Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 23, 2020

CHINA UPDATES China’s National Health Commission reported an 648 new confirmed cases, bringing the total number of confirmed cases to 76,936. Also were reported were 2,442 deaths and 22,888 patients discharged; 509 cases have improved from ‘serious condition’. In a recent speech to China’s top government and military leaders, President Xi Jinping said that COVID-19 was the fastest-spreading public health crisis in the country and that additional efforts are needed to control the spread in Beijing, which currently has approximately 400 confirmed cases. 

WHO UPDATES The WHO’s most recent situation report reported 1,402 cases in 28 countries outside of China. The case count grew by 202 cases since the previous situation report. The two new countries reporting cases were Lebanon and Israel. The WHO Director General spoke on the potential for greater international spread in a news conference this past Saturday. Members of the WHO response team have traveled to Wuhan as part of their official mission to China. 

IRAN UPDATES Iran reported 43 confirmed cases and 8 deaths. The outbreak started in the city of Qom and has now spread to at least four other cities within the country. Iran’s health minister made a statement that the country will have enough test kits to keep up with necessary public health measures, and that the government had already begun the distribution of masks in impacted cities. Other reports shared that Iran has shut down schools and cultural centers in select regions to deter the spread of disease. Two of Iran’s neighbors, Pakistan and Turkey, have closed their borders to the country in hopes of mitigating the risk of disease spread.

QUARANTINE AFTER RECOVERY According to the South China Morning Post , officials in China instituted a 14-day quarantine for those who recovered from COVID-19 because several discharged patients tested positive for the virus. Medical professionals in the region have warned officials of the phenomenon and have warned about the increased logistical challenges of handling these individuals in an already resource constrained environment. A member of China CDC said that the definition of close contacts who should undergo monitoring should be expanded, as it is possible that some individuals could transmit the virus two days before becoming asymptomatic. 

SOUTH KOREA ISSUES HIGHEST ALERT LEVEL As of this morning, the South Korean Centers for Disease Control reported 602 confirmed cases of COVID-19 within the country. 25,577 people have been tested, 17,520 of which have tested negative and 8,057 of which are still awaiting results. Case numbers have been growing quickly over the last few days prompting South Korea’s president to issue the highest level emergency alert for the country accompanied by calls for timely and impactful action.

ITALY INSTITUTES NEW CONTROL MEASURES Reporting 132 cases and 2 deaths, Italy instituted aggressive control measures, suspending demonstrations and events in both public and private settings, school services or field trips, museums, certain work activities and other public services in affected areas. Additionally, the decree reinforces the right of municipalities to quarantine close contacts. BBC has reported that a dozen towns in the northern regions of the country have been quarantined in light of the decree. The quarantine measures have resulted in authorities requesting about 50,000 people in these towns to stay at home. As such, it will be prohibited to enter or leave affected areas unless special permissions are granted.

DIAMOND PRINCESS DEATHS AND CASES EXPAND The Associated Press reported that a third death and 57 additional cases among passengers on the Diamond Princess cruise ship. In total, 691 cases are linked to the cruise liner. The most recent fatality was an 80 year old man who was one of the first people to develop symptoms on the ship after officials instituted a 14 day quarantine. As disembarkation continues, the Japanese Ministry of Health and Welfare requested that passengers still on the ship continue to remain in private rooms on the ship, and those who exhibit symptoms and test positive will disembark and be treated in the hospital. Close contacts of cases will be required to remain in quarantine. A recent New York Times article criticized the delayed response in instituting containment measures on the ship, including allowing passengers to continue with normal cruise ship activities for 72 hours after notification of the first case. The article also highlighted breaches in quarantine measures, such as sick crew members sleeping in cabins with other members who were allowed to continue normal duties on the ship.

US RESPONSE The New York Times described the burden on local health departments conducting public health monitoring of individuals returning from COVID-19 affected countries. Numbers of those undergoing monitoring vary, ranging from more than 200 in Illinois to nearly 7,000 in California. The resources required for monitoring, quarantining and isolating possible cases is resource intensive. For example, the article highlights that the public health response in Chicago will cost $150,000 per week, including $17,000 a week for people to remain quarantined at a facility that currently only about 5 people are using.

The US State Department and CDC raised travel alert warnings to Level 2 for Japan and South Korea. In its Traveler’s Health Alert for both Japan and South Korea , the CDC said that sustained community transmission was occurring in the countries and that older adults or those with chronic medical conditions should consider postponing nonessential travel. Echoing the CDC’s language, the State Department warnings for Japan and South Korea also stated that those suspected of having COVID-19 in these countries could face “travel delays, quarantine” and expensive medical costs.

Additionally, NPR reported on how the COVID-19 epidemic has exacerbated tensions between US and China, in light of US travel restrictions from China and limitations from China on allowing members from US CDC to be involved with response efforts in the country. These growing tensions come at a time of increased need for international cooperation.

NEW RESEARCH SUGGESTS VIRUS DID NOT ORIGINATE IN MARKET The South China Morning Post reported that new research published by scientists affiliated with the Chinese Academy of Science and Chinese Institute for Brain Research suggest the possibility that SARS-CoV-2 did not originate at the Huanan Seafood Wholesale Market but that the highly populated market boosted transmission of the virus. The researchers analyzed 93 virus samples from 12 countries and concluded that there were possibly two population expansions on December 8 and January 6. More research is needed to further assess the origins of the virus.