UNITED STATES
The US CDC reported 10.31 million total cases and 241,069 deaths. The US reported a new single-day incidence record for the second consecutive day, with 143,408 new cases, and the average daily incidence surpassed 120,000 new cases per day. The US reported more than 3,300 deaths in the past 2 days, and the average daily mortality increased to 1,134 deaths per day, the highest average since the very peak of the summer resurgence on August 1 (1,145). The US could surpass 250,000 cumulative deaths by the end of next week, and if this trend continues, the US is poised to report the highest daily mortality since the first COVID-19 surge in March-May.
From September 28 to October 19, the US daily incidence increased by 32% (43,373 new cases per day to 57,291). Shifting the mortality data by 3 weeks to account for the lag between incidence and mortality, the US COVID-19 mortality increased by 35% over the same length of time, from 721 deaths per day on October 19 to 976 on November 9. If a similar trend continues over the next several weeks (ie, that mortality continues to lag behind incidence by approximately 3 weeks), the US could soon face a major surge in mortality. From October 20 through November 9, US COVID-19 incidence increased by 91% (57,291 new cases per day to 109,663), which would correspond to an increase in mortality from 976 deaths per day to more than 1,850 over the next 3 weeks.
Mortality does not necessarily increase proportionately with incidence, but even half of that increase would correspond to more than 1,400 daily deaths. For reference, the peak daily mortality was 2,856 deaths per day on April 21, at a time when the epidemic was surging in New York City, Boston, and a small number of other cities, and we knew very little about the disease or effective clinical care. Hospitals did not have adequate bed space, ventilators, PPE, and other critical supplies, and field hospitals were established—and humanitarian hospital ships deployed—because even large urban hospitals were unable to handle the patient surge. Notably, the US CDC ensemble model forecasts that weekly mortality could reach more than 8,600 deaths by the first week of December, which would equate to approximately 1,230 daily deaths (50% prediction range: 1,052 to 1,536 deaths per day).
Half of all US states have reported more than 150,000 cumulative cases, and more than one-third have reported more than 200,000 cases:
>800,000: Florida
California’s COVID-19 website is reporting 991,609 cumulative cases, and Texas’ is reporting 993,841. We expect both states to surpass 1 million cases in the coming days. We also expect Virginia to surpass 200,000 cases in the near future.
The Johns Hopkins CSSE dashboard reported 10.59 million US cases and 242,811 deaths as of 12:30pm EST on November 13.
CHINA Shanghai, China, reported a locally acquired case of COVID-19 on November 10. While many countries around the world are battling a surge in COVID-19 incidence, this marks the first locally acquired infection in Shanghai in several months. According to local officials in China, the individual worked at Shanghai Pudong International Airport, and at least 25 close contacts have been quarantined. While SARS-CoV-2 emerged in China, China has largely contained its epidemic. In fact, the vast majority of cases over the past several months have been among arriving travelers. In an effort to maintain this level of epidemic control, the Chinese government is reportedly taking new steps to limit the possibility of importing COVID-19. One aspect of these efforts involves disinfecting packaging and transport vehicles carrying imported frozen food, after China identified contaminated food products as the source of several SARS-CoV-2 infections among cargo handlers and port workers.
PERU The Congress of the Republic of Peru voted earlier this week to remove President Martín Vizcarra Cornejo from office due to “permanent moral incapacity.” The vote passed by a count of 105 to 19, with a minimum of 87 votes required. The decision was driven by a myriad of factors, including the government’s response to the ongoing COVID-19 epidemic. Now-former President Vizcarra announced that he would not contest the outcome of the vote, and former President of the Congress, Manuel Merino De Lama, was sworn in as President of Peru on Tuesday. While the transition is undoubtedly causing political turmoil, which is particularly concerning in the midst of a pandemic, the peaceful and uncontested process could be a positive indication that the transition will not hinder Peru’s COVID-19 response. Peru has reported the highest cumulative per capita COVID-19 mortality in South America, and it ranks #2 in terms of cumulative per capita incidence, just behind Argentina.
KENYA Kenya, like many other sub-Saharan African countries, has reported much lower COVID-19 disease burden than initially anticipated by many experts. Researchers in Kenya conducted a study of SARS-CoV-2 seroprevalence in blood donors in order to provide insight into the scale of transmission in Kenya. The study, published in Science, assessed the presence of IgG antibodies against SARS-CoV-2 among Kenyan blood donors from April-June. The researchers analyze more than 3,000 blood samples collected at 4 Kenya National Blood Transfusion Service centers. Among these samples, 174 (5.6%) tested positive for SARS-CoV-2 antibodies. Seropositivity in individuals under the age of 55 ranged from 3.4% for individuals 45-54 years old to 7.0% for individuals 35-44 years old. None of the 71 donors aged 55-64 years were seropositive. Seroprevalence also varied significantly by geographic region. Seropositivity was highest among individuals in the Western region of the country (10.0%) and lowest in the Rift Valley region (1.9%), with most regions falling in the 4-7% range. Seropositivity was elevated in major urban areas, including Mombasa (9.3%) and Nairobi (8.9%).
The authors concluded that seroprevalence observed in their study was comparable to that observed in other countries, including China, Switzerland, and the US after their initial peaks in incidence, which is elevated compared to what would be expected based on Kenya’s reported incidence. While the relatively high seroprevalence could indicate that existing surveillance systems are not adequately capturing COVID-19 incidence in Kenya, the researchers believe this is not the predominant factor. The researchers argue that the sample population—which skewed heavily toward males, younger adults (eg, 25-34 years), and coastal regions of the country—more likely overestimates the national seroprevalence. If existing surveillance systems under-ascertained COVID-19 cases to the degree indicated by the seroprevalence results, it is likely that COVID-19 hospitalizations and mortality would be much higher than what has been reported thus far.
UKRANIAN PRESIDENT HOSPITALIZED Another head of state has been hospitalized because of COVID-19. Ukrainian President Volodymyr Zelenskiy announced on Monday that he was diagnosed with COVID-19 and admitted to the hospital for treatment. Reportedly, President Zelenskiy is experiencing relatively mild symptoms, and he was hospitalized as a precaution and to better facilitate his isolation. In a public statement, President Zelenskiy emphasized that his infection illustrates that nobody is safe from COVID-19, even with the highest levels of protection. Like the rest of Europe, Ukraine is facing a major surge in transmission, although, in contrast to some other European countries that were severely affected early in the pandemic, Ukraine’s first “wave” was much smaller and later. Ukraine is currently setting new records in terms of daily incidence and mortality, reporting more than 10,000 new cases and nearly 175 deaths per day.
SOUTH AFRICA INTERNATIONAL TRAVEL South African President Cyril Ramaphosa announced that the country is lifting restrictions on international travelers. South Africa previously resumed international travel in early October, but it restricted entry for travelers arriving from countries with high levels of transmission. While country-specific restrictions have been lifted, travelers must still provide evidence of a recent negative SARS-CoV-2 test before entering South Africa. South Africa’s tourism website and Department of Home Affairs website both still include a list of high-risk countries. The policy change aims to boost South Africa’s tourism sector; however, the decision comes amid a global rise in SARS-CoV-2 transmission, which has raised concern by some public health professionals. President Ramaphosa also indicated that the South African government will monitor COVID-19 trends closely to determine if the policy change has any adverse effects on COVID-19 incidence. South Africa has reported nearly 750,000
Via John Hopkins Center For Health Security
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