For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

Jan 22

COVID-19 Situation Report 358

Centre for Infectious Disease Epidemiology and Research (CIDER) For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 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 358. 22 January 2021

ii. Global Risk Assessment

Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 22 Jan 2021, 1300 SGT) Transmissibilit Severity of Availability of Treatment/ Overall Environmental Risk y Disease Vaccination# Risk Global (n=197 countries) High Moderate High Limited

Globally, 188 (95.4%) countries (excluding Based on CDC Case Of 51 countries reporting available territories*) have reported the outbreak. data, median fatality rate information, the number of countries R0 is estimated is currently that have commenced mass Using an incidence >20 cases/100,000 to be 5.8 (95% at 2.14% vaccination in each region are as people over the past 14-days as cut-off for CI 4.4–7.7), globally. follows: Combined WPRO and SEARO a surge in cases, the number of countries but the Most cases (3 countries), EURO (35 countries), reporting a surge in cases in each region estimated present as EMRO (5 countries), Americas (7 are as follows: Combined WPRO and effective flu-like countries), and Africa (1 country).& SEARO (6 countries), reproduction illness. EURO (50 countries), number in 202 As of 22 January 2021, 11 vaccines have EMRO (13 countries), Americas (29 countries been approved by at least 1 country.€ countries), and Africa (16 countries). ranged from 0.03 to 5.1.$ International clinical trials published on Only 4 (2%) countries/territories have no 2 September confirm that cheap, widely reported restrictions on inbound arrivals, available steroid drugs can help while 145 (78%) countries/territories have seriously ill patients survive Covid-19. partially reopened their borders – require The World Health Organization issued arrivals to produce a negative COVID-19 new treatment guidance, strongly High test result and/or undergo self-quarantine recommending steroids to treat upon arrival. 52 (28%) severely and critically ill patients, but countries/territories are totally closed to not to those with mild disease. [4] international arrivals. [1] Researchers have found all regimens of On October 7, the Centers for Disease anticoagulants to be far superior to no Control and Prevention (CDC) confirmed anticoagulants in COVID-19 patients. airborne transmission of SARS-CoV-2. [2] More specifically, patients on both a “therapeutic” or full dose and those on The U.S. CDC has revised its guidance on a “prophylactic” or lower dose, showed COVID-19 quarantine period from 14 days about a 50% higher chance of survival to 7-10 days, based one's test results and and roughly a 30% lower chance of symptoms. Individuals without symptoms intubation, than those not on only need quarantine for 10 days without anticoagulants. It was observed that testing; those tested negative can therapeutic and prophylactic quarantine for 7 days. [14] subcutaneous low-molecular weight heparin and therapeutic oral apixaban may lead to better results. [3]

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

33 (80.5%) countries have reported As of January Case Vaccine coverage information was outbreaks; but only 6 (14.6%) are 20, the fatality rate available for 3 countries as of 22 High reporting a surge in cases. estimated is 1.56%. January 2021. Coverage for: i) at least 1 effective dose was at <50% for 3 countries; ii) reproduction

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

13 (31.2%) countries have either a no. of 22 full vaccination was not reported in any constant decreasing change in incidence countries country. & or no case in the last 14 days. ranged from 0.46-1.2.$ Highest incidence over the past 14 days were reported from Indonesia, Japan, Malaysia, Maldives and Sri Lanka and highest case numbers were reported from India, Indonesia, Japan, Malaysia and Philippines.

At least 21 countries have closed their borders, 21 countries have opened their borders partially conditionally, and none are allowing free travel. European Region (n=53 countries) High Moderate Moderate Limited

52 (98.1%) countries have reported with As of January Case Vaccine coverage information was outbreaks; 50 (94.3%) countries are 20, the fatality rate available for 35 countries as of 21 reporting a surge in cases. estimated is 2.13%. January 2021. Coverage for i) at least 1 effective dose was at <50% for 35 countries; ii) 1 (1.9%) country has either a constant reproduction full vaccination was at <50% for 15 decreasing change in incidence or no case no. of 52 countries. & in the last 14 days. countries ranged from High Highest incidence over the past 14 days 0.031-1.3.$ were reported from Andorra, Czech Republic, Israel, Portugal and Spain and highest case numbers were reported from Germany, France, Russia, Spain and UK.

At least 6 countries have closed their borders, 46 countries have opened their borders partially conditionally, and only 1 country is allowing free travel. Eastern Mediterranean Region (n=22 countries) High Moderate High Limited

22 (100%) countries have reported with As of January Case Vaccine coverage information was outbreak; 13 (59.1%) countries are 20, the fatality rate available for 5 countries as of 21 reporting a surge in cases. estimated is 2.39%. January 2021. Coverage for: i) at least 1 effective dose was at <50% for 4 countries; ii) None of the countries has either a reproduction full vaccination was at <50% for 2 constant decreasing change in incidence no. of 21 countries. & or no case in the last 14 days. countries High ranged from As of June 25, the Abu Dhabi Stem Cell Highest incidence over the past 14 days 0.6-1.3.$ Centre has treated more than 2,000 were reported from Bahrain, Lebanon, COVID-19 patients using UAECell19. Palestine, Tunisia and UAE, and highest 1,200 have fully recovered. [6] case numbers were reported from Iran, Lebanon, Pakistan, 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]

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021 borders partially conditionally, and only 1 country is allowing free travel. Region of the Americas (n=35 countries) High Moderate High Limited

35 (100%) countries have reported with As of January Case Vaccine coverage information was outbreak; 29 (82.9%) countries are 20, the fatality rate available for 7 countries as of 21 reporting a surge in cases. estimated is 2.29%. January 2021. Coverage for: i) at least 1 effective dose was at <50% for 7 countries; ii) None of the country has either a constant reproduction full vaccination was at <50% for 5 decreasing change in incidence or no case no. of 34 countries. & in the last 14 days. countries ranged from The Food and Drug Administration has Highest incidence over the past 14 days 0.29-1.8.$ allowed the combination use of were reported from Brazil, Colombia, baricitinib and Remdesivir under Panama, St. Vincent Grenadines and USA, emergency use authorization. The EUA and highest case numbers were reported covers dosing of patients (above the age from Argentina, Brazil, Colombia, Mexico of two) who are on supplemental and USA. oxygen, receiving invasive mechanical ventilation or extracorporeal membrane At least 11 countries have closed their oxygenation. [12] borders, 22 countries have opened their borders partially conditionally, and 2 Health Canada has approved countries are allowing free travel. bamlanvimab, for the treatment of COVID-19 in patients 12 years and older with mild to moderate symptoms who High 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]. African Region (n=46 countries) Moderate Moderate High Limited

46 (100%) countries have reported with As of January Case Vaccine coverage information was High outbreak; 16 (34.8%) countries are 20, the fatality rate available for 1 country as of 21 January reporting a surge in cases. estimated is 2.34%. 2021. Coverage for: i) at least 1 dose effective was at <50% for 1 country ii) full

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

1 (2.2%) countries have either a constant reproduction vaccination was not reported in any decreasing change in incidence or no case no. of 43 country. & in the last 14 days. countries ranged from Ethiopia has approved the use of Highest incidence over the past 14 days 0.74-5.1.$ Dexamethasone treatment for seriously were reported from Botswana, Cabo ill COVID-19 patients. [13] Verde, Namibia, Seychelles and South Africa and highest case numbers were reported from Mozambique, Nigeria, South Africa, Zambia and Zimbabwe.

At least 9 countries have closed their borders, 38 countries have opened their borders partially conditionally, and no country is allowing free travel. *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. # Ongoing clinical trials of vaccines and treatment are summarised in section X %This is by no means an exhaustive list of lockdowns imposed globally. Tally is subjected to publication bias whereby certain countries may receive less media attention and hence, coverage on their travel bans implemented. $ 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://ourworldindata.org/covid-vaccinations; High vaccine coverage defined as >70% population with full vaccination € https://covid19.trackvaccines.org/vaccines/

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

iii. Global Epidemiology

Table 2. Summary of COVID-19 cases & fatalities globally (Updated as of 22 Jan 2021, 1300 SGT) Case- No. of Total Cases Case- Total Fatality Countries/ Outside Total Fatality Global Rate (%) R0 Territories Mainland Deaths Rate (%) Cases [outside with Cases China [overall] China] 5.8 (95% CI 4.4– 219 98,092,757 98,003,953 2,100,452 2.14% 2.14% 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 2.14 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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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

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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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

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 (Updated as of 22 Jan 2021, 1300 SGT) Country Total Cases Change Total Change Total Region Deaths Recovered 1 USA 25,196,086 +197111 420,285 +4391 15,100,991 Americas 2 India 10,626,200 +14481 153,067 +161 10,283,708 SEARO 3 Brazil 8,699,814 +59946 214,228 +1335 7,580,741 Americas 4 Russia 3,655,839 0 67,832 0 3,054,218 EURO 5 UK 3,543,646 +37892 94,580 +1290 1,586,707 EURO 6 France 2,987,965 +22848 71,998 +346 214,538 EURO 7 Spain 2,560,587 +148269 55,041 +404 N/A EURO 8 Italy 2,428,221 +14055 84,202 +521 1,827,451 EURO 9 Turkey 2,412,505 +6289 24,640 +153 2,290,032 EURO 10 Germany 2,108,895 +18734 51,151 +855 1,780,200 EURO 11 Colombia 1,972,345 +15366 50,187 +395 1,801,134 Americas 12 Argentina 1,843,077 +11396 46,355 +139 1,625,755 Americas 13 Mexico 1,711,283 +22339 146,174 +1803 1,277,978 Americas 14 Poland 1,457,755 +7008 34,561 +420 1,215,732 EURO 15 South Africa 1,380,807 +11381 39,501 +647 1,183,443 Africa 16 Iran 1,354,520 +6204 57,150 +93 1,144,549 EMRO 17 Ukraine 1,177,621 0 21,499 0 914,730 EURO 18 Peru 1,082,907 +4232 39,274 +117 997,285 Americas 19 Indonesia 951,651 +11703 27,203 +346 772,790 SEARO 20 Netherlands 932,884 +5774 13,337 +89 N/A EURO 21 Czechia 917,359 0 14,973 0 782,558 EURO 22 Canada 731,450 +5955 18,622 +160 645,729 Americas 23 Romania 703,776 +2878 17,554 +69 641,288 EURO 24 Belgium 686,827 +2571 20,620 +48 47,675 EURO 25 Chile 685,107 +4367 17,702 +108 642,004 Americas 26 Iraq 611,407 +809 12,977 +9 576,725 EMRO 27 Portugal 595,149 +13544 9,686 +221 434,237 EURO 28 Israel 582,869 +7027 4,245 +64 497,578 EURO 29 Sweden 542,952 +4985 10,921 +124 N/A EURO 30 Bangladesh 530,271 +584 7,966 +16 475,074 SEARO 31 Pakistan 528,891 +1745 11,204 +47 482,771 EMRO 32 Philippines 507,717 0 10,116 0 467,475 WPRO 33 Switzerland 507,123 +2205 8,971 +47 317,600 EURO 34 Morocco 463,706 +1164 8,076 +33 439,301 EMRO 35 Austria 399,798 +1702 7,288 +51 376,360 EURO 36 Serbia 379,093 +1648 3,830 +20 31,536 EURO 37 Saudi Arabia 365,775 +212 6,342 +4 357,337 EMRO

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

38 Hungary 355,662 +1410 11,713 +98 235,276 EURO 39 Japan 345,221 +5447 4,743 +96 273,187 WPRO 40 Jordan 318,181 +776 4,198 +11 304,200 EMRO 41 Panama 305,752 +1975 4,944 +32 250,215 Americas 42 Lebanon 269,241 +4594 2,151 +67 158,822 EMRO 43 Nepal 268,646 +336 1,979 +4 262,868 SEARO 44 UAE 267,258 +3529 766 +4 239,322 EMRO 45 Georgia 251,071 0 2,998 0 238,101 EURO 46 Ecuador 236,189 +1874 14,526 +89 199,332 Americas 47 Belarus 232,298 +1804 1,619 +9 216,744 EURO 48 Slovakia 231,242 +2464 3,801 +64 181,129 EURO 49 Azerbaijan 228,246 +218 3,053 +9 218,387 EURO 50 Croatia 227,326 +776 4,738 +27 219,082 EURO 51 Bulgaria 213,864 +455 8,741 +90 177,354 EURO 52 Dominican Republic 199,672 +1549 2,482 +12 146,020 Americas 53 Bolivia 196,393 +2648 9,818 +54 147,744 Americas 54 Denmark 192,265 +760 1,909 +37 176,003 EURO 55 Tunisia 190,884 +2511 5,989 +68 137,460 EMRO 56 Costa Rica 188,477 +765 2,506 +14 145,724 Americas 57 Ireland 181,922 +2598 2,818 +50 23,364 EURO 58 Kazakhstan 173,842 +1430 2,403 0 157,597 EURO 59 Lithuania 173,819 0 2,554 0 113,364 EURO 60 Malaysia 172,549 +3170 642 +12 130,152 WPRO 61 Armenia 165,528 0 3,021 0 154,046 EURO 62 Kuwait 159,834 +570 951 0 152,826 EMRO 63 Egypt 159,715 +752 8,801 +54 125,171 EMRO 64 Moldova 154,788 +670 3,315 +16 145,168 EURO 65 Slovenia 154,306 +1455 3,284 +27 131,377 EURO 66 Palestine 154,063 +473 1,757 +6 142,819 EMRO 67 Guatemala 152,395 +1071 5,389 +46 136,980 Americas 68 Greece 150,479 +506 5,570 +25 138,748 EURO 69 Qatar 148,258 +258 248 0 144,478 EMRO 70 Honduras 138,044 +1146 3,422 +16 60,392 Americas 71 Myanmar 136,166 +445 3,013 +16 119,973 SEARO 72 Oman 132,486 +169 1,517 +1 124,730 EMRO 73 Ethiopia 132,326 +292 2,057 +13 118,006 Africa 74 Paraguay 125,518 +1071 2,570 +14 100,848 Americas 75 Venezuela 122,260 +569 1,129 +7 114,299 Americas 76 Bosnia and 119,206 +489 4,536 +15 89,882 EURO Herzegovina 77 Nigeria 116,655 +1964 1,485 +7 93,646 Africa 78 Libya 111,746 +622 1,716 +1 89,909 EMRO 79 Algeria 104,852 +246 2,853 +4 71,343 Africa 80 Kenya 99,630 +186 1,739 +3 82,729 Africa

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81 Bahrain 98,878 +305 366 0 95,594 EMRO 82 North Macedonia 89,817 +354 2,754 +15 75,387 EURO 83 China 88,804 +103 4,635 0 82,495 WPRO 84 Kyrgyzstan 83,585 0 1,394 0 79,509 EURO 85 Uzbekistan 78,219 0 620 0 76,655 EURO 86 S. Korea 74,262 +344 1,328 +12 61,415 WPRO 87 Albania 69,916 +678 1,296 +5 42,426 EURO 88 Norway 60,259 +372 544 +1 49,835 EURO 89 Ghana 59,480 +1049 361 +3 56,706 Africa 90 Singapore 59,235 +38 29 0 58,959 WPRO 91 Latvia 58,710 +902 1,057 +25 42,517 EURO 92 Montenegro 56,998 +419 762 +4 47,974 EURO 93 Sri Lanka 56,076 +887 276 +2 47,984 SEARO 94 Afghanistan 54,483 0 2,370 0 46,887 EMRO 95 El Salvador 52,388 +951 1,530 0 46,013 Americas 96 Luxembourg 49,319 +115 562 0 46,499 EURO 97 Zambia 42,213 +1264 597 +12 31,522 Africa 98 Finland 41,565 +399 632 0 31,000 EURO 99 Estonia 39,212 +668 354 +5 28,743 EURO 100 Uganda 38,806 +178 316 +11 13,699 Africa 101 Uruguay 34,992 +698 347 +11 26,927 Americas 102 Namibia 31,515 +262 310 +9 29,230 Africa 103 Mozambique 30,225 +829 283 +12 19,510 Africa 104 Zimbabwe 30,047 +639 917 +38 19,569 Africa 105 Cyprus 29,636 +164 178 +2 2,057 EURO 106 Australia 28,753 +3 909 0 25,960 WPRO 107 Cameroon 28,010 0 455 0 26,861 Africa 108 Sudan 26,279 0 1,603 0 15,688 EMRO 109 Ivory Coast 25,751 +154 142 0 24,119 Africa 110 Senegal 23,909 +267 552 +6 19,916 Africa 111 DRC 21,398 +96 644 +4 14,865 Africa 112 Botswana 19,654 +1024 105 +17 15,911 Africa 113 Cuba 19,530 +408 184 +4 14,754 Americas 114 Angola 19,177 +84 448 +4 17,176 Africa 115 Madagascar 18,301 0 273 0 17,609 Africa 116 French Polynesia 17,820 +123 128 +1 4,842 Non 117 Malta 16,280 +151 245 +1 13,234 EURO 118 Mauritania 16,266 +54 410 +3 14,970 Africa 119 Malawi 16,049 +1198 396 +43 6,314 Africa 120 French Guiana 15,431 +120 76 0 9,995 Non 121 Maldives 14,765 +53 50 +1 13,683 SEARO 122 Jamaica 14,550 +63 331 0 11,809 Americas 123 Guinea 14,236 +29 81 0 13,509 Africa 124 Eswatini 14,017 +228 441 +14 8,822 Non

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

125 Syria 13,398 +85 866 +8 6,842 EMRO 126 Tajikistan 13,308 0 90 0 13,218 EURO 127 Cabo Verde 13,307 +83 122 +1 12,517 Africa 128 Thailand 13,104 +309 71 0 10,224 SEARO 129 Rwanda 12,170 +310 162 +9 7,973 Africa 130 Belize 11,676 +34 289 +3 10,962 Americas 131 Haiti 11,035 +72 243 +3 8,979 Americas 132 Gabon 10,120 0 66 0 9,809 Africa 133 Hong Kong 9,868 +70 167 +1 8,904 WPRO 134 Burkina Faso 9,719 +166 106 0 7,748 Africa 135 Réunion 9,584 0 45 0 9,053 Non 136 Andorra 9,379 +71 93 +1 8,474 EURO 137 Guadeloupe 8,980 0 154 0 2,242 Non 138 Bahamas 8,088 +13 175 0 6,720 Americas 139 Mali 7,911 +14 320 +2 5,666 Africa 140 Suriname 7,880 +97 146 0 7,027 Americas 141 Congo 7,794 +85 117 +3 5,846 Africa 142 Lesotho 7,504 +469 103 +1 1,867 Africa 143 Trinidad and Tobago 7,450 +20 133 0 6,974 Americas 144 Mayotte 7,158 +177 58 0 2,964 Non 145 Guyana 7,067 +52 170 0 6,277 Americas 146 Aruba 6,623 +61 52 0 6,013 Non 147 Martinique 6,327 0 44 0 98 Non 148 Nicaragua 6,204 0 168 0 4,225 Americas 149 Iceland 5,981 +6 29 0 5,846 EURO 150 Djibouti 5,916 +3 61 0 5,833 EMRO 151 Equatorial Guinea 5,365 0 86 0 5,191 Africa 152 CAR 4,974 0 63 0 4,885 Africa 153 Somalia 4,744 0 130 0 3,666 EMRO 154 Curaçao 4,537 +2 20 0 4,408 Non 155 Togo 4,505 +46 74 0 3,901 Africa 156 Niger 4,267 +18 147 0 3,357 Africa 157 Gambia 3,950 +12 128 0 3,697 Africa 158 Gibraltar 3,881 +36 59 +6 3,033 Non 159 South Sudan 3,788 +15 64 0 3,542 Africa 160 Benin 3,582 +25 48 +2 3,284 Africa 161 Channel Islands 3,407 +9 78 0 3,148 Non 162 Sierra Leone 3,081 +51 77 0 2,143 Africa 163 Chad 3,065 +53 114 0 2,193 Africa 164 San Marino 2,833 +18 65 0 2,556 EURO 165 Guinea-Bissau 2,510 0 45 0 2,405 Africa 166 Liechtenstein 2,415 +10 51 +1 2,322 Non 167 New Zealand 2,276 +9 25 0 2,178 WPRO 168 Yemen 2,115 0 614 +2 1,423 EMRO

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169 Comoros 1,935 +2 55 +1 1,210 Africa 170 Eritrea 1,913 +3 6 0 1,304 Africa 171 Liberia 1,901 0 84 0 1,714 Africa 172 Sint Maarten 1,708 +5 27 0 1,554 Non 173 Mongolia 1,592 +8 2 0 1,097 WPRO 174 Vietnam 1,546 +2 35 0 1,411 WPRO 175 Burundi 1,358 +36 2 0 773 Africa 176 Monaco 1,287 +25 9 0 1,058 EURO 177 Sao Tome and 1,171 +1 17 0 995 Africa Principe 178 Turks and Caicos 1,164 +39 7 0 935 Non 179 Barbados 1,156 0 9 0 493 Americas 180 Saint Martin 1,146 0 12 0 1,006 Non 181 Taiwan 873 +1 7 0 771 WPRO 182 Seychelles 866 +22 3 0 647 Africa 183 Bhutan 850 0 1 0 631 SEARO 184 Papua New Guinea 835 0 9 0 790 WPRO 185 Saint Lucia 718 +5 9 +1 354 Americas 186 Diamond Princess 712 0 13 0 699 NA 187 St. Vincent 690 +88 2 0 126 Americas Grenadines 188 Bermuda 684 0 12 0 611 Non 189 Faeroe Islands 652 0 1 0 644 Non 190 Mauritius 556 0 10 0 518 Africa 191 Tanzania 509 0 21 0 183 Africa 192 Cambodia 456 +3 0 0 399 WPRO 193 Isle of Man 432 0 25 0 357 Non 194 Cayman Islands 382 +1 2 0 346 Non 195 Caribbean 360 0 3 0 244 Non Netherlands 196 St. Barth 300 0 1 0 204 Non 197 Antigua and 192 +2 6 0 162 Americas Barbuda 198 Brunei 174 0 3 0 169 WPRO 199 Grenada 139 0 1 0 129 Americas 200 British Virgin Islands 114 0 1 0 95 Non 201 Dominica 113 0 0 0 104 Americas 202 Fiji 55 0 2 0 53 WPRO 203 Timor-Leste 53 0 0 0 49 SEARO 204 Macao 46 0 0 0 46 WPRO 205 New Caledonia 44 0 0 0 43 Non 206 Laos 41 0 0 0 41 WPRO 207 Falkland Islands 35 0 0 0 29 Non 208 Saint Kitts and Nevis 35 0 0 0 33 Americas 209 Greenland 30 0 0 0 29 Non

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210 Vatican City 27 0 0 0 15 Non 211 Solomon Islands 17 0 0 0 10 WPRO 212 Saint Pierre 16 0 0 0 16 Non Miquelon 213 Anguilla 15 0 0 0 15 Non 214 Montserrat 13 0 1 0 12 Non 215 Western Sahara 10 0 1 0 8 Non 216 MS Zaandam 9 0 2 0 7 NA 217 Marshall Islands 4 0 0 0 4 WPRO 218 Wallis and Futuna 4 0 0 0 1 Non 219 Samoa 2 0 0 0 2 WPRO 220 Micronesia 1 0 0 0 0 WPRO 221 Vanuatu 1 0 0 0 1 WPRO Total 98,092,757 +738884 2,100,452 +15954 70,266,976

Figure 4. Areas with reported confirmed cases of COVID-19 (11 January – 17 January 2021)

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

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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 358. 22 January 2021

Table 5. COVID-19 cases and deaths reported by provinces in China (Updated as of 22 Jan 2021, 1300 SGT) Area Existing Change from Total Deaths Change from Recovered Active previous day Diagnosed previous day Cases (Active cases) Cases (Deaths) Hebei 837 +8 1,249 7 0 405 Heilongjiang 306 +47 1,274 13 0 955 Jilin 181 +19 338 2 0 155 Shanghai 100 +2 1,624 7 0 1,517 Beijing 47 +3 1,020 9 0 964 Guangdong 41 +2 2,098 8 0 2,049 Shaanxi 26 0 533 3 0 504 Tianjin 23 -1 335 3 0 309 Liaoning 22 -3 396 2 0 372 Fujian 19 0 534 1 0 514 Zhejiang 17 0 1,316 1 0 1,298 Inner Mongolia 14 0 366 1 0 351 Sichuan 10 0 865 3 0 852 Shanxi 7 +1 231 0 0 224 Henan 5 0 1,303 22 0 1,276 Hunan 5 0 1,026 4 0 1,017 Jiangsu 4 0 688 0 0 684 Shandong 3 0 866 7 0 856 Guangxi 3 0 267 2 0 262 Hubei 1 0 68,150 4,512 0 63,637 Anhui 1 +1 994 6 0 987 Chongqing 1 0 591 6 0 584 Yunnan 1 -3 231 2 0 228 Xinjiang 0 0 980 3 0 977 Jiangxi 0 0 935 1 0 934 Gansu 0 0 182 2 0 180 Hainan 0 0 171 6 0 165 Guizhou 0 0 147 2 0 145 Ningxia 0 0 75 0 0 75 Qinghai 0 0 18 0 0 18 Tibet 0 0 1 0 0 1 Source: https://ncov.dxy.cn/ncovh5/view/pneumonia

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 358. 22 January 2021 iv. Travel Bans/Advisories & Quarantine Orders

[1] Netherlands – On 21 Jan, new requirements mandated by the government require passengers to obtain a negative COVID-19 rapid test result no later than four hours prior to departure to the Netherlands. In addition, passengers must also have a negative result from a PCR test conducted within 72 hours from their flight's departure to be let into the country. [2] USA – Starting Jan 26, travelers from abroad must furnish a negative COVID-19 test before departing for the U.S. and quarantine upon arrival. A mask order for travel is being implemented by the President and will apply to airports and planes, ships, intercity buses, trains and public transportation. USA President Joe Biden has already mandated masks on federal property. v. Lockdowns [3] China – Shanghai has imposed lockdowns on two of China’s best-known hospitals after they were linked to new coronavirus cases. Outpatient services have been suspended at Fudan University Shanghai Cancer Center and Renji Hospital, both of which have been cordoned off along with some surrounding residential communities. [4] Hong Kong – Hong Kong will for the first time lock down tens of thousands of city residents in a bid to contain a worsening outbreak in coronavirus-hit Yau Tsim Mong district, home to neighbourhoods filled with ageing, subdivided flats. The lockdown, the most drastic measure yet during the year-long pandemic, is expected to begin 23 Jan in the district’s two designated mandatory testing areas. Only residents who showed negative Covid-19 test results would be allowed to leave their buildings, sources familiar with the situation said, while none could leave the area until the restriction was lifted. [5] Lebanon – Authorities in Lebanon on Thursday 21 Jan extended a nationwide lockdown by a week, to Feb. 8, amid a steep rise in coronavirus deaths and infections that has overwhelmed the health care system. vi. Military Surveillance

No military-related infectious disease outbreaks were reported on 21 January 2021. vii. WHO Guidance & Other Protocols

No update was published by the WHO on 21 January 2021.

viii. CDC Guidance & Protocols

US CDC

The following update was published by the US CDC on 21 January 2021:

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 358. 22 January 2021

• CDC Guidance for Expanded Screening Testing to Reduce Silent Spread of SARS-CoV-2 Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/expanded- screening-testing.html • Strategies for Optimizing the Supply of Isolation Gowns Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation- gowns.html

EU CDC

The following update was published by the EU CDC on 21 January 2021:

• Risk related to the spread of new SARS-CoV-2 variants of concern in the EU/EEA – first update Available at: https://www.ecdc.europa.eu/en/publications-data/covid-19-risk-assessment- spread-new-variants-concern-eueea-first-update

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

The following update was reported on 22 January 2021:

[1] South Africa – ImmunityBio is set to initiate a Phase I clinical trial of its novel subcutaneous Covid-19 vaccine candidate, hAd5 T-cell, in South Africa, where the 501Y.V2 strain of SARS-CoV-2 was found.

Therapeutics The following update was reported on 22 January 2021:

[2] Global– Adding the arthritis drug tocilizumab to standard care for patients in hospital with severe or critical covid-19 is no better than standard care alone in improving clinical outcomes at 15 days, according to results of a new trial.

Adverse Reactions & Effects

The following table documents adverse reactions reported from approved vaccines and therapeutics. New updates are bolded.

Table 6: Compilation of reports & guidance on adverse reactions Vaccine Report/Guidance Reference

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 358. 22 January 2021

[Canada; Report] One person in Manitoba reportedly had an adverse reaction after receiving the first dose on December 23. There were 490 [1] more individuals vaccinated. [United Kingdom; Report] Two British healthcare workers suffered [2] anaphylactic shock after receiving the vaccine. [United States; Report] A healthcare worker in New York City suffered anaphylaxis after receiving Pfizer BioNTech’s vaccine. The worker is [3] currently in a stable condition. 30,000 people have been vaccinated so far. [United States; Report] Two healthcare workers in northern Idaho and the Treasure Valley, experienced severe allergic reactions after receiving [4] the vaccine. As of the time of reporting, one has fully recovered while the other is expected to be discharged soon. [United States; Report] There have been two cases of severe allergic reaction in Alaska after receiving the COVID-19 vaccine. Symptoms of [5] the latest case include tongue swelling, hoarse voice and difficulty breathing, which kicked in about 10 mins after receving the vaccine. [United States; Report] An individual at Decatur Morgan hospital, Alabama, experienced severe allergic reaction several minutes after [6] getting the vaccine. The patient is currently in a stable condition. [United States; Report] Two healthcare workers from Essentia Health, Minnesota had non-severe allergic reactions to the vaccine. About 2,500 [7] doses of the vaccines have been administered to frontline workers at Essentia Health. [United States; Report] According to Pfizer’s data submitted to the FDA, Pfizer BioNTech the most common side effects were swelling and redness at the vaccine injection site. Other noted common side effects in the trial included [8] fatigue, headache and muscle pain, which had a greater chance of occurring after the second dose than the first dose. [United States; Guidance] The Centers for Disease Control and Prevention (CDC) has issued new guidance on 21 December regarding allergies and coronavirus vaccines after reports of severe allergic [9] reactions to the jab. In the new guidance, the CDC recommends that those who have a severe reaction to the first shot of the vaccine should not receive the second jab. [United States; Guidance] Health experts have said that the side effects of COVID-19 vaccines by Pfizer BioNTech (and Moderna) are short-term and manageable. The American College of Allergy, Asthma & Immunology recently released a guideline on the risk of allergic [10] reactions to Pfizer BioNTech’s vaccine. The guideline is available at https://acaai.org/news/american-college-allergy-asthma-and- immunology-updates-guidance-risk-allergic-reactions-mrna. [Canada; Report] Of 11,930 doses of Pfizer BioNTech’s vaccine administered in British Columbia so far there have been 2 cases of [11] allergic reaction. [Israel; Report] On December 28, a 46-year-old man in Jerusalem suffered severe anaphylactic shock one hour after receiving a COVID-19 vaccination. He is the first in Israel to have such a reaction, and is [12] reportedly allergic to penicillin. His condition has since stabilized.

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 358. 22 January 2021

Separately, a 75-year old man died of heart failure at home some hours after receiving Pfizer BioNTech’s vaccine. The man was reported to have heart disease and cancer, and had suffered a number of previous heart attacks. While investigations are still ongoing, preliminary findings indicated that the death did not appear to be connected to the shot. [Finland; Report] On January 2, the first adverse reaction against the [13] vaccine was reported. No further details were released. [Mexico; Report] A 32-year-old doctor in Mexico has been admitted to intensive care unit with seizures, breathing difficulties and possible encephalomyelitis. While the cause of the adverse reaction is still under investigation, preliminary diagnosis indicates encephalomyelitis. The patient condition has been stablized and is receiving treatment to reduce inflammation. [14]

[15] [Update] The doctor was allergic to sulfa drugs and has a family history of allergies. After developing allergic reaction, medication was administered to recover from the symptoms. However, she had subsequently suffered from convulsion. Diagnosis at that time was allergic reaction to the vaccine but the cause for convulsion and reduction of muscle strength is still being studied. [Bulgaria; Report] As of January 4, Bulgaria’s Medicines Agency had received four reports of adverse reactions. One case of dizziness after administration, two cases of local pain at the vaccinated site, and one [16] case of a slight temperature increase. These side effects had passed off in less than a day. [Portugal; Report] A portugese health worker had suffered a sudden death 2 days after being vaccinated on 30 Dec. She did not suffer from any adverse side-effect after vaccinated and did not has any health problem. An autopsy is expected to be conducted soon. [17]

[18] [Update] In a 5 January 2020 press release, the Portuguese Ministry of Justice informed that preliminary data from the autopsy showed “no evidence of a causal relationship between the death and the vaccine that was received.” [Mexico; Report] By January 5, more than 44,000 people have received the first shot. As of January 4, about 110 people had reported allergic reaction to the vaccine but 80% were mild and only 5 people require hospitalization. Only one person was severely affected and remain in hospital.

[Update] As of 16 January 2021, 753 adverse events (729 mild and 24 [19] serious) allegedly caused by vaccination and immunization were [20] reported since 24 December 2020. The 24 serious events were reported from Coahuila (7 reports), Mexico City (4 cases), Chihuahua, State of Mexico, Guanajuato, Oaxaca and Yucatan (2 reports each) and Baja California, Hidalgo and Jalisco (1 report each). Of the 24 serious events reports, 6 remain hospitalized while the remaining have been discharged. [United States; Publication] Centre of Disease Control and Prevention [21] (CDC) has reviewed on the allergric reaction to the first dose of vaccine [22] during 14 to 23 December. Among the 1,893,360 first doses [23]

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 358. 22 January 2021

administered, 4,393 (0.2%) adverse events were reported. 21 cases of anaphylaxis (11.1 cases per million doses) were detected and 17 of them had history of allergies or allergy reaction. Of the 21 cases, 4 of them were hospitalized including 3 in intensive care and 20 of them had discharged or recovered by 23 December. There were no death reported.

[Update] The total number of cases of anaphylaxis has been updated to 29 as on 6 January.

[Update] CDC has roughly estimated that one in a hundred thousand people who received the Pfizer vaccine had severe allergic reactions. An average rate of 11.1 anaphylaxis cases per one million doses administered was estimated. [United States; Report] A Florida doctor had died several weeks after receiving the vaccine on 18 Dec. He had suffered from hemorrhagic stroke due to a lack of platelets. It is unclear if his death was related to the vaccine while his death is being investigated. It was reported that he had dots on the skin indicating internal bleeding 3 days after the [24] injection. Pfizer and BioNTech had not received any prior indication of [25] possible connection to thrombocytopenia.

[Update] As of 12 Jan, no evidence was obtained to suggest a connection between the vaccine and the death. [Canada; Report] Nine reports of adverse medical reactions which include a total of 65 symptoms, eight of which were considered severe, have been reported as of Jan. 1 but none were considered to be unexpected side effects. [26] [Update] Fifteen new reports of adverse medical reactions, five of which [27] were considered severe, have been reported as between January 1 and January 8. As of January 8, 24 reports of adverse effects were reported, consisting of 10 serious and 14-nonserious reports. All reports were considered to be expected side effects. [France; Report] Six reports of serious adverse effects with a favourable outcome were reported in France during the 3rd week of vaccination: 4 [28] cases of allergic reactions and 2 cases of tachycardia. Around 30 cases of non-serious adverse effects have been reported since 12 Jan 2021 [Norway; Report] As of 14 Jan 2021, 29 reports of side effects were reported in Norway. The 29 reports consisted of 13 deaths, 9 serious side effects and 7 less serious side effects. The deaths were all amongst frail and elderly patients in nursing homes, aged at least 80 years. [29] Serious side effects reported included allergic reactions, strong malaise and severe fever. Less serious side effects include severe pain at injection site. [United States; Report] A healthcare worker in Alaksa experienced an allergic reaction to the Moderna COVID-19 vaccine, 10 minutes within [30] receiving it on January 12. There was no information on allergy history of the healthcare worker. [Israel, Report] At least 13 cases of mild facial paralysis have been [31] reported upon receiving the vaccine.

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 358. 22 January 2021

[United Kingdom, Report] A severe adverse medical reaction was reported from a medical councillor aged 42 years within minutes after receiving his vaccine on 8 January 2021. The councilor experienced [32] breathing difficulties, fever and muscle aches, and was hospitalized for 1 day before his condition stabilized and eventually recovered. [Ireland, Report] As of 11 January 2021, 81 adverse events from [33] vaccination were reported, all involving expected mild side effects. [United States; Report] The FDA advisory committee has noted a special side effect of the vaccine from the clinical trials involving several patients with cosmetic facial fillers. The patients who experienced side [34] effect all had swelling and inflammation in the area that was given the filler. All reactions were resolved following treatment with steroids and antihistamines. [United States; Report] A Boston doctor experienced severe allergic reactions after receiving the Moderna COVID-19 vaccine on December [35] 24. The doctor has a history of shellfish allergy. [Canada; Report] On December 17, the US FDA reported two cases of adverse reactions in individuals who had received the Moderna vaccine. Both patients previously had dermal fillers and experienced some [36] swelling following the vaccination. The cases were likely to have occurred in Toronto, Canada. [United States; Report] A frontline worker in Robstown had experienced immediate numbness on the face after receiving the vaccine a week ago [37] but continues to have soreness and redness to her arms. [United States; Publication] Phase 3 clinical trial involving 30,420 volunteers had observed higher frequency of moderate, transient reactogenicity after vaccination in the vaccine group. Serious adverse events were rare and the incidence was similar between the placebo and vaccine groups. Hence there were no safety concern, apart from the Moderna [38] transient local and systemic reactions. [39]

[Update] The vaccine showed a 94.1% efficacy rate in its phase 3 trial, and serious adverse events occurred in just 0.6% of patients. A total of 2 deaths were reported in the vaccine group, one was due to cardiopulmonary arrest and the other was a suicide. [United States; Report] On 31 December, the Oregon Health Authority reported a case of anaphylaxis after a healthcare worker had taken the [40] vaccine this week and is recovering in the hospital. [Guidance] A new guidance from the American Society for Dermatologic Surgery (ASDS) has been released regarding side effects from the SARS- CoV-2 mRNA vaccine on dermal fillers. FDA data reports show three [41] participants out of 15,184 who received at least one dose of Moderna’s mRNA-1273 vaccine have developed lip for facial swelling in areas of dermal filler placement. [United States; Report] A Missouri healthcare worker experienced severe allergic reaction after receiving the Moderna COVID-19 vaccine [42] on December 29. The healthcare worker has a history of severe allergy reaction to MRI contrast dye. [United States, Report] Six reports of allergy reactions requiring medical attention 24 hours from vaccination, were reported amongst healthcare [43] workers on 14 January 2021. The healthcare workers were vaccinated

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 358. 22 January 2021

with lot 41L20A from the same vaccination site in San Diego. The site is temporarily closed for now and using other vaccines. California health officials recommend suspending the use of lot 41L20A, until investigation are complete. [United States, Report] A fatality was reported in a resident from a retirement home, after receiving the vaccine. Investigation on whether [44] the fatality was linked to receiving the vaccine is underway. [Argentina; Report] Of the total 32,013 patients who had received the Sputnik V vaccine, 1% (317 patients) had reported mild adverse reaction (fever [45] and headache). [India, Report] Ninety-three reports of adverse events following immunization with Astrazeneca & Oxford Uni. ( and Bharat Biotech) vaccines were reported from Delhi (51 mild and 1 serious report), Haryana (13 mild reports), Maharashtra (14 mild reports) and Kolkata (13 mild and 1 serious report). No fatalities have been reported.

[46] [Update] Between 16 January and 17 January, 447 reports of adverse [47] events following immunization have been reported across India. Only 3 Astrazeneca & [48] of the reports involved serious adverse events requiring hospitalization, Oxford Uni. [49] of which only 1 remains hospitalized. [50]

[Update] 82 AEFIs were reported across India on 20 January 2021. All

AEFIs reported were mild cases.

[Update] On the 22 Jan, Day 4 of the coronavirus vaccination drive in Delhi, 5,942 people were reportedly administered the shots and adverse events following immunisation (AEFI) was reported in 24 persons. Therapeutic/Drug Report/Guidance Reference NIL NIL NIL

x. Scientific Publications with Epidemiology and Clinical Focus

Implementing Building-Level SARS-CoV-2 Wastewater Surveillance on a University Campus [393]

Abstract

The COVID-19 pandemic has been a source of ongoing challenges and presents an increased risk of illness in group environments, including jails, long term care facilities, schools, and, of course, residential college campuses. Early reports that the SARS-CoV-2 virus was detectable in wastewater in advance of confirmed cases sparked widespread interest in wastewater based epidemiology (WBE) as a tool for mitigation of COVID-19 outbreaks. One hypothesis was that wastewater surveillance might provide a cost-effective alternative to other more expensive approaches such as pooled and random testing of groups. In this paper, we report the outcomes of a wastewater surveillance pilot program at the University of North Carolina at Charlotte, a large urban university with a substantial population of students living in on- campus dormitories. Surveillance was conducted at the building level on a thrice-weekly schedule throughout the university’s fall residential semester. In multiple cases, wastewater surveillance enabled identification of asymptomatic COVID-19 cases that were not detected by other components of the

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 358. 22 January 2021 campus monitoring program, which also included in-house contact tracing, symptomatic testing, scheduled testing of student athletes, and daily symptom reporting. In the context of all cluster events reported to the University community during the fall semester, wastewater-based testing events resulted in identification of smaller clusters than were reported in other types of cluster events. Wastewater surveillance was able to detect single asymptomatic individuals in dorms with total resident populations of 150-200. While the strategy described was developed for COVID-19, it is likely to be applicable to mitigation of future pandemics in universities and other group-living environments.

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 358. 22 January 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

Travel Bans/Advisories & Quarantine Orders 1. https://www.businessinsider.com/klm-cancels-long-haul-flights-after-netherlands-travel-restrictions- 2021-1 2. https://globalnews.ca/news/7591304/us-quarantine-rules-international-travel/

Lockdowns Refer to Situation Report 91 for all updates before 1st May 2020 3. https://journalstar.com/business/the-latest-fauci-to-resume-virus-updates-in-white- house/article_428e31b1-f154-590d-8f99-424fe23ea70b.html 4. https://www.scmp.com/news/hong-kong/health-environment/article/3118756/coronavirus-hong- kong-place-tens-thousands 5. https://www.arabnews.com/node/1796321/middle-east

Military Surveillance Nil

Vaccine/Therapeutics Development 1. https://www.clinicaltrialsarena.com/news/immunitybio-vaccine-trial-africa/ 2. https://www.sciencedaily.com/releases/2021/01/210120204037.htm

23 | 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 358. 22 January 2021

Compilation of Adverse Reactions 1. https://www.cbc.ca/news/canada/manitoba/covid-19-vaccine-manitoba-adverse-affect-1.5854915 2. https://www.dailymail.co.uk/news/article-9085941/Pfizer-COVID-19-vaccine-causing-allergic- reactions-rate-superior-shots.html 3. https://www.wsj.com/articles/new-york-city-health-care-worker-has-severe-adverse-reaction-to- covid-19-vaccine-11608760982 4. https://www.eastidahonews.com/2020/12/two-have-severe-allergic-reactions-after-receiving-covid- 19-vaccine-in-idaho/ 5. https://www.thehindu.com/news/international/second-severe-reaction-to-covid-19-vaccine- reported-in-us/article33370132.ece 6. https://www.wvtm13.com/article/severe-allergic-reaction-reported-following-covid-19-immunization- in-alabama/35059745# 7. https://www.fox21online.com/2020/12/21/two-essentia-health-employees-had-allergic-reactions-to- covid-19-vaccine/ 8. https://www.capegazette.com/article/covid-19-vaccine-discussing-most-common-side-effects/213242 9. https://www.independent.co.uk/news/world/americas/covid-vaccine-pfizer-allergic-reaction-cdc- b1776776.html 10. http://www.koreabiomed.com/news/articleView.html?idxno=10027 11. https://bc.ctvnews.ca/not-unexpected-b-c-reports-2-allergic-reactions-to-covid-19-vaccine-1.5247974 12. https://www.timesofisrael.com/family-ministry-say-no-link-to-vaccine-as-man-dies-hours-after- inoculation/ 13. https://www.aninews.in/news/world/europe/finland-confirms-first-adverse-reaction-to- pfizerbiontech-covid-19-vaccine20210102190911/ 14. https://www.livemint.com/news/world/arg-reports-adverse-reaction-to-sputnik-v-doc-gets-side- effects-from-pfizer-jab-11609633103810.html 15. https://mexiconewsdaily.com/news/coronavirus/covid-vaccinations-have-produced-110-allergic- reactions/ 16. https://sofiaglobe.com/2021/01/04/second-shipment-of-covid-19-vaccines-arrives-in-bulgaria/ 17. https://www.dailymail.co.uk/news/article-9111311/Portuguese-health-worker-41-dies-two-days- getting-Pfizer-covid-vaccine.html 18. https://healthfeedback.org/claimreview/covid-19-vaccine-did-not-cause-the-death-of-a-portuguese- woman-contrary-to-social-media-posts-suggestions/ 19. https://mexiconewsdaily.com/news/coronavirus/covid-vaccinations-have-produced-110-allergic- reactions/ 20. https://www.explica.co/six-people-are-hospitalized-for-adverse-reactions-to-vaccine/ 21. https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm?s_cid=mm7002e1_w 22. https://www.thehealthsite.com/news/29-cases-of-anaphylaxis-reported-after-initial-mrna-based- covid-19-shots-in-the-us-789791/ 23. https://clicklancashire.com/2021/01/09/severe-allergic-reaction-in-21-vaccinated-people.html 24. https://www.usatoday.com/story/news/health/2021/01/06/death-florida-doctor-following-pfizer- covid-19-vaccine-under-investigation-gregory-michael/6574414002/ 25. https://lancasteronline.com/news/health/news-briefs/article_2ec8e295-3dd6-5e6f-a719- b1e456e67e3e.html 26. https://www.cbc.ca/news/politics/adverse-events-covid-19-vaccines-1.5866357 27. https://health-infobase.canada.ca/covid-19/vaccine-safety/#summary

24 | 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 358. 22 January 2021

28. https://ansm.sante.fr/S-informer/Actualite/Point-de-situation-sur-la-surveillance-des-vaccins-contre- la-COVID-192 29. https://sputniknews.com/europe/202101151081772909-norway-links-13-deaths-to-pfizer-vaccines- side-effects/ 30. https://abc7.com/covid-19-pandemic-vaccine-moderna-side-effects/9012113/ 31. https://www.rt.com/news/512736-israel-facial-paralysis-13-covid-vaccine/ 32. https://www.lep.co.uk/health/coronavirus/preston-councillor-rushed-hospital-severe-covid-vaccine- side-effects-3103026 33. https://www.thejournal.ie/vaccines-lorraine-nolan-5328674-Jan2021/ 34. https://health.economictimes.indiatimes.com/news/industry/us-healthcare-worker-suffers-allergic- reaction-to-pfizer-vax/79789164 35. https://edition.cnn.com/2020/12/25/health/boston-health-care-worker-allergic-reaction-moderna- coronavirus-vaccine/index.html 36. https://www.ctvnews.ca/health/coronavirus/2-patients-with-facial-fillers-saw-swelling-after- receiving-moderna-vaccine-fda-1.5248564 37. https://www.kiiitv.com/article/news/health/coronavirus/vaccine/adverse-reactions-from-the- coronavirus-vaccine-are-minor-health-experts-explain-the-reaction-a-woman-had-at-the-drive-thru- clinic-in-robstown/503-cd33e1b5-138c-40e7-8e73-eef1f968e8cb 38. https://www.nejm.org/doi/full/10.1056/NEJMoa2035389 39. https://www.contagionlive.com/view/moderna-vaccine-study-data-shows-94-1-efficacy-serious-side- effects-rare 40. https://katu.com/news/coronavirus/oregon-health-care-worker-hospitalized-after-severe-reaction-to- coronavirus-vaccine 41. https://www.dermatologytimes.com/view/guidance-issued-for-covid-19-vaccine-side-effects-in- dermal-filler-patients 42. https://fox4kc.com/tracking-coronavirus/important-information-to-know-after-metro-healthcare- worker-suffers-severe-allergic-reaction-from-covid-19-vaccine/ 43. https://www.marketwatch.com/story/california-health-official-urges-halt-to-300-000-moderna- vaccinations-after-reports-of-allergic-reactions-01611011648 44. https://www.iheartradio.ca/am800/news/local-retirement-home-resident-dies-after-receiving-covid- 19-vaccine-investigation-launched-1.14400880 45. https://www.livemint.com/news/world/arg-reports-adverse-reaction-to-sputnik-v-doc-gets-side- effects-from-pfizer-jab-11609633103810.html 46. https://www.dailypioneer.com/2021/pioneer-exclusive/52-adverse-events-in-delhi--14-in-maha--13- in-haryana.html 47. https://www.deccanherald.com/national/coronavirus-vaccine-live-news-updates-astrazeneca-oxford- bharat-biotech-covaxin-covishield-healthworkers-free-vaccine-vaccination-drive-India-serum- institute-jan-16-narendra-modi-939594.html#1 48. https://www.firstpost.com/health/covid-19-vaccination-447-recipients-across-india-suffer-adverse- events-post-inoculation-how-aefi-is-tracked-reported-9210391.html 49. https://www.indiatoday.in/coronavirus-outbreak/vaccine-updates/story/coronavirus-vaccine-live- updates-january-20-india-export-world-covishield-covaxin-1760808-2021-01-20 50. https://www.thestatesman.com/cities/delhi/5942-get-jabs-in-delhi-on-day-four-24-aefi-cases- reported-1502947936.html

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 358. 22 January 2021

Scientific Reports

1. Gibas, C. J., Lambirth, K., Mittal, N., Juel, M. A. I., Barua, V. B., Brazell, L. R., ... & Munir, M. Implementing Building-Level SARS-CoV-2 Wastewater Surveillance on a University Campus. medRxiv, 2020-12.

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 358. 22 January 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

Saw Swee Hock School of Public Health National University of Singapore Tahir Foundation Building 12 Science Drive 2 #10-01 Singapore 117549

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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