The Foreign Office (FCO) is advising against all but essential travel to an increasing number of countries because of coronavirus. Some destinations have travel restrictions, quarantine measures, border closures and health screenings in place due to the outbreak. If travellers have recently been on another trip abroad to affected countries, entry to other destinations could be denied or travellers quarantined.
This article is being updated daily. It was last updated at 11pm, 16 March
The FCO is advising against all but essential travel to:
Europe: Albania, Czech Republic, Denmark, Estonia, Italy, Kosovo, Latvia, Lithuania, Malta, Moldova, Montenegro, North Macedonia, Norway, Poland, San Marino, Slovakia, Slovenia, Spain, Madeira and Porto Santo (Portugal), Romania, Serbia
Asia: Myanmar, China, Timor-Leste, Indonesia, North Korea, Daegu, Cheongdo and Gyeongsan (South Korea), Malaysia, Mongolia, Philippines, Sri Lanka, Vietnam
North America: US
Central America and the Caribbean: Belize, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Panama, Saint Kitts and Nevis, Trinidad & Tobago
South America: Argentina, Bolivia, Colombia, Ecuador, Paraguay, Peru, Suriname, Uruguay
Africa: Egypt, Equatorial Guinea, Ghana, Jordan, Kenya, Malawi, Morocco, Sierra Leone, South Africa
Cruise shipsThe FCO is advising against all travel on cruise ships for passengers aged 70 years and over or those with high-risk conditions. Some destinations are placing bans on cruise ships docking or passengers disembarking, including Australia, Chile, Colombia, Greece, Italy, Montenegro and Portugal.
The following countries have other restrictions and measures in place that may affect UK nationals (but the FCO is not advising against travelling there currently):
* EU proposes suspension of non-essential travel
The EU is proposing that all non-essential travel should be suspended to European Union for 30 days, the president of the EU commission has announced. This would affect travel from outside the EU, but the UK would be exempt.
AustriaThere are no direct flights between Austria and the UK, or direct air or rail connections from Austria to Italy, France, Spain or Switzerland. Any travellers coming from Italy by road will be stopped at the border and must present a health certificate stating that they are not affected by coronavirus. Ski resorts closed on 15 March in Tirol, Salzburg and Vorarlberg. Restaurants and shops open at limited hours.
Belgium, Bulgaria, France, Greece, Hungary, Iceland, Ireland, Luxembourg, Monaco, Netherlands, Romania and SwitzerlandCultural and sporting activities are prohibited; large gatherings restricted; restaurants and bars are closed; shops likely to be open at limited hours; public transport limited; and health screenings on arrival likely.
Croatia and Bosnia and HerzegovinaSelf-quarantine for 14 days. Some borders are closed and flights schedules limited.
Cyprus and UkraineBan on entry for UK travellers.
GermanySelf-quarantine for 14 days for anyone who has been in Italy, Switzerland or Austria in the 14 days before arrival. Land border restrictions with Austria, Denmark, France, Luxembourg and Switzerland (ie cross-border commuters and deliveries only).
GeorgiaBan on all travellers for two weeks from 18 March.
HungarySelf-quarantine for 14 days for travellers who have recently been in China, Italy, Iran, Israel or South Korea. Cultural and sporting activities are prohibited; restaurants and bars are closed; shops likely to be open at limited hours; health screenings on arrival likely.
Isle of ManSelf-quarantine for 14 days.
PortugalLand border restrictions with Spain (ie cross-border commuters and deliveries only).
RussiaSelf-quarantine of 14 days for travellers who have recently been in China, Italy, Iran, France, Germany, South Korea or Spain. All borders closed except with Azerbaijan and Finland.
TurkeySome flights to Europe suspended. Ban on entry to travellers who have been in or transited through China, Iran, Italy or South Korea in the 14 days before arrival.
No specific warningsFor UK nationals, there are currently no travel warnings or restrictions (relating to coronavirus) in place to the following countries. However, some have confirmed cases of coronavirus, with health screenings likely on arrival and quarantine possible: Armenia, Andorra, Azerbaijan, Belarus, Liechtenstein, Sweden.
BahrainSuspension of visas on arrival scheme. Self-quarantine for 14 days.
BangladeshSuspension of visa on arrival scheme. Ban on entry to travellers who have recently been in Europe (not including UK).
Bhutan, Kuwait, Qatar, Oman and Turkmenistan Ban on entry to UK travellers.
BruneiSelf-monitor for 14 days.
Hong Kong, Israel, Macao, Saudi Arabia, Singapore, Taiwan and Uzbekistan Self-quarantine for 14 days.
IndiaBan on entry to all travellers from the UK, EU, and Turkey from 18 March. All visas and e-visas invalid until 15 April. Quarantine of 14 days for anyone who has recently visited China, Italy, Iran, South Korea, France, Spain or Germany.
JapanBan on entry to travellers who have been in China, Iran or Italy in the 14 days before arrival.
Lebanon Direct flights suspended from affected countries on 17 March. Airlines flying into Beirut Rafic Hariri airport are being asked to refuse passengers who have been in the UK, France, Egypt, Syria, Iraq, Germany or Spain. UK nationals are strongly advised to review travel plans here.
MaldivesBan on entry to travellers who have been in Bangladesh, China, Iran, Italy or South Korea (Gyeongsang) in the 14 days before arrival.
PakistanInternational flights are limited to Karachi, Islamabad and Lahore airports, and some borders closed.
TajikistanBan on entry to travellers who have been in or transited through, China, Iran, Italy or South Korea in the 14 days before arrival.
ThailandTravellers who have recently been in affected countries require a health certificate stating that they are not affected by coronavirus. Self-monitor for 14 days. Songkran celebrations postponed and other large gatherings likely to be cancelled or postponed.
No specific warningsFor UK nationals, there are currently no travel warnings or restrictions (relating to coronavirus) in place to the following countries. However, some have confirmed cases of coronavirus, with health screenings likely on arrival, and quarantined possible: Cambodia, Kazakhstan, Kyrgyzstan, Laos, Nepal and UAE.
ArubaBan on entry to UK travellers.
Antigua & Barbuda, Bahamas and MontserratBan on entry to travellers who have recently been in China, Iran, Italy, Japan, South Korea or Singapore.
BarbadosQuarantine 14 days for any travellers recently been in Italy in the 14 days before arrival.
Bermuda and Canada Self-quarantine for 14 days.
Saint LuciaBan on entry to travellers who have been in China, Hong Kong, Japan, Italy, South Korea or Singapore in the 14 days before arrival.
Saint Vincent & the GrenadinesBan on entry to travellers who have been in China, Italy or Iran in the 14 days before arrival.
GrenadaBan on entry to travellers who have been in China, France, Germany, Iran, Italy, Japan, Singapore, South Korea or Spain in the 14 days before arrival.
GuyanaSelf-quarantine for 14 days for travellers who have recently been in Brazil, China, Dominican Republic, Iran, Italy, Japan, Jamaica, Malaysia, Panama, Thailand, St Vincent & the Grenadines, Singapore, South Korea or US
Turks & CaicosBan on entry to travellers who have been in China, Iran, Italy, Japan, Macao, South Korea or Singapore in the 21 days before arrival.
No specific warningsFor UK nationals, there are currently no travel warnings or restrictions (relating to coronavirus) in place to the following countries. However, some have confirmed cases of coronavirus, with health screenings likely on arrival, and quarantined possible: Brazil, Cayman Islands, Chile, Costa Rica, Cuba, Curacao, Dominica, Falkland Islands, Mexico, Nicaragua, and Saint Maarten.
Australia, New Zealand and Solomon IslandsSelf-quarantine for 14 days.
FijiBan on entry to anyone who has been in China, Iran, Italy or South Korea.
French PolynesiaAll travellers require a health certificate stating that they do not have coronavirus.
Kiribati, Micronesia and TongaMust have been spent 14 days in a country without any cases prior to arrival.
NauruBan on entry to travellers who have been in or transited through China, Hong Kong, Iran, Italy, Macao or South Korea in the 21 days before arrival.
PalauBan on entry to travellers who have been in China, Hong Kong or Macao in the 14 days before arrival.
VanuatuBan on entry to travellers who have been in China, Hong Kong Japan, Macao, South Korea, Singapore or Taiwan in the 14 days before arrival.
No specific warnings For UK nationals, there are currently no travel warnings or restrictions (relating to coronavirus) in place to the following countries. However, some have confirmed cases of coronavirus, with health screenings likely on arrival, and quarantine possible: Marshall Islands, New Caledonia, Papua New Guinea and Samoa.
AlgeriaSuspension of all air and sea travel to and from Europe from 19 March.
Angola, Congo, Mauritius and SeychellesBan on entry to travellers who have recently been in China, Iran, Italy or South Korea.
Benin, Botswana, Democratic Republic of Congo, Ethiopia, Mozambique, Rwanda, Tunisia and UgandaSelf-quarantine for 14 days for travellers who have recently been in affected countries.
ComorosMust have been spent 14 days in a country without any cases prior to arrival.
EritreaQuarantine of 14 days for travellers who have recently been in China, South Korea, Italy, Germany or US.
GuineaVisitors must submit their passports for a 14-day monitoring period.
MadagascarNo commercial passenger flights with Europe for 30 days from 20 March. Self-quarantine for 14 days for travellers who have recently been in affected countries.
No specific warningsFor UK nationals, there are currently no travel warnings or restrictions (relating to coronavirus) in place to the following countries. However, some have confirmed cases of coronavirus, with health screenings likely on arrival, and quarantine possible: Cameroon, Cape Verde, Cte dIvoire, Eswatini, Gabon, Gambia, Guinea-Bissau, Lesotho, Namibia, Nigeria, Senegal, Tom & Prncipe, Tanzania, Togo, Zambia and Zimbabwe.
As coronavirus continues to spread across the country and the globe, here is some important informationyou should know about the potentially deadly disease, and what you can do to mitigate its impact.
Coronavirus: The basics
What is coronavirus?
Coronaviruses are a family of viruses named after their appearance, a crown, said Dr. Mark Rupp, an infectious disease expert at the University of Nebraska Medical Center.
How dangerous is coronavirus?
Most coronaviruses cause mild symptomsthat patients easily recover from.
What is COVID-19 and how is it different from other coronaviruses?
COVID-19 is not the same as other coronaviruses that commonly circulate among humans and cause mild illness, like the common cold. Some cause illness in people, and others, such as canine and feline coronaviruses, only infect animals. Rarely, animal coronaviruses that infect animals have emerged to infect people and can spread between people, which is suspected to have occurred for the virus that causes COVID-19.
MERS and SARS are two other examples of coronaviruses that originated from animals and then spread to people.
When did the outbreak start?
The World Health Organization's China office says it began receiving reports in late December of a mysterious virus behind a number of pneumonia cases in Wuhan, a city in eastern China with a population of roughly 11 million people.
How does coronavirus compare to other outbreaks?
SARS and MERS came from animals, and this newest virus almost certainly did, too.
Is coronavirus Disease X?
The novel coronavirus has led one expert to say that it fits the criteria for Disease X,a designated placeholder on theWorld Health Organizations (WHO)list of illnesses that have potential to reach international epidemic levels.
Is coronavirus here to stay?
Dr. Robert Redfield, the director of theCDC, said the virus is probably with us beyond this season, beyond this year.
(Photo by Gary Hershorn/Getty Images)
Coronavirus: Symptoms and transmission
What are the symptoms?
Many symptoms of COVID-19 and influenza overlap, here's how to spot the differences.
How is coronavirus transmitted?
According to the CDC, coronaviruses are common in camels, cattle, catsand bats. Person-to-person transmissions are thought to occur when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread.
How often are people hospitalized for it?
The risk of contracting coronavirus remains low for most Americans, U.S. Surgeon General Dr. Jerome Adams said.
What if someone on my plane is sick?
No one likes to be seated near a sick passenger and thats especially true duringapandemic.
(AP Photo/Kathy Willens)
Coronavirus: Protecting yourself and others
How can you protect against getting it?
You can protect yourself from coronaviruses by following basic wellness practices.
How do I sanitize surfaces?
Keeping your home and surfaces clean using the correct disinfectants is crucial in preventing its spread.
How long can it survive on surfaces?
The novel coronavirus may be able to live on surfaces, namely metal, glass or plastic,for up to nine days if it resembles some of its other human coronavirus-causing cousins, that is.
Am Iwashing myhands correctly?
There are a few general rules to follow when it comes to washing your hands thoroughly, including for how long you should keep them under runningwater.
How do I make my own hand sanitizer?
If soap and water arent available, hand sanitizer is the next best option namely if it contains at least 60 percent alcohol, the CDCsays.
Do face masks help?
Surgical masks will not prevent your acquiring diseases, said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University, and the medical director of the National Foundation for Infectious Diseases.
How to stop touching your face
Keeping your hands off your face is easier said than done: One study found that people touch their faces some23 times an hour on average.
Can you get it through packages?
Surgeon GeneralJerome Adams said, There is no evidence right now that the coronavirus can be spread through mail.
How do you travel during the outbreak?
As the coronavirus risk grows globally, being smart about planning travel will help you stay safe.
(AP Photo/Jean-Francois Badias)
Coronavirus: Who is at risk?
Who is most at risk?
Young people, senior citizensand those with immune deficiencies could have an acute reaction if exposed to the virus.
Is it a threat to children?
One pediatrician said childrens'frequent exposure toseasonal illnesses couldactually be protecting them from COVID-19.
Does it affect pregnant women?
The CDC said that while risk to the American public remains low at this time, pregnant women should continue to engage in usual preventative actions to avoid infection, such as washing hands often and avoiding contact with people who are sick.
Coronavirus: Treatment and care
How do you test for it?
Before being tested for thedeadly virus, patients must first answer a series of questions.
How do you treat it?
Fox News received an in-depth look at the new disease fromDr. Debra Chew, a former epidemic intelligence officer for the CDC and an assistant professor of medicine at Rutgers New Jersey Medical School.
Is there a cure?
Health agencies recommend patients receive supportive care to relieve coronavirus symptoms.
How do you care for a relative who has it?
Even if the patient does test positive, it can be considered safe to continue supporting them with some extra precautions.
What happens after you recover from it?
A negative test doesn't always mean the patient is free of the virus
Tips on how to talk to your kids about coronavirus
Its important to remember that children take cues from the adults that surround them, so how you address the virus at home may reflect in their behavior.
Coronavirus: Coping with isolation and social distancing
How do I avoid going stir crazy at home?
With the outbreak of the novelcoronavirus(COVID-19), many people have been forced to work from homeand are choosing to keep their social interactions to a minimum.Here are some tips on how to stay sane in the time of coronavirus.
How do I get food delivered?
As more and more people across the U.S. arepreparing to stay infor the time being, some may be asking if it's safe to get fooddeliveredto their house.
Coronavirus: What to know about the mysterious illness
Coronaviruses are a family of viruses named after their appearance, a crown, said Dr. Mark Rupp, an infectious disease expert at the University of Nebraska Medical Center.
There are many types and a few are known to infect humans. Some cause colds and respiratory illnesses, while others have evolved into illnesses such as Severe Acute Respiratory Syndrome (SARS) andMiddle East Respiratory Syndrome (MERS).
SARS began in China and infected some 8,000 people during a 2002-2003 outbreak. Approximately 770 people died after it spread to other cities and countries.
"This is the third kind of novel coronavirus that we're having experience with that can cause lower respiratory tract disease," Rupp said Tuesday.
In some rare cases, the virus can be transmitted from animals to humans but are typically transferred during contact between humans, according to the CDC.
How dangerous is coronavirus?
The coronavirus, or what is now known as COVID-19, was first traced to an animal and seafood market in the city of Wuhan and has since spread to dozens of other countries, including the U.S. The illness is now said to be transferable between humans.
As news of the virus spread and death tolls began to spike, many have begun to questionhow dangerousthe new outbreak is. Coronaviruses, which get their name from their crown-like appearance, come in many types that cause illnesses in people and animals.
In an effort to curb the spread of the disease (human coronaviruses are passed through coughing and sneezing, close personal contact, touching objects with the virus on it and then touching the mouth, nose or eyes before washing your hands, according to the CDC, the city of Wuhan shut down all air and train traffic. On March 11, the World Health Organization declared the outbreak a global pandemic.
How coronavirus differs from flu: Symptoms to watch for
Officials are urging anyone who develops possible symptoms of the novel coronavirus to contact health care providers to inquire about next steps and possible testing, but with millions infected by the influenza virus in the U.S., many are wondering how to tell the difference between the two.
There is so much overlap in symptoms between flu and COVID-19 but a couple of hallmark differences do exist, Dr. Caesar Djavaherian, co-founder of Carbon Health, told Fox News. Influenza tends to cause much more body pain and the COVID-19 virus tends to feel much more like the common cold with fever, cough, runny nose and diarrhea. However, in a small portion of the population with either COVID-19 or influenza, symptoms progress to kidney failure and respiratory failure.
By the end of February, the Centers for Disease Control and Prevention (CDC) estimated that at least 32 million cases of the flu were reported in the U.S., resulting in 310,000 hospitalizations and 18,000 deaths. For the coronavirus, by March 12 the number of confirmed cases in the U.S. had reached over 1,000, with at least 30 deaths. .
But several health officials, including New York Gov. Andrew Cuomo, have cautioned that healthy Americans who contract COVID-19 may not even know that they have it, and will heal without any treatment. Others say their experience will be similar to that of a common cold, but for those with underlying health conditions, the virus can be severe.
The differences arise in the very small portion of the population who are at risk because of their lung or heart conditions whose lungs can fill with fluid or go into kidney failure and unfortunately, eventually die, with COVID-19, Djavaherian said.
One of the most imperative ways to stop the spread, experts say, is to avoid contact with a sick person, and to practice your own good hygiene. Part of that includes staying home when youre sick and thoroughly washing hands.
If you are sick, monitor your symptoms daily, and when your common cold turns into a deep unrelenting cough and then shortness of breath, those are the signs that we worry about and the signs that require patients to get medical attention right away, Djavaherian said. They may be from pneumonia but in a very, very small group of patients, maybe a COVID-19 infection that has gone into the lungs.
Djavaherian said its imperative to call your health care provider ahead of time to share your symptoms and concerns so that they can prepare the appropriate tests and protect others from potential exposure.
I also recommend using telemedicine, where you can see a doctor via phone or video, to get your questions answered from the comfort and safety of your own home without putting others or yourself at risk, he said.
How did the coronavirus outbreak start?
WHO's China office says it began receiving reports in late December of a mysterious virus behind a number of pneumonia cases in Wuhan.
Researchers suspect the virus originated at a seafood market in Wuhan, where wild animals, including birds, rabbits, bats, and snakes are traded.
It was initially believed the virus came from snakes. But a research paper by a team of virologists at the Wuhan Institute for Virology suggests that the coronavirus more likely came from bats, which was also the source of the SARS outbreak.
Bats are known to carry multiple viruses without getting sick, according to the New York Times, which said they have caused human diseases in Africa, Malaysia, Bangladesh and Australia, and are thought to be the reservoir for Ebola.
Authorities shut down the market on January 1. But by then, the virus had spread beyond the market and was being transmitted between people.
On January 12, Chinese health officials shared a genetic sequence of the virus with other countries to better diagnose the strain in patients.
Fame can afford a person a lot of privileges, but immunity to the coronavirus COVID-19 is not one of them. As some celebrities misguidedly don hazmat suits and face masks to protect themselves, others have begun wisely self-isolating as a preventative measure. And perhaps more important, several are using their platforms to urge everyone to stay informed and take this pandemic seriously.
But because no one is immune, several celebrities, athletes, politicians, and other public figures have been diagnosed. As the pandemic continues, we will keep this list updated. In the meantime, theres no time like the present for a refresher course in how to protect yourself.
This post has been updated.
The level of debt in Americas corporate sector amounts to 75 percent of the countrys gross domestic product, breaking the previous record set in 2008. Among large American companies, debt burdens are precariously high in the auto, hospitality and transportation sectors industries taking a direct hit from the coronavirus.
Hidden within the $16 trillion corporate debt market are many potential troublemakers, including the zombies. They are the natural spawn of a long period of record low interest rates, which has sent investors on a restless hunt for debt products that offer higher reward, with higher risk. Zombies now account for 16 percent of all the publicly traded companies in the United States, and more than 10 percent in Europe, according to the Bank for International Settlements, the bank for central banks. A look at the data reveals that zombies are especially prevalent in commodity industries like mining, coal and oil, which may spell upheavals to come for the shale oil industry, now a critical driver of the American economy.
Zombies are not the only potential source of trouble. To avoid regulations imposed on public companies since 2008, many have gone private in deals that typically saddle the company with huge debts. The average American company owned by a private equity firm has debts equal to six times its annual earnings, a level twice what ratings agencies consider junk.
Signs of debt stress are now multiplying in industries impacted by the coronavirus, including transportation and leisure, auto and, perhaps worst of all, oil. Slammed on one side by fear that the coronavirus will collapse demand, and on the other by fears of a supply glut, oil prices have fallen to below $35 a barrel far too low for many oil companies to meet their debt and interest payments.
Though investors always demand higher returns to buy bonds issued by financially shaky companies, the premium they demand on U.S. junk debt has nearly doubled since mid-February. By last week the premium they demand on the junk debt of oil companies was nearing levels seen in a recession.
Though the world has yet to see a virus-induced recession, this is now a rare pandemic. The direct effect on economic activity will be magnified not only by its impact on balky debtors, but also by the impact of failing companies on the bloated financial markets.
When markets fall, millions of investors feel less wealthy and cut back on spending. The economy slows. The bigger markets get, relative to the economy, the larger this negative wealth effect. And thanks again to seemingly endless promises of easy money, markets have never been bigger. Since 1980 the global financial markets (mainly stocks and bonds) have quadrupled to four times the size of the global economy, above the previous record highs set in 2008.
Since 2003 the world has faced three outbreaks caused by coronaviruses Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now the current outbreak caused by a virus known as 2019-nCoV.
Scientists have yet to find a way to stop these outbreaks before they start. But over the past 17 years, they have drastically shortened the time it takes to develop a vaccine after a new virus emerges.
This is largely due to technological advances and a greater commitment by governments and nonprofits to funding research on emerging infectious diseases.
Scientists are already racing to develop a vaccine for 2019-nCoV a feat that experts say is technically possible, but still may not come in time to help during this outbreak.
Science news reports that several groups started working on a vaccine for 2019-nCoV shortly after Chinese scientists shared the viruss genetic sequence in an online public database on Jan. 10.
Three of these groups are funded by Coalition for Epidemic Preparedness Innovations (CEPI), a nonprofit formed in 2017 to fund vaccine development for emerging infectious diseases.
Inovio Pharmaceuticals Inc. and Moderna Inc. both say they will have a vaccine ready for testing in animals in one month.
Moderna, which is working with the U.S. National Institute of Allergy and Infectious Diseases, estimates that it could have a vaccine ready for a phase one clinical trial in people in three months.
Moderna and Inovio are both using a newer vaccine technology based on specific DNA or messenger RNA (mRNA) sequences of the virus. The chosen sequence codes for a viral protein, such as one on the surface of the virus.
This type of vaccine can still elicit a protective immune response in a person. But because the protein is only a small piece of the virus, it doesnt cause illness.
Scientists using this method can also start designing a vaccine as soon as they have the viruss genetic sequence. With other methods, they would need to work with actual virus samples in the lab.
The nice thing about this technology is that it bypasses many of the traditional steps to vaccine discovery and development. So its very fast, said Dr. Jon Andrus, adjunct professor of global vaccinology and vaccine policy at the Milken Institute School of Public Health of George Washington University.
The third group, at the University of Queensland in Australia, is aiming to have a vaccine ready for testing in people in 16 weeks. They are developing a vaccine by growing viral proteins in cell cultures.
Drugmaker Johnson and Johnson, which is not funded by CEPI, started working on a vaccine two weeks ago, according to CNBC. The companys chief scientific officer estimates they could have a vaccine ready for market within a year.
Dr. Stanley Perlman, a professor of microbiology and immunology and pediatrics at the University of Iowa, said these rapid timelines may be feasible for development of the vaccine. But they may be too fast for careful evaluation of the safety and effectiveness of the vaccines.
Still, the platforms [being used to develop] these vaccines have been tested before, so are likely to be as safe as when used previously, said Perlman. Given the urgency of preventing further spread of the virus, this [rapid pace] is understandable.
Once scientists have created potential candidates, the vaccines still have to go through animal testing and small and large clinical trials in people. These stages are needed to make sure the vaccines work and are safe.
Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and co-director of the Texas Childrens Hospital Center for Vaccine Development, said you can only speed up animal and clinical trials so much.
In the end, these steps take time, he said. So thats going to be the rate-limiting step in determining whether theres going to be a vaccine available in time for this epidemic.
Hotez said there are some things you can do to make this testing go a little faster, like running some of the clinical trials in parallel. But in the end, youre still talking weeks to months, he said.
During the 2002-2003 SARS outbreak, it took about 20 months for a vaccine to be ready for testing in people.
By then, the outbreak had been contained with public health measures like isolating infected people, setting up quarantines, and identifying people who have come in contact with those who are sick.
These steps are already being done in the current outbreak. Whether these can contain 2019-nCoV depends on many factors, some of which are still unknown like how quickly the virus spreads and how serious the illness it causes is.
Not being able to predict how an outbreak is going to go, its always important to address the potential for vaccine development, said Andrus. When vaccines work, theyre excellent. In many cases, theyre the best way to prevent disease.
Even if a vaccine makes it through all the rounds of testing, its unlikely that drugmakers can manufacture enough vaccine to protect everyone who might be exposed to the virus.
Moderna, which currently has the largest manufacturing capacity of the three CEPI-funded groups, thinks it could produce 100 million doses in a year, according to Science.
That means health officials would need to prioritize who gets the vaccine. This is based on factors like who would have the most severe symptoms and who is most likely to spread the virus.
With the current outbreak, the World Health Organization estimates that only around 20 percent of people infected developed a serious illness.
Andrus says many of those who have died from infection have been older adults or those with chronic medical conditions. These are the people you would want to target with a vaccine.
Healthcare workers on the front lines of an outbreak are another group that you want to keep an eye on.
If healthcare workers become infected, they can amplify the outbreak because theyre in contact with so many patients, particularly individuals who might have chronic disease, said Andrus.
This is especially true since people can spread the virus even before they have symptoms.
Given that weve already had three coronavirus outbreaks since 2003, its clear that these beta-coronaviruses are going to become pretty regular phenomenon, said Hotez.
As a result, some experts say its time to develop a universal coronavirus vaccine that would work against all viruses in this family even the ones we dont know about yet.
Perlman said different types of coronaviruses share some of the same features, so a universal vaccine could theoretically be developed. But we know from efforts to develop HIV or influenza vaccines, that this is not easy, he said.
A universal vaccine, though, is not the only option to protect us from future outbreaks.
We may need to build up an infrastructure for coronaviruses that more or less resembles what we have for flu right now, said Hotez.
With flu, scientists continually monitor which influenza virus strains are active around the world. They then predict which ones will be active during the upcoming flu season and use this to develop the annual flu vaccine.
Coronaviruses are a little different, but Hotez thinks scientists could develop multiple vaccine candidates for use when an outbreak happens.
You could potentially have a coronavirus vaccine stockpiled and ready to go, he said. Even if its not a perfect match just like the flu vaccine isnt for the flu it could still do a lot to reduce hospitalization and mortality.
Coronaviruses without preventive vaccines are the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV), and thenovel coronavirus SARS-CoV-2, which causesCOVID-19 diseasein humans.
There are 5approaches currently being taken by various organizations deployingdifferent technologies to develop a vaccine against SARS-CoV-2.
As of March 16,2020, the US Food and Drug Administration has not approved any preventive or therapeutic vaccines for use against the SARS, MERS orSARS-CoV-2 coronaviruses.
The need for human coronavirusvaccines was first identified in the mid-1960s.Over the past 10 years, however, gaps in our scientific understanding remain.
The emergence of a highly pathogenic coronavirus (CoV) in the Middle East has sparked new interest in human coronaviruses around the world. MERS-CoVwas identified in 2012, almost 10 years after the highly fatal human SARS-CoVemerged from China in 2003.
During 2012, asubunit vaccine, RBD-S, started development to prevent severe acute respiratory syndrome (SARS) caused by SARS coronavirus (SARS-CoV), which is classified by the US NIH as a category C pathogen. This vaccine is comprised of a recombinant receptor-binding domain (RBD) of the SARS-CoV spike (S) protein and formulated on alum, together with a synthetic glucopyranosyl lipid A.
The initial coronavirus vaccine development effort (prototype RBD219 N1)was launched in 2012, by a research team which includedDr. Peter J. Hoetz, with Baylor Medical Center, in Houston, Texas.
Previous efforts to create a vaccine for SARS-CoV have utilized a number of approaches. In general, the potential vaccinescan be classified into six types: viral vector-based vaccine, DNA vaccine, subunit vaccine, nanoparticle-based vaccine, inactivated-whole virus vaccine and live-attenuated vaccine, which are discussed in detail.
Vaccines based on whole, inactivated SARS-CoV, spike subunits, recombinant viruses expressing SARS-CoV proteins, DNA plasmids expressing SARS-CoV proteins, or virus-like particles (VLPs) have all been testedin vitroandin vivo.
And research on MERS-CoV vaccination strategies is in the early stages. However, early studies using a modified vaccinia virus and spike subunit vaccines have been shown to induce MERS-CoV-neutralizing antibodies in mice.
An effective MERS-CoV vaccine is required to induce both robust humoral and cell-mediated immunities, particularly antibody responses are crucial for the survival of the vaccinated hosts (Du et al., 2016b). Previous studies indicated that the level of serum neutralizing antibodies correlated positively with the reduction of lung pathogenesis, which increased the survival of animals challenged with MERS-CoV (Zhao et al., 2015;Zhang et al., 2016). Therefore, most of the MERS-CoV vaccine candidates are still based on the full length or part of the S protein.
On February 5, 2020,JAMApublished a new study from genetic sequencing data, it appears that there was a single introduction into humans followed by the human-to-human virus spread. This novel virus shares 79.5% of the genetic sequence with SARS-CoV and has 96.2% homology to a bat coronavirus.In addition, 2019-nCoV shares the same cell entry receptor, ACE2, with SARS-CoV.
And on February 15, 2020, the CDC announced it hadgrown the COVID-19 virus in cell culture, which is necessary for further studies, including for additional genetic characterization. The cell-grown virus was sent to NIHsBEI Resources Repository for use by the broad scientific community to develop preventive and therapeutic vaccines.
Investigations are underway to determine the virus source, types of exposure that lead to infection, mode of transmission and the clinical pattern and course of the disease.
Content sourceson this webpage include, but are not limited to, the WHO, theCDC, industry studies, and clinicalTrials.gov. The content wasFact-Checked by Dr. Robert Carlson and other healthcare professionals on March 16, 2020. Precision Vax's digital network includes Coronavirus Today.com,Precision Vaccinations.com, Zika News.com, and Vax-Before-Travel.com.
As government response and public concern over Covid-19 ratchet up, the medical community is looking at two aspects. First, how much testing is optimal should we expand it beyond at-risk populations to fl atten the disease curve as South Korea has done, or does mass testing burden the healthcare system? Second, where do India and other countries stand in developing a vaccine?
ICMRS TESTING STRATEGY
INDIVIDUALS TESTED
WHERE ARE TESTS HAPPENING; AT WHAT COST?
Everything you need to know about COVID-19 vaccines.
COVID-19, the potentially fatal respiratory illness first detected in December 2019, has spread across the globe,forcing the cancellation of major events, postponing sports seasons and sending many into self-imposed quarantine. As health authorities and governments attempt to slow the spread, researchers are focusing their attention on the coronavirus that causes the disease: SARS-CoV-2.
Since it was first discovered as the causative agent of the new disease, scientists have been racing to get a better understanding of the virus' genetic makeup, how it infects cells and how to effectively treat it. Currently there's no cure, and medical specialists can only treat the symptoms of the disease. However, the long-term strategy to combat COVID-19, which has spread to every continent on Earth besides Antarctica, will be to develop a vaccine.
Developing new vaccines takes time, and they must be rigorously tested and confirmed safe via clinical trials before they can be routinely used in humans. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, has frequently stated that a vaccine is at least a year to 18 months away. Experts agree there's a ways to go yet.
Vaccines are incredibly important in the fight against disease. We've been able to keep a handful of viral diseases at bay for decades because of vaccine development. Even so, there exists confusion and unease about their usefulness. This guide explains what vaccines are, why they are so important and how scientists will use them in the fight against the coronavirus. As more candidates appear and are tested, we'll add them to this list, so bookmark this page and check back for the latest updates.
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A vaccine is a type of treatment aimed at stimulating the body's immune system to fight against infectious pathogens, like bacteria and viruses. They are,according to the World Health Organization, "one of the most effective ways to prevent diseases."
The human body is particularly resilient to disease, having evolved a natural defense system against nasty disease-causing microorganisms like bacteria and viruses. The defense system -- our immune system -- is composed of different types of white blood cells that can detect and destroy foreign invaders. Some gobble up bacteria, some produce antibodies which can tell the body what to destroy and take out the germs, and other cells memorize what the invaders look like, so the body can respond quickly if they invade again.
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Vaccines are a really clever fake-out. They make the body think it's infected so it stimulates this immune response. For instance, the measles vaccine tricks the body into thinking it has measles. When you are vaccinated for measles, your body generates a record of the measles virus. If you come into contact with it in the future, the body's immune system is primed and ready to beat it back before you can get sick.
The very first vaccine was developed by a scientist named Edward Jenner in the late 18th century. In a famous experiment, Jenner scraped pus from a milkmaid with cowpox -- a type of virus that causes disease mostly in cows and is very similar to the smallpox virus -- and introduced the pus into a young boy. The young boy became a little ill and had a mild case of cowpox. Later, Jenner inoculated the boy with smallpox, but he didn't get sick. Jenner's first injection of cowpox pus trained the boy's body to recognize the cowpox virus and, because it's so similar to smallpox, the young man was able to fight it off and not get sick.
Vaccines have come an incredibly long way since 1796. Scientists certainly don't inject pus from patients into other patients, and vaccines must abide by strict safety regulations, multiple rounds of clinical testing and strong governmental guidelines before they can be adopted for widespread use.
Vaccines contain a handful of different ingredients depending on their type and how they aim to generate an immune response. However, there's some commonality between them all.
The most important ingredient is the antigen. This is the part of the vaccine the body can recognize as foreign. Depending on the type of vaccine, an antigen could be molecules from viruses like a strand of DNA or a protein. It could instead be weakened versions of live viruses. For instance, the measles vaccine contains a weakened version of the measles virus. When a patient receives the measles vaccine, their immune system recognizes a protein present on the measles virus and learns to fight it off.
A second important ingredient is the adjuvant. An adjuvant works to amplify the immune response to an antigen. Whether a vaccine contains an adjuvant depends on the type of vaccine it is.
Some vaccines used to be stored in vials that could be used multiple times and, as such, contained preservatives that ensured they would be able to sit on a shelf without growing other nasty bacteria inside them. One such preservative is thimerosal, which has garnered a lot of attention because it contains trace amounts of easily cleared ethylmercury. Its inclusion in vaccines hasn't been shown to cause harm, according to the CDC. In places like Australia, single-use vials are now common, and thus preservatives such as thimerosal are no longer necessary in most vaccines.
In developing a vaccine for SARS-CoV-2, scientists need to find a viable antigen that will stimulate the body's immune system into defending against infection.
The pathogen at the center of the outbreak, SARS-CoV-2, belongs to the family of viruses known ascoronaviruses. This family is so named because, under a microscope, they appear with crownlike projections on their surface.
In developing a vaccine that targets SARS-CoV-2, scientists are looking at these projections intensely. The projections enable the virus to enter human cells where it can replicate and make copies of itself. They're known as "spike proteins" or "S" proteins. Researchers have been able to map the projections in 3D, and research suggests they could be a viable antigen in any coronavirus vaccine.
That's because the S protein is prevalent in coronaviruses we've battled in the past -- including the one that caused the SARS outbreak in China in 2002-03. This has given researchers a head start on building vaccines against part of the S protein and, using animal models, they've demonstrated they can generate an immune response.
There are many companies across the world working on a SARS-CoV-2 vaccine, developing different ways to stimulate the immune system. Some of the most talked about approaches are those using a relatively novel type of vaccine known as a "nucleic acid vaccine." These vaccines are essentially programmable, containing a small piece of genetic code to act as the antigen.
Biotech companies like Moderna have been able to generate new vaccine designs against SARS-CoV-2 rapidly by taking a piece of the genetic code for the S protein and fusing it with fatty nanoparticles that can be injected into the body. Imperial College London is designing a similar vaccine using coronavirus RNA -- its genetic code. Pennsylvania biotech company Inovio is generating strands of DNA it hopes will stimulate an immune response. Although these kinds of vaccines can be created quickly, none havs been brought to market yet.
Johnson & Johnson and French pharmaceutical giant Sanofi are both working with the US Biomedical Advanced Research and Development Authority to develop vaccines of their own. Sanofi's plan is to mix coronavirus DNA with genetic material from a harmless virus, whereas Johnson & Johnson will attempt to deactivate SARS-CoV-2, essentially switching off its ability to cause illness while ensuring it still stimulates the immune system.
Some research organizations, such as Boston Children's Hospital, are examining different kinds of adjuvants that will help amplify the immune response. This approach, according to the Harvard Gazette, will be targeted more toward the elderly, who don't respond as effectively when vaccinated. It's hoped that by studying adjuvants to boost a vaccine, the elderly can be vaccinated with a mix of ingredients that would supercharge their immunity.
Fauci, of the infectious diseases institute, posits that a vaccine is roughly a year and a half away, even though we're likely to see human trials start within the next month or two. This, according to a 60 Minutes interview with Fauci in March, is a fast turnaround.
"The good news is we did it more quickly than we've ever done it," Fauci told 60 Minutes. (Note: 60 Minutes and CNET share a common parent company, ViacomCBS.) "The sobering news is that it's not ready for prime time, for what we're going through now."
Why does vaccine production take so long? There are many steps involved and a lot of regulatory hurdles to jump through.
"For any medicine to be sold it needs to go through the standard process of clinical trials including phase 1 [to] 3 trials," said Bruce Thompson, dean of health at Swinburne University in Australia. "We need to ensure that the medicine is safe, will not do harm, and know how effective it is."
Scientists can't assume their vaccine design will just work -- they have to test, test and test again. They have to recruit thousands of people to ensure the safety of a vaccine and how useful it will be. The process can be broken down into six phases:
Traditionally, then, it could take a decade or more for a new vaccine to go from design to approval. In addition, once the regulatory processes have concluded a vaccine is safe, the drug companies have to send production into overdrive, so they can manufacture enough of the vaccine to increase immunity in the wider population.
With SARS-CoV-2, the process is being expedited in some instances. As STATnews reports, the vaccine in development by Moderna has moved from design straight into Phase I clinical trials of its mRNA vaccine, skipping tests in animal models. Those tests will take place at Seattle's Kaiser Permanente Washington Health Institute, and patients are now being enrolled.
Until that time, though, health workers, doctors and medical specialists must rely on current treatment options.
The best way to prevent illness is avoiding exposure. Those tips are below.
First: Antibiotics, medicine designed to fight bacteria, won't work on SARS-CoV-2, a virus. If you're infected, you will be asked to self-isolate, to prevent further spread of the disease, for 14 days. If symptoms escalate and you experience a shortness of breath, high fever and lethargy, you should seek medical care.
Treating cases of COVID-19 in the hospital is based on managing patient symptoms in the most appropriate way. For patients with severe disease adversely affecting the lungs, doctors place a tube into the airway so that they can be connected to ventilators -- machines which help control breathing.
There are no specific treatments for COVID-19 as yet, though a number are in the works, including experimental antivirals, which can attack the virus, and existing drugs targeted at other viruses like HIV which have shown some promise in treating COVID-19.
RemdesivirRemdesivir, an experimental antiviral made by biotech firm Gilead Sciences, has garnered a large part of the limelight. The drug has been used in the US, China and Italy, but only on a "compassionate basis" -- essentially, this drug hasn't received approval but can be used outside of a clinical trial on critically ill patients. Remdesivir isn't specifically designed to destroy SARS-CoV-2. Instead, it works by knocking out a specific piece of machinery in the virus, known as "RNA polymerase," which many viruses use to replicate. It has been shown in the past to be effective in human cells and mouse models.
Its effectiveness is still being debated, and much more rigorous study will be needed before this becomes a general treatment for SARS-CoV-2, if it does at all.
Other treatment optionsAn HIV medicine, Kaletra/Aluvia, has been used in China to treat COVID-19. According to a release by AbbVie, an Illinois-based pharmaceutical company, the treatment was provided as an experimental option for Chinese patients during "the early days" of fighting the virus. The company suggests it is collaborating with global health authorities including the Centers for Disease Control and Prevention and the World Health Organization.
A drug that has been used to treat malaria for around 70 years, chloroquine, has been floated as a potential candidate. It appears to be able to block viruses from binding to human cells and getting inside them to replicate. It also stimulates the immune system. A letter to the editor in journal Nature on Feb. 4 showed chloroquine was effective in combating SARS-CoV-2. A Chinese study emanating from Guangdong reports chloroquine improved patient outcomesand "might improve the success rate of treatment" and "shorten hospital stay."
It's not a good idea to rely on a vaccine to stop the spread of coronavirus because that's many months away. The best way to stop the spread, right now, is to continue practicing good personal hygiene and to limit interactions with others. "The best thing to do is the simple things like hand washing and hand sanitizing," Thompson said.
This outbreak is unprecedented, and changing behaviors is absolutely critical to stopping the spread.
There are a huge number of resources available from the WHO on protecting yourself against infection. It's clear the virus can spread from person to person, and transmission in communities has occurred across the world. Protection boils down to a few key things:
For much more information, you can head to CNET's guide
The coronavirus of 2019 has infected more than 155,000 people and claimed more than 5,000 lives. Some countries have closed their borders and discriminatory practices of xenophobia have swarmed their way into classrooms, the workplace, media and other institutions.
Hysteria, fear and anxiety have become the hallmarks of this growing epidemic since the first cases were reported in Wuhan, China. Exact incubation periods, profile of symptomatology and whether or not this is truly the first time coronavirus has been around are still in question. The anxiety surrounding this disease is even hampering the vitality of domestic and global economies. Last week, stocks tumbled for 7 consecutive days, with one of the sharpest declines occurring after President Trump gave a news conference earlier last week.
However, this writing wont be a political debate. It wont determine the fitness of Vice President Mike Pence to lead this national health emergencybut rather, will give needed attention to a public health and ethical concern.
Americans and other people around the world have been following the growing list of CDC guidelines. Weve been washing our hands for 20 seconds (approximate length of the Happy Birthday song sung twice), obeying travel restrictions, self-quarantining at the start of flu-like symptoms. Although these measures have potentially slowed the spread of the virus, an instrument to cease its transmission is needed. A vaccine would be the answer. Problem solved? Not quite.
On one hand, its estimated that a coronavirus vaccine may not be market-ready for approximately 1-2 years. On the other hand, according to U.S. Health and Human Services Secretary Alex Azar, the Trump administration cant promise that a vaccine will be affordable to all. Panicked and vulnerable Americans may not be able to get a preventative treatment to ensure their protection. A promising formula hasnt even made its way into a syringe yet, but somehow, has already been assigned an expensive price tag. Why so prematurely?
Market exclusivity appears to be a main culprit behind high drug prices in the U.S. As the coronavirus vaccine is in development, the first drug company to reach success in developing a vaccine will be granted a patent by the Food and Drug Administration (FDA), essentially ensuring several years of protected monopoly status and profit given it meets FDA qualifications. The presence of generic vaccines wont be a reality for several years, which is one of the most useful tactics in driving prices down.
Newsflash.America has seen this before. We have seen our best minds, resources and capital funneled towards public health crises. However, when the prized breakthrough is achieved, the less fortunate are the last in line to reap its benefits. For example, in 2013, the more effective drugs Solvaldi and Olysio were added to the market for treatment and cure of Hepatitis C, a viral infection that can cause liver damage and cancer.
A study in the Journal of Health & Biomedical Law highlighted the challenges patients face in getting these promising drugs within our complex healthcare system. Specifically, just one pill of Sovaldi costs approximately $1,000, which brings the total cost of the 12-week treatment to $84,000, according to the study. While patients with private insurance showed higher rates of denied authorization, even patients with Medicare and Medicaid faced strict restrictions when trying to access these drugs. Some need access to a primary care doctor, a hepatologist or to show proof that they do not use alcohol. This is a difficult laundry list for people to accomplish, particularly those who are a part of the lower economic class, with limited access to routine care or specialists who accept Medicaid.
What should be established as a low hanging and accessible fruit has been selfishly turned into a high-hanging potential source of disparity. I would argue that a medical practice or development fueled by a profitable end falls short of providing equitable access to healthcare. The practice of medicine exists for the expedient and efficient treatment of all, not the few with hefty pockets.
Although the warnings of HHS Secretary Azar and health care leaders may appear to simply be rhetoric at the moment, health disparities are not. Marginalized members of society will predictably carry the heaviest burden of this disease. Notably, Duke Health has been reported as the largest employer in Durham county, employing over 19,000 within its healthcare system. It can therefore be deduced that it is one of the largest contributors to not only the economy of Durham county, but the health of its residents. In light of its mission to deliver a healthier tomorrow, DukeHealth should not only investigate the epidemiology of this disease, but the access (or lack thereof) that residents may have to upcoming technologies and medical advances.
Whether private investors are called upon to make this vaccine a reality, which significantly drives up the cost, or not, the federal government should have the health and pockets of all in mind. To our public leaders and advisors, such as those with the federal Centers for Disease Control who are working on the front lines of this emerging pandemic: We, the people, are doing our part with adherence to guidelines that have been established to prevent transmission of COVID-19. We are hopeful that a vaccine would be economically accessible to everyone at risk. In the meantime, the subsidizing of coronavirus diagnostic tests and related treatment for non or underinsured people remains a reasonable public health response. Should the latter become a reality, our government can begin to match what has been its potential for centuries. Enabling the latter will begin to lessen the burdens of human finitude and show us what equitable human flourishing truly looks like.
Kirsten Simmons is a third-year medical student at Duke University School of Medicine. She is also completing a Masters of Health Science in Clinical Research and a Masters of Theological Studies at Duke University Divinity School as a Theology Medicine and Culture Fellow.
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First patient injected in trial of coronavirus vaccine
Updated: 2:11 PM EDT Mar 16, 2020
We all feel so helpless. This is an amazing opportunity for me to do something, said Jennifer Haller, 43, of Seattle.
We all feel so helpless. This is an amazing opportunity for me to do something, said Jennifer Haller, 43, of Seattle.
