Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.
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March 9, 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 most recent WHO COVID-19 Situation Report—with data through 10AM CET on March 8— reports 105,586 confirmed cases of COVID-19 worldwide, including 3,656 newly reported cases. There are now 102 countries reporting COVID-19 cases, an increase of 16 countries since our Friday update. Of these new cases, 3,610 (99%) were reported by countries outside of China, with Italy accounting for the largest proportion among individual countries (1,247 new cases). The WHO also reported 3,584 total deaths worldwide, an increase of 98 from the day before. As with the newly reported cases, the majority (73%) of the new deaths were reported outside of China. The Johns Hopkins COVID-19 dashboard reported 111,363 confirmed cases as of 10AM this morning.

China’s National Health Commission reported a total of 80,735 cases nationwide, including 3,119 deaths. Notably, no new local transmission of the virus was reported in mainland China outside of Hubei Province; 36 cases were reported in Wuhan, and 4 cases imported cases were reported in travelers arriving from Iran. In fact, only 1 domestically acquired case has been reported outside of Hubei Province on March 6-8. South Korea reported 7,382 confirmed cases, including 51 deaths. South Korea has tested more than 196,000 individuals so far in their response. Earlier today, South Korean President Moon Jae-in expressed optimism that the country will soon enter a “phase of stability.” As of March 8, the Italian Ministry of Health reported 6,387 confirmed cases of COVID-19, including 366 deaths. The majority of these cases have been located in northern regions of the country, with Lombardy and Emilia Romagna reporting a combined 5,369 cases (84%). Iran’s Ministry of Health reported 7,161 cases and 237 deaths nationwide. Notably, nearly 2,000 cases have been reported in Tehran, Iran’s capital.

US UPDATE Updated reports share that there are more than 500 cases and 22 deaths tied to the COVID-19 outbreak in the United States. Washington state, one of the areas where the virus has hit the hardest, reported 136 cases and 18 deaths, the majority of which are tied to King County (where Seattle is located). California reported 114 confirmed cases and 1 death tied to the outbreak, and New York state reported 105 total cases. There are now reported cases in at least 34 states and Washington, DC .

Several high-ranking US political figures have taken measures to voluntarily quarantine themselves and several staff members after reports surfaced that one of the domestic COVID-19 cases had contact with staff at the Conservative Political Action Conference in late February, held just outside Washington, DC. Across the United States, schools and groups have begun to take preventive measures to limit the spread of disease. Several major public health officials have lauded the implementation of voluntary social distancing measures and supported the idea that communities and individuals need to prepare in advance of documented transmission in their community. In California and Washington state, several school districts—including Northern California’s largest, which represents 63,000 students in Sacramento— have temporarily cancelled classes and other events in response to confirmed COVID-19 cases.

US LABORATORY TESTS On Sunday, New York Governor Andrew Cuomo publicly criticized the federal government's delay in providing tests for private laboratories. US FDA commissioner Stephen Hahn said late last week that the materials for more than 2 million tests would be sent to private US laboratories as early as today. Separately, the Bill and Melinda Gates Foundation announced earlier this morning that it will support a program that would offer Seattle residents at-home, mail-in COVID-19 tests.

In Seattle, employees at the University of Washington Medical System can get tested for COVID-19 in a drive-through clinic, according to NPR . The drive-through model is being implemented in an open-air hospital parking garage to help avoid people congregating in a more traditional clinic setting. The drive-through clinic, which is able to test approximately 1 person every 5 minutes and return results within about 24 hours, is currently limited to healthcare workers who are experiencing COVID-19 symptoms. The university is also planning to work with the Gates Foundation to develop home testing kits. 

US STATE DEPARTMENT TRAVEL ADVISORIES The US Department of State published a travel warning for cruise ships . The warning specifically recommends that US citizens—”particularly travelers with underlying health conditions—avoid travel on cruise ships due to the ongoing COVID-19 epidemic. The US CDC has acknowledged the increased risk for infection in cruise ship environments. The State Department notice emphasizes that travelers should not rely on the federal government for repatriation flights in the event of an outbreak onboard a cruise ship, noting that recent examples may not be standard operating procedure moving forward.

The State Department also issued a Level 3 travel advisory (“reconsider travel”) for Turkmenistan as a result of screening and quarantine measures implemented by the government in response to the COVID-19 epidemic. According to the travel advisory, incoming travelers may be forced to undergo involuntary quarantine at medical facilities in Turkmenistan, and they could potentially be “required to undergo medical testing unrelated to COVID-19 including but not limited to HIV testing.” The travel advisory was issued due to uncertainty around the length of quarantine, concerns about the quality of associated medical care standards, and the potential for rapid changes to travel and entry policies without warning.

The State Department also issued a Level 3 travel advisory (“reconsider travel”) for Azerbaijan as a result of an increase in COVID-19 cases due to immigration from neighboring Iran as well as response measures implemented by the Azerbaijani government. All arriving travelers in Azerbaijan are required to undergo screening for COVID-19, and suspected cases are being placed in quarantine facilities for monitoring. Additionally, travel restrictions implemented by other countries and reductions in commercial air services could limit options for medical evacuation from Azerbaijan, if necessary. The travel advisory also warns that medical treatment conditions in Azerbaijan are “not consistent with U.S. standards and basic medical supplies may be unavailable in some areas.”

ITALY RESPONSE The Italian government has taken a number of steps in an attempt to limit the spread SARS-CoV-2. Over the weekend, the Italian government cordoned a region containing almost a quarter of all Italian citizens . The measures do not permit the travel in or out of Lombardy and other surrounding towns, except for proven work or emergency-related reasons. The Ministry of Health also announced closures of a number of commercial entities—including movie theaters, museums, and bars—to reduce the risk of community transmission. The ordinance limited the number of open commercial entities to only those that could guarantee a distance of at least 1 meter between guests. The containment measures have led to varying amounts of social outrage in affected areas of the country. Prisoners in several prisons took guards hostage and incited riots in protest to restrictions on visitors implemented in response to COVID-19 risk.

OIL PRICES According to The New York Times , Saudi Arabia has substantially reduced its export oil prices in response to Russia’s recent refusal to join the Organization of Petroleum Exporting Countries (OPEC) in reducing production as COVID-19 has reduced global demand for oil. The move could negatively impact other oil-exporting countries, such as Venezuela and Iran, but it would reduce the price of gas for consumers. The changes in pricing come amid continuing declines in the stock market. 

TRAVEL RESTRICTIONS & TRAVEL-RELATED EXPOSURES Qatar is suspending all schools and universities nationwide for an indefinite period of time, beginning on March 10. The Qatar Government Communications Office also announced that the government is suspending travel to and from several countries, including but not limited to Bangladesh, Italy, India, Philippines, Sri Lanka, South Korea, Syria, and Thailand. According to South China Morning Post , political leaders in Hong Kong have also called for restrictions on anyone arriving from countries affected by COVID-19, including Italy and India. Currently, Hong Kong has only banned non-local residents coming from South Korea and Hubei Province in China, but the government has imposed mandatory quarantine from anyone coming from mainland China, Iran, and the 3 most affected cities in Italy. The calls came after 6 tourists in a Hong Kong tour group tested positive for SARS-CoV-2 after returning from India. NDTV News reported 400 people in Assam, India who were contacts of a US tourist have been quarantined after the tourist tested positive for SARS-CoV-2 after traveling through the Indian state.

IRAN RELEASES 70,000 PRISONERS DUE TO OUTBREAK Reuters reported that approximately 70,000 prisoners in Iran have been released. Judiciary chief Ebrahim Raisi announced that the release is temporary and is designed to reduce the spread of the virus in jails, according to US News

VACCINE DEVELOPMENT USING SYNTHETIC BIOLOGY STAT News reported that synthetic biology approaches are being utilized to develop candidate COVID-19 vaccines. In these vaccines, lab-developed RNA or DNA are designed to be delivered into cells, which aim to produce viral proteins that initiate an immune response. These approaches are being implemented to develop vaccines that are more effective, more stable, and more scalable than those developed and produced using existing practices. These efforts are part of a broader push to develop a coronavirus vaccine in time to substantially mitigate global transmission and mortality.