Coronavirus COVID-19 Outbreak – What's New

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

Updated: Thursday, July 16, 2020 09:22 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 eight countries with the highest reported COVID-19 activity (United States, Brazil, India, South Africa, Russia, Chile, Mexico, Pakistan). 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

July 16, 2020

Total

New

Total

New

United States

3,499,291

67,717

137,419

953

Brazil

1,966,748

39,924

75,366

1,233

India

968,876

32,695

24,915

606

Russia

746,369

6,422

11,770

156

Mexico

317,635

6,149

36,906

579

Colombia

165,169

5,271

5,814

189

Peru

337,724

3,857

12,417

188

Argentina

106,897

3,645

2,050

124

Bangladesh

193,590

3,533

2,457

33

Saudi Arabia

240,474

2,671

2,325

42

Pakistan

257,914

2,145

5,426

40

Canada

108,816

341

8,810

12

China

85,246

20

4,644

2

Other countries

4,535,879

56,105

253,573

1,415

TOTAL

13,530,628

230,495

583,892

5,572

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 July 15 at 12:15 ET
    • Total cases: more than 3.4 million in all 50 states
    • Deaths: more than 136,000 reported
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.[3]

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

July 15, 2020

Cases

Deaths

Total

Last 7d

Per 100k

Total

Per 100k

Florida

287,789

77,195

1,351

4,409

21

Texas

275,058

64,473

958

3,322

12

California

336,508

58,734

851

7,087

18

Georgia

123,963

23,493

1,178

3,054

29

Arizona

128,097

23,003

1,786

2,337

33

Louisiana

82,042

13,779

1,761

3,445

74

North Carolina

89,484

13,609

862

1,552

15

Tennessee

66,788

13,274

987

767

11

South Carolina

60,389

13,037

1,188

993

20

Alabama

57,308

11,487

1,173

1,166

24

Ohio

67,995

9,091

582

3,069

26

Illinois

156,638

7,064

1,229

7,419

58

Virginia

73,527

6,152

863

1,992

23

Nevada

29,832

5,812

983

636

21

Wisconsin

41,349

5,584

711

833

14

Pennsylvania

97,665

5,517

763

6,957

54

U.S. Centers for Disease Control.

Public Health

General

  • JAMA article[4] and editorial[5] 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.
  • NEJM published results from Phase 1 trial of Moderna mRNA-1273 vaccine in 45 adults age 18-55, testing three dose levels given as 2 vaccinations 28 days apart. All subjects produced antibodies and neutralizing activity on par with natural infection. Mild-moderate side effects were common.[6]
  • 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.[7]
  • 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.[8]
  • Meta-analysis of public health and protection measures showed:[9]
    • 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].[11]
  • NEJM publishes two articles detailing cases of multisystem inflammatory syndrome in children (MIS-C) reported in the U.S. related to COVID-19.[12],[13]
  • 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).[14]
  • BMJ retrospective case series provides details of first 1,000 COVID-19 patients presenting to a New York City medical center.[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

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 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 (test for trend p< 0.001).[18]
  • 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]
    • 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.[21]
    • NEJM reported a randomized trial showing HCQ did not prevent COVID-19 infection when used as postexposure prophylaxis within 4 days after exposure.[22]
    • 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.[23]
    • 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.[24]

Vaccines

Resources

For the Public

Feedback

Your feedback is appreciated!

Share this page

Share by emailShare by FacebookShare by Twitter

References

  1. Situation update worldwide. European Centre for Disease Prevention and Control. [https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases]
  2. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020.  [PMID:32087114]
  3. Coronavirus Locations: COVID-19 Map by County and State. USAFacts.org. [https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/]
  4. Wang X, Ferro EG, Zhou G, et al. Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA. 2020.  [PMID:32663246]
  5. Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA. 2020.  [PMID:32663243]
  6. Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. N Engl J Med. 2020.  [PMID:32663912]
  7. Pollán M, Pérez-Gómez B, Pastor-Barriuso R, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020.  [PMID:32645347]
  8. Morawska L, Milton DK. It is Time to Address Airborne Transmission of COVID-19. Clin Infect Dis. 2020.  [PMID:32628269]
  9. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020.  [PMID:32497510]
  10. Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission. U.S. Centers for Disease Control and Prevention. [https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-...]
  11. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020.  [PMID:32648899]
  12. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020.  [PMID:32598831]
  13. Dufort EM, Koumans EH, Chow EJ, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020.  [PMID:32598830]
  14. Ellinghaus D, Degenhardt F, Bujanda L, et al. Genomewide Association Study of Severe Covid-19 with Respiratory Failure. N Engl J Med. 2020.  [PMID:32558485]
  15. Argenziano MG, Bruce SL, Slater CL, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020;369:m1996.  [PMID:32471884]
  16. Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020.  [PMID:32412710]
  17. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed 27 June 2020.
  18. Mahase E. Covid-19: Low dose steroid cuts death in ventilated patients by one third, trial finds. BMJ. 2020;369:m2422.  [PMID:32546467]
  19. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. N Engl J Med. 2020.  [PMID:32445440]
  20. Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 Days in Patients with Severe Covid-19. N Engl J Med. 2020.  [PMID:32459919]
  21. Torjesen I. Covid-19: Hydroxychloroquine does not benefit hospitalised patients, UK trial finds. BMJ. 2020;369:m2263.  [PMID:32513810]
  22. Boulware DR, Pullen MF, Bangdiwala AS, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med. 2020.  [PMID:32492293]
  23. Rosenberg ES, Dufort EM, Udo T, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020.  [PMID:32392282]
  24. Hung IF, Lung KC, Tso EY, et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet. 2020.  [PMID:32401715]
  25. Abbasi J. The Promise and Peril of Antibody Testing for COVID-19. JAMA. 2020.  [PMID:32301958]
  26. Angulo FJ, Finelli L, Swerdlow DL. Reopening Society and the Need for Real-Time Assessment of COVID-19 at the Community Level. JAMA. 2020.  [PMID:32412582]
  27. Carfì A, Bernabei R, Landi F, et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020.  [PMID:32644129]
  28. Chandrashekar A, Liu J, Martinot AJ, et al. SARS-CoV-2 infection protects against rechallenge in rhesus macaques. Science. 2020.  [PMID:32434946]
  29. Chen WH, Strych U, Hotez PJ, et al. The SARS-CoV-2 Vaccine Pipeline: an Overview. Curr Trop Med Rep. 2020.  [PMID:32219057]
  30. Coronavirus Disease 2019 (COVID-19) Situation Reports. World Health Organization. [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-...]
  31. Coronavirus in the U.S.: Latest Map and Case Count. New York Times. [https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html]
  32. Gao Q, Bao L, Mao H, et al. Rapid development of an inactivated vaccine candidate for SARS-CoV-2. Science. 2020.  [PMID:32376603]
  33. Geleris J, Sun Y, Platt J, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020.  [PMID:32379955]
  34. Grein J, Ohmagari N, Shin D, et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. 2020.  [PMID:32275812]
  35. Halfmann PJ, Hatta M, Chiba S, et al. Transmission of SARS-CoV-2 in Domestic Cats. N Engl J Med. 2020.  [PMID:32402157]
  36. Kirkcaldy RD, King BA, Brooks JT. COVID-19 and Postinfection Immunity: Limited Evidence, Many Remaining Questions. JAMA. 2020.  [PMID:32391855]
  37. Kupferschmidt K, Cohen J. Race to find COVID-19 treatments accelerates. Science. 2020;367(6485):1412-1413.  [PMID:32217705]
  38. Li L, Zhang W, Hu Y, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA. 2020.  [PMID:32492084]
  39. Lurie N, Saville M, Hatchett R, et al. Developing Covid-19 Vaccines at Pandemic Speed. N Engl J Med. 2020.  [PMID:32227757]
  40. Mahase E. Covid-19: What is the evidence for cloth masks? BMJ. 2020;369:m1422.  [PMID:32265341]
  41. Mehra MR, Desai SS, Ruschitzka F, et al. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020.  [PMID:32450107]
  42. Moore BJB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020.  [PMID:32303591]
  43. NIH Clinical Trial Shows Remdesivir Accelerates Recovery from Advanced COVID-19 [News]. US National Institute of Allergy and Infectious Diseases. April 29, 2020. [https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-...]
  44. NIH clinical trial of investigational vaccine for COVID-19 begins: study enrolling Seattle-based healthy adult volunteers [News]. March 16, 2020. [https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investiga...]
  45. Norrie JD. Remdesivir for COVID-19: challenges of underpowered studies. Lancet. 2020;395(10236):1525-1527.  [PMID:32423580]
  46. Petherick A. Developing antibody tests for SARS-CoV-2. Lancet. 2020;395(10230):1101-1102.  [PMID:32247384]
  47. Schaffer DeRoo S, Pudalov NJ, Fu LY. Planning for a COVID-19 Vaccination Program. JAMA. 2020.  [PMID:32421155]
  48. Sethuraman N, Jeremiah SS, Ryo A. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA. 2020.  [PMID:32374370]
  49. Shi J, Wen Z, Zhong G, et al. Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS-coronavirus 2. Science. 2020.  [PMID:32269068]
  50. Stringhini S et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. June 11, 2020. S0140-6736(20)31304-0. [https://doi.org/10.1016/]
  51. Studdert DM, Hall MA. Disease Control, Civil Liberties, and Mass Testing - Calibrating Restrictions during the Covid-19 Pandemic. N Engl J Med. 2020.  [PMID:32272003]
  52. Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020;369:m1849.  [PMID:32409561]
  53. Treon SP, Castillo J, Skarbnik AP, et al. The BTK-inhibitor ibrutinib may protect against pulmonary injury in COVID-19 infected patients. Blood. 2020.  [PMID:32302379]
  54. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020.  [PMID:32410760]
  55. Walker PGT, Whittaker C, Watson OJ, et al. The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science. 2020.  [PMID:32532802]
  56. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020;395(10236):1569-1578.  [PMID:32423584]
  57. Woloshin S, Patel N, Kesselheim AS. False Negative Tests for SARS-CoV-2 Infection - Challenges and Implications. N Engl J Med. 2020.  [PMID:32502334]
Last updated: July 16, 2020