Coronavirus (COVID-19)
Coronavirus (COVID-19) is a respiratory illness caused by a new virus. Symptoms range from a mild cough to pneumonia. Some people recover easily, others may get very sick very quickly. There is evidence that it spreads from person to person. Good hygiene can prevent infection.
Many coronavirus infections may be spread by people who have recently caught the virus and have not yet begun to show symptoms, scientists have found.
An analysis of infections in Singapore and Tianjin in China revealed that two-thirds and three-quarters of people respectively appear to have caught it from others who were incubating the virus but still symptom-free.
The finding has dismayed infectious disease researchers as it means that isolating people once they start to feel ill will be far less effective at slowing the pandemic than had been hoped.
“This is one of the first things we were worried about when the outbreak began,” said Steven Riley, professor of infectious disease dynamics at Imperial College London, who was not involved in the work. “It was certainly unhoped for. This is one thing we really didn’t want to go this way.”
Researchers in Belgium and the Netherlands drew on data from outbreaks in Singapore and Tianjin to work out the “generation interval” for Covid-19. The generation interval is the time between one person getting infected and them infecting another. The figure is valuable for estimating the speed at which an outbreak will unfold.
The mean generation interval was 5.2 days in the Singapore cluster and 3.95 days in the China cluster, according to the analysis which is under review at an infectious disease journal. The scientists went on to calculate what proportion of infections were likely spread from people who were still incubating the virus and had yet to develop symptoms.
There are uncertainties in the figures because the scientists did not have precise information on who infected whom in the two clusters of disease. But even the lowest estimates show there was substantial transmission of coronavirus from people who had yet to fall ill.
In the Singapore cluster, between 45% and 84% of infections appeared to come from people incubating the virus. In China, the figures ranged from 65% to as much as 87%.
Tapiwa Ganyani, a researcher on the team, said the numbers suggest that isolating sick people would not be enough to quell the outbreak. “It is unlikely that these measures alone will suffice to control the Covid-19 epidemic,” he said. “Additional measures, such as social distancing, are required.”
The finding confirms recent comments from Maria Van Kerkhove, head of the World Health Organization’s emerging diseases and zoonoses unit, who said preliminary data showed patients shed more virus in the early stages of the disease, including when presymptomatic. A separate study that tracked nine patients in Germany found that levels of the virus might already be in decline when symptoms come on.
“The number helps us estimate how likely certain kinds of public health interventions are to work,” said Riley. “If you ask people to go home when they feel ill and they have infected half the people they are going to infect before they feel ill, then you know you are not going to get rid of those transmissions.” But he said it was still important to isolate those with symptoms, even if it would not be enough to stop the outbreak.
Ganyani stressed that the study looked at outbreaks where quarantine and other containment measures were already in place, which inflates the proportion of infections from presymptomatic people. “If control measures are less strict you would expect this estimate to be lower, but the number of secondary cases to be higher on average,” he said.
Rowland Kao, who studies infectious disease dynamics at the University of Edinburgh, said: “One of the factors that has distinguished this coronavirus pandemic from the Sars epidemic in 2003, is that Sars was infectious only after the development of clinical signs, which made it relatively easier to control. For the current pandemic, from very early on it was suspected that a substantial number of transmissions were arising before clinical signs appeared.
“What is important to know is that, in their analysis, isolation can play an important and possibly crucial role but needs to be supplemented by other measures,” he added.
Additional reporting by Hannah Devlin
Hong Kong and Singapore were hit early with the coronavirus. But each now has fewer than 200 cases, while France, Germany and Spain, which were hit late, all have more than 10 times that number.
Three weeks ago, Italy had only three cases. Now it has more than 10,000.
These dramatic differences show that how governments respond to this virus matters, says Mike Ryan, the World Health Organization's head of emergencies.
"Hope is not a strategy," says Ryan, who is an epidemiologist. "We are still very much in the up cycle of this epidemic."
The veteran of numerous global health crises, from SARS to bird flu to Ebola, Ryan points out that incredibly aggressive measures by China, South Korea and Japan appear to be bringing outbreaks in those countries under control.
"There's clearly an indication that a systematic government-led approach using all tactics and all elements available seems to be able to turn this disease around," he says.
He has been pleading with governments around the world to prepare for the new coronavirus before it shows up at their door — or to spring into action when it does arrive.
That's what Hong Kong and Singapore did.
Both quickly set up systems to try to identify and treat every case in their territory. Hong Kong developed diagnostic tests and rapidly deployed them to labs at every major hospital in the city. At one point in February, Hong Kong had 12,000 people in quarantine. Singapore's prime minister called for calm and assured residents that all health care related to the disease would be free.
Both Hong Kong and Singapore continue to find a few new cases each week, but they've avoided the explosive outbreaks that have occurred elsewhere.
Ashish Jha, who runs the Harvard Global Health Institute, says the response to the coronavirus has varied dramatically around the world. "Some countries have been very aggressive and have actually done quite a good job," he says. "Other countries have been quite lackadaisical and, I think, have suffered immensely from it. And I think there are lessons to be learned for all of us."
Italy and Iran both fall in the latter category. Jha says that before cases of COVID-19 were first diagnosed, Italy and Iran appeared to be in denial about the disease.
"I mean, you had the Iran deputy health minister coughing on national television talking about coronavirus," Jha says. "But really not taking it seriously."
That deputy health minister later tested positive for the virus.
As people started to get sick, neither Italy nor Iran did much testing. They were slow to stop mass gatherings. Eventually both countries were overwhelmed with cases.
So how has the United States' response been?
"Our response is much, much worse than almost any other country that's been affected," Jha says.
He uses the words "stunning," "fiasco" and "mind-blowing" to describe how bad it is.
"And I don't understand it," he says incredulously. "I still don't understand why we don't have extensive testing. Vietnam! Vietnam has tested more people than America has." (He's citing data from earlier this week. The U.S. has since started testing more widely, although exact figures still aren't available at a national level.)
The Centers for Disease Control and Prevention started screening overseas travelers for coronavirus in mid-January. But the initial test kits developed by the CDC were flawed, and it took weeks to sort out the problems. It's only this week that wide-scale testing has started to become available in the United States.
Jha believes that the weekslong delay in deploying tests — at a time when numerous other tests were available around the world — has completely hampered the U.S. response to this crisis.
"Without testing, you have no idea how extensive the infection is. You can't isolate people. You can't do anything," he says. "And so then we're left with a completely different set of choices. We have to shut schools, events and everything down, because that's the only tool available to us until we get testing back up. It's been stunning to me how bad the federal response has been."
He says right now there are probably five to 10 times as many cases out in the community as have actually been detected. Until these individuals are found, they are likely to infect more people, he says, and the outbreak in the United States is just going to continue to grow.
Hong Kong, which began testing in January and has been right up against the epicenter of the global outbreak, had only confirmed 126 cases through March 10. On that same day the U.S. reported twice that number for the previous 24 hours.
Watch for symptoms
Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.
The following symptoms may appear 2-14 days after exposure.*
- Fever
- Cough
- Shortness of breath
Call your doctor if you…
Develop symptoms, and have been in close contact with a person known to have COVID-19
OR
Have recently traveled from an area with widespread or ongoing community spread of COVID-19.
How to protect yourself
What to do if you are sick
The novel coronavirus that causes the disease COVID-19 has spread from the site of the original outbreak in China to affect 75 countries around the world. If effective controls aren't put into place, COIVID-19 could ultimately infect between 40% and 70% of the population worldwide in the coming year, according to Harvard T.H. Chan School of Public Health epidemiologist Marc Lipsitch.
Most of those cases would be mild, and some people might show no symptoms at all. But the prospect of being infected with a new virus can be frightening. The symptoms to look out for, according to the Centers for Disease Control and Prevention (CDC), are fever, coughing and shortness of breath. These symptoms usually appear between two days and two weeks of exposure to the virus.
According to a report in the Journal of the American Medical Association, as many as 98% of COVID-19 patients have a fever, between 76% and 82% have a dry cough, and 11% to 44% report exhaustion and fatigue.
In more serious cases of COVID-19, patients experience pneumonia, which means their lungs begin to fill with pockets of pus or fluid. This leads to intense shortness of breath and painful coughing.
Currently, testing for the virus that causes COVID-19 in the United States is limited to people with severe symptoms, according to Paul Biddinger, the director of the emergency preparedness research, evaluation and practice program at the Harvard T.H. Chan School of Public Health, who spoke in a university webcast March 2. This means that it isn't appropriate to be tested at the first sign of a fever or sniffle. Seeking medical care for mild illness can also potentially transmit that illness, or lead to catching new illnesses in the hospital or clinic, Biddinger added.
If you become ill with these symptoms and live in or have traveled to an area where COVID-19 is spreading, which now includes parts of the U.S., the CDC recommends calling your doctor first rather than traveling to a clinic. Physicians work with state health departments and the CDC to determine who should be tested for the new virus. However, the CDC also recommends that people with COVI-19 or any respiratory illness monitor their symptoms carefully. Worsening shortness of breath is reason to seek medical care, particularly for older individuals or people with underlying health conditions. The CDC information page has more information on what to do if you are sick.
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Coronavirus basics
The novel coronavirus, now called SARS-CoV-2, causes the disease COVID-19. The virus was first identified in Wuhan, China, on Dec. 31, 2019. Since then, it has spread to every continent except Antarctica. The death rate appears to be higher than that of the seasonal flu, but it also varies by location as well as a person's age, underlying health conditions, among other factors. For instance, in Hubei Province, the epicenter of the outbreak, the death rate reached 2.9%, whereas it was just 0.4% in other provinces in China, according to a study published Feb. 18 in the China CDC Weekly.
Scientists aren't certain where the virus originated, though they know that coronaviruses (which also include SARS and MERS) are passed between animals and humans. Research comparing the genetic sequence of SARS-CoV-2 with a viral database suggests it originated in bats. Since no bats were sold at the seafood market in Wuhan at the disease’s epicenter, researchers suggest an intermediate animal, possibly the pangolin (an endangered mammal) is responsible for the transmission to humans. There are currently no treatments for the disease, but labs are working on various types of treatments, including a vaccine.
Coronavirus: COVID-19 Is Now Officially A Pandemic, WHO Says
Updated at 3:20 p.m. ET
The COVID-19 viral disease that has swept into at least 114 countries and killed more than 4,000 people is now officially a pandemic, the World Health Organization announced Wednesday.
"This is the first pandemic caused by coronavirus," WHO Director-General Tedros Adhanom Ghebreyesus said at a briefing in Geneva.
It's the first time the WHO has called an outbreak a pandemic since the H1N1 "swine flu" in 2009.
Even as he raised the health emergency to its highest level, Tedros said hope remains that COVID-19 can be curtailed. And he urged countries to take action now to stop the disease.
"WHO has been in full response mode since we were notified of the first cases," Tedros said. "And we have called every day for countries to take urgent and aggressive action. We have rung the alarm bell loud and clear."
A newly identified coronavirus SARS-CoV-2 is spreading across the globe. Here's what you need to know about the virus and the disease it causes, called COVID-19.
Update on Wednesday, March 11 (ET):
—1st coronavirus death in New Jersey in a man in his 60s from Bergen County. There are more than 1,000 confirmed coronavirus cases in the U.S.
—There are now 29 coronavirus deaths in the U.S., with the first death linked to the virus in South Dakota being reported. (Other deaths: 23 in Washington, 2 in California, 2 in Florida and 1 in New Jersey).
—There are 4,368 deaths linked to the virus worldwide. Deaths worldwide exceed those from SARS. And 66,216 individuals have recovered from COVID-19.
—There are 121,061 confirmed coronavirus cases worldwide, with more cases popping up outside China than inside.
—Additional cases have been confirmed in New York, bringing the state's total to 190 as of Wednesday (Mar. 11). Mayor Bill de Blasio reported that 46 cases have been confirmed in New York City, according to the Times. Both New York and New Jersey have declared a state of emergency.
—Three Transportation Security Administration (TSA) officers at Mineta San Jose International Airport have tested positive for COVID-19, according to the San Jose Mercury News. The infected officers are receiving medical care and all TSA employees they've recently come in contact with have been directed to self-quarantine at home for the next 14 days.
—78 state and local public health labs in the U.S. now have the capacity to test 75,000 people for COVID-19 using CDC diagnostic test kits, Dr. Nancy Messonnier, Director of the National Center for Immunization and Respiratory Diseases, announced in a press briefing on Mar. 9.
—The Grand Princess cruise ship, holding 3,500 people with 21 who have tested positive for the coronavirus, docked off Oakland, California, and began disembarking passengers on Monday (March 9) and Tuesday (March 10).
—Italy's Prime Minister Guiseppe Conte announced Monday (March 9) a lockdown of the entire country, describing the measure as "I stay home."
—The South by Southwest (SXSW) festival in Austin, Texas, has been cancelled due to coronavirus concerns. The event, which was to take place March 13–22, typically attracts hundreds of thousands of people.
—The University of Washington in Seattle was the first U.S. college to cancel in-person classes due to coronavirus starting Monday (March 9). Other U.S. colleges have since followed suit, including Columbia, Harvard and Stanford University.
—WHO director-general calls on countries to take the outbreaks seriously and that "this is not a time for excuses."
—The U.S. has approved $8.3 billion in emergency funding for the country's coronavirus response.
—Hubei Province, where the outbreak began, reported no new COVID-19 cases on Friday (March 6), the first day without any new infections being reported, The New York Times reported.
—A dog in China whose owner has a confirmed case of COVID-19 has tested 'weak positive' for the virus, experts confirmed.
—The global mortality rate for COVID-19 is 3.4%, WHO said on March 2. This virus causes more severe illness than the flu, but doesn't spread as efficiently, the director-general said.
What are the symptoms this coronavirus causes?
The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. Recovery depends on the strength of the immune system. Many of those who have died were already in poor health.
Should I go to the doctor if I have a cough?
In the UK, the medical advice is that if you have recently travelled from areas affected by coronavirus, you should:
- stay indoors and avoid contact with other people as you would with the flu
- call NHS 111 to inform them of your recent travel to the area
More NHS advice on what to do if you think you have been exposed to the virus can be found here, and the full travel advice to UK nationals is available here.
Is the virus being transmitted from one person to another?
China’s national health commission confirmed human-to-human transmission in January, and there have been such transmissions elsewhere.
How many people have been affected?
As of 12 March, more than 125,000 people have been infected in more than 80 countries, according to the Johns Hopkins University Center for Systems Science and Engineering.
There have over 4,600 deaths globally. Just over 3,000 of those deaths have occurred in mainland China. 68,000 people have recovered from the coronavirus.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. Seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Another key unknown is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.
Have there been other coronaviruses?
Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In 2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.
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thanks for advice
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