WHO,Event Information Site for IHR National Focal

Date of Information Posted: 20 February 2020

HIGHLIGHTS (18 February to 20 February 2020)  

DATE	HIGHLIGHTS
FEBRUARY 20, 2020	Ø One new country (Islamic Republic of Iran) reported cases of COVID-19 in the past 24 hours.  Ø China has revised their guidance on case classification for COVID-19, removing the classification of “clinically diagnosed” previously used for Hubei province, and retaining only “suspected” and “confirmed” for all areas, the latter requiring laboratory confirmation. Some previously reported “clinically diagnosed” cases are thus expected to be discarded over the coming days as laboratory testing is conducted and some are found to be COVID-19-negative.
FEBRUARY 19, 2020	Ø WHO is working with an international network of statisticians and mathematical modelers to estimate key epidemiologic parameters of COVID19, such as the incubation period (the time between infection and symptom onset), case fatality ratio (CFR, the proportion of cases that die), and the serial interval (the time between symptom onset of a primary and secondary case). Reports of current analyses that have estimated these parameters are provided in this Situation Report as a summary of currently available evidence. These values should be considered preliminary and parameters will likely be updated as more information becomes available. Modelling can support decision-making but needs to be combined with rigorous data collection and a comprehensive analysis of the situation. Please see the Subject in Focus section for more information.  Ø Several online courses related to COVID-19 have been added to the OpenWHO platform: –A general introduction to emerging respiratory viruses, including novel coronaviruses (available in French, Simplified Chinese, and Spanish as well). – Critical Care of Severe Acute Respiratory Infections o Health and safety briefing for respiratory diseases – ePROTECT.
FEBRUARY 18, 2020	Ø WHO Operations Support and Logistics (OSL) continues to gather and assess the needs of Member States for critical items such as Personal Protective Equipment (PPE). On 14 February, OSL started the dispatch of laboratory COVID-19 testing kits for 56 countries. As of 17 February, 37 shipments have been dispatched to 34 countries and three regional offices.

Situation in Numbers:

Total and New Cases in Last 24 hours

 

	TOTAL CASES	NEW CASES
Globally	75,748 Confirmed	548
China+	74,675 Confirmed	399
	2,121 Deaths	115
Outside of China	1,073 Confirmed	149
	26 Countries	1
	8 deaths	5

 

WHO Risk Assessment:

China	Very High
Regional Level	High
Global Level	High

 Figure 1. Countries, territories or areas with reported confirmed cases of COVID-19, 20 February 2020

*The situation report includes information provided by national authorities as of 10 AM Central European Time.

+ As reported by China, which includes both laboratory confirmed and clinically diagnosed cases (currently only applicable to Hubei province, China)

 

SURVEILLANCE

Table 1. Confirmed and Suspected cases of COVID-19 acute respiratory disease reported by provinces, regions and cities in China, 20 February 2020

 

 Table 2. Countries, Territories or areas outside China with reported laboratory-confirmed COVID-19 cases and deaths. Data as of 20 February 2020

*Case classifications are based on WHO case definitions for COVID-19.

† Location of transmission is classified based on WHO analysis of available official data and may be subject to reclassification as additional data become available.

‡Cases identified on a cruise ship currently in Japanese territorial waters.

 

 Figure 2: Epidemic curve of COVID-19 cases (n=233) identified outside of China, by date of onset of symptoms and likely exposure location, 20 February 2020

Note: for figure 2: Of the 1073 cases reported outside China, 30 were detected while apparently asymptomatic. For the remaining 1043 cases, information on date of onset is available only for the 233 cases presented in the epidemiologic curve.

Figure 3: Epidemic curve of COVID-19 cases (n=1073) identified outside of China, by date of report and likely exposure location, 20 February 2020

STRATEGIC OBJECTIVES

WHO’s strategic objectives for this response are to:

• Limit human to human transmission including, reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread from China*;
• Identify, isolate and care for patients early, including providing optimized care for infected patients;
• Identify and reduce transmission from the animal source;
• Address crucial unknowns and about clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines;
• Communicate critical risk and event information to all communities and counter misinformation;
• Minimize social and economic impact through multisectoral partnerships.

*This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in healthcare settings, implementation of health measures for travellers, awareness raising in the population, risk communication.

 

PREPAREDNESS AND RESPONSE:

• All technical guidance documents regarding COVID-19 are available at WHO webpage.
• WHO is working closely with International Air Transport Association (IATA) and have jointly developed a guidance document to provide advice to cabin crew and airport workers, based on country queries. The guidance can be found on the IATA webpage.
• WHO has developed a protocol for the investigation of early cases (the “First Few X (FFX) Cases and contact investigation protocol for 2019-novel coronavirus (2019-nCoV) infection”). The protocol is designed to gain an early understanding of the key clinical, epidemiological and virological characteristics of the first cases of COVID19 infection detected in any individual country, to inform the development and updating of public health guidance to manage cases and reduce potential spread and impact of infection.
• WHO has been in regular and direct contact with Member States where cases have been reported. WHO is also informing other countries about the situation and providing support as requested.
• WHO has developed interim guidance for laboratory diagnosis, advice on the use of masks during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak, clinical management, infection prevention and control in health care settings, home care for patients with suspected novel coronavirus, risk communication and community engagement and Global Surveillance for human infection with novel coronavirus (2019-nCoV).
• WHO has prepared disease commodity package that includes an essential list of biomedical equipment, medicines and supplies necessary to care for patients with 2019-nCoV.
• WHO has provided recommendations to reduce risk of transmission from animals to humans.
• WHO has published an updated advice for international traffic in relation to the outbreak of the novel coronavirus 2019-nCoV.
• WHO has activated of R&D blueprint to accelerate diagnostics, vaccines, and therapeutics.
• WHO has developed an online course to provide general introduction to emerging respiratory viruses, including novel coronaviruses.
• WHO is providing guidance on early investigations, which are critical to carry out early in an outbreak of a new virus. The data collected from the protocols can be used to refine recommendations for surveillance and case definitions, to characterize the key epidemiological transmission features of COVID-19, help understand spread, severity, spectrum of disease, impact on the community and to inform operational models for implementation of countermeasures such as case isolation, contact-tracing and isolation.

Several protocols are available here: http://who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/early-investigation

• WHO is working with its networks of researchers and other experts to coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and other ways to identify, manage the disease and limit onward transmission. WHO has issued interim guidance for countries, which are updated regularly.
• WHO is working with global expert networks and partnerships for laboratory, infection prevention and control, clinical management and mathematical modelling.

 

RECOMMENDATIONS AND ADVICE FOR THE PUBLIC:

During previous outbreaks due to other coronavirus (Middle-East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)), human to human transmission occurred through droplets, contact and fomites, suggesting that the transmission mode of the COVID-19 can be similar. The basic principles to reduce the general risk of transmission of acute respiratory infections include the following:

• Avoiding close contact with people suffering from acute respiratory infections.
• Frequent hand-washing, especially after direct contact with ill people or their environment.
• Avoiding unprotected contact with farm or wild animals.
• People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).
• Within healthcare facilities, enhance standard infection prevention and control practices in hospitals, especially in emergency departments.

WHO does not recommend any specific health measures for travellers. In case of symptoms suggestive of respiratory illness either during or after travel, the travellers are encouraged to seek medical attention and share their travel history with their health care provider.