For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 321. 16 December 2020 Dec 16 COVID-19 Situation Report 321 Centre for Infectious Disease Epidemiology and Research (CIDER) For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 321. 16 December 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 research For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 321. 16 December 2020 ii. Global Risk Assessment Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 16 Dec 2020, 15:00 SGT) Severity of Availability of Treatment/ Overall Environmental Risk Transmissibility Disease Vaccination# Risk Global (n=197 countries) High Moderate High Limited Globally, 187 (94.9%) countries Based on CDC Case Researchers have found all regimens of * (excluding territories ) have data, median R0 is fatality rate anticoagulants to be far superior to no reported the outbreak. estimated to be is currently anticoagulants in COVID-19 patients. More 5.8 (95% CI 4.4– at 2.22% specifically, patients on both a “therapeutic” Using an incidence >20 7.7), but the globally. or full dose and those on a “prophylactic” or cases/100,000 people over the estimated Most cases lower dose, showed about a 50% higher past 14-days as cut-off for a effective present as chance of survival and roughly a 30% lower surge in cases, the number of reproduction flu-like chance of intubation, than those not on countries reporting a surge in number in 175 illness. anticoagulants. It was observed that cases in each region are as countries ranged therapeutic and prophylactic subcutaneous follows: Combined WPRO and from 0.3 to 2.2.$ low-molecular weight heparin and therapeutic SEARO (9 countries), oral apixaban may lead to better results [3]. EURO (50 countries), EMRO (13 countries), Americas International clinical trials published on 2 (24 countries), and Africa (6 September confirm that cheap, widely countries). available steroid drugs can help seriously ill patients survive Covid-19. The World Health Only 5 (3%) countries/territories Organization issued new treatment guidance, have no reported restrictions on strongly recommending steroids to treat inbound arrivals, while 143 severely and critically ill patients, but not to (77%) countries/territories have those with mild disease. [4] partially reopened their borders – require arrivals to produce a According to the World Health Organisation, High negative COVID-19 test result 48 potential vaccines are currently in clinical and/or undergo self-quarantine trials, but only 11 are in phase 3 as of upon arrival. 52 (28%) November 21. [5] countries/territories remain totally closed to international arrivals. [1] On October 7, the Centers for Disease Control and Prevention (CDC) confirmed airborne transmission of SARS-CoV-2. [2] The U.S. CDC has revised its guidelines regarding COVID-19 quarantine period, from 14 days to seven to 10 days, depending on one's test results and symptoms. If individuals do not develop symptoms, they only need quarantine for 10 days without testing; if they test negative, that period can be reduced to seven days. [39] 2 | P a g e Centre for infectious di sease epidemiology and research For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 321. 16 December 2020 Western Pacific Region and South-East Asia Region (n=41 countries) High Moderate Moderate Limited 32 (78.1%) countries have As of December Case As of October, Japan, Singapore, India and reported outbreaks; but only 9 14, the estimated fatality rate Australia, and Indonesia have approved the (22%) are reporting a surge in effective is 1.55%. use of Remdesivir for treatment. [6,7,8,9,10] cases. reproduction no. of 22 countries As of August, Japan and Taiwan have approved 15 (36.6%) countries have either ranged from 0.31- the use of Dexamethasone for treatment. a constant decreasing change in 1.3.$ [11,12] incidence or no case in the last 14 days. As of October, India and Indonesia have approved the use of Favipiravir for treatment. Highest incidence over the past [13] 14 days were reported from Malaysia, Maldives, Myanmar, As of June 25, the Ad5-nCoV developed by the Nepal and Sri Lanka and highest military and CanSino Biologics has been case numbers were reported approved for military use for a year. While from Bangladesh, India, phase 1 and 2 clinical tirals have shown its Indonesia, Japan and Malaysia. potential, its commercial success cannot be High guaranteed. [14] At least 17 countries have closed their borders, 25 Only July 22, China approved the emergency countries have opened their use of vaccine by Sinopharm. High risk group borders partially conditionally, such as medical workers, customs and border and none are allowing free officials were eligible to receive the vaccine. travel. [15] On Dec 3, Indonesia approved the use of vaccines from local pharmaceutical company PT Bio Farma, United Kingdom-based AstaZeneca, China’s Sinopharm/Sinovac Biotech, US pharma Moderna and Pfizer/BioNTech for vaccination programs. [16] As of December 15, Singapore has approved the use of Pfizer’s vaccine. [38] European Region (n=53 countries) High Moderate Moderate Limited 52 (98.1%) countries have As of December Case As of May, Britain started providing Remdesivir reported with outbreaks; 50 14, the estimated fatality rate to COVID-19 patients who are most likely to (94.3%) countries are reporting effective is 2.14%. benefit [17]. a surge in cases. reproduction no. of 52 countries Russia secured regulatory approval for the use 1 (1.9%) country has either a ranged from 0.59- of its antiviral drug Coronavir, to treat mild and High constant decreasing change in 1.5.$ moderate patients of Covid-19 [18]. incidence or no case in the last 14 days. As of 2 December, UK has granted emergency authorization for Pfizer-BioNTech’s COVID-19 Highest incidence over the past vaccine and will start rolling it out next week. 14 days were reported from It is set to prioritize healthcare workers, eldery Croatia, Georgia, Lithuania, and other vulnerable population. [19] Luxembourg and Turkey, and 3 | P a g e Centre for infectious di sease epidemiology and research For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 321. 16 December 2020 highest case numbers were Moscow began its first mass vaccination by reported from Germany, Italy, distributing the Sputnik V COVID-19 shot via 70 Russia, Turkey and UK. clinics on Dec 5. Vaccine would first be made available to doctors and other medical At least 7 countries have closed workers, teachers and social workers. [20] their borders, 44 countries have opened their borders partially As of December 8, the UK has begun mass conditionally, and only 2 vaccination using Pfizer’s vaccine. [40] countries are allowing free travel. Eastern Mediterranean Region (n=22 countries) High Moderate High Limited 22 (100%) countries have As of December Case A As of April, an Israeli firm is using placenta reported with outbreak; 13 14, the estimated fatality rate pluristem cells to treat COVID-19 patients on a (59.1%) countries are reporting effective is 2.49%. compassionate use basis. [21] a surge in cases. reproduction no. of 22 countries As of June 25, the Abu Dhabi Stem Cell Centre No country has either a constant ranged from 0.64- has treated more than 2,000 COVID-19 decreasing change in incidence 1.3.$ patients using UAECell19. 1,200 have fully or no case in the last 14 days. recovered. [22] Highest incidence over the past Bahrain has granted emergency approval for 14 days were reported from the use of a COVID-19 vaccine candidate on Iran, Jordan, Lebanon, Palestine frontline workers from Nov 3. The vaccine and UAE, and highest case candidate is a partnership between numbers were reported from Sinopharm’s China National Biotec Group Iran, Jordan, Morocco, Pakistan (CNBG) and Abu Dhabi-based artificial and Palestine. intelligence and cloud computing company Group 42 (G42). [23] At least 7 countries have closed their borders, 14 countries have As of December 14, Bahrain and Kuwait have opened their borders partially granted emergency use authorisation for the High conditionally, and only 1 country Pfizer/BioNTech COVID-19 vaccine. [24,25] is allowing free travel. As of December 9, Israel received its first shipment of Pfizer vaccines and plans to start administering the vaccines on Dec 20.