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

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May 7, 2020

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EPI UPDATE The WHO COVID-19 Situation Report for May 6 reports 3.59 million confirmed cases (71,463 new) and 247,503 deaths (4,102 new).

In an effort to identify emerging global hotspots, we looked at maps of recently reported cases per capita , total recently reported cases , and doubling time to identify new countries to monitor in our Epi Update section. Notably, the relative proportion of COVID-19 cases between regions is varying considerably over time. China represented the vast majority of cases through mid-to-late February. This shifted as transmission increased in other Asian countries, then Europe and the United States. Europe accounted for the majority of cases in March, and North America, principally driven by the United States, has led since early April. The proportion of cases in Asia has been increasing since late March, and the proportion in South America and Africa have been increasing since early April.

Several countries in Africa have fast doubling ti mes , indicating rapid growth . The epidemics in Chad, Ghana, Guinea-Bissau, Sierra Leone, and South Sudan are all doubling in less than a week , based on data from the past 3 days. Sudan has reported 852 total COVID-19 cases. Sudan’s doubling time had been approximately 5 days for approximately 2 weeks, but its epidemic appears to have slowed over the past several days. As noted above, Africa is representing an increasing proportion of the global COVID-19 cases. Overall, Africa represents only a small fraction of the total reported cases (2.8%), but considering the concerns regarding existing public health and healthcare capacity across the continent, this is a trend that merits close monitoring. 

In South America, several countries have recently reported elevated per capita COVID-19 incidence . While not necessarily notable in terms of total cases, the increase relative to population size warrants a closer look. Ecuador, Peru, Chile, and Brazil have all exhibited elevated per capita incidence, which is several orders of magnitude above the global trend. Peru now has a per capita incidence on par with the United States.

In the Eastern Mediterranean region , several countries have elevated or growing per capita COVID-19 incidence. Most notably, Qatar has reported approximately 250-300 cases per million population. This is more than double the incidence of other countries in the region, 4 times the per capita incidence in the United States, and more than 25 times the global incidence. Additionally, Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates are all exhibiting epidemic growth since mid-April.

Yemen reported its first COVID-19 case to the WHO on April 11 , but it did not report another case until April 30 . Yemen is experiencing one of the worst humanitarian emergencies in history, and there is concern that the pandemic could spread—or is already spreading—rapidly among the vulnerable population there. One health official reportedly indicated that testing availability is limited to only “a handful” of tests , which could mean that many cases are going undetected and unreported. Yemen’s Ministry of Public Health and Population reports only 1 case, but the WHO Situation Report indicates 23 cases. Yemen’s outbreak is doubling approximately every 2 days , and this period appears to be getting shorter.

Russia reported 11,231 new cases, which appears to be its highest daily incidence to date. Russia’s surpassed both Germany and France in terms of total cases to become #5 globally. Russia’s per capita COVID-19 incidence has steadily increased since it began reporting cases in early March, and it has now reached approximately the same per capita incidence as the United States.

Belarus is also exhibiting elevated and increasing per capita COVID-19 incidence . While per capita incidence in Europe as a whole has been declining since early April, Belarus has increased dramatically since mid-April. Currently, Belarus is reporting approximately 90 cases per million population each day, which is approximately 27% greater than Russia and the United States, nearly 3 times the total European incidence, and approximately 9 times the global incidence. Belarus has reported 20,168 total cases.

India reported 3,561 new cases, likely its second highest daily total . India’s epidemic continues to accelerate, despite national “lockdown” measures; however, increased testing capacity could account for some of the recent increase. Singapore reported 741 new COVID-19 cases, including 725 (97.8%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Singapore’s per capita COVID-19 incidence has increased substantially since early April, now nearly double the per capita incidence reported in the United States and 12 times the global value.

Tajikistan first reported cases to the WHO on May 1 , and its outbreak has quickly grown to hundreds of reported cases. Shortly before, on April 28 , the US Embassy in Tajikistan cautioned that while Tajikistan had not yet reported any cases, the situation could change quickly. Tajikistan reported 86 new cases today, bringing the national total to 379 (29.4% daily increase). In the midst of the newly reported cases, Tajik President Emomali Rahmon announced today that he is replacing the country’s Minister of Health and Social Protection . Tajikistan’s outbreak is currently more than doubling every 2 days , a concerning trend.

The US CDC reported 1.19 million total cases (21,303 new) and 70,802 deaths (2,523 new). In total, 13 states reported more than 25,000 cases (no change), including New York with more than 300,000; New Jersey more than 125,000; and 4 additional states with more than 50,000. Additionally, 35 states (no change), plus Guam, are reporting widespread community transmission.

In the United States the overall incidence may appear to have reached a plateau, but this does not necessarily capture variations in transmission dynamics across the country. For example, the New York metropolitan area—including New York, New Jersey, and Connecticut—has been the epicenter of the US COVID-19 epidemic. When you separate data for these states from the rest of the country , a much different trend emerges. The New York City metropolitan area exhibits a considerable and consistent decline in COVID-19 incidence that spans several weeks; however, the rest of the country has a concerning upward trend over a similar period. Similar trends are emerging at the state level as well, with key differences between cities affected early in the US epidemic and other areas. Some of this may be attributable to increased diagnostic testing, but likely not all of it.

New York state and New York City both reported slight increases, following several days of decreasing incidence. The percentage of tests that return a positive result continues to decline, an encouraging trend. We are continuing to monitor COVID-19 incidence trends in states that have started easing stay-at-home measures. We may begin to see indications of changes in transmission over the next several days.

The Johns Hopkins CSSE dashboard is reporting 1.23 million US cases and 73,573 deaths as of 11:30am on May 7.

US SARS-CoV-2 TESTING US COVID-19 epidemic projections are trending upward , with a number of models predicting higher incidence and deaths than they did earlier in the epidemic . Researchers at the Harvard Global Health Institute developed a model to estimate the testing capacity necessary for each state, which could inform policy decisions by providing insight into how current testing capacity compares to anticipated need. The researchers used multiple epidemic models to forecast the testing capacity needed, and while all of them resulted in different projections, all indicated that the current testing capacity is well below the estimated 917,450 weekly tests needed nationally to adequately capture the extent of community transmission.

US SOCIAL DISTANCING In Texas, 2 restaurants are directing their employees not to wear face masks as they resume dine-in operations. Reportedly, multiple employees indicated that the restaurants stated that they would not be permitted to work if they wear masks. The restaurant group’s website notes that face masks are not required to be worn by guests or staff and encourages those who are uncomfortable with policy to “join [them] at a later date.” Dallas County Judge Clay Jenkins recently amended his local “ safer at home ” order to mandate mask use; however, Texas Governor Greg Abbott’s order encourages the use of face coverings but prohibits local governments from “impos[ing] civil or criminal penalty for failure to wear a face covering.” The US CDC recommends the use of face masks for situations in which appropriate social distancing (eg, 6-foot separation) cannot be maintained, which could certainly apply in restaurants when taking orders or delivering food.

The Ohio Legislature passed a bill that would place restrictions on the duration of orders issued by the state’s Director of Health. The bill would require the Director of Health to apply to the legislature in order to extend an order, such as the “stay at home order” issued in response to the COVID-19 epidemic, beyond 14 days. Ohio Governor Mike DeWine has reportedly confirmed that he intends to veto the bill. This effort comes as some state legislatures across the country are increasing their opposition to executive orders and other policies enacted by governors or senior appointed officials that implement statewide social distancing measures.

White House officials have reportedly rejected proposed guidance developed by the US CDC that aims to assist states in implementing appropriate protective measures as they relax social distancing measures. According to several media reports , first reported by the Associated Press, the CDC presented the White House with a series of recommendations for various sectors—including schools and child care, faith-based organizations, restaurants and bars, public transit, and businesses employing vulnerable individuals—to facilitate a phased process of resuming operations. An unofficial draft of the recommendations were published by various media outlets in late April. Reportedly, White House officials viewed the draft guidance as “ overly prescriptive ,” particularly for parts of the country currently experiencing low levels of transmission, desiring instead to allow state governments to develop and implement their own requirements.

AFRICA RESPONSE EFFORTS The Director of the Africa Centres for Disease Control and Prevention (Africa CDC) reportedly denied allegations from the Tanzanian government that the coronavirus tests it supplied are faulty. The tests provided by Africa CDC were donated by the Jack Ma Foundation, but last weekend, Tanzanian President John Magufuli reportedly stated that attempts to validate the tests showed them to be unreliable. Testing capacity among African countries has increased over time, but gaps remain in testing and healthcare system capacity, such as ventilator and medical personnel availability.

Earlier this week, Resolve to Save Lives published data to inform governments on response measures. The report assessed perceived risk among surveyed African populations, including the proportion of the population who support various social distancing measures. The report highlighted that half of respondents estimated that they could run out of money or food within a week and that food insecurity was a driving force in decisions to break “stay at home” orders. The report also measured adherence to various social distancing measures based on mobile phone location data , which can provide governments with valuable information regarding the extent to which their populations are able to comply with recommended or mandated social distancing measures.

JAPAN APPROVES REMDESIVIR Following a decision by the US FDA to issue an Emergency Use Authorization for treating COVID-19 patients with remdesivir, Japan approved the drug’s use as well. Japan reportedly does not currently have a substantial supply of remdesivir; however, Gilead Sciences, developer of the drug, is coordinating with manufacturers in several countries, including in India and Pakistan, to provide production capacity to meet the increasing global demand. Gilead is pursuing a variety of approaches to increasing production capacity; however, concern remains regarding the process for allocating available inventory and ensuring affordable and equitable access around the world.

HEALTHCARE WORKER STUDENT LOAN FORGIVENESS A bill has been introduced to the US House of Representatives that would forgive federal and private student loans for frontline US healthcare workers responding to the COVID-19 epidemic. The Student Loan Forgiveness for Frontline Health Workers Act , introduced by Representative Carolyn Maloney (New York 12th District), aims to provide further financial support for healthcare workers treating COVID-19 patients. Several other efforts to forgive student loans during the COVID-19 epidemic have been introduced, as the economic impact of the COVID-19 epidemic has resulted in a variety of barriers to paying off student loans. The CARES Act suspended federal student loan interest accrual and loan repayments through September 2020, but none of the other measures have yet been passed into law.

ECONOMIC IMPACTS While COVID-19 incidence in many European countries appears to be declining for now, the economic impacts of the pandemic largely persist. The European Commission announced that it predicts the European economy will contract by more than 7% this year, indicating one of the worst recessions in history. Prior to the COVID-19 pandemic, it was expected that the region’s economy would grow by more than 1% in 2020. While the recession is expected to impact all European countries, the degree varies, ranging from a 4.5% decrease in Poland to a 9.75% decrease in Germany. The shrinking economy affects key trading partners like the US and China as well as lower-income countries in Sub Saharan Africa, where European countries are the largest foreign investors.

While some countries around the world have started relaxing social distancing measures and resuming some non-essential economic activity, the lack of global demand for certain types of goods has slowed economic recovery. In China , for example, economists observed a jump in exports to other countries in April, but analysts warn that this increase could be temporary. The immediate short-term demand for certain supplies, such as PPE, and increased demand as businesses begin to reopen may not last, particularly in light of longer-term financial limitations associated with the global recession. Foreign demand for exported goods may not be sufficient to drive global economic expansion.

SPORTS Several major sports leagues announced plans to resume play. In the United States, the National Football League (NFL; American football) issued guidelines for teams to resume operations at their training facilities. The NFL directed teams to develop plans to reopen training facilities by May 15, initially limited to non-player personnel. A timeline for resuming training and practice with players will be determined later. Teams are responsible for coordinating with state and local health officials to identify and implement appropriate protective measures at their facilities. The league is also coordinating with the players’ union to develop appropriate protective measures for players. Additionally, the NFL announced that it will debut the (tentative) schedule for the 2020 season tonight. Considering the uncertainty around the US COVID-19 epidemic’s trajectory, this schedule could change. The NFL already announced that international games scheduled for the upcoming season will be cancelled and, instead, played in the United States.

The Bundesliga (Germany football/soccer), in consultation with the German government, announced that it intends to resume play starting May 16 , with the aim of completing the season by the end of June. The remaining games will be played in empty stadiums, but at least one team has already filled its seats with cardboard cutouts of fans.