COVID-19 pandemic

From Wikipedia, the free encyclopedia

Jump to navigationJump to search

COVID-19 pandemic

Confirmed cases per 100,000 population as of 10 August 2020

  >3,000

  1,000–3,000

  300–1,000

  100–300

  30–100

  0–30

  None or no data

show
Cases per country

show
Deaths per capita
 Clockwise, starting from top:

A nurse caring for a COVID-19 patient in an intensive care unit

aboard a U.S. hospital ship

 Disinfection vehicles in Taiwan

 Donated medical supplies being received in the Philippines

 Burial in Iran

 The Italian government's outbreak task force

Disease Coronavirus disease 2019 (COVID-19)

Virus strain Severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2)[a]

Source Probably bats, possibly via pangolins[2][3]

Location Worldwide

First outbreak China[4]

Index case Wuhan, Hubei, China

30°37′11″N 114°15′28″E

Date 1 December 2019[4]–present

(8 months, 1 week and 2 days)

Confirmed cases 19,919,559[5]

Active cases 7,044,133[5]

 Recovered 12,143,142[5]

Deaths 732,284[5]

Territories 188[5]

The COVID-19 pandemic, also known as the coronavirus pandemic, is an

ongoing global 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 December 2019 in Wuhan, China.[4][6] The World
Health Organization declared the outbreak a Public Health Emergency of
International Concern on 30 January 2020 and a pandemic on 11 March.[7][8] As
of 10 August 2020, more than 19.9 million cases of COVID-19 have been
reported in more than 188 countries and territories, resulting in more than
732,000 deaths; more than 12.1 million people have recovered.[5]
The virus is primarily spread between people in close proximity,[b] most often
via small droplets produced by coughing,[c] sneezing, and talking.[9][10][12] The
droplets usually fall to the ground or onto surfaces rather than travelling through
air over long distances.[9][13] However, the transmission may also occur
through smaller droplets that are able to stay suspended in the air for longer
periods of time in enclosed spaces, as typical for airborne diseases.[14] Less
commonly, people may become infected by touching a contaminated surface
and then touching their face.[9][10] It is most contagious during the first three days
after the onset of symptoms, although spread is possible before symptoms
appear, and from people who do not show symptoms. [9][10]
Common symptoms include fever, cough, fatigue, shortness of breath, and loss
of sense of smell.[9][15][16] Complications may include pneumonia and acute
respiratory distress syndrome.[17] The time from exposure to onset of
symptoms is typically around five days but may range from two to fourteen
days.[18][19] There are several vaccine candidates in development, although none
have completed clinical trials to prove their safety and efficacy. There is no
known specific antiviral medication,[9] so primary treatment is
currently symptomatic.[20]
Recommended preventive measures include hand washing, covering one's
mouth when coughing, maintaining distance from other people, wearing a face
mask in public settings, disinfecting surfaces, increasing ventilation and air
filtration indoors,[21] and monitoring and self-isolation for people who suspect they
are infected.[9][22] Authorities worldwide have responded by implementing travel
restrictions, lockdowns, workplace hazard controls, and facility closures in order
to slow the spread of the disease. Many places have also worked to
increase testing capacity and trace contacts of infected persons.
The pandemic has caused global social and economic disruption,
[23]
 including the largest global recession since the Great Depression[24] and global
famines affecting 265 million people.[25] It has led to the postponement or
cancellation of sporting, religious, political, and cultural events,[26] widespread
supply shortages exacerbated by panic buying,[27][28] and decreased emissions of
pollutants and greenhouse gases.[29][30] Schools, universities, and colleges have
been closed either on a nationwide or local basis in 161 countries, affecting
approximately 98.6 percent of the world's student population. [31] Misinformation
 about the virus has circulated through social media and mass media. [32] 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.[33]

Contents

 1Epidemiology
o 1.1Background
o 1.2Cases
o 1.3Deaths
o 1.4Duration
 2Signs and symptoms
 3Cause
o 3.1Transmission
o 3.2Virology
 4Diagnosis
o 4.1Viral testing
o 4.2Imaging
 5Prevention
o 5.1Hand washing
o 5.2Social distancing
o 5.3Face masks and respiratory hygiene
o 5.4Self-isolation
o 5.5Surface cleaning
o 5.6Ventilation and air filtration
o 5.7Vaccine
 6Management
o 6.1Screening, containment and mitigation
o 6.2Health care
o 6.3Treatment
 7History
o 7.12020
 8National responses
o 8.1Asia
o 8.2Europe
o 8.3North America
o 8.4South America
o 8.5Africa
o 8.6Oceania
 9International responses
o 9.1Travel restrictions
o 9.2Evacuation of foreign citizens
o 9.3International aid
o 9.4United Nations response measures
 10Impact
o 10.1Economics
o 10.2Culture
o 10.3Politics
o 10.4Famine
 o 10.5Education
o 10.6Other health issues
o 10.7Environment and climate
o 10.8Xenophobia and racism
 11Information dissemination
o 11.1Misinformation
 12See also
 13Notes
 14References
 15External links
o 15.1Health agencies
o 15.2Directories
o 15.3Data and graphs
o 15.4Medical journals

Epidemiology
For country-level case and death data, see COVID-19 pandemic by country
and territory.

For country-level data, see:

COVID-19 pandemic by country and

territory

Cases Deaths
19,919,559 732,284

As of 10 August 2020[5]

Africa · Asia · Europe · North America
Oceania · South America

Background
On 31 December 2019, the World Health Organization (WHO) received reports
of a cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei,[34]
[35]
 and an investigation was launched at the start of January 2020. [36] 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.[37][7]
Several early infected people had visited Huanan Seafood Wholesale Market;
[38]
 the virus is therefore thought to be of zoonotic origin.[39] The virus that caused
the outbreak is known as SARS-CoV-2, a newly discovered virus closely related
to bat coronaviruses,[40] pangolin coronaviruses,[41][42] and SARS-CoV.[43] The
scientific consensus is that COVID-19 has a natural origin. [44][45] The probable bat-
to-human infection may have been among people processing bat carcasses
and guano in the production of traditional Chinese medicines.[46]
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.[47][48] Of the early cluster of cases reported that month,
two-thirds were found to have a link with the market. [49][50][51] 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.[52][53]
The WHO recognised the spread of COVID-19 as a pandemic on 11 March
2020[8] as Italy, Iran, South Korea, and Japan reported surging numbers of
cases. The number of cases outside China quickly surpassed the number of
cases inside China.[54]

The Huanan Seafood Wholesale Market in March 2020, after it was closed down.

Cases
Main articles: COVID-19 pandemic by country and territory and COVID-19
pandemic cases
Official case counts refer to the number of people who have been tested for
COVID-19 and whose test has been confirmed positive according to official
protocols.[55] [56] Many countries, early on, had official policies to not test those
with only mild symptoms.[57][58] 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.[59] 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. [60][61]
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.[62] 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. [63][64] Seroprevalence based
estimates are conservative as some studies shown that persons with mild
symptoms do not have detectable antibodies.[65] Some results (such as the
Gangelt study) have received substantial press coverage without first passing
through peer review.[66]
Analysis by age in China indicates that a relatively low proportion of cases
occur in individuals under 20.[67] 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. [68] A retrospective cohort study in
China found that children were as likely to be infected as adults. [69] Countries
that test more, relative to the number of deaths, have a younger age distribution
of cases, relative to the wider population. [70]
Initial estimates of the basic reproduction number (R0) for COVID-19 in January
were between 1.4 and 2.5,[71] but a subsequent analysis concluded that it may be
about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9).[72] 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. By mid-May 2020, the effective R was
close to or below 1.0 in many countries, meaning the spread of the disease in
these areas at that time was stable or decreasing. [73]

Epidemic curve of COVID-19 by date of report

 

Semi-log plot of daily new cases of COVID-19 (seven-day average) in the world and top five
current countries (mean with deaths)
 
 

Cases by country, plotted on a logarithmic scale[74]

 

Daily confirmed cases by country per million people, plotted on a logarithmic scale
 

COVID-19 total cases per 100 000 population from selected countries [75]
 
 

COVID-19 active cases per 100 000 population from selected countries [75]

Deaths
Main articles: COVID-19 pandemic deaths and COVID-19 pandemic death
rates by country
Further information: List of deaths due to COVID-19

Deceased in a 16 m (53 ft) "mobile morgue" outside a hospital in Hackensack, New Jersey

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.[76] As of 10 August 2020, approximately 732,000 [5] deaths
had been attributed to COVID-19. In China, as of 14 June, 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.[77] Individuals
of any age with COPD, obesity, type 2 diabetes mellitus and other underlying
health conditions are at increased risk of severe illness from COVID-19. [78][79]
The first confirmed death was in Wuhan on 9 January 2020. [80] The first death
outside of China occurred on 1 February in the Philippines,[81] and the first death
outside Asia was in France on 14 February. [82]
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 having been tested.[83] Conversely, deaths of people who had underlying
conditions may lead to overcounting.[84] Comparison of statistics for deaths for all
causes versus the seasonal average indicates excess mortality in many
countries.[85][86] 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. [85] This excess mortality
may include deaths due to strained healthcare systems and bans on elective
surgery.[87]
Multiple measures are used to quantify mortality.[88] These numbers vary by
region and over time, influenced by testing volume, healthcare system quality,
treatment options, government response,[89][90][91] time since the initial outbreak,
and population characteristics, such as age, sex, and overall health. [92] 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. [93]
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 3.7 percent (732,284 deaths for 19,919,559 cases) as of 10 August 2020.
[5]
 The number varies by region.[94]
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. [92] In
February the Institute for Disease Modeling estimated the IFR as 0.94 percent
(95-percent confidence interval 0.37–2.9), based on data from China. [95]
[96]
 The University of Oxford's Centre for Evidence-Based Medicine (CEBM)
estimated a global CFR of 0.8 to 9.6 percent (last revised 30 April) and IFR of
0.10 percent to 0.41 percent (last revised 2 May), acknowledging that this will
vary between populations due to differences in demographics. [97] The CDC
estimates for planning purposes that the fatality rate among those who are
symptomatic is 1.1 percent and that 40 percent of infected individuals are
asymptomatic, for an overall infection fatality rate of 0.65 percent (0.5 to 0.8
percent).[98][99]

Semi-log plot of daily deaths due to COVID-19 (seven-day average) in the world and top
five current countries (mean with cases)
 
 

Case fatality rate of COVID-19 by country and confirmed cases

 

COVID-19 deaths per 100 000 population from selected countries [100]

Duration
On 11 March 2020, the WHO said 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."[101] 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)". [102] 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.[103]

Signs and symptoms

Further information: Coronavirus disease 2019 §  Signs and symptoms
Symptoms of COVID-19[104]

The usual incubation period (the time between infection and symptom onset)

ranges from one to 14 days, and is most commonly five days. [9][105] Some infected
people have no symptoms, known as asymptomatic or presymptomatic carriers;
transmission from such a carrier is considered possible. [106] As at 6 April,
estimates of the asymptomatic ratio range widely from 5 to 80 percent.[107]
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, diarrhea, and rash.[108][17][16]
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.[16] Further development of the disease can lead
to complications including pneumonia, acute respiratory distress
syndrome, sepsis, septic shock, and kidney failure.[17]

Cause
Transmission
Further information: Coronavirus disease 2019

Respiratory droplets produced when a man sneezes, visualised using Tyndall scattering

COVID-19 is a new disease, and many of the details of its spread are still under
investigation.[9][10][12] It spreads easily between people—more easily
than influenza but not as easily as measles.[10] People are most infectious when
they show symptoms (even mild or non-specific symptoms), but may be
infectious for up to two days before symptoms appear (pre-symptomatic
transmission).[12] They remain infectious for an estimated seven to twelve days in
moderate cases and an average of two weeks in severe cases. [12] People can
also transmit the virus without showing any symptom
(asymptomatic transmission), but it is unclear how often this happens. [9][10][12] A
June 2020 review found that 40–45% of infected people are asymptomatic. [109]
COVID-19 spreads primarily when people are in close contact and one person
inhales small droplets produced by an infected person (symptomatic or not)
coughing, sneezing, talking, or singing.[12][110] The WHO recommends 1 metre
(3 ft) of social distance;[9] the US Centers for Disease Control and
Prevention (CDC) recommends 2 metres (6 ft).[10]
Transmission may also occur through aerosols, smaller droplets that are able to
stay suspended in the air for longer periods of time. [14] Experimental results show
the virus can survive in aerosol for up to three hours. [111] Some outbreaks have
also been reported in crowded and inadequately ventilated indoor locations
where infected persons spend long periods of time (such as restaurants and
nightclubs).[112] Aerosol transmission in such locations has not been ruled out.
[14]
 Some medical procedures performed on COVID-19 patients in health facilities
can generate those smaller droplets,[113] and result in the virus being transmitted
more easily than normal.[9][12]
Less commonly, when the contaminated droplets fall to floors or surfaces they
can remain infectious if people touch contaminated surfaces and then their
eyes, nose or mouth with unwashed hands.[9] On surfaces the amount of viable
active virus decreases over time until it can no longer cause infection, [12] and
surfaces are thought not to be the main way the virus spreads. [10] The level of
contamination required to transmit infection via surfaces is unknown, but the
virus can be detected for up to four hours on copper, up to one day on
cardboard, and up to three days on plastic (polypropylene) and stainless
steel (AISI 304).[12][114][115] Surfaces are easily decontaminated with household
disinfectants which destroy the virus outside the human body or on the hands.
[9]
 Disinfectants or bleach are not a treatment for COVID-19, and cause health
problems when not used properly, such as when used inside the human body. [116]
Sputum and saliva carry large amounts of virus.[9][10][12][117] Although COVID-19 is
not a sexually transmitted infection, direct contact such as kissing, intimate
contact, and fecal–oral routes are suspected to transmit the virus.[118][119] The virus
may occur in breast milk, but whether it is transmittable to the baby is unknown.
[120][121]

Estimates of the number of people infected by one person with COVID-19,

the R0, have varied. The WHO's initial estimates of R0 were 1.4–2.5 (average
1.95); however, a review in early April 2020 found the basic R0 (without control
measures) to be higher at 3.28 and the median R0 to be 2.79. [122]
Virology
Main article: Severe acute respiratory syndrome coronavirus 2
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.[43] All features of the novel
SARS-CoV-2 virus occur in related coronaviruses in nature.[123]
SARS-CoV-2 is closely related to SARS-CoV, and is thought to have
a zoonotic origin.[40] SARS-CoV-2 genetically clusters with the
genus Betacoronavirus, and is 96 percent identical at the whole genome level to
other bat coronavirus samples[124] and 92 percent identical to pangolin
coronavirus.[125]

Diagnosis
Main article: COVID-19 testing

Demonstration of a swab for COVID-19 testing

COVID-19 can provisionally be 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.[126][127]
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
the presence of viral RNA fragments.[128]
A number of laboratories and companies have developed serological tests,
which detect antibodies produced by the body in response to infection.
  Several have been evaluated by Public Health England and approved for use
[129]

in the UK.[130]
On 22 June 2020, UK health secretary Matt Hancock announced the country
would conduct a new "spit test" for COVID-19 on 14,000 key workers and their
families in Southampton, having them spit in a pot, which was collected
by Southampton University, with results expected within 48 hours. Hancock said
the test was easier than using swabs, and could enable people to conduct it at
home.[131]
Imaging

A CT scan of a person with COVID-19 shows lesions (bright regions) 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.[132] Many groups
have created COVID-19 datasets that include imagery such as the Italian
Radiological Society which has compiled an international online database of
imaging findings for confirmed cases.[133] Due to overlap with other infections
such as adenovirus, imaging without confirmation by rRT-PCR is of
limited specificity in identifying COVID-19.[132] 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.[127]

Prevention
Further information: Workplace hazard controls for COVID-19, Pandemic
prevention, preparations prior to COVID-19, COVID-19 surveillance,
and COVID-19 apps
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.[134][135] Physical
distancing measures are also recommended to prevent transmission. [136]
[137]
 Health care providers taking care of someone who may be infected are
recommended to use standard precautions, contact precautions, and eye
protection.[138][139]
Many governments have restricted or advised against all non-essential travel to
and from areas affected by the outbreak.[140] The virus has already spread within
communities in large parts of the world, with many not knowing where or how
they were infected.[141]
Misconceptions are circulating about how to prevent infection; for example,
rinsing the nose and gargling with mouthwash are not effective. [142] There is
no COVID-19 vaccine, though many organisations are working to develop one.
[143]