Although it is still unknown exactly where the outbreak first started, many early cases of COVID-19 have been attributed to people who have visited the Huanan

Background Although it is still unknown exactly where the outbreak first started, many early cases of COVID-19 have been attributed to people who have visited the Huanan Seafood Wholesale Market, located in Wuhan, Hubei, China.[12] On 11 February 2020, the World Health Organization (WHO) named the disease "COVID-19", which is short for coronavirus disease 2019.[13][14] The virus that caused the outbreak is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly discovered virus closely related to bat coronaviruses,[15] pangolin coronaviruses,[16][17] and SARS-CoV.[18] Scientific consensus is that COVID-19 is a zoonotic virus that arose from bats in a natural setting.[19][20][21] The earliest known person with symptoms was later discovered to have fallen ill on 1 December 2019, and that person did not have visible connections with the later wet market cluster.[22][23] However, an earlier case of infection could have occurred on 17 November.[24] Of the early cluster of cases reported that month, two thirds were found to have a link with the market.[25][26][27] There are several theories about when and where the very first case (the so-called patient zero) originated.[28] Cases Main articles: COVID-19 pandemic by country and territory and COVID-19 pandemic cases Total confirmed cases per country as of 24 February 2021. 10,000,000+ 1,000,000–9,999,999 100,000–999,999 10,000–99,999 1,000–9,999 100–999 1–99 0 Official case counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols.[29][30] Many countries, early on, had official policies to not test those with only mild symptoms.[31][32] An analysis of the early phase of the outbreak up to 23 January estimated 86 percent of COVID-19 infections had not been detected, and that these undocumented infections were the source for 79 percent of documented cases.[33] 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.[34][35] On 9 April 2020, preliminary results found that 15 percent of people tested in Gangelt, the centre of a major infection cluster in Germany, tested positive for antibodies.[36] Screening for COVID-19 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.[37][38] Seroprevalence based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies.[39] Some results (such as the Gangelt study) have received substantial press coverage without first passing through peer review.[40] Analysis by age in China indicates that a relatively low proportion of cases occur in individuals under 20.[41] It was not clear whether this was because young people were less likely to be infected, or less likely to develop serious symptoms and seek medical attention and be tested.[42] A retrospective cohort study in China found that children and adults were just as likely to be infected.[43] Initial estimates of the basic reproduction number (R0) for COVID-19 in January were between 1.4 and 2.5,[44] but a subsequent analysis concluded that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9).[45] R0 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 2020, the effective R was close to or below 1.0 in many countries, meaning the spread of the disease in these areas at that time was stable or decreasing.[46] Semi-log plot of weekly new cases of COVID-19 in the world and top five current countries (mean with deaths) COVID-19 total cases per 100 000 population from selected countries[47] COVID-19 active cases per 100 000 population from selected countries[47] Deaths Main articles: COVID-19 pandemic deaths and COVID-19 pandemic death rates by country Further information: List of deaths due to COVID-19 Deceased in a 16 m (53 ft) "mobile morgue" outside a hospital in Hackensack, New Jersey Official deaths from COVID-19 generally refer to people who died after testing positive according to protocols. These counts may ignore deaths of people who die without having been tested.[48] Conversely, deaths of people who had underlying conditions may lead to over-counting.[49] Comparisons of statistics for deaths for all causes versus the seasonal average indicate excess mortality in many countries.[50][51] This may include deaths due to strained healthcare systems and bans on elective surgery.[52] The first confirmed death was in Wuhan on 9 January 2020.[53] The first reported death outside of China occurred on 1 February in the Philippines,[54] and the first reported death outside Asia was in the United States on 6 February.[55] More than 95 percent of the people who contract COVID-19 recover. Otherwise, the time between symptoms onset and death usually ranges from 6 to 41 days, typically about 14 days.[56] As of 1 March 2021, more than 2.53 million[4] deaths have been attributed to COVID-19. People at the greatest risk from COVID-19 tend to be those with underlying conditions, such as those with a weakened immune system, serious heart or lung problems, severe obesity, or the elderly (including individuals age 65 years or older).[57][58] On 24 March 2020, the Centers for Disease Control and Prevention (CDC) of the United States, indicated the WHO had provided two codes for COVID-19: U07.1 when confirmed by laboratory testing and U07.2 for clinically or epidemiological diagnosis where laboratory confirmation is inconclusive or not available.[59][60] The CDC noted that "Because laboratory test results are not typically reported on death certificates in the U.S., [the National Center for Health Statistics (NCHS)] is not planning to implement U07.2 for mortality statistics" and that U07.1 would be used "If the death certificate reports terms such as 'probable COVID-19' or 'likely COVID-19'." The CDC also noted "It Is not likely that NCHS will follow up on these cases" and while the "underlying cause depends upon what and where conditions are reported on the death certificate, ... the rules for coding and selection of the ... cause of death are expected to result in COVID–19 being the underlying cause more often than not."[59] On 16 April 2020, the WHO, in its formal publication of the two codes, U07.1 and U07.2, "recognized that in many countries detail as to the laboratory confirmation... will not be reported [and] recommended, for mortality purposes only, to code COVID-19 provisionally to code U07.1 unless it is stated as 'probable' or 'suspected'."[61][62] It was also noted that the WHO "does not distinguish" between infection by SARS-CoV-2 and COVID-19.[63] Multiple measures are used to quantify mortality.[64] These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response,[65][66][67] time since the initial outbreak, and population characteristics, such as age, sex, and overall health.[68] Countries like Belgium include deaths from suspected cases of COVID-19, regardless of whether the person was tested, resulting in higher numbers compared to countries that include only test-confirmed cases.[69] The death-to-case ratio reflects the number of deaths attributed to COVID-19 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 2.2 percent (2,530,723 deaths for 114,067,962 cases) as of 1 March 2021.[4] The number varies by region.[70] Semi-log plot of weekly deaths due to COVID-19 in the world and top five current countries (mean with cases) COVID-19 deaths per 100 000 population from selected countries[47] Infection fatality ratio (IFR) Coronavirus HCoV-229E virus Types Diseases Vaccines Outbreaks, epidemics, and pandemics See also vte A crucial metric in assessing the severity of a disease is the infection fatality ratio (IFR), which is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections) as measured or estimated as of a specific date.[71][72][73] Epidemiologists frequently refer to this metric as the 'infection fatality rate' to clarify that it is expressed in percentage points (not as a decimal).[74][75][76] Other published studies refer to this metric as the 'infection fatality risk'.[77][78] In April 2020, an IFR range of 0.12–1.08% was derived from non-peer-reviewed serology surveys, with the upper bound characterised as much more credible and the range indicated as from 3 to 27 times deadlier than influenza (0.04%).[79] In June 2020, a peer-reviewed analysis of pre-serology data from mainland China yielded an overall IFR of 0.66% (with age-bracketed values ranging from 0.00161% for 0–9 years to 0.595% for 50–59 years to 7.8% for > 80 years).[80] In July 2020, the US CDC adopted the IFR as a "more directly measurable parameter for disease severity for COVID-19" and computed an overall 'best estimate' for planning purposes for the U.S. of 0.65% 

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