The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global
pandemic
A pandemic () is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic disease with a stable number of in ...
of
coronavirus disease 2019
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickl ...
(COVID-19) caused by
severe acute respiratory syndrome coronavirus 2
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19 (coronavirus disease 2019), the respiratory illness responsible for the ongoing COVID-19 pandemic. The virus previously had a ...
(SARS-CoV-2). The
novel virus was first identified in an outbreak in the Chinese city of
Wuhan
Wuhan (, ; ; ) is the capital of Hubei Province in the People's Republic of China. It is the largest city in Hubei and the most populous city in Central China, with a population of over eleven million, the ninth-most populous Chinese city a ...
in December 2019. Attempts to contain it there failed, allowing the virus to spread to other areas of Asia and later
worldwide. The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO) declared the outbreak a
public health emergency of international concern
A public health emergency of international concern (PHEIC) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the internatio ...
on 30 January 2020, and a pandemic on 11 March 2020. As of , the pandemic had caused
more than cases and
confirmed deaths, making it one of the
deadliest in history.
COVID-19 symptoms
The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less co ...
range from
undetectable to deadly, but most commonly include fever,
dry cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phas ...
, and fatigue. Severe illness is more likely in elderly patients and those with certain underlying medical conditions.
COVID-19 transmits when people breathe in air contaminated by droplets and small
airborne
Airborne or Airborn may refer to:
Arts, entertainment, and media
Films
* ''Airborne'' (1962 film), a 1962 American film directed by James Landis
* ''Airborne'' (1993 film), a comedy–drama film
* ''Airborne'' (1998 film), an action film sta ...
particles containing the virus. The risk of breathing these in is highest when people are in close proximity, but they can be inhaled over longer distances, particularly indoors. Transmission can also occur if contaminated fluids reach the eyes, nose, or mouth, or, more rarely, via contaminated surfaces. Infected individuals are typically contagious for 10 days and can spread the virus even if they do not develop symptoms. Mutations have
produced many strains (variants) with varying degrees of infectivity and virulence.
[
The ]COVID-19 vaccine
A COVID19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID19).
Prior to the COVID19 pandemic, an e ...
s have been approved and widely distributed in various countries since December 2020. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020, to 8 December 2021. Other recommended preventive measures include social distancing
In public health, social distancing, also called physical distancing, (NB. Regula Venske is president of the PEN Centre Germany.) is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious dis ...
, wearing masks, improving ventilation and air filtration, and quarantining those who have been exposed or are symptomatic. Treatments include novel antiviral drugs and symptom control. Public health mitigation measures include travel restrictions, lockdowns, business restrictions and closures, workplace hazard controls, quarantines, testing
An examination (exam or evaluation) or test is an educational assessment intended to measure a test-taker's knowledge, skill, aptitude, physical fitness, or classification in many other topics (e.g., beliefs). A test may be administered verba ...
systems, and contact tracing
In public health, contact tracing is the process of identifying persons who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individua ...
of the infected, which, together with treatments, serve to bring about the control and eventual end of the pandemic.
The pandemic has triggered severe social
Social organisms, including human(s), live collectively in interacting populations. This interaction is considered social whether they are aware of it or not, and whether the exchange is voluntary or not.
Etymology
The word "social" derives from ...
and economic disruption around the world, including the largest global recession since the Great Depression
The Great Depression (19291939) was an economic shock that impacted most countries across the world. It was a period of economic depression that became evident after a major fall in stock prices in the United States. The economic contagio ...
. Widespread supply shortages, including food shortages, were caused by supply chain disruptions. Reduced human activity saw an unprecedented decrease in pollution. Educational institutions
An educational institution is a place where people of different ages gain an education, including preschools, childcare, primary-elementary schools, secondary-high schools, and universities. They provide a large variety of learning environments an ...
and public areas were partially or fully closed in many jurisdictions, and many events were cancelled or postponed during 2020 and 2021. Misinformation has circulated through social media
Social media are interactive media technologies that facilitate the creation and sharing of information, ideas, interests, and other forms of expression through virtual communities and networks. While challenges to the definition of ''social me ...
and mass media
Mass media refers to a diverse array of media technologies that reach a large audience via mass communication. The technologies through which this communication takes place include a variety of outlets.
Broadcast media transmit informati ...
, and political tensions have intensified. The pandemic has raised issues of racial and geographic discrimination, health equity
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...
, and the balance
''The Balance'' is the third studio album by Welsh band Catfish and the Bottlemen. It was released on 26 April 2019 through Island Records and Capitol Records. It was preceded by the lead single "Longshot", which reached number 25 on the UK Singl ...
between public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
imperatives and individual rights.
While the WHO considers the pandemic global and ongoing , some countries are transitioning their public health approach towards regarding SARS-CoV-2 as an endemic virus.[
]
Etymology
The pandemic is known by several names. It is sometimes referred to as the "coronavirus pandemic" despite the existence of other human coronaviruses that have caused epidemics and outbreaks (e.g. SARS
Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, ''seve ...
).
During the initial outbreak in Wuhan
Wuhan (, ; ; ) is the capital of Hubei Province in the People's Republic of China. It is the largest city in Hubei and the most populous city in Central China, with a population of over eleven million, the ninth-most populous Chinese city a ...
, the virus and disease were commonly referred to as "coronavirus", "Wuhan coronavirus", "the coronavirus outbreak" and the "Wuhan coronavirus outbreak", with the disease sometimes called "Wuhan pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
". In January 2020, the WHO recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, ra ...
. WHO finalized the official names COVID-19 and SARS-CoV-2 on 11 February 2020. Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus ( ti, ቴዎድሮስ አድሓኖም ገብረኢየሱስ, sometimes spelt ti, ቴድሮስ ኣድሓኖም ገብረየሱስ, label=none; born 3 March 1965) is an Ethiopian public health official, researcher, and ...
explained: COfor ''corona'', VIfor ''virus'', Dfor ''disease'' and 19 for when the outbreak was first identified (31 December 2019). WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.
WHO names variants of concern
The term variant of concern (VOC) for SARS-CoV-2, which causes COVID-19, is a category used for variants of the virus where mutations in their spike protein receptor binding domain (RBD) substantially increase binding affinity (e.g., N501Y) i ...
and variants of interest using Greek letters
The Greek alphabet has been used to write the Greek language since the late 9th or early 8th century BCE. It is derived from the earlier Phoenician alphabet, and was the earliest known alphabetic script to have distinct letters for vowels as we ...
. The initial practice of naming them according to where the variants were identified (e.g. Delta began as the "Indian variant") is no longer common. A more systematic naming scheme reflects the variant's PANGO lineage (e.g., Omicron
Omicron (; uppercase Ο, lowercase ο, ell, όμικρον) is the 15th letter of the Greek alphabet. This letter is derived from the Phoenician letter ayin: . In classical Greek, omicron represented the close-mid back rounded vowel in contr ...
's lineage is B.1.1.529) and is used for other variants.
Epidemiology
Background
SARS-CoV-2 is a newly discovered virus that is closely related to bat coronaviruses, pangolin
Pangolins, sometimes known as scaly anteaters, are mammals of the order Pholidota (, from Ancient Greek ϕολιδωτός – "clad in scales"). The one extant family, the Manidae, has three genera: '' Manis'', ''Phataginus'', and '' Smuts ...
coronaviruses, and SARS-CoV. The first known outbreak
In epidemiology, an outbreak is a sudden increase in occurrences of a disease when cases are in excess of normal expectancy for the location or season. It may affect a small and localized group or impact upon thousands of people across an entire ...
started in Wuhan
Wuhan (, ; ; ) is the capital of Hubei Province in the People's Republic of China. It is the largest city in Hubei and the most populous city in Central China, with a population of over eleven million, the ninth-most populous Chinese city a ...
, Hubei, China, in November 2019. Many early cases were linked to people who had visited the Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier.
The scientific consensus is that the virus is most likely of a zoonotic
A zoonosis (; plural zoonoses) or zoonotic disease is an infectious disease of humans caused by a pathogen (an infectious agent, such as a bacterium, virus, parasite or prion) that has jumped from a non-human (usually a vertebrate) to a human. ...
origin, from bats or another closely-related mammal. Despite this, the subject has generated extensive speculation about alternative origins. The origin controversy heightened geopolitical divisions, notably between the United States and China.
The earliest known infected person fell ill on 1December 2019. That individual did not have a connection with the later wet market
A wet market (also called a public market or a traditional market) is a marketplace selling fresh foods such as meat, fish, produce and other consumption-oriented perishable goods in a non-supermarket setting, as distinguished from " dry mark ...
cluster. However, an earlier case may have occurred on 17 November. Two-thirds of the initial case cluster were linked with the market. Molecular clock
The molecular clock is a figurative term for a technique that uses the mutation rate of biomolecules to deduce the time in prehistory when two or more life forms diverged. The biomolecular data used for such calculations are usually nucleo ...
analysis suggests that the index case is likely to have been infected between mid-October and mid-November 2019.
Cases
Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias
In statistics, sampling bias is a bias in which a sample is collected in such a way that some members of the intended population have a lower or higher sampling probability than others. It results in a biased sample of a population (or non-human f ...
, studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes, anxiety disorders, and the total number of conditions.
In early 2020, a meta-analysis of self-reported cases in China by age indicated that a relatively low proportion of cases occurred in individuals under 20. It was not clear whether this was because young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study
A cohort study is a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation), performing ...
in China found that children
A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...
and adults were just as likely to be infected.
Among more thorough studies, preliminary results from 9 April 2020, found that in Gangelt, the centre of a major infection cluster in Germany, 15 per cent of a population sample tested positive for antibodies
An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of ...
. Screening for COVID-19 in pregnant women in New York City, and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence-based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies.
Initial estimates of the basic reproduction number
In epidemiology, the basic reproduction number, or basic reproductive number (sometimes called basic reproduction ratio or basic reproductive rate), denoted R_0 (pronounced ''R nought'' or ''R zero''), of an infection is the expected number of ...
(R0) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 per cent confidence interval
In frequentist statistics, a confidence interval (CI) is a range of estimates for an unknown parameter. A confidence interval is computed at a designated ''confidence level''; the 95% confidence level is most common, but other levels, such as 9 ...
of 3.8 to 8.9).
In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28December, 282,790,822 individuals worldwide had been confirmed as infected. , over 500 million cases were confirmed globally. Most cases are unconfirmed, with the Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is a research institute working in the area of global health statistics and impact evaluation at the University of Washington in Seattle. The Institute is headed by Christopher J.L. Murray ...
estimating the true number of cases as of early 2022 to be in the billions.
Deaths
As of , more than deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health.
Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts.
Official death counts have been claimed to underreport the actual death toll, because excess mortality
Excess may refer to:
* Angle excess, in spherical trigonometry
* Insurance excess, similar to a deductible
* Excess, in chemistry, a reagent that is not the limiting reagent
* "Excess", a song by Tricky from the album '' Blowback''
* ''Excess'' ( ...
(the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 16.6 to 28.3 million by ''The Economist
''The Economist'' is a British weekly newspaper printed in demitab format and published digitally. It focuses on current affairs, international business, politics, technology, and culture. Based in London, the newspaper is owned by The Eco ...
'', as well as over 10.3 million by the Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is a research institute working in the area of global health statistics and impact evaluation at the University of Washington in Seattle. The Institute is headed by Christopher J.L. Murray ...
and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study.
News article about the study: Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic.
In May 2022, the WHO estimated the number of excess deaths to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services.
The time between symptom onset and death ranges from6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions.
File:Covid-19 daily deaths in top 5 countries and the world.png, Semi-log plot of weekly deaths due to COVID-19 in the world and top six current countries (mean with cases)
File:Coronavirus-cfr.svg, Ongoing case fatality rate of COVID-19 by country
Infection fatality ratio (IFR)
The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points (not as a decimal). Other studies refer to this metric as the 'infection fatality risk'.
In November 2020, a review article in ''Nature'' reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%.
IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza
Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemispheres of Earth, hemisphere. It takes approximately two days to ...
.
In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections.
Case fatality ratio (CFR)
Another metric in assessing death rate is the case fatality ratio
In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people diagnosed with a certain disease, who end up dying of it. Unlike a disease's mortality rate, the CFR does not take in ...
(CFR), which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals.
Based on Johns Hopkins University
Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hemisphere. It consi ...
statistics, the global CFR is ( deaths for cases) as of . The number varies by region and has generally declined over time.
Disease
Variants
Several variants have been named by WHO and labelled as a variant of concern
The term variant of concern (VOC) for SARS-CoV-2, which causes COVID-19, is a category used for variants of the virus where mutations in their spike protein receptor binding domain (RBD) substantially increase binding affinity (e.g., N501Y) ...
(VoC) or a variant of interest (VoI). They share the more infectious D614G mutation: Delta dominated and then eliminated earlier VoC from most jurisdictions. Omicron's immune escape ability may allow it to spread via breakthrough infections, which in turn may allow it to coexist with Delta, which more often infects the unvaccinated.
Signs and symptoms
Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell
Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from hyposmia, which is a decreased sensitivity to some or all smells.
Anosmia can be due to a num ...
and taste
The gustatory system or sense of taste is the sensory system that is partially responsible for the perception of taste (flavor). Taste is the perception produced or stimulated when a substance in the mouth reacts chemically with taste receptor ...
, nasal congestion
Nasal congestion is the blockage of nasal breathing usually due to membranes lining the nose becoming swollen from inflamed blood vessels.
Background
In about 85% of cases, nasal congestion leads to mouth breathing rather than nasal breathin ...
and runny nose
Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin mucus fluid from the nose; it is a common condition. It is a common symptom of allergies ( hay fever) or certain viral infections, such as the common cold or COV ...
, cough, muscle pain
Myalgia (also called muscle pain and muscle ache in layman's terms) is the medical term for muscle pain. Myalgia is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another like ...
, sore throat
Sore throat, also known as throat pain, is pain or irritation of the throat. Usually, causes of sore throat include
* viral infections
* group A streptococcal infection (GAS) bacterial infection
* pharyngitis (inflammation of the throat)
* to ...
, fever, diarrhoea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
, and breathing difficulties
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum
Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigatio ...
, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell
Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from hyposmia, which is a decreased sensitivity to some or all smells.
Anosmia can be due to a num ...
is associated with COVID-19
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...
and is reported in as many as 88% of cases.
Transmission
The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol
An aerosol is a suspension of fine solid particles or liquid droplets in air or another gas. Aerosols can be natural or anthropogenic. Examples of natural aerosols are fog or mist, dust, forest exudates, and geyser steam. Examples of anthropogen ...
) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close. However, infection can occur over longer distances, particularly indoors.
Cause
SARS‑CoV‑2 belongs to the broad family of viruses known as coronavirus
Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the co ...
es. It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species.
Human coronaviruses are capable of causing illnesses ranging from the common cold
The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after expos ...
to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after 229E, NL63, OC43, HKU1, MERS-CoV
''Middle East respiratory syndrome–related coronavirus'' (''MERS-CoV''), or EMC/2012 ( HCoV-EMC/2012), is the virus that causes Middle East respiratory syndrome (MERS). It is a species of coronavirus which infects humans, bats, and camels. Th ...
, and the original SARS-CoV.
Diagnosis
The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease.
Prevention
Preventive measures to reduce the chances of infection include getting vaccinated, staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.
Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.
Vaccines
A COVID-19 vaccine
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19 (coronavirus disease 2019), the respiratory illness responsible for the ongoing COVID-19 pandemic. The virus previously had a ...
(SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID-19
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...
). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronavirus
Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the co ...
es causing diseases like severe acute respiratory syndrome
Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, ''sev ...
(SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic, often severe illness. On 10 January 2020, the SARS-CoV-2 genetic sequence
A nucleic acid sequence is a succession of bases signified by a series of a set of five different letters that indicate the order of nucleotides forming alleles within a DNA (using GACT) or RNA (GACU) molecule. By convention, sequences are us ...
data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19.
As of late-December 2021, more than 4.49 billion people had received one or more doses (8+ billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used.
On 8 November 2022, Novavax's COVID-19 vaccine booster was authorized for use in adults in the United Kingdom. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines.
On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics, in the city of Shanghai, China.
Treatment
For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor, Paxlovid (nirmatrelvir plus AIDS drug ritonavir
Ritonavir, sold under the brand name Norvir, is an antiretroviral drug used along with other medications to treat HIV/AIDS. This combination treatment is known as highly active antiretroviral therapy (HAART). Ritonavir is a protease inhibitor ...
), to treat adult patients. FDA later gave it an EUA.
Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferio ...
or NSAID
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and a healthy diet
A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.
A hea ...
are also recommended.
Supportive care
Symptomatic treatment, supportive care, supportive therapy, or palliative treatment is any medical therapy of a disease that only affects its symptoms, not the underlying cause. It is usually aimed at reducing the signs and symptoms for the comf ...
includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning, and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone
Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena ...
is recommended, to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...
for mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...
may be required to support breathing. Extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequa ...
(ECMO) has been used to address the issue of respiratory failure.
Existing drugs such as hydroxychloroquine
Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, an ...
, lopinavir/ritonavir, ivermectin
Ivermectin (, '' EYE-vər-MEK-tin'') is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, today it is used to treat i ...
and so-called early treatment are not recommended by US or European health authorities, as there is no good evidence they have any useful effect.[/] The antiviral remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO), due to limited evidence of its efficacy.
Prognosis
The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold
The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after expos ...
. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein
C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin- ...
levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...
s (ICU).
Between 5% and 50% of COVID-19 patients experience long COVID
Long COVID or long-haul COVID (also known as post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS)) is a condition characterized by long-term health problems persisting or app ...
, a condition characterized by long-term consequences
Consequence may refer to:
* Logical consequence, also known as a ''consequence relation'', or ''entailment''
* In operant conditioning, a result of some behavior
* Consequentialism, a theory in philosophy in which the morality of an act is determi ...
persisting after the typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue
Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
and memory problems, as well as malaise
As a medical term, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. The word has existed in French since at least the 12th century.
The term is often used ...
, headaches, shortness of breath
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
, loss of smell, muscle weakness
Muscle weakness is a lack of muscle strength. Its causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, includi ...
, low fever and cognitive dysfunction.
Strategies
Many countries attempted to slow or stop the spread of COVID-19 by recommending, mandating or prohibiting behaviour changes, while others relied primarily on providing information. Measures ranged from public advisories to stringent lockdowns. Outbreak control strategies are divided into elimination and mitigation. Experts differentiate between elimination strategies (known as "zero-COVID
Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support" (FTTIS), is a public health policy that has been implemented by some countries during the COVID-19 pandemic.Anna Llupià, Rodríguez-Giralt, Anna Fité, Lola Ála ...
") that aim to completely stop the spread of the virus within the community,[Anna Llupià, Rodríguez-Giralt, Anna Fité, Lola Álamo, Laura de la Torre, Ana Redondo, Mar Callau and Caterina Guinovart (2020) ]
What Is a Zero-COVID Strategy
'', Barcelona Institute for Global Health – COVID-19 & response strategy. "''The strategy of control and maximum suppression (zero-COVID) has been implemented successfully in a number of countries. The objective of this strategy is to keep transmission of the virus as close to zero as possible and ultimately to eliminate it entirely from particular geographical areas. The strategy aims to increase the capacity to identify and trace chains of transmission and to identify and manage outbreaks, while also integrating economic, psychological, social and healthcare support to guarantee the isolation of cases and contacts. This approach is also known as "Find, Test, Trace, Isolate and Support" (FTTIS)''" and mitigation strategies (commonly known as "flattening the curve
Flattening the curve was a public health strategy to slow down the spread of the SARS-CoV-2 virus during the early stages of the COVID-19 pandemic. The curve being flattened is the epidemic curve, a visual representation of the number of infec ...
") that attempt to lessen the effects of the virus on society, but which still tolerate some level of transmission within the community. These initial strategies can be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity.
''Nature'' reported in 2021 that 90 per cent of immunologists who responded to a survey "think that the coronavirus will become endemic
Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found else ...
".
Containment
Containment is undertaken to stop an outbreak from spreading into the general population. Infected individuals are isolated while they are infectious. The people they have interacted with are contacted and isolated for long enough to ensure that they are either not infected or no longer contagious. Screening is the starting point for containment. Screening is done by checking for symptoms to identify infected individuals, who can then be isolated or offered treatment. The Zero-COVID
Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support" (FTTIS), is a public health policy that has been implemented by some countries during the COVID-19 pandemic.Anna Llupià, Rodríguez-Giralt, Anna Fité, Lola Ála ...
strategy involves using public health measures such as contact tracing
In public health, contact tracing is the process of identifying persons who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individua ...
, mass testing, border quarantine, lockdowns and mitigation software to stop community transmission of COVID-19 as soon as it is detected, with the goal of getting the area back to zero detected infections and resuming normal economic and social activities. Successful containment or suppression reduces Rt to less than 1.
Mitigation
Should containment fail, efforts focus on mitigation: measures taken to slow the spread and limit its effects on the healthcare system and society.
Successful mitigation delays and decreases the epidemic peak, known as "flattening the epidemic curve". This decreases the risk of overwhelming health services and provides more time for developing vaccines and treatments. Individual behaviour changed in many jurisdictions. Many people worked from home instead of at their traditional workplaces.
Non-pharmaceutical interventions
Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks, self-quarantine, and hand hygiene
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/ bacteria/ microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the h ...
; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning.
Other measures
More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. China and Australia's lockdowns have been the most strict. New Zealand implemented the most severe travel restrictions. South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. Singapore provided financial support, quarantined, and imposed large fines for those who broke quarantine.
Contact tracing
Contact tracing
In public health, contact tracing is the process of identifying persons who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individua ...
attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic
The 2013–2016 epidemic of Ebola virus disease, centered in West Africa, Western Africa, was the most widespread List of Ebola outbreaks, outbreak of the disease in history. It caused major loss of life and Socioeconomics, socioeconomic disr ...
in 2014.
Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple
An apple is an edible fruit produced by an apple tree (''Malus domestica''). Apple trees are cultivated worldwide and are the most widely grown species in the genus '' Malus''. The tree originated in Central Asia, where its wild ancest ...
announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services.
Health care
WHO described increasing capacity and adapting healthcare as a fundamental mitigation. The ECDC and WHO's European regional office issued guidelines for hospitals and primary healthcare services for shifting resources at multiple levels, including focusing laboratory services towards testing, cancelling elective procedures, separating and isolating patients, and increasing intensive care
Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes pro ...
capabilities by training personnel and increasing ventilator
A ventilator is a piece of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators ...
s and beds. The pandemic drove widespread adoption of telehealth
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, mon ...
.
Improvised manufacturing
Due to capacity supply chain
In commerce, a supply chain is a network of facilities that procure raw materials, transform them into intermediate goods and then final products to customers through a distribution system. It refers to the network of organizations, people, activ ...
s limitations, some manufacturers began 3D printing
3D printing or additive manufacturing is the construction of a three-dimensional object from a CAD model or a digital 3D model. It can be done in a variety of processes in which material is deposited, joined or solidified under computer co ...
material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement
Patent infringement is the commission of a prohibited act with respect to a patented invention without permission from the patent holder. Permission may typically be granted in the form of a license. The definition of patent infringement may v ...
after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source
Open source is source code that is made freely available for possible modification and redistribution. Products include permission to use the source code, design documents, or content of the product. The open-source model is a decentralized so ...
designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shield
A face shield, an item of personal protective equipment (PPE), aims to protect the wearer's entire face (or part of it) from hazards such as flying objects and road debris, chemical splashes (in laboratories or in industry), or potentially ...
s, protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators, and hand sanitizer
Hand sanitizer (also known as hand antiseptic, hand disinfectant, hand rub, or handrub) is a liquid, gel or foam generally used to kill many viruses/bacteria/microorganisms on the hands. In most settings, hand washing with soap and water is g ...
. Novel devices were created such as ear savers, non-invasive ventilation
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alter ...
helmets, and ventilator splitters.
Herd immunity
In July 2021, several experts expressed concern that achieving herd immunity
Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become im ...
may not be possible because Delta can transmit among vaccinated individuals. CDC published data showing that vaccinated people could transmit Delta, something officials believed was less likely with other variants. Consequently, WHO and CDC encouraged vaccinated people to continue with non-pharmaceutical interventions such as masking, social distancing, and quarantining if exposed.
History
2019
The outbreak
In epidemiology, an outbreak is a sudden increase in occurrences of a disease when cases are in excess of normal expectancy for the location or season. It may affect a small and localized group or impact upon thousands of people across an entire ...
was discovered in Wuhan in November 2019. It is possible that human-to-human transmission was happening before the discovery. Based on a retrospective analysis starting from December 2019, the number of cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December.
A pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
cluster was observed on 26 December and treated by Doctor Zhang Jixian. She informed the Wuhan Jianghan CDC on 27 December. Vision Medicals reported the discovery of a novel coronavirus
Novel coronavirus (nCoV) is a provisional name given to coronaviruses of medical significance before a permanent name is decided upon. Although coronaviruses are endemic in humans and infections normally mild, such as the common cold (caused by ...
to the China CDC (CCDC) on 28 December.
On 30 December, a test report from CapitalBio Medlab addressed to Wuhan Central Hospital reported an erroneous positive result for SARS
Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, ''seve ...
, causing doctors there to alert authorities. Eight of those doctors, including Li Wenliang (who was also punished on 3January), were later admonished by the police for spreading false rumours; and Ai Fen was reprimanded. That evening, Wuhan Municipal Health Commission (WMHC) issued a notice about "the treatment of pneumonia of unknown cause". The next day, WMHC made the announcement public, confirming 27 cases—enough to trigger an investigation.
On 31 December, the WHO office in China was informed of cases of the pneumonia cases and immediately launched an investigation.
Official Chinese sources claimed that the early cases were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. However, in May 2020, CCDC director George Gao indicated the market was not the origin (animal samples had tested negative).
2020
On 11 January, WHO was notified by the Chinese National Health Commission that the outbreak was associated with exposures in the market, and that China had identified a new type of coronavirus, which it isolated on 7 January.
Initially, the number of cases doubled approximately every seven and a half days. In early and mid-January, the virus spread to other Chinese provinces, helped by the Chinese New Year migration. Wuhan was a transport hub and major rail interchange. On 10 January, the virus's genome was shared through GISAID. A retrospective study published in March found that 6,174 people had reported symptoms by 20 January. A 24 January report indicated human transmission, recommended personal protective equipment
Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, ...
for health workers, and advocated testing, given the outbreak's "pandemic potential". On 31 January the first published modelling study warned of inevitable "independent self-sustaining outbreaks in major cities globally" and called for "large-scale public health interventions."
On 30 January, 7,818 infections had been confirmed, leading WHO to declare the outbreak a Public Health Emergency of International Concern
A public health emergency of international concern (PHEIC) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the internatio ...
(PHEIC). On 11 March, WHO elevated it to a pandemic.
By 31 January, Italy had its first confirmed infections, in two tourists from China. On 19 March, Italy overtook China as the country with the most reported deaths. By 26 March, the United States had overtaken China and Italy as the country with the highest number of confirmed infections. Genomic analysis indicated that the majority of New York
New York most commonly refers to:
* New York City, the most populous city in the United States, located in the state of New York
* New York (state), a state in the northeastern United States
New York may also refer to:
Film and television
* '' ...
's confirmed infections came from Europe, rather than directly from Asia. Testing of prior samples revealed a person who was infected in France on 27 December 2019 and a person in the United States who died from the disease on 6February.
In October, WHO reported that one in ten people around the world may have been infected, or 780 million people, while only 35 million infections had been confirmed.
On 9 November, Pfizer
Pfizer Inc. ( ) is an American multinational pharmaceutical and biotechnology corporation headquartered on 42nd Street in Manhattan, New York City. The company was established in 1849 in New York by two German entrepreneurs, Charles Pfize ...
released trial results for a candidate vaccine, showing a 90 per cent effectiveness against infection. That day, Novavax
Novavax, Inc. is an American biotechnology company based in Gaithersburg, Maryland that develops vaccines to counter serious infectious diseases. Prior to 2020, company scientists developed experimental vaccines for influenza and respiratory sy ...
entered an FDA Fast Track application for their vaccine.
On 14 December, Public Health England
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as ...
reported that a variant had been discovered in the UK's southeast, predominantly in Kent
Kent is a county in South East England and one of the home counties. It borders Greater London to the north-west, Surrey to the west and East Sussex to the south-west, and Essex to the north across the estuary of the River Thames; it faces ...
. The variant, later named Alpha
Alpha (uppercase , lowercase ; grc, ἄλφα, ''álpha'', or ell, άλφα, álfa) is the first letter of the Greek alphabet. In the system of Greek numerals, it has a value of one. Alpha is derived from the Phoenician letter aleph , whi ...
, showed changes to the spike protein
In virology, a spike protein or peplomer protein is a protein that forms a large structure known as a spike or peplomer projecting from the surface of an enveloped virus. as cited in The proteins are usually glycoproteins that form dimers or ...
that could be more infectious. As of 13 December, 1,108 infections had been confirmed.
On 4 February 2020, US Secretary of Health and Human Services Alex Azar waived liability for vaccine manufacturers.
2021
On 2 January, the Alpha
Alpha (uppercase , lowercase ; grc, ἄλφα, ''álpha'', or ell, άλφα, álfa) is the first letter of the Greek alphabet. In the system of Greek numerals, it has a value of one. Alpha is derived from the Phoenician letter aleph , whi ...
variant, first discovered in the UK, had been identified in 33 countries. On 6 January, the Gamma variant was first identified in Japanese travellers returning from Brazil. On 29 January, it was reported that the Novavax vaccine was 49 per cent effective against the Beta
Beta (, ; uppercase , lowercase , or cursive ; grc, βῆτα, bē̂ta or ell, βήτα, víta) is the second letter of the Greek alphabet. In the system of Greek numerals, it has a value of 2. In Modern Greek, it represents the voiced labiod ...
variant in a clinical trial in South Africa. The CoronaVac vaccine was reported to be 50.4 per cent effective in a Brazil clinical trial.
On 12 March, several countries stopped using the Oxford-AstraZeneca COVID-19 vaccine due to blood clotting problems, specifically cerebral venous sinus thrombosis
Cerebral venous sinus thrombosis (CVST), cerebral venous and sinus thrombosis or cerebral venous thrombosis (CVT), is the presence of a blood clot in the dural venous sinuses (which drain blood from the brain), the cerebral veins, or both. Sympt ...
(CVST). On 20 March, the WHO and European Medicines Agency found no link to thrombus
A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of ...
, leading several countries to resume the vaccine. In March WHO reported that an animal host was the most likely origin, without ruling out other possibilities. The Delta variant
The Delta variant (B.1.617.2) was a variant of SARS-CoV-2, the virus that causes COVID-19. It was first detected in India in late 2020. The Delta variant was named on 31 May 2021 and had spread to over 179 countries by 22 November 2021. The ...
was first identified in India. In mid-April, the variant was first detected in the UK and two months later it had metastasized into a third wave there, forcing the government to delay reopening that was originally scheduled for June.
On 10 November, Germany advised against the Moderna vaccine for people under 30. On 24 November, the Omicron variant was detected in South Africa; a few days later the World Health Organization declared it a VoC (variant of concern). The new variant is more infectious than the Delta variant.
2022
On 1 January, Europe passed 100 million cases amidst a surge in the Omicron variant. Later that month on 14 January, the World Health Organization recommended two new treatments, Baricitinib
Baricitinib, sold under the brand name Olumiant among others, is a medication used for the treatment of rheumatoid arthritis, alopecia areata, and COVID-19. It acts as an inhibitor of janus kinase (JAK), blocking the subtypes JAK1 and JAK2. ...
, and Sotrovimab (although conditionally). Later on 24 January, it was reported that about 57% of the world had been infected by COVID-19, per the Institute for Health Metrics and Evaluation Model.
On 6 March, it was reported that the total worldwide death count had surpassed 6 million people since the start of the pandemic. Some time later, on 6 July, it was reported that Omicron subvariants BA.4 and BA.5 had spread worldwide.
On 21 October the United States surpassed 99 million cases of COVID-19, the most cases of any country.
On 30 October, it was reported that worldwide 424 deaths occurred due to the virus, the lowest since 385 deaths were reported on 12 March 2020. 17 November marked the three-year anniversary since health officials in China first detected COVID-19.
Ghebreyesus of the WHO stated on 14 September 2022, that " he world hasnever been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line".
On 11 November, the World Health Organization reported that deaths since the month of February have dropped 90 percent. Director-General Tedros Adhanom Ghebreyesus said this was "cause for optimism". On 3 December, the World Health Organization indicated that, "at least 90% of the world's population has some level of immunity to Sars-CoV-2". On 21 December, data from China's health authorities revealed that 248 million people, nearly 18 percent of its population, had been infected within just the first 20 days of December, as China abruptly halted its stringent lockdown measures.
National responses
National reactions ranged from strict lockdowns to public education campaigns. WHO recommended that curfews and lockdowns should be short-term measures to reorganise, regroup, rebalance resources, and protect the health care system.
As of 26 March 2020, 1.7 billion people worldwide were under some form of lockdown. This increased to 3.9 billion people by the first week of April—more than half the world's population.
Asia
As of the end of 2021, Asia's peak had come at the same time and at the same level as the world as a whole, in May 2021. However, cumulatively they had experienced only half the world average.
China opted for containment, inflicting strict lockdowns to eliminate spread.
The vaccines distributed in China included the BIBP, WIBP, and CoronaVac. It was reported on 11 December 2021, that China had vaccinated 1.162 billion of its citizens, or 82.5% of the total population of the country against COVID-19. China's large scale adoption of zero-COVID
Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support" (FTTIS), is a public health policy that has been implemented by some countries during the COVID-19 pandemic.Anna Llupià, Rodríguez-Giralt, Anna Fité, Lola Ála ...
had largely contained the first wave of infections of the disease. When the waves of infections due to the Omicron variant followed, China was almost alone in pursuing the strategy of zero-Covid to combat the spread of the virus in 2022. Lockdown continued to be employed in November to combat a new wave of cases; however, protests erupted in cities across China over the country's stringent measures, and in December that year, the country relaxed its zero-COVID policy. On 19 December 2022 it was reported that the "exit from zero-COVID" could drive deaths to about 1 million in the country of China.
The first case in India was reported on 30 January 2020. India ordered a nationwide lockdown starting 24 March 2020, with a phased unlock beginning 1 June 2020. Six cities accounted for around half of reported cases—Mumbai
Mumbai (, ; also known as Bombay — the official name until 1995) is the capital city of the Indian state of Maharashtra and the ''de facto'' financial centre of India. According to the United Nations, as of 2018, Mumbai is the secon ...
, Delhi
Delhi, officially the National Capital Territory (NCT) of Delhi, is a city and a union territory of India containing New Delhi, the capital of India. Straddling the Yamuna river, primarily its western or right bank, Delhi shares borders w ...
, Ahmedabad
Ahmedabad ( ; Gujarati: Amdavad ) is the most populous city in the Indian state of Gujarat. It is the administrative headquarters of the Ahmedabad district and the seat of the Gujarat High Court. Ahmedabad's population of 5,570,585 (per ...
, Chennai
Chennai (, ), formerly known as Madras ( the official name until 1996), is the capital city of Tamil Nadu, the southernmost Indian state. The largest city of the state in area and population, Chennai is located on the Coromandel Coast of th ...
, Pune
Pune (; ; also known as Poona, ( the official name from 1818 until 1978) is one of the most important industrial and educational hubs of India, with an estimated population of 7.4 million As of 2021, Pune Metropolitan Region is the largest i ...
and Kolkata
Kolkata (, or , ; also known as Calcutta , the official name until 2001) is the capital of the Indian state of West Bengal, on the eastern bank of the Hooghly River west of the border with Bangladesh. It is the primary business, comme ...
. Post-lockdown, the Government of India introduced a contact tracking app called Arogya Setu to help authorities manage contact tracing. Later this app was also used for a vaccination management program. India's vaccination program was considered to be the world's largest and the most successful with over 90% of citizens getting the first dose and another 65% getting the second dose. A second wave hit India in April 2021, straining healthcare services. On 21 October 2021, it was reported that the country had surpassed 1 billion vaccinations.
Iran reported its first confirmed cases on 19 February 2020, in Qom
Qom (also spelled as "Ghom", "Ghum", or "Qum") ( fa, قم ) is the seventh largest metropolis and also the seventh largest city in Iran. Qom is the capital of Qom Province. It is located to the south of Tehran. At the 2016 census, its pop ...
. Early measures included the cancellation of concerts and other cultural events, Friday prayers, and education shutdowns. Iran became a centre of the pandemic in February 2020. More than ten countries had traced their outbreaks to Iran by 28 February, indicating a more severe outbreak than the 388 reported cases. The Iranian Parliament
The Islamic Consultative Assembly ( fa, مجلس شورای اسلامی, Majles-e Showrā-ye Eslāmī), also called the Iranian Parliament, the Iranian Majles (Arabicised spelling Majlis) or ICA, is the national legislative body of Iran. The Pa ...
closed, after 23 of its 290 members tested positive on 3March 2020. At least twelve sitting or former Iranian politicians and government officials had died by 17 March 2020. By August 2021, the pandemic's fifth wave peaked, with more than 400 deaths in 1 day.
COVID-19 was confirmed in South Korea on 20 January 2020. Military bases were quarantined after tests showed three infected soldiers. South Korea introduced what was then considered the world's largest and best-organised screening programme, isolating infected people, and tracing and quarantining contacts. Screening methods included mandatory self-reporting by new international arrivals through mobile application, combined with drive-through
A drive-through or drive-thru (a sensational spelling of the word ''through''), is a type of take-out service provided by a business that allows customers to purchase products without leaving their cars. The format was pioneered in the United ...
testing, and increasing testing capability to 20,000 people/day. Despite some early criticisms, South Korea's programme was considered a success in controlling the outbreak without quarantining entire cities.
Europe
The global COVID-19 pandemic arrived in Europe with its first confirmed case in Bordeaux
Bordeaux ( , ; Gascon oc, Bordèu ; eu, Bordele; it, Bordò; es, Burdeos) is a port city on the river Garonne in the Gironde department, Southwestern France. It is the capital of the Nouvelle-Aquitaine region, as well as the prefectu ...
, France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
, on 24 January 2020, and subsequently spread widely across the continent. By 17 March 2020, every country in Europe had confirmed a case, and all have reported at least one death, with the exception of Vatican City
Vatican City (), officially the Vatican City State ( it, Stato della Città del Vaticano; la, Status Civitatis Vaticanae),—'
* german: Vatikanstadt, cf. '—' (in Austria: ')
* pl, Miasto Watykańskie, cf. '—'
* pt, Cidade do Vati ...
. Italy
Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...
was the first European nation to experience a major outbreak in early 2020, becoming the first country worldwide to introduce a national lockdown
A lockdown is a restriction policy for people, community or a country to stay where they are, usually due to specific risks (such as COVID-19) that could possibly harm the people if they move and interact freely.
The term is used for a prison ...
. By 13 March 2020, the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO) declared Europe the epicentre of the pandemic and it remained so until the WHO announced it had been overtaken by South America
South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere at the northern tip of the continent. It can also be described as the sou ...
on 22 May. By 18 March 2020, more than 250 million people were in lockdown
A lockdown is a restriction policy for people, community or a country to stay where they are, usually due to specific risks (such as COVID-19) that could possibly harm the people if they move and interact freely.
The term is used for a prison ...
in Europe. Despite deployment of COVID-19 vaccines
, 12.7billion COVID-19 vaccine doses have been administered worldwide, with 67.9 percent of the global population having received at least one dose. While 4.19million vaccines were then being administered daily, only 22.3 percent of people i ...
, Europe became the pandemic's epicentre once again in late 2021.
The Italian outbreak began on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. Cases began to rise sharply, which prompted the government to suspend flights to and from China and declare a state of emergency. On 22 February 2020, the Council of Ministers announced a new decree-law to contain the outbreak, including quarantining more than 50,000 people in northern Italy. On 4 March the Italian government ordered schools and universities closed as Italy reached a hundred deaths. Sport was suspended completely for at least one month. On 11 March Conte stopped nearly all commercial activity except supermarkets and pharmacies. On 19 March Italy overtook China as the country with the most COVID-19-related deaths. On 19 April the first wave ebbed, as 7-day deaths declined to 433. On 13 October, the Italian government again issued restrictive rules to contain the second wave. On 10 November Italy surpassed 1 million confirmed infections. On 23 November, it was reported that the second wave of the virus had led some hospitals to stop accepting patients.
The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 in La Gomera
La Gomera () is one of Spain's Canary Islands, located in the Atlantic Ocean off the coast of Africa. With an area of , it is the third smallest of the eight main islands of this archipelago. It belongs to the province of Santa Cruz de Tene ...
, Canary Islands. Post-hoc genetic analysis has shown that at least 15 strains of the virus had been imported, and community transmission began by mid-February. On 29 March, it was announced that, beginning the following day, all non-essential workers were ordered to remain at home for the next 14 days. The number of cases increased again in July in a number of cities including Barcelona
Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within c ...
, Zaragoza
Zaragoza, also known in English as Saragossa,''Encyclopædia Britannica'"Zaragoza (conventional Saragossa)" is the capital city of the Province of Zaragoza, Zaragoza Province and of the autonomous communities of Spain, autonomous community of Ara ...
and Madrid
Madrid ( , ) is the capital and most populous city of Spain. The city has almost 3.4 million inhabitants and a metropolitan area population of approximately 6.7 million. It is the second-largest city in the European Union (EU), and ...
, which led to reimposition of some restrictions but no national lockdown. By September 2021, Spain was one of the countries with the highest per centage of its population vaccinated (76% fully vaccinated and 79% with the first dose), while also being one of the countries more in favour of vaccines against COVID-19 (nearly 94% of its population were already vaccinated or wanted to be). However, as of 21 January 2022, this figure had only increased to 80.6%. Nevertheless, Spain leads Europe for per-capita full-vaccination rates. Italy is ranked second at 75%.
Sweden differed from most other European countries in that it mostly remained open. Per the Swedish Constitution, the Public Health Agency of Sweden has autonomy that prevents political interference and the agency favoured remaining open. The Swedish strategy focused on longer-term measures, based on the assumption that after lockdown the virus would resume spreading, with the same result. By the end of June, Sweden no longer had excess mortality
Excess may refer to:
* Angle excess, in spherical trigonometry
* Insurance excess, similar to a deductible
* Excess, in chemistry, a reagent that is not the limiting reagent
* "Excess", a song by Tricky from the album '' Blowback''
* ''Excess'' ( ...
.
Devolution in the United Kingdom
In the United Kingdom, devolution is the Parliament of the United Kingdom's statutory granting of a greater level of self-government to the Scottish Parliament, the Senedd (Welsh Parliament), the Northern Ireland Assembly and the London ...
meant that each of its four countries
A country is a distinct part of the world, such as a state (polity), state, nation, or other polity, political entity. It may be a sovereign state or make up one part of a larger state. For example, the country of Japan is an independent, so ...
developed its own response. England's restrictions were shorter-lived than the others. The UK government
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, image = HM Government logo.svg
, image_size = 220px
, image2 = Royal Coat of Arms of the United Kingdom (HM Government).svg
, image_size2 = 180px
, caption = Royal Arms
, date_est ...
started enforcing social distancing and quarantine measures on 18 March 2020. On 16 March, Prime Minister Boris Johnson
Alexander Boris de Pfeffel Johnson (; born 19 June 1964) is a British politician, writer and journalist who served as Prime Minister of the United Kingdom and Leader of the Conservative Party from 2019 to 2022. He previously served as ...
advised against non-essential travel and social contact, praising work from home
Remote work, also called work from home (WFH), work from anywhere, telework, remote job, mobile work, and distance work is an employment arrangement in which employees do not commute to a central place of work, such as an office building, ware ...
and avoiding venues such as pubs, restaurants, and theatres. On 20 March, the government ordered all leisure establishments to close, and promised to prevent unemployment. On 23 March, Johnson banned gatherings and restricted non-essential travel and outdoor activity. Unlike previous measures, these restrictions were enforceable by police through fines and dispersal of gatherings. Most non-essential businesses were ordered to close. On 24 April 2020, it was reported that a promising vaccine trial had begun in England; the government pledged more than £50 million towards research. On 16 April 2020, it was reported that the UK would have first access to the Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses would be available. On 2 December 2020, the UK became the first developed country to approve the Pfizer vaccine; 800,000 doses were immediately available for use. In August 2022 it was reported that viral infection cases had declined in the UK.
North America
The virus arrived in the United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
on 13 January 2020. Cases were reported in all North American countries after COVID-19 pandemic in Saint Kitts and Nevis, Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after COVID-19 pandemic in Bonaire, Bonaire confirmed a case on 16 April.
confirmed cases have been reported in the United States with deaths, the most of any country, and COVID-19 pandemic death rates by country, the nineteenth-highest per capita worldwide. COVID-19 is the List of disasters in the United States by death toll, deadliest pandemic in U.S. history; it was the third-leading cause of death in the U.S. in 2020, behind heart disease and cancer. From 2019 to 2020, U.S. life expectancy dropped by 3years for Hispanic Americans, 2.9years for African Americans, and 1.2years for white Americans. These effects have persisted as U.S. deaths due to COVID-19 in 2021 exceeded those in 2020. In the United States, COVID-19 vaccines became available in December 2020, under emergency use, beginning the COVID-19 vaccination in the United States, national vaccination program, with the first vaccine officially approved by the Food and Drug Administration on 23 August 2021. On 18 November 2022, while cases in the U.S. have declined, COVID variants BQ.1/BQ.1.1 have become dominant in the country.
In March 2020, as cases of community transmission were confirmed across COVID-19 pandemic in Canada, Canada, all of its provinces and territories declared states of emergency. Provinces and territories have, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. Cases surged across Canada, notably in the provinces of COVID-19 pandemic in British Columbia, British Columbia, COVID-19 pandemic in Alberta, Alberta, COVID-19 pandemic in Quebec, Quebec and COVID-19 pandemic in Ontario, Ontario, with the formation of the Atlantic Bubble, a Travel restrictions related to the COVID-19 pandemic, travel-restricted area of the country (formed of the four Atlantic Canada, Atlantic provinces). Vaccine passports were adopted in all provinces and two of the territories. Per a report on 11 November 2022, Canada is facing a surge in influenza, while COVID-19 is expected to rise during winter.
South America
The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo. By 3 April, all countries and territories in South America had recorded at least one case. On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of COVID-19 pandemic in Brazil, infections in Brazil, the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
WHO declared South America the epicentre of the pandemic. As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show.
The virus was confirmed to have spread to Brazil on 25 February 2020, when a man from São Paulo who had traveled to Italy tested positive for the virus. The disease had spread to every Federative units of Brazil, federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths. One estimate of Under-reporting#Disease, under-reporting was 22.62% of total reported COVID-19 mortality in 2020. As of , Brazil, with confirmed cases and deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only COVID-19 pandemic in the United States, those of the United States and COVID-19 pandemic in India, of India.
Africa
The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in COVID-19 pandemic in Egypt, Egypt. The first confirmed case in sub-Saharan Africa was announced in COVID-19 pandemic in Nigeria, Nigeria at the end of February 2020. Within three months, the virus had spread throughout the continent, as COVID-19 pandemic in Lesotho, Lesotho, the last African sovereign state to have remained free of the virus, reported a case on 13 May 2020. By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited. Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated. Many preventive measures National responses to the COVID-19 pandemic in Africa, have been implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations.
In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries. By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including COVID-19 pandemic in Malawi, Malawi and COVID-19 pandemic in Senegal, Senegal, recorded an uptick in new cases. The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'. In October 2022, it was reported by the World Health Organization that most countries on the African continent will miss the goal of 70 percent of their population being vaccinated by the end of 2022.
Oceania
The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne, COVID-19 pandemic in Australia, Australia. It has since spread elsewhere in the region. COVID-19 pandemic in Australia, Australia and COVID-19 pandemic in New Zealand, New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community.
As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria (Australia), Victoria had conceded defeat in their eradication efforts. In early October 2021, New Zealand also abandoned its elimination strategy. In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-zero to open up state and international borders. The open borders allowed the Omicron Variant of COVID-19 to enter quickly and cases subsequently exceeded 120,000 a day. By early March, with cases exceeding 1000 a day Western Australia conceded defeat in its eradication strategy and opened the borders after previously delaying the re-opening due to the omicron variant. Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing and density limits by April.
On 9 September restrictions were significantly relaxed. The mask mandate on aircraft was scrapped nationwide. 9 September was also the last day cases were reported daily in Australia as the country transitioned to weekly reporting instead. On 14 September, COVID-19 disaster payment for people who had to isolate due to COVID-19 was extended so long as isolating was mandated by the government. By 22 September all states had ended mask mandates on public transport including in Victoria where the mandate had lasted some 800 days. On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of the requirement for people to isolate from 14 October if they have COVID-19 due in part to high levels of 'hybrid immunity' and very low case numbers.
Antarctica
Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19 and was one of the last regions of the world affected directly by the pandemic. The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people are confirmed to have been infected.
Other responses
United Nations
In June 2020, the Secretary-General of the United Nations launched the UN Comprehensive Response to COVID-19. The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire, which aimed to open up humanitarian access to conflict zones.
WHO
The WHO spearheaded initiatives such as the COVID-19 Solidarity Response Fund to raise money for the pandemic response, the UN COVID-19 Supply Chain Task Force, and the solidarity trial for investigating potential treatment options for the disease. The COVAX program, co-led by the WHO, GAVI, and the Coalition for Epidemic Preparedness Innovations (CEPI), aimed to accelerate the development, manufacture, and distribution of COVID-19 vaccines, and to guarantee fair and equitable access across the world.
Protests against governmental measures
In several countries, protests rose against restrictions such as lockdowns. A February 2021 study found that protests against restrictions were likely to directly increase spread.
Restrictions
The pandemic shook the world's economy, with especially severe economic damage in the United States, Europe, and Latin America. A consensus report by American intelligence agencies in April 2021 concluded, "Efforts to contain and manage the virus have reinforced nationalist trends globally, as some states turned inward to protect their citizens and sometimes cast blame on marginalized groups." COVID-19 inflamed partisanship and polarisation around the world as bitter arguments exploded over how to respond. International trade was disrupted amid the formation of no-entry enclaves.
Travel restrictions
The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas, or for all travellers. Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world. One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures. Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late". The European Union rejected the idea of suspending the Schengen Agreement, Schengen free travel zone.
Repatriation of foreign citizens
Several countries repatriated their citizens and diplomatic staff from Wuhan and surroundings, primarily through Air charter, charter flights. Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany, and Thailand were among the first to do so. Brazil and New Zealand evacuated their own nationals and others. On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind. Pakistan declined to evacuate its citizens.
On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess outbreak, Diamond Princess cruise ship, and on 21 February, Canada evacuated 129 Canadians from the ship. In early March, the Indian government began repatriating its citizens from Iran. On 20 March, the United States began to withdraw some troops from Iraq.
Impact
Economics
The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008.
Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe (1979–2020), Flybe collapsed. The cruise line industry was hard hit, and train stations and ferry ports closed. International mail stopped or was delayed.
The retail sector faced reductions in store hours or closures. Retailers in Europe and Latin America faced traffic declines of 40 per cent. North America and Middle East retailers saw a 50–60 per cent drop. Shopping centres faced a 33–43 per cent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events.
Hundreds of millions of jobs were lost. including more than 40 million Americans. According to a report by Yelp, about 60% of US businesses that closed will stay shut permanently. The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 per cent, or $3.5 trillion.
Supply shortages
The outbreak was blamed for panic buying, emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust).
Shortage, Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain
In commerce, a supply chain is a network of facilities that procure raw materials, transform them into intermediate goods and then final products to customers through a distribution system. It refers to the network of organizations, people, activ ...
disruptions from factory and port shutdowns, and labour shortages.
Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products.
According to WHO's Adhanom, demand for personal protective equipment
Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, ...
(PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere.
In September 2021, the World Bank reported that food prices remain generally stable and the supply outlook remains positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021.
By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips.[US oil prices turn negative as demand dries up](_blank)
BBC, 21 April 2020. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia.
Culture
The performing arts and cultural heritage sectors have been profoundly affected by the pandemic, impacting organisations' operations as well as individualsboth employed and independentglobally. 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. A UNESCO report estimated ten million job losses worldwide in the culture and creative industries. Some services continued through digital platforms, such as live streaming concerts or web-based arts festivals.
Politics
The pandemic affected political systems, causing suspensions of legislative activities, isolations or deaths of politicians, and rescheduled elections. Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists.[''The Economist'', 4 April 2020, p. 14.]
On 23 March 2020, United Nations Secretary-General António Guterres, António Manuel de Oliveira Guterres appealed for a global ceasefire; 172 UN member states and observers signed a non-binding supporting statement in June, and the UN Security Council passed a United Nations Security Council Resolution 2532, resolution supporting it in July.
China
Multiple provincial-level administrators of the Chinese Communist Party were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary of the Communist Party, general secretary Xi Jinping. The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan, who was arrested and tortured.
Italy
In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte, Russian president Vladimir Putin ordered the Russian Armed Forces, Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and Ursula von der Leyen offered an official apology to the country.
United States
Beginning in mid-April 2020, protestors objected to government-imposed business closures and restricted personal movement and association.["Coronavirus: Anti-Lockdown Protests Grow Across US". BBC News. 17 April 2020]
Archived
from the original on 17 April 2020. Retrieved 17 April 2020. Simultaneously, essential workers protested in the form of a brief 2020 United States essential workers general strike, general strike. Some political analysts claimed that the pandemic contributed to President Donald Trump's 2020 United States presidential election, 2020 defeat.
The outbreak prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care, universal child care, paid sick leave, and higher levels of funding for public health. The Kaiser Family Foundation estimated the cost of preventable hospitalizations (of unvaccinated people) for COVID-19 in the United States between June and November 2021 at US$13.8 billion.
There were also protest in regards to vaccine mandates in the United States. One matter that was taken before the Supreme court which had to do with enforcing said mandates on private companies, resulted in OSHA losing the case.
Other countries
The number of journalists imprisoned or detained increased worldwide, with some related to the pandemic. The planned NATO "List of NATO exercises, Defender 2020" military exercise in Germany, Poland, and the Baltic states, the largest NATO war exercise since the end of the Cold War, was held on a reduced scale.
The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which launched a Saudi Arabian-led intervention in Yemen, military intervention in Yemen in March 2015, declared a ceasefire.
Japan–South Korea relations, Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response.
Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In the Philippines, lawmakers granted President Rodrigo Duterte temporary emergency powers. In Hungary, the parliament voted to allow prime minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt, Turkey, and Thailand, opposition activists and government critics were Misinformation related to the COVID-19 pandemic#Efforts to combat misinformation, arrested for allegedly spreading fake news. In India, journalists criticising the government's response were arrested or issued warnings by police and authorities.
Food systems
The pandemic disrupted food systems worldwide, hitting at a time when hunger and undernourishment were rising (an estimated 690 million people lacked food security in 2019). Food access fell – driven by falling incomes, lost remittances, and disruptions to food production. In some cases, food prices rose. The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. Per the World Health Organization, 811 million individuals were undernourished in 2020, "likely related to the fallout of COVID-19".
Education
The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education. Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion Learning, learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences. They shed light on social and economic issues, including student debt, digital learning, food insecurity, and homelessness, as well as access to Child care, childcare, health care, housing, internet, and Disability rights movement, disability services. The impact was more severe for disadvantaged children. The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic.
Health
The pandemic impacted global health for many other conditions. Hospital visits fell. Visits for heart attack symptoms declined by 38% in the US and 40% in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital."['Where are all our patients?': Covid phobia is keeping people with serious heart symptoms away from ERs](_blank)
''Stat News'', Usha Lee McFarling, 23 April 2020. People with strokes and appendicitis were less likely to seek treatment. Shortages related to the COVID-19 pandemic, Medical supply shortages impacted many people. The pandemic impacted mental health, increasing anxiety, depression, and post-traumatic stress disorder, affecting healthcare workers, patients and quarantined individuals.
In late 2022, during the first Northern Hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children. This formed the beginnings of the 2022 pediatric care crisis and what some experts have termed a "tripledemic" of seasonal influenza, Respiratory syncytial virus, Respiratory Syncytial Virus (RSV), and SARS-CoV-2 throughout North America. In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever. As of mid-December 2022, 19 children in the UK had died due to Streptococcus pyogenes, Strep A and the wave of infections had begun to spread into North America and Mainland Europe.
Environment
The pandemic and the reaction to it positively affected the Natural environment, environment and climate as a result of reduced human activity. During the "anthropause", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution. Economic impact of the COVID-19 pandemic#Transportation, Planned air travel and vehicle transportation declined. In China, COVID-19 lockdown in Hubei, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions. Earth system science, Earth systems scientist Marshall Burke estimated that two months of pollution reduction likely saved the lives of 53,000 to 77,000 Chinese residents.
A List of animals that can get SARS-CoV-2, wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering particularly fatal outcomes. In particular, both SARS-CoV-2 in mink, farmed and wild mink have developed symptomatic COVID-19 infections, leading to a 35–55% mortality rate in one study. Other animals, such as SARS-CoV-2 in white-tailed deer, white-tailed deer, have not exhibited as high mortality numbers but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa's wild deer herd.
Discrimination and prejudice
Heightened prejudice, xenophobia, and racism Sinophobe, toward people of Chinese and East Asian descent were documented around the world. Reports from February 2020 (when most confirmed cases were confined to China) cited racist sentiments about Chinese people 'deserving' the virus. Chinese people and other Asian peoples in the United Kingdom and United States reported increasing levels of abuse and assaults. Former US President Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", which others condemned as racist and xenophobic.
Age-based discrimination against older adults increased. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness.
Correspondence published in ''The Lancet'' on 20 November 2021, suggested the "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting vaccinated individuals' high rates of infection, high viral loads, and therefore their relevant role in transmission.
In January 2022, Amnesty International urged Italy
Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...
to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport.
Lifestyle changes
The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the job market. Online retailers in the US posted US$791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion from the year before. Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales. Hackers, cybercriminals, and scammers took advantage of the changes to launch new attacks. Education in some countries temporarily shifted from physical attendance to video conferencing. Massive layoffs shrank the airline, travel, hospitality, and other industries. Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst (nonprofit organization), Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine".
Historiography
A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine.
Religion
According to the Pew Research Center, amid the COVID-19 pandemic some religious groups defied public health measures and stated "the rules [during COVID-19] were a violation of religious freedom".
Information dissemination
Some news organizations removed their online paywalls for some or all of their pandemic-related articles and posts. Some scientific publishers made pandemic-related papers available with open access. The share of papers published on preprint servers prior to peer review increased dramatically. Research is indexed and searchable in the NIH COVID-19 Portfolio.
Misinformation
Misinformation and conspiracy theory, conspiracy theories about the pandemic are widespread. They travelled through mass media
Mass media refers to a diverse array of media technologies that reach a large audience via mass communication. The technologies through which this communication takes place include a variety of outlets.
Broadcast media transmit informati ...
, Impact of the COVID-19 pandemic on social media#Misinformation, social media, and text messaging. WHO declared an "infodemic" of incorrect information. Cognitive biases, such as jumping to conclusions and confirmation bias, were linked to Conspiracy theory, conspiracy beliefs, including COVID-19 vaccine hesitancy.
Transition to endemic phase
In June 2022, an article in ''Human Genome Organisation, Human Genomics'' said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase. The latter will require worldwide vigilance and cooperation, especially in emerging countries", and suggested that developed countries should assist in boosting vaccination rates worldwide.
As of 4 November 2022, health officials in some countries have said that COVID-19 is endemic or that the country was beginning to transition to an endemic phase. These include Cambodia, Indonesia, Lebanon, Malaysia, Mexico, Philippines, Singapore, South Korea, Spain and Vietnam.
On 3 December 2022, Tedros Adhanom Ghebreyesus, WHO Director-General indicated, "We are much closer to being able to say that the emergency phase of the pandemic is over".
Culture and society
The COVID-19 pandemic has been depicted in a variety of digital mediums in popular culture:
Films
* ''South Park: Post Covid,'' a 2021 animated comedy film depicting the main characters of ''South Park'' forty years after the COVID-19 pandemic broke out.
* ''Songbird (2020 film), Songbird'', 2020 science-fiction thriller film inspired by the COVID-19 pandemic, with an exaggerated twist of COVID-19 mutating into COVID-23 in 2024.
* ''Gotta Get Some Tissue!'', a 2021 animated short film and music video influenced by the COVID-19 pandemic.
Television
* The Grey's Anatomy (season 17), seventeenth season of ''Grey's Anatomy'', a 2005 series about the life of Dr. Meredith Grey and other doctors; this season focuses on the life during and after the COVID-19 pandemic.
* The sixth season of ''Queen Sugar'', a 2016 drama series focusing on a pair of siblings who are forced to cope with their new life of taking over the sugarcane farm after a loved one's death; in this season, the story is predominantly about the COVID-19 pandemic and some of the characters catching the virus, such as Charley.
* ''Social Distance (TV series), Social Distance'', a 2020 television series focusing on individuals who are forced to cope with the COVID-19 pandemic, the effects of quarantine, and the subsequent George Floyd protests.
See also
* Emerging infectious disease
* Globalization and disease
* List of epidemics
* Coronavirus diseases
Notes
References
Further reading
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External links
Health agencies
COVID-19
Questions & Answers
instructional videos
Facts/MythBusters
by the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
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COVID-19
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Q&A
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COVID-19
Q&A
by the Ministry of Health (Singapore), Ministry of Health, Singapore
COVID-19
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Data and graphs
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map
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historical data
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COVID-19 data sets
published by the European Centre for Disease Prevention and Control (ECDC)
COVID-19 Observer
based on Johns Hopkins University
Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hemisphere. It consi ...
data
COVID-19 Statistics and Research
published by Our World in Data
COVID-19 Tracker
from Stat (website), Stat News
COVID-19 Projections
for many countries published by Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is a research institute working in the area of global health statistics and impact evaluation at the University of Washington in Seattle. The Institute is headed by Christopher J.L. Murray ...
Medical journals
Coronavirus (COVID-19)
by ''The New England Journal of Medicine''
Coronavirus (COVID-19) Hub
by BMJ (company), BMJ Publishing Group
Coronavirus Disease 2019 (COVID-19)
by ''JAMA (journal), JAMA: The Journal of the American Medical Association''
COVID-19: Novel Coronavirus Outbreak
by Wiley (publisher), Wiley Publishing
COVID-19 pandemic (2019–20) Collection
by Public Library of Science (PLOS)
COVID-19 Portfolio
a curated collection of publications and preprints by National Institutes of Health (NIH)
COVID-19 Research Highlights
by Springer Nature
COVID-19 Resource Centre
by ''The Lancet''
Novel Coronavirus Information Center
by Elsevier
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