Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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March 25, 2020

EPI UPDATE The WHO COVID-19 Situation Report for March 24 reported 372,757 confirmed COVID-19 cases (39,827 new) and 16,231 deaths (1,722 new) globally. The WHO also reported that it delivered its 7th shipment of medical supplies , including lopinavir and ritonavir for the Solidarity Trial, to Iran earlier this week. The WHO also partnered with FIFA to implement an awareness-raising and risk communication campaign among the global soccer/football community. The program will involve at least 28 international stars, both women and men, from countries around the world, communicating in 13 different languages.

Pakistan continues to report a steady increase in COVID-19 cases. As of today, the Pakistan Ministry of National Health Services reported 991 confirmed cases (104 new), more than three times the number of cases 6 days ago . As we reported previously, there is concern about importing COVID-19 cases arriving from Iran, and as discussed below, there is concern that a recent mass gathering in Pakistan could have facilitated transmission domestically and to other countries.

The US CDC reported 44,183 total (confirmed and presumptive) COVID-19 cases on March 24 and 54,453 cases today (10,270 new). There were 544 deaths nationwide on March 24 and 737 deaths reported today (193 new). Of these cases, 97.1% 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 55,568 US cases and 809 deaths as of 12:00pm on March 24.

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

US SUPPLY CHAIN Yesterday, FEMA Administrator Peter Gaynor announced publicly that FEMA, now the agency leading the US COVID-19 response, would be using the Defense Production Act (DPA) for the first time in order to acquire SARS-CoV-2 tests and millions of masks. Shortly before that, however, US President Donald Trump issued a conflicting tweet noting that the federal government had not had to use the DPA at all. Later yesterday evening, FEMA issued a statement that the agency was able to “procure the test kits from the private market without evoking the DPA.”

Research has been ongoing to develop serological tests to detect antibodies to SARS-CoV-2. Serological tests could be used to identify individuals who have been previously infected and may have some level of immunity as a result. Researchers at Mount Sinai Icahn School of Medicine are planning to transfer the work to the hospital’s clinical laboratories this week in order to start testing patient samples. The nature of immunity from those who have survived COVID-19 has not yet been fully characterized. 

US ECONOMIC IMPACT In remarks yesterday at the White Coronavirus Task Force briefing , US President Donald Trump express his desire to ease nationwide social distancing guidelines, outlined under the White House’s ongoing “15-Day Plan,” by Easter, which falls on April 12. Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases, commented that the situation will continue to be evaluated daily, and a decision will be made regarding the future of national social distancing policies based on the available evidence and trends. Recommended measures may also differ at the state level.

The US Senate reportedly reached an agreement on a US$2 trillion economic stimulus package in response to the ongoing COVID-19 pandemic. The plan will include $1,200 checks directly to individuals to supplement lost income and other financial difficulties; $367 million in small business loans; a $500 billion loan fund for “industries, cities and states”; $130 billion for hospitals; and $150 billion for “state and local stimulus funds.” The bill also expands unemployment funding and increases associated benefits, includes transparency mechanisms regarding how funding is utilized, and prohibits stimulus funds from going to companies or programs owned by the President, White House staff, or member of Congress. The Senate is scheduled to vote on the bill today, but it is still unclear how it will proceed in the House of Representatives. The House is not in session, but there are mechanisms—such as “unanimous consent”—which could allow the bill to pass and be sent to the President without the Representatives voting in person.

DELIVERY DRIVERS VULNERABLE A report published today by Reuters looks at the COVID-19 risk for delivery drivers around the country and how major companies like Amazon, Walmart, and Target are managing the risk for their employees and contractors. Companies that rapidly ship and deliver goods, including food, across the country have become critical parts of the American and global supply chains. Many major companies offer paid time off and health insurance for their employees, or require contractors to offer them to their employees. But while employees may have paid time off, the amount may vary, including the time allowed for sick leave. Some of these companies have pledged funds to support employees who are diagnosed with COVID-19 or must undergo quarantine, but the processes in place to receive this compensation may be difficult to navigate, particularly for employees of contractors.

GLOBAL ECONOMIC IMPACT China has ramped up economic activity after 2 months of aggressive social distancing measures to slow the spread of SARS-CoV-2. As movement restrictions are relaxed, including for Hubei Province, companies are expected to begin resuming operations. Despite the low numbers of new cases, many of which are imported from other countries, news media have reported that worker shortages continue due to fear of reconvening and leading to subsequent outbreaks. China’s government injected stimulus funding into infrastructure projects and healthcare systems and instituted tax relief in an attempt to speed economic recovery, which could provide insight into the effects of these types of measures as other countries aim to stabilize their national economies in the coming weeks and months.

The rapid economic decline in countries around the world, including disruption in production and other economic activity, has led some economists to forecast a “ deep global recession .” There seems to be a “clear tension between preventing infections and ruining the economy,” and countries are struggling to identify the most appropriate balance. While China appears to be coming back online, companies elsewhere around the world are implementing measures to mitigate the risk to employees or due to interruptions of critical supply chains. Japanese automobile manufacturer Nissan, for example, announced the closure of factories in India and multiple countries in Africa and the Middle East as a result of national social distancing policies in those countries. Additionally, the decision to postpone the 2020 Olympics Games in Tokyo, Japan, have compounded existing economic challenges in Japan and resulted in potentially hundreds of millions of dollars of financial cost for television companies that were scheduled to televise the games. Fortunately, the decision was made to postpone the Olympics rather than cancel them, which will hopefully mitigate the long-term financial impact.

GLOBAL RESPONSE Doctors and nurses in Zimbabwe went on strike today over a lack of available protective gear against COVID-19. This follows a previous 4-month strike that ended in January 2020, led by doctors demanding better compensation and working conditions. Additionally, customs officials at key airports in the country also went on strike due a lack of protection. While Zimbabwe has reported only a few confirmed COVID-19 cases and 1 death, some have criticized the government for alleged underreporting of cases. Zimbabwe’s neighbor South Africa has reported more than 700 cases, indicating Zimbabwe could be vulnerable. There are also reports of individuals and businesses in Zimbabwe and other African countries disregarding national social distancing guidance and policies, further elevating the risk of transmission.

Amid a rising number of cases in Japan , particularly in Tokyo, the city’s governor asked residents to avoid “non-essential outings” until April 12. The governor also warned against unnecessary international travel and indicated the possibility of city lockdown in the future if cases continued to rise. Tokyo, reporting more than 200 cases, now has the country’s highest reported incidence. The announcement follows news that the Tokyo Olympics will be postponed and reports of Japanese residents engaging in large gatherings and growing weary of existing social distancing measures, in part due to the absence of a large spike in cases like what has been observed other countries. The resistance to long-term social distancing measures in China could potentially forecast similar responses in Europe, the United States, and elsewhere.
India’s Ministry of Home Affairs provided additional information on the country’s 21-day “lockdown.” Essential businesses, such as grocery stores and banks, will remain open, and home delivery is encouraged. All social, entertainment, academic, and religious gatherings are prohibited, and funerals are limited to no more than 20 people in attendance. Implementing these measures so rapidly in a densely populated nation of 1.3 billion people will be challenging. The rapid enactment of the shutdown has also reportedly led to some confusion about which stores should remain open, as police in certain areas have allegedly demanded food stores to close and journalists to cease working despite directives from the government to allow such work to continue.

COVID-19 MORTALITY One of the major challenges facing public health researchers is determining the case fatality risk of COVID-19. Based on the data available (and the data selected for the analysis), the case fatality ratio varies considerably from country to country and even between regions or cities within countries. The disease’s mortality depends heavily on a number of factors, including patients’ age and health, quality and capacity of the local health system, and available treatments, but at a national and global level, trends do emerge. One analysis observed drastically differing COVID-19 mortality by country , ranging from 9.5% in Italy to 0.4% in Germany, prompting questions about whether some countries’ response measures are contributing to lower mortality. This article focuses on Germany and its efforts to implement robust surveillance and testing policies, which may have helped to identify a broader scope of COVID-19 cases, including milder cases and asymptomatic infections that may not be captured in countries that are restricting testing to severe or hospitalized patients. Also of note, South Korea is reporting only a 1.3% case fatality ratio (second lowest reported here), and it has also implemented a robust testing program, performing more than 334,000 tests since the onset of the pandemic.

WHO GLOBAL HUMANITARIAN RESPONSE PLAN Earlier this morning, the UN, WHO, and UNICEF jointly announced the COVID-19 Global Humanitarian Response Plan , which aims to combat the pandemic in the world’s most vulnerable countries. The US$2 billion effort will be implemented by UN agencies and non-governmental organizations (NGO) to increase laboratory and clinical capacity to respond to the pandemic, improve sanitary and hygiene conditions, promote public messaging, and facilitate the movement of humanitarian responders to conduct response operations. Target countries will include those already facing significant humanitarian challenges, including due to “conflict, natural disasters and climate change,” and priority vulnerable populations will include children. Children are adversely affected by major health and humanitarian events, including “their education, mental health and access to basic health services.”

COVID-19 ON DEPLOYED US NAVY SHIP The US Navy reported its first confirmed COVID-19 case on a deployed ship , the aircraft carrier USS Theordore Roosevelt. The Roosevelt is one of the largest ships in the Navy, carrying approximately 5,000 personnel onboard. Sailors and Marines onboard work and live in extremely close contact for prolonged periods of time, which can easily result in outbreaks among the ship's crew, including diseases such as norovirus and adenovirus. The 3 infected Sailors are being quarantined and flown off the ship, which is intended to help contain the virus before it can spread further. The ship’s last port visit was in Da Nang, Vietnam, where Sailors and Marines were permitted to leave the ship. The Navy has reported COVID-19 cases onboard other ships, but all of those were on ships that were in port.