COVID-19 Updated Data and Developments - 4.2.2020

International case numbers as of April 2, 2020, 10:45 am

• 962,977 COVID-19 cases worldwide; 49,180 deaths; 202,935 recovered.¹
  • There is a frequently updated map of COVID-19 cases online at https://coronavirus.jhu.edu/map.html.
• The United States now has the highest number of COVID-19 cases in the world with over 216,768 diagnosed cases.
• Italy has the second highest number of cases with more than 110,000 cases and Spain has the third highest number of cases with more than 110,000 cases. However, the number of cases and deaths are soaring in Spain while cases in Italy may have begun to plateau.²
  • Deaths in Italy and Spain now exceed China. Italy has recorded 13,155 deaths due to COVID-19 and Spain has recorded 10,0034.
  • New COVID-19 cases in China have dramatically decreased since early February. Newly diagnosed cases in China have not exceeded 125 per day in the past week.
  • The number of diagnosed cases outside of China exceeds those within China-- nearly 90% of all coronavirus cases have been diagnosed in other countries throughout the world.
  • Studies from China finds that the mortality rate in Wuhan for symptomatic individuals is 1.4%.³ The death risk estimate from Wuhan, China is likely to be similar to that seen in the US if our healthcare system experiences a breakdown similar to that of the healthcare system in Wuhan.⁴ This finding indicates that proactive public health interventions to reduce burden on hospitals and healthcare workers, including social distancing, increased personal hygiene, and voluntary movement restrictions, are essential to reducing transmission and fatality rates.

Epidemic curve of confirmed cumulative coronavirus cases worldwide (from WHO COVID-19 Dashboard, as of 4/2/2020).

Coronavirus cases by date of report worldwide (from WHO COVID-19 Dashboard, as of 4/2/2020).⁵

US National case numbers as of April 2, 2020, 10:45 am⁶

• 216,768 cases of coronavirus confirmed by lab tests, 5,148 deaths, and 8,710 recovered cases.
  • New York has the highest number of confirmed cases at 84,046 followed by New Jersey at 22,255 cases and California at 9,907 cases.
  • New York City is the American epicenter of the COVID-19 outbreak with 47,439 cases. New York state currently has 9,500 people hospitalized due to COVID-19. Of those hospitalized, more than 2,300 are in intensive care.⁷
  • New urban hotspots are emerging in Detroit,⁸ Miami,⁹ Los Angeles,¹⁰ and Chicago.¹¹
  • The delay in ordering stringent control measures in Louisiana means that the state is now experiencing the fastest growing epidemic in the US.¹² Close social interactions, especially during the weeks leading up to Mardi Gras, appear to be at the root of the accelerating expansion.
• Risk in population:
  • A new study from the Lancet takes into account the undetected cases of COVID-19 to estimate a mortality rate of 0.66% in China.
  • A study based on data from Wuhan estimates that the mortality rate of symptomatic COVID-19 cases is 1.4%. Those aged 60 and above were at a much greater risk of death than those aged 30-59 and the risk of symptomatic infection increased with age.¹³
  • The fatality rate estimate for COVID-19 has been very difficult to estimate as testing practices and availability vary widely between countries. In many areas, testing has only been given to the most severely ill patients and so many more cases of coronavirus likely have gone undetected.¹⁴
  • The fatality rate from data already available is 1.3% in people 50-59, 0.4% in people 40-49, and 0.18% in people 30 to 39. Those that are 29 and under face mortality rates 0.09% and under, and children ages 0-9 are estimated to experience mortality at rates below 0.01%.¹⁵ Data from the CDC shows that young adults ages 20-44 face a substantial risk of serious illness and hospitalization from the coronavirus.¹⁶

• New data from the CDC has confirmed that individuals with underlying conditions are at greater risk of experiencing severe outcomes as a result of COVID-19. However, the CDC has reiterated that measures should be taken to protect all persons, including those without underlying conditions.¹⁷

• Elderly: The death rate in elderly adults aged 80 or older is very high and believed to be over 15% and possibly as high as 22%.¹⁸ Older adults (those over 60 and particularly those over 80) and those with serious chronic health conditions (including heart disease, diabetes, and lung disease) are at a higher risk of getting very ill due to COVID-19. ¹⁹

• Children: Initial evidence suggests that children seem to be getting infected at the same rate as adults but have milder symptoms.²⁰ In China only 2.4% of all cases are in young children.²¹ However, a new study of more than 2,000 children in China suggests that children may be more susceptible to coronavirus than previously thought. One third of the children included in the study were confirmed cases while the other two-thirds were suspected cases.²²
• Health care workers, home health aides, first responders, and teachers are among those at greatest risk of contracting coronavirus as a result of their job.²³
• Those that work in lower-income jobs may also face increased risk as the ability to work from home may not be feasible-- only 9.2% of those in the bottom income quartile (lowest 25% income earners) are able to work from home while 20.1% of those in the third income quartile (second-lowest, 25-50% incomes earners) are able to work from home.²⁴

New US developments

• There is increasing concern about the accuracy of COVID-19 testing in the US. Although data is currently limited but based on personal experience with patients, some doctors believe that ~30% of those who receive a negative test may actually be infected.²⁵
• New US intelligence suggests that China may have concealed the true number of COVID-19 cases. ²⁶
• The number of Americans applying for unemployment benefits doubled this week to 6.6 million, shattering last week’s already unprecedented record.²⁷
• New evidence suggests that social distancing measures in the US are contributing to a rapid decline in fevers, one of the most common symptoms of coronavirus infections. The number of fevers appears to be holding steady or dropping throughout most of the country, except in New Mexico (where stay at home orders were implemented later than other states) and New Orleans (as a result of crowding during Mardi Gras).²⁸
• Most states have imposed travel restrictions on out-of-state residents, particularly those from hard hit areas like New York City. ²⁹
• President Trump extends social distancing guidelines to April 30th.³⁰
  • Current guidelines recommend all Americans avoid nonessential travel, going to work, eating at bars and restaurants, or gathering in groups of more than 10.
• Johnson and Johnson will start human testing of their COVID-19 vaccine in September, to be ready for emergency use by early 2021. The vaccine would be sold on a not-for-profit basis.³¹
• On March 28, 2020, the CDC issued a travel advisory for New York, New Jersey, and Connecticut residents to refrain from non-essential domestic travel for 14 days.³²
• Congress passed and President Trump signed a $2 trillion rescue package to combat COVID-19.³³
  • Taxpayers with incomes up to $75,000 will receive $1,200 and families will receive an additional $500 per child.
  • Jobless insurance will be extended by 13 weeks and include enhanced benefits for four months. It will include freelancers, furloughed employees, and contractors.
  • Health systems and hospitals will receive $100 billion and will have increased Medicare payments.
• The March 19, 2020 State Department Global Level 4 Health Advisory – Do Not Travel remains in effect. All US citizens should avoid international travel and those abroad should arrange for their immediate return unless they plan to remain indefinitely. ³⁴
• Phase 1 clinical trial for a vaccine to protect against COVID-19 is underway in Seattle.³⁵
• The US Treasury and IRS delay the tax payment deadline by 90 days.³⁶

Known cases in Connecticut (call 211 or text "CTCOVID" to 898211 for information)

• As of April 2, 2020 there are 3557 confirmed cases, 766 hospitalizations, and 85 deaths.³⁷
  • Fairfield County: 1986 cases
  • Hartford County: 469 cases
  • Litchfield County: 131 cases
  • Middlesex County: 66 cases
  • New Haven County: 611 cases
  • New London County: 29 cases
  • Tolland County: 61 cases
  • Windham County: 19 cases
  • Pending address validation: 185 cases

As of April 2, 202 Yale New Haven Health has 214 COVID-19 patients.

• 55 patients are in the ICU and another 46 patients are on ventilators.
  • Compared to influenza patients who are on ventilators, more COVID-19 patients are on prolonged support.
• Two empty floors at the top of Smilow Cancer Center tower of YNHH have been opened up to accommodate the new CoV patients.
• Contact tracing
  • ~30 cases from Yale Health have had a contact tracing interview
  • ~106 contacts have been identified
  • ~64 contacts with sufficient information have had notification initiated

Connecticut developments³⁸

• Connecticut grocery stores will institute “Safe Store” practices this weekend. The guidelines limit the number of shoppers that can be in the store at any time.³⁹
• The Connecticut Department of Health reports testing 2,116 patients as of 03/29/2020.⁴⁰
• Yale launched a multimillion dollar fund to aid New Haven and will match dollar for dollar towards its $5 million goal.⁴¹
• The Connecticut Recovery Bridge Loan Program will make $25 million available to small business and nonprofit negatively affected by the pandemic. After receiving more than 4,000 applications they have temporarily stopped taking applications for the program.⁴²
• The Director of Infection Control at YNHH has confirmed that at the current rate of consumption and following current protective procedures, the hospital faces a shortage of some forms of personal protective equipment in two weeks.
• Professor Marie-Louise Landry at the Yale School of Medicine and her lab have established their own test for SARS-CoV-2 with the help of YSPH researcher Dr. Nate Grubaugh. Her clinical lab tested 752 patient samples from 3/13 to 3/21. They have been able to keep up and report results the same day samples are received.⁴³
• Governor Lamont requests that all “nonessential” workers stay home, starting at 8:00 pm on Monday, March 23. “Essential” workers include those in the health care sector, infrastructure, manufacturing, retail, food and agriculture, providers of basic necessities, services necessary to maintain public safety, and others.⁴⁴

Known cases in Rhode Island (call 401-222-8022 for information)

As of April 2, 2020⁴⁵

• 566 confirmed and presumptive cases
• 60 patients hospitalized
• 10 deaths in the state

Rhode Island developments⁴⁶

• All cars with out of state license plates are being asked to participate in voluntary checks when they enter Rhode Island. If visitors from out of state are planning to stay in Rhode Island, they are being asked to self-quarantine for 14 days and are also being asked to provide their name, phone number, and the address they are staying in the state to ensure that they are self-quarantining. The measure is intended to reduce the transmission of coronavirus from those visiting Rhode Island.⁴⁷
• The Rhode Island Department of Business Regulations is requesting that stores currently open to the public restrict the number of shoppers in their building to 20% of the posted Fire Marshal Capacity at any given time. This restriction is meant to reduce coronavirus spread as well as allow shoppers to maintain adequate social distance from one another while shopping.⁴⁸
• The Honeywell manufacturing facility in Smithfield is planning to create more than 500 new jobs in order to expand production of N95 face masks.⁴⁹
• Starting March 23, all public schools in Rhode Island will implement distance learning for at least two weeks.⁵⁰
• The Rhode Island Public Utilities Commission mandated that all regulated utilities in the state cannot terminate service, except to maintain public safety, during the coronavirus emergency.⁵¹
• Rhode Island bans gatherings of more than 25 people.⁵²

Key international developments

• Authorities in Panama have instituted new regulations that restrict who is allowed outside of their homes, based on gender. Women will be allowed outdoors on Monday, Wednesday, and Friday while men will be allowed outdoors on Tuesday, Thursday, and Saturday. Everyone is required to stay home on Sunday. This measure is intended to reduce the number of people outside on a given day and allow authorities to keep a better handle on people in public areas.⁵³
• The 2020 Summer Olympics in Tokyo will be postponed a year to July 23, 2021.⁵⁴
• On March 24, India’s Prime Minister Nirendra Modi announced a 21-day nationwide lockdown. The announcement caused millions of migrant workers to leave large city centers where they work to return home to their home villages, many of whom are unable to either afford to or simply cannot find space on transit options to take them home. Thus, millions of people are stranded and have to make the difficult decision to stay put, where they are unable to socially distance, or to undertake their journey on foot. The government plans to enact a $22.5 billion stimulus plan to provide direct cash transfers and food to those living in poverty.⁵⁵
• As COVID-19 spreads around the world, developing countries may be less prepared to deal with the pandemic than developed countries because of a lack of resources, general hygiene, and overcrowding.⁵⁶
• The president of Brazil, Jair Bolsinaro remains one of the last national leaders to downplay the severity of the pandemic. Nonetheless, the governors of all states save one have imposed restrictions, contradicting Bolsinaro.⁵⁷
• A hospital in Seoul, South Korea has implemented “phone booth” walk-in testing for COVID-19. The booths allow doctors to test patients for coronavirus while remaining separated by a plastic barrier to reduce patient-doctor contact and spread. After a patient has been tested, the entire booth can be rapidly disinfected before the next patient is consulted. This process has greatly increased the ability to test for coronavirus while decreasing the time it takes to consult individual patients and disinfect spaces that patients with coronavirus come in contact with.⁵⁸
• The EU bans all non-essential travel to Europe for at least 30 days. External borders will be closed but movement within member nations will still be allowed.⁵⁹
• The EU has linked Russian media outlets to disinformation about the coronavirus. The EU-produced report states that the disinformation seeks to undermine public trust in health care systems abroad.⁶⁰

What is coronavirus?

Coronavirus is a family of viruses that have been known to infect humans. Viruses in the family are known to cause the common cold, SARS, and MERS. The virus that causes COVID-19 infects people and is easily spread person-to-person but is far less virulent than SARS. Cases have been detected in most countries worldwide, including the United States, and has officially been declared a pandemic, or a global disease outbreak. COVID-19 causes a respiratory disease that may be identifiable by dry coughing, breathing difficulties, and fever. Those that suspect they are infected with coronavirus should call their health provider first and should not go to a health care facility unless directed to do so.

Nomenclature

The novel (new) coronavirus, formally named “SARS-CoV-2,” and the disease it causes has been named “coronavirus disease 2019” (abbreviated as COVID-19) by the World Health Organization.

Is there a vaccine?

A phase 1 clinical trial for a vaccine designed by Moderna to protect against COVID-19 is currently underway in Seattle.⁶¹ Vaccines must go through at least 3 clinical phases to ensure their efficacy and safety before they can be approved and used in the general population.⁶² Even with an expedited process it will be at least a year before a COVID-19 vaccine is fully developed and made available to the public.⁶³

What is a vaccine?

Vaccines are one of the most effective ways to prevent diseases. Vaccines are made out of killed or weakened parts of the virus or bacteria of interest. Once inside the body, the vaccine is able to stimulate the immune system to develop antibodies and thus immunity to the disease, all without the person getting the disease.⁶⁴

The vaccine currently being developed by Moderna uses genetic information, messenger RNA (mRNA), to deliver the vaccine. mRNA vaccines are an emerging platform and as of now no mRNA vaccine has reached the market. Compared to some forms of traditional vaccines (DNA-based, live/killed attenuated viruses), mRNA vaccines are thought to be safer because they are non-infectious and have no risk of potentially mutating inside the human body. Through chemical modifications mRNA is stabilized and readily enters into cells. Lastly, mRNA vaccine production is inexpensive, fast, and scalable.⁶⁵

Why did the CDC recommend an 8-week moratorium on in-person gatherings?

On Monday the US government officially recommended that people should avoid in-person gatherings of 10 or more people.⁶⁶ This recommendation is supported by evidence from South Korea and China, both of which appear to slowly be returning to life as normal after 8 weeks of anti-coronavirus measures.⁶⁷ On March 10, China closed the last of its temporary emergency hospitals⁶⁸ after seeing a dramatic decrease in new cases over the past couple of weeks.⁶⁹ Likewise, South Korea has experienced a substantial decrease in new cases over the past week.⁷⁰

As the United States contends with this new and evolving situation, it appears likely that many businesses, offices, and schools will remain closed for longer than two weeks.

Information highlights from CDC website⁷¹

• Symptoms
  • Symptoms may appear 2-14 days after exposure.
  • Fever
  • Cough
  • Shortness of breath
• Mounting anecdotal evidence suggests that a loss of smell and taste are significant symptoms associated with COVID-19. ⁷²
• Testing⁷³
  • As of March 15, all 50 states, the District of Columbia, and Guam have successfully verified COVID-19 diagnostic tests in state and local public health laboratories.
  • A number of states have opened “drive-through” coronavirus testing stations with more to come.⁷⁴

How is coronavirus spread?⁷⁵

• Person-to-person
  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.
• Respiratory droplets can spread through the air (6 feet) or land on nearby surfaces where they can survive for a period of time (“Our studies indicate that aerosol and fomite transmission of HCoV-19 is plausible, as the virus can remain viable in aerosols for multiple hours and on surfaces up to days.”)⁷⁶

Guidelines from the CDC to Minimize Chances of Infection⁷⁷

• Clean your hands often
• Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
• If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact
• Avoid close contact with people who are sick
• Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.
• Take steps to protect others
• Stay home if you’re sick
• Stay home if you are sick, except to get medical care. If you think you may have contracted the virus call your doctor first.
• Cover coughs and sneezes
• Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
• Throw used tissues in the trash.
• Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
• Wear a facemask if you are sick.
• If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick.
• If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.
• There are, however, increasing calls for all individuals to wear masks when they are outside of their homes. This is related to increasing evidence that even those asymptomatic can spread the virus if they are infected.⁷⁸
• Clean and disinfect
• Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
• If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.

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14https://www.npr.org/sections/goatsandsoda/2020/03/27/821958435/why-death-rates-from-coronavirus-can-be-deceiving

15https://nymag.com/intelligencer/2020/03/coronavirus-and-its-high-mortality-rate-among-older-patients.html

16 https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

17 https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm

18 https://www.nytimes.com/2020/03/14/health/coronavirus-elderly-protection.html

19https://www.businessinsider.com/coronavirus-death-rate-by-age-countries-2020-3#still-older-patients-in-south-korea-also-had-a-much-higher-death-rate-than-younger-ones-patients-older-than-80-had-a-72-death-rate-as-of-wednesday-6

20 https://www.nature.com/articles/s41591-020-0817-4

21https://www.washingtonpost.com/health/2020/03/10/coronavirus-is-mysteriously-sparing-kids-killing-elderly-understanding-why-may-help-defeat-virus/

22 https://www.nytimes.com/2020/03/17/health/coronavirus-childen.html

23 https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html

24 https://www.bls.gov/news.release/flex2.t01.htm

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27 https://www.cnbc.com/2020/04/02/weekly-jobless-claims.html?__source=twitter%7Cmain

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29 https://www.wsj.com/articles/states-restrict-travelers-from-coronavirus-hot-zones-11585518299

30 https://www.nytimes.com/2020/03/29/us/politics/trump-coronavirus-guidelines.html

31https://www.wsj.com/articles/johnson-johnson-to-begin-human-trials-on-covid-19-vaccine-by-september-11585569380

32 https://www.cdc.gov/media/releases/2020/s038-travel-advisory.html

33https://www.wsj.com/articles/house-lawmakers-race-to-washington-to-ensure-coronavirus-stimulus-passes-11585318472

34https://travel.state.gov/content/travel/en/traveladvisories/ea/travel-advisory-alert-global-level-4-health-advisory-issue.html

35https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins

36 https://www.cnbc.com/2020/03/17/treasury-and-irs-to-delay-tax-deadline-by-90-days.html

37 https://portal.ct.gov/coronavirus

38https://www.nhregister.com/news/coronavirus/article/Coronavirus-in-Connecticut-Live-updates-hour-by-15132401.php

39https://www.thehour.com/business/article/One-way-aisles-Plexiglas-shields-new-CT-15173676.php?src=nwkhpcp

40https://portal.ct.gov/coronavirus

41https://www.nhregister.com/news/coronavirus/article/Yale-launches-multimillion-dollar-fund-to-aid-New-15162549.php

42https://www.wtnh.com/news/connecticut/recovery-bridge-loan-program-temporarily-stops-taking-applications/

43 https://medicine.yale.edu/profile/marie_landry/

44 https://portal.ct.gov/DECD/Content/Coronavirus-for-Businesses/Coronavirus-for-Businesses

45 https://health.ri.gov/data/covid-19/

46 https://www.wpri.com/coronavirus/

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49https://www.wpri.com/health/coronavirus/increased-n95-mask-manufacturing-to-bring-500-new-jobs-to-ri/

50 https://www.necn.com/news/local/ri-gov-to-provide-update-on-coronavirus-response/2247461/

51 https://www.wpri.com/health/coronavirus/march-18-rhode-island-coronavirus-update/

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56https://www.wsj.com/articles/coronavirus-is-advancing-on-poor-nations-and-the-prognosis-is-troubling-11585149183

57 https://www.nytimes.com/2020/04/01/world/americas/brazil-bolsonaro-coronavirus.html

58https://www.straitstimes.com/asia/east-asia/south-korea-dials-up-coronavirus-testing-with-hospital-phone-booths

59 https://www.cnbc.com/2020/03/17/coronavirus-european-union-leaders-agree-to-close-borders.html

60 https://www.theguardian.com/world/2020/mar/18/russian-media-spreading-covid-19-disinformation

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71 https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/index.html

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78 https://www.vox.com/2020/3/31/21198132/coronavirus-covid-face-masks-n95-respirator-ppe-shortage