It has been now almost two months since the first reported case of the Coronavirus in Wuhan (China), which was later termed COVID-19 by the World Health Organisation (WHO). With 2,012 deaths (status 19.02.2020, WHO), the death toll has already by far outnumbered the SARS epidemic in 2003, which claimed 774 lives. Johns Hopkins CSSE has created a dynamic and comprehensible overview on the number and locations of COVID-19 cases, which demonstrate its rapid spread over countries and continents. [1-4]
Doctors and scientists have provided us with many insights over the last weeks. We have collected answers to some of the most interesting questions, also from an interdisciplinary point of view:
- Which insights have been gained on the epidemiology of COVID-19 and how dangerous is it?
- How have different sectors reacted to the 2019-nCoV outbreak?
- Which measures have different countries undertaken to contain the spread of the COVID-19?
Almost two months since the first case of the coronavirus. Which insights have already been gained?
Since the warning issued by the WHO and US Centers for Disease Control (CDC) on January 9 and January 6, respectively, many new insights were gained. In brief:
What is a Coronavirus?
A virus is a small infectious agent which consists of a protein shell that contains genetic material. Once inside an organism, it is capable to replicate within the host, eventually releasing its daughter viruses by bursting the host cell. Its viral surface protein can be recognised by the immune system as “non-self”, leading to an immune reaction which can range from flu-like symptoms to severe pneumonia as in the case of COVID-19. Characteristically for Coronaviruses is that their genetic material comprises of RNA. The name “corona” is derived from the Latin word for “crown”, which refers to their morphology. [1,5-6]
Origin of the COVID-19
Initially, it was assumed that the COVID-19 was most likely transmitted by bats, as its genetic material showed a 96% similarity to coronavirus samples collected from bats. However, it was thought probable there was still an intermediate host. New evidence might have closed the gap between humans and bats, assuming the intermediate host were pangolins, which showed a 99% genetic similarity. To obtain definitive proof, however, it would require testing of all animals which were traded on the market in Wuhan where the virus initially broke out. [1,5,7]
Transmission and incubation times
According to the US CDC, the COVID-19 is mainly spread through respiratory droplets. A recent study published in the Journal of the American Medical Association assumed that a secondary path of transmission might be via feces. In contrast, the assumption that transmission might also occur when the infected person was asymptomatic, as it was published in the New England Journal of Medicine, was proven faulty. Incubation times range from 3 to 14 days. [1,5,8-10]
How dangerous is the COVID-19?
Key factors which determine the severity of a virus are the number of infected people and the number of people who become severely ill. According to the WHO, the fatality of the COVID-19 virus currently amounts to approximately 2%. Compared to other viruses who caused epidemics in recent history, that is a fairly low rate. The SARS-virus’ fatality amounted to 10%, Ebola virus’ to 44%, and the Marburg virus’ even to 81%. However, this number needs to be taken with caution, as the COVID-19 epidemic is still in an early stage. [1,5,11]
Generally, it is mainly people of high age or with pre-existing medical conditions who are at the highest risk to become severely ill. [1,5]
The epidemic spreads – across day-to-day life, economy, healthcare systems, and politics
The effects the COVID-19 epidemic are of such extent, that they penetrate every aspect of life in the cities most severely hit by the outbreak, but also have detrimental consequences on the international economy. Politics and healthcare systems are put to the test.
With the lockdown of entire cities, closing of borders and travel restrictions, especially China’s economy is largely affected, also rattling entire supply chains across countries. In the New York Times it was reported that, for example, Under Armour would take a hit of $50 million to $60 million in revenues within the first few months because of the outbreak. The Disney theme parks which were shut in Shanghai and Hong Kong reported that their closing would reduce the company’s income by $175 million in the second quarter. 
Estimations so far indicate that the COVID-19 outbreak might affect the Chinese economy even stronger than in the aftermath of the SARS outbreak in 2003. Alicia García-Herrero, the chief economist for the Asia-Pacific at the French bank Natixis noted in a LinkedIn article that the coronavirus was hitting a weaker economy than back during the SRAS epidemic. She mentioned two reasons: First, the service sector was the key engine nowadays, which is also more severely affected than the manufacturing sector, China’s strongest sector in 2003. Second, the trade war with the USA negatively affected the investor relations. [13,14]
Different Healthcare systems are differently prepared for COVID-19 cases in their countries. Some highlighted facts and statements:
With the Chinese city of Wuhan being the origin of the COVID-19 virus, and the rapid spread through densely populated cities, China is by far the most severely affected country by the coronavirus, putting their healthcare system to test. The thousands of cases are undoubtedly overwhelming the country, drawing on drug supplies and human resources. This healthcare emergency revealed many of the weak points in the Chinese healthcare system, like the understaffed hospital personnel, lack of emergency supplies, and the unequal distribution of medical resources across China. Two temporary hospitals are currently being built by Chinese authorities to cope with the surge of infections. [15,16]
“Germany is well prepared for a pandemic,” a spokesperson for Health Minister Jens Spahn, told Welt on January 26. He continued: “There are clear pandemic plans, regular exercises and the resources to react quickly and effectively. We are constantly coordinating with all relevant national and international authorities on the situation.” This information was backed by the German Federal Ministry for Health. [17,18]
The Charité Virology Lab of Prof. Christian Drosten developed a COVID-19 diagnostic test, which delivers results within five hours. Being based on a so-called polymerase chain reaction, its development was only able after Chinese researchers published the genomic sequence of the virus in January. 
The University Center for Infectious Disease Research and Policy at the University of Minnesota has identified 153 life-saving drugs indispensable in the daily routines of US clinics, many of which are manufactured in China. Already now, 63 of these are not available to pharmacies on short notice or were put on shortage status. 
Jonathan Greene, director of emergency management and medical operations at the Department of Health and Human Services, told npr, that the surge capacity in the health care system was something that they thought a lot about and prepared for in the U.S. A diagnostic test could be developed within a few months, but as John Auerbach, president of Trust for America’s Health phrases in an article for npr: “Public health in America is generally underfunded and has been cut over the last decade.” 
According to the dynamic map by Johns Hopkins CSSE (status 19.02.2020) there has been only 1 case reported in the African countries so far. A larger spread of the epidemic within the African continent could pose a big threat, as there is a widespread lack of reagents for diagnostic testing. Many hospitals would not be prepared for a large number of cases of which statistically 25% require intensive care, as it was reported in The Guardian. The African CDC ran a workshop for scientists of 15 countries on COVID-19 diagnostic testing, seven of which count to the most vulnerable countries because of their contact to China according to the WHO. [4,22]
Although the newspapers were flooded with new information on a daily basis, there is still a lot of missing pieces in the puzzle. As science reporter Donald G. McNeil Jr. told in an interview with the New York Times: “In the beginning of every epidemic, there is the fog of war. I’d say we’re still in that fog.” It is only with open science, open communication, investments from governments in healthcare resources, and close collaboration that an epidemic like this can be contained. 
The COVID-19 epidemic has claimed more than 2,000 lives since its outbreak in December 2019. Read our News Review to get updated on the latest insights and developments.
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