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COVID-19 Situation Report 111 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.
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