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Intro

It is essential to learn as much as possible during a disease outbreak into order to collate evidence on how to best diagnose, treat and prevent new diseases and learn how to mitigate against future outbreaks. Here we summarise the latest information regarding COVID-19, drawing on evidence provided by governments and research institutions from around the world, and provide links to key papers and relevant resources.

Please check here regularly for more information, this dashboard is updated weekly: Last updated 06/05/2020.

Background Information

On 31st December 2019, the World Health Organisation (WHO) China Country Office was informed of cases of pneumonia with unknown etiology detected in Wuhan City, Hubei Province, China. From 31st December 2019 to 3rd January 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported. Chinese authorities identified the causative agent as a new type of coronavirus, which was isolated on 7 January 2020.

The virus, later termed SARS-CoV-2, is a betacoronavirus. Other known betacoronaviruses include SARS-CoV (SARS-CoV-1) and MERS-CoV, the viruses responsible for the SARS (2002-2004) and MERS (2012, 2015, 2018) outbreaks.

By 31st January 2020 nearly 10,000 confirmed infections of the novel disease, termed COVID-19, had been reported globally across 20 countries.

By 11th March 2020, nearly 120,000 confirmed infections had been reported globally across 114 countries/territories. The WHO declared COVID-19 a pandemic.

Nomenclature

On 11th Feb 2020, following WHO best practices for naming of new human infectious diseases, the WHO named the disease COVID-19, short for 'coronavirus disease 2019'.

The virus which causes COVID-19 has been named SARS-CoV-2, short for 'severe acute respiratory syndrome coronavirus 2', by the International Committee on Taxonomy of Viruses (ICTV).

Clarification surrounding the naming of the disease and the virus can be found here.

Some sources and documents may still be using the previous, interim name of the virus "2019-novel coronavirus" (2019-nCoV). Some sources may use the alternative interim term "Wuhan novel coronavirus" (WN-CoV).

Severity

The COVID-19 pandemic remains an ongoing situation, and the severity of the disease is yet to be fully assessed. Current information suggests that illness resulting from COVID-19 infection ranges from mild to severe, including illness resulting in death. Most COVID-19 illness is mild, but roughly 1 in 5 people (20%) who contract COVID-19 progress to severe illness. Patients with confirmed infection commonly report the following symptoms:

Fever
Fatigue
Dry Cough
Chest Tightness
Shortness of breath

Patients who progress to severe illness are likely to require intensive care. In severe cases, patients may present with:

Pneumonia
Acute Respiratory Distress Syndrome (ARDS)
Arrhythmias and/or Acute Cardiac Injury
Shock
Guillian-Barré Syndrome

In addition to mild-severe symptomatic patients, asymptomatic infection has been well documented. The precise frequency of asymptomatic COVID-19 infection is yet to be determined, and studies have so far been inconclusive. Current research has suggested that anywhere between 5-80% of people testing positive for SARS-CoV-2 may be asymptomatic. Further research is need to accurately determine the propotion of people who remain asymptomatic when testing positive for SARS-CoV-2.

Risk Factors for Severe Disease and Mortality

Severe illness and mortality can occur in any indivdual who tests positive for SARS-CoV-2 infection, but current data suggests that older people and/or those with advanced comorbidities are at a greater risk.

Findings from China and Italy have reported that case fatality rates are highest amongst those aged ≥70 years. A study conducted in the U.S. has reported similar findings, with 80% of COVID-19 related deaths occurring in those aged ≥65 years.

Comorbidities that have been associated with severe illness and mortality include

Cardiovascular disease
Diabetes mellitus
Hypertension
Chronic lung disease or moderate to severe asthma
Cancer (in particular hematologic malignancies, lung cancer, and metastatic disease)
Chronic kidney disease
Obesity
Hepatic Disorders
Immunocompromising conditions (e.g. cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, prolonged use of corticosteroids and other immune weakening medications)

Relevant Resources and Literature

The following resources may be useful in assessing COVID-19 severity:

Q&A on Coronaviruses (COVID-19) - WHO
Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention – UpToDate
Symptoms of Coronavirus – CDC
People Who Are at Higher Risk for Severe Illness - CDC
Coronavirus (COVID-19) Health Alert – Australian Government Department of Health
Estimates of the severity of coronavirus disease 2019: a model-based analysis – The Lancet: Infectious Diseases
In patients of COVID-19, what are the symptoms and clinical features of mild and moderate cases? – CEBM
COVID-19: What proportion are asymptomatic? – CEBM
Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China – JAMA
Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy - JAMA
Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020 - CDC
Care for Critically Ill Patients With COVID-19 - JAMA
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study – The Lancet
Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study – The Lancet: Respiratory Medicine

How quickly is the disease spreading?

Disease Timeline Summary

31^st December 2019
A cluster of 27 cases of pneumonia of unknown aetiology are reported by the Wuhan Municipal Health Commission, Wuhan City, Hubei province, China

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3^rd January 2020
A total of 44 cases have been detected in Wuhan and reported to the WHO China Country Office

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13^th January 2020
Thailand reports the first cases of laboratory-confirmed SARS-CoV-2 infection outside of China.

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20^th January 2020
204 confirmed cases of SARS-CoV-2 infection reported across 4 countries in Asia. The overwhelming majority of cases are reported from China.

↓

31^st January 2020
9, 847 confirmed SARS-CoV-2 infections globally, across 19 countries.

↓

1^st February 2020
Total number of confirmed cases globally surpasses 10,000

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13^th February 2020
Total number of confirmed cases globally surpasses 50,000

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28^th February 2020
84, 25 confirmed SARS-CoV-2 infections globally, across 52 countries.

↓

6^th March 2020
Total number of confirmed cases globally surpasses 100,000

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27^th March 2020
Total number of confirmed cases globally surpasses 500,000

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31^st March 2020
754,933 confirmed SARS-CoV-2 infections globally

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4^th April 2020
Total number of confirmed cases globally surpasses 1,000,000

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30^th April 2020
3,096,626 confirmed SARS-CoV-2 infections globally

The WHO began publishing situation reports on COVID-19 on 21st January 2020. Daily updates on the number of confirmed COVID-19 cases can be found in the WHO situational reports.

A map and dashboard developed by Center for Systems Science and Engineering (CSSE) at John Hopkins University (JHU) provides a real-time visualization of the reported cases of COVID-19.

Relevant Resources and Literature

The following resources may be useful in assessing how quickly COVID-19 is spreading:

Coronavirus disease (COVID-2019) situation reports - WHO
Coronavirus (COVID-19) Dashboard - WHO
COVID-19 Dashboard - CSSE
Temporal variation in transmission during the COVID-19 outbreak - CMMID
Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study - The Lancet: Infectious Diseases
High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2 - CDC
Coronavirus: the first three months as it happened - Nature
How fast is the new coronavirus spreading and how can it be stopped? - UKRI
Timeline - COVID-19 - WHO
Event background COVID-19 - ECDC

Transmission

Although the initial outbreak in Wuhan City was associated with exposure at a large seafood and live animal market (and hence a zoonotic source, with animal-to-human transmission), there is now evidence that the virus spreads from human to human, and in some regions community transmission is apparent. Nevertheless the exact mode of transmission of COVID-19 is currently unknown and further investigation is urgently needed in this area.

Most sources agree that the spread of COVID-19 occurs from person-to-person through resipratory droplets from the nose or mouth, produced when a person with COVID-19 coughs or breaths out. These droplets can land on people, objects or surfaces that are nearby. Other people can then catch COVID-19 by touching these surfaces, and then touching their eyes, nose or mouth. People can also catch COVID-19 by directly inhaling these respiratory droplets.

While the SARS-CoV 2 virus may be present in the faeces of someone with COVID-19, the risk of catching COVID-19 from the faces of an infected person is thought to be very low.

Several sources have produced Information on how COVID-19 is transmitted, including the WHO, the CDC, PHE and the Australian Deparment of Health.

On the 27^th Jan the WHO reported the following with regards to the incubation period of COVID-19:
‘Current estimates of the incubation period of the virus range from 2-10 days, and these estimates will be refined as more data become available. Understanding the time when infected patients may transmit the virus to others is critical for control efforts. Detailed epidemiological information from more people infected is needed to determine the infectious period of 2019-nCoV [COVID-19], in particular whether transmission can occur from asymptomatic individuals or during the incubation period.’

And on 1st Feb:
'The main driver of transmission, based on currently available data, is symptomatic cases. WHO is aware of possible transmission of 2019-nCoV [COVID-19] from infected people before they developed symptoms. Detailed exposure histories are being taken to better understand the pre-clinical phase of infection and how transmission may have occurred in these few instances. Asymptomatic infection may be rare, and transmission from an asymptomatic person is very rare with other coronaviruses, as we have seen with Middle East Respiratory Syndrome coronavirus. Thus, transmission from asymptomatic cases is likely not a major driver of transmission. Persons who are symptomatic will spread the virus more readily through coughing and sneezing'

Transmission of known Coronaviruses

The below paper discusses the high rate of SARS-CoV and MERS-CoV transmission between patients and healthcare workers:

SARS and MERS: recent insights into emerging coronaviruses

However, there have been very few reports of hospital outbreaks or COVID-19 infections of health care workers, which is a prominent feature of MERS-CoV and SARS-CoV.

The following resources may be useful in understanding the transmission of COVID-19:

The following articles discuss the transmission of known coronaviruses in depth:

How can transmission be prevented?

Advice on transmission prevention of COVID-19 has been provided by the WHO. These are standard recommendations for the general public to reduce exposure to and transmission of a range of illnesses are as follows, which include hand and respiratory hygiene, and safe food practices.

The CDC offers similar advice for the general prevention of the spread of respiratory viruses.

The following resources may be useful in understanding transmission prevention of COVID-19:

The below articles discuss investigations into preventing coronavirus transmission:

What are the current treatment options?

There is currently no vaccine available for COVID-19, and no recommended antiviral treatment. Treatment is therefore symptomatic and supportive.

The WHO advises the following supportive care if necessary (as for MERS-Cov) but patients should be assessed on a case-by-case basis.

Oxygen Therapy.
Mechanical Ventilation of severe cases (40%).
Use of Oximeter highly recommended
Intubation, ICU, ECMO required for severe patients.
Antibiotics
Analgesia/Antipyretics

Several studies into the treatment of MERS-CoV and SARS-CoV, have investigated the use of antibodies, IFNs, inhibitors of viral and host proteases, and host-directed therapies however the efficacy of such treatments remains unclear. Investigations into the use of antivirals such as Ribavirin, Lopinavir and Ritonavir have been inconclusive and are ongoing.

The WHO has activated an 'R&D Blueprint' to accelerate diagnostics, vaccines and therapeutics for COVID-19. The page contains reports of experimental treatments and vaccines, and reports of conulstations on trial design and cross reactivity with other coronaviruses

The following resources may also be useful in managing a COVID-19 infection:

The below articles discuss investigations into the treatment of coronaviruses:

What diagnostic tests are available to confirm COVID-19 infection?

Several assays that detect COVID-19 have been and are currently under development. Some assays may only detect COVID-19 and some may detect virus strains that are genetically similar.

The WHO has produced a list of groups that have shared protocols for in-house developed molecular assays. Most procedures assume a basic familiarity with PCR/RT-PCR assays.

The WHO has produced laboratory guidance for the testing for other coronaviruses (MERS-CoV). Routine confirmation of MERS-CoV infection is based on detection of unique sequences of virus RNA by nucleic acid amplification tests (NAAT) such as rRT-PCR with confirmation by nucleic acid sequencing when necessary. Similar information is available from the CDC.

The following resources may aid the diagnosis of COVID-19 infection:

The below articles discuss diagnosis of coronavirus infection in detail:

Data sharing

It is imperative that research findings and data relevant to the current outbreak are shared rapidly and openly.

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) have created a toolkit to facilitate the collection and sharing of standardised clinical data on patients hospitalised with suspected or confirmed infection with novel coronavirus (nCoV).

The toolkit provides researchers with the latest nCoV Case Record Form, which has has undergone extensive review and validation by international clinical experts and is available as a download or centralised eCRF, a nCoV Data Sharing Agreement (DSA), Ethics approval request letter template, and a REDCap brief and user guide.

The Data Sharing Working Group at the Global Research Collaboration For Infectious Disease Preparedness (GLOPID-R) have produced a webinar about their activities on data sharing for public health emergencies and the Public Health Emergency (PHE) Decision Tool.

The African coaLition for Epidemic Research, Response and Training (ALERRT) Knowledge Sharing Hub has templates to support data collection.

For more general guidance on making clinical data accessible, including tools, templates and further resources, please see the Data Sharing Toolkit on the EDCTP Knowledge Hub.