Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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March 18, 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 UPDATE The WHO COVID-19 Situation Report for March 17 reported 179,112 confirmed COVID-19 cases and 7,426 deaths across 160 countries/territories/areas, an increase of 11,526 cases, 475 deaths, and 8 countries from the previous day. The WHO also added reports broken down by region: Western Pacific 91,779 cases and 3,357 deaths; Europe 64,189 cases and 3,108 deaths; South-East Asia 508 cases and 9 deaths; Eastern Mediterranean 16,786 cases and 873 deaths; Americas 4,910 cases and 873 deaths; Africa 228 cases and 4 deaths. Of note, yesterday we reported 417 cases and 7 deaths for the continent of Africa. This corresponded to all countries on the continent and not the WHO African Region. Several African countries are part of the Eastern Mediterranean Region, which explains the lower number reported today by the WHO.

The Italian National Institute of Health’s daily update for March 17 reports 28,293 cases (3,235 new), including 2,629 healthcare workers (290 new), and 2,003 deaths (306 new) nationwide. Spain’s Ministry of Health reported 13,716 confirmed cases (2,538 new) and 598 deaths (107 new). Both France and Germany also reported more than 1,000 new cases, bringing France to 7,730 confirmed cases and Germany to 7,156 cases. The South Korean CDC reported 8,413 confirmed COVID-19 cases (93 new), including 84 deaths (3 new). Pakistan’s Ministry of National Health Services has reported a substantial increase in confirmed cases over the past several days, jumping from 31 on March 15 to 241 on March 18 (a 677% increase). China’s National Health Commission reported 13 new confirmed cases of COVID-19 and 11 new deaths nationwide, bringing the national total to 80,894 cases and 3,237 deaths. Notably, only 1 of the cases was domestic transmission (in Wuhan), and the other 12 cases were imported. China’s NHC also reported 167 cases in Hong Kong (10 new), 13 in Macau (2 new), and 77 in Taiwan (10 new).

We were unable to access the Iranian Ministry of Health website, and the WHO Situation Report does not include an update from yesterday’s totals for Iran. Modeling conducted by researchers at the Sharif University of Technology in Tehran estimates that under optimal conditions, including strict adherence to social distancing and sufficient access to medical supplies, Iran’s COVID-19 epidemic could peak within a week and would kill more than 12,000 people. In the absence of those intense mitigation conditions, however, the researchers estimate that the epidemic would peak in late May and could kill as many as 3.5 million Iranian citizens.

The US CDC reported 4,226 total (confirmed and presumptive) COVID-19 cases and 75 deaths across 53 states and Washington, DC; Puerto Rico, Guam, and the US Virgin Islands. Of these cases, 474 have an identified source (either travel-related or close contact of another identified case) and 3,752 cases (88.8%) are still under investigation. The Johns Hopkins CSSE dashboard is reporting a total of 6,519 COVID-19 cases and 115 deaths in the United States as of 11am on March 18.

NEW YORK SOCIAL DISTANCING Yesterday, New York Mayor Bill DeBlasio issued an executive order banning “pooled” or “shared rides” for 5 days. Pooled or shared rides refer to high-volume taxi or ride-sharing services that allow riders that are not otherwise part of the same group to ride together in the same vehicle, such as Uber Pool. Mayor DeBlasio also discussed the possibility of implementing a “shelter in place” order in New York in the coming days, similar to what is currently in place in San Francisco. Several reports note that New York Governor Andrew Cuomo opposed the idea and commented that the state government must approve any such measure. At a press conference, Mayor DeBlasio said a decision would be made in the next 48 hours, but it remains to be seen to what extent a citywide order would or could be implemented in New York.

US JOBS LOST A new poll found that nearly 1 in 5 of US workers have either lost their jobs or work reduced hours as a result of the COVID-19 epidemic in the United States. The poll— conducted by NPR, PBS News Hour, and Marist Poll —asked respondents a broad scope of questions, including perceptions of the President and state governments and their handling of the coronavirus response and the impact of the pandemic. In total, 18% of respondents have been fired or had their hours reduced due to the COVID-19 pandemic. Notably, this impact was greater in respondents earning less than $50,000 per year (25%) and those living in small cities or suburban areas (23%). The survey was conducted March 13-14, so it does not account for the spate of recent increases in social distancing across the country, including school closures, limiting restaurants to takeout or delivery, or the shelter in place order in the San Francisco Bay area.

Similarly, US Secretary of the Treasury Steven Mnuchin reportedly told Republican senators that prolonged economic impacts from the COVID-19 pandemic could lead to 20% unemployment in the United States if rapid action is not taken. These comments reportedly occurred during discussions about a proposed US$1 trillion economic stimulus package, but Treasury Department representatives emphasized that the statement was made to illustrate potential consequences and was not a forecast or prediction.

TRAVEL & MOVEMENT RESTRICTIONS A number of countries, regions, and states have implemented some form or movement or travel restrictions, ranging from border closures to “shelter in place” orders to broader social distancing efforts. The United States and Canada are reportedly working to finalize a joint restriction on non-essential travel between the two countries. The United States and Canada have both implemented travel restrictions for other countries, but the border remains open between them. The details have not yet been finalized, but an official announcement is expected in the coming days. Government officials have emphasized that any restrictions will not impact trade and business between the United States and Canada. US President Trump announced the border restrictions this morning via Twitter , but details have yet to be published.

Yesterday, France implemented domestic travel restrictions nationwide for a period of at least 15 days. Individuals are permitted to travel for essential purposes (e.g., medical reasons, travel to/from work if remote work is not an option, movement to purchase food or supplies), but they must carry a signed certificate that indicates their name, address, and purpose of their travel. Violators will be subject to a 135 Euro fine.

The European Commission implemented a 30-day restriction, effective immediately, on non-essential travel from all countries outside of Europe . The proposal was initiated on Monday, and EU governments reportedly endorsed the policy yesterday via videoconference . The travel restrictions will exempt citizens of EU countries (including the United Kingdom and other Schengen countries) and their families as well as permanent residents. The policy notes that the WHO does not support travel restrictions as effective measures to slow transmission, but the EU determined the need to take “urgent, immediate and concerted action” to combat COVID-19. The policy should allow countries to remove travel restrictions within the EU’s external border. The European Commission implemented a separate policy to ensure continued and effective transport of goods and services within the continent, including prioritizing emergency transportation and the supply of medicine, medical equipment, food, and other essential supplies. The European Commission also published guidance regarding travelers’ rights in the European Union in the context of the COVID-19 pandemic. The guidance includes information about travelers’ right to re-book or re-route their travel or receive compensation for cancelled travel, with specific sections on how these apply to situations in which travelers elect to cancel travel or are not permitted to travel, new national travel restrictions or policies, and restrictions imposed by travel companies (e.g. airlines) themselves. The guidance addresses rail, air, and maritime travel within the European Union.

South Africa imposed restrictions on travelers arriving from high-risk countries. Visa requests from international travelers who have visited high-risk countries (including Italy, Iran, South Korea, Spain, Germany, the United States, France, Switzerland, and China) in the past 20 days will be denied. All international travelers, including South African citizens, arriving in South Africa will be subjected to COVID-19 screening and may be required to undergo quarantine for a minimum of 14 days. All travelers already in South Africa who have traveled to a high-risk country since February 15 are required to “present themselves for testing.”

SPAIN NATIONALIZES PRIVATE HEALTH SYSTEM On Sunday, the Spanish government announced that private healthcare facilities will be placed under the control of regional governments , essentially nationalizing private sector health systems to supplement Spain’s National Health System and ensure clinical care is available for COVID-19 patients nationwide. Additionally, contracts will be extended for resident doctors in relevant specialties who are in their final year of training, and the government will permit hiring individuals with degrees or qualifications in the healthcare profession but who “have not yet specialised.” Furthermore, the government directed retired healthcare professionals under the age of 70 to make themselves available to regional governments to supplement existing healthcare system capacity. This announcement quickly followed Spain’s declaration of a state of emergency on Saturday.

ORIGIN OF SARS-COV-2 DETAILED Yesterday, Nature published a correspondence from a group of leading virologists and genetic epidemiologists that describes what is known about the origin of the SARS-CoV-2 virus. The authors review notable genetic features of the virus, including mutations in the receptor binding domain and structural features of the spike protein. Importantly, they also review evidence supporting the virus’ emergence from an animal reservoir. The authors consider other possible origins as well. They conclude that “the evidence shows that SARS-CoV-2 is not a purposefully manipulated virus,” and while “it is currently impossible to prove or disprove” other possible origins, they “do not believe that any type of laboratory-based scenario is plausible” based on SARS-CoV-2’s genetic characteristics.

US HEALTH SYSTEM CAPACITY Newly-published data from researchers at Harvard Global Health Institute illustrate the potential impact of COVID-19 on the available bed capacity at hospitals across the United States. Coverage of the analysis was published by both The New York Times and ProPublica . The study provides local estimates of the potential burden of COVID-19 under a variety of potential scenarios, including multiple rates of infection and epidemic timelines, and forecasts the number of beds required to manage COVID-19 patients. In one scenario that evaluated the impact of 40% of adults infected nationwide, the model found that 40% of local healthcare systems could not handle all of the patients “even if they could empty their beds of other patients.” The model does not account for ongoing efforts around the country to increase hospital and health system capacity, but the results highlight the critical importance of both bolstering the number of available beds and implementing effective social distancing measures to “flatten the curve.” The ProPublica coverage also allows readers to enter specific locations to view analysis for that geographic area.

DISINFECTING YOUR HOME The US CDC published guidance regarding how to clean and disinfect your home , if you live with someone who is infected with SARS-CoV-2. As more COVID-19 patients are identified and isolated at home, the CDC provided recommendations that can mitigate the risk of transmission within households. The principal recommendation is to wear gloves when touching or cleaning any potentially contaminated surfaces or objects. The guidance includes cleaning high-touch surfaces and objects (eg, countertops, tables, keyboards, light switches, doorknobs) with soap and water and disinfecting them using bleach-based cleaning products or alcohol. The guidance also includes guidance for laundry and cleaning soft surfaces (e.g., couch cushions) as well as food preparation and trash disposal. As always, hand hygiene is critical to reducing the risk of transmission.