On December 31, 2019, the first cases of a novel coronavirus were identified in Wuhan City, Hubei Province, China. Since then, the disease, now officially known as COVID-19, has spread to several countries and claimed the lives of over 391,000* people.
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The total number of confirmed cases of COVID-19, total number of related deaths and total number of those who have recovered. Information correct as of June 5th, 2020, 06:33 (UTC). *
As of March 11, 2020, cases of the virus had been confirmed in over 100 countries. You can keep up to date with the spread of the virus with this outbreak tracker from researchers at John Hopkins University.
Following a number of discussions, the outbreak was declared a PHEIC (Public Health Emergency of International Concern) by the WHO on January 30, 2020, signifying the global public health risk of the disease and the need for a coordinated international response. By this time, preventative measures such as travel restrictions had already begun to be put in place. A recent study has suggested that quarantine on a cruise ship has resulted in more coronavirus patients. However, were infected passengers to have left the ship, new epicenters of disease may well have been established. This reiterates the importance of effective quarantine measures. Many people are using face masks in a bid to protect themselves, however the effectiveness of this is questionable.
The outbreak was declared a pandemic on March 11, 2020, in response to the number of cases outside China increasing 13-fold, and the number of affected countries tripling over the past two weeks.
In response, Italy imposed a lock down on the whole country, and movement restrictions are being implemented elsewhere in an effort to halt the virus's spreads. As more and more countries impose varying degrees of restrictions, one group have surveyed the British public to see what they think about the measures being taken by the government.
A new modelling study has estimated that a combined approach of physical distancing interventions, comprising quarantine, school closure, and workplace distancing, is most effective at reducing the number of SARS-CoV-2 cases. Emphasis has also been placed on good hand hygiene to reduce spread of the virus.
A new approach to monitoring SARS-CoV-2, known as wastewater-based epidemiology, mines sewage samples for vital clues about human health. It can potentially identify levels of coronavirus infection at both a local and global scale and help to nip outbreaks in the bud before they are able to establish themselves and spread further.
What you need to know about coronavirus
What is a coronavirus?
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Other coronaviruses circulate among animals including camels, cats and bats. Occasionally, animal coronaviruses may acquire mutations that enable them to infect people and then spread between people. In 2002-2003, an outbreak of SARS originating in southern China eventually caused 8,098 cases across 37 countries, resulting in 774 deaths. Consequently, in the light of the recent outbreak, there is understandable fear of another such epidemic. Pangolins have been suggested as a possible route for the current outbreak from animals into people.
What are the symptoms of infection with this novel coronavirus?
Primary clinical signs include fever and breathing difficulties, associated with the development of pneumonia, however chills, sore throat and headache have also been described by those affected. Person-to-person spread is thought to occur via respiratory droplets, in a similar way to the spread of influenza. Whilst some individuals may experience only mild clinical signs, there have already been over 2,500 fatalities associated with the infection, mostly in the elderly or those with underlying medical conditions. A study has shown that tears however, pose a low risk in terms of viral spread.
Studies of the cases so far have indicated a median incubation period of 5.1 days, and that 97.5% of people who develop symptoms will do so within 11.5 days of exposure, suggesting the 14 day isolation period recommended is appropriate.
It is however important to bear in mind that individuals with coronavirus may be infectious prior to showing any symptoms. Such cases along with those who only experience mild clinical signs are thought to have fueled rapid "stealth transmission" through the population. Following the first known case of community-acquired COVID-19, lessons are being learnt.
There have also been some suggestions that loss of smell and taste could also be linked to coronavirus infection.
A recent study from the National Institutes of Health also demonstrates that SARS-CoV-2 is stable for several hours to days in aerosols and on surfaces, suggesting individuals could acquire the virus after touching contaminated objects. Soap appears to kill coronavirus successfully so thorough hand washing is recommended. Another study has looked at the role that speech plays in viral transmission.
In a recent study, researchers found that half of the patients they treated for mild COVID-19 infection still had coronavirus for up to eight days after symptoms disappeared.
The findings from a detailed report on the clinical course and treatment of Germany’s first group of COVID-19 patients are being used to develop criteria to determine the earliest point at which COVID-19 patients treated in hospitals with limited bed capacity can be safely discharged.
At Aarhus University, the environmental scientist Dario Caro from the Department of Environmental Science, and two health researchers, Prof. Bruno Frediani and Dr Edoardo Conticini, from the University of Siena in Italy have found yet another small piece in the puzzle of understanding the deadly disease. They have focused on examining why the mortality rate is up to 12% in the northern part of Italy, while it is only approx. 4.5% in the rest of the country. They found a probable correlation between air pollution and coronavirus-related mortality in two of the worst affected regions in northern Italy: Lombardy and Emilia Romagna. Another study by Martin Luther University Halle-Wittenberg found that elevated levels of nitrogen dioxide in the air may be associated with a high number of deaths from COVID-19. But is this a causative link or just a coincidence?
New data suggests that disease severity may be affected by genetic differences affecting individual's immune systems. An individual's immune response timing is also thought to impact the progress of disease.
Cytokine storms may affect the severity of COVID-19 cases by lowering T cell counts, according to a study published in Frontiers in Immunology. Researchers studying coronavirus cases in China found that sick patients had a significantly low number of T cells, a type of white blood cell that plays a crucial role in immune response, and that T cell counts were negatively correlated with case severity.
Experts have reviewed how the SARS-Cov-2 virus can cause an immune overreaction in the form of potentially lethal cytokine storm.
A new observational study aimed at identifying markers that predict how COVID-19 affects patients is being led by clinicians and academics at North Bristol NHS Trust and the University of Bristol.
How is the infection diagnosed?
Currently, testing is done is specialized laboratories. The first diagnostic assay to be published by the WHO as a guideline for diagnostic detection, was developed at the German Center for Infection Research in January. Several other tests are currently in development, including a lateral flow test and a gene sequencer.
A recent study has demonstrated that chest CT outperformed lab testing, suggesting it should be used as the primary screening tool for COVID-19. Novel coronavirus imaging has also shown “significant overlap” with SARS and MERS. A potential role for lung ultrasound in has also been suggested in COVID-19 diagnosis.
On February 28, the FDA issued a new policy for certain laboratories seeking to develop diagnostic tests for coronavirus to help expedite the availability of coronavirus diagnostics. As of March 18, 2020, six tests had been granted Emergency Use Authorization.
Researchers have now detected COVID-19 viral RNA and live virus in specimens other than nose-throat swabs and sputum samples, raising the possibility that the disease may spread through additional routes, thus testing should be changed accordingly.
The lab of Dr Changchun Liu at the University of Connecticut Health Center has recently developed a simple, low-cost, CRISPR-based method which can detect infectious diseases such as COVID-19.
Recent work has identified that biomarkers in sewerage could help analysts to monitor the spread of infection by testing wastewater.
Imperial College London’s Regius Professor of Engineering, Chris Toumazou FRS, is working with clinical researchers to test a rapid, lab-free PCR test that detects COVID-19 and delivers results in just over an hour.
A new study has explored the connection between levels of neutrophils with the severity of COVID-19 clinical signs.
A proof-of-concept study describes a quick, sensitive test for antibodies against the coronavirus in human blood. The test could help doctors track a person’s exposure to the disease, as well as confirm suspected COVID-19 cases that tested negative by other methods.
Researchers at the Duke-NUS Medical School in Singapore have announced a new blood test for neutralizing antibodies against SARS-CoV-2, the virus that causes COVID-19, and have formed public and private partnerships to begin working toward making the tests clinically available.
What treatments are available?
An open-access global COVID-19 Clinical Trial Tracker has been launched to help facilitate greater collaboration between critical stakeholders involved in tackling the COVID-19 outbreak.
COVID-19 is a viral infection, meaning antibiotics are not a viable treatment option. There are currently no anti-viral treatments available. Most patients will make a full recovery without treatment. Those with severe infections will be given supportive treatment such as oxygen or artificial ventilation to keep them alive until they start to recover themselves.
A recent study has suggested the use of steroids should be avoided. In addition, over-the-counter anti-inflammatory drugs, such as ibuprofen, should be avoided if you have coronavirus symptoms because they could worsen the condition, French authorities have warned.
Developing new drugs and vaccines can take years. Existing drugs may offer a possible "quick response" to the pandemic. Improving understanding of the virus, including it's structure, may also help to expedite the vaccine development process. This video explores the use of chloroquine and zinc as a treatment combinations.
An overview of published scientific information on potential therapeutic agents and vaccines for the new coronavirus, highlighted that to date, more than 500 patents have been issued for vaccines and therapeutic agents that could help prevent or treat coronavirus infections. A phase 1 clinical trial of a coronavirus vaccine has now commenced, and a phase II trial of SNG001, an interferon beta-based therapeutic, is set to start in coronavirus patients.
A study was recently published in the Journal of Biological Chemistry outlining how an antiviral drug that is currently being tested in patients with the novel coronavirus (COVID-19), remdesivir, works.
Furthermore, a preprint of a study conducted by researchers from Utrecht University, in collaboration with Erasmus MC and Harbor BioMed, outlines the first report of a human monoclonal antibody that can block SARS-CoV-2.
Clinical trials with low doses of rapamycin have been suggested as a way to protect the elderly from COVID-19.
To assist scientists in expediting therapeutic and preventaitve development, a portal for sharing data from coronavirus trials is set to launch.
Researchers from Queen’s University Belfast are currently screening approximately 1,000 drugs, which have already received regulatory approval for other indications, to ascertain if they can reduce virus infection or replication and virus-induced inflammatory responses in airway epithelial cell models and to determine if they can therefore be repurposed to treat COVID-19 patients.
Researchers report that intravenous transplantation of human mesenchymal stem cells appears to be safe and effective for treatment in seven patients with COVID-19 pneumonia.
Whilst the world waits for an effective COVID-19 vaccine to be developed, approved and made available globally, pharmaceutical companies are working in parallel to establish if existing approved or experimental drugs have the potential to be repurposed to treat patients infected with the novel coronavirus SARS-CoV-2.
An intranasal vaccine using an RNA virus for gene delivery protects against fatal MERS coronavirus infections in mice. Researchers are now applying this knowledge to tackle SARS-Cov2.
While the majority of people with COVID-19 won’t require hospitalization, those who do are likely to seek medical help as a result of acute respiratory distress syndrome, or ARDS, a severe lung injury common in patients with critical illnesses. At present, there is no effective treatment for ARDS other than supportive care with mechanical ventilation.
A team of physician-scientists at Beth Israel Deaconess Medical Center (BIDMC) — part of Beth Israel Lahey Health — are now enrolling patients in a clinical trial to evaluate a common anti-clotting drug for the treatment of COVID-19-positive patients with ARDS.
Temple University Hospital has treated the first BREATHE trial participant in the United States evaluating intravenous treatment with gimsilumab on mortality for patients with COVID-19 and acute respiratory distress syndrome.
The Arizona Center for Education and Research on Therapeutics (AZCERT), a nonprofit dedicated to the safe use of medicines, is making MedSafety Scan®, a web-based decision support system, available free to medical professionals around the world, especially those treating high risk COVID-19 patients.
A large collaborative effort combines artificial intelligence with physics-based drug docking and molecular dynamics simulations to rapidly hone in on the most promising molecules to test in the lab, in the search for a therapeutic strategy against COVID-19.
Researchers are now enrolling outpatients with COVID-19 for a randomized controlled trial of the effectiveness of two drug regimens – hydroxychloroquine and hydroxychloroquine with azithromycin.
A recent trial of Remdesivir has suggested that it is not associated with significant clinical benefits. Despite this, the FDA have issued emergency use authorization for its use in the treatment of COVID-19.
Four of six critically ill COVID-19 patients significantly improved after receiving an experimental therapeutic designed to reduce inflammation, a major cause of death from this disease, according to a new study.
Take a look inside the UK's vaccine clinical trial.
A recent study shows that the body's immune system is able to recognize SARS-CoV-2 in many ways, dispelling fears that the virus may elude ongoing efforts to create an effective vaccine.
How are scientists responding?
The complete genome of COVID-19 was recently posted on the UC Santa Cruz Genome Browser, an interactive web-based tool used by researchers all over the world to study genetic data. This enables scientists to look at the virus’ structure and research potential ways to attack it. Analyzing this genetic data, scientists have recently concluded that SARS-CoV-2 is a product of natural selection.
Scientists from Australia and France have also successfully cultured the virus from patient samples, enabling research to begin on potential treatments and vaccines.
Researchers from The University of Texas (UT) at Austin and the National Institutes of Health recently created the first 3D atomic scale map of the 2019-nCov spike protein using cryogenic electron microscopy (cryo-EM). Nanobodies which bind to this “spike” protein, have been isolated, which can be used to improve imaging of the virus.
A recent study has revealed the presence of a novel type of immune cell in the lungs which appear to have an important role in controlling inflammation during viral lung infection. Genetic variability in the human immune system has also been suggested to affect the susceptibility to, and severity of infection. Research also suggests that smoking cigarettes increases SARS-CoV-2 receptors in the lung.
The World Bank Group has also announced up to $12 Billion to support the COVID-19 response efforts. In another recent announcement, six research projects are to share a £20 Million fund.
The Internet of Things (IoT) is an automated solution that can scale quickly to match the speed of a growing epidemic. In the wake of the current coronavirus outbreak being declared a pandemic, we take a look at how the IoT is being employed here.
A comprehensive virological analysis of SARS-CoV-2 has now been published.
In a recent interview with Technology Networks, Professor Ben tenOever explained how he and his team are investigating the way host cells respond to viral infection, specifically SARS-CoV-2, and discusses some of the techniques that have been key in enabling them to understand the way different patients may respond.
*Data retrieved from the Johns Hopkins University Coronavirus Resource Centre.