Updates on the respiratory illness that has infected tens of thousands of people and killed several thousand.
19 March 11:00 GMT — No new confirmed cases in Hubei province
On 18 March, Hubei, the Chinese province at the centre of the coronavirus outbreak recorded no new cases of COVID-19 for the first time since the beginning of the epidemic, according to the country’s National Health Commission. Eight deaths were reported there that day.
A month ago, Hubei was confronting several thousand new confirmed cases each day. Since December, the province has recorded more than 67,000 people with COVID-19, and more than 3,000 deaths.
Across China, there were 39 new cases recorded on 18 March, and 13 deaths.
Italy now faces the largest number of daily new cases, with 3,526 confirmed yesterday. New cases have also surged in the United States, Iran, Spain, France and Germany.
An employee wearing a face mask disinfects a metro train in Moscow
A train in Moscow is disinfected.Credit: Alexander Nemenov/AFP/Getty
18 March 10:00 GMT — Deaths outside China surpass those inside the country
The total number of people who have died from COVID-19 outside China has overtaken deaths inside the country for the first time since the disease emerged, according to reports by the World Health Organization (WHO) on 16 March. The number of confirmed infections outside China surpassed those inside the country on the same day.
As of 17 March, there were 179,112 confirmed cases of COVID-19 globally, including 81,116 in China. Of the 7,426 deaths from the disease, 3,231 have been in China.
Europe had the largest 24-hour spike in new infections, with 8,507 reported since 16 March, and 428 deaths. Several regions recorded their first cases, including Somalia, Benin, Liberia and the Bahamas.
17 March 00:30 GMT — First vaccine clinical trials begin in the United States
A pharmacist gives a shot to a woman in the first-stage safety study clinical trial of a potential vaccine for the coronavirus
Pharmacist Michael Witte delivers a shot in an early-stage clinical trial for a potential coronavirus vaccine on 16 March.Credit: Ted S Warren/AP/Shutterstock
The first phase I clinical trial for a potential COVID-19 vaccine has begun in Seattle, Washington.
Four adults, the first of 45 eventual participants, received their first doses of an experimental vaccine developed through a partnership between the US National Institute of Allergy and Infectious Diseases (NIAID) and Moderna, a biotechnology company based in Cambridge, Massachusetts. But although it is an important milestone, the phase I trial is just the beginning of a long process to test the drug’s safety and efficacy.
The trial is being conducted at Kaiser Permanente Washington Health Research Institute, and will test a range of doses of the vaccine. Over the next 6 weeks, participants will receive their first doses, followed by a second 28 days later. Follow-up visits both in person and over the phone will assess participants’ health over a 14-month period, and blood samples will help researchers evaluate the body’s immune response to the experimental vaccine.
The potential vaccine is based on messenger RNA, which directs the body to make a protein found on the coronavirus’s outer shell. The hope is that this will elicit an immune response that protects against infection.
What China’s coronavirus response can teach the rest of the world
The team at Moderna had already been working on a vaccine for Middle East respiratory syndrome, which is caused by another coronavirus. The viruses’ similarities helped the researchers pivot to the search for a COVID-19 vaccine.
As a result, the phase I trial was “launched in record speed”, according to a statement from NIAID Director Anthony Fauci on 16 March. It took just 66 days from genetic sequencing of the virus to the first human injection of the vaccine candidate.
Researchers hope to have initial clinical-trial data within three months. But even in the best-case scenario, the vaccine would not be widely available to the public for at least another year, according to NIAID.
13 March 23:00 GMT — US president declares ‘national emergency’
US President Donald Trump called the coronavirus outbreak a national emergency on Friday afternoon. This gives his administration broad authority in its response to the disease, including access to up to US$50 billion in federal funds to combat the epidemic. Trump said that as many as half a million tests would be ready by early next week.
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Earlier in the day, the president announced measures to speed up testing in the United States, including providing funding to develop rapid tests and appointing a new federal coordinator to oversee the efforts.
More than 1,800 people have tested positive for the virus in the United States and at least 41 have died, according to The New York Times. The virus has now been detected in 47 states and the District of Columbia.
13 March 22:10 GMT — Harvard University orders research labs to shut down
Research laboratories at Harvard University in Cambridge, Massachusetts, have been ordered to prepare to shut down research operations amid the growing coronavirus outbreak. Harvard is one of the first major research universities to announce that it will wind down laboratory research. Dozens of universities worldwide have already moved teaching activities online or been closed in a bid to control the spread of the virus.
Despite Harvard’s move, labs there doing direct research on coronavirus will be able to continue their operations, a representative of the university’s medical school told Nature.
All labs must begin implementing a plan to stop all laboratory research activities by 18 March, said e-mails sent from deans to students and staff members in the faculty of arts and sciences and the medical school on 13 March. The suspension is expected to last for at least six to eight weeks, the e-mails say. Labs that work with live animals will be able to designate staff members for essential animal care, but microbial labs have been ordered to “freeze everything down”, says Tanush Jagdish, an evolutionary biologist at the university.
The race to unravel the United States’ biggest coronavirus outbreak
Exemptions will be made for essential experiments that “if discontinued would generate significant financial and data loss”, according to the e-mails.
Jagdish says that the announcement caught everyone in his lab off-guard. “For labs to be shut down in general was something we did not expect.” The labs that he works in had already implemented measures to prevent the spread of the coronavirus disease COVID-19. These included alternating shifts and making cleaning protocols stricter, in addition to extra cleaning that was instituted at the department and university levels. Until lab work can resume, researchers are devoting their time to writing grant proposals and theses, among other remote work, he says.
On 10 March, Harvard had mandated that gatherings of more than 25 people be held remotely, but the latest guidelines state that all meetings and courses should do this, regardless of size. In addition to conducting lab meetings by video chat, people have been discussing starting daily or weekly remote social hours, Jagdish says. “It helps to know that we’re all in this together.”
13 March 22:00 GMT — Europe now centre of pandemic, says WHO
Rome’s Via del Corso from Piazza del Popolo with some soldiers in the evening
Italy on lockdown: Rome’s Via del Corso.Credit: Giuseppe Fama/Pacific Press/LightRocket/Getty
Europe has now become the epicentre of the COVID-19 pandemic, says the World Health Organization (WHO).
More cases are now being reported there every day than were reported at the height of China’s epidemic, director-general Tedros Adhanom Ghebreyesus said in a 13 March press briefing. There are more reported cases and deaths in Europe than in the rest of the world combined, apart from China, Tedros said.
Italy, which has the largest outbreak in Europe, reported 2,651 new cases in the past day.
More than 132,000 cases of COVID-19 have now been reported from 123 countries and territories, according to the WHO.
11 March 16:35 GMT — Coronavirus outbreak is a pandemic, says WHO
After weeks of resisting mounting pressure from scientists, politicians and others, the World Health Organization (WHO) in Geneva, Switzerland, has decided to describe the coronavirus outbreak as a pandemic.
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The declaration comes after a 13-fold rise in the number of cases outside China in the past two weeks, and a trebling of countries affected — but does not change WHO strategy for tackling spread of the virus, director-general Tedros Adhanom Ghebreyesus said in an 11 March press briefing.
“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” said Tedros.
“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this coronavirus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do,” he said. “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.”
Many scientists had been calling for the change in language for weeks — after large outbreaks were detected in South Korea, Iran and Italy. At the time, some researchers suggested that countries would soon move from efforts that involve containing as many new cases as possible to social-distancing measures, such as school closures, that do not rely on knowing who is infected with the virus and who is not.
The virus has now been found in more than 100 countries. It has infected some 120,000 people, killing more than 4,000 of them. Several nations have closed schools in a bid to stop the virus, and Italy has entered an unprecedented countrywide lockdown.
“This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight,” said Tedros.
Researchers have been working rapidly since the outbreak came to light in January to characterize the virus, work out why it is so infectious, find out where it came from and help with diagnosing infections.
11 March 12:30 GMT — Transgenic animals for coronavirus research in high demand
Labs are scrambling to get their hands on transgenic animals that can be used to study the coronavirus and test drugs and vaccines. Ordinary mice seem to be resistant to infection by this coronavirus, so researchers conduct studies in rodents that produce a human version of the protein ACE2, which the virus uses to enter cells.
Labs rush to study coronavirus in transgenic animals — some are in short supply
But these mice — originally developed for research into severe acute respiratory syndrome, or SARS — are in short supply. One US breeding facility, the Jackson Laboratory in Bar Harbor, Maine, has received requests for 3,000 mice, and is now establishing a colony of these animals.
Researchers have also already reported initial results from studies in monkeys infected with coronavirus. The animals seemed to experience only a mild illness, similar to that in many humans. Scientists are now seeking animal models to mimic the more severe version of the illness.
11 March 07:30 GMT — Major chemistry meeting among cancelled scientific conferences
The American Chemical Society (ACS), the world’s largest scientific society, cancelled its meeting in Philadelphia, Pennsylvania, on Monday, 13 days before it was due to begin on 22 March.
The conference is one of a growing number of scientific meetings and conferences being cancelled because of coronavirus outbreaks. Governments and health officials are increasingly calling for the restriction of large gatherings, in an attempt to reduce the virus’s spread.
The ACS said the decision to cancel was based on several factors, including a rise in COVID-19 cases in the greater Philadelphia area and input from members who were increasingly concerned about travelling to and attending a large meeting. About 800 participants had already cancelled their registrations before the announcement, an ACS press officer told Nature.
The American Physical Society’s huge March Meeting was also cancelled last week, about a day before it was due to begin. Scores of other meetings are being postponed or being held virtually.
10 March 03:30 GMT — Call for more funding
At least US$8 billion is needed to address the most pressing threats posed by the new coronavirus, says the Global Preparedness Monitoring Board (GPMB), an independent group co-convened by the World Health Organization and the World Bank Group to combat public-health emergencies.
The money is needed in addition to the tens of billions of dollars already pledged by the International Monetary Fund, the World Bank Group and individual governments.
The GPMB released a report on 9 March calling on advanced economies, such as the members of the Group of Seven and Group of 20 industrialized nations, and financial institutions, to provide money to address five priority areas. These include strengthening weak health-care systems; supporting the World Health Organization’s efforts to help vulnerable countries; developing diagnostics, therapeutics and vaccines; strengthening regional surveillance; and ensuring that sufficient protective equipment is available for health workers.
9 March 04:00 GMT — Global cases pass 100,000
The number of known global cases of COVID-19 passed 100,000 over the weekend. On 8 March, the World Health Organization reported 105,586 confirmed cases across more than 100 countries and territories. Although the outbreak has been slowing in China, where it originated, the country still accounts for almost 80% of confirmed cases.
6 March 11:30 GMT — US Congress approves US$8.3 billion for coronavirus response
The United States Congress has passed an emergency spending bill that will allocate US$8.3 billion for the country’s coronavirus response. The House of Representatives passed the bill in a near-unanimous vote on Wednesday afternoon; the Senate followed suit on Thursday.
The bill will provide more than $3 billion to the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration for research on diagnostics, therapeutics and vaccines. Each US state will reportedly receive at least $4 million for state and local government responses. The bill also includes a provision to ensure that an eventual vaccine is affordable.
Other funding will contribute to the global coronavirus response and provide support for small businesses that are struggling in the wake of the outbreak. The bill will now go to President Donald Trump to be signed.
Elsewhere, the US National Science Foundation in Alexandria, Virginia, opened up a Rapid Response Research funding mechanism for non-medical coronavirus-related research. Such calls are often used to award funding for work exploring the impacts of natural disasters such as hurricanes and wildfires, and allow for an expedited review of research proposals.
5 March 15:30 GMT — China study suggests children are as likely to be infected as adults
Children are just as likely to become infected with the new coronavirus as adults, finds one of the most detailed studies yet published on the spread of the virus, known as SARS-CoV-2. The analysis — based on data from Shenzhen in China — provides a partial answer to one of the most pressing questions surrounding the outbreak: the role of children.
Previous studies have suggested that kids are much less likely than other age groups to develop severe symptoms when infected by the coronavirus. But it was not clear whether this was because they weren’t getting infected or because they were fighting off the infection more effectively.
“Kids are just as likely to get infected and they’re not getting sick,” says Justin Lessler, an infectious-disease epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. He co-led the study with three other epidemiologists — Qifang Bi, also at Johns Hopkins, Ting Ma at the Harbin Institute of Technology in Shenzhen and Tiejian Feng at the Shenzhen Center for Disease Control and Prevention. They posted the analysis to the medRxiv preprint server on 4 March.
The study is unique in that it looked at not only people who were infected with the virus, but also large numbers of their close contacts, some of whom were infected and many of whom were not. The researchers followed 391 people who were diagnosed on the basis of their symptoms, and 1,286 of their close contacts to see whether these contacts tested positive for the virus even if they didn’t show symptoms. Overall, the team found that children under 10 who had potentially been exposed to the virus were just as likely to become infected as other age groups, with between 7% and 8% of contacts of known cases later testing positive.
The authors also found that people who lived in the same household as someone infected with the virus were about six times more likely get infected than those who made contact with an infected person in other settings.
“This may be the first clear evidence that children are as susceptible as adults to SARS-CoV-2 infection,” says Ben Cowling, an infectious-disease epidemiologist at the University of Hong Kong. He wonders whether the fact that outbreaks haven’t been observed in schools could be down to the fact that children’s symptoms are mild.
Lessler says it’s still not clear whether children are important in transmitting the virus, as they are for influenza; children routinely develop flu symptoms and are common hubs in chains of transmission. “That’s one of the current critical remaining questions and we’re trying to figure out how to answer it,” he says. “I have a 7-month-old and a 6-year-old and I can’t imagine that, if they have any virus at all, they’re not getting it on somebody.”
The study could have important implications for slowing the spread of the virus through measures such as school closures. “Once we say containment is not an option, we can’t ignore the kids,” says Lessler.
“This is a key piece of data that may support school closures as an effective intervention,” Caitlin Rivers, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said in a tweet on 5 March.
5 March 12:55 GMT — World Bank pledges US$12 billion for coronavirus response
On 3 March, the World Bank Group pledged up to US$12 billion, including $8 billion in new funding, to support countries dealing with the coronavirus outbreak. The funding will be fast-tracked and consists of grants and low-interest loans, as well as technical support.
Most of the package is earmarked for strengthening health systems and improving access to treatment. The World Bank said it would prioritize funding for countries at high risk and with low capacity to deal with the outbreak. Half of the pledged money is from the International Finance Corporation, and is intended to strengthen global supply chains and support key industries such as pharmaceuticals.
4 March 12:00 GMT — Repurposed drugs in coronavirus spotlight
More than 80 clinical trials launch to test coronavirus treatments
Drugs used to treat HIV and an experimental antiviral drug developed to fight Ebola virus are among those that are rapidly being tested against the new coronavirus. There are no approved treatments for diseases caused by coronaviruses. But hundreds of clinical trials of drug candidates are planned or underway, with much of the focus on remdesivir, a candidate drug originally developed to treat the Ebola virus.
The drug, developed by the pharmaceutical firm Gilead Sciences of Foster City, California, is being tested in partnership with Chinese health authorities in randomized, controlled trials; two of these are set to finish in April. The compound works by trying to prevent the replication of the virus. “Remdesivir has quite high efficacy across all different coronaviruses and therefore it is one of the prime candidates to start being tested,” says Vincent Munster, chief of the viral ecology unit at the US National Institutes of Health.
2 March 21:00 GMT — Infections worldwide top 90,000
The number of people worldwide who have been infected with the coronavirus has passed 90,000. More than 3,000 have died since the outbreak began in December. The vast majority of cases — more than 80,000 — have occurred in China, but around 60 other countries are now also dealing with outbreaks. Many nations are preparing for a global pandemic, as reports of cases caused by spread within communities — rather than being imported from China — rise.
South Korea, Italy and Iran are fighting the largest outbreaks outside China.
Rapid spread. A line chart showing coronavirus case numbers in China and other countries from 20 Jan to 3 March.
Source: Johns Hopkins University
2 March 20:45 GMT — WHO raises alert to ‘very high’
At a press briefing on 29 February, the World Health Organization (WHO) announced that it had raised the global alert for COVID-19 to the highest possible level, short of calling it a pandemic. The virus has now spread to some 60 locations outside China, with new cases detected in Ireland, Monaco, Azerbaijan, Qatar and Ecuador.
The global alert for the spread and impact of the coronavirus outbreak increased from ‘high’ to ‘very high’. The alert remains ‘very high’ in China.
The global change was based on an assessment by WHO epidemiologists, which took into account the continued increase in the number of cases and affected locations, and the difficulties that some regions, including Iran and Italy, are facing in containing the spread of the coronavirus.
Tedros Adhanom Ghebreyesus, director-general of the WHO, said at the briefing that most cases were linked and could still be traced to known contacts or clusters, with no evidence of the virus spreading freely in communities. “As long as that is the case, we still have a chance of containing this virus, if robust action is taken to detect cases early, isolate and care for patients and trace contacts,” said Tedros.
The organization therefore once again resisted declaring the outbreak a pandemic. Mike Ryan, director of the WHO’s emergencies programme, said that such a decision would mean that efforts to contain and slow down the spread of the virus have failed, which has proved to be untrue in China, Singapore and other regions.
The WHO is still holding out hope that the virus can be contained, but we have probably crossed that threshold, says Adam Kamradt-Scott, a global health-security researcher at the University of Sydney, Australia.
Some countries have already begun to prepare their pandemic plans, which is an important precautionary measure, says Nigel McMillan, an infectious-disease researcher at Griffith University in Brisbane. Australia, for example, initiated its coronavirus emergency response on 27 February. The WHO is being overly cautious in not declaring a pandemic, says McMillan.
2 March 20:30 GMT — Transmission details emerge from WHO China analysis
China has mounted “perhaps the most ambitious, agile and aggressive disease containment effort in history” against a new infectious disease, the World Health Organization (WHO) said in a report released on 28 February, after nine days of meetings and site visits in China from 16 to 24 February. The report analyses data from the outbreak in China, and recommends steps that the country and others should take to curb COVID-19.
Daily reports of new cases are declining in the country, the WHO confirmed — so much so that authorities are now having problems recruiting participants for the more than 80 clinical trials there that are testing potential treatments for the coronavirus. Some experimental treatments should be prioritized over others, the health agency recommended.
The report’s analysis of data from China finds 99.9% similarity between the 104 strains of the coronavirus, named SARS-CoV-2, collected from people between December 2019 and mid-February 2020. This means that the virus is not mutating significantly. The median age of people infected is 51 years. And most cases of spread from person to person have been in hospitals, prisons or households, which implies that close contact is often required for the virus to spread between people. Airborne spread is not believed to be a major driver of transmission, the report says. In one preliminary study from the province of Guangdong, people in the same household as someone with COVID-19 had a 3–10% chance of being infected.
The WHO credits China’s ability to rein in the epidemic to a variety of measures. One is that 1,800 teams of epidemiologists have rapidly tracked tens of thousands of contacts of people infected with the virus in Hubei province, where the outbreak emerged. Up to 5% of these contacts ended up having the disease and were diagnosed quickly. And the report says the lockdown on travel out of Hubei — an unprecedented measure in a province of this size — curbed wider spread of the disease to China’s 1.4 billion citizens.
2 March 17:45 GMT — Coronavirus fears cancel huge physics meeting
Senior Nature reporter Davide Castelvecchi reports from Denver, Colorado, where the world’s biggest physics meeting has been cancelled because of coronavirus fears.
The meeting was scheduled to host 11,000 attendees. Some researchers are finding other ways to share their work, including informal meet-ups and virtual talks.
Several other scientific meetings have also been cancelled, as virus outbreaks emerge and escalate in countries around the world.
28 February 12:45 GMT — Coronavirus spreads to sub-Saharan Africa
The coronavirus outbreak has spread to 46 countries other than China — and now seems to be spreading faster outside China than inside.
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Several nations reported their first infections this week; cases included the first to be confirmed in sub-Saharan Africa, in Nigeria. The Nigeria Centre for Disease Control reported the case on 27 February and said it was working to trace the infected person’s contacts. Health authorities and researchers have feared the virus’s spread to African countries including Nigeria, where weak health systems could quickly be overwhelmed by a local outbreak.
The World Health Organization reports that more than 82,000 people worldwide have now been infected — more than 3,600 of those outside China. Cases in South Korea, which is handling the world’s second-largest outbreak, have exploded to more than 2,300.
China’s outbreak seems to be slowing, with the daily number of new cases dropping. Authorities reported 327 new infections nationwide on 27 February. A week earlier, on 20 February, that figure had been around 900. Outside China, about 750 new cases were reported on 27 February.
26 February 18:30 GMT — Brazil reports first case in South America
A case of COVID-19 has been confirmed in Brazil — the first in South America. On 26 February, Brazil’s minister of health, Luiz Henrique Mandetta, confirmed that a man who travelled to northern Italy between 9 and 21 February has the disease. Italy’s outbreak has escalated to 324 cases and 12 deaths, according to a virus tracker maintained by Johns Hopkins University in Baltimore, Maryland.
The Brazilian case is in a 61-year-old man who sought care for a fever, cough and sore throat yesterday at a hospital in São Paulo, where he tested positive for COVID-19. Officials say he is in stable condition and will be quarantined at home for 14 days. “We should only take those with severe respiratory conditions to the hospital,” said Mandetta in a tweet.
Algeria, Greece, Afghanistan, Bahrain, Iraq and Oman have all reported their first cases within the past two days. The virus’s appearance in South America now means that it has spread to every continent except Antarctica.
25 February 22:30 GMT — Trump requests emergency funding for coronavirus response
The administration of President Donald Trump has requested up to US$2.5 billion to fund the US response to COVID-19. In a 24 February letter to Congress, the Office of Management and Budget requested $1.25 billion in new funding and proposed to make up the rest by repurposing funds allocated to other programmes, including $535 million assigned to the Ebola response.
Time to use the p-word? Coronavirus enters dangerous new phase
Democratic legislators immediately criticized the requested sum as overdue and insufficient. The US government has allocated several times that figure for past outbreak responses: Congress approved about $5.4 billion for the 2014 Ebola outbreak, and in 2009 about $7.7 billion was directed to the H1N1 influenza pandemic response.
Public-health policy analysts expect the government to make some funds available, but it’s unclear how much will be appropriated, and how soon. “My expectation is that something will eventually be passed,” says Josh Michaud, a public-health policy analyst at the Kaiser Family Foundation, a non-profit organization in Washington DC. “What eventual form that is and whether it conforms to the risk that coronavirus poses is another question.”
25 February 21:00 GMT — Researchers anticipate unstoppable spread
Despite the World Health Organization’s decision not to describe the escalating coronavirus outbreak as a pandemic, some scientists say that the spread is already moving into a new, dangerous phase. They say measures to limit spread will have to shift from containment to mitigation, as countries including Iran, Italy and South Korea report growing outbreaks with hundreds of infections.
25 February 18:30 GMT — ‘There is lots of anxiety’: a scientist’s view from South Korea
Chemist Bartosz Grzybowski discusses his experiences in South Korea in the midst of the coronavirus outbreak.
Bartosz Grybowski is a crystal chemist in South Korea, where cases of the coronavirus have surged.
Crystal chemist Bartosz Grzybowski talks to the Nature Podcast’s Nick Howe about how the surging outbreak in South Korea is affecting daily life as a researcher. Grzybowski is at the Ulsan National Institute of Science and Technology, about 60 kilometres from the city of Daegu, where most of the country’s coronavirus cases have occurred. He says panic and fear reign — but the nation seems well prepared.
24 February 16:30 GMT — WHO says outbreak isn’t a pandemic
At a press briefing on 24 February, the World Health Organization (WHO) said that, despite the spread of the disease, the coronavirus outbreak does not yet amount to a pandemic. “Using the word pandemic now does not fit the facts, but it may cause fear,” said WHO director-general Tedros Adhanom Ghebreyesus.
“For the moment, we are not witnessing the uncontained global spread of this coronavirus, and we are not witnessing large-scale severe disease or death,” said Tedros. “Does this virus have pandemic potential? Absolutely. Are we there yet? From our assessment, not yet.”
Mike Ryan, director of the WHO’s emergencies programme, justified the organization’s position by explaining that the virus’s transmission remains poorly understood — and it seems that the rate of new infections is declining in China. He advised countries to focus on treating patients and reducing the chance of people spreading the virus to others.
24 February 14:00 GMT — Cases outside China are rising
The number of cases of COVID-19 outside China jumped over the weekend, with Italy, South Korea and Iran reporting new infections. Kuwait, Bahrain, Afghanistan and Iraq also confirmed their first cases on 24 February.
Coronavirus: hospitals must learn from past pandemics
Officials in Iran have reported up to 61 cases and 12 deaths. But the figures have been in flux, and case numbers will probably rise in the coming days, given that the number of deaths compared to overall cases is much higher than reported in other countries.
South Korea had confirmed 833 infections and 8 deaths as of 24 February, according to a virus tracker maintained by researchers at Johns Hopkins University in Baltimore, Maryland.
The virus is also spreading in Italy, where 230 people have been infected and 5 have died, according to the tracker.
At a meeting organized by the African Union on 22 February, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said he was especially worried about the rise in cases in Iran, South Korea and Italy. “The increasing signs of transmission outside China show that the window of opportunity we have for containing this virus is narrowing,” he said.
Meanwhile, more than 77,000 people have been infected in China, and the death toll there has passed 2,500.
20 February 13:30 GMT — Coronavirus death toll passes 2,000
More than 2,100 people worldwide have now died from COVID-19, the disease caused by the new coronavirus. On 20 February, Chinese authorities reported that 2,118 people there had died from the illness. Infections worldwide have topped 75,000; more than 74,000 are in China.
20 February 13:00 GMT — China’s case-counting methods raise concerns
Scientists have questioned the way in which China is counting cases of the coronavirus. China’s official reports on the number of infections have not been including people who have tested positive for the virus but have no symptoms. Researchers fear the practice is masking the epidemic’s true scale — but some public-health experts say China is right to prioritize tracking ill people who are spreading the disease.
Medical staff members working at a computer in an exhibition centre converted into a hospital in Wuhan, China
Medical staff working in an exhibition centre converted into a hospital in Wuhan, ChinaCredit: AFP/Getty
18 February 11:00 GMT — Has the outbreak in China peaked?
A study of nearly 45,000 confirmed COVID-19 cases in China suggests that the outbreak might already have reached its climax. The report, from the country’s Center for Disease Control and Prevention, says that the peak — the day with the highest number of new infections — occurred around the end of January. The number of new laboratory-confirmed cases per day declined from then to 11 February, the end of the study period. However, the number of new suspected cases and cases diagnosed by physicians using chest scans, known as clinically diagnosed cases, stayed at roughly the same levels.
Keep up to date, with Nature Briefing
The latest data on coronavirus infections in China appear to show a decline in new cases, said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), at a press briefing on 17 February, the same day the Chinese report was released. But he said the trend must be interpreted cautiously. “It’s too early to tell if this new reported decline will continue,” he said. “Every scenario is still on the table.”
Raina MacIntyre, a physician and epidemiologist at the University of New South Wales in Sydney, Australia, agrees that the data need to be considered with caution, but says the general trends are informative. The WHO’s reports also show a decline in new cases reported per day in China and worldwide, she says.
But the extended Chinese holiday period that ended on 9 February means there might be another increase in new cases around 21 February, as people return to work. “Often with epidemics we see more than one peak,” says MacIntyre.
Epidemiologists have been trying to estimate roughly when the outbreak will peak, so public-health officials can prepare hospitals and work out when it will be safe to lift travel restrictions in Wuhan and several nearby cities.
Some models suggest that the climax will happen any time now. Others say that it is months away and that the virus will infect millions — or, in one estimate, hundreds of millions — of people before then. This model assumes that many more people have been infected than is reflected by official counts, but that these people have no symptoms or are not ill enough to seek medical treatment.
Scanning electron microscope image shows SARS-CoV-2.
The coronavirus SARS-CoV-2, shown in a scanning-electron-microscope image.Credit: NIAID-RML/de Wit/Fischer
17 February 00:30 GMT — First case in Africa detected
The first case of the new coronavirus has been reported in Africa — in a person in Egypt. The country’s health ministry and the World Health Organization said on 15 February that the case had been detected as a result of Egypt’s programme to trace visitors who had come from affected countries. The person tested positive for the virus but had no symptoms. They are currently being isolated and are in a stable condition.
Scientists fear coronavirus spread in countries least able to contain it
Researchers have been apprehensive about the virus arriving in Africa, and about its potential to spread there. Vittoria Colizza, who models infectious diseases at the Pierre Louis Institute of Epidemiology and Public Health in Paris, told Nature that she’s most concerned about seven African nations that have a moderate risk of importing the virus, but whose weak health-care systems, low economic status or unstable political situation make them highly vulnerable. These countries are Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya.
Transmission electron microscope image shows SARS-CoV-2.
Electron-microscope image of the new coronavirus, now designated SARS-CoV-2.Credit: NIAID-RML/de Wit/Fischer
14 February 14:00 GMT — Chinese cases spike after diagnosis change
A sudden spike in new coronavirus cases reported in China this week shocked some researchers. But the huge bump in numbers isn’t a sign that the epidemic is worsening, say others; it is instead the result of authorities changing how cases are confirmed.
On 12 February, Hubei province reported nearly 15,000 new cases of COVID-19, the disease caused by the coronavirus, representing a 33% jump in total infections worldwide in a single day. Total infections in China now number around 64,000, with more than 1,300 deaths.
But most of the Hubei cases — about 13,000 — have been reported as a result of a new policy that means physicians in the province can diagnose suspected cases of COVID-19 on the basis of chest scans, rather than having to wait for genetic tests to confirm the presence of the virus, which can take days.
The policy was established in response to pleas from doctors who are overwhelmed by patients with respiratory diseases, and don’t have time to wait for lab results, says Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, who helped design and implement the policy. “The clinicians in Hubei made a very strong request to modify the criteria because of their heavy workload,” he says. Now they can care for people more quickly and ensure they are properly isolated to protect others, says Wu. “We need to save lives.”
The policy makes sense from a medical point of view, says Michael Mina, an infectious-disease immunologist and epidemiologist at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. “Triaging based on symptomatic evaluation and physical exam is the bedrock of hospital-based and clinical triage,” he says.
The new diagnosis method was listed in updated disease-reporting guidelines issued last week. It applies only to Hubei, where the virus originated in the city of Wuhan. Wu says that other provinces aren’t as overwhelmed with cases so will still need to confirm suspected cases with genetic tests or lab cultures of the virus taken from patients.
The Chinese state media outlet Xinhua urged calm after the spike was reported. “Although the figures rose, it does not mean that the epidemic in Wuhan has deepened,” it said.
On 14 February, Chinese authorities revealed for the first time the number of infections in medical staff. They said 1,716 health workers had contracted the virus, 6 of whom had died.
13 February 12:15 GMT — Chinese virologists raise concerns about virus name
Some researchers in China are unhappy with the designated name for the new coronavirus, SARS-CoV-2. They worry that the use of ‘SARS-CoV’ will confuse the public and impede efforts to control the pathogen’s spread.