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

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May 8, 2020

EPI UPDATE The WHO COVID-19 Situation Report for May 7 reports 3.67 million confirmed cases (83,456) and 254,045 deaths (6,539 new).

Ghana reported 3,091 total COVID-19 cases, 83.4% of which (2,579) are in the Greater Accra Region. Ghana is still reporting a relatively low number of new cases per capita. H owever, the epidemic is doubling approximately every 16 days. Many countries in Africa still have relatively few reported cases, so it is difficult to identify longer-term trends. Overall, Africa represents only a small fraction of the total reported cases (2.61%), but the longer-term trend indicates an increasing proportion of global cases. Considering the concerns regarding existing public health and healthcare capacity across the continent, including SARS-CoV-2 testing, this is a trend that merits close monitoring. 

Peru reported 58,526 confirmed cases, and its per capita incidence is increasing rapidly, now nearly 50% greater than the United States. Chile reported 24,581 confirmed cases (1,533 new), and 68.5% are in the Metropolitana region. Chile’s per capita daily incidence has increased dramatically over the past week or so, more than doubling since April 29. Brazil’s COVID-19 epidemic is also accelerating. Brazil reported a record daily incidence (10,503 new cases) on May 6 and another 9,888 new cases on May 7. This is more than 3 times the daily incidence reported in mid-April. At 135,106 total cases, Brazil represents approximately half of the reported cases in South America , and it is concerning that the epidemic continues to accelerate so quickly in South America’s most populous country .

Kuwait appears to be exhibiting an increasing trend in daily incidence, up from 300 new cases on April 29 to 641 new cases today. On a longer time scale, Kuwait’s per capita daily incidence has increased steadily since late March. Kuwait reported a total of 7,208 new cases. Saudi Arabia continues to report increasing daily incidence, more than tripling since mid-April

Russia reported 10,699 new cases, continuing its recent trend of more than 10,000 new cases per day . At this pace, Russia could potentially overtake the United Kingdom, Italy, and Spain by early next week to reach #2 globally, behind the United States. Belarus continues to exhibit 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 95 cases per million population each day, which is approximately 23% greater than the United States and 30% greater than Russia. Belarus reported 21,101 confirmed cases.

India reported 3,390 new cases, continuing its recent trend of elevated daily incidence . India’s epidemic continues to accelerate, despite national “lockdown” measures. We reported previously about an outbreak associated with a market in Chennai (Tamil Nadu state). The number of active COVID-19 cases in Tamil Nadu has more than tripled over the past 6 days—from 1,186 cases on May 2 to 3,825 today—and the total reported incidence more than doubled in that time—2,526 cases on May 2 to 5,409 today. Singapore reported 768 new COVID-19 cases, including 750 (97.6%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Residents of migrant worker dormitories represent 88.6% of all COVID-19 cases reported in Singapore. Singapore estimates that nearly 6% of the total population across all migrant worker dormitories are confirmed cases, compared to only 0.03% of the general public population.

The US CDC reported 1.22 million total cases (25,253 new) and 73,297 deaths (2,495 new). The CDC updated its state map display again, increasing the top category to more than 40,000 cases. In total, 7 states reported more than 40,000 cases, including New York with more than 300,000 and New Jersey with more than 125,000. Additionally, 35 states (no change), plus Guam, are reporting widespread community transmission.

New York state and New York City both reported slight increases in daily incidence, but both remained below most days reported last week (April 26-May2). The percentage of tests performed with positive results continues to decline. Last week, a total of 17.4% of tests in New York City were positive, compared to 11.9% so far this week. Statewide, the percent positive tests dropped from 15.7% last week to 10.6% this week. We are continuing to monitor COVID-19 incidence trends in states that have started easing social distancing measures. We may begin to see indications of changes in transmission over the next several days.

The Johns Hopkins CSSE dashboard is reporting 1.26 million US cases and 76,032 deaths as of 12:30pm on May 8.

ECONOMIC EFFECTS The COVID-19 epidemic in the United States continues to wreak havoc on the economy. The US Bureau of Labor Statistics published its April Employment Situation Summary this morning, revealing further indication of severe economic effects. The national unemployment rate increased from 4.4% in March to 14.7%, the largest monthly increase in history and a level of unemployment not seen since the Great Depression . The number of jobs fell by 20.5 million nationwide, which builds on a loss of 870,000 jobs in March. The COVID-19 pandemic has essentially negated all of the jobs gained in the 10 years since the Great Recession in a period of 2 months

COVID-19 & CHILDREN The role that children play in transmission of COVID-19 is still unclear. While evidence suggests that children are at lower risk for severe disease and death , the extent to which they are a source of transmission among close contacts or the community remains uncertain. Children have been subject to stay-at-home measures in many countries, some with more lenient provisions for children than for adults. Children in Spain have only recently been allowed to leave their homes for one hour of supervised play, but only those under 14 years old and only within one kilometer of their home. In the United States, state and local governments are currently making decisions regarding whether or not to resume school for this academic year. States such as Maryland, New York, Connecticut, and New Jersey have all closed schools for the remainder of the academic year, while the governor of Montana is allowing local school boards to begin in-person classes at their discretion. More research is needed to understand the role of children as sources of spread in this pandemic.

DISTRIBUTION OF REMDESIVIR Following its Emergency Use Authorization (EUA) by the US FDA as a treatment for COVID-19, the antiviral remdesivir is in high demand to treat patients. Gilead, the manufacturer of remdesivir, is donating 1.5 million vials of the product (equivalent to about 100,000-200,000 patient doses), but it is unclear how those doses are being allocated. Multiple healthcare providers described the US government process for remdesivir allocation as opaque and uneven. There appears to be no public decision-making process to determine how the drug will be distributed, in the United States or internationally. To fill the information gap, some informal efforts are attempting to track which hospitals have and have not received shipments of remdesivir. A report published by STAT News investigates the role that the US government played in funding the research and development of remdesivir. Initial investment by the US government could also potentially factor into decisions regarding how it is allocated or priced.

SARS-CoV-2 FOUND IN SEMEN A recent study published in JAMA Network Open detected the RNA of SARS-CoV-2 in the semen of a small sample of patients from China’s Henan province. Out of 38 patients, 6 had detectable RNA via RT-PCR analysis in semen samples. The authors acknowledge that these analyses do not indicate whether or not COVID-19 can be sexually transmitted, but they encourage more studies to be performed to answer this question. Other viruses can be found in semen and can be transmitted via sexual contact, including Zika and Ebola. In some cases, virus detected in semen can lead to person-to-person transmission, but this has not yet been established in the case of SARS-CoV-2.

PREPRINT QUALITY CONTROL Preprint servers, such as bioRxiv and medRxiv , have become important and highly referenced resources for information during the COVID-19 pandemic. While these repositories serve an important role in allowing emerging evidence to be published more quickly, with the goal of informing policy or research, they can also disseminate incorrect and potentially harmful information to readers who have less understanding of the crucial scientific peer-review process. The process to submit manuscripts for publication in a peer-reviewed journal can be lengthy, which can delay the impact of valuable information. In order to combat the dissemination of misleading information, managers of these servers are implementing new screening procedures and publication guidelines. Manuscripts are usually screened for plagiarism and topics that might cause harm to established public health and medical practices, but the screening is now expanded to topics that might fuel conspiracy theories or propagate harmful claims for unstudied treatments.

MEDICAL SUPPLY ACCESS IN PERU The city of Iquitos , Peru, has been particularly hard hit by the country’s COVID-19 epidemic, in part due to its remote location. Iquitos is located within the Amazon rainforest, and it is not accessible by road. Supplies must be regularly shipped by air, and residents and healthcare providers have reported a difficulty accessing basic medical supplies, such as oxygen, and a lack of support from the Peruvian government. In response, Peru’s Minister of Health, Víctor Zamora , reportedly pledged to establish daily flights to Iquitos to transport medical supplies, including oxygen. He also pledged to build two new facilities to supply oxygen for medical use in Iquitos to meet further demand. Peru has reported increasing COVID-19 incidence, and it has the highest per capita COVID-19 incidence in South America. 

DIAGNOSTIC TEST EUA The US FDA granted an EUA for the first CRISPR-based diagnostic test for SARS-CoV-2. CRISPR technologies have been developed for a wide variety of uses, including gene editing and gene drives. The Sherlock CRISPR SARS-CoV-2 test kit works by programming a CRISPR molecule to detect specific parts of the SARS-CoV-2 virus. Once the CRISPR system binds to its target site, a signal is released that can then be detected by researchers running the test. Sherlock stands for “ S pecific H igh-sensitivity E nzymatic R eporter un LOCK ing.” With the appropriate, corresponding instrumentation, this test kit could be used at the point of care, and results can be reported within minutes.

The FDA also authorized the use of a saliva-based diagnostic developed by Rutgers University. The test costs approximately US$100 each and enables individuals to collect specimens in their own home. The test kits must be sent back to Rutgers for processing, which can provide results in 48 hours (completing 20,000 tests per day). The test is aimed at individuals who are currently experiencing symptoms of COVID-19.

AFRICA COVID-19 RESOURCES A commentary published in The Lancet addresses existing and future challenges of global disparities in access to critical medical supplies, equipment, medications, and other materiel in the context of the COVID-19 pandemic. The authors note, “A governance crisis is unfolding alongside the pandemic as health officials around the world compete for access to scarce medical supplies.” Low- and middle-income countries around the world continue to struggle as they are forced to compete against wealthier nations to obtain access to testing kits and supplies and personal protective equipment, and similar challenges likely await them once medical countermeasures, including vaccines, become available.

The article focuses on challenges in Africa, but similar barriers exist elsewhere as well. Africa has reported relatively few cases, compared to other continents, but this is likely a reflection of testing availability rather than lower rates of transmission. South Africa has demonstrated success utilizing large-scale testing, but this capacity is not present in many other African nations. A combination of national and coordinated international (e.g., under the Africa CDC) efforts have increased testing availability across the continent, but capacity remains well below the recommended level. The authors acknowledge governments’ responsibility to protect their own citizens, but they urge political leaders to consider the broader global need to ensure equitable access to all countries, in terms of both testing capacity and future MCM availability, including vaccines. Increased funding support, coordinated and pooled efforts to purchase supplies, and distributed manufacturing capacity could serve to mitigate disparities in access to critical supplies during the COVID-19 pandemic and future large-scale health emergencies, but a coordinated international effort and commitment to equitable access are needed.