Epidemiology & clinical management of COVID-19

CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT| EVENTS

Epidemiology & clinical management of COVID-19

CORONAVIRUS (COVID-19) UPDATE NO. 3119 June 2020

CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS

• Nearly 8.25 million COVID-19 cases globally• Nearly 450 000 deaths

Top ten countries with the highest number of new cases over the past 24 hours:Chile - 36 179Brazil – 34 918USA – 27 921India - 12 881Russian Federation – 7 790Pakistan - 5 358 Saudi Arabia - 4 919Mexico - 4 599Peru - 4 164South Africa - 4 078

Current situation 1/2

Current global situation

Data as of 06h00 18.06.20


Current situation 2/2

Current global situation

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Number of new deaths of COVID-19 per day, by WHO Region

AFRO AMRO EMRO EURO SEARO WPRO


Epidemiological characteristics COVID-19

Epidemiology 1/6

This update covers two recently published reports on the epidemiological characteristics of COVID-19: One from China1 and one from The United States of America2

Time period analysed:• China: From December 2019 to 20 February 2020 • USA: From 22 January to 30 May 2020

Cases and deaths• China:

• 75 565 total, 55 924 lab confirmed , 2114 deaths• Median age: 48 years (IQR: 39-63); 51,1% male

• USA: • 1 761 503 total, 1 320,488 lab confirmed, 103 700 deaths• Median age: 48 years (IQR: 33-65); 48.9% female

1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w

http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm%3Fs_cid=mm6924e2_w


Age distribution of laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)

Epidemiology 2/6

1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w

0.9%

1.2%

8.1%

17.0%

19.2%

22.4%

19.2%

8.8%

3.2%

1.5%

3.7%

13.8%

16.3%

16.6%

17.9%

13.6%

8.0%

8.7%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

≤80

USA China

Age




Case fatality ratio by age group for laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 –

30.05.20)

0%

0.2%

0.2%

0.2%

0.4%

1.3%

3.6%

8.0%

14.8%

0.1%

0.1%

0.1%

0.4%

1.0%

2.4%

6.7%

16.6%

28.7%

0% 5% 10% 15% 20% 25% 30%

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

≤80

Case fatality ratio USA China

Age


Epidemiology 3/6




Proportion of cases of COVID-19 reporting selected symptoms –data from China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)

88%

68%

19%15%

5%

14% 14%

5% 4%1% 1%

33%

11%

38%

43%

50%

29%

36%

6%

20%

34%

12%8%

19%

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

feverCough

Shortn

ess of b

reath

Myalgia

Runny nose

Sore th

roat

Headach

e

Nausea/V

omiting

Abdominal Pain

Diarrhea

Loss

of smell o

r tast

e

hemoptysis

conjuncti

val…

sputum producti

onch

ills

Fatig

ue

China USA

Epidemiology 4/6





32.2%

30.2%

17.5%

4.8%

1.4%

7.6%

5.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Any cardiovascular disease

Diabetes

Chronic respiratory disease

Cancer

Neurological disability

Liver disease

Renal disease

Inmunocompromised

USA % CHINA %

Reported underlying medical conditions for laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)

Epidemiology 5/6





Disease severity in laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)

Disease severity China USA

Mild to moderate 80% 84%

Severe 15% 14%

Critical 5% 2%USA data:• Hospitalization was six times more frequent among patients with a reported underlying

condition (45.4%) compared to those without such conditions (7.6%)

• Death occurred 12 times more often among patients with reported underlying conditions (19.5%) compared with those without such conditions (1.6%)

Epidemiology 6/6





Clinical disease progression for COVID-19

Clinical management 1/5

Incubation period

Mild moderate disease

80%

Severe disease

15%

Critical5%

Death

Infectious

Onset symptoms (cough, fever)

Shortness of breath, hypoxia

Respiratory failure, multiorgan system dysfunction

Median 4-5 days (1-14 days)

Recovery average14 days

Median 7-10 days after onset symptoms

Median 10-12 days after onset symptoms


Care of suspected or confirmed mild COVID-19: symptomatic treatment

• Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home.

• Give symptomatic treatment such as antipyretics for fever and pain, adequate nutrition and appropriate rehydration.

• Counsel patients about signs and symptoms that should prompt urgent care.

Ø Antibiotic therapy or prophylaxis are not indicated



Care of moderate COVID-19 with pneumonia

• Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home. Patients with moderate illness may not require hospitalization.

• For patients at higher risk of severe disease, isolation in hospital is preferred.

• Antibiotics are not indicated unless there is clinical suspicion of a bacterial infection

• Monitor closely for signs or symptoms of disease progression.



Care of severe COVID-19 with pneumonia

• Equip all areas for severely ill patients with functioning oxygen system.

• Closely monitor patients for signs of clinical deterioration, such as rapidly progressive respiratory failure and shock; respond immediately with supportive care interventions.

• Monitor patients for signs of thromboembolism or related conditions, such as stroke, deep venous thrombosis, pulmonary embolism or acute coronary syndrome.



Recovery trial: Dexamethasone in ventilated COVID-19 patients• Statement by trial investigators (University of Oxford)Ø The results have not been published in a journal yet

• Over 6000 hospitalized patients were randomized to receive either dexamethasone (6 mg daily) or usual care for 10 days

• Dexamethasone was associated with significantly fewer deaths among patients compared with those given usual care

v Patients on oxygen: dexa group had one-fifth fewer deaths compared to usual care

v Patients on ventilator: dexa group had one-third fewer deaths compared to usual care

• For patients who didn't require oxygen or respiratory support, there was no observed additional benefit with dexamethasone

https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19


https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19


Upcoming eventsWebinar: Public Health Emergency Operations Centres (PHEOCs) for COVID 19 Response. Tuesday 23 June 14h00 Geneva time.Register

Pre-conference of the 1st WHO infodemiology conference.29 June 2020. https://www.who.int/news-room/events/detail/2020/06/29/default-calendar/pre-conference-1st-who-infodemiology-conference

https://who.zoom.us/webinar/register/WN_G7HZ6lLzSvSvWvB_Uyp0Og

https://www.who.int/news-room/events/detail/2020/06/29/default-calendar/pre-conference-1st-who-infodemiology-conference

Epidemiology & clinical management of COVID-19

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