Monday, February 24, 2020

Italian MOH: 219 COVID-19 Cases & 5 Deaths



The latest numbers from Italy's Ministry of Health show another 86 cases have been identified over the past 24 hours, and the number of fatalities has increased to 5.
Less than 96 hours ago Italy had only reported 3 cases, but it has become apparent that the virus has been circulating - undetected - in the region for several weeks. 
All of which raises the odds that other countries in Europe (and elsewhere) - which have not reported community cases - may be in for a rude awakening in the days ahead.

Civil protection: the point of the Covid-19 situation at 12 noon on 24 February

219 people are infected with the new Sars-CoV-2 coronavirus in Italy. Of these 5 people have died and one person has recovered.

These are the official figures communicated today at the 12 noon conference by the Commissioner for the emergency of civil protection, Angelo Borrelli.
Of the 213 people observed, 99 are hospitalized with symptoms, 23 are in intensive care and 91 are in home isolation.
In the individual Regions the number of infected people is as follows:
  • Lombardy Region: 167
  • Veneto Region: 26
  • Emilia Romagna Region: 18
  • Piedmont Region: 4
Watch the video of the Civil Protection press conference

For more information:

New coronavirus site

ISS website

Iraq Confirms 1st Imported COVID-19 Case (ex Iran)


Iraq becomes the third country (following Bahrain (n=1) and Kuwait (n=3)) in the past few hours to announce the detection of COVID-19 in a traveler from Iran, raising concerns over the extent of Iran's epidemic and its risk spreading to neighboring countries.

This announcement from the Iraqi MOH.

 The ministry shows that the results of laboratory tests conducted today for one of the students of religious sciences (Iranian nationality) who had entered the country before the decision of the ministerial crisis cell to stop travel showed that he was infected with the new coronavirus, and the case was revealed when the health teams investigated Visitors and students in their residences were referred to the designated hospital in Najaf province and sent swabs taken from him for laboratory testing and placed in isolation halls and the results of the analysis showed that he is carrying the virus.

All measures have been taken in compliance with the International Health Regulations to deal with the situation and contacts, hoping to cooperate with the procedures and disseminate health education and awareness messages as much as possible.
Ministry of Health and Environment
February 24, 2020
Posted by: Website Management | Date: 24-02-2020 | Time: 01:49:41 pm | Read: 51 |

Iran MOH Update: 66 COVID-19 Cases & 12 Deaths


Although the numbers probably only reflect the tip of the iceberg, overnight Iran announced another 18 confirmed COVID-19 cases, and raising their total to 66 cases and 12 deaths.  This mortality rate is hopefully artificially high due to limited and selective testing of only the most severely ill patients, but it needs to be watched carefully.

Overnight KUNA reports both Bahrain (n=1) and Kuwait (n=3) have reported imported cases with recent travel to Iran - joining Canada and Lebanon - suggesting that COVID-19 is well established in Iran and is accelerating.
It has been barely 5 days since Iran reported their first 2 COVID-19 cases, and while our ability to see what is happening there is limited, it seems likely that the virus has been spreading there - unnoticed - for weeks.  
Much like what we've seen this past week with Italy and South Korea, by the time community spread becomes obvious, it is already a crisis.

Director of public Relations and Information Center of the Ministry of Health announced:
18 new cases of KOVID19 in the country
The head of public Relations and Information Center of the Ministry of Health said yesterday to noon today and based on the study of laboratory specimens sent from different regions of the country and the patients suspected of having a new case of 18 years of new studies of this disease were positive.
Dr. Kianoosh Jahanpour, in an interview with WEBDA reporter, added: the laboratory specimens of 8 patients in Qom, one person in Hamedan province, three people in Tehran, two in Markazi province, two in the province of Isfahan and two people in Gilan province, were positive and four others were killed.
According to the new ones, we had 66 the definitive case of KVID19 in the country that unfortunately, 12 of them lost their lives in the past few days. What is based on medical reports in recent days is that, in general, people with this disease and the hospitalization, especially in the provinces of Qom, Tehran and Gilan have a better trend and are facing recovery.
The head of public Relations and Information Center of the Ministry of Health pointed out that the last days with the approval of the Central Camp Treatment Committee of the Ministry of Health, the latest recommended treatment methods, including the 5-item diet that agreed to the relevant experts, have been started for all hospitalized patients who have been affected by Kvidis 19.
He reiterated: The initial reports show a positive trend in public in patients with a new croinvirus, but it is not now possible to judge the effectiveness of this medicinal regimen and need more reviews and evaluations of course, positive and promising news the recent days were that at least three of the critically ill patients in the ICU, who were hospitalized in Arak and Tehran, had been transferred to the ward with a good public, and even one of them was discharged from the hospital with a recovery.
Dr. Jahanpour stressed: People who died on the effect of KVID19 were often residents of Qom, or have had a history of travel to the city in recent days and weeks, and from today, 22 centers will be established as a special Corona clinic in Tehran City. In the vicinity of them, Tehran emergency ambulances are present with protective means and facilities, and in case of patients ' suspicious, they will be transferred to certain centers and hospitals in Tehran, and the information of these clinics will be available to people soon.
The head of public Relations and Information Center of the Ministry of Health regarding the issues discussed in Tehran quarantine said: in scientific terms and according to the guidelines of the World Health Organization and the opinion of technical cornvirus, we do not believe in the complete quarantine of a city and a matter of Tehran's quarantine has no correctness and if it was made quarantine or restriction, this restriction must be made for the city of Qom.
Dr. Jahanpour noted: In recent days, the national headquarters for Management and Prevention of Cronvirus were formed by the Minister of Health and approved by the Government and communicated to the President and in its subset, the executive camp of the fight against the Corona was defeated in the form of a national mobilization to tackle and combat the opposition. The officials of the headquarters were also appointed by the Minister of Health and all the measures and decisions taken by the national headquarters will be required and all governmental and non-governmental devices will be obliged to comply with these cases.
He continued: People's visit to the symptoms of colds and flu continue to the offices and health centers, and those that are based on the description and clinical signs of triage and referral are subject to investigation and the process continues.
The head of public Relations and Information Center of the Ministry of Health said: we hope that by observing individual and public health as well as strong determination and motivation in society, we are able to inhibit, control and remove the disease in the shortest possible time./206

South Korea Adds Another 231 COVID-19 Cases Over Past 24 Hours


Yesterday, after South Korea's COVID-19 case count passed 600, their Ministry of Health raised their  COVID-19 Alert To Highest Level - SevereTwenty-four hours later, and the latest confirmed case count has now passed 830, making South Korea the second most affected nation on earth (following Mainland China).
This is even more remarkable considering that as of 5 days ago, South Korea had only reported 31 cases in the previous 30 days. 
Not only are there now 7 deaths reported from COVID-19 in South Korea, media reports indicate that a growing number (n=11) of South Korean military personnel have tested positive for the virus.

The latest (1600hrs KST) summary from their CDC follows, after which I'll return with some details on the spread of the virus across the South Korean peninsula.

The afternoon update (above) is just a summary, but the morning update (issued 10 hours ago) provides more details about the cases (to that point). 

While the majority of cases continue to be epidemiologically linked to the Shincheon Daegu Church, and to a lesser extent to patients, staff, and visitors to Qingdao Daenam Hospital in Cheongdo, the geographic spread of cases continues to expand (see chart below).

 Some excerpts from the morning report follow:

Coronavirus Infection-19 Domestic Outbreak (February 24, Regular Briefing)
Created 2020-02-24
○ Local communities are spreading mainly in Daegu (Shincheon Daegu Church) and Gyeongbuk Qingdao (Namnam Hospital), which are special infectious areas.
-Additional cases are also mainly focused on the family of the examiner, group facilities, medical institutions, etc.
-Taking precautionary measures to prepare for the possibility of proliferation at the national level, taking into account the speed and pattern of propagation.
○ As a result, the 'Special Control Areas for Infectious Diseases' and other regions have combined anti-spreading strategies and containment strategies in consideration of their respective epidemic characteristics. 
-In the 'Infectious Disease Special Control Area', rather than tracking individual patients' movements, the company quickly checks and isolates and treats contact time when infection is possible, and concentrates medical resources on serious patients to minimize the damage such as death.
-Outside of the special management area, the case of Shincheon Daegu Church linkage is checked first, but detailed epidemiological investigations and quarantine measures are being implemented to minimize the spread of the area due to sporadic cases.
□ The Central Defense Response Headquarters will revise and distribute the National Prevention Regulations in accordance with the transition to the severe stage.
○ The public should observe hand washing and coughing manners and be careful not to touch their eyes, nose and mouth with unwashed hands. Wear a mask when visiting a medical institution, avoid visiting many people, and avoid contact with people with fever or respiratory symptoms.

○ Pregnant women, those over 65 years of age, and chronic diseases should not visit places where many people gather. Inevitably, a mask should be worn when visiting a medical institution or going out.

○ People who have fever or respiratory symptoms should refrain from going to school without going to school or going to work. In addition, if the fever persists above 38 degrees or the symptoms become severe, ① call the call center (☎1339, ☎Area code + 120) or the local public health center, or ② visit the screening center * first.
* Ministry of Health and Welfare ( , top banner 'selected clinic operating list'), disease management headquarter ( , top banner 'selected clinic')

○ Persons in the Specialized Infectious Disease Control Zone should refrain from going out and visiting other areas. Those who are in containment are advised to follow the instructions of the medical personnel or quarantine authorities and also strictly implement self-isolation rules.

-Participants, especially those who attended the meetings of Shincheon Daegu Church, thoroughly implement self-isolation measures and, in case of fever or respiratory symptoms, first contact the local public health center or the Centers for Disease Control and Prevention (1339) and follow the instructions. It was recommended to receive medical treatment through

The CDC's (Revised) Risk Assessment On COVID-19


Although many experts - including our own CDC - have been vocal for weeks over the possibility that the COVID-19 crisis could evolve into a pandemic, the events of the past 120 hours in South Korea, Iran, Italy, and Japan have moved us substantially closer to that reality.
It's not something that a lot of countries are eager to say out loud, for fear of inciting panic or dragging down the economy - but it is now appears no longer just possible - but highly likely.  Some would say we are already there. 
While the decision to declare a pandemic lies with the World Health Organization - and it isn't clear how, or when that will happen - countries, businesses and individuals need to begin this week preparing as if a pandemic is on the way.
How bad, or disruptive that might be, remains unknown.  
We could - as we did with H1N1 in 2009 - discover that this COVID-19 virus is not as fearsome as first believed.  While I hope that is true, the evidence to date suggests we are not going to be as lucky in that regard as we were with the last pandemic.

Over the weekend the CDC has ratcheted up their warnings in their COVID-19 risk assessment (see below) - and while the current risk of infection in the United States is low - that could easily change over the next few weeks.

First, an excerpt (slightly reformatted for readability) from the CDC's latest situation report (follow the link to read it in its entirety), then I'll return with a postscript.

Coronavirus Disease 2019 (COVID-19) Situation Summary
This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.
Updated February 23, 2020

Risk Assessment

Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications). The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic. As community spread is detected in more and more countries, the world moves closer toward meeting the third criteria, worldwide spread of the new virus.

The potential public health threat posed by COVID-19 is high, both globally and to the United States.
But individual risk is dependent on exposure.
For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
Under current circumstances, certain people will have an increased risk of infection, for example healthcare workers caring for patients with COVID-19 and other close contacts of persons with COVID-19. CDC has developed guidance to help in the risk assessment and management of people with potential exposures to COVID-19.

However, it’s important to note that current global circumstances suggest it is likely that this virus will cause a pandemic. In that case, the risk assessment would be different.
What May Happen
More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.
  • Widespread transmission of COVID-19 in the United States would translate into large numbers of people needing medical care at the same time.
  • Schools, childcare centers, workplaces, and other places for mass gatherings may experience more absenteeism.
  • Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths.
  • Other critical infrastructure, such as law enforcement, emergency medical services, and transportation industry may also be affected.
  • Health care providers and hospitals may be overwhelmed.
At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy. 
          (Continue . . . )

None of this is designed to incite panic, but it should inspire action.  You don't have to go into full survivalist mode (this is my 4th pandemic, and I'm still around), but you should be preparing for disruptions.
People in Italy this weekend were caught unaware when nearly a dozen towns were quarantined with no notice.  Store shelves were quickly wiped clean as residents scrambled to buy food.  Despite the warning signs, few it appears, were prepared. 
A major focus of this blog has long been on practical preparedness for pandemics and other disasters (like hurricanes, earthquakes, floods, etc.). Over the past month I've been writing about COVID-19 preparedness in particular.  A few examples include:
Not Too Soon To Be Thinking About Preparedness
Why NPIs Will Be Our 1st Line Of Defense Against COVID-19
CDC Interim Guidance For Businesses & Employers On Novel Coronavirus
Does Your Company Have A CPO?
The Man In The Ironed Mask (Revisited) 
While I can't predict when it will arrive, or how bad it will be, the further spread of COVID-19 appears inevitable - and ready or not -  we as a society are going to have to find ways to deal with that. 

Sunday, February 23, 2020

ECDC Statement On Rapid Increase of COVID-19 Cases In Italy


I suspect that this weekend will - for millions of people in Europe and North America - be the first time that the COVID-19 crisis begins to feel `real' to them.  For most people, it has felt like a problem in China - or perhaps greater Asia - but not something that could be on their doorstep in a matter of weeks.
For people who live in Italy and Iran, and likely more countries we'll hear about over the next week or two, their time is now. 
It isn't often that we see a statement issued on a Sunday by the ECDC, but they are watching the situation carefully, and the events of the last 48 hours in Italy definitely merit one.

ECDC statement on the rapid increase of COVID-19 cases in Italy
News News story
23 Feb 2020

23 February 2020: ECDC statement on the rapid increase of COVID-19 cases in Italy by the ECDC Director Andrea Ammon.

In the last 24 hours, the Italian Ministry of Health confirmed an increasing number of COVID-19 cases, including two deaths, clustered in two regions in Northern Italy as well as single cases in other regions in Northern Italy.
ECDC is closely monitoring this situation. We have been in contact with the Italian authorities to provide all necessary assistance at this stage and support their efforts in limiting sustained local transmission.
Given the evolving situation, ECDC is assessing the impact that the clusters in Italy have on the overall risk for the EU/EEA and will issue an updated risk assessment within the next 24 hours.
ECDC is also in close contact with the European Commission and WHO/Europe. At the same time, ECDC continues to work with all the other EU Member States, to make sure they receive the best support.
As the situation is rapidly evolving, more cases are expected in Italy, and possibly in the EU, in the coming days.
According to the Istituto Superiore di Sanita (ISS), suspected cases of COVID-19 are first tested in the reference labs of the region and province. Those that test positive are retested in the ISS, and only those validated there are reported as confirmed cases.
The Italian authorities are identifying all contacts of the confirmed cases and have announced public health measures for containment, including suspension of mass gatherings, suspension of childcare and schools, and access to essential public services conditioned to the use of personal protective equipment.
These extraordinary measures in northern Italy are essential to limit the outbreak and may need to be replicated in other communities in the coming days.