COVID-19 activity has yet to hit the Americas with full force, especially Latin America and the Caribbean, and countries should prepare for rapid intensification over the next few weeks, the director of the Pan American Health Organization (PAHO) warned today.

Elsewhere, more countries—some trending down and some trending up—extended their lockdown measures, as cases rapidly rose in some African countries and some Asian nations battled resurgences.

The global total inched closer to 2 million today and stands at 1,956,077 cases in 185 countries, 125,123 of them fatal, according to the Johns Hopkins online dashboard.

PAHO chief warns of potential escalation

At a weekly media telebriefing, Carissa Etienne, MD, said physical distancing orders in some countries have given the region a chance to prepare, but she warned that countries considering transitions to more flexible measures should take them with extreme caution.

She said countries need to pair social distancing with social support to ensure that vulnerable people can comply without severely risking their livelihoods.

A rise in hospitalizations and deaths in countries such as Ecuador and Brazil shows how quickly the situation can evolve, Etienne warned. She said as of yesterday, the region has 644,986 cases and 25,551 deaths, with community transmission reported by growing numbers of countries in North America, Central America, South America, and the Caribbean.

Ecuador, for example, has reported a recent sharp rise in cases, with its outbreak centered in Guayaquil, one of the country's largest cities. The outbreak has overwhelmed the city's hospitals and morgues. Other hot spots in South America include Brazil, Peru, and Chile.

France extends lockdown; toll in UK nursing homes

French President Emmanuel Macron today announced that the country's lockdown will be extended until May 11. France has been on lockdown since Mar 17, but he said hospitals in Paris and eastern France are still under pressure, Reuters reported.

In an address to the nation, he signaled that schools and shops would reopen on May 11, but restaurants, hotels, cafes, and movie theaters would probably have to remain closed longer. Macron said international travel from non European countries will remain suspended until further notice.

Macron said by May 11, France will be able to test anyone with COVID-19 symptoms and provide nonmedical face masks to the public. He acknowledged that the country wasn't as prepared as it should have been, but it has coped.

The number of ICU patients in France has been declining since early April, and overwhelmed hospitals have sent patients to facilities in other parts of the country. However, the country is still experiencing numerous nursing home outbreaks along with a steady surge of new cases. Today it reported 6,524 more cases and 762 more deaths.

Elsewhere in Europe, the United Kingdom's cases and deaths today were up from yesterday's total, with 5,252 new cases and 778 more deaths. Representatives from British charities say the government death count underestimates COVID-19 deaths, because they only include fatalities that occur in hospitals, leaving out many that have occurred in nursing homes, the Associated Press (AP) reported. They pointed to Office of National Statistics numbers through Apr 3 that showed COVID-19 deaths were 15% higher than the National Health Service total.

The government said that one in eight care homes have been affected by COVID-19, but an executive from a chain of care homes said two-thirds of the facilities were affected.

Lockdown extensions in India, Pakistan

In India, Prime Minister Narenda Modi today announced that the country's lockdown will be extended at least until May 3, Reuters reported. Most of India's cases have been reported from 80 of more than 700 districts and includes the cities New Delhi and Mumbai.

First announced on Mar 24, India's lockdown was supposed to end today. Today the country reported 488 new cases, raising its total to 10,941.

Meanwhile, India's neighbor Pakistan today extended its lockdown by 2 weeks but said some industries will reopen in phases, the first which will be construction, according to a separate Reuters report. The country reported 341 more cases today, up from 266 yesterday, for a total of 5,837.

The country's hot spots are its populous Punjab province, which has recorded 50% of the cases, and Sindh province, Anadolu Agency reported. More than 100 healthcare workers have been infected in the outbreak, according to Pakistan's medical association.

Pandemic intensifies in parts of Africa

In Africa, pandemic cases are rising rapidly with only Comoros and Lesotho yet to report any cases, the WHO's African regional office said today in its weekly outbreaks and health emergency report. Confirmed cases have risen to 9,663, and the number of deaths has steadily grown to 461.

Eight countries have reported marked increases in the past week: Algeria Burkina Faso, Cameroon, Ivory Coast, Ghana, Nigeria, Senegal, and South Africa. Six of the countries with high case loads have high case-fatality rates, ranging from Algeria at 15% to Niger at 2.7%.

Most countries are experiencing local transmission with the virus spreading from country capitals to rural areas. The WHO said rigorous efforts are needed to control the situation, such as stepped-up surveillance and other preparedness actions.

In other African developments, the first United Nation's "Solidarity Flight" left Addis Ababa today carrying medical supplies to all African countries, containing personal protective equipment, thermometers, and ventilators. In a WHO statement, Director-General Tedros Adhanom Ghebreyesus, PhD, said the flight is part of a larger effort to get lifesaving medical supplies to 95 countries across all six WHO regions.

Asian countries battle COVID-19 sparks

Singapore today reported another surge in COVID-19 cases, with 334 cases reported today, according to the health ministry. Of those, 220 are linked to known clusters or other cases. The country has recently reported large outbreaks at dormitories housing foreign workers.

China, following a spike of 108 new cases yesterday, reported 89 new cases today, 86 of them imported and 3 local from Guangdong province, the National Health Commission said in its daily report.

Some of the recent cases are linked to an outbreak in the Heilongjiang province city of Suifenhe, which recently prompted a lockdown. Also, the Henan province county of Jia is on lockdown except for essential services, following a cluster of illnesses related to a doctor who returned from Wuhan, CBS News reported.