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2 0 2 0 V o l u m e 4 4https://doi.org/10.33321/cdi.2020.44.29
COVID-19, Australia: Epidemiology Report 9: Reporting week ending 23:59 AEDT 29 March 2020COVID-19 National Incident Room Surveillance Team
Communicable Diseases Intelligence ISSN: 2209-6051 Online
This journal is indexed by Index Medicus and Medline.
Creative Commons Licence - Attribution-NonCommercial-NoDerivatives CC BY-NC-ND
© 2020 Commonwealth of Australia as represented by the Department of Health
This publication is licensed under a Creative Commons Attribution- Non-Commercial NoDerivatives 4.0 International Licence from https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode (Licence). You must read and understand the Licence before using any material from this publication.
Restrictions The Licence does not cover, and there is no permission given for, use of any of the following material found in this publication (if any):
• the Commonwealth Coat of Arms (by way of information, the terms under which the Coat of Arms may be used can be found at www.itsanhonour.gov.au);
• any logos (including the Department of Health’s logo) and trademarks;
• any photographs and images;
• any signatures; and
• any material belonging to third parties.
Disclaimer Opinions expressed in Communicable Diseases Intelligence are those of the authors and not necessarily those of the Australian Government Department of Health or the Communicable Diseases Network Australia. Data may be subject to revision.
Enquiries Enquiries regarding any other use of this publication should be addressed to the Communication Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to: [email protected]
Communicable Diseases Network Australia Communicable Diseases Intelligence contributes to the work of the Communicable Diseases Network Australia. http://www.health.gov.au/cdna
Communicable Diseases Intelligence (CDI) is a peer-reviewed scientific journal published by the Office of Health Protection, Department of Health. The journal aims to disseminate information on the epidemiology, surveillance, prevention and control of communicable diseases of relevance to Australia.
Editor Tanja Farmer
Deputy Editor Simon Petrie
Design and Production Kasra Yousefi
Editorial Advisory Board David Durrheim, Mark Ferson, John Kaldor, Martyn Kirk and Linda Selvey
Website http://www.health.gov.au/cdi
Contacts Communicable Diseases Intelligence is produced by: Health Protection Policy Branch Office of Health Protection Australian Government Department of Health GPO Box 9848, (MDP 6) CANBERRA ACT 2601
Email: [email protected]
Submit an Article You are invited to submit your next communicable disease related article to the Communicable Diseases Intelligence (CDI) for consideration. More information regarding CDI can be found at: http://health.gov.au/cdi.
Further enquiries should be directed to: [email protected].
1 of 24 health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Weekly epidemiological report
COVID-19, Australia: Epidemiology Report 9:Reporting week ending 23:59 AEDT 29 March 2020
COVID-19 National Incident Room Surveillance Team
An error occurred in the legend for Figure 8 (Confirmed cases of overseas acquired COVID-19 infection (n = 2,352) by Standard Australian
Classification of Countries) as originally published, which inadvertently omitted the key depicting the confirmed cases from Sub-Saharan Africa.
This has now been amended.
Summary
This is the ninth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 29 March 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.
Keywords: SARS-CoV-2; novel coronavirus; 2019-nCoV; coronavirus disease 2019; COVID-19; acute respiratory disease; case definition; epidemiology; Australia
The following epidemiological data are subject to change both domestically and internationally due to the rapidly evolving situation. Australian cases are still under active investigation. While every effort has been made to standardise the investigation of cases nationally, there may be some differences between jurisdictions. For further information relating to the data incorporated in this series of reports, please refer to the Frequently Asked Questions addressed within the appendix to this report.
Australian situation
As at 23:59 AEDT 29 March 2020, there were 4,159 confirmed cases, including 15 deaths in Australia, reported to the National Notifiable Diseases Surveillance System (NNDSS)i (Table 1, Figure 1). Of the 4,159 confirmed cases, 48% were reported in NSW, 18% from Qld, 16% from Vic, 8% from WA, 7% from SA, 2% from ACT, 1% from Tas, and 0.3% from NT (Figures 2, 3). The rate of cases in Australia per 100,000 population was 16.4; in comparison, the rate per 100,000 population was 7.0 in the previous reporting period. Most cases are reported to
i Data were extracted on 30 March 2020 with data reported
to 29 March 2020. Due to the dynamic nature of the NNDSS,
data in this extract are subject to retrospective revision and
may vary from data published in previous reports and reports
of notification data by states and territories.
reside within major metropolitan areas, with a small number of cases reported outside these areas (Figures 2, 3).
During the current reporting week, 2,355 cases were reported; this is a 136% increase from cases reported during the previous reporting period. The median time between onset of symptoms and laboratory testing was two days (range 0–32 days).
The median age of notified cases in Australia was 48 years (range 0–98 years), with the largest number of cases in the 20–29 years age group (Figure 4). The highest rate of disease was among those in the 60–69 years age group (Figure 4). Notifications by gender were approximately equal, although there was some variation across age groups.
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In Australia:
• There have been 4,159 confirmed cases, including 15 deaths, reported in Australia up to23:59 AEDT 29 March 2020. Of confirmed cases, the highest proportion of cases have beenfrom New South Wales (48%), followed by Queensland (18%) and Victoria (16%);
• Forty-two percent of the total number of cases reported so far have been during the currentreporting week;
• Hospitalisation status was recorded for 2,129 cases, of which 19% were reported to have beenhospitalised due to their COVID-19 infection. Of these hospitalised cases, ICU (IntensiveCare Unit) status was recorded for 176 cases, of which 22% (n = 38) were admitted to anICU, with five cases requiring ventilation; and
• The rate of increase in cases has lowered over the reporting week. Whilst the effects of borderand recently-introduced social distancing measures are likely having an effect, it is too soonto tell whether this trend will be sustained.
Internationally:
• A total of 634,813 cases have been reported globally across 189 countries, territories andregions;
• The USA has overtaken Italy as the country with most reported cases (n = 103,321), however,the European Region continues to be the most heavily affected, with Italy, Spain and Ger-many accounting for 60% (n = 217,267) of all cases in the region; and
• A total of 29,891 deaths have been reported globally with over 70% (n = 21,427) reported inthe European Region.
Of the symptoms reported, cough (70%) was the most common. Forty-nine percent reported headache, 47% reported fever, 45% reported sore throat, and 34% reported runny nose (Figure 5). Only 2% or fewer of all cases reported either pneumonia or acute respiratory disease (ARD). An analysis of symptom combinations high-lights that cough is the predominant clinical presentation in combination with fever and/or sore throat (Figure 6).
Hospitalisation status was recorded for 2,129 cases, of which 18.9% (n = 402) were reported to have been hospitalised due to their COVID-19 infection. The median age of hospitalised cases was 58 years (range 0–98 years), with the high-est proportion of cases in the 60–69 years age
group. The most commonly reported comorbid condition among hospitalised cases was diabetes (6.2%), followed by cardiac disease (6.0%). Of these hospitalised cases, ICU (Intensive Care Unit) status was recorded for 176 cases of which 22% (n = 38) were recorded being admitted to an ICU, with five cases requiring ventilation.
Fifteen COVID-19 deaths were confirmed in Australia up to 29 March 2020. The median age was 81 years (range 67–94 years). Four of these deaths were in an aged care facility, four were associated with cruise ships and the other seven cases were acquired in the community. Seven of the cases were male and eight were female. The period between the date of illness onset and death ranged from 0 to 12 days. Of the 15
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confirmed deaths, three reported having comor-bidities, including diabetes, chronic respiratory conditions and stroke.
Of cases with a reported place of acquisition (2,964 of 4,159), 79% (n = 2,352) had a recent international travel history and 21% (n = 612) were considered to have been locally acquired (Figure 7). The majority of overseas-acquired cases (Figure 8) reported a travel history to the European Region, the Americas Region or on board cruise ships. Of the locally-acquired cases, the majority were considered to be contacts of a confirmed case, with a very small number of cases not able to be epidemiologically linked to a confirmed case. For the remainder of cases where a place of acquisition has not been reported, these cases are currently under public health investigation. The distribution of the source of infection for cases varied by jurisdiction.
Of the 4,159 confirmed cases, 27 cases (0.6%) were reported in Aboriginal and Torres Strait Islander persons. These 27 cases have been reported across several jurisdictions with the majority of cases reported in areas classified as ‘major cities of Australia’ based on the case’s usual place of residence. Completeness of the Indigenous status field was approximately 73%, with 11% of cases with a reported value of unknown.
Cluster and outbreak investigations
Investigations are taking place in states and ter-ritories in relation to a number of clusters and outbreaks of COVID-19. To date the largest out-breaks have been associated with cruise ships.
Closed environments, close contact between travellers from various countries, and crew transfers between voyages make cruise ships a unique environment for rapid disease transmis-sion.1 Cruise ships account for a substantial proportion of COVID-19 cases in Australia. Of cases with a reported place of acquisition, 23% (n = 670) were considered to have acquired their infection at sea.
During the period 7 to 23 February 2020, the largest outbreak of COVID-19 cases outside of mainland China occurred on the Diamond Princess cruise ship. Of the 3,711 passengers and crew, 712 (19.2%) were confirmed as having COVID-19 including 56 residents of Australia.
Between 7 and 29 March 2020, at least 17 cruise ships have docked in Australia and 9 have con-firmed cases of COVID-19.ii This includes the Ruby Princess which docked on 19 March 2020 and at the time of reporting was associated with 215 cases.
ii Data obtained on 1 April 2020.
Clusters:
• The term ‘cluster’ in relation to COVID-19 refers to two or more cases that are epidemiologi-cally related in time, place or person where a common source (such as an event or within a community) of infection is suspected but not yet established.
Outbreaks:
• The term ‘outbreak’ in relation to COVID-19 refers to two or more cases among a specific group of people and/or over a specific period of time where illness is associated with a com-mon source (such as an event or within a community).
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International situation
As at 23:59 AEDT 29 March 2020, the number of confirmed COVID-19 cases reported to the World Health Organization (WHO) was 634,813 globally.2 57% (n = 361,031) of all reported cases are from the European Region, 19% (n = 120,792) are from the Region of the Americas, and 16% (n = 102,788) are from the Western Pacific Region. The most affected countries with the highest number of reported cases across these regions are respectively Italy (n = 92,672), the United States of America (n = 103,321) and China, including special administrative regions (n = 82,341).
The number of new cases reported globally has continued to increase. As of the last reporting week, 15 countries, territories and areas reported cases of COVID-19 for the first time, bringing the total to 189 countries, territories and areas globally. The USA has now overtaken Italy as the country with most reported cases; however, the European Region continues to be the most heavily affected, with Italy, Spain and Germany accounting for 60% (n = 217,267) of all cases in the region. Of all the countries, territories and areas with known transmission classification (n = 189), 79% (n = 149) have reported local trans-mission of COVID-19.
The reported epidemiology varies by country with the trajectory of different countries’ out-breaks after their first 100 cases showing vari-ation. Figure 9 highlights that for a number of countries outside of mainland China which have reported more than 100 cases, their rates of increase continue to be high, particularly USA, Italy and Spain. For several other countries or regions including Singapore, Japan and Hong Kong there continues to be a slow rate of increase in their number of new cases, with the Republic of Korea reporting very few new cases each day. Reported case numbers will be influenced by rates of testing, case definition, and case detec-tion as well as overall health system capacity.
Border measures such as travel bans and man-datory 14-day quarantine for all return travel-lers have been put in place to reduce the risk of imported cases into Australia.
Globally, 29,891 deaths have been reported. Over 70% of deaths (n = 21,427) have been reported in the European Region, followed by 12% (n = 3,626) in the Western Pacific Region, and 9% (n = 2,668) in the Eastern Mediterranean Region. Italy, Spain, France and the United Kingdom have reported over 1,000 deaths in each respec-tive country, contributing to a combined total of 89% (n = 19,043) of deaths reported in the region. In the Western Pacific Region, 91% (n = 3,306) of all deaths are reported from China. Iran accounts for 94% (n = 2,517) of all deaths in the Eastern Mediterranean Region. The global proportion of cases that are reported to have died is 4.7%. This proportion is likely to be an overestimate due to variable levels of under-ascertainment of cases, especially those with mild infections. For several other countries or regions including the Republic of Korea, there continues to be a slow increase in their number of deaths, with few new deaths reported in the Republic of Korea each day (Figure 10).
Epidemiological features of COVID-19
The current estimates on epidemiological param-eters including severity, transmissibility and incubation period are uncertain. Estimates are likely to change as more information becomes available.
Transmission
Human-to-human transmission of SARS-CoV-2 is via droplets and fomites from an infected person to a close contact.3 COVID-19 can often present as a common cold-like illness, including in stools.4 A virological analysis of nine hospital-ised cases found active virus replication in upper respiratory tract tissues, with pharyngeal virus shedding during the first week of symptoms.4 However, current evidence does not support airborne or faecal-oral spread as major factors in transmission.3
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A study in China showed household contacts and those who travelled with a confirmed COVID-19 case was associated with an increased risk of infection.5 The study also examined the average time from symptom onset to disease confirma-tion among cases who were identified through contact-based surveillance (i.e. monitoring and testing of close contacts of confirmed COVID-19 cases) and symptom-based surveillance (i.e. symptomatic screening at airports, community fever monitoring and testing of hospital patients). Cases identified through contact-based surveil-lance were associated with a 2.3 day decrease from symptom onset to disease confirmation and a 1.9 day decrease from symptom onset to isolation, compared to cases found by symptom-based surveillance. Modelling studies suggest that undocumented infections are the source for over three-quarters of documented cases and effective contact tracing increases the probabil-ity of control.5,6
Incubation period
Estimates of median incubation period, based on seven published studies, are 5 to 6 days (ranging from 0 to 14 days).7 Patients with long incubation periods do occasionally occur, how-ever they are likely to be ‘outliers’ who should be studied further but are unlikely to represent a change in epidemiology of the virus.7
Molecular epidemiology
Since December 2019, the virus has diversified into multiple lineages as it has spread globally with some degree of geographical clustering. The whole genome sequences currently available from Australian cases are mostly in returned travellers from China, the Islamic Republic of Iran, Europe and the USA, and thereby reflect this global diversity. Recent work describes an emerging clade linked to the epidemic in the Islamic Republic of Iran.8
Clinical features
A recently published meta-analysis supports previous research that COVID-19 presents as
mild illness in the majority of cases with fever and cough being the most commonly reported symptoms. Severe or fatal outcomes tend to occur in the elderly or those with comorbid conditions.3,9
Some COVID-19 patients show neurological signs such as headache, nausea and vomiting. There is evidence that SARS-CoV-2 viruses are not always confined to the respiratory tract and may invade the central nervous system inducing neurological symptoms.10 As such, it is possible that invasion of the central nervous system is partially responsible for the acute respiratory failure of COVID-19 patients.10
Examination of cases and their close contacts in China found a positive association between age and time from symptom onset to recovery. Median time to recovery was estimated to be 27 days in 20–29 year olds, 32 days in 50–59 year olds, and 36 days in those aged over 70 years. The study also found an association between clinical severity and time from symptom onset to time to recovery. Compared to people with mild disease, those with moderate and severe disease were associated with a 19% and 58% increase in time to recovery, respectively.5
A retrospective cohort study looking at risk fac-tors for mortality among patients with COVID-19 who have experienced a definite outcome found an increase in the odds of in-hospital death associated with older age, higher sequen-tial organ failure assessment score and elevated blood d-dimer levels on admission.11 Detectable SARS-CoV-2 RNA persisted for a median of 20 days in survivors and until death in non-survivors.11
Several studies have identified cardiovascular implications resulting from COVID-19 infec-tion.12–14 Vascular inflammation has been observed in a number of cases and may be a potential mechanism for myocardial injury which can result in cardiac dysfunction and arrhythmias.
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Treatment
Current clinical management of COVID-19 cases focuses on early recognition, isolation, appropriate infection control measures and provision of supportive care.15 Whilst there is no specific antiviral treatment currently recom-mended for patients with suspected or confirmed SARS-CoV-2 infection, multiple clinical trials are underway to evaluate a number of thera-peutic agents, including remdesivir, lopinavir/ritonavir, and chloroquine.16
Public health response
A summary of the key events that have been associated with the emergence of COVID-19, including Australia’s public health response activities is provided at Figures 11 and 12. Since COVID-19 first emerged internationally, public health responses in Australia have continued to evolve with the changing body of knowledge and epidemiological profile, both from overseas and in Australia. During the current report-ing period, the Australian Health Protection Principal Committee have issued advice to inform the national public health response to the pandemic including suspension of all non-urgent elective surgery in both public and private sectors, scaling up of social distancing measures, limits to both indoor and outdoor public gatherings, and mandatory 14-day quar-antine in their port of arrival for all travellers entering Australia.17–19
Methods
Data for this report were current as at 23:59 hours AEDT, 29 March 2020.
This report outlines what is known epidemio-logically on COVID-19 in Australia and from publicly available data from WHO Situation Reports, other countries’ official updates and the scientific literature. Data on domestic cases in this report were collected from the NNDSS and additionally informed by jurisdictional health department media releases. The Communicable Diseases Network Australia (CDNA) developed
the case definition for probable, suspect and confirmed cases, which was modified at differ-ent time points during the outbreak (Table 2). Data were analysed using SAS to describe the epidemiology of COVID-19 in Australia and the progress of the epidemic. Data for the interna-tional cases of COVID-19 by country were com-piled from the latest WHO Situation Report. Case definitions may vary by country making comparisons difficult. Rapid reviews of the current state of knowledge on COVID-19 were conducted from the literature using PubMed.
Acknowledgements
This report represents surveillance data reported through CDNA as part of the nationally-coordi-nated response to COVID-19. We thank public health staff from incident emergency operations centres in state and territory health departments, and the Australian Government Department of Health, along with state and territory public health laboratories. We thank John Grewar for providing the R-code to produce Figure 6.
Author details
Corresponding author
COVID-19 National Incident Room Surveillance Team, Communicable Disease Epidemiology and Surveillance Section, Health Protection Policy Branch, Australian Government Department of Health, GPO Box 9484, MDP 14, Canberra, ACT 2601.
Email: [email protected]
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Figu
re 1
: Con
firm
ed c
ases
of C
OV
ID-1
9 in
fect
ion,
Aus
tral
ia, b
y da
te o
f illn
ess o
nset
a
050100
150
200
250
300
350
400
13-Jan-20
15-Jan-20
17-Jan-20
19-Jan-20
21-Jan-20
23-Jan-20
25-Jan-20
27-Jan-20
29-Jan-20
31-Jan-20
2-Feb-20
4-Feb-20
6-Feb-20
8-Feb-20
10-Feb-20
12-Feb-20
14-Feb-20
16-Feb-20
18-Feb-20
20-Feb-20
22-Feb-20
24-Feb-20
26-Feb-20
28-Feb-20
1-Mar-20
3-Mar-20
5-Mar-20
7-Mar-20
9-Mar-20
11-Mar-20
13-Mar-20
15-Mar-20
17-Mar-20
19-Mar-20
21-Mar-20
23-Mar-20
25-Mar-20
27-Mar-20
29-Mar-20
Number of cases
Dat
e of
illn
ess o
nset
ACT
NSW
NT
QLD
SATA
SVI
CW
A
a Re
cent
ly re
port
ed c
ases
sho
wn
in th
e gr
aph
shou
ld b
e in
terp
rete
d w
ith c
autio
n as
ther
e ca
n be
del
ays
in re
port
ing.
8 of 24
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Figu
re 2
: Con
firm
ed c
ases
of C
OV
ID-1
9, A
ustr
alia
, by
loca
tion
of u
sual
resid
ence
and
stat
istic
al a
rea
leve
l 3, a
s at 2
3 M
arch
202
0a
a Re
pres
ents
the
usua
l loc
atio
n of
resi
denc
e of
a c
ase,
whi
ch d
oes
not n
eces
saril
y m
ean
that
this
is th
e pl
ace
whe
re th
ey a
cqui
red
thei
r inf
ectio
n or
wer
e di
agno
sed.
Ove
rsea
s re
side
nts
who
do
not h
ave
a us
ual p
lace
of r
esid
ence
in A
ustr
alia
are
not
sho
wn.
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Figu
re 3
: Con
firm
ed c
ases
of C
OV
ID-1
9, A
ustr
alia
, by
loca
tion
of u
sual
resid
ence
and
stat
istic
al a
rea
leve
l 3, a
s at 1
Apr
il 20
20a
a Re
pres
ents
the
usua
l loc
atio
n of
resi
denc
e of
a c
ase,
whi
ch d
oes
not n
eces
saril
y m
ean
that
this
is th
e pl
ace
whe
re th
ey a
cqui
red
thei
r inf
ectio
n or
wer
e di
agno
sed.
Ove
rsea
s re
side
nts
who
do
not h
ave
a us
ual p
lace
of r
esid
ence
in A
ustr
alia
are
not
sho
wn.
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Tabl
e 1:
Cum
ulat
ive
notifi
ed c
ases
of c
onfir
med
CO
VID
-19
and
diag
nost
ic te
sts p
erfo
rmed
, Aus
tral
ia, b
y ju
risd
ictio
n
Juri
sdic
tion
a
Num
ber o
f new
cas
es th
is
repo
rtin
g pe
riod
b (W
eek
endi
ng 2
3:59
AED
T 29
M
arch
202
0)
Tota
l cas
esb
(to
23:5
9 A
EDT
29 M
arch
202
0)Ca
ses
per 1
00,0
00 p
opul
atio
nCu
mul
ativ
e nu
mbe
r of t
ests
pe
rfor
med
(pro
port
ion
of te
sts
posi
tive
%)
NSW
1,21
51,
981
24.5
91,3
08 (2
.2%
)
Vic
360
673
10.2
28,9
41 (2
.3%
)
Qld
376
738
14.5
45,1
07 (1
.6%
)
WA
144
313
11.9
13,3
37 (2
.3%
)
SA16
730
417
.424
,737
(1.2
%)
Tas
3859
11.0
1,72
0 (3
.4%
)
NT
1014
5.7
1,88
1 (0
.7%
)
ACT
4577
18.0
4,23
0 (1
.8%
)
Tota
l 2,
355
4,15
916
.421
1,26
1 (2
.0%
)
a N
SW =
New
Sou
th W
ales
, Vic
= V
icto
ria, Q
ld =
Que
ensl
and,
WA
= W
este
rn A
ustr
alia
, SA
= S
outh
Aus
tral
ia, T
as =
Tas
man
ia, N
T =
Nor
ther
n Te
rrito
ry, A
CT
= Au
stra
lian
Capi
tal T
errit
ory.
b D
ue to
the
dyna
mic
nat
ure
of th
e N
ND
SS, d
ata
in th
is e
xtra
ct a
re s
ubje
ct to
retr
ospe
ctiv
e re
visi
on a
nd m
ay v
ary
from
dat
a re
port
ed in
pre
viou
sly
publ
ishe
d re
port
s an
d re
port
s of
not
ifica
tion
data
by
stat
es
and
terr
itorie
s.
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Figu
re 4
: Cas
e nu
mbe
rs a
nd ra
tes o
f CO
VID
-19
case
s, A
ustr
alia
, by
age
and
sex
05101520253035
050100
150
200
250
300
350
400
450
500
0–9
10–1
920
–29
30–3
940
–49
50–5
960
–69
70–7
980
–89
90+
Rate per 100,000
Number of cases
Age
grou
p (y
ears
)
Mal
eFe
mal
eM
ale
rate
Fem
ale
rate
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Figu
re 5
: Fre
quen
cy o
f CO
VID
-19
sym
ptom
s in
confi
rmed
cas
es, A
ustr
alia
(n =
2,2
57)
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Figu
re 6
: Var
iatio
n in
com
bina
tions
of C
OV
ID-1
9 sy
mpt
oms i
n co
nfirm
ed c
ases
, Aus
tral
iaa
a Th
is fi
gure
sho
ws
the
varia
tion
in c
ombi
natio
ns o
f sym
ptom
s ob
serv
ed in
repo
rted
cas
es (n
= 2
,257
) for
the
five
mos
t fre
quen
tly o
bser
ved
sym
ptom
s (c
ough
, hea
dach
e, fe
ver,
sore
thro
at, r
unny
nos
e). T
he
horiz
onta
l bar
s on
the
left
sho
w th
e fr
eque
ncy
of s
ympt
om o
ccur
renc
e in
any
com
bina
tion
with
oth
er s
ympt
oms.
The
circ
les
and
lines
indi
cate
par
ticul
ar c
ombi
natio
ns o
f sym
ptom
s ob
serv
ed in
indi
vidu
al
patie
nts.
The
vert
ical
gre
en b
ars
indi
cate
the
freq
uenc
y of
occ
urre
nce
of th
e co
rres
pond
ing
com
bina
tion
of s
ympt
oms.
14 of 24
Weekly epidemiological report
Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020 health.gov.au/cdi
Figu
re 7
: Num
ber o
f CO
VID
-19
case
s by
plac
e of
acq
uisit
ion
over
tim
e, A
ustr
alia
(n =
4,1
59)a
050100
150
200
250
300
350
400
13-Jan-20
15-Jan-20
17-Jan-20
19-Jan-20
21-Jan-20
23-Jan-20
25-Jan-20
27-Jan-20
29-Jan-20
31-Jan-20
2-Feb-20
4-Feb-20
6-Feb-20
8-Feb-20
10-Feb-20
12-Feb-20
14-Feb-20
16-Feb-20
18-Feb-20
20-Feb-20
22-Feb-20
24-Feb-20
26-Feb-20
28-Feb-20
1-Mar-20
3-Mar-20
5-Mar-20
7-Mar-20
9-Mar-20
11-Mar-20
13-Mar-20
15-Mar-20
17-Mar-20
19-Mar-20
21-Mar-20
23-Mar-20
25-Mar-20
27-Mar-20
29-Mar-20
Number of cases
Date
of i
llnes
s ons
et
Loca
lly a
cqui
red,
not
epi
link
ed
Loca
lly a
cqui
red-
clos
e co
ntac
t of a
con
firm
ed c
ase
Ove
rsea
s acq
uire
d
Und
er in
vest
igat
ion
a Re
cent
ly re
port
ed c
ases
sho
wn
in th
e gr
aph
shou
ld b
e in
terp
rete
d w
ith c
autio
n as
ther
e ca
n be
del
ays
in re
port
ing.
15 of 24
Weekly epidemiological report
health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Figu
re 8
: Con
firm
ed c
ases
of o
vers
eas a
cqui
red
CO
VID
-19
infe
ctio
n (n
= 2
,352
) by
Stan
dard
Aus
tral
ian
Cla
ssifi
catio
n of
Cou
ntri
es (S
ACC)
a
050100
150
200
250
13-Jan-20
15-Jan-20
17-Jan-20
19-Jan-20
21-Jan-20
23-Jan-20
25-Jan-20
27-Jan-20
29-Jan-20
31-Jan-20
2-Feb-20
4-Feb-20
6-Feb-20
8-Feb-20
10-Feb-20
12-Feb-20
14-Feb-20
16-Feb-20
18-Feb-20
20-Feb-20
22-Feb-20
24-Feb-20
26-Feb-20
28-Feb-20
1-Mar-20
3-Mar-20
5-Mar-20
7-Mar-20
9-Mar-20
11-Mar-20
13-Mar-20
15-Mar-20
17-Mar-20
19-Mar-20
21-Mar-20
23-Mar-20
25-Mar-20
27-Mar-20
29-Mar-20
Number of cases
Date
of i
llnes
s ons
et
Amer
icas
At se
a (c
ruise
ship
s)Eu
rope
New
Zea
land
and
Pac
ific
Nor
th A
fric
a an
d th
e M
iddl
e Ea
stN
orth
-Eas
t Asia
Sout
h-Ea
st A
siaSo
uthe
rn a
nd C
entr
al A
siaSu
b-Sa
hara
n Af
rica
a Re
cent
ly re
port
ed c
ases
sho
wn
in th
e gr
aph
shou
ld b
e in
terp
rete
d w
ith c
autio
n as
ther
e ca
n be
del
ays
in re
port
ing.
16 of 24
Weekly epidemiological report
Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020 health.gov.au/cdi
Figu
re 9
: Num
ber o
f CO
VID
-19
case
s (lo
gari
thm
ic sc
ale)
by
sele
cted
coun
try
and
days
sinc
e pa
ssin
g 10
0 ca
ses,
up to
29
Mar
ch 2
020
100
1,00
0
10,0
00
100,
000
1,00
0,00
0
01
23
45
67
89
1011
1213
1415
1617
1819
2021
2223
2425
2627
2829
3031
3233
3435
3637
38
Number of cases (log scale)
Days
sin
ce p
assi
ng 1
00 c
ases
Aust
ralia
Italy
Isla
mic
Rep
ublic
of I
ran
Ger
man
yFr
ance
Spai
nU
KU
SARe
publ
ic o
f Kor
eaHo
ng K
ong*
Sing
apor
eJa
pan
17 of 24
Weekly epidemiological report
health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Figu
re 1
0: N
umbe
r of C
OV
ID-1
9 de
aths
(log
arith
mic
scal
e) b
y se
lect
ed co
untr
y an
d da
ys si
nce
pass
ing
50 d
eath
s, up
to 2
9 M
arch
202
0
50500
5,00
0
50,0
00
01
23
45
67
89
1011
1213
1415
1617
1819
2021
2223
2425
2627
Number of deaths (log scale)
Days
sin
ce p
assi
ng 5
0 de
aths
Repu
blic
of K
orea
Italy
Spai
n
Fran
ceU
KIra
n
USA
18 of 24
Weekly epidemiological report
Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020 health.gov.au/cdi
Figu
re 1
1. T
imel
ine
of C
OV
ID-1
9 re
late
d ev
ents
, inc
ludi
ng A
ustr
alia
n pu
blic
hea
lth re
spon
se a
ctiv
ities
, fro
m 3
1 D
ecem
ber 2
019
to 1
5 M
arch
202
0
31 D
ecem
ber 2
019
15 M
arch
2020
31-D
ec-1
9No
tifica
tion t
oW
HO pn
eum
onia
of un
know
n orig
in
7-Ja
n-20
SARS
-CoV
-2 id
entif
ied
11-F
eb-2
0W
HO an
noun
ced a
nam
e for
the
new
coro
navir
us di
seas
e: CO
VID-
19
11-M
ar-2
0W
HO ch
arac
teris
esCO
VID-
19 as
pand
emic
13-M
ar-2
0AH
PPC p
rovid
es re
com
men
datio
ns fo
rpu
blic g
athe
rings
, tes
ting a
nd so
cial d
istan
cing
12-M
ar-2
0AH
PPC p
rovid
es re
com
men
datio
nsfo
r hea
lthca
re an
d age
care
wor
kers
8-M
ar-2
0AH
PPC r
ecom
men
ds re
strict
ions o
nCO
VID-
19 co
ntac
ts an
d tra
velle
rsfro
m lis
ted h
igher
risk c
ount
ries
5-M
ar-2
0Re
strict
ions o
n tra
vel
from
Repu
blic
of Ko
rea
1-M
ar-2
0Re
strict
ions o
n tra
vel
from
Islam
ic Re
publi
c of Ir
an
1-Fe
b-20
Restr
iction
s on t
rave
lfro
m Ch
ina im
plem
ente
d
30-Ja
n-20
WHO
decla
res P
ublic
Hea
lthEm
erge
ncy o
f Inte
rnat
ional
Conc
ern
19 of 24
Weekly epidemiological report
health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Figu
re 1
2. T
imel
ine
of C
OV
ID-1
9 re
late
d ev
ents
, inc
ludi
ng A
ustr
alia
n pu
blic
hea
lth re
spon
se a
ctiv
ities
, fro
m 1
5 to
29
Mar
ch 2
020
15 M
arch
2020
29 M
arch
2020
20-M
ar-2
0Ta
sman
ia clo
ses b
orde
rsto
non-
esse
ntial
trav
eller
s
18-M
ar-2
0DF
AT ra
ises t
rave
l adv
ice fo
r all o
verse
asde
stina
tions
to Le
vel 4
'Do N
ot Tr
avel' 18
-Mar
-20
AHPP
C rec
omm
ends
the c
ontin
uatio
n of a
14 da
yqu
aran
tine r
equir
emen
tfo
r all r
etur
ning
trav
eller
s
21-M
ar-2
0Ql
d, W
A, N
T and
SA cl
ose b
orde
rsto
non-
esse
ntial
trav
eller
s
24-M
ar-2
0–
AHPP
C rec
omm
ends
tem
pora
ry su
spen
sion o
f all n
on-u
rgen
t e
lectiv
e pro
cedu
res i
n bot
h the
publi
c and
priva
te se
ctor.
– AH
PPC r
ecom
men
ds pr
ogre
ssive
scale
up of
socia
l dist
ancin
g m
easu
res w
ith st
rong
er m
easu
res i
n rela
tion t
o non
-esse
ntial
gat
herin
gs, a
nd co
nside
ratio
ns of
furth
er m
ore i
nten
se op
tions
. –
Aged
care
prov
iders
limits
visit
s to a
max
imum
of tw
o visi
tors
at o
ne ti
me p
er da
y
25-M
ar-2
0- A
HHPC
reco
mm
ends
that
scho
ol-ba
sed i
mm
unisa
tion
pro
gram
s, wi
th th
e exc
eptio
n of t
he de
liver
y of m
ening
ococ
cal
ACW
Y vac
cine,
are p
ause
d at t
he cu
rrent
tim
e.–A
ustra
lian c
itize
ns an
d Aus
tralia
n per
man
ent r
eside
nts a
re re
strict
ed f
rom
trav
ellin
g ove
rseas
.
26-M
ar-2
0Re
strict
ed m
ovem
ent i
nto c
erta
in re
mot
e are
asto
prot
ect c
omm
unity
mem
bers
from
COVI
D-19
28-M
ar-2
0Al
l peo
ple e
nter
ing A
ustra
lia re
quire
d to u
nder
take
a man
dato
ry 14
-day
quar
antin
e at d
esign
ated
facil
ities
(e.g
. hot
els) i
n the
ir por
t of a
rriva
l.
29-M
ar-2
0Bo
th in
door
and o
utdo
or pu
blic
gath
ering
s lim
ited t
o two
perso
ns on
ly
20 of 24 health.gov.au/cdiCommun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Tabl
e 2:
Aus
tral
ian
CO
VID
-19
case
defi
nitio
n20 a
s of 2
9 M
arch
202
0Ve
rsio
n: 2
.4D
ate
of d
evel
opm
ent:
26
Mar
ch 2
020
Confi
rmed
cas
eA
per
son
who
test
s po
sitiv
e to
a v
alid
ated
spe
cific
SA
RS-C
oV-2
nuc
leic
aci
d te
st o
r has
the
viru
s id
entifi
ed b
y el
ectr
on m
icro
scop
y or
vira
l cul
ture
.
Prob
able
cas
e A
per
son
with
feve
r (38
°C) o
r his
tory
of f
ever
(e.g
. nig
ht s
wea
ts, c
hills
) OR
acut
e re
spira
tory
infe
ctio
n (e
.g. c
ough
, sho
rtne
ss o
f bre
ath,
sor
e th
roat
) AN
D w
ho is
a
hous
ehol
d co
ntac
t of a
con
firm
ed o
r pro
babl
e ca
se o
f CO
VID
-19,
whe
re te
stin
g ha
s no
t bee
n co
nduc
ted.
Susp
ect c
ase
A p
erso
n w
ho m
eets
the
follo
win
g ep
idem
iolo
gica
l and
clin
ical
crit
eria
:
Epid
emio
logi
cal c
rite
ria
Clin
ical
cri
teri
aA
ctio
n
Very
hig
h ri
sk
• Cl
ose
cont
act i
n 14
day
s be
fore
illn
ess
onse
t with
a c
onfir
med
or p
roba
ble
case
• In
tern
atio
nal t
rave
l in
the
14 d
ays
prio
r to
illne
ss o
nset
• Cr
uise
shi
p pa
ssen
gers
and
cre
w w
ho h
ave
trav
elle
d in
the
14 d
ays
prio
r to
illne
ss o
nset
Feve
r (≥
38 °C
) or h
isto
ry o
f fe
ver
OR
Acu
te re
spira
tory
infe
ctio
n (e
.g. c
ough
, sho
rtne
ss o
f br
eath
, sor
e th
roat
)
Test
Hig
h ri
sk
1. T
wo
or m
ore
case
s of
illn
ess
clin
ical
ly c
onsi
sten
t with
CO
VID
-19
in th
e fo
llow
ing
sett
ings
:
• A
ged
care
and
oth
er re
side
ntia
l car
e fa
cilit
ies
• M
ilita
ry o
pera
tiona
l set
tings
• Bo
ardi
ng s
choo
ls•
Corr
ectio
nal f
acili
ties
• D
eten
tion
cent
res
• A
borig
inal
rura
l and
rem
ote
com
mun
ities
, in
cons
ulta
tion
with
the
loca
l PH
U•
Sett
ings
whe
re C
OVI
D-1
9 ou
tbre
aks
have
occ
urre
d, in
con
sulta
tion
with
the
loca
l PH
U
2. In
divi
dual
pat
ient
s w
ith il
lnes
s cl
inic
ally
con
sist
ent w
ith C
OVI
D-1
9 in
a g
eogr
aphi
cally
loca
lised
are
a w
ith
elev
ated
risk
of c
omm
unity
tran
smis
sion
, as
defin
ed b
y PH
Us
Feve
r (≥
38 °C
) or h
isto
ry
of fe
ver (
e.g.
nig
ht s
wea
ts,
chill
s)
OR
Acu
te re
spira
tory
infe
ctio
n (e
.g. c
ough
, sho
rtne
ss o
f br
eath
, sor
e th
roat
)
Test
(on
site
fo
r age
d ca
re
resi
dent
s, w
here
fe
asib
le)
21 of 24 health.gov.au/cdi Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020
Vers
ion:
2.4
Dat
e of
dev
elop
men
t: 2
6 M
arch
202
0
Mod
erat
e ri
sk•
Hea
lthca
re w
orke
rs, a
ged
or re
side
ntia
l car
e w
orke
rsFe
ver (
≥ 38
°C) o
r his
tory
of
feve
r (e.
g. n
ight
sw
eats
, ch
ills)
OR
Acu
te re
spira
tory
infe
ctio
n (e
.g. c
ough
, sho
rtne
ss o
f br
eath
, sor
e th
roat
)
Test
Back
grou
nd ri
sk(N
o ep
idem
iolo
gica
l ris
k fa
ctor
s)H
ospi
talis
ed p
atie
nts
with
fe
ver (
≥ 38
°C)
AN
D
Acu
te re
spira
tory
sym
ptom
s (e
.g. c
ough
, sho
rtne
ss o
f br
eath
, sor
e th
roat
) of a
n un
know
n ca
se
Test
22 of 24
Weekly epidemiological report
Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.29) Epub 3/4/2020 health.gov.au/cdi
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Appendix A: Frequently asked questions
Q: Can I request access to the COVID-19 data behind your CDI weekly reports?
A: National notification data on COVID-19 con-firmed cases is collated in the National Notifiable Disease Surveillance System (NNDSS) based on notifications made to state and territory health authorities under the provisions of their relevant public health legislation.
Normally, requests for the release of data from the NNDSS requires agreement from states and ter-ritories via the Communicable Diseases Network Australia, and, depending on the sensitivity of the data sought and proposed, ethics approval may also be required.
Due to the COVID-19 response, unfortunately, spe-cific requests for NNDSS data have been put on hold. We are currently looking into options to be able to respond to data requests in the near future.
We will continue to publish regular summaries and analyses of the NNDSS dataset and recommend the following resources be referred to in the meantime:
• NNDSS summary tables: http://www9.health.gov.au/cda/source/cda-index.cfm
• Daily case summary of cases: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers
• Communicable Diseases Intelligence COVID-19 weekly epidemiology report: https://www1.health.gov.au/internet/main/publishing.nsf/Content/novel_coronavirus_2019_ncov_weekly_epidemiology_reports_australia_2020.htm
• State and territory public health websites.
Q: Can I request access to data at post-code level of confirmed cases?
A: Data at this level cannot be released without eth-ics approval and permission would need to be sought from all states and territories via the Communicable Diseases Network Australia. As noted above, specific requests for NNDSS data are currently on hold.
A GIS/mapping analysis of cases will be included in each Communicable Diseases Intelligence COVID-19 weekly epidemiology report. In order to protect privacy of confirmed cases, data in this map will be presented at SA3 level.
Q. Where can I find more detailed data on COVID-19 cases?
A: We are currently looking into ways to provide more in-depth epidemiological analyses of COVID-19 cases, with regard to transmission and severity, including hospitalisation. These analyses will continue to be built upon in future iterations of the weekly Communicable Diseases Intelligence report.