COVID-19 situation: 20 April 2020

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Pandemic Threats and Health Emergencies

COVID-19 situation: 20 April 2020

Welcome to this special issue of the newsletter where we highlight latest research and policy news and literature on COVID-19 situation

Please send your feedback, articles and reports, or questions you would like to share to Dr. Chadia Wannous via email  

Wishing you useful reading!

COVID-19 Outbreak Situation 

Situation updates:
WHO situation report-91 by 20 April 2020

  • No new country/territory/area reported cases of COVID-19 in the past 24 hours.
  • The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. Dr Hans Henri P. Kluge, WHO Regional Director for Europe, marking the European Immunization Week 2020, stressed ‘we must not, especially now, let down our guard on immunizations’. WHO and UNICEF have released a joint statement to mark European Immunization Week 2020, which is availablehere.
  • WHO has published a brief on the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19. Concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects. However at present there is no evidence of severe adverse effects. The brief is available here.
  • WHO has recently published an updated strategy to help guide the public health response to COVID-19 which is available here
  • update on Emergency Medical Teams, the Global Health Cluster, the Global Outbreak Alert and Response Network, and Risk Communications and Community Engagement is also provided

Situation in Numbers
Total (new) cases in last 24 hours

  • 2314621 confirmed (72846) 157847 deaths (5296)
  • European Region1149071 confirmed (26882)103586 deaths (2648)
  • Region of the Americas 858631 confirmed (36771) 40615 deaths (2357)
  • Western Pacific Region132438 confirmed (1326) 5648 deaths (27)
  • Eastern Mediterranean Region129433 confirmed (4742) 6048 deaths (140)
  • -East Asia Region 29576 confirmed (2257) 1275 deaths (90)
  • African Region 14760 confirmed (868) 662 deaths (34)

Europe accounts for half of the total global reported cases but two-thirds of the reported deaths.
WHO Risk Assessment
Global Level    Very High
Links to the COVID-19 dashboards for most up-to-date figures:
WHO COVID-19 situation dashboard
WHO COVID-19 alerts in African Region
WHO COVID-19 readiness dashboard in African Region
WHO COVID-19 situation dashboard in European Region
WHO COVID-19 weekly surveillance dashboard in European Region
WHO COVID-19 situation dashboard in the Eastern Mediterranean Region
PAHO COVID-19 alerts in the Region of the Americas
All information about COVID- 19 can be found here:
Latest updates - Live press conference (Geneva)

Cuomo says COVID-19 cases have peaked in New York
"The continuation of this positive trend depends on our actions."
More »
Infections might vastly exceed official counts
Widespread antibody testing in a Californian county has revealed that the prevalence of coronavirus infections might be more than 50 times higher than official figures suggest. The results — which have not yet been peer reviewed — are some of the first of more than a dozen ‘seroprevalence surveys’ being carried out in cities worldwide to estimate true infection rates. But questions about the reliability of testing kits mean that the survey results might not be accurate.
(Nature | 7 min read)

Situation update for the EU/EEA and the UK as of 20 April 2020
As of 20 April 2020, 947 693 cases have been reported in the EU/EEA and the UK: Spain (195 944), Italy (178 972), Germany (141 672), United Kingdom (120 067), France (112 606), Belgium (38 496), Netherlands (32 655), Portugal (20 206), Ireland (15 251), Austria (14 710), Sweden (14 385), Poland (9 287), Romania (8 746), Denmark (7 384), Norway (7 068), Czechia (6 787), Finland (3 783), Luxembourg (3 550), Greece (2 235), Hungary (1 984), Croatia (1 871), Iceland (1 771), Estonia (1 528), Slovenia (1 330), Lithuania (1 326), Slovakia (1 161), Bulgaria (915), Cyprus (767), Latvia (727), Malta (427) and Liechtenstein (82).
As of 20 April 2020, 99 232 deaths have been reported in the EU/EEA and the UK: Italy (23 660), Spain (20 453), France (19 718), United Kingdom (16 060), Belgium (5 683), Germany (4 404), Netherlands (3 684), Sweden (1 540), Portugal (714), Ireland (610), Austria (452), Romania (434), Poland (360), Denmark (355), Hungary (199), Czechia (188), Norway (154), Greece (110), Finland (94), Slovenia (74), Luxembourg (73), Croatia (47), Bulgaria (43), Estonia (40), Lithuania (36), Cyprus (17), Slovakia (12), Iceland (9), Latvia (5), Malta (3) and Liechtenstein (1).
Situation dashboard: latest available data

Control Measures

WHO updated strategic plan
This strategic preparedness and response plan outlines the public health measures that the international community stands ready to provide to support all countries to prepare for and respond to COVID-19. The document takes what we have learned so far about the virus and translates that knowledge into strategic action that can guide the efforts of all national and international partners when developing context-specific national and regional operational plans.
COVID‑19 Strategy update 14 April 2020
Supporting documents
Draft operational planning guidance for UN country teams to support national preparedness and response for COVID-19. The purpose of the document is to provide a practical guide for the UNCTs and partners to develop a country level operational plan to support national governments to prepare for and respond to COVID‑19 in line with the Strategic preparedness and response plan.
Updated Country Preparedness and Response Status for COVID-19

Ethics and COVID-19: resource allocation and priority-setting
This policy brief answers a number of questions about the ethics of setting priorities for the allocation of resources during times of scarcity. Such decisions may include access to hospitals, ventilators, vaccines and medicines. It is essential that policies and practices are ethically justified in such contexts. The document provides a high-level ethical framework that can be used to guide decision-making, and complements WHO’s technical guidance.

Joint statement by WTO Director-General Roberto Azevêdo and WHO Director-General Tedros Adhanom Ghebreyesus
ITU-WHO Joint Statement: Unleashing information technology to defeat COVID-19
Why countries can’t meet the demand for gear against covid-19
A host of efforts are under way to unblock bottlenecks
UN health agency working on strategies to gradually lift COVID-19 restrictions
The World Health Organization (WHO) is working with countries on strategies to "gradually and safely" ease stay-at-home restrictions aimed at containing the spread of the new coronavirus, agency chief Tedros Adhanom Gebreyesus told journalists on Friday, though he cautioned against any sudden action.

Not even Singapore has been able to avoid a lockdown
The efficient city-state’s contact-tracing has not stopped the virus

Will an Antibody Test Allow Us to Go Back to School or Work?
Tests that reveal whether someone has been infected with the coronavirus are on their way. But they’re not perfect. Here’s what you need to know.
Why we need at least 500,000 tests per day to open the economy — and stay open
Ubiquitous testing is essential to the nation’s ability to succeed with the planned phased opening of the economy and to stay open (we explain why we need testing in this post). In our analysis below, we estimate that the number of tests needed every day is, at a minimum, 500,000, though we likely need many more.
Wet markets must conform to standards: WHO 
Australian Associated Press

Should wet markets be banned? It’s more complicated than it seems.

Infectious disease: Making — and breaking — the animal connection
Why Did The World Shut Down For COVID-19 But Not Ebola, SARS Or Swine Flu?

Countries measures

10 African Countries Have No Ventilators. That’s Only Part of the Problem.
Basic supplies like oxygen and soap are needed first to slow the spread of the coronavirus.
a number of countries in Africa reportedly have fewer than 10 ventilators nationwide, and 10 have no ventilators at all. Even more concerning, only 15% of the population in Sub-Saharan Africa has access to clean water and soap. Higher-resource countries, such as South Africa, have greater supply of medical resources needed to treat COVID-19 patients, highlighting considerable disparities within the continent.

Africa in the Path of Covid-19
Most African countries remain woefully unprepared for what’s coming. Kenya, for example, has only 200 intensive care beds for its entire population of 50 million. Compare that to the United States, which has 34 beds for every 100,000 people. Countries from Mali to Liberia have only a few ventilators for millions of people. In urban communities throughout Africa, health facilities tend to be overcrowded and understaffed, while in rural areas, poor roads and unreliable transport make it difficult for people to access care. Advanced health care is sorely lacking in nearly every country.

Germany has reportedly begun reopening businesses after approximately a month of “lockdown”.
Public health officials have recommended that people should wear face masks when riding on public transportation and in stores or other enclosed spaces, and some German states have made mask use mandatory. German Chancellor Angela Merkel urged people to follow guidance in order to avoid an increase in disease incidence, and she noted that it could take 14 days to evaluate the effects of resuming public activity on SARS-CoV-2 transmission. While some businesses have reopened, schools and certain businesses like hair salons are currently scheduled for opening May 4. Schools will reportedly prioritize final year students. While Germany contains the fifth-highest number of cases in the world, its number of deaths has remained relatively low, potentially a function of its extensive testing strategy.

Swedish “Herd Immunity”
According to news media reports, a Swedish health officials claimed that infection rates in Stockholm are slowing and that parts of the country could achieve “herd immunity” in the next several weeks. According to Dr. Anders Tegnell, Sweden’s national epidemiologist, epidemiological models indicated that data are showing decreased transmission in some cities, including Stockholm, and that there could be enough infected individuals in the city to make a substantial impact by May. He acknowledged that the models could be incorrect. The announcement comes amid reports of increased deaths in Sweden, which Dr. Tegnell attributed to a failure to protect high-risk populations rather than elevated levels of community transmission. Sweden has taken a rather unorthodox approach to responding to COVID-19, compared to other countries, resisting efforts to implement more aggressive social distancing measures. Swedish officials have emphasized that they are not attempting to develop herd immunity, but rather, they are not implementing formal “lockdown” like other countries. Despite the less aggressive distancing measures, Sweden has reported an increase in unemployment to 8%.

Iceland’s ‘Test Everyone’ Goal Has Skeptics, but It May Be Working
Critics say the Nordic island country should also have closed all of its schools and stopped tourism. But the government says it believes that new cases have peaked.

CDC labs were contaminated, delaying coronavirus testing, officials say.
New York Times

NIH partners with 16 drug companies in hopes of accelerating Covid-19 treatments and vaccines
The Trump administration announced Sunday that nursing homes with Covid-19 cases would now be required to notify residents, their families, and the CDC. 
Americans are eagerly awaiting the reopening of the country—but despite White House guidelines that foresee a near-future return to normalcy, scientists tend to disagree, the New York Times reports.
The Center for Health Security at the Johns Hopkins Bloomberg School of Public Health outlined a reopening plan Friday in a new report tailored to state governors.

These Aspiring Female Scientists in Afghanistan Designed a Cheap Ventilator to Treat COVID-19
Global Citizen
Scientific publications and reports and news

Caught in a superpower struggle: the inside story of the WHO's response to coronavirus – The Guardian

Withholding funding from the World Health Organization is wrong and dangerous, and must be reversed
Researchers everywhere must continue to press their lawmakers to act now and challenge US President Donald Trump’s undermining of the global health agency.
It isn’t yet clear whether the White House can withhold this funding — especially the portion that has been approved by the US Congress — and if so, how much it can keep back. But even talk of doing so in the middle of a global health and economic crisis cannot be condemned strongly enough.

WHO pushes back on claims

African regulatory agencies, ethics committees to expedite COVID-19 clinical trial reviews
EIW 2020 statement - We all look forward to the day when we can be protected from COVID-19 through a vaccine

Enabling Emergency Mass Vaccination: Innovations in Manufacturing and Administration During a Pandemic
The commentary highlights several key aspects and considerations for rapid vaccine manufacturing and calls for geographically distributed manufacturing capacity. Additionally, the authors describe potential benefits and considerations for next-generation vaccine administration approaches in order to streamline vaccine administration and expedite immunization coverage.
DRAFT landscape of COVID-19candidate vaccines –11 April 2020
According to the WHO, nearly 70 COVID-19 vaccine candidates are currently in development, with several undergoing early-stage clinical trials. Several candidates are using novel platforms, and others are using non-traditional methods of administration, including oral tablets and microneedle patches
Manufacturing Platform Developed for Large-Scale Production of COVID-19 Vaccine Candidate
MilliporeSigma and The Jenner Institute report that the Institute has begun preparations for the large-scale production of its COVID-19 vaccine candidate, ChAdOx1 nCoV-19. With patients enrolled for clinical trials for this vaccine, rapid development of the large-scale manufacturing process is a critical step in quickly and safely delivering it from the lab to patients, according to Udit Batra, CEO, MilliporeSigma.

Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China
The results of this case series show that only approximately one-fifth of patients who died of COVID-19 received invasive mechanical ventilation and further aggressive respiratory support prior to death, indicating that many patients had delayed intubation. Potential reasons for the delay include lack of invasive mechanical ventilators and lack of specific clinical training for respiratory support. Another interesting finding of this case series is that hypertension was the most common chronic comorbidity among patients who died.
Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model
The current pandemic coronavirus, SARS-CoV-2, was recently identified in patients with an acute respiratory syndrome, COVID-19. To compare its pathogenesis with that of previously emerging coronaviruses, we inoculated cynomolgus macaques with SARS-CoV-2 or MERS-CoV and compared the pathology and virology with historical reports of SARS-CoV infections.

The months of magical thinking: As the coronavirus swept over China, some experts were in denial

Why a study showing that covid-19 is everywhere is good news
If millions of people were infected weeks ago without dying, the virus must be less deadly than official data suggest
The Promise and Peril of Antibody Testing for COVID-19

Antibody tests get mixed reviews
Dozens of biotech companies have scrambled to distribute antibody tests that tell whether someone has been infected with the virus that causes COVID-19. These tests are being hailed as a game changer that could help to decide when to end controversial lockdown measures. But many tests developed so far have not been reliable. “No test is better than a bad test,” says infectious-disease researcher Michael Busch.
(Nature | 8 min read)

A systematic review of antibody mediated immunity to coronaviruses: antibody kinetics, correlates of protection, and association of antibody responses with severity of disease
The duration and nature of immunity generated in response to SARS-CoV-2 infection is unknown. Many public health responses and modeled scenarios for COVID-19 outbreaks caused by SARS- CoV-2 assume that infection results in an immune response that protects individuals from future infections or illness for some amount of time.

No proof of immunity in recovered coronavirus patients, says WHO
Head of WHO’s emergencies programme Dr Mike Ryan said antibody tests also raised ethical questions

Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver
The tests, many made in China without F.D.A. approval, are often inaccurate. Some doctors are misusing them. The rollout is nowhere close to the demand.

Will antibody tests for the coronavirus really change everything?
Touted as society’s way out of widespread lockdowns, scientists say the true potential of these rapidly developed tests is still unknown.

Everything we know about coronavirus immunity and antibodies — and plenty we still don’t
as political leaders push to find ways to let people return to their lives, some experts are cautioning that there remain plenty of questions about this virus — which has only been on people's radars for four months — and if and how long people will be immune after recovery.

Reports suggest many have had coronavirus with no symptoms

The People Who Risked Death for Immunity
 The Atlantic
As New York’s ventilator crisis abates, dialysis machines are now in short supply as health workers discover a pattern of kidney problems among severely ill COVID-19 patients.

COVID-19 studies: Obesity boosts risk; diagnosing health workers

How important is “silent spreading” in the covid-19 epidemic? Possibly, very
Accumulating evidence suggests a substantial chunk of the infections it causes are transmitted by people whose symptoms have not yet appeared—or even, like Mallon, who never develop symptoms at all. That has implications for the methods countries are employing to curb the pandemic

Why a highly-cited coronavirus model now projects thousands fewer US deaths than before
The model now projects 60,400 COVID-19 deaths in the U.S. by the summer, down from 84,000 deaths in earlier predictions.          

How does COVID-19 kill? Uncertainty is hampering doctors’ ability to choose treatments
Doctors are reaching for drugs that dampen the immune response — but these also undermine the body’s own fight against the coronavirus.

Coronavirus deaths ‘need new autopsy technique’

  • Post-mortem of suspected coronavirus deaths pose high risk for health workers
  • New minimally invasive technique being researched in Brazil since 2013
  • Technique will enable database of tissue samples to further knowledge of COVID-19

Vitamin D and Coronavirus Disparities

Coronavirus chemicals by ear
Do you know your lopinavir from your remdesivir and your chloroquine from your hydroxychloroquine? Catch up with a series of short podcasts about the chemical compounds being tested in the World Health Organization’s global SOLIDARITY drug trials (ritonavir is coming next week). (Chemistry World | Several sub-10 min listens)

ECCMID studies probe resistant pathogens in pets, pet food, and people
Two studies highlight concerns about the potential to spread superbugs from pets to people.
More »

Read Nature’s continuously updated selection of the must-read papers and preprints on COVID-19.
Consequences of the Outbreak on society and Economy
The coronavirus has upended global supply chains
leading to shortages and price increases that are cascading through factories, ports, retail stores and on to consumers. The crisis in global trade is unfurling so quickly that companies are struggling to plan ahead. That means disruptions could grow in the months to come, for products ranging from laptops to toilet paper to medicines. Above, empty shelves in Brenham, Texas, last month. The market for lifesaving equipment and supplies is under particular stress: Many nationalist world leaders see the coronavirus battle as a zero-sum game, and at least 69 countries have banned or restricted the export of protective equipment, medical devices or medicines, according to a monitoring project in Switzerland.

In Pursuit of PPE
As a chief physician executive, I rarely get involved in my health system’s supply-chain activities. The Covid-19 pandemic has changed that. Protecting our caregivers is essential so that these talented professionals can safely provide compassionate care to our patients. Yet we continue to be stymied by a lack of personal protective equipment (PPE), and the cavalry does not appear to be coming.

Put women and girls at centre of COVID-19 recovery: UN Secretary-General
Limited gains in gender equality and women’s rights made over the decades are in danger of being rolled back due to the COVID-19 pandemic, the UN Secretary-General said on Thursday.

The pandemic and the female academic
Silence and concentration are pivotal for my thinking and teaching. When I record lessons for my students to watch online, minimizing background noise is a must. But my son is two years old. In the first lesson I tried to record, you can clearly hear his toy trumpet playing during the last two slides of the presentation. Night and dawn — when he’s asleep — are my only options for recording.
Risk communication
Updated WHO Myth buster
WHO WhatsApp health alert launches in Arabic, French and Spanish

Advice on the use of masks in the context of COVID-19
This document provides advice on the use of masks in communities, during home care, and in health care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, public health and infection prevention and control (IPC) professionals, health care managers, health care workers (HCWs), and community health workers. This updated version includes a section on Advice to decision makers on the use of masks for healthy people in community settings.

Should the public wear masks to slow the spread of SARS-CoV-2?
Yes, but not at the expense of those worn by medical staff

Model suggests how airborne coronavirus particles spread in grocery store aisles
Based on their findings, the researchers recommend avoiding busy indoor spaces.
Opening remarks by WHO Director-General Dr Tedros Adhanom Ghebreyesus at today's virtual meeting of G20 health ministers hosted by Saudi Arabia
Opening remarks by WHO Director-General Dr Tedros Adhanom Ghebreyesus at today's virtual press conference regarding COVID-19, on 20 April 2020:
listen and download:
Recording: ‘One World: Together At Home’ global special 
WHO Technical guidance
The CDC published new guidance on COVID-19
The US CDC published updated versions a broad scope of COVID-19 guidance and information, including interim guidance for collecting and processing clinical specimens, handling the bodies of deceased persons under investigation (PUIs), operating schools and childcare centers, and infection control for COVID-19 patients.
The CDC also published updated information for vulnerable populations, including individuals with asthma and pregnant women, as well as updated information on caring for COVID-19 patients at home.
The CDC also made substantial updates to guidance regarding how to optimize the supply of personal protective equipment (PPE).
A series of short country response reports (in Europe) are daily being published, with reference to capacity, workforce, implications for ‘normal’ care, and reflections on socio-economic impacts.  There are now about 10 country reports available and new ones are posted each day. The first one was published last Friday April 3, and can be found here:

What are countries doing to contain the spread of the coronavirus? How are countries helping people, small businesses and the economy to weather the crisis and beyond?
This Country Policy Tracker helps you to navigate the global response to coronavirus (COVID-19).

The Coronavirus Papers unlocked: 5,352 scientific articles covering the coronavirus - fully searchable and free.

U.S. Department of Health & Human Services, recently developed Novel Coronavirus Resources Page.

Lancet Coronavirus Resource Centre
This resource brings together new 2019 novel coronavirus (2019-nCoV) content from across The Lancet journals as it is published. All content listed on this page is free to access.
Elsevier’s free health and medical research on novel coronavirus (2019-nCoV)

CIDRAP COVID-19 Resource Center
CIDRAP has created a one-stop comprehensive compilation of the most current, authorititive information available on the novel coronavirus. Visit the Resource Center often, as the outbreak is constantly evolving

Supporting coronavirus research with FREE access to over 17,000 Global Health records 
CABI’s Global Health – the go-to bibliographic database for the study and practice of national, regional and international public health – has made relevant content available for free to support the international effort to fight the outbreak of novel coronavirus (2019-nCoV). You can access the free open access content by following this link:

Training courses:
Introductory Infection Prevention and Control (IPC) for Novel Coronavirus (COVID-19) training module on Open WHO.
This course provides information on what facilities should be doing to be prepared to respond to a case of an emerging respiratory virus such as the novel coronavirus, how to identify a case once it occurs, and how to properly implement IPC measures to ensure there is no further transmission to HCW or to other patients and others in the healthcare facility.
This training is intended for healthcare workers and public health professionals, as it is focused on infection prevention and control.
Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control
Simplified Chinese course
The English version of this course is available here:
La versión en español de este curso está disponible aquí :
La version française de ce cours est disponible sur :

COVID-19 Micro learning 
ECDC has produced series of micro learning activities (5-30 minutes) related to COVID-19.
The short e-learning courses provide guidance on the application of non-pharmaceutical countermeasures and include the following:
1. Introduction to COVID-19 NPC
2. Personal protective equipment against COVID-19
3. Environmental countermeasures against COVID-19
4. Social distancing countermeasures against COVID-19
5. Travel related countermeasures against COVID-19



Research and Development

Global research on coronavirus disease (COVID-19)

Database of publications on coronavirus disease (COVID-19)

How research funders are trying to help
Researchers confined to their homes and unable to carry on with grant-funded work are becoming increasingly concerned about how the coronavirus pandemic will affect their funding. Nature spoke to the world’s major research funders to find out how they are adapting their funding policies.
(Nature | 8 min read)

Help Fight Coronavirus- Donate Now
Everyone can now support directly the response coordinated by WHO. People and organizations who want to help fight the pandemic and support WHO and partners can now donate through the COVID-Solidarity Response Fund for WHO at



Knowledge Sharing

Thank you for reading. If you have thoughts, feedback, story ideas, or questions you would like to share or interested in partnering with us on a special event coverage, please send a note to Chadia Wannous via email  


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