COVID-19 weekly epidemiological update, 2 February 2021

COVID-19 Weekly Epidemiological Update Data as received by WHO from national authorities, as of 31 January 2021, 10 am CET For the latest data and other updates on COVID-19, please see: • WHO COVID-19 Dashboard • WHO COVID-19 Weekly Operational Update Global epidemiological situation Globally, 3.7 million new cases were reported last week, a 13% decline as compared to the previous week, and the third consecutive week showing a decline in cases. There were 96 000 new deaths, and a 1% decline as compared to the previous week, (Figure 1). This brings the total number of cases to over 102 million and the total number of deaths to 2.2 million from 222 countries and territories. Last week, all WHO regions, except South-East Asia reported a decline in new cases (Table 1). Although new deaths declined globally by 1%, they rose in the Western Pacific (21%), Eastern Mediterranean (9%), and the Americas (4%). Saturday 30 January 2021 marked one year since WHO declared COVID-19 a Public Health Emergency of International Concern. At that time, there were 9826 cases in 20 countries, and 213 deaths in one country (all of which were in China). In the past week, the five countries reporting the highest number of new cases continue to be the United States of America (1 072 287 cases, a 15% decrease), Brazil (364 593 cases, a 1% increase), the United Kingdom of Great Britain and Northern Ireland (178 629 cases, a 31% decrease), France (141 092 cases, a 2% increase) and the Russian Federation (131 039 cases, a 13% decrease). Figure 1: COVID-19 cases reported weekly by WHO Region, and global deaths, as of 31 January 2021** **See data, table and figure notes 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 6 000 000 3 0 -D e c 2 0 -J a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s Reported week commencing Americas South-East Asia Europe Eastern Mediterranean Africa Western Pacific Deaths In this edition of the COVID-19 Weekly Epidemiological Update, special focus updates are provided on: • COVID-19 and Health Workers • SARS-CoV-2 variants of concern • Additional Region-specific information: African Region, Region of the Americas, Eastern Mediterranean Region, European Region, South-East Asia Region, and Western Pacific Region • Key Weekly Updates Note: From 3 February 2021, a daily log of major changes and errata in WHO daily aggregate case and death count data will no longer be published online. A record of historic data adjustment made will continue to be 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. Table 1. Newly reported and cumulative COVID-19 confirmed cases and deaths, by WHO Region, as of 31 January 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 1 888 070 (51%) -11% 45 345 051 (44%) 47 277 (49%) 4% 1 047 171 (47%) Europe 1 255 352 (34%) -18% 34 276 814 (34%) 36 674 (38%) -8% 745 590 (34%) South-East Asia 200 219 (5%) 3% 12 856 723 (13%) 3 258 (3%) 0% 197 707 (9%) Eastern Mediterranean 161 943 (4%) -5% 5 669 940 (6%) 3 272 (3%) 9% 134 189 (6%) Africa 108 391 (3%) -27% 2 570 474 (3%) 4 602 (5%) -8% 62 504 (3%) Western Pacific 72 135 (2%) -11% 1 420 024 (1%) 1 281 (1%) 21% 24 588 (1%) Global 3 686 110 (100%) -13% 102 139 771 (100%) 96 364 (100%) -1% 2 211 762 (100%) *Percent change in the number of newly confirmed cases/deaths in past seven days, compared to seven days prior. Regional percentages rounded to the nearest whole number, global totals may not equal 100%. **See data, table and figure notes. Figure 2. COVID-19 cases per 100 000 population reported in the last seven days by countries, territories and areas, 25 January through 31 January 2021** **See data, table and figure notes Special Focus: COVID-19 and Health Workers Overview In his press briefing of 29 January 2021, WHO Director-General Dr Tedros again emphasized that healthcare workers have been at the forefront of the response to the pandemic but are often under-protected and over- exposed. He reiterated his 18 January 2021 call to action: for governments and industry leaders to work together to ensure that in the first 100 days of 2021, vaccination of health workers and older people is underway in all countries. In this Special Focus – recognizing that 2021 has been designated as the International Year of Health and Care Workers – we present an overview of health worker SARS-CoV-2 infections using data collected via the WHO Global Surveillance systems, and analyse risk factors from available scientific literature. To date, a total of 183 countries have reported data via WHO Case Report Forms (CRFs) to date, covering 37 million cases (36% of current global COVID-19 cases). The CRFs were mainly received from Member States in the Region of the Americas and European Region. Over 16 million CRFs (43% of CRFs received, representing 16% of global COVID-19 cases) included information on occupation status, including health workers1. Within this subset, health workers accounted for close to 1.29 million COVID-19 cases, or 8% of cases. The median age of health worker cases was 42 years (interquartile range 27 to 60 years), and 68% were women. This is in line with the proportion of women working in the health and social sectors globally. At the outset, it is important to mention that the analyses based on CRF data provided to WHO has limitations, mainly due to variations in reporting coverage and completeness, reporting methods, some irregularity of weekly reports, health worker definitions, and lack of information about the setting of exposure. WHO advises Member States to use the definition of health workers as stated in the Surveillance Protocol for SARS-CoV-2 infection.2 Percentage of health worker infections and relative risk over time It is important to acknowledge that country-specific trends remain highly variable, and the data are based on reported cases (those testing positive for SARS-CoV-2) often without providing information on the overall number tested. Therefore, it is difficult to reliably compare incidence of health worker infections over time and trends should be interpreted with caution due to variations in reporting coverage and completeness, adaptations to testing strategies, differences in the implementation of public health measures and interventions, as well as differences in the circulation of SARS-CoV-2 in the community over time. Additionally, it is not possible to determine the place of exposure (e.g., health care facility or community) among health workers from WHO CFR data. Based on WHO CRF data, in the first three months of the pandemic, health worker infections slightly exceeded 10% of reported cases (Figure 3), declining to less than 5% by early-June 2020 (Epi week 2) and to approximately 2.5% by September 2020 (Epi week 37). 1 For the purposes of the case-based surveillance, ‘health workers’ were defined as those working “any job in a health care setting”. 2 The term “health worker” includes allied health workers and auxiliary health workers such as cleaning and laundry personnel, x-ray physicians and technicians, clerks, phlebotomists, respiratory therapists, nutritionists, social workers, physical therapists, laboratory personnel, cleaners, admission/reception clerks, patient transporters, catering staff and so on). Figure 3: Weekly total number of cases, and percentage of health worker cases among infected individuals reported, data from WHO Case Report Forms where occupation was indicated, 20 January 2020 to 31 January 2021. A relative risk measure (dividing the rate of health worker infections by that of the non-health workers) was calculated for each week by estimating the total number of health workers and non-health workers. The rate of health worker infections was calculated by dividing their number by all workers employed in the health and social sector. A similar rate of infection was calculated for non-health workers relative to the general population size. It must be noted that there has likely been surveillance bias and differences in testing of health workers compared to general population, particularly early on. Based on the data we have available, it is observed that health workers experienced more than triple the risk of infection as that of the general population in the period between mid-March to mid-May 2020. A similar level of relative risk3 was also reported by an observational cohort study of about 2 million community individuals and 100 000 front-line health-care workers in the United Kingdom of Great Britain and Northern Ireland, and the United States of America. Our data suggests this period of elevated risk was followed by a steep decline to that found in the general population by end of May 2020. Analysis of health worker risk factors WHO first commissioned a rapid systematic review of published literature on the risk factors in health workers for SARS-CoV-2 infections in April 2020 and this has been updated regularly since. The latest update on 24 December 2020 identified a total of 37 studies evaluating risk factors associated with SARS-CoV-2 infection in health workers. Highlights include: • SARS-CoV-2 infections occurred among health workers in various roles (clinical or non-clinical) and departments/settings (including outpatient and non-COVID-19 care settings). • There was no consistent difference in risk of infection between job titles, including between nurses compared with physicians, which represented the most commonly reported health worker roles. 3 Adjusted HR 3·40, 95% CI 3·37–3·43 • There was no association found between sex or age and risk of SARS-CoV-2 infection or seropositivity in health workers. • African-Americans and Hispanic health workers had an increased risk of SARS CoV-2 infection. • Education and training in infection prevention and control were associated with decreased risk of SARS- CoV-2 infection in health workers. • Certain exposures such as those involving intubations, other aerosol-generating procedures, direct patient contact, or contact with bodily secretions were found to be associated with increased infection risk compared with less intensive or direct exposure; though evidence was inconsistent, likely related to confounding factors such as those related to the availability, distribution, and use of PPE. • Evidence on the association between health worker infection and use of individual PPE measures (masks, gloves, gown, eye protection) and hand hygiene was limited. However, most studies found that availability and appropriate use of PPE as recommended by local authorities was associated with decreased risk of SARS-CoV-2 infection. Evidence on the use of N95 or FFP2 respirators versus medical/surgical masks was inconclusive and limited to two inconsistent observational studies. Further information on the use of masks in health facilities can be found in the interim guidance on mask use in the context of COVID-19. • Three studies found that universal masking in health facilities was associated with decreased risk of SARS-CoV-2 infection in health workers. A number of possible hypotheses may help to explain the observed trends in health worker infections. The higher proportion of health worker infections at the beginning of the pandemic in some countries may be due to the lack of preparedness to infectious disease outbreaks, of standard IPC precautions during care delivery, and reduced access to PPE, and overburdened health systems due to increased hospitalizations and limited health care capacities. Trends could also reflect different testing strategies prioritizing health workers over the general public. The subsequent decline in health worker infections could be a result of multiple interventions, including: i) training of health workers on IPC measures; ii) increased availability and appropriate use of personal protective equipment (PPE); iii) monitoring of IPC practices by occupational health and safety personnel; iv) improved clinical management based on improved knowledge about COVID-19, v) reduced bed capacity of COVID-19 patients in hospitals; vi) general reduction in community transmission with implementation of public health and social measures resulting in less pressure on hospital systems and hospitalizations; vi) increased SARS-CoV-2 testing capabilities; and, vii) increased knowledge of methods of transmission. Hence, it is impossible to determine from the available data how these interventions (individually or as a mix) contributed to the observed trends. The WHO review of available studies found that observational studies provided important insights but had some methodological limitations. These limitations include potential recall bias, low or unclear participation rates, small sample sizes, and challenges in disentangling the effect of different measures, which were often implemented at the same time. To bridge these gaps and improve the understanding of SARS-CoV-2 infection among health workers, WHO has developed a standardized protocol for COVID-19 surveillance among health workers that countries can use, and is leading an international multi-centre case-control study primarily aimed at identifying risk factors and settings of exposure. More than 140 sites in 28 countries have enrolled so far and recruitment is ongoing (for more information please contact: earlyinvestigations-2019-nCoV@who.int). Additionally, to mitigate health workers’ infections WHO has developed a health workers’ risk assessment and management of exposure to COVID-19 cases and guidance on Prevention, identification and management of health worker infection in the context of COVID-19. WHO continues to support health workforce managers and policy makers with the December 2020 release of Health workforce policy and management in the context of the COVID-19 pandemic response interim guidance, consolidating the evolving evidence on the design, management and preservation of the workforce necessary to respond to the COVID-19 pandemic and maintain essential health services. References International Labour Organization, 2020, ILOSTAT, 2/2/2021, https://ilostat.ilo.org/data/ Nguyen LH et al., Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5(9):E475–E483 Chou et al., Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers: A Living Rapid Review, Annals of Internal Medicine. 2020 Jul 21;173(2):120-136. doi: 10.7326/M20-1632. Epub 2020 May 5 Chou et al., Update Alert 6: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers, Annals of Internal Medicine. 2020 Nov 24 : L20-1323. Epub Nov 24. doi: 10.7326/L20-1323 Special Focus: Update on SARS-CoV-2 variants of concern WHO, in collaboration with national authorities, institutions and researchers, continues to monitor the public health events associated with SARS-CoV-2 variants and provides updates as new information becomes available. Further information on the background of the variants of concern (VOC) is available from previously published Disease Outbreak News and in the last four publications of the Weekly Epidemiological Updates. WHO continues to work with partners to evaluate available evidence around transmissibility, severity, antibody neutralization capabilities and potential impacts on vaccines of specific mutations, variants of interest and variants of concern. Here we provide an update on the geographical distribution of three variants of concern as reported by countries, territories and areas (hereafter countries) as of 2 February 2021: 1. Variant VOC 202012/01, lineage B.1.1.7: Since our last update on 27 January, variant VOC 202012/01 has been detected in ten additional countries. As of 2 February, a total of 80 countries across all six WHO regions have reported either imported cases or community transmission of this variant (Figure 5). Figure 5. Countries, territories and areas reporting SARS-CoV-2 VOC 202012/01 as of 2 February 2021 2. Variant 501Y.V2, lineage B.1.351: Since the last update on 27 January, 501Y.V2 has been reported from ten additional countries– now totaling 41 countries across four of the six WHO regions (Figure 6). Figure 6. Countries, territories and areas reporting SARS-CoV-2 501Y.V2 as of 2 February 2021 3. Variant P.1, lineage B.1.1.28: Since our last update, variant P.1 has been reported in two additional countries. To date, this variant is reported in ten countries across four of the six WHO regions (Figure 7). Figure 7. Countries, territories and areas reporting SARS-CoV-2 P.1 variant as of 2 February 2021 Last week, WHO held a multidisciplinary Global Transmission Discussion Seminar on SARS-CoV-2 variants and transmission. Participants from Brazil, Denmark, South Africa and the United Kingdom presented ongoing work aiming to understand transmission aspects of the variants of concern emerging in their countries, namely variants: P.1/P.2, cluster 5, 501Y.V2 and VOC202012/01, respectively. Initial analyses suggest that some variants may be more transmissible, possibly due to mutations that improve the virus’s ability to bind to human cells, but available studies have found that the modes of transmission have not changed. SARS-CoV-2 incidence and hospitalizations in a number of countries where VOC202012/01 and 501Y.V2 are circulating has started to decline in recent weeks, demonstrating the effectiveness of public health and social measures for controlling transmission of these variants. The emergence of new variants has highlighted the importance for everyone to continue to comply with local and national public health and social measures, and to take simple precautions, such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, cleaning your hands, and coughing into a bent elbow or tissue (see also Protect yourself and others from COVID-19). It remains critical to increase diagnostic capacity and strategic genetic sequencing of SARS-CoV-2 where capacity allows, and continue to share sequence data internationally in a timely manner. Genetic sequencing should be considered for a subset of SARS-CoV-2 cases in each country, especially among outbreaks or clusters where transmission and/or severity may appear unusual. WHO has recently issued guidance for SARS-CoV-2 suggesting how to apply the use sequencing to monitor virus evolution in addition to epidemiological and virologic surveillance sequencing (SARS-CoV-2 genomic sequencing for public health goals: Interim guidance; Genomic sequencing of SARS-CoV-2: a guide to implementation for maximum impact on public health). Situation by WHO Region African Region In the past week, the African Region reported over 108 000 cases and just over 4600 deaths, a 27% decrease in cases and an 8% decrease in deaths respectively compared to the previous week. Cases have decreased for two consecutive weeks. The highest numbers of new cases were reported in South Africa (44 397 new cases; 74.9 new cases per 100 000 population; a 44% decrease), Nigeria (9955 new cases; 4.8 new cases per 100 000; a 15% decrease) and Zambia (8760 new cases; 47.7 new cases per 100 000; a 3% increase). The countries reporting the highest number of new deaths in the past week were South Africa (3377 new deaths; 5.7 new deaths per 100 000; a 9% decrease), Zimbabwe (219 new deaths; 1.5 new deaths per 100 000; a 25% decrease) and Malawi (217 new deaths; 1.1 new deaths per 100 000; a 28% increase). Region of the Americas Over 1.8 million new cases and over 47 000 new deaths were reported in the Region of the Americas this week, a decrease of 11% and an increase of 4% respectively compared to the previous week. The highest numbers of new cases were reported from the United States of America (1 072 287 new cases; 324.0 new cases per 100 000 population; a 15% decrease), Brazil (364 593 new cases; 171.5 new cases per 100 000; a 1% increase) and Mexico (109 603 new cases; 85.0 new cases per 100 000; an 11% decrease). The highest numbers of deaths were reported from the same countries, the United States of America (22 506 new deaths; 6.8 new deaths per 100 000; a 4% increase), Mexico (8965 new deaths; 7.0 new deaths per 100 000; a 4% increase) and Brazil (7423 new deaths; 3.5 new deaths per 100 000; a 6% 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 a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s 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 a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s Reported week commencing Cases Deaths Eastern Mediterranean Region In the past week, the Eastern Mediterranean Region reported over 161 000 new cases, a decrease of 5% compared to last week. The region reported 3200 new deaths, a 9% increase. The three countries reporting the highest numbers of new cases continue to be the Islamic Republic of Iran (44 699 new cases, 53.2 new cases per 100 000 population, a 5% increase), Lebanon (22 326 new cases, 327.1 new cases per 100 000, a 19% decrease) and United Arab Emirates (26 285 new cases, 265.8 new cases per 100 000, 7% increase). The highest numbers of new deaths were reported in Lebanon (751 new deaths, 11.0 new death per 100 000, an 81% increase), Iran (595 new deaths, 0.7 new death per 100 000 population, a 3% increase), and Tunisia (526 new deaths, 4.5 new death per 100 000, a 2% decrease). European Region The European Region reported over 1.2 million new cases and over 36 000 new deaths, a decrease of 18% and 8% respectively when compared to the previous week. The three countries reporting the highest numbers of new cases were the United Kingdom (178 629 new cases, 263.1 new cases per 100 000, a 31% decrease), France (141 092 new cases; 216.2 new cases per 100 000, a 2% increase) and the Russian Federation (131 039 new cases, 89.8 new cases per 100 000, a 13% decrease). The highest numbers of deaths were reported from the United Kingdom (8242 new deaths; 12.1 new deaths per 100 000, a 6% decrease), Germany (5075 new deaths; 6.1 new deaths per 100 000, a 7% decrease) and the Russian Federation (3720 new deaths; 2.5 new deaths per 100 000, a 5% 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 3 0 -D e c 2 0 -J a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s 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 a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s Reported week commencing Cases Deaths South-East Asia Region Following slow declines in the number of new cases in the South-East Asia Region in recent weeks, there was a plateau in newly reported cases (200 000 new cases, 3% increase from last week), and deaths (3000 new deaths, 0% change) this week. The three countries reporting the highest numbers of new cases and new deaths were India (91 650 new cases; 6.6 new cases per 100 000, a 5% decrease), Indonesia (88 839 new cases; 32.5 new cases per 100 000; a 10% increase) and Sri Lanka (5706 new cases; 26.6 new cases per 100 000; an 8% increase). The three countries reporting the highest numbers of new deaths this week were Indonesia (2064 new deaths; 0.8 new deaths per 100 000, a 9% increase), India (935 new deaths; <0.1 new deaths per 100 000, a 12% decrease) and Bangladesh (108 new deaths; <0.1 new deaths per 100 000; a 10% decrease). Western Pacific Region The Western Pacific Region reported 72 000 new cases the past week, an 11% decrease compared the previous week, while a marked (21%) increase was seen in the number of new deaths, with over 1200 deaths reported this week. The three countries reporting the highest numbers of new cases in the region this week were Malaysia (29 206 new cases; 90.2 new cases per 100 000, a 15% decrease), Japan (26 081 new cases; 20.6 new cases per 100 000, a 32% decrease), and the Philippines (11 837 new cases; 10.8 new cases per 100 000, a 9% decrease). The three countries reporting the highest numbers of new deaths this week were Japan (635 new deaths; 0.5 new deaths per 100 000, an 8% increase), the Philippines (479 new deaths; 0.4 new deaths per 100 000, an 11% increase) and Malaysia (79 new deaths; 0.2 new deaths per 100 000, a 56% increase). 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 9 000 10 000 0 100 000 200 000 300 000 400 000 500 000 600 000 700 000 800 000 3 0 -D e c 2 0 -J a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s Reported week commencing Cases Deaths 0 200 400 600 800 1 000 1 200 1 400 1 600 0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000 3 0 -D e c 2 0 -J a n 1 0 -F e b 0 2 -M a r 2 3 -M a r 1 3 -A p r 0 4 -M a y 2 5 -M a y 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 c t 0 9 -N o v 3 0 -N o v 2 1 -D e c 1 1 -J a n D e a th s C a s e s Reported week commencing Cases Deaths Table 2. COVID-19 confirmed cases and deaths reported in the last seven days by countries, territories and areas, and WHO Region, as of 31 January 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 108 391 2 570 474 229.1 4 602 62 504 5.6 South Africa 44 397 1 449 236 2 443.5 3 377 43 951 74.1 Community transmission Nigeria 9 955 130 557 63.3 83 1 578 0.8 Community transmission Zambia 8 760 53 352 290.2 118 745 4.1 Community transmission Mozambique 6 077 37 705 120.6 66 363 1.2 Community transmission Ghana 5 312 65 427 210.6 44 405 1.3 Community transmission Malawi 5 058 23 497 122.8 217 687 3.6 Community transmission Ethiopia 3 723 137 021 119.2 28 2 091 1.8 Community transmission Botswana 2 663 21 293 905.5 46 134 5.7 Community transmission Rwanda 2 471 15 118 116.7 21 193 1.5 Community transmission Zimbabwe 2 264 33 271 223.9 219 1 193 8.0 Community transmission Algeria 1 753 107 122 244.3 27 2 888 6.6 Community transmission Senegal 1 753 26 213 156.6 52 621 3.7 Community transmission Namibia 1 615 33 828 1 331.3 33 350 13.8 Community transmission Côte d’Ivoire 1 566 28 178 106.8 7 152 0.6 Community transmission Eswatini 1 336 15 666 1 350.3 104 562 48.4 Community transmission Kenya 777 100 675 187.2 15 1 755 3.3 Community transmission Democratic Republic of the Congo 735 22 603 25.2 11 671 0.7 Community transmission Lesotho 622 8 278 386.4 37 160 7.5 Community transmission Burkina Faso 613 10 580 50.6 11 120 0.6 Community transmission Cabo Verde 567 13 981 2 514.6 9 133 23.9 Community transmission Uganda 489 39 533 86.4 7 324 0.7 Community transmission Gabon 470 10 748 482.9 1 68 3.1 Community transmission Comoros 458 2 718 312.6 20 90 10.3 Community transmission Madagascar 442 18 743 67.7 6 279 1.0 Community transmission Angola 415 19 782 60.2 7 464 1.4 Community transmission Sierra Leone 408 3 528 44.2 2 79 1.0 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 Togo 405 5 041 60.9 3 77 0.9 Community transmission Mauritania 238 16 460 354.0 8 418 9.0 Community transmission Chad 210 3 347 20.4 3 118 0.7 Community transmission Eritrea 195 2 135 60.2 1 7 0.2 Sporadic cases Niger 195 4 516 18.7 8 159 0.7 Community transmission South Sudan 188 3 961 35.4 0 64 0.6 Community transmission Guinea 175 14 475 110.2 1 82 0.6 Community transmission Burundi 160 1 632 13.7 0 2 0.0 Community transmission Seychelles 153 1 186 1 205.9 0 3 3.1 Clusters of cases Benin 143 3 786 31.2 0 48 0.4 Community transmission Gambia 132 4 090 169.2 0 128 5.3 Community transmission Equatorial Guinea 115 5 516 393.2 0 86 6.1 Community transmission Mali 104 8 069 39.8 7 330 1.6 Community transmission Congo 93 7 887 142.9 0 117 2.1 Community transmission Guinea-Bissau 92 2 623 133.3 0 45 2.3 Community transmission Sao Tome and Principe 74 1 256 573.1 0 17 7.8 Community transmission Liberia 25 1 939 38.3 0 84 1.7 Community transmission Mauritius 12 568 44.7 0 10 0.8 Sporadic cases Central African Republic 1 4 981 103.1 0 63 1.3 Community transmission Cameroon 0 29 617 111.6 0 462 1.7 Community transmission United Republic of Tanzania 0 509 0.9 0 21 0.0 Pending Territoriesiii Mayotte 687 8 231 3 017.1 2 61 22.4 Clusters of cases Réunion 295 9 996 1 116.5 1 46 5.1 Clusters of cases Americas 1 888 070 45 345 051 4 433.5 47 277 1 047 171 102.4 United States of America 1 072 287 25 676 612 7 757.2 22 506 433 173 130.9 Community transmission Brazil 364 593 9 118 513 4 289.9 7 423 222 666 104.8 Community transmission Mexico 109 603 1 841 893 1 428.6 8 965 156 579 121.4 Community transmission Colombia 90 215 2 077 633 4 083.2 2 698 53 284 104.7 Community transmission Argentina 61 532 1 915 362 4 237.9 1 200 47 775 105.7 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 Peru 37 779 1 125 875 3 414.7 1 259 40 686 123.4 Community transmission Canada 33 386 770 793 2 042.3 973 19 801 52.5 Community transmission Chile 28 253 722 900 3 781.6 485 18 339 95.9 Community transmission Bolivia (Plurinational State of) 15 135 213 392 1 828.1 355 10 226 87.6 Community transmission Ecuador 11 547 249 779 1 415.7 255 14 851 84.2 Community transmission Panama 10 460 318 253 7 375.9 241 5 221 121.0 Community transmission Dominican Republic 10 046 212 553 1 959.4 133 2 646 24.4 Community transmission Honduras 6 928 146 110 1 475.2 136 3 575 36.1 Community transmission Paraguay 5 516 131 886 1 849.1 108 2 693 37.8 Community transmission Guatemala 5 228 159 118 888.2 162 5 618 31.4 Community transmission Cuba 5 047 25 674 226.7 22 213 1.9 Clusters of cases Uruguay 4 359 40 529 1 166.7 61 425 12.2 Community transmission Costa Rica 3 968 193 276 3 794.1 86 2 604 51.1 Community transmission Venezuela (Bolivarian Republic of) 2 981 125 776 442.3 41 1 177 4.1 Community transmission El Salvador 1 317 53 989 832.4 63 1 614 24.9 Community transmission Jamaica 755 15 527 524.4 12 348 11.8 Community transmission Haiti 434 11 533 101.1 2 245 2.1 Community transmission Saint Lucia 425 1 195 650.8 3 13 7.1 Sporadic cases Suriname 419 8 364 1 425.8 6 154 26.3 Clusters of cases Guyana 385 7 528 957.1 5 175 22.2 Clusters of cases Barbados 255 1 498 521.3 3 12 4.2 Community transmission Belize 177 11 877 2 987.0 11 301 75.7 Community transmission Saint Vincent and the Grenadines 176 896 807.6 0 2 1.8 Clusters of cases Trinidad and Tobago 77 7 533 538.3 1 134 9.6 Community transmission Bahamas 64 8 174 2 078.6 1 176 44.8 Clusters of cases Nicaragua 39 4 992 75.4 1 169 2.6 Community transmission Antigua and Barbuda 23 218 222.6 1 7 7.1 Sporadic cases Dominica 4 117 162.5 0 0 0.0 Clusters of 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 Saint Kitts and Nevis 2 37 69.6 0 0 0.0 Sporadic cases Grenada 1 148 131.5 0 1 0.9 Sporadic cases Territoriesiii Puerto Rico 3 333 93 406 3 265.0 52 1 823 63.7 Community transmission French Guiana 419 16 083 5 384.7 0 76 25.4 Community transmission Aruba 235 6 858 6 423.4 6 58 54.3 Community transmission Turks and Caicos Islands 215 1 459 3 768.3 1 8 20.7 Clusters of cases Sint Maarten 114 1 822 4 248.9 0 27 63.0 Community transmission Guadeloupe 100 9 156 2 288.3 0 157 39.2 Community transmission Saint Martin 98 1 289 3 334.3 0 12 31.0 Community transmission United States Virgin Islands 63 2 398 2 296.4 0 24 23.0 Community transmission Curaçao 37 4 574 2 787.4 0 20 12.2 Community transmission Bonaire 12 362 1 730.8 0 3 14.3 Community transmission Cayman Islands 7 390 593.4 0 2 3.0 Sporadic cases Bermuda 5 691 1 109.6 0 12 19.3 Sporadic cases British Virgin Islands 4 141 466.3 0 1 3.3 Clusters of cases Saint Pierre and Miquelon 4 24 414.2 0 0 0.0 Clusters of cases Falkland Islands (Malvinas) 3 40 1 148.4 0 0 0.0 No cases Saint Barthélemy 3 379 3 834.1 0 0 0.0 Sporadic cases Anguilla 2 17 113.3 0 0 0.0 Sporadic cases Martinique 0 6 370 1 697.5 0 44 11.7 Community transmission Montserrat 0 13 260.1 0 1 20.0 No cases Saba 0 6 310.4 0 0 0.0 Sporadic cases Sint Eustatius 0 20 637.1 0 0 0.0 Sporadic cases Eastern Mediterranean 161 943 5 669 940 775.8 3 272 134 189 18.4 Iran (Islamic Republic of) 44 699 1 411 731 1 680.8 595 57 889 68.9 Community transmission United Arab Emirates 26 285 300 661 3 039.9 55 838 8.5 Community transmission Lebanon 22 326 298 913 4 379.4 751 3 031 44.4 Community transmission Pakistan 12 396 543 214 245.9 376 11 623 5.3 Community transmission Tunisia 12 154 207 468 1 755.4 526 6 680 56.5 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 Jordan 6 155 325 674 3 191.9 87 4 304 42.2 Community transmission Iraq 6 052 618 922 1 538.7 53 13 041 32.4 Community transmission Libya 5 110 117 650 1 712.2 105 1 842 26.8 Community transmission Morocco 4 922 470 691 1 275.2 131 8 259 22.4 Clusters of cases Egypt 4 275 165 418 161.6 361 9 263 9.1 Clusters of cases Kuwait 3 721 164 622 3 854.8 7 959 22.5 Community transmission Bahrain 3 170 102 626 6 031.2 5 372 21.9 Clusters of cases Qatar 2 212 150 984 5 240.6 0 248 8.6 Community transmission Saudi Arabia 1 628 367 813 1 056.5 22 6 372 18.3 Sporadic cases Oman 1 242 133 728 2 618.7 10 1 527 29.9 Community transmission Sudan 579 29 449 67.2 69 1 807 4.1 Community transmission Syrian Arab Republic 441 13 998 80.0 37 916 5.2 Community transmission Afghanistan 428 55 023 141.3 22 2 400 6.2 Clusters of cases Somalia 30 4 784 30.1 0 130 0.8 Community transmission Djibouti 13 5 931 600.3 1 62 6.3 Clusters of cases Yemen 2 2 124 7.1 0 616 2.1 Community transmission Territoriesiii occupied Palestinian territory 4 103 178 516 3 499.3 59 2 010 39.4 Community transmission Europe 1 255 352 34 276 814 3 672.2 36 674 745 590 79.9 The United Kingdom 178 629 3 796 092 5 591.9 8 242 105 571 155.5 Community transmission France 141 092 3 126 351 4 789.6 2 982 75 466 115.6 Community transmission Russian Federation 131 039 3 850 439 2 638.5 3 720 73 182 50.1 Clusters of cases Spain 109 866 2 705 001 5 785.5 1 153 57 806 123.6 Community transmission Italy 86 598 2 541 783 4 203.9 3 117 88 279 146.0 Clusters of cases Portugal 86 549 711 018 6 973.0 1 985 12 179 119.4 Clusters of cases Germany 81 427 2 216 363 2 645.3 5 075 56 945 68.0 Community transmission Czechia 47 157 984 774 9 195.8 939 16 308 152.3 Community transmission Turkey 46 573 2 470 901 2 929.7 932 25 865 30.7 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 Israel 45 194 637 242 7 362.2 406 4 722 54.6 Community transmission Poland 37 940 1 513 385 3 998.7 1 817 37 180 98.2 Community transmission Netherlands 31 069 974 761 5 688.8 455 13 958 81.5 Community transmission Ukraine 27 643 1 219 455 2 788.4 846 22 707 51.9 Community transmission Romania 17 724 726 918 3 778.6 542 18 264 94.9 Community transmission Sweden 16 073 566 957 5 613.8 76 11 591 114.8 Community transmission Belgium 15 503 710 153 6 127.5 283 21 092 182.0 Community transmission Slovakia 13 437 249 913 4 577.5 574 4 642 85.0 Clusters of cases Serbia 11 612 393 897 5 656.4 132 4 000 57.4 Community transmission Belarus 10 711 246 570 2 609.4 69 1 708 18.1 Community transmission Kazakhstan 9 953 235 844 1 256.0 91 3 126 16.6 Clusters of cases Austria 9 705 409 892 4 551.1 318 7 636 84.8 Community transmission Ireland 9 119 195 303 3 955.3 345 3 292 66.7 Community transmission Slovenia 8 593 166 473 8 007.6 124 3 752 180.5 Clusters of cases Switzerland 8 120 518 759 5 994.0 138 8 601 99.4 Community transmission Hungary 8 012 367 586 3 805.1 556 12 524 129.6 Community transmission Lithuania 5 915 182 539 6 705.3 154 2 803 103.0 Community transmission Albania 5 810 77 251 2 684.4 59 1 369 47.6 Clusters of cases Latvia 5 212 65 708 3 483.6 83 1 180 62.6 Community transmission Greece 4 827 156 473 1 501.2 157 5 779 55.4 Community transmission Georgia 4 593 258 111 6 470.3 123 3 178 79.7 Community transmission Denmark 4 178 198 095 3 420.0 137 2 106 36.4 Community transmission Bulgaria 3 922 218 618 3 146.3 217 9 028 129.9 Clusters of cases Republic of Moldova 3 576 159 513 3 954.3 87 3 434 85.1 Community transmission Croatia 3 506 232 426 5 661.7 200 5 027 122.5 Community transmission Estonia 3 492 44 208 3 332.6 43 419 31.6 Clusters of cases Montenegro 3 034 61 719 9 826.8 37 805 128.2 Clusters of cases Finland 2 068 44 402 801.4 23 671 12.1 Community transmission Bosnia and Herzegovina 2 051 121 891 3 715.3 127 4 696 143.1 Community transmission North Macedonia 2 047 92 518 4 440.8 69 2 848 136.7 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 Norway 2 010 62 575 1 154.3 19 563 10.4 Community transmission Azerbaijan 1 378 230 066 2 269.1 54 3 126 30.8 Clusters of cases Malta 1 245 17 903 4 054.6 16 267 60.5 Clusters of cases Armenia 990 167 026 5 636.6 41 3 080 103.9 Community transmission Luxembourg 966 50 547 8 074.9 15 579 92.5 Community transmission Cyprus 883 30 770 2 548.5 14 197 16.3 Clusters of cases Kyrgyzstan 629 84 529 1 295.6 12 1 412 21.6 Clusters of cases Andorra 386 9 885 12 793.6 5 101 130.7 Community transmission Uzbekistan 336 78 711 235.2 0 621 1.9 Clusters of cases San Marino 151 3 025 8 913.3 2 67 197.4 Community transmission Monaco 130 1 475 3 758.5 4 12 30.6 Sporadic cases Liechtenstein 50 2 561 6 715.3 0 46 120.6 Sporadic cases Iceland 21 6 002 1 758.9 0 29 8.5 Community transmission 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 Kosovo 2 235 59 891 3 219.3 42 1 482 79.7 Community transmission Gibraltar 191 4 096 12 157.5 14 73 216.7 Clusters of cases Guernsey 139 449 710.5 0 13 20.6 Community transmission Jersey 39 3 143 2 888.8 3 66 60.7 Community transmission Faroe Islands 2 654 1 338.4 0 1 2.0 Sporadic cases Isle of Man 2 434 510.4 0 25 29.4 No cases Greenland 0 30 52.8 0 0 0.0 No cases South-East Asia 200 219 12 856 723 636.0 3 258 197 707 9.8 India 91 650 10 746 183 778.7 935 154 274 11.2 Clusters of cases Indonesia 88 839 1 066 313 389.8 2 064 29 728 10.9 Community transmission Sri Lanka 5 706 63 293 295.6 33 313 1.5 Clusters of cases Thailand 5 282 18 782 26.9 4 77 0.1 Clusters of 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 Bangladesh 3 444 534 770 324.7 108 8 111 4.9 Community transmission Myanmar 2 766 139 864 257.1 80 3 125 5.7 Clusters of cases Nepal 1 674 270 854 929.6 33 2 027 7.0 Clusters of cases Maldives 851 15 736 2 911.1 1 51 9.4 Clusters of cases Bhutan 4 858 111.2 0 1 0.1 Clusters of cases Timor-Leste 3 70 5.3 0 0 0.0 Sporadic cases Western Pacific 72 135 1 420 024 72.3 1 281 24 588 1.3 Malaysia 29 206 209 661 647.8 79 746 2.3 Clusters of cases Japan 26 081 386 742 305.8 635 5 654 4.5 Clusters of cases Philippines 11 837 523 516 477.7 479 10 669 9.7 Community transmission Republic of Korea 3 122 78 203 152.5 71 1 420 2.8 Clusters of cases China 946 100 877 6.9 13 4 823 0.3 Clusters of cases Singapore 247 59 507 1 017.2 0 29 0.5 Sporadic cases Viet Nam 233 1 781 1.8 0 35 0.0 Clusters of cases Mongolia 131 1 742 53.1 0 2 0.1 Clusters of cases Australia 45 28 806 113.0 0 909 3.6 Clusters of cases New Zealand 21 1 947 40.4 0 25 0.5 Clusters of cases Cambodia 7 465 2.8 0 0 0.0 Sporadic cases Brunei Darussalam 5 180 41.1 0 3 0.7 Sporadic cases Papua New Guinea 2 851 9.5 0 9 0.1 Community transmission Lao People's Democratic Republic 1 44 0.6 0 0 0.0 Sporadic cases Fiji 0 55 6.1 0 2 0.2 Sporadic cases Solomon Islands 0 17 2.5 0 0 0.0 No cases Territoriesiii French Polynesia 208 18 060 6 429.2 3 131 46.6 Sporadic cases Guam 39 7 379 4 372.1 1 129 76.4 Clusters of cases New Caledonia 3 47 16.5 0 0 0.0 Sporadic cases Wallis and Futuna 1 5 44.5 0 0 0.0 Sporadic cases Marshall Islands 0 4 6.8 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 Northern Mariana Islands (Commonwealth of the) 0 132 229.3 0 2 3.5 Pending Samoa 0 2 1.0 0 0 0.0 No cases Vanuatu 0 1 0.3 0 0 0.0 No cases Global 3 686 110 102 139 771 1 310.3 96 364 2 211 762 28.4 **See data, table and figure notes Key Weekly Updates WHO Director-General Dr Tedros remarks On health workers and older people “I leave you with the challenge I set at the beginning of the week: together, we must ensure that vaccination of health workers and older people is underway in all countries within the first 100 days of this year.” Closing remarks at 148th session of the Executive Board On vaccine equity “Vaccine nationalism is self-defeating and inefficient, leaving the world’s poorest and most vulnerable people at risk.” The Director-General recommended three urgent actions: “First, prompt and equitable dose sharing is critical if we are to overcome this pandemic. Second, we need support to close the funding gap of 26 billion US dollars for the ACT Accelerator this year, including 7.8 billion dollars for COVAX. If fully funded, the ACT Accelerator would return up to 166 US dollars for every dollar invested. And third, even as we work to end the pandemic, we must learn the lessons it is teaching us.” NORAD Conference 2021, panel: Vaccine nationalism and global distribution and Closing remarks at 148th session of the Executive Board Therapeutics and vaccines “We have identified dexamethasone to treat severe disease, which is being stockpiled for use in low and lower- middle income countries. And the development and approval of safe and effective vaccines less than a year after the emergence of this new virus is a stunning scientific achievement. It gives us all a much-needed source of hope.” Debate on the report “COVID-19 vaccines: ethical, legal and practical considerations Moderna vaccine The Moderna COVID-19 (mRNA-1273) vaccine: what you need to know Interim recommendations for use of the Moderna mRNA-1273 vaccine against COVID-19 Testing WHO publishes new Essential Diagnostics List and urges countries to prioritize investments in testing The selection and use of essential in vitro diagnostics - TRS 1031 COVID-19 and oral health-care New videos explain how to prevent COVID-19 infection in oral health-care services Publications COVID-19 Clinical management: living guidance Laboratory biosafety guidance related to coronavirus disease (COVID-19): Interim guidance 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 – African Region – Region of the Americas – Eastern Mediterranean Region – South-East Asia Region – European Region – Western Pacific Region Recommendations and advice for the public – Protect yourself – Questions and answers – Travel advice – EPI-WIN: tailored information for individuals, organizations and communities 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. See the log of major changes and errata for details. 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. 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.