COVID-19 World Map: 209,839 Confirmed Cases; 167 Countries; 8,778 Deaths

Note: There is now a newer Novel Coronavirus (COVID-19) Situation Report 60.

WHO Novel Coronavirus (COVID-19) Situation Report 59

• Seven new countries/territories/areas (African Region (3), Eastern Mediterranean Region (1), European Region (1), and Region of the Americas (2)) have reported cases of COVID-19.
• The number of confirmed cases worldwide has exceeded 200,000. It took over three months to reach the first 100 00 confirmed cases, and only 12 days to reach the next 100,000.
• A new protocol to investigate the extent of COVID-19 infection in the population, as determined by positive antibody tests in the general population has been developed. The protocol is titled the Population-based age-stratified seroepidemiological investigation protocol for COVID-19 virus infection. See Subject in Focus below for details.

Risk Assessment

Global Level: Very High

Coronavirus Situation in Numbers

Globally

• 209,839 confirmed cases (16,556 new)
• 8,778 deaths (828 new)

Western Pacific Region

• 92,333 confirmed cases (488 new)
• 3,377 deaths (20 new)

European Region

• 87,108 confirmed cases (10,221 new)
• 4,084 deaths (591 new)

South-East Asia

• 657 confirmed cases (119 new)
• 23 deaths (14 new)

Eastern Mediterranean Region

• 19,518 confirmed cases (1,430 new)
• 1,161 deaths (150 new)

Regions of the Americas

• 9,144 confirmed cases (4,166 new)
• 119 deaths (50 new)

African Region

• 367 confirmed cases (132 new)
• 7 deaths (3 new)

Subject in Focus: New protocol for Early Epidemiologic investigations for public health response

With the emergence of COVID-19 virus, many uncertainties remain as to certain epidemiological, seroepidemiological (related to identifying antibodies in the population), clinical and virological characteristics of the virus and associated disease. Studies to assess these characteristics in different settings are critical to furthering our understanding. They will also provide the robust information needed to refine forecasting models and inform public health measures.

As such, WHO, in collaboration with technical partners, has adapted early epidemiological investigation protocols from pandemic influenza and from MERS-CoV, to better understand these characteristics and how they may be used to inform public health measures.

To date, five early seroepidemiological core protocols and data collection forms are available on the WHO COVID-19 Technical guidance website.

All protocols propose a standardized methodology to allow data and biological samples to be systematically collected, taking into consideration local setting and outbreak characteristics, and shared rapidly in a format that can be easily aggregated, tabulated, and analyzed across many different settings globally.

Study Protocol	Objectives
The First Few COVID-19 cases and contacts transmission investigation protocol (FFX)	To provide descriptions and/or estimates of the: clinical presentation of COVID-19 infection and course of associated disease secondary infection rate (SIR) and secondary clinical attack rate of COVID-19 infection among close contacts (overall, and by key factors such as setting, age, and sex, for various end-points) serial interval of COVID-19 infection symptomatic proportion of COVID-19 cases (through contact tracing and laboratory testing); and identification of possible routes of transmission
Households transmission of COVID-19 investigation protocol	To better understand the extent of transmission within a household by estimating the secondary infection rate for household contacts at an individual level, and factors associated with any variation in the secondary infection risk To characterize secondary cases including the range of clinical presentation, risk factors for infection, and the extent and fraction of asymptomatic infections To characterize serologic response following confirmed COVID-19infection
Assessment of COVID-19 risk factors among Health workers protocol	To better understand the extent of human-to-human transmission among healthcare workers, by estimating the secondary infection rate for healthcare worker contacts at an individual level To characterize the range of clinical presentation of infection and the risk factors for infection among health care workers To evaluate effectiveness of infection prevention and control measures among healthcare workers
Surface sampling of COVID-19 for health care professionals	To assess the extent and persistence of surface contamination with COVID-19 virus To identify environmental surfaces which may play a role in onwards transmission of COVID-19 infection
Population based serologic survey	To estimate age-specific seroprevalence

The latest protocol, the Population-based age-stratified seroepidemiological investigation protocol for COVID-19 virus infection, is intended to provide key epidemiological and serologic characteristics of COVID-19 virus in the general population. Specifically, data from this protocol will provide critical information about the extent of infection (as measured by the presence of antibodies in study subjects) in the general population, age-specific infection cumulative incidence, and the fraction of people with asymptomatic or subclinical infection.

The results of these investigations, whether individually or pooled across study sites/countries, will allow further understanding and provide robust estimates of key clinical, epidemiological, and virological characteristics of the COVID-19 virus, including:

• Key epidemiological parameters, such as: secondary infection rate and secondary clinical attack rate of COVID-19 infection among close contacts, asymptomatic fraction of infection, serial interval and incubation period of COVID-19, the basic reproduction number of COVID-19 infection
• Clinical presentation of COVID-19 infection and course of associated disease
• Risk factors for transmission and infection, and identification of possible routes of transmission
• Impact of infection prevention and control measures in health care settings
• Serological response following symptomatic COVID-19 infection
• Age-stratified seroprevalence of antibodies against COVID-19 virus
• Cumulative incidence of infection, including extent of age-specific infection
• Infection and disease-severity ratios (case-hospitalization ratio [CHR] and case-fatality ratio [CFR])
• Viral load and shedding profiles
• Viral persistence on surfaces

To date, 13 countries across five of the six WHO regions, including both high-income and low-and middle-income countries, have begun to implement at least one of the early investigation protocols. A further 18 countries have signaled their intention to implement one of the protocols. WHO will continue to support countries in their epidemiological investigations through the provision of clear and comprehensive protocols.

For more information, please contact: [email protected]

Countries, territories or areas with reported laboratory-confirmed COVID-19 cases and deaths, March 19, 2020

Country/Territory/Area	Confirmed Cases
China	81174
Italy	35713
Iran	17361
Spain	13716
France	9043
Republic of Korea	8413
Germany	8198
United States of America	7087
Switzerland	3010
United Kingdom	2630
Netherlands	2051
Austria	1646
Belgium	1486
Norway	1423
Sweden	1279
Denmark	1044
Japan	873
International (Diamond Princess Cruise Ship)	712
Malaysia	673
Portugal	642
Canada	569
Czech Republic	522
Australia	510
Qatar	442
Israel	427
Greece	418
Finland	359
Singapore	313
Ireland	292
Brazil	291
Poland	287
Slovenia	286
Estonia	258
Bahrain	256
Iceland	250
Romania	246
Pakistan	241
Chile	238
Saudi Arabia	238
Indonesia	227
Thailand	212
Luxembourg	210
Egypt	196
Turkey	191
Philippines	187
Iraq	164
Ecuador	155
Russian Federation	147
Peru	145
Kuwait	142
India	137
Lebanon	133
South Africa	116
United Arab Emirates	113
San Marino	109
Slovakia	105
Serbia	96
Colombia	93
Mexico	93
Bulgaria	92
Panama	86
Armenia	84
Croatia	81
Argentina	79
Algeria	72
Latvia	71
Vietnam	66
Albania	59
Cyprus	58
Faroe Islands	58
Hungary	58
Brunei Darussalam	56
Jordan	52
Costa Rica	50
Morocco	49
Malta	48
Belarus	46
Palestinian Territory	44
Sri Lanka	42
Andorra	39
Georgia	38
Bosnia and Herzegovina	36
Kazakhstan	36
North Macedonia	36
Republic of Moldova	36
Senegal	36
Venezuela	36
Cambodia	35
Azerbaijan	34
Guadeloupe	33
Oman	33
Tunisia	29
Uruguay	29
Burkina Faso	26
Lithuania	26
Liechtenstein	25
Martinique	23
Afghanistan	22
Dominican Republic	21
New Zealand	20
Ukraine	16
Uzbekistan	16
Jamaica	13
Maldives	13
Bolivia	12
French Guiana	11
Paraguay	11
Réunion	11
Rwanda	11
Bangladesh	10
Cameroon	10
Cuba	10
Côte d’Ivoire	9
Ghana	9
Honduras	9
Monaco	9
Gibraltar	8
Nigeria	8
Democratic Republic of the Congo	7
Kenya	7
Trinidad and Tobago	7
Ethiopia	6
Guatemala	6
Seychelles	6
Jersey	5
Guam	5
Mongolia	5
Puerto Rico	5
Aruba	4
Guyana	4
Saint Martin	4
Bahamas	3
Congo	3
Curaçao	3
Equatorial Guinea	3
French Polynesia	3
Gabon	3
Mauritius	3
Mayotte	3
Kyrgyzstan	3
Saint Barthelemy	3
United Republic of Tanzania	3
Barbados	2
Greenland	2
Liberia	2
Mauritania	2
Montenegro	2
Namibia	2
Saint Lucia	2
Sudan	2
Virgin Islands	2
Zambia	2
Antigua and Barbuda	1
Benin	1
Bhutan	1
Cayman Islands	1
Central African Republic	1
Djibouti	1
Eswatini	1
Gambia	1
Guernsey	1
Guinea	1
Holy See	1
Montserrat	1
Nepal	1
Saint Vincent and the Grenadines	1
Somalia	1
Suriname	1
Togo	1
Total	209839

Recommendations and Advice for the Public

If you are not in an area where COVID-19 is spreading, or if you have not traveled from one of those areas or have not been in close contact with someone who has and is feeling unwell, your chances of getting it are currently low. However, it’s understandable that you may feel stressed and anxious about the situation. It’s a good idea to get the facts to help you accurately determine your risks so that you can take reasonable precautions.

Your healthcare provider, your national public health authority and your employer are all potential sources of accurate information on COVID-19 and whether it is in your area. It is important to be informed of the situation where you live and take appropriate measures to protect yourself.

If you are in an area where there is an outbreak of COVID-19 you need to take the risk of infection seriously. Follow the advice issued by national and local health authorities. Although for most people COVID-19 causes only mild illness, it can make some people very ill. More rarely, the disease can be fatal. Older people, and those with pre-existing medical conditions (such as high blood pressure, heart problems or diabetes) appear to be more vulnerable.