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COVID-19 Update

Updated on 28 February 2020

The Situation:

As of Friday, 28 February, there are over 83,700 confirmed COVID-19 cases worldwide and 2,859 deaths. For the first time, for multiple days this week, the number of new cases reported outside of mainland China was higher than the number of cases reported by mainland China. The number of countries reporting their first cases of the virus jumped by twenty since Monday of this week.

The CDC has issued a Level 3 Alert for South Korea, avoid nonessential travel, while Iran and Italy were both changed from Level 1 to Level 2, Practice Enhanced Precautions.


Italy saw a spike in cases during the week including an over 50% increase between Wednesday and Thursday. Cases linked to travel in Italy were reported in Brazil, Georgia, Greece, N. Macedonia, Norway, Pakistan and Romania. The Italian government-imposed quarantines on 11 communes in the regions in an effort to stem the spread remain in place.

South Korea

The total number of cases in South Korea saw a significant increase as clusters were identified in two southern cities: Daegu and Cheongdo – both have been declared “special case zones”.

  • More than half of South Korea’s cases are in Daegu and centered around members of the same church


By 28 February, the death toll had risen to 34 – the highest number outside China – and the total number of infected people was 338, including several senior officials.

Authorities called off Friday prayers in the capitals of 23 of Iran’s 31 provinces, including Tehran and the Shi’ite Muslim holy cities of Qom and Mashhad


On 26 February, a woman in Japan who works as a tour bus guide tested positive for the second time with COVID-19 weeks after recovering. This woman is the first reinfected case in Japan. Japan totals 222 cases and 4 deaths

The largest study of Covid-19 cases done by researchers at the Chinese Center for Disease Control and Prevention (CCDC) analyzed 44,672 confirmed cases in China reported between 31 December 2019 and 11 February 2020:

  • With 1,023 deaths, the overall mortality rate was 2.3%

Mortality Rate Variance by Location:

  • In Hubei Province = 2.9%

  • Rest of China = 0.4%

  • Mortality Rate Variance by Age:

  • 80+ = 14.8%

  • 70-79 = 8.0%

  • 60-69 = 3.6%

  • 50-59 = 1.3%

  • 40-49 = 0.4%

  • 10-39 = 0.2%

  • No deaths reported in children from birth – 9 years of age

From CCDC report this week ending 21 February mortality rate variance by sex:

  • Men = 2.8%

  • Women = 1.7%

Other significant factors for consideration:

Experts estimated the actual number of cases could be much higher than what is being officially recorded and reported. If that is true, the mortality rate could be much lower.

Men were also disproportionately affected during MERS and SARS outbreaks.

Women, in general, have a stronger immune response than men.

China accounts for nearly a third of the world’s smokers with more than half of the men smoking compared to just over 2% of China’s women smoking.

Comparison to U.S. Influenza Season 2019-20

Compared to the U.S. flu season (according to CDC data):

  • The flu caused an estimated 26 million illnesses, 250,000 hospitalizations and 14,000 deaths this season

  • Current flu season mortality rate: 0.05%

  • “Typical” flu season mortality rate: 0.1%

Travel Effects:

  • Many countries have urged citizens to reconsider travel or avoid nonessential travel to China and avoid all travel to Hubei.

  • Airlines around the world suspended services to all or some of China

  • Several countries banned foreigners who recently traveled to China and/or are Chinese passport holders and increased health screening measure at ports of entry

  • Chinese nationals restricted from booking international flights out of the country

  • The Chinese government ordered 65 million people in Hubei Province to remain at home in an effort to contain Covid-19, allowing one family member out every three days for food and essentials and in cases of an emergencies. The use of private cars has been banned indefinitely.

Current CDC Travel Alerts for Covid-19:

Level 3 – Avoid all nonessential travel

Level 2 – Practice Enhanced Precautions

Level 1 – Practice usual precautions

Other Destinations with Apparent Community Spread:

Community spread means people have been infected with the virus, including some who are not sure how or where they became infected. At this time, the extent of virus spread is not sustained or widespread enough to meet the criteria for a travel notice.

Singapore, Taiwan, Thailand

Symptoms to Watch Out For:

Officials say the respiratory disease, is capable of spreading through human-to-human contact, droplets carried through sneezing and coughing, and germs left on inanimate objects. Chinese officials warn that the virus might spread during the incubation period – when a person has the virus but isn’t yet showing symptoms. Incubation period is currently believed to be anywhere from 1 to 14 days. Authorities have advised citizens to be on the lookout for the following symptoms:

  • High fever

  • Difficulty breathing or shortness of breath

  • Cough and/or sore throat

  • Muscle Aches in some cases also being reported

  • Pneumonia (secondary infection)

Mitigating Measures to Apply:

  • Monitor local authorities for updates

  • Avoid travel to or through China (including layovers) and specifically through Wuhan and Hubei province

  • Avoid contact with animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat)

  • Wash hands frequently with soap and water; use an alcohol-based hand sanitizer if soap and water isn’t available

  • Older travelers and those with underlying health issues may be at higher risk and should speak to their healthcare provider before travel

  • Avoid exposure to those presenting the above symptoms

  • Allow extra time for temperature screening at airports worldwide

  • Enroll in a Safe Traveler Program to receive warnings from your preferred embassy

  • Seek medical care immediately if you experience symptoms and have recently traveled to the infected areas; notify your healthcare provider of your recent travel

DISCLAIMER and Hold Harmless

Disclaimer: LSDS™ gathers information from multiple sources and offers insight and perspective to travelers. Sources cannot be validated for accuracy in every instance. Travelers assume all risk associated with their travel and are responsible for the decisions associated with travel and for their own safety. Users of this reference document agree, to hold harmless LSDS™ (LLC) its employees and clients associated with any risk or injury incurred during travel.


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