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July 2, 2020
COVID-19 at Six Months
Six months ago, in late December 2019, reports emerged about
27 cases of unidentified pneumonia
in Wuhan, China, potentially linked to a local market. At that time, very little was known about the disease, pathogen, or origin of the outbreak, and while we have learned much over the past 6 months, many mysteries remain.
The pandemic has grown to more than 10 million cases and 500,000 deaths across nearly every country around the world. As of
, the WHO reported 10.36 million cases and 508,055 deaths worldwide, covering more than 200 countries and territories. Among these countries and territories, 86 are reporting “Community Transmission”—the WHO’s highest tier—which indicates “larger outbreaks of local transmission,” “large numbers of cases not linkable to transmission chains,” and “multiple unrelated clusters in several areas of the country.”
The United States continues to lead the world in cumulative incidence, and it has recently alternated with Brazil as #1 for daily incidence. In total, 38 US states are reporting
increasing COVID-19 incidence
over the past 2 weeks, 24 are reporting
increasing COVID-19 hospitalizations
, and 20 are reporting test positivity greater than 5% and increasing. These concerning trends have prompted 13 states to
pause their recovery plans
and an additional 6 states to reverse course and re-implement or strengthen certain social distancing restrictions.
From the first reports of cases in China, our team at the Johns Hopkins Center for Health Security has been following and analyzing this situation closely. Thank you for reading our COVID-19 situation reports and learning alongside us as the pandemic spreads. We are grateful to our technical team, who pulls together these updates with diligence and rigor—Divya Hosangadi, Amanda Kobokovich, Elena Martin, Christina Potter, Marc Trotochaud, Rachel Vahey, and Matthew Watson; led by Matthew Shearer and Dr. Caitlin Rivers—as well as our communications team, Margaret Miller and Julia Cizek. Finally, thank you to our funders and donors who make these reports and the rest of our work possible.
In order to provide some context for the past 6 months, we have compiled a timeline of selected events since the onset of the pandemic:
: Wuhan Municipal Health Commission publishes the initial report of unidentified pneumonia, potentially linked to a local market
: US CDC issues a Level 1 travel watch for Wuhan, China
: First reported COVID-19 death in China
: First COVID-19 case reported outside of China
: First COVID-19 case reported in the US
: First imported COVID-19 cases reported in Europe (France)
: US CDC issues Level 3 travel warning for China, recommending against non-essential travel
: First documented SARS-CoV-2 transmission in Europe (Germany)
: First COVID-19 cases reported in Eastern Mediterranean Region (United Arab Emirates)
: WHO declares COVID-19 a Public Health Emergency of International Concern
: US CDC confirms first domestic transmission of SARS-CoV-2
: US implements travel restrictions for Mainland China
: The Diamond Princess cruise ship is quarantined in Yokohama, Japan, due to an ongoing COVID-19 outbreak onboard that resulted in at least 712 confirmed cases, including 9 deaths
: First COVID-19 case reported in the African Region (Algeria)*
: South Korea surpasses China as #1 globally in terms of daily COVID-19 incidence
: US implements travel restrictions for Iran
: Seattle and King County, Washington (US), advises high-risk individuals to avoid large gatherings
: Italy implements “lockdown” for affected areas of the Lombardy region in Northern Italy
: Italy expands “lockdown” measures to the entire country
: US implements travel restrictions for all of Europe
: WHO declares COVID-19 a pandemic
: US declares the COVID-19 epidemic to be a national emergency
: US implements travel restrictions for the UK and Ireland
: National “lockdown” goes into effect in Spain
: Six counties in the San Francisco Bay Area, California (US), issue the country’s first shelter-in-place orders
: The WHO announces the SOLIDARITY Trial, a global collaboration to conduct clinical trials for prospective COVID-19 medical countermeasures
: California (US) issues the first statewide “stay at home” order
: The University of Oxford (UK) begins enrolling patients for the RECOVERY Trial, a nationwide clinical trial effort in the UK for COVID-19 MCMs
: National “lockdown” ordered in India
: The International Olympic Committee announces that the 2020 Olympic Games, scheduled to be hosted in Japan, are postponed
: US CDC expands travel restrictions to cover
: US CDC issues domestic travel advisory for New York, New Jersey, and Connecticut
: Italy surpasses China as #1 globally in terms of cumulative COVID-19 incidence
: US surpasses Italy as #1 globally in terms of cumulative COVID-19 incidence (and remains #1 today)
: US government unveils Operation Warp Speed, a program to drive development and production of medical countermeasures against COVID-19
: WHO reports more than 100,000 new cases in a single day
: 5 million global cases
: US implements travel restrictions for Brazil
: US surpasses 100,000 cumulative reported COVID-19 deaths
: New York (US) enters Phase 1 of recovery (NYC on June 8)
: New Zealand declares SARS-CoV-2 eliminated
: European Commission recommends that European countries remove internal border restrictions by June 15 to enable travel within the continent
: European Council announces that European countries would lift travel restrictions for 15 countries beginning July 1
*Cases had been previously reported in Egypt, but Egypt is part of the Eastern Mediterranean Region.
The global situation has evolved dramatically since the onset of the pandemic. The initial focus was on Wuhan, as China instituted a strict “lockdown” of the city and its 11 million inhabitants that lasted months. The “lockdown” involved highly restrictive social and physical distancing measures, including a prohibition on entering or leaving the lockdown area. The virus quickly spread to and within countries around the world, gaining a foothold in communities in Europe, the Eastern Mediterranean, and the US that ultimately resulted in major national epidemics. As transmission increased across Europe and in the US, China successfully contained its epidemic. In addition to the “lockdown” in Wuhan, Chinese officials implemented intense contact tracing and testing efforts and rapidly expanded local health system capacity, including through the
construction of modular hospital facilities
As China contained the disease, the global COVID-19 burden shifted toward Europe and the US. As some countries began to gain control of their national epidemics, they looked ahead to relaxing social distancing measures and resuming social and economic activities. Some took slow, incremental approaches, while others progressed more rapidly. The pandemic continued to shift, sparking major epidemics in the Central and South American, Eastern Mediterranean, and South Asian regions, preying on areas that had not yet been severely affected. Portions of the US, particularly the New York City area, were severely affected early in the pandemic, but the country was able to begin bringing its epidemic under control from mid-April through the end of May, even as incidence shifted away from New York to other states and regions. As states began to ease social distancing measures, allowing “stay at home” and other statewide or regional orders to expire and promoting social and economic activity, areas that had not yet been severely affected began to report rapidly increasing incidence and other concerning COVID-19 trends.
Six months into the pandemic, the situation does not necessarily appear promising, but there is hope for the future.
Global incidence continues to increase exponentially, largely driven by major epidemics in multiple large countries, including Brazil, India, Mexico, and the US. And while most African countries have not reported elevated incidence, there is concern that limitations in testing and reporting may not be fully capturing the scale of the pandemic on the continent. Many experts believe that COVID-19 risk is growing and that we could be at the very beginning of a more serious “wave” of transmission that could last for months or longer.
Despite these concerning trends, there remains hope for the coming months. Numerous countries—including China, Italy, South Korea, Spain, and others that were severely affected early in the pandemic—have successfully brought their epidemics under control and achieved relatively low levels of transmission. New Zealand stands as an example to the rest of the world, having successfully eliminated COVID-19 earlier in June. These countries are providing templates for successful national-level responses and sharing lessons that other countries can leverage to improve their containment efforts.
Numerous efforts around the world are ongoing to develop, identify, and produce effective medical countermeasures against COVID-19. Several treatments have demonstrated some efficacy against COVID-19, including remdesivir and dexamethasone, and efforts are ongoing to develop and evaluate other treatment options. Perhaps even more critically, multiple promising vaccine candidates are progressing through various stages of clinical trials, and governments and other organizations are already investing to establish and scale up production capacity, in anticipation of positive future results, in order to increase availability as soon as an efficacious product is identified. Efforts are also ongoing to ensure that treatments and vaccines are available globally to promote equitable distribution for all countries as soon as possible.
The COVID-19 pandemic is far from over, but we are gaining experience and tools on a daily basis to improve our ability to combat it. Scientists, health practitioners, and other experts continue to learn more about the disease and the virus that causes it. We have a long way to go and a lot of hard work ahead of us, but we can
bring this pandemic under control. Each of us plays an important role, whether contributing directly to response operations as a frontline healthcare worker or public health official, ensuring the continuation of community services and infrastructure as an essential worker, developing and implementing policies as a researcher or elected official, or taking appropriate protective measures as part of your daily life.
Wear your mask, maintain physical distance, wash your hands, and stay home when you are sick. We are all in this together, even if we are 6 feet apart.