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February 26, 2020

EPI UPDATES China’s National Health Commission reported 406 new confirmed cases and 52 new deaths across the country . The NHC has reported a total of 78,064 confirmed cases and 2,715 deaths nationwide. A total of 29,745 cases have been discharged, and 2,491 suspected cases remain. The NHC also reported 126 cases in Hong Kong (2 deaths, 18 discharged), 10 cases in Macau (7 discharged), and 31 cases in Taiwan (1 death, 5 discharged).

The WHO Situation Report for February 25 reports 390 new confirmed COVID-19 cases and 11 new deaths outside China. In total 2,459 confirmed cases have been reported across 33 countries, including 34 deaths. Four new countries reported cases: Afghanistan, Bahrain, Iraq, and Oman. Globally, there are 80,239 cases of COVID-19. The report also includes epidemiological data illustrating the timeline and location of exposure for cases detected outside of China. Early in the epidemic, most cases were exposed in China and then traveled elsewhere; however, this trend has shifted in the past several weeks, with more exposures identified outside of China. The Situation Report also includes a link to a WHO training course for Infection Prevention and Control (IPC) for Novel Coronavirus (COVID-19) , which provides guidance for steps that healthcare facilities should be taking to prepare for COVID-19 patients.

South Korea’s Ministry of Health and Welfare officially reported 1,261 total confirmed cases of COVID, including 12 deaths, as of 4pm on February 26. This is an increase of 284 cases and 2 deaths from the previous day. Italy’s Ministry of Health reported 374 confirmed cases, including 12 deaths, as of noon on February 26, up from 283 cases and 7 deaths yesterday. Notably, 209 of the cases in Italy are in “home isolation” suggesting that they have relatively mild illness. Multiple media reports indicate that Iran has reported 139 total cases of COVID-19, including 19 deaths. This is an increase of 78 cases and 4 deaths since yesterday. Iran has the highest death total outside China. We have been unable to identify official government reports from Iran, so we are relying on traditional media to monitor the situation.

Brazil’s Ministry of Health confirmed the country’s first COVID-19 case. The individual is a 61-year-old male with recent travel to Italy. A press release published before confirmatory laboratory tests were complete indicated that the individual was experiencing mild illness. This is the first reported case in Latin and South America. The report from Brazil is not included in the WHO Situation Report, bringing the total to at least 34 countries.

UPDATED CHINA SURVEILLANCE & REPORTING GUIDANCE On February 23, China’s CDC published the Novel Coronavirus Pneumonia Prevention and Control Plan (5th edition) , which updates case definitions and reporting requirements for COVID-19, among other things. The biggest change is the removal of separate case criteria for Hubei Province and all other provinces. This update follows closely on changes to diagnosis criteria in the Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (6th edition) , which also removed the distinction between Hubei Province and other parts of China (published February 19). It is not clear whether this will change the data China reports.

CHINA RESPONSE GUIDANCE China’s State Council disseminated a series of guidance documents covering a broad scope of coronavirus response . The documents include recommendations for implementing infection prevention and control mechanisms as well as response to suspected or confirmed cases in public spaces (e.g., shopping malls, supermarkets), schools and universities, prisons, nursery schools and daycare centers, retirement and long-term care facilities, industrial and commercial workplaces, and mental health and medical facilities. The guidance documents are accompanied by instructions regarding broader public health and other interventions to mitigate transmission risk. Of note, the guidance outlines risk categories, based on travel and exposure history. High-risk individuals should undergo quarantine and observation/monitoring at medical facilities or in their homes. Medium-risk individuals should implement self-quarantine and monitoring at home. Low-risk individuals are permitted to move and travel freely as long as they do not have an elevated temperature (or presumably other COVID-19 symptoms).

CLINICAL TRIALS IN CHINA China’s State Council Department of Science, Technology, and Education published a “ Notice on Regulating Medical Institutions to Conduct Clinical Research on Novel Coronavirus Pneumonia Drug Therapy .” Under this plan, local and provincial health, science, and technology departments will collect information on proposed drugs and treatment protocols from institutions in their jurisdiction and forward them to a national-level scientific review board under the Ministry of Science and Technology. This expert group will identify appropriate drugs for clinical trial and submit its recommendations to the National Health Commission, which will coordinate with medical institutions to implement the trial protocols. Individual institutions are responsible for ensuring that programs are in place to promote timely and effective ethics review for the trials, and all trial results are required to be reported to a central database. The notice emphasizes the importance of continued infection prevention and control as well as quality assurance in the conduct of these clinical trials. Clinical trial results will be reviewed at the national level, and updates will be made to treatment protocols based on those trials that report positive results. Additional clinical trials may be conducted under the direction of China’s “drug regulatory authority” (presumably the National Medical Products Administration), which will be conducted “outside the scope of this notice.”

MEDICAL CARE FOR ELDERLY PATIENTS IN CHINA China’s National Health Commission published guidance for providing routine medical care for elderly patients with chronic health conditions in the midst of the SARS-CoV-2 epidemic. Elderly individuals, particularly those with underlying health conditions, have been shown to be at elevated risk for severe disease and death from COVID-19, and these measures aim to reduce their risk of exposure and transmission while receiving necessary routine health care. The guidance includes measures such as utilizing online scheduling and streamlining appointment times, registration/check-in processes, and waiting room design to reduce the risk of exposure to COVID-19 patients. Additionally, healthcare providers are encouraged to issue longer-term prescriptions for patients with stable conditions, which aims to reduce the risk of running out of prescribed medications and reduce office visits required for subsequent prescriptions. Remote or tele-health options, including via mobile communications platforms like WeChat, are encouraged to facilitate communication with elderly patients or their caregivers and reduce the need for office visits. Additionally, annual required physical examinations for elderly patients have been suspended, and they will be resumed gradually in the future as the epidemic comes under control.

SOUTH KOREA RESPONSE The South Korea Ministry of Health announced the passage of several pieces of national-level legislation as part of the COVID-19 epidemic response , including updates to the Act on Prevention and Management of Infectious Diseases, Quarantine Act, and Medical Law. The updates added a classification for potentially exposed individuals in conjunction with updated quarantine authorities. Additionally, penalties for violating isolation or quarantine orders were strengthened, including fines up to 10 million won (approximately US$8,200) and 1 year in prison. The updates also give the Minister of Health and Welfare the authority to prevent the export of drugs and other products in order to support domestic response operations. Updates to the Quarantine Act revise “the overall quarantine system,” including linking quarantine information systems with those for national immigration and passport authorities. The updates also implement measures designed to facilitate investigation and reporting of infectious diseases by healthcare institutions.

POSTPONING MASS GATHERINGS IN JAPAN Japanese Prime Minister Shinzo Abe called for sports and cultural events nationwide to be cancelled or postponed over the next 2 weeks. One of Tokyo’s professional baseball teams also recently announced that it would not permit fans to attend upcoming games, and the teams will play in an empty stadium to reduce the risk of transmission. Prime Minister Abe emphasized that the next several weeks are critical to containing SARS-Cov-2 and that mass gatherings like sporting events and festivals can elevate risk of transmission. A representative of the International Olympic Committee (IOC) stated that it would be more likely that the upcoming Summer Olympics in Tokyo would cancelled as opposed to postponed or moved as a result of COVID-19, but Japan’s Minister for the Tokyo Olympic and Paralympic Games, Seiko Hashimoto, noted that the IOC is continuing with plans to host the games as scheduled, from July 24 through August 9.

A series of Six Nations rugby matches between Italy and Ireland has been postponed , and possibly cancelled, over concerns about COVID-19. The matches were originally scheduled for March 6-8 in Dublin, Ireland.

AWARDING RESPONDERS China announced that it will reward select responders for their dedication to the COVID-19 epidemic response . Nominations will be accepted for individuals and groups that contributed to patient care, public health and epidemiology, scientific research, and other aspects of the epidemic response. China will recognize 100 groups and 500 individuals for their commitment and dedication, and winners will be awarded the Advanced Collective of National Coronavirus Health Pneumonia Epidemic Prevention and Control Work. They will receive medals and monetary bonuses in honor of their outstanding performance.