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COVID-19 Pandemic: Several Terms Redirect Here. For Other Uses, See and
COVID-19 Pandemic: Several Terms Redirect Here. For Other Uses, See and
The Huanan Seafood Wholesale Market in March 2020, after it was closed down.
Cases
Main articles: COVID-19 pandemic by country and territory and COVID-19
pandemic cases
Official case counts refer to the number of people who have been tested for COVID-
19 and whose test has been confirmed positive according to official protocols. [39]
[40]
Many countries, early on, had official policies to not test those with only mild
symptoms.[41][42] An analysis of the early phase of the outbreak up to 23 January
estimated 86 percent of COVID-19 infections had not been detected, and that these
undocumented infections were the source for 79 percent of documented cases.
[43]
Several other studies, using a variety of methods, have estimated that numbers of
infections in many countries are likely to be considerably greater than the reported
cases.[44][45]
On 9 April 2020, preliminary results found that 15 percent of people tested
in Gangelt, the centre of a major infection cluster in Germany, tested positive for
antibodies.[46] Screening for COVID-19 in pregnant women in New York City,
and blood donors in the Netherlands, has also found rates of positive antibody tests
that may indicate more infections than reported.[47][48] Seroprevalence based
estimates are conservative as some studies shown that persons with mild symptoms
do not have detectable antibodies. [49] Some results (such as the Gangelt study) have
received substantial press coverage without first passing through peer review. [50]
Analysis by age in China indicates that a relatively low proportion of cases occur in
individuals under 20.[51] It is not clear whether this is because young people are less
likely to be infected, or less likely to develop serious symptoms and seek medical
attention and be tested.[52] A retrospective cohort study in China found
that children and adults were just as likely to be infected. [53]
Initial estimates of the basic reproduction number (R0) for COVID-19 in January were
between 1.4 and 2.5,[54] but a subsequent analysis concluded that it may be about
5.7 (with a 95 percent confidence interval of 3.8 to 8.9).[55] R0 can vary across
populations and is not to be confused with the effective reproduction
number (commonly just called R), which takes into account effects such as social
distancing and herd immunity. By mid-May 2020, the effective R was close to or
below 1.0 in many countries, meaning the spread of the disease in these areas at
that time was stable or decreasing.[56]
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.[58] Conversely, deaths of people who had underlying conditions
may lead to over-counting.[59] Comparison of statistics for deaths for all causes
versus the seasonal average indicates excess mortality in many countries. [60][61] This
may include deaths due to strained healthcare systems and bans on elective
surgery.[62] The first confirmed death was in Wuhan on 9 January 2020. [63] The first
reported death outside of China occurred on 1 February in the Philippines, [64] and the
first reported death outside Asia was in the United States on 6 February. [65]
More than 95% of the people who contract COVID-19 recover. Otherwise, the time
between symptoms onset and death usually ranges from 6 to 41 days, typically
about 14 days.[66] As of 12 October 2020, more than 1.07 million[6] deaths had been
attributed to COVID-19. In China, as of 14 June, about 80% of deaths were recorded
in those over 60, and 75% had pre-existing health conditions
including cardiovascular disease and diabetes.[67] Individuals of any age with
underlying health conditions are at increased risk of severe illness.
On 24 March 2020, the Centers for Disease Control and Prevention (CDC) changed
criteria for attributing deaths to COVID-19 to include those marked
"probable"/"likely." The CDC said, "It is not likely that [the National Center for Health
Statistics (NCHS)] will follow up on these cases" and that while the "underlying
cause depends upon what and where conditions are reported on the death
certificate, … the rules for coding and selection of the ... cause of death are expected
to result in COVID–19 being the underlying cause more often than not." [68]
On 16 April, the WHO created two codes for classifying deaths: UO7.1, "confirmed
by laboratory testing irrespective of severity of clinical signs or symptoms"; and
UO7.2, "diagnosed clinically or epidemiologically but laboratory testing is
inconclusive or not available". The WHO "recognized that in many countries detail as
to the laboratory confirmation… will not be reported [and] recommended, for
mortality purposes only, to code COVID-19 provisionally to code U07.1 unless it is
stated as 'probable' or 'suspected'." [69][70] It was also noted that the WHO "does not
distinguish" between infection by SARS-CoV-2 and COVID-19. [71]
In August 2020, the CDC reported that in the United States 94% of COVID-19 death
certificates listed at least one comorbidity. [72] The reported comorbidities include
symptoms caused by COVID-19 infection which contributed to the fatality in addition
to pre-existing health conditions.[73] On 92% of American death certificates listing
COVID-19 as a cause of death, COVID-19 was listed as “the condition that began
the chain of events that ultimately led to the person’s death”. [74]
Multiple measures are used to quantify mortality. [75] These numbers vary by region
and over time, influenced by testing volume, healthcare system quality, treatment
options, government response,[76][77][78] time since the initial outbreak, and population
characteristics, such as age, sex, and overall health. [79] 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.[80]
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 2.9 percent (1,075,750
deaths for 37,395,029 cases) as of 12 October 2020. [6] The number varies by region.
[81]
The most important metric in assessing death rate is infection fatality ratio (IFR),[82]
[c]
which is the deaths attributed to disease divided by the number of infected
individuals to-date (including all asymptomatic and undiagnosed subjects). [84] The
CDC's ‘best estimate’ IFR for the U.S. by age bracket is 0.003% for 0–19 years;
0.02% for 20–49 years; 0.5% for 50–69 years; and 5.4% for 70+ years. [85]
[d]
The Centre for Evidence-Based Medicine (CEBM) has estimated global IFR at
between 0.10% to 0.41% (last revised 2 May), acknowledging that this will vary
between populations due to differences in demographics. [87] CEBM researchers have
noted a decrease in IFR in England over time; [88][e] and, for the UK and Italy (the two
Europeans nations worst hit by COVID-19), attribute the rise in daily cases, stability
in daily deaths, and shift of cases to a younger population to waning viral circulation,
misapplication of testing, and misinterpretation of test results rather than to
prevention, treatment, or virus mutation. [89]
The WHO reported serology testing for three locations in Europe (with some data
through 2 June) that show IFR estimates converging at approximately 0.5-1%. [83] The
BMJ noted that while some "serological tests … might be cheaper and easier to
implement at the point of care [than RT-PCR]", and such testing can identify
previously infected individuals, "caution is warranted … using serological tests for …
epidemiological surveillance". The review called for higher quality studies assessing
accuracy with reference to a standard of "RT-PCR performed on at least two
consecutive specimens, and, when feasible, includ[ing] viral cultures." [90][91] CEBM
researchers have called for in-hospital 'case definition' to record "CT lung findings
and associated blood tests" [92] and for the WHO to produce a "protocol to standardise
the use and interpretation of PCR" with continuous re-calibration. [93]
Another metric in assessing death rate is the case fatality rate (CFR), which is the
deaths attributed to disease divided by the number of diagnosed individuals to-date.
This metric can be misleading because of delay between symptom onset and death
and because testing focuses on individuals with symptoms (and particularly on those
manifesting more severe symptoms).[71] As of 31 August, researchers note that data
from Germany indicate that CFR has declined in all age groups with older age
groups driving the overall reduction and that, as Germany had a low CFR to start
with older age groups, it is likely in other countries with higher CFRs in older age
groups at the outset that the effect could be more extensive.
COVID-19 deaths per 100 000 population from selected countries [95]
Transmission
Main article: Transmission of COVID-19
Symptoms of COVID-19[104]
Symptoms of COVID-19 can be relatively non-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.[105][106][107]
Among those who develop symptoms, approximately one in five may become more
seriously ill and have difficulty breathing. [108] 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.[107] Further development of the disease can lead to complications
including pneumonia, acute respiratory distress syndrome, sepsis, septic shock,
and kidney failure.[106]
Cause
Virology
Main article: Severe acute respiratory syndrome coronavirus 2
Illustration of SARSr-CoV virion
SARS-CoV-2 is a Baltimore class IV[109] positive-sense single-stranded RNA
virus[110] that is contagious in humans.[111] As described by the U.S. National Institutes
of Health, it is the successor to SARS-CoV-1,[112][113] the strain that caused the 2002–
2004 SARS outbreak.
Taxonomically, SARS-CoV-2 is a strain of severe acute respiratory syndrome-
related coronavirus (SARSr-CoV).[114] It is believed to have zoonotic origins and has
close genetic similarity to bat coronaviruses, suggesting it emerged from a bat-borne
virus.[115][116][117][118] There is no evidence yet to link an intermediate host, such as
a pangolin, to its introduction to humans.[119][120] The virus shows little genetic
diversity, indicating that the spillover event introducing SARS-CoV-2 to humans is
likely to have occurred in late 2019. [121]
Epidemiological studies estimate each infection results in 5.7 new ones when no
members of the community are immune and no preventive measures taken.[122] The
virus primarily spreads between people through close contact and via respiratory
droplets produced from coughs or sneezes. [123][124] It mainly enters human cells by
binding to the receptor angiotensin converting enzyme 2 (ACE2).[115][125][126][127]
Diagnosis
Main article: COVID-19 testing
A CT scan of a person with COVID-19 shows lesions (bright regions) in the lungs.
Characteristic imaging features on chest radiographs and computed
tomography (CT) of people who are symptomatic include asymmetric
peripheral ground-glass opacities without pleural effusions.[143] Many groups have
created COVID-19 datasets that include imagery such as the Italian Radiological
Society which has compiled an international online database of imaging findings for
confirmed cases.[144] Due to overlap with other infections such as adenovirus,
imaging without confirmation by rRT-PCR is of limited specificity in identifying
COVID-19.[143] A large study in China compared chest CT results to PCR and
demonstrated that though imaging is less specific for the infection, it is faster and
more sensitive.[129]
Prevention
Further information: Workplace hazard controls for COVID-19, Pandemic
prevention, preparations prior to COVID-19, COVID-19 surveillance, and COVID-19
apps
Infographic by the U.S. Centers for Disease Control and Prevention (CDC), describing
how to stop the spread of germs
The CDC and WHO advise that masks reduce the spread of coronavirus by
asymptomatic and pre-symptomatic individuals (Taiwan President Tsai Ing-
wen pictured wearing a surgical mask)
The CDC and WHO recommend individuals wear non-medical face coverings in
public settings where there is an increased risk of transmission and where social
distancing measures are difficult to maintain. [162][163][164] This recommendation is meant
to reduce the spread of the disease by asymptomatic and pre-symtomatic individuals
and is complementary to established preventive measures such as social distancing.
[163][165]
Face coverings limit the volume and travel distance of expiratory droplets
dispersed when talking, breathing, and coughing. [163][165] Many countries and local
jurisdictions encourage or mandate the use of face masks or cloth face coverings by
members of the public to limit the spread of the virus. [166][167]
Masks are also strongly recommended for those who may have been infected and
those taking care of someone who may have the disease. [168] When not wearing a
mask, the CDC recommends covering the mouth and nose with a tissue when
coughing or sneezing and recommends using the inside of the elbow if no tissue is
available.[145] Proper hand hygiene after any cough or sneeze is encouraged.
[145]
Healthcare professionals interacting directly with COVID-19 patients are advised
to use respirators at least as protective as NIOSH-certified N95 or equivalent, in
addition to other personal protective equipment.[169]
Self-isolation
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.[180] In addition, soap and water disrupts the sticky bond between pathogens
and human skin which causes the coronavirus pathogen to slide off the hands/body.
[181]
CDC has recommended using an alcohol-based hand sanitiser with at least 60
percent alcohol by volume when soap and water are not readily available. [145] The
WHO advises people to avoid touching the eyes, nose, or mouth with unwashed
hands.[146][182] It is not clear whether washing hands with ash, if soap is not available,
is effective at reducing the spread of viral infections. [183]
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.
[184]
Ultraviolet germicidal irradiation may also be used.[178] 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 disinfected. [185]
Vaccine
Main article: COVID-19 vaccine