vaccine is based on a chimpanzee adenovirus platform that was under development prior to the COVID-19 pandemic. Notably, the Jenner Institute’s COVID-19 vaccine website explicitly states that media reports on the trial’s progress should not be given any credibility, but it does not provide any official update regarding the content in the New York Times article. The Jenner Institute’s vaccine website states that the best-case scenario is that Phase III efficacy trial data is available “by the autumn of 2020”; however, production is already being scaled up to allow for expanded trials and accelerated availability.

LONG-TERM CARE FACILITIES Long-term care facilities and other congregate settings for older adults have been especially high risk for transmission of SARS-CoV-2. There have been numerous well-characterized outbreaks , some of which resulted in as much as 80% of residents becoming infected. Combined with the increased risk of severe COVID-19 disease, these outbreaks have resulted in tragedies at many facilities. In England and Wales , almost a quarter of COVID-19 deaths across the country are among residents of care facilities. Similarly, about 40% of COVID-19 deaths in California are among residents of adult congregate living settings such as skilled nursing facilities, assisted living facilities, and nursing homes. The Kaiser Family Foundation aggregated data on state-level reporting of COVID-19 incidence and deaths. As of April 23, 36 states have reported some combination of cases and deaths occurring in long-term care facilities. These data show that more than 4,000 facilities have confirmed cases of COVID-19, and approximately 51,000 cases and 10,000 deaths have been attributed to these facilities. Long-term care facilities represent more than half of the deaths reported in at least 6 states.

PRISON OUTBREAK & COMMUNITY TRANSMISSION A COVID-19 outbreak in a prison in Marion, Ohio (US), has spread to the local community. As of April 28 , the Marion Correctional Institution reported 1,976 confirmed cases among the incarcerated individuals, more than 80% of the total population in the facility, plus an additional 169 cases among prison staff.* Marion County has reported a total of 121 cases outside the facility, more than half of which (66) have been linked to the prison outbreak. By population, Marion County is reportedly among the most severely impacted counties in Ohio, even after removing the cases associated with the prison outbreak. We have previously covered the elevated risk of transmission among populations that live in prolonged close quarters, including incarcerated individuals. This outbreak illustrates not only the high risk of transmission among the incarcerated populations, but also the risk of these outbreaks spreading to the local community. Notably, another prison in Pickaway County, Ohio, has reported 1,485 cases among individuals who are incarcerated at the facility.

* A previous report from April 23 indicated 2,023 confirmed cases at the Marion Correctional Institution (82% of the total incarcerated population) and 1,549 cases at the Pickaway Correctional Institution.

US ECONOMIC IMPACT The US Department of Commerce published “advance estimates” for the US economy in the first quarter of 2020 . The preliminary data indicate that the US gross domestic product (GDP) fell by 4.8% over the first 3 months of 2020, ending the longest period of economic expansion in US history . This quarter’s decrease was also the largest since 2008, at the height of the Great Recession. A significant decrease in consumer spending during the early months of the COVID-19 pandemic contributed to the economic contraction. The US Federal Reserve is expected to make a statement this afternoon following its first meeting since before states began implementing social distancing plans. Even as US states begin to plan for and implement efforts to ease social distancing, the future of the US economy remains uncertain.

In response to recent outbreaks at major meat processing facilities, some of which prompted those facilities to suspend operations, President Trump invoked the Defense Production Act to enable the US Department of Agriculture to ensure the continued operation of these facilities nationwide. The facilities will need to meet guidelines issued by the US CDC and Occupational Safety and Health Administration (OSHA). In response to the order, the United Food and Commercial Workers International Union , which represents workers at these facilities, called on the federal government to implement effective safety standards, including increased testing and PPE availability, to ensure the safety of workers as they continue to work during the pandemic. COVID-19 outbreaks have already resulted in the closure of major beef, pork, and poultry processing facilities in multiple states, resulting in major decreases to processing capacity .

AIR POLLUTION The general consensus among COVID-19 experts continues to be that the primary method of SARS-CoV-2 transmission is via respiratory droplets; however the role of other modes of transmission remains under investigation. A study conducted in Italy (not yet peer reviewed) detected the presence of SARS-CoV-2 RNA in air pollution particles. The particulate matter that contributes to air pollution can be inhaled, potentially providing an additional mechanism for SARS-CoV-2 infection. This study did not evaluate the viability of the virus detected in the air pollution, nor did it assess the potential for this route of exposure to result in infection.