PANDEMIC MONITOR: 5 March 2020
Since the ‘correction’ of equity markets sell-offs last week, governments across the world have announced stimulus packages or policy shifts in a bid to reduce the burden on corporate entities who are struggling amid the ongoing epidemic of the novel coronavirus, COVID-19, which has been spreading across the world since December 2019. However, investors will remain cautious in the one-month outlook as the outbreak is still in large part not contained.
New developments over the past seven days
Although the World Health Organization (WHO) did not declare the ongoing outbreaks of COVID-19 across the world a global pandemic, the UN’s health agency increased its risk assessment of further contagion from ‘High’ to ‘Very High’ on 27 February. In addition, it warned on 3 March that the world was entering ‘unchartered territory’, as the outbreak was spreading while countries, such as Italy and the UK, continue to report spikes in the total number of daily infections.
In total, 66 countries had confirmed infections as of 3 March. When the WHO last declared a global pandemic in 2003 for the H1N1 influenza outbreak, more than 70 countries had been affected.
As the outbreak continues to spread, it appears more certain that the WHO will declare a global pandemic within the one- to two-week outlook, unless there is a significant breakthrough made in limiting the spread of the virus or an effective cure is found. But such an event should not be expected for at least another 6-12 months.
The death rate has increased over the past week, with WHO Director-General Tedros Adhanom Ghebreyesus on 3 March confirming that 3.4 per cent of the total number of infected patients globally have died from the disease. However, he emphasised that death rates vary between 0.7 per cent and 4 per cent depending on the quality of the healthcare system in-country.
During the same press briefing, Ghebreyesus said that scientists still do not understand how COVID-19 behaves, including how it is transmitted specifically, although there are indications.
The Regional Breakdown
In the Americas, six Latin American countries – Argentina, Brazil, Chile, Dominican Republic, Ecuador, and Mexico – have confirmed cases of COVID-19 since 27 February, but all cases appear to have been imported, mainly from Italy.
The US continues to be the worst-affected country in the Americas with 64 cases in total and two fatalities as of 3 March. Authorities there are also grappling with ‘unexplained cases’ of infections in California and Oregon states. Canada is the second-worst affected country in the region with 27 cases in total, but no deaths.
While it is likely that more countries across the region will confirm COVID-19 transmission in the one-week outlook, companies with operations in countries with poor health care systems, such as Haiti, Guatemala, Honduras, and Venezuela, should monitor infections there as they are likely to become regional epicentres should the presence of the virus be confirmed also there. The region remains highly exposed to supply chains from China, Latin America’s second-largest trading partner after the US, which increases the likelihood of further contagion there.
In Asia, South Korea became the country with the largest number of COVID-19 infections outside China reaching a total of 28 fatalities and over 4,812 people formally diagnosed infected with the virus. This indicates a fatality rate of less than 0.5 per cent, which is a low average compared to other countries.
Outbreak clusters have emerged in France, Germany, Spain, Sweden and the UK over the past week, and authorities across Europe are increasingly concerned about its potential impact on public health and the EU’s macroeconomic outlook. Andorra, Poland, and Portugal all recorded their first cases of COVID-19.
Furthermore, European countries account for the largest number of fatalities globally so far. Italy, the worst-hit country in Europe, has the highest number of deaths. Italian authorities have implemented a series of measures to tackle the outbreak. As of 4 March, there were over 3,000 confirmed infections and 109 deaths, after local authorities reported a jump in new infections. This followed spikes in Sweden and the UK where authorities confirmed 16 and 36 new infections, respectively.
Almost half of the countries that the WHO designates as the ‘Europe region’, including Azerbaijan and Israel, have had locally transmitted cases.
Despite a slowdown in the number of new cases confirmed in Italy, officials are also mulling the introduction of a new quarantine red-zone near the industrial city of Bergamo due to the large concentration of cases there. Two red-zones, where special travel restrictions apply, were set up on 22 February; one encompasses 10 towns in the northern region of Lombardy and a smaller one in the nearby Veneto region.
Middle East and North Africa, and Central Asia
In the Middle East, attention remains focussed on the outbreak in Iran which had 1,501 total infections and 523 fatalities as of 3 March. That is a death rate of 2.86 per cent, and some news sources say that 1 in 10 Iranian members of parliament had been infected with the virus.
The infections have spread across borders with Jordan, Morocco, Saudi Arabia, and Tunisia all recording their first cases over the past seven days. Given the current rate of contagion and because the virus’ behaviour is unclear to epidemiologists, coupled with a likely slow and poor response by authorities in Iran, other countries in the region are also likely to confirm their first cases in the one-week outlook. This comes despite the fact that all of Iran’s neighbours have closed their shared borders with the country, and a number of countries have suspended direct flights with the Islamic Republic.
Egypt will prohibit entry of Qatari nationals from 6 March, including individuals who have a permanent residency. The move follows Qatar’s decision to ban individuals who had transited through Egypt from entering the country on 1 March over COVID-19 fears.
On 26 February, Saudi Arabia announced that it would no longer issue visas to pilgrims wishing to undertake Umrah pilgrimages to Mecca and Medina. This restriction is also in place for Saudi residents.
Nigeria and Senegal recorded the first infections in Sub-Saharan Africa. In both countries, the ‘patient-zeros’ had travelled either to France or Italy.
Other countries, such as Angola, DR Congo, Kenya, Madagascar, and Uganda have all confirmed continued testing of visitors for COVID-19, but no cases have been confirmed yet.
Nevertheless, given that many East African and Southern African countries supply chains are very exposed to the Chinese market, coupled with the ostensibly slow response by the Nigerian authorities to confirm the infection.
According to news reports the man was not isolated for almost 48 hours, which in a bustling megacity like Lagos is worrying. In Senegal, both confirmed cases as of 4 March were French nationals who have resettled in the country.
While epidemiologists continue to be puzzled by the behaviours of COVID-19 in infected patients, more treatments are being trialled.
Authorities in China have confirmed that some patients infected with COVID-19 have developed uncontrolled immune response, which can lead to life-threatening damage to lung tissue. It was likely against this backdrop that China’s National Health Commission on 4 March said it had approved the use of arthritis drug Tocilizumab – sold under the trademarked name Actemra a Swiss pharmaceutical firm Roche Holding AG’s – to treat some COVID-19 patients in severe condition.
The drug can be prescribed to patients exhibiting high levels of a protein called Interleukin 6, which may signal immunological diseases or inflammation, and serious lung damage. The drug has yet to receive approval from the country’s National Medical Product Association to be sold for treatment of COVID-19 patients and there is so far no clinical trial evidence that the drug will be effective on COVID-19 patients, though. The drug is registered for a three-month clinical trial lasting until 10 May. Chinese drug-makers are scrambling to develop biosimilars for the Swiss firm’s drug, or more affordable versions of biotech pharmaceuticals such as Actemra.
Patients in China and Japan have tested positive for COVID-19 weeks after they had been discharged from hospital is concerning some scientists, although Chinese authorities claim the re-infected patients were not contagious. Scientists explain this in two ways. On the one hand, convalescing patients may not be able to develop enough antibodies to develop immunity to the infection. On the other, some suspect the infection could be biphasic, meaning the virus could be dormant for a while before developing new symptoms. Some of the reinfections have also been blamed on poor initial testing of said patients.
Furthermore, a study by China’s National Science Review, published on 3 March, suggested that the difference between COVID-19 and severe acute respiratory syndrome (SARS), both of which are types of coronaviruses, could be much larger than previously anticipated. The study posits that the virus had generated 149 mutations since it was first confirmed, and that most mutations had occurred over the past few weeks. The current trend, according to the study, is that the virus has developed into two main strains – L and S, with the latter being the most common since the end of January.
Governments ramp up responses
As the outbreak continues to spread across regions, national governments are ramping up efforts to contain the spread of the virus, announcing scenarios planning and emergency funding to mitigate the risk of a pandemic.
The US Congress on 4 March passed a USD8.3 billion emergency spending package, while the state of California declared a state of emergency after a person infected with COVID-19 died. Meanwhile, senior military officials have confirmed in interviews to news outlets that the Pentagon was exploring and preparing for multiple scenarios.
In the UK, where authorities confirmed a total of 115 infections as of 5 March, the government published an action plan to deal with the outbreak, and has convened an extraordinary COBRA meeting with senior civil servants, military, and lawmakers. This includes providing financial support to some businesses facing short-term cash flow problems, while police and other emergency workers could assist companies in ensuring business continuity in the event of workforce shortages.
The government also announced a temporary change of rules with regards to paid statutory sick leave for staff who are being instructed to self-isolate, as the government forecasts that 1 in 5 workers will need to take sick leave. Staff who fall ill will now be entitled to sick pay from their first day of leave, as opposed to four under the current regime. The rule-change is intended to also incentivise workers on National Minimum Wage to be able to take out sick leave in case they are infected with the virus. This is likely to add another financial burden to companies, who are already facing liquidity shortages due to slowing demand.
In addition, the government said on Wednesday it would register COVID-19 as ‘notifiable’, which will help companies seek compensation from insurance providers in the event of cancellations made due to the virus.
In addition, according to a UK government paper, 80 per cent of the UK’s population could be infected with COVID-19 while there could be a 1 per cent death rate from the number of confirmed cases in a worst-case scenario. In Scotland, the government warned that 250,000, or 80 per cent of the population, could be admitted into hospital if the outbreak escalates into an epidemic.
Similar forecasts have been presented by the Danish and Swedish governments over the past week, although the predictions appear less gloomy than those in the UK. Furthermore, within the Swedish government coalition, there are now growing calls for greater flexibility for companies, with some arguing companies and staff should recognise the extraordinary situation and consent to reduce working hours and output, although there is no formal government proposal advocating for this yet.
The French government has also launched preparations for the worst-case scenario amid country-wide shortages of face masks and hand sanitizers. Hospitals across the country but especially in Paris have recorded the theft of at least 10,000 masks and 1,200 bottles of hand sanitizer. President Emmanuel Macron said on 3 March that the government would take over the production of masks until 31 May and ensure these are distributed to health workers or people already infected by the virus. Signalling the government’s intent on softening the blow to increasingly health-conscious consumers, finance minister Bruno Le Maire announced on 4 March that price controls on hand sanitizers would be imposed amid reports that the items were being sold at exorbitant prices.
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