Official numbers of reported cases and deaths are questioned at Dadhaleh Institute

Official numbers of reported cases and deaths are questioned

A number of countries including Iran, China and Japan are also increasingly facing questions about official reports of case counts and mortality figures, as modelling estimates and informal proxy indicators (e.g. total mortality, demand for funeral services, [... ]a few seconds.

A number of countries including Iran, China and Japan are also increasingly facing questions about official reports of case counts and mortality figures, as modelling estimates and informal proxy indicators (e.g. total mortality, demand for funeral services, local and social media accounts, etc.) suggest real figures may be significantly higher. There is likewise concern that the true outbreak size in India may be significantly higher than the 2,567 confirmed cases, which has doubled in just two days.

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More countries are adopting the WHO's number advice to "test, test, test"

Countries are increasingly adopting the WHO’s main advice to “test, test, test,” with total number of tests performed increasing 42% over the past week, as of April 1. Limited availability of diagnostic [... ]less than a minute.

Countries are increasingly adopting the WHO's main advice to "test, test, test," with total number of tests performed increasing 42% over the past week, as of April 1. Limited availability of diagnostic kits and laboratories in many low- and middle-income countries remain a critical concern and is almost certainly masking more widespread local transmission. Similar to prior pandemics, high initial Case Fatality Rates for COVID-19 are expected to trend downwards over time as countries adopt more wide-spread population testing (i.e. recording those dying with as opposed to from the virus). This is reflected in these CFR figures (in order of countries with the highest number of deaths), as of 3 April: Italy (12%), Spain (9.1%), U.S. (2.4%), France (7.1%), China (4.1%), Iran (6.3%)

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UN Secretary General calls for “Global Ceasefire”

The UN Secretary General has called for a “Global Ceasefire” and the UN Peacekeeping Office has postponed troop rotations in peacekeeping operations while establishing a Field Support Group to strengthen COVID-19 response [... ]a few seconds.

The UN Secretary General has called for a “Global Ceasefire” and the UN Peacekeeping Office has postponed troop rotations in peacekeeping operations while establishing a Field Support Group to strengthen COVID-19 response capacity.

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Humanitarian agencies urge countries to ensure protection of vulnerable groups

Over 2,304 cases and 99 deaths have been reported across 19 humanitarian sites, according to the UN Office for the Coordination of Humanitarian Affairs (UNOCHA). There are major concerns of excessive restrictions [... ]less than a minute.

Over 2,304 cases and 99 deaths have been reported across 19 humanitarian sites, according to the UN Office for the Coordination of Humanitarian Affairs (UNOCHA). There are major concerns of excessive restrictions on points of entry, according to the (IOM), limiting mobility and the delivery of essential goods. Humanitarian agencies, including the International Committee Red Cross (ICRC) and (MSF) have urged countries to ensure the protection of vulnerable groups, including internally displaced persons as well as asylum seekers, and to ensure access to essential goods such as medical equipment and food supplies, as the World Food Programme (WFP) is warning of anticipated food shortages. Over 3,015 cases and 126 deaths have been reported across 21 humanitarian sites, according to UNOCHA.

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Early mitigation measures are most effective, but restrictions cause concerns

Measures to flatten the curve — including lockdowns, quarantines, and shutting down of non-essential services — have been most effective when countries have acted quickly and adopted wide-scale measures of social and [... ]a few seconds.

Measures to flatten the curve — including lockdowns, quarantines, and shutting down of non-essential services — have been most effective when countries have acted quickly and adopted wide-scale measures of social and economic protection. Countries are increasing the adoption of restrictive control measures in an effort to flatten the curve. Ninety three percent of the world's population are now in countries that have imposed some form of travel restrictions, posing particular and heightened risks of outbreaks in humanitarian response locations, which can include internally displaced persons settings, refugee camps and informal urban settlements.

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UN launches $2 billion appeal for a Coordinated Global Humanitarian Response Plan

The UN Office for the Coordination for Humanitarian Affairs (OCHA) has issued a $2 billion appeal for a Coordinated Global Humanitarian Response Plan to support rapid mobilization of essential medical equipment, public information [... ]a few seconds.

The UN Office for the Coordination for Humanitarian Affairs (OCHA) has issued a $2 billion appeal for a Coordinated Global Humanitarian Response Plan to support rapid mobilization of essential medical equipment, public information campaigns, water and sanitation stations, and airbridges and logistics hubs to assist with the movement of supplies and humanitarian workers.

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Auxiliary health facilities set up in major urban centres

With the outbreak expected to spread more widely across the continent over the next two weeks, there are increasing concerns over health care system capacities. Auxiliary health facilities such as the U.S. [... ]a few seconds.

With the outbreak expected to spread more widely across the continent over the next two weeks, there are increasing concerns over health care system capacities. Auxiliary health facilities such as the U.S. Navy Hospital Ship Comfort deployed to the port of New York City (which is the largest affected city globally with over 50,000 cases), and field hospitals have been set up in major urban centres, including New York City's Central Park and in Toronto, Canada.

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Urban mass exodus in India

In addition to wide-spread reports of food shortages in India, the nationwide 21-day lockdown has led to a mass exodus of hundreds of thousands of people from major urban areas, increasing the risk of [... ]a few seconds.

In addition to wide-spread reports of food shortages in India, the nationwide 21-day lockdown has led to a mass exodus of hundreds of thousands of people from major urban areas, increasing the risk of local transmission in rural parts of the country. There is concern that the true outbreak size in India may be significantly higher than the 2,567 confirmed cases, which has doubled in just two days.

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Increasing diagnostic testing

Many countries are experiencing shortages in diagnostic testing kits, as the development, production and distribution remain critical challenges that impede early detection and access to care. There are also reports of significant [... ]less than a minute.

Many countries are experiencing shortages in diagnostic testing kits, as the development, production and distribution remain critical challenges that impede early detection and access to care. There are also reports of significant backlogs, in some cases taking over a week to provide results. Further efforts are needed in the development and scaling up of rapid (real-time) diagnostic tests. The Foundation for Innovative New Diagnostics (FIND), a WHO Collaborating Centre for Laboratory Strengthening and Diagnostic Technology Evaluation, has curated a list of the current Diagnostic Pipeline, while the U.S. FDA has now issued Emergency Use Authorizations to at least three COVID-19 rapid diagnostic tests over the last week, including:

Cepheid Xpert Xpress SARS-Cov-2 Test (45min)
Mesa Biotech Accula SARS-Cov-2 Test (30min)
Abbott ID NOW COVID-19 Rapid Test (5-15min)

Government of Canada accelerates approval for diagnostic tests

The Government of Canada has accelerated approval for the Cepheid and Abbott diagnostic tests, following the issuance of an Interim Order by the Minister of Health on March 18 to expedite access to [... ]a few seconds.

The Government of Canada has accelerated approval for the Cepheid and Abbott diagnostic tests, following the issuance of an Interim Order by the Minister of Health on March 18 to expedite access to COVID-19-related medical devices. The COVID-19 Emergency Response Act (Bill C-13) also received royal assent on March 25. Among the sweeping number and scope of measures, the COVID-19 Emergency Response Act amends the Patent Act in order to allow the Government of Canada to issue compulsory licenses to respond to a “public health emergency that is a matter of national concern,” which could apply to diagnostic kits but also personal protective equipment, medical devices and therapeutic products.

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Stats Summary: Americas

The numbers continue to surge in the U.S., with at least 6,098 reported deaths and 245,442 confirmed cases, accounting for almost a quarter of all worldwide cases. New York State has become [... ]less than a minute.

The numbers continue to surge in the U.S., with at least 6,098 reported deaths and 245,442 confirmed cases, accounting for almost a quarter of all worldwide cases. New York State has become the epicentre of the outbreak with almost 100,000 confirmed cases, while the U.S. reported over 1,000 deaths for the second day in a row. In Canada, the number of confirmed cases has also increased to 11,283, including 173 reported deaths. With the outbreak expected to spread more widely across the continent over the next two weeks, there are increasing concerns over health care system capacities. The number of cases in South and Central American countries continue to grow, with reported cases in Brazil continuing to jump almost 20% a day to 8,044, while Chile and Ecuador have seen spikes to 3,404 and 3,163 cases, respectively.

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Stats Summary: Europe

As of April 3, Italy and Spain together make up almost half of all confirmed deaths globally (13,915 and 10,348, respectively), while each country has also surpassed 110,000 confirmed cases. Across Europe, [... ]less than a minute.

As of April 3, Italy and Spain together make up almost half of all confirmed deaths globally (13,915 and 10,348, respectively), while each country has also surpassed 110,000 confirmed cases. Across Europe, ten countries are reporting more than 10,000 cases, while seven countries have reported over 1,000 deaths. Many European countries are also reporting alarmingly high Case Fatality Rates over 5%. Including Italy (12%), Netherlands and Spain (9.1%), UK (8.7%), France (7.1%), Belgium (6.6%), and Sweden (5.2%). This has been partly attributed to selective testing strategies in these countries, while widespread testing is likely contributing to relatively low CFR rate in countries like Germany (1.2%) and Austria (1.4%). The European CDC has nonetheless warned that current testing capacity and if countries do not enact mitigation strategies, Europe could see a scenario similar to China by the middle of April.

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Stats Summary: Asia

While China has virtually interrupted local transmission, it remains the fifth leading country with 81,620 confirmed cases and 3,322 reported deaths. Two thirds of new infections reported in China yesterday were asymptomatic, [... ]less than a minute.

While China has virtually interrupted local transmission, it remains the fifth leading country with 81,620 confirmed cases and 3,322 reported deaths. Two thirds of new infections reported in China yesterday were asymptomatic, which has been concerning as authorities have taken steps to end the lockdown of Hubei province (with Wuhan remaining under lockdown until at least April 8). The number of reported cases and deaths in Iran, meanwhile, keep rising to 53,183 and 3,294, respectively. There are no official lockdowns in Iran's major cities, despite internal government estimates that mortality rates could be drastically limited to 7,700 instead of the projected "tens of thousands" of deaths by adopting 'maximum' interventions (e.g. banning movement inside cities, quarantines). In South Korea 35% of confirmed cases within the last two weeks have been imported cases; more stringent control measures and monitoring have gone into effect as of today to deter incoming international travel. South Korea, Taiwan and Singapore have significantly slowed new case counts, with the focus shifting to the containment of imported cases.

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Stats Summary: Africa

Pandemic activity is increasing rapidly in Africa, with reported cases growing by 185% over the past week. At least 50 countries have reporting more than 7,100 confirmed cases and 289 deaths. South [... ]less than a minute.

Pandemic activity is increasing rapidly in Africa, with reported cases growing by 185% over the past week. At least 50 countries have reporting more than 7,100 confirmed cases and 289 deaths. South Africa has reported the largest number of cases (1,462), although almost half the continent’s cases are in four Northern Africa countries, including Algeria (986), Egypt (865), Morocco (735) and Tunisia (455). Alongside sporadic imported cases, most countries are also reporting local transmission, which remains a critical risk, with at least 15 countries now reporting more than 100 cases each. The UN and regional authorities have expressed concern over sub-Saharan Africa, as limited diagnostic testing kits and public health surveillance capacity may be masking and further exacerbate local outbreaks. Healthcare workers are also acutely at risk, with at least 123 confirmed cases. National governments have warned of limited stress tolerance of health systems to the anticipated surge in cases over the next two weeks, requesting urgent support from regional partners and the international community.

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Stats Summary: Global

The total number of cases continue to increase by at least 10% for a second day to 1,039,158, and 55,000 confirmed deaths, as of 3 April 2020 (9:25am EST). Although the U.S. [... ]a few seconds.

The total number of cases continue to increase by at least 10% for a second day to 1,039,158, and 55,000 confirmed deaths, as of 3 April 2020 (9:25am EST). Although the U.S. and Europe constitute over 70% of confirmed cases, the rapid increase of local clusters across low- and middle-income countries has emerged as a major concern.

CFR figures (in order of countries with the highest number of deaths)

Italy (11.4%) Spain (8.7%) Iran (6.5%) U.K. (8.2%) France (6.8%) China (4.1%) US (1.9%) Netherlands (8.3%)

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WHO COVID-19 Situation Report 74

Latest WHO COVID-19 Situation Report 74 (3 April 2020) [... ]a few seconds.

Latest WHO COVID-19 Situation Report 74 (3 April 2020)

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Research: Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries

Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries (Flaxman et al, Imperial College London) Findings This study attempts to infer the impact of [... ]less than a minute.

Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries (Flaxman et al, Imperial College London)

Findings

This study attempts to infer the impact of different interventions across 11 European countries using a semi-mechanistic Bayesian hierarchical model. The authors estimate that through the end of March, interventions taken by countries likely averted 59,000 deaths while reducing reproduction numbers. During this period, the authors also estimate that 7-43 million people may have been infected across the 11 countries (or approx. 2-11% of total population). Spain and Italy are estimated to have the highest attack rate, with Germany and Norway on the lower end (possibly reflecting the relative stages of the epidemics.

Interpretation

While the two to three-week delay between transmission changes and observed impact on mortality make it difficult to evaluate the effectiveness of recent interventions, the authors urge that preliminary evidence suggests that current interventions remain in place and that trends in cases and deaths be closely monitored to provide reassurance that transmission is slowing.

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Research: Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies

Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies (Wu et al, SSRN) Findings The initial growth rate in Italy (0.22) has reduced to 0.1 two weeks after [... ]nearly a minute.

Canada Needs to Rapidly Escalate Public Health Interventions for Its COVID-19 Mitigation Strategies (Wu et al, SSRN)

Findings

The initial growth rate in Italy (0.22) has reduced to 0.1 two weeks after the lockdown (8 Mar 2020). This corresponds to an extension of the doubling time from about 3.15 to almost 7 days. In comparison, the growth rate in Canada has increased from 0.13 from 1 March to 13 March up to 0.25 between 13 March to 22 March. This current growth rate corresponds to a doubling time of 2.7 days, and unless public health interventions escalate in Canada, we project 15,000 cases by March 31st. The case number can be reduced to 4,000 if escalated public health interventions can be implemented instantly to reduce the growth rate to 0.1, the same level achieved in Italy.

Interpretation

Intervention measures implemented by different countries have had various effects in reducing the growth rate and extending the doubling time, but their impacts come with a substantial delay (up to two weeks). Prompt and farsighted interventions are critical to counteract the very rapid initial growth of the COVID-19 epidemic. Mitigation plans must take into account the delayed effect of interventions by up to two weeks and the short doubling time of 3 to 4 days.

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Research: Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions

Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions (De Salazar et al, CDC Early Release) Findings The aim was to identify locations with [... ]less than a minute.

Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions (De Salazar et al, CDC Early Release)

Findings

The aim was to identify locations with likely undetected or under-detected imported cases of COVID-19. The results suggest that locations above the 95% PI of imported-and-reported cases could have higher case-detection capacity. Locations below the 95% PI might have undetected cases because of expected imported-and-reported case counts under high surveillance. Under-detection of cases could increase the international spread of the outbreak because the transmission chain could be lost, reducing opportunities to deploy case-based control strategies.

Interpretation

They recommend rapid strengthening of outbreak surveillance and control efforts in locations below the 95% PI lower bound to curb potential local transmission. Early detection of cases and implantation of appropriate control measures can reduce the risk for self-sustained transmission in all locations

Research: Substantial undocumented infection facilitates the rapid dissemination of COVID-19

Substantial undocumented infection facilitates the rapid dissemination of COVID-19 (Li et al, Science) Findings Using a model-inference framework, the authors estimates the contagiousness and proportion of undocumented infections of COVID-19 in 375 cities [... ]less than a minute.

Substantial undocumented infection facilitates the rapid dissemination of COVID-19 (Li et al, Science)

Findings

Using a model-inference framework, the authors estimates the contagiousness and proportion of undocumented infections of COVID-19 in 375 cities in China before (Jan 10-23) and after (Jan 24-Feb 8) implementation of control measures in Wuhan (including: travel restrictions self-quarantine and contact precautions, access to rapid testing and PPE). The effective reproduction number (Re), i.e. number of secondary infections per index infection, was 2.4. The authors estimate that before control measures, 86% of all infections were undocumented, estimated to be about half (55%) as contagious as reported infections. After Control Measures, the proportion of undocumented infections fell to 31-35%, while the Re decreased to 0.99-1.4.

Interpretation

Although inference results should be interpreted with caution, the study suggests that control measures in Wuhan as of Jan 23 altered the epidemiological characteristics of the outbreak.

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