Tulane Outbreak Daily | March 23, 2020

Editor’s Note: If you have information from your region to share, or want to post information to the website/Tulane Outbreak Daily send to cmiller15@tulane.edu. 

Featured Headlines

Lab Alert: Discontinue Use of the A549/MV1LU Mix for Respiratory Viral Culture Panels – CDC  Because of the risk of infection with SARS-CoV-2 among laboratory workers, CDC recommends that laboratories discontinue the use of the A549/MV1LU mix when they perform respiratory viral culture panels. Using these specific cell lines has been shown to result in a very low level of SARS-CoV replication. CDC recommends that laboratories perform respiratory viral culture panels using cell lines that will not support SARS-CoV viral replication.
New York City Region Is Now an Epicenter of the Coronavirus Pandemic – NYT The city and its suburbs account for roughly 5 percent of global cases, forcing officials to take urgent steps to stem the outbreak.
National Guard activated for 3 states as US COVID-19 cases pass 33,000 – CIDRAP Scientists Identify 69 Drugs to Test Against the Coronavirus – NYT Nearly 70 drugs and experimental compounds may be effective in treating the coronavirus. Twenty six of the coronavirus’s 29 genes were investigated, which direct production of the viral proteins. Researchers found 332 human proteins targeted by the coronavirus. Some viral proteins seemed to target just one human protein; other viral proteins are capable of targeting a dozen human cellular proteins.[related pre-pub paper
This Coronavirus Patient Dodged A Bullet With Hydroxychloroquine. Is She A Harbinger Or Outlier? – Forbes She had been ill since March 8, toughing it out through fatigue, a cough and fevers that brought on vicious chills for five evenings straight. Finally, on March 15, she went to an urgent care center and, on March 16, to an emergency room. Novins, who shared her lab tests and medication list, got her diagnosis March 19. She had the coronavirus, or COVID-19.
Government watchdog launches review into HHS’ coronavirus response – CNN The HHS inspector general is specifically launching a review into the department’s repatriation and quarantine efforts and looking into whether nursing homes — one of which became the US epicenter of the coronavirus outbreak

Fauci: U.S. ‘looking very closely’ at severe coronavirus symptoms in younger Americans – NBC News Fauci was responding to new data from the Centers for Disease Control and Prevention, which, after studying more than 4,000 cases in the U.S., showed that about 40 percent of those who were hospitalized for the virus as of March 16 were ages 20 to 54. Among the most critical cases, 12 percent of intensive care admissions were among those ages 20 to 44, while 36 percent were for those 45 to 64.

Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection – NYT Doctor groups are recommending testing and isolation for people who lose their ability to smell and taste, even if they have no other symptoms.On Friday, British ear, nose and throat doctors, citing reports from colleagues around the world, called on adults who lose their senses of smell to isolate themselves for seven days, even if they have no other symptoms, to slow the disease’s spread. The published data is limited, but doctors are concerned enough to raise warnings.

Lessons from Past Outbreaks Could Help Fight the Coronavirus Pandemic – Scientific American Whereas COVID-19 is caused by a coronavirus and not an influenza virus, the 1918 flu pandemic—which caused millions of deaths worldwide, might be the best model to understand this novel pathogen’s behavior. It is also an outbreak for which massive social interventions were undertaken.

Scientists Warned China Was a “Time Bomb” for Novel Coronavirus Outbreak in 2007 – SciTechDaily 12 years before the COVID-19 pandemic began, scientists warned, in a study published by Clinical Microbiology Reviews in 2007, that the situation in China was a “time bomb” for a dangerous virus outbreak. Their cause for concern was due to the culture of eating exotic mammals in southern China, with the crowded wet markets packed with wild game and lacking biosecurity, and the common presence of SARS-CoV-like viruses in horseshoe bats, in combination with the well-known ability of coronaviruses to undergo genetic recombination. [Related paper in Clinical Microbiology Reviews 2007]

What Singapore can teach the U.S. about responding to Covid-19 – Stat News Singapore, has managed to contain the spread of the SARS-CoV-2 virus within its borders, as have mainland China, Taiwan, Hong Kong, and South Korea. Commonalities of these successful responses include extensive preparation in the wake of the severe acute respiratory syndrome (SARS) outbreak in 2003, aggressive testing and transparent case reporting to both domestic and international stakeholders, swift and decisive interventions to promote or impose social distancing, and frequent and consistent public health communications.

[Opinion] Coronavirus and the least development countries – Reuters As countries queue up their COVD-19 response mechanisms, an even bigger threat has largely been ignored by the international community: What will happen when the coronavirus spreads to the world’s least developed countries (LDCs) and war-torn environments, where healthcare systems are informal, insufficient or nonexistent.


Editor’s note: Regarding the case counts below, please consider due to limited testing capabilities in some locations, the real number of cases could be considerably higher.

Official Reporting


Total (new) cases in last 24 hours

Globally: 292,142 confirmed (26,069) 12,784 deaths (1,600)
Western Pacific Region: 94,787 confirmed (750) 3,438 deaths (12)
European Region: 151,293 confirmed (22,752) 7,426 deaths (1,426)
South-East Asia Region: 1,257 confirmed (278) 45 deaths (7)
Eastern Mediterranean Region: 23,669 confirmed (1,314) 1,596 deaths (130)
Region of the Americas: 19,685 confirmed (808) 252 deaths (17)
African Region: 739 confirmed (167) 20 deaths (8)



As of March 22, 2020 (ECDC)

Confirmed Cases: 305,275
Deaths: 12,942
Cases < 15 Days: 203,152
For comparison, last Friday March 19, 2020

Confirmed Cases: 213,254
Deaths: 8,843
Cases < 15 Days 120,187

Total cases: 15,219
Total deaths: 201
Jurisdictions reporting cases: 54 (50 states, District of Columbia, Puerto Rico, Guam, and US Virgin Islands)

Travel Related: 337
Close Contact: 321
Under Investigation: 14,561
Total Cases: 15,219

Surveillance Headlines


Georgia: Trio Test Positive for Coronavirus at Georgia Prison – 103Radio

Ohio: Gov issued a stay-at-home order that goes into effect tomorrow and lasts until Apr 6 – CIDRAP It allows essential businesses to remain open, but exempts religious organizations, though the order warns that gathering in groups is dangerous. Ohio—with a population of about 11.7 million—has reported 351 cases, 3 of them fatal. CIDRAP

Louisiana: Governor  announced a stay-at-home order that begins tomorrow at 5:00 pm and is in effect until Apr 13. The order affects 4.6 million people; the state has reported 837 cases, 20 of them fatal. CIDRAP

New York: Reports 5,429 more cases, plus 58 more deaths, pushing its totals to 15,168 cases, 114 of them fatal. New York City has reported 9,045 of the cases. CIDRAP

New Jersey: Reported 587 new cases, plus 4 more deaths, lifting its respective totals to 1,914 and 587. CIDRAP

Washington (State): Reported 1,793 cases, 94 of them fatal. CIDRAP

California: Reported 224 more cases and 4 more deaths, putting the state’s respective totals at 1,468 and 27. CIDRAP

Washington DC: Kentucky Senator Rand Paul announced that he has tested positive for COVID-19.

Maryland: Maryland Gov. Hogan announces closure of non-essential businesses due to coronavirus pandemic – Baltimore Sun


Germany: Angela Merkel to quarantine after meeting infected doctor – DW

Germany: The total is at 18,610, reflecting the addition of 1,948 cases – CIDRAP

Spain: Reports 462 coronavirus deaths in just 24 hours – ElPais

Spain: The prime minister extended the state of emergency for another 15 days, and reported 394 more deaths, lifting its fatality count to 1,720, and 3,107 new cases, overall total to 28,603. – CIDRAP

Italy: Relentless Rise In COVID-19 Deaths – NPR

Italy: Reported 5,560 new cases, down from 6,557 new cases reported yesterday, raising its total to 59,138. Also reported were 651 more deaths, with a total of 5,476 deaths.


India: Is Maharashtra becoming India’s Covid-19 epicentre? – Times of India

Philippines: Medical City exceeds hospital capacity for COVID-19 patients – CNN Philippines

Middle East

Iran: Reported 1,028 more cases, up from 966 new cases reported yesterday, for a total of 21,638 cases. They also reported 129 more deaths, putting the fatality count at 1,685. Doctors Without Borders (MSF)announced that it is setting up an inflatable treatment unit in the Iranian city of Isfahan to treat critically ill patients. The 50-bed unit will be installed on the grounds of the city’s Amin Hospital and will be staffed by an MSF emergency team that includes nine doctors and logisticians who will work with local medical staff and coordinate with Iranian health officials. CIDRAP

Syria: Reported its first case, which involved a 20-year-old woman who had traveled abroad – CIDRAP


Uganda: First case reported, a citizen who arrived on a flight and was found to have a fever during airport screening. CIDRAP

Mozambique: Announced the first case CIDRAP

Kenya:  Confirmed 8 more cases, raising its total to 15. CIDRAP

Rwanda: Announced a 2-week lockdown to slow the spread of the virus, which followed the detection of 6 more cases that raised the country’s total to 17. CIDRAP

Burkina Faso: 4 government ministers have tested positive for the virus, and the number of cases has risen to 40, the highest in West Africa. CIDRAP

Travel Advisories

Look up current travel advisories at US Department of State

U.S. CDC Travel Advisories

Infection Prevention

EPA Updated Guidance on Disinfectants and Drinking Water – EPA

Covid-19: the science of soap – RMZ/New Zealand A virus is a very intriguing package of nucleic acid that is wrapped up in a protein exterior and then, in some cases, surrounded by a lipid – or a fat – envelope

Hospitals scramble to keep up with CDC N95, mask guidance – CIDRAP


Science and Tech

Coronavirus to be tracked using its genetic code – BBC Sequencing the coronavirus’s genetic code from different patients allows researchers to build up a picture of how the virus is spreading.

IBM, Amazon, Google and Microsoft partner with White House to provide compute resources for COVID-19 research – Tech Crunch The consortium will be working with a number of national labs and other institutions to offer a total of 330 petaflops of compute to various projects in epidemiology, bioinformatics and molecular modeling. Amazon, Google and Microsoft are also part of the consortium, which is being led by IBM, the White House Office of Science and Technology Policy, and the Department of Energy.

Patients treated with ACEIs and ARBs may be at increased risk of severe COVID-19 – Medical News.net Since patients treated with ACEIs and ARBS will have increased numbers of ACE2 receptors in their lungs for coronavirus S proteins to bind to, they may be at increased risk of severe disease outcomes due to SARS-CoV-2infections [related paper in Journal of Travel Medicine]


Information for Clinicians on Therapeutic Options for COVID-19 Patients – CDC There are no US Food and Drug Administration (FDA)-approved drugs specifically for the treatment of patients with COVID-19.  At present clinical management includes infection prevention and control measures and supportive care, including supplementary oxygen and mechanical ventilatory support when indicated.  An array of drugs approved for other indications as well as several investigational drugs are being studied in several hundred clinical trials that are underway across the globe. The purpose of this document is to provide information on two of the approved drugs (chloroquine and hydroxychloroquine) and one of the investigational agents (remdesivir) currently in use in the United States.

Gilead Pauses Compassionate Use of Experimental Antiviral for COVID-19 – Regulatory Focus Biopharma company Gilead said Sunday that it would temporarily pause allowing the use of the potential COVID-19 treatment remdesivir outside of clinical trials as the company looks to ramp up wider use of the antiviral following discussions with regulators worldwide.


FDA Approves New Rapid Coronavirus Test That Can Give Results In 45 Minutes – Forbes The FDA has granted EUA to Cepheid for their Xpert® Xpress SARS-CoV-2 test. This is a rapid molecular diagnostic test that can detect the presence of the COVID-19 causing coronavirus. How rapid is rapid? How about returning results in 45 minutes?

Published Research

A Retrospective Analysis of Influence of Environmental/Air Temperature and Relative Humidity on SARS-CoV-2 Outbreak – Virology [abstract] The pandemic threat SARS-CoV-2 is now beyond control though the country of origin of this virus had already been limited for the new infection. Number of infected people and countries have been increasing day by day. Considering the previous pandemic flues, it is hypothesizing that COVID-19 will be reduced with warming the global environmental temperature. Therefore, the current study was aimed to analyze the effect of temperature and relative humidity (RH) on spreading of SARS-CoV-2 infection. The COVID-19 confirmed cases of 31 different states in China and 70 cities of 11 countries were obtained from several online databases. The real time temperature and humidity of the respective regions were taken from an online weather forecasting data source. Correlation analyses showed that SARS-CoV-2 infectivity and spreading negatively correlated with temperature of most of the states of China or cities of the world or in a country. The effect of humidity on COVID-19 was found to be positively correlated inside the China and difference of humidity was not found among countries and/or various regions of the world. Moreover, a minimum number of COVID-19 cases have been confirmed in the temperate regions compared to regions/countries compared to regions/countries with relatively low temperature. In conclusion, the SARS-CoV-2 infection has been found in a wide range of temperatures. It might be hypothesized that comparatively elevated air temperature could play a detrimental effect for SARS-CoV-2 spread.

Molecular Analyses of Over Hundred Sixty Clinical Isolates of SARS-CoV-2: Insights on Likely Origin, Evolution and Spread, and Possible Intervention – Virology [Abstract] We are witnessing the severe third outbreak mediated by coronaviruses affecting global public health with unprecedented economic consequences. A better understanding of its phylogenetics, exploration of sequence features and mutational changes could unveil its genealogy to gain insights into the mechanism of transmission and development of possible interventions. Our comparative genomic analyses of >160 isolates of SARS-CoV-2 reveal phylogenetic kinship with other coronaviruses and emergence of evolutionary divergence in clinical isolates. t-SNE-based clustering revealed different clades but no continent specific clusters. Amino acid substitutions at RBD of spike protein provide possible reasons for rapid transmission. Few proteins specific to SARS-CoV-2 were identified which could have implications as therapeutic targets and diagnostic biomarkers. Virtual screening identified repurposed drugs, known nutraceuticals, for specific interventions. These phylogenetic observations reveal the ancestry and computational studies reveal the emergency measures to interject this emerging pathogen that pose threat to whole of mankind.

Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19  – Journal of Travel Medicine Intravenous infusions of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in experimental animals increase the numbers of angiotensin-converting enzyme 2 (ACE2) receptors in the cardiopulmonary circulation. ACE2 receptors serve as binding sites for SARS-CoV-2 virions in the lungs. Patients who take ACEIs and ARBS may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections.

Genomic analysis of a 2019-nCoV strain in the first COVID-19 patient found in Hangzhou, Zhejiang, China – [Published in Chinese Journal] [Abstract Conclusion]  The genome of Hangzhou 2019-nCoV strain was very close to the genomes of strains from other cities in China and overseas collected at early epidemic phase. The 2019-nCoV genome sequencing method used in this paper provides an useful tool for monitoring variation of viral genes.

Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia – American Journal of Roentgenology [Abstract Conclusion] The early clinical and laboratory findings of COVID-19 pneumonia are low to midgrade fever, dry cough, and fatigue with normal WBC count, reduced lymphocyte count, and elevated high-sensitivity C-reactive protein level. The early CT findings are patchy GGO with or without consolidation involving multiple lobes, mainly in the peripheral zone, accompanied by halo sign, vascular thickening, crazy paving pattern, or air bronchogram sign.

Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China – Journal of Infectious Diseases

An epidemic caused by SARS-Coronavirus-2 infection has spread unexpectedly in Wuhan, Hubei Province, China since December 2019. It is rarely reported about asymptomatic cases screened from close contacts. We study epidemiological and clinical outcome of 55 asymptomatic carriers who were laboratory-confirmed positive for the SARS-Coronavirus-2 by testing the nucleic acid of the pharyngeal swab samples. The evidence showed that asymptomatic carriers occurred more often in middle aged people who had close contact with infected family members. The majority of the cases developed to be mild and ordinary COVID-19 during hospital.

Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)

A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing – BioRXIV An outbreak of the novel coronavirus SARS-CoV-2, the causative agent of COVID-19 respiratory disease, has infected over 290,000 people since the end of 2019, killed over 12,000, and caused worldwide social and economic disruption. There are currently no antiviral drugs with proven efficacy nor are there vaccines for its prevention. Unfortunately, the scientific community has little knowledge of the molecular details of SARS-CoV-2 infection. To illuminate this, we cloned, tagged and expressed 26 of the 29 viral proteins in human cells and identified the human proteins physically associated with each using affinity-purification mass spectrometry (AP-MS), which identified 332 high confidence SARS-CoV-2-human protein-protein interactions (PPIs). Among these, we identify 66 druggable human proteins or host factors targeted by 69 existing FDA-approved drugs, drugs in clinical trials and/or preclinical compounds, that we are currently evaluating for efficacy in live SARS-CoV-2 infection assays. The identification of host dependency factors mediating virus infection may provide key insights into effective molecular targets for developing broadly acting antiviral therapeutics against SARS-CoV-2 and other deadly coronavirus strains.

Relationship between the ABO Blood Group and the COVID-19 Susceptibility – RXIV [Abstract Conclusion] People with blood group A have a significantly higher risk for acquiring COVID-19 compared with non-A blood groups, whereas blood group O has a significantly lower risk for the infection compared with non-O blood groups.

#COVID-19: The First Public Coronavirus Twitter Dataset – Univ Southern Calif  At the time of this writing, the novel coronavirus (COVID-19) pandemic outbreak has already put tremendous strain on many countries’ citizens, resources and economies around the world. Social distancing measures, travel bans, self-quarantines, and business closures are changing the very fabric of societies worldwide. With people forced out of public spaces, much conversation about these phenomena now occurs online, e.g., on social media platforms like Twitter. In this paper, we describe a multilingual coronavirus (COVID-19) Twitter dataset that we have been continuously collecting since January 22, 2020.

Infographics for Briefings

Coronavirus mapped: the latest figures as the outbreak spreads – Financial Times

Coronavirus: Everything you need to know in a visual explainer (updated daily) – South China Morning Post

Visualizing the spread of the coronavirus – USA Today

Economic Impact Infographics – Forbes

Policy & Guidance


Economic Impact

Stocks fall despite Fed’s unlimited bond-buying promise  – Financial Times

Dow Jones Dives 700 Points On Surging New York Coronavirus Cases, As U.S. Cases Jump Above 39,000; Apple Plunges – Investors Business Daily


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