What You Need to Know About the Coronavirus Outbreak

Chinese passengers arrive at a Beijing railway station amid the coronavirus outbreak. Kevin Frayer/Getty Images

A new coronavirus that originated in China has sparked fears of a potential pandemic, as health experts seek to answer questions about how it spreads.

Last updated February 24, 2020

Chinese passengers arrive at a Beijing railway station amid the coronavirus outbreak. Kevin Frayer/Getty Images
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A new coronavirus first reported in the Chinese city of Wuhan in late 2019 has begun to spread worldwide, reaching at least two dozen countries within weeks. By late February 2020, it had infected tens of thousands of people and killed more than two thousand, mostly within China.

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The Chinese government has struggled to quell the outbreak. At the same time, the World Health Organization (WHO) declared the crisis a public health emergency in order to boost the international response, and governments around the globe have ramped up efforts to prevent the virus’s spread within their borders, including quarantines, border closures, and intensified medical research. Scientists warn that the outbreak could soon grow to the level of a pandemic, and analysts say the world should brace for a sizable economic impact.

What are coronaviruses?

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They are a family of viruses common in animals, including bats, camels, and cows, and can sometimes be transmitted to humans. They are named for the crown-like spikes on their surface, which scientists believe the virus uses to enter cells and delay the immune system’s response. Coronaviruses can lead to fever, cough, and shortness of breath, and in more severe cases, kidney failure, acute respiratory illnesses such as pneumonia, and even death.

Have they caused outbreaks before?

Several coronaviruses have spread from animals to humans, leading to outbreaks in recent years. The most lethal has been Middle East Respiratory Syndrome (MERS), which was first transmitted to humans from camels in 2012 in Saudi Arabia. MERS has been fatal in one-third of patients, and has led to more than 850 deaths.

The most widespread of recent coronaviruses was Severe Acute Respiratory Syndrome (SARS), which was first reported in southern China in late 2002, and is believed to have been transferred to humans from civets, a cat-like species. An epidemic of SARS swelled across four continents in the months after its discovery, ultimately infecting more than eight thousand people across twenty-six countries and killing close to eight hundred before the virus was contained in July 2003.

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On December 30, 2019, Chinese officials notified the WHO of an outbreak of a new coronavirus disease, known as COVID-19, that was first detected in the city of Wuhan, in the central province of Hubei. The virus rapidly spread across China, as well as to dozens of other countries, including the United States. In February, the death toll for the coronavirus reached more than one thousand, surpassing the number of people killed during the SARS epidemic.

 

How is the new virus transmitted?

Like other coronaviruses, it is transmitted primarily through close contact with an infected person. Droplets generated by coughing or sneezing, saliva, mucus, and fecal matter can carry the virus and transfer it to nearby people. Health experts believe contact within about six feet is typically required for transmission.

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Health experts have not yet confirmed some crucial aspects of the virus’s spread, including:

  • how contagious it is;
  • the time it takes for an infected person to show symptoms, known as the incubation period;
  • whether a person who does not yet show symptoms can infect others;
  • whether animal-to-human transmission is ongoing;
  • what animal the virus was first transmitted from;
  • how long the virus survives on surfaces; and
  • whether the virus can be passed down from pregnant mothers to their babies.

Older people and those with preexisting health conditions are believed to be more at risk of developing severe symptoms.

 

Is there a vaccine?

No medicines to prevent or treat the virus are currently available, though researchers in both the public and private sectors are searching for possible medications, including vaccines, to be tested in clinical trials.

To lower the chances of getting sick, the WHO has urged people to wash their hands frequently, cover their noses and mouths when sneezing, and avoid anyone who appears sick. It advises anyone feeling sick who has traveled to China, or was in close contact with someone who has the virus, to seek medical care. Wearing a medical mask can help limit the spread, though it is not necessary unless a person is coughing, suspected to have the coronavirus, or caring for someone suspected to have the virus.

What has been China’s response?

When the first cases appeared in early December, Wuhan officials silenced doctors who warned of the new virus, and did not alert the public of a possible outbreak. (One of those doctors, Li Wenliang, later died from the virus.) By the time authorities issued warnings and alerted the WHO on December 31, the virus had already spread to an unmanageable level, experts say. Authorities closed an animal market where the virus was thought to have originated, but wildlife trading was not immediately banned throughout the city and province. “The government has failed to respond effectively,” writes CFR’s Yanzhong Huang. “Both the Wuhan and the central health authorities could already have done much more to stem the spread of this new virus.” The central government later offered a rare admission of its “shortcomings and deficiencies” and vowed to improve the emergency management system.

The outbreak initially spread rapidly. By January 30, every Chinese province had reported a case of the virus, cases appeared abroad, and 170 people had died, at which point Beijing, as well as local and provincial governments, took dramatic steps. Fifteen cities throughout Hubei Province were placed on full or partial lockdown, restricting the travel of more than fifty million people. The country’s Lunar New Year holiday, when hundreds of millions travel, was extended in many cities to prevent further spread; schools, offices, and factories remained closed. Chinese President Xi Jinping urged officials to prioritize reducing the number of cases and deaths and warned that those who didn’t do enough would be punished.

Wuhan has continued to face shortages of medical workers and supplies, including diagnostic test kits and hospital beds, that are needed to treat patients and monitor potential cases. Officials ordered the construction of two new hospitals, which were finished within two weeks, converted several buildings into makeshift hospitals, and deployed mobile hospitals. The central government sent thousands of medical personnel, including military doctors, to help. Smaller cities also experienced shortages.

An aerial photo shows dozens of hospital beds as workers finish converting a large space into a makeshift hospital.
Workers prepare a makeshift hospital for coronavirus patients in Wuhan, China. Cai Yang/Xinhua/Getty Images

What is the rest of the world doing to contain the outbreak?

WHO. On January 30, the WHO declared the outbreak a public health emergency of international concern, and soon after shepherded a global preparedness and response plan that asks for $675 million in funding from donors to last through April. The plan seeks to facilitate research to address “critical unknowns” about the virus; provide guidance; improve country readiness, particularly where health systems are weak; and boost surveillance, among other measures. The WHO has advised countries against closing borders and restricting trade, saying such measures would be a “recipe for disaster.”

East Asia. Hundreds of passengers aboard the Diamond Princess cruise ship, which was quarantined in Japan for two weeks in February, tested positive for the virus. At the end of the quarantine period, some who tested negative for the virus were allowed to disembark, sparking concerns among experts that they would later develop symptoms. In South Korea, as the number of cases jumped to more than eight hundred, President Moon Jae-in issued a red alert—the country’s highest—which allowed the government to restrict domestic travel and lock down cities.

Southeast Asia. In Southeast Asia, a region that largely depends on tourism and economic ties with China, many governments have urged their citizens not to worry about the coronavirus, despite dozens of cases in several countries. This has caused some experts to warn that the region will not be prepared if the outbreak worsens. “Several Southeast Asian governments have responded poorly to the spreading pandemic. This, in turn, has raised the risk of larger outbreaks in their countries,” writes CFR’s Joshua Kurlantzick. The Philippines, however, temporarily banned noncitizens who had recently visited China shortly before the first death from the virus outside China was reported there. Vietnam closed its land border with China and temporarily barred most flights from mainland China. Singapore announced that all visitors who recently traveled to China would be denied entry, and it suspended visas for Chinese passport holders. 

Europe and Eurasia. The European Union, which has recorded hundreds of cases, has taken several actions to contain the spread of the virus across its member states. On January 28, the bloc mobilized to bring hundreds of its citizens home from the Wuhan area. It also dedicated €10 million to investigate the virus. In Italy, as the number of cases soared into the hundreds, authorities placed nearly a dozen towns on lockdown. Mongolia and Russia, two of China’s neighbors, closed their land borders until at least early March.

Middle East. The outbreak also hit Iran, killing at least a dozen people, the largest death toll outside of China. The government closed schools and cultural centers in fourteen provinces. After cases linked to Iran were reported elsewhere in the Middle East, including in Bahrain and Iraq, several of Iran’s neighbors closed their borders with the country.

Sub-Saharan Africa. African countries have been on high alert, due to the expanded economic ties many of them have with China. Many countries have increased surveillance at airports and other ports of entry; some, including Kenya and Ethiopia, have made quarantines mandatory for Chinese travelers. Officials have also expressed concern about the thousands of African students studying in Hubei, as much of the province remains on lockdown, and several countries have ordered the evacuation of their citizens from China. Mozambique suspended visas for Chinese citizens.

As fear of the virus grows, the United Nations and the WHO have worked to tackle disinformation that has fueled discrimination, racism, and xenophobia against Chinese people around the world. The U.S. Centers for Disease Control and Prevention (CDC) has urged people not to assume that someone of Asian descent is more likely to have the virus.  

This video by CFR’s World101 library lays out what international health organizations and individual countries can do to fight the next pandemic.

What is the threat to the United States?

The United States declared the coronavirus outbreak a public health emergency in late January, despite a relatively low number of cases. The CDC said the risk to most Americans is low since the virus has not spread widely from person to person, but said it is preparing its response “as if this were the next pandemic.”

The Donald J. Trump administration launched a coronavirus task force, which temporarily banned Chinese travelers and non-U.S. citizens who recently visited mainland China from entering the United States. The State Department evacuated U.S. citizens from Wuhan and issued travel advisories for China, Japan, and South Korea because of high numbers of cases there. U.S. airlines, including Delta and United, canceled flights between China and the United States.

The CDC has led the U.S. public health response, which has included expanding screenings of travelers at airports, quarantining sick patients, offering public health guidance, and deploying hundreds of personnel to assist state and local health departments. It developed a test to diagnose the virus and started distributing test kits to health departments and hospitals throughout the United States and the world. The National Institutes of Health and several companies were working on a vaccine, a process that could take more than a year. The CDC has also urged people to get flu shots and take similar precautionary measures, as a particularly deadly U.S. flu season has coincided with the coronavirus outbreak.

If the virus spreads, however, the White House warned that “the public health system could be overwhelmed,” given the limited resources of both the CDC and local health departments. The Department of Health and Human Services requested additional funds from Congress in early February to combat the virus.

What are the economic consequences?

The outbreak has hurt Chinese businesses and their employees, disrupted global supply chains, and affected markets for commodities such as oil. Based on the impact of the SARS outbreak, experts expect that economic consequences will be felt around the world. The SARS crisis caused the global economy to lose an estimated $40 billion in 2003, when China was the world’s fifth-largest economy and contributed 4 percent of global gross domestic product (GDP). Now, China is the world’s second-largest economy and its share of global GDP has grown to 16 percent.

In China, which has already experienced an economic slowdown from the trade war with the United States, the government has ordered thousands of restaurants, movie theaters, factories, and other businesses to close through mid-February to prevent person-to-person transmission. It encouraged people to avoid traveling and asked airlines and other transportation providers to issue refunds. The economic hit has been exacerbated by the timing; the Lunar New Year is a time when many Chinese people travel and celebrate with purchases such as gifts or banquet meals. Experts say economic growth could slow dramatically during the first quarter of 2020.

The outbreak has disrupted commodities markets, including those for oil and copper. As the world’s biggest oil importer, China has experienced a sharp decrease in demand amid the outbreak, leading the Organization of the Petroleum Exporting Countries (OPEC) to consider oil production cuts. The closure of Chinese factories has disrupted the supply chains for vehicles, jets, and smartphones, among other products. For example, Hyundai slowed production at its factories in South Korea because of a lack of parts from China. The outbreak has also hurt businesses in the tourism industry, including hotels and cruise lines, as Chinese travelers account for more than 10 percent of global tourism revenue. Foreign companies, including Apple and Starbucks, temporarily shuttered their stories and factories in China.

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Resources

Think Global Health, a CFR initiative, tracks travel restrictions on China and traces the virus’s spread since December 2019.

In Foreign Affairs, CFR’s Elizabeth C. Economy writes that the coronavirus outbreak is a stress test for Xi Jinping.

The CDC shares information, including recommendations for the public, on its website.

The WHO provides daily updates and guidance regarding the outbreak on its novel coronavirus page.

The Johns Hopkins Center for Systems Science and Engineering maps coronavirus cases throughout the world.

The New York Times documents life in Wuhan during the city’s lockdown.