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Update on Global Pandemic

On March 20, World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus took part in a virtual press conference where he highlighted certain aspects of the pandemic at this time. He highlighted the example of China, where the outbreak of COVID-19 has been halted, pointing out that even the most dire situations can be turned around.

Dr. Tedros pointed out that the WHO has called for testing of all suspected cases, and to that end, the organization is working hard to increase the global supply of diagnostic kits, as well as personal protective equipment (PPE). In his March 19 briefing, he reported that the WHO has shipped PPE to nearly 70 countries, while 120 nations have received 1.5 million diagnostic kits. "Our aim is to build a continuous pipeline to ensure continuity of supply," he said. The WHO is finalizing export arrangements with producers in China so that more supplies can be sent to countries.

Tedros also warned younger people against complacency. "Data from many countries clearly show that people under 50 make up a significant proportion of patients requiring hospitalization," said Tedros. He stressed that solidarity between countries as well as between age groups is the key to defeating COVID-19.

Number of Cases Worldwide

As of March 20, 6:00 pm GMT, the worldwide statistics for COVID-19 pandemic as reported by Worldometer are:

Total Reported Cases: 266,208
- 164,418 active cases
- 101,790 closed cases

Deaths: 11,187

Recovered: 90,603

New cases from March 19 to 20: 21,314

The disease is now present in 160 countries.

This compares to figures from a week earlier on March 13 of 145,634 reported cases (67,669 active; 77,965 closed); 5,436 deaths; 70,931 recovered; 11,058 new cases over the previous day; in 138 countries.

The five countries with the highest number of cases on March 20 were:

China: 80,967 (compared to 80,815 on March 13); 56 cases per one million
Italy: 47,021 (compared to 17,660 on March 13); 778 cases per one million
Spain: 20,412 (compared to 5,232 on March 13); 437 cases per one million
Iran: 19,644 (compared to 11,364 on March 13); 234 cases per one million
Germany: 18,784

Compared to a week earlier, these figures show that Europe remains the epicentre of the pandemic and that the situation there has rapidly worsened in the past week. Of the top 20 countries with the highest number of reported cases, 14 of these are in Europe, four in Asia and two in North America. South Korea, which on March 13 had 7,979 reported cases for the fourth highest total, on March 20 had 8,652 cases.

Cases in Selected Countries by Region

In Europe on March 20, the five countries with the highest number of reported cases were:

Italy: 47,021 (37,860 active; 5,129 recovered; 4,032 deaths)
Spain: 20,412 (17,781 active; 1,588 recovered; 1,043 deaths)
Germany: 18,794 (18,561 active; 180 recovered; 53 deaths)
France: 10,995 (9,328 active; 1,295 recovered; 372 deaths)
Switzerland: 5,369 (5,298 active; 15 recovered; 56 deaths)

Amongst all affected countries, Italy now has the highest number of deaths, surpassing China on March 19. Its rate of infection in the past week is reported to be higher than that of China's at its peak. Overall in Europe in the past week, the rate of new infections was more than 10,000 per day.

France, Belgium, Italy and Spain have instituted "lockdown" measures to restrict people to their homes except for going out to buy food or medicine, going to work, hospitals or banks, or excursions for caregivers for the young or elderly. These include bans on gatherings. As for March 17, France has issued 4,000 fines for violating the restrictions. The EU has closed its borders to travellers from outside the EU. About 250 million people in the EU are presently under social-distancing and other restrictions due to the pandemic.

In Eurasia:

Turkey: 359 (355 active; 4 deaths)
Russia: 253 (240 active; 12 recovered; 1 death)
Armenia: 136
Kazakhstan: 52
Azerbajian: 44 (36 active; 7 recovered; 1 death)

Turkish newspaper the Daily Sabahreported on March 20 that "Turkey is almost in a state of self-quarantine with streets emptied over virus fears as the country announces both new cases and new precautionary measures." The report adds that while "No comprehensive lockdown is in place [...] escalating measures coupled with public compliance of health advisories" have left streets empty. On March 20, the Turkish presidency issued a decree, postponing all science, culture and art events until the end of April. Earlier in the week, President Recep Tayyip Erdo urged citizens to stay home for at least three weeks.

In West Asia:

Iran: 19,644 (11,466 active; 6,745 recovered; 1,433 deaths)
Israel: 705 (690 active; 15 recovered)
Qatar: 460 (450 active; 10 recovered)
Saudi Arabia: 344 (336 active; 8 recovered)
Bahrain: 291 (178 active; 112 recovered; 1 death)

The unjust U.S. sanctions against it are the "main obstacle" to the country's effective fight against the coronavirus pandemic, Iran's Foreign Minister Mohammad Javad Zarif said in a March 20 phone call with his Japanese counterpart Toshimitsu Moteg. The bans are obstructing Iran's access to medicine and medical equipment, he added. He requested the Japanese government increase its efforts to help remove the unilateral and illegal U.S. sanctions against Iran and thanked Japan for its assistance to fight the pandemic. The Japanese Foreign Minister highlighted the two nations' friendly ties, and said that his country plans to send to Iran the drug Avigan, which has been used in Japan to treat new strains of influenza and appears to be effective in coronavirus patients.

Minister Zarif has also written a letter to UN Secretary-General Antonio Guterres calling for the removal of the U.S. sanctions.

Iran's deputy health minister Alireza Raisi said on March 20 that of Iran's 31 provinces, provinces of Tehran, Isfahan, and Gilan have registered the highest number of cases of infection while 13 provinces have seen a big drop.

In South Asia:

Pakistan: 500 (484 active; 13 recovered; 3 deaths)
India: 249 (221 active; 23 recovered; 5 deaths)
Sri Lanka: 73 (70 active; 3 recovered)
Afghanistan: 24 (23 active; 1 recovered)
Bangladesh: 20 (16 active; 3 recovered; 1 death)

The newspaper Pakistan Today reported on March 20, "The government of Pakistan has [...] decided to close its border with Iran for two weeks, and the government will again review the situation after those two weeks. During this time, system of screening against COVID-19 will be made stronger. The Ministry of Education also decided to close all schools till April 14 due to the COVID-19 threat.

"The government has not yet decided to declare emergency, because the deceleration of emergency in Pakistan due to lethal threat of COVID-19 will result in creating more panic among the masses. This decision of not imposing an emergency is a good and necessary step of the government. The government has also decided to run a media campaign on the issue of COVID-19, to create awareness among the masses regarding prevention of this deadly disease. The [Special Assistant to the Prime Minister] on health also said that the government would also request the Chief Justice of Pakistan to close the civil courts and adjourn cases for at least three weeks."

Regarding the very low number of cases for India despite its population of 1.3 billion people, Ramanan Laxminarayan, Director of the Center for Disease Dynamics in Washington, DC, and a lecturer in Economics and Policy at Princeton University, in a recent interview with The Wire, said that India could be the next coronavirus hotspot. The Wire writes:

"Using the United States estimates for itself that 20-60 per cent of the population could be infected, Dr Laxminarayan said that means in the worst case scenario, 60 per cent of the Indian population could be infected -- which is some 700 or 800 million people. However, Dr Laxminarayan added that the vast majority would only be mildly affected. A very small percentage would become seriously ill and an even smaller percentage would, sadly, lose their lives.

"[...] Dr Laxminarayan said that he found it hard to believe the Union health ministry's official figure which, on their website at 12 pm on Wednesday [March 17], said that India had 130 people with the coronavirus infection in addition to the 14 who have recovered and the three who have died.

"He says if the United Kingdom can accept that they have underestimated the number infected by a factor of 12, at the very least the situation would be the same in India. That means there are over 1,500 undetected cases. In fact, given our size and population density Dr Laxminarayan estimates that India is bound to have 10,000 or more undetected coronavirus cases.

"Dr Laxminarayan also told The Wire that he disagrees with the Indian Council of Medical Research's [ICMR] official stand that India is still in stage 2 of the epidemic [local transmission] and has not entered stage 3 [community transmission]. Dr Laxminarayan said India probably entered stage 3 two or three weeks ago. He said he was saying this on the basis of the experience of the rest of the world and on the best scientific modelling projections. He also said that if you look at the steps that the government has taken -- shutting schools, colleges, theatres and cinemas -- this clearly suggests the government knows we are in stage 3 even if, for arguably good reasons, it does not want to publicly admit it.

"Dr Laxminarayan told The Wire that India needs to sharply ramp up its testing. He said we should be testing 10,000 people a day. Instead, according to the ICMR, as of 5 pm on March 17 India has only tested a total of 11,500 people.

"While Dr Laxminarayan agreed with the ICMR policy not to test asymptomatic people who have either come from coronavirus-affected countries or been in touch with coronavirus-infected people, he felt it was essential to test those who have symptoms such as coughs, cold, fever or respiratory distress even though they have no travel history or have not come in contact with an infected person. This second category must be tested otherwise we will not know what percentage of people with such symptoms are coronavirus-related as opposed to sufferers of ordinary seasonal colds, coughs and flu.

"Asked by The Wire for his assessment of the Indian government's handling of the coronavirus crisis, Dr Laxminarayan said that whilst it had acted promptly to check entry into the country and while sensible steps like shutting schools, colleges, theatres and cinemas had been taken, he was critical of the level of testing which he felt was woefully inadequate for a country with a 1.3 billion population.

"Dr Laxminarayan told The Wire that on the assumption somewhere between four and eight million people could need ICU treatment, India needs to urgently import ICU equipment, ventilators and a range of medicines. He said this has been right at the top of the advice he has given the government."

In Southeast Asia:

Malaysia: 1,030 (940 active; 87 recovered; 3 deaths)
Singapore: 385 (254 active; 131 recovered)
Indonesia: 369 (320 active; 17 recovered; 32 deaths)
Thailand: 322 (279 active; 42 recovered; 1 death)
Philippines: 230 (204 active; 8 recovered; 18 deaths)

The Jakarta Post on March 19 reported that "The World Health Organization on March 16 called on countries in the Southeast Asia region to urgently scale up aggressive measures to combat COVID-19, as the number of cases continues to rise globally. The virus, which was first detected in China, spread rapidly to 152 countries and territories, infecting nearly 175,000 people and killing 7,019.

"'The situation is evolving rapidly. We need to immediately scale up all efforts to prevent the virus from infecting more people,' said Poonam Khetrapal Singh, director of the WHO South-East Asia Regional Office (SEARO).

"'Urgent and aggressive measures are the need of the hour. We need to act now,' the WHO official said in a statement.

"Eight of the 11 countries grouped under WHO-SEARO have confirmed cases of COVID-19, and numbers are increasing quickly Khetrapal Singh said.


"Malaysia became the first country [in the region] to announce a two-week lockdown of the country, days after the Philippines moved to shutter its capital Manila and later the entire island of Luzon. Laos has sealed its borders with China and Myanmar, while people in Brunei, Singapore and Thailand have been ordered to restrict their movements."

In East Asia:

China: 80,967 (6,569 active; 71,150 recovered; 3,248 deaths)
South Korea: 8,652 (6,325 active; 2,233 recovered; 94 deaths)
Japan: 963 (715 active; 215 recovered; 33 deaths)
Taiwan: 135 (105 active; 28 recovered; 2 deaths)

On March 19, China reported that there were no new locally transmitted cases or suspected cases in Wuhan for the first time since the outbreak began, a result that was repeated on March 20. Michael Ryan, Executive Director of the WHO Health Emergencies Program, stated at a March 20 press conference that the results in China show that the coronavirus can be suppressed and its transmission chains broken through a massive all-sided societal effort, with coordination, solidarity, commitment and workable supply chains, as well as engagement of activated communities and brave health workers. "That is a message of hope to many other countries around the world who have very low number of cases right now," said Ryan.

In south Korea, one of the main measures taken against the pandemic has been widespread testing. The Hankyoreh reported on March 19: "As of March 17, South Korea has tested over 270,000 people for the novel coronavirus throughout the past two months. The number is noticeably higher than the 138,000 tests performed as of March 16 in Italy, which has experienced a steep rise in diagnoses. The cumulative number of patients who had tested positive as of the same day stood at 8,320 for South Korea and over 28,000 for Italy. Indeed, while other countries have been scrambling to restrict arrivals from abroad, south Korean disease prevention officials have focused more on swift testing for those with apparent symptoms and populations with a high risk of cluster infections. Kwon Gye-cheol, chairperson of the Korean Society for Laboratory Medicine (KSLM), explained, 'Once the virus has spread to a certain extent, it is not easy to stop infections simply by blocking overseas arrivals.'"

In North America:

USA: 16,517 (16,167 active; 125 recovered; 225 deaths)
Canada: 924 (901 active; 11 recovered; 12 deaths)
Mexico: 164 (159 active; 4 recovered; 1 death)

New measures announced in the region this week include agreements reached to block non-essential travel (e.g., for tourism or recreation) across the Mexico-U.S. border and the Canada-U.S. borders. Acting U.S. Homeland Security Secretary Chad Wolf told reporters at the White House on March 20, "We want to make sure that cargo continues, trade continues, heath care workers continue to be able to traverse that border. But tourism, some recreational activities and other things needs to stop during this crisis." As part of the new measures, the countries agreed to immediately turn back anyone attempting to “illegally” cross the borders. Irregular border crossings from the U.S. by those seeking asylum in Canada have increased due to attacks on undocumented migrants and others since the Trump administration took office.

In Central America and the Caribbean:

Panama: 137 (135 active; 1 recovered; 1 death)
Costa Rica: 89 (87 active; 2 deaths)
Dominican Republic: 72 (70 active; 2 deaths)
Cuba: 16 (15 active; 1 death)
Jamaica: 16 (13 active; 2 recovered; 1 death)

In South America:

Brazil: 654 (645 active; 2 recovered; 7 deaths)
Chile: 434 (428 active; 6 recovered)
Ecuador: 367 (359 active; 3 recovered; 5 deaths)
Peru: 234 (229 active; 4 deaths)
Colombia: 145 (144 active; 1 recovered)

In Africa:

Egypt: 256 (207 active; 42 recovered; 7 deaths)
South Africa: 202 active
Algeria: 90 (47 active; 32 recovered; 11 deaths)
Morocco: 74 (69 active; 2 recovered; 3 deaths)
Senegal: 38 (36 active; 2 recovered)

African countries have been relatively unaffected at this point in the pandemic. However, the WHO and others point out that the potential for the situation to rapidly degenerate is a real possibility. "We have seen how the virus actually accelerates after a certain [...] tipping point. So the best advice for Africa is to prepare for the worst and prepare today," said Dr. Tedros on March 17.

"We have different and significant barriers to health care in Africa, which could be a real challenge," said Dr. Ngozi Erondu, a senior research fellow at the Chatham House Centre for Global Health Security. Many countries in sub-Saharan Africa do not have the isolation wards or large number of health care workers to respond to a surge of COVID-19 patients, she said.

Dr. Bernard Olayo, founder of the Kenya-based Centre for Public Health and Development, said most countries in Africa cannot afford ventilators. Even if ventilators were provided by other countries, it's not sufficient because of the lack of qualified people to use them. "It's complex, it's very very complex because the patients that end up on ventilators require round the clock care by larger teams," he said.

Many patients could do well with just oxygen, he said, but close to half of health facilities in African countries do not have reliable oxygen supplies. Oxygen concentrators can be used, but given the frequent electricity cuts in many countries, oxygen generators and pressure cylinders are needed because they can function while power is out.

The WHO regional Africa director, Dr. Matshidiso Moeti, said the lack of ICU facilities and ventilators is one of the biggest challenges facing the continent. "We have been able to identify importing a field hospital-type of facility that can be set up and equipped with some of the key items needed, such as ventilators," she said. Training has begun in Republic of Congo and Senegal so health care workers will be ready to operate it, and World Bank funding is being made available, she said.

Elsie Kanza, head of Africa at the World Economic Forum, said many countries are deploying lessons learned from the Ebola outbreak in West Africa in 2014-2016 that killed over 10,000 people. The Africa Centers for Disease Control and Prevention was created to respond to that Ebola outbreak. As of March 18, 43 African countries can test for the coronavirus, the organization said.

In Oceania:

Australia: 876 (823 active; 7 deaths)
New Zealand: 39 active
Guam: 14 active
French Polynesia: 11 active

This article was published in

Volume 50 Number 9 - March 21, 2020

Article Link:
: Update on Global Pandemic


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