Global & Disaster Medicine

The World Health Organization has declared COVID-19 a global pandemic

https://www.cnbc.com/2020/03/11/who-declares-the-coronavirus-outbreak-a-global-pandemic.html

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020

11 March 2020

Good afternoon.

In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled.

There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives.

Thousands more are fighting for their lives in hospitals.

In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher.

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.

We have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus.

And we have never before seen a pandemic that can be controlled, at the same time.

WHO has been in full response mode since we were notified of the first cases.

And we have called every day for countries to take urgent and aggressive action.

We have rung the alarm bell loud and clear.

===

As I said on Monday, just looking at the number of cases and the number of countries affected does not tell the full story.

Of the 118,000 cases reported globally in 114 countries, more than 90 percent of cases are in just four countries, and two of those – China and the Republic of Korea – have significantly declining epidemics.

81 countries have not reported any cases, and 57 countries have reported 10 cases or less.

We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic.

If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.

Even those countries with community transmission or large clusters can turn the tide on this virus.

Several countries have demonstrated that this virus can be suppressed and controlled.

The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same – it’s whether they will.

Some countries are struggling with a lack of capacity.

Some countries are struggling with a lack of resources.

Some countries are struggling with a lack of resolve.

We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.

We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.

WHO’s mandate is public health. But we’re working with many partners across all sectors to mitigate the social and economic consequences of this pandemic.

This is not just a public health crisis, it is a crisis that will touch every sector – so every sector and every individual must be involved in the fight.

I have said from the beginning that countries must take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimize impact.

Let me summarize it in four key areas.

First, prepare and be ready.

Second, detect, protect and treat.

Third, reduce transmission.

Fourth, innovate and learn.

I remind all countries that we are calling on you to activate and scale up your emergency response mechanisms;

Communicate with your people about the risks and how they can protect themselves – this is everybody’s business;

Find, isolate, test and treat every case and trace every contact;

Ready your hospitals;

Protect and train your health workers.

And let’s all look out for each other, because we need each other.

===

There’s been so much attention on one word.

Let me give you some other words that matter much more, and that are much more actionable.

Prevention.

Preparedness.

Public health.

Political leadership.

And most of all, people.

We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.

I thank you.


How Coronavirus Hijacks Your Cells

https://www.nytimes.com/interactive/2020/03/11/science/how-coronavirus-hijacks-your-cells.html?action=click&module=RelatedLinks&pgtype=Article

 

 


The latest from the NY Times: Here’s what you need to know about COVID-19

Here’s what you need to know :


Coronavirus: A pandemic or not?

https://www.vox.com/future-perfect/2020/3/9/21163412/who-coronavirus-covid19-pandemic-world-health-organization

“………….The WHO says that since there’s still uncertainty about the disease’s impact, most countries still have only a few cases, and containment is not yet hopeless, the word “pandemic” isn’t appropriate yet. But many observers have disagreed with the WHO’s decision……… The World Health Organization defines an epidemic as “the occurrence in a community or region of cases of an illness … clearly in excess of normal expectancy.” The CDC defines it as “an increase, often sudden, in the number of cases of a disease above what is normally expected” in a region.……

According to A Dictionary of Epidemiology, the standard reference for epidemiologists, a pandemic is “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.”

A “pandemic” disease sounds much scarier than a mere “outbreak.” But it’s important to remember that “pandemic” refers to how many parts of the world are dealing with an elevated rate of the disease — and, in theory, says nothing about how serious the disease is………”


COVID-19 Resources

MAPS AND STATISTICS
US DHHS CDC Global COVID-19 Map
US DHHS CDC US Outbreak Statistics
COVID-19 Outbreak Tracker.  Johns Hopkins
COVID-19 Outbreak Tracker.  Kaiser Family Foundation
US Dpt of State Travel Advisories
DEFINITIONS, BACKGROUND, PLANS
US DHHS Public Health Emergency Declaration
Flu Types, definitions, and naming conventions.   US DHHS CDC
Definitions and Risk Assessments,  US DHHS CDC  (Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposure in Travel-associated or Community Settings)
National Pandemic Strategy Page,   US DHHS CDC
Pandemic Intervals Framework,  US DHHS CDC
Pandemic Phases,  World Health Organization (2009 H1N1)
INTERNATIONAL SITES
World Health Organization  (WHO)
EU European Centre for Disease Prevention and Control.  COVID-19 site
UK Government COVID-19 Publications
Canada Government COVID-19 Info Page
Mexico Government Dpt of Health COVID-19 Page
Australian Government.  Dpt of Health COVID-19 Resource page
US GOVERNMENT SITES
US DHHS Office of the Assistant Secretary for Preparedness and Response (ASPR) COVID-19 page (PHE.GOV)
US DHHS ASPR TRACIE.
US DHHS National Institutes of Health (NIH)
US DHHS NIH National Library of Medicine (NLM)
US DHHS CDC
   US DHHS CDC Travel Health Notices
   US DHHS CDC Weekly COVID-19 newsletter updates
US DHHS CDC NIOSH
   Respirator Information
US DHHS Centers for Medicare and Medicaid Services (CMS)
US DHHS Food and Drug Administration.
     COVID-19 Emergency Use Authorizations  (FDA)
US Dpt of Labor OSHA
US Dpt of State.  Overseas Security Advisory Council.
US Dpt of Transportation FAA.  Interim Aircrew Guidance for COVID-19
USA GOV International Traveler Issues for Americans
US National Governors Association.  COVID-19 Site
PROFESSIONAL, ORGANIZATIONAL, PRIVATE AND ACADEMIC SITES
American College of Emergency Physicians.  COVID-19 Resource page
American College Health Association
Health Industry Distributors Association
International Air Transport Association.  Air Transport and Communicable Diseases Page
National Ebola Training and Education Center.  (Search under COVID-19 Resources)
Network for Public Health Law.  Coronavirus Primer.  Authorities, etc…
University of Minnesota.  Center for Infectious Disease Research and Policy.  COVID-19 page.
Massachusetts General Hospital.  2019 Novel Coronavirus Toolkit
Region I (New England) Government Information Sites:
Boston Public Health Commission
Connecticut DPH
Massachusetts DPH
Maine CDC
New Hampshire DHHS
Rhode Island DOH
Vermont DOH

Coronavirus has been swift and ferocious in Italy. In less than 20 days, the number of confirmed cases has skyrocketed to more than 9,000 while the number of deaths has surpassed 450

https://www.cnbc.com/2020/03/09/italy-extends-its-quarantine-to-the-entire-country-pm-asks-residents-to-stay-at-home.html

“…….People throughout the country of 60 million should not travel other than for work or emergencies, Conte said. He added that all public gatherings will be banned and sporting events suspended. The decision was made to protect the most vulnerable people in the country, he said, and the measures will take effect Tuesday and last until April 3….”


China recorded just 19 new cases of COVID-19 on Tuesday

https://www.usatoday.com/story/news/world/2020/03/10/coronavirus-italy-china-global/5008438002/

“………While more than 3,000 people in China have died from the disease since it emerged in Wuhan in December, almost three-fourths of China’s more than 80,000 patients have recovered. Meanwhile, 14 makeshift hospitals constructed in Wuhan to care for the sick have been closed and public places closed for weeks amid the outbreak will reopen once they have been disinfected. …..”


A preliminary 5.8 magnitude earthquake struck off the coast of northern California Sunday night

DYFI intensity map


COVID-19: Environmental Cleaning and Disinfection Recommendations

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

Interim Recommendations for US Community Facilities with Suspected/Confirmed Coronavirus Disease 2019

 

Background

There is much to learn about the novel coronavirus that causes coronavirus disease 2019 (COVID-19). Based on what is currently known about the virus, spread from person-to-person happens most frequently among close contacts (within about 6 feet). This type of transmission occurs via respiratory droplets. Transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Transmission of coronavirus in general occurs much more commonly through respiratory droplets than through fomites. Current evidence suggests that novel coronavirus may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in community settings.

Purpose

This guidance provides recommendations on the cleaning and disinfection of rooms or areas of those with suspected or with confirmed COVID-19 have visited. It is aimed at limiting the survival of novel coronavirus in key environments. These recommendations will be updated if additional information becomes available.

These guidelines are focused on community, non-healthcare facilities (e.g., schools, institutions of higher education, offices, daycare centers, businesses, community centers) that do and do not house persons overnight. These guidelines are not meant  for cleaning staff in healthcare facilities or repatriation sites, households, or for others for whom specific guidance already exists.

Definitions
  • Community facilities (e.g., schools, daycares centers, businesses) comprise most non-healthcare settings that are visited by the general public outside of a household.
  • Cleaning refers to the removal of dirt and impurities, including germs, from surfaces. Cleaning alone does not kill germs. But by removing the germs, it decreases their number and therefore any risk of spreading infection.
  • Disinfecting works by using chemicals to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs. But killing germs remaining on a surface after cleaning further reduces any risk of spreading infection.

Cleaning and Disinfection After Persons Suspected/Confirmed to Have COVID-19 Have Been in the Facility

Timing and location of cleaning and disinfection of surfaces

  • At a school, daycare center, office, or other facility that does not house people overnight:
    • It is recommended to close off areas used by the ill persons and wait as long as practical before beginning cleaning and disinfection to minimize potential for exposure to respiratory droplets. Open outside doors and windows to increase air circulation in the area. If possible, wait up to 24 hours before beginning cleaning and disinfection.
    • Cleaning staff should clean and disinfect all areas (e.g., offices, bathrooms, and common areas) used by the ill persons, focusing especially on frequently touched surfaces.
  • At a facility that does house people overnight:
    • Follow Interim Guidance for US Institutions of Higher Education on working with state and local health officials to isolate ill persons and provide temporary housing as needed.
    • It is recommended to close off areas used by the ill persons and wait as long as practical before beginning cleaning and disinfection to minimize potential for exposure to respiratory droplets. Open outside doors and windows to increase air circulation in the area. If possible, wait up to 24 hours before beginning cleaning and disinfection.
    • In areas where ill persons are being housed in isolation, follow Interim Guidance for Environmental Cleaning and Disinfection for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019. This includes focusing on cleaning and disinfecting common areas where staff/others providing services may come into contact with ill persons, but reducing cleaning and disinfection of bedrooms/bathrooms used by ill persons to as needed.
    • In areas where ill persons have visited or used, continue routine cleaning and disinfection as in this guidance.

How to Clean and Disinfect

Surfaces

  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
    • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
  • Prepare a bleach solution by mixing:
    • 5 tablespoons (1/3rd cup) bleach per gallon of water or
    • 4 teaspoons bleach per quart of water
    • Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
    • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
    • If the items can be laundered, launder items in accordance with the manufacturer’s instructions using the warmest appropriate water setting for the items and then dry items completely.
    • Otherwise, use products with the EPA-approved emerging viral pathogens claims (examples at this linkpdf iconexternal icon) that are suitable for porous surfaces 

Linens, Clothing, and Other Items That Go in the Laundry

  • Do not shake dirty laundry; this minimize the possibility of dispersing virus through the air.
  • Wash items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry that has been in contact with an ill person can be washed with other people’s items.
  • Clean and disinfect hampers or other carts for transporting laundry according to guidance above for hard or soft surfaces.

Personal Protective Equipment (PPE) and Hand Hygiene:
  • Cleaning staff should wear disposable gloves and gowns for all tasks in the cleaning process, including handling trash.
    • Gloves and gowns should be compatible with the disinfectant products being used.
    • Additional PPE might be required based on the cleaning/disinfectant products being used and whether there is a risk of splash.
    • Gloves and gowns should be removed carefully to avoid contamination of the wearer and the surrounding area. Be sure to clean hands after removing gloves.
  • Gloves should be removed after cleaning a room or area occupied by ill persons. Clean hands immediately after gloves are removed.
  • Cleaning staff should immediately report breaches in PPE (e.g., tear in gloves) or any potential exposures to their supervisor.
  • Cleaning staff and others should clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water.
  • Follow normal preventive actions while at work and home, including cleaning hands and avoiding touching eyes, nose, or mouth with unwashed hands.
    • Additional key times to clean hands include:
      • After blowing one’s nose, coughing, or sneezing
      • After using the restroom
      • Before eating or preparing food
      • After contact with animals or pets
      • Before and after providing routine care for another person who needs assistance (e.g., a child)

Additional Considerations for Employers:
  • Employers should work with their local and state health departments to ensure appropriate local protocols and guidelines, such as updated/additional guidance for cleaning and disinfection, are followed, including for identification of new potential cases of COVID-19.
  • Employers should educate staff and workers performing cleaning, laundry, and trash pick-up activities to recognize the symptoms of COVID-19 and provide instructions on what to do if they develop symptoms within 14 days after their last possible exposure to the virus. At a minimum, any staff should immediately notify their supervisor and the local health department if they develop symptoms of COVID-19. The health department will provide guidance on what actions need to be taken.
  • Employers should develop policies for worker protection and provide training to all cleaning staff on site prior to providing cleaning tasks. Training should include when to use PPE, what PPE is necessary, how to properly don (put on), use, and doff (take off) PPE, and how to properly dispose of PPE.
  • Employers must ensure workers are trained on the hazards of the cleaning chemicals used in the workplace in accordance with OSHA’s Hazard Communication standard (29 CFR 1910.1200external icon).
  • Employers must comply with OSHA’s standards on Bloodborne Pathogens (29 CFR 1910.1030external icon), including proper disposal of regulated waste, and PPE (29 CFR 1910.132external icon).
  • 3D illustration of the novel coronavirus

COVID-19: Guidance for Student Foreign Travel for Institutions of Higher Education

https://www.cdc.gov/coronavirus/2019-ncov/community/student-foreign-travel.html

Jet airplane flying above the clouds

This guidance is for Institutes of Higher Education with students participating in foreign exchange or study abroad programs.

Consider postponing or canceling student foreign exchange programs

Given the global outbreak of novel coronavirus (COVID-19) institutes of higher education (IHE) should consider postponing or canceling upcoming student foreign exchange programs. IHE should consider asking current program participants to return to their home country. Those overseeing student foreign exchange programs should be aware that students may face unpredictable circumstances, travel restrictions, challenges in returning home or accessing health care while abroad.

IHEs should consider asking students participating in study abroad programs to return to the United States. IHEs should work with state and local public health officials to determine the best approach for when and how (e.g., chartered transportation for countries or areas assessed as high-risk for exposure) their study abroad students might return. All plans for returning study abroad students should be designed to protect participants from stigma and discrimination.

The COVID-19 situation is dynamic. Given the speed of spread and the number of countries experiencing human-to-human transmission, IHEs should evaluate the risks associated with choosing to maintain programs abroad and take the appropriate proactive measures. IHEs that continue to maintain programs abroad should monitor cdc.gov/COVID-19 for additional information.


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