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US Health Alert - Covid-19 Update

Updated on 3 April 2020

The Nation is adjusting to the new restrictions and protocols in place and we expect more of those restrictions to be leveraged in the coming days. Much of the US leadership is looking to the end of April-Mid May now as the next milestones. Here, we continue to scrutinize the effects of the shelter in place directives, increased testing, supply chain management and other factors to get a real sense of the success and challenges ahead. Large population centers where testing is increasing and those areas that are slow or delayed in emplacing shelter in place restrictions can expect to see increased numbers of infections and deaths. Please note: • The US has 244,159 documented cases – up from 188,247 on 1 April • NY Accounts for 9% of cases worldwide • NY and NJ account for nearly half of US cases • 5,421 cases are considered critical – up from 4,576 on 1 April • There are 10,411 recoveries in the US – over 3,000 new reports since 1 April • Even where shelter in place is not directed, we strongly recommend it be practiced to reduce the spread

In the coming days in addition to the more direct situational understanding, we will provide reports on crime trends, health and well-being statistics, and supply chain disruptions to keep you informed.

The Situation: Currently, the U.S. has at least 244,159, confirmed cases – the highest in the world - with 92,770 of those located in New York, which accounts for 9% of cases worldwide. Additionally, New Jersey 25,290 cases. Together, New York and New Jersey currently account for nearly half for the cases in the United States. There are approximately 33,040 hospitalizations (37 states are reporting figures) with 5,421 of those considered critical. There are 10,411 recorded recoveries and 6,098 recorded deaths.

According to the CDC, as of 2 April, there are 1,144 cases that are considered travel-related and 3,245 cases that are a product of close-contact. The rest of the cases are still under investigation for their origin.

There continues to be dramatic increases in daily case numbers can be attributed to the growing ability to test for the virus in local and state labs. As the country works through the backlog of tests, we may continue to see data spikes. In addition to this, some labs are gaining the ability to test through several different platforms, allowing for many more tests to be processed at one time.

On 27 March, the $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act (or CARES Act) passed in the House and was signed by President Trump. The Act is expected to provide aid to supply chains including those in the distribution and agriculture sectors as well as the airline industry and direct payments to Americans.

On March 28, The CDC issued a strong advisory against non-essential domestic travel of New York, New Jersey, and Connecticut residents. The governors of these states have full discretion on how to implement this advisory. Some states are advising individuals travelling from these states to self-quarantine upon arriving.

On March 29, President Trump extended the nationwide stay at home policy and social distancing guidelines until April 30.

On 30 March, the FDA issued limited emergency use authorization for drugs usually used to treat malaria: chloroquine and hydroxychloroquine. The FDA issued an Emergency Use Authorization to Illinois-based Abbott Labs on 27 March for a coronavirus test that delivers positive results in as little as five minutes and negative results in 13 minutes. The company expects the tests to be available by 1 April and expects to deliver 50,000 tests per day.

On March 31, President Trump and the Coronavirus Taskforce officially released a new model suggesting that the US death toll could rise to 240,000 with the current mitigation measures in place. This toll was 2.2 million without any mitigation. These numbers are subject to change as the real-time statistics change.

States are taking various measures to slow the spread: • Extended school closures • Closure of bars and restaurants • Banning gatherings of 10 or more (recommended by the US CDC) • Recommend residents avoid nursing homes and hospitals • Recommend elderly (60+) and those with pre-existing conditions to self-isolate • Curfews, while not mandatory, are recommended

New York City plans to release roughly 300 nonviolent inmates from Riker’s Island, after the city’s first prisoner tested positive for the coronavirus last week. The prisoners all have sentences of less than a year, and were found guilty of misdemeanor charges.

Governors across all 50 states, Puerto Rico, Guam, the U.S. Virgin Islands and Washington D.C. have mobilized components of their Army and Air National Guard to assist in their state’s response. U.S Navy Hospital Ship Comfort arrived New York on Monday, March 30. U.S Navy Hospital Ship Mercy arrived March 27 in California.

The following states have enacted a shelter-in-place or stay-at-home order, requiring citizens to remain at home except for essential purposes such as food and healthcare:

*States that have shelter-in-place orders in limited localities- these are not statewide at this time The following states have no form of shelter in place order in place at this time: South Dakota, Nebraska, Iowa, Arkansas

Changes in global travel restrictions: • On March 14, the Department of State authorized the departure of U.S. personnel and family members from any diplomatic or consular post in the world who have determined they are at higher risk of a poor outcome if exposed to COVID-19 or who have requested departure based on a commensurate justification. These departures may limit the ability of U.S. Embassies and consulates to provide services to U.S. citizens. • Canada and the U.S. mutually decided to close border on 18 March. • U.S. Department of State issues Global Level 4 Health Advisory – Do Not Travel on 19 March: The Department of State advises U.S. citizens to avoid all international travel due to the global impact of COVID-19. o In countries where commercial departure options remain available, U.S. citizens who live in the U.S. should arrange for immediate return, unless they are prepared to remain abroad for an indefinite period. o U.S. citizens who live abroad should avoid all international travel. Many countries are experiencing COVID-19 outbreaks and implementing travel restrictions and mandatory quarantines, closing borders, and prohibiting non-citizens from entry with little advance notice.

Airlines have cancelled many international flights and several cruise operators have suspended operations or cancelled trips. • On March 20, land ports of entry along the United States-Mexico border were limited to “essential travel” until April 20. • Current CDC Travel Alerts for Covid-19: o Level 3 – Avoid all nonessential travel: Brazil, Canada, Israel, Japan, China, Europe, Italy, Iran, Malaysia, South Korea, UK and Ireland and Cruise ships o Level 2 – Practice Enhanced Precautions Global COVID-19 Outbreak Notice

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. The virus might spread during the incubation period – which is believed to be from 1 to 14 days. Be on the lookout for the following symptoms: • High fever • Difficulty breathing or shortness of breath • Cough (usually dry) and/or sore throat • Fatigue • Muscle aches • Loss of smell and/or taste (uncommon) • Confusion, stroke-like symptoms, and/or seizures (rare) • Pneumonia (secondary infection)

Mitigating Measures to Apply while in the US: • Monitor local authorities for updates • Avoid non-essential travel to areas where the infection is known or spreading rapidly • Travelers who return from infected areas should self-quarantine • Practice social distancing at the workplace and in public spaces • Consider work from home arrangements for employees in locations where the virus is spreading or if employees must transit through those areas • Employees who feel ill or who have flu-like, respiratory or other symptoms should consider self-quarantine and or stay at home instead of attending office or other functions • Weigh the risks of conducting large scale gatherings where the virus is located and the potential for attendees to transit through higher risk areas • 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 • Avoid populated areas and gatherings if you feel ill (if at all possible) • Allow extra time for temperature screening at airports • Seek medical care immediately if you experience symptoms and have recently traveled to the infected areas; notify your healthcare provider of your recent travel • Confirm travel schedule is not impacted by the coronavirus (including quarantines, which may be individually-imposed, visit/visa restrictions etc.) • Ensure the validity of all visas prior to travel as this could be subject to restrictions and changes

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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