Public health experts around the globe are scrambling to understand, track, and contain a new virus that appeared in Wuhan, China, at the beginning of December 2019. The World Health Organization named the disease caused by the virus COVID-19, which references the type of virus and the year it emerged. The WHO declared that the virus is a pandemic.
The Verge is regularly updating this page with all the latest news and analysis.
You can see where and how many cases of the illness have been reported in this map. The majority of the illnesses were initially in China, where the virus first emerged, but the rate of new cases there has nearly stopped. There are now many times more cases outside of China than there were inside of it at the height of the outbreak. There are large outbreaks of the disease in multiple places, including Spain, Italy, and the United States.
As this important story continues to unfold, our hope is to answer all of your questions as people work to understand this virus and contain its spread.
Table of contents
Where did the virus come from?
At the end of December, public health officials from China informed the World Health Organization that they had a problem: an unknown, new virus was causing pneumonia-like illness in the city of Wuhan. They quickly determined that it was a coronavirus and that it was rapidly spreading through and outside of Wuhan.
Coronaviruses are common in animals of all kinds, and they sometimes can evolve into forms that can infect humans. Since the start of the century, two other coronaviruses have jumped to humans, causing the SARS outbreak in 2002 and the MERS outbreak in 2012.
Scientists think this new virus first became capable of jumping to humans at the beginning of December. It originally seemed like the virus first infected people at a seafood market in Wuhan and spread from there. But one analysis of early cases of the illness, published January 24th, found that the first patient to get sick did not have any contact with the market. Experts are still trying to trace the outbreak back to its source.
The type of animal the virus originated from is not clear, although one analysis found that the genetic sequence of the new virus is 96 percent identical to one coronavirus found in bats. Both SARS and MERS originated in bats.
Where is it spreading?
The virus is now spreading in dozens of countries around the world.
Although it originated in China, the country took aggressive action at the start of the outbreak, shutting down transportation in some cities and suspending public gatherings. Officials isolated sick people and aggressively tracked their contacts, and had a dedicated network of hospitals to test for the virus. The number of new infections reported in China has been declining, which indicated to WHO officials that transmission was slowing down — and that their containment measures were working.
Now, the WHO says, the epicenter of the pandemic is in Europe, which now has more new cases reported each day than China did at the height of its outbreak. In the US, though, the outbreak is accelerating faster than anywhere else in the world. New York City has the highest number of cases in the country. Previous US hot spots included a nursing home in Washington state, New Rochelle, New York, and the Boston area, where disease spread at a conference.
How dangerous is this new virus?
It takes information about both how severe an illness is and how easily it can spread to determine how “bad” it can be. Epidemiologists often use this tool to assess new strains of the flu, for example:
If an illness isn’t very severe (and kills only a small percentage of people), but it’s highly transmissible, it can still be devastating. An easily-transmitted illness that kills a small percentage of the people it infects can still cause a lot of deaths, precisely because so many people get sick.
The WHO named the illness caused by the coronavirus COVID-19 — “co” and “vi” for coronavirus, “d” for disease, and “19” for the year when the disease emerged.
COVID-19 is a serious illness, and it’s more dangerous than the flu. One CDC projection suggests that between 160 to 214 million people will be infected in the US, and that between 200,000 and 1.7 million could die. That doesn’t take into account actions taken to slow down the outbreak, though.
The symptoms of COVID-19 have ranged from mild, like those in a cold, to severe. Around 80 percent of confirmed cases are mild — at least, 80 percent of the cases that we know about. It’s still possible that there are many more mild cases of the illness that haven’t been flagged, which would shrink the percentage of cases that are severe. In about 15 percent of people, the illness is severe enough that they need to be hospitalized, and about 5 percent of cases are critical. It appears around half of the people with critical cases of the illness die from it.
So far, 2 or 3 percent of people who get sick with COVID-19 die, though it’s too early to say for sure how often it is fatal. Those numbers may change as the outbreak progresses, and will be different in different places, depending on the demographics of the population. By comparison, 14 to 15 percent of people who got sick from SARS died.
Different groups of people, though, are more at risk of having a severe case of the illness or of dying from it. Most deaths in this outbreak have been in older people and those who have underlying health issues, like heart disease, hypertension, and diabetes. In that group, people are more at risk of dying. Around 14 percent of people over the age of 80 who get sick will die, for example.
How easily can the virus spread?
The virus is moving rapidly around the world. The new coronavirus spreads quickly in contained environments, like on the cruise ship the Diamond Princess.
Early evidence suggested that, like other coronaviruses, the virus jumps between people who are in very close contact with each other. It also probably spreads when an infected person sneezes or coughs. Coughs and sneezes produce little droplets of mucus and saliva. If these droplets make it into another person’s eyes, mouth or nose, they can get sick. The viruses in those little droplets can also fall onto surfaces, like tables or doorknobs — if someone touches that surface and touches their eyes, mouth or nose, they can also get sick.
Early research shows that the virus can linger on surfaces such as plastic and stainless steel for a few days, which is why it’s important to clean countertops, doorknobs, and other places people touch regularly. The virus doesn’t appear to stay infectious on cardboard for longer than a day — so packages should be safe.
The new coronavirus doesn’t appear to spread through the air. Certain hospital procedures can artificially create airborne viruses, but that does not happen normally.
It’s also important to note that neither SARS-CoV classic nor SARS-CoV-2/HCoV19/COVID-19 normally form aerosols. These are only generated under very specific circumstances during certain hospital procedures (bronchoscopy, intubation).
— Dr. Angela Rasmussen (@angie_rasmussen) March 11, 2020
It’s still not clear when people with COVID-19 become contagious, or how long being contagious lasts. One study of nine people in Germany with mild cases of the illness found that they had high levels of the virus in their throats early on in the course of the disease, before they felt very sick. That may mean that people can spread the virus before they know they have it.
Chinese officials have said that they have seen cases where people with the virus infected others before they started showing symptoms. Research out of China showed that people without symptoms still have high levels of the virus in their throats and noses, so they may be passing it along if they cough or sneeze. In one case, a family in Anyang, China appeared to be sickened by an asymptomatic family member, according to a study in The Journal of the American Medical Association. A cluster of cases in Massachusetts appears to have been driven by people who spread the virus while they were asymptomatic.
Preliminary research suggests that people without symptoms or mild, almost unnoticeable symptoms may be driving the epidemic. That will make containing the spread of the virus more complicated.
Each sick person will go on to infect, on average, between 1.4 and 2.5 additional people, the WHO says, though that’s an early estimate. Other teams of researchers have published their own estimates, with most saying a sick person will infect an average of around two or three people.
Those numbers are called the virus’s R0 (pronounced “R-naught”). The R0 is the mathematical representation of how well an infection might be able to spread. The higher the number, the easier the disease is to spread. For comparison, the R0 for SARS was between two and five. But that doesn’t mean each sick person will actually infect that many people; quarantines and other actions taken to control outbreaks of a virus can bring down the number of people a sick person infects.
Can we treat this virus?
There aren’t any proven treatments for COVID-19, but there are dozens of studies underway to find some. One leading candidate is remdesivir, an antiviral medication originally developed to treat Ebola. There are clinical trials testing it in patients in China, in the US, and around the world. While there’s a lot of hype around the anti-malaria medication chloroquine, there’s still no evidence it — or any other drug — actually works.
Research teams and pharmaceutical companies are also working to develop a vaccine that can protect people from infection. However, vaccine development takes a long time. Even if everything goes smoothly, it will be around a year to 18 months before one is available, said Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases.
What can I do to protect myself and others?
Based on what we know so far, you can protect yourself with the same measures you’d take (and should be taking) to protect yourself against the flu: wash your hands, cover your mouth when you cough, and stay away from people who are ill. Stay home from work or school if you’re feeling sick, and if you can, stay home even if you’re not feeling sick. If you’re older or have a chronic health condition — which makes you more likely to have a severe case of the disease — you might want to stay away from crowded places, and postpone any unnecessary travel.
If you’re a young, healthy person, you might not feel very sick if you catch COVID-19. But if you don’t stay home and away from others, you could pass it on to someone who might get really sick. That’s why it’s so important to stay home.
One of the best ways to slow the spread of an outbreak is by staying away from other people, which is also called “social distancing.” That gives a virus less opportunity to jump from person to person. It’s why there aren’t going to be big events, professional sports, and in some places, school for a while. Those measures help blunt the impact of an outbreak by slowing the virus. If fewer people get sick at once, it’s easier for healthcare providers to give everyone good care.
Should I travel?
To blunt the spread of COIVD-19, everyone should avoid any unnecessary travel. The CDC recommends that older adults, in particular, or anyone who might be more at risk of having a severe case of illness should stay home.
Many countries, including the US, have travel restrictions in place and are placing travelers in quarantine if they’re suspected of having the disease or if they’ve been somewhere it’s spreading widely. Anyone taking a trip internationally should prepare for their plans to be disrupted.
What’s happening in the US?
The virus is spreading through the country, and multiple states and counties have made emergency declarations. Hot spots include Washington state, Louisiana, and New York. It may have been spreading in Washington and other states for weeks before it was first detected.
The US is on pace to have the worst outbreak of any country in the world so far.
As the case counts shoot up, governors and local officials have closed non-essential businesses and told people to work from home and stay away from others. Hospitals in New York City and other places are buckling under the strain of hundreds of critically ill people; they’re running short on protective equipment for nurses and ventilators to help patients breathe.
The virus spread undetected because CDC guidelines originally did not allow testing unless a sick person had been in a country with ongoing spread of the virus or who had been in contact with someone with a confirmed case of the disease could be tested. That delayed the diagnosis of patients who did not have those risk factors. They’ve since updated the guidance to say that doctors can use their best judgement based on a patient’s symptoms and location to decide if the patient should be tested.
Public health experts are struggling to slow the spread of disease because there are still a limited number of tests available. It took too long for the FDA and CDC to develop and distribute a functioning test, and longer still for testing capacity to increase. Thousands of people who think they’re sick still aren’t able to access testing.