What's New
According to Chinese health authorities, more than 1,400 additional, confirmed cases (including 192 deaths) of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported since February 21, 2020, throughout China, mainly in Hubei (> 1,400) Province. Most recent deaths have occurred in Hubei Province, with 4 deaths in the city of Shanghai and in Guangdong, Hebei, and Xinjiang provinces; 4,200 more patients have recovered and been discharged. More than 76,900 confirmed cases (including > 2,400 deaths)—reported through February 23 at 3:00 p.m. EST—have been officially reported since December 8, 2019. The confirmed case total in China and elsewhere for February 13-18 refers to laboratory-confirmed cases only, except for Hubei Province, where clinically confirmed cases are included in the confirmed case total. As of February 19, confirmed case numbers for Hubei Province no longer include clinically confirmed cases.
Three additional, imported confirmed cases from China have been reported since February 21 in Japan, Singapore, and the U.S.; just 6 cases have been reported in the past 7 days, and only 1 additional country has officially reported imported cases from China since February 2. More than 210 cases imported from China have been reported at international ports of entry since January 6 in 26 countries.
In contrast, more than 510 additional cases have been reported since February 21 in South Korea (> 390 cases, including 4 deaths), Italy (73 cases, including 2 deaths), Japan (> 35 cases), Iran (23 cases, including 3 deaths), Singapore, and United Arab Emirates. Since January 14, approximately 55 cases of severe disease and 23 deaths (at least 3 of these cases reported travel history to China) have been reported in cases exported from China or cases acquired outside of China. More than 320 of the 602 total cases reported in South Korea are from Daegu (and surrounding areas), and a majority of these cases are associated with a single case in a super-spreading event linked to the Shincheonji Church of Jesus and the Cheongdo Daenam Hospital. Visitors and residents of Daegu have been urged to stay indoors, and all nonessential travel to Daegu is prohibited for active U.S. service members. Eighteen cases were reported among South Korean tourists who traveled to Israel from February 8-15; contact tracing is underway in Israel. Cases in Iran continue to increase, and 4 exported cases from Iran have been reported in Canada, Lebanon, and the United Arab Emirates since February 21. More than 670 cases with transmission occurring outside of China (including locally acquired cases) have been reported since January 14 in 20 countries: Canada, Egypt, France, Germany, Hong Kong, Iran, Italy, Japan, Lebanon, Macau, Malaysia, Singapore, Spain (Canary Islands and Mallorca Island), South Korea, Taiwan, Thailand, United Arab Emirates, U.K., U.S., and Vietnam. Despite excellent public health infrastructure, Hong Kong, Japan, and Singapore have reported multiple known case clusters of COVID-19 with no established link to known transmission chains, which is worrisome for sustained transmission in those areas. In South Korea, Singapore, and Hong Kong, despite intensive efforts, locally acquired cases now outnumber imported cases 357 to 13 (South Korea), 60 to 13 (Hong Kong), and 56 to 24 (Singapore).
More than 60 additional cases have been reported since February 21 among passengers who were aboard the Diamond Princess cruise ship; 6 of these cases were among repatriated citizens in Australia (5 cases) and Hong Kong (1 case). More than 700 total cases (including 3 deaths and 36 in serious condition) have been reported; more than 330 cases were asymptomatic at the time of diagnosis. The mandatory 14-day quarantine aboard the ship officially expired on February 19, and the disembarkation of approximately 1,800 passengers has begun for those who are asymptomatic and negative for SARS-CoV-2. Approximately 970 passengers have disembarked since February 19; Canada, Israel, and Taiwan repatriated some of their citizens beginning on February 20. Indonesia, Italy, the Philippines, and the U.K. plan to repatriate citizens aboard the ship beginning on February 21. Citizens will be required to be symptom free when boarding their respective flights and will uniformly be subject to quarantine upon arrival in country. Approximately 1,000 crew members will remain aboard to complete an additional 14-day quarantine, which is now expected to expire on March 6. Approximately 300 passengers remain aboard the ship; 100 of these passengers have been identified as close contacts and will be removed and placed in a government-provided quarantine facility.
The U.S. CDC is now advising older adults and those with chronic medical conditions to consider postponing nonessential travel to Japan and South Korea. No precise definition for "older adults" has been provided. Israel now advises avoidance of nonessential travel to Hong Kong, Japan, Macau, Singapore, South Korea, Taiwan, and Thailand in addition to China. Israel has banned all nonresidents or noncitizens who visited Japan or South Korea in the last 14 days before arriving. In addition all citizens and residents arriving from Japan or South Korea (in addition to arrivals from China, Hong Kong, Macau, Singapore, or Thailand) will be subject to mandatory home quarantine in Israel.
Consensus guidelines on an interval for a safe return to work or the community for a confirmed case of COVID-19 require further data on viral shedding. At present, case-by-case decisions are needed. At present, where PCR testing is accessible in a timely manner, patients should have samples obtained from the nose and throat twice, spaced by 24 hours. No return to work should be allowed until all 4 such specimens are negative. The best estimate of when to start testing is 14 days after symptom onset but delayed until the patient has been well for at least a week. In a small study of serial swabs for PCR, most were negative within 14 days of symptom onset (including those who were very sick), but several minimally symptomatic persons were still minimally PCR-positive at 15 days and 1 at 21 days.
In addition to U.S. CDC, only 3 U.S. states (California, Illinois, and Nebraska) can currently test for SARS-CoV-2; some of the testing kits previously sent to other states and at least 30 countries were flawed and produced inconclusive results. U.S. CDC has increased its testing capacity until the testing kits are replaced.
