Saturday, February 29, 2020

King County WA Health Dept. COVID-19 Update (4pm EST) Live Link



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The CDC just held a press conference with Washington State health department officials to announce that state's 1st COVID-19 fatality, and the investigation into two people (1 patient, 1 HCW) at a long term care facility who have tested positive.

Others at this LTCF are symptomatic and are being tested.  

The Washington/King County Health Department will hold a press conference at 4pm (EST) 1pm Local time today.  Local TV station KIRO-7 will carry it at https://www.kiro7.com/video/live-stream//.

You can also view the broadcast on the King County Public Health's Facebook page.


Italy: MOH Announces 228 Additional COVID-19 Cases (n=1049)



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Italy now appears to be issuing only a single daily (1800 hrs CET) COVID-19 update.  Today they announced another 228 cases, and 8 additional deaths.

As we've seen in other countries, most cases are mild enough to be treated at home. But roughly 40% of the identified cases are hospitalized, and roughly a quarter of those (n=105) are in intensive care.


Covid-19: the cases in Italy at 6 pm on 29 February

As regards health monitoring relating to the spread of Coronavirus on the national territory, 1049 people are currently positive for the virus.

The number of people infected in the individual Regions is as follows: in Lombardy there are 615, 217 in Emilia-Romagna, 191 in Veneto, 42 in Liguria, 13 in Campania, 11 in Piedmont, 11 in Tuscany, 11 in the Marche, 6 in Lazio, 4 in Sicily, 3 in Puglia, 2 in Abruzzo, 1 in Calabria and 1 in the Autonomous Province of Bolzano.

There are 401 patients hospitalized with symptoms, 105 are in intensive care, while 543 are in home isolation. The number of people healed is 50. The dead are 29, this number, however, can be confirmed only after the Istituto Superiore di Sanità has established the actual cause of the death.

Watch the video with the point of the civil protection situation

CDC Releases HAN Update For Clinicians On COVID-19









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Yesterday, in CDC Revised Testing Criteria For COVID-19 PUIswe looked at new guidance released by the CDC late Thursday.  This morning we have a CDC HAN Update, released late yesterday - which is intended primarily for clinicians and public health officials - that replaces the previous guidance published on February 1st. 
Guidance is constantly changing as the threat evolves and we learn more about the virus, so we'll undoubtedly see more updates in the weeks and months ahead.
Due to its length, I only posted some excerpts. Follow the link to download and read the full update.

Update and Interim Guidance on Outbreak of Coronavirus Disease 2019 (COVID-19)

Distributed via the CDC Health Alert Network
February 28, 2020, 15:05 ET (3:05 PM ET)
CDCHAN-00428
Summary
The Centers for Disease Control and Prevention (CDC) continues to closely monitor and respond to the COVID-19 outbreak caused by the novel coronavirus, SARS-CoV-2.
This CDC Health Alert Network (HAN) Update provides updated guidance on evaluating and testing persons under investigation (PUIs) for COVID-19. It supersedes guidance provided in CDC’s HAN 427 distributed on February 1, 2020.
The outbreak that began in Wuhan, Hubei Province, has now spread throughout China and to 46 other countries and territories, including the United States. As of February 27, 2020, there were 78,497 reported cases in China and 3,797 cases in locations outside China. In addition to sustained transmission in China, there is evidence of community spread in several additional countries. CDC has updated travel guidance to reflect this information (https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html).
To date, there has been limited spread of COVID-19 in the United States. As of February 26, 2020, there were a total of 61 cases within the United States, 46 of these were among repatriated persons from high-risk settings. The other 15 cases were diagnosed in the United States; 12 were persons with a history of recent travel in China and 2 were persons in close household contact with a COVID-19 patient (i.e. person-to-person spread). One patient with COVID-19 who had no travel history or links to other known cases was reported on February 26, 2020, in California. The California Department of Public Health, local health departments, clinicians, and CDC are working together to investigate this case and are identifying contacts with whom this individual interacted.
CDC, state and local health departments, other federal agencies, and other partners have been implementing measures to slow and contain transmission of COVID-19 in the United States. These measures include assessing, monitoring, and caring for travelers arriving from areas with substantial COVID-19 transmission and identifying cases and contacts of cases in the United States.
Recognizing persons at risk for COVID-19 is a critical component of identifying cases and preventing further transmission. With expanding spread of COVID-19, additional areas of geographic risk are being identified and PUI criteria are being updated to reflect this spread. To prepare for possible additional person-to-person spread of COVID-19 in the United States, CDC continues to recommend that clinicians and state and local health departments consider COVID-19 in patients with severe respiratory illness even in the absence of travel history to affected areas or known exposure to another case.
Criteria to Guide Evaluation and Testing of Patients Under Investigation (PUI) for COVID-19 
Local or state health departments, in consultation with clinicians, should determine whether a patient is a PUI for COVID-19. The CDC clinical criteria for COVID-19 PUIs have been developed based on available information about this novel virus, as well as what is known about Severe Acute Respiratory Syndrome (SARS) (https://www.cdc.gov/sars/clinical/guidance.html) and Middle East Respiratory Syndrome (MERS) (https://www.cdc.gov/coronavirus/mers/interim-guidance.html#evaluation). These criteria are subject to change as additional information becomes available.
(Continue . . . )

Iran MOH: 205 New COVID-19 Cases (n=595 total)













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With (as of yesterday) at least 97 exported cases in the past week, Iran's COVID-19 outbreak is almost certainly many times greater than has been reported.  A week ago, when there were only 3 exported cases, there were estimates of as many as 18,000 cases.
Anecdotal reports seeping out of Iran suggest the death toll is much higher than has been reported as well.  
Officially, however, Iran this morning has announced 205 new cases, bringing the nation's total to 595 cases and  43 deaths. 

New Coronavirus Infection Statistics Released in the country; 
205 new cases of coid19 in country
The Director of the Public Relations and Information Centre in the Ministry of Health said: According to laboratory results, 205 new cases of confirmed contusion to Cowid19 were confirmed yesterday before noon today, bringing the total number of infected patients to 593 in the country.
In an interview with Webb's correspondent, Dr. Kianoosh Jahanpour stated: Among the new cases, 52 were from Tehran, 21 were from Qom, 17 were from Gilan, 22 were from Golestan, 12 were from Isfahan, 18 were from Central, 12 were from Mazandaran, 8 were from Fars, 6 were from East Azerbaijan, one was from Ilam, A case was related to Southern Khorasan Eight individuals were from the Alborz Department, 4 from Semnan, five from Kurdistan Province, 6 from Qazvin, 4 from Khuzestan, one from Sistan and Baluchistan, and four from Yazd Province.
He added: Regrettably, during the past 24 hours, nine of the Coivids19 people died in the country, bringing the total number of death toll from the disease to 43.
Ministry of Health spokesperson stressed that: We strongly recommend that in addition to observing personal, social and respiratory health, limiting traffic and interurban and interurban travel is not necessary, and we urge people to stay in their homes and cities, the best and safest, so that we will not see the disease spread further./206

CDC Updates & Expands Travel Warnings On COVID-19





















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On Tuesday (Feb 25th) South Korea joined Mainland China as having the highest CDC Traveler's warning due to COVID-19 (see  CDC Raises South Korea Travel Advisory: Level 3, Avoid Nonessential Travel).

Late yesterday the CDC added Italy and Iran to the Warning - Level 3, Avoid Nonessential Travel list.





Additionally, Japan has been placed on an  Alert - Level 2, Practice Enhanced Precautions list.

South Korea Adds 813 COVID-19 Cases Over Past 24 Hours



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In the South Korea's largest one-day spike in confirmed cases to date, their CDC has announced 813 new cases overnight, bringing that nation's total to 3,150 cases and 17 deaths.

Remarkably, 10 days ago South Korea had only reported 31 cases, making today's update literally a 100-fold increase since then.




A breakdown of the 1st 16 deaths (as of their 0900hrs report) shows that while most of the fatalities have been in older people, at least one was in his 30s and 6 others were under the age of 60. Most, however, had comorbidities. 


As a result of analyzing the characteristics of 16 fatalities in Korea, 10 males (62.5%) and 6 females (37.5%) among the 16 fatalities, and 3 persons over 70s (18.6%), 60 There were six (37.5%) and five in their 50s (31.3%).

A few epidemiological notes from the 0900hrs update include


□ Many of the cases under investigation in the Infectious Disease Control Zone are found to be related to the Shincheon Daegu Church.

○ The Daegu Metropolitan City identified 761 of the 1,299 bequest boxes that were previously surveyed. It is estimated that 1,356 people and 133 people in Gyeongbuk area.

-In the future, we will continue to conduct further investigations in consultation with the local governments, and related cases are expected to continue for the time being.

○ In addition, two additional persons (one employee and one family contact) who were in quarantine related to Qingdao Daenam Hospital were confirmed.

* 103 people existing inpatients and 14 employees, family contacts 2 people
☞ 36 out of Tainan hospital, 72 people other hospital transport, four people, including seven people killed, another local resident
- about 36 people are currently hospitalized in Tainan Hospital At the same time, 24 patients were found to be negative, mainly in patients with mild to moderate symptoms. In addition, 21 patients were identified as negative for 29 patients transferred to the National Mental Health Center. As a result, we will consider release of quarantine if further testing confirms voice.

Washington State DOH: 2 Presumptive Positive COVID-19 Cases

Credit Washington State  DOH 









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The third state reporting presumptive positive COVID-19 cases overnight is Washington, which has detected two; one with recent travel history to Daegu, South Korea and the other a student at a high school in  Snohomish County with no travel history and no known risk exposure.
While we've been watching the spread of COVID-19 - primarily in Asia - for the past two months, last Friday we began to see an abrupt rise in cases in Europe and the Middle East.
Now that local testing is becoming increasingly available, we need to be prepared to see a similar uptick in cases here in the United States.  While most cases will be mild, for some smaller percent of cases, this can be a serious - even life threatening - infection.

If you haven't already begun to prepare (see Time To Line Up A `Flu Buddy' and An Appropriate Level Of Personal Preparedness For COVID-19), this weekend would be an excellent time to start.


Additional Cases of COVID-19 in Washington State

OLYMPIA – The Washington State Department of Health, Public Health – Seattle & King County, and Snohomish Health District, are announcing two new cases of COVID-19, currently classified as “presumptive positives.” A presumptive positive is a test that comes back positive at the Public Health Laboratory and is pending confirmation at the Centers for Disease Control and Prevention (CDC.)
The individuals reside in both King and Snohomish Counties. In King County, a woman in her 50s with confirmed travel to Daegu, South Korea is a presumptive positive. She is currently in home isolation.
In Snohomish County, a person under the age of 18 with no travel history is also a presumptive positive. He is currently in home isolation as well. That patient visited Seattle Children’s North Clinic on Monday, Feb. 24. Snohomish County Health District is working alongside the Everett Public Schools to ensure the safety of students and staff at Jackson High School, where this student attends. Everett Public Schools is taking this very seriously and in an abundance of caution, the superintendent has decided to close Jackson High School on Monday to allow three days for deep cleaning.
While the King County case is believed to be travel-related, we don’t know how or where the new Snohomish County case was infected. We are working hard to find and identify how the patients were exposed as well as tracing people who might have been exposed to this patient.

“Now that we are able to expedite test results here at the Public Health Lab in Shoreline, we’re getting results on suspected local cases a lot faster,” said State Health Officer Dr. Kathy Lofy. “Given the extent of global spread, we expect to identify more individuals with COVID-19 in Washington. We want to emphasize the importance of practicing good health habits.”
COVID-19 has the potential to be a serious health risk in our country. Health departments at the federal, state, and local level are working together and with other partners to prepare. 
Healthcare systems are getting ready to potentially see more patients than usual. Schools are receiving updated guidance on what to do to stay safe if they have cases, and what preventative measures they should take if they do not.

Oregon DOH On Their 1st Presumptive Community Acquired COVID-19 Case

Credit Wikipedia









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The expectation of many health officials has been that - given the amount of international travel both to and from the United States - by now COVID-19 has been `seeded' into the population and is slowly spreading under the radar.

But if you test for it, you'll find it. 
After a series of fits and starts, local testing for the novel coronavirus began this week in many new jurisdictions, and overnight we've learned of 4 presumptive positive test results.  Three of which appear to be community acquired. 


We've already looked at California's 2nd case.  Here is the statement from the State of Oregon on their case - an adult school employee who first fell ill 10 days ago - which may have resulted in exposure of teachers and students in the Lake Oswego school district.


Health officials continue investigating as they urge good hand hygiene, covering coughs, staying home if sick
PORTLAND, Ore.—Oregon Health Authority has confirmed Oregon’s first, presumptive case of novel coronavirus, COVID-19, public health officials announced today.
The case, an adult resident of Washington County, experienced symptoms of COVID-19 beginning Feb. 19, and a sample was collected from the individual today. The sample was sent to the Oregon State Public Health Laboratory in Hillsboro, which used the new COVID-19 test kit it received Wednesday from the Centers for Disease Control and Prevention. The lab tested the sample today—only hours after it validated the new CDC test kit.
“Our first concern is for this individual, to make sure they’re being cared for and is able to recover,” said OHA Director Patrick Allen. “Our next priority is finding out who this individual had contact with and make sure they know about their risks, and to let them know how they can get care if they need it. We said this was a fast-moving situation, and that has proved to be true.”
The case was not a person under monitoring or a person under investigation. The individual had neither a history of travel to a country where the virus was circulating, nor is believed to have had a close contact with another confirmed case—the two most common sources of exposure. As such, public health officials are considering it a likely community-transmitted case, meaning that the origin of the infection is unknown.
“We are awaiting confirmation of the test results from the Centers for Disease Control and Prevention, but at this time we are considering this a presumptive case,” said Dean Sidelinger, MD, MSed. “The person in now appropriate isolation and appropriate care.”
The individual spent time in a school in the Lake Oswego school district and may have exposed students and staff there. Public health officials will investigate potential exposures there and contact employees and families of children to let them know next steps.
The individual has been isolated and is being cared for at Kaiser Permanente Westside Medical Center in Hillsboro.
OHA epidemiologists are working closely with public health investigators at Washington County Department of Health and Human Services to identify close contacts of the case.
OHA officials continue to recommend people in Oregon take everyday precautions to prevent the spread of many respiratory illnesses, including COVID-19 and influenza:
  • Cover your coughs and sneezes with a tissue and then throw the tissue in the trash.
  • Wash your hands often with soap and water for 20 seconds. If soap and water are not readily available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Clean and disinfect surfaces that are often touched.
  • Take care of your health overall. Staying current on your vaccinations, including flu vaccine, eating well and exercising all help your body stay resilient.
  • Consult CDC’s travel website for any travel advisories and steps to protect yourself if you plan to travel outside of the US.

CDC Statement On 4 Presumptive Positive COVID-19 Cases In U.S.









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Since my last blog on California's 2nd confirmed community acquired COVID-19 case - posted barely 8 hours ago - the CDC has announced 3 additional presumptive U.S. cases (Washington State & Oregon).
At least two of which appear to be the result of community transmission, and students and teachers (in both states) at a couple of schools may have been exposed. 
While I'll have blogs up on both of those events shortly, here is the CDC's overnight statement on these cases.
CDC Announces Additional COVID-19 Presumptive Positive Cases
Media Statement
For Immediate Release: Friday, February 28, 2020
Contact: Media Relations
(404) 639-3286
The Centers for Disease Control and Prevention (CDC) is aware of four new presumptive positive cases of COVID-19 announced by state public health authorities who are currently conducting investigations.
  1. California has announced a second possible instance of community spread.
  1. Oregon has announced its first possible instance of community spread.
  1. The state of Washington has announced two presumptive cases. One is likely travel related. The other is the state’s first possible instance of community spread.
Community spread means spread of an illness for which the source of infection is unknown. One previous possible instance of community spread was announced in California on February 26.
The four patients tested positive for the virus that causes COVID-19 in their respective states using the CDC-developed rRT-PCR. They are considered presumptive positive cases pending CDC confirmatory testing. However, CDC and State and local public health authorities are proceeding with public health investigations and response activities as if these were confirmed cases.
With both confirmed and presumptive positive cases, CDC recommends healthcare providers follow the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
These four cases bring the total number of COVID-19 cases detected through the U.S. public health system to 19.
The federal government has been working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat. Unprecedented, aggressive efforts have been taken to contain the spread and mitigate the impact of this virus. CDC and federal partners have been preparing for the detection of additional instances of person-to-person spread of COVID-19 for weeks. The federal government will continue to respond aggressively to this rapidly evolving situation.

Friday, February 28, 2020

California: Live News Conference On 2nd Community Acquired COVID-19 Case 7pm EST

 









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Just a head's up.  There have been reports (AP News  & Local NBC affiliate) over the past hour that a second community acquired COVID-19 case has been identified - this time in Santa Clara, California.
The Santa Clara Health Department will live stream a news conference on their facebook page at 7pm EST (4pm PST) at : https://www.facebook.com/sccpublichealth/
It seems likely that with two cases identified with only limited testing to date, that we'll find the virus in more places next week as testing is expanded to include those without recent travel to China (see CDC Revised Testing Criteria For COVID-19 PUIs).




Italy MOH: 171 Additional COVID-19 Cases Over Past 24 Hours



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Italy did not issue a 1200 hrs COVID-19 update today, but did post an abbreviated 1800 hrs report, albeit without the breakout of cases by locality that we've seen previously.

To date, they have announced 821 confirmed cases, and 21 deaths.

Covid-19: cases in Italy at 6 pm on February 28th


821 people are infected with the new Sars-CoV-2 coronavirus in Italy, 21 people have died and 46 have been healed.
Compared to the bulletin at 6 pm on February 27, there was an increase in the number of infected people by 171 units.

There are 345 patients hospitalized with symptoms, 64 are in intensive care, while 412 are in home isolation.

These are the official figures communicated today at the 18:00 conference by the Commissioner for the emergency of civil protection, Angelo Borrelli.

Watch the video with the point of the civil protection situation

For more information:

Japan MOH Announces 17 New COVID-19 Cases - 2 Deaths


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Although the number of COVID-19 cases in Japan is a fraction of what has been reported in South Korea, the numbers continue to rise steadily each day. Yesterday, the government ordered the closing of all schools for the month of March, and today Hokkaido declared a state of emergency over coronavirus.
Today, in addition to 17 new confirmed cases (plus two asymptomatic cases),  the MOH announced the 5th and 6th fatal outcomes among the passengers of the Diamond Princess. 
To date, Japan has identified 230 positive cases (excluding those from the Diamond Princess), 208 of which are symptomatic, and 22 asymptomatic.


Outbreaks of patients related to the new coronavirus (192-208 cases)
From today (February 28), 17 patients and two asymptomatic pathogen carriers from this new type of coronavirus-related infectious disease from Sagamihara, Shizuoka, Hokkaido, Sapporo, Nagoya, and Osaka prefectures We have reported as follows.
With this announcement, 230 people (208 patients and 22 asymptomatic pathogen carriers) have been infected in Japan, including one quarantine officer (asymptomatic pathogen carrier) announced today. 
Regarding this matter, we will carry out proactive epidemiological investigations, including the identification of close contacts.

Outline:

  • Sagamihara city: 2 patients (192 cases: female in 40s, 193 cases: male in 20s)
  • Shizuoka city: 1 patient (194 cases: male in 60s)
  • Hokkaido: 9 patients (195 cases : Women in their 80s, 196th: Men under the age of 10, 197th: Men in their 80s, 198th: Women in their 60s, 199th: Men in their 60s, 200th: Men in their 60s, 201st: Female in their 60s, 202: Male in their 40s, Male in their 203s: Male in their 70s)
  • Sapporo: 3 patients (Female in their 60s, Female in their 60s, 205: Male in their 60s, 206: Male in their 60s) )
  • Ishikawa Prefecture: 1 symptom-free pathogen carrier (male in 50s)
  • Nagoya City: 1 patient (207th: male in 60s)
  • Osaka: 1 patient (208: female in their 40s), one symptomless pathogen carrier (female under 10) or less, information from Sagamihara, Shizuoka, Hokkaido, Sapporo, Nagoya, Osaka
* If the contents of the documents released by the local government do not conform to the ministry's standard, they will be published in accordance with the ministry's standard.
Sagamihara CityShizuoka CityHokkaidoSapporo CityNagoya CityOsaka Prefecture

The MOH also reported the deaths of two more COVID-19 cases who were passengers on the Diamond Princess.
Patient (5th death)
1 Outline
(1) Age: 70s
(2) Gender: Female
(3) Place of residence: Tokyo
(4) Basic illness: Hypertension, Diabetes
2 Cause of death Pneumonia
3 Progress

  • February 3 Yokohama Quarantine started at port quarantine anchorage.
  • February 5 Cruise ship returns to Yokohama. Conducted a PCR test as a patient.
  • February 6 A new coronavirus was found positive.
  • February 7 She was transported to a medical institution and was hospitalized under the Infectious Diseases Law.
  • February 12 Diagnosis of pneumonia by imaging examination.
  • February 19 Respiratory condition worsened, and artificial respiration was started.
  • February 28 Death confirmed.

Patient (6th death)
1 Outline of patient(1)
Gender: Male(2)
Nationality: UK

An Appropriate Level Of Personal Preparedness For COVID-19



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Twice during the 2009 H1N1 pandemic (once in May and again in October) I wrote essays entitled An Appropriate Level Of Concern where I attempted to outline my sense of the seriousness of the pandemic, and the logical things people should be doing to prepare for it.
My advice was predicated on the assumption that H1N1 would be a high morbidity - low mortality pandemic event, and on general preparedness advice everyone should be following regardless of any pandemic threat. 
Specifically, I suggested that everyone :
  • have a good family and business emergency plan
  • acquire at least a 2-week supply of emergency supplies
  • routinely practice good flu hygiene
  • get the appropriate vaccines when and if they become available
  • have and be a flu buddy
  • look out for your neighbors and greater community
Pretty simple stuff.  No underground bunkers, no 10-year-supply of freeze dried foods, or an armory befitting of a small Latin American country.  
 And all things you should have and do all of the time. 
In 2014, when Ebola raged across Africa, and the first few cases showed up in the United States, I wrote  An Appropriate Level Of Concern Over Ebola In The US I wrote:
Given that I write about emergency preparedness often, I’m getting a lot of inquires - from friends and readers alike - as to what I’m doing to prepare now that Ebola has reached the United States. Rather than deal with this question a hundred times over, I’ll lay it out here.

Nothing special. That is, nothing I wouldn’t be doing anyway.
 

Ebola isn't airborne, it isn't transmissible until after symptoms appeared.  It was never going to spread massively in the United States, no matter how much the notion was hyped by an excitable press.

But we live in a dangerous world, where earthquakes, hurricanes, tornadoes, floods . . . and even more mundane events like auto accidents, or slips and falls at home . . . can ruin your entire day.
And pandemic or not, these things are going to continue to happen.  The only difference is, dealing with an earthquake,  a hurricane, or a flood during a pandemic becomes that much harder. 
The standard advice I give in this blog several dozen times a year still applies.  We may need to add a few tweaks for a pandemic, but if you are already prepared for a natural disaster (see below), you are 90% prepared to deal with a pandemic.

Where you live, and your local threat environment, will dictate some changes, but as a general rule, the things you should have in advance to deal with any disaster or emergency include:
  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials
  • A decent first-aid kit, so that you can treat injuries
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration
  • A way to provide light when the grid is down.
  • A way to cook safely without electricity
  • A way to purify or filter water
  • A way to stay cool (fans) or warm when the power is out.
  • A small supply of cash to use in case credit/debit machines are not working
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy, and in case you must evacuate, a bug-out bag
  • Spare supply of essential prescription medicines that you or your family may need
  • A way to entertain yourself, or your kids, during a prolonged blackout or shelter-in-place
While some of this is more appropriate to a hurricane or an earthquake than a pandemic, you can't know in advance what challenges you and your family might face in an emergency.  The goal is to be reasonably prepared to deal with a wide range of problems.

In last September's #NatlPrep: Personal Pandemic Preparedness, we looked at the things that individuals and families should do to prepare for a pandemic, as recommended by the CDC, FEMA.gov, and Ready.gov.
This advice from Ready.gov.
Pandemic
Before a Pandemic
  • Store a two week supply of water and food.
  • Periodically check your regular prescription drugs to ensure a continuous supply in your home.
  • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
  • Get copies and maintain electronic versions of health records from doctors, hospitals, pharmacies and other sources and store them, for personal reference. Get help accessing electronic help records.
  • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
To all of this, I would add (one or more) `Flu buddies (see Time To Line Up A `Flu Buddy'), a copious supply of hand sanitizer, and if you can find them, a box of surgical masks (to wear if you are symptomatic, not for `casual wear' in public). 

Admittedly, COVID-19 looks to be much more serious than the 2009 H1N1 pandemic, and I expect that societal disruptions to be far greater. A modicum of personal preparedness undertaken now could go a long ways towards making those disruptions more palatable, and could even be lifesaving.
Like it or not, dealing with fallout from COVID-19 in the months ahead isn't going to optional for any of us.
The better prepared we are going into this - as individuals, families, businesses, and communities - the more likely we are to limit its impact.

Iran: INRA Reports 143 New COVID-19 Cases & 8 Additional Deaths



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Based on the number of exported cases we've seen reported over the past week, the real number of cases in Iran is undoubtedly many times greater than is being reported, but official numbers are all we really have to go on.
State run media IRNA (Islamic Republic News Agency) is reporting this morning a jump of 143 confirmed cases, and 8 additional deaths over the past 24 hours, bringing Iran's totals to 388 cases and 34 fatalities. 
The higher than normal mortality rate (currently 9%) that Iran has reported since the start of their outbreak is concerning, but may be artificially skewed if only the `sickest of the sick' are currently being tested and identified.

Coronavirus death toll in Iran reaches 34
TEHRAN - IRNA - The Head of the Public Relations and Information Center of the Ministry of Health announced that: The number of confirmed cases of the new Coronavirus virus in the country increased by 143 new cases to 388. In the past few days 73 have improved and 34 have died.
Kianoosh Jahanpour on Friday talked about the latest exact number of the Coronavirus Virus in the country: Since yesterday at noon, 143 cases of definite diagnosis of the Coronavirus have been reported in Iran. Iranian province is composed of 64 new cases, Gilan province 25 cases, Qom province 16 cases, Esfahan province 10 cases.
Mazandaran six new cases, Ardebil one case, Alborz 3 cases, Semnan 3 cases and 2 cases including Qazvin 2, East Azerbaijan 2 cases. Eight of them died.
He continued: The overall number of patients in Iran is 388.
Jahanpour said: The mean age of hospitalization was more than 50 years and the average age of death was over the sixty-0 years.
The Director of the Public Relations and Information Center in the Ministry of Health said: Today, the fifth meeting of the Anti-Coronavirus Headquarters was held with the presence of the first vice president.
Gen. Mohammed al-Askari. Eighty to 90 percent of progress is made in conjunction with CKRV, compliance with both individual and public health points, and strict recommendations on reducing trade and travel between cities and towns. Tours to some provinces is high. The road minister's report showed that Mazandaran province was one of the provinces with many more input automobiles than the output cars.
Jahanpour continued: As in the past days, we stress that there is no safer place than our homes and cities against the Coronavirus.
The Director of the Public Relations and Information Center in the Ministry of Health said: Government support measures and health systems are continuing in cooperation with other ministries and will be developed and we hope to reach the best point by increasing each other.

South Korea Adds Another 315 COVID-19 Cases (n=2337)



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Over the past 48 hours the number of COVID-19 cases identified in South Korea has nearly doubled with the addition of more than 1,000 new cases.   The Feb 28th 0900hrs and 1600hrs updates from the Korean CDC  - combined - have added 571 cases over the past 24 hours.



A breakdown of cases by location (as of their 0900hrs report), and some excerpts from the accompanying epidemiological notes follow:


○ In Busan, 63 people were confirmed * by 9 am today, and 32 cases (50.8%) were related to the hot spring church in Dongnae-gu.
* It will be distributed to 65 people in the aggregate data as of 10:00 pm
○ In Gyeongbuk area, it is centered on group facilities (conventional Chilgok Milal Love House, Yecheon Paradise Village, and Gyeongsan Seorin Nursing Home (confirmed one employee among 122 employees and residents)). It is expected to add cases related to the Daegu Church.
-At Qingdao Daenam Hospital, three additional employees * who were in containment were confirmed *, and a total of 117 people ** were confirmed as cases related to Qingdao South Hospital. 
* 103 patients out of 117, 13 employees, 1 family contact (43 of whom are currently in hospital at Daenam Hospital, 64 are transferred to other hospitals, 7 are killed, 3 are residents of other regions)
○ In Chungnam, 16 people were confirmed * by 9 am today, and checkups are occurring mainly in Cheonan sports facilities.
* It is distributed to 28 people in the aggregate data as of 13:00 on the day of Chungnam itself.
In addition, one patient who had been admitted from February 20-25 at Gongju Medical Center was confirmed, and the inpatients and staff members who had contact with the confirmed patients are currently being quarantined.
□ The Centers for Disease Control and Prevention will provide 'Infectious Disease Management Special Education' to 'Medical Areas with Infectious Diseases' to prevent the spread within Corona19.
Correct personal protective equipment * and proper transport of infected patients are essential to protect the safety of medical staff. In addition, proper disinfection and cleaning of facilities and equipment exposed to viruses are also important to prevent the spread.
* The recommended level of protective equipment is different depending on the treatment situation, and 4 types of personal protective equipment including disposable waterproof long-sleeved gown or whole body protective equipment (Level D) are recommended for respiratory sampling.
          (Continue . . . )

NCDC: Nigeria Confirms 1st COVID-19 Case
















#14,977

Nigeria joins Algeria and Egypt as African nations which have detected imported cases of COVID-19, with the announcement overnight of a positive test on an Italian citizen who returned to Lagos on February 25th from Milan, Italy.
While cases in Africa remain very limited, so is testing and surveillance, leading many experts to worry that COVID-19 could already be circulating - unnoticed - in several African nations. 
The very good news is this particular case was identified early, contact tracing is already underway, and prospects for containment of spread from this case appear pretty good.  There are, of course, concerns of other - possibly asymptomatic - travelers who may enter the country and not be picked up by surveillance.

This statement from the Nigerian CDC:

FIRST CASE OF CORONA VIRUS DISEASE CONFIRMED IN NIGERIA
Friday, February 28, 2020
The Federal Ministry of Health has confirmed a coronavirus disease (COVID-19) case in Lagos State, Nigeria. The case, which was confirmed on the 27th of February 2020, is the first case to be reported in Nigeria since the beginning of the outbreak in China in January 2020.

The case is an Italian citizen who works in Nigeria and returned from Milan, Italy to Lagos, Nigeria on the 25th of February 2020. He was confirmed by the Virology Laboratory of the Lagos University Teaching Hospital, part of the Laboratory Network of the Nigeria Centre for Disease Control. The patient is clinically stable, with no serious symptoms, and is being managed at the Infectious Disease Hospital in Yaba, Lagos.

The Government of Nigeria, through the Federal Ministry of Health has been strengthening measures to ensure an outbreak in Nigeria is controlled and contained quickly. The multi-sectoral Coronavirus Preparedness Group led by the Nigeria Centre for Disease Control (NCDC) has immediately activated its national Emergency Operations Centre and will work closely with Lagos State Health authorities to respond to this case and implement firm control measures.
I wish to assure all Nigerians that have we have been beefing up our preparedness capabilities since the first confirmation of cases in China, and we will use all the resources made available by the government to respond to this case.
We have already started working to identify all the contacts of the patient, since he entered Nigeria. Please be reminded that most people who become infected may experience only mild illness and recover easily, but it can be more severe in others, particularly the elderly and persons with other underlying chronic illnesses. All Nigerians should take care of their health and maintain hand and respiratory hygiene to protect themselves and others, including their own families, following the precautions below:
1. Regularly and thoroughly wash your hands with soap and water, and use alcohol-based hand sanitiser.
2. Maintain at least 1 & half metres (5 feet) distance between yourself and anyone who is coughing or sneezing.
3. Persons with persistent cough or sneezing should stay home or keep a social distance, but not mix in crowd.
4. Make sure you and people around you, follow good respiratory hygiene, meaning cover your mouth and nose with a tissue or into your sleeve at the bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
5. Stay home if you feel unwell with symptoms like fever, cough and difficulty in breathing. Please call NCDC toll free number which is available day and night, for guidance- 0800-970000-10. Do not engage in self-medication
6. Stay informed on the latest developments about COVID-19 through official channels on TV and Radio, including the Lagos State Ministry of Health, NCDC and Federal Ministry of Health.
Citizens must not abuse social media and indulge in spreading misinformation that causes fear and panic. The Federal Ministry of Health, through Nigeria Centre for Disease Control, will continue to provide updates and will initiate all measures required to prevent the spread of any outbreak in Nigeria.
Dr Osagie Ehanire
Hon. Minister of Health



CDC Revised Testing Criteria For COVID-19 PUIs








#14,976

While the number of domestic COVID-19 cases in the United States remains encouragingly low, until now, testing of PUIs (Patients Under Investigation) has been limited (see chart below) to those with recent travel to China or suspected contact with a known case.


Attempts to expand testing have been hampered by an inconsistent and unreliable validation test, which - according to the a CIDRAP News report late yesterday (see Feds to allow state public health labs to test for COVID-19 - is a step that is no longer required.

With an expanding number of countries with large numbers of COVID-19 cases (South Korea, Italy, Iran, Japan, etc.) - and the discovery of what appears to be a community acquired case in California (see California Reports A Possible Community Acquired COVID-19 Case) - the CDC late yesterday released revised criteria for evaluating, testing, and reporting suspect cases.
The biggest changes involve adding 4 countries (Iran, Italy, Japan & South Korea) to the `Countries With Widespread or Community Transmission' testing list, and allowing clinicians to test patients with no relevant travel history who are hospitalized with ARDS or pneumonia and have no alternate explanatory diagnosis. 
I've only posted the highlights below. Clinicians and other interested parties will want to follow the link and read the update in its entirety.

Evaluating and Reporting Persons Under Investigation (PUI)Summary of Recent Changes

Revisions were made on February 27, 2020, to reflect the following:Information updated in the “Criteria to Guide Evaluation of PUI for COVID-19” section.

Updated February 27, 2020
Limited information is available to characterize the spectrum of clinical illness associated with coronavirus disease 2019 (COVID-19). No vaccine or specific treatment for COVID-19 is available; care is supportive.
The CDC clinical criteria for a COVID-19 person under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.
Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.

Criteria to Guide Evaluation of PUI for COVID-19

Local health departments, in consultation with clinicians, should determine whether a patient is a PUI for COVID-2019. The CDC clinical criteria for COVID-19 PUIs have been developed based on available information about this novel virus, as well as what is known about Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). These criteria are subject to change as additional information becomes available.

Thursday, February 27, 2020

South Korea Adds Another 256 COVID-19 Cases (n=2022)



#14,975



South Korea's CDC has released the overnight COVID-19 numbers in their 0900hrs KST update, adding 256 newly confirmed cases, bringing that country's total to 2022 cases and 13 deaths.

This remarkable run-up in cases began 10 days ago, at a time when South Korea had detected only 31 cases in the previous month.  Since then we've seen more than a 60-fold increase, with more than half of those cases linked to the Shincheon Daegu Church.
Other clusters are reportedly linked to several hospitals and long-term care facilities. 
The summary chart from the latest update follows:


COVID-19 Roundup: France, Germany, Spain & Sweden












#14,974

While Italy, Iran, South Korea are getting the bulk of our attention due to their rapidly expanding case numbers, there's increasing activity in many other countries as well. The virus is proliferating in the Middle East, and in the past few days, we're starting to see a good deal of activity in Europe.

The dedicated newshounds at FluTrackers are doing a terrific job gathering and posting these reports 24/7, and if they are not a several-times-a-day stop for you, you are missing out on a terrific real time resource and an amazing repository of infectious disease tracking and information.

A few of their updates from the past couple of hours (h/t Gert van der Hoek) include:
FRANCE 
Olivier Véran, the Minister of Health, announced that France was facing "a significant increase" in the number of cases of contamination by the coronavirus on its territory this Thursday. 38 cases are now confirmed in France. 
https://www.bfmtv.com
Number of confirmed cases Covid-19 grows tot 38, 20 new cases today.
EN DIRECT - Coronavirus: le nombre de cas de contamination confirmés en France passe de 18 à 38


GERMANY 

Thursday, February 27: Coronavirus in NRW: 20 infected in NRW confirmed, hundreds in quarantine

In North Rhine-Westphalia, 14 other people have been shown to be infected with the novel corona virus. The district of Heinsberg and the NRW Ministry of Health announced on Thursday evening that the number of confirmed Covid-19 cases in the district of Heinsberg had increased to 20.

Around 400 are under domestic quarantine. Among them are 300 people who attended a carnival session on February 15 in Gangelt in the Heinsberg district.
Thursday, February 27: Four more coronavirus cases in Baden-Württemberg

In Baden-Württemberg, four other people have been infected with the novel corona virus. The Ministry of Social Affairs announced on Thursday evening in Stuttgart. This means that the number of confirmed infections in the state has risen to eight.

Coronavirus-Newsblog: Infizierte aus Heinsberg sehen sich Anfeindungen ausgesetzt | Kölnische Rundschauhttps://www.rundschau-online.deLandrat Stephan Pusch nimmt das infizierte Ehepaar aus Gangelt in Schutz. Die Situation sei für die Familien belastend.

SPAIN
Spain reports first locally transmitted coronavirus case
Coronavirus in Spain: Spain reports first locally transmitted coronavirus case | Society | EL PAÍS in Englishhttps://english.elpais.com
A man in the Madrid region is in serious condition as the national tally rises to 17, confirming suspicions that the virus had been circulating for days without being detected


SWEDEN
Further cases of covid-19 in several regions
PUBLISHED FEBRUARY 27, 2020
A further five people in Sweden have been detected infected by covid-19. This applies to three people in Västra Götaland, one person in the Uppsala Region and one person in the Stockholm region.
Inbjudan till pressträff: Ytterligare fall av covid-19 i flera regioner — Folkhälsomyndighetenhttps://www.folkhalsomyndigheten.se

Italy: MOH Reports Another 122 COVID-19 Case (n=650)



#14,973


The latest (1800 hrs CET) update from the Italian MOH has been posted and we find 122 additional COVID-19  cases and 3 more deaths have been added since this morning's update. Over the past 24 hours Italy has seen an increase of 250 cases, and 5 fatalities. 
This remarkable surge began a only a week ago, when Italy's case count still stood at 3. 
A stark reminder of how quickly `contained' can go to `widespread'.  The latest (translated) update follows:

Covid-19: the cases in Italy at 18 on 27 February

650 people are infected with the new Sars-CoV-2 coronavirus in Italy. Of these, 17 people died and 45 people recovered.

Compared to the 12 noon bulletin of 27 February, there was an increase in the number of infected people of 122 units.

There are 248 patients hospitalized with symptoms, 56 are in intensive care, while 284 are in home isolation.

These are the official figures communicated today at the 18:00 conference by the Commissioner for the emergency of civil protection, Angelo Borrelli.

In the individual Regions the number of infected people is as follows:
  • Lombardy: 403
  • Veneto: 111
  • Emilia Romagna: 97
  • Liguria: 19
  • Sicily: 4
  • Campania: 3
  • Lazio: 3 (the 2 Chinese tourists and the resigned researcher - all recovered)
  • Brands: 3
  • Piedmont: 2
  • Tuscany: 2
  • Abruzzo: 1
  • Puglia: 1
  • Autonomous Province of Bolzano: 1

Hong Kong AFCD: Dog Tests `Weakly Positive' For COVID-19



#14,972

Over the past couple of decades we've seen quite a few reports of `reverse zoonosis', where companion animals - mostly dogs and cats, but sometime ferrets and other small mammals - have contracted a novel virus from human contact
During the H1N1 pandemic of 2009 we saw both dogs (see US: Dog Tests Positive For H1N1) and cats (see Companion Animals And Novel H1N1) infected with the virus.
Dogs and cats are also susceptible to many of the same kinds of novel viruses that humans are.
Given that the COVID-19 coronavirus appears to have originated in a mammal (bats), and has jumped species - probably at least twice -  is not terribly surprising that companion animals of infected individuals might be susceptible to the infection as well.

Hong Kong today is reporting a `weakly positive' test result on an asymptomatic canine companion.  They will run more tests, but it is too soon to say whether the dog is truly infected - and if so - if the animal is infectious to other animals or to humans. 

In any event, this could tell us a lot more about how the virus can jump species, and they types of hosts it may find suitable.


Detection of low level of COVID-19 virus in pet dog

A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (February 28) that a pet dog had been tested weak positive to COVID-19 virus.
The AFCD received a referral from the Department of Health on February 26 that a dog of a patient infected with COVID-19 disease virus will be handed over to the AFCD.
Staff of the AFCD picked up the dog from a residential flat at Tai Hang in the evening on the same day and sent the dog to the animal keeping facility at the Hong Kong Port of Hong Kong-Zhuhai-Macao Bridge. Oral, nasal and rectal samples were collected for testing of COVID-19 virus. The nasal and oral cavity samples were tested weak positive to COVID-19 virus. The dog does not have any relevant symptoms.

The above dog is the only dog under quarantine at animal keeping facility at the Hong Kong Port of Hong Kong-Zhuhai-Macao Bridge at the moment. There are no other animals using the said facility. Staff of the department will step up cleansing and disinfection of the animal keeping facility.
At present, the AFCD does not have evidence that pet animals can be infected with COVID-19 virus or can be a source of infection to people. The Department will conduct close monitoring of the above dog and collect further samples for testing to confirm if the dog has really been infected with the virus or this is a result of environmental contamination of the dog's mouth and nose.
Repeated tests will be conducted for the dog and it will only be returned when the test result is negative.
The spokesman said that to ensure public and animal health, the department strongly advise mammalian pets of patients confirmed to have been infected with COVID-19 virus to be put under quarantine by the AFCD. The pets will be delivered to the designated animal keeping facilities of the AFCD for quarantine and veterinary surveillance for 14 days. Samples will be collected for testing of COVID-19 virus as appropriate.
The spokesman reminded the pet owners to maintain a good habit of hygiene, and wash their hands thoroughly with soap or alcohol sanitiser after contacting pets. Pet owners shall wear masks while going out. If there are any changes in the health condition of the pets, advice from veterinarians should be sought as soon as possible.

Ends/Friday, February 28, 2020
Issued at HKT 0:55

Japan MOH: 23 New Domestic COVID-19 Cases - 1 Additional Death



#14,971

Japan continues to report increasing numbers of domestic COVID-19 cases, prompting a decision announced overnight to close all of Japan's schools until early April.   Today, the MOH reports another 23 cases - with the bulk of them from Hokkaido - along with the 4th fatality.

The total number of domestic (excluding Diamond Princess) cases that have tested positive is 210, with 19 reported as `asymptomatic', and 190 symptomatic cases.


Outbreaks of patients related to novel coronavirus (168-190 cases)

Today (February 27), 23 patients with this new type of coronavirus-related infectious disease are reported from Gifu, Ishikawa, Kanagawa, Tokyo, Osaka, Hokkaido and Nagoya as follows. I will report it.
With this announcement, 210 people (191 patients and 19 asymptomatic pathogen carriers) have been infected in Japan, including one patient (191st case) of the Yokohama Quarantine Station staff.
Regarding this matter, we will carry out proactive epidemiological investigations, including the identification of close contacts.
Outline:
  • Gifu Prefecture: Patients 2 cases 168 cases: Males in their 50s, 169 cases: Females in their 50s
  • Ishikawa Prefecture: 1 patient (170 cases: Males in their 50s)
  • Kanagawa Prefecture: 1 patient (171 cases) : Male in their 50s)
  • Tokyo: 1 patient (172 cases: female in their 60s)
  • Osaka: 1 patient (173 cases: male in their 40s)
  • Hokkaido: 15 patients (174: male in their 50s, 175: male in their 50s, 176: male in their 30s, 177: male in their 70s, 178: male in their 60s, 179: Male in their 40s, 180: Male in their 40s, 181: Male under 10 years, 182: Male in their 30s, 183: Male under 10 years, 184: Male in their 80s, 185: Men in their 30s, 186: Men in their 80s, 187: Men in their 60s, 188: Women in their 40s)
  • Nagoya: 2 patients (189: Women in their 60s, 190: Men in their 60s) )
Below, information from Gifu, Ishikawa, Kanagawa, Tokyo, Osaka, Hokkaido, and Nagoya.
* If the contents of the documents published by local governments do not conform to the publication standards of the Ministry, The announcement is made in accordance with the publication standard.
Gifu Prefecture 1 , Gifu Prefecture 2
Ishikawa Prefecture
Kanagawa Prefecture
Tokyo
Osaka Prefecture
Hokkaido 1 , Hokkaido 2
Nagoya

Details on Japan's 4th fatality follow:

About death of patient associated with new coronavirus
Today (February 27), Hokkaido reported a fatal case related to this new type of coronavirus. 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.
We will carry out proactive epidemiological investigations on this matter, including the identification of close contacts.

Summary (4th domestic death)
(1) Age: 80s (99th domestic death )
(2) Gender: Male
(3) Place of residence: Hokkaido
(4) Cause of death: Under confirmation
(5) Elapsed

  • February 3 Bitter. Hospitalized at medical institution A in Hokkaido.
  • February 22 PCR test positive. Hospitalized at medical institution B in Hokkaido. The condition was stable, but gradually worsened after hospitalization.
  • February 27 Dawn Confirmed death.
(6) Action history: No travel history. Details are currently under investigation.