Updates on the emerging novel coronavirus pandemic from the Johns Hopkins Center for Health Security.
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Brazil
has officially reported 24,831 new cases, more than 1.86 million cases total. This daily incidence is nearly 20,000 cases lower than the most recently reported daily incidence of about 42,000 last week. Brazil still remains #2 globally in terms of
daily incidence
, following the US. However, today appears to be the third consecutive day of decreasing incidence.
Mexico
reported 5,822 new cases, now ranking #6 globally in terms of
daily incidence
. The reported number of new cases today is lower than the more than 7,000 reported most recently on July 10; however it is too early to tell whether this indicates a longer term trend. Central and South America still remain a concerning locus of increasing daily COVID-19 incidence, with
Colombia
(#7),
Peru
(#8),
Argentina
(#9), and
Chile
(#11) all within the top 15 countries reporting highest
daily incidence
. Additionally,
Panama
(#3) , Brazil (#8) and Chile (#10) are all within the top 10 countries of
per capita daily incidence
. Central and South American countries also represent 5 of the top 18 countries in terms of
per capita daily incidence
.
India
has continued to report increasing
daily incidence
, with 28,151 new cases, and remaining #3 globally in terms of
daily incidence
.
Pakistan
has continued a downward trend in daily incidence since its peak last month, with 2,769 new cases reported in the last 24 hours compared to 2,954 two days ago. Additionally, the country’s active cases, currently totaling 84,442, has continued to remain below 90,000. Pakistan has fallen to #13 globally in terms of
daily incidence
, now currently below Bangladesh.
Bangladesh
has also reported steady daily incidence as well, reporting 3,099 cases in the past 24 hours compared to 2,949 new cases reported on July 10.
Israel
, reporting increasing incidence last week, is currently demonstrating a small dip in
its incidence
over the past two days. Israel has now fallen one position lower to from #10 to #11 globally in terms of
per capita daily incidence
. The Eastern Mediterranean Region remains a hotspot based on per capita incidence, representing 5 of the top 10 countries in terms of per capita incidence:
Oman
(#1),
Bahrain
(#2),
Qatar
(#7),
Kuwait
(#9), and Israel (#11).
Armenia
has jumped to #6 in global
per capita incidence
. Additionally,
Saudi Arabia
is #10 in
daily incidence
, reporting 2,852 new cases, alongside Iraq as a country in the region reporting over
1,000 new cases per day
.
UNITED STATES
The
US CDC
reported a total of 3.29 million total cases (60,469 new) and 134,884 total deaths (312 new today, 906 yesterday). While the number of new cases reported today is currently lower than that reported on Friday, July 10 (64,771 new), it continues the trend of reporting over 50,000 new cases per day. A total of 22 states and New York City have reported more than 40,000 total cases, unchanged from Friday. States with some of the highest case counts include California with over 300,000 cases, Florida and Texas each with over 250,000, and New Jersey, New York City, New York State, and Illinois with at least 150,000 cases. Over the weekend,
Florida
broke a US state record of daily new cases, with over 15,200 new cases in a day, making it the
single-largest increase
in daily case counts reported by any state. In addition, 3 additional states have at least 100,000 cases. There has been a 68% increase in number of new daily cases reported compared to 2 weeks ago, up from 32,220 to 54,100 cases yesterday (
Two Week Tracker
).
Regional analysis
of state-level COVID-19 data continues to show the epidemic accelerating across most regions in the US. The South, Southwest, West, and Midwest regions all have demonstrated marked increases in daily new cases, with the rate of increases also accelerating particularly in the South. The midwest, after having successfully slowing its epidemic by mid-June, is now approaching the similar weekly incidence rates it experienced during its first peak in early May. While the Midwest has reported about 5%
test positivity
that has been steadily increasing since June 18th, the South and Southwest have about 13% and 18%
test positivity
, respectively, compared to about 2% in mid-Atlantic and New England.
US RESPONSE
Testing challenges and limitations that have hampered the US response efforts from the first days of the pandemic have increased as COVID-19 incidence continues to resurge. According to
the CDC
, the US has conducted 40,787,857 tests across the country, of which approximately 9% have come back positive nationwide. As supply chain limitations and infrastructure challenges became evident in March, the Trump Administration assigned ADM Brett Giroir to address testing efforts and ensure national scale up, with a goal of having the capacity to conduct at least 500,000 tests per day. Much of the response efforts to expand testing, however, fell substantially onto
state and local officials
to manage, and although testing capacity increased across the US as a whole, wide disparities remain across states remain. As case counts rise, many states are now reporting
substantial delays
in receiving test results, sometimes taking up to 14 days. In addition to supply constraints and lab capacity limitations, logistical challenges such as transporting large numbers of samples, and communicating results to public health responders in a timely manner have caused delays.
Separately, about 1,000 current employees at the United States Centers for Disease Control and Prevention (CDC) - equivalent to at least 9% of the organization’s total workforce - have
signed
a letter addressed to CDC Director Dr. Robert Redfield regarding racial discrimination in the workplace and racism as a greater public health crisis.
The letter
comes at a particularly fraught time for CDC as the organization.
REMDESIVIR SUPPLY CHAIN ISSUES
Remdesivir, produced by Gilead Sciences, is one of the few therapeutics that has received emergency use authorization for treatment of the disease outside of research studies. However, access to the medication has been
inconsistent
. Despite the US receiving 940,000 doses in donations and buying about
500,000 doses
of the drug, hospitals across the country have reportedly experienced substantial and critical shortages. The supply is predicted to be sufficient through the end of September, but some health departments have already reportedly run out of their allocation. As of now,
allocation
is reportedly determined proportionally according to the CDC’s Healthcare Safety Network, US Health and Human Services Protect and
Teletracking
, a private company, but experts are concerned that data used to make these allocations may be out of date and not predictive of future COVID-19 hot spots and related burdens on health systems.
OUTBREAK AT OKINAWA BASE
The United States Marine Corps houses about half of the 55,000 US troops in Japan, or approximately 20,000 service members, in Okinawa. The Japanese island community has experienced only 148 confirmed infections of COVID-19 since February, but
American troops
have reported 94 new cases today at
three bases
on the island. Governor Denny Tamaki of the prefecture
expressed
concern for whether the bases’ response will be sufficient to prevent a new wave of infection.The base has reportedly been on a virtual
lockdown
that bans travel off-base without prior approval as well as other
restrictions
.
REPORT ON HEALTHCARE WORKERS
Amnesty International, a nongovernmental organization committed to responding to human rights abuses,
released
a
report
today regarding the abuses inflicted on healthcare workers and other essential workers during the COVID-19 pandemic. The
report
notes that government protections for this group have thus far been inadequate and makes specific recommendations for improvement. Amnesty International notes that at least
3,000 health workers
in 79 countries have died from COVID-19, and that healthcare workers are sometimes forced to work under inhumane conditions with threats of violence and stigma hanging over them. The report indicates that health workers who identify as black, Asian or another minority ethnic group are at an increased risk of infection and death.
Reports
of community members harassing health workers with threats of violence or discrimination. At least ten countries have reported
attempts to evict
health workers due to their occupation and attacks on healthcare workers have been documented in at least eleven countries. The authors of the report advocate for increases in access to personal protective equipment for health workers, better recording of healthcare workers deaths due to COVID-19, policy changes to limit reprisals against health workers who speak out, better compensation for health workers who become sick on the job and improvements in investigation of violence against health workers.
BCG VACCINE
A
study
published in the Proceedings of the National Academies of the Sciences recently indicates that bacillus Calmette-Guérin (BCG) vaccine may provide cross-protection against COVID-19, though the study authors note that further evaluation is needed.
BCG vaccine
is currently used in a limited number of countries to prevent tuberculosis, although its
efficacy
remains
controversial
. Authors of the
study
note that prior to the COVID-19 pandemic, BCG was hypothesized to provide additional nonspecific immunity against respiratory diseases other than tuberculosis, reducing mortality due to respiratory diseases in vaccinated individuals compared to unvaccinated individuals. This study attempts to assess whether or not this effect is significant after controlling for confounding variables. The findings indicate that BCG vaccination may provide protection from severe COVID-19 outcomes but controlled clinical trials and additional assessments are needed to confirm the hypothesis.
SARS-COV-2 IMMUNITY
The immunity induced from SARS-CoV-2 infection has yet to be fully understood and characterized, and the duration of immunity is unclear. News media recently
reported
anecdotal observations from a physician about a patient who tested positive while ill, fully recovered and then consistently tests negative, only to subsequently become severely ill and test positive months later, suggesting reinfection. Others have increasingly observed patients dealing with
long-term infections
that take
many weeks
or even months to clear with ebbs and lulls of symptoms.
It is unknown whether or not recurrent infections are tied to
waning immunity
after initial infection. A recent study found that individuals infected could elicit a wide range of antibody levels, which could vary based on length of time of infection or severity of disease. Notably, the study observed that high binding antibodies were not necessarily always associated with the development of neutralizing antibodies, and thus the authors warned to demonstrate caution when using ELISAs and other antibody binding assays as an indicator of neutralizing antibodies, as seropositivity may not always mean protection from future infection. Furthermore, others have observed that some patients have
never developed
protective antibodies post-infection. The potential implications of waning or incomplete SARS-CoV-2 immunity may indicate that post-infection immunity is temporary or not robust enough to fight off a second infection, which in turn raises concerns for the potential efficacy of future vaccines. However, more research is needed to understand the duration and durability of immunity.
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