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

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May 14, 2020

EPI UPDATE The WHO COVID-19 Situation Report for May 13 reports 4.17 million confirmed cases (81,577 new) and 287,399 deaths (4,245 new). The global total could potentially reach 300,000 deaths by this weekend.

At the continent level, South America, Asia, and Africa are all reporting increasing per capita daily incidence . South America is now on par with Europe, as national epidemics in European countries are largely on the decline. North America is exhibiting decreasing daily incidence, but this is largely driven by the United States.

In the Eastern Mediterranean, several countries are exhibiting concerning elevated and increasing trends in per capita daily COVID-19 incidence. Bahrain, Kuwait, Qatar, and Saudi Arabia are all reporting more than 50 new cases daily per million population . Because these are relatively small countries, the total daily incidence is not necessarily enough to garner global attention; however, the daily incidence is very high relative to their total population. Saudi Arabia is currently reporting nearly the same per capita daily incidence as the United States—55.36 new cases per million in Saudi Arabia compared to 61.38 in the United States. Bahrain (171.41) and Kuwait (182.65) are approximately three times that value, and at 464.99 new cases per million, Qatar is 9 times that amount. According to multiple reports , much of the elevated COVID-19 incidence in these countries is among foreign, expatriate, or migrant workers, many of whom live in camps or dormitories like the situation in Singapore . Ministry of Health updates in Bahrain , Kuwait , Qatar , and Saudi Arabia indicate that the majority of cases in each country are not citizens.

Russia reported nearly 10,000 new cases, continuing its recent trend of elevated incidence . Russia reached 250,000 cases, and it has reported more than 9,000 new cases per day since May 2. The United Kingdom continues to report steadily decreasing daily incidence, but it moved up to #3 in the world in terms of total cases with 230,985. Spain and Italy are now #4 and #5, respectively.

India reported 3,722 new cases, continuing its recent trend of elevated daily incidence . India could surpass China in terms of total incidence by this weekend. Tamil Nadu state, where a large outbreak has been linked to one of Asia’s largest markets, reported 509 new cases and has nearly 7,000 active cases, the second highest total of all Indian states. Singapore reported 752 new cases, including 750 (99.7%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Singapore estimates that 7.36% of the total population across all migrant worker dormitories are confirmed cases, compared to only 0.03% of the general public population. Of the 26,098 total COVID-19 cases reported in Singapore, 23,758 (91.0%) are among residents of migrant worker dormitories, including 98.4% of cases reported over the past 2 weeks.

The US CDC reported 1.36 million total cases (21,467 new) and 82,246 deaths (1,426 new). The United States could potentially reach 1.5 million cases by Tuesday next week. In total, 9 states (increase of 2) reported more than 40,000 cases, including New York with more than 300,000; New Jersey with more than 125,000; and Illinois and Massachusetts with more than 75,000. Additionally, 35 states (no change), plus Guam, are reporting widespread community transmission.

New York state and New York City both reported increases in daily incidence from the previous day; however, they both reported a substantial increase in the number of tests performed as well. New York City reported a 54% increase in the number of tests from the previous day (compared to a 47% increase in new cases), and the state reported a 65% increase in tests (compared to a 52% increase in new cases).

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 1.40 million US cases and 84,313 deaths as of 11:30am on May 14.

FRANCE ECONOMIC AID MEASURES France announced that it will implement a set of economic relief measures totaling to €18 billion (US$19.4 billion) to aid the country’s tourism industry. Tourism accounts for nearly 8% of France’s economy, and the industry has suffered substantially during the pandemic. The government will reportedly reimburse companies 70% of furloughed workers’ wages, with hopes that financial support can be phased out as businesses reopen in regions of low transmission. Prime Minister Edouard Philippe remains hopeful that restrictive social distancing measures, currently including prohibitions on travel exceeding 100km and beach closures, can be lifted in time to allow for summer vacations in France.

UN URGES MENTAL HEALTH SUPPORT In a recently published policy brief , the UN urged “governments, civil society, health authorities and others” to unite and address the short- and longer-term mental health impacts of the COVID-19 pandemic. The report highlights the needs of vulnerable populations, including first responders and front-line healthcare workers, older adults, children, women, and refugees or those in conflict settings. In addition to fear of illness or death and the growing challenges posed by mis- and disinformation, individuals are also experiencing a broad scope of secondary mental health effects, including financial insecurity or social isolation. The report advises that emergency psychosocial support should become more widely available, including remote mental health care. Furthermore, the report calls for prioritizing the protection and promotion of human rights of those with severe mental health conditions, as their needs can often be neglected in major emergencies. 

TYPHOON IN THE PHILIPPINES Typhoon Vongfong hit the Philippines, its first of the year, with wind gusts of more than 150 miles per hour (240 kph), causing substantial damage to parts of the country. The COVID-19 pandemic response is posing major logistical and financial constraints for the Philippines, and it is particularly difficult to provide shelter to affected communities while maintaining social distancing. An estimated 200,000 people need to be evacuated from their homes due to concerns of winds, flooding, and landslides. Certain evacuation centers, including school classrooms, are reportedly only able to house a fraction of their former capacity in order to avoid overcrowding, which can facilitate SARS-CoV-2 transmission. Additional shelters have been opened, and evacuees are being given masks to reduce the risk of transmission. The Philippines averages 20 typhoons a year , so responders are only beginning their annual struggle, this time complicated by the ongoing pandemic response. 

WUHAN PLANS FOR WIDESPREAD TESTING Chinese officials have outlined the plan to implement widespread testing of Wuhan’s 11 million residents following the recent detection of a cluster of COVID-19 cases. The plan is scheduled to be completed in 10 days , an unprecedented scale for SARS-CoV-2 testing in any country. After excluding those who have already been recently tested, Wuhan authorities would still need to conduct at least 730,000 tests per day to meet the 10-day timeline. The current testing capacity for Wuhan is estimated to be approximately 100,000 tests per day. The Hubei Province Health Commission reported that Wuhan currently has 63 testing sites and 386 sampling sites, which would correspond to 1,890 people per day at each sampling site. The highest daily total reported at any site in Wuhan to date is 1,741, so this will be an enormous undertaking. Local officials are distributing notices and informational fliers to spread awareness of the testing efforts. Companies developing testing kits are reportedly rushing to meet the sudden high demand.

JAPAN LIFTS STATE OF EMERGENCY Japanese Prime Minister Shinzo Abe announced that Japan will lift the state of emergency in all but 8 prefectures, based on assessments that COVID-19 incidence is slowing and testing capacity is increasing. Residents in the remaining prefectures—Hokkaido, Tokyo, Chiba, Saitama, Kanagawa, Osaka, Hyogo, and Kyoto—are still being asked to limit social interactions by 80%, and the possibility of lifting social distancing measures in those prefectures will reportedly be reconsidered next week. While the Prime Minister acknowledged that lifting restrictions will enable some businesses to reopen, social distancing in public should continue as the “new normal.”

COVID-19 THREATENS SUSTAINABLE DEVELOPMENT GOALS WHO Director-General Tedros Adhanom Ghebreyesus discussed the recently published 2020 World Health Statistics Report , which monitors health statistics for the Sustainable Development Goals. The report indicates that significant progress has been made globally, with some of the biggest gains in low- and middle-income countries (LMICs). From 2000 to 2016, life expectancy increased by 21% in LMICs and approximately 4% in higher-income countries. Access to preventative health and treatments for common illnesses like HIV and malaria facilitated much of the improvement. The COVID-19 pandemic threatens to stall or reverse some of this progress. Vulnerable aspects of global health, such as maintaining routine immunization coverage and access to other common essential health services, are being negatively impacted by the pandemic and associated response measures. In addition to effects on the provision and availability of health services, the ability to pay for healthcare is likely to be impacted as well. The WHO estimates that 1 billion people worldwide (13% of the global population) could be 10% or more of their income on health services by the end of 2020, the majority of which will be from LMICs.

WHO ANNOUNCES LAUNCH OF NEW INFORMATIONAL APPS The WHO announced the launch of 2 different COVID-19 smartphone apps, for healthcare workers and the general public. The WHO Academy app provides health workers with information on COVID-19 resources and guidance developed by the WHO as well as training and virtual workshops to support efforts to safely and effectively care for COVID-19 patients. A survey of healthcare workers found that many felt that they lacked sufficient information about infection prevention and control measures (including the proper use of personal protective equipment (PPE) and case management. The WHO Info app is designed to provide updated and accurate COVID-19 information to the general public as well as details on WHO efforts to combat COVID-19. Both apps are available for Apple and Android devices.

NATIONAL TESTING STUDIES Several European countries recently published data from large surveys to estimate the scope of their national COVID-19 epidemics. France and Spain both conducted serological surveys to determine the proportion of the population that has ever been infected with SARS-CoV-2. In France, the study estimated that 4.4% of the population had previously been infected, and similarly, Spain estimated that 5% of the population had been infected. For comparison, France has reported 140,734 confirmed cases, representing approximately 0.2% of the entire population , and Spain has reported 229,540 confirmed cases, representing approximately 0.5% of its population. Both studies also provide regional breakdowns for the data. These two serological studies indicate that there could potentially be 10-20 undetected infections for every known case. While this may seem like a large number, consider that at least 95% of both populations in both countries still have not been infected, based on these results.

Sweden announced results from two studies conducted utilizing molecular diagnostic tests, one on a national level and one in Stockholm. The national study involved more than 2,500 participants from across the country, but results are not available for individual regions. A press release issued by Sweden’s Public Health Authority reports that the study estimated 0.9% of the national population had active SARS-CoV-2 infection at the time of the study (April 21-24). A smaller study conducted in Stockholm (679 participants) estimated that 2.3% of local residents had active infection during the same time period, which is similar to a previous study conducted several weeks earlier. Unlike the serological studies, these data only represent ongoing active infections at the time of the survey, as the molecular tests cannot detect prior infections. The press release states that more detailed results will be presented in the coming days.

STATE TESTING & REPORTING US states have taken a variety of approaches to reporting COVID-19 cases, hospitalizations, and deaths as well as SARS-CoV-2 testing capacity, with varying degrees of detail. An article published in The Atlantic , which operates the COVID Tracking Project , discusses the challenges and limitations associated with differences in how states report COVID-19 data. The article uses Virginia’s recent decision report molecular and serological tests performed as a single value to illustrate the problem, but the challenge applies broadly to all states. There are not sufficient standards or requirements for state-level reporting of disease data, including for COVID-19, and the way states report data can make it difficult to compile an accurate picture of the current status of the US COVID-19 epidemic, compare states, or identify relevant trends. Independent efforts, such as the COVID Tracking Project or the Johns Hopkins CSSE dashboard , attempt to compile various state-level data into centralized databases to support analysis, but they are not able to effectively capture or compare data that is not reported by every state. Data is critical to making informed decisions regarding epidemic response operations and policies, and the absence of a coordinated and consistent reporting mechanism in the United States can pose a major barrier to state and national epidemic response efforts.

US HOUSE OF REPRESENTATIVES HEARING This morning, Dr. Rick Bright , former Director of the Biomedical Advanced Research and Development Authority (BARDA), testified in a hearing at the US House of Representatives . Dr. Bright filed a whistleblower complaint shortly after being removed from his position at BARDA, alleging that he was removed in retaliation for conflicts regarding US government policies regarding medical countermeasures for COVID-19. In his opening statement , Dr. Bright forecasts that “2020 will be the darkest winter in modern history” and emphasizes the importance of basing policy and operational decisions on reliable scientific evidence. Following the whistleblower complaint, several reports emerged claiming that the Office of the Special Counsel had found “reasonable grounds” that Dr. Bright’s removal was retaliatory and that he should be temporarily reinstated; however, the Office of the Special Counsel has not confirmed that.

WISCONSIN SUPREME COURT OVERTURNS “SAFER AT HOME” ORDER The Wisconsin Supreme Court (US) ruled yesterday that the state’s “safer at home” order, issued by Secretary of the Department of Health Services Andrea Palm, was issued outside the scope of her authority . The decision largely nullified the order with immediate effect, which permitted businesses to reopen and removed prohibitions on large gatherings. The court allowed existing restrictions that closed schools to remain as well as language permitting local governments to implement their own restrictions. Following the decision, some restaurants and bars reopened , some of which did not appear to impose any social distancing or other protective measures. Some local governments are reportedly developing and implementing their own restrictions, but they will likely result in inconsistencies across the state. Any future efforts by the governor or appointed state officials to implement COVID-19 policies will be required to utilize the normal process, which involves the state legislature and could take weeks or longer to pass.