COVID-19 Roundup: Coronavirus Now a National Emergency, With Plans to Increase Testing

President Donald Trump on Friday declared the novel coronavirus a national emergency, which unlocks billions of dollars in federal funding to fight the disease’s spread. He also announced the creation of a website to direct symptomatic individuals to drive-through testing locations, in hopes of increasing access to testing for those who show signs of COVID-19.

“I am officially declaring a national emergency, 2 very big words,” Trump said in the Rose Garden press conference, accompanied by health officials, business leaders, and Vice President Mike Pence. By invoking the Stafford Act, financial and physical assistance will be streamlined through the Federal Emergency Management Agency.

Trump highlighted several examples of ongoing partnerships with the private sector, including expedited processing of Roche’s application for a new coronavirus test approval and Google’s help launching a website that will ask users questions about symptoms and direct those in need to drive-through testing locations, where they will be swabbed without leaving their cars. Pence noted that several large retailers throughout the country would be volunteering some of their parking lots as a destination for the drive-up testing.

Other actions announced by the president include the waiving of interest on federal student loans until further notice.

“All Americans have a role to play in defeating this virus,” Trump said, emphasizing the importance of containing the virus’ spread.

Wednesday, March 11 Developments:

The World Health Organization (WHO) declared Wednesday that the global crisis over the new coronavirus is now a pandemic, according to The Associated Press.

Tedros Adhanom Ghebreyesus, who heads the agency, said at a briefing in Geneva the WHO is “deeply concerned by the alarming levels of spread and severity” of the outbreak. He also expressed concern about “the alarming levels of inaction.”

“All countries can still change the course of this pandemic. If countries detect, test, treat, isolate, trace and mobilize their people in the response,” Tedros said.

Italy, which along with Iran are now the 2 hardest hit countries as the virus subsides in China, late Wednesday announced that all businesses except pharmacies and grocery stores would be forced to close, according to Reuters.

In the United States, the NCAA said its championship basketball tournament would be played later this month without fans. Several other college and professional sports events have been either cancelled or ordered played in empty venues.

Also Wednesday, CMS released guidance for hospices and nursing homes; the CDC has said that people over 65 are at the greatest risk of more severe illness. The information includes when hospices should screen, treat, and transfer patients to more advanced care. Hospices should screen patients before they are admitted, CMS said.

A memorandum to nursing homes advises when facilities should monitor or limit visitors who are showing symptoms of illness, monitor and restrict staff with potential illness, transfer a patient who has tested positive or is suspected of having COVID-19, or accept a patient from a hospital following a COVID-19 diagnosis.

Meanwhile, stocks extended their plunge, falling into a bear market, with the the Dow Jones Industrial Average falling 1464 points, bringing it 20% below its record set last month.

Monday, March 2 Developments:

Italy expanded a lockdown, originally for 16 million people in the northern part of the country, to the entire nation, and in the United States, the Dow Jones Industrial Average tumbled 7.8% Monday, its steepest drop since the 2008 financial crisis, as fears rose over business and societal impacts of the new coronavirus.

The Associated Press reported that the drop on Wall Street was so sharp that it triggered the first automatic halt in trading in more than 2 decades, and that European markets are now in a bear market.

Italy's prime minister expanded travel restrictions across the entire country. According to a dashboard created by Johns Hopkins, the number of total global cases surpassed 113,500, and over 600 in the United States. But Italy has the highest number of cases after China at the moment—9172.

The Grand Princess, the cruise ship idling off the coast of California with more than 3500 people aboard, arrived at the port of Oakland Monday as officials prepared to start bringing passengers to military bases for quarantine or get them back to their home countries; 21 of them are infected.

Incubation Period of COVID-19 Appears to Be 5 Days, Study Says

Meanwhile, the 14-day quarantine period used by the CDC for individuals with likely exposure to the new coronavirus is reasonable, based on study results indicating that the median disease incubation period is 5.1 days, according to a study¹ published in Annals of Internal Medicine.

Researchers from at Johns Hopkins Bloomberg School of Public Health analyzed publicly available data on infections from the new coronavirus, SARS-CoV-2, that causes the respiratory illness COVID-19.

For the study, the researchers analyzed 181 cases from China and other countries that were detected before February 24, were reported in the media, and included likely dates of exposure and symptom onset. Most of the cases (161 of the 181) involved travel to or from Wuhan, China, or to Hubei, the province of which Wuhan is the capital. Other cases had evidence of contact with travelers from Hubei or persons with known infection.

Cases were collected from 24 countries and regions outside mainland China (n = 108) and 25 provinces within mainland China (n = 73).

Of the 181 cases, 108 were male (60%), 69 (38%) were female, and 4 (2%) were of unknown sex. The median age was 44.5 years (interquartile range [IQR], 34.0-55.5 years). The median time from when symptoms appeared to hospitalization was 1.2 days (range, 0.2-29.9 days).

The estimated median incubation period of COVID-19 was 5.1 days (CI, 4.5-5.8 days), with fewer than 2.5% of those infected showing symptoms within 2.2 days (CI, 1.8-2.9 days) of exposure. For the vast majority—97.5%—of those infected, symptoms will occur within 11.5 days (CI, 8.2-15.6 days).

The CDC and many other public health authorities have been using a 14-day quarantine or active-monitoring period for individuals who are known to be at high risk of infection due to contact with known cases or travel to a heavily affected area. But the authors said longer monitoring periods might be justified in extreme cases.

Reference

1. Lauer SA, Grantz KH, Bi Q, et al. The incubation period of COVID-19 from publicly reported confirmed cases: Estimation and application [published online March 10, 2020]. Ann Intern Med. doi: 10.7326/M20-0504.