communicable diseases intelligence 2020 - covid …...between 7 and 29 march 2020, at least 17...

2 0 2 0 V o l u m e 4 4https://doi.org/10.33321/cdi.2020.44.29

COVID-19, Australia: Epidemiology Report 9: Reporting week ending 23:59 AEDT 29 March 2020COVID-19 National Incident Room Surveillance Team

Communicable Diseases Intelligence ISSN: 2209-6051 Online

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1 of 24 health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020

Weekly epidemiological report

COVID-19, Australia: Epidemiology Report 9:Reporting week ending 23:59 AEDT 29 March 2020

COVID-19 National Incident Room Surveillance Team

An error occurred in the legend for Figure 8 (Confirmed cases of overseas acquired COVID-19 infection (n = 2,352) by Standard Australian

Classification of Countries) as originally published, which inadvertently omitted the key depicting the confirmed cases from Sub-Saharan Africa.

This has now been amended.

Summary

This is the ninth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 29 March 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.

Keywords: SARS-CoV-2; novel coronavirus; 2019-nCoV; coronavirus disease 2019; COVID-19; acute respiratory disease; case definition; epidemiology; Australia

The following epidemiological data are subject to change both domestically and internationally due to the rapidly evolving situation. Australian cases are still under active investigation. While every effort has been made to standardise the investigation of cases nationally, there may be some differences between jurisdictions. For further information relating to the data incorporated in this series of reports, please refer to the Frequently Asked Questions addressed within the appendix to this report.

Australian situation

As at 23:59 AEDT 29 March 2020, there were 4,159 confirmed cases, including 15 deaths in Australia, reported to the National Notifiable Diseases Surveillance System (NNDSS)i (Table 1, Figure 1). Of the 4,159 confirmed cases, 48% were reported in NSW, 18% from Qld, 16% from Vic, 8% from WA, 7% from SA, 2% from ACT, 1% from Tas, and 0.3% from NT (Figures 2, 3). The rate of cases in Australia per 100,000 population was 16.4; in comparison, the rate per 100,000 population was 7.0 in the previous reporting period. Most cases are reported to

i Data were extracted on 30 March 2020 with data reported

to 29 March 2020. Due to the dynamic nature of the NNDSS,

data in this extract are subject to retrospective revision and

may vary from data published in previous reports and reports

of notification data by states and territories.

reside within major metropolitan areas, with a small number of cases reported outside these areas (Figures 2, 3).

During the current reporting week, 2,355 cases were reported; this is a 136% increase from cases reported during the previous reporting period. The median time between onset of symptoms and laboratory testing was two days (range 0–32 days).

The median age of notified cases in Australia was 48 years (range 0–98 years), with the largest number of cases in the 20–29 years age group (Figure 4). The highest rate of disease was among those in the 60–69 years age group (Figure 4). Notifications by gender were approximately equal, although there was some variation across age groups.

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Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020 health.gov.au/cdi

In Australia:

• There have been 4,159 confirmed cases, including 15 deaths, reported in Australia up to23:59 AEDT 29 March 2020. Of confirmed cases, the highest proportion of cases have beenfrom New South Wales (48%), followed by Queensland (18%) and Victoria (16%);

• Forty-two percent of the total number of cases reported so far have been during the currentreporting week;

• Hospitalisation status was recorded for 2,129 cases, of which 19% were reported to have beenhospitalised due to their COVID-19 infection. Of these hospitalised cases, ICU (IntensiveCare Unit) status was recorded for 176 cases, of which 22% (n = 38) were admitted to anICU, with five cases requiring ventilation; and

• The rate of increase in cases has lowered over the reporting week. Whilst the effects of borderand recently-introduced social distancing measures are likely having an effect, it is too soonto tell whether this trend will be sustained.

Internationally:

• A total of 634,813 cases have been reported globally across 189 countries, territories andregions;

• The USA has overtaken Italy as the country with most reported cases (n = 103,321), however,the European Region continues to be the most heavily affected, with Italy, Spain and Ger-many accounting for 60% (n = 217,267) of all cases in the region; and

• A total of 29,891 deaths have been reported globally with over 70% (n = 21,427) reported inthe European Region.

Of the symptoms reported, cough (70%) was the most common. Forty-nine percent reported headache, 47% reported fever, 45% reported sore throat, and 34% reported runny nose (Figure 5). Only 2% or fewer of all cases reported either pneumonia or acute respiratory disease (ARD). An analysis of symptom combinations high-lights that cough is the predominant clinical presentation in combination with fever and/or sore throat (Figure 6).

Hospitalisation status was recorded for 2,129 cases, of which 18.9% (n = 402) were reported to have been hospitalised due to their COVID-19 infection. The median age of hospitalised cases was 58 years (range 0–98 years), with the high-est proportion of cases in the 60–69 years age

group. The most commonly reported comorbid condition among hospitalised cases was diabetes (6.2%), followed by cardiac disease (6.0%). Of these hospitalised cases, ICU (Intensive Care Unit) status was recorded for 176 cases of which 22% (n = 38) were recorded being admitted to an ICU, with five cases requiring ventilation.

Fifteen COVID-19 deaths were confirmed in Australia up to 29 March 2020. The median age was 81 years (range 67–94 years). Four of these deaths were in an aged care facility, four were associated with cruise ships and the other seven cases were acquired in the community. Seven of the cases were male and eight were female. The period between the date of illness onset and death ranged from 0 to 12 days. Of the 15

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health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020

confirmed deaths, three reported having comor-bidities, including diabetes, chronic respiratory conditions and stroke.

Of cases with a reported place of acquisition (2,964 of 4,159), 79% (n = 2,352) had a recent international travel history and 21% (n = 612) were considered to have been locally acquired (Figure 7). The majority of overseas-acquired cases (Figure 8) reported a travel history to the European Region, the Americas Region or on board cruise ships. Of the locally-acquired cases, the majority were considered to be contacts of a confirmed case, with a very small number of cases not able to be epidemiologically linked to a confirmed case. For the remainder of cases where a place of acquisition has not been reported, these cases are currently under public health investigation. The distribution of the source of infection for cases varied by jurisdiction.

Of the 4,159 confirmed cases, 27 cases (0.6%) were reported in Aboriginal and Torres Strait Islander persons. These 27 cases have been reported across several jurisdictions with the majority of cases reported in areas classified as ‘major cities of Australia’ based on the case’s usual place of residence. Completeness of the Indigenous status field was approximately 73%, with 11% of cases with a reported value of unknown.

Cluster and outbreak investigations

Investigations are taking place in states and ter-ritories in relation to a number of clusters and outbreaks of COVID-19. To date the largest out-breaks have been associated with cruise ships.

Closed environments, close contact between travellers from various countries, and crew transfers between voyages make cruise ships a unique environment for rapid disease transmis-sion.1 Cruise ships account for a substantial proportion of COVID-19 cases in Australia. Of cases with a reported place of acquisition, 23% (n = 670) were considered to have acquired their infection at sea.

During the period 7 to 23 February 2020, the largest outbreak of COVID-19 cases outside of mainland China occurred on the Diamond Princess cruise ship. Of the 3,711 passengers and crew, 712 (19.2%) were confirmed as having COVID-19 including 56 residents of Australia.

Between 7 and 29 March 2020, at least 17 cruise ships have docked in Australia and 9 have con-firmed cases of COVID-19.ii This includes the Ruby Princess which docked on 19 March 2020 and at the time of reporting was associated with 215 cases.

ii Data obtained on 1 April 2020.

Clusters:

• The term ‘cluster’ in relation to COVID-19 refers to two or more cases that are epidemiologi-cally related in time, place or person where a common source (such as an event or within a community) of infection is suspected but not yet established.

Outbreaks:

• The term ‘outbreak’ in relation to COVID-19 refers to two or more cases among a specific group of people and/or over a specific period of time where illness is associated with a com-mon source (such as an event or within a community).

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International situation

As at 23:59 AEDT 29 March 2020, the number of confirmed COVID-19 cases reported to the World Health Organization (WHO) was 634,813 globally.2 57% (n = 361,031) of all reported cases are from the European Region, 19% (n = 120,792) are from the Region of the Americas, and 16% (n = 102,788) are from the Western Pacific Region. The most affected countries with the highest number of reported cases across these regions are respectively Italy (n = 92,672), the United States of America (n = 103,321) and China, including special administrative regions (n = 82,341).

The number of new cases reported globally has continued to increase. As of the last reporting week, 15 countries, territories and areas reported cases of COVID-19 for the first time, bringing the total to 189 countries, territories and areas globally. The USA has now overtaken Italy as the country with most reported cases; however, the European Region continues to be the most heavily affected, with Italy, Spain and Germany accounting for 60% (n = 217,267) of all cases in the region. Of all the countries, territories and areas with known transmission classification (n = 189), 79% (n = 149) have reported local trans-mission of COVID-19.

The reported epidemiology varies by country with the trajectory of different countries’ out-breaks after their first 100 cases showing vari-ation. Figure 9 highlights that for a number of countries outside of mainland China which have reported more than 100 cases, their rates of increase continue to be high, particularly USA, Italy and Spain. For several other countries or regions including Singapore, Japan and Hong Kong there continues to be a slow rate of increase in their number of new cases, with the Republic of Korea reporting very few new cases each day. Reported case numbers will be influenced by rates of testing, case definition, and case detec-tion as well as overall health system capacity.

Border measures such as travel bans and man-datory 14-day quarantine for all return travel-lers have been put in place to reduce the risk of imported cases into Australia.

Globally, 29,891 deaths have been reported. Over 70% of deaths (n = 21,427) have been reported in the European Region, followed by 12% (n = 3,626) in the Western Pacific Region, and 9% (n = 2,668) in the Eastern Mediterranean Region. Italy, Spain, France and the United Kingdom have reported over 1,000 deaths in each respec-tive country, contributing to a combined total of 89% (n = 19,043) of deaths reported in the region. In the Western Pacific Region, 91% (n = 3,306) of all deaths are reported from China. Iran accounts for 94% (n = 2,517) of all deaths in the Eastern Mediterranean Region. The global proportion of cases that are reported to have died is 4.7%. This proportion is likely to be an overestimate due to variable levels of under-ascertainment of cases, especially those with mild infections. For several other countries or regions including the Republic of Korea, there continues to be a slow increase in their number of deaths, with few new deaths reported in the Republic of Korea each day (Figure 10).

Epidemiological features of COVID-19

The current estimates on epidemiological param-eters including severity, transmissibility and incubation period are uncertain. Estimates are likely to change as more information becomes available.

Transmission

Human-to-human transmission of SARS-CoV-2 is via droplets and fomites from an infected person to a close contact.3 COVID-19 can often present as a common cold-like illness, including in stools.4 A virological analysis of nine hospital-ised cases found active virus replication in upper respiratory tract tissues, with pharyngeal virus shedding during the first week of symptoms.4 However, current evidence does not support airborne or faecal-oral spread as major factors in transmission.3

5 of 24



A study in China showed household contacts and those who travelled with a confirmed COVID-19 case was associated with an increased risk of infection.5 The study also examined the average time from symptom onset to disease confirma-tion among cases who were identified through contact-based surveillance (i.e. monitoring and testing of close contacts of confirmed COVID-19 cases) and symptom-based surveillance (i.e. symptomatic screening at airports, community fever monitoring and testing of hospital patients). Cases identified through contact-based surveil-lance were associated with a 2.3 day decrease from symptom onset to disease confirmation and a 1.9 day decrease from symptom onset to isolation, compared to cases found by symptom-based surveillance. Modelling studies suggest that undocumented infections are the source for over three-quarters of documented cases and effective contact tracing increases the probabil-ity of control.5,6

Incubation period

Estimates of median incubation period, based on seven published studies, are 5 to 6 days (ranging from 0 to 14 days).7 Patients with long incubation periods do occasionally occur, how-ever they are likely to be ‘outliers’ who should be studied further but are unlikely to represent a change in epidemiology of the virus.7

Molecular epidemiology

Since December 2019, the virus has diversified into multiple lineages as it has spread globally with some degree of geographical clustering. The whole genome sequences currently available from Australian cases are mostly in returned travellers from China, the Islamic Republic of Iran, Europe and the USA, and thereby reflect this global diversity. Recent work describes an emerging clade linked to the epidemic in the Islamic Republic of Iran.8

Clinical features

A recently published meta-analysis supports previous research that COVID-19 presents as

mild illness in the majority of cases with fever and cough being the most commonly reported symptoms. Severe or fatal outcomes tend to occur in the elderly or those with comorbid conditions.3,9

Some COVID-19 patients show neurological signs such as headache, nausea and vomiting. There is evidence that SARS-CoV-2 viruses are not always confined to the respiratory tract and may invade the central nervous system inducing neurological symptoms.10 As such, it is possible that invasion of the central nervous system is partially responsible for the acute respiratory failure of COVID-19 patients.10

Examination of cases and their close contacts in China found a positive association between age and time from symptom onset to recovery. Median time to recovery was estimated to be 27 days in 20–29 year olds, 32 days in 50–59 year olds, and 36 days in those aged over 70 years. The study also found an association between clinical severity and time from symptom onset to time to recovery. Compared to people with mild disease, those with moderate and severe disease were associated with a 19% and 58% increase in time to recovery, respectively.5

A retrospective cohort study looking at risk fac-tors for mortality among patients with COVID-19 who have experienced a definite outcome found an increase in the odds of in-hospital death associated with older age, higher sequen-tial organ failure assessment score and elevated blood d-dimer levels on admission.11 Detectable SARS-CoV-2 RNA persisted for a median of 20 days in survivors and until death in non-survivors.11

Several studies have identified cardiovascular implications resulting from COVID-19 infec-tion.12–14 Vascular inflammation has been observed in a number of cases and may be a potential mechanism for myocardial injury which can result in cardiac dysfunction and arrhythmias.

6 of 24



Treatment

Current clinical management of COVID-19 cases focuses on early recognition, isolation, appropriate infection control measures and provision of supportive care.15 Whilst there is no specific antiviral treatment currently recom-mended for patients with suspected or confirmed SARS-CoV-2 infection, multiple clinical trials are underway to evaluate a number of thera-peutic agents, including remdesivir, lopinavir/ritonavir, and chloroquine.16

Public health response

A summary of the key events that have been associated with the emergence of COVID-19, including Australia’s public health response activities is provided at Figures 11 and 12. Since COVID-19 first emerged internationally, public health responses in Australia have continued to evolve with the changing body of knowledge and epidemiological profile, both from overseas and in Australia. During the current report-ing period, the Australian Health Protection Principal Committee have issued advice to inform the national public health response to the pandemic including suspension of all non-urgent elective surgery in both public and private sectors, scaling up of social distancing measures, limits to both indoor and outdoor public gatherings, and mandatory 14-day quar-antine in their port of arrival for all travellers entering Australia.17–19

Methods

Data for this report were current as at 23:59 hours AEDT, 29 March 2020.

This report outlines what is known epidemio-logically on COVID-19 in Australia and from publicly available data from WHO Situation Reports, other countries’ official updates and the scientific literature. Data on domestic cases in this report were collected from the NNDSS and additionally informed by jurisdictional health department media releases. The Communicable Diseases Network Australia (CDNA) developed

the case definition for probable, suspect and confirmed cases, which was modified at differ-ent time points during the outbreak (Table 2). Data were analysed using SAS to describe the epidemiology of COVID-19 in Australia and the progress of the epidemic. Data for the interna-tional cases of COVID-19 by country were com-piled from the latest WHO Situation Report. Case definitions may vary by country making comparisons difficult. Rapid reviews of the current state of knowledge on COVID-19 were conducted from the literature using PubMed.

Acknowledgements

This report represents surveillance data reported through CDNA as part of the nationally-coordi-nated response to COVID-19. We thank public health staff from incident emergency operations centres in state and territory health departments, and the Australian Government Department of Health, along with state and territory public health laboratories. We thank John Grewar for providing the R-code to produce Figure 6.

Author details

Corresponding author

COVID-19 National Incident Room Surveillance Team, Communicable Disease Epidemiology and Surveillance Section, Health Protection Policy Branch, Australian Government Department of Health, GPO Box 9484, MDP 14, Canberra, ACT 2601.

Email: [email protected]

7 of 24



Figu

re 1

: Con

firm

ed c

ases

of C

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ID-1

9 in

fect

ion,

Aus

tral

ia, b

y da

te o

f illn

ess o

nset

a

050100

150

200

250

300

350

400

13-Jan-20

15-Jan-20

17-Jan-20

19-Jan-20

21-Jan-20

23-Jan-20

25-Jan-20

27-Jan-20

29-Jan-20

31-Jan-20

2-Feb-20

4-Feb-20

6-Feb-20

8-Feb-20

10-Feb-20

12-Feb-20

14-Feb-20

16-Feb-20

18-Feb-20

20-Feb-20

22-Feb-20

24-Feb-20

26-Feb-20

28-Feb-20

1-Mar-20

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5-Mar-20

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13-Mar-20

15-Mar-20

17-Mar-20

19-Mar-20

21-Mar-20

23-Mar-20

25-Mar-20

27-Mar-20

29-Mar-20

Number of cases

Dat

e of

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ess o

nset

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NT

QLD

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8 of 24



Figu

re 2

: Con

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of C

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ustr

alia

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tion

of u

sual

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ence

and

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l 3, a

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arch

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ase,

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ch d

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who

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ave

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esid

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alia

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9 of 24



Figu

re 3

: Con

firm

ed c

ases

of C

OV

ID-1

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ustr

alia

, by

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of u

sual

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ch d

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Tabl

e 1:

Cum

ulat

ive

notifi

ed c

ases

of c

onfir

med

CO

VID

-19

and

diag

nost

ic te

sts p

erfo

rmed

, Aus

tral

ia, b

y ju

risd

ictio

n

Juri

sdic

tion

a

Num

ber o

f new

cas

es th

is

repo

rtin

g pe

riod

b (W

eek

endi

ng 2

3:59

AED

T 29

M

arch

202

0)

Tota

l cas

esb

(to

23:5

9 A

EDT

29 M

arch

202

0)Ca

ses

per 1

00,0

00 p

opul

atio

nCu

mul

ativ

e nu

mbe

r of t

ests

pe

rfor

med

(pro

port

ion

of te

sts

posi

tive

%)

NSW

1,21

51,

981

24.5

91,3

08 (2

.2%

)

Vic

360

673

10.2

28,9

41 (2

.3%

)

Qld

376

738

14.5

45,1

07 (1

.6%

)

WA

144

313

11.9

13,3

37 (2

.3%

)

SA16

730

417

.424

,737

(1.2

%)

Tas

3859

11.0

1,72

0 (3

.4%

)

NT

1014

5.7

1,88

1 (0

.7%

)

ACT

4577

18.0

4,23

0 (1

.8%

)

Tota

l 2,

355

4,15

916

.421

1,26

1 (2

.0%

)

a N

SW =

New

Sou

th W

ales

, Vic

= V

icto

ria, Q

ld =

Que

ensl

and,

WA

= W

este

rn A

ustr

alia

, SA

= S

outh

Aus

tral

ia, T

as =

Tas

man

ia, N

T =

Nor

ther

n Te

rrito

ry, A

CT

= Au

stra

lian

Capi

tal T

errit

ory.

b D

ue to

the

dyna

mic

nat

ure

of th

e N

ND

SS, d

ata

in th

is e

xtra

ct a

re s

ubje

ct to

retr

ospe

ctiv

e re

visi

on a

nd m

ay v

ary

from

dat

a re

port

ed in

pre

viou

sly

publ

ishe

d re

port

s an

d re

port

s of

not

ifica

tion

data

by

stat

es

and

terr

itorie

s.

11 of 24



Figu

re 4

: Cas

e nu

mbe

rs a

nd ra

tes o

f CO

VID

-19

case

s, A

ustr

alia

, by

age

and

sex

05101520253035

050100

150

200

250

300

350

400

450

500

0–9

10–1

920

–29

30–3

940

–49

50–5

960

–69

70–7

980

–89

90+

Rate per 100,000

Number of cases

Age

grou

p (y

ears

)

Mal

eFe

mal

eM

ale

rate

Fem

ale

rate

12 of 24



Figu

re 5

: Fre

quen

cy o

f CO

VID

-19

sym

ptom

s in

confi

rmed

cas

es, A

ustr

alia

(n =

2,2

57)

13 of 24



Figu

re 6

: Var

iatio

n in

com

bina

tions

of C

OV

ID-1

9 sy

mpt

oms i

n co

nfirm

ed c

ases

, Aus

tral

iaa

a Th

is fi

gure

sho

ws

the

varia

tion

in c

ombi

natio

ns o

f sym

ptom

s ob

serv

ed in

repo

rted

cas

es (n

= 2

,257

) for

the

five

mos

t fre

quen

tly o

bser

ved

sym

ptom

s (c

ough

, hea

dach

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ver,

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at, r

unny

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he

horiz

onta

l bar

s on

the

left

sho

w th

e fr

eque

ncy

of s

ympt

om o

ccur

renc

e in

any

com

bina

tion

with

oth

er s

ympt

oms.

The

circ

les

and

lines

indi

cate

par

ticul

ar c

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natio

ns o

f sym

ptom

s ob

serv

ed in

indi

vidu

al

patie

nts.

The

vert

ical

gre

en b

ars

indi

cate

the

freq

uenc

y of

occ

urre

nce

of th

e co

rres

pond

ing

com

bina

tion

of s

ympt

oms.

14 of 24



Figu

re 7

: Num

ber o

f CO

VID

-19

case

s by

plac

e of

acq

uisit

ion

over

tim

e, A

ustr

alia

(n =

4,1

59)a

050100

150

200

250

300

350

400

13-Jan-20

15-Jan-20

17-Jan-20

19-Jan-20

21-Jan-20

23-Jan-20

25-Jan-20

27-Jan-20

29-Jan-20

31-Jan-20

2-Feb-20

4-Feb-20

6-Feb-20

8-Feb-20

10-Feb-20

12-Feb-20

14-Feb-20

16-Feb-20

18-Feb-20

20-Feb-20

22-Feb-20

24-Feb-20

26-Feb-20

28-Feb-20

1-Mar-20

3-Mar-20

5-Mar-20

7-Mar-20

9-Mar-20

11-Mar-20

13-Mar-20

15-Mar-20

17-Mar-20

19-Mar-20

21-Mar-20

23-Mar-20

25-Mar-20

27-Mar-20

29-Mar-20

Number of cases

Date

of i

llnes

s ons

et

Loca

lly a

cqui

red,

not

epi

link

ed

Loca

lly a

cqui

red-

clos

e co

ntac

t of a

con

firm

ed c

ase

Ove

rsea

s acq

uire

d

Und

er in

vest

igat

ion

a Re

cent

ly re

port

ed c

ases

sho

wn

in th

e gr

aph

shou

ld b

e in

terp

rete

d w

ith c

autio

n as

ther

e ca

n be

del

ays

in re

port

ing.

15 of 24



Figu

re 8

: Con

firm

ed c

ases

of o

vers

eas a

cqui

red

CO

VID

-19

infe

ctio

n (n

= 2

,352

) by

Stan

dard

Aus

tral

ian

Cla

ssifi

catio

n of

Cou

ntri

es (S

ACC)

a

050100

150

200

250

13-Jan-20

15-Jan-20

17-Jan-20

19-Jan-20

21-Jan-20

23-Jan-20

25-Jan-20

27-Jan-20

29-Jan-20

31-Jan-20

2-Feb-20

4-Feb-20

6-Feb-20

8-Feb-20

10-Feb-20

12-Feb-20

14-Feb-20

16-Feb-20

18-Feb-20

20-Feb-20

22-Feb-20

24-Feb-20

26-Feb-20

28-Feb-20

1-Mar-20

3-Mar-20

5-Mar-20

7-Mar-20

9-Mar-20

11-Mar-20

13-Mar-20

15-Mar-20

17-Mar-20

19-Mar-20

21-Mar-20

23-Mar-20

25-Mar-20

27-Mar-20

29-Mar-20

Number of cases

Date

of i

llnes

s ons

et

Amer

icas

At se

a (c

ruise

ship

s)Eu

rope

New

Zea

land

and

Pac

ific

Nor

th A

fric

a an

d th

e M

iddl

e Ea

stN

orth

-Eas

t Asia

Sout

h-Ea

st A

siaSo

uthe

rn a

nd C

entr

al A

siaSu

b-Sa

hara

n Af

rica

a Re

cent

ly re

port

ed c

ases

sho

wn

in th

e gr

aph

shou

ld b

e in

terp

rete

d w

ith c

autio

n as

ther

e ca

n be

del

ays

in re

port

ing.

16 of 24



Figu

re 9

: Num

ber o

f CO

VID

-19

case

s (lo

gari

thm

ic sc

ale)

by

sele

cted

coun

try

and

days

sinc

e pa

ssin

g 10

0 ca

ses,

up to

29

Mar

ch 2

020

100

1,00

0

10,0

00

100,

000

1,00

0,00

0

01

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

2829

3031

3233

3435

3637

38

Number of cases (log scale)

Days

sin

ce p

assi

ng 1

00 c

ases

Aust

ralia

Italy

Isla

mic

Rep

ublic

of I

ran

Ger

man

yFr

ance

Spai

nU

KU

SARe

publ

ic o

f Kor

eaHo

ng K

ong*

Sing

apor

eJa

pan

17 of 24



Figu

re 1

0: N

umbe

r of C

OV

ID-1

9 de

aths

(log

arith

mic

scal

e) b

y se

lect

ed co

untr

y an

d da

ys si

nce

pass

ing

50 d

eath

s, up

to 2

9 M

arch

202

0

50500

5,00

0

50,0

00

01

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

Number of deaths (log scale)

Days

sin

ce p

assi

ng 5

0 de

aths

Repu

blic

of K

orea

Italy

Spai

n

Fran

ceU

KIra

n

USA

18 of 24



Figu

re 1

1. T

imel

ine

of C

OV

ID-1

9 re

late

d ev

ents

, inc

ludi

ng A

ustr

alia

n pu

blic

hea

lth re

spon

se a

ctiv

ities

, fro

m 3

1 D

ecem

ber 2

019

to 1

5 M

arch

202

0

31 D

ecem

ber 2

019

15 M

arch

2020

31-D

ec-1

9No

tifica

tion t

oW

HO pn

eum

onia

of un

know

n orig

in

7-Ja

n-20

SARS

-CoV

-2 id

entif

ied

11-F

eb-2

0W

HO an

noun

ced a

nam

e for

the

new

coro

navir

us di

seas

e: CO

VID-

19

11-M

ar-2

0W

HO ch

arac

teris

esCO

VID-

19 as

pand

emic

13-M

ar-2

0AH

PPC p

rovid

es re

com

men

datio

ns fo

rpu

blic g

athe

rings

, tes

ting a

nd so

cial d

istan

cing

12-M

ar-2

0AH

PPC p

rovid

es re

com

men

datio

nsfo

r hea

lthca

re an

d age

care

wor

kers

8-M

ar-2

0AH

PPC r

ecom

men

ds re

strict

ions o

nCO

VID-

19 co

ntac

ts an

d tra

velle

rsfro

m lis

ted h

igher

risk c

ount

ries

5-M

ar-2

0Re

strict

ions o

n tra

vel

from

Repu

blic

of Ko

rea

1-M

ar-2

0Re

strict

ions o

n tra

vel

from

Islam

ic Re

publi

c of Ir

an

1-Fe

b-20

Restr

iction

s on t

rave

lfro

m Ch

ina im

plem

ente

d

30-Ja

n-20

WHO

decla

res P

ublic

Hea

lthEm

erge

ncy o

f Inte

rnat

ional

Conc

ern

19 of 24



Figu

re 1

2. T

imel

ine

of C

OV

ID-1

9 re

late

d ev

ents

, inc

ludi

ng A

ustr

alia

n pu

blic

hea

lth re

spon

se a

ctiv

ities

, fro

m 1

5 to

29

Mar

ch 2

020

15 M

arch

2020

29 M

arch

2020

20-M

ar-2

0Ta

sman

ia clo

ses b

orde

rsto

non-

esse

ntial

trav

eller

s

18-M

ar-2

0DF

AT ra

ises t

rave

l adv

ice fo

r all o

verse

asde

stina

tions

to Le

vel 4

'Do N

ot Tr

avel' 18

-Mar

-20

AHPP

C rec

omm

ends

the c

ontin

uatio

n of a

14 da

yqu

aran

tine r

equir

emen

tfo

r all r

etur

ning

trav

eller

s

21-M

ar-2

0Ql

d, W

A, N

T and

SA cl

ose b

orde

rsto

non-

esse

ntial

trav

eller

s

24-M

ar-2

0–

AHPP

C rec

omm

ends

tem

pora

ry su

spen

sion o

f all n

on-u

rgen

t e

lectiv

e pro

cedu

res i

n bot

h the

publi

c and

priva

te se

ctor.

– AH

PPC r

ecom

men

ds pr

ogre

ssive

scale

up of

socia

l dist

ancin

g m

easu

res w

ith st

rong

er m

easu

res i

n rela

tion t

o non

-esse

ntial

gat

herin

gs, a

nd co

nside

ratio

ns of

furth

er m

ore i

nten

se op

tions

. –

Aged

care

prov

iders

limits

visit

s to a

max

imum

of tw

o visi

tors

at o

ne ti

me p

er da

y

25-M

ar-2

0- A

HHPC

reco

mm

ends

that

scho

ol-ba

sed i

mm

unisa

tion

pro

gram

s, wi

th th

e exc

eptio

n of t

he de

liver

y of m

ening

ococ

cal

ACW

Y vac

cine,

are p

ause

d at t

he cu

rrent

tim

e.–A

ustra

lian c

itize

ns an

d Aus

tralia

n per

man

ent r

eside

nts a

re re

strict

ed f

rom

trav

ellin

g ove

rseas

.

26-M

ar-2

0Re

strict

ed m

ovem

ent i

nto c

erta

in re

mot

e are

asto

prot

ect c

omm

unity

mem

bers

from

COVI

D-19

28-M

ar-2

0Al

l peo

ple e

nter

ing A

ustra

lia re

quire

d to u

nder

take

a man

dato

ry 14

-day

quar

antin

e at d

esign

ated

facil

ities

(e.g

. hot

els) i

n the

ir por

t of a

rriva

l.

29-M

ar-2

0Bo

th in

door

and o

utdo

or pu

blic

gath

ering

s lim

ited t

o two

perso

ns on

ly

20 of 24 health.gov.au/cdiCommun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020

Tabl

e 2:

Aus

tral

ian

CO

VID

-19

case

defi

nitio

n20 a

s of 2

9 M

arch

202

0Ve

rsio

n: 2

.4D

ate

of d

evel

opm

ent:

26

Mar

ch 2

020

Confi

rmed

cas

eA

per

son

who

test

s po

sitiv

e to

a v

alid

ated

spe

cific

SA

RS-C

oV-2

nuc

leic

aci

d te

st o

r has

the

viru

s id

entifi

ed b

y el

ectr

on m

icro

scop

y or

vira

l cul

ture

.

Prob

able

cas

e A

per

son

with

feve

r (38

°C) o

r his

tory

of f

ever

(e.g

. nig

ht s

wea

ts, c

hills

) OR

acut

e re

spira

tory

infe

ctio

n (e

.g. c

ough

, sho

rtne

ss o

f bre

ath,

sor

e th

roat

) AN

D w

ho is

a

hous

ehol

d co

ntac

t of a

con

firm

ed o

r pro

babl

e ca

se o

f CO

VID

-19,

whe

re te

stin

g ha

s no

t bee

n co

nduc

ted.

Susp

ect c

ase

A p

erso

n w

ho m

eets

the

follo

win

g ep

idem

iolo

gica

l and

clin

ical

crit

eria

:

Epid

emio

logi

cal c

rite

ria

Clin

ical

cri

teri

aA

ctio

n

Very

hig

h ri

sk

• Cl

ose

cont

act i

n 14

day

s be

fore

illn

ess

onse

t with

a c

onfir

med

or p

roba

ble

case

• In

tern

atio

nal t

rave

l in

the

14 d

ays

prio

r to

illne

ss o

nset

• Cr

uise

shi

p pa

ssen

gers

and

cre

w w

ho h

ave

trav

elle

d in

the

14 d

ays

prio

r to

illne

ss o

nset

Feve

r (≥

38 °C

) or h

isto

ry o

f fe

ver

OR

Acu

te re

spira

tory

infe

ctio

n (e

.g. c

ough

, sho

rtne

ss o

f br

eath

, sor

e th

roat

)

Test

Hig

h ri

sk

1. T

wo

or m

ore

case

s of

illn

ess

clin

ical

ly c

onsi

sten

t with

CO

VID

-19

in th

e fo

llow

ing

sett

ings

:

• A

ged

care

and

oth

er re

side

ntia

l car

e fa

cilit

ies

• M

ilita

ry o

pera

tiona

l set

tings

• Bo

ardi

ng s

choo

ls•

Corr

ectio

nal f

acili

ties

• D

eten

tion

cent

res

• A

borig

inal

rura

l and

rem

ote

com

mun

ities

, in

cons

ulta

tion

with

the

loca

l PH

U•

Sett

ings

whe

re C

OVI

D-1

9 ou

tbre

aks

have

occ

urre

d, in

con

sulta

tion

with

the

loca

l PH

U

2. In

divi

dual

pat

ient

s w

ith il

lnes

s cl

inic

ally

con

sist

ent w

ith C

OVI

D-1

9 in

a g

eogr

aphi

cally

loca

lised

are

a w

ith

elev

ated

risk

of c

omm

unity

tran

smis

sion

, as

defin

ed b

y PH

Us

Feve

r (≥

38 °C

) or h

isto

ry

of fe

ver (

e.g.

nig

ht s

wea

ts,

chill

s)

OR

Acu

te re

spira

tory

infe

ctio

n (e

.g. c

ough

, sho

rtne

ss o

f br

eath

, sor

e th

roat

)

Test

(on

site

fo

r age

d ca

re

resi

dent

s, w

here

fe

asib

le)

21 of 24 health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020

Vers

ion:

2.4

Dat

e of

dev

elop

men

t: 2

6 M

arch

202

0

Mod

erat

e ri

sk•

Hea

lthca

re w

orke

rs, a

ged

or re

side

ntia

l car

e w

orke

rsFe

ver (

≥ 38

°C) o

r his

tory

of

feve

r (e.

g. n

ight

sw

eats

, ch

ills)

OR

Acu

te re

spira

tory

infe

ctio

n (e

.g. c

ough

, sho

rtne

ss o

f br

eath

, sor

e th

roat

)

Test

Back

grou

nd ri

sk(N

o ep

idem

iolo

gica

l ris

k fa

ctor

s)H

ospi

talis

ed p

atie

nts

with

fe

ver (

≥ 38

°C)

AN

D

Acu

te re

spira

tory

sym

ptom

s (e

.g. c

ough

, sho

rtne

ss o

f br

eath

, sor

e th

roat

) of a

n un

know

n ca

se

Test

22 of 24



References

1. Moriarty LF, Plucinski MM, Marston BJ, Kur-batova EV, Knust B, Murray EL et al. Public health responses to COVID-19 outbreaks on cruise ships – worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):347–52.

2. World Health Organization (WHO). Coro-navirus disease 2019 (COVID-19) situa-tion report – 69: 29 March 2020. Geneva: WHO; 2020. [Accessed on 30 March 2020.] Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200329-sitrep-69-covid-19.pdf.

3. WHO. Report of the WHO-China joint mission on coronavirus disease 2019 (COV-ID-19). Geneva: WHO; 2020. [Accessed on 1 March 2020.] Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.

4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortal-ity of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020. doi: https://doi.org/10.1016/S0140-6736(20)30566-3.

5. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z et al. Epidemiology and transmission of COVID-19 in Shenzhen China: analysis of 391 cases and 1286 of their close contacts. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.03.20028423.

6. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science. 2020. doi: https://doi.org/10.1126/science.abb3221.

7. WHO. Coronavirus disease 2019 (COV-ID-19) situation report – 29: 18 February 2020. Geneva: WHO; 2020. [Accessed on 15 March 2020.] Available from: https://www.

who.int/docs/default-source/coronaviruse/situation-reports/20200218-sitrep-29-cov-id-19.pdf.

8. Eden JS, Rockett R, Carter I, Rahman H, de Ligt J, Hadfield J et al. An emergent clade of SARS-CoV-2 linked to returned travellers from Iran. bioRxiv. 2020. doi: https://doi.org/10.1101/2020.03.15.992818.

9. Sun P, Qie S, Liu Z, Ren J, Xi JJ. Clinical char-acteristics of 50466 patients with 2019-nCoV infection. medRxiv. 2020. doi: https://doi.org/10.1101/2020.02.18.20024539.

10. Li Y, Bai W, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may be at least par-tially responsible for the respiratory failure of COVID-19 patients. J Med Virol. 2020. doi: https://doi.org/10.1002/jmv.25728.

11. Woelfel R, Corman VM, Guggemos W, Seil-maier M, Zange S, Mueller MA et al. Clini-cal presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission clus-ter. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.05.20030502.

12. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D et al. Cardiac in-volvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020. doi: https://doi.org/10.1001/jamacar-dio.2020.1096.

13. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020. doi: https://doi.org/10.1001/jamacar-dio.2020.1017.

14. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020. doi: https://doi.org/10.1001/jamacardio.2020.1286.

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15. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. [Internet.] Geneva: WHO; 2020. [Accessed on 23 Febru-ary 2020.] Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-sus-pected.

16. Harrison, C. Coronavirus puts drug re-purposing on the fast track. Nat Biotechnol. 2020. doi: https://doi.org/10.1038/d41587-020-00003-1.

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24 of 24



Appendix A: Frequently asked questions

Q: Can I request access to the COVID-19 data behind your CDI weekly reports?

A: National notification data on COVID-19 con-firmed cases is collated in the National Notifiable Disease Surveillance System (NNDSS) based on notifications made to state and territory health authorities under the provisions of their relevant public health legislation.

Normally, requests for the release of data from the NNDSS requires agreement from states and ter-ritories via the Communicable Diseases Network Australia, and, depending on the sensitivity of the data sought and proposed, ethics approval may also be required.

Due to the COVID-19 response, unfortunately, spe-cific requests for NNDSS data have been put on hold. We are currently looking into options to be able to respond to data requests in the near future.

We will continue to publish regular summaries and analyses of the NNDSS dataset and recommend the following resources be referred to in the meantime:

• NNDSS summary tables: http://www9.health.gov.au/cda/source/cda-index.cfm

• Daily case summary of cases: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers

• Communicable Diseases Intelligence COVID-19 weekly epidemiology report: https://www1.health.gov.au/internet/main/publishing.nsf/Content/novel_coronavirus_2019_ncov_weekly_epidemiology_reports_australia_2020.htm

• State and territory public health websites.

Q: Can I request access to data at post-code level of confirmed cases?

A: Data at this level cannot be released without eth-ics approval and permission would need to be sought from all states and territories via the Communicable Diseases Network Australia. As noted above, specific requests for NNDSS data are currently on hold.

A GIS/mapping analysis of cases will be included in each Communicable Diseases Intelligence COVID-19 weekly epidemiology report. In order to protect privacy of confirmed cases, data in this map will be presented at SA3 level.

Q. Where can I find more detailed data on COVID-19 cases?

A: We are currently looking into ways to provide more in-depth epidemiological analyses of COVID-19 cases, with regard to transmission and severity, including hospitalisation. These analyses will continue to be built upon in future iterations of the weekly Communicable Diseases Intelligence report.

communicable diseases intelligence 2020 - covid …...between 7 and 29 march 2020, at least 17...

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