Coronavirus disease 2019 (COVID-19): situation report, 101

Data as receiv ed by WHO from national authorities by 10:00 CEST, 30 April 2020 Coronavirus disease 2019 (COVID-19) Situation Report – 101 HIGHLIGHTS • WHO reminds health authorities to take specific steps to protect health care workers and communities during essential immunization activities during the COVID-19 pandemic. PAHO has published an article on this, available here. • WHO AMRO/PAHO Director, Dr Carissa F. Etienne, has urged for vaccination programs to continue during the COVID-19 pandemic: “If we fall behind on routine immunizations, particularly for children, we risk outbreaks, thus overwhelming hospitals and clinics with preventable diseases in addition to COVID-19.” Her full statement is available here. • WHO/EURO Director, Dr Hans Henri P. Kluge, called for transparent knowledge- sharing, tailored support on the ground, and steadfast solidarity. His statement is available here. • WHO SEARO organized a meeting yesterday with vaccine manufacturers and national regulatory authorities to discuss future COVID-19 vaccine manufacturing in the Region. An article on this is available here. • WHO endeavours to ensure that all Member States have timely and accurate testing capacity for COVID-19. In the ‘Subject in Focus’ below, we describe some of the mechanisms WHO uses to support Member States. Figure 1. Countries, territories or areas with reported confirmed cases of COVID-19, 30 April 2020 SITUATION IN NUMBERS total (new cases in last 24 hours) Globally 3 090 445 confirmed (71 839) 217 769 deaths (9797) European Region 1 434 649 confirmed (27 824) 135 961 deaths (6650) Region of the Americas 1 246 190 confirmed (33 102) 65 228 deaths (2824) Eastern Mediterranean Region 182 417 confirmed (5489) 7447 deaths (143) Western Pacific Region 147 743 confirmed (1294) 6094 deaths (57) South-East Asia Region 54 021 confirmed (2670) 2088 deaths (87) African Region 24 713 confirmed (1460) 938 deaths (36) WHO RISK ASSESSMENT Global Level Very High SUBJECT IN FOCUS: Detection of disease – an update on laboratory services for COVID-19 Diagnostic laboratory testing is a cornerstone of the management of the COVID-19 pandemic. It allows for the detection of cases to inform care and for the isolation of infected individuals to interrupt disease transmission. Confirmatory testing also enables the disease to be tracked in the community and for clusters of cases to be identified. WHO endeavours to ensure that all Member States have timely and accurate testing capacity for COVID- 19. This is done through several mechanisms. First, a reference laboratory network has been established across the 6 WHO regions, and recently expanded to include some two dozen laboratories with expertise in virology, diagnostics, sequencing, and often viral culture (see Figure 2 below). These laboratories act to support Member States that currently do not have testing capacity or need to get confirmation of their initial test results while building in-country capacity. These same laboratories serve as a valuable source of support for strategic planning for the WHO HQ team and provide guidance to the WHO Regional Office laboratory focal points as well. A shipment fund to allow transport of samples to WHO reference laboratories for confirmatory testing has been made available to cover transport costs. Second, working with WHO’s Global Influenza Surveillance and Response System, surveillance testing for COVID -19 disease has been established in clinics caring for patients with respiratory disease, giving an early hint to community penetration by COVID-19. Figure 2. WHO COVID-19 Reference Laboratory Network Third, since February 24th WHO has been providing polymerase chain reaction (PCR) kits for COVID-19 directly to countries, offering Member States the capacity to detect cases or clusters before the disease gains a strong foothold. The scale of provision of tests is set to rise to millions of tests per month with the recent formation of the Diagnostics Consortium of donor and technical agencies convened by WHO to align and coordinate procurement of validated diagnostic test kits and related laboratory materials. SURVEILLANCE Table 1. Countries, territories or areas with reported laboratory-confirmed COVID-19 cases and deaths, by WHO region.* Data as of 30 April 2020 Reporting Country/ Territory/Area† Total confirmed‡ cases New confirmed cases Total deaths New deaths Transmission classification§ Days since last reported case Western Pacific Region China 84373 4 4643 0 Clusters of cases 0 Singapore 15641 690 14 0 Clusters of cases 0 Japan 14088 236 415 26 Clusters of cases 0 Republic of Korea 10765 4 247 1 Clusters of cases 0 Philippines 8212 254 558 28 Clusters of cases 0 Australia 6746 8 90 2 Clusters of cases 0 Malaysia 5945 94 100 0 Clusters of cases 0 New Zealand 1129 3 19 0 Clusters of cases 0 Viet Nam 270 0 0 0 Clusters of cases 5 Brunei Darussalam 138 0 1 0 Sporadic cases 10 Cambodia 122 0 0 0 Sporadic cases 18 Mongolia 38 0 0 0 Sporadic cases 3 Lao People's Democratic Republic 19 0 0 0 Sporadic cases 17 Fiji 18 0 0 0 Sporadic cases 9 Papua New Guinea 8 0 0 0 Sporadic cases 7 Territories** Guam 141 1 5 0 Clusters of cases 0 French Polynesia 58 0 0 0 Sporadic cases 2 New Caledonia 18 0 0 0 Sporadic cases 27 Northern Mariana Islands (Commonwealth of the) 14 0 2 0 Pending 12 European Region Spain 212917 2144 24275 453 Community transmission 0 Italy 203591 2086 27682 323 Community transmission 0 The United Kingdom 165225 4076 26097 4419 Community transmission 0 Germany 159119 1478 6288 173 Community transmission 0 France 127066 1602 24054 427 Community transmission 0 Turkey 117589 2936 3081 89 Community transmission 0 Russian Federation 106498 7099 1073 101 Clusters of cases 0 Belgium 47859 525 7501 170 Community transmission 0 Netherlands 38802 386 4711 145 Community transmission 0 Switzerland 29324 143 1407 28 Community transmission 0 Portugal 24505 183 973 25 Community transmission 0 Sweden 20302 681 2462 107 Community transmission 0 Ireland 20253 376 1190 31 Community transmission 0 Israel 15782 0 212 0 Pending 1 Austria 15364 50 580 11 Community transmission 0 Belarus 13181 973 84 5 Clusters of cases 0 Poland 12640 422 624 28 Community transmission 0 Romania 11978 362 675 25 Community transmission 0 Ukraine 10406 540 261 11 Community transmission 0 Denmark 9008 157 443 9 Pending 0 Serbia 8724 227 173 5 Pending 0 Norway 7667 62 202 7 Pending 0 Czechia 7579 75 227 0 Community transmission 0 Finland 4906 166 206 7 Pending 0 Republic of Moldova 3771 133 116 7 Pending 0 Luxembourg 3769 28 89 0 Pending 0 Kazakhstan 3333 255 25 0 Pending 0 Hungary 2775 48 312 12 Clusters of cases 0 Greece 2576 42 139 3 Community transmission 0 Armenia 2066 134 32 2 Clusters of cases 0 Croatia 2062 15 67 4 Community transmission 0 Uzbekistan 2031 76 9 1 Clusters of cases 0 Iceland 1797 2 10 0 Community transmission 0 Azerbaijan 1766 49 23 1 Clusters of cases 0 Bosnia and Herzegovina 1689 101 64 2 Community transmission 0 Estonia 1666 6 50 0 Pending 0 Bulgaria 1447 48 64 6 Pending 0 North Macedonia 1442 21 73 2 Clusters of cases 0 Slovenia 1418 10 89 3 Community transmission 0 Slovakia 1391 7 22 2 Clusters of cases 0 Lithuania 1375 0 45 1 Community transmission 0 Latvia 849 13 15 2 Community transmission 0 Cyprus 843 6 20 0 Clusters of cases 0 Albania 773 7 31 1 Clusters of cases 0 Andorra 753 0 41 0 Community transmission 1 Kyrgyzstan 746 17 8 0 Clusters of cases 0 San Marino 563 10 41 0 Community transmission 0 Georgia 539 22 6 0 Community transmission 0 Malta 463 13 4 0 Pending 0 Montenegro 322 1 7 0 Clusters of cases 0 Liechtenstein 83 0 1 0 Pending 4 Monaco 68 0 1 0 Sporadic cases 16 Holy See 10 0 0 0 Sporadic cases 1 Territories** Kosovo[1] 799 9 22 0 Community transmission 0 Isle of Man 309 1 21 1 Pending 0 Jersey 284 1 20 1 Pending 0 Guernsey 247 0 13 0 Community transmission 2 Faroe Islands 187 0 0 0 Pending 6 Gibraltar 141 0 0 0 Clusters of cases 3 Greenland 11 0 0 0 Pending 24 South-East Asia Region India 33050 1718 1074 67 Clusters of cases 0 Indonesia 9771 260 784 11 Community transmission 0 Bangladesh 7103 641 163 8 Pending 0 Thailand 2954 7 54 0 Clusters of cases 0 Sri Lanka 649 30 7 0 Clusters of cases 0 Maldives 256 11 0 0 Clusters of cases 0 Myanmar 150 0 6 1 Clusters of cases 1 Nepal 57 3 0 0 Sporadic cases 0 Timor-Leste 24 0 0 0 Clusters of cases 6 Bhutan 7 0 0 0 Sporadic cases 7 Eastern Mediterranean Region Iran (Islamic Republic of) 93657 1073 5957 80 Community transmission 0 Saudi Arabia 21402 1325 157 5 Clusters of cases 0 Pakistan 15759 874 346 19 Clusters of cases 0 Qatar 12564 643 10 0 Pending 0 United Arab Emirates 11929 549 98 9 Pending 0 Egypt 5268 226 380 21 Clusters of cases 0 Morocco 4359 107 168 3 Clusters of cases 0 Kuwait 3740 300 24 1 Clusters of cases 0 Bahrain 2921 110 8 0 Clusters of cases 0 Oman 2348 74 10 0 Clusters of cases 0 Iraq 2003 75 92 2 Clusters of cases 0 Afghanistan 1827 0 60 0 Clusters of cases 1 Djibouti 1077 5 2 0 Clusters of cases 0 Tunisia 980 5 40 0 Community transmission 0 Lebanon 721 4 24 0 Clusters of cases 0 Somalia 582 54 28 0 Sporadic cases 0 Jordan 451 2 8 0 Clusters of cases 0 Sudan 375 57 28 3 Sporadic cases 0 Libya 61 0 2 0 Clusters of cases 5 Syrian Arab Republic 43 0 3 0 Community transmission 2 Yemen 6 5 0 0 Pending 0 Territories** occupied Palestinian territory 344 1 2 0 Clusters of cases 0 Region of the Americas United States of America 1003974 20517 52428 1936 Community transmission 0 Brazil 71886 5385 5017 474 Community transmission 0 Canada 50363 1349 2904 138 Community transmission 0 Peru 31190 2491 854 72 Community transmission 0 Ecuador 24675 417 883 12 Community transmission 0 Mexico 16752 1223 1569 135 Community transmission 0 Chile 14885 520 216 9 Community transmission 0 Dominican Republic 6652 236 293 7 Community transmission 0 Panama 6200 179 176 9 Community transmission 0 Colombia 5949 352 269 16 Community transmission 0 Argentina 4201 182 207 10 Community transmission 0 Cuba 1467 30 58 0 Clusters of cases 0 Bolivia (Plurinational State of) 1053 39 55 2 Clusters of cases 0 Honduras 738 36 66 2 Clusters of cases 0 Costa Rica 705 8 6 0 Clusters of cases 0 Uruguay 625 5 15 0 Clusters of cases 0 Guatemala 557 27 16 1 Clusters of cases 0 Jamaica 381 17 7 0 Clusters of cases 0 El Salvador 377 32 9 1 Clusters of cases 0 Venezuela (Bolivarian Republic of) 329 0 10 0 Clusters of cases 1 Paraguay 239 9 9 0 Community transmission 0 Trinidad and Tobago 116 0 8 0 Sporadic cases 2 Bahamas 80 0 11 0 Clusters of cases 2 Barbados 80 0 6 0 Clusters of cases 1 Haiti 76 0 6 0 Clusters of cases 1 Guyana 75 1 8 0 Clusters of cases 0 Antigua and Barbuda 24 0 3 0 Clusters of cases 7 Grenada 19 1 0 0 Clusters of cases 0 Belize 18 0 2 0 Sporadic cases 15 Saint Lucia 17 2 0 0 Sporadic cases 0 Dominica 16 0 0 0 Clusters of cases 19 Saint Vincent and the Grenadines 16 1 0 0 Sporadic cases 0 Saint Kitts and Nevis 15 0 0 0 Sporadic cases 9 Nicaragua 13 0 3 0 Pending 3 Suriname 10 0 1 0 Sporadic cases 26 Territories** Puerto Rico 1433 33 54 0 Clusters of cases 0 Martinique 175 0 14 0 Clusters of cases 3 Guadeloupe 151 2 11 0 Clusters of cases 0 French Guiana 125 1 1 0 Clusters of cases 0 Bermuda 111 1 6 0 Clusters of cases 0 Aruba 100 0 2 0 Clusters of cases 7 Sint Maarten 75 0 13 0 Clusters of cases 1 Cayman Islands 73 3 1 0 Clusters of cases 0 United States Virgin Islands 62 3 4 0 Clusters of cases 0 Saint Martin 38 0 3 0 Sporadic cases 7 Curaçao 16 0 1 0 Sporadic cases 2 Falkland Islands (Malvinas) 13 0 0 0 Clusters of cases 4 Turks and Caicos Islands 12 0 1 0 Sporadic cases 2 Montserrat 11 0 1 0 Sporadic cases 16 Bonaire, Sint Eustatius and Saba 6 0 0 0 Sporadic cases 2 British Virgin Islands 6 0 1 0 Sporadic cases 4 Saint Barthélemy 6 0 0 0 Sporadic cases 30 Anguilla 3 0 0 0 Sporadic cases 26 Saint Pierre and Miquelon 1 0 0 0 Sporadic cases 22 African Region South Africa 5350 354 103 10 Community transmission 0 Algeria 3848 199 444 7 Community transmission 0 Cameroon 1806 101 59 1 Clusters of cases 0 Ghana 1671 0 16 0 Clusters of cases 1 Nigeria 1532 195 44 4 Community transmission 0 Guinea 1351 111 7 0 Community transmission 0 Côte d’Ivoire 1238 55 14 0 Clusters of cases 0 Senegal 882 59 9 0 Clusters of cases 0 Niger 713 4 32 1 Clusters of cases 0 Burkina Faso 638 0 42 0 Community transmission 1 Democratic Republic of the Congo 500 9 31 1 Clusters of cases 0 Mali 482 58 25 1 Clusters of cases 0 United Republic of Tanzania 480 180 16 6 Clusters of cases 0 Kenya 384 10 15 1 Clusters of cases 0 Mauritius 332 0 10 0 Community transmission 3 Equatorial Guinea 315 0 1 0 Clusters of cases 1 Gabon 276 38 3 0 Clusters of cases 0 Rwanda 225 13 0 0 Clusters of cases 0 Congo 220 13 9 1 Clusters of cases 0 Liberia 141 0 16 0 Clusters of cases 1 Ethiopia 130 4 3 0 Clusters of cases 0 Madagascar 128 0 0 0 Clusters of cases 3 Sierra Leone 116 12 5 1 Clusters of cases 0 Cabo Verde 113 0 1 0 Sporadic cases 1 Togo 109 10 7 1 Clusters of cases 0 Zambia 97 2 3 0 Sporadic cases 0 Eswatini 91 20 1 0 Sporadic cases 0 Uganda 79 0 0 0 Sporadic cases 2 Guinea-Bissau 77 4 1 0 Sporadic cases 0 Mozambique 76 0 0 0 Sporadic cases 3 Benin 69 5 2 1 Sporadic cases 0 Chad 52 0 2 0 Sporadic cases 1 Central African Republic 50 0 0 0 Sporadic cases 1 Eritrea 39 0 0 0 Sporadic cases 11 Malawi 36 0 3 0 Sporadic cases 2 South Sudan 34 0 0 0 Sporadic cases 1 Zimbabwe 32 0 4 0 Sporadic cases 1 Angola 27 0 2 0 Sporadic cases 2 Botswana 23 0 1 0 Sporadic cases 1 Namibia 16 0 0 0 Sporadic cases 24 Burundi 15 0 1 0 Sporadic cases 3 Gambia 11 1 1 0 Sporadic cases 0 São Tomé and Príncipe 11 0 0 0 Sporadic cases 1 Seychelles 11 0 0 0 Sporadic cases 23 Mauritania 7 0 1 0 Sporadic cases 19 Territories** Mayotte 460 0 4 0 Clusters of cases 1 Réunion 420 3 0 0 Clusters of cases 0 Subtotal for all Regions 3 089733 71839 217756 9797 International conveyance (Diamond Princess) 712 0 13 0 Not Applicable†† 45 Grand total 3 090445 71839 217769 9797 *Countries are arranged by official WHO regions, in descending order by the number of total confirmed cases. Overseas territories** are listed under the WHO region that administers them. †The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city 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. ‡Case classifications are based on WHO case definitions for COVID-19. §Transmission classification is based on a process of country/territory/area self-reporting. Classifications are reviewed on a weekly basis and may be upgraded or downgraded as new information becomes available. Not all locations within a given count ry/territory/area are equally affected; countries/territories/areas experiencing multiple types of transmission are classified in the highest category reported. With in a given transmission category, different countries/territories/areas may have differing degrees of transmission as indicated by the differing numbers of cases, recency of cases, and other factors. Terms: - No cases: Countries/territories/areas with no confirmed cases (not shown in table) - Sporadic cases: Countries/territories/areas with one or more cases, imported or locally detected - Clusters of cases: Countries/territories/areas experiencing cases, clustered in time, geographic location and/or by common exposures - Community transmission: Countries/area/territories experiencing larger outbreaks of local transmission defined through an assessment of factors including, but not limited to: - Large numbers of cases not linkable to transmission chains - Large numbers of cases from sentinel lab surveillance - Multiple unrelated clusters in several areas of the country/territory/area ** “Territories” include territories, areas, overseas dependencies and other jurisdictions of similar status [1] All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). †† As the international conveyance (Diamond Princess) is no longer occupied, transmission classification cannot be applied. Due to differences in reporting methods, retrospective data consolidation, and reporting delays, the number of new cases may not always reflect the exact difference between yesterday’s and today’s totals. WHO COVID-19 Situation Reports present official counts of confirmed COVID-19 cases, thus differences between WHO reports and other sources of COVID -19 data using different inclusion criteria and different data cutoff times are to be expected. The number of cases for Lithuania has been adjusted retrospectively by Lithuanian authorities to include only those with positive polymerase chain reaction (PCR) test results. Figure 3. Epidemic curve of confirmed COVID-19, by date of report and WHO region through 30 April 2020 PREPAREDNESS AND RESPONSE • To view all technical guidance documents regarding COVID-19, please go to this webpage. • WHO has developed interim guidance for laboratory diagnosis, advice on the use of masks during home care and in health care settings in the context of COVID-19 outbreak, clinical management, infection prevention and control in health care settings, home care for patients with suspected novel coronavirus, risk communication and community engagement and Global Surveillance for human infection with COVID-19. • WHO is working closely with International Air Transport Association (IATA) and have jointly developed a guidance document to provide advice to cabin crew and airport workers, based on country queries. The guidance can be found on the IATA webpage. • WHO has been in regular and direct contact with Member States where cases have been reported. WHO is also informing other countries about the situation and providing support as requested. • WHO is working with its networks of researchers and other experts to coordinate global work on surveillance, epidemiology, mathematical modelling, diagnostics and virology, clinical care and treatment, infection prevention and control, and risk communication. WHO has issued interim guidance for countries, which are updated regularly. • WHO has prepared a disease commodity package that includes an essential list of biomedical equipment, medicines and supplies necessary to care for patients with COVID-19. • WHO has provided recommendations to reduce risk of transmission from animals to humans. • WHO has published an updated recommendations for international traffic in relation to COVID-19 outbreak . • WHO has activated the R&D blueprint to accelerate diagnostics, vaccines, and therapeutics. • OpenWHO is an interactive, web-based, knowledge-transfer platform offering free online courses to improve the response to health emergencies. COVID-19 resources are hosted on 2 learning channels: one for courses in official WHO languages here and a second for courses in additional national languages here. o There are more than 1.5 million enrolments in the platform's courses to support the COVID-19 response. Specifically, WHO has developed courses on the following topics: o A general introduction to emerging respiratory viruses, including novel coronaviruses (available in Arabic, Chinese, English, French, Russian, Spanish, Bengali, Hindi, Hungarian, Indian Sign Language, Indonesian, Macedonian, Persian, Portuguese, Serbian, Turkish and Vietnamese); STRATEGIC OBJECTIVES WHO’s strategic objectives for this response are to: • Interrupt human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread*; • Identify, isolate and care for patients early, including providing optimized care for infected patients; • Identify and reduce transmission from the animal source; • Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines; • Communicate critical risk and event information to all communities and counter misinformation; • Minimize social and economic impact through multisectoral partnerships. *This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travelers, awareness-raising in the population and risk communication. o Clinical care for Severe Acute Respiratory Infection (SARI) (available in English, French, Russian, Spanish, Indonesian, Portuguese and Vietnamese); o Health and safety briefing for respiratory diseases – ePROTECT (available in Arabic, Chinese, English, French, Russian, Spanish, Indonesian and Portuguese); o Infection Prevention and Control for COVID-19 (available in Chinese, English, French, Russian, Spanish, Indonesian, Italian, Japanese, Macedonian, Portuguese, Ser bian and Turkish); o COVID-19 operational planning guidelines and partners platform to support country preparedness and response (available in Chinese, English, French, Russian, Indonesian and Portuguese); o SARI treatment facility design (available in Arabic, English, Italian and Portuguese); o An introduction to Go.Data – field data collection, chains of transmission and contact follow-up (available in English and coming soon in additional languages); o How to put on and remove personal protective equipment (PPE) for COVID-19 (available in English and coming soon in additional languages); and o Standard precautions for hand hygiene (available in English and coming soon in additional languages). • WHO is providing guidance on early investigations, which are critical in an outbreak of a new virus. The data collected from the protocols can be used to refine recommendations for surveillance and case definitions, to characterize the key epidemiological transmission features of COVID-19, help understand spread, severity, spectrum of disease, impact on the community and to inform operational models for implementation of countermeasures such as case isolation, contact tracing and isolation. Several protocols are available here. One such protocol is for the investigation of early COVID-19 cases and contacts (the “First Few X (FFX) Cases and contact investigation protocol for 2019-novel coronavirus (2019-nCoV) infection”). The protocol is designed to gain an early understanding of the key clinical, epidemiological and virological characteristics of the first cases of COVID-19 infection detected in any individual country, to inform the development and updating of public health guidance to manage cases and reduce the potential spread and impact of infection. RECOMMENDATIONS AND ADVICE FOR THE PUBLIC If you are not in an area where COVID-19 is spreading or have not travelled from an area where COVID-19 is spreading or have not been in contact with an infected patient, your risk of infection is low. It is understandable that you may feel anxious about the outbreak. Get the facts from reliable sources to help you accurately determine your risks so that you can take reasonable precautions (see Frequently Asked Questions). Seek guidance from WHO, your healthcare provider, your national public health authority or your employer for accurate information on COVID -19 and whether COVID-19 is circulating where you live. It is important to be informed of the situation and take appropriate measures to protect yourself and your family (see Protection measures for everyone). If you are in an area where there are cases of COVID-19 you need to take the risk of infection seriously. Follow the advice of WHO and guidance issued by national and local health authorities. For most people, COVID-19 infection will cause mild illness however, it can make some people very ill and, in some people, it can be fatal. Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease (See Protection measures for persons who are in or have recently visited (past 14 days) areas where COVID-19 is spreading). CASE DEFINITIONS WHO periodically updates the Global Surveillance for human infection with coronavirus disease (COVID-19) document which includes case definitions. For easy reference, case definitions are included below. Suspect case A. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset. OR B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID -19 case (see definition of contact) in the last 14 days prior to symptom onset; OR C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation. Probable case A. A suspect case for whom testing for the COVID-19 virus is inconclusive. a. Inconclusive being the result of the test reported by the laboratory. OR B. A suspect case for whom testing could not be performed for any reason. Confirmed case A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. • Technical guidance for laboratory testing can be found here. Definition of contact A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case: 1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes; 2. Direct physical contact with a probable or confirmed case; 3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment1; OR 4. Other situations as indicated by local risk assessments. Note: for confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken which led to confirmation. Definition of COVID-19 death COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery between the illness and death. Further guidance for certification and classification (coding) of COVID-19 as cause of death is available here. 1 World Health Organization. Infection prevention and control during health care when COVID-19 is suspected https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)- infection-is-suspected-20200125