Epidemiology of corona virus in the world and its effect on economy in china

THE CHINA ECONOMY
Dr.Naushad Khan

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EPIDEMIOLOGY OF CORONA VIRUS IN THE WORLD AND ITS EFFECTS ON

Email:-
Shah Faisal

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Institute of Development Studies, The University of Agriculture Peshawar

Student of B.Sc Hons Agriculture, The University of Agriculture Peshawar

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ABSTRACT

The study was carried out since 3, March, 2020. The major objective was that to see the epidemiology of
corona virus in the world and its effects on the China economy. Secondary data was used and total 15 articles

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were downloaded from the net and read again and again and draw the conclusion about epidemiology of the
corona virus in the world and checked its effects on China economy. The result indicates that the virus was
spread from the Hunan Sea food market China and then spread to the whole world slowly gradually which
reached to majority world countries and have created panic in the whole world. Every country of the world

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now try how to control the situation but the main epicenter is the China City Wuhan province Hoebi. The
China government have sealed the boundaries of this city and no one has right to cross the boundaries of this

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city in China. They all are locked in the homes for protection purpose and China all Health departments are
engaged in health services to infected community of the country. Majority Health servants have been
affected by this virus but the people of the health services try how to control the situation. The trend is now

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on the declined while new cases were also appeared day by day but the nation is struggling for its control
measures. WHO experts involved in China how to control this epidemic disease which have destroy the
whole world. All schools and colleges have been closed and there is a ban on all social activities in the

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country. No factory was run for the purpose of production and all airports of the country have been sealed
while all outsiders have been banned for entering into China. The China country is in a position of hustle and
bustle. All developmental programs of the country have been closed for further activates of development.

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Due this panic the country inflation rate of the goods are very high which reached to 50%. The growth of the
economy is also on the declined at 2% which was 6% in the past. China is the big country of the world and
this country economy is linked with all world countries economy. Through this way all world economy is in
a trouble because they have sealed their airports and no one have right to come from China or someone go to

This preprint research paper has not been peer reviewed. Electronic copy available at: />

China. Similarly the virus reached to every corner of the world and indifferent countries the trend is

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different of the infected people. The number of South Korea infected person is seconded in the world and
followed by Iran, Japan, United State, Thailand, Denmark, Ireland etc. These countries have great traded
activities with the china and because of this those countries have been highly affected by this virus. Majority
hypertension, diabetes infected people were died by this virus. Still no vaccine was discovered for its control
and it is reported that the world scientist are busy in vaccine discovery and it is the possibility that in one
year the vaccine will be discovered. No proper treatment in the world have been identified for this virus
controlling but the infected people only are kept in hospital and only first aid applied to them and the people

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who immunity power is high who very easily recovered from the virus. The study further explain that the
virus sever attack is on the old people whose age is above 80 while below 9-15 years infection is less than
the other age people. Through social contact this virus transmitted to other people in the study area. People

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mostly wear the facemask and plastic cloth for its protection. Similarly the virus was carried out by traveling
from one country to another. It was also found that the transmitting source is the Hoebi Province and Wuhan
City in the world. The study further clarified that the whole world is in the panic and everyone try how to
control the situation. On the basis of problems the study recommend that all airports of the world should be

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closed and entry from one country to other country should be banned; Plastic clothe and facemask should be
wore for its transition from one person to another; Food items should be checked by food inspector; All
boundaries of all countries of the world should be sealed; Test laboratories of corona virus should be
multiplied in the world; All countries of the world should be helped of one another in this panic and terror

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time, World scientist should try for discovery of vaccine; More funds should be provided to china and also
provided good Doctors by WHO for this problem solution; Help mostly on humanitarian basses; Keep the

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infected person in warm room and should be treated well; Always wear the facemask and plastic cloths when
contact to infected persons in the hospital; Through air craft, food and medicine should be provided to
affected country of the world for food and medicine crisis’s; All countries of the world population virus test

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is requested for its best control.

Epidemiology, Corona Virus, World, Economy, China

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Key Words:-

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1. INTRODUCTION
The distribution of virus from one place to other is called epidemiology. Through social contact the
virus transfer from one person to other and create the panic which in the long run affect the economy
of the country. The transformation of virus was started from the see food market Wuhan city province

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Hoebi. All virus of the world directly link with this city and there majority people have been died

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which covered 81 percent of the whole number of death in the country. In the start the rumor was
spread by Dr.Li who give this message on the E chat while administration of the country have
claimed rumor against the country while latter on 20 January 2020 the message was advertised by
media that a new virus as like SARS was identified by Doctor which have kill so many person in the
Wuhan city province Hoebi. The message reached to each corner of the world and a panic was raised
by world community. Large number of death was announced by media in the Wuhan city. When the
number increase more then the WHO declared emergency in the world. The panic in other countries

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of the world was not huge but latter on the number of the infected person in other countries of the
world were also increased. Among these countries South Korea, Japan, Iran, Saudi Arabia,
Afghanistan, United State, Ireland, Afghanistan, Pakistan, India, Russia, Kuwait, Qatar, Arab

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Emirate, France were top countries of the world. Where also this virus was spread and infect many

person in these countries. The number in South Korea was greater than the other countries of the
world which followed by Iran and two ship where large number of person were affected in these ship
which is still stay on their own places try. The problem is now very dangerous and number of affectee

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day by day increasing in different countries of the world. So its good solution is required. The world
scientist day and night work for vaccine discovery while still no vaccine has been discovered by any
scientist. The problem of the China is on the decline but other countries of the world panic day by
day increasing. So now it is the duty of the UNO to try for its solution. This panic has been disturbed

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the economy of the world as well as the China. All business in China is closed. All countries entry is
banned in China. All factories are closed and the export and import both are highly affected. The

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China mostly imported the oil from oil countries. So now to this panic the import has been closed and
it is a very great threat to the world economy. Not only China economy have been highly affected
while the economy of all world countries have been negatively affected by this panic which have

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been started from the China Wuhan City province Hoebi. Seeing to its importance the present study
was arranged to examine the epidemiology of corona virus in the world and its impact on the China

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economy .

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2. METHODS AND MATERIAL

The Universe of the study was the whole world and China. Total 15 articles were downloaded
from the net and read in depth and draw the conclusion according to the objectives of the study
All articles were read again and again and analyzed the situation about the whole world and

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effect is fell on the economy of China.

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China economy to what extent Corona virus have been distributed in the world and what type

3. REVIEW OF ARTICLES ABOUT CORONA VIRUS EPIDEMOLOGY AND
ITS EFFECT ON CHINA ECONOMY

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a. Cohen and Kupferschmidt (25th Feb, 2020) reported that global march of COVID-19 is beginning
to look unstoppable. In just the past week, a countrywide outbreak surfaced in Iran, spawning
additional cases in Iraq, Oman, and Bahrain. Italy put 10 towns in the north on lockdown after the

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virus rapidly spread there. An Italian physician carried the virus to the Spanish island of Tenerife,
a popular holiday spot for northern Europeans, and Austria and Croatia reported their first cases.
Meanwhile, South Korea’s outbreak kept growing explosively and Japan reported additional
cases in the wake of the botched quarantine of a cruise ship. The virus may be spreading stealthily

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in many more places. A modeling group at Imperial College London has estimated that about
two-thirds of the cases exported from China have yet to be detected. The World Health
Organization (WHO) still avoided using the word “pandemic” to describe the burgeoning crisis
today, instead talking about “epidemics in different parts of the world.” But many scientists say

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that regardless of what it’s called, the window for containment is now almost certainly shut. “It
looks to me like this virus really has escaped from China and is being transmitted quite widely,”

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says Christopher Dye, an epidemiologist at the University of Oxford. “I’m now feeling much
more pessimistic that it can be controlled.” In the United States, “disruption to everyday life
might be severe,” Nancy Messonnier, who leads the coronavirus response for the U.S. Centers for

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Disease Control and Prevention, warned on 25 February. “They are asking the American public to
work with them to prepare for the expectation that this is going to be bad.”Dye and others say it’s
time to rethink the public health response. So far, efforts have focused on containment: slowing

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the spread of the virus within China, keeping it from being exported to other countries, and, when

patients do cross borders, aggressively tracing anyone they were in contact with and quarantining
those people for 2 weeks. But if the virus, named SARS-CoV-2, has gone global, travel

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restrictions may become less effective than measures to limit outbreaks and reduce their impact,
wherever they are, for instance, by closing schools, preparing hospitals, or even imposing the
kind of draconian quarantine imposed on huge cities in China.“Border measures will not be as

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effective or even feasible, and the focus will be on community mitigation measures until a

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vaccine becomes available in sufficient quantities,” says Luciana Borio, a former biodefense
preparedness expert at the U.S. National Security Council who is now vice president at In-Q-Tel,
a not-for-profit venture capital firm. “The fight now is to mitigate, keep the health care system
working, and don’t panic,” adds Alessandro Vespignani, an infectious disease modeler at
Northeastern University. “This has a range of outcomes from the equivalent of a very bad flu
season to something that is perhaps a little bit worse than that.”Public health experts disagree,
however, about how quickly the travel restrictions that have marked the first phase of the

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epidemic should be loosened. Early this week, the total number of cases stood at more than

80,000 with 2705 deaths—with 97% of the total still in China. Some countries have gone so far as
to ban all flights to and from China; the United States quarantines anyone who has been in hard-

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hit Hubei province and refuses entry to foreign nationals if they have been anywhere in China
during the past 2 weeks. Several countries have also added restrictions against South Korea and
Iran. The restrictions have worked to some degree, scientists say. “If we had not put a travel
restriction on, we would have had many, many, many more travel-related cases than we have,”

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says Anthony Fauci, who heads the U.S. National Institute of Allergy and Infectious Diseases.
But many epidemiologists have claimed that travel bans buy little extra time, and WHO doesn’t
endorse them. The received wisdom is that bans can backfire, for example, by hampering the flow
of necessary medical supplies and eroding public trust. And as the list of affected countries

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grows, the bans will become harder to enforce and will make less sense: There is little point in
spending huge amounts of resources to keep out the occasional infected person if you already

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have thousands in your own country. The restrictions also come at a steep price. China’s economy
has already taken an enormous hit from COVID-19, as has the airline industry. China also exports
many products, from pharmaceuticals to cell phones, and manufacturing disruptions are causing

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massive supply chain problems.“It would be very hard politically and probably not even prudent
to relax travel restrictions tomorrow,” says Harvard University epidemiologist Marc Lipsitch.
“But in a week, if the news continues at the pace that it’s been the last few days, I think it will

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become clear that travel restrictions are not the major countermeasure anymore.”Smaller scale
containment efforts will remain helpful, says WHO’s Bruce Aylward, who led an international
mission to China over the past 2 weeks. In a report from the mission that Aylward discussed but

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did not publicly release, the group concludes that the Chinese epidemic peaked between 23
January and 2 February and that the country’s aggressive containment efforts in Hubei, where at
least 50 million people have been on lockdown, gave other provinces time to prepare for the virus

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and ultimately prevent “probably hundreds of thousands” of cases. “It’s important that other

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countries think about this and think about whether they apply something—not necessarily full
lockdowns everywhere, but that same rigorous approach.”Yet China’s domestic restrictions have
come at a huge cost to individuals, says Lawrence Gostin, who specializes in global health policy
at Georgetown University Law Center. He calls the policies “astounding, unprecedented, and
medieval,” and says he is particularly concerned about the physical and mental well-being of
people in Hubei who are housebound, under intensive surveillance, and facing shortages of health

services. “This would be unthinkable in probably any country in the world but China,” he says.

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(Italy’s lockdowns are for relatively small towns, not major cities.)China is slowly beginning to
lift the restrictions in regions at lower risk, which could expose huge numbers of people to the
infection, Dye says. “If normal life is restored in China, then we could expect another

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resurgence,” he adds. Still, delaying illness can have a big payoff, Lipsitch says. It will mean a
lower burden on hospitals and a chance to better train vulnerable health care workers on how to
protect themselves, more time for citizens to prepare, and more time to test potentially life-saving
drugs and, in the longer term, vaccines. “If I had a choice of getting [COVID-19] today or getting

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it 6 months from now, I would definitely prefer to get it 6 months from now,” Lipsitch says.
Flattening the peak of an epidemic also means fewer people are infected overall, he says. Other
countries could adopt only certain elements from China’s strategy. An updated analysis coauthored by Dye and posted on the preprint server med Rxiv concludes that suspending public

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transport, closing entertainment venues, and banning public gatherings were the most effective
mitigation interventions in China. “We don’t have direct proof, of course, because we don’t have

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a properly controlled experiment,” Dye says. “But those measures were probably working to push

down the number of cases.” One question is whether closing schools will help. “We just don’t
know what role kids play” in the epidemic, Lipsitch says. “That’s something that anybody who

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has 100 or more cases could start to study.”Some countries may decide it’s better not to impede
the free flow of people too much, keep schools and businesses open, and forgo the quarantining
of cities. “That’s quite a big decision to make with regards to public health,” Dye says, “because

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essentially, it’s saying, ‘We’re going to let this virus go.’”To prepare for what’s coming, hospitals
can stockpile respiratory equipment and add beds. More intensive use of the vaccines against
influenza and pneumococcal infections could help reduce the burden of those respiratory diseases

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on the health care system and make it easier to identify COVID-19 cases, which produce similar
symptoms. Governments can issue messages about the importance of hand washing and staying
home if you’re ill. Whatever the rest of the world does, it’s essential that it take action soon,

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Aylward says, and he hopes other countries will learn from China. “The single biggest lesson is:

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Speed is everything,” he says. “And you know what worries me most? Has the rest of the world
learned the lesson of speed?” />

b. There are two sources that provide age, sex, and co morbidity statistics: The Report of the WHOChina Joint Mission published on Feb. 28 by WHO, which is based on 55,924 laboratory
confirmed cases. The report notes that "The Joint Mission acknowledge the known challenges and
biases of reporting crude CFR early in an epidemic". How to calculate the mortality rate during

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an outbreak.A paper by the Chinese CCDC released on Feb. 17, which is based
on 72,314 confirmed, suspected, and asymptomatic cases of COVID-19 in China as of Feb. 11,
and was published in the Chinese Journal of Epidemiology. We will list data from both, labeling

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them as "confirmed cases" and "all cases" respectively in the tables. Death Rate = (number of
deaths / number of cases) = probability of dying if infected by the virus (%). This probability
differs depending on the age group. The percentages shown below do not have to add up to 100%,
as they do not represent share of deaths by age group. Rather, it represents, for a person in a given

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age group, the risk of dying if infected with COVID-19.. In general, relatively few cases are seen
among children. o/coronavirus/coronavirus-cases/
c. Health officials in China have published the first details of more than 44,000 cases of Covid-19,
in the biggest study since the outbreak began .Data from the Chinese Centre for Disease Control

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and Prevention (CCDC) fonnd that more than 80% of the cases have been mild, with the sick and
elderly most at risk. The research also points to the high risk to medical staff. A hospital director

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in the city of Wuhan died from the virus on Tuesday. Liu Zhiming, 51, was the director of the
Wuchang Hospital in Wuhan - one of the leading hospitals in the virus epicenter. He is one of the
most senior health officials to die so far. Hubei, whose capital is Wuhan, is the worst affected

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province in the country. The report by the CCDC shows the province's death rate is 2.9%
compared with 0.4% in the rest of the country. The findings put the overall death rate of the
Covid-19 virus at 2.3%.China's latest official figures released on Tuesday put the overall death

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toll at 1,868 and 72,436 infections. Officials reported 98 new deaths and 1,886 new cases in the

past day, with 93 of those deaths and 1,807 infections in Hubei province. 12,000 people have
recovered, according to Chinese authorities. While the results largely confirm previous

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descriptions of the virus and patterns of infection, the study includes a detailed breakdown of the
44,672 confirmed cases across all of China. It fonnd that 80.9% of infections are classified as
mild, 13.8% as severe and only 4.7% as critical. The number of deaths among those infected,

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known as the fatality rate, remains low but rises among those over 80 years old. Looking at the

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sex ratio, men are more likely to die (2.8%) than women (1.7%).The study also identified which
existing illnesses put patients at risk. It puts cardiovascular disease at number one, followed by
diabetes, chronic respiratory disease and hypertension. Pointing out the risk to medical staff, the
paper says that a total of 3,019 health workers have been infected, 1,716 of which were confirmed
cases. Five had died by 11 February, which was the last day of data included in the research. On
13 February, China broadened its definition of how to diagnose people, including "clinically
diagnosed cases" which previously were counted separate from "confirmed cases". This is by far

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the most detailed study of the coronavirus outbreak within China. It gives us incredible insight
into what is happening, but the picture is far from complete. You can study only the cases you
find, and other scientists have estimated there could be 10 times as many people infected as are

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ending up in the official statistics. That means the overall death rate is likely to be lower than the
one reported in this study. The report also suggests the outbreak peaked in late January, but it is
too soon to know for sure. What this analysis clearly describes is a "highly contagious" virus that
spreads "extremely rapidly" even in the face of an "extreme response" by China. That should be a

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warning to the rest of the world. The study suggests that the downward trend in the overall
epidemic curve could mean that "isolation of whole cities, broadcast of critical information (e.g.,
promoting hand washing, mask wearing, and care seeking) with high frequency through multiple
channels, and mobilization of a

multi-sector

rapid

returning

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response teams is helping to curb the epidemic". But the authors also warn that with many people
a

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holiday,

the

country

"needs to prepare

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for the possible rebound of the epidemic". China's response to the virus has seen the lockdown of
Wuhan - the largest city in Hubei - and the rest of the province as well as severe travel restrictions
on movements across the country. The virus has spread beyond mainland China to countries

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around the globe and two cruise ships are now confirmed to have been affected. The Diamond
Princess was quarantined in the Japanese port of Yokohama on 3 February, after a man from
Hong Kong tested positive. More than 450 of the 3,700 people on board have since become

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infected. The US has begun evacuating its citizens from the vessel. On Tuesday South Korea

joined the list of the countries and territories also planning to get their residents out which already
includes Canada, Australia, the UK, Israel and Hong Kong. A second ship, the MS Westerdam,

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was turned away by multiple ports around Asia over fears it could be carrying the virus. It was
finally cleared to dock in Sihanoukville, Cambodia, after no cases were found on board.
Disembarking passengers were personally welcomed by Prime Minister Hun Sen. No one was

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quarantined. However, days later, a woman who had been on the ship tested positive after

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arriving in Malaysia. Huge efforts are now being made to track down the passengers, who have
moved on to many different countries including Malaysia and Thailand, but also further afield to
the US and Canada. Several countries have said they will not admit foreign visitors who were on
the ship. There are still 255 guests and 747 crew on board the MS Westerdam, while more than

400 passengers have been sent to a hotel in the Cambodian capital, Phnom Penh, to await test
results. />
d. Kenneth McIntosh, MD (2020) told that in late 2019, a novel coronavirus, now designated SARS-

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CoV-2, was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in
China. In February 2020, the World Health Organization (WHO) designated the disease COVID19, which stands for coronavirus disease 2019. Since the first reports of COVID-19, infection has

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spread to include more than 70,000 cases in China and increasing cases worldwide, prompting the
WHO to declare a public health emergency in late January 2020. The possibility of COVID-19
should be considered primary patients with fever and/or lower respiratory tract symptoms who
reside in or have recently (within the prior 14 days) traveled to areas where community

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transmission has been reported (eg, China, South Korea, Italy, Iran, Japan) or who have had
recent close contact with a confirmed or suspected case of COVID-19. Clinicians should also be
aware of the possibility of COVID-19 in patients with severe respiratory illness when no other
etiology can be identified. Upon suspicion of COVID-19, infection control measures should be

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implemented and public health officials notified. In health care settings in the United States, the
Centers for Disease Control and Prevention (CDC) recommends standard, contact, and airborne

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precautions , as well as eye protection. In addition to testing for other respiratory pathogens,
upper and lower respiratory tract specimens should be tested for SARS-CoV-2. Additional
specimens (eg, stool, urine) can also be collected. Management consists of supportive care. Home

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management may be possible for patients with mild illness who can be adequately isolated in the
outpatient setting. To reduce the risk of transmission in the community, individuals should be
advised to wash hands diligently, practice respiratory hygiene (eg, cover their cough), and avoid

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close contact with ill individuals, if possible. Facemasks are not routinely recommended for
asymptomatic individuals to prevent exposure in the community. The WHO has issued interim
guidance on surveillance case definitions, laboratory diagnosis, and clinical management. The

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CDC has also issued interim guidance. Coronaviruses are important human and animal

pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of
pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in

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an epidemic throughout China, with sporadic cases reported globally. In February 2020, the

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World Health Organization designated the disease COVID-19, which stands for coronavirus
disease 2019 . The virus that causes COVID-19 is designated severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2); previously, it was referred to as 2019-nCoV.Understanding of
COVID-19 is evolving. Interim guidance has been issued by the World Health Organization and
by the United States Centers for Disease Control and Prevention . Links to these and other related
society guidelines are found elsewhere. This topic will discuss the epidemiology, clinical features,
diagnosis, management, and prevention of COVID-19. Community-acquired coronaviruses,

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severe acute respiratory syndrome (SARS) coronavirus, and Middle East respiratory syndrome
(MERS) coronavirus are discussed separately. Geographic distribution — Since the first reports
of cases from Wuhan, a city in the Hubei Province of China, at the end of 2019, more than 70,000

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COVID-19 cases have been reported in China; these include all laboratory-confirmed cases as
well as clinically diagnosed cases in the Hubei Province. A joint World Health Organization
(WHO)-China fact-finding mission estimated that the epidemic in China peaked between late
January and early February 2020 . Nevertheless, the case count in China continues to rise daily;

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the majority of reports are from Hubei and surrounding provinces, but numerous cases have been
reported in other provinces and municipalities throughout China. Increasing numbers of cases
have also been reported in other countries across continents except Antarctica, and the rate of new
cases outside of China has outpaced the rate in China. These cases have occurred mainly among

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travelers from China and those who have had contact with travelers from China. However,
ongoing local transmission has driven smaller outbreaks in some locations outside of China,

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including South Korea, Italy, Iran, and Japan, and infections elsewhere have been identified in
travelers from those countries .In the United States, COVID-19 was identified in a patient in
northern California without recent travel or contact with anyone known to have COVID-19,

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suggesting the possibility of local transmission. The CDC is watching this case very carefully.
Updated case counts in English can be found on the World Health Organization and European
Centre for Disease Prevention and Control websites. Transmission — Understanding of the

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transmission risk is incomplete. Person-to-person spread is thought to occur mainly via
respiratory droplets, resembling the spread of influenza. However, given the current uncertainty
regarding transmission mechanisms, airborne precautions are recommended routinely in some

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countries and in the setting of certain high-risk procedures in others. (See 'Infection control for
suspected or confirmed cases' below and 'Society guideline links' below.) Epidemiologic
investigation in Wuhan identified an initial association with a seafood market where most patients

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had worked or visited and which was subsequently closed for disinfection . The seafood market

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also sold live rabbits, snakes, and other animals. However, as the outbreak progressed, most
laboratory-confirmed cases had no contact with this market, and cases were identified among
health care workers and other contacts of patients with COVID-19. Human-to-human
transmission has been confirmed in China and has also been identified in other countries. As an
example, in the United States, among 11 patients diagnosed with COVID-19, nine had travelled
to Wuhan, China, and the other two had been in close contact with patients who had laboratoryconfirmed COVID-19 .Detection of viral RNA from respiratory specimens of patients with

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exposure but no symptoms has been reported, and transmission of the COVID-19 virus from
asymptomatic individuals (or individuals within the incubation period) has been described .
However, the extent to which this occurs remains unknown.COVID-19 virus RNA has been

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detected in blood and stool specimens, although it is not known whether these specimens contain
infectious virus. Full-genome sequencing and phylogenic analysis indicated that the coronavirus
that causes COVID-19 is a beta coronavirus in the same subgenus as the severe acute respiratory
syndrome (SARS) virus (as well as several bat coronaviruses), but in a different clad. The

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apparent structure of the receptor-binding gene region is very similar to that of the SARS

coronavirus, and there is speculation that it will be shown to use the same receptor for cell entry.
The Coronavirus Study Group of the International Committee on Taxonomy of Viruses has
proposed that this virus be designated severe acute respiratory syndrome coronavirus 2 (SARS-

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CoV-2). The Middle East respiratory syndrome (MERS) virus, another beta coronavirus, appears
more distantly related . The closest RNA sequence similarity is to two bat coronaviruses, and it

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appears likely that bats are the primary source; whether COVID-19 virus is transmitted directly
from bats or through some other mechanism (eg, through an intermediate host) is unknown. The
incubation period for COVID-19 is thought to be within 14 days following exposure, with most

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cases occurring approximately five days after exposure .In a family cluster of infections, the onset
of fever and respiratory symptoms occurred approximately three to six days after presumptive
exposure . Similarly, in an analysis of 10 patients with confirmed COVID-19 pneumonia, the

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estimated mean incubation period was five days . Pneumonia appears to be the most frequent
serious manifestation of infection, characterized primarily by fever, cough, dyspnea, and bilateral
infiltrates on chest imaging . Most infections are not severe, although many patients have had

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critical illness. Specifically, in a report from the Chinese Center for Disease Control and

Prevention that included approximately 44,500 confirmed infections with an estimation of disease
severity, 81 percent were mild (no or mild pneumonia), 14 percent were severe (eg, with dyspnea,

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hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours), and 5 percent were

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critical (eg, with respiratory failure, shock, or multiorgan dysfunction) . The overall case-fatality
rate was 2.3 percent; no deaths were reported among non critical cases. According to a joint
World Health Organization (WHO)-China fact-finding mission, the case-fatality rate ranged from
2 to 4 percent in Wuhan and was 0.7 percent in the rest of China . Most of the fatal cases have
occurred in patients with advanced age or underlying medical co morbidities. In addition to
respiratory symptoms, gastrointestinal symptoms (eg, nausea and diarrhea) have been reported in
some patients, but these are relatively uncommon. Asymptomatic infections have also been

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described, but their frequency is unknown. In patients with COVID-19, the white blood cell count
can vary. Leukopenia, leukocytosis, and lymphopenia have been reported, although lymphopenia
appears most common . Elevated aminon transferase levels have also been described. On

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admission, many patients with pneumonia have normal serum procalcitonin levels; however, in
those requiring intensive care unit (ICU) care, they are more likely to be elevated . According to
the WHO, recovery time appears to be around two weeks for mild infections and three to six

weeks for severe disease .Several cohort studies of patients from Wuhan with confirmed COVID-

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19 have illustrated the range of clinical findings . In a study describing 138 patients with COVID19 pneumonia in Wuhan, the median age was 56 years (interquartile range 42 to 68 years) .
Nearly all (99 percent) reported fever, 59 percent had a dry cough, and 35 percent had myalgias.
Dyspnea developed in 31 percent after a median of five days of illness. Lymphopenia was

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common, and all patients had parenchymal lung abnormalities on computed tomography of the
chest, including bilateral patchy shadows or ground-glass opacities. Acute respiratory distress

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syndrome developed in 20 percent, and mechanical ventilation was implemented in 12.3 percent.
Among the six patients who died, D-dimer levels were higher and lymphopenia was more severe
compared with survivors. In one report of 21 patients with laboratory-confirmed COVID-19 who

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did not develop severe respiratory distress, lung abnormalities were most severe approximately 10
days after symptom onset . Reports of cohorts in locations outside of Wuhan have described
similar clinical findings, although some have suggested that milder illness may be more common.

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As an example, in a study of 62 patients with COVID-19 in the Zhejiang province of China, all

but one had pneumonia, but only two developed dyspnea, and only one warranted mechanical

ventilation. The approach to initial management should focus on early recognition of suspect

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cases, immediate isolation, and institution of infection control measures. At present, the

possibility of COVID-19 should be considered primarily in patients with fever and/or lower
respiratory tract symptoms who reside in or have recently (within the prior 14 days) traveled to

This preprint research paper has not been peer reviewed. Electronic copy available at: />

areas where community transmission has been reported (eg, China, South Korea, Italy, Iran,

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Japan) (see 'Geographic distribution' above) or Have had recent (within the prior 14 days) close
contact with a confirmed or suspected case of COVID-19. Clinicians should also be aware of the
possibility of COVID-19 in travelers from or residents in other locations outside of China where
community transmission has been reported. The possibility of COVID-19 should also be
considered in patients with severe lower respiratory tract illness when an alternative etiology
cannot be identified, even if there has been no clear exposure. When COVID-19 is suspected,
infection control measures should be implemented and public health officials notified. Infection

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control precautions are discussed elsewhere. The specific case definitions and clinical criteria for
pursuing diagnostic evaluation differ slightly between expert groups. Clinical criteria for patients
under investigation from the United States Centers for Disease Control and Prevention (CDC) are

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also found online and are summarized in the Apendex-1.Case definitions from the World Health
Organization are found in its technical guidance online.Case definitions from the European
Centre for Disease Prevention and Control are found on its website.Laboratory testing — Patients
who meet the clinical criteria for patients under investigation or specific definitions for suspect

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cases, as discussed above, should undergo testing for SARS-CoV-2 (the virus that causes
COVID-19), in addition to testing for other respiratory pathogens. In the United States, the CDC
recommends collection of specimens to test for SARS-CoV-2 from the upper respiratory tract
and, if possible, the lower respiratory tract (sputum, tracheal aspirate, or bronchoalveolar lavage).
collected.

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Induction of sputum is not indicated. Additional specimens (eg, stool, urine) can also be
Respiratory

specimen

collection

should

be

performed

under

airborne

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precautions.SARS-CoV-2 RNA is detected by polymerase chain reaction; in the United States,
testing is performed by the CDC or a CDC-qualified lab . A positive test for SARS-CoV-2
confirms the diagnosis of COVID-19. If initial testing is negative but the suspicion for COVID-19

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remains, the WHO recommends re sampling and testing from multiple respiratory tract sites .For
safety reasons, specimens from a patient with suspected or documented COVID-19 should not be
submitted for viral culture. The importance of testing for other pathogens was highlighted in a

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report of 210 symptomatic patients with suspected COVID-19; 30 tested positive for another
respiratory viral pathogen, and 11 tested positive for SARS-CoV-2 and supportive care. Clinical
guidance can be found on the World Health Organization (WHO) and Centers for Disease

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Control and Prevention (CDC) websites .Supportive care for sepsis and acute respiratory distress
syndrome is discussed elsewhere. The WHO and CDC recommend glucocorticoids not be used in

patients with COVID-19 pneumonia unless there are other indications (eg, exacerbation of

This preprint research paper has not been peer reviewed. Electronic copy available at: />

chronic obstructive pulmonary disease) [24,45]. Glucocorticoids have been associated with an

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increased risk for mortality in patients with influenza and delayed viral clearance in patients with
Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Although they were
widely used in management of severe acute respiratory syndrome (SARS), there was no good
evidence for benefit, and there was persuasive evidence of adverse short- and long-term harm.
Investigational agents are being explored for antiviral treatment of COVID-19. As an example,
several randomized trials are underway to evaluate the efficacy of remedesivire for moderate or
severe COVID-19 [47]. Remdesivir is a novel nucleotide analogue that has activity against

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SARS-CoV-2 in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro
and in animal studies. The compassionate use of remdesivir through an investigational new drug
application was described in a case report of one of the first patients with COVID-19 in the

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United States . Any clinical impact of remdesivir on COVID-19 remains unknown. There has also
been interest in the combined protease inhibitor lopinavir-ritonavir, which is used for the
treatment of HIV infection. This combined agent has in vitro activity against the SARS-CoV and
appears to have some activity against MERS-CoV in animal studies. The use of this agent for

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treatment of COVID-19 has been described in case reports , but its efficacy is unclear, and it is
being evaluated in larger randomized trials. Practitioners in China should be aware of local
guidelines regarding treatment and also assess their patients for eligibility in available clinical
trials. A registry of international clinical trials can be found on the WHO website and at clinical

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trials.gov.Home care — Home management may be appropriate for patients with mild infection
who can be adequately isolated in the outpatient setting. Management of such patients should

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focus on prevention of transmission to others, and monitoring for clinical deterioration, which
should prompt hospitalization. Interim recommendations on home management of patients with
COVID-19 can be found on the WHO and CDC websites. Infection control for suspected or

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confirmed cases. Infection control to limit transmission is an essential component of care in
patients with suspected or documented COVID-19. In one report of 138 patients with COVID-19
in China, it was estimated that 43 percent acquired infection in the hospital setting .Individuals

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with suspected infection in the community should be advised to wear a medical mask to contain
their respiratory secretions and seek medical attention. In the health care setting, the World
Health Organization (WHO) and United States Centers for Disease Control and Prevention

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(CDC) recommendations for infection control for suspected or confirmed infections differ
slightly: The WHO recommends standard, contact, and droplet precautions, with eye or face

protection. The addition of airborne precautions is warranted during aerosol-generating

This preprint research paper has not been peer reviewed. Electronic copy available at: />

procedures, such as tracheal intubation, noninvasive ventilation, tracheotomy, cardiopulmonary
manual

ventilation

before

intubation,

and

bronchoscope.

The

CDC

iew
ed

resuscitation,

recommends standard, contact, and airborne precautions, with eye protection. If an airborne
infection isolation room (ie, a single patient negative pressure room) is not readily available, the
patient should wear a mask and be placed in a private room with the door closed, and any
personnel entering the room should wear the appropriate personal protection equipment. Patients
with suspected or confirmed COVID-19 who require hospitalization should be cared for in a
facility that can provide an airborne infection isolation room. Elements of the different types of

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infection control precautions are detailed in apendex-2. Forhealth care workers who have had a
potential exposure to COVID-19, the CDC has provided guidelines for work restriction and
monitoring. The approach depends upon the duration of exposure, the patient's symptoms,

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whether the patient was wearing a facemask, the type of personal protective equipment used by
the provider, and whether an aerosol-generating procedure was performed. Links to additional
infection control guidelines are found below. The decision to discontinue infection control
precautions for patients with COVID-19 should be made on a case-by-case basis in consultation

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with experts in infection prevention and control and public health officials. Factors to inform this
decision include resolution of clinical signs and symptoms and negative results of reversetranscription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 on two sequential
paired nasopharyngeal and throat specimens (ie, four specimens total, each handled separately),

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with each pair collected ≥24 hours apart. Positive RT-PCR tests for SARS-CoV-2 were reported

in four laboratory-confirmed COVID-19 patients after they had clinically improved and tested

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negative on two consecutive tests . The clinical significance of this finding is uncertain; it is
unknown whether these individuals continued to shed infectious virus. Environmental
disinfection — To help reduce the spread of COVID-19 virus, environmental infection control

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procedures should also be implemented . In United States health care settings, the CDC states
routine cleaning and disinfection procedures are appropriate for COVID-19 virus . Products
approved by the Environmental Protection Agency for emerging viral pathogens should be used.

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Specific guidance on environmental measures, including those used in the home setting, is
available on the CDC and WHO websites. Additional information is also found in a separate topic
review. Preventing exposure in the community — The WHO advises general measures to reduce

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transmission of infection, including diligent hand washing, respiratory hygiene (eg, covering the
cough), and avoiding close contact with live or dead animals and ill individuals.It notes that for

people without respiratory symptoms, wearing a medical mask in the community is not required,

This preprint research paper has not been peer reviewed. Electronic copy available at: />

even if COVID-19 is prevalent in the area; wearing a mask does not decrease the importance of

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other general measures to prevent infection, and it may result in unnecessary cost and supply
problems . In the United States, the CDC also does not recommend masks for asymptomatic
individuals in the community .Individuals who are caring for patients with suspected or
documented COVID-19 at home, however, should wear a tightly fitting medical mask when in
the same room as that patient. Global public health measures — On January 30, 2020, the WHO
declared the COVID-19 outbreak a public health emergency of international concern. With the
growing numbers of cases in countries outside of China raising concerns for global spread of the

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virus, the WHO has indicated three priorities for countries: protecting health workers, engaging
communities to protect those at highest risk of severe disease (eg, older adults and those with
medical comorbidities), and supporting vulnerable countries in containing infection .The WHO

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does not recommend international travel restrictions but does acknowledge that movement
restriction may be temporarily useful in some settings. The WHO advises exit screening for
international travelers from areas with ongoing transmission of COVID-19 virus to identify
individuals with fever, cough, or potential high-risk exposure . Many countries also perform entry

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screening (eg, temperature, assessment for signs and symptoms). More detailed travel information
is available on the WHO website.In the United States, the CDC currently recommends that

individuals avoid all nonessential travel to mainland China ; individuals returning from China will
be required to enter through designated airports, undergo screening for signs of illness on arrival,

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and be monitored (potentially under quarantine) by health officials for 14 days. Foreign nationals
who have been in China during the past 14 days may be temporarily suspended from entry. The

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CDC also recommends against nonessential travel to South Korea and has released travel
advisories regarding other locations where community transmission has been reported . The CDC
website provides updated guidance on travel restrictions as well as risk assessment and

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management of persons with a suspected exposure to COVID-19. Although many cases of
COVID-19 can be detected through entry screening, some may be missed. As an example, in
Germany, 114 travelers returning from Wuhan were considered to be asymptomatic during entry

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screening but, when tested for COVID-19 virus by RT-PCR, two tested positive . However, the
role of asymptomatic patients in transmitting infection to others, and thus the value of PCR
testing of asymptomatic individuals on entry, remains unclear. Pregnant women — Minimal

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information is available regarding COVID-19 during pregnancy In two reports including a total of
18 pregnant women with suspected or confirmed COVID-19 pneumonia, there was no laboratory

evidence of transmission of the virus to the neonate . However, two neonatal cases of infection

This preprint research paper has not been peer reviewed. Electronic copy available at: />

have been documented. In one case, the diagnosis was made at day 17 of life after close contact

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with the infant's mother and a maternity matron who were both infected with the virus. The other
case was diagnosed 36 hours after birth; the source and time of transmission in that case were
unclear. The approach to prevention, evaluation, diagnosis, and treatment of pregnant women
with suspected COVID-19 should be similar to that in non pregnant individuals), with
consideration that pregnant women with other potentially severe respiratory infections, such as
influenza, severe acute respiratory syndrome (SARS)-CoV, or Middle East respiratory syndrome
(MERS)-CoV, appear to be more vulnerable to developing severe sequelae. Additionally, the

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American College of Obstetricians and Gynecologists (ACOG) specifies that infants born to
mothers with confirmed COVID-19 should be considered a patient under investigation and
appropriately isolated and evaluated. It is unknown whether the virus can be transmitted through

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breast milk; however, droplet transmission could occur through close contact during
breastfeeding. ACOG recommends that mothers with confirmed COVID-19 or symptomatic
mothers with suspected COVID-19 take precautions to prevent transmission to the infant during
breastfeeding (including assiduous hand hygiene and using a facemask) or consider having a

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different individual feed expressed breast milk to the infant . UpToDate offers two types of
patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education
pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four
or five key questions a patient might have about a given condition. These articles are best for

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patients who want a general overview and who prefer short, easy-to-read materials. Beyond the
Basics patient education pieces are longer, more sophisticated, and more detailed. These articles

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are written at the 10th to 12th grade reading level and are best for patients who want in-depth
information and are comfortable with some medical jargon. Here are the patient education articles
that are relevant to this topic. We encourage you to print or e-mail these topics to your patients.

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(You can also locate patient education articles on a variety of subjects by searching on "patient
info" and the keyword(s) of interest.)Basics topic (see "Patient education: Coronavirus disease
2019 (COVID-19) (The Basics)")designated SARS-CoV-2, was identified as the cause of an

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outbreak of acute respiratory illness in Wuhan, a city in China. In February 2020, the World
Health Organization (WHO) designated the disease COVID-19, which stands for coronavirus
disease 2019. Since the first reports of COVID-19, infection has spread to include more than

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70,000 cases in China and increasing cases worldwide, prompting the WHO to declare a public
health emergency in late January 2020. (See 'Epidemiology' above.).The possibility of COVID-19
should be considered primarily in patients with fever and/or lower respiratory tract symptoms

This preprint research paper has not been peer reviewed. Electronic copy available at: />

who reside in or have recently (within the prior 14 days) traveled to areas where community

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transmission has been reported (eg, China, South Korea, Italy, Iran, Japan) or who have had
recent close contact with a confirmed or suspected case of COVID-19. Clinicians should also be
aware of the possibility of COVID-19 in patients with severe respiratory illness when no other
etiology can be identified. In the United States, the specific criteria for patients under
investigation are outlined in the apendex-1(See 'Clinical features' above and 'Evaluation and
diagnosis' above.).Upon suspicion of COVID-19, infection control measures should be
implemented and public health officials notified. In health care settings in the United States, the

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Centers for Disease Control and Prevention (CDC) recommends standard, contact, and airborne
precautions In addition to testing for other respiratory pathogens, upper and lower respiratory
tract specimens should be tested for SARS-CoV-2. Additional specimens (eg, stool, urine) can

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also be collected. Management consists of supportive care. Home management may be possible
for patients with mild illness who can be adequately isolated in the outpatient setting. To reduce
the risk of transmission in the community, individuals should be advised to wash hands diligently,
practice respiratory hygiene (eg, cover their cough), and avoid close contact with ill individuals, if

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possible. Facemasks are not routinely recommended for asymptomatic individuals to prevent
exposure in the communityhe WHO has issued interim guidance on surveillance case definitions,
laboratory diagnosis, and clinical management. The CDC has also issued interim guidance.
/>
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e. It is caused by a member of the coronavirus family that has never been encountered before. Like
other coronaviruses, it has come from animals. Many of those initially infected either worked or

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frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.The
virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and
breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia,

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antibiotics are of no use. The antiviral drugs we have against flu will not work. Recovery depends
on the strength of the immune system. Many of those who have died were already in poor health.
In the UK, the medical advice is that if you have recently travelled from areas affected by

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coronavirus, you should stay indoors and avoid contact with other people as you would with the
flu and Call NHS 111 to inform them of your recent travel to the area. More NHS advice on what
to do if you think you have been exposed to the virus can be found here, and the full travel advice

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to UK nationals is available here. China’s national health commission has confirmed human-tohuman transmission, and there have been such transmissions elsewhere. As of 2 March, the
outbreak has affected an estimated 87,000 people globally. In mainland China, of the 80,026

This preprint research paper has not been peer reviewed. Electronic copy available at: />

confirmed cases, 44,462 (56%) have recovered and 2,912 (or 3.6%) have died. The coronavirus

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has spread to at least other 30 other countries. The most badly affected include Japan, with 850
cases, including 691 from a cruise ship docked in Yokohama, and four deaths. Italy has recorded
at least 1,100 cases and 29 deaths, while South Korea has recorded more than 4,212 cases and 22
deaths. There have also been deaths in Hong Kong, Taiwan, France, the US and the Philippines.
There have been 40 recorded cases and no fatalities to date in the UK. We don’t yet know how
dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality
rate is around 2% in the epicenter of the outbreak, Hubei province, and less than that elsewhere.

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For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause
about 400,000 deaths each year globally. Sars had a death rate of more than 10%. Another key
unknown is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no

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vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the
population – elderly people or those with existing respiratory or immune problems – to protect
themselves. Hand-washing and avoiding other people if you feel unwell are important. One
sensible step is to get the flu vaccine, which will reduce the burden on health services if the

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outbreak turns into a wider epidemic. Severe acute respiratory syndrome (Sars) and Middle
Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In
2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than
8,000 people and killing more than 750. Mers appears to be less easily passed from human to

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human, but has greater lethality, killing 35% of about 2,500 people who have been infected. No.
A pandemic, in WHO terms, is “the worldwide spread of a disease”. The spread of the virus

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outside China is worrying but not an unexpected development. The WHO has declared the
outbreak to be a public health emergency of international concern. The key issues are how
transmissible this new coronavirus is between people, and what proportion become severely ill

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and end up in hospital. Often viruses that spread easily tend to have a milder impact. Generally,

the coronavirus appears to be hitting older people hardest, with few cases in children. we have a
small favour to ask. More people, like you, are reading and supporting the Guardian’s

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independent, investigative journalism than ever before. And unlike many news organizations, we
made the choice to keep our reporting open for all, regardless of where they live or what they can
afford to pay. The Guardian will engage with the most critical issues of our time – from the

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escalating climate catastrophe to widespread inequality to the influence of big tech on our lives.
At a time when factual information is a necessity, we believe that each of us, around the world,
deserves access to accurate reporting with integrity at its heart. Our editorial independence means

This preprint research paper has not been peer reviewed. Electronic copy available at: />

we set our own agenda and voice our own opinions. Guardian journalism is free from commercial

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and political bias and not influenced by billionaire owners or shareholders. This means we can
give a voice to those less heard, explore where others turn away, and rigorously challenge those
in power. We hope you will consider supporting us today. We need your support to keep
delivering quality journalism that’s open and independent. Every reader contribution, however
big

or

small,

is

so

valuable.

/>
coronavirus-symptoms-wuhan-china-covid-19

f. It was a bruising year for China. A trade war with the United States left its economy expanding at

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the slowest pace in 30 years. And economists estimate 4 million jobs may have been lost in 2019.
This year is already being defined by the outbreak of the coronavirus which has killed thousands
and has infected thousands more, putting the brakes on China's economy. Economists polled by

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Reuters expect China's growth rate to slump to 4.5 percent in the first quarter of this year from 6
percent in the previous quarter. That would be the slowest pace since the financial crisis. With
much of the country in lockdown, the virus could affect up to 42 percent of China's economy,
according to Standard Chartered. Companies may struggle to make payments on loans leading to

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a rise in what is called non-performing loans of $1.1 trillion, according to Standard and Poor's.

Chinese airlines have been forced to ground planes and are expected to lose $12.8bn in revenue.
Globally, the airline industry is set to lose $29bn, according to the International Air
Transportation Association (IATA). And the effect of COVID-19 is being felt regionally."Well,

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as you know, from 15 to 20 years ago China was already dubbed as 'the factory of the world' so
then what we have seen now is that the supply chain sourcing has been interrupted," Reuben

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Mondejar, professor for Asian Initiatives at the IESE Business School, University of Navarra,
tells Al Jazeera. Argentina's economy is expected to contract for the third consecutive year.
Inflation is running at more than 50 percent and the country is in talks with the International

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Monetary Fund (IMF) to avoid a default on its debt. Since the late 1950s, the IMF has provided
loans and bailouts to Argentina more than 20 times. But this time it has finally admitted what
everyone else was saying - that Argentina's debt is "unsustainable". The country has debts of

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more than $320bn. The IMF now says they will have to take losses on their holdings. And there
seems to be a determination in Buenos Aires that they will not accept any new austerity measures.
In fact, the new President Alberto Fernandez has instead frozen prices and increased salaries.

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Richard Segal, a senior analyst with Manulife Asset Management, explains that the situation in

Argentina has been stressed for many years."The IMF is acknowledging what we have
understood for a long time, meaning that the public debt is unsustainable and it needs to be

This preprint research paper has not been peer reviewed. Electronic copy available at: />

written

down

quite

substantially.

Source: Al

Jazeera

News.

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ed

/>
g. The "whole world needs to be on alert" to fight the coronavirus, the head of the World Health
Organization's Health Emergencies Programme has said. Dr Mike Ryan praised China's response
to the deadly outbreak, saying: "The challenge is great but the response has been massive."The
WHO will meet on Thursday to discuss whether the virus constitutes a global health emergency.
The Chinese city of Wuhan is the epicenter of the outbreak. But the virus has spread across China

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and to at least 16 countries globally, including Thailand, France, the US and Australia. More than
130 people have died in China and close to 6,000 have been infected. There is no specific cure or
vaccine. A number of people have recovered after treatment, however. China coronavirus: A

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visual guide to the outbreak. Coronavirus: How worried should we be?The WHO's Dr Ryan said
an international team of experts was being assembled to go to China and work with experts there
to learn more about how the disease is transmitted."We are at an important juncture in this event.
We believe these chains of transmission can still be interrupted," he said. Scientists in Australia

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have managed to recreate the new coronavirus outside of China, raising hope that it could be used
to develop an early-diagnosis test. WHO director-general Tedros Adhanom Ghebreyesus, who
visited China this week, said most people who contracted the virus were suffering only "milder
symptoms", but about 20% had severe effects such as pneumonia and respiratory failure. He said

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that China "needs the world's solidarity and support," and that "the world is pulling together to
end the outbreak, building on lessons learned from past outbreaks."The director-general added

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that the WHO "deeply regrets" referring to the worldwide risk from the virus as "moderate" in
three reports last week instead of "high". He described the person-to-person spread of the illness
in Germany, Vietnam and Japan as worrying, and said experts would consider it on Thursday

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when deciding whether to declare a global emergency. The city's residents are enduring an
isolated, frightening time. Most forms of traffic have been banned, and 11 million people are shut
up in their homes, trying to minimize the spread of the virus. Wuhan people cry out 'stay strong'

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from windows .Videos have emerged online of neighbours shouting "Wuhan jiayou!" out of their
windows - roughly translated to "Stay strong Wuhan!" or "Keep on going Wuhan". The phrase
has been trending on Weibo, China's Twitter-like social media site, with people from around the

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country posting supportive messages."We will get through this. Wuhan jiayou, the whole country
is supporting you," read one comment on Weibo. "This is the first day since the lockdown that
I've had to go out," a man in his 50s told the AFP news agency on Wednesday, on a mostly-

This preprint research paper has not been peer reviewed. Electronic copy available at: />

deserted street."I have no choice because I need to buy food." How deadly is this virus? It is a

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basic question, but the answer is elusive. (See 'Preventing exposure in the community' above.) It
is far too simplistic to take the 130 deaths and the 6,000 cases and come up with a death rate of
2%. We're in the middle of the outbreak and thousands of those patients are still being treated.
We don't know if they will live or die, so they can't be used in these calculations. We also don't

know how many mild and undetected cases are out there."It is very early to make any statements
on what the overall mortality rate may be," the WHO's Maria Van Kerkhove has warned. Also,
the deadliness of the new virus is only one component of its threat. Flu kills hundreds of

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thousands of people each year not because it is super-deadly, but because it is able to infect so
many people. Hundreds of foreign nationals are being evacuated from Wuhan, where the virus
first emerged, with Japan, the US and the EU among those repatriating their citizens. Some 200

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Japanese nationals have landed at Tokyo's Haneda airport, and 240 Americans - including
workers from the local US consulate - left Wuhan on Wednesday. The US flight landed at a
California military base and was met on the tarmac by emergency vehicles. The defense
department said those on board would be monitored and sent to local hospitals if they fell ill.

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Wuhan: The London-sized city where the virus began. Britons will not fly home from Wuhan on
Thursday Island quarantine plan as foreigners leave China. Australia plans to quarantine its
evacuees on Christmas island, 2,000km (1,200 miles) from the mainland. Two aircraft to fly EU
citizens home have been scheduled, with 250 French nationals leaving on the first flight. South

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Korea said some 700 of its citizens would leave on four flights this week. Both Malaysia and the
Philippines have also pledged to evacuate their citizens in and around Wuhan.Canada has

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chartered a plane to bring home around 160 of its nationals, but said it could take several days to
get permission to land near Wuhan. On Tuesday, Hong Kong announced plans to slash crossborder travel between the city and mainland China. British Airways has suspended all flights to

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and from the Chinese mainland, and the UK's Foreign Office warned against "all but essential
travel" there. Several other airlines have taken similar measures. United Airlines and Cathay
Pacific are restricting flights, while Lion Air - one of Asia's biggest airlines - is stopping flights to

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China from Saturday. Cathay Pacific has also suspended in-flight trolley services, changed some
aspects of its meal offer, and stopped giving out hot towels, pillows, blankets and magazines in an
effort to prevent the virus spreading. />
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h. The soldier, the first U.S. service member known to be infected, has been quarantined in his offbase residence, the military said An American soldier in South Korea has tested positive for the
new coronavirus, the U.S. military said on Wednesday. The patient, a 23-year-old man, is based

This preprint research paper has not been peer reviewed. Electronic copy available at: />

in Camp Carroll in Waegwan, only 12 miles from Daegu, the South Korean city at the center of

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an outbreak in the country. The soldier, the first U.S. service member to become infected, has
been quarantined in his off-base residence, the military said. The soldier visited Camp Walker, a

military base in Daegu, on Monday and visited Camp Carroll from Friday to Tuesday. South
Korean and American “health professionals are actively conducting contact tracing to determine
whether any others may have been exposed,” the military said. The military added that it was
“implementing all appropriate control measures to help control the spread of Covid-19 and
remains at risk level ‘high’” for all its 28,500 soldiers stationed in South Korea “as a prudent

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measure to protect the force.” Those measures include advising all troops to “limit non-mission
essential” meetings and “off-installation travel.” At the gates of the American military bases
across South Korea, stations have been set up to administer temperature checks and screening

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questionnaires. On Tuesday, the United States and South Korea said they would consider scaling
back joint military exercise after an outbreak among South Korean soldiers had infected at least
13.South Korea reported 169 new patients on Wednesday, bringing the total number to 1,146, the
biggest outbreak outside China. More than half of the patients were residents of Daegu.

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Americans should brace for the likelihood that the coronavirus will spread to communities in the
United States, the Centers for Disease Control and Prevention warned Tuesday.“It’s not so much
of a question of if this will happen in this country anymore but a question of when this will
happen,” said Dr. Nancy Messonnier, director of the National Center for Immunization and

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Respiratory Diseases. President Trump, in India, said that the United States was well able to

protect itself against the spread of the coronavirus and offered an optimistic outlook.“I think the

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whole situation will start working out,” Mr. Trump said during a news conference. [Watch the
video.]But his own health officials were not so upbeat. Dr. Messonnier said that public health
officials have no idea whether the spread of the disease to the United States would be mild or

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severe, but that Americans should be ready for a significant disruption to their daily lives.“We are
asking the American public to prepare for the expectation that this might be bad,” Dr. Messonnier
said. The secretary of health and human services delivered an equally sobering message on

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Tuesday. The secretary, Alex M. Azar II, told a Senate committee, “This is an unprecedented,

potentially severe health challenge globally.”“We cannot hermetically seal off the United States
to a virus,” Mr. Azar said. “And we need to be realistic about that.”Federal and local health

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departments will need as many as 300 million masks for health care workers and additional
ventilators for hospitals to prepare for a major outbreak of the coronavirus, he said. On Monday,
the Trump administration requested $2.5 billion to help stop the spread of the virus. Lawmakers

This preprint research paper has not been peer reviewed. Electronic copy available at: />

from both parties made it clear they were unconvinced the Trump administration was prepared.

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When Senator John Kennedy, Republican of Louisiana, pressed for an exact number of people
expected to be infected, the acting secretary of the Homeland Security Department, Chad F. Wolf,
could not answer.“I’m all for committees and task forces but you’re the secretary,” Mr. Kennedy
responded. “I think you ought to know that answer. A clinical trial has begun in Nebraska to test
whether an experimental drug can treat the new coronavirus, starting with an American who was
quarantined on the Diamond Princess cruise ship in Japan, the National Institutes of Health said
on Tuesday.Meanwhile, the Food and Drug Administration said it was closely watching the

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supplies of 20 unrelated drugs that are either made in China, where the epidemic has drastically
reduced manufacturing, or contain ingredients from China. The agency did not say which drugs,
but the world relies heavily on China for supplies of many essential medications, like aspirin and

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penicillin.In the trial, the patient is being treated with the drug remdesivir, an antiviral developed
by Gilead Sciences. The test is taking place at the University of Nebraska Medical Center in
Omaha, which has a special bio containment unit, according to the National Institute of Allergy
and Infectious Diseases, part of the N.I.H. Thirteen people from the cruise ship have been taken

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there for treatment. There are no approved treatments for illnesses caused by coronaviruses,
including the new one, known as Covid-19. Remdesivir is already being tested in two clinical

trials in China, but efforts to enroll patients there have faltered.“We urgently need a safe and
effective treatment for Covid-19,” said Dr. Anthony S. Fauci, the director of the allergy and

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infectious diseases institute, at a briefing at the Department of Health and Human Services.
Several companies are also working to develop a vaccine for the virus. One of them, Moderna,

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said Monday it had delivered an experimental vaccine to the N.I.H. for early testing in humans, a
record-setting pace. But “even at rocket speed,” releasing a vaccine would take at least a year, Dr.
Fauci cautioned. He projected that initial human trials would begin in a month and a half, with

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about 45 people, and last three to four months. Then it would have to be expanded to “hundreds,
if not thousands” of subjects in countries with active disease transmission, which would take six
to eight months, he said. A day after its worst one-day slide in two years, the S&P 500 fell 3

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percent on Tuesday in response to the coronavirus threat, a decline that put the blue chip index
firmly in the red for the year. The yield on the 10-year Treasury note fell to a record low, a

possible sign that investors expect growth in the United States to slow. Investors continued to

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dump stocks a day after the S&P 500 had lost 3.4 percent, after officials in Italy and South Korea

reported new infections on Monday. Tuesday’s decline came as federal officials warned that the
epidemic was likely to reach the United States with potentially severe impacts. For weeks, U.S.

This preprint research paper has not been peer reviewed. Electronic copy available at: />

investors had largely shrugged off the economic risks of the virus even as it disrupted global

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supply chains and shut down factories in China. As recently as last Wednesday, the S&P 500 was
at a record high. Fears have grown stronger about the virus’s effect on the global economy. The
declines in the S&P 500 were led by energy, industrial and materials shares, the sectors of the
market closely tied to Chinese demand for raw materials. As stocks dropped sharply, investors
moved into the safety of government bonds, pushing their prices up and yields down. A
coronavirus outbreak in Italy, the worst outside Asia, appears to be spreading. New cases — most
linked to the Italian epicenter, Lombardy — were reported on Tuesday in Spain, Austria, Croatia,

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Switzerland and France. The authorities in Algeria reported their country’s first confirmed case,
an Italian, though it was not immediately clear if the person had been in Italy recently. Italy
reported a total of 322 infections through Tuesday, up from 229 a day earlier, with reports of new

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cases in Tuscany and Sicily. The death toll rose to 10, from seven. Austrian authorities said two
24-year-olds from Lombardy living in Innsbruck, Austria, had tested positive. A 36-year-old
Italian woman living in Barcelona tested positive after returning from a trip to Lombardy,

according to Spanish authorities. They are also dealing, on the island of Tenerife, with a couple

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from Lombardy who are both infected.A man who visited Milan in mid-February has become
Croatia’s first confirmed coronavirus patient, the Croatian prime minister, Andrej Plenkovic, said
in a news conference.France announced two new cases, one a young Chinese woman who arrived
in early February and the other a Frenchman returning from a trip to Lombardy. The reports

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added to fears that the virus could spread rapidly across the Continent, where the Schengen zone
allows largely free movement among 26 countries. Olivier Véran, France’s health minister, said

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after a meeting of European health ministers that they were working on a “collective
strategy.”“As of now, we wish to be extremely clear on the fact that there is no reason to close the
borders between our countries, which would be disproportionate and inefficient,” he told

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reporters in Rome. Italy has installed checkpoints and deployed its army to the “red area” in
Lombardy, Michele Capone, a carabinieri official, told the Italian news agency ANSA. With
public gatherings restricted, the soccer team International of Milan will play its home game on

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Thursday, against Ludogorets of Bulgaria, without fans in the stadium. In southern Italy, the
region of Basilicata has said it will quarantine arriving northerners, while the regions of Puglia

and Calabria have asked travelers from affected areas to inform the local authorities. Prime

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Minister Giuseppe Conte said on Monday that such restrictions were “not justified.”The
government of Croatia took pains to emphasize its preparedness and project calm. But the virus’s
emergence

in

the

Balkans

could

test

poorly

funded

health

systems, which

are

This preprint research paper has not been peer reviewed. Electronic copy available at: />