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

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April 6, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 6 reported 1,133,758 confirmed COVID-19 cases (82,061 new since the previous day; 237,308 new since Friday’s briefing) and 62,784 deaths (5,798 new since the previous day; 17,258 new since Friday’s briefing). The global totals reached 50,000 deaths on April 3 and 1 million cases on April 4 .

The Russian Ministry of Health reported a total of 6,343 cases, an increase of more than 50% since Friday’s briefing (2,194 new). Iran reported 60,500 confirmed cases of COVID-19 (7,317 new since Friday’s briefing), including 3,739 deaths (445 new since Friday’s briefing). Iran’s COVID-19 epidemic is still growing steadily, but the daily incidence appears to be decreasing slowly in recent days, down to 2,274 new cases in the most recent update. Pakistan posted an updated COVID-19 website, including a data dashboard and detailed epidemiological updates , instead of daily situation reports. As of this morning, Pakistan reported 3,277 confirmed cases (827 new cases since Friday’s briefing) and 50 deaths (15 new since Friday’s briefing). The trajectory of Pakistan’s epidemic appears to be accelerating. In fact, the 397 cases reported since yesterday marks the country’s highest single-day total since the start of the pandemic.

China reported local transmission (1 case) in Wuhan on April 4, the first in that city since March 24 . The news of this case comes as China prepares to relax travel restrictions to the city , where the SARS-CoV-2 first emerged, on April 8.

Spain reported a total of 135,032 confirmed cases and 13,055 deaths. Spain has the second most cases in the world, ahead of Italy, but its daily incidence has decreased considerably over the past week. Spain's incidence fell from a high of 9,222 new cases on March 31 to 4,273 in the most recent report. Italy’s decline in daily COVID-19 incidence is also continuing, but more slowly . Italy reports 128,948 confirmed cases, and 15,887 deaths. A number of other countries in Europe have reported recent declines in daily incidence as well, including France , Germany , and Austria .

The Ecuadorian Ministry of Health reports 3,646 confirmed cases and 180 deaths. Considering the reports last week that many possible COVID-19 victims died in their homes, it is possible that many more cases and deaths are not being accounted for by existing surveillance strategies in Ecuador.

The US CDC reported 304,826 cases (27,043 new since the previous day; 65,007 new since Friday’s briefing) and 7,616 deaths (1,023 new since the previous day; 3,103 new since Friday’s briefing) on April 6. Of these cases, fewer than 2.5% have an identified exposure—travel-related or close contact of a known case. As of yesterday, 11 states have reported more than 5,000 cases (2 new since Friday’s briefing), and 27 states have reported widespread community transmission (1 new since Friday’s briefing). The Johns Hopkins CSSE dashboard is reporting 338,995 US cases and 9,683 deaths as of 11:45am on April 6.

US RESPONSE CRITICISM US government contracts obtained by the Associated Press indicate that the federal government “largely waited until mid-March to begin placing bulk orders of N95 respirators, mechanical ventilators and other equipment needed by front-line health care workers.” From the beginning, health officials and experts noted that travel restrictions implemented for China and other countries affected early in the pandemic would only slow the introduction of COVID-19 to the United States , and reports of delays in bolstering federal stockpiles have prompted criticism that the US government “basically wasted two months” rather than using the extra time to initiate response activities in anticipation of an inevitable domestic epidemic.

In response to the recent action taken by US President Donald Trump to invoke the Defense Production Act to compel manufacturer 3M to increase production of N95 respirators and prioritize US government orders, the company published a statement noting the potential negative impacts of the government’s action. The statement emphasizes that 3M has already scaled up N95 respirator production in response to the COVID-19 pandemic; however, direction from the federal government to restrict the export of respirators could have downstream effects on the number of respirators available in the United States. In particular, 3M is a major supplier to other countries, and decreased exports will pose challenges to health and humanitarian responses elsewhere. Additionally, restrictions on 3M exports could spark similar measures by countries, which could ultimately result in fewer respirators available to be imported into the United States. The restriction on exports prompted opposition by Canadian Prime Minister Justin Trudeau , who noted that Canada has numerous products that are key to the US response and that a cooperative approach to ensure international support would be critical for both countries .

US SOCIAL DISTANCING A recent poll conducted by the Associated Press and NORC looked at evolving perceptions of COVID-19 risk in the United States and their effect on individuals’ activities. According to the poll, Americans are increasingly participating in recommended social distancing measures. Currently, 94% of respondents are avoiding large groups (compared to 68% in mid-March), 70% are avoiding touching their face (up from 59% in mid-March), and 52% have stocked up on food (35% in mid-March). Additionally, 92% are washing their hands more frequently, up from 88% in March.

On Friday, the US CDC updated guidance regarding the use of masks among the general public . Based on data collected over the course of the pandemic, the CDC now “recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.” The new guidance is based on the current understanding that individuals with no symptoms or mild symptoms can transmit SARS-CoV-2 to others, so wearing a mask could reduce that risk. The mask use aims to trap droplets expelled by the mask wearer in order to reduce the amount of virus potentially released into the environment. The CDC emphasizes that respirators and surgical masks should be reserved for healthcare personnel and that wearing a mask does not replace existing social distancing guidance. The CDC also provides instructions for constructing homemade masks for this purpose—as well as donning, doffing, and washing instructions.

UK PRIME MINISTER HOSPITALIZED Ten days after UK Prime Minister Boris Johnson tested positive for SARS-CoV-2, the Prime Minister was admitted to the hospital as a precaution because he continues to experience symptoms. Reportedly, a spokesperson for the Prime Minister commented that Prime Minister Johnson remains “in charge of the government” despite being hospitalized. Yesterday, the Prime Minister issued a letter to the nation encouraging citizens to continue to adhere to prescribed social distancing measures in order to mitigate the impact of COVID-19 on UK hospitals and health systems.

IRAN EMERGENCY COVID-19 HOSPITAL The Iranian government announced that it will establish an emergency COVID-19 hospital at the Iran Mall. The treatment center will provide 3,000 beds, and it will be fully equipped with the facilities and equipment necessary to treat COVID-19 patients, including mechanical ventilators. Iranian officials noted that they are hopeful that this capacity will not be necessary, as the national incidence has recently begun to decline, but it will be available if necessary.

WASHINGTON SENDING VENTILATORS TO NEW YORK Washington Governor Jay Inslee announced that the state will return 400 ventilators obtained from the SNS in order to support the COVID-19 response in New York and other states. In light of the recent decline in COVID-19 incidence in Washington, state officials, including representatives from the Washington State Hospital Association, determined that they did not need the additional ventilators to support their response operations at this time. Additionally, Washington state purchased 750 ventilators of their own, which are anticipated to arrive in the coming weeks.

SEROLOGICAL SURVEYS According to a report by STAT News , the US CDC announced it has initiated serological test studies to better characterize the scope of the COVID-19 pandemic. The effort will consist of 3 studies covering several high-transmission areas in the United States, an expanded effort to include other areas of the country, and targeted populations, including healthcare workers. The serological studies will provide indications of prior SARS-CoV-2 infections that were not detected through existing surveillance systems that rely on diagnostic tests. COVID-19 cases, and asymptomatic infections, that did not seek care or were unable to obtain a diagnostic test will have antibodies that can be detected by serological tests, which will allow health officials to better understand how widespread the disease actually is in the community and inform our understanding of COVID-19’s severity. The study in US "hot spots" has already commenced, and the other 2 studies will begin in the coming months.

DAIRY FARMERS DUMPING MILK US dairy farmers are reportedly being forced to dispose of milk as national supply chain disruptions interrupt the ability to deliver products where they are needed. The interruption to restaurant operations, both domestically and internationally, and increased demand at grocery stores have necessitated major changes to how highly perishable products—including milk, cheese, and butter—are shipped. Schools , another major consumer of milk and other dairy products, are also closed in many places in the United States and around the world, further shifting demand. In a letter to its members, one US farming organization suggested that farmers consider culling portions of their herds due to the inability to make use of the milk they produce. Unfortunately, the logistical problems that ultimately lead to insufficient supply to the consumer have also resulted in increased prices at grocery stores, despite the fact that excess supply is available at dairy farms.

AFGHANS RETURN HOME FROM IRAN More than 200,000 Afghans living in Iran are reportedly returning home , raising concerns about the potential for spreading COVID-19. Concerns about Iran’s COVID-19 epidemic, including job losses as businesses close in response to national social distancing measures, are leading Afghans to migrate across the border to return to their home country. According to an article published by the Associated Press, Afghanistan has reported 273 confirmed COVID-19 cases, 210 of which were imported from Iran. The Johns Hopkins CSEE dashboard reports 367 cases in Afghanistan, but we have been unable to identify an official government report. Data from the International Organization of Migration indicates that 145,000 of the 198,000 Afghans returning from Iran so far in 2020 crossed the border in March, but many are not able to be appropriately screened or monitored once they enter Afghanistan. Much like concerns about increased transmission in Pakistan related to imported cases from Iran, Afghanistan could be facing an imminent COVID-19 epidemic.