Sunday, February 23, 2020

Japan MOH: 12 More Domestic COVID-19 Cases


Japans domestic COVID-19 case reports (excluding Diamond Princess cases) also continue to climb, with 12 new cases over the past 24 hours.  Hokkaido, in particularly, is reporting increased community transmission.

Outbreaks of patients related to the new coronavirus (114th to 125th cases)

Today (February 23), Sapporo City, Nagoya City, Chiba Prefecture and Hokkaido reported the following 12 cases of the new coronavirus-related infectious diseases as follows.

With this announcement, the number of domestically infected people is 144 (125 patients, 16 asymptomatic pathogen carriers, 3 confirmed positive).

We will carry out proactive epidemiological investigations on this matter, including the identification of close contacts.

  • Sapporo City: 1 patient (114 cases: 70s male)
  • Nagoya City: 2 patients (115 cases: 70s female, 116 cases: 70s male)
  • Chiba: 1 patient (117 cases) Eyes: Men in their 40s)
  • Hokkaido: 8 patients (118th: Men in their 30s, 119th: Women in their 60s, 120th: Men in their 20s, 121st: Men in their 70s, 122th: 30s (Women, 123: Men in their 80s, 124: Women in their 40s, 125: Women in their 20s)Below, information from Sapporo City, Nagoya City, Chiba Prefecture, and Hokkaido.

* If the contents of the documents published by local governments do not conform to the Ministry's publication standards, they will be published in accordance with the Ministry's publication standards. .

Sapporo City
Nagoya City○ Chiba Prefecture
○ Hokkaido 1 , Hokkaido 2

Iranian MOH: 43 COVID-19 Cases & 8 Deaths


While surveillance has probably only picked up a tiny fraction of the cases inside Iran, the Iranian MOH announced 15 new confirmed cases (n=43) today, and raised the death toll to 8.  It seems likely that only the `sickest of the sick' are currently being identified.
While the messaging by the MOH and the State run media IRNA (Islamic Republic News Agency) continues to paint COVID-19 as no worse than the flu, the extraordinary measures being order to control its spread must have many Iranians scratching their heads. 
 This (translated) update from the Iranian MOH.

15 new cases of definitive Kovid 19 in the country

The head of the Ministry of Public Relations and Information Center said: "Yesterday and today, based on the laboratory results, 15 new cases of CVD 19 were reported in the country and the number of people infected with the virus increased to 43 in Iran."
Dr. Kianoush Jahanpour, speaking to a Webda reporter, said: "Of the 15 new cases of new coronavirus (Kovid 19) in the country, 7 are related to Qom, 4 are hospitalized in Tehran, two are related. The city of Rasht has one person from Tonekabon and one from the central province. Unfortunately, three of these people died and the death toll from Covid 19 has so far reached eight.
He also stated that today at the meeting of the technical and executive staff of Kovid Disease Control 19, it was decided to distribute health packages including masks, gels or disinfectants and training materials by Qom and Door houses from today.
The head of the Public Relations Committee's Coronavirus Countermeasures Department of the Ministry of Health noted: It was also planned to distribute a protective kit to all specific patients across the country under the supervision of the Transplant and Disease Management Center, with a mechanism to be specified.
Dr. Jahanpour added: The promising news is that the Scientific and Technical Committee has begun a new drug treatment for Kovid 19 patients in Iran after investigations. Also, health certificates for travelers abroad will be issued in coordination with the Ministry of Health's Deputy Health and Directorate-General for International Cooperation at the ministry's international airports for the time being.
He emphasized: With the announcement of the Minister of Health last night, all universities and higher education centers in 10 provinces will be closed by the end of the week.
Dr Jahanpour said: All cinemas, showrooms, sports Olympiads, conferences, seminars, camps and gatherings have been postponed until further notice and it is stipulated that competitions will be held without the presence of spectators.
At the end, he said: "We strongly recommend our dear people, personal hygiene, frequent hand washing with liquid soap and water, avoid contamination, smell and hug and disinfect, disinfecting devices and contact surfaces and Respect for breathing practices. Following these simple steps will be the key and the most important and most effective way to cut off the transmission chain.

The Missing Links


One of the stark differences between the United States - and a great many other countries around the world - is that our government agencies (FEMA, READY.GOV, CDC, etc.) actively promote individual and family preparedness.
The Month of September is designated National Preparedness Month, each May NOAA and the National Hurricane Center hold a Hurricane Preparedness Week, in March there is a National Severe Weather Week and a Tsunami Preparedness Weekand in October most of the states around the country take part in a yearly Shake-Out earthquake drill. 
The standard advice is that every household should have at least 2-weeks worth of food and water, a first aid kit, and an NWS Weather radio urges every household have an emergency plan, and have even published recommendations on how to prepare before a pandemic. 

In 2017, the CDC released a 16-page Household Pandemic Planning guide, which emphasizes the use of NPIs - or Non-Pharmaceutical Interventions - during a pandemic.
Get Your Household Ready for Pandemic Flu [PDF – 16 pages]
Three weeks ago, in CDC Interim Guidance: Infection Control For Home Care Of Suspected Or Confirmed 2019-nCoV Cases, we looked at specific advice for the care of COVID-19 patients at home.

They urge people to buy an umbrella while the sun is shining, because they know that once the rain starts, umbrellas will be in very short supply.  And at that point, banging the preparedness drum can cause panic buying, or worse.
Sadly, far too people take these recommendations to heart, and many find themselves scrambling to prepare when a blizzard, hurricane, or some other disaster looms.  But at least the information is out there for people who want it. 
With a few notable exceptions - like Japan's Earthquake Preparedness Messaging - Tokyo's X Day - personal and family preparedness gets very little mention around the world.  Perhaps it's a cultural thing, based on a deep and pervasive denialism that anything truly `bad' will happen, or a firm belief that during a crisis governments will find a way to provide.
But it has always seemed short sighted to me. And never more so than now, with a global health crisis looming. 
Fourteen years ago we looked at a Lancet study that predicted, based on a 1918-like pandemic scenario, could claim as many 62 million lives, and that 96% of those deaths would occur in developing countries.
Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis
Prof Christopher JL Murray DPhil , Prof Alan D Lopez PhD, Brian Chin ScB, Dennis Feehan AB , Prof Kenneth H Hill PhD
Three years ago, in  Are We Prepared to Help Low-Resource Populations Mitigate a Severe Pandemic?, we looked at many of the reasons why poorer countries will fare far worse during a pandemic, and some ideas on how to change that (Note: new link to paper).

Ten years after the last pandemic, at least for most of the world, I have to wonder.
Where are the practical recommendations - to individuals and families - on how to prepare for a pandemic?  Guidance on how to safely care for someone in the home who is sick with the novel coronavirus?  How to implement community NPIs, or how to make a homebrew facemask?
This is the sort of thing I would expect the WHO to take the lead on, but most of their advice - so far, at least - appears geared more towards macro issues and governments rather than individuals. Perhaps that will change, but right now there is a genuine need around the world, and time is growing short.

While I recommend people try to avail themselves of the CDC's excellent guidance, not everyone has access to the internet (or knows where to find it), and their advice really needs to simplified and condensed, translated into scores of languages, and be tailored to local customs and available resources. 
Basic information -  presented with simple graphics and in multiple languages - could save a lot of lives, if it were presented to vulnerable populations early in a pandemic. 
While ideally this sort of information would have already been prepared, and made publicly available (much in the way the CDC has done for years) long before a pandemic threatened, it isn't too late.

But the clock is ticking.

South Korea Raises COVID-19 Alert To Highest Level - Severe


With more than 600 cases now identified - most of them locally acquired - South Korea today raised their alert status to its highest level (Severe) as the country works to contain their outbreak.

 You can access an English Language summary from Yonhap News (S. Korea raises virus alert level to 'highest' as cases spike), or follow the link below to the announcement on the MOH website.  A few (translated) excerpts include:

Corona Virus Infection-Briefing of the 19th National Task Force
-Corona 19 Defense Response and Future Plans, Acquisition of Bedsides and Human Resources by Region, and Phase-by-Step Plan-
□ Corona Virus Infectious Disease-19 Pan-governmental Affairs Conference, chaired by President Moon Jae-in, discussed the risks of infectious disease alerts, the situation and future plans for the Corona 19 quarantine, and plans for securing hospital beds and human resources and phased utilization.

Infectious disease crisis alert raised to “ severe ”

□ In the current system, the infectious disease crisis alert is in the 'border' stage, and is responding to the 'severe' stages centered on the Central Defense Response Headquarters (DCE) and the Central Accident and Welfare Division (Health and Welfare).
○ Today's pan-governmental measures conference will strengthen the response system by upgrading the crisis warning stage to “serious” as a preemptive measure against the possibility of the nationwide deployment of Corona 19.
-This measure takes into account the early stage of spreading and spreading of community around specific regions and groups, but requires preemptive response considering the possibility of spreading nationwide considering the speed of spread.
○ The government maintains consistency with the existing central defense countermeasures headquarters (the Centers for Disease Control and Prevention) and the central accident procurement headquarters (health and welfare) system to support them while maintaining consistency with the central disaster safety countermeasure headquarters. (1st Minister: Health and Welfare Minister, 2nd Minister: Ministry of Public Administration and Security)
-Responding to government departments and strengthening the support system of the central government and local governments, the government will respond with unprecedented strong and prompt measures without being bound by regulations.
○ In the 'severe' phase, the government will implement containment policies, such as blocking outflow of corona 19, patient discovery and contact isolation, while continuing to implement strategies to block and minimize the spread of communities.
The measures were decided through the government's discussion this afternoon and the Crisis Assessment Meeting at the Centers for Disease Control and Prevention, and were applied through the Minister of Health and Welfare.
□ At the 'serious' stage, the government will push for strong countermeasures, such as social isolation, to prevent more proliferation of corona.
○ First, the Daegu region requested autonomous restraint and restrictions on movement for at least two weeks, and the deceased box was requested to be promptly inspected by the screening clinic.
-In addition, residents of other regions who visited the Daegu area were asked to refrain from going out in accordance with the Daegu area and to be promptly inspected in case of any symptoms.
○ The government also plans to designate a dedicated hospital for rapid treatment and secure beds for patients with low severity among patients with corona19 confirmation.
-In this regard, it will designate and introduce an infectious disease consulting hospital for each trial within one week, and will secure 1,000 additional beds for Daegu regional patrons and secure 10,000 therapeutic beds nationwide. .
○ On the other hand, the government said that it was preparing for the introduction of medical personnel for early diagnosis, sampling and treatment of patients with mild respiratory diseases through medical organizations.
In addition, the government has promised to provide adequate courtesy and loss compensation for medical workers who cooperate to prevent the spread of infectious diseases.
Lastly, the government recommended that events be held in narrow indoor spaces or crowded events and refrain from going outside and taking rest in case of fever or respiratory symptoms.
-We also asked the employer to cooperate with them to allow sick leave without a medical certificate.

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Japan MOH: 3rd COVID-19 Death From Diamond Princess - 57 New Positive Cases

Credit Wikipedia


The saga of the Diamond Princess, still quarantined (with the crew) in Yokohama, Japan continues, with the announcement this morning of a third death, and a new batch of positive test results.

About death of patient associated with cruise ship under quarantine at Yokohama Port
Today, February 23, a cruise ship-related patient who has been quarantined at Yokohama Port has died. I pray for the soul of the deceased.
Information will be provided only to the extent that the consent of the bereaved family regarding the presentation has been obtained. When reporting, please give due consideration to the privacy of the deceased and the bereaved.

Patient (3rd case)1 Outline
(1) Age: 80s
(2) Gender: Male
(3) Nationality: Japan
(4) Basic disease: Applicable
2 Cause of death Pneumonia
3 Progress
  • February 3 At Yokohama Port Quarantine Anchorage Quarantine started.
  • February 5 Cruise ship returns to Yokohama. Thereafter, transported to a medical institution as a patient.
  • February 23 Death confirmed.
A second announcement this morning reveals 57 new positive test results (55 crew, 2 passengers), nearly all of which are currently asymptomatic.

About new coronavirus infection confirmed on cruise ship during quarantine at Yokohama Port (published on February 23)

The cruise ship Diamond Princess, which arrived at Yokohama Port on February 3, is undergoing quarantine at sea.
Samples were collected between February 19 and February 21 and the results of the PCR tests were as follows.
1) Crew
Out of the 819 samples whose results were found, 55 were positive (including 50 asymptomatic pathogen carriers).
2) Passenger
Out of the twelve specimens for which the results were determined, two specimens were positive (of which two specimen holders had asymptomatic pathogens).

South Korea COVID-19 Case Count Passes 600


Five short days ago South Korea had only racked up 31 COVID-19 cases in just under a month.  Starting on Wednesday we began to see signs of significant community spread of the virus, and over the past 72 hours we've seen over 500 cases reported.

The 1600hrs (KST) summary shows 169 cases have been added over the past 24 hours.  Down a bit over the 229 cases reported the previous 24 hours, but still sizable.  Today's count sits at 602, and deaths have increased to 5, as well.

The afternoon update (above) is just a summary, but the morning update (issued 9 hours ago) provides more details about the cases (to that point).  Some excerpts from the morning report follow:

Coronavirus Infection-19 Domestic Outbreaks (February 23)
□ The Centers for Disease Control and Prevention (CEO Eun-Kyung Jung), as of February 23, 20, 9:00 am, 210 people (123 people compared to 16:00) compared to 9:00 am the day before, 556 people have been confirmed. Of these, 534 were said to be in quarantine. In addition, 16,038 were negative for the test and 6,039 were for the test.

○ Among the 556 members so far, there are 309 cases (55.6%) related to the Shincheon Earth Church.

The current status and major regional conditions of newly confirmed patients are as follows.

In Seoul, an investigation is underway around the case of Eunpyeong St. Mary's Hospital. To date, two confirmed patients * have occurred in the hospital.

* 161st patient (85 years old, male, transporter), 365th patient (58 years old, male, hospitalized patient)

-The 161st patient had symptoms such as fever and cough since February 2. To date, 302 * of the contacts were identified, and 75 of the patients were hospitalized for single room isolation, discharged patients and staff. .

* 75 hospitalized patients, 187 discharged patients, 28 employees, 12 families and communities

-The 365th patient developed fever and headache symptoms from Feb. 2, and was admitted to Eunpyeong St. Mary's Hospital from Feb. 5 to 22. We are investigating additional places and contacts.
In Busan, seven people were confirmed * by 9 am today. Among them, four confirmed persons were related to Shincheon Daegu Church and three confirmed persons related to Oncheon Church in Dongnae-gu.

* 16 patients including additional confirmed patients after 9 am (Busan Metropolitan Presentation)

-The patients who were confirmed as sons of Wuhan citizens of the Onsen church were included (01-year-old male). Investigation is in progress. After returning from Wuhan, my father retested on February 22 and confirmed negatively.
-The church ceased religious events as of today, and in the event of fever or respiratory symptoms among members who participated in the religious event on February 16, they first contacted the local public health center or the Center for Disease Control (1339). We recommended that you see your doctor at your nearest screening clinic as instructed.

○ The Daegu area has secured a list of members of the Shincheon District Daegu Church to check for symptom by wire contact, guide the self-isolation, and promptly inspect any symptoms.

-In addition, 510 patients with pneumonia over 19 years of age were admitted to the area, and 470 patients were examined so far, and a total of 2 patients were identified by 2.22 days.

-As a result, Daegu is conducting investigations and quarantine measures with the possibility of expanding the community, and securing 246 beds of Keimyung University Daegu Dongsan Hospital and 274 beds of Daegu Medical Center for quarantine treatment of surging patients. 101 medical personnel, including health doctors and nurses, will be treated.

○ In Gwangju area, a total of 7 confirmed patients besides existing 21st century hospitals were confirmed. All attended or contacted religious events at Shinchon Daegu Church, and the investigation is being conducted mainly on the families of the patients and whether they use the Shincheon Learning Center in Gwangju.

In Gyeongbuk, a third death case (born in 63, male) involving Qingdao Daenam Hospital occurred. The patient was admitted to the hospital for a long time, was confirmed to have died of aggravated pneumonia, and its association with corona 19 is being investigated.

-In Gyeongbuk, an additional 18 out of 39 people who have visited the Holy Land of Israel from February 8 to 16 were confirmed *, and the remaining 21 are being tested. 17 Catholics in Andong Diocese (Gyeongbuk), 1 guide (Seoul)

-41 churches in the Andong diocese of Catholic church, where the sponsors were confirmed, decided to suspend mass and meeting until March 13.

The National Defense Agency's headquarters says that the current situation is spreading in some regions and groups, and it is necessary to quickly find patients in the regions and group members, promptly isolate the patients, and proceed with active treatment. Most importantly, he said.

○ If you visit or contact Shinchon Daegu Church in February, refrain from outside activities and stay at home, observe hand washing and coughing manners, and whether you have fever or respiratory symptoms (cough, sore throat, dyspnea, etc.) Closely watched for symptoms and immediately reported them to the local public health center.
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