Epidemic curve of COVID-19 by date of report

Semi-log plot of weekly new cases of COVID-19 in

the world and top five current countries (mean with
deaths)
 COVID-19 active cases per 100 000
population from selected countries[75]
COVID-19 total cases per 100 000 population
from selected countries[75]

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.[76] As of 30 August 2020,
approximately 843,000[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.[77]
Individuals of any age with COPD, obesity, type 2 diabetes mellitus
and other underlying health conditions are at increased risk of
Deceased in a 16 m (53 ft) "mobile
severe illness from COVID-19.[78][79] morgue" outside a hospital in
Hackensack, New Jersey
The first confirmed death was in Wuhan on 9 January 2020.[80] The
first death outside of China occurred on 1 February in the
Philippines,[81] and the first death outside Asia was in France on 14 February.[82]

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 having been tested.[83] Conversely, deaths
of people who had underlying conditions may lead to over-counting.[84] Comparison of statistics for
deaths for all causes versus the seasonal average indicates excess mortality in many countries.[85][86] 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.[85] This excess mortality may include
deaths due to strained healthcare systems and bans on elective surgery.[87]

Multiple measures are used to quantify mortality.[88] These numbers vary by region and over time,
influenced by testing volume, healthcare system quality, treatment options, government
response,[89][90][91] time since the initial outbreak, and population characteristics, such as age, sex, and
overall health.[92] 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.[93]

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 3.4 percent (843,586 deaths for 25,051,178 cases) as of 30 August 2020.[5] The
number varies by region.[94]

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.[92] 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.[95][96] 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.[97] The CDC estimates for planning purposes that the
fatality rate among those who are symptomatic is 1.1 percent and that 40 percent of infected individuals
are asymptomatic, for an overall infection fatality rate of 0.65 percent (0.5 to 0.8 percent).[98][99]
 Semi-log plot of weekly deaths due to COVID-19 in the
world and top five current countries (mean with cases)

Case fatality rate of COVID-19 by country and COVID-19 deaths per 100 000 population from
confirmed cases selected countries[100]

Duration

On 11 March 2020, the WHO said 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."[101] The Imperial College study led by Neil Ferguson stated that physical distancing and other
measures will be required "until a vaccine becomes available.[102] 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.[103]

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.[10][105]
Some infected people have no symptoms, known
as asymptomatic or presymptomatic carriers;
transmission from such a carrier is considered
possible.[106] As at 6 April, estimates of the
asymptomatic ratio range widely from 5 to 80
percent.[107]

Symptoms of COVID-19 can be relatively non- Symptoms of COVID-19[104]

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.[108][17][16]

Among those who develop symptoms, approximately one in five may become more seriously ill and have
difficulty breathing.[10] 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.[16] Further development of the disease can lead to complications
including pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and kidney failure.[17]

Cause

Transmission

COVID‑19 is a new disease, and many of the details of its spread are
still under investigation.[10][11][12] It spreads easily between people—
more easily than influenza but not as easily as measles.[11] People are
most infectious when they show symptoms (even mild or non-
specific symptoms), but may be infectious for up to two days before
symptoms appear (pre-symptomatic transmission).[12] They remain
infectious for an estimated seven to twelve days in moderate cases
and an average of two weeks in severe cases.[12] People can also
transmit the virus without showing any symptom (asymptomatic Respiratory droplets produced when
transmission), but it is unclear how often this happens.[10][11][12] A a man sneezes, visualised using
June 2020 review found that 40–45% of infected people are Tyndall scattering
asymptomatic.[109]

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][110] The
WHO recommends 1 metre (3 ft) of social distance;[10] the US Centers for Disease Control and
Prevention (CDC) recommends 2 metres (6 ft).[11]

Transmission may also occur through aerosols, smaller droplets that are able to stay suspended in the air
for longer periods of time.[14] Experimental results show the virus can survive in aerosol for up to three
hours.[111] Some outbreaks have also been reported in crowded and inadequately ventilated indoor
locations where infected persons spend long periods of time (such as restaurants and nightclubs).[112]