Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

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The Johns Hopkins Center for Health Security also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.
EPI UPDATE The WHO COVID-19 Dashboard reports 44.59 million cases and 1.18 million deaths as of 4:30am EDT on October 30.

The US CDC reported 8.83 million total cases, 227,045 total deaths, and 521,726 new cases in the past 7 days. The daily COVID-19 incidence continues to increase, now up to 81,599 new cases per day, representing a 22% increase in daily reported cases compared to last week and now surpassing the previous highest peak in mid-July.

The US CDC reported 1,060 new deaths per day on October 29, an increase from the 483 new deaths per day reported on October 26. This increase in mortality approximately represents a 15% increase in daily reported mortality compared to last week. Mortality in the US has been relatively steady for the month of October, but could potentially increase with the current rise in cases as several hospitals in the Midwest report becoming overwhelmed. 

Most US states have at least 100,000 cases, including 13 states with more than 200,000 cases:
>900,000: California
>800,000: Texas
>700,000: Florida
>400,000: New York
>300,000: Georgia, Illinois

In terms of cases per 100,000 population, states in the West and Midwest including but not limited to Montana, North and South Dakota, Wisconsin, Wyoming and have reported at least 50 new cases per 100,000 population within the past 7 days. Idaho, which was in that category last week, reported 48 new cases per 100,000 and is still of concern for high levels of new cases. North and South Dakota have reported a staggering 114.2 and 112.6 cases per 100,000 population, after slow adoption of social distancing and public health measures. North Dakota received criticism from Dr. Deborah Birx over the lack of mask wearing in public spaces. 

The Johns Hopkins CSSE dashboard reported 8.95 million US cases and 228,696 deaths as of 9:24am EDT on October 30.

On Tuesday October 27, 33,000 new cases were confirmed in France, at their highest level since April. French President Emmanuel Macron announced that the entire country will be re-entering a nationwide lockdown beginning today, October 30, and lasting until December 1. People may only leave their homes to seek medical care, buy essential goods, or use their daily 1 hour of outdoor exercise. Businesses not selling essential goods must close for at least the next 2 weeks, if not longer. Employers are allowed to bring in their employees if they deem that they cannot perform their job from home. Unlike the first nationwide lockdown in the spring, schools will remain open. Already, about half of France’s ICU beds are occupied by COVID-19 patients. In Paris, about 70% of ICU beds are occupied by COVID-19 patients. The French government hopes that the renewal of these strict measures will prevent their healthcare system from being overwhelmed. According to a recent Lancet paper, the first nationwide lockdown successfully decreased population mobility across many scales, local, regional, and national. 

Similar to France’s actions, German Chancellor Angela Merkel announced that Germany would be entering a nationwide partial lockdown. The lockdown period is set to begin on November 2 and end on November 30. Non-essential businesses, such as bars, movie theaters, and nightclubs, must close down and restaurants will be limited to carry-out only. People may not gather in groups larger than 10. Professional sports will be allowed to play with no fan attendance. Like France, schools will remain open, signaling the intention of the German government to prioritize education over entertainment. However, entertainment and other non-essential businesses will be provided with subsidies to partially cover their financial losses. Germany recorded over 22,000 new cases last Friday, a new record for the country. Merkel further announced that health authorities are unable to trace the origin of over 75% of reported cases, indicating rapid and uncontrolled spread of COVID-19. 

Belgium & Czech Republic
Compared to other countries across Europe, Belgium and the Czech Republic have significantly higher cases per 100,000 population. By comparison, all EU countries together average about 33 cases per 100,000 while Belgium and Czech Republic report 146 and 115 per 100,000, respectively. Experts are struggling to find a specific reason that these two countries are doing worse compared to their neighbors, but some believe that high population density in cities and travel patterns to visit relatives could be factors. Both governments also were slow to implement control measures, such as mask mandates and event closures, when cases began to climb in late August. Despite new efforts to control the spread of COVID-19, Belgium’s top health official warned that the country could run out of its 2,000 ICU beds in as little as 2 weeks.

Belgium’s newly installed Prime Minister Alexander De Croo has worked with opposing political factions to implement new control strategies. These include a curfew from midnight to 5 am, restricting restaurants to carry-out service only, and encouraging working from home where possible. In the Czech Republic, gatherings of more than 10 people indoors and 20 people outdoors are banned, high schools and universities must switch to online learning, non-essential businesses are closed, and a mask mandate has been reintroduced. Unfortunately, public faith in the Czech health minister Roman Prymula has greatly decreased after he was photographed dining in a restaurant owned by a personal friend after he had forced sit-in dining to close. The Czech Prime Minister has told Prymula to resign or be fired, as the scandal has reached high levels of outrage.

HUMAN RIGHTS WATCH REPORT A new report by Human Rights Watch stresses the need for transparency and maintaining commitments to equity in the development of COVID-19 vaccines. The report outlines key elements needed for COVID-19 vaccine development and distribution to continue with a human-rights based approach for all. High income countries, where a significant portion of vaccine development is occurring, have discussed or secured deals with developers in which that country reserves future doses for their exclusive use. This concept of “vaccine nationalism” is inherently detrimental to any global effort to provide equitable access to a future COVID-19 vaccine, the report says. Human Rights Watch says that governments should take all measures possible to ensure that scientific benefits of research are shared as widely as possible “to prevent the unacceptable prioritization of profit for some over benefit for all.”

ARGENTINA WASTEWATER SURVEILLANCE Diagnostic testing and contact tracing have been limiting factors for many governments as they struggle to contain and control their respective COVID-19 outbreaks. The WHO recently released a scientific brief that suggests countries with limited resources for clinical surveillance could conduct environmental surveillance in wastewater systems. By pooling samples that represent a large group of people, such as an office building or military base, countries can maximize limited testing resources. Several countries have implemented a wastewater surveillance strategy for these reasons, but authors of a pre-print study in Argentina wanted to explore this strategy in settlements that do not have sewer networks or wastewater treatment facilities. Informal settlements already are at higher risk of COVID-19 outbreaks due to crowded living situations and poor access to hygiene and sanitation facilities. The authors studied a low-resource settlement within Buenos Aires of which only 25% of residents are connected to municipal sewage. The remaining residents dispose of their waste in a communal lagoon which then is pumped into the municipal waste system. Surface wastewater samples were taken from the pumping station and RT-PCR was used to identify and quantify SARS-CoV-2 RNA. The authors found that they could achieve a sensitivity of identifying 1 reported case per 135 residents using this strategy. They further found that the concentration of viral RNA correlated well with the number of cases identified through traditional contact tracing and testing methods within the settlement. Further research in this area could create a wider evidence base for environmental surveillance in settings without traditional wastewater treatment systems. 

CHINA CASES Mainland China reported 42 new cases on October 27, the highest daily count in nearly two months, since August 10 when 44 cases were reported. 22 of the new cases were asymptomatic. The city of Kashgar aims to test 4.6 million residents to contain its latest outbreak after a 17-year-old tested positive during routine testing, who is thought to be the root of 183 case cluster. The National Health Commission has sent teams to assist in the endeavor and raised the emergency response indicator to the highest level. Kashgar is not the first city to implement city-wide testing; Qingdao tested 11 million people in five days following a cluster of cases in early October. While Chinese health authorities clearly have the ability to test large numbers of people in urban settings, some health authorities have noted the difficulties of large-scale testing in rural settings and especially among rural ethnic minorities.

SUCCESS IN TAIWAN Taiwan, an island of 23 million people, recently achieved an impressive milestone in their COVID-19 response this week when it reached 200 days without recording a single locally transmitted SARS-CoV-2 infection. The last reported domestic case of COVID-19 was on April 12, and the island has reported a little over 550 cases and 7 deaths. Taiwan is one of the only places in the world to have achieved this, and demonstrates that implementation of robust public health response measures can control SARS-CoV-2 transmission. Early in the pandemic, experts were concerned that Taiwan would experience a large outbreak, particularly due to its proximity and connectivity to China. However, Taiwan’s COVID-19 response was extensive and proactive, taking in lessons learned from their 2003 SARS epidemic. When China’s epidemic was surging early in the year, Taiwanese officials instituted widespread contact tracing and public health containment measures, as well as technologies to support those initiatives. Additionally, officials connected their national health insurance database to immigration and customs data to support real-time alerts to medical staff of patient travel history during clinical visits. Officials also used QR code scanning and online systems to assess risk levels among travelers and triage them through customs and immigration accordingly. 

Furthermore, the Health Ministry and Taiwanese Vice President, an epidemiologist, gave frequent announcements to the public that encouraged uptake of behaviors including mask wearing and hand washing. Notably, unlike other areas also known for their robust and successful COVID-19 responses, Taiwan achieved control of SARS-CoV-2 transmission without implementing an extensive lockdown. While some have argued that it is possible that some transmission is occurring undetected in Taiwan, and not all of the Taiwanese response measures are feasible in other countries, Taiwan’s experience has been far more successful than that of other high-income settings like the US. The experience of Taiwan demonstrates that proactive and expansive implementation of public health measures, paired with clear communication from trusted officials, can successfully manage and contain epidemics of highly transmissible pathogens. 

MELBOURNE’S LOCKDOWN Australia’s second largest city, Melbourne, has finally ended the world’s longest lockdown, clocking at 111 days as of this Wednesday. The lockdown was originally imposed in response to the high incidence of 700 cases or more per day and included strict stay-at-home restrictions and curfews. Adapted mitigation measures are now in place for the metropolitan area such as mandated mask usage when outside the home and restrictions on travel from the home; residents are allowed to travel up to 25 kilometers from their home unless they are traveling to seek care, deliver caregiving, go to work, attend in-person education, utilize childcare services, purchase essential goods if there is no nearby vendor, or seek help for an emergency. Public gatherings are limited to 10 people or less with more people allowed in certain cases, such as funerals or outdoor religious gatherings. Up to two individuals from the same household are allowed to visit another household per day. Various businesses are open with distancing and capacity caps in place. Children may participate in contact or non-contact sports while adults are allowed to participate in outdoor non-contact sports with physical distancing in place. Individuals who do not follow new restrictions may be fined up to $20,000 per individual or $100,000 per business. 

IMMUNITY IN ICELAND A new article in The New England Journal of Medicine measured humoral immunity over time among 30,576 people in Iceland. Humoral immunity refers to B-cells and antibody production. This study’s sample size is considerable compared to the overall population size of 361,313 in 2019 and could be a fairly accurate representation of Iceland’s COVID-19 seroprevalence. Eight sample groups were tested using six different assays. Two of the sample groups, hospitalized and recovered individuals with confirmed COVID-19, were tested using all six assays including Pan-Ig antibody assays and assays for antibody quantification. The six other sample groups were tested with just the two Pan-Ig antibody assays. These six groups included one group of individuals completing quarantine, two groups from two regional hotspots, one group of individuals tested upon seeking medical care, one group of pre-pandemic samples from 2017 and one group of pre-pandemic samples from early 2020. Among other findings, authors estimated that 0.9% of the Icelandic population had been previously infected by SARS-CoV-2 with an infection fatality rate of 0.3%. Authors also predicted that 30% of SARS-CoV-2 infections in Iceland occurred among individuals who were not quarantined and were not tested by qPCR. 56% of SARS-CoV-2 infections in Iceland were diagnosed properly using qPCR while the remaining 14% were infections that occurred during quarantine but were not diagnosed via qPCR. 

RUSSIA MASK MANDATE AND VACCINE The Russian government issued an order, effective Wednesday, mandating that masks be worn in all public spaces or where more than 50 people may gather. Published on the federal health watchdog agency site, Rospotrebnadzor, the department also advised local authorities to ban all entertainment activities between 11 pm and 6 am, in addition to strengthening safety protocols for public transit, taxis, restaurants, shops, and theaters. The nationwide mask mandate  now counters President Vladimir Putin’s previous resistance to nationwide measures in earlier months, which largely left response efforts to the discretion of Russia’s 85 regional governors. 

Eight of the 25 Moscow clinics involved in Russia’s vaccine trial are temporarily halting vaccination of new trial participants due to a shortage of doses. The high influx of new participants at the clinics has meant several clinics have administered all their allotted first-dose supply. Three clinics are now only administering the second dose to already enrolled participants, which is administered 21 days after the first dose. The vaccine is developed and manufactured by the Gamelaya Institute, who is partnering with private Russian pharmaceutical companies to increase production. The vaccine manufacturers and study coordinators hope to restart the vaccine trials around November 10. 

MARSHALL ISLANDS’ FIRST CASES The Marshall Islands, a remote sovereign nation composed of a group of islands located in the Pacific Ocean, has recorded their first cases since the beginning of the pandemic. The two cases arrived on the Marshall Islands on a US military flight. Both were asymptomatic when tested and did not have any interaction with the general population; instead, both persons immediately entered quarantine upon arrival as dictated by entry procedures. US military members are allowed to enter the US military base as long as they immediately begin a 3 week quarantine. The Marshall Islands government has reassured its citizens that these cases have been contained to avoid spread. The Marshall Islands quickly closed itself off from travel when the COVID-19 pandemic began, much like other Pacific island nations. Its neighbors, including Kiribati, Vanuatu, Micronesia, and Samoa, likewise have not experienced cases of COVID-19 and are remaining firm on travel restrictions in order to maintain that streak. 
SYSTEMIC RACISM & COVID-19 The Johns Hopkins Center for Health Security’s journal, Health Security, issued a call for papers for an upcoming Special Feature on systemic racism in the context of the COVID-19 pandemic (scheduled for May/June 2021). Additional information is available here.