Coronavirus COVID-19 Outbreak – What's New

William M. Detmer, MD, supported by the Unbound Medicine Team

Updated: Friday, August 07, 2020 10:53 ET

Coronavirus Guidelines

What’s New Here

Recent updates

What’s New Elsewhere

COVID-19 Cases

Around the Globe

New Cases in Countries with Highest COVID-19 Activity
New Cases in Countries with Highest COVID-19 Activity

Recent Confirmed Cases in countries with the highest reported COVID-19 activity (United States, Brazil, India, South Africa, Russia, Mexico, Peru, Colombia). Note that the left axis is linear rather than logarithmic and represents the number of cases reported (rolling 3-day average) to the European CDC by each country.

Click for Live Updates.

Data sources: European CDC. Our World in Data.

Total and New COVID-19 Cases — from European CDC

Cases

Deaths

August 7, 2020

Total

New

Total

New

India

2,027,074

62,538

41,585

886

United States

4,883,646

59,755

160,104

1,848

Brazil

2,912,212

53,139

98,493

1,237

Colombia

357,710

11,996

11,939

315

South Africa

538,184

8,307

9,604

306

Peru

455,409

7,785

20,424

196

Argentina

220,669

7,147

4,135

126

Mexico

462,690

6,590

50,517

819

Russia

871,894

4,551

14,606

74

Philippines

119,460

3,480

2,150

27

Iraq

140,603

3,047

5,161

67

Bangladesh

249,651

2,977

3,306

39

Iran

320,117

2,634

17,816

14

Other countries

5,517,426

44,585

274,778

949

TOTAL

19,076,745

278,531

714,618

6,903

European Centre for Disease Prevention and Control.[1]

Note: ECDC statistics are reported daily. See other sources for hour-by-hour updates.

Statistics may differ from other reporting agencies.

COVID-19 Outbreak Map by Johns Hopkins CSSE – Updated Hourly
Coronavirus 2019 COVID-19 Outbreak Map

Click one of the links below to see the latest.
Desktop | Mobile
Source: Johns Hopkins Center for Systems Science and Engineering (CSSE).[2]

In the United States

  • As of August 6 at 17:45 ET (CDC)
    • Total cases: more than 4.8 million in all 50 states
    • Deaths: more than 157,800 reported
U.S. Key COVID-19 Metrics: August 7
U.S. Key COVID-19 Metrics - What's New

Key COVID-19 metrics in the United States since April 1. Dark lines represent 7-day averages.

Click for Live Updates.

Source: The COVID-19 Tracking Project[3]

U.S. Cases and Deaths by State and County
coronavirus curve by state

Aggregate data from the Centers for Disease Control and Prevention (CDC) and state- and local-level public health agencies. County-level data is confirmed by referencing state and local agencies directly. Confirmed cases and deaths reflect cumulative totals since January 22nd, 2020.

Click for Live Updates.

Source: USAFacts.org.[4]

U.S. States with the Most COVID-19 Activity

August 6, 2020

Cases

Deaths

Total

Last 7d

Per 100k

Total

Per 100k

Texas

459,887

56,580

1,602

7,497

26

Florida

497,181

50,930

2,334

7,627

36

California

524,722

49,417

1,326

9,703

25

Georgia

201,713

23,390

1,918

3,984

38

Arizona

182,203

13,930

2,541

3,932

55

Tennessee

114,098

13,276

1,685

1,144

17

Louisiana

125,943

13,170

2,703

4,096

88

North Carolina

129,288

11,438

1,245

2,050

20

Illinois

187,752

11,386

1,474

7,770

61

Alabama

94,819

11,037

1,940

1,698

35

South Carolina

95,472

9,626

1,878

1,894

37

Missouri

55,321

8,571

903

1,273

21

Ohio

96,305

8,412

824

3,596

31

Nevada

53,068

7,047

1,749

917

30

Virginia

95,867

6,963

1,126

2,299

27

U.S. Centers for Disease Control.

Public Health

General

  • JAMA Internal Medicine reported that in the period from March 23 to May 12, 2020 in 10 U.S. cities the proportion of persons with detectable antibodies to SARS-CoV-2 was between 1% (San Francisco) and 7% (New York City). This translates to 6–24 times the rate of COVID-19 cases reported in these locations during the same period.[5]
  • JAMA article[6] and editorial[7] reported and discussed how universal mask wearing reduced transmision of SARS-CoV-2 virus among heathcare workers, strengthening the case for universal mask wearing by the public.
  • The Lancet reported on a nationwide serologic survey for COVID-19 in Spain, a country hard-hit by the first coronavirus wave, and showed seropositivity in only ~5% of the population (higher in urban and lower in rural areas). Approximately one-third of seropositive participants reported having had no symptoms of COVID-19.[8]
  • Commentary in Clinical Infectious Diseases reviews the potential for airborne spread of COVID-19 in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale) and advocates for suitable preventive measures to mitigate this route of airborne transmission.[9]
  • Meta-analysis of public health and protection measures showed:[10]
    • Physical distancing (>1 meter) reduced risk of infection by 82% in both health-care and community settings. Additional distancing provided additional risk reduction.
    • Masks reduced risk of infection by 85% with greater effectiveness in healthcare settings than in the community likely due to use of N95 respirators in health-care settings
    • Eye protection resulted in a 78% reduction in infection; infection via the ocular route might occur by aerosol transmission or self-inoculation.

U.S. CDC Guidance

  • Considerations for Gatherings and Events
    • Lowest risk: Virtual-only activities, events, and gatherings.
    • More risk: Smaller outdoor and in-person gatherings in which individuals from different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., community, town, city, or county).
    • Higher risk: Medium-sized in-person gatherings that are adapted to allow individuals to remain spaced at least 6 feet apart and with attendees coming from outside the local area.
    • Highest risk: Large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.
  • Public health guidance for safely re-opening the US economy (PDF; 60 pages).
Phased Plan and Indicators for Reopening America

Gating Criteria

Threshold for entering Phase 1

Threshold for entering Phase 2

Threshold for entering Phase 3

Decreases in newly identified COVID-19 cases

Downward trajectory (or near-zero incidence) of documented cases over a 14-day period

Downward trajectory (or near-zero incidence) of documented cases for at least 14 days after entering Phase 1

Downward trajectory (or near-zero incidence) of documented cases for at least 14 days after entering Phase 2

Decreases in emergency department (ED) and/or outpatient visits for COVID-like illness (CLI)

Downward trajectory (or near-zero incidence) of CLI syndromic cases reported over a 14-day period

Downward trajectory (or near-zero incidence) of CLI syndromic cases reported for at least 14 days after entering Phase 1

Downward trajectory (or near-zero incidence) of CLI syndromic cases reported for at least an additional 14days after entering Phase 2

Decreases in ED and/or outpatient visits for influenza-like illness (ILI)

Downward trajectory (or near-zero incidence) of ILI reported over a 14-day period

Downward trajectory (or near-zero incidence) of ILI reported for at least 14 days after entering Phase 1

Downward trajectory (or near-zero incidence) of ILI reported for at least an additional 14 days after entering Phase 2

Decreases in percentage of SARS-CoV-2 tests positive

Downward trajectory (or near-zero percent positive) of positive tests as a percentage of total tests over a 14-day period (flat or increasing volume of tests)

Downward trajectory (or near-zero percent positive) of positive tests as a percentage of total tests for 14 days after entering Phase 1 (flat or increasing volume of tests)

Downward trajectory (or near-zero percent positive) of positive tests as a percentage of total tests for at least 14 days after entering Phase 2 (flat or increasing volume of tests)

Treat all patients without crisis care

Jurisdiction inpatient & ICU beds < 80% full Staff shortage in last week = no PPE supplies adequate for >4 days

Jurisdiction inpatient & ICU beds < 75% full Staff shortage in last week = no PPE supplies adequate for >4 days

Jurisdiction inpatient & ICU beds < 70% full Staff shortage in last week = no PPE supplies adequate for >15 days

Robust testing program

Test availability such that percentage of positive tests is < 20% for 14 days Median time from test order to result is < 4 days

Test availability such that percentage of positive tests is < 15% for 14 days Median time from test order to result is < 3 days

Test availability such that the percentage of positive tests is < 10% for 14 days Median time from test order to result is < 2 days

CDC Activities and Initiatives Supporting the COVID-19 Response. May 2020. Centers for Disease Control and Prevention (CDC). PDF Report (60 pages)

Other Resources

Medical

Clinical Care

  • JAMA publishes review of COVID-19 pathophysiology, transmission, diagnosis, and treatment [July 10].[12]
  • NEJM publishes two articles detailing cases of multisystem inflammatory syndrome in children (MIS-C) reported in the U.S. related to COVID-19.[13],[14]
  • COVID-19 Diagnosis & Treatment Overviewupdated June 28 from the Johns Hopkins Antibiotic (ABX) Guide powered by Unbound Medicine
  • NEJM genomewide association study finds a gene cluster (3p21.31) significantly associated with COVID-19 patients who develop respiratory failure. Another gene locus was associated with ABO blood group (Type A at higher risk, Type 0 at lower risk).[15]
  • NEJM publishes review of treatment of severe COVID-19.[16]
  • CDC updates Frequently Asked Questions and Answers and Clinical Care Guidelines and for HCPs.
  • COVID-19 for Clinicians video series – featuring experts from Johns Hopkins Medicine

Vaccines

Drugs

  • Corticosteroids (Dexamethasone):
    • NIH Guidelines recommend dexamethasone 6mg per day for up to 10 days in hospitalized COVID-19 patients who are mechanically ventilated or who require supplemental oxygen.[17]
    • Preliminary results from the UK RECOVERY trial published in NEJM showed Dexamethasone 6 mg once daily, taken orally or by injection for 10 days reduced the 28 day mortality rate by 17% (0.83 (0.74 to 0.92); P=0.0007) with a highly significant trend showing greatest benefit among patients needing ventilation (see table below).[18]
Dexamethasone Effect on 28-Day Mortality

Respiratory Support
at Randomization

Dexamethasone

% mortality

Usual Care

% mortality

Rate Ratio
(95% CI)

Invasive mechanical ventilation

29.3

41.4

0.64 (0.51 to 0.81)

Oxygen only

23.3

26.2

0.82 (0.72 to 0.94)

No oxygen received

17.8

14.0

1.19 (0.91 to 1.55)

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report.[18]

CI = Confidence Interval

  • Remdesivir:
    • NIH Guidelines recommend remdesivir in hospitalized patients with an oxygen saturation < 94% on ambient air or who require mechanical ventilation, ECMO or supplemental oxygen.[17]
    • Preliminary results of an NIH-sponsored randomized clinical trial (ACTT; NCT04280705) published in NEJM showed remdesivir accelerated recovery from advanced COVID-19:[19]
Preliminary Results from ACTT trial

Remdesivir

Placebo

Significance

Median Time to Recovery (Days)

11

15

p< 0.001

Mortality

7.1%

11.9%

HR 0.70
95% CI, 0.47 to 1.04

Serious Adverse Effects

21.1%

27.0%

Preliminary Results from Adaptive COVID-19 Treatment Trial (ACTT).[19]

HR = Hazard Ratio for Death

    • NEJM study in patients with severe COVID-19 not requiring mechanical ventilation did not show a significant difference between a 5-day and 10-day course of remdesivir. With no placebo control, the magnitude of benefit of treatment could not be determined.[20]
    • Available in the U.S. by FDA emergency use authorization (EUA). Availability is limited – allocation within states controlled by state policies.
  • Hydroxychloroquine (HCQ):
    • NIH Guidelines recommend against use of chloroquine or hydroxychloroquine for the treatment of COVID-19, except in a clinical trial.[17]
    • NEJM article reported that HCQ, alone or with azithromycin, did not improve clinical status in patients hospitalized with mild-moderate COVID-19 at 15 days as compared with standard care.[21]
    • Annals of Internal Medicine reported on randomized trial of of 491 patients where HCQ given to nonhosptialized adults with early COVID-19 did not substantially reduce symptom severity or improve outcomes.[22]
    • UK RECOVERY trial: HCQ treatment arm stopped after preliminary analysis showed HCQ did not reduce mortality or improve other outcomes in hospitalized COVID-19 patients.[23]
    • NEJM reported a randomized trial showing HCQ did not prevent COVID-19 infection when used as postexposure prophylaxis within 4 days after exposure.[24]
    • Observational study published in JAMA showed amongst 1,438 hospitalized COVID-19 patients those receiving HCQ, azithromycin, or both had no significant differences in mortality from those not receiving these drugs.[25]
    • Observational study published in NEJM showed HCQ not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death.
  • Interferon beta-1b, lopinavir–ritonavir, and ribavirin combination reported in an open label, randomized trial (NCT04276688) to be safe and superior to lopinavir–ritonavir alone in alleviating symptoms and shortening hosptial stay and viral shedding in patients with mild to moderate COVID-19.[26]

Resources

For the Public

Feedback

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Last updated: August 7, 2020