The outbreak of COVID-19 sparked global anxiety and concern around the world. What are the realities of the pandemic? We investigate.

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In December 2019, reports emerged that a coronavirus that specialists had never seen before in humans had begun to spread among the population of Wuhan, a large city in the Chinese province of Hubei.

From there, the virus spread around the world, leading the World Health Organization (WHO) to declare this a pandemic in March 2020.

The novel coronavirus — called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) — has been responsible for millions of infections and more than 2 million deaths. The highest number of deaths has occurred in the United States.

As the pandemic persists, scientists continue to make discoveries that may help find ways to treat and prevent infection with the virus.

This article aims to answer some questions that people are asking about the virus and the pandemic.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

SARS-CoV-2 is a coronavirus that causes coronavirus disease 2019 (COVID-19). Coronaviruses are a family of viruses that target and affect mammals’ respiratory systems.

There are four main ranks of coronaviruses: alpha, beta, delta, and gamma. Most of these only affect animals, but some of the alpha and beta types can pass to humans.

Only two coronaviruses have previously caused global outbreaks.

The SARS coronavirus — responsible for severe acute respiratory syndrome (SARS) — started spreading in 2002 in China. It mainly affected the populations of mainland China and Hong Kong, and it disappeared in 2003.

The MERS coronavirus — responsible for Middle East respiratory syndrome (MERS) — emerged in Saudi Arabia in 2012. It has led to 858 deaths since then.

When humans first contract a coronavirus, it usually results from contact with an infected animal.

Some of the most common carriers are bats, though they do not typically transmit coronaviruses directly to humans. Instead, the virus might pass through an intermediary animal, which will usually, though not always, be a domestic one.

The SARS coronavirus spread to humans via civet cats, while the MERS virus spread via dromedaries, a type of camel. However, determining which type of animal is transmitting a coronavirus to humans can be difficult.

In the case of SARS-CoV-2, initial reports from China tied the outbreak to a seafood market in central Wuhan. As a result, local authorities closed down the market on January 1, 2020.

However, later assessments suggested that this market was unlikely to be the single source of the coronavirus outbreak, as some people with the virus early on had no connection with it.

Specialists have not yet been able to determine the true source of the virus or even confirm whether there was a single original reservoir.

When MNT contacted the WHO for comment, their spokespeople emphasized:

“We don’t yet know [what the specific source of SARS-CoV-2 was]. Researchers in China are studying this but have not yet identified a source.”

Although it likely originated in animals, SARS-CoV-2 now transmits directly between people.

The Centers for Disease Control and Prevention (CDC) warn that people can pass on the virus even if they never have symptoms of the infection.

A person can also transmit the virus before symptoms appear. This asymptomatic period usually lasts for 2–14 days after exposure to the virus.

For this reason, everyone should take steps to prevent transmission, such as:

  • washing the hands frequently
  • wearing a face-covering in public
  • staying at least 6 feet (2 meters) away from others
  • avoiding crowded places

In January 2020 scientists found that, genetically, SARS-CoV-2 is most similar to two bat coronaviruses: bat-SL-CoVZC45 and bat-SL-CoVZXC21. Its genomic sequence is 88% the same as theirs.

The same study showed that the RNA of SARS-CoV-2 is about 79% the same as that of the SARS coronavirus and approximately 50% the same as that of the MERS virus.

Earlier research suggested that pangolins may have been the initial propagators of SARS-CoV-2 among humans, as the virus’s genomic sequence appears to be 99% the same as that of a coronavirus specific to these animals.

More recent research, however, including a study from October 2020, emphasizes that pangolins, bats, and other animals are not to blame for epidemics or pandemics affecting humans.

Instead, the real triggers are societal structures that drive human-animal contact. Blaming wildlife can also lead to unnecessary slaughter and the devastating loss of wildlife biodiversity, the researchers explain.

As with other coronaviruses, SARS-CoV-2 causes symptoms of respiratory disease.

According to the CDC, the symptoms of COVID-19 can include:

  • a cough
  • shortness of breath and difficulty breathing
  • fatigue
  • a headache
  • congestion or a runny nose
  • a fever
  • chills
  • muscle pain
  • a sore throat
  • a new loss of taste or smell
  • nausea or vomiting
  • diarrhea

A study published in The Lancet reports that around 81% of people with COVID-19 have mild symptoms and do not require hospitalization.

“Current information suggests that the virus can cause mild flu-like symptoms as well as more severe disease. Most [people] seem to have mild disease, and up to 20% appear to progress to more severe disease, including pneumonia, respiratory failure, and in some cases, death,” WHO spokespeople told MNT.

In an official WHO interview in early 2020, Dr. Maria Van Kerkhove explained that because the symptoms of COVID-19 can be very generic, it can be difficult to distinguish between them and the symptoms of other respiratory infections.

To understand exactly what a person is dealing with, she said, specialists test viral samples, checking to see whether the virus’s RNA structure matches that of SARS-CoV-2.

Now, tests are widely available in many countries. People who may have symptoms of COVID-19 or may have had exposure to the virus can seek a test to confirm whether the virus is present in their body.

The WHO officially classified COVID-19 as a pandemic on March 11, 2020.

In a declaration, WHO Director-General Dr. Tedros Adhanom Ghebreyesus stated:

“[The] WHO has been assessing this outbreak around the clock, and we are deeply concerned, both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have, therefore, made the assessment that COVID-19 can be characterized as a pandemic.

‘Pandemic’ is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change [the] WHO’s assessment of the threat posed by this virus. It doesn’t change what [the] WHO is doing, and it doesn’t change what countries should do.”

The global implications have been severe. Since March 2020, schools have closed, people have worked from home when possible, and many businesses have closed their doors, some for good.

Countries have closed their international borders and discouraged travel unless it is deemed essential.

In the U.S., the White House set guidelines advising people to physically distance, avoid large gatherings, and practice good hygiene. Some states also have their own measures. Find out about state and local guidance here.

Meanwhile, many questions remain about the nature of SARS-CoV-2 and what the future holds, especially now that new variants are emerging.

Reported mortality rates vary from country to country. The current COVID-19 case fatality rate in the U.S. appears to be around 1.7%. This number is lower than it was earlier in the pandemic — but that is partly because more people are undergoing tests, even when they have mild or no symptoms.

In response to questions about this, WHO spokespeople told MNT: “This is a new disease, and our understanding is changing rapidly. We will continue to analyze information on both current and any new cases.”

“With MERS, we know that approximately 35% of reported patients with [MERS coronavirus] infection have died. [The] WHO estimated that the case fatality ratio of SARS ranges from 0–50%, depending on the age group affected, with an overall estimate of case fatality of 14–15%.”

Experts no longer consider SARS a risk. The WHO report that since 2003, there have only been a few cases of the disease, resulting from laboratory accidents or, possibly, transmission from animals.

According to research, SARS-CoV-2 seems to be more infectious than other coronaviruses — such as those that cause SARS and MERS — but less likely to lead to death.

However, the CDC note that older adults and people of any age with certain health conditions, such as cancer, type 2 diabetes, and some heart-related issues have a higher risk of severe illness due to COVID-19.

Reports suggest that COVID-19 seems to be equally prevalent among all genders but that males are more likely than females to have worse outcomes and death rates. This difference may be due to biological, behavioral, or social factors.

Read more about sex differences and COVID-19 here.

There have been fewer reported cases of COVID-19 in children than in adults. Children tend to have mild or no symptoms.

However, infants under 1 year old and children with certain medical conditions might have an increased risk of severe illness from COVID-19.

Some children with COVID-19 have developed a rare but serious condition called multisystem inflammatory syndrome in children, known as MIS-C. The condition has features similar to those of Kawasaki disease and toxic shock syndrome.

This syndrome is rare. Researchers are still investigating its causes and possible connection with COVID-19.

During pregnancy, people may have an increased risk of severe illness from COVID-19 and a higher risk of some complications, such as preterm birth. It is uncommon for a pregnant person to transmit COVID-19 to a newborn, but it can happen.

Read more about pregnancy and COVID-19 here.

A study from the United Kingdom published in May 2020 and currently available online in preprint form, found that Black women and women of marginalized ethnic groups accounted for more than half of the pregnant women hospitalized with COVID-19.

This finding is among a mounting body of evidence that COVID-19 has a disproportionate effect on people who are Black, Asian, or of other marginalized ethnicities. Some experts explain that this stems from widespread discrimination and systemic racism in healthcare.

Read more about racial inequalities in COVID-19 and healthcare here.

Prevention guidelines urge people to have excellent personal hygiene and avoid close contact with others.

Experts believe that SARS-CoV-2 transmits through respiratory droplets. The CDC recommend maintaining a distance of at least 6 feet (2 meters) from other people to avoid contact with these droplets.

There is currently no evidence that the virus transmits through eating food or drinking water. A person could contract the virus from touching contaminated food packaging, but experts believe that this is not the main way that the virus spreads.

People should wash their hands with soap and water for at least 20 seconds at a time before preparing or eating food.

The CDC recommend wearing a cloth face covering when out in public, such as when going to the grocery store. This is to slow the spread of the virus and prevent its transmission — which can occur even among people who have no symptoms.

Learn how to make face masks here.

People who have symptoms or believe they may have been exposed to the virus can seek a test. State and local health department websites have information about testing facilities.

The Food and Drug Administration (FDA) has approved some COVID-19 home testing kits. Using the cotton swab in the kit, a person can collect a nasal sample and mail it to a designated laboratory for testing.

There is currently no cure for COVID-19, but some treatments may help manage symptoms.

Most people do not need hospital care but should rest at home and avoid all contact with others. Symptoms generally improve in about 2 weeks, according to an ongoing survey in the U.K.

People with severe symptoms may need to spend time in a hospital. They may need oxygen therapy and the use of a mechanical respirator.

In the U.S., two drugs have approval specifically for use against COVID-19 in hospitals. Remdesivir (Veklury), is an antiviral drug that may slow the progress of the underlying virus. The other is dexamethasone (Decadron), a corticosteroid that can help manage inflammation.

Over the years, researchers have looked into treatments and vaccines for other coronaviruses, and these may prove useful against the virus that causes COVID-19. A drug that already has approval for other uses is more likely to be safe.

The FDA have a special emergency program to investigate potential COVID-19 treatments. As of January 2021, they have reviewed more than 400 trials, and more than 591 drug development programs are underway.

Several large international trials are also ongoing in the search for a treatment. The WHO launched the largest of these, which is called Solidarity and involves more than 100 countries.

Medications

So far, only dexamethasone and remdesivir have approval for use in the U.S., where their respective brand names are Decadron and Veklury.

Other relevant treatments that have approval for emergency use only in the U.S. are:

Several drugs are currently in phase 3 clinical trials, which are late-stage, large-scale studies. These include:

  • tocilizumab (Actemra), an immunosuppressant drug that doctors use to treat arthritis
  • bucillamine, another anti-arthritis drug
  • apixaban (Eliquis), a blood thinner
  • heparin, another blood thinner

The FDA withdrew emergency approval for the malaria drugs hydroxychloroquine and chloroquine after new evidence suggested that the risks of taking each outweighed the benefits for people with COVID-19.

Vaccines

Researchers have been racing to find a vaccine to prevent COVID-19.

Two vaccines currently have FDA approval for use in the U.S. These are the Pfizer-BioNTech vaccine and the Moderna vaccine.

A vaccination program started in the U.S. in December 2020. The vaccine itself is free. A person may need to pay an administrative fee, however. This will be reimbursed by insurance companies or the Department of Health and Human Services.

Other vaccines are under development, and some others already have approval for use in other countries.

Read more from the WHO on vaccines.

For more information about the ongoing pandemic and for detailed guidelines, here are a few international resources:

MNT will continue to report on developments, ensuring that our readers are well-supplied with accurate, up-to-date information.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.