Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
The Center for Health Security will be analyzing and providing update on  the emerging novel cor on avirus. If you would like to receive these daily  update s, please  sign up here and select COVID-19. Additi on al resources are also available  on  our  website .

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.