On December 31, 2019, the World Health Organisation’s (WHO) China office heard the first reports of a previously-unknown virus behind a number of pneumonia cases in Wuhan, a city in Eastern China with a population of over 11 million.
What started as an epidemic mainly limited to China has now become a truly global pandemic. There have now been over 343,421 confirmed cases and 14,790 deaths, according the John Hopkins University Covid-19 dashboard, which collates information from national and international health authorities. The disease has been detected in more 150 countries and territories, with Italy, the US and Spain experiencing the most widespread outbreaks outside of China. In the UK, there have been 5,683 confirmed cases and 281 deaths as of March 20.
The Chinese government responded to the initial outbreak by placing Wuhan and nearby cities under a de-facto quarantine encompassing roughly 50 million people in Hubei province. This quarantine is now slowly being lifted, as authorities watch to see whether cases will rise again. In Italy, which is experiencing the largest outbreak outside of China, the government took the unprecedented step of extending a lockdown to the entire country, shutting cinemas, theatres, gyms, discos and pubs and banning funerals and weddings. In the UK, the government has shut pubs, restaurants, bars and cafés, advised people to avoid all unnecessary social interaction or travel and directed households in which one person falls ill with coronavirus symptoms to quarantine themselves for 14 days.
On March 11 the WHO officially declared that the Covid-19 outbreak is a pandemic. "WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction," said its director-general Tedros Adhanom Ghebreyesus. Although the WHO designated Covid-19 a "public health emergency of international concern" (PHEIC) on January 30, it had been reluctant to call it a pandemic. "Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death," Adhanom said.
A quick note on naming. Although popularly referred to as coronavirus, on February 11, the WHO announced the official name of the disease: Covid-19. The virus that causes that disease is likely to be called Severe Acute Respiratory Syndrome Coronavirus 2, or Sars-CoV-2 for short, according to a draft paper from the International Committee on the Taxonomy of Viruses.
How did Covid-19 start?
The disease appears to have originated from a Wuhan seafood market where wild animals, including marmots, birds, rabbits, bats and snakes, are traded illegally. Coronaviruses are known to jump from animals to humans, so it’s thought that the first people infected with the disease – a group primarily made up of stallholders from the seafood market – contracted it from contact with animals.
Although an initial analysis of the virus that causes Covid-19 suggested it was similar to viruses seen in snakes, the hunt for the animal source of Covid-19 is still on. A team of virologists at the Wuhan Institute for Virology released a detailed papershowing that the new coronaviruses' genetic makeup is 96 per cent identical to that of a coronavirus found in bats, while an as-yet unpublished study argues that genetic sequences of coronavirus in pangolins are 99 per cent similar to the human virus. Some early cases of Covid-19, however, appear to have inflicted people with no link to the Wuhan market at all, suggesting that the initial route of human infection may pre-date the market cases.
The Wuhan market was shut down for inspection and cleaning on January 1, but by then it appears that Covid-19 was already starting to spread beyond the market itself. On January 21, the WHO Western Pacific office said the disease was also being transmitted between humans – evidence of which is apparent after medical staff became infected with the virus. Since then, evidence of widespread human-to-human transmission outside of China has been well established, making chances of containing the virus much harder.
What exactly is Covid-19?
Coronaviruses are a large group of viruses that are known to infect both humans and animals, and in humans cause respiratory illness that range from common colds to much more serious infections. The most well-known case of a coronavirus epidemic was Severe Acute Respiratory Syndrome (Sars), which, after first being detected in southern China in 2002, went on to affect 26 countries and resulted in more than 8,000 cases and 774 deaths.
While the cause of the current outbreak was initially unknown, on January 7 Chinese health authorities identified that it was caused by to a strain of coronavirus that hadn’t been encountered in humans before. Five days later the Chinese government shared the genetic sequence of the virus so that other countries could develop their own diagnostic kits. That virus is now called Sars-CoV-2.
Although symptoms of coronavirusesare often mild – the most common symptoms are a fever and dry cough – in some cases they lead to more serious respiratory tract illness including pneumonia and bronchitis. These can be particularly dangerous in older patients, or people who have existing health conditions, and this appears to be the case with Covid-19. A study of 44,415 early Chinese Covid-19 patients found that 81 per cent of people with confirmed infections experienced only mild symptoms. Of the remaining cases, 14 per cent were in a severe condition while five per cent of people were critical cases, suffering from respiratory failure, septic shock or multiple organ failure. In the Chinese study, 2.3 per cent of all confirmed cases died, although the actual death rate is probably much lower as many more people will have been infected with the virus than tested positive.
How far has it spread?
China has borne the brunt of Covid-19 infections (so far). As of March 11, Chinese health authorities had acknowledged over 81,250 cases and 3,253 deaths – most of them within the province of Hubei. On March 17, China recorded just 39 new cases of the virus – a remarkable slowdown for a country which, at the peak of its outbreak in mid-February, saw more than 5,000 cases in a single day.
But while things were slowing down in China, the outbreak started picking up in the rest of the world. There are now confirmed cases in at least 150 countries and territories. Outside of China, Italy has seen the highest number of cases, with 59,138 confirmed infections, mostly in the north of the country, and 5,476 deaths – more than in China. The entire country is now on lockdown after the quarantine covering the north of the country was extended on March 9.
Spain is also in the grip of a significant outbreak. The country has 29,909 confirmed infections and 1,813 deaths – the second-highest number within Europe. There, citizens are under lockdown, with the government shutting all schools, bars, restaurants and non-essential supermarkets down. People are only allowed to leave their homes to buy food or to go to work. Germany has 26,159 cases and 106 deaths, with the state of Bavaria implementing a full lockdown.
Iran, too, is seeing a surge in cases. The country has confirmed at least 1,685 deaths and 21,638 cases. Many cases are linked to Qom, a major Shiite religious centre and a city with more than one million residents. In the US, there have been more than 35,224 cases and 417 deaths, with Illinois, New York and California all ordering citizens not to leave their homes unless absolutely necessary.
While the number of new cases continues to rise sharply, people are also recovering from the infection. Globally, 84,960 people have recovered from Covid-19 – about 29 per cent of all of the people who had confirmed infections, although the true number of coronavirus cases will be much higher.
What are the symptoms of Covid-19?
Covid-19 shares many of its symptoms with the flu or common cold, although there are certain symptoms common to flu and colds that are not usually seen in Covid-19. People with confirmed cases of Covid-19 rarely suffer from a runny nose, for instance.
The most common Covid-19 symptoms are a fever and a dry cough. Of 55,924 early Chinese cases of the disease, nearly 90 per cent of patients experienced a fever and just over two-thirds suffered with a dry cough. That’s why the UK government is advising anyone with a high temperature or a new, continuous cough to stay at home for seven days or, if they live with other people, for the entire household to isolate for 14 days from the first onset of symptoms.
Other Covid-19 symptoms are less common. Just under 40 per cent of people with the disease experience fatigue, while a third of people cough up sputum – a thick mucus from within the lungs. Other rarer symptoms include shortness of breath, muscle pain, sore throats, headaches or chills. According to the WHO, symptoms tend to appear between five and six days after infection.
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