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

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April 7, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 7 reported 1,210,956 confirmed COVID-19 cases (77,200 new) and 67,594 deaths (4,810 new).

The Russian Ministry of Health reported a total of 7,497 cases (1,154 new), an increase of 18% since the previous day. At this rate, Russia’s reported COVID-19 incidence would be expected to double approximately every 4 days. Iran reported 62,589 confirmed cases (2,089 new), including 3,872 deaths (133 new). Iran’s epidemic is still growing steadily, but the daily incidence appears to be decreasing, down to 2,089 new cases in the most recent update. Pakistan reported 3,864 cases through April 6, and the 577 new cases is the country’s highest daily total, indicating that its epidemic continues to accelerate .

China reported no new cases in Wuhan, following yesterday’s reported local transmission, the city’s first since March 31.

Spain reported a total of 140,510 confirmed cases (5,478 new) and 13,798 deaths (743 new). The new daily total is markedly higher than the 4,273 new cases in the previous report ; however, this could be a function of reporting on Monday compared to Sunday. Italy’s decline in daily COVID-19 continues. From a high of 6,557 new cases on March 21 , Italy is down to 3,599 on April 6, its lowest daily total since the peak. Italy reports 132,547 confirmed cases, and 16,523 deaths.

The Ecuadorian Ministry of Health reports 3,747 confirmed cases (101 new) and 191 deaths (11 new). Considering the reports last week that many possible COVID-19 victims died in their homes, it is possible that many COVID-19 cases and deaths are not being accounted for by existing surveillance strategies in Ecuador.

The US CDC reported 330,891 cases (26,065 new) and 8,910 deaths (1,294 new) on April 6. As of yesterday, 13 states reported more than 5,000 cases (2 new), and 29 states reported widespread community transmission (2 new). The Johns Hopkins CSSE dashboard is reporting 378,289 US cases and 11,830 deaths as of 12:00pm on April 7.

UK PRIME MINISTER IN ICU We reported yesterday that UK Prime Minister Boris Johnson was admitted to the hospital for observation and testing after continuing to experience symptoms 10 days after testing positive for SARS-CoV-2. Yesterday, the Prime Minister’s Office released a statement that he was admitted to an intensive care unit after his condition worsened. Reportedly, the Prime Minister is receiving oxygen, but he is currently not using a ventilator. The British government confirmed that Foreign Secretary Dominic Raab will stand in for Prime Minister Johnson.

HYDROXYCHLOROQUINE The drug hydroxychloroquine —historically used to treat malaria, lupus, and other conditions—remains in the spotlight as a potential COVID-19 therapeutic. While there are anecdotal reports that the drug has provided benefit to some COVID-19 patients, reliable clinical trial data remains lacking, and it is unclear to what extent the drug is safe and effective against SARS-CoV-2. The US Food and Drug Administration currently reports nationwide shortages for both chloroquine and hydroxychloroquine . A number of clinical trials for these two drugs have been registered with the National Institutes of Health ; however, none of those listed have yet reported results.

In response to the shortage, President Trump called on India to relax export restrictions to allow hydroxychloroquine to be shipped to the United States, and at yesterday’s White House Coronavirus Task Force briefing, he referenced potential “retaliation” if India did not comply with the request. India reportedly acquiesced to the request and will allow hydroxychloroquine to be exported to the United States. This request follows a US government announcement that it would restrict shipments of personal protective equipment to other countries under the Defense Production Act.

COVID-19 IN CHILDREN The US CDC COVID-19 Response Team published a study of COVID-19 disease presentation and severity in US children. The study, published in the CDC’s Morbidity and Mortality Weekly Report , analyzed clinical data for 149,082 COVID-19 patients in the United States reported between February 12-April 2, including 2,572 pediatric patients. Pediatric patients represented only 1.7% of those patients. Compared to adult COVID-19 patients, fewer pediatric patients experienced fever, cough, or shortness of breath (73% vs 93%). With respect to disease severity, only 5.7% of pediatric patients were hospitalized, compared to 10% for adult patients. Three deaths were reported among the pediatric patients, but investigation is still ongoing to determine if COVID-19 was the likely cause of death in these patients. The study also provides analysis of underlying conditions in pediatric patients. Among those with available data (345 cases), 23% had at least 1 underlying health condition, with chronic lung disease (including asthma), heart disease, and compromised immune system being the most commonly reported. These data support the current understanding that COVID-19 disease tends to be more severe in adults than in children; however, severe disease and death can still occur in pediatric patients.

COVID-19 VACCINE A vaccine against the SARS-CoV-2 virus could still be months or years away from being ready for widespread use; however, clinical trials have commenced, and plans are being developed to promote the rapid availability once one becomes available. In a recent interview with STAT News , Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Initiative (CEPI), discussed the current state of SARS-CoV-2 vaccine research and prospects for rapid scale-up of production capacity. CEPI is currently supporting at least 8 vaccine candidates, with the potential for future additions. He noted that many of these platforms will likely fail; however, the world needs to look ahead to ensure the existence of production capacity as soon as a successful product is identified. This could mean investing in production facilities and even potentially initiating production of products prior to their approval, knowing that some will not be used.

Following recent comments by two French clinicians and false rumors of comments by UN Secretary-General Antonio Guterres regarding the conduct of initial vaccine clinical trials in Africa, WHO Director-General Tedros Adhanom Ghebreyesus issued a stark rebuke of the notion that African populations would serve as test subjects for candidate vaccines. Dr. Tedros condemned the statements made by the clinicians “in the strongest possible terms” and referred to them as “appalling” and rooted in a “colonial mentality.” He emphasized that “Africa can’t and won’t be a testing ground for any vaccine.” 

AIRPLANE PRODUCTION HALTED The world’s two largest aircraft manufacturers both announced that they would suspend production of commercial aircraft at major US facilities. Manufacturing facilities for Boeing’s 787 and Airbus’ A220 and A320 will be closed, affecting more than 8,000 total employees. The companies will pay furloughed employees that are unable to work remotely, at least temporarily. Airbus has already suspended production at facilities in Europe, and Boeing previously suspended work at facilities in Washington state.

International travel restrictions and domestic concerns about cities with high rates of SARS-CoV-2 transmission have reduced travel demand worldwide. In addition to existing reductions, multiple US airlines recently announced further cuts to travel to and from New York-area airports —including JFK, Newark, and LaGuardia—due to concerns about the growing epidemic in the area and substantial decreases in demand. Considering the magnitude of the pandemic’s impact on global travel, particularly air travel, it is highly uncertain how the recovery will play out and how long, if ever, it will take to return to normal production and flight operations.

ELECTIONS DURING THE PANDEMIC A recent decision by the Wisconsin state Supreme Court overturned an executive order by Wisconsin Governor Tony Evers that would have suspended in-person voting during the state’s primary election today. Yesterday, Governor Evers issued a last-minute executive order suspending in-person voting in the state through June 9 due to concerns about SARS-CoV-2 transmission at voting sites. Later that day, however, the state Supreme Court overturned the order , and the state’s primary election takes place today as scheduled. Reports indicate that many voters are hesitant about voting in person, particularly in light of the state’s “safer at home” order. Additionally, many voting locations were not open, which would result in longer lines and wait times for those who do vote. Furthermore, the US Supreme Court ruled to overturn a lower court’s decision that would have extended absentee voting in Wisconsin until April 13, allowing ballots submitted after the election date to be counted.

In South Korea, national parliamentary elections next week will reportedly proceed as scheduled. Voters will be required to wear face masks and gloves and use hand sanitizer, and they will undergo a fever screening before being permitted to vote. Some COVID-19 patients will be permitted to vote remotely from their home or hospitals; however, they “would have needed to register for home voting between March 24 and March 28.” Special early voting locations will be established to allow those diagnosed after March 28 to vote in person, and voters with an elevated temperature identified through the fever screening will be permitted to vote in a designated location.

JAPAN DECLARES NATIONAL EMERGENCY Japan officially declared a month-long State of Emergency for 7 prefectures , including Tokyo and Osaka. Prime Minister Shinzo Abe urged residents in affected areas to reduce their interactions with others by at least 70 to 80 percent. The emergency declaration enables governors in the key prefectures to request that residents stay home and to only engage in essential activities. Public transportation and airline operators, however, could continue as well as other essential businesses. Notably, the stay at home requests enabled through the emergency declaration are reportedly not orders and, therefore, violators will not be penalized. It is hoped that Japanese residents will voluntarily comply with the requested restrictions. In addition to implementing social distancing measures, the government also approved a US$990 billion USD stimulus package , approximately 20% of the country’s economic output, making it one of the relatively largest economic support packages passed in response to the pandemic.

EU ECONOMIC RESCUE PACKAGE EU officials are expected to agree shortly about financing an approximately 500 billion Euro economic stimulus package to support EU countries. Discussions around the possibility of issuing debt shared by EU countries have grown contentious . Heavily-affected and more financially constrained countries such as Italy and Spain have requested issuing joint debt, whereas more fiscally conservative countries such as Germany and the Netherlands have opposed those requests, arguing that other measures have been implemented to ease economic constraints for those affected countries. Additionally, governments are expected to agree on a plan by the European Commission and the Netherlands to develop 20 billion Euro emergency support fund that issues grants for medical supplies and other resources.

INDIA CONSIDERS EXTENDING LOCKDOWN Indian Prime Minister Narendra Modi and other government officials are considering approaches to gradually lifting or possibly extending the ongoing nationwide “lockdown,” currently set to end on April 14. News media have reported that certain state-level governments have requested the lockdown to be extended past its current end date, and Prime Minister Modi has discussed a gradual relaxation of restrictions to avoid spikes in SARS-CoV-2 transmission after the lockdown ends. The Indian government has also called for increased domestic manufacturing of essential medicine and supplies to bolster India’s capacity to respond to COVID-19.

According to a report published today by the UN’s International Labour Organization , more than 80% of the global workforce is currently affected by some form of workplace closure. Additionally, the pandemic is expected to reduce the total number of global working hours in the second quarter of 2020 by 6.7%, which equates to 195 million full-time workers during that period.

WHATSAPP COMBATS COVID-19 MISINFORMATION WhatsApp , a communication application used by approximately 2 billion people worldwide, has increased its restrictions on forwarding messages to just one new chat at a time in response to increased reports of forwarded COVID-19 content and misinformation on its app. The move strengthens existing restrictions implemented since 2018 and follows similar actions by other social media companies like Facebook and Twitter that aim to reduce access to coronavirus-related misinformation. It is very difficult to assess the degree to which COVID-19 misinformation has spread, but the WHO and national health authorities have developed WhatsApp chat resources to increase access to verified information.

GLOBAL FOOD SUPPLY CHAINS Global supply chains for food are increasingly being affected by the pandemic. Staples such as rice and wheat are rapidly increasing in price; countries that are reliant on food imports are particularly affected. While there are not yet reported shortages of food itself, there are multiple factors that could affect food pricing and accessibility, including unnecessary stockpiling, limitations on food exports, and disruptions in delivery capacity. While food pricing and supply are predominantly affected by upstream factors in the global supply chain, grocery store workers and similar jobs may be at increased vulnerability as these businesses continue to operate as “essential services” during the pandemic. Grocery stores in certain areas have reportedly taken additional precautions to sanitize workspaces and protect employees, and some have temporarily shut to do more extensive cleaning before re-opening. 

UN WARNS OF INCREASING DOMESTIC VIOLENCE UN Secretary-General, António Guterres recently raised concerns about the sharp rise in domestic violence occurring globally, as countries increasingly resort to implementing “lockdowns” and other restrictive measures to enforce social distancing. He urged governments to implement mechanisms to prevent violence against women into national response plans amid findings that the number of women calling support services has doubled, while healthcare staff and police forces are limited in their ability to help given their current strain.

US SUPPLY SHORTAGES According to a US Department of Health and Human Services survey , US hospitals have reported shortages of key supplies, including disinfectants and masks, and even food and toilet paper. The report indicated that hospitals were seeking masks and other materials from unorthodox sources such as nail salons and hardware stores. Additionally, the survey highlighted that shipments received from the federal government contained expired materials and that hospitals were in competition with each other to access masks and other PPE as shortages and price gouging increased. The survey was administered March 23-27 and involved 323 hospitals across the country. President Trump disputed some of the survey’s findings during yesterday’s Coronavirus Task Force briefing that hospitals still had severe shortages of testing supplies and extended wait times to receive results.