World Bank Commits US$ 12 Billion To COVID-19 Battle As Death Rate Inches Higher; 40% Shortage in Health Worker Protective Gear Disease Surveillance 03/03/2020 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Temperature check at Hartsfield-Jackson Atlanta International Airport, USA. In the face of worldwide shortages, WHO recommends masks only in health care and border control settings, and for people experiencing flu-like symptoms. The World Bank on Tuesday announced the immediate release of US$12 billion to support countries struggling to respond to the COVID-19 crisis. That followed news that the global death rate from the novel coronavirus was now averaging around 3.4% as compared to around 2% of cases previously reported by WHO. In comparison, estimated fatality rates for seasonal flu are just a fraction of that – ranging between an average mortality of about .1% based on historical records of the United States Centers for Disease Control data to .4% in other settings, depending on the country, year and population vaccine status. The new data was released at the WHO daily press briefing, where WHO Director General Dr Tedros Adhanom Ghebreyesus also highlighted the severe worldwide shortage of personal protective equipment (PPE) for health care workers – equipment that will be critical in containing the now running tap of new cases abroad from becoming a larger flood. “We are concerned that countries’ abilities to respond are being compromised by the severe and increasing disruption to the global supply of personal protective equipment – caused by rising demand, hoarding and misuse,” said Dr Tedros, noting that worldwide PPE supplies need to increase by 40%. He spoke as China again set a record low of only 129 new cases, the fewest since 20 January. But abroad there were record highs, once more, with 1,848 new cases reported in 48 countries overnight Monday. The reports included 12 new countries reporting infections for the first time. Korea, Iran and Italy continued to be the hotspots with 80% of the new cases outside China occurring in those three countries. Total cases worldwide now total 92,314 in 79 countries as of Tuesday evening Central European Time. Even China is now at risk of re-importing the outbreak. Caixin news reported that officials in the eastern Chinese province of Zhejiang confirmed eight new cases of COVID-19 in people recently returned from Italy, where they had worked in a restaurant in Bergamo – a town near the epicentre of Italy’s outbreak. Global Cases of COVID-19 as of 6:30PM CET 3 March 2020. COVID-19: Much More Severe than Flu – Not Many Asymptomatic Cases Along with being more fatal, COVID-19 causes more severe disease than seasonal influenza, the WHO Director-General also noted, in remarks that appeared intended to dispel some of the myths surrounding the new disease. “While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease,” he said. “Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected,” added the WHO Director General. In fact USCDC data shows ten-year flu mortality averages .1% – or roughly 34 times fewer deaths in relation to the number of people infected. Dr Tedros’ remarks came just a day after the US Acting Secretary of Homeland Security, Chad Wolf, told the Senate Appropriations Committee that the death rate from the COVID-19 virus was comparable to that of seasonal flu: “Worldwide… I believe it is under 2%.. it’s between 1.5 and 2%,” Wolf said in televised remarks, adding [incorrectly] that the mortality rate for seasonal flu was “right around that percentage as well. I don’t have it offhand, but it’s right around 2%.” Previous data published by China CDC have also highlighted how COVID-19 death rates also vary sharply by age. An analysis of 44,672 cases reported as of 11 February in China found that the average mortality rate for people aged 10-49 was only about .2-.4%, while death rates for people aged 60-79 ranged from 3.6-8% and nearly 15% of people age 80 or older who were infected with COVID-19 had died. Significantly, those numbers were based on the now out-of-date estimate of a 2.3% average mortality rate. So far, a revised age and gender-related breakdown of the new mortality 3.4% mortality rate has not been published by WHO, China, or institutions elsewhere. But based on trends to date, it would likely reflect even higher average mortality rates across older age groups. In another important new finding, few COVID-19 cases are turning out to be entirely asymptomatic, the WHO Director-General also added. While more large scale studies of immunity have to be done, that is the evidence so far from one large scale Chinese study in Guandong province, as well as from very wide-scale testing of cases and contacts in China, Singapore and elsewhere. “Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days,” said Dr Tedros. “Some countries are looking for cases of COVID-19 using surveillance systems for influenza and other respiratory diseases. Countries such as China, Ghana, Singapore and elsewhere have found very few cases of COVID-19 among such samples – or no cases at all. “The only way to be sure is by looking for COVID-19 antibodies in large numbers of people, and several countries are now doing those studies. This will give us further insight into the extent of infection in populations over time,” he added, noting that WHO has developed protocols available on its public COVID-19 platform, for how such studies should be done. WHO Calls on Manufacturers to Boost Production of Personal Protective Equipment by 40% In terms of the personal protective equipment, that is critical to prevent the spread of disease in health facilities, the world is facing both supply shortages and soaring costs, the Director General said. “Prices of surgical masks have increased six-fold, N95 respirators have more than tripled, and gowns cost double their previous price, said Dr. Tedros. “Worldwide shortages are leaving doctors, nurses and other frontline healthcare workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons,” he observed.”Supplies can take months to deliver, market manipulation is widespread, and stocks are often sold to the highest bidder.” He noted that WHO has shipped nearly half a million sets of personal protective equipment to 27 countries, but supplies are rapidly depleting. And yet in the coming months, projections are that 89 million more medical masks will be required for the COVID-19 response along with 76 million examination gloves and 1.6 million goggles. “Globally, it is estimated that PPE supplies need to be increased by 40 per cent.” Dr. Tedros said that WHO was working with governments, manufacturers and its Pandemic Supply Chain Network to “boost production and secure supplies for critically affected and at-risk countries. “We continue to call on manufacturers to urgently increase production to meet this demand and guarantee supplies.” “And we have called on governments to develop incentives for manufacturers to ramp up production. This includes easing restrictions on the export and distribution of personal protective equipment and other medical supplies. “We can’t stop COVID-19 without protecting our health workers.” US CDC Updates Testing Guidelines Amidst Continuing Brouhaha over Lack of Tests Meanwhile, in the United States, controversy continued to rumble over reports of delayed testing of suspected COVID-19 cases, due to overly restrictive USCDC guidelines and a shortage of testing kits. In one report, the New York Times quoted the story of a woman who had reported for testing with a high fever and breathing difficulties on 19 February, but was refused a test because her fever was not high enough, and she hadn’t recently travelled to China. The woman was later found to be positive with the disease, after a contact was reported ill. In the wake of such incidents, the US CDC said on Friday that it had changed its criteria for testing suspected cases on Friday to allow cases of respiratory illness with no known contact with COVID-19 cases to be tested. WHO also updated its case definition for suspected cases Friday to account for links with growing hotspots of the outbreak in Italy, Iran, and South Korea; with the definition now being cases of serious respiratory illness in those with recent travel history to any place with local transmission. As of 27 Feb, the US CDC now encourages COVID-19 testing at clinicians’ discretion, for people reporting “fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza)” …. even if “no sources of exposure has been identified.” The first case of community transmission of COVID-19 in the US was confirmed in a California woman last Thursday – days after she had reportedly presented with severe respiratory illness at the University of California Davis Medical Center. In a press release the UC Davis hospital reported that an initial request for COVID-19 testing was “not immediately administered” because the woman did not “fit the existing CDC criteria for COVID-19.” However, when questioned by reporters Nancy Messonier, the US Centers for Disease Control’s designated COVID-19 spokesperson, said that the CDC team handling testing requests has “not said no to any request” and that according to their records, a test for COVID-19 was recommended for the California case on Sunday 23 February, the same day the case was first reported to the CDC. World Bank Makes US$ 12 Billion “initial” commitment In a press release, the World Bank Group said “an initial package of up to $12 billion” was being made available in immeidate support to assist countries coping with the health and economic impacts of the epidemic. Calling it a “fast-track” package, a press releaase said that the money, “will help developing countries strengthen health systems, including better access to health services to safeguard people from the epidemic, strengthen disease surveillance, bolster public health interventions, and work with the private sector to reduce the impact on economies.” “We are working to provide a fast, flexible response based on developing country needs in dealing with the spread of COVID-19,” said World Bank Group President David Malpass. “This includes emergency financing, policy advice, and technical assistance, building on the World Bank Group’s existing instruments and expertise to help countries respond to the crisis.” The health aspects of the package will include support for: strengthening health services and primary health care; bolstering disease monitoring and reporting; training front line health workers; encouraging community engagement to maintain public trust; and improving access to treatment for the poorest patients, the announcement stated. The Bank will also provide policy and technical advice to ensure countries can access global expertise. The financial package will include grants and low-interest loans for low-income countries as well as loans for middle-income countries, financed by the Banks various branches. The announcement was welcomed by Jeremy Farrar, Director of Wellcome Trust, who just days ago had publicly challenged top World Bank officials to immediately come forward with at least US$ 10 billion dollars in immediate aid. “This is a remarkable and unprecedented move by the World Bank – and one which will make a huge difference to the global response to this already immensely challenging epidemic,” Farrar said. “This support will be critical to enabling efforts globally to get ahead of the rapid spread of COVID-19. This is not simply a health crisis – it is a global crisis which is already impacting every sector of society. “This commitment from the World Bank is needed if we are to have a chance of averting long-term catastrophe worldwide. It will be vital to supporting the ongoing global response, co-ordinated by the WHO, and to support health systems and societies around the world, particularly in vulnerable regions. It will also facilitate accelerated research and development of vaccines, diagnostics and treatments, ensuring equitable access to advances made. The World Bank deserves great credit for the speed and scale of its response.” This story was updated 4 March 2020 Image Credits: US CDC, Johns Hopkins CSSE. 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