For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
May 20
COVID-19 Situation Report 111
Centre for Infectious Disease Epidemiology and Research (CIDER) For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
i. Background
In December, China notified the World Health Organization (WHO) of several cases of human respiratory illness, which appeared to be linked to an open seafood and livestock market in the city of Wuhan. The infecting agent has since been identified as a novel coronavirus, previously known as 2019-nCoV and now called SAR-CoV-2; The new name of the disease has also been termed COVID-19, as of 11th February 2020. Although the virus is presumed zoonotic in origin, person-to-person spread is evident. Screening of travellers, travel bans and quarantine measures are being implemented in many countries. Despite these precautions, it is anticipated that more cases will be seen both inside China and internationally. The WHO declared the outbreak of COVID-19 constitutes a Public Health Emergency of International Concern on 30 January. On 11 March, 2020, WHO declared the coronavirus outbreak a pandemic as the global death toll rose above 4,600 and the number of confirmed cases topped 125,000. This report aims to update Global Risk Assessment, Global Epidemiology, Quarantine Orders, Travel Ban/Advisory by countries, WHO’s and CDC’s Guidance and Protocols and Scientific publication on a daily basis. New updates in the tables are bolded.
1 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020 ii. Global Risk Assessment Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 20th May, 15:00 SG Time) Availability of Severity of Overall Environmental Risk Transmissibility Treatment/ Disease Risk Vaccination# Global (n=197 countries) High Moderate High Limited
Globally, 183 (92.9%) countries Estimated Case fatality Anti-viral drug Favilavir * (excluding territories ) have mean R0 for rate is was approved for reported the outbreak. COVID-19 is currently at treatment of COVID-19 Parts of China including Hubei around 3.28, 6.51% by National Medical have relaxed lock-down with a median globally. Products measures; As of 2 May, 30 of 2.79 and IQR Most cases Administration of China th provinces/cities in China have of 1.16 present as on 18 February 2020 de-escalated the COVID-19 flu-like [6]. The drug is also response level from level one to illness. tested for treatment in two or three (with level one Based on recent Japan [1]; being the most serious in the CDC data, four-tier, government response Actemra (Tocilizumab), median R0 is system). This leaves Hubei is now being used to province remaining at level one. estimated to be treat serious As of 8 April, China lifted its 76- 5.8 (95% CI 4.4– coronavirus patients day lockdown in Wuhan. 7.7), but the with lung damage in estimated mean China as of 4th March The latest data from the United time-varying 2020; Nations specialized agency for effective R0 in tourism shows that 100% of On April 10th, clinical 104 countries High destinations as of 20 April have improvement was restrictions in place. Of these, ranged from 0.6 observed in 68% of 83% have had COVID-19-related to 1.6. $ patients with severe restrictions in place already for illness, who were four or more weeks and, as of served Remdesivir as 20 April, so far no destination compassionate use [2]; has lifted them. This represents the most severe restriction on Anti-viral drug international travel in history [5] Remdesivir (by Gilead Sciences Inc.) was At least 112 countries approved by US Food worldwide have imposed and Drug lockdowns of varying scales; Administration for Singapore has extended its emergency use in circuit breaker until 1 Jun 2020.% COVID-19 patients with low blood-oxygen levels or who need breathing support [14] and by Japan under exceptional measures [15].
2 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Remdesivir will be licensed to five generic drug manufacturers, Cipla Ltd., Ferozsons Laboratories, Hetero Labs Ltd., Jubilant Lifesciences, and Mylan to make drug in 127 countries. [16] Western Pacific Region and South-East Asia Region (n=41 countries) High Moderate Moderate Limited
28 (68.3%) countries have South Korea Case fatality Anti-viral drug Favilavir reported outbreaks; (estimated Rt) - rate is 3.60%. was approved for 1.1 (90% CI: 0.5- treatment of COVID-19 34 countries have travel ban for 1.6) $ by National Medical China, 32 for Korea, 20 for Products Japan, 22 for Italy and 22 for India (estimated Administration of China
Iran. Rt) - 1.2 (90% on 18th February 2020. CI: 1.2-1.3) $. The drug is also tested At least 17 countries have as treatment in Japan imposed lockdowns (nationwide [3]; or state-specific) since the pandemic escalated, 7 of which Actemra (Tocilizumab), have reportedly extended their is now being used to restriction measures. treat serious coronavirus patients with lung damage in China as of 4th March 2020; High
Malaysia is using Tocilizumab while concurrently evaluating them in clinical trials for severe cases of Covid-19 [4].
Japan has approved the use of antiviral drug remdesivir against severe COVID-19 cases [15].
3 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
European Region (n=53 countries) High Moderate High Limited
52 (98.1%) countries have UK (estimated Case fatality UK has selected reported with outbreaks; Rt) – 1.1, 90% CI rate is 8.44%. Bemcentinib as the first (1.1, 1.2) $ drug to be tested and 36 countries have travel ban for will commence Phase II China, 36 for Korea, 36 for Spain clinical trial in 120 Japan, 24 for Italy and 38 for (estimated Rt) – Iran. 0.7 (90% CI: 0.6- subjects across 6 UK 0.8) $. NHS hospital trusts. At least 35 countries have imposed lockdowns (nationwide Germany Russia - favipiravir, has or state-specific) since the (estimated Rt) – produced promising pandemic escalated, 11 of which 0.9 (90% CI: 0.9- results in early clinical have reportedly extended their 1) $. trials in Russia restriction measures. Northern High Ireland (estimated Rt) – 0.8, Republic of Ireland – 0.5 (0.3-0.5)
As of 10th May, Re in England was reported between 0.5 - 0.9) and in Scotland estimated Re was between 0.7 – 1
Eastern Mediterranean Region (n=22 countries) High Moderate Moderate Limited
22 (100%) countries have Iran (estimated Case fatality An Israeli firm is using reported with outbreak; Rt) – 1 (90% CI: rate is 2.84%. placenta pluristem cells 0.9-1) $. to treat COVID-19 12 countries have travel ban for patients on a China, 10 for Korea, 8 for Japan, Iraq (estimated compassionate use 10 for Italy and 10 for Iran. Rt) – 1.4 (90% basis. [5] High CI: 1.1-1.6) $. At least 16 countries have The Oman Ministry of imposed lockdowns (nationwide Health approved or state-specific) since the hydroxychloroquine for pandemic escalated, 5 of which therapeutic use in have reportedly extended their COVID-19 treatment. restriction measures. This comes as studies document conflicting
4 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
results of hydroxychloroquine efficacy. [6]
Region of the Americas (n=35 countries) High Moderate Moderate Limited
35 (100%) countries have Global median Case fatality Costa Rica is currently reported with outbreak; R0 is estimated rate is 5.92%. also using hydroxyl- to be 5.8 (95% chloroquine to treat 14 countries have travel ban for COVID-19 patients [7]; CI 4.4–7.7). China, 13 for Korea, 11 for Japan, 14 for Italy and 14 for United States Anti-viral drug Iran. Remdesivir (by Gilead (estimated Rt) – Sciences Inc.) was High At least 17 countries have 1.1 (90% CI: 1.1- approved by US Food imposed lockdowns (nationwide 1.1) $. and Drug or state-specific) since the Administration for pandemic escalated, 6 of which emergency use in have reportedly extended their COVID-19 patients with restriction measures. low blood-oxygen levels or who need breathing support [14].
African Region (n=46 countries) High Moderate Moderate Absent
46 (100%) countries have Global median Case fatality reported with outbreak; R0 is estimated rate is 2.86%. to be 5.8 (95% 8 countries have travel ban for CI 4.4–7.7) $. China, 11 for Korea, 7 for Japan, 10 for Italy and 9 for Iran. Nigeria
(estimated Rt) – High At least 24 countries have imposed lockdowns (nationwide 1.5 (90% CI: 1.3- or state-specific) since the 1.6) $. pandemic escalated, 7 of which have reportedly extended their Ghana restriction measures. (estimated Rt) – 1.3 (90% CI: 1.1- 1.4) $.
*Only WHO member states are included. 30 territories that have reported cases (with the exception of Palestine) are excluded from the tabulation of total countries affected/imported/local cases and case fatality rate. Refer to WHO situation reports or table 4 for information. **The travel ban consists of both certain areas of China, Japan, Korea, Italy and Iran or the whole country #Ongoing clinical trials of vaccines and treatment are summarised in a separate section in this report. %This is by no means an exhaustive list of lockdowns imposed globally. Tally is subjected to publication bias whereby certain countries may receive less media attention and hence, coverage on their lockdowns. Lockdowns of varying scales are imposed across nations, for this compilation, all countries that have imposed some form of movement restriction, nationwide or state-specific are included. $ https://epiforecasts.io/covid/posts/global/, as of 5 May 2020
5 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
iii. Global Epidemiology Table 2. Summary of COVID-19 cases & fatalities globally (Updated as of 20 May, 15:00 SG Time) Case- No. of Total Cases Case- Total Fatality Countries/ Outside Total Fatality Global Rate (%) R0 Territories Mainland Deaths Rate (%) Cases [outside with Cases China [overall] China]
213 4989280 4906315 324970 6.51% 6.53% 5.8 (95% CI 4.4–7.7)^
^Based on early release as of 10th April, 2020: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
Table 3. Comparison with other viruses Virus Incubation Period (Days) Case Fatality Rate (%) R0 Median = 5.1$ SARS-CoV-2 6.51 5.8 (95% CI 4.4–7.7) ^ (2-14) or up to 24* SARS-CoV 2-7 9.6 2.0 <1 (higher in health MERS-CoV 5 (2-14) 34 care setting) Swine Flu 1-4 0.02 1.2-1.6 *Data on 1099 patients from 552 hospitals in 31 provinces of China ^https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article $Data on 181 cases outside china
Figure 1. Growth Factor of Daily New Cases (Mainland China+ Other countries)
Growth Factor = every day’s cases/cases on previous day. A growth factor above 1 indicates an increase, whereas one between 0 and 1 it is a sign of decline, with the quantity eventually becoming zero. A growth factor below 1 (or above 1 but trending downward) is a positive sign, whereas a growth factor constantly above 1 is the sign of exponential growth. *Huge jump in cases on Feb. 12 is attributed to the change in diagnostic criteria in China.
6 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Figure 2. Growth Factor excluding mainland China
Figure 3. Growth Factor of Novel Coronavirus Daily Deaths (Mainland China + Other Countries)
Growth Factor = every day’s cases/cases on previous day. A growth factor above 1 indicates an increase, whereas one between 0 and 1 it is a sign of decline, with the quantity eventually becoming zero. A growth factor below 1 (or above 1 but trending downward) is a positive sign, whereas a growth factor constantly above 1 is the sign of exponential growth. Source: https://www.worldometers.info/coronavirus/coronavirus-cases/
7 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Case Breakdown by Countries Live update of COVID-19 global cases can be seen at https://storymaps.arcgis.com/stories/a1746ada9bff48c09ef76e5a788b5910
Table 4. Breakdown of COVID-19 confirmed cases and deaths (Updated as of 20 May, 15:00 SG Time)
Country Total Cases Change Total Change Total Region Deaths Recovered 1 USA 1,570,583 +20289 93533 +1552 361180 Americas 2 Russia 299,941 +9263 2837 +115 76130 EURO 3 Spain 278,803 +615 27778 +69 196958 EURO 4 Brazil 271,885 +16517 17983 +1130 106794 Americas 5 UK 248,818 +2412 35341 +545 N/A EURO 6 Italy 226,699 +813 32169 +162 129401 EURO 7 France 180,809 +882 28022 -217 62563 EURO 8 Germany 177,827 +538 8193 +70 156900 EURO 9 Turkey 151,615 +1022 4199 +28 112895 EURO 10 Iran 124,603 +2111 7119 +62 97173 EMRO 11 India 106,886 +5625 3303 +139 42309 SEARO 12 Peru 99,483 +4550 2914 +125 36524 Americas 13 China 82,965 +5 4634 0 78244 WPRO 14 Canada 79,112 +1040 5912 +70 40050 Americas 15 Saudi Arabia 59,854 +2509 329 +9 31634 EMRO 16 Belgium 55,791 +232 9108 +28 14687 EURO 17 Mexico 54,346 +2713 5666 +334 37325 Americas 18 Chile 49,579 +3520 509 +31 21507 Americas 19 Pakistan 45,898 +1932 985 +46 13101 EMRO 20 Netherlands 44,249 +108 5715 +21 N/A EURO 21 Qatar 35,606 +1637 15 0 5634 EMRO 22 Ecuador 34,151 +569 2839 +40 3457 Americas 23 Belarus 31,508 +936 175 +4 10620 EURO 24 Sweden 30,799 +422 3743 +45 4971 EURO 25 Switzerland 30,618 +21 1891 +5 27700 EURO 26 Portugal 29,432 +223 1247 +16 6431 EURO 27 Singapore 28,794 0 22 0 10365 WPRO 28 Bangladesh 25,121 +1251 370 +21 4993 SEARO 29 UAE 25,063 +873 227 +3 10791 EMRO 30 Ireland 24,251 +51 1561 +14 19470 EURO 31 Poland 19,268 +383 948 +12 7903 EURO 32 Ukraine 18,876 +260 548 +13 5632 EURO 33 Indonesia 18,496 +486 1221 +30 4467 SEARO 34 South Africa 17,200 +767 312 +26 7960 Africa 35 Romania 17,191 +155 1141 +21 10166 EURO
8 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
36 Colombia 16,935 +640 613 +21 4050 Americas 37 Kuwait 16,764 +1073 121 +3 4681 EMRO 38 Israel 16,659 +16 278 +2 13435 EURO 39 Japan 16,367 +62 768 +19 11564 WPRO 40 Austria 16,321 +52 632 +3 14678 EURO 41 Egypt 13,484 +720 659 +14 3742 EMRO 42 Dominican Republic 13,223 +498 441 +7 6613 Americas 43 Philippines 12,942 +224 837 +6 2843 WPRO 44 S. Korea 11,110 +32 263 0 10066 WPRO 45 Denmark 11,044 +76 551 +3 9416 EURO 46 Serbia 10,733 +34 234 +3 4904 EURO 47 Panama 9,867 +141 281 +2 6194 Americas 48 Argentina 8,809 +438 393 +11 2872 Americas 49 Czechia 8,647 +61 302 +5 5726 EURO 50 Norway 8,267 +10 233 0 32 EURO 51 Afghanistan 7,653 +581 178 +5 850 EMRO 52 Bahrain 7,532 +348 12 0 2952 EMRO 53 Algeria 7,377 +176 561 +6 3746 Africa 54 Australia 7,079 +11 100 0 6442 WPRO 55 Morocco 7,023 +71 193 +1 3901 EMRO 56 Malaysia 6,978 +37 114 +1 5646 WPRO 57 Kazakhstan 6,969 +218 35 0 3598 EURO 58 Nigeria 6,401 +226 192 +1 1734 Africa 59 Finland 6,399 +19 301 +1 5000 EURO 60 Moldova 6,340 +202 221 +4 2508 EURO 61 Ghana 6,096 +361 31 +2 1773 Africa 62 Oman 5,671 +292 27 +2 1574 EMRO 63 Armenia 5,041 0 64 0 2164 EURO 64 Bolivia 4,481 +218 189 +15 533 Americas 65 Luxembourg 3,958 +11 109 +2 3718 EURO 66 Iraq 3,611 +57 131 +4 2366 EMRO 67 Hungary 3,598 +42 470 +3 1454 EURO 68 Cameroon 3,529 0 140 0 1567 Africa 69 Azerbaijan 3,518 +131 41 +1 2198 EURO 70 Thailand 3,034 +1 56 0 2888 SEARO 71 Honduras 2,955 +157 147 +1 349 Americas 72 Uzbekistan 2,880 +78 13 0 2338 EURO 73 Guinea 2,863 +67 18 +2 1525 Africa 74 Greece 2,840 +4 165 0 1374 EURO 75 Sudan 2,728 +137 111 +6 286 EMRO 76 Senegal 2,617 +73 30 +4 1133 Africa 77 Bosnia and 2,321 +17 134 +1 1522 EURO Herzegovina
9 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
78 Bulgaria 2,292 +33 116 +4 684 EURO 79 Croatia 2,232 +4 96 +1 1967 EURO 80 Ivory Coast 2,153 +34 28 0 1050 Africa 81 Guatemala 2,133 +132 43 +5 155 Americas 82 Tajikistan 1,936 +207 41 0 641 EURO 83 Cuba 1,887 +6 79 0 1538 Americas 84 North Macedonia 1,839 +22 106 +2 1351 EURO 85 Iceland 1,802 0 10 0 1789 EURO 86 Estonia 1,791 +7 64 0 938 EURO 87 DRC 1,731 +193 61 0 302 Africa 88 Djibouti 1,618 +100 7 0 1033 EMRO 89 El Salvador 1,571 +73 31 +1 531 Americas 90 Lithuania 1,562 +15 60 +1 1025 EURO 91 New Zealand 1503 0 21 0 1447 WPRO 92 Somalia 1502 +47 59 +2 178 EMRO 93 Gabon 1502 +70 12 +1 318 Africa 94 Slovakia 1495 0 28 0 1192 EURO 95 Slovenia 1467 +1 104 0 1338 EURO 96 Mayotte 1370 0 18 0 627 Non 97 Kyrgyzstan 1270 +27 14 0 910 EURO 98 Maldives 1143 +37 4 0 91 SEARO 99 Hong Kong 1056 0 4 0 1025 WPRO 100 Tunisia 1044 +1 47 +1 826 EMRO 101 Guinea-Bissau 1038 +6 6 +2 42 Africa 102 Sri Lanka 1027 +35 9 0 569 SEARO 103 Latvia 1016 +7 21 +2 694 EURO 104 Kenya 963 +51 50 0 358 Africa 105 Lebanon 954 +23 26 0 251 EMRO 106 Albania 949 +1 31 0 742 EURO 107 Cyprus 918 +1 17 0 516 EURO 108 Niger 914 +5 55 0 734 Africa 109 Mali 901 +27 53 +1 529 Africa 110 Costa Rica 882 +16 10 0 577 Americas 111 Paraguay 829 +41 11 0 230 Americas 112 Equatorial Guinea 825 +106 7 0 22 Africa 113 Burkina Faso 796 0 51 0 652 Africa 114 Zambia 772 +11 7 0 192 Africa 115 Andorra 761 0 51 0 628 EURO 116 Venezuela 749 +131 10 0 253 Americas 117 Uruguay 738 +1 20 0 579 Americas 118 Georgia 713 +11 12 0 475 EURO 119 Diamond Princess 712 0 13 0 651 NA
10 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
120 San Marino 655 +1 41 0 211 EURO 121 Jordan 649 +20 9 0 417 EMRO 122 Haiti 596 +63 22 +1 21 Americas 123 Malta 569 +11 6 0 460 EURO 124 Channel Islands 555 0 44 +1 479 Non 125 Chad 545 +26 56 +3 139 Africa 126 Sierra Leone 534 +15 33 0 167 Africa 127 Jamaica 520 0 9 0 145 Americas 128 Tanzania 509 0 21 0 183 Africa 129 Réunion 446 0 0 0 354 Non 130 Taiwan 440 0 7 0 402 WPRO 131 Congo 420 +8 15 0 132 Africa 132 Nepal 402 +27 2 0 37 SEARO 133 Palestine 391 +3 2 0 346 EMRO 134 CAR 366 +39 0 0 18 Africa 135 Ethiopia 365 +13 5 0 120 Africa 136 Togo 338 +8 12 0 107 Africa 137 Isle of Man 335 0 24 0 300 Non 138 Cabo Verde 335 +7 3 0 85 Africa 139 Mauritius 332 0 10 0 322 Africa 140 Madagascar 326 +4 2 +1 119 Africa 141 Montenegro 324 0 9 0 312 EURO 142 Vietnam 324 0 0 0 263 WPRO 143 Rwanda 308 +11 0 0 209 Africa 144 South Sudan 290 0 4 0 4 Africa 145 Uganda 260 +12 0 0 63 Africa 146 Nicaragua 254 +229 17 +9 199 Americas 147 Sao Tome and 251 +5 8 +1 4 Africa Principe 148 Liberia 233 +4 23 +1 125 Africa 149 French Guiana 218 +8 1 0 136 Non 150 Eswatini 208 +3 2 0 87 Non 151 Myanmar 193 +2 6 0 104 SEARO 152 Martinique 192 0 14 0 91 Non 153 Faeroe Islands 187 0 0 0 187 Non 154 Yemen 167 +37 28 +8 5 EMRO 155 Guadeloupe 155 0 13 0 109 Non 156 Gibraltar 147 0 0 0 145 Non 157 Mozambique 146 +1 0 0 44 Africa 158 Brunei 141 0 1 0 136 WPRO 159 Mongolia 140 0 0 0 26 WPRO 160 Mauritania 131 +50 4 0 7 Africa
11 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
161 Benin 130 -209 2 0 83 Africa 162 Guyana 125 +1 10 0 46 Americas 163 Bermuda 125 0 9 0 78 Non 164 Cambodia 122 0 0 0 122 WPRO 165 Trinidad and Tobago 116 0 8 0 107 Americas 166 Cayman Islands 111 +17 1 0 55 Non 167 Aruba 101 0 3 0 93 Non 168 Monaco 97 0 4 0 87 EURO 169 Bahamas 96 0 11 0 43 Americas 170 Barbados 90 +2 7 0 68 Americas 171 Liechtenstein 82 0 1 0 55 Non 172 Sint Maarten 77 0 15 0 54 Non 173 Malawi 70 0 3 0 27 Africa 174 Libya 68 +3 3 0 35 EMRO 175 French Polynesia 60 0 0 0 60 Non 176 Syria 58 0 3 0 36 EMRO 177 Angola 52 +2 3 0 17 Africa 178 Zimbabwe 46 0 4 0 18 Africa 179 Macao 45 0 0 0 45 WPRO 180 Burundi 42 0 1 0 20 Africa 181 Saint Martin 39 0 3 0 30 Non 182 Eritrea 39 0 0 0 39 Africa 183 Antigua and Barbuda 25 0 3 0 19 Americas 184 Botswana 25 0 1 0 17 Africa 185 Gambia 24 0 1 0 13 Africa 186 Timor-Leste 24 0 0 0 24 SEARO 187 Grenada 22 0 0 0 14 Americas 188 Bhutan 21 0 0 0 5 SEARO 189 Laos 19 0 0 0 14 WPRO 190 Belize 18 0 2 0 16 Americas 191 Fiji 18 0 0 0 15 WPRO 192 New Caledonia 18 0 0 0 18 Non 193 Saint Lucia 18 0 0 0 18 Americas 194 St. Vincent 17 0 0 0 14 Americas Grenadines 195 Curaçao 16 0 1 0 14 Non 196 Dominica 16 0 0 0 16 Americas 197 Namibia 16 0 0 0 13 Africa 198 Saint Kitts and Nevis 15 0 0 0 15 Americas 199 Falkland Islands 13 0 0 0 13 Non 200 Turks and Caicos 12 0 1 0 10 Non 201 Vatican City 12 0 0 0 2 Non
12 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
202 Comoros 11 0 1 0 3 Africa 203 Montserrat 11 0 1 0 10 Non 204 Suriname 11 0 1 0 9 Americas 205 Greenland 11 0 0 0 11 Non 206 Seychelles 11 0 0 0 11 Africa 207 MS Zaandam 9 0 2 0 0 NA 208 British Virgin Islands 8 0 1 0 6 Non 209 Papua New Guinea 8 0 0 0 8 WPRO 210 Caribbean 6 0 0 0 6 Non Netherlands 211 St. Barth 6 0 0 0 6 Non 212 Western Sahara 6 0 0 0 6 Non 213 Anguilla 3 0 0 0 3 Non 214 Lesotho 1 0 0 0 0 Africa 215 Saint Pierre Miquelon 1 0 0 0 1 Non Total 4,989,280 +94247 324,970 +4778 1,959,928
Figure 4. Areas with reported confirmed cases of COVID-19, 13th – 19th May 2020
Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
13 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Table 5. COVID-19 cases and deaths reported by provinces in China (Updated as of 20th May, 15:30 SG Time)
Area Existing Change from Total Deaths Change from Recovered Active Cases previous day Diagnosed previous day (Active cases) Cases (Deaths) Jilin 25 -1 152 2 0 125 Inner Mongolia 20 +1 217 1 0 196 Shanghai 15 -3 667 7 0 645 Hubei 7 0 68135 4512 0 63616 Beijing 6 0 593 9 0 578 Guangdong 3 0 1590 8 0 1579 Liaoning 3 0 149 2 0 144 Shaanxi 2 0 308 3 0 303 Tianjin 2 0 192 3 0 187 Shandong 1 0 788 7 0 780 Hainan 1 0 169 6 0 162 Henan 0 0 1276 22 0 1254 Zhejiang 0 0 1268 1 0 1267 Hunan 0 0 1019 4 0 1015 Anhui 0 0 991 6 0 985 Heilongjiang 0 0 945 13 0 932 Jiangxi 0 0 937 1 0 936 Jiangsu 0 0 653 0 0 653 Chongqing 0 0 579 6 0 573 Sichuan 0 0 561 3 0 558 Fujian 0 0 356 1 0 355 Hebei 0 0 328 6 0 322 Guangxi 0 0 254 2 0 252 Shanxi 0 0 198 0 0 198 Yunnan 0 0 185 2 0 183 Guizhou 0 0 147 2 0 145 Gansu 0 0 139 2 0 137 Xinjiang 0 0 76 3 0 73 Ningxia 0 0 75 0 0 75 Qinghai 0 0 18 0 0 18 Tibet 0 0 1 0 0 1
Source: https://ncov.dxy.cn/ncovh5/view/pneumonia
14 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Table 6. COVID-19 cases by states/provinces/cities/territories of each country Country Areas affected 1 Afghanistan Herat, Kabul, Samangan, Kandahar 2 Albania Durrës, Fier, Elbasan, Gjirokastër 3 Algeria Alger, Blida, Tizi Ouzou 4 Andorra Andorra la Vella 5 Argentina Buenos Aires, Cordoba, Capital Federal, Chaco, Santa Fe 6 Armenia Erevan, Ararat, Kotayk’ Queensland, Victoria, New South Wales, South Australia, Western 7 Australia Australia, Tasmania, Jarvis Bay Territory Wien, Niederosterreich, Steiermark, Salzburg, Tyrol, Vorarlberg, 8 Austria Burgenland, Karnten, Obersterreich 9 Bahrain Al Manamah 10 Bangladesh Dhaka Minsk, Horad Minsk, Vitsyebskaya, Mahilyowskaya, Homyel’ Voblasc’, 11 Belarus Brestskaya, Hrodzenskaya 12 Belgium Brussels, Vlaamse Gewest, Wallonne 13 Bhutan Thimphu 14 Bolivia Oruro, Santa Cruz Bosnia and 15 Republika Srpska, Federacija Bosna i Hercegovina Herzegovina São Paulo, Rio de Janeiro, Bahia, Espirito Santo, Paraná, Goiás, Rio Grande do Sul, Minas Gerais, Pernambuco, Santa Catarina, Ceará, Amazonas, Rio 16 Brazil Grande do Norte, Maranhão, Parã, Goiãs, Amapã, Paraíba, Alagoas, Roraima, Acre, Sergipe, Piauí, Rondônia, Tocantins, Mato Grosso 17 Brunei Tutong 18 Bulgaria Sofija, Gabrovo, Pleven, Shumen, Kyustendil 19 Burkina Faso Centre-Ouest Kampong Chaam, Krong Preah Sihanouk, Phnom Penh, Banteay Mean 20 Cambodia Chey 21 Cameroon Centre, Littoral Ontario, British Columbia, Quebec, Alberta, Manitoba, New Brunswick, 22 Canada Saskatchewan, Newfoundland and Labrador, Nova Scotia Valparaíso, Santiago Metropolitan Region, Biobío, Araucania, Los Lagos, 23 Chile Magallanes, Libertador General Bernardo O'Higgins, Maule, Antofagasta 24 China See Table 4 Bogotá (Distrito Capital), Antioquia, Bolivar, Cundinamarca, Valle del 25 Colombia Cauca, Meta, Atlántico 26 Congo DRC Kinshasa 27 Costa Rica Limon, San Jose, Heredia, Alajuela Grad Zagreb, Primorsko-goranska, Istarska, Varazdinska, Osjecko- 28 Croatia baranjska, Splitsko-dalmatinska 29 Cuba Sancti Spíritus, La Habana, Isla de la Juventud 30 Cyprus Lemesos, Larnaka Praha, Olomoucky, Ustecky, Jihočeský, Stredocesky, Plzensky, Czech 31 Kralovehradecky, Vysocina, Pardubicky, Moravskoslezský, Jihomoravský, Republic Zlínský, Karlovarskym, Liberecky
15 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
32 Denmark Sjaelland, Hovedstaden, Midtylland, Faroe Islands Dominican 33 Monte Plata, Distrito Nacional, Santiago, Santo Domingo, Duarte, La vega Republic 34 Ecuador Orellana, Guayas, Los Ríos, Pichincha, Azuay, Manabí, El Oro, Santa Elena 35 Egypt Al Uqsur, Al Qahirah 36 El Salvador San Salvador 37 Estonia Harjumaa, Saaremaa, Virumaa, Pärnumaa, Tartumaa, Ida-Virumaa Rovaniemi, Uusimaa, Lappi, Varsinais-Suomi, Pirkanmaa, Kanta-Hame, 38 Finland Pohjois-Karjala, Keski-Pohjanmaa, Pohjois-Savo, Pohjois-Pohjanmaa, Satakunta, Etelä-Pohjanmaa, Kainuu, Pirkanmaa Bordeaux, Ile-de-France, Rhone-Alpes, Aquitaine, Bourgogne, Bretagne, Cote d’Azur, Nord-Pas-de-Calais, Centre, Hauts-de-France, Grand Est, 39 France Occitanie, Normandie, Rhone-Alpes, Corse, Pays de la Loire, French Guiana, Martinique, Saint Martin, Réunion, French Polynesia, Guadeloupe, Mayotte 40 Gabon Estuaire 41 Georgia T’bilisi Bavaria, Munich, Hessen, Bayern, North Rhine-Westphalia, Baden- Wurttemberg, Rheinland-Pflaz, Hamburg, Schleswig-Holstein, Bremen, 42 Germany Niedersachsen, Thuringen, Berlin, Saxony, Brandenburg, Saarland, Sachsen-Anhalt, Mecklenburg-Vorpommern 43 Ghana Ashanti, Greater Accra 44 Greece Attiki, Kentriki Makedonia, Dytiki Ellada, Peloponnisos, Attiki 45 Guatemala Guatemala 46 Guinea Conakry 47 Guinea-Bissau Bissau 48 Guyana Cuyuni-Mazaruni 49 Honduras Cortés, Francisco Morazan, Colon, Atlantida To Kwa Wan, Kowloon, Lam Tin, Tsuen Wan New Town, Tsing Yi, 50 Hong Kong Aberdeen 51 Hungary Budapest, Pest 52 Iceland Reykjavik, Hofuoborgarsvaei utan Reykjavikur, Suðurland Kerala, Delhi, Punjab, Haryana, Bihar, Maharastra, Telangana, Karnataka, 53 India Rajasthan, Uttar Pradesh, Jammu and Kashmir, Lakshadweep, Gujarat, Tamil Nadu, Madhya Pradesh, Andhra Pradesh, West Bengal, Haryana Jakarta, Jawa Barat (west), Banten, Jawa Timur (east), Jawa Tengah, Jawa 54 Indonesia Tengah (central), Sulawesi Selatan (south) Qom, Arak, Tehran, Gilan, Markazi, Tonekabon, Lorestan, Kermanshah, Khuzestan, Mazandaran, Sistan va Baluchestan, Hormozgan, Kohkiluyeh and Buyer Ahmad, Semnan, Ardabil, Kordestan, Azarbayjan-e-sharqi, Hamadan, Qazvin, Alborz, Fars, Golestan, Khorasan-e Razavi, Khorasan-e 55 Iran Janubi, Azarbayjan-e-Gharbi, Esfahan, Markazi, Kerman, Zanjan, Yazd, Ilam, Kerman, Chahar Mahall va Bakhtiari, Khorasan-e Shemali, Bushehr, Azarbayjan-e-Sharqi (east), Azarbayjan-e-Gharbi (west), Khorasan-e Shemali (north), Hamadan, At Ta’mim, An Najaf, Baghdad, Babil, As Sulaymaniyah, Maysan, Wasit, 56 Iraq Karbala, Arbil, Al Anbar, Al Basrah 57 Ireland Leinster, Connaught, Munster, Ulster (north)
16 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
58 Israel Tel Aviv, HaMerkaz, HaZafon, HaDarom, Palestine, Yerushalayim, Hefa Rome, Padua, Lombardy, Veneto, Venice, Emilia-Romagna, Piedmont, Lazio, Tuscany, Sicily, Liguria, Autonomous Province of Balzano, Marche, 59 Italy Campania, Abruzzo, Alto Adige, Puglia, Umbria, Calabria, Friulia-Venzia Giulia, Basilicata, Sardegna, Trento & Bolzano, Valle d'Aosta, Molise 60 Jamaica Kingston Kanagawa, Chiba, Osaka, Nara, Mie, Kyoto, Yokohama, Tokyo, Aichi (Nagoya), Hokkaido, Okinawa, Saitama, Wakayama, Sapporo, Ishikawa, 61 Japan Hukuoka, Tokushima, Gifu, Fukuoka, Kumamoto, Nagano, Tochigi, Miyagi, Hyogo, Koti, Sizuoka, Ehime, Niigata, Gunma, Yamaguti, Akita, Yamanasi, Hukui, Kyoto 62 Jordan Ma’an 63 Kazakhstan Almaty, Astana 64 Kenya Nairobi City 65 Kuwait Al Ahmadi 66 Kyrgyzstan Bishkek 67 Latvia Riga 68 Lebanon Liban-Nord, Mont-Liban 69 Liechtenstein Triesenberg 70 Lithuania Siauliu, Vilniaus, Kauno, Klaipedos 71 Luxembourg Luxembourg 72 Macau Lotus Bridge, Barrier Gate checkpoint Johor, Kedah, Langkawi, Sarawak, Selangor, Negeri Sembilan, Kuala 73 Malaysia Lumpur, Kelantan, Sabah, Penang, Melaka, Pahang, Perak, Perlis, Terengganu 74 Malta Malta 75 Mauritius Mauritius 76 Maldives Uthuru 77 Mali Kayes Distrito Federal, Sinaloa, Chiapas, Coahuila, Jalisco, Nuevo León, Puebla, 78 Mexico Baja California, Sinaloa, Quintana Roo, Tabasco, Veracruz, Chihuahua, Morelos, Yucatán 79 Moldova Chisinau, Lapusna, Soroca, Cahul 80 Montenegro Montenegro 81 Monaco Monaco Grand Casablanca, Marrakech-Tensift-Al Haouz, Rabat-Salé-Zemmour- 82 Morocco Zaer, Laâyoune-Boujdour-Sakia El Hamra, Fès-Boulemane, Tangier- Tetouan 83 Nepal Bagmati Gelderland, Noord-Holland, Noord-Brabant, Zuid-Holland, Utrecht, South- 84 Netherlands Holland, Limburg, Drenthe, Overijssel, Overijssel, Friesland, Flevoland, Groningen, Zeeland 85 New Zealand Auckland, Wellington, Marlborough, Southland, Waikato, Cantebury North 86 Centar, Centar Zupa, Sopiste Macedonia 87 Niger Niamey, Tahoua, Tillabéri
17 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Lagos, Kano, FCT, Borno, Gombe, Katsine, Bauchi, Ogun, Kaduna, Sokoto, Jigawa, Edo, Zamfara, Oyo, Osun, Kwara, Kebbi, Akwa Ibom, Delta, Rivers, 88 Nigeria Adamawa, Taraba, Ondo, Yobe, Ekiti, Nasarawa, Enugu, Niger, Bayelsa, Ebonyi, Plateau, Abia, Benue, Imo, Anambra North 89 Centar, Sopiste, Debar, Kumanovo Macedonia Birgen, Trondelag, Troms, Oslo, Akershus, Hordaland, Aust, Agder, 90 Norway Rogaland, Finnmark, Vestfold og Telemark , Viken, Vestland, Innlandet, More og Romsdal, Nordland, Troms 91 Oman Masqat Karachi, Islamabad, Sind, Punjab, Federally Administered Tribal Areas, 92 Pakistan North-West Frontier, Northern Areas 93 Paraguay Asunción Lima, Huenuco, Loreto, El Callao, Lambayeque, Piura, Ancash, La Libertad, 94 Peru Ucayali, Arequipa, Ica, 95 Philippines Manila, Cavite, Bataan Lubuskie, Slaskie, Dolnoslaskie, Lubelskie, Mazowieckie, Wielkopolskie, Warminsko-mazurskie, Podkarpackie, Zachodniopomorskie, Lodz, 96 Poland Opolskie, Malopolskie, Kujawsko-pomorskie, Zachodniopomorskie, Podlaskie 97 Portugal Porto, Viseu, Lisboa, Coimbra, Faro, Castelo Branco, Beja 98 Qatar Ad Daw ah Gorj, Maramures, Timis, Bucuresti, Hunedoara, Iasi, Arad, Constanta, 99 Romania Covasna, Moskovskaya, Brasov, Ilfov, Arges, Suceava, Brasov, Constanta, Arad, Neamt, Cluj, Hunedoara, Timis, Mures, Galati, Botosani, Bihor Zabaikalsky, Tyumen (Tyumenskaya), Buryatiya, Moskva, Lipetskaya, Sankt-Peterburg, Komi, Nizhegorodskaya, Krasnodyarskiy, Leningradskaya, Murmanskaya, Dagestan, Bryanskaya, Bashkortostan, Tul'skaya, Rostovskaya, Ingushskaya, Ryazanskaya, Mordoviya, Tverskaya, Tatarstan, Mariy El, Kaluzhskaya, Chechenskaya, Vladimirskaya, Stavropol'skiy, Khabarovskiy, Chuvashskaya, Kurskaya, Sverdlovskaya, 100 Russia Severnaya Osetiya, Tambovskaya, Yaroslavskaya, Kabardino-Balkarskaya, Yamalo-Nenentskiy, Chelyabinskaya, Orlovskaya, Novosibirskaya, Saratovskaya, Orenburgskaya, Voronezhskaya, Permskiy, Kirovskaya, Primorskiy, Lipetskaya, Samarskaya, Volgogradskaya, Penzenskaya, Kaliningradskaya, Altay, Ul'yanovskaya, Astrakhanskaya, Smolenskaya, Belgorodskaya, Ivanovskaya, Khanty-Mansiyskiy, Karachayevo- Cherkesskaya, Sakha, Kalmykiya, Arkhangel'skaya 101 Rwanda Ville de Kigali 102 San Marino San Marino 103 Saudi Arabia Ar Riyad Vojvodina, Beograd, Raska, Toplica, Zajecar, Zlatibor, Kolubara, Nisava, 104 Serbia Pomoravlje, Jablanica 105 Senegal Dakar Bratislavsky kraj, Zilinsky kraj, Kosicky kraj, Trenciansky kraj, Nitriansky 106 Slovakia kraj, Presovsky kraj Ljubljana, Murska Sobota, Postojna, Metlika, Novo Mesto, Celje, Maribor, 107 Slovenia Koper 108 South Africa Gauteng, KwaZulu-Natal, Western Cape, Eastern Cape
18 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Cities: Incheon, Seoul, Gwangju, Daegu, Jeju, Cheongdo, Busan, Daejeon, Ulsan; Provinces: Hyeongbuk, Kyeongnam, Chungnam, Gyeonggu, 109 S. Korea Jeonbuk, Gyeongnam, Gyeonggido, Gyeongbuk, Gangwon, Jeolla-nam, Jeolla-buk, Sejoing, Chungbuk Yong Thai Hang medicinal shop, The Life Church and Missions Singapore, 110 Singapore Grand Hyatt Singapore, Seletar Aerospace Heights, Assembly of God church, Wizlearn Technologies, SAFRA Jurong La Gomera, Illes Balears, Tenerife, Barcelona, Valencia, Madrid, Catalunya, Catalonia, Canaries, Castilla y Leon, Andalucia, Aragon, 111 Spain Basnahira, Pais Vasco, Extremadura, Asturias, Navarra, La Rioja, Galicia, Basque Country, Castilla-La Mancha, Murcia, Cantabria, Melilla, Ceuta 112 Sri Lanka Colombo, Basnahira 113 Sudan Jonkopings, Vastra Gotalands, Stockholms, Uppsala, Skane, Varmlands, Östergötland, Södermanland, Kronobergs, Västernorrland, Jamtlands, 114 Sweden Orebro, Västerbotten, Blekinge, Norrbottens, Gavleborgs, Vastmanlands, Dalarnas, Dalarnas, Gotlands, Hallands, Gavleborgs Graubunden, Geneve, Ticino, Aargau, Basel-Stadt, Vaud, Zurich, Basel- Landschaft, Bern, Fribourg, Valais, Schwyz, Neuchatel, Sankt Gallen, Zug, 115 Switzerland Luzern, Jura, Solothurn, Nidwalden, Appenzell Ausserrhoden, Glarus, Obwalden, Thurgau, Uri Taipei, Changhua, Kaohsiung, Nantou, Taoyuan, Yilan, New Taipei, Tainan, 116 Taiwan Taichung 117 Tajikistan Region of Republican Subordination Bangkok, Rayong, Sattahip, Nakhon Pathom and Samitivej hospitals, 118 Thailand Chiang mai, Krung Thep Maha Nakhon, Nonthaburi, Chon Buri, Ratchaburi, Chai Nat, Phuket 119 Timor-Leste Timor-Leste Trinidad and 120 Trinidad Tobago 121 Tunisia Tunis, Bizerte, Siliana, La Manouba Ankara, Istanbul, Konya, Kocaeli, Isparta, Sakarya, Adana, Bursa, Samsun, 122 Turkey Zonguldak, Kayseri, Antalya, Izmir, Tekirda, Eskiehir, Yalova, Balikesir, Manisa 123 U.A.E. Dubai, Abu Dhabi England, Gibraltar, Northern Ireland, Scotland and Wales, Jersey, Isle of 124 U.K. Man Chernihivska, Kyivs'ka, Kyiv, Ternopil's'ka, Ivano-Frankivsk, Vinnyts’ka, 125 Ukraine Rivnens'ka, Dnipropetrovs'ka, L'vivs'ka, Odes'ka, Zakarpats'ka, Kharkivs'ka 126 Uruguay Montevideo, Canelones Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa , Kansas, Kentucky, Maryland, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New 127 USA Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, Wyoming, Vermont, Virginia, District of Columbia, Hawaii, Puerto Rico, US military, *Navajo Nation, Federal Prisions
19 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
128 Uruguay Maldonado 129 Uzbekistan Toshkent, Buxoro 130 Venezuela Miranda, Distrito Federal Ho Chi Minh City, Hanoi, Vinh Phuc, Thanh Hoa, Nha Trang, Khanh Hoa, 131 Vietnam Quang Nam, Quang Ninh, Da Nang, Lai Chau, Lao Cai, Binh Thuan 132 Zambia Lusaka Main source: https://early-alert.maps.arcgis.com/apps/opsdashboard/index.html#/20bfbf89c8e74c0494c90b1ae0fa7b78 *US territories iv. Travel Ban/Advisory & Quarantine Orders Global Updates
Finland – Eleven students of a school in Mantsala in southern Finland were quarantined after exposure to COVID-19 when schools in the country reopened in the middle of May. [21] Laos - 2,648 people in the capital Vientiane, have been quarantined at 91 accommodation centers. On Monday, a total of 1,761 people entering Laos through international border checkpoints. [71] USA - More than a dozen Round Rock firefighters in Texas are in quarantine after they were exposed to paramedics with COVID-19. [157] Netherland - the entry ban for non-EU citizens, the United Kingdom and the Schengen Area has been prolonged until June 15. [78] Norway - Norway has extended its leisure travel ban until August 20, but said it will continue to explore whether some exemptions could be implemented before then. [84] Turkey – On 19th May a travel ban in 15 major cities was announced for another 15 days and will continue from May 20 to June 3. Air, land, and sea travels to and from these cities will be restricted: Istanbul, Ankara, Izmir, Balikesir, Bursa, Eskisehir, Gaziantep, Kayseri, Kocaeli, Konya, Manisa, Sakarya, Samsun, Van and Zonguldak. [117] v. Lockdown Global Updates
Egypt - As of 20 May, the quarantine period for overseas arrivals will be reduced to seven days. Overseas arrivals will be tested upon arrival and will be sent to spend seven days at quarantine facilities. If a person’s results after seven days are negative, they will be released and required to isolate themselves in their own homes. [87] France - As of May 20, French citizens and residents returning from abroad will be asked to place themselves in voluntary coronavirus quarantine. The request will only be made for those who return from countries outside the European Union. [105] Spain – After announcing a two-week quarantine last week, Spain lifted a ban on direct flights and ships from Italy but retained a block on cruise ships and a quarantine for inbound travelers. [328]
20 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
vi. Military Surveillance 14 CAF members assisting long-term care homes diagnosed with COVID-19 [152]
As of 20th May, 14 Canadian Armed Forces (CAF) members assigned to the military’s COVID-19 response operation (Operation Laser) have been diagnosed with COVID-19. Another 43 members are in self- isolation after potential exposure to COVID-19. Of the 14 confirmed infections, five tested positive while assisting at the same nursing home in Ontario. The five CAF members who also tested positive last week while helping out in long-term care homes in Quebec and Ontario also made up part of the 14 infections. The CAF would be sending replacements for the 57 members who’ve either been infected or exposed to the virus.
vii. WHO Guidance & Other Protocols
The following updates were published by the WHO between 11th – 19th May:
Considerations for school-related public health measures in the context of COVID-19 Available at: https://www.who.int/publications-detail/considerations-for-school-related-public- health-measures-in-the-context-of-covid-19
Contact tracing in the context of COVID-19 Available at: https://www.who.int/publications-detail/contact-tracing-in-the-context-of-covid- 19
Surveillance strategies for COVID-19 human infection Available at: https://www.who.int/publications-detail/surveillance-strategies-for-covid-19- human-infection
Considerations for public health and social measures in the workplace in the context of COVID-19 Available at: https://www.who.int/publications-detail/considerations-for-public-health-and- social-measures-in-the-workplace-in-the-context-of-covid-19
Public health criteria to adjust public health and social measures in the context of COVID-19 Available at: https://www.who.int/publications-detail/public-health-criteria-to-adjust-public- health-and-social-measures-in-the-context-of-covid-19
Laboratory biosafety guidance related to coronavirus disease (COVID-19) Available at: https://www.who.int/publications-detail/laboratory-biosafety-guidance-related-to- coronavirus-disease-(covid-19)
21 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Considerations for mass gatherings in the context of COVID-19: annex: considerations in adjusting public health and social measures in the context of COVID-19 Available at: https://www.who.int/publications-detail/considerations-for-mass-gatherings-in- the-context-of-covid-19-annex-considerations-in-adjusting-public-health-and-social-measures- in-the-context-of-covid-19
Gender and COVID-19 Available at: https://www.who.int/publications-detail/gender-and-covid-19
Immunization in the context of COVID-19 pandemic Available at: https://www.who.int/publications-detail/immunization-in-the-context-of-covid-19- pandemic
Multisystem inflammatory syndrome in children and adolescents with COVID-19 Available at: https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in- children-and-adolescents-with-covid-19
Cleaning and disinfection of environmental surfaces in the context of COVID-19 Available at: https://www.who.int/publications-detail/cleaning-and-disinfection-of- environmental-surfaces-inthe-context-of-covid-19
Case Report Form for suspected cases of Multisystem inflammatory syndrome (MIS) in children and adolescents temporally related to COVID-19 Available at: https://www.who.int/publications-detail/case-report-form-for-suspected-cases-of- multisystem-inflammatory-syndrome-(mis)-in-children-and-adolescents-temporally-related-to- covid-19
Overview of Public Health and Social Measures in the context of COVID-19 Available at: https://www.who.int/publications-detail/overview-of-public-health-and-social- measures-in-the-context-of-covid-19 viii. CDC Guidance & Protocols
US CDC
No updates were published by the US CDC on 19th May 2020.
EU CDC
The following updates were published by the EU CDC on 19th May 2020. Infographic: COVID-19 in care homes Available at: https://www.ecdc.europa.eu/en/publications-data/covid-19-care-homes- infographic Surveillance of COVID-19 at long-term care facilities in the EU/EEA
22 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Available at: https://www.ecdc.europa.eu/en/publications-data/surveillance-COVID-19-long- term-care-facilities-EU-EEA
23 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020 ix. Ongoing Clinical Trials for COVID-19
Noteworthy reports are included to inform main developments of COVID-19 pharmaceutics. This is by no means an exhaustive list of all ongoing trials of therapeutics and vaccines. A global map and registry of trials is also visualised & accessible at: https://www.covid-nma.com/dataviz/ and trial results are available at: https://covid-nma.com/living_data/index.php
Table 8: Clinical Trials for Vaccines Country Trial Reference WPRO China China has also approved the first clinical trial for a vaccine (Ad5-nCoV, an [1] hybrid of “live virus” and “recombinant protein”) conducted by the [2] Academy of Military Medical Sciences. Recruitment commenced on 16th [3] March 2020. The Phase I trial was completed in April 2020 and Phase II [4] trials have commenced recruitment on 12 April 2020. [5] [6] The phase-II human clinical began in Wuhan with 500 volunteer [7] participants.
China has approved 2 additional clinical trials for vaccines using inactivated coronavirus pathogens. On 13th April, one vaccine developed by a Beijing-based unit of Nasdaq-listed Sinovac Biotech was approved and another vaccine, being developed by the Wuhan Institute of Biological Products and the Wuhan Institute of Virology, was approved on 12th April. China now has three different clinical trials for three possible coronavirus vaccines in the works.
China's inactivated COVID-19 vaccine entered 2nd-phase clinical trial on 25th April. China has approved three COVID-19 vaccine candidates for clinical trials. An adenovirus vector vaccine was the first COVID-19 vaccine in the world that has entered the second phase of clinical trial.
As of 15th May, China had 5 potential coronavirus vaccine in a human trial and more are on the way. So far there have been no "major adverse reactions" reported among the 2,575 volunteers participating in the five phase-two tests. If all goes well, these 5 trials would complete the second phase of clinical trials in July this year.
As of 17th May, it has been confirmed that 3 COVID-19 vaccines entered phase II clinical trials Singapore The Agency for Science, Technology and Research has partnered with [8] Japanese pharmaceutical company Chugai Pharmabody Research to develop an antibody that targets specific areas of the coronavirus, preventing it from infecting cells.
24 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Duke-NUS Medical School, together with United States medicine company Arcturus Therapeutics, is working on a vaccine that gets the human body to produce part of the virus in order to fight it.
Home-grown contract development and manufacturing organisation Esco Aster is also collaborating with US biotech company Vivaldi Biosciences to develop a vaccine that protects against Covid-19 and the flu, and can be easily adapted if the coronavirus mutates. Australia Phase I vaccine trial of NVX-CoV2373 by Novavax to commence in mid- [9] May 2020. EURO Germany CureVac (unlisted German company) aims to start testing an experimental [10] vaccine on humans by summer of 2020. [11]
German vaccine regulators approved the clinical trial of BNT162 by BioNTech and Pfizer. 200 healthy people will be recruited for the trial. This marks the fourth COVID-19 vaccine trial worldwide. United A million doses of a potential vaccine ChAdOx1-nCov-19 are currently [12] Kingdom being manufactured even before trials that prove its effectiveness. [13] Recruitment for phase 1 trials are ongoing. [14] [15] The trial for ChAdOx1-nCov-19, slated to begin on 23 April 2020, will be [16] tested in around 500 volunteers.The vaccine is a potentially ideal candidate against the virus as it can generate a strong immune response from one dose.
The pre-print results showed that the "ChAdOx1 nCoV-19" vaccine has been effective in preventing damage to the lungs without any signs of immune-enhanced diseases. As on May 13, more than 1000 volunteers have already participated in human clinical trials of this vaccine.
An experimental Covid-19 vaccine developed by cigarette maker British American Tobacco Plc is slated to begin the first phase of human trials as soon as late June if authorized by drug regulators. Pre-clinical tests of the vaccine have shown positive immune response. Kazakhstan The World Health Organization (WHO) registered the inert SARS-Cov2 [17] vaccine developed at the Kazakh Research Institute for Biological Safety Problems to the shortlist of COVID-19 candidate vaccines in preclinical evaluation on May 15 Americas United The first clinical trial on a COVID-19 vaccine (mRNA-1273 by Moderna States Inc.) will begin in US the week of 23rd March 2020. [18] On 7 May, Moderna has been cleared by FDA to move into Phase II trial. [19] 600 participants will be enrolled in the coming weeks to begin assessing [20] whether the potential vaccine can induce antibodies production in the [21] human immune system that recognize SARS-CoV-2. Moderna reported [22] promising early results on Monday (May 18) from the first clinical tests [23] performed on a small number of volunteers. Interim Phase 1 data, while [24]
25 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
early, demonstrate that vaccination with mRNA-1273 elicits an immune response of the magnitude caused by natural infection.
Another vaccine candidate (INO-4800) by Inovio Pharmaceuticals began Phase 1 trial on 6 April 2020.
Cuba began recruitment for Phase I vaccine trial of their vaccine candidate (CIGB-2020) on 27 March 2020. A total of 37 subjects were enrolled for the study. Study will be completed in mid-July 2020
Pfizer and BioNTech have started dosing participants in the Phase I/II clinical trial assessing the BNT162 vaccine candidate in US. The study will look at the safety, immunogenicity and optimal dose level of four mRNA vaccine candidates in a single, continuous study and involves up to 360 healthy participants on the trial’s dose level escalation part.
Novavax has seen promising results in the NVX-CoV2373 corona vaccine candidate. The company is now moving to the next stage -- testing on humans.
Table 9: Clinical Trials for Therapeutics
Country Trial Reference Global AstraZeneca on 14 April, mentioned it would start a new clinical trial of Calquence. Early [25] data suggests Calquence appears to reduce the severity of COVID-19-induced respiratory [26] distress. The goal of the new trial, called CALVARI, is to assess the effectiveness and safety of the drug.
The World Health Organisation launched an international clinical trial “Solidarity Trial” to compare 4 treatment options against standard of care, and assess their relative effectiveness. There are currently more than 100 participating countries. The treatments compared are Remdesivir; Lopinavir/Ritonavir; Lopinavir/Ritonavir with Interferon beta- 1a; and Chloroquine/Hydroxychloroquine. WPRO Tocilizumab is concurrently evaluated in clinical trials as it is used for [27] Malaysia severe cases of Covid-19. Singapore is looking at 11 recovered COVID-19 patients to donate blood [28] for plasma therapy treatment. [29]
Singapore About 90 severely ill Covid-19 patients who require oxygen support, have been enrolled in three trials of remdesivir as of May 8th, two by drugmaker Gilead Sciences and one by the National Institute of Allergy and Infectious Diseases in the United States. Takeda Pharmaceutical is aiming to roll out an antibody treatment for [30] Japan COVID-19 as early as this year - a concentration of antibodies taken from patients who have recovered from COVID-19. Hong Kong is looking at the use of triple combination of interferon beta- [31] Hong Kong 1b, lopinavir–ritonavir, and ribavirin and have found promising findings in its phase II trial.
26 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Glenmark Pharmaceuticals Limited is conducting Phase III clinical trials [32] of Favipiravir for COVID-19 patients. It is estimated to complete by [33] July/August 2020.
University of Hyderabad (UoH) and CSIR-Centre for Cellular and India Molecular Biology (CCMB) are collaborating with Vins Bioproducts Ltd, to develop antibody fragment-based immunotherapy for immediate treatment for COVID-19 pandemic. The antibodies, raised in horses using inactivated coronavirus is fractionated and purified to produce antibody fragments F(ab’)2 for neutralizing coronavirus in the patients for recovery. combination of antiprotozoal medicine called Ivermectin in a single dose [34] Bangladesh with Doxycycline, an antibiotic, has yielded astounding results with all of the 60 COVID-19 patients recovering Five innovative drugs have been approved for clinical trials, and all of [35] China them have entered phase II clinical studies. Europe The UK Department of Health and Social Care and UK Research and [36] Innovation launched a national collaborative platform named [37] Accelerating, COVID-19 Research & Development (ACCORD). This is a single, national multi-centre trial platform provided by the clinical research company IQVIA, and the UK’s leading research expertise through the National Institute for Health Research to rapidly test United potential drugs through early stage clinical trials and feed them into the Kingdom UK’s large-scale COVID-19 studies such as the RECOVERY trial, currently the world’s largest randomised controlled clinical trial for COVID-19 treatment. Bemcentinib developed by BerGenBio ADS is selected as the first candidate to be tested under ACCORD study, will commence Phase II clinical trial in 120 subjects across 6 UK NHS hospital trusts. A candidate drug for treating the new coronavirus, favipiravir, has [38] produced promising results in early clinical trials in Russia, according to the Russian Direct Investment Fund (RDIF). 60% percent of the 40 Russia coronavirus patients taking tablets of favipiravir, which was first developed in Japan under the name Avigan, tested negative for the virus within five days and said the treatment could cut coronavirus recovery times in half. Germany's Max Planck Institute of Colloids and Interfaces in Potsdam in [39] collaboration with the US company ArtemiLife are exploring a cell based study using test extracts from the Artemisia annua plant, also known as Germany sweet wormwood, as well as derivatives isolated from the plant such as artemisinin. The scientists expect results by the end of May and if found to be effective, clinical studies on humans, would be required. EMRO United Arab The UAE is carrying out clinical trials of plasma therapy to treat COVID- [40] Emirates 19 patients. A pluristem cell therapy (using placenta cells) by Israeli company that is [41] on compassionate use in US has successfully treated it first American [42] Israel patient. The therapy had been utilised in the first six critically ill patients in Israel, all of whom survived a week later. As the treatment remains
27 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
available to patients under compassionate use through regulatory clearances in the US and Israel, the company is looking to initiate a multinational clinical study.
Itzchak Levy at the Sheba Medical Center in Israel launched a self- funded camostat trial in April which is a 35 year old pancreatitis drug made by Osaka-based Ono Pharmaceutical Co. Americas FDA has given a go-ahead for the human clinical testing of a new drug [43] named EIDD-2801, being developed at Emory University. It’s been [44] touted as a 'relief drug' for Covid-19 claiming to be effective against the [45] entire coronavirus family. [46] [47] Fujifilm Corporation will begin its first US clinical trials of Avigan, a [48] Japanese anti-viral drug. The drug is currently tested for treatment in China as well.
FDA has approved a phase III trial by Novartis assessing hydroxychloroquine in more than a dozen sites in the US. Enrolment will begin in a few weeks from 20 April 2020.
National Institutes of Health is conducting a clinical study to look at the combination of antiviral drug remdesivir and anti-inflammatory United States treatment baricitinib in COVID-19 patients.
NIAID-funded AIDS Clinical Trials Group (ACTG) in collaboration with Teva Pharmaceuticals has initiated a randomized matched pair clinical trial to evaluate if a combination of hydroxychloroquine together with the antibiotic azithromycin can prevent hospitalization and death from COVID-19. The Phase 2b trial will enroll approximaty 2,000 adults at participating ACTG sites across the United States. The first participant was enrolled on 17th May in San Diego, California.
anti COVID-19 drug candidate, Brilacidin tested by Innovation Pharmaceuticals, showed a reduction in the viral titer (load) of SARS- CoV-2 by 75% after only 1 hour of pre-incubation prior to infection at a concentration of 10μM as compared to vehicle control in an in vitro experiment using VERO cells.
28 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020 x. Scientific Publications with Epidemiology and Clinical Focus
Only abstracts of new publications will be included in this section. Refer to annex B for past abstracts.
Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression [142]
Abstract
Objective: Many laboratory indicators form a skewed distribution with outliers, for which robust methods are needed to precisely determine and quantify fatality risk factors.
Method: A total of 192 critically ill patients (142 were discharged and 50 died in the hospital) with COVID-19 were included in the sample. Quantile regression was used to determine discrepant laboratory indexes between survivors and non-survivors and quantile shift (QS) was used to quantify the difference. Logistic regression was then used to calculate the odds ratio (OR) and the predictive power of death for each risk indicator.
Results: After adjusting for multiple comparisons and controlling numerous confounders, quantile regression revealed that the laboratory indexes of non-survivors were significantly higher in C-reactive protein (CRP; QS = 0.835, p <0.001), white blood cell counts (WBC; QS = 0.743, p <0.001), glutamic oxaloacetic transaminase (AST; QS = 0.735, p <0.001), blood glucose (BG; QS = 0.608, p = 0.059), fibrin degradation product (FDP; QS = 0.730, p = 0.080), and partial pressure of carbon dioxide (PCO 2 ), and lower in oxygen saturation (SO 2 ; QS = 0.312, p <0.001), calcium (Ca 2+ ; QS = 0.306, p = 0.073), and PH. Most of these abnormalities were associated with increased fatality risk and can predict the probability of death, especially, CRP which is the most prominent index with an odds ratio of 205.97 and predictive accuracy of 93.2%.
Conclusion: Laboratory indexes provided reliable information on mortality in critically ill patients, which might help improve clinical prediction and treatment at an early stage.
29 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020 xi. Sources
Global Risk Assessment
1. https://www.nytimes.com/2020/04/27/world/europe/coronavirus-vaccine-update-oxford.html 2. https://techcrunch.com/2020/03/24/fda-now-allows-treatment-of-life-threatening-covid-19-cases- using-blood-from-patients-who-have-recovered/ 3. https://www.pnas.org/content/early/2020/04/02/2004168117 4. http://www.koreabiomed.com/news/articleView.html?idxno=7936 5. https://www.unwto.org/news/covid-19-travel-restrictions 6. https://www.pharmaceutical-technology.com/news/fujifilm-favipiravir-covid-19/ 7. https://fox8.com/news/coronavirus/us-beginning-trials-of-japanese-anti-viral-drug-as-potential- covid-19-treatment/ 8. https://www.nejm.org/doi/full/10.1056/NEJMoa2007016?query=featured_coronavirus 9. https://www.aljazeera.com/news/2020/04/fda-warns-hydroxychloroquine-treat-covid-19- 200424160930040.html 10. https://www.nst.com.my/education/2020/04/583940/um-leads-clinical-trials-tocilizumab-covid-19- treatment 11. https://news.abs-cbn.com/overseas/04/22/20/israeli-firm-treating-covid-19-patients-with-placenta- cells-reports 12. https://www.arabnews.com/node/1662476/middle-east 13. https://ticotimes.net/2020/04/22/costa-rica-using-hydroxychloroquine-for-covid-19-treatment 14. https://www.bloomberg.com/news/articles/2020-05-01/gilead-drug-is-cleared-for-emergency-use- by-fda-trump-says?srnd=premium&sref=T96IplOq 15. https://www.channelnewsasia.com/news/asia/covid-19-japan-remdesivir-drug-treatment- coronavirus-12711690 16. https://www.cnbc.com/2020/05/12/remdesivir-coronavirus-treatment-gilead-strikes-deal-to- make-drug-in-127-countries.html 17. https://www.belfasttelegraph.co.uk/news/health/coronavirus/coronavirus-covid-19-reproductive- rate-lower-in-republic-than-northern-ireland-39189683.html 18. https://academic.oup.com/jtm/article/27/2/taaa021/5735319 19. https://www.coronavirustoday.com/r-number-refers-either-basic-or-effective-reproduction- number
Global Epidemiology
1. https://www.indiatoday.in/india/story/kerala-reports-first-confirmed-novel-coronavirus-case-in- india-1641593-2020-01-30 2. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html 3. https://globalnews.ca/news/6474270/coronavirus-confirmed-toronto/ 4. http://www.colombopage.com/archive_20A/Jan27_1580144354CH.php 5. https://www.theguardian.com/world/2020/feb/05/eight-year-old-boy-becomes-australias-13th- coronavirus-case-as-nz-evacuation-goes-ahead 6. https://www.doh.gov.ph/2019-nCoV?fbclid=IwAR3vGMymmcQzSKpgBxMAPTM6_j9A1UJZ8- W38IHXiqpzKwaJQ5OFVvhFnN0 7. https://news.abs-cbn.com/overseas/01/30/20/finland-confirms-its-first-coronavirus-case
30 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
8. https://www.who.int/cambodia/news/detail/28-01-2020-ministry-of-health-responds-to-first- positive-case-of-new-coronavirus 9. https://www.aa.com.tr/en/europe/italy-reports-two-confirmed-cases-of-coronavirus/1719704 10. https://www.nytimes.com/aponline/2020/01/31/world/asia/ap-as-china-outbreak-the-latest-1st-ld- writethru.html 11. https://www.theedgemarkets.com/article/coronavirus-spreading-munich-shows-difficulty-halting- new-bug 12. https://macaunews.mo/no-new-coronavirus-cases-in-48-hours/ 13. https://www.siasat.com/nepal-reports-first-case-coronavirus-infection-1803627/ 14. https://www.cdc.gov/coronavirus/2019-nCoV/cases-in-us.html 15. http://www.cidrap.umn.edu/news-perspective/2020/01/three-more-novel-coronavirus-cases- reported-us 16. https://www.aa.com.tr/en/europe/france-reports-sixth-confirmed-coronavirus-case/1719720 17. https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections- respiratoires/infection-a-coronavirus/articles/cas-de-pneumonies-associees-a-un-nouveau- coronavirus-2019-nCoV-a-wuhan-en-chine 18. https://www.thelocal.fr/20200131/coronavirus-in-france-what-you-need-to-know 19. http://outbreaknewstoday.com/taiwan-1st-locally-transmitted-novel-coronavirus-case-reported- 48793/ 20. https://www.iatatravelcentre.com/international-travel-document-news/1580226297.htm 21. https://focustaiwan.tw/society/202001300016 22. https://www.straitstimes.com/asia/se-asia/malaysia-confirms-eighth-case-of-infection 23. https://www.health.gov.au/news/coronavirus-update-at-a-glance 24. https://www.scmp.com/news/hong-kong/health-environment/article/3048289/china-coronavirus- another-patient-tests-positive 25. https://www.channelnewsasia.com/news/singapore/wuhan-virus-singapore-new-confirmed-cases- 13-12369838 26. https://www.channelnewsasia.com/news/asia/wuhan-virus-thailand-first-human-coronavirus- transmission-12374356 27. https://www.straitstimes.com/asia/east-asia/wuhan-virus-japan-to-enforce-special-measures-for- coronavirus-from-saturday 28. https://edition.cnn.com/asia/live-news/coronavirus-outbreak-01-31-20-intl- hnk/h_d25fc709f2df82305c0ff3dc6f383449 29. https://www.dailymail.co.uk/health/article-7951403/Coronavirus-hits-UK.html 30. https://www.ecdc.europa.eu/sites/default/files/documents/novel-coronavirus-risk-assessment- china-second-update.pdf 31. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b 48e9ecf6 32. http://3g.dxy.cn/newh5/view/pneumonia 33. http://outbreaknewstoday.com/japan-reports-3rd-locally-acquired-2019-ncov-case-this-case-from- chiba-65157/ 34. https://www.channelnewsasia.com/news/singapore/wuhan-virus-singapore-new-cases- coronavirus-china-12373156 35. https://www.chinadailyhk.com/article/119823 36. https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-01-20-intl-hnk/index.html 37. https://wsiltv.com/2020/01/31/the-latest-who-virus-could-overwhelm-africa-health-systems/ 38. https://www.cdc.gov/media/releases/2020/s0131-seventh-case-coronavirus.html
31 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
39. https://meduza.io/en/feature/2020/01/31/coronavirus-detected-in-russia-what-we-know-so-far 40. https://www.garda.com/crisis24/news-alerts/310456/sweden-health-officials-confirm-first-case-of- novel-coronavirus-january-31-update-1 41. https://www.garda.com/crisis24/news-alerts/310471/spain-health-officials-confirm-first-case-of- novel-coronavirus-january-31-update-1 42. https://vietnamnews.vn/society/591717/viet-nam-announces-sixth-coronavirus-case.html 43. https://www.hindustantimes.com/world-news/vietnam-suspends-mainland-china-flights-over-virus- fears/story-ECebpKNBKAekEG5uHXigjO.html 44. https://www.japantimes.co.jp/news/2020/02/01/national/shinzo-abe-combat-coronavirus- outbreak-japan/#.XjaZ4M4zZPY 45. https://newsinfo.inquirer.net/1222873/doh-confirms-second-case-of-ncov-in-ph 46. https://www.moh.gov.sg/news-highlights/details/two-more-confirmed-imported-cases-of-novel- coronavirus-infection-in-singapore 47. https://www.theweek.in/news/india/2020/02/02/second-case-of-novel-coronavirus-confirmed- kerala.html 48. https://www.health.gov.au/news/coronavirus-update-at-a-glance 49. https://www.nst.com.my/world/world/2020/02/561776/coronavirus-evacuees-arrive-germany-8th- infection-confirmed 50. https://www.zaobao.com.sg/realtime/china/story20200202-1025663 51. https://www.bostonherald.com/2020/02/01/first-case-of-coronavirus-confirmed-in-massachusetts- dph/ 52. https://www.wefornews.com/uae-confirms-5th-coronavirus-case/ 53. https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030 54. https://www.usnews.com/news/best-states/california/articles/2020-02-02/9th-us-case-of-new- virus-confirmed-in-san-francisco-bay-area 55. https://apnews.com/ee9c8fb693b06f1cf63f16e494333ce5 56. https://macaunews.mo/8th-coronavirus-case-confirmed-in-a-macau-resident/ 57. https://www.hongkongfp.com/2020/01/31/breaking-coronavirus-hong-kong-govt-closes-schools- march-declares-global-emergency/ 58. https://www.theguardian.com/world/live/2020/feb/04/coronavirus-live-updates-china-wuhan- outbreak-death-toll-latest-news-update 59. https://www.egypttoday.com/Article/1/81270/Germany-reports-12-cases-of-new-Coronavirus 60. https://www.dw.com/en/coronavirus-g7-countries-agree-to-coordinate-response-live-updates/a- 52238408 61. https://macaunews.mo/10th-coronavirus-case-confirmed/ 62. https://www.straitstimes.com/asia/se-asia/coronavirus-malaysia-confirms-first-citizen-infected- with-virus-total-cases-now-10 63. https://vietnamnews.vn/society/591803/viet-nam-confirms-9th-coronavirus-case-hong-kong- reports-first-death-from-infection.html 64. https://vietnaminsider.vn/9th-person-infected-with-new-coronavirus-in-vietnam/ 65. https://economictimes.indiatimes.com/news/politics-and-nation/third-coronavirus-case-reported- from-india/articleshow/73895001.cms?from=mdr 66. https://www.channelnewsasia.com/news/singapore/wuhan-virus-coronavirus-singapore- community-spread-tourists-12389314?cid=telegram_cna_social_28112017_cna 67. https://en.trend.az/casia/kazakhstan/3186267.html 68. https://www.scmp.com/news/asia/australasia/article/3048924/coronavirus-australia-vietnam- evacuees-quarantined-cambodia
32 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
69. https://www.businessinsider.sg/us-troops-in-south-korea-face-possible-wuhan-coronavirus- quarantine-2020-2/?r=US&IR=T 70. https://vietnamnews.vn/society/591803/viet-nam-confirms-9th-coronavirus-case-hong-kong- reports-first-death-from-infection.html 71. https://en.vietnamplus.vn/thailand-confirms-six-new-ncov-infection-cases/168158.vnp 72. https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-04-20/index.html 73. http://www.cidrap.umn.edu/news-perspective/2020/02/ncov-total-tops-20000-officials-probe- spread-nations-outside-china 74. http://news.ycwb.com/2020-02/05/content_30542464.htm 75. https://focustaiwan.tw/society/202002040019 76. https://vietnaminsider.vn/vietnam-confirms-10th-patient-infected-with-ncov/ 77. http://www.koreaherald.com/view.php?ud=20200205000121 78. https://www.channelnewsasia.com/news/asia/japan-wuhan-coronavirus-cruise-ship-quarantine- virus-12393602 79. https://www.nippon.com/en/news/yjj2020020401328/new-coronavirus-cases-in-japan-increase-to- 23.html 80. https://www.straitstimes.com/asia/se-asia/coronavirus-malaysia-confirms-2-new-cases-to-bring- total-to-12-a-suspected-case-at-klcc 81. https://www.cnnphilippines.com/news/2020/2/5/third-novel-coronavirus-case-Philippines.html 82. https://www.channelnewsasia.com/news/asia/wuhan-virus-cruise-ship-japan-infected-12399872 83. https://www.moh.gov.sg/news-highlights/details/four-more-confirmed-cases-of-novel-coronavirus- infection-in-singapore 84. https://www.straitstimes.com/asia/east-asia/coronavirus-south-korea-confirms-new-case-man- infected-in-singapore 85. http://www.koreaherald.com/view.php?ud=20200206000097 86. http://www.rfi.fr/cn/%E4%B8%AD%E5%9B%BD/20200205- %E6%9E%97%E9%83%91%E9%A6%99%E6%B8%AF%E7%A1%AE%E8%AF%8A%E7%97%85%E4%BE% 8B%E8%BE%BE21%E4%BE%8B- %E5%91%A8%E5%85%AD%E8%B5%B7%E5%86%85%E5%9C%B0%E5%85%A5%E6%B8%AF%E9%A1 %BB%E9%9A%94%E7%A6%BB14%E5%A4%A9 87. http://www.ejinsight.com/20200205-authorities-confirm-more-local-transmission-cases-of- coronavirus/ 88. https://www.info.gov.hk/gia/general/202002/05/P2020020500690.htm 89. https://www.theonlinecitizen.com/2020/02/06/hong-kong-braces-for-human-to-human- transmission-within-city-amidst-global-coronavirus-outbreak/ 90. https://www.theguardian.com/world/2020/feb/05/coronavirus-peter-dutton-says-australians- could-be-quarantined-in-mining-camps 91. https://www.taiwannews.com.tw/en/news/3872333 92. https://www.businessinsider.sg/coronavirus-wisconsin-12-cases-united-states-2020-2/?r=US&IR=T 93. https://www.channelnewsasia.com/news/asia/wuhan-coronavirus-malaysia-locally-transmitted- 12401166 94. http://english.hani.co.kr/arti/english_edition/e_national/927405.html 95. https://www.businessinsider.sg/wuhan-coronavirus-traveling-in-south-korea-outbreak-2020- 2/?r=US&IR=T 96. https://reliefweb.int/report/thailand/novel-coronavirus-2019-ncov-who-thailand-situation-report-6- february-2020 97. https://www.mhlw.go.jp/stf/newpage_09290.html
33 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
98. https://www.pharmaceutical-technology.com/features/coronavirus-affected-countries-thailand- measures-impact-tourism/ 99. https://nidss.cdc.gov.tw/en/SingleDisease.aspx?dc=1&dt=5&disease=19cov 100. https://www.worldometers.info/coronavirus/coronavirus-cases/ 101. https://www-who-int.libproxy1.nus.edu.sg/docs/default-source/coronaviruse/situation- reports/20200207-sitrep-18-ncov.pdf?sfvrsn=fa644293_2 102. https://www.pharmaceutical-technology.com/features/coronavirus-outbreak-the-countries- affected/ 103. https://www.scmp.com/comment/opinion/article/3049198/coronavirus-travel-bans-shutting-door- china-now-will-hurt-goodwill 104. https://www-who-int.libproxy1.nus.edu.sg/csr/disease/coronavirus_infections/risk-assessment- august-2018.pdf?ua=1&ua=1 105. https://www-ncbi-nlm-nih-gov.libproxy1.nus.edu.sg/pubmed/19545404 106. https://www.straitstimes.com/asia/east-asia/coronavirus-hubei-province-reveals-fatality-rate-for- first-time-wuhan-comes-in-second 107. https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1 108. https://www.anzen.mofa.go.jp/covid19/pdfhistory_world.html#India 109. http://www.0404.go.kr/dev/newest_view.mofa?id=ATC0000000007701&pagenum=1&mst_id=MST 0000000000041 110. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media- briefing-on-covid-19---11-march-2020
Travel Bans/Advisories & Quarantine Orders 21. http://www.china.org.cn/world/Off_the_Wire/2020-05/20/content_76064511.htm 71. http://www.xinhuanet.com/english/2020-05/19/c_139069894.htm 78. https://www.schengenvisainfo.com/news/netherlands-extends-entry-ban-until-june-15/ 84. https://www.rcinet.ca/eye-on-the-arctic/2020/05/19/covid-19-roundup-svalbard-greenland-finland- copy/ 117. http://www.xinhuanet.com/english/2020-05/20/c_139070652.htm 157. https://www.kvue.com/article/news/health/coronavirus/round-rock-firefighters-exposed-to- coronavirus/269-b06f1741-4868-48df-a6e9-a5e1c81109c2
Lockdowns/Large Scale Quarantine 87. https://egyptianstreets.com/2020/05/19/egypt-reduces-mandatory-quarantine-for-overseas- arrivals-to-seven-days/ 105. https://www.france24.com/en/20200519-french-returning-from-abroad-asked-to-place- themselves-in-covid-19-quarantine 328. https://www.channelnewsasia.com/news/world/spain-lifts-ban-on-flights-from-italy--but-tourism- still-off-cards-12749174
Military Surveillance
152. https://globalnews.ca/news/6957253/coronavirus-canada-caf-seniors-homes/
34 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Ongoing Clinical Trials
1. https://www.channelnewsasia.com/news/asia/coronavirus-covid-19-china-human-trial-vaccine- 12548902 2. https://www.financialexpress.com/lifestyle/health/china-begins-phase-ii-clinical-trial-of-covid-19- vaccine-in-wuhan/1927423/ 3. https://www.voanews.com/science-health/coronavirus-outbreak/china-approves-trials-2-more- coronavirus-vaccines 4. http://english.scio.gov.cn/chinavoices/2020-04/26/content_75976792.htm 5. https://clinicaltrials.gov/ct2/show/NCT04341389 6. https://www.channelnewsasia.com/news/asia/china-has-fifth-covid-19-vaccine-in-human-trial- official-12737450 7. http://www.xinhuanet.com/english/2020-05/17/c_139064549.htm 8. https://www.straitstimes.com/singapore/health/spore-researchers-in-global-search-for-covid-19- vaccines 9. https://www.clinicaltrialsarena.com/news/novavax-nucleus-launch-covid-19-vaccine-trials/ 10. https://www.cnbc.com/2020/03/17/hopes-of-a-coronavirus-vaccine-mount-as-three-key-biotech- players-make-progress.html 11. https://www.channelnewsasia.com/news/world/covid-19-coronavirus-vaccine-germany-human- testing-12667122 12. https://www.channelnewsasia.com/news/world/uk-scientists-to-make-a-million-potential-covid-19- vaccines-before-proof-12653580 13. https://www.pmlive.com/pharma_news/oxford_university_covid- 19_vaccine_to_start_human_testing_tomorrow_1338762 14. https://www.telegraph.co.uk/global-health/science-and-disease/oxford-university-trial-coronavirus- vaccine-covid-news/ 15. https://www.indiatoday.in/science/story/coronavirus-experts-progress-oxford-covid-vaccine- 1678210-2020-05-15 16. https://www.bloomberg.com/news/articles/2020-05-15/cigarette-maker-s-coronavirus-vaccine- poised-for-human-tests 17. https://astanatimes.com/2020/05/who-approves-kazakh-covid-19-vaccine-for-preclinical-trials/ 18. https://astanatimes.com/2020/05/who-approves-kazakh-covid-19-vaccine-for-preclinical-trials/ 19. https://www.independent.co.uk/news/world/americas/coronavirus-vaccine-trial-us-cdc-trump- cure-seattle-covid-19-latest-a9403671.html 20. http://www.tiogapublishing.com/news/state/inovio-initiates-phase-1-clinical-trial-of-its-covid-19- vaccine-and-plans-first-dose/article_eba8f875-75b8-55bd-8dc6-1f76b39a489c.html 21. http://rpcec.sld.cu/en/trials/RPCEC00000306-En 22. https://www.wired.com/story/frontrunners-emerge-in-the-race-for-a-covid-19-vaccine/ 23. https://www.clinicaltrialsarena.com/news/pfizer-biontech-covid-19-vaccine-us/ 24. https://www.businesstoday.in/current/economy-politics/coronavirus-vaccine-update-moderna- novavax-lead-race-chinese-firm-builds-largest-vaccine-plant/story/403798.html 25. https://www.channelnewsasia.com/news/world/covid-19-coronavirus-drugmaker-results-vaccine- test-12746564 26. https://money.yahoo.com/coronavirus-astra-zeneca-to-start-trial-on-covid-19-treatment-drug- 074355277.html 27. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel- coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
35 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
28. https://www.nst.com.my/education/2020/04/583940/um-leads-clinical-trials-tocilizumab-covid-19- treatment 29. https://www.nst.com.my/education/2020/04/583940/um-leads-clinical-trials-tocilizumab-covid-19- treatment 30. https://asia.nikkei.com/Business/Pharmaceuticals/Japan-s-Takeda-in-push-to-debut-COVID-19- treatment-this-year 31. https://www.eurekalert.org/pub_releases/2020-05/tl-pss050820.php 32. https://www.straitstimes.com/singapore/health/patients-in-spore-with-severe-covid-19-enrolled- in-drug-trials 33. https://www.hindustantimes.com/india-news/glenmark-begins-phase-3-clinical-trials-of- favipiravir/story-8ykNqhJWZhc2pWnAQZBWVN.html 34. https://www.thehindu.com/sci-tech/science/antibody-fragment-based-therapy-against-covid-19- underway/article31592935.ece 35. https://www.nihr.ac.uk/news/national-collaborative-platform-launched-to-fast-track-potential- covid-19-treatments/24678 36. https://www.bergenbio.com/bergenbios-bemcentinib-selected-to-be-fast-tracked-as-potential- treatment-for-covid-19-through-new-national-uk-government-clinical-trial-initiative/ 37. https://www.livemint.com/news/world/coronavirus-effective-drug-combination-found-claim- bangladeshi-doctors-11589718389637.html 38. http://www.xinhuanet.com/english/2020-05/17/c_139064549.htm 39. https://www.firstpost.com/health/clinical-trials-for-potential-coronavirus-drug-favipiravir-in-russia- have-shown-some-promising-results-8367181.html 40. https://newsaf.cgtn.com/news/2020-05-16/Madagascar-s-COVID-19-drink-undergoes-testing-in- Germany-QwsvdnU7gQ/index.html 41. https://www.arabnews.com/node/1657566/middle-east 42. https://www.natureworldnews.com/articles/43692/20200421/covid-19-pluristem-american- patient.htm 43. https://www.livemint.com/news/world/coroanvirus-treatment-2-japanese-drugs-see-growing- interest-as-trials-underway-11589523168118.html 44. https://www.indiatoday.in/science/story/new-drug-promises-to-change-covid-19-response-gets- nod-for-human-trials-1666240-2020-04-12 45. https://fox8.com/news/coronavirus/us-beginning-trials-of-japanese-anti-viral-drug-as-potential- covid-19-treatment/ 46. https://www.genengnews.com/news/novartis-plans-phase-iii-trial-of-hydroxychloroquine-for-covid- 19/ 47. https://www.channelnewsasia.com/news/world/nih-begins-study-of-remdesivir-with-anti- inflammatory-drug-to-treat-covid-19-12716728 48. https://www.globenewswire.com/news-release/2020/05/19/2035552/0/en/Innovation- Pharmaceuticals-Brilacidin-Reduces-Viral-Titer-of-SARS-CoV-2-COVID-19-by-75-percent-After-Only- 1-Hour-of-Preincubation-in-In-Vitro-Study-at-BSL-3-Facility-Demonstrates-P.html 49. https://scitechdaily.com/nih-begins-clinical-trial-of-hydroxychloroquine-and-azithromycin-to-treat- covid-19/ 50. https://www.globenewswire.com/news-release/2020/05/19/2035552/0/en/Innovation- Pharmaceuticals-Brilacidin-Reduces-Viral-Titer-of-SARS-CoV-2-COVID-19-by-75-percent-After-Only- 1-Hour-of-Preincubation-in-In-Vitro-Study-at-BSL-3-Facility-Demonstrates-P.html
Scientific Reports 142. Linli, Z., Chen, Y., & Guo, S. (2020). Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression
36 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 111. 20 May 2020
Acknowledgement:
Dr. Pang Junxiong, Vincent
Ms Chua Ee Yong Pearleen
Ms Chua Hui Lan
Ms Gwee Xiao Wei Sylvia
Ms Koh Jiayun
Ms Shah Shimoni Urvish
Ms Shwe Sin Win
Ms Wang Min Xian
Any queries? Email Sylvia Gwee @ [email protected]
Centre for Infectious Disease Epidemiology and Research
Saw Swee Hock School of Public Health National University of Singapore Tahir Foundation Building 12 Science Drive 2 #10-01 Singapore 117549
For more information, please visit: Our NUS website: https://sph.nus.edu.sg/partnerships/cider/ Our blog: https://blog.nus.edu.sg/nuscider/
37 | P a g e Centre for infectious di sease epidemiology and r e s e a r c h