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worldwide health alert - coved-19 update

Updated on 3 April 2020

Globally we have surpassed a million confirmed cases. We have also noted that over 20% of all currently confirmed cases have recovered. While restrictions continue to increase across many parts of the globe including shelter in place directives for many countries there are incremental positive indicators. This does not mean the worst is behind us, but we can begin to see more clearly now the most affected demographics, the measures that are working, and what we must safeguard against as we inch closer to returning to work (several weeks away). These next 4 weeks will be key in determining the effects of restrictions as well as the clear way ahead for much of the world. We are closely monitoring China’s return to work to look for behavioral and systems changes that will safeguard against the virus’ return. We are monitoring the effects of restricted movements in Italy and other locations. The medical infrastructure in many countries will experience a case volume that far outpaces their capability which will also adversely impact recovery rates. Please note: • 1,039,166 cases across 181 countries globally • 218,864 recoveries • 55,092 deaths • Social distancing and shelter in place directives are increasing across the globe and represent the fastest way to slow the spread

The Situation: As of Friday, 3 April, there are 1,039,166 confirmed COVID-19 cases worldwide – over 155,000 more cases than Wednesday. This data includes 55,092 deaths and 218,864 recoveries. A total of 181 countries are reporting confirmed cases – one more than Wednesday. World leaders continue to plead with the public to heed instructions for social distancing as many countries face (or surpass) critical capacity points of their healthcare systems and implement country-wide quarantine measures and lockdowns.

The U.N. Secretary General: “the pandemic is the world’s biggest challenge since World War II” as a U.N. report estimates that 25 million jobs could be lost worldwide. Experts are saying the number of cases and deaths worldwide are “seriously under-counted” due to mild cases that are missed, lack of testing and governments underplaying the pandemic’s impact.

Vaccine trials are under way in the U.S., Europe and China, but will take 12-18 months to be fully developed and released to the public. Four possible coronavirus treatment test results due by the end of this week, says French Minister of Research Frederique Vidal. The four possible treatments have been tested in 3,000 volunteers across Europe.

Europe France, Italy and Spain continue as Europe’s worst-hit countries with over 33,000 deaths combined, making up over 56% of the worldwide death toll. • Hope: #s show that the Italy, France and Spain might be flattening their curves, could be nearing or even past their peaks. • Spain reported 932 deaths Friday, less than the day before. More than half of Spain’s over 10,000 deaths have come in the past 7 days. Saw its smallest daily increase in cases from Thursday to Friday with 2,770 since 20 March. • Paris sets up roadblocks out of city to keep anyone from violating lockdowns for Easter school vacation. • European countries handling uptick in domestic violence: o Italy launches new app for victims to report without having to make a phone call o French government encourages victims to seek help at pharmacies ▪ Reports 32% increase in police interventions nationally and a 36% increase in Paris • Germany’s Angela Merkel returns to work after quarantine period and testing negative for coronavirus. o Germany reports 145 new deaths, pushing total past 1,000 • U.K. opens massive field hospital with 4,000 bed capacity at ExCeL conference center in London. o PM Boris Johnson to stay in self-quarantine longer as he is still showing symptoms. Friday was supposed to be his final day.

Asia/ Southeast Asia WHO warns that the pandemic is “far from over” in Asia.

• China asks foreign ministries to stop sending diplomats to Beijing for work or rotation. Out of 84 foreign diplomats arriving in Beijing last week 66% had become close contacts of confirmed cases. • Wuhan officials still advising residents to not go out unless absolutely necessary. • Singapore to close schools and most work places starting Monday after seeing a sharp increase in cases over past couple weeks. Reported 5th death on Friday. • Philippine’s numbers continue steep rise – reporting 385 new cases Friday pushes total over 3,000 as death toll rose to 136 after biggest single-day jump of 29. Social unrest is also increasing as police arrested 21 on Wednesday for protesting the lack of government assistance. President Duterte responded by saying that anyone who creates trouble should be shot dead.

Middle East WHO’s regional director for the eastern Mediterranean calls for countries in the region to “be more aggressive” in testing and tracing efforts as the Middle East sees a jump in cases over the week from 32,000 to 58,000. Refugee camps are of particular concern.

Africa • South Africa (in the middle of a 3-week lockdown) loses world-reknowned Dr. Gita Ramjee, a leading authority in the fight against HIV and TB, to complications due to Covid-19. South Africa has the highest number of people living with HIV in the world.


U.S. cases climb to 189,633 confirmed cases, 4,081 total deaths and 7,136 recovered. About 90% of the U.S. population is under ‘stay-at-home’ orders as of Friday morning.

New York’s death toll climbs past 1,500 as the state continues to lead as the epicenter for the outbreak in the U.S. and NYC’s mayor warning that next week will be “much harder”. • As of Tuesday, New York reported 75,795 total cases, 43,139 of those in New York City alone. (Hubei Province has reported 67,801) • White House officials warned anyone who has come from or passed through New York City recently to self-quarantine for 14 days.

Federal stay-at-home measures and social distancing guidelines were extended through 30 April. On 30 March, the FDA issued limited emergency use authorization for drugs usually used to treat malaria: chloroquine and hydroxychloroquine.

Dr. Fauci says it would “not be surprising” to see 100,000 deaths in U.S. from the coronavirus. Compared to the 2017-2018 flu season, which killed 60,000 in the U.S., stating that this virus is “clearly worse”. High end projections put number of U.S. deaths at around 200,000.

Please note changes to the following chart: Numbers in ( ) reflect ranking or number of cases in the previous report on 30 March for comparison. New countries to reach the top 25 and data are in red.

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.

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 and other hot spots around the globe. • Several countries banned foreigners who recently traveled to China and/or are Chinese passport holders and increased health screening measure at ports of entry • Specialized quarantines based on needs per country. • Travel Ban on Europe – to take affect Friday, March 13 at midnight, no travel from Schengen Area countries.

o From DHS: These countries, known as the Schengen Area, include: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, and Switzerland. This does not apply to legal permanent residents, (generally) immediate family members of U.S. citizens, and other individuals who are identified in the proclamation. LINK

• Updated 19 March - Department of State – Global Level 4 Health Advisory – Do Not Travel o The Department of State advises U.S. citizens to avoid all international travel due to the global impact of COVID-19. ▪ In countries where commercial departure options remain available, U.S. citizens who live in the United States should arrange for immediate return to the United States, unless they are prepared to remain abroad for an indefinite period. ▪ 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. If you choose to travel internationally, your travel plans may be severely disrupted, and you may be forced to remain outside of the United States for an indefinite timeframe. o 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.

Department of State – Information for Travelers - LINK o Includes advise for U.S. citizens that are currently abroad with specific information for those in China, Europe and on cruise ships.

o Covid-19 virus related emergency numbers: ▪ From U.S. or Canada: 1-888-407-4747 ▪ From Overseas: +1 202-501-4444 ▪ Enroll in STEP - LINK

• Current CDC Travel Alerts for Covid-19: o Level 3 – Avoid all nonessential travel – Global COVID-19 Pandemic Notice – Widespread Ongoing Transmission - LINK o See LINK for all current travel alerts by country

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 in some cases also being reported • Loss of smell and/or taste (uncommon) • Confusion, stroke-like symptoms, and/or seizures (rare) • 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, Northern Italy, South Korea, certain areas in the United States and other notable hotspots where transmission is high or on the rise across the globe. • 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 • Large scale gatherings should be avoided • 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 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 • Confirm travel schedule is not impacted by the coronavirus (including quarantines, which may be individually-imposed, visit/visa restrictions, entry/exit requirements and restrictions, etc.) • Ensure the validity of all visas prior to travel as this could be subject to restrictions and changes

Affected Travelers and others: All travelers have the potential for exposure

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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