As of 26 March 2020, the United States has the most active cases of COVID-19 in world and has surpassed China.

1. YALE ESF-8 SPECIAL REPORT
CORONAVIRUS (COVID-19)
US RESPONSE
AS OF 26 MARCH 2020
2300 HRS EST
US FEDERAL GOVERMENT
• CORONAVIRUS.GOV
• USA.GOV
HHS
COVID-19
CDC
• CDC – COVID-19
NIH
• COVID-19
NIOSH
• NIOSH CORONAVISUS
FEMA
• FEMA
DOD
Coronavirus Response
USAF _ COVID-19
NEWS SOURCES
• New York Times
COVID-19 Coverage
• WASHINGTON POST
• Reuters
• CNN
• Xinhua
ASSOCIATION
• AMERICAN HOSPITAL
ASSOCIATION
• NRHA
SITUATION - GLOBAL
PORTALS, BLOGS, AND RESOURCES
• YALE NEWHAVEN HEALTH – COVID-19
• YALE MEDICINE
• YALE NEWS _COVID 19
• JOHN HOPKINS UNIVERSITY COVID-19 GLOBAL CASES (CSSE)
• COVID-19 SURVEILLANCE DASHBOARD
• CIDRAP
• H5N1
• VIROLOGY DOWN UNDER BLOG
• CONTAGION LIVE
• WORLDOMETER
• 1POINT3ACRES
UNITED STATES
85,428
1,290
GLOBAL
531,860
24,057
GLOBAL
GLOBAL
122,203
Currently, COVID-19 is rapidly spreading worldwide. The
speed with which COVID-19 can cause nationally
incapacitating epidemics once transmission within the
community is established, indicates that in a few weeks or
even days.
BACKGROUND WHO
• WHO –COVID-19
• ECHO
• PAHO
AFRO
• EMRO
• Western Pacific
OCHA
• ReliefWeb
ECDC
• European Centre for
Disease Prevention and
Control
CCDC
• China Center for Disease
Control and Prevention
INTERNATIONAL
CONFIRMED CASES
DEATHS
UNITED STATES
RECOVERED
UNITED STATES
JOUNALS AND ONLINE LIBRARIES
• BMJ
• Cambridge University Press
• Cochrane
• Elsevier
• JAMA Network
• The Lancet 2019-nCoV Resource Centre
• New England Journal of Medicine
• Oxford University Press
• Wiley
CASES IN US
713
SITUATION - US
As of 26 March 2020, the United States
has the most active cases of COVID-19
in world and has surpassed China.

2. WHAT IS COVID-19
Coronavirus disease (COVID-19) is a new strain that was discovered in 2019
and has not been previously identified in humans. Coronaviruses are zoonotic,
meaning they are transmitted between animals and people.
HOW IS IT SPREAD?
People can catch COVID-19 from others who have the virus. The disease
spreads from person to person through small droplets from the nose or mouth
when a person with COVID-19 coughs or exhales. Droplets can land surfaces
around the infected person and other can catch COVID-19 by touching these
objects or surfaces, then touching their eyes, nose or mouth. People can also
catch COVID-19 if they breathe in droplets from the infected person. This is
why it is important to stay more than 3 feet away from a person who is
sick. (WHO)
Time from exposure to onset of symptoms is generally between 2 and 14
days. (CDC)
WHAT ARE THE SYMPTONS?
Common symptoms include fever, cough, and shortness of breath (CDC).
Complications may include pneumonia and acute respiratory distress
syndrome.
PREVENTIVE MEASURES
Recommended preventive measures: hand washing, covering the mouth
when coughing, maintaining distance from other people, and monitoring
and self-isolation for people who suspect they are infected.
NOTE: Anecdotal evidence is rapidly accumulating from sites around the
world that anosmia (lack of smell) and dysgeusia (lack of taste) are significant
symptoms associated with the COVID-19 pandemic. Anosmia, in particular,
has been seen in patients ultimately testing positive for the coronavirus with
no other symptoms.
BACKGROUND
WHERE: WORLDWIDE
WHEN: DECEMBER 2019 - CURRENT
SITUATION PANDEMIC OUTBREAK – COVID-19
BACKGROUND:
At the end of December 2019, Chinese public health authorities reported
several cases of acute respiratory syndrome in Wuhan City, Hubei province,
China. Chinese scientists soon identified a novel coronavirus as the main
causative agent. The disease is now referred to as coronavirus disease 2019
(COVID-19), and the causative virus is called severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2).
It is a new strain of coronavirus that has not been previously identified in
humans.
The initial outbreak in Wuhan spread rapidly, affecting other parts of China.
Cases were soon detected in several other countries. Outbreaks and clusters
of the disease have since been observed in Asia, Europe, Australia, Africa and
the Americas. (ECDC)

3. SITUATION - GLOBAL
GLOBALLY
EUROPE
• WHO has declared COVID-19 a global pandemic
• 196 countries, areas or territories have confirmed cases
• Europe is now the epi-center of the virus
• The ECDC, in its seventh COVID-19 assessment, said that, since Mar
12, all European countries have now reported cases and that 63%
of the global cases have been in Europe. With current testing
capacity and if nations do not enact mitigation strategies, Europe
could see by the middle of April a scenario similar to what China
experienced in Hubei province at the beginning of the outbreak.
• In EU/EEA countries with available data, 30% of diagnosed COVID-
19 cases were hospitalized and 4% had severe illness.
• Hospitalization rates were higher for those aged 60 years and
above. Estimates of crude case-fatality for Germany, Italy and Spain
showed that both the risk and absolute numbers of deaths rapidly
increased with age for those aged 60 years and above in each
country.
• Among hospitalized cases, severe illness was reported in 15% of
cases, and death occurred in 12% of these cases, with higher case–
fatality rates in older adults. (ECDC)
ITALY
• On 26 March Italy reported 6,153 new cases, its second highest
daily total, lifting its overall number to 80,539. Italy also reported
662 more deaths, raising its fatality count to 8,165.
SPAIN
• On 26 March, Spain's daily total was 6,673 cases today, along with
442 more deaths, raising its respective totals to 56,188 and 4,089.
• The Spanish government extended its lockdown until at least Apr
12.
• The United Kingdom reported 2,128 new cases, along with 113
more deaths, putting the country over the 10,000-case mark with
11,658. So far, 578 patients in the UK have died from their
infections.
GERMANY - now has 36,508 cases, 44 of them fatal.
RISK ASSESSMENT
• The risk of severe disease associated with COVID-19 for people in the EU/EEA
and the UK is currently considered moderate for the general population and
very high for older adults and individuals with chronic underlying conditions.
• The risk of occurrence of widespread national community transmission of
COVID-19 in the EU/EEA and the UK in the coming weeks is moderate if
effective mitigation measures are in place and very high if insufficient
mitigation measures are in place.
• The risk of healthcare system capacity being exceeded in the EU/EEA and
the UK in the coming weeks is considered high.

4. SITUATION - GLOBAL
• The African continent is rapidly being engulfed by the global coronavirus disease
(COVID-19) pandemic, with 43 countries reporting confirmed cases and a few
countries beginning to exhibit community transmission.
• This recent trend is concerning as most of the low-income African countries
have several vulnerabilities, including fragile health systems to cope up with
high caseloads, high prevalence of HIV, malnutrition and a rising incidence of
non-communicable and other chronic illnesses. (AFRO)
RUSSIA - Announced that the country would seal all its borders
and cancel all international flights, except for ones bringing
Russians home.
ASIA
CHINA - Announced that foreigners will be barred from
entering the country, except for diplomats and crew of
international airlines and ships. It also reduced the number of
international flights going in and out of China.
Nearly all the country's new COVID-19 cases over the past few
weeks have been imported cases.
AFRICA
SOURCE: NYT

5. DISTRIBUTION OF COVID-19 CASES WORLDWIDE
SOURCE: WHO SITREP #66

6. EPIDEMIC CURVE OF CONFIRMED COVID-19,
(AS OF 26 MARCH 2020)
SOURCE: WHO SITREP #63
ECDC

7. CASE DISTRTIBUTION COVID-19
(AS OF 26 MARCH 2020)
SOURCE: WHO SITREP #63
ECDC

8. SITUATION - US
On 26 March, Governor Bel Edwards in a press conference said that he
expects his state to be out of ventilators by the first week of April and that
the state needed an additional 600 machines
Louisiana Department of Health reports 676 patients are in hospitals, and
239 are on ventilators
• Confirmed cases of the novel coronavirus, COVID-19, reached 82,404
today in the United States, giving it the most cases in the world.
• 26 March was the most active day so far in the country, with 14,042 new
cases reported, and the national death toll reaching 1,069 fatalities.
• Certain hot spots are appearing to produce a hospitalization rate that was
doubling every 2 to 3 days, namely in New York City and in parts of
California.
• Detroit, New Orleans, and Atlanta all reported quickly filling intensive
care units (ICUs)
NEW YORK
As of 26 March New York state reported 39,125 cases, the most of any state in
the country
During his daily briefing, Governor Cuomo said 5,327 people are currently
hospitalized in the state for COVID-19, including 1,290 patients in ICUs.
NY Health officials project that 140,000 people will be hospitalized with the
coronavirus over the next 14 to 21 days.
NEW JERSEY
New Jersey are ported a surge on 26 March, of 2,492 newly confirmed
infections in a 24 hour period, brings the state’s total to 6,876.
LOUISIANA
SOURCE: CIDRAP
SEATTLE TIMES
GOV CUOMO DAILY BRIEF
The state Department of Health announced 627 newly confirmed cases
on 26 MARCH, bringing the state total to 3,207 cases, including 147
deaths. The bulk of Washington’s cases remain in King County, which has
seen 1,577 people fall ill and 109 die.
WASHINGTON

9. SITUATION - US
STATE CASES DEATHS
New York 39,125 454
New Jersey 6,876 81
California 4,019 82
Washington 3,207 150
Michigan 2,844 61
Illinois 2,541 26
Florida 2,484 29
Massachusetts 2,417 25
Louisiana 2,304 83
Pennsylvania 1,795 18
Texas 1,639 22
Georgia 1,505 56
Colorado 1,430 19
Tennessee 1,097 3
Connecticut 1,012 21
Ohio 868 15
North Carolina 744 3
Wisconsin 728 10
Indiana 645 17
Maryland 583 4
Missouri 520 9
Alabama 517 1
Arizona 508 8
Mississippi 485 6
Virginia 468 10
South Carolina 456 9
Nevada 420 10
Utah 396 1
STATE CASES DEATHS
Minnesota 344 2
Arkansas 335 2
Oregon 316 11
District of Columbia 267 3
Oklahoma 248 7
Kentucky 247 5
Iowa 179 1
Kansas 172 3
Rhode Island 165 0
Vermont 158 9
Maine 155 0
Idaho 146 3
New Hampshire 137 1
New Mexico 136 1
Delaware 130 1
Hawaii 106 0
Montana 90 0
Nebraska 74 0
Puerto Rico 64 2
North Dakota 57 0
Alaska 56 1
Wyoming 53 0
West Virginia 52 0
South Dakota 46 1
Guam 45 1
Virgin Islands 17 0
Note: The Grand Princess Cruise Ship had 28 US confirmed cases and the Dimond Princess 49.
SOURCE AS OF 2300 hrs 26 MARH 2020: JOHN HOPKINS UNIVERSITY COVID-19 GLOBAL CASES (CSSE)

10. CASES IN THE US
SOURCE:JOHN HOPKINS UNIVERSITY COVID-19 GLOBAL CASES (CSSE)
SOURCE: NYT
• The number of known cases of the coronavirus in the United
States continues to surge.
• US has more known cases of coronavirus than any other
country
SOURCE: NYT

11. US RESPONSE
FEMA
• All 50 states, the District of Columbia, 5 territories, and 5 tribal
nations are working directly with FEMA under the nationwide
emergency declaration for COVID-19
• Using new acquisitions, the Strategic National Stockpile, and
Department of Defense allocations, FEMA is leading the
coordinated Federal agency efforts increasing hospital capacity,
community-based testing sites (CBTS), and significant deployment
of personal protective equipment and medical equipment.
• NRCC: Level I in unified effort with HHS SOC
• All RRCCs activated
• President Donald J. Trump Approves Major Disaster Declaration for Maryland
(English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for Illinois
(English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for New
Jersey (English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for North
Carolina (English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for Florida
(English) (Spanish)
• President Donald J. Trump Approve Major Disaster Declaration for Texas
(English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for Louisiana
(English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for Iowa
(English) (Spanish)
• President Donald J. Trump Directs FEMA Support Under Emergency
Declaration for COVID-19 (English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for
New York (English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for
Washington (English) (Spanish)
• President Donald J. Trump Approves Major Disaster Declaration for
California (English) (Spanish)
DECLARATIONS

12. US RESPONSE
HHS
• Department of Health and Human Services designated certain health and
medical resources needed to respond to the spread of COVID-19 subject to
hoarding restrictions under the Defense Production Act and a March
23 executive order. The designation includes N95 and certain other
respirators, ventilators, personal protective equipment, drug products,
medical device sterilization services and disinfecting devices.
• HHS Secretary Alex Azar yesterday asked the nation’s governors to immediately
allow health professionals licensed or certified in other states to practice in
their state in person or through telemedicine. In addition, he asked states to:
o Waive certain statutory and regulatory standards “not necessary for the
applicable standards of care to establish a patient-provider relationship,
diagnose, and deliver treatment recommendations” using telehealth
technologies
o Relax scope of practice requirements for health professionals, including
allowing them to practice in all care settings;
o Allow physicians to supervise a greater number of other health care
professionals and to do so using remote or telephonic means;
o Allow for rapid certification/licensure and recertification/relicensure of certain
health care professionals
o Develop a list of their state liability protections for in-state and out-of-state
health professionals during this national emergency and modify, rescind or
waive any medical malpractice policies that may prevent coverage of health
professionals responding to the COVID-19 emergency in another state;
o Modify laws or regulations as appropriate to allow medical students to triage,
diagnose and treat patients under the supervision of licensed medical staff; and
o Allow pharmaceutical deliveries without signature to prevent delivery person
contact with recipients.
SOURCE: CDC

13. US RESPONSE
ARNORTH
• At the direction of U.S Northern Command, U.S. Army North
requested the deployment of units to provide defense support of
civil authorities in response to the COVID-19 national emergency.
• Active Duty units supporting this mission include:
o Joint Task Force-Civil Support Headquarters, Joint Base
Langley-Eustis, Va.
o 3rd Expeditionary Sustainment Command, Ft. Bragg, NC
o 4th Sustainment Brigade, 4th Infantry Division, Fort
Carson, CO
o 63rd Expeditionary Signal Battalion, Fort Stewart, GA
SOURCE: DOD
The following US Army Hospital Centers a deploying:
• 531st Hospital Center - Fort Campbell, Kentucky to
support New York
• 9th Hospital Center - Fort Hood, Texas to New York
• 627th Hospital Center - Fort Carson, Colorado to
Washington State
The advance party is on the ground .The main body will arrive at Joint
Base McGuire Dix Lakehurst, 27 MARCH. They will set up at the Javits
Center in New York this weekend, and they will be operational for
non-COVID-19 patients beginning March 30. (DOD)
1st MED Brigade headquarters has been assigned to support the Joint
Task Force – Civil Support’s COVID-19 response efforts, and will be
leading medical planning operations from Fort Hood.
SOURCE: WHITE HOUSE DAILEY BRIEF – 26 MARCH 2020
USNS MERCY
• The USNS Mercy, a 1000 bed ship, will deploy to the port of Los Angeles this
week and will serve as a referral hospital for non-COVID-19 patients currently
admitted to shore-based hospitals, and will provide a full spectrum of medical
care to include critical and urgent care for adults.
• The ship sailed from Naval Station San Diego on March 23 for Los Angeles .
Over 800 Navy medical personnel and support staff, and more than 70 civil
service mariners are on board. The ship will arrive is Los Angeles on Friday,
27 March..
USNS COMFORT
• U.S.N.S. Comfort will disembark on Saturday, 28 MARCH, from Norfolk, Va.,
and arrive at Manhattan’s Pier 90 on Monday, 30 March and will serve as a
referral hospital for non-COVID-19 patients currently admitted to shore-
based hospitals, and will provide a full spectrum of medical care to include
critical and urgent care for adults.

14. US RESPONSE
• The US Army Corps of Engineers (USACE) and the US Department of Health
and Human Services (HHS) developed Guidance materials to support
States and municipalities in assessing and prioritizing potential facilities,
and to rapidly engage contractors to convert and prepare the sites for
medical use.
• USACE is working with 18 state governments to provide planning and
concept development and increase bed space by converting dorms, hotels,
and other buildings into temporary medical facilities in 3 to 4 weeks
• Javits Center in New York city will be the first alternate care facility to be
created. Work began on 23 March to create the 1,000 bed facility and
should be completed in 10 days.
• Three other location in in NY will also be converted:
o SUNY Stony Brook
o SUNY Old Westbury
o Westchester Convention Center
ARMY CORPS OF ENGINEERS (USACE)
SOURCE:USACE NY District
Birdseye view of the Alternate Care Facility at Jacob Javits Convention Center.
USACE
SOURCE: USACE
SOURCE: USACE

15. US RESPONSE
NATIONAL GUARD
• Over 11,400 National Guard are currently mobilized to assist states in
their efforts to combat the virus.
• The President has approved mobilizing troops under title 32 for
Washington, California and New York. The troops will remain of under
the command and control of the governors in these perspective states.
• Current National Guard COVID-19 response missions include, but are
not limited to:
o Delivering food in hard-hit communities
o Manning call centers to be a knowledgeable and calming voice
o Providing critical Personal Protective Equipment training
and sample collection to first responders and hospital
personnel
o Supporting local emergency management agencies with
response planning and execution
o Providing support to testing facilities
o Serving as response liaisons and support to state Emergency
Operations Centers
o Proving transportation and assessment support to
healthcare providers
o Assisting with disinfecting/cleaning of common public
spaces
DUAL STATUS COMMANDERS
Dual-status commanders have been appointed in eight states, with 10 more
awaiting approval, as the National Guard continues to support COVID-19 response
efforts throughout the country.
The states where dual-status commanders have been appointed are California,
Colorado, Massachusetts, Maryland, New York, Oklahoma, South Carolina and
Washington.
NOTE: A dual-status commander is typically appointed in large, complex stateside
missions or response efforts involving both Guard members in state, or Title 32,
status and other service members in federal, or Title 10 status.
Army Spc. Reagan Long, left, a horizontal construction engineer with the New York Army
National Guard’s 827th Engineer Company, and Army Pfc. Naomi Velez, a horizontal
construction engineer with the New York Army Guard’s 152nd Engineer Support Company,
register people at a COVID-19 mobile screening center in New Rochelle, New York(U.S.
Army photo by Sgt. Amouris Coss)
Governors across all 50 states, Puerto Rico, Guam, the U.S. Virgin Islands
and Washington D.C. have each mobilized components of their Army and
Air National Guard to assist in their state’s response to the COVID-19
pandemic.