COVID-19 continues to raise concerns for organizations around the globe. In response to the recent outbreaks in Italy, Iran, and South Korea, and as part of our commitment to keeping you informed, we asked our health and regional analysts to provide insights on these three distinct outbreaks.

Navigate to country-specific insights: Italy | South Korea | Iran

 

Coronavirus by the Numbers 

 

Can you provide an update on the latest COVID-19 developments from the past week?

Zulfah Albertyn-Blanchard, Health Intelligence Analyst:
As of Feb. 28, 2020, there have been 83,310 cases confirmed globally. These cases are laboratory confirmed. There have been nearly 2,900 deaths, which is likely an under-reporting due to the death certificate notification process in China. There have been cases reported across all regions of the globe (50 countries and territories) with China most affected, followed by the EU. The daily reported confirmed cases have declined since Feb. 14.

 

Italy Becomes First European Country with COVID-19 Outbreak

 

This is Europe’s first significant COVID-19 outbreak. About a month ago, the first COVID-19 cases in Italy involved Chinese tourists who traveled to Rome. Since then, additional cases manifested. What can you tell us about the recent spike in confirmed cases?

Zulfah Albertyn-Blanchard, Health Intelligence Analyst:

Confirmed Coronavirus Cases in Italy by Province

As of Feb. 27, Italy has reported 650 cases of COVID-19, the second-largest reported number of cases outside of China. Most cases have been reported in the Lombardy, Veneto, and Emilia-Romagna regions, with eight other regions also reporting at least one confirmed case. Of these cases, 284 are recovering at home in isolation, 248 are hospitalized, 56 are in ICU, and 45 individuals have recovered. The Italian government has issued ordinances at the national and regional levels to assist in the management of the outbreak; this includes the closure of any educational facilities in areas that have at least one confirmed case as well study abroad programs. Four US universities have closed their study abroad programs to Italy until further notice.

There’s been some intergovernmental tension between national and regional governmental bodies with respect to how the outbreak was mishandled at the beginning.

 

We’ve seen some organizations canceling events due to the outbreak. How is the Italian government responding to the outbreak?

Ben Plane, Regional Analyst, EUROPE:
As you would expect, the Italian government is taking the outbreak extremely seriously; 11 of the worst-affected towns in the Lombardy and Veneto regions have been quarantined with complete bans on entry and exit and the suspension of non-essential public services until March 8 at least.

Across parts of northern Italy, more broadly, a number of regional authorities are closing public spaces and educational facilities, though currently, all major transport infrastructure remains in operation - and as you mentioned, multiple events have been canceled or amended as a result. This has included authorities in Venice electing to end the Carnival two days early as well as various football matches being postponed or played with no fans in attendance in order to limit large gatherings of people where the virus may spread more easily.

 

Are there signs that the self-isolation may elevate to a more official quarantine process?

Ben Plane, Regional Analyst, EUROPE
Self-isolation is hard to govern, but national health authorities in countries with few confirmed cases maintain it as the most effective way to prevent the virus from spreading. However, if outbreaks were to reach a critical level in those countries, then it is possible that governments would move to more formal quarantine processes such as those we’ve seen in Italy. This would be decided at a national level, and health ministers in France, Germany, and Greece have suggested they would consider strict quarantine measures if required in the future.

 

Are governments that border Italy taking any precautionary measures?

Ben Plane, Regional Analyst, EUROPE
Travelers arriving in neighboring countries from northern Italy may be subject to additional health screening measures, such as temperature scans, to check for possible symptoms. Individuals may then be asked to self-isolate based on these results or what parts of Italy they have visited; self-isolation is being requested for anyone who has arrived from one of the eleven quarantined towns for instance, and temporary quarantines have been placed on buildings with suspected or confirmed coronavirus cases, such as a hotel in Austria.

Additionally, the Austrian government did briefly halt rail traffic from Italy on Feb. 23 to test two individuals for suspected coronavirus. In this case, the results were negative, and the train was allowed to continue its journey; however, similar measures could be enacted by any government neighboring Italy leading to short-term disruptions. While many neighboring governments have canceled school trips to Italy and some are encouraging citizens to postpone travel to the affected area, they have not so far issued official advice to avoid traveling to the country.

Despite these measures, health officials are expecting further infections in Europe, and governments are mobilizing resources in anticipation of this. France, for example, is preparing certain hospitals to accept and effectively treat patients with coronavirus, and multiple countries are canceling public events and ordering protective equipment for health workers.

 

Are there any travel restrictions in place?

Ben Plane, Regional Analyst, EUROPE
No travel restrictions to Italy have currently been enacted by European governments, and officials have stated they are committed to keeping borders with Italy and other countries in the Schengen Area open as they do not believe it would be an effective measure in combating the spread of the disease. However, each individual country in the Schengen Area, which is a group of European countries that have agreed to eliminate controls on mutual borders, has the right to impose temporary restrictions on their borders. Depending on how the situation develops, future restrictions cannot be ruled out. In the meantime, we are likely to see further temporary and ad hoc measures in response to specific concerns such as the Austria example I gave a moment ago, leading to sporadic disruptions mainly impacting travel from Italy.

 

The 2020 UEFA European Football Championship is scheduled to take place from June 12-July 12. Have there been any announcements about how COVID-19 response initiatives might impact the tournament?

Ben Plane, Regional Analyst, EUROPE
There are definitely some concerns that the tournament may be impacted, and organizers have confirmed they are monitoring the situation; however, as it isn’t scheduled to begin until June, it is too early to predict any final decisions on amending the competition. It is useful to note that there are many club-level football matches scheduled across the continent before the Euros, and the organizers will be able to assess the effectiveness of various actions likely to be carried out by regional football associations and national governments in response to coronavirus when making a decision about the Euro 2020.

 

Spike in Confirmed Coronavirus Cases in South Korea 

 

The spike in confirmed COVID-19 cases in South Korea positions the country as the second-highest confirmed cases next to China. What’s the history with confirmed COVID-19 cases in South Korea?

Confirmed Coronavirus Cases by Province in South Korea

Zulfah Albertyn-Blanchard, Health Intelligence Analyst:
There have been more than 2,000 cases confirmed in South Korea as of Feb. 28 of which 26 are in isolation and 13 have been deceased. This is the largest number of reported cases outside of China, to date. Seventeen provinces have reported at least one confirmed case with Daegu Province being most affected reporting 1,314 confirmed cases. The first confirmed case was reported on Jan. 19 in Seoul when a 35-year-old Chinese woman with a travel history to Wuhan, Hubei suffered from a fever and respiratory problems. Since the first case was reported, there was slow increase in imported confirmed cases across the country until Feb. 21 when 100 cases were reported in one day to Feb. 27 when 505 cases were reported. This rapid increase in case count is likely due to South Korea’s improved surveillance and reporting methods for COVID-19 since it is now able to do batch testing; as of Feb. 27 health officials have tested 70,940 cases of which 2,022 are confirmed, 44,167 are negative, and 24,751 are still under investigation. Health officials continue to investigate the rumors that an individual from the Shincheonji Church of Jesus had infected churchgoers with COVID-19 causing mass hysteria. This resulted in the quarantine of more than 9,000 Shincheonji followers who are currently being tested for COVID-19. 

 

What restrictions has South Korea’s government implemented as a result of the COVID-19 outbreak, and has that changed since the latest spike in confirmed cases?

Lee Ridley, Intelligence Manager, APAC
The government has introduced more measures since cases began to spike, and health officials increased the alert level for COVID-19 to red – the highest level – on Feb. 21. They declared Daegu and Cheongdo County, just south of Daegu, as special care zones. A special care zone allows officials to dedicate resources to find and isolate potential cases. Local officials in the affected areas have banned mass gatherings and encouraged residents to remain at home. Officials in Seoul have also banned rallies at popular gathering spots and closed public welfare offices in the capital. Authorities have also moved to shut down locations of the Shincheonji Church of Jesus – the source of the largest cluster in Daegu. The government has also ordered the closure of childcare centers across the country for 10 days, though many were already closed. The Catholic Church in the country also announced it would suspend masses to help prevent the spread of the disease.

Prior to the spike in Daegu and Cheongdo County, South Korea only had a few dozen confirmed cases, so the government was largely reactive to prevent the disease from making further in-roads in the country. They had increased health screenings for passengers from mainland China, and later Hong Kong and Macau. They also banned passengers from China’s Hubei Province and halted visa-free travel to Jeju, a popular holiday destination. Officials also banned cruise ships from docking at ports in the country.

 

Was the move to ban cruise ships made after the COVID-19 outbreak aboard the Diamond Prince cruise ship (Japan)?

Lee Ridley, Intelligence Manager, APAC
Yes, after the discovery of the Diamond Princess cases, several countries in the region moved to ban cruise ships from docking. The decision in South Korea was also prompted by the MS Westerdam, which was also scheduled to dock in Japan but was turned away. It eventually docked in Cambodia, and passengers were able to disembark.

 

Are there any unique travel restrictions in and out of South Korea that organizations need to be aware of?

Lee Ridley, Intelligence Manager, APAC
South Korean officials still have not significantly limited travel into the country, particularly when compared to other countries with close transport links with China. However, that could change in the coming days. The more disruptive development is that countries in Asia and other parts of the world have started to prevent foreign nationals from entering their country if they have transited or traveled in South Korea within 14 days of arrival. This is the situation in Hong Kong, as well as several Pacific and Middle Eastern countries.

Some other countries have only imposed travel bans on passengers who have traveled to Daegu and Cheongdo County, the most affected areas of the country.

Taiwan and Macau, as well as Thailand, the UK, and other countries are requiring health inspections and self-quarantine measures for travelers who were in or transited South Korea within 14 days of arrival. Reports indicate that some provincial authorities in mainland China have also enforced quarantines for passengers without prior notification.

The Philippines has also banned most of its citizens from traveling to South Korea, though with exceptions.

All these measures are likely to force managers to reconsider travel policy and travel providers to reroute personnel, particularly as Incheon Airport is a major airline hub in Northeast Asia. Many companies are already restricting travel to Daegu and Cheongdo, and in many cases, to South Korea. Travel restrictions are likely to become more widespread if cases begin to increase significantly in other cities in the country.

 

Iran Struggles to Respond to Latest Outbreak 

 

Another country with an increase in reported cases is Iran. Do we know any information about the recent confirmed cases here?

The majority of confirmed Coronavirus cases in Iran have been reported in Qom.

Zulfah Albertyn-Blanchard, Health Intelligence Analyst:
The first reported cases were from Qom on Feb. 19; however, both cases were deceased. In just over a week, 243 cases were confirmed in Iran with, the majority of cases reported in Gilan, Qom. However, this case count is likely an underestimation due to poor health infrastructure across the 31 provinces resulting in inadequate surveillance, testing, and reporting of COVID-19. The country only received testing kits on Feb. 25, just a week following the first confirmed cases, due to availability issues. The ongoing conflict in Iran has made it quite difficult for health care facilities to provide adequate and effective treatment for COVID-19 confirmed cases in addition to other health issues impacting Iranians daily.

 

What effect does the COVID-19 outbreak have on travel in and out of Iran? Are there any restrictions organizations need to be aware of?

Dalilah Dawood, Regional Analyst, MENA
Several countries have imposed travel restrictions on Iran. Countries that share a land border with Iran – Afghanistan, Armenia, Iraq, Pakistan, and Turkey – have suspended both air and ground travel. Other countries in the wider region such as Kuwait, Oman, the United Arab Emirates (UAE), Qatar, Jordan, and Saudi Arabia have introduced more restrictions, including halting flights to and from Iran and banning travelers who have recently been in the country.

More countries are likely to follow suit as the death toll in Iran rises and spreads to more cities. If travel restrictions extend for a long period, Iran could face further economic difficulties as it would be unable to export non-oil products to other countries. For example, Iran sought to expand its non-oil exports to offset the US sanctions on its oil sector, but the COVID-19 outbreak is likely to affect this. Iran’s main trading partners, Iraq, Turkey, and Afghanistan, have shut the border, disrupting supply chains.

 

Aside from travel restrictions and advisories, are there any other measures the Iranian government is taking to manage the spread of COVID-19?

Dalilah Dawood, Regional Analyst, MENA
The Iranian government is under extreme pressure to handle the situation. In response to the outbreak, authorities have shut down schools, universities, and educational institutions in several provinces, canceled concerts and large public gatherings, and distributed masks. They have also stepped up efforts to disinfect public transportation and sites more frequently. Most recently, authorities canceled Friday prayers in affected provinces and advised people to avoid religious gatherings.

The Iranian government insists that it has the situation under control, but the figures prove otherwise. Iran currently has the highest fatality rate outside mainland China; as of Feb. 27, official sources report that at least 26 people have died although a lawmaker from Qom suggests that the figure could be as high as 50.

The fatality rate of 16 percent in Iran is also much higher than China’s 2 percent. This is likely due to the lack of preparedness of the government and medical facilities in dealing with the spread. Unlike East Asian countries such as Singapore, which experienced the SARS outbreak in 2003, and South Korea, which had MERS in 2015, Iran has not experienced an infectious disease outbreak of this scale. Iran has also refused to impose quarantines, unlike in Italy, saying they are ineffective.

Authorities may increase screenings of pilgrims ahead of Imam Ali’s birthday on March 7. Millions of Iranians visit the shrine of Imam Ali in Mashhad annually during the occasion, but numbers are likely to be lower this year. So far, no cases have been confirmed in Mashhad, but five of Kuwait’s confirmed cases had traveled to the city. 

 

How likely is it that Iran will be able to contain the virus?

Dalilah Dawood, Regional Analyst, MENA
It will be hard for Iran to contain the virus at this point as it has spread to many cities. A team from the World Health Organization (WHO) has recently arrived in Iran to assist authorities in handling the situation.

The COVID-19 outbreak is likely to isolate Iran further from the rest of the world. Iran’s health services have already been impacted by US sanctions and the virus will further strain medical staff. The Iranian government will face many challenges in controlling the outbreak and subsequently addressing its effects on the economy. 
 

Precautions

 

What should people do if they suspect they may have been in contact with someone who has contracted COVID-19?

Zulfah Albertyn-Blanchard, Health Intelligence Analyst:
If you have been in contact with someone that has COVID-19 and start to feel unwell with mild symptoms such as a headache or a runny nose, it is recommended to stay home until you recover. This is so that you can avoid being in contact with others, thus limiting the likelihood of spreading the virus as well as allowing medical facilities to run more effectively by treating individuals that have developed serious complications from the disease such as pneumonia or other serious medical conditions which is determined by the facility through their triage system. However, if you do develop a fever, cough, and difficulty breathing, it is recommended that you seek medical attention immediately. Call your healthcare provider in advance, preferably en-route, so that your provider can direct you to the right health facility based on where you’re located and limit the spread of COVID-19.

 


 

For more information about COVID-19 and SARS-CoV-2, and to access intelligence alerts, travel restrictions, airline route suspensions, the latest confirmed virus counts by country, and more, visit the Coronavirus Intelligence Hub.

 


 

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