201920 coronavirus pandemic – Wikipedia

The 201920 coronavirus pandemic is an ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[3] The outbreak was first identified in Wuhan, Hubei, China, in December 2019 and recognised as a pandemic by the World Health Organization (WHO) on 11 March 2020.[4] As of 16 March, more than 183,000 cases of the disease have been reported in over 160 countries and territories, resulting in more than 7,100 deaths and around 79,000 recoveries.[2] Regions affected by major outbreaks include mainland China, Europe, Iran, South Korea, and the United States.[2] On 13 March, the WHO stated that Europe had become the new epicentre of the pandemic.[5]

The virus primarily spreads between people in a similar manner to influenza, via respiratory droplets from coughing or exhaling.[6][7][8] People are thought to be most contagious when symptomatic, though some spread might be possible before symptoms show.[9][10] The time between exposure and symptom onset is typically five days, but may range from two to fourteen days.[8][11] Common symptoms include fever, cough and shortness of breath.[8][11] Complications may include pneumonia and acute respiratory distress syndrome. Currently, there is no vaccine or specific antiviral treatment, but research is ongoing. Efforts are aimed at managing symptoms and supportive therapy. Recommended preventive measures include handwashing, covering the mouth when coughing, maintaining distance from other people (particularly those who are unwell), and monitoring and self-isolation for fourteen days for people who suspect they are infected.[7][8][12]

Efforts to prevent spread have included travel restrictions, quarantines, curfews, event postponements and cancellations, and facility closures. These include a quarantine of Hubei, the nationwide quarantines of Italy, Spain, the Czech Republic, and Germany,[13] curfew measures in China and South Korea,[14][15][16] various border closures or incoming passenger restrictions,[17][18] screening methods at airports and train stations,[19] and travel advisories regarding regions with community spread.[20][21][22][23]Schools and universities have closed either on a nationwide or local basis in at least 61 countries, affecting around 600million students.[24]

Effects of the pandemic include social and economic instability,[25]xenophobia and racism against Chinese and East Asian people, closure of religious institutions, cancelling or postponing of sporting and cultural events,[26] as well as the online spread of misinformation and conspiracy theories about the virus.[27][28][29]

On 31 December 2019, a cluster of pneumonia cases of unknown cause was reported by health authorities in Wuhan, the capital of Hubei province, China,[149] and an investigation was launched in early January 2020.[150] These cases mostly had links to the Huanan Seafood Wholesale Market, which also sold live animals; consequently, the virus is thought to have a zoonotic origin.[151] The virus that caused the outbreak is known as SARS-CoV-2, a new virus closely related to bat coronaviruses,[152]pangolin coronaviruses[153] and SARS-CoV.[154] It is believed that the virus possibly originated in horseshoe bats (genus Rhinolophus).[155]

The earliest person with symptoms was traced back to 1 December 2019, someone who did not have connections with the later cluster linked to the wet market.[156][157] Of the early cluster of cases reported in December 2019, two-thirds were found to have a link with the market.[1][158][159] On 14 March 2020, an unverified report from the South China Morning Post said that a 55-year-old from Hubei province could have been the first person who contracted the disease on 17 November.[160][161]

On 26 February 2020, the WHO reported that, as new cases reportedly dropped in China but suddenly increased in Italy, Iran, and South Korea, the number of new cases outside China had exceeded the number of new cases in China for the first time.[162]

There may be substantial underreporting of cases, particularly among those with milder symptoms.[163][164] Reported numbers may also reflect local decisions on whom and when to test. As an example, on 13 March 2020, the UK reported 798 confirmed cases, but health officials estimated the actual number of people infected was probably between 5,000 and 10,000.[165]

As of 26 February, "very few" cases have been reported among youth.[11] A report from the WHO noted that those 19 and under made up just 2.4 percent of cases worldwide.[166]

WHO has recognised that it is the first known pandemic that can be controlled in at least several world regions.[4]

Among those who died from the disease, the time from development of symptoms to death was between 6 and 41 days, with a median of 14 days.[11]

As of 16March2020[update], more than 7,100 deaths have been attributed to COVID-19.[2] According to China's NHC, most of those who died were elderly about 80% of deaths were in those over 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes.[167]

The first confirmed death was on 9 January 2020 in Wuhan.[168] The first death outside China occurred on 1 February in the Philippines,[169][170] and the first death outside Asia was in France.[171] By 28 February, outside mainland China, more than a dozen deaths were recorded in each of Iran, South Korea and Italy.[172][173][174] By 13 March, over 40 countries and territories had reported deaths, on every continent (except Antarctica).[175]

Growth in total confirmed cases

Semi-log plot of daily new confirmed cases by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world total[176][177]

Semi-log plot of coronavirus daily deaths by region: Hubei Province, mainland China excluding Hubei, the rest of the world (ROW), and the world total[176][177]

Case fatality rates by age group in China. Data through 11 February 2020.[178]

The severity of diagnosed COVID-19 cases in China[179]

Symptoms of COVID-19 are non-specific and those infected may either be asymptomatic or develop flu like symptoms such as fever, cough, fatigue, shortness of breath, or muscle pain. The typical signs and symptoms and their prevalence, are shown in the corresponding table.[180]

Further development can lead to severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock and death. Some of those infected may be asymptomatic, returning test results that confirm infection but show no clinical symptoms, so researchers have issued advice that those with close contact to confirmed infected people should be closely monitored and examined to rule out infection.[1][181][182][183]

The usual incubation period (the time between infection and symptom onset) ranges from one to fourteen days; it is most commonly five days.[184][185] In one case, it had an incubation period of 27 days.[186]

The primary mode of transmission is via respiratory droplets that people exhale, for example when coughing or sneezing.[6][187][188] Droplets stay suspended in the air for only a short time but may stay viable and contagious on a metal, glass or plastic surface.[189] Details for the virus are not available as of 26February2020[update], and it is assumed that they are similar to other coronaviruses, which survive for up to nine days at room temperature.[190]Disinfection of surfaces is possible with substances such as 6271% ethanol, 50100% isopropanol, 0.2% sodium hypochlorite, 0.5% hydrogen peroxide, and 0.27.5% povidone-iodine, applied for one minute; benzalkonium chloride and chlorhexidine gluconate are less effective.[190]

The WHO has stated that the risk of spread from someone without symptoms is "very low". However, if someone has beginning symptoms and a mild cough, there is a risk of transmission.[191]

There have been estimates for the basic reproduction number (the average number of people an infected person is likely to infect), ranging from 2.13[192] to 4.82.[193][194] This is similar to severe acute respiratory syndrome-related coronavirus (SARS-CoV).[195]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[154]

SARS-CoV-2 is closely related to the original SARS-CoV.[196] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[180][197] In February 2020, Chinese researchers found that there is only one amino acid difference in certain genome sequences between the viruses found in pangolins and those from humans, implying that pangolins may have been an intermediate host.[198]

Infection by the virus can be provisionally diagnosed on the basis of symptoms, though confirmation is ultimately by reverse transcription polymerase chain reaction (rRT-PCR) of infected secretions (71% sensitivity) and CT imaging (98% sensitivity).[199]

The WHO has published several RNA testing protocols for SARS-CoV-2, with the first issued on 17 January.[200][201][202][203] Testing uses real-time reverse transcription polymerase chain reaction (rRT-PCR).[204] The test can be done on respiratory or blood samples.[205] Results are generally available within a few hours to days.[206][207]

A person is considered at risk if they have travelled to an area with ongoing community transmission within the previous 14 days, or have had close contact with an infected person. Common key indicators include fever, coughing and shortness of breath. Other possible indicators include fatigue, myalgia, anorexia, sputum production and sore throat.[208]

Characteristic imaging features on radiographs and computed tomography have been described in a limited case series.[209] The Italian Radiological Society is compiling an international online database of imaging findings for confirmed cases.[210] However, due to overlap with other infections such as adenovirus, imaging without confirmation by PCR is of limited use in identifying COVID-19.[209]

Strategies for preventing transmission of the disease include overall good personal hygiene, hand washing, avoiding touching the eyes, nose or mouth with unwashed hands, coughing/sneezing into a tissue and putting the tissue directly into a dustbin and (for those who may already have the infection) wearing a surgical mask in public.[211][212][213]Social distancing measures are also recommended to prevent transmission.[214][215]

Many governments advise against all non-essential travel to countries and areas affected by the outbreak.[216] China has banned the trading and consumption of wild animals.[217]

Health care providers taking care of someone who may be infected are recommended to use standard precautions, contact precautions and airborne precautions with eye protection.[218]

Contact tracing is an important method for health authorities to determine the source of an infection and to prevent further transmission.[219] Misconceptions are circulating about how to prevent infection, for example: rinsing the nose and gargling with mouthwash are not effective.[220]

As of 13 March 2020, there is no COVID-19 vaccine though a number of organizations are working to develop one.[221]

Handwashing is recommended to prevent the spread of the disease. The US Centers for Disease Control and Prevention (CDC) recommends that people wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. It further recommended using an alcohol-based hand sanitiser with at least 60% alcohol by volume when soap and water are not readily available.[211] The WHO also advises people to avoid touching the eyes, nose, or mouth with unwashed hands.[212][222]

Health organisations recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing (the tissue should then be disposed of immediately).[212][223]

The use of surgical masks by those who may be infected has been recommended,[224][225][226] as they can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing and coughing.[227] The WHO has issued instructions on when and how to use masks.[228]

Masks have also been recommended for use by those taking care of someone who may have the disease.[226] Masks are not recommended for most people. There is limited evidence that the wearing of surgical masks by uninfected people at low risk is effective,[226] although they may help people avoid touching their face. Surgical masks are the lowest grade of protection, and are designed mainly to protect others from the wearer. Masks designed to protect the wearer are technically "respirators", though calling them "masks" is common. Only China has specifically recommended the use of masks by healthy members of the public.[176][227][229] Nevertheless, face masks have been widely used by healthy people in Hong Kong,[230] Japan,[231] Malaysia,[232] and Singapore.[233][234]

Social distancing includes infection control actions intended to slow the spread of disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may also apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, not shaking hands, and physically distancing themselves from others.[235][236][237] Many governments are now mandating or recommending social distancing in regions affected by the outbreak.[238][239][240]

Older adults and those with serious chronic conditions face increased risk of serious illness and complications and have been advised by the US CDC to avoid crowds and stay home as much as possible in areas of community outbreak.[241]

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected.[242]

It is presumed that the virus has reached the stage of community spread in large parts of the world. This means that the virus is spreading within communities whose members have not travelled to areas with widespread transmission. Government health agencies recommend that individuals self-isolate if they develop a continuous cough or a high-temperature fever. The self-isolation period should last for at least 14 days but preferably longer.[243]Additionally, individuals who have recently travelled to a country with widespread transmission or who have been in direct contact with someone diagnosed with COVID-19 have also been asked by some government health agencies to self-quarantine or practise social distancing for 14 days from the time of last possible exposure.[7][8][244]

The National Health Services has recommended that those self-quarantining at home stay two meters away from others within the household. Individuals undergoing self-quarantine should avoid contact with the elderly and chronically ill. People that self-quarantine should regularly wash their hands so that they don't spread the disease to others in the house or onto surfaces and objects that others will touch. As long as symptoms don't significantly worsen health services shouldn't be contacted.[242]

There are two basic strategies in the control of an outbreak: containment and mitigation. Containment is done in the early stages of the outbreak, and aims to trace and isolate those infected to stop the disease from spreading to the rest of the population. When it is no longer possible to contain the spread of the disease, efforts then move to the mitigation stage, when measures are taken to slow the spread and mitigate its effects on the health care system and society. A combination of both containment and mitigation measures may be undertaken at the same time.[247]

Part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as flattening the epidemic curve.[245] This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed.[245] Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures, such as hand hygiene, wearing face-masks and self-quarantine; community measures aimed at social distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning.

More drastic actions were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities affecting 60 million individuals in Hubei, and strict travel bans.[249] Other countries adopted a variety of measures aimed at limiting the spread of the virus. For example, South Korea introduced mass screening, localised quarantines, and issuing alerts on the movements of affected individuals. Singapore provided financial support for those infected who quarantine themselves and imposed large fines for those who failed to do so. Taiwan increased face-mask production, and penalised hoarding of medical supplies.[250] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.[251]

There are no specific antiviral medications, but development efforts are underway. Attempts to relieve the symptoms may include taking regular (over-the-counter) cold medications,[252] drinking fluids, and resting.[211] Depending on the severity, oxygen therapy, intravenous fluids and breathing support may be required.[253] The use of steroids may worsen outcomes.[254] Several compounds, which were previously approved for treatment of other viral diseases, such as favipiravir, ribavirin, remdesivir,[255] and galidesivir, are being investigated.[256][257]

The first known case of the novel coronavirus was traced back to 1 December 2019 in Wuhan, Hubei, China.[156] A later unconfirmed claim, citing Chinese government documents, suggests that the first victim was a 55-year-old man who fell ill on 17 November 2019.[258][under discussion] Within the next month, the number of coronavirus cases in Hubei gradually increased to a couple hundred, before rapidly increasing in January 2020. On 31 December 2019, the virus had caused enough cases of unknown pneumonia to be reported to health authorities in Wuhan, the capital of Hubei province, China,[149] and an investigation into the illness began early in the following month.[150] These were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals, consequently the virus is thought to have a zoonotic origin.[151]

During the early stages, the number of cases doubled approximately every seven and a half days.[259] In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration, with Wuhan being a transport hub and major rail interchange in China; infected people quickly spread throughout the country.[180] On 20 January, China reported nearly 140 new cases in a day, including two people in Beijing and one in Shenzhen.[260] Later official data shows that 6,174 people had already developed symptoms by 20 January 2020.[261]

On 30 January, the WHO declared the outbreak to be a Public Health Emergency of International Concern.[262] Its director, Tedros Adhanom, has maintained his praise of China's response to the virus as of 24 February "to avoid a significant number of cases", despite the disease's potential to have sustained community transmission in other world regions.[263]

On 13 March, the WHO declared Europe to be the new centre of the pandemic, after the rate of new cases in Europe surpassed those recorded in other regions of the world apart from China.[264] By 16 March 2020, the total number of cases reported around the world outside China had exceeded that of Mainland China.[265] As of 16March2020[update], over 183,000 cases have been reported worldwide; more than 7,100 people have died; and over 79,000 have recovered.[2] There is thought to be a substantial underreporting of cases, particularly of cases with milder symptoms or no symptoms.[266][267]

As of 29 February, apart from mainland China, the epidemic had spread to several other countries around the world, with the most affected being South Korea, Italy and Iran. National response measures have included containment measures such as quarantines and curfews.[268]

The first person known to have fallen ill due to the new virus was in Wuhan on 1 December 2019.[156] A public notice on the outbreak was released on 31 December.[269] WHO was informed of the outbreak on the same day.[149] In late December, a group of eight medical personnel posted warnings but were warned by Wuhan police for "spreading rumours" for likening the virus to SARS.[270][271] By 7 January, the Chinese Government were discussing prevention and control of COVID-19.[272][273] In the early stages of the outbreak, Chinese National Health Commission said that they had no "clear evidence" of human-to-human transmissions.[274]

The Chinese Communist Party launched an aggressive campaign described by the Party general secretary Xi Jinping as a "people's war" to contain the spread of the virus.[275] In what has been described as "the largest quarantine in human history",[276] a quarantine was announced on 23 January stopping travel in and out of Wuhan,[277] which was extended to a total of 15 cities in Hubei.[278] Private vehicle use was banned in the city.[279]Chinese New Year (25 January) celebrations were cancelled in many places.[280] The authority announced the construction a temporary hospital Huoshenshan Hospital, which was completed in 10 days, and 14 temporary hospitals were constructed in China in total.[281]

On 26 January, the Communist Party and the government instituted further measures to contain the COVID-19 outbreak, including health declarations for travellers and changes to national holidays.[282] The leading group decided to extend the Spring Festival holiday to contain the outbreak.[283] Universities and schools around the country were also closed.[284][285][286] The regions of Hong Kong and Macau instituted several measures, particularly in regard to schools and universities.[287] Remote working measures were instituted in several Chinese regions.[288] Various travel restrictions were enacted.[288][289] Other provinces and cities outside Hubei imposed travel restrictions. Public transport was modified,[290][288] and museums throughout China were temporarily closed.[291][292]

After the outbreak entered its global phase in March, many Chinese students studying in Europe and the United States have returned home as the domestic daily new cases in China declined. Chinese authorities has taken strict measures to prevent the virus from "importing" from other countries. For example, Beijing has imposed a 14-day mandatory quarantine for all international travellers entering the city.[293]

The early response by the Wuhan authorities was criticised as prioritising a control of information that might be unfavorable for local officials over public safety, and the Chinese government was also criticised for cover-ups and downplaying the initial discovery and severity of the outbreak.[294]Whistleblowing from various Chinese doctors, including Li Wenliang on 30 December revealed that Wuhan hospital authorities were already aware that the virus was a SARS-like coronavirus and patients were already placed under quarantine.[295] However, news of the outbreak was dismissed as "rumor mongering" by the Wuhan Public Security Bureau.[296][297] By the time China had informed the WHO of the new coronavirus on 31 December, The New York Times reported that the government was still keeping "its own citizens in the dark".[298][299] Observers have also blamed the institutional censorship structure of the country's press that left senior officials with inaccurate information on the outbreak and "contributed to a prolonged period of inaction that allowed the virus to spread".[298][299] Some experts doubted the accuracy of the number of cases reported by the Chinese government, which repeatedly changed how it counted coronavirus cases.[300][301][302] The Chinese government has also been accused of rejecting help from the CDC and the WHO.[303]

Although criticisms have been levelled at the aggressive response of China to the virus,[304] China's actions have also been praised by some foreign leaders such as U.S. President Trump, German Chancellor Angela Merkel[305] and Russian president Vladimir Putin.[306][307] The director of WHO Tedros Adhanom Ghebreyesus congratulated Chinese government "for the extraordinary measures it has taken to contain the outbreak",[308] and a later WHO report described China's response as "perhaps the most ambitious, agile and aggressive disease containment effort in history".[309] According to a media report on 16 March, the economy in China was very hard-hit in the first two months of 2020 due to the measures taken by the government to curtail virus spread, and retail sales plunged 20.5%[310]

The outbreak was confirmed to have spread to Italy on 31 January, when two Chinese tourists tested positive for SARS-CoV-2 in Rome.[311] In response, the Italian government suspended all flights to and from China and declared a state of emergency.[312] On 31 January, the Italian Council of Ministers appointed Angelo Borrelli, head of the Civil Protection, as Special Commissioner for the COVID-19 Emergency.[313][314] An unassociated cluster of COVID-19 cases was later further detected starting with 16 confirmed cases in Lombardy on 21 February.[315]

On 22 February, the Council of Ministers announced a new decree-law to contain the outbreak, including quarantining more than 50,000 people from 11 different municipalities in northern Italy.[316] Prime Minister Giuseppe Conte said "In the outbreak areas, entry and exit will not be provided. Suspension of work activities and sports events has already been ordered in those areas."[317][318]

On 4 March, the Italian government ordered the full closure of all schools and universities nationwide as Italy reached 100 deaths. All major sporting events, including Serie A football matches, will be held behind closed doors until April.[319] On 9 March, all sport was suspended completely for at least one month.[320] On 11 March, Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and pharmacies.[321][322]

On 6 March, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published medical ethics recommendations regarding triage protocols that might be employed.[323][324][325] As of 16March2020[update], there were 27,980 confirmed cases, 2,158 deaths and 2,729 recoveries in Italy.[326] On 16 March it was reported that in the last 24 hours 368 people have died of the virus. After China it is the worst hit country by the coronavirus.[327]

South Korea confirmed its first case on 20 January. There was a large increase in cases on 20 February,[328] potentially attributable to a gathering in Daegu of a new religious movement known as the Shincheonji Church of Jesus.[328][329][330]

A hospital was suspected by some as propagating the outbreak.[331][332] As of 22 February, among 9,336 followers of the church, 1,261 reported symptoms.[333] A petition was circulated requesting the church's disbandment.[334] On 28 February, over 2,000 confirmed cases were reported,[335] rising to 3,150 on 29 February.[336]

All South Korean military bases were on quarantine after tests confirmed that three soldiers were indeed positive for the virus.[331] Airline schedules were also affected and therefore they were changed.[337][338]

More than 1.5million South Koreans have signed a petition to impeach President Moon Jae-in over what they claim is the government's mishandling of the outbreak.[339]On 13 March, it was reported that South Korea is using a drive-thru method for testing for the virus. The test takes 10 minutes to do, and the results are available the next day.[340]

North Korea closed its border with China in January. The North Korean government officially denied to the WHO that they had any cases, but South Korean sources estimate at least 180 to 200 deaths among the army alone, not counting those among the civilian population. There is no estimate of those merely infected.[341]

Iran reported its first confirmed cases of SARS-CoV-2 infections on 19 February in Qom, where according to the Ministry of Health and Medical Education, two people had died later that day.[342][343] Early measures announced by the government included the cancellation of concerts and other cultural events,[344] sporting events,[345] and Friday prayers,[346] closure of universities, higher education institutions and schools,[347] and allocated 5trillion rials to combat the virus.[348] President Hassan Rouhani said on 26 February 2020 that there were no plans to quarantine areas affected by the outbreak, and only individuals would be quarantined.[349]Shia shrines in Qom remained open to pilgrims.[350]

Iran became a centre of the spread of the virus after China.[351][352] Amidst claims of a cover-up of the extent of the outbreak in the country,[353] over ten countries have traced their cases back to Iran by 28 February, indicating that the extent of the outbreak may be more severe than the 388 cases reported by the Iranian government by that date.[352][354] The Iranian Parliament was shut down, with 23 of the 290 members of parliament reported to have had tested positive for the virus on 3 March.[355] A number of senior government officials as well as two members of parliament have died from the disease.[356] On 15 March, the Iranian government reported 100 deaths in a single day, the most ever recorded in such a time period.[357]

On 31 January, the Trump administration limited entry into the United States, as immigrants or non-immigrants, of all aliens who were physically present within the People's Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States.[358]

In the Pacific Northwest state of Washington, the first death in the United States was reported on 29 February, after an outbreak at a Life Care Centers of America elderly care in Kirkland, Washington,[359] following which Washington governor Jay Inslee declared a state of emergency.[360] Florida and California also declared a state of emergency in early March.[361][362][363] Over a dozen schools in the Seattle area cancelled classes on 3 March, for disinfection and other precautionary measures.[364] On 6 March, the University of Washington cancelled in-person classes; the Seattle-based university is home to 50,000 students.[365] Multiple public and private schools outside New York City have closed.[366] All schools within the Elk Grove Unified School District in the Sacramento, California, area shut down on 7 March, after a case of the virus appeared in Elk Grove.[367]

Major US corporations, including Amazon, Facebook, Twitter and Goldman Sachs imposed employee travel restrictions and some cancelled conferences.[368] Some companies, including Microsoft, GitHub and Square, Inc., also encouraged employees to work from home.[369]

Many major US sports leagues cancelled scheduled events. The National Basketball Association (NBA) suspended the 201920 season indefinitely. On 12 March, the Major League Soccer (MLS) and Major League Rugby (MLR) announced their 2020 seasons would be suspended for 30 days.[370][371] The National Hockey League (NHL) suspended play of the 201920 season.[372]Major League Baseball announced it would be suspending operations, including the remaining spring training games, and delaying the start of the 2020 season for at least two weeks.[373] On March 16, the National Association for Stock Car Auto Racing (NASCAR) announced that all race events through May 3 would be postponed.[374] Other events cancelled or suspended include the NCAA Men's Division I Basketball Tournament, the XFL season,[375] the Indian Wells Masters and Miami Open.[376][377]

On 11 March, President Trump announced the suspension of most travel from Europe (excluding the United Kingdom) for 30 days, beginning on 13 March. He also said that health insurance companies agreed to waive all co-payments for coronavirus treatments and extend insurance coverage to cover coronavirus treatments.[378] The Department of Homeland Security clarified that the travel suspension only applied to the Schengen Area; it does not apply to European countries that are not members of the Schengen Agreement, such as the United Kingdom, the Republic of Ireland, Croatia, Albania, or Belarus.[379] Furthermore, the travel ban does not apply to US citizens or permanent residents, or their family members or those travelling on certain types of visa.[380] On 14 March, President Trump expanded the travel ban on Europe to include the United Kingdom and Ireland.[381] In addition, a representative of the insurance industry clarified that, contrary to the president's statement, major health insurers had only agreed to waive co-payments for coronavirus testing, and not for coronavirus treatment, which is far more costly.[382]

As of 16March2020[update], the epidemic was reported to be present in 49 of the 50 states, plus the District of Columbia. The number of confirmed cases in the U.S. rose to 4,734, with 93 deaths.[383][384] On 13 March, U.S. President Trump declared a national emergency due to the virus outbreak. The action made federal funds available to respond to the crisis.[385] Per media reports on 15 March, many businesses closed or reduced hours throughout the U.S. as a method to try to combat the virus.[386]

The White House has been criticized for downplaying the threat, controlling the messaging, and directing health officials and scientists to "coordinate all public statements and appearances" related to the virus with the office of Vice President Mike Pence.[387][388] Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told The New York Times that he was instructed by the White House not to talk about the coronavirus without clearance.[389] President of the United States Donald Trump has vowed to "keep the numbers low", leading to claims that he is trying to limit the magnitude of the published statistics.[390] On 4 March, the Centers for Disease Control and Prevention of the United States deleted the running tally of the number of people tested for the coronavirus across the US from its website. Allegations of a cover-up and concerns has risen that the deletion could possibly limit the country's response to the epidemic.[391]

The 201920 coronavirus pandemic was confirmed to have spread to Japan on 23 January 2020 from China.[citation needed]

On 27 February 2020, Prime Minister Shinzo Abe requested that all Japanese elementary, junior high, and high schools close until early April to help contain the virus.[392] The outbreak has been a concern for the 2020 Summer Olympics which is scheduled to take place in Tokyo starting at the end of July.[393] The Japanese government has thus been taking extra precautions to help minimise the outbreak's impact.[394] On 15 March it was reported that 15 coronavirus clusters had been identified in Japan, with the largest cluster in the Osaka area.[395]

The UK response to the virus first emerged as one of the most lax and controversial of the affected countries and as of 16 March 2020 the British government has not imposed any form of social distancing or mass quarantine measures on its citizens.[396][397] On 15 March it was reported that the UK government would no longer test those individuals self-isolating with mild symptoms of coronavirus, however, it would extend testing for those individuals seeking hospital treatment for the virus or those in long-term care facilities.[398]

The pandemic has spread to multiple other countries, in total, more than 160 territories have had at least one case.[399] Due to the coronavirus pandemic in Europe, multiple countries in the Schengen Area have restricted the free movement within the area, and set up border controls.[400]

An analysis of air travel patterns was used to map out and predict patterns of spread and was published in the The Journal of Travel Medicine in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo and Taipei had the largest volume of travellers from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people travelling from Wuhan. Bali was reported as least able in terms of preparedness, while cities in Australia were considered most able.[401][402]

There have been international comments that the 2020 Olympics should be moved from Japan or postponed. On 22 January, the Asian Football Confederation (AFC) announced that it would be moving the matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and Thailand.[403] A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney.[404] The Asia-Pacific Olympic boxing qualifiers, which were originally set to be held in Wuhan from 3 to 14 February, were also cancelled and moved to Amman, Jordan to be held between 3 and 11 March.[405][406]

Australia released its Emergency Response Plan for Novel Coronavirus (COVID-19) on 7 February. It states that much is yet to be discovered about COVID-19, and that Australia will emphasise border control and communication in its response to the pandemic.[407]

A worker disinfects an ambulance in Daegu, South Korea

Prime Minister Giuseppe Conte and the Italian task force discuss how to respond to the coronavirus outbreak

As a result of the outbreak, many countries and regions including most of the Schengen area,[408] Armenia,[409] Australia,[410] India,[411] Iraq,[412][413] Indonesia,[414]Kazakhstan,[415] Kuwait,[416] Malaysia, Maldives, Mongolia, New Zealand, Philippines, Singapore, Sri Lanka, Taiwan,[417] Vietnam,[418] and the United States[419] have imposed temporary entry bans on Chinese citizens or recent visitors to China, or have ceased issuing visas and reimposed visa requirements on Chinese citizens.[420] Samoa even started refusing entry to its own citizens who had previously been to China, attracting widespread condemnation over the legality of the decision.[421][422]

The European Union rejected the idea of suspending the Schengen free travel zone and introducing border controls with Italy,[423][424][425] which has been criticised by some European politicians.[426][427] After some EU member states announced complete closure of their national borders to foreign nationals,[428] the European Commission President Ursula von der Leyen said that "Certain controls may be justified, but general travel bans are not seen as being the most effective by the World Health Organization."[429]

Saudi Arabia has temporarily banned foreigners from entering Mecca and Medina, two of Islam's holiest pilgrimage sites, to prevent the spread of coronavirus in the Kingdom.[430] The United States suspended travel from the Schengen Area and the UK.[431] Many countries then started closing their borders to virtually all non-citizens or non-residents in rapid succession, including India,[432] Slovakia,[433] Denmark,[434] Poland,[435] and Lithuania.[436]

Owing to the effective quarantine of public transport in Wuhan and Hubei, several countries have planned to evacuate their citizens and diplomatic staff from the area, primarily through chartered flights of the home nation that have been provided clearance by Chinese authorities. Canada, the United States, Japan, India, France, Australia, Sri Lanka, Germany and Thailand were among the first to plan the evacuation of their citizens.[437] Pakistan has said that it will not be evacuating any citizens from China.[438] On 7 February, Brazil evacuated 34 Brazilians or family members in addition to four Poles, a Chinese and an Indian citizen. The citizens of Poland, China and India got off the plane in Poland, where the Brazilian plane made a stopover before following its route to Brazil. Brazilian citizens who went to Wuhan were quarantined at a military base near Brasilia.[439][440][441] On the same day, 215 Canadians (176 from the first plane, and 39 from a second plane chartered by the US government) were evacuated from Wuhan, China, to CFB Trenton to be quarantined for two weeks. On 11 February, another plane of Canadians (185) from Wuhan landed at CFB Trenton. Australian authorities evacuated 277 citizens on 3 and 4 February to the Christmas Island Detention Centre which had been "repurposed" as a quarantine facility, where they remained for 14 days.[442][443][444] A New Zealand evacuation flight arrived at Auckland on 5 February; the passengers (including some from Australia and the Pacific) were quarantined in a naval base at Whangaparoa north of Auckland.[445] The United States announced that it would evacuate Americans aboard the cruise ship Diamond Princess.[446] On 21 February, a plane carrying 129 Canadian passengers evacuated from Diamond Princess landed in Trenton, Ontario.[447] The Indian government has scheduled its air force to evacuate its citizens from Iran.[448]

On 5 February, the Chinese foreign ministry stated that 21 countries (including Belarus, Pakistan, Trinidad and Tobago, Egypt and Iran) had sent aid to China.[449]

The US city of Pittsburgh announced plans to send medical aid to Wuhan, which is its sister city.[450] The University of Pittsburgh Medical Center (UPMC) also announced plans to provide help.[451] Some Chinese students at other American universities have also joined together to help send aid to virus-stricken parts of China, with a joint group in the Greater Chicago Area reportedly managing to send 50,000 N95 masks and 1,500 protection suits to hospitals in the Hubei province on 30 January.[452]

The humanitarian aid organisation Direct Relief, in co-ordination with FedEx transportation and logistics support, sent 200,000 face masks along with other personal protective equipment, including gloves and gowns, by emergency airlift to arrive in Wuhan Union Hospital, who requested the supplies, by 30 January.[453] The Gates Foundation stated on 26 January that it would donate US$5million in aid to support the response in China that will be aimed at assisting "emergency funds and corresponding technical support to help front-line responders".[454] On 5 February, Bill and Melinda further announced a $100million donation to the World Health Organization, who made an appeal for funding contributions to the international community the same day. The donation will be used to fund vaccine research and treatment efforts along with protecting "at-risk populations in Africa and South Asia."[455]

Japan, in the process of co-ordinating a plane flight to Wuhan to pick up Japanese nationals in the city, has promised that the plane will first carry into Wuhan aid supplies that Japanese foreign minister Toshimitsu Motegi stated will consist of "masks and protective suits for Chinese people as well as for Japanese nationals".[456] On 26 January, the plane arrived in Wuhan, donating its supply of one million face masks to the city.[457] Also among the aid supplies were 20,000 protective suits for medical staff across Hubei donated by the Tokyo Metropolitan Government.[458]

On 28 January, the city of Mito donated 50,000 masks to its sister-city of Chongqing, and on 6 February, the city of Okayama sent 22,000 masks to Luoyang, its sister-city. The ruling Liberal Democratic Party on February 10, made a symbolic deduction of 5,000 yen from the March salary of every LDP parliamentarian, a total of 2 million yen, to donate to China, with the party's secretary-general, Toshihiro Nikai, stating that "For Japan, when it sees a virus outbreak in China, it is like seeing a relative or neighbor suffering. Japanese people are willing to help China and hope the outbreak will pass as soon as possible."[459]

Peace Winds Japan has declared it will send a staff member to China to help distribute the face masks and other goods that the NGO will send to the country.[458]

Other countries have also announced aid efforts. Malaysia announced a donation of 18 million medical gloves to China.[460] The Philippine Red Cross also donated $1.4million worth of Philippine-made face masks, which were shipped to Wuhan.[461] Turkey dispatched medical equipment,[462] and Germany delivered various medical supplies including 10,000 Hazmat suits.[463] On 19 February, Singapore Red Cross announced that they will send $2.26million worth of aid to China, consisting of protective material and training.[464]

The WHO has commended the efforts of Chinese authorities in managing and containing the epidemic, with Director-General Tedros Adhanom Ghebreyesus expressing "confidence in China's approach to controlling the epidemic" and calling for the public to "remain calm".[465] The WHO noted the contrast between the 2003 epidemic, where Chinese authorities were accused of secrecy that impeded prevention and containment efforts, and the current crisis where the central government "has provided regular updates to avoid panic ahead of Lunar New Year holidays."[466]

On 23 January, in reaction to the central authorities' decision to implement a transportation ban in Wuhan, WHO representative Gauden Galea remarked that while it was "certainly not a recommendation the WHO has made," it was also "a very important indication of the commitment to contain the epidemic in the place where it is most concentrated" and called it "unprecedented in public health history."[466]

On 30 January, following confirmation of human-to-human transmission outside China and the increase in the number of cases in other countries, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), the sixth PHEIC since the measure was first invoked during the 2009 swine flu pandemic. Tedros clarified that the PHEIC, in this case, was "not a vote of no confidence in China," but because of the risk of global spread, especially to low- and middle-income countries without robust health systems.[262][467] In response to the implementations of travel restrictions, Tedros stated that "there is no reason for measures that unnecessarily interfere with international travel and trade" and that "WHO doesn't recommend limiting trade and movement."[468]

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