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Worldwide Health Alert – COVID-19 Update

Updated on 20 March 2020

The Situation:

As of Friday, 20 March, there are over 245,400 confirmed COVID-19 cases worldwide, a 75,000 case increase from Monday. This data includes 10,031 deaths and 86,035 recoveries. A total of 163 countries are reporting confirmed cases, an increase of 15 since Monday.

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.

Several significant changes in global travel restrictions put in place over the week.

  • The FCO put out an advisory against all non-essential international travel beginning 17 March for at least 30 days.

  • The EU institutes a 30-day ban on non-essential travel to at least 26 European countries from the rest of the world.

  • 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 – link and details below


Italy’s deaths surpassed China’s this week as the case load continues to climb at an alarming rate. The entire country remains on lockdown, though Chinese health officials warned the Italian government that their lockdown measures are not strict enough.

Spain became second European nation to see death toll reach over 1,000 as emergency services have reached saturation.

Health officials warn that European hospitals could become overwhelmed by number of patients in a matter of days.


Malaysia saw a sharp increase in cases during the week – most of which were linked to a large religious gathering, prompting the CDC to issue a Level 3 Travel Alert for the country (see link below).

China reports no new domestically transmitted cases for the first time since the beginning of the outbreak on Thursday and again on Friday. Turns focus to keeping cases from overseas out.

Hong Kong and Singapore both reported record new case numbers on Friday with 48 and 47 respectively, as they battle a second wave of infections the majority of which are coming back from overseas travel. Taiwan also reported 27 new cases and its second death in a similar struggle. All countries are still reporting some domestically transmitted cases as well.

Australian officials are scrambling to round up passengers off the Ruby Princess cruise ship after four passengers tested positive. Thousands of passengers disembarked the ship in Sydney on 19 March.


The U.S. saw significant increases in number of cases reported as more testing is being carried out across the nation. State and local governments have made moves to implement closures to reinforce ‘social distancing’ and comply with the guidance for no gatherings of more than 10 people issued by the White House.

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.

  • 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

  • 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.

  • 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

  • Includes advise for U.S. citizens that are currently abroad with specific information for those in China, Europe and on cruise ships.

Current CDC Travel Alerts for Covid-19:

Level 3 – Avoid all nonessential travel

Level 2 – Practice Enhanced Precautions

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

  • 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 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 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 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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