Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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March 24, 2020

EPI UPDATE The WHO COVID-19 Situation Report for March 23 reported 332,930 confirmed COVID-19 cases (40,788 new) and 14,510 deaths (1,727 new) globally. 

The number of reported COVID-19 cases in Pakistan has nearly tripled since last Thursday. As of today, the Pakistan Ministry of National Health Services reports 887 confirmed cases (103 new since yesterday), compared to 302 on March 19 . As we reported previously, there is concern about importing COVID-19 cases arriving from Iran and additional concern that a recent mass gathering in Pakistan could have facilitated transmission both domestically and to other countries.

Hong Kong has reported a surge in cases over the past week or so. The Hong Kong Centre for Health Protection reported 149 cases on March 15, but that number more than doubled through yesterday, when Hong Kong reported 357 cases. For several weeks, Hong Kong had maintained a slow but steady increase in cases; however, the recent incidence is considerably higher. Many of the recently reported cases have a history of travel.

Singapore has also recorded a high number of cases in people with a recent history of travel. The Singapore Ministry of Health reported a total of 137 imported cases since March 21 and only 36 domestic cases (March 21 , 22 , 23 , 24 ). All but 10 of the 137 returning travelers were residents of Hong Kong, so it is possible that some could have acquired the infection in Hong Kong prior to traveling and were detected only after they returned. 

The US CDC reported 33,404 total (confirmed and presumptive) COVID-19 cases and 400 deaths nationwide on March 23, more than double the number of cases reported on Friday and just shy of twice the reported deaths. Of these cases, 97.0% do not have an identified exposure—travel-related or close contact of a known case—and are still under investigation. The Johns Hopkins CSSE dashboard is reporting 46,485 US cases and 591 deaths as of 8:45am on March 24.

The New York Times is compiling national-level COVID-19 incidence data to track the epi curves in real time.

US RESPONSE Yesterday, the White House announced the COVID-19 High Performance Computing Consortium , a new public-private partnership that aims to “significantly advance the pace of scientific discovery in the fight to stop the virus.” The consortium brings together high-power computing resources from across the private sector, academic institutions, and federal agencies and resource organizations—”all volunteering free compute time and resources”—to tackle highly technical and complex challenges associated with COVID-19. Researchers requiring advanced computing resources, such as to identify prospective compounds or formulations for vaccines and treatment products, are encouraged to submit proposals via an online system.

The US Senate is reportedly making progress toward an economic stimulus package , now estimated at US$2 trillion, which could potentially pass the Senate as early as today. The “phase 3” funding aims to provide financial security for workers and businesses as well as boost funding for hospitals and health systems as they prepare for and respond to an increase in COVID-19 cases. There appears to be optimism that an agreement can be reached soon . A proposal presented recently by Speaker of the House Nancy Pelosi outlines a number of additional measures supported by Democrats. The House proposal—the Take Responsibility for Workers and Families Act —outlines US$2.5 trillion in economic support, but it is unclear the extent to which the Senate version of the bill will include any of these provisions. 

On Friday, March 20, the US Army Corps of Engineers announced plans to convert hotels, university dormitories, and similar spaces into hospitals to increase clinical bed space to support the COVID-19 response. States will identify suitable spaces—principally, those currently out of service and empty—and lease them to the Army Corps of Engineers, which will rapidly convert the available rooms for clinical care, with capabilities similar to intensive care units (ICUs), using standardized construction plans. FEMA and the Department of Health and Human Services will provide supplies for these units. The program is already being implemented in New York, and the Department of Defense plans to extend it to at least 18 states in the coming weeks. States will also be permitted to implement the program on their own, without needing to wait for the Corps of Engineers, using the same conversion plans and operational model. The plan is also adaptable to other settings like gymnasiums, arenas, or convention center, but those sites may focus on a lower level of clinical care due to the inability to separate patients into individual rooms.

WHO SARS-CoV-2 TESTING GUIDANCE The WHO published updated testing guidance for SARS-CoV-2 , noting the existing limitations on testing supplies and capacity compared to the needs of the growing pandemic. The WHO breaks down its guidance into 4 tiers based on the level of transmission in the country: no cases, sporadic cases, clusters of cases, and community transmission. The WHO recommends testing all suspected cases in countries with no reported cases, sporadic cases, and clusters of cases. The WHO emphasizes that the absence of reported cases does not mean that transmission is not occurring, and rapid response needs to be taken to initiate contact tracing and containment efforts for each confirmed case in these 3 tiers. The WHO recommends that countries identifying their first case allow WHO laboratories to conduct confirmatory testing. For countries with community transmission, the volume and burden of testing could quickly exceed existing capacity, and the WHO recommends prioritizing available testing capacity, specifically for vulnerable populations and healthcare workers. Additional priorities for testing include the first suspected cases at facilities at high risk for rapid transmission such as “schools, long-term living facilities, prisons, [and] hospitals.”

SEATTLE COMMUNITY TESTING Building on an existing pilot study to conduct seasonal influenza surveillance, the Seattle Coronavirus Assessment Network (SCAN) aims to better characterize community transmission of SARS-CoV-2. SCAN will perform SARS-CoV-2 testing for a representative sample of the Seattle population, including for individuals not experiencing COVID-19 symptoms, in order to more accurately evaluate the scope of the local epidemic. The extent to which SARS-CoV-2 infection results in mild or no disease and the role of asymptomatic infections and mild cases in driving community transmission remains uncertain, particularly as testing in the United States largely remains limited to more severe cases—especially, those requiring hospitalization. SCAN aims to conduct 300 tests per day, with an additional 100 tests from local clinical specimens, and the program will notify participants if their test is positive so that they can reduce the risk of further transmission.

NATIONAL “STAY AT HOME” ORDERS & CURFEWS In an address to the nation, United Kingdom Prime Minister Boris Johnson announced yesterday that the United Kingdom will implement similar measures to those recently announced in Germany . Individuals are instructed to remain home except for essential activities, including shopping for food and other necessary supplies, medical needs, and outdoor activity. The UK will also restrict gatherings of more than 2 people (excluding members of the same household), and events such as weddings and funerals will be prohibited. Additionally, non-essential businesses and locations where people gather—eg, libraries, playgrounds, gyms, and places of worship—will be closed. Parks will remain open for outdoor activities, but gatherings will be prohibited.

Indian Prime Minister Shri Narendra Modi announced a nationwide “lockdown” for India. Previously, some parts of the country had been under various levels of movement restrictions and curfew, but this will implement a consistent, mandatory policy for the entire population. The announcement did not include specific details regarding how the “lockdown” would be implemented or whether exceptions will be made like other countries (or states and cities in the United States) for medical care, shopping for essential supplies, or outdoor activity. Prime Minister Modi did state that the government would work to ensure the availability of essential supplies during this period. The nationwide restrictions will be implemented for the next 21 days, and Prime Minister Modi emphasized the importance of adhering to the social distancing measure, noting that failing in the next 21 days could set the country back 21 years.

Saudi Arabia implemented a curfew from 7pm until 6am for a period of 21 days in an effort to limit SARS-CoV-2 transmission. The curfew includes exceptions for essential activities such as shopping for groceries or other supplies, medical needs, supply chain and shipping (particularly for the health sector and food), and other essential services like gas stations, the energy sector, and emergency services. Today, the Saudi Press Agency reported that a woman was arrested for violating the curfew. Violators could face fines or imprisonment .

CALLS FOR EASING SOCIAL DISTANCING As the United Kingdom, India, Saudi Arabia, and other countries are implementing increasingly restrictive social distancing measures, elected officials and others in the United States are calling for a relaxation of existing restrictions in order to stave off economic impacts. US President Donald Trump is reportedly anxious to ease federal social distancing guidelines in order to mitigate their financial impact. Texas Lt. Governor Dan Patrick , who turns 70 next week, commented yesterday that he would risk death from COVID-19 in order to return to normal—and implied that other high-risk individuals would as well—because he believes that long-term social distancing would result in permanent damage to the American economy and society. Some cities in Texas have implemented “stay at home” or “shelter in place” orders, but there is no statewide order like exists in some other states.

OLYMPICS FATE DECIDED Yesterday, we reported that the status of the 2020 Summer Olympics in Tokyo, Japan, was uncertain, with the International Olympic Committee (IOC) committing to enhancing preparedness efforts and considering a later date for the games. Yesterday afternoon, numerous media outlets covered a story originally reported by USA Today that the 2020 Olympics were officially postponed, likely until 2021, based on comments from a prominent IOC member. While the IOC may not have actually come to a decision at that point , it published an official announcement this morning: the 2020 Tokyo Olympic Games will be postponed until 2021 in order to “safeguard the health of the athletes, everybody involved in the Olympic Games and the international community.” The Olympic flame will continue to burn in Tokyo, and the games will retain their designation as the 2020 Olympics despite the event’s new date.

MASS GATHERING TRANSMISSION Reports are emerging about multiple confirmed COVID-19 cases among attendees at a recent large religious gathering in Pakistan . A gathering of Tablighi Jamaat, a global Muslim missionary group, was hosted March 10-12 in eastern Pakistan. The event drew tens of thousands of members from across Pakistan and around the world, and at least 11 attendees have tested positive for SARS-CoV-2 since leaving the event. The first 2 cases in the Gaza Strip, 4 individuals from a province in southern Pakistan, and 5 individuals from Kyrgyzstan have all tested positive, but there may be others. The majority of attendees arrived from within Pakistan, which is currently facing a rapidly growing epidemic, but “at least a few thousand” were from other countries. According to this report, more than half of Malaysia’s reported COVID-19 cases have been traced back to a similar event in Kuala Lumpur earlier in the year, and attendees of that event are believed to have transmitted the disease to multiple other countries in Southeast Asia.

HUBEI PROVINCE ENDS “LOCKDOWN” China’s National Health Commission reported today that movement and travel restrictions in Hubei Province are being relaxed starting today. Hubei’s provincial government stated that Hubei Province will restore travel across its border, but travelers would be required to carry a “digital health certificate” issued by the provincial government in order to leave the province. It appears that a negative PCR test is required in order to obtain the certificate. Travelers entering Hubei will not require a health certificate. Travel restrictions for Wuhan will be relaxed starting on April 8, and further guidance and information will be published in the future regarding the resumption of other activities, including schools.

VULNERABLE POPULATIONS As cases of COVID-19 increase worldwide, there is growing concern about vulnerable populations. Incarcerated populations are at increased risk for infectious diseases due to confined living conditions. Rikers Island in New York City reported that 21 inmates and 17 employees have tested positive for SARS-CoV-2. There have been calls to release incarcerated individuals in an effort to prevent large numbers of infections and potential unnecessary death among these populations.

Refugees and internally displaced populations are also at elevated risk due to poor living conditions, forced mobility within countries and across borders, and a lack of access to social and medical services. All activities except emergency services have reportedly been suspended at 34 Rohingya refugee camps in Cox’s Bazar, Bangladesh, where 1.1 million Rohingya people live after fleeing Myanmar. Groups such as these lack access to critical testing and medical services needed during the COVID-19 crisis. Additionally, Syria confirmed its first case of COVID-19, raising concerns about an epidemic among the country’s large displaced population caused by years of civil war and government oppression. United Nations Secretary General António Guterres made an appeal to the global community for a “global ceasefire” and for the world to unite in this time of crisis, calling for a focus on the common enemy of COVID-19, which threatens individuals and communities around the world.