 Introduction

 Background:

December 31st  2019 

WHO was alerted to several cases of pneumonia in Wuhan City, Hubei Province of
China. The virus did not match any other known virus. 

January 7th 2020

Chinese authorities confirmed that they had identified a new virus. The new virus is
a coronavirus, which is a family of viruses that include the common cold, and viruses
such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East
Respiratory Syndrome). This new virus was temporarily named “2019-nCoV.” 1 

February 28th 2020 

WHO stated its risk assessment worldwide for the Coronavirus was now "very high".

March 11th 2020 

The spread of the coronavirus was declared a Pandemic by the World Health
Organization

March 31st 2020

More than a third of humanity are under some form of lockdown.

April 24th 2020 

World leaders unite to ensure everyone can access new vaccines, tests and treatments
for COVID-!9 as they develop. 

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.

Several known coronaviruses are circulating in animals that have not yet infected
humans. This new strain of conoravirus has been officially referred to as the novel
coronavirus (2019-nCoV). 2

WHO has been working with global experts from the day they were informed, to learn
more about the virus, how it affects the people who are sick with it, how they can be
treated, and what countries can do to respond. 3

What is SARS and MERS?

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a
coronavirus called SARS-associated coronavirus (SARS-CoV). SARS was first reported
in Asia in February 2003. The illness spread to more than two dozen countries in North
America, South America, Europe, and Asia before the SARS global outbreak of 2003
was contained (4). Middle East respiratory syndrome (MERS) is a viral respiratory
disease caused by a novel coronavirus (Middle East respiratory syndrome coronavirus,
or MERS‐CoV) that was first identified in Saudi Arabia in 2012 (5). MERS-CoV and
SARS-CoV have been known to frequently cause severe symptoms. MERS symptoms
 usually include fever, cough, and shortness of breath which often progress to pneumonia.
About 3 or 4 out of every 10 patients reported with MERS have died. MERS cases
continue to occur, primarily in the Arabian Peninsula. SARS symptoms often included
fever, chills, and body aches which usually progressed to pneumonia. No human cases
of SARS have been reported anywhere in the world since 2004 (6).

 Signs and Symptoms of Coronaviruses - General Overview

 Common human coronaviruses usually cause mild to moderate upper-respiratory

tract illnesses, like the common cold. Most people get infected with these viruses at some
point in their lives. These illnesses usually only last for a short amount of
time. Symptoms may include:

o Runny nose

o Headache 

o Cough

o Sore throat 

o Fever

o General feeling of being unwell

o Repeated shaking with chills

o Muscle pain

o New loss of taste or smell

 Human coronaviruses can sometimes cause lower-respiratory tract illnesses,

such as pneumonia or bronchitis. This is more common in people with cardiopulmonary
disease, people with weakened immune systems, infants, and older adults. 7

 Signs and Symptoms of the Novel Coronavirus (2019-nCoV)



Source: WHO

 Based on what was seen with other coronaviruses, it is believed that symptoms

of 2019-nCoV may appear in as few as 2 days or as long as 14 after exposure.

 Emergency Warning Signs:

 According to the CDC, seek medical attention immediately if you have any of
these emergency warning signs8  *:

o Trouble breathing

o Persistent pain or pressure in the chest

o New confusion or inability to arouse

o Bluish lips or face

 

 * This list is not all inclusive. Please consult your medical provider for any other
symptoms that are severe or concerning to you.

 Coronavirus - Transmission and Treatment

 Introduction

 2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have their
origins in bats. 

 Chinese authorities successfully sequenced the genome of the virus allowing for
effective detection. The US CDC confirmed the same genome in the first two cases in the
US.  

Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCov
in Wuhan, China had some link to a large seafood and live animal market (also known
as "wet markets"),  suggesting that initial spread of the virus was animal-to-person. 

Subsequently it has become clear that human-to-human contact is able to spread the
virus. The complete clinical picture with regard to 2019-nCoV is still not fully clear.
Reported illnesses have ranged from infected people with little to no symptoms to people
being severely ill and dying. 1

 How does the Novel Coronavirus spread from Person-to-Person?

 Human coronaviruses most commonly spread from an infected person to others

through:

o The air by coughing and sneezing

o Close personal contact, such as touching or shaking hands

o Touching an object or surface with the virus on it, then touching your
mouth, nose, or eyes before washing your hands

o Rarely, fecal contamination

 When person-to-person spread has occurred with MERS and SARS, it is thought
to have happened mainly via respiratory droplets produced when an infected person
coughs or sneezes, similar to how influenza and other respiratory pathogens spread.
Spread of SARS and MERS between people has generally occurred between close
contacts. 2

It’s important to note that how easily a virus spreads person-to-person can vary. Some
viruses are highly contagious (like measles), while other viruses are less so. 3

 Should you be tested for the Novel Coronavirus (2019-nC0V)?

 US CDC guidelines state: "If you develop a fever* and symptom of respiratory
illness, such as cough or shortness of breath, within 14 days after travel from China,
you should call ahead to a healthcare professional and mention your recent travel or
close contact. If you have had close contact** with someone showing these symptoms
who has recently traveled from this area, you should call ahead to a healthcare
professional and mention your close contact and their recent travel." As the virus has
now spread globally, the connection with China is significant but becoming less
important.

* Fever may not be present in some patients, such as those who are very young, elderly,
immunosuppressed, or taking certain fever-lowering medications. Clinical judgment
should be used to guide testing of patients in such situations.

** Close contact is defined as:

o being within approximately 6 feet (2 meters), or within the room or care

area, of a novel coronavirus case for a prolonged period of time while not wearing
recommended personal protective equipment ; close contact can include caring for, living
with, visiting, or sharing a health care waiting area or room with a novel coronavirus
case.– or –

o having direct contact with infectious secretions of a novel coronavirus

case (e.g., being coughed on) while not wearing recommended personal protective
equipment. 4

 Treatment
 According to the US CDC, there is no specific antiviral treatment recommended
for the novel coronavirus infection. People infected with 2019-nCoV should receive
supportive care to help relieve symptoms. For severe cases, treatment should include
care to support vital organ functions. People who think they may have been exposed to
2019-nCoV should contact your healthcare provider immediately. 5

 What happens in hospital?

 Those who get admitted to hospital are given treatment for their symptoms while
their immune systems try to fight the virus off. Hospitalization also serves to isolate
patients and stop the virus spreading. In severe cases, the virus can cause pneumonia -
an inflammation of the lungs. In those cases breathing may need to be
supported. Patients are given oxygen and in the worst cases may be put on a ventilator. 

In milder cases, patients struggling to maintain blood pressure can be given an

intravenous drip. Fluids can also be given in cases of diarrhea, and ibuprofen is also
available for pain relief. 6

 How Deadly is the Coronavirus?

 Based on data from 44,000 patients with this coronavirus, the WHO says:

o 81% develop mild symptoms.

o 14% develop severe symptoms.

o 5% become critically ill.

 The proportion dying from the disease appears low (between 1% and 2%) but the
figures are unreliable.

Thousands are still being treated but may go on to die - so the death rate could be
higher. But it is also unclear how many mild cases remain unreported - so the death rate
could also be lower.

To put this into context, about one billion people catch influenza every year, with between
290,000 and 650,000 deaths.


 How to Self-Isolate

 If you suspect you have coronavirus, have been in contact with someone who
has it, or have been to a place where there are a lot of cases of the virus, then the official
advice is to self-isolate.

The top five methods to successfully self-isolate include:

1. Stay at home - Do not go to work or school, or other public spaces. Do not have any
visitors.

 2. Call ahead - If you develop symptoms such as a cough or fever, then seek
advice first by phoning your local medical center or hospital. Don't just turn up as this
could potentially spread the virus if you have it.

3. Separate yourself - If you live with others then you should stay in a well-ventilated
bedroom with the door shut. If you share a bathroom then use it after everyone else.
Don't share towels and toiletries.

4. Dispose of waste carefully - Your waste should be double-bagged.

5. Order in food - Order food online or ask your family or friends to help. Ask the person
to leave food deliveries on the doorstep.

 Coronavirus - Recent Developments

 Overview
 Patients with 2019-nCoV infection, are presenting with a wide range of
symptoms. Most seem to have mild disease, and about 20% appear to progress to
severe disease, including pneumonia, respiratory failure and in some cases death.1 

According to real-time data from Johns Hopkins University as of 8:00 am (GMT) June

15th 2020, the latest figures on the novel coronavirus are as follows:

7,914,866 cases confirmed globally 

o 433,472 confirmed deaths, with the first death outside of China reported

in the Philippines.

o 3,778,083 patients of the virus have been reported as having recovered

fully.

o The virus has now been confirmed in 188 countries and territories

 How the Coronavirus has Spread in China

 Thousands of patients have been infected with the virus across China, with
central Hubei province being the worst-affected. Restrictions on travel are affecting at
least 20 million people across 10 cities - including the capital Wuhan, where the virus
emerged. 

In a bid to tackle the increased demand for medical services, the authorities are building
makeshift hospitals. People have been asked to wear face masks in public places. 

As of March 24th, the Chinese government relaxed travel restrictions. National

monuments such as the Great Wall of China were in part re-opened.


Source: China National Health Commission, BBC Research, January 28th 2020

 Locations with Confirmed Cases of Novel Coronavirus

 According to data from Johns Hopkins University5, as of June 15th 2020,
over 188 countries/territories have confirmed cases of the novel coronavirus.
 Distribution of Novel Coronavirus cases:


 Other Recent Developments

 In February, Scientists in Australia became the first to recreate the new

coronavirus outside of China in what they have called a "significant breakthrough". The
discovery will be shared with the World Health Organization (WHO) in the hope it may
help efforts to diagnose and treat the virus. 

Scientists in China have also recreated the virus and shared its genome sequence.

Chinese authorities have said the virus - like a normal flu - is able to spread during its
incubation period. According to the WHO, the incubation period can range from two to 14
days, however, WHO said it it remains unclear whether it is contagious before symptoms
appear. 7

As of late March, the United States of America overtook China as the country with the
most infections worldwide. 

By mid-May, a number of other countries have also overtaken the number of cases in
China including Brazil, Italy, Iran, France, Germany, Russia, Spain, Turkey and the UK.

 On March 8th, the government of Italy placed 16 million people under quarantine
in the Northern Italian Lombardy region as it battled to contain the spread of
coronavirus. Closures of schools, gyms, museums, nightclubs and other venues was also
announced.
 For the first time, Pope Francis live-streamed his Sunday Prayers in St. Peter’s Square
rather than appearing in person.

As of March 16th, More than 100 million people in Europe faced country lockdowns as
governments requested no travel outside the home except for exceptional circumstances
and the purchasing of food, going to work, or seeking medical treatment. 

As of March 17th, Global deaths and infections from Covid19 surpassed those inside
China for the first time since the beginning of the outbreak.

 Italy, Spain and France were the first countries to order national lockdowns.
Other countries in Europe and around the world followed, so most countries have been in
some form of lockdown.

In the United States, as of June 15th, the virus has infected 2,094,069 people and
caused 115,732 deaths, turning the virus spread into a serious health crisis. 
The U.S. outbreak is outpacing the rate of infections in even some of the worst hit
countries of the world. There are now more new cases per day in America than any other
nation.

 Coronavirus - International Response

 Overview

 Outbreaks of novel virus infections among people are always of public health
concern. The risk from these outbreaks depends on characteristics of the virus, including
whether and how well it spreads between people, the severity of resulting illness, and the
medical or other measures available to control the impact of the virus (for example,
vaccine or treatment medications).  1

 The World Health Organisation coordinates global responses in these case.

Established in 1948, it is the directing and coordinating authority on international health
within the United Nations system.

 WHO Coronavirus Crisis Strategic Objectives:

o Interrupt human-to-human transmission including reducing secondary
infections among close contacts and health care workers, preventing
transmission amplification events, and preventing further international
spread*

o Identify, isolate and care for patients early, including providing optimized
care for infected patients.

o Identify and reduce transmission from the animal source

o Address crucial unknowns regarding clinical severity, extent of

transmission and infection, treatment options, and accelerate the
development of diagnostics, therapeutics and vaccines

o Communicate critical risk and event information to all communities and

counter misinformation

o Minimize social and economic impact through multisectoral partnerships.

  *  This can be achieved through a combination of public health measures, such as rapid identification,
diagnosis and management of the cases, identification and follow up of the contacts, infection prevention

and control in health care settings, implementation of health measures for travellers, awareness-raising in

the population and risk communication.

 Commercial Airline Industry

 As of late March 2020, the international airline industry, as a result of the spread
of the coronavirus to almost all nations, has almost ground to a halt except for
international traffic bringing essential supplies. 

Ryanair, the largest airline in Europe stated that it would ground all planes for the months
of April and May 2020.

In the United States, the number of American travellers boarding commercial flights have
risen steadily through April. Social Distancing practices and the wearing of facemasks
are not being facilitated or followed, even though they are spacing out passengers.

 Quarantine in Northern Italy

 Italy became Europe's first significantly impacted country. The outbreak in Italy
centered around a group of towns in the Lombardy and Veneto regions. By late Feb, 11
towns were closed-off, in which more than 50,000 people were quarantined.

 Italian authorities have confirmed more than 236,989 cases and 34,345 deaths

there. Since March 17th 2020, Italy has been in full lockdown.

Italy's Prime Minister Giuseppe Conte announced on Sunday 26th April 2020, that his
country would soon begin the process of reopening its economy after undergoing the
longest novel coronavirus lockdown anywhere to date.

 Europe

 In late April and May, leaders across Europe prepare to ease lockdown while
avoiding a dangerous resurgance of the virus. An increase in testing and tracing apps,
provision of face masks are some of the plans that are being considered.

 The key points from this module are:

o On January 7th 2020, Chinese authorities confirmed that they had
identified a new virus, which is believed to have originated from Wuhan, China. The new
virus is a coronavirus, which is a family of viruses that include the common cold, and
viruses such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East
Respiratory Syndrome). This new virus was temporarily named “2019-nCoV.” 

o As the virus has now spread globally, the connection with China is
significant but becoming less important.

o Coronaviruses are zoonotic, meaning they are transmitted between

animals and people.

o Symptoms can include fever, followed by a dry cough and then, after a
week, leads to shortness of breath and some patients needing hospital treatment. Other
symptoms can include sneezing, headaches, and possible kidney failure. 

o Human coronaviruses most commonly spread from an infected person to

others through: the air by coughing and sneezing; close personal contact, such as
touching or shaking hands; touching an object or surface with the virus on it, then
touching your mouth, nose, or eyes before washing your hands and rarely, fecal
contamination.

o If you develop a fever and symptoms of respiratory illness, such

as cough or shortness of breath, within 14 days after travel or coming into contact
with someone who has traveled, you should call ahead to a healthcare professional
and mention your recent travel or close contact. 

 On January 27th, 2020 CDC issued updated travel guidance for China,
recommending that travelers avoid all nonessential travel to all of the country (Level 3
Travel Health Notice).
 On March 11th 2020, the spread of the coronavirus was declared a Pandemic
by the World Health Organization

 As of June 15 2020, 7,914,866 cases confirmed globally 

  A total of 433,472 people (June 15 2020) so far have died following infection

with the novel coronavirus.

 It has also been reported that 3,778,083 (June 15 2020) people have so far

covered from this coronavirus
o