Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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February 28, 2020

A number of localities are reporting first cases of COVID-19 they include: Azerbaijan , Belarus , Iceland , Lithuania , Mexico , New Zealand , Northern Ireland , Republic of San Marino , and Wales . According to the latest WHO situation report , a total of 47 countries have reported cases.

WESTERN PACIFIC REGION China's National Health Commission reported 327 new cases of COVID-19, 318 of which are in Hubei Province, mostly in Wuhan. The first imported case in China was confirmed in a traveler from Iran. There were 44 new reported deaths reported bringing the total to 2,788. In total mainland China has a total of 78,824 confirmed cases of COVID-19. South Korea CDC is reporting 315 new cases bringing the total to 2,337. The cases are concentrated in Daegu. South Korea has undertaken impressive testing efforts in an effort to quickly identify individuals infected with SARS-CoV-2, including initiating over 10,000 tests during the day today. The Japanese Ministry of Health reported 210 new cases; 191 cases were experiencing symptoms of infection at the time of testing and 19 were asymptomatic. Another passenger of the Diamond Princess Cruise ship, a British citizen, has died . The prefecture of Hokkaido declared a state of emergency which includes a request for residents to remain in their homes. Nationwide , schools in Japan will remain closed through March. 

AFRICAN REGION The first case of COVID-19 was in Nigeria was confirmed yesterday in Lagos. The case is an Italian citizen working in Nigeria with a recent travel history to Milan. The patient is reported to be in good condition and is being treated at the Infectious Disease Hospital in Yaba, Lagos.

EUROPEAN REGION The Ministry of Health in Italy reported 128 new cases bringing the total to 650 total cases and 17 deaths. A case in Germany has tested positive for COVID-19 identified through the countries influenza surveillance system. The patient was tested after reportedly testing negative for influenza. According to the latest WHO situation report , six countries in the European Region have reported at least one locally-acquired case.

EASTERN MEDITERRANEAN The Ministry of Health spokesperson from Iran reported 388 confirmed cases and 34 deaths, including confirmed infection of the Vice President for Women and Family Affairs. Thus far several lawmakers in Iran have tested positive for infection. Iran’s former ambassador to the Vatican died yesterday from COVID-19; the ambassador was a notable figure in the Qom seminary.

DIAGNOSTIC CAPABILITY IN UNITED STATES The US Centers for Disease Control issued updated criteria for identifying and testing “persons under investigation” for suspected COVID-19. Relevant travel histories were expanded to include Iran, Italy, Japan and South Korea, in addition to China. People hospitalized with acute respiratory syndromes who have tested negative for other respiratory viruses and do not have a connection to a known case or to an area with ongoing transmission of the virus may now also meet the PUI criteria. 

US RESPONSE Following reports of problems with the test kit distributed to public health labs, the diagnostic test used in the US has been modified to use two rather than three molecular targets. Forty public health labs at the state and local level have been approved to use the test and all 93 labs are expected to be up by the end of next week. In other news, several media outlets reported that US officials will need approval from Vice President Mike Pence before speaking about the outbreak. It was also recently reported by the New York Times and the Washington Post that there are complaints that teams responding COVID-19 were not given adequate training or equipment. 

SINGAPORE SEROLOGY TEST Science reported that Singapore used a serological test to diagnose a suspected patient with COVID-19. Developed by the Duke-NUS Medical School in Singapore, the assay relies on antibody detection rather than PCR. Antibody tests can identify people who have developed an immune response against the virus, such as those who have recovered and cleared the virus from their body.

WHO PUBLISHES REPORT ON JOINT MISSION WHO published its report on the recently-completed joint mission with China. The mission, led by Drs Bruce Aylward and Wannian Liang, consisted of 25 experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, and the USA. The report recognized China’s containment measures as some of the most “ambitious, agile and aggressive” in recent history, relying on a national approach of temperature monitoring, masking individuals, and hand washing as well as other containment measures that were adjusted over time as the outbreak evolved.

WHO PROVIDES UPDATED GUIDANCE ON TRAVEL WHO released updated recommendations for international trade and travel in response to the COVID-19 epidemic. WHO has continued to advise against restricting trade and travel to countries experiencing COVID-19 outbreaks, citing a lack of evidence that travel restrictions are effective and arguing that restrictions could interfere with the provision of aid and support for response efforts as well as economic growth. However, WHO stated that in “certain circumstances, measures to restrict movement of people may prove temporarily useful” such as in settings with less international travel and limited response capacities. Travel measures may “only be justified at the beginning of an outbreak” to help affected countries gain time. A total of 38 countries have officially reported to WHO the implementation of measures that significantly affect international travel to affected countries. The recommendations come at a time when widespread restrictions on travel are being implemented for countries affected beyond China, such as South Korea

US FDA REPORTS POSSIBLE SUPPLY CHAIN DISRUPTIONS OF MEDICATIONS FDA Commissioner Stephen Hahn released a statement saying that a manufacturer of a drug has reported shortages due to affected production as a result of COVID-19. The product was not specified. The announcement also said that since late January, FDA has been in contact with over 180 manufacturers, and has identified 20 drugs with active ingredients or final products solely sourced from China. Additionally, FDA is in contact with 63 manufacturers that produce essential medical devices. While drug manufacturers are required to notify FDA of anticipated supply disruptions, medical device manufacturers are not required to do so. 

ECONOMIC IMPACTS OF GROWING EPIDEMIC CONTINUE The New York Times reported that stock markets are continuing to tumble and share prices are continuing to fall in a major sell-off fueled by COVID-19 related fears of economic impacts. Reuters reported that approximately $5 trillion USD has been “wiped off” world markets, leading to one of the worst weeks in the stock market since the 2008 financial crisis.  Switzerland instituted restrictions on large gatherings, and Yonhap News Agency reported that Hyundai Motor Co has halted operations at one of its domestic plants. South China Morning Post also reported continued downstream supply chain disruptions, particularly in the electronics industry, as manufacturing in China has been severely affected or halted.

PETS OF COVID-19 PATIENTS QUARANTINED IN HONG KONG South China Morning Post reported that Hong Kong has recommended 14-day quarantine for pet cats and dogs of COVID-19 patients. The announcement follows reports that tests of a pet dog of a COVID-19 returned a “weak-positive” result, based on positive samples from nasal and oral swabs. Researchers have suggested that it is possible the positive test result is due to environmental exposure rather than actual infection, and there is currently no evidence that dogs can be infected with other coronaviruses such as SARS or MERS. 

Our next briefing will be published on March 2, 2020. For the latest guidance, visit the WHO coronavirus homepage .