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

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EPI UPDATE The WHO COVID-19 Situation Report for July 14 reports 12.96 million cases (196,775 new) and 570,288 deaths (3,624 new). The Americas region continues to lead in new cases, accounting for 110,549 (56.2%) of new cases and 1,853 (51.1%) of new deaths. 

India continues its trend of increased daily COVID-19 incidence , posting its highest daily total to date with 29,429 new COVID-19 cases. India has seen a continued rise in cases and remains #3 globally in terms of daily incidence behind the United States and Brazil. Pakistan continues to report decreasing incidence since its peak in mid-June, reporting only 2,165 new cases on July 14. The country has lowered its total number of active cases to under 80,000, half of which are within the Sindh Province. Bangladesh has had a recent uptick in daily incidence, reporting over 3,500 new cases for the first time since July 1. As of July 14, Bangladesh’s test positivity rate was at 25%.

Brazil reported 41,875 new cases, continuing a recent trend of highly variable daily incidence. The past two weeks saw a flattening of newly reported COVID-19 cases in Brazil, each ending with around 260,000. Brazil remains #2 globally in terms of daily incidence , however the most recent data suggests that Brazil and India may be nearing similar daily incidence rates. Mexico reported 7,051 new cases, after 2 days of reporting daily incidence less than 5,000. Similarly to Brazil, Mexico has reported fluctuating daily incidence rates likely due to the county’s reporting and surveillance systems.  

Israel reported 1,728 new COVID-19 cases. Since the beginning of the month, Israel has had a daily incidence of over 1,000 on all but one day, and in total, has continued to see an upward trend. It has been noted in past update letters that the Eastern Mediterranean Region remains a global hotspot in terms of per capita incidence, including 5 of the top 10 countries (Oman, Bahrain, Israel, Qatar, and Kuwait).

South Africa remains among the top countries globally in terms of both per capita (currently #4) and total daily incidence (currently #4). South Africa reported 11,369 new cases on July 15, joining the US, India and Brazil as the only countries reporting over 10,000 new cases.

The US CDC reported 3.35 million total cases (58,858 new) and 135,235 deaths (351 new). The 7-day average for daily incidence has risen steadily since it’s plateau in early June, and now sits at 58,619, its highest total since the pandemic began. In total, 24 states (increase of 2) and New York City have reported more than 40,000 total cases, including California with almost 330,000 cases; Florida and Texas with more than 250,000 cases; and 6 additional states and New York City with more than 100,000. The Johns Hopkins CSSE dashboard reported 3.45 million US cases and 136,807 deaths as of 1:00pm on July 15.

MEDICAL COUNTERMEASURES ADVANCEMENTS A new paper published in the New England Journal of Medicine outlines new results of Moderna’s phase 1 trials for its mRNA SARS-CoV-2 vaccine candidate. The trial enrolled 45 healthy adults ages 18-55 to partake in a dose escalation experiment. Participants were broken into 3 groups, each receiving a different dosage of the vaccine candidate. Participants received 2 doses of the vaccine candidate 28 days apart, and were tested for resulting antibody response throughout the study period. The results showed a promising level of immune response after the second vaccine in each dosage group. The study noted several adverse outcomes amongst participants, but none of serious safety concern. There is no expert consensus on this study’s results, but many acknowledge that it is a positive step toward vaccine development. According to a post on, Moderna has plans to start a 30,000 person phase 3 trial later this month. 

Two new papers published earlier this week outlined the potential use of tocilizumab, a drug typically used forrheumatoid arthritis, to treat severe COVID-19 patients. The first paper , published in the Journal of Infection , examined the safety and efficacy of tocilizumab in severe and critical COVID-19 patients. The paper provided a retrospective analysis of patients from a singular hospital who were given tocilizumab treatment when diagnosed with severe COVID-19 disease. In total, 74 patients were given such treatment and subsequently compared to 148 matched controls. The paper found that these patients were more likely to survive their illness than matched controls, but that adverse events resulted in longer hospitalization time. The second paper , published in Clinical Infectious Diseases , looked at the effectiveness of tocilizumab treatment in patients suffering from COVID-19 that required mechanical ventilation. The paper compared 78 patients who received tocilizumab and 76 that did not, and found that the treatment was associated with a 45% decrease in patient mortality. While these papers present only initial findings, it opens the door for future research in this area. 

A systematic review of the current landscape of clinical trials for COVID-19 therapeutics in the United States was published in JAMA Network Open on Monday - “Characteristics of the Multiplicity of Randomized Clinical Trials for Coronavirus Disease 2019 Launched During the Pandemic.” Of the 674 trials yielded from the search, 83.4% were randomized multigroup studies and only 71.1% of studies included a validated control group such as standard of care or a placebo group. The most commonly tested interventions involved chloroquines (143 trials). The research letter findings also discusses issues regarding multiplicity where many clinical trials are being conducted to test the same therapeutic. Authors note that practice could increase the likelihood of finding a positive result based on chance and lead to complications in trial management, including competition for recruitment, that could lower statistical relevance. 

HIGHLIGHTS FROM THE WHO DIRECTOR-GENERAL BRIEFING On Monday, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus gave his opening remarks during a media briefing regarding the ongoing COVID-19 pandemic. The Director-General noted that countries fall into four categories: those that quelled their COVID-19 outbreak within the first few cases being reported, those that experienced a major outbreak that was brought under control through strong leadership and public health measures, those that overcame their initial peak but are struggling after lessening restrictions and those that are undergoing intense transmission. He noted three steps for future outbreak control: “(1) A focus on reducing mortality and reducing transmission, (2) an empowered, engaged community that takes individual behavior measures in the interest of each other, and (3) strong government leadership and with coordination of comprehensive strategies that are communicated clearly and consistently”. 

US RESPONSE The US continues to see increased COVID-19 activity across the country. States that have seen spikes in cases are now faced with the decision of whether to revert back to more stringent community mitigation measures in an attempt to reduce the spread of the virus. Yesterday, California Governor outlined that California will be asking businesses to alter their operations once again and announced that both Los Angeles and San Diego school districts will start this fall online. Many US businesses and economists have expressed concerns that the resurgence of COVID-19, and the corresponding transition to restricted business activity, will threaten the country’s economic recovery. This comes amidst news that some of the US’ economic buffering plans, including certain unemployment benefits, are lapsing, leaving many unemployed in an economically vulnerable position. 

News broke yesterday that the current Presidential Administration has ordered hospitals to bypass the CDC when sharing COVID-19 data with the US government. The new process would have data sent to a central database within HHS. Officials from the president’s administration have suggested that this move was used to improve information access for the White House coronavirus task force, allowing the group to make decisions around the allocation of supplies including PPE and medical countermeasures. Many experts worry that this transition may limit data access and harm public transparency. The Presidential Administration has also asked governors to consider sending the National Guard to assist in hospital data collection efforts.

US MASK USAGE CDC leadership, including Dr. Robert Redfield, Dr. Jay Butler and Dr. John Brooks, published a commentary in JAMA on Tuesday to promote the universal use of masks for healthcare workers, patients and in the community. The commentary referenced multiple academic papers that support mask usage to prevent the spread of SARS-CoV-2. Two new articles were also published by CDC’s Morbidity and Mortality Weekly Report yesterday: “ Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020 ” and “ Absence of Apparent Transmission of SARS-CoV-2 form Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy - Springfield Missouri, May 2020 ”. The first article described online surveys conducted in April and May regarding attitudes and behavior regarding mask usage, recent time spent outside the home and demographic characteristics. Findings indicate that rates of face covering usage increased after the White House Coronavirus Task Force and CDC recommended use of a cloth face covering when outside the home. These conclusions support consistent public health messaging promoting the use of face masks. The second article described a case study wherein two hair stylists were found to be SARS-CoV-2 positive but did not transmit to any of their 139 clients. Both the stylists and clients wore face masks due to city ordinance and company policy, which may have protected against onward transmission.

WHO VACCINE LANDSCAPE Earlier today, the WHO published a draft of landscape documents tracking the current COVID-19 vaccines under development. The document reports the platform basis, type, developer, viruses targeted, and status of clinical and regulatory evaluation for 23 candidates in clinical evaluation and 140 candidates in preclinical evaluation. Of the candidates undergoing clinical trials, there are 10 candidates undergoing only Phase 1 trials and 8 candidates undergoing combined Phase 1/2 trials. Two candidates are in Phase 1 trials and Phase 2 trials separately. Three candidates are undergoing Phase 3 trials: an inactivated candidate by Sinovac, a non-replicating viral vector candidate by University of Oxford and AstraZeneca, and an RNA candidate by Moderna and the National Institute of Allergy and Infectious Diseases.