Updates on the emerging novel coronavirus pandemic from the Johns Hopkins Center for Health Security.

The Center for Health Security is analyzing and providing update on  the emerging novel cor on avirus. If you would like to receive these update s, please subscribe below and select COVID-19. Additi on al resources are also available  on  our  website .
EPI UPDATE The WHO COVID-19 Situation Report for July 12 reports 12,552,765 cases (230,370 new) and 561,617 deaths (5,285 new), continuing an overall trend of reporting over 200,000 new cases per day.

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 .

Remaining #4 in total daily incidence as well as per capita daily incidence , South Africa remains a country of concern with fluctuating incidence that is currently at 12,058 new cases today, compared to 13,497 new cases yesterday and 12,348 new cases on July 11. 

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. 

The Johns Hopkins CSSE dashboard reported 3.32 million US cases and 135,295 deaths as of 1:15pm on July 13.

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.