Global & Disaster Medicine

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Coronavirus Disease 2019 Information for Travel

https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

This page includes information about Coronavirus Disease 2019 (COVID-19) for travelers and travel related industries.

Traveler pulling a suitcase. Airplane in the background.

Travelers from China Arriving in the US
Warning Level 3

CDC recommends that travelers avoid all nonessential travel to:

Alert Level 2

These destinations are experiencing sustained community transmission of respiratory illness caused by the novel coronavirus (COVID-19). The virus can spread from person to person. Older adults and those with chronic medical conditions should consider postponing nonessential travel.

Watch Level 1

CDC does not recommend canceling or postponing travel to the following destinations. Travelers should practice usual precautions.

Other Destinations with Apparent Community Spread
  • Singapore
  • Taiwan
  • Thailand
  • Vietnam

Community spread means people have been infected with the virus, including some who are not sure how or where they became infected. At this time, the extent of virus spread is not sustained or widespread enough to meet the criteria for a travel health notice. If that changes, CDC will update this page.


CDC Travelers’ Health Update: 2/25/20

Coronavirus Disease 2019

Travel: Because of the novel (new) coronavirus outbreak, CDC recommends that travelers avoid travel to mainland China, South Korea, and reconsider cruise ship travel to or within Asia. The recommendation to avoid travel to China applies only to mainland China and does not include Hong Kong, Macau, or the island of Taiwan. CDC has posted several country-specific travel health notices for coronavirus. These notices are also listed in the travel health notice section below. The coronavirus situation is evolving rapidly, and CDC is following it very closely.

 


A randomized, controlled clinical trial to evaluate the safety and efficacy of the investigational antiviral remdesivir in hospitalized adults diagnosed with coronavirus disease 2019 (COVID-19) has begun at the University of Nebraska Medical Center (UNMC) in Omaha.

NIH

“……Remdesivir, developed by Gilead Sciences Inc., is an investigational broad-spectrum antiviral treatment. It was previously tested in humans with Ebola virus disease and has shown promise in animal models for treating Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), which are caused by other coronaviruses.

“We urgently need a safe and effective treatment for COVID-19. Although remdesivir has been administered to some patients with COVID-19, we do not have solid data to indicate it can improve clinical outcomes,” said NIAID Director and U.S. Coronavirus Task Force member Anthony S. Fauci, M.D. “A randomized, placebo-controlled trial is the gold standard for determining if an experimental treatment can benefit patients.”

Clinical trials of remdesivir are also ongoing in China. NIAID developed the current study taking those designs into account, and in accordance with consultations convened by the WHO on the development of a therapeutic trial for patients with COVID-19.

Participants in the NIH-sponsored trial must have laboratory-confirmed SARS-CoV-2 infection and evidence of lung involvement, including rattling sounds when breathing (rales) with a need for supplemental oxygen or abnormal chest X-rays, or illness requiring mechanical ventilation. Individuals with confirmed infection who have mild, cold-like symptoms or no apparent symptoms will not be included in the study. In accordance with standard clinical research protocols, eligible patients will provide informed consent to participate in the trial.

All potential participants will undergo a baseline physical exam before receiving treatment. Eligible study participants will then be randomly assigned either to the investigational treatment group or the placebo group. The study is double-blind, meaning trial investigators and participants would not know who is receiving remdesivir or placebo. Participants in the investigational treatment group will receive 200 milligrams (mg) of remdesivir intravenously on the first day of enrollment to the study. They will receive another 100 mg each day for the duration of hospitalization, for up to 10 days total. The placebo group will receive, at an equal volume, a solution that resembles remdesivir but contains only inactive ingredients.

Clinicians will regularly monitor participants and will assign them daily scores based on a predefined scale of clinical outcomes that considers factors such as temperature, blood pressure and use of supplemental oxygen, among others. Participants also will be asked to provide blood samples and nose and throat swabs approximately every two days. Researchers will test these specimens for SARS-CoV-2.

Initially, investigators will compare participant outcomes on day 15 in both the remdesivir group and the placebo group to see if the investigational drug increased clinical benefit compared to placebo. Outcomes are scored on a seven-point scale ranging from fully recovered to death. Investigators will reevaluate this scale after reviewing data from the first 100 participants.

An independent data and safety monitoring board (DSMB) will monitor ongoing results to ensure patient well-being and safety as well as study integrity. The DSMB will recommend the study be halted if there is clear and substantial evidence of a treatment difference between drug and placebo.

Andre Kalil, M.D., professor of internal medicine at UNMC and an infectious diseases physician at Nebraska Medicine, is leading the trial at UNMC. Thirteen people repatriated by the U.S. State Department from the Diamond Princess cruise ship were transported to the National Quarantine Unit, located within the Training, Simulation and Quarantine Center on the UNMC/Nebraska Medicine campus in Omaha on February 17, 2020. The passengers were in a close setting where there had been significant spread of COVID-19 and were sent to the unit for continued isolation and possibly further care. The CDC has since reported that 11 people in the UNMC unit have confirmed SARS-CoV-2 infection.

UNMC’s National Quarantine Unit is supported by the office of the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services. It has a 20-bed capacity and is in close proximity to the Nebraska Biocontainment Unit, should a higher level of care be needed. Clinical trial participants are cared for in the biocontainment unit….”


A hotel in Tenerife in Spain’s Canary Islands has been locked down after a visiting Italian doctor tested positive for coronavirus.

BBC: https://www.bbc.com/news/world-europe-51627597

“…..Hundreds of guests at the H10 Costa Adeje Palace Hotel were initially told to stay in their rooms as medical tests were carried out, Spanish media report.

The doctor is reportedly from the Lombardy region, where Italian authorities are battling an outbreak……”

Dust Storm Over Canary Islands

NASA


Italy is struggling to understand how it went from six coronavirus cases to more than 200 since last Friday

BBC: https://www.bbc.com/news/world-europe-51628084

“…So far, seven people have died.

“Patient zero” – the individual first infected – has still not been identified….”


Most of South Korea’s 833 cases, as of today, are in Daegu. And most are connected to an obscure religious group called the Shincheonji Church of Jesus.

NPR

“……Case numbers doubled for several days in a row last week. The virus spread to every major city and province in the country. As a result, the government on Sunday raised the country’s virus alert level to red, its highest, for the first time since 2009. This gave authorities the power to shut down schools and restrict flights in and out of the country. It also advised all citizens showing symptoms of respiratory ailments or fever to stay away from work and school and self-quarantine……”


The Center for Health Security & COVID-19

February 17, 2020

 

EPI UPDATES China’s National Health Commission reports 2,048 new confirmed cases, 1,563 suspected cases, and 105 deaths (including 100 in Hubei province). There have been 70,548 confirmed cases, and 1,770 deaths across 31 provincial regions in mainland China. A total of 150, 539 individuals are now under medical observation.

 

WHO reports a total of 683 confirmed cases outside of China across 25 countries and 3 deaths.

France has reported its first death in an 80-year Chinese tourist, becoming the first fatality in Europe from COVID-19.

Japan reports that 454 individuals have tested positive on the Diamond Princess cruise ship, including 189 asymptomatic cases. Japan also reported an additional 38 cases in the country.

Singapore has also confirmed a total of 77 cases, with 103 cases pending test results. Among the new cases reported in the country today, one came from Wuhan and one was linked to a previous case.

 

 

 

US STATEMENT ON REPATRIATION OF DIAMOND PRINCESS PASSENGERS The US State Department undertook voluntary repatriation of over 300 US citizens and immediate family members from the Diamond Princess cruise ship. During the evacuation, US officials were notified that 14 passengers had tested positive for the virus. These individuals, who were asymptomatic, were isolated on the aircraft. The flight will land at Travis Air Force Base or Joint Base San Antonio and individuals will remain under quarantine for 14 days.

 

 

COMPLEX SUPPLY CHAINS Supply chain disruptions and access to critical commodities such as personal protective equipment continues to be a primary concern during the ongoing COVID-19 outbreak. The challenge rests not only in the manufacturing of final product goods, but in the access to raw materials needed for manufacturing. For the United States, even if a commodity is manufactured domestically, it is likely that at least some component comes from a foreign supplier. So while economic projections may be estimating the impact epidemic in one way, understanding of supply chain complexities suggests that the indirect impacts may be far greater. Currently Chinese manufacturers of masks are operating at 76% capacity, producing approximately 15.2 million masks daily. However, projections of mask demand are estimated to be 50-60 million resulting in global runs on face masks and the implementation of rationing procedures by the Chinese government.

 

 

WHO RESPONSE TEAM ON THE GROUND IN CHINA The multidisciplinary international team of experts responding on behalf of the World Health Organization arrived in China and is beginning meetings with Chinese officials to discuss response strategies. The team is currently in Beijing and scheduled to visit Guangdong and Sichuan. The question remains on whether the team will visit Hubei province, the epicenter of the epidemic. Without visiting the epicenter of the outbreak it is unclear how well the team will be able to fully understand the current situation on the ground.

 

 

EMERGING CRITICISM OF RESPONSE IN CHINA Some news media have been critical of China’s home quarantine policy in Wuhan, citing the deaths of four family members while self-quarantining in their home.


Is there a risk for transportation of COVID-19 from Wuhan to other cities in China?

Du Z, Wang L, Chauchemez S, Xu X, Wang X, Cowling BJ, et al. Risk for transportation of 2019 novel coronavirus disease from Wuhan to other cities in China. Emerg Infect Dis. 2020 May [date cited]. https://doi.org/10.3201/eid2605.200146

DOI: 10.3201/eid2605.200146

Abstract:  “On January 23, 2020, China quarantined Wuhan to contain 2019 novel coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89–190) cities and >99% in the 4 largest metropolitan areas.

Risks for transportation of 2019 novel coronavirus disease (COVID-19) from Wuhan, China, before a quarantine was imposed on January 23, 2020. A) Daily travel volume to and from Wuhan, given as a percentage of the Wuhan population. Gray shading indicates the start of Spring Festival season on January 10, 2020, a peak travel period in China. B) Estimated and reported daily prevalence of COVID-19 in Wuhan. The green line and shading indicate model estimates of cumulative cases since December 1, 201

Risks for transportation of 2019 novel coronavirus disease (COVID-19) from Wuhan, China, before a quarantine was imposed on January 23, 2020. A) Daily travel volume to and from Wuhan, given as a percentage of the Wuhan population. Gray shading indicates the start of Spring Festival season on January 10, 2020, a peak travel period in China. B) Estimated and reported daily prevalence of COVID-19 in Wuhan. The green line and shading indicate model estimates of cumulative cases since December 1, 2019, with 95% credible interval bounds, assuming an epidemic doubling time of 7.31 days (95% credible interval 6.26–9.66 days). Black dots indicate cumulative confirmed case counts during January 1–22, 2020 (10). Gray shading at right indicates the start of Spring Festival season. C) Probability that >1 COVID-19 case infected in Wuhan traveled to cities in China by January 22, 2020. The 131 cities with a risk threshold >50% are indicated in shades of orange; 239 cities below that threshold are indicated in shades of blue. Map generated by using Mapbox (https://www.mapbox.com).

 


China: Feb 13’s briefing on novel coronavirus cases in China

 

Feb 13: Daily briefing on novel coronavirus cases in China

Updated: 2020-02-13

|

en.nhc.gov.cn

On Feb 12, 31 provincial-level regions on the Chinese mainland as well as the Xinjiang Production and Construction Corps reported 15,152 new cases of confirmed infections (including 13,332 clinical cases in Hubei province), 2,807 new cases of suspected infections and 254 deaths (242 in Hubei province, 2 in Henan province, 1 in Tianjin, 1 in Hebei province, 1 in Liaoning province, 1 in Heilongjiang province, 1 in Anhui province, 1 in Shandong province, 1 in Guangdong province, 1 in Guangxi Zhuang autonomous region, 1 in Hainan province and 1 in the Xinjiang Production and Construction Corps). Serious cases decreased by 174. 1,171 patients were released from hospitals after being cured. 29,429 people who had had close contact with infected patients were freed from medical observation.

As of 24:00 on Feb 12, the National Health Commission had received 59,804 reports of confirmed cases and 1,367 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 5,911 patients had been cured and discharged from hospital. There still remained 52,526 confirmed cases (including 8,030 in serious condition) and 13,435 suspected cases. So far, 471,531 people have been identified as having had close contact with infected patients. 181,386 are now under medical observation.

On Feb 12, Hubei province reported 14,840 new cases of confirmed infections (including 13,436 in Wuhan), 1,377 new cases of suspected infections (including 620 in Wuhan), and 242 deaths (including 216 in Wuhan). 802 patients were released from hospitals after being cured, including 538 in Wuhan.

As of 24:00 on Feb 12, Hubei province had reported 48,206 cases of confirmed infections (including 32,994 in Wuhan) and 1,310 deaths (including 1,036 in Wuhan). In all, 3,441 patients had been cured and discharged from hospital, including 1,915 in Wuhan. There still remained 43,455 confirmed cases (including 30,043 in Wuhan), with 7,084 in serious condition (including 5,426 in Wuhan), and 9,028 suspected cases (including 4,904 in Wuhan).

In order to promote the early diagnosis and treatment of patients infected with novel coronavirus and ensure all the patients in Hubei can be received and treated, the diagnosis criteria have been differentiated between Hubei and other provincial regions. Clinically diagnosed criteria have been established in Hubei. Suspected cases with pneumonia images are diagnosed as clinical cases, so that they can receive standard treatment as soon as possible in accordance with the relevant requirements of confirmed cases, further improving the success rate of treatment. At present, 13,332 clinical cases reported in Hubei have been included in the confirmed case statistics, and all-out efforts have been made to enhance treatment, reduce serious cases and decrease the fatality rate.

As of 24:00 on Feb 12, 78 confirmed infections had been reported in the Hong Kong and Macao special administrative regions and Taiwan province: 50 in Hong Kong (1 had been dead  and 1 had been cured and discharged from hospital), 10 in Macao (2 had been cured and discharged from hospital) and 18 in Taiwan (1 had been cured and discharged from hospital).


World experts and funders set priorities for COVID-19 research

https://www.who.int/news-room/detail/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research

12 February 2020

News release
Geneva, Switzerland

Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

“This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

  • the natural history of the virus, its transmission and diagnosis;
  • animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
  • epidemiological studies;
  • clinical characterization and management of disease caused by the virus;
  • infection prevention and control, including best ways to protect health care workers;
  • research and development for candidate therapeutics and vaccines;
  • ethical considerations for research;
  • and integration of social sciences into the outbreak response.

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need,  in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

Note to editors

GloPID-R is a global alliance of international research funding organizations investing in preparedness and response to epidemics.


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