2021 Coronavirus: the first three months as it happened

 11 March 16:35 GMT — Coronavirus outbreak is a pandemic, says WHO

After weeks of resisting mounting pressure from scientists, politicians and others, the World Health Organization (WHO) in Geneva, Switzerland, has decided to describe the coronavirus outbreak as a pandemic.

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The declaration comes after a 13-fold rise in the number of cases outside China in the past two weeks, and a trebling of countries affected — but does not change WHO strategy for tackling spread of the virus, director-general Tedros Adhanom Ghebreyesus said in an 11 March press briefing.

“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,” said Tedros.

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

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Many scientists had been calling for the change in language for weeks — after large outbreaks were detected in South Korea, Iran and Italy. At the time, some researchers suggested that countries would soon move from efforts that involve containing as many new cases as possible to social-distancing measures, such as school closures, that do not rely on knowing who is infected with the virus and who is not.

The virus has now been found in more than 100 countries. It has infected some 120,000 people, killing more than 4,000 of them. Several nations have closed schools in a bid to stop the virus, and Italy has entered an unprecedented countrywide lockdown.

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“This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight,” said Tedros.

Researchers have been working rapidly since the outbreak came to light in January to characterize the virus, work out why it is so infectious, find out where it came from and help with diagnosing infections.

11 March 12:30 GMT — Transgenic animals for coronavirus research in high demand

Labs are scrambling to get their hands on transgenic animals that can be used to study the coronavirus and test drugs and vaccines. Ordinary mice seem to be resistant to infection by this coronavirus, so researchers conduct studies in rodents that produce a human version of the protein ACE2, which the virus uses to enter cells.

Labs rush to study coronavirus in transgenic animals — some are in short supply

But these mice — originally developed for research into severe acute respiratory syndrome, or SARS — are in short supply. One US breeding facility, the Jackson Laboratory in Bar Harbor, Maine, has received requests for 3,000 mice, and is now establishing a colony of these animals.

Researchers have also already reported initial results from studies in monkeys infected with coronavirus. The animals seemed to experience only a mild illness, similar to that in many humans. Scientists are now seeking animal models to mimic the more severe version of the illness.

11 March 07:30 GMT — Major chemistry meeting among cancelled scientific conferences

The American Chemical Society (ACS), the world’s largest scientific society, cancelled its meeting in Philadelphia, Pennsylvania, on Monday, 13 days before it was due to begin on 22 March.

The conference is one of a growing number of scientific meetings and conferences being cancelled because of coronavirus outbreaks. Governments and health officials are increasingly calling for the restriction of large gatherings, in an attempt to reduce the virus’s spread.

The ACS said the decision to cancel was based on several factors, including a rise in COVID-19 cases in the greater Philadelphia area and input from members who were increasingly concerned about travelling to and attending a large meeting. About 800 participants had already cancelled their registrations before the announcement, an ACS press officer told Nature.

The American Physical Society’s huge March Meeting was also cancelled last week, about a day before it was due to begin. Scores of other meetings are being postponed or being held virtually.

10 March 03:30 GMT — Call for more funding

At least US$8 billion is needed to address the most pressing threats posed by the new coronavirus, says the Global Preparedness Monitoring Board (GPMB), an independent group co-convened by the World Health Organization and the World Bank Group to combat public-health emergencies.

The money is needed in addition to the tens of billions of dollars already pledged by the International Monetary Fund, the World Bank Group and individual governments.

The GPMB released a report on 9 March calling on advanced economies, such as the members of the Group of Seven and Group of 20 industrialized nations, and financial institutions, to provide money to address five priority areas. These include strengthening weak health-care systems; supporting the World Health Organization’s efforts to help vulnerable countries; developing diagnostics, therapeutics and vaccines; strengthening regional surveillance; and ensuring that sufficient protective equipment is available for health workers.

9 March 04:00 GMT — Global cases pass 100,000

The number of known global cases of COVID-19 passed 100,000 over the weekend. On 8 March, the World Health Organization reported 105,586 confirmed cases across more than 100 countries and territories. Although the outbreak has been slowing in China, where it originated, the country still accounts for almost 80% of confirmed cases.

6 March 11:30 GMT — US Congress approves US$8.3 billion for coronavirus response

The United States Congress has passed an emergency spending bill that will allocate US$8.3 billion for the country’s coronavirus response. The House of Representatives passed the bill in a near-unanimous vote on Wednesday afternoon; the Senate followed suit on Thursday.

The bill will provide more than $3 billion to the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration for research on diagnostics, therapeutics and vaccines. Each US state will reportedly receive at least $4 million for state and local government responses. The bill also includes a provision to ensure that an eventual vaccine is affordable.

Other funding will contribute to the global coronavirus response and provide support for small businesses that are struggling in the wake of the outbreak. The bill will now go to President Donald Trump to be signed.

Elsewhere, the US National Science Foundation in Alexandria, Virginia, opened up a Rapid Response Research funding mechanism for non-medical coronavirus-related research. Such calls are often used to award funding for work exploring the impacts of natural disasters such as hurricanes and wildfires, and allow for an expedited review of research proposals.

5 March 15:30 GMT — China study suggests children are as likely to be infected as adults

Children are just as likely to become infected with the new coronavirus as adults, finds one of the most detailed studies yet published on the spread of the virus, known as SARS-CoV-2. The analysis — based on data from Shenzhen in China — provides a partial answer to one of the most pressing questions surrounding the outbreak: the role of children.

Previous studies have suggested that kids are much less likely than other age groups to develop severe symptoms when infected by the coronavirus. But it was not clear whether this was because they weren’t getting infected or because they were fighting off the infection more effectively.

“Kids are just as likely to get infected and they’re not getting sick,” says Justin Lessler, an infectious-disease epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. He co-led the study with three other epidemiologists — Qifang Bi, also at Johns Hopkins, Ting Ma at the Harbin Institute of Technology in Shenzhen and Tiejian Feng at the Shenzhen Center for Disease Control and Prevention. They posted the analysis to the medRxiv preprint server on 4 March.

The study is unique in that it looked at not only people who were infected with the virus, but also large numbers of their close contacts, some of whom were infected and many of whom were not. The researchers followed 391 people who were diagnosed on the basis of their symptoms, and 1,286 of their close contacts to see whether these contacts tested positive for the virus even if they didn’t show symptoms. Overall, the team found that children under 10 who had potentially been exposed to the virus were just as likely to become infected as other age groups, with between 7% and 8% of contacts of known cases later testing positive.

The authors also found that people who lived in the same household as someone infected with the virus were about six times more likely get infected than those who made contact with an infected person in other settings.

“This may be the first clear evidence that children are as susceptible as adults to SARS-CoV-2 infection,” says Ben Cowling, an infectious-disease epidemiologist at the University of Hong Kong. He wonders whether the fact that outbreaks haven’t been observed in schools could be down to the fact that children’s symptoms are mild.

Lessler says it’s still not clear whether children are important in transmitting the virus, as they are for influenza; children routinely develop flu symptoms and are common hubs in chains of transmission. “That’s one of the current critical remaining questions and we’re trying to figure out how to answer it,” he says. “I have a 7-month-old and a 6-year-old and I can’t imagine that, if they have any virus at all, they’re not getting it on somebody.”

The study could have important implications for slowing the spread of the virus through measures such as school closures. “Once we say containment is not an option, we can’t ignore the kids,” says Lessler.

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“This is a key piece of data that may support school closures as an effective intervention,” Caitlin Rivers, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said in a tweet on 5 March.

5 March 12:55 GMT — World Bank pledges US$12 billion for coronavirus response

On 3 March, the World Bank Group pledged up to US$12 billion, including $8 billion in new funding, to support countries dealing with the coronavirus outbreak. The funding will be fast-tracked and consists of grants and low-interest loans, as well as technical support.

Most of the package is earmarked for strengthening health systems and improving access to treatment. The World Bank said it would prioritize funding for countries at high risk and with low capacity to deal with the outbreak. Half of the pledged money is from the International Finance Corporation, and is intended to strengthen global supply chains and support key industries such as pharmaceuticals.

4 March 12:00 GMT — Repurposed drugs in coronavirus spotlight

More than 80 clinical trials launch to test coronavirus treatments

Drugs used to treat HIV and an experimental antiviral drug developed to fight Ebola virus are among those that are rapidly being tested against the new coronavirus. There are no approved treatments for diseases caused by coronaviruses. But hundreds of clinical trials of drug candidates are planned or underway, with much of the focus on remdesivir, a candidate drug originally developed to treat the Ebola virus.

The drug, developed by the pharmaceutical firm Gilead Sciences of Foster City, California, is being tested in partnership with Chinese health authorities in randomized, controlled trials; two of these are set to finish in April. The compound works by trying to prevent the replication of the virus. “Remdesivir has quite high efficacy across all different coronaviruses and therefore it is one of the prime candidates to start being tested,” says Vincent Munster, chief of the viral ecology unit at the US National Institutes of Health.

2 March 21:00 GMT — Infections worldwide top 90,000

The number of people worldwide who have been infected with the coronavirus has passed 90,000. More than 3,000 have died since the outbreak began in December. The vast majority of cases — more than 80,000 — have occurred in China, but around 60 other countries are now also dealing with outbreaks. Many nations are preparing for a global pandemic, as reports of cases caused by spread within communities — rather than being imported from China — rise.

South Korea, Italy and Iran are fighting the largest outbreaks outside China.

Source: Johns Hopkins University

2 March 20:45 GMT — WHO raises alert to ‘very high’

At a press briefing on 29 February, the World Health Organization (WHO) announced that it had raised the global alert for COVID-19 to the highest possible level, short of calling it a pandemic. The virus has now spread to some 60 locations outside China, with new cases detected in Ireland, Monaco, Azerbaijan, Qatar and Ecuador.

The global alert for the spread and impact of the coronavirus outbreak increased from ‘high’ to ‘very high’. The alert remains ‘very high’ in China.

The global change was based on an assessment by WHO epidemiologists, which took into account the continued increase in the number of cases and affected locations, and the difficulties that some regions, including Iran and Italy, are facing in containing the spread of the coronavirus.

Tedros Adhanom Ghebreyesus, director-general of the WHO, said at the briefing that most cases were linked and could still be traced to known contacts or clusters, with no evidence of the virus spreading freely in communities. “As long as that is the case, we still have a chance of containing this virus, if robust action is taken to detect cases early, isolate and care for patients and trace contacts,” said Tedros.

The organization therefore once again resisted declaring the outbreak a pandemic. Mike Ryan, director of the WHO’s emergencies programme, said that such a decision would mean that efforts to contain and slow down the spread of the virus have failed, which has proved to be untrue in China, Singapore and other regions.

The WHO is still holding out hope that the virus can be contained, but we have probably crossed that threshold, says Adam Kamradt-Scott, a global health-security researcher at the University of Sydney, Australia.

Some countries have already begun to prepare their pandemic plans, which is an important precautionary measure, says Nigel McMillan, an infectious-disease researcher at Griffith University in Brisbane. Australia, for example, initiated its coronavirus emergency response on 27 February. The WHO is being overly cautious in not declaring a pandemic, says McMillan.

2 March 20:30 GMT — Transmission details emerge from WHO China analysis

China has mounted “perhaps the most ambitious, agile and aggressive disease containment effort in history” against a new infectious disease, the World Health Organization (WHO) said in a report released on 28 February, after nine days of meetings and site visits in China from 16 to 24 February. The report analyses data from the outbreak in China, and recommends steps that the country and others should take to curb COVID-19.

Daily reports of new cases are declining in the country, the WHO confirmed — so much so that authorities are now having problems recruiting participants for the more than 80 clinical trials there that are testing potential treatments for the coronavirus. Some experimental treatments should be prioritized over others, the health agency recommended.

The report’s analysis of data from China finds 99.9% similarity between the 104 strains of the coronavirus, named SARS-CoV-2, collected from people between December 2019 and mid-February 2020. This means that the virus is not mutating significantly. The median age of people infected is 51 years. And most cases of spread from person to person have been in hospitals, prisons or households, which implies that close contact is often required for the virus to spread between people. Airborne spread is not believed to be a major driver of transmission, the report says. In one preliminary study from the province of Guangdong, people in the same household as someone with COVID-19 had a 3–10% chance of being infected.

The WHO credits China’s ability to rein in the epidemic to a variety of measures. One is that 1,800 teams of epidemiologists have rapidly tracked tens of thousands of contacts of people infected with the virus in Hubei province, where the outbreak emerged. Up to 5% of these contacts ended up having the disease and were diagnosed quickly. And the report says the lockdown on travel out of Hubei — an unprecedented measure in a province of this size — curbed wider spread of the disease to China’s 1.4 billion citizens.

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