COVID-19 weekly epidemiological update, 19 April 2021

COVID-19 Weekly Epidemiological Update Data as received by WHO from national authorities, as of 18 April 2021, 10 am CET In this edition: • Global overview • Special focus: Update on WHO COVID-19 global rapid risk assessment • Special focus: Pandemic influenza surveillance – drawing a parallel with the COVID-19 pandemic • Special focus: SARS-CoV-2 variants • WHO regional overviews • Key weekly updates Global overview Globally, new COVID-19 cases increased for the eighth consecutive week, with more than 5.2 million new cases reported in the last week – surpassing the previous peak in early January 2021 (Figure 1). The number of new deaths increased for the fifth consecutive week, an 8% increase as compared to the previous with over 83 000 new deaths reported. Last week the reported cumulative COVID-19 death toll surpassed 3 million lives; the pace of deaths is accelerating, it took nine months to reach 1 million deaths, another four to surpass 2 million, and just three to reach 3 million deaths. Figure 1. COVID-19 cases reported weekly by WHO Region, and global deaths, as of 18 April 2021** **See Annex: Data, table and figure notes While all regions except the European Region reported an increase in incident cases in the last week, the largest increase continues to be reported by the South-East Asia Region, largely driven by India, followed by the Western Pacific Region (Table 1). All regions except the European and Western Pacific regions reported an increase in the number of weekly deaths, with the largest increase in the South-East Asia Region due to an 0 20 000 40 000 60 000 80 000 100 000 120 000 0 1 000 000 2 000 000 3 000 000 4 000 000 5 000 000 30 -D ec 20 -J an 10 -F eb 02 -M ar 23 -M ar 13 -A p r 04 -M ay 25 -M ay 15 -J u n 06 -J u l 27 -J u l 17 -A u g 07 -S ep 28 -S ep 19 -O ct 09 -N o v 30 -N o v 21 -D ec 11 -J an 01 -F eb 22 -F eb 15 -M ar 05 -A p r D ea th s C as es Reported week commencing Americas South-East Asia Europe Eastern Mediterranean Africa Western Pacific Deaths increase in deaths in India, followed by the Eastern Mediterranean Region, largely due to an increase in new deaths in the Islamic Republic of Iran. The countries reporting the highest number of new cases represent three of the six WHO regions: India (1 429 304 new cases; 64% increase), the United States of America (477 778 new cases; 2% increase), Brazil (459 281 new cases; 1% decrease), Turkey (414 312 new cases; 17% increase), and France (233 275 new cases; 12% decrease). Table 1. Newly reported and cumulative COVID-19 cases and deaths, by WHO Region, as of 18 April 2021** WHO Region New cases in last 7 days (%) Change in new cases in last 7 days * Cumulative cases (%) New deaths in last 7 days (%) Change in new deaths in last 7 days * Cumulative deaths (%) Americas 1 525 505 (29%) 7% 59 551 000 (42%) 39 482 (47%) 8% 1 444 736 (48%) Europe 1 624 060 (31%) -3% 49 208 464 (35%) 26 302 (32%) -3% 1 035 294 (34%) South-East Asia 1 518 708 (29%) 57% 17 696 534 (13%) 9 447 (11%) 49% 237 832 (8%) Eastern Mediterranean 386 176 (7%) 6% 8 444 694 (6%) 5 460 (7%) 23% 170 580 (6%) Africa 54 297 (1%) 7% 3 225 261 (2%) 1 170 (1%) 14% 80 715 (3%) Western Pacific 128 176 (2%) 15% 2 205 688 (2%) 1 444 (2%) -8% 34 918 (1%) Global 5 236 922 (100%) 14% 140 332 386 (100%) 83 305 (100%) 8% 3 004 088 (100%) *Percent change in the number of newly confirmed cases/deaths in past seven days, compared to seven days prior **See Annex: Data, table and figure notes For the latest data and other updates on COVID-19, please see: • WHO COVID-19 Dashboard • WHO COVID-19 Weekly Operational Update Figure 2. COVID-19 cases per 100 000 population reported by countries, territories and areas, 12-18 April 2021** **See Annex: Data, table and figure notes Special Focus: Update on WHO COVID-19 global rapid risk assessment, 13 April 2021 As the COVID-19 pandemic, response and our understanding of the SARS-CoV-2 virus continue to evolve, WHO’s most recent assessment is that the global public health risk remains very high. Under the Emergency Response Framework, WHO undertakes risk assessments and situation analyses on a regular basis to inform our response to emerging issues. In addition, WHO periodically formally reviews the current risk status of risks through an in-depth hazard, exposure and context assessment; as well as a review of the vulnerabilities and capacities to respond and to investigate the current risk to human health, risks of ongoing spread globally, and risk of insufficient control capacities. Such assessments are used as an internal-WHO decision- making tool, but they also additionally to support independent deliberations, including (but not limited to) meetings of the IHR Emergency Committee. Ten COVID-19 rapid risk assessments have been undertaken to date, and additional assessments have been completed for specific events surrounding the emergence of SARS-CoV-2 variants of concern (VOCs). Here, we provide a synopsis of the most recent in-depth global rapid risk assessment. The COVID-19 pandemic shows no signs of easing, with global case and death incidence increasing at a concerning rate since mid-February 2021; a third of the global cumulative COVID-19 cases and deaths has been reported in the last three months alone, with weekly cases reaching similar levels as the previous peak in January 2021. Marked geographical variation in the pandemic trajectory continues to be observed at regional and country levels, with sharp rises observed in the South-East Asia, Eastern Mediterranean and Western Pacific regions in recent weeks. The global infection fatality ratio (IFR) was estimated between 0.1% to 1.0%, an increase from January largely driven by an increase in the Region of the Americas. Globally mortality rates continue to be higher for those over 40 years as well as for males as compared to females. The resurgences in the last four months have likely been driven in part by both the emergence of SARS-CoV-2 VOCs and inconsistent use/early easing of public health and social measures (PHSM). As surveillance and sequencing activities to detect SARS-CoV-2 variant cases are strengthened, the number of countries reporting the three variants designated as global VOCs has increased. All three VOCs are associated with increased transmission. Additionally, some have been associated with increased disease severity (VOC 202012/01 and 501Y.V2), increased risk of immune escape (501Y.V2 and P.1), and/or significant reductions in neutralization (501Y.V2 and P.1) by convalescent or post-vaccine sera compared to wild-type/non-VOC variants, suggesting increased risk of vaccine failure or reinfection. In addition to the VOCs, six variants have thus far been designated as SARS-CoV-2 variants of interest (VOIs), and a further 19 variants are currently under investigation, highlighting that especially as global incidence remains high, there is continued risk of emergence of more variants with phenotypic implications and global importance in the coming months. The high burden of COVID-19 globally has continued to challenge surveillance systems, leading to a large gap in the completeness of demographic information shared for reported cases. In line with the WHO surveillance guidelines, efforts are being made to strengthen surveillance and reporting, however, many challenges persist especially for low-income countries. The ongoing pandemic also continues to challenge public health and healthcare capacities in most countries, as often the same human resources are spread across clinical management and outbreak response activities including vaccine rollout. The recent increase in cases reported in most regions has added to the healthcare workload and aggravated shortages of resources and the capacity to care for both those with COVID-19 and patients with other illnesses; over 90% of countries have reported some level of service disruptions and almost 40% have reported disruptions to essential primary health care services. Infection prevention and control (IPC) and PHSM have proven to be critical in mitigating and limiting transmission and deaths due to COVID-19. The use of PHSM must be continuously monitored and adjusted, especially in the context of VOCs, to account for the intensity of transmission as well as the capacity of the health system at both national and sub-national levels. While reports confirm that most people continue to support PHSM as part of national COVID-19 response strategies, pandemic fatigue is occurring, undermining the impact of PHSM on transmission. In some countries, a lack of trust in government responses and increasing frustration and uncertainty about the duration of the pandemic, coupled with the economic impacts of the response to COVID-19, have led to protests against PHSM. The cornerstone of treatment for COVID-19 remains early detection and clinical assessment along with the use of oxygen and systemic corticosteroid therapy for those with severe or critical COVID-19. Markets for personal protective equipment (PPE), PCR tests, and medical oxygen equipment have begun to adjust to the higher demand, and the Biomedical Consortium (part of the UN Supply Chain) continues to support the scale-up of oxygen supply in under-resourced settings, where supply chains remain vulnerable to manufacturing and transport shutdowns/restrictions. The supply chain network, however, continues to face constraints in the availability of containers and ships, adding challenges in maintaining the cold-chain requirements of COVID-19 vaccines from production to administration. As of 12 April 2021, four vaccines have received Emergency Use Listing by WHO. A total of 781 million doses of COVID-19 vaccines have been administered in 196 economies. However, 24 economies (including 12 from the African Region and seven from the Western Pacific Region) have not yet started vaccination. The current uneven and inequitable access and distribution of COVID-19 vaccines is exacerbating global inequalities, which coupled with the emergence of VOCs, risks prolonging the pandemic. With a COVAX target of 20-30% population coverage with a single vaccine dose by the end of the year, and considering that the proportion of the population with immunity acquired through infection is likely less than 25%, much of the global population is still susceptible to infection. Additionally, the degree and duration of immunity conferred by natural infection, COVID-19 vaccination or the combination of both are still being investigated, and some studies suggest that those who receive vaccines may still transmit SARS-CoV2 infection to susceptible contacts. While global vaccine acceptance generally remains high, country variations have been observed due to a multitude of reasons, including exposure to misinformation as well as the attitudes of local healthcare professionals, who can play an important role in building or undermining vaccine confidence. While our understanding of the SARS-CoV-2 virus and the complex immune response triggered by it continues to grow, much still remains unknown including the effectiveness of vaccination in reducing transmission; the duration of immunity; the role of children in transmission; and the frequency and nature of post-COVID-19 condition (“long COVID”). The emergence of VOCs introduces further unknowns such as the potential for immune escape and as to how these changes in the virus affect the global epidemiology. Additional resources • Further information about WHO risk assessment process Special Focus: Pandemic influenza surveillance – drawing a parallel with the COVID-19 pandemic Surveillance approaches for the COVID-19 pandemic have combined the use and adaptation of existing systems as well as the establishment of new systems to meet the surveillance objectives. The Global Influenza Surveillance and Response System (GISRS) is an example of this, and has been leveraged to support the critical need to monitor trends in concurrent community circulation of both SARS-CoV-2 and seasonal influenza (see 9 March 2021 Special Focus for background information). Here, we look at parallels between surveillance approaches to influenza and the COVID-19 pandemic. Critically, under both influenza and COVID-19 pandemic scenarios, surveillance relies upon multiple systems to: • Verify and detect emergence and transmission, • Monitor the geographic spread and related morbidity and mortality, and • Assess the severity and inform development and update of vaccines and other control measures. The WHO guidance on public health surveillance during an influenza pandemic highlight the different surveillance objectives and components needed at different phases before, during and after a pandemic (Figure 3). Figure 3: The continuum of pandemic influenza phases (Source: WHO, 2017) Alert Phase In the alert phase, surveillance objectives are focused on the detection of all cases and the verification of human- to-human transmission, with an aim to interrupt virus transmission and its geographic spread and understand the virus. Event-based surveillance, active case finding and routine influenza and other respiratory virus surveillance systems (e.g., GISRS), are useful in this phase. Event-based surveillance (EBS) is undertaken routinely by public health authorities globally to support the rapid detection and early response to signals of outbreaks of influenza and other respiratory viruses with the potential to spread from animals to humans or cause human-to-human transmission. EBS can be used for example to detect signals of clusters/outbreaks of severe respiratory disease, infections among healthcare workers, unexpected changes in routine surveillance data trends, unusually high sales of pharmaceuticals used for respiratory disease treatment, illnesses in humans linked to animal outbreaks, etc. EBS is used routinely to support COVID-19 surveillance – supporting epidemic intelligence activities for the detection and investigation of unusual epidemiological trends or changes, which combined with surveillance from other formal and informal sources, support ongoing COVID-19 situation awareness, risk assessment and an evidence-based response. Active case finding through contact tracing and cluster/outbreak investigation are recommended for interrupting SARS-CoV-2 transmission and are similarly recommended for finding new suspected cases, documenting potential human-to-human transmission, and providing targeted interventions to decrease the risk of illness and interrupt further transmission of pandemic influenza viruses. Pandemic Phase Once it is clear community transmission is occurring, monitoring the situation remains critical to inform risk assessments and adjust public health interventions. During this phase, it is important to understand the virus evolution and its geographic spread, severity of disease and groups at high risk for severe disease. Surveillance activities would focus on obtaining high quality data and favour specificity over sensitivity (i.e., would not necessarily attempt to identify all cases). Wherever possible, the use and strengthening of existing surveillance systems should be favoured. Often different systems capture information for mild illness, severe illness requiring hospitalization, and mortality, which collectively provide a foundation for surveillance during the pandemic phase. A healthcare-based surveillance approach serves as the primary approach for year-round influenza surveillance and is considered an essential surveillance approach for COVID-19 as well. During periods of heightened surveillance, other community-based case investigation and surveillance activities serve to provide additional epidemiological information. • Sentinel surveillance: Existing influenza surveillance systems that use a sentinel approach emphasize collecting quality data for epidemiological and virological surveillance from a limited number of surveillance sites. Sentinel healthcare facilities are chosen based on representativeness, feasibility, and sustainability. The use of strict case definitions and testing all or a subset of cases is for surveillance purposes and not for case management or outbreak investigation. During a pandemic, ongoing sentinel surveillance aids in tracking trends; geographical spread; impact of response measures; transmission and virus characteristics, including the evolution and emergence of variants; and vaccine effectiveness. A sentinel approach to monitoring COVID-19 is recommended as a complementary approach to comprehensive surveillance at present and many countries use existing sentinel influenza surveillance systems to monitor trends in COVID-19 activity and virus characteristics. • Non-sentinel surveillance: Influenza virological surveillance also relies on non-sentinel surveillance, where specimens may be collected from non-sentinel sites and where the results are more often used for clinical management and diagnostics. Compared to sentinel surveillance, information coming from non-sentinel surveillance is often not as detailed, and the cases selected for testing may not meet standard case definitions. • Universal surveillance: Many countries perform universal surveillance for influenza and other respiratory pathogens, often relying on electronic health record data to collect information on all patients seeking care for an influenza-like illnesses (ILI) or severe acute respiratory illness (SARI), or individuals with a suspected or confirmed laboratory diagnosis of a notifiable respiratory pathogen (including influenza or COVID-19), to either supplement or replace sentinel surveillance. Currently COVID-19 surveillance aims to capture data from any and all COVID-19 cases, no matter where they are diagnosed. • Mortality surveillance: Many countries monitor influenza-related mortality through surveillance of influenza- related deaths (using death certificates) or through statistical analysis of excess mortality attributed to influenza. The regular counting of COVID-19 deaths on a daily or weekly basis is currently recommended as part of COVID-19 surveillance mortality monitoring, including through death certificates. While not commonly done during influenza epidemics, more frequent collection and reporting of influenza-related deaths may be warranted during the pandemic phase. • Other sources: o It is estimated that around half of individuals infected with influenza do not seek healthcare for their illness.1 Participatory surveillance for ILI involves the ongoing collection of self-reporting of symptoms from a voluntary cohort of participants who may not seek healthcare for their illness and complements data from healthcare-based surveillance systems. Some countries are also adapting current participatory surveillance systems or developing new ones for monitoring COVID-19. o Special studies and modelling can generate information on transmission dynamics, risk and severity during a pandemic. Work done since the 2009 influenza pandemic as part of pandemic influenza preparedness activities have informed the COVID 19 response. o Sero-epidemiological and transmission study protocols developed for use in a future influenza pandemic were immediately updated for use in the COVID-19 pandemic. Reporting of data to WHO Current public health guidance recommends SARS-CoV-2 infections to be nationally notifiable, with case-based reporting on a voluntary basis, and detailed aggregated data reporting requested on a weekly basis to WHO. During further influenza pandemics, similar reporting requirements may be recommended initially. As the pandemic continues, countries would shift towards monitoring the situation, and the consistent and timely reporting of routine aggregated influenza data to regional and global WHO platforms may shift to weekly reporting of routine influenza surveillance data. It remains critical to draw lessons and sustain the momentum of the COVID-19 response to further strengthen and standardize both local and global surveillance systems to enable a robust approach to future pandemics caused by influenza and other pathogens. Additional resources • Global epidemiological surveillance standards for influenza • Manual for the laboratory diagnosis and virological surveillance of influenza • WHO Guidance for Surveillance during an Influenza Pandemic • Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases 1 Ma W, et al. (2018) The healthcare seeking rate of individuals with influenza like illness: a meta-analysis, Infectious Diseases, 50:10, 728- 735, https://doi.org/10.1080/23744235.2018.1472805 Special Focus: Update on SARS-CoV-2 Variants WHO, in collaboration with national authorities, institutions and researchers, routinely assesses if variants of SARS-CoV-2 result in changes in transmissibility, clinical presentation and severity, or if they impact public health and social measures (PHSM). Systems have been established to detect “signals” of potential variants of concern (VOCs) or variants of interest (VOIs) and assess these based on the risk posed to global public health (see also working definitions). National authorities may choose to designate other variants of local interest/concern. Detailed information on currently circulating VOCs and VOIs is available in previously published editions of the Weekly Epidemiological Update. Here we provide a brief update on the geographical distribution of the three VOCs as of 20 April 2021, as well as an update on detected VOIs (Table 2). As surveillance activities to detect SARS-CoV-2 variants are strengthened at local and national levels, including by strategic genomic sequencing, the number of countries/areas/territories (hereafter countries) reporting VOCs and VOIs has continued to increase. Since our last update on 13 April, VOC 202012/01 has been detected in five additional countries, variant 501Y.V2 in five additional countries, and variant P.1 has been reported in two additional countries. As of 20 April, a total 137 countries have reported VOC 202012/01 (Figure 4), 85 countries variant 501Y.V2 (Figure 5), and 52 countries variant P.1 (Figure 6) – see also Annex 2. The information presented here should be interpreted with due consideration of surveillance limitations, including differences in sequencing capacities and prioritization of samples for sequencing between countries. Table 2: SARS-CoV-2 variants of concern (VOC) and variants of interest (VOI), as of 20 April 2021* Nextstrain clade Pango lineage GISAID clade Alternate names First detected in Earliest samples Characteristic mutations VOC 20I/501Y.V1 B.1.1.7 GR VOC 202012/01† United Kingdom Sep 2020 H69/V70 del, Y144 del, N501Y, A570D, P681H, S106/G107/F108 del 20H/501Y.V2† B.1.351 GH VOC 202012/02 South Africa Aug 2020 L242/A243/L244 del, K417N, E484K, N501Y, S106/G107/F108 del 20J/501Y.V3 B.1.1.28.1, alias P.1† GR VOC 202101/02 Brazil and Japan Dec 2020 K417T, E484K, N501Y, S106/G107/F108 del VOI 20C B.1.525 G/484K.V3 - United Kingdom and Nigeria Dec 2020 H69-V70 del, Y144 del, Q52R, E484K, Q677H, D614G, and F888L 20C/S.452R B.1.427/ B.1.429 GH/452R.V1 CAL.20C/L452R United States of America Jun 2020 L452R, W152C, S13I, D614G 20B/S.484K B.1.1.28.2, alias P.2 GR - Brazil Apr 2020 L18F, T20N, P26S, F157L, E484K, D614G, S929I, V1176F Not yet assigned B.1.1.28.3, alias P.3 Not yet assigned PHL-B.1.1.28 Philippines and Japan Feb 2021 141-143 del, E484K, N501Y, P681H 20C B.1.526 with E484K or S477N GH - United States of America Nov 2020 L5F, T95I, D253G, D614G, A701V, E484K or S477N 20C B.1.616 GH - France Jan 2021 G142 del, D66H, Y144V, D215G, V483A, D614G, H655Y, G669S, Q949R, N1187D †While work is ongoing to establish standardized nomenclature for key variants, these are the names by which WHO will refer to them in this publication. Figure 4. Countries, territories and areas reporting SARS-CoV-2 VOC 202012/01, as of 20 April 2021 Figure 5. Countries, territories and areas reporting SARS-CoV-2 variant 501Y.V2, as of 20 April 2021 Figure 6. Countries, territories and areas reporting SARS-CoV-2 variant P.1, as of 20 April 2021 WHO recommendations The chances of SARS-CoV-2 mutating increases with its frequency of human and animal infections. Hence, reducing transmission of SARS-CoV-2 through established disease control methods as well as avoiding introductions into animal populations are crucial aspects of the global strategy to reduce the occurrence of mutations that have negative public health implications. PHSM remain critical to curb the spread of SARS- CoV-2 and its variants. Evidence from multiple countries with extensive transmission of VOCs has indicated that the implementation of PHSM and infection prevention and control (IPC) measures in health facilities has been effective in reducing COVID-19 case incidence, which has led to a reduction in hospitalizations and deaths among COVID-19 patients. National and local authorities are encouraged to continue strengthening existing PHSM, IPC and disease control activities. Authorities are also encouraged to strengthen surveillance and sequencing capacities and apply a systematic approach to provide a representative indication of the extent of transmission of SARS-CoV-2 variants based on the local context, and the detection of unusual events. Additional resources • Proposed working definitions of SARS-CoV-2 Variants of Interest and Variants of Concern • COVID-19 new variants: Knowledge gaps and research • PAHO Epidemiological Update: Variants of SARS-CoV-2 in the Americas - 24 March 2021 • PAHO COVID-19 Situation Reports • WPRO COVID-19 Situation Reports • SEARO COVID-19 Situation Reports • EMRO COVID-19 Situation Reports • Joint ECDC-WHO/EURO weekly surveillance report • Genomic sequencing of SARS-CoV-2: a guide to implementation for maximum impact on public health • Considerations for implementing and adjusting PHSM in the context of COVID-19 • Disease Outbreak News on SARS-CoV-2 Variants, 31 December 2020 WHO regional overviews African Region The Africa Region reported over 54 000 new cases and over 1100 new deaths, a 7% and a 14% increase respectively compared to the previous week. The number of weekly cases continues to fluctuate over the last eight weeks, with no clear trend, while weekly deaths increased last week reflecting a large increase in deaths reported by South Africa. The highest numbers of new cases were reported from Ethiopia (12 981 new cases; 11.3 new cases per 100 000 population; a 7% decrease), South Africa (8153 new cases; 13.7 new cases per 100 000; a 35% increase), and Kenya (6103 new cases; 11.3 new cases per 100 000; a 14% decrease). The highest numbers of new deaths were reported from South Africa (455 new deaths; 0.8 new deaths per 100 000 population; a 51% increase), Ethiopia (182 new deaths; 0.2 new deaths per 100 000; a 13% decrease), and Kenya (133 new deaths; 0.2 new deaths per 100 000; a 7% increase). Region of the Americas The Region of the Americas reported over 1.5 million new cases and over 39 000 new deaths, a 7% and an 8% increase respectively compared to the previous week. The region has reported an overall increasing trend in new cases for the last eight weeks and new deaths for the last five weeks. The highest numbers of new cases were reported from the United States of America (477 778 new cases; 144.3 new cases per 100 000; a 2% increase), Brazil (459 281 new cases; 216.1 new cases per 100 000; a 1% decrease), and Argentina (160 747 new cases; 355.7 new cases per 100 000; a 29% increase). The highest numbers of new deaths were reported from Brazil (20 031 new deaths; 9.4 new deaths per 100 000; a 2% decrease), the United States of America (5146 new deaths; 1.6 new deaths per 100 000; a 1% decrease), and Mexico (4673 new deaths; 3.6 new deaths per 100 000; a 48% increase). 0 1 000 2 000 3 000 4 000 5 000 6 000 0 20 000 40 000 60 000 80 000 100 000 120 000 140 000 160 000 180 000 200 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths 0 5 000 10 000 15 000 20 000 25 000 30 000 35 000 40 000 45 000 50 000 0 500 000 1 000 000 1 500 000 2 000 000 2 500 000 3 000 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths Eastern Mediterranean Region The Eastern Mediterranean Region reported over 386 000 new cases and over 5400 new deaths, a 6% and a 23% increase respectively compared to the previous week. The upward trend in cases and deaths reported since February 2021 continues, with a sharper increase in new deaths the last two weeks. The highest numbers of new cases were reported from the Islamic Republic of Iran (166 367 new cases; 198.1 new cases per 100 000; a 29% increase), Iraq (52 832 new cases; 131.3 new cases per 100 000; a 6% increase), and Pakistan (34 190 new cases; 15.5 new cases per 100 000; a 3% increase). The highest numbers of new deaths were reported from the Islamic Republic of Iran (2095 new deaths; 2.5 new deaths per 100 000; a 70% increase), Pakistan (765 new deaths; 0.3 new deaths per 100 000; a 21% increase), and Tunisia (482 new deaths; 4.1 new deaths per 100 000; a 59% increase). European Region The European Region reported over 1.6 million new cases and over 26 000 new deaths. The region reported a slight decrease in new cases (3%) for the second week in a row, a sign that transmission in the region may be slowing as the number of new deaths also decreased (3%) for the first time following a five-week increasing trend. The highest numbers of new cases were reported from Turkey (414 312 new cases; 491.2 new cases per 100 000; a 17% increase), France (233 275 new cases; 358.7 new cases per 100 000; a 12% decrease), and Germany (143 994 new cases; 173.1 new cases per 100 000; a 28% increase). The highest numbers of new deaths were reported from Poland (3611 new deaths; 9.5 new deaths per 100 000; a 4% increase), Ukraine (2772 new deaths; 6.3 new deaths per 100 000; a 3% increase), and Italy (2753 new deaths; 4.6 new deaths per 100 000; a 14% decrease). 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 0 50 000 100 000 150 000 200 000 250 000 300 000 350 000 400 000 450 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths 0 5 000 10 000 15 000 20 000 25 000 30 000 35 000 40 000 45 000 0 500 000 1 000 000 1 500 000 2 000 000 2 500 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths South-East Asia Region The South-East Asia Region reported over 1.5 million new cases and over 9400 new deaths, a 57% and a 49% increase respectively compared to the previous week. The increasing trend in new cases and deaths, which appears to be accelerating, continued last week, with weekly cases rising sharply for the sixth consecutive week while weekly deaths rose for the fifth consecutive week. The trend in the region continues to be driven largely by the trajectory of the outbreak in India which reported the highest numbers of new cases (1 429 304 new cases; 103.6 new cases per 100 000; a 64% increase), followed by Indonesia (36 895 new cases; 13.5 new cases per 100 000; a 4% increase), and Bangladesh (36 315 new cases; 22.1 new cases per 100 000; a 25% decrease). The highest numbers of new deaths were reported from India (7875 new deaths; 0.6 new deaths per 100 000; a 69% increase), Indonesia (885 new deaths; 0.3 new deaths per 100 000; a 26% decrease), and Bangladesh (622 new deaths; 0.4 new deaths per 100 000; a 39% increase). Western Pacific Region The Western Pacific Region reported over 128 000 new cases and over 1400 new deaths, a 15% increase and an 8% decrease respectively compared to the previous week. Cases increased for the sixth consecutive week, while deaths decreased after rising for three weeks, continuing to largely reflect the trajectory of deaths reported by the Philippines, the most affected country in the region. The highest numbers of new cases were reported from the Philippines (72 848 new cases; 66.5 new cases per 100 000; a 5% increase), Japan (26 426 new cases; 20.9 new cases per 100 000; a 29% increase), and Malaysia (13 742 new cases; 42.5 new cases per 100 000; a 45% increase). The highest numbers of new deaths were reported from the Philippines (1066 new deaths; 1.0 new deaths per 100 000; a 19% decrease), Japan (240 new deaths; 0.2 new deaths per 100 000; a 49% increase), and Malaysia (49 new deaths; 0.2 new deaths per 100 000; a 40% increase). 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 9 000 10 000 0 200 000 400 000 600 000 800 000 1 000 000 1 200 000 1 400 000 1 600 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths 0 200 400 600 800 1 000 1 200 1 400 1 600 1 800 0 20 000 40 000 60 000 80 000 100 000 120 000 140 000 3 0 -D e c 2 0 -J an 1 0 -F e b 0 2 -M ar 2 3 -M ar 1 3 -A p r 0 4 -M ay 2 5 -M ay 1 5 -J u n 0 6 -J u l 2 7 -J u l 1 7 -A u g 0 7 -S e p 2 8 -S e p 1 9 -O ct 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J an 0 1 -F e b 2 2 -F e b 1 5 -M ar 0 5 -A p r D ea th s C as es Reported week commencing Cases Deaths Key weekly updates WHO Director-General's key message Opening remarks at the media briefing on COVID-19 – 19 April 2021: • More than 3 million deaths have been reported to WHO. It took 9 months to reach 1 million deaths; 4 months to reach 2 million, and 3 months to reach 3 million. Big numbers can make us numb, but each one of these deaths is a tragedy for families, communities and nations. • Greta Thunberg has become the powerful voice of a younger generation demanding climate action. Greta announced a donation of 100 000 Euros from the Greta Thunberg Foundation in support of COVAX to provide vaccines to people in need. • WHO has partnered with an alliance of the six largest youth development organizations in the world to form the Global Youth Mobilization, to empower young people to respond to the challenges created by the pandemic in their local communities. Updates and publications • Statement on the seventh meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic • Global Advisory Committee on Vaccine Safety (GACVS) review of latest evidence of rare adverse blood coagulation events with AstraZeneca COVID-19 Vaccine (Vaxzevria and Covishield) • Pfizer BioNTech COVID-19 vaccine: What you need to know • COVID-19 News updates: Latest news from WHO on COVID-19 and other breaking health stories Technical guidance and other resources • Technical guidance • WHO Coronavirus Disease (COVID-19) Dashboard • Weekly COVID-19 Operational Updates • WHO COVID-19 case definitions • COVID-19 Supply Chain Inter-Agency Coordination Cell Weekly Situational Update • Research and Development • Online courses on COVID-19 in official UN languages and in additional national languages • The Strategic Preparedness and Response Plan (SPRP) outlining the support the international community can provide to all countries to prepare and respond to the virus • Updates from WHO regions: o African Region o Region of the Americas o Eastern Mediterranean Region o South-East Asia Region o European Region o Western Pacific Region • Recommendations and advice for the public: o Protect yourself o Questions and answers o Travel advice • EPI-WIN: tailored information for individuals, organizations and communities • WHO Academy COVID-19 mobile learning app Annex Annex 1. COVID-19 confirmed cases and deaths reported in the last seven days by countries, territories and areas, and WHO Region, as of 18 April 2021** Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Africa 54 297 3 225 261 287.5 1 170 80 715 7.2 Ethiopia 12 981 240 236 209.0 182 3 328 2.9 Community transmission South Africa 8 153 1 565 680 2 639.9 455 53 711 90.6 Community transmission Kenya 6 103 151 287 281.4 133 2 463 4.6 Community transmission Cameroon 4 394 61 731 232.5 68 919 3.5 Community transmission Madagascar 4 069 31 617 114.2 45 538 1.9 Community transmission Botswana 1 401 44 075 1 874.2 35 671 28.5 Community transmission Cabo Verde 1 346 19 975 3 592.7 12 189 34.0 Community transmission Mali 1 275 12 980 64.1 24 429 2.1 Community transmission Gabon 1 222 21 858 982.1 6 133 6.0 Community transmission Namibia 1 192 46 515 1 830.6 38 602 23.7 Community transmission Algeria 1 108 119 486 272.5 26 3 152 7.2 Community transmission Eswatini 1 042 18 415 1 587.3 2 671 57.8 Community transmission Angola 969 24 300 73.9 11 561 1.7 Community transmission Zambia 926 90 844 494.1 8 1 234 6.7 Community transmission Guinea 653 21 460 163.4 5 138 1.1 Community transmission Mozambique 556 69 134 221.2 9 798 2.6 Community transmission Togo 549 12 496 150.9 3 119 1.4 Community transmission Rwanda 523 23 866 184.3 8 322 2.5 Community transmission Burundi 458 3 612 30.4 0 6 0.1 Community transmission Nigeria 411 164 147 79.6 1 2 061 1.0 Community transmission Ghana 403 91 663 295.0 17 771 2.5 Community transmission Zimbabwe 396 37 669 253.4 14 1 552 10.4 Community transmission Côte d’Ivoire 374 45 519 172.6 13 274 1.0 Community transmission Senegal 367 39 731 237.3 13 1 090 6.5 Community transmission Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Democratic Republic of the Congo 352 28 894 32.3 0 745 0.8 Community transmission Seychelles 344 4 834 4 915.2 1 25 25.4 Community transmission Central African Republic 322 5 787 119.8 1 75 1.6 Community transmission Uganda 227 41 340 90.4 1 338 0.7 Community transmission Burkina Faso 158 13 114 62.7 2 154 0.7 Community transmission Gambia 131 5 733 237.2 2 170 7.0 Community transmission Malawi 129 33 934 177.4 11 1 138 5.9 Community transmission Mauritania 116 18 121 389.7 2 452 9.7 Community transmission Benin 96 7 611 62.8 3 96 0.8 Community transmission South Sudan 92 10 432 93.2 0 114 1.0 Community transmission Mauritius 91 1 203 94.6 3 15 1.2 Clusters of cases Chad 75 4 691 28.6 1 168 1.0 Community transmission Eritrea 44 3 491 98.4 0 10 0.3 Community transmission Niger 42 5 114 21.1 2 190 0.8 Community transmission Equatorial Guinea 40 7 259 517.4 0 106 7.6 Community transmission Guinea-Bissau 32 3 710 188.5 0 66 3.4 Community transmission Sierra Leone 27 4 020 50.4 0 79 1.0 Community transmission Comoros 26 3 815 438.7 0 146 16.8 Community transmission Sao Tome and Principe 12 2 275 1 038.1 0 35 16.0 Community transmission Liberia 5 2 071 40.9 0 85 1.7 Community transmission Lesotho 2 10 709 499.9 0 315 14.7 Community transmission Congo 0 10 084 182.7 0 137 2.5 Community transmission United Republic of Tanzania 0 509 0.9 0 21 0.0 Pending Territoriesiii Réunion 917 18 425 2 057.9 12 135 15.1 Community transmission Mayotte 146 19 789 7 253.6 1 168 61.6 Community transmission Americas 1 525 505 59 551 000 5 822.5 39 482 1 444 736 141.3 United States of America 477 778 31 250 635 9 441.2 5 146 560 858 169.4 Community transmission Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Brazil 459 281 13 832 455 6 507.6 20 031 368 749 173.5 Community transmission Argentina 160 747 2 658 628 5 882.5 1 734 59 084 130.7 Community transmission Colombia 115 216 2 619 422 5 147.9 2 281 67 564 132.8 Community transmission Canada 60 784 1 106 062 2 930.6 290 23 541 62.4 Community transmission Peru 60 532 1 689 051 5 122.7 2 169 56 454 171.2 Community transmission Chile 48 826 1 117 348 5 845.0 842 25 055 131.1 Community transmission Mexico 27 875 2 299 939 1 783.8 4 673 211 693 164.2 Community transmission Uruguay 21 623 159 569 4 593.6 425 1 788 51.5 Community transmission Paraguay 14 664 246 806 3 460.3 479 5 177 72.6 Community transmission Ecuador 13 280 358 157 2 030.0 366 17 641 100.0 Community transmission Guatemala 9 667 212 307 1 185.0 189 7 190 40.1 Community transmission Venezuela (Bolivarian Republic of) 8 148 180 609 635.1 131 1 870 6.6 Community transmission Cuba 6 902 92 474 816.4 59 512 4.5 Community transmission Bolivia (Plurinational State of) 6 711 287 360 2 461.7 197 12 625 108.2 Community transmission Costa Rica 6 033 228 577 4 487.1 53 3 071 60.3 Community transmission Honduras 5 134 199 682 2 016.1 168 4 934 49.8 Community transmission Dominican Republic 3 441 260 627 2 402.6 29 3 414 31.5 Community transmission Panama 2 151 360 249 8 349.2 29 6 185 143.3 Community transmission El Salvador 1 913 67 404 1 039.2 24 2 072 31.9 Community transmission Jamaica 1 565 43 684 1 475.2 52 721 24.3 Community transmission Guyana 684 11 642 1 480.1 15 267 33.9 Clusters of cases Trinidad and Tobago 419 8 742 624.7 5 150 10.7 Community transmission Bahamas 279 9 696 2 465.6 5 194 49.3 Clusters of cases Suriname 231 9 496 1 618.7 9 187 31.9 Clusters of cases Haiti 78 12 918 113.3 0 251 2.2 Community transmission Saint Lucia 69 4 398 2 395.1 1 65 35.4 Community transmission Barbados 65 3 773 1 312.9 0 44 15.3 Community transmission Belize 51 12 538 3 153.2 0 318 80.0 Community transmission Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Nicaragua 41 5 407 81.6 1 180 2.7 Community transmission Antigua and Barbuda 31 1 213 1 238.7 1 31 31.7 Clusters of cases Saint Vincent and the Grenadines 29 1 819 1 639.6 0 10 9.0 Community transmission Dominica 7 172 238.9 0 0 0.0 Clusters of cases Grenada 2 159 141.3 0 1 0.9 Sporadic cases Saint Kitts and Nevis 0 44 82.7 0 0 0.0 Sporadic cases Territoriesiii Puerto Rico 7 371 120 571 4 214.5 42 2 194 76.7 Community transmission Curaçao 1 042 11 674 7 114.3 20 80 48.8 Community transmission Martinique 871 9 758 2 600.3 7 66 17.6 Community transmission Guadeloupe 623 12 927 3 230.7 5 194 48.5 Community transmission French Guiana 532 18 081 6 053.6 1 95 31.8 Community transmission Aruba 323 10 219 9 571.4 0 92 86.2 Community transmission Bermuda 287 2 060 3 308.0 3 17 27.3 Community transmission United States Virgin Islands 57 3 028 2 899.7 0 26 24.9 Community transmission Bonaire 36 1 511 7 224.5 0 14 66.9 Community transmission Sint Maarten 28 2 202 5 135.0 0 27 63.0 Community transmission Saint Barthélemy 26 954 9 651.0 0 1 10.1 Clusters of cases Turks and Caicos Islands 25 2 369 6 118.6 0 17 43.9 Clusters of cases British Virgin Islands 9 187 618.4 0 1 3.3 Clusters of cases Cayman Islands 9 525 798.8 0 2 3.0 Sporadic cases Saint Martin 7 1 710 4 423.3 0 13 33.6 Community transmission Falkland Islands (Malvinas) 2 62 1 780.1 0 0 0.0 Sporadic cases Anguilla 0 29 193.3 0 0 0.0 Sporadic cases Montserrat 0 20 400.1 0 1 20.0 No cases Saba 0 6 310.4 0 0 0.0 No cases Saint Pierre and Miquelon 0 25 431.4 0 0 0.0 Sporadic cases Sint Eustatius 0 20 637.1 0 0 0.0 No cases Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Eastern Mediterranean 386 176 8 444 694 1 155.5 5 460 170 580 23.3 Iran (Islamic Republic of) 166 367 2 215 445 2 637.7 2 095 66 327 79.0 Community transmission Iraq 52 832 970 987 2 414.0 270 14 948 37.2 Community transmission Pakistan 34 190 750 158 339.6 765 16 094 7.3 Community transmission Jordan 21 071 683 466 6 698.6 470 8 178 80.2 Community transmission Lebanon 13 870 508 503 7 450.1 256 6 886 100.9 Community transmission Tunisia 13 679 283 976 2 402.8 482 9 717 82.2 Community transmission United Arab Emirates 13 287 495 224 5 007.1 21 1 550 15.7 Clusters of cases Kuwait 10 156 255 860 5 991.2 37 1 440 33.7 Community transmission Oman 8 663 176 668 3 459.6 74 1 821 35.7 Community transmission Bahrain 7 711 163 113 9 586.0 34 588 34.6 Community transmission Qatar 6 693 195 757 6 794.6 45 376 13.1 Community transmission Saudi Arabia 6 418 404 054 1 160.6 63 6 810 19.6 Community transmission Egypt 5 807 215 484 210.6 289 12 694 12.4 Community transmission Libya 4 243 171 131 2 490.5 75 2 882 41.9 Community transmission Morocco 3 759 505 447 1 369.4 53 8 944 24.2 Community transmission Syrian Arab Republic 886 21 004 120.0 69 1 437 8.2 Community transmission Djibouti 690 10 412 1 053.8 21 114 11.5 Community transmission Afghanistan 633 57 793 148.5 18 2 539 6.5 Community transmission Somalia 566 12 837 80.8 51 656 4.1 Community transmission Yemen 494 5 774 19.4 88 1 120 3.8 Community transmission Sudan 221 33 022 75.3 35 2 208 5.0 Clusters of cases Territoriesiii occupied Palestinian territory 13 940 308 579 6 048.9 149 3 251 63.7 Community transmission Europe 1 624 060 49 208 464 5 273.8 26 302 1 035 294 111.0 Kosovo[1] 3 686 101 110 85 2 051 Community transmission Turkey 414 312 4 212 645 4 994.9 1 906 35 608 42.2 Community transmission France 233 275 5 178 513 7 962.1 1 965 99 921 153.6 Community transmission Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Germany 143 994 3 142 262 3 778.3 1 561 79 914 96.1 Community transmission Poland 113 394 2 688 025 7 081.6 3 611 62 032 163.4 Community transmission Italy 103 366 3 857 443 6 467.7 2 753 116 676 195.6 Clusters of cases Ukraine 93 261 1 946 510 4 450.8 2 772 39 786 91.0 Community transmission Russian Federation 60 711 4 702 101 3 222.1 2 596 105 582 72.3 Clusters of cases Netherlands 52 986 1 395 233 8 015.1 152 16 904 97.1 Community transmission Sweden 35 133 900 138 8 715.9 28 13 788 133.5 Community transmission Spain 31 084 3 396 685 7 176.2 176 76 882 162.4 Community transmission Hungary 30 344 750 508 7 682.1 1 767 25 184 257.8 Community transmission Romania 24 174 1 027 039 5 313.5 1 066 26 072 134.9 Community transmission Belgium 23 034 949 994 8 244.7 252 23 741 206.0 Community transmission Serbia 20 823 660 299 9 532.7 254 5 954 86.0 Community transmission Czechia 20 158 1 600 347 14 965.0 618 28 426 265.8 Community transmission Greece 19 681 313 444 2 924.3 564 9 397 87.7 Community transmission Kazakhstan 18 391 341 599 1 819.3 194 4 157 22.1 Clusters of cases The United Kingdom 17 893 4 385 942 6 460.7 180 127 260 187.5 Community transmission Austria 16 296 588 101 6 607.1 223 9 616 108.0 Community transmission Croatia 15 274 307 790 7 584.5 254 6 562 161.7 Community transmission Azerbaijan 14 943 298 522 2 944.2 228 4 107 40.5 Clusters of cases Bulgaria 14 432 385 963 5 552.2 787 15 138 217.8 Clusters of cases Switzerland 9 883 629 507 7 273.7 20 9 815 113.4 Community transmission Belarus 8 060 342 923 3 629.1 69 2 413 25.5 Community transmission Lithuania 7 458 233 631 8 361.6 73 3 760 134.6 Community transmission Bosnia and Herzegovina 7 171 190 296 5 800.3 479 7 837 238.9 Community transmission Georgia 6 962 295 358 7 404.0 62 3 939 98.7 Community transmission Armenia 5 703 208 520 7 036.9 143 3 878 130.9 Community transmission Slovenia 5 645 231 599 11 050.3 26 4 460 212.8 Clusters of cases North Macedonia 5 576 146 733 7 043.0 237 4 419 212.1 Community transmission Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Slovakia 4 912 375 974 6 888.7 541 11 106 203.5 Clusters of cases Denmark 4 630 241 731 4 151.5 13 2 452 42.1 Community transmission Republic of Moldova 4 608 245 494 6 085.7 179 5 548 137.5 Community transmission Cyprus 4 372 55 407 6 239.5 16 288 32.4 Clusters of cases Norway 4 264 106 223 1 979.0 24 708 13.2 Community transmission Latvia 3 757 110 997 5 818.4 62 2 048 107.4 Community transmission Portugal 3 632 830 560 8 066.9 32 16 942 164.6 Clusters of cases Estonia 3 380 117 554 8 845.5 72 1 092 82.2 Clusters of cases Ireland 2 595 243 238 4 899.6 52 4 835 97.4 Community transmission Finland 1 926 83 633 1 513.6 19 887 16.1 Community transmission Uzbekistan 1 758 86 680 259.0 3 637 1.9 Clusters of cases Kyrgyzstan 1 656 91 883 1 408.3 27 1 549 23.7 Clusters of cases Albania 1 301 129 456 4 498.4 30 2 340 81.3 Clusters of cases Montenegro 1 130 95 548 15 213.1 61 1 434 228.3 Clusters of cases Israel 1 113 836 926 9 669.3 42 6 334 73.2 Community transmission Luxembourg 1 096 64 746 10 341.0 17 785 125.4 Community transmission Malta 379 29 927 5 816.0 7 409 79.5 Clusters of cases Andorra 274 12 771 16 528.8 3 123 159.2 Community transmission San Marino 54 5 010 14 762.2 1 86 253.4 Community transmission Liechtenstein 51 2 892 7 463.8 0 54 139.4 Sporadic cases Iceland 28 6 286 1 726.3 0 29 8.0 Community transmission Monaco 22 2 395 6 102.8 0 31 79.0 Sporadic cases Holy See 0 26 3 213.8 0 0 0.0 Sporadic cases Tajikistan 0 13 714 143.8 0 91 1.0 Pending Territoriesiii Gibraltar 14 4 291 12 736.3 0 94 279.0 Clusters of cases Jersey 2 3 232 2 998.3 0 69 64.0 Community transmission Faroe Islands 1 662 1 354.8 0 1 2.0 Sporadic cases Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Guernsey 1 822 1 275.1 0 14 21.7 Community transmission Isle of Man 1 1 575 1 852.2 0 29 34.1 No cases Greenland 0 31 54.6 0 0 0.0 No cases South-East Asia 1 518 708 17 696 534 875.5 9 447 237 832 11.8 India 1 429 304 14 788 109 1 071.6 7 875 177 150 12.8 Clusters of cases Indonesia 36 895 1 599 763 584.9 885 43 328 15.8 Community transmission Bangladesh 36 315 715 252 434.3 622 10 283 6.2 Community transmission Thailand 9 727 42 352 60.7 4 101 0.1 Clusters of cases Nepal 3 933 283 658 973.5 36 3 075 10.6 Clusters of cases Sri Lanka 1 591 96 439 450.4 22 617 2.9 Clusters of cases Maldives 621 26 145 4 836.8 2 69 12.8 Clusters of cases Timor-Leste 228 1 236 93.7 1 2 0.2 Clusters of cases Myanmar 52 142 628 262.1 0 3 206 5.9 Clusters of cases Bhutan 42 952 123.4 0 1 0.1 Sporadic cases Western Pacific 128 176 2 205 688 112.3 1 444 34 918 1.8 Philippines 72 848 926 035 845.1 1 066 15 810 14.4 Community transmission Japan 26 426 529 829 418.9 240 9 622 7.6 Clusters of cases Malaysia 13 742 372 859 1 152.0 49 1 370 4.2 Community transmission Mongolia 6 472 20 655 630.1 21 41 1.3 Clusters of cases Republic of Korea 4 560 114 114 222.6 29 1 797 3.5 Clusters of cases Cambodia 2 151 6 389 38.2 14 43 0.3 Sporadic cases Papua New Guinea 1 296 9 738 108.8 21 89 1.0 Community transmission China 190 103 273 7.0 3 4 856 0.3 Clusters of cases Singapore 175 60 808 1 039.4 0 30 0.5 Sporadic cases Australia 109 29 505 115.7 1 910 3.6 Clusters of cases Viet Nam 89 2 781 2.9 0 35 0.0 Clusters of cases New Zealand 20 2 238 46.4 0 26 0.5 Clusters of cases Lao People's Democratic Republic 9 58 0.8 0 0 0.0 Sporadic cases Reporting Country/Territory/Areai New cases in last 7 days Cumulative cases Cumulative cases per 100 thousand population New deaths in last 7 days Cumulative deaths Cumulative deaths per 100 thousand population Transmission classificationii Fiji 4 72 8.0 0 2 0.2 Sporadic cases Brunei Darussalam 2 221 50.5 0 3 0.7 Sporadic cases Solomon Islands 0 20 2.9 0 0 0.0 No cases Territoriesiii French Polynesia 44 18 696 6 655.6 0 141 50.2 Sporadic cases Guam 29 7 654 4 535.0 0 136 80.6 Clusters of cases Wallis and Futuna 6 447 3 974.7 0 5 44.5 Sporadic cases New Caledonia 2 123 43.1 0 0 0.0 Sporadic cases Northern Mariana Islands (Commonwealth of the) 2 162 281.5 0 2 3.5 Pending Marshall Islands 0 4 6.8 0 0 0.0 No cases Samoa 0 4 2.0 0 0 0.0 No cases Vanuatu 0 3 1.0 0 0 0.0 No cases Global 5 236 922 140 332 386 83 305 3 004 088 *See Annex: Data, table and figure notes Annex 2. List of countries/territories/areas reporting variants of concern as of 20 April 2021** Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) Afghanistan Verified* Albania Not Verified Algeria Verified Angola Verified Verified Argentina Verified Verified Armenia Not Verified* Aruba Verified Verified Verified Australia Verified Verified Verified Austria Verified Verified Verified Azerbaijan Verified Bahrain Verified Bangladesh Verified Not Verified Barbados Verified Belarus Verified Belgium Verified Verified Verified Belize Verified Bonaire Verified Bosnia and Herzegovina Not Verified Botswana Verified Brazil Verified Verified Verified Brunei Darussalam Verified Verified Bulgaria Verified Cabo Verde Verified Cambodia Verified Cameroon Verified Canada Verified Verified Verified Cayman Islands Verified Chile Verified Verified* Verified Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) China Verified Verified Verified Colombia Verified* Verified Comoros Verified Costa Rica Verified Verified Verified Croatia Verified Not Verified Cuba Verified Verified Curaçao Verified Cyprus Verified Czechia Verified Not Verified Democratic Republic of the Congo Verified Verified Denmark Verified Verified Verified Dominican Republic Verified Ecuador Verified Verified* Estonia Verified Not Verified Eswatini Verified Faroe Islands Verified Finland Verified Verified Verified France Verified Verified Verified French Guiana Verified Verified* Verified French Polynesia Verified Verified Gambia Verified Georgia Verified Germany Verified Verified Verified Ghana Verified Verified Gibraltar Not Verified Greece Verified Verified Grenada Verified Guadeloupe† Verified Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) Guyana Not Verified Hungary Verified Not Verified Iceland Verified India Verified Verified Verified Indonesia Verified Iran (Islamic Republic of) Verified Iraq Verified Ireland Verified Verified Not Verified Israel Verified Verified Italy Verified Not Verified Verified Jamaica Verified Japan Verified Verified Verified Jordan Verified Verified* Verified* Kazakhstan Not Verified Not Verified Kenya Not Verified Verified Kosovo[1] Verified Kuwait Verified Latvia Verified Verified Lebanon Verified Lesotho Verified Libya Verified Verified Liechtenstein Verified Lithuania Verified Verified Luxembourg Verified Verified Not Verified Malawi Verified Verified Malaysia Verified Verified Malta Verified Not Verified Martinique† Verified Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) Mauritius Not Verified Mayotte Verified Verified Mexico Verified Verified Monaco Verified Not Verified Montenegro Verified Morocco Verified Mozambique Verified Namibia Verified Nepal Verified Netherlands Verified Verified Verified New Caledonia Verified New Zealand Verified Verified Not Verified Nigeria Verified North Macedonia Verified Norway Verified Verified Verified occupied Palestinian territory Verified Verified Oman Verified Pakistan Verified Panama Verified* Verified Verified Paraguay Verified Peru Verified Verified Philippines Verified Verified Verified Poland Verified Not Verified Not Verified Portugal Verified Verified Not Verified Puerto Rico Verified Verified Qatar Verified Verified Republic of Korea Verified Verified Verified Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) Republic of Moldova Not Verified Réunion Verified Verified Verified Romania Verified Verified Verified Russian Federation Verified Not Verified Rwanda Not Verified Not Verified Saint Barthélemy Verified Saint Lucia Verified Saint Martin Verified Verified Verified Saudi Arabia Verified Senegal Verified Serbia Verified Singapore Verified Not Verified Sint Maarten Verified Slovakia Verified Not Verified Slovenia Verified Verified Not Verified South Africa Verified Verified Spain Verified Verified Verified Sri Lanka Verified Verified Suriname Verified Verified Verified Sweden Verified Verified Verified Switzerland Verified Verified Not Verified Country/Territory/Area VOC 202012/01 (B.1.1.7) 501Y.v2 (B.1.351) P.1 (B.1.1.28) Syrian Arab Republic Not Verified* Thailand Verified Verified The United Kingdom Verified Verified Verified Togo Verified Trinidad and Tobago Verified Tunisia Verified Turkey Verified Not Verified Not Verified Turks and Caicos Islands Verified Uganda Not Verified Ukraine Not Verified Not Verified* United Arab Emirates Verified Verified Verified United Republic of Tanzania Verified United States of America Verified Verified Verified Uruguay Verified Verified Uzbekistan Verified Not Verified* Venezuela (Bolivarian Republic of) Verified Viet Nam Verified Verified Wallis and Futuna Not Verified Zambia Verified Zimbabwe Verified *New country added in this update. †Variants 501Y.V2 and P.1 for Guadeloupe and Martinique were removed based on further information received. **See Annex : Data, table and figure notes Annex 3. Data, table and figure notes Data presented are based on official laboratory-confirmed COVID-19 case and deaths reported to WHO by country/territories/areas, largely based upon WHO case definitions and surveillance guidance. While steps are taken to ensure accuracy and reliability, all data are subject to continuous verification and change, and caution must be taken when interpreting these data as several factors influence the counts presented, with variable underestimation of true case and death incidence, and variable delays to reflecting these data at global level. Case detection, inclusion criteria, testing strategies, reporting practices, and data cut-off and lag times differ between countries/territories/areas. A small number of countries/territories/areas report combined probable and laboratory-confirmed cases. Differences are to be expected between information products published by WHO, national public health authorities, and other sources. Due to public health authorities conducting data reconciliation exercises which remove large numbers of cases or deaths from their total counts, negative numbers may be displayed in the new cases/deaths columns as appropriate. When additional details become available that allow the subtractions to be suitably apportioned to previous days, graphics will be updated accordingly. A record of historic data adjustment made is available upon request by emailing epi-data-support@who.int. Please specify the country(ies) of interest, time period(s), and purpose of the request/intended usage. Prior situation reports will not be edited; see covid19.who.int for the most up-to-date data. Global totals include 745 cases and 13 deaths reported from international conveyances. The designations employed, and the presentation of these materials do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Countries, territories and areas are arranged under the administering WHO region. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. [1] All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). In the map, number of cases of Serbia and Kosovo (UNSCR 1244, 1999) have been aggregated for visualization purposes. i Excludes countries, territories, and areas that have never reported a confirmed COVID-19 case (Annex 1), or the detection of a variant of concern (Annex 2). ii Transmission classification is based on a process of country/territory/area self-reporting. Classifications are reviewed on a weekly basis and may be revised as new information becomes available. Differing degrees of transmission may be present within countries/territories/areas. For further information, please see: Considerations for implementing and adjusting public health and social measures in the context of COVID-19: • No (active) cases: No new cases detected for at least 28 days (two times the maximum incubation period), in the presence of a robust surveillance system. This implies a near-zero risk of infection for the general population. • Imported / Sporadic cases: Cases detected in the past 14 days are all imported, sporadic (e.g., laboratory acquired or zoonotic) or are all linked to imported/sporadic cases, and there are no clear signals of further locally acquired transmission. This implies minimal risk of infection for the general population. • Clusters of cases: Cases detected in the past 14 days are predominantly limited to well-defined clusters that are not directly linked to imported cases, but which are all linked by time, geographic location and common exposures. It is assumed that there are a number of unidentified cases in the area. This implies a low risk of infection to others in the wider community if exposure to these clusters is avoided. • Community transmission: Which encompasses a range of levels from low to very high incidence, as described below and informed by a series of indicators described in the aforementioned guidance. As these subcategorization are not currently collated at the global level, but rather intended for use by national and sub-national public health authorities for local decision-making, community transmission has not been disaggregated in this information product. o CT1: Low incidence of locally acquired, widely dispersed cases detected in the past 14 days, with many of the cases not linked to specific clusters; transmission may be focused in certain population sub-groups. Low risk of infection for the general population. o CT2: Moderate incidence of locally acquired, widely dispersed cases detected in the past 14 days; transmission less focused in certain population sub-groups. Moderate risk of infection for the general population. o CT3: High incidence of locally acquired, widely dispersed cases in the past 14 days; transmission widespread and not focused in population sub-groups. High risk of infection for the general population. o CT4: Very high incidence of locally acquired, widely dispersed cases in the past 14 days. Very high risk of infection for the general population. • Pending: transmission classification has not been reported to WHO. iii “Territories” include territories, areas, overseas dependencies and other jurisdictions of similar status.