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PreviewAdvancedSpecial charactersHelpHeadingLevel 2Level 3Level 4Level 5FormatInsertLatinLatin extendedIPASymbolsGreekGreek extendedCyrillicArabicArabic extendedHebrewBanglaTamilTeluguSinhalaDevanagariGujaratiThaiLaoKhmerCanadian AboriginalRunesÁáÀàÂâÄäÃãǍǎĀāĂ㥹ÅåĆćĈĉÇçČčĊċĐđĎďÉéÈèÊêËëĚěĒēĔĕĖėĘęĜĝĢģĞğĠġĤĥĦħÍíÌìÎîÏïĨĩǏǐĪīĬĭİıĮįĴĵĶķĹĺĻļĽľŁłŃńÑñŅņŇňÓóÒòÔôÖöÕõǑǒŌōŎŏǪǫŐőŔŕŖŗŘřŚśŜŝŞşŠšȘșȚțŤťÚúÙùÛûÜüŨũŮůǓǔŪūǖǘǚǜŬŭŲųŰűŴŵÝýŶŷŸÿȲȳŹźŽžŻżÆæǢǣØøŒœßÐðÞþƏəFormattingLinksHeadingsListsFilesDiscussionReferencesDescriptionWhat you typeWhat you getItalic''Italic text''Italic textBold'''Bold text'''Bold textBold & italic'''''Bold & italic text'''''Bold & italic textDescriptionWhat you typeWhat you getReferencePage text.<ref>[https://www.example.org/ Link text], additional text.</ref>Page text.[1]Named referencePage text.<ref name="test">[https://www.example.org/ Link text]</ref>Page text.[2]Additional use of the same referencePage text.<ref name="test" />Page text.[2]Display references<references />↑ Link text, additional text.↑ Link text== Epidemiology == {{#invoke:Infobox|infoboxTemplate |subheader=For country-level [[Template:COVID-19 pandemic data|data]], see: |subheader2=<div style="padding:3px 0; font-size:larger;">'''[[COVID-19 pandemic by country and territory]]'''</div> |image=[[File:732-bar-chart.svg|link=COVID-19 pandemic by country and territory|80px|732-bar-chart]] |rowstyle1=text-align:center |data1= <div style="display:inline-block;margin: 0 5px 10px">'''[[COVID-19 pandemic cases|Cases]]'''<br /><span style="font-size:1.2em;">{{COVID-19 data/Text|XW|cases}}</span></div><div style="display:inline-block;margin: 0 5px 10px">'''[[COVID-19 pandemic deaths|Deaths]]'''<br /><span style="font-size:1.2em;">{{COVID-19 data/Text|XW|deaths}}</span></div> <div>As of {{COVID-19 data/Date|format=j F Y}}</div> {{flatlist|class=nowraplinks|style=margin:5px 10px 5px;font-weight:bold;|1= * [[COVID-19 pandemic in Africa|Africa]] * [[COVID-19 pandemic in Asia|Asia]] * [[COVID-19 pandemic in Europe|Europe]] * [[COVID-19 pandemic in North America|North America]] * [[COVID-19 pandemic in Oceania|Oceania]] * [[COVID-19 pandemic in South America|South America]] * [[COVID-19 pandemic in Antarctica|Antarctica]] }} }} === Background === {{Main|Origin of COVID-19|COVID-19 pandemic in Hubei}} SARS-CoV-2 is a virus closely related to [[Bat virome#Coronaviruses|bat coronaviruses]],<ref name="LancetNowcasting" /> [[pangolin]] coronaviruses,<ref name="ia56U" /><ref name="Zhang6April2020">{{#invoke:cite journal||vauthors=Zhang T, Wu Q, Zhang Z|date=April 2020|title=Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak|journal=Current Biology|volume=30|issue=7|pages=1346–1351.e2|doi=10.1016/j.cub.2020.03.022|pmc=7156161|pmid=32197085|bibcode=2020CBio...30E1346Z }}</ref> and [[Severe acute respiratory syndrome coronavirus|SARS-CoV]].<ref name="ECDC risk assessment" /> The first known [[outbreak]] (the [[2019–2020 COVID-19 outbreak in mainland China]]) started in [[Wuhan]], Hubei, China, in December 2019.<ref>{{cite journal |vauthors=Liu J, Liu S, Wei H, Yang X |title=Epidemiology, clinical characteristics of the first cases of COVID-19 |journal=Eur J Clin Invest |volume=50 |issue=10 |pages=e13364 |date=October 2020 |pmid=32725884 |doi=10.1111/eci.13364 |s2cid=220852984 |type=Review}}</ref> Many early cases were linked to people who had visited the [[Huanan Seafood Wholesale Market]] there,<ref name="Sun2020epidemiology">{{#invoke:cite journal || vauthors = Sun J, He WT, Wang L, Lai A, Ji X, Zhai X, Li G, Suchard MA, Tian J, Zhou J, Veit M, Su S | title = COVID-19: Epidemiology, Evolution, and Cross-Disciplinary Perspectives | journal = Trends in Molecular Medicine | volume = 26 | issue = 5 | pages = 483–495 | date = May 2020 | pmid = 32359479 | pmc = 7118693 | doi = 10.1016/j.molmed.2020.02.008 }}</ref><ref>{{#invoke:cite news ||title=WHO Points To Wildlife Farms In Southern China As Likely Source Of Pandemic |url=https://www.npr.org/sections/goatsandsoda/2021/03/15/977527808/who-points-to-wildlife-farms-in-southwest-china-as-likely-source-of-pandemic?t=1616302540855 |publisher=[[NPR]] |date=15 March 2021}}</ref><ref name="Maxmen2021whoReport">{{#invoke:cite journal || vauthors = Maxmen A | title = WHO report into COVID pandemic origins zeroes in on animal markets, not labs | journal = Nature | volume = 592 | issue = 7853 | pages = 173–174 | date = April 2021 | pmid = 33785930 | doi = 10.1038/d41586-021-00865-8 | s2cid = 232429241 | bibcode = 2021Natur.592..173M |doi-access=free}}</ref> but it is possible that human-to-human transmission began earlier.<ref name="Hu2020natureReviews" /><ref name="Graham2020immunity">{{#invoke:cite journal || vauthors = Graham RL, Baric RS | title = SARS-CoV-2: Combating Coronavirus Emergence | journal = Immunity | volume = 52 | issue = 5 | pages = 734–736 | date = May 2020 | pmid = 32392464 | pmc = 7207110 | doi = 10.1016/j.immuni.2020.04.016 }}</ref> [[Molecular clock]] analysis suggests that the first cases were likely to have been between October and November 2019.<ref>{{#invoke:cite journal || vauthors = To KK, Sridhar S, Chiu KH, Hung DL, Li X, Hung IF, Tam AR, Chung TW, Chan JF, Zhang AJ, Cheng VC, Yuen KY | title = Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic | journal = Emerging Microbes & Infections | volume = 10 | issue = 1 | pages = 507–535 | date = December 2021 | pmid = 33666147 | pmc = 8006950 | doi = 10.1080/22221751.2021.1898291 }}</ref> The scientific consensus is that the virus is most likely of a [[zoonotic]] origin, from bats or another closely related mammal.<ref name="Hu2020natureReviews">{{#invoke:cite journal || vauthors = Hu B, Guo H, Zhou P, Shi ZL | title = Characteristics of SARS-CoV-2 and COVID-19 | journal = Nature Reviews. Microbiology | volume = 19 | issue = 3 | pages = 141–154 | date = March 2021 | pmid = 33024307 | pmc = 7537588 | doi = 10.1038/s41579-020-00459-7 }}</ref><ref>Multiple sources: * {{#invoke:cite news ||work=[[EurekAlert!]] |publisher=Scripps Research Institute |title=The COVID-19 coronavirus epidemic has a natural origin, scientists say – Scripps Research's analysis of public genome sequence data from SARS‑CoV‑2 and related viruses found no evidence that the virus was made in a laboratory or otherwise engineered |url=https://www.eurekalert.org/pub_releases/2020-03/sri-tcc031720.php |date=17 March 2020 |access-date=15 April 2020 }} * {{#invoke:cite journal || vauthors = Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF | title = The proximal origin of SARS-CoV-2 | journal = Nature Medicine | volume = 26 | issue = 4 | pages = 450–452 | date = April 2020 | pmid = 32284615 | pmc = 7095063 | doi = 10.1038/s41591-020-0820-9 | doi-access = free }} * {{#invoke:cite journal || vauthors = Latinne A, Hu B, Olival KJ, Zhu G, Zhang L, Li H, Chmura AA, Field HE, Zambrana-Torrelio C, Epstein JH, Li B, Zhang W, Wang LF, Shi ZL, Daszak P | title = Origin and cross-species transmission of bat coronaviruses in China | journal = Nature Communications | volume = 11 | issue = 1 | page = 4235 | date = August 2020 | pmid = 32843626 | pmc = 7447761 | doi = 10.1038/s41467-020-17687-3 | bibcode = 2020NatCo..11.4235L }} * {{#invoke:cite news || vauthors = Fox M |date=7 July 2021 |title=Coronavirus almost certainly came from an animal, not a lab leak, top scientists argue |url=https://www.cnn.com/2021/07/07/health/origins-coronavirus-letter-virologists-scn/index.html |work=CNN |location= |access-date=9 July 2021}} * {{#invoke:cite news ||author=<!--Staff writer(s)/no by-line.--> |date=19 November 2021 |title=Market in China's Wuhan likely origin of COVID-19 outbreak – study |url=https://www.reuters.com/world/market-chinas-wuhan-likely-origin-covid-19-outbreak-study-2021-11-19/ |work=Reuters |location= |access-date=19 November 2021}}</ref><ref name="To2021lessons">{{#invoke:cite journal||vauthors=To KK, Sridhar S, Chiu KH, Hung DL, Li X, Hung IF, Tam AR, Chung TW, Chan JF, Zhang AJ, Cheng VC, Yuen KY|date=March 2021|title=Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic|journal=Emerging Microbes & Infections|volume=10|issue=1|pages=507–535|doi=10.1080/22221751.2021.1898291|pmc=8006950|pmid=33666147}}</ref> While other explanations such as speculations that SARS-CoV-2 was accidentally [[COVID-19 lab leak theory|released from a laboratory]] have been proposed,<ref name="CovidMayHave">{{cite news |last1=Horowitz |first1=Josh |last2=Stanway |first2=David |date=9 February 2021 |title=COVID may have taken 'convoluted path' to Wuhan, WHO team leader says |publisher=Reuters |url=https://www.reuters.com/article/us-health-coronavirus-who-china/covid-may-have-taken-convoluted-path-to-wuhan-who-team-leader-says-idUSKBN2A90BW |url-status=live |access-date=10 February 2021 |archive-url=https://web.archive.org/web/20210210092128/https://www.reuters.com/article/us-health-coronavirus-who-china/covid-may-have-taken-convoluted-path-to-wuhan-who-team-leader-says-idUSKBN2A90BW |archive-date=10 February 2021}}</ref><ref name="nofact">{{cite news |last1=Pauls |first1=Karen |last2=Yates |first2=Jeff |date=27 January 2020 |title=Online claims that Chinese scientists stole coronavirus from Winnipeg lab have 'no factual basis' |publisher=Canadian Broadcasting Corporation |url=https://www.cbc.ca/news/canada/manitoba/china-coronavirus-online-chatter-conspiracy-1.5442376 |url-status=live |access-date=8 February 2020 |archive-url=https://web.archive.org/web/20200208134329/https://www.cbc.ca/news/canada/manitoba/china-coronavirus-online-chatter-conspiracy-1.5442376 |archive-date=8 February 2020}}</ref><ref name="20200208economist">{{cite news |date=8 February 2020 |title=China's rulers see the coronavirus as a chance to tighten their grip |newspaper=[[The Economist]] |url=https://www.economist.com/china/2020/02/08/chinas-rulers-see-the-coronavirus-as-a-chance-to-tighten-their-grip |url-status=live |access-date=29 February 2020 |archive-url=https://archive.today/20200229034330/https://www.economist.com/china/2020/02/08/chinas-rulers-see-the-coronavirus-as-a-chance-to-tighten-their-grip |archive-date=29 February 2020}}</ref> these are not supported by evidence.<ref name="Holmes2021">{{cite journal | vauthors = Holmes EC, Goldstein SA, Rasmussen AL, Robertson DL, Crits-Christoph A, Wertheim JO, Anthony SJ, Barclay WS, Boni MF, Doherty PC, Farrar J |title=The Origins of SARS-CoV-2: A Critical Review |journal=Cell |date=August 2021 | volume = 184 | issue = 19 | pages = 4848–4856 |doi=10.1016/j.cell.2021.08.017| pmid = 34480864 |pmc=8373617 }}</ref> === Cases === {{Main|COVID-19 pandemic by country and territory|COVID-19 pandemic cases}} Official "case" counts refer to the number of people who have been [[COVID-19 testing|tested for COVID-19]] and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease.<ref name="1ceLG">{{#invoke:cite web || url=https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117 |title=Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases |publisher=[[World Health Organization]] (WHO) |access-date=30 March 2020}}</ref><ref name="J0rix">{{#invoke:cite web || url=https://ourworldindata.org/grapher/full-list-cumulative-total-tests-per-thousand |title=Total tests for COVID-19 per 1,000 people |website=Our World in Data |access-date=16 April 2020}}</ref> Due to the effect of [[sampling bias]], studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts.<ref name="WqXOo">{{#invoke:cite web || url=https://www.imperial.ac.uk/medicine/departments/school-public-health/infectious-disease-epidemiology/mrc-global-infectious-disease-analysis/covid-19/report-13-europe-npi-impact/ |title=Report 13 – Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries |website=Imperial College London |access-date=7 April 2020}}</ref><ref name="BtFLV">{{#invoke:cite journal || vauthors = Lau H, Khosrawipour V, Kocbach P, Mikolajczyk A, Ichii H, Schubert J, Bania J, Khosrawipour T | title = Internationally lost COVID-19 cases | journal = Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi | volume = 53 | issue = 3 | pages = 454–458 | date = June 2020 | pmid = 32205091 | pmc = 7102572 | doi = 10.1016/j.jmii.2020.03.013 }}</ref> Many countries, early on, had official policies to not test those with only mild symptoms.<ref name="elpais640000">{{#invoke:cite news || url=https://english.elpais.com/society/2020-03-23/640000-rapid-coronavirus-tests-arrive-in-spain.html |title=640,000 rapid coronavirus tests arrive in Spain | vauthors = Sevillano EG, Linde P, Vizoso S |date=23 March 2020 |newspaper=El País English Edition |access-date=2 April 2020 }}</ref><ref name="20200313reuters">{{#invoke:cite news || vauthors = Parodi E, Jewkes S, Cha S, Park JM |date=12 March 2020 |title=Special Report: Italy and South Korea virus outbreaks reveal disparity in deaths and tactics |work=[[Reuters]] |url=https://www.reuters.com/article/us-health-coronavirus-response-specialre-idUSKBN20Z27P |url-status=live |access-date=11 May 2022 |archive-url=https://web.archive.org/web/20200312210714/https://www.reuters.com/article/us-health-coronavirus-response-specialre-idUSKBN20Z27P |archive-date=12 March 2020}}</ref> The strongest risk factors for severe illness are obesity, [[complications of diabetes]], anxiety disorders, and the total number of conditions.<ref>{{#invoke:cite journal || vauthors = Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, Chevinsky JR, Schieber LZ, Summers AD, Lavery AM, Preston LE, Danielson ML, Cui Z, Namulanda G, Yusuf H, Mac Kenzie WR, Wong KK, Baggs J, Boehmer TK, Gundlapalli AV | title = Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020 – March 2021 | journal = Preventing Chronic Disease | volume = 18 | pages = E66 | date = July 2021 | pmid = 34197283 | pmc = 8269743 | doi = 10.5888/pcd18.210123 | publisher = Centers for Disease Control and Prevention }}</ref> During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested.<ref name="vox21190033">{{#invoke:cite web || url=https://www.vox.com/2020/3/23/21190033/coronavirus-covid-19-deaths-by-age |title=The Covid-19 risks for different age groups, explained | vauthors = Scott D |date=23 March 2020 |website=Vox |access-date=12 April 2020}}</ref> A retrospective [[cohort study]] in China found that [[Impact of the COVID-19 pandemic on children|children]] and adults were just as likely to be infected.<ref name="489Q3">{{#invoke:cite journal || vauthors = Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, Liu X, Wei L, Truelove SA, Zhang T, Gao W, Cheng C, Tang X, Wu X, Wu Y, Sun B, Huang S, Sun Y, Zhang J, Ma T, Lessler J, Feng T | title = Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study | journal = The Lancet. Infectious Diseases | volume = 20 | issue = 8 | pages = 911–919 | date = August 2020 | pmid = 32353347 | pmc = 7185944 | doi = 10.1016/S1473-3099(20)30287-5 }}</ref> Among more thorough studies, [[COVID-19 Case-Cluster-Study|preliminary results]] from 9 April 2020, found that in [[Gangelt]], the centre of a major infection cluster in Germany, 15 percent of a population sample tested positive for [[antibody|antibodies]].<ref name="otW1O">{{#invoke:cite web || url=https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf |title=Vorläufiges Ergebnis und Schlussfolgerungen der COVID-19 Case-Cluster-Study (Gemeinde Gangelt) | vauthors = Streeck H |date=9 April 2020 |website=Land NRW – State of North Rhine-Westphalia |access-date=13 April 2020}}</ref> Screening for COVID-19 in pregnant women [[COVID-19 pandemic in New York City|in New York City]], and [[blood donor]]s in the Netherlands, found rates of positive antibody tests that indicated more infections than reported.<ref name="rCdvL">{{#invoke:cite journal || vauthors = Sutton D, Fuchs K, D'Alton M, Goffman D | title = Universal Screening for SARS-CoV-2 in Women Admitted for Delivery | journal = The New England Journal of Medicine | volume = 382 | issue = 22 | pages = 2163–2164 | date = May 2020 | pmid = 32283004 | pmc = 7175422 | doi = 10.1056/NEJMc2009316 }}</ref><ref name="20200416reuters">{{#invoke:cite news ||url=https://www.reuters.com/article/us-health-coronavirus-netherlands-study-idUSKCN21Y102 |title=Dutch study suggests 3% of population may have coronavirus antibodies |date=16 April 2020 |work=Reuters |access-date=20 April 2020}}</ref> [[Seroprevalence]]-based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies.<ref name="0LgFK">{{#invoke:cite web || title=Interactive Serology Dashboard for Commercial Laboratory Surveys |url=https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-labs-interactive-serology-dashboard.html |date=21 July 2020 |access-date=24 July 2020 |publisher=Centres for Disease Control and Prevention}}</ref> Initial estimates of the [[basic reproduction number]] (R<sub>0</sub>) for COVID-19 in January 2020 were between 1.4 and 2.5,<ref name="WFNfK">{{#invoke:cite web || url=https://www.who.int/news-room/detail/23-01-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) |title=Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus 2019 (n-CoV) on 23 January 2020 |publisher=[[World Health Organization]] (WHO) |access-date=9 April 2020}}</ref> but a subsequent analysis claimed that it may be about 5.7 (with a 95 percent [[confidence interval]] of 3.8 to 8.9).<ref name="mmCQc">{{#invoke:cite journal || vauthors = Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R | title = High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2 | journal = Emerging Infectious Diseases | volume = 26 | issue = 7 | pages = 1470–1477 | date = July 2020 | pmid = 32255761 | pmc = 7323562 | doi = 10.3201/eid2607.200282 | s2cid = 215410037 }}</ref> In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28{{nbsp}}December, 282,790,822 individuals worldwide had been confirmed as infected.<ref>{{#invoke:cite web ||title=ArcGIS Dashboards |url=https://gisanddata.maps.arcgis.com/apps/dashboards/bda7594740fd40299423467b48e9ecf6 |publisher=gisanddata.maps.arcgis.com |access-date=22 December 2021}}</ref> {{As of |2022|April|14}}, over 500 million cases were confirmed globally.<ref>{{#invoke:cite web ||last1=B |first1=Kavya |last2=Mazumder |first2=Aparupa |title=Worldwide COVID cases surpass 500 mln as Omicron variant BA.2 surges |url=https://www.reuters.com/business/healthcare-pharmaceuticals/worldwide-covid-cases-surpass-500-mln-omicron-variant-ba2-surges-2022-04-14/ |website=Reuters |access-date=21 April 2022 |date=14 April 2022}}</ref> Most cases are unconfirmed, with the [[Institute for Health Metrics and Evaluation]] estimating the true number of cases as of early 2022 to be in the billions.<ref name="57percent1" /><ref name="57percent2" /> [[File:Covid-19 new cases in top 5 countries and the world.png|thumb|center|400px|Semi-log plot of weekly new cases of COVID-19 in the world and the current top six countries (mean with deaths)]] === Deaths === {{Main|COVID-19 pandemic deaths|COVID-19 pandemic death rates by country}} {{Further|List of deaths due to COVID-19}} [[File:COVID19 deceased in Hackensack NJ April 27.jpg|thumb|The deceased in a refrigerated "mobile morgue" outside a hospital in [[Hackensack, New Jersey]], US, in April 2020]] [[File:Covid-19 São Paulo - Cemiterios.jpg|thumb|Gravediggers bury the body of a man suspected of having died of COVID-19 in the cemetery of Vila Alpina, east side of [[São Paulo]], in April 2020.]] [[File:Global excess and reported COVID-19 deaths and death rates per 100,000 population.webp|thumb|Global excess and reported COVID-19 deaths and deaths per 100,000 according to the WHO study<ref name="10.1038/s41586-022-05522-2"/>]] As of {{Cases in the COVID-19 pandemic|date|editlink=|ref=no}}, more than {{Cases in the COVID-19 pandemic|dround|editlink=|ref=yes}} deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020.<ref name="AutoDW-25" /> These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response,<ref>Multiple sources: * {{#invoke:cite magazine||title=The Best Global Responses to the COVID-19 Pandemic|url=https://time.com/5851633/best-global-responses-covid-19/|magazine=Time|access-date=18 August 2020}} * {{#invoke:cite web||date=11 May 2020|title=Portugal and Spain: same peninsula, very different coronavirus impact|url=https://english.elpais.com/spanish_news/2020-05-11/portugal-and-spain-same-peninsula-very-different-coronavirus-impact.html|access-date=25 May 2020|website=El País|vauthors=Barrio PL, del Javier M}} * {{#invoke:cite news||date=5 April 2020|title=Fewer deaths in Veneto offer clues for fight against virus|website=Financial Times|url=https://www.ft.com/content/9c75d47f-49ee-4613-add1-a692b97d95d3|access-date=25 May 2020|vauthors=Johnson M}}</ref> time since the initial outbreak, and population characteristics, such as age, sex, and overall health.<ref name="worldindata">{{#invoke:cite journal||vauthors=Ritchie H, Roser M|date=25 March 2020|title=What do we know about the risk of dying from COVID-19?|url=https://ourworldindata.org/covid-mortality-risk|journal=[[Our World in Data]]|access-date=28 March 2020|veditors=Chivers T}}</ref> Multiple measures are used to quantify mortality.<ref name="wBm2a">{{#invoke:cite web||date=18 February 2019|title=Principles of Epidemiology {{!}} Lesson 3 – Section 3|url=https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section3.html|access-date=28 March 2020|website=US [[Centers for Disease Control and Prevention]] (CDC)}}</ref> Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test.<ref name="20200331reuters">{{#invoke:cite news||date=31 March 2020|title=Italy's coronavirus deaths could be underestimated in data: Official|work=Reuters|url=https://www.reuters.com/article/us-health-coronavirus-italy-data/italys-coronavirus-deaths-could-be-underestimated-in-data-official-idUSKBN21I250}}</ref> Conversely, deaths of people who died from underlying conditions following a positive test may be included.<ref name="stuff120443722">{{#invoke:cite web || title=Coronavirus: Is Covid-19 really the cause of all the fatalities in Italy?|url=https://www.stuff.co.nz/national/health/coronavirus/120443722/coronavirus-is-covid19-really-the-cause-of-all-the-fatalities-in-italy|access-date=16 April 2020|website=Stuff|date=20 March 2020}}</ref> Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts.<ref name="npr841005901">{{#invoke:cite news|| vauthors = Schultz T |date=22 April 2020|title=Why Belgium's Death Rate Is So High: It Counts Lots Of Suspected COVID-19 Cases|newspaper=NPR|url=https://www.npr.org/sections/coronavirus-live-updates/2020/04/22/841005901/why-belgiums-death-rate-is-so-high-it-counts-lots-of-suspected-covid-19-cases|access-date=25 April 2020}}</ref> Official death counts have been claimed to underreport the actual death toll, because [[Mortality displacement|excess mortality]] (the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone.<ref name=":7">{{#invoke:cite news||title=Tracking covid-19 excess deaths across countries|newspaper=The Economist|url=https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker|access-date=6 November 2022}}</ref> Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by ''[[The Economist]]'',<ref name=Economist2023 /><ref name=":7" /> as well as over 18.5 million by 1 April 2023 by the [[Institute for Health Metrics and Evaluation]]<ref name="COVID-19 Projections">{{#invoke:cite web || title=COVID-19 Projections|url=https://covid19.healthdata.org/|access-date=20 January 2022|website=Institute for Health Metrics and Evaluation}}</ref> and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study.<ref name="10.1016/S0140-6736(21)02796-3">{{#invoke:cite journal || title = Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21 | journal = Lancet | volume = 399 | issue = 10334 | pages = 1513–1536 | date = April 2022 | pmid = 35279232 | pmc = 8912932 | doi = 10.1016/S0140-6736(21)02796-3 | last1 = Wang | first1 = Haidong | last2 = Paulson | first2 = Katherine R. | last3 = Pease | first3 = Spencer A. | last4 = Watson | first4 = Stefanie | last5 = Comfort | first5 = Haley | last6 = Zheng | first6 = Peng | last7 = Aravkin | first7 = Aleksandr Y. | last8 = Bisignano | first8 = Catherine | last9 = Barber | first9 = Ryan M. | last10 = Alam | first10 = Tahiya | last11 = Fuller | first11 = John E. | last12 = May | first12 = Erin A. | last13 = Jones | first13 = Darwin Phan | last14 = Frisch | first14 = Meghan E. | last15 = Abbafati | first15 = Cristiana | last16 = Adolph | first16 = Christopher | last17 = Allorant | first17 = Adrien | last18 = Amlag | first18 = Joanne O. | last19 = Bang-Jensen | first19 = Bree | last20 = Bertolacci | first20 = Gregory J. | last21 = Bloom | first21 = Sabina S. | last22 = Carter | first22 = Austin | last23 = Castro | first23 = Emma | last24 = Chakrabarti | first24 = Suman | last25 = Chattopadhyay | first25 = Jhilik | last26 = Cogen | first26 = Rebecca M. | last27 = Collins | first27 = James K. | last28 = Cooperrider | first28 = Kimberly | last29 = Dai | first29 = Xiaochen | last30 = Dangel | first30 = William James }}<br />News article about the study: {{#invoke:cite journal || vauthors = Adam D | title = COVID's true death toll: much higher than official records | journal = Nature | volume = 603 | issue = 7902 | page = 562 | date = March 2022 | pmid = 35277684 | doi = 10.1038/d41586-022-00708-0 | s2cid = 247407282 | bibcode = 2022Natur.603..562A }}</ref> Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection).<ref name="20200429reason">{{#invoke:cite web || date=29 April 2020|title=What 'Excess Deaths' Do and Don't Tell Us About COVID-19|url=https://reason.com/2020/04/29/what-excess-deaths-do-and-dont-tell-us-about-covid-19/|access-date=4 May 2020|website=Reason}}</ref> Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic.<ref name="10.1016/S0140-6736(21)02796-3"/><!--as well as from potential likely coincidental concurrent increases or issues with the expected deaths modelling/data.--> In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because [[Impact of the COVID-19 pandemic on other health issues|people with other conditions could not access medical services]].<ref>{{#invoke:cite news ||url=https://www.bbc.co.uk/news/health-61327778 |title=Covid: World's true pandemic death toll nearly 15 million, says WHO|first1= Naomi |last1=Grimley|first2= Jack |last2=Cornish|first3= Nassos |last3=Stylianou|work=BBC News |date=5 May 2022}}</ref><ref>{{#invoke:cite news ||title=Nearly 15 million deaths directly or indirectly linked to COVID-19 {{!}} UN News |url=https://news.un.org/en/story/2022/05/1117582 |access-date=4 February 2023 |work=news.un.org |date=5 May 2022 }}</ref> A December 2022 [[WHO]] study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like [[years of potential life lost]] and may make the pandemic 2021's [[List of causes of death by rate|leading cause of death]].<ref>{{#invoke:cite news ||title=Nearly 15 million excess deaths occurred globally in 2020 and 2021 |url=https://www.newscientist.com/article/2351763-nearly-15-million-excess-deaths-occurred-globally-in-2020-and-2021/ |access-date=17 January 2023 |work=New Scientist}}</ref><ref>{{#invoke:cite web ||title=Globale Übersterblichkeit durch COVID-19 |url=https://www.sciencemediacenter.de/alle-angebote/research-in-context/details/news/globale-uebersterblichkeit-durch-covid-19/ |website=www.sciencemediacenter.de |access-date=17 January 2023 }}</ref><ref name="10.1038/s41586-022-05522-2">{{#invoke:cite journal ||last1=Msemburi |first1=William |last2=Karlinsky |first2=Ariel |last3=Knutson |first3=Victoria |last4=Aleshin-Guendel |first4=Serge |last5=Chatterji |first5=Somnath |last6=Wakefield |first6=Jon |title=The WHO estimates of excess mortality associated with the COVID-19 pandemic |journal=Nature |date=January 2023 |volume=613 |issue=7942 |pages=130–137 |doi=10.1038/s41586-022-05522-2 |pmid=36517599 |pmc=9812776 |bibcode=2023Natur.613..130M |issn=1476-4687|doi-access=free}}</ref> The time between symptom onset and death ranges from{{nbsp}}6 to 41 days, typically about 14 days.<ref name="pathogenesis" /> Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions.<ref>{{#invoke:cite journal || vauthors = Yanez ND, Weiss NS, Romand JA, Treggiari MM | title = COVID-19 mortality risk for older men and women | journal = BMC Public Health | volume = 20 | issue = 1 | page = 1742 | date = November 2020 | pmid = 33213391 | pmc = 7675386 | doi = 10.1186/s12889-020-09826-8 |doi-access=free}}</ref><ref name="6XONR">{{#invoke:cite web || date=15 March 2021|title=People with Certain Medical Conditions|url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html|access-date=19 March 2021|website=Centers for Disease Control and Prevention}}</ref> <br> <gallery mode="packed" widths="360px" heights="160"> File:Covid-19 daily deaths in top 5 countries and the world.png|Semi-log plot of weekly deaths due to COVID-19 in the world and top six current countries (mean with cases) File:Mapping estimated P-scores (excess deaths relative to expected deaths).webp|alt=Excess deaths relative to expected deaths (the patterns indicate the quality of the all-cause mortality data that were available for each respective country)|Excess deaths relative to expected deaths (The patterns indicate the quality of the all-cause mortality data that were available for each respective country.)<ref name="10.1038/s41586-022-05522-2"/> File:COVID-19 pandemic excess deaths - global and WHO region P-scores (excess deaths relative to expected deaths).webp|Excess deaths relative to expected deaths (global and WHO region)<ref name="10.1038/s41586-022-05522-2"/> File:The 25 countries with the highest total estimated COVID-19 pandemic excess deaths between January 2020 and December 2021.webp|The 25 countries with the highest total estimated COVID-19 pandemic excess deaths between January 2020 and December 2021<ref name="10.1038/s41586-022-05522-2"/> File:The 25 countries with the highest mean P-scores (excess deaths relative to expected deaths).webp|The 25 countries with the highest mean P-scores (excess deaths relative to expected deaths)<ref name="10.1038/s41586-022-05522-2"/> </gallery> ==== Infection fatality ratio (IFR) ==== {{See also|List of human disease case fatality rates}} {| class="wikitable floatright" |+ class="nowrap" | IFR estimate per <br />age group<ref name="EJE_levinetal" /> |- ! Age group !! IFR |- | 0–34 || 0.004% |- | 35–44 || 0.068% |- | 45–54 || 0.23% |- | 55–64 || 0.75% |- | 65–74 || 2.5% |- | 75–84 || 8.5% |- | 85 + || 28.3% |} The [[Infection fatality rate|infection fatality ratio]] (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals).<ref name="fjMw6">{{#invoke:cite web || vauthors = Tate N |title=What Changing Death Rates Tell Us About COVID-19|url=https://www.webmd.com/lung/news/20200901/what-changing-death-rates-tell-us-about-covid|access-date=19 September 2020|website=WebMD}}</ref><ref name="WHOest">{{#invoke:cite web || date=4 August 2020|title=Estimating mortality from COVID-19|url=https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19|access-date=21 September 2020|publisher=World Health Organization}}</ref><ref name="ovoEx">{{#invoke:cite web ||date=11 February 2020|title=Coronavirus Disease 2019 (COVID-19)|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html|access-date=19 September 2020|website=Centers for Disease Control and Prevention}}</ref> It is expressed in percentage points.<ref>Multiple sources: * {{#invoke:cite journal || vauthors = Mallapaty S | title = How deadly is the coronavirus? Scientists are close to an answer | journal = Nature | volume = 582 | issue = 7813 | pages = 467–468 | date = June 2020 | pmid = 32546810 | doi = 10.1038/d41586-020-01738-2 | s2cid = 219726496 | doi-access = free | bibcode = 2020Natur.582..467M }} * {{#invoke:cite journal || vauthors = Alwan NA, Burgess RA, Ashworth S, Beale R, Bhadelia N, Bogaert D, Dowd J, Eckerle I, Goldman LR, Greenhalgh T, Gurdasani D, Hamdy A, Hanage WP, Hodcroft EB, Hyde Z, Kellam P, Kelly-Irving M, Krammer F, Lipsitch M, McNally A, McKee M, Nouri A, Pimenta D, Priesemann V, Rutter H, Silver J, Sridhar D, Swanton C, Walensky RP, Yamey G, Ziauddeen H | title = Scientific consensus on the COVID-19 pandemic: we need to act now | journal = Lancet | volume = 396 | issue = 10260 | pages = e71–e72 | date = October 2020 | pmid = 33069277 | pmc = 7557300 | doi = 10.1016/S0140-6736(20)32153-X }} * {{#invoke:cite journal || vauthors = Meyerowitz-Katz G, Merone L | title = A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates | journal = International Journal of Infectious Diseases | volume = 101 | pages = 138–148 | date = December 2020 | pmid = 33007452 | pmc = 7524446 | doi = 10.1016/j.ijid.2020.09.1464 }}</ref> Other studies refer to this metric as the ''infection fatality risk''.<ref>{{#invoke:cite journal || vauthors = Yang W, Kandula S, Huynh M, Greene SK, Van Wye G, Li W, Chan HT, McGibbon E, Yeung A, Olson D, Fine A, Shaman J | title = Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis | journal = The Lancet. Infectious Diseases | volume = 21 | issue = 2 | pages = 203–212 | date = February 2021 | pmid = 33091374 | pmc = 7572090 | doi = 10.1016/S1473-3099(20)30769-6 }}</ref><ref>{{#invoke:cite journal || vauthors = Pastor-Barriuso R, Pérez-Gómez B, Hernán MA, Pérez-Olmeda M, Yotti R, Oteo-Iglesias J, Sanmartín JL, León-Gómez I, Fernández-García A, Fernández-Navarro P, Cruz I, Martín M, Delgado-Sanz C, Fernández de Larrea N, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Larrauri A, Pollán M | title = Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study | journal = BMJ | volume = 371 | pages = m4509 | date = November 2020 | pmid = 33246972 | pmc = 7690290 | doi = 10.1136/bmj.m4509 }}</ref> In November 2020, a review article in [[Nature (journal)|''Nature'']] reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%.<ref>{{#invoke:cite journal || vauthors = O'Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DA, Azman AS, Paireau J, Fontanet A, Cauchemez S, Salje H | title = Age-specific mortality and immunity patterns of SARS-CoV-2 | journal = Nature | volume = 590 | issue = 7844 | pages = 140–145 | date = February 2021 | pmid = 33137809 | doi = 10.1038/s41586-020-2918-0 | bibcode = 2021Natur.590..140O | s2cid = 226244375 | doi-access = free }}</ref> IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups.<ref name="EJE_levinetal" /> For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from [[seasonal influenza]].<ref name="EJE_levinetal" /> In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections.<ref name="EJE_levinetal">{{#invoke:cite journal || vauthors = Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G | title = Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications | journal = European Journal of Epidemiology | volume = 35 | issue = 12 | pages = 1123–1138 | date = December 2020 | pmid = 33289900 | pmc = 7721859 | doi = 10.1007/s10654-020-00698-1 | doi-access = free }}</ref> There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV.<ref>{{#invoke:cite journal ||last1=Pitlik |first1=SD |title=COVID-19 Compared to Other Pandemic Diseases. |journal=Rambam Maimonides Medical Journal |date=31 July 2020 |volume=11 |issue=3 |pages=e0027 |doi=10.5041/RMMJ.10418 |pmid=32792043 |pmc=7426550 }}</ref> For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19.<ref>{{#invoke:cite book ||last1=Spence |first1=Nicholas D. |last2=Sekercioglu |first2=Fatih |title=Indigenous Health and Well-Being in the COVID-19 Pandemic |date=31 August 2022 |publisher=Taylor & Francis |isbn=978-1-000-64420-3 |url=https://books.google.com/books?id=CA5_EAAAQBAJ&dq=infection+fatality+ratio++influenza++is+0.1%25+united+states&pg=PT125 |access-date=12 May 2023 }}</ref> ==== Case fatality ratio (CFR) ==== Another metric in assessing death rate is the [[case fatality rate|case fatality ratio]] (CFR),{{efn|Some refer to "fatality rate"; however, "fatality ratio" is more accurate as this is not per unit time.<ref name="WHOest" />}} which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals.<ref name="Hauser 2020">{{#invoke:cite journal||vauthors=Hauser A, Counotte MJ, Margossian CC, Konstantinoudis G, Low N, Althaus CL, Riou J|date=July 2020|title=Estimation of SARS-CoV-2 mortality during the early stages of an epidemic: A modeling study in Hubei, China, and six regions in Europe|journal=PLOS Medicine|volume=17|issue=7|pages=e1003189|doi=10.1371/journal.pmed.1003189|pmc=7386608|pmid=32722715|doi-access=free}}</ref> Based on [[Johns Hopkins University]] statistics, the global CFR is {{replace|{{Cases in the COVID-19 pandemic|ratio|editlink=|ref=no}}|%| percent}} ({{Cases in the COVID-19 pandemic|deaths|editlink=|ref=no}} deaths for {{Cases in the COVID-19 pandemic|confirmed|editlink=|ref=no}} cases) as of {{Cases in the COVID-19 pandemic|date|editlink=|ref=no}}.{{Cases in the COVID-19 pandemic|ref=yes}} The number varies by region and has generally declined over time.<ref name="b0L7I">{{#invoke:cite journal||vauthors=Lazzerini M, Putoto G|date=May 2020|title=COVID-19 in Italy: momentous decisions and many uncertainties|journal=The Lancet. Global Health|volume=8|issue=5|pages=e641–e642|doi=10.1016/S2214-109X(20)30110-8|pmc=7104294|pmid=32199072}}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. If you do not want your writing to be edited mercilessly, then do not submit it here. You are also promising us that you wrote this yourself, or copied it from a public domain or similar free resource (see Christianpedia:Copyrights for details). Do not submit copyrighted work without permission! Cancel Editing help (opens in new window) Discuss this page