Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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March 10, 2020

Note: although we include case counts to help provide situational awareness to our readers, the numbers are constantly changing. Please refer to the WHO or the public health agencies of affected countries for the latest information.

EPI UPDATES China’s National Health Commission reported 19 new cases and 17 new deaths, bringing the total there to 80,754 cases and 3,316 deaths. All of the new deaths occurred in Hubei province. The Republic of Korea’s Centers for Disease Control and Prevention reported 131 new cases and 3 new deaths, bringing the total there to 13,526 confirmed cases and 54 deaths. The majority of cases in there are either occurring in or epidemiologically linked to Daegu or in Gyeongbuk province. Although 38% of the cases in ROK have been reported in males, 61.1% of deaths are male. The Ministry of Health in Japan reported 26 new confirmed infections, 19 among symptomatic individuals and 7 among asymptomatic individuals. 

In Italy , Europe’s worst affected country, there have been 9,172 total confirmed cases and 463 deaths, making it the 2nd largest outbreak outside of mainland China. The Prime Minister expanded movement restrictions to the entire country. The decision came after a spike in deaths from COVID-19. The measures include cancellation of all public gatherings, restriction of movement throughout the country, and an extension of school and university closures through at least the next month. Spain has reported 1,622 confirmed cases, another substantial increase in cases from previously reported case numbers. 

Iran reports a total of 8,042 cases, including 291 deaths. Iran has closed schools but has not implemented any mandatory movement restrictions or quarantine measures thus far. 

Brazil is expanding COVID-19 surveillance nationwide. All patients who are admitted with flu-like symptoms will be tested regardless of the presence of epidemiological links to other cases or travel history. Brazil has confirmed 25 cases.  

Burkina Faso reported its first two cases of COVID-19 in individuals with travel history to France. Burkina Faso is the 9th country on the African continent to confirm cases of COVID-19. At the Kigali Bus Park in Rwanda, hand washing stations have been installed and passengers are instructed to wash their hands before boarding buses. Rwanda has not reported any cases of COVID-19.

The Washington State Department of Health reported 162 confirmed cases and 22 deaths, the majority of which are reported in Seattle-King County; 19 of the 22 deaths reported in Washington State are from the Life Care Center, a long term care facility. The California Department of Health reported 133 confirmed cases and 1 death. Channel Islands has confirmed its first case of COVID-19 in an individual with travel history to Spain. New York State reported 142 cases, 123 of which are outside of New York City. The majority of cases are in Westchester County. The 6th confirmed case in Maryland is among an individual with travel history to Turkey, which currently has not reported any cases of COVID-19. The US Centers for Disease Control reported 647 cases in 37 states and Washington DC. 

US RESPONSE AND TESTING CAPACITY Santa Clara County , which has reported 43 confirmed cases, has ordered the cancelation of all mass gatherings. Sacramento County is no longer requiring automatic quarantine for people with a known exposure, indicating a shift from containment to mitigation measures. New York announced the enactment of a containment area for a one-mile radius around the area with the highest numbers of cases in Westchester County. There will not be movement restrictions, but there will be widespread cancellation of events. The National Guard will be supporting cleaning efforts and ensuring food is delivered to individuals in quarantine. Various universities have decided to cancel classes or move to an online-only format in order to promote social distancing among students. 

The University of Washington Department of Laboratory Medicine has increased testing capacity; clinicians throughout the United States are now able to order SARS-CoV-2 testing from the University of Washington. University of Washington is also offering drive-through testing similar to efforts taken in South Korea . In other news, a paper published in JAMA discusses the gaps in testing and how the regulatory environment influenced the distribution of tests in the United States. The paper highlights ongoing challenges with establishing testing strategies during outbreaks of novel pathogens. 
IMPACT ON VULNERABLE POPULATIONS A new story from the New York Times begins to detail the extended and unintended impacts stemming from the country’s decision to shut down major cities in an attempt to stall the spread of the COVID-19 outbreak. The story outlines the downstream effects of these social distancing measures and suggests that there is sufficient evidence to say that things like surge pricing and inaccessible messaging had a disproportionately large impact on vulnerable populations living in Wuhan city. 

NEW ACADEMIC RESEARCH A new study from the Annals of Internal Medicine  provides a new estimate for the incubation of COVID-19. Researchers collected publically-available data on 181 patients who contracted the disease outside of Hubei province. The authors found that the median incubation period was 5.1 days and that 97.5% of people that do develop symptoms did so within 11.5 days. They also found that “the median time from symptom onset and hospitalization was 1.2 days.” The study noted that these results were potentially biased since all of the data was derived from patients that required hospitalization. 

ECONOMIC IMPACT Reports from the United Nations Trade and Development Agency suggest that the COVID-19 outbreak will likely cost the global economy $1 trillion in 2020, with worst case scenarios showing a range as high as $2 trillion. Italy has discussed a number of options to bolster their economy during their national shut down. Earlier today, reports came out that the Italian government was in talks with banks across the country to stall debt payments for citizens stuck in lockdown. 

Domestically, US stocks dropped roughly 7% yesterday - the worst single day drop since 2008. High ranking political officials have held conversations on a potential stimulus package to mitigate the economic impact of the virus, including options like payroll tax cuts and ways to secure wages for hourly workers. Earlier today, Apple CEO Tim Cook shared that retail workers would be granted extended sick leave if they show COVID-19 symptoms, this follows the route of other companies like Trader Joes who announced a similar plan last week.