COVID-19 pandemic

The COVID-19 pandemic, also

known as the coronavirus COVID-19 pandemic
pandemic, is an ongoing global
pandemic of coronavirus disease 2019
(COVID-19), caused by severe acute
respiratory syndrome coronavirus 2
(SARS-CoV-2).[1] The outbreak was
first identified in Wuhan, China, in
December 2019.[4][6] The World Health
Organization declared the outbreak a
Public Health Emergency of
International Concern on 30 January Confirmed cases per 100,000 population as of 22 June 2020:
2020, and a pandemic on 11
March.[7][8] As of 22 June 2020, more    >1,000    10–30
than 9 million cases of COVID-19 have    300–1,000    0–10
been reported in more than 188
countries and territories, resulting in    100–300    None or no data
more than 469,000 deaths; more than    30–100
4.46 million people have recovered.[5]

The virus is primarily spread between Total confirmed cases [show]

people during close contact,[c] most
often via small droplets produced by
coughing,[d] sneezing, and
talking.[9][10][12] The droplets usually
fall to the ground or onto surfaces
rather than travelling through air over
long distances.[9] However, research as
of June 2020 has shown that speech-
generated droplets may remain
airborne for tens of minutes.[13] Less Map of total confirmed cases as of 22 June 2020
commonly, people may become infected    1,000,000+
by touching a contaminated surface and    100,000–999,999
then touching their face.[9][10] It is most
   10,000–99,999
contagious during the first three days
after the onset of symptoms, although    1,000–9,999
spread is possible before symptoms    100–999
appear, and from people who do not
   1–99
show symptoms.[9][10]
   None or no data
Common symptoms include fever,
cough, fatigue, shortness of breath, and Confirmed deaths (per 1,000,000 population) [show]
loss of sense of smell.[9][14][15]
Complications may include pneumonia
and acute respiratory distress
syndrome. [16] The time from exposure
to onset of symptoms is typically
around five days but may range from
two to fourteen days.[17][18] There is no
known vaccine or specific antiviral
treatment.[9] Primary treatment is
symptomatic and supportive
therapy.[19]
Map of confirmed deaths per capita as of 22 June 2020

Recommended preventive measures    100+

include hand washing, covering one's    10–100
mouth when coughing, maintaining    1–10
distance from other people, wearing a
face mask in public settings, and    0.1–1
monitoring and self-isolation for people    >0–0.1
who suspect they are infected.[9][20]    None or no data
Authorities worldwide have responded
by implementing travel restrictions, Confirmed cases (per capita interactive timeline) [show]
lockdowns, workplace hazard controls,
and facility closures. Many places have
also worked to increase testing capacity ▶
and trace contacts of infected persons.

The pandemic has caused global social

and economic disruption,[21] including
the largest global recession since the
Great Depression.[22] It has led to the
postponement or cancellation of
sporting, religious, political, and Timeline map of confirmed cases per capita
cultural events,[23] widespread supply (drag circle to adjust; may not work on mobile)
shortages exacerbated by panic See larger version
buying, [24][25][26] and decreased    10,000+
emissions of pollutants and greenhouse
   1,000–10,000
gases.[27][28] Schools, universities, and
colleges have been closed either on a    100–1,000
nationwide or local basis in 172    >0–100
countries, affecting approximately 98.5
   None or no data
percent of the world's student
population.[29] Misinformation about
the virus has circulated through social
media and the mass media.[30] There
have been incidents of xenophobia and
discrimination against Chinese people
and against those perceived as being
Chinese or as being from areas with
high infection rates.[31][32][33]

Contents
Epidemiology
Background
Cases
Deaths
Duration
Signs and symptoms
Cause
Transmission
Virology
Diagnosis
Viral testing Top to bottom:
Imaging A nurse caring for a COVID-19 patient in an intensive care unit aboard
a U.S. hospital ship · The Italian government's outbreak task force ·
Prevention
Disinfection vehicles in Taipei · Temporary graves in Iran · Low stock in
Hand washing
an Australian supermarket due to panic buying
Surface cleaning
Face masks and respiratory Disease Coronavirus disease 2019 (COVID-19)
hygiene Virus strain Severe acute respiratory syndrome
Social distancing coronavirus 2 (SARS‑CoV‑2)[a]
Self-isolation
Source Probably bats, possibly via pangolins[2][3]
Management
Location Worldwide
Screening, containment and
mitigation First outbreak China[4]
Health care Index case Wuhan, Hubei, China
Treatment 30°37′11″N 114°15′28″E

History Date 1 December 2019[4] – present

(6 months and 3 weeks)
National responses
Asia Confirmed cases 9,003,042[5][b]
Europe Active cases 4,068,397[5]
North America Recovered 4,465,425[5]
South America
Deaths 469,220[5]
Africa
Territories 188[5]
Oceania
International responses
Travel restrictions
Evacuation of foreign citizens
International aid
WHO response measures
Impact
Economics
Culture
Politics
Education
Other health issues
 Environment and climate
Xenophobia and racism
Information dissemination
Misinformation
See also
Notes
References
External links Play media
Health agencies Video summary (script) on the coronavirus disease
Directories (4:12 min)
Data and graphs
Medical journals

Epidemiology

Background

On 31 December 2019, health authorities in China reported to the World Health Organization (WHO) a
cluster of viral pneumonia cases of unknown cause in Wuhan, Hubei,[330][331] and an investigation was
launched in early January 2020.[332] On 30 January, the WHO declared the outbreak a Public Health
Emergency of International Concern (PHEIC)—7,818 cases confirmed globally, affecting 19 countries in
five WHO regions.[333][334]

Several of the early cases had visited Huanan Seafood Wholesale Market[335] and so the virus is thought
to have a zoonotic origin.[336] The virus that caused the outbreak is known as SARS-CoV-2, a newly
discovered virus closely related to bat coronaviruses,[337] pangolin coronaviruses,[338][339] and SARS-
CoV.[340] The scientific consensus is that COVID-19 has a natural origin.[341][342] The probable bat-to-
human infection may have been among people processing bat carcasses and guano in the production of
traditional Chinese medicines.[343]

The earliest known person with symptoms was later discovered to have fallen ill on 1 December 2019,
and that person did not have visible connections with the later wet market cluster.[344][345] Of the early
cluster of cases reported that month, two-thirds were found to have a link with the market.[346][347][348]
On 13 March 2020, an unverified report from the South China Morning Post suggested a case traced
back to 17 November 2019 (a 55-year-old from Hubei) may have been the first person infected.[349][350]

The WHO recognized the spread of COVID-19 as a pandemic on 11 March 2020 [351] as Italy, Iran, South
Korea, and Japan reported surging cases. The total numbers outside China quickly passed China's.[352]

Cases

Cases refer to the number of people who have been tested for COVID-19, and whose test has been
confirmed positive according to official protocols.[353] As of 24 May, countries that publicised their
testing data have typically performed many tests equal to 2.6 percent of their population, while no
country has tested samples equal to more than 17.3 percent of its population.[354] Many countries, early
on, had official policies to not COVID-19 pandemic by country and territory
test those with only mild
Location[e] Cases[b] Deaths[f] Recov.[g] Ref.
symptoms.[355][356] An analysis
of the early phase of the World[h] 9,003,042 469,220 4,465,425 [5]

outbreak up to 23 January United States[i] 2,324,956 121,766 721,716 [41]

estimated 86 percent of COVID- Brazil[j] 1,086,990 50,659 543,186 [45][46]

19 infections had not been Russia[k] 592,280 8,206 344,416 [47]

[48]
detected, and that these India 425,282 13,699 237,196
undocumented infections were United Kingdom[l] 305,289 42,647 No data [50][51]
[52][53]
the source for 79 percent of Peru 254,936 8,045 141,967
documented cases.[357] Several Chile[m] 246,963 4,502 No data [55]

other studies, using a variety of Spain[n] 246,272 28,322 150,376 [56]

methods, have estimated that Italy 238,499 34,634 182,893 [57][58]

numbers of infections in many Iran 207,525 9,742 166,427 [59]

countries are likely to be Germany[o] 191,576 8,961 174,885 [61][60]

considerably greater than the Turkey 187,685 4,950 160,240 [62]

reported cases.[358][359] Pakistan 181,088 3,590 71,458 [63]

Mexico 180,545 21,825 135,279 [64][65]

On 9 April 2020, preliminary France[p] 160,377 29,640 74,372 [66]
results found that 15 percent of Saudi Arabia 157,612 1,267 101,130 [67]
people tested in Gangelt, the Bangladesh 112,306 1,464 45,077 [68]
centre of a major infection Canada 101,337 8,430 63,886 [69]
cluster in Germany, tested South Africa 97,302 1,930 51,608 [70]
positive for antibodies.[360] Qatar 87,369 98 68,319 [71]
Screening for COVID-19 in China[q] 83,396 4,634 78,413 [72]

pregnant women in New York Colombia 68,652 2,237 27,360 [73]

City, and blood donors in the Belgium[r] 60,550 9,696 16,771 [75]
Netherlands, has also found Belarus 59,023 351 37,923 [76]
rates of positive antibody tests Sweden 56,043 5,053 No data [77]
that may indicate more Egypt[s] 55,233 2,193 14,736 [78]
infections than Ecuador 50,640 4,223 5,040 [79]
reported. [361][362] However, Netherlands[t] 49,593 6,090 No data [81]
such antibody surveys can be Indonesia 46,845 2,500 18,735 [82]
unreliable due to a selection United Arab Emirates 44,925 302 32,415 [83]
bias in who volunteers to take Argentina[u] 42,772 1,011 12,715 [85]
the tests, and due to false Singapore 42,313 26 35,590 [86][87]
positives. Some results (such as Kuwait 39,650 326 31,240 [88]
the Gangelt study) have Portugal 39,133 1,530 25,376 [89]
received substantial press Ukraine[v] 36,560 1,002 16,509 [90]
coverage without first passing Poland 31,931 1,356 16,683 [91][92]
through peer review.[363] Switzerland 31,292 1,680 29,000 [93][94]

Iraq 30,868 1,100 13,935 [95]

Analysis by age in China [96][97]
Philippines 30,682 1,177 8,143
indicates that a relatively low [98]
Oman 29,471 131 15,552
proportion of cases occur in [99]
Afghanistan 28,833 581 8,764
individuals under 20.[364] It is [100]
Dominican Republic 26,677 662 15,138
not clear whether this is [101]
Panama 26,030 501 14,359
because young people are less [102]
Ireland 25,383 1,717 23,308
likely to be infected, or less [103]
Romania 24,045 1,512 16,911
likely to develop serious [104]
Bolivia 23,512 740 5,086
symptoms and seek medical [105]
Bahrain 21,764 63 16,419
attention and be tested.[365] A
retrospective cohort study in Israel[w] 20,778 306 15,694 [106]
[107]
China found that children were Armenia 20,268 350 9,002
[108]
as likely to be infected as Nigeria 20,244 518 6,879
adults.[366] Countries that test Japan[x] 17,799 953 16,108 [109]
[110]
more, relative to the number of Kazakhstan 17,732 120 10,897
[111]
deaths, have a younger age Austria 17,341 690 16,197
distribution of cases, relative to Moldova[y] 14,200 473 7,896 [112]
[113]
the wider population.[367] Ghana 14,007 85 10,473
Serbia[z] 12,894 261 11,348 [114]

Initial estimates of the basic Guatemala 12,755 514 2,558 [115]

reproduction number (R0) for Azerbaijan[aa] 12,729 154 6,799 [116]

[117]
COVID-19 in January were South Korea 12,438 280 10,881
between 1.4 and 2.5,[368] but a Denmark[ab] 12,391 600 11,282 [118]
[119]
subsequent analysis concluded Honduras 12,250 358 1,275
[120][121]
that it may be about 5.7 (with a Algeria 11,920 852 8,559
[122][123]
95 percent confidence interval Cameroon 11,892 303 7,710
of 3.8 to 8.9).[369] R0 can vary Czech Republic 10,498 336 7,499 [124]

across populations and is not to Morocco[ac] 9,977 214 8,284 [126]

[127][128]
be confused with the effective Nepal 9,026 23 1,579
reproduction number Norway[ad] 8,745 244 8,138 [131]
[132]
(commonly just called R), which Sudan 8,580 521 3,325
[133]
takes into account effects such Malaysia 8,572 121 8,156
[134]
as social distancing and herd Ivory Coast 7,492 54 3,068
immunity. By mid-May 2020, Australia[ae] 7,459 102 6,896 [135]

the effective R was close to or Finland[af] 7,143 326 6,200 [138]

[139]
below 1.0 in many countries, Uzbekistan 6,358 19 4,377
[140]
meaning the spread of the Senegal 5,888 55 3,919
disease in these areas at that DR Congo[ag] 5,826 130 841 [141]
[142]
time was stable or Tajikistan 5,457 52 3,995
[370] North Macedonia 5,106 238 1,926 [143][144]
decreasing.
Haiti 5,077 88 24 [145]

Guinea 4,988 28 3,669 [146]

Kenya 4,738 123 1,607 [147]

El Salvador 4,626 98 2,535 [148]

Djibouti 4,582 45 3,859 [149]

Ethiopia 4,532 74 1,213 [150]

Gabon 4,428 34 1,750 [151]

Luxembourg 4,120 110 3,956 [152]

Hungary 4,102 572 2,590 [153]

Bulgaria 3,872 199 2,027 [154]

Venezuela 3,790 33 835 [155][156]

Bosnia and Herzegovina 3,273 169 2,241 [157]

Greece 3,266 190 1,374 [158]

Kyrgyzstan 3,151 37 2,011 [159]

Thailand 3,151 58 3,022 [160]

Mauritania 2,984 111 811 [161]

Central African Republic 2,808 23 472 [162]

Somalia[ah] 2,779 90 782 [163]

Croatia 2,317 107 2,142 [164]

Cuba[ai] 2,312 85 2,103 [165]

Costa Rica 2,213 12 1,032 [166]

Maldives 2,203 8 1,803 [167]

Estonia 1,981 69 1,758 [168]

Albania 1,962 44 1,134 [169]

Sri Lanka 1,951 11 1,526 [170]

Mali 1,933 109 1,255 [171]

South Sudan 1,892 34 169 [172][173]

Iceland 1,823 10 1,805 [174]

Nicaragua 1,823 64 1,238 [91][175]

Lithuania 1,798 76 1,475 [176]

Equatorial Guinea 1,664 32 515 [177]

Madagascar 1,596 14 655 [178]

Lebanon 1,587 32 1,068 [179]

Slovakia 1,587 28 1,447 [180]

Guinea-Bissau 1,541 17 153 [181]

Puerto Rico 1,533 149 850 [182]

Slovenia 1,520 109 1,359 [183][184]

Kosovo 1,486 33 953 [185]

Zambia 1,430 11 1,194 [186][187]

Paraguay 1,379 13 7871 [188]

Sierra Leone 1,327 55 788 [189][190]

New Zealand 1,163 22 1,132 [191]

Tunisia 1,157 50 1,020 [192]

Hong Kong 1,132 5 1,078 [193]

Latvia 1,111 30 903 [91][194]

USS Theodore Roosevelt[aj] 1,102 1 751 [195][196]

Charles de Gaulle[ak] 1,081 0 0 [197]

Niger 1,036 67 911 [201]

Jordan 1,033 9 739 [202]

Donetsk PR[al] 1,003 60 278 [203]

Cyprus[am] 986 19 824 [204]

Yemen 941 256 347 [205]

Georgia[an] 908 14 761 [206]

Burkina Faso 903 53 814 [207][208]

Cape Verde 890 8 377 [209]

Congo[ao] 883 27 391 [210][211]

Uruguay[ap] 876 25 814 [212]

Andorra 855 52 792 [213]

Chad 858 74 752 [214]

Palestine 833 3 439 [215]

Uganda 770 0 578 [216][217]

Benin 765 13 253 [218]

Mozambique 733 5 181 [219]

Malawi 749 11 258 [220]

Rwanda 728 2 359 [221][222]

Diamond Princess[x] 712 14 653 [223][224]

São Tomé and Príncipe 698 12 203 [225]

San Marino 696 42 610 [226]

Malta 665 9 616 [227]

Jamaica 657 10 462 [228]

Eswatini 635 5 285 [229]

Liberia 626 34 254 [230]

Libya 571 10 103 [231][232]

Togo 569 13 375 [233]

Somaliland[aq] 550 27 64 [234][235]

Tanzania[ar] 509 21 183 [237][238]

Zimbabwe 489 4 64 [239][240]

Luhansk PR[al] 469 11 420 [241]

Taiwan[as] 446 7 434 [243]

Montenegro 362 9 315 [244]

Vietnam 349 0 327 [245]

Mauritius 337 10 326 [246]

Isle of Man[at] 336 24 312 [247]

Jersey 318 31 297 [248]

Suriname 314 8 106 [249]

Myanmar 290 6 200 [250]

Guernsey 252 13 238 [251]

Comoros 247 5 159 [252]

Guam[aj] 222 5 170 [41][253]

Mongolia 206 0 139 [254]

Syria[au] 204 7 83 [255]

Cayman Islands 195 1 143 [256]

Faroe Islands 187 0 187 [257]

Guyana 184 12 103 [258]

Angola 183 9 77 [259]

Gibraltar 176 0 174 [260]

Costa Atlantica 148 0 148 [261][262]

Bermuda 146 9 132 [263]

Burundi 144 1 93 [264]

Eritrea 143 0 39 [265]

Brunei 141 3 138 [266][267]

Cambodia 129 0 127 [268]

Greg Mortimer[ap] 128 1 No data [269][270]

Trinidad and Tobago 117 8 109 [271]

Northern Cyprus[av] 108 4 104 [272]

Bahamas 104 11 74 [273]

Aruba 101 3 98 [274]

Monaco 100 4 94 [275]

Barbados 97 7 85 [276]

Artsakh[aw] 96 0 58 [277]

Botswana 89 1 25 [278]

Liechtenstein 82 1 55 [279][280]

South Ossetia[ax] 81 0 43 [277]

Sint Maarten 77 15 62 [281]

U.S. Virgin Islands 76 6 64 [282]

Bhutan 68 0 28 [283]

Namibia 63 0 21 [284][285]

French Polynesia 60 0 60 [286]

Macau 45 0 45 [287]

Abkhazia[ay] 38 1 27 [277]

The Gambia 37 2 24 [288]

Northern Mariana Islands 30 2 19 [289]

Saint Vincent[az] 29 0 26 [290][291]

Antigua and Barbuda 26 3 22 [292][293]
East Timor 24 0 24 [294]

Curaçao 23 1 19 [295]

Grenada 23 0 23 [296][297]
Belize 22 2 17 [298]

New Caledonia 21 0 21 [299]

Laos 19 0 19 [300]

Saint Lucia 19 0 18 [301][302]

Fiji 18 0 18 [303]

Dominica 18 0 16 [304]

Saint Kitts and Nevis 15 0 15 [305]

Turks and Caicos Islands 14 1 11 [306]

Falkland Islands 13 0 13 [307]

Greenland 13 0 13 [308]

MS Zaandam[ba] 13 4 No data [311][312]

Coral Princess [bb] 12 3 No data [314]

Vatican City 12 0 12 [315]

Montserrat 11 1 10 [316]

Seychelles 11 0 11 [317]

Papua New Guinea 9 0 8 [318]

British Virgin Islands 8 1 7 [319]

HNLMS Dolfijn[bc] 8 0 8 [320][323]

Lesotho 4 0 2 [324]

Anguilla 3 0 3 [325]

Saba 3 0 3 [326]

Bonaire 2 0 2 [327]

Sint Eustatius 2 0 2 [328]

Saint Pierre and Miquelon 1 0 1 [329]

As of 22 June 2020 (UTC) · History of cases: China, international

For notes, see the Notes section.

Epidemic curve of COVID-19 by date of report

 Semi-log graph showing the total Semi-log plot of daily new cases of
(cumulative) number of confirmed cases COVID-19 (seven-day average) in the
from the first reported date for the ten world and top five current countries
most affected countries[371] (mean with deaths)

Semi-log plot of cases in some countries Seven-day rolling average of daily

with high growth rates (post-China) with confirmed cases per million by country
three-day projections based on the (selected for clarity). Includes test data by
exponential growth rates color[372]
 Linear plot of worldwide COVID-19 cases, COVID-19 total cases per 100 000
recoveries, and deaths[373] population from selected countries[374]

Deaths

Most people who contract COVID-19 recover. For those who do not,
the time between the onset of symptoms and death usually ranges
from 6 to 41 days, typically about 14 days.[375] As of 22 June 2020,
approximately 469,000[5] deaths had been attributed to COVID-19.
In China, as of 14 June, about 80 percent of deaths were recorded in
those aged over 60, and 75 percent had pre-existing health
conditions including cardiovascular diseases and diabetes.[376]

The first confirmed death was in Wuhan on 9 January 2020.[377] The

Deceased in a 16 m (53 ft) "mobile
first death outside of China occurred on 1  February in the
morgue" outside a hospital in
Philippines,[378] and the first death outside Asia was in France on 14 Hackensack, New Jersey
February.[379]

Official deaths from COVID-19 generally refer to people who died

after testing positive according to protocols. This may ignore deaths of people who die without testing,
e.g. at home or in nursing homes.[380] Conversely, deaths of people who had underlying conditions may
lead to overcounting.[381] Comparison of statistics for deaths for all causes versus the seasonal average
indicates excess mortality in many countries.[382][383] In the worst affected areas, mortality has been
several times higher than average. In New York City, deaths have been four times higher than average, in
Paris twice as high, and in many European countries, deaths have been on average 20 to 30 percent
higher than normal.[382] This excess mortality may include deaths due to strained healthcare systems
and bans on elective surgery.[384]

Multiple measures are used to quantify mortality.[385] These numbers vary by region and over time,
influenced by testing volume, healthcare system quality, treatment options, government
response,[386][387][388] time since the initial outbreak, and population characteristics, such as age, sex,
and overall health.[389] Some countries (like Belgium) include deaths from suspected cases of COVID-19,
regardless of whether the person was tested, resulting in higher numbers compared to countries that
include only test-confirmed cases.[390]
The death-to-case ratio reflects the number of deaths attributed to COVID-19 divided by the number of
diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global
death-to-case ratio is 5.2  percent (469,220 deaths for 9,003,042 cases) as of 22 June 2020.[5] The
number varies by region.[391]

Other measures include the case fatality rate (CFR), which reflects the percentage of diagnosed people
who die from a disease, and the infection fatality rate (IFR), which reflects the percentage of infected
(diagnosed and undiagnosed) who die from a disease. These statistics are not timebound and follow a
specific population from infection through case resolution. Our World in Data states that as of 25 March
2020 the IFR cannot be accurately calculated as neither the total number of cases nor the total deaths, is
known.[392] In February the Institute for Disease Modeling estimated the IFR as 0.94 percent (95-
percent confidence interval 0.37–2.9), based on data from China.[393][394] The University of Oxford's
Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.8 to 9.6 percent (last revised
30 April) and IFR of 0.10 percent to 0.41 percent (last revised 2 May), acknowledging that this will vary
between populations due to differences in demographics.[395] The CDC estimates for planning purposes
that the fatality rate among those who are symptomatic is 0.4 percent (0.2 to 1 percent) and that 35
percent of infected individuals are asymptomatic, for an overall infection fatality rate of 0.26 percent (as
of 20 May).[396][397]
 Semi-log plot of daily deaths due to COVID-19 Case fatality rate of COVID-19 by country
(seven-day average) in the world and top five and confirmed cases
current countries (mean with cases)

Ongoing case fatality rate of COVID-19 by COVID-19 deaths per 100 000 population
country from selected countries[398]

Duration

On 11 March 2020, the WHO said that the pandemic could be controlled.[8] The peak and ultimate
duration of the outbreak are uncertain and may differ by location. Maciej Boni of Penn State University
said, "Left unchecked, infectious outbreaks typically plateau and then start to decline when the disease
runs out of available hosts. But it's almost impossible to make any sensible projection right now about
when that will be."[399] The Imperial College study led by Neil Ferguson stated that physical distancing
and other measures will be required "until a vaccine becomes available (potentially 18 months or
more)".[400] William Schaffner of Vanderbilt University said because the coronavirus is "so readily
transmissible", it "might turn into a seasonal disease, making a comeback every year". The virulence of
the comeback would depend on herd immunity and the extent of mutation.[401]

Signs and symptoms

The usual incubation period (the time between
infection and symptom onset) ranges from one to
14 days, and is most commonly five days.[9][403]
Some infected people have no symptoms, known
as asymptomatic or presymptomatic carriers;
transmission from such a carrier is considered
possible.[404] As at 6  April, estimates of the
asymptomatic ratio range widely from 5 to 80
percent.[405]

Symptoms of COVID-19 can be relatively non- Symptoms of COVID-19[402]

specific; the two most common symptoms are
fever (88 percent) and dry cough (68 percent).
Less common symptoms include fatigue, respiratory sputum production (phlegm), loss of the sense of
smell, loss of taste, shortness of breath, muscle and joint pain, sore throat, headache, chills, vomiting,
coughing out blood, diarrhea, and rash.[406][407][408]

Among those who develop symptoms, approximately one in five may become more seriously ill and have
difficulty breathing.[9] Emergency symptoms include difficulty breathing, persistent chest pain or
pressure, sudden confusion, difficulty waking, and bluish face or lips; immediate medical attention is
advised if these symptoms are present.[15] Further development of the disease can lead to complications
including pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and kidney failure.[407]

Cause

Transmission

COVID-19 spreads primarily when people are in close contact and

one person inhales small droplets produced by an infected person
(symptomatic or not) coughing, sneezing, talking, or singing.[12][409]
The WHO recommends 1 metre (3  ft) of social distance;[9] the U.S.
CDC recommends 2 metres (6  ft).[10] People can transmit the virus
without showing symptoms, but it is unclear how often this
happens.[9][10][12] One estimate of the number of those infected who
are asymptomatic is 40%.[410]
Respiratory droplets produced when
People are most infectious when they show symptoms (even mild or a man sneezes, visualised using
non-specific symptoms), but may be infectious for up to two days Tyndall scattering
before symptoms appear (pre-symptomatic transmission).[12] They
remain infectious an estimated seven to twelve days in moderate
cases and an average of two weeks in severe cases.[12]

When the contaminated droplets fall to floors or surfaces they can, though less commonly, remain
infectious if people touch contaminated surfaces and then their eyes, nose or mouth with unwashed
hands.[9] On surfaces the amount of active virus decreases over time until it can no longer cause
infection,[12] and surfaces are thought not to be the main way the virus spreads.[10] It is unknown what
amount of virus on surfaces is required to cause infection via this method, but it can be detected for up to
four hours on copper, up to one day on cardboard, and up to three days on plastic (polypropylene) and
stainless steel (AISI 304).[12][411][412] Surfaces are easily decontaminated with household disinfectants
which kill the virus outside the human body or on the hands.[9] Disinfectants or bleach are not a
treatment for COVID-19, and cause health problems when not used properly, such as when used inside
the human body.[413]

Sputum and saliva carry large amounts of virus.[9][10][12][414] Although COVID-19 is not a sexually
transmitted infection, kissing, intimate contact, and faecal-oral routes are suspected to transmit the
virus.[415][416] Some medical procedures are aerosol-generating,[417] and result in the virus being
transmitted more easily than normal.[9][12]

COVID-19 is a new disease, and many of the details of its spread are still under investigation.[9][10][12] It
spreads easily between people—easier than influenza but not as easily as measles.[10] Estimates of the
number of people infected by one person with COVID-19 (the R0) have varied widely. The WHO's initial
estimates of the R0 were 1.4-2.5 (average 1.95), however a more recent review found the basic R0
(without control measures) to be higher at 3.28 and the median R0 to be 2.79.[418]

The virus may occur in breast milk, but it's unknown whether it's infectious and transmittable to the
baby.[419][420]

Virology

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a

novel virus, first isolated from three people with pneumonia
connected to the cluster of acute respiratory illness cases in
Wuhan.[340] All features of the novel SARS-CoV-2 virus occur in
related coronaviruses in nature.[421]

SARS-CoV-2 is closely related to SARS-CoV, and is thought to have

a zoonotic origin.[337] SARS-CoV-2 genetically clusters with the
genus Betacoronavirus, and is 96 percent identical at the whole
genome level to other bat coronavirus samples[422] and 92 percent Illustration of SARSr‑CoV virion
identical to pangolin coronavirus.[423]

Diagnosis
COVID-19 can be provisionally diagnosed on the basis of symptoms
and confirmed using reverse transcription polymerase chain reaction
(RT-PCR) testing of infected secretions or CT imaging of the
chest.[424][425]

Viral testing

Demonstration of a swab for
COVID-19 testing
The standard test for current infection with SARS-CoV-2 uses RNA
testing of respiratory secretions collected using a nasopharyngeal
swab, though it is possible to test other samples. This test uses real-
time rRT-PCR which detects the presence of viral RNA
fragments.[426]
A number of laboratories and companies have developed serological tests, which detect antibodies
produced by the body in response to infection.[427] Several have been evaluated by Public Health
England and approved for use in the UK.[428]

On 22 June 2020, health secretary of the UK, Matt Hancock announced that the country will be
conducting a new “spit test” for COVID-19, which would be trialed on 14,000 key workers and their
families in Southampton. The test was supposed to be conducted by spitting in a pot, which was collected
by Southampton University. Results of the test were expected to be declared within 48 hours. According
to Hancock, the test was easier than using swabs, and could potentially enable people to conduct it at
home.[429]

Imaging

Characteristic imaging features on chest radiographs and computed

tomography (CT) of people who are symptomatic include
asymmetric peripheral ground-glass opacities without pleural
effusions.[430] The Italian Radiological Society is compiling an
international online database of imaging findings for confirmed
cases.[431] Due to overlap with other infections such as adenovirus,
imaging without confirmation by rRT-PCR is of limited specificity in
identifying COVID-19.[430] A large study in China compared chest
CT results to PCR and demonstrated that though imaging is less A CT scan of a person with
specific for the infection, it is faster and more sensitive.[425] COVID‑19 shows lesions (bright
regions) in the lungs.

Prevention
Strategies for preventing transmission of the disease include maintaining overall good personal hygiene,
washing hands, avoiding touching the eyes, nose, or mouth with unwashed hands, and coughing or
sneezing into a tissue, and putting the tissue directly into a waste container. Those who may already have
the infection have been advised to wear a surgical mask in public.[432][433] Physical distancing measures
are also recommended to prevent transmission.[434][435] Health care providers taking care of someone
who may be infected are recommended to use standard precautions, contact precautions, and eye
protection.[436]

Many governments have restricted or advised against all non-essential travel to and from countries and
areas affected by the outbreak.[437] The virus has already spread within communities in large parts of the
world, with many not knowing where or how they were infected.[438]

Misconceptions are circulating about how to prevent infection; for example, rinsing the nose and
gargling with mouthwash are not effective.[439] There is no COVID-19 vaccine, though many
organisations are working to develop one.[440]

Hand washing

Hand washing is recommended to prevent the spread of the disease. The CDC recommends that people
wash hands often with soap and water for at least twenty seconds, especially after going to the toilet or
when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. This is
because outside the human body, the virus is killed by household soap, which bursts its protective
bubble.[20] CDC further recommended using an alcohol-based hand sanitiser with at least 60 percent
alcohol by volume when soap and water are not
readily available.[432] The WHO advises people
to avoid touching the eyes, nose, or mouth with
unwashed hands.[433][441] It is not clear
whether washing hands with ash, if soap is not
available, is effective at reducing the spread of
viral infections.[442]

Surface cleaning

Surfaces may be decontaminated with a

number of solutions (within one minute of
exposure to the disinfectant for a stainless steel
surface), including 62–71 percent ethanol, 50–
100 percent isopropanol, 0.1 percent sodium
hypochlorite, 0.5 percent hydrogen peroxide,
and 0.2–7.5 percent povidone-iodine. Other
solutions, such as benzalkonium chloride and
chlorhexidine gluconate, are less effective.[443]
The CDC recommends that if a COVID-19 case
is suspected or confirmed at a facility such as
an office or day care, all areas such as offices,
bathrooms, common areas, shared electronic
equipment like tablets, touch screens,
keyboards, remote controls, and ATM
machines used by the ill persons should be Infographic by the U.S. Centers for Disease Control and
disinfected.[444] Prevention (CDC), describing how to stop the spread of
germs

Face masks and respiratory hygiene

Recommendations for wearing cloth masks have been a subject of debate.[446] The WHO originally
recommended that healthy people wear masks only if they are at high risk, such as those who are caring
for a person with COVID-19.[447] China and the United States, among other countries, have encouraged
the use of face masks or cloth face coverings more generally by members of the public to limit the spread
of the virus by asymptomatic individuals as a precautionary principle.[448][449] Several national and local
governments have made wearing masks mandatory.[450]

Surgical masks are recommended for those who may be infected, as wearing this type of mask can limit
the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and
coughing.[447]

In June 2020, the WHO changed its policy on wearing face masks, saying they should be worn in public
places in order to help to prevent the spread of COVID-19.[451]

Social distancing

Social distancing (also known as physical 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 apply social
distancing methods by staying at
home, limiting travel, avoiding
crowded areas, using no-contact
greetings, and physically
distancing themselves from
others.[433][452][453] Many
governments are now mandating
or recommending social Taiwan President Tsai Ing-wen
Physical distancing in Toronto, with
distancing in regions affected by wearing a surgical mask
a limited number of customers the outbreak.[454][455] Non-
allowed inside a store cooperation with distancing
measures in some areas has
contributed to the further spread
of the pandemic.[456]

The maximum gathering size recommended by U.S. government

bodies and health organisations was swiftly reduced from 250 people
(if there were no known COVID-19 spread in a region) to 50 people, Slovakia was among the first
and later to 10.[457] On 22 March 2020, Germany banned public countries in the world to make the
gatherings of more than two people.[458] A Cochrane review found wearing of masks mandatory in
public.[445]
that early quarantine with other public health measures are effective
in limiting the pandemic, but the best manner of adopting and
relaxing policies are uncertain, as local conditions vary.[453]

Older adults and those with underlying medical conditions such as diabetes, heart disease, respiratory
disease, hypertension, and compromised immune systems face increased risk of serious illness and
complications and have been advised by the CDC to stay home as much as possible in areas of
community outbreak.[459][460]

In late March 2020, the WHO and other health bodies began to replace the use of the term "social
distancing" with "physical distancing", to clarify that the aim is to reduce physical contact while
maintaining social connections, either virtually or at a distance. The use of the term "social distancing"
had led to implications that people should engage in complete social isolation, rather than encouraging
them to stay in contact through alternative means.[461][462] Some authorities have issued sexual health
guidelines for the pandemic, which include recommendations to have sex only with someone you live
with, and who does not have the virus or symptoms of the virus.[463][464]

Self-isolation

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who
suspect they have been infected. Health agencies have issued detailed instructions for proper self-
isolation.[466][467]

Many governments have mandated or recommended self-quarantine for entire populations.[468][469] The
strongest self-quarantine instructions have been issued to those in high risk groups.[470] Those who may
have been exposed to someone with COVID-19 and those who have recently travelled to a country or
region with the widespread transmission have been advised to self-quarantine for 14 days from the time
of last possible exposure.[9][17][471]
Management

Screening, containment and mitigation

Strategies in the control of an outbreak are screening,

containment (or suppression) and mitigation.
Screening is done with a device such as a
thermometer to detect the elevated body temperature
associated with fevers caused by the coronavirus.[476]
Containment is undertaken in the early stages of the Without pandemic containment measures—such as
outbreak and aims to trace and isolate those infected social distancing, vaccination, and use of face masks—
as well as introduce other measures to stop the pathogens can spread exponentially.[465] This graphic
disease from spreading. When it is no longer possible shows how early adoption of containment measures
to contain the disease, efforts then move to the tends to protect wider swaths of the population.
mitigation stage: measures are taken to slow the
spread and mitigate its effects on the healthcare
system and on society. A combination of both
containment and mitigation measures may be
undertaken at the same time.[477] Suppression
requires more extreme measures so as to reverse the
pandemic by reducing the basic reproduction
number to less than 1.[400]

Part of managing an infectious disease outbreak is

trying to delay and decrease the epidemic peak,
known as flattening the epidemic curve.[472] This
decreases the risk of health services being Goals of mitigation include delaying and reducing peak
overwhelmed and provides more time for vaccines burden on healthcare (flattening the curve) and
and treatments to be developed. [472] Non- lessening overall cases and health impact.[472][473]
pharmaceutical interventions that may manage the Moreover, progressively greater increases in
healthcare capacity (raising the line) such as by
outbreak include personal preventive measures such
increasing bed count, personnel, and equipment, helps
as hand hygiene, wearing face masks, and self-
to meet increased demand.[474]
quarantine; community measures aimed at physical
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.[478]

More drastic actions aimed at containing the outbreak were taken in China once the severity of the
outbreak became apparent, such as quarantining entire cities and imposing strict travel bans.[479] Other
countries also adopted a variety of measures aimed at limiting the spread of the virus. South Korea
introduced the mass screening and localised quarantines and issued alerts on the movements of infected
individuals. Singapore provided financial support for those infected who quarantined themselves and
imposed large fines for those who failed to do so. Taiwan increased face mask production and penalised
hoarding of medical supplies.[480]

Simulations for Great Britain and the United States show that mitigation (slowing but not stopping
epidemic spread) and suppression (reversing epidemic growth) have major challenges. Optimal
mitigation policies might reduce peak healthcare demand by two-thirds and deaths by half, but still
result in hundreds of thousands of deaths and overwhelmed health systems. Suppression can be
preferred but needs to be maintained for as long as
the virus is circulating in the human population (or
until a vaccine becomes available), as transmission
otherwise quickly rebounds when measures are
relaxed. Long-term intervention to suppress the
pandemic has considerable social and economic
costs.[400]

Contact tracing

Contact tracing is an important method for health Mitigation attempts that are inadequate in strictness or
authorities to determine the source of infection and duration—such as premature relaxation of distancing
to prevent further transmission. [481] The use of rules or stay-at-home orders—can allow a resurgence
location data from mobile phones by governments after the initial surge and mitigation.[472][475]
for this purpose has prompted privacy concerns, with
Amnesty International and more than a hundred
other organisations issuing a statement calling for limits on this kind of surveillance.[482]

Several mobile apps have been implemented or proposed for voluntary use, and as of 7 April 2020 more
than a dozen expert groups were working on privacy-friendly solutions such as using Bluetooth to log a
user's proximity to other cellphones.[482] (Users are alerted if they have been near someone who
subsequently tests positive.)[482]

On 10 April 2020, Google and Apple jointly announced an initiative for privacy-preserving contact
tracing based on Bluetooth technology and cryptography.[483][484] The system is intended to allow
governments to create official privacy-preserving coronavirus tracking apps, with the eventual goal of
integration of this functionality directly into the iOS and Android mobile platforms.[485] In Europe and
in the U.S., Palantir Technologies is also providing COVID-19 tracking services.[486]

Health care

Increasing capacity and adapting healthcare for the needs of COVID-

19 patients is described by the WHO as a fundamental outbreak
response measure.[487] The ECDC and the European regional office
of the WHO have issued guidelines for hospitals and primary
healthcare services for shifting of resources at multiple levels,
including focusing laboratory services towards COVID-19 testing,
cancelling elective procedures whenever possible, separating and
isolating COVID-19 positive patients, and increasing intensive care
capabilities by training personnel and increasing the number of
An army-constructed field hospital
available ventilators and beds.[487][488] In addition, in an attempt to outside Östra sjukhuset (Eastern
maintain physical distancing, and to protect both patients and hospital) in Gothenburg, Sweden,
clinicians, in some areas non-emergency healthcare services are contains temporary intensive care
being provided virtually.[489][490][491] units for COVID-19 patients.

Due to capacity limitations in the standard supply chains, some

manufacturers are 3D printing healthcare material such as nasal swabs and ventilator parts.[492][493] In
one example, when an Italian hospital urgently required a ventilator valve, and the supplier was unable
to deliver in the timescale required, a local startup received legal threats due to alleged patent
infringement after reverse-engineering and printing the required hundred valves overnight.[494][495][496]
On 23 April 2020, NASA reported building, in 37 days, a ventilator which is currently undergoing further
testing. NASA is seeking fast-track approval.[497][498]

Treatment

Antiviral medications are under investigation for COVID-19[499] None has yet been shown to be clearly
effective on mortality in published randomised controlled trials.[499] However, remdesivir may affect the
time it takes to recover from the virus.[500] Emergency use authorisation for remdesivir was granted in
the U.S. on 1  May, for people hospitalised with severe COVID-19.[501] The interim authorisation was
granted considering the lack of other specific treatments, and that its potential benefits appear to
outweigh the potential risks.[501][502]

Taking over-the-counter cold medications,[503] drinking fluids, and resting may help alleviate
symptoms.[432] Depending on the severity, oxygen therapy, intravenous fluids, and breathing support
may be required.[504]

Other trials are investigating whether existing medications can be used effectively against COVID-19 or
the immune reaction to it.[499][505] On 16 June, the RECOVERY Trial group released a statement that
their preliminary results show low dose dexamethasone reduces mortality in patients receiving
respiratory support,[506] though previous reviews had suggested the use of steroids may worsen
outcomes.[507]

History
There are several theories about where the very first
case (the so-called patient zero) originated.[509]
According to an unpublicised report from the
Chinese government, the first case can be traced back
to 17 November 2019; the person was a 55-year old
citizen in the Hubei province.[510] There were four
men and five women reported to be infected in
November, but none of them were "patient zero".[510]
Starting from December, the number of coronavirus
cases in Hubei gradually increased, reaching 60 by
20 December[511] and at least 266 by 31
December.[512] According to official Chinese sources,
these were mostly linked to the Huanan Seafood Cases by country, plotted on a logarithmic scale[508]
Wholesale Market, which also sold live animals. [336]
In May 2020, George Gao, the director of the Chinese
Center for Disease Control and Prevention, said animal samples collected from the seafood market had
tested negative for the virus, indicating that the market was the site of an early superspreading event, but
it was not the site of the initial outbreak.[513]

On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an
unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision
Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a
new coronavirus.[514] A pneumonia cluster of unknown cause was observed on 26 December and treated
by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27
December.[515] On 30 December, a test report addressed to Wuhan Central Hospital, from company
CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan
Central Hospital to alert their colleagues and relevant hospital authorities of the result. That evening, the
Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment
of pneumonia of unknown cause".[516] Eight of these doctors, including Li Wenliang (punished on
3 January),[517] were later admonished by the police for spreading false rumours, and another, Ai Fen,
was reprimanded by her superiors for raising the alarm.[518]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia
outbreak of unknown cause on 31 December, confirming 27 cases[330][519][520]—enough to trigger an
investigation.[332]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a
half days.[521] In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the
Chinese New Year migration and Wuhan being a transport hub and major rail interchange.[422] On 20
January, China reported nearly 140 new cases in one day, including two people in Beijing and one in
Shenzhen.[522] Later official data shows 6,174 people had already developed symptoms by then,[523] and
more may have been infected.[524] A report in The Lancet on 24 January indicated human transmission,
strongly recommended personal protective equipment for health workers, and said testing for the virus
was essential due to its "pandemic potential".[346][525] On 30 January, the WHO declared the
coronavirus a public health emergency of international concern.[524] By this time, the outbreak spread by
a factor of 100 to 200 times.[526]

On 31 January 2020, Italy had its first confirmed cases, two tourists from China.[527] As of 13 March
2020, the WHO considered Europe the active centre of the pandemic.[528] On 19 March 2020, Italy
overtook China as the country with the most deaths.[529] By 26 March, the United States had overtaken
China and Italy with the highest number of confirmed cases in the world.[530] Research on coronavirus
genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather
than directly from China or any other Asian country.[531] Retesting of prior samples found a person in
France who had the virus on 27 December 2019[532][533] and a person in the United States who died from
the disease on 6 February 2020.[534]

On 11 June 2020, after 55 days without a locally transmitted case,[535] Beijing reported the first COVID-
19 case, followed by two more cases on June 12.[536] As for June 15, 79 cases were officially
confirmed.[537] Most of these patients went to Xinfadi Wholesale Market.[535][538]

As of 22 June 2020, more than 9 million cases have been reported worldwide; more than 469,000 people
have died and more than 4.46 million have recovered.[539][540]

National responses
A total of 188[5] countries and territories have had at least one case of COVID-19 so far. Due to the
pandemic in Europe, many countries in the Schengen Area have restricted free movement and set up
border controls.[541] National reactions have included containment measures such as quarantines and
curfews (known as stay-at-home orders, shelter-in-place orders, or lockdowns).[542]

By 26 March, 1.7 billion people worldwide were under some form of lockdown,[543] which increased to
3.9 billion people by the first week of April—more than half the world's population.[544][545]
By late April, around 300 million people were under lockdown in nations of Europe, including but not
limited to Italy, Spain, France, and the United Kingdom, while around 200  million people were under
lockdown in Latin America.[546] Nearly 300 million people, or about 90 percent of the population, were
under some form of lockdown in the United States,[547] around 100  million people in the
Philippines,[546] about 59  million people in South Africa,[548] and 1.3  billion people have been under
lockdown in India.[549][550] On 21 May 100,000 new infections occurred worldwide, the most since the
start of the pandemic, while overall 5 million cases were surpassed.[551]

Asia

As of 19 May 2020, cases have been reported in all Asian countries except for Turkmenistan and North
Korea, although these countries likely also have cases.[552][553] Despite being the first area of the world
hit by the outbreak, the early wide-scale response of some Asian states, particularly South Korea,[554]
Taiwan,[555] and Vietnam,[556] has allowed them to fare comparatively well.

China

The first confirmed case of COVID-19 has been traced

back to 1  December 2019 in Wuhan;[344] one
unconfirmed report suggests the earliest case was on 17
November.[349] Doctor Zhang Jixian observed a cluster of
pneumonia cases of unknown cause on 26 December,
upon which her hospital informed Wuhan Jianghan CDC
on 27 December.[557][558] Initial genetic testing of patient
samples on 27 December 2019 indicated the presence of a
SARS-like coronavirus.[557] A public notice was released
by Wuhan Municipal Health Commission on 31
December, confirming 27 cases and suggesting wearing
face masks.[520] The WHO was informed on the same
day.[330] As these notifications occurred, doctors in
Wuhan were warned by police for "spreading rumours" Confirmed cases of COVID-19 per 100,000
about the outbreak.[559] The Chinese National Health inhabitants by province, as of 13 April, showing
Commission initially said there was no "clear evidence" of Hubei with around 40 times more cases than any
human-to-human transmission.[560] In a 14 January other province
conference call, Chinese officials said privately that    Hubei Province: 114.40 cases per
human-to-human transmission was a possibility, and 100,000
pandemic preparations were needed.[561] In a briefing    1.5–2.5 cases per 100,000
posted during the night of 14–15 January, the Wuhan    1–1.5 cases per 100,000
Municipal Health Commission said the possibility of
   0.5–1 cases per 100,000
limited human-to-human transmission could not be
ruled out.[562]    >0–0.5 cases per 100,000

On 20 January, the Chinese National Health Commission

confirmed human-to-human transmission of the virus.[563] That same day, Chinese Communist Party
general secretary Xi Jinping and State Council premier Li Keqiang issued their first public comments
about the virus, telling people in infected areas to practice social distancing and avoid travel.[564][565]
During the Chinese New Year travel period, authorities instigated a City of Wuhan lockdown.[566] On 10
February the Chinese government launched a radical campaign described by paramount leader and
Chinese Communist Party general secretary Xi as a "people's war" to contain the viral spread.[567] In "the
largest quarantine in human history",[568] a cordon
sanitaire on 23 January stopped travel in and out of
Wuhan,[569][570] then extended to fifteen Hubei cities
affecting about 57 million people.[571] Private vehicle
use was banned in the city.[572] Several Chinese New
Year (25 January) celebrations were also
cancelled.[573] Authorities announced the
construction of a temporary hospital, Huoshenshan
Hospital, completed in ten days.[574] Leishenshan
Hospital, was later built to handle additional
patients.[575] China also converted other facilities in Semi-log graph of new cases and deaths in China
Wuhan, such as convention centres and stadiums, during the COVID-19 epidemic showing the lockdown
into temporary hospitals.[576] and lifting

On 26 January, the government instituted further measures to

Wuhan Leishenshan Hospital, an
emergency speciality field hospital
built in response to the pandemic
contain the COVID-19 outbreak, including issuing health
declarations for travellers and extending the Spring Festival
holiday.[578] Universities and schools around the country were also
closed.[579][580][581] The regions of Hong Kong and Macau instituted
several measures, particularly in regard to schools and
universities.[582] Remote working measures were instituted in
several Chinese regions.[583] Travel restrictions were enacted in and
outside of Hubei.[583][584] Public transport was modified,[585] and
museums throughout China were temporarily closed.[583][586][587]
Control of public movement was applied in many cities, and an
estimated 760 million people (more than half the population) faced
some form of outdoor restriction.[588] In January and February
2020, during the height of the epidemic in Wuhan, about 5 million
people lost their jobs.[589] Many of China's nearly 300 million rural
migrant workers have been stranded at home in inland provinces or
trapped in Hubei province.[590][591]

A temporary hospital for treating After the outbreak entered its global phase in March, Chinese
mild cases of COVID-19 in Wuhan, authorities took strict measures to prevent the virus re-entering
one of more than ten such hospitals China from other countries. For example, Beijing imposed a 14-day
in the city[577] mandatory quarantine for all international travellers entering the
city.[592] At the same time, a strong anti-foreigner sentiment quickly
took hold,[593] and foreigners experienced harassment by the
general public[594] and forced evictions from apartments and hotels.[33][595]

On 24 March, Chinese Premier Li Keqiang reported that the spread of domestically transmitted cases has
been basically blocked and the outbreak has been controlled in China.[596] The same day travel
restrictions were eased in Hubei, apart from Wuhan, two months after the lockdown was imposed.[597]
The Chinese Ministry of Foreign Affairs announced on 26 March that entry for visa or residence permit
holders would be suspended from 28 March onwards, with no specific details on when this policy would
end. Those wishing to enter China must to apply for visas in Chinese embassies or consulates.[598][599]
The Chinese government encouraged businesses and factories to re-open on 30 March, and provided
monetary stimulus packages for firms.[600]
The State Council declared a day of mourning to begin with a national three-minute moment of silence
on 4  April, coinciding with Qingming Festival, although the central government asked families to pay
their respects online in observance of physical distancing to avoid a renewed COVID-19 outbreak.[601] On
25 April the last patients were discharged in Wuhan.[602] On 13 May the city of Jilin was put on
lockdown, sparking fear of a second wave of infection.[603]

Iran

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 that day.[605][606] Early
measures announced by the government included the cancellation of
concerts and other cultural events,[607] sporting events,[608] Friday
prayers,[609] and closures of universities, higher education
institutions, and schools.[610] Iran allocated 5  trillion rials
(equivalent to US$120,000,000) to combat the virus.[611] President Disinfection of Tehran Metro trains
against coronavirus. Similar
Hassan Rouhani said on 26 February there were no plans to
measures have also been taken in
quarantine areas affected by the outbreak, and only individuals
other countries.[604]
would be quarantined.[612] Plans to limit travel between cities were
announced in March,[613] although heavy traffic between cities ahead
of the Persian New Year Nowruz continued.[614] Shia shrines in Qom remained open to pilgrims until 16
March.[615][616]

Iran became a centre of the spread of the virus after China during February.[617][618] More than ten
countries had traced their cases back to Iran by 28 February, indicating the outbreak may have been
more severe than the 388 cases reported by the Iranian government by that date.[618][619] The Iranian
Parliament was shut down, with 23 of its 290 members reported to have had tested positive for the virus
on 3 March.[620] On 15 March, the Iranian government reported a hundred deaths in a single day, the
most recorded in the country since the outbreak began.[621] At least twelve sitting or former Iranian
politicians and government officials had died from the disease by 17 March.[622] By 23 March, Iran was
experiencing fifty new cases every hour and one new death every ten minutes due to coronavirus.[623]
According to a WHO official, there may be five times more cases in Iran than what is being reported. It is
also suggested that U.S. sanctions on Iran may be affecting the country's financial ability to respond to
the viral outbreak.[624] The UN High Commissioner for Human Rights has demanded economic
sanctions to be eased for nations most affected by the pandemic, including Iran.[625] On 20 April it was
reported that Iran had reopened shopping malls and other shopping areas across the country, though
there is a fear of the second wave of infection due to this move.[626] After reaching a low in new cases in
early May, a new peak was reported on 4 June, raising fear of a second wave.[627]

South Korea

COVID-19 was confirmed to have spread to South Korea on 20 January 2020 from China. The nation's
health agency reported a significant increase in confirmed cases on 20 February,[628] largely attributed
to a gathering in Daegu of the Shincheonji Church of Jesus.[628][629] Shincheonji devotees visiting Daegu
from Wuhan were suspected to be the origin of the outbreak.[630][631] By 22 February, among 9,336
followers of the church, 1,261 or about 13 percent reported symptoms.[632]
South Korea declared the highest level of alert on 23 February
2020.[633] On 28 February, more than 2,000 confirmed cases were
reported,[634] rising to 3,150 on 29 February.[635] All South Korean
military bases were quarantined after tests showed three soldiers
had the virus.[630] Airline schedules were also changed.[636][637]

South Korea introduced what

A banner in Seoul displays
coronavirus infection prevention
tips.
success in controlling the outbreak without quarantining entire cities.[554][642][643]
was considered the largest and
best-organised programme in
A drive-through test centre at the
the world to screen the Gyeongju Public Health Centre
population for the virus, isolate
any infected people, and trace
and quarantine those who contacted them.[554][638] Screening
methods included mandatory self-reporting of symptoms by new
international arrivals through mobile application,[639] drive-through
testing for the virus with the results available the next day,[640] and
increasing testing capability to allow up to 20,000 people to be
tested every day.[641] South Korea's programme is considered a

South Korean society was initially polarised on President Moon Jae-in's response to the crisis, many
signing petitions either praising it or calling for impeachment.[644] On 23 March, it was reported that
South Korea had the lowest one-day case total in four weeks.[641] On 29 March it was reported that
beginning 1 April all new overseas arrivals will be quarantined for two weeks.[645] Per media reports on
1 April, South Korea has received requests for virus testing assistance from 121 different countries.[646]
On 15 May it was reported that about two thousand businesses were told to close again when a cluster of
a hundred infected individuals was discovered; contact tracing is being done on 11,000 people.[647]

Europe

As of 13  March  2020, when the number of new cases became greater than those in China, the World
Health Organization (WHO) began to consider Europe the active centre of the pandemic.[648][649] Cases
by country across Europe had doubled over periods of typically 3 to 4 days, with some countries (mostly
those at earlier stages of detection) showing doubling every 2 days.[650]

As of 17 March, all countries within Europe had a confirmed case of COVID-19, with Montenegro being
the last European country to report at least one case.[651] At least one death has been reported in all
European countries, apart from the Vatican City.

As of 18 March, more than 250 million people were in lockdown in Europe.[652]

As of 24 May, 68 days since its first recorded case, Montenegro became the first COVID-19-free country
in Europe.[653][654] However, 44 days since the last confirmed, a new imported case were identified in
Montenegro.[655]

Italy

The outbreak was confirmed to have spread to Italy on 31 January, when two Chinese tourists tested
positive for SARS-CoV-2 in Rome.[527] Cases began to rise sharply, which prompted the Italian
government to suspend all flights to and from China and declare a state of emergency.[656] An
unassociated cluster of COVID-19 cases was later
detected, starting with 16 confirmed cases in Lombardy
on 21 February.[657]

Civil Protection volunteers conduct

health checks at the Guglielmo
Marconi Airport in Bologna on
5 February.
Cases of COVID-19 per 100,000 residents in
Europe. The numbers are not comparable, as the
On 22 February, the Council of Ministers announced a testing strategy differs among countries and time
new decree-law to contain the outbreak, including periods.
quarantining more than 50,000 people from eleven
different municipalities in northern Italy.[658] 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."[659][660]

On 4 March, the Italian government ordered the full closure of all schools and universities nationwide as
Italy reached a hundred deaths. All major sporting events were to be held behind closed doors until
April,[661] but on 9 March all sport was suspended completely for at least one month.[662] On 11 March,
Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and
pharmacies.[663][664]

On 6 March, the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
published medical ethics recommendations regarding triage protocols.[665][666][667] On 19 March, Italy
overtook China as the country with the most coronavirus-related deaths in the world after reporting
3,405 fatalities from the pandemic.[668][669] On 22 March, it was reported that Russia had sent nine
military planes with medical equipment to Italy.[670] As of 12 June, there were 236,305 confirmed cases,
34,223 deaths, and 173,085 recoveries in Italy, with the majority of those cases occurring in the
Lombardy region.[671] A CNN report indicated that the combination of Italy's large elderly population
and inability to test all who have the virus to date may be contributing to the high fatality rate.[672] On 19
April, it was reported that the country had its lowest deaths at 433 in seven days and some businesses are
asking for a loosening of restrictions after six weeks of lockdown.[673]

Spain

The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested
positive for SARS-CoV-2 in La Gomera, Canary Islands.[674] Post-hoc genetic analysis has shown that at
least 15 strains of the virus had been imported, and community transmission began by mid-
February.[675] By 13 March, cases had been confirmed in all 50 provinces of the country.
The lockdown was imposed on 14 March 2020.[676] On 29 March, it
was announced that, beginning the following day, all non-essential
workers were ordered to remain at home for the next 14 days.[677] By
late March, the Community of Madrid has recorded the most cases
and deaths in the country. Medical professionals and those who live
in retirement homes have experienced especially high infection
rates.[678] On 25 March, the death toll in Spain surpassed that of
mainland China, and only that of Italy was higher.[679] On 2  April,
950 people died of the virus in a 24-hour period—at the time, the
most by any country in a single day.[680] On 17 May, the daily death Residents of Valencia, Spain,
toll announced by the Spanish government fell below 100 for the first maintaining social distancing while
time,[681] and 1 June was the first day without deaths by queueing
coronavirus.[682] The state of alarm ended on 21 June.[683]

As of 21 June 2020, there have been 246,272 confirmed cases and 28,323 deaths.[684] The actual number
of cases was considered to be much higher, as many people with only mild or no symptoms were unlikely
to have been tested.[685][686] On 4 June, the results of the second wave of a Spanish Government nation-
wide seroprevalence study showed that the percentage of population which could have been infected
during the pandemic would be around 5,2%[687], approximately 2 million people,[688] a figure ten times
higher than the number of confirmed cases on that date. According to this study based on sample of
more than 63,000 people, Madrid and several provinces of Castilla–La Mancha and Castilla y León
would be the most affected areas with a percentage of infection greater than 10%.[689][690]The number of
deaths is also believed to be an underestimate due to lack of testing and reporting, perhaps by as much as
15,815 according to the Spanish Ministy of Health monitoring system on daily excess mortality (Sistema
de Monitorización de la Mortalidad Diaria - MoMo).[691]

United Kingdom

Prior to 18 March 2020, the British government did not impose any form of
social distancing or mass quarantine measures on its citizens.[692][693] As a
result, the government received criticism for the perceived lack of pace and
intensity in its response to concerns faced by the public.[694][695]

On 16 March, Prime Minister Boris Johnson made an announcement

advising against all non-essential travel and social contact, suggesting
people work from home where possible and avoid venues such as pubs,
restaurants, and theatres.[696][697] On 20 March, the government
announced that all leisure establishments such as pubs and gyms were to
close as soon as possible,[698] and promised to pay up to 80 percent of
The "Wee Annie" statue in workers' wages to a limit of £2,500 per month to prevent unemployment
Gourock, Scotland, was during the crisis.[699]
given a face mask during
the pandemic. On 23 March, the prime minister announced tougher social distancing
measures, banning gatherings of more than two people and restricting
travel and outdoor activity to that deemed strictly necessary. Unlike
previous measures, these restrictions were enforceable by police through the issuing of fines and the
dispersal of gatherings. Most businesses were ordered to close, with exceptions for businesses deemed
"essential", including supermarkets, pharmacies, banks, hardware shops, petrol stations, and
garages.[700]
On 24 April it was reported that one of the more promising vaccine trials had begun in England; the
government has pledged, in total, more than 50 million pounds towards research.[701]

To ensure the UK health services had sufficient capacity to treat

people with COVID-19, a number of temporary critical care hospitals
were built.[702] The first to be operational was the 4000-bed capacity
NHS Nightingale Hospital London, constructed within the ExCeL
convention centre over nine days.[703] On 4 May, it was announced
that the Nightingale Hospital in London would be placed on standby
and remaining patients transferred to other facilities.[704] This
followed reports that NHS Nightingale in London "treated 51 VE Day celebrations took place
patients" within the first three weeks of opening.[705] On 5  May, under lockdown in the United
official figures revealed that Britain had the worst COVID-19 death Kingdom as in this socially-
toll in Europe, prompting calls for an inquiry into the handling of the distanced street party in Wetherby,
pandemic. The death toll in the United Kingdom was nearly 29,427 West Yorkshire.
for those tested positive for the virus. Later, it was calculated at
32,313, after taking the official death count for Scotland and
Northern Ireland into account.[706] On 16 April it was reported that the UK would have first access to the
Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses in the UK
would be available.[707]

France

Although it was originally thought the pandemic reached France on

24 January 2020, when the first COVID-19 case in Europe was
confirmed in Bordeaux, it was later discovered that a person near
Paris had tested positive for the virus on 27 December 2019 after
retesting old samples.[532][533] A key event in the spread of the
disease in the country was the annual assembly of the Christian
Open Door Church between 17 and 24 February in Mulhouse, which
was attended by about 2,500 people, at least half of whom are
believed to have contracted the virus.[708][709]
France has been transferring
COVID-19 patients from overloaded
On 13 March, Prime Minister Édouard Philippe ordered the closure
hospitals to hospitals in other
of all non-essential public places,[710] and on 16 March, French regions via military helicopters, as
President Emmanuel Macron announced mandatory home seen here at Strasbourg Airport.
confinement, a policy which was extended at least until 11
May.[711][712][713] As of 23 April, France has reported more than
120,804 confirmed cases, 21,856 deaths, and 42,088 recoveries,[714] ranking fourth in number of
confirmed cases.[715] In April, there were riots in some Paris suburbs.[716] On 18 May, it was reported
that schools in France had to close again after reopening, due to COVID-19 case flare-ups.[717]

Sweden

Sweden differed from most other European countries in that it mostly remained open.[718] Per the
Swedish Constitution, the Public Health Agency of Sweden has autonomy which prevents political
interference and the agency's policy favored forgoing a lockdown in an attempt to reach herd
immunity.[719] The New York Times said that, as of May 2020, the outbreak had been far deadlier there
but the economic impact had been reduced as Swedes have continued to go to work, restaurants, and
shopping.[718][720] On 19 May, it was reported that the country had in the week of 12–19 May the highest
per capita deaths in Europe, 6.25 deaths per million per day.[721]

North America

United States

On 20 January 2020, the first known case of COVID-

19 was confirmed in the Pacific Northwest state of
Washington in a man who had returned from Wuhan
on 15 January.[722] On 31 January, the Trump
administration declared a public health
emergency, [723] and restricted entry for travellers
from China who were not U.S. citizens.[724]

On 28 January, the Centers for Disease Control and

Prevention (CDC) announced they had developed
their own testing kit.[725] Despite this, the United
States had a slow start in testing, which obscured the Cases of COVID-19 per 100,000 residents by county
extent of the outbreak.[726][727] Testing was marred
by defective test kits produced by the government in
February, a lack of federal approval for non-government test kits, and restrictive criteria for people to
qualify for a test.[726][727]

By 2 March there were 80 confirmed cases, with half of the cases in California. Florida and New York had
declared their first two cases and the state of Washington reported many suspected cases and the first
death. Vice President Pence maintained that the threat of the virus spreading throughout the U.S. was
small.[728][729][730]

On 6 March, President Trump signed the Coronavirus Preparedness

and Response Supplemental Appropriations Act, which provided
$8.3 billion in emergency funding for federal agencies to respond to
the outbreak.[731][732] Corporations encouraged employees to work
from home.[733] Sports events and seasons were cancelled.[23]

On 13 March, Trump declared a national emergency, which made

federal funds available to respond to the crisis.[734] Beginning on 15
March, many businesses closed or reduced hours[735] and schools
Donald Trump signs the
Coronavirus Preparedness and across the country were shutting down.[736][737] By 17 March, the
Response Supplemental epidemic had been confirmed in all fifty states and in the District of
Appropriations Act into law with Alex Columbia.[738] On 26 March, the United States had more confirmed
Azar on 6 March 2020. cases than any other country.[530] U.S. federal health inspectors
surveyed 323 hospitals in late March; reporting "severe shortages" of
test supplies, "widespread shortages" of personal protective
equipment (PPE), and other strained resources due to extended patient stays while awaiting test
results.[739]
On 22 April, it was reported that two Californians had died from the
virus (not, as previously thought, influenza) on 6  and 17 February,
three weeks before the first official COVID-19 death in the U.S. had
been acknowledged.[534] By 24 April, 889,309 cases had been
confirmed and 50,256 people had died.[740] As of 17 May, according
to a New York Times database, more than 1,474,600 people had been
infected and at least 88,600 had died in the United States. The
Times stated that, prior to 29 April, only deaths confirmed through
testing were reported, but new criteria include probable cases and
deaths. As of 17 May, the U.S., which accounts for about 4.25 percent The hospital ship USNS Comfort
of the world's population, had about 29 percent of the confirmed arrives in Manhattan.
coronavirus deaths.[741]

The White House has been criticised for downplaying the threat and controlling the messaging by
directing health officials and scientists to coordinate public statements and publications related to the
virus with the office of Vice-President Mike Pence.[742] On 14 April, President Trump halted funding to
the World Health Organization (WHO), saying they had mismanaged the pandemic. He also said the U.S.
would not participate in a global effort with the WHO to develop a vaccine and drugs to combat the
virus.[743] On 1 May the CDC presented a 17-page report titled "Guidance for Implementing the Opening
Up America Again Framework" to the administration. It had been written to provide advice for faith
leaders, places of business, and other public places, educators, and state and local officials as they began
to reopen. The White House refused to use the report. Trump said he felt the guidelines were too
restrictive, commenting "I see the new normal being what it was three months ago. I think we want to go
back to where it was."[744][745]

By mid-May reports of new cases began to level off and most states began to open restaurants and other
places of business, placing limits to the numbers of people allowed in the establishment at the same time.
The head of the NIAID, Anthony Fauci, warned that if caution was not used the rate of infections could
rebound and he was particularly concerned about opening the schools in the fall. President Trump
expressed surprise and disapproval at Fauci's statements saying, "To me it's not an acceptable answer,
especially when it comes to schools."[746]

South America
The pandemic was confirmed to have reached South America on 26
February when Brazil confirmed a case in São Paulo.[747] By 3 April,
all countries and territories in South America had recorded at least
one case.[748]

On April 17, the highest number of cases and deaths was registered
in Brazil,[749] followed by Peru and Chile in the number of confirmed
cases.[750]
Workers being trained to disinfect
On May 13, it was reported that Latin America and the Caribbean
buses in Olinda, Pernambuco,
had reported over 400,000 cases of infection with 23,091 deaths. On
Brazil, 16 March 2020
May 22, citing especially the rapid increase of infections in Brazil,
the WHO declared that South America is presently the epicentre of
the coronavirus pandemic.[751] As of 25 May, the area had more than
636,000 confirmed cases and more than 31,000 deaths. However, due to a dearth of testing and medical
facilities it is believed that the outbreak is far larger than the official numbers show.[752][753]
Brazil

On 20 May it was reported that Brazil had a record 1,179 deaths in a single day, for a total of almost
18,000 fatalities. With a total number of almost 272,000 cases, Brazil became the country with the third-
highest number of cases, following Russia and the United States.[754] On 25 May, Brazil exceeded the
number of reported cases in Russia when they reported that 11,687 new cases had been confirmed over
the previous 24 hours, bringing the total number to over 374,800, with more than 23,400 deaths.
President Jair Bolsonaro has created a great deal of controversy referring to the virus as a "little flu" and
frequently speaking out against preventive measures such as lockdowns and quarantines. His attitude
towards the outbreak has so closely matched that of U.S. president Donald Trump he has been called the
"Trump of the Tropics".[755]

In June 2020, the government of Brazil attempted to conceal the actual figures of the COVID-19 active
cases and deaths, as it stopped publishing the total number of infections and deaths. On 5 June, Brazil's
health ministry took down the official website reflecting the total numbers of infections and deaths. The
website was live on 6 June, with only the number of infections of previous 24 hours. The last official
numbers reported about 615,000 infections and over 34,000 deaths.[756] On 15 June, it was reported
that the worldwide cases had jumped from 7 to 8 million in one week, citing Latin America, specifically
Brazil as one of the countries where cases are surging, in this case, towards 1 million cases.[757]

Africa

According to Michael Yao, WHO's head of emergency operations in

Africa, early detection is vital because the continent's health systems
"are already overwhelmed by many ongoing disease
outbreaks".[758][759] Advisers say that a strategy based on testing
could allow African countries to minimise lockdowns that inflict
enormous hardship on those who depend on income earned day by
day to be able to feed themselves and their families. Even in the best
scenario, the United Nations says 74  million test kits and 30,000
ventilators will be needed by the continent's 1.3  billion people in
U.S. Air Force airmen unload a C-17
aircraft carrying approximately 2020.[760] Most of the reported cases are from six countries: South
1,800 kg (4,000 lb) of medical Africa, Nigeria, Ghana, Morocco, Egypt and Algeria, but it is believed
supplies in Niamey, Niger 23 April that there is widespread under-reporting in other African countries
2020. with poorer health care systems.[761] Cases have been confirmed in
all African countries, with Lesotho the last country to report its first
coronavirus case on 13 May 2020.[762] There have been no reported
cases in the British Overseas Territory of Saint Helena, Ascension and Tristan da Cunha.[763]

Oceania
The pandemic was confirmed to have reached Oceania on 25 January 2020 with the first confirmed case
reported in Melbourne, Australia.[764] It has since spread elsewhere in the region,[765] although many
small Pacific island nations have thus far avoided the outbreak by closing their international borders. As
of 21 June, ten Oceania sovereign states have yet to report a case - Kiribati, Marshall Islands, Federated
State of Micronesia, Nauru, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu.

On 19 May 2020, Australia filed a motion with the UN for an inquiry into the origins of the virus, and the
response of the UN and governments. More than 100 countries supported this motion, and it was passed
unanimously.[766][767]
International responses

Travel restrictions

As a result of the pandemic, many countries and regions imposed quarantines, entry bans, or other
restrictions, either for citizens, recent travellers to affected areas,[768] or for all travellers.[769] Together
with a decreased willingness to travel, this had a negative economic and social impact on the travel
sector. Concerns have been raised over the effectiveness of travel restrictions to contain the spread of
COVID-19.[770] A study in Science found that travel restrictions had only modestly affected the initial
spread of COVID-19, unless combined with infection prevention and control measures to considerably
reduce transmissions.[771] Researchers concluded that "travel restrictions are most useful in the early and
late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late".[772]

The European Union rejected the idea of suspending the Schengen free travel zone and introducing
border controls with Italy,[773][774] a decision which has been criticised by some European
politicians.[775][776]

Evacuation of foreign citizens

Owing to the effective quarantine of public transport in Wuhan and

Hubei, several countries evacuated their citizens and diplomatic staff
from the area, primarily through chartered flights of the home
nation, with Chinese authorities providing clearance. Canada, the
United States, Japan, India,[777] Sri Lanka, Australia, France,
Argentina, Germany, and Thailand were among the first to plan the
evacuation of their citizens.[778] Brazil and New Zealand also
evacuated their own nationals and some other people.[779][780] On 14 Ukraine evacuates Ukrainian and
March, South Africa repatriated 112 South Africans who tested foreign citizens from Wuhan, China.
negative for the virus from Wuhan, while four who showed
symptoms were left behind to mitigate risk.[781] Pakistan said it
would not evacuate citizens from China.[782]

On 15 February, the U.S. announced it would evacuate Americans aboard the cruise ship Diamond
Princess,[783] and on 21 February, Canada evacuated 129 Canadian passengers from the ship.[784] In
early March, the Indian government began evacuating its citizens from Iran.[785][786] On 20 March, the
United States began to partially withdraw its troops from Iraq due to the pandemic.[787]

International aid

Aid to China

Some Chinese students at American universities sent aid, including 50,000 N95 masks on 30
January.[788] The humanitarian aid organisation Direct Relief sent 200,000 face masks and other
personal protective equipment to the Wuhan Union Hospital the same day.[789] On 5  February, the
Chinese foreign ministry said 21 countries (including Belarus, Pakistan, Trinidad and Tobago, Egypt, and
Iran) had sent aid to China,[790] and Bill and Melinda Gates announced a $100 million donation to the
WHO to fund vaccine research and treatment efforts and protect "at-risk populations in Africa and South
Asia".[791] Interaksyon said the Chinese government had donated 200,000 masks to the Philippines on
6 February after Philippine senator Richard Gordon shipped 3.16  million masks to Wuhan.[792] On 19
February, the Singapore Red Cross announced it would send $2.26 million worth of aid to China.[793]

Several countries donated masks, medical equipment or money to China, including Japan,[794] Turkey,
Russia,[795] Malaysia,[796] Germany,[797] and Canada.[798][799] The U.S. State Department said on
7 February it had facilitated the transportation of nearly 17.8 tons of medical supplies to China.[800] The
same day, U.S. Secretary of State Pompeo announced a $100 million pledge to China and other countries
to aid their fights against the virus,[801] though on 21 March China said it had not received epidemic
funding from the U.S. government and reiterated that on 3 April. Several corporations have also donated
money or medical equipment to China.[802]

Aid to the world

After cases in China stabilised, the country began sending aid to

other nations.[803] In March, China, Cuba and Russia sent medical
supplies and experts to help Italy deal with its coronavirus
outbreak;[804][805] China sent three medical teams and donated
more than forty tons of medical supplies to Italy.[806] Businessman
Jack Ma sent 1.1  million testing kits, 6  million face masks, and
60,000 protective suits to Ethiopia for distribution by the African
Union.[807][808] He later sent 5,000 testing kits, 100,000 face masks
Medical supplies donated by China
and 5 ventilators to Panama.[809] being received at Villamor Air Base
in the Philippines
The Netherlands, Spain, Turkey, Georgia, and the Czech Republic
expressed concerns over Chinese-made masks and test kits.[810] For
instance, Spain withdrew 58,000 Chinese-made coronavirus testing kits with an accuracy rate of 30
percent, while the Netherlands recalled 600,000 Chinese face masks which were said to be defective,[811]
but China said this was due to misuse.[812] Belgium recalled 100,000 unusable masks, which were
thought to be from China but were in fact from Colombia.[813] The Philippines stopped using test kits
donated by China due to their 40 percent accuracy.[814] The Chinese government said product
instructions might not have been followed, and that some products were not purchased directly from
certified companies.[815] Chinese aid was well received in parts of Latin America and Africa.[816][817] On
2 April, the World Bank launched emergency support operations for developing countries.[818] According
to a statement from its Ministry of Foreign Affairs, Turkey provides the largest amount of humanitarian
aid in the world while ranking third worldwide in supplying medical aid.[819][820]

WHO response measures

Taiwan posted an inquiry to the WHO on 31 December 2019, shortly after receiving China's
notification.[821][822] The WHO has commended the Chinese authorities for providing "regular updates",
contrasting it to the 2002–2004 SARS outbreak when they were accused of secrecy.[823] The WHO
stated on 5  January that cases of pneumonia of unknown cause had been reported,[824] and issued
technical briefings on 10 and 11 January warning of risks of human-to-human transmission and urging
precautions due to the similarity to earlier SARS and MERS outbreaks.[825] though in public
announcements it said there was "no clear evidence of human-to-human transmission" as late as 14
January.[826] On 20 January, the WHO said it was "now very clear" human-to-human transmission of
the coronavirus had occurred, given that healthcare workers had been infected.[827] On 27 January, the
WHO assessed the risk of the outbreak to be "high at the global level".[828]
On 30 January, the WHO declared the outbreak a Public Health
Emergency of International Concern (PHEIC), warning that "all
countries should be prepared for containment, including active
surveillance, early detection, isolation and case management, contact
tracing and prevention of onward spread" of the virus,[7][829]
following an increase in cases outside China. This was the sixth-ever
PHEIC since the measure was first invoked during the 2009 swine
flu pandemic. WHO Director-General Tedros Adhanom said the
PHEIC was due to "the risk of global spread, especially to low- and
WHO Director-General Tedros
middle-income countries without robust health systems" but that the Adhanom
WHO did not "recommend limiting trade and
movement". [7][830][831]

On 11 February, the WHO established COVID-19 as the name of the

disease, and UN Secretary-General António Guterres agreed to
provide the "power of the entire UN system in the response". A UN
Crisis Management Team was activated, allowing coordination of the
entire United Nations, which the WHO stated will allow them to
"focus on the health response while the other agencies can bring
their expertise to bear on the wider social, economic and
developmental implications of the outbreak".[832] On 25 February,
WHO representatives with Tehran the WHO declared "the world should do more to prepare for a
city managers possible coronavirus pandemic," stating that while it was too early to
call it a pandemic, countries should be "in a phase of
preparedness".[833] On 28 February, WHO officials said the
coronavirus threat assessment at the global level would be raised from "high" to "very high", its highest
level of alert and risk assessment.[834] On 11 March, the WHO declared the coronavirus outbreak a
pandemic.[835] The Director-General said the WHO was "deeply concerned both by the alarming levels of
spread and severity, and by the alarming levels of inaction".[8] Critics have said the WHO handled the
pandemic inadequately and that the PHEIC and pandemic classification came too late.[836] The third
meeting of the WHO Emergency Committee on 30 April renewed the declaration of PHEIC for the
second time.[837]

Impact

Economics

The outbreak is a major destabilising threat to the global economy. Agathe Demarais of the Economist
Intelligence Unit has forecast that markets will remain volatile until a clearer image emerges on potential
outcomes. One estimate from an expert at Washington University in St. Louis gave a $300+  billion
impact on the world's supply chain that could last up to two years.[838] Global stock markets fell on 24
February due to a significant rise in the number of COVID-19 cases outside China.[839][840] On 27
February, due to mounting worries about the coronavirus outbreak, U.S. stock indexes posted their
sharpest falls since 2008, with the Dow falling 1,191 points (the largest one-day drop since the financial
crisis of 2007–08)[841] and all three major indexes ending the week down more than 10 percent.[842] On
28 February, Scope Ratings GmbH affirmed China's sovereign credit rating but maintained a Negative
Outlook.[843] Stocks plunged again due to coronavirus fears, the largest fall being on 16 March.[844]
Many consider an economic recession likely.[845][846]
Lloyd's of London has estimated that the global insurance industry
will absorb losses of US$204  billion, exceeding the losses from the
2017 Atlantic Hurricane season and 9/11, suggesting that the
COVID-19 pandemic will likely go down in history as the costliest
disaster ever in human history.[847]

Tourism is one of the worst

A highway sign on the Gardiner
Expressway in Toronto discouraging
non-essential travel
affected sectors due to travel
bans, closing of public places
including travel attractions, and
"Those who can, put something in;
advice of governments against
those who can't, help yourself."
travel. Numerous airlines have
Bologna, April 2020.
cancelled flights due to lower
demand, and British regional
airline Flybe collapsed.[848] The cruise line industry was hard
hit,[849] and several train stations and ferry ports have also been
closed.[850] International mail between some countries stopped or
was delayed due to reduced transportation between them or
suspension of domestic service.[851]

The retail sector has been impacted globally, with reductions in store hours or temporary closures.[852]
Visits to retailers in Europe and Latin America declined by 40 percent. North America and Middle East
retailers saw a 50–60 percent drop.[853] This also resulted in a 33–43 percent drop in foot traffic to
shopping centres in March compared to February. Shopping mall operators around the world imposed
additional measures, such as increased sanitation, installation of thermal scanners to check the
temperature of shoppers, and cancellation of events.[854]

Hundreds of millions of jobs could be lost globally.[855][856] More than 40 million Americans lost their
jobs and filed unemployment insurance claims.[857] According to a United Nations Economic
Commission for Latin America estimate, the pandemic-induced recession could leave 14–22  million
more people in extreme poverty in Latin America than would have been in that situation without the
pandemic.[858]

Supply shortages

The outbreak has been blamed for several instances of supply

shortages, stemming from globally increased usage of equipment to
fight outbreaks, panic buying (which in several places led to shelves
being cleared of grocery essentials such as food, toilet paper, and
bottled water), and disruption to factory and logistic operations.[859]
The spread of panic buying has been found to stem from perceived
threat, perceived scarcity, fear of the unknown, coping behaviour
and social psychological factors (e.g. social influence and trust).[860]
The technology industry, in particular, has warned of delays to
Coronavirus fears have led to panic
shipments of electronic goods.[861] According to the WHO director- buying of essentials across the
general Tedros Adhanom, demand for personal protection world, including toilet paper, dried
equipment has risen a hundredfold, leading to prices up to twenty and/or instant noodles, bread, rice,
times the normal price and also delays in the supply of medical items vegetables, disinfectant, and
rubbing alcohol.
of four to six months.[862][863] It has also caused a shortage of personal protective equipment worldwide,
with the WHO warning that this will endanger health workers.[864]

The impact of the coronavirus outbreak was worldwide. The virus created a shortage of precursors (raw
material) used in the manufacturing of fentanyl and methamphetamine. The Yuancheng Group,
headquartered in Wuhan, China, is one of the leading suppliers.[865] Price increases and shortages in
these illegal drugs have been noticed on the street of the UK.[866] U.S. law enforcement also told the New
York Post Mexican drug cartels were having difficulty in obtaining precursors.[867]

The pandemic has disrupted global food supplies and threatens to trigger a new food crisis.[868][869]
David Beasley, head of the World Food Programme (WFP), said "we could be facing multiple famines of
biblical proportions within a short few months."[870]

Senior officials at the United Nations estimated in April 2020 that an additional 130 million people could
starve, for a total of 265 million by the end of 2020.[871][870][872]

Oil and other energy markets

In early February 2020, Organization of the Petroleum Exporting Countries (OPEC) "scrambled" after a
steep decline in oil prices due to lower demand from China.[873] On Monday, 20 April, the price of West
Texas Intermediate (WTI) went negative and fell to a record low (minus $37.63 a barrel) due to traders'
offloading holdings so as not to take delivery and incur storage costs.[874] June prices were down but in
the positive range, with a barrel of West Texas trading above $20.[874]

Culture

The performing arts and cultural heritage sectors have been

profoundly affected by the pandemic, impacting organisations'
operations as well as individuals—both employed and independent—
globally. Arts and culture sector organisations attempted to uphold
their (often publicly funded) mission to provide access to cultural
heritage to the community, maintain the safety of their employees
and the public, and support artists where possible. By March 2020,
Closed entrance to the Shah Abdol- across the world and to varying degrees, museums, libraries,
Azim Shrine in Ray, Iran performance venues, and other cultural institutions had been
indefinitely closed with their exhibitions, events and performances
cancelled or postponed.[875] In response there were intensive efforts
to provide alternative services through digital platforms.[876][877][878]

Holy Week observances in Rome, which occur during the last week of the Christian penitential season of
Lent, were cancelled.[877] Many dioceses have recommended older Christians stay home rather than
attend Mass on Sundays; services have been made available via radio, online live streaming and
television, though some congregations have made provisions for drive-in worship.[879][880][877] With the
Roman Catholic Diocese of Rome closing its churches and chapels and St. Peter's Square emptied of
Christian pilgrims,[877] other religious bodies also cancelled in-person services and limited public
gatherings in churches, mosques, synagogues, temples and gurdwaras.[877] Iran's Health Ministry
announced the cancellation of Friday prayers in areas affected by the outbreak and shrines were later
closed,[609][616] while Saudi Arabia banned the entry of foreign pilgrims as well as its residents to holy
sites in Mecca and Medina.[881][882]
The pandemic has caused the most significant disruption to the
worldwide sporting calendar since the Second World War. Most
major sporting events have been cancelled or postponed, including
the 2019–20 UEFA Champions League,[883] 2019–20 Premier
League,[884] UEFA Euro 2020, 2019–20 NBA season,[885] and
2019–20 NHL season.[886] The outbreak disrupted plans for the
2020 Summer Olympics, which were originally scheduled to start at
the end of July; the International Olympic Committee announced on
24 March that they will be "rescheduled to a date beyond 2020 but
not later than summer 2021".[887][888] An American Catholic military
chaplain prepares for a live-
The entertainment industry has also been affected, with many music streamed Mass in an empty chapel
groups suspending or cancelling concert tours.[889][890] The at Offutt Air Force Base in March
Eurovision Song Contest, which was due to be held in the 2020.
Netherlands in May, was cancelled, however the Netherlands was
retained as host for 2021.[891][892] Many large theatres such as those
on Broadway also suspended all performances.[893] Some artists have explored ways to continue to
produce and share work over the internet as an alternative to traditional live performance, such as live
streaming concerts[894] or creating web-based "festivals" for artists to perform, distribute, and publicise
their work.[895] Online, numerous COVID-19-themed Internet memes have spread as many turn to
humour and distraction amid uncertainty.[896]

Politics

The pandemic has affected the political systems of multiple countries, causing suspensions of legislative
activities,[897] isolations or deaths of multiple politicians,[898] and rescheduling of elections due to fears
of spreading the virus.[899]

Starting in late May, large-scale protests against police brutality in at least 200 U.S. cities and later
worldwide in response to the killing of George Floyd raised concerns of a resurgence of the virus.[900]

China

The Chinese government has been criticised by the United States

government,[901] UK Minister for the Cabinet Office Michael
Gove,[902] and others[903] for its handling of the pandemic. A
number of provincial-level administrators of the Communist Party of
China were dismissed over their handling of the quarantine efforts in
central China, a sign of discontent with their response to the
outbreak. Some commentators believed this move was intended to Chinese Communist Party general
protect Chinese Communist Party general secretary Xi Jinping from secretary Xi Jinping (left) with State
the controversy.[904] The U.S. intelligence community says China Council Premier Li Keqiang
intentionally under-reported its number of coronavirus cases.[905]
The Chinese government maintains it has acted swiftly and
transparently.[906][907]

Italy
In early March, the Italian government criticised the European Union's lack of solidarity with
coronavirus-affected Italy[908][909]—Maurizio Massari, Italy's ambassador to the EU, said "only China
responded bilaterally", not the EU.[910] On 22 March, after a phone call with Italian Prime Minister
Giuseppe Conte, Russian president Vladimir Putin had the Russian army send military medics,
disinfection vehicles, and other medical equipment to Italy.[911] President of Lombardy Attilio Fontana
and Italian Foreign Minister Luigi Di Maio expressed their gratitude for the aid.[912] Russia also sent a
cargo plane with medical aid to the United States.[913] Kremlin spokesman Dmitry Peskov said "when
offering assistance to U.S. colleagues, [Putin] assumes that when U.S. manufacturers of medical
equipment and materials gain momentum, they will also be able to reciprocate if necessary."[914]

United States

The outbreak prompted calls for the United States to adopt social
policies common in other wealthy countries, including universal
health care, universal child care, paid sick leave, and higher levels of
funding for public health.[916][917][918] Political analysts anticipated
it may negatively affect Donald Trump's chances of re-election in the
2020 presidential election.[919][920] Beginning in mid-April 2020,
there were protests in several U.S. states against government-
imposed business closures and restricted personal movement and
association.[921]
Several hundred anti-lockdown
protesters rallied at the Ohio
Other countries Statehouse 20 April.[915]

The planned NATO "Defender 2020" military exercise in Germany,

Poland, and the Baltic states, the largest NATO war exercise since the end of the Cold War, will be held
on a reduced scale.[922][923] The Campaign for Nuclear Disarmament's general secretary Kate Hudson
criticised the exercise, saying "it jeopardises the lives not only of the troops from the U.S. and the many
European countries participating but the inhabitants of the countries in which they are operating."[924]

The Iranian government has been heavily affected by the virus, with about two dozen parliament
members and fifteen current or former political figures infected.[619][925] Iran's President Hassan
Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, saying they were
struggling to fight the outbreak due to a lack of access to international markets from the United States
sanctions against Iran.[926] Saudi Arabia, which launched a military intervention in Yemen in March
2015, declared a ceasefire.[927]

Diplomatic relations between Japan and South Korea worsened due to the pandemic.[928] South Korea
criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced anyone coming
from South Korea would be placed in quarantine for two weeks at government-designated sites.[929]
South Korean society was initially polarised on President Moon Jae-in's response to the crisis; many
Koreans signed petitions either calling for Moon's impeachment or praising his response.[644]

Some countries have passed emergency legislation in response to the pandemic. Some commentators
have expressed concern that it could allow governments to strengthen their grip on power.[930][931] In
the Philippines, lawmakers granted president Rodrigo Duterte temporary emergency powers during the
pandemic.[932] In Hungary, the parliament voted to allow the prime minister, Viktor Orbán, to rule by
decree indefinitely, suspend parliament as well as elections, and punish those deemed to have spread
false information about the virus and the government's handling of the crisis.[933] In some countries,
including Egypt,[934] Turkey,[935] and Thailand,[932] opposition activists and government critics have
been arrested for allegedly spreading fake news about the COVID-19 pandemic.[936]

Education

The pandemic has affected

educational systems worldwide,
leading to the near-total closures of
schools, universities and
colleges. [937]

Most governments around the

world have temporarily closed
educational institutions in an
attempt to contain the spread of
COVID-19.[938] As of 7 June 2020,
approximately 1.725 billion learners
are currently affected due to school
closures in response to the Learners affected by school closures caused by COVID-19 as of
pandemic. According to UNICEF 7 June 2020
monitoring, 134 countries are    Country-wide school closures
currently implementing nationwide    Localized school closures
closures and 38 are implementing    No school closures
local closures, impacting about 98.5
   No data
percent of the world's student
population. 39 countries' schools
are currently open.[939]

On 23 March 2020, Cambridge International Examinations (CIE) released a statement announcing the
cancellation of Cambridge IGCSE, Cambridge O Level, Cambridge International AS & A Level,
Cambridge AICE Diploma, and Cambridge Pre-U examinations for the May/June 2020 series across all
countries.[940] International Baccalaureate exams have also been cancelled.[941] In addition, Advanced
Placement Exams, SAT administrations, and ACT administrations have been moved online and
cancelled.

School closures impact not only students, teachers, and families.[942] but have far-reaching economic
and societal consequences.[943][944] School closures in response to the pandemic have shed light on
various social and economic issues, including student debt,[945] digital learning,[946][947] food
insecurity,[948] and homelessness,[949][950] as well as access to childcare,[951] health care,[952]
housing,[953] internet,[954] and disability services.[955] The impact was more severe for disadvantaged
children and their families, causing interrupted learning, compromised nutrition, childcare problems,
and consequent economic cost to families who could not work.[29][956]

In response to school closures, UNESCO recommended the use of distance learning programs and open
educational applications and platforms that schools and teachers can use to reach learners remotely and
limit the disruption of education.[957]

Other health issues

The pandemic has had many impacts on global health beyond those caused by the COVID-19 disease
itself. It has led to a reduction in hospital visits for other reasons. There have been 38 per cent fewer
hospital visits for heart attack symptoms in the United States and 40 per cent fewer in Spain.[958] The
head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home
because they're too scared to go to the hospital."[959] There is also concern that people with strokes and
appendicitis are not seeking timely treatment.[959] Shortages of medical supplies have impacted people
with various conditions.[960]

In several countries there has been a marked reduction of spread of sexually transmitted infections,
including HIV, attributable to COVID-19 quarantines, social distancing measures, and recommendations
to not engage in casual sex.[961][962] Similarly, in some places, rates of transmission of influenza and
other respiratory viruses significantly decreased during the pandemic.[963][964][965] The pandemic has
also negatively impacted mental health globally.[966]

Environment and climate

The worldwide disruption caused by the pandemic

has resulted in numerous impacts on the
environment and the climate. The considerable
decline in planned travel[968] has caused many
regions to experience a large drop in air pollution. In
China, lockdowns and other measures resulted in a
25  per cent reduction in carbon emissions[969]
and  50 per cent reduction in nitrogen oxides
emissions,[970] which one Earth systems scientist
estimated may have saved at least 77,000 lives over
two months.[971][972] Other positive impacts on the
environment include governance-system-controlled
investments towards a sustainable energy transition
and other goals related to environmental protection
such as the European Union's seven-year €1 trillion
budget proposal and €750 billion recovery plan Images from the NASA Earth Observatory show a
"Next Generation EU" which seeks to reserve 25% of stark drop in pollution in Wuhan, China, when
EU spending for climate-friendly comparing NO2 levels in early 2019 (top) and early
expenditure. [973][974][975][976][977] 2020 (bottom).[967]

However, the outbreak has also provided cover for

illegal activities such as deforestation of the Amazon rainforest[978][979] and poaching in Africa,[980][981]
hindered environmental diplomacy efforts,[982] and created economic fallout that some predict will slow
investment in green energy technologies.[983]

Xenophobia and racism

Since the start of the outbreak, heightened prejudice, xenophobia, and racism have been documented
around the world toward people of Chinese and East Asian descent,[984][985][986] Reports from February
(when most cases were confined to China) documented racist sentiments expressed in groups worldwide
about Chinese people deserving the virus.[987][988][989] Citizens in countries including Malaysia,[990]
New Zealand,[991] Singapore,[992] Japan,[993] Vietnam,[994] and South Korea lobbied to ban Chinese
people from entering their countries.[995] Chinese people and other Asians in the United Kingdom and
United States have reported increasing levels of racist abuse and assaults.[32][996][997] U.S. president
Donald Trump has been criticised for referring to the coronavirus as the "Chinese Virus", which critics
say is racist and anti-Chinese.[998][999][1000]

Following the progression of the outbreak to new hotspot countries,

Houston's Chinatown experienced a
reduction in business early during
the outbreak when there were still
only a few cases.[1001]
people from Italy (the first country in Europe to experience a serious
outbreak of COVID-19) were also subjected to suspicion and
xenophobia,[1002][1003] as were people from hotspots in other
countries. Discrimination against Muslims in India escalated after
public health authorities identified an Islamic missionary group's
gathering in New Delhi in early March 2020 as a source of
spread.[1004] Paris has seen riots break out over police treatment of
ethnic minorities during the coronavirus lockdown.[1005] Racism and
xenophobia towards South Asians and Southeast Asians increased in
the Arab states of the Persian Gulf.[1006][1007][1008] South Korea's
LGBTQ community was blamed by some for the spread of COVID-19
in Seoul.[1009][1010]

In China, xenophobia and racism against non-Chinese residents has been inflamed by the pandemic,
with foreigners described as "foreign garbage" and targeted for "disposal".[1011] Some black people were
evicted from their homes by police and told to leave China within 24 hours, due to disinformation that
they and other foreigners were spreading the virus.[1012] Chinese racism and xenophobia was criticised
by foreign governments and diplomatic corps,[1013] and China apologised for discriminatory practices
such as restaurants excluding black customers,[1014] although these and other accusations of harassment,
discrimination and eviction of black people in China continued.[1015]

Information dissemination
Many newspaper agencies removed their online paywalls for some or all of their coronavirus-related
articles and posts,[1016] while scientific publishers made scientific papers related to the outbreak
available with open access.[1017] Some scientists chose to share their results quickly on preprint servers
such as bioRxiv.[1018]

Misinformation

The pandemic has resulted in misinformation and conspiracy theories about the scale of the pandemic
and the origin, prevention, diagnosis, and treatment of the disease.[1020][1021][1022] False information,
including intentional disinformation, has been spread through social media,[1021][1023] text
messaging,[1024] and mass media,[1025] including the tabloid media,[1026] conservative media,[1027][1028]
and state media of countries such as China,[1029][1030] Russia,[1031][1032] Iran,[1033] and
Turkmenistan.[1021][1034] It has also been reportedly spread by covert operations backed by states such as
Saudi Arabia,[1035] Russia and China to generate panic and sow distrust in other
countries.[1036][1037][1038][1039] In some countries, such as India,[1040] Bangladesh,[1041] and
Ethiopia,[1042] journalists have been arrested for allegedly spreading fake news about the pandemic.[1043]

Misinformation has been propagated by celebrities, politicians[1044][1045] (including heads of state in

countries such as the United States,[1046][1047] Iran,[1048] and Brazil[1049][1050]), and other prominent
public figures.[1051] Commercial scams have claimed to offer at-home tests, supposed preventives, and
"miracle" cures.[1052][1053] Several religious groups have claimed their faith will protect them from the
virus.[1054][1055][1056] Some people have claimed the virus
is a bioweapon accidentally or purposefully leaked from a
laboratory,[1057][1058] a population-control scheme, the
result of a spy operation,[1022][1023][1059] or the side effect
of 5G upgrades to cellular networks.[1060]

The World Health Organization has declared an

"infodemic" of incorrect information about the virus,
which poses risks to global health.[1021]
Play media
See also U.S. president Donald Trump suggested at a
press briefing on 23 April that disinfectant
Coronavirus disease 2019 injections or exposure to ultraviolet light might
help treat COVID-19. There is no evidence that
Emerging infectious disease
either could be a viable method.[1019] (1:05 min)
Globalisation and disease
List of epidemics and pandemics

Notes
a. In summary, this article is about the coronavirus pandemic, which is caused by the disease COVID-
19, which is caused by the virus SARS‑CoV‑2.[1]
b. Cases: This number shows the cumulative number of confirmed human cases reported to date. The
actual number of infections and cases is likely to be higher than reported.[34] Reporting criteria and
testing capacity vary between countries.
The total number of cases may not necessarily add up due to the frequency of values being updated
for each location.
c. Close contact is defined as one metre (~3.3 feet) by the WHO[9] and ~1.8 metres (six feet) by the
CDC.[10]
d. An uncovered cough can travel up to 8.2 metres (27 feet).[11]
e. Location: Countries, territories, and international conveyances where cases were diagnosed. The
nationality of the infected and the origin of infection may vary. For some countries, cases are split into
respective territories and noted accordingly.
f. Deaths: Reporting criteria vary between countries.
The total number of deaths may not necessarily add up due to the frequency of values being updated
for each location.
g. Recoveries: May not correspond to actual current figures and not all recoveries may be reported.
Reporting criteria vary between countries.
The total number of recoveries may not necessarily add up due to the frequency of values being
updated for each location.
h. World
Total numbers worldwide. Some locations, including North Korea, have yet to report cases.
 i. United States
1. Figures include cases identified on the Grand Princess.
2. Figures do not include the unincorporated territories of Puerto Rico, Guam, Northern Mariana
Islands, and U.S. Virgin Islands, all of which are listed separately.
3. Not all states or overseas territories report recovery data.
4. Cases include clinically diagnosed cases as per CDC guidelines.[35]
5. Recoveries and deaths include probable deaths and people released from quarantine as per
CDC guidelines.[36][37][38]
6. Figures from the United States Department of Defense are only released on a branch-by branch
basis since April 2020, without distinction between domestic and foreign deployment, and cases
may be reported to local health authorities.[39]
7. Cases for the USS Theodore Roosevelt, currently docked at Guam, are reported separate from
national figures but included in the Navy's totals.
8. There is also one case reported from Guantanamo Bay Naval Base not included in any other
nation or territory's counts.[40] Since April 2020, the United States Department of Defense has
directed all bases, including Guantanamo Bay, to not publicize case statistics.[39]
j. Brazil
Since 6 June, the Brazilian government has ordered the Ministry of Health to stop reporting the
total number of deaths and active cases.[42][43] After this, the National Council of Health
Secretaries assumed the function of reporting the total number of deaths and active cases.[44]
k. Russia
1. Including cases from the disputed Crimea and Sevastopol.
2. Excluding the cases from Diamond Princess cruise ship which are classified as "on an
international conveyance".
l. United Kingdom
1. Excluding all British Overseas Territories and Crown dependencies.
2. As of 23 March 2020, the UK government does not publish the number of recoveries. The last
update on 22 March reported 135 recovered patients.[49]
m. Chile
1. Including the special territory of Easter Island.
2. On 2 June 2020, the Chilean government decided to not publish the number of recovered
patients.
3. Deaths only include cases with positive PCR tests and catalogued as "COVID-19 related death"
by the Civil Registry and Identification Service. This number is informed on the daily reports of the
Ministry of Health. On 20 June 2020, the Ministry confirmed 7,144 as the total number of deaths,
including suspected cases without PCR test. However, this number won't be released daily and
only on a weekly basis.[54]
n. Spain
Excludes serology–confirmed cases.
o. Germany
1. Not all state authorities count recoveries.[60]
2. Recoveries include estimations by the Robert Koch Institute.[60][61]
p. France
1. Including overseas regions of French Guiana, Guadeloupe, Martinique, Mayotte and Réunion,
and collectivities of Saint Barthélemy and Saint Martin.
2. Excluding collectivities of New Caledonia, French Polynesia and Saint Pierre and Miquelon.
3. Recoveries only include hospitalized cases.[66]
4. Figures for total confirmed cases and total deaths include data from both hospital and nursing
home (ESMS: établissements sociaux et médico-sociaux).[66]
q. China
1. Excluding 114 asymptomatic cases under medical observation as of 21 June 2020.
2. Asymptomatic cases were not reported before 31 March 2020.
3. Excluding Special Administrative Regions of Hong Kong and Macau.
4. Does not include Taiwan.
r. Belgium
The number of deaths also includes untested cases and cases in retirement homes that
presumably died because of COVID-19, whilst most countries only include deaths of tested cases
in hospitals.[74]
s. Egypt
Includes cases identified on the MS River Anuket.
t. Netherlands
1. The Kingdom of the Netherlands consists of a) the Netherlands* [the country as opposed to the
kingdom; listed here], which in turn includes the Caribbean Netherlands, that are made up of the
special municipalities Bonaire*, Saba* and Sint Eustatius*; b) Aruba*; c) Curaçao*; and d) Sint
Maarten*. All regions marked with an asterisk are listed separately.
2. The Dutch Government agency RIVM, responsible for the constituent country the Netherlands,
does not count its number of recoveries.[80]
u. Argentina
Excluding confirmed cases on the claimed territory of the Falkland Islands. Since 11 April, the
Argentine Ministry of Health includes them in their official reports.[84]
v. Ukraine
1. Excluding cases from the disputed Crimea and Sevastopol. Cases in these territories are
included in the Russian total.
2. Excluding cases from the unrecognized Donetsk and Lugansk People's Republics.
w. Israel
1. Including cases from the disputed Golan Heights.
2. Excluding cases from the Palestinian National Authority.
x. Diamond Princess and Japan
The British cruise ship Diamond Princess was in Japanese waters, and the Japanese
administration was asked to manage its quarantine, with the passengers having not entered
Japan. Therefore, this case is included in neither the Japanese nor British official counts. The
World Health Organization classifies the cases as being located "on an international
conveyance".
 y. Moldova
Including the disputed territory of Transnistria.
z. Serbia
Excluding cases from the disputed territory of Kosovo.
aa. Azerbaijan
Excluding the self-declared state of Artsakh.
ab. Denmark
The autonomous territories of the Faroe Islands and Greenland are listed separately.
ac. Morocco
Including cases in the disputed Western Sahara territory controlled by Morocco. There are no
confirmed cases in the rest of Western Sahara.[125]
ad. Norway
Estimation of the number of infected:
As of 23 March 2020, according to figures from just over 40 per cent of all GPs in Norway,
20,200 patients have been registered with the "corona code" R991. The figure includes both
cases where the patient has been diagnosed with coronavirus infection through testing, and
where the GP has used the "corona code" after assessing the patient's symptoms against the
criteria by the Norwegian Institute of Public Health.[129]
As of 24 March 2020, the Norwegian Institute of Public Health estimates that between 7,120
and 23,140 Norwegians are infected with the coronavirus.[130]
ae. Australia
Excluding the cases from Diamond Princess cruise ship which are classified as "on an
international conveyance". Ten cases, including one fatality recorded by the Australian
government.
af. Finland
1. Including the autonomous region of the Åland Islands.
2. The number of recoveries is an estimate based on reported cases which were reported at least
two weeks ago and there is no other monitoring data on the course of the disease.[136] The exact
number of recoveries is not known, as only a small proportion of patients have been
hospitalized.[137]
ag. DR Congo
The Democratic Republic of the Congo.
ah. Somalia
Excluding the de facto state of Somaliland.
ai. Cuba
1. Includes cases on the MS Braemar.
2. Excluding cases from Guantanamo Bay, which is governed by the United States.
aj. Guam and USS Theodore Roosevelt
Cases for the USS Theodore Roosevelt, currently docked at Guam, are reported separately.
ak. Charles de Gaulle
1. Including cases on the escort frigate Chevalier Paul.
2. Florence Parly, Minister of the Armed Forces, reported to the National Assembly's National
Defense and Armed Forces Committee that 2010 sailors of the carrier battle group led by Charles
de Gaulle had been tested, with 1081 tests returning positive so far.[197] Many of these cases
were aboard Charles de Gaulle, some of the cases were reportedly aboard French frigate
Chevalier Paul, and it is unclear if any other ships in the battle group had cases on
board.[198][199][200]
al. Donetsk and Luhansk People's Republic
Note that these territories are distinct from the Ukraine-administered regions of the Donetsk and
Luhansk Oblasts.
am. Cyprus
1. Including the British Overseas Territory of Akrotiri and Dhekelia.
2. Excluding de facto state of Northern Cyprus.
an. Georgia
Excluding the de facto states of Abkhazia and South Ossetia.
ao. Congo
Also known as the Republic of the Congo and not to be confused with the DR Congo.
ap. Greg Mortimer and Uruguay
Although currently anchored off the coast of Uruguay, cases for the Greg Mortimer are currently
reported separately. Six have been transferred inland for hospitalization.
aq. Somaliland
Cases from this de facto state are not counted by Somalia.
ar. Figures for Tanzania are for 29 April as the country stopped publishing figures on coronavirus cases
on that date.[236]
as. Taiwan

Including cases from the ROCS Pan Shi.[242]

at. Isle of Man
Recoveries are presumed. Defined as "An individual testing positive for coronavirus who
completes the 14 day self-isolation period from the onset of symptoms who is at home on day 15,
or an individual who is discharged from hospital following more severe symptoms."[247]
au. Syria
Excluding cases from the disputed Golan Heights.
av. Northern Cyprus
Cases from this de facto state are not counted by Cyprus.
aw. Artsakh
Cases from this de facto state are not counted by Azerbaijan.
ax. South Ossetia
Cases from this de facto state are not counted by Georgia.
ay. Abkhazia
Cases from this de facto state are not counted by Georgia.
az. Saint Vincent
The sovereign state of Saint Vincent and the Grenadines.
ba. MS Zaandam
1. Including cases from MS Rotterdam.
2. The MS Rotterdam rendezvoused with the Zaandam on 26 March off the coast of Panama City to
provide support and evacuate healthy passengers. Both have since docked in Florida.[309][310]
3. MS Zaandam and Rotterdam's numbers are currently not counted in any national figures.
bb. Coral Princess
1. The cruise ship Coral Princess has tested positive cases since early April 2020 and has since
docked in Miami.[313]
2. Coral Princess's numbers are currently not counted in any national figures.
bc. HNLMS Dolfijn
1. All 8 cases currently associated with Dolfijn were reported while the submarine was at sea in the
waters between Scotland and the Netherlands.[320]
2. It is unclear whether the National Institute for Public Health and the Environment (RIVM) is
including these cases in their total count, but neither their daily update details nor their daily
epidemiological situation reports appear to have mentioned the ship, with a breakdown of cases
listing the twelve provinces of the country of the Netherlands (as opposed to the kingdom)
accounting for all the cases in the total count.[321][322]

References
1. "Naming the coronavirus disease (COVID-19) and the virus that causes it" (https://www.who.int/emer
gencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid
-2019)-and-the-virus-that-causes-it). World Health Organization (WHO).
2. "Coronavirus very likely of animal origin, no sign of lab manipulation: WHO" (https://www.reuters.co
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▶
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➕
rejoint leurs bases. Une suspicion d'épidémie de #Covid19 à bord a motivé la décision immédiate

⤵
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