RESEARCH PAPER

COVID-19 ORIGIN AND GLOBAL SPREAD

FROM: GROUP 1 TO:

CHAITANYA(19BCOM57) MAJOR GENERAL

SHIVAM(19BCOM61) PROFESSOR GW DWIVEDI
YUKTA(19BCOM56)
GITANSHI19BCOM59)
PRIYA(19BCOM58)
VAIBHAV(19BCOM60)
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.

Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and
recover without requiring special treatment. Older people, and those with underlying medical
problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely
to develop serious illness.

The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus,
the disease it causes and how it spreads. Protect yourself and others from infection by washing your
hands or using an alcohol-based rub frequently and not touching your face.

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an
infected person coughs or sneezes, so it’s important that you also practice respiratory etiquette (for
example, by coughing into a flexed elbow).
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory
syndrome coronavirus. It was first isolated from three people with pneumonia connected to the
cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2
virus particle occur in related coronaviruses in nature.

In July 2020, WHO and China began the groundwork for studies to better understand the origins of
the virus. Terms of Reference (TORs) were agreed that defined a phased approach, and the scope of
studies, the main guiding principles, and expected deliverables. The TORs envisaged an initial Phase 1
of short-term studies to better understand how the virus might have been introduced and started to
circulate in Wuhan, China.

WHO selected an international multidisciplinary team of experts to work closely with a

multidisciplinary team of Chinese experts in the design, support and conduct of these studies and to
conduct a follow-up visit to review progress and agree upon a series of further studies.

The joint international team comprised 17 Chinese and 17 international experts from other countries,
the World Health Organization (WHO), the Global Outbreak Alert and Response Network (GOARN),
and the World Organisation for Animal Health (OIE) (Annex B). The Food and Agriculture Organization
of the United Nations (FAO) participated as an observer. Following initial online meetings, a joint study
was conducted over a 28-day period from 14 January to 10 February 2021 in the city of Wuhan,
People’s Republic of China.
The team agreed a workplan and established working groups to review the progress made in Phase 1
studies in the areas of: epidemiology; animals and the environment; and molecular epidemiology and
bioinformatics. During the course of the discussions, the international experts gained deeper
understanding of the methods used and data obtained. In response to requests during the visit,
further data and analyses were generated, reflecting a productive iterative approach to refining the
design and interpretation of complex studies in all areas.

In addition to group work, the team shared scientific and thematic presentations on relevant topics to
help inform its work, undertook a series of site visits to important locations and conducted interviews
with key informants.

The epidemiology working group closely examined the possibilities of identifying earlier cases of
COVID-19 through studies from surveillance of morbidity due to respiratory diseases in and around
Wuhan in late 2019. It also drew on national sentinel surveillance data; laboratory confirmations of
disease; reports of retail pharmacy purchases for antipyretics, cold and cough medications; a
convenience subset of stored samples of more than 4500 research project samples from the second
half of 2019 stored at various hospitals in Wuhan, the rest of Hubei Province and other provinces. In
none of these studies was their evidence of an impact of the causative agent of COVID-19 on morbidity
in the months before the outbreak of COVID-19.

Furthermore, surveillance data on all-cause mortality and pneumonia-specific mortality from Wuhan
city and the rest of Hubei Province were reviewed. The documented rapid increase in all-cause
mortality 7 and pneumonia-specific deaths in the third week of 2020 indicated that virus transmission
was widespread among the population of Wuhan by the first week of 2020. The steep increase in
mortality that occurred one to two weeks later among the population in the Hubei Province outside
Wuhan suggested that the epidemic in Wuhan preceded the spread in the rest of Hubei Province.

Both surveillance data and cases reported to the National Notifiable Disease Reporting System
(NNDRS) in China were subjected to clinical review. The NNDRS was notified of 174 COVID-19 cases
with onset of symptoms in December 2019. In an extensive exercise by 233 health institutions in
Wuhan, some 76,253 records of cases of respiratory conditions in the two months of October and
November before the outbreak in late 2019 were scrutinized clinically. Although 92 cases were
considered to be compatible with SARS-CoV-2 infection after review, subsequent testing and further
external multidisciplinary clinical review determined that none was in fact due to SARS-CoV-2
infection. Based on the analysis of this and other surveillance data, it is considered unlikely that any
substantial transmission of SARS-CoV-2 infection was occurring in Wuhan during those two months.
Many of the early cases were associated with the Huanan market, but a similar number of cases were
associated with other markets and some were not associated with any markets. Transmission within
the wider community in December could account for cases not associated with the Huanan market
which, together with the presence of early cases not associated with that market, could suggest that
the Huanan market was not the original source of the outbreak. Other milder cases that were not
identified, however, could provide the link between the Huanan market and early cases without an
apparent link to the market. No firm conclusion therefore about the role of the Huanan market in the
origin of the outbreak, or how the infection was introduced into the market, can currently be drawn.

The molecular epidemiology and bioinformatics working group examined the genomic data of viruses
collected from animals. Evidence from surveys and targeted studies so far have shown that the
coronaviruses most highly related to SARS-CoV-2 are found in bats and pangolins, suggesting that
these mammals may be the reservoir of the virus that causes COVID-19. However, neither of the
viruses identified so far from these mammalian species is sufficiently similar to SARS-CoV-2 to serve
as its direct progenitor. In addition to these findings, the high susceptibility of mink and cats to SARS-
CoV2 suggests that additional species of animals may act as a potential reservoir.

To analyse the viral genomes and epidemiological data from the early phase of the outbreak, the team
reviewed data collected through the China National Centre for Bioinformation integrated database on
all available coronaviruses sequences and their metadata. All sequence data from samples collected
in December 2019 and January 2020 were subjected to deeper analysis to see the diversity of viruses
in the first phases of the outbreak. For the cases detected in Wuhan, data on samples from cases with
illness onset before 31 December 2019 were linked with epidemiological background data. Several
samples from patients with exposure to the Huanan market had identical virus genomes, suggesting
that they may have been part of a cluster. However, the sequence data also showed that some
diversity of viruses already existed in the early phase of the outbreak in Wuhan, suggesting unsampled
chains of transmission beyond the Huanan market cluster. There was no obvious clustering by the
epidemiological parameters of exposure to raw meat or furry animals.

In addition, the time to the most recent common ancestor of the SARS-CoV-2 sequences in the final
data set was estimated and compared with results from previous studies. Such analyses can be
considered estimates but do not provide definitive proof of time of origins. Based on molecular
sequence data, the results suggested that the outbreak may have started sometime in the months
before the middle of December 2019. The point estimates for the time to the most recent ancestor
ranged from late September to early December, but most estimates were between mid-November
and early December.
Finally, the team reviewed data from published studies from different countries suggesting early
circulation of SARS-CoV-2. The findings suggest that circulation of SARS-CoV-2 preceded the initial
detection of cases by several weeks. Some of the suspected positive samples were detected even
earlier 8 than the first case in Wuhan, suggesting the possibility of missed circulation in other
countries. So far, however, the quality of the studies is limited. Nonetheless, it is important to
investigate these potential early events.

The animal and environment working group reviewed existing knowledge on coronaviruses that are
phylogenetically related to SARS-CoV-2 identified in different animals, including horseshoe bats
(Rhinolophus spp) and pangolins. However, the presence of SARS-CoV-2 has not been detected
through sampling and testing of bats or of wildlife across China. More than 80 000 wildlife, livestock
and poultry samples were collected from 31 provinces in China and no positive result was identified
for SARS-CoV-2 antibody or nucleic acid before and after the SARS-CoV-2 outbreak in China. Through
extensive testing of animal products in the Huanan market, no evidence of animal infections was
found.

Environmental sampling in Huanan market from right at the point of its closing showed out of 923
environmental samples in Huanan market, 73 samples were positive. This revealed widespread
contamination of surfaces with SARS-CoV-2, compatible with introduction of the virus through
infected people, infected animals or contaminated products.

The supply chains to Huanan market included cold-chain products and animal products from 20
countries, including those where samples have been reported as positive for SARS-CoV-2 before the
end of 2019 and those where close relatives of SARS-CoV-2 are found. There is evidence that some
domesticated wildlife the products of which were sold in the market are susceptible to SARS-CoV, but
none of the animal products sampled in the market tested positive in this study. In the early phase of
pandemic, due to lack of awareness of the potential role of cold chain in virus introduction and
transmission, the cold-chain products were not tested. These findings, however, do raise the
possibility of different potential pathways of introduction. Preliminary sampling and testing of other
markets in Wuhan and upstream suppliers to the Huanan market taken during 2020 did not reveal
evidence of SARS-CoV-2 circulating in animals.

SARS-CoV-2 has been found to persist in conditions found in frozen food, packaging and cold-chain
products. Index cases in recent outbreaks in China have been linked to the cold chain; the virus has
been found on packages and products from other countries that supply China with cold-chain
products, indicating that it can be carried long distances on cold-chain products.
Further analysis will examine spatial and temporal correlations and correct for underlying biases in
sampling, and also to trace frozen products back to the Huanan market from suppliers.

The team suggested next-phase studies to help tracing the origin of SARS-CoV-2 and the closest
common ancestor to this virus, including analysis of trade and history of trade in animals and products
in other markets, particularly in markets epidemiologically linked to early human cases or sequence
data, surveys of susceptible animals in farms in South-East Asia and further afield for viruses related
to SARS-CoV-2, livestock farms where coronavirus-susceptible animals are present, and continued,
targeted surveys of fur farms for SARS-CoV-2 and related viruses. Farmers, suppliers, and their
contacts could be followed up, and cohorts of workers who have an occupational risk of exposure to
animals and cold-chain products could be serologically tested for unusually high antibody titres that
might suggest a risk for SARS-Cov-2 emergence.

The next phase studies include testing wildlife samples for SARS-CoV-2 related viral sequence and
antibodies; continuing surveys of Rhinolophus bats in southern provinces of China and countries
around East Asia, South-East Asia and any other regions where Rhinolophus bats are distributed;
tracing the cold chain product supplier countries where SARS-CoV-2 positive testing was preliminarily
reported before the end of 2019, and where evidence of more distantly related SARSr-CoV in bats
outside Asia were reported, if there are credible links. Conduct further relevant traceability research
studies in countries and regions with initial reports of positive results in sewage, serum, human or
animal tissues/swab and other SARS-CoV-2 test by the end of 2019. Convene a global expert group to
support future joint traceability research on the origin of epidemics.

The joint international team made a series of recommendations for each area and in doing so assessed
the likelihood of different possible pathways for the introduction of the virus.

The joint international team examined four scenarios for introduction:

 direct zoonotic transmission to humans

 introduction through an intermediate host followed by spill over
 introduction through the (cold) food chain
 introduction through a laboratory incident.

For each of these possible pathways of emergence, the joint team conducted a qualitative risk
assessment, considering the available scientific evidence and findings. It also stated the arguments
against each possibility. The team assessed the relative likelihood of these pathways and prioritized
further studies that would potentially increase knowledge and understanding globally. 
The joint team’s assessment of likelihood of each possible pathway was as follows:

 direct zoonotic spill over is considered to be a possible-to-likely pathway

 introduction through an intermediate host is considered to be a likely to very likely pathway
 introduction through cold/ food chain products is considered a possible pathway
 introduction through a laboratory incident was considered to be an extremely unlikely
pathway.

GLOBAL SPREAD

The coronavirus pandemic has sickened more than 158,357,600 people, according to official counts.
As of Monday morning, at least 3,291,700 people have died from coronavirus. See vaccinations by
country on our world tracker page.

The pandemic has recently been affecting a lot more people due to a mutation in the virus. This has
brought a second wave of covid 19 in the South-East Asian region.
This map shows the average daily cases per 100,000 people in the past week. In this map we can
clearly see that the virus has grown a lot more in the months of April and May.

The coronavirus pandemic grew worse in March, as new cases have increased in Europe and South
America and south-east Asia.

The following are some of the most affected countries in the recent months: -
The following are some Countries where new cases are higher had a daily average of at least four new
cases per 100,000 people over the past week. The charts, which are all on the same scale, show daily
cases per capita and are of countries with at least five million people.

The following are some Countries where new cases are lower had a daily average of less than four
new cases per 100,000 people over the past week. The charts, which are all on the same scale, show
daily cases per capita and are of countries with at least five million people.

These countries have had the highest growth in newly reported deaths over the last 14 days. Deaths
tend to rise a few weeks after a rise in infections, as there is typically a delay between when people
are infected, when they die and when deaths are reported. Some deaths reported in the last two
weeks may have occurred much earlier because of these delays.
The outbreak was initially defined by a series of shifting epicentres — including Wuhan, China; Iran;
northern Italy; Spain; and New York. But the pandemic has now reached nearly every country in the
world.

WHAT YOU CAN DO

Experts’ understanding of how the Covid-19 works is growing. It seems that there are four factors that
most likely play a role: how close you get to an infected person; how long you are near that person;
whether that person expels viral droplets on or near you; and how much you touch your face
afterwards. Here is a guide to the symptoms of Covid-19.
You can help reduce your risk and do your part to protect others by following some basic steps:

 Keep your distance from others. Stay at least six feet away from people outside your
household as much as possible.

 Wear a mask outside your home. A mask protects others from your germs, and it protects you
from infection as well. The more people who wear masks, the more we all stay safer.

 Wash your hands often. Anytime you come in contact with a surface outside your home, scrub
with soap for at least 20 seconds, rinse and then dry your hands with a clean towel.

 Avoid touching your face. The virus can spread when our hands come into contact with the
virus, and we touch our nose, mouth or eyes. Try to keep your hands away from your face
unless you have just recently washed them.