COVID-19 Updated Data & Developments - March 23, 2020

Nomenclature

The novel (new) coronavirus, formally named “SARS-CoV-2,” and the disease it causes has been named “coronavirus disease 2019” (abbreviated as COVID-19) by the World Health Organization.

What is coronavirus?

Coronavirus is a family of viruses that have been known to infect humans. Viruses in the family are known to cause the common cold, SARS, and MERS. The virus that causes COVID-19 infects people and is easily spread person-to-person but is far less virulent than SARS. Cases have been detected in most countries worldwide, including the United States, and has officially been declared a pandemic, or a global disease outbreak. COVID-19 causes a respiratory disease that may be identifiable by dry coughing, breathing difficulties, and fever. Those that suspect they are infected with coronavirus should call their health provider first and should not go to a health care facility unless directed to do so.

Is there a vaccine?

A phase 1 clinical trial for a vaccine designed by Moderna to protect against COVID-19 is currently underway in Seattle.¹ Vaccines must go through at least 3 clinical phases to ensure their efficacy and safety before they can be approved and used in the general population. ² Even with an expedited process it will be at least a year before a COVID-19 vaccine is fully developed and made available to the public.³

What is a vaccine?

Vaccines are one of the most effective ways to prevent diseases. Vaccines are made out of killed or weakened parts of the virus or bacteria of interest. Once inside the body, the vaccine is able to stimulate the immune system to develop antibodies and thus immunity to the disease, all without the person getting the disease.⁴

The vaccine currently being developed by Moderna uses genetic information, messenger RNA (mRNA), to deliver the vaccine. mRNA vaccines are an emerging platform and as of now no mRNA vaccine has reached the market. Compared to some forms of traditional vaccines (DNA-based, live/killed attenuated viruses), mRNA vaccines are thought to be safer because they are non-infectious and have no risk of potentially mutating inside the human body. Through chemical modifications mRNA is stabilized and readily enters into cells. Lastly, mRNA vaccine production is inexpensive, fast, and scalable.⁵

Why did the CDC recommend an 8-week moratorium on in-person gatherings?

On Monday the US government officially recommended that people should avoid in-person gatherings of 10 or more people.⁶ This recommendation is supported by evidence from South Korea and China, both of which appear to slowly be returning to life as normal after 8 weeks of anti-coronavirus measures. ⁷ On March 10, China closed the last of its temporary emergency hospitals ⁸ after seeing a dramatic decrease in new cases over the past couple of weeks. ⁹ Likewise, South Korea has experienced a substantial decrease in new cases over the past week.¹⁰

As the United States contends with this new and evolving situation, it appears likely that many businesses, offices, and schools will remain closed for longer than two weeks.

Information highlights from CDC website ¹¹

• Symptoms
  • Symptoms may appear 2-14 days after exposure.
    • Fever
    • Cough
    • Shortness of breath
• Testing¹²
  • As of March 15, all 50 states, the District of Columbia, and Guam have successfully verified COVID-19 diagnostic tests in state and local public health laboratories.
  • A number of states have opened “drive-through” coronavirus testing stations with more to come.¹³

How is coronavirus spread?¹⁴

• Person-to-person

Guidelines from the CDC to Minimize Chances of Infection ¹⁶

• Clean your hands often
• Avoid close contact
  • Avoid close contact with people who are sick
  • Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.
• Take steps to protect others
  • Stay home if you’re sick
    • Stay home if you are sick, except to get medical care. If you think you may have contracted the virus call your doctor first.
  • Cover coughs and sneezes
    • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
    • Throw used tissues in the trash.
    • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
  • Wear a facemask if you are sick
    • If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick.
    • If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.
  • Clean and disinfect
    • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
    • If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.

International case numbers

• Monday, 03/23/20 10:30 am: 351,731 COVID-19 cases worldwide; 15,374 deaths; 100,430 recovered. ¹⁷
• Besides China, Italy has the second highest number of cases with over 59,000 cases. Italy now has the highest number of COVID-19-related deaths at 5,476 total.
  • The number of diagnosed cases outside of China exceeds those within China alone-- more than 60% of all coronavirus cases were diagnosed in other countries throughout the world.
  • New information from China finds that the mortality rate in Wuhan for symptomatic individuals is 1.4%. ¹⁸ The death risk estimate from Wuhan, China is likely higher than the rate that will likely be seen in the US and is associated with a breakdown of the healthcare system.¹⁹ This finding indicates that proactive public health interventions to reduce burden on hospitals and healthcare workers, including social distancing, increased personal hygiene, and voluntary movement restrictions, are essential to reducing transmission and fatality rates. Incidence and mortality rates will likely vary from country to country depending on the health system and public health responses.

Epidemic curve of confirmed cumulative coronavirus cases worldwide (from WHO COVID-19 Dashboard, as of 3/23/2020).

Coronavirus cases by date of report worldwide (from WHO COVID-19 Dashboard, as of 3/23/2020).²⁰

US National case numbers as of March 23, 2020, 12:30 pm²¹

• More than 40,000 cases of coronavirus confirmed by lab tests and 473 deaths. ²²
• Risk in population:²³
  • General: Current estimates show that about 9 people per 1000 (1% case fatality rate) US COVID-19 cases will die of the disease. ²⁴ By contrast, the fatality rate from data already available is 1.3% in people 50-59, 0.4% in people 40-49, and 0.18% in people 30 to 39. Those that are 29 and under face mortality rates 0.09% and under, and children ages 0-9 are estimated to experience mortality at rates below 0.01%. ²⁵ New data from the CDC shows that young adults ages 20-44 face a substantial risk of serious illness and hospitalization from the coronavirus.²⁶
  • Elderly: The death rate in elderly age 80 or older is very high and believed to be over 15% and possibly as high as 22%. ²⁷ Older adults (those over 60 and particularly those over 80) and those with serious chronic health conditions (including heart disease, diabetes, and lung disease) are at a higher risk of getting very ill due to COVID-19. ²⁸
  • Children: Initial evidence suggests that children seem to be getting infected at the same rate as adults but have milder symptoms. ²⁹ In China only 2.4% of all cases are in young children. ³⁰ However, a new study of more than 2,000 children in China suggests that children may be more susceptible to coronavirus than previously thought. One third of the children included in the study were confirmed cases while the other two-thirds were suspected cases.³¹
• Health care workers, home health aides, first responders, and teachers are among those at greatest risk of contracting coronavirus as a result of their job.³²
• Those that work in lower-income jobs may also face increased risk as the ability to work from home may not be feasible-- only 9.2% of those in the the bottom income quartile (lowest 25% income earners) are able to work from home while 20.1% of those in the third income quartile (second-lowest, 25-50% incomes earners) are able to work from home. ³³

New US developments

• As of March 19, 2020 the State Department has raised their travel warning to a Global Level 4 Health Advisory – Do Not Travel. All US citizens should avoid international travel and those abroad should arrange for their immediate return unless they plan to remain indefinitely. ³⁴
• Phase 1 clinical trial for a vaccine to protect against COVID-19 is underway in Seattle.³⁵
• The US-Canadian border will be closed to all non-essential travel.³⁶
• The US Treasury and IRS delay the tax payment deadline by 90 days.³⁷
• As of March 18, the US government recommends all gatherings of more than 10 people be canceled or postponed.³⁸
• Drive-through testing has commenced in NYC, New Haven, and Hartford. People need to call first and be given permission to go from their doctor for testing.
• New York, New Jersey, Connecticut have banned gatherings of more than 50 people.³⁹

Known cases in Connecticut (call 211 or text "CTCOVID" to 898211)

• As of 03/23/2020, there are 327 confirmed cases, 51 hospitalizations, and 8 deaths.⁴⁰
  • Fairfield County: 208 cases
  • Hartford County: 54 cases
  • Litchfield County: 12 cases
  • Middlesex County: 6 cases
  • New Haven County: 29 cases
  • New London County: 3 cases
  • Tolland County: 14 cases
  • Windham County: 1 case

Connecticut developments⁴¹

• Professor Marie-Louise Landry at the Yale School of Medicine and her lab have established their own test for SARS-CoV-2 with the help of YSPH researcher Dr. Nate Grubaugh. Her clinical lab tested 752 patients samples from 3/13 to 3/21. They have been able to keep up and report results the same day samples are received. ⁴²
• Governor Lamont requests that all “nonessential” workers stay home, starting at 8:00 pm on Monday, March 23. “Essential” workers include those in the health care sector, infrastructure, manufacturing, retail, food and agriculture, providers of basic necessities, services necessary to maintain public safety, and others. ⁴³
• New Haven
  • New Haven residents are encouraged to stay at home other than to make essential trips for groceries or medical supplies.
  • Yale New Haven Hospital and the city’s elderly housing complexes have restricted visitation.
  • During the school shutdown, pre-packaged breakfast and lunches will be provided at 37 schools from 9am-noon in a “Grab and go” program. ⁴⁴
  • Stop & Shop announces new hours. The store will be open from 6am-7:30am for those older than 60 years old only. ⁴⁵
• Access Health CT is announcing a special enrollment period for residents without health insurance the opportunity to purchase it. ⁴⁶
• Connecticut bans gatherings of more than 50 people ⁴⁷
  • Restaurants/bars will be takeout/delivery ONLY
  • Gyms closed
  • Movie theaters closed
  • Casinos closed
• All public schools will be closed until at least March 31. ⁴⁸
• The CT Public Utilities Regulatory Authority (PURA) ordered a moratorium on all utility shut-offs. Gas, electric, and water public services shall refrain from terminating utility service to residential customers, except to maintain public safety, for 30 days to ensure that all residents can safely stay at home.⁴⁹
• The CT State Department of Education received a waiver from the federal government to ensure that students can continue to receive meals during school closures and consume them at home. Many school districts have already begun to provide free meals for students. ⁵⁰

Known cases in Rhode Island (call 401-222-8022)

• As of 3/23/2020:⁵²
  • 83 confirmed and presumptive cases
  • 216 tests pending results
  • 2,750 people currently instructed to self-quarantine

Rhode Island developments⁵³

• The Honeywell manufacturing facility in Smithfield is planning to create more than 500 new jobs in order to expand production of N95 face masks.⁵⁴
• Governor Raimondo ordered that all entertainment and recreational businesses, including barbershops, salons, and tattoo shops, close starting at 5:00 pm on Monday, March 23.⁵⁵
• Starting March 23, all public schools in Rhode Island will implement distance learning for at least two weeks.⁵⁶
• The Rhode Island Public Utilities Commission mandated that all regulated utilities in the state cannot terminate service, except to maintain public safety, during the coronavirus emergency.⁵⁷
• Governor Raimondo signed an executive order on March 18 requiring that all health insurers doing business in the state pay for medically appropriate tele-health visits at the same rate as in-person office visits.⁵⁸
• Rhode Island bans gatherings of more than 25 people.⁵⁹
• Schools throughout Rhode Island are providing free “grab and go” meals to all children 18 and under while schools are closed.⁶⁰ All public schools and childcare centers in the state are currently closed through March 20.⁶¹
• Governor Raimondo ordered that all dine-in food and beverage service in restaurants, bars, coffee shops, and other businesses must shut down until March 30. Take-out, delivery, and drive-thru service can continue.⁶²

Key international developments

• Mounting anecdotal evidence suggests that a loss of smell and taste are significant symptoms associated with COVID-19.⁶³
• A hospital in Seoul, South Korea has implemented “phone booth” walk-in testing for COVID-19. The booths allow doctors to test patients for coronavirus while remaining separated by a plastic barrier to reduce patient-doctor contact and spread. After a patient has been tested, the entire booth can be rapidly disinfected before the next patient is consulted. This process has greatly increased the ability to test for coronavirus while decreasing the time it takes to consult individual patients and disinfect spaces that patients with coronavirus come in contact with.⁶⁴
• After reporting no new cases for the third day, China has begun removing checkpoints in Wuhan, the hardest hit city.⁶⁵
• The EU bans all non-essential travel to Europe for at least 30 days. External borders will be closed but movement within member nations will still be allowed.⁶⁶
• The EU has linked Russian media outlets to disinformation about the coronavirus. The EU-produced report states that the disinformation seeks to undermine public trust in health care systems abroad.⁶⁷
• Japan is reporting its first case of a person becoming reinfected with the coronavirus after showing signs they had fully recovered. There have also been a number of cases of reinfection in China.⁶⁸
  

[1]https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins

[2] https://www.cdc.gov/vaccines/basics/test-approve.html

[3] https://www.nytimes.com/2020/03/16/health/coronavirus-vaccine.html

[4] https://www.cdc.gov/vaccines/vpd/vpd-vac-basics.html

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906799/

[6]https://www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf

[7] https://www.nytimes.com/2020/03/17/opinion/coronavirus-social-distancing-effect.html

[8] http://www.xinhuanet.com/english/2020-03/10/c_138863160.htm

[9] https://www.worldometers.info/coronavirus/country/china/

[10] https://www.worldometers.info/coronavirus/country/south-korea/

[11] https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/index.html

[12]https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Ftesting-in-us.html

[13] https://www.businessinsider.com/drive-through-coronavirus-tests-states-2020-3

[14] https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html

[15] https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf

[16] https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html

[17] https://coronavirus.jhu.edu/map.html

[18]

[19] https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article

[20] https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

[21] https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[22] https://coronavirus.jhu.edu/map.html

[23] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

[24] (Possibly outdated) https://www.bbc.com/news/health-51674743

[25]https://nymag.com/intelligencer/2020/03/coronavirus-and-its-high-mortality-rate-among-older-patients.html

[26]

[27] https://www.nytimes.com/2020/03/14/health/coronavirus-elderly-protection.html

[28]https://www.businessinsider.com/coronavirus-death-rate-by-age-countries-2020-3#still-older-patients-in-south-korea-also-had-a-much-higher-death-rate-than-younger-ones-patients-older-than-80-had-a-72-death-rate-as-of-wednesday-6

[29] https://www.nature.com/articles/s41591-020-0817-4

[30]https://www.washingtonpost.com/health/2020/03/10/coronavirus-is-mysteriously-sparing-kids-killing-elderly-understanding-why-may-help-defeat-virus/

[31] https://www.nytimes.com/2020/03/17/health/coronavirus-childen.html

[32] https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html

[33] https://www.bls.gov/news.release/flex2.t01.htm

[34]https://travel.state.gov/content/travel/en/traveladvisories/ea/travel-advisory-alert-global-level-4-health-advisory-issue.html

[35]https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins

[36] https://twitter.com/realDonaldTrump/status/1240271178692005889

[37] https://www.cnbc.com/2020/03/17/treasury-and-irs-to-delay-tax-deadline-by-90-days.html

[38]https://www.cdc.gov/coronavirus/2019-ncov/community/large-events/mass-gatherings-ready-for-covid-19.html

[39] https://twitter.com/NYGovCuomo/status/1239558725528178689

[40] https://portal.ct.gov/coronavirus

[41]https://www.nhregister.com/news/coronavirus/article/Coronavirus-in-Connecticut-Live-updates-hour-by-15132401.php

[42] https://medicine.yale.edu/profile/marie_landry/

[43] https://portal.ct.gov/DECD/Content/Coronavirus-for-Businesses/Coronavirus-for-Businesses

[44]https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3Af83d7741-3855-414e-92b0-3d6f0440238b

[45] https://www.foxnews.com/us/stop-shop-special-hours-coronavirus

[46] https://learn.accesshealthct.com/

[47] https://twitter.com/NYGovCuomo/status/1239558725528178689

[48] https://patch.com/connecticut/guilford/coronavirus-ct-gov-closes-all-schools-state-has-now-26-cases

[49] https://portal.ct.gov/Coronavirus

[50]https://www.nhregister.com/news/coronavirus/article/CT-school-districts-to-offer-meals-during-15132705.php

[51] https://patch.com/connecticut/naugatuck/school-meals-during-coronavirus-closure-announced

[52] https://health.ri.gov/data/covid-19/

[53] https://www.wpri.com/coronavirus/

[54] https://www.wpri.com/health/coronavirus/increased-n95-mask-manufacturing-to-bring-500-new-jobs-to-ri/

[55] https://www.wpri.com/health/coronavirus/raimondo-covid-19-update-sunday/

[56] https://www.necn.com/news/local/ri-gov-to-provide-update-on-coronavirus-response/2247461/

[57] https://www.wpri.com/health/coronavirus/march-18-rhode-island-coronavirus-update/

[58] https://www.wpri.com/health/coronavirus/march-18-rhode-island-coronavirus-update/

[59] https://twitter.com/cnnbrk/status/1239590086519463937

[60]https://www.wpri.com/health/coronavirus/providence-schools-offering-free-grab-and-go-lunches-to-students/

[61]https://thehill.com/homenews/state-watch/487466-ri-gov-gina-raimondo-announces-closure-of-all-public-schools-next-week

[62] https://www.wpri.com/health/coronavirus/raimondo-briefing-on-coronavirus-expected-to-start-at-10-a-m/

[63]https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html?smtyp=cur&smid=tw-nytimes

[64]https://www.straitstimes.com/asia/east-asia/south-korea-dials-up-coronavirus-testing-with-hospital-phone-booths

[65]https://www.scmp.com/news/china/society/article/3076270/coronavirus-fireworks-wuhan-checkpoints-are-taken-down-other

[66] https://www.cnbc.com/2020/03/17/coronavirus-european-union-leaders-agree-to-close-borders.html

[67] https://www.theguardian.com/world/2020/mar/18/russian-media-spreading-covid-19-disinformation

[68]https://thehill.com/changing-america/well-being/prevention-cures/484942-japan-confirms-first-case-of-person-reinfected