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March 2, 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 the affected countries for the latest information.
GLOBAL EPI UPDATES
The March 1 WHO
Situation Report
reports a total of 87,137 confirmed cases of COVID-19 in 59 countries, including 2,977 deaths. Since Friday, 12 new countries have reported cases of COVID-19: Azerbaijan, Belarus, Ecuador, Ireland, Lithuania, Mexico, Monaco, Netherlands, New Zealand, Nigeria, San Marino, and Qatar. A total of 4,843 new cases and 107 new deaths were reported globally since Friday. Notably, the February 28
Situation Report
raised the regional and global risk assessments to “very high,” in line with the risk assessment for China.
WESTERN PACFIC REGION
The WHO reports a total of 4,147 confirmed COVID-19 cases in the Western Pacific Region, excluding China. China’s
National Health Commission
reported a total of 80,026 confirmed cases of COVID-19 (67,103 in Hubei Province; 49,315 in Wuhan), including 2,912 deaths (2,803 in Hubei Province; 2,227 in Wuhan). This is an increase of 1,202 cases and 124 deaths nationwide since Friday. The NHC also reported 98 cumulative cases in Hong Kong, 10 in Macau, and 40 in Taiwan. The
Japanese Ministry of Health
reported 232 cumulative confirmed domestic cases of COVID-19, 6 deaths, and 22 “asymptomatic carriers.” Japan also has an additional 11 total cases and 4 asymptomatic infections among repatriated individuals. South Korea reported a total of 4,212 confirmed cases of COVID-19 as of March 2, more than double the national total of 2,022 cases
reported Friday morning
. COVID-19 deaths nearly doubled in South Korea as well, rising to 22 on Monday. The
South Korean government is preparing a supplemental funding bill
that aims to secure more than 6.2 trillion won (~US$5.12 billion) to combat the COVID-19 epidemic. This funding proposal is even larger than the supplemental funding bill awarded during the 2015 MERS outbreak, although the actual response ultimately cost nearly twice that amount.
EUROPEAN REGION
The
WHO European Regional Office dashboard
reports 2,180 total confirmed cases, including 37 deaths, as of 16:00 CET on March 2. Of those, 1,689 are in Italy. The dashboard also includes reports of cases in four new countries: Armenia, Czech Republic, Iceland, and Luxembourg. The United Kingdom
Department of Health and Social Care
reported a total of 40 confirmed cases. Most of the new cases had relevant travel to areas with ongoing community transmission or contact with a known case in the UK. One new case had no relevant travel history, and an investigation is ongoing to determine any exposure to known cases.
Germany’s Robert Koch Institute
reported a total of 157 cases of COVID-19 (including 2 repatriated cases), an increase of more than 100 cases since the
WHO’s February 28 Situation Report
, which reported 26 cases in Germany. The
French government
reported 130 confirmed cases of COVID-19, including 2 deaths, as of March, up from 38 cases reported in the WHO’s February 28 Situation Report.
ECDC RISK ASSESSMENT
The
European CDC
published an updated COVID-19 risk assessment which found the overall risk to be moderate to high, with high risk for those in areas with active community transmission. The risk to EU/UK healthcare system capacity and the risk of widespread and sustained transmission are both assessed as moderate to high. The report notes the upward trend in the number of cases and countries reporting cases, including domestic transmission.
EASTERN MEDITERRANEAN REGION
On Sunday, the EMRO region provided case counts for its Member States on
Twitter
. Iran’s outbreak, the official tally for which was reported at 978 confirmed cases and 54 deaths, remains of high concern. Of note, the death of Mohammad Mirmohammadi was
announced
today. Mirmohammadi, aged 71, was a member of Iran’s Expediency Council, which advises Ayatollah Ali Khamenei. The WHO
announced
today that it has sent a team to Tehran to help with the outbreak response efforts. Iraq
reported
an additional 6 cases, bringing the total there to 19.
REGION OF THE AMERICAS
The March 1
WHO Situation Report
reports COVID-19 cases in five countries: Brazil (2), Canada (19), Mexico (2), Ecuador (1) and the United States (62). The US total includes 46 Americans who contracted the virus while staying on the Diamond Princess cruise ship.
US UPDATE
On Saturday, the Seattle & King County and Washington State Health Departments
confirmed
that a patient who died in the Seattle area tested positive for the virus, marking the first confirmed COVID-19 death within the United States. Given the case details, public health experts suggest that the infection was the result of community transmission in the region. Additional cases in the region were announced on Sunday; the
Washington State Department of Health
reported a total of 13 confirmed cases and 2 deaths in the state. Of those, 10 cases and both deaths were reported in
King County
(which contains Seattle). An additional 231 individuals are currently under monitoring statewide. Estimates vary for how long the virus has been circulating in the region, but some have
suggested
that it could be as long as several weeks.
In the past few days, more confirmed cases have been found across the country, including in
new areas
such as
California
,
Illinois
,
Florida
,
Rhode Island
, and
New York
. The New York case is in an individual who had recently traveled to Iran. The woman is not in serious condition and has
isolated
herself at home, but the case emphasizes the need for preparedness in one of the country’s largest cities.
RESPONSE MEASURES OF DIFFERENT COUNTRIES
An
article
in
The New York Times
describes a smartphone application that China is using to alert users of potential disease exposure and to recommend social distancing. The app is not being used throughout all of mainland China, but is in widespread use in Hubei and Zhejiang provinces. In Paris, staff at the Louvre
forced
a closure of the museum this past weekend over coronavirus fears. The United Kingdom’s government has
said
that all options, ranging from school closure to city lockdowns, are being considered. The Italian government published an
overview
of COVID-19 containment measures broken down by region. The most restrictive measures are implemented in 11 of the hardest-hit cities, including movement restrictions in affected areas, suspension of mass gathering events and schools, closure of museums and other cultural sites, suspension of government office operations, and interruptions of private sector business.
US PANDEMIC PREPAREDNESS DETAILED
On Sunday,
The New York Times
published a comprehensive
article
on US pandemic preparedness that details the COVID-19 pandemic’s projected impacts on the US healthcare system and public health agencies as well as the potential impact of social distancing measures such as school closures and cancellations of mass gatherings. The article highlights the nationwide dearth of surge capacity in intensive care units, and in particular, the potential for a significant supply/demand mismatch for mechanical ventilation, which may be required for the most severe COVID-19 cases.
Separately, Dr. Thomas Inglesby and Anita Cicero (Director and Deputy Director at the Center for Health Security, respectively) published an opinion piece in
The New York Times
describing
critical actions
that the US public health and healthcare systems should be taking now to prepare for and respond to COVID-19 in the United States. Recommendations include preparing hospitals to care for large numbers of critically ill patients and an emphasis on following infection control procedures for healthcare providers. In addition, they note, “[p]ublic health professionals will also need to work with political leaders to make hard decisions on if or when large events should be canceled, workers should be told to telecommute, schools should change the way they operate or schools should close. While these actions may slow the spread of the disease, they could have negative consequences.”
US FDA TESTING GUIDANCE UPDATES
On February 29, the US FDA published a
guidance document
that specified its revised policy for diagnostic testing for SAR-CoV-s. Laboratories that are certified by the FDA to perform high-complexity testing under the Clinical Laboratory Improvement Amendments will be permitted to develop in-house diagnostic kits. After the test is appropriately validated utilizing the criteria described in the guidance, these laboratories must apply for an emergency use authorization to receive official authorization to use the tests; however, the
key benefit
is that these laboratories will be able use the tests on clinical samples while awaiting the EUA from the FDA. Scott Becker, from the Association of Public Health Laboratories, said that
41 laboratories
will be able to use the CDC’s diagnostic tests by early this week and that capacity will expand to 10,000 patients per day by the end of the week.
ECONOMIC IMPACTS
Economists continue to look at the growth of the outbreak as a
probable source
for a recession amongst affected countries and the entire global market. China’s public health response over the past month showed the potential for supply shock, with a large reduction in their production capacity due to isolated workers. Some economists are reporting that it is increasingly difficult to model the economic impact of widespread quarantines in places like the United States, which could create challenges for groups like the service industry. Countries that have experienced some of the larger COVID-19 outbreaks have begun to see stock shares rebound slightly as governments consider stimulus plans that could aim to stabilize markets. Earlier today, the Japanese stock market
saw
a minor rebound based on investor’s hopes of a coming stimulus package. Additionally, both Italy and China
saw
some positive signs due to cuts on global interest rates.
STATE DEPARTMENT AND CDC UPDATE TRAVEL ADVISORIES
On February 29, the US State Department and CDC updated their travel advisories. The State Department has increased its advisory to level 3 for
Italy
, suggesting to reconsider travel.
CDC
recommends that travelers should avoid all nonessential travel to the country due to widespread community transmission. Similarly, the
State Department
issued a level 3 travel warning to South Korea advising to reconsider travel, and the
CDC
has recommended avoiding all nonessential travel. A Level 4 State Department travel advisory (Do Not Travel) remains in place for
China
. The existing Level 4 travel advisory for
Iran
, originally implemented over security concerns, was updated to include an additional warning about the country’s COVID-19 outbreak and associated protective measures.
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