Naming

The pandemic is known by several names. It is often referred to as its colloquial name, "the
coronavirus pandemic",[9] despite the existence of other human coronaviruses that have caused
epidemics and outbreaks (e.g. SARS).[10] Before it was declared a pandemic, it was known as
"the coronavirus outbreak" and "Wuhan coronavirus outbreak". [11]
During the initial outbreak in Wuhan, the virus and disease were commonly referred to as
"coronavirus" and "Wuhan coronavirus", [12] with the disease sometimes called "Wuhan
pneumonia".[13][14] In January 2020, the WHO recommended 2019-nCoV [15] and 2019-nCoV acute
respiratory disease[16] as interim names for the virus and disease per 2015 guidance and
international guidelines against using geographical locations (e.g. Wuhan, China), animal
species, or groups of people in disease and virus names in part to prevent social stigma.[17] The
official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.
[18]
 Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the
outbreak was first identified (31 December 2019). [19] The WHO additionally uses "the COVID-19
virus" and "the virus responsible for COVID-19" in public communications. [18]
The variants of the virus are also known by several names. Before being given official names by
the WHO, they were commonly named after where the variants were found (e.g. Delta variant
was known as the Indian variant), [20] and are also known colloquially as "variants of concern". [21]
[22]
 At the end of May 2021, the WHO assigned labels to all the variants after introducing a new
policy of using Greek letters for variants of concern and variants of interest. [23]

Epidemiology
For country-level data, see:

COVID-19 pandemic by country and territory

Cases
232,066,390

Deaths
4,751,480

As of 27 September 2021[4]

 Africa

 Asia

 Europe

 North America

 Oceania

 South America
  Antarctica

Background
Main articles: Investigations into the origin of COVID-19 and COVID-19 pandemic in Hubei

Although the exact origin of the virus is still unknown, [24] the first outbreak started in Wuhan,
Hubei, China in November 2019. Many early cases of COVID-19 were linked to people who had
visited the Huanan Seafood Wholesale Market in Wuhan,[25][26][27] but it is possible that human-to-
human transmission was already happening before this.[28][29] On 11 February 2020, the World
Health Organization (WHO) named the disease "COVID-19", which is short for "coronavirus
disease 2019".[30][31] The virus that caused the outbreak is known as severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), a newly discovered virus closely related to bat
coronaviruses,[32] pangolin coronaviruses,[33][34] and SARS-CoV.[35] The scientific consensus is that
the virus is most likely of zoonotic origin, from bats or another closely-related mammal. [28]
[36]
 Despite this, the subject has generated extensive speculation and conspiracy theories, [37]
[29]
 which were amplified by rapidly growing online echo chambers.[38] Global geopolitical divisions,
notably between the United States and China, have been heightened because of this issue. [39]
The earliest known person with symptoms was later discovered to have fallen ill on 1 December
2019, and that person did not have visible connections with the later wet market cluster.[40]
[41]
 However, an earlier case of infection could have occurred on 17 November. [42] Of the early
cluster of cases reported that month, two-thirds were found to have a link with the market. [43][44]
[45]
 Molecular clock analysis suggests that the index case is likely to have been infected with the
virus between mid-October and mid-November 2019. [46][47]

Cases
Main articles: COVID-19 pandemic by country and territory and COVID-19 pandemic cases

Cumulative confirmed cases by country, as of 25 August 2021

   10,000,000+
   1,000,000–9,999,999
   100,000–999,999
   10,000–99,999
   1,000–9,999
   100–999
   1–99
   0
Official case counts refer to the number of people who have been tested for COVID-19 and
whose test has been confirmed positive according to official protocols. [48][49] Many countries, early
on, had official policies to not test those with only mild symptoms. [50][51] An analysis of the early
phase of the outbreak up to 23 January estimated 86 percent of COVID-19 infections had not
been detected, and that these undocumented infections were the source for 79 percent of
documented cases.[52] Several other studies, using a variety of methods, have estimated that
numbers of infections in many countries are likely to be considerably greater than the reported
cases.[53][54]
On 9 April 2020, preliminary results found that 15 percent of people tested in Gangelt, the centre
of a major infection cluster in Germany, tested positive for antibodies.[55] Screening for COVID-19
in pregnant women in New York City, and blood donors in the Netherlands, has also found rates
of positive antibody tests that may indicate more infections than reported. [56][57] Seroprevalence
based estimates are conservative as some studies show that persons with mild symptoms do not
have detectable antibodies.[58] Some results (such as the Gangelt study) have received
substantial press coverage without first passing through peer review. [59]
An analysis in early 2020 of cases by age in China indicated that a relatively low proportion of
cases occurred in individuals under 20.[60] It was not clear whether this was because young
people were less likely to be infected, or less likely to develop serious symptoms and seek
medical attention and be tested.[61] A retrospective cohort study in China found that children and
adults were just as likely to be infected. [62]
Initial estimates of the basic reproduction number (R0) for COVID-19 in January were between
1.4 and 2.5,[63] but a subsequent analysis concluded that it may be about 5.7 (with a 95
percent confidence interval of 3.8 to 8.9).[64] R0 can vary across populations and is not to be
confused with the effective reproduction number (commonly just called R), which takes into
account effects such as social distancing and herd immunity. By mid-May 2020, the effective R
was close to or below 1.0 in many countries, meaning the spread of the disease in these areas at
that time was stable or decreasing.[65]

Semi-log plot of weekly new cases of COVID-19 in the world and the current top six
countries (mean with deaths)
 
 

COVID-19 total cases per 100 000 population from selected countries [66]
 

COVID-19 active cases per 100 000 population from selected countries [66]

Deaths
Main articles: COVID-19 pandemic deaths and COVID-19 pandemic death rates by country

Further information: List of deaths due to COVID-19

Deceased in a refrigerated "mobile morgue" outside a hospital in Hackensack, New Jersey, USA

Official deaths from COVID-19 generally refer to people who died after testing positive according
to protocols. These counts may ignore deaths of people who die without having been tested.
[67]
 Conversely, deaths of people who had underlying conditions may lead to over-counting.
[68]
 Comparisons of statistics for deaths for all causes versus the seasonal average indicate
excess mortality in many countries. [69][70] This may include deaths due to strained healthcare
systems and bans on elective surgery.[71] The first confirmed death was in Wuhan on 9 January
2020.[72] Nevertheless, the first reported death outside of China occurred on 1 February 2020 in
the Philippines,[73] and the first reported death outside Asia was in the United States on 6
February 2020.[74]
More than 95 per cent of the people who contract COVID-19 recover. Otherwise, the time
between symptoms onset and death usually ranges from 6 to 41 days, typically about 14 days.
[75]
 As of 27 September 2021, more than 4.75 million[4] deaths have been attributed to COVID-19.
People at the greatest risk of mortality from COVID-19 tend to be those with underlying
conditions, such as those with a weakened immune system, serious heart or lung problems,
severe obesity, or the elderly (including individuals age 65 years or older). [76][77] The strongest risk
factors for severe COVID-19 illness are obesity, complications of diabetes, and anxiety disorders.
[78]

Multiple measures are used to quantify mortality.[79] These numbers vary by region and over time,
influenced by testing volume, healthcare system quality, treatment options, government
response,[80] time since the initial outbreak, and population characteristics, such as age, sex, and
overall health.[81] Countries like Belgium include deaths from suspected cases of COVID-19,
regardless of whether the person was tested, resulting in higher numbers compared to countries
that include only test-confirmed cases.[82]
The death-to-case ratio reflects the number of deaths attributed to COVID-19 divided by the
number of diagnosed cases within a given time interval. Based on Johns Hopkins University
statistics, the global death-to-case ratio is 2.05 percent (4,751,480 deaths for 232,066,390
cases) as of 27 September 2021.[4] The number varies by region.[83]


 Semi-log plot of weekly deaths due to COVID-19 in the world and top six current
countries (mean with cases)
 

COVID-19 deaths per 100 000 population from selected countries [66]
The official death counts have been criticised for underreporting the actual death toll, because
comparisons of death rates before and during the pandemic show an increase in deaths that is
not explained by COVID-19 deaths alone. [6] Using such data, estimates of the true number of
deaths from COVID-19 worldwide have included a range from 9.5 to 18.6 million by The
Economist, as well as over 10.3 million by the Institute for Health Metrics and Evaluation.[6][7]
Reporting
On 24 March 2020, the Centers for Disease Control and Prevention (CDC) of the United States,
indicated the WHO had provided two codes for COVID-19: U07.1 when confirmed by laboratory
testing and U07.2 for clinically or epidemiological diagnosis where laboratory confirmation is
inconclusive or not available.[84][85] The CDC noted that "Because laboratory test results are not
typically reported on death certificates in the US, [the National Center for Health
Statistics (NCHS)] is not planning to implement U07.2 for mortality statistics" and that U07.1
would be used "If the death certificate reports terms such as 'probable COVID-19' or 'likely
COVID-19'." The CDC also noted "It Is not likely that NCHS will follow up on these cases" and
while the "underlying cause depends upon what and where conditions are reported on the death
certificate, ... the rules for coding and selection of the ... cause of death are expected to result in
COVID–19 being the underlying cause more often than not." [84]
On 16 April 2020, the WHO, in its formal publication of the two codes, U07.1 and U07.2,
"recognized that in many countries detail as to the laboratory confirmation ... will not be reported
[and] recommended, for mortality purposes only, to code COVID-19 provisionally to code U07.1
unless it is stated as 'probable' or 'suspected'."[86][87] It was also noted that the WHO "does not
distinguish" between infection by SARS-CoV-2 and COVID-19. [88]
Infection fatality ratio (IFR)

Coronaviruses
 show

Types

show

Diseases

show

Vaccines

show

Epidemics and pandemics

show

See also

 v
 t
 e

A crucial metric in assessing the severity of a disease is the infection fatality ratio (IFR), which is
the cumulative number of deaths attributed to the disease divided by the cumulative number of
infected individuals (including asymptomatic and undiagnosed infections) as measured or
estimated as of a specific date.[89][90][91] Epidemiologists frequently refer to this metric as the
'infection fatality rate' to clarify that it is expressed in percentage points (not as a decimal).
[92]
 Other published studies refer to this metric as the 'infection fatality risk'. [93][94]
In November 2020, a review article in Nature reported estimates of population-weighted IFRs for
a number of countries, excluding deaths in elderly care facilities, and found a median range of
0.24% to 1.49%.[95]
In December 2020, a systematic review and meta-analysis published in the European Journal of
Epidemiology estimated that population-weighted IFR was 0.5% to 1% in some countries
(France, Netherlands, New Zealand, and Portugal), 1% to 2% in several other countries
(Australia, England, Lithuania, and Spain), and about 2.5% in Italy; these estimates included
fatalities in elderly care facilities.[96] This study also found that most of the differences in IFR
across locations reflected corresponding differences in the age composition of the population
and the age-specific pattern of infection rates, due to very low IFRs for children and younger
adults (e.g., 0.002% at age 10 and 0.01% at age 25) and progressively higher IFRs for older
adults (0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). [96] These results
were also highlighted in a December 2020 report issued by the World Health Organization. [97]
IFR estimate per age group[96]

Age group IFR

0–34 0.004%

35–44 0.068%

45–54 0.23%

55–64 0.75%

65–74 2.5%

75–84 8.5%

85 + 28.3%

Burial of a deceased COVID-19 patient in Hamadan, Iran, March 2020

An analysis of those IFR rates indicates that COVID-19 is hazardous not only for the elderly but
also for middle-aged adults, for whom a fatal COVID-19 infection is two orders of magnitude
more likely than the annualised risk of a fatal automobile accident and far more dangerous than
seasonal influenza.[96]
Case fatality ratio (CFR)
Another metric in assessing death rate is the case fatality ratio (CFR),[a] which is deaths attributed
to disease divided by individuals diagnosed to-date. This metric can be misleading because of
the delay between symptom onset and death and because testing focuses on individuals with
symptoms (and particularly on those manifesting more severe symptoms). [88] On 4 August 2020,
WHO indicated "at this early stage of the pandemic, most estimates of fatality ratios have been
based on cases detected through surveillance and calculated using crude methods, giving rise to
widely variable estimates of CFR by country – from less than 0.1% to over 25%." [90]

Disease
Main article: COVID-19

Signs and symptoms

Main article: Symptoms of COVID-19
Symptoms of COVID-19

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness.[98][99] Common

symptoms include headache, loss of smell and taste, nasal congestion and runny
nose, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties.[100] People with
the same infection may have different symptoms, and their symptoms may change over time.
Three common clusters of symptoms have been identified: one respiratory symptom cluster with
cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle
and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain,
vomiting, and diarrhea.[100] In people without prior ear, nose, and throat disorders, loss of
taste combined with loss of smell is associated with COVID-19.[101]
Of people who show symptoms, 81% develop only mild to moderate symptoms (up to
mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50%
lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory
failure, shock, or multiorgan dysfunction).[102] At least a third of the people who are infected with
the virus do not develop noticeable symptoms at any point in time. [103]
[104]
 These asymptomatic carriers tend not to get tested and can spread the disease. [104][105][106]
[107]
 Other infected people will develop symptoms later, called "pre-symptomatic", or have very
mild symptoms and can also spread the virus.[107]
As is common with infections, there is a delay between the moment a person first becomes
infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five
days.[108] Most symptomatic people experience symptoms within two to seven days after
exposure, and almost all will experience at least one symptom within 12 days. [108][109]
Most people recover from the acute phase of the disease. However, some people – over half of
a cohort of home-isolated young patients[110][111] – continue to experience a range of effects, such
as fatigue, for months after recovery, a condition called long COVID; long-term damage to
organs has been observed. Multi-year studies are underway to further investigate the long-term
effects of the disease.[112]

Transmission
Main article: Transmission of COVID-19

The respiratory route of spread of COVID-19, encompassing larger droplets and aerosols.

The disease is mainly transmitted via the airborne route when people inhale droplets and small
airborne particles (that form an aerosol) that infected people breath out as they breathe, talk,
cough, sneeze, or sing.[113][114][115] Infected people are more likely to transmit COVID-19 when they
are physically close. However, infection can occur over longer distances, particularly indoors. [113]
[116]

Infectivity begins as early as three days before symptoms appear, and people are most infectious
just prior to and during the onset of symptoms.[117] It declines after the first week, but infected
people remain contagious for up to 20 days. People can spread the disease even if they
are asymptomatic.[118][119][117]
Infectious particles range in size from aerosols that remain suspended in the air for long periods
of time to larger droplets that remain airborne or fall to the ground. [120][121] Various groups utilise
terms such as "airborne" and "droplet" both in technical and general ways, leading to confusion
around terminology.[122] Additionally, COVID-19 research has redefined the traditional
understanding of how respiratory viruses are transmitted. [121][123] The largest droplets of respiratory
fluid do not travel far, and can be inhaled or land on mucous membranes on the eyes, nose, or
mouth to infect.[120] Aerosols are highest in concentration when people are in close proximity,
which leads to easier viral transmission when people are physically close, [120][121][123] but airborne
transmission can occur at longer distances, mainly in locations that are poorly ventilated; [120] in
those conditions small particles can remain suspended in the air for minutes to hours. [120]
The number of people generally infected by one infected person varies; [124] as only 10 to 20% of
people are responsible for the disease's spread. [125] It often spreads in clusters, where infections
can be traced back to an index case or geographical location. [126] Often in these
instances, superspreading events occur, where many people are infected by one person. [124]

Cause
Main article: Severe acute respiratory syndrome coronavirus 2

Illustration of SARS-CoV-2 virion

SARS-CoV-2 belongs to the broad family of viruses known as coronaviruses.[127] It is a positive-

sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses
infect humans, other mammals, and avian species, including livestock and companion animals.
[128]
 Human coronaviruses are capable of causing illnesses ranging from the common cold to more
severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ~34%). SARS-
CoV-2 is the seventh known coronavirus to infect people,
after 229E, NL63, OC43, HKU1, MERS-CoV, and the original SARS-CoV.[129]
Viral genetic sequence data can provide critical information about whether viruses separated by
time and space are likely to be epidemiologically linked. [130] With a sufficient number of
sequenced genomes, it is possible to reconstruct a phylogenetic tree of the mutation history of a
family of viruses. By 12 January 2020, five genomes of SARS-CoV-2 had been isolated from
Wuhan and reported by the Chinese Center for Disease Control and Prevention (CCDC) and
other institutions;[131][132] the number of genomes increased to 42 by 30 January 2020. [133] A
phylogenetic analysis of those samples showed they were "highly related with at most seven
mutations relative to a common ancestor", implying that the first human infection occurred in
November or December 2019.[133] Examination of the topology of the phylogenetic tree at the start
of the pandemic also found high similarities between human isolates. [134] As of
21 August 2021, 3,422 SARS-CoV-2 genomes, belonging to 19 strains, sampled on all
continents except Antarctica were publicly available. [135]

Diagnosis
Main article: COVID-19 § Diagnosis

Further information: COVID-19 testing

Demonstration of a nasopharyngeal swab for COVID-19 testing

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests,[136][137] which
detects the presence of viral RNA fragments.[138] As these tests detect RNA but not infectious
virus, its "ability to determine duration of infectivity of patients is limited." [139] The test is typically
done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or
sputum sample may also be used.[140][141] Results are generally available within hours.[136] The WHO
has published several testing protocols for the disease. [142]
Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical
suspicion of infection but are not recommended for routine screening. [143][144] Bilateral
multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are
common in early infection.[143][145] Subpleural dominance, crazy paving (lobular septal thickening
with variable alveolar filling), and consolidation may appear as the disease progresses.[143]
[146]
 Characteristic imaging features on chest radiographs and computed tomography (CT) of
people who are symptomatic include asymmetric peripheral ground-glass opacities
without pleural effusions.[147]

Prevention
Further information: COVID-19 § Prevention, Face masks during the COVID-19 pandemic,
and Social distancing measures related to the COVID-19 pandemic

Without pandemic containment measures – such as social distancing, vaccination, and face masks –
pathogens can spread exponentially.[148] This graphic shows how early adoption of containment measures
tends to protect wider swaths of the population.
Preventive measures to reduce the chances of infection include getting vaccinated, staying at
home, wearing a mask in public, avoiding crowded places, keeping distance from others,
ventilating indoor spaces, managing potential exposure durations, [149] washing hands with soap
and water often and for at least twenty seconds, practising good respiratory hygiene, and
avoiding touching the eyes, nose, or mouth with unwashed hands. [150][151]
Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to
stay home except to get medical care, call ahead before visiting a healthcare provider, wear a
face mask before entering the healthcare provider's office and when in any room or vehicle with
another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and
water and avoid sharing personal household items. [152][153]

Vaccines
Main article: COVID-19 vaccine

See also: History of COVID-19 vaccine development and Deployment of COVID-19 vaccines

A doctor at Walter Reed National Military Medical Center receiving a COVID-19 vaccination

A COVID-19 vaccine is a vaccine intended to provide acquired immunity against severe acute

respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease
2019 (COVID-19). Prior to the COVID-19 pandemic, an established body of knowledge existed
about the structure and function of coronaviruses causing diseases like severe acute respiratory
syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated
the development of various vaccine platforms during early 2020.[154] The initial focus of SARS-
CoV-2 vaccines was on preventing symptomatic, often severe illness.[155] On 10 January 2020,
the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the
global pharmaceutical industry announced a major commitment to address COVID-19. [156] The
COVID-19 vaccines are widely credited for their role in reducing the spread, severity, and death
caused by COVID-19.[157]
Many countries have implemented phased distribution plans that prioritize those at highest risk of
complications, such as the elderly, and those at high risk of exposure and transmission, such as
healthcare workers.[158] Single dose interim use is under consideration to extend vaccination to as
many people as possible until vaccine availability improves. [159][160][161][162]

On 21 December 2020, the European Union approved the Pfizer BioNTech vaccine.

Vaccinations began to be administered on 27 December 2020. The Moderna vaccine was
authorised on 6 January 2021 and the AstraZeneca vaccine was authorised on 29 January 2021.
[163]
Vaccinations at an old people's home in Gijón, Spain

On 4 February 2020, US Secretary of Health and Human Services Alex Azar published a notice

of declaration under the Public Readiness and Emergency Preparedness Act for medical
countermeasures against COVID-19, covering "any vaccine, used to treat, diagnose, cure,
prevent, or mitigate COVID-19, or the transmission of SARS-CoV-2 or a virus mutating
therefrom", and stating that the declaration precludes "liability claims alleging negligence by a
manufacturer in creating a vaccine, or negligence by a health care provider in prescribing the
wrong dose, absent willful misconduct". [164] The declaration is effective in the United States
through 1 October 2024.[165] On 8 December, it was reported that the AstraZeneca vaccine is
about 70% effective, according to a study.[166]
As of mid-August 2021, more than 4.6 billion doses of COVID-19 vaccines have been
administered in over 190 countries worldwide. The Oxford-AstraZeneca vaccine is the most
widely used around the globe. [167]