COVID-19
Updates on the emerging novel coronavirus pandemic from the Johns Hopkins Center for Health Security.
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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 July 1, 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:
December 31: Wuhan Municipal Health Commission publishes the initial report of unidentified pneumonia, potentially linked to a local market
January 6: US CDC issues a Level 1 travel watch for Wuhan, China
January 11: First reported COVID-19 death in China
January 13: First COVID-19 case reported outside of China
January 21: First COVID-19 case reported in the US
January 23: China implements “lockdown” in Wuhan
January 24: First imported COVID-19 cases reported in Europe (France)
January 27: US CDC issues Level 3 travel warning for China, recommending against non-essential travel
January 27: First documented SARS-CoV-2 transmission in Europe (Germany)
January 29: First COVID-19 cases reported in Eastern Mediterranean Region (United Arab Emirates)
January 30: WHO declares COVID-19 a Public Health Emergency of International Concern
January 30: US CDC confirms first domestic transmission of SARS-CoV-2
January 31: US implements travel restrictions for Mainland China
February 5: 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
February 25: First COVID-19 case reported in the African Region (Algeria)*
February 27: South Korea surpasses China as #1 globally in terms of daily COVID-19 incidence
February 29: US implements travel restrictions for Iran
March 4: Seattle and King County, Washington (US), advises high-risk individuals to avoid large gatherings
March 8: Italy implements “lockdown” for affected areas of the Lombardy region in Northern Italy
March 10: Italy expands “lockdown” measures to the entire country
March 11: US implements travel restrictions for all of Europe
March 11: WHO declares COVID-19 a pandemic
March 13: US declares the COVID-19 epidemic to be a national emergency
March 14: US implements travel restrictions for the UK and Ireland
March 15: National “lockdown” goes into effect in Spain
March 16: Six counties in the San Francisco Bay Area, California (US), issue the country’s first shelter-in-place orders
March 18: The WHO announces the SOLIDARITY Trial, a global collaboration to conduct clinical trials for prospective COVID-19 medical countermeasures
March 19: California (US) issues the first statewide “stay at home” order
March 23: The University of Oxford (UK) begins enrolling patients for the RECOVERY Trial, a nationwide clinical trial effort in the UK for COVID-19 MCMs
March 24: National “lockdown” ordered in India
March 24: The International Olympic Committee announces that the 2020 Olympic Games, scheduled to be hosted in Japan, are postponed
March 27: US CDC expands travel restrictions to cover all other countries
March 28: US CDC issues domestic travel advisory for New York, New Jersey, and Connecticut
March 28: Italy surpasses China as #1 globally in terms of cumulative COVID-19 incidence
March 29: US surpasses Italy as #1 globally in terms of cumulative COVID-19 incidence (and remains #1 today)
April 4: 1 million global cases
May 15: US government unveils Operation Warp Speed, a program to drive development and production of medical countermeasures against COVID-19
May 17: WHO reports more than 100,000 new cases in a single day
May 23: 5 million global cases
May 24: US implements travel restrictions for Brazil
May 28: US surpasses 100,000 cumulative reported COVID-19 deaths
May 29: New York (US) enters Phase 1 of recovery (NYC on June 8)
June 8: New Zealand declares SARS-CoV-2 eliminated
June 11: European Commission recommends that European countries remove internal border restrictions by June 15 to enable travel within the continent
June 29: 10 million global cases
June 30: 500,000 global deaths
June 30: 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 and will 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.
