COVID-19

Global &Brazil Regional Update 3 PM WDC. 11 July 2020

PAHO UPDATES • In the Region of the Americas, an additional 142,992 cases and 3,500 deaths were reported in the past 24 hours, representing a 2.24% relative increase in cases and GLOBAL a 1.25% relative increase in deaths, compared to the previous day. • Countries reporting the highest numbers of new cases (≥ 1,000) compared with 12,465,387 the previous day are: United States of America (66,281 additional cases, 2.1% cases increase), Brazil (45,048 additional cases, 2.6% increase), Mexico (6,891 additional cases, 2.4% increase), (Colombia (6,803 additional cases, 5.1% increase), Argentina (3,367 additional cases, 3.7% increase), Peru (3,198 additional cases, 1.0% 559,835 increase), Chile (2,755 additional cases, 0.9% increase), Bolivia (1,452 additional deaths cases, 3.3%), Ecuador (1,408 additional cases, 2.1% increase), Dominican Republic (1,041 additional cases, 2% increase) and Panama (1,041 additional cases, 2.5% increase). 216 countries/areas/territories • Compared to the previous day, the following countries/territories have a relative increase in cases ≥ 5%: Belize (12.1%, 4 additional cases), Virgin Islands, US (9.2%, 14 additional cases), Costa Rica (5.6%, 360 additional cases), Venezuela (5.1%, 431 additional cases), • Countries reporting the highest numbers of new deaths are: Brazil (1,214 PAHO additional deaths, 1.8% increase), United States of America (803 additional deaths, 0.6% increase), Mexico (665 additional deaths, 2.0% increase), and Colombia (211 additional deaths, 4.5% increase). 6,540,222 cases • Compared to the previous day, the following countries/territories have a relative increase in deaths ≥ 5%: (13.0%, 3 additional deaths), Martinique (7.1%, 1 additional death), and Honduras (6.5%, 46 additional death) 283,357 deaths • United States of America accounts for 48.4% of all cases and 47.1% of all deaths for the Region of the Americas and Brazil accounts for 27.5% of all cases and 24.8% of all deaths. Combined, these two countries account for 75.9% of all cases and 54 72.0% of all deaths currently reported in the Region of the Americas. countries/areas/territories

• The pooled crude case-fatality estimate (the number of reported deaths divided Table 1: Cumulative cases, deaths by the reported cases) in the Region of the Americas is 4.3% (median country- & crude case fatality rate (CFR%) specific estimate: 3.0%; IQR: (0.8% - 5.5%). among PAHO countries/territories with ≥ 10,000 cumulative cases. • Countries/territories/areas with no new cases for >14 days: Saint-Barthélemy (102 days), Anguilla (98 days), Falkland Islands (Malvinas) (76 days), British Virgin Country/Territory Cases Deaths CFR (%) Islands (56 days), Grenada (45 days), Dominica (28 days), and Saint Vincent and United States of America 3,163,581 133,486 4.2% Grenadines (23 days). Brazil 1,800,827 70,398 3.9% GLOBAL UPDATES FROM LAST 24 HOURS Peru 319,646 11,500 3.6% Chile 312,029 6,881 2.2% From WHO’s summary concerning COVID-19: Mexico 289,174 34,191 11.8% • 220,724 new confirmed cases: United States of America, Brazil, India, South Africa, Colombia 140,776 4,925 3.5% Mexico, Russian Federation, Colombia, Argentina, Peru and Saudi Arabia are the 10 Canada 107,126 8,759 8.2% countries reporting the highest number of new cases. Argentina 94,060 1,787 1.9% • 5,299 new deaths: Brazil, United States of America, Mexico, India, Russian Ecuador 67,209 5,031 7.5% Federation, Colombia, Peru, Iran, Islamic Republic of, South Africa, and Chile are the 10 countries reporting the highest number of new deaths. Bolivia 45,565 1,702 3.7% Panama 43,257 863 2.0% Dominican Republic 43,114 880 2.0% Guatemala 27,619 1,139 4.1% Honduras 27,053 750 2.8%

Pan American Health Organization / World Health Organization. Washington, D.C.: PAHO/WHO; 2020 www.paho.org | © PAHO/WHO, 2020

More information available at: https://paho-covid19-response-who.hub.arcgis.com/

WHO HIGHLIGHTS Scientific Brief: Transmission of SARS-CoV-2: implications for infection prevention precautions: On 9 July, WHO published an update to the scientific brief published on 29 March 2020. The modes of transmission section briefly describe possible modes of transmission for SARS-CoV-2, including contact, droplet, airborne, fomite, fecal-oral, bloodborne, mother-to-child, and animal-to-human transmission. Infection with SARS-CoV-2 primarily causes respiratory illness ranging from mild disease to severe disease and death, and some people infected with the virus never develop symptoms.

COUNTRY SPOTLIGHT French Guinea – Ministry of Public Health, Point épidémio régional, Spécial COVID-19. 9 July 2020 As of 11 July, total of 5,949 cases including 26 deaths have been reported. Epidemiological Trends: An average of 130 cases a day have been reported in the past week (ending 9 July) compared to the 200 cases reported the previous week (ending 2 July). The incidence of new confirmed cases is down for almost 5 days. However, the decreasing trend should be interpreted with caution because (i) % positivity of daily samples tested remains high at rates between 25% and 30% and (ii) there was a decrease in the total number of tests carried out this week compared to the previous week (649 people tested this vs. 1,000 tested last week).

Figure 1: Evolution of the positivity rate (%) of samples for SARS-COV-2 per epi-week. EW 1- EW 28 (week incomplete)

Source: Sante publique & France Agence régionale de santé (ARS) Guyane

Mortality: A significant increase in mortality from all causes and all ages was observed in EW 26. The increase in mortality observed may be linked to the COVID-19 epidemic, although it is not yet possible to estimate the precise attributable share.

Laboratory surveillance: Virologic surveillance has detected 22 Covid-19 positive patients out of a total of 76 samples analyzed since March. All the positives were detected among the samples taken since the last week of May (EW 22). With an average positivity rate of 44% over the past three weeks, these trends indicate that Covid-19 could represent a little more than a third of the ARI cases seen at the clinics from city over the past few weeks.

Geographic spread: Cases have been detected in all communes during the last 7 days with the exception of Iracoubo, , Saül and Saint Elie. The incidence of daily cases is higher in the most populated municipalities, which may also reflect a greater screening access.

Hospitalizations: During the first week of July (EW-27), the number of emergency visits for suspected Covid-19 in the three services in the region remained high and at a relatively stable level. COVID-19 related visits represented an average of 15% of all emergency department visits (versus 17% the previous week) and up to 19% on July 3.

ICU Patients: Between the beginning of March and until July 8, 64 people were admitted to the intensive care unit. The characteristics are only available for 34 of them: 56% were under the age of 65 years, 75% presented with moderate acute respiratory distress syndrome. All those for whom information is available (97%) had at least one co-morbidity: obesity Map 1. Reported number of cumulative COVID-19 cases in the Region of the Americas and corresponding incidence rate (per 100,000 persons) by country/territory. As of 11 July 2020. (82%), high blood pressure (58%) and diabetes (47%) were the most common.

Map 2. Reported number of cumulative COVID-19 cases in the Central American sub-region and corresponding incidence rate (per 100,000 persons) by country/territory (sub-national level). As of 11 July 2020.

Map 3. Reported number of cumulative COVID-19 cases in the Caribbean sub-region and corresponding incidence rate (per 100,000 persons) by country/territory (sub-national level). As of 11 July 2020.

Cumulative COVID-19 cases and deaths reported by countries and territories in the Americas, as of 11 July 2020

Updated as of 3 PM

% Relative Sub-Region Country/Territory Cases Deaths Recovered Transmission Type Increase in Cases Canada 107,126 8,759 70,901 0% Community transmission Mexico 289,174 34,191 177,079 2% Community transmission North America United States of America (the) 3,163,581 133,486 982,877 2% Community transmission Subtotal 3,559,881 176,436 1,230,857 2% Belize 37 2 20 12% Sporadic cases Costa Rica 6,845 27 2,110 6% Community transmission El Salvador 9,391 254 5,516 3% Community transmission Guatemala 27,619 1,139 4,024 4% Community transmission Central America Honduras 27,053 750 2,850 3% Community transmission Nicaragua 2,411 91 1,993 0% Community transmission Panama 43,257 863 21,426 2% Community transmission Subtotal 116,613 3,126 37,939 3% Argentina 94,060 1,787 41,408 4% Community transmission Bolivia (the Plurinational State of) 45,565 1,702 13,918 3% Community transmission Brazil 1,800,827 70,398 1,078,763 3% Community transmission Chile 312,029 6,881 281,140 1% Community transmission Colombia 140,776 4,925 58,800 5% Community transmission South America Ecuador 67,209 5,031 30,134 2% Community transmission Paraguay 2,736 20 1,256 0% Community transmission Peru 319,646 11,500 210,638 1% Community transmission Uruguay 985 29 886 1% Clusters of cases Venezuela (Bolivarian Republic of) 8,803 83 2,671 5% Community transmission Subtotal 2,792,636 102,356 1,719,614 2% Anguilla 3 3 0% No Cases Antigua and Barbuda 74 3 57 1% Cluster of cases Aruba 105 3 98 0% Sporadic cases Bahamas (the) 108 11 89 1% Clusters of cases Barbados 98 7 90 0% Clusters of cases Bermuda 150 9 137 1% Sporadic cases Bonaire, Sint Eustatius, and Saba 7 7 0% No cases Cayman Islands 201 1 197 0% Clusters of cases Cuba 2,420 87 2,254 0% Clusters of cases Curacao 25 1 24 0% No Cases Dominica 18 18 0% Clusters of cases Dominican Republic (the) 43,114 880 20,996 3% Community transmission Falkland Islands (the) [Malvinas] 13 13 0% No Cases French Guiana 5,949 26 2,981 4% Community transmission Grenada 23 23 0% Clusters of cases Guadeloupe 190 14 157 0% Clusters of cases Caribbean and Atlantic Guyana 290 16 134 1% Clusters of cases Ocean Islands Haiti 6,617 135 2,590 1% Community transmission Jamaica 753 10 603 0% Clusters of cases Martinique 255 15 98 2% Clusters of cases Montserrat 12 1 8 0% No Cases Puerto Rico 9,366 167 0 3% Community transmission Saint Barthelemy 6 6 0% No Cases Saint Kitts and Nevis 17 15 0% No Cases Saint Lucia 22 19 0% Sporadic cases Saint Martin 44 3 37 0% Sporadic cases Saint Pierre and Miquelon 2 1 0% No Cases Saint Vincent and the Grenadines 29 29 0% Sporadic cases Sint Maarten 78 15 63 0% No Cases 729 18 481 0% Clusters of cases Trinidad and Tobago 133 8 120 0% Sporadic cases Turks and Caicos 66 2 10 0% Clusters of cases Virgin Islands (UK) 8 1 7 0% No Cases Virgin Islands (US) 167 6 92 9% Clusters of cases Subtotal 71,092 1,439 31,457 3% Total 6,540,222 283,357 3,019,867 2% NOTES: Case and death counts may include both confirmed and probable classifications depending on the reporting Member State. Recovered counts as indicated and defined by reporting Member States. To date, rapid diagnostic tests (RDTs) are not recommended for use by WHO. Data is updated on a weekly basis for Guadeloupe, Martinique, Nicaragua, and Saint Martin."'

United States of America: Case and death counts includes both confirmed and probable classifications, as published on the U.S. Centers for Disease Control and Prevention (US CDC) website on 11 July (for data confirmed at 16:00 EST the previous day). Excludes counts for Guam, Commonwealth of the Northern Marianas, Puerto Rico, and the United States Virgin Islands. Sources: https://bit.ly/2WJN2dd and https://bit.ly/2zUMSZ1. Recovered counts as reported by state and territorial health authorities, available at the COVID Tracking Project https://bit.ly/2ztbRC6

Chile: Confirmed cases include both symptomatic and asymptomatic PCR-positive cases, as defined by the Chile MoH. Total deaths include probable deaths. Recovered cases are based on symptom onset date. Available at: https://bit.ly/2KQ99Jw and https://bit.ly/3hJUtuI

Ecuador: Aggregated case total as reported by the Ecuador Ministry of Public Health (56845 positive by RT-PCR + 8956 by RDTs). To date, these RDTs are not recommended for use by WHO. The Ecuador Ministry of Public Health reports an additional 3289 'probable deaths' under investigation that are not included in this table. Recovered counts are the sum of the recovered patients, hospital discharges, and epidemiological discharges as per the Ecuador Ministry of Public Health. Available at: https://bit.ly/2RZtqjR

Mexico: Recovered counts as reported by the Mexico MoH, as defined as all those positive for SARS-CoV-2 with a symptom onset date of more than 14 days, with no date of death, available at: https://bit.ly/3bIOdz0

Peru: Aggregated case total as reported by the Peru MoH (81835 by RT-PCR + 237811 by RDTs). To date, these RDTs are not recommended for use by WHO.

Puerto Rico: Aggregated case total as reported by the Puerto Rico Department of Health (DoH); 2435 were positive by RT-PCR and 6931 were positive by serological tests. Total deaths include probable deaths. Available at: https://bit.ly/2VvjksQ