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Information and Guidance about Global Travel on Cruise Ships, Including River Cruises, due to Coronavirus Disease 2019 (COVID-19) Summary The Centers for Disease Control and Prevention (CDC) recommends all persons defer any travel on cruise ships, including river cruises, worldwide because of the increased risk of SARS-CoV-2 transmission onboard ships. Deferring travel is especially important for older adults and all people with serious chronic medical conditions (such as heart disease, diabetes or lung disease), because of their increased risk for severe disease. This health update provides information to clinicians and state and local health departments about the current coronavirus disease 2019 (COVID-19) situation and the risks associated with travel on cruise ships, including river cruises. Background Cruise ship passengers, including those who take river cruises, are at increased risk of exposure to SARS-CoV-2, the virus that causes COVID-19. In the past month, there have been reports of outbreaks of COVID-19 among passengers and crew on cruises. Recent examples include 696 cases and 8 deaths on the Diamond Princesscruise ship in Japan, 28 cases on the Grand Princess cruise ship in the United States, and at least 60 cases in 15 states associated with multiple Nile River voyages in Egypt as of March 14, 2020. Illness onset occurred both onboard ships and after passengers returned to the United States. The proximity of passengers and crew on small ships and boats traveling on rivers may result in an even higher number of COVID-19 infections. Recommendations for Clinicians Ask all patients about their planned or recent cruise ship travel, including river cruises. Pre-travel advice Advise patients to defer all cruise ship travel, including river cruises, worldwide. Explain that their return travel to the United States may be impacted, and formal quarantine procedures may be implemented if confirmed cases are identified on board. Explain that appropriate medical care or medical evacuation may not be available internationally. Explain that some countries may refuse docking or disembarkation if there are known or suspected cases on board. For patients who still intend to cruise, advise them to practice social distancing and monitor their health both during travel and for 14 days from the time they disembark. Social distancing means staying out of crowded places, avoiding group gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others, when possible. Post-travel management Tell patients to follow CDC’s guidance on steps to prevent the spread of COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html) if they develop acute febrile or respiratory illness after travel. Implement recommended infection prevention and control practices (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html) if you suspect a patient has COVID-19. Immediately notify the local health department (https://www.naccho.org/membership/lhd-directory) if a patient meets clinical and epidemiologic criteria for a person under investigation (PUI) (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html) for COVID-19 and test as appropriate. Recommendations for State and Local Health Departments Check The Epidemic Information Exchange(Epi-X) notification system for information on COVID-19 cases on cruise ships and river cruises. For More Information State and local health departments can contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 for assistance with obtaining, storing, and shipping appropriate specimens to CDC for testing, including after hours, weekends, or holidays. The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations. Categories of Health Alert Network messages: Health Alert - Requires immediate action or attention; highest level of importance Health Advisory - May not require immediate action; provides important information for a specific incident or situation Health Update - Unlikely to require immediate action; provides updated information regarding an incident or situation HAN Info Service - Does not require immediate action; provides general public health information

Vermont cases of COVID-19 4 Vermonters tested negative for COVID-19 348 Vermonters being monitored 241 Vermonters who have completed monitoring 132 In addition, four non-Vermont residents tested positive at the Vermont Public Health Laboratory. This table is updated daily by 1:00 p.m. Last updated: March 15, 2020 https://www.healthvermont.gov/response/infectious-disease/2019-novel-coronavirus

Our knowledge of COVID-19 is still rapidly evolving. The risk assessment will be updated as needed. 2019 Novel Coronavirus (COVID-19) in Washington Updated on March 15, 2020 at 3:00 p.m. County Positive/Confirmed Cases Deaths Clark 3 0 Columbia 1 0 Grant 2 1 Grays Harbor 1 0 Island 6 0 Jefferson 3 0 King 420 37 Kitsap 3 0 Kittitas 3 0 Lincoln 1 0 Pierce 29 0 Skagit 4 0 Snohomish 176 4 Spokane 3 0 Thurston 3 0 Whatcom 3 0 Yakima 4 0 Unassigned 104 0 Total 769 42 Confirmed Cases by Age 0 to 19 years 2% 20 to 29 years 7% 30 to 39 years 11% 40 to 49 years 12% 50 to 59 years 16% 60 to 69 years 14% 70 to 79 years 18% 80+ years 20% Confirmed Cases by Sex Female 53% Male 43% Unknown 4% Number of Individuals Tested Positive 769 Negative 9451 Note on the county and unassigned data: This data changes rapidly as labs conduct tests and discover new cases. Labs assign those cases to a county. Counties or the Department of Health then determine the appropriate county of jurisdiction. Those don’t always match initially. We’re working to reduce the “unassigned” number to 0. Contact the local health department for county specific information. Note on the deaths: Some deaths may be reported by health care providers, medical examiners/coroners, local health departments, or others before they are included in the statewide count. It takes longer for the state to announce deaths because they are often reported first to the local health department and then to us. Note on the number of infections: Public health experts agree that the true number of people who have been infected with COVID-19 in Washington greatly exceeds the number of COVID-19 infections that have been laboratory-confirmed. It is very difficult to know exactly how many people in Washington have been infected to date since most people with COVID-19 experience mild illness and the ability to get tested is still not widely available. https://www.doh.wa.gov/Emergencies/Coronavirus

Our knowledge of COVID-19 is still rapidly evolving. The risk assessment will be updated as needed. 2019 Novel Coronavirus (COVID-19) in Washington Updated on March 15, 2020 at 3:00 p.m. County Positive/Confirmed Cases Deaths Clark 3 0 Columbia 1 0 Grant 2 1 Grays Harbor 1 0 Island 6 0 Jefferson 3 0 King 420 37 Kitsap 3 0 Kittitas 3 0 Lincoln 1 0 Pierce 29 0 Skagit 4 0 Snohomish 176 4 Spokane 3 0 Thurston 3 0 Whatcom 3 0 Yakima 4 0 Unassigned 104 0 Total 769 42

Wyoming’s Coronavirus Total Up to Three March 14, 2020 The Wyoming Department of Health (WDH) has been notified of the third known case of coronavirus disease 2019 (COVID-19) among state residents. The patient is an adult male Sheridan County resident who is linked to a previously identified Sheridan County case. Testing was performed in Colorado, where the man is visiting. WDH is continuing to follow up to learn more about the person’s exposure risk and to identify and communicate with anyone who may have been in close contact with the patient. Known contacts will be monitored for symptoms and tested if needed. For more information about coronavirus disease 2019 and Wyoming, visit: https://health.wyo.gov/publichealth/infectious-disease-epidemiology-unit/disease/novel-coronavirus/. For more details about the disease from the CDC, visit: https://www.cdc.gov/coronavirus/2019-nCoV/index.html. https://health.wyo.gov/wyomings-coronavirus-total-up-to-three/

WV CASES Updated: 03/14/2020 0 Total Positive Cases 38 Total Negative Cases* 0 Total Deaths 1 Tests Pending* *NOTE: Now that COVID-19 testing is expanded and available through commercial laboratories and some hospitals, DHHR is only reporting those tests that have been processed through its state public health lab. All positive results obtained by commercial laboratories are reportable to DHHR and are included in the positive case counts. https://dhhr.wv.gov/COVID-19/Pages/default.aspx

Coronavirus Disease 2019 (COVID-19) in Alabama Updated: March 15, 2020 6:20 p.m (CT) County of Residence Cases Baldwin 1 Elmore 1 Lee 1 Jefferson 12 Limestone 1 Montgomery 1 Shelby 2 Tuscaloosa 3 Total 22 Deaths: 0 http://alabamapublichealth.gov/infectiousdiseases/2019-coronavirus.html

Testing at ASPHL for COVID-19 in Arizona Data last updated | 3/15/2020 9:00:38 AM https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-home

Status Update as of March 15, 2020 Confirmed Cases of COVID-19 in Arkansas 16 Persons Under Investigation (PUI) 30 People being monitored by ADH with daily check-in and guidance because of an identified risk 237 Past PUIs with negative test results 103 Current as of 3/15/2020. ADH has activated a call center to answer questions from health care providers and the public about the novel coronavirus. During normal business hours (8:00am – 4:30pm), urgent and non-urgent calls, please call 1-800-803-7847. After normal business hours, urgent calls needing immediate response, please call 501-661-2136. https://www.healthy.arkansas.gov/https://www.healthy.arkansas.gov/programs-services/topics/novel-coronavirus

UPDATED: March 15, 1:45 p.m. COVID-19 Test Result Overview Positive*: 131 Total number of people tested at the state lab**: 758 *Originally we classified cases as “presumptive positive” until they could be re-tested by the Centers for Disease Control (CDC). The CDC confirmed we no longer need to send positive cases for re-testing because the test they perform is identical to the CDPHE testing. Therefore, all positive cases reported here are confirmed positive. **Now that private labs are conducting testing, the positive cases number represents all positive cases in the state. Private labs are not required to report negative numbers to the state, so we are not reporting total numbers of negative cases. Please note: information may change slightly as more information is collected on each patient. Positive cases by county of residence Adams County: 6 Arapahoe County: 15 Boulder County: 3 Clear Creek County: 1 Denver County: 24 Douglas County: 8 Eagle County: 22 El Paso County: 4 Garfield County: 1 Gunnison County: 8 Jefferson County: 12 Larimer County: 1 Mesa County: 1 Pitkin County: 2 Pueblo County: 1 Summit County: 1 Weld County: 5 Unknown county: 1 Out of state visitors - 15 (Currently located in these counties:) Pitkin - 9 Eagle - 2 Routt - 1 Denver - 1 Waiting on information - 2 Deaths: One female in her 80s from El Paso County Age: Teenage – 7 20s – 13 30s – 26 40s – 24 50s – 26 60s – 16 70s – 14 80s – 5 Resident/Visitor: Residents: 115 Visitors: 16 Sex: Female: 63 Male: 68 https://docs.google.com/document/d/e/2PACX-1vRSxDeeJEaDxir0cCd9Sfji8ZPKzNaCPZnvRCbG63Oa1ztz4B4r7xG_wsoC9ucd_ei3--Pz7UD50yQD/pub

Latest COVID-19 Testing Data in Connecticut Updated 6:00 p.m. on Sunday, March 15, 2020 Total patients who tested positive (including presumptive positive): 26 Fairfield County: 16 Hartford County: 3 Litchfield County: 4 New Haven County: 3 https://portal.ct.gov/Coronavirus

Reported Cases of COVID-19 in Delaware * As of 3/15/2020, 3:00 P.M. Positive 7 County breakdown of Positive New Castle: 7 Kent: 0 Sussex: 0 https://dhss.delaware.gov/dhss/dph/epi/2019novelcoronavirus.html

Officials Announce 29 New Cases of Coronavirus Disease in Illinois 15th Mar, 2020 SPRINGFIELD - The Illinois Department of Public Health today announced 29 new cases of coronavirus disease (COVID-19) across Illinois. Five additional counties are now reporting cases – Champaign, Clinton, Sangamon, Whiteside, and Winnebago counties. Other locations with cases include Chicago and Cook, Cumberland, DuPage, Kane, Lake, McHenry, St. Clair, and Woodford counties. “We are seeing the number of COVID-19 cases increase exponentially and in more locations across Illinois,” said IDPH Director Dr. Ngozi Ezike. “At this point, it is best to assume that the coronavirus is circulating in your community and you should take the same precautions when interacting with other people that you would when interacting with someone who has tested positive for COVID-19. This may seem like an extreme step, but this is how we reduce the number of new cases and prevent the health care system from being overwhelmed.” Currently, IDPH is reporting 93 cases in 13 counties in Illinois. Cases have occurred in all age ranges and the number of cases that do not have a clear connection to travel or a known COVID-19 case is increasing. Social distancing measures, such as working from home when possible, limiting the amount of time spent in the community, and trying to avoid public transportation as much as possible, will help reduce the number of people who become sick at any given time and the possibility of exhausting our health care resources. For information about how you, your school, workplace, and community can prepare, please visit Preventing COVID-19 Spread in Communities. For general questions about COVID-19, call the hotline at 1-800-889-3931 or email [email protected]. A list of local health departments can be found on the IDPH website. http://www.dph.illinois.gov/news/public-health-officials-announce-29-new-cases-coronavirus-disease-illinois

Situation Overview KDHE continues to closely monitor an outbreak of a respiratory illness caused by a novel coronavirus named coronavirus disease 2019 (COVID–19). The outbreak first started in Wuhan, China, but cases have been identified around the world including in the United States. The first case in the United States was announced January 21, 2020. KDHE Response Activities • Other labs in the state are beginning to test for COVID-19. These labs are asked to send all results to KDHE. KDHE will continue reporting/announcing results from these labs for Kansas cases. • KDHE will update its website with the case information daily by 5 p.m. • KDHE has created a toolkit of Kansas-specific guidance to help local public health departments engage with their community partners on COVID-19 planning. It can be found on the KDHE website: www.kdheks.gov/coronavirus. New information is added daily. • KDHE has a phone-bank operation that is staffed during regular business hours. The phone number is 1-866-534-3463 (1-866-KDHEINF). KDHE also has an email address for general inquiries, [email protected]. Please note these contact numbers are for general questions and cannot provide you with medical evaluations. If you are feeling ill, please stay home and call your healthcare provider. For more information: www.kdheks.gov/coronavirus 2019 Novel Coronavirus (COVID-19) in Kansas Test Results Updated 3/15/20 at 3 p.m. Positive (confirmed) 8 (1 death included) Negative 166 Positive Case Information County Number Johnson County 5 Wyandotte County 1 Butler County 1 Franklin County 1 http://www.kdheks.gov/coronavirus/publicupdate/COVID-19_March_15_2020.pdf

Current as of March 15, 2020 at 4 p.m. Eastern time Kentucky Coronavirus MonitoringNumber Tested: 254Positive: 20 Note: These figures are updated daily at 4 p.m. Eastern time and reflect all cases reported to KDPH as of that time. https://chfs.ky.gov/agencies/dph/pages/covid19.aspx

About Coronavirus (COVID-19) The Centers for Disease Control and Prevention (CDC) and the Louisiana Office of Public Health continue to closely monitor this outbreak. This information will be updated twice daily at 9:30 a.m. and 5:30 p.m.To prevent the spread of infection, the Louisiana Department of Health is heavily engaged in priority public health actions. These actions include, but are not limited to: working with healthcare facilities with presumptive patients to identify exposed healthcare workers and make appropriate recommendations; ensuring all recommended infection control precautions are implemented in the healthcare facilities until we determine that the patient is no longer infectious, notifying and monitoring close contacts; coordinating with CDC All information on this website reflects the most current information provided to the State. It is subject to change based on further investigations, and will be updated accordingly. http://www.ldh.la.gov/coronavirus/ Coronavirus.gov Website

The table below is updated once each day Monday through Friday by 12 PM EDT. Maine COVID-19 Testing Data Updated: March 13, 2020 at 2:00 PM Total Confirmed Cases1 Total Presumptive Positive Cases2 Total Preliminary Presumptive Positive Cases3 Persons With Negative Tests4 Persons With Tests Pending5 0 2 1 91 17 1A case is confirmed when the positive result is confirmed at US CDC. 2A presumptive positive result is when a sample sent by a health provider directly to the state lab tests positive or the state lab validates positive results from non-governmental labs. Maine CDC sends samples from presumptive positive tests to US CDC for confirmation. 3A preliminary presumptive positive result is when a patient tests positive at a non-governmental laboratory. The samples are sent to Maine's state lab for validation. 4This number represents negative tests from state, reference, or commerical laboratories, or at US CDC. 5This number represents the number of tests pending at Maine’s Health and Environmental Testing Laboratory. Tests pending at commercial labs are not included in this number. https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml

COVID-19 Statistics in Maryland Number of Confirmed Cases: 31 Anne Arundel (2) Baltimore City (1) Baltimore County (3) Carroll (1) Charles (1) Harford (2) Prince George's (9) Montgomery (12) https://coronavirus.maryland.gov/

The virus doesn't do well in sunlight.

MICHIGAN DATA Michigan Data: Date 3/14/2020 Meets PUI Criteria: Testing Approved 172 Negative for 2019-nCoV 205 Positive for 2019-nCoV 33 Test Results Pending 26 Referred for Assessment and/or Monitoring to Date** 661 Total Assessment and/or Monitoring Referrals Under Active Monitoring 255 Positive number has been updated. All other numbers are pending. Test results will be updated daily; typically in the evening. Testing data included in the chart reflects COVID-19 tests conducted by the MDHHS Bureau of Laboratories. Any additional testing underway by private lab companies is not reflected. *PUI - Persons Under Investigation **This includes referrals from CDC airport quarantine stations, self-referrals, close contacts of pending PUIs and healthcare provider referrals entered by local health departments. https://www.michigan.gov/coronavirus

Mississippi positive cases: 10 as of March 15, 2020 Individuals tested by the MSDH Public Health Laboratory: 90 as of March 13, 2020 Mississippi Cases New cases reported today, March 15, 2020 County Cases Copiah 1 Hinds 2 Pearl River 1 All Mississippi cases to date County Cases Copiah 2 Hinds 2 Forrest 3 Leflore 1 Pearl River 2 Mississippi COVID-19 Case Map Location for all cases where details are known. https://msdh.ms.gov/msdhsite/_static/14,0,420.html

The data provided below will be updated weekly and all data are provisional and subject to change as we continue our investigation. Test Results for Persons Under Investigation (PUI)* Last updated 3/10/2020, 1:00 PM Confirmed** 1 Presumptive† 4 Negative*** 168 *According to the latest CDC guidelines, PUI are individuals with COVID-19 symptoms—but not necessarily the virus—who may have been exposed through close contact with a confirmed case, travel to an affected region, or who have severe respiratory illness requiring hospitalization with no more likely diagnosis and no source of exposure has been identified. **Confirmed: Persons who tested positive for COVID-19 by CDC †Presumptive: Persons who tested positive for COVID-19 by a state or local laboratory and CDC confirmation is pending. ***Negative: Persons who have tested negative for COVID-19 and for whom no further follow up is needed. http://dpbh.nv.gov/Programs/OPHIE/dta/Hot_Topics/Coronavirus/

New Hampshire 2019 Novel Coronavirus (COVID-19) Summary Report (updated March 15, 2020, 9:00 AM) Number of Persons with COVID-191 13 Number of Persons with Test Pending in PHL2 95 Total Number of Persons Tested at NH PHL3 379 Number of Persons Being Monitored in NH (approximate point in time) 450 1 Includes specimens confirmed by CDC confirmatory testing.2 Includes specimens tested at NH Public Health Laboratories (PHL) and other laboratories.3 Includes specimens received and awaiting testing at NH Public Health Laboratories (PHL). https://www.nh.gov/covid19/

COVID-19 Cases by County Note: After further investigation, the case numbers by county for March 15 have changed slightly. These numbers are subject to change as the Department reconciles data we receive from commercial laboratories. Bergen County: 29 Positive Test Result(s) Monmouth County: 12 Positive Test Result(s) Middlesex County: 12 Positive Test Result(s) Essex County: 11 Positive Test Result(s) Hudson County: 11 Positive Test Result(s) Passaic County: 5 Positive Test Result(s) Burlington County: 4 Positive Test Result(s) Union County: 4 Positive Test Result(s) Morris County: 4 Positive Test Result(s) Camden County: 2 Positive Test Result(s) Ocean County: 2 Positive Test Result(s) Mercer County: 1 Positive Test Result(s) Somerset County: 1 Positive Test Result(s) https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml

Updated daily by 11 a.m. each day. Last updated 10:30 a.m., March 15, 2020. NC Cases NC Deaths US Cases US Deaths 32 0 1,694 41 County Map Situation Updates NC State Laboratory of Public Health (NCSLPH) The numbers in this section represent only NCSLPH testing and supplies. Now that commercial and hospital laboratories are online with testing and expanding capacity, the NCSLPH will continue to work with partners across the public health systems to support identification and confirmation of COVID-19, assess the prevalence of COVID-19 in a community, and provide testing for underserved populations who may not have access to commercial testing. Supplies for approximately 410 patients at the NCSLPH and does not include supplies at university and commercial laboratories. 259 total tests completed at the NCSLPH and does not include tests at university and commercial laboratories. https://www.ncdhhs.gov/covid-19-case-count-nc