COVID-19 pandemic

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COVID-19 pandemic
COVID-19 Outbreak World Map per Capita.svg
Map of confirmed cases per capita as of 17 May 2020
  10+ confirmed cases per 1,000
  3–10 confirmed cases per 1,000
  1–3 confirmed cases per 1,000
  0.3–1 confirmed cases per 1,000
  0.1–0.3 confirmed cases per 1,000
  >0–0.1 confirmed cases per 1,000
  No confirmed cases or no data
Total confirmed cases map
COVID-19 Outbreak World Map.svg
Map of total confirmed cases as of 16 May 2020
  1,000,000+ confirmed cases
  100,000–999,999 confirmed cases
  10,000–99,999 confirmed cases
  1,000–9,999 confirmed cases
  100–999 confirmed cases
  1–99 confirmed cases
  No confirmed cases or no data
Confirmed deaths per capita map
COVID-19 Outbreak World Map Total Deaths per Capita.svg
Map of confirmed deaths per capita as of 16 May 2020
  100+ confirmed deaths per million
  10–100 confirmed deaths per million
  1–10 confirmed deaths per million
  0.1–1 confirmed deaths per million
  >0–0.1 confirmed deaths per million
  No confirmed deaths or no data
Confirmed cases per capita interactive timeline

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Timeline map of confirmed cases per capita
(drag circle to adjust; may not work on mobile)
See larger version
  1,000+ confirmed cases per million
  100–1,000 confirmed cases per million
  10–100 confirmed cases per million
  >0–10 confirmed cases per million
  No confirmed cases or no data
A nurse caring for a patient with COVID-19 in an intensive care unit
Meeting of the Italian government task force to face the coronavirus outbreak, 23 February 2020
Taiwanese 33rd Chemical Corps spraying disinfectant on a street in Taipei
Passengers at Linate Airport in Milan have their temperatures taken
Almost empty supermarket aisle in Melbourne, Australia
(Top to bottom)
DiseaseCoronavirus disease 2019 (COVID-19)
Virus strainSevere acute respiratory syndrome
coronavirus 2
(SARS‑CoV‑2)[lower-alpha 1]
SourceProbably bats, possibly via pangolins[2][3]
LocationWorldwide
First outbreakChina[4]
Index caseWuhan, Hubei, China
30°37′11″N 114°15′28″E / 30.61972°N 114.25778°E / 30.61972; 114.25778
DateDecember 2019[4] – present
(1 year, 7 months and 4 weeks)
Confirmed cases115,128,349[5][lower-alpha 2]
Active cases47,470,776[5]
Recovered65,099,514[5]
Deaths
2,558,059[5]
Territories
192[5]

The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing pandemic of coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2).[1] The outbreak was first identified in Wuhan, China, in December 2019.[4][6] The World Health Organization declared the outbreak a Public Health Emergency of International Concern on 30 January, and a pandemic on 11 March.[7][8] As of 4 March 2021, more than 115 million cases of COVID-19 have been reported in more than 192 countries and territories, resulting in more than 2.55 million deaths. More than 65 million people have recovered.[5]

{{#lst:Coronavirus disease 2019|Spread}}

Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell.[9][10][11] Complications may include pneumonia and acute respiratory distress syndrome.[12] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[13][14] There is no known vaccine or specific antiviral treatment.[9] Primary treatment is symptomatic and supportive therapy.[15]<section begin="intro-cases" /><section end="intro-cases" /><section begin="intro-cases" /><section end="intro-cases" /><section begin="intro-cases" /><section end="intro-cases" />

Recommended preventive measures include hand washing, covering one's mouth when coughing, maintaining distance from other people, wearing a face mask in public settings, and monitoring and self-isolation for people who suspect they are infected.[9][16] Authorities worldwide have responded by implementing travel restrictions, lockdowns, workplace hazard controls, and facility closures. Many places have also worked to increase testing capacity and trace contacts of infected persons.

The pandemic has caused severe global economic disruption,[17] including the largest global recession since the Great Depression.[18] It has led to the postponement or cancellation of sporting, religious, political, and cultural events,[19] widespread supply shortages exacerbated by panic buying,[20][21] and decreased emissions of pollutants and greenhouse gases.[22][23] Schools, universities, and colleges have closed either on a nationwide or local basis in 186 countries, affecting approximately 98.5 percent of the world's student population.[24] Misinformation about the virus has spread online,[25] and there have been incidents of xenophobia and discrimination against Chinese people and against those perceived as being Chinese or as being from areas with high infection rates.[26][27][28] File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm

Epidemiology

Locations[lower-alpha 3] Cases[lower-alpha 2] Deaths[lower-alpha 4] Recov.[lower-alpha 5] Ref.
229 115,128,349 2,558,059 65,099,514 [5]
United States[lower-alpha 6] 1,510,506 89,700 276,031 [36]
Russia[lower-alpha 7] 281,752 2,631 67,373 [37]
United Kingdom[lower-alpha 8] 243,303 34,636 No data [39][40]
Brazil 233,648 15,668 89,672 [41][42]
Spain[lower-alpha 9] 231,350 27,650 149,576 [43]
Italy 225,435 31,908 125,176 [44][45]
Germany[lower-alpha 10] 176,639 8,027 153,400 [47][46]
Turkey 149,435 4,140 109,962 [48]
France[lower-alpha 11] 142,411 28,108 61,213 [49]
Iran 120,198 6,988 94,464 [50]
India 90,927 2,872 34,109 [51]
Peru 88,541 2,523 28,272 [52][53]
China[lower-alpha 12] 82,947 4,634 78,227 [54]
Canada 76,944 5,781 38,463 [55]
Belgium[lower-alpha 13] 55,280 9,052 14,630 [57]
Saudi Arabia 54,752 312 25,722 [58]
Mexico 47,144 5,045 31,848 [59][60]
Netherlands[lower-alpha 14] 43,995 5,680 No data [62]
Chile[lower-alpha 15] 41,428 421 18,014 [69]
Pakistan 40,151 873 11,341 [70]
Ecuador 32,763 2,688 3,433 [71]
Qatar 32,604 15 4.370 [72]
Switzerland 30,587 1,603 27,400 [73][74]
Sweden 30,143 3,679 4,971 [75][76]
Belarus 29,650 165 9,932 [77]
Portugal 29,036 1,218 4,636 [78]
Singapore 28,038 22 9,340 [79][80]
Ireland 24,112 1,543 19,470 [81][82]
United Arab Emirates 23,358 220 8,512 [83]
Bangladesh 22,268 328 4,373 [84]
Poland 18,394 919 7,451 [75][85]
Ukraine[lower-alpha 16] 18,291 514 5,116 [86]
Indonesia 17,514 1,148 4,129 [87]
Romania 16,871 1,097 9,890 [88]
Israel[lower-alpha 17] 16,607 271 12,884 [89]
Japan[lower-alpha 18] 16,253 729 10,809 [90][91]
Austria 16,167 629 14,563 [92][93]
Colombia 14,939 562 3,587 [94]
South Africa 14,355 261 6,478 [95]
Kuwait 14,850 112 4,093 [96][97]
Philippines 12,513 824 2,635 [98][99]
Dominican Republic 12,110 428 3,726 [100]
Egypt[lower-alpha 19] 11,719 612 3,526 [101]
South Korea 11,050 262 9,888 [102]
Denmark[lower-alpha 20] 10,927 547 9,227 [103]
Serbia[lower-alpha 21] 10,610 230 4,713 [104]
Panama 9,449 269 6,080 [105]
Czech Republic 8,457 297 5,422 [106]
Norway[lower-alpha 22] 8,244 232 7,114 [109]
Argentina[lower-alpha 23] 7,792 363 2,521 [111]
Australia[lower-alpha 24] 7,049 98 6,367 [112]
Algeria 7,019 548 3,507 [113][114]
Bahrain 6,956 12 2,910 [115]
Malaysia 6,894 113 5,571 [116]
Morocco[lower-alpha 25] 6,870 192 3,660 [118]
Afghanistan 6,664 169 784 [119]
Finland[lower-alpha 26] 6,347 298 5,000 [120]
Kazakhstan 6,157 34 3,090 [122]
Moldova[lower-alpha 27] 6,060 211 2,408 [123]
Ghana 5,735 29 1,754 [124]
Nigeria 5,621 176 1,472 [125]
Oman 5,186 22 1,465 [126]
Armenia 4,472 60 1,925 [127]
Luxembourg 3,945 107 3,702 [128]
Bolivia 3,826 165 473 [129]
Hungary 3,509 451 1,396 [130]
Iraq 3,404 123 2,218
[131]
Azerbaijan[lower-alpha 28] 3,274 39 2,015 [132]
Cameroon 3,105 140 1,567 [133]
Thailand 3,028 56 2,856 [134]
Greece 2,834 163 1,374 [135][136]
Uzbekistan 2,746 12 2,247 [137]
Guinea 2,658 16 1,133 [138]
Puerto Rico 2,646 123 850 [139][36]
Honduras 2,565 138 278 [140]
Senegal 2,480 25 973 [141]
Bosnia & Herzegovina 2,290 133 1,436 [142]
Sudan 2,289 97 222 [143]
Croatia 2,226 95 1,936 [144]
Bulgaria 2,211 108 598 [145]
Ivory Coast 2,109 27 1,004 [146]
Cuba[lower-alpha 29] 1,872 79 1,495 [147]
Iceland 1,802 10 1,782 [148]
North Macedonia 1,792 101 1,293 [149]
Estonia 1,774 63 938 [150]
Guatemala 1,763 33 138 [151]
Lithuania 1,541 56 997 [152]
Tajikistan 1,524 39 0 [153]
Slovakia 1,494 28 1,163 [154]
Slovenia 1,466 104 273 [155][156]
DR Congo[lower-alpha 30] 1,454 61 270 [157]
Somalia[lower-alpha 31] 1,421 56 152 [158]
Djibouti 1,401 4 972 [159]
El Salvador 1,338 27 462 [160]
Gabon 1,320 11 244 [161]
New Zealand[lower-alpha 32] 1,149 21 1,433 [162]
Kyrgyzstan 1,138 14 804 [163]
USS Theodore Roosevelt[lower-alpha 33] 1,102 1 53 [164]
Maldives 1,090 4 58 [165]
Charles de Gaulle[lower-alpha 34] 1,081 0 0 [166]
Hong Kong 1,056 4 1,024 [170]
Tunisia 1,037 45 807 [171]
Latvia 1,008 19 662 [75][172]
Sri Lanka 981 9 538 [173]
Guinea-Bissau 969 4 26 [174]
Kosovo 955 29 691 [175]
Albania 946 31 715 [176]
Cyprus[lower-alpha 35] 916 17 515 [177]
Lebanon 911 26 247 [178]
Niger 889 51 689 [179]
Kenya 887 50 313 [180]
Costa Rica 863 10 565 [181]
Mali 860 452 494 [182]
Burkina Faso 796 51 644 [183]
Paraguay 786 11 1202 [184]
Andorra 761 51 617 [185]
Zambia 753 7 188 [186]
Uruguay[lower-alpha 36] 733 19 558 [187]
Diamond Princess[lower-alpha 18] 712 14 653 [90][188]
Georgia[lower-alpha 37] 695 12 425 [189]
San Marino 654 41 201 [190]
Jordan 613 9 408 [191]
Equatorial Guinea 594 7 22 [192]
Malta 553 6 454 [193]
Jamaica 517 9 121 [194]
Tanzania 509 21 183 [195][196]
Sierra Leone 505 32 141 [197]
Venezuela 504 10 241 [198]
Chad 503 53 117 [199]
Taiwan[lower-alpha 38] 440 7 389 [201]
Congo[lower-alpha 39] 412 15 110 [202][203]
Palestine 381 2 335 [204]
Benin 339 2 83 [205]
Isle of Man[lower-alpha 40] 335 24 285 [206]
Mauritius 332 10 322 [207]
Cape Verde 328 2 67 [208]
Montenegro 324 9 311 [209]
Vietnam 320 0 260 [210]
Ethiopia 317 5 113 [211]
Luhansk PR[lower-alpha 41] 312 2 104 [212]
Haiti 310 20 19 [213]
Madagascar 304 1 114 [214]
Jersey 302 27 226 [215]
Central African Republic 301 0 13 [216][217]
Togo 298 11 99 [218]
Rwanda 292 0 197 [219][220]
Nepal 295 2 36 [221][222]
Guernsey 252 13 232 [223]
Donetsk PR[lower-alpha 41] 246 5 36 [224]
South Sudan 236 4 4 [225]
São Tomé & Príncipe 235 7 4 [226][227]
Uganda 227 0 63 [228][229]
Liberia 226 21 120 [230]
Eswatini 203 2 73 [231]
Faroe Islands 187 0 187 [232]
Myanmar 184 6 97 [233]
Guam[lower-alpha 33] 154 5 128 [36][234]
Costa Atlantica 148 0 0 [235]
Gibraltar 147 0 145 [236]
Brunei 141 1 136 [237][238]
Mozambique 137 0 44 [239]
Mongolia 136 0 21 [240]
Greg Mortimer[lower-alpha 36] 128 0 No data [241]
Yemen 128 20 1 [242]
Bermuda 123 9 73 [243]
Cambodia 122 0 122 [244]
Guyana 117 10 43 [245]
Trinidad & Tobago 116 8 107 [246]
Northern Cyprus[lower-alpha 42] 108 4 104 [247]
Aruba 101 3 93 [248]
Bahamas 96 11 42 [249]
Monaco 96 4 87 [250]
Cayman Islands 94 1 55 [251]
Somaliland[lower-alpha 43] 87 8 15 [252]
Barbados 86 7 67 [253]
Liechtenstein 82 1 55 [254][255]
Sint Maarten 77 15 54 [256]
U.S. Virgin Islands 69 6 61 [257]
Libya 65 3 28 [258]
Malawi 65 3 24 [259]
French Polynesia 60 0 59 [260]
Syria[lower-alpha 44] 58 3 36 [261]
Angola 48 2 14 [262]
Macau 45 0 44 [263]
Zimbabwe 44 4 17 [264][265]
Mauritania 40 3 7 [266]
Eritrea 39 0 38 [267]
South Ossetia[lower-alpha 45] 30 0 0 [268]
Nicaragua 25 8 7 [75][269]
Antigua & Barbuda 24 3 11 [270]
East Timor 24 0 21 [271]
Botswana 24 1 17 [272][273]
Burundi 23 1 11 [274]
The Gambia 23 1 12 [275]
Grenada 22 0 14 [276]
Bhutan 21 0 5 [277]
Northern Mariana Islands 21 2 12 [278]
Artsakh[lower-alpha 46] 20 0 8 [268]
Laos 19 0 14 [279]
Belize 18 2 16 [280]
Fiji 18 0 15 [281]
New Caledonia 18 0 18 [282]
Saint Lucia 18 0 18 [283][284]
Abkhazia[lower-alpha 47] 17 1 2 [268]
Saint Vincent[lower-alpha 48] 17 0 14 [285][286]
Curaçao 16 1 14 [287]
Dominica 16 0 15 [288]
Namibia 16 0 13 [289]
Saint Kitts & Nevis 15 0 14 [290]
Falkland Islands 13 0 13 [291]
MS Zaandam[lower-alpha 49] 13 4 No data [294][295]
Coral Princess[lower-alpha 50] 12 2 No data [297]
Turks & Caicos Islands 12 1 10 [298]
Vatican City 12 0 2 [299]
Comoros 11 1 3 [300]
Greenland 11 0 11 [301]
Montserrat 11 1 10 [302]
Seychelles 11 0 7 [303]
Suriname 10 1 9 [304]
British Virgin Islands 8 1 6 [305]
HNLMS Dolfijn[lower-alpha 51] 8 0 No data [306]
Papua New Guinea 8 0 8 [309]
Anguilla 3 0 3 [310]
Bonaire 2 0 2 [311]
Saba 2 0 2 [312]
Sint Eustatius 2 0 2 [313]
Lesotho 1 0 0 [314]
Saint Pierre & Miquelon 1 0 1 [315]
As of 17 May 2020 (UTC) · History of cases: China, international
For notes, see the Notes section.

Background

On 31 December 2019, health authorities in China reported to the World Health Organization (WHO) a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei Province,[316][317] and an investigation was launched in early January 2020.[318] On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC)—7,818 cases confirmed globally, affecting 19 countries in five WHO regions.[319][320]

Several of the early cases had visited Huanan Seafood Wholesale Market [321] and so the virus is thought to have a zoonotic origin.[322] The virus that caused the outbreak is known as SARS‑CoV‑2, a newly discovered virus closely related to bat coronaviruses,[323] pangolin coronaviruses,[324][325] and SARS-CoV.[326] The scientific consensus is that COVID-19 has a natural origin.[327][328] The probable bat-to-human infection may have been among people processing bat carcasses and guano in the production of traditional Chinese medicines.[329]

The earliest known person with symptoms was later discovered to have fallen ill on 1 December 2019, and that person did not have visible connections with the later wet market cluster.[330][331] Of the early cluster of cases reported that month, two-thirds were found to have a link with the market.[332][333][334] On 13 March 2020, an unverified report from the South China Morning Post suggested a case traced back to 17 November 2019 (a 55-year-old from Hubei) may have been the first person infected.[335][336]

The WHO recognized the spread of COVID-19 as a pandemic on 11 March 2020.[337] Italy, Iran, South Korea, and Japan reported surging cases. The total numbers outside China quickly passed China's.[338]

Cases

Cases refer to the number of people who have been tested for COVID-19, and whose test has been confirmed positive according to official protocols.[339] As of

  1. REDIRECT Template:Testing for COVID-19

, countries that publicised their testing data have typically performed many tests equal to

  1. REDIRECT Template:Testing for COVID-19

percent of their population, while no country tested samples equal to more than

  1. REDIRECT Template:Testing for COVID-19

percent of its population.[340] Many countries, early on, had official policies to not test those with only mild symptoms.[341][342] An analysis of the early phase of the outbreak up to 23 January estimated 86 percent of COVID-19 infections had not been detected, and that these undocumented infections were the source for 79 percent of documented cases.[343] Several other studies, using a variety of methods, have estimated that numbers of infections in many countries are likely to be considerably greater than the reported cases.[344][345]

On 9 April 2020, preliminary results found that 15 percent of people tested in Gangelt, the centre of a major infection cluster in Germany, tested positive for antibodies.[346] Screening for COVID-19 in pregnant women in New York City, and blood donors in the Netherlands, has also found rates of positive antibody tests that may indicate more infections than reported.[347][348] However, such antibody surveys can be unreliable due to a selection bias in who volunteers to take the tests, and due to false positives. Some results (such as the Gangelt study) have received substantial press coverage without first passing through peer review.[349]

Analysis by age in China indicates that a relatively low proportion of cases occur in individuals under 20.[350] It is not clear whether this is because young people are less likely to be infected, or less likely to develop serious symptoms and seek medical attention and be tested.[351] A retrospective cohort study in China found that children were as likely to be infected as adults.[352] Countries that test more, relative to the number of deaths, have a younger age distribution of cases, relative to the wider population.[353]

Initial estimates of the basic reproduction number (R0) for COVID-19 in January were between 1.4 and 2.5,[354] but a subsequent analysis has concluded that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9).[355] R0 can vary across populations and is not to be confused with the effective reproduction number (commonly just called R), which takes into account effects such as social distancing and herd immunity. As of mid-May 2020, the effective R is close to or below 1.0 in many countries, meaning the spread of the disease in these areas is stable or decreasing.[356]

Deaths

Deceased in a 16 m (53 ft) "mobile morgue" outside a hospital in Hackensack, New Jersey, United States on 27 April 2020

Most people who contract COVID-19 recover. For those who do not, the time between the onset of symptoms and death usually ranges from 6 to 41 days, typically about 14 days.[363] As of 4 March 2021, approximately 2.55 million[5] deaths had been attributed to COVID-19. In China, as of 5 February, about 80 percent of deaths were recorded in those aged over 60, and 75 percent had pre-existing health conditions including cardiovascular diseases and diabetes.[364]

The first confirmed death was in Wuhan on 9 January 2020.[365] The first death outside of China occurred on 1 February in the Philippines,[366] and the first death outside Asia was in France on 14 February.[367]

Official deaths from COVID-19 generally refer to people who died after testing positive according to protocols. This may ignore deaths of people who die without testing, e.g. at home or in nursing homes.[368] Conversely, deaths of people who had underlying conditions may lead to overcounting.[369] Comparison of statistics for deaths for all causes versus the seasonal average indicates excess mortality in many countries.[370][371] In the worst affected areas, mortality has been several times higher than average. In New York City, deaths have been four times higher than average, in Paris twice as high, and in many European countries, deaths have been on average 20 to 30 percent higher than normal.[370] This excess mortality may include deaths due to strained healthcare systems and bans on elective surgery.[372]

Several measures are used to quantify mortality.[373] These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics, such as age, sex, and overall health.[374] Some countries (like Belgium) include deaths from suspected cases of COVID-19, regardless of whether the person was tested, resulting in higher numbers compared to countries that include only test-confirmed cases.[375]

The death-to-case ratio reflects the number of deaths attributed to COVID-19 divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2 percent (2,558,059 deaths for 115,128,349 cases) as of 4 March 2021.[5] The number varies by region.[376]

Other measures include the case fatality rate (CFR), which reflects the percentage of diagnosed people who die from a disease, and the infection fatality rate (IFR), which reflects the percentage of infected (diagnosed and undiagnosed) who die from a disease. These statistics are not timebound and follow a specific population from infection through case resolution. Our World in Data states that as of 25 March 2020 the IFR cannot be accurately calculated as neither the total number of cases nor the total deaths, is known.[377] In February the Institute for Disease Modeling estimated the IFR as 0.94% (95% confidence interval 0.37-2.9), based on data from China.[378][379] The University of Oxford's Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.82 percent and IFR of 0.1 percent to 0.41 percent, acknowledging that this will vary between populations due to differences in demographics.[380]

Duration

The WHO said on 11 March 2020 the pandemic could be controlled.[8] The peak and ultimate duration of the outbreak are uncertain and may differ by location. Maciej Boni of Penn State University said, "Left unchecked, infectious outbreaks typically plateau and then start to decline when the disease runs out of available hosts. But it's almost impossible to make any sensible projection right now about when that will be."[383] The Imperial College study led by Neil Ferguson stated that physical distancing and other measures will be required "until a vaccine becomes available (potentially 18 months or more)".[384] William Schaffner of Vanderbilt University said because the coronavirus is "so readily transmissible", it "might turn into a seasonal disease, making a comeback every year". The virulence of the comeback would depend on herd immunity and the extent of mutation.[385]

Signs and symptoms

Symptoms of COVID-19[386]

The usual incubation period (the time between infection and symptom onset) ranges from one to 14 days, and is most commonly five days.[9][387] Some infected people have no symptoms, known as asymptomatic or presymptomatic carriers; transmission from such a carrier is considered possible.[388] As at 6 April, estimates of the asymptomatic ratio range widely from 5% to 80%.[389]

Symptoms of COVID-19 can be relatively non-specific; the two most common symptoms are fever (88 percent) and dry cough (68 percent). Less common symptoms include fatigue, respiratory sputum production (phlegm), loss of the sense of smell, loss of taste, shortness of breath, muscle and joint pain, sore throat, headache, chills, vomiting, coughing out blood, and diarrhea.[390][391][392]

Among those who develop symptoms, approximately one in five may become more seriously ill and have difficulty breathing.[9] Emergency symptoms include difficulty breathing, persistent chest pain or pressure, sudden confusion, difficulty waking, and bluish face or lips; immediate medical attention is advised if these symptoms are present.[11] Further development of the disease can lead to complications including pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and kidney failure.[391]

Cause

Transmission

{{#lst:Coronavirus disease 2019|Transmission}}

Virology

Illustration of SARSr‑CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a novel virus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[326] All features of the novel SARS‑CoV‑2 virus occur in related coronaviruses in nature.[393]

SARS‑CoV‑2 is closely related to SARS‑CoV, and is thought to have a zoonotic origin.[323] SARS‑CoV‑2 genetically clusters with the genus Betacoronavirus, and is 96 percent identical at the whole genome level to other bat coronavirus samples[394] and 92 percent identical to pangolin coronavirus.[395]

Diagnosis

Demonstration of a swab for COVID-19 testing

COVID-19 can be provisionally diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) testing of infected secretions or CT imaging of the chest.[396][397]

Viral testing

The standard test for current infection with SARS-CoV-2 uses RNA testing of respiratory secretions collected using a nasopharyngeal swab, though it is possible to test other samples. This test uses real-time rRT-PCR which detects presence of viral RNA fragments.[398]

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection.[399] Several have been evaluated by Public Health England and approved for use in the UK.[400]

Imaging

A CT scan of a person with COVID‑19 shows light patches in the lungs.

Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.[401] The Italian Radiological Society is compiling an international online database of imaging findings for confirmed cases.[402] Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19.[401] A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.[397]

Prevention

Infographic by the U.S. Centers for Disease Control and Prevention (CDC), describing how to stop the spread of germs

Strategies for preventing transmission of the disease include maintaining overall good personal hygiene, washing hands, avoiding touching the eyes, nose, or mouth with unwashed hands, and coughing or sneezing into a tissue, and putting the tissue directly into a waste container. Those who may already have the infection have been advised to wear a surgical mask in public.[403][404] Physical distancing measures are also recommended to prevent transmission.[405][406] Health care providers taking care of someone who may be infected are recommended to use standard precautions, contact precautions, and eye protection.[407]

Many governments have restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak.[408] The virus has already spread within communities in large parts of the world, with many not knowing where or how they were infected.[409]

Misconceptions are circulating about how to prevent infection; for example, rinsing the nose and gargling with mouthwash are not effective.[410] There is no COVID-19 vaccine, though many organisations are working to develop one.[411]

Hand washing

Hand washing is recommended to prevent the spread of the disease. The CDC recommends that people wash hands often with soap and water for at least twenty seconds (the length of singing "Happy Birthday" twice), especially after going to the toilet or when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. This is because outside the human body, the virus is killed by household soap, which bursts its protective bubble.[16] CDC further recommended using an alcohol-based hand sanitiser with at least 60 percent alcohol by volume when soap and water are not readily available.[403] The WHO advises people to avoid touching the eyes, nose, or mouth with unwashed hands.[404][412] It is not clear if washing hands with ash if soap is not available is effective at reducing the spread of viral infections.[413]

Surface cleaning

Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective.[414] The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons, should be disinfected.[415]

Face masks and respiratory hygiene

Taiwan President Tsai Ing-wen wearing a mask

Recommendations for wearing masks have been a subject of debate.[416] The WHO has recommended healthy people wear masks only if they are at high risk, such as those who are caring for a person with COVID-19.[417] China and the United States, among other countries, have encouraged the use of face masks or cloth face coverings more generally by members of the public to limit the spread of the virus by asymptomatic individuals as a precautionary principle.[418][419] Several national and local governments have made wearing masks mandatory.[420]

Surgical masks are recommended for those who may be infected, as wearing this type of mask can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing.[417]

Social distancing

Physical distancing in Toronto, with a limited number of customers allowed inside a store

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others.[404][421][422] Many governments are now mandating or recommending social distancing in regions affected by the outbreak.[423][424] Non-cooperation with distancing measures in some areas has contributed to the further spread of the pandemic.[425]

The maximum gathering size recommended by U.S. government bodies and health organisations was swiftly reduced from 250 people (if there was no known COVID-19 spread in a region) to 50 people, and later to 10.[426] On 22 March 2020, Germany banned public gatherings of more than two people.[427] A Cochrane review found that early quarantine with other public health measures are effective in limiting the pandemic, but the best manner of adopting and relaxing policies are uncertain, as local conditions vary.[422]

Older adults and those with underlying medical conditions such as diabetes, heart disease, respiratory disease, hypertension, and compromised immune systems face increased risk of serious illness and complications and have been advised by the CDC to stay home as much as possible in areas of community outbreak.[428][429]

In late March 2020, the WHO and other health bodies began to replace the use of the term "social distancing" with "physical distancing", to clarify that the aim is to reduce physical contact while maintaining social connections, either virtually or at a distance. The use of the term "social distancing" had led to implications that people should engage in complete social isolation, rather than encouraging them to stay in contact through alternative means.[430][431]

Some authorities have issued sexual health guidelines for use during the pandemic. These include recommendations to have sex only with someone you live with, and who does not have the virus or symptoms of the virus.[432][433]

Self-isolation

Transmission of COVID-19 depends on many factors, including physical distance.

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation.[434][435]

Many governments have mandated or recommended self-quarantine for entire populations living in affected areas.[436][437] The strongest self-quarantine instructions have been issued to those in high risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.[9][13][438]

Management

Containment and mitigation

Goals of mitigation include delaying and reducing peak burden on healthcare (flattening the curve) and lessening overall cases and health impact.[439][440] Moreover, progressively greater increases in healthcare capacity (raising the line) such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[441]
Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[439][442]

Strategies in the control of an outbreak are containment or suppression, and mitigation. Containment is undertaken in the early stages of the outbreak and aims to trace and isolate those infected as well as introduce other measures of infection control and vaccinations to stop the disease from spreading to the rest of the population. When it is no longer possible to contain the spread of the disease, efforts then move to the mitigation stage: measures are taken to slow the spread and mitigate its effects on the healthcare system and society. A combination of both containment and mitigation measures may be undertaken at the same time.[443] Suppression requires more extreme measures so as to reverse the pandemic by reducing the basic reproduction number to less than 1.[384]

Part of managing an infectious disease outbreak is trying to delay and decrease the epidemic peak, known as flattening the epidemic curve.[439] This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed.[439] Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures such as hand hygiene, wearing face masks, and self-quarantine; community measures aimed at physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning.[444]

More drastic actions aimed at containing the outbreak were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities and imposing strict travel bans.[445] Other countries also adopted a variety of measures aimed at limiting the spread of the virus. South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. Singapore provided financial support for those infected who quarantined themselves and imposed large fines for those who failed to do so. Taiwan increased face mask production and penalised hoarding of medical supplies.[446]

Simulations for Great Britain and the United States show that mitigation (slowing but not stopping epidemic spread) and suppression (reversing epidemic growth) have major challenges. Optimal mitigation policies might reduce peak healthcare demand by two-thirds and deaths by half, but still result in hundreds of thousands of deaths and overwhelmed health systems. Suppression can be preferred but needs to be maintained for as long as the virus is circulating in the human population (or until a vaccine becomes available), as transmission otherwise quickly rebounds when measures are relaxed. Long-term intervention to suppress the pandemic has considerable social and economic costs.[384]

Contact tracing

Contact tracing is an important method for health authorities to determine the source of an infection and to prevent further transmission.[447] The use of location data from mobile phones by governments for this purpose has prompted privacy concerns, with Amnesty International and more than a hundred other organisations issuing a statement calling for limits on this kind of surveillance.[448]

Several mobile apps have been implemented or proposed for voluntary use, and as of 7 April 2020 more than a dozen expert groups were working on privacy-friendly solutions such as using Bluetooth to log a user's proximity to other cellphones.[448] Users could then receive a message if they've been in close contact with someone who has subsequently tested positive for COVID-19.[448]

On 10 April 2020 Google and Apple jointly announced an initiative for privacy-preserving contact tracing based on Bluetooth technology and cryptography.[449][450] The system is intended to allow governments to create official privacy-preserving coronavirus tracking apps, with the eventual goal of integration of this functionality directly into the iOS and Android mobile platforms.[451] In Europe and in the U.S., Palantir Technologies is also providing COVID-19 tracking services.[452]

Health care

An army-constructed field hospital outside Östra sjukhuset (Eastern hospital) in Gothenburg, Sweden, contains temporary intensive care units for COVID-19 patients.

Increasing capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure.[453] The ECDC and the European regional office of the WHO have issued guidelines for hospitals and primary healthcare services for shifting of resources at multiple levels, including focusing laboratory services towards COVID-19 testing, cancelling elective procedures whenever possible, separating and isolating COVID-19 positive patients, and increasing intensive care capabilities by training personnel and increasing the number of available ventilators and beds.[453][454]

Due to capacity limitations in the standard supply chains, some manufacturers are 3D printing healthcare material such as nasal swabs and ventilator parts.[455][456] In one example, when an Italian hospital urgently required a ventilator valve, and the supplier was unable to deliver in the timescale required, a local startup received legal threats due to alleged patent infringement and reverse-engineered and printed the required hundred valves overnight.[457][458][459] On 23 April 2020, NASA reported building, in 37 days, a ventilator which is currently undergoing further testing. NASA is seeking fast-track approval.[460][461]

Treatment

Antiviral medications are under investigation for COVID-19, as well as medications targeting the immune response.[462] None has yet been shown to be clearly effective on mortality in published randomised controlled trials.[462] However, remdesivir may have an effect on the time it takes to recover from the virus.[463] Emergency use authorisation for remdesivir was granted in the U.S. on 1 May, for people hospitalised with severe COVID-19. The interim authorisation was granted considering the lack of other specific treatments, and that its potential benefits appear to outweigh the potential risks.[464] Taking over-the-counter cold medications,[465] drinking fluids, and resting may help alleviate symptoms.[403] Depending on the severity, oxygen therapy, intravenous fluids, and breathing support may be required.[466] The use of steroids may worsen outcomes.[467] Several compounds which were previously approved for treatment of other viral diseases are being investigated for use in treating COVID-19.[468]

History

Cases by country, plotted on a logarithmic scale[469]

There are several theories about where the very first case (the so-called patient zero) originated.[470] The first known case may trace back to 1 December 2019 in Wuhan, Hubei, China.[330] Over the next month, the number of coronavirus cases in Hubei gradually increased. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals.[322]

On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus.[471] A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December.[472][473] On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. That evening, the Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause".[474] Eight of these doctors, including Li Wenliang (punished on 3 January),[475] were later admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm.[476]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases[316][477][478]—enough to trigger an investigation.[318]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days.[479] In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange.[394] On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen.[480] Later official data shows 6,174 people had already developed symptoms by then,[481] and more may have been infected.[482] A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential".[332][483] On 30 January, the WHO declared the coronavirus a public health emergency of international concern.[482]

On 31 January 2020, Italy had its first confirmed cases, two tourists from China.[484] As of 13 March 2020 the WHO considered Europe the active centre of the pandemic.[485] On 19 March 2020, Italy overtook China as the country with the most deaths.[486] By 26 March, the United States had overtaken China and Italy with the highest number of confirmed cases in the world.[487] Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country.[488] Retesting of prior samples found a person in France who had the virus on 27 December 2019[489][490] and a person in the United States who died from the disease on 6 February 2020.[491]

As of 15 May 2020, more than 115 million cases have been reported worldwide; more than 2.55 million people have died and more than 65 million have recovered.[492][493]

National responses

Map of national and subnational lockdowns as of 30 March 2020 (table; more details)
  National lockdown
  Subnational lockdown
  No lockdown

A total of 192[5] countries and territories have had at least one case of COVID-19 so far. Due to the pandemic in Europe, many countries in the Schengen Area have restricted free movement and set up border controls.[494] National reactions have included containment measures such as quarantines and curfews (known as stay-at-home orders, shelter-in-place orders, or lockdowns).[495]

By 26 March, 1.7 billion people worldwide were under some form of lockdown,[496] which increased to 3.9 billion people by the first week of April—more than half the world's population.[497][498]

By late April, around 300 million people were under lockdown in nations of Europe, including but not limited to Italy, Spain, France, and the United Kingdom, while around 200 million people were under lockdown in Latin America.[499] Nearly 300 million people, or about 90 percent of the population, were under some form of lockdown in the United States,[500] around 100 million people in the Philippines,[499] about 59 million people in South Africa,[501] and 1.3 billion people have been under lockdown in India.[502][503]

Asia

As of 30 April 2020, cases have been reported in all Asian countries except for Turkmenistan[504] and North Korea,[505] although these countries likely also have cases.[506]

"Ramadan exodus" contributed to the spread of the virus in Indonesia,[507] despite government regulations on social distancing and despite a lockdown slated to run until June.[508]

China

Confirmed cases of COVID-19 per 100,000 inhabitants by province, as of 13 April, showing Hubei with around 40 times more cases than any other province
  Hubei Province: 114.40 cases per 100,000
  1.5–2.5 cases per 100,000
  1–1.5 cases per 100,000
  0.5–1 cases per 100,000
  >0–0.5 cases per 100,000
Semi-log graph of new cases and deaths in China during the COVID-19 epidemic showing the lockdown and lifting

The first confirmed case of COVID-19 has been traced back to 1 December 2019 in Wuhan;[330] one unconfirmed report suggests the earliest case was on 17 November.[335] Doctor Zhang Jixian observed a cluster of pneumonia cases of unknown cause on 26 December, upon which her hospital informed Wuhan Jianghan CDC on 27 December.[509][510] Initial genetic testing of patient samples on 27 December 2019 indicated the presence of a SARS-like coronavirus.[509] A public notice was released by Wuhan Municipal Health Commission on 31 December, confirming 27 cases and suggesting wearing face masks.[478] The WHO was informed on the same day.[316] As these notifications occurred, doctors in Wuhan were warned by police for "spreading rumours" about the outbreak.[511] The Chinese National Health Commission initially said there was no "clear evidence" of human-to-human transmission.[512] In a 14 January conference call, Chinese officials said privately that human-to-human transmission was a possibility, and pandemic preparations were needed.[513] In a briefing posted during the night of 14–15 January, the Wuhan Municipal Health Commission said the possibility of limited human-to-human transmission could not be ruled out.[514]

On 20 January, the Chinese National Health Commission announced that human-to-human transmission of the coronavirus had already occurred.[515] That same day, Chinese Communist Party general secretary Xi Jinping and State Council premier Li Keqiang issued their first public comments about the virus, telling people in infected areas to practice social distancing and avoid travel.[516][517] During the Chinese New Year travel period, authorities instigated a City of Wuhan lockdown.[518] On 10 February, since Wuhan travellers already transported the virus to some Asian countries,[519][520][521] the Chinese government launched a radical campaign described by paramount leader and Chinese Communist Party general secretary Xi as a "people's war" to contain the viral spread.[522] In "the largest quarantine in human history",[523] a cordon sanitaire on 23 January stopped travel in and out of Wuhan,[524][525] then extended to fifteen Hubei cities affecting about 57 million people.[526] Private vehicle use was banned in the city.[527] Several Chinese New Year (25 January) celebrations were also cancelled.[528] Authorities announced the construction of a temporary hospital, Huoshenshan Hospital, completed in ten days.[529] Leishenshan Hospital, was later built to handle additional patients.[530] China also converted other facilities in Wuhan, such as convention centres and stadiums, into temporary hospitals.[531]

Wuhan Leishenshan Hospital, an emergency speciality field hospital built in response to the pandemic
A temporary hospital for treating mild cases of COVID-19 in Wuhan, one of more than ten such hospitals in the city[532]

On 26 January, the government instituted further measures to contain the COVID-19 outbreak, including issuing health declarations for travellers[533] and extending the Spring Festival holiday.[534] Universities and schools around the country were also closed.[535][536][537] The regions of Hong Kong and Macau instituted several measures, particularly in regard to schools and universities.[538] Remote working measures were instituted in several Chinese regions.[539] Travel restrictions were enacted in and outside of Hubei.[539][540] Public transport was modified,[541] and museums throughout China were temporarily closed.[539][542][543] Control of public movement was applied in many cities, and it has been estimated that 760 million people (more than half the population) faced some form of outdoor restriction.[544] In January and February 2020, during the height of the epidemic in Wuhan, about 5 million people lost their jobs.[545] Many of China's nearly 300 million rural migrant workers have been stranded at home in inland provinces or trapped in Hubei province.[546][547]

After the outbreak entered its global phase in March, Chinese authorities took strict measures to prevent the virus re-entering China from other countries. For example, Beijing imposed a 14-day mandatory quarantine for all international travellers entering the city.[548] At the same time, a strong anti-foreigner sentiment quickly took hold,[549] and foreigners experienced harassment by the general public[550] and forced evictions from apartments and hotels.[28][551]

On 24 March, Chinese Premier Li Keqiang reported that the spread of domestically transmitted cases has been basically blocked and the outbreak has been controlled in China.[552] The same day travel restrictions were eased in Hubei, apart from Wuhan, two months after the lockdown was imposed.[553]The Chinese Ministry of Foreign Affairs announced on 26 March that entry for visa or residence permit holders would be suspended from 28 March onwards, with no specific details on when this policy would end. Those wishing to enter China must to apply for visas in Chinese embassies or consulates.[554][555] The Chinese government encouraged businesses and factories to re-open on 30 March, and provided monetary stimulus packages for firms.[556]

The State Council declared a day of mourning to begin with a national three-minute moment of silence on 4 April, coinciding with Qingming Festival, although the central government asked families to pay their respects online in observance of physical distancing to avoid a renewed COVID-19 outbreak.[557] On 25 April the last patients were discharged in Wuhan.[558] On 13 May the city of Jilin was put on lockdown, sparking fear of a second wave of infection.[559]

Iran

Disinfection of Tehran Metro trains against coronavirus. Similar measures have also been taken in other countries.[560]

Iran reported its first confirmed cases of SARS‑CoV‑2 infections on 19 February in Qom, where, according to the Ministry of Health and Medical Education, two people died later that day.[561][562] Early measures announced by the government included the cancellation of concerts and other cultural events,[563] sporting events,[564] and Friday prayers,[565] and closures of universities, higher education institutions, and schools.[566] Iran allocated 5 trillion rials (equivalent to US$120,000,000) to combat the virus.[567] President Hassan Rouhani said on 26 February 2020 there were no plans to quarantine areas affected by the outbreak, and only individuals would be quarantined.[568] Plans to limit travel between cities were announced in March,[569] although heavy traffic between cities ahead of the Persian New Year Nowruz continued.[570] Shia shrines in Qom remained open to pilgrims until 16 March.[571][572]

Iran became a centre of the spread of the virus after China during February.[573][574] More than ten countries had traced their cases back to Iran by 28 February, indicating the outbreak may have been more severe than the 388 cases reported by the Iranian government by that date.[574][575] The Iranian Parliament was shut down, with 23 of its 290 members reported to have had tested positive for the virus on 3 March.[576] On 15 March, the Iranian government reported a hundred deaths in a single day, the most recorded in the country since the outbreak began.[577] At least twelve sitting or former Iranian politicians and government officials had died from the disease by 17 March.[578] By 23 March, Iran was experiencing fifty new cases every hour and one new death every ten minutes due to coronavirus.[579] According to a WHO official, there may be five times more cases in Iran than what is being reported. It is also suggested that U.S. sanctions on Iran may be affecting the country's financial ability to respond to the viral outbreak.[580] The UN High Commissioner for Human Rights has demanded economic sanctions to be eased for nations most affected by the pandemic, including Iran.[581] On 20 April it was reported that Iran had reopened shopping malls and other shopping areas across the country, though there is fear of a second wave of infection due to this move.[582] In March and again in April, there were reports that Iran was under-reporting COVID-19 cases and deaths.[583][584]

South Korea

A drive-through test centre at the Gyeongju Public Health Centre

COVID-19 was confirmed to have spread to South Korea on 20 January 2020 from China. The nation's health agency reported a significant increase in confirmed cases on 20 February,[585] largely attributed to a gathering in Daegu of the Shincheonji Church of Jesus.[585][586] Shincheonji devotees visiting Daegu from Wuhan were suspected to be the origin of the outbreak.[587][588] As of 22 February, among 9,336 followers of the church, 1,261 or about 13 percent reported symptoms.[589]

South Korea declared the highest level of alert on 23 February 2020.[590] On 28 February, more than 2,000 confirmed cases were reported,[591] rising to 3,150 on 29 February.[592] All South Korean military bases were quarantined after tests showed three soldiers had the virus.[587] Airline schedules were also changed.[593][594]

A banner in Seoul displays coronavirus infection prevention tips.

South Korea introduced what was considered the largest and best-organised programme in the world to screen the population for the virus, isolate any infected people, and trace and quarantine those who contacted them.[595][596] Screening methods included mandatory self-reporting of symptoms by new international arrivals through mobile application,[597] drive-through testing for the virus with the results available the next day,[598] and increasing testing capability to allow up to 20,000 people to be tested every day.[599] South Korea's programme is considered a success in controlling the outbreak without quarantining entire cities.[595][600][601]

South Korean society was initially polarised on President Moon Jae-in's response to the crisis, many signing petitions either praising it or calling for impeachment.[602] On 23 March, it was reported that South Korea had the lowest one-day case total in four weeks.[599] On 29 March it was reported that beginning 1 April all new overseas arrivals will be quarantined for two weeks.[603] Per media reports on 1 April, South Korea has received requests for virus testing assistance from 121 different countries.[604] On 15 May it was reported that about 2,000 businesses were told to close again when a cluster of 100 COVID-19 infected individuals was discovered, contact tracing is being done on 11,000 people.[605]

Europe

Confirmed cases of SARS‑CoV‑2 infected people in relation to the population of the country (cases per million inhabitants).[493] The numbers are not comparable, as the testing strategy differs among countries and time periods.
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Italy

The outbreak was confirmed to have spread to Italy on 31 January, when two Chinese tourists tested positive for SARS‑CoV‑2 in Rome.[484] Cases began to rise sharply, which prompted the Italian government to suspend all flights to and from China and declare a state of emergency.[606] An unassociated cluster of COVID-19 cases was later detected, starting with 16 confirmed cases in Lombardy on 21 February.[607]

Civil Protection volunteers carry out health checks at the Guglielmo Marconi Airport in Bologna on 5 February.

On 22 February, the Council of Ministers announced a new decree-law to contain the outbreak, including quarantining more than 50,000 people from eleven different municipalities in northern Italy.[608] Prime Minister Giuseppe Conte said, "In the outbreak areas, entry and exit will not be provided. Suspension of work activities and sports events has already been ordered in those areas."[609][610]

On 4 March, the Italian government ordered the full closure of all schools and universities nationwide as Italy reached a hundred deaths. All major sporting events, including Serie A football matches, were to be held behind closed doors until April,[611] but on 9 March all sport was suspended completely for at least one month.[612] On 11 March, Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and pharmacies.[613][614]

On 6 March, the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published medical ethics recommendations regarding triage protocols.[615][616][617] On 19 March, Italy overtook China as the country with the most coronavirus-related deaths in the world after reporting 3,405 fatalities from the pandemic.[618][619] On 22 March, it was reported that Russia had sent nine military planes with medical equipment to Italy.[620] As of 9 May, there were 217,185 confirmed cases, 30,201 deaths, and 99,023 recoveries in Italy, with the majority of those cases occurring in the Lombardy region.[621] A CNN report indicated that the combination of Italy's large elderly population and inability to test all who have the virus to date may be contributing to the high fatality rate.[622] On 19 April it was reported that the country had its lowest deaths at 433 in seven days, some businesses after six weeks of lockdown are asking for a loosening of restrictions.[623]

Spain

Residents of Valencia, Spain, maintaining social distancing while queueing
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United Kingdom

The "Wee Annie" statue in Gourock, Scotland was given a face mask during the pandemic.

Before 18 March 2020, the British government did not impose any form of social distancing or mass quarantine measures on its citizens.[624][625] As a result, the government received criticism for the perceived lack of pace and intensity in its response to concerns faced by the public.[626][627]

On 16 March, Prime Minister Boris Johnson made an announcement advising against all non-essential travel and social contact, suggesting people work from home where possible and avoid venues such as pubs, restaurants, and theatres.[628][629] On 20 March, the government announced that all leisure establishments such as pubs and gyms were to close as soon as possible,[630] and promised to pay up to 80 percent of workers' wages to a limit of £2,500 per month to prevent unemployment during the crisis.[631]

On 23 March, the prime minister announced tougher social distancing measures, banning gatherings of more than two people and restricting travel and outdoor activity to that deemed strictly necessary. Unlike previous measures, these restrictions were enforceable by police through the issuing of fines and the dispersal of gatherings. Most businesses were ordered to close, with exceptions for businesses deemed "essential", including supermarkets, pharmacies, banks, hardware shops, petrol stations, and garages.[632]

On 24 April it was reported that one of the more promising vaccine trials had begun in England; the government has pledged, in total, more than 50 million pounds towards research.[633]

To ensure the UK health services had sufficient capacity to treat people with COVID-19, a number of temporary critical care hospitals were built.[634] The first to be operational was the 4000-bed capacity NHS Nightingale Hospital London, constructed within the ExCeL convention centre over nine days.[635] On 4 May, it was announced that the Nightingale Hospital in London would be placed on standby and remaining patients transferred to other facilities.[636] This comes after reports that NHS Nightingale in London "treated 51 patients" within the first three weeks of opening.[637] On 5 May, official figures revealed that Britain had the worst COVID-19 death toll in Europe, prompting calls for an inquiry into the handling of the pandemic. The death toll in the United Kingdom was nearly 29,427 for those tested positive for the virus. Later, it was calculated at 32,313, after taking the official death count for Scotland and Northern Ireland into account.[638]On 16 April it was reported that the U.K. would have first access to the Oxford vaccine, should the trial be successful,some 30 million doses in the U.K would be available[639]

France

File:Strasbourg-Entzheim, évacuation patients COVID-19 par un hélicoptère de l'armée de terre (NH90 immatriculation EAX) - 3.jpg
France has been transferring COVID-19 patients from overloaded hospitals to hospitals in other regions via military helicopters, as seen here at Strasbourg Airport.

Although it was originally thought the pandemic reached France on 24 January 2020, when the first COVID-19 case in Europe was confirmed in Bordeaux, it was later discovered that a person near Paris had tested positive for the virus on 27 December 2019 after retesting old samples.[489][490] A key event in the spread of the disease in the country was the annual assembly of the Christian Open Door Church between 17 and 24 February in Mulhouse, which was attended by about 2,500 people, at least half of whom are believed to have contracted the virus.[640][641]

On 13 March, Prime Minister Édouard Philippe ordered the closure of all non-essential public places,[642] and on 16 March, French President Emmanuel Macron announced mandatory home confinement, a policy which has been extended at least until 11 May.[643][644][645] As of 23 April, France has reported more than 120,804 confirmed cases, 21,856 deaths, and 42,088 recoveries,[646] ranking fourth in number of confirmed cases.[647] In April, there were riots in some Paris suburbs.[648]

North America

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United States

Confirmed cases of COVID-19 per million inhabitants by state, as of 3 May 2020

On 20 January 2020, the first known case of COVID-19 was confirmed in the Pacific Northwest state of Washington in a man who had returned from Wuhan on 15 January.[649] On 31 January, the Trump administration declared a public health emergency,[650] and restricted entry for travellers from China who were not U.S. citizens.[651]

On 28 January, the Centers for Disease Control and Prevention—the leading public health institute of the U.S. government—announced they had developed their own testing kit.[652] Despite this, the United States had a slow start in testing, which obscured the extent of the outbreak.[653][654] Testing was marred by defective test kits produced by the government in February, a lack of federal approval for non-government test kits (by academia, companies, and hospitals) until the end of February, and restrictive criteria for people to qualify for a test.[653][654]

After the first death in the United States was reported in Washington state on 29 February,[655] Governor Jay Inslee declared a state of emergency,[656] an action soon followed by other states.[657][658] By mid-March, schools across the country were shutting down.[659]

On 6 March, the United States was advised of projections for the impact of the new coronavirus on the country by a group of scientists at Imperial College London.[660] On the same day, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provided $8.3 billion in emergency funding for federal agencies to respond to the outbreak.[661] Corporations encouraged employees to work from home.[662] Sports events and seasons were cancelled.[19]

On 11 and 12 March, Trump announced travel restrictions for most of Europe for 30 days,[663] including the United Kingdom and Ireland.[664] On 13 March, he declared a national emergency, which made federal funds available to respond to the crisis.[665] Beginning on 15 March, many businesses closed or reduced hours throughout the U.S. to try to reduce the spread of the virus.[666] By 17 March, the epidemic had been confirmed in all fifty states and in the District of Columbia.[667] On 26 March, the United States had more confirmed cases than any other country.[487] U.S. federal health inspectors surveyed 323 hospitals in late March; reporting "severe shortages" of test supplies, "widespread shortages" of personal protective equipment (PPE), and other strained resources due to extended patient stays while awaiting test results.[668]

The hospital ship USNS Comfort arrived in Manhattan on 30 March.

As of 24 April, 889,309 cases had been confirmed and 50,256 people had died.[669] As of 17 May, according to a New York Times database more than 1,474,600 people had been infected and at least 88,600 had died. The Times advises that previous to 29 April only deaths confirmed through testing were reported, however since confirmed cases are widely considered to be an undercount some state and local governments now identify probable cases and deaths using criteria that were developed by states and the federal government.[670]

The White House has been criticised for downplaying the threat and controlling the messaging by directing health officials and scientists to coordinate public statements and publications related to the virus with the office of Vice-President Mike Pence.[671] Some U.S. officials and commentators criticised U.S. reliance on importation of critical materials, including essential medical supplies, from China.[672][673]

On 14 April, President Trump halted funding to the World Health Organization, saying they had mismanaged the pandemic.[674] In late April, Trump said he would sign an executive order to temporarily suspend immigration to the United States because of the pandemic.[675] On 22 April, U.S. Secretary of State Mike Pompeo said on Fox News that China had denied U.S. scientists permission to enter the country to ascertain the origin of the current pandemic, but did not give details of any requests for such visits.[676] On 22 April it was reported that two Californians had died from the virus (not, as previously thought, influenza) on 6 and 17 February, three weeks before the first official COVID-19 death in the U.S. had been acknowledged.[491]

South America

Workers being trained to disinfect buses in Olinda, Pernambuco, Brazil, 16 March 2020
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Africa

{{#lsth:COVID-19 pandemic by country and territory|Africa}}

Oceania

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International responses

Travel restrictions

As a result of the pandemic, many countries and regions imposed quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas,[677] or for all travellers.[678] Together with a decreased willingness to travel, this had a negative economic and social impact on the travel sector. Concerns have been raised over the effectiveness of travel restrictions to contain the spread of COVID-19.[679] A study in Science found that travel restrictions had only modest effects delaying the initial spread of COVID-19, unless combined with infection prevention and control measures to considerably reduce transmissions.[680] Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late".[681]

The European Union rejected the idea of suspending the Schengen free travel zone and introducing border controls with Italy,[682][683] a decision which has been criticised by some European politicians.[684][685]

Evacuation of foreign citizens

Ukraine evacuates Ukrainian and foreign citizens from Wuhan, China.

Owing to the effective quarantine of public transport in Wuhan and Hubei, several countries evacuated their citizens and diplomatic staff from the area, primarily through chartered flights of the home nation, with Chinese authorities providing clearance. Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany, and Thailand were among the first to plan the evacuation of their citizens.[686] Brazil and New Zealand also evacuated their own nationals and some other people.[687][688] On 14 March, South Africa repatriated 112 South Africans who tested negative for the virus from Wuhan, while four who showed symptoms were left behind to mitigate risk.[689] Pakistan said it would not evacuate citizens from China.[690]

On 15 February, the U.S. announced it would evacuate Americans aboard the cruise ship Diamond Princess,[691] and on 21 February, Canada evacuated 129 Canadian passengers from the ship.[692] In early March, the Indian government began evacuating its citizens from Iran.[693][694] On 20 March, the United States began to partially withdraw its troops from Iraq due to the pandemic.[695]

International aid

Aid to China

File:Digital billboard in Shibuya expressing support against coronavirus.jpg
"Be Strong China", in English and several other languages

On 5 February, the Chinese foreign ministry said 21 countries (including Belarus, Pakistan, Trinidad and Tobago, Egypt, and Iran) had sent aid to China.[696] Some Chinese students at American universities joined together to help send aid to virus-stricken parts of China, with a joint group in the greater Chicago area reportedly managing to send 50,000 N95 masks to hospitals in the Hubei province on 30 January.[697]

The humanitarian aid organisation Direct Relief, in coordination with FedEx, sent 200,000 face masks along with other personal protective equipment, including gloves and gowns, by emergency airlift to the Wuhan Union Hospital by 30 January.[698] On 5 February, Bill and Melinda Gates announced a $100 million donation to the WHO to fund vaccine research and treatment efforts along with protecting "at-risk populations in Africa and South Asia".[699] Interaksyon reported that the Chinese government had donated 200,000 masks to the Philippines on 6 February after Philippine senator Richard Gordon shipped 3.16 million masks to Wuhan.[700] On 19 February, the Singapore Red Cross announced it would send $2.26 million worth of aid to China.[701]

Several countries donated masks, medical equipment or money to China, including Japan,[702] Turkey, Russia,[703] Malaysia (18 million medical gloves),[704] Germany,[705] and Canada.[706][707] The U.S. State Department said on 7 February it had facilitated the transportation of nearly 17.8 tons of medical supplies to China, including masks, gowns, gauze, respirators, and other materials.[708] On the same day, U.S. Secretary of State Pompeo announced a $100 million pledge to China and other countries to aid their fights against the virus,[709] though on 21 March China said it had not received epidemic funding from the U.S. government and reiterated that on 3 April.[710] Several corporations have also donated money or medical equipment to China.[711]

Aid to the globe

Medical supplies donated by China being received at Villamor Air Base in the Philippines

After cases in China stabilised, the country began sending aid to other nations.[712][713] In March, China, Cuba and Russia sent medical supplies and experts to help Italy deal with its coronavirus outbreak;[714][715] China sent three medical teams and donated more than forty tons of medical supplies to Italy.[716] The Spectator USA, citing an unnamed senior Trump administration official, said China had sold back to Italy the same PPE Italy had donated to China.[717] Businessman Jack Ma sent 1.1 million testing kits, 6 million face masks, and 60,000 protective suits to Addis Ababa, Ethiopia for distribution by the African Union.[718][719] He later sent 5,000 testing kits, 100,000 face masks and 5 ventilators to Panama.[720]

The Netherlands, Spain, Turkey, Georgia, and the Czech Republic expressed their concerns over Chinese-made masks and test kits.[721] For instance, Spain withdrew 58,000 Chinese-made coronavirus testing kits with an accuracy rate of 30 percent, while the Netherlands recalled 600,000 Chinese face masks which were said to defective,[722] yet this could have been due to product misuse.[723] Belgium recalled 100,000 unusable masks, thought to be from China, but were in fact from Colombia.[724] The Philippines stopped using test kits donated by China due to their 40 percent accuracy.[725] The Chinese government said product instructions might not have been followed, and that some products were not purchased directly from certified companies.[726][727] However, Chinese aid was well-received in parts of Latin America and Africa.[728][729] On 2 April, the World Bank launched emergency support operations for developing countries.[730] According to a statement from Ministry of Foreign Affairs, Turkey provides the largest amount of humanitarian aid in the world while ranking third worldwide in supplying medical aid.[731][732]

WHO response measures

The WHO has commended Chinese authorities,[733] noting the contrast between the 2002–2004 SARS outbreak when they were accused of secrecy and the current crisis where the central government "has provided regular updates".[734] Critics have said the WHO handled the pandemic inadequately, the public health emergency declaration and pandemic classification coming too late.[735]

December 2019

China and Taiwan both notified the WHO of a new virus on 31 December 2019.[736] Taiwan and the WHO later got into a dispute about the content of Taiwan's message and the WHO's lack of response to the state, which is not a WHO observer due to diplomatic pressure from China.[737][738]

January 2020

WHO Director-General Tedros Adhanom

The WHO stated on 5 January 2020 that cases of pneumonia of unknown cause had been reported,[739] and issued its technical briefings on 10 and 11 January, warning of a strong possibility of human-to-human transmission and urging precautions due to the similarity to earlier SARS and MERS outbreaks.[740] although in public announcements it said there was "no clear evidence of human-to-human transmission" as late as 14 January.[741] On 20 January, the WHO said it was "now very clear" that human-to-human transmission of the coronavirus had occurred, given that healthcare workers had been infected.[742] On 27 January, the WHO assessed the risk of the outbreak to be "high at the global level".[743]

On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), warning that "all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread" of the virus.[7][744] The announcement came after an increase in the number of cases outside China. This was the sixth-ever PHEIC since the measure was first invoked during the 2009 swine flu pandemic. WHO Director-General Tedros Adhanom said the PHEIC was due to "the risk of global spread, especially to low- and middle-income countries without robust health systems [and] there is no reason for measures that unnecessarily interfere with international travel and trade. [The WHO] doesn't recommend limiting trade and movement. We call on all countries to implement decisions that are evidence-based and consistent."[7][745][746]

February 2020

WHO representatives with Tehran city managers

On 11 February, the WHO in a press conference established COVID-19 as the name of the disease. On the same day, Tedros said UN Secretary-General António Guterres agreed to provide the "power of the entire UN system in the response". A UN Crisis Management Team was then activated, allowing coordination of the entire United Nations, which the WHO stated will allow them to "focus on the health response while the other agencies can bring their expertise to bear on the wider social, economic and developmental implications of the outbreak".[747]

On 25 February, the WHO declared "the world should do more to prepare for a possible coronavirus pandemic," stating that while it was too early to call it a pandemic, countries should be "in a phase of preparedness".[748]

On 28 February, WHO officials said the coronavirus threat assessment at the global level would be raised from "high" to "very high", its highest level of alert and risk assessment. Mike Ryan, executive director of the WHO's health emergencies program, warned that "this is a reality check for every government on the planet: Wake up. Get ready. This virus may be on its way and you need to be ready," urging that the right response measures could help avert "the worst of it". Ryan stated that current data did not warrant public health officials to declare a global pandemic, saying such a declaration would mean "we're essentially accepting that every human on the planet will be exposed to that virus."[749]

March 2020

On 11 March, the WHO declared the coronavirus outbreak a pandemic.[750] The Director-General said the WHO was "deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction".[8]

Impact

Economics

"Those who can, put something in; those who can't, help yourself." Bologna, April 2020.
A highway sign on the Gardiner Expressway in Toronto discouraging non-essential travel

The outbreak is a major destabilising threat to the global economy. Agathe Demarais of the Economist Intelligence Unit has forecast that markets will remain volatile until a clearer image emerges on potential outcomes. One estimate from an expert at Washington University in St. Louis gave a $300+ billion impact on the world's supply chain that could last up to two years.[751] Global stock markets fell on 24 February due to a significant rise in the number of COVID-19 cases outside China.[752][753] On 27 February, due to mounting worries about the coronavirus outbreak, U.S. stock indexes posted their sharpest falls since 2008, with the Dow falling 1,191 points (the largest one-day drop since the financial crisis of 2007–08)[754] and all three major indexes ending the week down more than 10 percent.[755] On 28 February, Scope Ratings GmbH affirmed China's sovereign credit rating but maintained a Negative Outlook.[756] Stocks plunged again due to coronavirus fears, the largest fall being on 16 March.[757] Many consider an economic recession likely.[758][759]

Tourism is one of the worst affected sectors due to travel bans, closing of public places including travel attractions, and advice of governments against travel. Numerous airlines have cancelled flights due to lower demand, and British regional airline Flybe collapsed.[760] The cruise line industry was hard hit,[761] and several train stations and ferry ports have also been closed.[762] International mail between some countries stopped or was delayed due to reduced transportation between them or suspension of domestic service.[763]

The retail sector has been impacted globally, with reductions in store hours or temporary closures.[764] Visits to retailers in Europe and Latin America declined by 40 percent. North America and Middle East retailers saw a 50–60 percent drop.[765] This also resulted in a 33–43 percent drop in foot traffic to shopping centres in March compared to February. Shopping mall operators around the world imposed additional measures, such as increased sanitation, installation of thermal scanners to check the temperature of shoppers, and cancellation of events.[766]

Hundreds of millions of jobs could be lost globally.[767][768] More than 36 million Americans lost their jobs and applied for government aid.[769][770]

According to a United Nations Economic Commission for Latin America estimate, the pandemic-induced recession could leave 14–22 million more people in extreme poverty in Latin America than would have been in that situation without the pandemic.[771] The pandemic has disrupted global food supplies and threatens to trigger a new food crisis.[772][773] David Beasley, head of the World Food Programme (WFP), said "we could be facing multiple famines of biblical proportions within a short few months."[774]

Supply shortages

Coronavirus fears have led to panic buying of essentials across the world, including toilet paper, dried and/or instant noodles, bread, rice, vegetables, disinfectant, and rubbing alcohol.

The outbreak has been blamed for several instances of supply shortages, stemming from globally increased usage of equipment to fight outbreaks, panic buying (which in several places led to shelves being cleared of grocery essentials such as food, toilet paper, and bottled water), and disruption to factory and logistic operations.[775] The technology industry, in particular, has warned of delays to shipments of electronic goods.[776] According to the WHO director-general Tedros Adhanom, demand for personal protection equipment has risen a hundredfold, leading to prices up to twenty times the normal price and also delays in the supply of medical items of four to six months.[777][778] It has also caused a shortage of personal protective equipment worldwide, with the WHO warning that this will endanger health workers.[779]

The impact of the coronavirus outbreak was worldwide. The virus created a shortage of precursors used in the manufacturing of fentanyl and methamphetamine. The Yuancheng Group, located in Wuhan, China, is one of the leading suppliers of these chemical raw materials.[780] Price increases and shortages in these illegal drugs have been noticed on the street of the UK.[781] U.S. law enforcement also told the New York Post Mexican drug cartels were having difficulty in obtaining precursors.[782]

Senior officials at the United Nations estimated in April 2020 that an additional 130 million people could develop starvation, for a total of 265 million by the end of 2020.[783][784][785]

Oil and other energy markets

In early February 2020, Organization of the Petroleum Exporting Countries (OPEC) "scrambled" after a steep decline in oil prices due to lower demand from China.[786] On Monday, 20 April, the price of West Texas Intermediate (WTI) went negative and fell to a record low (minus $37.63 a barrel) due to traders' offloading holdings so as not to take delivery and incur storage costs.[787] June prices were down but in the positive range, with a barrel of West Texas trading above $20.[787]

Culture

Closed entrance to the Shah Abdol-Azim Shrine in Ray, Iran

The performing arts and cultural heritage sectors have been profoundly affected by the pandemic, impacting organisations' operations as well as individuals—both employed and independent—globally. Arts and culture sector organisations attempted to uphold their (often publicly funded) mission to provide access to cultural heritage to the community, maintain the safety of their employees and the public, and support artists where possible. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed.[788] In response there were intensive efforts to provide alternative services through digital platforms.[789][790][791]

Door of a public library in Island Bay, New Zealand

Holy Week observances in Rome, which occur during the last week of the Christian penitential season of Lent, were cancelled.[790] Many dioceses have recommended older Christians stay home rather than attend Mass on Sundays. (Services are available via radio, online live streaming and television.)[792][793][790] With the Roman Catholic Diocese of Rome closing its churches and chapels and St. Peter's Square emptied of Christian pilgrims,[790] other religious bodies also cancelled services and limited public gatherings in churches, mosques, synagogues, temples and gurdwaras.[790] Iran's Health Ministry announced the cancellation of Friday prayers in areas affected by the outbreak and shrines were later closed,[565][572] while Saudi Arabia banned the entry of foreign pilgrims as well as its residents to holy sites in Mecca and Medina.[794][795] The World Health Organization (WHO) advised COVID-19 patients to consult a physician before and possibly abstain from fasting (a part of Ramadan),[796] as it can weaken the immune system,[797] though it says "healthy people should be able to (...) fast as in earlier years."[798]

The pandemic has caused the most significant disruption to the worldwide sporting calendar since the Second World War. Most major sporting events have been cancelled or postponed, including the 2019–20 UEFA Champions League,[799] 2019–20 Premier League,[800] UEFA Euro 2020, 2019–20 NBA season,[801] and 2019–20 NHL season.[802] The outbreak disrupted plans for the 2020 Summer Olympics, which were originally scheduled to start at the end of July; the International Olympic Committee announced on 24 March that they will be "rescheduled to a date beyond 2020 but not later than summer 2021".[803][804]

The entertainment industry has also been affected, with many music groups suspending or cancelling concert tours.[805][806] Many large theatres such as those on Broadway also suspended all performances.[807] Some artists have explored ways to continue to produce and share work over the internet as an alternative to traditional live performance, such as live streaming concerts[808] or creating web-based "festivals" for artists to perform, distribute, and publicise their work.[809] Online, numerous coronavirus-themed Internet memes have spread as many turn to humour and distraction amid uncertainty.[810]

Politics

The pandemic has affected the political systems of multiple countries, causing suspensions of legislative activities,[811] isolations or deaths of multiple politicians,[812] and rescheduling of elections due to fears of spreading the virus.[813]

China

Chinese Communist Party general secretary Xi Jinping (left) with State Council Premier Li Keqiang

The Chinese government has been criticised by the United States government,[814] UK Minister for the Cabinet Office Michael Gove,[815] and others[816] for its handling of the pandemic. A number of provincial-level administrators of the Communist Party of China were dismissed over their handling of the quarantine efforts in central China, a sign of discontent with their response to the outbreak. Some commentators believed this move was intended to protect Chinese Communist Party general secretary Xi Jinping from the controversy.[817] The U.S. intelligence community says China intentionally under-reported its number of coronavirus cases.[818]

Italy

In early March, the Italian government criticised the European Union's lack of solidarity with coronavirus-affected Italy[819][820]—Maurizio Massari, Italy's ambassador to the EU, said "only China responded bilaterally", not the EU.[821] On 22 March, after a phone call with Italian Prime Minister Giuseppe Conte, Russian president Vladimir Putin had the Russian army send military medics, disinfection vehicles, and other medical equipment to Italy.[822] President of Lombardy Attilio Fontana and Italian Foreign Minister Luigi Di Maio expressed their gratitude for the aid.[823] Russia also sent a cargo plane with medical aid to the United States.[824] Kremlin spokesman Dmitry Peskov said "when offering assistance to U.S. colleagues, [Putin] assumes that when U.S. manufacturers of medical equipment and materials gain momentum, they will also be able to reciprocate if necessary."[825]

United States

Several hundred anti-lockdown protesters rallied at the Ohio Statehouse 20 April.[826]

The outbreak prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care, universal child care, paid sick leave, and higher levels of funding for public health.[827][828][829] Political analysts anticipated it may negatively affect Donald Trump's chances of re-election in the 2020 presidential election.[830][831] Beginning in mid-April 2020, there were protests in several U.S. states against government-imposed business closures and restricted personal movement and association.[832]

Other countries

The planned NATO "Defender 2020" military exercise in Germany, Poland, and the Baltic states, the largest NATO war exercise since the end of the Cold War, will be held on a reduced scale.[833][834] The Campaign for Nuclear Disarmament's general secretary Kate Hudson criticised the exercise, saying "it jeopardises the lives not only of the troops from the U.S. and the many European countries participating but the inhabitants of the countries in which they are operating."[835]

UK Prime Minister Boris Johnson (left, back row) tested positive for COVID-19 in March 2020. Russian President Vladimir Putin (right, back row) began working remotely from his office at Novo-Ogaryovo after meeting with an infected doctor.

The Iranian government has been heavily affected by the virus, with about two dozen parliament members and fifteen current or former political figures infected.[575][836] Iran's President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, saying they were struggling to fight the outbreak due to a lack of access to international markets from the United States sanctions against Iran.[837] Saudi Arabia, which launched a military intervention in Yemen in March 2015, declared a ceasefire.[838]

Diplomatic relations between Japan and South Korea worsened due to the pandemic.[839] South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced anyone coming from South Korea would be placed in quarantine for two weeks at government-designated sites.[840] South Korean society was initially polarised on President Moon Jae-in's response to the crisis; many Koreans signed petitions either calling for Moon's impeachment or praising his response.[602]

Some countries have passed emergency legislation in response to the pandemic. Some commentators have expressed concern that it could allow governments to strengthen their grip on power.[841][842] In the Philippines, lawmakers granted president Rodrigo Duterte temporary emergency powers during the pandemic.[843] In Hungary, the parliament voted to allow the prime minister, Viktor Orbán, to rule by decree indefinitely, suspend parliament as well as elections, and punish those deemed to have spread false information about the virus and the government's handling of the crisis.[844] In some countries, including Egypt,[845] Turkey,[846] and Thailand,[843] opposition activists and government critics have been arrested for allegedly spreading fake news about the COVID-19 pandemic.[847]

Education

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Other health issues

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Environment and climate

{{#lsth:Impact of the COVID-19 pandemic on the environment}}

Xenophobia and racism

Since the start of the outbreak, heightened prejudice, xenophobia, and racism have been documented around the world toward people of Chinese and East Asian descent,[848][849][850] Reports from February (when most cases were confined to China) documented racist sentiments expressed in groups worldwide about Chinese people deserving the virus.[851][852][853] Citizens in countries including Malaysia,[854] New Zealand,[855] Singapore,[856] Japan,[857] Vietnam,[858] and South Korea lobbied to ban Chinese people from entering their countries.[859] Chinese people and other Asians in the United Kingdom and United States have reported increasing levels of racist abuse and assaults.[860][27][861] U.S. president Donald Trump has been criticised for referring to the coronavirus as the "Chinese Virus", which critics say is racist and anti-Chinese.[862][863][864]

Houston's Chinatown experienced a reduction in business early during the outbreak when there were still only a few cases.[865]

Following the progression of the outbreak to new hotspot countries, people from Italy (the first country in Europe to experience a serious outbreak of COVID-19) were also subjected to suspicion and xenophobia,[866][867] as were people from hotspots in other countries. Discrimination against Muslims in India escalated after public health authorities identified an Islamic missionary group's gathering in New Delhi in early March 2020 as a source of spread.[868] Paris has seen riots break out over police treatment of ethnic minorities during the coronavirus lockdown.[869] Racism and xenophobia towards South Asians and Southeast Asians increased in the Arab states of the Persian Gulf.[870][871][872]

In China, xenophobia and racism against non-Chinese residents has been inflamed by the pandemic, with foreigners described as "foreign garbage" and targeted for "disposal".[873] Some black people were evicted from their homes by police and told to leave China within 24 hours, due to disinformation that they and other foreigners were spreading the virus.[874] Chinese racism and xenophobia was criticised by foreign governments and diplomatic corps,[875] and China apologised for discriminatory practices such as restaurants excluding black customers,[876] although these and other accusations of harassment, discrimination and eviction of black people in China continued.[877]<section begin="ChineseVirus" /><section end="ChineseVirus" />

Information dissemination

Some newspapers with paywalls have removed them for some or all of their coronavirus coverage.[878] Many scientific publishers made scientific papers related to the outbreak available with open access.[879] Some scientists chose to share their results quickly on preprint servers such as bioRxiv.[880]

Misinformation

File:President Donald Trump suggests measures to treat COVID-19 during Coronavirus Task Force press briefing.webm

{{#lsth:Misinformation related to the COVID-19 pandemic}}

See also

Notes

  1. In summary, this article is about the coronavirus pandemic, which is caused by the disease COVID-19, which is caused by the virus SARS‑CoV‑2.[1]
  2. 2.0 2.1 This number shows the cumulative number of confirmed human cases reported to date. The actual number of infections and cases is likely to be higher than reported.[29]
    The total number of cases may not necessarily add up due to the frequency of values being updated for each location.
    Reporting criteria and testing capacity varies between countries.
  3. Countries, territories, and international conveyances where cases were diagnosed. The nationality of the infected and the origin of infection may vary. For some countries, cases are split into respective territories and noted accordingly.
  4. Total deaths may not necessarily add up due to the frequency of values updating for each location. Reporting criteria varies between countries.
  5. Reported recoveries. May not correspond to actual current figures and not all recoveries may be reported. Total recoveries may not necessarily add up due to the frequency of values updating for each location.
  6. United States
    1. Figures include cases identified on the Grand Princess.
    2. Figures do not include the unincorporated territories of Puerto Rico, Guam, Northern Mariana Islands, and U.S. Virgin Islands, all of which are listed separately.
    3. Not all states or overseas territories report recovery data.
    4. Cases include clinically diagnosed cases as per CDC guidelines.[30]
    5. Recoveries and deaths include probable deaths and people released from quarantine as per CDC guidelines.[31][32][33]
    6. Figures from the United States Department of Defense are only released on a branch-by branch basis since April 2020, without distinction between domestic and foreign deployment, and cases may be reported to local health authorities.[34]
    7. Cases for the USS Theodore Roosevelt, currently docked at Guam, are reported separate from national figures but included in the Navy's totals.
    8. There is also one case reported from Guantanamo Bay Naval Base not included in any other nation or territory's counts.[35] Since April 2020, the United States Department of Defense has directed all bases, including Guantanamo Bay, to not publicize case statistics.[34]
  7. Russia
    1. Including cases from the disputed Crimea and Sevastopol.
    2. Excluding the cases from Diamond Princess cruise ship which are classified as "on an international conveyance".
  8. United Kingdom
    1. Excluding all British Overseas Territories and Crown dependencies.
    2. As of 23 March 2020, the UK government does not publish the number of recoveries. The last update on 22 March reported 135 recovered patients.[38]
  9. Spain
    1. Excludes serology–confirmed cases.
  10. Germany
    1. Not all state authorities count recoveries.[46]
    2. Recoveries include estimations by the Robert Koch Institute.[46][47]
  11. France
    1. Including French overseas regions Saint Martin and Saint Barthélemy.
    2. Excluding collectivities of New Caledonia, French Polynesia and Saint Pierre and Miquelon.
    3. Recoveries only include hospitalized cases.[49]
    4. Figures for total confirmed cases and total deaths include data from both hospital and nursing home (ESMS: établissements sociaux et médico-sociaux).[49]
  12. China
    1. Excluding 515 asymptomatic cases under medical observation as of 16 May 2020.
    2. Asymptomatic cases were not reported before 31 March 2020.
    3. Excluding Special Administrative Regions of Hong Kong and Macau.
    4. Does not include Taiwan.
  13. Belgium
    1. The number of deaths also includes untested cases and cases in retirement homes that presumably died because of COVID-19, whilst most countries only include deaths of tested cases in hospitals.[56]
  14. Netherlands
    1. All four constituent countries of the Kingdom of the Netherlands (i.e. the country of the Netherlands [in this table row], Aruba, Curaçao, and Sint Maarten) and the special municipalities of the Caribbean Netherlands (Bonaire, Saba and Sint Eustatius) are listed separately.
    2. The Dutch Government agency RIVM, responsible for the constituent country the Netherlands, does not count its number of recoveries.[61]
  15. Chile
    1. Including the special territory of Easter Island.
    2. On 29 April 2020, the Chilean government started to inform the number of asymptomatic confirmed cases, separated from the official number of confirmed cases.[63] Since 30 April, all confirmed cases (no matter their symptoms) are included in the official number.
    3. Chilean authorities define a person as "recovered" after 14 days since the detection of the virus because "they are no longer contagious".[64] Initially, patients who have died of coronavirus were counted as recovered, following the same criteria, according to Health Minister Jaime Mañalich;[65][66][67] however, this was changed later and Chilean reports inform the number of recovered separated from the deceased.[68]
  16. Ukraine
    1. Excluding cases from the disputed Crimea and Sevastopol. Cases in these territories are included in the Russian total.
    2. Excluding cases from the unrecognized Donetsk and Lugansk People's Republics.
  17. Israel
    1. Including cases from the disputed Golan Heights.
    2. Excluding cases from the State of Palestine.
  18. 18.0 18.1 Diamond Princess and Japan
    1. The British cruise ship Diamond Princess was in Japanese waters, and the Japanese administration was asked to manage its quarantine, with the passengers having not entered Japan. Therefore, this case is included in neither the Japanese nor British official counts. The World Health Organization classifies the cases as being located "on an international conveyance".
  19. Egypt
    1. Includes cases identified on the MS River Anuket.
  20. Denmark
    1. The autonomous territories of the Faroe Islands and Greenland are listed separately.
  21. Serbia
    1. Excluding cases from the disputed Kosovo.
  22. Norway
    1. Estimation of the number of infected:
      • As of 23 March 2020, according to figures from just over 40 per cent of all GPs in Norway, 20,200 patients have been registered with the "corona code" R991. The figure includes both cases where the patient has been diagnosed with coronavirus infection through testing, and where the GP has used the "corona code" after assessing the patient's symptoms against the criteria by the Norwegian Institute of Public Health.[107]
      • As of 24 March 2020, the Norwegian Institute of Public Health estimates that between 7,120 and 23,140 Norwegians are infected with the coronavirus.[108]
  23. Argentina
    1. Excluding confirmed cases on the claimed territory of the Falkland Islands. Since 11 April, the Argentine Ministry of Health includes them in their official reports.[110]
  24. Australia
    1. Excluding the cases from Diamond Princess cruise ship which are classified as "on an international conveyance". Ten cases, including one fatality recorded by the Australian government.
  25. Morocco
    1. Including cases in the disputed Western Sahara territory controlled by Morocco. There are no confirmed cases in the rest of Western Sahara.[117]
  26. Finland
    1. Including the autonomous region of the Åland Islands.
    2. The number of recoveries is an estimate based on reported cases which were reported at least two weeks ago and there is no other monitoring data on the course of the disease.[120] The exact number of recoveries is not known, as only a small proportion of patients have been hospitalized.[121]
  27. Moldova
    1. Including the disputed territory of Transnistria.
  28. Azerbaijan
    1. Excluding the self-declared state of Artsakh.
  29. Cuba
    1. Includes cases on the MS Braemar.
    2. Excluding cases from Guantanamo Bay, which is governed by the United States.
  30. DR Congo
  31. Somalia
    1. Excluding the de facto state of Somaliland.
  32. New Zealand
    1. Recovered figures include those from 350 probable but unconfirmed cases.
  33. 33.0 33.1 Guam and USS Theodore Roosevelt
    1. Cases for the USS Theodore Roosevelt, currently docked at Guam, are reported separately.
  34. Charles de Gaulle
    1. Including cases on the escort frigate Chevalier Paul.
    2. Florence Parly, Minister of the Armed Forces, reported to the National Assembly's National Defense and Armed Forces Committee [fr] that 2010 sailors of the carrier battle group led by Charles de Gaulle had been tested, with 1081 tests returning positive so far.[166] Many of these cases were aboard Charles de Gaulle, some of the cases were reportedly aboard French frigate Chevalier Paul, and it is unclear if any other ships in the battle group had cases on board.[167][168][169]
  35. Cyprus
  36. 36.0 36.1 Greg Mortimer and Uruguay
    1. Although currently anchored off the coast of Uruguay, cases for the Greg Mortimer are currently reported separately. Six have been transferred inland for hospitalization.
  37. Georgia
    1. Excluding the de facto states of Abkhazia and South Ossetia.
  38. Taiwan
    1. Including cases from the ROCS Pan Shi.[200]
  39. Congo
    1. Also known as the Republic of the Congo and not to be confused with the DR Congo.
  40. Isle of Man
    1. Recoveries are presumed. Defined as "An individual testing positive for coronavirus who completes the 14 day self-isolation period from the onset of symptoms who is at home on day 15, or an individual who is discharged from hospital following more severe symptoms."[206]
  41. 41.0 41.1 Donetsk and Luhansk People's Republic
    1. Note that these territories are distinct from the Ukraine-administered regions of the Donetsk and Luhansk Oblasts.
  42. Northern Cyprus
    1. Cases from this de facto state are not counted by Cyprus.
  43. Somaliland
    1. Cases from this de facto state are not counted by Somalia.
  44. Syria
    1. Excluding cases from the disputed Golan Heights.
  45. South Ossetia
    1. Cases from this de facto state are not counted by Georgia.
  46. Artsakh
    1. Cases from this de facto state are not counted by Azerbaijan.
  47. Abkhazia
    1. Cases from this de facto state are not counted by Georgia.
  48. Saint Vincent
    1. The sovereign state of Saint Vincent and the Grenadines.
  49. MS Zaandam
    1. Including cases from MS Rotterdam.
    2. The MS Rotterdam rendezvoused with the Zaandam on March 26 off the coast of Panama City to provide support and evacuate healthy passengers. Both have since docked in Florida.[292][293]
    3. MS Zaandam and Rotterdam's numbers are currently not counted in any national figures.
  50. Coral Princess
    1. The cruise ship Coral Princess has tested positive cases since early April 2020 and has since docked in Miami.[296]
    2. Coral Princess's numbers are currently not counted in any national figures.
  51. HNLMS Dolfijn
    1. All 8 cases currently associated with Dolfijn were reported while the submarine was at sea in the waters between Scotland and the Netherlands.[306]
    2. It is unclear whether the Netherlands National Institute for Public Health and the Environment (RIVM) is including these cases in their total count, but neither their daily update details nor their daily epidemiological situation reports appear to have mentioned the ship, with a breakdown of cases listing the twelve provinces of the country of the Netherlands (as opposed to the kingdom) accounting for all the cases in the total count.[307][308]
    3. As RIVM does not report recoveries, and militaries are generally less transparent than most government agencies due to operations security concerns, it is assumed that no official report on recoveries is forthcoming.

References

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[408] [410] [407] [404] [412] [465] [466] [333] [334] [883] [7] [478] [316] [528] [524] [527] [534] [533] [535] [537] [536] [538] [539] [540] [541] [542] [543] [686] [690] [687] [691] [692] [696] [697] [698] [699] [702] [704] [705] [701] [733] [734] [746] [745] [747] [748] [608] [609] [610] [848] [879] [880] [776] [751] [786] [752] [753] [777] [778] [335] [8] [492] [13] [363] [17] [19] [318] [323] [358]

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