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

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

EPIDEMIOLOGY OF CORONA VIRUS IN THE WORLD AND ITS EFFECTS ON

THE CHINA ECONOMY

Dr.Naushad Khan Institute of Development Studies, The University of Agriculture Peshawar

Email:- drkhan@aup.edu.pk

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

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 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 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 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

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 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 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 Preprint not peer reviewed

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

is requested for its best control

Key Words:- Epidemiology, Corona Virus, World, Economy, China

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 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

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 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 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 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 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 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 economy

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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China economy to what extent Corona virus have been distributed in the world and what type effect is fell on the economy of China

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

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 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

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 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,” 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 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 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 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 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 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 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,” 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

hard-of necessary medical supplies and eroding public trust And as the list hard-of affected countries 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 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 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 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 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 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 (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 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

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 co-authored by Dye and posted on the preprint server med Rxiv concludes that suspending public 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

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 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 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

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: Speed is everything,” he says “And you know what worries me most? Has the rest of the world learned the lesson of speed?”https://www.sciencemag.org/news/2020/02/coronavirus-seems-unstoppable-what-should-world-do-now.

b There are two sources that provide age, sex, and co morbidity statistics: The Report of the

WHO-China 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

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 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 age group, the risk of dying if infected with COVID-19 In general, relatively few cases are seen among children https://www.worldometers.info/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 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

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 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 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 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 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 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 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 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

response teams is helping to curb the epidemic" But the authors also warn that with many people returning from a long holiday, the country "needs to prepare 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 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 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, 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 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 https://www.bbc.com/news/world-asia-china-51540981

d Kenneth McIntosh, MD (2020) told that in late 2019, a novel coronavirus, now designated 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 COVID-

SARS-19, which stands for coronavirus disease 2019 Since the first reports of COVID-SARS-19, infection has 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 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 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 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 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 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 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 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, 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 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; 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 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, 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, 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 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 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 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 confirmed COVID-19 Detection of viral RNA from respiratory specimens of patients with 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 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 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-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 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 cases occurring approximately five days after exposure In a family cluster of infections, the onset

laboratory-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 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 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 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 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 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-

19 have illustrated the range of clinical findings In a study describing 138 patients with

COVID-19 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 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 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 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

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 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

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areas where community transmission has been reported (eg, China, South Korea, Italy, Iran, 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 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 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 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) Induction of sputum is not indicated Additional specimens (eg, stool, urine) can also be collected Respiratory specimen collection should be performed under airborne 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 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 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 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

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

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procedures, such as tracheal intubation, noninvasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscope The CDC 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 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, 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 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 reverse-transcription 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), 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 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 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 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 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,

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

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

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

https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19

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 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, 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 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

to UK nationals is available here China’s national health commission has confirmed human 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

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

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we set our own agenda and voice our own opinions Guardian journalism is free from commercial 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 https://www.theguardian.com/world/2020/mar/02/what-is-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 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 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

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,

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 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 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 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 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

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written down quite substantially Source: Al Jazeera News https://www.aljazeera.com/programmes/countingthecost/2020/02/coronavirus-outbreak-affecting-global-economy-200229125804909.html

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 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 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 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 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 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 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' 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 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-

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