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Another photo from my trip down to Gary, IN with Chris Nitz. The old hospital had some amazing scenes, like this one, where the irony of what the place once was in contrast to what it was now really came through. This sign in particular jumped out at me in relation to the surrounding wall.
Also, in other news, you can now find my pictures at my new Blog!
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© Charles Dastodd - All Rights Reserved
Napoli
Quartieri Spagnoli (Spanish Quarters) is a part of the city of Naples in Italy. The Neapolitan language is stronger here than anywhere else. It is a poor area, suffering from high unemployment and strong influence of Camorra. The area, encompassing c. 800,000 square metres, consists of a grid of around eighteen streets by twelve, including a population of some 14,000 inhabitants.
The Quartieri were created in the 16th to house Spanish garrisons, hence the name, whose role was to quench revolts from the Neapolitan population. Soon they became an infamous quarter with a high rate of criminality and prostitution.
The area has among the highest rates of respiratory diseases, unemployment and youth crime in Europe. The housing in the Quartieri Spagnoli consists usually six storied blocks with a roof terrace and a central courtyard. The width of the average street is about 3 metres.
Among the historic churches in the district are:
Church of the Immacolata Concezione e Purificazione di Maria de' nobili in Montecalvario
Church of San Carlo alle Mortelle
Church of San Mattia
Church of Santa Maria della Concezione a Montecalvario
Church of Santa Maria della Lettera
Church of Santa Maria della Mercede a Montecalvario
Church of Santa Maria Francesca delle Cinque Piaghe
Church of Sant'Anna di Palazzo
Church of Santa Maria del Rosario a Portamedina
Church of Santa Maria della Concordia
Church of Santa Maria delle Grazie a Toledo
Convent and church of Santa Maria dello Splendore
Church of Santa Maria Ognibene
Church of Santa Teresella degli Spagnoli
Church of the Trinità dei Pellegrini
Church of the Santissima Trinità degli Spagnoli
Copyright - All images are copyright © protected. All Rights Reserved. Copying, altering, displaying or redistribution of any of these images without written permission from the artist is strictly prohibited
About 80 days, with upper respiratory tract infection, inflammation in the eyes, intestinal function disorder caused by nematode and ear mite.
(I'm not sure about the usage of words above. If anyone knows the proper or professional names of the diseases or symptoms, please help to correct. :))
绒绒 means fluffy.
Soundtrack // Bande-son: COIL ("Who By Fire ?" / Leonard COHEN cover): www.youtube.com/watch?v=XDteoj-jDpE
"And who by fire, who by water... Who in the sunshine, who in the night time... Who by high ordeal, who by common trial... Who in your merry merry month of may... Who by very slow decay,.."
D'autres analogies arbres-objets // Other analogies tree-object: www.flickr.com/photos/regisa/albums/72157629028663303
En parallèle de la Route de Bergues, de l'autre côté du canal, la Rue des Forts puis la Route du Golf sont des voies bénies pour qui désire se plonger dans une mer de verdure au sein de l'agglomération dunkerquoise. Parc d'agglomération du Fort-Louis, Bois des Forts, site du golf... autant de destinations bienfaitrices pour une population locale défraîchie par la pollution atmosphérique.
Il fut un temps où le littoral dunkerquois était pourtant réputé pour son air sain, maritime et iodé, à tel point que l’on y construisait au début du XXème siècle des sanatorium pour les malades atteints d’affections respiratoires. Aujourd’hui, l’air qu'on y respire nuit à la santé ! Quelques exemples illustratifs : les retombées de poussières sédimentables sont particulièrement élevées sur le littoral dunkerquois avec des niveaux atteignant parfois plus de 1500 mg/m²/jour (dépassement de 50% du seuil autorisé) ; taux de nickel particulièrement élevé sur le dunkerquois (moyenne 6 fois plus élevée qu’ailleurs dans la région NPDC avec une concentration de 25,14 ng/m3 d’air en moyenne annuelle pour 2006, dépassant ainsi la valeur cible de 20 ng/m3) ; les particules en suspension (PM10) inquiètent aussi avec des chiffres à 26µg/m3 de moyenne annuelle, ces moyennes cachent des mesures à 52µ/m3 sur Mardyck (village en proximité industrielle). À Dunkerque, la pollution est massive du fait de la trop grande concentration d’installations industrielles fortement émettrices de produits polluants et qui se rajoutent à ceux émis par le secteur des transports.
Ce cimetière coudekerquois, malheureusement, est donc voué à manquer de places dans un avenir proche... :(
//
Along the "Route de Bergues" leading to the fortified city of Bergues, on the other side of the canal, the "Rue des Forts" and "Route du Golf" are blessed for those wishing to dive into a sea of green in the Dunkirk area. The Fort Louis park, the "Bois des Forts", the golf-club site ... are dream destinations for local people suffering with the air pollution.
There was a time when the coast at Dunkerque was yet known for its healthy and iodized air, to the point that sanatoriums were built in the early twentieth century for patients with respiratory diseases. Today, the air they breathe affects theirr health. A few illustrative examples: dustfall sedimentable are particularly high on the coast at Dunkerque with levels sometimes reaching more than 1500 mg / m² / day (over 50% of the permitted threshold); particularly high levels of nickel (average 6 times higher than elsewhere in the region with a concentration of 25.14 ng/m3 air annual average for 2006, exceeding the target value of 20 ng/m3) airborne particles (PM10) also worry with figures of 26μg/m3 average, these averages hide measures on 52μ/m3 Mardyck (village near industrial site).
At Dunkirk, massive pollution is due to the excessive concentration of industrial facilities that emit highly polluting products, which are in addition to those issued by the transport sector.
This cemetery in Coudekerque, unfortunately, is doomed to miss places in the near future ... : (
"Peut-être le plus spectaculaire de la série, superbe !" (VINCENT / www.flickr.com/photos/58769600@N07/)
"Des tombes et son chandelier... Superbe." ((Patrick CANHAN / www.flickr.com/photos/patpardon/)
Own texture
This is Fynn posing for the camera in his full, fluffy glory. I like how the hairs on his ear are highlighted by the backlight.
Fynn is still doing quite well these days. His respiratory problems are always getting worse when it's damp and cold but so far he hasn't needed any antibiotics yet. That's good because winter will be long.
In this difficult times, we all have to learn something new. From Monday, it will be mandatory to wear respiratory masks on public transport and in shops. It is fundamentally not wrong to fix the respiratory mask behind the ears.
If you're dependent on heroin or another opioid, you may be offered a substitute drug, such as methadone.
Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for opioid maintenance therapy in opioid dependence and for chronic pain management. It is most commonly used to treat addiction to heroin or other opioids, and to reduce risk of fatal overdose from street drugs. Prescribed daily, the medicine relieves craving and removes withdrawal symptoms.
Methadone was developed in 1937 in Germany by scientists working for I.G. Farbenindustrie AG at the Farbwerke Hoechst who were looking for a synthetic opioid that could be created with readily available precursors, to solve Germany's opium shortage problem.
On 11 September 1941 Bockmühl and Ehrhart filed an application for a patent for a synthetic substance they called Hoechst 10820 or Polamidon (a name still in regular use in Germany) and whose structure had only slight relation to morphine or the opiate alkaloids.(Bockmühl and Ehrhart, 1949). It was brought to market in 1943 and was widely used by the German army during WWII.
In the 1930s, pethidine (meperidine) went into production in Germany; however, production of methadone, then being developed under the designation Hoechst 10820, was not carried forward because of side effects discovered in the early research.
After the war, all German patents, trade names and research records were requisitioned and expropriated by the Allies.
The records on the research work of the I.G. Farbenkonzern at the Farbwerke Hoechst were confiscated by the U.S. Department of Commerce Intelligence, investigated by a Technical Industrial Committee of the U.S. Department of State and then brought to the US.
The report published by the committee noted that while methadone was potentially addictive, it produced less sedation and respiratory depression than morphine and was thus interesting as a commercial drug.
7% within the "young adult" age bracket had taken a Class A drug in 2018/19. (UK Gov)
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More Street shots: Urban
Almost and After Dark: Dawn Dusk & Night
check out more Hong Kong Streets & Candid shots here:
Taking the Streets in Hong Kong
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Without makeup, with oxygen canula, minimal editing. Photo © 2017 Charles Spencer.
Friends, this is the face that goes with the name Katharine Hanna. My partner and caregiver Charles has posted an appeal on the crowd-sourcing website GoFundMe for assistance with expenses related to my incurable respiratory failure. Details are explained there. Here is the link:
www.gofundme.com/care-for-katharine
This is a paragraph from that page: “I need help to live so I'm reaching out to you. I want to live as fully as I can for as long as I can, God willing—and, if my energy allows, to continue making and sharing images of beauty. Recently my focus shifted radically from preparing to die soon to being open to improved energy, comfort, and productivity. At 5 feet 8 inches, I weigh 92 pounds and have extreme shortness of breath and weakness. I am oxygen-dependent (compressor and portable tanks) 24/7. Charles, my loving and loyal partner and care giver, has been carrying the weight of most of the household tasks and my care for over 4 years. My brother is very generous in helping us meet our monthly household expenses. Although my Medicare and supplemental insurance cover most medically-prescribed comfort measures (vs. curative measures which I discontinued entirely prior to starting hospice), other important parts of my care must be paid for out-of-pocket. And Charles and I can no longer pay for them without help. These include: a natural supplement (for improved energy and reduced occurrence and severity of lung infections); home care service 4 hours a week (to take some of the burden off Charles and maintain a clean and safe living space); durable medical equipment not covered by insurance (for mobility, safety, and pain management), and massage (to reduce the back pain and alleviate extreme dryness caused by medications). All of these make life in this body more tolerable and can free up my attention and energy for creative work ..." which I hope to continue as long as I live.
Recently I've been posting photos mostly from my computer archives. I hope to resume making new photos soon, especially flower macros. With love and thanks to all my Flickr friends. ♥
Came to me one night seriously ill with an upper respiratory illness. Several weeks later and over $500 she is a well kitten in her new home. She has a strange personality displaying much playfulness and attacking while showing her teeth against you when made to do something against her will. Later she will be in your lap just purring away. Sometimes, I am not sure she is a cat. Love her anyway.
The Gastown Business Improvement Association created the Murals of Gratitude project and invited artists to use plywood boards as their canvas.
The main function of the plywood is to discourage break-ins and thefts that have increased since the start of the COVID-19 pandemic.
The initiative was started by Kim Briscoe of the custom framing and art shop, Kimprints.
This painting is by respiratory therapist Izzie Cheung is of three of her own colleagues.
Cheung had just finished her first four days at VGH after her graduation was accelerated to help during the COVIV-19 pandemic when she painted the mural on one of Kimprints boarded windows on Water Street in Gastown.
Colorful flowerbeds in Ciechocinek :)
Ciechocinek is a spa town in Kuyavian-Pomeranian Voivodeship, Poland, located on the Vistula River. Ciechocinek is known for its unique 'saline graduation towers'. Experts have considered the local saline springs to be of extreme value and named the thermal spring no. 14 "a wonder of nature". The therapeutic qualities of these springs are directed toward curing
cardiovascular, respiratory, orthopedic, traumatic, rheumatic, nervous system and women's diseases. In Ciechocinek is located a large complex of graduation towers. The complex consists of three graduation towers with a total length of over 2 km. Many tourists visit it for health reasons.
Kwiatowe dywany w Ciechocinku :)
Ciechocinek jest miastem o charakterze uzdrowiskowym. Część uzdrowiskowa bogata jest w zieleń parków, skwerów, kwietników i
dywanów kwiatowych. Co roku przyjeżdża wielu kuracjuszy i turystów. Podstawą rozwoju są wody lecznicze: chlorkowo-sodowe, bromkowe, jodkowe, żelaziste, borowe, które pochodzą z licznych na tym terenie źródeł solankowych. Leczy się tutaj choroby narządów ruchu, reumatyczne, ortopedyczno-urazowe, kobiece, układu oddechowego, nerwowego i krążenia. W północnej części uzdrowiska znajduje się Park Zdrojowy, założony w 1875 – 1876 roku w stylu krajobrazowym z licznymi gatunkami drzew i krzewów. Ponadto w Ciechocinku znajdują się największe w Europie, najsłynniejsze i najstarsze (XIX wiek) polskie tężnie.
Severe acute respiratory syndrome coronavirus 2 based on the CDC's computer rendering.
Visible is the exterior of the viral lipid envelope (grey), the Membrane (M) protein (orange), the Envelope (E) protein (yellow) and the characteristic SARS-CoV-2 Glycoprotein Spike (S) proteins (red).
Science for anyone interested:
Lipid envelopes facilitate virus entry into host cells by membrane fusion, help with immune evasion, and provide additional protection for the viral genome (consisting of positive-sense RNA within a helical nucleocapsid in SARS-CoV-2). Washing your hands with soap inactivates viruses by disrupting this lipid bilayer.
Coronavirus M protein is essential for packing and assembly of viral components during the formation of virions. It also has a structural role and may contribute to viral pathology through immune dysregulation.
Coronavirus E protein forms a pentameric ion channel (represented by 5-petal flowers) known as a viroporin. These increase the permeability of the host cell membranes to aid with budding of virions from the golgi and release from cells. The E protein is also believed to assist the M protein in viral assembly.
Coronavirus Spike proteins are the characteristic surface antigens of coronaviruses from which they derive their name.
These proteins have a trimeric structure represented here using tricorns.
It will likely be the main target for vaccine development.
The spike proteins' most important function is to mediate viral attachment to host cell receptors and therefore it also confers tissue and host species specificity. In the case of SARS-Cov-2 (and its predecessor SARS-CoV) the spike proteins bind to human ACE2 (angiotensin converting enzyme 2), an enzyme involved in control of blood pressure and vascular homeostasis, which is most highly expressed on the surface membranes of cells in the kidneys, heart and lungs.
Since the lungs are easily accessible through inhalation of virions, SARS-CoV-2 commonly causes lower respiratory tract infections. Cells of the alveoli, which enable gas exchange between the air and the blood, are particularly affected and are lysed as newly produced virions burst out of their host cells. This causes damage to the alveoli which attracts immune cells leading to inflammation which further damages the alveoli. Inflamed alveoli fill with fluid (pneumonia) which prevents efficient gas exchange causing the shortness of breath commonly seen in patients, while irritation of nerves in the inflamed tissue results in the dry cough, helping to further transmit the virus. Severe cases of viral pneumonia may lead to secondary infections (eg. bacterial) and are the main cause of COVID-19 deaths.
If you made it this far you're an absolute mad lad.
Italian postcard by Rizzoli, Milano, 1939, for Orologi e Cinturini Delgia. Photo: Studio Chaplin.
American actress Paulette Goddard (1905-1990) started her career as a fashion model and as a Ziegfeld Girl in several Broadway shows. In the 1940s, she became a major star of Paramount Pictures. She was Charlie Chaplin's leading lady in Modern Times (1936), and The Great Dictator. Goddard was nominated for an Oscar for Best Supporting Actress for So Proudly We Hail! (1943). Her husbands included Chaplin, Burgess Meredith, and Erich Maria Remarque.
Paulette Goddard was born Pauline Marion Levy in Whitestone Landing, Long Island, New York. Sources variously cite her year of birth as 1911 and 1914, and the place as Whitestone Landing, New York, USA. However, municipal employees in Ronco, Switzerland, where she died, gave her birth year of record as 1905. Goddard was the daughter of Joseph Russell Levy, the son of a prosperous Jewish cigar manufacturer from Salt Lake City, and Alta Mae Goddard, who was of Episcopalian English heritage. They married in 1908 and separated while their daughter was very young, although the divorce did not become final until 1926. According to Goddard, her father left them, but according to J. R. Levy, Alta absconded with the child. Goddard was raised by her mother, and did not meet her father again until the late 1930s, after she had become famous. To avoid a custody battle, she and her mother moved often during her childhood, even relocating to Canada at one point. Goddard began modeling at an early age to support her mother and herself, working for Saks Fifth Avenue, Hattie Carnegie, and others. An important figure in her childhood was her great uncle, Charles Goddard, the owner of the American Druggists Syndicate. He played a central role in Goddard's career, introducing her to Broadway impresario Florenz Ziegfeld. She made her stage debut as a dancer in Ziegfeld's summer revue, 'No Foolin' (1926), which was also the first time that she used the stage name Paulette Goddard. Ziegfeld hired her for another musical, 'Rio Rita', which opened in February 1927, but she left the show after only three weeks to appear in the play 'The Unconquerable Male', produced by Archie Selwyn. It was, however, a flop and closed after only three days following its premiere in Atlantic City. Soon after the play closed, Goddard was introduced to the much older lumber tycoon Edgar James, president of the Southern Lumber Company, by Charles Goddard. She married him in June 1927 in Rye, New York, but the marriage was short. Goddard was granted a divorce in Reno, Nevada, in 1929, receiving a divorce settlement of $375,000. Tony Fontana at IMDb: "A stunning natural beauty, Paulette could mesmerize any man she met, a fact she was well aware of. "
Paulette Goddard first visited Hollywood in 1929, when she appeared as an uncredited extra in two films, the Laurel and Hardy short film Berth Marks (Lewis R. Foster, 1929), and George Fitzmaurice's drama The Locked Door (1929). Following her divorce, she briefly visited Europe before returning to Hollywood in late 1930 with her mother. Her second attempt at acting was no more successful than the first, as she landed work only as an extra. In 1930, she signed her first film contract with producer Samuel Goldwyn to appear as a Goldwyn Girl in Whoopee! (Thornton Freeland, 1930) with Eddie Cantor. She also appeared in City Streets (Rouben Mamoulian, 1931) with Gary Cooper, Ladies of the Big House (Marion Gering, 1931) starring Sylvia Sidney, and The Girl Habit (Edward F. Cline, 1931) for Paramount, and The Mouthpiece (James Flood, Elliott Nugent, 1932) for Warners. Goldwyn and she did not get along, and she began working for Hal Roach Studios, appearing in a string of uncredited supporting roles for the next four years, including Young Ironsides (James Parrott, 1932) with Charley Chase, and Pack Up Your Troubles (1932) with Laurel and Hardy. One of her bigger roles in that period was as a blond 'Goldwyn Girl' in the Eddie Cantor film The Kid from Spain (Leo McCarey, 1932). Goldwyn also used Goddard in The Bowery (Raoul Walsh, 1933) with Wallace Beery, Roman Scandals (Frank Tuttle, 1933), and Kid Millions (Roy Del Ruth, 1934) with Eddie Cantor. The year she signed with Goldwyn, Goddard began dating Charlie Chaplin, a relationship that received substantial attention from the press. They were reportedly married in secret in Canton, China, in June 1936. It marked a turning point in Goddard's career when Chaplin cast her as his leading lady in his box office hit, Modern Times (1936). Her role as 'The Gamin', an orphan girl who runs away from the authorities and becomes The Tramp's companion, was her first credited film appearance and garnered her mainly positive reviews, Frank S. Nugent of The New York Times describing her as "the fitting recipient of the great Charlot's championship". Following the success of Modern Times, Chaplin planned other projects with Goddard in mind as a co-star, but he worked slowly, and Goddard worried that the public might forget about her if she did not continue to make regular film appearances. She signed a contract with David O. Selznick and appeared with Janet Gaynor in the comedy The Young in Heart (Richard Wallace, 1938) before Selznick lent her to MGM to appear in two films. The first of these, Dramatic School (Robert B. Sinclair, 1938), co-starred Luise Rainer, but the film received mediocre reviews and failed to attract an audience. Her next film, The Women (George Cukor, 1939), was a success. With an all-female cast headed by Norma Shearer, Joan Crawford, and Rosalind Russell, the film's supporting role of Miriam Aarons was played by Goddard. Pauline Kael later wrote of Goddard, "she is a stand-out. fun."
David O' Selznick was pleased with Paulette Goddard's performances, particularly her work in The Young in Heart, and considered her for the role of Scarlett O'Hara in Gone With the Wind (Victor Fleming, 1939). Initial screen tests convinced Selznick and director George Cukor that Goddard would require coaching to be effective in the role, but that she showed promise, and she was the first actress given a Technicolor screen test. After he was introduced to Vivien Leigh, he wrote to his wife that Leigh was a "dark horse" and that his choice had "narrowed down to Paulette, Jean Arthur, Joan Bennett, and Vivien Leigh". After a series of tests with Leigh that pleased both Selznick and Cukor, Selznick cancelled the further tests that had been scheduled for Goddard, and the part was given to Leigh. Goddard's next film, The Cat and the Canary (Elliott Nugent, 1939) with Bob Hope, was a turning point in the careers of both actors. The success of the film established her as a genuine star. Her performance won her a ten-year contract with Paramount Studios, which was one of the premier studios of the day. They promptly were re-teamed in The Ghost Breakers (George Marshall, 1940), again a huge hit. Goddard starred with Chaplin again in his film The Great Dictator (1940). In 1942, Goddard was granted a Mexican divorce from Chaplin. The couple split amicably, with Chaplin agreeing to a generous settlement. At Paramount, Goddard was used by Cecil B. De Mille in the action epic North West Mounted Police (1940), playing the second female lead. She was Fred Astaire's leading lady in the acclaimed musical Second Chorus/Swing it (H.C. Potter, 1940), where she met actor Burgess Meredith, her third husband. Goddard made Pot o' Gold (George Marshall, 1941), a comedy with James Stewart, then supported Charles Boyer and Olivia de Havilland in Hold Back the Dawn (Mitchell Leisen, 1941), from a script by Wilder and Brackett, directed by Mitchell Leisen. Goddard was teamed with Hope for a third time in Nothing But the Truth (Elliott Nugent, 1942), then made The Lady Has Plans (Sidney Lanfield, 1942), a comedy with Ray Milland. She co-starred with Milland and John Wayne in Reap the Wild Wind (Cecil B. DeMille, 1942), playing the lead, a Scarlett O'Hara type character. The film was a huge hit. Goddard did The Forest Rangers (George Marshall, 1942) with Fred MacMurray. One of her better-remembered film appearances was in the variety musical Star Spangled Rhythm (George Marshall, 1943), in which she sang "A Sweater, a Sarong, and a Peekaboo Bang" with Dorothy Lamour and Veronica Lake.
Paulette Goddard received one Oscar nomination for Best Supporting Actress for So Proudly We Hail! (Mark Sandrich, 1943) opposite Claudette Colbert and Veronica Lake. She didn't win, but it solidified her as a top draw. Goddard was teamed with Fred MacMurray in the delightful comedy Standing Room Only (Sidney Lanfield, 1944) and Sonny Tufts in I Love a Soldier (Mark Sandrich, 1944). In May 1944, she married Burgess Meredith at David O. Selznick's home in Beverly Hills. Goddard's most successful film was Kitty (Mitchell Leisen, 1945), in which she played the title role. Denny Jackson/Robert Sieger at IMDb: "The film was a hit with moviegoers, as she played an ordinary English woman transformed into a duchess. The film was filled with plenty of comedy, dramatic and romantic scenes that appealed to virtually everyone." In The Diary of a Chambermaid (1946), Goddard starred with husband Burgess Meredith under the direction of Jean Renoir. It was made for United Artists. At Paramount she did Suddenly It's Spring (Mitchell Leisen, 1947) with Fred MacMurray, and De Mille's 18th century romantic drama Unconquered (Cecil B. DeMille, 1947), with Cary Grant. During the Hollywood Blacklist, when she and blacklisted husband Meredith were mobbed by a baying crowd screaming "Communists!" on their way to a premiere, Goddard is said to have turned to her husband and said, "Shall I roll down the window and hit them with my diamonds, Bugsy?" In 1947, she made An Ideal Husband in Britain for Alexander Korda, and was accompanied on a publicity trip to Brussels by Clarissa Spencer-Churchill, niece of Sir Winston Churchill and future wife of future Prime Minister Anthony Eden. She divorced Meredith in June 1949, and also left Paramount. In 1949, she formed Monterey Pictures with John Steinbeck. Goddard starred in Anna Lucasta (Irving Rapper, 1949), then went to Mexico for The Torch (Emilio Fernández, 1950). In England, she was in Babes in Bagdad (Edgar G. Ulmer, 1952), then she went to Hollywood for Vice Squad (Arnold Laven, 1953) with Edward G. Robinson, and Charge of the Lancers (William Castle, 1954) with Jean-Pierre Aumont. Her last starring role was in the English production A Stranger Came Home/The Unholy Four (Terence Fisher, 1954).
Paulette Goddard began appearing in summer stock and on television, guest starring on episodes of Sherlock Holmes, an adaptation of The Women, this time playing the role of Sylvia Fowler, The Errol Flynn Theatre, The Joseph Cotten Show, and The Ford Television Theatre. She was in an episode of Adventures in Paradise and a TV version of The Phantom. After her marriage to Erich Maria Remarque in 1958, Goddard largely retired from acting and moved to Ronco sopra Ascona, Switzerland. In 1964, she attempted a comeback in films with a supporting role in the Italian film Gli indifferenti/Time of Indifference (Francesco Maselli, 1964), starring Claudia Cardinale and Rod Steiger, which was her last feature film. After Remarque's death in 1970, she made one last attempt at acting, when she accepted a small role in an episode of the TV series The Snoop Sisters, The Female Instinct (Leonards Stern, 1972) with Helen Hayes and Mildred Natwick. Upon Remarque's death, Goddard inherited much of his money and several important properties across Europe, including a wealth of contemporary art, which augmented her own long-standing collection. During this period, her talent at accumulating wealth became a byword among the old Hollywood élite. During the 1980s, she became a fairly well known (and highly visible) socialite in New York City, appearing covered with jewels at many high-profile cultural functions with several well-known men, including Andy Warhol, with whom she sustained a friendship for many years until his death in 1987. Paulette Goddard underwent invasive treatment for breast cancer in 1975, successfully by all accounts. In 1990, she died at her home in Switzerland from heart failure while under respiratory support due to emphysema, She is buried in Ronco Village Cemetery, next to Remarque and her mother. Goddard had no children. She became a stepmother to Charles Chaplin's two sons, Charles Chaplin Jr. and Sydney Chaplin, while she and Charlie were married. In his memoirs, 'My Father Charlie Chaplin' (1960), Charles Jr. describes her as a lovely, caring and intelligent woman throughout the book. In October 1944, she suffered the miscarriage of a son with Burgess Meredith. Goddard, whose own formal education did not go beyond high school, bequeathed US$20 million to New York University (NYU) in New York City.
Sources: Tony Fontana (IMDb), Denny Jackson / Robert Sieger (IMDb), Wikipedia and IMDb.
And, please check out our blog European Film Star Postcards.
American postcard by Movie Candid Color Card, Beverly Hills, Calif., no. A18. Photo: Jack Albin (Kodachrome). Publicity still for Bride of Vengeance/A Mask for Lucretia (Mitchell Leisen, 1949). Caption: Paulette Goddard, former Ziegfeld girl, later cavorted for Samuel Goldwyn, and won stardom opposite Charlie Chaplin in Modern Times. Paulette really clicked at Paramount, where she teamed with Bob Hope, and followed with several starring roles for C.B. De Mille. Once married to Charlie Chaplin, she is now the wife of actor Burgess Meredith.
American actress Paulette Goddard (1905-1990) started her career as a fashion model and as a Ziegfeld Girl in several Broadway shows. In the 1940s, she became a major star of Paramount Pictures. She was Charlie Chaplin's leading lady in Modern Times (1936), and The Great Dictator. Goddard was nominated for an Oscar for Best Supporting Actress for So Proudly We Hail! (1943). Her husbands included Chaplin, Burgess Meredith, and Erich Maria Remarque.
Paulette Goddard was born Pauline Marion Levy in Whitestone Landing, Long Island, New York. Sources variously cite her year of birth as 1911 and 1914, and the place as Whitestone Landing, New York, USA. However, municipal employees in Ronco, Switzerland, where she died, gave her birth year of record as 1905. Goddard was the daughter of Joseph Russell Levy, the son of a prosperous Jewish cigar manufacturer from Salt Lake City, and Alta Mae Goddard, who was of Episcopalian English heritage. They married in 1908 and separated while their daughter was very young, although the divorce did not become final until 1926. According to Goddard, her father left them, but according to J. R. Levy, Alta absconded with the child. Goddard was raised by her mother and did not meet her father again until the late 1930s after she had become famous. To avoid a custody battle, she and her mother moved often during her childhood, even relocating to Canada at one point. Goddard began modeling at an early age to support her mother and herself, working for Saks Fifth Avenue, Hattie Carnegie, and others. An important figure in her childhood was her great uncle, Charles Goddard, the owner of the American Druggists Syndicate. He played a central role in Goddard's career, introducing her to Broadway impresario Florenz Ziegfeld. She made her stage debut as a dancer in Ziegfeld's summer revue, 'No Foolin' (1926), which was also the first time that she used the stage name Paulette Goddard. Ziegfeld hired her for another musical, 'Rio Rita', which opened in February 1927, but she left the show after only three weeks to appear in the play 'The Unconquerable Male', produced by Archie Selwyn. It was, however, a flop and closed after only three days following its premiere in Atlantic City. Soon after the play closed, Goddard was introduced to the much older lumber tycoon Edgar James, president of the Southern Lumber Company, by Charles Goddard. She married him in June 1927 in Rye, New York, but the marriage was short. Goddard was granted a divorce in Reno, Nevada, in 1929, receiving a divorce settlement of $375,000. Tony Fontana at IMDb: "A stunning natural beauty, Paulette could mesmerize any man she met, a fact she was well aware of. "
Paulette Goddard first visited Hollywood in 1929, when she appeared as an uncredited extra in two films, the Laurel and Hardy short film Berth Marks (Lewis R. Foster, 1929), and George Fitzmaurice's drama The Locked Door (1929). Following her divorce, she briefly visited Europe before returning to Hollywood in late 1930 with her mother. Her second attempt at acting was no more successful than the first, as she landed work only as an extra. In 1930, she signed her first film contract with producer Samuel Goldwyn to appear as a Goldwyn Girl in Whoopee! (Thornton Freeland, 1930) with Eddie Cantor. She also appeared in City Streets (Rouben Mamoulian, 1931) with Gary Cooper, Ladies of the Big House (Marion Gering, 1931) starring Sylvia Sidney, and The Girl Habit (Edward F. Cline, 1931) for Paramount, and The Mouthpiece (James Flood, Elliott Nugent, 1932) for Warners. Goldwyn and she did not get along, and she began working for Hal Roach Studios, appearing in a string of uncredited supporting roles for the next four years, including Young Ironsides (James Parrott, 1932) with Charley Chase, and Pack Up Your Troubles (1932) with Laurel and Hardy. One of her bigger roles in that period was as a blond 'Goldwyn Girl' in the Eddie Cantor film The Kid from Spain (Leo McCarey, 1932). Goldwyn also used Goddard in The Bowery (Raoul Walsh, 1933) with Wallace Beery, Roman Scandals (Frank Tuttle, 1933), and Kid Millions (Roy Del Ruth, 1934) with Eddie Cantor. The year she signed with Goldwyn, Goddard began dating Charlie Chaplin, a relationship that received substantial attention from the press. They were reportedly married in secret in Canton, China, in June 1936. It marked a turning point in Goddard's career when Chaplin cast her as his leading lady in his box office hit, Modern Times (1936). Her role as 'The Gamin', an orphan girl who runs away from the authorities and becomes The Tramp's companion, was her first credited film appearance and garnered her mainly positive reviews, Frank S. Nugent of The New York Times describing her as "the fitting recipient of the great Charlot's championship". Following the success of Modern Times, Chaplin planned other projects with Goddard in mind as a co-star, but he worked slowly, and Goddard worried that the public might forget about her if she did not continue to make regular film appearances. She signed a contract with David O. Selznick and appeared with Janet Gaynor in the comedy The Young in Heart (Richard Wallace, 1938) before Selznick lent her to MGM to appear in two films. The first of these, Dramatic School (Robert B. Sinclair, 1938), co-starred Luise Rainer, but the film received mediocre reviews and failed to attract an audience. Her next film, The Women (George Cukor, 1939), was a success. With an all-female cast headed by Norma Shearer, Joan Crawford, and Rosalind Russell, the film's supporting role of Miriam Aarons was played by Goddard. Pauline Kael later wrote of Goddard, "she is a stand-out. fun."
David O' Selznick was pleased with Paulette Goddard's performances, particularly her work in The Young in Heart, and considered her for the role of Scarlett O'Hara in Gone With the Wind (Victor Fleming, 1939). Initial screen tests convinced Selznick and director George Cukor that Goddard would require coaching to be effective in the role, but that she showed promise, and she was the first actress given a Technicolor screen test. After he was introduced to Vivien Leigh, he wrote to his wife that Leigh was a "dark horse" and that his choice had "narrowed down to Paulette, Jean Arthur, Joan Bennett, and Vivien Leigh". After a series of tests with Leigh that pleased both Selznick and Cukor, Selznick cancelled the further tests that had been scheduled for Goddard, and the part was given to Leigh. Goddard's next film, The Cat and the Canary (Elliott Nugent, 1939) with Bob Hope, was a turning point in the careers of both actors. The success of the film established her as a genuine star. Her performance won her a ten-year contract with Paramount Studios, which was one of the premier studios of the day. They promptly were re-teamed in The Ghost Breakers (George Marshall, 1940), again a huge hit. Goddard starred with Chaplin again in his film The Great Dictator (1940). In 1942, Goddard was granted a Mexican divorce from Chaplin. The couple split amicably, with Chaplin agreeing to a generous settlement. At Paramount, Goddard was used by Cecil B. De Mille in the action epic North West Mounted Police (1940), playing the second female lead. She was Fred Astaire's leading lady in the acclaimed musical Second Chorus/Swing it (H.C. Potter, 1940), where she met actor Burgess Meredith, her third husband. Goddard made Pot o' Gold (George Marshall, 1941), a comedy with James Stewart, then supported Charles Boyer and Olivia de Havilland in Hold Back the Dawn (Mitchell Leisen, 1941), from a script by Wilder and Brackett, directed by Mitchell Leisen. Goddard was teamed with Hope for a third time in Nothing But the Truth (Elliott Nugent, 1942), then made The Lady Has Plans (Sidney Lanfield, 1942), a comedy with Ray Milland. She co-starred with Milland and John Wayne in Reap the Wild Wind (Cecil B. DeMille, 1942), playing the lead, a Scarlett O'Hara type character. The film was a huge hit. Goddard did The Forest Rangers (George Marshall, 1942) with Fred MacMurray. One of her better-remembered film appearances was in the variety musical Star Spangled Rhythm (George Marshall, 1943), in which she sang "A Sweater, a Sarong, and a Peekaboo Bang" with Dorothy Lamour and Veronica Lake.
Paulette Goddard received one Oscar nomination for Best Supporting Actress for So Proudly We Hail! (Mark Sandrich, 1943) opposite Claudette Colbert and Veronica Lake. She didn't win, but it solidified her as a top draw. Goddard was teamed with Fred MacMurray in the delightful comedy Standing Room Only (Sidney Lanfield, 1944) and Sonny Tufts in I Love a Soldier (Mark Sandrich, 1944). In May 1944, she married Burgess Meredith at David O. Selznick's home in Beverly Hills. Goddard's most successful film was Kitty (Mitchell Leisen, 1945), in which she played the title role. Denny Jackson/Robert Sieger at IMDb: "The film was a hit with moviegoers, as she played an ordinary English woman transformed into a duchess. The film was filled with plenty of comedy, dramatic and romantic scenes that appealed to virtually everyone." In The Diary of a Chambermaid (1946), Goddard starred with husband Burgess Meredith under the direction of Jean Renoir. It was made for United Artists. At Paramount she did Suddenly It's Spring (Mitchell Leisen, 1947) with Fred MacMurray, and De Mille's 18th-century romantic drama Unconquered (Cecil B. DeMille, 1947), with Cary Grant. During the Hollywood Blacklist, when she and blacklisted husband Meredith were mobbed by a baying crowd screaming "Communists!" on their way to a premiere, Goddard is said to have turned to her husband and said, "Shall I roll down the window and hit them with my diamonds, Bugsy?" In 1947, she made An Ideal Husband in Britain for Alexander Korda and was accompanied on a publicity trip to Brussels by Clarissa Spencer-Churchill, niece of Sir Winston Churchill and future wife of future Prime Minister Anthony Eden. She divorced Meredith in June 1949 and also left Paramount. In 1949, she formed Monterey Pictures with John Steinbeck. Goddard starred in Anna Lucasta (Irving Rapper, 1949), then went to Mexico for The Torch (Emilio Fernández, 1950). In England, she was in Babes in Bagdad (Edgar G. Ulmer, 1952), then she went to Hollywood for Vice Squad (Arnold Laven, 1953) with Edward G. Robinson, and Charge of the Lancers (William Castle, 1954) with Jean-Pierre Aumont. Her last starring role was in the English production A Stranger Came Home/The Unholy Four (Terence Fisher, 1954).
Paulette Goddard began appearing in summer stock and on television, guest-starring on episodes of Sherlock Holmes, an adaptation of The Women, this time playing the role of Sylvia Fowler, The Errol Flynn Theatre, The Joseph Cotten Show, and The Ford Television Theatre. She was in an episode of Adventures in Paradise and a TV version of The Phantom. After her marriage to Erich Maria Remarque in 1958, Goddard largely retired from acting and moved to Ronco sopra Ascona, Switzerland. In 1964, she attempted a comeback in films with a supporting role in the Italian film Gli indifferenti/Time of Indifference (Francesco Maselli, 1964), starring Claudia Cardinale and Rod Steiger, which was her last feature film. After Remarque's death in 1970, she made one last attempt at acting, when she accepted a small role in an episode of the TV series The Snoop Sisters, The Female Instinct (Leonards Stern, 1972) with Helen Hayes and Mildred Natwick. Upon Remarque's death, Goddard inherited much of his money and several important properties across Europe, including a wealth of contemporary art, which augmented her own long-standing collection. During this period, her talent at accumulating wealth became a byword among the old Hollywood élite. During the 1980s, she became a fairly well known (and highly visible) socialite in New York City, appearing covered with jewels at many high-profile cultural functions with several well-known men, including Andy Warhol, with whom she sustained a friendship for many years until his death in 1987. Paulette Goddard underwent invasive treatment for breast cancer in 1975, successfully by all accounts. In 1990, she died at her home in Switzerland from heart failure while under respiratory support due to emphysema, She is buried in Ronco Village Cemetery, next to Remarque and her mother. Goddard had no children. She became a stepmother to Charles Chaplin's two sons, Charles Chaplin Jr. and Sydney Chaplin, while she and Charlie were married. In his memoirs, 'My Father Charlie Chaplin' (1960), Charles Jr. describes her as a lovely, caring, and intelligent woman throughout the book. In October 1944, she suffered the miscarriage of a son with Burgess Meredith. Goddard, whose own formal education did not go beyond high school, bequeathed US$20 million to New York University (NYU) in New York City.
Sources: Tony Fontana (IMDb), Denny Jackson / Robert Sieger (IMDb), Wikipedia, and IMDb.
And, please check out our blog European Film Star Postcards.
Model: Daphne Braun
Fashion & Styling: Carina Musitowski
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See complete three series at www.farbanomalie.de
Respiratory problems Occupational and environmental exposures.The respiratory tract comes into contact with approximately 14 000 litres of air during a standard working week. The quality of the air we breathe has major implications for our respiratory health. Any part of the respiratory tract, from the nose to the alveoli, may be adversely affected by exposure to airborne contaminants.Some of the effects of exposures may be immediate, whereas others such as asbestos-related lung disease may not present for many decades. Airborne contaminants may be the primary cause of respiratory disease or can exacerbate pre-existing respiratory conditions such as asthma and chronic obstructive pulmonary disease. Clinicians should have a high index of suspicion and question their patients with breathing problems about occupational and environmental exposures, especially in the setting of new onset symptoms.Identification of occupational and environmental causes of respiratory disease is important because control of these exposures may lead to a cure for some people and prevention of disease in others. In Australia and other developed countries, effective occupational health and safety legislation has resulted in protection of workers from traditional causes of occupational lung disease, such as asbestos and silica. Current exposures may be subtle and require a high index of suspicion from the treating clinician.Air contaminants may be dusts, gases, vapours or fumes. Any part of the respiratory tract can be adversely affected by poor air quality, from the nose to the alveoli. The site affected within the respiratory tract depends on the integrity of defense mechanisms and the properties of the air contaminants (Figure 1). Other determinants include individual susceptibility and the intensity and duration of the exposure.. If a patient presents with new onset respiratory symptoms it is useful to ask about recent changes in their environment, such as whether they have a new pet at home or if they have commenced a new job. It is also useful to ask whether symptoms improve when away from an exposure. Symptoms of recent onset occupational asthma may improve over a weekend but are more likely to improve over a week or when on holidays. Longstanding or severe occupational asthma may not improve until many months after removal of the cause, if at all.
www.racgp.org.au/afp/2012/november/respiratory-problems/
Breathing Off , daylight; same people that can't breathe clean air, drink potable water.
Environmental Sensitivities, also known as Environmental Illness or Environmental Disease is a name that says it all. A person who is ill because of his environment (food, drink, air) has Environmental Sensitivities. Some people consider Multiple Chemical Sensitivities as another name for the same illness, but it is actually a subset of Environmental Illness. The body cannot deal with all the toxins it comes into contact with every day. Immune System Dysfunction happens. Auto-immune Disease is the body mistaking a part of itself as the enemy and attacking it.The things that trigger reactions can be chemicals, natural and manmade, at very low concentrations. A lot of these manmade chemicals were developed after World War II (including pesticides, cleaning products, etc.) and are petroleum based (petro-chemicals). Some of the natural substances that cause problems are grass, pollen, animal hair, or mould.TOTAL LOAD refers to the different impacts on your system. Think of your immune system as a rain barrel, all of the stresses fill it up. The total load is reached but you may not be aware of the different things making you ill.According to Drs. Rossenbaum and Susser, Multiple Chemical Sensitivity (Environmental Sensitivities) is progressive in nature. Because scents are such a serious problem let's look at them more closely (over 4000 chemicals used in the fragrance industry).We usually do not smell many of the scents we and others are emitting until we become hypersensitive. These chemicals could be causing minor problems for years but we do not see the cause/effect. However, as time passes our bodies become weakened from constant exposure. Overloaded passageways in our bodies, the back up of chemicals in the blood stream, muscles, nervous system, organs, etc. leads to a variety of symptoms. Poor air quality, the length of time the chemical clings to clothes, closed in buildings, etc. hold these chemicals and our bodies absorb them.The doctor can send you for allergy tests. These are generally skin tests. Small amounts of known allergens are placed under the skin. Your skin welts up into bumps that are measurable. This tells you what you are allergic to and the seriousness of the allergy. However, there are times when the reactions are not suggestive of allergies but of Environmental Sensitivities. These tests are a starting point and can be used to give you a direction. However, they are not as reliable as other tests (i.e. RAST).There are several things you can do to treat ES depending on what affects you.Avoiding the offending substances is critical. There are steps you take to do this (a) clean the bedroom, take out clothes, books, comforters, cushions/pillows, etc.; (b) wear a mask or take oxygen in public; (c) get rid of chemical cleaners, personal care products, and synthetic clothing.Eat foods that are not harmful (avoid those you react to), clean foods thoroughly, eat organic.
www.nsnet.org/idacan/enviro.html
The Stimulating Breath (also called the Bellows Breath).The Stimulating Breath is adapted from yogic breathing techniques. Its aim is to raise vital energy and increase alertness.Inhale and exhale rapidly through your nose, keeping your mouth closed but relaxed. Your breaths in and out should be equal in duration, but as short as possible. This is a noisy breathing exercise.Try for three in-and-out breath cycles per second. This produces a quick movement of the diaphragm, suggesting a bellows. Breathe normally after each cycle.Do not do for more than 15 seconds on your first try. Each time you practice the Stimulating Breath, you can increase your time by five seconds or so, until you reach a full minute.If done properly, you may feel invigorated, comparable to the heightened awareness you feel after a good workout. You should feel the effort at the back of the neck, the diaphragm, the chest and the abdomen. Try this diaphragmatic breathing exercise the next time you need an energy boost and feel yourself reaching for a cup of coffee.
www.drweil.com/drw/u/ART00521/three-breathing-exercises.html
COP21.Americans Rank Climate Change as Top Environmental Problem.Americans now rank climate change as the country’s most pressing environmental concern, a new survey reveals. m.livescience.com/4287-americans-rank-climate-change-top-...
The important point to remember is that natural fluctuations in the climate system will continue with global warming, but the baseline will climb higher and higher. This means that scientists can't confidently predict, for example, the first year it will be too hot to grow wheat in Kansas or the first summer the Arctic will be ice-free. But crossing both thresholds is assured unless we reduce greenhouse gas emissions.
www.polarbearsinternational.org/about-polar-bears/climate...
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[8] The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[9][10] As of 26 April 2020, more than 2.89 million cases have been reported across 185 countries and territories, resulting in more than 203,000 deaths. More than 822,000 people have recovered.[7]
Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell.[5][11][12] While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm.[13][9][14] More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin.[5] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[5][15]
The virus is primarily spread between people during close contact,[a] often via small droplets produced by coughing,[b] sneezing, or talking.[6][16][18] The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances.[6][19][20] People may also become infected by touching a contaminated surface and then touching their face.[6][16] In experimental settings, the virus may survive on surfaces for up to 72 hours.[21][22][23] It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.[24] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[25] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.[26][27]
Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs, and keeping unwashed hands away from the face.[28][29] In addition, the use of a face covering is recommended for those who suspect they have the virus and their caregivers.[30][31] Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.[32][31][33] Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[6] Also masks purchased by the public may impact availability for health care providers.
Currently, there is no vaccine or specific antiviral treatment for COVID-19.[6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.[34] The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[35][36] on 30 January 2020 and a pandemic on 11 March 2020.[10] Local transmission of the disease has occurred in most countries across all six WHO regions.[37]
File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm
Video summary (script)
Contents
1Signs and symptoms
2Cause
2.1Transmission
2.2Virology
3Pathophysiology
3.1Immunopathology
4Diagnosis
4.1Pathology
5Prevention
6Management
6.1Medications
6.2Protective equipment
6.3Mechanical ventilation
6.4Acute respiratory distress syndrome
6.5Experimental treatment
6.6Information technology
6.7Psychological support
7Prognosis
7.1Reinfection
8History
9Epidemiology
9.1Infection fatality rate
9.2Sex differences
10Society and culture
10.1Name
10.2Misinformation
10.3Protests
11Other animals
12Research
12.1Vaccine
12.2Medications
12.3Anti-cytokine storm
12.4Passive antibodies
13See also
14Notes
15References
16External links
16.1Health agencies
16.2Directories
16.3Medical journals
Signs and symptoms
Symptom[4]Range
Fever83–99%
Cough59–82%
Loss of Appetite40–84%
Fatigue44–70%
Shortness of breath31–40%
Coughing up sputum28–33%
Loss of smell15[38] to 30%[12][39]
Muscle aches and pains11–35%
Fever is the most common symptom, although some older people and those with other health problems experience fever later in the disease.[4][40] In one study, 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization.[4][41]
Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains.[4][5][42][43] Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.[44][45][46] Less common symptoms include sneezing, runny nose, or sore throat.[47]
More serious symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips. Immediate medical attention is advised if these symptoms are present.[5][48]
In some, the disease may progress to pneumonia, multi-organ failure, and death.[9][14] In those who develop severe symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.[4] Some cases in China initially presented with only chest tightness and palpitations.[49]
Loss of smell was identified as a common symptom of COVID‑19 in March 2020,[12][39] although perhaps not as common as initially reported.[38] A decreased sense of smell and/or disturbances in taste have also been reported.[50] Estimates for loss of smell range from 15%[38] to 30%.[12][39]
As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The incubation period for COVID‑19 is typically five to six days but may range from two to 14 days,[51][52] although 97.5% of people who develop symptoms will do so within 11.5 days of infection.[53]
A minority of cases do not develop noticeable symptoms at any point in time.[54][55] These asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known.[56][57] However, preliminary evidence suggests they may contribute to the spread of the disease.[58][59] In March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of confirmed cases remained asymptomatic during their hospital stay.[59][60]
A number of neurological symptoms has been reported including seizures, stroke, encephalitis and Guillain-Barre syndrome.[61] Cardiovascular related complications may include heart failure, irregular electrical activity, blood clots, and heart inflammation.[62]
Cause
See also: Severe acute respiratory syndrome coronavirus 2
Transmission
Cough/sneeze droplets visualised in dark background using Tyndall scattering
Respiratory droplets produced when a man is sneezing visualised using Tyndall scattering
File:COVID19 in numbers- R0, the case fatality rate and why we need to flatten the curve.webm
A video discussing the basic reproduction number and case fatality rate in the context of the pandemic
Some details about how the disease is spread are still being determined.[16][18] The WHO and the U.S. Centers for Disease Control and Prevention (CDC) say it is primarily spread during close contact and by small droplets produced when people cough, sneeze or talk;[6][16] with close contact being within approximately 1–2 m (3–7 ft).[6][63] Both sputum and saliva can carry large viral loads.[64] Loud talking releases more droplets than normal talking.[65] A study in Singapore found that an uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet).[66] An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 metres (27 feet).[17]
Respiratory droplets may also be produced while breathing out, including when talking. Though the virus is not generally airborne,[6][67] the National Academy of Sciences has suggested that bioaerosol transmission may be possible.[68] In one study cited, air collectors positioned in the hallway outside of people's rooms yielded samples positive for viral RNA but finding infectious virus has proven elusive.[68] The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[16] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolised and thus result in an airborne spread.[67] Initial studies suggested a doubling time of the number of infected persons of 6–7 days and a basic reproduction number (R0 ) of 2.2–2.7, but a study published on April 7, 2020, calculated a much higher median R0 value of 5.7 in Wuhan.[69]
It may also spread when one touches a contaminated surface, known as fomite transmission, and then touches one's eyes, nose or mouth.[6] While there are concerns it may spread via faeces, this risk is believed to be low.[6][16]
The virus is most contagious when people are symptomatic; though spread is may be possible before symptoms emerge and from those who never develop symptoms.[6][70] A portion of individuals with coronavirus lack symptoms.[71] The European Centre for Disease Prevention and Control (ECDC) says while it is not entirely clear how easily the disease spreads, one person generally infects two or three others.[18]
The virus survives for hours to days on surfaces.[6][18] Specifically, the virus was found to be detectable for one day on cardboard, for up to three days on plastic (polypropylene) and stainless steel (AISI 304), and for up to four hours on 99% copper.[21][23] This, however, varies depending on the humidity and temperature.[72][73] Surfaces may be decontaminated with many solutions (with one minute of exposure to the product achieving a 4 or more log reduction (99.99% reduction)), including 78–95% ethanol (alcohol used in spirits), 70–100% 2-propanol (isopropyl alcohol), the combination of 45% 2-propanol with 30% 1-propanol, 0.21% sodium hypochlorite (bleach), 0.5% hydrogen peroxide, or 0.23–7.5% povidone-iodine. Soap and detergent are also effective if correctly used; soap products degrade the virus' fatty protective layer, deactivating it, as well as freeing them from the skin and other surfaces.[74] Other solutions, such as benzalkonium chloride and chlorhexidine gluconate (a surgical disinfectant), are less effective.[75]
In a Hong Kong study, saliva samples were taken a median of two days after the start of hospitalization. In five of six patients, the first sample showed the highest viral load, and the sixth patient showed the highest viral load on the second day tested.[64]
Virology
Main article: Severe acute respiratory syndrome coronavirus 2
Illustration of SARSr-CoV virion
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[76] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.[77] Outside the human body, the virus is killed by household soap, which bursts its protective bubble.[26]
SARS-CoV-2 is closely related to the original SARS-CoV.[78] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[47] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.[79]
Pathophysiology
The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[80] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective,[81][82] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested.[83] As the alveolar disease progresses, respiratory failure might develop and death may follow.[82]
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[84] as well as endothelial cells and enterocytes of the small intestine.[85]
ACE2 is present in the brain, and there is growing evidence of neurological manifestations in people with COVID‑19. It is not certain if the virus can directly infect the brain by crossing the barriers that separate the circulation of the brain and the general circulation. Other coronaviruses are able to infect the brain via a synaptic route to the respiratory centre in the medulla, through mechanoreceptors like pulmonary stretch receptors and chemoreceptors (primarily central chemoreceptors) within the lungs.[medical citation needed] It is possible that dysfunction within the respiratory centre further worsens the ARDS seen in COVID‑19 patients. Common neurological presentations include a loss of smell, headaches, nausea, and vomiting. Encephalopathy has been noted to occur in some patients (and confirmed with imaging), with some reports of detection of the virus after cerebrospinal fluid assays although the presence of oligoclonal bands seems to be a common denominator in these patients.[86]
The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[87] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[88] and is more frequent in severe disease.[89] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[87] ACE2 receptors are highly expressed in the heart and are involved in heart function.[87][90] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections and may be related to poor prognosis.[91][92] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside with the presentation of viral pneumonia.[93]
Another common cause of death is complications related to the kidneys[93]—SARS-CoV-2 directly infects kidney cells, as confirmed in post-mortem studies. Acute kidney injury is a common complication and cause of death; this is more significant in patients with already compromised kidney function, especially in people with pre-existing chronic conditions such as hypertension and diabetes which specifically cause nephropathy in the long run.[94]
Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.[95]
Immunopathology
Although SARS-COV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[96]
Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[97]
Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[98] Lymphocytic infiltrates have also been reported at autopsy.[95]
Diagnosis
Main article: COVID-19 testing
Demonstration of a nasopharyngeal swab for COVID-19 testing
CDC rRT-PCR test kit for COVID-19[99]
The WHO has published several testing protocols for the disease.[100] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[101] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[25][102] Results are generally available within a few hours to two days.[103][104] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value.[105] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][106][107] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.[108][109][110] The Chinese experience with testing has shown the accuracy is only 60 to 70%.[111] The FDA in the United States approved the first point-of-care test on 21 March 2020 for use at the end of that month.[112]
Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[113]
A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car).[64]
Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[26][27] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[26] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[26][114]
In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.[115]
Typical CT imaging findings
CT imaging of rapid progression stage
Pathology
Few data are available about microscopic lesions and the pathophysiology of COVID‑19.[116][117] The main pathological findings at autopsy are:
Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema
Four types of severity of viral pneumonia can be observed:
minor pneumonia: minor serous exudation, minor fibrin exudation
mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation
severe pneumonia: diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.
healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis
plasmocytosis in BAL[118]
Blood: disseminated intravascular coagulation (DIC);[119] leukoerythroblastic reaction[120]
Liver: microvesicular steatosis
Prevention
See also: 2019–20 coronavirus pandemic § Prevention, flatten the curve, and workplace hazard controls for COVID-19
Progressively stronger mitigation efforts to reduce the number of active cases at any given time—known as "flattening the curve"—allows healthcare services to better manage the same volume of patients.[121][122][123] Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[124]
Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[122][125]
Preventive measures to reduce the chances of infection include staying at home, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[126][127][128] The CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available.[126] Proper hand hygiene after any cough or sneeze is encouraged.[126] The CDC has recommended the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain, in part to limit transmission by asymptomatic individuals.[129] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside of the setting of a clinical trial.[130]
Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings.[131] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart.[132] There is no medication known to be effective at preventing COVID‑19.[133] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas.[134]
As a vaccine is not expected until 2021 at the earliest,[135] a key part of managing COVID‑19 is trying to decrease the epidemic peak, known as "flattening the curve".[122] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[122][125]
According to the WHO, the use of masks is recommended only if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[136] For the European Centre for Disease Prevention and Control (ECDC) face masks "... could be considered especially when visiting busy closed spaces ..." but "... only as a complementary measure ..."[137] Several countries have recommended that healthy individuals wear face masks or cloth face coverings (like scarves or bandanas) at least in certain public settings, including China,[138] Hong Kong,[139] Spain,[140] Italy (Lombardy region),[141] and the United States.[129]
Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[30][142] The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[126]
For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[143]
Prevention efforts are multiplicative, with effects far beyond that of a single spread. Each avoided case leads to more avoided cases down the line, which in turn can stop the outbreak in its tracks.
File:COVID19 W ENG.ogv
Handwashing instructions
Management
People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.[144][145][146] The CDC recommends that those who suspect they carry the virus wear a simple face mask.[30] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[41][147] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.[148] Supportive treatments may be useful in those with mild symptoms at the early stage of infection.[149]
The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19.[130][150][151] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC.[152][153]
Medications
See also: Coronavirus disease 2019 § Research
As of April 2020, there is no specific treatment for COVID‑19.[6][133] Research is, however, ongoing. For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[130][157] and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.[158]
While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these medications.[130][159][160][161] Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.[162][163]
Medications to prevent blood clotting have been suggested for treatment,[91] and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy (elevated D-dimer).[164]
Protective equipment
See also: COVID-19 related shortages
The CDC recommends four steps to putting on personal protective equipment (PPE).[165]
Precautions must be taken to minimise the risk of virus transmission, especially in healthcare settings when performing procedures that can generate aerosols, such as intubation or hand ventilation.[166] For healthcare professionals caring for people with COVID‑19, the CDC recommends placing the person in an Airborne Infection Isolation Room (AIIR) in addition to using standard precautions, contact precautions, and airborne precautions.[167]
The CDC outlines the guidelines for the use of personal protective equipment (PPE) during the pandemic. The recommended gear is a PPE gown, respirator or facemask, eye protection, and medical gloves.[168][169]
When available, respirators (instead of facemasks) are preferred.[170] N95 respirators are approved for industrial settings but the FDA has authorised the masks for use under an Emergency Use Authorisation (EUA). They are designed to protect from airborne particles like dust but effectiveness against a specific biological agent is not guaranteed for off-label uses.[171] When masks are not available, the CDC recommends using face shields or, as a last resort, homemade masks.[172]
Mechanical ventilation
Most cases of COVID‑19 are not severe enough to require mechanical ventilation or alternatives, but a percentage of cases are.[173][174] The type of respiratory support for individuals with COVID‑19 related respiratory failure is being actively studied for people in the hospital, with some evidence that intubation can be avoided with a high flow nasal cannula or bi-level positive airway pressure.[175] Whether either of these two leads to the same benefit for people who are critically ill is not known.[176] Some doctors prefer staying with invasive mechanical ventilation when available because this technique limits the spread of aerosol particles compared to a high flow nasal cannula.[173]
Severe cases are most common in older adults (those older than 60 years,[173] and especially those older than 80 years).[177] Many developed countries do not have enough hospital beds per capita, which limits a health system's capacity to handle a sudden spike in the number of COVID‑19 cases severe enough to require hospitalisation.[178] This limited capacity is a significant driver behind calls to flatten the curve.[178] One study in China found 5% were admitted to intensive care units, 2.3% needed mechanical support of ventilation, and 1.4% died.[41] In China, approximately 30% of people in hospital with COVID‑19 are eventually admitted to ICU.[4]
Acute respiratory distress syndrome
Main article: Acute respiratory distress syndrome
Mechanical ventilation becomes more complex as acute respiratory distress syndrome (ARDS) develops in COVID‑19 and oxygenation becomes increasingly difficult.[179] Ventilators capable of pressure control modes and high PEEP[180] are needed to maximise oxygen delivery while minimising the risk of ventilator-associated lung injury and pneumothorax.[181] High PEEP may not be available on older ventilators.
Options for ARDS[179]
TherapyRecommendations
High-flow nasal oxygenFor SpO2 <93%. May prevent the need for intubation and ventilation
Tidal volume6mL per kg and can be reduced to 4mL/kg
Plateau airway pressureKeep below 30 cmH2O if possible (high respiratory rate (35 per minute) may be required)
Positive end-expiratory pressureModerate to high levels
Prone positioningFor worsening oxygenation
Fluid managementGoal is a negative balance of 0.5–1.0L per day
AntibioticsFor secondary bacterial infections
GlucocorticoidsNot recommended
Experimental treatment
See also: § Research
Research into potential treatments started in January 2020,[182] and several antiviral drugs are in clinical trials.[183][184] Remdesivir appears to be the most promising.[133] Although new medications may take until 2021 to develop,[185] several of the medications being tested are already approved for other uses or are already in advanced testing.[186] Antiviral medication may be tried in people with severe disease.[144] The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[187]
The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases where the person's life is seriously or immediately threatened. It has not undergone the clinical studies needed to show it is safe and effective for the disease.[188][189][190]
Information technology
See also: Contact tracing and Government by algorithm
In February 2020, China launched a mobile app to deal with the disease outbreak.[191] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.[192]
Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.[193][194] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. The measure was taken to enforce quarantine and protect those who may come into contact with infected citizens.[195] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.[196] Russia deployed facial recognition technology to detect quarantine breakers.[197] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".[198] German government conducted a 48 hours weekend hackathon with more than 42.000 participants.[199][200] Two million people in the UK used an app developed in March 2020 by King's College London and Zoe to track people with COVID‑19 symptoms.[201] Also, the president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[202]
Psychological support
See also: Mental health during the 2019–20 coronavirus pandemic
Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.[203][204]
The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people's mental health and wellbeing."[205][206]
Prognosis
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The severity of diagnosed cases in China
The severity of diagnosed COVID-19 cases in China[207]
Case fatality rates for COVID-19 by age by country.
Case fatality rates by age group:
China, as of 11 February 2020[208]
South Korea, as of 15 April 2020[209]
Spain, as of 24 April 2020[210]
Italy, as of 23 April 2020[211]
Case fatality rate depending on other health problems
Case fatality rate in China depending on other health problems. Data through 11 February 2020.[208]
Case fatality rate by country and number of cases
The number of deaths vs total cases by country and approximate case fatality rate[212]
The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[47]
Children make up a small proportion of reported cases, with about 1% of cases being under 10 years, and 4% aged 10-19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[213][214][215] Pregnant women may be at higher risk for severe infection with COVID-19 based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[216][217] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[213]
In some people, COVID‑19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.[218][219] Complications associated with COVID‑19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.[220] Approximately 20-30% of people who present with COVID‑19 demonstrate elevated liver enzymes (transaminases).[133] Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.[221]
Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[222]
Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[223] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[224] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, patients transferred to an ICU had a median time of seven days between hospitalisation and death.[224] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[225] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[226] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[47] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[49] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[227]
The availability of medical resources and the socioeconomics of a region may also affect mortality.[228] Estimates of the mortality from the condition vary because of those regional differences,[229] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[230] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[231][232] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[233]
Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[234] This may also lead to post-intensive care syndrome following recovery.[235]
Case fatality rates (%) by age and country
Age0–910–1920–2930–3940–4950–5960–6970–7980-8990+
China as of 11 February[208]0.00.20.20.20.41.33.68.014.8
Denmark as of 25 April[236]0.24.515.524.940.7
Italy as of 23 April[211]0.20.00.10.40.92.610.024.930.826.1
Netherlands as of 17 April[237]0.00.30.10.20.51.57.623.230.029.3
Portugal as of 24 April[238]0.00.00.00.00.30.62.88.516.5
S. Korea as of 15 April[209]0.00.00.00.10.20.72.59.722.2
Spain as of 24 April[210]0.30.40.30.30.61.34.413.220.320.1
Switzerland as of 25 April[239]0.90.00.00.10.00.52.710.124.0
Case fatality rates (%) by age in the United States
Age0–1920–4445–5455–6465–7475–8485+
United States as of 16 March[240]0.00.1–0.20.5–0.81.4–2.62.7–4.94.3–10.510.4–27.3
Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.
Estimate of infection fatality rates and probability of severe disease course (%) by age based on cases from China[241]
0–910–1920–2930–3940–4950–5960–6970–7980+
Severe disease0.0
(0.0–0.0)0.04
(0.02–0.08)1.0
(0.62–2.1)3.4
(2.0–7.0)4.3
(2.5–8.7)8.2
(4.9–17)11
(7.0–24)17
(9.9–34)18
(11–38)
Death0.0016
(0.00016–0.025)0.0070
(0.0015–0.050)0.031
(0.014–0.092)0.084
(0.041–0.19)0.16
(0.076–0.32)0.60
(0.34–1.3)1.9
(1.1–3.9)4.3
(2.5–8.4)7.8
(3.8–13)
Total infection fatality rate is estimated to be 0.66% (0.39–1.3). Infection fatality rate is fatality per all infected individuals, regardless of whether they were diagnosed or had any symptoms. Numbers in parentheses are 95% credible intervals for the estimates.
Reinfection
As of March 2020, it was unknown if past infection provides effective and long-term immunity in people who recover from the disease.[242] Immunity is seen as likely, based on the behaviour of other coronaviruses,[243] but cases in which recovery from COVID‑19 have been followed by positive tests for coronavirus at a later date have been reported.[244][245][246][247] These cases are believed to be worsening of a lingering infection rather than re-infection.[247]
History
Main article: Timeline of the 2019–20 coronavirus pandemic
The virus is thought to be natural and has an animal origin,[77] through spillover infection.[248] The actual origin is unknown, but by December 2019 the spread of infection was almost entirely driven by human-to-human transmission.[208][249] A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1 December 2019.[250][251][252] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[253] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[254][255]
Epidemiology
Main article: 2019–20 coronavirus pandemic
Several measures are commonly used to quantify mortality.[256] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[257]
The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 7.0% (203,044/2,899,830) as of 26 April 2020.[7] The number varies by region.[258]
Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.[259]
Total confirmed cases over time
Total deaths over time
Total confirmed cases of COVID‑19 per million people, 10 April 2020[260]
Total confirmed deaths due to COVID‑19 per million people, 10 April 2020[261]
Infection fatality rate
Our World in Data states that as of March 25, 2020, the infection fatality rate (IFR) cannot be accurately calculated.[262] In February, the World Health Organization estimated the IFR at 0.94%, with a confidence interval between 0.37 percent to 2.9 percent.[263] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.72 percent and IFR of 0.1 percent to 0.36 percent.[264] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37 percent there.[264] Firm lower limits to local infection fatality rates were established, such as in Bergamo province, where 0.57% of the population has died, leading to a minimum IFR of 0.57% in the province. This population fatality rate (PFR) minimum increases as more people get infected and run through their disease.[265][266] Similarly, as of April 22 in the New York City area, there were 15,411 deaths confirmed from COVID-19, and 19,200 excess deaths.[267] Very recently, the first results of antibody testing have come in, but there are no valid scientific reports based on them available yet. A Bloomberg Opinion piece provides a survey.[268][269]
Sex differences
Main article: Gendered impact of the 2019–20 coronavirus pandemic
The impact of the pandemic and its mortality rate are different for men and women.[270] Mortality is higher in men in studies conducted in China and Italy.[271][272][273] The highest risk for men is in their 50s, with the gap between men and women closing only at 90.[273] In China, the death rate was 2.8 percent for men and 1.7 percent for women.[273] The exact reasons for this sex-difference are not known, but genetic and behavioural factors could be a reason.[270] Sex-based immunological differences, a lower prevalence of smoking in women, and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[273] In Europe, of those infected with COVID‑19, 57% were men; of those infected with COVID‑19 who also died, 72% were men.[274] As of April 2020, the U.S. government is not tracking sex-related data of COVID‑19 infections.[275] Research has shown that viral illnesses like Ebola, HIV, influenza, and SARS affect men and women differently.[275] A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus.[276] School closures, lockdowns, and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate existing gender disparity.[270][277]
Society and culture
Name
During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[278][279][280] with the disease sometimes called "Wuhan pneumonia".[281][282] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[283] Middle East Respiratory Syndrome, and Zika virus.[284]
In January 2020, the World Health Organisation recommended 2019-nCov[285] and 2019-nCoV acute respiratory disease[286] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma.[287][288][289]
The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[290] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[291] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.[290] Both the disease and virus are commonly referred to as "coronavirus" in the media and public discourse.
Misinformation
Main article: Misinformation related to the 2019–20 coronavirus pandemic
After the initial outbreak of COVID‑19, conspiracy theories, misinformation, and disinformation emerged regarding the origin, scale, prevention, treatment, and other aspects of the disease and rapidly spread online.[292][293][294][295]
Protests
Beginning April 17, 2020, news media began reporting on a wave of demonstrations protesting against state-mandated quarantine restrictions in in Michigan, Ohio, and Kentucky.[296][297]
Other animals
Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.[298] Tigers at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite.[299]
A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens.[300]
Research
Main article: COVID-19 drug development
No medication or vaccine is approved to treat the disease.[186] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[301][302] In March, the World Health Organisation initiated the "SOLIDARITY Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.[303]
Vaccine
Main article: COVID-19 vaccine
There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells.[304] Three vaccination strategies are being investigated. First, researchers aim to build a whole virus vaccine. The use of such a virus, be it inactive or dead, aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from any of these strategies would have to be tested for safety and efficacy.[305]
On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, United States. The vaccine contains a harmless genetic code copied from the virus that causes the disease.[306]
Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial.[307]
Medications
Main article: COVID-19 drug repurposing research
At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020 or scheduled to provide results in April from hospitals in China.[308][309] There are more than 300 active clinical trials underway as of April 2020.[133] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine.[309] Repurposed antiviral drugs make up most of the Chinese research, with nine phase III trials on remdesivir across several countries due to report by the end of April.[308][309] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[309]
The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.[310][311]
Several existing medications are being evaluated for the treatment of COVID‑19,[186] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta.[303][312] There is tentative evidence for efficacy by remdesivir, as of March 2020.[313][314] Clinical improvement was observed in patients treated with compassionate-use remdesivir.[315] Remdesivir inhibits SARS-CoV-2 in vitro.[316] Phase III clinical trials are underway in the U.S., China, and Italy.[186][308][317]
In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe illness.[318] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[316]
There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement.[319][320] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study.[133]
Oseltamivir does not inhibit SARS-CoV-2 in vitro and has no known role in COVID‑19 treatment.[133]
Anti-cytokine storm
Cytokine release syndrome (CRS) can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may have anti-cytokine storm properties.[321]
Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed.[322][323] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[324][325] Combined with a serum ferritin blood test to identify cytokine storms, it is meant to counter such developments, which are thought to be the cause of death in some affected people.[326][327][328] The interleukin-6 receptor antagonist was approved by the FDA to undergo a phase III clinical trial assessing the medication's impact on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017.[329] To date, there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no impact on the incidence of CRS.[330]
Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19.[331]
The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6.[332]
Passive antibodies
Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[333] This strategy was tried for SARS with inconclusive results.[333] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible.[333] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[333] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment.[334]
From Wikipedia, the free encyclopedia
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This article is about the group of viruses. For the disease involved in the 2019–20 coronavirus pandemic, see Coronavirus disease 2019. For the virus that causes this disease, see Severe acute respiratory syndrome coronavirus 2.
Orthocoronavirinae
Coronaviruses 004 lores.jpg
Transmission electron micrograph (TEM) of avian infectious bronchitis virus
SARS-CoV-2 without background.png
Illustration of the morphology of coronaviruses; the club-shaped viral spike peplomers, colored red, create the look of a corona surrounding the virion when observed with an electron microscope.
Virus classification e
(unranked):Virus
Realm:Riboviria
Phylum:incertae sedis
Order:Nidovirales
Family:Coronaviridae
Subfamily:Orthocoronavirinae
Genera[1]
Alphacoronavirus
Betacoronavirus
Gammacoronavirus
Deltacoronavirus
Synonyms[2][3][4]
Coronavirinae
Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can range from mild to lethal. Mild illnesses include some cases of the common cold (which has other possible causes, predominantly rhinoviruses), while more lethal varieties can cause SARS, MERS, and COVID-19. Symptoms in other species vary: in chickens, they cause an upper respiratory tract disease, while in cows and pigs they cause diarrhea. There are yet to be vaccines or antiviral drugs to prevent or treat human coronavirus infections.
Coronaviruses constitute the subfamily Orthocoronavirinae, in the family Coronaviridae, order Nidovirales, and realm Riboviria.[5][6] They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses ranges from approximately 26 to 32 kilobases, one of the largest among RNA viruses.[7] They have characteristic club-shaped spikes that project from their surface, which in electron micrographs create an image reminiscent of the solar corona from which their name derives.[8]
Contents
1Discovery
2Etymology
3Morphology
4Genome
5Life cycle
5.1Entry
5.2Replication
5.3Release
6Transmission
7Taxonomy
8Evolution
9Human coronaviruses
10Outbreaks of coronavirus diseases
10.1Severe acute respiratory syndrome (SARS)
10.2Middle East respiratory syndrome (MERS)
10.3Coronavirus disease 2019 (COVID-19)
11Other animals
11.1Diseases caused
11.2Domestic animals
12Genomic cis-acting elements
13Genome packaging
14See also
15References
16Further reading
Discovery
Coronaviruses were first discovered in the 1930s when an acute respiratory infection of domesticated chickens was shown to be caused by infectious bronchitis virus (IBV). In the 1940s, two more animal coronaviruses, mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), were isolated.[9]
Human coronaviruses were discovered in the 1960s.[10] The earliest ones studied were from human patients with the common cold, which were later named human coronavirus 229E and human coronavirus OC43.[11] Other human coronaviruses have since been identified, including SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 in 2019. Most of these have involved serious respiratory tract infections.
Etymology
The name "coronavirus" is derived from Latin corona, meaning "crown" or "wreath", itself a borrowing from Greek κορώνη korṓnē, "garland, wreath". The name refers to the characteristic appearance of virions (the infective form of the virus) by electron microscopy, which have a fringe of large, bulbous surface projections creating an image reminiscent of a crown or of a solar corona. This morphology is created by the viral spike peplomers, which are proteins on the surface of the virus.[8][12]
Morphology
Cross-sectional model of a coronavirus
Cross-sectional model of a coronavirus
Coronaviruses are large pleomorphic spherical particles with bulbous surface projections.[13] The average diameter of the virus particles is around 120 nm (.12 μm). The diameter of the envelope is ~80 nm (.08 μm) and the spikes are ~20 nm (.02 μm) long. The envelope of the virus in electron micrographs appears as a distinct pair of electron dense shells.[14][15]
The viral envelope consists of a lipid bilayer where the membrane (M), envelope (E) and spike (S) structural proteins are anchored.[16] A subset of coronaviruses (specifically the members of betacoronavirus subgroup A) also have a shorter spike-like surface protein called hemagglutinin esterase (HE).[5]
Inside the envelope, there is the nucleocapsid, which is formed from multiple copies of the nucleocapsid (N) protein, which are bound to the positive-sense single-stranded RNA genome in a continuous beads-on-a-string type conformation.[15][17] The lipid bilayer envelope, membrane proteins, and nucleocapsid protect the virus when it is outside the host cell.[18]
Genome
See also: Severe acute respiratory syndrome-related coronavirus § Genome
Schematic representation of the genome organization and functional domains of S protein for SARS-CoV and MERS-CoV
Coronaviruses contain a positive-sense, single-stranded RNA genome. The genome size for coronaviruses ranges from 26.4 to 31.7 kilobases.[7] The genome size is one of the largest among RNA viruses. The genome has a 5′ methylated cap and a 3′ polyadenylated tail.[15]
The genome organization for a coronavirus is 5′-leader-UTR-replicase/transcriptase-spike (S)-envelope (E)-membrane (M)-nucleocapsid (N)-3′UTR-poly (A) tail. The open reading frames 1a and 1b, which occupy the first two-thirds of the genome, encode the replicase/transcriptase polyprotein. The replicase/transcriptase polyprotein self cleaves to form nonstructural proteins.[15]
The later reading frames encode the four major structural proteins: spike, envelope, membrane, and nucleocapsid.[19] Interspersed between these reading frames are the reading frames for the accessory proteins. The number of accessory proteins and their function is unique depending on the specific coronavirus.[15]
Life cycle
Entry
The life cycle of a coronavirus
Infection begins when the viral spike (S) glycoprotein attaches to its complementary host cell receptor. After attachment, a protease of the host cell cleaves and activates the receptor-attached spike protein. Depending on the host cell protease available, cleavage and activation allows the virus to enter the host cell by endocytosis or direct fusion of the viral envelop with the host membrane.[20]
On entry into the host cell, the virus particle is uncoated, and its genome enters the cell cytoplasm.[15] The coronavirus RNA genome has a 5′ methylated cap and a 3′ polyadenylated tail, which allows the RNA to attach to the host cell's ribosome for translation.[15] The host ribosome translates the initial overlapping open reading frame of the virus genome and forms a long polyprotein. The polyprotein has its own proteases which cleave the polyprotein into multiple nonstructural proteins.[15]
Replication
A number of the nonstructural proteins coalesce to form a multi-protein replicase-transcriptase complex (RTC). The main replicase-transcriptase protein is the RNA-dependent RNA polymerase (RdRp). It is directly involved in the replication and transcription of RNA from an RNA strand. The other nonstructural proteins in the complex assist in the replication and transcription process. The exoribonuclease nonstructural protein, for instance, provides extra fidelity to replication by providing a proofreading function which the RNA-dependent RNA polymerase lacks.[21]
One of the main functions of the complex is to replicate the viral genome. RdRp directly mediates the synthesis of negative-sense genomic RNA from the positive-sense genomic RNA. This is followed by the replication of positive-sense genomic RNA from the negative-sense genomic RNA.[15] The other important function of the complex is to transcribe the viral genome. RdRp directly mediates the synthesis of negative-sense subgenomic RNA molecules from the positive-sense genomic RNA. This is followed by the transcription of these negative-sense subgenomic RNA molecules to their corresponding positive-sense mRNAs.[15]
Release
The replicated positive-sense genomic RNA becomes the genome of the progeny viruses. The mRNAs are gene transcripts of the last third of the virus genome after the initial overlapping reading frame. These mRNAs are translated by the host's ribosomes into the structural proteins and a number of accessory proteins.[15] RNA translation occurs inside the endoplasmic reticulum. The viral structural proteins S, E, and M move along the secretory pathway into the Golgi intermediate compartment. There, the M proteins direct most protein-protein interactions required for assembly of viruses following its binding to the nucleocapsid.[22] Progeny viruses are then released from the host cell by exocytosis through secretory vesicles.[22]
Transmission
The interaction of the coronavirus spike protein with its complement host cell receptor is central in determining the tissue tropism, infectivity, and species range of the virus.[23][24] The SARS coronavirus, for example, infects human cells by attaching to the angiotensin-converting enzyme 2 (ACE2) receptor.[25]
Taxonomy
For a more detailed list of members, see Coronaviridae.
Phylogenetic tree of coronaviruses
The scientific name for coronavirus is Orthocoronavirinae or Coronavirinae.[2][3][4] Coronavirus belongs to the family of Coronaviridae.
Genus: Alphacoronavirus
Species: Human coronavirus 229E, Human coronavirus NL63, Miniopterus bat coronavirus 1, Miniopterus bat coronavirus HKU8, Porcine epidemic diarrhea virus, Rhinolophus bat coronavirus HKU2, Scotophilus bat coronavirus 512
Genus Betacoronavirus; type species: Murine coronavirus
Species: Betacoronavirus 1 (Human coronavirus OC43), Human coronavirus HKU1, Murine coronavirus, Pipistrellus bat coronavirus HKU5, Rousettus bat coronavirus HKU9, Severe acute respiratory syndrome-related coronavirus (SARS-CoV, SARS-CoV-2), Tylonycteris bat coronavirus HKU4, Middle East respiratory syndrome-related coronavirus, Hedgehog coronavirus 1 (EriCoV)
Genus Gammacoronavirus; type species: Infectious bronchitis virus
Species: Beluga whale coronavirus SW1, Infectious bronchitis virus
Genus Deltacoronavirus; type species: Bulbul coronavirus HKU11
Species: Bulbul coronavirus HKU11, Porcine coronavirus HKU15
Evolution
The most recent common ancestor (MRCA) of all coronaviruses has been estimated to have existed as recently as 8000 BCE, though some models place the MRCA as far back as 55 million years or more, implying long term coevolution with bats.[26] The MRCAs of the alphacoronavirus line has been placed at about 2400 BCE, the betacoronavirus line at 3300 BCE, the gammacoronavirus line at 2800 BCE, and the deltacoronavirus line at about 3000 BCE. It appears that bats and birds, as warm-blooded flying vertebrates, are ideal hosts for the coronavirus gene source (with bats for alphacoronavirus and betacoronavirus, and birds for gammacoronavirus and deltacoronavirus) to fuel coronavirus evolution and dissemination.[27]
Bovine coronavirus and canine respiratory coronaviruses diverged from a common ancestor recently (~ 1950).[28] Bovine coronavirus and human coronavirus OC43 diverged around the 1890s. Bovine coronavirus diverged from the equine coronavirus species at the end of the 18th century.[29]
The MRCA of human coronavirus OC43 has been dated to the 1950s.[30]
MERS-CoV, although related to several bat coronavirus species, appears to have diverged from these several centuries ago.[31] The human coronavirus NL63 and a bat coronavirus shared an MRCA 563–822 years ago.[32]
The most closely related bat coronavirus and SARS-CoV diverged in 1986.[33] A path of evolution of the SARS virus and keen relationship with bats have been proposed. The authors suggest that the coronaviruses have been coevolved with bats for a long time and the ancestors of SARS-CoV first infected the species of the genus Hipposideridae, subsequently spread to species of the Rhinolophidae and then to civets, and finally to humans.[34][35]
Alpaca coronavirus and human coronavirus 229E diverged before 1960.[36]
Human coronaviruses
Illustration of SARSr-CoV virion
Coronaviruses vary significantly in risk factor. Some can kill more than 30% of those infected (such as MERS-CoV), and some are relatively harmless, such as the common cold.[15] Coronaviruses cause colds with major symptoms, such as fever, and a sore throat from swollen adenoids, occurring primarily in the winter and early spring seasons.[37] Coronaviruses can cause pneumonia (either direct viral pneumonia or secondary bacterial pneumonia) and bronchitis (either direct viral bronchitis or secondary bacterial bronchitis).[38] The human coronavirus discovered in 2003, SARS-CoV, which causes severe acute respiratory syndrome (SARS), has a unique pathogenesis because it causes both upper and lower respiratory tract infections.[38]
Six species of human coronaviruses are known, with one species subdivided into two different strains, making seven strains of human coronaviruses altogether. Four of these strains produce the generally mild symptoms of the common cold:
Human coronavirus OC43 (HCoV-OC43), of the genus β-CoV
Human coronavirus HKU1 (HCoV-HKU1), β-CoV, its genome has 75% similarity to OC43[39]
Human coronavirus 229E (HCoV-229E), α-CoV
Human coronavirus NL63 (HCoV-NL63), α-CoV
Three strains (two species) produce symptoms that are potentially severe; all three of these are β-CoV strains:
Middle East respiratory syndrome-related coronavirus (MERS-CoV)
Severe acute respiratory syndrome coronavirus (SARS-CoV)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
The coronaviruses HCoV-229E, -NL63, -OC43, and -HKU1 continually circulate in the human population and cause respiratory infections in adults and children worldwide.[40]
Outbreaks of coronavirus diseases
Severe acute respiratory syndrome (SARS)
Main article: Severe acute respiratory syndrome
Characteristics of human coronavirus strains
MERS-CoV, SARS-CoV, SARS-CoV-2,
and related diseases
MERS-CoVSARS-CoVSARS-CoV-2
DiseaseMERSSARSCOVID-19
Outbreaks2012, 2015,
20182002–20042019–2020
pandemic
Epidemiology
Date of first
identified caseJune
2012November
2002December
2019[41]
Location of first
identified caseJeddah,
Saudi ArabiaShunde,
ChinaWuhan,
China
Age average5644[42][a]56[43]
Sex ratio3.3:10.8:1[44]1.6:1[43]
Confirmed cases24948096[45]1,601,018[46][b]
Deaths858774[45]95,718[46][b]
Case fatality rate37%9.2%6.0%[46]
Symptoms
Fever98%99–100%87.9%[47]
Dry cough47%29–75%67.7%[47]
Dyspnea72%40–42%18.6%[47]
Diarrhea26%20–25%3.7%[47]
Sore throat21%13–25%13.9%[47]
Ventilatory support24.5%[48]14–20%4.1%[49]
Notes
^ Based on data from Hong Kong.
^ Jump up to: a b Data as of 10 April 2020.
vte
In 2003, following the outbreak of severe acute respiratory syndrome (SARS) which had begun the prior year in Asia, and secondary cases elsewhere in the world, the World Health Organization (WHO) issued a press release stating that a novel coronavirus identified by a number of laboratories was the causative agent for SARS. The virus was officially named the SARS coronavirus (SARS-CoV). More than 8,000 people were infected, about ten percent of whom died.[25]
Middle East respiratory syndrome (MERS)
Main article: Middle East respiratory syndrome
In September 2012, a new type of coronavirus was identified, initially called Novel Coronavirus 2012, and now officially named Middle East respiratory syndrome coronavirus (MERS-CoV).[50][51] The World Health Organization issued a global alert soon after.[52] The WHO update on 28 September 2012 said the virus did not seem to pass easily from person to person.[53] However, on 12 May 2013, a case of human-to-human transmission in France was confirmed by the French Ministry of Social Affairs and Health.[54] In addition, cases of human-to-human transmission were reported by the Ministry of Health in Tunisia. Two confirmed cases involved people who seemed to have caught the disease from their late father, who became ill after a visit to Qatar and Saudi Arabia. Despite this, it appears the virus had trouble spreading from human to human, as most individuals who are infected do not transmit the virus.[55] By 30 October 2013, there were 124 cases and 52 deaths in Saudi Arabia.[56]
After the Dutch Erasmus Medical Centre sequenced the virus, the virus was given a new name, Human Coronavirus—Erasmus Medical Centre (HCoV-EMC). The final name for the virus is Middle East respiratory syndrome coronavirus (MERS-CoV). The only U.S. cases (both survived) were recorded in May 2014.[57]
In May 2015, an outbreak of MERS-CoV occurred in the Republic of Korea, when a man who had traveled to the Middle East, visited four hospitals in the Seoul area to treat his illness. This caused one of the largest outbreaks of MERS-CoV outside the Middle East.[58] As of December 2019, 2,468 cases of MERS-CoV infection had been confirmed by laboratory tests, 851 of which were fatal, a mortality rate of approximately 34.5%.[59]
Coronavirus disease 2019 (COVID-19)
Main article: Coronavirus disease 2019
In December 2019, a pneumonia outbreak was reported in Wuhan, China.[60] On 31 December 2019, the outbreak was traced to a novel strain of coronavirus,[61] which was given the interim name 2019-nCoV by the World Health Organization (WHO),[62][63][64] later renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses. Some researchers have suggested the Huanan Seafood Wholesale Market may not be the original source of viral transmission to humans.[65][66]
As of 10 April 2020, there have been at least 95,718[46] confirmed deaths and more than 1,601,018[46] confirmed cases in the coronavirus pneumonia pandemic. The Wuhan strain has been identified as a new strain of Betacoronavirus from group 2B with approximately 70% genetic similarity to the SARS-CoV.[67] The virus has a 96% similarity to a bat coronavirus, so it is widely suspected to originate from bats as well.[65][68] The pandemic has resulted in travel restrictions and nationwide lockdowns in several countries.
Other animals
Coronaviruses have been recognized as causing pathological conditions in veterinary medicine since the 1930s.[9] Except for avian infectious bronchitis, the major related diseases have mainly an intestinal location.[69]
Diseases caused
Coronaviruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. They also cause a range of diseases in farm animals and domesticated pets, some of which can be serious and are a threat to the farming industry. In chickens, the infectious bronchitis virus (IBV), a coronavirus, targets not only the respiratory tract but also the urogenital tract. The virus can spread to different organs throughout the chicken.[70] Economically significant coronaviruses of farm animals include porcine coronavirus (transmissible gastroenteritis coronavirus, TGE) and bovine coronavirus, which both result in diarrhea in young animals. Feline coronavirus: two forms, feline enteric coronavirus is a pathogen of minor clinical significance, but spontaneous mutation of this virus can result in feline infectious peritonitis (FIP), a disease associated with high mortality. Similarly, there are two types of coronavirus that infect ferrets: Ferret enteric coronavirus causes a gastrointestinal syndrome known as epizootic catarrhal enteritis (ECE), and a more lethal systemic version of the virus (like FIP in cats) known as ferret systemic coronavirus (FSC).[71] There are two types of canine coronavirus (CCoV), one that causes mild gastrointestinal disease and one that has been found to cause respiratory disease. Mouse hepatitis virus (MHV) is a coronavirus that causes an epidemic murine illness with high mortality, especially among colonies of laboratory mice.[72] Sialodacryoadenitis virus (SDAV) is highly infectious coronavirus of laboratory rats, which can be transmitted between individuals by direct contact and indirectly by aerosol. Acute infections have high morbidity and tropism for the salivary, lachrymal and harderian glands.[73]
A HKU2-related bat coronavirus called swine acute diarrhea syndrome coronavirus (SADS-CoV) causes diarrhea in pigs.[74]
Prior to the discovery of SARS-CoV, MHV had been the best-studied coronavirus both in vivo and in vitro as well as at the molecular level. Some strains of MHV cause a progressive demyelinating encephalitis in mice which has been used as a murine model for multiple sclerosis. Significant research efforts have been focused on elucidating the viral pathogenesis of these animal coronaviruses, especially by virologists interested in veterinary and zoonotic diseases.[75]
Domestic animals
Infectious bronchitis virus (IBV) causes avian infectious bronchitis.
Porcine coronavirus (transmissible gastroenteritis coronavirus of pigs, TGEV).[76][77]
Bovine coronavirus (BCV), responsible for severe profuse enteritis in of young calves.
Feline coronavirus (FCoV) causes mild enteritis in cats as well as severe Feline infectious peritonitis (other variants of the same virus).
the two types of canine coronavirus (CCoV) (one causing enteritis, the other found in respiratory diseases).
Turkey coronavirus (TCV) causes enteritis in turkeys.
Ferret enteric coronavirus causes epizootic catarrhal enteritis in ferrets.
Ferret systemic coronavirus causes FIP-like systemic syndrome in ferrets.[78]
Pantropic canine coronavirus.
Rabbit enteric coronavirus causes acute gastrointestinal disease and diarrhea in young European rabbits. Mortality rates are high.[79]
Porcine epidemic diarrhea virus (PED or PEDV), has emerged around the world.[80]
Genomic cis-acting elements
In common with the genomes of all other RNA viruses, coronavirus genomes contain cis-acting RNA elements that ensure the specific replication of viral RNA by a virally encoded RNA-dependent RNA polymerase. The embedded cis-acting elements devoted to coronavirus replication constitute a small fraction of the total genome, but this is presumed to be a reflection of the fact that coronaviruses have the largest genomes of all RNA viruses. The boundaries of cis-acting elements essential to replication are fairly well-defined, and the RNA secondary structures of these regions are understood. However, how these cis-acting structures and sequences interact with the viral replicase and host cell components to allow RNA synthesis is not well understood.[81][5]
Genome packaging
The assembly of infectious coronavirus particles requires the selection of viral genomic RNA from a cellular pool that contains an abundant excess of non-viral and viral RNAs. Among the seven to ten specific viral mRNAs synthesized in virus-infected cells, only the full-length genomic RNA is packaged efficiently into coronavirus particles. Studies have revealed cis-acting elements and trans-acting viral factors involved in the coronavirus genome encapsidation and packaging. Understanding the molecular mechanisms of genome selection and packaging is critical for developing antiviral strategies and viral expression vectors based on the coronavirus genome.[81][5]
A missing filter... Picture or maybe in the air of the time that brews a little anguish, it grinds ideas by dint of filtering the words... the cunning life with a twist. Angel or mill?
The COVID-19 pandemic has resulted in conspiracy theories and misinformation about the scale of the pandemic and the origin, prevention, diagnosis, and treatment of the disease.[1][2][3] False information, including intentional disinformation, has been spread through social media,[2][4] text messages,[5] and mass media,[6] including the tabloid media,[7] conservative media,[8][9] state media of countries such as China,[10][11] Russia,[12][13] Iran,[14] and Turkmenistan.[2][15] It has also been spread by state-backed covert operations to generate panic and sow distrust in other countries.[16][17]
Misinformation has been propagated by celebrities, politicians[18][19] (including heads of state in countries such as the United States,[20][21] Iran,[22] and Brazil[23]), and other prominent public figures.[24] Commercial scams have claimed to offer at-home tests, supposed preventives, and "miracle" cures.[25][26] Politicians and leaders of some countries have promoted purported cures, while some religious groups said that the faith of their followers and God will protect them from the virus.[27][28][29] Others have claimed the virus is a lab-developed bio-weapon that was accidentally leaked,[30][31] or deliberately designed to target a country,[32] or one with a patented vaccine, a population control scheme, the result of a spy operation,[3][4] or linked to 5G networks.[33]
The World Health Organization has declared an "infodemic" of incorrect information about the virus, which poses risks to global health.[2]
Types and origin and effect
On January 30, the BBC reported about the increasing spread of conspiracy theories and false health advice in relation to COVID-19. Notable examples at the time included false health advice shared on social media and private chats, as well as conspiracy theories such as the origin in bat soup and the outbreak being planned with the participation of the Pirbright Institute.[1][34] On January 31, The Guardian listed seven instances of misinformation, adding the conspiracy theories about bioweapons and the link to 5G technology, and including varied false health advice.[35]
In an attempt to speed up research sharing, many researches have turned to preprint servers such as arXiv, bioRxiv, medRxiv or SSRN. Papers can be uploaded to these servers without peer review or any other editorial process that ensures research quality. Some of these papers have contributed to the spread of conspiracy theories. The most notable case was a preprint paper uploaded to bioRxiv which claimed that the virus contained HIV "insertions". Following the controversy, the paper was withdrawn.[36][37][38]
According to a study published by the Reuters Institute for the Study of Journalism, most misinformation related to COVID-19 involves "various forms of reconfiguration, where existing and often true information is spun, twisted, recontextualised, or reworked". While less misinformation "was completely fabricated". The study found no deep fakes in the studied sample. The study also found that "top-down misinformation from politicians, celebrities, and other prominent public figures", while accounting for a minority of the samples, captured a majority of the social media engagement. According to their classification, the largest category of misinformation (39%) includes "misleading or false claims about the actions or policies of public authorities, including government and international bodies like the WHO or the UN".[39]
A natural experiment correlated coronavirus misinformation with increased infection and death; of two similar television news shows on the same network, one took coronavirus seriously about a month earlier than the other. People and groups exposed to the slow-response news show had higher infection and death rates.[40]
The misinformations have been used by politicians, interest groups, and state actors in many countries to scapegoat other countries for the mishandling of the domestic responses, as well as furthering political, financial agenda.[41][42][43]
Combative efforts
Further information: Impact of the 2019–20 coronavirus pandemic on journalism
File:ITU - AI for Good Webinar Series - COVID-19 Misinformation and Disinformation during COVID-19.webm
International Telecommunication Union
On February 2, the World Health Organization (WHO) described a "massive infodemic", citing an over-abundance of reported information, accurate and false, about the virus that "makes it hard for people to find trustworthy sources and reliable guidance when they need it". The WHO stated that the high demand for timely and trustworthy information has incentivised the creation of a direct WHO 24/7 myth-busting hotline where its communication and social media teams have been monitoring and responding to misinformation through its website and social media pages.[44][45][46] The WHO specifically debunked several claims as false, including the claim that a person can tell if they have the virus or not simply by holding their breath; the claim that drinking large amounts of water will protect against the virus; and the claim that gargling salt water prevents infection.[47]
In early February, Facebook, Twitter and Google said they were working with WHO to address "misinformation".[48] In a blogpost, Facebook stated they would remove content flagged by global health organizations and local authorities that violate its content policy on misinformation leading to "physical harm".[49] Facebook is also giving free advertising to WHO.[50] Nonetheless, a week after Trump's speculation that sunlight could kill the virus, the New York Times found "780 Facebook groups, 290 Facebook pages, nine Instagram accounts and thousands of tweets pushing UV light therapies," content which those companies declined to remove from their platforms.[51]
At the end of February, Amazon removed more than a million products claimed to cure or protect against coronavirus, and removed tens of thousands of listings for health products whose prices were "significantly higher than recent prices offered on or off Amazon", although numerous items were "still being sold at unusually high prices" as of February 28.[52]
Millions of instances of COVID-19 misinformation have occurred across a number of online platforms.[53] Other fake news researchers noted certain rumors started in China; many of them later spread to Korea and the United States, prompting several universities in Korea to start the multilingual Facts Before Rumors campaign to separate common claims seen online.[54][55][56][57]
The media has praised Wikipedia's coverage of COVID-19 and its combating the inclusion of misinformation through efforts led by the Wiki Project Med Foundation and the English-language Wikipedia's WikiProject Medicine, among other groups.[58][59][60]
Many local newspapers have been severely affected by losses in advertising revenues from coronavirus; journalists have been laid off, and some have closed altogether.[61]
Many newspapers with paywalls lowered them for some or all their coronavirus coverage.[62][63] Many scientific publishers made scientific papers related to the outbreak open access.[64]
The Turkish Interior Ministry has been arresting social media users whose posts were "targeting officials and spreading panic and fear by suggesting the virus had spread widely in Turkey and that officials had taken insufficient measures".[65] Iran's military said 3600 people have been arrested for "spreading rumors" about coronavirus in the country.[66] In Cambodia, some individuals who expressed concerns about the spread of COVID-19 have been arrested on fake news charges.[67][68] Algerian lawmakers passed a law criminalising "fake news" deemed harmful to "public order and state security".[69] In the Philippines,[70] China,[71] India,[72][73] Egypt,[74] Bangladesh,[75] Morocco,[76] Pakistan,[77] Saudi Arabia,[78] Oman,[79] Iran,[80] Vietnam, Laos,[81] Indonesia,[73] Mongolia,[73] Sri Lanka,[73] Kenya, South Africa,[82] Somalia,[83] Thailand,[84] Kazakhstan,[85] Azerbaijan,[86] Malaysia[87] and Hong Kong, people have been arrested for allegedly spreading false information about the coronavirus pandemic.[88][73] The United Arab Emirates have introduced criminal penalties for the spread of misinformation and rumours related to the outbreak.[89]
Conspiracy theories
Conspiracy theories have appeared both in social media and in mainstream news outlets, and are heavily influenced by geopolitics.[90]
Accidental leakage
Virologist and immunologist Vincent R. Racaniello said that "accident theories – and the lab-made theories before them – reflect a lack of understanding of the genetic make-up of Sars-CoV-2."[91]
A number of allegations have emerged supposing a link between the virus and Wuhan Institute of Virology (WIV); among these is that the virus was an accidental leakage from WIV.[92] In 2017, U.S. molecular biologist Richard H. Ebright expressed caution when the WIV was expanded to become mainland China's first biosafety level 4 (BSL-4) laboratory, noting previous escapes of the SARS virus at other Chinese laboratories.[93] While Ebright refuted several conspiracy theories regarding the WIV (e.g., bioweapons research, or that the virus was engineered), he told BBC China this did not represent the possibility that the virus can be "completely ruled out" from entering the population due to a laboratory accident.[92] Various researchers contacted by NPR concluded there was "virtually no chance" (in NPR's words) that the pandemic virus had accidentally escaped from a laboratory.[94] Disinformation researcher Nina Jankowicz from Wilson Center indicates the lab leakage claim entered mainstream media in United States during April, propagated by pro-Trump news outlet.[43]
On February 14, 2020, Chinese scientists explored the possibility of accidental leakage and published speculations on scientific social networking website ResearchGate. The paper was neither peer-reviewed nor presented any evidence for its claims.[95] On March 5, the author of paper told Wall Street Journal in an interview why he decided to withdrew the paper by the end of February, stating: "the speculation about the possible origins in the post was based on published papers and media, and was not supported by direct proofs."[96][97] Several newspapers have referenced the paper.[95] Scientific American reported that Shi Zhengli, the lead researcher at WIV, started investigation on mishandling of experimental materials in the lab records, especially during disposal. She also tried to cross-check the novel coronavirus genome with the genetic information of other bat coronaviruses her team had collected. The result showed none of the sequences matched those of the viruses her team had sampled from bat caves.[98]
In February, it was alleged that the first person infected may have been a researcher at the institute named Huang Yanling.[99] Rumours circulated on Chinese social media that the researcher had become infected and died, prompting a denial from WIV, saying she was a graduate student enrolled in the Institute until 2015 and is not the patient zero.[100][99] In April, the conspiracy theory started to circulate around on Youtube and got picked up by conservative media, National Review.[101][6]
The South China Morning Post (SCMP) reported that one of the WIV's lead researchers, Shi Zhengli, was the particular focus of personal attacks in Chinese social media alleging that her work on bat-based viruses was the source of the virus; this led Shi to post: "I swear with my life, [the virus] has nothing to do with the lab". When asked by the SCMP to comment on the attacks, Shi responded: "My time must be spent on more important matters".[102] Caixin reported Shi made further public statements against "perceived tinfoil-hat theories about the new virus's source", quoting her as saying: "The novel 2019 coronavirus is nature punishing the human race for keeping uncivilized living habits. I, Shi Zhengli, swear on my life that it has nothing to do with our laboratory".[103] Immunologist Vincent Racaniello stated that virus leaking theory "reflect a lack of understanding of the genetic make-up of Sars-CoV-2 and its relationship to the bat virus". He says the bat virus researched in the institution "would not have been able to infect humans—the human Sars-CoV-2 has additional changes that allows it to infect humans."[91]
On April 14, the U.S. Chairman of the Joint Chiefs of Staff, General Mark Milley, in response to questions about the virus being manufactured in a lab, said "... it's inconclusive, although the weight of evidence seems to indicate natural. But we don't know for certain."[104] On that same day, Washington Post columnist Josh Rogin detailed a leaked cable of a 2018 trip made to the WIV by scientists from the U.S. Embassy. The article was referenced and cited by conservative media to push the lab leakage theory.[43] Rogin's article went on to say that "What the U.S. officials learned during their visits concerned them so much that they dispatched two diplomatic cables categorized as Sensitive But Unclassified back to Washington. The cables warned about safety and management weaknesses at the WIV lab and proposed more attention and help. The first cable, which I obtained, also warns that the lab's work on bat coronaviruses and their potential human transmission represented a risk of a new SARS-like pandemic."[105] Rogin's article pointed out there was no evidence that the coronavirus was engineered, "But that is not the same as saying it didn't come from the lab, which spent years testing bat coronaviruses in animals."[105] The article went on to quote Xiao Qiang, a research scientist at the School of Information at the University of California, Berkeley, "I don't think it's a conspiracy theory. I think it's a legitimate question that needs to be investigated and answered. To understand exactly how this originated is critical knowledge for preventing this from happening in the future."[105] Washington Post's article and subsequent broadcasts drew criticism from virologist Angela Rasmussen of Columbia University, which she states "It's irresponsible for political reporters like Rogin [to] uncritically regurgitate a secret 'cable' without asking a single virologist or ecologist or making any attempt to understand the scientific context."[43] Rasmussen later compared biosafety procedure concerns to "having the health inspector come to your restaurant. It could just be, ‘Oh, you need to keep your chemical showers better stocked.’ It doesn’t suggest, however, that there are tremendous problems.”[106]
Days later, multiple media outlets confirmed that U.S. intelligence officials were investigating the possibility that the virus started in the WIV.[107][108][109][110] On April 23, Vox presented disputed arguments on lab leakage claims from several scientists.[111] Scientists suggested that virus samples cultured in the lab have significant amount of difference compare to SARS-CoV-2. The virus institution sampled RaTG13 in Yunnan, the closest known relative of the novel coronavirus with 96% shared genome. Edward Holmes, SARS-CoV-2 researcher at the University of Sydney, explained 4% of difference "is equivalent to an average of 50 years (and at least 20 years) of evolutionary change."[111][112] Virologist Peter Daszak, president of the EcoHealth Alliance, which studies emerging infectious diseases, noted the estimation that 1–7 million people in Southeast Asia who live or work in proximity to bats are infected each year with bat coronaviruses. In the interview with Vox, he comments, "There are probably half a dozen people that do work in those labs. So let's compare 1 million to 7 million people a year to half a dozen people; it's just not logical."[94][111]
On April 30, The New York Times reported the Trump administration demanded intelligence agencies to find evidence linking WIV with the origin of SARS-Cov-2. Secretary of State and former Central Intelligence Agency (C.I.A) director Mike Pompeo was reportedly leading the push on finding information regarding the virus origin. Analysts were concerned that pressure from senior officials could distort assessments from the intelligence community. Anthony Ruggiero, the head of the National Security Council which responsible for tracking weapons of mass destruction, expressed frustration during a video conference that C.I.A. was unable to form conclusive answer on the origin of the virus. According to current and former government officials, as of April 30, C.I.A has yet to gather any information beyond circumstantial evidence to bolster the lab theory.[113][114] US intelligence officers suggested that Chinese officials tried to conceal the severity of the outbreak in early days, but no evidence had shown China attempted to cover up a lab accident.[115] One day later, Trump claimed he has evidence of the lab theory, but offers no further details on it.[116][117] Jamie Metzl, a senior fellow at the Atlantic Council, claimed the SARS-CoV-2 virus "likely" came from a Wuhan virology testing laboratory, based on "circumstantial evidence". He was quoted as saying, "I have no definitive way of proving this thesis."[118]
On April 30, 2020, the U.S. intelligence and scientific communities issued a public statement dismissing the idea that the virus was not natural, while the investigation of the lab accident theory was ongoing.[119][120] The White House suggested an alternative explanation, along with a seemingly contradictory message, that the virus was man-made. In an interview with ABC News, Secretary of State Pompeo said he has no reason to disbelieve the intelligence community that the virus was natural. However, this contradicted the comment he made earlier in the same interview, in which he said "the best experts so far seem to think it was man-made. I have no reason to disbelieve that at this point."[121][122][123] On May 4, Australian tabloid The Daily Telegraph claimed a reportedly leaked dossier from Five Eyes, which alleged the probable outbreak was from the Wuhan lab.[124] Fox News and national security commentators in the US quickly followed up The Telegraph story,[125][126] rising the tension within international intelligence community.[127] Australian government, which is part of the Five Eyes nations, determined the leaked dossier was not a Five Eyes document, but a compilation of open-source materials that contained no information generated by intelligence gathering.[128] German intelligence community denied the claim of the leaked dossier, instead supported the probability of a natural cause.[129][130] Australian government sees the promotion of the lab theory from the United States counterproductive to Australia’s push for a more broad international-supported independent inquiry into the virus origins.[127] Senior officials in Australian government speculated the dossier was leaked by US embassy in Canberra to promote a narrative in Australia media that diverged from the mainstream belief of Australia.[127][128][125]
Beijing rejected the White House's claim, calling the claim "part of an election year strategy by President Donald Trump’s Republican Party".[131] Hua Chunying, Chinese Foreign Ministry spokeswoman, urged Mike Pompeo to present evidence for his claim. "Mr. Pompeo cannot present any evidence because he does not have any," Hua told a journalist during a regular briefing, "This matter should be handled by scientists and professionals instead of politicians out of their domestic political needs."[131][132] The Chinese ambassador, in an opinion published in the Washington Post, called on the White House to end the "blame game" over the coronavirus.[133][134] As of May 5, assessments and internal sources from the Five Eyes nations indicated that the coronavirus outbreak was the result of a laboratory accident was "highly unlikely", since the human infection was "highly likely" a result of natural human and animal interaction. However, to reach such a conclusion with total certainty would still require greater cooperation and transparency from the Chinese side.[135]
Anti-Israeli and antisemitic
Further information: Antisemitic canard
Iran's Press TV asserted that "Zionist elements developed a deadlier strain of coronavirus against Iran".[14] Similarly, various Arab media outlets accused Israel and the United States of creating and spreading COVID-19, avian flu, and SARS.[136] Users on social media offered a variety of theories, including the supposition that Jews had manufactured COVID-19 to precipitate a global stock market collapse and thereby profit via insider trading,[137] while a guest on Turkish television posited a more ambitious scenario in which Jews and Zionists had created COVID-19, avian flu, and Crimean–Congo hemorrhagic fever to "design the world, seize countries, [and] neuter the world's population".[138]
Israeli attempts to develop a COVID-19 vaccine prompted mixed reactions. Grand Ayatollah Naser Makarem Shirazi denied initial reports that he had ruled that a Zionist-made vaccine would be halal,[139] and one Press TV journalist tweeted that "I'd rather take my chances with the virus than consume an Israeli vaccine".[140] A columnist for the Turkish Yeni Akit asserted that such a vaccine could be a ruse to carry out mass sterilization.[141]
An alert by the U.S. Federal Bureau of Investigation regarding the possible threat of far-right extremists intentionally spreading the coronavirus mentioned blame being assigned to Jews and Jewish leaders for causing the pandemic and several statewide shutdowns.[142]
Anti-Muslim
Further information: 2020 Tablighi Jamaat coronavirus hotspot in Delhi
In India, Muslims have been blamed for spreading infection following the emergence of cases linked to a Tablighi Jamaat religious gathering.[143] There are reports of vilification of Muslims on social media and attacks on individuals in India.[144] Claims have been made Muslims are selling food contaminated with coronavirus and that a mosque in Patna was sheltering people from Italy and Iran.[145] These claims were shown to be false.[146] In the UK, there are reports of far-right groups blaming Muslims for the coronavirus outbreak and falsely claiming that mosques remained open after the national ban on large gatherings.[147]
Bioengineered virus
It has been repeatedly claimed that the virus was deliberately created by humans.
Nature Medicine published an article arguing against the conspiracy theory that the virus was created artificially. The high-affinity binding of its peplomers to human angiotensin-converting enzyme 2 (ACE2) was shown to be "most likely the result of natural selection on a human or human-like ACE2 that permits another optimal binding solution to arise".[148] In case of genetic manipulation, one of the several reverse-genetic systems for betacoronaviruses would probably have been used, while the genetic data irrefutably showed that the virus is not derived from a previously used virus template.[148] The overall molecular structure of the virus was found to be distinct from the known coronaviruses and most closely resembles that of viruses of bats and pangolins that were little studied and never known to harm humans.[149]
In February 2020, the Financial Times quoted virus expert and global co-lead coronavirus investigator Trevor Bedford: "There is no evidence whatsoever of genetic engineering that we can find", and "The evidence we have is that the mutations [in the virus] are completely consistent with natural evolution".[150] Bedford further explained, "The most likely scenario, based on genetic analysis, was that the virus was transmitted by a bat to another mammal between 20–70 years ago. This intermediary animal—not yet identified—passed it on to its first human host in the city of Wuhan in late November or early December 2019".[150]
On February 19, 2020, The Lancet published a letter of a group of scientists condemning "conspiracy theories suggesting that COVID-19 does not have a natural origin".[151]
Chinese biological weapon
India
Amidst a rise in Sinophobia, there have been conspiracy theories reported on India's social networks that the virus is "a bioweapon that went rogue" and also fake videos alleging that Chinese authorities are killing citizens to prevent its spread.[152]
Ukraine
According to the Kyiv Post, two common conspiracy theories online in Ukraine are that American author Dean Koontz predicted the pandemic in his 1981 novel The Eyes of Darkness, and that the coronavirus is a bioweapon leaked from a secret lab in Wuhan.[153]
United Kingdom
Tobias Ellwood said, "It would be irresponsible to suggest the source of this outbreak was an error in a Chinese military biological weapons programme ... But without greater Chinese transparency we cannot entirely completely sure."[154]
In February, Conservative MP Tobias Ellwood, chair of the Defence Select Committee of the UK House of Commons, publicly questioned the role of the Chinese Army's Wuhan Institute for Biological Products and called for the "greater transparency over the origins of the coronavirus".[154][non-primary source needed] The Daily Mail reported in early April 2020 that a member of COBRA (an ad-hoc government committee tasked with advising on crises[citation needed]) has stated while government intelligence does not dispute that the virus has a zoonotic origin, it also does not discount the idea of a leak from a Wuhan laboratory, saying "Perhaps it is no coincidence that there is that laboratory in Wuhan"; the Asia Times reported the story as if it were factual,[155] perhaps unaware of the reputation of the Daily Mail.
United States
Further information: Cyberwarfare in the United States and Propaganda in the United States
In January 2020, BBC News published an article about coronavirus misinformation, citing two January 24 articles from The Washington Times that said the virus was part of a Chinese biological weapons program, based at the Wuhan Institute of Virology (WIV).[1] The Washington Post later published an article debunking the conspiracy theory, citing U.S. experts who explained why the WIV was unsuitable for bioweapon research, that most countries had abandoned bioweapons as fruitless, and that there was no evidence the virus was genetically engineered.[156]
On January 29, financial news website and blog ZeroHedge suggested without evidence that a scientist at the WIV created the COVID-19 strain responsible for the coronavirus outbreak. Zerohedge listed the full contact details of the scientist supposedly responsible, a practice known as doxing, by including the scientist's name, photo, and phone number, suggesting to readers that they "pay [the Chinese scientist] a visit" if they wanted to know "what really caused the coronavirus pandemic".[157] Twitter later permanently suspended the blog's account for violating its platform-manipulation policy.[158]
Logo of the fictional Umbrella Corporation, which some internet rumours linked to the pandemic. The corporation was invented for the Resident Evil game series.
In January 2020, Buzzfeed News reported on an internet meme of a link between the logo of the WIV and "Umbrella Corporation", the agency that created the virus responsible for a zombie apocalypse in the Resident Evil franchise. Posts online noted that "Racoon [sic]" (the main city in Resident Evil) was an anagram of "Corona".[159] Snopes noted that the logo was not from the WIV, but a company named Shanghai Ruilan Bao Hu San Biotech Ltd (located some 500 miles (800 km) away in Shanghai), and that the correct name of the city in Resident Evil was "Raccoon City".[159]
In February 2020, U.S. Senator Tom Cotton (R-AR) suggested the virus may have originated in a Chinese bioweapon laboratory.[160] Francis Boyle, a law professor, also expressed support for the bioweapon theory suggesting it was the result of unintended leaks.[161] Cotton elaborated on Twitter that his opinion was only one of "at least four hypotheses". Multiple medical experts have indicated there is no evidence for these claims.[162] Conservative political commentator Rush Limbaugh said on The Rush Limbaugh Show—the most popular radio show in the U.S.—that the virus was probably "a ChiCom laboratory experiment" and the Chinese government was using the virus and the media hysteria surrounding it to bring down Donald Trump.[163][164]
On February 6, the White House asked scientists and medical researchers to rapidly investigate the origins of the virus both to address the current spread and "to inform future outbreak preparation and better understand animal/human and environmental transmission aspects of coronaviruses".[165] American magazine Foreign Policy said Xi Jinping's "political agenda may turn out to be a root cause of the epidemic" and that his Belt and Road Initiative has "made it possible for a local disease to become a global menace".[90]
The Inverse reported that "Christopher Bouzy, the founder of Bot Sentinel, conducted a Twitter analysis for Inverse and found [online] bots and trollbots are making an array of false claims. These bots are claiming China intentionally created the virus, that it's a biological weapon, that Democrats are overstating the threat to hurt Donald Trump and more. While we can't confirm the origin of these bots, they are decidedly pro-Trump."[166]
Conservative commentator Josh Bernstein claimed that the Democratic Party and the "medical deep state" were collaborating with the Chinese government to create and release the coronavirus to bring down Donald Trump. Bernstein went on to suggest those responsible should be locked in a room with infected coronavirus patients as punishment.[167][168]
Jerry Falwell Jr., the president of Liberty University, promoted a conspiracy theory on Fox News that North Korea and China conspired together to create the coronavirus.[169] He also said people were overreacting to the coronavirus outbreak and that Democrats were trying to use the situation to harm President Trump.[170]
Hospital ship attack
The hospital ship USNS Mercy (T-AH-19) deployed to the Port of Los Angeles to provide backup medical services for the region. On March 31, 2020, a Pacific Harbor Line freight train was deliberately derailed by its onboard engineer in an attempt to crash into the ship, but the attack was unsuccessful and no one was injured.[171][172] According to U.S. federal prosecutors, the train's engineer "[...] was suspicious of the Mercy, believing it had an alternate purpose related to COVID-19 or a government takeover".[173]
Population control scheme
See also: List of conspiracy theories § RFID chips
According to the BBC, Jordan Sather, a conspiracy theory YouTuber supporting the far-right QAnon conspiracy theory and the anti-vax movement, has falsely claimed the outbreak was a population control scheme created by Pirbright Institute in England and by former Microsoft CEO Bill Gates. This belief is held mostly by right-wing libertarians, NWO conspiracy theorists, and Christian Fundamentalists.[1][174]
Spy operation
Some people have alleged that the coronavirus was stolen from a Canadian virus research lab by Chinese scientists. Health Canada and the Public Health Agency of Canada said that conspiracy theory had "no factual basis".[175] The stories seem to have been derived[176] from a July 2019 news article[177] stating that some Chinese researchers had their security access to a Canadian Level 4 virology facility revoked in a federal police investigation; Canadian officials described this as an administrative matter and "there is absolutely no risk to the Canadian public."[177]
This article was published by the Canadian Broadcasting Corporation (CBC);[176] responding to the conspiracy theories, the CBC later stated that "CBC reporting never claimed the two scientists were spies, or that they brought any version of the coronavirus to the lab in Wuhan". While pathogen samples were transferred from the lab in Winnipeg, Canada to Beijing, China, on March 31, 2019, neither of the samples was a coronavirus, the Public Health Agency of Canada says the shipment conformed to all federal policies, and there has not been any statement that the researchers under investigation were responsible for sending the shipment. The current location of the researchers under investigation by the Royal Canadian Mounted Police is not being released.[175][178][179]
In the midst of the coronavirus epidemic, a senior research associate and expert in biological warfare with the Begin-Sadat Center for Strategic Studies, referring to a NATO press conference, identified suspicions of espionage as the reason behind the expulsions from the lab, but made no suggestion that coronavirus was taken from the Canadian lab or that it is the result of bioweapons defense research in China.[180]
U.S. biological weapon
Arab world
According to Washington DC-based nonprofit Middle East Media Research Institute, numerous writers in the Arabic press have promoted the conspiracy theory that COVID-19, as well as SARS and the swine flu virus, were deliberately created and spread to sell vaccines against these diseases, and it is "part of an economic and psychological war waged by the U.S. against China with the aim of weakening it and presenting it as a backward country and a source of diseases".[181] Iraqi political analyst Sabah Al-Akili on Al-Etejah TV, Saudi daily Al-Watan writer Sa'ud Al-Shehry, Syrian daily Al-Thawra columnist Hussein Saqer, and Egyptian journalist Ahmad Rif'at on Egyptian news website Vetogate, were some examples given by MEMRI as propagators of the U.S. biowarfare conspiracy theory in the Arabic world.[181]
China
Further information: Cyberwarfare by China, Propaganda in China, and Chinese information operations and information warfare
The Xinhua News Agency is among the news outlets that have published false information about COVID-19's origins.
According to London-based The Economist, plenty of conspiracy theories exist on China's internet about COVID-19 being the CIA's creation to keep China down.[182] NBC News however has noted that there have also been debunking efforts of U.S.-related conspiracy theories posted online, with a WeChat search of "Coronavirus is from the U.S." reported to mostly yield articles explaining why such claims are unreasonable.[183] According to an investigation by ProPublica, such conspiracy theories and disinformation have been propagated under the direction of China News Service, the country's second largest government-owned media outlet controlled by the United Front Work Department.[184] Global Times and Xinhua News Agency have similarly been implicated in propagating disinformation related to COVID-19's origins.[185][186]
Multiple conspiracy articles in Chinese from the SARS era resurfaced during the outbreak with altered details, claiming SARS is biological warfare. Some said BGI Group from China sold genetic information of the Chinese people to the U.S., which then specifically targeted the genome of Chinese individuals.[187]
On January 26, Chinese military enthusiast website Xilu published an article, claimed how the U.S. artificially combined the virus to "precisely target Chinese people".[188][189] The article was removed in early February. The article was further distorted on social media in Taiwan, which claimed "Top Chinese military website admitted novel coronavirus was Chinese-made bio-weapons".[190] Taiwan Fact-check center debunked the original article and its divergence, suggesting the original Xilu article distorted the conclusion from a legitimate research on Chinese scientific magazine Science China Life Sciences, which never mentioned the virus was engineered.[190] The fact-check center explained Xilu is a military enthusiastic tabloid established by a private company, thus it doesn't represent the voice of Chinese military.[190]
Some articles on popular sites in China have also cast suspicion on U.S. military athletes participating in the Wuhan 2019 Military World Games, which lasted until the end of October 2019, and have suggested they deployed the virus. They claim the inattentive attitude and disproportionately below-average results of American athletes in the games indicate they might have been there for other purposes and they might actually be bio-warfare operatives. Such posts stated that their place of residence during their stay in Wuhan was also close to the Huanan Seafood Wholesale Market, where the first known cluster of cases occurred.[191]
In March 2020, this conspiracy theory was endorsed by Zhao Lijian, a spokesperson from the Ministry of Foreign Affairs of the People's Republic of China.[192][193][194][195] On March 13, the U.S. government summoned Chinese Ambassador Cui Tiankai to Washington over the coronavirus conspiracy theory.[196] Over the next month, conspiracy theorists narrowed their focus to one U.S. Army Reservist, a woman who participated in the games in Wuhan as a cyclist, claiming she is "patient zero". According to a CNN report, these theories have been spread by George Webb, who has nearly 100,000 followers on YouTube, and have been amplified by a report by CPC-owned newspaper Global Times.[197][198]
Iran
Further information: Propaganda in Iran
Reza Malekzadeh, deputy health minister, rejected bioterrorism theories.
According to Radio Farda, Iranian cleric Seyyed Mohammad Saeedi accused U.S. President Donald Trump of targeting Qom with coronavirus "to damage its culture and honor". Saeedi claimed that Trump is fulfilling his promise to hit Iranian cultural sites, if Iranians took revenge for the airstrike that killed of Quds Force Commander Qasem Soleimani.[199]
Iranian TV personality Ali Akbar Raefipour claimed the coronavirus was part of a "hybrid warfare" programme waged by the United States on Iran and China.[200] Brigadier General Gholam Reza Jalali, head of Iranian Civil Defense Organization, claimed the coronavirus is likely a biological attack on China and Iran with economic goals.[201][202]
Hossein Salami, the head of Islamic Revolutionary Guard Corps (IRGC), claimed the coronavirus outbreak in Iran may be due to a U.S. "biological attack".[203] Several Iranian politicians, including Hossein Amir-Abdollahian, Rasoul Falahati, Alireza Panahian, Abolfazl Hasanbeigi and Gholamali Jafarzadeh Imanabadi, also made similar remarks.[204] Iranian Supreme Leader, the Ayatollah Ali Khamenei, made similar suggestions.[205]
Former Iranian president Mahmoud Ahmadinejad sent a letter to the United Nations on March 9, claiming that "it is clear to the world that the mutated coronavirus was produced in lab" and that COVID-19 is "a new weapon for establishing and/or maintaining political and economic upper hand in the global arena".[206]
The late[207] Ayatollah Hashem Bathaie Golpayegani claimed that "America is the source of coronavirus, because America went head to head with China and realised it cannot keep up with it economically or militarily."[208]
Reza Malekzadeh, Iran's deputy health minister and former Minister of Health, rejected claims that the virus was a biological weapon, pointing out that the U.S. would be suffering heavily from it. He said Iran was hard-hit because its close ties to China and reluctance to cut air ties introduced the virus, and because early cases had been mistaken for influenza.[205]
Philippines
In the Philippine Senate, Tito Sotto has promoted his belief that COVID-19 is a bioweapon.
A Filipino Senator, Tito Sotto, played a bioweapon conspiracy video in a February 2020 Senate hearing, suggesting the coronavirus is biowarfare waged against China.[209][210]
Russia
Further information: Cyberwarfare by Russia and Propaganda in the Russian Federation
On February 22, U.S. officials alleged that Russia is behind an ongoing disinformation campaign, using thousands of social media accounts on Twitter, Facebook and Instagram to deliberately promote unfounded conspiracy theories, claiming the virus is a biological weapon manufactured by the CIA and the U.S. is waging economic war on China using the virus.[211][12][212] The acting assistant secretary of state for Europe and Eurasia, Philip Reeker, said "Russia's intent is to sow discord and undermine U.S. institutions and alliances from within" and "by spreading disinformation about coronavirus, Russian malign actors are once again choosing to threaten public safety by distracting from the global health response."[211] Russia denies the allegation, saying "this is a deliberately false story".[213]
According to U.S.-based The National Interest magazine, although official Russian channels had been muted on pushing the U.S. biowarfare conspiracy theory, other Russian media elements do not share the Kremlin's restraint.[214] Zvezda, a news outlet funded by the Russian Defense Ministry, published an article titled "Coronavirus: American biological warfare against Russia and China", claiming that the virus is intended to damage the Chinese economy, weakening its hand in the next round of trade negotiations.[214] Ultra-nationalist politician and leader of the Liberal Democratic Party of Russia, Vladimir Zhirinovsky, claimed on a Moscow radio station that the virus was an experiment by the Pentagon and pharmaceutical companies. Politician Igor Nikulin made rounds on Russian television and news media, arguing that Wuhan was chosen for the attack because the presence of a BSL-4 virus lab provided a cover story for the Pentagon and CIA about a Chinese bio-experiment leak.[214] An EU-document claims 80 attempts by Russian media to spread disinformation related to the epidemic.[215]
According to the East StratCom Task Force, the Sputnik news agency was active publishing stories speculating that the virus could've been invented in Latvia, that it was used by Communist Party of China to curb protests in Hong Kong, that it was introduced intentionally to reduce the number of elder people in Italy, that it was targeted against the Yellow Vests movement, and making many other speculations. Sputnik branches in countries including Armenia, Belarus, Spain, and in the Middle East came up with versions of these stories.[216]
Venezuela
Constituent Assembly member Elvis Méndez declared that the coronavirus was a "bacteriological sickness created in '89, in '90 and historically" and that it was a sickness "inoculated by the gringos". Méndez theorized that the virus was a weapon against Latin America and China and that its purpose was "to demoralize the person, to weaken to install their system".[217]
COVID-19 recovery
It has been wrongly claimed that anyone infected with COVID-19 will have the virus in their bodies for life. While there is no curative treatment, infected individuals can recover from the disease, eliminating the virus from their bodies; getting supportive medical care early can help.[279]
COVID-19 xenophobic blaming by ethnicity and religion
Main article: List of incidents of xenophobia and racism related to the 2019–20 coronavirus pandemic
File:IOM - Fighting Stigma and Discrimination against Migrants during COVID-19.webm
UN video warns that misinformation against groups may lower testing rates and increase transmission.
COVID-19-related xenophobic attacks have been made against people the attacker blamed for COVID-19 on the basis of their ethnicity. People who are considered to look Chinese have been subjected to COVID-19-related verbal and physical attacks in many other countries, often by people accusing them of transmitting the virus.[281][282][283] Within China, there has been discrimination (such as evictions and non-service in shops) against people from anywhere closer to Wuhan (where the pandemic started) and against anyone perceived as being non-Chinese (especially those considered African), as the Chinese government has blamed continuing cases on re-introductions of the virus from abroad (90% of reintroduced cases were by Chinese passport-holders). Neighbouring countries have also discriminated against people seen as Westerners.[284][285][286] People have also simply blamed other local groups along the lines of pre-existing social tensions and divisions, sometimes citing reporting of COVID-19 cases within that group. For instance, Muslims have been widely blamed, shunned, and discriminated against in India (including some violent attacks), amid unfounded claims that Muslims are deliberately spreading COVID-19, and a Muslim event at which the disease did spread has received far more public attention than many similar events run by other groups and the government.[287] White supremacist groups have blamed COVID-19 on non-whites and advocated deliberately infecting minorities they dislike, such as Jews.[288]
False causes
5G
5G towers have been burned by people wrongly blaming them for COVID-19.
Openreach engineers appealed on anti-5G Facebook groups, saying they aren't involved in mobile networks, and workplace abuse is making it difficult for them to maintain phonelines and broadband.
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In February 2020 BBC News reported that conspiracy theorists on social media groups alleged a link between coronavirus and 5G mobile networks, claiming that Wuhan and Diamond Princess outbreaks were directly caused by electromagnetic fields and by the introduction of 5G and wireless technologies. Some conspiracy theorists also alleged that the coronavirus outbreak was a cover-up for a 5G-related illness.[33] In March 2020, Thomas Cowan, a holistic medical practitioner who trained as a physician and operates on probation with Medical Board of California, alleged that coronavirus is caused by 5G, based on the claims that African countries were not affected significantly by the pandemic and Africa was not a 5G region.[289][290] Cowan also falsely alleged that the viruses were wastes from cells that are poisoned by electromagnetic fields and historical viral pandemics coincided with the major developments in radio technology.[290] The video of his claims went viral and was recirculated by celebrities including Woody Harrelson, John Cusack, and singer Keri Hilson.[291] The claims may also have been recirculated by an alleged "coordinated disinformation campaign", similar to campaigns used by the Internet Research Agency in Saint Petersburg, Russia.[292] The claims were criticized on social media and debunked by Reuters,[293] USA Today,[294] Full Fact[295] and American Public Health Association executive director Georges C. Benjamin.[289][296]
Professor Steve Powis, national medical director of NHS England, described theories linking 5G mobile phone networks to COVID-19 as the "worst kind of fake news".[297] Viruses cannot be transmitted by radio waves. COVID-19 has spread and continues to spread in many countries that do not have 5G networks.[279]
After telecommunications masts in several parts of the United Kingdom were the subject of arson attacks, British Cabinet Office Minister Michael Gove said the theory that COVID-19 virus may be spread by 5G wireless communication is "just nonsense, dangerous nonsense as well".[298] Vodafone announced that two Vodafone masts and two it shares with O2 had been targeted.[299][300]
By Monday April 6, 2020 at least 20 mobile phone masts in the UK had been vandalised since the previous Thursday.[301] Because of slow rollout of 5G in the UK, many of the damaged masts had only 3G and 4G equipment.[301] Mobile phone and home broadband operators estimated there were at least 30 incidents of confronting engineers maintaining equipment in the week up to April 6.[301] There have been eleven incidents of attempted arson at mobile phone masts in the Netherlands, including one case where "Fuck 5G" was written, as well as in Ireland and Cyprus.[302][303] Facebook has deleted multiple messages encouraging attacks on 5G equipment.[301]
Engineers working for Openreach posted pleas on anti-5G Facebook groups asking to be spared abuse as they are not involved with maintaining mobile networks.[304] Mobile UK said the incidents were affecting attempts to maintain networks that support home working and provide critical connections to vulnerable customers, emergency services and hospitals.[304] A widely circulated video shows people working for broadband company Community Fibre being abused by a woman who accuses them of installing 5G as part of a plan to kill the population.[304]
YouTube announced that it would reduce the amount of content claiming links between 5G and coronavirus.[299] Videos that are conspiratorial about 5G that do not mention coronavirus would not be removed, though they might be considered "borderline content", removed from search recommendations and losing advertising revenue.[299] The discredited claims had been circulated by British conspiracy theorist David Icke in videos (subsequently removed) on YouTube and Vimeo, and an interview by London Live TV network, prompting calls for action by Ofcom.[305][306]
On April 13, 2020, Gardaí were investigating fires at 5G masts in County Donegal, Ireland.[307] Gardaí and fire services had attended the fires the previous night in an attempt to put them out.[307] Although Gardaí were awaiting results of tests they were treating the fires as deliberate.[307]
There were 20 suspected arson attacks on phone masts in the UK over the Easter 2020 weekend.[297] These included an incident in Dagenham where three men were arrested on suspicion of arson, a fire in Huddersfield that affected a mast used by emergency services and a fire in a mast that provides mobile connectivity to the NHS Nightingale Hospital Birmingham.[297]
Ofcom issued guidance to ITV following comments by Eamonn Holmes after comments made by Holmes about 5G and coronavirus on This Morning.[308] Ofcom said the comments were "ambiguous" and "ill-judged" and they "risked undermining viewers' trust in advice from public authorities and scientific evidence".[308] Ofcom also local channel London Live in breach of standards for an interview it had with David Icke who it said had " expressed views which had the potential to cause significant harm to viewers in London during the pandemic".[308]
Some telecoms engineers have reported threats of violence, including threats to stab and murder them, by individuals who believe them to be working on 5G networks.[309] West Midlands Police said the crimes in question are being taken very seriously.[309]
On April 24, 2020 The Guardian revealed that an evangelical pastor from Luton had provided the male voice on a recording blaming 5G for deaths caused by coronavirus.[310] Jonathon James claimed to have formerly headed the largest business-unit at Vodafone, but insiders at the company said that he was hired for a sales position in 2014 when 5G was not a priority for the company and that 5G would not have been part of his job.[310] He left the company after less than a year.[310]
Mosquitoes
It has been claimed that mosquitoes transmit coronavirus. There is no evidence that this is true; coronavirus spreads through small droplets of saliva and mucus.[279]
Petrol pumps
A warning claiming to be from the Australia Department of Health said coronavirus spreads through petrol pumps and that everyone should wear gloves when filling up petrol in their cars.[311]
Shoe-wearing
There were claims that wearing shoes at one's home was the reason behind the spread of the coronavirus in Italy.[312]
Resistance/susceptibility based on ethnicity
There have been claims that specific ethnicities are more or less vulnerable to COVID-19. COVID-19 is a new zoonotic disease, so no population has yet had the time to develop population immunity.[medical citation needed]
Beginning on February 11, reports, quickly spread via Facebook, implied that a Cameroonian student in China had been completely cured of the virus due to his African genetics. While a student was successfully treated, other media sources have noted that no evidence implies Africans are more resistant to the virus and labeled such claims as false information.[313] Kenyan Secretary of Health Mutahi Kagwe explicitly refuted rumors that "those with black skin cannot get coronavirus", while announcing Kenya's first case on March 13.[314] This myth was cited as a contributing factor in the disproportionately high rates of infection and death observed among African Americans.[315][316]
There have been claims of "Indian immunity": that the people of India have more immunity to the COVID-19 virus due to living conditions in India. This idea was deemed "absolute drivel" by Anand Krishnan, professor at the Centre for Community Medicine of the All India Institute of Medical Sciences (AIIMS). He said there was no population immunity to the COVID-19 virus yet, as it is new, and it is not even clear whether people who have recovered from COVID-19 will have lasting immunity, as this happens with some viruses but not with others.[317]
Iran's Supreme Leader Ayatollah Ali Khamenei claimed the virus was genetically targeted at Iranians by the U.S., and this is why it is seriously affecting Iran. He did not offer any evidence.[318][22]
Religious protection
A number of religious groups have claimed protection due to their faith, some refusing to stop large religious gatherings. In Israel, some Ultra-Orthodox Jews initially refused to close synagogues and religious seminaries and disregarded government restrictions because "The Torah protects and saves",[319] which resulted in an 8 times faster rate of infection among some groups.[320] The Tablighi Jamaat movement organised mass gatherings in Malaysia, India, and Pakistan whose participants believed that God will protect them resulted the biggest rise in COVID-19 cases in a number of countries.[321][29][322] In Iran, the head of Fatima Masumeh Shrine encouraged pilgrims to visit the shrine despite calls to close the shrine, saying that they "consider this holy shrine to be a place of healing."[323] In South Korea the River of Grace Community Church in Gyeonggi Province spread the virus after spraying salt water into their members' mouths in the belief that it would kill the virus,[324] while the Shincheonji Church of Jesus in Daegu where a church leader claimed that no Shincheonji worshipers had caught the virus in February while hundreds died in Wuhan later caused in the biggest spread of the virus in the country.[325][326]
In Somalia, myths have spread claiming Muslims are immune to the virus.[327]
Unproven protective and aggravating factors
Vegetarian immunity
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This section needs expansion. You can help by adding to it. (April 2020)
Claims that vegetarians are immune to coronavirus spread online in India, causing "#NoMeat_NoCoronaVirus" to trend on Twitter.[328][better source needed] Eating meat does not have an effect on COVID-19 spread, except for people near where animals are slaughtered, said Anand Krishnan.[329] Fisheries, Dairying and Animal Husbandry Minister Giriraj Singh said the rumour had significantly affected industry, with the price of a chicken falling to a third of pre-pandemic levels. He also described efforts to improve the hygiene of the meat supply chain.[330]
Efficacy of hand sanitiser, "antibacterial" soaps
Washing in soap and water for at least 20 seconds is the best way to clean hands. Second-best is a hand sanitizer that is at least 60% alcohol.[331]
Claims that hand sanitiser is merely "antibacterial not antiviral", and therefore ineffective against COVID-19, have spread widely on Twitter and other social networks. While the effectiveness of sanitiser depends on the specific ingredients, most hand sanitiser sold commercially inactivates SARS-CoV-2, which causes COVID-19.[332][333] Hand sanitizer is recommended against COVID-19,[279] though unlike soap, it is not effective against all types of germs.[334] Washing in soap and water for at least 20 seconds is recommended by the U.S. Centers for Disease Control (CDC) as the best way to clean hands in most situations. However, if soap and water are not available, a hand sanitizer that is at least 60% alcohol can be used instead, unless hands are visibly dirty or greasy.[331][335] The CDC and the Food and Drug Administration both recommend plain soap; there is no evidence that "antibacterial soaps" are any better, and limited evidence that they might be worse long-term.[336][337]
Alcohol (ethanol and poisonous methanol)
Contrary to some reports, drinking alcohol does not protect against COVID-19, and can increase health risks[279] (short term and long term). Drinking alcohol is ethanol; other alcohols, such as methanol, which causes methanol poisoning, are acutely poisonous, and may be present in badly-prepared alcoholic beverages.[338]
Iran has reported incidents of methanol poisoning, caused by the false belief that drinking alcohol would cure or protect against coronavirus;[339] alcohol is banned in Iran, and bootleg alcohol may contain methanol.[340] According to Iranian media in March 2020, nearly 300 people have died and more than a thousand have become ill due to methanol poisoning, while Associated Press gave figures of around 480 deaths with 2,850 others affected.[341] The number of deaths due to methanol poisoning in Iran reached over 700 by April.[342] Iranian social media had circulated a story from British tabloids that a British man and others had been cured of coronavirus with whiskey and honey,[339][343] which combined with the use of alcohol-based hand sanitizers as disinfectants, led to the false belief that drinking high-proof alcohol can kill the virus.[339][340][341]
Similar incidents have occurred in Turkey, with 30 Turkmenistan citizens dying from methanol poisoning related to coronavirus cure claims.[344][345]
In Kenya, the Governor of Nairobi Mike Sonko has come under scrutiny for including small bottles of the cognac Hennessy in care packages, falsely claiming that alcohol serves as "throat sanitizer" and that, from research, it is believed that "alcohol plays a major role in killing the coronavirus."[346][347]
Cocaine
Cocaine does not protect against COVID-19. Several viral tweets purporting that snorting cocaine would sterilize one's nostrils of the coronavirus spread around Europe and Africa. In response, the French Ministry of Health released a public service announcement debunking this claim, saying "No, cocaine does NOT protect against COVID-19. It is an addictive drug that causes serious side effects and is harmful to people's health." The World Health Organisation also debunked the claim.[348]
Ibuprofen
A tweet from French health minister Olivier Véran, a bulletin from the French health ministry, and a small speculative study in The Lancet Respiratory Medicine raised concerns about ibuprofen worsening COVID-19, which spread extensively on social media. The European Medicines Agency[349] and the World Health Organization recommended COVID-19 patients keep taking ibuprofen as directed, citing lack of convincing evidence of any danger.[350]
Helicopter spraying
In some Asian countries, it has been claimed that one should stay at home on particular days when helicopters spray disinfectant over homes for killing off COVID-19; no such spraying is taking place.[351][352]
Cruise ships safety from infection
Main article: COVID-19 pandemic on cruise ships
Claims by cruise-ship operators notwithstanding, there are many cases of coronaviruses in hot climates; some countries in the Caribbean, the Mediterranean, and the Persian Gulf are severely affected.
In March 2020, the Miami New Times reported that managers at Norwegian Cruise Line had prepared a set of responses intended to convince wary customers to book cruises, including "blatantly false" claims that the coronavirus "can only survive in cold temperatures, so the Caribbean is a fantastic choice for your next cruise", that "[s]cientists and medical professionals have confirmed that the warm weather of the spring will be the end of the [c]oronavirus", and that the virus "cannot live in the amazingly warm and tropical temperatures that your cruise will be sailing to".[353]
Flu is seasonal (becoming less frequent in the summer) in some countries, but not in others. While it is possible that the COVID-19 coronavirus will also show some seasonality, it is not yet known.[354][355][356][medical citation needed] The COVID-19 coronavirus spread along international air travel routes, including to tropical locations.[357] Outbreaks on cruise ships, where an older population lives in close quarters, frequently touching surfaces which others have touched, were common.[358][359]
It seems that COVID-19 can be transmitted in all climates.[279] It has seriously affected many warm-climate countries. For instance, Dubai, with an year-round average daily high of 28.0 Celsius (82.3°F) and the airport said to have the world's most international traffic, has had thousands of cases.
Vaccine pre-existence
It was reported that multiple social media posts have promoted a conspiracy theory claiming the virus was known and that a vaccine was already available. PolitiFact and FactCheck.org noted that no vaccine currently exists for COVID-19. The patents cited by various social media posts reference existing patents for genetic sequences and vaccines for other strains of coronavirus such as the SARS coronavirus.[360][4] The WHO reported as of February 5, 2020, that amid news reports of "breakthrough" drugs being discovered to treat people infected with the virus, there were no known effective treatments;[361] this included antibiotics and herbal remedies not being useful.[362] Scientists are working to develop a vaccine, but as of March 18, 2020, no vaccine candidates have completed Phase II clinical trials.[citation needed]
Miscellaneous
Name of the disease
Social media posts and internet memes claimed that COVID-19 means "Chinese Originated Viral Infectious Disease 19", or similar, as supposedly the "19th virus to come out of China".[477] In fact, the WHO named the disease as follows: CO stands for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[478]
Bat soup
Some media outlets, including Daily Mail and RT, as well as individuals, disseminated a video showing a Chinese woman eating a bat, falsely suggesting it was filmed in Wuhan and connecting it to the outbreak.[479][480] However, the widely circulated video contains unrelated footage of a Chinese travel vlogger, Wang Mengyun, eating bat soup in the island country of Palau in 2016.[479][480][481][482] Wang posted an apology on Weibo,[481][482] in which she said she had been abused and threatened,[481] and that she had only wanted to showcase Palauan cuisine.[481][482] The spread of misinformation about bat consumption has been characterized by xenophobic and racist sentiment toward Asians.[90][483][484] In contrast, scientists suggest the virus originated in bats and migrated into an intermediary host animal before infecting people.[90][485]
en.wikipedia.org/wiki/Misinformation_related_to_the_COVID...
he 2019–20 coronavirus pandemic is an ongoing pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The outbreak started in Wuhan, Hubei province, China, in December 2019. The World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern on 30 January 2020 and recognized it as a pandemic on 11 March 2020. As of 4 April 2020, more than 1.18 million cases of COVID-19 have been reported in more than 200 countries and territories,[5] resulting in more than 63,900 deaths. More than 244,000 people have recovered. The virus is mainly spread during close contact,[c] and by small droplets produced during coughing,[d] sneezing, or talking. These small droplets may also be produced during breathing, but rapidly fall to the ground or surfaces and are not generally spread through the air over large distances.People may also catch COVID-19 by touching a contaminated surface and then their face. The virus can survive on surfaces up to 72 hours. It is most contagious during the first 3 days after symptom onset, although spread may be possible before symptoms appear and in later stages of the disease. The time between exposure and symptom onset is typically around five days, but may range from 2 to 14 days. Common symptoms include fever, cough, and shortness of breath.Complications may include pneumonia and acute respiratory distress syndrome. There is no known vaccine or specific antiviral treatment.Primary treatment is symptomatic and supportive therapy. Recommended preventive measures include hand washing, covering one's mouth when coughing, maintaining distance from other people, and monitoring and self-isolation for people who suspect they are infected. Efforts to prevent the virus spread include travel restrictions, quarantines, curfews, workplace hazard controls, event postponements and cancellations, and facility closures. These include national or regional quarantines throughout the world (starting with the quarantine of Hubei), curfew measures in mainland China and South Korea, various border closures or incoming passenger restrictions,screening at airports and train stations, and outgoing passenger travel bans. The pandemic has led to severe global socioeconomic disruption, the postponement or cancellation of sporting, religious, and cultural events, and widespread fears of supply shortages resulting in panic buying.Schools and universities have closed either on a nationwide or local basis in more than 160 countries, affecting nearly 90 percent of the world's student population. Misinformation about the virus has spread online, and there have been incidents of xenophobia and discrimination against Chinese people and people of East and Southeast Asian descent and appearance, as well as against people from emergent hotspots around the globe. Health authorities in Wuhan, the capital of Hubei province, China, reported a cluster of pneumonia cases of unknown cause on 31 December 2019, and an investigation was launched in early January 2020. The cases mostly had links to the Huanan Seafood Wholesale Market and so the virus is thought to have a zoonotic origin. The virus that caused the outbreak is known as SARS-CoV-2, a newly discovered virus closely related to bat coronaviruses, pangolin coronaviruses, and SARS-CoV. The earliest known person with symptoms was later discovered to have fallen ill on 1 December 2019, and that person did not have visible connections with the later wet market cluster. Of the early cluster of cases reported in December 2019, two-thirds were found to have a link with the market.[314][315][316] On 13 March 2020, an unverified report from the South China Morning Post suggested that a case traced back to 17 November 2019, in a 55-year-old from Hubei province, may have been the first. On 26 February 2020, the WHO reported that, as new cases reportedly declined in China but suddenly increased in Italy, Iran, and South Korea, the number of new cases outside China had exceeded the number of new cases within China for the first time. There may be substantial underreporting of cases, particularly among those with milder symptoms. By 26 February, relatively few cases had been reported among youths, with those 19 and under making up 2.4% of cases worldwide. Government sources in Germany and the United Kingdom estimate that 60–70% of the population will need to become infected before effective herd immunity can be achieved. Cases refers to the number of people who have been tested for COVID-19, and whose test has been confirmed positive according to official protocols.[326] The number of people infected with COVID-19 will likely be much higher, as many of those with only mild or no symptoms may not have been tested. As of 23 March, no country had tested more than 3% of its population, and many countries have had official policies not to test those with only mild symptoms, such as Italy, the Netherlands, Spain, and Switzerland. The time from development of symptoms to death has been between 6 and 41 days, with the most common being 14 days.[18] As of 4 April 2020, approximately 63,900[4] deaths had been attributed to COVID-19. In China, as of 5 February about 80% of deaths were in those over 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes. The first confirmed death was on 9 January 2020 in Wuhan. The first death outside mainland China occurred on 1 February in the Philippines, and the first death outside Asia was in France on 14 February. By 28 February, outside mainland China, more than a dozen deaths each were recorded in Iran, South Korea, and Italy. By 13 March, more than forty countries and territories had reported deaths, on every continent except Antarctica. Several measures are commonly used to quantify mortality. These numbers vary by region and over time, and are influenced by the volume of testing, healthcare system quality, treatment options, time since initial outbreak, and population characteristics such as age, sex, and overall health. The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 5.4% (63,902/1,181,825) as of 4 April 2020.[4] The number varies by region. Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time bound and follow a specific population from infection through case resolution. A number of academics have attempted to calculate these numbers for specific populations. Some researchers have also attempted to estimate the IFR for the pandemic as a whole. In China, estimates for the "crude CFR", i.e. the death-to-case ratio decreased from 17.3% (for those with symptom onset 1–10 January 2020) to 0.7% (for those with symptom onset after 1 February 2020). The WHO asserts that the pandemic can be controlled. The peak and ultimate duration of the outbreak are uncertain and may differ by location. Maciej Boni of Penn State University stated, "Left unchecked, infectious outbreaks typically plateau and then start to decline when the disease runs out of available hosts. But it's almost impossible to make any sensible projection right now about when that will be". However, the Chinese government's senior medical adviser Zhong Nanshan argued that "it could be over by June" if all countries can be mobilized to follow the WHO's advice on measures to stop the spread of the virus. Adam Kucharski of the London School of Hygiene & Tropical Medicine stated that SARS-CoV-2 "is going to be circulating, potentially for a year or two".According to the Imperial College study led by Neil Ferguson, physical distancing and other measures will be required "until a vaccine becomes available (potentially 18 months or more)". William Schaffner of Vanderbilt University stated, "I think it's unlikely that this coronavirus—because it's so readily transmissible—will disappear completely" and it "might turn into a seasonal disease, making a comeback every year". The virulence of the comeback would depend on herd immunity and the extent of mutation. Symptoms of COVID-19 can be relatively non-specific and infected people may be asymptomatic. The two most common symptoms are fever (88%) and dry cough (68%). Less common symptoms include fatigue, respiratory sputum production (phlegm), loss of the sense of smell, shortness of breath, muscle and joint pain, sore throat, headache, chills, vomiting, hemoptysis, diarrhea, or cyanosis. The WHO states that approximately one person in six becomes seriously ill and has difficulty breathing.[357] The U.S. Centers for Disease Control and Prevention (CDC) lists emergency symptoms as difficulty breathing, persistent chest pain or pressure, sudden confusion, difficulty waking, and bluish face or lips; immediate medical attention is advised if these symptoms are present. Further development of the disease can lead to severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock and death. Some of those infected may be asymptomatic, with no clinical symptoms but test results that confirm infection, so researchers have issued advice that those with close contact to confirmed infected people should be closely monitored and examined to rule out infection.Chinese estimates of the asymptomatic ratio range from few to 44%. The usual incubation period (the time between infection and symptom onset) ranges from one to 14 days; it is most commonly five days. As an example of uncertainty, estimates of loss of smell for people with COVID-19 were 30%, and then estimates fell to 15%. Some details about how the disease is spread are still being determined. The disease is believed to be primarily spread during close contact and by small droplets produced during coughing, sneezing, or talking;[9][10][12] with close contact being within 1 to 2 metres (3 to 6 feet). Studies have found that an uncovered coughing can lead to droplets travelling up to 4.5 metres (15 feet) to 8.2 metres (27 feet). Respiratory droplets may also be produced during breathing out, including when talking, though the virus is not generally airborne. The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[369] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolized and thus result in airborne spread. It may also spread when one touches a contaminated surface and then touches their eyes, nose, or mouth.[9] While there are concerns it may spread by feces, this risk is believed to be low.[9][10] The Government of China denied the possibility of fecal-oral transmission of SARS-CoV-2. The virus is most contagious during the first 3 days after onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.People have tested positive for the disease up to 3 days before onset of symptoms suggesting transmission is possible before developing significant symptoms. Only few reports of laboratory-confirmed asymptomatic cases exist, but asymptomatic transmission has been identified by some countries during contact tracing investigations. The European Centre for Disease Prevention and Control (ECDC) states that while it is not entirely clear how easily the disease spreads, one person generally infects two to three others.The virus survives for hours to days on surfaces. Specifically, the virus was found to be detectable for up to three days on plastic and stainless steel, for one day on cardboard, and for up to four hours on copper. This, however, varies based on the humidity and temperature. However, pets or other livestock may test positive but can't pass on coronavirus to humans, as there were reported cases of infected pets such as a cat in Belgium and two dogs in Hong Kong. There have been reports were those diagnosed with coronavirus and seemingly recovered, have been readmitted to hospitals after testing positive for the virus a second time. These cases are believed to be worsening of a lingering infection rather than re-infection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature. Outside the human body, the virus is killed by household soap, which bursts its protective bubble. SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). In February 2020, Chinese researchers found that there is only one amino acid difference in certain parts of the genome sequences between the viruses from pangolins and those from humans, however, whole-genome comparison to date found at most 92% of genetic material shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host. Infection by the virus can be provisionally diagnosed on the basis of symptoms, though confirmation is ultimately by reverse transcription polymerase chain reaction (rRT-PCR) of infected secretions or CT imaging. A study comparing PCR to CT in Wuhan has suggested that CT is significantly more sensitive than PCR, though less specific, with many of its imaging features overlapping with other pneumonias and disease processes. As of March 2020, the American College of Radiology recommends that "CT should not be used to screen for or as a first-line test to diagnose COVID-19". The WHO has published several RNA testing protocols for SARS-CoV-2, with the first issued on 17 January. Testing uses real-time reverse transcription polymerase chain reaction (rRT-PCR). The test can be done on respiratory or blood samples. Results are generally available within a few hours to days. A person is considered at risk if they have travelled to an area with ongoing community transmission within the previous 14 days, or have had close contact with an infected person. Common key indicators include fever, coughing, and shortness of breath. Other possible indicators include fatigue, myalgia, anorexia, sputum production, and sore throat. Characteristic imaging features on radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground glass opacities and absent pleural effusions. The Italian Radiological Society is compiling an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by PCR is of limited specificity in identifying COVID-19. However, a large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive, suggesting its consideration as a screening tool in epidemic areas.[395] Artificial intelligence-based convolutional neural networks have been developed to detect imaging features of the virus with both radiographs and CT. Strategies for preventing transmission of the disease include maintaining overall good personal hygiene, washing hands, avoiding touching the eyes, nose, or mouth with unwashed hands, and coughing or sneezing into a tissue and putting the tissue directly into a waste container. Those who may already have the infection have been advised to wear a surgical mask in public. Physical distancing measures are also recommended to prevent transmission. Many governments have restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak. However, the virus has reached the stage of community spread in large parts of the world. This means that the virus is spreading within communities, and some community members don't know where or how they were infected. Health care providers taking care of someone who may be infected are recommended to use standard precautions, contact precautions, and eye protection.
Contact tracing is an important method for health authorities to determine the source of an infection and to prevent further transmission. Misconceptions are circulating about how to prevent infection; for example, rinsing the nose and gargling with mouthwash are not effective. There is no COVID-19 vaccine, though many organizations are working to develop one. Hand washing is recommended to prevent the spread of the disease. The CDC recommends that people wash hands often with soap and water for at least twenty seconds, especially after going to the toilet or when hands are visibly dirty; before eating; and after blowing one's nose, coughing, or sneezing. This is because outside the human body, the virus is killed by household soap, which bursts its protective bubble. CDC further recommended using an alcohol-based hand sanitizer with at least 60% alcohol by volume when soap and water are not readily available.[398] The WHO advises people to avoid touching the eyes, nose, or mouth with unwashed hands. Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 62–71% ethanol, 50–100% isopropanol, 0.1% sodium hypochlorite, 0.5% hydrogen peroxide, and 0.2–7.5% povidone-iodine. Other solutions, such as benzalkonium chloride and chrohexidine gluconate, are less effective. The CDC recommends that if a COVID case is suspected or confirmed at a facility such as an office or daycare, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons, should be disinfected. Health organizations recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing, and disposing of any tissue immediately. Surgical masks are recommended for those who may be infected, as wearing a mask can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing. The WHO has issued instructions on when and how to use masks. According to Stephen Griffin, a virologist at the University of Leeds, "Wearing a mask can reduce the propensity [of] people to touch their faces, which is a major source of infection without proper hand hygiene." Masks have also been recommended for use by those taking care of someone who may have the disease. The WHO has recommended the wearing of masks by healthy people only if they are at high risk, such as those who are caring for a person with COVID-19, although they also acknowledge that wearing masks may help people avoid touching their face. Several countries have started to encourage the use of face masks by members of the public. China has specifically recommended the use of disposable medical masks by healthy members of the public, particularly when coming into close contact (≤1 metre) with other people. Hong Kong recommends wearing a surgical mask when taking public transport or staying in crowded places. Thailand's health officials are encouraging people to make face masks at home out of cloth and wash them daily. The Czech Republic and Slovakia banned going out in public without wearing a mask or covering one's nose and mouth. The Austrian government mandated that everyone entering a grocery store must wear a face mask. Israel has asked all residents to wear face masks when in public. Taiwan, which has been producing ten million masks per day since mid-March, required passengers on trains and intercity buses to wear face masks on 1 April.Panama has asked its citizens to wear a face mask. Face masks have also been widely used in Japan, South Korea, Malaysia, and Singapore. Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of disease by minimizing close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak. The maximum gathering size recommended by government bodies and health organizations was swiftly reduced from 250 people (if there was no known COVID-19 spread in a region) to 50 people, and later to 10 people. On 22 March 2020, Germany banned public gatherings of more than two people. Older adults and those with underlying medical conditions such as diabetes, heart disease, respiratory disease, hypertension, and compromised immune systems face increased risk of serious illness and complications and have been advised by the CDC to stay home as much as possible in areas of community outbreak. In late March 2020, the WHO and other health bodies began to replace the use of the term "social distancing" with "physical distancing", to clarify that the aim is to reduce physical contact while maintaining social connections, either virtually or at a distance. The use of the term "social distancing" had led to implications that people should engage in complete social isolation, rather than encouraging them to stay in contact with others through alternative means. The government in Ireland released sexual health guidelines during the pandemic. These included recommendations to only have sex with someone you live with, who does not have the virus or symptoms of the virus. In late March 2020, it was reported that for more than 70 million people in India, who live in clustered slums and comprise of about one sixth of the total urban population, social distancing is not only physically impossible, but economically too. The reported reproduction rate of the COVID-19 disease could be 20% higher in Indian slums due to impenetrable living conditions, as compared to the global ratio, i.e. 2 to 3 percent.Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations living in affected areas.] The strongest self-quarantine instructions have been issued to those in high risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.Strategies in the control of an outbreak are containment or suppression, and mitigation. Containment is undertaken in the early stages of the outbreak and aims to trace and isolate those infected as well as introduce other measures of infection control and vaccinations to stop the disease from spreading to the rest of the population. When it is no longer possible to contain the spread of the disease, efforts then move to the mitigation stage: measures are taken to slow the spread and mitigate its effects on the healthcare system and society. A combination of both containment and mitigation measures may be undertaken at the same time. Suppression requires more extreme measures so as to reverse the pandemic by reducing the basic reproduction number to less than 1. Part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as flattening the epidemic curve.[457] This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed. Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures, such as hand hygiene, wearing face-masks, and self-quarantine; community measures aimed at physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning. More drastic actions aimed at containing the outbreak were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities and imposing strict travel bans. Other countries also adopted a variety of measures aimed at limiting the spread of the virus. South Korea introduced mass screening and localized quarantines, and issued alerts on the movements of infected individuals. Singapore provided financial support for those infected who quarantined themselves and imposed large fines for those who failed to do so. Taiwan increased face mask production and penalized hoarding of medical supplies. Simulations for Great Britain and the United States show that mitigation (slowing but not stopping epidemic spread) and suppression (reversing epidemic growth) have major challenges. Optimal mitigation policies might reduce peak healthcare demand by 2/3 and deaths by half, but still result in hundreds of thousands of deaths and health systems being overwhelmed. Suppression can be preferred but needs to be maintained for as long as the virus is circulating in the human population (or until a vaccine becomes available, if that comes first), as transmission otherwise quickly rebounds when measures are relaxed. Long-term intervention to suppress the pandemic causes social and economic costs. There are no specific antiviral medications approved for COVID-19, but development efforts are underway, including testing of existing medications. Taking over-the-counter cold medications, drinking fluids, and resting may help alleviate symptoms. Depending on the severity, oxygen therapy, intravenous fluids, and breathing support may be required. The use of steroids may worsen outcomes.Several compounds that were previously approved for treatment of other viral diseases are being investigated for use in treating COVID-19. The World Health Organization also stated that some “traditional and home remedies” that can provide relief of the symptoms caused by SARS-CoV-19. Increasing capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure.[469] The ECDC and the European regional office of the WHO have issued guidelines for hospitals and primary healthcare services for shifting of resources at multiple levels, including focusing laboratory services towards COVID-19 testing, cancelling elective procedures whenever possible, separating and isolating COVID-19 positive patients, and increasing intensive care capabilities by training personnel and increasing the number of available ventilators and beds.
High-profile virologist Didier Raoult, a leading proponent of the controversial drug chloroquine as a treatment for Covid-19, says the virus is disappearing in Marseille. But the city's regional health boss says it’s far too early for such conclusions.
In a video on twitter on Tuesday night, the specialist in infectious diseases at Marseille university hospital declared that the virus is “gradually disappearing” in the city.
“There is a very significant drop in the number of positive tests and an even bigger drop among those who are tested who have no symptoms,” he says.
At the height of the epidemic, Raoult’s Méditerranée Infection Foundation counted 368 new cases per day. But now he says numbers are around 60 to 80.
“It’s possible that the epidemic will disappear in the spring", he says, "A few weeks from now, it’s possible that there will be no more cases. We don’t know why, but we see it quite often, with the majority of viral respiratory illnesses.”
However, the Director General of the Regional Health Agency for the Marseille area worries about such suggestions.
"It is far too early to make predictions about the end of the epidemic", Philippe de Mester told the French newspaper France Bleu Provence. "We know nothing about its duration, unfortunately. It is true that we have recorded a slowdown in the spread of the epidemic, but not an actual decline. The epidemic will continue and it will take a few more weeks”
He stressed the importance of continuing to follow the lockdown rules.
Raoult regularly posts videos on Twitter, communicating directly with the public and not simply to the scientific community.
His long hair and unconventional manner are part of the anti-establishment style he appears to cultivate and he has a growing number of followers.
Supporters of his treatment see him as provincial hero challenging a Parisian scientific establishment and a working doctor standing up to researchers in ivory towers.
He maintains that an anti-malaria drug, hydroxychloroquine, combined with the antibiotic azithromicyne, is an effective treatment for Covid-19 patients, if used before they need intensive care.
He has published results from his use of this approach which show considerable success but with no neutral control group for comparison, there is no conclusive proof that patients recover because of his treatment. As a result, it has not been authorised for use except in certain conditions in hospitals. The drug is known to have negative side effects but it is already used against malaria and in the treatment of Lupus and rheumatoid arthritis.
In an interview in Le Figaro on 3 April, Raoult was critical of today’s medical research processes.
He said that trial methodology established during the fight against Aids was not suitable for all situations and that the “group of people” who worked together at that time adhered to such methods too rigidly. He said that research had become too divorced from medicine.
Although Raoult himself is both a researcher and a clinical practitioner, he distinguished between the two, saying that as a doctor he wanted to use what seemed to work. In a health crisis, he said, lengthy trials could be shortened for a drug which is already in use.
Numerous other trials on hydroxychloroquine are underway but so far none which tests his exact approach.
It is unclear why his critics in the scientific community have not conducted such trials, to prove or disprove its effectiveness.
Instead the impression is given of a scientific community which is unwilling for some reason to explore certain options versus a maverick burnishing a reputation.
Several mostly right wing politicians have voiced support for Raoult and former health minister Philippe Douste-Blazy, a cardiologist, launched a petition to allow wider use of hydroxychloroquine.
In an interview with RFI on Wednesday, President Macron said he was “convinced he is a great scientist”, describing him as one of our most eminent experts. Macron has now called for rigorous trials of Raoult’s treatment approach to be conducted very soon so that its efficacy can be proved or disproved.
Born in Senegal, where he spent his childhood, the French doctor and researcher has maintained strong professional and emotional ties with the continent. And many African countries are already using chloroquine to treat people infected with Covid-19.
On 24 March, Professor Didier Raoult slammed the door on the circle of researchers who were supposed to advise the French president on the pandemic.
Disagreeing with the containment policy adopted by France, which favours mass screening, the iconoclastic infectiologist has just been disavowed by his peers, who are reluctant to endorse the use of hydroxychloroquine against coronavirus.
On Thursday 9 April, Raoult could measure the progress made when President Emmanuel Macron travelled especially to Marseilles to talk to him in order to “take stock of the question of treatment.”
This was a strong political gesture in favour of Raoult’s theses, whose promotion of the use of hydroxychloroquine to treat coronavirus patients has been the subject of much controversy for several weeks.
READ MORE: Coronavirus: 9 things to know about chloroquine
Pre-COVID-19 era
A specialist in emerging tropical infectious diseases at Marseille’s Faculty of Medical and Paramedical Sciences and at the Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, the long-haired professor with the pepper and salt beard was still largely unknown to the general public at the end of February when his views on a chloroquine-based coronavirus treatment began to be heard.
Since then, the Frenchman has seen his media and digital fame take off. And in the ranks of its most fervent supporters, the African continent is not to be outdone.
Is it because the chemical compound he uses to treat his patients, hydroxychloroquine, is well known on the continent, where it has long been used to treat malaria? In two publications exposing tests carried out on some 20 patients, then on 80, the researcher and his teams conclude that “hydroxychloroquine combined with azithromycin is effective in the treatment of COVID-19”.
This quinine derivative is currently the subject of several studies. Those carried out by Professor Raoult have indeed aroused reservations among many experts, who reproach him for not having respected standard scientific protocols. At the end of March in France, the High Council of Public Health considered that chloroquine could be administered to patients suffering from “serious forms” of the coronavirus.”
READ MORE: To fight coronavirus, Burkina Faso is tempted by chloroquine
Those African countries that opt for chloroquine
At Fann Hospital in Dakar, Professor Moussa Seydi, head of the department of infectious and tropical diseases, has already administered chloroquine alone to the first 100 patients who tested positive for COVID-19. “In Marseille, Dr Didier Raoult published encouraging preliminary results. The combination of hydroxychloroquine and azithromycin should make it possible to shorten the carrying time [of the virus], in order to accelerate the healing of the sick,” Seydi told Jeune Afrique on 19 March. To use this drug, he says he relied on the study co-signed by his French counterpart.
Like Senegal, Burkina Faso, Algeria and Morocco have also opted for chloroquine.
On 23 March, the Ministry of Health of the Cherifian Kingdom thus requisitioned the national stocks and distributed to the directors of CHU the protocol for the prescription of chloroquine and hydroxychloroquine for confirmed cases of COVID-19. A decision inspired by Chinese research on the subject, and studies conducted by the French researcher, according to a member of the Moroccan committee in charge of the fight against the pandemic.
Born and raised in Senegal
If Professor Raoult is well known on the continent, it is also because this specialist in tropical and infectious diseases, in addition to having grown up there, has worked a lot there. It was in Dakar that the Frenchman is said to have caught the research virus.
Born in 1952 in the Senegalese capital, he lives there, in the building of the Research Office for Food and African Nutrition (Orana), created by his father.
This building sits opposite the Pasteur Institute in Dakar which houses the frontline laboratory in the fight against the epidemic in Senegal, and is where this son of a nurse and a military doctor stationed at the capital’s main hospital, took his first steps.
A childhood marked by happy memories of playing on the beach at Anse Bernard, made the move “complicated” when the young Didier Raoult arrived in Marseille at the age of 9. “Being partly Senegalese, I can’t help but feel concerned by what’s happening in Africa,” he says in a video addressed to the Senegalese group eMédia on 7 April.
QUEST FOR CHLOROQUINE
Coronavirus: Didier Raoult the African and chloroquine, from Dakar to Brazzaville
By Marième Soumaré, Rémy Darras
Posted on Wednesday, 15 April 2020 19:39
didier raoult
Professor Didier Raoult with Doctor Cheikh Sokhna (in the yellow shirt) in Niokolo-Koba park in Senegal, August 2019 © DR
Born in Senegal, where he spent his childhood, the French doctor and researcher has maintained strong professional and emotional ties with the continent. And many African countries are already using chloroquine to treat people infected with Covid-19.
On 24 March, Professor Didier Raoult slammed the door on the circle of researchers who were supposed to advise the French president on the pandemic.
Disagreeing with the containment policy adopted by France, which favours mass screening, the iconoclastic infectiologist has just been disavowed by his peers, who are reluctant to endorse the use of hydroxychloroquine against coronavirus.
On Thursday 9 April, Raoult could measure the progress made when President Emmanuel Macron travelled especially to Marseilles to talk to him in order to “take stock of the question of treatment.”
This was a strong political gesture in favour of Raoult’s theses, whose promotion of the use of hydroxychloroquine to treat coronavirus patients has been the subject of much controversy for several weeks.
READ MORE: Coronavirus: 9 things to know about chloroquine
Pre-COVID-19 era
A specialist in emerging tropical infectious diseases at Marseille’s Faculty of Medical and Paramedical Sciences and at the Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, the long-haired professor with the pepper and salt beard was still largely unknown to the general public at the end of February when his views on a chloroquine-based coronavirus treatment began to be heard.
Since then, the Frenchman has seen his media and digital fame take off. And in the ranks of its most fervent supporters, the African continent is not to be outdone.
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Is it because the chemical compound he uses to treat his patients, hydroxychloroquine, is well known on the continent, where it has long been used to treat malaria? In two publications exposing tests carried out on some 20 patients, then on 80, the researcher and his teams conclude that “hydroxychloroquine combined with azithromycin is effective in the treatment of COVID-19”.
This quinine derivative is currently the subject of several studies. Those carried out by Professor Raoult have indeed aroused reservations among many experts, who reproach him for not having respected standard scientific protocols. At the end of March in France, the High Council of Public Health considered that chloroquine could be administered to patients suffering from “serious forms” of the coronavirus.”
READ MORE: To fight coronavirus, Burkina Faso is tempted by chloroquine
Those African countries that opt for chloroquine
At Fann Hospital in Dakar, Professor Moussa Seydi, head of the department of infectious and tropical diseases, has already administered chloroquine alone to the first 100 patients who tested positive for COVID-19. “In Marseille, Dr Didier Raoult published encouraging preliminary results. The combination of hydroxychloroquine and azithromycin should make it possible to shorten the carrying time [of the virus], in order to accelerate the healing of the sick,” Seydi told Jeune Afrique on 19 March. To use this drug, he says he relied on the study co-signed by his French counterpart.
Like Senegal, Burkina Faso, Algeria and Morocco have also opted for chloroquine.
On 23 March, the Ministry of Health of the Cherifian Kingdom thus requisitioned the national stocks and distributed to the directors of CHU the protocol for the prescription of chloroquine and hydroxychloroquine for confirmed cases of COVID-19. A decision inspired by Chinese research on the subject, and studies conducted by the French researcher, according to a member of the Moroccan committee in charge of the fight against the pandemic.
Born and raised in Senegal
If Professor Raoult is well known on the continent, it is also because this specialist in tropical and infectious diseases, in addition to having grown up there, has worked a lot there. It was in Dakar that the Frenchman is said to have caught the research virus.
Born in 1952 in the Senegalese capital, he lives there, in the building of the Research Office for Food and African Nutrition (Orana), created by his father.
This building sits opposite the Pasteur Institute in Dakar which houses the frontline laboratory in the fight against the epidemic in Senegal, and is where this son of a nurse and a military doctor stationed at the capital’s main hospital, took his first steps.
A childhood marked by happy memories of playing on the beach at Anse Bernard, made the move “complicated” when the young Didier Raoult arrived in Marseille at the age of 9. “Being partly Senegalese, I can’t help but feel concerned by what’s happening in Africa,” he says in a video addressed to the Senegalese group eMédia on 7 April.
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In 2008, Raoult established a joint research unit at his IHU in the Senegalese capital dedicated to communicable infectious diseases – one of Raoult’s two African teams with the Algiers team. The latter claims to produce 10% of scientific publications in the country of Teranga. “He wanted to have a lot of field staff: epidemiologists, virologists and bacteriologists,” explains one of his close friends, epidemiologist and biologist Cheikh Sokhna, team leader at the IHU Méditerranée Infection in Marseille.
READ MORE: To fight coronavirus, Burkina Faso is tempted by chloroquine
Research on all fronts
Sokhna, also a Senegalese, is director of research at the Institut de recherche pour le développement (IRD), and regularly exchanges with Professor Raoult. This week, IHU’s Senegalese team of about thirty people was due to submit a research project to the Senegalese Ministry of Health on the protocol of the chloroquine-azithromycin combination.
An encouraging sign, according to Sokhna, is that the prevalence of coronavirus seems to be lower in areas where the use of antimalarial drugs such as chloroquine or mefloquine is frequent.
“This can be seen very crudely. But other factors will have to be taken into account before any definitive conclusions can be drawn,” adds the enthusiastic and cautious researcher, who is usually based in Marseille but is currently on a long-term mission in Dakar.
This mixed research unit is far from being the only innovation driven by Didier Raoult in Africa. In 2012, the French researcher installed a MALDI-TOF at the main hospital in Dakar: a mass spectrometer that can detect bacteria in a few hours, compared to the usual two to three days with traditional methods.
Then, starting in 2015, he set up three small laboratories in Dakar and two villages in the Fatick region (Centre-West), three small laboratories – points of care (POC), in the jargon of the milieu – which allow blood or saliva to be taken and the origin of the disease or fever to be quickly given so that the nurses can propose an effective remedy in good time.
Didier Raoult launches research all over Senegal. On malaria, borreliosis, rickettsiosis, malnutrition, hand washing – “which can reduce diarrhoeal diseases by 50% and respiratory diseases by 30%”. The French doctor was already working with his Senegalese teams on other less severe forms of the coronavirus family that existed in the country, causing colds and pneumopathies.
READ MORE: Top 10 coronavirus fake news items
“Big African brother”
Every year, since 2008, he comes to spend a week in Dakar, participating in the IRD’s scientific day organized by Cheikh Sokhna, which brings together health actors and NGOs. It was on this occasion that he met two renowned scientists: the parasitologist Oumar Gaye, from the Cheikh-Anta-Diop University of Dakar (Ucad), and the pharmacist-colonel Souleymane Mboup, virologist and bacteriologist. They will join the scientific board of the IHU Méditerranée Infection, where the second will succeed the first.
All these names join the large community of African researchers gathered around the Marseille-based professor, including the Congolese Jean Akiana, from the Marien Ngouabi University in Brazzaville, the Algerian Idir Bitam, from the National Veterinary College in Algiers, and the Malian Ogobara Doumbo (who died in 2018). They all consider their peer as a “big African brother”. Not to mention his former doctoral students, with whom he has plans to create cutting-edge laboratories in Guinea-Conakry.
Described as an anti-conformist in the fight against dogma, familiar with the terrain but resistant to the beaten track, Professor Raoult does not hesitate to travel to the African countryside. “It’s an elephant that likes to come into contact with gorillas,” says Dr. Jean Akiana, director of health technologies at the Ministry of Health and a researcher at the National Public Health Laboratory in Brazzaville.
Interested in the transmission of bacteria from animals to humans, and vice versa, Raoult also went to meet gorillas in the Lésio-Louna reserve, in the Pool region, in south-eastern Congo-Brazzaville, to analyse their microorganisms and compare their residues with human faeces. “Picornavirus of the same family as coronavirus was found in the gorillas’ faeces. If we see Ebola genes, it could be a warning,” says Jean Akiana.
Akiana recently received a credit from Professor Raoult’s laboratory to travel to the Tchimpounga reserve to check whether chimpanzees might be the cause of the wild polio virus that struck Pointe-Noire in 2015. The Marseille-based professor also travelled to several departments such as Likouala, Sangha and the Plateaux to prospect for new micro-organisms with no immediate link to an identified outbreak. Samples that, when examined in Marseille, could help to take the lead when new epidemics occur.
In Algiers, a team made up of 100% Algerian teaching and research staff, is working on the final establishment of a research laboratory. The joint unit based in the Algerian capital is also working on infectious disease surveillance, taking advantage of the facilities of the Marseille-based institute.
Without foreigners, “no science in France”
“Its main objective is to help French-speaking countries, to transfer cutting-edge technology and to train young researchers in these innovative diagnostic tools,” says Sokhna. But Raoult, on the other hand, also knows very well what his country’s science owes to the African continent.
Critical of the restrictions imposed by the French administration in terms of the time it takes to obtain a visa, he believes that today the French scientific community relies above all on the contribution of doctoral students from the Maghreb and sub-Saharan Africa. During Emmanuel Macron’s visit, the Head of State was welcomed by a team of young researchers from Algeria, Morocco, Mali and Burkina Faso.
“In France, 50% of PhD students are foreigners. Without foreigners, there is no French science,” Raoult pointed out at a conference in 2013. At the time, the French researcher praised the work of the émigrés who are part of his team, the “engine of war” in scientific research. “The best, the most intelligent, the most dynamic, those who work on Sundays are only Sub-Saharan Africans and North Africans. That’s it! That’s the way it is.”
READ MORE: Coronavirus: Ending Europe’s colonial approach to medicine in Africa
Free spirit
The theme of the conference? “Disobedience at the heart of the research innovation process”. Raoult is known for not embarrassing himself in manners and freeing himself from doctrine, insulted by some, adulated by others, Raoult is a lasting figure. And he doesn’t seem to care. “I couldn’t imagine [my studies] triggering passions of this nature, I don’t even know where they come from,” he says in a video posted online on 8 April, in which he announces the imminent results of his new study, this time involving 1,000 patients.
According to the French press, the professor would have presented last Thursday to Emmanuel Macron his results, which establish a rate of virological cure of his patients of more than 91%. Accustomed to not being listened to by politicians, who take researchers “for strange birds”, Professor Raoult, says he is “guided by curiosity and exploratory research”.
Will he be able to rally Macron to his cause? In a recent Odoxa barometer, Raoult the iconoclast, appears in any case in second place among the favourite personalities of the French.
www.theafricareport.com/26264/coronavirus-didier-raoult-t...
After removing an item from the wall of my old office I found this that looks like a severe Covid-19 case with a tracheotomy in the neck. Respiratory failure is one of the main causes of death that can occur in up to 10% of cases, more so in those with chronic disease including asthma, COPD, diabetes, etc. As of April 1st, 2793 cases and 53 deaths in Ontario. 17 cases in my area.
A few years after Daphne Du Maurier had written The Birds and before Alfred Hitchcock decided to relocate the Cornish story's setting to Bodega Bay, California I was being tutored in avian lore via the adventures of Chicken Licken a Grimm story about disillusion, propaganda and the monarchy.
"The smaller birds were at the window now. He recognized the light tap-tapping of their beaks and the soft brush of their wings. The hawks ignored the windows. They concentrated their attack upon the door. Nat listened to the tearing sound of splintering wood and wondered how many million years of memory were stored in those little brains, behind the stabbing beaks, the
piercing eyes, now giving them this instinct to destroy mankind with all the deft precision of machines".
I remember seeing Gannets flying level beside us, on my way home to Scilly from the rarely accessible bridge of the ferry The Scillonian, the sea was lively and the ship carried just a few of us, the Gannets looked so dramatic as they fearlessly plunged into the sea like darts of gold and white, so utterly apart from us humans, they lived on the distant edge of ordinary life even ordinary life in the far west.
Gannet's would very occasionally be washed up on the beach at Porthcressa, a drawing by Lucien Freud of a dead Puffin was made on Scilly during the war years when he was seeking somewhere to practice within British territory, I don't know whereabouts he stayed on the islands but he didn't stay long. Lucien Freuds "view" of animals seemed daringly kindly, remotely humane, he posed several dead birds and animals in his formative stages, employing a meticulous observation and a concise linear articulation, Two of Freuds best works in the early period were the Dead Puffin and the Dead Heron (1945), they please me aesthetically and partly because I know intuitively, exactly where he found the Puffin, he made another drawing (rather more of a painting) titled Scillonian Beachscape (1945-6) it describes a pithalo blue sea with a more cerulean foreshore and an ochre beach with a puffin, sea holly and what I and every Scillonian kid would know as the Great Wrasse Rock, even though its highly stylised I just know thats where he found a dead puffin.(Rotted Puffin 1944) because the Wrasse rock was visible from my bedroom window at Parsons Field on the Little-Porth Bank.
The Dead Heron painting with its distinctive black tuft of plumage and squamous matrix of glittering organisation is distinguished by Bruce Bernard in Thinking About Lucian Freud in ISBN 0-679-45254-0 Lucian Freud ; "This phase was perhaps a provoking sop to his sophisticated admirers (and himself) while his eyes raked the streets and hedgerows for the right turning, which, though anticipated a few times, might be said to have been found in 1945 when he painted the beautiful Dead Heron (plate 51) . His ever deepening power of concentration turned the heron into something like a tragic phoenix. I find it the first seriously beautiful painting that Freud achieved - a miracle of care in the organisation of its complex pattern, and also in his ability to let it breathe, despite its lifeless subject and strict definition. Freud could never paint or draw an animal, how ever long dead, without conveying a sense of its once personal life."
Black capped birds and black headed plumage is a characteristic form with birds, there are many such variations in species I'm particularly in awe of Gavia Immer The Great Northern Diver, but Im sure its possible to think of dozens more, once you've heard "The Loon" at night the stars become like causeway stepping stones.
Magpies, Canada Geese,Black Caps,Arctic Terns sooo many, Do these birds have any other shared commonality apart from this distinction?, I hope to find out more. A judge in a court of law drapes his head with a black square of cloth to pronounce the barbaric sentence of death on a fellow being, does the black cap separate his or her decision from their humanity?
Ὄρνιθες The Birds by Aristophanes Hear us, you who are no more than leaves always falling, you mortals benighted by nature,
You enfeebled and powerless creatures of earth always haunting a world of mere shadows,
Entities without wings, insubstantial as dreams, you ephemeral things, you human beings:
Turn your minds to our words, our etherial words, for the words of the birds last forever!
Lastnight I went along the beach at Marazion, the Red River flowed beneath the granite bridge where a union flag hung at half mast for the funeral of the queen, the stream water springs over to where the tide had pushed a slick of ore weed back up the beach, now dry, dark and spattered with the remains and feathers of dead Gannets, plastic bottles and petrochemical tar.
Rainbow patterns on the water surface spreading a layer of ancient tree sap and hydrophobic dragons blood, those dead Gannets that evolved from a group of meat-eating-dinosaurs called theropods, their dawn chorus would have been far deeper than the hard-rock-mining Cornish Voice Choirs that dug their way down to the minerals, coal and crude oil seams towards which the Dinosaurs uniquely contributed, they now rise and return as flotsam and oil spill, microbeads, herbicide, pesticide, particles and machine made medicines.
The avian influenza hemagglutinin binds alpha 2-3 sialic acid receptors, while human influenza hemagglutinins bind alpha 2-6 sialic acid receptors. This means when the H5N1 strain infects humans, it will replicate in the lower respiratory tract, and consequently causes viral pneumonia. There is as yet no human form of H5N1, so all humans who have caught it so far have caught avian H5N1.
Longevity is no longer a shared concern, the grounded flocks, the beached shoals, the massive cars, it is the sell by date of the big me, the brand, the surviving competitor with a wind turbine blocking their view, the shareholders equity among a community of inequality.
El Cant dels Ocells - Pablo Casals
En veure despuntar el major lluminar, en la nit més joiosa
Els ocellts cantant a festjar-lo van amb sa veu melidrosa.
Els ocellets cantant a festjar-lo van amb sa veu melidrosa.
L'ocell rei de l'espai va pels aires volant cantant amb melodia
Dient Jesús és nat per treure'ns del pecat i dar-nos alegria.
Dient Jesús és nat per treure'ns del pecat i dar-nos alegria.
Cantava la perdiu. Me'n vaig a fer el niu dins d'aquesta establida
Per veure l'Infant com està tremolant en braços de Maria.
Per veure l'Infant com està tremolant en braços de Maria.
The Birds Aristophanes, meanwhile...Pisthetaerus and Euelpides emerge from the Hoopoe's bower laughing at each other's unconvincing resemblance to a bird. After discussion, they name the city-in-the-sky Nephelokokkygia, or literally "cloud-cuckoo-land" (Νεφελοκοκκυγία), and then Pisthetaerus begins to take charge of things, ordering his friend to oversee the building of the city walls while he organizes and leads a religious service in honour of birds as the new gods. During this service, he is pestered by visitors, including a young versifier out to hire himself to the new city as its official poet, Pisthetaerus chases off all these intruders and then goes offstage to finish the rituals. The birds of the Chorus step forward for another aside with the audience (parabasis). They make known laws forbidding crimes against their kind (such as catching, caging, stuffing, or eating them), and they end by advising the festival judges to award them first place or risk getting shat on. Avoid cruelty!!
Small Bitter gourds are very rare species and powerful Ayurveda medicine for many diseases.
Bitter melon, also known as bitter gourd in karela (in India), is a unique vegetable-fruit that can be used as food or medicine. It is the edible part of the plant Momordica Charantia, which is a vine of the Cucurbitaceae family and is considered the most bitter among all fruits and vegetables.
Bitter gourds are very low in calories but dense with precious nutrients. It is an excellent source of vitamins B1, B2, and B3, C, magnesium, folate, zinc, phosphorus, manganese, and has high dietary fiber. It is rich in iron, contains twice the beta-carotene of broccoli, twice the calcium of spinach, and twice the potassium of a banana
Health Benefits
Blood disorders: Bitter gourd juice is highly beneficial for treating blood disorders like blood boils and itching due to
toxemia. Mix 2 ounces of fresh bitter gourd juice with some lime juice. Sip it slowly on an empty stomach daily for between four and six months and see improvement in your condition.
Cancer: The juice of bitter gourd contains an enzyme that inhibits the transportation of glucose (sugar) that lowers blood sugar levels, also cuts off cancer cells’ food supply, retarding their growth.
Cholera: In early stages of cholera, take two teaspoonfuls juice of bitter gourd leaves, mix with two teaspoonfuls white onion juice and one teaspoonful lime juice. Sip this concoction daily till you get well.
Diabetes mellitus: Bitter melon contains a hypoglycemic compound (a plant insulin) that is highly beneficial in lowering sugar levels in blood and urine. Bitter melon juice has been shown to significantly improve glucose tolerance without increasing blood insulin levels.
Energy: Regular consumption of bitter gourd juice has been proven to improve energy and stamina level. Even sleeping patterns have been shown to be improved/stabilized.
Eye problems: The high beta-carotene and other properties in bitter gourd makes it one of the finest vegetable-fruit that help alleviate eye problems and improving eyesight.
Gout: Bitter gourd juice is liver cleansing. It helps clean up a toxic blood, improves blood circulation and relieves gout pain.
Hangover: Bitter melon juice may be beneficial in the treatment of a hangover for its alcohol intoxication properties. It also help cleanse and repair and nourish liver problems due to alcohol consumption.
Immune booster: This bitter juice can also help to build your immune system and increase your body’s resistance against infection.
Piles: Mix three teaspoonfuls of juice from bitter melon leaves with a glassful of buttermilk. Take this every morning on empty stomach for about a month and see an improvement to your condition. To hasten the healing, use the paste of the roots of bitter melon plant and apply over the piles.
Psoriasis: Regular consumption of this bitter juice has also been known to improve psoriasis condition and other fungal infections like ring-worm and athletes feet.
Respiratory disorders: Take two ounces of fresh bitter melon juice and mix with a cup of honey diluted in water. Drink daily to improve asthma, bronchitis and pharyngitis.
Toxemia: Bitter gourd contains beneficial properties that cleanses the blood from toxins. Sip two teaspoonfuls of the juice daily to help cleanse the liver. Also helpful in ridding jaundice for the same reasons.
Info_ juicing-for-health.com/health-benefits-of-bitter-gourd
Megalopyge sp.
Chiriquí Province, Panama
The caterpillars of flannel moths are bizarre looking creatures, with long, wavy, hairlike setae that often appear to have been fashioned into a miniature faux-hawk. Although they may look cute and cuddly, these caterpillars are venomous, and touching them will result in a painful sting and skin irritation that can last for several days. The pain is reported to be severe, and has been compared to experiencing a broken a bone, kidney stones, or blunt-force trauma. This pain may radiate beyond the location of the sting, and can cause pseudoparalysis and swelling of the lymph nodes. Less common symptoms include muscle spasms, respiratory distress, difficulty swallowing, and convulsions.
If anyone knows what species this is, let me know—until then, it’s the panda bear caterpillar.
Creative artwork featuring 3D renderings of respiratory syncytial virus (RSV)—a common contagious virus that infects the human respiratory tract—colorized as follows: (the viral envelope is purple, G- glycoproteins are light blue, and F-glycoproteins are orange). F-glycoproteins allow the virus to fuse with and infect human cells.
Credit: NIAID/NIH