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

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May 12, 2020

EPI UPDATE The WHO COVID-19 Situation Report for May 11 reports 4.01 million confirmed cases (88,891 new) and 278,892 deaths (4,531 new). The global total could potentially reach 300,000 deaths by later this week.

Africa, Asia, and South America continue to represent an increasing proportion of the global COVID-19 cases —currently about 4.5%, 20%, and 16%, respectively. As a whole, Europe has exhibited decreasing daily incidence since early April, while Africa, Asia, and South America are all steadily increasing. North America remains relatively steady, largely driven by the United States. Notably, the doubling times for every continent have increased since early April. Africa and South America are doubling the fastest at 14.9 and 16.6 days, respectively. Africa and Asia both appear to be holding relatively steady over the past several weeks, with Africa doubling approximately every 14-16 days and Asia doubling around 25-30 days.

Russia reported 232,243 confirmed cases, which is approximately 11,000 new cases from the previous day. Russia continues its recent trend of elevated incidence , and it could reach 250,000 cases by Thursday. Russia is now #2 in the world in terms of reported COVID-19 cases. The United Kingdom appears to be well on its way to recording its fourth consecutive week of decreasing incidence and deaths (by specimen date).

Brazil’s COVID-19 epidemic is accelerating considerably. Since approximately mid-March, Brazil’s weekly incidence has increased steadily. Last week, Brazil reported 59,380 new cases, nearly 60% greater than the previous week’s total. Additionally, Brazil reported its highest daily incidence last week on May 9: 10,611 new cases. Peru and Chile are also reporting elevated and increasing COVID-19 incidence, and they both report higher per capita incidence than Brazil. Chile is currently reporting approximately double the daily incidence (1,000-1,100 new cases per day) that it reported in late April (500 new cases per day).

India reported more than 3,600 new cases, continuing its recent trend of elevated daily incidence . Tamil Nadu state, where a large outbreak has been linked to one of Asia’s largest markets, reported nearly 800 new cases. Singapore reported 884 new cases, including 877 (99.2%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Singapore estimates that 6.91% of the total population across all migrant worker dormitories are confirmed cases, compared to only 0.03% of the general public population.

UNITED STATES
The US CDC reported 1.32 million total cases (23,792 new) and 79,756 deaths (985 new). The daily totals for both cases and deaths are lower than the recent trend; however, reporting delays over the weekend typically manifest in the CDC’s Monday and Tuesday updates. The United States could potentially reach 1.5 million cases by Tuesday next week. In total, 7 states. Notably, this is one fewer than yesterday. Additionally, 35 states (no change), plus Guam, are reporting widespread community transmission.

New York state and New York City both reported their fourth consecutive day of decreasing daily incidence and their lowest daily incidence since March 17. The percent positive tests continues to decline as well. The number of tests has remained relatively steady in New York City for the past 3 weeks, and statewide tests have increased over that period, even as incidence continues to decrease.

The New York Times continues to track state-level COVID-19 incidence, with a focus on state policies regarding social distancing.

The Johns Hopkins CSSE dashboard is reporting 1.35 million US cases and 81,076 deaths as of 12:30pm on May 12.

CORRECTION FROM MAY 11: Yesterday, we incorrectly stated that Maine was reporting 600-800 new cases per day. We mistakenly reported the cumulative data for Maine’s “Other Confirmed Cases.” Maine’s daily incidence has increased since late April—up from approximately 10-25 new cases per day (April 18-29) to approximately 20-40 new cases per day (April 30-May 11)—and reported its highest daily total of 76 cases on May 7. Maine has reported a total of 1,477 total cases.

ENFORCING SOCIAL DISTANCING As US states begin to relax social distancing policies, businesses and governments both are struggling to maintain and enforce appropriate protective measures. In Pennsylvania, where social distancing is being relaxed on a county-by-county basis, Governor Tom Wolfe addressed reports of counties and businesses moving forward without authorization from the state government. Pennsylvania has implemented a system to categorize COVID-19 risk at the country level, based on available epidemiological data, and counties will progress through these categories as conditions improve. Governor Wolf emphasized that progressing too rapidly would risk increased transmission. He stated that local governments that prematurely relax social distancing measures could risk losing federal COVID-19 funding distributed by the state and that businesses that reopen ahead of schedule could lose their insurance or liquor license. In Colorado, a city government forced a local restaurant to close after a video surfaced that showed patrons crowding into the dining area on Mother’s Day in defiance of statewide restrictions on in-person dining. The restaurant reportedly opened for in-person dining after receiving instruction from the local health department not to do so. In South Dakota, casinos were permitted to reopen , which reportedly drew large crowds. According to one report, some casinos were operating at 85-90% of their designed occupancy. The casinos required dealers to wear face shields or masks, gaming tables were limited to 2 players, and some slot machines were shut down to promote social distancing. Patrons are supposed to maintain 6-foot social distancing; however, the included image shows some individuals in close proximity without wearing face masks.

Even in states where statewide social distancing restrictions remain in place, some businesses have struggled to operate while implementing appropriate protective policies. One ice cream shop in Massachusetts reopened utilizing online ordering and pickup only, but some local residents attempted to place in-person orders and then verbally berated employees when they had to wait. The incident resulted in at least one employee quitting and the shop closing.

PLANS TO RELAX SOCIAL DISTANCING Governments around the world, both at the national and sub-national levels, continue to announce plans to relax social distancing. The phased approach—ie, gradually and incrementally easing restrictions over time—appears to be favored. On Sunday, UK Prime Minister Boris Johnson announced the national COVID-19 recovery plan.  The UK plan proceeds in 3 steps, the first of which is set to begin on May 13. The first step keeps many existing restrictions in place and encourages continued remote work to the extent possible; however, some measures will ease. Step 2, which the UK government tentatively aims to begin implementing on June 1, will permit some non-essential retail businesses and schools to resume operations. The exact date will depend on when the country meets its self-prescribed metrics to demonstrate control over the epidemic. Step 3 will expand the operation of non-essential businesses, to include “hairdressers and beauty salons” and pubs, although “some venues which are, by design, crowded...may prove difficult to enact distancing [and] may still not be able to re-open safely at this point.” Step 3 will not commence any earlier than July 4.

In the United States, New York Governor Andrew Cuomo announced the state’s plan to begin relaxing social distancing measures, following continued declines in COVID-19 incidence and increases in testing capacity. The New York plan will operate on a regional level, enabling some parts of the state to resume activities before others, if they meet the designated criteria. Specific metrics for determining the ability to progress to the next phase address COVID-19 incidence and mortality, health system capacity, and contact tracing and testing capacity. The plan also includes guidance for businesses, schools, and individuals regarding the protective measures they can and should take as social distancing restrictions are eased.

Some US states are progressing through the early phases of their recovery. In Illinois, for example, Governor J.B. Pritzker announced that 3 of the state’s 4 “medical regions” have met the established criteria for moving to the third phase of recovery. The remaining region is home to Chicago, and it has not yet met the threshold of 20% test positivity (currently 22.3%), which it is required to remain below for 14 days in order to move from Phase 2 (Flattening) to Phase 3 (Recovery). Phase 3 will not begin for any region prior to May 29, so the remaining region could still meet the requirement and progress to the next phase along with the other regions. Phase 3 in Illinois will permit “manufacturing, offices, retail, barbershops and salons” to resume limited operations. Phase 4 permits restaurants and bars to reopen for in-person service, and schools and travel can resume. Phase 5 includes larger events such as festivals and conferences.

In advance of his Senate testimony scheduled for earlier today, Dr. Anthony Fauci emphasized that relaxing social distancing measures prematurely could “result in needless suffering and death” and could “actually set us back on our quest to return to normal.”

SPORTS Several major sports leagues are beginning to develop and implement plans to resume competition. One of Europe’s premier football/soccer leagues, Germany’s Bundesliga, will resume play this weekend, with 8 games scheduled for May 16-18 . In the United States, NASCAR (stock car racing) will resume its 2020 season on May 17 at Darlington Raceway in South Carolina. NASCAR will compete without fans present, and teams will implement social distancing measures. Darlington Raceway was selected, in part, due to its close proximity to team headquarters, which allows drivers and other personnel to reduce the amount of time staying in the local area. Yesterday, Dr. Anthony Fauci addressed the possibility of the National Football League (NFL; American football) playing this fall. Last week, the NFL released the schedule for the 2020-21 season, a decision that raised a number of questions about the possibility of resuming regular sports seasons. Dr. Fauci was clear about the dangers that sporting events pose as opportunities for transmission, and he emphasized that the epidemiological situation should dictate the league's decision regarding when and how to begin play. He noted that routine testing would be necessary to ensure the safety of players and team employees. 

Major League Baseball (MLB) has reportedly reached an agreement to begin the delayed 2020 season this July. Team owners have approved the plan, and league officials are scheduled to meet with the players’ union today to discuss additional details, including financial issues and player safety, for the proposed shortened season. Leadership in some states have expressed skepticism of such plans, including California Governor Gavin Newsom, who said that the state will not allow any activities that conflict with public health and public safety guidance.

CRUISE SHIPS Shipboard living conditions, including cruise ships and aircraft carriers, have demonstrated the ability to facilitate the rapid spread of COVID-19 among passengers and crew. In light of this evidence, the US CDC previously issued a No Sail Order for all cruise ships operating in US waters to mitigate the risk of additional shipboard outbreaks. The original order was extended in April and is currently scheduled to expire on July 24. As a result of the order, some ships remain at sea , including some that are still awaiting repatriation for passengers. According to several reports, tens of thousands of cruise ship crew around the world remain quarantined onboard their ships with nowhere to go. The US CDC published interim guidance regarding the processes necessary to disembark crew members from these ships.

Carnival Cruise Line recently announced that it intends to resume services on select cruise routes starting August 1. Despite the elevated risk of onboard transmission, prospective passengers were reportedly eager to make reservations. According to one report, representatives from a travel agency indicated that bookings since the announcement were 3 times the volume reported during the same period in 2019.

MEAT PROCESSING FACILITIES An investigation conducted by Business Insider identified more than 4,500 COVID-19 cases associated with meat processing facilities linked to the Tyson company, including 18 confirmed COVID-19 deaths. Working conditions in American meat processing facilities continue to draw national attention due to these large associated outbreaks. Tyson announced several policy changes in an effort to limit the impact of the disease on its workforce, including efforts to relax its attendance policy and waive the waiting period to qualify for short-term disability. Tyson’s does not currently offer full paid sick leave for employees, but the short-term disability program covers a portion of employees’ pay. The previous policy covered 60% of employees’ pay, but this was increased in April to 90%, which is scheduled to last through at least the end of June.

COVID-19 OUTBREAK AT TENNESSEE PRISON As we have covered previously, the living conditions at correctional facilities present a number of opportunities for COVID-19 spread. Major outbreaks have been identified at correctional facilities in the United States and around the world, some of which have spilled over into the local community. The Bledsoe County Correctional Complex in Tennessee (US) highlights the elevated transmission risk in such facilities. Over the past few weeks, the prison has reported approximately 600 COVID-19 cases, including both incarcerated individuals and facility staff. Policy and logistical barriers to implementing social distancing, disinfection, and other infection control mechanisms allowed the disease to spread rapidly within the facility. The conditions resulted in several facility personnel to take voluntary leave. Once the facility initiated widespread testing, health officials identified several hundred COVID-19 cases.

SARS-CoV-2 VACCINE The Coalition for Epidemic Preparedness Innovation (CEPI) announced additional funding to support a promising candidate vaccine against SARS-CoV-2. The vaccine, developed by Novavax, aims to initiate a Phase 1 clinical trial later this month. The new funding will include US$384 million to support Phase 1 and 2 clinical trials as well as “large-scale manufacture” of the vaccine. CEPI previously provided US$4 million to support the vaccine’s development and initial testing, but the recent announcement is orders of magnitude greater than that. Additionally, the funding will support efforts to provide manufacturing partners around the world with the necessary technology to facilitate globally distributed production, if the vaccine proves to be safe and effective.

WUHAN CONFIRMS NEW COVID-19 CASES For the first time in more than 30 days, Wuhan, China , the former epicenter of the COVID-19 pandemic, reported a cluster of new cases. The new cluster includes at least 6 new cases, the majority of which were tied to a husband and wife and their surrounding residential community. Wuhan, which reported tens of thousands of COVID-19 cases earlier this year, began relaxing highly restrictive social distancing measures approximately a month ago, including travel to other parts of the country, after 2 months of “lockdown.” The Chinese government will reportedly implement a plan to test all 11 million Wuhan residents in an effort to prevent further spread of the disease. China’s National Health Commission also sent a team of experts to investigate a cluster of cases in Shulan , in northeast China, where at least 11 local cases have been reported.