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edelweiss eden-young edie-sedgwick edina-blond edita-ungerova edwige-faillel eileen-wells elaine-collins elaine-davis elaine-southern elena-berkova elena-maria-ricci eleonore-leipert eleonore-melzer elfi eliane-florian elisabeth-bure elisabeth-graine elisabeth-tulin elisabeth-volkmann elis-black elis-diamond elise elise-di-medici elizabeth-del-mar elizabeth-lawrence ella-botts-rice elle-devyne ellen-earl ellen-silva elle-rio elly-akira elly-arai elodie-delage elsa-bangz elsa-maroussia else-petersen ember emili-doll emily-davinci emily-evermoore emily-george emily-jewel emily-weickert emmanuelle-pareze emmanuelle-riviere emma-redd envy-mi erica-andrews erica-boyer erica-eaton erica-havens erica-idol erica-lauren erika-bella erika-cool erika-heaven erika-lockett eri-kikuchi erin-brown erna-haffner esa-marie esme-monroe esmerelda esther-studer eva-allen eva-angel eva-angelina eva-bassan eva-dionisio eva-eden eva-gross eva-kay eva-khris eva-kleber eva-lovia eva-lux eva-luxuria eva-quang eva-uettori eve-laurence evelyne-lang evelyne-manta evelyne-pomorska evie-delatosso fabiana-venturi fabiola-toledo faith-bacon faith-grant faith-stevens fallon fanny-garreau fanny-steel fany-fantasy fatima-choplin faye-runaway faye-young felicia-fox felicia-tang feline-fabre fiona-richmond flame flechero-pardo flick-shagwell flora-carosello florence-cayrol florentina-fuga flore-soller flower floyd-xxx foxy-lae franca-stoppi france-lomay france-quenie france-raygil francesca-le frances-farmer francoise francoise-blanchard frankie-leigh franziska-stommer frederique-moreau fuentes-medina-karen-jeffries gabriella gabriella-mirelba gabriella-vincze gabrielle-behar gail-force gail-palmer gail-sterling gallia gandara-arteaga-stacey-wells ganzed-herreras-jane-baker garcia-hernando-bridgette-monet garcia-saez-esther-allen gauge gene-tierney genevieve-corado georgette-neale georgette-saunders georgia-peach georgina-spelvin georgina-spelvin-serena-dolly-pop geraldine-martin gerda-van-den-broek ghislaine-plat gia-allemand gia-carangi gia-givanna gianna-lynn gianna-michaels gia-regency gia-rouge gigi-allens gilda-arancio gili-sky gina-carrera gina-delaney gina-gianetti gina-janssen gina-lee gina-lynn gina-martell gina-rodriguez gina-valentino ginette ginevra-hollander ginger-jay ginger-lea ginger-lee ginger-lynn ginny-may ginny-noack giovanna gisela-krauss gisela-schwarz gisele-backer giselle-monet giulietta-masina gladys-laroche gleice-kelly gloria-hatrick-mclean gloria-hope gloria-leonard gloria-swanson gloria-todd golden-jade goldie-sparxx gonzalez-benito-karen-summer gota-gobert grazia-de-giorgi greta-carlson greta-garbo greta-milos gudrun-grau guia-lauri-filzi guida-hernandez gwenda-farnel gwen-summers habas-maria-de-las-mercedes-xxx haley-paige hare-krane harley-lavey harley-raine haruka-sanada haruki-sato hasna-cosi hayley-jade hazel-young heather-deeley heather-ellis heather-fields heather-hart heather-hunter heather-joy heather-lere heather-lyn heather-manfield heather-summers heather-thomas heather-torrance heather-vandeven heather-wayne heather-young hedda-hopper heidi heidi-brooks heidi-van-horny helena-belmonte helene-shirley helene-wolf helen-madigan helen-thomas helga-konig helga-sven helga-wild hell-fire-alicia-geisha helly-mae-hellfire henessy herrin-samantha hibiki-otsuki hibiki-otsuki-xxx hillary-scott hillary-summers hina-akiyoshi hippy-chick hitomi-kitagawa hitomi-kobayashi hollie-stevens holli-woods holly holly-daze holly-hollywood holly-joy holly-page holly-ryder holly-sampson holly-woodlawn honey honey-lips honey-wilder honey-wilder-joan-victoria honey-winter honoka horny-lily horra-xxx hotaru-akane hot-motocat hot-rikki hottie-hollie hottie-hollie-xxx houston houston-uluvpunani hunter-bryce hurones-de-castroponce-xxx hyapatia-lee ida-fabry ildiko ildiko-smits illana-moor ilona-szmick ilona-von-montagh inari-vachs index.txt india ines-ridere ingrid-barlon ingrid-choray iori-kogawa irene-falcke iris-fonbona-pamela-jennings irma isabel-jewell isabella-dior isabella-grimaldi isabella-soprano isabelle-allay isabelle-brell isabelle-collin-dufresne isabelle-leman isabelle-marchall isabelle-mauchretien isabelle-torilla isa-dery isadora-duncan isadora-tiffany-lane-nikko isis-nile ismael-arroyo isobel-elsom isobel-wren ivana-sugar iveta ivete-bonfa ivette-blanche ivonne-fischer-tau ivy-wynn izrah-indica jackie-curtis jackie-dartois jackie-right jacqueline-carol jacqueline-lorians jacqueline-mars-liliane-bettencourt jacy-allen jada-fire jada-stevens jade-east jade-hsu jade-marcela jade-nichols jade-summers jade-sweet jade-wong jahn-gold jaimee-foxworth jamie-brooks jamie-james jamie-leigh jamie-summers jana-irrova jana-mrazkova jane-baker jane-darling janee-diamond jane-iwanoff jane-lindsay jane-lixx janet-jacme janet-wood janey-robbins janice-lisa-de-leeuw janine-lindemulder jan-kay-taylor-sandra january-seraph japanese-garden-monaco jasmine jasmine-delatori jasmine-grey jasmine-rouge jayden-simone jaylyn-rose jayna-woods jayne-paygan jazella-moore jazmin-luna-gold jazzmine j-c-taylor jean-afrique jeanette-littledove jeanette-sinclair jean-harlow jeanie-marie-sullivan jean-jennings jeanna-fine jeanne-darville jeanne-silver jeannie-baker jeannie-pepper jean-peters jean-seberg jelena-jensen jemma-valentine jenna-haze jenna-jameson jenna-jane jenna-presley jenna-wells jennifer jennifer-blowdryer-ant-mae jennifer-haussmann jennifer-janes jennifer-jordan jennifer-jost jennifer-morante jennifer-noxt jennifer-stewart jennifer-thomas jennifer-vanbeaver jennifer-welles jennifer-west jennifer-west-melinda-sale jenny jenny-baxter jenny-feeling jenny-fields jenny-joyce jenny-poussin jenny-ryder jenny-wings jersey-jaxin jesie-st-james jesie-st-james-desiree-west jesse-capelli jesse-jane jessica-bangkok jessica-bogart jessica-darlin jessica-dee jessica-drake jessica-fiorentino jessica-gabriel jessica-jaymes jessica-kizaki jessica-laine jessica-may jessica-rizzo jessica-road jessica-stehl jessica-von-rotz jessica-wylde jessie-andrews jessie-rogers jessie-storm jessi-foster jess-west jessy-juice jessy-laurent jezebel-yum jill jill-ferari jillian-janson jill-kelly jill-munroe jill-munroe-xxx jiz-lee joana-redgrave joan-blondell joan-crawford joan-devlon joanna-angel joanna-hilden joanna-jet joanna-storm joanna-sweet joan-turner jocelyne-clairis jodie-moore jody-maxwell joelle-coeur joelle-lequement joelle-petinot joey-karson joey-karson-xxx joey-valentine johana-quandt-bunny-bleu johanna-ebertseder johnni-black johnny-rocket jo-jo-laine jordana-james jordan-green jordan-james jordanna-black jordan-nevaeh jordan-star jorge-pinilla-gonzalez jose-calvo jose-luis-garcia-rodriguez josephine-baker josephine-carrington josiane-bongura joslyn-james joy-jericho juan-godino-xxx juditha-arlou judith-fritsch judith-hamilton juicy-pearl julia-ann julia-chanel julia-dal-fuoco julia-hayes juliana-grandi julianne-james julia-paes julia-parton julia-perrin julia-power juli-ashton julia-swen julia-thomas julia-verlaine julie-bouche julie-ellis julie-meadows julie-rage julie-robbins julie-simone julie-skyhigh juliet-anderson juliet-brosini juliet-graham juliette-carelton juliette-jett julio-cesar-perez jutta-eimann kacey-jordan kagney-linn-karter kahlia kaitlyn-ashley kalena-rios kami-andrews kamila-smith kana-aono kandee-licks kandee-lopes kandi-barbour kaoru-kuroki kapri-styles kara-nox karen-boston-marlene-munroe karen-dior karen-lancaume karen-summer kari-foxx kari-klark karine-gambier karine-hornel karin-lorson karin-schubert karli-sweet karmen-kennedy karol-castro karoline-houtart karolly-mel kascha kasey-chase kasey-rodgers kasha-bella kassi-nova kat kate-asabuki kate-frost kate-jones kate-mundt kathia-nobili kathleen-gentry kathleen-white kathy-divan kathy-harcourt kathy-heart kathy-hilton kathy-kash katie-cassidy katie-cummings katie-king katie-morgan katina katja-love kat-langer katrina-isis katrina-kraven katty-thurman katy-borman katy-caro kawanna-di-prado kaycee-dean kayden-kross kayla-kupcakes kaylani-lei kaylee-rain kay-parker k-c-valentine keama-kim keanna kei-marimura kei-mizutani keira-fox keira-moon keisha keisha-grey keity-bittencourt keli-richards kelli-sparks kelli-tyler kelly-adams kelly-an kelly-blue kelly-broox kelly-deep kelly-fire kelly-hearn kelly-jean kelly-kay kelly-kline kelly-lee kelly-madison kelly-nichols kelly-royce kelly-shibari kelly-skyline kelly-stewart kelly-summer kelly-trump kendra-jade kendra-kay kendra-lust kendra-white kenzie-kyle kenzi-marie keri-windsor ketthy-divan kianna-dior kiara-edwards kiki-kakuchi kiki-vidis kiley-heart kim-alexis kimber-blake kimberly-carson kimberly-devine kimberly-franklin kimberly-kane kimberly-kummings kimberly-kupps kimberly-kyle kim-chambers kim-de-place kim-holland kimi-gee kimkim-de kim-kitaine kimmie-lee kimmy-nipples kina-kara kira-eggers kira-red kirsten-passer kirsten-price kirsty-waay kitten-natividad kitty-catherine kitty-doll kitty-fox kitty-johnson kitty-kat kitty-langdon kitty-lynxxx kitty-marie kitty-rains kitty-shayne kitty-shayne-polly kitty-yung kleio-valentien kobe-tai kokone-mizutani kora-cummings kotono-suzukaze kream kris-lara krista-lane krista-maze kristara-barrington kristarah-knight kristen-kane kristi-klenot kristi-myst kristina-blonde kristina-king kristina-klevits kristina-soderszk kristina-st-james kristine-adams kristine-heller kristin-steen krisztina-ventura krystal-de-boor krystal-steal krysti-lynn kylee-karr kylee-nash kylee-strutt kylie-brooks kylie-channel kylie-haze kylie-ireland kylie-wylde kymberlee-anne kym-wilde kyoko-aizome kyoko-hashimoto kyoko-kazama kyoko-nakajima kyoto-sun kyra-reese lachelle-marie lacy-rose lady-amanda-wyldefyre lady-cartier lady-stephanie laetitia-bisset laetitia-thomas lake-russell lana-burner lana-cox lana-wood lanny-barby lara-amour lara-roxx lara-stevens lataya-roxx latoya laura-antonelli laura-clair laura-gemser laura-lazare laura-leslie laura-levi laura-lion laura-may laura-orsolya laura-palmer laura-paouck laura-valerie laura-zanzibar laure-cottereau laure-moutoussamy lauren-black lauren-brice laurence-boutin laurence-jarry laurence-thibault lauren-montgomery lauren-phoenix laurien-dominique laurien-dominique-xxx laurien-wilde laurie-smith laurie-wallace laurine-powel-dana-lynn lauri-noel lauryl-canyon lauryn-may lavinia-silva lea-demae lea-de-mae leah-wilde lea-lexus lea-magic lea-martini leanna-bacci leanna-foxxx leanni-lei leda-simonetti lee-caroll lee-carroll leena leena-la-bianca leena-rey leigh-livingston leila-lopes leilani lemon-hanazawa lene-hefner lenora-bruce leslie leslie-glass leslie-winston lesllie-bovee letha-weapons leticia-vlasak letizia-bruni lexi-belle lexi-carrington lexi-davis lexi-lane lexi-matthews leyla-soubeyrand lezley-zen lia-fire liberty-jane liliane-gray liliane-lemieuvre lili-damita lili-marlene lilli-carati lillie-langtry lily-carter lily-gilder lily-labeau lily-rodgers lily-valentine linda-chu linda-clemens linda-dull linda-hamilton-desiree-cousteau linda-lovelace linda-reeves linda-shaw linda-shaw-lindsey-snow linda-sue-ragsdale linda-vale linda-wong linda-york linda-york-brittany-newland lindsey-springer linnea-quigley linnea-quigley-sally-webster linsey-dawn-mckenzie linzi-drew lisa-ann lisa-bright lisa-chest lisa-de-leeuw lisa-kage lisa-k-loring lisa-k-loring-leticia lisa-lake lisa-lipps lisa-melendez lisa-sparkle lisa-sue-corey li-sellgren liselotte-mann lise-pinson little-cinderella little-oral-annie livia-choice liza-dwyer liza-harper liz-eldridge liz-renay lizz-tayler lizzy-borden logan-labrent lois-ayres lois-ayres-sondra-stillman lola-cait lollipop lollipop-xxx lolo-ferrari lone-helmer long-jean-silver loni-bunny loni-evans loni-morgan loni-sanders loni-sanders-sulka-ginger loona-luxx lopez-rodriguez lopez-rodriguez-danica-rhea loray-white lorelei-lee lorelei-rand lorena-layson lorena-sanchez lori-alexia lori-blue lori-pleasure lorissa-mccomas lorrie-lovett lotta-topp lottie-hayworth-annette-haven louella-parsons louisa-lamour louise-brooks lucette-gill lucia-hyde luci-diamond lucie-bee lucie-doll lucienne-camille lucie-theodorova luci-power lucki-chatsworth lucy-levon lucy-van-dam luigina-nike luis-alberto-rodriguez-martinez luis-alberto-rodriguez-martinez-julia-perrin lulu-devine luna-corazon lupe-fuentes lupe-velez lydia-baum lydie-beggy lydie-marlene lynn-ann-newton lynn-franciss lynn-harris lynn-holmes lynn-lemay lynn-lucas lynn-monteil lynn-ray lynn-stevens lynn-stone lynnz lynx-canon lynx-canon-jody-jean-damage lynx-dyan lysa-thatcher lysa-thatcher-sonya-summers mabel-normand mackenzie-wolf macy-nihongo maddison-knox madelina-ray madison madison-parker madison-young madoka-hitomi mae-victoria mae-west magdalena-lynn maggie-randall mahela-sweet maiko-tanimoto maila-nurmi mai-lin maitland-ward mai-uehara maja-lee makayla-cox malezia malisa-longo malisa-longo-xxx mandarine mandi-wine mandy-bright mandy-malone mandy-may mandy-mistery mandy-starr mannuella-marino mao-hamasaki mao-kurata mara-manzan marcia-minor maren margareth margaret-lee margaret-moser margit-ojetz margit-rauthe margitta-hofer margo-stevens margot-mahler maria-catala maria-domingues mariah-cherry maria-loren maria-mancini maria-mercedes-garcia-martin maria-montez marianne-aubert marianne-marks marianne-wackerle marian-wilde-juliet-anderson maria-ozawa maria-rohm maria-schell maria-schneider maria-tortuga maria-tortuga-brandy-wine mari-ayukawa marica-hase marie-anne marie-christine-chireix marie-christine-covi marie-christine-guennec marie-christine-veroda marie-claude-moreau marie-dentord marie-dominique-cabannes marie-france marie-france-morel marie-lavar marie-line-chanaud marie-luise-lusewitz marie-noelly marie-pierre-barathon marie-pierre-castel marie-sharp marika-green mariko-kawana marilyn-chambers marilyne-leroy marilyn-gee marilyn-jess marilyn-martyn marilyn-monroe marilyn-rose marilyn-star marina-hedman marina-samson marina-shiina marion-aye marion-davidson marion-davies marion-schultz marion-webb mari-possa marisa-betancourt marissa-malibu marita-ekberg marita-kemper marlena marlene-myller marlene-stevens-lisa-k-loring marlene-willoughby marry-queen martine-capellaro martine-flety martine-grimaud martine-kelly martine-schultz martine-vaugirard marya-franca-fisolo-kristara-barrington maryanne-fisher maryann-price-jessica-wylde mary-ann-van-dekken mary-carey mary-hubay maryline-guillaume marylin-star marylou-bambi-tammy-barbara-scott mary-millington mary-ramunno mary-stuart mary-ure mascha-mouton masha mata-hari mateo-bravo maude-carolle maud-kennedy maureen-spring mauvais-denoir maxi-mounds maxine-tyler maya-black maya-france maya-gold maya-kawamura may-ling-su megan-leigh megan-martinez megan-pryce megan-reece mei-ling mei-matsumoto meisa-hanai melanie-hotlips melanie-rose melanie-scott melba-bruce melba-cruz melinda-russell melissa-bonsardo melissa-del-prado melissa-gilbern melissa-golden melissa-harrington melissa-hill melissa-martinez melissa-melendez melissa-monet mellanie-monroe melody-gerdon mercedes-dragon mercedes-lynn merle-michaels mesha-lynn mette-von-kohl mia-beck mia-khalifa mia-lina mia-malkova mia-peach mia-powers mia-rose mia-smiles michaell-lombardi michele-gabriel michele-grubert michele-leska michele-raven michele-rousseau michelle-aston michelle-charrier michelle-davy michelle-ferrari michelle-greco michelle-maren michelle-maylene michelle-michaels michelle-monroe michelle-thorne michelle-villers micki-lynn micky-love midori mieres-carrillo-little-oral-annie miguel-armijo-gutierrez mihiro mika-barthel mika-choix mika-tan miki-torii mikki-davidson mikki-taylor milan-hunglow mimi-miyagi mimi-morgan mina-houghe minako-komukai minami-aoyama mindy-mccready mindy-rae ming-jade ming-toy minia-malove mio-kayama miranda-stevens mireille-dargent miriam-wateau mishka miss-bunny miss-meadow miss-pomodoro missy missy-graham missy-stone missy-vega missy-warner misti-dawn misti-jane mistress-candice mistress-jacqueline misty-anderson misty-dawn misty-rain misty-regan misty-stone miyuki-son moana-pozzi moira-callen molly-manning-melinda-york mona-lisa mona-page moni monica-baal monica-marc monica-mattos monica-mayhem monica-melao monica-orsini monica-swinn monika-peta monika-sandmayr monika-unco monique-alexander monique-bruno monique-cardin monique-carrere monique-charell monique-demoan monique-gabrielle monique-la-belle monique-vita morelle-dekeigh morena-black morgane morgan-fairlane morrigan-hel mousiendi moxxie-maddron mulani-rivera muriel-montosse myriam-benzerti mysti-may nadege nadege-arnaud nadezhda-savina nadia-baumel nadia-day nadia-ford nadia-styles nadine-bronx nadine-de-rangot nadine-perles nadine-perrier nadine-proutnal nadine-roussial nadine-scant nadi-phuket nana-natsume nana-ninomiya nancee-kelly nanci-disrober nanci-suiter nancy-dare nancy-hoffman nancy-hoffman-nancy-nukee nancy-spungen nancy-suiter-sally-swift nancy-vee nao-oikawa nao-saejima nao-tachibana natacha-delyro natacha-karenoff natacha-lori natalia-wood natali-demore natalie-north natalli-diangelo natascha-throat natasha-blu natasha-nunez natasha-skyler natasha-vega nathalie-feraud nathalie-grobert nathalie-idoux nathalie-lhermite nathalie-morin nathalie-tussot nathalie-zeiger natsuki-ozawa naudia-nyce nautica-thorn neiro-suzuka nellie-gold nessa-devil nessy-grant nesty nica-noelle nicki-hunter nicky-reed nicole-bass nicole-berg nicole-bernard nicole-black nicole-clitman nicole-grey nicole-guettard nicole-london nicole-parks nicole-scott nicole-taylor nicolette-fauludi nicole-velna nicole-west nicolly-spiller nika-blond nika-mamic niki-cole niki-lee-young nikita-gross nikita-love nikita-rush nikki-benz nikki-charm nikki-delano nikki-grand nikki-kane nikki-king nikki-knight nikki-kyle nikki-randall nikki-rhodes nikki-santana nikki-shane nikki-sinn nikki-steele nikki-tyler nikki-wilde niko nina-cherry nina-deponca nina-hartley nina-heart nina-milano nina-preta nina-swiss noa-emiri noa-imai nomi noname-jane nozomi-momoi nyobi-khan oana-efria obaya-roberts olesja-derevko olga-cabaeva olga-conti olga-gebhard olga-georges-picot olga-pechova olga-petrova olga-vallejo-monika-sommer olive-dundee olivia-alize olivia-del-rio olivia-flores olivia-kennedy olivia-la-roche olivia-lua olivia-nova olivia-outre ona-z ophelia-tozzi orchidea-keresztes ordax-pelaz orsolya-blonde oya-basak paige-turner paisley-hunter pamela-bocchi pamela-courson pamela-dee pamela-jennings pamela-mann pamela-stanford pamela-stealt pamella-anderson pam-sanders pam-snyder pandora paola-albini paola-montenero paola-pasetti paola-senatore paru-silios pascale-cherill pascale-vital pascale-vouillot pat-manning pat-rhea patricia patricia-araujo patricia-bismark patricia-bouvier patricia-cat patricia-dale patricia-diamond patricia-kennedy patricia-kimberly patricia-rhomberg patricia-santos patrizia-predan patti-cakes patti-petite patti-petite-sophie-cara-lott patty-boyd patty-plenty patty-rhodes-rhonda-petty paula-brasile paula-harlow paula-meadows paula-morton paula-price paula-styles paula-winters paulette-goddard pauline-chan-bo-lin pauline-teutscher pedro-arevalo peg-entwistle peggy-church penelope penelope-jones penelope-pumpkins penelope-valentin penny-flame penny-pax petra-abstein petra-hermanova petra-lamas peyton-lafferty peyton-sins phaedra-grant phaery-burd phaery-i-burd phyllis-gates pia-snow pilar-fernandez-perez pilar-fernandez-perez-marina-lotar pina-pellicer pinky-love piper-fawn piper-smith pipi-anderson poppy-morgan porsche-lynn porsha-carrera pratyusha-banerjee precious-silver princess-donna priscillia-lenn priya-anjali-rai purple-passion puton-antonia-chabes-havas pypy-anderson queen-annina queeny-love rachael-livingston rachel-ashley rachel-honey rachel-love rachel-luv rachel-mhas rachel-roxxx rachel-ryan rachel-ryder racquel-darrian rafaela-tiazinha rane-revere ran-masaki raven raven-de-la-croix raven-richards raven-riley raven-turner raylene 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shelby-star shelby-stevens shelly-berlin shelly-lyons sheridan sheri-st-clair sheyla-cats shine-louise-houston shirly-duke shonna-lynn shrima-malati shyla-foxxx shyla-stylez shy-love sibylle-rauch siegried-cellier sierra-sinn sierra-skye sigrid-horne-rasmussen sigrun-theil silva-xxx silver-forrest silver-starr silvia-bella silvia-saint silvia-solar silvie-de-lux silvy-taylor simone-graf simone-west sindee-coxx sindy-angel sindy-lange sindy-shy sinnamon-love sinn-sage siobhan-hunter sirpa-lane sirpa-lane skin-diamond skye-lee skylar-knight skylar-paige skylar-price skyler-dupree smokie-flame smoking-mary-jane sofia-moon sola-aoi solange-hop solange-shannon somchit-traymany sondra-locke sonya sonya-summers sonya-summers-chelsea-mcclane sophia-ferrari sophia-santi sophia-solana sophie-anderson sophie-bulle sophie-call sophie-duflot sophie-evans sophie-fibelle sophie-guers sophie-pressle sophie-roche spantaneeus-xtasty sparkly-devil sparky-vasc stacey-cash stacey-donovan stacey-fuxx 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sylvia-brand sylvia-diams sylvia-engelmann sylvia-kristel sylvia-miles syreeta-taylor syren-de-mer syvette szabina-black szelina-black szilvia-lauren tabitha-stevens tai-ellis taija-rae taisa-banx taissia-shanti taja talia-james tallie-cochrane tallulah-bankhead tamaki-katori tamara-joyce tamara-lee tamara-longley tamara-n-joy tamara-west tami-lynn tami-white tammi-ann tammy tammy-lee tammy-reynolds tania tania-busselier tania-lorenzo tania-russof tanielle tanja-fielmann tanja-simon tanja-vetell tantala-ray tanya-danielle tanya-fox tanya-foxx tanya-hansen tanya-lawson tanya-nordic tanya-rusic tanya-tate tanya-valis tanyukha tara-aire tara-flynn tarney-halle tarra-white taryn-thomas tasha-jones tasha-reign tasha-voux tatjana-belousova tatjana-skomorokhova tatum-reed tawnee-lee tawny-pearl tawny-roberts tayla-rox taylor-hayes taylor-summers taylor-wane teddi-austin teddi-barrett tera-bond tera-heart tera-joy tera-patrick tera-wray teresa-may teresa-orlowski tericka-dye teri-diver 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tylene-buck tymeisha tyra-olsen ulla-bjergskov ulla-luna ulrike-butz ulrike-lary ultramax ursula-austin ursula-buchfellner ursula-cavalcanti ursula-donovan ursula-gaussmann ursula-maria-schaefer ursula-moore ursula-more ursula-reit ursula-white uschi-digart uschi-karnat uschi-wagner valentina valeria valerie-leveau valerie-marron valerie-marron-xxx valerie-sidy valerie-stone valery-hilton valhalla vanessa vanessa-blue vanessa-chase vanessa-del-rio vanessa-doll vanessa-freeman vanessa-michaels vanessa-ozdanic vanessa-tibbs vanilla-deville vanity varela-martin-alicyn-sterling velvet-summers venus verena veri-knotty veronica-avluv veronica-dol veronica-hart veronica-hart-debbie-hill veronica-hill veronica-moser veronica-rayne veronica-sage veronica-taylor veronica-vera veronika-vanoza veronique-maugarski via-paxton vicky-lindsay vicky-steele vicky-vette vicky-vicci victoria-adams victoria-corsaut victoria-evans victoria-gold victoria-knight victoria-luna victoria-paris victoria-sands 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Remdesivir Remdesivir sold under the brand name Veklury is a broad spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences It is administered via injection into a vein As of remdesivir is being tested as a specific treatment for COVID and has been authorized for emergency use in the US India Singapore and approved for use in Japan for people with severe symptoms It also received approval in the UK in May however it was going to be rationed due to limited supply It may shorten the time it takes to recover from the infection Side effects may include liver inflammation and an infusion related reaction with nausea low blood pressure and sweating It is a prodrug that is converted into GS a ribonucleotide analog medical citation needed Earlier studies found antiviral activity against several RNA viruses including SARS coronavirus and MERS coronavirus but it is not approved for any indication Remdesivir was originally developed to treat hepatitis C and was then tested against Ebola virus disease and Marburg virus disease but was ineffective for all of these viral infections Contents Side effects Research Ebola COVID Access Pharmacology Activation Mechanism of action Pharmacokinetics Resistance Interactions Synthesis Terminology Other animals References Further reading External links Side effects The most common adverse effects in studies of remdesivir for COVID include respiratory failure and organ impairment including low albumin low potassium low count of red blood cells low count of platelets that help with clotting and yellow discoloration of the skin unreliable medical source Other reported side effects include gastrointestinal distress elevated transaminase levels in the blood liver enzymes and infusion site reactions Other possible side effects of remdesivir include Infusion-related reactions Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given Signs and symptoms of infusion-related reactions may include low blood pressure nausea vomiting sweating and shivering Increases in levels of liver enzymes seen in abnormal liver blood tests Increases in levels of liver enzymes have been seen in people who have received remdesivir which may be a sign of inflammation or damage to cells in the liver Research Remdesivir was originally created and developed by Gilead Sciences in as part of the company's research and development program for hepatitis C It did not work against hepatitis C as hoped but was then repurposed and studied as a potential treatment for Ebola virus disease and Marburg virus infections According to the Czech News Agency this new line of research was carried out under the direction of scientist Tomáš Cihlár Gilead Sciences subsequently discovered that remdesivir had antiviral activity in vitro against multiple filoviruses pneumoviruses paramyxoviruses and coronaviruses Preclinical and clinical research and development was done in collaboration between Gilead Sciences and various U S government agencies and academic institutions During the mid s the Mintz Levin law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the United States Patent and Trademark Office USPTO The USPTO granted two patents on remdesivir to Gilead Sciences on April one for filoviruses and one which covered both arenaviruses and coronaviruses Ebola In October the United States Army Medical Research Institute of Infectious Diseases USAMRIID announced preclinical results that remdesivir had blocked the Ebola virus in Rhesus monkeys Travis Warren who has been a USAMRIID principal investigator since said that the work is a result of the continuing collaboration between USAMRIID and Gilead Sciences The initial screening of the Gilead Sciences compound library to find molecules with promising antiviral activity was performed by scientists at the Centers for Disease Control and Prevention CDC As a result of this work it was recommended that remdesivir should be further developed as a potential treatment unreliable medical source Remdesivir was rapidly pushed through clinical trials due to the West African Ebola virus epidemic of eventually being used in people with the disease Preliminary results were promising it was used in the emergency setting during the Kivu Ebola epidemic that started in along with further clinical trials until August when Congolese health officials announced that it was significantly less effective than monoclonal antibody treatments such as mAb and REGN EB The trials however established its safety profile COVID See also Coronavirus disease Research and COVID drug repurposing research Remdesivir As of April remdesivir was viewed as the most promising treatment for COVID and was included among four treatments under evaluation in the international Solidarity trial and European Discovery trial The FDA stated on May that it is reasonable to believe that known and potential benefits of remdesivir outweigh its known and potential risks in some specific populations hospitalized with severe COVID As of May there was no good evidence that remdesivir reduced mortality in people with COVID In January Gilead Sciences began laboratory testing of remdesivir against SARS CoV stating that remdesivir had been shown to be active against severe acute respiratory syndrome SARS and Middle East respiratory syndrome MERS in animal models On January the Wuhan Institute of Virology applied for a Chinese use patent for treating COVID In a trial in China over February March remdesivir was not effective in reducing the time for improvement from COVID or deaths and caused various adverse effects requiring the investigators to terminate the trial On March the World Health Organization WHO announced the launch of a trial that would include one group treated with remdesivir Other clinical trials are underway or planned Preliminary data from an international multi center placebo controlled double blind randomized controlled trial carried out by the U S National Institutes of Health suggests that remdesivir is effective in reducing the recovery time from to days in people hospitalized with COVID On April based on results of the ACTT trial the National Institute of Allergy and Infectious Diseases NIAID announced that remdesivir was better than a placebo in reducing time to recovery for people hospitalized with advanced COVID and lung involvement The study appeared on The New England Journal of Medicine website almost a month later on May and despite generally positive results the study concluded that given high mortality despite the use of remdesivir it is clear that treatment with an antiviral drug alone is not likely to be sufficient A previous Chinese study published in The Lancet did not show significant benefits or drawbacks of using remdesivir concluding that further research is required to understand the effectiveness of the drug John David Norrie of the Clinical Trials Unit of the University of Edinburgh Medical School criticised that article as underpowered due to a lack of significant results as well as the fact that the study was ended prematurely Based on the results of its study the NIH stopped the ACTT trial and provided remdesivir to participants assigned to received placebo In April the European Medicines Agency EMA started a 'rolling review' of data on the use of remdesivir in COVID It completed the review in May In June the Committee for Medicinal Products for Human Use CHMP of the European Medicines Agency EMA started evaluating remdesivir for a conditional marketing authorization after receiving an application from Gilead Sciences On June the committee recommended granting a conditional marketing authorization for remdesivir for the treatment of COVID in adults and adolescents from years of age with pneumonia who require supplemental oxygen The brand name will be Veklury A small trial of remdesivir in rhesus macaque monkeys with COVID infections reported that early treatment with remdesivir reduced damage and disease progression but not viral shedding Access In January Gilead began working on restarting remdesivir production in glass lined steel chemical reactors at its manufacturing plant in Edmonton Alberta On February the company flew its entire stock of remdesivir kilograms in powder form left over from Ebola research to its filling plant in La Verne California to start filling vials The Edmonton plant finished its first new batch of remdesivir in April Around the same time fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January On March the drug was provisionally approved for use for COVID patients in a serious condition as a result of the outbreak in the Czech Republic On March United States President Donald Trump announced that remdesivir was available for compassionate use for people with COVID FDA Commissioner Stephen Hahn confirmed the statement at the same press conference It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since January On March Gilead voluntarily suspended access for compassionate use excepting cases of critically ill children and pregnant women for reasons related to supply citing the need to continue to provide the agent for testing in clinical trials In April the European Medicines Agency EMA provided recommendations on compassionate use of remdesivir for COVID in the EU As of April access in Canada was available only through clinical trials On May the U S Food and Drug Administration granted Gilead emergency use authorization EUA for remdesivir to be distributed and used by licensed health care providers to treat adults and children hospitalized with severe COVID- Severe COVID- is defined as patients with an oxygen saturation SpO = on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring extracorporeal membrane oxygenation ECMO a heart lung bypass machine Distribution of remdesivir under the EUA will be controlled by the U S government for use consistent with the terms and conditions of the EUA Gilead will supply remdesivir to authorized distributors or directly to a U S government agency who will distribute to hospitals and other healthcare facilities as directed by the U S Government in collaboration with state and local government authorities as needed Gilead stated they were donating million vials for emergency use and estimated as of April they had enough remdesivir for treatment courses and expect to have courses by October and one million courses by the end of On May Japan's Ministry of Health Labour and Welfare approved the drug for use in Japan in a fast tracked process based on the U S emergency authorization The initial distribution of the drug in the U S was tripped up by seemingly capricious decision making and finger pointing resulting in over a week of confusion and frustration among health care providers and patients alike On May the United States Department of Health and Human Services HHS explained in a statement that it would be distributing remdesivir vials to state health departments then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into community level needs HHS also clarified that only vials of Gilead's promised donation of million vials would be going to American patients However HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds including California Florida and Pennsylvania In May Gilead indicated they would increase the number of doses donated to the U S from to around Some of the initial distribution was sent to the wrong hospitals to hospitals with no intensive care units and to facilities without the needed refrigeration to store it On May the Committee for Medicinal Products for Human Use CHMP of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation In addition to those undergoing invasive mechanical ventilation the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen non invasive ventilation high flow oxygen devices or ECMO extracorporeal membrane oxygenation The updated recommendations were based on preliminary results from the NIAID ACTT study which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID In addition a treatment duration of five days was introduced alongside the longer ten day course based on preliminary results from another study GS US suggesting that for those not requiring mechanical ventilation or ECMO the treatment course may be shortened from ten to five days without any loss of efficacy Individuals who receive a five day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days On May Gilead announced that it had granted non exclusive voluntary licenses to five generic drug companies in India and Pakistan to manufacture remdesivir for distribution to countries The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID emergency or another medicine or vaccine is approved for COVID whichever comes first On June India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees Cipla and Hetero Drugs On June Gilead announced that it had set the price of remdesivir at US per vial for the governments of developed countries including the United States and US for U S private health insurance companies The expected course of treatment is six vials over five days for a total cost of US Being a repurposed drug the minimum production cost for remdesivir is estimated at US per day of treatment On that same day HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's wholesale acquisition price HHS would continue to work together with state governments and drug wholesaler AmerisourceBergen to allocate shipments of remdesivir vials to American hospitals through the end of September and in exchange during that three month timeframe July August and September American patients would be allocated over of Gilead's projected remdesivir output of more than treatment courses Absent from these announcements was any discussion of allocation of remdesivir production to the approximately countries omitted from Gilead's generic drug licensing agreements including much of Europe and countries as populous as Brazil China and Mexico or the countries listed on those agreements during the time it will take for Gilead's generic licensees to ramp up their own production As the implications of this began to sink in several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs including Australia Germany and the United Kingdom Pharmacology Activation Activation of remdesivir into its active triphosphate metabolite Remdesivir is a ProTide Prodrug of nucleoTide that is able to diffuse into cells where it is converted to GS mono phosphate via the actions of esterases and a phosphoamidase this in turn is further phosphorylated to its active metabolite triphosphate by nucleoside phosphate kinases Mechanism of action As an adenosine nucleoside triphosphate analog the active metabolite of remdesivir interferes with the action of viral RNA dependent RNA polymerase and evades proofreading by viral exoribonuclease ExoN causing a decrease in viral RNA production In some viruses such as the respiratory syncytial virus it causes the RNA dependent RNA polymerases to pause but its predominant effect as in Ebola is to induce an irreversible chain termination Unlike with many other chain terminators this is not mediated by preventing addition of the immediately subsequent nucleotide but is instead delayed occurring after five additional bases have been added to the growing RNA chain For the RNA Dependent RNA Polymerase of MERS CoV SARS CoV and SARS CoV arrest of RNA synthesis occurs after incorporation of three additional nucleotides Hence remdesivir is classified as a direct acting antiviral agent that works as a delayed chain terminator Pharmacokinetics In non human primates the plasma half life of the prodrug is minutes with the main metabolite being the nucleoside GS Two hours post injection the main metabolite GS is present at micromolar concentrations whilst intact Remdesivir is no longer detectable Because of this rapid extracellular conversion to the nucleoside GS some researchers have questioned whether the active nucleotide triphosphate is truly derived from Remdesivir pro drug removal or whether it occurs by GS phosphorylation The activated nucleotide triphosphate form has sustained intracellular levels in PBMC and presumably in other cells as well Resistance Mutations in the mouse hepatitis virus RNA replicase that cause partial resistance to remdesivir were identified in These mutations make the viruses less effective in nature and the researchers believe they will likely not persist where the drug is not being used Interactions Remdesivir is at least partially metabolized by the cytochrome P enzymes CYP C CYP D and CYP A Blood plasma concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P inducers such as rifampicin carbamazepine phenobarbital phenytoin primidone and St John's wort On June the FDA updated the fact sheets for the emergency use authorization of remdesivir to warn that using chloroquine or hydroxychloroquine with remdesivir may reduce the antiviral activity of remdesivir Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on in vitro data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir Synthesis Synthesis of remdesivir in structural formulae Remdesivir can be synthesized in multiple steps from ribose derivatives The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences In this method intermediate a is firstly prepared from L alanine and phenyl phosphorodichloridate in presence of triethylamine and dichloromethane triple benzyl protected ribose is oxidized by dimethyl sulfoxide with acetic anhydride and give the lactone intermediate b pyrrolo f triazin amine is brominated and the amine group is protected by excess trimethylsilyl chloride n Butyllithium undergoes a halogen lithium exchange reaction with the bromide at - °C - °F to yield the intermediate c The intermediate b is then added to a solution containing intermediate c dropwise After quenching the reaction in a weakly acidic aqueous solution a mixture of anomers was obtained It was then reacted with an excess of trimethylsilyl cyanide in dichloromethane at - °C - °F for minutes Trimethylsilyl triflate was added and reacts for one additional hour and the mixture was quenched in an aqueous sodium hydrogen carbonate A nitrile intermediate was obtained The protective group benzyl was then removed with boron trichloride in dichloromethane at - °C - °F The excess of boron trichloride was quenched in a mixture of potassium carbonate and methanol A benzyl free intermediate was obtained The isomers were then separated via reversed phase HPLC The optically pure compound and intermediate a are reacted with trimethyl phosphate and methylimidazole to obtain a diastereomer mixture of remdesivir In the end optically pure remdesivir can be obtained through chiral resolution methods medical citation needed Yes B B Fox alias for Bibi Fox Yes B B Black alias for Bibi Black Yes Babara Hill alias for Agnes Rondo Yes Babe alias for Sara Joy Yes Babe Chriistine alias for Renee Pornero Yes Babe Fleur alias for Fleur Yes Babefleur alias for Fleur Yes Babel alias for Lara Yes Babeta Yes Babeta alias for Bernadetta Yes Babeta Benoite alias for Bernadetta Yes Babeta C alias for Babeta Yes Babeth alias for Babette Yes Babetta alias for Bernadetta Yes Babette Yes Babette alias for Babette Blue Yes Babette alias for Babette D Yes Babette alias for Elisabeth Dime Yes Babette Blue Yes Babette Bure alias for Elisabeth Buré Yes Babette Chantilly alias for Lenka Seborova Yes Babette D Yes Babette Yes Babette Yes Babette Babora alias for Barbora Yes Babra Brass alias for Barra Brass Yes Babs Yes Babs alias for Lee Seratos Yes Babs Hofmann Yes Babs Yes Babsi Babsi alias for Barbara Yes Babsi alias for Carmen Herzog Yes Babsi alias for Monika Yes Babsi alias for Sherry Yes Babsi Belle alias for Babsy Yes Babsi Braun Babsi Bums Babsi Köcher alias for Anke Bonn Yes Babsi Lüdemann Yes Babsi Yes Babsi Yes Babsy Yes Babsy Gibbson alias for Carmen Herzog Yes Babsy King Babsy Miles alias for Carmen Herzog Yes Babsy Yes Babuska Yes Baby Baby Blond Yes Baby Blonde alias for Barra Brass Yes Baby Cakes alias for Gyongy Fodor Yes Baby Czilla alias for Csilla Arcovic Yes Baby Doll Yes Baby Doll alias for Karen Yes Baby Dream Yes Baby Face Yes Baby Face alias for Csilla Arcovic Yes Baby Fox alias for Bibi Fox Yes Baby Girl Yes Baby Hot alias for Vanessa Yes Baby Jane alias for Sabrina Yes Baby Lou alias for Babylou Yes Baby Love Baby Mar Yes Baby Marilin alias for Baby Marilyn Yes Baby Marilyn Yes Baby Marylin alias for Baby Marilyn Yes Baby Mia alias for Grace Yes Baby Nicole Yes Baby Nielsen Yes Baby Paola Baby Pozzi Yes Baby Rose Baby Silver Yes Baby Sky Yes Babylou Yes Bac alias for Jane Dee Yes Backy Bad Girl alias for Juliana Grandi Yes Badiya alias for Lolly Cat Yes Bady Samual Yes Bagheera Yes Baghera Bagira alias for Summer Breeze Yes Bahia alias for Djaya Yes Bahra alias for Josette Most Yes Baiba Yes Bailee alias for Bailey Yes Bailey Yes Bailey alias for Babylou Yes Bailey alias for Bailey Ryder Yes Bailey Raider alias for Bailey Ryder Yes Bailey Rhyder alias for Bailey Ryder Yes Bailey Ryder Yes Bailey Yes Bailey Yes Baily alias for Babylou Yes Baily alias for Bailey Yes Baluchka alias for Evelyne Lang Yes Bamba alias for Sonechka Yes Bambi Yes Bambi Black Yes Bambi Ink Yes Bambi Stewart alias for Bambi Yes Bambi Yes Bambi Yes Bambie alias for Bambie Dolce Yes Bambie alias for Barbara Voice Yes Bambie Dolce Yes Bambino Bambola Yes Bambola alias for Monique Silver Bamboo Yes Bambu alias for Bamboo Yes Bamby alias for Bambi Yes Bamby alias for Melodie Yes Bamby Sweet Bans alias for Faith Yes Bara alias for Barbara Babeurre Yes Bara alias for Josette Most Yes Bara alias for Valentina Rossi Yes Bara Brass alias for Barra Brass Yes Bara Page alias for Venday Yes Barbamiska Yes Barbara Yes Barbara alias for Abigaile Johnson Yes Barbara alias for Andrea Czepke Yes Barbara alias for Angel Dark Yes Barbara alias for Angel Snow Yes Barbara alias for Babs Yes Barbara alias for Barbamiska Yes Barbara alias for Barbara Devil Yes Barbara alias for Barbara Doll Yes Barbara alias for Barbara Gandalf Yes Barbara alias for Barbara Korneck Yes Barbara alias for Barbara Moss Yes Barbara alias for Barbara Rose Yes Barbara alias for Barbara Stiller Yes Barbara alias for Barbara Summer Yes Barbara alias for Barbara Tai Yes Barbara alias for Barbara Voice Yes Barbara alias for Barbarella Barbara alias for Barbie Vura Yes Barbara alias for Barbie White Yes Barbara alias for Barra Brass Yes Barbara alias for Bernadetta Yes Barbara alias for Betty Hurst Yes Barbara alias for Brenda Yes Barbara alias for Carmen Yes Barbara alias for Claudine St Jacques Yes Barbara alias for Eniko Borinsky Yes Barbara alias for Ginger Yes Barbara alias for Jane Dee Yes Barbara alias for Jennifer Clarck Yes Barbara alias for Kata Yes Barbara alias for Kata Yes Barbara alias for Lulu Perez Yes Barbara alias for Monica Spice Yes Barbara alias for Nataly Yes Barbara alias for Petula Joy Yes Barbara alias for Sophie Yes Barbara alias for Thunde Yes Barbara alias for Tina Yes Barbara alias for Valerie Barbara alias for Yulija Belozerskaja Yes Barbara Angel alias for Barbara Moss Yes Barbara Babeurre Yes Barbara Beck alias for Bärbel von Staden Yes Barbara Bic Yes Barbara Boche alias for Georgina Davis Yes Barbara Boutet Yes Barbara C alias for Barbie White Yes Barbara Caron Yes Barbara Citron alias for Michelle Davy Yes Barbara Dahl alias for Barbara Doll Yes Barbara Devil Yes Barbara Dol alias for Lola Yes Barbara Doll Yes Barbara Doller alias for Barbara Voice Yes Barbara El Fire alias for Eliss Fire Yes Barbara Ewald alias for Alexandra Ross Yes Barbara Gandalf Yes Barbara H alias for Barbara Summer Yes Barbara Hang alias for Barbara Voice Yes Barbara Hell alias for Carmen Yes Barbara Helner alias for Barbra Braun Yes Barbara Hill alias for Agnes Rondo Yes Barbara Junior alias for Barbara Summer Yes Barbara Keys Yes Barbara Klingered alias for Barbara Scott Yes Barbara Klingred alias for Barbara Scott Yes Barbara Korneck Yes Barbara Legrand alias for Bärbel von Staden Yes Barbara Love alias for Beatrice Poggi Yes Barbara Masson alias for Sandrine Sufne Yes Barbara Miller alias for Francoise Monteil Barbara Miller alias for Karine Gambier Yes Barbara Molat alias for Barbara Tai Yes Barbara Monti Yes Barbara Moore alias for Emmanuelle Kane Yes Barbara Moose Yes Barbara Moser alias for Barbara Moose Yes Barbara Moss Yes Barbara Neri alias for Elena Nikulina Yes Barbara Nova Yes Barbara Ossenkopp Yes Barbara Paci Yes Barbara Peyrat alias for Nicole Segaud Yes Barbara Queen alias for Lydia Yes Barbara Raggi Yes Barbara Raisin alias for Barbara Doll Yes Barbara Reimann Yes Barbara Rose Yes Barbara Rosenthal Yes Barbara Scott Yes Barbara Sellers alias for Karine Gambier Yes Barbara Smeeth alias for Babs Yes Barbara Sommer Yes Barbara Stephen alias for Karine Gambier Yes Barbara Stiller Yes Barbara Stoickowa alias for Barbara Rose Yes Barbara Sumer alias for Barbara Summer Yes Barbara Summer Yes Barbara Summers alias for Barbara Summer Yes Barbara Sweet Yes Barbara Sweet alias for Barbra Sweet Yes Barbara Tai Yes Barbara Takacs alias for Monika Yes Barbara Takacz alias for Monika Yes Barbara Urso Barbara Vaice alias for Barbara Voice Yes Barbara Vamp Yes Bárbara Vamp alias for Barbara Vamp Yes Barbara Voice Yes Barbara von Staten alias for Bärbel von Staden Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbara Yes Barbarella Barbarella alias for Bimba Yes Barbarella alias for Paola Yes Barbarella alias for Virna Anderson Yes Barbariska alias for Barbamiska Yes Barbel alias for Verona Yes Barbera alias for Yulija Belozerskaja Yes Barbette alias for Bernadetta Yes Barbi alias for Angie Hard Yes Barbi alias for Babs Yes Barbi alias for Barbie Rhea Yes Barbi alias for Eva D Yes Barbi alias for Lolita Angel Yes Barbi Andersson alias for Dominique Saint Claire Yes Barbi Rhea alias for Barbie Rhea Yes Barbie Barbie alias for Angel Snow Yes Barbie alias for Babs Yes Barbie alias for Barbara Voice Yes Barbie alias for Barbara Yes Barbie alias for Barbie Rhea Yes Barbie alias for Barbie Vura Yes Barbie alias for Barbie White Yes Barbie alias for Diana Barbie Swede Yes Barbie alias for Doll Yes Barbie alias for Emily Thorne Yes Barbie alias for Gaby Black Yes Barbie alias for Karina Yes Barbie alias for Kianna Yes Barbie alias for Lolita Angel Yes Barbie B alias for Babs Yes Barbie Black Yes Barbie Blond alias for Lisa Rose Yes Barbie Blonde alias for Lisa Rose Yes Barbie Boller alias for Karina Yes Barbie Cagli alias for Barbie Cagly Barbie Cagly Barbie Est Yes Barbie Ginger alias for Babs Yes Barbie Gold Yes Barbie Knight alias for Barbie White Yes Barbie Night alias for Barbie White Yes Barbie Pink Yes Barbie Rhea Yes Barbie Richmond Yes Barbie St John alias for Tanja Tycoon Yes Barbie Star alias for Dora Venter Yes Barbie Swede alias for Diana Barbie Swede Yes Barbie the Boller alias for Karina Yes Barbie Voice alias for Barbara Voice Yes Barbie Vura Yes Barbie White Yes Barbie Yes Barbie Yes Barbie Diana Swede alias for Diana Barbie Swede Yes Barbii alias for Barbara Voice Yes Barbora Yes Barbora alias for Barbara Babeurre Yes Barbora alias for Barbara Moss Yes Barbora alias for Barra Brass Yes Barbora alias for Kari Yes Barbora alias for Nataly Yes Barbora alias for Nikita Yes Barbora alias for Penelope Amour Yes Barbora alias for Samantha B Yes Barbora Brill alias for Josette Most Yes Barbora H alias for Valentina Rossi Yes Barbora Homolka alias for Barbara Summer Yes Barbora S alias for Josette Most Yes Barbra Barbra alias for Ursula Yes Barbra Braun Yes Barbra Sweet Yes Barbro Yes Barby Barby alias for Barbara Voice Yes Barby alias for Barbie Rhea Yes Barby alias for Barbie White Yes Barby alias for Lotty Yes Barby alias for Simone Horvath Yes Barby Pink alias for Barbie Pink Yes Barra Brass Yes Bartscha alias for Regina Yes Baybee Cakes alias for Gyongy Fodor Yes Bea alias for Bea Dumas Yes Bea alias for Bea Frisch Yes Bea alias for Bea Stiel Yes Bea alias for Beatrice Poggi Yes Bea alias for Bia Yes Bea alias for Krisztina Ventura Yes Bea Bos alias for Bia Yes Bea Bravour Yes Bea Buscu Yes Bea Dumas Yes Bea Fiedler Yes Bea Frisch Yes Bea Lipstick Bea Melodie Yes Bea Melody alias for Bea Melodie Yes Bea Sel Bea Somorjai alias for Beata Smorjai Yes Bea Stiel Yes Bea Bea Yes Bea Yes Bea Yes Bea Yes Bea Yes Beata alias for Beata Deak Yes Beata alias for Beata Smorjai Yes Beata alias for Betty Dark Yes Beata alias for Betty Yes Beata alias for Deborah Wells Yes Beata alias for Evelina Yes Beata alias for Krisztina Ventura Yes Beata alias for Melanie Yes Beata Beau Yes Beata Bitvai alias for Deborah Wells Yes Beata D alias for Beata Deak Yes Beata Dalle Yes Beata Deak Yes Beata Doby alias for Bia Yes Beata Lund alias for Deborah Wells Yes Beata Lund alias for Manila May Yes Beata Smorjai Yes Beata Sonne alias for Kira Red Yes Beata Szabo alias for Betty Dark Yes Beata Undine Yes Beata Vacek Yes Beata Vacek alias for Deborah Wells Yes Beata Yes Beata Yes Beata Yes Beate alias for Bea Dumas Yes Beate alias for Beata Dalle Yes Beate alias for Beata Yes Beate alias for Csilla Arcovic Yes Beate alias for Deborah Wells Yes Beate alias for Evelina Yes Beate alias for Maria Yes Beate alias for Sweet Claudia Yes Beate alias for Sylvi Black Yes Beate Biehler Yes Beate Bitvai alias for Deborah Wells Yes Beate Breitner alias for Bea Dumas Yes Beate Friedman Yes Beate Gränitz Yes Beate Köhler alias for Nina Yes Beate Meier Yes Beate Salter alias for Lola Yes Beate Beate Beate Yes Beate Yes Beate Yes Beate Yes Beatha Bitoune alias for Deborah Wells Yes Beatka alias for Bella Karina Yes Beatrice Beatrice alias for Bea Yes Beatrice alias for Beatrice Poggi Yes Beatrice alias for Beatrice Taverne Yes Beatrice alias for Betty Love Yes Beatrice alias for Brianna Yes Béatrice alias for Cathy Yes Beatrice alias for Ivana Sugar Yes Beatrice alias for Lenka Yes Beatrice alias for Tanata Yes Béatrice Barcares Beatrice Bella alias for Beatrice Poggi Yes Beatrice Conti Beatrice Foss alias for Beatrice Poggi Yes Beatrice Ginther alias for Bea Dumas Yes Béatrice Harnois Yes Beatrice La Roche Yes Beatrice Lancel Beatrice Lanzi Yes Beatrice Melon alias for Béatrice Valle Yes Beatrice Milano alias for Evelina Yes Beatrice Monti Beatrice Poggi Yes Beatrice Sall alias for Béatrice Valle Yes Béatrice Szebo alias for Beatrice Poggi Yes Beatrice Taverne Yes Béatrice Valle Yes Beatrice Valle Yes Béatrice Vidal Yes Beatrice X alias for Beata Yes Beatrice Yes Beatrice Beatrice Beatrice Yes Beatrice Yes Beatrice Yes Beatrix alias for Alina Grey Yes Beatrix alias for Anita Gyongy Yes Beatrix alias for Bea Frisch Yes Beatrix alias for Bea Stiel Yes Beatrix alias for Beatrice Poggi Yes Beatrix alias for Gilda Roberts Yes Beatrix alias for Julia Taylor Yes Beatrix de Hoorn Beatrix K alias for Beatrix Kismarton Yes Beatrix K alias for Lucy Yes Beatrix Kismarton Yes Beatrix Monroe Beatrix Monroe alias for Trixi Monroe Yes Beatrix Pierce Yes Beatrix Roche Yes Beatrix S alias for Bea Frisch Yes Beatrix Suc Beatrix ten Hoff Yes Beatrix Valle Yes Béatrix Valle alias for Béatrice Valle Yes Beatrix Beba Yes Beba Ross Yes Beba Beby Pozzi alias for Baby Pozzi Yes Becca alias for Jenny Simpson Yes Beccy Lavender Yes Becky Becky alias for Keira Moon Yes Becky Skelton alias for Nikky Yes Becky Stevens Yes Becky Yes Bee alias for Tina Lee Yes Bee Joux Belicia Yes Belicia Avalos alias for Belicia Yes Belicia Salome alias for Belicia Yes Belicia Steele alias for Belicia Yes Belinda alias for Adeline Lange Yes Belinda alias for Benta Yes Belinda alias for Mellie Yes Belinda alias for Rose Yes Belinda alias for Venday Yes Belinda Barcley alias for Vanessa Delgiron Yes Belinda Bayer Yes Belinda Blue alias for Adeline Lange Yes Belinda D'Amour alias for Bella Diamond Yes Belinda Lari Yes Belinda Walk alias for Cristina Valenti Yes Belinda Yes Belinda Yes Belinda Belinda Yes Belinda Yes Belinda Belinda Belinda Yes Belinda Yes Belisa Bet Yes Belissima alias for Anita Queen Yes Belka alias for Svetlana Belochkina Yes Belkis Toscano alias for Angel Dickens Yes Bell alias for Belle Yes Bella alias for Anje Yes Bella alias for Bella Baby Yes Bella alias for Bella Morgan Yes Bella alias for Bernadetta Yes Bella alias for Cristina Bella Yes Bella alias for Daria Glower Yes Bella alias for Frances Laurent Yes Bella alias for Joyce Black Yes Bella alias for Lilith Yes Bella alias for Murka Yes Bella alias for Stephanie Silver Yes Bella Anne alias for Bella Baby Yes Bella Babe alias for Bella Baby Yes Bella Baby Yes Bella Banx Yes Bella Beretta Yes Bella Blond Yes Bella Blow Yes Bella D alias for Bella Baby Yes Bella Diamond Yes Bella G alias for Sara Hilton Yes Bella Gucci alias for Iris Yes Bella Karina Yes Bella Konchalka alias for Rosee Yes Bella Krysta Yes Bella Luna Yes Bella Moore alias for Iris Yes Bella Moore alias for Kikki Dee Yes Bella Morgan Yes Bella Riger Bella Russa Yes Bella Shepard alias for Bella Baby Yes Bella West Yes Bella Yes Bella Yes Bella Yes Bella Yes Bella Yes Bella Yes Bella Yes Belle Yes Belle Claire Yes Belle De Jour Yes Bellina Yes Bellina alias for Bella Baby Yes Bellinda alias for Adeline Lange Yes Bellinda alias for Lucy Anne Yes Bellinda Bond Belly Saint alias for Betty Saint Yes Belochka alias for Svetlana Belochkina Yes Benedetta alias for Bernadette Manfredi Yes Benedetta Ausilio Benedetta Bonomi Benedetta Dei Benita alias for Benita Milano Yes Benita Hausdung alias for Benita Milano Yes Benita Milano Yes Benita Pajero alias for Benita Milano Yes Benji Yes Bennadett Lukics Yes Bennita alias for Benita Milano Yes Benta Yes Bente Yes Bente Nielsen Yes Bente Yes Beppy alias for Bepsy Yes Bepsy Yes Berana alias for Breana Yes Berbera alias for Bettina Yes Berinice Yes Berit Agedahl Yes Berlin alias for Kristina Black Yes Berlin alias for Sheyla Cats Yes Bernadett alias for Bernadetta Yes Bernadett alias for Bernadette Manfredi Yes Bernadett alias for Fione Absolut Yes Bernadett alias for Melody Magic Yes Bernadett Yes Bernadetta Yes Bernadetta alias for Jennifer London Yes Bernadette alias for Bernadett Yes Bernadette alias for Bernadetta Yes Bernadette alias for Bernadette Manfredi Yes Bernadette alias for Edith Yes Bernadette alias for Melody Magic Yes Bernadette alias for Tanja Fielmann Yes Bernadette alias for Viva Singer Yes Bernadette alias for Vivian Tigress Yes Bernadette Auer Bernadette Bouret alias for Sophie Guers Yes Bernadette Dior alias for Bernadette Manfredi Yes Bernadette Haymes alias for Olga Yes Bernadette Manfredi Yes Bernadette Noel alias for Bernadette Manfredi Yes Bernadette Suceladeçou alias for Sophie Guers Yes Bernadotte Yes Bernardeta alias for Bernadetta Yes Bernardotte alias for Bernadotte Yes Bernice alias for Berinice Yes Bernuella alias for Meri Yes Berta alias for Elis Black Yes Berta alias for Roxy Taggart Yes Berta Blasi alias for Anne Andersson Yes Berta Cabré Yes Berta Singerman alias for Berta Cabré Yes Berta Vogl Bertha Butt alias for Kristina Varga Yes Bertha Klingspor alias for Barbara Scott Yes Berthe Yes Bertie alias for Arian Joy Yes Bertie A alias for Eva Berger Yes Beryl alias for Svetlana Belochkina Yes Bessie Yes Beta Frati alias for Elizabeth Yes Beth alias for Krisztina Ventura Yes Beth alias for Petra Gil Yes Beth Daylor alias for Elisabeth King Yes Bethanie Yes Bethany Yes Betina alias for Milada Yes Betina Campbell Yes Betsey Kite alias for Dulsina Yes Betsy Yes Betsy alias for Lioness Yes Betti Yes Betti alias for Ronita Yes Betti Bburago Yes Betti G alias for Betty G Yes Betti G alias for Tyler Yes Bettina Yes Bettina alias for Benita Milano Yes Bettina alias for Betina Campbell Yes Bettina alias for Tina Yes Bettina alias for Zafira Yes Bettina Campbell alias for Betina Campbell Yes Bettina Campell alias for Betina Campbell Yes Bettina DiCapri Yes Bettina Kox Yes Bettina Mingus alias for Iris Yes Bettina Rau alias for Roswitha Yes Bettina Yes Bettina Yes Betty alias for Ahud Yes Betty alias for Allie Cat Yes Betty alias for Amy Yes Betty alias for Antonia Sainz Yes Betty alias for Bailey Ryder Yes Betty alias for Bernadette Manfredi Yes Betty alias for Betty Anderson Yes Betty alias for Betty Babe Yes Betty alias for Betty Belle Yes Betty alias for Betty Bop Yes Betty alias for Betty Gabor Yes Betty alias for Betty Gordon Yes Betty alias for Betty Hurst Yes Betty alias for Betty Love Yes Betty alias for Betty Summer Yes Betty alias for Betty Wong Yes Betty alias for Danny Ricci Yes Betty alias for Edita Ungerova Yes Betty alias for Edith Yes Betty alias for Elke Nagold Yes Betty alias for Gabriella Vincze Yes Betty alias for Isabelle Yes Betty alias for Ivana Sugar Yes Betty alias for Katrin Yes Betty alias for Kristall Rush Yes Betty alias for Lexy Little Yes Betty alias for Louise Black Yes Betty alias for Maria Yes Betty alias for Melinda Yes Betty alias for Melody Magic Yes Betty alias for Nikol W Yes Betty alias for Petty Pol Yes Betty alias for Rady Yes Betty alias for Ronita Yes Betty alias for Tanya Valis Yes Betty alias for Zafira Yes Betty Adams alias for Katy Borman Yes Betty Andersen alias for Betty Anderson Yes Betty Anderson Yes Betty B Betty Babe Yes Betty Bell alias for Betty Belle Yes Betty Belle Yes Betty Belle alias for Melody Magic Yes Betty Beniski Yes Betty Berg Yes Betty Bi Yes Betty Blue Yes Betty Blue alias for Betty Yes Betty Blue Yes Betty Boday alias for Betty Yes Betty Boop alias for Betty Bop Yes Betty Bop Yes Betty C alias for Betty Saint Yes Betty Carter alias for Lina Romay Yes Betty Dark Yes Betty Davis alias for Catherine Ringer Yes Betty Extreme alias for Betty G Yes Betty Fare Betty Fox alias for Liz Petri Yes Betty G Yes Betty Gabor Yes Betty Gordon Yes Betty Hurst Yes Betty Ice alias for Zafira Yes Betty Jane alias for Béatrice Valle Yes Betty Kone Betty Lamone alias for Elisabeth Dime Yes Betty Love Yes Betty Love Yes Betty Mery alias for Veronica Devil Yes Betty Mool Yes Betty Moon alias for Marie Claire Yes Betty Myriam alias for Michèle le Brumann Yes Betty Plume alias for Tanya Valis Yes Betty Rixton alias for Betty Stylle Yes Betty Saint Yes Betty Six Yes Betty Spark Yes Betty Spitz Betty Stefani alias for Gyongy Fodor Yes Betty Stevens alias for Betty Dark Yes Betty Style alias for Betty Stylle Yes Betty Stylle Yes Betty Summer Yes Betty Torri alias for Katia Grimaldi Yes Betty Versa Yes Betty Vixen alias for Betty Yes Betty White Yes Betty Wong Yes Betty Yes Betty Yes Betty Yes Betty Yes Betty Betty Yes Betty Yes Betty Yes Betty Yes Betty Yes Betty Yes Betty Betty Yes Betty Yes Betty Yes Betty Yes Betty Betty Yes Beverly Yes Beverly Yes Beverly Bia Yes Bia alias for Yvett Bia Yes Bianca alias for Bianca Arden Yes Bianca alias for Bianca Biggs Yes Bianca alias for Bianca Dark Yes Bianca alias for Bianca Romanova Yes Bianca alias for Bianka Yes Bianca alias for Bianka Lovely Yes Bianca alias for Gloria Garett Yes Bianca alias for Jessy Brown Yes Bianca alias for Katharina Yes Bianca alias for Kiss Yes Bianca alias for Kitty Yes Bianca alias for Kitty Yes Bianca Arden Yes Bianca Ascari alias for Rita Cardinale Yes Bianca Astor alias for Meridian Yes Bianca Bella Bianca Belle Bianca Biggs Yes Bianca Bruni alias for Bianca Yes Bianca Dark Yes Bianca Deville Yes Bianca E alias for Bianka Lovely Yes Bianca Ferrero Yes Bianca Garcia alias for Lorena Garcia Yes Bianca Germany alias for Bianca Germany Yes Bianca Golden Yes Bianca Jebi Yes Bianca K alias for Bianca Biggs Yes Bianca Lovely alias for Bianka Lovely Yes Bianca Menotti Yes Bianca Moore alias for Julia Perrin Yes Bianca Nonis Yes Bianca Oxa alias for Bianca Yes Bianca Pearl Yes Bianca Ramos alias for Karli Sweet Yes Bianca Resa Yes Bianca Romanova Yes Bianca Villa Bianca Yes Bianca Yes Bianca Yes Bianca Yes Bianca Yes Bianca Yes Bianca Bianca Yes Bianca Yes Bianca Bianca Yes Bianca Yes Bianca Germany Yes Biancka Yes Biancka alias for Bianca Yes Bianka Yes Bianka alias for Bianca Menotti Yes Bianka alias for Bianca Romanova Yes Bianka alias for Bianka Lovely Yes Bianka alias for Emma Diamond Yes Bianka alias for Gloria Garett Yes Bianka Ardan alias for Bianca Arden Yes Bianka Golden alias for Bianca Golden Yes Bianka Lovely Yes Bianka V alias for Bianca Golden Yes Bianka Yes Bibbi Boobz Yes Bibbi Fox alias for Bibi Fox Yes Bibi alias for Bibi Fox Yes Bibi alias for Habibi Yes Bibi Black Yes Bibi Blue Yes Bibi Boobz alias for Bibbi Boobz Yes Bibi Fox Yes Bibi Mulatra Yes Bibi Noel Yes Bibi Taylor Yes Bibian Norai Yes Bibie Mulatra alias for Bibi Mulatra Yes Biby alias for Bibi Fox Yes Biby alias for Jenny Yes Bie Warburg alias for Anne Bie Warburg Yes Bieke Big Tits Jill alias for Jill Morena Yes Biggi Yes Biggi alias for Alexandra Ross Yes Biggi alias for Biggi Bums Yes Biggi alias for Biggi Mondi Yes Biggi alias for Biggy Blonde Yes Biggi alias for Bigi Maier Yes Biggi alias for Fanny Steel Yes Biggi alias for Karina Yes Biggi alias for Lolita Yes Biggi alias for Monika Yes Biggi Bums Yes Biggi Deinhardt Yes Biggi Frech Biggi Gibb Yes Biggi Mondi Yes Biggi Mondy alias for Biggi Mondi Yes Biggi Rainhard alias for Anastasia Priry Yes Biggi Reviera alias for Biggy Blonde Yes Biggi Staudinger Yes Biggi Stenzhorn Yes Biggi Tanz Yes Biggi Biggi Yes Biggi Yes Biggy alias for Biggi Bums Yes Biggy alias for Biggy Blonde Yes Biggy Blonde Yes Biggy Gibb alias for Biggi Gibb Yes Biggy King alias for Liv Yes Biggy Mondi alias for Biggi Mondi Yes Biggy Rivera alias for Biggy Blonde Yes Biggy Stanz alias for Biggi Stenzhorn Yes Biggy Sten alias for Biggi Stenzhorn Yes Bigi Bigi Doree alias for Bigi Maier Yes Bigi King alias for Bigi Maier Yes Bigi Maier Yes Bijou Yes Bijou alias for Stracy Yes Billie alias for Brenda Moon Yes Billie Jo Yes Billie Star Yes Billy alias for Billy Raise Yes Billy Jane alias for Jean Bryant Yes Billy Rais alias for Billy Raise Yes Billy Raise Yes Bimba Yes Bimba Sawacco Yes Bimbola X Bine alias for Josette Most Yes Birdy alias for Lise Pinson Yes Birgit Yes Birgit alias for Alexandra Ross Yes Birgit alias for Christine Axelle Yes Birgit Bockelmann alias for Diane Dupont Yes Birgit Buschak Yes Birgit Regine alias for Elisabeth Buré Yes Birgit Tetzlaff Yes Birgit Zambulo alias for Birgit Zamulo Yes Birgit Zamulo Yes Birgit Yes Birgit Yes Birgitta Birgitta alias for Pretty Page Yes Birgitta Lund alias for Andrea Szabo Yes Birgitta Svensson alias for France Lomay Yes Birgitta Yes Birgitte Yes Birgitte Maier alias for Brigitte Maier Yes Birgitte Meyer alias for Brigitte Maier Yes Birthe Yes Bitchy Black Angel alias for Angel Black Yes Black Angelica alias for Black Angelika Yes Black Angelicka alias for Black Angelika Yes Black Angelika Yes Black Angelina alias for Black Angelika Yes Black Bossy Yes Black Cat Yes Black Cat alias for Kaira Paolo Yes Black Diamond Yes Black Lady Yes Black Lynn Black Panther Yes Black Pearl Yes Black Puma alias for Puma Black Yes Black Queen alias for Laura Lion Yes Black Sonia alias for Sonia Black Yes Black Sonja alias for Sonia Black Yes Black Tolly alias for Tolly Cristall Yes Black Widow Yes Black Widow alias for Monika Holst Yes Blackie Nell alias for Marie Claude Moreau Yes Blacky alias for Charlene Roben Yes Blake Yes Blanca Brooke Yes Blanche Yes Blanche Bradburry Yes Blandine alias for Blondina Yes Blanka Yes Bliss alias for Venday Yes Blond Angel alias for Angel Blond Yes Blond Cat Yes Blond Panni alias for Blond Panny Yes Blond Panny Yes Blond Isi alias for Bella Blond Yes Blonde Isi alias for Bella Blond Yes Blondi Blondi alias for Blondie Yes Blondi alias for Blondye Yes Blondi alias for Gina Blonde Yes Blondi alias for Miss Blondie Yes Blondi Blondie Yes Blondie alias for Asia Blondi Yes Blondie alias for Blondye Yes Blondie alias for Celina Davis Yes Blondie alias for Holly Fosters Yes Blondie alias for Miss Blondie Yes Blondie alias for Pascale Vouillot Yes Blondie alias for Tiffany Diamond Yes Blondie Blondie Yes Blondie Blondie Yes Blondie Yes Blondina Yes Blondine alias for Blondina Yes Blondine alias for Blondye Yes Blondy Yes Blondy alias for Betty Blue Yes Blondy alias for Blondye Yes Blondy Yes Blondye Yes Blondye alias for Miss Blondie Yes Blue Angel Yes Blue Angel alias for Teena Yes Blue Ice alias for Elena Maria Ricci Yes Blue Rose Yes Blue Rosses alias for Rosses Yes Blumelove alias for Sarah Blue Yes Bo Yes Bo Doolitle alias for Barbara Boutet Yes Bo Piccolo Bobbi alias for Bobbi Eden Yes Bobbi Eden Yes Bobbie Eden alias for Bobbi Eden Yes Bobby Yes Bobby Eden alias for Bobbi Eden Yes Bodil Joensen Yes Bogie alias for Jennifer Morante Yes Bolivia alias for Bolivia Samsonite Yes Bolivia Samsonite Yes Bombshell Yes Bonanita alias for Anita Blond Yes Bonita alias for Bonita White Yes Bonita alias for Josette Most Yes Bonita Pajero alias for Benita Milano Yes Bonita Super alias for Danièle Nègre Yes Bonita White Yes Bonni alias for Grace Yes Bonnie Bonnie Bon alias for Bonny Bon Yes Bonnie Bond alias for Bonny Bon Yes Bonnie Parker alias for Princesse Elisa Yes Bonnie Shai Yes Bonnie Williams Yes Bonnie Yes Bonnie Yes Bonny Bonny alias for Tanechka Yes Bonny A alias for Willow Yes Bonny Anderson alias for Willow Yes Bonny Bo alias for Bonny Bon Yes Bonny Bon Yes Bonny Bone alias for Bonny Bon Yes Bony Bo alias for Bonny Bon Yes Boobies alias for Sue Garner Yes Boroga alias for Boroka Balls Yes Boroka alias for Boroka Balls Yes Boroka Balls Yes Boroka Bolls alias for Boroka Balls Yes Boroka Borre alias for Boroka Balls Yes Boroka Borress alias for Boroka Balls Yes Bozena alias for Ester Yes Bozena alias for Silvie Deluxe Yes Bozena Z alias for Eliss Fire Yes Brabra alias for Coco de Mal Yes Brandi alias for Naomi Nevena Yes Brandi Smile alias for Brandy Smile Yes Brandy Yes Brandy alias for Betty Dark Yes Brandy alias for Brandy Emerson Yes Brandy alias for Brandy Smile Yes Brandy alias for Chantal Ferrara Yes Brandy alias for Pepe Yes Brandy alias for Sugar Baby Yes Brandy Blue alias for Brigitte Maier Yes Brandy C alias for Sara Brandy Canyon Yes Brandy Canyon alias for Sara Brandy Canyon Yes Brandy Emerson Yes Brandy Lee alias for Teri Sweet Yes Brandy McDaniels alias for Conny Yes Brandy Sara Canyon alias for Sara Brandy Canyon Yes Brandy Smile Yes Brandy Smith alias for Eva Roberts Yes Brandy Trickle Yes Brandy Yes Brazilia alias for Cheryl Sweet Yes Breana Yes Breanna alias for Breana Yes Bree alias for Jana Maho Yes Brenda Yes Brenda alias for Jennifer Clarck Yes Brenda alias for Sprmda Yes Brenda Black alias for Amanda Yes Brenda Boop Yes Brenda Haven alias for Elisa Mateo Brenda Haven alias for Lina Romay Yes Brenda Logan alias for Henriett Yes Brenda Martinez alias for Brenda Boop Yes Brenda Moon Yes Brenda Morray Yes Brenda Yes Brenda Yes Brendy alias for Brandy Yes Brendy Logan alias for Henriett Yes Bretta Yes Bretta alias for Andy Yes Briana Belluci alias for Briana Beluci Briana Belucci alias for Briana Beluci Briana Beluci Briana Bounce Yes Brianna Yes Brianna alias for Anne Yes Brianna alias for Pepe Yes Bridget alias for Angelika Yes Bridget alias for Brigit Yes Bridget alias for Gitta Blond Yes Bridget alias for Josette Most Yes Bridget alias for Pink Pussy Yes Bridget alias for Sugar Baby Yes Bridget B alias for Brigit Yes Bridget Bont alias for Angelika Yes Bridget Joli Yes Bridget Jolie alias for Bridget Joli Yes Bridget Maier alias for Brigitte Maier Yes Bridget Moon alias for Valeria Horj Yes Bridgett Yes Bridgette alias for Brigitte Maier Yes Bridgette alias for Pink Pussy Yes Bridgette Bleu alias for Brigitte Maier Yes Bridgette Maier alias for Brigitte Maier Yes Brigette Lanning alias for Karine Gambier Yes Brigette Page alias for Patty Peage Yes Brighite Yes Brighitta alias for Lisa Rose Yes Brigi B alias for Gitta Blond Yes Brigi K alias for Jennifer Reed Yes Brigida Danziger Brigit Yes Brigita alias for Brigitta Biggs Yes Brigite Yes Brigitt Yes Brigitta Yes Brigitta alias for Aiden Yes Brigitta alias for Brigitta Nelson Yes Brigitta alias for Brigitte le Mans Yes Brigitta alias for Brigitte Yes Brigitta alias for Ginna Brigitta Yes Brigitta alias for Gitta Blond Yes Brigitta alias for Gitta Ramone Yes Brigitta alias for Lisa Rose Yes Brigitta alias for Rita Yes Brigitta alias for Sonya Smith Yes Brigitta Biggs Yes Brigitta Black Brigitta Boobs alias for Sonya Smith Yes Brigitta Bui Yes Brigitta Bui Kocsis alias for Brigitta Bui Yes Brigitta Bulgari alias for Brigitta Bui Yes Brigitta Buykocsis alias for Brigitta Bui Yes Brigitta Fazelas alias for Brigitta Yes Brigitta Fox alias for Brigitte Fox Yes Brigitta Gold Yes Brigitta Kiss Yes Brigitta Kocsis alias for Brigitta Bui Yes Brigitta Mass alias for Brigitta Biggs Yes Brigitta Nelson Yes Brigitta Raab alias for Brigitta Nelson Yes Brigitta Reinert Yes Brigitta Welling alias for Brigitta Nelson Yes Brigitta Wellington alias for Brigitta Nelson Yes Brigitta Yes Brigitta Brigitta Yes Brigitta Yes Brigitta Yes Brigitte Yes Brigitte alias for Angelika Yes Brigitte alias for Biggi Mondi Yes Brigitte alias for Bridgett Yes Brigitte alias for Brigitta Biggs Yes Brigitte alias for Brigitte Lahaie Yes Brigitte alias for Brigitte Maier Yes Brigitte alias for Daniela Nanou Yes Brigitte alias for Eszter Frank Yes Brigitte alias for Ildiko Yes Brigitte alias for Jenny McArthur Yes Brigitte alias for Marianne Sperber Yes Brigitte alias for Sabrina Yes Brigitte alias for Szilvia Yes Brigitte Ansai Yes Brigitte Berthet Yes Brigitte Bordeaux alias for Brigitte Lahaie Yes Brigitte Borghese alias for Brigitte de Borghese Yes Brigitte Bui alias for Brigitta Bui Yes Brigitte Buy alias for Brigitta Bui Yes Brigitte Cartier alias for Brigitte Verbecq Yes Brigitte Dao Brigitte de Boghers alias for Brigitte de Borghese Yes Brigitte de Borghese Yes Brigitte Fox Yes Brigitte Haas Yes Brigitte Hawas Brigitte Horn alias for Biggi Stenzhorn Yes Brigitte Hunter alias for Britney Yes Brigitte Iles Yes Brigitte Lahaie Yes Brigitte Lahaye alias for Brigitte Lahaie Yes Brigitte Latour alias for Christine Béton Yes Brigitte Lavray Yes Brigitte le Mans Yes Brigitte Lelaurain Yes Brigitte Lilan Yes Brigitte Maier Yes Brigitte Malden alias for Biggi Mondi Yes Brigitte Monnin Yes Brigitte Moore alias for Lisa Rose Yes Brigitte Nadiegda Yes Brigitte Nentin Brigitte Nonnin alias for Brigitte Monnin Yes Brigitte Olier alias for Jacqueline Wild Yes Brigitte P alias for Wanda Tanner Yes Brigitte Petronio Yes Brigitte Piga alias for Brigitte Verbecq Yes Brigitte Robert alias for Obaya Roberts Yes Brigitte Simonin alias for Brigitte Lahaie Yes Brigitte Stone Yes Brigitte Valier Brigitte Verbeck alias for Brigitte Verbecq Yes Brigitte Verbecq Yes Brigitte Verbek alias for Brigitte Verbecq Yes Brigitte Verbeq alias for Brigitte Verbecq Yes Brigitte Yes Brigitte Brigitte Yes Brigitte Yes Brigitte Yes Brigitte Yes Brigitte Yes Brigitte Brill Xandra alias for Xandra Brill Yes Brilliant alias for Isabell Rider Yes Brit Anderson Brita alias for Brigitta Nelson Yes Brita Stine alias for Britta Stine Yes Britany Britany Whisper Yes Brithney Yes Britnee Yes Britney Yes Britney alias for Angels Elis Yes Britney alias for Britnee Yes Britney alias for Brittany Spring Yes Britney alias for Csilla Arcovic Yes Britney alias for Gitta Blond Yes Britney alias for Jennifer London Yes Britney alias for Kristina Yes Britney alias for Sandra Kalermen Yes Britney alias for Sugar Baby Yes Britney B Yes Britney Lightspeed alias for Jana Mrazkova Yes Britney Spring alias for Brittany Spring Yes Britney Yes Britney Yes Britt alias for Jytte Petersen Yes Britt Angel Yes Britt Boyer Britt Corvin Yes Britt Dee Yes Britt Korwin alias for Britt Corvin Yes Britt Web Yes Britt Yes Britta Britta Gruga Yes Britta Nelson alias for Brigitta Nelson Yes Britta Ramos Yes Britta Stine Yes Britta von Endt alias for Emily Cooper Yes Britta von Wendt alias for Anette Montana Yes Britta Yes Britta Brittaney alias for Britney Yes Brittany alias for Britnee Yes Brittany alias for Brittany Bardot Yes Brittany alias for Brittany Spring Yes Brittany alias for Kata Yes Brittany alias for Lolita Yes Brittany Bardot Yes Brittany Lawrence alias for Brittany Bardot Yes Brittany Love alias for Brittany Bardot Yes Brittany Spring Yes Brittany Stone alias for Lolita Yes Brittany Whisper alias for Britany Whisper Yes Britte Stekmund Brittney alias for Britnee Yes Brittney alias for Britney Yes Brittney alias for Jennifer London Yes Broke Summer alias for Brooke Yes Brook alias for Foxy Yes Brook alias for Trinity Yes Brooke Yes Brooke alias for Gitta Blond Yes Brooke alias for Teena Yes Brooke Lee alias for Anastasia Blonde Yes Brooke Lynn Yes Brooke Summer alias for Brooke Yes Brooke Brooklyn alias for Dulce Yes Bruna Brunetta alias for Rebecca Amata Yes Brunja del Rio alias for Drunna Yes Bryana alias for Pepe Yes Bubi Yes Buffy alias for Katja Yes Bulgari alias for Ashley Bulgari Yes Bulija Yes Bulle Yes Bulma Rey Yes Bunny alias for Gabbana Yes Bunny alias for Leenda Yes Burcu Yener Yes Bustine alias for Justine Moore Yes Busty alias for Mandy Dee Yes Busty Flesh Yes Busty Flesh alias for Lydia P Yes Busty Jay alias for Jay Sweet Butterfly alias for Lepidoptera Yes Buxom Lucy alias for Julia Miles Yes Bäbel Wolf alias for Susanne Wolf Yes Bärbel Yes Bärbel alias for Barbara Yes Bärbel alias for Bea Dumas Yes Bärbel Bo Yes Bärbel Cohn alias for Alana Joy Yes Bärbel Mössinger Yes Bärbel von Staden Yes Bärbel Wolf alias for Susanne Wolf Yes Bärbel Yes Bärbel Remdesivir requires raw materials reagents and catalysts to make and approximately chemical steps Some of the ingredients are extremely dangerous to humans especially trimethylsilyl cyanide The original end to end manufacturing process required to months to go from raw materials at contract manufacturers to finished product but after restarting production in January Gilead Sciences was able to find ways to reduce the production time to six months Terminology Remdesivir is the international nonproprietary name INN while the development code name was GS Other animals GS was shown in to have promise for treating feline infectious peritonitis caused by a coronavirus It has not been evaluated or approved by the Food and Drug Administration FDA for the treatment of feline coronavirus or feline infectious peritonitis but has been available since through websites and social media as an unregulated black market substance as confirmed by the UC Davis School of Veterinary Medicine Coronavirus disease COVID is an infectious disease caused by severe acute respiratory syndrome coronavirus SARS CoV It was first identified in December in Wuhan Hubei China and has resulted in an ongoing pandemic The first confirmed case has been traced back to November in Hubei As of July more than million cases have been reported across countries and territories resulting in more than deaths More than million people have recovered Common symptoms include fever cough fatigue shortness of breath and loss of smell and taste While the majority of cases result in mild symptoms some progress to acute respiratory distress syndrome ARDS possibly precipitated by cytokine storm multi organ failure septic shock and blood clots The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days The virus is primarily spread between people during close contact a most often via small droplets produced by coughing b sneezing and talking The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances However research as of June has shown that speech generated droplets may remain airborne for tens of minutes Less commonly people may become infected by touching a contaminated surface and then touching their face It is most contagious during the first three days after the onset of symptoms although spread is possible before symptoms appear and from people who do not show symptoms The standard method of diagnosis is by real time reverse transcription polymerase chain reaction rRT PCR from a nasopharyngeal swab 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 CT imaging for routine screening Recommended measures to prevent infection include frequent hand washing maintaining physical distance from others especially from those with symptoms quarantine especially for those with symptoms covering coughs and keeping unwashed hands away from the face The use of cloth face coverings such as a scarf or a bandana has been recommended by health officials in public settings to minimise the risk of transmissions with some authorities requiring their use Health officials also stated that medical grade face masks such as N masks should only be used by healthcare workers first responders and those who directly care for infected individuals There are no vaccines nor specific antiviral treatments for COVID Management involves the treatment of symptoms supportive care isolation and experimental measures The World Health Organization WHO declared the COVID outbreak a public health emergency of international concern PHEIC on January and a pandemic on March Local transmission of the disease has occurred in most countries across all six WHO regions File En Wikipedia VideoWiki Coronavirus disease webm Video summary script Contents Signs and symptoms Complications Cause Transmission Virology Pathophysiology Immunopathology Diagnosis Pathology Prevention Management Prognosis History Epidemiology Infection fatality rate Sex differences Ethnic differences Society and culture Name Misinformation Decreased emergency room use Other animals Research Vaccine Medications Cytokine storm Passive antibodies See also Notes References External links Health agencies Directories Medical journals Treatment guidelines Signs and symptoms Symptoms of COVID Symptom Range Fever Cough Loss of appetite Fatigue Shortness of breath Coughing up sputum Muscle aches and pains Symptoms of COVID Fever is the most common symptom of COVID but is highly variable in severity and presentation with some older immunocompromised or critically ill people not having fever at all In one study only of people had fever when they presented to the hospital while went on to develop fever at some point during their hospitalization Other common symptoms include cough loss of appetite fatigue shortness of breath sputum production and muscle and joint pains Symptoms such as nausea vomiting and diarrhoea have been observed in varying percentages Less common symptoms include sneezing runny nose sore throat and skin lesions Some cases in China initially presented with only chest tightness and palpitations A decreased sense of smell or disturbances in taste may occur Loss of smell was a presenting symptom in of confirmed cases in South Korea 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 typical incubation period for COVID is five or six days but it can range from one to fourteen days with approximately ten percent of cases taking longer An early key to the diagnosis is the tempo of the illness Early symptoms may include a wide variety of symptoms but infrequently involves shortness of breath Shortness of breath usually develops several days after initial symptoms Shortness of breath that begins immediately along with fever and cough is more likely to be anxiety than COVID The most critical days of illness tend to be those following the development of shortness of breath A minority of cases do not develop noticeable symptoms at any point in time These asymptomatic carriers tend not to get tested and their role in transmission is not fully known Preliminary evidence suggested they may contribute to the spread of the disease In June a spokeswoman of WHO said that asymptomatic transmission appears to be rare but the evidence for the claim was not released The next day WHO clarified that they had intended a narrow definition of asymptomatic that did not include pre symptomatic or paucisymptomatic weak symptoms transmission and that up to of transmission may be asymptomatic Transmission without symptoms does occur Complications Complications may include pneumonia acute respiratory distress syndrome ARDS multi organ failure septic shock and death Cardiovascular complications may include heart failure arrhythmias heart inflammation and blood clots A study published in The New England Journal of Medicine concluded that the risk for severe COVID was higher for people with type A blood than those with other blood types Approximately of people who present with COVID have elevated liver enzymes reflecting liver injury Neurologic manifestations include seizure stroke encephalitis and Guillain Barré syndrome which includes loss of motor functions Following the infection children may develop paediatric multisystem inflammatory syndrome which has symptoms similar to Kawasaki disease which can be fatal Cause Transmission Cough sneeze droplets visualised in dark background using Tyndall scattering Respiratory droplets produced when a man sneezes visualised using Tyndall scattering COVID spreads primarily when people are in close contact and one person inhales small droplets produced by an infected person symptomatic or not coughing sneezing talking or singing The WHO recommends metre ft of social distance the U S Centers for Disease Control and Prevention CDC recommends metres ft People can transmit the virus without showing symptoms but it is unclear how often this happens A June review found the likelihood of those infected that are asymptomatic to be People are most infectious when they show symptoms even mild or non specific symptoms but may be infectious for up to two days before symptoms appear pre symptomatic transmission They remain infectious an estimated seven to twelve days in moderate cases and an average of two weeks in severe cases When the contaminated droplets fall to floors or surfaces they can though less commonly remain infectious if people touch contaminated surfaces and then their eyes nose or mouth with unwashed hands On surfaces the amount of active virus decreases over time until it can no longer cause infection and surfaces are thought not to be the main way the virus spreads It is unknown what amount of virus on surfaces is required to cause infection via this method but it can be detected for up to four hours on copper up to one day on cardboard and up to three days on plastic polypropylene and stainless steel AISI Surfaces are easily decontaminated with household disinfectants which kill the virus outside the human body or on the hands Disinfectants or bleach are not a treatment for COVID and cause health problems when not used properly such as when used inside the human body Sputum and saliva carry large amounts of virus Although COVID is not a sexually transmitted infection kissing intimate contact and faecal oral routes are suspected to transmit the virus Some medical procedures are aerosol generating and result in the virus being transmitted more easily than normal COVID is a new disease and many of the details of its spread are still under investigation It spreads easily between people easier than influenza but not as easily as measles Estimates of the number of people infected by one person with COVID the R have varied widely The WHO's initial estimates of the R were average however a more recent when review found the basic R without control measures to be higher at and the median R to be The virus may occur in breast milk but it's unknown whether it's infectious and transmittable to the baby Virology Main article Severe acute respiratory syndrome coronavirus Illustration of SARSr CoV virion Severe acute respiratory syndrome coronavirus SARS CoV 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 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 is closely related to the original SARS CoV It is thought to have an animal 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 identical at the whole genome level to other bat coronavirus samples BatCov RaTG In February 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 when found that at most of genetic material was shared between pangolin coronavirus and SARS CoV which is insufficient to prove pangolins to be the intermediate host Pathophysiology The lungs are the organs most affected by COVID because the virus accesses host cells via the enzyme angiotensin converting enzyme ACE 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 ACE and enter the host cell The density of ACE in each tissue correlates with the severity of the disease in that tissue and some have suggested decreasing ACE activity might be protective unreliable medical source though another view is that increasing ACE using angiotensin II receptor blocker medications could be protective As the alveolar disease progresses respiratory failure might develop and death may follow unreliable medical source SARS CoV may also cause respiratory failure through affecting the brainstem as other coronaviruses have been found to invade the central nervous system CNS While virus has been detected in cerebrospinal fluid of autopsies the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE in the brain unreliable medical source The virus also affects gastrointestinal organs as ACE is abundantly expressed in the glandular cells of gastric duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine unreliable medical source The virus can cause acute myocardial injury and chronic damage to the cardiovascular system An acute cardiac injury was found in of infected people admitted to the hospital in Wuhan China and is more frequent in severe disease unreliable medical source 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 ACE receptors in the heart ACE receptors are highly expressed in the heart and are involved in heart function A high incidence of thrombosis and venous thromboembolism have been found in ICU patients with COVID infections and may be related to poor prognosis unreliable medical source unreliable medical source 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 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 the presentation of viral pneumonia better source needed Another common cause of death is complications related to the kidneys better source needed Early reports show that up to of hospitalized patients in both China and New York have experienced some injury to their kidneys including some persons with no previous kidney problems Autopsies of people who died of COVID have found diffuse alveolar damage DAD and lymphocyte containing inflammatory infiltrates within the lung unreliable medical source Immunopathology Although SARS CoV has a tropism for ACE expressing epithelial cells of the respiratory tract patients with severe COVID have symptoms of systemic hyperinflammation Clinical laboratory findings of elevated IL IL IL granulocyte macrophage colony stimulating factor GM CSF interferon ? inducible protein IP monocyte chemoattractant protein MCP macrophage inflammatory protein a MIP a and tumour necrosis factor a TNF a indicative of cytokine release syndrome CRS suggest an underlying immunopathology Additionally people with COVID 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 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 secreting monocytes and severe lung pathology in COVID patients citation needed Lymphocytic infiltrates have also been reported at autopsy unreliable medical source Diagnosis Main article COVID testing Demonstration of a nasopharyngeal swab for COVID testing CDC rRT PCR test kit for COVID The WHO has published several testing protocols for the disease The standard method of testing is real time reverse transcription polymerase chain reaction rRT PCR The test is typically done on respiratory samples obtained by a nasopharyngeal swab however a nasal swab or sputum sample may also be used Results are generally available within a few hours to two days Blood tests can be used but these require two blood samples taken two weeks apart and the results have little immediate value 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 As of April 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 The Chinese experience with testing has shown the accuracy is only to The US Food and Drug Administration FDA approved the first point of care test on March for use at the end of that month 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 A study asked hospitalised COVID 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 Along with laboratory testing chest CT scans may be helpful to diagnose COVID in individuals with a high clinical suspicion of infection but are not recommended for routine screening Bilateral multilobar ground glass opacities with a peripheral asymmetric and posterior distribution are common in early infection Subpleural dominance crazy paving lobular septal thickening with variable alveolar filling and consolidation may appear as the disease progresses In late the WHO assigned emergency ICD disease codes U for deaths from lab confirmed SARS CoV infection and U for deaths from clinically or epidemiologically diagnosed COVID without lab confirmed SARS CoV infection Typical CT imaging findings CT imaging of rapid progression stage Pathology Few data are available about microscopic lesions and the pathophysiology of COVID The main pathological findings at autopsy are citation needed 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 Blood disseminated intravascular coagulation DIC leukoerythroblastic reaction Liver microvesicular steatosis citation needed Prevention See also COVID pandemic Prevention flatten the curve workplace hazard controls for COVID and cloth face mask Without pandemic containment measures such as social distancing vaccination and use of face masks pathogens can spread exponentially This graphic shows how early adoption of containment measures tends to protect wider swaths of the population Progressively stronger mitigation efforts to reduce the number of active cases at any given time flattening the curve allows healthcare services to better manage the same volume of patients 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 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 A COVID vaccine is not expected until at the earliest The U S National Institutes of Health guidelines do not recommend any medication for prevention of COVID before or after exposure to the SARS CoV virus outside the setting of a clinical trial Without a vaccine other prophylactic measures or effective treatments a key part of managing COVID is trying to decrease and delay the epidemic peak known as flattening the curve 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 Preventive measures to reduce the chances of infection include staying at home wearing a mask in public avoiding crowded places keeping distance from others washing hands with soap and water often and for at least seconds practising good respiratory hygiene and avoiding touching the eyes nose or mouth with unwashed hands The CDC and WHO recommend individuals wear non medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain This recommendation is meant to reduce the spread of the disease by asymptomatic and pre symtomatic individuals and is complementary to established preventive measures such as social distancing Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking breathing and coughing Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease Medical grade facemasks such as N masks should be reserved and prioritised for healthcare workers and first responders When not wearing a mask 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 Proper hand hygiene after any cough or sneeze is encouraged 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 Distancing guidelines also include that people stay at least feet m apart 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 The CDC also recommends that individuals wash hands often with soap and water for at least seconds especially after going to the toilet or when hands are visibly dirty before eating and after blowing one's nose coughing or sneezing The CDC further recommends using an alcohol based hand sanitiser with at least alcohol but only when soap and water are not readily available 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 Those diagnosed with COVID 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 Management Main article Management of COVID People are managed with supportive care which may include fluid therapy oxygen support and supporting other affected vital organs The CDC recommends those who suspect they carry the virus wear a simple face mask Extracorporeal membrane oxygenation ECMO has been used to address the issue of respiratory failure but its benefits are still under consideration citation needed Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity Supportive treatments may be useful in those with mild symptoms at the early stage of infection 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 Intensivists and pulmonologists in the U S have compiled treatment recommendations from various agencies into a free resource the IBCC Prognosis Question book new svg This article relies too much on references to primary sources Please improve this by adding secondary or tertiary sources March Learn how and when to remove this template message Main article Prognosis of COVID See also Mortality due to COVID The severity of diagnosed cases in China The severity of diagnosed COVID cases in China Case fatality rates for COVID by age by country Case fatality rates by age group China as of February South Korea as of June Spain as of May Italy as of June Case fatality rate depending on other health problems Case fatality rate in China depending on other health problems Data through February Case fatality rate by country and number of cases The number of deaths vs total cases by country and approximate case fatality rate The severity of COVID 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 Children make up a small proportion of reported cases with about of cases being under years and aged years They are likely to have milder symptoms and a lower chance of severe disease than adults In those younger than years the risk of death is less than while in those older than it is more than Pregnant women may be at higher risk of severe COVID infection based on data from other similar viruses like severe acute respiratory syndrome SARS and Middle East respiratory syndrome MERS but data for COVID is lacking According to scientific reviews smokers are more likely to require intensive care or die compared to non smokers air pollution is similarly associated with risk factors and obesity contributes to an increased health risk of COVID Case fatality rates by age and country Age Country Argentina as of May Australia as of June Canada as of June Alberta as of June Br Columbia as of June Ontario as of June Quebec as of June Chile as of May China as of February Colombia as of June Denmark as of June Finland as of June Germany as of June Bavaria as of June Israel as of May Italy as of June Japan as of May Mexico as of June Netherlands as of June Norway as of June Philippines as of June Portugal as of June South Africa as of May South Korea as of June Spain as of May Sweden as of June Switzerland as of June United States Colorado as of June Connecticut as of June Georgia as of June Idaho as of June Indiana as of June Kentucky as of May Maryland as of May Massachusetts as of May Minnesota as of May Mississippi as of May Missouri as of May Nevada as of May N Hampshire as of May Oregon as of May Texas as of May Virginia as of May Washington as of May Wisconsin as of May Some studies have found that the neutrophil to lymphocyte ratio NLR may be helpful in early screening for severe illness Most of those who die of COVID have pre existing underlying conditions including hypertension diabetes mellitus and cardiovascular disease The Istituto Superiore di Sanità reported that out of of deaths where medical charts were available of people had at least one comorbidity with the average person having diseases According to the same report the median time between the onset of symptoms and death was ten days with five being spent hospitalised However people transferred to an ICU had a median time of seven days between hospitalisation and death In a study of early cases the median time from exhibiting initial symptoms to death was days with a full range of six to days In a study by the National Health Commission NHC of China men had a death rate of while women had a death rate of In of the deaths reported by the National Health Commission of China heart damage was noted by elevated levels of troponin or cardiac arrest According to March data from the United States of those hospitalised had preexisting conditions The availability of medical resources and the socioeconomics of a region may also affect mortality Concerns have been raised about long term sequelae of the disease The Hong Kong Hospital Authority found a drop of to in lung capacity in some people who recovered from the disease and lung scans suggested organ damage This may also lead to post intensive care syndrome following recovery History Main article Timeline of the COVID pandemic The virus is thought to be natural and has an animal origin through spillover infection The first known human infections were in China A study of the first cases of confirmed COVID published in January in The Lancet reported the earliest date of onset of symptoms as December Official publications from the WHO reported the earliest onset of symptoms as December Human to human transmission was confirmed by the WHO and Chinese authorities by January According to official Chinese sources these were mostly linked to the Huanan Seafood Wholesale Market which also sold live animals In May George Gao the director of the Chinese Center for Disease Control and Prevention said animal samples collected from the seafood market had tested negative for the virus indicating that the market was the site of an early superspreading event but it was not the site of the initial outbreak Traces of the virus have been found in wastewater that was collected from Milan and Turin Italy on December There are several theories about where the very first case the so called patient zero originated According to an unpublicised report from the Chinese government the first case can be traced back to November the person was a year old citizen in the Hubei province There were four men and five women reported to be infected in November but none of them were patient zero By December the spread of infection was almost entirely driven by human to human transmission The number of coronavirus cases in Hubei gradually increased reaching by December and at least by December On December Wuhan Central Hospital sent a bronchoalveolar lavage fluid BAL sample from an unresolved clinical case to sequencing company Vision Medicals On and December Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test showing a new coronavirus A pneumonia cluster of unknown cause was observed on December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital who informed the Wuhan Jianghan CDC on December On December a test report addressed to Wuhan Central Hospital from company CapitalBio Medlab stated an erroneous positive result for SARS causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result That evening the Wuhan Municipal Health Commission issued a notice to various medical institutions on the treatment of pneumonia of unknown cause Eight of these doctors including Li Wenliang punished on January were later admonished by the police for spreading false rumours and another Ai Fen was reprimanded by her superiors for raising the alarm The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on December confirming cases enough to trigger an investigation During the early stages of the outbreak the number of cases doubled approximately every seven and a half days In early and mid January the virus spread to other Chinese provinces helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange On January China reported nearly new cases in one day including two people in Beijing and one in Shenzhen Later official data shows people had already developed symptoms by then and more may have been infected A report in The Lancet on January indicated human transmission strongly recommended personal protective equipment for health workers and said testing for the virus was essential due to its pandemic potential On January the WHO declared the coronavirus a public health emergency of international concern By this time the outbreak spread by a factor of to times On January Italy had its first confirmed cases two tourists from China As of March the WHO considered Europe the active centre of the pandemic On March Italy overtook China as the country with the most deaths By March the United States had overtaken China and Italy with the highest number of confirmed cases in the world Research on coronavirus genomes indicates the majority of COVID cases in New York came from European travellers rather than directly from China or any other Asian country Retesting of prior samples found a person in France who had the virus on December and a person in the United States who died from the disease on February On June after days without a locally transmitted case Beijing reported the first COVID case followed by two more cases on June By June cases were officially confirmed Most of these patients went to Xinfadi Wholesale Market Epidemiology Main article COVID pandemic 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 the 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 as of July 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 Many academics have attempted to calculate these numbers for specific populations Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing In the United States the prisoner population is aging and many of them are at high risk for poor outcomes from COVID due to high rates of coexisting heart and lung disease and poor access to high quality healthcare Total confirmed cases over time Total deaths over time Total confirmed cases of COVID per million people Total confirmed deaths due to COVID per million people Infection fatality rate Infection fatality rate or infection fatality ratio is distinguished from case fatality rate The case fatality rate CFR for a disease is the proportion of deaths from the disease compared to the total number of people diagnosed with the disease within a certain period of time The infection fatality ratio IFR in contrast is the proportion of deaths among all the infected individuals IFR unlike CFR attempts to account for all asymptomatic and undiagnosed infections Our World in Data states that as of March the infection fatality rate IFR for coronavirus cannot be accurately calculated In February the World Health Organization reported estimates of IFR between and The University of Oxford Centre for Evidence Based Medicine CEBM estimated a global CFR of to percent last revised April and IFR of to percent last revised May According to CEBM random antibody testing in Germany suggested an IFR of to there Firm lower limits of infection fatality rates have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate As of June in New York City with a population of million individuals confirmed and probable have died with COVID of the population In Bergamo province of the population has died The CDC estimates for planning purposes that the fatality rate among those who are symptomatic is to and that of infected individuals are asymptomatic for an overall infection fatality rate of as of May To get a better view on the number of people infected as of April initial antibody testing had been carried out but peer reviewed scientific analyses had not yet been published On May antibody testing in New York suggested an IFR of Sex differences Main article Gendered impact of the COVID pandemic Early reviews of epidemiologic data showed greater impact of the pandemic and a higher mortality rate in men in China and Italy The Chinese Center for Disease Control and Prevention reported the death rate was percent for men and percent for women Later reviews in June indicated that there is no significant difference in susceptibility or in CFR between genders One review acknowledges the different mortality rates in Chinese men suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors Ethnic differences In the U S a greater proportion of deaths due to COVID have occurred among African Americans Structural factors that prevent African Americans from practicing social distancing include their concentration in crowded substandard housing and in essential occupations such as public transit and health care Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes hypertension and heart disease also increase their risk of death Similar issues affect Native American and Latino communities According to a U S health policy non profit of American Indian and Alaska Native People AIAN non elderly adults are at risk of serious illness compared to of white non elderly adults The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water Leaders have called for efforts to research and address the disparities In the U K a greater proportion of deaths due to COVID have occurred in those of a Black Asian and other ethnic minority background Several factors such as poverty poor nutrition and living in overcrowded properties may have caused this citation needed Society and culture Name During the initial outbreak in Wuhan China the virus and disease were commonly referred to as coronavirus and Wuhan coronavirus with the disease sometimes called Wuhan pneumonia In the past many diseases have been named after geographical locations such as the Spanish flu Middle East Respiratory Syndrome and Zika virus In January the World Health Organisation recommended nCov and nCoV acute respiratory disease as interim names for the virus and disease per 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 The official names COVID and SARS CoV were issued by the WHO on February WHO chief Tedros Adhanom Ghebreyesus explained CO for corona VI for virus D for disease and for when the outbreak was first identified December The WHO additionally uses the COVID virus and the virus responsible for COVID in public communications Misinformation Main article Misinformation related to the COVID pandemic After the initial outbreak of COVID conspiracy theorists spread misinformation and disinformation regarding the origin scale prevention treatment and other aspects of the disease which rapidly spread online Decreased emergency room use In Austria fewer persons sought help for cardiac symptoms in the month of March A study estimated that there were incidents of preventable cardiac death as compared to confirmed deaths from Coronavirus as of March A preliminary study in the U S found under utilization of cardiac care units as compared to normal The head of cardiology at the University of Arizona has stated My worry is some of these people are dying at home because they're too scared to go to the hospital There is also concern that persons with symptoms of stroke and appendicitis are delaying seeking help 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 Tigers and lions at the Bronx Zoo in New York United States tested positive for the virus and showed symptoms of COVID including a dry cough and loss of appetite Minks at two farms in the Netherlands also tested positive for COVID 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 In March researchers from the University of Hong Kong have shown that Syrian hamsters could be a model organism for COVID research Research Main article COVID drug development No medication or vaccine is approved with the specific indication to treat the disease International research on vaccines and medicines in COVID is underway by government organisations academic groups and industry researchers 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 The World Health Organization suspended hydroxychloroquine from its global drug trials for COVID treatments on May due to safety concerns It had previously enrolled patients from countries in the Solidarity Trial France Italy and Belgium also banned the use of hydroxychloroquine as a COVID treatment There has been a great deal of COVID research involving accelerated research processes and publishing shortcuts to meet the global demand To minimise the harm from misinformation medical professionals and the public are advised to expect rapid changes to available information and to be attentive to retractions and other updates Vaccine Main article COVID 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 use the ACE receptor to enter human cells Six vaccination strategies are being investigated Four of these as of early July are being tested in clinical trials First researchers aim to build a whole virus vaccine The use of such inactive virus aims to elicit a prompt immune response of the human body to a new infection with COVID 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 such research focuses on the S spike protein that helps the virus intrude the ACE enzyme receptor A third strategy is that of the nucleic acid vaccines DNA or RNA vaccines a novel technique for creating a vaccination Fourthly scientists are attempting to use viral vectors to deliver the SARS CoV antigen gene into the cell These can be replicating or non replicating As of early July only non replicating viral vectors are in clinical trials Viral vectors in clinical trials include Chimpanzee Adenovirus Adenovirus type and Adenovirus type Scientists are also working to develop an attenuated COVID vaccine and a COVID vaccine using virus like particles but these are still in preclinical research Experimental vaccines from any of these strategies would have to be tested for safety and efficacy On March the first clinical trial of a vaccine started with four volunteers in Seattle Washington United States The vaccine contains a harmless genetic code copied from the virus that causes the disease Antibody dependent enhancement has been suggested as a potential challenge for vaccine development for SARS COV but this is controversial Medications Main article COVID drug repurposing research At least phase II IV efficacy trials in COVID were concluded in March or scheduled to provide results in April from hospitals in China There are more than active clinical trials underway as of April Seven trials were evaluating already approved treatments including four studies on hydroxychloroquine or chloroquine Repurposed antiviral drugs make up most of the research with nine phase III trials on remdesivir across several countries due to report by the end of April Other candidates in trials include vasodilators corticosteroids immune therapies lipoic acid bevacizumab and recombinant angiotensin converting enzyme The COVID Clinical Research Coalition has goals to facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies fast track approvals for the candidate therapeutic compounds ensure standardised and rapid analysis of emerging efficacy and safety data and facilitate sharing of clinical trial outcomes before publication Several existing medications are being evaluated for the treatment of COVID including remdesivir chloroquine hydroxychloroquine lopinavir ritonavir and lopinavir ritonavir combined with interferon beta There is tentative evidence for efficacy by remdesivir and on May the United States Food and Drug Administration FDA gave the drug an emergency use authorization for people hospitalized with severe COVID Phase III clinical trials for several drugs are underway in several countries including the U S China and Italy There are mixed results as of April as to the effectiveness of hydroxychloroquine as a treatment for COVID with some studies showing little or no improvement One study has shown an association between hydroxychloroquine or chloroquine use with higher death rates along with other side effects A retraction of this study by its authors was published by The Lancet on June 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 On June the FDA updated the fact sheets for the emergency use authorization of remdesivir to warn that using chloroquine or hydroxychloroquine with remdesivir may reduce the antiviral activity of remdesivir Initial clinical trial results of dexamethasone in the United Kingdom released in June showed a reduction of mortality of one third for patients who are critically ill on ventilators and one fifth for those on oxygen in a randomised trial involving patients and six treatments Because this is a well tested and widely available treatment this was welcomed by the WHO Cytokine storm A cytokine storm can be a complication in the later stages of severe COVID There is preliminary evidence that hydroxychloroquine may be useful in controlling cytokine storms in late phase severe forms of the disease Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed It is undergoing a phase non randomised trial at the national level in Italy after showing positive results in people with severe disease Combined with a serum ferritin blood test to identify a cytokine storm also called cytokine storm syndrome not to be confused with cytokine release syndrome it is meant to counter such developments which are thought to be the cause of death in some affected people The interleukin receptor antagonist was approved by the Food and Drug Administration FDA to undergo a phase III clinical trial assessing its effectiveness on COVID based on retrospective case studies for the treatment of steroid refractory cytokine release syndrome induced by a different cause CAR T cell therapy in To date when there is no randomised controlled evidence that tocilizumab is an efficacious treatment for CRS Prophylactic tocilizumab has been shown to increase serum IL levels by saturating the IL R driving IL across the blood brain barrier and exacerbating neurotoxicity while having no effect on the incidence of CRS 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 The Feinstein Institute of Northwell Health announced in March a study on a human antibody that may prevent the activity of IL Passive antibodies A coronavirus disease COVID 'ko?v?d 'k?v?d coronavirus respiratory syndrome coronavirus pneumonia coronavirus flu or any other variant is a disease caused by members of the coronavirus CoV family Coronaviruses cause different coronavirus diseases including severe acute respiratory syndrome SARS Middle East respiratory syndrome MERS and coronavirus disease COVID Some strains of coronaviruses can also cause the common cold The coronavirus outbreak caused by COVID was declared a pandemic by the World Health Organization WHO on March Local transmission of the disease has been recorded in many countries across all six WHO regions COVID is caused by the SARS CoV coronavirus SARS CoV is the third zoonotic coronavirus after SARS CoV and MERS CoV Contents Etymology Human coronavirus diseases Zoonotic coronavirus diseases SARS MERS COVID Diseases in other animals Gallery See also References External links Etymology Corona is derived from Latin corona meaning crown garland Virus also comes from Latin where it means slimy liquid or poison Human coronavirus diseases Coronavirus disease was first discovered in humans in the s The virus Human coronavirus E HCoV E was first isolated in A further three coronaviridae were identified in humans these being human coronavirus NL HCoV NL Human coronavirus OC HCoV OC and Human coronavirus HKU HCoV HKU HCoV E and HCoV NL are Alphacoronavirus a CoV or Alpha CoV while HCoV OC HCoV HKU MERS CoV SARS CoV are Betacoronavirus ß CoV or Beta CoV In November an outbreak of Severe Acute Respiratory Syndrome SARS was discovered This disease originated in China and subsequently spread to Vietnam Hong Kong Taiwan Singapore and Canada A new coronavirus was identified in with a SARS like illness called the Middle East Respiratory Syndrome MERS CoV resulted in a limited number of outbreaks mostly in Saudi Arabia and other middle eastern countries In December a novel coronavirus nCoV was identified in Wuhan China which was isolated on January The World Health Organisation recommended the interim name of the disease as nCoV acute respiratory disease nCoV ARD and novel coronavirus nCov as the virus However the disease has subsequently been reclassified as coronavirus disease COVID and the virus as severe acute respiratory syndrome coronavirus SARS CoV which is closely related to the earlier SARS CoV and genetically clusters within Betacoronavirus with subgenus Sarbecovirus Zoonotic coronavirus diseases Characteristics of zoonotic coronavirus strains MERS CoV SARS CoV SARS CoV and related diseases MERS CoV SARS CoV SARS CoV Disease MERS SARS COVID Outbreaks pandemic Epidemiology Date of first identified case June November December Location of first identified case Jeddah Saudi Arabia Shunde China Wuhan China Age average a Sex ratio M F Confirmed cases b Deaths b Case fatality rate Symptoms Fever Dry cough Dyspnea Diarrhea Sore throat Ventilatory use Notes Based on data from Hong Kong Data as of July vte A zoonotic disease is an infectious disease caused by a pathogen an infectious agent such as a bacterium virus parasite or prion that has jumped from an animal usually a vertebrate to a human SARS CoV is the third zoonotic coronavirus after SARS CoV and MERS CoV although there is evidence that may support a zoonotic origin of HCoV NL too SARS Main article Severe acute respiratory syndrome In severe acute respiratory syndrome coronavirus SARS CoV causing severe acute respiratory syndrome SARS led to the SARS outbreak More than people from different countries and territories were infected and at least died MERS Main article Middle East respiratory syndrome In Middle East respiratory syndrome related coronavirus MERS CoV causing Middle East respiratory syndrome MERS was identified MERS CoV is responsible for the MERS outbreak primarily in the Middle East the MERS outbreak in South Korea and the MERS outbreak primarily in Saudi Arabia COVID Main article Coronavirus disease The severe acute respiratory syndrome coronavirus SARS CoV causes coronavirus disease COVID which in December led to a pneumonia outbreak in Wuhan China which developed into the COVID pandemic Diseases in other animals Coronaviruses have been recognized as causing pathological conditions in veterinary medicine since the s They infect a range of animals such as swine cattle horses camels cats dogs rodents birds bats and other wildlife The majority of animal related coronaviruses infect the intestinal tract and are transmitted by a fecal oral route Gallery Illustration of a SARS CoV virus which causes coronavirus disease The coronavirus recession also known as the COVID recession the Great Shutdown or the Great Lockdown is a major global recession which arose as an economic consequence of the ongoing COVID pandemic The first major sign of the coronavirus recession was the stock market crash on February and the International Monetary Fund IMF reported on April that all of the G nations had already entered or were entering into a deep recession and that there had already been a significant slowdown of growth in emerging economies IMF projections suggest that the coronavirus recession will be the most severe global economic downturn since the Great Depression and that it will be far worse than the Great Recession of The pandemic has led to more than a third of the world's population being placed on lockdown to stop the spread of COVID It has caused severe repercussions for economies across the world following soon after a global economic slowdown during that saw stagnation of stock markets and consumer activity worldwide This recession has seen unusually high and rapid increases in unemployment in many countries and the inability in the United States for state funded unemployment insurance computer systems and processes to keep up with applications The United Nations UN predicted in April that global unemployment will wipe out per cent of working hours globally in the second quarter of equivalent to million full time workers In western nations unemployment is expected to be at around with more severely affected nations from the COVID pandemic having higher unemployment rates The developing world is also being affected by a drop in remittances The recession saw a drop in the price of oil triggered by the Russia Saudi Arabia oil price war the collapse of tourism the hospitality industry the energy industry and a significant downturn in consumer activity in comparison to the previous decade Global stock markets crashed around to during late February and March respectively During the crash global stock markets made unprecedented and volatile swings mainly due to extreme uncertainty in the markets Contents Background Corporate debt bubble global economic slowdown China United States trade war Brexit Causes COVID pandemic Lockdowns Russia Saudi Arabia oil price war Financial crisis Black Monday I March Crash Black Thursday March Crash Black Monday II March Impact by country Africa Botswana Egypt Ethiopia Namibia Zambia Americas Argentina Belize Brazil Canada Mexico United States Asia Pacific Australia Bangladesh China Fiji India Iraq Japan Lebanon Nepal New Zealand Philippines Singapore Europe Belarus France Germany Italy United Kingdom Summary of national impacts Impact by sector Automotive industry Energy Tourism Restaurants Retail Transportation Impact by occupation and demographic Impact of U S protests Food insecurity National fiscal responses See also References Background Corporate debt bubble Main article Corporate debt bubble Since the Financial crisis of there has been a large increase in corporate debt rising from of gross world product in to in or about trillion In the world's eight largest economies China the United States Japan the United Kingdom France Spain Italy and Germany total corporate debt was about trillion in compared to trillion in If the economic climate worsens companies with high levels of debt run the risk of being unable to make their interest payments to lenders or refinance their debt forcing them into restructuring The Institute of International Finance forecast in that in an economic downturn half as severe as the crisis trillion in debt would be owed by non financial firms without the earnings to cover the interest payments on the debt they issued The McKinsey Global Institute warned in that the greatest risks would be to emerging markets such as China India and Brazil where of bonds had been issued by high risk companies global economic slowdown During the IMF reported that the world economy was going through a synchronized slowdown which entered into its slowest pace since the Great Financial Crisis 'Cracks' were showing in the consumer market as global markets began to suffer through a 'sharp deterioration' of manufacturing activity Global growth was believed to have peaked in when the world's total industrial output began to start a sustained decline in early The IMF blamed 'heightened trade and geopolitical tensions' as the main reason for the slowdown citing Brexit and the China United States trade war as primary reasons for slowdown in while other economists blamed liquidity issues In April the U S yield curve inverted which sparked fears of a recession across the world The inverted yield curve and trade war fears prompted a sell off in global stock markets during March which prompted more fears that a recession was imminent Rising debt levels in the European Union and the United States had always been a concern for economists However in that concern was heightened during the economic slowdown and economists began warning of a 'debt bomb' occurring during the next economic crisis Debt in was higher than that during the height of the Great Financial Crisis Economists who have argued that this increased debt is what led to debt defaults in economies and businesses across the world during the recession The first signs of trouble leading up to the collapse occurred in September when the US Federal Reserve began intervening in the role of investor to provide funds in the repo markets the overnight repo rate spiked above during that time which would play a crucial factor in triggering the events that led up to the crash China United States trade war Main article China United States trade war The China United States trade war occurred during to early and caused significant damage across global economies President Donald Trump in began setting tariffs and other trade barriers on China with the goal of forcing it to make changes to what the U S says are unfair trade practices Among those trade practices and their effects are the growing trade deficit the alleged theft of intellectual property and the alleged forced transfer of American technology to China In the United States the trade war brought struggles for farmers and manufacturers and higher prices for consumers which resulted in the U S manufacturing industry entering into a 'mild recession' during In other countries it has also caused economic damage including violent protests in Chile and Ecuador due to transport and energy price surges though some countries have benefited from increased manufacturing to fill the gaps It has also led to stock market instability The governments of several countries including China and the United States have taken steps to address some of the damage caused by a deterioration in China United States relations and tit for tat tariffs During the recession the downturn of consumerism and manufacturing from the trade war is believed to have inflated the economic crisis Brexit Main article Economic effects of Brexit In Europe economies were hampered by the economic effects of the United Kingdom's withdrawal from the European Union better known as Brexit British and EU growth stagnated during leading up to Brexit mainly due to uncertainty around the crisis The United Kingdom experienced a 'near recession' in which weakened the British economy when entering into Many businesses left the United Kingdom to move into the EU which resulted in trade loss and economic downturn for both EU members and the UK Causes Further information Social distancing measures related to the COVID pandemic The COVID pandemic is the most impactful pandemic since the Spanish flu in When the pandemic first arose in late and more consequently in the world was going through economic stagnation and significant consumer downturn Most economists believed a recession though one which wouldn't be too severe was coming As a result of the fast spread of the pandemic economies across the world have had to initiate 'lockdowns' to curb the spread of the pandemic This resulted in the collapse of various industries and consumerism all at once which put major pressure on banks and employment This caused a stock market crash and thereafter the recession With new social distancing measures taken in response to the pandemic a Great Lockdown occurred of the world economy COVID pandemic See also Economic impact of the COVID pandemic and COVID pandemic The COVID pandemic is an ongoing pandemic of coronavirus disease COVID caused by severe acute respiratory syndrome coronavirus SARS CoV the outbreak was identified in Wuhan China in December declared to be a Public Health Emergency of International Concern on January and recognized as a pandemic by the World Health Organization on March The pandemic has led to severe global economic disruption the postponement or cancellation of sporting religious political and cultural events and widespread shortages of supplies exacerbated by panic buying Schools universities and colleges have closed either on a nationwide or local basis in countries affecting approximately percent of the world's student population Many governments have restricted or advised against all non essential travel to and from countries and areas affected by the outbreak However the virus is already spreading within communities in large parts of the world with many not knowing where or how they were infected Scanning electron microscope image of SARS CoV centre yellow The COVID pandemic has had far reaching consequences beyond the spread of the disease and efforts to quarantine it As the pandemic has spread around the globe concerns have shifted from supply side manufacturing issues to decreased business in the services sector The pandemic is considered unanimously as a major factor in causing the recession The pandemic has affected nearly every major industry negatively was one of the main causes of the stock market crash and has resulted in major curbings of social liberties and movement Lockdowns Main article COVID pandemic lockdowns While stay at home orders clearly affect many types of business especially those that provide in person services including retail stores restaurants and hotels entertainment venues and museums medical offices and beauty salons and spas government orders are not the sole pressure on those businesses In the United States people began to change their economic behavior days before their local governments declared stay at home orders and by May changes in individuals' rates of movement according to smartphone data did not always correlate with local laws Russia Saudi Arabia oil price war Main article Russia Saudi Arabia oil price war The reduction in the demand for travel and the lack of factory activity due to the COVID pandemic significantly impacted demand for oil causing its price to fall The Russian Saudi Arabia oil price war became a cause in worsening the recession due to it crashing the price of oil In mid February the International Energy Agency forecasted that oil demand growth in would be the smallest since Chinese demand slump resulted in a meeting of the Organization of the Petroleum Exporting Countries OPEC to discuss a potential cut in production to balance the loss in demand The cartel initially made a tentative agreement to cut oil production by million barrels per day following a meeting in Vienna on March which would bring the production levels to the lowest it has been since the Iraq War After OPEC and Russia failed to agree on oil production cuts on March and Saudi Arabia and Russia both announced increases in oil production on March oil prices fell by percent On March Saudi Arabia unexpectedly announced that it would increase production of crude oil and sell it at a discount of a barrel to customers in Asia the US and Europe following the breakdown of negotiations as Russia resisted calls to cut production The biggest discounts targeted Russian oil customers in northwestern Europe Prior to the announcement the price of oil had gone down by more than since the start of the year and upon Saudi Arabia's announcement it dropped a further percent though later recovered somewhat Brent Crude used to price two thirds of the world's crude oil supplies experienced the largest drop since the Gulf War on the night of March Also the price of West Texas Intermediate fell to its lowest level since February Energy expert Bob McNally noted This is the first time since and ' that a massive negative demand shock has coincided with a supply shock in that case it was the Smoot Hawley Tariff Act precipitating a collapse in international trade during the Great Depression coinciding with discovery of the East Texas Oil Field during the Texas oil boom Fears of the Russian Saudi Arabian oil price war caused a plunge in U S stocks and have had a particular impact on American producers of shale oil Financial crisis Main article stock market crash See also Financial market impact of the COVID pandemic Movement of the DJIA between January and March The global stock market crash began on February Due to the COVID pandemic global markets banks and businesses were all facing crises not seen since the Great Depression in citation needed From to February stock markets worldwide reported their largest one week declines since the financial crisis thus entering a correction Global markets into early March became extremely volatile with large swings occurring in global markets On March most global markets reported severe contractions mainly in response to the COVID pandemic and an oil price war between Russia and the OPEC countries led by Saudi Arabia This became colloquially known as Black Monday I and at the time was the worst drop since the Great Recession in Three days after Black Monday I there was another drop Black Thursday where stocks across Europe and North America fell more than Wall Street experienced its largest single day percentage drop since Black Monday in and the FTSE MIB of the Borsa Italiana fell nearly becoming the worst hit market during Black Thursday Despite a temporary rally on March with markets posting their best day since all three Wall Street indexes fell more than when markets re opened on March During this time one benchmark stock market index in all G countries and of the G countries had been declared to be in Bear markets citation needed Black Monday I March Crash Prior to opening the Dow Jones Industrial Average futures market experienced a point drop based on the pandemic and fall in the oil price described above triggering a trading curb or circuit breaker that caused the futures market to suspend trading for minutes This predicted point drop would establish March as being among the most points the Dow Jones Industrial Average has dropped in a single day When the market opened on March the Dow Jones Industrial Average plummeted points on opening points lower than the prediction The United States' Dow Jones Industrial Average lost more than points described by The News International as the biggest ever fall in intraday trading The Dow Jones Industrial Average hit a number of trading circuit breakers to curb panicked selling Oil firms Chevron and ExxonMobil fell about The NASDAQ Composite also in the United States lost over points clarification needed The S P fell by Oil prices fell and the yields on year and year U S Treasury securities fell below and respectively Canada's S P TSX Composite Index finished the day off by more than Brazil's IBOVESPA gave up erasing over months of gains for the index Australia's ASX lost its biggest daily drop since though it rebounded later in the day London's FTSE lost suffering its worst drop since the financial crisis BP and Shell Oil experienced intraday price drops of nearly The FTSE MIB CAC and DAX tanked as well with Italy affected the most as the COVID pandemic in the country continues They fell and respectively The STOXX Europe fell to more than below its peak earlier in the year In a number of Asian markets Japan Singapore the Philippines and Indonesia shares declined over from their most recent peaks entering bear market territory In Japan the Nikkei plummeted In Singapore the Straits Times Index fell In China the CSI Index lost In Hong Kong the Hang Seng index sank In Pakistan the PSX saw the largest ever intra day plunge in the country's history losing points or The market closed with the KSE index down In India the BSE SENSEX closed points lower at while the NSE Nifty was down by points to Former George W Bush administration energy policy advisor Bob McNally noted This is the first time since and ' that a massive negative demand shock has coincided with a supply shock in the previous case it was the Smoot Hawley Tariff Act precipitating a collapse in international trade during the Great Depression coinciding with discovery of the East Texas Oil Field during the Texas oil boom The Washington Post posited that pandemic related turmoil could spark a collapse of the corporate debt bubble sparking and worsening a recession The Central Bank of Russia announced that it would suspend foreign exchange market purchases in domestic markets for days while the Central Bank of Brazil auctioned an additional billion the foreign exchange market in two separate transactions and the Bank of Mexico increased its foreign exchange auctions program from billion to billion After announcing a billion fiscal stimulus programs on December Japanese Prime Minister Shinzo Abe announced additional government spending while Indonesian Finance Minister Sri Mulyani announced additional stimulus as well Black Thursday March Black Thursday was a global stock market crash on March as part of the greater stock market crash US stock markets suffered from the greatest single day percentage fall since the stock market crash Following Black Monday three days earlier Black Thursday was attributed to the COVID pandemic and a lack of investor confidence in US President Donald Trump after he declared a day travel ban against the Schengen Area Additionally the European Central Bank under the lead of Christine Lagarde decided to not cut interest rates despite market expectations leading to a drop in S P futures of more than points in less than an hour Bank Indonesia announced open market purchases of Rp trillion or million in government bonds while Bank Indonesia Governor Perry Warjiyo stated that Bank Indonesia's open market purchases of government bonds had climbed to Rp trillion on the year and Rp trillion since the end of January Despite declining to cut its deposit rate the European Central Bank increased its asset purchases by € billion or billion while the Federal Reserve announced trillion in open market purchases Australian Prime Minister Scott Morrison announced a A billion fiscal stimulus package The Reserve Bank of India announced that it would conduct a six month billion currency swap for U S dollars while the Reserve Bank of Australia announced A billion in repurchases of government bonds The Central Bank of Brazil auctioned billion Foreign exchange spots Asia Pacific stock markets closed down with the Nikkei of the Tokyo Stock Exchange the Hang Seng Index of the Hong Kong Stock Exchange and the IDX Composite of the Indonesia Stock Exchange falling to more than below their week highs European stock markets closed down with the FTSE Index on the London Stock Exchange the DAX on the Frankfurt Stock Exchange the CAC on the Euronext Paris and the FTSE MIB on the Borsa Italiana all closing more than below their most recent peaks while the Dow Jones Industrial Average closed down an additional eclipsing the one day record set on March the NASDAQ Composite was down and the S P was down with the NASDAQ and S P also falling to more than below their peaks and the declines activated the trading curb at the New York Stock Exchange for the second time that week Oil prices dropped by while the yields on year and year U S Treasury securities increased to and and their yield curve finished normal Crash The US's Dow Jones Industrial Average and S P Index suffered from the greatest single day percentage fall since the stock market crash as did the UK's FTSE which fell The Canadian S P TSX Composite Index dropped its largest one day drop since The FTSE MIB Italian index closed with a loss the worst in its history Germany's DAX fell and France's CAC In Brazil the Ibovespa plummeted after trading in the B was halted twice within the intraday it also moved below the mark before closing above it The NIFTY on the National Stock Exchange of India fell to more than below its most recent peak while the BSE SENSEX on the Bombay Stock Exchange fell or to The benchmark stock market index on the Johannesburg Stock Exchange fell by The MERVAL on the Buenos Aires Stock Exchange fell to on the week March was the second time following March that the drop circuit breaker was triggered since being implemented in In Colombia the peso set an all time low against the U S dollar when it traded above pesos for the first time on record The Mexican peso also set an all time record low against the U S dollar trading at pesos The cryptocurrency Bitcoin dropped its worst day in seven years Other cryptocurrencies fell sharply as well Black Monday II March Over the preceding weekend the Saudi Arabian Monetary Authority announced a billion credit line package to small and medium sized companies while South African President Cyril Ramaphosa announced a fiscal stimulus package The Federal Reserve announced that it would cut the federal funds rate target to lower reserve requirements to zero and begin a billion quantitative easing program Dow futures tumbled more than points and Standard Poor's futures dropped triggering a circuit breaker On Monday March Asia Pacific and European stock markets closed down with the S P ASX setting a one day record fall of collapsing from the peak that was reached on February The Dow Jones Industrial Average the NASDAQ Composite and the S P all fell by with the Dow eclipsing the one day drop record set on March and the trading curb being activated at the beginning of trading for the third time after and March Oil prices fell by while the yields on year and year U S Treasury securities fell to and respectively while their yield curve remained normal for the third straight trading session Map showing real GDP growth rates in as projected by the International Monetary Fund as of June The Cboe Volatility Index closed at on March the highest ever closing for the index though there were higher intraday peaks in Around noon on March the Federal Reserve Bank of New York announced that it would conduct a billion repurchase through the afternoon of that day Indonesian Finance Minister Sri Mulyani announced an additional Rp trillion in tax related fiscal stimulus The Central Bank of the Republic of Turkey lowered its reserve requirement from to The Bank of Japan announced that it would not cut its bank rate lower from minus but that it would conduct more open market purchases of Exchange traded funds After cutting its bank rate by basis points on February the Central Bank of Russia announced that it would keep its bank rate at while the Bank of Korea announced that it would cut its overnight rate by basis points to The Central Bank of Chile cut its benchmark rate while the Reserve Bank of New Zealand cut its official cash rate by basis points to The Czech National Bank announced that it would cut its bank rate by basis points to Impact by country icon This section needs expansion You can help by adding to it May Africa In April Sub Saharan Africa appeared poised to enter its first recession in years but this time for a longer duration The World Bank predicted that overall sub Saharan Africa's economy would shrink by ? during African countries cumulatively owe billion to China from loans taken as of May China was considering granting deadline extensions for repayment and in June Chinese leader Xi Jinping said that some interest free loans to certain countries would be forgiven Botswana Botswana has been affected by sharp falls in the diamond trade tourism and other sectors Egypt The Egyptian economy is taking a heavy toll by the global recession Tourism which employs one in ten Egyptians and contributes about of the GDP has largely stopped while remittances from migrant workers abroad of GDP are also expected to fall The cheap fuel prices and slower demand have also led some shipping companies to avoid the Suez Canal and instead opt for traveling by the Cape of Good Hope leading to reduced transit fees for the government Ethiopia Ethiopia is heavily dependent for export income on its national carrier Ethiopian Airlines which has announced suspensions on flight routes Exports of flowers and other agricultural products have dropped sharply Namibia Namibia's central bank sees the nation's economy shrinking by This will be the biggest shrink of GDP since its independence in The tourism and hospitality industries has accounted for N billion being lost as jobs have been affected The central bank also announced that the diamond mining sector will decline by in while uranium mining may shrink Zambia Zambia is facing a severe debt crisis Almost half the national budget goes towards interest payments with questions about whether the country will be able to make all future payments Americas Argentina Argentina entered its th sovereign default in history due to the recession The government has taken over one of the largest agroexporting companies Vicentín S A I C after it incurred in a debt of more than billion Belize The fall in travel is expected to drive Belize into a deep recession in Brazil The Brazilian government forecast that its economy will experience its biggest crash since with a gross domestic product contraction of At the first trimester of the gross domestic product was smaller than the GDP of the first trimester of and it decreased to the same level of Canada By April the national unemployment rate in Canada was Total employment increased by million and total hours worked fell by between February and April Canadian manufacturing sales in March fell to the lowest level since mid as sales by auto manufacturers and parts suppliers plunged more than In response the Government of Canada introduced several benefits including the Canada Emergency Response Benefit the Canada Emergency Student Benefit and the Canada Emergency Wage Subsidy West Edmonton Mall for the st time in history shut down World Water Park and Galaxyland temporarily Mexico Mexico's outlook was already poor before the crisis with a mild recession in The economic development plans of president Andrés Manuel López Obrador were predicated on revenue from the state oil company Pemex but the oil price collapse has now raised doubts on those plans Beyond oil the country's economy also relies on tourism trade with the United States as well as remittances which all are also being affected All of this leading to what could be Mexico's worst recession in a century and the worst in Latin America after Venezuela United States Before the pandemic there were signs of recession The US yield curve inverted in mid usually indicative of a forthcoming recession Starting in March job loss was rapid About million jobs were lost in the United States in the three weeks ending on April Unemployment claims reached a record high with million claims made in the week ending on March The previous record had been from On May the Bureau of Labor Statistics reported a U unemployment official unemployment figure of the highest level recorded since with U unemployment total unemployed plus marginally attached and part time underemployed workers reaching Restaurant patronage fell sharply across the country and major airlines reduced their operations on a large scale The Big Three car manufacturers all halted production In April construction of new homes dropped by reaching the lowest level in five years The St Louis Fed Financial Stress Index increased sharply from below zero to during March The United States Department of Commerce reported that consumer spending fell by percent during the month of March It was the largest monthly drop since record keeping began in As a result the country's gross domestic product reduced at a rate of percent during the first quarter of The largest economic stimulus legislation in American history a trillion package called the CARES Act was signed into law on March The Congressional Budget Office reported in May that The unemployment rate increased from in February to in April representing a decline of more than million people employed plus another million persons that exited the labor force Job declines were focused on industries that rely on in person interactions such as retail education health services leisure and hospitality For example of the million leisure and hospitality jobs were lost in March and April The economic impact was expected to hit smaller and newer businesses harder as they typically have less financial cushion Real inflation adjusted consumer spending fell from February to April as social distancing reached its peak In April car and light truck sales were below the late monthly average Mortgage applications fell in April versus April Real GDP was forecast to fall at a nearly annual rate in the second quarter or versus the prior quarter with a return to positive quarter to quarter growth of in Q and in Q However real GDP was not expected to regain its Q level until or later The unemployment rate was forecast to average in and in In June economic analyst Jim Cramer said that the response to the coronavirus recession has led to the biggest transfer of wealth to the ultra wealthy in modern history Asia Pacific Australia Australia before the recession was suffering from an unusually severe and expensive bushfire season which damaged the economy and domestic trade routes Not only that but Australia had experienced significant slowdown in their economic growth with economists in late saying that Australia was 'teetering on the edge of a recession' As a result of this and the effects of the recession Australia is expecting a deep recession with at least of the able working population becoming unemployed according to the Australian treasury and at least a GDP retraction according to the IMF In April a water consultant predicted a shortage of rice and other staples during the pandemic unless farmers' water allocations were changed The unemployment level of is projected to rise to a year high of according to Treasury data released in April The Jobseeker Allowance unemployment benefit was doubled in April but Prime Minister Scott Morrison said that this would likely be reduced when the pandemic ends As of April up to a million people have been laid off due to effects of the recession Over individuals applied for unemployment support at the peak day Bangladesh The Bangladeshi economy is heavily dependent on the garment industry and remittances from migrant workers The garment industry has been heavily affected having already been contracting in Remittances in turn are expected to fall percent China As a result of the recession China's economy contracted for the first time in almost years The national GDP for the first quarter of dropped year on year quarter on quarter and the GDP for Hubei Province dropped in the same period In May Chinese Premier Li Keqiang announced that for the first time in history the central government wouldn't set an economic growth target for with the economy having contracted by compared to and China facing an unpredictable time However the government also stated an intention to create million new urban jobs until the end of Fiji On March the Reserve Bank of Fiji reduced its overnight policy rate OPR a and predicted the domestic economy to fall into a recession after decades of economic growth Later on June the national bank predicted the Fijian economy to contract severely this year due to falling consumption and investment associated with ongoing job losses Annual inflation remained in negative territory in May and is forecast to edge up to percent by year end The OPR is the key interest rate used by the Reserve Bank of Fiji RBF to officially indicate and communicate its monetary policy stance A reduction in the OPR signifies an easing of monetary policy India Further information Economic impact of the COVID pandemic in India The IMF predicted the growth rate of India in the financial year of as but in the following financial year they predict it to be IMF also predicted that India and China are the only two major economies that will maintain positive growth rates Iraq As of the government income comes from oil it will be extremely heavily hit by the drop in prices Japan In Japan the th quarter GDP shrank from the previous quarter due to two main factors One is the government's raise in consumption tax from to despite opposition from the citizens The other is the devastating effects of Typhoon Hagibis also known as the Reiwa East Japan Typhoon ????????? Reiwa Gannen Higashi Nihon Taifu or Typhoon Number ?? The th depression th typhoon and rd super typhoon of the Pacific typhoon season it was the strongest typhoon in decades to strike mainland Japan and one of the largest typhoons ever recorded at a peak diameter of nautical miles mi km It was also the costliest Pacific typhoon on record surpassing Typhoon Mireille's record by more than US billion when not adjusted for inflation In the resort town of Hakone record rainfall of almost a meter mm inches fell in only hours This adds to the effect of the pandemic on people's lives and the economy the prime minister unveiling a 'massive stimulus amounting to of GDP Lebanon Further information Lebanese protests and Lebanon liquidity crisis Since August Lebanon had been experiencing a major economic crisis that was caused by an increase in the official exchange rate between the Lebanese pound and the United States dollar Nepal As millions of Nepalis work outside of the country at least hundreds of thousands are expected to return due to layoffs abroad in what has been labelled a crisis that may overwhelm the Nepali state New Zealand The New Zealand Treasury projected that the country could experience an unemployment rate of if the country remains in lockdown for four weeks Finance Minister Grant Robertson has vowed that the Government will keep the unemployment rate below Prior to lockdown the unemployment rate was at BNZ economists are predicting a fall in property prices and an even larger decline in the construction of new homes GDP contracted in the first quarter of Philippines The Philippines' real GDP contracted by in the first quarter of the first contraction since the fourth quarter of a year after the Asian financial crisis with a technical recession deemed likely to be posted within Singapore Main article COVID pandemic in Singapore Property investment sales in Singapore fell per cent to billion in the first quarter of this year from the previous three months as the pandemic took its toll on investor sentiment a report from Cushman Wakefield on April showed On April the Monetary Authority of Singapore MAS said in its latest half yearly macroeconomic review Singapore will enter into a recession this year because of the blow from the COVID pandemic resulting in job losses and lower wages with significant uncertainty over how long and intense the downturn will be Depending on how the pandemic evolves and the efficacy of policy responses around the world Singapore's economic growth could even dip below the forecast range of minus four to minus one per cent to record its worst ever contraction On April the Ministry of Manpower MOM said that total employment excluding foreign domestic workers dropped by in the first three months of the year mainly due to a significant reduction in foreign employment Among Singapore citizens the unemployment rate increased from per cent to per cent while the resident unemployment rate which includes permanent residents increased from per cent to per cent On May Singapore Airlines SIA posted its first annual net loss in years a net loss of S million in the fourth quarter reversing from a net profit of S million in the corresponding quarter a year ago Europe The European Purchasing Managers' Index a key indicator of economic activity crashed to a record low of in April Normally any figure below is a sign of economic decline Belarus The Belarusian economy is being negatively affected by the loss of Russian oil subsidies and the drop in price of Belarus' refined oil products France France's yellow vest movement caused significant economic damage to the French economy in alongside a global slowdown France has been significantly hit hard by the pandemic with two months of 'strict lockdown' imposed on the French society On April the Bank of France officially declared that the French economy was in recession shrinking by percent in the first quarter of Germany Minister of Finance of Hesse Thomas Schäfer was found dead on March Schäfer left a suicide note where he mentions the hopeless economic situation in the country as one of the reasons Italy Italy's unemployment rate is expected to rise to with fearing unemployment in March The preliminary estimate of Q Italian GDP shows a quarter on quarter fall YoY a much steeper decline than in any quarter seen either during the financial crisis or the sovereign debt crisis United Kingdom On March the Bank of England cut the interest rate to a historic low of Quantitative easing was extended by £ billion to a total of £ billion since the start of the Great Recession A day later the Chancellor of the Exchequer announced the government would spend £ billion to bolster the economy On March non essential business and travel were officially banned in the UK to limit the spread of SARS CoV In April the Bank agreed to extend the government's overdraft facility from £ million to an undisclosed amount for the first time since Household spending fell in April compared with April April's Purchasing Managers' Index score was points the lowest since records began in indicating a severe downturn of business activity By the start of May of the British workforce had been furloughed temporarily laid off Government schemes were launched to help furloughed employees and self employed workers whose incomes had been affected by the outbreak effectively paying of their regular incomes subject to eligibility The Bank estimated that the UK economy could shrink in the first half of and that unemployment was likely to rise to in Economic growth was already weak before the crisis with growth in the fourth quarter of On May the Office for National Statistics announced a fall in GDP in the first quarter of including a then record monthly fall in March The Chancellor warned it was very likely the UK was going through a significant recession Summary of national impacts Effect on national economies Region Effect on annual GDP Unemployment Australia Austria Argentina Belgium Brazil Canada Chile Colombia Denmark Eurozone France Germany Greece Hong Kong Israel Italy Japan Malaysia Mexico Netherlands Norway Peru Russia Saudi Arabia Singapore South Africa South Korea Spain Sweden Taiwan Thailand Turkey United Kingdom United States Impact by sector Various service sectors are expected to be hit especially hard by the coronavirus recession Automotive industry New vehicle sales in the United States have declined by The American Big Three have all shut down their US factories The German automotive industry is coming into the crisis after having already suffered from the Dieselgate scandal as well as competition from electric cars Energy File Oil Tankers sit off the coast of Southern California webm Oil tankers sit off the coast of Southern California April The demand shock to oil was so severe that the price of American oil futures contracts became negative bottoming out at per barrel on the West Texas Intermediate as traders started paying for buyers to take the product before storage capacity ran out This was despite an earlier OPEC deal which cut world production by and ended the Russia Saudi Arabia oil price war Tourism Main article Impact of the COVID pandemic on tourism The global tourism industry may shrink up to due to the pandemic Restaurants Main article Impact of the COVID pandemic on the restaurant industry The COVID pandemic has impacted the restaurant business In the beginning of March some major cities in the US announced that bars and restaurants would be closed to sit down diners and limited to takeout orders and delivery Some employees were fired and more employees lacked sick leave in the sector compared to similar sectors Retail Shopping centers and other retailers around the world have reduced hours or closed down entirely Many were expected not to recover thereby accelerating the effects of the retail apocalypse Department stores and clothing shops have been especially hit Transportation This section only describes one highly specialized aspect of its associated subject Please help improve this article by adding more general information The talk page may contain suggestions March Main article Impact of the COVID pandemic on aviation See also Impact of the COVID pandemic on tourism A nearly empty flight from Beijing to Los Angeles during the pandemic The pandemic has had a significant impact on the aviation industry due to the resulting travel restrictions as well as slump in demand among travelers Significant reductions in passenger numbers have resulted in planes flying empty between airports and the cancellation of flights citation needed The following airlines have gone bankrupt or into administration Compass Airlines Flybe Trans States Airlines Virgin Australia Air Mauritius Avianca The cruise ship industry has also been heavily affected by a downturn with the share prices of the major cruise lines down Impact by occupation and demographic Differences across occupations caused difference in the economic effects across groups Certain jobs were less suitable for remote work e g because they involve working with people closely or with particular materials Women tended to be affected more than men The employment of immigrants in the U S declined more than for the native born partly because the kinds of job immigrants held Impact of U S protests Further information George Floyd protests Economic impact Boarded up storefronts at New York City's Saks Fifth Avenue during the George Floyd protests The economic impact of the protests in the U S has exacerbated the coronavirus recession by sharply curtailing consumer confidence straining local businesses and overwhelming public infrastructure with large scale property damage costing an estimated million A number of small businesses already suffering from the economic impact of the COVID pandemic were harmed by vandalism property destruction and looting Curfews instated by local governments in response to both the pandemic and protests have also restricted access to the downtown areas to essential workers lowering economic output The U S stock market has remained unaffected or otherwise increased since the start of the protests on May The protest's first fortnight coincided with a rise in the stock market A resurgence of coronavirus facilitated by mass protests could exacerbate the stock market crash according to Canadian economists at RBC The protests have disrupted national supply chains over uncertainty regarding public safety a resurgence of COVID and consumer confidence A number of Fortune companies with large distribution networks have scaled back deliveries and shuttered stores in high impact areas Mass demonstrations of both peaceful and violent varieties has been linked to diminished consumer confidence and demand stemming from the public health risks of group gatherings amid COVID Large scale property damage stemming from the protests has led to increased insurance claims bankruptcies and curbed economic activity among small businesses and state governments Insurance claims arising from property damage suffered in rioting is still being assessed but is thought to be significant perhaps record breaking Public financing and funding particularly on the state level has also been impacted by the protests The coronavirus recession has eroded large parts of state budgets which have subsequently struggled to finance the police overtime pay security costs and infrastructure repairs related to the demonstrations State governments have since June announced budget cuts to police departments as well as increased funding to other public safety measures Food insecurity See also Impact of the COVID pandemic on the food industry Unlike the Great Recession it is expected that the coronavirus recession will also affect the majority of developing nations On April the United Nations World Food Programme warned that a famine of biblical proportions was expected in several parts of the world as a result of the pandemic The release of Global Report on Food Crises indicated that countries were at risk with David Beasley estimating that in a worst case scenario about three dozen countries would succumb to famine This is particularly an issue in several countries affected by war including the Yemeni Civil War the Syrian Civil War insurgency in the Maghreb and the Afghanistan Conflict and occurs on a background of the locust storms in East Africa Nestlé PepsiCo the United Nations Foundation and farmers' unions have written to the G for support in maintaining food distributions in order to prevent food shortages It is estimated that double the number of people will go hungry when compared to pre pandemic levels The United Nations forecasts that the following member states will have significant areas with poor food security categorised as under stress IPC phase crisis IPC phase emergency IPC phase or critical emergency IPC phase in Afghanistan Angola Burkina Faso Cabo Verde Cameroon CAR Chad Cote d'Ivoire DR Congo El Salvador Eswatini Ethiopia Gambia Guatemala Guinea Guinea Bissau Haiti Honduras Iraq Kenya Lesotho Liberia Libya Madagascar Malawi Mali Mauritania Mozambique Myanmar Namibia Nicaragua Niger Nigeria Pakistan Rwanda Senegal Sierra Leone Somalia South Sudan Sudan Syria Uganda Tanzania Venezuela Yemen Zambia Zimbabwe It also raises alerts around Bangladesh in Cox's Bazar Colombia amongst Venezuelan migrants Djibouti Ecuador amongst Venezuelan migrants Lebanon amongst Syrian refugees Palestine Turkey amongst Syrian refugees Ukraine in the Luhansk and Donetsk oblasts Donetsk People's Republic not recognised by the UN Luhansk People's Republic not recognised by the UN National fiscal responses Several countries have announced stimulus programs to counter the effects of the recession Below is a summary table based on data from the International Monetary Fund unless otherwise specified Country Direct spending billions US Direct spending GDP Loan guarantees and asset purchases billions US Notes Additional sources Australia Austria Azerbaijan Bahrain Belgium Canada Chile China Cyprus Czech Republic Denmark Another is estimated to come from automatic stabilizers Egypt Estonia European Union Not including individual action by states France Germany States have announced additional spending Greece Hong Kong India Iran Ireland Israel Italy The COVID pandemic also known as the coronavirus pandemic is an ongoing global pandemic of coronavirus disease COVID caused by severe acute respiratory syndrome coronavirus SARS CoV The outbreak was first identified in Wuhan China in December The World Health Organization declared the outbreak a Public Health Emergency of International Concern on January and a pandemic on March As of July more than million cases of COVID have been reported in more than countries and territories resulting in more than deaths more than million people have recovered The virus is primarily spread between people during close contact c most often via small droplets produced by coughing d sneezing and talking The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances However research as of June has shown that speech generated droplets may remain airborne for tens of minutes Less commonly people may become infected by touching a contaminated surface and then touching their face It is most contagious during the first three days after the onset of symptoms although spread is possible before symptoms appear and from people who do not show symptoms Common symptoms include fever cough fatigue shortness of breath and loss of sense of smell Complications may include pneumonia and acute respiratory distress syndrome The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days 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 wearing a face mask in public settings and monitoring and self isolation for people who suspect they are infected Authorities worldwide have responded by implementing travel restrictions lockdowns workplace hazard controls and facility closures Many places have also worked to increase testing capacity and trace contacts of infected persons The pandemic has caused global social and economic disruption including the largest global recession since the Great Depression It has led to the postponement or cancellation of sporting religious political and cultural events widespread supply shortages exacerbated by panic buying and decreased emissions of pollutants and greenhouse gases Schools universities and colleges have been closed either on a nationwide or local basis in countries affecting approximately percent of the world's student population Misinformation about the virus has circulated through social media and mass media There have been incidents of xenophobia and discrimination against Chinese people and against those perceived as being Chinese or as being from areas with high infection rates File En Wikipedia VideoWiki Coronavirus disease webm Video summary script on the coronavirus disease min Contents Epidemiology Background Cases Deaths Duration Signs and symptoms Cause Transmission Virology Diagnosis Viral testing Imaging Prevention Hand washing Surface cleaning Face masks and respiratory hygiene Social distancing Self isolation Management Screening containment and mitigation Health care Treatment History National responses Asia Europe North America South America Africa Oceania International responses Travel restrictions Evacuation of foreign citizens International aid WHO response measures Impact Economics Culture Politics Education Other health issues Environment and climate Xenophobia and racism Information dissemination Misinformation See also Notes References External links Health agencies Directories Data and graphs Medical journals Epidemiology show all vte COVID pandemic by country and territory Location e Cases b Deaths f Recov g Ref World h United States i Brazil j Russia k India Peru Chile l United Kingdom m No data Spain n Mexico Italy Iran Pakistan Turkey Saudi Arabia Germany o South Africa France p Bangladesh Colombia Canada Qatar China q Egypt r Sweden No data Argentina s Belarus Belgium t Indonesia Ecuador Iraq Netherlands u No data United Arab Emirates Kuwait Ukraine v Singapore Kazakhstan Oman Portugal Philippines Bolivia Poland Panama Dominican Republic Afghanistan Switzerland Bahrain Romania Israel w Armenia Nigeria Ireland Guatemala Honduras Azerbaijan x Japan y Ghana Austria Moldova z Serbia aa Nepal Algeria Morocco ab South Korea Denmark ac Cameroon Czech Republic Ivory Coast Sudan Uzbekistan Norway ad Malaysia Australia ae DR Congo af El Salvador Finland ag Kenya Senegal North Macedonia Kyrgyzstan Venezuela Tajikistan Haiti Ethiopia Guinea Gabon Bulgaria Bosnia and Herzegovina Djibouti Mauritania Luxembourg Costa Rica Hungary Central African Republic Greece Palestine Thailand Equatorial Guinea Kosovo Croatia Somalia ah Albania Nicaragua Madagascar Maldives Cuba ai Paraguay Mali Sri Lanka South Sudan Estonia Iceland Lebanon Lithuania Guinea Bissau Slovakia Slovenia Zambia Puerto Rico Congo aj Sierra Leone Malawi Cape Verde Hong Kong Benin Yemen New Zealand Tunisia Donetsk PR ak Jordan Latvia USS Theodore Roosevelt al Charles de Gaulle am Niger Rwanda Cyprus an Burkina Faso Uruguay ao Georgia ap Mozambique Uganda Chad Andorra Eswatini Libya Liberia São Tomé and Príncipe Diamond Princess y Jamaica San Marino Malta Togo Zimbabwe Montenegro Suriname Somaliland aq Luhansk PR ak Taiwan ar Vietnam Namibia Mauritius Isle of Man as Jersey Comoros Myanmar Syria at Angola Guam al Guernsey Guyana Botswana Mongolia Eritrea Cayman Islands Faroe Islands Gibraltar Burundi Costa Atlantica Bermuda Brunei Cambodia Trinidad and Tobago Greg Mortimer ao No data Artsakh au Northern Cyprus av Aruba Bahamas Monaco Barbados South Ossetia aw Liechtenstein Seychelles Bhutan Sint Maarten U S Virgin Islands Antigua and Barbuda French Polynesia The Gambia Macau Turks and Caicos Islands Abkhazia ax Lesotho Northern Mariana Islands Saint Vincent ay Belize Curaçao East Timor Grenada New Caledonia Laos Saint Lucia Dominica Fiji Saint Kitts and Nevis Falkland Islands Greenland MS Zaandam az No data Coral Princess ba No data Vatican City Montserrat Papua New Guinea British Virgin Islands HNLMS Dolfijn bb Anguilla Saba Bonaire Sint Eustatius Saint Pierre and Miquelon Tanzania bc No data No data No data As of July UTC • History of cases • History of deaths For notes see the Notes section Background On December health authorities in China reported to the World Health Organization WHO a cluster of viral pneumonia cases of unknown cause in Wuhan Hubei and an investigation was launched in early January On January the WHO declared the outbreak a Public Health Emergency of International Concern PHEIC cases confirmed globally affecting countries in five WHO regions Several early infected had visited Huanan Seafood Wholesale Market the virus is therefore thought to be of zoonotic origin The virus that caused the outbreak is known as SARS CoV a newly discovered virus closely related to bat coronaviruses pangolin coronaviruses and SARS CoV The scientific consensus is that COVID has a natural origin The probable bat to human infection may have been among people processing bat carcasses and guano in the production of traditional Chinese medicines The earliest known person with symptoms was later discovered to have fallen ill on December and that person did not have visible connections with the later wet market cluster Of the early cluster of cases reported that month two thirds were found to have a link with the market On March an unverified report from the South China Morning Post suggested a case traced back to November a year old from Hubei may have been the first person infected The WHO recognized the spread of COVID as a pandemic on March as Italy Iran South Korea and Japan reported surging cases The total numbers outside China quickly passed China's Cases Main articles COVID pandemic by country and territory and COVID pandemic cases Cases refer to the number of people who have been tested for COVID and whose test has been confirmed positive according to official protocols As of May countries that publicised their testing data have typically performed many tests equal to percent of their population while no country has tested samples equal to more than percent of its population Many countries early on had official policies to not test those with only mild symptoms An analysis of the early phase of the outbreak up to January estimated percent of COVID infections had not been detected and that these undocumented infections were the source for percent of documented cases Several other studies using a variety of methods have estimated that numbers of infections in many countries are likely to be considerably greater than the reported cases On April preliminary results found that percent of people tested in Gangelt the centre of a major infection cluster in Germany tested positive for antibodies Screening for COVID in pregnant women in New York City and blood donors in the Netherlands has also found rates of positive antibody tests that may indicate more infections than reported However such antibody surveys can be unreliable due to a selection bias in who volunteers to take the tests and due to false positives Some results such as the Gangelt study have received substantial press coverage without first passing through peer review Analysis by age in China indicates that a relatively low proportion of cases occur in individuals under It is not clear whether this is because young people are less likely to be infected or less likely to develop serious symptoms and seek medical attention and be tested A retrospective cohort study in China found that children were as likely to be infected as adults Countries that test more relative to the number of deaths have a younger age distribution of cases relative to the wider population Initial estimates of the basic reproduction number R for COVID in January were between and but a subsequent analysis concluded that it may be about with a percent confidence interval of to R can vary across populations and is not to be confused with the effective reproduction number commonly just called R which takes into account effects such as social distancing and herd immunity By mid May the effective R was close to or below in many countries meaning the spread of the disease in these areas at that time was stable or decreasing Epidemic curve of COVID by date of report Semi log graph showing the total cumulative number of confirmed cases from the first reported date for the ten most affected countries Semi log plot of daily new cases of COVID seven day average in the world and top five current countries mean with deaths Semi log plot of cases in some countries with high growth rates post China with three day projections based on the exponential growth rates Cases by country plotted on a logarithmic scale Seven day rolling average of daily confirmed cases per million by country selected for clarity Includes test data by color COVID total cases per population from selected countries COVID active cases per population from selected countries Deaths Main articles COVID pandemic deaths and Mortality due to COVID Further information List of deaths due to COVID Deceased in a m ft mobile morgue outside a hospital in Hackensack New Jersey Most people who contract COVID recover For those who do not the time between the onset of symptoms and death usually ranges from to days typically about days As of July approximately deaths had been attributed to COVID In China as of June about percent of deaths were recorded in those aged over and percent had pre existing health conditions including cardiovascular diseases and diabetes The first confirmed death was in Wuhan on January The first death outside of China occurred on February in the Philippines and the first death outside Asia was in France on February Official deaths from COVID generally refer to people who died after testing positive according to protocols This may ignore deaths of people who die without testing e g at home or in nursing homes Conversely deaths of people who had underlying conditions may lead to overcounting Comparison of statistics for deaths for all causes versus the seasonal average indicates excess mortality in many countries In the worst affected areas mortality has been several times higher than average In New York City deaths have been four times higher than average in Paris twice as high and in many European countries deaths have been on average to percent higher than normal This excess mortality may include deaths due to strained healthcare systems and bans on elective surgery Multiple measures are used to quantify mortality These numbers vary by region and over time influenced by testing volume healthcare system quality treatment options government response time since the initial outbreak and population characteristics such as age sex and overall health Some countries like Belgium include deaths from suspected cases of COVID regardless of whether the person was tested resulting in higher numbers compared to countries that include only test confirmed cases The death to case ratio reflects the number of deaths attributed to COVID 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 percent deaths for cases as of July The number varies by region Other measures include the case fatality rate CFR which reflects the percentage of diagnosed people who die from a disease and the infection fatality rate IFR which reflects the percentage of infected diagnosed and undiagnosed who die from a disease These statistics are not timebound and follow a specific population from infection through case resolution Our World in Data states that as of March the IFR cannot be accurately calculated as neither the total number of cases nor the total deaths is known In February the Institute for Disease Modeling estimated the IFR as percent percent confidence interval based on data from China The University of Oxford's Centre for Evidence Based Medicine CEBM estimated a global CFR of to percent last revised April and IFR of percent to percent last revised May acknowledging that this will vary between populations due to differences in demographics The CDC estimates for planning purposes that the fatality rate among those who are symptomatic is percent to percent and that percent of infected individuals are asymptomatic for an overall infection fatality rate of percent as of May Semi log plot of daily deaths due to COVID seven day average in the world and top five current countries mean with cases Case fatality rate of COVID by country and confirmed cases Ongoing case fatality rate of COVID by country COVID deaths per population from selected countries Duration On March the WHO said the pandemic could be controlled The peak and ultimate duration of the outbreak are uncertain and may differ by location Maciej Boni of Penn State University said 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 The Imperial College study led by Neil Ferguson stated that physical distancing and other measures will be required until a vaccine becomes available potentially months or more William Schaffner of Vanderbilt University said because the coronavirus is so readily transmissible 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 Signs and symptoms Further information Coronavirus disease Signs and symptoms Symptoms of COVID The usual incubation period the time between infection and symptom onset ranges from one to days and is most commonly five days Some infected people have no symptoms known as asymptomatic or presymptomatic carriers transmission from such a carrier is considered possible As at April estimates of the asymptomatic ratio range widely from to percent Symptoms of COVID can be relatively non specific the two most common symptoms are fever percent and dry cough percent Less common symptoms include fatigue respiratory sputum production phlegm loss of the sense of smell loss of taste shortness of breath muscle and joint pain sore throat headache chills vomiting coughing out blood diarrhea and rash Among those who develop symptoms approximately one in five may become more seriously ill and have difficulty breathing Emergency symptoms include 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 complications including pneumonia acute respiratory distress syndrome sepsis septic shock and kidney failure Cause Transmission Further information Coronavirus disease Cough sneeze droplets visualised in dark background using Tyndall scattering Respiratory droplets produced when a man sneezes visualised using Tyndall scattering COVID spreads primarily when people are in close contact and one person inhales small droplets produced by an infected person symptomatic or not coughing sneezing talking or singing The WHO recommends metre ft of social distance the U S Centers for Disease Control and Prevention CDC recommends metres ft People can transmit the virus without showing symptoms but it is unclear how often this happens A June review found the likelihood of those infected that are asymptomatic to be People are most infectious when they show symptoms even mild or non specific symptoms but may be infectious for up to two days before symptoms appear pre symptomatic transmission They remain infectious an estimated seven to twelve days in moderate cases and an average of two weeks in severe cases When the contaminated droplets fall to floors or surfaces they can though less commonly remain infectious if people touch contaminated surfaces and then their eyes nose or mouth with unwashed hands On surfaces the amount of active virus decreases over time until it can no longer cause infection and surfaces are thought not to be the main way the virus spreads It is unknown what amount of virus on surfaces is required to cause infection via this method but it can be detected for up to four hours on copper up to one day on cardboard and up to three days on plastic polypropylene and stainless steel AISI Surfaces are easily decontaminated with household disinfectants which kill the virus outside the human body or on the hands Disinfectants or bleach are not a treatment for COVID and cause health problems when not used properly such as when used inside the human body Sputum and saliva carry large amounts of virus Although COVID is not a sexually transmitted infection kissing intimate contact and faecal oral routes are suspected to transmit the virus Some medical procedures are aerosol generating and result in the virus being transmitted more easily than normal COVID is a new disease and many of the details of its spread are still under investigation It spreads easily between people easier than influenza but not as easily as measles Estimates of the number of people infected by one person with COVID the R have varied widely The WHO's initial estimates of the R were average however a more recent when review found the basic R without control measures to be higher at and the median R to be The virus may occur in breast milk but it's unknown whether it's infectious and transmittable to the baby Virology Main article Severe acute respiratory syndrome coronavirus Illustration of SARSr CoV virion Severe acute respiratory syndrome coronavirus SARS CoV is a novel virus 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 virus occur in related coronaviruses in nature SARS CoV is closely related to SARS CoV and is thought to have a zoonotic origin SARS CoV genetically clusters with the genus Betacoronavirus and is percent identical at the whole genome level to other bat coronavirus samples and percent identical to pangolin coronavirus Diagnosis Main article COVID testing Demonstration of a swab for COVID testing COVID can be provisionally diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction RT PCR testing of infected secretions or CT imaging of the chest Viral testing The standard test for current infection with SARS CoV uses RNA testing of respiratory secretions collected using a nasopharyngeal swab though it is possible to test other samples This test uses real time rRT PCR which detects the presence of viral RNA fragments A number of laboratories and companies have developed serological tests which detect antibodies produced by the body in response to infection Several have been evaluated by Public Health England and approved for use in the UK On June UK health secretary Matt Hancock announced the country would conduct a new spit test for COVID on key workers and their families in Southampton having them spit in a pot which was collected by Southampton University with results expected within hours Hancock said the test was easier than using swabs and could enable people to conduct it at home Imaging A CT scan of a person with COVID shows lesions bright regions in the lungs Characteristic imaging features on chest radiographs and computed tomography CT of people who are symptomatic include asymmetric peripheral ground glass opacities without 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 rRT PCR is of limited specificity in identifying COVID 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 Prevention Further information Workplace hazard controls for COVID Pandemic prevention preparations prior to COVID COVID surveillance and COVID apps Infographic by the U S Centers for Disease Control and Prevention CDC describing how to stop the spread of germs 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 Health care providers taking care of someone who may be infected are recommended to use standard precautions contact precautions and eye protection Many governments have restricted or advised against all non essential travel to and from areas affected by the outbreak The virus has already spread within communities in large parts of the world with many not knowing where or how they were infected Misconceptions are circulating about how to prevent infection for example rinsing the nose and gargling with mouthwash are not effective There is no COVID vaccine though many organisations are working to develop one Hand washing Main article Hand washing 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 sanitiser with at least percent alcohol by volume when soap and water are not readily available The WHO advises people to avoid touching the eyes nose or mouth with unwashed hands It is not clear whether washing hands with ash if soap is not available is effective at reducing the spread of viral infections Surface cleaning Surfaces may be decontaminated with a number of solutions within one minute of exposure to the disinfectant for a stainless steel surface including percent ethanol percent isopropanol percent sodium hypochlorite percent hydrogen peroxide and percent povidone iodine Other solutions such as benzalkonium chloride and chlorhexidine gluconate are less effective The CDC recommends that if a COVID case is suspected or confirmed at a facility such as an office or day care 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 Face masks and respiratory hygiene Main article Face masks during the COVID pandemic Taiwan President Tsai Ing wen wearing a surgical mask Slovakia was among the first countries in the world to make the wearing of masks mandatory in public The CDC and WHO recommend individuals wear non medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain This recommendation is meant to reduce the spread of the disease by asymptomatic and pre symtomatic individuals and is complementary to established preventive measures such as social distancing Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking breathing and coughing Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease Medical grade facemasks such as N masks should be reserved and prioritised for healthcare workers and first responders When not wearing a mask 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 Proper hand hygiene after any cough or sneeze is encouraged Social distancing Main article Social distancing measures related to the COVID pandemic Physical distancing in Toronto with a limited number of customers allowed inside a store Social distancing also known as physical distancing includes infection control actions intended to slow the spread of disease by minimising 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 Non cooperation with distancing measures in some areas has contributed to the further spread of the pandemic The maximum gathering size recommended by U S government bodies and health organisations was swiftly reduced from people if there were no known COVID spread in a region to people and later to On March Germany banned public gatherings of more than two people A Cochrane review found that early quarantine with other public health measures are effective in limiting the pandemic but the best manner of adopting and relaxing policies are uncertain as local conditions vary 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 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 through alternative means Some authorities have issued sexual health guidelines for the pandemic which include recommendations to have sex only with someone you live with and who does not have the virus or symptoms of the virus Self isolation Without pandemic containment measures such as social distancing vaccination and use of face masks pathogens can spread exponentially This graphic shows how early adoption of containment measures tends to protect wider swaths of the population Self isolation at home has been recommended for those diagnosed with COVID 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 The strongest self quarantine instructions have been issued to those in high risk groups Those who may have been exposed to someone with COVID and those who have recently travelled to a country or region with the widespread transmission have been advised to self quarantine for days from the time of last possible exposure Management Further information Coronavirus disease Management and Pandemic Management Screening containment and mitigation Further information Flatten the curve Goals of mitigation include delaying and reducing peak burden on healthcare flattening the curve and lessening overall cases and health impact Moreover progressively greater increases in healthcare capacity raising the line such as by increasing bed count personnel and equipment help to meet increased demand 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 Strategies in the control of an outbreak are screening containment or suppression and mitigation Screening is done with a device such as a thermometer to detect the elevated body temperature associated with fevers caused by the coronavirus Containment is undertaken in the early stages of the outbreak and aims to trace and isolate those infected as well as introduce other measures to stop the disease from spreading When it is no longer possible to contain 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 on 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 Part of managing an infectious disease outbreak is trying to delay and decrease the epidemic peak known as flattening the epidemic curve 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 the mass screening and localised 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 penalised 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 two thirds and deaths by half but still result in hundreds of thousands of deaths and overwhelmed health systems 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 as transmission otherwise quickly rebounds when measures are relaxed Long term intervention to suppress the pandemic has considerable social and economic costs Contact tracing See also Management of COVID Information technology and Government by algorithm Contact tracing is an important method for health authorities to determine the source of infection and to prevent further transmission The use of location data from mobile phones by governments for this purpose has prompted privacy concerns with Amnesty International and more than a hundred other organisations issuing a statement calling for limits on this kind of surveillance Several mobile apps have been implemented or proposed for voluntary use and as of April more than a dozen expert groups were working on privacy friendly solutions such as using Bluetooth to log a user's proximity to other cellphones Users are alerted if they have been near someone who subsequently tests positive On April Google and Apple jointly announced an initiative for privacy preserving contact tracing based on Bluetooth technology and cryptography The system is intended to allow governments to create official privacy preserving coronavirus tracking apps with the eventual goal of integration of this functionality directly into the iOS and Android mobile platforms In Europe and in the U S Palantir Technologies is also providing COVID tracking services Health care Further information Flatten the curve list of countries by hospital beds and Shortages related to the COVID pandemic An army constructed field hospital outside Östra sjukhuset Eastern hospital in Gothenburg Sweden contains temporary intensive care units for COVID patients Increasing capacity and adapting healthcare for the needs of COVID patients is described by the WHO as a fundamental outbreak response measure 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 testing cancelling elective procedures whenever possible separating and isolating COVID positive patients and increasing intensive care capabilities by training personnel and increasing the number of available ventilators and beds In addition in an attempt to maintain physical distancing and to protect both patients and clinicians in some areas non emergency healthcare services are being provided virtually Due to capacity limitations in the standard supply chains some manufacturers are D printing healthcare material such as nasal swabs and ventilator parts In one example when an Italian hospital urgently required a ventilator valve and the supplier was unable to deliver in the timescale required a local startup received legal threats due to alleged patent infringement after reverse engineering and printing the required hundred valves overnight On April NASA reported building in days a ventilator which is currently undergoing further testing NASA is seeking fast track approval Treatment Main articles COVID drug development and COVID vaccine An exhausted anesthesiologist physician in Pesaro Italy March Antiviral medications are under investigation for COVID None has yet been shown to be clearly effective on mortality in published randomised controlled trials However remdesivir may affect the time it takes to recover from the virus Emergency use authorisation for remdesivir was granted in the U S on May for people hospitalised with severe COVID The interim authorisation was granted considering the lack of other specific treatments and that its potential benefits appear to outweigh the potential risks 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 Other trials are investigating whether existing medications can be used effectively against COVID or the immune reaction to it On June the RECOVERY Trial group released a statement that their preliminary results show low dose dexamethasone reduces mortality in patients receiving respiratory support though previous reviews had suggested the use of steroids may worsen outcomes Demand for dexamethasone surged after publication of the preprint History Main article Timeline of the COVID pandemic Cumulative per capita confirmed COVID cases? Desc i svgInteractive timeline map of confirmed cases per million people drag circle to adjust may not work on mobile There are several theories about when and where the very first case the so called patient zero originated According to an unpublicised report from the Chinese government the first case can be traced back to November the person was a year old citizen in the Hubei province There were four men and five women reported to be infected in November but none of them were patient zero Starting from December the number of coronavirus cases in Hubei gradually increased reaching by December and at least by December According to official Chinese sources these early cases were mostly linked to the Huanan Seafood Wholesale Market which also sold live animals In May George Gao the director of the Chinese Center for Disease Control and Prevention said animal samples collected from the seafood market had tested negative for the virus indicating the market was not the source of the initial outbreak On December Wuhan Central Hospital sent a bronchoalveolar lavage fluid BAL sample from an unresolved clinical case to sequencing company Vision Medicals On and December Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test showing a new coronavirus A pneumonia cluster of unknown cause was observed on December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital who informed the Wuhan Jianghan CDC on December On December a test report addressed to Wuhan Central Hospital from company CapitalBio Medlab stated that there was an erroneous positive result for SARS causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result Eight of those doctors including Li Wenliang who was also punished on January were later admonished by the police for spreading false rumours and another doctor Ai Fen was reprimanded by her superiors for raising the alarm That evening the Wuhan Municipal Health Commission issued a notice to various medical institutions about the treatment of pneumonia of unknown cause The next day the Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause confirming cases enough to trigger an investigation During the early stages of the outbreak the number of cases doubled approximately every seven and a half days In early and mid January the virus spread to other Chinese provinces helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange On January China reported nearly new cases in one day including two people in Beijing and one in Shenzhen A retrospective official study published in March found that people had already developed symptoms by January most of them would be diagnosed later and more may have been infected A report in The Lancet on January indicated human transmission strongly recommended personal protective equipment for health workers and said testing for the virus was essential due to its pandemic potential On January the WHO declared the coronavirus a public health emergency of international concern By this time the outbreak spread by a factor of to times clarification needed On January Italy had its first confirmed cases two tourists from China As of March the WHO considered Europe the active centre of the pandemic On March Italy overtook China as the country with the most reported deaths By March the United States had overtaken China and Italy with the highest number of confirmed cases in the world Research on coronavirus genomes indicates the majority of COVID cases in New York came from European travellers rather than directly from China or any other Asian country Retesting of prior samples found a person in France who had the virus on December and a person in the United States who died from the disease on February On June after days without a locally transmitted case being reported the city of Beijing reported a single COVID case followed by two more cases on June As for June cases were officially confirmed Most of these patients went to Xinfadi Wholesale Market As of July more than million cases have been reported worldwide more than people have died and more than million have recovered National responses Main articles COVID pandemic lockdowns COVID pandemic by country and territory and National responses to the COVID pandemic A total of countries and territories have had at least one case of COVID so far Due to the pandemic in Europe many countries in the Schengen Area have restricted free movement and set up border controls National reactions have included containment measures such as quarantines and curfews known as stay at home orders shelter in place orders or lockdowns By March billion people worldwide were under some form of lockdown which increased to billion people by the first week of April more than half the world's population By late April around million people were under lockdown in nations of Europe including but not limited to Italy Spain France and the United Kingdom while around million people were under lockdown in Latin America Nearly million people or about percent of the population were under some form of lockdown in the United States around million people in the Philippines about million people in South Africa and billion people have been under lockdown in India On May new infections occurred worldwide the most since the start of the pandemic while overall million cases were surpassed Asia Main article COVID pandemic in Asia As of May cases have been reported in all Asian countries except for Turkmenistan and North Korea although these countries likely also have cases Despite being the first area of the world hit by the outbreak the early wide scale response of some Asian states particularly South Korea Taiwan and Vietnam has allowed them to fare comparatively well China Main article COVID pandemic in mainland China Confirmed cases of COVID per inhabitants by province as of April showing Hubei with around times more cases than any other province Hubei Province cases per cases per cases per cases per > cases per Semi log graph of new cases and deaths in China during the COVID epidemic showing the lockdown and lifting The first confirmed case of COVID has been traced back to December in Wuhan one unconfirmed report suggests the earliest case was on November Doctor Zhang Jixian observed a cluster of pneumonia cases of unknown cause on December upon which her hospital informed Wuhan Jianghan CDC on December Initial genetic testing of patient samples on December indicated the presence of a SARS like coronavirus A public notice was released by Wuhan Municipal Health Commission on December confirming cases and suggesting wearing face masks The WHO was informed on the same day As these notifications occurred doctors in Wuhan were warned by police for spreading rumours about the outbreak The Chinese National Health Commission initially said there was no clear evidence of human to human transmission In a January conference call Chinese officials said privately that human to human transmission was a possibility and pandemic preparations were needed In a briefing posted during the night of January the Wuhan Municipal Health Commission said the possibility of limited human to human transmission could not be ruled out On January the Chinese National Health Commission confirmed human to human transmission of the virus That same day Chinese Communist Party general secretary Xi Jinping and State Council premier Li Keqiang issued their first public comments about the virus telling people in infected areas to practice social distancing and avoid travel During the Chinese New Year travel period authorities instigated a City of Wuhan lockdown On February the Chinese government launched a radical campaign described by paramount leader and Chinese Communist Party general secretary Xi as a people's war to contain the viral spread In the largest quarantine in human history a cordon sanitaire on January stopped travel in and out of Wuhan then extended to fifteen Hubei cities affecting about million people Private vehicle use was banned in the city Several Chinese New Year January celebrations were also cancelled Authorities announced the construction of a temporary hospital Huoshenshan Hospital completed in ten days Leishenshan Hospital was later built to handle additional patients China also converted other facilities in Wuhan such as convention centres and stadiums into temporary hospitals Wuhan Leishenshan Hospital an emergency speciality field hospital built in response to the pandemic A temporary hospital for treating mild cases of COVID in Wuhan one of more than ten such hospitals in the city On January the government instituted further measures to contain the COVID outbreak including issuing health declarations for travellers and extending the Spring Festival holiday Universities and schools around the country were also closed The regions of Hong Kong and Macau instituted several measures particularly in regard to schools and universities Remote working measures were instituted in several Chinese regions Travel restrictions were enacted in and outside of Hubei Public transport was modified and museums throughout China were temporarily closed Control of public movement was applied in many cities and an estimated million people more than half the population faced some form of outdoor restriction In January and February during the height of the epidemic in Wuhan about million people lost their jobs Many of China's nearly million rural migrant workers have been stranded at home in inland provinces or trapped in Hubei province After the outbreak entered its global phase in March Chinese authorities took strict measures to prevent the virus re entering China from other countries For example Beijing imposed a day mandatory quarantine for all international travellers entering the city At the same time a strong anti foreigner sentiment quickly took hold and foreigners experienced harassment by the general public and forced evictions from apartments and hotels On March Chinese Premier Li Keqiang reported that the spread of domestically transmitted cases has been basically blocked and the outbreak has been controlled in China The same day travel restrictions were eased in Hubei apart from Wuhan two months after the lockdown was imposed The Chinese Ministry of Foreign Affairs announced on March that entry for visa or residence permit holders would be suspended from March onwards with no specific details on when this policy would end Those wishing to enter China must to apply for visas in Chinese embassies or consulates The Chinese government encouraged businesses and factories to re open on March and provided monetary stimulus packages for firms The State Council declared a day of mourning to begin with a national three minute moment of silence on April coinciding with Qingming Festival although the central government asked families to pay their respects online in observance of physical distancing to avoid a renewed COVID outbreak On April the last patients were discharged in Wuhan On May the city of Jilin was put on lockdown sparking fear of a second wave of infection Iran Main article COVID pandemic in Iran Disinfection of Tehran Metro trains against coronavirus Similar measures have also been taken in other countries Iran reported its first confirmed cases of SARS CoV infections on February in Qom where according to the Ministry of Health and Medical Education two people had died that day Early measures announced by the government included the cancellation of concerts and other cultural events sporting events Friday prayers and closures of universities higher education institutions and schools Iran allocated trillion rials equivalent to US to combat the virus President Hassan Rouhani said on February there were no plans to quarantine areas affected by the outbreak and only individuals would be quarantined Plans to limit travel between cities were announced in March although heavy traffic between cities ahead of the Persian New Year Nowruz continued Shia shrines in Qom remained open to pilgrims until March Iran became a centre of the spread of the virus after China during February More than ten countries had traced their cases back to Iran by February indicating the outbreak may have been more severe than the cases reported by the Iranian government by that date The Iranian Parliament was shut down with of its members reported to have had tested positive for the virus on March On March the Iranian government reported a hundred deaths in a single day the most recorded in the country since the outbreak began At least twelve sitting or former Iranian politicians and government officials had died from the disease by March By March Iran was experiencing fifty new cases every hour and one new death every ten minutes due to coronavirus According to a WHO official there may be five times more cases in Iran than what is being reported It is also suggested that U S sanctions on Iran may be affecting the country's financial ability to respond to the viral outbreak The UN High Commissioner for Human Rights has demanded economic sanctions to be eased for nations most affected by the pandemic including Iran On April it was reported that Iran had reopened shopping malls and other shopping areas across the country though there is a fear of the second wave of infection due to this move After reaching a low in new cases in early May a new peak was reported on June raising fear of a second wave South Korea Main article COVID pandemic in South Korea A drive through test centre at the Gyeongju Public Health Centre COVID was confirmed to have spread to South Korea on January from China The nation's health agency reported a significant increase in confirmed cases on February largely attributed to a gathering in Daegu of the Shincheonji Church of Jesus Shincheonji devotees visiting Daegu from Wuhan were suspected to be the origin of the outbreak By February among followers of the church or about percent reported symptoms South Korea declared the highest level of alert on February On February more than confirmed cases were reported rising to on February All South Korean military bases were quarantined after tests showed three soldiers had the virus Airline schedules were also changed A banner in Seoul displays coronavirus infection prevention tips South Korea introduced what was considered the largest and best organised programme in the world to screen the population for the virus isolate any infected people and trace and quarantine those who contacted them Screening methods included mandatory self reporting of symptoms by new international arrivals through mobile application drive through testing for the virus with the results available the next day and increasing testing capability to allow up to people to be tested every day South Korea's programme is considered a success in controlling the outbreak without quarantining entire cities South Korean society was initially polarised on President Moon Jae in's response to the crisis many signing petitions either praising it or calling for impeachment On March it was reported that South Korea had the lowest one day case total in four weeks On March it was reported that beginning April all new overseas arrivals will be quarantined for two weeks Per media reports on April South Korea has received requests for virus testing assistance from different countries On May it was reported that about two thousand businesses were told to close again when a cluster of a hundred infected individuals was discovered contact tracing is being done on people Europe Cases of COVID per residents in Europe The numbers are not comparable as the testing strategy differs among countries and time periods Main article COVID pandemic in Europe As of March when the number of new cases became greater than those in China the World Health Organization WHO began to consider Europe the active centre of the pandemic Cases by country across Europe had doubled over periods of typically to days with some countries mostly those at earlier stages of detection showing doubling every days As of March all countries within Europe had a confirmed case of COVID with Montenegro being the last European country to report at least one case At least one death has been reported in all European countries apart from the Vatican City As of March more than million people were in lockdown in Europe As of May days since its first recorded case Montenegro became the first COVID free country in Europe but this situation lasted only days before a newly imported case was identified there Italy Main article COVID pandemic in Italy The outbreak was confirmed to have spread to Italy on January when two Chinese tourists tested positive for SARS CoV in Rome Cases began to rise sharply which prompted the Italian government to suspend all flights to and from China and declare a state of emergency An unassociated cluster of COVID cases was later detected starting with confirmed cases in Lombardy on February Civil Protection volunteers conduct health checks at the Guglielmo Marconi Airport in Bologna on February On February the Council of Ministers announced a new decree law to contain the outbreak including quarantining more than people from eleven different municipalities in northern Italy Prime Minister Giuseppe Conte said In the outbreak areas entry and exit will not be provided Suspension of work activities and sports events has already been ordered in those areas On March the Italian government ordered the full closure of all schools and universities nationwide as Italy reached a hundred deaths All major sporting events were to be held behind closed doors until April but on March all sport was suspended completely for at least one month On March Prime Minister Conte ordered stoppage of nearly all commercial activity except supermarkets and pharmacies On March the Italian College of Anaesthesia Analgesia Resuscitation and Intensive Care SIAARTI published medical ethics recommendations regarding triage protocols On March Italy overtook China as the country with the most coronavirus related deaths in the world after reporting fatalities from the pandemic On March it was reported that Russia had sent nine military planes with medical equipment to Italy As of June there were confirmed cases deaths and recoveries in Italy with the majority of those cases occurring in the Lombardy region A CNN report indicated that the combination of Italy's large elderly population and inability to test all who have the virus to date may be contributing to the high fatality rate On April it was reported that the country had its lowest deaths at in seven days and some businesses are asking for a loosening of restrictions after six weeks of lockdown Spain Main article COVID pandemic in Spain Residents of Valencia Spain maintaining social distancing while queueing The virus was first confirmed to have spread to Spain on January when a German tourist tested positive for SARS CoV in La Gomera Canary Islands Post hoc genetic analysis has shown that at least strains of the virus had been imported and community transmission began by mid February By March cases had been confirmed in all provinces of the country The lockdown was imposed on March On March it was announced that beginning the following day all non essential workers were ordered to remain at home for the next days By late March the Community of Madrid has recorded the most cases and deaths in the country Medical professionals and those who live in retirement homes have experienced especially high infection rates On March the death toll in Spain surpassed that of mainland China and only that of Italy was higher On April people died of the virus in a hour period at the time the most by any country in a single day On May the daily death toll announced by the Spanish government fell below for the first time and June was the first day without deaths by coronavirus The state of alarm ended on June As of June there have been confirmed cases and deaths The actual number of cases was considered to be much higher as many people with only mild or no symptoms were unlikely to have been tested On June the results of the second wave of a Spanish Government nation wide seroprevalence study showed that the percentage of population which could have been infected during the pandemic would be around approximately million people a figure ten times higher than the number of confirmed cases on that date According to this study based on sample of more than people Madrid and several provinces of Castilla La Mancha and Castilla y León would be the most affected areas with a percentage of infection greater than The number of deaths is also believed to be an underestimate due to lack of testing and reporting perhaps by as much as according to the Spanish Ministry of Health monitoring system on daily excess mortality Sistema de Monitorización de la Mortalidad Diaria MoMo United Kingdom Main article COVID pandemic in the United Kingdom The Wee Annie statue in Gourock Scotland was given a face mask during the pandemic Prior to March the British government did not impose any form of social distancing or mass quarantine measures on its citizens As a result the government received criticism for the perceived lack of pace and intensity in its response to concerns faced by the public On March Prime Minister Boris Johnson made an announcement advising against all non essential travel and social contact suggesting people work from home where possible and avoid venues such as pubs restaurants and theatres On March the government announced that all leisure establishments such as pubs and gyms were to close as soon as possible and promised to pay up to percent of workers' wages to a limit of £ per month to prevent unemployment during the crisis On March the prime minister announced tougher social distancing measures banning gatherings of more than two people and restricting travel and outdoor activity to that deemed strictly necessary Unlike previous measures these restrictions were enforceable by police through the issuing of fines and the dispersal of gatherings Most businesses were ordered to close with exceptions for businesses deemed essential including supermarkets pharmacies banks hardware shops petrol stations and garages On April it was reported that one of the more promising vaccine trials had begun in England the government has pledged in total more than million pounds towards research VE Day celebrations took place under lockdown in the United Kingdom as in this socially distanced street party in Wetherby West Yorkshire To ensure the UK health services had sufficient capacity to treat people with COVID a number of temporary critical care hospitals were built The first to be operational was the bed capacity NHS Nightingale Hospital London constructed within the ExCeL convention centre over nine days On May it was announced that the Nightingale Hospital in London would be placed on standby and remaining patients transferred to other facilities This followed reports that NHS Nightingale in London treated patients within the first three weeks of opening On May official figures revealed that Britain had the worst COVID death toll in Europe prompting calls for an inquiry into the handling of the pandemic The death toll in the United Kingdom was nearly for those tested positive for the virus Later it was calculated at after taking the official death count for Scotland and Northern Ireland into account On April it was reported that the UK would have first access to the Oxford vaccine due to a prior contract should the trial be successful some million doses in the UK would be available France Main article COVID pandemic in France France has been transferring COVID patients from overloaded hospitals to hospitals in other regions via military helicopters as seen here at Strasbourg Airport Although it was originally thought the pandemic reached France on January when the first COVID case in Europe was confirmed in Bordeaux it was later discovered that a person near Paris had tested positive for the virus on December after retesting old samples A key event in the spread of the disease in the country was the annual assembly of the Christian Open Door Church between and February in Mulhouse which was attended by about people at least half of whom are believed to have contracted the virus On March Prime Minister Édouard Philippe ordered the closure of all non essential public places and on March French President Emmanuel Macron announced mandatory home confinement a policy which was extended at least until May As of April France has reported more than confirmed cases deaths and recoveries ranking fourth in number of confirmed cases In April there were riots in some Paris suburbs On May it was reported that schools in France had to close again after reopening due to COVID case flare ups Sweden Main article COVID pandemic in Sweden Sweden differed from most other European countries in that it mostly remained open Per the Swedish Constitution the Public Health Agency of Sweden has autonomy which prevents political interference and the agency's policy favored forgoing a lockdown in an attempt to reach herd immunity The New York Times said that as of May the outbreak had been far deadlier there but the economic impact had been reduced as Swedes have continued to go to work restaurants and shopping On May it was reported that the country had in the week of May the highest per capita deaths in Europe deaths per million per day North America Main article COVID pandemic in North America United States Main article COVID pandemic in the United States Cases of COVID per residents by county On January the first known case of COVID was confirmed in the Pacific Northwest state of Washington in a man who had returned from Wuhan on January On January the Trump administration declared a public health emergency and restricted entry for travellers from China who were not U S citizens On January the Centers for Disease Control and Prevention CDC announced they had developed their own testing kit Despite this the United States had a slow start in testing which obscured the extent of the outbreak Testing was marred by defective test kits produced by the government in February a lack of federal approval for non government test kits and restrictive criteria for people to qualify for a test By March there were confirmed cases half of them in California Florida and New York had declared their first two cases and the state of Washington reported many suspected cases and the first death Vice President Pence maintained that the threat of the virus spreading throughout the U S was small Donald Trump signs the Coronavirus Preparedness and Response Supplemental Appropriations Act into law with Alex Azar on March On March President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act which provided billion in emergency funding for federal agencies to respond to the outbreak Corporations encouraged employees to work from home Sports events and seasons were cancelled On March Trump declared a national emergency which made federal funds available to respond to the crisis Beginning on March many businesses closed or reduced hours and schools across the country were shutting down By March the epidemic had been confirmed in all fifty states and in the District of Columbia On March the United States had more confirmed cases than any other country U S federal health inspectors surveyed hospitals in late March reporting severe shortages of test supplies widespread shortages of personal protective equipment PPE and other strained resources due to extended patient stays while awaiting test results The hospital ship USNS Comfort arrives in Manhattan On April it was reported that two Californians had died from the virus not as previously thought influenza on and February three weeks before the first official COVID death in the U S had been acknowledged By April cases had been confirmed and people had died As of May according to a New York Times database more than people had been infected and at least had died in the United States The Times said that prior to April only deaths confirmed through testing were reported but new criteria include probable cases and deaths As of May the U S which accounts for about percent of the world's population had about percent of the confirmed coronavirus deaths The White House has been criticised for downplaying the threat and controlling the messaging directing health officials and scientists to coordinate public statements and publications related to the virus with the office of Vice President Mike Pence On April President Trump halted funding to the World Health Organization WHO saying they mismanaged the pandemic He also said the U S would not participate in a global effort with the WHO to develop a vaccine and drugs to combat the virus On May the CDC presented a page report titled Guidance for Implementing the Opening Up America Again Framework to the administration written to provide advice for faith leaders places of business and other public places educators and state and local officials as they reopened The White House refused to use the report and Trump said he felt the guidelines were too restrictive commenting I see the new normal being what it was three months ago I think we want to go back to where it was By mid May reports of new cases began to level off and most states began to open restaurants and other places of business placing limits to the numbers of people allowed in the establishment at the same time The head of the NIAID Anthony Fauci warned that if caution was not used the rate of infections could rebound and he was particularly concerned about opening the schools in the fall President Trump expressed disapproval of Fauci's statements saying To me it's not an acceptable answer especially when it comes to schools By mid June new cases began to rise once again with increases in the percent of positive tests and number of hospitalizations occurring in states such as Texas California Florida and Arizona South America Main article COVID pandemic in South America Workers being trained to disinfect buses in Olinda Pernambuco Brazil March The pandemic was confirmed to have reached South America on February when Brazil confirmed a case in São Paulo By April all countries and territories in South America had recorded at least one case On April the highest number of cases and deaths was registered in Brazil followed by Peru and Chile in the number of confirmed cases On May it was reported that Latin America and the Caribbean had reported over cases of infection with deaths On May citing especially the rapid increase of infections in Brazil the WHO declared that South America is presently the epicentre of the coronavirus pandemic As of June South America has more than million confirmed cases and more than deaths However due to a dearth of testing and medical facilities it is believed that the outbreak is far larger than the official numbers show Brazil Main article COVID pandemic in Brazil On May it was reported that Brazil had a record deaths in a single day for a total of almost fatalities With a total number of almost cases Brazil became the country with the third highest number of cases following Russia and the United States On May Brazil exceeded the number of reported cases in Russia when they reported that new cases had been confirmed over the previous hours bringing the total number to over with more than deaths President Jair Bolsonaro has created a great deal of controversy referring to the virus as a little flu and frequently speaking out against preventive measures such as lockdowns and quarantines His attitude towards the outbreak has so closely matched that of U S president Donald Trump he has been called the Trump of the Tropics In June the government of Brazil attempted to conceal the actual figures of the COVID active cases and deaths as it stopped publishing the total number of infections and deaths On June Brazil's health ministry took down the official website reflecting the total numbers of infections and deaths The website was live on June with only the number of infections of previous hours The last official numbers reported about infections and over deaths On June it was reported that the worldwide cases had jumped from seven to eight million in one week citing Latin America specifically Brazil as one of the countries where cases are surging in this case towards million cases Africa Main article COVID pandemic in Africa U S Air Force airmen unload a C aircraft carrying approximately kg lb of medical supplies in Niamey Niger April According to Michael Yao WHO's head of emergency operations in Africa early detection is vital because the continent's health systems are already overwhelmed by many ongoing disease outbreaks Advisers say that a strategy based on testing could allow African countries to minimise lockdowns that inflict enormous hardship on those who depend on income earned day by day to be able to feed themselves and their families Even in the best scenario the United Nations says million test kits and ventilators will be needed by the continent's billion people in Most of the reported cases are from six countries South Africa Nigeria Ghana Morocco Egypt and Algeria but it is believed that there is widespread under reporting in other African countries with poorer health care systems Cases have been confirmed in all African countries with Lesotho the last country to report its first coronavirus case on May There have been no reported cases in the British Overseas Territory of Saint Helena Ascension and Tristan da Cunha Oceania Main article COVID pandemic in Oceania The pandemic was confirmed to have reached Oceania on January with the first confirmed case reported in Melbourne Australia It has since spread elsewhere in the region although many small Pacific island nations have thus far avoided the outbreak by closing their international borders As of July ten Oceania sovereign states have yet to report a case Kiribati Marshall Islands Federated State of Micronesia Nauru Palau Samoa Solomon Islands Tonga Tuvalu and Vanuatu On May Australia filed a motion with the UN for an inquiry into the origins of the virus and the response of the UN and governments More than countries supported this motion and it was passed unanimously International responses Further information Timeline of the COVID pandemic Travel restrictions Main article Travel restrictions related to the COVID pandemic As a result of the pandemic many countries and regions imposed quarantines entry bans or other restrictions either for citizens recent travellers to affected areas or for all travellers Together with a decreased willingness to travel this had a negative economic and social impact on the travel sector Concerns have been raised over the effectiveness of travel restrictions to contain the spread of COVID A study in Science found that travel restrictions had only modestly affected the initial spread of COVID unless combined with infection prevention and control measures to considerably reduce transmissions Researchers concluded that travel restrictions are most useful in the early and late phase of an epidemic and restrictions of travel from Wuhan unfortunately came too late The European Union rejected the idea of suspending the Schengen free travel zone and introducing border controls with Italy a decision which has been criticised by some European politicians Evacuation of foreign citizens Main article Evacuations related to the COVID pandemic Ukraine evacuates Ukrainian and foreign citizens from Wuhan China Owing to the effective quarantine of public transport in Wuhan and Hubei several countries evacuated their citizens and diplomatic staff from the area primarily through chartered flights of the home nation with Chinese authorities providing clearance Canada the United States Japan India Sri Lanka Australia France Argentina Germany and Thailand were among the first to plan the evacuation of their citizens Brazil and New Zealand also evacuated their own nationals and some other people On March South Africa repatriated South Africans who tested negative for the virus from Wuhan while four who showed symptoms were left behind to mitigate risk Pakistan said it would not evacuate citizens from China On February the U S announced it would evacuate Americans aboard the cruise ship Diamond Princess and on February Canada evacuated Canadian passengers from the ship In early March the Indian government began evacuating its citizens from Iran On March the United States began to partially withdraw its troops from Iraq due to the pandemic International aid Aid to China Some Chinese students at American universities sent aid including N masks on January The humanitarian aid organisation Direct Relief sent face masks and other personal protective equipment to the Wuhan Union Hospital the same day On February the Chinese foreign ministry said countries including Belarus Pakistan Trinidad and Tobago Egypt and Iran had sent aid to China and Bill and Melinda Gates announced a million donation to the WHO to fund vaccine research and treatment efforts and protect at risk populations in Africa and South Asia Interaksyon said the Chinese government had donated masks to the Philippines on February after Philippine senator Richard Gordon shipped million masks to Wuhan On February the Singapore Red Cross announced it would send million worth of aid to China Several countries donated masks medical equipment or money to China including Japan Turkey Russia Malaysia Germany and Canada The U S State Department said on February it had facilitated the transportation of nearly tons of medical supplies to China The same day U S Secretary of State Pompeo announced a million pledge to China and other countries to aid their fights against the virus though on March China said it had not received epidemic funding from the U S government and reiterated that on April citation needed Several corporations have also donated money or medical equipment to China Aid to the world Medical supplies donated by China being received at Villamor Air Base in the Philippines After cases in China stabilised the country began sending aid to other nations In March China Cuba and Russia sent medical supplies and experts to help Italy deal with its coronavirus outbreak China sent three medical teams and donated more than forty tons of medical supplies to Italy Businessman Jack Ma sent million testing kits million face masks and protective suits to Ethiopia for distribution by the African Union He later sent testing kits face masks and ventilators to Panama The Netherlands Spain Turkey Georgia and the Czech Republic expressed concerns over Chinese made masks and test kits For instance Spain withdrew Chinese made coronavirus testing kits with an accuracy rate of percent while the Netherlands recalled Chinese face masks which were said to be defective but China said this was due to misuse Belgium recalled unusable masks which were thought to be from China but were in fact from Colombia The Philippines stopped using test kits donated by China due to their percent accuracy The Chinese government said product instructions might not have been followed and that some products were not purchased directly from certified companies Chinese aid was well received in parts of Latin America and Africa On April the World Bank launched emergency support operations for developing countries According to a statement from its Ministry of Foreign Affairs Turkey provides the largest amount of humanitarian aid in the world while ranking third worldwide in supplying medical aid WHO response measures Main article World Health Organization's response to the COVID pandemic WHO Director General Tedros Adhanom Taiwan posted an inquiry to the WHO on December The WHO has commended the Chinese authorities for providing regular updates contrasting it to the SARS outbreak when they were accused of secrecy The WHO said on January that cases of pneumonia of unknown cause had been reported and issued technical briefings on and January warning of risks of human to human transmission and urging precautions due to the similarity to earlier SARS and MERS outbreaks though in public announcements it said there was no clear evidence of human to human transmission as late as January On January the WHO said it was now very clear human to human transmission of the coronavirus had occurred given that healthcare workers had been infected On January the WHO assessed the risk of the outbreak to be high at the global level On January the WHO declared the outbreak a Public Health Emergency of International Concern PHEIC warning that all countries should be prepared for containment including active surveillance early detection isolation and case management contact tracing and prevention of onward spread of the virus following an increase in cases outside China This was the sixth ever PHEIC since the measure was first invoked during the swine flu pandemic WHO Director General Tedros Adhanom said the PHEIC was due to the risk of global spread especially to low and middle income countries without robust health systems but that the WHO did not recommend limiting trade and movement WHO representatives with Tehran city managers On February the WHO established COVID as the name of the disease and UN Secretary General António Guterres agreed to provide the power of the entire UN system in the response A UN Crisis Management Team was activated allowing coordination of the entire United Nations which the WHO said will allow them to focus on the health response while the other agencies can bring their expertise to bear on the wider social economic and developmental implications of the outbreak On February the WHO declared the world should do more to prepare for a possible coronavirus pandemic stating that while it was too early to call it a pandemic countries should be in a phase of preparedness On February WHO officials said the coronavirus threat assessment at the global level would be raised from high to very high its highest level of alert and risk assessment On March the WHO declared the coronavirus outbreak a pandemic The Director General said the WHO was deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction Critics have said the WHO handled the pandemic inadequately and that the PHEIC and pandemic classification came too late The third meeting of the WHO Emergency Committee on April renewed the declaration of PHEIC for the second time Impact Main article Impact of the COVID pandemic Further information Social impact of the COVID pandemic Economics Main article Economic impact of the COVID pandemic See also Impact of the COVID pandemic on aviation on science and technology on financial markets stock market crash and Coronavirus recession Those who can put something in those who can't help yourself Bologna April The outbreak is a major destabilising threat to the global economy Agathe Demarais of the Economist Intelligence Unit has forecast that markets will remain volatile until a clearer image emerges on potential outcomes One estimate from an expert at Washington University in St Louis gave a billion impact on the world's supply chain that could last up to two years Global stock markets fell on February due to a significant rise in the number of COVID cases outside China On February due to mounting worries about the coronavirus outbreak U S stock indexes posted their sharpest falls since with the Dow falling points the largest one day drop since the financial crisis of and all three major indexes ending the week down more than percent On February Scope Ratings GmbH affirmed China's sovereign credit rating but maintained a Negative Outlook Stocks plunged again due to coronavirus fears the largest fall being on March Many consider an economic recession likely Lloyd's of London has estimated that the global insurance industry will absorb losses of US billion exceeding the losses from the Atlantic Hurricane season and suggesting the COVID pandemic will likely go down in history as the costliest disaster ever in human history A highway sign on the Gardiner Expressway in Toronto discouraging non essential travel Tourism is one of the worst affected sectors due to travel bans closing of public places including travel attractions and advice of governments against travel Numerous airlines have cancelled flights due to lower demand and British regional airline Flybe collapsed The cruise line industry was hard hit and several train stations and ferry ports have also been closed International mail between some countries stopped or was delayed due to reduced transportation between them or suspension of domestic service The retail sector has been impacted globally with reductions in store hours or temporary closures Visits to retailers in Europe and Latin America declined by percent North America and Middle East retailers saw a percent drop This also resulted in a percent drop in foot traffic to shopping centres in March compared to February Shopping mall operators around the world imposed additional measures such as increased sanitation installation of thermal scanners to check the temperature of shoppers and cancellation of events Hundreds of millions of jobs could be lost globally More than million Americans lost their jobs and filed unemployment insurance claims According to a United Nations Economic Commission for Latin America estimate the pandemic induced recession could leave million more people in extreme poverty in Latin America than would have been in that situation without the pandemic Supply shortages Main article Shortages related to the COVID pandemic Coronavirus fears have led to panic buying of essentials across the world including toilet paper dried and or instant noodles bread rice vegetables disinfectant and rubbing alcohol The outbreak has been blamed for several instances of supply shortages stemming from globally increased usage of equipment to fight outbreaks panic buying which in several places led to shelves being cleared of grocery essentials such as food toilet paper and bottled water and disruption to factory and logistic operations The spread of panic buying has been found to stem from perceived threat perceived scarcity fear of the unknown coping behaviour and social psychological factors e g social influence and trust The technology industry in particular has warned of delays to shipments of electronic goods According to the WHO director general Tedros Adhanom demand for personal protection equipment has risen a hundredfold leading to prices up to twenty times the normal price and also delays in the supply of medical items of four to six months It has also caused a shortage of personal protective equipment worldwide with the WHO warning that this will endanger health workers The impact of the coronavirus outbreak was worldwide The virus created a shortage of precursors raw material used in the manufacturing of fentanyl and methamphetamine The Yuancheng Group headquartered in Wuhan China is one of the leading suppliers Price increases and shortages in these illegal drugs have been noticed on the street of the UK U S law enforcement also told the New York Post Mexican drug cartels were having difficulty in obtaining precursors The pandemic has disrupted global food supplies and threatens to trigger a new food crisis David Beasley head of the World Food Programme WFP said we could be facing multiple famines of biblical proportions within a short few months Senior officials at the United Nations estimated in April that an additional million people could starve for a total of million by the end of Oil and other energy markets In early February Organization of the Petroleum Exporting Countries OPEC scrambled after a steep decline in oil prices due to lower demand from China On Monday April the price of West Texas Intermediate WTI went negative and fell to a record low minus a barrel due to traders' offloading holdings so as not to take delivery and incur storage costs June prices were down but in the positive range with a barrel of West Texas trading above Culture Main article List of events affected by the COVID pandemic Further information Impact of the COVID pandemic on the arts and cultural heritage on cinema on religion on sports on television on video games on performing arts and on music Closed entrance to the Shah Abdol Azim Shrine in Ray Iran The performing arts and cultural heritage sectors have been profoundly affected by the pandemic impacting organisations' operations as well as individuals both employed and independent globally Arts and culture sector organisations attempted to uphold their often publicly funded mission to provide access to cultural heritage to the community maintain the safety of their employees and the public and support artists where possible By March across the world and to varying degrees museums libraries performance venues and other cultural institutions had been indefinitely closed with their exhibitions events and performances cancelled or postponed In response there were intensive efforts to provide alternative services through digital platforms A man wearing purple vestments and standing at an altar uses a mobile phone camera to record himself Empty pews are visible in the background An American Catholic military chaplain prepares for a live streamed Mass in an empty chapel at Offutt Air Force Base in March Holy Week observances in Rome which occur during the last week of the Christian penitential season of Lent were cancelled Many dioceses have recommended older Christians stay home rather than attend Mass on Sundays services have been made available via radio online live streaming and television though some congregations have made provisions for drive in worship With the Roman Catholic Diocese of Rome closing its churches and chapels and St Peter's Square emptied of Christian pilgrims other religious bodies also cancelled in person services and limited public gatherings in churches mosques synagogues temples and gurdwaras Iran's Health Ministry announced the cancellation of Friday prayers in areas affected by the outbreak and shrines were later closed while Saudi Arabia banned the entry of foreign pilgrims as well as its residents to holy sites in Mecca and Medina The pandemic has caused the most significant disruption to the worldwide sporting calendar since the Second World War Most major sporting events have been cancelled or postponed including the UEFA Champions League Premier League UEFA Euro NBA season and NHL season The outbreak disrupted plans for the Summer Olympics which were originally scheduled to start at the end of July the International Olympic Committee announced on March that they will be rescheduled to a date beyond but not later than summer The entertainment industry has also been affected with many music groups suspending or cancelling concert tours The Eurovision Song Contest which was due to be held in the Netherlands in May was cancelled however the Netherlands was retained as host for Many large theatres such as those on Broadway also suspended all performances Some artists have explored ways to continue to produce and share work over the internet as an alternative to traditional live performance such as live streaming concerts or creating web based festivals for artists to perform distribute and publicise their work Online numerous COVID themed Internet memes have spread as many turn to humour and distraction amid the uncertainty Politics Main article Impact of the COVID pandemic on politics The pandemic has affected the political systems of multiple countries causing suspensions of legislative activities isolations or deaths of multiple politicians and rescheduling of elections due to fears of spreading the virus Starting in late May large scale protests against police brutality in at least U S cities and later worldwide in response to the killing of George Floyd raised concerns of a resurgence of the virus China Further information China United States relations COVID Chinese Communist Party general secretary Xi Jinping left with State Council Premier Li Keqiang The Chinese government has been criticised by the United States government UK Minister for the Cabinet Office Michael Gove and others for its handling of the pandemic A number of provincial level administrators of the Communist Party of China were dismissed over their handling of the quarantine efforts in central China a sign of discontent with their response to the outbreak Some commentators believed this move was intended to protect Chinese Communist Party general secretary Xi Jinping from the controversy The U S intelligence community says China intentionally under reported its number of coronavirus cases The Chinese government maintains it has acted swiftly and transparently Italy In early March the Italian government criticised the European Union's lack of solidarity with coronavirus affected Italy Maurizio Massari Italy's ambassador to the EU said only China responded bilaterally not the EU On March after a phone call with Italian Prime Minister Giuseppe Conte Russian president Vladimir Putin had the Russian army send military medics disinfection vehicles and other medical equipment to Italy President of Lombardy Attilio Fontana and Italian Foreign Minister Luigi Di Maio expressed their gratitude for the aid Russia also sent a cargo plane with medical aid to the United States Kremlin spokesman Dmitry Peskov said when offering assistance to U S colleagues Putin assumes that when U S manufacturers of medical equipment and materials gain momentum they will also be able to reciprocate if necessary In early April Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant and Ursula von der Leyen offered an official apology to the country United States Several hundred anti lockdown protesters rallied at the Ohio Statehouse April The outbreak prompted calls for the United States to adopt social policies common in other wealthy countries including universal health care universal child care paid sick leave and higher levels of funding for public health Political analysts anticipated it may negatively affect Donald Trump's chances of re election Beginning in mid April there were protests in several U S states against government imposed business closures and restricted personal movement and association Other countries The planned NATO Defender military exercise in Germany Poland and the Baltic states the largest NATO war exercise since the end of the Cold War will be held on a reduced scale The Campaign for Nuclear Disarmament's general secretary Kate Hudson criticised the exercise saying it jeopardises the lives not only of the troops from the U S and the many European countries participating but the inhabitants of the countries in which they are operating The Iranian government has been heavily affected by the virus with about two dozen parliament members and fifteen current or former political figures infected Iran's President Hassan Rouhani wrote a public letter to world leaders asking for help on March saying they were struggling to fight the outbreak due to a lack of access to international markets from the United States sanctions against Iran Saudi Arabia which launched a military intervention in Yemen in March declared a ceasefire Diplomatic relations between Japan and South Korea worsened due to the pandemic South Korea criticised Japan's ambiguous and passive quarantine efforts after Japan announced anyone coming from South Korea would be placed in quarantine for two weeks at government designated sites South Korean society was initially polarised on President Moon Jae in's response to the crisis many Koreans signed petitions either calling for Moon's impeachment or praising his response Some countries have passed emergency legislation in response to the pandemic Some commentators have expressed concern that it could allow governments to strengthen their grip on power In the Philippines lawmakers granted president Rodrigo Duterte temporary emergency powers during the pandemic In Hungary the parliament voted to allow the prime minister Viktor Orbán to rule by decree indefinitely suspend parliament as well as elections and punish those deemed to have spread false information about the virus and the government's handling of the crisis In some countries including Egypt Turkey and Thailand opposition activists and government critics have been arrested for allegedly spreading fake news about the COVID pandemic Education Main article Impact of the COVID pandemic on education Learners affected by school closures caused by COVID as of June Country wide school closures Localized school closures No school closures No data The pandemic has affected educational systems worldwide leading to the near total closures of schools universities and colleges Most governments around the world have temporarily closed educational institutions in an attempt to contain the spread of COVID As of June approximately billion learners are currently affected due to school closures in response to the pandemic According to UNICEF monitoring countries are currently implementing nationwide closures and are implementing local closures impacting about percent of the world's student population countries' schools are currently open On March Cambridge International Examinations CIE released a statement announcing the cancellation of Cambridge IGCSE Cambridge O Level Cambridge International AS A Level Cambridge AICE Diploma and Cambridge Pre U examinations for the May June series across all countries International Baccalaureate exams have also been cancelled In addition Advanced Placement Exams SAT administrations and ACT administrations have been moved online and cancelled School closures impact not only students teachers and families but have far reaching economic and societal consequences School closures in response to the pandemic have shed light on various social and economic issues including student debt digital learning food insecurity and homelessness as well as access to childcare health care housing internet and disability services The impact was more severe for disadvantaged children and their families causing interrupted learning compromised nutrition childcare problems and consequent economic cost to families who could not work In response to school closures UNESCO recommended the use of distance learning programs and open educational applications and platforms that schools and teachers can use to reach learners remotely and limit the disruption of education Other health issues Main article Impact of the COVID pandemic on other health issues The pandemic has had many impacts on global health beyond those caused by the COVID disease itself It has led to a reduction in hospital visits for other reasons There have been per cent fewer hospital visits for heart attack symptoms in the United States and per cent fewer in Spain The head of cardiology at the University of Arizona said My worry is some of these people are dying at home because they're too scared to go to the hospital There is also concern that people with strokes and appendicitis are not seeking timely treatment Shortages of medical supplies have impacted people with various conditions In several countries there has been a marked reduction of spread of sexually transmitted infections including HIV attributable to COVID quarantines social distancing measures and recommendations to not engage in casual sex Similarly in some places rates of transmission of influenza and other respiratory viruses significantly decreased during the pandemic The pandemic has also negatively impacted mental health globally including increased loneliness resulting from social distancing Environment and climate Main article Impact of the COVID pandemic on the environment Images from the NASA Earth Observatory show a stark drop in pollution in Wuhan China when comparing NO levels in early top and early bottom The worldwide disruption caused by the pandemic has resulted in numerous impacts on the environment and the climate The considerable decline in planned travel has caused many regions to experience a large drop in air pollution In China lockdowns and other measures resulted in a per cent reduction in carbon emissions and per cent reduction in nitrogen oxides emissions which one Earth systems scientist estimated may have saved at least lives over two months Other positive impacts on the environment include governance system controlled investments towards a sustainable energy transition and other goals related to environmental protection such as the European Union's seven year € trillion budget proposal and € billion recovery plan Next Generation EU which seeks to reserve of EU spending for climate friendly expenditure However the outbreak has also provided cover for illegal activities such as deforestation of the Amazon rainforest and poaching in Africa hindered environmental diplomacy efforts and created economic fallout that some predict will slow investment in green energy technologies Xenophobia and racism Main article List of incidents of xenophobia and racism related to the COVID pandemic Since the start of the outbreak heightened prejudice xenophobia and racism have been documented around the world toward people of Chinese and East Asian descent Reports from February when most cases were confined to China documented racist sentiments expressed in groups worldwide about Chinese people deserving the virus Citizens in countries including Malaysia New Zealand Singapore Japan Vietnam and South Korea lobbied to ban Chinese people from entering their countries Chinese people and other Asians in the United Kingdom and United States have reported increasing levels of racist abuse and assaults U S president Donald Trump has been criticised for referring to the coronavirus as the Chinese Virus and Kung Flu which critics say is racist and anti Chinese Houston's Chinatown experienced a reduction in business early during the outbreak when there were still only a few cases Following the progression of the outbreak to new hotspot countries people from Italy the first country in Europe to experience a serious outbreak of COVID were also subjected to suspicion and xenophobia as were people from hotspots in other countries Discrimination against Muslims in India escalated after public health authorities identified an Islamic missionary group's gathering in New Delhi in early March as a source of spread Paris has seen riots break out over police treatment of ethnic minorities during the coronavirus lockdown Racism and xenophobia towards South Asians and Southeast Asians increased in the Arab states of the Persian Gulf South Korea's LGBTQ community was blamed by some for the spread of COVID in Seoul In China xenophobia and racism against non Chinese residents has been inflamed by the pandemic a comic posted on Weibo described foreigners as foreign garbage targeted for disposal Some black people were evicted from their homes by police and told to leave China within hours due to disinformation that they and other foreigners were spreading the virus Other harassment discrimination and evictions of Africans in China were alleged This racism and xenophobia was criticised by foreign governments and diplomatic corps and the Chinese ambassador to Zimbabwe A McDonald's branch in Guangzhou barring black sparked anger in China and overseas and McDonald's closed the location Information dissemination Further information Media coverage of the COVID pandemic COVID pandemic on social media and Impact of the COVID pandemic on journalism Many newspaper agencies removed their online paywalls for some or all of their coronavirus related articles and posts while scientific publishers made scientific papers related to the outbreak available with open access Some scientists chose to share their results quickly on preprint servers such as bioRxiv Misinformation Main article Misinformation related to the COVID pandemic File President Donald Trump suggests measures to treat COVID during Coronavirus Task Force press briefing webm U S president Donald Trump suggested at a press briefing on April that disinfectant injections or exposure to ultraviolet light might help treat COVID There is no evidence that either could be a viable method min The pandemic has resulted in misinformation and conspiracy theories about the scale of the pandemic and the origin prevention diagnosis and treatment of the disease False information including intentional disinformation has been spread through social media text messaging and mass media including the tabloid media conservative media and state media of countries such as China Russia Iran and Turkmenistan It has also been reportedly spread by covert operations backed by states such as Saudi Arabia Russia and China to generate panic and sow distrust in other countries In some countries such as India Bangladesh and Ethiopia journalists have been arrested for allegedly spreading fake news about the pandemic Misinformation has been propagated by celebrities politicians including heads of state in countries such as the United States Iran and Brazil and other prominent public figures Commercial scams have claimed to offer at home tests supposed preventives and miracle cures Several religious groups have claimed their faith will protect them from the virus Some people have claimed the virus is a bioweapon accidentally or purposefully leaked from a laboratory a population control scheme the result of a spy operation or the side effect of G upgrades to cellular networks The World Health Organization has declared an infodemic of incorrect information about the virus which poses risks to global health Japan Kazakhstan Luxembourg Macau Malaysia New Zealand Norway Pakistan Provincial governments have also announced fiscal measures Peru announced expenditure of from total GDP Qatar Russia Total of the recovery plan in Serbia South Korea Singapore Switzerland Thailand Turkey United Arab Emirates United States Electron micrograph of SARS CoV with its visible coronae Electron microscope image showing SARS CoV emerging from the surface of cells blue pink cultured in the lab MERS CoV particles as seen by negative stain electron microscopy Formation of Human coronavirus HKU a coronavirus causing symptoms of the common cold in humans Development of neutralizing antibodies for treating COVID In the receptor binding stage the S subunit of SARS CoV binds human ACE on the host cell surface Antibodies that bind the RBD domain on the S subunit might block the interaction of the RBD and the ACE In the viral fusion stage after the cleavage of S subunit the viral fusion peptide FP on the S subunit inserts into the host cell membrane inducing the conformational change of the S subunit which forms a six helix bundle HB with the HR and HR trimers Antibodies that target the HR domains might block viral fusion Ab antibody Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID to people who need them is being investigated as a non vaccine method of passive immunisation This strategy was tried for SARS with inconclusive results Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS CoV The spike protein of SARS CoV is the primary target for neutralizing antibodies It has been proposed that selection of broad neutralizing antibodies against SARS CoV and SARS CoV might be useful for treating not only COVID but also future SARS related CoV infections Other mechanisms however such as antibody dependent cellular cytotoxicity and or phagocytosis may be possible Other forms of passive antibody therapy for example using manufactured monoclonal antibodies are in development 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