Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV)and Severe Acute Respiratory Syndrome (SARS-CoV).
Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans.
Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.
Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.
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]
But in early March, after about two months of aggressive containment measures, things started to change. The number of cases started decreasing; Chinas leader, Xi Jinping, paid a visit to Wuhan, the city at the epicenter of the outbreak; and life has started to slowly return to normal.
Yaneer Bar-Yam, a physicist and the founding president of the New England Complex Systems Institute, a research institution that studies systems and networks, based his assessment partially off Chinas response. It will take a month and a half, plus a logarithmic correction, once we start doing whats needed, he said.
But most experts, Dr. Bar-Yam included, do not consider the United States to have started the appropriate clock. Although cities are shutting down school systems and restaurants, social distancing is still a recommendation, rather than an enforced policy, as it is in Italy.
Its like a wrecking ball thats going to hit the building, but it hasnt hit yet, Dr. Bar-Yam said. Every day that we dont do something, its getting worse, and by a lot.
There is also a question as to how the coronavirus will behave in the long term. It might be seasonal, abating with warmer weather.
It might act like the Zika virus, a mosquito-borne illness that causes birth defects. For much of 2016, it devastated communities in South America and Southeast Asia. But for the past three years, there have been few cases.
It might act like the 2009 swine flu pandemic, which infected millions and caused more than 10,000 deaths. But now that virus is just part of our annual flu cycle, according to Andrew Pekosz, a professor of microbiology at the Johns Hopkins Bloomberg School of Public Health.
"We have the same number of cases that Italy had two weeks ago. We have a choice to make," US Surgeon General Dr. Jerome Adams said. "Do we want to really lean into social distancing and mitigation strategies and flatten the curve or do we just want to keep going on with business as usual and end up being Italy?"
This week has already brought a sharp increase in both US cases and deaths.
On Sunday evening, there were 3,349 cases of coronavirus in the US. That number jumped by more than 1,000 in about 24 hours. The number of deaths climbed by more than 20 in that time frame.
Throughout the day on Monday, orders for an altered American reality poured in as cases across the US reached 4,466 and 87 people had died.
Closed restaurants, bars, theaters, gyms
"You have to think of this in a wartime world view," New York City Mayor Bill de Blasio said Monday. "You have to think of this as something where you're going to see a massive mobilization to save lives, to help people through their suffering with this disease."
Residents across the country received similar guidance.
Public health officials in Colorado ordered restaurants, bars, gyms, theaters and casinos to close their doors for 30 days. Facilities will still be allowed to sell food and beverages through options like drive-through and delivery services.
"Based on the experience of other countries, the state of Washington, and modeling data, the sooner we begin social distancing measures on a large enough scale, the more quickly we can slow transmission of the virus," Colorado Department of Public Health and Environment Executive Director Jill Hunsaker Ryan said.
Similar orders were issued in states including Maryland, Kentucky, Louisiana and Indiana.
Meanwhile, states such as New York, New Jersey, Connecticut, Michigan and Wisconsin put a ban this week on gatherings of 50 people or more.
In San Francisco, Mayor London Breed issued "shelter in place" guidance, requiring the city's residents to stay inside and leave only for essential needs -- things like grocery shopping, and going to the police, bank, gas stations and pharmacies.
"We know these measures will significantly disrupt people's day to day lives, but they are absolutely necessary," the mayor said in a Monday statement. "This is going to be a defining moment for our city and we all have a responsibility to do our part to protect our neighbors and slow the spread of this virus by staying at home unless it is absolutely essential to go outside."
'No more than 10 people,' government says
The orders came the same day the federal government released a new set of guidelines for the next 15 days to fight the spread of the virus. One part of those guidelines: steering clear of groups with more than 10 people.
As President Donald Trump announced the recommendations from the White House, the Dow saw its worst point drop in history. Trump said the country "may" be headed toward a recession but said he was instead focused on fighting off the coronavirus.
The guidelines also urged Americans to avoid eating and drinking at bars and restaurants and to instead opt for drive-through, pickup or delivery options.
"We'd much rather be ahead of the curve than behind it, and that's what we are," Trump said Monday evening.
The guidelines came largely after governors across the country signed new orders and directives in response to the virus -- and called on the federal government to step up its efforts.
"Every state doing their own thing, different cities doing their own thing, it's confusing, it's chaos," New York Gov. Andrew Cuomo said Monday night. "The federal government should come up, step in, and say this is what we're going to do. This is what we do in schools, this is what we do in businesses, here are the rules and then the states can adjust the rules to their particular circumstances."
Maryland Gov. Larry Hogan told CNN Monday that while state senators are on the "front lines" of the response to the virus, a clear set of guidelines from the federal government would be helpful.
"We're all taking actions that we believe are necessary in our state," he said.
'We are woefully short' on medical equipment
Shortly after New York, New Jersey and Connecticut announced bans on mass public gatherings, the governors of the three states said in a conference call they were also worried about shortages of medical equipment.
"We need hospital beds over the next couple of weeks," New Jersey Gov. Phil Murphy said. "We are woefully short as a region, as a country, in terms of being able to take care of folks -- especially if this surge comes in the way we expect it."
"We are badly outgunned in that front and that's where we do need the (federal government) to help step up," he said.
One Georgia hospital ripped through months' worth of supplies while tending to coronavirus patients, its president told CNN.
Scott Steiner, president and CEO of Phoebe Putney Health Systems, told CNN that despite being well-prepared in terms of protective gear -- with six months' worth of inventory stockpiled -- the system has gone through five months five months' worth of that inventory in six days.
But Department of Health and Human Services officials said in a call with medical professionals Monday there isn't enough stockpiled medical equipment like masks, gowns and gloves in the national stockpile to fill in the gaps that states and local communities may see, a source on the call told CNN.
HHS officials said the government didn't yet have a solution for possible shortfalls but was working on one.
"We have been transparent that more supplies are needed -- hence the request to Congress for additional funding so we could procure more and scale up production," an HHS spokesperson said in a statement to CNN. "The role at the Federal level is to appropriately implement regulatory relief, provide alternative sources and support manufacturing, and adjust allocation to appropriately target areas in need."
How long will it last?
In the government news conference Monday, Trump said the country's new normal may last until July or August.
Guidance from health officials gives some insight on how long the outbreaks may substantially affect the country.
The US Centers for Disease Control and Prevention Sunday recommended no gatherings with 50 people or more take place for the next eight weeks.
Meanwhile, a novel coronavirus vaccine trial in the US gave a dose to its first participant, the National Institute of Allergy and Infectious Diseases said Monday.
The study aims to enroll a total of 45 healthy adults over a six-week time frame. Each participant will receive two injections about a month apart in varying doses.
It's meant to establish that the vaccine is safe and induces a desired response from participants' immune systems. Proving that the vaccine is effective in preventing infection from the coronavirus, however, will require follow-up studies involving many more participants, which will take many more months, experts say.
CNN's Kristen Holmes, Rob Frehse, Michael Nedelman, Ben Tinker and Angela Barajas contributed to this report.
My husband, a far bigger information sponge than I am, is more measured. He knows when to stop reading headlines, go make dinner, and fix himself a drink. (Actually, on the cocktail front, were pretty similarly aligned. So thats good.) Hes not wearing his stress. Hes a thermos bottle you cant discern the temperature of the contents inside whereas Im more of a mood ring.
This dynamic is a familiar one in our relationship. When Donald Trump was elected, my husband and I had a running argument.
Me: You are underreacting.
Him: No, Im not. You are overreacting.
So now, here we are again, with each of us assuming our familiar positions on the tennis court. I asked Perel what she made of it. Her reply was one of the wisest Im sure to hear in this time of upheaval.
If you polarize and you think that theres only one way to do things, she said, its fake certainty. The whole point is that youre discovering it along the way.
Which means that when couples clash over strategies and coping styles, its important to remember that both parties within reason, of course are right. Or potentially right. Each person deserves a hearing. Theres really no way to know.
This one drop of insight, to me, was everything akin to the moment in high school chemistry class when youre titrating a solution and the stuff in the beaker goes from pink to clear.
In most times of crisis, we can turn to others for succor and comfort. In this particular crisis, were strongly encouraged if not forced to self-isolate. That puts an enormous burden on our partners. Even under the best of circumstances, we can tire them out with a familiar soundtrack of stories, observations, and anxieties.
Everyone is just trying to get by day to day at the moment, said Krista Schwarz, an assistant professor of finance at the University of Pennsylvanias Wharton business school. Right now is not the time to grow the company its the time to stay solvent.
Investors who buy company bonds are asking for higher interest rates as compensation for the additional risk, which could put more stress on companies with already strained finances. For instance, companies are struggling to issue commercial paper a popular form of short-term promissory note typically used to cover payroll, rent and other immediate payments because the few skittish investors who arent steering entirely clear are demanding the highest premium in more than a decade.
Whats more, the debt that is already circulating in the financial markets, including corporate bonds and packages of corporate loans, is looking less safe for investors to hold. Some big money managers like pension funds are obligated to keep risky products off their books but many are big buyers of company bonds, which in better times were considered safe and prudent investments. But with the changing environment, the credit ratings on such bonds are going down.
On Monday, S&P Global Ratings downgraded Exxon Mobil, the biggest American oil company, to AA from AA+ citing lower oil and natural gas prices, weak demand for chemicals and low refining margins. A downgrade could make it harder for Exxon to borrow.
But its the smaller companies which underpin the American economy and tend to lean more heavily on debt that could be especially hurt by a run on credit.
On Monday morning, after Ohios governor had shuttered schools, restaurants and bars across the state, Mr. Albrecht, the hotel owner, met with his 125 employees and vowed to keep them as busy as possible, even if traffic dwindles.
Everythings going to be O.K., he said. Were just going to have to ride it out.
Jeanna Smialek contributed reporting from Washington, Michael de la Merced from London and Clifford Krauss from Houston.
Coronavirus is spreading faster in London than any other part of the country. What do we know about the spread, why it is faster, and what is the governments advice?
According to the Public Health England website, London has recorded 407 cases, almost half the total number of cases in England, 1,099, and dwarfing the figures in large cities such as Manchester, which has nine cases, and Birmingham, which has eight.
In his first daily press conference on the crisis, the prime minister said the capital was racing up the epidemiological curve and that everyone in London needed to start working from home, avoid pubs and restaurants, and keep physical distance from each other.
It is now clear that the peak of the epidemic is coming faster in some parts of the country than in others. It looks as though London is now a few weeks ahead, said Johnson.
So to relieve the pressure on the London health system and to slow the spread in London, it is important that Londoners now pay special attention to what we are saying about avoiding non-essential contact and to take particularly seriously the advice about working from home and avoiding confined spaces such as pubs and restaurants.
The highest number of cases have been recorded in the Royal Borough of Kensington and Chelsea, which has seen 43 cases, while Hackney/City of London has seen 20, and Tower Hamlets, home to Canary Wharf but also to one of the most deprived communities in Britain, has recorded just nine.
From tomorrow, expect the streets to be deserted. Many offices have already introduced an element of remote working, and although the governments announcement is not legally binding, it will carry a lot of weight with responsible employers.
Yes and no. The concentration of cases in Italy, which has seen the most reported cases in Europe, remains in the north of the country. In the US, Washington has the highest number of cases, followed closely by New York. In Japan the only cluster with more than 50 cases is in Osaka, where infections spread from events in a live music venue. A map released by the ministry of health on Monday showed that one of the biggest clusters in Tokyo (10 to 49 people) followed a New Years Eve party.
No. Some have suggested that frequent flying of people in a richer borough in London or recent ski holidays to Italy may have increased the incidence in Kensington and Chelsea, but this is speculation.
The UK has stopped testing people who do not need hospitalisation. This has been very controversial as it prevents the behaviour mapping that we have seen in Japan.
Anthony Costello, a UK paediatrician and former director of the World Health Organization (WHO), has criticised this approach and said he had personally written to the chief medical officer, Professor Chris Whitty, asking for testing to continue in the community.
You test the population like crazy, find out where the cases are, immediately quarantine them and do contact tracing and get them out of the community. This deals with family clusters. Thats the key bedrock of getting this under control, Costello told the Guardian.
Six counties in the San Francisco Bay Area about 6.7 million people are under a shelter in place order to try to stem the spread of the novel coronavirus, the Los Angeles Times reports.
The order will go into effect at 12:01AM PT on Tuesday, March 17th, and it will include San Francisco, Santa Clara, San Mateo, Marin, Contra Costa, and Alameda counties, according to the San Francisco Chronicle. The order, which will affect most businesses in the Bay Area, will stay in effect through April 7th.
San Francisco Mayor London Breed tweeted that the directive will require people to stay home except for essential needs and that necessary government functions & essential stores will remain open.
The order bans nonessential gatherings of any size as well as nonessential travel on foot, bicycle, scooter, automobile or public transit, the Chronicle reports.
Travel for medical care, to shop for necessary supplies, and to help family and friends who need assistance will be allowed. Airports, public transit, and taxis will continue to operate for essential travel. People are encouraged to practice social distancing and keep six feet apart from others when possible. Delivery services that bring food, goods or services directly to residences can continue to operate as well.
We are in a rough place, and we are going to have difficult times ahead of us, San Mateo County Health Officer Scott Morrow told the Mercury News. The measures were putting in place are temporary, but they will last longer than any of us want. This is the time to unite as a community, come to each others aid and dig really deep to find your best inner self and pull out all the compassion, gratitude and kindness you can.
This is the biggest metro area in the US to implement such a lockdown in response to the outbreak. As of Monday morning, California had 335 confirmed cases of the virus, with 114 in the Bay Area and 37 in in San Francisco proper. In-person classes at Stanford University were canceled beginning March 9th after a faculty member tested positive for the novel coronavirus.
On March 11th, Breed ordered all gatherings of more than 1,000 people banned in the city for two weeks, but a few days later, the order was revised to ban gatherings of just 100 people or more. Nearby counties, like San Mateo, also recently began implementing social gathering bans of 50 or more people, which is what the Centers for Disease Control and Prevention now recommends.
Update March 16th, 5PM ET: Adds information that food delivery can continue and comment from San Mateo Health officer.
When news of the coronavirus broke at the end of last year, and as the stories from the outbreak became more alarming over time, I found myself wondering how health anxiety sufferers were coping.
You see, I used to be one. In late 2015, I suffered a post-traumatic stress disorder relapse which led to debilitating anxiety, much of which was health-related. During that period, I was paralyzed by the thought of becoming ill and dying. I was constantly checking for symptoms and signs of disease online and I was fixated on the health of my loved ones.
After treatment, including trauma-focused CBT, I almost completely recovered. But I remember vividly how it felt to be in an all-consuming state of panic. For many months, it ruled my entire existence. Approximately 40 million American adults roughly 18% of the population have an anxiety disorder, while in the UK there were 8.2 million cases of anxiety in 2013. There are few statistics about health anxiety, but it can affect those who have an existing anxiety disorder or those who have experienced a life event such as bereavement, birth trauma or an accident. In times like these, where a global pandemic is taking up most of the media conversation, it can be even more difficult to stay calm.
Here is some advice that may give some comfort to those of you who are struggling.
We all want to keep up to date, but when you have health anxiety the need to check and read the latest updates can become compulsive, feeding the anxiety. Try having a news detox, or allocating yourself a time limit for reading or watching news. If youre really worried about missing something crucial, you can always tell friends and family to contact you in the event of an emergency situation in order to keep you informed.
Seeking reassurance can make you feel calmer for a little while, but in my experience, it is always temporary. Your brain creates a feedback cycle where you become increasingly reliant on reassurance, which only serves to reinforce the anxiety. Its natural to want your loved ones to tell you things will be OK, but when you start needing that reassurance several times a day its time to take a step back.
Dr Google is not, and never will be, your friend, especially not when you are a sufferer of health anxiety. Nor will message-boards and forums. Try to remember that people visit these places when they have reason to be concerned. Once you start understanding its a skewed lens, youll be better able to put things in perspective
This is a CBT exercise which involves giving a persistent thought the courtroom treatment, by confronting it with a rational counter-statement. For example, if your persistent thought is something like Everyone I love will die from this virus you can counter it with factual statements such as Actually, most people who get Covid-19 are likely to make a full recovery, and thats assuming mum, dad and my little sister will even catch it at all. As my mother always says: Just because you think something, doesnt make it true.
Even if its just star jumps in your bedroom, or shaking your body parts like youre in the warm-up section of a hippie acting class, exercise will help get the adrenaline out of your system and channel the panic elsewhere.
From guided yogic breathing to using a strong smell (I favored lavender oil), grounding exercises can help bring you back to reality. I also found bending over to touch my toes and then very slowly standing up starting at the base of my spine to be beneficial, as it centers me. You can look for examples online, but sometimes, something as simple as sitting on the floor can help.
Give yourself half an hour to worry about this to your hearts content, and then you have to go and do something else.
Anything that will give you a little boost can help. It doesnt need to involve spending money: you can also cook yourself something nice, have a hot bath, or listen to a song you love.
When you are in it, anxiety always feels as though it will never end, but it will. Its hard to remember this, but do try. I genuinely thought that I would never recover, and now even though we are in a public health crisis, I feel calm and have things in perspective. Its a worrying time, and many of us, myself included, will have loved ones who might be showing symptoms, but the tendency to jump to the worst-case scenario very rarely reflects reality. Be kind to yourself. It may be a bit cheesy, but this too shall pass.
An engineer from Charter, one of the largest phone and internet providers in the U.S., sent an email blast to a senior vice president and hundreds of engineers on Friday.
In the email, Nick Wheeler, a video operations engineer based in Denver,criticized his employer for not allowing its staff to work from home despite ongoing efforts to lock down vast swathes of the U.S. to combat the coronavirus pandemic.
The email was short. I do not understand why we are still coming into the office as the COVID-19 pandemic surges around us, he wrote.
The CDC guidelines are clear. The CDPHE guidelines are clear. The WHO guidelines are clear. The science of social distancing is real. We have the complete ability to do our jobs entirely from home, he wrote, reeling off the advice from several state and federal government departments and international health organizations. Coming into the office now is pointlessly reckless. Its also socially irresponsible. Charter, like the rest of us, should do what is necessary to help reduce the spread of coronavirus. Social distancing has a real slowing effect on the virus that means lives can be saved.
A hazard condition isnt acceptable for the infrastructure beyond the short-term. Why is it acceptable for our health? wrote Wheeler.
Hours later, he was no longer an employee.
Just a few minutes after Wheeler sent the email, he was summoned to a vice presidents office to a conference call with human resources. In a call with TechCrunch, Wheeler said his email was described as irresponsible and inciting fear. He said it was hard to understand why Charter had not implemented a work-from-home policy after the coronavirus outbreak was upgraded to a pandemic.
Wheeler said he was given an ultimatum. Either he could work from the office or take sick leave. Staff are not allowed to work from home, he was told. Wheeler offered his resignation, but was sent home instead and asked to think about his decision until Monday.
Later in the day, he received a call from work. Charter accepted his resignation, effective immediately.
I do not understand why we are still coming into the office as the COVID-19 pandemic surges around us.Nick Wheeler, former Charter employee
Although Charter and others have pledged not to charge late fees or terminate its services to customers during the pandemic, employees are internally expressing frustration that their health and safety appear not to be a priority.
Wheeler is going on the record because he said it was unacceptable that Charter is, unlike other companies, not employing a work-from-home strategy in an effort to combat the spread of COVID-19.
Just on Monday, the San Francisco Bay Area was put on lockdown, and both New York and Denver where Wheeler lives announced the closure of bars and restaurants and the banning of public gatherings of more than 50 people to limit the viruss spread. Shortly after, the White House said it is advising against gatherings of 10 people or more, and that Americans should continue to practice social distancing.
If I can understand and do this at a human level, Charter should be able to do it at a larger level, he said.
Cameron Blanchard, a spokesperson for Charter, said the company does not discuss individual employee circumstances. In a broader statement, Charter said its continuing our normal operations but that its reviewing our business continuity plans daily as conditions are changing rapidly.
Charter finds itself largely alone in mandating employees to work from its offices as its rivals push ahead with advising staff to work from home where possible.
AT&T said in its guidance that its asking employees who are in jobs that can be done from home should do so until further notice. Verizon, which owns TechCrunch, also said its encouraging employees to work remotely. Comcast is reportedly testing a number of work-from-home scenarios.
TechCrunch spoke to several Charter employees, whom we are not naming as they fear retribution from the company. The employees said they had seen Wheelers email. One described the email as speaking what was already a bubbling of concern among employees.
The employees said that Charters leadership has long disallowed working from home, and that management decides on a case-by-case basis and only when theyve seen a doctors note. The employees said that in absence of a work-from-home policy, employees are expected to burn through their sick leave.
Staff are given a week of sick leave a year, which accrues over time, but current government guidance is to self-quarantine for two weeks after symptoms subside, meaning some staff would have to take a portion of unpaid sick leave.
But Charter has shown little sign of backing down. In an all-staff email sent Saturday and seen by TechCrunch, Charters chief executive Tom Rutledge doubled down on the policy.
You may have heard that some companies are instituting broad remote working policies for some of their employees. While we are preparing for that possibility by geography, Charter is not doing the same today, said Rutledge. We provide critical communications services and we believe our approach to supporting front line employees is the right way for us to operate at this time to continue to deliver those important services to our customers.
The email said that the 15% of its employees who perform back-office work and management are expected to continue coming into the offices.
Stay home if you are sick, or caring for someone who is sick, but continue to report to your usual work location if you are not, the email said. While some back office and management functions can be performed remotely, they are more effective from the office, said Rutledge.
One of the employees we spoke to described the email as tone-deaf.
The employees said two or three staff had been tested for coronavirus, according to internal emails from Charters human resources, but that their test results had not been disclosed, compounding their fears about having to continue to go into the office.
Wheeler is not alone in his concerns. At least two other emails allegedly sent by employees, which were posted anonymously to Reddit but TechCrunch is unable to verify their authenticity, criticized Charter for putting its employees under harm and risk.
One of the employees we spoke to agreed. Theres no reason why the back-end staff cant be working from home, they said.
