Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 25, 2020

EPI UPDATES The daily briefing from the Chinese National Health Commission reports 508 new confirmed cases and 71 deaths, bringing the total number of confirmed cases to 77,658 and 2,663 total deaths. There are 2,824 additional suspected cases and 87,902 individuals are under medical observation. 

South Korea Centers for Disease Control is reporting 977 confirmed cases and 10 deaths. Public health officials are actively planning to test 200,000 members of the Shincheonji Church in which most confirmed cases have been linked back to. There is an additional cluster of 186 cases linked to a hospital in Daegu. 

A bulletin from the Italian Ministry of Health reports 283 infections and 7 deaths. The majority of cases are in the Lombardy region, however cases have been confirmed in 7 additional localities in Italy. 

A total of 5 cases are now confirmed in Spain. Four cases have been confirmed on the Canary Island of Tenerife, which has a small outbreak resulting from an infected traveler from Italy. All infected individuals were staying at the same Tenerife hotel, and now more than 1,000 tourists at the hotel have been placed on lockdown (ie, quarantine). In addition, one case has been confirmed in a 36 year old Italian woman living in Barcelona. The woman reportedly visited the Bergamo and Milan areas of northern Italy between February 12 and 22.

There are 61 confirmed cases in Iran and 15 deaths. Notably, the Iranian deputy health minister has tested positive for COVID-19. Public gatherings have been banned in an effort to reduce transmission during the ongoing outbreak, the ban will be in place until the Persian New Year. The General Civil Aviation Authority United Arab Emirates has suspended all flights from Iran. 

CORRECTION FROM FEB 24 BRIEFING  We reported yesterday “over 32,000 individuals tested in [South Korea], with roughly two-thirds coming back negative for SARS-COV-2.” This was an incorrect interpretation of a machine-translated chart . As of yesterday, the South Korean Ministry of Health tested 32,756 individuals, 833 (2%) of these tests were positive for COVID-19, 20,292 (62%) were negative, and 11,631(36%) were still pending results.

CROATIA, AUSTRIA, AND SWITZERLAND REPORT FIRST CASES Austria has confirmed its first two cases of COVID-19 in Tyrol. Both cases have previous travel to Italy’s Lombardy region which is seeing increases in cases. 

Switzerland also confirmed its first coronavirus case. The case was identified in canton Ticino in the southern part of the country, which borders Italy. The infected individual was reported to have been infected around February 15 in the Milan region of Italy.

Reuters has reported that Croatia has confirmed its first case of COVID-19. According to the news report, Prime Minister Andrej Plenkovic specified that the person is younger and with mild symptoms. In a previous press conference published, Health Minister Vili Beros discussed increased screening measures and questioning for people entering Croatia at border checkpoints. Foreigners reporting symptoms will be turned away. Additionally, quarantine measures would be implemented for people with a history of possible exposure. 

US RESPONSE STAT News has reported that the US CDC has publicly stated that it expects COVID-19 to spread at the community level, and that the disruptions to daily life could be “severe”. The CDC also recommended that parents should discuss the possibility of school closures with schools, and that businesses should consider telecommuting options for work. Additionally, the CDC has  issued a Level-3 travel advisory to South Korea recommending avoiding all non-essential travel, stating that there is “limited access to adequate medical care in affected areas”. This follows announcements of Level-2 travel advisories for Italy and Iran , which call for enhanced precautions and recommendations to postpone nonessential travel for older adults and those with chronic medical conditions. The CDC has also reported as additional 18 confirmed cases among individuals repatriated from the Diamond Princess cruise ship. This brings the national total to 53, of these cases 14 are among travelers and their contacts and 39 are among individuals repatriated to the United States. 

HONG KONG EXTENDS SCHOOL CLOSURES The South China Morning Post has reported that the Hong Kong Ministry of Education is extending the length of time of its school closures, which have already been closed for more than 3 weeks. The announcement now specifies all schools will be closed until at least April 20th. 

JAPAN AND OTHER COUNTRIES FACE BUSINESS BANKRUPTCIES The Japan Times reported the first business  to file bankruptcy in the country due to the COVID-19 epidemic. The business, a hotel in Aichi Prefecture, suffered financially from travel cancellations, particularly from Chinese tourists. Globally, the New York Times has reported that stock markets have fallen as reports of growing cases in new countries have spread. European markets have recently recorded their worst day since 2016, particularly as Italy has locked down affected towns and other European cities have been affected or on alert. 

MODERNA SHIPS VACCINE FOR PHASE I STUDY Moderna Inc. announced that it has shipped its COVID-19 vaccine mRNA-1273 to the National Institutes of Health where it will undergo Phase I clinical trials. The vaccine encodes for a perfusion stabilized form of the Spike protein which is necessary for the membrane fusion and subsequent infection of the cell with the virus. 

FRUSTRATION IN UNITED STATES OVER TESTING DELAYS There continues to be frustration over delays in diagnostic test distribution in the United States. Currently only 5 states, California, Illinois, Nebraska, Nevada, and Tennessee have capacity to test. The Association of Public Health Laboratories has issued a letter to FDA requesting approval to begin developing their own tests. Despite additional testing capacity around the world, issues with the CDC diagnostic test continues to prevent wider spread testing capacity in the United States. 

EFFECTIVENESS OF SCREENING MEASURES  Researchers from the US and the UK have published a preprint research article estimating the impact of different screening programs targeted towards COVID-19. The researchers concluded that screening measures will detect less than half of infected travelers, but effectiveness could increase marginally as the growth of the epidemic slows. Longer incubation periods can make it increasingly difficult to detect individuals who exhibit no or very mild symptoms. Additionally, the lack of clear risk factors associated with COVID-19 transmission could make it harder for individuals to voluntarily avoid traveling or other measures if they suspect exposure.  These factors, paired with the high prevalence of undetectable cases, substantially reduce the effectiveness of travel screenings at the border. 

BAN ON THE SALE OF WILDLIFE   Chinese officials began drafting a decision to ban the trade and consumption of wildlife in order to protect public health and prevent future outbreaks. The decision comes in light of the ongoing COVID-19 global epidemic which involved exposure to the Wuhan wildlife market amongst the earliest cases of the disease. The overconsumption of wildlife has been acknowledged as a danger to health security and the decision from National People’s Congress would make consumption and trade of wildlife punishable by law. 

EMERGENCY MEETING OF CENTRAL EUROPEAN HEALTH MINISTERS Health Ministers from Austria, Italy, Slovenia, France, Switzerland, and Germany will meet today in Italy to discuss the ongoing spread of COVID-19 in Europe. The crisis meeting will focus on joint control measures. 

PERSONAL PREPAREDNESS MEASURES  Increases in cases outside of China have signaled concern amongst public health leaders that an increase in scale of the ongoing COVID-19 epidemic may be evident. This reality can be distressing and emphasizing that now is the time to prepare not panic. This report discusses personal preparedness measures that can be taken to mitigate the potential stressors seen with more widespread transmission they include (1) taking steps now to ensure a sufficient supply of prescription medications in case pharmacies are overwhelmed (2) maintaining a supply of non-perishable food, including pet food in case there are supply chain disruptions (3) practicing touching your face less and avoiding contact such as shaking hands. These measures while simple can greatly reduce stress and still a greater level of personal preparedness.

WHO MISSION TO CHINA Dr. Bruce Aylward gave a press briefing summarizing the international joint mission in China related to understanding the COVID-19 outbreak. The report from this mission will be forthcoming shortly. However, Dr. Aylward reported on 1) what China has done to respond to the epidemic, 2) the impact of those actions, and 3) implications for China and the world going forward. Dr. Aylward emphasized the comprehensiveness of China’s response to identify cases and reduce transmission, that the movement restrictions did seem to have a significant effect on the outbreak. He also suggested that the data from China do not show evidence of a large number of asymptomatic cases or unidentified community spread (although he said that he may still be proven wrong on this). He also said that he did not see significant evidence to suggest that children are drivers of infection with this virus. In terms of the implications for the world, Dr. Aylward said that China has done a very good job of managing severe and critical patients in hospitals and that the same care may be difficult to replicate in other parts of the world. He suggested that measures to increase surveillance and testing, and prepare hospitals to manage COVID-19 cases are important for managing outbreaks of this virus. Additional points can be found in the video linked above.