Epidemiology and Clinical Management of COVID-19 Update - June 2020
The update covers the global situation of COVID-19 with nearly 8.25 million cases and 450,000 deaths reported worldwide. The top ten countries with the highest number of new cases include Chile, Brazil, USA, India, and others. Epidemiological characteristics from China and the USA are discussed, detailing total cases, deaths, and age distributions.
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CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT| EVENTS Epidemiology & clinical management of COVID-19 CORONAVIRUS (COVID-19) UPDATE NO. 31 19 June 2020
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Current global situation Nearly 8.25 million COVID-19 cases globally Nearly 450 000 deaths Top ten countries with the highest number of new cases over the past 24 hours: Top ten countries with the highest number of new cases over the past 24 hours: Chile - 36 179 Brazil 34 918 USA 27 921 India - 12 881 Russian Federation 7 790 Pakistan - 5 358 Saudi Arabia - 4 919 Mexico - 4 599 Peru - 4 164 South Africa - 4 078 Data as of 06h00 18.06.20 Current situation 1/2
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Current global situation Number of new deaths of COVID-19 per day, by WHO Region 6000 5000 4000 New daily deaths 3000 2000 1000 0 AFRO AMRO EMRO EURO SEARO WPRO Current situation 2/2
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Epidemiological characteristics COVID-19 This update covers two recently published reports on the epidemiological characteristics of COVID-19: One from China1and one from The United States of America2 Time period analysed: China China: From December 2019 to 20 February 2020 USA USA: From 22 January to 30 May 2020 Cases and deaths China China: 75 565 total, 55 924 lab confirmed , 2114 deaths Median age: 48 years (IQR: 39-63); 51,1% male USA USA: 1 761 503 total, 1 320,488 lab confirmed, 103 700 deaths Median age: 48 years (IQR: 33-65); 48.9% female 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 1/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Age distribution of laboratory confirmed COVID-19 cases in China (01.12.19 20.02.20) and USA (22.01.20 30.05.20) 8.7% 80 3.2% 8.0% 70-79 8.8% 13.6% 60-69 19.2% 17.9% 50-59 22.4% 16.6% 40-49 Age 19.2% 16.3% 30-39 17.0% 13.8% 20-29 8.1% 3.7% 10-19 1.2% 1.5% 0-9 0.9% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% USA China 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 2/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Case fatality ratio by age group for laboratory confirmed COVID-19 cases in China (01.12.19 20.02.20) and USA (22.01.20 30.05.20) 28.7% 80 14.8% 16.6% 70-79 8.0% 6.7% 60-69 3.6% 2.4% 50-59 1.3% Age 1.0% 40-49 0.4% 0.4% 30-39 0.2% 0.1% 20-29 0.2% 0.1% 10-19 0.2% 0.1% 0-9 0% 0% 5% 10% 15% 20% 25% 30% USA China Case fatality ratio 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 3/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Proportion of cases of COVID-19 reporting selected symptoms data from China (01.12.19 20.02.20) and USA (22.01.20 30.05.20) 100% 88% 90% China USA 80% 68% 70% 60% 50% 50% 43% 38% 40% 36% 34% 33% 29% 30% 20% 19% 19% 20% 15% 14% 14% 6% 12% 11% 8% 8% 10% 5% 5% 4% 1% 1% 0% 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 4/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Reported underlying medical conditions for laboratory confirmed COVID-19 cases in China (01.12.19 20.02.20) and USA (22.01.20 30.05.20) 5.3% Inmunocompromised 7.6% Renal disease 1.4% Liver disease 4.8% Neurological disability Cancer 17.5% Chronic respiratory disease 30.2% Diabetes 32.2% Any cardiovascular disease 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% USA % CHINA % 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 5/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Disease severity in laboratory confirmed COVID-19 cases in China (01.12.19 20.02.20) and USA (22.01.20 30.05.20) Disease severity Disease severity China China USA USA Mild to moderate 80% 84% Severe 15% 14% Critical 5% 2% USA data: Hospitalization was six times more frequent among patients with a reported underlying condition (45.4%) compared to those without such conditions (7.6%) Death occurred 12 times more often among patients with reported underlying conditions (19.5%) compared with those without such conditions (1.6%) 1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w Epidemiology 6/6
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Clinical disease progression for COVID-19 Onset symptoms Onset symptoms (cough, fever) (cough, fever) Shortness of Shortness of breath, hypoxia breath, hypoxia Respiratory failure, Respiratory failure, multiorgan system dysfunction multiorgan system dysfunction Infectious Severe Severe disease disease Mild moderate Mild moderate disease disease Critical Critical Incubation Incubation period period Death Death 5% 5% 15% 15% 80% 80% Median 10 Median 10- -12 days after onset symptoms after onset symptoms 12 days Median 7 Median 7- -10 days after 10 days after onset symptoms onset symptoms Median 4 Median 4- -5 days (1 (1- -14 days) 14 days) 5 days Recovery average Recovery average 14 days 14 days Clinical management 1/5
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Care of suspected or confirmed mild COVID-19: symptomatic treatment Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home. Give symptomatic treatment such as antipyretics for fever and pain, adequate nutrition and appropriate rehydration. Counsel patients about signs and symptoms that should prompt urgent care. Antibiotic therapy or prophylaxis are not indicated Clinical management 2/5
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Care of moderate COVID-19 with pneumonia Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home. Patients with moderate illness may not require hospitalization. For patients at higher risk of severe disease, isolation in hospital is preferred. Antibiotics are not indicated unless there is clinical suspicion of a bacterial infection Monitor closely for signs or symptoms of disease progression. Clinical management 3/5
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Care of severe COVID-19 with pneumonia Equip all areas for severely ill patients with functioning oxygen system. Closely monitor patients for signs of clinical deterioration, such as rapidly progressive respiratory failure and shock; respond immediately with supportive care interventions. Monitor patients for signs of thromboembolism or related conditions, such as stroke, deep venous thrombosis, pulmonary embolism or acute coronary syndrome. Clinical management 4/5
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Recovery trial: Dexamethasone in ventilated COVID-19 patients Statement by trial investigators (University of Oxford) The results have not been published in a journal yet Over 6000 hospitalized patients were randomized to receive either dexamethasone (6 mg daily) or usual care for 10 days Dexamethasone was associated with significantly fewer deaths among patients compared with those given usual care Patients on oxygen: dexa group had one-fifth fewer deaths usual care Patients on ventilator: dexa group had one-third fewer deaths compared to usual care For patients who didn't require oxygen or respiratory support, there was no observed additional benefit with dexamethasone compared to https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of- covid-19 Clinical management 5/5
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS Upcoming events Webinar: Public Health Emergency Operations Centres (PHEOCs) for COVID 19 Response. Tuesday 23 June 14h00 Geneva time. Register Pre-conference of the 1st WHO infodemiology conference. 29 June 2020. https://www.who.int/news- room/events/detail/2020/06/29/default-calendar/pre-conference-1st- who-infodemiology-conference
