Coronavirus disease 2019 (COVID-19) WHO Situation Report – 41

WHO is working closely with clinicians caring for patients with COVID-19, in China and across the globe and international experts on infectious disease to better understand, in real time, the clinical presentation, natural history and treatment interventions for COVID-19.

Coronavirus disease 2019 (COVID-19) Situation Report – 41

Data as reported by 10AM CET 01 March 2020

  • Five new Member States (Azerbaijan, Ecuador, Ireland, Monaco and Qatar) reported cases of COVID-19 in the past 24 hours.
  • Working with clinicians is crucial to understanding the clinical presentation, natural history and treatment interventions for COVID-19. WHO has published interim clinical guidance, clinical training materials and has launched a global clinical data platform to gather data and improve care for COVID-19 patients. This information is critical to inform the public health response. More information can be found in the Subject in Focus.
  • The number of confirmed cases in Hubei province, China, has increased for two successive days after a period of decline. WHO is monitoring the situation and working to understand its possible significance.
  • WHO has published updated recommendations for international traffic in relation to COVID-19 outbreak. They can be found here.

SITUATION IN NUMBERS

total and new cases in last 24 hours

 

Globally

87 137 confirmed (1739 new)

 

China

79 968 confirmed (579 new)

2873 deaths (35 new)

 

Outside of China

7169 confirmed (1160 new)

58 countries (5 new)

104 deaths (18 new)

 

WHO RISK ASSESSMENT

SUBJECT IN FOCUS: CLINICAL MANAGEMENT OF PATIENTS WITH COVID-19

 

WHO is working closely with clinicians caring for patients with COVID-19, in China and across the globe and international experts on infectious disease to better understand, in real time, the clinical presentation, natural history and treatment interventions for COVID-19.

 

A majority of patients with COVID-19 are adults. Among 44 672 patients in China with confirmed infection, 2.1% were below the age of 201. The most commonly reported symptoms included fever, dry cough, and shortness of breath, and most patients (80%) experienced mild illness. Approximately 14% experienced severe disease and 5% were critically ill. Early reports suggest that illness severity is associated with age (>60 years old) and co-morbid disease.

 

Clinical care of patients with COVID-19 focuses on early recognition, immediate isolation and implementation of appropriate infection prevention and control (IPC) measures; provision of symptomatic care for those with mild illness; and optimized supportive care for those with severe disease. WHO has published patient management guidance, including interim clinical care guidance for hospitalized patients and home care guidance for those with mild disease that may be treated at home in isolation when the health system is strained.

 

Oxygen therapy is the major treatment intervention for patients with severe COVID-19. All countries should work to optimize the availability of pulse oximeters and medical oxygen systems. Mortality in those with critical illness has been reported as over 50%, thus implementation of proven critical care interventions such as lung protective ventilation should be optimized. COVID-19 critical care clinical training materials are available on https://openwho.org/courses/severe-acute-respiratory-infection. The first regional COVID-19 Clinical Case Management training was conducted in Brazzaville from 25-28 February 2020 with representatives from 18 countries of the WHO African region. WHO will continue to conduct such trainings to increase global knowledge on the management and care of patients with COVID-19.

 

WHO launched the Global COVID-19 Clinical Data Platform to aggregate and report on clinical severity to inform the public health response. Member States are encouraged to contribute by contacting [email protected] for log-in information.

 

As there is currently no known effective antiviral therapy for COVID-19, the WHO R&D Blueprint has prioritized investigational therapeutics and developed a master randomized clinical trial protocol that can be used and adapted at the national level. There are many ongoing ethics-approved clinical trials evaluating a number of different therapeutic interventions globally including priority agents such as ritonavir/lopinavir and remdesivir.

 

  1. Wu, Z. et al. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China; Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Feb 24, 2020.
Epidemic Curve of COVID-19
Epidemic Curve of COVID-19

SURVEILLANCE

 

Table 1. Confirmed and suspected cases of COVID-19 acute respiratory disease reported by provinces, regions and cities in China, Data as 01 March 2020

 

Province/ Region/ City

 

Population (10,000s)

Daily Cumulative
Confirmed cases Suspected cases  

Deaths

Confirmed cases  

Deaths

Hubei 5917 570 64 34 66907 2761
Guangdong 11346 0 1 0 1349 7
Henan 9605 0 0 1 1272 22
Zhejiang 5737 0 0 0 1205 1
Hunan 6899 0 0 0 1018 4
Anhui 6324 0 0 0 990 6
Jiangxi 4648 0 0 0 935 1
Shandong 10047 0 0 0 756 6
Jiangsu 8051 0 0 0 631 0
Chongqing 3102 0 6 0 576 6
Sichuan 8341 0 1 0 538 3
Heilongjiang 3773 0 0 0 480 13
Beijing 2154 2 18 0 413 8
Shanghai 2424 0 10 0 337 3
Hebei 7556 0 0 0 318 6
Fujian 3941 0 0 0 296 1
Guangxi 4926 0 0 0 252 2
Shaanxi 3864 0 0 0 245 1
Yunnan 4830 0 0 0 174 2
Hainan 934 0 3 0 168 5
Guizhou 3600 0 0 0 146 2
Tianjin 1560 0 11 0 136 3
Shanxi 3718 0 0 0 133 0
Liaoning 4359 1 11 0 122 1
Hong Kong SAR 745 1 0 0 95 2
Jilin 2704 0 6 0 93 1
Gansu 2637 0 0 0 91 2
Xinjiang 2487 0 0 0 76 3
Inner Mongolia 2534 0 0 0 75 0
Ningxia 688 0 1 0 73 0
Taipei and environs 2359 5 0 0 39 1
Qinghai 603 0 0 0 18 0
Macao SAR 66 0 0 0 10 0
Xizang 344 0 0 0 1 0
Total 142823 579 132 35 79968 2873

 

Table 2. Countries, territories or areas outside China with reported laboratory-confirmed COVID-19 cases and deaths. Data as of 01 March 2020

Country Total confirmed* cases (new) Total deaths (new) Transmission classification Days since last reported case
Western Pacific Region
Republic of Korea 3736 (586) 18 (1) Local transmission 0
Japan 239 (9) 5 (0) Local transmission 0
Singapore 102 (4) 0 (0) Local transmission 0
Australia 25 (1) 0 (0) Local transmission 0
Malaysia 24 (0) 0 (0) Local transmission 2
Viet Nam 16 (0) 0 (0) Local transmission 17
Philippines 3 (0) 1 (0) Imported cases only 26
Cambodia 1 (0) 0 (0) Imported cases only 34
New Zealand 1 (0) 0 (0) Imported cases only 2
European Region
Italy 1128 (240) 29 (8) Local transmission 0
France 100 (43) 2 (0) Local transmission 0
Germany 57 (0) 0 (0) Local transmission 1
Spain 45 (13) 0 (0) Local transmission 0
The United Kingdom 23 (3) 0 (0) Local transmission 0
Switzerland 18 (8) 0 (0) Imported cases only 0
Norway 15 (9) 0 (0) Local transmission 0
Sweden 13 (1) 0 (0) Imported cases only 0
Austria 10 (5) 0 (0) Imported cases only 0
Croatia 7 (2) 0 (0) Local transmission 0
Israel 7 (2) 0 (0) Imported cases only 0
Netherlands 7 (5) 0 (0) Local transmission 0
Azerbaijan 3 (3) 0 (0) Imported cases only 0
Denmark 3 (1) 0 (0) Imported cases only 0
Georgia 3 (1) 0 (0) Imported cases only 0
Greece 3 (0) 0 (0) Imported cases only 2
Romania 3 (0) 0 (0) Imported cases only 1
Finland 2 (0) 0 (0) Imported cases only 4
Russian Federation 2 (0) 0 (0) Imported cases only 30
Belarus 1 (0) 0 (0) Imported cases only 2
Belgium 1 (0) 0 (0) Imported cases only 26
Estonia 1 (0) 0 (0) Imported cases only 3
Ireland 1 (1) 0 (0) Imported cases only 0
Lithuania 1 (0) 0 (0) Imported cases only 2
Monaco 1 (1) 0 (0) Under investigation 0
North Macedonia 1 (0) 0 (0) Imported cases only 4
San Marino 1 (0) 0 (0) Local transmission 1
South-East Asia Region
Thailand 42 (0) 0 (0) Local transmission 1
India 3 (0) 0 (0) Imported cases only 27
Nepal 1 (0) 0 (0) Imported cases only 48
Sri Lanka 1 (0) 0 (0) Imported cases only 34
Eastern Mediterranean Region
Iran (Islamic Republic of) 593 (205) 43 (9) Local transmission 0
Kuwait 45 (0) 0 (0) Imported cases only 1
Bahrain 40 (2) 0 (0) Imported cases only 0
United Arab Emirates 19 (0) 0 (0) Local transmission 1
Iraq 13 (5) 0 (0) Imported cases only 0

 

Oman 6 (0) 0 (0) Imported cases only 2
Pakistan 4 (2) 0 (0) Imported cases only 0
Lebanon 2 (0) 0 (0) Imported cases only 4
Afghanistan 1 (0) 0 (0) Imported cases only 6
Egypt 1 (0) 0 (0) Imported cases only 16
Qatar 1 (1) 0 (0) Imported cases only 0
Region of the Americas
United States of America 62 (0) 0 (0) Local transmission 1
Canada 19 (5) 0 (0) Local transmission 0
Brazil 2 (1) 0 (0) Imported cases only 0
Mexico 2 (0) 0 (0) Imported cases only 1
Ecuador 1 (1) 0 (0) Imported cases only 0
African Region
Algeria 1 (0) 0 (0) Imported cases only 5
Nigeria 1 (0) 0 (0) Imported cases only 2
Subtotal for all regions 6464 (1160) 98 (18)
International conveyance (Diamond Princess) ‡ 705 (0) 6 (0) Local transmission 4
Grand total§ 7169 (1160) 104 (18)

*Case classifications are based on WHO case definitions for COVID-19.

Transmission classification is based on WHO analysis of available official data and may be subject to reclassification as additional data become available. Countries/territories/areas experiencing multiple types of transmission are classified in the highest category for which there is evidence; they may be removed from a given category if interruption of transmission can be demonstrated. It should be noted that even within categories, different countries/territories/areas may have differing degrees of transmission as indicated by the differing numbers of cases and other factors. Not all locations within a given country/territory/area are equally affected.

Terms:

  • Community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through routine screening of sentinel
  • Local transmission indicates locations where the source of infection is within the reporting
  • Imported cases only indicates locations where all cases have been acquired outside the location of
  • Under investigation indicates locations where type of transmission has not been determined for any
  • Interrupted transmission indicates locations where interruption of transmission has been demonstrated (details to be determined)

‡Cases identified on a cruise ship currently in Japanese territorial waters.

  • 278 female/393 male/6498 unknown. 31 healthcare workers (7 female/12 male/ 12 unknown).
STRATEGIC OBJECTIVES

 

WHO’s strategic objectives for this response are to:

 

·       Interrupt human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread*;

·       Identify, isolate and care for patients early, including providing optimized care for infected patients;

·       Identify and reduce transmission from the animal source;

·       Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines;

·       Communicate critical risk and event information to all communities and counter misinformation;

·       Minimize social and economic impact through multisectoral partnerships.

 

*This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travelers, awareness-raising in the population and risk communication.

PREPAREDNESS AND RESPONSE

 

 

  • WHO is providing guidance on early investigations, which are critical to carry out early in an outbreak of a new virus. The data collected from the protocols can be used to refine recommendations for surveillance and case definitions, to characterize the key epidemiological transmission features of COVID-19, help understand spread, severity, spectrum of disease, impact on the community and to inform operational models for implementation of countermeasures such as case isolation, contact tracing and isolation. Several protocols are available here: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/early-investigations One such protocol is for the investigation of early COVID-19 cases and contacts (the “First Few X (FFX) Cases and contact investigation protocol for 2019-novel coronavirus (2019-nCoV) infection”). The protocol is designed to gain an early understanding of the key clinical, epidemiological and virological characteristics of the first cases of COVID-19 infection detected in any individual country, to inform the development and updating of public health guidance to manage cases and reduce the potential spread and impact of
Distribution of COVID-19 cases as of 1 March 2019
Distribution of COVID-19 cases as of 1 March 2019

RECOMMENDATIONS AND ADVICE FOR THE PUBLIC

 

If you are not in an area where COVID-19 is spreading, or have not travelled from an area where COVID-19 is spreading, or have not been in contact with an infected patient, your risk of infection is low. It is understandable that you may feel anxious about the outbreak. It’s a good idea to get the facts from reliable sources to help you accurately determine your risks so that you can take reasonable precautions (See Frequently Asked Questions). Seek guidance from WHO, your healthcare provider, your national public health authority or your employer for accurate information on COVID-19 and whether COVID-19 is circulating where you live. It is important to be informed of the situation and take appropriate measures to protect yourself and your family (see Protection measures for everyone).

 

If you are in an area where there are cases of COVID-19 you need to take the risk of infection seriously. Follow the advice of WHO and guidance issued by national and local health authorities. For most people, COVID-19 infection will cause mild illness however, it can make some people very ill and, in some people, it can be fatal. Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease (See Protection measures for persons who are in or have recently visited (past 14 days) areas where COVID-19 is spreading).

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