On December 31, 2019, the World Health Organisation’s (WHO) China office heard the first reports of a previously-unknown virus behind a number of pneumonia cases in Wuhan, a city in Eastern China with a population of over 11 million.
What started as an epidemic mainly limited to China has now become a truly global pandemic. There have now been over 5,595,091 confirmed cases and 350,547 deaths, according the John Hopkins University Covid-19 dashboard, which collates information from national and international health authorities. The disease has been detected in more than 200 countries and territories, with the US, Brazil and Russia experiencing the most widespread outbreaks, followed by the UK, Spain and Italy. In the UK, there have been 265,227 confirmed cases and 37,048 deaths as of May 26. The true number of infections and deaths is likely to be considerably higher.
The Chinese government responded to the initial outbreak by placing Wuhan and nearby cities under a de-facto quarantine encompassing roughly 50 million people in Hubei province. This quarantine is now slowly being lifted, as authorities watch to see whether cases will rise again. The US is now the new epicentre of the Covid-19 outbreak. As of May 27, the country has 1,681,418 confirmed infections and 98,929 deaths. In Italy, where the death toll surpassed that of China on March 19, the government took the unprecedented step of extending a lockdown to the entire country, shutting cinemas, theatres, gyms, discos and pubs and banning funerals and weddings. In the UK, the government has shut schools, pubs, restaurants, bars, cafés and all non-essential shops for at least nine weeks. On May 10 Boris Johnson outlined a flexible plan that would see some schools reopen by June depending on the current threat posed to the UK by the virus.
On March 23, prime minister Boris Johnson put the UK under lockdown saying that police will now have the power to fine people who gather in groups of more than two or who are outside for non-essential reasons. People with the main coronavirus symptoms – a fever or dry cough – are required to stay at home for seven days while households in which at least one person is displaying symptoms should quarantine themselves for 14 days. Four days later the prime minister and health secretary Matt Hancock both tested positive for the virus – Johnson spent three nights in intensive care and then stayed at the prime minister's country residence, Chequers to recover. He returned to work at Downing Street on the morning of April 27.
On March 11 the WHO officially declared the Covid-19 outbreak a pandemic. "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 its director-general Tedros Adhanom Ghebreyesus. Although the WHO designated Covid-19 a "public health emergency of international concern" (PHEIC) on January 30, it had been reluctant to call it a pandemic. "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," Adhanom said.
A quick note on naming. Although popularly referred to as coronavirus, on February 11, the WHO announced the official name of the disease: Covid-19. The virus that causes that disease is called Severe Acute Respiratory Syndrome Coronavirus 2, or Sars-CoV-2 for short.
How did Covid-19 start?
The disease appears to have originated from a Wuhan seafood market where wild animals, including marmots, birds, rabbits, bats and snakes, are traded illegally. Coronaviruses are known to jump from animals to humans, so it’s thought that the first people infected with the disease – a group primarily made up of stallholders from the seafood market – contracted it from contact with animals.
The hunt for the animal source of Covid-19 is still unknown, although there are some strong contenders. A team of virologists at the Wuhan Institute for Virology released a detailed paper showing that the new coronaviruses' genetic makeup is 96 per cent identical to that of a coronavirus found in bats, while a study published on March 26 argues that genetic sequences of coronavirus in pangolins are between 88.5 and 92.4 per cent similar to the human virus. Some early cases of Covid-19, however, appear to have inflicted people with no link to the Wuhan market at all, suggesting that the initial route of human infection may pre-date the market cases.
The Wuhan market was shut down for inspection and cleaning on January 1, but by then it appears that Covid-19 was already starting to spread beyond the market itself. On January 21, the WHO Western Pacific office said the disease was also being transmitted between humans – evidence of which is apparent after medical staff became infected with the virus.
What exactly is Covid-19?
Coronaviruses are a large group of viruses that are known to infect both humans and animals, and in humans cause respiratory illness that range from common colds to much more serious infections. The most well-known case of a coronavirus epidemic was Severe Acute Respiratory Syndrome (Sars), which, after first being detected in southern China in 2002, went on to affect 26 countries and resulted in more than 8,000 cases and 774 deaths.
While the cause of the current outbreak was initially unknown, on January 7 Chinese health authorities identified that it was caused by to a strain of coronavirus that hadn’t been encountered in humans before. Five days later the Chinese government shared the genetic sequence of the virus so that other countries could develop their own diagnostic kits. That virus is now called Sars-CoV-2.
Although symptoms of coronaviruses are often mild – the most common symptoms are a fever and dry cough – in some cases they lead to more serious respiratory tract illness including pneumonia and bronchitis. These can be particularly dangerous in older patients, or people who have existing health conditions, and this appears to be the case with Covid-19. A study of 44,415 early Chinese Covid-19 patients found that 81 per cent of people with confirmed infections experienced only mild symptoms. Of the remaining cases, 14 per cent were in a severe condition while five per cent of people were critical cases, suffering from respiratory failure, septic shock or multiple organ failure. In the Chinese study, 2.3 per cent of all confirmed cases died, although the actual death rate is probably much lower as many more people will have been infected with the virus than tested positive.
How far has it spread?
China felt the initial brunt of the Covid-19 epidemic. At the peak of its outbreak in mid-February, the country saw more than 5,000 cases in a single day. As of May 27, Chinese health authorities had acknowledged over 84,103 cases and 4,638 deaths – most of them within the province of Hubei. Since March, however, the country has seen a remarkable slowdown. On March 17, China recorded just 39 new cases of the virus. Most of the country's new cases are imported from elsewhere in the world – for now at least, it appears that China has its outbreak under control.
But while things were slowing down in China, the outbreak started picking up in the rest of the world. There are now confirmed cases in at least 200 countries and territories. The US has seen the highest number of cases. The country – which has been criticised for its slow rollout of testing and confused approach to the crisis – now has 1,681,418 confirmed infections and 98,929 deaths. With 370,680 confirmed cases and 3,807 deaths, Russia's mortality rate appears to be particularly low. The true death toll may be underreported because the country's statistics only include the deaths of people directly attributed to Covid-19.
After the UK, Italy has seen the highest number of deaths in Europe, with 32,955 deaths and 230,555 confirmed infections, mostly in the north of the country. The country has had the longest-running lockdown of any country and on May 4 started to ease its restrictions for the first time after nine weeks.
Spain is also in the grip of a significant outbreak. The country has 236,259 confirmed infections and 27,117 deaths. There, citizens are under lockdown, with the government shutting all schools, bars, restaurants and non-essential supermarkets down. People are only allowed to leave their homes to buy food or to go to work. Germany has 181,200 confirmed cases and 8,386 deaths, a rate lower than many other European countries. Social distancing rules stayed in place until May 4, but the country is slowly relaxing its requirements with shops and schools starting to re-open their doors. Austria, which has 16,557 confirmed cases and 643 deaths was the first European country to partially lift its lockdown on April 14.
While the number of new cases continues to rise sharply, people are also recovering from the infection. Globally, 2,288,965 people have recovered from Covid-19 – about 41 per cent of all of the people who had confirmed infections, although the true number of coronavirus cases will be much higher.
What's the latest in the UK?
As of May 26, the UK has reported 265,227 confirmed Covid-19 infections and 37,048 deaths – the highest death toll in Europe. In total, 2,064,329 people have been tested for the disease. On March 16, prime minister Boris Johnson led the first daily coronavirus press conference, saying that the government now advised all UK residents to avoid non-essential social contact and travel where possible. On Friday March 20 this was extended to include a shutdown of all bars, pubs, cafés and restaurants in the UK. From the same day all schools in England, Scotland and Wales were shut until further notice. Only vulnerable children, or those who are the sons and daughters of employees in the NHS or other key industries, will be permitted to remain at school. Transport for London is currently running a reduced tube, bus and rail service meant only for key workers and has seen an 80 per cent reduction in passenger numbers since February 27.
On March 23 – after a weekend where many seemed to flout the social distancing recommendations – the prime minister announced a ratcheting-up of the UK's coronavirus policies. Now, people are only allowed to leave their homes for essential work, for food or medical supplies, to care for a vulnerable person or to exercise. Police will have the ability to fine those who do not comply with the new rules, the prime minister said in his address to the nation. The government also asked UK mobile networks to send a message to everyone in the UK instructing them that they must stay at home.
People who currently live alone are recommended to self-isolate for seven days if they develop a fever or persistent dry cough – the two most common symptoms of coronavirus. For families and other people who live together, the advice is that the entire household should self-isolate if any member develops either of those symptoms. This strategy is part of the government's 'delay phase' plan to flatten the peak of the virus and reduce the burden on the NHS.
A key part of this plan is shielding those who are most vulnerable to Covid-19: people older than 70, or those who have underlying health conditions. The NHS has identified the 1.5 million people most vulnerable and sent them letters instructing them to self-isolate for 12 weeks. These people are being asked not to leave their houses under any circumstances, to minimise all face-to-face contact and for all deliveries of food and medication to be left at their doorsteps.
Although the prime minister said that this shielding may last as long as 12 weeks in order to ensure that the peak of the outbreak has passed, modelling from Imperial College London suggests that these measures may have to be in place for as long as 18 months. On May 10 prime minister Boris Johnson announced that the UK lockdown would be in place until at least June when some shops and schools will be allowed to re-open.
Despite these measures, some have been critical that the government's stance doesn't go far enough. Italy and Spain both had in place even more restrictive lockdowns, while South Korea has rolled-out extremely comprehensive testing for many of its population. The government has also been ramping up antibody tests which should eventually be able to detect who has been previously exposed to the virus, although there are serious doubts over the accuracy of the currently available tests. The first 1,000 samples suggest 17 per cent of adults in London and around 5 per cent across England have coronavirus antibodies.
What are the symptoms of Covid-19?
Covid-19 shares many of its symptoms with the flu or common cold, although there are certain symptoms common to flu and colds that are not usually seen in Covid-19. People with confirmed cases of Covid-19 rarely suffer from a runny nose, for instance.
The most common Covid-19 symptoms are a fever and a dry cough. Of 55,924 early Chinese cases of the disease, nearly 90 per cent of patients experienced a fever and just over two-thirds suffered with a dry cough. That’s why the UK government is advising anyone with a high temperature or a new, continuous cough to stay at home for seven days or, if they live with other people, for the entire household to isolate for 14 days from the first onset of symptoms.
Other Covid-19 symptoms are less common. Just under 40 per cent of people with the disease experience fatigue, while a third of people cough up sputum – a thick mucus from within the lungs. Other rarer symptoms include shortness of breath, muscle pain, sore throats, headaches or chills, loss of smell or taste. According to the WHO, symptoms tend to appear between five and six days after infection.
What’s happening with a vaccine?
A vaccine for Covid-19 isn’t around the corner. Bringing vaccines to the market is a notoriously slow process and any potential vaccine will have to pass multiple stages of testing for safety and effectiveness. And once we know a vaccine is safe, we will also need to manufacture it at a scale high enough to use across the world. It’s likely that any vaccine is around 18 months away.
That said, there is lots of work being done to develop a vaccine for Covid-19. The pharmaceutical firm Sanofi is trying to build on its already-approved flu vaccine and turn it into something suitable to treat Covid-19. Other approaches – such as one being trialled by the University of Oxford – are focusing on the external spike proteins on the Covid-19 virus as a way to target vaccines.
But accelerating these efforts will require funding. The Coalition for Epidemic Preparedness Innovations (CEPI) has called for $2 billion in funding to support the development of new coronavirus vaccines.
What will happen next?
As the number of daily infections and deaths has plateaued in many places, European countries are taking tentative steps to ease their lockdown measures with varying approaches.
Italy's daily coronavirus death toll is at its lowest since March 14 and since May 4, citizens are allowed to visit their relatives in small numbers. Factories and construction sites are allowed to reopen, but schools will remain closed until September. From June 3, the country will also be welcoming tourists back in the country. In Spain, citizens are allowed to exercise and walk outdoors, and since May 25, restaurants, bars, shopping malls, museums, and places of worship are starting to re-open at 30 to 50 per cent capacity. Borders will remain closed to foreign tourists until July.
The UK will remain on lockdown until at least June 1, however, prime minister Boris Johnson announced on May 10 that construction and manufacturing workers in England should start returning to work. If the reproduction number remains below 1, he said, the country might be in a position to begin the phased re-opening of shops and get primary pupils back into schools in June. Some cafes and restaurants with outdoor space, places of worship, theatres and cinemas might open their doors again from July with extra hygiene and social distancing measures.
In order to prevent a deadly second wave of infections, the UK and its European neighbours are ramping up testing in the wider community. The UK Department of Health and Social Care will contact 20,000 households in England and invite them to take part in an initial study to track coronavirus transmission. All participants will receive a nose and throat swab to test for whether or not they currently have the virus and adults in some 1,000 of the households will provide monthly blood samples to find out what proportion of the population has developed antibodies to Covid-19. The study is set to be extended to 300,000 people over the next 12 months.
Work on contact tracing apps is also underway in the UK. But unlike in countries like South Korea and China, which use a combination of CCTV, credit card data and geolocation information, the UK's app will rely on the short-range wireless technology Bluetooth to trace people's location. The idea is that when a person has crossed paths with someone who has tested positive for coronavirus, the app can be instantly alert them and let them request a test.
Matt Reynolds is WIRED's science editor. He tweets from @mattsreynolds1
Updated 27.05.20, 09:30 BST: The article has been updated to reflect the latest figures about the spread of Covid-19. The original version of the article was published at 11:30 GMT on January 23, 2020.
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