Mapped: Where the coronavirus is spreading

Tracking the global response to COVID-19.

Coronavirus cases have been reported in more than two dozen countries.
Confirmed coronavirus cases have been reported in the Middle East, Africa, Europe, North and South America, the Caribbean, and Australia and New Zealand. (TNH)

The number of countries reporting coronavirus infections continues to climb as health authorities rush to contain the pandemic.

Global confirmed cases of the coronavirus exceeded 1.27 million by 6 April, including more than 69,000 deaths. More than 180 countries or territories are reporting infections – including a rising number with weak health systems and large refugee and migrant populations.

There's particular concern about the virus hitting congested refugee areas, particularly at a time when the pandemic has stretched aid resources across the globe.

Syria has recorded its first cases – and its first death. A growing list of other countries already facing emergencies or instability – the Democratic Republic of Congo, Somalia, Central African Republic, Ethiopia, Sudan, Bangladesh, Myanmar, or Venezuela, for example – are reporting rising caseloads. Ukraine, Iraq, Cameroon, Burkina Faso, and Afghanistan have the most confirmed cases among countries with pre-existing response appeals.

The virus has reached Haiti in the Caribbean as well as remote Pacific countries like Papua New Guinea and Fiji, where vast distances can magnify the difficulties of epidemic response.

The illness caused by the virus is officially known as COVID-19, short for "coronavirus disease 2019".

More than 80 percent of China’s cases are found in Wuhan, the capital of Hubei province and the outbreak's epicentre. Chinese authorities first publicly reported the emergence of a new respiratory illness with pneumonia-like symptoms in Wuhan on 31 December. The new coronavirus rapidly reached every province or region in mainland China before peaking in early February. Infections have been on a steady decline since then: China has reported only a few dozen new daily cases since 7 March.

Outside China, however, infections continue to multiply as the outbreak escalates in new epicentres thousands of kilometres away. The spread has been rapid: there were only 30 jurisdictions with confirmed cases as recently as 21 February. Now, there are far more new daily infections being recorded globally than what China was reporting at the height of its outbreak.

Some Asian nations that saw a handful of the first imported cases in January are now facing a second wave of infections including imported cases from Europe. Confirmed cases have reached the Middle East, Africa, Europe, the Americas, the Caribbean, and the Pacific.

The World Health Organisation has launched a $675 million response plan aimed at helping countries with weaker health systems get ready. It previously declared the virus outbreak a global health emergency – known as a public health emergency of international concern, or PHEIC.

The UN launched an unprecedented global appeal on 25 March, calling for $2 billion in new funds to tackle coronavirus in countries with critical humanitarian needs.

"This virus, which was unknown to us three months ago, has exposed the weaknesses and inequities in our health systems and societies, our lack of preparedness, and the gaps in our supply chains and other essential systems," said the WHO's director-general, Tedros Adhanom Ghebreyesus.

Why is there disagreement about global containment efforts?

There are unanswered questions about the virus itself and how to contain it.

Countries have ratcheted up restrictions, imposed mandatory quarantines, suspended flights, or closed borders to foreign travellers entirely. But there’s disagreement among public health professionals about whether border shutdowns and screenings are effective – or even counterproductive.

The WHO says border closures and travel restrictions likely delayed the spread of the virus but did not prevent it. Public health experts say border closures can exacerbate outbreaks by driving migration underground – away from public health systems.

The WHO has been cautious about border restrictions and even screenings when taking the rare step of declaring global health emergencies.

The European Centre for Disease Prevention and Control says the effectiveness of coronavirus entry screening is “low” – its models estimated that three quarters of cases would go undetected.

Separate estimates by the London School of Hygiene and Tropical Medicine found thermal scanning might only flag one in every five arriving passengers infected with the virus.

Just as important are public education and robust medical follow-up procedures to ensure people who do develop symptoms know to seek out healthcare – and that healthcare staff know the signs and what to do. The Lancet medical journal has urged that frontline clinics – not just higher-level disease-control centres – are “armed” with diagnostic kits.

The WHO has been cautious about border restrictions and even screenings when taking the rare step of declaring global health emergencies.

When the WHO declared a PHEIC for the Ebola outbreak in the Democratic Republic of Congo last year, it warned against shutting borders or imposing travel restrictions.

“Such measures are usually implemented out of fear and have no basis in science,” the WHO said at the time. “They push the movement of people and goods to informal border crossings that are not monitored, thus increasing the chances of the spread of disease.”

Under international health regulations, countries are obligated to justify their emergency border restrictions with the WHO. At least 136 countries have restrictions, but it’s unclear what, if any, actions the agency will take.

Are there undetected cases?

The outbreak’s rapid evolution means that researchers have been rushing to study the virus in real time – and revising early estimates that become obsolete by the day.

Much of this research was focused on China, but attention is now pivoting as cases surge elsewhere. Iran has announced thousands of confirmed cases since mid-February, but critics have accused Iranian authorities of downplaying or concealing the extent of the outbreak.

"The lack of identified Covid-19 cases in countries with far closer travel ties to Iran suggests that cases in these countries are likely being missed, rather than being truly absent."

One study published by Canadian researchers estimated there were actually 18,300 infections in Iran in February (when the country was reporting fewer than 50 patients), based on confirmed cases from Iran showing up in Canada, Lebanon, and the United Arab Emirates. The study, based on calculations including airline traffic data, also concluded that nearer countries like Syria are likely to have infections despite not reporting cases at the time (Syria reported its first case on 23 March).

"The lack of identified Covid-19 cases in countries with far closer travel ties to Iran suggests that cases in these countries are likely being missed, rather than being truly absent," the researchers said. "This is concerning, both for public health in Iran itself, and because of the high likelihood for outward dissemination of the epidemic to neighbouring countries with lower capacity to respond to infectious diseases epidemics."

Health experts warn that all such studies are based on models that rely on incomplete data and assumptions – useful for estimating risk or potential spread, but far from definitive.

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