WHO Encourages Continued Vigilance As Lockdowns Are Eased; Several Areas of Concern Persist

Worldwide – May 6, 2020

WHO Encourages Continued Vigilance as Lockdowns Are Eased; Several Areas of Concern Persist

Authors: Stephanie Kiefer, Senior Regional Analyst – Europe, the Caucasus, & Central Asia Samson Sampson, Senior Regional Analyst – Middle East & North Africa Kimberly Doyle, Senior Regional Analyst – Sub-Saharan Africa Zachary Nelson, Senior Regional Analyst – Latin America & the Caribbean Josh Strongin, Lead Intelligence Analyst – North America Zachary Huffman, Regional Analyst – Asia/Pacific Contact: [email protected]

OVERVIEW The global number of confirmed cases of novel coronavirus (COVID-19) has exceeded 3.6 million people and more than 256,000 associated deaths have been reported, according to Johns Hopkins University. On May 1, the World Health Organization (WHO) said that the COVID-19 pandemic remains a public health emergency of international concern, the organization’s uppermost alarm level. Following a meeting of independent international experts evaluating the WHO’s recommendations on COVID-19 and the status of the pandemic, the next such meeting to assess the progression of the pandemic is to occur within 90 days.

The WHO cautioned last week that Europe continues to be “very much in the grip” of the pandemic and vigilance has been encouraged to mitigate the dangers of any severe resurgence. Many countries in Europe have gradually advanced with the easing of nationwide lockdowns without notable sustained spikes in new cases to date. However, active outbreaks in Russia and elsewhere around the world, including but not limited to the United States and Brazil, continue to be areas of concern.

Cumulative COVID-19 Cases per 100,000, as of Tuesday, May 5

Source: European Centre for Disease Prevention and Control (ECDC)

SPREAD OF COVID-19: EUROPE

Many European countries are continuing with a planned easing of restrictions, with no initial signs of serious and persistent revivals of an outbreak in those countries where some measures have already been scaled back. The outbreak in Russia continues to be of concern, as the pace of spread is rapid and there are reports of persistent shortages of supplies for healthcare workers. European Centre for Disease Prevention and Control (ECDC) Director Andrea Ammon recently updated the European Parliament on the outbreak in Europe, noting that Bulgaria was the only one of 31 countries in the region monitored by the ECDC that is still having an increase in confirmed daily cases. Ammon also reported that there had not been substantial changes for two weeks prior in Poland, Romania, Sweden, and the United Kingdom, indicating the stabilization of outbreaks in those countries.

Distribution of New Confirmed COVID-19 Cases Per Day in EU/EEA and UK

Source: European Centre for Disease Prevention and Control (ECDC)

• Belarus remains an outlier in Europe as it continues to resist a nationwide lockdown, and President Alexander Lukashenko recently said that he is continuing with plans for the annual military parade on May 9 to commemorate the end of World War II in Europe. • On Thursday, Poland’s parliament is scheduled to decide whether the planned presidential election on May 10 will go ahead via postal ballot. Poland has eased some lockdown restrictions this week, though concerns persist over the timing of the election during the COVID-19 crisis. • New car sales in the UK for April crashed to similar levels as other countries earlier hit by COVID-19 and associated lockdowns, with new car registrations down by 97 percent. • Austria said on May 5 that the initial easing of lockdown measures three weeks ago had not resulted in a spike in COVID-19 cases, as the virus growth rate has remained low. • Spanish Prime Minister Pedro Sanchez plans to seek an extension to the country’s state of alarm from parliament on Wednesday, though the vote is expected to be contentious. The current state of alarm expires on May 9, and each two-week extension requires parliamentary approval.

• Ireland published a five-phase roadmap for easing restrictions from May 18 into August, which can be found here: https://www.gov.ie/en/news/58bc8b-taoiseach-announces-roadmap-for- reopening-society-and-business-and-u/. • The UK’s lockdown has freed up resources for police to pursue people wanted by authorities, according to a senior London officer, including cracking down on “county lines” narcotics dealing. • The eurozone economy contracted by 3.5 percent in the first quarter of 2020, while the European Union’s gross national product declined by 3.5 percent for the same period. The European Central Bank has warned of a potential 5-12 percent contraction of the eurozone economy for 2020. • The European Commission reported that its general economic sentiment indicator had a bloc- wide 28.8-point drop to 65.8 in April, representing a substantial decline in confidence across business sectors and by consumers. • Norway plans to cut its oil production by 13 percent in response to the global drop in demand. • Spain’s economy minister has warned of a possible 9.2 percent drop in GDP this year, but anticipates swift recovery progress in 2021. Updates Around the Region

Germany On May 5, German health officials reported that the rate of COVID-19 reproduction in the country is about 0.71, continuing a recent declining trend despite limited lockdown easing since late April. As Germany continues with steps to ease restrictions, there is state-by-state variance in the rollback of lockdown measures that is expected to continue through the coming weeks and months due to the country’s federal system. On May 5, the Bavarian prime minister announced that outdoor dining establishments would be permitted to reopen from May 18, with provisions in place for sufficient distancing and hygiene precautions. A week later, indoor dining facilities can reopen to the public. The Bavarian prime minister also noted that hotels will be able to open from May 30. Chancellor Angela Merkel will be meeting with state premiers on May 6 regarding further easing of lockdown measures and potential efforts to coordinate at a national level and/or between states.

France Daily deaths have overall been decreasing, though increases in the daily figures were reported on May 4 and 5, with more than 25,500 deaths in total in the country attributed to COVID-19. Despite the recent uptick, the number of COVID-19 hospitalizations and intensive care patients has been declining. A team of doctors at a Paris hospital released a study this week that had involved recent tests of some patients’ samples who had received hospital care prior to COVID-19’s known presence in the country, with one sample from December testing positive for COVID-19. The patient had not recently traveled internationally, raising the prospect that the virus was in circulation around France considerably earlier than the initial official reports of first infections in late January.

The French government plans to release a map of the country on May 7 with each department assigned as red or green, indicating whether lockdown rollbacks can take place. Potential changes to lockdown measures across the country will be able to commence from May 11. President Emmanuel Macron cautioned French citizens on May 5 that it is still too soon to consider vacations, particularly

the busy summer period, suggesting that there may be limits on international travel, such as restricting holidays to within Europe. However, he indicated that more clarity on the topic is anticipated in early June.

Italy Italy’s active case count has declined to 98,467, another sign that the spread of the outbreak in the country continues to stabilize while regions undertake varying degrees of reopening from lockdown. With the cautious relaxing of measures this week, it is estimated that four million people are able to resume work around the country. Many nonessential retail businesses are still closed and restaurants are limited to takeaway services. Manufacturing has been restarting this week along with the opening up of the textile sector. In Venice, shop owners recently held a flash mob protest to call for the more shops and other businesses to be allowed to reopen.

Russia On May 5, Russia continued a string of daily reports of confirmed new COVID-19 cases exceeding 10,000, with the total number of confirmed infections in the country surpassing 155,000 and 1,451 total deaths. As the outbreak continues to spread across the country and Moscow remains the epicenter of the country’s outbreak, some two dozen hospitals have been forced to close and undergo quarantine. Shortages of personal protective equipment (PPE) are ongoing challenges for healthcare workers. There have also been reports of medical personnel being afraid to speak openly regarding the outbreak, with suspicions raised after three healthcare workers in recent weeks fell from hospital windows, two of whom died and the third was being kept in hospital for treatment of sustained injuries.

United Kingdom UK officials at the government’s daily COVID-19 briefing on May 5 said that the daily confirmed case levels remain higher than preferable, while the reproduction rate of the virus (the average number of how many others are infected by someone who has contracted COVID-19) remains between 0.6 and 0.9 in the UK. Also on May 5, the UK’s Office for National Statistics (ONS), which compiles statistics on COVID-19 fatalities from death certificates referencing COVID-19, reported that there had been more than 7,000 deaths not previously included in official figures. The ONS statistics bring the total COVID-19 deaths counted by the UK government to 32,313, surpassing Italy as the highest death toll in a European country, though British officials had noted that different countries tally COVID-19 fatalities in different ways. The latest data has spurred persistent criticism that the British government was slow to take action against the outbreak and the country now appears to be among the hardest- hit nations in the region.

The government is due to review lockdown measures by May 7; Prime Minister Boris Johnson is expected within the coming days to set forth the government’s plan for easing lockdown measures and provide corresponding guidance to workplaces reopening. That presentation is anticipated on Sunday, though shifts on the timing of publicizing the long-sought roadmap for reopening cannot be ruled out. Extensive modifications to restrictions are not currently anticipated due to the continued elevated levels of new confirmed cases daily.

Confirmed Cases Worldwide as of Tuesday Morning, May 5 Country/Region May 5 April 28 Country/Region May 5 April 28 United States 1,180,634 988,451 South Korea 10,804 10,752 Spain 218,011 209,465 Bangladesh 10,143 5,913 Italy 211,938 199,414 Denmark 9,670 8,698 United Kingdom 190,584 157,149 Serbia 9,557 8,275 Germany 163,860 156,337 Philippines 9,485 7,777 Russia 145,268 87,147 Dominican Republic 8,235 6,135 France 131,863 128,339 Colombia 7,973 5,597 Turkey 127,659 112,261 Norway 7,847 7,533 Brazil 107,780 66,501 Czech Republic 7,819 7,449 Iran 98,647 91,472 Panama 7,387 6,021 Mainland China 82,881 82,836 South Africa 7,220 4,793 Canada 60,772 48,489 Australia 6,825 6,725 Belgium 50,267 46,687 Egypt 6,813 4,782 Peru 47,372 28,699 Malaysia 6,353 5,820 India 46,433 29,435 Finland 5,327 4,695 Netherlands 40,770 38,245 Kuwait 5,278 3,288 Ecuador 31,881 23,240 Morocco 5,043 4,120 Switzerland 29,898 29,081 Argentina 4,874 3,990 Saudi Arabia 28,656 18,811 Algeria 4,648 3,517 Portugal 25,524 24,027 Moldova 4,248 3,481 Mexico 24,905 15,529 Kazakhstan 4,121 2,860 Sweden 22,721 18,926 Luxembourg 3,828 3,729 Ireland 21,722 19,648 Bahrain 3,533 2,723 Pakistan 21,501 14,079 Hungary 3,065 2,649 Chile 20,643 13,813 Thailand 2,987 2,938 Singapore 18,778 14,423 Afghanistan 2,894 1,703 Belarus 17,489 11,289 Nigeria 2,802 1,337 Israel 16,246 15,466 Ghana 2,719 1,550 Qatar 16,191 11,244 Oman 2,637 2,049 Austria 15,621 15,256 Greece 2,632 2,534 Japan 15,231 13,576 Armenia 2,507 1,867 United Arab Emirates 14,730 10,839 Iraq 2,346 1,847 Poland 14,006 11,902 Uzbekistan 2,189 1,904 Romania 13,512 11,339 Cameroon 2,104 1,621 Ukraine 12,331 9,009 Croatia 2,101 2,039 Indonesia 11,587 9,096 Azerbaijan 1,984 1,678 Source: European Centre for Disease Prevention and Control (ECDC), and various media outlets

Confirmed Cases Worldwide as of Tuesday Morning, May 5 April May April Country/Region May 5 Country/Region 28 5 28 Bosnia and Herzegovina 1,926 1,564 Georgia 593 497 Puerto Rico 1,843 1,389 El Salvador 587 323 Iceland 1,799 1,792 San Marino 582 538 Guinea 1,710 1,163 Mali 580 408 Estonia 1,703 1,647 Maldives 551 214 Bolivia 1,681 1,014 Palestine 524 495 Cuba 1,668 1,389 Kenya 490 363 Bulgaria 1,652 1,363 Malta 480 450 North Macedonia 1,518 1,399 United Republic of Tanzania 480 300 Slovenia 1,439 1,407 Jamaica 471 364 Cote dIvoire 1,432 1,164 Jordan 465 449 Lithuania 1,419 1,449 Taiwan 438 429 Slovakia 1,413 1,381 Paraguay 415 230 Senegal 1,271 735 Guinea Bissau 413 73 Honduras 1,178 693 Gabon 367 211 New Zealand 1,137 1,124 Venezuela 361 329 Djibouti 1,116 1,035 Mauritius 334 334 Hong Kong 1,040 1,037 Isle of Man 325 308 Tunisia 1,018 967 Montenegro 323 321 Latvia 896 818 Equatorial Guinea 315 258 Cyprus 874 822 Jersey 293 283 Kosovo 855 780 Vietnam 271 270 Kyrgyzstan 843 708 Rwanda 261 207 Albania 803 736 Guernsey 252 247 Somalia 756 480 Congo 236 207 Niger 755 701 Tajikistan 230 0 Sri Lanka 755 588 Faroe Islands 187 187 Andorra 750 743 Sierra Leone 178 99 Costa Rica 742 697 Cape Verde 175 109 Lebanon 740 710 Sao Tome and Principe 174 8 Guatemala 730 530 Liberia 166 133 Diamond Princess Cruise Ship 696 696 Myanmar 161 146 Democratic Republic of the Congo 684 471 Guam 149 144 Sudan 678 275 Madagascar 149 128 Burkina Faso 672 635 Gibraltar 144 141 Uruguay 657 620 Ethiopia 140 124 Source: European Centre for Disease Prevention and Control (ECDC), and various media outlets

Confirmed Cases Worldwide as of Tuesday Morning, May 5 April April Country/Region May 5 Country/Region May 5 28 28 Brunei Darussalam 138 138 Timor Leste 24 24 Zambia 137 89 Botswana 23 22 Togo 126 99 Grenada 21 18 Cambodia 122 122 Laos 19 19 Chad 117 46 Burundi 19 15 Trinidad and Tobago 116 116 New Caledonia 18 18 Eswatini 116 65 Belize 18 18 Bermuda 115 110 Fiji 18 18 Aruba 100 100 Saint Lucia 18 15 Haiti 100 76 Saint Vincent and the Grenadines 17 15 Uganda 97 79 Gambia 17 10 Benin 96 64 Namibia 16 16 Monaco 95 95 Dominica 16 16 Central African Republic 94 50 Curaçao 16 16 Guyana 92 74 Saint Kitts and Nevis 15 15 Liechtenstein 83 83 Nicaragua 15 13 Bahamas 83 80 Northern Mariana Islands 14 14 Barbados 82 80 Falkland Islands (Malvinas) 13 13 Nepal 82 52 Turks and Caicos islands 12 12 Mozambique 80 76 Yemen 12 1 Sint Maarten 76 75 Greenland 11 11 Cayman Islands 75 70 Montserrat 11 11 United States Virgin Islands 66 59 Seychelles 11 11 Libya 63 61 Holy See 11 9 French Polynesia 58 58 Suriname 10 10 South Sudan 46 6 Papua New Guinea 8 8 Macau 45 45 Mauritania 8 7 Syria 44 43 Bhutan 7 7 Mongolia 41 38 British Virgin Islands 7 6 Malawi 41 36 Bonaire, Saint Eustatius and Saba 6 6 Eritrea 39 39 Western Sahara 6 6 Angola 35 27 Comoros 4 0 Zimbabwe 34 32 Anguilla 3 3 Antigua and Barbuda 25 24 Source: European Centre for Disease Prevention and Control (ECDC), and various media outlets

SPREAD OF COVID-19: ASIA/PACIFIC

The number of confirmed COVID-19 cases in the Asia-Pacific region has risen to more than 226,000, a 17 percent increase over last week. The death toll is now at more than 8,900, which represents a 13 percent increase over the previous week.

East Asia

Japan • Tokyo, which remains the epicenter of the outbreak in Japan, reported 58 new cases on May 5, the third day in a row of fewer than 100 new cases, which could indicate that the outbreak has begun to stabilize. Continued low rates of testing, however, make it difficult to definitively point to a decline in the outbreak. More than 150,000 COVID-19 tests have been carried out as of May 4. • On May 4, Prime Minister Shinzo Abe extended the nationwide state of emergency until May 31, although he said the government would reevaluate the situation on May 14 and that there is a possibility that the emergency will be lifted before the end of the month. The measure had previously been set to expire on May 6. The extension was issued with the government pointing to decreased numbers of new cases but stating that the decrease was not as great as had been targeted. The past week has seen new daily cases in the country of around 300 or less, with the government eyeing a goal of fewer than 100 new daily cases nationwide. o A primary reason for the extension of the state of emergency is that the medical system remains strained by the high volume of patients and it is feared that lifting restrictions now could lead to a surge in patients and a resulting collapse in the healthcare system. ▪ The city government in Tokyo has acquired five hotels that are being used to house patients who exhibit more mild symptoms of COVID-19 in order to free up space in hospitals. The city currently has around 1,500 such rooms available but plans to raise that number to around 2,800. o As governments in Japan lack the authority to order business closures and can instead only make recommendations, the city government in Tokyo announced on May 5, that it would offer additional financial assistance to businesses such as restaurants and bars that agree to remain closed during the extended state of emergency. o Even under the extended state of emergency, business restrictions will be eased in some less affected prefectures. ▪ Museums, parks, and libraries are also expected to reopen provided they carry out social distancing measures. China • Hubei Province, where COVID-19 originated, on May 2, lowered its virus response to level two from level one on a four-tier system. The lower rating loosens some travel and quarantine restrictions for domestic travelers and comes as China’s situation remains largely stabilized. • Shanghai Disneyland is planning to carry out a phased reopening of the park on May 11. Enhanced safety measures will be implemented, such as physical distancing requirements

throughout the park, limitations on guest capacity, increased cleaning and disinfection procedures, and requiring advance registration prior to arrival. South Korea • The government announced on May 4 that beginning May 6, the country will enter its next phase of virus response referred to as “routine distancing” or “everyday life quarantine.” Under this new phase, most business and other activities will be normal albeit with social distancing procedures added, with people being advised to remain at home when sick, wear a mask when not at home, maintain six feet of social distance from others, and other recommendations. Schools are reopening across the country gradually. Southeast Asia

Singapore • The number of new infections among Singapore’s population of migrant workers remains high, with 568 of the 573 new confirmed cases on May 4 being discovered in that group. Community transmission within the rest of the population appears to be stabilized. o The government is now working to find temporary housing for recovered migrant workers outside of their usual dormitories that are often overcrowded. New housing arrangements for workers could also lead to transportation and other disruptions to businesses depending on how far workers must travel to their worksites. • Although Singapore’s “circuit breaker” lockdown will remain in place until June 1, officials announced on May 3 that some businesses will be allowed to resume operations on May 12 with safeguards in place like increased social distancing and continued remote work when possible. Additional health checks are likely to be implemented in some instances, including at some work locations. o This loosening of restrictions will be done in phases, with priority given to industrial and manufacturing businesses, and entertainment and social businesses probably not opening until later. ▪ Manufacturing output in Singapore was down in April for the third month in a row due both to lockdown measures and to lowered global demand caused by COVID-19-related disruptions. Indonesia • Although COVID-19 testing in Indonesia remains sparse, with fewer than 90,000 people currently tested, the country continues to report high numbers of new daily cases. May 5 saw a record 484 new cases confirmed. • Manufacturing output in Indonesia dropped sharply in April from March due to lockdown restrictions and lowered product demand abroad. According to the government, around 2.8 million people were out of work by the middle of April due to COVID-19-related disruptions, with officials estimating that as many as 5.2 million people in total may lose their jobs due to the outbreak. • President Joko Widodo reported on Monday that around 89,000 Indonesian migrant workers have returned from abroad over the past several weeks, with some 16,000 more expected in the near future. The government is concerned about the potential for additional COVID-19

cases to be imported with returning workers and plans to quarantine all returning Indonesians for 14 days. Philippines • New daily cases of COVID-19 in the Philippines have hovered around the 150 to high 200s range for the past week, with most new cases being reported in Metro Manila. The government continues to ramp up testing efforts, with 20,000 tests expected to be completed daily by May 15 and a goal in place of 30,000 daily tests by the end of the month. The number of labs able to analyze COVID-19 swab tests is also planned to increase to 78 by the end of May from the present 22. o The government also intends to increase the use of mass testing, including in the Metro Manila area. Currently, testing is restricted primarily to people exhibiting more severe symptoms and those considered to be more vulnerable to infection. South Asia

India • The number of new COVID-19 cases in India spiked on May 4 to 3,900. This is due at least in part to increased testing across the country. India, which previously had a very low test rate, has been working to raise the number of daily tests conducted, reaching approximately 80,000 tests being carried out on May 4. The government’s goal is 100,000 tests per day by the end of the month. o The previously lower rate of testing makes it hard to judge the situation based solely on the high daily numbers being reported now; however, the fact that the country has been under lockdown conditions for over a month makes the continuing high numbers concerning, even if the sudden spike is largely attributable to increased testing. • On May 1, the government extended the country’s lockdown until May 18. Restrictions were relaxed in some areas, although most major metro areas remain classified as “red zones” where heavy restrictions will remain in place. o Some additional retail locations were able to open on May 4 with enhanced social distancing procedures in place, even in more impacted areas. Media sources, though, reported long lines at some locations, particularly outside liquor stores in multiple cities, and local officials in Delhi threatened to close newly opened shops that did not maintain social distancing both inside and outside. o Some additional restrictions have been relaxed in red zones despite the continuation of regulations: ▪ Private offices may reopen with 33 percent of their normal in-person workforce and remaining employees working from home. ▪ Several industrial sectors may resume operations, including pharmaceutical and medical production facilities, IT locations, jute mills, and packaging facilities. ▪ Some construction work may resume. ▪ Online retailers supplying essential goods may resume operations. o Less restrictive “orange zones” and “green zones” continue to regulate traffic to varying degrees.

Bangladesh • The number of new cases in Bangladesh reached a daily record of 688 on May 4. • Bangladesh is now carrying out around 5,000 tests per day and updated reports indicate that the country has tested as many as 80,000 people in total as of May 3. The testing rate remains low, and the actual number of cases is likely much higher, especially as daily cases continue to increase while testing is expanded. • The country’s lockdown has been extended to May 16, although some sectors have already been allowed to resume operations. o Many garment factories reopened last week, and additional factories are expected to gradually restart. o Farm operations will resume slowly. o Shopping complexes and malls have begun to reopen, some with reduced opening hours. Maldives • The number of confirmed cases in the Maldives continues to rise sharply, with 557 reported on May 5 up from 277 on April 30. • Over half of the country’s cases have been confirmed in Bangladeshi migrant workers, most in the capital Malé. o The government is now taking steps to relocate migrant workers who may have been exposed to the virus to government facilities for quarantine. Many workers live in crowded apartment buildings where social distancing is difficult or impossible to achieve. Oceania

Australia and New Zealand New Zealand Prime Minister Jacinda Ardern participated in an Australian cabinet meeting on May 5, after which she and Australian Prime Minister Scott Morrison promised to continue working towards a “trans-Tasman bubble” that would allow travel between the two countries to resume. Both officials said that more progress needed to be made before free travel becomes possible and offered no timeline for a resumption of travel. New Zealand reported no new cases of COVID-19 on May 5, while Australia reported only 25.

States Reporting COVID-19 Cases as of Tuesday, May 5

Source: U.S. Centers for Disease Control and Prevention (CDC)

SPREAD OF COVID-19: NORTH AMERICA

United States The United States continues to show signs of a stabilized COVID-19 outbreak. Over the last three weeks, daily case numbers have largely remained between 25,000 to 30,000 while daily death numbers have averaged between 1,500-2,000. Though stabilization appears to have been reached nationally, there has yet to be any evidence of decreases in either cases or deaths and many states and localities, especially outside the New York City metro area, are reporting increases in cases and deaths. Nonetheless, many states have begun relaxing certain restrictions and 14 states have lifted stay-at-home orders as of Tuesday. There remains a significant concern among public health officials that new or worsening outbreaks will occur as states reopen, especially as testing and contact tracing abilities of states remain inadequate. State officials have cautioned that previous restrictions, including stay-at-home orders, may have to be reissued if infection levels begin to rise again. As of Tuesday, 1,194,000 cases and 70,272 deaths have been reported across the United States.

Canada Much like the United States, Canada appears to have hit a stabilization in cases and deaths without seeing signs of a decrease yet. Daily deaths in the country have varied between 120 to 170 while daily case numbers have varied between 1,400 to 1,700. With the stabilization, several provinces have lifted stay-at-home orders or begun the easing of restrictions on nonessential businesses. This includes Alberta, Manitoba, Quebec, and Saskatchewan. Though not to the same extent as the situation in the United States, concern remains among public health officials that reopenings are happening too quickly and may lead to a new surge in cases and reissuance of restrictions. As of Tuesday, at least 61,159 cases and 3,915 deaths have been reported within Canada.

Recent Developments • Various models and projections have increased the projected number of deaths in the U.S. due to COVID-19. The new estimates range between 100,000 to 200,000 deaths by August. The changes are largely attributed to the widespread loosening of restrictions. • Following JetBlue Airways, Delta, American Airlines, and United Airlines have begun to require passengers to wear face coverings in addition to flight attendants. All Canadian airlines had previously required face coverings. • Denver International Airport (DEN) will become the first U.S. airport to require face coverings for passengers, employees, and visitors starting Wednesday, May 6. • Officials are now estimating at least 20,000 COVID-19 deaths in the U.S. are related to assisted living facilities. • On Friday, May 1, a security guard at a Family Dollar store in Flint, MI, was fatally shot by customers after attempting to enforce the state-mandated face covering policy. Three people were arrested. • Wendy’s U.S. restaurants have reported that approximately 18 percent of restaurants across the country are dealing with beef shortages leading to menu items being out of stock. Widespread shortages have not been reported at other restaurant chains or in grocery stores. • However, Kroger has begun to institute purchase limits on ground beef and fresh pork products at certain stores. • The Willow Creek School in Willow Creek, MT, will become the first U.S. school to physically reopen for students. At least 45 states and Washington DC have canceled in-person schooling for the rest of the academic year. • Anti-lockdown protests have continued across the United States over the last week, the most notable involving several thousand people in Huntington Beach, CA, on Friday. While a number of these protests have involved armed individuals, the protests themselves continue to be largely peaceful. It remains to be seen whether protests will continue as restrictions begin to be lifted across various states. • Friday also saw widespread walkouts across the country in conjunction with annual May Day action. Employees with a wide variety of companies participated including Amazon, Whole Foods, Instacart, Walmart, FedEx, Target, and Shipt. No major operational disruptions were reported due to the walkouts. Additional labor actions remain a possibility as workers continue to voice concerns about pay and worker protections in relation to the ongoing COVID-19 outbreak.

SPREAD OF COVID-19: MIDDLE EAST AND NORTH AFRICA

As of this writing, 326,173 cases of COVID-19 have been reported across the Middle East and North Africa (MENA) since the virus first appeared in the region in the United Arab Emirates on January 29. Of these, 11,539 have been fatal. Turkey remains the MENA nation most affected by the coronavirus after surpassing Iran on April 18, though official data suggests that daily jumps in new infections and deaths continue to decline. This appears to be the case for much of the MENA, as the region’s overall coronavirus curve appears to be flattening. This has led a growing number of countries to begin relaxing restrictions and restoring economic activities upended by lockdown measures. However, a

handful of MENA nations continue to witness rapidly increasing COVID-19 case counts, while Afghanistan and Yemen, which previously had relatively paltry case tallies, have begun to witness an acceleration of their outbreaks of late. These countries have been slower to reopen parts of their economy and, in many cases, have extended curfews and restrictions on personal movement. Meanwhile, lengthy coronavirus shutdowns and their associated economic impacts continue to aggravate socioeconomic tensions and prompt localized protests and unrest, while the focus of authorities on combating COVID-19 seems to have created security gaps for the Islamic State (IS) and like-minded militants to exploit.

Although the number of confirmed coronavirus cases in the Middle East and North Africa continues to gradually increase, the region’s overall COVID-19 curve appears to be flattening, with the rate of new infections and deaths slowing.

• COVID-19 cases in the MENA have increased by roughly seven percent since April 28. This represents a decline compared to the period between April 21-28, when the region witnessed an approximately 25-percent increase in new infections. The daily rate of new cases worldwide has ranged between two and three percent over the past week. • Over the past ten days, the MENA region has averaged around 7,000 new cases per day, compared to a peak of almost 10,000 daily infections on April 11. • Authorities in Iran, Jordan, Tunisia, and Turkey claim to have their respective COVID-19 outbreaks under control, while official data suggests that additional countries/territories have or could be approaching the peak of their epidemics, notably Israel, Morocco, and the Palestinian territories. • Conversely, Gulf countries have been witnessing daily case increases upwards of five percent over the past week, with Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates all recording sizeable daily jumps. • Pakistan’s COVID-19 epidemic continues to accelerate, with the country posting its seven highest daily incidence totals over the past seven days. • Likewise, Afghanistan and Yemen, which previously had relatively few coronavirus cases, especially the latter, have seen rises in recent days. • The coronavirus caseloads in Libya and Syria have remained relatively unchanged, with conflict and poor testing regimes widely perceived to be hampering data completeness.

With the rate of new cases and fatalities slowing, more MENA governments have begun easing coronavirus restrictions, though some have adopted uneven approaches to ward against a second wave of contagion or in response to violations of health and social distancing guidelines.

• Countries that have purportedly stabilized the spread of the coronavirus sufficiently are increasingly easing lockdown measures and other COVID-19 containment efforts. • The vast majority of MENA governments are taking a phased approach, allowing businesses and industries to reopen gradually, with limited capacity and precautionary measures, such as wearing personal protective equipment and social distancing, in place. • Iran and Jordan have mostly lifted all restrictions on economic activities and public transportation, though the latter’s land borders remain closed, commercial flights remain halted, and a nightly curfew continues.

• Lebanon is presently in the second phase of its four-stage reopening plan, with restaurants, parks, outdoor sports courts, and barber and auto repair shops allowed to reopen on May 4. The food and agriculture sectors, small and retail shops, sweets shops, hotels, some factories, and the electricity and water sectors were permitted to resume operations from April 27. • Over three million Tunisians began returning to work on May 4 after the government initiated its three-phase coronavirus exit. The sectors involved in the first stage included government administrations, public transport, construction projects, and some shops. • Reportedly amid pressure from its tourism industry, Egypt announced late May 3 that hotels in key regions would be allowed to reopen to domestic travelers, provided they have a clinic with a resident doctor on-site, regularly screen temperatures and disinfect equipment, and keep occupancy rates at no more than 25 percent through May 31. • Bahrain, Saudi Arabia, and the UAE have allowed shopping malls and some retail centers to reopen. • Israeli Prime Minister Benjamin Netanyahu lifted restrictions on inter-city travel, while markets and shopping centers will reopen in the coming days. • Turkish President Recep Tayyip Erdoğan announced the partial easing of anti-virus efforts from May 4, including the lifting of a ban on entry and exit by land, air, and sea to the provinces of Erzurum, Aydin, Hatay, Malatya, Mersin, Antalya, and Mugla, and the relaxing of confinement orders for individuals under the age of 20 and above 65, allowing senior and youth citizens to go outside for four hours for one day a week starting next weekend. • At the same time, in an apparent setback to efforts to ease coronavirus-related restrictions, Iraqi authorities extended a nationwide curfew and ordered a lockdown in Kirkuk to control the spread of COVID-19, while authorities in Saudi Arabia and Oman have placed Dammam’s 2nd Industrial City area and Muscat’s Wadi Kabir Industrial Estate area, respectively, under lockdown. • Additionally, authorities in Algeria and the UAE have shut down several businesses that were recently allowed to reopen for allegedly failing to comply with social distancing and other precautionary measures against COVID-19. • The uneven reopening of local economies and loosening of coronavirus-prompted restrictions signal what will likely be a gradual, incremental return to normalcy, with the potential for curbs on personal movement and social interactions to be reinstated in the event of a resurgence of COVID-19 infections or non-compliance by the public.

The deepening economic impact of the COVID-19 pandemic and governments’ efforts to combat the virus continue to stoke public frustration and socioeconomic grievances, leading to localized protests and unrest. Likewise, regional militant groups appear to be taking advantage of the coronavirus outbreak to increase attacks.

• On May 3, authorities in Kuwait dispersed a so-called riot by expatriate workers from Egypt who were demanding repatriation at an unspecified group shelter, signaling rising tensions and discontent among the emirate’s population of foreign workers over their treatment as the government attempts to curb the spread of COVID-19. • Protesters gathered in Tel Aviv on May 3 to call for financial assistance from the Israeli government in light of the coronavirus-induced economic downturn, while local Arab councils began a strike on May 5 over what they allege is “discrimination” by the state in granting emergency financial relief to local authorities.

• Despite authorities having extended a coronavirus lockdown by two weeks on May 5, as well as the resumption of economic activities and the government’s approval of an economic rescue plan, near-daily protests have occurred in several Lebanese cities and towns in recent weeks over the state’s fiscal policies and deteriorating economic conditions in the country. A continuation of demonstrations that began last year, the renewed gatherings have increasingly turned violent, with bank branches having been frequently targeted in firebomb attacks. • Meanwhile, Islamic State (IS) remnants in Iraq and Syria are said to be capitalizing on local authorities’ focus on curbing the spread of COVID-19 to ramp up attacks. The number of operations claimed by IS reportedly doubled last month, with the organization taking credit for 113 in Iraq alone, up from a monthly average of 49 between January and March. Attacks have also become deadlier and more sophisticated. • In Afghanistan, US military officials have said that Taliban attacks have increased since Washington signed a withdrawal deal with the insurgent movement in late February— reportedly up 70 percent from the same period last year. • The escalation in militant violence has also coincided with the Islamic holy month of Ramadan, when jihadists across the Middle East and North Africa often step up their operations, purportedly based upon the belief that fighters who are killed during this period have a better chance of entering paradise.

SPREAD OF COVID-19: LATIN AMERICA AND THE CARIBBEAN

Throughout Latin America and the Caribbean, at least 275,491 people have tested positive for COVID-19, and the disease has claimed at least 14,530 lives. The region’s caseload increased by roughly 53 percent from the same time last week. Although the infection rate has eased in many countries that have implemented strict movement restrictions, it has continued to climb almost exponentially in Brazil, which is rapidly becoming a global hot spot for the disease. After Brazil’s caseload of 108,620, Peru has the second-highest number of confirmed cases (47,372), followed by Ecuador (31,881), Mexico (24,905), Chile (22,016), and the Dominican Republic (8,480).

Across the region, many federal and state/provincial governments have announced plans to begin scaling back restrictions on businesses. Some have already begun to roll out the first phases of such initiatives, and more plan to do so in the coming weeks. Roughly half of all Latin Americans work in the informal sector, which has been decimated by the pandemic and accompanying lockdown orders. Coupled with the major hits taken by commodity exports and the tourism sector, unemployment has surged and policymakers throughout the region have come under increasing pressure to reopen businesses. The Inter-American Development Bank has surmised that most countries in Latin America would not be able to maintain generalized lockdowns for more than two months, owing to the composition of their economies. While dialing back quarantines and stay-at-home orders will offer a degree of economic relief, the inherent tradeoff is that it will run the risk of causing a rebound in COVID-19 infections. Brazil is a unique outlier, where some cities have only recently announced plans to enact strict lockdowns, following weeks of ineffective half-measures.

Brazil • Recent studies have found the COVID-19 infection rate in Brazil to be among the highest in the world. The case fatality rate of 6.9 percent is the highest in Latin America.

• On May 3rd, President Jair Bolsonaro attended another rally in which he called for the economy to be reopened and criticized governors for enacting COVID-19-related restrictions. He condemned a number of recent rulings that have been issued by the Brazilian Federal Supreme Court, including one that had overturned his categorization of religious gatherings as “essential.” • Global fuel prices remain close to record lows owing to the lockdown orders that remain in effect around the world. Accordingly, Brazil’s state-owned petroleum company, Petrobras, has reduced staffing at its 13 domestic refineries, and decreased output by 200,000 barrels per day. • Meat producer JBS SA has been authorized to reopen a poultry plant in the southern state of Rio Grande do Sul beginning on May 7th. The facility had previously been ordered to close following a COVID-19 outbreak. • Retail outlets and shopping malls in some states (particularly in the south) have reopened with additional health protocols in place. Still, some media outlets claim that sales remain roughly 80 percent lower than average, as many consumers continue to rely on online shopping. • On May 5th, the city of São Luis in the northeastern state of Maranhão was the first major city in the country to implement a strict lockdown. For ten days, residents are barred from traveling outside, except for essential purposes such as purchasing food or medicine. • Fortaleza, the capital of the northeastern state of Ceará, plans to similarly implement a 20-day lockdown beginning on Friday, May 8th.

Ecuador • May 4th marked the beginning of Ecuador’s plan to gradually scale back COVID-19 movement restrictions. The move has been described as a transition from an “isolation phase” to a “social distancing phase.” • The plan to reopen the economy is being guided by a “traffic light system,” which classifies the country’s cities and cantons as red, yellow, or green based upon their number of active COVID-19 cases. The fewer the cases a district has, the fewer restrictions will remain in place on businesses and individual mobility.

Mexico • Recent polls show that a majority of respondents continue to approve of the nationwide lockdown, and President Andrés Manuel López Obrador’s approval rating has increased eight points (to 68 percent) since March. • Deputy Health Secretary López-Gatell announced on May 3rd that Mexico is no longer following the “sentinel” approach to disease surveillance, in which emphasis was placed on broad trends and individual COVID-19 cases were knowingly underreported. Public health officials have instead sought to improve testing capabilities. • Although roughly 25,000 COVID-19 cases have been confirmed in the country, the Mexican Secretariat of Health has stated that the actual caseload most likely exceeds 100,000. • The shutdown of assembly plants that have been deemed “non-essential” by the Mexican government continues to disrupt international supply chains for the auto industry and a range of other sectors. Mexican policymakers have previously indicated that auto plants will likely be authorized to resume at least partial operations at some point in May.

• The governor of Chihuahua State, where are large number of U.S.-owned plants are located, has rejected calls from American business representatives to establish a unique schedule for reopening automotive and aerospace factories. Governor Javier Corral indicated that his state will continue to adhere to federal guidelines. • Local news outlets report that members of the Sinaloa Cartel have begun to enforce a curfew throughout the city of Culiacán, the capital of Sinaloa State. Images that have circulated on social media purportedly depict violators being assaulted with wooden planks.

Argentina • Lawmakers were authorized to resume legislative sessions in Congress on May 4th. However, only 46 legislators are permitted inside the chamber at once, with the others being required to attend remotely. • The governor of the northern province of Jujuy has announced that restaurants, shopping malls, and other businesses will be allowed to resume limited operations with enhanced safety protocols on Saturday, May 9th. The governor claims that the move is warranted because the province has not recorded a new case of COVID-19 in over one month. Other provinces could potentially seek to follow suit. • The government has prohibited the closure of bank accounts for bouncing checks or failing to pay banking fees through June 30th. Utility companies are likewise barred from cutting off service to customers for failing to pay their bills through May 31st.

Uruguay • With one of the lower caseloads in Latin America, Uruguay has adopted a more rapid plan for reopening its economy. Media sources report that roughly 85 percent of businesses were permitted to open over the weekend. • Restaurants, retail outlets, and other commercial establishments have implemented varying health protocols, such as limiting store occupancy, mandating social distancing, and requiring patrons to wear masks.

SPREAD OF COVID-19: SUB-SAHARAN AFRICA

Over the last week, the number of confirmed COVID-19 cases in sub-Saharan Africa has risen to over 30,000. The number of fatalities has also reached more than 700, marking an over 40 percent increase in both confirmed cases and deaths. While the outbreak continues to grow exponentially in a number of countries and territories, notably Nigeria, it appears to be stabilizing in others, especially those that have enacted strict lockdowns or confinement measures and coupled them with increased testing. This includes South Africa, Mauritius, Reunion, and Djibouti. Despite this evidence, an increasing number of countries have announced plans to begin gradually lifting their public health measures. This could help ease tensions and reduce the risk of protests and clashes with security forces; however, there are also persistent concerns that it could lead to a second wave of cases, particularly if not accompanied by an uptick in testing and tracing of potential cases and contacts.

Regional Overview and Trends • As of the morning of Tuesday, May 5, the number of confirmed COVID-19 cases in sub- Saharan Africa has reached at least 30,531. This marks a 48 percent increase in cases compared to last Tuesday, April 28. • The number of fatalities has also risen by approximately 45 percent to 728. This gives the region an overall case fatality ratio of around two percent. • Comoros reported its first confirmed case on April 30, bringing the number of affected countries and territories in the region to 50. Only Lesotho has not reported any confirmed cases. • Over the last week, exponential increases in cases have been recorded in a number of countries, notably Sao Tome and Principe (1913%), South Sudan (717%), Guinea-Bissau (300%), Chad (154%), Sudan (147%), Central African Republic (124%), Nigeria (110%), and Gabon (109%). • No new cases have been recorded in Namibia and Seychelles. • Minimal increases in cases have been reported in several countries, notably Mauritius, Reunion, Djibouti, Botswana, Mozambique, Burkina Faso, and Niger. Most of these countries have introduced strict lockdown or confinement orders and have conducted amongst the highest numbers of tests per capita. • Of the countries that have recorded over 100 confirmed cases, significantly higher-than- average case fatality ratios have occurred in Liberia (11%), Chad (9%), Togo (7%), Burkina Faso (7%), Sudan (6%), Sierra Leone (5%), Mali (5%), the Democratic Republic of the Congo (5%), Niger (5%), Kenya (5%), and Somalia (5%). • Mauritius, Djibouti, and Mayotte have recorded the highest per capita testing rates in the region.

Areas of Concern South Africa remains the worst-affected country in the region, recording over 7,200 cases, or approximately 24 percent of all cases in sub-Saharan Africa. While the number of cases appears to have stabilized in recent weeks, several record-high daily increases in cases have been reported over the last week. This is due largely to increased testing, as the overall number of positive tests remains around three percent; however, it also highlights the high public health risk across the country. The Western Cape has also recorded a significantly higher positive test rate, making it the new epicenter of the outbreak. While the move to Level 4 restrictions has allowed more businesses to reopen, including the mining industry, the Dwarsrivier Chrome Mine was closed on Tuesday, May 4, after an employee tested positive for the virus. This underscores the risk to business operations as the economy begins to slowly reopen.

Nigeria has recorded several record high daily increases in new cases over the last week, rapidly becoming the second-worst-affected country in sub-Saharan Africa. Around half of the cases have occurred in Lagos State, but a growing number have been recorded in Kano State over the last week. The rise in cases is occurring as Nigeria began to lift the lockdown measures in Abuja, Lagos, and Ogun State on May 4. Although it remains unclear if the two developments are linked, there are concerns that authorities have not ramped up testing and tracing capabilities sufficiently to

compensate for the lockdowns. Nigeria has tested less than 1,000 people per day and 20,000 people total.

The number of confirmed cases in Ghana has risen by 75 percent compared to last week, making it the third-worst-affected country in the region. The Greater Accra Region remains the hotspot for transmission, accounting for over 85 percent of all cases in the country. Ghana lifted the lockdowns in the Greater Accra and Kumasi areas on April 20 and although authorities claim that no surge in cases has occurred, there has been little evidence that the outbreak is stabilizing.

Updated Public Health Measures and Security Implications An increasing number of countries and territories have announced plans to begin easing their lockdowns, confinement orders, and other public health measures. This includes Rwanda, Uganda, Burkina Faso, Namibia, Cameroon, Seychelles, and Mauritius. A vast majority of countries are doing so gradually, allowing some retail stores, businesses, and economic sectors to reopen. Domestic flights have also resumed in several locations, including Namibia and Seychelles; however, most international flights remain suspended. Other restrictions on public gatherings, border closures, and curfews largely remain in effect. While some countries such as South Africa and Mauritius have ramped up testing and tracing of potential contacts to compensate for the lifting of the lockdowns, there are concerns that a failure to do so in other countries could lead to a second wave of cases.

Despite the lifting of the lockdowns and confinement orders, protests against these measures and clashes with security forces have continued in multiple locations. In Nigeria, sources reported that four people were killed last weekend in Taraba State as police sought to disperse a cultural festival. In the French overseas territory of Mayotte, ten police officers were injured last weekend in rioting and clashes with protesting residents. There were also reports of looting and stone throwing in Mamoudzou. Additional protests have been reported in recent days in the Mathare area of Nairobi, as well as in several informal settlements across South Africa. Health workers in Kenya have also threatened to embark on a strike over a lack of protective equipment to shield them from COVID-19. While the lifting of the measures is likely to help ease this lockdown fatigue and could reduce the risk of unrest, further protests and violence cannot be ruled out as long as some of these measures remain in place and the economic impacts of the pandemic continue.

ASSESSMENT

The continued stabilization and gradual decline of COVID-19 outbreaks in many countries that have been under prolonged lockdown has drawn support for restrictive measures to combat the spread of the virus, though the full socioeconomic costs of such lockdowns are continuing to materialize. Prolonged lockdowns have also drawn detractors, many of whom oppose the economic disruption and potential personal losses from stringent measures. Around the world, challenges persist in balancing the best interests of public health and the economic welfare of populations, with disinformation campaigns continuing to distort and undermine crisis responses. Furthermore, it remains to be seen how people may respond in the event that an outbreak in a given country or sub- region has a significant resurgence and tighter restrictions could be reintroduced.

Active outbreaks in sizable countries around the world continue to be of concern, and there is intense ongoing global competition for supplies related to the COVID-19 pandemic. More than 100

prospective vaccines are in various stages of development, with about ten vaccine candidates starting the phase of clinical testing. The scope of effective measures to combat COVID-19 outbreaks continue to evolve, as does the global scientific knowledge base of the virus. While the world is likely at least months away still for one or several viable vaccines for COVID-19, the development of effective limited solutions, at least in the interim, to help monitor the spread of the virus and trace possible contacts of infected persons could enable more efficient responses to developing outbreaks or hotspots. However, technology-based solutions such as mobile applications for tracing may be less effective in areas where sizable portions of a population lack smartphones or similar technology used for those tracing methods. It is advised to continue monitoring the shifting pandemic and associated lockdown measures, to abide by national and sub-national restrictions, and to follow guidance from personal healthcare providers as well as national and international health organizations.

About the Author Stephanie Kiefer is the Senior Regional Analyst for Europe, the Caucasus, and Central Asia. Stephanie earned her BA in Political Science and Philosophy from Indiana University, with a year studying abroad at the University of Kent in England. She earned her MA in International Relations from University of Kent’s Brussels School of International Studies, and she has a working familiarity with French. Stephanie has previous experience working for a consulting group and a LexisNexis company in Washington DC.

She can be reached at [email protected].