Global epidemiological situation

The number of new cases per week has remained stable at 2 million for the past three weeks (Figure 1),
with a cumulative total of over 34.8 million cases. Over 1 million deaths have now been reported
globally, of which the majority were reported in the Region of the Americas (55%), followed by Europe
(23%). In the past week, the regions of the Americas, South-East Asia, and Europe account for 91% of
new cases. Five countries (namely India, the United States of America, Brazil, Argentina and France)
reported 60% of new global cases this past week, while Israel registered the highest incidence (3717 new
cases per 1 million population). Globally, the highest percentage of cases have been reported in the
25-39 age group, with approximately 50% of cases in the 25-64 age group. However, the percentage of
deaths increases with age, and approximately 75% of deaths are in those aged 65 years and above.

 

Although globally the number of new cases was similar to the number of cases in the previous week,
there is considerable variation on a country- by-country basis. In several countries, the number of new
cases is rising again, and in many (most notably within the European Region) the second wave is
exceeding previous peaks; this can be partly attributed to enhancements in surveillance capacities over
time. In other countries, we have seen a gradual decline in new cases from earlier peaks in August, for
example in Brazil, Colombia and Peru. In India and the Philippines, the number of new cases appears to
have stabilized, but they are still reporting high numbers. There are also examples of countries that have
consistently shown an increasing incidence as their first wave continues; these include Indonesia, Iraq,
and Myanmar, although Indonesia is reporting a slight drop this week. South Africa and Australia are
examples of countries that have successfully managed to reduce the number of new cases and have seen
large reductions from earlier peaks.

 

African Region

South Africa and Ethiopia continue to report the highest numbers of new cases in Africa, followed by
Mozambique, Uganda, and Nigeria. Africa has seen a continuous decline in case of incidence since mid-July;
however, this trend is now slowing (Figure 3). For the first week since early August, the number of new
deaths has risen – led by South Africa with a 29% increase in deaths in the past week.

 

South Africa also has the second-highest mortality rate in the Region – 11 461 deaths per 1 million
population. The provinces of Gauteng and the Western Cape have reported the most cases and deaths
to date; however, these regions, as well as the country itself, have maintained sustained declines in the
daily incidence since the end of July. Despite this, weekly case numbers have continued to rise in less
populated provinces. The country moved to Alert Level 1 as of 21 September (the least stringent of the
five alert levels applied by the South African Goverment), with all sectors of the economy now open with
strict adherence to public health protocols. A WHO surge team of experts, including infectious disease
specialists and epidemiologists, is currently in South Africa and is continuing to work with the National
Department of Health.

 

New weekly cases have risen in Angola from 400 in the week of 7 September to 698 cases in the past
week, a 74% increase, although the number of new cases has declined by 10% from the past week.
Angola recently upgraded their self-reported transmission classification from ‘clusters of cases’ to
‘community transmission’. Luanda province remains the epicenter with around 90% of all cases. A total
of 16 out of the 18 provinces have reported confirmed cases. WHO has trained around 90 community
health mobilizers now operating across Luanda.

 

Region of the Americas

A similar incidence of new cases was reported across the region over the past week (Figure 4) in
comparison to the previous week. The United States of America, Brazil, Argentina, Colombia, Mexico and
Peru registered the highest number of weekly new cases.

 

The United States of America continues to record approximately 300 000 new cases per week (894 new
cases per 1 million population). Declines observed over July and August have stagnated in recent weeks,
with several states reporting sharp rises in case numbers – most notably in Midwest states. Canada is
also showing a large increase in new cases and new deaths compared with last week, at 43% and 208%
respectively. Likewise, Argentina continues to report an increase in cases and deaths, with cumulative
deaths exceeding 20 000 last week after a backlog of over 3000 reported deaths from Buenos Aires.

 

Since peaking at just over 300 000 new weekly cases in the week of 27 July, new cases in Brazil have
fallen to 190 000 new cases in the past week (898 new cases per 1 million population). Weekly new
cases have also fallen in Colombia and Peru.

 

In the Region of the Americas, as in other Regions, older persons are far more likely to experience severe
disease following infection. Brazil reported that 76% of COVID-19 related deaths during February to
September 2020 were in adults aged 60 years and older. In Peru, people over the age of 70 years had
the highest COVID-19 mortality rates during March-May 2020, and estimates from Canada show that
more than 80% of COVID-19 deaths have occurred in long-term-care facilities. WHO has published
guidance on Preventing and managing COVID-19 across long-term care services with an annexe providing a
comprehensive set of actions for policymakers, national and local decision-makers and other actors.

 

Eastern Mediterranean Region

A similar incidence of new cases was reported from the Eastern Mediterranean Region over the past
week (Figure 5) in comparison to the previous week. Iraq, Iran, Morocco, and Lebanon are reporting the
highest numbers of new cases for the past week. Iraq has reported over 20 000 cases per week since
the beginning of August and this week just under 30 000 cases new cases (745 cases per 1 million
population) were reported. In Jordan, case incidence has almost doubled each week for the past five
weeks, with over 6600 new cases (a 90% increase on the previous week) reported last week.

 

Since the start of September, the Islamic Republic of Iran has shown an upward trend in weekly new
cases and is reporting their highest number of new cases – 25 000 new cases (298 cases per 1 million
population) – since the beginning of the pandemic.

 

Lebanon reported a 19% increase in new cases compared with the previous week and has one of the
highest rates of new cases in the Region (1209 new cases per 1 million population). On 29 September,
WHO also launched an initiative to rebuild the Ministry of Public Health’s Central Drug Warehouse in
Qarantina, Lebanon, which was destroyed by the Beirut port blast on 4 August.

 

European Region

The incidence of new cases has continued to increase in the European Region overall (Figure 6). France,
the Russian Federation, the United Kingdom, Spain, and Israel reported the highest numbers of new
cases in the past week. The numbers of new cases and new deaths in the Russian Federation, the United
Kingdom, Ukraine, and several other countries in Europe are showing considerable increases compared
with last week. The Netherlands, Czechia, Germany, and Italy have also reported sizable increases. Israel
continues to have the highest incidence of new cases per 1 million population in the region and globally,
with over 32 000 cases reported in the past week (3717 new cases per 1 million population).

 

With over 1.2 million COVID-19 cases, and over 63 000 new cases in the past week (436 cases per 1
million population), the Russia Federation is reporting the second-highest number of new cases in
Europe and the sixth highest number globally. Russia’s weekly new cases peaked at 75 000 cases in the
week of 4 May, with a gradual decrease observed through late August, but rapid increases observed in
the last three weeks.

 

In contrast to other European countries, Ukraine did not observe a large first peak but has reported a
continuous increase in new cases since mid-June. Over 27 000 new cases were reported in the past week
(636 new cases per 1 million population), a 21% rise from the week before. Since the start of the
outbreak, WHO has supported the Ministry of Health to further develop three key areas of its health
system: health financing, service delivery, and governance. In September, WHO experts worked together
with national authorities to make sure rehabilitation services are fully functional and well-integrated into
health care.

 

South-East Asia Region

A gradual decline in the case and death incidence in the South-East Asia Region continued during the past
week (Figure 7). Nevertheless, the Region contributes almost a third (n=614 502, 30%) of new cases
reported globally in the past week. At the same time, current weekly case incidence (304 per 1 million
population) is markedly lower than that which is currently observed in the Americas and Europe.

 

India, reporting over 500 000 new cases per week since late-August, again contributed the majority of
incident cases in the Region (91%) and globally (27%) last week, bringing cumulative counts in the
country to an excess of 6.5 million cases and 100 000 deaths (10% of the global total). Over several
months, case numbers in India rose rapidly, with Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu,
and Uttar Pradesh reporting the highest numbers of cases. This increase occurred with a concurrent
expansion in testing activity, which has since stabilized at 7–8 million samples tested per week (or 5.2–
5.8 samples tested/1000 persons/week) in the past five weeks. Weekly incidence of new cases is
gradually easing, falling to 403 new cases per 1 million population (556 841 cases) this past week, after
peaking three weeks ago, while test positivity rates fell marginally to 7.1%.

 

Indonesia is currently the second most affected country in the Region, nearing 300 000 cases to date,
including over 28 000 new cases (or 103 new cases per 1 million population) in the past week. Almost
60% of cases to date have been reported from the island of Java, which includes the capital Jakarta.
Suspected case numbers have risen sharply in recent weeks; however, testing capacity has thus far been
unable to meet demand, with approximately 23% (n=30 940 people) people tested among some 132 000
suspected cases reported on 30 September. Among four provinces that achieved a benchmark of
1 person tested/1000 population/week during September, weekly test positivity rates ranged markedly
from less than 5% to over 40%, highlighting the heterogeneity in both surveillance capacity and COVID19 activities across the island.

 

In Myanmar, COVID-19 incidence has risen sharply, with cumulative counts almost doubling each week
since mid-August, and over 6500 new cases (or 120 new cases per 1 million population) reported in the
past week. Rakhine State and the country’s largest city, Yangon has reported around 75% of cases and
has been hardest hit to date, with a possibility of community transmission in areas. On 20 September,
Myanmar announced a stay-home order for its biggest city Yangon.

 

Western Pacific Region

In the Western Pacific Region, the weekly number of new cases reported continues to fluctuate (Figure
8). The Philippines, Japan, and Malaysia are reporting the highest numbers of new cases, with Malaysia
reporting an increase of 119% in new cases compared with last week.

 

Around three-quarters (73%) of new cases in the region were from the Philippines. Although weekly new
cases in the Philippines peaked in the week of 10 August, the incidence of new cases remains relatively
high compared to others in the Region, with over 18 000 new cases in the past week (165 cases per 1
million population). Data as of 29 September shows that 50% of cases are in the age group 20-39 years,
while 60% of deaths are in those aged 60 years and over. There is community transmission in all regions
of the country, with three regions – National Capital Region, Region 3, and Region 4A – showing higher
transmission intensity. The National Capital Region continues to report the most cases, with half of
the national cases, where Metro Manila mayors have recommended the extension of the general
community quarantine status for the month of October.

 

In Malaysia, the weekly number of new cases has been increasing for the past 3 weeks, with 1319 cases
reported in the past week (40 new cases per 1 million population). The state of Sabah has been the
worst affected in recent weeks, accounting for 77% of cases reported in September. A number of
clusters in other states have also been linked to travelers from Sabah. Malaysia has a nationwide
recovery movement control order (RMCO) in place and most communities and services are operating
under these limited restrictions. However, targeted enhanced movement control orders (TEMCO), the
most stringent form of community and business restrictions, have been implemented in a number of
areas with high levels of community transmission.

 

The Solomon Islands recorded their first COVID-19 case: a student returning from the Philippines on a
repatriation flight. The Solomon Islands have planned to use repatriation flights to return students
studying in the Philippines and Indonesia. Since early January 2020, WHO has been working closely
alongside Pacific Governments and Ministries of Health, in collaboration with partners, to ensure that
countries are well prepared to respond to the threat of COVID-19.

 

Key weekly updates

Diagnostics: WHO issued the first and second Emergency Use Listing for a quality antigen-based rapid
diagnostic test. WHO published guidance highlights the value of these tests in areas where community
transmission is widespread and where nucleic acid amplification-based diagnostic testing is either
unavailable or where test results are significantly delayed. On 28 September, the Access to COVID-19
Tools (ACT) Accelerator announced 120 million high-quality, affordable COVID-19 antigen rapid tests to
be made available to low- and middle-income countries.

 

• Diagnostics: WHO published the final version of Target Product Profiles (TPP) for priority diagnostics.
These TPPs describe the desirable and minimal acceptable profiles for four tests: (i) point of care tests for
suspected cases and their close contacts where reference assay testing is unavailable, or turnaround
times obviate clinical utility; (ii) tests for diagnosis or confirmation of acute or subacute infection, suitable
for low or high-volume needs; (iii) point of care test for prior infection; and (iv) tests for prior infection for
moderate to high volume needs.

 

• COVAX: The Director-General Dr Tedros, in his regular media briefing on 2 October, highlighted 168 have
joined COVAX. Through the ACT Accelerator and COVAX Facility, any vaccines that are proven to be safe
and effective will be rolled out equitably across the world.

 

• International Day of Older Persons: On 1 October, the International Day of Older Persons, WHO
launched a package of tools, including a digital application to help health and social workers provide
better care for older people. A data portal was also launched that will compile data on global indicators
for monitoring the health and well-being of people aged 60 and over. Globally, older persons and those
receiving long term care account for a majority of COVID-19 severe cases and deaths.

 

• Mental Health: Billions of people around the world have been affected by COVID-19 pandemic,
which is having an added impact on people’s mental health. On 10 October, World Mental Health Day,
WHO is organizing a Big Event for Mental Health. The advocacy event will focus on the urgent need to
address the world’s chronic under-investment in mental health – a problem that has been thrown into
the spotlight during the COVID-19 pandemic.

 

• Preparedness: During the United Nations General Assembly, a high-level event on ‘Sustainable
preparedness for health security and resilience: Adopting a whole-of-society approach and breaking the
“panic-then-forget” cycle’ was organized and co-hosted by Finland, France, and Indonesia, along with the
WHO. As the world crossed a grim milestone with over a million lives lost to COVID-19, with many more
expected to have died from unprecedented disruptions to health systems. The event highlighted the
need for sustainable health emergency preparedness as COVID-19 will not be the world’s last health
emergency.