COVID-19 pandemic

2019–20 coronavirus pandemic
Map of confirmed cases per capita as of 3 April 2020   1,000+ confirmed cases per million   100–1,000 confirmed cases per million   10–100 confirmed cases per million   1–10 confirmed cases per million   >0–1 confirmed cases per million   No confirmed cases or no data
Total confirmed cases map Map of total confirmed cases as of 3 April 2020   100,000+ confirmed cases   10,000–99,999 confirmed cases   1,000–9,999 confirmed cases   100–999 confirmed cases   10–99 confirmed cases   1–9 confirmed cases   No confirmed cases or no data
Deaths per capita map Map of deaths per capita as of 3 April 2020   100+ deaths per million   10–100 deaths per million   1–10 deaths per million   0.1–1 deaths per million   0.01–0.1 deaths per million   >0–0.01 deaths per million   No deaths or no data
Confirmed cases per capita interactive timeline Timeline map of confirmed cases per capita (drag circle to adjust; may not work on mobile) See larger version   1000+ cases per million   100-1000 cases per million   10-100 cases per million   <10 cases per million   No cases or no data
Meeting of the Italian government task force to face the coronavirus outbreak, 23 February 2020 (clockwise from top) Hospitalised patients in Tehran Disinfection vehicles in Taipei Low stocks at an Australian supermarket due to panic buying Health checks at Linate Airport in Milan The Italian government's outbreak task force
Disease	Coronavirus disease 2019 (COVID-19)
Virus strain	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Source	Bats and possibly pangolins
Location	Worldwide (list of locations)
First outbreak	Huanan Seafood Wholesale Market
Index case	Wuhan, Hubei, China 30°37′11″N 114°15′28″E
Date	1 December 2019 – ongoing (4 years, 8 months and 2 weeks)
Confirmed cases	> 676 million
Recovered	>
Deaths	> 6.88 million
Territories	200+

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). The outbreak started in Wuhan, Hubei Province, China, in December 2019. The World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern on 30 January 2020 and recognised it as a pandemic on 11 March 2020. As of 10 March 2023, more than 676 million cases of COVID-19 have been reported in more than 190 countries and 200 territories, resulting in more than 6.88 million deaths. More than people have recovered.

The virus is mainly spread during close contact, and by small droplets produced when people cough, sneeze, or talk. These small droplets may be produced during breathing but the virus is not generally airborne. People may also catch COVID-19 by touching a contaminated surface and then their face. The virus can survive on surfaces up to 72 hours.It is most contagious during the first 3 days after onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease. The time between exposure and symptom onset is typically around five days, but may range from 2 to 14 days. Common symptoms include fever, cough, and shortness of breath. Complications may include pneumonia and acute respiratory distress syndrome. There is no known vaccine or specific antiviral treatment. Primary treatment is symptomatic and supportive therapy. Recommended preventive measures include hand washing, covering one's mouth when coughing, maintaining distance from other people, and monitoring and self-isolation for people who suspect they are infected.

Efforts to prevent the virus spreading include travel restrictions, quarantines, curfews, workplace hazard controls, event postponements and cancellations, and facility closures. These include national or regional quarantines throughout the world (starting with the quarantine of Hubei), curfew measures in mainland China and South Korea, various border closures or incoming passenger restrictions, screening at airports and train stations, and outgoing passenger travel bans.

The pandemic has led to severe global socioeconomic disruption, the postponement or cancellation of sporting, religious, and cultural events, and widespread fears of supply shortages resulting in panic buying. Schools and universities have closed either on a nationwide or local basis in more than 160 countries, affecting nearly 90 percent of the world's student population. Misinformation about the virus has spread online, and there have been incidents of xenophobia and discrimination against Chinese people, other people of East and Southeast Asian descent and appearance, and others from hotspots.

Epidemiology

Main articles: 2019–20 coronavirus pandemic by country and territory, cases/WHO situation reports, and deaths/WHO situation reports

Updated August 14, 2024.

COVID-19 pandemic by location

	Location	Cases	Deaths
	World	775,829,432	7,056,095
	European Union	185,801,974	1,262,824
	United States	103,436,829	1,192,328
	China	99,371,132	122,289
	India	45,041,435	533,623
	France	38,997,490	168,091
	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	26,774,728	197,301
	United Kingdom	24,971,207	232,112
	Russia	24,260,951	403,178
	Turkey	17,004,718	101,419
	Spain	13,980,340	121,852
	Australia	11,861,161	25,236
	Vietnam	11,624,000	43,206
	Argentina	10,113,717	130,686
	Taiwan	9,970,937	17,672
	Netherlands	8,639,625	22,986
	Iran	7,627,863	146,837
	Mexico	7,618,633	334,537
	Indonesia	6,829,353	162,059
	Poland	6,668,336	120,722
	Colombia	6,390,900	142,727
	Austria	6,082,429	22,534
	Greece	5,667,848	39,215
	Portugal	5,663,071	28,759
	Ukraine	5,532,606	109,920
	Chile	5,401,026	62,730
	Malaysia	5,306,834	37,351
	Belgium	4,871,551	34,339
	Israel	4,841,558	12,707
	Canada	4,819,017	55,282
	Thailand	4,798,620	34,714
	Czech Republic	4,761,348	43,508
	Peru	4,526,977	220,975
	Switzerland	4,457,441	14,170
	Philippines	4,140,383	66,864
	South Africa	4,072,763	102,595
	Romania	3,536,986	68,819
	Denmark	3,435,679	9,693
	Singapore	3,006,155	2,024
	Hong Kong	2,876,106	13,466
	Sweden	2,754,551	27,370
	New Zealand	2,637,318	4,268
	Serbia	2,583,470	18,057
	Iraq	2,465,545	25,375
	Hungary	2,230,657	49,053
	Bangladesh	2,051,308	29,499
	Slovakia	1,877,940	21,226
	Georgia	1,863,615	17,150
	Republic of Ireland	1,749,357	9,726
	Jordan	1,746,997	14,122
	Pakistan	1,580,631	30,656
	Norway	1,511,902	5,732
	Kazakhstan	1,504,370	19,072
	Finland	1,499,712	11,466
	Lithuania	1,368,548	9,810
	Slovenia	1,356,433	10,078
	Bulgaria	1,329,731	38,700
	Croatia	1,317,144	18,752
	Morocco	1,279,115	16,305
	Puerto Rico	1,252,713	5,938
	Guatemala	1,250,370	20,203
	Lebanon	1,239,904	10,947
	Costa Rica	1,234,701	9,372
	Bolivia	1,212,145	22,387
	Tunisia	1,153,361	29,423
	Cuba	1,113,662	8,530
	Ecuador	1,077,288	36,050
	United Arab Emirates	1,067,030	2,349
	Panama	1,044,821	8,748
	Uruguay	1,041,329	7,682
	Mongolia	1,011,489	2,136
	Nepal	1,003,450	12,031
	Belarus	994,037	7,118
	Latvia	977,765	7,475
	Saudi Arabia	841,469	9,646
	Azerbaijan	835,694	10,353
	Paraguay	735,759	19,880
	Palestine	703,228	5,708
	Bahrain	696,614	1,536
	Cyprus	696,410	1,451
	Sri Lanka	672,797	16,907
	Kuwait	667,290	2,570
	Dominican Republic	661,103	4,384
	Myanmar	642,859	19,494
	Moldova	636,777	12,243
	Estonia	610,471	2,998
	Venezuela	552,695	5,856
	Egypt	516,023	24,830
	Qatar	514,524	690
	Libya	507,269	6,437
	Ethiopia	501,193	7,574
	Réunion	494,595	921
	Honduras	472,893	11,114
	Armenia	452,273	8,777
	Bosnia and Herzegovina	403,666	16,392
	Oman	399,449	4,628
	Luxembourg	393,352	1,000
	North Macedonia	350,808	9,978
	Zambia	349,769	4,077
	Brunei	347,435	178
	Kenya	344,105	5,689
	Albania	335,047	3,605
	Botswana	330,696	2,801
	Mauritius	328,167	1,073
	Kosovo	274,279	3,212
	Algeria	272,115	6,881
	Nigeria	267,188	3,155
	Zimbabwe	266,386	5,740
	Montenegro	251,280	2,654
	Afghanistan	235,214	7,998
	Mozambique	233,842	2,252
	Martinique	230,354	1,104
	Laos	219,060	671
	Iceland	210,347	186
	Guadeloupe	203,235	1,021
	El Salvador	201,916	4,230
	Trinidad and Tobago	191,496	4,390
	Maldives	186,694	316
	Uzbekistan	175,081	1,016
	Namibia	172,532	4,108
	Uganda	172,154	3,632
	Ghana	172,061	1,462
	Jamaica	157,165	3,611
	Cambodia	139,313	3,056
	Rwanda	133,264	1,468
	Cameroon	125,242	1,974
	Malta	122,716	921
	Barbados	108,525	593
	Angola	107,481	1,937
	Democratic Republic of the Congo	100,973	1,474
	French Guiana	98,041	413
	Senegal	89,457	1,971
	Malawi	89,168	2,686
	Kyrgyzstan	88,953	1,024
	Ivory Coast	88,434	835
	Suriname	82,501	1,406
	New Caledonia	80,163	314
	French Polynesia	79,340	650
	Eswatini	75,356	1,427
	Guyana	74,439	1,302
	Belize	71,414	688
	Fiji	69,047	885
	Madagascar	68,566	1,428
	Jersey	66,391	161
	Cabo Verde	64,474	417
	Sudan	63,993	5,046
	Mauritania	63,872	997
	Bhutan	62,697	21
	Syria	57,423	3,163
	Burundi	54,569	15
	Guam	52,287	419
	Seychelles	51,790	172
	Gabon	49,051	307
	Andorra	48,015	159
	Papua New Guinea	46,864	670
	Curaçao	45,883	305
	Aruba	44,224	292
	Tanzania	43,230	846
	Mayotte	42,027	187
	Togo	39,530	290
	Bahamas	39,127	849
	Guinea	38,572	468
	Isle of Man	38,008	116
	Lesotho	36,138	709
	Guernsey	35,326	67
	Faroe Islands	34,658	28
	Haiti	34,298	860
	Mali	33,166	743
	Cayman Islands	31,472	37
	Saint Lucia	30,271	410
	Benin	28,036	163
	Somalia	27,334	1,361
	Federated States of Micronesia	26,460	65
	Solomon Islands	25,954	199
	United States Virgin Islands	25,389	132
	San Marino	25,292	126
	Republic of the Congo	25,227	389
	Timor-Leste	23,460	138
	Burkina Faso	22,139	400
	Liechtenstein	21,587	89
	Gibraltar	20,550	113
	Grenada	19,693	238
	Bermuda	18,860	165
	South Sudan	18,823	147
	Tajikistan	17,786	125
	Monaco	17,181	67
	Equatorial Guinea	17,130	183
	Samoa	17,057	31
	Tonga	16,976	12
	Marshall Islands	16,252	17
	Nicaragua	16,183	245
	Dominica	16,047	74
	Djibouti	15,690	189
	Central African Republic	15,441	113
	Northern Mariana Islands	14,881	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	9,518	315
	Comoros	9,109	160
	Antigua and Barbuda	9,106	146
	American Samoa	8,359	34
	Sierra Leone	7,979	125
	Liberia	7,930	294
	Chad	7,702	194
	British Virgin Islands	7,557	64
	Cook Islands	7,344	2
	Turks and Caicos Islands	6,805	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	—
	Falkland Islands	1,923	—
	Montserrat	1,403	8
	Niue	1,074	—
	Tokelau	80	0
	Vatican City	26	0
	Pitcairn Islands	4	—
	North Korea	1	6
	Turkmenistan	0	0

Health authorities in Wuhan, the capital of Hubei province, China, reported a cluster of pneumonia cases of unknown cause on 31 December 2019, and an investigation was launched in early January 2020. The cases mostly had links to the Huanan Seafood Wholesale Market and so the virus is thought to have a zoonotic origin. The virus that caused the outbreak is known as SARS-CoV-2, a newly discovered virus closely related to bat coronaviruses, pangolin coronaviruses, and SARS-CoV.

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. Of the early cluster of cases reported in December 2019, two-thirds were found to have a link with the market. On 13 March 2020, an unverified report from the South China Morning Post suggested that a case traced back to 17 November 2019, in a 55-year-old from Hubei province, may have been the first.

On 26 February 2020, the WHO reported that, as new cases reportedly declined 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 within China for the first time. There may be substantial underreporting of cases, particularly among those with milder symptoms. By 26 February, relatively few cases had been reported among youths, with those 19 and under making up 2.4% of cases worldwide.

Government sources in Germany and the United Kingdom estimate that 60–70% of the population will need to become infected before effective herd immunity can be achieved.

Cases

Cases refers to the number of people who have been tested for COVID-19, and whose test has been confirmed positive according to official protocols. The number of people infected with COVID-19 will likely be much higher, as many of those with only mild or no symptoms may not have been tested. As of 23 March, no country had tested more than 3% of its population, and many countries have had official policies not to test those with only mild symptoms, such as Italy, the Netherlands, Spain, and Switzerland.

Deaths

The time from development of symptoms to death has been between 6 and 41 days, with the most common being 14 days. As of 10 March 2023, approximately 6.88 million deaths had been attributed to COVID-19. In China, as of 5 February 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 mainland China occurred on 1 February in the Philippines, and the first death outside Asia was in France on 14 February. By 28 February, outside mainland China, more than a dozen deaths each were recorded in Iran, South Korea, and Italy. By 13 March, more than forty countries and territories had reported deaths, on every continent except Antarctica.

Several measures are commonly used to quantify mortality. These numbers vary by region and over time, and are influenced by the volume of testing, healthcare system quality, treatment options, time since initial outbreak, and population characteristics such as age, sex, and overall health.

The death-to-case ratio reflects the number of deaths 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 1.02% (6,881,955/676,609,955) as of 10 March 2023. The number varies by region.

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time bound and follow a specific population from infection through case resolution. A number of academics have attempted to calculate these numbers for specific populations.

In China, estimates for the "crude CFR", i.e. the death-to-case ratio decreased from 17.3% (for those with symptom onset 1–10 January 2020) to 0.7% (for those with symptom onset after 1 February 2020).

Diagrams

Charts are regularly updated, as of late March 2020.

• 
  Total confirmed cases of COVID-19 per million people
• 
  Total confirmed deaths due to COVID-19 per million people
• 
  Epidemic curve of COVID-19 by date of report
• 
  Semi-log graph showing the change in total (cumulative) count from the first reported date for the ten most affected countries
• 
  Semi-log plot of daily new cases of COVID-19 in the world and top five countries (averaged with deaths)
• 
  Semi-log plot of daily deaths due to COVID-19 in the world and top five countries (averaged with cases)
• 
  Semi-log plot of cases in some countries with high growth rates (post-China) with doubling times and three-day projections based on the exponential growth rates
• 
  Case fatality rate of COVID-19 by country and confirmed cases
• 
  Ongoing case fatality rate of COVID-19 by country

Duration

The WHO asserts that the pandemic can be controlled. The peak and ultimate duration of the outbreak are uncertain and may differ by location. Maciej Boni of Penn State University stated, "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". However, the Chinese government's senior medical adviser Zhong Nanshan argued that "it could be over by June" if all countries can be mobilised to follow the WHO's advice on measures to stop the spread of the virus. Adam Kucharski of the London School of Hygiene & Tropical Medicine stated that SARS-CoV-2 "is going to be circulating, potentially for a year or two". According to the Imperial College study led by Neil Ferguson, physical distancing and other measures will be required "until a vaccine becomes available (potentially 18 months or more)". William Schaffner of Vanderbilt University stated, "I think it's unlikely that this coronavirus—because it's so readily transmissible—will disappear completely" and 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.

Signs and symptoms

Main article: Coronavirus disease 2019

Symptoms of COVID-19

Symptoms of COVID-19 can be relatively non-specific and infected people may be asymptomatic. The two most common symptoms are fever (88%) and dry cough (68%). Less common symptoms include fatigue, respiratory sputum production (phlegm), loss of the sense of smell, shortness of breath, muscle and joint pain, sore throat, headache, or chills.

The WHO states that approximately one person in six becomes seriously ill and has difficulty breathing. The U.S. Centers for Disease Control and Prevention (CDC) lists emergency symptoms as 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.

Further development of the disease can lead to severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock and death. Some of those infected may be asymptomatic, with no clinical symptoms but test results that confirm infection, so researchers have issued advice that those with close contact to confirmed infected people should be closely monitored and examined to rule out infection. Chinese estimates of the asymptomatic ratio range from few to 44%. The usual incubation period (the time between infection and symptom onset) ranges from one to 14 days; it is most commonly five days.

As an example of uncertainty, estimates of loss of smell for coronavirus patients were 30%, and then estimates fell to 15%.

Cause

Transmission

Further information: Transmission (medicine), Fomite, and Contact tracing

Respiratory droplets, produced when a man is sneezing

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

Some details about how the disease is spread are still being determined. The disease is believed to be primarily spread during close contact and by small droplets produced when people cough, sneeze, or talk; with close contact being within 1 to 2 metres (3 to 6 feet). Studies have found that an uncovered coughing can lead to droplets travelling up to 4.5 metres (15 feet) to 8.2 metres (27 feet).

Respiratory droplets may also be produced during breathing out, including when talking, though the virus is not generally airborne. The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolized and thus result in airborne spread. It may also spread when one touches a contaminated surface and then touches their eyes, nose, or mouth. While there are concerns it may spread by feces, this risk is believed to be low.

The virus is most contagious during the first 3 days after onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.Patients have tested positive for the disease up to 3 days before onset of symptoms suggesting transmission is possible before developing significant symptoms. Only few reports of laboratory-confirmed asymptomatic cases exist, but asymptomatic transmission has been identified by some countries during contact tracing investigations. The European Centre for Disease Prevention and Control (ECDC) states that while it is not entirely clear how easily the disease spreads, one person generally infects two to three others.

The virus survives for hours to days on surfaces. Specifically, the virus was found to be detectable for up to three days on plastic and stainless steel, for one day on cardboard, and for up to four hours on copper. This, however, varies based on the humidity and temperature.

However, pets or other livestock may test positive but can't pass on coronavirus to humans, as there were reported cases of infected pets such as a cat in Belgium and two dogs in Hong Kong.

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 severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.

Outside the human body, the virus is killed by household soap, which bursts its protective bubble.

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 parts of the genome sequences between the viruses from 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 or CT imaging. A study comparing PCR to CT in Wuhan has suggested that CT is significantly more sensitive than PCR, though less specific, with many of its imaging features overlapping with other pneumonias and disease processes. As of March 2020, the American College of Radiology recommends that "CT should not be used to screen for or as a first-line test to diagnose COVID-19".

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 (CT) of symptomatic patients include asymmetric peripheral ground glass opacities and absent pleural effusions. The Italian Radiological Society is compiling an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by PCR is of limited specificity in identifying COVID-19. However, 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, suggesting its consideration as a screening tool in epidemic areas. Artificial intelligence-based convolutional neural networks have been developed to detect imaging features of the virus with both radiographs and CT.

Prevention

Further information: Workplace hazard controls for COVID-19 and Pandemic prevention

Infographic by the United States 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. Physical 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, and some community members don't know where or how they were infected.

Health care providers taking care of someone who may be infected are recommended to use standard precautions, contact precautions, and 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. There is no COVID-19 vaccine, though many organisations are working to develop one.

Hand washing

Main article: Hand washing

Hand washing is recommended to prevent the spread of the disease. The CDC recommends that people wash hands often with soap and water for at least twenty seconds, especially after going to the toilet or when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. This is because outside the human body, the virus is killed by household soap, which bursts its protective bubble. CDC 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 advises people to avoid touching the eyes, nose, or mouth with unwashed hands.

Surface cleaning

Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 62–71% ethanol, 50–100% isopropanol, 0.1% sodium hypochlorite, 0.5% hydrogen peroxide, and 0.2–7.5% povidone-iodine. Other solutions, such as benzalkonium chloride and chrohexidine gluconate, are less effective.

Face masks and respiratory hygiene

People in Hong Kong wearing face masks

Health organisations recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing, and disposing of any tissue immediately. Surgical masks are recommended for those who may be infected, as wearing a mask 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. According to Stephen Griffin, a virologist at the University of Leeds, "Wearing a mask can reduce the propensity [of] people to touch their faces, which is a major source of infection without proper hand hygiene."

Masks have also been recommended for use by those taking care of someone who may have the disease. The WHO has recommended the wearing of masks by healthy people only if they are at high risk, such as those who are caring for a person with COVID-19, although they also acknowledge that wearing masks may help people avoid touching their face. Several countries have started to encourage the use of face masks by members of the public.

China has specifically recommended the use of disposable medical masks by healthy members of the public, particularly when coming into close contact (≤1 metre) with other people. Hong Kong recommends wearing a surgical mask when taking public transport or staying in crowded places. Thailand's health officials are encouraging people to make face masks at home out of cloth and wash them daily. The Czech Republic and Slovakia banned going out in public without wearing a mask or covering one's nose and mouth. The Austrian government mandated that everyone entering a grocery store must wear a face mask. Israel has asked all residents to wear face masks when in public. Taiwan, which has been producing ten million masks per day since mid-March, required passengers on trains and intercity buses to wear face masks on 1 April. Panama has asked its citizens to wear a face mask whenever possible. Face masks have also been widely used in Japan, South Korea, Malaysia, and Singapore.

Social distancing

Main article: Social distancing

Social distancing (also known as physical 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 apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak. The maximum gathering size recommended by government bodies and health organisations was swiftly reduced from 250 people (if there was no known COVID-19 spread in a region) to 50 people, and later to 10 people. On 22 March 2020, Germany banned public gatherings of more than two people.

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

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

The government in Ireland released sexual health guidelines during the pandemic. These included recommendations to only have sex with someone you live with, who does not have the virus or symptoms of the virus.

In late March 2020, it was reported that for more than 70 million people in India, who live in clustered slums and comprise of about one sixth of the total urban population, social distancing is not only physically impossible, but economically too. The reported reproduction rate of the COVID-19 disease could be 20% higher in Indian slums due to impenetrable living conditions, as compared to the global ratio, i.e. 2 to 3 percent.

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  Social distancing by maintaining physical separation at a London pharmacy on 23 March 2020
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  Infographic describing the importance of social distancing
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  Signage in a shop promoting social distancing (in German)

Self-isolation

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

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

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

Containment and mitigation

The goal of community mitigation: (1) delay outbreak peak; (2) reduce peak burden on healthcare, known as "flattening the curve"; (3) lessen overall cases and health impact

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

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 physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning.

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

Simulations for Great Britain and the United States show that mitigation (slowing but not stopping epidemic spread) and suppression (reversing epidemic growth) have major challenges. Optimal mitigation policies might reduce peak healthcare demand by 2/3 and deaths by half, but still result in hundreds of thousands of deaths and health systems being overwhelmed. Suppression can be preferred but needs to be maintained for as long as the virus is circulating in the human population (or until a vaccine becomes available, if that comes first), as transmission otherwise quickly rebounds when measures are relaxed. Long-term intervention to suppress the pandemic causes social and economic costs.

Management

Further information: Coronavirus disease 2019 § Management, and Pandemic § Management

Treatment

There are no specific antiviral medications approved for COVID-19, but development efforts are underway, including testing of existing medications. Taking over-the-counter cold medications, drinking fluids, and resting may help alleviate symptoms. Depending on the severity, oxygen therapy, intravenous fluids, and breathing support may be required. The use of steroids may worsen outcomes. Several compounds that were previously approved for treatment of other viral diseases are being investigated for use in treating COVID-19.

Health care capacity

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

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  An army-constructed field hospital outside Östra sjukhuset (Eastern hospital) in Gothenburg, Sweden contains temporary intensive care units for COVID-19 patients.
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  External triage helps avoid mixing patients who come to the emergency department for COVID-19 with those who have other complaints, employed here in New Orleans.
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  The Huoshenshan Hospital was constructed in Wuhan, China in response to the COVID-19 pandemic.
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  Part of the McCormick Place convention centre in Chicago, Illinois is being converted into a 3,000-bed field hospital for the disease

History

Main article: Timeline of the 2019–20 coronavirus pandemic

Cases by country plotted on a logarithmic scale

There are various theories about where the very first case (the so-called patient zero) may have originated. The first known case of the novel coronavirus may trace back to 1 December 2019 in Wuhan, Hubei, China. Within a month, the number of coronavirus cases in Hubei gradually increased. These were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals, and one theory is that the virus came from one of these kinds of animals, in other words, has a zoonotic origin.

A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a group of doctors at Wuhan Central Hospital alerted their colleagues of a "SARS-like coronavirus". Eight of these doctors, including Li Wenliang, were admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm. The Wuhan Municipal Health Commission later released a public notice on 31 December and informed the WHO. Enough cases of unknown pneumonia had been reported to health authorities in Wuhan to trigger an investigation in early January.

During the early stages of the outbreak, 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 and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one 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.

As of 3 April 2020, more than 676 million cases have been reported worldwide; more than 6.88 million people have died and more than have recovered. The United States has overtaken China and Italy to have the highest number of confirmed cases in the world.

Domestic responses

Main articles: 2019–20 coronavirus pandemic by country and territory and National responses to the 2019–20 coronavirus pandemic

Further information: Criticism of response to the 2019–20 coronavirus pandemic

Map of national and subnational lockdowns as of 30 March 2020 (table; more details)

  National lockdown

  Subnational lockdown

  No lockdown

Around 200 countries and territories have had at least one case. Due to the pandemic in Europe, many countries in the Schengen Area have restricted free movement and set up border controls. National reactions have included containment measures such as quarantines (known as stay-at-home orders, shelter-in-place orders, or lockdown) and curfews.

As of 2 April, nearly 300 million people, or about 90% of the population, are under some form of lockdown in the United States, more than 50 million people are in lockdown in the Philippines, about 59 million people are in lockdown in South Africa, and 1.3 billion people are in lockdown in India. On 26 March, 1.7 billion people worldwide were under some form of lockdown, which increased to 2.6 billion people two days later—around a third of the world's population.

China

Main article: 2019–20 coronavirus pandemic in mainland China

Aerial video from China News Service shows mostly empty roads after motor vehicles were banned in central urban areas of Wuhan.

The first confirmed case of COVID-19 has been traced back to 1 December 2019 in Wuhan; one unconfirmed report suggests the earliest case was on 17 November. Doctor Zhang Jixian observed a pneumonia-cluster of unknown cause on 26 December, upon which her hospital informed Wuhan Jianghan CDC on 27 December. A public notice was released by Wuhan Municipal Health Commission on 31 December. The WHO was informed on the same day. As these notifications occurred, doctors in Wuhan were warned by police for "spreading rumours" about the outbreak. The Chinese National Health Commission initially claimed that there was no "clear evidence" of human-to-human transmission.

A temporary hospital for treating mild cases of COVID-19 in Wuhan, one of more than 10 such hospitals in the city

The Chinese Communist Party launched a radical campaign later 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, affecting a total of about 57 million people. Private vehicle use was banned in the city. Chinese New Year (25 January) celebrations were cancelled in many places. The authorities also announced the construction of 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 issuing health declarations for travellers and extending the Spring Festival holiday. 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. Travel restrictions were enacted in and outside of Hubei. Public transport was modified, and museums throughout China were temporarily closed. Control of public movement was applied in many cities, and it has been estimated that about 760 million people (more than half the population) faced some form of outdoor restriction.

After the outbreak entered its global phase in March, Chinese authorities took 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.

On 23 March, mainland China had gone five days with only one case transmitted domestically, in this instance via a traveller returning to Guangzhou from Istanbul. On 24 March 2020, Chinese Premier Li Keqiang reported that the spread of domestically transmitted cases has been basically blocked and the outbreak has been controlled in China. The same day travel restrictions were eased in Hubei, apart from Wuhan, two months after the lockdown was imposed.

The Chinese Ministry of Foreign Affairs announced on 26 March 2020 that entry for visa or residence permit holders will be suspended from 28 March onwards, with no specific details on when this policy will end. Those wishing to enter China will have to apply for visas in Chinese embassies or consulates. The government of China encourage businesses and factories to re-open on 30 March, and provided monetary stimulus packages for firms. On 1 April, two U.S. officials claimed China underreported its cases and deaths according to a report by United States Intelligence Community. The officals asked not to be identified because the report is secret, and denied to detail its contents.

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. The nation's health agency reported a significant increase in confirmed cases on 20 February, largely attributed to a gathering in Daegu of a new religious movement known as the Shincheonji Church of Jesus. Shincheonji devotees visiting Daegu from Wuhan were suspected to be the origin of the outbreak. As of 22 February, among 9,336 followers of the church, 1,261 or about 13% reported symptoms.

South Korea declared the highest level of alert on 23 February 2020. On 28 February, more than 2,000 confirmed cases were reported in Korea, rising to 3,150 on 29 February. All South Korean military bases were quarantined after tests confirmed that three soldiers were positive for the virus. Airline schedules were also affected and therefore they were changed.

South Korea introduced what was considered the largest and best-organised program in the world to screen the population for the virus, and isolate any infected people as well as tracing and quarantining those who contacted them. Screening methods included mandatory self-reporting of symptoms by new international arrivals through mobile application, drive-thru testing for the virus with the results available the next day, and increasing testing capability to allow up to 20,000 people to be tested every day. South Korea's program is considered to be a success in controlling the outbreak despite not quarantining entire cities.

The South Korean society was initially polarised on President Moon Jae-in's response to the crisis. Many Koreans signed petitions either calling for the impeachment of Moon over what they claimed to be government mishandling of the outbreak, or praising his response. On 23 March, it was reported that South Korea had the lowest one-day case total in four weeks. On 29 March it was reported that beginning 1 April all new overseas arrivals will be quarantined for two weeks. Per media reports on 1 April, South Korea has received requests for virus testing assistance from 121 different countries.

Iran

Main article: 2020 coronavirus pandemic in Iran

Disinfection of Tehran Metro trains 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 died later that day. Early measures announced by the government included the cancellation of concerts and other cultural events, sporting events, and Friday prayers, and closures of universities, higher education institutions, and schools. Iran allocated five 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, although heavy traffic between cities ahead of the Persian New Year Nowruz continued. 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 Iran, more than ten countries had 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 its 290 members reported to have had tested positive for the virus on 3 March. On 12 March, the Human Rights Watch urged the Iranian prison authorities to unconditionally release the human rights defenders detained for peaceful dissent, and to also temporarily release all the eligible prisoners. It stated that there is a greater risk of the virus to spread in closed institutions like detention centres, which also lack adequate medical care. On 15 March, the Iranian government reported 100 deaths in a single day, the most recorded in the country since the outbreak began. At least 12 sitting or former Iranian politicians and government officials had died from the disease by 17 March. By 23 March, Iran was experiencing 50 new cases every hour and one new death every ten minutes due to coronavirus. According to a WHO official, there may be five times more cases in Iran than what is being reported. It is also suggested that U.S. sanctions on Iran may be affecting the country's financial ability to respond to the viral outbreak. The UN High Commissioner for Human Rights has demanded economic sanctions to be eased for nations most affected by the pandemic, including Iran.

Europe

Main article: 2020 coronavirus pandemic in Europe

Map of confirmed cases in Europe per million inhabitants

As of 18 March, more than 250 million people are in lockdown in Europe.

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. Cases began to rise sharply, which prompted the Italian government to suspend all flights to and from China and declare a state of emergency. An unassociated cluster of COVID-19 cases was later 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, were be held behind closed doors until April, but 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. On 19 March, Italy overtook China as the country with the most coronavirus-related deaths in the world after reporting 3,405 fatalities from the pandemic. On 22 March, it was reported that Russia had sent nine military planes with medical equipment to Italy. As of 30 March, there were 101,739 confirmed cases, 11,591 deaths, and 14,620 recoveries in Italy, with the majority of those cases occurring in the Lombardy region. A CNN report indicated that the combination of Italy's large elderly population and inability to test all who have the virus to date may be contributing to the high fatality rate.

Spain

Main article: 2020 coronavirus pandemic in Spain

People maintain social distancing in Valencia, Spain.

The 2019–20 coronavirus pandemic was confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 in La Gomera, Canary Islands.

On 24 February, following the COVID-19 outbreak in Italy, Spain confirmed multiple cases related to the Italian clusters, originating from a medical doctor from Lombardy, Italy, who was on holiday in Tenerife.

By 3 March, Madrid had become the major focus of the pandemic in Spain, with a major outbreak linked to evangelical churches in eastern Madrid. A state of alarm and national lockdown was imposed on 14 March. More than 350,000 tests for COVID-19 had been conducted by 21 March. The daily death toll surpassed 800 on 28 March, with 832 people dying in a single day, and peaking at 950 dead on 3 April, the highest number in the world recorded over 24 hours. As of 29 March, at least 6,803 people have died and 4,907 people were hospitalised in intensive care (1,429 in the Community of Madrid). On 29 March it was announced that, beginning the following day, all non-essential workers were to stay home for the next 14 days. On 31 March it was reported that a record 849 individuals died due to the virus, while hundreds have been arrested for violating the lockdown. A few days later, on 2 April per reports, 950 people died in a 24-hour period, the most by any country during the pandemic in a single day. The next day Spain surpassed Italy in total cases due to the virus, and is now second only to the U.S. which has a quarter of a million cases

United Kingdom

Main article: 2020 coronavirus pandemic in the United Kingdom

People in London buying canned foods and toilet paper on 18 March 2020

The United Kingdom's response to the virus first emerged as one of the most relaxed of the affected countries, and until 18 March 2020, the British government did not impose any form of social distancing or mass quarantine measures on its citizens. As a result, the government received criticism for the perceived lack of pace and intensity in its response to concerns faced by the public.

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

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

On 25 March, Prince Charles tested positive for coronavirus, with Clarence House announcing that he was displaying mild symptoms.

On 27 March, Prime Minister Boris Johnson and Health Secretary Matt Hancock tested positive for COVID-19. They are in isolation but Johnson said he will continue to lead the government's response via videoconference. On the same day, the government's Chief Medical Adviser Chris Whitty announced that he was self-isolating after experiencing symptoms of the virus. On 29 March, the number of confirmed deaths passed 1,000 individuals, and the Prime Minister indicated that stricter lockdown measures could be put in place. On 31 March, the UK experienced a record 563 deaths over a 24-hour period.

France

Main article: 2020 coronavirus pandemic in France

The virus was confirmed to have spread to France on 24 January 2020, when the first COVID-19 case in Europe and France was confirmed in Bordeaux. It involved a 48-year-old French citizen who arrived in France from China. Two more cases were confirmed by the end of the day, all among individuals who had recently returned from China. A Chinese tourist was admitted to a hospital in Paris on 28 January and died on 14 February, marking the first death from COVID-19 in Europe and France. It was also the first death outside of Asia. A national lockdown was put in place on 17 March. As of 29 March, there have been 40,174 confirmed cases, 2,606 deaths, and at least 7,202 recoveries in France. On 30 March, it was reported that in France, a record 418 individuals had died due to the virus within 24 hours.

Germany

Main article: 2020 coronavirus pandemic in Germany

The virus was confirmed to have been transmitted to Germany on 27 January 2020, when the first COVID-19 case was confirmed in Bavaria. The majority of the COVID-19 cases in January and early February originated from the headquarters of a car parts manufacturer in Bavaria. Later, new clusters were introduced by travellers from Italy, China, and Iran. As of 29 March, Germany has reported 62,440 cases, 541 deaths, and 5,024 recoveries. According to a media report on 29 March, the fatality rate in Germany is 0.5%, which is much lower than other European countries such as Spain. The report speculates this could be due to the country starting widespread testing early, having a better-equipped healthcare system, differences in population age distribution, or Germany not testing as many people postmortem compared to other countries.

United States

Main article: 2020 coronavirus pandemic in the United States

Confirmed cases of COVID-19 per million inhabitants by state, as of 2 April 2020

The first known case in the United States of COVID-19 was confirmed in the Pacific Northwest state of Washington on 20 January 2020, in a man who had returned from Wuhan on 15 January. The White House Coronavirus Task Force was established on 29 January. On 31 January, the Trump administration declared a public health emergency, and placed restrictions on entry for travellers from China.

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

On 28 January 2020, the Center for Disease Control—the leading public health institute of the U.S. government—announced they had developed their own testing kit. Despite doing so, the United States had a slow start in testing, which obscured the true extent of the outbreak at the time. Testing was marred by defective test kits produced by the federal government in February, a lack of federal government approval for non-government test kits (by academia, companies and hospitals) until the end of February, and restrictive criteria for people to qualify for a test until early March (a doctor's order was required thereafter). By 27 February, The Washington Post reported fewer than 4,000 tests had been conducted in the United States. By 13 March, The Atlantic reported that less than 14,000 tests had been conducted. On 22 March, the Associated Press reported: "Many people who have symptoms and a doctor's order have waited hours or days for a test."

After the first death in the United States was reported in Washington state on 29 February, Governor Jay Inslee declared a state of emergency, an action that was soon followed by other states. Schools in the Seattle area cancelled classes on 3 March, and by mid-March, schools across the country were shutting down.

On 6 March, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provided $8.3 billion in emergency funding for federal agencies to respond to the outbreak. Corporations imposed employee travel restrictions, cancelled conferences, and encouraged employees to work from home. Sports events and seasons were cancelled.

On 11 March, Trump announced travel restrictions for most of Europe, excluding the United Kingdom, for 30 days, effective 13 March. The following day, he expanded the restrictions to include the United Kingdom and Ireland. On 13 March, he declared a national emergency, which made federal funds available to respond to the crisis. Beginning on 15 March, many businesses closed or reduced hours throughout the U.S. to try to reduce the spread of the virus. By 17 March, the epidemic had been confirmed in all 50 states and in the District of Columbia.

On 23 March, it was reported that New York City had 10,700 cases of the coronavirus, more than the total number of cases in South Korea. However, the governor said on 25 March that social distancing seemed to be working, as estimates of case doubling slowed from 2.0 days to 4.7 days. As of 28 March, there were 32,308 confirmed cases in New York City, and 672 people had died from the virus.

On 26 March, the United States was reported to have more confirmed coronavirus infection cases than any other country in the world, including China and Italy.

As of 31 March, 164,845 cases have been confirmed in the United States, and 3,183 people have died. Per media reports on 30 March, U.S. President Trump has decided to extend social distancing guidelines until 30 April. On the same day, the USNS Comfort, a hospital ship with about 1000 beds, made anchor in New York. On 3 April, the U.S. had a record 884 deaths, due to the coronavirus virus in a 24 hour period. In the state of New York the cases have exceeded 100,000 people on 3 April.

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. Overall approval of Trump's management of the crisis has been polarised along partisan lines. Some U.S. officials and commentators criticised the U.S. reliance on importation of critical materials, including essential medical supplies, from China.

International responses

Further information: Timeline of the 2019–20 coronavirus pandemic and Criticism of response to the 2019–20 coronavirus pandemic

An analysis of air travel patterns was used to map and predict patterns of spread and was published in The Journal of Travel Medicine in mid-January 2020. Based on 2018 information from the International Air Transport Association, 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 among the 20 most popular destination cities in terms of preparedness, while cities in Australia were considered most able.

Australia released its Emergency Response Plan for Novel Coronavirus (COVID-19) on 7 February. It stated that much was yet to be discovered about COVID-19, and that Australia would emphasise border control and communication in its response to the pandemic. On 21 March, a human biosecurity emergency was declared in Australia.

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 (red)

As a result of the outbreak, many countries and regions have imposed quarantines or entry bans for citizens or visitors of the most affected areas of the pandemic.

The European Union rejected the idea of suspending the Schengen free travel zone and introducing border controls with Italy, a decision which has been criticised 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." The United States suspended travel from the Schengen Area and later the Common Travel Area.

Evacuation of foreign citizens

Main article: 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, with Chinese authorities providing clearance. 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 person, and an Indian citizen. The citizens of Poland, China, and India deplaned 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 Brasília. On the same day, 215 Canadians (176 from the first plane, and 39 from a second plane chartered by the U.S. government) were evacuated from Wuhan to CFB Trenton to be quarantined for two weeks.

On 11 February, another plane of 185 Canadians 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 in Auckland on 5 February; its passengers (including some from Australia and the Pacific) were quarantined at a naval base in Whangaparoa, north of Auckland. On 15 February, the United States announced that it would evacuate Americans aboard the cruise ship Diamond Princess. On 21 February, a plane carrying 129 Canadian passengers who had been evacuated from Diamond Princess landed in Trenton, Ontario. In early March, the Indian government began evacuating its citizens from Iran.

On 14 March a South African Airways aircraft chartered by the South African Government repatriated 112 South African citizens. Medical screening was performed prior to departure, and four South Africans who were showing signs of coronavirus were left behind to mitigate risk. Only South Africans who tested negative were repatriated. Test results cleared all the South Africans, including the flight crew, pilots, hotel staff, police and soldiers involved in the humanitarian mission who, as a precautionary measure, all remained under observation and in quarantine for a 14-day period at The Ranch Resort.

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. Some Chinese students at American universities joined together to help send aid to virus-stricken parts of China, with a joint group in the greater Chicago area reportedly managing to send 50,000 N95 masks to hospitals in the Hubei province on 30 January.

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

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.

Japan donated one million face masks to Wuhan, Turkey dispatched medical equipment, Russia sent more than 13 tonnes of medical supplies to Wuhan, Malaysia announced a donation of 18 million medical gloves to China, Germany delivered various medical supplies including 10,000 Hazmat suits, and the United States donated 17.8 tons of medical supplies to China and promised an additional $100 million in financial support to affected countries.

After cases in China seemed to stabilize, the country has been sending aid to various nations hit by the pandemic. In March 2020, China, Cuba and Russia sent medical supplies and experts to help Italy deal with its coronavirus outbreak. Businessman Jack Ma sent 1.1 million testing kits, 6 million face masks, and 60,000 protective suits to Addis Ababa, Ethiopia for distribution by the African Union. He later sent 5,000 testing kits, 100,000 face masks and 5 ventilators to Panama. Ma also donated medical supplies to Canada.

However, the Netherlands, Spain, Turkey, Georgia, and the Czech Republic expressed their concerns over Chinese-made masks and test kits. For instance, Spain withdrew 58,000 Chinese-made coronavirus testing kits with an accuracy rate of just 30%, meanwhile, the Netherlands recalled 600,000 Chinese face masks which were defective. In addition, there were reports regarding disputes related to exporting masks between countries, such as between Germany, Austria and Switzerland; Czech Republic and Italy; and the United States and France.

WHO response measures

The World Health Organization (WHO) has commended the efforts of Chinese authorities in managing and containing the epidemic. The WHO noted the contrast between the 2002–2004 SARS outbreak, 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".

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. WHO Director-General Tedros Adhanom said that the PHEIC was due to "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 the "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 support 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 António 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 coordination 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 on the 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 and 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 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 the 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 a pandemic. The Director-General said that the WHO was "deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction".

The World Health Organization (WHO) has faced significant criticism for what is seen as inadequate handling of the pandemic, including the late declaration of a public health emergency and the classification of the virus as a Pandemic. The backlash included a petition for the WHO Director-General Tedros Adhanom to tender his resignation, currently signed by 678,000 people as of 31 March.

Right to health

On 26 March 2020, dozens of UN human rights experts emphasised respecting the rights of every individual during the COVID-19 pandemic. The expert group stated that everyone is entitled to life-saving interventions and the government holds this responsibility. The group stressed that the lack of resources or health insurance should never serve as a justification for discrimination against a specific group. The experts underscored that every individual has the right to health, including people with disabilities, belonging to minority groups, older people, internally displaced people, the homeless, those living in extremely poor conditions, people in detention, as well as refugees and other unspecified groups in need of government support.

Economic and social policy responses

International governmental organisations are addressing the economic and social impacts of the COVID-19 crisis. The Organisation for Economic Co-operation and Development has launched a platform (See "Tackling the coronavirus (COVID-19)" at www.oecd.org/coronavirus) to provide timely and comprehensive information on policy responses in countries around the world, as well as viewpoints and advice. From policies to strengthen health systems and the world economy to addressing the effects of lockdown and restrictions on travel, the digital hub includes a Country Policy Tracker, and aims to help countries learn from each other and to facilitate a co-ordinated global response to the coronavirus challenge

Impact

Politics

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

Chinese Communist Party general secretary Xi Jinping (left) and State Council Premier Li Keqiang (right), who are in charge of prevention and control of the epidemic in China

The Chinese government has been criticised by the United States, UK Minister for the Cabinet Office Michael Gove, and Brazil President Jair Bolsonaro's son Eduardo Bolsonaro for its handling of the pandemic, which began in the Chinese province of Hubei. 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 commentators believe that this move was intended to protect Communist Party general secretary Xi Jinping from the public's anger over the coronavirus outbreak. The Communist Party of China has used censorship domestically and social media abroad to deflect blame away from itself. Some Chinese officials rejected an earlier acknowledgement of the coronavirus outbreak starting in Wuhan, in favour of conspiracy theories about the COVID-19 originating from the U.S. or Italy. The U.S. administration of Donald Trump has pushed back against such disinformation by referring to the coronavirus as "Chinese virus" or "Wuhan virus" saying that China's "censorship supercharged a virus that has now turned into a global pandemic", which has in turn been criticised by some critics as racism and "distract[ing] from his administration's failure to contain the disease". The Daily Beast obtained a U.S. government cable outlining a communications stratagem with apparent origins in the National Security Council, with one official being quoted as "Everything is about China. We’re being told to try and get this messaging out in any way possible, including press conferences and television appearances."

Outlets such as Politico, Foreign Policy, and Bloomberg have reported that China's efforts to send aid to virus-stricken countries is part of a propaganda push for global influence. Authorities in Australia, Czech Republic, the Netherlands, Spain and Turkey have rejected some testing kits made by non-state-approved Chinese companies as below standard or defective. EU foreign policy chief Josep Borrell warned that there is "a geo-political component including a struggle for influence through spinning and the 'politics of generosity'". Borrell also said that "China is aggressively pushing the message that, unlike the US, it is a responsible and reliable partner."

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

In early March, the Italian government criticised the European Union's lack of solidarity with coronavirus-affected Italy. Maurizio Massari, Italy's ambassador to the EU, said that "Only China responded bilaterally. Certainly, this is not a good sign of European solidarity." On 22 March, after a phone call with Italian Prime Minister Giuseppe Conte, Russian president Vladimir Putin arranged the Russian army to send military medics, special disinfection vehicles, and other medical equipment to Italy. Italy's La Stampa newspaper cited an anonymous "high-level political source" that 80 per cent of Russia's aid was "useless or of little use to Italy". The source accused Russia of embarking on a "geopolitical and diplomatic" charm offensive. The President of Lombardy, Attilio Fontana, and Italian Foreign Minister Luigi Di Maio dismissed the media reports and expressed their gratitude. Russia also sent a cargo plane with medical aid to the United States. Kremlin spokesman Dmitry Peskov said that "when offering assistance to US colleagues, [Putin] assumes that when US manufacturers of medical equipment and materials gain momentum, they will also be able to reciprocate if necessary."

The planned NATO "Defender 2020" military exercise in Germany, Poland, and the Baltic states, the largest NATO war exercise since the end of the Cold War, will be held on a reduced scale. The Campaign for Nuclear Disarmament's general secretary Kate Hudson criticised the Defender 2020 exercise: "In the current public-health crisis, it jeopardises the lives not only of the troops from the US and the many European countries participating but the inhabitants of the countries in which they are operating."

The Iranian government has been heavily affected by the virus, with around two dozen parliament members infected as well as fifteen other current or former political figures. Iran's President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, saying that his country is struggling to fight the outbreak due to lack of access to international markets as a result of the United States sanctions against Iran.

The outbreak has 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. Political analysts anticipated it may negatively affect Donald Trump's chances of re-election in the 2020 presidential election.

Diplomatic relations between Japan and South Korea worsened due to the pandemic. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced anybody coming from South Korea will be placed in two weeks' quarantine at government-designated sites.

The pandemic has allowed countries to pass emergency legislation in response. Some commentators have expressed concerns that it could allow governments to strengthen their grip on power. In Hungary, its parliament voted to allow the prime minister, Viktor Orbán, to rule by decree indefinitely, suspend parliament as well as elections and punish those deemed to have spread false information about the virus and the government's handling of the crisis.

Education

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

Learners affected by school closures caused by COVID-19

  Country-wide school closures

  Localised school closures

  No school closures

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As of 29 March 2020, more than 1.5 billion children and other students were affected by nationwide school closures. Others have been disrupted by localised closures. As of 27 March, nearly 90 percent of the world's student population was out of class. Regions with schools remaining open include Taiwan, Singapore, Australia, Sweden, and some U.S. states.

On 23 March 2020, Cambridge International Examinations (CIE) released a statement announcing the cancellation of Cambridge IGCSE, Cambridge O Level, Cambridge International AS & A Level, Cambridge AICE Diploma, and Cambridge Pre-U examinations for the May/June 2020 series across all countries. International Baccalaureate exams have also been cancelled.

Even when school closures were temporary, the measures carried high social and economic costs, affecting people across communities. The impact was more severe for disadvantaged children and their families, causing interrupted learning, compromised nutrition, childcare problems, and consequent economic cost to families who could not work.

In response to school closures, UNESCO recommended 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.

Socioeconomics

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

See also: Impact of the 2019–20 coronavirus pandemic on aviation, on science and technology, on financial markets, and 2020 stock market crash

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

The coronavirus outbreak has been blamed for 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 United States Food and Drug Administration has issued warnings about shortages to drugs and medical equipment due to increased consumer demand and supplier disruption. Several localities 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. 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. It has also caused a shortage of personal protective equipment worldwide, with the WHO warning that this will endanger health workers. In Australia, the pandemic has provided a new opportunity for daigou shoppers to sell Australian product into China. The activity has created a shortage of baby formula in some supermarkets.

As mainland China is a major economy and 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. In January 2020, some analysts estimated that the economic fallout of the epidemic on global growth could surpass that of the 2002–2004 SARS outbreak. One estimate from an expert at Washington University in St. Louis gave a $300+ billion impact on the world's supply chain that could last up to two years. Organization of the Petroleum Exporting Countries (OPEC) 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 U.S. 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%. 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. Many consider an economic recession to be likely. Economist Mohamed El-Erian praised central banks' and states' timely emergency measures. Central banks are reacting more quickly than they did to the 2008 financial crash.

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 Airlines, 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.

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

Despite the high prevalence of COVID-19 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. Measures by China and Italy against the hoarding and illicit trade of critical products have been successful, 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 requiring food producers to keep reserves for such emergencies.

Damage to the global economy has been felt in China: 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%.

Culture

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

Further information: Impact of the 2019–20 coronavirus pandemic on the arts and cultural heritage, on cinema, on religion, on sports, on television, and on video games

The closed entrance to the Shah Abdol-Azim Shrine in Ray, Iran. Cultural sites and other public spaces throughout the world were closed to slow the spread of the pandemic.

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

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

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; some churches have made church services available via radio, online livestreaming or television while others are offering drive-in worship. With the Roman Catholic Diocese of Rome closing its churches and chapels and St. Peter's Square emptied of Christian pilgrims, other religious bodies also cancelled services and limited public gatherings in churches, mosques, synagogues, temples and gurdwaras. Iran's Health Ministry announced the cancellation of Friday prayers in areas affected by the outbreak and shrines were later closed, while Saudi Arabia banned the entry of foreign pilgrims as well as its residents to holy sites in Mecca and Medina.

Announcement posted in the door of a public library in Island Bay, New Zealand that it is closed due to the pandemic, and will waive all late return fees

The pandemic has caused the most significant disruption to the worldwide sporting calendar since the Second World War. Most major sporting events have been either 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 disrupted plans for the 2020 Summer Olympics, which were originally scheduled to start at the end of July; the International Olympic Committee announced on 24 March that the event will be "rescheduled to a date beyond 2020 but not later than summer 2021".

Casinos and other gaming venues worldwide have closed and live poker tournaments have been either postponed or cancelled. This has led many gamblers to move online, with many online gambling sites reporting significant increases in their rates of new sign-ups.

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.

Environment and climate

Empty A1 motorway in Slovenia

Due to the coronavirus outbreak's impact on travel and industry, many regions experienced a drop in air pollution. 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. One expert estimated that this reduction may have saved at least 77,000 lives. 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. In Venice, the water in the canals cleared and experienced an increased presence of fish and waterfowl; the Venice mayor's office clarified that the increase in water clarity was due to the settling of sediment that is disturbed by boat traffic and mentioned the decrease in air pollution along the waterways.

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. However, extended quarantine periods have boosted adoption of remote work policies. As a consequence of the unprecedented use of disposable face masks, significant numbers are entering the natural environment, adding to the worldwide burden of plastic waste.

The European Centre for Medium-Range Weather Forecasts (ECMWF) announced that a worldwide reduction in aircraft flights due to the pandemic could impact the accuracy of weather forecasts, citing commercial airlines' use of Aircraft Meteorological Data Relay (AMDAR) as an integral contribution to weather forecast accuracy. The ECMWF predicted that AMDAR coverage would decrease by 65% or more due to the drop in commercial flights.

The pandemic has also impacted climate diplomacy, as the 2020 United Nations Climate Change Conference was postponed to 2021 in response the pandemic after its venue was converted to a field hospital. This conference was crucial as nations were scheduled to submit enhanced nationally determined contributions to the Paris Agreement, with enhanced ambition. The pandemic also limits the ability of nations, particularly developing nations with low state capacity, to submit nationally determined contributions, as they focus on the pandemic.

Xenophobia and racism

Main article: List of incidents of xenophobia and racism related to the 2019–20 coronavirus pandemic

Houston Chinatown experienced a reduction in business early during the outbreak when there were still few cases.

Since the outbreak of COVID-19, heightened prejudice, xenophobia, and racism have been noted toward people of Chinese and East Asian descent, and against people from hotspots in Europe, the United States and other countries. Incidents of fear, suspicion, and hostility have been observed in many countries, particularly in Europe, East Asia, North America, and the Asia-Pacific region. Reports from February (where the majority of the cases had still been confined to China) have documented sentiments expressed in various groups worldwide of Chinese people deserving the virus or receiving what has been claimed as justified retribution. Some countries in Africa have also seen a rise in anti-Chinese sentiment. Many residents of Wuhan and Hubei have reported discrimination based on their regional origin. There has been support for the Chinese, both on and offline, and towards those in virus-stricken areas. Following the progression of the outbreak to new hotspot countries, people from Italy, the first country in Europe to experience a serious outbreak of COVID-19, could also be subjected to suspicion and xenophobia.

Citizens in countries including Malaysia, New Zealand, Singapore, and South Korea initially signed petitions lobbying to ban Chinese people from entering their countries in an effort to stop the disease. In Japan, the hashtag #ChineseDontComeToJapan trended on Twitter. Chinese people as well as other Asians in the United Kingdom and the United States have reported increasing levels of racist abuse, as well as assaults. U.S. president Donald Trump has faced criticism for referring to the coronavirus as the "Chinese Virus", a term considered by some critics to be racist and anti-Chinese. In response to reports of Sinophobic incidents, Trump tweeted: "It is very important that we totally protect our Asian American community in the United States, and all around the world." Protesters in Ukraine attacked buses carrying Ukrainian and foreign evacuees from Wuhan to Novi Sanzhary. 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. The Bharatiya Janata Party's State unit president in West Bengal Dilip Ghosh stated that the Chinese had destroyed nature and "that's why the God took revenge against them." The remarks were later condemned by the Chinese consulate in Kolkata, calling it "erroneous".

South Korean Foreign Minister Kang Kyung-wha has described Israel's forced quarantine of South Koreans as "excessive". Israel Today published a Korean complaint that "Israel is Treating [Korean and other Asian] Tourists Like Coronavirus". 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 hostility 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. Local authorities in Bolivia quarantined Japanese nationals despite them having no coronavirus-related symptoms.

As COVID-19 cases in China fell while those in the West and around the world rose, anti-Western sentiment has risen in Hong Kong as well as Mainland China, as expats are accused of introducing a "second wave" of the disease. According to The Guardian, Westerners and other foreigners in China have reported increased incidences of xenophobia against them, with a recent online article having the headline "Beware of a second outbreak started by foreign garbage". Similar issues have been noted in other parts of Asia.

Anti-Caucasian sentiment has also risen in Thailand, where Westerners are accused of spreading the disease. As the pandemic has progressed, there have also been isolated instances of prejudice against Westerners, particularly Western tourists accused of importing the disease. Thai Health minister Anutin Charnvirakul made negative comments about "dirty" Westerners, saying they "never shower" and are more likely to spread the virus than Asians. In March 2020, foreigners from Europe, US and Israel started facing xenophobia and discrimination in India, including evictions from rented homes.

There have been reports of anti-Roma xenophobia in some EU member states. Islamists have exploited the disease to foster anti-Western sentiment. There were also false rumours in India, amplified by bloggers and some social media channels, that some Muslims who returned from Dubai refused to undergo coronavirus testing for religious reasons. Muslim gatherings organised by the Tablighi Jamaat have resulted in large increased of cases in Malaysia, Pakistan and India, and in India, this has triggered Islamophobic reactions and increased communal tension.

The Anti-Defamation League and Life After Hate observed that in addition to the wave of anti-Chinese xenophobia online, there was a white nationalist and white supremacist-fueled wave of anti-Semitic and racist anti-Israeli agitation, including but not limited to claims that Jews and/or Israelis were spreading the virus, but also an online campaign to infect Jews with the virus as a means of murder. The ADL was especially concerned with the prevalence of anti-Semitic messaging on Twitter, Instagram, Steam, Discord and TikTok combined with the increased internet usage by children after school closings. The FBI also warned that white supremacists groups were plotting to "expose Jewish people to coronavirus" by having members use themselves as bio-weapons" to infect areas Jewish people are deemed likely to visit. On 23 March, the FBI foiled a terrorist plot by a white supremacist to use a car bomb to blow up a Missouri hospital overflowing with COVID-19 patients, with the man having referenced far-right conspiracy theories that the virus was "engineered by Jews", online before he was shot and killed in an altercation with FBI agents.

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

Many newspapers with paywalls have removed them for some or all of their coronavirus coverage. 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.

Misinformation

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

See also: 2019–20 coronavirus pandemic on social media

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.

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, They have also debunked some false claims. The United States government has taken action to counter some online rumors, as well as to shut down commercial scams offering at-home tests, supposed preventives, and "miracle" cures - some promoted by celebrities such as Jim Bakker and Alex Jones.

See also

• Emerging infectious disease – Infectious disease of emerging pathogen, often novel in its outbreak range or transmission mode
• List of epidemics – List of infectious diseases that rapidly spread across a large region, usually worldwidePages displaying short descriptions of redirect targets
• Wildlife trafficking and emerging zoonotic diseases – Health risks associated with the trade in exotic wildlifePages displaying short descriptions of redirect targets

References

•  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 education​, UNESCO.

External links

Government health agencies

• COVID-19 (Questions & Answers, Instructional Videos) by the World Health Organization
• COVID-19 (Q&A) by the European Centre for Disease Prevention and Control
• COVID-19 by the China National Health Commission
• COVID-19 (Q&A) by the Singapore Ministry of Health
• COVID-19 (Q&A) by the U.S. Centers for Disease Control
• Coronavirus Disease 2019 (Q&A) by the National Institute for Occupational Safety and Health

Directories

• COVID-19 Directory on Curlie
• COVID-19 Resource Directory on OpenMD

Data and maps

• Coronavirus disease (COVID-2019) situation reports and map by the World Health Organization
• Coronavirus COVID-19 Global Cases and historical data created by Lauren Gardner at Johns Hopkins University
• World Travel Restrictions based on WFP data
• Coronavirus Observer based on Johns Hopkins University data

Medical journals

• Coronavirus Disease 2019 (COVID-19) by JAMA
• Coronavirus: News and Resources by BMJ Publishing Group
• Novel Coronavirus Information Center by Elsevier
• COVID-19 Resource Centre by The Lancet
• SARS-CoV-2 and COVID-19 by Nature
• Coronavirus (Covid-19) by New England Journal of Medicine
• Covid-19: Novel Coronavirus by Wiley Publishing

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