COVID-19 update
To date, 136 Washington residents spanning eight of the state’s 39 counties have tested positive and 18 people have died of the new coronavirus, 16 of them connected to the Life Care nursing home, public health officials announced Sunday.
Seattle and surrounding King County remain the epicenter, with 83 cases of COVID-19 and 17 deaths from it. Notably, 15 patients and one frequent visitor at Life Care are among the fatalities, including three who died Friday and two Saturday, King County public health officials said Sunday.
They gave details about two newly announced deaths among Life Care patients: a woman in her 80s and a man in his 90s died Friday and Saturday. Both died in area hospitals.
CORONAVIRUS IN OREGON: FULL COVERAGE
The updated numbers from the state Department of Health and the King County health agency are likely an undercount, both because testing has not been widespread and because state and local health agencies are working to confirm an influx of reports from labs, hospitals and medical examiners. The University of Washington is offering tests along with the state public health laboratory.
Officials are instructing those who are not at high risk of severe symptoms to isolate themselves and to call before visiting their doctors.
So far, multiple cases have been detected in King County, neighboring Snohomish County and Pierce County, home to Tacoma. The state health department announced three new positive tests in Pierce County on Sunday, bringing the county’s total to four. The Tacoma News-Tribune reported that at least two of the Pierce County residents, one man in his 40s and another in his 50s, are hospitalized.
Five other far-flung counties have so far detected a single case each: Clark County just north of Portland, Grant County east of Yakima in central Washington, Jefferson County in northwest Washington, Spokane County on the state’s eastern border and Kittitas County just north of Yakima. In addition, state officials reported 13 more cases Sunday that they termed “unassigned” to any particular county.
Washington’s lone coronavirus death outside King County was in Snohomish County.
People at high risk for complications from COVID-19 are:
• People older than 60 years
• People with chronic medical conditions such as heart disease, lung disease, or diabetes
• People with weakened immune systems
• Pregnant people
People in these groups and families who live with those at higher risk for severe illness need to take action to prepare and protect themselves, King County health officials advised.
As Maryland officials confirmed three cases of the new coronavirus in the state this week, healthcare experts have instructed people to adopt myriad preventative measures in hopes of containing the disease.
But what should Marylanders do if they suspect they have been exposed to COVID-19 or are have symptoms such as fever, cough and breathing trouble?
Here’s what experts recommend if you believe you could have the disease:
As Maryland officials confirmed three cases of the new coronavirus in the state this week, healthcare experts have instructed people to adopt myriad preventative measures in hopes of containing the disease.
But what should Marylanders do if they suspect they have been exposed to COVID-19 or are have symptoms such as fever, cough and breathing trouble?
Here’s what experts recommend if you believe you could have the disease:
Don’t go to the doctor right away. Call first.
While some Marylanders’ first instinct may be to make an appointment with a doctor or head to a hospital, the Centers for Disease Control and Prevention is urging people to call ahead first to alert healthcare providers to coronavirus concerns.
This will help medical professionals to take steps to keep others from getting infected or exposed, the agency website states. Tell them about recent travel and close contacts, such as other members of the household.
If possible, put on a face mask before coming into contact with other people or entering a facility and ask the healthcare provider to call the local or state health department.
In the event of a medical emergency, people should call 911 and notify the dispatch personnel that they are being evaluated for COVID-19, the CDC recommends.
While some Marylanders’ first instinct may be to make an appointment with a doctor or head to a hospital, the Centers for Disease Control and Prevention is urging people to call ahead first to alert healthcare providers to coronavirus concerns.
This will help medical professionals to take steps to keep others from getting infected or exposed, the agency website states. Tell them about recent travel and close contacts, such as other members of the household.
If possible, put on a face mask before coming into contact with other people or entering a facility and ask the healthcare provider to call the local or state health department.
In the event of a medical emergency, people should call 911 and notify the dispatch personnel that they are being evaluated for COVID-19, the CDC recommends.
Getting tested
To request COVID-19 testing for a suspect case, healthcare providers must contact the state’s Infectious Disease Bureau at 410-767-6700 during business hours or call the state’s Emergency Call Center after hours at 410-795-7365 to arrange the initial disease consultation, according to Maryland health officials.
COVID-19 testing can only be conducted with authorization from a state physician–epidemiologist and is restricted to patients who meet the current CDC criteria, which was recently expanded to include people who have not traveled or come in contact with someone infected but are hospitalized with serious symptoms not otherwise explained.
Health officials will likely collect patient specimens from the upper and lower respiratory tract.
In the three Maryland cases, the patients were instructed to go to an unidentified hospital emergency room where medical staff in protective equipment collected samples for testing.
Gov. Larry Hogan announced Thursday night that the three cases were confirmed at the Public Health Laboratory in East Baltimore, which was approved Tuesday to test patients for COVID-19. Local testing is expected to shorten the amount of time it takes to get results to a day from the several days it took from the Centers for Disease Control and Prevention lab in Atlanta.
To request COVID-19 testing for a suspect case, healthcare providers must contact the state’s Infectious Disease Bureau at 410-767-6700 during business hours or call the state’s Emergency Call Center after hours at 410-795-7365 to arrange the initial disease consultation, according to Maryland health officials.
COVID-19 testing can only be conducted with authorization from a state physician–epidemiologist and is restricted to patients who meet the current CDC criteria, which was recently expanded to include people who have not traveled or come in contact with someone infected but are hospitalized with serious symptoms not otherwise explained.
Health officials will likely collect patient specimens from the upper and lower respiratory tract.
In the three Maryland cases, the patients were instructed to go to an unidentified hospital emergency room where medical staff in protective equipment collected samples for testing.
Gov. Larry Hogan announced Thursday night that the three cases were confirmed at the Public Health Laboratory in East Baltimore, which was approved Tuesday to test patients for COVID-19. Local testing is expected to shorten the amount of time it takes to get results to a day from the several days it took from the Centers for Disease Control and Prevention lab in Atlanta.
Okay I’ve been tested. Now what?
The three Marylanders who tested positive for the new coronavirus are all in isolation in their homes, state officials said.
The CDC recommends patients with COVID-19 stay home with the exception of seeking medical care. Patients should not attend work or school and should avoid using public transportation, ride-sharing and taxis, the CDC recommends.
Those who have self-isolated within the home should separate from other people and animals. Wearing a face mask, covering coughs and sneezes is believed to help mitigate the spread of the infection. The CDC recommends individuals who are ill should avoid sharing personal household items, clean hands often, clean all “high-touch” surfaces like counters and doorknobs.
Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments, the CDC states.
As of February 19, a total of 2012 deaths have been confirmed and more than 75,192 confirmed cases have been recorded worldwide as of 09:00 (UCT). Cases have been confirmed in every Chinese region (mainland), in addition to Hong Kong SAR, Taiwan, China, and Macau SAR. This includes urban centers such as Beijing, Shanghai, and Shenzhen.
Out of the 2012 deaths reported, 2006 has been reported in China (mainland), two*1 in Hong Kong (Special Administrative Region), one in the Philippines, one in Japan, one in Taiwan, and one in France.
Internationally, the virus has now been confirmed in the US, the UK, Australia, Canada, France, Belgium, Italy, Germany, Sweden, Finland, Spain, Russia, Egypt, United Arab Emirates, Malaysia, Nepal, Thailand, Japan, South Korea, Singapore, Cambodia, Sri Lanka, Vietnam, the Philippines, India. 542 cases were confirmed on a cruise ship quarantined in Japan in what became the biggest cluster of coronavirus infections outside mainland China. Passengers began disembarking on February 19; those infected have already been transferred to hospitals. The US CDC said the quarantine “may not have been sufficient to prevent transmission among individuals on the ship”. *
1 Information with an asterisk have been updated as of the report’s publication date
COVID-19 Factsheet
February 19, 2020
The situation as of February 19, 2020
Chinese authorities have taken strict measures to curb the outbreak:
▪ On February 15, Chinese Government has ordered people returning to Beijing from holidays to quarantine themselves for 14 days, stating individuals failing to obey government orders would be held accountable under the law. It remains unclear whether the restrictions would apply to non-residents and foreigners arriving from abroad.
▪ Chinese returned to work on February 10 after the government eased some traveling/working restrictions. However, a large number of workplaces reportedly remain closed as of February 17 and many people work from home.
▪ Authorities in Hubei province have further tightened restrictions on February 16 with vehicles, apart from essential services, banned from the roads and companies unable to resume work until further notice.
▪ Universities, primary and middle schools, and kindergartens across China will postpone the opening of the spring semester until further notice, according to the General Office of the State Council. In Beijing, it has already been announced that the start of the Chinese school year scheduled for 17/2 would be postponed, without further details. Many other provinces and municipalities, such as Guangdong, Anhui, Zhejiang, Heilongjiang, Jiangsu, Shandong, Hebei, Jiangxi, and Inner Mongolia, as well as Shanghai and Chongqing have announced the closure of all schools until at least the end of February, with no date of resumption. In Shanghai, authorities announced that the semester from primary and secondary schools will start via online learning.
▪ Lots of tourist sites have been closed to the public until further notice on January 24 (section of the Great Wall, Beijing's Forbidden City, Shanghai, Disneyland China). Several cultural and sportive events have also been postponed.
▪ On January 28, China urged its citizens to postpone trips abroad.
▪ China Railway announced on January 28 that some trails along the Beijing Railway will be suspended through 26 February. Railway police have also increased prevention and control measures at stations nationwide until further notice.
▪ Numerous Chinese cities and provinces are subject to travel bans and other restrictive measures imposed by the Chinese authorities. ‘Transport suspension’ includes restrictions on flights, trains, and other public transport services.
▪ In Hong Kong SAR, the suspension of school classes has been extended until at least March 16. The government also said civil servants would be allowed to work from home until February 23.
Japan announced on February 17, that public crowds in Tokyo will be limited to prevent further spread of the disease.
On February 13, the Vietnamese Ministry of Health ordered the quarantine for twenty days of the commune of Son Loi, located in Vinh Phuc Province near Hanoi after a new case was reported, bringing the number of people infected to six in the area (Binh Xuyen district). The government has also suspended festivals and sporting events throughout the country as a precaution.
In Mongolia, all education centers (schools, kindergartens, universities, etc.) will be closed until March 30* and all public gatherings have been banned.
While China’s government top medical adviser on the outbreak said that the outbreak may peak in April, before easing, the director-general of the WHO expressed concerns about a small number of cases outside China that were transmitted without any travel to China and could be “the spark that becomes a bigger fire”. WHO chief added on February 11 that the first vaccine was 18 months away.
Travel restrictions
Several countries have taken measures (including fever screening) to step up surveillance at airports. 2
Some countries have advised their citizens against all unnecessary trips to China and against all trip to Hubei province.3 Some have implemented a ‘DO NOT TRAVEL’ warning to China to its citizens.
Several neighboring countries have decided to close their land borders with China:
▪ Kyrgyzstan
▪ Mongolia
▪ Nepal
▪ Russia
▪ In Hong Kong SAR, all border crossings with mainland China except for the Shenzhen Bay joint checkpoint and the Hong Kong SAR-Zhuhai-Macau SAR Bridge will be closed from February 3
▪ North Korea has closed borders to all foreign tourists
▪ Vietnam closed border crossing at Lao Cai to Chinese nationals.
Numerous airlines have canceled part or all routes within/to China. Other airlines such as US’ American Airlines and United Airlines have also suspended flights to Hong Kong SAR.4
Some neighboring countries have implemented transportation restrictions to China.
▪ Russia’s rail line operator Russian Railways announced on February 2, that it will cancel train service to China.
▪ Hong Kong SAR authorities suspended high-speed rail services and ferries from Hong Kong SAR to mainland China until further notice as of January 30.
▪ Kazakhstan has suspended all forms of passenger transportation services to and from China as of February 3.
▪ Vietnam has suspended on February 4 all passenger trains to and from China indefinitely.
Several countries have implemented entry restrictions for travelers who visited China recently.
▪ On January 31, the United States declared a public health emergency, which will temporarily suspend entry into the United States of foreign nationals who pose a risk of transmitting the 2019 novel coronavirus. The restriction applies to any foreign nationals that have visited China in the last two weeks. It is not specified whether these measures apply exclusively to travelers into mainland China or if those from Hong Kong SAR and Taiwan, China are also subject to screenings. Americans who visited Hubei province only would be quarantined for up to two weeks. Those arriving from other parts of China are subject to screening. The government also raised its travel advisory for China to “Do Not Travel.”
2 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/ 3 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/ 4 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/
▪ Bahamas authorities have implemented a travel ban restricting any non-residents, regardless of nationality, who have visited mainland China within the last 20 days from entering the country.
▪ Trinidad and Tobago have banned arrivals of travelers who have been to mainland China, until further notice. TT nationals and permanent residents returning from China will not be allowed to enter the country for 14 days after leaving China.
▪ Antigua & Bermuda has banned arrivals of travelers who have been to mainland China, until further notice. The government has not yet given any time limits permissible between leaving China and traveling to Antigua and Barbuda.
▪ Marshall Islands announced a ban on direct travel from China to the islands: "Any traveler with travel originating from or transiting through China must spend at least 14 days in a country not affected by COVID-19."
▪ Jamaica health authorities announced that individuals entering the country from China will spend 14 days in quarantine facilities provided by the government.
▪ Saint Lucia will ban non-nationals who have recently visited China within 14 days from entering the country.
▪ Suriname announced on February 6, that all passengers from China will be quarantined for 14 days. Travelers (non-residents) who have been in China for 14 days (from the date of declaration) are no longer admitted to the territory.
▪ Grenada issued new entry restrictions on February 2 for individuals traveling from China. Any non-national who has travel history to mainland China within the past 14 days, either originating or in transit, will not be allowed entry at any local port. All nationals with similar travel history will be placed under a 14-day quarantine as a precaution.
▪ The government of St Vincent and the Grenadines announced on February 8 that anyone has been in mainland China in the last 14 days and arriving in the country would be quarantined.
▪ Belize’s authorities announced on February 8, that travelers who have visited China within the past 14 days will be denied entry prior to arrival.
▪ The Government of Barbados has announced that individuals who have visited Hubei Province (China) within the past 14 days will be placed in quarantine at the local Infection Control Centre. Individuals who have been to other parts of China, and countries other than China who might have been affected by the virus in the past 14 days will be screened and if necessary placed in-home quarantine.
▪ Samoa (US): All foreigners except Samoa citizens are required to spend 14 days in Hawaii before entering the territory.
▪ On February 1, the Australian government announced it will deny entry to foreign nationals who traveled through or left mainland China. As of Saturday, those traveling from Hong Kong SAR and Taiwan, China are not subject to this measure. Citizens, permanent residents, and their immediate family, legal guardians, and spouses will be allowed entry, though will be required to
self-isolate. The measure was extended until February 22 and will be reviewed each week. In addition to this, the government also raised its advice level for China to: “Do not go to China”.
▪ New Zealand has banned all foreign nationals traveling from, or transiting through mainland China, from entering the country as of February 3 until at least February 23. All other travelers to New Zealand will be subject to increased screening measures. New Zealand nationals and permanent residents returning from China will still be able to enter the country, but will be required to self-isolate for 14 days after arrival. The alert level for travel to mainland China has been raised to "Do not travel."
▪ Singapore has banned arrivals of travelers who have been to China in the last 14 days. It has also stopped issuing visas to Chinese nationals, and declared the suspension of previously-issued visas to Chinese nationals. Singapore nationals, Permanent Residents and long-term visa holders returning from China will be placed in quarantine for 14 days.
▪ Mongolia has barred all Chinese nationals and foreigners from entering the country by plane, rail and road from February 1, through March 2. After February 6, Mongolians in China will only be allowed to return via Ulaanbaatar's Chinggis Khaan International Airport (ULN) or the Zamiin Uud rail border.
▪ In Russia, Chinese nationals will be banned from entering the Russian Federation from February 20. However, the new measures will not affect travelers who are transiting at Russian airports*.
▪ Kyrgyzstan health authorities announced that individuals entering the country from China will spend 14 days in quarantine facilities provided by the government.
▪ Turkmenistan has put quarantine measures in place for foreign travelers arriving at airport. Travelers may be sent to hospitals for mandatory quarantine if they display symptoms of possible exposure and/or travel histories indicating possible exposure to the virus.
▪ Authorities in Uzbekistan announced that individuals coming from China or having transited through China, including Hong Kong and Macao SARs, within 14 days before entering the country will spend 14 days in quarantine*.
▪ Japan said that it would bar foreigners who had visited Hubei in the past 14 days.
▪ Taiwan’s Bureau of Consular Affairs (BOCA) announced that starting February 7, in view of the fact that the Taiwan government has designated all areas of China, including Hong Kong and Macao SARs, as being severely affected by the novel coronavirus outbreak (areas of level 2 or higher), foreign nationals who have visited or resided anywhere in China, including Hong Kong and Macao SARs, in the previous 14 days will be temporarily prohibited from entering Taiwan. Entry visa applications by such foreign nationals, including those submitted for special reasons, will not be accepted by Taiwan’s overseas missions while this temporary measure is in effect. In addition, foreign nationals possessing a valid Taiwan Resident Certificate who have visited or resided in China, including Hong Kong and Macao SARs, in the previous 14 days shall be permitted entry but shall self-isolate in their home and carefully monitor their health for a period of 14 days after returning to Taiwan. The Taiwan Center for Disease Control (CDC) announced February 11, that all travelers arriving from areas outside of China, Hong Kong, and Macao SARs will be required to complete a health declaration form and accurately provide their travel and contact history regarding whether they have visited China, Hong Kong, or Macau SARs over the past 14 days before entry. If travelers provide inaccurate information or refuse, they will be fined up to $5000 USD.
▪ Hong Kong SAR announced that all travelers from mainland China, including Hong Kong SAR residents, will be required to be on quarantine for 14 days. Reports also indicate that civil servants will be asked to remain home until February 16 at the earliest.
▪ Bangladesh will no longer allow entry of Chinese nationals unless they are prescreened.
▪ The Maldives has banned arrivals of travelers who have been to mainland China, until further notice. Only Maldivian citizens who are returning from mainland China will be exempted, though they will be placed under quarantine.
▪ South Korea will ban the entry of foreigners from Hubei province from February 4, until further notice. Travelers arriving from China, Hong Kong, and Macao SARs are required to complete a health declaration on arrival, provide local contact details, and report daily on health conditions using an app.
▪ The Philippines government has temporarily banned the entry of any person, regardless of nationality, except Filipino citizens and holders of Permanent Resident Visa directly coming from China and its SARs. Also in place is a temporary ban on the entry of any person, regardless of nationality, except Filipino citizens and holders of Permanent Resident Visa who within 14 days immediately preceding arrival in the Philippines, has been to China and its SARs. There is a mandatory 14-day quarantine for Filipinos and Permanent Resident Visa holders coming from any place in China and its SARs.
▪ Indonesia has barred visitors who have been in China in the past 14 days.
▪ India bans entry of all Chinese nationals as well as foreigners who traveled to China since January 15.
▪ Malaysia has stopped issuing visas to travelers from any province placed under lockdown by the Chinese government.
▪ The Vietnamese authorities on February 15 have banned entry to individuals (excluding citizens and permanent residents) that have traveled from or transited through China in the preceding 14 days.
▪ Papua New Guinea has banned all travelers from Asia from entering the country via air and sea. The border with Indonesia has been temporarily closed.
▪ Brunei announced it would ban entry to all travelers that have been in Hubei, Zhejiang, and Jiangsu provinces in the 14 days prior to their intended travel date, with the exception of citizens and permanent residents of Brunei.
▪ Tonga has required that a health declaration card must be completed by all foreign travelers upon arrival from February 3. If traveling from China, a 14 days self-quarantine in a country free from the virus will be required. A medical clearance within three days before traveling to Tonga will also be required.
▪ Samoa has imposed restrictions for anyone traveling to the island. A health declaration form must be completed by all foreign travelers upon arrival. Travelers from mainland China, Hong Kong SAR, and Macau SAR must spend at least 14 self-quarantine days in a country free from the virus. Travelers from countries with confirmed virus cases must undergo a medical examination three days before traveling. The full list can be found here.
▪ Guam will deny entry to travelers who have been in China (excluding Hong Kong and Macau SARs) within 14 days of arrival in Guam*.
▪ Palau announced a new regulation that will deny entry to travelers who have been to China, Hong Kong, and Macao SARs in the 14 days prior to their arrival.
▪ Solomon Islands authorities announced a new regulation that will deny entry to travelers who have been to any country with a confirmed case in the 14 days prior to their arrival. Residents and those with long-term passes (e.g., work permits, student visas) are exempted from the restriction.
▪ Vanuatu authorities decided on January 31 that anyone who has traveled to or been in China, Hong-Kong SAR, Macao SAR, and Taiwan (China) or having transited through China, Hong-Kong SAR, and Macao SAR, and Taiwan (China), in the 14 days prior to their arrival in Vanuatu will not be allowed to enter in the country. Passengers who have traveled to or been in mainland China, Hong Kong, Macao, or Taiwan (China) as of December 31, and spent the 14 days prior to their arrival in Vanuatu in another country, will be required to provide a medical certification issued by a doctor stating that they do not have respiratory illnesses. Any traveler showing symptoms of respiratory illness (fever, runny nose, flu-like condition, headache, chest pain, or breathing difficulties) must provide a medical certificate indicating a negative result of the COVID-19 coronavirus test.
▪ Timor-Leste authorities will deny entry to anyone who has visited the province of Hubei in the past four weeks. If you transited in other provinces in China in the last four weeks, you might be forbidden to enter the territory unless you present a medical certificate issued by a recognized medical institution.
▪ Israel expanded quarantine orders on February 16, to include individuals that have traveled to Thailand, Hong Kong SAR, Singapore, or Macao SAR in the preceding 14 day. Previous quarantine orders included individuals having traveled to China, Taiwan, South Korea, or Japan.
▪ Iraqi authorities announced that it would prohibit foreign travelers coming from China by sea, land, or air, to enter the country, adding that travelers with a Chinese visa issued on or after January 14, arriving at Erbil and Souleymanieh International Airports will be denied entry.
▪ Saudi Arabia announced it is barring its nationals and residents from traveling to China. It stated that citizens who do not observe the policy would face consequences, and residents will not be permitted to enter the country.
▪ In Jordan, all travelers arriving via Jordanian airports and land borders will be screened for the virus. Those displaying symptoms of the virus and have a travel record that may indicate possible exposure will be immediately moved to Al Bashir hospital in Amman for a 14-day quarantine.
▪ In Lebanon, authorities announced on February 9, that all arrivals from China will be placed under home quarantine. The announcement also stated that screening tests and isolation rooms were prepared at the Rafic Hariri government hospital in Beirut. It is not clear whether this policy applies to travelers entering Lebanon directly from China or if it includes those with recent travels to China as well.
▪ Gabon announced that it was suspending entry to its territory for all passengers from China until further notice.
▪ Angolan authorities have announced on February 6, that all passengers from China will be automatically placed in quarantine, without specifying how it will be applied.
▪ Malagasy authorities have forbidden all airlines to aboard travelers coming from China, Hong Kong or Macao SARs or having transited through those areas within 14 days before taking their flight to Madagascar.
▪ The government of Sierra Leone announced that travelers who have visited China in the last 14 days and wishing to enter the country at any point of entry would be subject to a period of quarantine, with regular follow up by trained health workers to monitor health for the duration of the incubation period.
Several countries have also implemented visa restrictions to Chinese nationals; some examples include Canada, Czech Republic, Greece, Italy, Kazakhstan, Mozambique, Sri Lanka, the Philippines, India, and Vietnam. Visa restrictions have also been implemented in some countries for foreign nationals who have visited China in the past days.
• Existing Indian visas of all Chinese nationals and other foreign nationals who are either based out of China or who have visited China in the last two weeks are canceled.
• Vietnamese authorities announced that visas will not be issued for all non-Vietnamese nationals arriving from mainland China, excluding Hong Kong and Macao SARs, or who stayed in China within 14 days of their arrival in Vietnam.
Recommendations
As the human to human transmission has been confirmed and the disease can notably be transmitted:
▪ By air by infected people coughing or sneezing
▪ By close personal contact, such as touching or shaking hands
The WHO advises that measures to limit the risk of exportation or importation of the disease should be implemented.
To reduce the general risk of transmission, travelers are advised to abide the following measures:
▪ Frequently clean hands by using alcohol-based hand rub or soap and water
▪ When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands
▪ Avoid close contact with anyone who has fever and cough
▪ If you have fever, cough and difficulty breathing seek medical care early and share previous travel history with your health care provider
▪ When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces in contact with animals
▪ The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good food safety practices
▪ Adhere to all instructions issued by local authorities and their home governments
In the case that symptoms suggestive of respiratory illness emerge either during or after travel, such as:
▪ Fever, cough, shortness of breath, and breathing difficulties
▪ In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death. Pneumonia symptoms include dry cough, chest pain, fever, and trouble breathing. Pneumonia can be contagious and can be transmitted from human to human.
Travelers are encouraged to seek medical attention and share their travel history with their health care provider. Travelers returning from China who develop symptoms of pneumonia are advised to call emergency services before going to the doctor or hospital to avoid potential spread of the disease.
The US Center for Diseases Control (CDC) increased their health alert to Level 3 and warned all individuals to avoid all nonessential travel to the whole of China. In particular, CDC officials warned that the virus poses an increased threat to older adults with underlying health conditions.
The WHO declared that the COVID-19 outbreak is a "public health emergency of international concern."
For more information
▪ WHO Novel Coronavirus (COVID-19) website
▪ European Centre for Disease Prevention and Control, Novel coronavirus in China page
▪ US CDC COVID-19 webpage
▪ An up-to-date source indicating the number of cases in each country can be found here.
The three Marylanders who tested positive for the new coronavirus are all in isolation in their homes, state officials said.
The CDC recommends patients with COVID-19 stay home with the exception of seeking medical care. Patients should not attend work or school and should avoid using public transportation, ride-sharing and taxis, the CDC recommends.
Those who have self-isolated within the home should separate from other people and animals. Wearing a face mask, covering coughs and sneezes is believed to help mitigate the spread of the infection. The CDC recommends individuals who are ill should avoid sharing personal household items, clean hands often, clean all “high-touch” surfaces like counters and doorknobs.
Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments, the CDC states.
As of February 19, a total of 2012 deaths have been confirmed and more than 75,192 confirmed cases have been recorded worldwide as of 09:00 (UCT). Cases have been confirmed in every Chinese region (mainland), in addition to Hong Kong SAR, Taiwan, China, and Macau SAR. This includes urban centers such as Beijing, Shanghai, and Shenzhen.
Out of the 2012 deaths reported, 2006 has been reported in China (mainland), two*1 in Hong Kong (Special Administrative Region), one in the Philippines, one in Japan, one in Taiwan, and one in France.
Internationally, the virus has now been confirmed in the US, the UK, Australia, Canada, France, Belgium, Italy, Germany, Sweden, Finland, Spain, Russia, Egypt, United Arab Emirates, Malaysia, Nepal, Thailand, Japan, South Korea, Singapore, Cambodia, Sri Lanka, Vietnam, the Philippines, India. 542 cases were confirmed on a cruise ship quarantined in Japan in what became the biggest cluster of coronavirus infections outside mainland China. Passengers began disembarking on February 19; those infected have already been transferred to hospitals. The US CDC said the quarantine “may not have been sufficient to prevent transmission among individuals on the ship”. *
1 Information with an asterisk have been updated as of the report’s publication date
COVID-19 Factsheet
February 19, 2020
The situation as of February 19, 2020
Chinese authorities have taken strict measures to curb the outbreak:
▪ On February 15, Chinese Government has ordered people returning to Beijing from holidays to quarantine themselves for 14 days, stating individuals failing to obey government orders would be held accountable under the law. It remains unclear whether the restrictions would apply to non-residents and foreigners arriving from abroad.
▪ Chinese returned to work on February 10 after the government eased some traveling/working restrictions. However, a large number of workplaces reportedly remain closed as of February 17 and many people work from home.
▪ Authorities in Hubei province have further tightened restrictions on February 16 with vehicles, apart from essential services, banned from the roads and companies unable to resume work until further notice.
▪ Universities, primary and middle schools, and kindergartens across China will postpone the opening of the spring semester until further notice, according to the General Office of the State Council. In Beijing, it has already been announced that the start of the Chinese school year scheduled for 17/2 would be postponed, without further details. Many other provinces and municipalities, such as Guangdong, Anhui, Zhejiang, Heilongjiang, Jiangsu, Shandong, Hebei, Jiangxi, and Inner Mongolia, as well as Shanghai and Chongqing have announced the closure of all schools until at least the end of February, with no date of resumption. In Shanghai, authorities announced that the semester from primary and secondary schools will start via online learning.
▪ Lots of tourist sites have been closed to the public until further notice on January 24 (section of the Great Wall, Beijing's Forbidden City, Shanghai, Disneyland China). Several cultural and sportive events have also been postponed.
▪ On January 28, China urged its citizens to postpone trips abroad.
▪ China Railway announced on January 28 that some trails along the Beijing Railway will be suspended through 26 February. Railway police have also increased prevention and control measures at stations nationwide until further notice.
▪ Numerous Chinese cities and provinces are subject to travel bans and other restrictive measures imposed by the Chinese authorities. ‘Transport suspension’ includes restrictions on flights, trains, and other public transport services.
▪ In Hong Kong SAR, the suspension of school classes has been extended until at least March 16. The government also said civil servants would be allowed to work from home until February 23.
Japan announced on February 17, that public crowds in Tokyo will be limited to prevent further spread of the disease.
On February 13, the Vietnamese Ministry of Health ordered the quarantine for twenty days of the commune of Son Loi, located in Vinh Phuc Province near Hanoi after a new case was reported, bringing the number of people infected to six in the area (Binh Xuyen district). The government has also suspended festivals and sporting events throughout the country as a precaution.
In Mongolia, all education centers (schools, kindergartens, universities, etc.) will be closed until March 30* and all public gatherings have been banned.
While China’s government top medical adviser on the outbreak said that the outbreak may peak in April, before easing, the director-general of the WHO expressed concerns about a small number of cases outside China that were transmitted without any travel to China and could be “the spark that becomes a bigger fire”. WHO chief added on February 11 that the first vaccine was 18 months away.
Travel restrictions
Several countries have taken measures (including fever screening) to step up surveillance at airports. 2
Some countries have advised their citizens against all unnecessary trips to China and against all trip to Hubei province.3 Some have implemented a ‘DO NOT TRAVEL’ warning to China to its citizens.
Several neighboring countries have decided to close their land borders with China:
▪ Kyrgyzstan
▪ Mongolia
▪ Nepal
▪ Russia
▪ In Hong Kong SAR, all border crossings with mainland China except for the Shenzhen Bay joint checkpoint and the Hong Kong SAR-Zhuhai-Macau SAR Bridge will be closed from February 3
▪ North Korea has closed borders to all foreign tourists
▪ Vietnam closed border crossing at Lao Cai to Chinese nationals.
Numerous airlines have canceled part or all routes within/to China. Other airlines such as US’ American Airlines and United Airlines have also suspended flights to Hong Kong SAR.4
Some neighboring countries have implemented transportation restrictions to China.
▪ Russia’s rail line operator Russian Railways announced on February 2, that it will cancel train service to China.
▪ Hong Kong SAR authorities suspended high-speed rail services and ferries from Hong Kong SAR to mainland China until further notice as of January 30.
▪ Kazakhstan has suspended all forms of passenger transportation services to and from China as of February 3.
▪ Vietnam has suspended on February 4 all passenger trains to and from China indefinitely.
Several countries have implemented entry restrictions for travelers who visited China recently.
▪ On January 31, the United States declared a public health emergency, which will temporarily suspend entry into the United States of foreign nationals who pose a risk of transmitting the 2019 novel coronavirus. The restriction applies to any foreign nationals that have visited China in the last two weeks. It is not specified whether these measures apply exclusively to travelers into mainland China or if those from Hong Kong SAR and Taiwan, China are also subject to screenings. Americans who visited Hubei province only would be quarantined for up to two weeks. Those arriving from other parts of China are subject to screening. The government also raised its travel advisory for China to “Do Not Travel.”
2 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/ 3 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/ 4 For more information, please refer to the alerts on the Travel Security Platform https://travelsecurity.garda.com/
▪ Bahamas authorities have implemented a travel ban restricting any non-residents, regardless of nationality, who have visited mainland China within the last 20 days from entering the country.
▪ Trinidad and Tobago have banned arrivals of travelers who have been to mainland China, until further notice. TT nationals and permanent residents returning from China will not be allowed to enter the country for 14 days after leaving China.
▪ Antigua & Bermuda has banned arrivals of travelers who have been to mainland China, until further notice. The government has not yet given any time limits permissible between leaving China and traveling to Antigua and Barbuda.
▪ Marshall Islands announced a ban on direct travel from China to the islands: "Any traveler with travel originating from or transiting through China must spend at least 14 days in a country not affected by COVID-19."
▪ Jamaica health authorities announced that individuals entering the country from China will spend 14 days in quarantine facilities provided by the government.
▪ Saint Lucia will ban non-nationals who have recently visited China within 14 days from entering the country.
▪ Suriname announced on February 6, that all passengers from China will be quarantined for 14 days. Travelers (non-residents) who have been in China for 14 days (from the date of declaration) are no longer admitted to the territory.
▪ Grenada issued new entry restrictions on February 2 for individuals traveling from China. Any non-national who has travel history to mainland China within the past 14 days, either originating or in transit, will not be allowed entry at any local port. All nationals with similar travel history will be placed under a 14-day quarantine as a precaution.
▪ The government of St Vincent and the Grenadines announced on February 8 that anyone has been in mainland China in the last 14 days and arriving in the country would be quarantined.
▪ Belize’s authorities announced on February 8, that travelers who have visited China within the past 14 days will be denied entry prior to arrival.
▪ The Government of Barbados has announced that individuals who have visited Hubei Province (China) within the past 14 days will be placed in quarantine at the local Infection Control Centre. Individuals who have been to other parts of China, and countries other than China who might have been affected by the virus in the past 14 days will be screened and if necessary placed in-home quarantine.
▪ Samoa (US): All foreigners except Samoa citizens are required to spend 14 days in Hawaii before entering the territory.
▪ On February 1, the Australian government announced it will deny entry to foreign nationals who traveled through or left mainland China. As of Saturday, those traveling from Hong Kong SAR and Taiwan, China are not subject to this measure. Citizens, permanent residents, and their immediate family, legal guardians, and spouses will be allowed entry, though will be required to
self-isolate. The measure was extended until February 22 and will be reviewed each week. In addition to this, the government also raised its advice level for China to: “Do not go to China”.
▪ New Zealand has banned all foreign nationals traveling from, or transiting through mainland China, from entering the country as of February 3 until at least February 23. All other travelers to New Zealand will be subject to increased screening measures. New Zealand nationals and permanent residents returning from China will still be able to enter the country, but will be required to self-isolate for 14 days after arrival. The alert level for travel to mainland China has been raised to "Do not travel."
▪ Singapore has banned arrivals of travelers who have been to China in the last 14 days. It has also stopped issuing visas to Chinese nationals, and declared the suspension of previously-issued visas to Chinese nationals. Singapore nationals, Permanent Residents and long-term visa holders returning from China will be placed in quarantine for 14 days.
▪ Mongolia has barred all Chinese nationals and foreigners from entering the country by plane, rail and road from February 1, through March 2. After February 6, Mongolians in China will only be allowed to return via Ulaanbaatar's Chinggis Khaan International Airport (ULN) or the Zamiin Uud rail border.
▪ In Russia, Chinese nationals will be banned from entering the Russian Federation from February 20. However, the new measures will not affect travelers who are transiting at Russian airports*.
▪ Kyrgyzstan health authorities announced that individuals entering the country from China will spend 14 days in quarantine facilities provided by the government.
▪ Turkmenistan has put quarantine measures in place for foreign travelers arriving at airport. Travelers may be sent to hospitals for mandatory quarantine if they display symptoms of possible exposure and/or travel histories indicating possible exposure to the virus.
▪ Authorities in Uzbekistan announced that individuals coming from China or having transited through China, including Hong Kong and Macao SARs, within 14 days before entering the country will spend 14 days in quarantine*.
▪ Japan said that it would bar foreigners who had visited Hubei in the past 14 days.
▪ Taiwan’s Bureau of Consular Affairs (BOCA) announced that starting February 7, in view of the fact that the Taiwan government has designated all areas of China, including Hong Kong and Macao SARs, as being severely affected by the novel coronavirus outbreak (areas of level 2 or higher), foreign nationals who have visited or resided anywhere in China, including Hong Kong and Macao SARs, in the previous 14 days will be temporarily prohibited from entering Taiwan. Entry visa applications by such foreign nationals, including those submitted for special reasons, will not be accepted by Taiwan’s overseas missions while this temporary measure is in effect. In addition, foreign nationals possessing a valid Taiwan Resident Certificate who have visited or resided in China, including Hong Kong and Macao SARs, in the previous 14 days shall be permitted entry but shall self-isolate in their home and carefully monitor their health for a period of 14 days after returning to Taiwan. The Taiwan Center for Disease Control (CDC) announced February 11, that all travelers arriving from areas outside of China, Hong Kong, and Macao SARs will be required to complete a health declaration form and accurately provide their travel and contact history regarding whether they have visited China, Hong Kong, or Macau SARs over the past 14 days before entry. If travelers provide inaccurate information or refuse, they will be fined up to $5000 USD.
▪ Hong Kong SAR announced that all travelers from mainland China, including Hong Kong SAR residents, will be required to be on quarantine for 14 days. Reports also indicate that civil servants will be asked to remain home until February 16 at the earliest.
▪ Bangladesh will no longer allow entry of Chinese nationals unless they are prescreened.
▪ The Maldives has banned arrivals of travelers who have been to mainland China, until further notice. Only Maldivian citizens who are returning from mainland China will be exempted, though they will be placed under quarantine.
▪ South Korea will ban the entry of foreigners from Hubei province from February 4, until further notice. Travelers arriving from China, Hong Kong, and Macao SARs are required to complete a health declaration on arrival, provide local contact details, and report daily on health conditions using an app.
▪ The Philippines government has temporarily banned the entry of any person, regardless of nationality, except Filipino citizens and holders of Permanent Resident Visa directly coming from China and its SARs. Also in place is a temporary ban on the entry of any person, regardless of nationality, except Filipino citizens and holders of Permanent Resident Visa who within 14 days immediately preceding arrival in the Philippines, has been to China and its SARs. There is a mandatory 14-day quarantine for Filipinos and Permanent Resident Visa holders coming from any place in China and its SARs.
▪ Indonesia has barred visitors who have been in China in the past 14 days.
▪ India bans entry of all Chinese nationals as well as foreigners who traveled to China since January 15.
▪ Malaysia has stopped issuing visas to travelers from any province placed under lockdown by the Chinese government.
▪ The Vietnamese authorities on February 15 have banned entry to individuals (excluding citizens and permanent residents) that have traveled from or transited through China in the preceding 14 days.
▪ Papua New Guinea has banned all travelers from Asia from entering the country via air and sea. The border with Indonesia has been temporarily closed.
▪ Brunei announced it would ban entry to all travelers that have been in Hubei, Zhejiang, and Jiangsu provinces in the 14 days prior to their intended travel date, with the exception of citizens and permanent residents of Brunei.
▪ Tonga has required that a health declaration card must be completed by all foreign travelers upon arrival from February 3. If traveling from China, a 14 days self-quarantine in a country free from the virus will be required. A medical clearance within three days before traveling to Tonga will also be required.
▪ Samoa has imposed restrictions for anyone traveling to the island. A health declaration form must be completed by all foreign travelers upon arrival. Travelers from mainland China, Hong Kong SAR, and Macau SAR must spend at least 14 self-quarantine days in a country free from the virus. Travelers from countries with confirmed virus cases must undergo a medical examination three days before traveling. The full list can be found here.
▪ Guam will deny entry to travelers who have been in China (excluding Hong Kong and Macau SARs) within 14 days of arrival in Guam*.
▪ Palau announced a new regulation that will deny entry to travelers who have been to China, Hong Kong, and Macao SARs in the 14 days prior to their arrival.
▪ Solomon Islands authorities announced a new regulation that will deny entry to travelers who have been to any country with a confirmed case in the 14 days prior to their arrival. Residents and those with long-term passes (e.g., work permits, student visas) are exempted from the restriction.
▪ Vanuatu authorities decided on January 31 that anyone who has traveled to or been in China, Hong-Kong SAR, Macao SAR, and Taiwan (China) or having transited through China, Hong-Kong SAR, and Macao SAR, and Taiwan (China), in the 14 days prior to their arrival in Vanuatu will not be allowed to enter in the country. Passengers who have traveled to or been in mainland China, Hong Kong, Macao, or Taiwan (China) as of December 31, and spent the 14 days prior to their arrival in Vanuatu in another country, will be required to provide a medical certification issued by a doctor stating that they do not have respiratory illnesses. Any traveler showing symptoms of respiratory illness (fever, runny nose, flu-like condition, headache, chest pain, or breathing difficulties) must provide a medical certificate indicating a negative result of the COVID-19 coronavirus test.
▪ Timor-Leste authorities will deny entry to anyone who has visited the province of Hubei in the past four weeks. If you transited in other provinces in China in the last four weeks, you might be forbidden to enter the territory unless you present a medical certificate issued by a recognized medical institution.
▪ Israel expanded quarantine orders on February 16, to include individuals that have traveled to Thailand, Hong Kong SAR, Singapore, or Macao SAR in the preceding 14 day. Previous quarantine orders included individuals having traveled to China, Taiwan, South Korea, or Japan.
▪ Iraqi authorities announced that it would prohibit foreign travelers coming from China by sea, land, or air, to enter the country, adding that travelers with a Chinese visa issued on or after January 14, arriving at Erbil and Souleymanieh International Airports will be denied entry.
▪ Saudi Arabia announced it is barring its nationals and residents from traveling to China. It stated that citizens who do not observe the policy would face consequences, and residents will not be permitted to enter the country.
▪ In Jordan, all travelers arriving via Jordanian airports and land borders will be screened for the virus. Those displaying symptoms of the virus and have a travel record that may indicate possible exposure will be immediately moved to Al Bashir hospital in Amman for a 14-day quarantine.
▪ In Lebanon, authorities announced on February 9, that all arrivals from China will be placed under home quarantine. The announcement also stated that screening tests and isolation rooms were prepared at the Rafic Hariri government hospital in Beirut. It is not clear whether this policy applies to travelers entering Lebanon directly from China or if it includes those with recent travels to China as well.
▪ Gabon announced that it was suspending entry to its territory for all passengers from China until further notice.
▪ Angolan authorities have announced on February 6, that all passengers from China will be automatically placed in quarantine, without specifying how it will be applied.
▪ Malagasy authorities have forbidden all airlines to aboard travelers coming from China, Hong Kong or Macao SARs or having transited through those areas within 14 days before taking their flight to Madagascar.
▪ The government of Sierra Leone announced that travelers who have visited China in the last 14 days and wishing to enter the country at any point of entry would be subject to a period of quarantine, with regular follow up by trained health workers to monitor health for the duration of the incubation period.
Several countries have also implemented visa restrictions to Chinese nationals; some examples include Canada, Czech Republic, Greece, Italy, Kazakhstan, Mozambique, Sri Lanka, the Philippines, India, and Vietnam. Visa restrictions have also been implemented in some countries for foreign nationals who have visited China in the past days.
• Existing Indian visas of all Chinese nationals and other foreign nationals who are either based out of China or who have visited China in the last two weeks are canceled.
• Vietnamese authorities announced that visas will not be issued for all non-Vietnamese nationals arriving from mainland China, excluding Hong Kong and Macao SARs, or who stayed in China within 14 days of their arrival in Vietnam.
Recommendations
As the human to human transmission has been confirmed and the disease can notably be transmitted:
▪ By air by infected people coughing or sneezing
▪ By close personal contact, such as touching or shaking hands
The WHO advises that measures to limit the risk of exportation or importation of the disease should be implemented.
To reduce the general risk of transmission, travelers are advised to abide the following measures:
▪ Frequently clean hands by using alcohol-based hand rub or soap and water
▪ When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands
▪ Avoid close contact with anyone who has fever and cough
▪ If you have fever, cough and difficulty breathing seek medical care early and share previous travel history with your health care provider
▪ When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces in contact with animals
▪ The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good food safety practices
▪ Adhere to all instructions issued by local authorities and their home governments
In the case that symptoms suggestive of respiratory illness emerge either during or after travel, such as:
▪ Fever, cough, shortness of breath, and breathing difficulties
▪ In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death. Pneumonia symptoms include dry cough, chest pain, fever, and trouble breathing. Pneumonia can be contagious and can be transmitted from human to human.
Travelers are encouraged to seek medical attention and share their travel history with their health care provider. Travelers returning from China who develop symptoms of pneumonia are advised to call emergency services before going to the doctor or hospital to avoid potential spread of the disease.
The US Center for Diseases Control (CDC) increased their health alert to Level 3 and warned all individuals to avoid all nonessential travel to the whole of China. In particular, CDC officials warned that the virus poses an increased threat to older adults with underlying health conditions.
The WHO declared that the COVID-19 outbreak is a "public health emergency of international concern."
For more information
▪ WHO Novel Coronavirus (COVID-19) website
▪ European Centre for Disease Prevention and Control, Novel coronavirus in China page
▪ US CDC COVID-19 webpage
▪ An up-to-date source indicating the number of cases in each country can be found here. 
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