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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)

Coronavirus infections continue to climb as health authorities rush to contain the pandemic.

Global confirmed cases of the new coronavirus exceeded 32.14 million by 25 September, including roughly 981,000 deaths. There's particular concern about the virus in countries with weak health systems, congested urban centres, or large populations of refugees, displaced people, or migrants – particularly at a time when the pandemic has stretched aid resources across the globe.

The pandemic has doubled the number of people who need humanitarian aid worldwide, according to the UN. A record appeal released on 17 July called for $10.3 billion to address coronavirus impacts this year. 

Countries already facing emergencies or instability – the Democratic Republic of Congo, Afghanistan, Somalia, Central African Republic, Nigeria, Sudan, Burkina Faso, Myanmar, or Venezuela, for example – are reporting rising caseloads. ColombiaBangladeshIraqUkraine, and Ethiopia have the most confirmed cases among countries with pre-pandemic response appeals.

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

Chinese authorities first publicly reported the emergence of a new respiratory illness with pneumonia-like symptoms in Wuhan, the capital of Hubei province, on 31 December. The new coronavirus rapidly reached every province or region in mainland China before peaking in early February.

Outside China, 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. Central and South America emerged as hotspots by early June; the number of new cases in Europe were at their lowest since March. South Asian countries India, Pakistan, and Bangladesh –  home to nearly a quarter of the world’s population – are seeing rapidly rising caseloads.

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. The figure was revised upward to $6.7 billion in early May, then increased again to more than $10 billion in July. Beyond the immediate humanitarian impacts, the cost of helping the world's most vulnerable 10 percent facing COVID-19's socio-economic repercussions could total $90 billion, according to UN estimates.

"Too many countries are headed in the wrong direction," the WHO's director-general, Tedros Adhanom Ghebreyesus, said on 13 July, after 230,000 new global cases were reported the previous day. "The virus remains public enemy number one, but the actions of many governments and people do not reflect this."

Why is there disagreement about global containment efforts?

There are unanswered questions about the virus itself and how to contain it before it escalated into a pandemic.

Countries 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. Early on, The Lancet medical journal urged that frontline clinics – not just higher-level disease-control centres – be “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 rushed to study the virus in real time – revising early estimates that became obsolete by the day.

Much of this research was focused on China, but attention pivoted as cases surge elsewhere. Iran announced its outbreak starting in mid-February, but critics have accused Iranian authorities of downplaying or concealing the extent.

"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.

il/ag

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