COVID-19 Global Health Portal
Last updated: 21 June 2020 2:05pm EST Sources:
Confirmed Cases of COVID-19
Testing & Epidemiological Estimates
(1) Worldometer: Based on data from the WHO, CDC, ECDC, NHC, as well as direct reporting from local, provincial, and national health authorities.
(2) UN Office for the Coordination of Humanitarian Affairs (OCHA): Number of confirmed cases and deaths in UNOCHA countries with Humanitarian Response or Regional Refugee Response Plans.
(3) Foundation for Innovative New Diagnostics (FIND): Early and widespread testing strategies have been linked with lower CFR over time, particularly with increasing reports of asymptomatic transmission.
(4) Centre for Evidence Based Medicine (Oxford University): Correlated with transmission dynamics, demography, and control & testing strategies. High initial CFR is expected to trend downward with widespread testing (i.e. recording those dying with as opposed to from the virus).
(5) Liu et al: Review of twelve studies that used stochastic, mathematical, and statistical modelling methods, as R0 can also var by population and transmission dynamics.
(6) Lauer et al: Along with serial interval, important in understanding transmission dynamics, particularly where pre- and asymptomatic transmission occurs.
Last updated: 21 June 2020 2:05pm EST
Update on the State of the Pandemic
Prepared by Dr. James Orbinski (Director, Dahdaleh Institute for Global Health Research) and Aria Ilyad Ahmad (Global Health Foresighting Research Fellow, Dahdaleh Institute for Global Health Research).
Developments in the Global Health and Humanitarian Response to COVID-19 (May 21-28, 2020)
State of the Pandemic
COVID-19: A Magnifying Glass for Inequalities
- According to the latest report by UNDP, global human development is projected to decline for the first time since the UN defined and began measuring the concept in 1990. Unlike other crises over the past three decades, the “triple hit to health, education and income” as a result of COVID-19 has been reported globally. The UNDP warns that developing countries that are less able to cope with the pandemic’s social and economic fallout remain acutely vulnerable. The report urges countries to focus on equity in order to limit these impacts. Closing the digital divide by providing more equitable internet access, for example, is estimated to cost less than 1% of the fiscal support packages but could result in a two-thirds reduction of the impact of school closures that currently leave 60% of children globally without access to education.
WHO COVID-19 Strategic Preparedness and Response Plan
- The WHO published a Strategy Update to the COVID‐19 Strategic Preparedness and Response Plan of the emerging epidemiological situation in order to support countries preparing for a phased transition from widespread transmission to a steady state of low‐level or no transmission. The Strategy Update emphasizes a whole-of-UN approach, and provides practical guidance for whole‐of‐society strategic action that can be adapted to local conditions and capacities. Countries have been asked to identify the lead coordinator of multiagency COVID-19 plans, map existing preparedness and response capacities and gaps, engage key technical and operational partners to identify appropriate coordination mechanisms and mobilize resources and capacities, and to establish monitoring mechanisms and operational reviews to track progress and adjust strategies.
- An accompanying COVID‐19 Monitoring & Evaluation Framework was developed to support countries, listing key public health and health systems indicators for countries to monitor their preparedness and response to the pandemic. The M&E Framework is organized across three dimensions: Geographical Scope (global, all countries, priority countries); Planning and Monitoring Needs (informing strategic planning, operational tracking, evidence‐based decision‐making, as well as advocacy and transparency between donors, UN agencies, and partners); and across 9 Pillars (Country‐level coordination/planning/monitoring, Risk communication/community engagement, Surveillance/rapid response teams, Points of entry/travel/transport, National laboratories, Infection prevention & control, Case management, Operational support & logistics, Maintaining essential health services & systems).
World Economic Forum’s COVID-19 Risks Outlook
- The World Economic Forum, which publishes the annual Global Risks Report, released two new reports that map the global risks, challenges and opportunities that COVID-19 presents. Adopting a complex systems approach, the reports highlight the interdependencies within and across borders but also health, economic, environmental, social, geopolitical systems. At the same time, the emphasis in both documents tilts towards the Great Transformation that will be needed. These include the need to reframe essential public services, notably health but also education, care and social safety nets. The factors that promote and inhibit solidarity and compassion are also raised, alongside needed behavioural shifts towards more sustainable consumption and mobility habits.
Global fiscal support during the COVID pandemic
- The monthly IMF Fiscal Monitor adjusted the estimated fiscal support by countries around the world to US$9 trillion as a result of COVID-19. This was roughly divided between public sector loans (and other equity injections) as well as direct budgetary support. The IMF reports that a second wave of government measures to address the economic impact of the pandemic this past month accounted for the $1 trillion increase in the overall figure.
- The G20 account for most of this sum ($8 trillion), reinforcing global inequities in the distribution of resources and fiscal support capacities. Developing countries, meanwhile, are also anticipating a “hidden debt risk” due to the unprecedented synchronization of fiscal stresses. Including currency depreciation, capital outflows and foreign-currency borrowing.
Dynamic intervention to relax lockdowns and school closures
- A study in the European Journal of Epidemiology modelled dynamic interventions (i.e. cycles of lockdown to reduce R0 to below 1, and intervals of relaxed social distancing) across 16 distinct countries globally. The authors conclude that a ‘rolling schedule’ of 50 days of lockdown followed by 30 days of relaxation could reduce transmission levels and keep ICU demands below national capacities. The model furthermore suggests that adopting such dynamic suppression measures over 18 months could lead to significant reductions of new infections and deaths, particularly in developing countries. Since each model was only run one time per country, one study limitation is testing underlying factors at one fixed value rather than a range of possible outcomes from multiple runs, introducing uncertainty.
- The SAGE group in the U.K. also released a report last week that modelled the impact of eight scenarios of school re-opening on community transmission of COVID-19. Between the two extremes of staying closed and fully opening, the most promising scenario was breaking classes into two cohorts and alternating between ‘two weeks on / two weeks off’ over academic year. The authors acknowledge the uncertainties associated with the model, but nevertheless suggest that the impact of school re-opening is likely to be relatively small compared to maintenance of other social distancing measures in the broader community.
Equity and Protection
A call to arms to protect vulnerable populations from COVID-19
- The WHO and UNHCR signed an agreement to strengthen partnerships and operational capacities that focus on improving access to health services for some 70 million forcibly displaced people around the world from COVID-19.
- The Global Centre for the Responsibility to Protect also issued an appeal to the UN Security Council urging greater protection of civilians in conflict-affected countries. The joint letter, endorsed by dozens of leading global civil society organizations, notes the unprecedented challenges vulnerable and at-risk communities face in a growing number of humanitarian response locations. It also calls on the Security Council to reaffirm and enforce international humanitarian law, calls on practical steps and financial mechanisms, and a whole-of-society and whole-of-UN approach to prevent, respond to and mitigate the impact of COVID-19.
- Physicians for Human Rights have also issued a letter that challenges the public health basis for the U.S. CDC’s announcement of indefinite extension of border shutdowns. The letter argues that this policy is driven by immigration politics rather than public health based on an expert review, which warned that this measure needlessly targets and exposes this vulnerable group based on their immigration status, contrary to U.S. law.
Hidden risks of COVID-19: violence against women and girls
- UN Women published a report based on a rapid assessment to understand the impact of COVID-19 on violence against women and girls and service provision. The synthesis is based on data collection from government and civil society partners in 49 countries, highlighting the increasing prevalence of gender-based violence that often go unreported. UN Women also released an accompanying pocket tool that provides practical guidelines for gender-responsive evaluation management and data collection, structured around the four main evaluation phases: planning, preparation, conduct, and reporting and follow-up. In a separate article, researchers draw attention to the escalating global crisis in access to reproductive health.
- Future Strategy Forum: COVID-19 and Grand Strategy (CSIS)
- Wednesday, June 3 (1-2pm EST)
- Global crises, local action: a humanitarian reset in response to COVID-19 (ODI)
- Wednesday, June 3 (6:30pm EST)
- Humanitarian Operations During COVID-19: A Conversation with UNHCR (CSIS)
- Monday, June 8 (9:30 am EST)
Clinical Public Health
The latest on COVID-19 transmission dynamics: good and bad news
- A study in Physics of Fluids reporting on the mechanisms of coughing and airborne transmission of viruses. While cough droplets in typical environmental conditions will travel less than the widely mandated 2 meters for social distancing, the authors note that changes in air flow and other environmental properties (e.g. wind, temperature, humidity) can cause that figure to rise quite dramatically. For example, even modest winds (i.e. 4 to 15km/h) could result in saliva droplets dispersing and traveling up to 6 meters. Although the study provides guidelines on the mechanical aspects of droplet transmission, experts suggest the computer simulation may not capture the process of dilution, while the relationship to viral transmission also remains unclear.
- A non-peer reviewed pre-print of a study on bioRxiv examining mutations of the novel Coronavirus did not find any variants that had increased transmissibility. While this suggests none of the known mutations are cause for immediate concern, the findings do not rule out the possibility of emerging future variants with different properties. The Director of the Francis Crick Institute has also suggested testing the study conclusions in functional assays of frequently occurring variants in order to examine their proposed mechanisms.
- The U.S. Centers for Disease Control and Prevention issued a new guidance with five COVID-19 planning scenarios to public health authorities based on lower and upper bounds across three parameters: virus transmissibility and disease severity, transmission prior to onset of symptoms, and infections that don’t develop symptoms. One of the scenarios, representing the CDC’s “current best estimate about viral transmission and disease severity in the U.S.” (assuming a R0 of 2.5), approximates 35% of COVID-19 infections may be asymptomatic, and that 0.4% of symptomatic positive cases result in mortality. Epidemiologists, however, question the estimates of symptomatic case fatality rate in the scenarios – from 0.2% (least severe) to 1% (most severe) – which is lower than the reported range in the literature.
Face masks: latest guidance, demand and supply challenges
- Global demand for face masks has far outpaced supply, impacting health care workers but also the public, as governments are increasingly mandating face coverings as a precondition for lifting lockdowns. According to the latest guidance from the WHO and the S. CDC, however, face masks are only recommended for healthy people that are not able to socially distance or if they are taking care of someone with COVID-19.
- Limited access and soaring prices have disproportionately affected vulnerable populations, particularly as more than 50 countries have made mask-wearing in public mandatory. In March, the WHO estimated that 89 million medical masks would be required each month. Although companies around the world have repurposed their manufacturing capacity to develop face masks, quality control has been a significant issue with millions of masks rejected for failing to meet international standards. Many of these masks were made in China, which increased production 12-fold since January, and is projected to account for 85% of all masks globally by the end of the year (compared to just over half in 2019).
- A pre-print study from the University of Edinburgh provided two conclusions when analyzing aerosol dispersion from a variety of different face coverings. First, while medical respirator masks provide protection against inhaling germs, they may not protect others from exhaled germs, which suggests greater caution by the public in maintaining a distance from someone wearing respirator masks. The second relevant conclusion is that even home-made cloth masks and face shields are effective at blocking upwards of 50% of exhaled germs (granted they fit closely all around the face).
Immunity Passports: 10 practical challenges and ethical objections
- As countries eagerly hope to end the lockdowns that have decimated national economies, one idea that has gained traction is the issuance of immunity passports to those that have either tested negative or recovered from COVID-19. In Nature, however, an article this week outlines four practical challenges and six ethical objections to immunity passports:
- Unclear whether recovered patients develop immunity to future exposure to virus.
- Serological testing for antibodies remains unreliable (low specificity and specificity).
- No country has sufficient serological testing capacity (minimum of two per person).
- Only a small fraction of the population would be certified (e.g. less than 0.5% of the U.S. population based on current number of confirmed cases).
- Systems to monitor immunity will erode privacy and increase the risk of forgery.
- Marginalized communities will be disproportionately impacted, including profiling and potential harms to racial, sexual, religious or other minority groups.
- Unfair access due to testing shortages and systemic inequities.
- Create further inequity between immuno-privileged and vulnerable communities.
- Could open the possibility for discrimination on the basis of other health information (e.g. mental health status, genetic tests) by employers, insurers, or law enforcement.
- Can lead to perverse incentives, e.g. if social and economic liberties are only granted to people who recover from COVID-19.
Recruiting Digital First Responders to counter pandemic misinformation
- An alarming new study of more than 200 million Twitter posts since January that mention COVID-19, estimates that 45% were sent by accounts that behave more like bots than humans. Although the researchers from Carnegie Mellon University are not able to conclusively identify the individuals or groups behind the accounts, the bot activity is two- to three-times higher than projections based on prior disasters, crises and elections. The study also identifies at least 100 false narratives about the Coronavirus pandemic that bot accounts have disseminated, including theories about hospitals being filled with mannequins or tweets that link disease transmission to 5G technology. In addition to inciting fear and social disorder (in the U.K., for example, dozens of wireless towers have been destroyed), misinformation on social media poses significant public health risks.
- The twin issues of increasing access to the internet and fighting misinformation have been core priorities of the UN Secretary General, who last week announced the launch of a new ‘Verified’ The program will aim to recruit millions of ‘digital first responders’ around the world to counter misinformation about the COVID-19 pandemic. This network of ‘information volunteers’ would also share a daily fact-based UN feed that either fill an information void or that actively counter false narratives about the pandemic.
- The Smithsonian Science Education Center also released a rapid response guide for young people on the science and social science of the novel Coronavirus based on the UN SDGs. COVID-19: How Can I Protect Myself and Others? was developed in collaboration with the WHO and the InterAcademy Partnership, a global network of over 140 national academies of science, engineering, and medicine. The guide is currently available in 16 languages (particularly African and Asian languages) and for various age groups (ranging from 8 to 17), providing learning activities, tasks as well as tools for young people to keep themselves, their families and communities safe.
Access and R&D
Updates on COVID-19 clinical trials
The pace of research and development for treatments and vaccines for the novel Coronavirus has intensified, with dozens of clinical trials underway around the world. Several papers were published over the weekend with preliminary findings on the two largest studies that were both stopped for different reasons.
- In the New England Journal of Medicine, researchers reported on a randomized double-blind study for remdesivir by the U.S. CDC that was stopped prematurely due to positive preliminary results. For patients hospitalised with COVID-19, the antiretroviral appears to reduce the recovery time (by four days) and mortality (from 12% to 7%), while presenting no additional adverse events. While this is promising, the results appear to be worse for visible minorities (a group that has been disproportionately impacted by the pandemic). Researchers have also been surprised that patients treated sooner after symptom onset may not have markedly better outcomes than those treated later in the course of disease.
- A paper in the Lancet, meanwhile, presents on the WHO Global COVID-19 Solidarity Trail on chloroquine and hydroxychloroquine. Based on the advice of the WHO Executive Group – comprised of experts from ten countries involved in the trial – the observational study was stopped as preliminary findings suggest the possibility of higher mortality rates. The WHO Chief Scientist committed to a comprehensive analysis of all emerging clinical trial data globally to consider benefit and harm, acknowledging that unlike randomized controlled trials, observational studies have been known to yield misleading results. Expertshave also critiqued the failure of the study to adequately adjust for the fact that many of the patients in the trial are more likely to be severely ill and already at increased risk of death.
Ethics of controlled Coronavirus infection
An article in Science this week also expresses concern in the growing trend of researchers pursuing, and thousands of people expressing interest in participating in, controlled human infection (CHI) studies, i.e. deliberately exposing healthy people to COVID-19 to study infection and treatment efficacy. The authors present an ethical framework for CHIs that emphasizes “social value” as fundamental in justifying these studies. The proposed Ethical Framework for SARS-CoV-2 CHI considers six additional criteria, including: Reasonable Risk-Benefit Profile, Context-Specific Stakeholder Engagement, Suitable Site Selection, Fair Participant Selection, Robust Informed Consent, and Proportionate Payment.
Everyone in the (patent) pool
- More than 100 former heads of government and leading scientists have urged all COVID-19 related research and intellectual property to be shared freely, and for the equitable distribution of vaccines. An editorial this week in Nature laments that the growing concern of “techno-protectionism” necessitates such a letter, while highlighting the remarkable speed of advancements as a result of global consortia of researchers (“Work that would normally have taken months, possibly years, is completed in weeks”). The Nature article focuses particularly on the patent pool model that is was popularized by the UNITAID Medicines Patent Pool that was successful in bringing antiretrovirals to market.
- The World Health Assembly Resolution last week made explicit reference to IP rights flexibilities with respect to R&D, manufacturing and distribution of COVID-19 vaccines. Support was not unanimous, however, as some countries (notably the U.S. and the U.K) and research consortia (including the Coalition for Epidemic Preparedness Innovations) expressed their preference for conventional models where vaccine developers retain the IP rights that they may sub-license and their determined price. An article in the Harvard Business Review drew attention to the dangers of this form of ‘vaccine nationalism’, particularly as the underlying research thus far has been pooled and governments around the world have shouldered much of the risk in funding the vaccine effort.
Ten actions to boost local manufacturing in developing countries
- Record demand globally for medical supplies like PPEs, diagnostics and treatments for COVID-19 has disproportionately affected affordability and access in developing countries. While local and regional production has gained more prominence, producers and investors in developing countries often face unique challenges. The UNCTAD highlights at least five: lack of capital, technical and resource capacity; low quality and regulatory standards; weak enabling policy frameworks; small markets and unstable demand; and poor physical infrastructure. In order to increase coordination and cooperation with existing initiatives (e.g. WHO voluntary technology pool and ACT Accelerator Global Response Framework) and partner agencies (e.g. The Global Fund, UNICEF, UNIDO, and UNAIDS), the UCTAD proposes the following ten actions to boost medicine production capacity in developing countries:
- Investment in skills development to ensure GMP-compliant production
- Sharing COVID-19-related technologies to enable affordable mass production
- Target impact investors to access necessary capital
- Build partnerships to initiate “lighthouse” projects on low-hanging fruit
- Improve investment incentives to increase local firms’ sustainability
- Use streamlined regulation to facilitate investment
- Invest in infrastructure
- Emphasize the regional approach to reduce costs
- Seek funding from official development assistance
- Ensure sustainability of efforts despite an unpredictable market
Global Map of COVID-19 Innovations
- StartupBlink in collaboration with Health Innovation Exchange (a UNAIDS initiative) and the Moscow Agency of Innovations launched a Coronavirus Innovation Map this week. The platform aims to connect innovators with venture capital and government officials in order to support the response to COVID-19 and address its impacts across five categories: prevention, diagnosis, treatment, information and life and business adaptation. Over 500 innovations are currently on the visual database, and the Health Innovation Exchange has committed to producing a report on shortlisted innovations to share with country partners.
Local Challenges, Local Solutions: African Innovators and COVID-19
- Among the WHO reforms in 2018 were three key priorities: increasing capacity around digital health, recruiting diverse and younger leaders, and seeking local solutions to local challenges. This past week, the WHO AFRO Regional Office hosted an inaugural virtual event at the intersection of all three: showcasing solutions by young African innovators that have been implemented to address local challenges in responding to the pandemic. From the 350 innovators in attendance, the virtual event highlighted eight projects, including interactive public transport contact tracing apps, mobile testing booths and low-cost critical care beds. The event builds on a ‘Hackathon’ the WHO AFRO Region hosted in April to develop scalable solutions that align with one of the priority areas, providing seed funding to three projects.
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