For citation: Centre for Infectious Disease and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

June 25

COVID-19 Situation Report 469

Centre for Infectious Disease Epidemiology and Research (CIDER) For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

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.

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

ii. Global Risk Assessment

Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 25 June 2021, 1500H SGT) Severity of Availability of Treatment/ Overall Environmental Risk Transmissibility Disease # Risk Global (n=198 countries) High Moderate High Limited

Globally, 188 (95%) countries (excluding Based on CDC Case The number of countries that have * territories ) have reported the outbreak. data, median R0 fatality rate commenced mass vaccination in each is estimated to is currently region are as follows: Combined WPRO Using an incidence >20 cases/100,000 be 5.8 (95% CI at 2.17% and SEARO (33 countries), EURO (53 people over the past 14-days as cut-off for 4.4–7.7), but globally. countries), EMRO (20 countries), a surge in cases, the number of countries the estimated Most cases Americas (34 countries), and Africa (44 reporting a surge in cases in each region effective present as countries).& are as follows: Combined WPRO and reproduction flu-like SEARO (14 countries), number in 175 illness. International clinical trials published on 2 EURO (32 countries), countries September confirm that cheap, widely EMRO (14 countries), Americas (29 ranged from available steroid drugs can help seriously countries), and Africa (12 countries). 0.038 to 3.6.$ ill patients survive Covid-19. The World Health Organization issued new Only 4 (2%) countries/territories have no treatment guidance, strongly reported restrictions on inbound arrivals, recommending steroids to treat severely while 147 (79%) countries/territories have and critically ill patients, but not to those partially reopened their borders – require with mild disease. [4] arrivals to produce a negative COVID-19 test result and/or undergo self-quarantine Researchers have found all regimens of upon arrival. 48 (26%) anticoagulants to be far superior to no countries/territories are totally closed to anticoagulants in COVID-19 patients. international arrivals. [1] More specifically, patients on both a High “therapeutic” or full dose and those on a On October 7, the Centers for Disease “prophylactic” or lower dose, showed Control and Prevention (CDC) confirmed about a 50% higher chance of survival airborne transmission of SARS-CoV-2. [2] and roughly a 30% lower chance of intubation, than those not on The U.S. CDC has revised its guidance on anticoagulants. It was observed that COVID-19 quarantine period from 14 days therapeutic and prophylactic to 7-10 days, based one's test results and subcutaneous low-molecular weight symptoms. Individuals without symptoms heparin and therapeutic oral apixaban only need quarantine for 10 days without may lead to better results. [3] testing; those tested negative can quarantine for 7 days. [14] A new strain known as B.1.525 containing the same E484K mutation The US Centers for Disease Control and found in the Brazilian and South African Prevention (CDC) on 10 Feb announced variants has been detected in Britain that fully vaccinated people did not need [18]. to quarantine if they received their last dose within three months and 14 days after their last shot, the time it takes to develop immunity. [16]

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

Western Pacific Region and South-East Asia Region (n=41 countries) Moderate Moderate Moderate High

32 (78.1%) countries have reported As of June 22 Case 33 countries have commenced outbreaks; but only 14 (34.2%) countries the estimated fatality rate vaccination as of 25 June 2021. Coverage are reporting a surge in cases. effective is 1.41%. was available for the following: i) at least reproduction 1 dose was at <50% for 27 countries; 51- 13 (31.7%) countries have either a no. of 25 70% for 4 countries; >70% for 1 country constant decreasing change in incidence countries ii) full vaccination was at <50% for 21 & or no case in the last 14 days. ranged from countries; 51-70% for 1 country. $ 0.5-1.8. Indonesia has approved Russian drug Highest incidence over the past 14 days Avifavir for emergency use. [22] were reported from Fiji, Malaysia, High Maldives, Mongolia and Sri Lanka and China has approved the use of 3 highest case numbers were reported from traditional chinese medicines, Qingfei Bangladesh, India, Indonesia, Malaysia Paidu Formula, Huashi Baidu Formula and Philippines. and Xuanfei Baidu Formula, for COVID-19 treatment. [20] At least 17 countries have closed their borders, 23 countries have opened their As of 4 June, India has approved a borders partially conditionally, and none is combination of monoclonal antibodies, allowing free travel. bamlanivimab and etesevimab for restricted use in emergency situations in hospital settings in adults [24]. European Region (n=53 countries) High Moderate High High

52 (98.1%) countries have reported with As of June 22, Case 53 countries have commenced outbreaks; 32 (60.4%) countries are the estimated fatality rate vaccination as of 25 June 2021. Coverage reporting a surge in cases. effective is 2.11%. was available for the following i) at least reproduction 1 dose was at <50% for 36 countries and 2 (3.8%) countries have either a constant no. of 51 51-70% for 14 countries, >70% for 2 decreasing change in incidence or no case countries countries; ii) full vaccination was at <50% in the last 14 days. ranged from for 46 countries; 51-70% for 3 countries. 0.36-3.6.$ & Highest incidence over the past 14 days High were reported from Georgia, Kyrgyzstan, On February 28, France authorized its Portugal, Russia and United Kingdom, first ever use of synthetic monoclonal and highest case numbers were reported antibody, bamlanivab by Eli Lilly, for use from France, Russia, Spain, Turkey and on severe COVID-19 patients. [19] United Kingdom. As of February 14, Italy authorized the At least 6 countries have closed their use of the two monoclonal antibodies of borders, 46 countries have opened their companies Eli Lilly and Regeneron aimed borders partially conditionally, and only 1 mainly at more serious patients with country is allowing free travel. COVID-19 [17]. Eastern Mediterranean Region (n=22 countries) High Moderate Moderate High

22 (100%) countries have reported with As of June 22, Case 20 countries have commenced outbreak; 14 (63.6%) countries are the estimated fatality rate vaccination as of 25 June 2021. Coverage High reporting a surge in cases. effective is 1.98%. was available for the following: i) at least reproduction 1 dose was at <50% for 16 countries; 51- no. of 20 70% for 1 country; >70% for 1 country ii) countries

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

No (0%) country has either a constant ranged from full vaccination was at <50% for 12 decreasing change in incidence or no case 0.5-1.2.$ countries; 51-70% for 1 country. & in the last 14 days. As of June 25, the Abu Dhabi Stem Cell Highest incidence over the past 14 days Centre has treated more than 2,000 were reported from Bahrain, Kuwait, COVID-19 patients using UAECell19. Oman, Tunisia, and UAE, and highest case 1,200 have fully recovered. [6] numbers were reported from Iran, Iraq, Oman, Tunisia and UAE. As of April, an Israeli firm is using placenta pluristem cells to treat COVID- At least 5 countries have closed their 19 patients on a compassionate use borders, 16 countries have opened their basis. [5] borders partially conditionally, and only 1 country is allowing free travel. As of June 4, UAE authorised the emergency use of Sotrovimab, a kind of monoclonal antibody drug [25]. Region of the Americas (n=35 countries) High Moderate High High

35 (100%) countries have reported with As of June 22, Case 34 countries have commenced outbreak; 29 (82.9%) countries are the estimated fatality rate vaccination as of 25 June 2021. Coverage reporting a surge in cases. effective is 2.62%. was available for the following: i) at least reproduction 1 dose was at <50% for 30 countries and 2 (5.7%) countries have either a constant no. of 34 51-70% for 4 countries; ii) full vaccination decreasing change in incidence or no case countries was at <50% for 23 countries; 51-70% for in the last 14 days. ranged from 1 country. & 0.7-1.6.$ Highest incidence over the past 14 days With the increase of multiple variants of were reported from Argentina, Colombia, COVID-19, the U.S. FDA will limit the use Saint Kitts and Nevis, Suriname and of monoclonal antibody treatments Uruguay, and highest case numbers were developed by Regeneron and Eli Lilly due reported from Argentina, Brazil, Chile, to concerns the medications are not Colombia and USA. effective against these new strains. Eli Lilly’s bamlanivimab will not be At least 11 countries have closed their distributed to California, Arizona and borders, 22 countries have opened their Nevada, where those variants are more High borders partially conditionally, and 2 common. [21] countries are allowing free travel. FDA has issued EUA to Eli Lilly’s combination antibody therapy of bamlanivimab and etesevimab to treat mild to moderate COVID-19 patients who are at risk of serious illness or hospitalization. [15]

The Food and Drug Administration has allowed the combination use of baricitinib and Remdesivir under emergency use authorization. The EUA covers dosing of patients (above the age of two) who are on supplemental oxygen, receiving invasive mechanical ventilation or extracorporeal membrane oxygenation. [12]

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

Health Canada has approved bamlanvimab, for the treatment of COVID-19 in patients 12 years and older with mild to moderate symptoms who are at risk of severe disease progression. [11]

FDA has allowed emergency use of Eli Lilly & Co’s bamlanivimab for non- hospitalized patients at risk of serious illness due to age or other conditions. [10]

FDA has issued emergency authorisation for convalescent plasma to treat COVID- 19. [9]

RLF-100 (aviptadil) by NeuroRx and Relief Therapeutics was approved for emergency use in COVID-19 patients who are too ill to participate in the trial. [8]

As of October 22, remdesivir is the first and only FDA-approved COVID-19 treatment in the U.S. [7].

FDA has issued emergency authorisation for sotrovimab to treat mild-to-moderate Covid-19 adults and paediatric patients (12 years old and older weighing at least 40kg) who are at risk of severe disease progression. [23] African Region (n=47 countries) Moderate Moderate High High

47 (100%) countries have reported with As of June 22, Case 44 countries have commenced outbreak; 12 (26.1%) countries are the estimated fatality rate vaccination as of 25 June 2021. Coverage reporting a surge in cases. effective is 2.41%. was available for the following: i) at least reproduction 1 dose was at <50% for 41 countries and 1 (2.1%) countries have either a constant no. of 45 >70% for 1 country; ii) full vaccination decreasing change in incidence or no case countries was at <50% for 12 countries; 51-70% for in the last 14 days. ranged from 1 country. & 0.038-2.7.$ Highest incidence over the past 14 days Ethiopia has approved the use of High were reported from Botswana, Namibia, Dexamethasone treatment for seriously Seychelles, South Africa and Zambia, and ill COVID-19 patients. [13] highest case numbers were reported from Botswana, Namibia, South Africa, Uganda and Zambia.

At least 9 countries have closed their borders, 38 countries have opened their borders partially conditionally, and no country is allowing free travel.

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

*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. $ https://epiforecasts.io/covid/posts/global/ ^Differences between R0 and effective R can be found here https://www.coronavirustoday.com/r-number-refers- either-basic-or-effective-reproduction-number & https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/; High coverage defined as >70% population with full vaccination

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iii. Global Epidemiology

Table 2. Summary of COVID-19 cases & fatalities globally (Updated as of 25 June 2021, 1500H SGT) Case- No. of Total Cases Case- Fatality Countries/ Total Global Outside Total Fatality Rate (%) R0 Territories Cases Mainland Deaths Rate (%) [outside with Cases China [overall] China] 5.8 (95% CI 4.4– 219 180,780,160 180,688,467 3,916,338 2.17% 2.16% 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 2.17 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 care MERS-CoV 5 (2-14) 34 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 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.

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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 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/

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Case Breakdown by Countries Live update of COVID-19 global cases can be found at https://storymaps.arcgis.com/stories/a1746ada9bff48c09ef76e5a788b5910

Table 4. Breakdown of COVID-19 confirmed cases and deaths from 18 – 25 June 2021 (Updated as of 25 June 2021, 1500H SGT) Total Total Country Total Cases Change Change Region Deaths Recovered 1 USA 34,464,956 +87364 618,685 +2245 28,871,914 Americas 2 India 30,134,445 +371652 393,338 +9817 29,128,267 SEARO 3 Brazil 18,243,483 +539442 509,282 +13110 16,511,701 Americas 4 France 5,764,329 +14638 110,906 +272 5,590,123 EURO 5 Turkey 5,393,248 +39095 49,417 +405 5,254,708 EURO 6 Russia 5,388,695 +124648 131,463 +3471 4,915,615 EURO 7 UK 4,684,572 +83949 128,048 +103 4,310,259 EURO 8 Argentina 4,350,564 +128164 91,438 +3649 3,967,633 Americas 9 Italy 4,255,700 +5945 127,362 +172 4,066,029 EURO 10 Colombia 4,060,013 +200189 102,636 +4480 3,769,887 Americas 11 Spain 3,777,539 +24311 80,766 +132 3,572,254 EURO 12 Germany 3,733,077 +5453 91,178 +358 3,616,800 EURO 13 Iran 3,140,129 +69703 83,473 +854 2,797,105 EMRO 14 Poland 2,879,336 +1060 74,917 +183 2,651,045 EURO 15 Mexico 2,493,087 +25444 232,068 +1276 1,982,674 Americas 16 Ukraine 2,232,790 +4598 52,234 +282 2,160,137 EURO 17 Indonesia 2,053,995 +103719 55,949 +2196 1,826,504 SEARO 18 Peru 2,040,186 +20470 191,286 +1529 N/A Americas 19 South Africa 1,877,143 +91064 59,406 +1083 1,675,827 Africa 20 Netherlands 1,681,580 +4872 17,735 +13 1,613,649 EURO 21 Czechia 1,666,686 +1026 30,292 +35 1,634,292 EURO 22 Chile 1,531,872 +33641 31,797 +657 1,468,137 Americas 23 Canada 1,411,634 +5381 26,191 +179 1,376,094 Americas 24 Philippines 1,378,260 +38803 24,036 +760 1,302,814 WPRO 25 Iraq 1,311,093 +36464 16,999 +188 1,217,982 EMRO 26 Sweden 1,088,896 +4260 14,584 +47 1,052,467 EURO 27 Belgium 1,081,908 +3657 25,152 +35 1,021,987 EURO 28 Romania 1,080,457 +387 32,771 +656 1,045,303 EURO 29 Pakistan 952,907 +6680 22,152 +239 897,834 EMRO 30 Bangladesh 872,935 +31848 13,868 +523 794,783 SEARO 31 Portugal 869,879 +8251 17,079 +22 823,103 EURO 32 Israel 840,430 +683 6,429 +1 833,212 EURO 33 Hungary 807,844 +522 29,972 +24 736,854 EURO 34 Japan 789,440 +10102 14,553 +284 756,293 WPRO 35 Jordan 748,685 +3319 9,703 +68 732,475 EMRO 36 Malaysia 716,847 +38083 4,721 +519 650,964 WPRO

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37 Serbia 716,096 +654 7,019 +34 706,549 EURO 38 Switzerland 702,398 +944 10,878 +9 679,259 EURO 39 Austria 649,922 +741 10,697 +23 636,923 EURO 40 Nepal 629,431 +13447 8,918 +321 570,958 SEARO 41 UAE 620,309 +14181 1,775 +34 599,131 EMRO 42 Lebanon 544,002 +903 7,835 +24 531,156 EMRO 43 Morocco 528,180 +2737 9,265 +40 515,030 EMRO 44 Saudi Arabia 479,390 +8667 7,730 +95 460,338 EMRO 45 Ecuador 449,483 +7142 21,377 +202 415,508 Americas 46 Bolivia 429,178 +11983 16,414 +490 348,915 Americas 47 Bulgaria 421,401 +542 18,022 +42 393,948 EURO 48 Greece 419,909 +2656 12,604 +116 402,047 EURO 49 Kazakhstan 414,712 +8329 4,281 +70 389,406 EURO 50 Paraguay 413,457 +12214 12,086 +792 354,697 Americas 51 Belarus 413,139 +4518 3,082 +67 405,909 EURO 52 Panama 397,727 +6537 6,500 +42 379,858 Americas 53 Tunisia 395,362 +18671 14,406 +614 342,598 EMRO 54 Slovakia 391,456 +246 12,502 +38 378,307 EURO 55 Georgia 362,183 +5263 5,237 +123 348,267 EURO 56 Uruguay 361,994 +13332 5,413 +261 334,971 Americas 57 Croatia 359,403 +485 8,192 +27 350,669 EURO 58 Costa Rica 359,266 +10240 4,581 +122 285,356 Americas 59 Kuwait 346,560 +12344 1,903 +61 326,102 EMRO 60 Azerbaijan 335,676 +337 4,965 +6 329,870 EURO 61 Dominican 320,136 +7321 3,781 +48 261,405 Americas Republic 62 Palestine 313,015 +681 3,555 +10 306,532 EMRO 63 Denmark 292,352 +1335 2,531 +3 286,366 EURO 64 Guatemala 286,708 +9781 8,894 +345 258,646 Americas 65 Egypt 279,184 +3583 16,002 +242 208,192 EMRO 66 Lithuania 278,590 +413 4,375 +18 267,055 EURO 67 Ethiopia 275,601 +826 4,296 +34 257,429 Africa 68 Ireland 270,097 +2051 4,989 +48 254,426 EURO 69 Venezuela 265,642 +8780 3,023 +117 246,983 Americas 70 Bahrain 264,405 +2904 1,334 +63 257,757 EMRO 71 Slovenia 257,164 +380 4,417 +8 251,692 EURO 72 Honduras 256,818 +5669 6,879 +160 92,187 Americas 73 Oman 256,542 +13819 2,848 +222 224,077 EMRO 74 Moldova 256,387 +393 6,180 +18 249,381 EURO 75 Sri Lanka 248,050 +14986 2,814 +389 212,825 SEARO 76 Thailand 236,291 +25509 1,819 +242 193,106 SEARO 77 Armenia 224,635 +635 4,505 +14 216,423 EURO 78 Qatar 221,378 +1053 587 +6 218,928 EMRO 79 Bosnia and 204,936 +145 9,653 +27 181,199 EURO Herzegovina

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80 Libya 191,660 +1514 3,185 +15 177,106 EMRO 81 Kenya 181,239 +3957 3,538 +104 123,462 Africa 82 Cuba 174,789 +11374 1,209 +86 164,038 Americas 83 Nigeria 167,401 +259 2,118 +1 163,933 Africa 84 North Macedonia 155,655 +62 5,481 +9 149,933 EURO 85 S. Korea 153,789 +3551 2,009 +13 145,389 WPRO 86 Myanmar 150,714 +3946 3,275 +25 134,589 SEARO 87 Zambia 140,620 +18376 1,855 +330 115,898 Africa 88 Algeria 137,403 +2563 3,669 +64 95,599 Africa 89 Latvia 137,110 +566 2,500 +18 132,960 EURO 90 Albania 132,499 +18 2,455 +1 129,966 EURO 91 Estonia 130,898 +203 1,269 +2 126,968 EURO 92 Norway 130,270 +1372 792 +2 88,952 EURO 93 Kyrgyzstan 118,981 +5551 1,964 +44 107,391 EURO 94 Afghanistan 111,592 +12748 4,519 +576 66,799 EMRO 95 Uzbekistan 108,184 +2965 725 +8 104,007 EURO 96 Mongolia 104,900 +16384 493 +82 67,579 WPRO 97 Montenegro 100,131 +111 1,609 +5 98,243 EURO 98 Ghana 95,259 +435 794 +4 93,148 Africa 99 Finland 94,719 +638 969 +2 46,000 EURO 100 China 91,693 +159 4,636 0 86,571 WPRO 101 Cameroon 80,487 +159 1,320 +7 78,224 Africa 102 Namibia 78,723 +8611 1,279 +172 62,026 Africa 103 El Salvador 77,484 +989 2,356 +41 71,603 Americas 104 Uganda 75,537 +8322 781 +239 50,350 Africa 105 Cyprus 74,174 +730 374 0 72,199 EURO 106 Mozambique 73,652 +1723 863 +19 70,352 Africa 107 Maldives 72,678 +1322 207 +6 68,197 SEARO 108 Luxembourg 70,586 +83 818 0 69,555 EURO 109 Botswana 67,492 +4245 1,095 +155 61,341 Africa 110 Singapore 62,493 +127 35 +1 62,140 WPRO 111 Jamaica 49,841 +338 1,049 +26 29,322 Americas 112 Ivory Coast 48,058 +85 309 +3 47,511 Africa 113 Cambodia 46,065 +4484 509 +115 40,769 WPRO 114 Zimbabwe 44,306 +3379 1,709 +62 37,524 Africa 115 Senegal 42,677 +471 1,159 +1 41,058 Africa 116 Madagascar 42,166 +132 905 +13 40,524 Africa 117 DRC 38,936 +2358 896 +30 28,115 Africa 118 Angola 38,091 +802 881 +30 32,340 Africa 119 Sudan 36,574 +227 2,750 +13 30,423 EMRO 120 Malawi 35,219 +517 1,178 +14 32,974 Africa 121 Rwanda 34,143 +4546 402 +25 26,865 Africa 122 Cabo Verde 32,257 +399 285 +5 31,276 Africa

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123 Trinidad and 31,429 +1473 775 +76 23,014 Americas Tobago 124 Malta 30,598 +13 420 +1 30,151 EURO 125 Australia 30,424 +115 910 0 29,307 WPRO 126 Réunion 29,502 +1061 226 +6 27,585 Non 127 French Guiana 27,040 +897 142 +6 9,995 Non 128 Syria 25,287 +296 1,859 +27 21,774 EMRO 129 Gabon 24,958 +126 159 +2 24,509 Africa 130 Guinea 23,615 +184 168 +1 22,379 Africa 131 Suriname 20,723 +1362 490 +54 15,943 Americas 132 Mauritania 20,512 +259 483 +3 19,548 Africa 133 Guyana 19,565 +832 458 +17 17,405 Americas 134 Mayotte 19,389 -787 174 +1 2,964 Non 135 French Polynesia 18,992 +35 142 0 18,822 Non 136 Eswatini 18,947 +163 678 +2 18,059 Africa 137 Haiti 17,963 +915 400 +31 12,777 Americas 138 Papua New 17,079 +280 173 +6 16,480 WPRO Guinea 139 Guadeloupe 16,881 +129 230 +1 2,250 Non 140 Somalia 14,875 +34 775 0 7,231 EMRO 141 Seychelles 14,620 +497 59 +4 13,323 Africa 142 Mali 14,396 +32 525 +2 10,043 Africa 143 Taiwan 14,389 +805 605 +108 10,380 WPRO 144 Vietnam 14,323 +2092 72 +11 5,759 WPRO 145 Andorra 13,877 +38 127 0 13,694 EURO 146 Togo 13,749 +67 128 +1 13,379 Africa 147 Burkina Faso 13,474 +14 168 +1 13,295 Africa 148 Tajikistan 13,371 +63 90 0 13,229 EURO 149 Belize 13,104 +110 329 +2 12,595 Americas 150 Bahamas 12,407 +165 244 +4 11,393 Americas 151 Congo 12,404 +106 164 +3 11,211 Africa 152 Curaçao 12,327 +19 126 +3 12,166 Non 153 Martinique 12,264 +86 98 0 98 Non 154 Hong Kong 11,906 +24 210 0 11,619 WPRO 155 Djibouti 11,597 +12 155 +1 11,436 EMRO 156 Lesotho 11,168 +218 329 +3 6,445 Africa 157 Aruba 11,125 +26 107 0 10,983 Non 158 South Sudan 10,812 +48 115 0 10,514 Africa 159 Timor-Leste 8,889 +385 20 +1 7,966 SEARO 160 Equatorial Guinea 8,712 +32 120 0 8,506 Africa 161 Benin 8,170 +30 104 +1 8,000 Africa 162 Nicaragua 7,920 +224 189 +1 4,225 Americas 163 CAR 7,139 +38 98 0 6,859 Africa 164 Yemen 6,905 +36 1,356 +5 3,995 EMRO 165 Iceland 6,637 +15 30 0 6,595 EURO

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166 Gambia 6,054 +30 181 0 5,844 Africa 167 Eritrea 5,664 +470 21 +2 5,147 Africa 168 Niger 5,475 +18 193 0 5,199 Africa 169 Burundi 5,334 +236 8 0 773 Africa 170 Saint Lucia 5,238 +50 84 +4 5,084 Americas 171 Sierra Leone 5,155 +602 87 +5 3,368 Africa 172 San Marino 5,090 0 90 0 5,000 EURO 173 Chad 4,951 +7 174 0 4,769 Africa 174 Gibraltar 4,335 +18 94 0 4,216 Non 175 Channel Islands 4,150 +26 86 0 3,994 Non 176 Barbados 4,057 +18 47 0 3,992 Americas 177 Comoros 3,912 +7 146 0 3,745 Africa 178 Guinea-Bissau 3,844 +25 69 0 3,569 Africa 179 Liberia 3,265 +469 110 +15 2,222 Africa 180 Liechtenstein 3,031 +5 59 0 2,957 Non 181 Fiji 2,848 +1315 13 +7 653 WPRO 182 New Zealand 2,725 +11 26 0 2,680 WPRO 183 Sint Maarten 2,594 +33 33 +1 2,509 Non 184 Monaco 2,562 +17 33 0 2,496 EURO 185 Bermuda 2,504 +5 33 0 2,461 Non 186 Turks and Caicos 2,424 +1 18 0 2,396 Non 187 Sao Tome and 2,364 +6 37 0 2,317 Africa Principe 188 Saint Martin 2,276 +143 12 0 1,399 Non 189 St. Vincent 2,216 +38 12 0 1,967 Americas Grenadines 190 Laos 2,080 +46 3 0 1,962 WPRO 191 Bhutan 2,006 +124 1 0 1,737 SEARO 192 Mauritius 1,779 +78 18 0 1,331 Africa 193 Caribbean 1,635 +6 17 0 1,609 Non Netherlands 194 Isle of Man 1,603 +4 29 0 1,569 Non 195 Antigua and 1,263 0 42 0 1,221 Americas Barbuda 196 St. Barth 1,005 0 1 0 462 Non 197 Faeroe Islands 770 +12 1 0 756 Non 198 Diamond Princess 712 0 13 0 699 NA 199 Cayman Islands 609 +10 2 0 588 Non 200 Tanzania 509 0 21 0 183 Africa 201 Wallis and Futuna 445 0 7 0 438 Non 202 Saint Kitts and 425 +146 3 +2 98 Americas Nevis 203 British Virgin 298 +50 1 0 293 Non Islands 204 Brunei 256 +6 3 0 245 WPRO 205 Dominica 192 +1 0 0 189 Americas

13 | 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 469. 25 June 2021

206 Grenada 161 0 1 0 160 Americas 207 New Caledonia 129 +1 0 0 58 Non 208 Anguilla 109 0 0 0 109 Non 209 Falkland Islands 63 0 0 0 63 Non 210 Macao 53 0 0 0 51 WPRO 211 Greenland 50 +1 0 0 40 Non 212 Vatican City 27 0 0 0 27 Non 213 Saint Pierre 26 0 0 0 25 Non Miquelon 214 Montserrat 20 0 1 0 19 Non 215 Solomon Islands 20 0 0 0 20 WPRO 216 Western Sahara 10 0 1 0 8 Non 217 MS Zaandam 9 0 2 0 7 NA 218 Vanuatu 4 0 1 0 3 WPRO 219 Marshall Islands 4 0 0 0 4 WPRO 220 Samoa 3 0 0 0 3 WPRO 221 Saint Helena 2 0 0 0 2 Non 222 Micronesia 1 0 0 0 1 WPRO Total 180,780,160 +2573669 3,916,338 58,323 163,710,963

Figure 4. Areas with reported confirmed cases of COVID-19 (14 – 20 June 2021)

Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

14 | 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 469. 25 June 2021

Table 5. COVID-19 cases and deaths reported by states/UT in India between 18 – 25 June, 2021 (Updated as of 25 June 2021, 1500H SGT) Change Change Change Change Total Total Name of from from Total from Total from Diagnosed Active State / UT previous previous Recovered previous Deaths previous Cases Cases week week week week Andaman and Nicobar 7440 +105 99 -5 7214 +110 127 0 Islands Andhra 1867017 +34115 49683 -20148 1804844 +53940 12490 +323 Pradesh Arunachal 34214 +1731 2565 -148 31487 +1875 162 +4 Pradesh Assam 493688 +20235 31014 -7126 458330 +27122 4344 +239 Bihar 720717 +2013 2558 -1246 708586 +3213 9573 +46 Chandigarh 61542 +232 247 -185 60488 +412 807 +5 Chhattisgarh 992391 +3056 7314 -3368 971662 +6370 13415 +54 Dadra and Nagar Haveli 10526 +34 59 -12 10463 +46 4 0 and Daman and Diu Delhi 1433475 +1607 1767 -787 1406760 +2332 24948 +62 Goa 165426 +1814 2727 -1097 159677 +2858 3022 +53 Gujarat 822887 +1228 4427 -3322 808418 +4526 10042 +24 Haryana 768002 +1164 1990 -1237 756679 +2215 9333 +186 Himachal 201210 +1511 2123 -1307 195624 +2779 3463 +39 Pradesh Jammu and 313476 +3459 6537 -4065 302655 +7466 4284 +58 Kashmir Jharkhand 345028 +899 1224 -722 338698 +1610 5106 +11 Karnataka 2823444 +33106 110546 -36201 2678473 +68316 34425 +991 Kerala 2854325 +80382 100308 -8685 2741436 +88229 12581 +838 Ladakh 19903 +199 314 -168 19387 +365 202 +2 Lakshadweep 9601 +224 322 -77 9232 +299 47 +2 Madhya 789561 +607 1280 -1704 779432 +2141 8849 +170 Pradesh Maharashtra 6007431 +62721 124911 -18137 5762661 +77025 119859 +3833 Manipur 66171 +3828 9174 +72 55912 +3692 1085 +64 Meghalaya 46878 +3146 4424 -185 41647 +3286 807 +45 Mizoram 18859 +2422 4455 +723 14316 +1686 88 +13 Nagaland 24629 +588 1509 -859 22641 +1434 479 +13 Odisha 890596 +23904 30337 -9285 856498 +32899 3761 +290 Puducherry 115925 +1977 3077 -1256 111114 +3209 1734 +24 Punjab 593941 +3385 5274 -4205 572723 +7384 15944 +206 Rajasthan 951695 +1077 2019 -2243 940771 +3290 8905 +30 Sikkim 19681 +785 2282 -625 17101 +1399 298 +11 Tamil Nadu 2449577 +51713 49845 -50678 2367831 +101038 31901 +1353

15 | 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 469. 25 June 2021

Telangana 617776 +8359 16030 -3491 598139 +11777 3607 +73 Tripura 63868 +2529 3828 -1045 59378 +3549 662 +25 Uttarakhand 339245 +1179 2739 -732 329432 +1848 7074 +63 Uttar 1705014 +1281 3552 -2467 1679096 +3412 22366 +336 Pradesh West Bengal 1489286 +15037 22308 +235 1449462 +14468 17516 +334 Total 30134445 +30015797 612868 +584784 29128267 +29039290 393310 +391723 Source: https://www.mohfw.gov.in/

16 | 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 469. 25 June 2021

iv. Travel Bans/Advisories & Quarantine Orders

[1] Canada –

• From 5 July 2021, Canadian citizens which have been vaccinated with a Canada-approved vaccine for at least 14 days prior to arrival will be exempted from the 14-day mandatory quarantine upon return. All arrivals must also provide a negative COVID-19 test result from 72 hours before arrival and take a second test upon arrival. • The travel ban with Pakistan will be lifted on 21 June 2021, but that with India has been extended until 21 July 2021. Border restrictions on nonessential travel with the United States have also been extended until 21 July 2021.

[2] Denmark – From 19 June 2021, arrivals from Albania, North Macedonia, Lebanon and Serbia, and several regions in Greece, Spain, France and Switzerland will be allowed to enter Denmark without quarantine and double testing requirements; no countries have been added from the yellow to the orange list.

[3] Estonia – From 21 June 2021, arrivals from Latvia and Denmark are to undergo mandatory 10-days quarantine, at least until 27 June 2021. Unvaccinated travellers from the following third countries will also be permitted to enter Estonia, even for tourism: Albania, Australia, the United States, Hong Kong, Israel, Japan, Lebanon, South Korea, Macau, Northern Macedonia, Rwanda, Serbia, Singapore, Thailand, Taiwan and New Zealand.

[4] France – From 23 June 2021, Russia, Namibia and Seychelles have been added to France’s list of red countries, bringing the total number of countries in the red list to 19. Travellers from the red list countries will only be allowed to enter France with a strong purpose of travel, and those permitted to enter will have to present a negative PCR or test taken within the last 48 hours, undergo randon antigen testing upon arrival and go though mandatory quarantine upon arrival (7 days for those vaccinated with an approved vaccine, 10 days for the unvaccinated).

[5] Germany – International vaccinated arrivals from countries outside the EU will be allowed to enter Germany without quarantine from 25 June 2021, so long they are not coming from a virus variant area.

[6] Greece – Tourists from Greece-approved countries or with the EU’s COVID-19 vaccine passport will be allowed to enter Greece without restrictions if they present a negative rapid antigen test result upon arrival from 21 June 2021.

[7, 8] Hong Kong –

• From 30 June 2021, the mandatory quarantine period for returning citizens to Hong Kong, who were fully vaccinated for at least 14 days, with a negative test for COVID-19 and a positive test for anitiboddies, from high- to low-risk areas will be decreased to 7 days. The scheme is expected to be extended to non-citizens by end-July 2021. • From 25 June 2021, passenger flights from Indonesia will be suspended with the end date not specified.

17 | 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 469. 25 June 2021

[9] Israel – From 22 June 2021, all passengers have to undergo a PCR test before leaving the airport, and all arrivals from high-risk countries are to undergo mandatory quarantine regardless of vaccination status. The travel advisory against all non-urgent foreign travel was released on 23 June 2021; all departing Israeli travellers are also required to sign a declaration against entering countries designated as virus hotspots.

[10] Italy – Arrivals from Britain will be subject to a mandatory 5-day quarantine from 25 June 2021, but those from United States, Canada, Japan and other EU states will be exempted from quarantine if they have proof of vaccination or a recent negative COVID-19 test result.

[11] Netherlands – From 24 June 2021, all arrivals from United States, Albania, Lebanon, North Macedonia, Serbia, and Taiwan will be exempted from any restriction upon entering Netherlands.

[12] New Zealand – Departures from the New South Wales, Australia will be suspended from 22 June to 6 July 2021, while those from Victoria will be resumed from 22 June 2021.

[13] Norway – Norway entered its third phase of reopening borders to international travellers, and ended the travel advisory against outbound travel to EEA/Schengen, United Kingdom and EU’s list of epidemiologically safe third countries for residents on 19 June 2021. The travel advisory against travel to countries out of the aforementioned countries remains active until 10 August 2021. The quarantine requirements remain unchanged until 5 July 2021, after which the quarantine rules will be aligned to the EU country colouring system.

[14] Spain – Updated entry requirements will exempt travellers from most German and Italy regions and multiple countries from entry restrictions to enter Spain, as these regions have been excluded from Spains list of high-risk countries based on rates.

[15] Sweden – From 30 June until 31 August 2021, an entry ban will be imposed against EU/EUAA travellers without a vaccination certificate, a negative COVID-19 test result, or a certificate confirming the previous recovery from the virus.

[16] Switzerland – From 26 June 2021, arrivals from any Schengen Area and third countries will be exempted from quarantine, and those who are vaccinated or have receovered from a recent infection will also be exempted from producing negative COVID-19 test results.

[17] Taiwan – All arrivals will be tested on the last day before exiting their mandatory 14-day quarantine upon arrival. The border is currently closed to all international arrivals except for citizens and legal residents, at least until 28 June 2021.

[18] United Arab Emirates (Dubai) – Arrivals from India, South Africa and Nigeria with a valid residence visa and 2 doses of a UAE-approved vaccine will be allowed to enter the emirate from 19 June 2021. Arrivals will also require a negative PCR test taken within 48 hours before departure, a rapid test 4 hours before departure and another PCR test on arrival with institutional quarantine required until results are received.

[19] United Kingdom (Bermuda Island) – From 20 June 2021, all non-immunised travellers will be quarantined for 14-days at an authorised hotel upon arrival.

18 | 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 469. 25 June 2021

[20] United Kingdom – From 30 June 2021, Malta, Madeira, the Balearic Islands, several UK overseas territories and Caribbean islands (including Barbados) will be added to UK’s green travel list, allowing UK, Scottish and Wales residents returning from these countries to be exempted from quarantine upon return. Dominican Republic, Eritrea, Haiti. Mongolia, Tunisia and Uganda will be added onto the red list from 30 June 2021.

[21, 22] United States –

• The travel ban on nonessential travel through shared land borders with Canada and Mexico has been extended until 21 July 2021. • Hawaii: Fully vaccinated US mainland travellers will be exempted from testing and quarantine restrictions from 8 July 2021.

19 | 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 469. 25 June 2021

v. Lockdowns

[1-3] Australia –

• From 23 June 2021, all capacity limits and mass gathering measures will be lifted in Western Australia, although citizens are to practise physical distancing when possible. • Targeted lockdowns enforced in the central, and eastern surburbs of Sydney, from 25 June to 2 July 2021. Residents and people working in the affected areas are to stay at home except for essential reasons. Other restrictions imposed until 2 July 2021, through the Greater Sydney include mandatory masking in all indoor non-residential settings and at organised outdoor events, and limiting household visitors at 5 guests, dance and gym classes at 20 attendees with mask requirements, outdoor events at 50% capacity and capacity limits on public transportation.

[4] Bangladesh – A lockdown was imposed in 7 districts (Rajbari, Gopalganj, Gazipur, Munshiganj, Madaripur, Manikganj, Narayanganj) from 22 June to 30 June 2021. Under the lockdown restrictions, all government offices are to remain closed with only essential services including health, utility and COVID-19 vaccination allowed to operate. Vehicles from these districts will also not be allowed to enter Dhaka unless those on emergency services.

[5] France – Eased restrictions from 30 June 2021 will allow standing concerts and festivals to resume, and nightclubs are allowed to reopen from 9 July at 75% indoor capacity.

[6] Hong Kong – Eased restrictions from 21 June 2021 to allow increase operating capacities and venue limits at dining and entertainment establishments, exercise facilities, weddings, religious premises, local tours and events. Full operating capacity has been allowed at some venues if two-thirds of the attendees have at least a dose of vaccination.

[7, 8] India -

• Telangana: The statewide lockdown was completely lifted from 20 June 2021, and schools will be allowed to reopen from 1 July 2021. • Karnataka: Relaxations from 21 June 2021, in 16 districts with fewer cases • New Delhi: Reopening of bars, public parks, gardens and golf clubs from 21 June 2021. Bars and restaurants allowed to operate at 50% capacity, but cinemas, gyms and spas remain closed until 28 June 2021. • Uttar Pradesh: Malls and restaurants allowed to operate at 50% capacity until 9 pm on weekdays, and shops and markets outside containment zones to open 5 days a week. The daily night curfew from 9 pm to 7 am, and weekend curfew in all districts remains active. • Uttarakhand: From 20 June 2021, hotels, restaurants, bars, government and non-essential private offices will be allowed to operate at 50% capacity, while offices related to essential services can operate at full capacity. However, the statewide curfew was extended until 29 June 2021. • Haryana: The statewide lockdown has been extended until 28 June 2021, but some restructions have been relaced from 20 June 2021. These include increasing the limits at weddings or funerals to 50 people, allowing corporate offices to operate at full capacity, and club houses, restaurants, bars and golf courses to operate at 50% seating capacity.

20 | 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 469. 25 June 2021

• Tamil Nadu: Statewide lockdown was extended until 28 June 2021, with tightest restrictions in 11 districts in Tier-1 with highest caseloads, and easted restrictions in Tiers-2 and -3 districts with lower caseloads. Weddings and related ceremonies in Tiers-1 and -2 districts are limited at 50 attendees with e-registration required. Transport in Tiers-2 and -3 districts are allowed to operate at 50% and full capacity respectively. • Jammu and Kashmir: The weekend curfew in 8 districts have been lifted from 20 June 2021, but daily night curfew from 8 pm till 7 am remains across the territory. • Goa: Statewide curfew has been extended untl 28 June 2021, but shops in shopping malls except for cinemas, thetres, multiplexes and entertainment zones, will be allowed to open between 7 am to 3 pm from 20 June 2021. • Mizoram: Extension of lockdown until 30 June 2021, but inter-village movement will be allowed, non-essential retail shops will be allowed to open on specific days within the Aizawl Municipal Corporation (AMC) area and all economic activities will be allowed to resumt outside the AMC area. • Tripura: The curfew from 2pm to 5am in 12 local bodies will be extended until 25 June 2021, but the night curfew from 6pm to 5 am in villages have been lifted from 20 June 2021. All standalong shops and commercial establishments will be allowed to operate between 6 am to 2 pm, and government and private offices allowed to operate until 4 pm at 50% capacity.

[9] Indonesia – Tightened restrictions will be imposed for 2 weeks from 21 June 2021, in 29 “red zones” with high infection rates. These restructions include suspension of religious worship services, limiting operating capacity to 25% in restaurants, cafes and malls, and an additional 9pm to 4 am curfew in 10 locations.

[10] Laos – The nationwide lockdown was extended for another 15 days from 19 June 2021.

[11] Mexico – New restrictions imposed in Moscow include banning all entertainment and sports events with more than 500 attendees from 22 June 2021, and all dining establishments to only allow vaccinated customers, those who recovered from a COVID-19 infection within the past 6 months or can provide a negative test result taken in the past 72 hours, into their premises from 21 June 2021.

[12] Oman – A daily lockdown from 8 pm to 4 am has been reimposed countrywide from 19 June 2021.

[13] Portugal – Tightened restrictions will be imposed in Lisbon and Albufeira from 25 June 2021. The new restrictions include shortened operating hours and limited capacity for restaurants and cafes on weekends, limiting wedding and baptism venues at 25% capacity, and banning two-way travel in and out of Lisbon on weekends (except for those with a negative test result).

[14] Siberia – A two-week lockdown in Buryatia will commence on 27 July 2021, during which only essential services will be allowed to operate.

[15] South Korea – Eased restrictions that will go into effect from July 2021 to allow extended operating hours in restaurants and cafes in Seoul until midnight, and increase gathering limits nationwide to 8 people, with a temporary limit of 6 people during the 2-week transition period in greater Seoul.

[16, 17]Tunisia – Targeted lockdowns were imposed in areas where the infection rate reaches 400 cases out of every 100,000 residents. On 20 June 2021, 4 governates (Kairouan, Siliana, Zaghouan and

21 | 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 469. 25 June 2021

Bejakn) were placed under lockdown; on 24 June 2021, 11 regions of 7 governates were also placed under lockdown.

[18] Turkey – The weekly one-day lockdown and nightly curfews will end on 1 July 2021.

[19] Uganda – A 42-day nationwide lockdown has been imposed from 18 June 2021. All cross-boundary district and intradistrict movement of public transport and by private vehicles or boda bodas will be suspended unless permission from relavant authorities have been obtained.

[20, 21] United Kingdom –

• England: Easing of all coronavirus restrictions have been postponed till 19 July 2021 but some restrictions eased to allow increased limits at weddings depending on the venue size, and resumption of overnight trips for children (in groups of 30), and piloting of large events. • Wales: Capacity restrictions for music, comedy and weddings increasing proportionately with a venue’s size • Northern Ireland: Planned easing of restrictions postponed to at least 5 July 2021 • Scotland: Coronavirus restrictions to be extended until mid-July. Nonessential trips between Scotland and Manhester and Salford were also barred from 20 June 2021.

vi. Military Surveillance

[1] Israel Two new COVID-19 cases were reported amongst vaccinated soldiers on 22 June 2021.

[2, 3] South Korea Three cases were reported from Army soldiers on 24 and 25 June 2021, following their recent vacation. This brings the total number of cases in the South Korean military to 1,012 cases as of 25 June 2021.

[4, 5] United States Forces Japan A total of three cases were reported from Yokosuka Naval Base (2 cases) and Kadena Air Base (1 case) on 22 June 2021, since the last update on 18 June 2021. The case from Kadena Air Base was detected during mandatory testing prior to travelling to the United States. Cases from Yokosuka Naval Base were detected from base employees who presented symptoms (1 case) and during a medical evaluation (1 case).

[5, 6] United States Forces Korea Between 18 June and 24 June 2021, 16 cases were reported from 14 service members, one military contractor and one affiliated family member. This brings the total number of cases reported amongst USFK-affiliated population to 919 cases, as of 24 June 2021. The infected service members from Camp Humphreys (5 cases) and Camp Casy (2 cases) were close contacts of other cases and were confirmed positive on 17 and 18 June 2021. Remaining cases were detected upon arrival in South Korea. All cases are currently isolated at designated quarantine facilities.

22 | 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 469. 25 June 2021 vii. WHO Guidance & Other Protocols

The following updates were published by the WHO from 18 – 25 June 2021:

• A family toolbox for managing health and happiness during COVID-19 Available at: https://www.who.int/publications/m/item/a-family-toolbox-for-managing-health- and-happiness-during-covid-19 • Managing family risk: A facilitator’s toolbox for empowering families to manage risks during COVID-19 Available at: https://www.who.int/publications/m/item/managing-family-risk-a-facilitator-s- toolbox-for-empowering-families-to-manage-risks-during-covid-19

viii. CDC Guidance & Protocols

US CDC

The following updates were published by the US CDC from 18 – 25 June 2021:

• Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html • Guidance for Reporting SARS-CoV-2 Sequencing Results Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/reporting-sequencing- guidance.html • Selected Adverse Events Reported after COVID-19 Vaccination Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html • CDC Readiness and Planning Tool: To Prevent the Spread of COVID-19 in Primary and Secondary Schools in Low Resource Non-U.S. Settings Available at: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/school-readiness- planning-tool.html • Operational Considerations for Adapting a Contact Tracing Program to Respond to the COVID- 19 Pandemic in non-US Settings Available at: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/operational- considerations-contact-tracing.html • Operational Considerations for Adapting a Contact Tracing Program to Respond to the COVID- 19 Pandemic in non-US Settings Available at: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/operational- considerations-contact-tracing.html • Monitoring and Evaluation Action Guide: Wearing Masks as a COVID-19 Community Mitigation Strategy Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/mask-evaluation.html • COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy — Eight Integrated Health Care Organizations, United States, December 14, 2020–May 8, 2021 Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e2.htm?s_cid=mm7024e2_x

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

• Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–March⁠ 2021 Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7024a3.htm?s_cid=mm7024a3_x

EU CDC

The following update was published by the EU CDC from 18 – 25 June 2021:

• Threat Assessment Brief: Implications for the EU/EEA on the spread of the SARS-CoV-2 Delta (B.1.617.2) variant of concern Available at: https://www.ecdc.europa.eu/en/publications-data/threat-assessment-emergence- and-impact-sars-cov-2-delta-variant • Communicable disease threats report, 13-19 June 2021, week 24 Available at: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats- report-13-19-june-2021-week-24 • Communicable disease threats report, 20-26 June 2021, week 25 Available at: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats- report-20-26-june-2021-week-25

ix. Vaccines/Therapeutics Development

Noteworthy reports are included to inform main developments of COVID-19 pharmaceutics. Past updates are available from situation report 211 onwards. 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. A living systematic review of vaccine trials is also accessable at https://covid-nma.com/vaccines/ or https://covid-nma.com/ .

Vaccines

[1, 2] Australia –

• Phase 1 for a nasal spray vaccine candidate has commented on 19 June 2021, led by Brisbane’s Nucleus Network. • Phase 1 clinical trial for a gene-based DNA vaccine delivered via a needle-free system commenced on 25 June 2021. The trial will recruit 150 healthy pariticpants to examine the safety of two doses of the vaccine given one month apart, and the efficacy of lower vaccine dose into the skin rather than muscle.

[3] Bangladesh – Nationwide vaccination drive resumed on 19 June 2021, after it was suspected for approximately 2 months due to vaccine supply issues.

[4] Cuba

• Preliminary results from Phase 3 trials of the three-shot vaccine demonstrated a supposed 92.28% efficacy against the coronavirus. Exact details of outcomes measured for efficacy were

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

not released. Cuba’s authorities have already started administering the experimental vaccines en masse as part of “intervention studies”. • Preliminary results from Phase 3 trials of the three-show Soberana 2 vaccine indicated 62% efficacy with just two doses.

[5] Guyana – The Sputnik V was endorsed for use in adults aged above 18 years old on 19 June 2021.

[6] Thailand

• Phase 2 trials for COVID-19 vaccine candidate NDV-HXP-S has commenced, with the exact start date unannounced • Phase 1 trials for the vaccine candidate developed by Chulalongkorn’s Vaccine Research Center commenced on 21 June 2021. The vaccine candidate is developed using tmessenger RNA

[7] United States – Efficacy trial for the Moderna vaccine candidate to be expanded to include adults aged 18 to 29 years old, including those that choose to not be vaccinated. The trial will enrol approximately 18,000 young adults (6,000 vaccinated at recruitment, 6,000 vaccinated 4 months from recruitment, and 6,000 who choose not to be vaccinated) across at least 40 recruitment sites.

[8] United States – The CDC Vaccine Safety Technical Work Group reported a potential association between myocarditis and pericarditis and mRNA vaccines in people aged 12-39 years old. There have been 4.4 reports of either issue per million vaccine doses administered and a 12.6 per million report rate after the second dose. Symptoms include chest pain, shortness of breath and heart palpitations, with the majority of patients experiencing symptoms within a week of vaccination. These side effects were more prevalent in younger men and after their second dose, at a rate of 32 per million doses given.

Therapeutics

[9] Global – Meta-analysis of 15 trials on ivermectin as a therapeutic for COVID-19 infection suggested that ivermectin reduced the risk of death by 62%, compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73; n = 2438; I2 = 49%; moderate-certainty evidence). that risk of death was found to be 2.3% among hospitalized patients treated with ivermectin, compared to 7.8% for those who were not. Low-certainty evidence suggested that ivermectin may not be beneficial for patients in “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” suggested the utility of ivermectin in preventing clinical progression to severe disease.

[10] United States – The ACTIV-4B trial which evaluated low-dose (2.5 mg twice daily) apixaban (Eliquis, Bristol Myers Squibb/Pfizer), high-dose (5 mg twice daily) apixaban, aspirin 81 mg daily and placebo in patients with COVID-19 who were mildly symptomatic but clinically stable without risk factors for thrombotic events has been stopped early due to very low event rates of major cardiopulmonary complications. The event rates do not justify preventive anticoagulant or antiplatelet therapy unless otherwise clinically indicated.

25 | 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 469. 25 June 2021

Vaccine Approval Status

Table 6: Number of approving countries per vaccine as of 22 June 2021 Number of countries Developer Vaccine approving Anhui Zhifei Longcom RBD-Dimer 2 Bharat Biotech 9 CanSino Ad5-nCoV 8 Chumakov Center Kovivac 1 FBRI EpiVacCorona 2 Gamaleya Sputnik V 68 Johnson & Johnson Ad26.COV2.S 52 Kazakhstan RIBSP QazCovid-in 1 Minhai Biotechnology Co SARS-CoV-2 Vaccine (Vero Cells) 1 Moderna mRNA-1273 53 Oxford/AstraZeneca AZD1222 115 BioNTech/Pfizer BNT162b2 89 Serum Institute of India Covishield 43 Shifa Pharmed Industrial COVID-19 1 Co Sinopharm BBIBP-CorV 53 Sinopharm Inactivated 1 Sinovac CoronaVac 32 Takeda TAK-919 1 Source: https://covid19.trackvaccines.org/vaccines/

Adverse Reactions & Effects

[1, 2] India – • Kerala: Seven cases of Guillan-Barre syndrome were reported from a medical centre, of the 1.2 million people vaccinated with the Astrazeneca vaccine. The cases received the vaccine 10-22 days prior to diagnosis. • Mumbai: A total of 993 AEFIs were reported from the 49 lakh administered (44.5 lakh were administered with Covishield vaccine) through the city since mass vaccination started, of which 927 were minor AEFIs and 66 severe AEFIs. Of the serious AEFIs, 31 required brief hospitalisations while the remaining 35 AEFIs included 24 fatalities and 9 cases of paralysis, weakness or prolonged hospitalisation. None of the fatalities have been directly linked to vaccination, and all but 1 occurred in people aged above 50 years old.

[3] Mexico – As of 12 February 2021, 6,536 AEFI were reported since 24 December 2020, of which 65.1% had at least one neurologic AEFI (non-serious 99.6%). A total of 33 serious events were reported; 17 (51.5%) were neurologic, of which 16 cases had been discharged without deaths. [4] Philippines – A total of 1,233 AEFIs were reported out of the 183,794 individuals vaccinated in the Zamboanga Peninsula (0.67%) with vaccines provided by the Department of Health, as of 18 June 2021. Most AEFIs reported were mild. [5] South Korea – The first vaccine-associated death was reported on 21 June 2021, in male in his 30s. The cause of death was determined to be thrombocytopenic thrombosis resulting from vaccination with the Astrazeneca vaccine. The deceased received his dose on 27 May 2021, suffered an onset of

26 | 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 469. 25 June 2021

symptoms on 5 June 2021, was hospitalised on 8 June 2021 following declined consciousness even after treatment at the neighbourhood clinic, and died on 16 June 2021 despite continuous treatment in the hospital. [6] United Kingdom – As of 9 June 2021, a total of 885 suspected AEFIs related to the Astrazeneca COVID-19 vaccine candidate were reported, of which 34 reports of myocarditis, 61 reports of pericarditis and 740 spontaneous adverse reactions associated with anaphylaxis or anaphylactoid reactions were confirmed associated with vaccination. In addition, 390 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) have been reported following vaccination. [7] United Kingdom (Northern Ireland) – A death linked to vaccination was reported in a man aged over 90 years old in the Northern Trust area, in the first quarter of 2021. No additional details regarding the death was released. As of 9 June 2021, a total of 2,354 AEFIs were reported for the Astrazeneca vaccine, and 1,554 AEFIs were reported for the Pfizer vaccine in Northern Ireland. Most AEFIs reported were mild, with 9 reports of thrombocytopenia in those receiving the Astrazeneca vaccine.

27 | 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 469. 25 June 2021

x. Scientific Publications with Epidemiology and Clinical Focus

Apparent Discordance between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review [1]

Objective: Many survivors of COVID-19 experience ongoing signs and symptoms affecting multiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages.

Methods: MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to evaluate the quality of consensus guidelines.

Results: Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living (ADL) or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, ADL and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation.

Conclusion: There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self- management and access to rehabilitation specialists in multidisciplinary teams.

Impact: Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.

Comparison of Blood Counts and Markers of Inflammation and Coagulation in Patients With and Without COVID-19 Presenting to the Emergency Department in Seattle, WA [2]

Objectives: We compared complete blood count (CBC) with differential and markers of inflammation and coagulation in patients with and without coronavirus disease 2019 (COVID-19) presenting to emergency departments in Seattle, WA.

Methods: We reviewed laboratory values for 1 week following each COVID-19 test for adult patients who received a standard severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) test before April 13, 2020. Results were compared by COVID-19 status and clinical course.

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

Results: In total 1,027 patients met inclusion criteria. Patients with COVID-19 (n = 155) had lower leukocytes (P < .0001), lymphocytes (P < .0001), platelets (P < .0001), and higher hemoglobin (P = .0140) than those without, but absolute differences were small. Serum albumin was lower in patients with COVID-19 (P < .0001) and serum albumin, neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW) were each associated with disease severity. NLR did not differ between patients with COVID- 19 and those without (P = .8012).

Conclusions: Patients with COVID-19 had modestly lower leukocyte, lymphocyte, and platelet counts and higher hemoglobin values than patients without COVID-19. The NLR, serum albumin, and RDW varied with disease severity, regardless of COVID-19 status..

50-gene risk profiles in peripheral blood predict COVID-19 outcomes: A retrospective, multicenter cohort study [3]

Background: COVID-19 has been associated with Interstitial Lung Disease features. The immune transcriptomic overlap between Idiopathic Pulmonary Fibrosis (IPF) and COVID-19 has not been investigated.

Methods: we analyzed blood transcript levels of 50 genes known to predict IPF mortality in three COVID- 19 and two IPF cohorts. The Scoring Algorithm of Molecular Subphenotypes (SAMS) was applied to distinguish high versus low-risk profiles in all cohorts. SAMS cutoffs derived from the COVID-19 Discovery cohort were used to predict intensive care unit (ICU) status, need for mechanical ventilation, and in-hospital mortality in the COVID-19 Validation cohort. A COVID-19 Single-cell RNA-sequencing cohort was used to identify the cellular sources of the 50-gene risk profiles. The same COVID-19 SAMS cutoffs were used to predict mortality in the IPF cohorts.

Findings: 50-gene risk profiles discriminated severe from mild COVID-19 in the Discovery cohort (P = 0·015) and predicted ICU admission, need for mechanical ventilation, and in-hospital mortality (AUC: 0·77, 0·75, and 0·74, respectively, P < 0·001) in the COVID-19 Validation cohort. In COVID-19, 50-gene expressing cells with a high-risk profile included monocytes, dendritic cells, and neutrophils, while low- risk profile-expressing cells included CD4+, CD8+ T lymphocytes, IgG producing plasmablasts, B cells, NK, and gamma/delta T cells. Same COVID-19 SAMS cutoffs were also predictive of mortality in the University of Chicago (HR:5·26, 95%CI:1·81-15·27, P = 0·0013) and Imperial College of London (HR:4·31, 95%CI:1·81-10·23, P = 0·0016) IPF cohorts.

Interpretation: 50-gene risk profiles in peripheral blood predict COVID-19 and IPF outcomes. The cellular sources of these gene expression changes suggest common innate and adaptive immune responses in both diseases.

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

xi. Sources

Global Risk Assessment 1. https://www.trip.com/travel-restrictions-covid-19/ 2. https://losangeleno.com/coronavirus-los-angeles/october-1/ 3. https://www.europeanpharmaceuticalreview.com/news/126922/study-shows-anticoagulation- therapy-beneficial-for-covid-19-patients/ 4. https://www.nytimes.com/2020/09/02/health/coronavirus-steroids.html 5. https://news.abs-cbn.com/overseas/04/22/20/israeli-firm-treating-covid-19-patients-with-placenta- cells-reports 6. https://www.khaleejtimes.com/coronavirus-pandemic/uae-stem-cell-therapy-for-coronavirus-treats- over-2000-patients-1200-fully-recover- 7. https://www.dailytarheel.com/article/2020/11/university-baric-lab-researchers 8. https://www.todayonline.com/world/relief-neurorx-say-emergency-treatment-rlf-100-helps-critically- ill-covid-patients 9. https://www.channelnewsasia.com/news/world/us-plasma-treatment-covid-19-donald-trump-fda- 13046312 10. https://www.reuters.com/article/us-health-coronavirus-eli-lilly-fda-idUSKBN27P35L 11. https://bc.ctvnews.ca/vancouver-developed-covid-19-treatment-approved-for-use-1.5201168 12. https://www.outsourcing-pharma.com/Article/2020/11/23/FDA-grants-EUA-for-combo-COVID-19- treatment 13. https://tribune.com.pk/story/2246746/3-ethiopia-use-dexamethasone-covid-19-patients/ 14. http://www.xinhuanet.com/english/2020-12/03/c_139560671.htm 15. https://www.reuters.com/article/us-health-coronavirus-lilly-fda/eli-lillys-antibody-combination- receives-fda-emergency-use-authorization-for-covid-19-idUSKBN2AA02P 16. https://www.channelnewsasia.com/news/world/covid-19-vaccine-no-quarantine-14-days-exposure- us-cdc-14173034 17. https://www.explica.co/covid-19-italy-approves-two-new-monoclonal-antibody-drugs-against-covid/ 18. https://thenewdaily.com.au/news/2021/02/17/uk-new-covid-strain/ 19. https://www.rfi.fr/en/science-and-technology/20210228-france-authorises-first-synthetic-antibody- treatment-for-covid-19-monoclonal-eli-lilly-bamlanivimab 20. https://www.globaltimes.cn/page/202103/1217150.shtml 21. https://www.biospace.com/article/fda-suspends-use-of-monoclonal-antibody-cocktail-in-three- states-due-to-rise-of-california-covid-19-variant/ 22. https://en.antaranews.com/news/170926/bpom-approves-covid-19-drug-avifavir-for-emergency-use 23. https://www.globenewswire.com/news-release/2021/05/26/2236926/0/en/GSK-and-Vir- Biotechnology-Announce-Sotrovimab-VIR-7831-Receives-Emergency-Use-Authorization-from-the-US- FDA-for-Treatment-of-Mild-to-Moderate-COVID-19-in-High-Risk-Adults-and-Pedia.html 24. http://www.businessworld.in/article/Eli-Lilly-Gets-Indian-Emergency-Use-Nod-For-COVID-19- Antibody-Drug-Combination/02-06-2021-391665/ 25. https://gulfnews.com/special-reports/monoclonal-antibodies-will-they-help-end-covid-19- 1.1622392290149

Travel Bans/Advisories & Quarantine Orders 1. http://www.tribtown.com/2021/06/21/cn-virus-outbreak-canada-border-2/

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

2. https://www.schengenvisainfo.com/news/denmark-ends-entry-restrictions-for-albania-serbia-north- macedonia-several-eu-regions/ 3. https://www.schengenvisainfo.com/news/estonia-imposes-mandatory-quarantine-for-arrivals-from- latvia-denmark/ 4. https://www.schengenvisainfo.com/news/france-imposes-stricter-entry-restrictions-for-travellers- from-russia/ 5. https://www.thenationalnews.com/lifestyle/travel/germany-travel-guide-country-reopens- quarantine-free-to-vaccinated-visitors-1.1244949 6. https://www.schengenvisainfo.com/news/greece-now-accepts-negative-covid-19-rapid-antigen-tests- for-entry/ 7. https://www.scmp.com/news/hong-kong/health-environment/article/3138131/coronavirus-hong- kong-reduce-covid-19-quarantine 8. https://asia.nikkei.com/Spotlight/Coronavirus/Coronavirus-Free-to-read/Coronavirus-latest-Hong- Kong-to-ban-passenger-flights-from-Indonesia 9. https://www.bmj.com/content/373/bmj.n1617 10. https://www.arabnews.com/node/1879006/world 11. https://www.schengenvisainfo.com/news/netherlands-to-remove-entry-ban-for-tourists-from-us-5- other-third-countries-from-june-24/ 12. https://www.reuters.com/world/asia-pacific/australias-new-south-wales-logs-biggest-rise-covid-19- cases-week-2021-06-22/ https://www.stuff.co.nz/travel/news/300341677/covid19-nsw-travel- bubble-on-hold-for-another-12-days-after-case-surge 13. https://www.schengenvisainfo.com/news/norway-unfolds-strategy-for-safely-restoring-travel-amid- covid-19/ 14. https://www.schengenvisainfo.com/news/spain-abolishes-covid-19-testing-requirement-for-arrivals- from-majority-of-german-italian-regions/ 15. https://www.schengenvisainfo.com/news/sweden-extends-entry-ban-against-eu-eea-travellers- without-covid-19-immunity-test-results-until-august-31/ 16. https://www.schengenvisainfo.com/news/switzerland-relaxes-entry-restrictions-for-travellers-from- schengen-area-third-countries/ 17. https://focustaiwan.tw/society/202106220015 18. https://www.france24.com/en/live-news/20210620-emirates-to-fly-from-india-again-after-ban-over- virus 19. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e 20. https://www.bbc.com/news/uk-57597299 https://www.theguardian.com/politics/live/2021/jun/24/uk-covid-live-news-green-list-international- travel-coronavirus-latest-updates 21. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e 22. https://www.wfmj.com/story/44170248/the-latest-hawaii-to-drop-rules-for-vaccinated-travelers

Lockdowns Refer to Situation Report 91 for all updates before 1st May 2020 1. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e 2. https://www.usnews.com/news/health-news/articles/2021-06-24/coronavirus-cluster-in-australian- state-prompts-travel-ban-mask-requirements 3. https://www.bbc.com/news/world-australia-57590969 4. https://www.wionews.com/south-asia/bangladesh-government-orders-lockdown-in-seven-districts- 393010 5. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

6. https://www.scmp.com/news/hong-kong/health-environment/article/3138131/coronavirus-hong- kong-reduce-covid-19-quarantine 7. https://www.indiatoday.in/coronavirus-outbreak/story/covid-19-unlock-india-delhi-up-haryana-tamil- nadu-telangana-goa-1817284-2021-06-20 8. https://www.globaltimes.cn/page/202106/1226743.shtml 9. https://www.reuters.com/world/asia-pacific/indonesia-tighten-covid-19-restrictions-2-weeks-after- rising-cases-minister-2021-06-21/ 10. http://www.xinhuanet.com/english/asiapacific/2021-06/19/c_1310017088_2.htm 11. https://www.washingtonpost.com/politics/moscow-imposes-new-virus-restrictions-as-cases-remain- high/2021/06/22/0bd01920-d36b-11eb-b39f-05a2d776b1f4_story.html 12. https://timesofindia.indiatimes.com/world/middle-east/covid-19-surge-in-oman-leads-to-new- lockdown/articleshow/83681765.cms 13. https://www.bloomberg.com/news/articles/2021-06-24/portugal-says-lisbon-stores-will-close-earlier- during-weekends 14. https://abcnews.go.com/Health/wireStory/infections-soar-siberian-region-imposes-week-lockdown- 78444273 15. https://en.yna.co.kr/view/AEN20210620000653320 16. http://www.xinhuanet.com/english/africa/2021-06/21/c_1310018760.htm 17. http://www.xinhuanet.com/english/africa/2021-06/25/c_1310026357.htm 18. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e 19. https://www.voanews.com/covid-19-pandemic/uganda-imposes-42-day-covid-19-lockdown 20. https://www.bbc.com/news/uk-57552793 21. https://www.ft.com/content/8c3c9d36-1f18-4e42-9b84-e15f75b9246e

Military Surveillance 1. https://www.haaretz.com/israel-news/israel-sees-highest-covid-daily--in-two-months-as- delta-variant-spreads-1.9928700 2. https://en.yna.co.kr/view/AEN20210624004700325 3. https://en.yna.co.kr/view/AEN20210625004700325 4. https://www.stripes.com/branches/navy/2021-06-22/finally-back-to-normal-bars-nightclubs-no- longer-off-limits-to-yokosuka-sailors-1767128.html 5. https://www.stripes.com/theaters/asia_pacific/2021-06-23/only-36-people-attend-pandemic- abbreviated-commemoration-for-battle-of-okinawa-1777578.html 6. https://en.yna.co.kr/view/AEN20210624006900325?section=search

Vaccine/Therapeutics Development 1. https://www.voanews.com/east-asia-pacific/researchers-begin-trials-covid-19-nasal-spray-vaccine 2. https://www.sydney.edu.au/news-opinion/news/2021/06/25/first-australian-covid-19-dna-vaccine- trial-commences-.html 3. https://www.arabnews.com/node/1880156/world 4. https://medicalxpress.com/news/2021-06-cuban-covid-vaccine-abdala-percent.html 5. https://demerarawaves.com/2021/06/19/medical-council-endorses-sputnik-v-vaccine/ 6. https://www.voanews.com/covid-19-pandemic/thailand-starts-human-trials-homegrown-covid-19- vaccines 7. https://www.reuters.com/business/healthcare-pharmaceuticals/study-testing-moderna-vaccine- transmission-prevention-include-young-adults-2021-06-22/ 8. https://www.ft.com/content/af162963-078c-4c63-9731-e4c8d5e5de2a

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 469. 25 June 2021

9. https://www.biospace.com/article/data-supports-use-of-anti-parasitic-drug-ivermectin-in-covid-19- patients-study-shows/ 10. https://www.healio.com/news/cardiology/20210621/activ4b-trial-of-antithrombotic-therapy-in- covid19-ends-early-due-to-low-event-rates

Compilation of Adverse Reactions 1. https://health.economictimes.indiatimes.com/news/industry/astrazeneca-covid-vaccine-linked-to- rare-neurological-disorder-in-india-uk/83766947 2. https://timesofindia.indiatimes.com/city/mumbai/mumbai-of-49l-doses-given-in-city-66-lead-to- adverse-events/articleshow/83793764.cms 3. https://www.docwirenews.com/abstracts/neurologic-adverse-events-among-704003-first-dose- recipients-of-the-bnt162b2-mrna-covid-19-vaccine-in-mexico-a-nationwide-descriptive-study/ 4. https://www.pna.gov.ph/articles/1144545 5. https://www.koreabiomed.com/news/articleView.html?idxno=11438 6. https://www.precisionvaccinations.com/2021/06/20/uk-confirms-adverse-reactions%C2%A0- %C2%A0vaxzevria-covid-19-vaccine 7. https://www.bbc.com/news/uk-northern-ireland-57584775

Scientific Reports 1. Webber SC, Tittlemier BJ, Loewen HJ. Apparent Discordance between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review. Phys Ther. 2021 Jun 21:pzab155. doi: 10.1093/ptj/pzab155. Epub ahead of print. PMID: 34160029. 2. Chandler CM, Reid MC, Cherian S, Sabath DE, Edlefsen KL. Comparison of Blood Counts and Markers of Inflammation and Coagulation in Patients With and Without COVID-19 Presenting to the Emergency Department in Seattle, WA. Am J Clin Pathol. 2021 Jun 21:aqab052. doi: 10.1093/ajcp/aqab052. Epub ahead of print. PMID: 34151348. 3. Juan Guardela BM, Sun J, Zhang T, Xu B, Balnis J, Huang Y, Ma SF, Molyneaux PL, Maher TM, Noth I, Michaud G, Jaitovich A, Herazo-Maya JD. 50-gene risk profiles in peripheral blood predict COVID-19 outcomes: A retrospective, multicenter cohort study. EBioMedicine. 2021 Jun 19;69:103439. doi: 10.1016/j.ebiom.2021.103439. Epub ahead of print. PMID: 34157486; PMCID: PMC8214725.

33 | 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 469. 25 June 2021

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 Wang Min Xian

Mr Lau Wai Hong Nicholas

Any queries? Email Sylvia Gwee @ [email protected]

Centre for Infectious Disease Epidemiology and Research

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For more information, please visit:

Our NUS website: https://sph.nus.edu.sg/partnerships/cider/ Our blog: https://blog.nus.edu.sg/nuscider/

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