COVID-19
Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.

The Center for Health Security is analyzing and providing update s  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 .
May 1, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 30 reports 3.09 million confirmed cases (71,839 new) and 217,769 deaths (9,797 new) worldwide. The WHO continues to emphasize the importance of maintaining routine vaccination services during the COVID-19 pandemic .

The UK COVID-19 epidemic appears to be continuing its decline in daily incidence; it looks like last week will be the second consecutive week of decreasing incidence. Russia reported 7,933 new cases, which appears to be its highest daily incidence . This is the second consecutive day that Russia has reported more than 7,000 new cases.

Following 2 days of daily incidence greater than 1,800, India reported 1,433 new cases. Pakistan reported 990 new cases, the third consecutive day of setting a new high for daily incidence. While Pakistan’s daily incidence continues to increase, its doubling time remains relatively consistent at approximately 11 days.

Singapore reported 932 new COVID-19 cases, 905 (97.1%) of whom are residents of migrant worker dormitories. In total , Singapore has reported 14,776 cases among dormitory residents, 4.6% of the estimated total population living in those facilities. These cases also represent 86.4% of all COVID-19 cases reported in Singapore. Since April 18, Singapore has reported 11,504 cases among dormitory residents (plus an additional 543 cases among migrant workers living elsewhere), compared to only 254 community cases. Indonesia reported 433 new cases, its third highest daily incidence. Indonesia’s daily incidence has fluctuated considerably over the past week, but the daily values have largely remained between 250 and 450 new cases per day since the middle of April. Bangladesh reported 571 new cases. This is Pakistan's second highest daily total, but it is approximately the same as the previous day. Bangladesh has reported its 4 highest daily incidence totals over the past 4 days.

New York state and New York City both reported a slight increase in new cases over the previous day. We are continuing to monitor COVID-19 incidence trends in states that have started easing social distancing measures; however, it could be several weeks before any effects begin to emerge in reported data.

The Indian Health Service reported 3,212 confirmed cases. Notably, nearly two-thirds of those cases (1,999) are reported among the Navajo Nation.

The US CDC reported 1.03 million total cases (26,512 new) and 60,057 deaths (2,552 new). This is the second consecutive day of increasing incidence, but the daily total is still less than most days over the past several weeks. In total, 12 states reported more than 25,000 cases (1 new), including New York with more than 200,000; New Jersey more than 100,000; and Illinois and Massachusetts more than 50,000. Additionally, 36 states (increase of 1), plus Guam, are reporting widespread community transmission.

The Johns Hopkins CSSE dashboard is reporting 1.07 million US cases and 63,019 deaths as of 8:30am on May 1.

US STATES EXTEND STAY AT HOME ORDERS A number of US states had emergency declarations and “stay at home” orders that were scheduled to expire at the end of April or beginning of May. Some governors elected to allow them to expire in an effort to resume economic activity in their states, but others extended those orders. States that extended the orders took a variety of approaches, including relaxing some restrictions while maintaining others and varying the duration of the extensions. These states include Arizona , Illinois , Louisiana , Michigan , Minnesota , Nevada , and Ohio . Several other states, including Washington , are expected to issue extensions in the coming days. The governors and health officials in these states determined that COVID-19 data does not yet indicate that the epidemic is sufficiently under control to allow further relaxation of social distancing measures. Notably, the decision by Michigan Governor Gretchen Whitmer prompted a protest , during which protesters, some armed with assault-stye rifles and other firearms, entered the state house. Both chambers of the Michigan Legislature passed bills attempting to overturn Governor Whitmer’s executive orders and authorizing their leadership to file associated lawsuits against the governor. Additionally, California Governor Gavin Newsom announced the closure of a number of state parks and beaches in an effort to mitigate large crowds that have been reported in some locations in recent days. The decision to close beaches has angered some local communities, some of which have reportedly threatened to file lawsuits to oppose the restrictions.

US INITIATIVE TO STUDY CORONAVIRUS GENOME The US CDC announced a new program to collect and analyze genomic data during the COVID-19 pandemic. The effort—labeled SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES)—will leverage “clinical and public health laboratories, academic institutions, and the private sector” across the country to characterize the genetic evolution of the SARS-CoV-2 virus over the course of the pandemic, support disease surveillance and contact tracing, and inform diagnostic, therapeutic, and vaccine development. Other countries, including Canada and the United Kingdom, are initiating similar programs. Coordinating national genetic sequencing efforts through a centralized mechanism, under the CDC’s Advanced Molecular Detection (AMD) program, can establish common standards for data collection and reporting, which can help researchers make better use of the data.

MARYLAND NURSING HOME TESTING Yesterday, Maryland Governor Larry Hogan announced expansions to the state’s COVID-19 response, including enhancing response efforts at nursing homes statewide. These actions included appointing the state’s Surgeon General as the Emergency Safety and Compliance Officer for nursing homes, conducting universal testing for nursing home staff and residents, and implementing daily evaluation for nursing home residents for COVID-19 symptoms. The plan also notes that the state will provide supplemental healthcare professionals to bolster understaffed nursing homes. Nursing home residents account for 19% of Maryland’s total COVID-19 cases and 46% of the state’s total deaths. 

SPORTS As countries around the world attempt to gain control of the COVID-19 pandemic and begin to plan for or implement efforts to relax social distancing, sports teams and leagues are evaluating future schedules and potential mitigation measures that may be necessary to resume competition. One sports marketing agency estimated that half of the scheduled major sporting events worldwide have already been cancelled due to the pandemic, with more cancellations possible in the future. Some leagues have started announcing tentative timelines for returning to action, although most emphasize that early events will likely not permit spectators to be present. In the United States , the White House Coronavirus Task Force has been coordinating with league officials from professional and amateur athletics leagues and organizations during this planning process. The PGA Tour (golf) and NASCAR (auto racing) are among the first leagues to schedule events; however, the Little League World Series , which involves teams from 84 countries around the world, has been cancelled. Dr. Anthony Fauci indicated that sports could face prolonged disruptions and that some leagues may need to cancel their seasons entirely.

Some leagues around the world have already resumed play. In Taiwan , baseball has resumed, but without fans present. To avoid the sight of empty stadiums , cardboard cutouts of fans are being placed in seats to give the appearance of a full stadium. The Tour de France is tentatively scheduled to start on August 29, but France’s phased “deconfinement” plan will reportedly prohibit large sporting events until at least September. In the absence of traditional sporting events, some professional athletes and leagues are attempting to make the best of the situation through the use of e-sports platforms (ie, video games), including Formula 1 (auto racing).

With respect to recreational athletes, golf may be among the easiest to adapt in terms of maintaining social distancing. Some US state and local governments are permitting the operation of golf courses, including relaxing existing measures to allow them to open. Multiple golf magazines and websites are documenting state and local policies for golf courses across the country.

RESPIRATOR DECONTAMINATION A new decontamination system developed by Battelle is now operating in multiple cities across the United States. Over the past month, the system received US FDA authorization, and the company has deployed units in at least 7 states, with additional plans for others, including the Washington, DC area. The decontamination system utilizes vaporized hydrogen peroxide to kill viruses, including SARS-CoV-2, in N95 respirators, and the process can be performed as many as 20 times per respirator. Battelle announced in mid-April that a contract with the federal government would enable health systems to utilize the service free of charge . Each unit has a capacity of 80,000 respirators per day, and the federal contract will fund as many as 60 sites, which could provide a total capacity of nearly 5 million respirators per day. This kind of service could substantially impact the availability of respirators, particularly as some states and health systems continue to struggle to obtain sufficient supply of personal protective equipment (PPE).

MAJOR AIRLINES MANDATING MASK USE Multiple major US airlines announced yesterday that passengers will be required to wear face masks onboard commercial aircraft starting in May. The Federal Aviation Administration (FAA) has not mandated mask use for airline passengers or crew, but the airlines themselves made the determination in response to pressure from employees and unions. Several airlines had previously announced face mask policies, but American , Delta , and United Airlines all announced policies yesterday. These represent 3 of the 4 largest airlines in the United States; the second-largest airline, Southwest Airlines, has reportedly not yet announced a mandatory mask use policy.

LOOKING TOWARD RECOVERY While the vast majority of resources, attention, and effort are currently aimed at COVID-19 response operations, actions taken now to plan and prepare for recovery activities can have a major impact on the speed at which public health, healthcare, and society can reach a new state of normal and on the ultimate resilience that state will have to future events. Dr. Monica Schoch-Spana, Senior Scholar at the Johns Hopkins Center for Health Security, published an article in Clinical Infectious Diseases that outlines considerations that responders and governments can take now in order as they begin to look ahead to recovery. Critical factors for recovery from an epidemic or pandemic event include potential long-term health effects for victims, regaining full functionality for health systems, and lasting economic and social disruptions. Dr. Schoch-Spana emphasizes that recovery from events like the COVID-19 pandemic are complex, and progress may be inconsistent and uneven across affected areas. Recuperating a society after a pandemic is not necessarily as straightforward as reconstructing a physical environment after a natural disaster, and progress cannot necessarily be measured in the same way. She encourages a holistic approach to identifying needs, resources, partners, evaluation metrics, and goals, and she presents a model framework for “post-epidemic recuperation.” Necessary activities are grouped under 6 phases of recovery—Respond, Resolve, Restore, Revitalize, Research/Relieve, and Reform—which could potentially extend years after the event.