COVID-19 pandemic

2020 coronavirus pandemic
Map of total reported confirmed cases as of 18 March 2020    10,000+ confirmed cases    1,000–9,999 confirmed cases    100–999 confirmed cases    10–99 confirmed cases    1–9 confirmed cases    No confirmed cases
Map of reported confirmed cases per capita as of 18 March 2020    >1 case per 10,000 inhabitants    1–10 cases per 100,000 inhabitants    1–10 cases per 1 million inhabitants    1–10 cases per 10 million inhabitants    1–10 cases per 100 million inhabitants    No confirmed cases
File:2020 coronavirus task force.jpg (clockwise from top) Hospitalised patients in Tehran, Iran Disinfection vehicles in Taipei, Taiwan Emptied shelves in an Australian supermarket due to panic buying Health checks at Linate Airport in Milan, Italy Italian government outbreak task force
Disease	Coronavirus disease 2019 (COVID-19)
Virus strain	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Location	Worldwide (list of locations); current epicenter is Europe
Index case	Wuhan, Hubei, China 30°37′11″N 114°15′28″E
Date	1 December 2019–present (5 years and 2 weeks)
Confirmed cases	206,000+
Recovered	82,000+
Deaths	8,200+
Territories	170

The 2019–20 coronavirus pandemic is an ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First identified in Wuhan, Hubei, China, in December 2019, the outbreak was recognised as a pandemic by the World Health Organization (WHO) on 11 March 2020. As of 18 March 2020, more than 206,000 cases of COVID-19 have been reported in at least 170 countries and territories, with major outbreaks in China, Iran and the European Union. More than 8,200 people have died and over 82,000 have recovered. On 13 March, the WHO announced that Europe has become the new epicenter of the pandemic.

The virus is primarily spread between people similar to influenza, via respiratory droplets from coughing and sneezing. It is considered most contagious when people are symptomatic, although transmission may be possible before symptoms appear. The time between exposure and symptom onset is typically five days, but may range from two to fourteen days. Common symptoms include fever, cough, and shortness of breath. Complications may include pneumonia and acute respiratory distress syndrome. Currently, there is no vaccine or specific antiviral treatment; efforts consist of symptom alleviation and supportive therapy. Recommended preventive measures include hand washing, covering the mouth when coughing, maintaining distance from other people (particularly those who are unwell), and monitoring and self-isolation for fourteen days for people who suspect they are infected.

Efforts to prevent spread have included travel restrictions, quarantines, curfews, event postponements and cancellations, and facility closures. These include a quarantine of Hubei, the nationwide quarantines of Italy, Spain, France, the Czech Republic, and Germany, curfew measures in China and South Korea, various border closures or incoming passenger restrictions, screening methods at airports and train stations, and travel advisories regarding regions with community transmission. Schools and universities have closed either on a nationwide or local basis in at least 115 countries, affecting more than 950 million students.

Effects of the pandemic include social and economic instability, the postponement or cancellation of sporting and cultural events, the suspension of in-person religious services, xenophobia and racism against Chinese, East and Southeast Asian people as well as the online spread of misinformation and conspiracy theories about the virus.

Epidemiology

Main pages: 2019–20 coronavirus pandemic by country and territory and Template:2019–20 coronavirus pandemic data/WHO situation reports

Updated December 15, 2024.

COVID-19 pandemic by location

	Location	Cases	Deaths
	World	776,973,220	7,077,717
	European Union	186,310,334	1,266,260
	United States	103,436,829	1,209,009
	China	99,381,302	122,377
	India	45,044,485	533,658
	France	39,008,268	168,120
	Germany	38,437,756	174,979
	Brazil	37,511,921	702,116
	South Korea	34,571,873	35,934
	Japan	33,803,572	74,694
	Italy	26,826,486	197,542
	United Kingdom	25,018,085	232,112
	Russia	24,704,524	403,828
	Turkey	17,004,712	101,419
	Spain	13,980,340	121,852
	Australia	11,861,161	25,236
	Vietnam	11,624,000	43,206
	Argentina	10,109,877	130,719
	Taiwan	9,970,937	17,672
	Netherlands	8,641,797	22,986
	Iran	7,627,863	146,837
	Mexico	7,622,433	334,809
	Indonesia	6,829,916	162,059
	Poland	6,765,482	120,955
	Colombia	6,394,582	142,727
	Austria	6,082,971	22,534
	Greece	5,742,253	39,764
	Portugal	5,670,089	29,070
	Ukraine	5,541,310	109,925
	Chile	5,406,974	64,497
	Malaysia	5,322,678	37,351
	Belgium	4,891,945	34,339
	Israel	4,841,558	12,707
	Czech Republic	4,821,194	43,748
	Canada	4,819,055	55,282
	Thailand	4,806,280	34,741
	Peru	4,526,977	220,975
	Switzerland	4,472,572	14,170
	Philippines	4,173,631	66,864
	South Africa	4,072,837	102,595
	Romania	3,567,145	68,943
	Denmark	3,444,241	10,012
	Singapore	3,006,155	2,024
	Hong Kong	2,876,106	13,466
	Sweden	2,768,329	28,226
	New Zealand	2,658,636	4,476
	Serbia	2,583,470	18,057
	Iraq	2,465,545	25,375
	Hungary	2,237,074	49,104
	Bangladesh	2,051,511	29,499
	Slovakia	1,885,131	21,260
	Georgia	1,864,383	17,151
	Republic of Ireland	1,751,473	9,907
	Jordan	1,746,997	14,122
	Pakistan	1,580,631	30,656
	Norway	1,528,929	5,732
	Kazakhstan	1,504,370	19,072
	Finland	1,499,712	11,466
	Lithuania	1,417,176	9,859
	Slovenia	1,360,618	9,914
	Croatia	1,351,718	18,779
	Bulgaria	1,338,778	38,764
	Morocco	1,279,115	16,305
	Puerto Rico	1,252,713	5,938
	Guatemala	1,250,394	20,203
	Lebanon	1,239,904	10,947
	Costa Rica	1,235,781	9,374
	Bolivia	1,212,156	22,387
	Tunisia	1,153,361	29,423
	Cuba	1,113,662	8,530
	Ecuador	1,078,863	36,055
	United Arab Emirates	1,067,030	2,349
	Panama	1,044,987	8,756
	Uruguay	1,042,209	7,687
	Mongolia	1,011,489	2,136
	Nepal	1,003,450	12,031
	Belarus	994,045	7,118
	Latvia	977,765	7,475
	Saudi Arabia	841,469	9,646
	Azerbaijan	836,492	10,353
	Paraguay	735,759	19,880
	Cyprus	709,396	1,497
	Palestine	703,228	5,708
	Bahrain	696,614	1,536
	Sri Lanka	672,812	16,907
	Kuwait	667,290	2,570
	Dominican Republic	661,103	4,384
	Moldova	650,784	12,282
	Myanmar	643,234	19,494
	Estonia	613,128	2,998
	Venezuela	552,695	5,856
	Egypt	516,023	24,830
	Qatar	514,524	690
	Libya	507,269	6,437
	Ethiopia	501,258	7,574
	Réunion	494,595	921
	Honduras	472,910	11,114
	Armenia	453,040	8,779
	Bosnia and Herzegovina	404,024	16,404
	Oman	399,449	4,628
	Luxembourg	396,500	1,000
	North Macedonia	352,060	9,990
	Zambia	349,892	4,078
	Brunei	349,706	182
	Kenya	344,113	5,689
	Albania	337,196	3,608
	Botswana	330,696	2,801
	Mauritius	329,294	1,074
	Kosovo	274,279	3,212
	Algeria	272,175	6,881
	Nigeria	267,189	3,155
	Zimbabwe	266,396	5,740
	Montenegro	251,280	2,654
	Afghanistan	235,214	7,998
	Mozambique	233,845	2,252
	Martinique	230,354	1,104
	Laos	219,060	671
	Iceland	210,720	186
	Guadeloupe	203,235	1,021
	El Salvador	201,965	4,230
	Trinidad and Tobago	191,496	4,390
	Maldives	186,694	316
	Uzbekistan	175,081	1,016
	Namibia	172,556	4,110
	Ghana	172,324	1,463
	Uganda	172,159	3,632
	Jamaica	157,337	3,619
	Cambodia	139,325	3,056
	Rwanda	133,266	1,468
	Cameroon	125,279	1,974
	Malta	123,569	1,167
	Barbados	108,836	593
	Angola	107,487	1,937
	Democratic Republic of the Congo	100,984	1,474
	French Guiana	98,041	413
	Senegal	89,316	1,972
	Malawi	89,168	2,686
	Kyrgyzstan	88,953	1,024
	Ivory Coast	88,455	835
	Suriname	82,504	1,406
	New Caledonia	80,203	314
	French Polynesia	79,451	650
	Eswatini	75,356	1,427
	Guyana	74,492	1,302
	Belize	71,430	688
	Fiji	69,047	885
	Madagascar	68,582	1,428
	Jersey	66,391	161
	Cabo Verde	64,474	417
	Sudan	63,993	5,046
	Mauritania	63,879	997
	Bhutan	62,697	21
	Syria	57,423	3,163
	Burundi	54,569	15
	Guam	52,287	419
	Seychelles	51,892	172
	Gabon	49,056	307
	Andorra	48,015	159
	Papua New Guinea	46,864	670
	Curaçao	45,883	305
	Aruba	44,224	292
	Tanzania	43,312	846
	Mayotte	42,027	187
	Togo	39,537	290
	Bahamas	39,127	849
	Guinea	38,582	468
	Isle of Man	38,008	116
	Lesotho	36,138	709
	Guernsey	35,326	67
	Haiti	34,690	860
	Faroe Islands	34,658	28
	Mali	33,180	743
	Federated States of Micronesia	31,765	65
	Cayman Islands	31,472	37
	Saint Lucia	30,231	410
	Benin	28,036	163
	Somalia	27,334	1,361
	Solomon Islands	25,954	199
	United States Virgin Islands	25,389	132
	San Marino	25,292	126
	Republic of the Congo	25,234	389
	Timor-Leste	23,460	138
	Burkina Faso	22,160	400
	Liechtenstein	21,609	89
	Gibraltar	20,550	113
	Grenada	19,693	238
	Bermuda	18,860	165
	South Sudan	18,855	147
	Tajikistan	17,786	125
	Monaco	17,181	67
	Equatorial Guinea	17,130	183
	Samoa	17,057	31
	Tonga	16,992	13
	Marshall Islands	16,297	17
	Nicaragua	16,196	245
	Dominica	16,047	74
	Djibouti	15,690	189
	Central African Republic	15,443	113
	Northern Mariana Islands	14,985	41
	Gambia	12,627	372
	Collectivity of Saint Martin	12,324	46
	Vanuatu	12,019	14
	Greenland	11,971	21
	Yemen	11,945	2,159
	Caribbean Netherlands	11,922	41
	Sint Maarten	11,051	92
	Eritrea	10,189	103
	Saint Vincent and the Grenadines	9,674	124
	Guinea-Bissau	9,614	177
	Niger	9,528	315
	Comoros	9,109	161
	Antigua and Barbuda	9,106	146
	American Samoa	8,359	34
	Liberia	8,090	294
	Sierra Leone	7,985	126
	Chad	7,702	194
	British Virgin Islands	7,628	64
	Cook Islands	7,375	2
	Turks and Caicos Islands	6,826	40
	Sao Tome and Principe	6,771	80
	Saint Kitts and Nevis	6,607	46
	Palau	6,372	10
	Saint Barthélemy	5,507	5
	Nauru	5,393	1
	Kiribati	5,085	24
	Anguilla	3,904	12
	Wallis and Futuna	3,760	9
	Macau	3,514	121
	Saint Pierre and Miquelon	3,426	2
	Tuvalu	2,943	1
	Saint Helena, Ascension and Tristan da Cunha	2,166	0
	Falkland Islands	1,923	0
	Montserrat	1,403	8
	Niue	1,092	0
	Tokelau	80	0
	Vatican City	26	0
	Pitcairn Islands	4	0
	Turkmenistan	0	0
	North Korea	0	0

A cluster of pneumonia cases of unknown cause was reported by health authorities in Wuhan, the capital of Hubei province, China on 31 December 2019 and an investigation was launched in early January 2020. These cases mostly had links to the Huanan Seafood Wholesale Market, which also sold live animals; consequently, the virus is thought to have a zoonotic origin. The virus that caused the outbreak is known as SARS-CoV-2, a new virus closely related to bat coronaviruses, pangolin coronaviruses and SARS-CoV. It is believed that the virus possibly originated in horseshoe bats (genus Rhinolophus).

The earliest person with symptoms was traced back to 1 December 2019, someone who did not have connections with the later cluster linked to the wet market. Of the early cluster of cases reported in December 2019, two-thirds were found to have a link with the market. On 14 March 2020, an unverified report from the South China Morning Post said that a 55-year-old from Hubei province could have been the first person who contracted the disease on 17 November.

On 26 February 2020, the WHO reported that, as new cases reportedly dropped in China but suddenly increased in Italy, Iran, and South Korea, the number of new cases outside China had exceeded the number of new cases in China for the first time.

There may be substantial underreporting of cases, particularly among those with milder symptoms. Reported numbers may also reflect local decisions on whom and when to test. As an example, on 13 March 2020, the UK reported 798 confirmed cases, but health officials estimated the actual number of people infected was probably between 5,000 and 10,000.

As of 26 February, "very few" cases have been reported among youth. A report from the WHO noted that those 19 and under made up just 2.4 percent of cases worldwide.

Deaths

Among those who died from the disease, the time from development of symptoms to death was between 6 and 41 days, with a median of 14 days.

As of 18 March 2020, more than 8,200 deaths have been attributed to COVID-19. According to China's NHC, most of those who died were elderly – about 80% of deaths were in those over 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes.

The first confirmed death was on 9 January 2020 in Wuhan. The first death outside China occurred on 1 February in the Philippines, and the first death outside Asia was in France. By 28 February, outside mainland China, more than a dozen deaths were recorded in each of Iran, South Korea and Italy. By 13 March, over 40 countries and territories had reported deaths, on every continent except Antarctica.

Diagrams

• 
  Growth in total confirmed cases
• 
  Cases in mainland China (see detailed breakdown)
• 
  Cases outside China
• 
  Semi-log plot of cumulative incidence of confirmed cases and deaths in China and the rest of the world (ROW)
• 
  Semi-log plot of daily new confirmed cases by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world total
• 
  Semi-log plot of coronavirus daily deaths by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world total
• 
  Case fatality rates by age group in China. Now out-of-date, as data only through 11 February 2020.
• 
  The severity of diagnosed COVID-19 cases in China. Now out-of-date, as data only through 11 February 2020.

Signs and symptoms

Main article: Coronavirus disease 2019

Coronavirus symptoms

Symptom	Percentage
Fever	87.9%
Dry cough	67.7%
Fatigue	38.1%
Sputum production	33.4%
Shortness of breath	18.6%
Muscle pain or joint pain	14.8%
Sore throat	13.9%
Headache	13.6%
Chills	11.4%
Nausea or vomiting	05.0%
Nasal congestion	04.8%
Diarrhoea	03.7%
Haemoptysis	00.9%
Conjunctival congestion	00.8%

COVID-19 symptoms

Symptoms of COVID-19 are non-specific and those infected may either be asymptomatic or develop flu like symptoms such as fever, cough, fatigue, shortness of breath, or muscle pain. The typical signs and symptoms and their prevalence, are shown in the corresponding table.

Further development can lead to severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock and death. Some of those infected may be asymptomatic, returning test results that confirm infection but show no clinical symptoms, so researchers have issued advice that those with close contact to confirmed infected people should be closely monitored and examined to rule out infection.

The usual incubation period (the time between infection and symptom onset) ranges from one to fourteen days; it is most commonly five days. In one case, it had an incubation period of 27 days.

Cause

Transmission

A video discussing the basic reproduction number and case fatality rate in the context of the pandemic.

The primary mode of transmission is via respiratory droplets that people exhale, for example when coughing or sneezing. Droplets stay suspended in the air for only a short time but may stay viable and contagious on a metal, glass or plastic surface. The stability of the SARS-CoV-2 virus in the air and on various surfaces is believed to be comparable to that of other coronaviruses, some of which can survive for up to nine days at room temperature. Its similarity to SARS-CoV-1 in particular was confirmed in laboratory tests that found both viruses could survive up to or beyond 72 hours on plastic and stainless steel. A survey of research on the inactivation other coronaviruses using various biocidal agents suggests that disinfecting surfaces contaminated with SARS-CoV-2 may also be achieved using similar solutions, including 62–71% ethanol, 50–100% isopropanol, 0.1% sodium hypochlorite (after one minute), 0.5% hydrogen peroxide, and 0.2–7.5% povidone-iodine; benzalkonium chloride and chlorhexidine gluconate are less effective.

The WHO has stated that the risk of spread from someone without symptoms is "very low". However, if someone has beginning symptoms and a mild cough, there is a risk of transmission.

There have been estimates for the basic reproduction number (the average number of people an infected person is likely to infect), ranging from 2.13 to 4.82. This is similar to severe acute respiratory syndrome-related coronavirus (SARS-CoV).

Virology

Main article: Severe acute respiratory syndrome coronavirus 2

Microscopy image showing SARS-CoV-2. The spikes on the outer edge of the virus particles resemble a crown, giving the disease its characteristic name.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). In February 2020, Chinese researchers found that there is only one amino acid difference in certain genome sequences between the viruses found in pangolins and those from humans, however, whole genome comparison to date found at most 92% of genetic material shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.

Diagnosis

Main article: COVID-19 testing

Infection by the virus can be provisionally diagnosed on the basis of symptoms, though confirmation is ultimately by reverse transcription polymerase chain reaction (rRT-PCR) of infected secretions (71% sensitivity) and CT imaging (98% sensitivity).

Viral testing

The WHO has published several RNA testing protocols for SARS-CoV-2, with the first issued on 17 January. Testing uses real-time reverse transcription polymerase chain reaction (rRT-PCR). The test can be done on respiratory or blood samples. Results are generally available within a few hours to days.

A person is considered at risk if they have travelled to an area with ongoing community transmission within the previous 14 days, or have had close contact with an infected person. Common key indicators include fever, coughing and shortness of breath. Other possible indicators include fatigue, myalgia, anorexia, sputum production and sore throat.

Imaging

Characteristic imaging features on radiographs and computed tomography have been described in a limited case series. The Italian Radiological Society is compiling an international online database of imaging findings for confirmed cases. However, due to overlap with other infections such as adenovirus, imaging without confirmation by PCR is of limited use in identifying COVID-19.

Prevention

Infographic by the United States CDC, describing how to stop the spread of germs.

Strategies for preventing transmission of the disease include overall good personal hygiene, hand washing, avoiding touching the eyes, nose or mouth with unwashed hands, coughing/sneezing into a tissue and putting the tissue directly into a dustbin. Those who may already have the infection have been advised to wear a surgical mask in public. Social distancing measures are also recommended to prevent transmission.

Many governments have restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak. However, the virus has reached the stage of community spread in large parts of the world. This means that the virus is spreading within communities whose members have not travelled to areas with widespread transmission.

Health care providers taking care of someone who may be infected are recommended to use standard precautions, contact precautions and airborne precautions with eye protection.

Contact tracing is an important method for health authorities to determine the source of an infection and to prevent further transmission. Misconceptions are circulating about how to prevent infection, for example: rinsing the nose and gargling with mouthwash are not effective.

As of 13 March 2020, there is no COVID-19 vaccine though a number of organizations are working to develop one.China has banned the trading and consumption of wild animals.

Hand washing

Hand washing is recommended to prevent the spread of the disease. The US Centers for Disease Control and Prevention (CDC) recommends that people wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. It further recommended using an alcohol-based hand sanitizer with at least 60% alcohol by volume when soap and water are not readily available. The WHO also advises people to avoid touching the eyes, nose, or mouth with unwashed hands.

Respiratory hygiene

Health organizations recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing (the tissue should then be disposed of immediately). The use of surgical masks by those who may be infected has been recommended, as they can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing and coughing. The WHO has issued instructions on when and how to use masks.

Masks have also been recommended for use by those taking care of someone who may have the disease. Masks are not recommended for most people. There is limited evidence that the wearing of surgical masks by uninfected people at low risk is effective, although they may help people avoid touching their face. Surgical masks are the lowest grade of protection, and are designed mainly to protect others from the wearer. Masks designed to protect the wearer are technically "respirators", though calling them "masks" is common. Only China has specifically recommended the use of masks by healthy members of the public. Nevertheless, face masks have been widely used by healthy people in Hong Kong, Japan, Malaysia, and Singapore.

Social distancing

Main article: Social distancing

Social distancing includes infection control actions intended to slow the spread of disease by minimizing close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may also apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, not shaking hands, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

Older adults and those with serious chronic conditions face increased risk of serious illness and complications and have been advised by the US CDC to avoid crowds and stay home as much as possible in areas of community outbreak.

Self-isolation

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected.

Additionally, individuals who have recently travelled to a country with widespread transmission or who have been in direct contact with someone diagnosed with COVID-19 have also been asked by some government health agencies to self-quarantine or practise social distancing for 14 days from the time of last possible exposure.

The National Health Service in the UK has recommended that those with symptoms of COVID-19 should stay at home for 14 days, taking precautions to avoid infecting others within the household. As long as symptoms don't significantly worsen health services should not be contacted.

Management

See also: Coronavirus disease 2019 § Management, and Pandemic § Management

Outbreak

The goal of community mitigation, (1) delay outbreak peak (2) decompress peak burden on healthcare, known as flattening the curve (3) diminish overall cases and health impact.

There are two basic strategies in the control of an outbreak: containment and mitigation. Containment is done in the early stages of the outbreak, and aims to trace and isolate those infected 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, when measures are taken to slow the spread and mitigate its effects on the health care system and society. A combination of both containment and mitigation measures may be undertaken at the same time.

Part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as flattening the epidemic curve. This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed. 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 social 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.

More drastic actions were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities affecting 60 million individuals in Hubei, and strict travel bans. Other countries adopted a variety of measures aimed at limiting the spread of the virus. For example, South Korea introduced mass screening, localized quarantines, and issuing alerts on the movements of affected individuals. Singapore provided financial support for those infected who quarantine themselves and imposed large fines for those who failed to do so. Taiwan increased face-mask production, and penalized hoarding of medical supplies. Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.

Illness

There are no specific antiviral medications, but development efforts are underway. Attempts to relieve the symptoms may include taking regular (over-the-counter) cold medications, drinking fluids, and resting. Depending on the severity, oxygen therapy, intravenous fluids and breathing support may be required. The use of steroids may worsen outcomes. Several compounds, which were previously approved for treatment of other viral diseases, such as favipiravir, ribavirin, remdesivir, and galidesivir, are being investigated.

History

Main article: Timeline of the 2019–20 coronavirus pandemic

People in Guangzhou wearing masks

The first known case of the novel coronavirus was traced back to 1 December 2019 in Wuhan, Hubei, China. A later unconfirmed claim, citing Chinese government documents, suggests that the first victim was a 55-year-old man who fell ill on 17 November 2019. Within the next month, the number of coronavirus cases in Hubei gradually increased to a couple of hundred, before rapidly increasing in January 2020. On 31 December 2019, the virus had caused enough cases of unknown pneumonia to be reported to health authorities in Wuhan, the capital of Hubei province, China, and an investigation into the illness began early in the following month. These were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals, consequently the virus is thought to have a zoonotic origin.

During the early stages, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration, with Wuhan being a transport hub and major rail interchange in China; infected people quickly spread throughout the country. On 20 January, China reported nearly 140 new cases in a day, including two people in Beijing and one in Shenzhen. Later official data shows that 6,174 people had already developed symptoms by 20 January 2020.

On 30 January, the WHO declared the outbreak to be a Public Health Emergency of International Concern. On 24 February, its director, Tedros Adhanom, warned that the virus could become a global pandemic due to increasing numbers of cases outside China.

On 13 March, the WHO declared Europe to be the new centre of the pandemic, after the rate of new cases in Europe surpassed those recorded in other regions of the world apart from China. By 16 March 2020, the total number of cases reported around the world outside China had exceeded that of Mainland China. As of 18 March 2020, over 206,000 cases have been reported worldwide; more than 8,200 people have died; and over 82,000 have recovered. There is thought to be a substantial underreporting of cases, particularly of cases with milder symptoms or no symptoms.

Domestic responses

Main article: National responses to the 2019–20 coronavirus pandemic

See also: Criticism of response to the 2019–20 coronavirus pandemic

As of 29 February, apart from mainland China, the epidemic had spread to several other countries around the world, with the most affected being South Korea, Italy and Iran. National response measures have included containment measures such as quarantines and curfews.

China

Main article: 2019–20 coronavirus pandemic in mainland China

"Aerial photography of roads after motor vehicles are banned in central urban areas of Wuhan: few vehicle traces" – Video news from China News Service

Body temperature screening at the entrance of Beijing Subway

Exit-Entry permit ticket for residents in Changzhou during the outbreak; one person is allowed to leave home and buy necessities per two days per household

The first person known to have fallen ill due to the new virus was traced back to 1 December 2019 in Wuhan. Doctor Zhang Jixian observed a cluster of unknown pneumonia on 26 December, and her hospital informed Wuhan Jianghan CDC on 27 December. A public notice on the outbreak was released by Wuhan Municipal Health Commission on 31 December. WHO was informed of the outbreak on the same day. On 1 January 2020, Wuhan police announced eight people, who later found to be all doctors, were summoned and warned for "spreading rumours" likening the disease to SARS. Doctor Li Wenliang was also "admonished" by police on 3 Jan. In the early stages of the outbreak, Chinese National Health Commission said that they had no "clear evidence" of human-to-human transmissions.

The Chinese Communist Party launched an radical campaign described by the Party general secretary Xi Jinping as a "people's war" to contain the spread of the virus. In what has been described as "the largest quarantine in human history", a quarantine was announced on 23 January stopping travel in and out of Wuhan, which was extended to a total of 15 cities in Hubei. Private vehicle use was banned in the city. Chinese New Year (25 January) celebrations were cancelled in many places. The authority also announced the construction a temporary hospital Huoshenshan Hospital, which was completed in 10 days, and 14 temporary hospitals were constructed in China in total.

On 26 January, the Communist Party and the government instituted further measures to contain the COVID-19 outbreak, including health declarations for travellers and changes to national holidays. The leading group decided to extend the Spring Festival holiday to contain the outbreak. Universities and schools around the country were also closed. The regions of Hong Kong and Macau instituted several measures, particularly in regard to schools and universities. Remote working measures were instituted in several Chinese regions. Various travel restrictions were enacted. Other provinces and cities outside Hubei imposed travel restrictions. Public transport was modified, and museums throughout China were temporarily closed. Control of movement of people was applied in many cities, and it has been estimated that over half of China's population, around 760 million people, faced some forms of restriction going out of their homes.

After the outbreak entered its global phase in March, many Chinese students studying in Europe and the United States have returned home as the domestic daily new cases in China declined. Chinese authorities has taken strict measures to prevent the virus from "importing" from other countries. For example, Beijing has imposed a 14-day mandatory quarantine for all international travellers entering the city.

The early response by the Wuhan authorities was criticized as prioritizing a control of information that might be unfavorable for local officials over public safety, and the Chinese government was also criticized for cover-ups and downplaying the initial discovery and severity of the outbreak. Whistleblowing from various Chinese doctors, including Li Wenliang on 30 December revealed that Wuhan hospital authorities were already aware that the virus was a SARS-like coronavirus and patients were already placed under quarantine. However, news of the outbreak was dismissed as "rumor mongering" by the Wuhan Public Security Bureau. By the time China had informed the WHO of the new coronavirus on 31 December, The New York Times reported that the government was still keeping "its own citizens in the dark". Observers have also blamed the institutional censorship structure of the country's press that left senior officials with inaccurate information on the outbreak and "contributed to a prolonged period of inaction that allowed the virus to spread". Some experts doubted the accuracy of the number of cases reported by the Chinese government, which repeatedly changed how it counted coronavirus cases. The Chinese government has also been accused of rejecting help from the CDC and the WHO.

Although criticisms have been levelled at the aggressive response of China to control the outbreak, China's actions have also been praised by some foreign leaders such as U.S. President Donald Trump, and Russian president Vladimir Putin. The director of WHO Tedros Adhanom Ghebreyesus congratulated Chinese government "for the extraordinary measures it has taken to contain the outbreak", and a later WHO report described China's response as "perhaps the most ambitious, agile and aggressive disease containment effort in history". According to a media report on 16 March, the economy in China was very hard-hit in the first two months of 2020 due to the measures taken by the government to curtail virus spread, and retail sales plunged 20.5%

Italy

Main article: 2020 coronavirus pandemic in Italy

Civil Protection volunteers carrying out health checks at the Guglielmo Marconi Airport in Bologna

The outbreak was confirmed to have spread to Italy on 31 January, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. In response, the Italian government suspended all flights to and from China and declared a state of emergency. On 31 January, the Italian Council of Ministers appointed Angelo Borrelli, head of the Civil Protection, as Special Commissioner for the COVID-19 Emergency. An unassociated cluster of COVID-19 cases was later further detected starting with 16 confirmed cases in Lombardy on 21 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 11 different municipalities in northern Italy. 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."

On 4 March, the Italian government ordered the full closure of all schools and universities nationwide as Italy reached 100 deaths. All major sporting events, including Serie A football matches, will be held behind closed doors until April. On 9 March, all sport was suspended completely for at least one month. On 11 March, Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and pharmacies.

On 6 March, the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published medical ethics recommendations regarding triage protocols that might be employed. As of 17 March 2020, there were 31,506 confirmed cases, 2,503 deaths and 2,941 recoveries in Italy. On 16 March it was reported that in the previous 24 hours 368 people had died of the virus. After China, it is the worst affected country by COVID-19.

South Korea

Main article: 2020 coronavirus pandemic in South Korea

Coronavirus infection prevention tips banner in Seoul

Covid 19 was confirmed to have spread to South Korea on 20 January 2020 from China. There was a large increase in cases on 20 February, potentially attributable to a gathering in Daegu of a new religious movement known as the Shincheonji Church of Jesus.

42 Chinese Shincheonji devotees visiting Daegu from Wuhan China were suspected by some as propagating the outbreak. As of 22 February, among 9,336 followers of the church, 1,261 reported symptoms. A petition was circulated requesting the church's disbandment. On 28 February, over 2,000 confirmed cases were reported, rising to 3,150 on 29 February.

All South Korean military bases were on quarantine after tests confirmed that three soldiers were indeed positive for the virus. Airline schedules were also affected and therefore they were changed.

More than 1.5 million South Koreans have signed a petition to impeach President Moon Jae-in over what they claim is the government's mishandling of the outbreak. On 13 March, it was reported that South Korea is using a drive-thru method for testing for the virus. The test takes 10 minutes to do, and the results are available the next day.

On 17 March 2020, around 70 church devotees infected with the virus after attending the River of Grace Community Church claimed to have been caused by spraying salt-water into followers' mouths, under the belief that this would protect them from the virus.

North Korea

Main article: 2020 coronavirus pandemic in North Korea

North Korea closed its border with China in January. The North Korean government officially denied to the WHO that they had any cases, but South Korean sources estimate at least 180 to 200 deaths among the army alone, not counting those among the civilian population. There is no estimate of those merely infected.

Iran

Main article: 2020 coronavirus pandemic in Iran

Disinfection of Tehran subway wagons against coronavirus

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 had died later that day. Early measures announced by the government included the cancellation of concerts and other cultural events, sporting events, and Friday prayers, closure of universities, higher education institutions and schools, and allocated 5 trillion rials to combat the virus. President Hassan Rouhani said on 26 February 2020 that there were no plans to quarantine areas affected by the outbreak, and only individuals would be quarantined. Plans to limit travel between cities were announced in March. Shia shrines in Qom remained open to pilgrims until 16 March 2020.

Iran became a centre of the spread of the virus after China. Amidst claims of a cover-up of the extent of the outbreak in the country, over ten countries have traced their cases back to Iran by 28 February, indicating that the extent of the outbreak may be more severe than the 388 cases reported by the Iranian government by that date. The Iranian Parliament was shut down, with 23 of the 290 members of parliament reported to have had tested positive for the virus on 3 March. A number of senior government officials as well as two members of parliament have died from the disease. On 15 March, the Iranian government reported 100 deaths in a single day, up to that point, the most ever recorded in such a time period.

United States

Main article: 2020 coronavirus pandemic in the United States

Coronavirus in US counties

Disinfection of New York City Subway cars against coronavirus

On 31 January, the Trump administration limited entry into the United States, as immigrants or non-immigrants, of all aliens who were physically present within the People's Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States.

President Trump signs the Coronavirus Preparedness and Response Supplemental Appropriations Act into law on March 6, 2020

In the Pacific Northwest state of Washington, the first death in the United States was reported on 29 February, after an outbreak at a Life Care Centers of America elderly care in Kirkland, Washington, following which Washington governor Jay Inslee declared a state of emergency. Florida and California also declared a state of emergency in early March. Over a dozen schools in the Seattle area cancelled classes on 3 March, for disinfection and other precautionary measures. On 6 March, the University of Washington cancelled in-person classes; the Seattle-based university is home to 50,000 students. Multiple public and private schools outside New York City have closed. All schools within the Elk Grove Unified School District in the Sacramento, California, area shut down on 7 March, after a case of the virus appeared in Elk Grove.

On 6 March, president Donald Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act into law. The bill provides $8.3 billion in emergency funding for federal agencies to respond to the outbreak.

Major US corporations, including Amazon, Facebook, Twitter and Goldman Sachs imposed employee travel restrictions and some cancelled conferences. Some companies, including Microsoft, GitHub and Square, Inc., also encouraged employees to work from home.

Many major US sports leagues cancelled scheduled events. The National Basketball Association (NBA) suspended the 2019–20 season indefinitely. On 12 March, the Major League Soccer (MLS) and Major League Rugby (MLR) announced their 2020 seasons would be suspended for 30 days. The National Hockey League (NHL) suspended play of the 2019–20 season. Major League Baseball announced it would be suspending operations, including the remaining spring training games, and delaying the start of the 2020 season for at least two weeks. On 16 March, the National Association for Stock Car Auto Racing (NASCAR) announced that all race events through 3 May would be postponed. Other events cancelled or suspended include the NCAA Men's Division I Basketball Tournament, the XFL season, the Indian Wells Masters and Miami Open.

Travelers at Hartsfield-Jackson Atlanta International Airport wearing facemasks

On 11 March, President Donald Trump announced the suspension of most travel from Europe (excluding the United Kingdom) for 30 days, beginning on 13 March. He also said that health insurance companies agreed to waive all co-payments for coronavirus treatments and extend insurance coverage to cover coronavirus treatments. The Department of Homeland Security clarified that the travel suspension only applied to the Schengen Area; it does not apply to European countries that are not members of the Schengen Agreement, such as the United Kingdom, the Republic of Ireland, Croatia, Albania, or Belarus. Furthermore, the travel ban does not apply to US citizens or permanent residents, or their family members or those travelling on certain types of visa. On 14 March, President Trump expanded the travel ban on Europe to include the United Kingdom and Ireland. In addition, a representative of the insurance industry clarified that, contrary to the president's statement, major health insurers had only agreed to waive co-payments for coronavirus testing, and not for coronavirus treatment, which is far more costly.

As of 18 March 2020, the epidemic was reported to be present in all states, plus the District of Columbia. The number of confirmed cases in the U.S. rose to 7,301, with 116 deaths. On 13 March, U.S. President Trump declared a national emergency due to the virus outbreak. The action made federal funds available to respond to the crisis. Per media reports on 15 March, many businesses closed or reduced hours throughout the U.S. as a method to try to combat the virus.

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. On 27 February, The New York Times reported that Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that he was instructed by the White House not to talk about the coronavirus without clearance. President Trump has vowed to "keep the numbers low", leading to claims that he is trying to limit the magnitude of the published statistics. On 4 March, the Centers for Disease Control and Prevention of the United States deleted the running tally of the number of people tested for the coronavirus across the US from its website. Allegations of a cover-up and concerns has risen that the deletion could possibly limit the country's response to the epidemic.

Japan

Main article: 2020 coronavirus pandemic in Japan

People in Tokyo wearing masks

The 2019–20 coronavirus pandemic was confirmed to have spread to Japan on 16 January 2020 from China.

On 27 February 2020, Prime Minister Shinzo Abe requested that all Japanese elementary, junior high, and high schools close until early April to help contain the virus. The outbreak has been a concern for the 2020 Summer Olympics which is scheduled to take place in Tokyo starting at the end of July. The Japanese government has thus been taking extra precautions to help minimize the outbreak's impact. On 15 March it was reported that 15 coronavirus clusters had been identified in Japan, with the largest cluster in the Osaka area.

United Kingdom

Main article: 2020 coronavirus pandemic in the United Kingdom

The UK response to the virus first emerged as one of the most lax and controversial of the affected countries and as of 18 March 2020 the British government has not imposed any form of social distancing or mass quarantine measures on its citizens. On 15 March it was reported that the UK government would no longer test those individuals self-isolating with mild symptoms of coronavirus, however, it would extend testing for those individuals seeking hospital treatment for the virus or those in long-term care facilities. On 16 March, Prime Minister Boris Johnson made an announcement advising against all non-essential travel and social contact, to include working from home where possible and avoiding venues such as pubs, restaurants and theatres. The government has been widely criticised for not doing enough to address the issues and concerns faced by the public, both nationally and internationally.

Other countries

Main article: 2019–20 coronavirus pandemic by country and territory

The virus has spread to multiple other countries, in total, 170 territories have had at least one case. Due to the coronavirus pandemic in Europe, multiple countries in the Schengen Area have restricted the free movement within the area, and set up border controls.

International responses

See also: December 2019 – January 2020, February 2020, March 2020, and Criticism of response to the 2019–20 coronavirus pandemic

An analysis of air travel patterns was used to map out and predict patterns of spread and was published in the The Journal of Travel Medicine in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo and Taipei had the largest volume of travellers from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people travelling from Wuhan. Bali was reported as least able in terms of preparedness, while cities in Australia were considered most able.

There have been international comments that the 2020 Olympics should be moved from Japan or postponed. On 22 January, the Asian Football Confederation (AFC) announced that it would be moving the matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and Thailand. A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney. The Asia-Pacific Olympic boxing qualifiers, which were originally set to be held in Wuhan from 3 to 14 February, were also cancelled and moved to Amman, Jordan to be held between 3 and 11 March.

Australia released its Emergency Response Plan for Novel Coronavirus (COVID-19) on 7 February. It states that much is yet to be discovered about COVID-19, and that Australia will emphasise border control and communication in its response to the pandemic.

• 
  Announcement on a television screen at Delft University of Technology in the Netherlands, advising students not to travel to China (19 February 2020)
• A worker disinfects an ambulance in Daegu, South Korea
  A worker disinfects an ambulance in Daegu, South Korea
• Prime Minister Giuseppe Conte and the Italian task force discuss how to respond to the coronavirus outbreak
  Prime Minister Giuseppe Conte and the Italian task force discuss how to respond to the coronavirus outbreak

Travel restrictions

Main article: Travel restrictions related to the 2019–20 coronavirus pandemic

Countries that have implemented a global travel ban in response to the COVID-19 pandemic

As a result of the outbreak, many countries and regions including most of the Schengen area, Armenia, Australia, India, Iraq, Indonesia, Kazakhstan, Kuwait, Malaysia, Maldives, Mongolia, New Zealand, Philippines, Singapore, Sri Lanka, Taiwan, Vietnam, and the United States have imposed temporary entry bans on Chinese citizens or recent visitors to China, or have ceased issuing visas and reimposed visa requirements on Chinese citizens. Samoa even started refusing entry to its own citizens who had previously been to China, attracting widespread condemnation over the legality of the decision.

The European Union rejected the idea of suspending the Schengen free travel zone and introducing border controls with Italy, which has been criticized by some European politicians. After some EU member states announced complete closure of their national borders to foreign nationals, the European Commission President Ursula von der Leyen said that "Certain controls may be justified, but general travel bans are not seen as being the most effective by the World Health Organization."

Saudi Arabia has temporarily banned foreigners from entering Mecca and Medina, two of Islam's holiest pilgrimage sites, to prevent the spread of coronavirus in the Kingdom. The United States suspended travel from the Schengen Area and the UK. Many countries then started closing their borders to virtually all non-citizens or non-residents in rapid succession, including India, Slovakia, Denmark, Poland, and Lithuania.

Evacuation of foreign citizens

See also: Evacuations related to the 2019–20 coronavirus pandemic

Ukraine evacuates Ukrainian and foreign citizens from Wuhan

Owing to the effective quarantine of public transport in Wuhan and Hubei, several countries have planned to evacuate their citizens and diplomatic staff from the area, primarily through chartered flights of the home nation that have been provided clearance by Chinese authorities. Canada, the United States, Japan, India, France, Australia, Sri Lanka, Germany and Thailand were among the first to plan the evacuation of their citizens. Pakistan has said that it will not be evacuating any citizens from China. On 7 February, Brazil evacuated 34 Brazilians or family members in addition to four Poles, a Chinese and an Indian citizen. The citizens of Poland, China and India got off the plane in Poland, where the Brazilian plane made a stopover before following its route to Brazil. Brazilian citizens who went to Wuhan were quarantined at a military base near Brasilia. On the same day, 215 Canadians (176 from the first plane, and 39 from a second plane chartered by the US government) were evacuated from Wuhan, China, to CFB Trenton to be quarantined for two weeks. On 11 February, another plane of Canadians (185) from Wuhan landed at CFB Trenton. Australian authorities evacuated 277 citizens on 3 and 4 February to the Christmas Island Detention Centre which had been "repurposed" as a quarantine facility, where they remained for 14 days. A New Zealand evacuation flight arrived at Auckland on 5 February; the passengers (including some from Australia and the Pacific) were quarantined in a naval base at Whangaparoa north of Auckland. The United States announced that it would evacuate Americans aboard the cruise ship Diamond Princess. On 21 February, a plane carrying 129 Canadian passengers evacuated from Diamond Princess landed in Trenton, Ontario. The Indian government has scheduled its air force to evacuate its citizens from Iran.

International aid

File:Digital billboard in Shibuya expressing support against coronavirus.jpg

Digital billboard conveying support with the words "Be Strong China" in various languages at Shibuya in Tokyo on 10 February

On 5 February, the Chinese foreign ministry stated that 21 countries (including Belarus, Pakistan, Trinidad and Tobago, Egypt and Iran) had sent aid to China.

The US city of Pittsburgh announced plans to send medical aid to Wuhan, which is its sister city. The University of Pittsburgh Medical Center (UPMC) also announced plans to provide help. Some Chinese students at other American universities have also 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 and 1,500 protection suits to hospitals in the Hubei province on 30 January.

The humanitarian aid organization Direct Relief, in co-ordination with FedEx transportation and logistics support, sent 200,000 face masks along with other personal protective equipment, including gloves and gowns, by emergency airlift to arrive in Wuhan Union Hospital, who requested the supplies, by 30 January. The Gates Foundation stated on 26 January that it would donate US$5 million in aid to support the response in China that will be aimed at assisting "emergency funds and corresponding technical support to help front-line responders". On 5 February, Bill and Melinda further announced a $100 million donation to the World Health Organization, who made an appeal for funding contributions to the international community the same day. The donation will be used to fund vaccine research and treatment efforts along with protecting "at-risk populations in Africa and South Asia."

Japan, in the process of co-ordinating a plane flight to Wuhan to pick up Japanese nationals in the city, has promised that the plane will first carry into Wuhan aid supplies that Japanese foreign minister Toshimitsu Motegi stated will consist of "masks and protective suits for Chinese people as well as for Japanese nationals". On 26 January, the plane arrived in Wuhan, donating its supply of one million face masks to the city. Also among the aid supplies were 20,000 protective suits for medical staff across Hubei donated by the Tokyo Metropolitan Government.

File:Azadi Tower lights in support of China against coronavirus 2.jpg

Tehran's Azadi Tower lights in the colours of the Flag of China to show support

On 28 January, the city of Mito donated 50,000 masks to its sister-city of Chongqing, and on 6 February, the city of Okayama sent 22,000 masks to Luoyang, its sister-city. The ruling Liberal Democratic Party on 10 February, made a symbolic deduction of 5,000 yen from the March salary of every LDP parliamentarian, a total of 2 million yen, to donate to China, with the party's secretary-general, Toshihiro Nikai, stating that "For Japan, when it sees a virus outbreak in China, it is like seeing a relative or neighbor suffering. Japanese people are willing to help China and hope the outbreak will pass as soon as possible."

Other countries have also announced aid efforts. Malaysia announced a donation of 18 million medical gloves to China. The Philippine Red Cross also donated $1.4 million worth of Philippine-made face masks, which were shipped to Wuhan. Turkey dispatched medical equipment, and Germany delivered various medical supplies including 10,000 Hazmat suits. On 19 February, Singapore Red Cross announced that they will send $2.26 million worth of aid to China, consisting of protective material and training.

WHO response measures

The WHO has commended the efforts of Chinese authorities in managing and containing the epidemic, with Director-General Tedros Adhanom Ghebreyesus expressing "confidence in China's approach to controlling the epidemic" and calling for the public to "remain calm". The WHO noted the contrast between the 2003 epidemic, where Chinese authorities were accused of secrecy that impeded prevention and containment efforts, and the current crisis where the central government "has provided regular updates to avoid panic ahead of Lunar New Year holidays."

World Health Organization (WHO) Director-General Tedros Adhanom

On 23 January, in reaction to the central authorities' decision to implement a transportation ban in Wuhan, WHO representative Gauden Galea remarked that while it was "certainly not a recommendation the WHO has made," it was also "a very important indication of the commitment to contain the epidemic in the place where it is most concentrated" and called it "unprecedented in public health history."

On 30 January, following confirmation of human-to-human transmission outside China and the increase in the number of cases in other countries, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), the sixth PHEIC since the measure was first invoked during the 2009 swine flu pandemic. Tedros clarified that the PHEIC, in this case, was "not a vote of no confidence in China," but because of the risk of global spread, especially to low- and middle-income countries without robust health systems. In response to the implementations of travel restrictions, Tedros stated that "there is no reason for measures that unnecessarily interfere with international travel and trade" and that "WHO doesn't recommend limiting trade and movement."

On 5 February, the WHO appealed to the global community for a $675 million contribution to fund strategic preparedness in low-income countries, citing the urgency to develop those countries which "do not have the systems in place to detect people who have contracted the virus, even if it were to emerge." Tedros further made statements declaring that "We are only as strong as our weakest link" and urged the international community to "invest today or pay more later."

On 11 February, the WHO in a press conference established COVID-19 as the name of the disease. On the same day, Tedros stated that UN Secretary-General Antonio Guterres had agreed to provide the "power of the entire UN system in the response." A UN Crisis Management Team was activated as a result, allowing co-ordination of the entire United Nations response, which the WHO states 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."

WHO representatives holding joint meeting with Tehran administrators

On 14 February, a WHO-led Joint Mission Team with China was activated to provide international and WHO experts to touch ground in China to assist in the domestic management and evaluate "the severity and the transmissibility of the disease" by hosting workshops and meetings with key national-level institutions to conduct field visits to assess the "impact of response activities at provincial and county levels, including urban and rural settings."

On 25 February, the WHO declared that "the world should do more to prepare for a possible coronavirus pandemic," stating that while it was still too early to call it a pandemic, countries should nonetheless be "in a phase of preparedness." In response to a developing outbreak in Iran, the WHO sent a Joint Mission Team there on the same day to assess the situation.

On 28 February, WHO officials said that 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 WHO's health emergencies program, warned in a statement 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 the world avoid "the worst of it." Ryan further stated that the current data did not warrant public health officials to declare a global pandemic, saying that such a declaration would mean "we're essentially accepting that every human on the planet will be exposed to that virus."

On 11 March the WHO declared the coronavirus outbreak an official pandemic. The Director-General said that WHO was "deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction."

Political impacts

Main article: Impact of the 2019–20 coronavirus pandemic on politics

Some have criticized European Union's lack of solidarity with coronavirus-affected Italy.

A number of provincial-level administrators of the Communist Party of China (CPC) were dismissed over their handling of the quarantine efforts in Central China, a sign of discontent with the political establishment's response to the outbreak in those regions. Some experts believe this is likely in a move to protect Communist Party general secretary Xi Jinping from people's anger over the coronavirus outbreak. Some commentators have suggested that outcry over the disease could be a rare protest against the CPC. Protests in Hong Kong strengthened due to fears of immigration from mainland China. Taiwan has also voiced concern over being included in any travel ban involving the People's Republic of China due to the "one-China policy" and Chinese claims. A few countries have been using the epidemic to build political bridges with Beijing, raising accusations that these countries, which include Cambodia among others, were putting politics before health, attempting to use the outbreak to show tribute to the CPC. Existing tensions between the US and China may have delayed a coordinated effort to combat the outbreak in Wuhan.

The Government of the Islamic Republic of Iran has been heavily affected by the virus. The spread of the virus has raised questions about the future survival of the regime. Iran's President Hassan Rouhani wrote a public letter to world leaders asking for help, saying that his country doesn't have access to international markets due to the United States sanctions against Iran.

The coronavirus outbreak in the United States may affect negatively Donald Trump's chances of re-election at the 2020 United States presidential election. European Union leaders condemned the U.S. decision to restrict travel from Europe to the United States. The outbreak also prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care, universal child care, paid family leave, and higher levels of funding for public health. Some state emergency orders have waived open meeting laws that require the public have physical access to the meeting location, allowing meetings to be held by public teleconference. Diplomatic relations between Japan and South Korea worsened, as South Korea criticized Japan's "ambiguous and passive quarantine efforts".

Societal impacts

Impact on education

Main article: Impact of the 2019–20 coronavirus pandemic on education

Learners affected by school closures caused by COVID-19 as of 17 March 2020

  Localised school closures

  Country-wide school closures

As of 17 March, more than 960 million children and youth are not attending school because of temporary or indefinite country wide school closures mandated by governments in an attempt to slow the spread of COVID-19. 105 countries have shut schools nationwide, affecting students who would normally attend pre-primary to upper-secondary classes. 15 countries have implemented localized school closures to prevent or contain COVID-19, affecting an additional 640 million school children and youth.

Even when school closures are temporary, it carries high social and economic costs. The disruptions they cause affect people across communities, but their impact is more severe for disadvantaged children and their families including interrupted learning, compromised nutrition, childcare problems and consequent economic cost to families who cannot work.

In response to school closures caused by COVID-19, UNESCO recommends the use of distance learning programs and open educational applications and platforms that schools and teachers can use to reach learners remotely and limit the disruption of education.

Cultural and religious impacts

Main article: List of major events affected by the 2019–20 coronavirus pandemic

See also: Impact of the 2019–20 coronavirus pandemic on religion, on cinema, on television, and on sports

Another recent and rapidly accelerating fallout of the disease is the cancellation of religious services, major events in sports, the film industry, and other societal events, such as music festivals and concerts, technology conferences, fashion shows and sports.

The Vatican announced that Holy Week observances in Rome, which occur during the last week of the Christian penitential season of Lent, have been cancelled. Many dioceses have recommended older Christians to stay at home rather than attending Mass on Sundays, which is usually required; some churches have made church services available via online livestreaming or television. With the Roman Catholic Diocese of Rome closing its churches and chapels, Saint Peter's Square is now empty of Christian pilgrims; on the other hand the Archdiocese of New York, though cancelling services, has left its churches open for prayer. Likewise, the Islamic Society of North America recommended that congregations suspend Friday congregational prayers and gatherings. The Rabbinical Council of America issued a guideline stating that "public gatherings in synagogues and schools should be severely limited" while the Sikh Coalition recommended the cancelling of services at gurdwaras.

Several major sporting events were cancelled or postponed, including the 2019–20 UEFA Champions League, 2019–20 Premier League, UEFA Euro 2020, 2019–20 NBA season, and 2019-20 NHL season. The outbreak has been a concern for the 2020 Summer Olympics which is scheduled to take place in Tokyo starting at the end of July.

The entertainment industry has also been affected, with various music groups suspending or cancelling concert tours. Many large theatres such as those on Broadway also suspended all performances. 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 or creating web-based "festivals" for artists to perform, distribute and publicize their work.

Socio-economic impact

Main article: Socio-economic impact of the 2019–20 coronavirus pandemic

See also: Impact of the 2019–20 coronavirus pandemic on aviation and tourism and on financial markets

See also: Russia–Saudi Arabia oil price war and 2020 stock market crash

Coronavirus fears have led to panic buying of essentials in Singapore and elsewhere, including toilet paper, dried and/or instant noodles, bread, rice, vegetables, disinfectant and rubbing alcohol

The coronavirus outbreak has been attributed to several instances of supply shortages, stemming from: globally increased usage of equipment to fight the outbreaks, panic buying and disruption to factory and logistic operations. The FDA has issued warnings about shortages to drugs and medical equipment due to increased consumer demand and supplier disruption. Several localities, such as the United States, Italy and Hong Kong, also witnessed panic buying that led to shelves being cleared of grocery essentials such as food, toilet paper and bottled water, inducing supply shortages. The technology industry in particular has been warning about delays to shipments of electronic goods. According to WHO director-general Tedros Adhanom, the demand for personal protection equipment has risen 100-fold and this demand has led to the increase in prices of up to twenty times the normal price and also induced delays on the supply of medical items for four to six months. This has also caused a shortage of personal protective equipment worldwide, with the WHO warning that this will endanger health workers.

As mainland China is a major economy and a manufacturing hub, the viral outbreak has been seen to pose a major destabilizing 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. Some analysts have estimated that the economic fallout of the epidemic on global growth could surpass that of the SARS outbreak. One estimate gives a $300+ billion impact on world's supply chain that could last up to two years. Organization of the Petroleum Exporting Countries reportedly "scrambled" after a steep decline in oil prices due to lower demand from China. Global stock markets fell on 24 February due to a significant rise in the number of COVID-19 cases outside mainland China. On 27 February, due to mounting worries about the coronavirus outbreak, various US stock indexes including the NASDAQ-100, the S&P 500 Index and the Dow Jones Industrial Average, 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. All three indexes ended the week down more than 10 percent. On 28 February, Scope Ratings GmbH affirmed China's sovereign credit rating, but maintained a Negative Outlook. Stocks plunged again based on coronavirus fears, the largest fall being on 16 March 2020. Many consider an economic recession to be likely.

The near-empty arrival hall of Seoul–Incheon International Airport in South Korea on 6 March

Tourism is one of the worst affected sectors due to travel bans, closing of public places including travel attractions, and advise of governments against any travel all over the world. As a consequence, numerous airlines have cancelled flights due to lower demand, including British Airways, China Eastern and Qantas, while British regional airline Flybe collapsed. Several train stations and ferry ports have also been closed. The epidemic coincided with the Chunyun, a major travel season associated with the Chinese New Year holiday. A number of events involving large crowds were cancelled by national and regional governments, including annual New Year festivals, with private companies also independently closing their shops and tourist attractions such as Hong Kong Disneyland and Shanghai Disneyland. Many Lunar New Year events and tourist attractions have been closed to prevent mass gatherings, including the Forbidden City in Beijing and traditional temple fairs. In 24 of China's 31 provinces, municipalities and regions, authorities extended the New Year's holiday to 10 February, instructing most workplaces not to re-open until that date. These regions represented 80% of the country's GDP and 90% of exports. Hong Kong raised its infectious disease response level to the highest and declared an emergency, closing schools until March and cancelling its New Year celebrations.

Despite the high prevalence of coronavirus cases in Northern Italy and the Wuhan region, and the ensuing high demand for food products, both areas have been spared from acute food shortages. Effective measures by China and Italy against the hoarding and illicit trade of critical products have been carried out with success, avoiding acute food shortages that were anticipated in Europe as well as in North America. Northern Italy with its significant agricultural production has not seen a large reduction, but prices may increase according to industry representatives. Empty food shelves were only encountered temporarily, even in Wuhan city, while Chinese government officials released pork reserves to assure sufficient nourishment of the population. Similar laws exist in Italy, that require food producers to keep reserves for such emergencies.

Environmental impacts

Due to the coronavirus outbreak's impact on travel and industry, many regions experienced a drop in air pollution. Between 1 January and 11 March 2020, the European Space Agency observed a marked decline in nitrous oxide emissions from cars, power plants and factories in the Po Valley region in northern Italy, coinciding with lockdowns in the region. The Centre for Research on Energy and Clean Air reported that methods to contain the spread of coronavirus, such as quarantines and travel bans, resulted in a 25% reduction of carbon emission in China. In the first month of lockdowns, China produced approximately 200 million fewer metric tons of carbon dioxide than the same period in 2019, due to the reduction in air traffic, oil refining, and coal consumption.

Despite a temporary decline in global carbon emissions, the International Energy Agency warned that the economic turmoil caused by the coronavirus outbreak may prevent or delay companies from investing in green energy.

Potential long-term impacts

See also: Globalization and disease

The political, cultural, and socio-economic impacts of the pandemic may together cause major changes in human society. They include the rise in remote work, localization of global supply chains, and increased political polarization.

The pandemic has been claimed to be causing a "revolution in working from home" as major corporations have transitioned to telecommuting arrangements in order to slow the spread of the virus. This effect has also been observed in the rise of online learning in higher education. Additionally, there may also be a reduction in business travel and international conferences, with virtual substitutes replacing them.

A more widespread reversal of globalization has also been discussed, especially in regards to supply chains. The German Economy Minister has supported localization of supply chains in reaction to the pandemic.

Xenophobia and racism

Main article: Xenophobia and racism related to the 2019–20 coronavirus pandemic

Houston Chinatown where businesses claim a 50–75% reduction in business due to the pandemic.

Since the outbreak of COVID-19, heightened prejudice, xenophobia and racism have been noted toward people of Chinese and other East Asian descent, as incidents of fear, suspicion and hostility have been observed in many countries, particularly in Europe, North America and the Asia-Pacific region. Some countries in Africa were seeing rising anti-Chinese sentiment as well. There has been support for the Chinese, both on and offline towards those in virus-stricken areas, but many residents of Wuhan and Hubei have reported experiencing discrimination based on their regional origin. Since the progression of the outbreak to new hot-spot countries, people from Italy, the center of Europe's coronavirus outbreak, have also been subjected to suspicion and xenophobia.

Citizens in numerous countries such as Malaysia, New Zealand, Singapore and South Korea have signed petitions lobbying their government to ban Chinese people from entering their country. In Japan, the hashtag #ChineseDontComeToJapan had been trending on Twitter. Chinese people in the United Kingdom said they were facing increasing levels of racist abuse, with cases of assaults reported. Protesters in Ukraine attacked buses carrying Ukrainian and foreign evacuees from Wuhan. Students from Northeast India, which shares a border with China, who study in major Indian cities have reportedly experienced harassment related to the coronavirus outbreak. Local authorities in Bolivia quarantined Japanese nationals despite them having no coronavirus-related symptoms. In the Russian cities of Moscow and Yekaterinburg, Chinese nationals were targeted by quarantine enforcing campaigns, as well as police raids, which were condemned by human rights advocates as racial profiling. The Chinese Embassy in Germany has acknowledged a rise in hostile cases against its citizens since the outbreak. Children of Asian descent were ostracized and mocked over their origins in middle schools near Paris. Many French-Vietnamese report also being subject to harassment since the coronavirus outbreak in Wuhan.

On 30 January, the WHO's Emergency Committee issued a statement advising all countries to be mindful of the "principles of Article 3 of the IHR (the International Health Regulations)," which the WHO says is a caution against "actions that promote stigma or discrimination," when conducting national response measures to the outbreak.

Information dissemination

Open-access papers

Owing to the urgency of the epidemic, many scientific publishers made scientific papers related to the outbreak available with open access. Some scientists chose to share their results quickly on preprint servers such as bioRxiv, while archivists created an open access database of over 5,000 papers about coronaviruses, which they downloaded from Sci-Hub. In addition, the platform Outbreak Science Rapid PREreview was launched to perform rapid open peer review of preprints related to emerging outbreaks.

Medical care providers, including intensivists and pulmonologists, involved in the Free Open Access Medicine movement rapidly compiled both disease information and treatment procedures in the Internet Book of Critical Care which was quickly circulated by institutions including Princeton and UPenn.

Citizen science

Interactive computing games have also been used to help with "designing and identifying proteins that may be able to bind to and neutralise the SARS-CoV-2 spike protein that it uses to invade host cells. The scientists hope that players' creations will yield insights that will allow them to create an effective antiviral therapy for COVID-19." Foldit is an online video game that challenges players to fold various proteins into shapes where they are stable: "Players—who can work alone or in teams—are using the game's puzzle system to develop new protein structures that can be tested by biochemists in the lab for use in antiviral drugs." Folding@home developed by the Stanford University is asking people for donating their CPU time for computational drug design and other types of molecular dynamics involving SARS-CoV-2.

Misinformation

Main article: Misinformation related to the 2019–20 coronavirus pandemic

After the initial outbreak, conspiracy theories and misinformation spread online regarding the origin and scale of the COVID-19 coronavirus. Various social media posts claimed the virus was a bio-weapon, a population control scheme, or the result of a spy operation.

Facebook, Google and Twitter announced that they would take stringent measures against possible misinformation. In a blog post, Facebook stated they would remove content flagged by leading global health organizations and local authorities that violates its content policy on misinformation leading to "physical harm."

On 2 February, the WHO declared there was a "massive infodemic" accompanying the outbreak and response, citing an overabundance of reported information, accurate and false, about the virus that "makes it hard for people to find trustworthy sources and reliable guidance when they need it." The WHO stated that the high demand for timely and trustworthy information has incentivized the creation of a direct WHO 24/7 myth-busting hotline where its communication and social media teams have been monitoring and responding to misinformation through its website and social media pages. The WHO has specifically debunked as false some claims that have circulated on social media, including that a person can tell if they have the virus or not simply by holding their breath; that drinking lots of water will protect against the virus; and that that gargling salt water will prevent infection.

Taiwanese authorities have accused 50 Cent Party's internet trolls of spreading disinformation online to sow fear and panic among Taiwanese. According to The Economist, conspiracy theories about COVID-19 being the CIA's creation to keep China down were all over the Chinese internet. On 26 January, Chinese military news agency Xilu published an article claiming the virus was artificially combined by the United States to "precisely target Chinese people". Zhao Lijian, a spokesman from China's Ministry of Foreign Affairs, tweeted in March 2020 that the disease may have been introduced by members of the American Army who visited Wuhan in October 2019. On 22 February, US officials said that they have discovered Russia-linked social media accounts deliberately promoting anti-American conspiracy theories, such as "waging economic war" on China, which was denied by Russia.

Trump's top economic adviser Larry Kudlow and some members of the United States Congress have been accused of giving misinformation about the coronavirus. Christopher Bouzy, the founder of Bot Sentinel, made a Twitter analysis for Inverse and found that trollbots linked to the Republican Party "are making an array of false claims" about the coronavirus outbreak.

According to Radio Farda, Iranian cleric Seyyed Mohammad Saeedi accused President Trump of targeting Qom with coronavirus to fulfill his previous promise of retaliation against Iranian cultural sites. Iranian researcher Ali Akbar Raefipour claimed that the coronavirus was part of a "hybrid warfare" program waged by the United States on Iran and China. Iran's Press TV asserted that "Zionist elements developed a deadlier strain of coronavirus against Iran". According to the Middle East Media Research Institute, numerous writers in the Arabic media have promoted the conspiracy theory that COVID-19 was deliberately created and spread by the United States, as "part of an economic and psychological war waged by the US against China with the aim of weakening it and presenting it as a backward country and a source of diseases".

In a move which commentators consider state propaganda to deflect blame for poor handling of the epidemic, some officials, including a foreign ministry spokesman, the state news agency Xinhua, have protested at alleged "politicisation" of the outbreak by countries. Possibly prompted by a press conference on 27 February where Zhong Nanshan, a prominent expert, said that "the coronavirus first appeared in China but may not have originated in China", individual officials have echoed Xinhua's claim that "The WHO has said many times that COVID-19 is a global phenomenon with its source still undetermined."

See also

• Cross-species transmission
• Emerging infectious disease
• List of epidemics
• List of people with coronavirus disease 2019
• List of public venues and institutions closed during the 2019–20 coronavirus pandemic
• Virgin soil epidemic
• Wildlife trafficking and emerging zoonotic diseases

Note

•  This article incorporates text from a free content work. Text taken from 290 million students out of school due to COVID-19: UNESCO releases first global numbers and mobilizes response​, UNESCO.
•  This article incorporates text from a free content work. Text taken from Coronavirus impacts educatio​, UNESCO.

Further reading

• Zhou F, Yu T, Du R, et al. (March 2020). "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study". Lancet. doi:10.1016/s0140-6736(20)30566-3. ISSN 0140-6736. PMID 32171076.

External links

Government health agencies

• World Health Organization: COVID-19 (Questions & Answers)
• European Centre for Disease Prevention and Control: COVID-19 (Q&A)
• China National Health Commission: COVID-19
• Singapore Ministry of Health: COVID-19 (Q&A)
• U.S. Centers for Disease Control: COVID-19 (Q&A)
• National Institute for Occupational Safety and Health, Coronavirus Disease 2019
• Filtering out Confusion: Frequently Asked Questions about Respiratory Protection, US National Institute for Occupational Safety and Health

Data and maps

• Coronavirus disease (COVID-2019) situation reports by the World Health Organization (official numbers of confirmed cases by country)
• Coronavirus COVID-19 Global Cases and historical data by Johns Hopkins University
• Covid-19 latest news and resources by The BMJ
• COVID-19 Resource Centre by The Lancet
• Coronavirus Resource Hub by Cell Press
• Coronavirus Observer based on Johns Hopkins University data