COVID-19 pandemic

The COVID-19 pandemic, also known as the

coronavirus pandemic, is an ongoing pandemic of
COVID-19 pandemic
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, and a pandemic on 11 March.[7][8] As of
27 May 2020, more than 5.59 million cases of
COVID-19 have been reported in more than 188
countries and territories, resulting in more than Map of confirmed cases per capita as of
350,000 deaths. More than 2.28 million people have 27 May 2020
recovered from the virus.[5] 10+ confirmed cases per 1,000
3–10 confirmed cases per 1,000
The virus is primarily spread between people during
close contact,[c] most often via small droplets 1–3 confirmed cases per 1,000
produced by coughing,[d] sneezing, and 0.3–1 confirmed cases per 1,000
talking.[9][10][12] The droplets usually fall to the 0.1–0.3 confirmed cases per 1,000
ground or onto surfaces rather than travelling
>0–0.1 confirmed cases per 1,000
through air over long distances.[9] Less commonly,
people may become infected by touching a No confirmed cases or no data
contaminated surface and then touching their
Total confirmed cases map
face.[9][10] It is most contagious during the first three
days after the onset of symptoms, although spread is
possible before symptoms appear, and from people
who do not show symptoms.[9][10]

Common symptoms include fever, cough, fatigue,

shortness of breath, and loss of sense of
smell.[9][13][14] Complications may include
pneumonia and acute respiratory distress
syndrome. [15] The time from exposure to onset of
symptoms is typically around five days but may Map of total confirmed cases as of 24 May 2020
range from two to fourteen days.[16][17] There is no 1,000,000+ confirmed cases
known vaccine or specific antiviral treatment.[9] 100,000–999,999 confirmed cases
Primary treatment is symptomatic and supportive
10,000–99,999 confirmed cases
therapy.[18]
1,000–9,999 confirmed cases
Recommended preventive measures include hand 100–999 confirmed cases
washing, covering one's mouth when coughing,
1–99 confirmed cases
maintaining distance from other people, wearing a
face mask in public settings, and monitoring and No confirmed cases or no data
self-isolation for people who suspect they are
Confirmed deaths per capita map
infected.[9][19] Authorities worldwide have
responded by implementing travel restrictions,
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,[20] including the largest global
recession since the Great Depression.[21] It has led to
Map of confirmed deaths per capita as of
the postponement or cancellation of sporting,
religious, political, and cultural events,[22] 24 May 2020
widespread supply shortages exacerbated by panic 100+ confirmed deaths per million
buying,[23][24] and decreased emissions of pollutants 10–100 confirmed deaths per million
and greenhouse gases.[25][26] Schools, universities, 1–10 confirmed deaths per million
and colleges have been closed either on a nationwide
or local basis in 177 countries, affecting 0.1–1 confirmed deaths per million
approximately 98.6 percent of the world's student >0–0.1 confirmed deaths per million
population.[27] Misinformation about the virus has No confirmed deaths or no data
spread widely,[28] and there have been incidents of
xenophobia and discrimination against Chinese Confirmed cases per capita
people and against those perceived as being Chinese interactive timeline
or as being from areas with high infection
rates.[29][30][31]

Contents
Epidemiology
Background
Cases
Deaths Timeline map of confirmed cases per capita
Duration (drag circle to adjust; may not work on mobile)
See larger version
Signs and symptoms
1,000+ confirmed cases per million
Cause
100–1,000 confirmed cases per million
Transmission
Virology 10–100 confirmed cases per million
>0–10 confirmed cases per million
Diagnosis
Viral testing No confirmed cases or no data
Imaging
Prevention
Hand washing
Surface cleaning
Face masks and respiratory hygiene
Social distancing
Self-isolation
Management
Containment and mitigation
Health care
 Treatment
History
National responses
Asia
Europe
North America
South America
Africa
Oceania
International responses
Travel restrictions
Evacuation of foreign citizens Top to bottom:
International aid A nurse caring for a COVID-19 patient in an intensive
WHO response measures care unit aboard a U.S. hospital ship · The Italian
government's outbreak task force · Disinfection
Impact
vehicles in Taipei, Taiwan · Health checks at Linate
Economics
Airport in Milan, Italy · Low stock in an Australian
Culture
supermarket due to panic buying
Politics
Education Disease Coronavirus disease 2019 (COVID-
Other health issues 19)
Environment and climate Virus strain Severe acute respiratory syndrome
Xenophobia and racism coronavirus 2 (SARS‑CoV‑2)[a]
Information dissemination Source Probably bats, possibly via
Misinformation pangolins[2][3]

See also Location Worldwide

Notes First outbreak China[4]

References Index case Wuhan, Hubei, China

30°37′11″N 114°15′28″E
External links
Health agencies Date December 2019[4] – present
Directories (5 months, 3 weeks and 5 days)
Data and graphs Confirmed 5,591,067[5][b]
Medical journals cases
Active cases 2,953,457[5]
Recovered 2,287,152[5]
Deaths 350,458[5]
Territories 188[5]
 Play media
Video summary (script) on the coronavirus disease
(4:12 min)

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,[321]
and an investigation was
launched in early January
2020.[322] 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.[323][324]

Several of the early cases had

visited Huanan Seafood
Wholesale Market [325] and so
the virus is thought to have a
zoonotic origin.[326] The virus
that caused the outbreak is
known as SARS‑CoV‑2, a
newly discovered virus closely
related to bat
coronaviruses, [327] pangolin
coronaviruses, [328][329] and
SARS-CoV.[330] The scientific
consensus is that COVID-19
has a natural origin.[331][332]
The probable bat-to-human COVID-19 pandemic by country and territory
infection may have been
among people processing bat
carcasses and guano in the Locations[e] Cases[b] Deaths[f] Recov.[g] Ref.
production of traditional [5]
229 5,591,067 350,458 2,287,152
Chinese medicines.[333]
United States[h] 1,716,612 100,191 364,797 [39]

Brazil 394,507 24,600 159,611 [40][41]

The earliest known person
with symptoms was later Russia[i] 370,680 3,968 142,208 [42]

discovered to have fallen ill on United Kingdom[j] 265,227 37,048 No data [44][45]

1 December 2019, and that Spain[k] 236,529 27,117 150,376 [46]

Italy 230,555 32,955 144,658 [47][48]

person did not have visible
connections with the later wet Germany[l] 181,288 8,498 163,681 [50][49]

Turkey 158,762 4,397 121,507 [51]

market cluster.[334][335] Of the
India 151,767 4,337 64,426 [52]
early cluster of cases reported
that month, two-thirds were France[m] 145,555 28,530 65,879 [53]

Iran 141,591 7,564 111,176 [54]

found to have a link with the
[55][56]
market.[336][337][338] On 13 Peru 129,751 3,788 52,906
Canada 86,647 6,639 45,339 [57]
March 2020, an unverified
report from the South China China[n] 82,993 4,634 78,280 [58]

Morning Post suggested a case Chile[o] 77,961 806 30,915 [65]

Saudi Arabia 76,726 411 48,450 [66]

traced back to 17 November
Mexico 74,560 8,134 52,219 [67][68]
2019 (a 55-year-old from
Pakistan 59,151 1,225 19,142 [69]
Hubei) may have been the first
person infected.[339][340] Belgium[p] 57,592 9,364 15,465 [71]

Qatar 48,677 30 13,283 [72]

The WHO recognized the Netherlands[q] 45,769 5,871 No data [74]

spread of COVID-19 as a Belarus 38,956 214 15,923 [75]

pandemic on 11 March Bangladesh 38,292 544 7,925 [76]

2020.[341] Italy, Iran, South Ecuador 37,355 3,203 3,560 [77]

Korea, and Japan reported Sweden 35,088 4,220 4,971 [78][79]

surging cases. The total Singapore 32,876 23 16,444 [80][81]

numbers outside China quickly United Arab Emirates 31,086 253 15,982 [82]

passed China's.[342] Portugal 31,007 1,342 18,096 [83]

Switzerland 30,776 1,649 28,200 [84][85]

Ireland 24,735 1,615 21,060 [86]

Cases South Africa 24,264 524 12,741 [87]

Indonesia 23,851 1,473 6,057 [88]

Cases refer to the number of Colombia 23,003 776 5,511 [89]
people who have been tested Kuwait 22,575 172 7,306 [90]
for COVID-19, and whose test Poland 22,303 1,025 10,330 [78][91]
has been confirmed positive Ukraine[r] 21,905 658 7,995 [92]
according to official Egypt[s] 18,756 797 5,027 [93]
protocols.[343] As of 24 May, Romania 18,429 1,210 11,874 [94]
countries that publicised their
Israel[t] 16,771 281 14,486 [95]
testing data have typically
Japan[u] 16,662 862 13,810 [96][97]
performed many tests equal to [98][99]
Austria 16,496 643 15,182
2.6 percent of their population, [100]
Dominican Republic 15,264 468 8,534
while no country has tested [101][102]
Philippines 15,049 904 3,506
samples equal to more than
Argentina[v] 13,215 490 4,154 [104]
17.3 percent of its [105]
[344] Afghanistan 11,831 220 1,128
population. Many [106]
Panama 11,447 313 6,379
countries, early on, had official Denmark[w] 11,426 563 10,044 [107]

policies to not test those with South Korea 11,265 269 10,295 [108]

only mild symptoms.[345][346] Serbia[x] 11,227 239 6,067 [109]

An analysis of the early phase Bahrain 9,366 14 4,938 [110]

of the outbreak up to 23 Kazakhstan 9,304 37 4,746 [111]

January estimated 86 percent Czech Republic 9,050 317 6,270 [112]

of COVID-19 infections had Algeria 8,697 617 4,918 [113][114]

not been detected, and that Norway[y] 8,383 236 7,727 [117]
these undocumented infections Oman 8,373 38 2,177 [118]
were the source for 79 percent Nigeria 8,344 249 2,385 [119]

of documented cases.[347] Malaysia 7,619 115 6,083 [120]

Several other studies, using a Morocco[z] 7,577 202 4,881 [122]

variety of methods, have Moldova[aa] 7,305 267 3,884 [123]

Armenia 7,774 98 3,255 [124]

estimated that numbers of
infections in many countries Australia[ab] 7,131 102 6,553 [125]

Ghana 7,117 34 2,317 [126]

are likely to be considerably
Bolivia 6,660 261 647 [127]
greater than the reported
cases.[348][349] Finland[ac] 6,628 312 5,100 [128]

Cameroon 5,436 165 1,865 [130][131]

On 9 April 2020, preliminary Iraq 4,848 169 2,852 [132]

results found that 15 percent of Azerbaijan[ad] 4,403 52 2,819 [133]
people tested in Gangelt, the Honduras 4,189 182 473 [134]

centre of a major infection Luxembourg 3,995 110 3,783 [135]

cluster in Germany, tested Sudan 3,976 170 503 [136]

positive for antibodies.[350] Hungary 3,793 505 1,856 [137]

Guatemala 3,760 59 274 [138]

Screening for COVID-19 in
Uzbekistan 3,333 14 2,659 [139]
pregnant women in New York
Puerto Rico 3,324 129 850 [140][39]
City, and blood donors in the
Guinea 3,275 20 1,673 [141]
Netherlands, has also found
Tajikistan 3,266 47 1,417 [142]
rates of positive antibody tests
Senegal 3,161 39 1,565 [143]
that may indicate more
infections than Thailand 3,054 57 2,931 [144]

reported. [351][352] However, Greece 2,892 173 1,374 [145]

such antibody surveys can be Ivory Coast 2,477 30 1,286 [146]

unreliable due to a selection Djibouti 2,468 14 1,079 [147]

bias in who volunteers to take Bulgaria 2,443 130 880 [148]

the tests, and due to false Bosnia & Herzegovina 2,435 151 1,744 [149]

positives. Some results (such DR Congo[ae] 2,296 67 337 [150]

as the Gangelt study) have Croatia 2,244 101 2,046 [151]

received substantial press Gabon 2,238 14 593 [152]

coverage without first passing El Salvador 2,042 36 787 [153]

through peer review.[353] North Macedonia 2,014 116 1,453 [154]

Cuba[af] 1,963 82 1,709 [155]

Analysis by age in China Estonia 1,840 66 1,561 [156]

indicates that a relatively low Iceland 1,804 10 1,792 [157]

proportion of cases occur in Somalia[ag] 1,711 67 253 [158]
individuals under 20.[354] It is Lithuania 1,639 65 1,165 [159]
not clear whether this is Kyrgyzstan 1,520 16 1043 [160]
because young people are less Slovakia 1,515 28 1,327 [161]
likely to be infected, or less Slovenia 1,469 108 1,346 [162][163]
likely to develop serious Maldives 1,438 5 197 [164]
symptoms and seek medical Kenya 1,348 52 405 [165]
attention and be tested.[355] A Sri Lanka 1,319 10 712 [166]

Venezuela 1,211 11 302 [167]

retrospective cohort study in
Guinea-Bissau 1,178 7 42 [168]
China found that children were
as likely to be infected as New Zealand[ah] 1,154 21 1,462 [169]
[170]
adults.[356] Countries that test Lebanon 1,140 26 689
more, relative to the number of USS Theodore Roosevelt[ai] 1,102 1 53 [171]

deaths, have a younger age Charles de Gaulle[aj] 1,081 0 0 [172]

Mali 1,077 70 617 [176]

distribution of cases, relative
Hong Kong 1,066 4 1,033 [177]
to the wider population.[357]
Haiti 1,063 31 22 [178]

Latvia 1,053 22 741 [78][179]

Initial estimates of the basic
Tunisia 1,051 48 919 [180]
reproduction number (R0) for
Equatorial Guinea 1,043 12 165 [181]
COVID-19 in January were
[182]
between 1.4 and 2.5,[358] but a Albania 1,050 33 812
Kosovo 1,047 30 794 [183]
subsequent analysis has
Costa Rica 956 10 634 [184]
concluded that it may be about
Niger 952 63 796 [185]
5.7 (with a 95 percent
confidence interval of 3.8 to Cyprus[ak] 939 17 594 [186]

8.9).[359] R0 can vary across Zambia 920 7 336 [187]

Paraguay 877 11 382 [188]

populations and is not to be
Burkina Faso 832 52 672 [189][190]
confused with the effective
South Sudan 806 8 6 [191][192]
reproduction number
(commonly just called R), Uruguay[al] 789 22 638 [193]

Nepal 772 4 151 [194][195]

which takes into account
Andorra 763 51 663 [196]
effects such as social
Nicaragua 759 35 370 [78][197]
distancing and herd immunity.
As of mid-May 2020, the Sierra Leone 754 44 297 [198][199]

effective R is close to or below Georgia[am] 732 12 537 [200]

1.0 in many countries, Jordan 718 9 488 [201]

meaning the spread of the Diamond Princess[u] 712 14 653 [96][202]

Ethiopia 701 6 167 [203]

disease in these areas is stable
or decreasing.[360] Chad 700 62 303 [204]

Central African Republic 671 1 22 [205][206]

San Marino 666 42 275 [207]

Malta 611 6 485 [208]

Madagascar 586 2 147 [209]

Jamaica 556 9 238 [210]

Tanzania 509 21 183 [211][212]

Congo[an] 469 16 137 [213][214]

São Tomé & Príncipe 441 12 68 [215]

Taiwan[ao] 441 7 416 [217]

Palestine 429 3 365 [218]

Donetsk PR[ap] 409 13 103 [219]

Togo 391 13 177 [220]

Cape Verde 390 4 155 [221]

Luhansk PR[ap] 384 6 184 [222]

Rwanda 369 0 244 [223][224]

Isle of Man[aq] 336 24 306 [225]

Mauritius 334 10 322 [226]

Vietnam 327 0 272 [227]

Montenegro 324 9 315 [228]

Jersey 307 29 280 [229]

Mauritania 268 13 15 [230]

Liberia 266 26 144 [231]

Eswatini 261 2 164 [232]

Uganda 253 0 69 [233][234]

Guernsey 252 13 237 [235]

Yemen 249 49 10 [236]

Somaliland[ar] 217 17 21 [237]

Mozambique 213 1 71 [238]

Benin 208 3 118 [239]

Myanmar 206 6 124 [240]

Faroe Islands 187 0 187 [241]

Guam[ai] 169 5 139 [39][242]

Gibraltar 154 0 147 [243]

Costa Atlantica 148 0 0 [244]

Brunei 141 1 137 [245][246]

Mongolia 141 0 32 [247]

Bermuda 139 9 91 [248]

Guyana 139 11 62 [249]

Cayman Islands 137 1 63 [250]

Greg Mortimer[al] 128 1 No data [251][252]

Cambodia 124 0 122 [253]

Syria[as] 121 4 41 [254]

Trinidad & Tobago 116 8 108 [255]

Northern Cyprus[at] 108 4 104 [256]

Aruba 101 3 95 [257]

Malawi 101 4 37 [258]

Bahamas 100 11 46 [259]

Monaco 98 4 90 [260]

Barbados 92 7 71 [261]

Comoros 87 1 21 [262]

Liechtenstein 82 1 55 [263][264]

Libya 77 3 40 [265]

Sint Maarten 77 15 60 [266]

Angola 70 4 18 [267]

U.S. Virgin Islands 69 6 61 [268]

French Polynesia 60 0 60 [269]

Zimbabwe 56 4 25 [270][271]

Macau 45 0 45 [272]

Burundi 42 1 20 [273]

Eritrea 39 0 39 [274]

South Ossetia[au] 36 0 22 [275]

Botswana 35 1 20 [276][277]

Artsakh[av] 34 0 14 [275]

Abkhazia[aw] 28 1 15 [275]

Bhutan 27 0 6 [278]

The Gambia 25 1 13 [279]

Antigua & Barbuda 24 3 19 [280]

East Timor 24 0 24 [281]

Grenada 23 0 18 [282][283]

Namibia 22 0 14 [284]

Northern Mariana Islands 22 2 13 [285]

Laos 19 0 14 [286]
Belize 18 2 16 [287]

Curaçao 18 1 14 [288]

Fiji 18 0 15 [289]

New Caledonia 18 0 18 [290]

Saint Lucia 18 0 18 [291][292]

Saint Vincent [ax] 18 0 14 [293][294]
Dominica 16 0 16 [295]

Saint Kitts & Nevis 15 0 15 [296]

Falkland Islands 13 0 13 [297]

MS Zaandam [ay] 13 4 No data [300][301]

Coral Princess [az] 12 2 No data [303]

Greenland 12 0 11 [304]

Turks & Caicos Islands 12 1 10 [305]

Vatican City 12 0 2 [306]

Montserrat 11 1 10 [307]

Seychelles 11 0 11 [308]

Suriname 11 1 9 [309]

British Virgin Islands 8 1 6 [310]

HNLMS Dolfijn[ba] 8 0 No data [311]

Papua New Guinea 8 0 8 [314]

Anguilla 3 0 3 [315]

Saba 3 0 3 [316]

Bonaire 2 0 2 [317]

Lesotho 2 0 0 [318]

Sint Eustatius 2 0 2 [319]

Saint Pierre & Miquelon 1 0 1 [320]

As of 27 May 2020 (UTC) · History of cases: China, international

For notes, see the Notes section.
Total confirmed cases of COVID-19 per Epidemic curve of COVID-19 by date of
million people[361] report

Semi-log graph showing the total Semi-log plot of daily new cases of COVID-19
(cumulative) number of confirmed cases (7-day average) in the world and top five
from the first reported date for the ten countries (mean with deaths)
most affected countries[362]
 Semi-log plot of cases in some countries 7-day rolling average of daily confirmed
with high growth rates (post-China) with cases per million by country[363]
three-day projections based on the
exponential growth rates

Linear plot of worldwide COVID-19 cases, COVID-19 total cases per 100 000
recoveries, and deaths[364] population from selected countries[365]

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.[366] As of 27 May 2020,
approximately 350,000[5] deaths had been attributed to COVID-19.
In China, as of 5 February, 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.[367]

The first confirmed death was in Wuhan on 9 January 2020.[368] 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,[369] and the first death outside Asia was in France on 14 Hackensack, New Jersey, United
February.[370] States on 27 April 2020
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.[371]
Conversely, deaths of people who had underlying conditions may lead to overcounting.[372] Comparison of
statistics for deaths for all causes versus the seasonal average indicates excess mortality in many
countries.[373][374] 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.[373] This excess mortality may
include deaths due to strained healthcare systems and bans on elective surgery.[375]

Several measures are used to quantify mortality.[376] These numbers vary by region and over time,
influenced by testing volume, healthcare system quality, treatment options, effectiveness and rapidity of
government response,[377][378][379] time since the initial outbreak, and population characteristics, such as
age, sex, and overall health.[380] 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.[381]

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 6.3 percent (350,458 deaths for 5,591,067 cases) as of 27 May 2020.[5] The number varies by
region.[382]

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.[383]
In February the Institute for Disease Modeling estimated the IFR as 0.94% (95% confidence interval 0.37–
2.9), based on data from China.[384][385] 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.[386] The CDC estimates for planning purposes that the fatality rate among those who are
symptomatic is 0.4% (0.2% to 1%) and that 35% of infected individuals are asymptomatic, for an overall
infection fatality rate of 0.26% (as of 20 May).[387][388]
 Total confirmed deaths due to COVID-19 Semi-log plot of daily deaths due to COVID-19
per million people[389] (7-day average) in the world and top five
countries (mean with cases)

Case fatality rate of COVID-19 by country Ongoing case fatality rate of COVID-19 by
and confirmed cases country

COVID-19 deaths per 100 000 population

from selected countries[390]

Duration
The WHO said on 11 March 2020 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."[391] 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)".[392] 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.[393]

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][395] Some infected people have no
symptoms, known as asymptomatic or
presymptomatic carriers; transmission from
such a carrier is considered possible.[396] As at
6 April, estimates of the asymptomatic ratio
range widely from 5% to 80%.[397]
Symptoms of COVID-19 [394]
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.[398][399][400]

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.[14] Further development of the disease can lead to complications including
pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and kidney failure.[399]

Cause

Transmission

COVID-19 spreads mainly when people are in close contact (two metres or six feet) via small droplets
produced during coughing, sneezing, or talking.[9][12] Contaminated droplets exhaled by infected people are
then inhaled into the lungs, or settle on other people's faces to cause new infection.[10] The droplets are
relatively heavy, usually fall to surfaces, and do not travel far through the air.[9][12] 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%.[401]

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 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
Respiratory droplets produced when
this method, but it can be detected for up to four hours on copper, up a man sneezes, visualised using
to one day on cardboard, and up to three days on plastic Tyndall scattering
(polypropylene) and stainless steel (AISI 304).[12][402][403] 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.[404]

Sputum and saliva carry large amounts of virus.[9][10][12][405]

Although COVID‑19 is not a sexually transmitted infection, kissing,
intimate contact, and faecal-oral routes are suspected to transmit the Play media
virus.[406][407] Some medical procedures are aerosol-generating[408] A video discussing the basic
and result in the virus being transmitted more easily than reproduction number and case
normal.[9][12] fatality rate in the context of the
pandemic (10:19 min)
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.[409]

The virus may occur in breastmilk.[410]

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.[330] All features of the novel SARS‑CoV‑2 virus occur in
related coronaviruses in nature.[411]

SARS‑CoV‑2 is closely related to SARS‑CoV, and is thought to

have a zoonotic origin.[327] SARS‑CoV‑2 genetically clusters with
the genus Betacoronavirus, and is 96 percent identical at the whole
genome level to other bat coronavirus samples[412] and 92 percent Illustration of SARSr‑CoV virion
identical to pangolin coronavirus.[413]

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.[414][415]

Viral 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 presence of viral RNA fragments.[416]
Demonstration of a swab for COVID-
19 testing
A number of laboratories and companies have developed serological
tests, which detect antibodies produced by the body in response to
infection.[417] Several have been evaluated by Public Health
England and approved for use in the UK.[418]

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.[419] The Italian Radiological Society is compiling an
international online database of imaging findings for confirmed
cases.[420] Due to overlap with other infections such as adenovirus,
imaging without confirmation by rRT-PCR is of limited specificity
in identifying COVID-19.[419] A large study in China compared
chest CT results to PCR and demonstrated that though imaging is A CT scan of a person with
less specific for the infection, it is faster and more sensitive.[415] 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.[421][422] Physical distancing measures are also
recommended to prevent transmission.[423][424] Health care providers taking care of someone who may be
infected are recommended to use standard precautions, contact precautions, and eye protection.[425]

Many governments have restricted or advised against all non-essential travel to and from countries and areas
affected by the outbreak.[426] The virus has already spread within communities in large parts of the world,
with many not knowing where or how they were infected.[427]

Misconceptions are circulating about how to prevent infection; for example, rinsing the nose and gargling
with mouthwash are not effective.[428] There is no COVID-19 vaccine, though many organisations are
working to develop one.[429]

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.[19] 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.[421] The WHO advises
people to avoid touching the eyes, nose, or
mouth with unwashed hands.[422][430] It is
not clear if washing hands with ash if soap is
not available is effective at reducing the
spread of viral infections.[431]

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 Infographic by the U.S. Centers for Disease Control and
ethanol, 50–100 percent isopropanol, 0.1 Prevention (CDC), describing how to stop the spread of germs
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.[432] 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.[433]

Face masks and respiratory hygiene

Recommendations for wearing masks have been a subject of

debate.[434] The WHO has recommended healthy people wear masks
only if they are at high risk, such as those who are caring for a
person with COVID-19.[435] 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.[436][437] Several national and local governments have
Taiwan President Tsai Ing-wen
made wearing masks mandatory.[438] wearing a mask

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.[435]
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.[422][439][440] Many governments
are now mandating or recommending social distancing in regions
Physical distancing in Toronto, with a
affected by the outbreak.[441][442] Non-cooperation with distancing
limited number of customers allowed
inside a store
measures in some areas has contributed to the further spread of the
pandemic.[443]

The maximum gathering size recommended by U.S. government

bodies and health organisations was swiftly reduced from 250 people (if there was no known COVID-19
spread in a region) to 50 people, and later to 10.[444] On 22 March 2020, Germany banned public gatherings
of more than two people.[445] A Cochrane review found 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.[440]

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.[446][447]

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.[448][449]

Some authorities have issued sexual health guidelines for use during the pandemic. These include
recommendations to have sex only with someone you live with, and who does not have the virus or
symptoms of the virus.[450][451]

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.[452][453]

Many governments have mandated or recommended self-quarantine for entire populations living in affected
areas.[454][455] The strongest self-quarantine instructions have been issued to those in high risk groups.
Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a
country or region with widespread transmission have been advised to self-quarantine for 14 days from the
time of last possible exposure.[9][16][456]

Management
Containment and mitigation

Strategies in the control of an outbreak are

containment or suppression, and mitigation.
Containment is undertaken in the early stages of the
outbreak and aims to trace and isolate those
infected as well as introduce other measures of
infection control and vaccinations to stop the
disease from spreading to the rest of the population.
When it is no longer possible to contain the spread
of the disease, efforts then move to the mitigation
stage: measures are taken to slow the spread and Transmission of COVID-19 depends on physical
mitigate its effects on the healthcare system and proximity.
society. A combination of both containment and
mitigation measures may be undertaken at the same
time.[461] Suppression requires more extreme
measures so as to reverse the pandemic by reducing
the basic reproduction number to less than 1.[392]

Part of managing an infectious disease outbreak is

trying to delay and decrease the epidemic peak,
known as flattening the epidemic curve.[457] This
decreases the risk of health services being
overwhelmed and provides more time for vaccines
and treatments to be developed.[457] Non-
pharmaceutical interventions that may manage the Goals of mitigation include delaying and reducing peak
outbreak include personal preventive measures burden on healthcare (flattening the curve) and
such as hand hygiene, wearing face masks, and lessening overall cases and health impact.[457][458]
self-quarantine; community measures aimed at Moreover, progressively greater increases in healthcare
physical distancing such as closing schools and capacity (raising the line) such as by increasing bed
cancelling mass gathering events; community count, personnel, and equipment, helps to meet
engagement to encourage acceptance and increased demand.[459]
participation in such interventions; as well as
environmental measures such surface cleaning.[462]

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.[463]
Other countries also adopted a variety of measures
aimed at limiting the spread of the virus. South
Korea introduced mass screening and localised
quarantines, and issued alerts on the movements of
infected individuals. Singapore provided financial
support for those infected who quarantined Mitigation attempts that are inadequate in strictness or
themselves and imposed large fines for those who duration—such as premature relaxation of distancing
failed to do so. Taiwan increased face mask rules or stay-at-home orders—can allow a resurgence
production and penalised hoarding of medical after the initial surge and mitigation.[457][460]
supplies.[464]
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.[392]

Contact tracing

Contact tracing is an important method for health authorities to determine the source of an infection and to
prevent further transmission.[465] The use of location data from mobile phones by governments 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.[466]

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.[466] Users could then receive a message if they've been in close contact
with someone who has subsequently tested positive for COVID-19.[466]

On 10 April 2020 Google and Apple jointly announced an initiative for privacy-preserving contact tracing
based on Bluetooth technology and cryptography.[467][468] 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.[469] In Europe and in the U.S., Palantir
Technologies is also providing COVID-19 tracking services.[470]

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.[471] 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.[471][472]
outside Östra sjukhuset (Eastern
hospital) in Gothenburg, Sweden,
Due to capacity limitations in the standard supply chains, some
contains temporary intensive care
manufacturers are 3D printing healthcare material such as nasal
units for COVID-19 patients.
swabs and ventilator parts.[473][474] 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.[475][476][477] On
23 April 2020, NASA reported building, in 37 days, a ventilator which is currently undergoing further
testing. NASA is seeking fast-track approval.[478][479]

Treatment
Antiviral medications are under investigation for COVID-19, as well as medications targeting the immune
response.[480] None has yet been shown to be clearly effective on mortality in published randomised
controlled trials.[480] However, remdesivir may have an effect on the time it takes to recover from the
virus.[481] Emergency use authorisation for remdesivir was granted in the U.S. on 1 May, for people
hospitalised with severe COVID-19. The interim authorisation was granted considering the lack of other
specific treatments, and that its potential benefits appear to outweigh the potential risks.[482] Taking over-
the-counter cold medications,[483] drinking fluids, and resting may help alleviate symptoms.[421] Depending
on the severity, oxygen therapy, intravenous fluids, and breathing support may be required.[484] The use of
steroids may worsen outcomes.[485] Several compounds which were previously approved for treatment of
other viral diseases are being investigated for use in treating COVID-19.[486]

History
There are several theories about where the very
first case (the so-called patient zero)
originated.[488] The first known case may trace
back to 1 December 2019 in Wuhan, Hubei,
China.[334] Over the next month, the number of
coronavirus cases in Hubei gradually increased.
According to official Chinese sources, these were
mostly linked to the Huanan Seafood Wholesale
Market, which also sold live animals.[326]

On 24 December, Wuhan Central Hospital sent a

bronchoalveolar lavage fluid (BAL) sample from
an unresolved clinical case to sequencing company
Cases by country, plotted on a logarithmic scale[487]
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.[489] 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.[490][491] 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".[492] Eight of these doctors, including Li Wenliang (punished on
3 January),[493] were later admonished by the police for spreading false rumours, and another, Ai Fen, was
reprimanded by her superiors for raising the alarm.[494]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of
unknown cause on 31 December, confirming 27 cases[321][495][496]—enough to trigger an investigation.[322]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half
days.[497] 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.[412] On 20 January, China
reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen.[498] Later
official data shows 6,174 people had already developed symptoms by then,[499] and more may have been
infected.[500] 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".[336][501] On 30 January, the WHO declared the coronavirus a public health emergency
of international concern.[500]
On 31 January 2020, Italy had its first confirmed cases, two tourists from China.[502] As of 13 March 2020,
the WHO considered Europe the active centre of the pandemic.[503] On 19 March 2020, Italy overtook
China as the country with the most deaths.[504] By 26 March, the United States had overtaken China and
Italy with the highest number of confirmed cases in the world.[505] 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.[506] Retesting of prior samples found a person in France who had
the virus on 27 December 2019[507][508] and a person in the United States who died from the disease on
6 February 2020.[509]

As of 19 May 2020, more than 5.59 million cases have been reported worldwide; more than 350,000 people
have died and more than 2.28 million have recovered.[510][511]

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.[512] National reactions have
included containment measures such as quarantines
and curfews (known as stay-at-home orders,
shelter-in-place orders, or lockdowns).[513]

By 26 March, 1.7 billion people worldwide were Map of national and subnational lockdowns as of 30
under some form of lockdown,[514] which March 2020 (table; more details)
increased to 3.9 billion people by the first week of National lockdown
April—more than half the world's Subnational lockdown
population.[515][516]
No lockdown
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.[517] Nearly 300 million people, or about 90 percent of the population, were
under some form of lockdown in the United States,[518] around 100 million people in the Philippines,[517]
about 59 million people in South Africa,[519] and 1.3 billion people have been under lockdown in
India.[520][521] On 21 May 100,000 new infections occurred worldwide, the most since the start of the
pandemic, while overall 5 million cases were surpassed.[522]

Asia

As of 19 May 2020, cases have been reported in all Asian countries except for Turkmenistan[523] and North
Korea,[524] although these countries likely also have cases.[525] Despite being the first area of the world hit
by the outbreak, the early wide-scale response of some Asian states, particularly South Korea,[526]
Taiwan,[527] and Vietnam[528] 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;[334]
one unconfirmed report suggests the earliest case
was on 17 November.[339] 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.[529][530] Initial genetic testing of patient
samples on 27 December 2019 indicated the
presence of a SARS-like coronavirus.[529] A public
notice was released by Wuhan Municipal Health
Commission on 31 December, confirming 27 cases
and suggesting wearing face masks.[496] The WHO
was informed on the same day.[321] As these
notifications occurred, doctors in Wuhan were
warned by police for "spreading rumours" about the Confirmed cases of COVID-19 per 100,000 inhabitants
outbreak.[531] The Chinese National Health by province, as of 13 April, showing Hubei with around
Commission initially said there was no "clear 40 times more cases than any other province
evidence" of human-to-human transmission.[532] In Hubei Province: 114.40 cases per 100,000
a 14 January conference call, Chinese officials said 1.5–2.5 cases per 100,000
privately that human-to-human transmission was a
1–1.5 cases per 100,000
possibility, and pandemic preparations were
needed.[533] In a briefing posted during the night of 0.5–1 cases per 100,000
14–15 January, the Wuhan Municipal Health >0–0.5 cases per 100,000
Commission said the possibility of limited human-
to-human transmission could not be ruled out.[534]

On 20 January, the Chinese National Health

Commission confirmed human-to-human
transmission of the virus. [535] 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.[536][537] During the
Chinese New Year travel period, authorities
instigated a City of Wuhan lockdown.[538] On 10 Semi-log graph of new cases and deaths in China
February the Chinese government launched a during the COVID-19 epidemic showing the lockdown
radical campaign described by paramount leader and lifting
and Chinese Communist Party general secretary Xi
as a "people's war" to contain the viral spread.[539]
In "the largest quarantine in human history",[540] a cordon sanitaire on 23 January stopped travel in and out
of Wuhan,[541][542] then extended to fifteen Hubei cities affecting about 57 million people.[543] Private
vehicle use was banned in the city.[544] Several Chinese New Year (25 January) celebrations were also
cancelled.[545] Authorities announced the construction of a temporary hospital, Huoshenshan Hospital,
completed in ten days.[546] Leishenshan Hospital, was later built to handle additional patients.[547] China
also converted other facilities in Wuhan, such as convention centres and stadiums, into temporary
hospitals.[548]
 On 26 January, the government instituted further measures to
contain the COVID-19 outbreak, including issuing health
declarations for travelers and extending the Spring Festival
holiday.[550] Universities and schools around the country were also
closed.[551][552][553] The regions of Hong Kong and Macau
instituted several measures, particularly in regard to schools and
universities.[554] Remote working measures were instituted in
Wuhan Leishenshan Hospital, an several Chinese regions.[555] Travel restrictions were enacted in and
emergency speciality field hospital outside of Hubei.[555][556] Public transport was modified,[557] and
built in response to the pandemic museums throughout China were temporarily closed.[555][558][559]
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.[560] In January and February
2020, during the height of the epidemic in Wuhan, about 5 million
people lost their jobs.[561] Many of China's nearly 300 million rural
migrant workers have been stranded at home in inland provinces or
trapped in Hubei province.[562][563]

After the outbreak entered its global phase in March, Chinese

authorities took strict measures to prevent the virus re-entering
China from other countries. For example, Beijing imposed a 14-day
A temporary hospital for treating mild mandatory quarantine for all international travellers entering the
cases of COVID-19 in Wuhan, one of city.[564] At the same time, a strong anti-foreigner sentiment quickly
more than ten such hospitals in the took hold,[565] and foreigners experienced harassment by the
city[549] general public[566] and forced evictions from apartments and
hotels.[31][567]

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.[568] The same day travel restrictions
were eased in Hubei, apart from Wuhan, two months after the lockdown was imposed.[569] 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.[570][571] The Chinese government
encouraged businesses and factories to re-open on 30 March, and provided monetary stimulus packages for
firms.[572]

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.[573] On 25
April the last patients were discharged in Wuhan.[574] On 13 May the city of Jilin was put on lockdown,
sparking fear of a second wave of infection.[575]

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 died on that day.[577][578] Early measures
announced by the government included the cancellation of concerts and other cultural events,[579] sporting
events,[580] Friday prayers,[581] and closures of universities, higher education institutions, and schools.[582]
Iran allocated 5 trillion rials (equivalent to US$120,000,000) to combat the virus.[583] President Hassan
Rouhani said on 26 February there were no plans to quarantine areas affected by the outbreak, and only
individuals would be quarantined.[584] Plans to limit travel between cities were announced in March,[585]
although heavy traffic between cities ahead of the Persian New Year
Nowruz continued.[586] Shia shrines in Qom remained open to
pilgrims until 16 March.[587][588]

Iran became a centre of the spread of the virus after China during
February.[589][590] 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.[590][591] The Iranian Parliament was shut down, with 23 Disinfection of Tehran Metro trains
against coronavirus. Similar
of its 290 members reported to have had tested positive for the virus
measures have also been taken in
on 3 March.[592] On 15 March, the Iranian government reported a
other countries.[576]
hundred deaths in a single day, the most recorded in the country
since the outbreak began.[593] At least twelve sitting or former
Iranian politicians and government officials had died from the
disease by 17 March.[594] By 23 March, Iran was experiencing fifty new cases every hour and one new
death every ten minutes due to coronavirus.[595] 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.[596] The UN High Commissioner for Human
Rights has demanded economic sanctions to be eased for nations most affected by the pandemic, including
Iran.[597] On 20 April it was reported that Iran had reopened shopping malls and other shopping areas across
the country, though there is fear of a second wave of infection due to this move.[598] In March, and again in
April, there were reports that Iran was under-reporting COVID-19 cases and deaths.[599][600]

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,[601] largely
attributed to a gathering in Daegu of the Shincheonji Church of
Jesus.[601][602] Shincheonji devotees visiting Daegu from Wuhan
were suspected to be the origin of the outbreak.[603][604] By 22
February, among 9,336 followers of the church, 1,261 or about 13
percent reported symptoms.[605] A drive-through test centre at the
Gyeongju Public Health Centre
South Korea declared the highest level of alert on 23 February
2020.[606] On 28 February, more than 2,000 confirmed cases were
reported,[607] rising to 3,150 on 29 February.[608] All South Korean military bases were quarantined after
tests showed three soldiers had the virus.[603] Airline schedules were also changed.[609][610]

South Korea introduced what was considered the largest and best-
organised programme in the world to screen the population for the
virus, isolate any infected people, and trace and quarantine those
who contacted them.[526][611] Screening methods included
mandatory self-reporting of symptoms by new international arrivals
through mobile application,[612] drive-through testing for the virus
with the results available the next day,[613] and increasing testing
A banner in Seoul displays capability to allow up to 20,000 people to be tested every day.[614]
coronavirus infection prevention tips. South Korea's programme is considered a success in controlling the
outbreak without quarantining entire cities.[526][615][616]
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.[617] On 23 March, it was reported that South Korea
had the lowest one-day case total in four weeks.[614] On 29 March it was reported that beginning 1 April all
new overseas arrivals will be quarantined for two weeks.[618] Per media reports on 1 April, South Korea has
received requests for virus testing assistance from 121 different countries.[619] 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.[620]

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.[621] 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.[622]

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.[623]
At least one death has been reported in all European
countries, apart from the Vatican City. Confirmed infections in relation to population
(cases per million inhabitants).[511] The numbers
As of 18 March, more than 250 million people were in are not comparable, as the testing strategy differs
lockdown in Europe.[624] among countries and time periods.

As of 24 May, 68 days since the first case recorded,

Montenegro become the first COVID-free country in the Europe.[625][626]

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.[502] Cases began to rise sharply, which prompted the Italian government to
suspend all flights to and from China and declare a state of emergency.[627] An unassociated cluster of
COVID-19 cases was later detected, starting with 16 confirmed cases in Lombardy on 21 February.[628]

On 22 February, the Council of Ministers announced a new decree-law to contain the outbreak, including
quarantining more than 50,000 people from eleven different municipalities in northern Italy.[629] 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."[630][631]

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,[632] but on 9 March all sport was suspended completely for at least one month.[633] On 11 March,
Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and
pharmacies.[634][635]

On 6 March, the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
published medical ethics recommendations regarding triage protocols.[636][637][638] 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.[639][640] On 22 March, it was reported
that Russia had sent nine military planes with medical equipment to
Italy.[641] As of 9 May, there were 217,185 confirmed cases, 30,201
deaths, and 99,023 recoveries in Italy, with the majority of those
cases occurring in the Lombardy region.[642] 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.[643] On 19 April it was reported that the
country had its lowest deaths at 433 in seven days, some businesses
Civil Protection volunteers conduct after six weeks of lockdown are asking for a loosening of
health checks at the Guglielmo restrictions.[644]
Marconi Airport in Bologna on
5 February.
Spain

The pandemic 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.[645] Post-hoc genetic analysis has shown that at least
15 strains of the virus had been imported, and community
transmission began by mid-February.[646] By 13 March, cases had
been confirmed in all 50 provinces of the country.

The lockdown was imposed on 14 March 2020.[647] On 29 March it

Residents of Valencia, Spain,
was announced that, beginning the following day, all non-essential
maintaining social distancing while
workers were ordered to remain at home for the next 14 days.[648] queueing
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.[649] On 25 March the death
toll in Spain surpassed that of mainland China, and only Italy's was higher.[650] 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.[651] As of
25 May 2020 the daily death toll announced by the Spanish government has been below 100 after on 17
May for the first time in two months it fell below that figure.[652]

As of 26 May 2020, there have been 236,259 confirmed cases and 27,117 deaths while there have been
150,376 recoveries.[653] 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.[654][655] On 13 May, the results of the first
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%, approximately 2 million
people,[656] 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 Castilla–La Mancha would be the most
affected regions with a percentage of infection greater than 10%.[657][658] The number of deaths is also
believed to be an underestimate due to lack of testing and reporting, perhaps by as much as 5,700–6,000
according to different excess mortality analysis.[659][660]

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.[661][662] As a result, the government received criticism for the perceived
lack of pace and intensity in its response to concerns faced by the public.[663][664]
 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.[665][666] On 20 March, the government announced
that all leisure establishments such as pubs and gyms were to close as soon
as possible,[667] and promised to pay up to 80 percent of workers' wages to a
limit of £2,500 per month to prevent unemployment during the crisis.[668]

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
The "Wee Annie" statue in of fines and the dispersal of gatherings. Most businesses were ordered to
Gourock, Scotland, was close, with exceptions for businesses deemed "essential", including
given a face mask during supermarkets, pharmacies, banks, hardware shops, petrol stations, and
the pandemic. garages.[669]

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.[670]

To ensure the UK health services had sufficient capacity to treat people with COVID-19, a number of
temporary critical care hospitals were built.[671] The first to be operational was the 4000-bed capacity NHS
Nightingale Hospital London, constructed within the ExCeL convention centre over nine days.[672] On
4 May, it was announced that the Nightingale Hospital in London would be placed on standby and
remaining patients transferred to other facilities.[673] This followed reports that NHS Nightingale in London
"treated 51 patients" within the first three weeks of opening.[674] On 5 May, official figures revealed that
Britain had the worst COVID-19 death toll in Europe, prompting calls for an inquiry into the handling of the
pandemic. The death toll in the United Kingdom was nearly 29,427 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.[675] On 16 April it was reported that the UK would have first access to the Oxford vaccine; should
the trial be successful, some 30 million doses in the UK would be available.[676]

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.[507][508] 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.[677][678]
France has been transferring
COVID-19 patients from overloaded
On 13 March, Prime Minister Édouard Philippe ordered the closure
hospitals to hospitals in other regions
of all non-essential public places,[679] and on 16 March, French
via military helicopters, as seen here
President Emmanuel Macron announced mandatory home at Strasbourg Airport.
confinement, a policy which was extended at least until 11
May.[680][681][682] As of 23 April, France has reported more than
120,804 confirmed cases, 21,856 deaths, and 42,088 recoveries,[683] ranking fourth in number of confirmed
cases.[684] In April, there were riots in some Paris suburbs.[685] On 18 April it was reported that schools in
France had to close again after reopening, due to COVID-19 case flare-ups.[686]

Sweden

Sweden differed from most other European countries in that it mostly remained open.[687] Per the Swedish
Constitution, the Public Health Agency of Sweden has autonomy that prevents political interference and the
agency's policy favored forgoing a lockdown in an attempt to reach herd immunity.[688] 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.[687][689] On 19 May, it was
reported that the country had in the week 12–19 May the highest per capita deaths in Europe, 6.25 deaths
per million per day.[690]

North America

The first cases in North America were reported in the United States in January 2020. Cases were reported in
all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North
American territories after Bonaire confirmed a case on 16 April.[691]

On 26 March 2020, the U.S. became the country with the highest number of confirmed COVID-19
infections, with over 82,000 cases.[692] On 11 April 2020, the U.S. became the country with the highest
official death toll for COVID-19, with over 20,000 deaths.[693] As of 15 May 2020 the total cases of
COVID-19 were 1,571,908 with 95,764 total deaths.[694]

Canada reported 60,616 cases and 3,842 deaths on 4 May,[695] while Mexico reported 23,471 cases and
2,154 deaths.[696] The Dominican Republic and Cuba are the only Caribbean countries reporting more than
1,000 cases (7,954 and 1,649, respectively), while Panama and Honduras led Central America with 7,197
and 1,055 cases, respectively.[697]

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.[698] On 31 January, the
Trump administration declared a public health
emergency,[699] and restricted entry for travelers
from China who were not U.S. citizens.[700]

On 28 January, the Centers for Disease Control and

Prevention (CDC) announced they had developed
their own testing kit.[701] Despite this, the United
Confirmed cases of COVID-19 per million inhabitants by
States had a slow start in testing, which obscured
state
the extent of the outbreak.[702][703] 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.[702][703]
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.[704][705][706]

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.[707][708] Corporations encouraged employees to work
from home.[709] Sports events and seasons were cancelled.[22]

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

federal funds available to respond to the crisis.[710] Beginning on 15
Donald Trump signs the Coronavirus
March, many businesses closed or reduced hours[711] and schools
Preparedness and Response across the country were shutting down.[712][713] By 17 March, the
Supplemental Appropriations Act into epidemic had been confirmed in all fifty states and in the District of
law with Alex Azar on 6 March 2020. Columbia.[714] On 26 March, the United States had more confirmed
cases than any other country.[505] 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.[715]

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.[509] By 24 April, 889,309 cases had been
confirmed and 50,256 people had died.[716] 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—previous 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 The hospital ship USNS Comfort
4.25% of the world's population, had about 29% of the confirmed arrives in Manhattan on 30 March.
coronavirus deaths.[717] During April, 182 patients were
treated by the ship's hospital medical
The White House has been criticised for downplaying the threat and crew.
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.[718] 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.[719] 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."[720][721]

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."[722]

South America
The pandemic was confirmed to have reached South America on 26
February when Brazil confirmed a case in São Paulo.[723] By 3
April, all countries and territories in South America had recorded at
least one case.[724] On April 17, the highest number of cases and
deaths was registered in Brazil,[725] followed by Peru and Chile in
the number of confirmed cases.[726]

The introduction of the virus to South America was largely related to

international travel by the more affluent. Rapid spread resulted from
Workers being trained to disinfect
an overburdened health care system, a lack of testing, and a large
buses in Olinda, Pernambuco, Brazil,
impoverished population, many of whom live in very close
16 March 2020
proximity and are unable to socially distance or stop work.

On 20 April 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.[727] On
22 May, citing especially the rapid increase of infections in Brazil, the WHO declared South America to
currently be the epicenter of the pandemic.[728] 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 that he has been called the "Trump of the Tropics." [729]

Ecuador has also been overwhelmed by a large surge in April even though it is believed that both the
number of cases and the number of deaths is being grossly under-reported. It is thought that the spike in the
number of cases may be due in part to transport links between Guayaquil, a large key port, and Spain. The
BBC reports that so many have died in Guayaquil that residents have been "forced to store bodies in their
homes for up to five days" or even in the street and the government began to distribute thousands of
cardboard coffins to residents. Ecuador's vice president, Otto Sonnenholzer, apologised to the nation saying,
"We have seen images that should never have happened, and as your public servant I apologise."[730]

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".[731][732]
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 2020.[733] Most of the reported cases are
from four countries: South Africa, Morocco, Egypt and Algeria, but it is believed that there is widespread
under-reporting in other African countries with poorer health care systems.[734] Cases have been confirmed
in all African countries, with Lesotho the last country to report its first coronavirus case on 13 May
2020.[735] There have been no reported cases in the British Overseas Territories of Saint Helena, Ascension
and Tristan da Cunha.
 Oceania
The pandemic was confirmed to have reached Oceania on 25
January 2020 with the first confirmed case reported in Melbourne,
Australia.[736] It has since spread elsewhere in the region,[737]
although many small Pacific island nations have thus far avoided the
outbreak by closing their international borders. As of 27 May 2020,
ten Oceania sovereign states have yet to report a case.

On 19 May 2020, Australia filed a motion with the UN for an

U.S. Air Force airmen unload a C-17
inquiry into the origins of the virus, and the response of the UN and
aircraft carrying approximately 4,000
pounds of medical supplies in
governments. More than 100 countries supported this motion, and it
Niamey, Niger 23 April 2020. was passed unanimously.[738][739]

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,[740] or for all travellers.[741] 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.[742] A study in Science found that travel restrictions had only modest effects delaying the initial spread
of COVID-19, unless combined with infection prevention and control measures to considerably reduce
transmissions.[743] 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".[744]

The European Union rejected the idea of suspending the Schengen free travel zone and introducing border
controls with Italy,[745][746] a decision which has been criticised by some European politicians.[747][748]

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, Sri Lanka, Australia, France, Argentina,
Germany, and Thailand were among the first to plan the evacuation
of their citizens.[749] Brazil and New Zealand also evacuated their
own nationals and some other people.[750][751] On 14 March, South Ukraine evacuates Ukrainian and
Africa repatriated 112 South Africans who tested negative for the foreign citizens from Wuhan, China.
virus from Wuhan, while four who showed symptoms were left
behind to mitigate risk.[752] Pakistan said it would not evacuate
citizens from China.[753]

On 15 February, the U.S. announced it would evacuate Americans aboard the cruise ship Diamond
Princess,[754] and on 21 February, Canada evacuated 129 Canadian passengers from the ship.[755] In early
March, the Indian government began evacuating its citizens from Iran.[756][757] On 20 March, the United
States began to partially withdraw its troops from Iraq due to the pandemic.[758]
International aid

Aid to China

Some Chinese students at American universities sent aid, including 50,000 N95 masks on 30 January.[759]
The humanitarian aid organisation Direct Relief sent 200,000 face masks and other personal protective
equipment to the Wuhan Union Hospital the same day.[760] On 5 February, the Chinese foreign ministry said
21 countries (including Belarus, Pakistan, Trinidad and Tobago, Egypt, and Iran) had sent aid to China,[761]
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".[762] 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.[763] On 19 February, the Singapore Red Cross
announced it would send $2.26 million worth of aid to China.[764]

Several countries donated masks, medical equipment or money to China, including Japan,[765] Turkey,
Russia,[766] Malaysia,[767] Germany,[768] and Canada.[769][770] The U.S. State Department said on
7 February it had facilitated the transportation of nearly 17.8 tons of medical supplies to China.[771] 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,[772] 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.[773]

Aid to the world

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

other nations.[774] In March, China, Cuba and Russia sent medical
supplies and experts to help Italy deal with its coronavirus
outbreak;[775][776] China sent three medical teams and donated more
than forty tons of medical supplies to Italy.[777] 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.[778][779] He later sent 5,000 testing kits, 100,000 face masks
Medical supplies donated by China
and 5 ventilators to Panama.[780] 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.[781] 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,[782] yet this
could have been due to product misuse. Belgium recalled 100,000 unusable masks, which were thought to
be from China but were in fact from Colombia.[783] The Philippines stopped using test kits donated by
China due to their 40 percent accuracy.[784] The Chinese government said product instructions might not
have been followed, and that some products were not purchased directly from certified companies.[785][786]
Chinese aid was well-received in parts of Latin America and Africa.[787][788] On 2 April, the World Bank
launched emergency support operations for developing countries.[789] 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.[790][791]

WHO response measures

Taiwan notified the WHO of a new virus on 31 December 2019.[792]
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.[793] The WHO stated on
5 January that cases of pneumonia of unknown cause had been
reported,[794] 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.[795] though in public announcements it said there was "no WHO Director-General Tedros
clear evidence of human-to-human transmission" as late as 14 Adhanom
January.[796] 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.[797] On 27 January, the WHO assessed the risk of the
outbreak to be "high at the global level".[798]

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][799] 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 middle-income countries without robust
health systems" but that the WHO did not "recommend limiting trade and movement".[7][800][801]

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".[802] 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".[803] 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.[804] On 11 March, the WHO declared the coronavirus outbreak a
pandemic.[805] 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 public health emergency declaration and pandemic classification came
too late.[806]

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.[807] Global stock markets fell on 24 February
due to a significant rise in the number of COVID-19 cases outside
China.[808][809] 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)[810] and all three major
indexes ending the week down more than 10 percent.[811] On 28
February, Scope Ratings GmbH affirmed China's sovereign credit
rating but maintained a Negative Outlook.[812] Stocks plunged again
due to coronavirus fears, the largest fall being on 16 March.[813]
Many consider an economic recession likely.[814][815] "Those who can, put something in;
those who can't, help yourself."
Lloyd's of London has estimated that the global insurance industry Bologna, April 2020.
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.[816]

Tourism is one of the worst affected sectors due to travel bans,

closing of public places including travel attractions, and advice of
governments against travel. Numerous airlines have cancelled flights
due to lower demand, and British regional airline Flybe
collapsed.[817] The cruise line industry was hard hit,[818] and several
train stations and ferry ports have also been closed.[819] International A highway sign on the Gardiner
mail between some countries stopped or was delayed due to reduced Expressway in Toronto discouraging
transportation between them or suspension of domestic service.[820] non-essential travel

The retail sector has been impacted globally, with reductions in store
hours or temporary closures.[821] Visits to retailers in Europe and Latin America declined by 40 percent.
North America and Middle East retailers saw a 50–60 percent drop.[822] 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.[823]

Hundreds of millions of jobs could be lost globally.[824][825] Nearly 40 million Americans lost their jobs and
applied for government aid.[826][827]

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.[828]

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.[829] The technology industry, in particular, has warned of delays to shipments of electronic
goods.[830] According to the WHO director-general Tedros Adhanom, demand for personal protection
equipment has risen a hundredfold, leading to prices up to twenty times the normal price and also delays in
the supply of medical items of four to six months.[831][832] It has also caused a shortage of personal
protective equipment worldwide, with the WHO warning that this will endanger health workers.[833]
 The impact of the coronavirus outbreak was worldwide. The virus
created a shortage of precursors used in the manufacturing of
fentanyl and methamphetamine. The Yuancheng Group, located in
Wuhan, China, is one of the leading suppliers of these chemical raw
materials.[834] Price increases and shortages in these illegal drugs
have been noticed on the street of the UK.[835] U.S. law enforcement
also told the New York Post Mexican drug cartels were having
difficulty in obtaining precursors.[836]

Coronavirus fears have led to panic

The pandemic has disrupted global food supplies and threatens to
buying of essentials across the trigger a new food crisis.[837][838] David Beasley, head of the World
world, including toilet paper, dried Food Programme (WFP), said "we could be facing multiple famines
and/or instant noodles, bread, rice, of biblical proportions within a short few months."[839]
vegetables, disinfectant, and rubbing
alcohol. 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.[840][839][841]

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.[842] 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.[843] June prices were down but in the
positive range, with a barrel of West Texas trading above $20.[843]

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.[844] In response there were intensive efforts
to provide alternative services through digital platforms.[845][846][847]

Holy Week observances in Rome, which occur during the last week of the Christian penitential season of
Lent, were cancelled.[846] Many dioceses have recommended older Christians stay home rather than attend
Mass on Sundays. (Services are available via radio, online live streaming and television.)[848][849][846] With
the Roman Catholic Diocese of Rome closing its churches and chapels and St. Peter's Square emptied of
Christian pilgrims,[846] other religious bodies also cancelled services and limited public gatherings in
churches, mosques, synagogues, temples and gurdwaras.[846] Iran's Health Ministry announced the
cancellation of Friday prayers in areas affected by the outbreak and shrines were later closed,[581][588] while
Saudi Arabia banned the entry of foreign pilgrims as well as its residents to holy sites in Mecca and
Medina.[850][851] The World Health Organization (WHO) advised COVID-19 patients to consult a physician
before and possibly abstain from fasting (a part of Ramadan),[852] as
it can weaken the immune system,[853] though it says "healthy
people should be able to (...) fast as in earlier years."[854]

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,[855] 2019–20 Premier
League,[856] UEFA Euro 2020, 2019–20 NBA season,[857] and
2019–20 NHL season.[858] The outbreak disrupted plans for the An American military chaplain
2020 Summer Olympics, which were originally scheduled to start at prepares for a live-streamed Catholic
the end of July; the International Olympic Committee announced on mass in an empty chapel at Offutt Air
24 March that they will be "rescheduled to a date beyond 2020 but Force Base in March 2020.
not later than summer 2021".[859][860]

The entertainment industry has also been affected, with many music groups suspending or cancelling
concert tours.[861][862] The Eurovision Song Contest, which was due to be held in the Netherlands in May,
was postponed until 2021.[863] Many large theatres such as those on Broadway also suspended all
performances.[864] 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[865] or creating web-based
"festivals" for artists to perform, distribute, and publicise their work.[866] Online, numerous COVID-19-
themed Internet memes have spread as many turn to humour and distraction amid uncertainty.[867]

Politics

The pandemic has affected the political systems of multiple countries, causing suspensions of legislative
activities,[868] isolations or deaths of multiple politicians,[869] and rescheduling of elections due to fears of
spreading the virus.[870]

China

The Chinese government has been criticised by the United States

government,[871] UK Minister for the Cabinet Office Michael
Gove,[872] and others[873] 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.[874] The U.S. intelligence community says China Council Premier Li Keqiang
intentionally under-reported its number of coronavirus cases.[875]

Italy

In early March, the Italian government criticised the European Union's lack of solidarity with coronavirus-
affected Italy[876][877]—Maurizio Massari, Italy's ambassador to the EU, said "only China responded
bilaterally", not the EU.[878] 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.[879] President of Lombardy Attilio Fontana and Italian Foreign Minister
Luigi Di Maio expressed their gratitude for the aid.[880] Russia also sent a cargo plane with medical aid to
the United States.[881] 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."[882]

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.[884][885][886] Political analysts anticipated
it may negatively affect Donald Trump's chances of re-election in
the 2020 presidential election.[887][888] Beginning in mid-April
2020, there were protests in several U.S. states against government-
imposed business closures and restricted personal movement and
association.[889]
Several hundred anti-lockdown
protesters rallied at the Ohio
Other countries Statehouse 20 April.[883]

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.[890][891] 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."[892]

The Iranian government has been heavily affected by the virus, with
about two dozen parliament members and fifteen current or former
political figures infected.[591][893] 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.[894] Saudi Arabia, which launched a military
intervention in Yemen in March 2015, declared a ceasefire.[895]
UK Prime Minister Boris Johnson
(left, back row) tested positive for Diplomatic relations between Japan and South Korea worsened due
COVID-19 in March 2020. Russian to the pandemic.[896] South Korea criticised Japan's "ambiguous and
President Vladimir Putin (right, back passive quarantine efforts" after Japan announced anyone coming
row) began working remotely from
from South Korea would be placed in quarantine for two weeks at
his office at Novo-Ogaryovo after
government-designated sites.[897] South Korean society was initially
meeting with an infected doctor.
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.[617]

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.[898][899] In the
Philippines, lawmakers granted president Rodrigo Duterte temporary emergency powers during the
pandemic.[900] 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.[901] In some countries, including
Egypt,[902] Turkey,[903] and Thailand,[900] opposition activists and government critics have been arrested for
allegedly spreading fake news about the COVID-19 pandemic.[904]
Education

The COVID-19 pandemic has

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

Most governments around the

world have temporarily closed
educational institutions in an
attempt to contain the spread of
COVID-19.[905] As of 24 May
2020, approximately 1.725
billion learners are currently
affected due to school closures Learners affected by school closures caused by COVID-19 as of
in response to the pandemic. 14 May 2020
According to UNICEF Country-wide school closures
monitoring, 153 countries are Localized school closures
currently implementing No school closures
nationwide closures and 24 are
No data
implementing local closures,
impacting about 98.6 percent of
the world's student population.
10 countries' schools are currently open.[906]

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.[907]
International Baccalaureate exams have also been cancelled.[908] 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.[909] but have far-reaching economic and
societal consequences.[910][911] School closures in response to the pandemic have shed light on various
social and economic issues, including student debt,[912] digital learning,[913][914] food insecurity,[915] and
homelessness,[916][917] as well as access to childcare,[918] health care,[919] housing,[920] internet,[921] and
disability services.[922] 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.[27][923]

In response to school closures, UNESCO recommended the use of distance learning programmes and open
educational applications and platforms that schools and teachers can use to reach learners remotely and limit
the disruption of education.[924]

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.[925] 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."[926] There is also concern that people with strokes and appendicitis are not
seeking timely treatment.[926] Shortages of medical supplies have impacted people with various
conditions.[927]

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.[928][929] Similarly, in some places, rates of transmission of influenza and other
respiratory viruses significantly decreased during the pandemic.[930][931][932] The pandemic has also
negatively impacted mental health globally.[933]

Environment and climate

The worldwide disruption caused by the pandemic

has resulted in numerous impacts on the
environment and the climate. The severe decline in
planned travel[935] has caused many regions to
experience a drop in air pollution. In China,
lockdowns and other measures resulted in a 25 per
cent reduction in carbon emissions[936] and 50
percent reduction in nitrogen oxides emissions,[937]
which one Earth systems scientist estimated may
have saved at least 77,000 lives over two
months.[938][939] However, the outbreak has also
provided cover for illegal activities such as
deforestation of the Amazon rainforest[940][941] and
poaching in Africa,[942][943] hindered
environmental diplomacy efforts,[944] and created
economic fallout that is predicted to slow Images from the NASA Earth Observatory show a stark
drop in pollution in Wuhan, China, when comparing NO2
investment in green energy technologies.[945]
levels in early 2019 (top) and early 2020 (bottom).[934]

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,[946][947][948] Reports from February (when
most cases were confined to China) documented racist sentiments expressed in groups worldwide about
Chinese people deserving the virus.[949][950][951] Citizens in countries including Malaysia,[952] New
Zealand,[953] Singapore,[954] Japan,[955] Vietnam,[956] and South Korea lobbied to ban Chinese people from
entering their countries.[957] Chinese people and other Asians in the United Kingdom and United States
have reported increasing levels of racist abuse and assaults.[30][958][959] 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.[960][961][962]

Following the progression of the outbreak to new hotspot countries, people from Italy (the first country in
Europe to experience a serious outbreak of COVID-19) were also subjected to suspicion and
xenophobia,[964][965] 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.[966] Paris has seen riots break out over police treatment of
ethnic minorities during the coronavirus lockdown.[967] Racism and xenophobia towards South Asians and
Southeast Asians increased in the Arab states of the Persian Gulf.[968][969][970] South Korea's LGBTQ
community was blamed by some for the spread of COVID-19 in Seoul.[971][972]
 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".[973] 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.[974] Chinese racism and
xenophobia was criticised by foreign governments and diplomatic
corps,[975] and China apologised for discriminatory practices such as
Houston's Chinatown experienced a restaurants excluding black customers,[976] although these and other
reduction in business early during the accusations of harassment, discrimination and eviction of black
outbreak when there were still only a people in China continued.[977]
few cases.[963]

Information dissemination
Many newspaper agencies removed their online paywalls for some or all of their coronavirus-related articles
and posts,[978] while scientific publishers made scientific papers related to the outbreak available with open
access.[979] Some scientists chose to share their results quickly on preprint servers such as bioRxiv.[980]

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.[982][983][984] False
information, including intentional disinformation, has been spread
through social media,[983][985] text messaging,[986] and mass
media,[987] including the tabloid media,[988] conservative
media,[989][990] and state media of countries such as China,[991][992] Play media
Russia,[993][994] Iran,[995] and Turkmenistan.[983][996] It has also U.S. president Donald Trump
been spread by state-backed covert operations to generate panic and suggested at a press briefing on
sow distrust in other countries.[997][998][999] In some countries, such 23 April that disinfectant injections or
as India,[1,000] Bangladesh,[1,001] and Ethiopia,[1,002] journalists exposure to ultraviolet light might
help treat COVID-19. There is no
have been arrested for allegedly spreading fake news about the
evidence that either could be a viable
pandemic.[1,003]
method.[981] (1:05 min)
Misinformation has been propagated by celebrities,
politicians [1,004][1,005] (including heads of state in countries such as
the United States, [1,006][1,007] Iran,[1,008] and Brazil[1,009]), and other prominent public figures.[1,010]
Commercial scams have claimed to offer at-home tests, supposed preventives, and "miracle"
cures.[1,011][1,012] Several religious groups have claimed their faith will protect them from the
virus.[1,013][1,014][1,015] Some people have claimed the virus is a bio-weapon accidentally or purposefully
leaked from a laboratory,[1,016][1,017] a population control scheme, the result of a spy
operation,[984][985][1,018] or the side effect of improvements, called 5G, to cell telephone networks.[1,019]

The World Health Organization has declared an "infodemic" of incorrect information about the virus, which
poses risks to global health.[983]

See also
Coronavirus disease 2019
 Emerging infectious disease
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.[32]
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. Locations. 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. 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.[33]
5. Recoveries and deaths include probable deaths and people released from quarantine as
per CDC guidelines.[34][35][36]
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.[37]
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.[38] Since April 2020, the United States Department of
Defense has directed all bases, including Guantanamo Bay, to not publicize case
statistics.[37]
i. Russia
Including cases from the disputed Crimea and Sevastopol.
 j. 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.[43]
k. Spain
Excludes serology–confirmed cases.
l. Germany

1. Not all state authorities count recoveries.[49]

2. Recoveries include estimations by the Robert Koch Institute.[49][50]
m. France
1. Including French overseas regions of French Guiana, Saint Martin and Saint Barthélemy.
2. Excluding collectivities of New Caledonia, French Polynesia and Saint Pierre and
Miquelon.
3. Recoveries only include hospitalized cases.[53]
4. Figures for total confirmed cases and total deaths include data from both hospital and
nursing home (ESMS: établissements sociaux et médico-sociaux).[53]
n. China
1. Excluding 403 asymptomatic cases under medical observation as of 25 May 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.
o. Chile
1. Including the special territory of Easter Island.
2. On 29 April 2020, the Chilean government started to inform the number of asymptomatic
confirmed cases, separated from the official number of confirmed cases.[59] Since 30 April,
all confirmed cases (no matter their symptoms) are included in the official number.
3. Chilean authorities define a person as "recovered" after 14 days since the detection of the
virus because "they are no longer contagious".[60] Initially, patients who have died of
coronavirus were counted as recovered, following the same criteria, according to Health
Minister Jaime Mañalich;[61][62][63] however, this was changed later and Chilean reports
inform the number of recovered separated from the deceased.[64]
p. 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.[70]
q. Netherlands
1. All four constituent countries of the Kingdom of the Netherlands (i.e. the country of the
Netherlands [in this table row], Aruba, Curaçao, and Sint Maarten) and the special
municipalities of the Caribbean Netherlands (Bonaire, Saba and Sint Eustatius) are listed
separately.
2. The Dutch Government agency RIVM, responsible for the constituent country the
Netherlands, does not count its number of recoveries.[73]
 r. 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.
s. Egypt
Includes cases identified on the MS River Anuket.
t. Israel
1. Including cases from the disputed Golan Heights.
2. Excluding cases from the State of Palestine.
u. 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".
v. 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.[103]
w. Denmark
The autonomous territories of the Faroe Islands and Greenland are listed separately.
x. Serbia
Excluding cases from the disputed territory of Kosovo.
y. 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.[115]
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.[116]
z. Morocco
Including cases in the disputed Western Sahara territory controlled by Morocco. There are
no confirmed cases in the rest of Western Sahara.[121]
aa. Moldova
Including the disputed territory of Transnistria.
ab. 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.
ac. 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.[128] The exact number of recoveries is not known, as only a small proportion of
patients have been hospitalized.[129]
ad. Azerbaijan
Excluding the self-declared state of Artsakh.
ae. DR Congo
The Democratic Republic of the Congo.
af. Cuba
1. Includes cases on the MS Braemar.
2. Excluding cases from Guantanamo Bay, which is governed by the United States.
ag. Somalia
Excluding the de facto state of Somaliland.
ah. New Zealand
Recovered figures include those from 350 probable but unconfirmed cases, for a total of
1,503 confirmed and probable cases.
ai. Guam and USS Theodore Roosevelt
Cases for the USS Theodore Roosevelt, currently docked at Guam, are reported
separately.
aj. 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.[172] 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.[173][174][175]
ak. Cyprus
1. Including the British Overseas Territory of Akrotiri and Dhekelia.
2. Excluding de facto state of Northern Cyprus.
al. 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.
am. Georgia
Excluding the de facto states of Abkhazia and South Ossetia.
an. Congo
Also known as the Republic of the Congo and not to be confused with the DR Congo.
ao. Taiwan

Including cases from the ROCS Pan Shi.[216]

ap. Donetsk and Luhansk People's Republic
Note that these territories are distinct from the Ukraine-administered regions of the Donetsk
and Luhansk Oblasts.
aq. 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."[225]
ar. Somaliland
Cases from this de facto state are not counted by Somalia.
as. Syria
Excluding cases from the disputed Golan Heights.
at. Northern Cyprus
Cases from this de facto state are not counted by Cyprus.
au. South Ossetia
Cases from this de facto state are not counted by Georgia.
av. Artsakh
Cases from this de facto state are not counted by Azerbaijan.
aw. Abkhazia
Cases from this de facto state are not counted by Georgia.
ax. Saint Vincent
The sovereign state of Saint Vincent and the Grenadines.
ay. MS Zaandam
1. Including cases from MS Rotterdam.
2. The MS Rotterdam rendezvoused with the Zaandam on March 26 off the coast of Panama
City to provide support and evacuate healthy passengers. Both have since docked in
Florida.[298][299]
3. MS Zaandam and Rotterdam's numbers are currently not counted in any national figures.
az. Coral Princess
1. The cruise ship Coral Princess has tested positive cases since early April 2020 and has
since docked in Miami.[302]
2. Coral Princess's numbers are currently not counted in any national figures.
ba. 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.[311]
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.[312][313]
3. As RIVM does not report recoveries, and militaries are generally less transparent than
most government agencies due to operations security concerns, it is assumed that no
official report on recoveries is forthcoming.

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External links

Health agencies
COVID-19 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019) (Questions &
Answers (http://www.who.int/news-room/q-a-detail/q-a-coronaviruses), instructional videos (htt
ps://www.youtube.com/playlist?list=PLbpi6ZahtOH5PLTT1yfXxcxDsNM40N1uG)) by the World
Health Organization
COVID-19 (https://www.ecdc.europa.eu/en/novel-coronavirus-china) (Q&A (http://www.ecdc.eu
ropa.eu/en/novel-coronavirus-china/questions-answers)) by the European Centre for Disease
Prevention and Control
COVID-19 (http://en.nhc.gov.cn/antivirusfight.html) by the National Health Commission, China
COVID-19 (https://www.moh.gov.sg/covid-19) (Q&A (http://www.moh.gov.sg/covid-19/faqs)) by
the Ministry of Health, Singapore
COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/index.html) (Q&A (https://www.cdc.go
v/coronavirus/2019-ncov/about/index.html)) by the U.S. Centers for Disease Control
Coronavirus Disease 2019 (https://www.cdc.gov/niosh/emres/2019_ncov.html) (Q&A (https://w
ww.cdc.gov/niosh/docs/2018-130/pdfs/2018-130.pdf?id=10.26616/NIOSHPUB2018130)) by
the U.S. National Institute for Occupational Safety and Health

Directories
 COVID-19 Directory on Curlie (https://curlie.org/Health/Conditions_and_Diseases/Respiratory_
Disorders/COVID-19/)
COVID-19 Resource Directory on OpenMD (https://openmd.com/directory/covid-19)

Data and graphs

Coronavirus disease (COVID-2019) situation reports (https://www.who.int/emergencies/diseas
es/novel-coronavirus-2019/situation-reports/) and map (https://who.sprinklr.com/) by the World
Health Organization
Coronavirus Resource Center (https://coronavirus.jhu.edu/), map (https://coronavirus.jhu.edu/
map.html), and historical data (https://github.com/CSSEGISandData/COVID-19) by Johns
Hopkins University
Historical data about COVID-19 cases (https://www.ecdc.europa.eu/en/publications-data/downl
oad-todays-data-geographic-distribution-covid-19-cases-worldwide) published by the
European Centre for Disease Prevention and Control (ECDC)
World Travel Restrictions (http://unwfp.maps.arcgis.com/apps/opsdashboard/index.html#/42b8
837bb25049b9b1f69a9555d55808) based on WFP data
Coronavirus Observer (https://covid.observer) based on Johns Hopkins University data
Covid-19 coronavirus pandemic (https://www.worldometers.info/coronavirus/) published by
Worldometer
Coronavirus Disease (COVID-19) Statistics and Research (https://ourworldindata.org/coronavir
us) published by Our World in Data
COVID-19 Projections (https://covid19.healthdata.org/united-states-of-america) for many
countries published by Institute for Health Metrics and Evaluation
Spreadsheets: Country comparisons (https://sites.google.com/site/covid19comparisongraphs/)
Spreadsheets: Historical data with additional computations (https://sites.google.com/site/pande
micdata/)
Epidemic Calculator (https://gabgoh.github.io/COVID/index.html)
Stat News Covid-19 Tracker (https://www.statnews.com/feature/coronavirus/covid-19-tracker/)

Medical journals
Coronavirus Disease 2019 (COVID-19) (https://jamanetwork.com/journals/jama/pages/coronav
irus-alert) by JAMA
Coronavirus: News and Resources (https://www.bmj.com/coronavirus) by BMJ Publishing
Group
Novel Coronavirus Information Center (https://www.elsevier.com/connect/coronavirus-informati
on-center) by Elsevier
COVID-19 Resource Centre (https://www.thelancet.com/coronavirus) by The Lancet
SARS‑CoV‑2 and COVID-19 (https://www.springernature.com/gp/researchers/campaigns/coro
navirus) by Nature
Coronavirus (Covid-19) (https://www.nejm.org/coronavirus) by The New England Journal of
Medicine
Covid-19: Novel Coronavirus (https://novel-coronavirus.onlinelibrary.wiley.com/) by Wiley
Publishing

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