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The second is a French man returning from a stay in Lombardy, in northern Italy. The latter was hospitalized in the Auvergne-Rhône-Alpes region: "His condition does not inspire concern". https://www.bfmtv.com/sante/direct-coronavirus-covid-19-chine-italie-france-epidemie-pandemie-morts-symptomes/

Madrid confirms its first case of coronavirus, a 24-year-old News Telecinco / EFE02/25/202023: 19h. A young man who was traveling in northern Italy It is the fifth case confirmed in Spain in the last 24 hours A 24-year-old who was traveling in northern Italy is the first case of coronavirus confirmed in the Community of Madrid and the seventh in Spain (two of them have already been discharged) Sources of the Ministry of Health of the Community of Madrid have confirmed this information.

A 24-year-old who was traveling in northern Italy is the first case of coronavirus confirmed in the Community of Madrid https://www.telecinco.es/informativos/salud/madrid-coronavirus-llega_18_2905095401.html

FOURTH CONTAGION IN SPAIN An Italian in Barcelona, the first case of coronavirus confirmed on the Peninsula The health authorities have located and quarantined 25 people who have maintained contact with the patient, although they ensure that they all remain healthy By JRS 02/25/2020 - 16:09 Updated: 02/25/2020 - 18:21 Last minute of the coronavirus: 25 people isolated by the case of Covid-19 in Catalonia Human tests of the coronavirus vaccine would not be ready until summer Navarra will give an extra € 262 to the toilets that offer to treat infections The Department of Health of the Generalitat has confirmed on Tuesday the first case of Covid-19 coronavirus registered in Catalonia, which is the first infection within the Iberian Peninsula and the fourth in Spain, after those registered in La Gomera, Mallorca and Tenerife, in that order. The new affected is a 36-year-old Italian patient who had traveled to the north of her native country between February 22 and 22, as explained in a press conference by the Catalan Secretary of Public Health, Joan Guix. [Last minute of Covid-19 coronavirus] The young woman has "flu-like symptoms" and remains admitted to the Hospital Clínic de la Ciudad Condal, although she could be isolated at home "if the pressure of patients were high" because "no special care is required". In any case, for the definitive confirmation of the infection it will be necessary to wait for the test that the National Center of Microbiology will carry out in the next hours, in compliance with the protocol marked by Health. Along the same lines, health authorities have located and quarantined 25 people who have maintained contact with the patient. "They are in isolation but they are not sick people," Guix said, while calling for calm: "Without underestimating the coronavirus, I am more worried about the flu as an epidemiologist, but the idea is that I don't join the list of infections that live with us. " Tras conocer la noticia, el presidente del Gobierno, Pedro Sánchez, ha pedido "tranquilidad" y "confianza" en el sistema de salud pública. Por su parte, el ministro de Sanidad, Salvador Illa, ha convocado esta tarde una reunión con los consejeros de Sanidad de las comunidades autónomas para abordar esta cuestión. "Estamos en permanente comunicación con todos ellos", ha explicado el líder del Ejecutivo a su entrada al Pleno del Senado. Después de que los dos primeros casos confirmados en España —un turista alemán de paso en La Gomera y un ciudadano británico que residía en Mallorca— recibieran el alta, actualmente se mantienen infectadas tres personas. A la ingresada en Barcelona se suman un médico italiano y su mujer, que practicaban turismo en Tenerife. En las inmediaciones del hotel donde se alojaron, el H10 Costa Adeje Palace, se ha aislado a un millar de personas ante la posibilidad de que hayan contagiado el virus a otros huéspedes. El mayor estudio del coronavirus disecciona la enfermedad: así se comporta el Covid-19 S.S.G. Covid-19 has killed more than 2,500 people in China and the number of infected already exceeds 75,000, according to the National Health Commission of the Asian country. Although most cases have been registered in Wuhan, capital of the Hubei province and focus of the infection, the outbreak has exceeded the borders of 30 different countries , to the point that the World Health Organization (WHO) has called to the different governments and populations to prepare themselves by all possible means for a "potential pandemic".

The new affected is a 36-year-old Italian patient who had traveled to the north of her native country between February 22 and 22, as explained in a press conference by the Catalan Secretary of Public Health, Joan Guix. https://www.elconfidencial.com/sucesos/2020-02-25/cataluna-primer-caso-coronavirus-peninsula_2469724/

Algerian health minister confirms first COVID-19 case By AT editor - 25 February 2020 at 9:49 pm Algeria has confirmed the first case of coronavirus within its borders according to health minister Abderrahmane Benbouzid, who announced the finding to the nation on state-owned ENTV Tuesday evening. The patient is an Italian citizen who arrived in the country on February 17 and has been placed in isolation, the ministry said. It’s just the second case confirmed on the African continent, but it comes as the COVID-19 virus has spread from Asia to many new nations across Europe and the Middle East. Off the coast of Morocco on Gran Canaria, President Ángel Víctor Torres and Teresa Cruz Oval, the health minister, held an emergency meeting Tuesday to deal with the case of another Italian traveler. He is a doctor who tested positive after suspecting he was ill with the virus and seeking medical attention. That patient and a female companion who also tested positive for the coronavirus, believed to be his spouse, are being treated at Our Lady of La Candelaria Hospital, the government said.

The patient is an Italian citizen who arrived in the country on February 17 and has been placed in isolation, the ministry said. https://africatimes.com/2020/02/25/algerian-health-minister-confirms-first-covid-19-case/

40 PCR positives repatriated from Diamond Princess

Funding concerns Have been preparing for Pandemic for years Never prepared for everything Surprises are expected This pandemic could be bad

Congress briefed on possible severe pandemic CDC increasingly concerned about community spread Don't know severity or when In other countries outbreak has moved quickly

Preparing for Mitigation (hard to distinguish COVID from other resp diseases without accurate PCR test)

Test turn around at CDC is 1 day (once received)

Time to prepare is NOW

Kits delays No backlog at CDC Commercial kits coming online

Preparations have been made for influenza, Now applying plans to COVID

Schools, Businesses, Hospitals,Large Gatherings

Non-Pharmaceutical Interventions (NPIs) CDC documents available

Spread in US Not if but when

Rapidly evolving and expanding Community spread: Hong Kong, Iran, Italy, Japan, Singapore, South Korea, Thailand

AUDIO https://www.cdc.gov/media/releases/2020/t0225-cdc-telebriefing-covid-19-update.mp3

Media Advisory For Immediate Release Tuesday Feb. 25, 2020 Contact: CDC Media Relations (404) 639-3286 CDC Media Telebriefing: Update onCOVID-19 What The Centers for Disease Control and Prevention (CDC) will provide an update to media on the COVID-19 response. Who Nancy Messonnier, M.D., Director, National Center for Immunization and Respiratory Diseases When 11:30 a.m. ET Tuesday, Feb. 25, 2020 Dial-In Media: 800-857-9756 International: 1-212-287-1647 PASSCODE: CDC MEDIA Non-Media: 888-795-0855 International: 1-630-395-0498 PASSCODE: 3896719 Important Instructions Due to anticipated high volume, please plan to dial in to the telebriefing 15 minutes before the start time. Media: If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question. You may queue up at any time. You will hear a tone to indicate your question is pending. TRANSCRIPT A transcript will be available following the briefing at CDC’s web site:www.cdc.gov/media.

References World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–34. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200223-sitrep-34-covid-19.pdf?sfvrsn=44ff8fd3_2pdf iconexternal icon Holloway R, Rasmussen SA, Zaza S, Cox NJ, Jernigan DB. Updated preparedness and response framework for influenza pandemics. MMWR Recomm Rep 2014;63(No. RR-6). PubMedexternal icon Reed C, Biggerstaff M, Finelli L, et al. Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics. Emerg Infect Dis 2013;19:85–91. CrossRefexternal icon PubMedexternal icon Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. CrossRefexternal icon PubMedexternal icon The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly 2020. Epub February 17, 2020. Qualls N, Levitt A, Kanade N, et al.; CDC Community Mitigation Guidelines Work Group. Community mitigation guidelines to prevent pandemic influenza—United States, 2017. MMWR Recomm Rep 2017;66(No. RR-1). CrossRefexternal icon PubMedexternal icon Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A 2007;104:7582–7. CrossRefexternal icon PubMedexternal icon Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA 2007;298:644–54. CrossRefexternal icon PubMedexternal icon Dawood FS, Chung JR, Kim SS, et al. Interim estimates of 2019–20 seasonal influenza vaccine effectiveness—United States, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:177–82. CrossRefexternal icon PubMedexternal icon

Discussion COVID-19 is a serious public health threat. Cases of COVID-19 have been diagnosed in the United States, primarily in travelers from China and quarantined repatriates, and also in two close contacts of COVID-19 patients. Currently, COVID-19 is not recognized to be spreading in U.S. communities. If sustained transmission in U.S. communities is identified, the U.S. response strategy will enhance implementation of actions to slow spread in communities (2,6). Implementation of basic precautions of infection control and prevention, including staying home when ill and practicing respiratory and hand hygiene will become increasingly important. Community-level nonpharmaceutical intervention might include school dismissals and social distancing in other settings (e.g., postponement or cancellation of mass gatherings and telework and remote-meeting options in workplaces). These measures can be disruptive and might have societal and economic impact on individual persons and communities (6). However, studies have shown that early layered implementation of these interventions can reduce the community spread and impact of infectious pathogens such as pandemic influenza, even when specific pharmaceutical treatments and vaccines are not available (7,8). These measures might be critical to avert widespread COVID-19 transmission in U.S. communities (2,6). Mitigation measures implemented in China have included the closing of major transport hubs and preventing exit from certain cities with widespread transmission, cancellation of Chinese New Year celebrations, and prohibition of attendance at school and work (5). However, the impact of these measures in China has not yet been evaluated. In the United States, the National Institutes of Health (NIH) and their collaborators are working on development of candidate vaccines and therapeutics for COVID-19. In China, multiple clinical trials of investigational therapeutics have been implemented, including two clinical trials of remdesivir, an investigational antiviral drug.§§ An NIH randomized controlled clinical trial of investigational therapeutics for hospitalized COVID-19 patients in the United States was approved by the Food and Drug Administration; the first investigational therapeutic to be studied is remdesivir.¶¶ In the absence of a vaccine or therapeutic, community mitigation measures are the primary method to respond to widespread transmission and supportive care is the current medical treatment. COVID-19 symptoms are similar to those of influenza (e.g., fever, cough, and shortness of breath), and the current outbreak is occurring during a time of year when respiratory illnesses from influenza and other viruses, including other coronaviruses that cause the “common cold,” are highly prevalent. To prevent influenza and possible unnecessary evaluation for COVID-19, all persons aged ≥6 months should receive an annual influenza vaccine; vaccination is still available and effective in helping to prevent influenza (9). To decrease risk for respiratory disease, persons can practice recommended preventive measures.*** Persons ill with symptoms of COVID-19 who have had contact with a person with COVID-19 or recent travel to countries with apparent community spread††† should communicate with their health care provider. Before seeking medical care, they should consult with their provider to make arrangements to prevent possible transmission in the health care setting. In a medical emergency, they should inform emergency medical personnel about possible COVID-19 exposure. Areas for additional COVID-19 investigation include 1) further clarifying the incubation period and duration of virus shedding, which have implications for duration of quarantine and other mitigation measures; 2) studying the relative importance of various modes of transmission, including the role of droplets, aerosols, and fomites; understanding these transmission modes has major implications for infection control and prevention, including the use of personal protective equipment; 3) determining the severity and case-fatality rate of COVD-19 among cases in the U.S. health care system, as well as more fully describing the spectrum of illness and risk factors for infection and severe disease; 4) determining the role of asymptomatic infection in ongoing transmission; and 5) assessing the immunologic response to infection to aid in the development of vaccines and therapeutics. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action.

CDC Public Health Response As of February 24, 2020, a total of 1,336 CDC staff members have been involved in the COVID-19 response, including clinicians (i.e., physicians, nurses, and pharmacists), epidemiologists, veterinarians, laboratorians, communicators, data scientists and modelers, and coordination staff members. Of these CDC staff members, 497 (37%) have been deployed to 39 locations in the United States and internationally, including CDC quarantine stations at U.S. ports of entry, state and local health departments, hospitals, and U.S. military bases that are housing quarantined persons, as well as WHO and ministries of health around the world. CDC staff members are working with state, local, tribal, and territorial health departments and other public health authorities to assist with case identification, contact tracing, evaluation of persons under investigation (PUI) for COVID-19,* and medical management of cases; and with academic partners to understand the virulence, risk for transmission, and other characteristics of this novel virus. CDC teams are working with the Department of Homeland Security at 11 airports where all flights from China are being directed to screen travelers returning to the United States, and to refer them to U.S. health departments for oversight of self-monitoring. CDC is also working with other agencies of the U.S. government including the U.S. Department of Defense; multiple operational divisions with the U.S. Department of Health and Human Services, including the Assistant Secretary for Preparedness and Response and the Administration for Children and Families; and the U.S. Department of State to safely evacuate U.S. citizens, residents, and their families to the United States from international locations where there is substantial, sustained transmission of COVID-19, and to house them and monitor their health during a 14-day quarantine period. Specific guidance has been developed and posted online for health care settings, including for patient management; infection control and prevention; laboratory testing; environmental cleaning; worker safety; and international travel.† Guidance is updated as more is learned. To prepare for the possibility of community spread of COVID-19, CDC has developed tailored guidance and communications materials for communities, health care settings, public health, laboratories, schools, and businesses. Chinese and Spanish versions of certain documents are available. Information for travelers. Several recent travel notices have been posted by CDC to inform travelers and clinicians about current health issues that could affect travelers’ health.§ A Level 3 travel notice (avoid all nonessential travel) for China has been in effect since January 27. On February 19, Level 1 travel notices (practice usual precautions) for travelers to Hong Kong and Japan were posted. On February 22, the Level 1 travel notice for Japan was raised to Level 2 (practice enhanced precautions). A Level 2 travel notice was posted for South Korea on February 22, which was updated to Level 3 on February 24. Level 1 travel notices were posted for Iran and Italy on February 23, and then updated to Level 2 on February 24. In addition, CDC has posted information for travelers regarding apparent community transmission in Singapore, Taiwan, Thailand, and Vietnam, and recommendations for persons to reconsider cruise ship voyages in Asia. Airport screening. As of February 23, a total of 46,016 air travelers had been screened at the 11 U.S. airports to which all flights from China are being directed. Since February 2, travelers to the United States who have been in China in the preceding 14 days have been limited to U.S. citizens and lawful permanent residents and others as outlined in a presidential proclamation.¶ Incoming passengers are screened for fever, cough, and shortness of breath. Any travelers with signs or symptoms of illness receive a more comprehensive public health assessment. As of February 23, 11 travelers were referred to a hospital and tested for infection; one tested positive and was isolated and managed medically. Seventeen travelers were quarantined for 14 days because of travel from Hubei Province, China, an area that was designated as high risk for exposure to COVID-19**; 13 of these 17 have completed their quarantine period. Persons under investigation (PUIs). Recognizing persons at risk for COVID-19 is a critical component of identifying cases and preventing further transmission. CDC has responded to clinical inquiries from public health officials, health care providers, and repatriation teams to evaluate and test PUIs in the United States for COVID-19 following CDC guidance. As of February 23, 479 persons from 43 states and territories had been or are being tested for COVID-19; 14 (3%) had a positive test, 412 (86%) had a negative test, and 53 (11%) test results are pending. Laboratory testing. As part of laboratory surge capacity for the response, CDC laboratories are testing for SARS-CoV-2 to assist with diagnosis of COVID-19. During January 18–February 23, CDC laboratories used real-time reverse transcription–polymerase chain reaction (RT-PCR) to test 2,620 specimens from 1,007 persons for SARS-CoV-2. Some additional testing is performed at selected state and other public health laboratories, with confirmatory testing at CDC. CDC is developing a serologic test to assist with surveillance for SARS-CoV-2 circulation in the U.S. population. The test detects antibodies (immunoglobulin [Ig]G, IgA, and IgM) indicating SARS-COV-2 virus exposure or past infection. In addition, CDC laboratories are developing assays to detect SARS-CoV-2 viral RNA and antigens in tissue specimens. Finally, following CDC’s establishment of SARS-CoV-2 in cell culture, CDC shared virus isolates with the Biodefense and Emerging Infections Research Resources Repository to securely distribute isolates to U.S. public health and academic institutions for additional research, including vaccine development. Repatriation flights from areas with substantial COVID-19 transmission. During January 29–February 6, the U.S. government repatriated 808 U.S. citizens, residents, and their families from Hubei Province, China, on five chartered flights. At the time of departure, all travelers were free of symptoms for COVID-19 (fever or feverishness, cough, difficulty breathing). After arriving in the United States, the repatriated travelers were quarantined for 14 days at one of five U.S. military bases. CDC and U.S. government staff members monitored these travelers’ health. As of February 23, 28 (3%) of these persons developed COVID-19-related symptoms and were evaluated for infection; three were found to be positive for SARS-CoV-2 and were referred for medical care and isolation. As of February 24, the remaining 805 travelers had completed their 14-day quarantine. On February 3, passengers and crew of the Diamond Princess cruise ship were quarantined off Yokohama, Japan; a passenger who had recently disembarked in Hong Kong was confirmed to have COVID-19, and ongoing transmission was identified on the ship. By February 16, a total of 355 cases of COVID-19 had been identified among passengers and crew,†† including 67 U.S. citizens or residents. As a result, during February 16–17, the U.S. government assisted in the repatriation of 329 U.S. citizens or residents from the ship. These travelers returned on two chartered flights. As of February 23, 36 (11%) of these repatriated persons had tested positive for SARS-CoV-2 and are under appropriate medical supervision. The remaining repatriated persons are in quarantine for 14 days. CDC is working with the U.S. embassy in Japan and the Japanese government to support U.S. passengers and crew who remained in Japan.

COVID-19 Cases in the United States As of February 23, 14 COVID-19 cases had been diagnosed in the following six states: Arizona (one case), California (eight), Illinois (two), Massachusetts (one), Washington (one), and Wisconsin (one). Twelve of these 14 cases were related to travel to China, and two cases occurred through person-to-person transmission to close household contacts of a person with confirmed COVID-19. An additional 39 cases were reported among repatriated U.S. citizens, residents, and their families returning from Hubei province, China (three), and from the Diamond Princess cruise ship that was docked in Yokohama, Japan (36). Thus, there have been 53 cases within the United States. No deaths have been reported in the United States.